Annual report - State Board of Health, State of Florida

FLORIDA
STATE BOARD
OF
HEALTH

19595

!,AN" N UAL REPORT.,

State Board of Health

State of 7orivd

1959

The following statistical reports will be published separately:
SUPPLEMENT I FLORIDA VITAL STATISTICS, 1959
SUPPLEMENT II FLORIDA MORBIDITY STATISTICS, 1959

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

Report

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6/4-

The Honorable JOHN D. MILTON, M.D., President
Florida State Board Of Health,
Miami, Florida

Dear Dr. Milton:

I herewith submit the annual report of the Florida
State Board of Health for the year ending December 31,
1959.

Sincerely yours,

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

May 1, 1960
Jacksonville, Florida

His Excellency, LEROY COLLINS
Governor of Florida
Tallahassee, Florida

Sir:

I beg to hand you herewith a report of the Florida
State Board of Health for the period January 1, 1959, to
December 31, 1959, inclusive.

Respectfully submitted,

JOHN D. MILTON, M.D.
President

May 1, 1960
Miami, Florida

Members of the
FLORIDA STATE BOARD OF HEALTH

CHARLES J. COLLINS, M.D., President
Orlando

T. M. CUMBIE, Ph.G.
Quincy

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

SULLIVAN G. BEDELL, M.D.
Jacksonville

JOHN D. MILTON, M.D.
Miami

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH

December 31, 1959

DIRECTORS

State Health Officer ..................................Wilson T. Sowder, M.D., M.P.H.
Assistant State Health Officer ................Albert V. Hardy, M.D., Dr.P.H.
Assistant State Health Officer ..............Clarence M. Sharp, M.D.
Personnel Officer ........................................Elizabeth Reed, R.N., B.S., Acting
Bureau of Finance and Accounts ..............Fred B. Ragland, B.S.
Assistant Director ....................................Paul R. Tidwell, B.B.A.
Purchasing Agent ........................................G. Wilson Baltzell, B.S.

Bureau of Vital Statistics ............................Everett H. Williams, Jr., M.S., Hyg.

Bureau of Local Health Services ..............Wade N. Stephens, M.D., M.P.H.
Assistant Director ......................................Hubert V. King, M.D.
Division of Public Health Nursing ............Ruth E. Mettinger, R.N.
Division of Sanitation ..............................A. W. Morrison, Jr.
Nutrition Services .......................... ..........Mary B. Deaver, M.S.
Bureau of Preventable Diseases ...................James O. Bond, M.D., M.P.H.
Division of Radiological and
Occupational Health ..........................Edwin G. Williams, M.D.
Division of Tuberculosis Control ..............Dwight Wharton, M.D.
Division of Epidemiology ........................Robert E. Markush, M.D., M.P.H.,
Acting
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 ........................... ...............John L. Enyart, M.D.
Division of Chronic Diseases......................Lorenzo L. Parks, M.D., M.P.H.
Bureau of Laboratories ................................Nathan J. Schneider, Ph. D.
Miami Regional Laboratory ...................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. Grover, M.S.
Tampa Regional Laboratory ....................H. D. Venters, B.S.
West Palm Beach Regional Laboratory ....Lorraine Carson

Bureau of Maternal and Child Health ........Simon D. Doff, M.D., M.P.H.
Assistant Director ....................................Edward L. Flemming, Ed. D.
Bureau of Mental Health .........................Wayne Yeager, 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. Eng.
Assistant Director ....................................Sidney A. Berkowitz, M.S. Eng.
Division of Water Supply .......................John B. Miller, B.S., M.P.H.
Division of Waste Water ..........................Ralph H. Baker, Jr., M.S.S.E.
Bureau of Narcotics................................. Frank S. Castor, Ph.G.
Division of Health Information.....................Elizabeth Reed, R.N., B.S.

DIRECTORS OF COUNTY HEALTH DEPARTMENTS

(As of December 31, 1959)

Alachua.............................................................Edward G. Byrne, M.D., M.P.H.
Bay........................................................... ... A. F. Ullman, M.D.
Brevard....................................... .... Albert 0. Rossi, M.D.
Broward .....................................Paul W. Hughes, M.D., M.P.H.
Dade...................................... ....................T. E. Cato, M.D., M.P.H.
Duval....................................................Thomas E. Morgan, M.D., M.P.H.
Escambia .......................................................J. C. McSween, M.D.
Hillsborough.. ................................................Frank V. Chappell, M.D., M.P.H.
Jefferson............................ ..........................Thomas S. Englar, M.D., M.P.H.
Lake.................................-- ..- J. Basil Hall, M.D., M.P.H.
Leon............. .. ......... ....................... Joseph M. Bistowish, M.D., M.P.H.
Manatee...................................................... rederick K. Allen, M.D.
Marion.........................................................Patrick H. Smith, M.D.
Monroe........................................................James L. Wardlaw, Jr., M.D., M.P.H.
Okaloosa.......................................................... B. R. Provost, M.D.
Orange...... .................................................J. Harland Paul, M.D., M.P.H.
Palm Beach................................................C. L. Brumback, M.D., M.P.H.
Pinellas...................................... ...............William C. Ballard, M.D., M.P.H.
Polk............................. .......................Chester L. Nayfield, M.D., M.P.H.
Santa Rosa.............................. ..............Walter F. Sidwell, M.D.
Sarasota..............................................-William L. Wright, M.D., M.P.H.
Seminole.................. .................... Wade N. Stephens, M.D., M.P.H.,
(Acting)
Volusia.................... .......................... .. D. V. Galloway, M.D., M.P.H.
Baker-Nassau..............................................James C. Loranger, M.D.
Calhoun-Jackson...............................................Terry Bird, M.D., M.P.H.
Collier-Lee.................................................. Joseph W. Lawrence, M.D.
Flagler-Putnam............................................ James R. Sayers, M.D.
Gadsden-Liberty...............................................B. D. Blackwelder, M.D., M.P.H.
Madison-Taylor.................... ................Clyde L. Brothers, M.D.
Osceola-Indian River.......................................C. C. Flood, M.D., M.P.H.
Pasco-Sumter...............................................Charles E. Gill, M.D., M.P.H.
Bradford-Clay-Union......................................A. Y. Covington, M.D., M.P.H.
Charlotte-DeSoto-Hardee...........................James K. Cooke, M.D.
Citrus-Hernando-Levy.............. ..........Harold F. Bonifield, M.D., M.P.H.
Columbia-Gilchrist-Hamilton......... .... Arthur R. Moler, M.D.
Franklin-Gulf-Wakulla.................................... Henry I. Langston, M.D., M.P.H.
Glades-Hendry-Highlands............................William F. Hill, Jr., M.D.
Holmes-Walton-Washington..................... McKinley Cheshire, Jr., M.D.
Martin-Okeechobee-St. Lucie.........................Neill D. Miller, M.D.
Suwannee-Dixie-Lafayette............... Wade N. Stephens, M.D., M.P.H.,
(Acting)

Organizational Chart of the Florida State Board of Health

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1 I I- '- I I I
i--lfl llwIt-M | rrI. |

66 County Health Departments

TABLE OF CONTENTS

Page
General Summary (including Activities of the Board, Legisla-
tion, Public Health Research, Scholarships and Personnel)........ 1

Division of Health Information................................................................ 16

Bureau of Local Health Services (including Divisions of Public
Health Nursing and Sanitation; Nutrition Services)...................... 19

Bureau of Vital Statistics .......................................................................... 59

Bureau of Maternal and Child Health.................................................... 72

Bureau of Preventable Diseases (including Divisions of Epidemio-
logy [Venereal Disease Control], Radiological and Occupa-
tional Health, Tuberculosis Control and Veterinary Public
H health) .............................................................................................. 82

Bureau of Laboratories ........................................................................... 120

Bureau of Special Health Services (including Division of Hos-
pitals and Nursing Homes; Hospital Service for the Indigent
Program; Division of Chronic Diseases: Heart, Cancer and
Diabetes; Accident Prevention Program) ...................................... 137

Bureau of Sanitary Engineering (including Divisions of Waste
Water and Water Supply; Shellfish and Crustacea Program;
Subdivision Sanitation; Polk-Hillsborough County Air Pol-
lution Control District; Bedding Act Administration).................... 153

Bureau of Mental Health (including Florida Council on Training
and Research in Mental Health).................................................... 190

Bureau of N arcotics .................................................................................. 203

Bureau of Entomology (including Entomological Research
C enter) .............................................................................................. 207

Bureau of Dental H health .......................................................................... 221

Bureau of Finance and Accounts (including Purchasing and
Property) .......................................................................................... 227

GENERAL SUMMARY
W. T. SOWDER, M.D., M.P.H., State Health Officer
A. V. HARDY, M.D., Dr. P.H., Assistant State Health Officer
C. M. SHARP, M.D., Assistant State Health Officer
GENERAL
The year under review was one of continuing progress in established
directions. There were no crises such as that caused by the emergency
needs of migratory laborers; there was no new building to be dedicated;
and no major new programs were initiated. The chief problem of the
year has been attempting to meet expanding needs with little or no
budgetary or personnel increases.
Recruitment was a less troublesome problem late in 1959 than earlier
in the year or in the preceding year. At the end of 1959, all health
officer positions in the counties, except two, were filled. There were few
vacancies for other personnel.
A second Assistant State Health Officer, C. M. Sharp, M.D., was
designated and transferred to this new position in September. His major
responsibilities are in providing administrative assistance to the State
Health Officer. The Division of Industrial Hygiene was reorganized and
became the Division of Radiological and Occupational Health. In line
with this change in emphasis, a health physicist and supporting personnel
were employed. A radiologist was assigned to the Division from the U. S.
Public Health Service. Responsibility for air pollution previously in this
division was transferred to the Bureau of Sanitary Engineering.
Legislative enactment called for joint action with the State Depart-
ment of Public Welfare in the provision of medical services to the re-
cipients of public assistance. This was recommended to enable the state
to benefit from matching federal funds. Despite the rigid federal require-
ments, a joint program was evolved and initiated as of October 1. In
the remaining months of the year problems in the operation of a program
designed to satisfy federal requirements were in evidence. However,
with the better understanding of the difference between the state-county
program and the federal-state matching program, the objections to the
necessary changes were less in evidence. Gradually the benefit derived
from additional funds obtained through federal matching were out-
weighing the troublesome administrative features of this joint activity.
Within the limitation imposed by restricted budget, there were
gratifying advances. The Cancer Control Program attained a full time
director and some additional support for the Tumor Clinics. The mental
health worker program continued to expand and to become better
established in the various County Health Departments served. Epide-
miology was greatly strengthened through the assignment by the USPHS
of 2 medical officers. The preceptorship program in the dental field is
beginning to more adequately meet the extensive public health dental
needs in the state. Nursing home licensure has been strengthened through
the assignment to this program of a full time worker trained in hospital
administration. The difficult-to-design accident prevention program

2 ANNUAL REPORT, 1959

began to take effective shape. These are illustrative of the varying
modifications which have added strength to established programs.
There is a continuing awareness of handicaps imposed by less than
adequate facilities. In Jacksonville 2 major bureaus are housed in rented
quarters. There is great need for the final wing of the new headquarters
building. Two of the regional laboratories are housed in very old and
unsatisfactory quarters which cannot be renovated at any reasonable
cost. There is urgent need to proceed with construction of new quarters
financed in part through the sale of present facilities and through federal
matching funds. The air pollution, entomological and stream pollution
studies in Polk County are housed in temporary quarters. It appears
obvious that there will be continuing need for laboratory facilities in this
rapidly expanding region. Plans are underway to obtain a transfer (from
the State Department of Agriculture to the State Board of Health) of
a plot of land immediately adjacent to the Polk County Health Depart-
ment building in Winter Haven. Final plans for this building should
materialize within the year. The above are high priority requirements for
the improvement of physical facilities for public health in Florida.
During the year the State Health Officer was elected President of
the Association of State and Territorial Health Officers. He continued
as a member of the Executive Board and the Governing Council of the
American Public Health Association. Also the Assistant State Health
Officer, A. V. Hardy, M.D., spent 6 weeks during August and September
as a consultant to the World Health Organization in Geneva and Yugo-
slavia. This was a continuation and extension of his previous work with
that organization in planning for the study and control of the acute
diarrheal diseases.

ACTIVITIES OF THE BOARD
WILSON T. SOWDER, M.D., M.P.H.
Secretary
The year was marked by the resignation of the President, Charles
J. Collins, M.D., of Orlando, shortly before the end of his term in Novem-
ber. To replace him the Governor appointed W. S. Horn, D.O., of
Palmetto, Florida. F. P. Meyer, D.D.S., of St. Petersburg was reappointed
for an additional 4 year term beginning in November 1959. The Vice
President, Mr. T. M. Cumbie, served as Acting President during the
remainder of the calendar year.
Five meetings were held and the dates, places and the major items
of business transacted were as follows:
February 10-Jacksonville
1. Adopted a policy to encourage consultation to national and
international agencies by allowing the same number of days
of leave, and under the same conditions, as is allowed for military
service. This policy is applied, however, only to persons not
receiving military leave during the year.

GENERAL SUMMARY 3

2. Adopted a policy to encourage the employment of older persons
in the field of public health.
3. Voted to continue the use of health cards after hearing a
recommendation to this effect by C. M. Sharp, M.D., director
of the Bureau of Preventable Diseases.
4. Reviewed various proposals for submission by the State Board
of Health to the Legislature and approved and endorsed various
items of proposed legislation. The Board specifically endorsed
special legislation for expanding the dental public health pro-
gram and for establishing home nursing services throughout
the state.
5. Approved and endorsed the report of the Governor's Citizens
Medical Committee on Health.
6. Reelected Charles J. Collins, M.D., as President and Mr. T. M.
Cumbie as Vice President.

May 3-Bal Harbour, Miami Beach
1. Adopted revision of Chapter XIX, Wholesale and Retail Dis-
tribution of Frozen Foods.
2. Adopted revision Chapter XXV, Labor Camps. This was done
because the previous code did not cover migratory labor camps.
These changes were intended to serve a temporary purpose until
the passage of an act pending in the Legislature on migratory
labor camps.
3. Approved the 10 applicants for medical scholarships as recom-
mended by the Medical Scholarship Committee.
4. Approved the 18 applicants for public health scholarships recom-
mended by Dr. Sowder and by a staff committee.
5. Approved the appointment of Edwin Williams, M.D., as direc-
tor of the Division of Industrial Hygiene to be effective about
August first to replace the incumbent, James Reid, M.D.,
resigned.
6. Endorsed a bill proposed by Dr. Sowder for an appropriation of
$15,000 to begin the purchase of the block across Julia Street
from the State Board of Health.
7. Abolished the Division of Venereal Disease Control and placed
venereal disease control activities in the newly created Division
of Epidemiology in the Bureau of Preventable Diseases.

July 19-Fernandina Beach
1. Heard reports and discussed laws passed and appropriations made
by the Legislature.
2. Voted to authorize the distribution of state funds to County
Health Departments in the same way as the previous year.

4 ANNUAL REPORT, 1959

3. Approved the transfer of the Air Pollution Control Program
from the Division of Industrial Hygiene in the Bureau of Pre-
ventable Diseases to the Bureau of Sanitary Engineering.
4. Approved revisions of Chapter XXIV of the Sanitary Code
relating to School Sanitation.
5. Studied proposed revisions of regulations for the licensing of
hospitals. Action postponed.
6. Approved the appointment of members of the Advisory Com-
mittee on Hospital Service for the Indigent.
7. Approved the appointment of Dwight Wharton, M.D., as direc-
tor of the Division of Tuberculosis Control.
8. Approved the appointment of James O. Bond, M.D., as director
of the Bureau of Preventable Diseases effective September first,
replacing C. M. Sharp, M.D., appointed as Assistant State
Health Officer. Approval for Dr Sharp's appointment as As-
sistant State Health Officer given by Board in 1958 to be
effective when practical. Dr. Sharp became Assistant State
Health Officer effective July first.
9. Approved the transfer of General Data Processing Services from
the Bureau of Vital Statistics to the State Health Officer's office.

August 9-Jacksonville
1. Met with the Advisory Committee on Hospital Services for the
Indigent, the Director of the State Department of Public Wel-
fare, and representatives of the Florida Medical Association and
Florida Hospital Association for the purpose of considering a
proposed contract between the State Board of Health and State
Department of Public Welfare for hospitalization of public
welfare recipients. Upon the recommendation of the Advisory
Committee, the Board approved the contract with the State
Department of Public Welfare.
2. Adopted revision of the regulations for the licensing of hospitals.
3. Upon the recommendation of the Dental Scholarship Com-
mittee (the State Board of Dental Examiners) approved the
awarding of 11 scholarships for the study of dentistry.
4. Authorized the State Health Officer to proceed with the pur-
chase of 2 lots across Julia Street from the State Board of Health
with funds provided by the Legislature.
5. Approved a plan for the place of practice of recipients of dental
scholarships.
6. Approved the appointment of J. E. Fulghum, M.D., as director
of the Cancer Control Program in the Bureau of Special Health
Services.

GENERAL SUMMARY 5

November 1-Orlando
1. Changed the name of the Division of Industrial Hygiene to
Division of Radiological and Occupational Health.
2. Approved the appointment of Mr. Ralph Baker as director of
the Division of Waste Water in the Bureau of Sanitary
Engineering.
3. Reviewed and discussed the last report of the State Auditor on
the financial operations of the State Board of Health.
4. Postponed action to set up out-patient clinics as provided by
amendment to indigent hospitalization law because of the
shortage of funds.
5. Approved revision of Chapter XXV, Camps. This revision was
made necessary by passage of a specific law for the regulation
of migratory labor camp housing and sanitation by the last
Legislature.
6. Authorized the State Health Officer to make contracts from
time to time with the Florida Medical Foundation for services
rendered.
7. Approved a plan for the distribution of funds to County Health
Departments for the remainder of the fiscal year.
8. Adopted revisions of the regulations for nursing home licensure.
9. Approved the study of a plan for group insurance for State
Board of Health employees and appointed a Committee on
Insurance to study the problem. The committee membership
to consist of the members of the Executive Committee of the
Florida Public Health Association plus Mr. Robert Carter.

PUBLIC HEALTH RESEARCH
A. V. HARDY, M.D., Dr.P.H.
Assistant State Health Officer and
Coordinator of Research
In this Annual Report, the record of research performed in the
various bureaus and divisions is included as a part of the report of each
bureau and division. As in the past there has been a particularly active
research program in the Bureau of Entomology, notably at the Entomolo-
gical Research Center in Vero Beach. The Bureau of Preventable
Diseases markedly expanded its study program late in the year. In
cooperation with the Communicable Disease Center, the Division of
Epidemiology undertook a survey of the immunization status for the
various infectious diseases in Hillsborough County. It also was actively
involved in the investigation of encephalitis which occurred in unusual
numbers in the late months of 1959 in Pinellas County. All findings
in this study have been reviewed in association with out-of-state consul-

6 ANNUAL REPORT, 1959

tants. It was agreed that the clinical, epidemiological and laboratory
features pointed to diagnosis of the St. Louis type of encephalitis. This
expansion of studies of the Bureau of Preventable Diseases was made
possible through the assignment by the U. S. Public Health Service
of 2 epidemiologists. Also early in the year a previous employee of the
Bureau of Laboratories, who had just completed his training in medicine,
joined the bureau to undertake the field studies of pulmonary infections
due to atypical acid-fast bacilli.

In a similar way one can point to a continuation of studies sponsored
through the Bureaus of Maternal and Child Health, Mental Health
and Laboratories, all adequately described in the reports of these
bureaus.

In the County Health Departments the studies of health problems
of the aged have moved forward under the energetic leadership of
Howard Carter, M.D., in Pinellas County. Irving Webber, Ph.D., who
contributed as a consultant from the beginning of the studies, was ap-
pointed as a full time staff member in August. In Hillsborough County
the Coordinated Community Mental Illness Program has developed in
a satisfying manner.

An activity of great interest was planned in the late months of 1959.
A field trial of oral polio vaccine in Dade County was developed as a
cooperative project by the County Health Department, the County
Medical Society and the University of Miami Medical School. Under
the leadership of T. E. Cato, M.D. (director of the County Health
Department) and with the joint direction of Eugene Flipse, M.D., and
George Erickson, M.D., the plans for this major undertaking took final
form in the late weeks of the year. It is anticipated that the conduct
of this study will prove to be one of the major research efforts in public
health in Florida in 1960.
There has been a continuing awareness of the need for research
designed to improve the effectiveness of public health programs. To this
end the Kellogg Foundation provided support for studies in Public Health
Administration. Under this 5 year grant a Health Officer IV, a health
program analyst and a secretary were employed, together with the
part-time assistance of a social scientist and needed consultants. Work
under this grant was fully activated in September. There has been
gratifying progress since that time in developing procedures for a critical
review and analysis of all programs of bureaus and divisions. By its early
productivity, this study promises to be one of the most significant under-
taken by the State Board of Health.
Of the new support for research obtained during the year the
approval of one research training grant was of particular interest. This
will make it possible to provide opportunities for suitably qualified physi-
cians and social scientists to obtain research training in connection with
selected studies in Florida. This grant should gradually add to the re-
search capacity in the state and in surrounding areas.

GENERAL SUMMARY

Research grants in effect in 1959 were in excess of $300,000. Addi-
tional grants approved during the year totaled approximately $200,000
of which the largest item was for the field trial of oral polio vaccine.
Funds for this joint study are being administered through the University
of Miami. It is hoped and anticipated that grant funds available for
research will continue to increase.
Articles by staff members:
Hardy, A. V. Research in Our Health Departments. J. Florida M.
Ass. 45: 1148-1151, April 1959.
Hardy, A. V. Diarrheal Diseases of Infants and Children. Bull.
World Health Org. 21: 309-319, 1959.
Hardy, A. V. The Responsibility of Public Health Agencies for the
Health of the Aged. University of Florida Press Society and the
Health of Older People, 9: 131-141, March 1959.

SCHOLARSHIPS FOR PROFESSIONAL EDUCATION
The 1959 session of the Legislature created scholarships for the study
of medicine, dentistry and the several disciplines concerned with mental
health. Each program requires that the scholarship be repaid by a period
of compensatory practice in an area that is in need of the scholarship
recipient's professional training.
Forty thousand dollars a year is appropriated for scholarships for the
study of medicine. The scholarships are awarded by the State Board of
Health upon the recommendation of a 7-man advisory committee
authorized by statute. The deans of Florida's 2 medical schools are
ex-officio members. The remaining 5 members are designated by the
President of the Florida Medical Association. The 2 exofficio members
were Dean George T. Harrell of the University of Florida and Assistant
Dean John C. Finerty of the University of Miami. The five physicians
designated by the Florida Medical Association were Richard C. Clay,
Miami; James T. Cook, Jr., Marianna; T. Z. Cason, Jacksonville; Melvin
M. Simmons, Chairman, Sarasota and Homer L. Pearson, Jr., Miami.
Forty thousand dollars is appropriated annually for the award of
scholarships for the study of dentistry. The statute provides that the State
Board of Health award dental scholarships upon the recommendation of
the State Board of Dental Examiners. The following dentists served on
that Board in 1959: Frank T. Scott, Jacksonville; D. J. Zimmerman,
Ft. Myers; Robert Thoburn, Daytona Beach; Rupert H. Gillespie, West
Palm Beach; F. F. Farver, Chairman, Miami Beach; J. M. Pepper,
Vice-Chairman, Pensacola; and R. P. Taylor, Jr., Secretary-Treasurer.
Upon the recommendation of the Florida Council on Training and
Research in Mental Health, scholarships or stipends are awarded by the
State Board of Health each year for the training of residents in psychiatry,
interns in clinical psychology, psychiatric nurses and psychiatric social
workers.

8 ANNUAL REPORT, 1959

Through the Federal Social Security Act of 1935, the State Board
of Health receives federal funds which are used to provide stipends to
the employees of the State Board of Health and its affiliated County
Health Departments for specialized professional training. These stipends
are awarded by the State Board of Health to its career employees who
evidence potential for growth and service in specialized areas of public
health.
Persons receiving scholarships in 1959 were:

MEDICAL
Scholarships Awarded in 1959:

Robert Allen Boudet............Gainesville
Gordon Thomas Couch........Pensacola
James Edward Davis............Madison
Francis Thomas Greene....Tallahassee
Everett Norwood
McCormick .................. Jacksonville

William Michael McGaw..........Miami
Howard Wayne Ramsey..........Palatka
John Wayne Ross..............Tallahassee
David Oliver Westmark........Pensacola
Wilbur Williams, Jr.....St. Petersburg
Lawrence Delano Kelley....Jacksonville

Continuing Scholarships awarded prior to 1959:
Awarded 1956: Awarded 1957: Awarded 1958:
William Henry Hubbard Robert Edwin Allen, Jr. Jarrett Charles Black
Glen Mayo Ernest Austin Robert Elliott Blakey
Luther C. McRae David Merle Bleech William Edwin Braun
Charles T. Ozaki Hoyt Horne James Wilson Bridges
Arthur Warren Sweat Edwin Keenan House, Jr. Karl George Gerlach
John Franklin Mason, Jr. Ed R. McDonough
Ronald Joseph Scheib Troy E. Overstreet
Leonidas Martin Turner, Jr. Lawrence E. Newman
Joseph Albert Walton, Jr. Ralph E. Reed
Richard Burke Welch Earl Taylor
Raymond Charles Walker
Robert Paul C. Whittier
George A. Williams
Lawrence Donald Porter

DENTAL
Scholarships Awarded in 1959:

George W. Alexander........Jacksonville
Parris Brown..........................Pensacola
Robert A. Brown....DeFuniak Springs
Gene Watkins Eng....................Miami
Robert G. Fountain..............Crestview

Henry Normand
Hudon .................... St. Petersburg
Paul V. Ladd.............................Miami
Daniel G. Noland....................Tampa
Thomas M. Scott.................Live Oak
Marlin Drant Walker.............Tampa

Continuing Scholarships awarded prior to 1959:

Awarded 1956:
William Gage Boyd, Jr.
Henry James Johnson
George E. Carver
Thomas Marshall Darden
Joe Holland Dowdy

Awarded 1957:

Awarded 1958:

Richard Kingsley Ames Alvin Bayer, III
Jay Brenner Wilbur Knox Collins
Robert Hardin Carter James Emmett Mongoven
William Howard Filler Rudolph Robinson
Robert B. Hayling Raymond William Gage, II

GENERAL SUMMARY

Wade Burke Hammer
Harry Gruen
David Campbell McCoy
Alfred J. Phillips
Richard Rafael Souviron
Raymond Edwin Rogers
Donald Spence

Peter B. Mills
Bennie Thompkins
Harold Thomas Wilson
Lester C. Young
Robert Wylly Butler

Stephen H. Mills
Oran Lloyd Turner, Jr.
James E. Thompson
Parnick Auston Williams
Harold D. Jordon

MENTAL HEALTH

RESIDENTS IN PSYCHIATRY

Herbert C. Anderson, M.D........Miami
William H. Geiger, M. D...........Miami
Ernest O. Herreid, Jr. M.D.....Miami
Evan Katz, M.D.......................Miami
Lyle B. Kunz, M.D.................Miami

Stanley S. NeeDell, M.D.........Miami
Wilford M. Provo, M.D.............Miami
Martin Rosenthal, M. D...........Miami
Ronald A. Shellow, M.D...........Miami

CLINICAL PSYCHOLOGY

Frances P. Brown........Ft. Lauderdale
Charles E. Buchanan..........Gainesville
Laurence T. Carroll, Jr...........Miami
Donald B. Clark..........Ft. Lauderdale
William G. Murdy..............Gainesville

Nathan W. Perry, Jr.....St. Petersburg
Thomas D. Prutsman....Ft. Lauderdale
Eve Lyn Weeks.............Coral Gables
Betty Whitney...................Hallandale

PSYCHIATRIC NURSING
Mary Helen Livingston......Tallahassee
Jamie Cook Watnee........Coral Gables
Wynelle Mims Scherer....St. Augustine

PSYCHIATRIC SOCIAL WORK

First Year
Edwin C. Bowers.............Tallahassee
Annabel M. Brantley............Key West
Ellen May Ellis..................Lakeland
Robert R. Furlough............Tallahassee
Allyn D. Gibson....................Lakeland
Murray L. Kaufman................Tampa
William A. Masterson........Jacksonville
William A. Proctor......Ft. Lauderdale
Roy Taine................................Leesburg
William A. Masterson dropped out as of 12
Temple Hess picked up beginning 12/15/5

Second Year
Humbert V. Arcamonte
............Miami Springs
Thomas H. Broome, Jr.......Marianna
J. Pomeroy Carter..................Live Oak
Stanley D. Davenport........Hawthorne
Patsy Nell Hirt................Tallahassee
Eleanor F. Moore....................Miami
Richard S. Sheffer..............Clearwater

PUBLIC HEALTH PERSONNEL
Cecilia J. Link...............Public Health Nurse.........Broward County
Fern Kingham.................Public Health Nurse.........Polk County
Nan Richardson...............Public Health Nurse.........Alachua County
Wilma P. Dickey...............Public Health Nurse.........Madison County
Florine A. Marshall.......Public Health Nurse........ Escambia County
Joseph K. Kastor............Sanitarian .................. inellas County
Charles I. Wollins............Sanitarian .........................Dade County
Charles G. Jordan...........Sanitary Engineer.............Dade County
Marvin L. Wicker..........Sanitary Engineer............Bureau of Sanitary Engineering
Melvin P. Reid, Ph.D.....Clinical Psychologist........Bureau of Mental Health
Banna I. Rodriguez.........Mental Health Worker...Palm Beach County

10 ANNUAL REPORT, 1959

PERSONNEL OFFICE
ELIZABETH REED, B. S.
Acting Personnel Officer
During the year many things occurred that had ramifications which
effected and affected the operations of the Personnel Office. Some of
these are: changes in environment; changes in office personnel; the con-
tinual increase in work load; and the legislative spending philosophy for
the 1959-61 biennium.
The environment of the Personnel Office has changed considerably
since the beginning of 1959, when the Personnel Office was located in
small and overcrowded quarters. Then in February 1959, the office was
moved to its present location, with more commodious quarters.
Although there was added only one new part-time clerk to the staff,
there was a 58 per cent turnover in personnel, which is reflected as fol-
lows: a stenographer was replaced in February; a clerk-typist was re-
placed in January and again in September; a personnel technician was
replaced in July. There were 3 acting Personnel Officers during the year.
The work load continued to increase. The Personnel Office pro-
cessed the employment papers of 493 new employees, 367 terminations
(full and part-time employees), 1576 salary advancements; 294 salary
adjustments were given in lieu of salary advancements; 27 merit increases
were approved; and, 21 employees that were on a fee basis were placed
on the regular payroll in October. Social Security payments were revised
upward, necessitating considerable paper work.
One hundred seventy-two new classified positions were added to the
Table of Organization, in addition to 109 positions that were reclassified
to a higher level. Only 7 positions were temporarily down-graded.
Twelve employees successfully completed the academic requirements
leading to the Master of Public Health degree; while one obtained a
Master of Arts in Education, and one completed the year's program of
study in public health nursing.
On July 1, 1959, the Legislative Appropriation Act went into effect,
which provided that all state agencies were limited to the positions that
were in the Legislative Budget; and that each employee was eligible for
a 5 per cent increase only in salary over their June 1959 rate (for the
position that he was in), for the biennium July 1, 1959, through June 30,
1961.
TABLE 1
MERIT SYSTEM STATUS OF STATE AND LOCAL HEALTH UNIT
PERSONNEL AS OF DECEMBER 31, 1958 AND 1959
Status 1958 1959 Per cent change
Permanent and Probationary 1457 1656 +13.65
Provisional 64 37 -42.18
Temporary 0 6
Emergency 26 15 -42.31
Exempt and Part-Time 293 273 6.83
Total 1840 1987 + 7.99

I ABLU:

DISTRIBUTION OF PERSONNEL-STATE BOARD OF HEALTH

(OTHER THAN COUNTY HEALTH DEPARTMENTS)

DECEMBER 31, 1959

Dental Health. ....8 5 2 1
and Purchasing & Property... 39 2 1 9 27

Grand Total................ ............ 86 20 29 14 22 48 26 81 61 191 86
Administration SHO ..... .............. ...... ........... 183 5 1 6 1
Personnel .......................... ...... 1 9 1 16 1
Data Processing............................. 15 1 3 8 8
Total .................................. 46 3 8 4 26 3 2
Dental Healtho ................... .......... eao. 8 6 2 1
Finance Fiscal..................... .......... .. 12 5 7
and Purchasing & Property ........................ 39 2 1 9 27
Accounts Total.................................. 117 3 1 7 1 16 27
Health Information ........................................ 13 5 1 6 1
Jacksonville ................................ 1 16 1 1 16 7 10
M iami .o ................................... 20 7 7 2 4
Orland .................................... 7 2 1 1 3
Laboratories Pensacola .................................. 8 2 2 1 2 1
Tallahassee .................................. 1 2 1 2
Tampaa........................... 13..9 6 4 2 7
est Palm Beach............................ 6 22 1 2 1 1
Total ....... ........................... 117 36 1 1 34 15 29 1
Local eBureauDi.....s..... ...................... 17 28
Health Nutrition................................ 6 5 1
Services Public Health Nursing ........................ 14 12 2
anitation................................... 8 6 1 2
Total................. ................ 35 2 5 12 1 5 10
Maternal and Child Health............ ..... .... ......... 30 5 1 8 7 6 2
Mental Health ............................................... 11 1 1 4 5
Narcotics .................. ................................. 13 9 4
Serc Bureau ................................... 27 2 1 2 2
Radiological and Occupational Health........... 8 1 1 2 1 1 2
Preventable Tuberculosis Control.......................... 21 1 1 10 8 1
Diseases Venereal Disease Control...................... 11 8 8
Epidemiology .mology ............................... 2 2
Veterinary Public Health ....................... 5 2 1 2
Total................................... 54 4 1 2 3 3 21 19 1
Sanitary Engineer ng .... ........ .. ... ..... ..... ........ 67 27 3 8 9 1 19
Special Bureau and Hospitals and Nursing Homes...... 15 2 1 5 7
Health Chronic Diseases ............................. 10 3 1 1 1 4
Services Total .................................. 25 5 1 1 1 5 1 11
Entomology. ..................................... ......... .. 73 1 2 28 3 13 24 2
Vital Statistics............................................... 43 4 39

12 ANNUAL REPORT, 1959

TABLE 3

DISTRIBUTION OF PERSONNEL IN COUNTY
HEALTH DEPARTMENTS-DECEMBER 31, 1959

COUNTY 0

Total.......... 1,401 54 11 270 475 2 3 76 21 272 112 105
lahu .............. 41 1 8 11 5 6 6
Baker ............... 4 1 1 1 1
Bay................. 16 1 4 5 2 2 1 1
Bradford............. 5 1 2 1 1
Brevard.............. 31 1 6 8 2 2 7 5
Broward............. 54 1 2 10 17 5 2 13 3 1
Calhoun............. 4 1 1 1 1
Charlotte............ 5 1* 1 2 1
Citrus. ............... 5 1 2 1 1
Clay.............. .. 8 1* 2 3 1 1
Collier............... 10 2 2 3 3
Columbia............ 7 1* 2 2 1 1
Dade................. 227 5 3 49 101 1 7 1 42 9 9
DeSoto.............. 5 1 2 1 1
Dixie................ 4 1 1 1 1
Duval............... 36 1 6 11 7 1 5 4 1
Escambia............ 62 1 8 14 1 15 7 6
Flagler............ .. 4 1 1 1 1
Franklin............. 5 1* 1 1 1 1
Gadsden............. 14 1* 3 6 2 1 1
Gilchrist............. 2 1 1
Glades............... 1 1
Gulf................. 5 1 2 1 1
Hamilton............ 4 1 1 1 1
Hardee .............. 5 1 2 1 1
Hendry.............. 5 1 2 1 1
Hernando............ 2 1 1
Highlands............ 8 1* 2 2 1 1 1
Hillsborough......... 142 5 1 28 45 1 8 3 27 18 6
Holmes.............. 5 1 2 1 1
Indian River......... 8 1* 1 5 1
Jackson.............. 14 1* 2 5 1 2 1 2
Jefferson ............. 8 1 1 3 2 1
Lafayette. .......... 4 1 1 1 1
Lake................ 17 1 3 7 1 2 2 1
Lee ................ 13 1* 3 5 1 2 1
Leon................ 31 2 5 9 5 6 4
Levy ............... 6 1* 1 2 1 1
Liberty. ............. 2 1 1
Madison............ 8 1* 1 2 2 1 1
Manatee............. 20 1 5 5 2 4 1 2
Marion.............. 14 1 3 5 1 2 1 1
Martin.............. 6 2 2 1
Monroe.............. 16 1 2 6 3 3 1
Nassau .............. 11 1I 2 3 2 3
Okaloosa............. 13 1 2 4 2 4
Okeechobee.......... 3 1 1 1
Orange.............. 58 2 8 16 3 6 14 5 4
Osceola .............. 5 2 1 1 1
Palm Beach.......... 69 2 1 12 20 3 2 12 7 10
Pasco ............ 5 1* 1 2 1
Pinellas............. 121 3 1 23 46 1 1 7 1 23 10 5
Polk ................. 71 2 1 14 23 3 1 15 6 6
Putnam.............. 11 1* 2 4 1 3
St.Lucie............. 15 1* 5 2 2 2 1 2
Santa Rosa........... 9 1 2 3 1 2
Sarasota............. 34 1 1 6 12 2 9 2 1
Seminole............. 10 1 3 3 1 2
Sumter .............. 4 1 1 1 1
Suwannee............ 7 1 3 1 2
Taylor............... 4 1 1 1 1
Union............... 3 1 1 1
Volusia.............. 53 2 1 9 16 1 4 1 7 7 4
Wakulla............. 2 1 1
Walton.............. 7 1* 1 2 1 1 1
Washington.......... 5 1 2 1 1

* County Health Officer for two or more County Health Units. See roster of County Health
Officers.
** Includes all part-time employees in County Health Departments.

Chart Title
Physicians

GENERAL SUMMARY

LEGEND

(See Table 3)

Class Titles
Health Officer I thru V (Including Psychiatrists)

Sanitary Engineers Sanitary Engineer I thru VI

Sanitarians Sanitarian I thru Director of Sanitation

Public Health Nurses Public Health Nurse I thru V

Professional Bioanalyst I thru V
Laboratory Workers Chemist I thru III

Administrative, Accountant I thru V
Fiscal, and Administrative Assistant I thru IV
Professional Administrative Services Director
Attorney I thru IV
Buyer, Purchasing Agent I & II
Fiscal Accountant I thru IV
Health Program Analyst
Hospital Consultant
Personnel Officer I & II
Personnel Technician I & II
Public Health Laboratory Director
Public Health Statistician I & II
Procedures Director
Vital Statistics Director

Other Professional Biologist I thru V
Clinical Psychologist I thru IV
Dental Hygienist
Dental Preceptorship
Entomologist I thru V
Health Educator I thru IV
Librarian
Medical Social Worker
Mental Health Worker I & II
Narcotics Inspector I thru IV

Nutritionist I thru III
Psychiatric Nursing Consultant
Psychiatric Social Worker I thru IV
Public Health Dentist I thru III
Public Health Physicist
Research Social Scientist
Social Scientist
Social Work Supervisor
Veterinarian I thru III

14 ANNUAL REPORT, 1959

LEGEND (Continued)

Chart Title Class Titles

Technical Building Construction Supt.
Chief Plumbing Inspector
Draftsman
Health Physics Technician
Illustrator I and & II
Instrument Maker
Laboratory Technician I thru III
Plumbing Inspector
X-Ray Technician I thru III

Clerical Account Clerk
Bookkeeping Machine Opr. I & II
Clerk I thru IV
Clerk Messenger
Clerk Typist I & II
Data Processor I thru III
Data Processing Manager I thru III
Data Processing Supervisor
Duplicating Equipment Opr. I & II
Duplicating Equipment Supr. I & II
Key Punch Operator & Supervisor
Stenographer I & II
Switchboard Operator I & II
Transcriber Operator
Vari-Typist

All Others Bedding Inspector I & II
Building Maintenance Superintendent
Chief Guard
Clinic Aide
Custodial Worker I & II
Dental Assistant
Domestic Worker
Foreman
General Foreman
Health Field Worker I thru III
Janitor
Laborer I thru III
Laboratory Diener
Mosquito Control Foreman

GENERAL SUMMARY

TABLE 4

TERMINATIONS AND TURNOVER RATES BY CLASSIFICATION

FOR THE FLORIDA STATE BOARD OF HEALTH AND COUNTY
HEALTH UNITS, CALENDAR YEAR 1959
(FULL-TIME EMPLOYEES ONLY)

SALARY
CLASSIFICATION Total Un-I I-- I I I -
der 150- 200- 300- 400- 500- 600- 700- 800- 900
$150 199 299 399 499 699 699 799 899 Plus
TERMINATIONS

Total-All Employees........ 321 47 138 90 13 10 12 1 7 3
Physicians.................. 10 7 3
Sanitary Engineers ........... 3 1 1 1
Sanitarians ................. 21 3 15 2 1
Public Health Nurses ........ 69 16 50 2 1
Prof. Laboratory Workers....
Adm. & Fiscal Professionals... 5 1 3 1
Other Professionals .......... 25 5 5 5 9 1
Technical................... 9 5 2 2
Clerical.................... 114 16 92 6
All Others .................. 65 31 22 12
TURNOVER RATE (ANNUAL PERCENTAGE)
Total-All Employees........ 17.2 61.8 27.8 14.6 3.7 10.7 21.8 5.0 17.1 5.7
Physicians.................. 14.3 38.8 6.2
Sanitary Engineers.......... 08.3 20.0 25.0 07.1
Sanitarans................. 07.3 150.0 11.7 01.5 05.0
Public Health Nurses........ 13.7 41.0 14.8 01.7 100.0
Prof. Laboratory Workers....
Adm. & Fiscal Professionals... 15.1 14.2 23.0 25.0
Other Professionals. ......... 15.8 29.4 10.6 15.1 33.3 08.3
Technical.................. 11.8 12.1 07.6 28.5
Clerical..................... 25.3 88.8 29.4 05.1
All Others .................. 33.6 53.4 25.2 30.7

16 ANNUAL REPORT, 1959

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

Several new positions for health educators opened up in County
Health Departments. There are now 9 budgeted positions for health edu-
cators on the local level. It is felt that this indicates a greater apprecia-
tion of the role that they must play in public health programs of the
future.

More time was spent with bureau and division directors in endeav-
oring to determine the place of health education in old as well as new
programs. Accident prevention and radiological health are two examples.

As usual there was preoccupation with media and materials designed
to inform the general public. Assistance was given to many County Health
Departments and other bureaus and divisions in complementing their ef-
forts in this direction.

There is a continuous interest in the 3 day orientation programs
for public health and related personnel. A backlog of applicants are al-
ways waiting for the next one. Two were scheduled in 1959.

TOOLS
A large portion of the budget is spent on Florida Health Notes. This
publication goes to approximately 15,000 persons each month, except July
and August. It seems to continue in popularity since requests to be put
on the mailing list are received daily. Subjects covered in 1959 were
sewage problems, mental health, housing, research, viruses, frozen foods,
community nursing service and health careers. The services of a con-
sulting layout artist have improved its appearance.
The exhibits consultant held over 50 planning conferences and as-
sisted with displays at 20 fairs and conventions. He also turned out over
300 other pieces of work such as charts, maps, TV props, etc. Many of
the State Board of Health's standard exhibits were lost in a flood in May
which invaded the consultant's workshop. He assisted in layouts, car-
toons, illustrations and attended a 2 weeks audio-visual course at the
Communicable Disease Center in Atlanta.
The press, radio and TV maintained interest in public health with 76
releases originating at the State Board of Health. Many inquiries are re-
ceived from editors, popular subjects being cardiovascular disease,
cancer, mental health, radiological safety, accident prevention and
environmental sanitation.
The flood of requests for pamphlets never ceases though emphasis
is constantly placed on their wise use in smaller quantity. Approximately

HEALTH INFORMATION 17
375,000 pamphlets were distributed, the most popular being those on nu-
trition, communicable diseases and weight control. There was an increase
in requests originating in schools.

AUDIO-VISUAL AIDS LIBRARY

There is a slow but steady increase in the use of all audio-visual aids
with a beginning interest in more use of tapes, slides and filmstrips. The
number of aids circulated were 5,803, an increase of almost 4 per cent
over the previous year. Approximately 586,000 persons saw these aids,
which does not include estimated audiences who saw 6 films telecast and
heard 20 radio transcriptions. There were also TV spot announcements
and 35 mm X-ray trailers circulated.

Requests were received from all 67 counties .. A new electroni-
cally operated film inspection machine was purchased. A new booking
order form was devised. Both of these have resulted in more efficient
operation ... 2 projects with which the library assisted were the circula-
tion of tape recordings of the 1959 Heart Seminar and 35 mm slide sets
on the care of premature infants. Both have had wide use Many
requests are made of the staff to assist in the instruction of trainees in
using projection equipment and in the planning for TV programs .
Projection equipment was loaned 255 times to SBH personnel.

Because of the heavy circulation load, there has not been sufficient
time to evaluate the subject coverage (which is spotty), to study the new
equipment that is being offered, to devise a better method of previewing
new aids and to investigate still projection which could be a promising
new development.

LIBRARY

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

The appearance of the library has been greatly improved by the pur-
chase of new reading tables, index table, chairs, 2 new stacks and by
repainting old equipment to harmonize.
During the year 766 books were bound, making the total volumes
in the library 15,757. A total of 2559 reference questions were answered;
24 bibliographies compiled; 75 items borrowed from and 15 items loaned
to other libraries; 94 photostats secured from the National Library of
Medicine.
Circulation figures: books, 1717; journals, 8112; pamphlets, 37; in-
definite loans, 218; total: 10,084.

18 ANNUAL REPORT, 1959

In reviewing new books and journals added in 1959, interest is noted
in radiological health, mental health, air pollution and sanitation. Many
more items are needed in the radiological field but funds, as usual, are
limited. The collection is not balanced but use must be made of cate-
gorical funds when they are available. Some extra funds were released
for binding some back issues of journals.

GENERAL
Health education in Florida in 1959 included many day-to-day ac-
tivities that need not be discussed in detail. Some of these were: the
editing of the Annual Report; assistance with editing Annual Reports for
several county health departments; a visit to the University of North
Carolina to recruit health educators and a schedule made for a group
of its graduate students to tour Florida; attendance at meetings and co-
operation with Florida Education Association and Florida Congress of
Parents and Teachers.
Direction of or assistance with all types of orientation and training:
the three-day orientation programs for public health personnel; social
welfare students; sanitarian trainees; Florida State University School of
Nursing students; foreign visitors; summer students in public health at
the Central Office.
The Teachers Project in Health Education required much time and
effort through June and July (for details see the report of the Bu-
reau of Maternal and Child Health elsewhere in this volume). A sum-
mer student employee was guided as was a colored health educator
attached to the Venereal Disease section. Consultation was given in some
measure to all the local health educators, with special attention given to
the new ones in Brevard County and the Migrant Project in Palm Beach
County. Visits were made to County Health Departments upon request.
Telecasts over an educational station (WJCT) took a disproportion-
ate amount of time and effort, though excellent cooperation was re-
ceived from professional personnel in the Central Office in these presenta-
tions. Numerous talks were made before varied groups and many meetings
attended. The usual excellent relations with voluntary agencies were
enjoyed. An exploratory health survey of a sampling of students at a local
high school included a questionnaire on health facts and an interview
on attitudes toward health. Assistance was given to a staff psychologist
in a number of seminars on child growth and development.

LOCAL HEALTH SERVICES 19

BUREAU OF LOCAL HEALTH SERVICES
WADE N. STEPHENS, M.D., M.P.H.
Director
Hubert U. King, M.D.
Assistant Director
The Director of Local Health Services, aided by his assistant, super-
vises the directors of the County Health Departments and is responsible
for their recruitment, orientation and training. He also furnishes consulta-
tion to them in the fields of administration and program balance. The
records consultants teach the clerks, especially those newly employed,
to fill out records properly and file them efficiently. The Divisions of
Public Health Nursing and Sanitation and the Nutrition Services offer
consultation, aid in recruitment, orientation and training in their res-
pective fields.

COUNTY HEALTH DEPARTMENTS
At the end of 1959, there were 23 single County Health Departments
employing full time health officers. There were 8 bi-county units and 9
tri-county units. St. Johns County remains the only one in the state with-
out an approved County Health Department. It requires 60 physicians
to operate the County Health Departments. Forty of these are the direc-
tors of units. Eight county health officers were newly employed during
1959, and there were 2 vacancies at the end of the year.
On December 31, 1959 there were 1372 employees on the payrolls
of the 66 County Health Departments, an increase of 82 over last year.
This expansion was made possible by a total budget of $7,640,156, or
$1.82 per capital, of which $5,232,596, or $1.25 per capital came from
county contributions and $2,407,560 or 57 cents per capital from state
and federal funds.

TRAINING
A four and one-half day Seminar in Public Health Administration
was given November 30-December 4, 1959, to which all physicians
employed in the past several years were invited. Twenty-one program
directors from the State Board of Health contributed to the program,
and 16 recently employed health officers, assistant health officers and
residents in public health administration attended. The seminar filled a
long felt need, and was well received by those attending.
During the year 2 county health officers received Master of Public
Health degrees. There are now 23 county health officers who have
received this degree, and 15 who are diplomats of the American Board
of Preventive Medicine. The quality of Florida's health officers appears
to be better than the national average.

20 ANNUAL REPORT, 1959

HEALTH DEPARTMENT HOUSING
The building and remodeling of health centers has continued during
the year. There are now only 27 of the 66 health departments housed
in inadequate quarters. Thirty-nine are in comfortable quarters, either
recently built or remodeled, and 6 more will be constructing new quar-
ters during the next year or two.
The following County Health Departments had buildings erected
in 1959: Franklin County, Apalachicola; Washington County, Chipley;
Sarasota County, Sarasota; and Broward County (new county building,
not Hill-Burton), Ft. Lauderdale. Auxiliary health centers were com-
pleted at Lake Wales and Haines City in Polk County and Pompano
Beach in Broward County.
Sixty-nine subsidiary health centers are adequate for their purpose,
but 48 remain inadequate.

RECORDS CONSULTATION SERVICE
The two records consultants made 139 visits to County Health De-
partments for the purpose of teaching the proper use of records and clari-
fying routine office procedures. In the course of these visits they gave
orientation and elementary training to 9 newly employed clerks. They
reviewed the filing systems and recommended changes in 10 counties.
Most of the visits made also involved some activity in the interest of more
accurate and complete vital statistics reporting. These consultants are re-
sponsible for the accuracy of the monthly reports of activities, so some
visits were for the purpose of clarifying the instructions for filling out the
report.
During 1959 extensive revisions were made in payroll procedures. The
records consultants organized and conducted 6 district meetings at which
the new procedures were explained. The changes caused but little con-
fusion, so the meetings must be considered as very successful.
At the request of the director of the Accident Prevention Program,
the consultants made a study of the records and files of 5 poison control
centers. They are now equipped to help these centers, which are located
in hospitals, keep better and more uniform records, and to improve their
relationships with County Health Departments.

COUNTY HEALTH DEPARTMENT ACTIVITIES
The statistical report of County Health Department activities,
printed in succeeding pages, is designed to show the numbers and types
of program activities entered into by County Health Departments. It re-
cords the quantity of the service given in each listed category.
The number of nurses employed in all the County Health Depart-
ments increased from 503 at the end of 1958 to 541 at the end of 1959,
an increase of 7.5 per cent. One index of nursing activity (total nursing

LOCAL HEALTH SERVICES

visits) shows that in a group of traditional public health programs the
increase in activity was only 4 per cent. During the same time visits in
the comparatively new programs (chronic diseases and mental health)
increased 18.9 per cent. In 1959 a new activity, accident prevention, ap-
peared on the report, showing 893 visits. These figures reflect changes
in the character of the total public health program. They also give some
basis for the belief that there has been a considerable increase in general
efficiency, in spite of the fact that almost every one of the new nurses
employed during the year was without previous public health experience.
There are few items in our activities report that give any indication
of the results of all the activity reported. One index of results obtained in
nursing program may be formulated by comparing the referrals made for
diagnosis or treatment with the number of referrals completed. In 1958,
30.8 per cent of all referrals (except dental) were completed. The
figures for 1959 show that 35.8 per cent were completed. This could
be an indication of improved effectiveness in the field of referral
follow-up.
The number of sanitarians employed increased from 277 in 1958 to
304 in 1959, an increase of 9.9 per cent. During the same period an in-
dex derived from the cumulative monthly report shows an increase of
17.4 per cent in overall sanitation activity. Of the many sanitation pro-
grams, those concerned with water supply and sewage disposal show the
greatest increase. These are required by law and by agreement with the
Federal Housing Administration and Veterans Administration, so they
must be carried out. The pressure of these programs, has, in rapidly grow-
ing counties, prevented the necessary expansion of other activities. It ap-
pears that food inspection, a most important activity, is being spread more
and more thinly, and is not keeping up with the growth of the state.
Both nurses and sanitarians are working harder than ever before,
because their numbers have not kept pace with the demands made on
them. Under ideal conditions there should be 385 sanitarians instead of
304, and 922 nurses instead of 541, to meet the demands of the estimated
population of the state. The 1959 legislature imposed restrictions on the
creation of new positions in County Health Departments which have
slowed down the employment of new personnel. These restrictions will
continue in force until the legislature meets in 1961. It is to be hoped
they will then be relaxed to allow the normal expansion of health de-
partments to meet the needs of a larger population.

NEW TRENDS IN LOCAL PUBLIC HEALTH PROGRAMS
Perhaps the most obvious of new trends is the increased interest in
public health research at the community level, and in demonstration
projects with research implications. At least 15 projects and studies were
underway in various counties during the year. Five of these are fully de-
veloped research studies supported by funds from outside the county. At
least 2 others are carefully planned studies carried on locally without ad-
ditional financial aid. Eight or more were less well developed projects,

22 ANNUAL REPORT, 1959

undertaken primarily for the purpose of future planning in smaller
counties. This count may be incomplete, because such local projects are
not always reported until the results are all recorded.
Newer case-finding techniques are beginning to be used. Skin-
testing for tuberculosis was used in 64 counties; in at least 8 of these there
were mass programs carried out on selected groups. The relatives of
known diabetics were screened for diabetes in 11 counties.
The dental program at a local level has been greatly stimulated by
the employment of 8 dentists recently graduated from dental school
under the preceptorship of county dental societies. Before the develop-
ment of this program only 3 counties had an organized dental program.
In 1959 there were 11. The white mobile dental units of the State Bureau
of Dental Health gave dental care in 9 additional counties, and the
colored unit in 10.
There are now 5 localities where bedside nursing is included as a
part of the duties of the public health nurse. This service is being well
received, and will undoubtedly be extended to other areas in the future.
For some years many cities have been making long range plans for
expansion and rebuilding. Now a number of counties are developing com-
prehensive plans for drainage, sewerage, water and zoning. It is usual to
make the issuance of building permits contingent upon health department
approval of sewage disposal and water facilities; as the county-wide drain-
age and sewage projects develop further they can be expected to improve
the public health.
The mental health program continues to expand. There are now 16
guidance clinics employing 145 persons and serving the entire state as
completely as is possible with this limited personnel. There are also 26
mental health workers in County Health Departments, who work with
the clinics and participate in community mental health programs.
The Red Cross Gray Ladies are well known for their volunteer work
in hospitals. In 1959 they were assisting in the health departments and
schools as well. This efficiently organized group of volunteers has been
found most helpful. Other counties may be expected to ask for such help
in the future.

SUMMARY
Over the state, County Health Department activities show an in-
crease in both quantity and quality over last year. There appears to be
a steady increase in personnel and in the flexibility necessary for contin-
ued progress, although in many areas programs are not changing or
expanding quickly enough to meet present and future needs. Greater
attention is being given to long range planning and community organiza-
tion. It seems certain that the Florida public health program will con-
tinue to be as dynamic in the future as it has been in the past.

LOCAL HEALTH SERVICES 23

DIVISION OF PUBLIC HEALTH NURSING
RUTH E. METTINGER, R.N.
Director
The Division of Public Health Nursing consists of a director, 5
nursing consultants, a nurse-midwife consultant and 2 clerical personnel.
The functions of the divisions are to: aid County Health Departments
in the recruitment of qualified public health nurses; function, assist or
organize orientation and basic training programs for nurses; promote
inservice education programs in both academic and seminar forms;
recommend nurses for out-of-state training; offer trained consultant
service to public health nurses in the county units; evaluate County
Health Department nursing services on request; aid in the supervised
midwife training program and to issue midwife licenses upon recom-
mendation and request of the director of the County Health Department;
promote the organization of combination nursing services, especially in
rural areas; and work in close cooperation with other bureaus and
divisions, with other state agencies and with professional, voluntary and
civic organizations to develop adequate public health nursing programs.

RECRUITMENT
As of December 31, 1949 there were 383 public health nurses
employed in the County Health Departments, voluntary agencies and
the Crippled Children's Commission. As of December 31, 1959 there
were 615 public health nurses employed, an increase of 61 per cent in the
10-year period. Approximately 40 per cent of the number now employed
have had the year of study in public health nursing.
At the end of the year there were 29 vacancies in the County Health
Departments. The majority of the vacancies are to fill PHN II and
higher classifications.

TRAINING
Continuous inservice education programs are accepted as a most
important adjunct to good public health nursing by the majority of the
public health nurses in Florida. Monthly inservice study groups are
available in most areas for the nurses and there is increasing active
participation. Classes are planned around the felt needs of the local
group. Consultants assist by providing some reference materials, actually
participating as the nominal leader of the group until local personnel
are able to assume this role and by securing other resource persons.
Two and one-half day workshops in Human Relations and Leadership
Skills were conducted in Jacksonville, Vero Beach, Tallahassee, Key West
and Fort Lauderdale. A total of 113 nurses from County Health Depart-
ments and allied agencies participated in these experiences. Techniques
in leadership, understanding self, understanding others, understanding

24 ANNUAL REPORT, 1959

groups and inter-personal skills in nursing are used as basis for problem-
solving discussions. (See report of Bureau of Mental Health elsewhere
in this report.)
Twenty nursing supervisors and senior nurses participated in a three-
day workshop in Jacksonville and Fort Lauderdale. These experiences
are designed to help the supervisors work more effectively with staff
nurses in improving nurse-patient relationships.
An evaluation of the inservice training center for nurses at Gaines-
ville was made covering the period from 1945-59. One hundred and
sixty-one public health nurses have had inservice training (2 months),
9 of them in 1959. Approximately 60 per cent of the nurses employed
in the County Health Departments have not had formal preparation
or experience in public health, therefore, it is imperative that a training
center be continued.
Five scholarships were granted by the State Board of Health to
public health nurses for advanced education in public health nursing.
(See Scholarships for Professional Education elsewhere in this report.)
Three nurses received scholarships to attend the three-weeks program in
rehabilitation at The Kirkpatrick Memorial Institute of Physical Medicine
and Rehabilitation, Winter Park.
In 1959 County Health Departments provided clinical experience
in public health nursing for 77 basic nursing students from the following
collegiate schools; Florida State University, Florida A & M University,
University of Florida, University of Miami and Barry College.
Three graduate students from Peabody College and 2 from Vander-
bilt University were assigned to the Hillsborough County Health Depart-
ment for 3 months' field experience in public health nursing; Pinellas
County Health Department accepted 3 students from Peabody and Palm
Beach County Health Department accepted 1. Thirteen Southern
Missionary College students, who received their clinical experience at
Central Florida Tuberculosis Hospital at Orlando, received 120 hours
field experience each at the Orange County Health Department, integrat-
ing their field work with clinical work in the hospital. A total of 22
out-of-state students received field experience in public health nursing in
the County Health Departments.
The program for field experience is outlined by public health nursing
instructors at the respective collegiate schools and upon approval by this
division and by the nursing directors of the county health units where
the students are accepted for affiliation, definite plans are made to be
followed during the experience period. The consultants visit the area
to assist in an advisory capacity.
Opportunity for observation of field experience was provided a
number of public health nursing staff members, students in the basic
course of nursing and other groups. Other persons receiving orientation
or field training experience, or who observed the midwife program were

LOCAL HEALTH SERVICES

from South America, British West Indies, Barbados as well as the other
states.
Miss Eli Magnussen, Director of the public health nursing section,
Department of Health in Denmark, a consultant to World Health
Organization, was invited by the U. S. Public Health Service and
Children's Bureau to visit the United States to give consultation to states
and other interested groups. Florida was included in her itinerary and
she spent one week in the state observing the combination nursing
programs in Clay, Baker, Volusia and Dade Counties.
Two separate American Red Cross courses in mother and baby care
were conducted during 1959. The courses were co-sponsored by the
County Health Department and high school. Parents attended the
evening class and high school students comprised the day class.

CONSULTANT SERVICE
One new public health nurse consultant was added to the 5 already
employed during the year. This decreases the area covered by each and
permits more intensive service to rural counties who have the greatest
need. A total of 189 visits were made to County Health Departments
by division personnel to: give guidance and support to the public health
nurses; improve the quality of service; coordinate nursing programs with
the activities of the sanitarians, mental health workers and health educa-
tors; orient newly employed nurses; encourage intelligent use of records;
and assist in evaluating the performance of nursing personnel.
One consultant will continue to serve as resource person for the
nursing home program. She was instrumental in the development of the
first short course ever offered in the South for nursing home admini-
strators. (See report of Nursing Home Program elsewhere in this re-
port). Routine inspection of the nursing homes in Jacksonville is done
by this consultant.
Intensive assistance is given by one consultant on the Civil Defense
program and disaster nursing. Classes and demonstrations were held in
9 counties during 1959. She also participated in the Accident Prevention
Program.
Most significant is the increase in the number of requests for evalua-
tion of nursing services. These were made in Orange, Franklin, Pasco,
Sumter and Manatee Counties in 1959. Without exception these careful
studies emphasize the need for additional nursing personnel, development
of new programs and guidance in selecting priorities in nursing service.

MIDWIVES AND THEIR TRAINING
A sharp decrease in the number of midwives in Florida during the
past decade is reflected in the following figures: midwives licensed in
Florida as of December 31, 1949 were 439; as of December 31, 1959

26 ANNUAL REPORT, 1959

there were 238. This represents a decrease of 46 per cent and a related
increase in the adequacy of obstetrical care by physicians and hospitals.
All of the midwives were reached through 21 midwife meetings and
individual home visits by the midwife consultant. In all of the one-day
educational meetings held in the County Health Departments through-
out the state, the public health nursing staff in each area assisted the
consultant in planning, scheduling and securing needed teaching aids;
they also participated in the actual meeting.

COMBINED NURSING SERVICES
Increased emphasis was directed toward furthering the combination
service, recommending that each nurse include in the generalized public
health nursing program, the multiple functions of health teaching, preven-
tion of illness, control of disease, rehabilitation and nursing care of the
sick when visiting in the home.
The success of an approach to a combination service depends, to a
great measure, on the organization of a citizens' committee which has to
be activated prior to the establishment of the program or the employment
of an additional nursess. The vital role of such a committee underscores
an understanding and appreciation of the philosophy that forms the
background of the combination service. Two major premises have to be
kept in mind. If properly developed and established, this committee
endorses the principle that participation by responsible and well-informed
citizens, representing the entire county, is indispensable for the proper
direction and growth of the service. The committee must realize that
their work is as important and vitally related to family health care as is
the role of the nurse in the performance of her various health duties.
Informed people are needed to fashion a citizens' committee in order that
community awareness may be hastened to an intimate individual appre-
ciation and understanding of the value of this essential family service
to the end that it may receive the type of sincere personal and community-
wide support it deserves. Leadership, official and voluntary, must trans-
late the meaning of the service to the people.
The above philosophy has and is being implemented by the person-
nel of this division in counties that have initiated the program and in
counties contemplating the service. Palm Beach County Health Depart-
ment started the service in the Glades area the latter part of 1959.
Florida now has 5 combination services; Sarasota, Volusia, Clay and
Baker Counties and in the Glades area. The division assisted Jefferson
County Health Department and the western area of Volusia County with
their preplanning for combining their respective services. These will be
activated in 1960.

LOCAL HEALTH SERVICES 27

DIVISION OF SANITATION
A. W. MORRISON, JR.
Director
Division activity followed previously established lines during the
first half of 1959. In July, however, additional activities, including res-
ponsibility for a number of environmental sanitation programs, were
assigned to the division. Two experienced sanitarians were transferred
to the division at this time bringing the consultant staff up to 5 members.
Work was completed on the revision of classification specifications for
the sanitarian series early in the year. The new specifications were
adopted by the Florida Merit System on June 12 and have been in use
since that date.
New regulations covering the handling and distribution of frozen
foods and a revision of regulations for educational, recreational and
migratory labor camps were prepared during the year. These regulations
were adopted by the State Board of Health as chapters of the State Sani-
tary Code. Studies were undertaken in 2 additional Code areas: food
service and trailer parks. County Health Department sanitarians from
various sections of the state served on the study committees. Revision
of regulations in these and certain other areas of the Sanitary Code
will be recommended during the coming year.

CONSULTANT SERVICE
The primary function of this division is to provide effective consul-
tant services to the County Health Departments. Staff members made
293 field visits in 1959. Each of the 67 counties was visited at least
once during the last 6 months of the year. The length of visits ranged
from a few hours to 1 and 2 week periods, depending upon purpose of
the visit and situations encountered.
Sanitation programs were evaluated in 4 counties. In each case,
records were checked, activities studied and surveys were conducted to
determine program coverage and effectiveness. Recommendations, based
upon local needs, were made to the respective health officers and
sanitarians.
Staff consultants participated in the planning and presentation of
various training programs in the counties. Each also taught one or more
classes in the Sanitarian Inservice Training Program. Some of the other
activities of the consultants included: one staff member served for 2
months as part-time sanitation director of a County Health Department
during a period of local reorganization; another conducted a sanitary
survey of the 23 nursing homes in the City of Jacksonville and a third
supervised the disinfection program of a tuberculosis hospital which was
to be converted to a training center for children.

28 ANNUAL REPORT, 1959

SANITARIAN INSERVICE TRAINING
Three inservice training courses were conducted during the year. As
in previous years, each twelve-week course consisted of an eight-week
didactic training period in Jacksonville with a four-week internship in
selected County Health Departments. Twenty sanitarians from 15 Florida
counties and a student from Honduras completed the program in 1959.
The training course received highly favorable comments from U. S.
Public Health Service representatives following an evaluation of the
program.

SANITARIAN TRAINEES 1959
County Number County Number
Alachua 1 Orange 1
Broward 1 Pinellas 2
Charlotte 1 Polk 1
Dade 3 Putnam 1
Hillsborough 2 Sarasota 1
Manatee 1 Taylor 1
Marion 1 Volusia 2
Nassau 1 (Honduras) 1

Additional training activities included planning and conducting a
short course in sanitation for State Barber Board inspectors and assistance
in planning sanitation programs for state and national public health
meetings.

FOOD HANDLER TRAINING
Efforts were directed toward designing food handler training programs
for specific groups with special emphasis on managerial personnel. Staff
consultants participated in the planning and presentation of this type pro-
gram for school lunchroom supervisors from 6 central Florida counties in
June. Similar assistance was provided for other food handler courses in
Glades, Hendry, Orange, Taylor and St. Johns Counties during the year.
The counties reported 3435 food handlers certified in the regular six-
hour courses in 1959. This total is significantly less than the previous year
as the permanent courses in both Dade and Escambia Counties declined in
attendance.

FOOD SANITATION
Since the primary purpose of all public health food sanitation programs
is the prevention of food-borne diseases, considerable attention was devoted
to improvement of methodology in this field. A packet of forms containing
instructions for proper procedures in handling and recording food-borne
outbreaks with a list of needed equipment and supplies for preparation
of field investigation kits was adopted as an official record form. Each
County Health Department was urged to prepare one or more of the

LOCAL HEALTH SERVICES

investigation kits for ready availability at all times. Three county sani-
tarians and 1 staff consultant attended a five-day USPHS training
course on applied procedures for the control of food-borne diseases.
All counties continued control activity in the food service and food
sales areas. An increasing number of counties are engaged in sanitation
programs covering various food processing operations as this field rapidly
expands. Consultants rendered assistance in the food area to County Health
Departments, school lunchroom personnel and others throughout the year.
The division maintained close liaison with related state and federal agencies
in areas of mutual interest.

COMMON CARRIER CERTIFICATION
This division, through the County Health Departments, continued
program activity covering the 22 airline caterers and 4 railroad commis-
saries operating in Florida. Survey reports were submitted to USPHS on a
semi-annual basis for inclusion in certification listings.
The gigantic Miami International Airport terminal, opened in 1959,
provided new facilities for one of the major airline caterers. Several other
caterers were relocated in improved quarters during the year. The Dade
County Health Department now has a sanitarian devoting full time to air-
port sanitation activities.

FOOD PROCESSING PLANTS
Rapid advances in the technology of food processing coupled with in-
creasing consumer demand for processed food products continues to add
to the number and variety of food processing plants in the state. Five
additional counties engaged in sanitation activity in this field during the
year raising the number involved to 21. Plants increased from 217
to 282 in 1959.

CAMP SANITATION
Although this program activity includes recreational and educational
camps, major emphasis was again directed toward the improvement of mi-
grant labor camp facilities in some 26 counties of the state. The 1959 Legis-
lature passed a law requiring migrant labor camps be licensed by the State
Board of Health. This law, which became effective in June, provided the
necessary legal foundation for our program. Every effort was then made
to develop camp regulations that would be effective, practical and
enforceable in accordance with the law. Such action was completed
in October and new camp regulations were adopted by the Board in
November.
Considerable progress has been made by the counties involved in
migrant labor camp activity.

30 ANNUAL REPORT, 1959

BOTTLED WATER PLANTS
One new plant began operation during the year bringing the number
of approved bottled water plants to 27 in the state. Three out-of-state
plants are also approved to ship bottled water into Florida. Considerable
activity was noted in proposals by established plants to add distilled,
de-ionized or de-mineralized waters to their product list. In each case,
the plants were required to install proper equipment for such processing
and to provide proper labeling of the product offered for sale. Routine
sampling and laboratory testing of all bottled waters is a continuing
function of this program.

TOURIST AND TRAILER PARKS
Activities relating to operation of the tourist and trailer park program
demanded a significant portion of the division's office and field time. Staff
consultants worked with local sanitarians in a concerted attempt to bring
program activity up-to-date in all counties. These efforts resulted in County
Health Departments submitting 851 applications for permit during the last
6 months of the year. Applications covered new trailer parks, expansion of
previously permitted parks, changes in park ownership and many facilities
which had been operating without permit. Each application was carefully
reviewed for conformance with legal requirements before a permit was is-
sued. A total of 2310 tourist and trailer parks were operating under current
state permit at the close of 1959.

RENDERING PLANTS
Regulations covering rendering plants became effective in January.
Certain problems in odor control and the disposal of plant wastes from
these establishments are currently being studied by the National Renderers
Association. This industry-sponsored research may well lead to solution of
existent problems. One new plant was constructed during the year raising
the number of approved plants to 7. Several plants were visited by staff con-
sultants and it is expected that increased local control of these establish-
ments will be exercised by County Health Departments in the future.

SCHOOL SANITATION
This program is now handled in cooperation with the Bureau of Sani-
tary Engineering with major emphasis directed toward increased County
Health Department participation in school construction activity. Opera-
tional aspects of the program continue to be carried out by local sanitarians.
Escambia and Alachua County Health Departments prepared and distrib-
uted bound copies of their annual school sanitation survey reports. They
have found this to be an effective method of maintaining high standards of
sanitation in the schools of their respective counties.

LOCAL HEALTH SERVICES 31

HOUSING
In cooperation with the Leon County Health Department, housing
survey activity was continued in Tallahassee. This project, using Leon
County as a training source, is being expanded to include other County
Health Departments in the further development of housing survey tech-
niques. Hamilton County Health Department has made considerable pro-
gress in setting up procedures for a survey of all housing in the City of
Jasper. This survey will use a modification of the Tallahassee short
form evaluation and will utilize voluntary workers to conduct the survey.
The Institute of Governmental Research, Florida State University, has
assisted in planning and will train the voluntary workers. They will
compile, evaluate and report findings in the Tallahassee, Jasper and
subsequent surveys in accordance with a federal research grant.

TABLE 5

PERMITTED ESTABLISHMENTS AND FACILITIES 1959
FOOD BOTTLED
COUNTY TRAILER PROCESSING RENDERING WATER
PARKS PLANTS PLANTS PLANTS
Alachua 80 1
Baker 2
Bay 63
Brevard 80 2
Broward 101 3 1 2
Calhoun 2
Charlotte 12 1
Clay 15 1
Collier 16 1
Columbia 3
Dade 72 77 41 2 3
Duval 163 1 1
Escambia 144
Flagler 2
Franklin 1
Gadsden 7
Gulf 4
Hamilton 8
Hardee 3
Hendry 3
Highlands 6
Hillsborough 212 35 5 2 2
Indian River 13 2 1
Jackson 5 2 1
Lake 35 1
Lee 48 1 1
Leon 44
Levy 5
Madison 1
Manatee 75 7 2
Marion 31 1
Martin 26 5 1
Monroe 54
Nassau 6
Okaloosa 41

32 ANNUAL REPORT, 1959

Okeechobee 2
Orange 101 8 2 1
Osceola 10 1
Palm Beach 62 12 1 3
Pasco 84
Pinellas 239 54 1 3
Polk 207 11 1
Putnam 9 2 2
St. Johns 10
St. Lucie 20 10 2 1
Santa Rosa 18
Sarasota 65 23 1 2
Seminole 12 1
Sumter 17
Suwannee 1
Taylor 5
Volusia 63 25 1 2
Walton 3
Out of State 3
2310 282 61 7 30

SANITARY NUISANCES
The majority of reports of insanitary conditions received by the di-
vision were referred to the County Health Departments for appropriate ac-
tion. When necessary, staff consultants provided assistance to local health
officers and sanitarians in these matters.

RECRUITMENT
Recruitment activities were continued with additional contacts being
made at both state and private colleges and universities. Three students en-
rolled in the Sanitary Science program at Florida State University in Sep-
tember. One is a foreign student who plans to return to Thailand but the
other two appear to be good prospects for sanitarian positions in the County
Health Departments.
A sanitarian recruitment brochure was distributed early in the year
and considerable progress has been made in the preparation of a color
slide series to be used at "career day" programs in the high schools.
Articles by staff members:
Morrison, A. W., Jr. Present Educational Requirements for Entry-
Grade Sanitarians in the United States. Sanitarian 21: 193-4, Jan.-Feb.
1959.

NUTRITION SERVICES
MARY BRICE DEAVER, M.S.
Director

Completing its first full year in the Bureau of Local Health Services,
Nutrition Services has reflected some changes in policies, methods of opera-
tion and programs. There have also been some staff changes with one

LOCAL HEALTH SERVICES 33

vacant position for a district consultant being filled and one staff
member starting a year's educational leave to pursue graduate work in
public health nutrition.
One of the primary responsibilities of Nutrition Services is to provide
consultation, information and materials to the County Health Departments
since the general health program should incorporate nutrition as an essen-
tial component of good health. To carry out this responsibility, the
consultants have attempted during the year to acquaint each of their
counties with the services available and to schedule regular visits to the
county when requested. It is felt that regularly scheduled consultation
will mean more efficient, continuous service to the health department
and, consequently, better coverage for the community. It will also mean
that with careful planning more counties can be reached with a reduction
in time spent in travel.
During the year 61 counties have been visited. Services have varied
with the individual needs and programs of the county ranging from direct
service to clinic patients to inservice education for staff members.
In maternal and child health a number of home visits were made and
individual patient referrals seen; 20 group conferences and 107 individual
ones held; 11 classes were taught with a total attendance of 410.
Increasing attention is being given to the area of mental retardation.
This is a field in which much new information is available and assistance
has been given directly to parents as well as consultation to professional
personnel.
In school health 41 group conferences and 66 individual conferences
were held; 50 classes and 30 talks given with a total attendance of 4262.
These include services to both teachers and school lunch personnel.
In the chronic disease field home visits were made and individual pa-
tient conferences held with those having special problems. Classes were
held for diabetics, heart patients and for weight control patients with a total
attendance of 1737. This is an area where more requests are received and
more attention is being demanded. Prevention and postponement of the
onset of the chronic diseases and control and treatment after their develop-
ment are both important; these topics are major interest ones in public
health today and are requested in inservice education often.
Emphasis was placed on inservice education-fitting nutrition in as a
part of total health. These meetings were held mainly for nurses and other
health department staff members but in some instances professional person-
nel such as caseworkers from departments of welfare, hospital personnel,
etc., were included. Eighty-two group conferences were held and 102 indi-
vidual ones; 26 classes were taught, reaching 188 persons; 40 additional ses-
sions were attended by nutritionists, serving as consultants for inservice
meetings.
There were many requests for assistance with community programs,
many of them concerned with weight control and many with food fads and

34 ANNUAL REPORT, 1959

fallacies. As always, requests for talks were filled for PTA, civic clubs and
other organizations, mainly on normal nutrition and child feeding.
A series of television programs on low sodium diet was presented and
Nutrition Services was responsible for 4 of the regular weekly television pro-
grams of the State Board of Health. In addition, several of the con-
sultants participated in radio programs during the year.
Dietary consultation to institutions is demanding more and more time.
As the number of small hospitals, nursing homes and child caring facilities
increases, so the requests for assistance with food service problems grow, for
very few of these establishments have trained dietitians or, indeed, anyone
trained in food service work available to them. It is impossible for the nu-
tritionist serving 18 counties to spent sufficient time with dietary consulta-
tion to individual institutions. It is increasingly evident that this problem
must be met through full time dietary consultation if we are to provide
anything approaching adequate service in this area. One hundred and
thirteen visits were made to such institutions and varied in length from
one-half day to one week. During the year work has been done on a
Manual for Child Caring Institutions and Nursery Schools and this will
be available early in the next year.
In the area of training, field experience was offered for 1 graduate
student from the University of North Carolina and 1 undergraduate stu-
dent from the College of St. Elizabeth in New Jersey. In addition, several
visits have been made, classes taught and consultation given in an effort to
assist schools of nursing with nutrition in the public health training pro-
gram. Efforts have been made also toward starting a long-range program
for the recruitment and training of public health nutritionists.
Cooperation with other state agencies continued throughout the year.
The entire staff participated in both state and county school lunch work-
shops given in various parts of the state. Cooperation has also been given
to the Florida Committee on Rural Health in its statewide efforts to com-
bat food fads and fallacies. This is a long term project which will be con-
tinued.
"Nutrition In A Nutshell", a bi-monthly publication mainly for health
department personnel, gives an opportunity to disseminate information on
some of the newer findings in the field. Each staff member contributes
information to be included in it.
The Migrant Project has offered many opportunities for the nutrition-
ist assigned to it to investigate and explore methods to improve the
nutritional status as well as exploring the present status of the migrant work-
ers. A special study on the dietary patterns and food habits was under-
taken and completed and should be ready for publication soon.
It is hoped that efforts at closer planning and coordination with other
divisions and bureaus which have been made during the year will continue
and will result in more efficient service and better consultation to the
counties.

TABLE 6

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

00
s1 d I .4*
.2 $ S 0 d -
I M I' 5, ? : i
d c R A ASB

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service............
2. Field and Office Visits............
3. Hookworm Treatment Given.........
TYPE OF IMMUNIZATION
4. Smallpox......................
5. Diphtheria.....................
6. Whooping Cough................
7. Tetanus......................
8. Poliomyelitis. ...................
9. Typhoid .................. .....
10. Rabies-Human ...................
11. Rabies-Animals ..................
B. VENEREAL DISEASE CONTROL
1. Admissions to Service...............
2. Not Infected.......................
3. Treated in Clinic ...................
4. Treated by Priv. Physician..........
5. Ret. to Treatment in this Clinic......
6. Epidemiological Treatment of Contacts
7. Dropped or Transferred.............
8. Patients Interviewed ...............
9. Contacts Obtained .................
10-11. Field & Office Visits ............
C. TUBERCULOSIS CONTROL
1. Admission to Service-Case Active...
2. Adm. to Service-Case Inactive .....
3. Adm. to Service-Contacts & Susoects

69 286
8 519
68 132

33 761
242 1,035
42 209

32 2 21 11 24
128 6 79 20 71
249 13 150 129 123

64 0 155
83 0 601
21 1,220 12

156 29
221 41
156 97

12,526
9,709
2,797
4 <
90
9C
341
0
1,187
1,816
22,187 W

92
233
420 0(
Ul

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

A. COMMUNICABLE DISEASE r
CONTROL
1. Admissions to Service ............... 71 15 9 5 37 3 40 0 161 4 61 9 1,300 17 5 235 71
2. Field and Office Visits............... 152 15 14 10 39 3 5 0 186 6 73 9 1,684 29 5 239 129
3. Hookworm Treatment Given......... 161 5 162 93 171 11 524 1,566 141 34 94 19 353 336 35 209 72
TYPE OF IMMUNIZATION
4. Smallpox. ......................... 5,968 130 293 1,629 38 436 380 63 232 1,609 238 226 5,935 415 339 991 922
5. Diphtheria... ..................... 6,426 377 219 2,704 122 101 842 767 413 407 382 579 11,858 877 707 2,399 877
6. Whooping Cough................... 4,376 157 221 840 62 50 801 767 270 209 270 345 6,555 449 379 1,187 357
7. Tetanus.......................... 9,714 459 660 4,364 225 119 1,237 1,800 573 429 865 96 15,674 1,204 987 3,823 1646
8. Poliomyelitis ...................... 5,923 1,079 1,101 5,134 472 240 1,563 498 1,084 818 549 755 17,492 1,148 993 4,37 1031
9. Typhoid ........................... 6,007 15 517 2,312 72 4 1,166 194 50 35 13 42 1,896 331 497 2,074 143
10. abies-Humans ................... 0 0 1 0 0 0 0 0 0 5 0 37 0 0 0
11. Rabies-Animals. ................... 0 0 0 77 156 439 0 96 0 0 30,145 0 0 0 370
B. VENEREAL DISEASE CONTROL
1. Admissions to Service............... 2,413 14 15 125 2 37 11 17 2 31 5 63 3,014 5 36 48 37
2.NotInfected...................... 805 0 5 38 0 12 5 0 1 20 1 8 932 0 0 0 2
3. Treated in Clinic.................. 1,578 10 8 31 2 12 5 15 1 10 4 32 1,456 2 31 46 18
4. Treated by Priv. Physician .......... 1 0 2 15 0 1 1 0 0 0 0 1 32 0 1 6 2
5. Ret. to Treatment in this Clinic.. 18 1 0 0 0 0 0 4 0 0 0 25 9 1 0 4 1
6. Epidemiological Treatment of Contacts 9 0 0 35 0 2 0 0 1 3 0 4 388 0 7 1 9
7. Dropped or Transferred ............. 2 0 0 6 0 0 0 0 0 0 0 0 73 0 0 1 1
8. Patients Interviewed.. ......... 740 5 13 21 1 13 2 8 0 10 0 40 725 6 29 39 25
9. Contacts Obtained .................. 968 0 4 44 1 13 2 4 0 13 0 25 1,359 0 19 28 14
10-11. Field and Office Visits............ 4,048 43 44 466 2 52 27 21 3 79 10 95 14,464 20 86 100 51
C. TUBERCULOSIS CONTROL
1. Admission to Service-Case Active. .. 174 0 5 15 0 1 0 4 9 8 1 4 319 5 7 9 0
2. Adm. To Service-Case Inactive..... 225 10 12 35 0 3 21 17 18 8 4 46 742 13 41 65 12
3. Adm. to Service-Contacts & Suspects 1,286 1 53 216 13 6 107 9 20 24 17 95 4,215 45 46 64 17

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

A d o I
0

A. COMMUNICABLE DISEASE --
CONTROL t94
1. Admissions to Service .............. 3 74 32 575 110 83 26 13 95 9 106 98 107 5 562 7 77
2. Field and Office Visits.............. 3 136 48 633 118 92 26 26 99 10 128 129 143 11 2,326 27 228
3. Hookworm Treatment Given......... 62 55 103 136 116 245 190 16 332 18 0 50 287 5 387 202 24
TYPE OF IMMUNIZATION
4. Smallpox.......................... 133 87 1,526 2,059 236 191 1,132 387 1,067 769 884 1,152 1,130 244 2,624 292 11,588
5. Diphtheria........................ 136 595 1,693 1,347 648 343 885 663 1,262 846 955 1,737 2,678 306 4,988 903 10,818
6. Whooping Cough. .................. 91 370 789 1,342 246 206 405 387 838 383 424 737 1,849 130 3,073 636 3,145 -
7. Tetanus......................... 270 625 3,035 3,132 858 553 1,830 803 2,231 1,104 1,606 2,485 3,380 813 6,889 911 13,985 _
8. Poliomyelitis...................... 357 1,246 3,091 2,556 686 1,020 2,075 1,301 4,738 1,740 459 3,009 3,566 478 5,493 1,035 13,611
9. Typhoid ......................... 165 22 815 2,069 475 336 552 85 2,263 942 918 4,030 2,261 161 3,402 444 1,035
10. Rabies-Human.................... 0 0 2 0 0 0 4 0 0 0 1 0 0 0 0 0
11. Rabies-Animals.................... 0 0 0 0 0 0 293 8,100 0 0 0 0 0 0 0 0 0
B. VENEREAL DISEASE CONTROL
1. Admissions to Service............... 11 19 107 892 22 1 18 313 632 52 103 18 78 25 411 32 848
2. NotInfected ....................... 13 4 9 121 1 0 8 78 152 6 8 2 1 2 47 0 190
3. Treated in Clinic. ................. 3 2 73 570 7 1 8 140 362 25 50 7 67 12 190 23 474
4. Treated by Priv. Physician.......... 0 6 0 34 0 0 0 10 5 6 4 5 3 1 13 0 1
5. Ret. to Treatment in this Clinic...... 0 1 4 63 1 0 0 69 8 1 7 1 8 0 27 0 64
6. Epidemiological Treatment of Contacts 0 0 22 104 7 0 3 35 75 9 39 3 9 10 20 10 98
7. Dropped or Transferred............. 0 2 0 0 0 0 0 5 7 3 1 0 3 0 0 0 9
8. Patients Interviewed................ 2 2 73 404 7 0 18 97 285 33 34 6 65 12 120 27 183
9. Contacts Obtained .................. 2 1 48 749 8 0 5 103 284 30 28 1 51 13 301 31 263
10-11. Field & Office Visits............... 47 42 160 2,888 38 2 61 638 1,909 85 326 91 109 43 1,634 84 1,950 V
C. TUBERCULOSIS CONTROL
1. Admission to Service-Case Active... 3 52 26 91 7 1 4 27 23 22 19 6 26 4 50 15 147
2. Adm. to Service-Case Inactive...... 0 96 79 80 8 8 24 77 99 25 42 34 30 13 115 31 330
3. Adm. to Service-Contacts & Suspects 6 365 236 316 74 10 98 85 82 53 187 68 141 64 522 69 304 (A
-

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

A. COMMUNICABLE DISEASE
CONTROL
1. Admissions to Service...............
2. Field and Office Visits ..................
3. Hookworm Treatment Given.........
TYPE OF IMMUNIZATION
4. Smallpox...................... .
5. Diphtheria......................
6. Whooping Cough...................
7. Tetanus. .................. .......
8. Poliomyelitis ...................
9. Typhoid..........................
10. Rabies-Human...................
11. Rabies-Animals...................
B. VENEREAL DISEASE CONTROL
1. Admissions to Service...............
2. Not Infected......................
3. Treated in Clinic ..................
4. Treated by Priv. Physician..........
5. Ret. to Treatment in this clinic......
6. Epidemiological Treatment of Contacts
7. Dropped or Transferred.............
8. Patients Interviewed................
9. Contacts Obtained .................
10-11. Field & Office Visits .............
C. TUBERCULOSIS CONTROL
1. Admission to Service-Case Active...
2. Adm. to Service-Case Inactive......
3. Adm. to Service-Contacts & SusDects

*1 1- -1- I I I-- I -

221 161 432
407 372 732
62 63 589

20 122 89 14
28 375 254 41
99 599 518 54

267 0
269 0
95 133

20 35 9 15
65 2 12 14
106 17 10 101

7 234
7 543
134 387

57 0 5
220 6 39
276 22 139

z

ar

J_

7,469
12,793
11,372

84,499
120,782
75,478
173,170
215,194
58,695
82
37,583

33,313
17,722
11,832
294
898
2,050
233
6,827
9,421
97,781

2,150
6,406
17.367

II

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

l a -
d a

to to R 1 P

Tuberculosis Control Cont'd.
4. No. of Persons X-rayed-
Miniature Films................... 6,713 0 0 0 0 25,728 0 0 1,458 0 2,098 2,278 23,526 3,842 0 98
5. No. of Persons X-rayed-Large Films. 638 50 686 269 3,636 1,848 117 359 53 147 168 91 7,863 333 21 2,248
6. Tuberculin Test................... 449 20 154 155 124 1,253 83 20 26 71 153 32 1,849 9 14 350
7. Field Visits........................ 755 36 73 429 561 3,264 29 145 17 234 398 103 5,239 74 36 1,330
8. Office Visits....................... 240 20 276 163 462 1,155 134 98 102 115 345 39 28,168 77 52 2,210
9. Cases Hospitalized .................. 22 3 13 8 19 99 0 2 1 2 10 6 707 2 3 25
D. MATERNITY SERVICE
1-2. Patients Admitted to
Maternity Medical Service........... 129 12 88 78 254 466 0 0 2 88 91 0 3,033 0 41 48
3. Visits by Antepartum Cases
to Medical Conferences ............. 296 20 201 193 291 742 0 0 2 251 345 0 9,993 0 66 124
4. Patients given Postpartum
Medical Examinations .............. 79 12 9 1 47 147 0 0 0 4 14 0 953 0 4 8
5. Patients Admitted to
Maternity Nursing Service........... 991 89 143 128 228 594 30 2 24 126 131 167 3,475 0 52 237 CQ
6. Field Nursing Visits ................ 1,252 95 154 456 847 537 14 5 44 445 186 339 9,618 0 93 290
7. Office Nursing Visits................ 1,322 27 230 88 648 2,005 59 2 304 604 392 9,195 0 204 216
8. Number of Midwife Meetings........ 2 2 0 1 9 34 3 0 0 1 0 11 10 0 0 0
9. Visits for Midwife Supervision....... 55 9 11 40 54 147 4 0 0 18 29 55 94 0 35 0
10. No. of Midwife Deliveries
Supervised by Health Dept. Personnel. 8 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0
11. No. of Individuals Enrolled in
Classes for Expectant Mothers....... 204 0 0 0 0 0 0 0 0 0 0 0 646 0 0 0
E. CHILD HEALTH SERVICES
1-2a. Adm. to Well Child C
Medical Service-Infants ............ 241 2 65 62 142 498 3 1 1 44 31 82 4,395 0 10 282
1-2-b. Adm. to Well Child
Medical Service-1-4 ................ 64 7 18 114 242 34 2 12 21 52 43 128 5,987 0 5 152
1-2-c. Adm. to Well Child
Medical Service-5 over............. 17 2 6 80 111 14 0 16 12 189 34 121 3,153 0 2 111 W
3. Visits to Well Child Medical 0
Conference: Infants ................ 279 2 162 120 144 816 3 1 5 63 62 82 9,849 0 10 727
1-4. ................... 80 8 25 204 242 37 2 13 21 66 109 128 12,648 0 5 275
5-over .................. 29 2 8 132 113 14 0 16 12 197 58 121 5,396 0 2 127

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

14

-P Z 1 r 5

Tuberculosis Control Cont'd. =
4. No. of Persons X-rayed-
Miniature Films................... 8,304 811 1,279 0 385 817 1,888 1,172 1,555 1,579 1,620 4,801 59,882 0 0 1 0
5. No. of Persons X-rayed-Large Film.. 1,594 158 137 204 17 107 502 36 411 414 49 488 1,295 63 182 261 42
6. Tuberculin Test.................... 614 30 32 290 6 11 34 19 16 65 14 187 7,075 163 169 33 36 r
7. Field Visits....................... 3,916 22 36 1,009 23 28 94 51 33 111 64 97 4,185 47 191 290 35
8. Office Visits........................ 395 42 112 118 6 3 144 66 61 42 54 208 5,787 110 51 302 40 M
9. Cases Hospitalized.................. 66 0 7 15 1 2 6 2 4 8 3 3 106 0 6 6 1 O
D. MATERNITY SERVICE
1-2. Patients Admitted to
Maternity Medical Service........... 461 61 7 363 2 20 18 10 28 63 16 12 2,076 5 0 137 47 I-
3. Visits by Antepartum Cases
to Medical Conferences ............ 953 156 9 866 3 41 24 10 54 127 23 20 7,740 5 0 173 98
4. Patients given Postpartum
Medical Examinations.............. 130 31 0 135 0 0 8 0 7 0 1 0 845 0 0 52 8
5. Patients Admitted to Maternity 10
Nursing Service.................... 894 71 13 800 45 34 24 139 91 49 24 14 2,667 23 87 380 90
6. Field Nursing Visits ................ 1,818 103 6 1,212 108 36 20 344 25 66 27 37 4,458 21 209 855 143
7. Office Nursing Visits................ 1,232 235 22 1,331 8 31 28 319 94 17 30 7 9,708 50 125 837 160 -0
8. Number of Midwife Meetings........ 1 2 0 9 0 0 1 3 0 0 0 0 0 0 0 6 0
9. Visits for Midwife Supervision...... 22 1 4 158 0 0 7 4 4 0 8 0 0 10 4 144 3
10. No. of Midwife Deliveries
Supervised by Health Dept. Personnel. 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0
11. No. of Individuals Enrolled in
Classes for Expectant Mothers....... 103 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0
E. CHILD HEALTH SERVICES
1-2-a. Adm. to Well Child
Medical Service-Infants ........... 325 25 0 194 0 1 1 0 10 9 1 4 2,962 6 0 16 31
1-2-b. Adm. to Well Child
Medical Service-1-4 ................ 66 9 0 125 0 0 2 0 4 10 0 0 4,830 8 0 4 4
1-2-c. Adm. to Well Child
Medical Service-5 over............. 9 0 0 16 0 0 0 0 1 1 0 1 4,688 1 0 6 6
3. Visits to Well Child Medical
Conference: Infants................. 496 37 0 217 0 1 1 0 10 9 1 4 5,833 6 0 16 35
1-4................... 173 15 0 147 0 0 2 0 4 10 0 0 8,741 9 0 6 4
5-over ................. 31 0 0 22 0 0 0 0 1 1 0 1 6,657 1 0 7 7

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

4. No. of Persons X-rayed-
__ _a r N o 0 0 0 pAMO

Tuberculosis Control Cont'd. 0
4. No. of Persons X-rayed-
Miniature Films... ................. 8,963 71 19,007 1,653 0 0 0 8,144 2,753 0 0 0 920 23,958 0 10,662
6. No. of Persons X-rayed-Large Films. 11 552 1,455 669 99 13 91 489 896 212 1,311 186 1,914 99 818 120 1,968 -4
6. Tuberculin Test................. ... 140 647 185 27 2 76 552 1,540 468 240 18 1,591 309 449 77 7,019
7. Field Visits........................ 18 1,187 236 731 230 20 66 266 470 156 576 466 445 133 1,901 182 1,735
8. Office Visits........................ 14 245 561 332 79 11 184 166 42 43 310 223 190 81 954 185 807
9. Cases Hospitalized................. 1 38 21 45 2 1 5 26 20 10 9 5 17 6 77 7 130
D. MATERNITY SERVICE
1-2. Patients Admitted to
Maternity Medical Service........... 4 93 177 180 73 6 55 94 0 0 58 7 16 0 893 72 346 -1
3. Visits by Antepartum Cases
to Medical Conferences. ............. 4 204 240 570 158 11 149 283 0 0 142 12 16 0 2,116 207 1,105
4. Patients given Postpartum
Medical Examinations........... .. 0 29 74 45 7 14 44 0 0 20 0 0 0 231 22 95
5. Patients Admitted to Maternity
Nursing Service.................... 20 259 419 345 99 15 164 124 80 3 146 74 91 0 767 114 752 r
6. Field Nursing Visits................. 24 370 500 1,103 48 10 365 166 263 1 290 154 97 0 886 196 1,469
7. Office Nursing Visits................ 35 258 863 8 170 22 220 368 4 2 250 34 137 0 2,140 331 398
8. Number of Midwife Meetings......... 0 0 13 14 0 0 4 2 7 0 6 11 1 0 18 0 19
9. Visits for Midwife Supervision....... 9 26 3 59 6 0 17 29 0 4 49 15 0 2 13 9
10. No. of Midwife Deliveries
Supervised by Health Dept. Personnel. 0 0 1 0 0 0 0 0 0 0 0 0 2 0 0
11. No. of Individuals Enrolled in -
Classes for Expectant Mothers ....... 0 0 0 0 19 0 0 8 0 0 0 0 3 0 52 0 0
E. CHILD HEALTH SERVICES
1-2-a.Adm. to Well Child
Medical Service-Infants ........... 1 33 75 128 4 9 7 114 0 0 23 8 1 0 52 48 239
1-2-b. Adm. to Well Child
Medical Service-1-4............... 0 2 4 149 0 6 4 235 0 0 31 16 5 0 53 22 55
1-2-c. Adm. to Well Child
Medical Service-5 over............. 0 1 55 22 0 12 13 223 0 0 4 47 1 0 24 0 83
3. Visits to Well Child Medical
Conference: Infants.................. 1 34 75 139 4 10 11 188 0 0 24 9 1 0 248 54 483
1-4.................... 0 3 4 236 0 8 4 296 0 0 38 16 0 94 34 117
5-over................... 0 1 55 23 0 12 14 249 0 00 4 471 1 0 59 0 130

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

.0 0U 0 M 0
0M C3

Tuberculosis Control Cont'd.
4. No. of Persons X-rayed--
Miniature Films ................... 3,189 27,432 23,857 4,412 0 13 3,292 0 2,761 1 0 0 20,682 685 0 0 312,290
5. No. of Persons X-rayed-Large Films. 361 4,532 1,795 1,440 224 74 528 442 150 99 73 34 6,990 30 171 47 51,880
6. Tuberculin Test............. .. 3,019 358 2,802 146 30 291 82 76 476 73 128 0 2,001 42 94 121 36,635
7. Field Visits ....................... 151 1,68 2,193 224 438 371 673 472 158 68 86 15 1,440 86 128 63 40,024
8. Office Visits ........................ 304 6,640 1,799 79 461 103 116 434 213 167 143 52 622 21 362 207 57,347
9. Cases Hospitalized .................. 17 87 63 11 21 9 15 18 5 8 3 0 25 0 4 7 1,871 W
D. MATERNITY SERVICE
1-2. Patients Admitted to -=
Maternity Medical Service......... .. 16 597 1,004 162 226 2 99 130 15 11 40 40 202 41 7 25 12,347
3. Visits by Antepartum Cases
to Medical Conferences ............. 24 2,761 2,845 451 787 3 379 231 18 13 56 111 939 114 8 25 36,808
4. Patients given Postpartum
Medical Examinations .............. 1 322 151 63 0 0 69 46 2 0 4 2 102 12 2 11 3,870 0
5. Patients Admitted to Maternity U1
Nursing Service................. 45 786 1,562 240 272 5 112 394 133 27 49 63 377 65 45 105 19,614
6. Field Nursing Visits ............. 35 1,171 2,763 350 382 5 419 660 117 19 52 46 764 155 78 182 37,003 '0
7. Office Nursing Visits ............... 118 3,614 4,637 540 1,044 6 471 347 109 58 113 111 397 56 125 153 46,671
8. Number of Midwife Meetings....... 5 7 14 10 0 0 0 13 2 1 2 0 0 2 1 1 248
9. Visits for Midwife Supervision....... 0 22 63 15 4 0 0 83 31 2 9 0 52 20 12 10 1,490
10. No. of Midwife Deliveries Super-
vised by health dept. personnel....... 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 17
11. No. of Individuals Enrolled in
Classes for Expectant Mothers...... 0 458 0 0 0 0 56 0 0 0 0 0 0 0 0 0 1,569
E. CHILD HEALTH SERVICES
1-2-a. Adm. to Well Child
Medical Service-Infants............ 4 717 714 58 94 0 32 37 25 1 10 59 244 18 5 6 12,214
1-2-b. Adm. to Well Child
Medical Service---4 ............... 25 723 107 25 0 3 28 0 15 0 3 29 383 2 3 3 13,874
1-2-c. Adm. to Well Child
Medical Service-5-over................ 0 500 92 25 0 2 40 1 2 0 9 42 275 7 177 0 10,254
3. Visits to Well Child Medical
Conference: Infants ................ 4 1,389 1,138 63 163 0 44 37 25 1 11 68 616 18 7 6 23,812
1-4 ................... 25 1,193 150 27 0 3 44 0 15 0 5 82 834 2 3 3 26,215
5-over ................. .0 715 99 32 0 2 56 1 2 0 9 96 504 8 181 015,255

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

Child Health Services Cont'd.

Infants ............... 820 143 112 238 365 910 25 29 21 172 88 223 4,000 2 73 655
1-4.................. 821 271 179 607 605 245 35 27 54 476 152 506 4,892 7 125 475
5-over ................ 1,040 182 382 343 485 4,841 76 473 42 1,127 237 202 8,140 447 157 764
7. Field Nursing Visits-Infants........ 1,463 307 353 790 901 1,403 39 17 55 537 103 227 9,933 1 88 761
1-4............ 1,483 617 413 1,875 1,583 732 66 51 211 1,037 195 455 10,378 1 100 600
5-over.........1,396 466 646 743 1,170 1,154 93 298 101 809 271 201 8,214 338 231 842
8. Office Nursing Visits-Infants ........ 817 55 387 60 222 1,529 26 59 3 82 153 132 5,925 3 39 994
1-4........... 711 160 68 112 394 328 29 68 5 108 353 190 7,937 13 30 481
5-over ........ 1,008 283 269 149 372 12,357 74 567 3 1,381 230 117 57,504 187 47 561
9. Nurse-Teacher Conference........... 2,233 128 1,566 419 487 2,952 102 261 78 620 632 0 21,652 286 267 4,116
F. SCHOOL HEALTH
1. Pupils Examined by Physician
with parent present................. 104 43 35 262 39 1,784 9 95 149 213 8 59 4,823 5 95 79
(b) Referred for Further Diagnosis.... 22 28 0 57 0 535 0 0 14 32 5 17 0 3 0 0
(c) Completed Referrals ............. 14 0 0 46 0 7 0 0 2 3 6 10 0 2 0 3
2. Pupils examined by physician
with parent not present ............. 12 67 453 83 6 6,865 79 0 576 21 7 69 15,672 6 245 43
(b) Referred for Further Diagnosis.... 10 5 30 27 0 2,357 0 0 39 1 5 12 0 1 2 0 .
(c) Completed Referrals............. 11 0 0 25 0 394 0 0 0 0 3 9 0 1 0 43
3. Screening by other health department
personnel-Visual.................. 777 74 8,595 138 4 1,747 111 1,505 210 1,550 1,957 0 40,540 0 130 20,499
(b) Referred for Further Diagnosis.... 268 12 661 43 0 777 88 75 36 183 506 0 4,754 0 43 1,861
(c) Completed Referrals ............. 276 8 117 26 3 539 25 23 11 97 141 0 1,231 0 10 363
4. Screening by other health department
personnel-Audiometer testing....... 1,292 567 837 0 0 226 133 1,708 1 1 273 0 35,207 87 3 94
(b) Referred for Further Diagnosis.... 181 1 85 0 0 51 1 19 1 1 33 0 1,091 2 2 12
(c) Completed Referrals............. 107 0 0 0 0 3 0 5 0 0 25 0 439 2 1 1
G. DENTAL HEALTH
1. Number of Dental Inspections....... 5,419 425 0 0 13,597 0 382 254 97 0 0 0 184 68 445
2. Number Requiring Treatment........ 1,711 380 0 0 1 2,103 0 232 99 29 0 0 0 131 124 427

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

I I ~ .~ .4 5'

Child Health Services Cont'd.
6. Admissions to Nursing Service
Infants ............... 876 87 30 892 58 25 184 297 209
1-4 ................. 39 179 36 1,699 133 4 47 41 81 20 68 13 7,150 29 78 459 318 Id
5-over ............... 1,590 120 54 770 6 14 109 22 279 63 80 106 11,279 134 267 301 248
7. Field Nursing Visits-Infants........ 2,363 122 43 1,539 10 52 8 216 29 127 84 89 3,408 27 25 789 374 0
1-4 ............ 884 146 57 3,181 343 11 43 266 36 37 108 26 3,243 23 227 1,303 452
5-over.........1,490 63 51 1,004 42 22 127 141 151 53 105 184 6,044 104 457 668 113
8. Office Nursing Visits-Infants ....... 1,314 104 12 315 10 0 10 161 13 7 15 2 8,288 20 114 113 251
1-4........... 370 201 8 299 25 0 72 18 14 0 15 4 13,372 40 47 59 270
5-over......... 3,842 116 26 454 1 7 296 29 357 38 8 0 14,894 222 281 178 222
9. Nurse-Teacher Conference........... 2,638 27 39 1,115 8 54 313 292 168 207 74 82 8,790 0 132 613 515 133
F. SCHOOL HEALTH 10
1. Pupils Examined by Physician
with parent present ................ 102 95 11 363 40 40 70 317 20 164 201 689 2,063 226 180 12 163 U1
(b) Referred for Further Diagnosis.... 16 7 3 35 1 0 5 6 8 9 9 125 296 0 1 2 9 0
(c) Completed Referrals ............ 1 0 0 17 0 0 5 5 6 11 0 38 135 0 0 1 2
2. Pupils Examined by Physician
with parent not present ............ 20 13 12 30 155 1 67 289 228 868 691 170 3,584 275 94 23 10
(b) Referred for Further Diagnosis .... 2 3 0 72 1 0 0 7 4 11 44 17 767 0 0 0 1
(c) CompletedReferrals............. 0 0 0 1 0 0 5 1 2 45 0 29 0 0 0 0
8. Screening by other health department
personnel-Visual................ 16,018 744 73 2,364 390 2 440 4 517 123 163 63 57,156 131 396 1,762 395
(b) Referred for further Diagnosis.... 2,578 60 19 213 11 0 57 4 56 7 6 18 3,462 6 60 228 16
(e) Completed Referrals ............ 389 0 0 84 5 0 57 0 35 0 11 2,171 7 68 47 8
4. Screening by other health department
personnel-Audiometer testing....... 2,414 48 4 783 0 9 122 0 372 5 0 9 27,394 3 156 247 0
(b) Referred for Further Diagnosis.... 128 0 0 25 0 0 7 0 4 0 0 4 2,141 0 87 9 0
(c) Completed Referrals ............ 10 0 0 22 0 0 7 0 0 0 0 0 954 0 16 1 0
G. DENTAL HEALTH
1. Number of dental inspections......... 1,235 0 0 0 0 0 0 0 0 0 12428,13 189 0 0 253
2. Number requiring treatment ......... 1,058 0 3 0 0 0 0 0 0 0 90 15,205 162 0 0 218

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

o S
F1 a 0

Child Health Services Cont'd. '
6. Admissions to Nursing Service t[-
Infants ............... 64 276 319 491 32 41 175 173 107 38 193 67 77 1 1,069 154 651
1-4.................. 107 470 445 633 82 54 137 304 129 167 429 82 112 1 1,152 317 263 4
5-over................ 98 638 612 694 105 61 376 1,163 787 92 773 360 557 100 1,383 323 2,444
7. Field Nursing Visits-Infants........ 144 407 405 1,567 29 28 395 214 253 53 370 116 115 0 1,433 167 2,120
1-4............ 264 548 518 1,847 82 62 189 207 329 213 843 210 186 1 1,697 480 869
5-over........ 245 816 418 2,262 109 67 268 395 1,104 170 715 382 733 51 2,193 98 3,686 i
8. Office Nursing Visits-Infants ....... 46 111 135 24 9 27 63 118 3 3 207 56 61 2 2,891 262 172
1-4........... 57 247 128 14 10 24 21 256 7 59 590 178 125 4 5,196 452 184 1-
5-over......... 80 247 386 47 31 28 465 1,286 224 54 1,283 863 390 84 12,026 431 7,730
9. Nurse-Teacher Conference............ 31 506 208 459 50 81 295 1,119 1,113 235 666 419 626 52 1,597 292 4,949
F. SCHOOL HEALTH
1. Pupils Examined by Physician
with parent present ................ 35 731 1 469 255 47 7 212 0 79 191 47 425 57 106 110 198 C)
(b) Referred for Further Diagnosis.... 0 0 0 18 11 4 3 13 0 8 15 0 40 2 2 1 28
(c) Completed Referrals. ............ 0 24 3 1 1 1 0 3 0 0 3 0 1 0 0 0 33
2. Pupils Examined by Physician
with parent not present ............ 94 166 103 41 308 26 10 94 5,758 51 339 65 620 2 16 5 39
(b) Referred for Further Diagnosis.... 3 4 5 2 10 4 1 17 1 7 63 1 13 0 0 0 31
(c) Completed Referrals............. 0 0 1 1 5 0 0 3 3 0 13 0 0 0 1
3. Screening by other health department
personnel-Visual................. 5 2,206 904 4,872 1,363 187 223 1,413 2,780 847 5,222 32 1,047 64 10,320 102 22,223
(b) Referred for Further Diagnosis.... 4 435 125 734 100 7 40 217 430 54 423 5 104 32 752 30 1,344
(c) Completed Referrals............. 3 107 14 248 50 3 5 18 126 2 127 6 36 9 747 18 260
4. Screening by other health department m
personnel-Audiometer testing....... 202 33 2,766 1,297 4 0 0 395 210 2,827 100 3 16 1,057 64 4,592
(b) Referred for Further Diagnosis.... O 33 0 171 36 0 0 0 9 2 28 0 0 7 40 15 285
(c) Completed Referrals ............. 4 0 68 23 0 0 1 1 0 15 0 0 0 3 4 163
G. DENTAL HEALTH 4h
1. Number of dental inspections......... 3,760 0 0 0 0 11 0 0 0 0 0 29,502 0 2,642 U1
2. Number requiring treatment......... 02,796 0 0 0 0 0 5 0 0 0 0 0 0 13,393 0 1,495

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

0 00
O M a 5 '

Child Health Services Cont'd.
6. Admissions to Nursing Service LT
Infants............... 47 1,043 2,214 192 254 20 115 328 130 87 71 94 354 64 58 98 23,882
1-4.................. 106 1,525 2,251 166 367 71 105 455 136 277 105 139 310 129 133 196 31,376
5-over................ 237 6,782 4,533 225 23 1,805 387 703 56 344 133 165 2,036 175 1,339 20 63,909
7. Field Nursing Visits-Infants ....... 18 1,766 3,897 285 514 63 411 583 134 59 68 71 665 141 98 132 43,254
1-4............ 62 2,181 4,742 279 831 167 402 724 145 228 142 289 497 180 140 285 50,022
5-over ......... 140 6,433 3,629 328 25 548 962 1,182 49 207 114 219 2,128 122 248 27 57,815
8. Office Nursing Visits-Infants ........ 49 2,071 4,206 131 203 35 33 188 90 116 49 84 266 63 127 70 33,206
1-4........... 120 2,459 3,138 213 10 213 24 322 89 201 40 134 288 66 202 98 40,985
5-over....... 433 13,232 6,165 444 0 2,150 355 1,198 90 359 64 180 3,366 130 1,614 16 151,561
9. Nurse-Teacher Conference .......... 474 10,980 5,535 309 1 792 1,329 982 160 191 83 24 575 66 76 38 85,312
F. SCHOOL HEALTH 10
1. Pupils Examined by Physician Ul
with parent present.................. 12 12,096 1,240 150 0 321 27 97 162 31 2 94 206 73 188 115 30,342
(b) Referred for Further Diagnosis.... 1 12,024 229 4 0 183 12 17 37 0 1 6 1 6 10 1 13,972 10
(c) Completed Referrals............. 0 2,127 12 0 0 18 7 0 5 0 0 3 1 4 3 0 2,564
2. Pupils Examined by Physician
with parent not present ............. 1 2,646 185 45 0 224 130 27 36 119 22 97 20 100 420 247 42,719
(b) Referred for Further Diagnosis.... 1 2,950 10 2 0 102 39 3 0 0 0 7 0 4 9 0 6,707
(c) Completed Referrals ............. 0 502 9 0 0 43 12 1 0 0 0 5 0 4 1 0 1,476
3. Screening by other health department
personnel-Visual................... 87 57,021 10,897 798 0 820 7,924 287 563 220 1 132 11,425 807 947 288 304,605
(b) Referred for Further Diagnosis.... 35 3,698 1,230 50 0 186 484 57 66 21 1 24 636 58 236 21 27,697
(c) Completed Referrals ............. 19 2,162 163 31 0 52 166 63 29 10 0 13 158 20 37 8 10,465
4. Screening by other health department
personnel-Audio-meter testing...... 430,305 971 1 0 0 1,186 34 1 90 0 0 9,453 0 167 395 128,168
(b) Referred for Further Diagnosis.... 787 59 1 0 0 77 4 0 3 0 0 152 0 11 8 5,613
(c) Completed Referrals ............. 0 367 5 0 38 33 0 0 0 0 17 0 1 0 2,336
G. DENTAL HEALTH
1. Number of dental inspections ........ 115 33,386 2,507 0 0 0 167 0 378 1,245 0 0 3,188 0 228 0 117,938
2. Number requiring treatment ......... 105 14,200 1,996 0 0 0 132 0 0 893 0 0 2,435 0 188 0 59,606

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

1 I h A i I|

Dental Health Cont'd.
3. Number completing treatment....... 2,145 100 0 0 0 439 0 8 99 0 0 0 239 0 0 49
4. Number Admitted to Clinic
for treatment...................... 1,243 150 0 0 0 714 0 0 99 0 218 0 1,139 0 124 153
5. Total fillings ....................... 3,546 100 0 0 0 2,746 0 0 99 0 400 0 5,164 0 54 486
6. Total extractions................... 293 120 0 0 0 881 0 0 17 0 267 0 1,620 0 38 95
7. Topical applications of fluoride....... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
H. CHRONIC DISEASES >
1. Adm. to Cancer Service ............ 49 5 90 49 35 189 15 15 6 45 56 11 66 10 4 8 1
2. Field Visits-Cancer ................ 57 7 108 234 80 164 20 41 9 105 252 1 701 73 3 53 1
3. Office Visits-Cancer ............... 161 6 240 77 37 624 9 7 6 30 98 11 27 28 2 0
4. Adm. to Orthopedic Service.......... 54 4 144 74 113 88 30 53 25 71 35 0 16 83 27 18
5. Field Visits-Orthopedic Service...... 185 17 450 283 473 204 87 45 41 224 167 0 55 83 51 39
6. Office Visits--Orthopedic Service..... 139 5 43 110 221 44 28 62 29 240 46 0 5 143 6 4
7. Adm. to Diabetes Service............ 16 8 13 19 32 29 8 19 13 29 8 0 12 5 8 4
8. Field Visits-Diabetes .............. 87 15 58 54 160 164 1 17 33 137 49 0 3 4 14 6
9. Office Visits-Diabetes.............. 16 19 63 30 126 88 45 39 14 15 54 0 18 9 54 0
10. Adm. to Cardiovascular Renal Disease 14 31 35 88 61 18 1 2 27 58 5 0 78 4 20 9 104 W
11. Field Visits-Cardiovascular
Renal Disease ................... 28 67 95 271 212 38 0 2 23 219 55 0 1,409 4 8 9 975
12. Office Visits-Cardiovascular -
Renal Disease...................... 20 112 113 134 210 13 11 0 82 18 8 0 15 0 68 1 0
J. MENTAL HEALTH
1. Admission to Service-Children...... 262 16 1 5 45 291 5 18 16 43 178 0 994 23 9 12
2. Adm. to Service-St. Hospital Pts.... 94 1 49 17 38 23 7 9 16 18 5 0 196 2 2 53 C/r
3. Adm. to Service-Other Adults....... 125 2 0 9 59 356 5 0 4 51 62 2 143 1 3 11
4. Field Visits-With Patients.......... 432 13 127 55 114 149 16 27 69 79 81 0 762 4 12 118
5. Field Visits-About Patients......... 376 49 55 71 176 536 35 38 145 92 135 1 1,180 27 14 73
6. Office Visits-With Patients......... 276 2 3 38 67 1,240 3 26 4 35 892 2 4,598 27 1 7
7. Office Visits-About Patients........ 417 14 1 20 104 760 10 62 12 66 475 0 4,900 33 2 16
8. Mental Health Conferences ......... 609 107 0 10 112 2,254 73 22 136 27 249 0 1,072 79 7 55 S

TABLE 6 (Continued) .
co
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

z

Dental Health Cont'd.
3.Numbercompletingtreatment....... 4 0 2 0 0 0 0 0 0 0 0 01,429 2 0 0 3
4. Number Admitted to Clinic
fortreatment...................... 193 0 2 0 0 0 0 0 0 0 02,108 0 0 0 64
5. Total fillings....................... 594 0 11 0 0 0 0 0 0 0 0 0 3,320 0 0 0 129
6.Totalextractions................... 231 0 3 0 0 0 0 0 0 0 0 0 3,232 0 0 0 11
7. Topical applications offluoride....... 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0

H. CHRONIC DISEASES
1. Adm. to Cancer Service............. 375 2 13 42 3 9 21 14 11 13 6 13 453 30 19 30 6
2. Field Visits-Cancer ............... 1,185 39 21 155 17 18 59 19 11 22 18 24 1,104 14 71 76 10
3. Office Visits-Cancer............... 840 6 18 11 0 9 39 32 8 44 13 18 1,311 49 5 19 6
4. Adm. to Orthopedic Service.......... 378 3 37 137 3 3 42 7 11 16 15 26 831 57 47 181 30
5. Field Visits-Orthopedic Service...... 993 9 12 500 16 10 105 4 25 53 23 29 1,180 87 212 331 75 0
6. Office Visits-Orthopedic Service.... 33 1 66 122 0 0 114 4 3 4 7 10 257 119 50 386 13
7. Adm. to Diabetes Service............ 117 6 14 30 4 4 22 16 3 26 2 27 691 56 42 24 11
8. Field Visits-Diabetes............... 858 22 15 108 17 12 18 1 3 12 1 22 1,385 15 200 60 2 0
9. Office Visits-Diabetes.............. 288 16 65 57 3 2 56 32 3 75 2 47 6,906 295 39 163 39
10. Adm. to Cardiovascular Renal Disease 317 13 42 121 10 3 34 41 1 9 4 2 924 21 5 58 18
11. Field Visits-Cardiovascular
Renal Disease..................... 1,784 48 0 551 22 23 65 1 1 22 0 1 2,942 31 24 184 16
12. Office Visits-Cardiovascular
Renal Disease ..................... 1,112 9 149 303 85 1 183 138 0 52 30 1 1,122 26 1 239 8
J. MENTAL HEALTH
1. Admission to Service--Children ..... 372 24 0 54 0 23 20 0 87 56 9 25 861 8 33 16 0
2. Adm.toService-St. Hospital Pts... 126 1 8 16 0 0 3 0 2 5 12 8 258 10 3 20 15
3. Adm. toService-Other Adults....... 101 6 1 75 1 2 8 0 3 12 1 33 353 5 17 14 0
4. Field Visits-With Patients.......... 385 3 8 216 0 7 7 0 2 22 35 84 1,046 5 86 140 8
5. Field Visits-About Patients......... 417 3 9 204 1 25 13 0 52 56 84 108 648 15 100 324 2
6. Office Visits-With Patients ......... 1,823 34 4 169 0 18 18 0 98 47 6 13 2,435 7 66 13 10
7. Office Visits-About Patients........ 1,869 12 5 83 0 21 9 0 170 71 15 39 2,291 25 68 25 3
8. Mental Health Conferences ........... 0 1 0 282 0 9 3 0 45 18 141 42 235 8 29 225 1

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

4. Number admitted to Clinic-
for treatment...................... 0 885 0 0 0 0 0 88 0 0 0 0 0 0 616 0 2,730
5. Total fillings....................... 0 1,735 0 0 0 0 0 92 0 0 0 0 0 0 281 02,37
6.Totalextractions .................. 0 406 0 0 0 0 0 79 0 0 0 0 01,029 01,69
7. Topical applications of fluoride....... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H. CHRONIC DISEASES
1. Adm. to Cancer Service ............ 10 44 46 71 12 15 17 20 0 15 61 24 16 10 118 11 21
2. Field Visits-Cancer................ 43 74 62 20 8 24 36 34 0 21 188 59 31 30 17 6 376
3. OfficeVisits-Cancer................ 1 21 28 200 5 17 20 3 0 9 50 3 31 4 1,135 7 1,060
4.Adm. toOrthopedicService....... 24 83 160 20 27 38 3 111 17 108 1 72 28 102 44 9
Field Visits-O rthopedic Service...... 71 149 82 67 27 4 118 63 345 57 213 88 245 6 232 88

6. OfficeVisits-menOrthopedic Service..... 12 45 227 697 16 11 2 7 12 9 37 8 61 20 52 3 42,730
H. CHRONIC DISEASES

7. Adm. to Diabetes Service ............ 8 23 8 28 8 9 9 61 13 18 40 10 26 10 21 24 23
Field Visits-Diabetes ............... 13 49 62 21 2 22 142 48 2 246 36 68 29 25 2 37 11 4
9. Office Visits-Diabetes ............... 44 11 11 177 43 90 71 0 2 11 106 74 73 23 114 87 1,060
1. Adm. to Orthopediovascular ..........enal Disease 49 18 1 2 36 76 4 6 30 4 51 12 47 2 27 22 395
11. Field Visits-Carthopediovascularvice 149 82 6 2 34 118 6 345 57 213 88 245 56 2 88 525

Renal Disease...................... 160 21 0 4 44 291 6 24 49 8 118 48 63 1 65 22 277
12. Office Visits-Orthopediovascularvice 12 7 12 61 20 43
Renaldm. Disease rvice...................... 101 23 28 8 9 61 164 72 4 10 24 7 147 1 41 83 23

J. MENTAL HEALTH r\
Field VissiontoService-tes...Children........ 24 6 2 2 2 8 10 0 44 77 25 42 14 36 23 699 12 311
Adm.ice Visits-Di t.Hospital Pts........... 3 14 3 2 26 4 9 49 31 11 9 1 13 3 65 1 29 46
10. Adm. to Cardiovasculavice-Other enal Disease...... 3 42 2 36 762 1 62 89 4 80 12 47 26 2 47
4. Field Visits-With Patientscular 21 20 99 12 9 10 12 114 220 26 38 2 44 10 184 12 23
Field Visits-About Patients.................... 9 33 166 6 121 12 7 331 400 346 140 7 36 191 11 39277
12. Office Visits-Cardiovascular

6. Office Visits-With Patients..................... 101 9 8 1,763 9 32 3 91 2 1 42 6 17 784 16 3
J. MENTAL HEALTH
1. Admission to Service-Children ...... 0 24 54 222 8 10 0 44 77 25 42 14 35 23 699 12 31
2. Adm. to Servie-St. Hospital Pts.. 3 14 35 2 26 4 9 49 31 1 19 1 13 3 65 1 292 td
3. Adm. to Service-4Other Adults....... 5 3 42 227 9 22 1 62 89 4 80 3 12 3 26 2 47
4. Field Visits-With Patients.......... 21 20 99 12 59 10 12 114 220 26 385 25 44 10 184 12 238
5. Field Visits-About Patients.......... 9 33 166 61 121' 121 7 331 400 55 346 140 70 36 191 11 399
6. Office Visits-With Patients......... 22 5 85 1,763 9 32 3 91 52 15 61 42 6 17 784 16 35
7. Office Visits-About Patients........ 0 12 396 629 12 20 3 145 259 25 149 126 16 32 2,328 11 387 ,si
8. Mental Health Conferences........... 0 0 155 14 43 13 1 157 201 29 422 326 8 20 126 9 188 0

TABLE 6 (Continued) Lu
o
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

4 P4 I m m mD D II

Dental Health Cont'd. W
3. Number completing treatment....... 61 1,019 81 0 0 0 36 0 0 40 0 0 355 0 7 0 8,538 M
4. Number admitted to clinic for
treatment.......................... 49 1,146 170 0 0 0 0 0 51 183 0 0 424 0 0 0 12,549 10
5. Total fillings. ....................... 78 4,372 646 0 0 0 1 0 64 204 0 0 1,371 0 0 0 27,868 O
6. Total extractions ................... 55 722 439 0 0 0 0 7 38 41 0 0 534 0 0 0 11,848
7. Topicalapplications of fluoride...... 0 0 0 0 0 0 0 0 0 0 2 0 0 0 4
E. CHRONIC DISEASES 1H
1. Adm. to Cancer Service ............. 23 483 334 13 14 45 62 17 28 15 41 10 59 6 8 15 3,640
2. Field Visits-Cancer ................ 4 1,414 294 52 28 50 576 32 39 17 58 36 511 14 8 34 8,968
3. Office Visits-Cancer................ 32 1,341 1,293 8 3 53 27 9 25 13 60 12 10 3 4 27 9,305 .
4. Adm. to Orthopedic Service.......... 44 88 125 35 48 83 94 31 50 87 34 13 118 29 76 33 4,750
5. Field Visits-Orthopedic Service...... 24 709 378 156 140 180 403 172 92 106 80 13 583 113 215 112 12,612 '0
6. Office Visits-Orthopedic Service..... 140 12 87 52 46 216 15 56 55 121 57 11 12 13 140 64 4,746 ,
7. Adm. to Diabetes Service............ 13 172 184 9 5 29 38 5 15 25 14 17 83 7 40 11 2,323
8. Field Visits-Diabetes .............. 13 371 664 14 12 23 142 7 5 2 27 8 1,610 25 59 6 7,427 0E
9. Office Visits-Diabetes ........... 124 794 230 9 0 67 14 1 18 38 63 87 292 37 278 77 11,800
10. Adm. to Cardiovascular Renal Disease 18 374 123 1 0 3 56 73 11 11 79 9 6 55 1 21 8 3,460
11. Field Visits-Cardiovascular
Renal Disease ..................... 4 4,192 226 35 10 40 973 26 6 22 1 7 1,291 6 36 10 17,216
12. Office Visits-Cardiovascular
Renal Disease..................... 35 789 151 9 0 149 2 4 15 360 10 6 0 0 83 13 7,087
J. MENTAL HEALTH
Admission to Service-Children ........ 5 60 274 11 166 85 54 64 6 0 29 0 193 3 10 0 5,786
2. Adm. to Service-St. Hospital Pts.... 17 277 98 19 3 13 59 27 10 2 7 1 89 2 24 2 2,235
3. Adm. to Service-Other Adults....... 4 187 109 7 51 6 171 50 3 4 2 87 4 1 0 2,791
4. Field Visits-With Patients......... 33 380 265 45 51 48 491 172 17 3 12 4 304 1 31 5 7,465
5. Field Visits-About Patients......... 12 476 312 67 42 65 922 806 28 3 24 5 281 6 43 14 10,503
6. Office Visits-With Patients......... 15 167 1,817 11 1,076 12 173 24 15 6 27 0 841 5 15 2 19,206
7. Office Visits-About Patients........ 6 522 1,126 13 713 104 1859 29 3 12 0 2,967 2 34 3 22,900
8. Mental Health Conferences......... ... 184 406 8 362 46 328 136 1 0 0 0 1,132 0 0 0 10,211

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

0 4

0 0 I t 4 I

K. MISCELLANEOUS
1. Adm. Morbidity Service............. 268 36 90 277 47 37 14 9 17 300 117 265 41 26 65 23 4
2. Field and Office Visits-Morbidity .... 45 133 320 700 366 98 31 88 62 812 285 459 399 67 328 40 9
3. General Medical Examinations....... 151 0 24 132 83 1,703 24 0 76 36 21 36 2,071 18 9 0
4. Health Cards Issued ................ 3,051 117 2,304 284 2,909 14,492 76 336 351 256 494 228 17,746 368 197 5,487
5. Visits in the Interest of Vital
Statistics ......................... 34 6 121 59 95 21 3 9 7 20 8 2 56 55 106 0
6. Conferences or Visits in the
Interest of Civil Defense............ 0 0 10 38 18 0 2 0 0 72 1 0 0 1 0 0
7. Visits in the interest of reported
accidents, including poisoning........ 52 0 13 14 1 68 0 0 1 0 1 0 238 0 0 0
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service ................ 3 0 8 1 5 30 1 0 0 2 0 1 95 0 0 29
2. Visits to Nursing Homes ............ 65 0 24 9 19 205 1 0 0 3 0 2 951 0 0 111
P. SANITATION E
1. Approved Water Supplies Installed,
Private & Semi-Public ............. 498 0 0 0 419 671 0 1 1 3 0 0 5 0 1 147
2. Approved Water Supplies Installed,
New Public Water Connections...... 26 0 0 0 56 1 0 0 0 0 0 0 5 0 0 5,881
3. New Specification Privies Installed.... 24 5 0 0 5 0 2 2 0 0 0 0 0 0 0 2
4. Percolation Water Table or
Soil Log Test. ..................... 1,736 4 240 36 3,714 163 3 13 79 251 82 0 1 2 15 2,062
5. Subdivision Analysis................ 142 5 9 5 124 91 0 1 2 4 11 2 295 4 0 19
6. Pollution Survey ................... 11 0 3 1 4 189 0 0 0 0 0 0 9 2 0 0
7. New Specification Septic
Tanks Installed ... ..... 1,268 52 534 102 2,287 6,016 38 364 17 60 211 394 6 120 13 645
8. Rabies-Number of Animal
Bites Investigated................ 273 10 37 21 359 1,328 0 69 5 64 38 23 2,938 23 3 901
9. Field Visits for Rabies Investigation. 912 11 62 30 609 2,836 1 33 5 233 64 37 10,164 45 6 0
10. Complaints Investigated............ 721 13 216 54 987 1,230 11 162 52 46 85 16 7,664 73 38 1,982 UL
11. Nuisances Corrected ................ 207 17 162 29 230 822 3 88 24 29 54 14 4,113 13 19 913 8
12-19. Field Visits..................... 7,847 501 3,707 177 13,177 13,753 251 1,865 326 892 835 1,606 48.885 499 163 7,832

TABLE 6 (Continued)
Ul
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959 to

z

W A I I i | -

K. MISCELLANEOUS
1. Adm. Morbidity Service............. 251 112 28 75 78 31 57 337 26 55 2 85 971 42 28 62 4
2. Field and Office Visits--Morbidity.... 2,016 232 48 791 284 120 156 704 142 237 44 124 5,450 95 153 220 5
3. General Medical Examinations....... 628 48 44 68 40 76 43 12 7 26 57 230 818 38 35 49 25
4. Health Cards Issued................ 9,895 187 350 707 108 59 269 263 502 398 239 823 39,370 156 485 668 154 "
5. Visits in the Interest of Vital....
Statistics .......... 39 19 2 286 5 5 98 6 1 31 2 45 5 5 6 97 59 O
6. Conferences or Visits in the
Interest of Civil Defense............ 3 0 0 0 0 0 4 0 0 0 0 0 2 3 0 2
7. Visits in the interest of reported -3
accidents, including poisoning........ 66 0 0 0 0 0 1 0 0 7 0 0 152 0 0 0 0
M. NURSING HOMES
1. Number of Nursing Homes -
Admitted to Service ................ 17 0 0 0 0 0 0 0 1 0 2 3 34 2 2 0 1 '
2. Visits to Nursing Homes............ 126 0 0 0 0 0 0 0 7 0 7 8 787 24 18 0 2
P. SANITATION
1. Approved Water Supplies Installed,
Private & Semi-Public............. 748 0 0 51 0 1 2 0 0 0 68 1,033 0 0 0 8
2. Approved Water Supplies Installed,
New Public Water Connections...... 1,714 0 0 366 0 0 50 0 1 2 5 0 1,685 0 0 5 2
3. New Specification Privies Installed.... 37 3 0 65 1 1 0 5 0 1 0 0 176 0 1 5 11
4. Percolation Water Table or
Soil Log Test ...................... 107 70 35 59 0 0 30 1 1 22 43 36 1,087 82 109 21 6
5. Subdivision Analysis................ 18 2 0 5 0 4 0 0 0 15 1 85 118 0 22 0 0
6. Pollution Survey .................. 11 0 0 61 0 0 0 0 0 0 0 0 19 0 2 0 0
7. New Specification Septic
Tanks Installed................... 2,034 60 14 123 62 25 53 11 96 108 65 749 3,235 28 111 46 10
8. Rabies-Number of Animal
Bites Investigated .................. 987 2 10 6 4 20 10 10 16 6 4 39 2,808 16 22 10 7
9. Field Visits for Rabies Investigation.. 3,521 6 38 11 3 30 1 36 23 14 5 72 12,325 18 24 10 8
10. Complaints Investigated............ 2,550 14 112 73 3 26 12 24 46 77 54 130 2,837 37 203 27 26
11. Nuisances Corrected ............... 2,406 8 40 149 3 7 2 7 10 22 24 60 2,770 20 21 4 6
12-19. Field Visits ..................... 26098 141 375 940 596 218 697 325 782 650 402 2,646 40,352 203 914 549 473

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

I
i

9 d 1 0 i o 0 0 P 0

K. MISCELLANEOUS n
1 Adm. Morbidity Service ............ 36 34 138 11 69 3 1 69 2 13 229 87 253 19 75 20 339
2. Field and Office Visits-Morbidity... 219 61 240 155 245 379 24 211 9 35 551 187 1,545 27 215 57 1,980
3. General Medical Examinations....... 4 50 42 24 216 2 9 257 404 0 6 43 93 0 12 12 238 -
4. Health Cards Issued............... 21 856 2,537 2,709 600 90 177 2,773 1,787 0 1,436 834 1,314 135 0 355 6,629
5. Visits in the Interest of Vital
Statistics.......................... 4 11 13 3 9 13 8 12 49 8 12 22 20 1 25 3 571
6. Conferences or Visits in the
Interest ofCivilDefense........... 0 0 1 0 0 0 0 16 11 12 0 0 1 0 3 1
7. Visits in the interest of reported
accidents, including poisoning........ 0 0 0 2 0 0 0 12 0 1 0 0 0 94 0 47
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service ............ .. 10 3 2 1 0 0 6 2 1 0 0 0 1 17 10 18
2. Visits to Nursing Homes.......... 0 22 21 14 5 0 0 65 13 3 0 0 8 253 39 125
P. SANITATION
1. Approved Water Supplies Installed,
Private & Semi-Public.............. 0 0 0 0 2 9 2 0 117 47 1 0 1 1 0 20 0
2. Approved Water Supplies Installed,
New Public Water Connections...... 0 0 0 4 0 7 0 0 10 52 0 0 2 7 0 10 0
3. New Specification Privies Installed.... 0 0 0 0 0 0 0 16 8 0 0 8 0 0 3 0 5
4. Percolation Water Table or
Soil Log Test ................... 4 149 0 42 14 2 3 132 236 160 0 38 136 67 5,585 59 238 -4
5. Subdivision Analysis................ 0 43 0 2 9 0 0 2 15 1 0 1 4 2 195 85 1
6. Pollution Survey .................. 0 2 374 241 0 0 2 0 14 20 12 1 1 0 20 4 34
7. New Specification Septic .
Tanks Installed ................... 5 913 384 498 71 14 12 1,231 292 190 57 94 293 94 5,068 209 2,331
8. Rabies-Number of Animal
Bites Investigated.................. 0 46 86 222 35 0 11 198 127 25 182 7 153 26 1,829 60 294
9. Field Visits for Rabies Investigation.. 2 96 114 958 58 0 19 427 33 104 239 32 153 27 1,937 96 62
10. Complaints Investigated.......... .. 7 265 73 602 13 4 9 308 640 70 174 57 161 12 5,326 188 1,846 U1
11. Nuisances Corrected ................ 3 63 9 106 13 2 3 164 295 33 148 13 107 7 1,258 41 672 (A
12-19. Field Visits ..................... 59 2,356 1,268 3,676 656 203 346 3,757 1,885 1,430 4,114 652 3,278 343 50,444 1,338 10,180

TABLE 6 (Continued)
Un
SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

K. MISCELLANEOUS

1. Adm. Morbidity Service............. 51 800 512 338 3 134 121 35 57 155 46 110 153 12 204 2 8,160
2. Field and Office Visits-Morbidity.... 76 7,119 1,527 551 4 234 1,031 54 73 547 76 264 2,144 40 307 2 35,752
3. General Medical Examinations....... 37 300 167 95 0 82 176 2 6 17 2 52 2,063 14 175 93 11321
4. Health Cards Issued................ 2,042 29,300 5,659 985 975 529 2,185 516 454 284 509 84 4,864 207 393 383 174,446
5. Visits in the Interest of Vital
Statistics ......................... 7 0 42 2 12 6 79 14 6 3 3 18 74 8 9 1 2,381 O
6. Conferences or Visits in the
Interest of Civil Defense............ 0 25 8 4 0 0 7 0 0 0 0 4 11 0 0 0 263
7. Visits in the interest of reported 3
accidents, including poisoning ....... 1 6 13 0 0 0 97 3 0 0 0 0 2 2 0 0 893
M. NURSING HOMES
1. Number of Nursing Homes
Admitted to Service ............... 7 28 30 4 5 0 9 10 1 1 0 0 21 0 01 1 425 60
2. Visits to Nursing Homes............ 31 487 163 20 8 104 62 1 1 3 87 0 0 4 4,255

P. SANITATION
1. Approved Water Supplies Installed,
Private & Semi-Public.n............ 4 4 4 13 2 0 126 27 0 0 1 1 0 2 1 2 4,047

3. New Specification Privies Installed.... 4 26 16 0 2 1 3 0 27 3 0 24 12 0 3 0 507
Percolation Water Table or
Soil Log Test..................... 61 4,647 1,63 83 493 20 803 76 12 74 9 0 37 6 0 0 25,769
Subdivision Analysis............... 1 86 0 1 0 49 53 0 18 0 0 93 2 0 0 1,598
6. Pollution Surveyg ..p...o .......... 0 12 23 0 2 8 14 4 0 0 4 0 5 0 0 0 1109
7. New Specification Septic
Tanks Installed.................... 132 3,266 2,180 93 360 157 1,607 1,008 41 38 38 28 1,761 3 94 26 41,545
8. Rabies-Number of Animal
Bites Investigated .................. 3 407 491 32 86 52 225 74 42 8 12 19 4 1 28 15,049
9. Field Visits for Rabies Investigation.. 22 889 1,238 45 3 63 634 121 81 6 2 2 474 7 10 0 39,574
10. Complaints Investigated............ 9 2,338 688 83 179 66 99 265 31 12 9 401 14 1 18 4,34
11. Nuisances Corrected ............... 17 73 475 52 184 9 260 123 32 11 13 4 203 45 13 17415
12-19. Field Visits..................... 29 30,268 7,326 669 4,749 2,034 15,566 1,260 69 310 475 787 6,212 117 772 36 325,695
12-19. Field Visits ................... .. 293 3,6 7,326 66947920456616059 310 7 8 ,1 1171 772 86 325,695

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

t-q

R. PROTECTION OF FOOD AND MILK

2. Field Visits to Food-handling
Establishments..................... 2,339 378 2,014 634 2,180 4,541 320 382 85 949 176 269 35,751 125 108 2,227
3. Number of Food-handlers'
Certificates Awarded ................ 1 0 0 0 1 23 0 0 0 71 0 0 2,102 0 0 0
4. Dairy Farms Admitted to Service.... 17 3 5 4 6 0 12 1 0 10 0 8 94 3 0 0
5. Field Visits to Dairy Farms.......... 207 15 206 43 46 0 238 2 0 68 0 33 1,230 53 0 0
6. Milk & Milk Products Plants
Admitted to Service ................ 2 0 17 4 5 1 0 1 0 2 0 2 99 0 0 0
7. Field Visits to Milk & Milk
Products Plants .................... 56 0 34 32 21 76 0 3 0 20 0 16 3,452 0 0 0 2
8. Cows Tuberculin Tested............. 2 27 104 0 0 297 0 0 0 30 0 0 6,368 389 0 0
9. Cows Bangs Tested................. 0 0 104 40 0 0 0 0 0 30 0 0 0 462 0 0
10. Dairy Farms under Mastitis
Control Program ................... 8 0 0 0 0 0 0 0 0 8 0 0 0 3 0 0
V. HEALTH INFORMATION
1. Meetings Attended.................. 699 41 64 90 608 347 58 27 84 267 270 10 1,985 20 9 132
2. Lectures and Motion Pictures
Showings.......................... 569 23 180 15 128 186 61 55 61 93 71 3 1,194 44 29 66
4.Radio & Television Programs........ 9 0 0 0 2 0 0 0 0 0 10 1 10 6 0 2
5. News Articles Published............. 11 31 0 13 2 1 4 15 9 55 8 3 65 23 21 2
6. Exhibits Displayed ................. 5 0 10 0 9 1 1 5 0 10 1 0 5 2 2 0
X. LABORATORY
1-21. Specimens Examined............. 8,464 1,923 6,891 1,824 9,688 28,100 1,275 1,876 962 1,607 3,781 3,3786,804 2,179 2,266 21,291

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

z

Ct

I 0

1. Food-handling Establishments
Admitted to Service................ 465 86 29 86 5 37 98 29 25 54 21 149 2,805 98 25 146 40 O
2. Field Visits to Food-handling
Establishments.......... .......... 3,950 362 241 400 132 51 999 71 100 104 53 398 81,198 503 163 1,559 266
3. Number of Food-handlers'
Certificates Awarded............... 1,107 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -3
4. Dairy Farms Admitted to Service.... 64 1 0 8 0 5 1 1 3 7 2 4 101 35 5 35 8
5. Field Visits to Dairy Farms.......... 829 3 0 227 0 58 13 2 42 15 3 46 2,494 312 62 411 55
6. Milk & Milk Products Plants
Admitted to Service................ 5 0 0 2 0 0 0 0 0 0 0 4 62 1 3 3 1
7. Field Visits to Milk & Milk 10
ProductsPlants.................... 128 0 0 35 0 0 0 0 0 0 0 6 1,311 1 12 44 6
8. Cows Tuberculin Tested............. 3,323 0 0 345 0 0 38 0 279 0 0 0 19,151 678 448 654 713 LI
9. Cows Bangs Tested ................. 3,643 0 0 345 0 0 38 0 0 0 0 0 3,721 645 2 654 713 0
10. Dairy Farms under Mastitis
Control Program................... 0 0 0 0 0 0 0 0 0 2 0 0 101 0 0 0 8
V. HEALTH INFORMATION
1. Meetings Attended ................ 406 5 21 144 3 27 33 15 120 49 17 79 1,772 62 237 106 66
2. Lectures and Motion Pictures
Showings.......................... 577 2 16 147 8 1 50 3 49 16 16 11 697 46 35 173 131
4. Radio & Television Programs........ 0 0 0 0 0 0 85 0 1 0 0 2 12 44 0 0 0
5. News Articles Published............. 53 10 3 64 1 6 9 13 3 18 8 14 68 17 5 0 5
6. Exhibits Displayed.................. 2 0 0 0 1 0 1 0 3 1 0 0 5 4 1 1 0
X. LABORATORY
1-21. Specimens Examined.............. 27,074 1,057 1,216 5,063 430 909 1,603 2,153 2,988 2,817 665 2,366 107,974 2,163 3,102 5,547 1,000

TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

R. PROTECTION OF FOOD AND MILK
1. Food-handling Establishments
Admitted to Service ..........
2. Field Visits to Food-handling
Establishments ....................
3. Number of Food-handlers'
Certificates Awarded..............
4. Dairy Farms Admitted to Service....
5. Field Visits to Dairy Farms.........
6. Milk & Milk Products Plants
Admitted to Service................
7. Field Visits to Milk & Milk
Products Plants ...................
8. Cows Tuberculin Tested............
9. Cows Bangs Tested ................
10. Dairy Farms under Mastitis
Control Program ..................
V. HEALTH INFORMATION
1. Meetings Attended.................
2. Lectures and Motion Pictures
Showings ......................
4. Radio & Television Programs.......
5. News Articles Published.............
6. Exhibits Displayed................
X. LABORATORY
1-21. Snecimens Examined .............

M0'5
I aIo I.r'

S

679
1,622
127
18
270
30
8o
1,345
24,993 W
18,036 t
2 W

724
458
ob
0
0 C/1

1-1 Spcmn Exmie ....... 401 9011 616 2 808129123

7.623 20.5621 2.067

989) 2411 8196 6667

4071 908 14616 280 3

UL
TABLE 6 (Continued)

SOME MAJOR ACTIVITIES OF LOCAL HEALTH UNITS DURING 1959

0 0
1 ~ I 0 ^4 I- -
Sg g 4 f a I g 0

R. PROTECTION OF FOOD AND MILK
1. Food-handling Establishments
Admitted to Service. ............... 59 2,509 867 188 297 181 469 97 74 44 72 22 1,086 27 93 73 22,719
2. Field Visits to Food-handling
Establishments .................... 504 12,667 5,666 488 3,116 771 1,237 621 298 680 160 56 4,379 198 292 280 136,137
3. Number of Food-handlers'
Certificates Awarded............... 0 0 0 0 0 1 0 0 0 0 0 2 0 0 0 0 3,435
4. Dairy Farms Admitted to Service.... 16 26 47 3 6 25 10 2 7 6 0 6 22 0 15 12 804
5. Field Visits to Dairy Farms.......... 344 487 395 12 50 374 72 10 86 71 0 37 381 0 177 190 11,133
6. Milk & Milk Products Plants
Admitted to Service ................ 0 50 2 1 5 0 4 1 0 0 2 0 6 0 4 1 356
7. Field Visits to Milk & Milk
Products Plants. ................... 0 780 21 2 50 0 25 1 0 0 2 0 195 0 35 1 7,969
8. Cows Tuberculin Tested............. 2,862 5,412 4,447 0 2,069 0 32 0 327 111 0 214 0 0 2,197 586 91,966
9. Cows Bangs Tested................. 161 5,411 1,048 0 95 1 0 0 319 100 0 113 0 0 1,194 524 44,209
10. Dairy Farms under Mastitis
Control Program ................... 21 25 82 0 0 0 3 0 0 1 0 0 0 0 15 0 282
V. HEALTH INFORMATION
1. Meetings Attended................. 103 840 261 60 91 227 255 87 18 36 42 23 387 13 57 11 12,990
2. Lectures and Motion Pictures
Showings........................ 13 1,061 648 8 50 28 148 84 24 5 82 7 118 35 61 7 9,730
4. Radio & Television Programs ........ 0 42 9 0 0 1 9 0 0 2 3 0 0 0 8 0 3,524
5. News Articles Published............. 1 103 74 1 0 19 73 4 20 4 12 9 34 0 9 0 1,261
6. Exhibits Displayed. ................ 0 15 3 0 0 0 11 0 1 0 2 0 1 0 21 2 151
X. LABORATORY
1-21. Specimens Examined............ 2,551 50,966 24,182 3,618 3,395 4,032 3,407 2,190 2,695 1,641 1,567 1,015 8,127 1,802 2,863 1,822 571,165

'2

ti
0

VITAL STATISTICS

BUREAU OF VITAL STATISTICS
EVERETT H. WILLIAMS, JR., M.S., Hyg.
Director
This bureau is responsible for records of birth, stillbirth, death, mar-
riage, annulment of marriage, divorce, legal change of name and adoption.
These records are required by state law and they serve two main purposes.
First, they serve as a legal record of the event showing when, where and
to whom it occurred. Copies of the original certificates, when properly cer-
tified, are specified by law as prima facie evidence of the facts stated there-
on. Upon receipt of the required fee certified copies are issued to applicants
who have a proper interest in the record.
The second purpose for recording vital events is their statistical value.
Public health agencies are particularly interested in statistical data concern-
ing births, stillbirths and deaths. Since public health personnel are the pri-
mary users of these data it is proper for the State Board of Health to have
the legal responsibility for collecting and preserving the records.

COLLECTION
It is axiomatic that statistical data can be no better than the data on
the original records. For this reason the collection of records is a most im-
portant phase of vital statistics. Completeness, accuracy and timeliness are
the three factors which registrars must constantly strive to improve. The
goal is to have a certificate filed for every event, to have accurate data on
every certificate and to have every certificate filed within the time limit pre-
scribed by law.
Marriages, annulments of marriage, divorces, legal changes of name
and adoptions are reported by the county judges and clerks of circuit
courts and very little difficulty is experienced in the collection of these
records. Birth certificates should be reported within 10 days by the
attendant at birth. Stillbirth and death certificates are the responsibility
of the funeral director and must be filed before burial, removal from
the county or before the expiration of 3 days. Because so many persons
are involved, the collection of birth, stillbirth and death records is diffi-
cult. These records are filed with the local registrar, in each county and
then forwarded to the state office. County health officers are the local
registrars in all counties except St. Johns.
Local registrars are responsible for the proper filing of birth, stillbirth
and death certificates within their county. Complete, accurate and timely
registration of vital events does not just happen. Efficient registration is
the result of conscientious effort on the part of registrars. One measure-
ment of the relative efficiency of vital statistics registration in each county
is shown in the "Vital Statistics Scoreboard" which is published annually
(Table 13). The top 10 counties are to be congratulated on their
superior performance. They are Glades, Duval, Hernando, Jefferson,
Baker, Hillsborough, Dade, Orange, Citrus and Sarasota. The "Score-

60 ANNUAL REPORT, 1959

board" shows that 93.7 per cent of all birth certificates and 97.2 per cent
of all death certificates were filed and forwarded to the Bureau of Vital
Statistics within the prescribed time limit. The steady improvement in
this index of performance is gratifying.
Last year 215,624 current certificates were registered with the bu-
reau, an increase of 5.5 per cent over the preceding year. Processing each of
these records includes the following: check to see that certificate is
properly completed, return those which do not meet minimum standards,
query others which are not complete or have inconsistent or erroneous
data, code for statistics, put in proper order for permanent filing, number,
keypunch for indexing and statistics, microfilm, bind and send to vault
for permanent storage.

INDEXING
The re-indexing project for old records which was started several years
ago is progressing slowly. No personnel are available for full time work on
this project, so it is being done as a spare time job whenever current work
is completed. These revised indexes when completed will result in
shortening searching procedures and will facilitate the training of new
employees.

CERTIFICATIONS

The issuance of certified copies is another of the large-volume jobs
performed by the bureau. Last year 107,272 requests for certification
were received and processed. The volume of requests received has re-
mained fairly constant for the past 4 years. This is probably due to the
fact that more County Health Departments are beginning to issue certified
copies of records and certifications are obtained at the county level rather
than from the State Board of Health. The bureau was again able to
process all routine requests within 24 hours after receipt. It is always
gratifying to be able to give prompt service.

AMENDMENTS

The amendment of records is another of the major functions of this
bureau and is most complex. In every case the applicant must submit evi-
dence to substantiate his request. Each case must be adjudicated by bureau
personnel and processed only when sufficient evidence has been submitted.
In this respect the bureau acts as a quasi-judicial agency. A wide variety
of requests are received each year under the following broad categories:
Adoption, legitimation, change of parentage, legal change of name, cor-
rection of date of birth, correction of race or sex, correction of spelling,
correction of parent's age and others.

VITAL STATISTICS 61

DELAYED REGISTRATION OF BIRTH
Although births are required by law to be registered within 10 days
after occurrence, a certificate is accepted on the current form if filed by the
attendant at birth prior to the child's fourth birthday. After the fourth
birthday only a "Delayed Birth Certificate" can be filed. This must be
accompanied by documentary evidence which is sufficient to substantiate
the person's name, parentage, date and place of birth. Every effort is made
to see that evidence requirements are strong enough to minimize the
establishment of fraudulent records and at the same time permit appli-
cants to obtain sufficient evidence with a minimum of effort. In some
cases it is most difficult to explain to the applicant why there is so much
"red tape" involved in filing a delayed birth record. Last year a total
of 3264 births were registered in this fashion.

BUREAU REORGANIZATION
On July 1, that portion of the bureau which deals with data processing
was transferred to Administration to become a service unit for all bureaus
and divisions.

POPULATION
The population of the state as of July 1, 1959 was estimated to be
4,610,600, an increase of 3.6 per cent over the figure of 4,448,000 for the
previous year. The white population was estimated to be 3,727,400 persons
and the nonwhite population 883,200.

STATISTICS
This report contains only a brief summary of statistical data for the
year. An analysis of vital statistics data for 1959 in greater detail is pre-
sented in Supplement 1 of this report under the title FLORIDA VITAL
STATISTICS, 1959. Because of the time lag in receipt of records, figures
for births and deaths in this report are labeled "preliminary". Final figures
are contained in the above mentioned supplement, and Tables 9a, 10a and
1 la contain figures for 1958.

BIRTHS
The preliminary birth figure for 1959 is 112,826 compared with the
108,014 (final figure) in 1958. White births increased from 78,125 in 1958
to 82,034 and the nonwhite increased from 29,889 to 30,792 in 1959.
This gives estimated birth rates (per 1000 population) for 1959 of 24:5
for total births, 22.0 for white and 34.9 for nonwhite, compared with the
final rates per 1000 population in 1958 of 24.3, 21.7 and 35.4 respect-
ively.

62 ANNUAL REPORT, 1959

DEATHS
Preliminary tabulations for 1959 give a total of 44,162 deaths with
35,531 white and 8631 nonwhite, compared with a total of 43,353 in 1958
with 34,540 white and 8813 nonwhite. However, the rate per 1000 popu-
lation dropped from 9.7 in 1958 to 9.6 in 1959. The rates per 1000 popula-
tion for the white race decreased from 9.6 in 1958 to 9.5 in 1959 while the
nonwhite rate declined from 10.4 to 9.8. The 10 leading causes remained
much the same, but it is interesting to note that some of the rates indicate
a decline. The rate per 100,000 population reflects a decline for diseases of
the heart from 343.5 in 1958 to 332.7 in 1959, while cerebral vascular di-
sease declined from 115.1 to 110.5. The rate of all accidents declined from
62.9 to 59.5 per 100,000, and the influenza and pneumonia rate dropped
from 32.6 to 26.9. The cancer rate per 100,000 population increased from
149.3 to 156.6, and diseases of early infancy increased from 45.7 to 46.6.
These leading 6 causes have retained this position during the past decade.
The remaining 4 of the 10 leading causes changed as general arterioscle-
rosis moved into seventh place with a rate of 14.8 per 100,000 population
in 1959 compared with 13.6 in 1958. Congenital malformations moved
from eleventh place in 1958 with a rate of 11.9 to eighth place and a rate
of 13.1 in 1959. Diabetes Mellitus dropped from seventh to ninth place
with a rate per 100,000 population of 13.7 in 1958 and 12.9 in 1959. Sui-
cides dropped into tenth place with a rate of 12.4 per 100,000.

MARRIAGES, DIVORCES AND ANNULMENTS
Preliminary tabulations indicate that marriages increased from 34,569
in 1958 to 38,595 in 1959, an increase of 11.6 per cent. The rate per 1000
population increased from 7.8 in 1958 to 8.4 in 1959. Divorces and
annulments also increased from 17,604 in 1958 to 19,544 in 1959. This
indicates a slight increase in the rate per 1000 population from 4.0 in
1958 to 4.2 in 1959.

VITAL STATISTICS 63

TABLE 7

ACTIVITIES OF THE BUREAU OF VITAL STATISTICS

DURING THE YEARS 1958 AND 1959

5 .7-

ACTIVITY

Current certificates filed....... ................
Delayed birth certificates filed ......................
Adoption decrees received ...........................
Amended certificates filed for adoptions.............
Amended certificates filed for legitimations and
correction of parentage .......................
Requests for certifications:
Total ........................ ..............
Fee paid ................................
Free........................................
Photostats made .............. ................
Birth registration cards made ......................
Fees collected and transmitted to State Treasurer......

1958

1959

*1 I.-~ --

204,412
3,542
4,530
3,292

992

108,050
87,290
20,760
122,550
21,937
$132,242.99

215,624
3,264
3,904
3,404

926

107,252
86,700
20,572
133,140
22,036
$137,636.33

TABLE 8

RESIDENT BIRTHS AND DEATHS WITH RATES PER 1,000

POPULATION, FLORIDA, 1931-1959

YEAR POPULATION BIRTHS BIRTH RATE DEATHS DEATH RATE

1959* 4,610,600 112,826 24.5 44,162 9.6
1958 4,448,000 108,014 24.3 43,353 9.7
1957 4,250,400 103,806 24.4 39,937 9.4
1956 3,897,400 97,320 25.0 36,705 9.4
1955 3,643,562 89,112 24.5 33,295 9.1
1954 3,481,528 84,831 24.4 31,603 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 64,347 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

*1959 data based upon preliminary totals

PER CENT
CHANGE

+ 5.5
- 7.8
- 13.2
+ 3.4

- 6.7

- 0.7
- 0.7
- 0.9
+ 8.6
+ 0.5
+ 4.1

TABLE 9

RESIDENT DEATHS AND DEATH RATES BY CAUSE, BY RACE, FLORIDA, 1959 (PRELIMINARY)

CAUSE OF DEATH DEATHS Rate per 100,000 Population
(Numbers in parentheses refer to the International List of Causes of Death)
Total White Nonwhite Total White Nonwhite
TOTAL DEATHS ........................................................... 44,162 35,531 8,631 9.6* 9.5* 9.8*
Tuberculosis of respiratory system (001-008)...................................... .......... 210 153 57 4.6 4.1 6.5
Tuberculosis, other forms (010-019)... .................................................. 16 8 8 .3 .2 .9
Syphilis and its sequelae (020-029)............... ................................... 100 50 50 2.2 1.3 5.7
Typhoid fever (040) ................... ...................... ... .............. ....... 0 0 0 -
Dysentery, all forms (045-048) ........................................................... 9 2 7 .2 .1 .8
Diphtheria (055) ... ................................................................. 5 1 4 .1 .0 .5
M eningococcal infections (057)................ .............. ................. ... ... ... ... 14 8 6 .3 .2 .7
Acute poliomyelitis (080) ................... ............... ................... .... 12 12 0 .3 .3 -
Acute infectious encephalitis (082) .......................... ................. .... ... 21 14 7 .5 .4 .8
M easles (085)..................................... 11 3 8 .2 .1 .9
Typhus and other rickettsial diseases (100-108) ............................................... 0 0 0 -
All other diseases classified as infective & parasitic (030-138) with exception of above causes....... 178 105 73 3.9 2.8 8.3
Malignant neoplasms, including neoplasms of lymphatic & haematopoietic tissues (140-205)........ 7,219 6,310 909 156.6 169.3 102.9
Diabetes mellitus (260).................................. .............. ..... ....... .. .. 593 463 130 12.9 12.4 14.8
Anemias (290-293)................................ .... ................ .......... 115 71 44 2.5 1.9 5.0
Major cardiovascular-renal disease........................................................ 22,437 18,987 3,450 486.6 509.4 390.6
Cerebral vascular disease (330-334).................................................. 5,094 3,971 1,123 110.5 106.5 127.2
Rheumatic fever (400-402).................. .......................................... 27 15 12 .6 .4 1.4
Diseases of the heart ............................................................. .. 15,340 13,419 1,921 332.7 360.0 217.5
Chronic rheumatic heart disease (410-416)............................................ 451 407 44 9.8 10.9 5.0
Arteriosclerotic heart disease, coronary disease (420) ...................................... 11,582 10,591 991 251.2 284.1 112.2
Nonrheumatic chronic endocarditis & myocardial degeneration (421, 422) ............ 1,031 833 198 22.4 22.3 22.4
Hypertension with heart disease (440-443)............................................ 1,437 914 523 31.2 24.5 59.2
Other diseases of heart (430-434) ..................................................... 839 674 165 18.2 18.1 18.7
Hypertension without heart disease (444-447)............................................. 346 230 116 7.5 6.2 13.1
General arteriosclerosis (450)........................................................... 683 615 68 14.8 16.5 7.7
Other circulatory disease (451-468)................. .............. ...... ......... ...... 610 525 85 13.2 14.1 9.6
Chronic and unspecified nephritis (592-594) ............................................... 337 212 125 7.3 5.7 14.2
Influenza (480-483) .............................. ................ .... ................ 65 28 37 1.4 .8 4.2
Pneumonia (490-493) ................................................................ 1,173 783 390 25.4 21.0 44.2
Ulcer of stomach and duodenum (540-541)................................................... 267 226 41 5.8 6.1 4.6
Intestinal obstruction and hernia (560, 561, 570) ............................................ 240 189 51 5.2 5.1 5.8
Gastritis, duodenitis, enteritis & colitis, except diarrhea of the newborn (543, 571, 572)............ 332 172 160 7.2 4.6 18.1
Cirrhosis of liver (581) .................... .............. ........ ... .............. .... 532 468 64 11.5 12.6 7.2
Acute nephritis and nephrosis (590, 591) .................................................... 60 35 25 1.3 .9 2.8
Complications of pregnancy, childbirth & the puerperium (640-62, 660, 670-689)................. 57 17 40 5.1"* 2.1"* 13.0"
Congenital malformations (750-759) ....................................................... 602 456 146 13.1 12.2 16.5
Birth injuries, postnatal asphyxia & atelectasis (760-762)...................................... 922 609 313 20.0 16.3 35.4
Infection of the newborn (763-768) ......................................................... 183 87 96 4.0 2.3 10.9
Other diseases peculiar to early infancy and immaturity unqualified (769-776) ... ............... 1,043 635 408 22.6 17.0 46.2
Symptoms, senility, and ill-defined causes (780-795).......................................... 938 582 356 20.3 15.6 40.3
All other diseases (residual) ............................................................ 2,987 2,311 676 64.8 62.0 76.5
Motor vehicle accidents (810-835)) ................ ....................................... 1,112 892 220 24.1 23.9 24.9
All other accidents (800-802, 840-962)...................................................... 1,633 1,153 480 35.4 30.9 54.3
Suicide & self-inflicted injury (963, 970-979) ................................ .........5... 670 550 20 12.4 14.8 2.3
Homicide (964, 965, 980-999) ......................................................... 506 151 355 11.0 4.1 40.2

Infant mortality (deaths under one year of age) ............................................ 3,537 2,046 1,491 31.3"* 24.9*' 48.4"*
1~t e ,0 ouain**aepr1,0 iebrh 5Rte e ,0 iebr

*Rate per 1,000 population

**"Rate per 10,000 live births

***Rate per 1,000 live births

RESIDENT DEATHS AND DEATH RATES BY A S Y RACE, FLORIDA, 1958 (FINAL FIGURES)

CAUSE OF DEATH DEATHS Rate per 100,000 Population
(Numbers in parentheses refer to the International List of Causes of Death)
Total White Nonwhite Total White Nonwhite
TOTAL DEATHS ............................. ............................ 43,353 34,540 8,813 9.7* 9.6* 10.4*
Tuberculosis of respiratory system (001-008)................................................. 259 182 77 5.8 5.1 9.1
Tuberculosis, other forms (010-019) ....................................................... 28 11 17 0.6 0.3 2.0
Syphilis and its sequelae (020-029)......................................................... 101 50 51 2.3 1.4 6.0
Typhoid fever (040) .................... ........................... ............ ....... 0 0 -
Dysentery, all forms (045-048) ............................................................ 11 3 8 0.2 0.1 0.9
Scarlet fever & strep. sore throat (050, 051) ................................................. 5 3 2 0.1 0.1 0.2
D iphtheria (055) ................... ... ............................ ..................... 3 3 0 0.1 0.1 -
Whooping cough (056).................. ....................................... .. 2 1 1 0.0 0.0 0.1
Meningococcal infections (057) .......................................................... 24 16 8 0.5 0.4 0.9
Acute poliomyelitis (080) ...................................................... .......... 6 6 0 0.1 0.2 -
Acute infectious encephalitis (082) ........................................................ 15 9 6 0.3 0.2 0.7
M easles (085)............................................................................ 12 11 1 0.3 0.3 0.1
Typhus & other rickettsial diseases (100-108) ................................................ 0 0 0 -
All other diseases classified as infective & parasitic (030-138) with exception of above causes....... 192 120 72 4.3 3.3 8.5
Malignant neoplasms, including neoplasms of lymphatic & haematopoietic tissues (140-205)......... 6,639 5,725 914 149.3 158.9 108.2
Benign & unspecified neoplasms (210-239) ................... .................... ......... 120 91 29 2.7 2.5 3.4
Diabetes mellitus (260)............................................................... .. 611 470 141 13.7 13.0 16.7
Anemias (290-293) ......................................................... ....... ... 99 66 33 2.2 1.8 3.9
Major cardiovascular-renal disease ....................................................... 22,199 18,572 3,627 499.1 515.4 429.3
Cerebral vascular disease (330-334) ................. .................................. 5,120 3,975 1,145 115.1 110.3 135.5
Rheumatic fever (400-402) ............................................................. 1 10 5 0.3 0.3 0.6
Diseases of the heart (410-443)..................................................... ... 15,280 13,212 2,068 343.5 366.7 244.8
Chronic rheumatic heart disease (410-416)............................................. 481 410 71 10.8 11.4 8.4
Arteriosclerotic heart disease, coronary disease (420)...................................... 11,240 10,260 980 252.7 284.8 116.0
Nonrheumatic chronic endocarditis & myocardial degeneration (421-422) ................... 1,137 883 254 25.6 24.5 30.1
Hypertension with heart disease (440-443)... ........................................ 1,648 1,077 571 37.1 29.9 67.6
Other diseases of heart (430-434)............... ...................................... 774 582 192 17.4 16.2 22.7
Hypertension without heart disease (444-447) ............................................ 305 210 95 6.9 5.8 11.2 C
General arteriosclerosis (450)........... ............................................. 604 511 93 13.6 14.2 11.0
Other circulatory disease (451-468) .................................... .................. 520 432 88 11.7 12.0 10.4
Chronic and unspecified nephritis (592-594) .............................................. 355 222 133 8.0 6.2 15.7
Influenza (480-483) ....................... .......... ........ ...... ................... 157 74 83 3.5 2.1 9.8
Pneumonia (490-493) ....................................................... ....... 1,291 877 414 29.0 24.3 49.0
Bronchitis (500-502) ........................................ ....................... 101 73 28 2.3 2.0 3.3
Ulcer of stomach & duodenum (540, 541).................................................... 281 246 35 6.3 6.8 4.1
Appendicitis (550-553) .................................................................... 49 35 14 1.1 1.0 1.7
Intestinal obstruction & hernia (560, 561, 570) ............................................... 242 193 49 5.4 5.4 5.8
Gastritis, duodenitis, enteritis & colitis except diarrhea of the newborn (543, 571, 572)............ 278 147 131 6.2 4.1 15.5
Cirrhosis of liver (581) .. ................................................ ........... 555 488 67 12.5 13.5 7.9 -4
Acute nephritis (590-591)................................................................ 54 30 24 1.2 0.8 2.8
Hyperplasia of prostate (610) .............................................................. 116 97 19 2.6 2.7 2.2
Complications of pregnancy, childbirth & the puerperium (640-652, 660, 670-689)................. 63 23 40 5.8* 2.9** 13.4*" CE
Congenital malformations (750-759) ...................................................... 528 400 128 11.9 11.1 15.1
Birth injuries, postnatal asphyxia & atelectasis (760-762) .......... .......................... 911 564 347 20.5 15.7 41.1
Infection of the newborn (763-768) ...................................... .................. 166 77 89 3.7 2.1 10.5
Other diseases peculiar to early infancy and immaturity unqualified (769-776) .................... 957 578 379 21.5 16.0 44.9
Symptoms, senility, and ill-defined causes (780-795) ......................................... 949 568 381 21.3 15.8 45.1 0
All other diseases (residual) ................ ..... ............... ...... ............ ..... 2,452 1,919 533 55.1 53.3 63.1
Motor vehicle accidents (810-835) ..................................................... 1,149 898 251 25.8 24.9 29.7
All other accidents (800-802, 840-962) ................................................... 1,650 1,175 475 37.1 32.6 56.2
Suicide & self-inflicted injury (963, 970-979) ...................................... ....... 602 577 25 13.5 16.0 3.0
Homicide (964, 965, 980-999) ......................... ........ .... .... ...... ........ .... 476 162 314 10.7 4.5 37.2
Infant mortality (deaths under one year of age)... ....... .. ................... ...... 3,425 1,924 1,501 31.7"' 24.6"1 50.2**

*Rate per 1,000 population

**Rate per 10,000 live births

***Rate per 1,000 live births

66 ANNUAL REPORT, 1959

TABLE 10

ESTIMATED POPULATION AND PRELIMINARY TOTALS OF

BIRTHS, DEATHS, AND INFANT DEATHS,

BY RACE, BY COUNTY, FLORIDA, 1959

Population BIRTHS DEATHS INFANT DEATHS
COUNTY Estimate
1959 Total White Nonwhite Total White Nonwhite Total White Nonwhite

STATE...... 4,610,600* 112,826 82,034 30,792 44,162 35,531 8,631 3,537 2,046 1,491

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...

81,600
6,800
65,400
12,900
101,500
280,800
8,000
9,300
7,700
18,800
15,800
19,700
855,800
11,400
4,300
437,100
167,600
5,700
6,100
47,000
3,000
3,300
10,000
7,900
13,500
7,400
10,800
18,500
373,900
11,800
23,400
37,000
9,600
2,400
52,800
45,600
79,500
10,100
3,000
14,000
57,800
49,100
15,200
54,000
15,500
57,700
5,400
246,600
18,300
223,500
31,500
323,100
180,000
33,400
32,500
34,700
25,500
61,100
51,200
12,300
14,100
14,500
8,900
113,100
5,300
14,300
11.200

1,995
192
2,124
305
3,102
6,882
181
194
157
581
373
542
19,217
238
139
12,399
5,350
137
173
1,097
64
68
265
219
286
229
290
537
9,373
212
566
804
271
51
1,174
1,272
1,896
212
77
390
1,112
1,280
369
1,378
441
1,947
158
6,539
377
4,944
647
5,576
4,337
843
633
982
914
1,242
1,392
291
327
365
102
2,356
105
315
220

1,347
139
1,747
204
2,603
4,562
144
176
109
487
305
334
14,203
146
109
8,861
3,918
67
138
276
48
41
187
99
250
135
184
351
7,549
198
856
503
78
40
822
941
1,161
109
56
177
758
695
220
1,236
310
1,769
130
5,200
310
3,192
530
4,366
3,166
510
375
477
839
1,007
943
166
202
272
72
1,649
58
267
155

648
53
377
101
499
2,320
37
18
48
94
68
208
5,014
92
80
8,538
1,432
70
35
821
16
27
78
120
36
94
106
186
1,824
14
210
301
193
11
352
331
735
103
21
213
354
585
149
142
131
178
28
1,339
67
1,752
117
1,210
1,171
33
258
505
75
235
449
125
125
93
30
707
47
48
65

533
55
412
128
598
2,562
75
123
100
138
131
227
8,023
113
30
3,679
1,183
49
83
350
14
29
63
94
107
77
105
234
3,709
113
263
333
110
24
633
452
480
106
37
125
852
534
178
302
134
254
50
1,982
266
2,091
407
5,076
1,639
321
341
353
155
816
433
127
167
130
44
1,515
40
150
105

335
37
337
99
494
2,080
64
118
83
111
93
148
6,999
76
25
2,439
808
33
59
118
12
14
36
53
103
45
74
187
3,085
107
207
206
47
20
525
358
255
70
29
65
727
330
134
245
79
223
38
1,695
248
1,637
374
4,777
1,314
206
241
229
134
735
276
92
110
87
30
1,275
27
128
86

*Includes State Institutions.

198
18
75
29
104
482
11
5
17
27
38
79
1,024
37
5
1,240
375
16
24
232
2
15
27
41
4
32
81
47
624
6
56
127
63
4
108
94
225
36
8
60
125
204
44
57
55
31
12
287
18
454
33
299
325
115
100
124
21
81
157
35
57
43
14
240
13
22
19

VITAL STATISTICS

TABLE 10-A

ESTIMATED POPULATION AND TOTALS OF RESIDENT BIRTHS,

DEATHS, AND INFANT DEATHS, BY RACE,
BY COUNTY, FLORIDA, 1958
(Final Figures)

Population BIRTHS DEATHS INFANT DEATHS
COUNTY Estimate
1958 Total White Nonwhite Total White Nonwhite Total White Nonwhite

STATE... 4,448,000* 108,014 78,125 29,889 43,353 34,540 8,813 3,425 1,924 1,501

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 ......
Suwanee......
Taylor ......
Union........
Volusia ......
Wakulla .....
Walton.......
Washineton...

80,500
6,800
63,600
12,200
86,200
265,900
7,800
7,200
8,400
19,700
13,900
18,600
846,800
11,600
4,400
427,200
166,400
5,300
5,700
50,100
3,300
3,100
8,900
8,300
13,600
7,200
9,800
17,400
359,300
11,600
23,100
34,100
9,500
2,800
52,200
40,800
78,000
9,900
2,800
14,200
56,300
47,500
13,100
54,000
14,900
56,500
5,100
237,600
16,300
214,300
30,800
296,100
176,000
33,500
31,300
33,600
25,200
59,000
46,200
11,500
14,100
14,000
10,600
102,100
5,100
14,200
10.900

1,921
222
2,109
316
2,748
6,362
183
130
167
526
380
460
19,163
213
109
11,829
5,390
151
158
1,115
61
54
264
210
256
175
284
457
8,888
218
525
865
245
45
1,079
902
1,899
238
77
358
1,121
1,165
359
1,417
480
1,941
149
5,688
298
4,884
619
5,182
4,256
867
674
997
837
1,151
1,197
272
337
331
97
2,262
132
322
227

1,270
158
1,759
209
2,300
4,191
133
114
118
451
310
267
14,138
189
95
8,431
4,008
70
109
293
51
30
174
74
219
101
181
291
7,150
208
321
528
57
33
737
636
1,122
128
60
156
770
615
221
1,259
336
1,782
108
4,501
241
3,260
496
3,996
3,130
509
410
494
758
905
762
167
213
239
59
1,572
81
262
159

651
64
350
107
448
2,171
50
16
49
75
70
193
5,025
74
14
3,398
1,382
81
49
822
10
24
90
136
37
74
103
166
1,738
10
204
337
188
12
342
266
777
110
17
202
351
550
138
158
144
159
41
1,187
57
1,624
123
1,186
1,126
358
264
503
79
246
435
105
124
92
38
690
51
60
68

553
52
390
132
588
2,386
70
101
117
130
112
189
7,886
101
45
3,578
1,226
54
67
339
30
24
72
81
125
55
112
243
3,558
109
243
297
118
26
595
441
481
121
24
165
773
543
167
276
130
266
56
2,088
292
2,134
409
4,914
1,547
383
314
350
188
764
404
98
166
107
52
1,575
60
150
111

296
35
300
100
483
1,894
64
90
94
102
85
108
6,886
78
32
2,418
827
31
42
113
28
14
51
44
113
35
85
183
2,969
102
192
183
44
23
484
335
259
61
19
81
662
327
122
229
84
236
38
1,769
258
1,615
372
4,573
1,250
218
195
241
164
689
246
69
113
68
35
1,332
39
121
92

257
17
90
32
105
492
6
11
23
28
27
81
1,000
23
13
1,160
399
23
25
226
2
10
21
37
12
20
27
60
589
7
51
114
74
3
111
106
222
60
5
84
111
216
45
47
46
30
18
319
34
519
37
341
297
165
119
109
24
75
158
29
53
39
17
243
21
29
19

*Includes institution populations (16,400).

68 ANNUAL REPORT, 1959

TABLE 11

PRELIMINARY TOTALS OF RESIDENT DEATHS FROM CERTAIN
CAUSES, BY COUNTY, FLORIDA, 1959

Cardio-Vascular-Renal
Diseases
S -

STATE.............. 57 226 100 9 12 7,219 593 115 1,238 5,094 15,340 337 1,666 1,112 1,633
Alachua............... 0 0 0 0 0 71 3 1 17 81 158 6 19 13 23
Baker............... 0 0 0 0 0 3 1 0 4 6 13 1 2 2 4
Bay................ 0 1 0 0 1 66 1 1 16 49 116 1 12 12 25
Bradford............. 1 3 0 0 0 20 2 0 3 18 45 0 3 2 4
Brevard............ 0 3 2 0 0 85 7 1 23 53 190 8 20 28 29
Broward............. 4 8 8 1 0 473 34 7 76 259 870 28 90 71 102
Calhoun............. 0 0 0 0 0 9 2 0 2 14 29 0 1 3 5
Charlotte............ 0 1 0 0 0 19 2 1 4 14 48 0 6 4 3
Citrus............... 0 0 0 0 0 14 0 0 0 12 33 0 8 3 8
Clay................ 0 0 0 0 0 15 2 1 6 20 42 0 5 7 8
Collier................ 0 0 0 0 0 18 2 0 5 20 29 2 2 3 10
Columbia............ 0 2 1 0 0 29 3 0 9 34 65 0 8 7 13
Dade................ 9 53 23 0 3 1,515 129 18 239 645 2,871 40 308 190 263
DeSoto.. ......... 0 1 0 0 0 20 2 2 3 15 39 3 1 5 6
Dixie................ 1 1 0 0 0 6 1 0 2 4 7 0 0 3 1
Duval............... 3 36 13 0 0 520 47 10 100 480 1,109 32 150 112 144
Escambia............ 4 9 3 0 1 151 11 7 47 122 869 8 24 37 66
Flagler............... 0 0 0 0 0 4 1 0 0 10 17 1 4 0 2
Franklin............. 0 1 1 0 0 12 1 1 3 15 29 0 5 0 3
Gadsden. ........... 2 2 0 1 0 81 5 1 20 50 115 1 14 8 15
Gilchrist............. 0 0 0 0 0 1 0 0 0 5 6 0 0 1 0
Glades............... 0 1 0 0 0 5 0 0 1 4 7 1 1 1 2
Gulf................. 0 0 1 0 0 7 1 0 2 3 22 0 4 0 6
Hamilton............ 1 0 0 0 0 18 0 1 1 9 34 1 3 0 10
Hardee.............. 0 1 1 0 0 19 1 0 2 9 41 2 4 0 7
Hendry.............. 0 1 0 0 0 9 0 0 4 11 22 0 2 4 2
Hernando............ 0 0 1 0 0 18 1 2 2 11 25 2 5 8 3
Highlands........... 0 2 0 0 0 28 1 0 9 28 85 1 7 8 7
Hillsborough......... 4 20 6 0 3 578 45 8 66 396 1,170 31 141 72 131
Holmes............. 0 1 0 0 0 14 2 0 3 20 38 0 1 5 6
Indian River......... 0 1 2 0 0 35 6 0 8 14 102 3 10 12 7
Jackson.............. 0 1 0 0 0 51 3 1 9 61 92 5 8 12 13
Jefferson............. 0 0 0 0 0 9 1 0 10 19 34 0 6 2 6
Lafayette............ 0 0 0 0 0 4 0 0 0 3 8 0 2 1 1
Lake................ 3 4 2 0 0 117 11 2 24 52 226 4 23 13 44
Lee.................. 0 2 0 0 1 79 8 1 20 48 180 2 21 12 16
Leon................ 8 0 0 0 0 58 4 0 17 81 129 7 15 16 29
Levy................ 0 0 1 0 0 14 1 1 3 15 41 1 5 2 3
Liberty.............. 0 0 0 0 0 3 0 0 2 7 15 0 1 2 2
Madison............. 0 2 2 0 0 9 3 0 4 11 46 0 5 2 4
Manatee............. 1 2 1 1 0 120 23 2 35 94 355 8 39 16 17
Marion.............. 0 2 2 0 0 72 8 2 8 67 189 10 26 19 23
Martin............... 0 1 1 0 0 29 2 1 10 22 44 1 5 4 7
Monroe.............. 0 2 0 0 0 50 6 1 9 42 85 3 12 15 6
Nassau.............. 0 0 0 0 0 15 1 1 0 15 50 2 5 3 5
Okaloosa ............. 1 1 0 0 0 32 2 2 10 30 61 8 3 7 11
Okeechobee........... 0 0 0 0 0 9 1 0 3 6 13 0 2 1 4
Orange .............. 2 10 3 1 1 309 18 4 54 206 779 12 75 64 76
Osceola.............. 0 0 0 0 1 40 3 1 4 86 97 1 19 4 12
PalmBeach.......... 2 7 2 2 0 381 32 5 52 209 781 9 65 57 72
Pasco................ 1 3 1 0 0 79 4 1 8 53 141 2 10 11 9
Pinellas .............. 2 17 11 0 1 944 59 10 94 764 2,054 31 203 61 107
Polk................. 3 2 0 0 0 245 24 3 39 249 541 13 64 49 71
Putnam............... 2 3 0 1 0 42 8 0 12 30 115 16 12 6 15
St.Johns............. 1 2 0 2 0 51 4 1 11 33 123 1 20 11 13
St. Lucie............. 1 1 1 0 0 60 3 0 17 37 110 6 15 12 9
SantaRosa............ 0 2 0 0 0 21 2 0 6 24 48 0 6 4 4
Sarasota ............. 2 1 1 0 0 152 10 6 18 88 816 2 42 10 17
Seminole............. 0 4 2 0 0 53 12 0 15 37 154 5 12 13 25
Sumter .............. 1 0 0 0 0 18 3 0 4 21 42 1 1 5 12
Suwannee............ 1 0 1 0 0 16 0 0 10 25 61 4 4 4 5
Taylor................ 0 1 0 0 0 19 2 1 4 19 39 1 6 4 8
Union............... 0 0 0 0 0 8 0 0 1 6 19 0 2 2 2
Volusia............... 1 6 7 0 0 275 22 4 40 211 572 12 60 35 42
Wakulla............. 0 0 0 0 0 5 0 2 0 4 10 0 2 2 6
Walton .............. 1 1 0 0 0 13 0 0 7 25 41 3 2 7 11
Washington.......... 0 1 0 0 0 9 0 1 1 13 33 0 8 3 11
*Includes all vascular lesions affecting the central nervous system.

VITAL STATISTICS 69

TABLE 11-A

RESIDENT DEATHS FROM CERTAIN CAUSES,
BY COUNTY, FLORIDA, 1958 (FINAL FIGURES)

Cardio-Vascular-Renal
3 Diseases

I 8 j j I lill I i o3

STATE.............. 63 287 101 11 6 6,639 611 99 1,448 5,120 15,280 355 1,444 1,149 1,650
Alachua............. 0 2 2 0 0 71 8 3 21 112 151 7 18 12 24
Baker... .... 0 0 0 0 0 1 0 2 6 18 0 2 5 7
Bay ................ 0 1 1 0 0 48 3 0 15 41 110 2 10 18 22
Bradford............ 5 0 0 0 17 1 0 7 18 43 0 5 7 6
Brevard............. 2 2 1 0 0 90 7 0 25 52 195 3 18 21 24
Broward............ 2 11 11 0 0 897 80 6 78 241 859 28 81 66 103
Calhoun......... 0 0 0 0 0 8 0 0 6 16 25 0 1 1 1
Charlotte............ 0 0 0 0 0 20 1 0 2 13 44 0 1 1 2
Citrus ............... 0 0 0 0 22 0 0 0 11 50 0 7 5 7
Clay... ...... 1 0 1 0 0 11 0 0 4 21 38 1 6 7 7
Collier... ...... 0 0 0 0 0 12 1 0 2 10 38 1 3 8 4
Columbia ........... 2 0 0 0 0 18 8 0 5 50 52 1 8 2 11
Dade............... 6 67 24 2 1 1,386 121 19 300 716 2,870 36 224 190 243
DeSoto.............. 0 0 0 0 0 20 4 0 1 13 32 3 1 3 4
Dixie ............... 0 1 0 0 0 7 0 0 0 5 20 2 2 1 3
Duval............... 5 45 17 1 0 35 43 9 137 485 1,053 8 127 113 165
Escambia........... 4 12 3 1 0 157 13 2 50 125 428 10 27 32 58
Flagler .............. 0 0 0 0 6 0 0 4 14 0 3 2 2
Franklin ....... 1 0 0 1 0 12 1 0 5 7 25 0 1 0 1
Gadsden ............ 3 2 1 0 0 32 8 0 14 43 89 4 9 11 17
Gilchrist.................. 0 0 0 0 3 1 0 3 3 11 0 3 0 1
Glades............ 0 0 0 0 0 0 0 0 1 2 2 2 4
Gulf................. 1 1 0 0 14 0 0 2 10 20 0 4 2 3
Hamilton............ 1 0 0 0 4 8 0 5 11 31 0 3 2 8
Hardee.......... ... 2 0 0 2 1 0 4 11 33 2 10 11 4
Hendry............. 1 0 0 0 0 4 0 0 4 16 0 1 2 5
Hernando ........... 0 1 0 0 0 15 1 1 7 16 4 2 4 6
Highlands ......... 1 1 1 0 0 89 8 2 5 2 86 2 10 6 12
Hillsborough......... 6 80 6 2 1 07 56 10 7 331 1,207 30 96 89 143
Holmes............. 0 0 0 0 0 13 2 0 1 15 48 0 5 7 5
Indian River........ 0 0 1 0 0 33 3 0 9 21 96 1 10 9 11
Jackson............. 1 3 0 2 0 32 2 0 12 66 88 8 13 12 14
Jefferson ............ 0 0 0 0 0 1 2 0 8 23 4 1 4 3 6
Lafayette ........... 0 0 0 0 0 2 0 0 0 2 16 0 0 0 0
Lake................ 1 2 2 0 0 74 1 1 29 61 224 4 23 14 23
Lee.................. 2 5 0 0 0 59 6 2 10 37 150 3 16 13 18
Leon................ 2 1 0 0 61 3 0 25 72 118 7 16 14 26
Levy............... 1 0 0 0 0 17 1 0 5 18 42 0 5 4 4
Liberty. ............. 0 0 0 0 0 0 0 2 2 10 0 1 0 0
Madison... ......... 0 0 1 0 0 8 3 1 8 20 67 3 2 2 16
Manatee ......... 1 2 0 0 0 100 1 2 3 95 15 5 41 21 17
Marion .............. 0 2 2 0 0 57 11 2 26 70 200 11 18 19 29
Martin .............. 1 0 0 0 29 0 0 4 25 6 3 6 4
Monroe ......... 0 1 0 0 0 50 5 0 12 38 64 3 6 7 12
Nassau ............. 1 0 0 0 21 4 0 8 24 36 0 4 2 2
Okaloosa............ 1 4 0 0 0 29 1 0 10 25 68 3 7 15 21
Okeechobee .......... 1 0 0 0 1 0 0 3 6 8 0 1 8
Orange ............. 8 20 4 0 2 294 2 6 74 265 796 17 72 48 76
Osceola.............. 2 0 0 0 82 2 1 10 39 124 2 18 4 8
Palm Beach......... 4 7 5 0 0 39 0 60 263 744 7 58 79 65
Pasco ............... 1 8 1 0 0 6 7 1 8 49 158 1 21 14 10
Pinellas ............. 22 9 0 0 912 65 12 123 674 1,958 27 182 59 119
Polk................ 4 6 0 0 1 243 19 6 47 205 563 15 56 44 64
Putnam.............. 1 0 0 0 51 6 2 11 39 134 19 7 10 22
St. Johns............ 0 2 1 0 0 44 7 0 12 30 108 1 11 6 17
St. Lucie............ 1 0 0 0 0 52 2 1 14 45 113 3 14 13 13
Santa Rosa........... 0 2 0 0 0 18 1 0 6 32 55 4 10 10 7
Sarasota ............. 0 1 2 0 0 128 13 0 19 81 311 5 29 17 23
Seminole ............ 1 1 1 2 1 53 6 2 12 36 137 10 12 11 26
Sumter.............. 0 1 0 0 0 9 2 1 5 18 88 0 4 1 5
Suwannee .. ..... 0 1 0 0 0 2 1 0 7 27 56 2 7 4 8
Taylor............... 0 0 0 0 0 1 0 0 7 23 22 3 4 3 7
Union ...... .. 0 1 0 0 0 101 0 0 6 20 0 2 2 2
Volusia.............. 1 6 2 0 0 241 29 2 38 212 612 11 66 43 47
Wakulla............. 0 1 0 0 5 1 0 5 11 14 0 2 3 5
Walton.............. 8 1 0 0 0 14 0 0 10 31 48 3 3 5 6
Washington.......... 0 1 0 0 0 10 0 0 3 24 30 0 4 5 8
'Includes all vascular lesions affecting the central nervous system.

70 ANNUAL REPORT, 1959

TABLE 12

MARRIAGES BY RACE, DIVORCES, AND ANNULMENTS

FOR FLORIDA, AND EACH COUNTY, 1959

MARRIAGES
COUNTY Divorces Annulments
Total White Nonwhite
STATE ....................... 38,588 31,607 6,981 19,363 187
Alachua....................... 453 341 112 182 2
Baker......................... 65 52 13 121
Bay.......................... 637 440 97 257
Bradford..................... 94 78 16 88 3
Brevard ....................... 726 606 120 732 4
Broward ...................... 2,482 1,980 602 983 8
Calhoun....................... 39 89 0 41
Charlotte...................... 99 93 6 49 3
Citrus ........................ 107 92 15 71
Clay.......................... 142 111 31 81
Collier........................ 139 133 6 39
Columbia ...................... 168 122 46 73
Dade.................. ....... 8,127 6,976 1,151 4,593 54
DeSoto....................... 129 102 27 26 1
Dixie ......................... 40 31 9 15
Duval ........................ 2,684 2,043 641 1,621 7
Escambia ...................... 1,478 1,191 287 767 17
Flagler........................ 68 47 21 224 2
Franklin....................... 54 41 13 25
Gadsden....................... 179 87 92 61
Gilchrist....................... 47 39 8 7
Glades........................ 34 19 15 9
Gulf .................. ....... 89 71 18 59
Hamilton .... .................. 74 55 19 34
Hardee........................ 169 148 21 255 6
Hendry....................... 137 112 25 47
Hernando.................... 142 128 14 54 1
Highlands ..................... 199 132 67 84 2
Hillsborough ................... 3,413 2,882 531 1,633 10
Holmes....................... 112 104 8 69
Indian River .................. 213 161 62 53
Jackson....................... 183 135 48 81 1
Jefferson..................... 63 24 39 10
Lafayette ...................... 22 19 3 3
Lake.......................... 484 357 127 722 7
Lee .......................... 857 299 58 190 2
Leon.......................... 463 316 147 219 5
Levy ................... ....... 88 56 32 24
Liberty ....................... 10 10 0 8
Madison ...................... 73 53 20 23
Manatee....................... 493 398 95 137 1
Marion...................... 411 295 116 92 1
Martin........................ 151 113 38 46 1
Monroe ...................... 450 407 43 260 5
Nassau........................ 75 65 10 34
Okaloosa..................... 329 306 23 254 5
Okeechobee ................... 67 61 6 27
Orange........................ 2,062 1,693 369 281
Osceola....................... 247 195 52 2
Palm Beach ................... 1,690 1,297 393 752 3
Pasco......................... 370 337 33 135 4
Pinellas ...................... 2,712 2,407 305 1,056 10
Polk.......................... 1,794 1,478 316 747 9
Putnam ...................... 244 174 70 513 3
St. Johns...................... 233 170 63 173 1
St. Lucie ...................... 335 222 113 140 1
Santa Rosa .................... 234 216 18 75
Sarasota....................... 555 501 54 257 2
Seminole...................... 402 278 124 162
Sumter .................. ..... 129 103 26 103 1
Suwannee ..................... 113 92 21 51
Taylor .......... .............. 100 82 18 28
Union ......................... 50 37 13 42
Volusia ........................ 949 783 166 502 5
Wakulla ....................... 45 31 14 0
Walton ....................... 93 84 9 33
Washington ................... 73 57 16 28

VITAL STATISTICS 71

TABLE 13

FLORIDA STATE BOARD OF HEALTH VITAL STATISTICS
SCOREBOARD BASED ON PROMPTNESS AND COM-
PLETENESS OF CERTIFICATES FILED IN 1959
Percent of Percent of Percent of
Certificates Complete Monthly Total Score Change
COUNTY Rank Filed on Time Certificates Reports (Maximum from 1958
Submitted = 500) Total Score
Births Deaths Births Deaths on time
Glades.......... 1 100.0 100.0 100.0 100.0 100.0 500.0 +67.4
Duval........... 2 99.8 99.9 99.9 99.8 100.0 499.4 + 7.0
Hernando........ 3 100.0 99.2 99.7 100.0 100.0 498.9 + 3.0
Jefferson......... 4 99.4 100.0 99.0 100.0 100.0 498.4 + 2.4
Baker........... 5 100.0 98.1 100.0 100.0 100.0 498.1 1.3
Hillsborough...... 6 98.3 99.6 99.9 99.9 100.0 497.7 + .6
Dade............ 7 97.5 99.9 99.9 99.8 100.0 497.1 + 0.4
Orange.......... 8 98.1 98.8 99.9 99.8 100.0 496.6 1.2
Citrus........... 9 98.5 100.0 99.2 98.8 100.0 496.6 .4
Sarasota ......... 10 99.3 99.7 99.1 98.4 100.0 496.5 + 0.2
Broward......... 11 97.2 99.9 99.4 99.6 100.0 496.1 0.3
Volusia.......... 12 98.6 98.5 99.4 99.5 100.0 496.0 + 1.9
Martin.......... 13 97.5 97.6 99.4 100.0 100.0 494.5 3.7
Suwannee........ 14 96.7 97.8 100.0 100.0 100.0 494.5 + 4.9
Seminole ......... 15 99.2 99.1 99.4 96.3 100.0 494.0 + 0.4
St. Lucie......... 16 99.6 95.6 99.5 98.8 100.0 493.5 0.5
Wakulla.......... 17 100.0 92.3 100.0 100.0 100.0 492.3 5.8
Escambia ....... 18 94.2 98.2 99.7 99.5 100.0 491.6 +16.3
Franklin ......... 19 98.8 98.6 99.4 94.3 100.0 491.1 1.4
Polk............. 20 93.6 97.4 99.7 99.6 100.0 490.3 + 9.4
Hardee........... 21 94.0 97.9 100.0 97.9 100.0 489.8 +11.0
Washington...... 22 97.6 95.0 97.1 99.0 100.0 488.7 +18.2
Pinellas.......... 23 90.0 98.5 99.8 99.8 100.0 488.1 + 2.0
St. Johns........ 24 97.6 98.2 99.7 99.1 91.7 486.3 + 1.5
Alachua.......... 25 92.8 94.7 99.7 98.5 100.0 485.7 + 9.1
Calhoun.......... 26 92.3 98.0 97.1 98.0 100.0 485.4 +26.6
Holmes ......... 27 96.3 92.7 96.3 100.0 100.0 485.3 +16.4
STATE...... 93.7 97.2 99.6 99.4 94.7 484.6 + 3.1
Gulf............. 28 95.4 93.4 99.0 96.7 100.0 484.5 4.0
Manatee ......... 29 97.9 98.0 98.9 97.4 91.7 483.9 0.9
Putnam.......... 30 93.6 88.8 99.6 99.6 100.0 481.6 + 4.8
Levy............ 31 89.9 93.6 98.7 98.7 100.0 480.9 + 4.0
Madison......... 32 85.4 99.1 97.0 99.1 100.0 480.6 4.4
Walton.......... 33 90.7 90.1 100.0 99.3 100.0 480.1 1.0
Palm Beach ...... 34 83.0 97.8 99.8 99.3 100.0 479.9 + 1.0
Brevard.......... 35 86.3 93.2 99.3 99.7 100.0 478.5 +14.9
Flagler........... 36 100.0 97.6 100.0 97.6 83.3 478.5 +13.3
DeSoto .......... 37 98.7 97.6 100.0 98.4 83.3 478.0 3.4
Taylor........... 38 86.8 99.2 96.3 95.2 100.0 477.5 + 3.8
Osceola. ......... 39 84.4 96.2 97.8 98.5 100.0 476.9 -12.5
Indian River...... 40 98.7 97.7 98.5 98.5 83.3 476.7 +46.8
Hamilton.......... 41 91.6 87.5 98.9 98.6 100.0 476.6 +14.6
Gadsden......... 42 82.6 94.8 99.1 99.6 100.0 476.1 + 2.2
Monroe ......... 43 89.6 88.2 99.6 98.6 100.0 476.0 +12.1
Highlands........ 44 89.5 95.2 98.9 98.2 91.7 473.5 6.3
Clay............. 45 86.0 95.0 99.5 97.5 91.7 469.7 -14.1
Okeechobee....... 46 80.7 90.0 98.2 100.0 100.0 468.9 -11.7
Santa Rosa....... 47 92.6 84.7 99.7 100.0 91.7 468.7 +15.0
Okaloosa......... 48 85.9 81.7 99.0 99.1 100.0 465.7 +46.5
Bradford......... 49 95.1 96.3 99.0 100.0 75.0 465.4 +17.0
Lake............. 50 88.5 78.5 98.8 98.8 100.0 464.6 6.3
Union............ 51 85.7 90.7 95.7 98.1 91.7 461.9 +29.9
Charlotte.......... 52 65.2 93.6 98.3 99.2 100.0 456.3 -20.6
Bay............. 53 79.3 78.1 99.7 98.3 100.0 455.4 9.2
Nassau........... 54 87.2 94.5 98.5 99.2 75.0 454.4 -33.9
Leon............. 55 92.5 88.8 99.1 98.9 75.0 454.8 +23.3
Jackson.......... 56 83.4 77.0 99.5 99.6 91.7 451.2 +14.2
Lafayette ........ 57 77.3 93.3 95.5 100.0 83.3 449.4 + 8.8
Hendry .......... 58 52.4 96.8 97.3 100.0 100.0 446.5 +29.9
Dixie. ............ 59 61.8 100.0 96.4 94.1 91.7 444.0 -11.2
Collier........... 60 67.8 90.8 100.0 100.0 83.3 441.4 +27.3
Sumter........... 61 65.6 75.0 100.0 100.0 100.0 440.6 + 8.8
Pasco............ 62 74.8 88.8 97.5 98.6 75.0 434.7 -22.6
Gilchrist......... 63 59.1 75.0 100.0 100.0 100.0 434.1 -45.8
Marion........... 64 61.5 85.6 97.9 98.7 83.3 427.0 0.7
Lee............... 65 64.4 88.5 98.2 97.6 75.0 423.7 + 0.4
Columbia......... 66 74.8 84.8 100.0 98.4 58.3 416.3 -35.7
Liberty. ......... 67 58.3 60.0 91.7 100.0 75.0 385.0 -67.8

72 ANNUAL REPORT, 1959

BUREAU OF MATERNAL AND CHILD HEAf
S. D. DOFF, M.D., M.P.H., Directc
E. L. FLEMMING, Ed.D., Assistant

VITAL DATA

The year of this report marks the end of a decade chara,
in Florida by many interesting changes having important imp
for this bureau. During the decade the proportion of our po;
in the age groups from birth to age 19 has increased at a rate
exceeding that of "the aged" -65 and over, reaching close to
cent of the total population in 1959.
Comparison of 1940-49 and 1950-59 shows that the former )
average birth rate of 21.5 per 1,000 population and an average
death rate of 43.3 per 1,000 live births, and the decade just en
average birth rate of 24.5 and an average infant death of 31.8.
Most of the decrease in infant mortality is of course due to better
control of infectious diseases. The progress that can still be made in
this area seems to be limited. As Table 14 shows we appear to have
reached a point beyond which further decreases may not be achieved
except by unusual application of existing programs or the designing of
new programs bearing particularly on neonatal health problems.

TABLE 14

RESIDENT INFANT DEATHS AND NOTES -PER 1000
LIVE BIRTHS BY RACE, FLORIDA 1950-59

TOTAL WHITE NONWHITE
YEAR
Deaths Rate Deaths Rate Deaths Rate
1959*.................... 8,537 31.4 2,046 25.1 1,491 48.2
1958...................... 3,425 31.7 1,924 24.6 1,501 50.2
1957...................... 3,317 32.0 1,827 24.4 1,490 51.6
1956...................... 3,090 31.8 1,652 23.7 1,438 52.2
1955...................... 2,649 29.7 1,476 23.0 1,178 46.8
1954...................... 2,654 31.3 1,526 24.8 1,128 48.5
1953...................... 2,487 31.1 1,418 24.3 1,069 49.0
1952..................... 2,526 34.0 1,385 25.8 1,141 55.3
1951...................... 2,329 33.1 1,362 27.0 967 48.4
1950...................... 2,078 82.8 1,225 26.8 853 45.7
*Preliminary Data
Death records and sickness rate (morbidity) reporting have been
useful for many years as indicators of the more serious public health
problems and as indices of progress in prevention and control. These
indices alone no longer suffice.
Among reportable communicable diseases, the most important are
shown below together with the number of deaths due to each among
children under 15 (1958 data latest available).

MATERNAL AND CHILD HEALTH

Cases Reported Deaths

Diphtheria
Dysentery A & B
Gonorrhea
Infectious Hepatitis
Meningococcus M
Salmonellosis
Tetanus
Tuberculosis active
Typhoid Fever
Measles
Chicken pox
Mumps
Polio

54
188
236
88
70
82
20
59
9
12,514
not available
2,702
161

Among nonreportable diseases for the year (1958) sele
shown for deaths only among children under 15.

Heart Disease
Congenital Malformations
Certain Diseases of Early Infancy (including prematurity)
Accidents (excluding motor vehicle)
Malignant Neoplasms

.cted ones are

Deaths
28
477
2034
397
72

With the exception of cancer which is reportable, the presence of
uncounted thousands of children with moderate to severe disabling
disease of a chronic or lethal type can be suspected in Florida from the
annual reports of state agencies prodiving special services to them.

Agency
Florida Crippled Children's Comn
Florida Council for the Blind
Sunland Training Center
State School for the Deaf and B

(1958) Children Served or Domiciled
mission 1600 (hospitalized)
604 patients
2000 (waiting list 1600?)
lind 711 pupils

The need for reasonably accurate reporting of certain noninfectious
diseases is critical and methods of collecting such data must be developed.
In the collection of vital data we stand somewhat in the same relation
to current public health problems as did public health workers in the
early 1900s before expansion of birth registration areas.
If the population explosion in Florida portends any serious problems
for the state we believe they are to be found in the growing burden
of young persons chronically sick with diseases against which preventive
measures must be developed, treatment and rehabilitative services
organized.

74 ANNUAL REPORT, 1959

CHILD HEALTH
The preventive aspects of obstetrics and pediatrics and their appli-
cation in public health and child welfare are the stock in trade of this
bureau and of County Health Departments engaged in public health
activities for children.
The preventive programs of the past year are here outlined in
relation to the period in child growth and development which they
primarily serve and to available morbidity and/or mortality data.

MATERNAL HEALTH (Fetal Health)
In 1958 there were 1812 stillbirths (fetal deaths). These deaths
sometimes referred to as "fetal wastage" are part of a continuum which
includes the over 2000 deaths due to diseases of early infancy, more
than 500 deaths due to congenital malformations and a few thousand
survivors with these diseases as a chronic condition.
Careful attention to the health of pregnant women and prevention
of common complications of pregnancy result in fewer interruptions
of pregnancy, fewer stillbirths, less premature births and a lower incidence
of deformities and birth injuries. Prenatal clinics of County Health
Departments provided preventive services to 12,000 indigent or medically
indigent pregnant women during the year, or approximately 10 per cent
of all reported pregnancies. Each made an average of 3 visits to
the clinic in the antepartum period. However, only 3690 women (a little
more than one-fourth of those attending prenatal clinics) were given
postpartum medical examinations. One may raise the question whether
maternal health programs of County Health Departments, particularly
prenatal clinics, are provided out of a great concern for the health of the
fetus and the production of healthy offspring and a lesser concern for
the health of the mother.
Maternal deaths are at the lowest level in our history of record-
keeping with a preliminary total of 57 maternal deaths in 1959, a rate
of 5.1. Our maternal death rate for white women was 2.1 which is lower
than the national average. These low rates are related to the fact that
about 93 per cent of all births took place in hospitals. While further small
decreases in the maternal death rate can be anticipated as facilities for
obstetrical care improve, it is essential that future studies in the field of
maternal health be designed to record maternal morbidity in addition
to maternal mortality as an index of progress. It is a reasonable hypo-
thesis that the very low maternal death rate is an indication of the
ability of physicians using modern methods of treatment to prevent death.
The midwife still provided a large portion of obstetrical care in
Florida as indicated by some 7000 midwife-attended births in homes.
Almost all of these births are in women who have attended prenatal
clinics of County Health Departments. Licensure and close supervision
of midwives by county health officers gives reasonable assurance of safe

MATERNAL AND CHILD HEALTH

childbirth for pregnant women who choose to have their babies at home.
Continuing efforts of our county health officers to evolve workable
low-cost maternity plans will lead to an even larger percentage of hospital
deliveries than previously. However, midwives must be provided with the
opportunity for continual inservice training under the immediate super-
vision of physicians. Better methods of recording the events of births
attended by midwives must be developed.

INFANT HEALTH
During 1958 there were 108,014 births, a rate of 24.3 per 1000 popu-
lation. In the same period 3425 infant deaths were recorded of which
2365, more than two-thirds, occurred in the first month of life, the
neonatal period. Our inability to effect any substantial reduction in
the infant death rate during 1950-59 is due to failure of medical science
as yet to find effective tools for prevention of the chief causes of neonatal
deaths.
TABLE 15
Neonatal Deaths from Selected Causes 1958
Congenital Malformations 240
Birth Injury 298
Accidents 19
Postnatal Asphyxia and Atalectosis 600
Pneumonia of Newborn 113
Diarrhea & other infections 52
Hemolytic Disease 46
Nutritional Maladjustments, etc. 217
Immaturity* 615
*Immaturity is an associated cause in the majority of all neonatal deaths.
The number of survivors of these and other diseases of the newborn is
unknown.
Among infants between 1 and 12 months of age, the main causes
of death were diseases of the respiratory and gastrointestinal system, con-
genital malformations and accidents due to inhalation or the ingestion
of food or other objects causing suffocation or obstruction, accidents
causing mechanical suffocation in bed or cradle and other accidents.
Health department preventive programs for infants are represented
by prenatal clinic services described above and the well child medical
conferences which served 9,820 infants in 1959. Among the newly born
careful examination is made to detect defects in development. Mothers
are instructed concerning the hazards to infants in the first month.
Feeding problems receive major attention.
Prematurity and related disorders of newborn were given special
attention by the Premature Demonstration Center of Jackson Memorial
Hospital, Miami. In its tenth year of operation 230 premature infants

76 ANNUAL REPORT, 1959

were hospitalized under the Premature Demonstration Program of this
bureau for a total of 5752 hospital days. This is slightly less than half
the number of infants cared for in the Center during the year, which
would mean that the number of hospital days would be approximately
twice that given above. During 1959 two five-day seminars on care of
premature infants were given by the Center staff. Seventy-two hospital
nurses and 8 physicians attended. This brings to 142 the number of
nurses and to 30 the number of physicians who have attended these
postgraduate training programs started in 1958. Nurses came from
hospitals in all major cities of Florida, with approximately 50 per cent
coming from hospitals having a capacity of less than 100 beds. Two
crossroads clinics on care of the premature infant were given by the
special project staff for 20 physicians and 175 nurses working in rural
hospitals having 25-50 beds. The Premature Demonstration Center has
now been designated to serve as a regional training center and will offer
a three-week postgraduate course in 1960. This project has stimulated
moderate progress in construction of premature nurseries in hospitals
but available facilities are still seriously inadequate. In 1959 nine per
cent of 110,000 live births were recorded as premature. Fifteen hundred
infant deaths were attributed to prematurity.

PRESCHOOL YEARS 1 4
In programming for this period of life County Health Department
personnel put major emphasis on prevention of pneumonia, meningitis
and other infections and accidents. Congenital malformations and the
frequent appearance of neoplasms are also noted.

TABLE 16
Deaths from Selected Causes Age 1- 4 (1958)
Deaths Percentage of All Deaths
Total (all causes) 588 100
Infectious Diseases 179 30.4
Congenital Malformations 65 11.1
Malignant Neoplasms 28 4.8
Accidents (Excluding
motor vehicle) 124 21.1
In 1958 County Health Departments admitted to well-child medi-
cal service 11,000 children age 1-4 mostly of indigent families. Nurses
held 27,000 child health conferences. Immunizations were given against
smallpox, diptheria, whooping cough, tetanus, poliomyelitis and typhoid
fever. During the year this bureau, with the Division of Health In-
formation, prepared a number of spot announcements which urged the
examination and immunization of all preschool children. These were
distributed to newspapers, radio and TV stations and were read or
heard daily during the summer months.

MATERNAL AND CHILD HEALTH

Table 16 emphasizes the importance of teaching accident prevention
to mothers of children 1-4. In 1959 thousands of special leaflets were
distributed calling the attention of parents to the most common causes
of accidents in this age group. This was done in cooperation with the
Florida Pediatric Society by the petiatric consultant of this bureau.
Currently neither vital records nor morbidity reports make any ref-
erence to a child health problem of growing importance commonly
recognized in the preschool child. This is represented by the steady ac-
cumulation of serious growth and development defects, many attended
by moderate to severe degrees of mental retardation. These are of deep
concern as well to the state training institutions and the State Depart-
ment of Education.
The special project in mental retardation, the Developmental
Evaluation Clinic, Miami, is now in its second year, accepting pre-
school children suspected of mental deficiencies for developmental
evaluation on referral from physicians. Operational research in early
detection, diagnosis and management of cases is carried on. A pedia-
trician, psychologist, public health nurse and social worker are studying
problems of mentally retarded children in a family and community
setting. Particular attention is being given to development of public
health nurse roles. An interesting feature of the first report of the clinic
showed 22 per cent of referrals had I.Q.s in the normal range.

CHILD HEALTH 5-14 YEARS
That the years between 5 and 14 represented a period of relative
good health is indicated by the vital records. Accidents caused about
half of all deaths in this period, and malignant neoplasms 9 per cent.
However, marginal defects, many of which were not detected in the pre-
school period and which often lead to serious disability in later years,
were commonly found.
Preventive medical programs of the County Health Departments
with the schools of Florida provided 523,000 separate screening examina-
tions. Approximately 55,000 of the screening tests required referral for
further diagnosis. Careful teacher observation of pupils often discloses
signs leading to the discovery of important defects. Vision, hearing and
dental defects were most common. Especially troublesome is the frequency
of mental health problems among children at this phase. About 5500
children were admitted to the mental health services of County Health
Departments last year. Child guidance clinics reported 2640 children'
ages 5-13 were discharged in 1959.
Formal health instruction is started during these years. To improve
such instruction in schools, the Teachers Project in Health Education
gave public health instruction to 69 teachers in the summer of 1959.
Twenty-four County Health Departments joined with the University
of Florida, Florida State University, University of Miami and Bethune-
Cookman College. The health educator of this bureau coordinated

78 ANNUAL REPORT, 1959

various aspects of the project (initiated in 1955) with the cooperation
of local Boards of Public Instruction, the State Department of Educa-
tion, voluntary health agencies and the Division of Health Information.
In view of the frequent occurrence of accidents and of accidental
deaths, parents and children are educated to accident hazards by dis-
tribution of pamphlets prepared especially for children 5 to 14 years of
age.
CHILD HEALTH 15-19
Preventive medical services have not been fully developed for the
adolescent. Preliminary observations in a junior-senior high school were
made in 1959 by a team of State Board of Health consultants working
with a County Health Department public health nurse and sanitarian.
Dental defects appeared to be more common than in the 5-14 age group.
Serious mental health problems were evident. Physical defects were not
frequent. Nutrition studies indicated preference for foods deficient in
vitamin C.
An interesting aspect of the study was the high interest students
showed in health information beginning with those in the ninth grade.
This suggested that more intensive instruction in health and preventive
aspects of disease should be given at this time.
Difficulties in social adjustment to the school environment were
common. Ill effects of unfavorable home conditions were revealed. These
findings may be related to the results of a separate study by the State
Board of Health, 1953, of vital records which showed that 22 per cent
of all births among mothers age 19 or under were illegitimate. In 1958
there were 18,232 infants born to mothers age 19 and under.

HEALTH SERVICES FOR MIGRATORY
AGRICULTURAL WORKERS
The special project to develop health services for migrants is now
in its third year. Personnel engaged in this project includes 6 public
health nurses, a medical social consultant, health educator, liaison
worker, sanitarian, nutritionist, two clerks and 6 physicians (part-time)
who offer comprehensive health services to the migrant and his family,
but mainly to mothers and children.
As a direct result of the team's study of the problems of the mi-
grants, several new service programs are now offered. Perhaps the most
significant is that of low-cost maternity care. In this program, the
migrant mothers are given regular prenatal examinations in a clinic
setting, are delivered in the hospital and provided with a postpartum
check-up 6 weeks after delivery. Medical fees and hospital costs are com-
patible with income of migrant laborers.
The sanitarian's study and reports of housing conditions at the mi-
grant labor camps were helpful in the preparation of House Bill 269
(Chapter 59-476) which was made law in the 1959 session of the Legis-
lature. This law which defines migrant labor camps requires that such
camps be licensed in accordance with Chapter XXV of the Sanitary

MATERNAL AND CHILD HEALTH 79

Code of the State of Florida. Its enforcement has brought about better
housing conditions for migrants.
The health educator, nutritionist and liaison worker have developed
an educational leaflet series on child care, accident prevention and gen-
eral health. Formal instruction has been made available to family
groups of migrants and to pregnant women by the organization of eve-
ning meetings, in order to obtain as large an attendance as possible.
A comprehensive report of the progress made by the team during
its 3 years of study was prepared by the team members. This booklet,
entitled "Migrant Project 1959" has been widely distributed and en-
thusiastically received by other state agencies, legislators, educators and
many health and welfare groups throughout the state, as well as other
states interested in problems of agricultural migrants. The report has
found its way to foreign countries through the Children's Bureau.

NINTH ANNUAL POSTGRADUATE
OBSTETRIC-PEDIATRIC SEMINAR
The ninth annual seminar was held at Ormond Beach under the
sponsorship of the Bureaus of Maternal and Child Health of the State
Health Departments of Florida, Georgia, Alabama and South Carolina,
the Florida Academy of General Practice and the Maternal Welfare Com-
mittee of the Florida Medical Association. Physician interest in the three-
day seminar continues to grow as indicated by Table 17.

TABLE 17
ANNUAL POSTGRADUATE OBSTETRIC-PEDIATRIC
SEMINARS 1951-59
ATTENDANCE ACCORDING TO PROFESSIONS

PROFESSION 1951 1952 1953 1954 1955 1956 1957 1958 1959
Physicians ..................... 195 187 174 179 196 24 278 272 345
Nurses............. ........... 7 1 77 96 102 88 118 135 98
Nutritionists & other............ 6 8 2 7 4 3 5 1 24
TOTAL ATTENDANCE... 208 226 253 282 302 845 401 408 467

TABLE 18
1959 POSTGRADUATE OBSTETRIC-PEDIATRIC SEMINAR
REGISTRATION BY STATES

STATE Doctors Nurses Others Total

Alabam a....................................... 46 3 0 49
Georgia ........................................ 79 8 2 84
South Carolina.................................. 37 3 0 40
Other States .................................... 11 0 0 11
Florida......................................... 172 89 22 283
TOTALS................................ 345 98 24 467

80 ANNUAL REPORT,

MENTAL RETARDATION
The problem of mental retardation in Flo-
cantly during the year 1959. Of the 108,014 ba..
it is an educated guess that 3 per cent, or abou,
tarded. Mortality figure indicates not over 1600 r.
died during the year. Thus, at least 1700 mental re
Florida's 1959 child population. Of these 1700 it is'
sufficiently retarded to require institutionalization.
will need to build a new institution the size of the Sunk
at Gainesville every 6 years just to handle severely I
We still add about 1360 mentally retarded children requI
ing and education to our local communities. Parents, afte;
the initial shock of having a mentally retarded child, he.
sources to help them understand their child and their role
It has been felt that County Health Department person.
much to help parents of mental retardates.
To this end a two-day training and orientation program has been
developed which has been attended by health, welfare and education
personnel. A full time public health nurse consultant has been assigned
to work with the consultant on child growth and development in or-
ganizing and presenting the orientation sessions. During 1959 three of
the two-day training programs were held at Sunland Training Center. In
addition to these programs a one-day seminar in mental retardation
was developed and tested in one of the local health departments. In light
of the enthusiastic response to this seminar, it will be made available to
all County Health Department personnel.

CONSULTATION SERVICES
Discussion groups on problems encountered in rearing healthy chil-
dren were held in various parts of the state by the consultant on child
growth and development. A total of 94 seminars reaching approximately
4000 parents, educators and health personnel were held during 1959.
They were sponsored by Parent-Teacher Associations, Woman's Clubs,
schools and County Health Departments. Their aim was achievement
of a greater understanding of child behavior with the hope that this
knowledge would reassure the adults of their skills in handling children
and free them from the tension produced by ignorance. While it is dif-
ficult to measure the results of this program, there is evidence that the
people exposed to the training are prone to consider the child as an in-
tegrated physical-psycho-social organism reacting to the various stresses
rather than a bad child or a sick child.
A pediatric consultant was added to the central office staff in July
1959 and has begun an evaluation of County Health Department well
child medical conferences and school health programs, and other
activities involving preventive medical services for children including
development of accident prevention education materials.

MATERNAL AND CHILD HEALTH 81

PUBLICATION
Migrant Project 1959: a 55 page report of 3 years study and de-
velopment of health services for migrant agricultural workers.

Article by staff member:
Doff, S. D., and Turner, J. S., Jr.* Rheumatic Fever Below Age
Five. J.Florida M.Asso. 45:1416-18, June 1959.
*Asst. Surgeon, USPHS assigned to Heart Disease Control Program of the Florida
State Board of Health from 1956-1958.

82 ANNUAL REPORT, 1959

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

During 1959 the bureau and all its divisions, save one, had changes
in directorships. From the U. S. Public Health Service 2 physician-
trainees were assigned to the Division of Epidemiology. A new position
of Special Research Epidemiologist was established.

Two important new programs as major extensions of old programs
were made during the year. The increasing importance of radiological
health in public health was recognized by the official change in name of
the Division of Industrial Hygiene to the Division of Radiological and
Occupational Health, with significant increases to its staff. Under a grant
from the National Institute of Health the program of study of atypical
tuberculosis infections was expanded into a full research project.

The Venereal Disease Control Program was incorporated into the
administrative structure of the Division of Epidemiology, recognizing
its important part and place in general communicable disease control
activities.

As a bureau, interests and efforts had a major orientation toward
those preventable diseases which are communicable. Tuberculosis and
syphilis continue to be the most difficult to control, thereby presenting
the greatest problems both in numbers of cases and control efforts. De-
spite this, the decline in these diseases as a cause of death or disability
over the past 50 years has been dramatic. Certain communicable diseases
for which there are effective preventive measures continue to embarrass
us by their presence. These include tetanus, diptheria, whooping cough,
parasitic diseases, poliomyelitis and typhoid fever. Others, which were
a significant source of trouble only 15 years ago, are essentially absent
and require only suppression and surveillance for sporadic cases. Amongst
these are malaria, typhus, brucellosis and milk-borne disease. In con-
trast to past years, the viral diseases are requiring careful investigation
and research. Many are newly diagnosable with laboratory techniques
not available 5 years ago; some are newly detected diseases in Florida;
others are perhaps even new disease agents for man. All require new
skills in prevention and control.

Certain diseases of concern to the bureau are preventable if only
facts and ideas can be made more communicable. These are the oc-
cupational diseases, of increasing importance due to Florida's rapid
industrial growth. In radiological health a unique situation is encountered
in preventable disease. As yet no significant diseases of public health
importance have occurred due to radiation hazards, and for the first
time a public health program is given an opportunity to prevent even
the environmental hazard from which disease could ensue.

PREVENTABLE DISEASES

The bureau went to some effort to strengthen its relationship with
the County Health Departments in Florida. An orientation program, con-
trasting with the usual one but complementary to it, was carried out
wherein the new division and program directors spent time in certain
counties learning the duties, responsibilities and problems of County
Health Departments. The usual orientation programs are held in Jack-
sonville with County Health Department personnel gaining an acquaint-
ance with the state programs. Although the bureau gives some direct
services to local units through X rays, laboratory services, biologicals or
inspections, by far the greatest time and contribution is in cooperative
consultation and teamwork with County Health Departments in carrying
out programs.
Looking toward another health agency neighbor, the relationship
with the communicable disease control activities of the U. S. Public
Health Service were further improved. Besides the full time assistance
of an Epidemic Intelligence Service Officer, (USPHS) 3 major investi-
gations were carried on in conjunction with the Communicable Disease
Center, and one with the Tuberculosis Division of the Bureau of Special
Health Services (USPHS). Two full time PHS physicians and one vet-
erinarian have served in special programs in venereal disease control,
radiological health and veterinary public health.
Within the bureau frequent cooperative activities are carried on.
To mention only a few would include the loan of an X ray technician
by the Division of Tuberculosis Control to the radiological survey team:
the survey of mobile X ray units for safety by the Division of Radio-
logical and Occupational Health; the cooperative study of bovine
tuberculosis suspected of human origin by the Divisions of Veterinary
Public Health and Tuberculosis Control; the field investigation of en-
cephalitis and polio by general disease investigators; the cooperative
investigation of brucellosis and leptospirosis by Veterinary Public Health
and Epidemiology. In these and many other ways the 4 divisions func-
tion as an integral unit in Florida's public health program.

DIVISION OF EPIDEMIOLOGY
ROBERT E. MARKUSH, M.D., M.P.H.
Acting Director
JAMES F. MOLLOY, D.D.
Assistant Epidemiologist
SPECIAL COMMUNICABLE DISEASE ACTIVITIES
POLIOMYELITIS
Reported cases of poliomyelitis declined from 252 in 1958,
to 197 in 1959. While the number of non-paralytic and unspecified
cases dropped sharply from 155 in 1958 to 65 in 1959, paralytic cases
increased from 97 to 132. In 1958, Dade County, and perhaps other
areas in the state as well, began to report as aspetic meningitis what

84 ANNUAL REPORT, 1959

formerly had been diagnosed as non-paralytic poliomyelitis. Despite
this, outbreaks of aseptic meningitis that the state experienced in 1958
apparently permitted a drop in reported cases of this syndrome from 349
in 1958 to 143 in 1959. The total of non-paralytic polio plus aseptic
meningitis, therefore, dropped 59 per cent, while the total of paralytic
cases increased 36 per cent.
Because of the severity of the disease, the availability of an effective
vaccine, and the interest of the public, the division again gave consid-
erable attention to poliomyelitis. Intense surveillance of reported polio-
myelitis, which the State Board of Health instituted last year in coopera-
tion with the U. S. Public Health Service, continued through 1959.
Although no epidemics were reported from the state, 4 special polio-
myelitis surveillance reports were prepared during the year. They were
designed to describe the epidemiological characteristics of the poliomye-
litis cases occurring in Florida. Because of difficulty in interpreting cases
diagnosed as non-paralytic, most conclusions were based on paralytic
rates. The first report (August) pointed out that the attack rate in male
children under age 5 years is strikingly high when compared to the rate
in other age groups and to the rate for females. In the nonwhite, more-
over, the discrepancy between male and female attack rates is far
greater than is true for the white. The second report (September) in-
cluded a breakdown suggesting that most paralytic cases occur in people
who have not been vaccinated. When only those cases with laboratory
confirmation were analyzed, as was done in a third report, the paucity of
cases among the vaccinated was even more striking. Except for a few
cases of Type III, the laboratory results indicate that most of the cases
were caused by Type I virus.
The final poliomyelitis surveillance report in 1959 (October) com-
pared the epidemiological pattern for 1959 with the two previous years.
It pointed out that the incidence among the white race has been con-
sistently higher than the nonwhite, despite the strikingly opposite
situation in the rest of the nation. The rates in males have been consist-
ently higher than the rates in females. There has been no marked change
in the past 3 years in the age-specific attack rates, except that the rates
in children under age 5 in both 1958 and 1959 were considerably higher
than in 1957. The past year differed from the 2 previous years in
the unusually large discrepancy between the male and female nonwhite
attack rates. The following are the comparable rates, per 100,000 popu-
lation for the 3 years:
1. By Color .1957 1958 1959
White 3.8 5.9 4.8
Nonwhite 2.7 5.2 2.8
Ratio 1.4 1.1 1.7
2. By Sex
Male 3.8 6.9 5.6
Female 2.3 4.7 3.3
Ratio 1.7 1.3 1.7

PREVENTABLE DISEASES

3. By Age
0-4 6.8 18.7 17.3
5-14 5.7 9.7 6.1
15-39 3.3 4.8 3.8
40+ 0.1 0.4 0.1
4. By Color-Sex
White
Male 3.9 6.9 5.8
Female 2.4 4.9 3.7
Ratio 1.6 1.4 1.5
Nonwhite
Male 3.4 6.8 4.4
Female 1.8 3.7 1.4
Ratio 1.9 1.8 3.1
A study of the seasonal variation in poliomyelitis during 1959
showed the usual sub-tropical pattern of a long season of increased inci-
dence without complete regression during the winter months. In 1959
it appeared that more paralytic cases occurred in the early months of
the year, compared to previous years and also compared to nonparalytic
cases. Although the reasons for this were not all apparent, the tendency
for non-paralytic central nervous system disease to both occur and be
reported as poliomyelitis is probably greater in the summer season. The
peak occurrence of reported poliomyelitis by week occurred in 1959 in
the first week of August, which is slightly later than expected based on
the seasonal pattern of recent years.

DIPHTHERIA
The year ended in Florida with a total of 83 reported cases
of diphtheria. This gave an attack rate of 1.9 per 100,000 population,
which is low for Florida, but still almost twice that of the nation. In
1959 there were 4 deaths in the state resulting from clinically diagnosed
diphtheria.
The 4 counties with the highest diphtheria case rates were Pasco,
Putnam, St. Johns and Duval. In this last county, a sharply localized
outbreak in October, occurring in Jacksonville, caused an abrupt rise
in cases which in turn gave Florida's diphtheria season an earlier start
than is usual. The outbreak was carefully investigated by the Jackson-
ville City Health Department and this division. The cases all came from
a small crowded section of the city. All were nonwhite, 90 per cent were
under 10 years of age, and 20 of 23 were unvaccinated. Due to the
crowded living conditions, person-to-person spread was considered the
most probable means of transmission. A patient with skin ulcers that
contained diphtheria organisms was discovered during the investigation;
she may have been responsible for several of the cases. The clinical di-
sease was not generally severe and there were no deaths. All organisms
isolated were of the mitis strain.

86 ANNUAL REPORT, 1959

A special diphtheria surveillance report was prepared during the
year which called attention to the high rates in Negroes, in children un-
der 10, in the unimmunized and in the areas of Tampa and Jacksonville.

INFECTIOUS HEPATITIS
Although infectious hepatitis has been reported as such in Flor
ida only since 1954, the 342 cases that were reported in 1959 rep-
resented more cases than in any of the other 5 reporting years.
The figures indicate that there has been a steady annual increase since
the low point in 1956. Because of the state's rapid population increase,
the rate per 100,000 this year is not so large as were the rates in the peak
hepatitis years, 1952, 1953 and 1954; the rates for 1952 and 1953 were
based on cases reported as "jaundice."
Increased numbers of cases reported from 4 counties accounted in
large part for the unusual incidence this year. In these counties, Brow-
ard, Duval, Hillsborough and Manatee, the division played varying roles
in investigation and surveillance.
The first outbreak investigated was that of 20 cases occurring at
Bradenton and Palmetto, in Manatee County, where cases were linked
through person-to-person contact and possibly through a contaminated
well. The second investigation was prompted by 5 cases occurring in an
elementary school in Duval County. In this instance, person-to-person
contact again appeared to be the mode of spread. A third investigation
was conducted in Broward County; an outbreak of 11 cases was traced
to personal contact between children living within an area of a few
blocks, many of whom rode the same school bus. In all these investiga-
tions, gamma globulin was recommended to those in close contact with
the clinical cases.
An outbreak of infectious hepatitis occurred early in December in
an elementary school in Ruskin, Hillsborough County. This was investi-
gated by the Hillsborough County Health Department.
Because of the increasing number of cases, a "Report on Hepatitis"
was issued in December. Analysis of the 308 cases occurring up to Decem-
ber 11 indicated an attack rate per 100,000 of 6.3 for the white and 8.1
for the nonwhite, which is not a significant difference. There was no
apparent difference in attack rates by sex, with 156 cases in males and
145 in females. Analysis by 10 year age groups indicated that the 10-19
year olds were at greater risk, with their 65 cases representing a rate per
100,000 of 10.4. More cases, however, occurred in those under age 10,
where the 78 cases gave a rate of 9.0 per 100,000. The rate in the 20
to 29 year olds was 8.2; in the older age groups the rates decreased to
a low of 2.3 for those over age 60.

VIRAL ENCEPHALITIS
Late in October, the Pinellas County Health Department re-
quested epidemiological aid from this division because of an increased

PREVENTABLE DISEASES 87

incidence of encephalitis. With the assistance of the Communi-
cable Disease Center of the USPHS, 72 cases were eventually clinically
confirmed. Two clinical syndromes were encountered; the first, and more
common, generally occurred in people over the age of 50 and consisted
of a fairly severe encephalitis. Except for 5 deaths, recovery generally
required 2-4 weeks. A second, less severe, syndrome was more common
in younger people and followed the pattern of aseptic meningitis. Be-
cause of the fairly general urban distribution, the high attack rate among
the elderly, the absence of infant cases, the relatively low case fatality
rate of about 7 per cent, and the virtual absence of known vectors of
Eastern Equine encephalitis, the epidemiological study suggested the
diagnosis of St. Louis encephalitis. The finding of rises in the titers of
antibodies against St. Louis encephalitis antigens by the complement
fixation, hemagglutination inhibition, or serum neutralizing tests for
arthropod-borne viruses in the sera of at least 20 of the 58 cases who
were tested, 2 of whom had aseptic meningitis, gave more support to the
diagnosis of St. Louis encephalitis. Three cases occurring during the out-
break were found to have evidence of recent infection by Eastern Equine
encephalitis virus.

The first cases that should probably be included in the outbreak oc-
curred toward the end of July. The number of cases occurring each week
gradually built up to a peak at the beginning of September, then
dropped off temporarily. A second and greater wave reached its peak
in the middle of October, when 10 cases occurred in one week. The cases
gradually tapered off until, early in December, there were no new cases.
An intensive search in the area detected no unusual illness in animals,
wild birds, or domestic flocks. Attempts to isolate a viral agent from
specimens that included human stool, blood, brain and cerebro-spinal
fluid; blood from wild birds; and five small mosquito pools were all
negative. Very few of the known vectors of Eastern Equine encephalitis
or St. Louis encephalitis were present in the area during the period of
maximum incidence.

Although a few cases of presumptive St. Louis encephalitis had been
reported from the Miami area last year, the cases in St. Petersburg
represent the first outbreak of probable St. Louis encephalitis reported
in Florida.

A single sporadic case of St. Louis encephalitis infection was re-
ported from Naples, in Collier County.

The 73 cases of viral encephalitis reported in Florida in 1959 is by
far the greatest number ever reported in one year in the state. In 1958
the second greatest number, 24, were reported. It may be significant that
the 2 counties that reported the second and third greatest numbers of
cases in 1959 were Polk County with 8, and Hillsborough County with
5; both are geographically close to Pinellas County.

88 ANNUAL REPORT, 1959

TYPHOID FEVER
The Virginia Health Department alerted us to several cases
of typhoid fever among migrant workers returning to Kissimmee,
Florida, who had been involved in a large outbreak of typhoid fever in
Winchester, Virginia. Investigation by this division, working in conjunc-
tion with the Osceola County Health Department, concluded that the
Kissimmee cases were the result, but not the cause of the Winchester
outbreak.
Twenty-eight cases of typhoid fever were reported in Florida during
1959.

LEPTOSPIROSIS
In August 2 cases of leptospirosis that occurred in Duval
County were carefully studied for source of infection. Although water
specimens were taken from a suspect river in which one of the cases had
been water skiing, and from a stagnant pond in which the other had
waded, all laboratory tests were negative for leptospira.

OTHER COMMUNICABLE DISEASE INVESTIGATIONS
Four cases of typus fever were recorded during the year. One of
these, in a 12 year old white male in Plant City, received special investi-
gation from this division.
One case of possible meningococcal meningitis occurring at the Rai-
ford State Prison was investigated. Antibiotics were administered before
laboratory confirmation of the diagnosis could be obtained. Sulfa drugs
were administered to all the contacts of the patient. Although the patient
died, there were no further cases. The total number of meningococcal
meningitis cases reported in 1959 was 55.
Communicable diseases notable by their absence or few reports
during 1959 include marlaria with 2; brucellosis with 5 and Hansen's
Disease with 1. There were no reports of large outbreaks of food
poisoning, diarrhea or impetigo of the newborn, or influenza or other
communicable diseases.

OTHER DIVISION ACTIVITIES

IMMUNIZATION SURVEY
In cooperation with the Hillsborough County Health Depart-
ment and the Communicable Disease Center of the USPHS, a
survey of Hillsborough County was carried out to determine the
immunization levels of the population against poliomyelitis, diph-
theria, tentanus and smallpox. Although CDC had conducted more than
40 similar surveys in other states, this was the first such survey in Florida.
Almost 1000 families in the county were interviewed. The results of the

PREVENTABLE DISEASES 89

survey indicated that the proportion immunized against all 4 diseases,
especially against poliomyelitis, decreased markedly as socio-economic
status decreased. It was found, for example, that in those under age 5
in the City of Tampa, 83 per cent of the white upper socio-economic
group had received 3 or more inoculations against poliomyelitis,
whereas the comparable figure for the lower white was 43 per cent and
for the Negroes, 21 per cent. It is anticipated that the results of the
survey will be useful to the health department in planning its immuniza-
tion programs.

HEALTH EDUCATION
Assistance was given in a health education pilot study at a Jack-
sonville high school. Technical advice, and examination on communicable
diseases, and instruction for a group of teachers on the general subject
of communicable diseases was offered.

NON-COMMUNICABLE DISEASE ACTIVITIES
In keeping with the growing recognition that epidemiological tech-
niques can enrich our understanding of chronic and non-communicable
conditions, the division cooperated with other bureaus in the develop-
ment of research programs. The division, while participating in the
organizational stages of the inter-bureau Committee on Accident Pre-
vention, explored several possible areas in which it could assist in the
study of the epidemiology of injuries.

HEALTH EVALUATION STUDY
The division assisted the Bureau of Maternal and Child Health in
evaluating the health status of the students at Jacksonville Beach
high school. Information was obtained on the occurrence of skin lesions,
and the possible association of these with personal hygiene and the isola-
tion of straphylococci from the noses of these students.

VENEREAL DISEASE CONTROL
The Venereal Disease Control Program became a section of the
Division of Epidemiology during 1959.
The program has maintained the same basic format with one pro-
gram addition. The past year saw the beginning of an effort to control
venereal infections through a long range plan of education. To this end,
a Negro health educator was added to the staff. The emphasis of this
program is on prevention rather than cure. The children of today are
the adults of tomorrow, and as such are the ones in need of a good edu-
cational program geared toward eliminating the ignorance and other
factors causing conduct and activity leading to venereal infection. One
of the communicable diseases, venereal disease, has not generally been
included in the health program of most schools, possibly because of the

90 ANNUAL REPORT, 1959

taboos associated with it. Venereal disease is as much a part of the total
communicable diseases as are any of the others. The program is not en-
deavoring to pull the venereal diseases out and set them apart from the
communicable diseases, but rather, is interested in emphasizing the im-
portant facts of venereal disease since this is not being carried out in
general health programs.

The personnel doing this work are very wisely working with prin-
cipals, teachers and health educators engaged in public education. The
theory is that those who work with and are closely associated with the
pupils are in the best position to correlate the teaching of venereal di-
sease education with all subject areas. By so doing, the stigma usually
attached to the subject is lacking. Efforts then are directed toward the
teachers, supervisors and school administrators who in turn will work
with and teach this subject.
Presently, a pilot study is being conducted in one of the Negro
junior-senior high schools in Duval County. Pertinent and informative
presentations about communicable diseases, with emphasis on venereal
disease, are presented to the teachers by the health educator along with
key consultants from the state and local health departments, the State
Department of Education, and Duval County School Board.
There was a significant increase in the number of cases of syphilis
reported. Table 20 shows a comparison for the years 1958 and 1959. As
shown in the table, there is an increase in number of reported cases, of
36.0 per cent in all stages of syphilis, an increase of 71.1 per cent in
early infectious syphilis, and a 13.3 per cent increase in gonorrhea and
other general diseases. The increased rates per 100,000 are slightly less,
but are still significant. This increase must be considered a true increase
in the incidence of the disease rather than as a product of better re-
porting. The increase in reported lesion syphilis bears this out.
It is interesting to note that reporting by private physicians also
showed a marked increase. The percentage of increase by category is as
follows: all syphilis, 46.1 per cent increase; lesion syphilis, 83.7 per cent;
private physicians reported and treated 51.9 per cent of the total syphilis
cases.
The program has 13 full time interviewer-investigators who have
received special training in working with infected persons. The state is
divided into districts with a trained person assigned to each district to
provide epidemiologic services to all County Health Departments and
private physicians desiring these services.
A continuing program to extend epidemiology beyond named sex
contacts is in effect. The testing of suspects and associates allows an early
detection and treatment of infected persons.
Emphasis was placed on getting private laboratories doing sero-
logies to cooperate with this program. This cooperation allows for more

PREVENTABLE DISEASES 91

accurate reporting of reactive specimens and adds to the accuracy of
case reporting.
The venereal disease investigators are continuing to give assistance
to local health officers individually and collectively in communicable
disease programs and studies other than their specific general disease
programs.

	Cover
	Title Page
	Letter of transmittal
	Members of the Florida state board...
	Official staff Florida state board...
	Directors of county health...
	Organizational chart of the Florida...
	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 mental health
	Bureau of narcotics
	Bureau of entomology
	Bureau of dental health
	Bureau of finance and accounts

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