Annual report - State Board of Health, State of Florida

FLORIDA
STATE BOARD
OF
HEALTH

1966

ANNUAL J1.REPOR

%peporf

State Board of Health

Of

1966

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

State

,-,4 ntlcl

1710ricla

The Honorable Eugene G. Peek, Jr., M.D., President
Florida State Board of Health
Ocala, Florida 32670

Dear Dr. Peek:
I herewith submit the annual report of the Florida
State Board of Health for the year ending December
31, 1966.

Sincerely yours,
WILSON T. SOWDER, M.D., M.P.H.
State Health Officer

May 1, 1967
Jacksonville, Florida 32201

His Excellency, Claude R. Kirk, Jr.
Governor of Florida
Tallahassee, Florida 32301

Sir:
I herewith present the report of the Florida State
Board of Health for the period of January 1, 1966, to
December 31, 1966, inclusive.

Respectfully,
EUGENE G. PEEK, JR., M.D.
President

May 1, 1967
Ocala, Florida 32670

Members of the
FLORIDA STATE BOARD OF HEALTH

EUGENE G. PEEK, JR., M.D., President
Ocala

T. M. CUMBIE, Ph.G., Vice-President
Quincy

LEO M. WATCHEL, M.D.
Jacksonville

WILLIAM O. SHUMPERT, D.D.S.
Ft. Lauderdale

W. S. HORN, D.O.
Palmetto

DIRECTORS OF COUNTY HEALTH DEPARTMENTS
(as of December 31, 1966)

Alachua ................ Edward G. Byrne, M.D., M.P.H.
Bay .................. A. F. Ullman, M. D.
Brevard....... ........ T. Paul Haney, M.D., Dr.P.H.
Broward. ............... Paul W. Hughes, M.D., M.P.H.
Collier ................ Clyde L. Brothers, M.D.
Dade ................. T. E. Cato, M.D., M.P.H.
Duval. ................. Patricia C. Cowdery, M.D. (Acting)
Escambia. .............. E. E. Metcalfe, M.D.
Hillsborough. ............ John S. Neill, M.D., M.P.H.
Lake ................. Basil Hall, M.D., M.P.H.
Lee .................. J. W. Lawrence, M.D.
Leon ................. Clifford G. Blitch, M.D.
Manatee ............... George M. Dame, M.D.
Marion. .............. .. James B. Stapleton, M.D.
Monroe ............... Jose T. Sanchez, Jr., M.D. (Acting)
Okaloosa .............. Henry I. Langston, M.D., M.P.H.
Orange. ................ Wilfred N. Sisk, M.D., M.P.H.
Palm Beach ........... C. L. Brumback, M.D., M.P.H.
Pinellas. ............... John T. Obenschain, M.D., M.P.H.
Polk .................. Malcolm J. Ford, M.D., M.P.H. (Acting)
St. Johns ............. Mason Morris, Jr., M.D.
Santa Rosa ............. A. E. Harbeson, M.D.
Sarasota. ............... David L. Crane, M.D., M.P.H.
Seminole ...... ........ Frank Leone, M.D.
Volusia ............... D. V. Galloway, M.D., M.P.H.
Baker-Nassau. ........... B. F. Woolsey, M.D.
Calhoun-Jackson.......... Terry Bird, M.D., M.P.H.
Flagler-Putnam ....... ... J. Culpepper Brooks, Jr., M.D.
Franklin-Gulf ........... Malcolm J. Ford, M.D., M.P.H. (Acting)
Gadsden-Liberty ......... B. D. Blackwelder, M.D., M.P.H.
Jefferson-Wakulla ........ P. H. Smith, M.D.
Madison-Taylor .......... Luther A. Brendle, M.D., M.P.H.
Osceola-Indian River ...... C. C. Flood, M.D., M.P.H.
Pasco-Sumter ........... John L. Ingham, M.D.
Bradford-Clay-Union ...... A. Y. Covington, M.D., M.P.H.
Charlotte-DeSoto-Hardee ... Francis R. Meyers, M.D.
Citrus-Hernando-Levy ..... H. F. Bonifield, M.D., M.P.H.
Columbia-Hamilton-Gilchrist. F. Barton Wells, M.D.
Glades-Hendry-Highlands ... William F. Hill, Jr., M.D., M.P.H.
Holmes-Walton-Washington. William G. Simpson, M.D., M.P.H.
Martin-Okeechobee-St. Lucie. Neill D. Miller, M.D.
Suwannee-Dixie-Lafayette... John S. Williams, M.D.

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
(as of December 31, 1966)

State Health Officer .......... ...... Wilson T. Sowder, M.D., M.P.H.
Deputy State Health Officer ......... Malcolm J. Ford, M.D., M.P.H.
Program and Planning
Assistant State Health Officer. .... G. Foard McGinnes, M.D., Dr.P.H.
Encephalitis Research Center
Assistant State Health Officer ..... James 0. Bond, M.D., M.P.H.
Division of Health Education ........ Vincent Granell, B.S., Ed.D.
Librarian ................. Mildred T. Clark, B.A., B.S., M.A.
Division of Personnel. ........... Miles T. Dean, B.S., M.A.
Division of Public Health Nursing. Enid Mathison, R.N., M.P.H.
Bureau of Adult Health and
Chronic Diseases. .............. J. E. Fulghum, M.D.
Bureau of Dental Health............. Floyd H. DeCamp, D.D.S.
Assistant Director. ............. Delmar R. Miller, D.D.S., M.P.H.
Bureau of Entomology. ............ John A. Mulrennan, B.S.A.
Entomological Research Center ..... Maurice W. Provost, Ph.D.
Bureau of Finance and Accounts ...... Fred B. Ragland, B.S.
Assistant Director. .............. Paul R. Tidwell, B.B.A.
Purchasing Agent .............. Frank E. Craft, B.S.B.A.
Bureau of Health Facilities and
Services...................... C. L. Nayfield, M.D., M.P.H.
Bureau of Laboratories ............ Nathan J. Schneider, Ph.D., M.P.H.
Assistant Director. .............. Warren R. Hoffert, Ph.D., M.P.H.
Miami Regional Laboratory ........ Robert A. Graves, M.S., M.P.H.
Orlando Regional Laboratory....... Max T. Trainer, M.S.
Pensacola Regional Laboratory ..... Emory D. Lord, M.S.
Tallahassee Regional Laboratory. E. Ann Roberts, B.S.
Tampa Regional Laboratory ....... E. Charles Hartwig, D.S.C.
West Palm Beach Regional
Laboratory. ................ Lorraine Carson
Bureau of Local Health Services
Deputy State Health Officer......... Malcolm J. Ford, M.D., M.P.H.
Assistant Director .............. Hubert U. King, M.D.
Division of Nutrition ............ Mildred Kaufman, B.S., M.S.
Division of Sanitation. ........... A. W. Morrison, Jr., R.S.
Bureau of Maternal and Child Health. J. E. Fulghum, M.D. (Acting)
Bureau of Narcotics .............. Frank S. Castor, Ph.G.
Bureau of Preventable Diseases
Assistant State Health Officer ...... Albert V. Hardy, M.D., Dr.P.H. (Acting)
Division of Epidemiology ......... E. Charlton Prather, 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 Veterinary Public Health. James B. Nichols, D.V.M.
Bureau of Research
Assistant State Health Officer ...... Albert V. Hardy, M.D., Dr.P.H.
Bureau of Sanitary Engineering....... David B. Lee, M.S.Eng.
Assistant Director. ............. Sidney A. Berkowitz, M.S.Eng.
Division of Industrial Waste ....... Vincent D. Patton, M.S.S.E.
Division of Special Services ....... Charles E. Cook, C.E.
Division of Waste Water .......... Ralph H. Baker, Jr., M.S.S.E.
Division of Water Supply .......... John B. Miller, M.P.H.
Bureau of Vital Statistics. ........... Everett H. Williams, Jr., M.S.Hyg.
Division of Data Processing ....... Harold F. Goodwin
Division of Public Health Statistics Oliver H. Boorde, M.P.H.
Division of Vital Records ......... Charles H. Carter

LIST OF TABLES

Number

1 Employees in the Florida State Board of Health and
county health units .........................
2 Employees in administrative units of the Florida
State Board of Health (excluding county health
departments) ............................
3 Personnel in county health units . . . . .
4 Employment, terminations and turnover rate. ........
5 Patient visits, Florida tumor clinics ..............
6 Glaucoma screening program data ..... ..........
7 Arthropod-borne virus isolations from mosquitoes .....
8 Summary of pest control registration and enforcement ..
9 Funds received by county health units .............
10 Major evaluation indices by types of
hospitalization program .....................
11 Applications processed and approved for payment
by hospitalization program ...................
12 Hospital evaluation statistics ...................
13 Number of extended care facilities licensed and
number ceased operations. . . . . .
14 Examinations performed by Florida State Board of
Health Laboratories ........................
15 Specimens submitted to State Board of Health
Laboratories ............................
16 Examinations performed in tuberculosis hospital
laboratories ..............................
17 Viral and rickettsial diagnostic findings for
1885 patients ............................
18 Arbovirus isolations by specimen source ...........
19 Permitted establishments and facilities ............
20 Major activities of local health units ..............
21 Postgraduate obstetric-pediatric seminar
registration ....... ......................
22 Practitioners registered with the State Board
of Health ...............................
23 Reported syphilis cases and rates per 100,000
population ..............................
24 Reported cases of early syphilis by age and race. .
25 Sources of radiation by county'. ..................
26 Summary of X-ray surveys and consultations ........
27 New active tuberculosis cases and
tuberculosis deaths ........................
28 Reported active cases of tuberculosis .............
29 Results of 70mm X-ray screenings ...............
30 Results from state X-ray survey units ..............
31 Tuberculosis cases in central register. .............
32 Tuberculosis case register statistics. ..............

Page

101

103

105

168

171

179
179
184
184

194
194
195
196
197
198

LIST OF TABLES (cont'd.)

Number Page

33 Cases of animal rabies ...................... 205
34 Engineering laboratories basic water quality data ..... 215
35 Industrial waste and incinerator projects approved ..... 223
36 Summary of activities relating to shellfish and
crustacea plants .......................... 229
37 Sewerage projects approved ................... 232
38 Sewage treatment plants by types and capacity ......... 234
39 Waste water projects processed locally with
estimated cost ........................... 234
40 Water projects approved with capacity increase and
estimated cost ........................... 240
41 Permits issued for swimming pools, natural
bathing places, water wells and plans approved
for proposed public swimming pools. ............ 241
42 Water plants visited ......................... 242
43 Water and sewage works operators short schools. ..... 243
44 Sanitation of water supplies serving interstate
carriers ............................... 243
45 Activities of the Division of Vital Records .......... 253
46 Resident births and deaths with rates per
100,000 population ......................... 253
47 Twenty leading causes of death . . . .. 254
48 Resident deaths and death rates (preliminary 1966) .... 255
49 Resident deaths and death rates (final figures 1965) .... 256
50 Estimated population and resident birth, death and
infant deaths (preliminary 1966). . . . ... 257
51 Estimated population and resident birth, death and
infant death rates (final figures 1965) . . .. 258
52 Marriages by race, divorces and annulments by
county ................................. 259
53 Vital statistics scoreboard. . . . .... 260

FIGURES

Number Page

1 Reported syphilis case rate per 100,000 population..... 178
2 Sewage treatment plants approved. ...... . ... 233

Organizational Chart of the

Florida State Board of Health

GOVERNOR

--------"- -- ----------- -_ ----------- BOARD OF HEALTH ______- ---RA OF_____ BRALT_ -
( 5 Members )

MEDICAL SCHOLARSHIP DENTAL SCHOLARSHIP HOSPITAL LICENSURE ADVISORY COMMITTEE
VOSP I I IPCES I ON
ADVISORY COMMITTTTE ADVISORY COMMITTEE ADVISORY COUNCIL FORHOSPL SERVICE AIR POLLUTION
AVR CMT C T CNFOR THE INDIGENT CONTROL COMM SSlON

STATE HEALTH OFFICER NE

DEPUTY STATE HEALTH OFFICER
Bureau of Local Health Services
(Civil Defense & Accident Prev.)

I- I I I

BUREAU OF BUREAU OF ASSISTANT
FINANCE & ADULT HEALTH LABORATORIES STATE HEALTH
ACCOUNTS. AND CHRONIC (Regional Labs.) OFFICER
DISEASES Operations.

BUREAU OF
ENTOMOLOGY
NTMOLOGYBUREAU OF BUREAU OF
(Research Ctr., RESEARCH DENTAL HEALTH
West Florida
Arthropod
Research Lab.,
Mosquito Cont'l
Districts.
A.Aegypti Erad.
Project.)

Division of
Personnel

ASSISTANT BUREAU OF
STATE HEALTH BUREAU OF HEALTH
OFFICER NARCOTICS FACILITIES
Prog.Planning & SERVICES

I I
BUREAU OF BUREAU OF
MATERNAL ENCEPHALITIS VITAL STATISTICS
CHILD HEALTH RESEARCH Division of
(Migratory CENTER Vital Records.
Labor)
Lao-r_ Division of
Public Health
Statistics
Division of
Data
Processing
Division of
Health Division of
Education Public Health
(Library) Nursing

5-

- S -

DEC 1966

67 County Health Departments

BUREAU OF
PREVENTABLE
DISEASES
(Occupational
Health)
Division of
Radiological
Health
Division of
Veterinary
Public Health
(Milk Sanit.)
Division of
Epidemiology
(Communicable
Diseases,
V.D.Control)
Division of
Tuberculosis
Control.

BUREAU OF
SANITARY
ENGINEERING
(Stream San.
Waste Trtmt.
Construction
Division of
Industrial
Waste
(Air Pollution)
Division of
Waste Water
Division of
Water Supply
(Swimming
Pools)
Division of
Spec.Services
(Subdivision,
Shellfish)

Division of Sanitation

Division of Nutrition
/I\

A

TABLE OF CONTENTS

Page

Administration (including Activities of the Board; Train-
ing Coordination; Scholarships; Encephalitis Research
Center; Divisions of Health Education, Personnel and
Public Health Nursing) ............................ 1
Bureau of Adult Health and Chronic Diseases .......... .. 30
Bureau of Dental Health ............................. 45
Bureau of Entomology (including Entomological
Research Center)............................... 50
Bureau of Finance and Accounts (including Purchasing
and Property ...................................... 69
Bureau of Health Facilities and Services ............... 79
Bureau of Laboratories............................... 92
Bureau of Local Health Services (including Accident
Prevention, Health Mobilization and Home Health
Services; and Divisions of Nutrition and Sanitation) ...... 107
Bureau of Maternal and Child Health .................. 162
Bureau of Narcotics ............................. 169
Bureau of Preventable Diseases (including Divisions of
Epidemiology [Venereal Disease Control Program],
Radiological and Occupational Health, Tuberculosis
Control and Veterinary Public Health) ............... 172
Bureau of Research ............................. 206
Bureau of Sanitary Engineering (including Divisions
of Industrial Waste, Special Services, Waste Water
and Water Supply). ................... ........... 208
Bureau of Vital Statistics (including Divisions of Data
Processing, Public Health Statistics and Vital Records) ... 244
Articles by Staff Members. ......................... 261

TENURES OF STATE HEALTH OFFICERS

J. Y. PORTER, M.D., 1889-1917
W. H. COX, M.D., 1917-1919
R. N. GREENE, M.D., 1919-1921
R. C. TURCK, M.D., 1921-1925
B. L. ARMS, M.D., 1925-1929
HENRY HANSON, M.D., 1929-1935
W. A. McPHAUL, M.D., 1935-1939
A. B. McCREARY, M.D., 1939-1940
W. H. PICKETT, M.D., 1941-1942
HENRY HANSON, M.D., 1942-1945
W. T. SOWDER, M.D., 1945*-
A. V. HARDY, M.D., 1961-1962 (Acting)
W. T. SOWDER, M.D., 1963-

*On leave October 1961 to December 1962

OFFICE OF STATE HEALTH OFFICER I

WILSON T. SOWDER, M.D., M.P.H.
State Health Officer
Each year brings new problems, and 1966 had its share. Some
of them are still far from solved, but satisfactory progress has
been made.
The year saw the beginning of a trend that may result in sweep-
ing changes in public health practice. Many new activities or expan-
sions of existing programs featured comprehensive medical care for
considerable portions of the population. While health departments in
Florida usually do not themselves provide complete treatment, den-
tal care and hospitalization, the administration of programs involv-
ing comprehensive care demands new relationships with physicians,
dentists, hospitals and other state agencies. New disciplines, notably
social service, are becoming involved. Every public health worker
will have additional responsibilities in community planning and co-
operative action. The principal factors causing this trend are Med-
icare and comprehensive care projects financed through federal,
state and local funds.
Environmental health was a subject of great popular interest,
especially air and water pollution. The issues of Florida Health
Notes for January and February 1967, describe State Board of Health
(SBH) activities in these fields. Florida's air was found by a federal
survey to be cleaner than that of any state except New Hampshire,
Wyoming and Hawaii. The state was fifth in the amount of nonfederal
funds spent to abate the pollution that does exist.
Communicable diseases remain a primary concern of all health
agencies. Foremost among problems is venereal disease. After
eight consecutive years of increase, infectious syphilis showed a
slight decline in 1966. There is need for continued active pursuit
and treatment of those infected.
Another of Florida's Tuberculosis Hospitals closed during the
year, leaving only two in operation. This reflects an improvement in
home treatment of the disease, not a decrease in incidence. The
number of new cases found has increased every year since 1959, in-
cluding the past year.
Quick epidemiological investigation may have presented the
establishment of bubonic plague in the wild rodents of Florida. Four
jackrabbits brought from New Mexico, where the disease exists,
were traced to a Marion County farm and destroyed. The premises
were fumigated.
A new disease was discovered by pathologists and the health
officer in Orange County. It is an encephalitis caused by infestation
with an amoeba that is commonly found in freshwater lakes. Ap-
parently it enters the body through the nose while swimming. Four
confirmed cases have been identified, and doctors in the area are on
the lookout for more.

2 ANNUAL REPORT, 1966

Not a single case of polio was reported in 1966. It now seems
possible to reduce measles in a similar way. Measles immunization
was emphasized in all counties, and mass immunization programs
for measles were carried out in six counties.
In Maternal and Child Health the outstanding event of the year
was the approval of five Maternal and Infant Care Projects in the
state. At the time of approval Florida had 10 per cent of the total of
such projects in the country.
All but one of the counties now have active family planning pro-
grams, but the service is reaching only about 20,000 women, ap-
proximately 10 per cent of those who should have an opportunity to
make use of it.
The cooperative phenylketonuria (PKU) testing program, the re-
sponsibility for which the SBH was given by the 1965 legislature, has
progressed so that about 70 per cent infants born are being tested.
In the area of aging and chronic disease the most important
event was the advent of Medicare on July first. Florida has shown
greater than average progress in the certification of institutions and
agencies for participation. Of the 189 hospitals licensed by the SBH,
172, containing 94 per cent of all beds, were certified for Medicare.
Two hospitals also have certified extended care facilities, and 89 of
the 350 nursing homes in the state were certified. Fifty-seven home
health agencies in 49 counties were certified for home health care.
Most of these were county health departments (CHD).
Heart disease, the first cause of death in Florida, continued to
find more victims. Emphysema-bronchitis has increased 3-1/2
times in the past decade. Many authorities consider smoking to be
a factor in both the above diseases as well as lung cancer. Renewal
of a federal grant which supported an educational program on Smok-
ing and Health was requested for 1967.
Program consultation in the Bureaus and activities in the CHDs
continued to increase, although in many programs the volume of
service provided was not keeping up with population growth.
During 1966 there were 42 research, demonstration and service
projects operated by the SBH and CHD's, involving over $12 million
in federal and $2.5 million in local funds. The only state funds that
supported these projects were the comparatively small amounts
used to help operate the three research laboratories in Tampa, Vero
Beach and Panama City.
The organizational structure was changed during the year. A
Deputy State Health Officer was played in charge of Local Health
Services and the two original Deputy State Health Officer positions
were changed to Assistant State Health Officers. On November 1,
G. Foard McGinnes, M.D., Dr.P.H., was appointed Assistant State
Health Officer for Program and Planning. The position, Assistant
State Health Officer for Operations, is still vacant. The immediate
Office of the State Health Officer included a health program analyst,

GENERAL ADMINISTRATION

two internal auditors, two attorneys and a press secretary. Organi-
zational units directly responsible to the State Health Officer were:
Program and Planning, Operations, the Divisions of Public Health
Nursing, Personnel, Health Education, the Encephalitis Research
Center and the Coordinator of Training.
The Bureau of Special Health Services, abolished in December
1965, was replaced by a Bureau of Adult Health and Chronic Diseases
and a Bureau of Health Facilities and Services.
Among those who resigned or retired during the year were
Clarence M. Sharp, M.D., Director of the Bureau of Preventable Dis-
eases, Deputy State Health Officer Elton Osborne, M.D., and Robert
Schultz, M.D., Coordinator of Training. David L. Crane, M. D.,
Director of the Bureau of Maternal and Child Health, transferred to
Sarasota County as Director of the Sarasota CHD. These positions
remain open because we have been unable to fill them with per-
manent personnel.
There has always been difficulty in obtaining qualified personnel
for key positions. The general recruitment picture looks worse than
ever, because the comprehensive care projects and similar pro-
grams under other agencies require physicians, nurses, nutrition-
ists, social workers and others who otherwise might be employed
for more general programs at state or county level. At the end of
1966 salaries in general were not competitive either with private
employment or other state health departments.

Staff Activities
A public health analyst was added to the State Health Officer's
staff in 1966. His assignments may take him into any aspect of pro-
gram or operation. While the Coordinator of Training position was
vacant in the latter part of the year he has been in charge of train-
ing and recruitment.
The internal auditor and his assistant examined the accounts of
35 health departments to insure that spending was in accordance with
state and local laws.
A second full-time attorney was employed in 1966 because of the
continuing increase in enforcement litigation. Water and air pol-
lution, control of drugs, hospital and nursing home licensure, vital
records and the disposition of dead bodies, Florida Merit System
appeals and the Sanitary Code infractions are among the legal prob-
lems. The SBH intervened in a Federal Power Commission hearing
on a petition to allow the building of additional natural gas lines into
Florida. The examiner disapproved the petition, and the case has
been appealed to the full commission.
A total of 75 news releases relative to SBH activities was sent
to newspapers, magazines, television and radio. Various news
media were assisted 67 times, and 26 special interviews, stories or
photos were set up.

4 ANNUAL REPORT, 1966

PROGRAM PLANNING
MALCOLM J. FORD, M.D., M.P.H.
Deputy State Health Officer
(through October)
G. FOARD McGINNES, M.D., Dr.P.H.
Assistant State Health Officer
(from November)

The broad general purpose of this office is to encourage and aid
in the imaginative planning of new programs and the evaluation and
replanning of existing ones at all levels.
The review of project grant applications occupies a large pro-
portion of the staff's time. At the end of 1966, 42 active projects
were being operated by the State Board of Health (SBH) and county
health departments (CHD) involving over $12 million in federal funds
and $2.5 million of state and local moneys. Fifteen hundred workers
who are paid from project funds would probably not be employed in
CHDs if these projects did not exist. Eighteen other federally-
financed projects are being operated or have been applied for by
other state or voluntary organizations with the approval of the SBH.
Fourteen agreements with state, federal, local and voluntary agen-
cies or with institutions were in effect.
During 1966, Program Planning conducted reviews of the Occu-
pational Health program and the Bureau of Maternal and Child
Health, and was responsible for the administration of the latter for
a part of the year. It was responsible for the narrative portion of
the State Report and Plan on the basis of which federal funds are
allotted to the state, and for special reports requested from many
sources. In all its activities it worked in close cooperation with
bureau, division and program directors.
The Assistant State Health Officer also served as project direc-
tor for study of the effects of pesticides on humans continued under
a contract with the U. S. Public Health Service. Both acute poison-
ings and long term effects are being explored. Persons occupation-
ally exposed to pesticides from several counties have been examined
and will be followed. Included are workers from formulating plants,
flower farm workers, spraymen, painters and agricultural workers.
Under a subcontract with the University of Miami special biochem-
ical studies have been made in kidney function and amino acid me-
tabolism. Studies in possible association of pesticides with certain
diseases are also being studied under the subcontract. Under a
subcontract with the Dade County Medical Examiner's office studies
of acute pesticide poisonings are being made.
A long term statewide study of individuals employed in the pest-
icide applicating industry for general health conditions over the past
20 years and more intensively in the future has been continued. Also

GENERAL ADMINISTRATION

observations on the use of pesticides among the general population
in Dade County have been made through questionnaire survey of
households. In addition monitoring studies of water and human tis-
sue obtained at autopsy have been instituted. The problems of labor-
atory analyses are being worked out and tests are being done in the
Central Laboratory in Jacksonville as well as the Miami Branch
Laboratory. While no conclusions have been reached in all these
studies several interesting leads have developed for further study.
Joint meetings with other state agencies interested in pesticide
use and control were held. These provided a useful exchange of in-
formation and lead to better coordination of efforts in this field.

ACTIVITIES OF THE BOARD
January 30- Jacksonville
1. Re-elected Eugene G. Peek, Jr., M.D., as President of the
Board and Mr. T. M. Cumbie as Vice President.
2. Discussed the working relationship of the Air Pollution Con-
trol Commission and the State Board of Health with George
Westbrook, Ph.D., Chairman of the Commission.
3. Discussed the latest draft of the Multi-County Maternal and
Child Health Project and approved it with certain changes.
4. Heard a report on the purchase of land in Jacksonville by
Wilson T. Sowder, M.D.
5. Heard a report by Dr. Sowder on the status of the Medicare
Program, Title XVIII.
6. Heard reports by Dr. Sowder and Malcolm J. Ford, M.D.,
on the Home Health Services Program and approved the
operation of this program through the county health depart-
ments (CHDs); and further authorized them to accept reim-
bursement for Medicare services rendered in this program.
7. Accepted the information on the resignation of David Crane,
M.D., director of the Bureau of Maternal and Child Health,
and approved the appointment of Dr. Ford as Acting Director
temporarily.
8. Accepted the information about the illness of C. M. Sharp,
M.D.
9. Approved Dr. Sowder's acceptance of an invitation to the
Seventh International Congress of the International Associa-
tion of Gerontology in Vienna, Austria, June, 1966.
10. Heard a report on the law regarding the examinations of
ambulance drivers.
11. Conducted a hearing with interested persons from the City
of Hialeah on the problem of septic tanks.

6 ANNUAL REPORT, 1966

12. Approved a revision of Chapter 170C-4, "Standards for In-
dividual Sewage Disposal Facilities" of the State Sanitary
Code.
13. Approved the issuance of conditional licenses to appropriate
Homes for the Aged applying for licensure until such a time
that the Board adopted regulations.
14. Adopted a policy for employees traveling by air when using
federal or matching funds.
15. Approved the abolishment of the Bureau of Mental Health.
16. Approved the change in names of two bureaus to Bureau of
Health Facilities and Services and Bureau of Adult Health
and Chronic Diseases.
17. Heard a report by Leo M. Wachtel, M.D., on the meeting of
the Florida Advisory Council for Heart, Cancer and Stroke.
18. Approved the appointment of the Director of Local Health
Services as ex-officio member, State and Local Relations
Committee.
19. Discussed the policy on the licensure of dentists and physi-
cians employed by the State Board of Health (SBH).
20. Approved the publication of the booklet "Guidelines A
Ready Reference To Current Obstetric Practice."

March 27- Jacksonville
1. Discussed proposed regulations for homes for the aged and
recommended that further study be given them; and they be
brought back before the Board when this has been done, The
Board approved of continuing to issue conditional licenses
to those homes where necessary until such a time as agreed
upon regulations could be submitted.
2. Approved the revision of the policy on air travel to include
special consultants to the SBH and that their travel not be
restricted to tourist but that they be allowed to travel first
class.
3. Approved an equipment list in connection with the enforce-
ment of the ambulance law; and further that permit and
certificate forms be approved for use in this program.
4. Discussed regulations under Chapter 170-D with members
of the Home Builders Association.
5. Approved a proposed letter to Senator Lister Hill regarding
Senate Bill S-3008.
6. Approved the creation of a position of Deputy State Health
Officer for Bureau of Local Health Services and the renam-
ing of the two deputy positions to that of Assistant State

GENERAL ADMINISTRATION 7

Officer with rank and salary equivalent to that of bureau
directors.
7. Approved the employment of W. W. Rogers, M.D., for the
development of an employee health service.
8. Approved the appointment of A. V. Hardy, M.D., as Acting
Director of the Bureau of Preventable Diseases upon the
retirement of Dr. Sharp.
9. Presented a twenty year pin to Dr. Sharp, Director of the
Bureau of Preventable Diseases, and expressed appreciation
for his excellent service to the SBH.
10. Approved candidates forpostgraduate training for 1966-67.
11. Discussed the establishment of an Advisory Committee on
Independent Laboratories for the Medicare Program and its
membership.
12. Discussed the request of the Pest Control Association for
the elimination of the regulation by the SBH requiring the
fingerprinting of pest control operators but took no action.
13. Heard of resignation of Elton Osborne, M.D., to accept the
position of deputy state health officer with the Georgia State
Health Department and presented him with a certificate of
appreciation.

May 14 Hollywood
1. Heard a report by Dr. Sowder that the Home Builders As-
sociation did not at this time have any suggestions for
changes in the regulations for septic tanks.
2. Approved recipients for medical scholarships and adopted a
resolution by the Advisory Committee to phase out the med-
ical scholarship program but continue the osteopathic
scholarship; and further that it be increased from $1000
to $2000 per year.
3. Agreed to support legislation proposed by the State Board of
Dental Examiners which would reduce the number of dental
scholarships awarded annually from 10 to five and increase
the annual value of each scholarship from $1000 to $2000.
4. Discussed requests for licensure of Automedic Hospital by
citizens in the Vero Beach area in view of action taken by
the Advisory Council on Hospital Licensure not to grant a
license. The Board directed the staff of the Bureau of
Health Facilities and Services to study this matter and
present a report to the Board.
5. Approved the employment of an additional attorney to assist
the Bureau of Sanitary Engineering with its various legal
problems.

8 ANNUAL REPORT, 1966

6. Approved revisions in the Air Pollution Regulations, Chap-
ter 170C-9.
7. Approved an amendment in Chapter 170D-2, Nursing Homes
and Related Facilities, regarding the mailing of narcotics.
8. Discussed proposed regulations on pathological wastes in
hospitals and directed that the Florida Hospital Association
be consulted prior to their submission to the Board for
adoption.
9. Approved the inclusion of two additional accountants posi-
tions for the office of the internal auditor.
10. Heard a report from Dr. Ford regarding the preliminary
report of the State-Local Relations Committee.

May 15 Hollywood
1. Discussed action taken by the House of Delegates of the
Florida Medical Association regarding public health pro-
grams carried on by the SBH.

July 24 Jacksonville
1. Discussed in open hearing the proposed regulations on
homes for the aged with various groups including the Flor-
ida Nursing Home Association and recommended that these
be studied further and be referred to the Commission on
Aging for study.
2. Approved the appointment of an Advisory Committee for
Independent Laboratories for the Medicare Program the
membership of which to be determined later.
3. Discussed with Floyd Hurt, M.D., the part of the radiologist
in the Medicare Program.
4. Discussed the licensure of the Atomedic Hospital with Kip
Kelso, M.D., and the staff of the Bureau of Health Facilities
and Services and directed the staff to report at the next
meeting on their findings in view of this discussion.
5. Discussed the preliminary report of the State-Local Rela-
tions Committee with the members of the Committee.
6. Approved revisions in Chapter 170C-4, Standards for Inde-
pendent Sewage Disposal Facilities.
7. Discussed the proposed constitutional revision and directed
Dr. Sowder to express the opinion of the Board that the
Board of Health should be included in this revision.
8. Approved an amendment to the Narcotic Law whereby legis-
lation be prepared for submission to the legislature in 1967
for the control of LSD.

GENERAL ADMINISTRATION 9
9. Approved the postponement of postgraduate training for
Mr. Paul Tidwell because of illness of Mr. Fred Ragland
until the fall of 1967.
10. Approved postgraduate training for Mr. Alfred Mueller, Jr.,
Sanitarian, Palm Beach CHD.
11. Discussed a proposed project on Maternity and Infant Care
in Tampa and directed that it be operated in cooperation
with the SBH and the CHD.
12. Discussed with the Florida Pest Control Association pro-
cedures for fingerprinting under the regulations and adopted
some simplifications in them.
13. Approved a policy on dual employment for drafting and
directed that Dr. Sowder contact the Attorney General prior
to formalizing this proposal.
14. Approved a legislative budget to be submitted to the Legis-
lature in 1967 for the SBH and the CHDs.
15. Authorized and directed Dr. Sowder to oppose any legisla-
tion that would transfer the responsibility for the air and
water pollution control programs outside of the SBH.
16. Discussed the State Audit Report of the SBH.

October 2 Jacksonville
1. Approved a new Section 170C-10.11, Disposal of Pathological
Wastes be added to Chapter 170C-10, Garbage and Rubbish.
2. Discussed the licensure of the Ercildoune Hospital (Ato-
medic) and took no action until a report of the Hearing Body
is received.
3. Adopted a statement of policy regarding air and water
pollution.
4. Approved the membership of the Advisory Committee on
Independent Laboratories in connection with the Medicare
Program.
5. Confirmed the mail vote for the postgraduate training of
Howard Carter, M.D., for the period 1966-67.
6. Held a hearing with resident of Lake Shadow, Orlando, Flor-
ida, regarding pollution of the lake.
7. Approved a policy on dual employment for employees of the
SBH and CHDs.
8. Approved a per diem rate for persons serving on various
commissions, councils, etc., who are appointed by the Gov-
ernor to advise the SBH.

10 ANNUAL REPORT, 1966

9. Reaffirmed the policy on the licensure of physicians.
10. Approved the appointment of Foard McGinnes, M.D., for the
position as Director of the Office of Planning.
11. Discussed salary ranges proposed by the Merit System for
dentists and directed to write the Merit System about the
inadequacy.
12. Approved the sending of a memorandum to all CHDs en-
couraging their participation in the Home Care Programs in
their communities.
13. Approved the payment of eight days per diem to Edwin G.
Williams, M.D., Director of the Division of Radiological and
Occupational Health, while attending a meeting in Rome,
Italy.
14. Approved the taking of legal action against the City of Ever-
glades.

December 11 -Jacksonville
1. Heard a report from Dr. Sowder on the investigation of the
Lake Shadow situation.
2. Discussed amendments to the Narcotics Laws and directed
that these proposals be submitted to the Board in writing
for their study.
3. Approved the granting of a provisional license for a special
hospital to the Ercildoune Hospital.
4. Approved an organizational plan for Civil Defense.
5. Approved the separation of the OccupationalHealth Program
from the Division of Radiological Health and to place it under
the direct supervision of the director of the Bureau of Pre-
ventable Diseases; and further that the present laboratory
personnel engaged in occupational health work be placed in
the Bureau of Laboratories.
6. Approved the re-appointment of Mr. Don Evans and the ap-
pointment of Mr. Lamar Hancock to the Advisory Committee
for Hospital Services for the Indigent.
7. Directed Dr. Sowder to prepare a bill on air and water pol-
lution in line with the Board's statement of policy regarding
this subject.
8. Endorsed the sending of a communication to Governor Hay-
don Burns, and Governor-Elect Claude R. Kirk, Jr., regard-
ing the Comprehensive Planning Law.

GENERAL ADMINISTRATION

ENCEPHALITIS RESEARCH CENTER
JAMES O. BOND, M.D., M.P.H.
Director
Studies of the epidemiology of California encephalitis continued
to occupy the major attention of the Encephalitis Research Center,
(ERC) staff. No new infections with this virus were detected in the
613 human surveillance cases examined. Of the four previously de-
tected cases, three were shown by serologic and epidemiologic evi-
dence to have acquired their infections in the resort areas of west-
ern North Carolina. Of 426 individuals examined in the household
rebleeding surveys, no serologic conversions were detected in 1966,
using California encephalitis (CE), St. Louis encephalitis (SLE).
Western (WE) and Eastern encephalitis (EE) antigens. New labora-
tory evidence accumulated during the year, however, strongly
suggests that the serologic tests being used for California encepha-
litis are relatively insensitive in detecting infections with local
strains of CE viruses. Three separate laboratory infection experi-
ments were carried out with domestic rabbits during the year, using
the original prototype California encephalitis strain (BFS-283), a
local trivittatus and a local Keystone strain. The serologic tests
which have been used routinely for CE studies were not able to de-
tect infection in the rabbits with the trivittatus and Keystone strains
of virus, although the rabbits developed viremia. The conclusion
appears warranted that the extensive negative serologic evidence
accumulated in man and mammals, insofar as CE infections are
concerned, does not adequately represent the amount of infection
occurring with local strains of CE virus. These findings have
initiated an extensive laboratory research program attempting to
develop a more sensitive serologic test for detection of infections
with the local CE strains.
There is no question of the abundance of these CE viruses in
nature. Seventy-nine isolations were made during 1966, chiefly from
the fresh water Aedes genus of mosquitoes. However, an important
new observation was the six CE virus recoveries from the blood of
sentinel rabbits placed in a rural swamp study site to detect the
occurrence of virus in mammals. Extensive ecological studies in
this site during 1966, demonstrated that the Aedes mosquitoes
emerged very soon after the heavy spring rains in June, rapidly
became infected with the CE viruses and maintained unusually high
infection rates through August, gradually diminishing through Oc-
tober. Host preference studies indicated they fed on both mammals
and birds during this period of time, with a slight preference for
mammals. An ecological survey by a summer student during this
same period demonstrated very few mammal species available in
the swamp, thus, narrowing down the list of potential mammalian
reservoirs for this virus.
The surveillance for human cases of arbovirus infection was

12 ANNUAL REPORT, 1966

again completely negative in 1966, although 613 cases were referred
for laboratory diagnoses. This concludes the fourth successive year
in which no human cases of SLE occurred in the Tampa Bay area.
However, other viral infections were frequently detected. In con-
junction with the virology section of the Bureau of Laboratories,
Jacksonville, 30 viral isolations were made; 25 of them, entero-
viruses. This was the highest total of enteroviruses for any one year
in the four successive years of surveillance. Fifteen ECHO viruses
were isolated (Types 5, 7, 9 and 29), nine Coxsackie viruses (Types
A B2, B3 and Bs) and one polio virus (Type II). Also recovered
were two adenovirus strains, one herpes simplex and two for which
the identification is incomplete. Of the viral diseases identified by
serologic tests, mumps again was the most prevalent with 13 cases.
Herpes simplex or zoster accounted for four, infectious mono-
mucleosis one and rubeola two. The Tampa Bay area experienced a
marked increase of viral respiratory illnesses in early 1966, along
with the rest of Florida and the United States. A special study of a
junior high school in Pinellas County was carried out in conjunction
with the Pinellas County Health Department and influenza B virus
recovered. A number of serologic conversions to influenza virus
also were identified in these pupils. The increased interest in
respiratory illness also resulted in the identification of seven
Mycoplasma pneumoniae cases in the Tampa Bay area. This sur-
veillance and diagnostic service for viral infections has developed
into one of the major activities of the ERC.
The special studies of humans who had serologic evidence of
previous infection with dengue fever of SLE were continued. Epi-
demiologic and serologic data were collected on a group of 29 per-
sons, most of whom were infected with dengue fever sometime in
early life and maintained high titers of antibody. Dengue antibodies
cause considerable crossing in the SLE serologic tests, and precise
information is required to differentiate the two infections. The ob-
servation of immunologic crossing led to further studies of the pos-
sible protective effect of prior dengue fever infection against the
subsequent development of SLE, if exposure to the latter virus
occurs. Epidemiologic or serologic data and laboratory cross chal-
lenge experiments have shown a modest amount of cross protection
between these two viruses.
The biology and entomology sections again had the opportunity to
study an epizootic of Eastern encephalitis in the Tampa Bay area.
Thirty-three clinical cases in horses were reported by practicing
veterinarians. Brains were obtained from 13 of these, and seven
yielded viral isolates all identified as EE virus. Combined sero-
logic and virologic data indicated that at least 12 cases of EE, two
of WE and nine of undetermined viral etiology occurred in horses
during July, August and September, 1966. Six recoveries of EE virus
from mosquitoes, all Culiseta melanura, supplemented these data
from horses. The year-round transmission of EE virus in Florida

GENERAL ADMINISTRATION

was emphasized by the demonstration of serologic conversion in
sentinel chickens in November accompanied by recovery of EE virus
from C. melanura mosquitoes at the same time and place. A
summary of the four years experience with EE virus in this area
indicates it can be recovered at any season of the year from mos-
quitoes, and has been recovered from horses (at either ERC lab-
oratory or others in the state) during all major seasons. Wild birds
and mammals, sentinel chickens, sentinel rabbits and sentinel
pigeons were again used extensively to detect serologic evidence of
arbovirus activity in the region. All were negative except for the
previously described evidence of CE and EE viruses. Attempts were
made again in 1966 to recover virus from northward migrating birds
landing on the Dry Tortugas Islands at the very southernmost tip of
Florida. Two hundred ninety-three birds were collected, repre-
senting 45 different species; however, none yielded any arbovirus.
The long term studies of small mammals in the Big Bend area of
Hillsborough County continued. There was no serologic evidence of
Group B virus activity in 1966; however, two additional viral iso-
lates from cotton rats were made. These appear to be identical to
those found previously and, despite extensive studies in the Uni-
versity of Pittsburgh, these are as yet unidentified.
Project entomologists continued their studies of the basic biology
and behavior of the Aedes and Culex mosquitoes shown to be arbo-
virus vectors in this area. Precipitin tests of engorged mosquitoes
were carried out in conjunction with the Entomological Research
Center at Vero Beach. During June, July and August, special col-
lections of engorged mosquitoes were made to coincide with the
maximum activity of CE viruses. Aedes infirmatus fed on mammals
more often than on birds and Aedes atlanticus fed equally on both
groups. Both species also fed on turtles. Incidents of more than
one host per feeding were encountered in both species, often mixing
mammalian and avian sources. In the late winter and early spring,
additional studies were made on Culex nigripalpus and Culex
salinarius. During that time of the year, these species appeared to
feed mostly on mammals. Later in the year (September through
December), C. nigripalpus appears to feed on avian sources. C.
melanura is principally an avian feeder year round, although oc-
casional mammal and turtle feedings were detected.
A year long study was conducted during the year to determine
which of five different combinations or types of attractants was most
efficient in collecting large numbers of arbovirus vector mosquitoes.
Attractants compared were chicken, carbon dioxide, both chicken
and carbon dioxide in combination, CDC light trap, and CDC light
trap and carbon dioxide in combination. The CDC light trap and
carbon dioxide combination was shown to be the most effective
means of collecting large numbers of these mosquitoes. It collected
more varieties of species and was more consistent throughout the
changing seasons.

14 ANNUAL REPORT, 1966

A colony of C. nigripalpus has been established in the insectary
and carried through more than 25 generations. A. infirmatus were
also successfully reared from eggs in the insectary and used for two
different laboratory transmission experiments. In September, do-
mestic rabbits were infected with the local Keystone strain of CE
virus and attempts were made to transmit this to A. infirmatus
mosquitoes and back to suckling mice. The rabbits, unfortunately,
did not develop a high enough viremia to infect the mosquitoes and
no transmission was demonstrated with this experiment.
The virology and serology laboratories continued to support all
of the above field activities. Of 4338 specimens examined for virus,
118 separate recoveries of arthropod-borne viruses were made.
These included the following groups of arboviruses, California-79,
Eastern encephalitis-13, Bunyamwera-13, Hart Park-like-11, and
cotton rat agents-two. Recoveries of one or more arboviral agents
were made each month of the year, except December, for which
testing results are not yet complete. Maximum recoveries were
during the period June, July and August, when California group
viruses were most active.
In conjunction with the University of Pittsburgh, the laboratory
continued its studies of the new tick agent, termed Sawgrass virus,
which was recovered from the tick Dermacentor variabilis taken
from a raccoon in 1964. Nine separate recoveries from ticks found
on either raccoons, opossums or rabbits have been compared by the
CF test and all are shown to be identical. Serologic studies for CF
antibodies to this agent have been performed in the University of
Pittsburgh on a group of representative human and mammalian sera
from the Tampa Bay area; all were negative. A group of sera was
collected from tick infested dogs by a summer student during the
year, and a preliminary screening of these for serum neutralizing
antibodies to the Sawgrass virus has also been negative.
With the support of General Research monies, the laboratory
has undertaken an extensive program to develop a microtechnique
for assaying serum neutralizing antibodies using cell cultures. Pre-
liminary work has been with EE and WE viruses, although once the
technique is established, it will be useful in examining sera for CE
antibody.
The laboratory section moved to the new space provided on the
third floor of the Tampa Regional Laboratory of the Florida State
Board of Health. Constructed primarily for virus research, the
space provides the most modern equipment and facilities in contrast
to the renovated space in a dormitory the laboratory has been using
for the past three years.
In June of the year under discussion, the ERC co-sponsored a
symposium or arbovirus research with the University of South
Florida. Over 100 scientists and interested persons attended this
seminar to hear 30 different scientific presentations. The meeting

GENERAL ADMINISTRATION

was held in conjunction with the annual meeting of the Encephalitis
Advisory Committee of the Florida State Board of Health. The
Encephalitis Research Center staff had interesting international
contacts during the year. A medical student from the University of
Sheffield in Sheffield, England, spent the summer months in the ERC.
Papers were presented by different members of the ERC staff to a
symposium on California viruses in Bratislava, Czechoslovakia, to
the American Society of Tropical Medicine and Hygiene in Puerto
Rico, and to the Western Society for Pediatric Research in Cali-
fornia. A major amount of staff time in the fall months was devoted
to the preparation of a new National Institutes of Health grant re-
quest to extend the project for another five years after the termi-
nation of the current grant in November, 1967.

TRAINING COORDINATION
R. V. SCHULTZ, M.D., M.P.H.
Coordinator of Training
This program consists of two major functions: providing plan-
ning, guidance, and participation in in-service training programs for
public health personnel throughout Florida; and the administration
and coordination of the agency's academic training program. In
addition, the Coordinator functions as the focal point for receiving
and disseminating training information and advice, and provides
liaison services between the State Board of Health (SBH) and institu-
tions of higher learning, federal training programs and other pro-
fessional educational efforts related to public health. The Training
Coordination Program is within the office of the State Health Officer.

Professional Education Scholarships
The SBH administers scholarship programs for the study of
medicine, dentistry, and for graduate and undergraduate education
for career public health employees.
Scholarships for the study of medicine are awarded and admin-
istered by the SBH in cooperation with the seven members of the
Medical Scholarship Advisory Committee. The Committee Chair-
man is David W. Goddard, M.D., of Daytona Beach. The law governing
this program provides for one scholarship for the study of osteo-
pathic medicine. This scholarship recipient is recommended by the
State Board of Osteopathic Medical Examiners. The financial pro-
visions of the medical scholarship program have been inadequate.
Other scholarship sources are now available and a major reason for
the program-training, and placement of physicians in Florida areas
of medical need-has not been effective. The SBH, in agreement with
the Medical Scholarship Advisory Committee has, therefore, de-
cided to discontinue awarding medical scholarships.
Seven medical scholarships were awarded in 1966. This is the

16 ANNUAL REPORT,

final year of the program. Provision has been made to continue all
scholarships granted in 1966 and earlier so that all recipients still
in school may complete their medical training. The one osteopathic
scholarship, unlike the others, will continue to be awarded each year
by the SBH.
Dental scholarships are awarded by the SBH upon the recom-
mendations of the State Board of Dental Examiners. This program
is administered by the Bureau of Dental Health. The SBH will con-
tinue this activity, but because the financial aspects of these schol-
arships are also too limited, plans have been developed to decrease
the number of scholarships in future years so that funds for each
remaining scholarship can be increased.
Other professional training scholarships are granted to public
health personnel in order to develop highly trained and appropriately
specialized career employees in the county health departments and
the central office of the SBH. Federal funds for this program are
provided through the Social Security Act of 1935.

MEDICAL
Scholarships Awarded in 1966
Alvin Bryant ..........................
James Thomas Dawsey ....................
Jack Earle Maniscalco ....................
Charles Wilson Moore, Jr. .................
Elliott Craig Raby........................
Rudolf Bernard Wenleder ..................
*David Douglas Asmussen. ..................

............ Dade
........ .. Dade
........ Hil lsborough
........... Broward
........... Putnam
............. Dade
.............Leon

Continuing Scholarships Awarded Prior to 1966:
Awarded 1963: Awarded 1964:
Calvin Collins, Jr. ***Daniel Leslie Benboe
**Beatrice Alfreda Denefield **Clarence M. Harris, III
Ronica Mahoney Kluge Jack Benson Owen
*Bodo Eitel Pyko **Elena Suzanne Rose
Kathleen Mary Santi *Orville Leon Barks, Jr.
Ira Harmon Wenze **James Patrick O'Leary
**Philip Eugene Wright Elizabeth Orene Vaughan
**Charles Edward Walbroel
Rosetta Mae Bush
Edmond Delaney Robinson
Dale Miner Braman

Awarded 1965:
**Gordon Charles Finlayson
Louis B. St. Petery
Monica Anne Minyard
(Maternity Leave 1965-66)
**William Clark Morgan

*Osteopathic scholarship
**Scholarship surrendered
***Dropped from school

*Donald L. McBath
George L. Sanders
Julia Carolyn Revell
Harrison Denison Williams
Wayne Raymond Johnson

1966

GENERAL ADMINISTRATION 17

DENTAL
Scholarships Awarded in 1966:
William O. Bolton, Jr .................... ............. Pinellas
Douglas W. Booher .................................... Pinellas
Harvey I. Cohen .......................................Dade
H. J. Emmons .................................... Broward
Alan J. Frank. ................... .................... Dade
Robert E. Hirschfield ................................... Dade
Owen B. Lovejoy....................................... Polk
James E. Moore, Jr................................... Duval
Conrad C. Theiss, Jr................................. Charlotte
Continuing Scholarships Awarded Prior to 1966:
Awarded 1963: Awarded 1964:
John F. Bembry Wayne D. Bradley
*Norman M. Bevan, Jr. Roger E. Gibson
Frederick A. Booth, III *Charles L. Graves, III
**Robert L. Ferdinand James R. Hoover
Anthony B. Frilingos Ronald J. Marien
George D. Sanchez James E. Owens
Michael R. Kennedy William A. Thompson
Awarded 1965:
Melvin C. Beard, II David W. Rawson
Albert J. Endruschat John L. Ricks, Jr.
Richard L. Finkbeiner Drew H. Turner, Jr.
Nathan A. Graddy Richard H.Waldbart,Jr.
Leonard W. Peterson John W. Shannon
*Dropped from school
**Surrendered scholarship

PUBLIC HEALTH PERSONNEL
Mark Austin. . . Procedures Analyst. . . . ... SBH
Vernon Buttram . .... Health Field Worker II ............ SBH
H. W. Carter, M. D....... Public Health Physician III .......... SBH
James B. Earle . . County Sanitation Director ........ Hernando
Dorothy L. Harris ........ Public Health Nurse II . . .. Marion
E. Henry King, M.D. ....... Assistant County Health Director ...... Broward
Miss Mary Anne Marshbourne. Nutrition Field Coordinator. . ... SBH
Mrs. Grace Berry Brown . Nutrition Consultant . . Palm Beach
Miss Barbara Moulton, R.N.. Consultant, MCH Training Program . SBH
Alfred Mueller, Jr. . Sanitarian . . . . Palm Beach
Charles E. Oxar, D.D.S..... Dental Division Director. ... . . .Dade
Milton S. Saslaw, M.D...... Research Director ................ ..Dade
Ben Frank Watkins ....... Sanitary Engineer II . . . ... SBH
Arthur C. Stanley . ... Sanitarian ............... . .Pinellas
William W. Mahoney ...... Sanitarian . . . ..... St. Lucie
Harry S. Wein............ Sanitarian ................... .....Dade

18 ANNUAL REPORT, 1966

DIVISION OF HEALTH EDUCATION
VINCENT GRANELL, Ed.D.
Director
The division has enjoyed a banner year in exemplifying the phi-
losophy of service to all. Each section of the division has increased
activities in a supreme effort to satisfy as many requests as pos-
sible from the bureaus and divisions in the State Board of Health
(SBH), county health departments (CHD), voluntary health agencies,
PTAs, schools, other health related professions and the general
public. A total of 15 health educators is employed in CHDs and
there are three vacancies.

Medical Library
The library enjoyed a year of unprecedented growth reflected by
an increase in user population and a larger number of books and
journals circulated. There were added 2206 new books and bound
journals bringing the total number of volumes to 23,046 at the end of
the year. Seven hundred and eight outdated books were withdrawn-
a record number for one year. The vertical file of unbound publi-
cations was increased by 100.
The library was used extensively by the personnel in the SBH
and CHDs. Through interlibrary loans to the libraries of the Jack-
sonville Hospitals Educational Program many local physicians and
others were served. Among professional persons using the library
were physicians, nurses, teachers, lawyers and public welfare per-
sonnel. Other users were students working on term papers and
science projects.
A total of 2432 books was checked out, 1155 on indefinite loan
and 338 pamphlets. Journals circulated throughout the state totaled
11,045. The library made 2030 day loans (books and journals used
in the library) and 79 interlibrary loans. Thirty-nine bibliographies
were compiled, 2242 reference questions answered, and 3544 photo-
copies made. Seven issues of the "Book Bulletin" were published
announcing the newest additions to the collection.
A complete renovation of library materials shelved in the attic
was accomplished. There are 3770 bound journals, prior to 1945,
shelved in order readily available upon request. A journal shelf list
available in the library permits rapid appraisal of the material in
the attic,
An extensive program of binding of the journal collection was
undertaken for the volumes from 1963 to date. A determined effort
was made to obtain copies of the missing issues so sets could be
completed. The vertical file on pamphlets was brought up-to-date
and a second supplement to the "Bibliography of Articles Written by
Personnel of the State Board of Health" was printed and widely
distributed.

GENERAL ADMINISTRATION

A new photocopier was placed in the library which permitted
more prompt and effective satisfaction of the numerous requests for
photocopies.
The staff worked diligently in the development of a grant pro-
posal for participation in the Medical Library Resource Grant hoping
to enhance greatly the service ability of the library.

Audio-Visual Library
The Audio-Visual Library had an increase in all activities for
1966. Circulation figure of motion pictures and other aids was
12,157, an increase of 1692 over the previous year, or 16.1 per cent.
There were 8164 booking orders processed which represents an in-
crease of 6.3 per cent over the 1965 figure. All the aids were used
24,774 times reflecting an increase over the 1965 total of 11.4 per
cent. The equipment used outside the confines of the audio-visual
physical plant amounted to 348 pieces, an increase of 9.7 per cent
over last year.
The library added 301 prints of motion pictures to its collection,
some purchased and some on permanent loan from bureaus, divi-
sions or outside agencies. Twenty-five prints were removed from
circulation because of obsolescence or excessive damage. Film
suppliers loaned 127 prints for preview or use within the SBH.
Inventory as of January 1, 1967 included 1593 prints of motion pic-
tures with 580 separate titles and 259 items of other visual aids
such as filmstrips and slides. A catalog supplement and the annual
circulation survey were printed and distributed.

Pamphlets
Pamphlet distribution showed an increase of 90,646 from the
previous year figure of 324,475 for a total of 415,124. The categories
most frequently requested in pamphlets were communicable dis-
eases, nutrition, safety, chronic diseases, maternal and child health,
Florida Health Notes, health careers and sanitation. Reading packets
were prepared and distributed to the teachers enrolled in the Health
Project in Teacher Education.

Publications, Radio and Television
Eleven issues of Florida Health Notes were printed during the
year with an average press run of 21,000 copies. Subjects for the
various issues were sewage and water plant operators, family plan-
ning, swimming pools, birth certificates, county health officers,
prevention of highway accidents, Medicare, heart disease, home
health services, a simplified annual report and a special summer
issue on food hygiene. A total of 42 other books, pamphlets, posters,
fliers and folders was printed.

20 ANNUAL REPORT,

The information specialist made eight trips for the purpose of
doing research and making photographs for Florida Health Notes.
Photographic assignments were covered for the Suwannee CHD,
Division of Nutrition, Project Manasota-88, 3rd Annual Industrial
Editors' Learning and Development Day and the Florida Public
Health Association convention. Consultative services were rendered
to various bureaus and divisions of SBH and a few of the CHDs.
Radio spot announcements were kept current and 14 new spots
were developed and distributed to 201 radio stations.
A 12-month calendar of events of interest to public health per-
sonnel was produced and distributed to all bureaus and divisions as
well as CHDs and other health related agencies. A quarterly publi-
cation specialized in the light side of the news related to personnel
at the SBH, CHDs and voluntary health agencies.

Exhibits and Illustrations
The exhibits consultant had a 15 per cent increase of items ac-
complished over the previous year. He completed 44 exhibits and
displays during the year, made 103 reproductions, 43 illustrations
and also produced 127 charts, graphs and maps, 227 signs plus
photographic materials for 78 slides and made 50 miscellaneous
projects. He was involved in 70 conferences and made 12 trips for
consultation on exhibits and other creative productions.

Educational Activities
The health consultant was active in a variety of educational pro-
grams with PTAs, CHDs, voluntary health agencies and other lay
organizations. Three general orientation programs were held during
the year, each for a duration of four and one-half days. Workshops
on communications problems were conducted for CHDs. Human re-
lations workshops were planned and conducted in cooperation with a
university and nursing students of hospitals. Action snapshots were
taken at migrant workshops, and talks given at adult basic education
conferences. A three-day workshop was attended in Houston, Texas,
on "The Small Group: Its Role in Decision Making in Public Health."
The 10 "Education for All" conferences sponsored by the State
Department of Education were attended by the health education con-
sultant and the director of the division. Many CHD personnel also
attended the conference scheduled in their area. The consultant
participated in the development of the Health Project in Teacher
Education (see report of the Bureau of Maternal and Child Health
elsewhere in this report) and worked with the universities and the
CHDs to develop an effective program.

1966

GENERAL ADMINISTRATION

DIVISION OF PERSONNEL
MILES T. DEAN, M.A.
Director
This division is responsible for the administration of the per-
sonnel program of the State Board of Health (SBH). This includes
advising administrative officers concerning personnel practices and
development; putting into effect procedures for carrying out ap-
proved personnel policies; participating in the preparation and
administration of the approved Classification and Compensation
Plan; administering the leave regulation; maintaining adequate per-
sonnel records on all persons employed in the agency; acting as
liaison official with the Florida Merit System involving requests for
certificates and reporting on the selection of eligibles, promotions,
salary advancements, salary adjustments, demotions, transfers,
dismissals, lay-offs and resignations; providing and administering
a service rating system and the preparation of state and federal
reports. Payroll operation, also a responsibility of this division,
includes the administration of leave accounting, the employee insur-
ance program, retirement and Social Security, as well as the prepa-
ration of the administrative payroll and distribution of warrants.
Preparation of the salary portion of the Legislative Requesting and
the Operational Budgets is also a responsibility of this division.
The total number of employees in the SBH continued to increase
during the past year. There was a considerable increase in employ-
ments due, to a degree, to the increased turnover rate. There were
1838 employment during this year. An increase in personnel was
made in the Grants and Donations category, especially in the instal-
lation of Maternity and Infant Care Programs. A change in the class
specifications used by the SBH was made in most professional
classes extending the probationary period from six months to one
year.
Turnover of personnel continued to be a substantial problem.
There was a significant increase in the turnover rate for all em-
ployees during the year. Only approximately 67 per cent of the
sanitary engineer positions were filled despite continuous and exten-
sive recruitment in this area. Recruitment of the entire spectrum
of health workers continued to be very difficult with ever increasing
employment above the minimum salary range being necessary.

22 ANNUAL REPORT, 1966

TABLE 1

EMPLOYEES IN THE FLORIDA STATE BOARD

OF HEALTH AND COUNTY HEALTH UNITS
AS OF DECEMBER 31, 1957-1966

State County Health Total
Year Office Departments Employees

1966 ................... ............. .. 929 2769 3698
1965..................................... 914 2647 3561
1964..................... .. .............. 843 2326 3169
1963.................... ............. 762 1918 2680
1962 .......................... .......... 692 1821 2513
1961................... .............. 626 1593 2219
1960 ........................ ..... ...... 604 1534 2138
1959........................ ............. 586 1396 1982
1958..................................... 558 1321 1879
1957..................................... 528 1234 1762

TABLE 2

PERSONNEL IN ADMINISTRATIVE UNITS OF THE FLORIDA STATE BOARD OF HEALTH

(EXCLUDING COUNTY HEALTH DEPARTMENTS), BY CLASSIFICATION

DECEMBER 31, 1966

2-

ADMINISTRATIVE UNIT 0 | o 0 0
-s U u.T 0 00 .S o
0 .Z. J- O .-0 0.

Grand Total. ...................................... ...... 929 34 13 93 33 16 114 230 297 99
Administration
Research.................................................... ..... 8 1 2 4
Training ................... .... ............ .. ........ 2 1 .....
State Health Officer ............................................ 27 5 ..... 9 10 3
Health Education ............................................ 15 ..... ..... .... ..... ..... ..... 5 6 4
Personnel ................... .......................... 12 ....... ..... 3 9
Nursing ...................................... .... .. 12 ..... ..... 10 2
Encephalitis Research Center. ................. ............... 10 3 ..... ..... ..... ..... 5 1 1
Dental Health .... ............. ................... 20 ..... 1"3 ..... ..... ..... 2 1 4
Entomology
State and Regional Offices ............................... 21 ..... ..... ..... .... 3 11 4 2
Research Center-Vero Beach ............................ 21 ..... ..... ..... ..... ..... 1 13 2 5
Anthropod Laboratory in West Florida ........................... 12 ..... ..... ..... ..... ..... 3 5 2 2
Finance and Accounts
Fiscal ......................... ........ ...... ...... 14 6 7 1
Purchasing and Property................... ............... 8 5 3
Building and Facilities .................................. 36 ..... ..... ..... ..... ...... 7 28
Laboratories
Central-Jacksonville ...................................... 59 ..... ..... ..... ..... ..... 31 19 8 1
Miami ................... .......................... .. 22 ..... ..... ..... ..... ..... 12 6 4
Orlando ...................................... ..... 11 .... 2 1
Pensacola .........9 ..... ..... ..... ..... ..... 4 3 1 1
Tallahassee............................................ 6 ..... ..... ..... ..... ..... 3 2 1
Tampa ................... ..25 ..... ..... ..... ........... 14 7 3 1
West Palm Beach ...... 7 ..... .......... ..... 3 3 1
Epidemiology of St. Louis Encephalitis ............................ 11 ..... 1 .... ..... 7 ..... 3

TABLE 2 (Continued)

PERSONNEL IN ADMINISTRATIVE UNITS OF THE FLORIDA STATE BOARD OF HEALTH
z
(EXCLUDING COUNTY HEALTH DEPARTMENTS), BY CLASSIFICATION z
C
DECEMBER 31, 1966 >
i-

o W

ADMINISTRATIVE UNIT u u O
Io S 0 t u a t
"- o 0 .. oO

Local Health Services
Bureau of Local Health Services ................... .. 8 2 ..... ..... ..... ..... ..... 2 4
Sanitation ................ ............................... 8 .....6 2
Nutrition ............ .. ........................ ....... 14 ..... ..... ..... ..... ..... ..... 12 2 .....
Civil Defense ........... ..... .......................... 2 ..... .... ..... ..... ..... 1 1 .... 0
Accident Prevention ...................... ...... ........ .. 2 1 1
Maternal and Child Health ....................... ............ 77 6 ..... 29 11 1 9 13 8
Narcotics .......................... ... ............... ... 18 ..... ..... ..... ..... ..... .... 12 6
Preventable Diseases
Bureau of Preventable Diseases ................. ............ 16 3 ..... ..... ..... 1 3 9 ....
Radiological and Occupational Health .......................... 18 1 ..... ..... ..... 2 10 5
Tuberculosis Control ............... ........... 96 5 ..... 36 ..... ..... 2 18 33 2
Veneral Disease Control. ................. ............ ... . 17 ..... ..... ..... ..... ..... ..... 16 ...
Veterinary Public Health ................. ........ ........... 4 ..... ..... ..... ..... 2 2
Vaccination Assistance Project .......... ........ ..... 60 16 .....4 17 23
Sanitary Engineering and Air Pollution Control. .................. 89 ..... ..... ..... 32 5 12 6 27 7
Health Facilities and Services
Bureau of Health Facilities and Services ................... ..... 42 3 ..... .... ..... ..... ..... 18 20 1
Chronic Diseases ................ ...................... ... 21 3 ..... 1 .... ..... ..... 5 11 1
Vital Statistics
Bureau and Division of Vital Records. ........................... 50 ..... .......... ..... ...... 50 2 46 2
Statistics ................... ....... .................. 5 ..... .... ..... ..... ..... ..... 3 2
Data Processing ................... ............. ........ 14 ..... ..... ..... ..... ..... .. 3 11

GENERAL ADMINISTRATION 25

TABLE 3

PERSONNEL IN COUNTY HEALTH UNITS, BY CLASSIFICATION,

FLORIDA, DECEMBER 31, 1966

S
COUNTY S x 0 Oc 5

-a. Z S Og 0 <

Grand Total.......... 2769 110 16 811 21 355 51 83 514 808

Alachua ........... 49 1 1 11 ...... 7 ...... 4 11 14
Baker ............. 5 ...... .. 2 ......... ...... ...... 1 1
Bay ............... 16 1 ...... 6 ...... 4 ...... ...... 3 2
Bradford ........... 6 1 ...... 2 ...... 1 ...... ...... 1 1
Brevard .......... 55 1 ........ 19 2 12 3 1 17 ......
Broward ............ 121 2 2 40 3 20 4 3 40 7
Calhoun ........... 5 ..... ..... 2 ......... ...... ...... 1 1
Charlotte. ........... 12 1 ...... 5 ...... 3 ...... ...... 3 ......
Citrus............ 5 1 ...... 2 ...... 1 ...... ...... 1 ......
Cloy .. .......... 12 ...... ...... 7 ...... 2 ...... ...... 2 1
Collier . . ... 12 1 ...... 3 ...... 3 4 1
Columbia...... .... 1.. 1 1 ...... 3 ...... 3 ...... ...... 3 1
Dade ............. 410 45 2 165 5 57 17 20 72 27
DeSoto .. .......... 6 ...... ...... 3 .. 1 ...... 1 .... ...... 2 ......
Dixie ............. 4 ....... ....... 2 ...... ...... ...... ...... 1 1
Duval. ............ .. 60 2 1 23 ...... 13 2 ...... 13 6
Escombia........... 67 3 ...... 24 ...... 12 2 2 16 8
Flagler ............ 4 ...... ...... 2 ...... 1 ...... ...... 1 ......
Franklin ........... 3 ...... ...... ...... ...... 1 ...... ...... 1
Gadsden ......... 14 1 ...... 6 ...... 3 ..... ...... 3 1
G ilchrist. ........... 2 ...... ...... 1 ...... ...... ...... ...... 1 ......
Glades ......... .. ...... ...... .......... 1 ...... .......... 1
Gulf ............. 5 ...... ....... 2 ...... 1 ...... ...... 2 .
Hamilton. ........... 4 ...... ...... 1 ...... 1 ...... ...... 1 1
Hordee ........... 8 ...... 1 3 ...... 1 ...... ...... 2 1
Hendry ........... 14 1 ...... 5 ...... 1 ...... ...... 4 3
Hernando............ 2 ...... ...... 1 ...... ...... .... i .. ...... ..1
Highlands ......... 9 1 ...... 3 ...... 3 ...... ...... 2 ......
Hillsborough. ......... 204 8 ...... 75 2 35 4 7 36 37
Holmes. .......... .. 6 ...... ...... 2 ...... 1 ...... ...... 1 2
Indian River ......... 12 1 ...... 6 ...... 2 ...... ...... 2 1
Jackson .. 14 ...... 6 ................14 1 6 2 3
Jefferson. .......... .. 6 1 ...... 2 ...... 1 ...... ...... 1 1
Lafayette. .......... .. 4 ..... ...... ...... ...... ...... 1 1
Lake ...... 16 6 .. 3 ............16 1 6 4 2
Lee .............. 25 1 ...... 8 ...... 4 1 ...... 6 5
Leon....... ..... 35 2 ...... 11 ...... 7 ...... 1 10 4
Levy ............. 8 .. ............8 3 2 2
Liberty ........... 2 ...... ...... 1 ....... ...... ...... ...... 1 .
Modison ............ 6 1 ...... 2 ...... 1 ...... ...... 1 1
Manatee .......... 43 1 1 12 1 8 2 2 10 6
Marion ........... 21 1 ...... 9 ...... 5 ...... 1 4 1
Martin ... . 5 ..... ..... 2 ...... 2 ... ...... ......
Monroe........... 19 1 ...... 6 ...... 3 ...... ...... 4 5
Nassau ............. 14 1 ...... 5 ...... 2 ...... ...... 5 1
Okaloos ........ .. 22 ....... 8 ...... 4 1 ...... 4 4
Okeechobee.......... 4 ...... ...... 1 ...... 1 ...... ...... 1 1
Orange........... 123 3 1 45 ...... 17 1 8 28 20
O sceola .......... 8 ...... ...... 2 ...... 2 ...... ...... 3 1
Palm Beach ......... 148 5 2 47 3 20 3 11 32 25
Pasco ............. 8 1 ...... 3 ...... 1 ...... ...... 2 1
Pinellas. ............ 192 6 1 78 3 28 8 10 41 17
Polk.............. 92 1 1 39 2 11 2 2 20 14
Putnam ........... 14 1 1 5 ..... 3 ...... ...... 3 1
St. Johns .. 11 ...... 4 ...... 2 ...... ...... 2 2
St. Lucie .. 18 ...... 5 .......... 4 ...... 1 5 2
Santa Rosa ......... 13 ..........13 1 2 ...... ...... 2 2
Sarasota ........ 58 1 1 21 ...... 10 ...... 1 17 7
Seminole .. 19 ...... 9 ...... 3 ............19 1 94 2
Sumter ........... 4 ...... ...... 1 ...... 1 ...... ...... 1 1
Suwannee ........ 10 1 ...... 4 ...... 1 ...... ...... 2 2
Taylor ............ 5 ...... ...... 2 ...... 1 ...... ...... 1 1
Union ........... 3 ...... ...... 1 ...... 1 ...... ...... 1 ......
Volusia. ........... 54 2 1 22 ...... 9 1 ...... 11 8
W akulla ........... 2 ...... ...... ...... ...... ...... ...... .....
Walton ........... .. 9 1 ...... 3 ...... 1 ...... 1 1 2
Washington 6 .. .......6 3 ...... 1 ...... ...... 1

26 ANNUAL REPORT, 1966

TABLE 3 (Continued)

PERSONNEL IN COUNTY HEALTH UNITS, BY CLASSIFICATION,

FLORIDA, DECEMBER 31, 1966

Aede ae mosque

Eradication Program Total 583 ...... ....... .. ...... ............. 8 30 545
Alachua A. A........ 15 ...... ...... ...... ...... ...... ...... ...... I 14
Brevard A. A... ...... 22 ....... ....... ...... ...... ...... ...... ...... 1 21
Broward A. A.......... .. 34 ....... ....... ...... ........ ...... ...... ...... 1 33
Dode A. A.......... ... 82 ....... ...... ...... ...... ...... ...... 2 3 77
Duval A. A.......... .. 33 ....... ....... ...... ...... ...... ...... 4 10 19
Escambia A. A... ..... 14 ....... ....... ...... ...... ...... ...... ...... 1 13
COUNillsb rough A. A...... 92 ...... ...... ...... ...... ...... ...... 2 3 87
Lee A. A........... 32 ...... ...... ...... ...... ...... ...... ...... 1 31
Leon A. A........... 10 ...... ...... ...... ...... ....... ...... ....... 1 9
z -9 eE 01 U S

Aedes aegypti mosquito

Eradication Program Total 583 ...... ...... ...... ...... ...... ...... 8 30...... 54...... 5422
AlachuMonroe A. A....... 1 ...... ...... ...... ...... ...... ...... ...... 1 11
Orangerd A. A......... 1522 ...... ...... ...... ...... ...... ...... ...... 1 14
P alm Beach A. A ...... ...... ......... 5. ... .. ...... ... ...... ...... ...... 1 24
PineasA. A. ......... 273 ...... ...... ...... ...... ...... ...... 2 ..... 72
Polu A. A........... 33 ...... ...... ...... ...... ...... ...... 4 10 351
St. ucie A. A........ 132 ...... ...... ...... ...... ...... ...... ...... 1 31
Hillsborough A. A...... 92 ...... ...... ...... ...... ...... ...... 2 3 87
Lee A. A. .......... 32 ...... ...... .... ...... ...... ...... 31
Leon.A. A...:....... 10 ...... ...... ...... ...... ...... ...... ...... 9 11

Marsotae A. A ........ 221 ...... ...... ...... ...... ...... ...... ...... 1 20
Monroa A. A......... 12 ...... ...... ...... ...... ...... ...... ...... 1 12
Orange A. A......... 15 ...... ...... ...... ...... ...... ...... ...... 1 14
Palm Beach A. A...... 25 ...... ...... ...... ...... ...... ...... ...... 24
PinellasA. A.. .... 73 ...... ...... ...... ...... ...... ...... ...... 72
Polk A. A........... 36 ...... ...... ...... ...... ...... ...... ...... 35
St. Lucie A. A........ 32 ...... ...... ...... ...... ...... ...... ...... 1 31
Sarasota A. A. ....... 21 ...... ...... ...... ...... ...... ...... ...... 1 20
VolusioA. A.. ....... 13 ...... ...... ...... ...... ...... ...... ...... 1 12

GENERAL ADMINISTRATION 27

TABLE 4
EMPLOYMENT, TERMINATIONS, AND TURNOVER RATES BY
CLASSIFICATION AND SALARY, FLORIDA STATE BOARD OF HEALTH
AND COUNTY HEALTH UNITS, 1966

(full-time employees only)

SALARY
CLASSIFICATION Under 200- 300- 400- 500- 600- 700- 800- 900- 1,000
Total 199 299 399 499 599 699 799 899 999 Over
TERMINATIONS 1966

Total-All Employees ......... 1,495 35 231 932 185 47 35 7 8 3 12
Physicians ................ 13 .. ..... ..... .... .... .. .... .... 1 11
Dentists.................. 16 ........ ..... ... ... 14 1 1 .... ....
Sanitarians................ 43 .... .... 2 37 3 1 .... ..
Sanitary Engineers ........... 5 .... ........... 1 1 1 ... 1 1
Public Health Nurses........... 137 .... .... 29 92 13 1 1 1 ........
Laboratory Workers
(Prof. & Technical). ......... 39 .... 10 25 1 2 1 .... ............
Other Professional
and Technical ............ 122 .. 15 17 35 27 17 4 6 1 ....
Clerical ................. 208 9 135 60 4 ..... .. ... .... ..... ....
All Others .............. 913 26 71 799 16 1 .... ......... ....

TURNOVER RATE*

Total-All Employees ........ .. 43.0 29.9 49.0 82.0 19.7 11.9 20.8 11.5 17.4 13.0 10.3
Physicians ................ 12.7 .... .... .... .... ..... ........ 12.5 11.7
Dentists.................. 69.6 .... .... ........... 116.7 20.0 20.0 0 0
Sanitarians................. 5.3 ........ 1.8 7.1 2.0 3.6 0 0 ........
Sanitary Engineers ........... 9.4 ... .... ..... 12.5 11.1 16.7 0 14.3 8.3
Public Health Nurses ........ .. 36.4 .... .... 580.0 63.0 9.2 1.8 9.1 33.3 0 ....
Laboratory Workers
(Prof. & Technical). ......... 14.5 .... 22.7 37.3 1.9 4.8 3.2 0 0 0 0
Other Professional
and Technical ............ 62.2 0 500.0 154.5 62.5 54.0 54.8 17.4 37.5 25.0 0
Clerical ................. 26.6 33.3 47.4 15.1 5.6 0 .... 0 .... .
All Others. .............. 106.3 29.2 50.7 145.5 20.3 50.0 0 .... .... .... ....

*Terminations as a per cent of average 1966 full-time employment, by salary within each classification.

DIVISION OF PUBLIC HEALTH NURSING

ENID MATHISON, R.N., M.P.H.
Director
The division attempts to ensure that the highest quality nursing
service possible is available in each of the county health depart-
ments (CHDs). Information, advice and assistance in connection with
the public health nursing aspects of projects and programs is pro-
vided all bureaus and divisions of the State Board of Health (SBH).
Public health nursing, available to every member of the community,
is integrated and coordinated with all services of the total public
health program. The nurse has specific professional functions as a
member of the health team; guidance for the direction of nursing
programs and services on the local level is provided by the division.
Public health nursing in a rapidly changing society requires con-
stant re-evaluation so that it may adapt into programs and services
at all levels. Consultants from the division work closely with the

28 ANNUAL REPORT, 1966

personnel in CHDs to assist them in establishing priorities for
nursing programs. When services must be curtailed in some areas,
as new programs are initiated without the addition of new staff mem-
bers, assistance is given in making decisions as to which services
will be reduced or dropped.
A very serious handicap to the work of the division this year has
been the inability to fill four vacantpositions. One of the consultants,
with the longest experience in the state, became coordinator of the
Home Health Services Program. The advent of Medicare and num-
erous new special projects which require nursing services for im-
plementation have made it necessary for the staff members to re-
direct their activities.
The first two months (January and February) were devoted al-
most exclusively to surveys of local health agencies, both official
and voluntary, to determine their eligibility for recommendation for
certification as providers of services under Medicare. Revisits to
give assistance in meeting the conditions of participation were nec-
essary in most of the agencies, sometimes as many as three visits
were made. It was gratifying that 57 agencies were eligible for
certification by the end of the year.

In July a hospital nursing consultant joined the staff; she has
worked most effectively in the nursing home program.

In cooperation with the School of Nursing at Florida State Uni-
versity, a short-term traineeship grant was obtained for a five-day
workshop on Public Health Nursing Supervision. Forty-five super-
visors and potential supervisors participated; five were from
Georgia, South Carolina and Tennessee.
Under the leadership of the assistant director of the division, the
Continuing Education Committee, composed of local directors of
nursing, supervisors, staff nurses and public health faculty from
two colleges of nursing, published a GUIDE FOR ORIENTATION
OF NURSES NEW TO PUBLIC HEALTH and a GUIDE FOR A
HOME HEALTH AIDE PROGRAM. Numerous requests for these
have been received from other states. All consultants have given
additional attention to the continuing education groups on local levels
to help them prepare for Medicare, special maternal and infant care
projects and other special programs. In 50 of the counties there are
regularly scheduled in-service education programs, 17 have either
intermittent or no programs.
To meet the requirement, an eight-week planned orientation is
given new public health nurses who have not had preparation or ex-
perience in public health, prior to receiving permanent status. Four
field teaching centers are available to nurses from counties which
do not have a qualified and adequate staff to provide the approved
orientation. Sixteen nurses received the training away from their

GENERAL ADMINISTRATION

homes. Stipends were provided for them during the orientation
period. The larger counties conduct courses for their staffs.
Special emphasis has been devoted to the overall home health
aide program, with careful attention given to the establishment of a
proper image of this new member of the nursing team in the eyes of
health agencies and the public. Because of the very successful ex-
perience the St. Petersburg Visiting Nurse Association has had in a
home health aide program (established in September, 1964), this
group agreed to provide a five-day orientation for nurses who would
supervise the service in other agencies throughout the state. Sixteen
public health nurses attended and 12 certified Home Health Services
are using the home health aide on their team. All aides receive the
course as outlined in the Guide prepared by the Continuing Education
Committee.
To meet the requirements of Medicare for establishing a valid
cost for services rendered recipients served through Home Health
Agencies, consultants are giving concentrated help to the nurses in
doing their time and cost studies. The average cost per home visit
for disease and disability is $5.59 and for health supervision $4.17.
Other average costs are: clinic session $33.11, visit to a school
$15.94, visit to a nursing home or day care center $9.92 and class
or group teaching $15.69.
Efforts to improve and extend medical services to all maternity
patients have been rewarding as evidenced by the fact that licensed
midwives are not practicing in 18 counties. The total number of
midwives is 11 less than last year; 168 were licensed this year.
Support in the form of a stipend is still provided by the Bureau of
Maternal and Child Health for new midwife trainees to attend the
three-week training program made possible by the Seminole CHD
and the Marie Francis Maternity Home in Sanford. Applicants are
carefully selected, and after a need is established, and recom-
mended by both the CHD and the maternal and child health nursing
consultant.
Eight orientation programs for professional workers were
scheduled by the consultant in the Mental Retardation Program at
the four Sunland Training Centers; attendance was 106. Over 100
persons participated in two community educational programs on
mental retardation.
Requests for programs and workshops in rehabilitation nursing
exceed the time available by the consultant in this specialty. Forty
programs were conducted for public health nurses and nursing home
personnel. There is urgent need for this service in the nursing
homes throughout the state.
The consultants made 400 visits to CHDs and voluntary health
agencies.

30 ANNUAL REPORT, 1966

BUREAU OF ADULT HEALTH AND
CHRONIC DISEASES
J. E. FULGHUM, M.D.
Director
The nature and extent of the complexities of various chronic dis-
eases which present themselves as public health problems continue
to receive the attention of this bureau. Education and training pro-
grams have played a large part in the activities of the bureau staff.
Progress has been made in increasing the knowledge and awareness
of the public about chronic diseases. Active participation directed
to the professional level has been successful in bringing to the
physician an awareness and appraisal of the newer methods of pre-
vention, diagnosis, treatment and rehabilitation of patients with
chronic diseases. Health profile screening has been emphasized
where such programs met the needs of the community.
The active ongoing programs within the bureau are programs in
aging, cancer, heart disease, diabetes, prevention of blindness and
smoking and health.

Consultation Visits
During 1966, the staff of the bureau provided field consultation
visits as follows: cancer 74, heart 32, diabetes 90, prevention of
blindness 45, smoking and health 10, and other special projects 23,
with a combined total of 274 trips or visits.

Relationship with Other Organizations and Agencies
The bureau is represented on the Florida Cancer Council, the
Florida Coordinating Council for Cardiovascular Diseases and the
American Cancer Society, Florida Division, Inc., the Florida Com-
mittee on Smoking and Health, Florida Diabetes Association, Florida
Tuberculosis and Respiratory Disease Association and the Florida
Society for the Prevention of Blindness. These activities contribute
to a good working relationship with the major voluntary agencies
within the state.

Health Profile Screening
At the request of the Charlotte County Medical Society, made
through the Charlotte County Health Department (CHD), the bureau
conducted a Health Profile Screening Program in Port Charlotte one
week in 1966. The purpose of this program was to provide screening
examinations, at no cost, to the general public. Positive screenees
were referred to their private physicians for diagnosis and treat-
ment. Persons over 35 were accepted for the following screening
examinations: 1) medical history, 2) height and weight, 3) visual
acuity, 4) tonometric examination, 5) blood pressure, 6) X ray and
7) blood sugar determination. A total of 1824 persons was screened

ADULT HEALTH AND CHRONIC DISEASES 31

and 706 suspects were found and referred to the physicians in Char-
lotte County. From the number referred, 46 suspects or 2.5 per
cent were referred for glaucoma and 176 or 9.6 per cent were re-
ferred for diabetes.

AGING
Health problems of the aging are well known and identifiable.
There are presently 750,000 older (over 65) persons in Florida who
are afflicted with the usual infirmities of the aging. This total of
older Floridians will be increased to an estimated 1,000,000 per-
sons by 1970. Many of these people are on fixed incomes and have
been caught up in the increased cost of living, high taxes and dis-
abilities resulting from the chronic diseases. They find themselves
with depleted resources and become dependent on the community for
assistance. Florida is above the national average in proportion of
older persons because it is a favorite retirement state.
Responsibility for the health programs for aging is vested in
the bureau. Close liaison is maintained with the Commission and
Council (the voluntary health agency in Florida) on Aging and the
Florida Medical Association Committee on Aging. Health services
for the aging are provided as a part of the general health services
which are available to the population at large.
It is desirable to establish an active program on aging in the
bureau so that health education, preventative screening, early case
finding and physical rehabilitation programs can be planned for and
implemented.
A survey of the states and territories has been made to deter-
mine the extent of health programs in aging being conducted in state
health departments. Results of this survey are being compiled and
studied.

CANCER CONTROL PROGRAM
During 1966 malignant neoplasms or cancer maintained position
as the second leading cause of death for Floridians and thus remains
a major health problem for Florida. Cancer mortality continues up-
ward from 9701 Floridians in 1964 to 10,352 in 1965 and it is esti-
mated that it will exceed 10,700 for 1966.
The provisionalcancer death rate per 100,000 in 1966 for Florida
was 179.9, while the estimate for the United States was 160.0. This
large variance of rates is understandable in view of the rise in
Florida's population over 65 years of age.
In the past decade, 1955 to 1965, cancer mortality in Florida for
most sites experienced only a slight increase or in some cases a
tendency to level off. The large increase in the overall mortality
rate of 141.9 in 1955 to 179.9 in 1966 was substantially due to

32 ANNUAL REPORT, 1966

increased rates for a few sites. The sites mainly responsible for
this rise were cancers of the lungs, the digestive system and the fe-
male breast. Cancers of cervix uteri continued to lead in the down-
ward trend for cancer mortality and gives evidence of the fruitful
results for the doctrine of early detection. The need for cancer con-
trol has never been greater and this need continues to grow with the
techniques and the advancement of knowledge in the management and
control of the cancer patient.

Tumor Clinics
The Cancer Control Program continued during the year to lend
its full support to the Florida tumor clinic system. The tumor clinic
at White-Wilson Clinic, Fort Walton Beach, Florida, was closed on
June 1, 1966. No new clinics were approved during 1966, however,
interest and inquiries for forming new clinics remains strong. There
are presently 27 approved tumor clinics operating throughout the
state. It is conjecture at this time to say whether Medicare was the
cause for the drop in patient visits to the clinics from 39,655 in 1965
to 35,596 in the past year. The private physician serving without
compensation continues to be the mainstay of the tumor clinic. The
hospital furnishes without charge supplies, equipment, space and in
some instances personnel to support the clinic. Approximately 50
per cent of the ancillary clinic personnel, such as tumor clinic sec-
retaries and registry clerks, is furnished by the State Board of
Health (SBH) Cancer Control Program. The American Cancer Society,
Florida Division, Inc., also lends support to the tumor clinics and
sponsors some clinic personnel. Volunteers serve in many clinics
on part-time positions. The SBH furnishes limited fees for diag-
nostic work, radium and X-ray treatment for the indigent outpatient.

Cervical Cytology Program
The County Cervical Cytology Program experienced excellent
growth during 1966. These programs are planned around ongoing
programs of the local CHDs by introducing the "Pap smear" tech-
nique along with other examinations being conducted in the Bureau
of Maternal and Child Health (MCH) programs of "Family Planning,"
"Postpartum Care" or other allied clinics. Twenty-six counties
engaged in cervical cytology during 1965, screening 11,362 women.
Through December, 1966, there were 39 counties engaged in cervical
cytology screening 21,042 women. From those screened, 438 sus-
picious or positive cases or 2.1 per cent were referred to tumor
clinics for further examination or treatment.

Statistical Tabulating Center
The Statistical Tabulating Center originated as a federal project
grant from July, 1963 through December, 1965. This center was
formed at the recommendation of the Florida Cancer Council and the

ADULT HEALTH AND CHRONIC DISEASES 33

Florida Association of Tumor Clinic Directors. The project became
a permanent part of the Cancer Control Program in 1966 and is now
an ongoing program. There are currently 19 registries reporting to
the center.
The value of the center in improving and maintaining quality
control of cancer case records has proven itself. The center is able
to monitor and assist the independent member registries towards
upgrading their registry, cancer records and follow-up procedures.
A system of providing an annual follow-up listing during the month
of follow-up for each registry has been instituted. This will aid the
registry as a checklist and should result in a minimum of "lost to
follow-up" cases.
The center publishes an annual report reflecting the information
and statistics in its case files. The detail of data being collected is
comprehensive. Interest in the central registry is expected to grow
with the anticipated production in 1968 of a five-year survival re-
port. A preliminary three-year report is under consideration.
Professional interest remains strong in the center, its reports
and progress. The Florida Cancer Council and the Florida Associa-
tion of Tumor Clinic Directors continue active support of the center,
and have provided steering committees for the center in its growth.
A current committee by the tumor clinic directors is making a study
of presenting data from the center in slide form for educational
purposes. The center in the future will provide professional and lay
groups with the cancer facts for Florida.

Polk County-Aid to Dependent Children Survey-Cytology
The Cancer Control Program conducted a survey of Aid to De-
pendent Children recipients of Polk County in cooperation with the
Polk CHD. From January 1, 1966 through September, 1966, 1138
women were screened, and seven positive and 33 suspicious cases
were found.

34 ANNUAL REPORT, 1966

TABLE 5
PATIENT VISITS TO TUMOR CLINICS
ASSOCIATED WITH CANCER CONTROL PROGRAM,
FLORIDA, 1966
1966

Alachua General Hospital.................... ............................... 125
Bay County Tumor Clinic.................................... ................... ... 616
Brevard County Tumor Clinic ...................................................... 50
Broward General Hospital ................ ...................... .................. 325
Duval Medical Center ........................................................ 5496
Escambia General Hospital ................... ................................ 2187
Halifax District Hospital ................. ................... .................. 146
Hollywood Memorial Hospital .............. ................................... 225
Jackson Memorial Hospital .................... ................................. 3246
Lee Memorial Hospital ........................................................ *
Leesburg General Hospital ............... ......................... .............. 11
Manatee Memorial Hospital....................................... ............ .. 149
Mercy Hospital ................... .................................... 338
Mt. Sinai Hospital. ........................................................... 1359
Munroe Memorial Hospital....................................... ............. .. 288
Okaloosa County Tumor Clinic ................... ................................ 31
Orange Memorial Hospital................... ............................... 3144
Pinellas County Tumor Clinic .................................................... 2095
Polk County Tumor Clinic ................... ................................. 1622
St. Francis Hospital .......... .............................................. ...... 662
St. Lucie County Tumor Clinic ..................................... ..... ........ 215
St. Mary's Hospital .................................... .................. .. ... 984
St. Vincent's Hospital......... ...... .................... ......... .......... 2433
Sarasota County Tumor Clinic ........................................... ..... 237
Tallahassee Memorial Hospital ................... ............................. 1300
Tampa General Hospital ...................................................... 3653
University of Florida ................... ...................... ............. 3612
Variety Children's Hospital ....................................................... 1047

TOTAL......................... .. ............ .......... ............... 35596
Clinic patients treated in private physician's office no report.
** Closed during 1966 (June 1).

HEART DISEASE CONTROL PROGRAM

Heart disease continues to be Florida's most serious health
problem. Mortality statistics show heart disease to be the main
cause of death in the state. The death rate per 100,000 rose from
324.5 in 1956, to 379.2 in 1956. While some of this is undoubtedly
due to the increasing number of older people, the rate has also in-
creased for the age group between 45 and 64 years. The SBH has
continued to work with the Florida Heart Association and maintains
its supporting role with the Florida Heart Council.

Rheumatic Fever Prophylaxis

The prophylactic treatment of all patients with documented rheu-
matic fever has been an effective method of reducing the incidence
of chronic rheumatic heart disease. The SBH provides penicillin
and sulfadiazine through CHDs to medically indigent patients upon
request of their family physician. The registry shows 1228 people
were receiving prophylactic treatment through this program at a
cost of $11,028 or $9.17 per person per year.

Heart Clinics

Heart clinics are supported through CHDs from heart funds.

ADULT HEALTH AND CHRONIC DISEASES 35

Medically indigent patients are provided with specialized care
through these clinics which are staffed by private physicians serving
without compensation. Most of the clinics are supported jointly by
the Florida Heart Association, the Crippled Children's Commission
and the SBH. CHDs report 7825 patients admitted to heart disease
control activities in 1966.

Health Education
Probably the most effective public health activity in the Heart
Disease Control Program is health education. The CHDs and local
heart association offices act as distribution centers for pamphlets,
brochures and other literature concerning heart disease. The SBH
cooperates with the Florida Heart Association in the distribution of
educational material. Speakers are made available and audio-visual
aids are furnished to civic organizations and schools on request.
A resource bulletin, "The Heart and Circulatory System," is being
prepared jointly by the Florida Heart Association and the SBH.

Prevention
The prime public health goal in the realm of heart disease is
prevention. Congenital heart defects can be prevented only when the
responsible factors are well understood and an informed public is
giventhe choice of preventing pregnancies under conditions known to
yield a high per cent of defects. Some progress is being made in
that certain virus infections and some drugs are known to contribute
to the per cent of infants born with defects. Rheumatic heart disease
is beginning to respond to the prophylactic treatment program which
prevents secondary streptococcal infection. Arteriosclerotic heart
disease is still not completely understood, however, the medical
profession has agreed that certain factors are so closely related to
the disease that they can be used as criteria for detecting those
most likely to develop an acute heart attack. Cigarette smoking,
inactivity, obesity, diabetes, hypertension and hypercholesterolemia
are factors thought to be amenable to manipulation by the combined
efforts of the patient and his physician. Screening programs for
these factors are being developed to identify the high risk person
and refer him to his private physician for a personalized prophy-
lactic treatment program.

Symposium on Coronary Intensive Care Units
The director of the bureau made the plans for a symposium on
the operation of intensive care units for coronary patients. It was
held on January 16, 1966, in Cocoa Beach, with the professional as-
sistance of the Florida Heart Association and financial support of
the U. S. Public Health Service (USPHS). Legal and administrative,
as well as professional problems related to the operation of this
specialized type of intensive care units were discussed.

36 ANNUAL REPORT,

Intensive Coronary Care Units
Until some method of preventing myocardial infarction has been
developed, the profession will be able to reduce the death rate from
this disease by treating patients with acute coronary disease in
intensive care units designed specifically for these patients. The
SBH is interested in helping hospitals find financial support for such
units. Eight hospitals have coronary care units separate from gen-
eral intensive care units, and three others are planned for 1967.

Stroke Rehabilitation Project
A special rehabilitation project for stroke patients was started
in Escambia County where patients are treated in group sessions.
The project has demonstrated the marked improvement in patient
motivation when rehabilitation efforts are made in small groups of
patients with a similar degree of disability. The stimulus of com-
peting with other patients has been a strong positive motivating
influence.

Cardiovascular Seminar
The SBH and the Florida Heart Association co-sponsored the
Ninth Biennial Cardiovascular Seminar which was partially financed
through contributions from the SBH. The session was of great value
in bringing Florida cardiologists together to share in the recent
advances in the field.

DIABETES CONTROL PROGRAM
Florida's popularity as a retirement area has caused a steady
rise in the state's median age and a corresponding increase in the
number of both known and unknown diabetics who are now residents
of Florida. Based on preliminary data obtained during the period
January 1, to September 30, it is estimated that 933 Florida resi-
dents died of diabetes during 1966.
In 1966, diabetes ranked as the tenth leading cause of death
among Florida residents.
Diabetic retinitis is one of the important causes of blindness
within the state. Only cataracts and glaucoma are greater causal
factors for blindness at this time.
The Diabetes Control Program is organized into three major
areas as follows: Insulin distribution, casefinding and education.

Insulin Distribution
State funds are used to furnish insulin for the medically indigent
patients of the state. Approximately 3309 medically indigent diabetic
patients are now receiving all or part of their insulin from state
sources through the CHDs. The average annual cost per patient

1966

ADULT HEALTH AND CHRONIC DISEASES 37

under this program increased from $15.05 in 1965 to $15.87 in 1966,
primarily due to the increase in cost of insulin.
The insulin distribution program has a local diabetes registry
which is used for follow-ups, for relative casefinding programs and
as a reliable source of data for program evaluation.

Casefinding
Casefinding is primarily the responsibility of the CHD, with as-
sistance from the community and the SBH in the areas of consul-
tation, program planning and limited aid for conducting diabetic
surveys. Casefinding activities were reported in counties throughout
the state. Well over 32,402 persons were reported screened in
programs during 1966, with approximately 1167 persons being re-
ferred to their family physicians for diagnosis.
Casefinding activities have been primarily in three areas: office
of private physicians, community diabetes screening programs and
relative testing programs.
Diabetes screening has been introduced into most of the migrant
clinics in the state utilizing the rapid blood stick method for those
individuals who fall into the "high risk categories." Suspects are
then given further diagnostic evaluation before a diagnosis is made
by the physicians.
Two new types of blood testing, Destrostix and Unopette, were
phased into the program during 1965 and 1966, which allow greater
flexibility in casefinding and routine patient care.
The screening forms for use in mass screening programs were
simplified and condensed during the year. These forms, combined
with the use of "Diet Check List," developed by the director of the
Division of Nutrition, have greatly facilitiated the registering of the
screenees and the determination of the approximate amount of car-
bohydrate each has consumed prior to the administration of the test.
Screening programs for diabetics is another method of con-
ducting extensive public education. Large coordinated community
diabetes screening programs are being conducted in Florida during
Diabetes Week, health fairs and at other times. Postprandial blood
sugar determinations, two hours after a test meal, is considered to
be the method of choice. Relative testing programs are the most
productive and CHDs and communities are encouraged to conduct
such screening programs at regular intervals.

Professional Information
The Florida Diabetes Seminar was held on September 29 and 30,
1966, in Miami Beach. The Florida Diabetes Association, the Uni-
versity of Miami Medical School, the Postgraduate Education Branch
of the University of Florida College of Medicine and the SBH

38 ANNUAL REPORT, 1966

cooperated in the planning and presentation of this professional
seminar. Over 100 physicians from Florida attended this two-day
meeting.
Several classes were held for CHD nurses, stressing the impor-
tance of diabetes screening, methods of casefinding and patient edu-
cation. The purpose of the classes was to inform nurses of the latest
techniques of screening and patient education and to review symp-
toms, treatment and complications.

Public Education
Societies for diabetic laymen are a most important means of
promoting lay and patient educational activities as well as case-
finding. During the past year, the Diabetes Control Program staff
has assisted the Florida Diabetes Association and their local lay
societies in disseminating pertinent information. At the present time
there are 14 active societies for diabetic laymen within the state.

Timely Topics, a monthly bulletin for diabetics, is prepared and
distributed to over 4000 persons per month. These persons are
diabetics, relatives of diabetics, friends of the diabetic, or have a
genuine interest in diabetes control. Timely Topics represents an
economical way to get timely information to the diabetics. Copies
are available on request.

Patient Education
Brevard, Broward, Dade, Escambia, Highlands, Hillsborough,
Lake, Manatee, Orange, Palm Beach, Pinellas, Polk, Sarasota and
Volusia CHDs are carrying on programs involving patient education.
These are coordinated programs, co-sponsored by the CHD, the
local medical society and/or the local society for diabetic laymen.
Two new pamphlets, one for the lay public entitled, Here is a
Quiz Game That May Save Your Life and the other Screening and
Diagnosis in Diabetes Mellitis for the Physician, were made avail-
able for distribution during the year. Both were well received and
have proved to be quite popular.

Other Studies
A special study is still being conducted by the Pinellas CHD to
explore the causal factors and treatment of hypoglycemia and its
relationship to alcoholism. Blood sugar levels are measured before
a challenge meal and at intervals one, two or three hours post-
prandially. These tests are conducted among volunteers of the local
branch for Alcoholics Anonymous and the results are recorded on
individual graphs for comparison and evaluation of the hypothesis
that "the alcoholic may be induced to imbibe due to the rapid fluc-
tuation in blood sugar from hyperglycemia to hypoglycemia."

ADULT HEALTH AND CHRONIC DISEASES 39

PREVENTION OF BLINDNESS PROGRAM (GLAUCOMA)
Glaucoma is the second ranking cause of blindness in Florida,
and accounts for about 15 per cent of all blindness in the state.
Glaucoma affects two per cent of the population over 40 years of age
and a significant number of persons under age 40. The state and
federal government spend at least $300,000 per year through the Aid
to the Blind Program to persons blind due to glaucoma. Because of
the continued increase of senior citizens moving to Florida for re-
tirement, it is expected that blindness due to glaucoma will increase
more than the national average. Loss of vision caused by glaucoma
can usually be prevented if the disease is detected early and ade-
quately treated. Glaucoma occurs most often after the age of 40,
and the disease increases in incidence with age.
The objectives of this program are to support the establishment
and operation of glaucoma detection centers in populous areas of the
state in conjunction with the assistance of the local ophthalmologists
and the community resources; to screen the population for glau-
coma and refer those individuals found with increased ocular ten-
sions to ophthalmologists for diagnosis and treatment when indicated;
to do operational research on newer methods and techniques of glau-
coma screening; to compile, study and utilize the multitude of data
available as a result do screening activities; to encourage profes-
sional education of interns, residents, general practitioners and in-
ternists of the state in appropriate screening methods and tech-
niques of ophthalmological examinations so that these physicians can
then incorporate such screening methods as a routine procedure in
their private practices; and to promote public information and lay
education societies.
Most of the effort and expenditures during 1966 were directed
toward the early detection of glaucoma in the established screening
centers throughout the state. Four counties conducted fulltime
screening programs, with the financial assistance and consultation
of the Neurological and Sensory Disease Service Program, USPHS,
the SBH, and the many community resources. These screening
centers continue to have excellent response from the residents of
these areas. During 1966, 32,672 persons were screened for glau-
coma and 1044 (3.2 per cent) were referred to medical eye doctors
for diagnostic evaluation. Since the first screening program was
initiated in 1962, nearly 100,000 persons have been screened for
glaucoma and 2846 (2.9 per cent) suspects were referred for diag-
nostic evaluation. The excellent follow-up of the suspects continues
to be a highlight of the program. The screening centers have re-
ferred over 2800 suspects to local ophthalmologists for diagnosis
and lost less than five per cent to follow-up.
1s

40 ANNUAL REPORT,

Established Programs
Polk County Eye Clinic
The Polk County Eye Clinic, initiated April, 1962, was the first
to conduct a glaucoma detection program. This past year, 8586
persons were screened for glaucoma, and 167 (2 per cent) were re-
ferred to medical eye doctors for diagnostic evaluation. The clinic
has screened a total of 47,004 since it was opened and referred 1107
(2.4 per cent) glaucoma suspects to medical eye doctors.
The staff at the Polk County Eye Clinic conducts a family -relative
study on those persons who have been diagnosed with glaucoma. To
date 197 relatives of known glaucoma patients have been screened,
and 21 of these (10.7 per cent) have been referred as suspects. The
results of this family-relative study further indicate the need for
blood relatives to be examined for glaucoma. Although this type of
casefinding is more time consuming, it does appear worthwhile if
the schedule will permit.
The Polk County Eye Clinic has served as a training center for
workers from other counties that are interested in the prevention of
blindness. Personnel from the Polk County Center have assisted with
the initiation of severalother programs around the state. This serv-
ice allows more stability and continuity in training other persons.

Volusia County Eye Clinic
The Volusia County Eye Clinic has been in operation since Sep-
tember, 1963. The clinic, located in Daytona Beach, is known as the
Halifax District Hospital Eye Clinic. This clinic offers glaucoma
screening and other complete eye services. During the year, 4739
persons were screened for glaucoma, and 85 (1.8 per cent) were re-
ferred to medical eye doctors for diagnosis. A total of 24,560 per-
sons has been screened since the clinic opened, and 567 (2.3 per
cent) have been referred to the medical eye doctors. It is of interest
to note that the referral rate for the nonwhite (5.8 per cent) is con-
siderably higher than the white population (2.2 per cent). Further
study will be carried out on the nonwhite group to determine if this
high rate will remain constant.

Broward County Glaucoma Detection Program
A glaucoma screening program was initiated in Broward County,
January, 1965. A nurse is assigned to the CHD and is supervised by
the director of the Broward CHD and a Fort Lauderdale ophthalmol-
ogist. This program has demonstrated excellent cooperation between
the CHD, the ophthalmologists and the Broward County Medical
Society.
The Broward County Program has been very successful to date.
A total of 15,989 persons has been examined for glaucoma and 689
(4.4 per cent) of these have been referred to medical eye doctors for

1966

ADULT HEALTH AND CHRONIC DISEASES 41

diagnosis. Screening clinics have been scheduled in all areas of the
county to provide an opportunity for more citizens to benefit from
this service.

Pinellas County
The Pinellas County Glaucoma Screening Program was initiated
October, 1965. This program is supervised by the Pinellas CHD,
with assistance from the Pinellas County ophthalmologists and the
Pinellas County Medical Society. The response to this new program
by the local citizens has been excellent. Because of the great de-
mand for glaucoma screening, it was necessary to employ an ad-
ditional nurse to assist with the program. A total of 12,312 persons
has been screened for glaucoma since the program was initiated,
and 474 (3.9 per cent) suspects have been referred for diagnostic
evaluation.

Duval County
An eye clinic has been established at the Duval County Medical
Center in Jacksonville. This clinic provides total eye care for the
indigent population of Duval County. A nurse has been provided to
assist in the clinic and to screen for glaucomain the medical center.
About 500 patients are being followed in the glaucoma clinic. Ap-
proximately 10 new cases are found each month. This clinic con-
tinues to provide eye care to a needed group of persons that other-
wise would not be able to obtain such care.

Seminole County
A part-time glaucoma screening program was established in
Seminole County in 1965. The health director obtained approval from
the Seminole County Medical Society and then support from the Lions
Club and two ophthalmologists from Orange County. Screening
clinics are conducted two afternoons each month in the CHD. The
ophthalmologists have instructed nurses from the CHD stsff so they
can assist with the screening program. The clinics have been busy
each time they were conducted and have screened approximately
700 persons, of which 10 were positive for glaucoma.

Short Term Programs
Glaucoma screening programs of one to five days duration have
been conducted as special projects in some areas of the state. This
type of program is valuable where continuous screening centers are
not feasible. One such program was conducted in Charlotte County
and a total of 1826 persons was screened and 46 were referred for
diagnostic evaluation. These short term projects have found many
unknown cases of glaucoma and have also helped make the public
more aware of the disease.

42 ANNUAL REPORT, 1966

Other Activities

Survey of Screenees with Less than 20/40 Visual Acuity
A special activity that three of the screening centers undertook
this past year was a survey of 518 persons that were not glaucoma
suspects but could not read 20/40 when tested at the glaucoma
screening clinics. The three centers mailed a total of 518 letters to
persons that could not read 20/40, and asked if they had visited an
eye doctor since they had been made aware that their vision was
less than 20/40, and what type of doctor they visited. A total of 327
(63 per cent) persons returned the questionnaire which indicated that
198 (61 per cent) had their eyes examined by an eye doctor after
being made aware that their vision was less than 20/40. Since the
program was initiated, 17,606 persons have been found with vision
less than 20/40.

Special Studies

A Double Study of 106 Screenees
A special glaucoma project was carried out at the Halifax Dis-
trict Hospital to determine the number of glaucoma patients missed
in Glaucoma Detection Programs and to evaluate the present testing
methods of glaucoma screening. Single tonometry measurements
were compared to other accepted tests used to diagnose glaucoma,
such as disc evaluation, tonography, visual fields and applanation
tonometry. A total of 106 patients was tested and seven persons
were found to have early signs of glaucoma. This project confirmed
the suspicion that with single tonometry measurements up to 50 per
cent of the screenees with glaucoma may be missed. However, this
cannot be helped since in the early stages of glaucoma, the intra-
ocular pressure may be normal at the time of day that the tension is
checked, but may go up at night or other times of the day. Only
through repeated tension checks can patients with glaucoma be de-
tected and this is the reason for the recommendation that patients
return for annual rechecks.

Examination of 65 Diabetic Children
Another special project was to examine an entire camp of dia-
betic children to determine evidence of diabetic involvement of the
eye at an early age and whether there is a greater incidence of
glaucoma in diabetic children as reported in the literature. This
project was carried out at CampImmokalee. Sixty-five children were
examined and no abnormal intraocular pressures were found. Only
one child had evidence of early diabetic involvement of the funds.

Summary
Since the beginning of this program in April, 1962, the follow-up

ADULT HEALTH AND CHRONIC DISEASES 43

to diagnose data for all glaucoma detection programs is sum-
marized as follows:
Total screened, all ages ................. 99,865
Number referred to ophthalmologists for diagnosis. 2,846
New cases diagnosed glaucoma. ................ 1,309
Cases diagnosed borderline .................. 261
Diagnosed negative for glaucoma ............ .. 975
Suspects being followed ................ ... 228
Lost to follow-up:
a. Cannot locate ....................... 21
b. Uncooperative.............. .... ...... 36
c. Illness or deceased...................... 16
Number persons not able to read 20/40............ 17,606

TABLE 6

GLAUCOMA SCREENING PROGRAM DATA,
FLORIDA, 1966
County and Age Persons Persons Per cent
Examined Referred Referred
TOTAL .............. ......... ............... 32,672 1044 3.2
COUNTY
Broward ................... .................... .. 8968 389 4.3
Pinellas ... ..... ......................... 10,379 403 3.9
Polk ........ ... .. ................... 8586 167 2.0
Volusia ........................... .......... .. 4739 85 1.8

AGE
Under 35 ................... .................... 3928 16 .4
35-44 ......................................... 3882 51 1.3
45-54 ................ ......................... 4829 109 2.3
55-64 ................... .................. .. 7073 238 3.4
65-74 ....................................... 9885 464 4.7
75-84 ........ .......... ..................... 2880 153 5.3
85+ ... ............ ........................... 195 13 6.7

SMOKING AND HEALTH
The bureau has continued to lend its full support and direction to
the activities of the Florida Committee on Smoking and Health. The
committee consists of representatives from: Florida Medical As-
sociation, SBH, Florida Heart Association, American Cancer So-
ciety, Florida Division, Florida Tuberculosis and Respiratory Dis-
ease Association and Florida State Department of Education. An
office for the committee is maintained in the bureau.
The committee serves in an advisory capacity and furnishes con-
sultant services when requested. It does notin any way try to super-
cede existing programs, active joint committees or duplicate work
being done by other groups.
The committee has been instrumental in the preparation and dis-
tribution of much informational and educational material. Some of
the most recent materials and publications are: a pamphlet entitled
"The Logical Move" which is aimed at the adult smoker. Every
physician in Florida was sent a copy of the pamphlet. Since that time

44 ANNUAL REPORT, 1966

physicians have requested 10,000 additional copies for their office
use.
A "Teacher's Guide for Fifth and Sixth Grades" was compiled
and released in November. Two thousand copies have been sent to
interested teachers on request.
One of the concerns has been giving guidance in the organization
of local committees throughout the state as well as assisting local
committees and councils with their plans and programs. Local
committees are currently established in 17 counties and negotiations
are currently in action for establishment of committees in other
counties. The basic membership of the local committees correspond
closely to that of the state and national committees on Smoking and
Health, but is open to other interested community groups.
The local committees have had many programs, such as, smok-
ing and health conferences, school programs, joint showings of
available films and establishment of reference files in the school
libraries. These committees are giving continued support and effort
to the smoking problem.

BUREAU OF DENTAL HEALTH 45
FLOYD H. DeCAMP, D.D.S.
Director
DELMAR R. MILLER, D.D.S., M.P.H.
Assistant Director
The review of program activities of the Bureau of Dental Health
indicates steady progress despite the fact that due to recruiting dif-
ficulties, several county health department (CHD) dental clinics were
not staffed. Also, for most of the year, only one of the two mobile
dental clinics was staffed. This seriously handicaps the dental ser-
vices usually rendered to underprivileged children in counties with
few, or no, practicing dentists. There are six counties in Florida
which, though they have a sufficient population to support a private
dentist, are unable to secure one.

Special Programs
The bureau contributed to the Operation Headstart Program of
the U.S. Office of Economic Opportunity in Duval County by assign-
ing a full-time public health dentist and dental hygienist to the
mobile unit for a period of six weeks. The bureau also assisted in
the special maternity and infant care projects (see Maternal and
Child Health elsewhere in this report) through assistance in planning
and inception of allied dental programs.
The bureau, through its mobile dental unit assigned to Highlands,
Glades and Hendry Counties, made dental services available to
some of the inhabitants of the Big Cypress and Brighton Indian res-
ervations under a contract with the U.S. Public Health Service
(USPHS). The services provided by the State Board of Health (SBH)
were in addition to those usually provided to underprivileged resi-
dents of Glades, Hendry and Highlands Counties. The unit assigned
for 30 working days to the reservations and the distribution of the
time allotted to each depended upon the dental needs of the people.
During 1966, large numbers of school children of migrant work-
ers received dental care in CHD clinics. During this year, the bureau
assigned a dental hygienist to some of these areas to give dental ex-
aminations to both adults and children. In a few areas, stannous
fluoride was applied to the children's teeth.
In February, a dental clinic was started at the Migrant Health
Center in Broward County. The members of the Broward County
Dental Society donated many of the dental instruments. Two dentists
were employed to work on alternate evenings to work three hours an
evening. This became an important part of the total service offered
the migrant.

Lee County also served emergency treatment to migrants but on
a very limited basis.

46 ANNUAL REPORT, 1966

PRECEPTORSHIP PROGRAM

A major percentage of CHD dental clinics continued to be staffed
by preceptorship dentists. About 135 qualified young dentists have
served in the preceptorship program since its inception in 1957.
These men are selected by the Florida State Board of Dental
Examiners and their work is supervised by dental consultants from
this bureau, a committee of dentists from the local dental society
and the directors of CHDs in their respective areas. After comple-
tion of their preceptorship contracts, most preceptees enter private
practice in Florida and continue interest in the public health prob-
lems of their communities. Counties served by dental preceptees
during all Or a portion of 1966 were: Alachua, Broward, Charlotte,
Collier, DeSoto, Duval, Flagler, Glades, Hardee, Hendry, Highlands,
Hillsborough, Lake, Manatee, Marion, Palm Beach, Polk, Putnam,
Sarasota and Santa Rosa. Two mobile dental clinics from this bureau
and Jacksonville City Health Department also were served by pre-
ceptees. In addition to the group of dental preceptees who served
throughout the state, there were 13 other dentists engaged in full-
time dental public health work on county and state levels.

DENTAL SCHOLARSHIPS
Ten dental scholarships were awarded in 1966, of which one was
declined. Scholarships are awarded in accordance with the dental
scholarship law which provides a stipend of up to $1000 a year for
as many as fouryears for recipients who agree to practice in "areas
of need" (where there are few or no dentists) for 12 months for each
$1000 received. A total of 121 scholarships have been awarded
since 1955, five of which were declined. During the year, there were
37 students attending nine various dental schools. Of these 37 stu-
dents, five graduated in June.
Disposition of scholarship graduates to date:
Serving in "areas of need" ..................... 18
Repaid scholarships in full ................. .. 23
In military service .................. ....... 10
Completed compensatory practice ................ 19
Repaying stipends received .................... 3
Obligated to pay but not qualified for
Florida licensure .......................... 5
TOTAL ......... ...... ........ 78

DENTAL CLINICS
There were 39 public health dental clinics operated in 29 counties
during 1966. Dental services were concentrated on underprivileged
children in elementary grades with some services being provided
for underprivileged expectant mothers. Three clinics were staffed
by local dentists who volunteered their services.

DENTAL HEALTH 47

Full-time licensed public health dentists served all or a portion
of the year in the following counties: Broward, Dade, Jackson,
Liberty, Orange, Duval, Pinellas, Hillsborough, Volusia, Manatee
and Palm Beach. In addition, several other counties received dental
services from the two completely equipped mobile dental clinics
operated by the bureau and assigned on request and as time per-
mitted to counties having few or no practicing dentists. These mobile
clinics are supervised by bureau dental staff, local preceptorship
committees and county health officers in counties or areas where
the clinics are assigned. One mobile clinic operated two months and
the other operated six months during the year. Following is a sum-
mary of the services performed:
School dental inspections .................. 58
New patients ............................ 658
Repeat patients ........................... 585
Prophylaxes.............................. 113
Fillings (all types). ....................... 2675
Extractions.............................. 950
Miscellaneous treatments. .................... 212
Topical fluoride applications .................. 32
Talks given to school and civic groups ........... 12
Pamphlets distributed ................. ...... 350
A new dental clinic was equipped and began operation in Leon
County with local dentists volunteering their services. In Clay
County, a new clinic equipped in 1965, began operation with local
dentists providing services on a volunteer basis. New equipment
was installed in the DeSoto County clinic, replacing equipment found
to be antiquated and inadequate. Broward County and Lee County
acquired equipment for additional dental clinic facilities.
The services of a full-time dental hygienist were utilized for the
entire year. Through her efforts, 2206 dental inspections, 516
prophylaxes and 481 topical fluoride treatments were given under-
privileged children. In addition, 39 lectures were given with a com-
bined attendance of 1624. The hygienist participated in local Head-
start Programs in three counties and in the migrant health program
of one county.

FLUORIDATION
Interest in fluoridation of community water supplies continued at
a high level during the year. Daytona Beach, Melbourne and San-
ford began fluoridation and the measure was approved for Eau Gallie.
Sebring held a public referendum on fluoridation and a negative de-
cision resulted.
At the close of 1966, 35 Florida cities with an estimated popu-
lation of 1,033,654 were fluoridating water supplies. A total of 26
other cities having a combined population of over 309,486 is served
by water supplies containing approximately the correct amount of

48 ANNUAL REPORT, 1966

fluoride as a natural component. A total estimated population ex-
ceeding 1,343,140 now receive the benefits of water containing
fluoride at near optimal level to control dental decay.

LACTOBACILLUS LABORATORY PROGRAM
In conjunction with the Bureau of Laboratories, the lactobacillus
acidophilus caries susceptibility testing service was continued
through the year. This simple saliva test provides dentists with a
reliable indicator of the caries activity level of patients at any given
time. It is then possible to prescribe carefully controlled low carbo-
hydrate diets for specified periods to reduce tooth decay rates.
During the year, nearly 100 dentists utilized this service.

HEALTH EDUCATION
Activities to improve dental health through education centered
chiefly around the teacher who is responsible for helping children,
developing proper habits, practices and attitudes about their dental
health. Through the PTA, parents were encouraged to use present
day knowledge and research to improve their own dental health and
that of their children.
The single, most important piece of dental health education ma-
terial used in the public and private schools and libraries throughout
the state was Bulletin 7, DESIGN FOR TEACHING DENTAL HEALTH
IN FLORIDA SCHOOLS. A total of 590 bulletins was distributed
this last year by the bureau to CHD personnel and church schools.
In addition, a total of 17,886 pieces of materials was distributed
to the total educational program.
Some 1200 local dentists in accordance with the Florida State
Dental Society policy, served elementary and secondary schools as
dental advisors. These doctors are sought in increasing numbers
yearly by the urban schools to work particularly with the teachers
in stressing dental health education of parents and students doing
dental inspections of particular grades and promoting career day
and science fair activities. In cooperation with this program, 12
group meetings, as well as many individual office meetings, were
held in 20 of the counties with the dentists to orient them on their
schools and education materials available from the county and SBH
to use in the schools.
The health educator visited 29 junior colleges and the university
health classes at least once a term. Visits were also made to the
three schools of dental hygiene.
For the purpose of recruiting future dental personnel, 10 exhibits
were staffed for career day programs, and every high school having
an established career day was helped to have dental careers pre-
sented by local dentists and dental hygienists.

DENTAL HEALTH 49

The dental health educator worked with the district nutritionist
in two pilot nutritional programs. Needed work was begun with six
counties to encourage earlier dental care for the mentally retarded
child. Visits were made to four Florida Sunland Training Centers to
determine the value of certain dental educational materials to their
program.
The dental health educator worked as SBH consultant at the Uni-
versity of South Florida in the Florida Health Project in Teacher
Education again last summer. She continued to serve as consultant
to leaders in the 4H summer program and 12 visits were made to
local 4H Clubs on request during the year.

ORAL CANCER DIAGNOSIS PROJECT
The bureau, in cooperation with the Florida State Dental Society
and the Florida Northeast District Dental Society, initiated in 1964
an Oral Cancer Diagnosis Project in a 17-county area of Northeast
Florida. It was funded by the U. S. Public Health Service with the
understanding that it would later be evaluated and considered for
expansion on a statewide basis if the project was successful.
The evaluation committee, consisting of four dentists, a phy-
sician, an oral surgeon and a pathologist, decided to expand the
program statewide after observing the satisfactory results obtained
in the local area the first year.
During 1966, six oral cancer orientation programs for dentists
were given throughout the state.
A total of 581 oral cancer diagnostic kits was distributed to par-
ticipating dentists during the year. Medical pathologists in most
areas of the state examined the smears and biopsies submitted by
the dentists.
In the project thus far, 131 dentists have submitted a total of 494
smears and 281 biopsies. From these pathological specimens, 17
malignancies were discovered; many inthe early stages. All patients
with premalignant or malignant lesions have been periodically fol-
lowed post-operatively by the bureau, local dentists and physicians.
Many other infectious, benign and premalignant oral lesions have
also been diagnosed since the start of this program.

50 ANNUAL REPORT, 1966

BUREAU OF ENTOMOLOGY

J. A. MULRENNAN, B.S.A.
Director
The major responsibilities of this bureau are: administration of
the state aid arthropod control program; technical supervision of
the federally financed and supervised Aedes aegypti Eradication
Project in Florida; supervision of arthropod research laboratories
located in Panama City, Vero Beach and Winter Haven; operation
of the arthropod identification laboratory and an encephalitis sur-
veillance program; and administration of the Pest Control Act.
The federally-supported Aedes aegypti Eradication Project con-
tinued throughout the year. State contract funds expended in 1966
amounted to $3,364,656. An average of 729 state personnel was em-
ployed on the project. Operations, including inspection and treat-
ment, were carried out in 23 counties. A total of 1,978,820 premises
was inspected, and 1,959,270 were found negative. At the end of the
year there were 407 operational zones; 236 were reported to be
negative.

ARTHROPOD CONTROL
General
Fifty-seven counties and districts participated in the State Aid
program. In Bay, Duval, Lee and Walton Counties two separate
programs were operated, which gives a total of 53 of Florida's 67
counties having one or more program elements for the control of
arthropods.
These 57 counties and districts budgeted $6,325,659 in local
funds for their fiscal year ending September 30, 1966. The state
matching fund rate for source reduction was 18.0 per cent for this
period, which gave the counties and districts $966,413 in State II
funds plus an additional $721,406 in State I funds. The total funds
budgeted amounted to $8,013,478. The state fund matching rate, be-
ginning October 1, 1966, was reduced to 14.0 per cent.

Source Reduction Accomplishments
Diking St. Lucie County completed construction of dikes around
the major salt-marsh mosquito breeding areas, purchased three new
18,000 gallon per minute (GPM) portable pumps, and used these with
two older pumps to keep the marshes flooded. Excellent control of
salt-marsh mosquito breeding was obtained, this being the first year
the district was able to keep all diked marshes under water.
Brevard County, in cooperation with National Aeronautic and
Space Administration (NASA), made substantial progress with NASA
machines and personnel constructing dikes around many hundreds of

ENTOMOLOGY 51

acres of breeding area near the missile sites. Approximately 22
miles of dikes were rebuilt or constructed this year.
Martin County, in cooperation with the Town of Jupiter Island,
reconstructed dikes around about 50 acres of salt marsh adjacent to
the town. The town purchased a new 18,000 GPM portable pump to
keep the marshes flooded.
Diking of Tomoka Marsh in Volusia County was begun but not
completed during the year. Difficulties are being experienced with
the completed sections; in some areas, these are slowly sinking in
the unstable soil to almost the original ground elevation. This area
of this marsh is several hundred acres.
Diking and flooding one area of about 1500 acres in Lee County
is expected to be initiated in 1967.
Machine Ditching Thirty-four counties and districts were en-
gaged in machine ditching programs. In Indian River and Pinellas
Counties all major ditching projects have been completed. These
two counties are engaged principally in a stand-by ditch maintenance
operation. Most other counties have sufficient new ditching work to
keep them busy for many years.
Hydraulic Dredging Indian River County continued dredging
operations throughout 1966; however, only the last six months were
productive. During this time 27 acres were filled.
The following summarizes source reduction work during the
year. Where field costs are shown, capital investment, depreciation,
or supervision above the level of field supervisor or foreman are
not included.

1965 1966
Machine Ditching and Maintenance
Number of counties participating .. .......... 34 34
Miles of ditches dug or maintained ........... 427.74 460.82
Cubic yards of earth excavated ............. 3,662,598 3,690,550
Total field cost ....................... *$575,643
Field cost per cubic yard .............. ... $0.156
Construction and Maintenance of Dikes
Number of counties participating .......... .4 5
Miles of dike constructed or rebuilt .......... 34.06 39.44
Cubic yards earth placed in dikes. .......... 694,343 740,300
Total field cost ........ ... ............ $78,994
Field cost per cubic yard .............. ... $0.107
Hydraulic Dredging
Number of counties participating ........ 2 1
Number of dredges operated ............... 2 1
Acres breeding area filled ................ 48 27.3
Cubic yards earth fill placed. ............... 206,252 112,808
Average labor cost per cubic yard ........... $0.057 $0.269
*Figures not available due to revised reporting procedures.

52 ANNUAL REPORT,

Deepening and Filling (Draglines and Bulldozers)
Number of counties participating . . ... 3 3
Acres breeding area improved . . .... 113.3 67.03
Average labor cost per acre . . ..... $92.47 $74.37
Sanitary Landfills
Number of counties operating landfills . 38 40
Total number of landfill sites operated ....... .. 143 160
Total field costs in all counties . . .... $659,482 $742,564
Cubic yards of garbage disposed of . .... 5,673,595 6,872,618
Total field costs per cubic yard . . .... $0.116 $0.108

Temporary Control Measures
The counties and/or districts reporting the use of aircraft for
arthropod control were Brevard, Broward, Collier, Dade, Hills-
borough, Indian River, Lee, Monroe and Volusia.
Lee County aircraft, including six planes and one helicopter, re-
ported a total of approximately 950 hours in larviciding and adulti-
ciding work. Paris green, Abate, methoxychlor, Baytex, Dibrom,
1.5 per cent BHC and malathion were applied. It was first noted in
this county that salt-marsh mosquitoes were showing a high re-
sistance to malathion when applied as a fog. For this reason various
insecticides were used this year. Emphasis is now being placed on
larvae inspection work, which will be followed by application of
Paris green pellets where found needed.
Ground adulticiding work continued inmost participating counties
and districts. The following summarizes this work and direct field
costs, which do not include capital investment, depreciation or
supervision and overhead expenses.
1965 1966
Ground Fogging (Using malathion and/or Dibrom Formulations)
Number of counties participating ........... 54 53
Number of hours fog machines operated........ 57,737 49,253
Number of miles fogged ................. 389,571 329,532
Gallons of formulation used ............. 2,806,887 2,511,679
Total field cost ......... ......... $1,271,100 $1,138,910
Average cost per hour for fogging............ $22.02 $23.13
Average cost per mile for fogging ........... $3.26 $3.46
Aircraft Operations (Fogging)
Number of counties participating. ........... 4 5
Gallons of insecticidal formulation applied .. 303,408 239,860
Acres treated. ........................ 2,641,833 1,892,793
Gallons applied per acre (average). .......... 0.1148 0.1267
Labor cost per acre ................. Incomplete $0.0141
Aircraft Operations (Spraying)
Number of counties participating ........... 5 6
Gallons of spray formulation used. ........... 214,459 234,424
Acres treated. ................... .... .. 308,512 730,856
Average gallons applied per acre ........... 0.6951 0.321
Labor cost per acre treated ............... Incomplete $0.0757

1966

ENTOMOLOGY 53

Aircraft Operations (Larviciding)
Number of counties larviciding with Paris green 4 5
Pounds of Paris green pellets applied ........ 313,490 723,111
Number of acres treated. ............... .. 18,541 45,819
Pounds applied per acre (Aver. 5% formulation).. 16.9 15.78
Labor cost per acre treated . . .. Incomplete $0.221

Dog Fly Control
Dog fly control activities were conducted in Bay, Franklin, Gulf,
Okaloosa, Santa Rosa and Walton Counties. No work was reported
in Escambia or Wakulla Counties. Localized outbreaks of fairly
short duration occurred, which appears to indicate some deficiencies
in inspection and the application of control measures may have
occurred.
Treatment consists of spraying the grass deposits strandedon
the Gulf of Mexico shoreline with DDT at approximately 10-day
intervals.
The following is a summary of control work performed by six
counties:
1965 1966
Total miles of shoreline treated. .................... 963 1,033
Gallons of DDT concentrate used ................. 12,219 6,563
Average labor cost per mile ................. ..... $9.47 $8.68
Number of man-hours labor required ............... 7,774 6,028

Counties Participating and Local Fund Budgets
Counties participating in the State Arthropod Control program in
1966, and the amounts of local funds budgeted by these counties
and/or districts for the fiscal year October 1, 1965 through Sep-
tember 30, 1966 follow:

LOCAL LOCAL
COUNTY FUNDS COUNTY FUNDS
Alachua $ 78,490.00 Franklin $ 15,000.00
Bay (Comm.) 101,407.00 Gadsden 13,246.53
Bay (Gulf) 59,088.32 Gulf 46,255.44
Bradford 15,075.10 Hardee 3,000.00
Brevard 393,416.26 Hernando 19,858.00
Broward 92,174.00 Highlands 4,440.00
Charlotte 31,105.65 Hillsborough 387,250.00
Citrus 122,224.36 Holmes 4,400.00
Collier 268,059.87 Indian River 319,229.20
Columbia 14,541.63 Jackson 5,285.62
Dade 271,417.00 Jefferson 10,727.23
Duval (East) 101,978.90 Lake 120,500.00
Duval (Northeast) 134,797.00 Lee (District) 539,875.65
Escambia 180,576.22 Lee (Beach) 73,150.15
Flagler 15,173.30 Leon 82,500.00

54 ANNUAL REPORT,

$ 17,000.00
2,000.00
157,269.73
30,223.43
46,535.61
290,911.00
61,249.00
45,138.50
94,536.00
48,500.00
351,888.00
97,248.00
350,388.37
246,669.00

Putnam
St. Johns
St. Lucie
Santa Rosa
Sarasota
Seminole
Suwannee
Taylor
Volusia
Wakulla
Walton
Walton (South)
Washington
Total

$ 26,000.00
92,000.00
173,554.20
52,698.43
143,871.32
19,600.00
15,750.00
5,050.00
380,647.86
19,010.72
7,500.00
23,477.31
2,700.00
$6,325,658.91

Total Local Funds Budgeted ..................
Total State Funds Remitted to Counties . . .
TOTAL BUDGETED FUNDS FOR ARTHROPOD
CONTROL

.$6,325,659.00*
.1,687,819.00**

$8,013,478.00

*The local budgeted funds contain some items not matchable with
state funds.
**The total state fund allocation of $3,300,000 for the 1965-67
biennium is adjusted on the basis of over and under allocations each year.

Engineering
The engineering section provided assistance to counties and dis-
tricts in program planning and execution, budgeting, and the prepa-
ration of specifications for the purchase of heavy equipment. A
survey of the garbage and waste disposal problem was made for
Palm Beach County; but the report and recommendations had not
been completed at the end of the year. A similar survey was made
in Lee County, and a report and recommendations were furnished
the Board of County Commissioners. Waste disposal problems
throughout the state have required considerable time of this office.

Regional Entomologists
There has been no change in regional entomological activities
during the year except coordination with the U.S. Corps of Engineers
in dredging and trapping operations. New personnel includes one
man, shared part-time with the Winter Haven Midge Laboratory,
used for encephalitis mosquito trapping. Entomologists were sta-
tioned in Miami, Tampa, Orlando, Jacksonville, Marianna and Pan-
ama City and maintained liaison between the state officer, research
centers, districts and counties. As the season and problem neces-
sitated their activities extended into all activities connected with the
mosquito control operations in the 57 counties and mosquito control
districts and into regulatory activities concerning 1247 pest control
operators in 790 businesses.

Levy
Madison
Manatee
Marion
Martin
Monroe
Nassau
Okaloosa
Orange
Osceola
Palm Beach
Pasco
Pinellas
Polk

~

1966

ENTOMOLOGY 55

Regional entomologists are, directly or indirectly, concerned
with budget planning, project approval, inspections, or regulatory
phase of the mosquito and pest control programs.
Expansion was noted in several activities. These included the
increases: of World Health Organization personnel sent to Florida
for training, educational activities concerned with the establishment.
of mosquito districts; in requests for assistance to calibrate equip-
ment for Paris green pellet application by airplanes and particularly
by helicopter; in requests for Boards of County Commissioners for
information and explanation of the proper methods of budgeting and
details of fund matching; and in the South Florida workload, due to
the new law including applicators in the Lawn and Ornamental Shrub
field as a category in the Structural Pest Control law. The prob-
lems of repair, location, relocation and maintenance of mosquito
traps for all programs continue. A new survey for trapping sites
around and near impoundments connected with the Florida Barge
Canal has been undertaken in cooperation with the U. S. Corps of
Engineers. Trapping and sampling will evaluate malaria mosquito
production, as this area is suitable for Anopheles production; how-
ever, the major effort will be directed to encephalitis surveillance.
Numerous substantial dredging operations performed by con-
tractors for the Corps of Engineers along the St. Johns River and
Intracoastal Waterway have been coordinated by regional ento-
mologists andthe districts concernedin an effort to obtainplacement
of spoil areas where they will cause a minimum of mosquito breeding
and be mutually beneficial to all.

Arthropod Identification Laboratory
The primary interest of arthropod identification in the bureau's
Jacksonville laboratory is mosquitoes; however, it is called upon to
determine the identity of nearly everything that annoys, bites or
stings. The work is vitally important in our encephalitis surveil-
lance program and in the evaluation of the effectiveness of county
and district mosquito control operations.
The 1966 season has been slightly above normal in overall mos-
quito production. The increase in encephalitis work has continued
on a sporadic basis, with bursts of activity in the early summer and
for 10 days or more following rainy periods. The weekly informa-
tional publication, "Salt-Marsh Mosquitograms," has been continued
as an advisory to mosquito districts and other interested persons.
Identifications from freshwater collections at Woodruff Dam, North
Bay and 54 other selected fresh and salt water locations throughout
the state have been continued on a research basis.
The programmed collections to find the mosquito vectors of
encephalitis have continued in areas of known and suspected equine
cases throughout the state. All encephalitis mosquito collections for

56 ANNUAL REPORT, 1966

this laboratory were made with CDC traps, used in conjunction with
CO2 in areas where available. This trap has proven to be more
efficient in sampling a broad spectrum of mosquitoes.
The technicians identified 8919 collections containing 796,164
adult mosquitoes in the regular program and 91 other collections
from special locations for an additional 4168 adults. Four hundred
and twelve larvae were identified from 15 collections submitted.
In the encephalitis program, 685 collections from CDC light
traps, four sweep nets and one aspirator collections taken from 26
counties, contained 132,431 mosquitoes, were processed alive, and
pooled for virus studies. The details of these collections are re-
ported by the SBH virus laboratory.

Midge Studies
Research was continued during 1966 on the chironomid midges
of Florida, their life histories, biology, ecology, and classification.
Sixteen collections of live chironomids were made in streams,
ponds, ditches, lakes and rivers. A total of 1245 larvae were
brought into the laboratory for rearing, and 404 adults emerged.
Three collections of adult chironomids (approximately 175 speci-
mens) were identified for the Midge Research Laboratory at Winter
Haven, and one collection submitted by a water plant operator. Mis-
cellaneous insects were identified for 10 individuals who brought
them to the laboratory.

TABLE 7

ARTHROPOD-BORNE VIRUS ISOLATIONS FROM MOSQUITOES, FLORIDA,
JANUARY 1, 1966 THROUGH SEPTEMBER 7, 1966

COUNTIES WITH VIRUS ISOLATIONS

8 3
POSITIVE MOSQUITO SPECIES

o_ 'duO 9 a 4, -i 0 0.
.2.0

An. crucians ............................. I(B) 2(B) I(C) 4 313
A. infir atus. ............................. 1(C) 1(C) 1(C) 1(C) 4 96
A. atlanticus ............................ 3(C) 2(C) 1(E) 1(C) 1(C) 8 86
A. taeniorhynchus. .......................... 1(B) 1 19
C. nigripalpus ............................ 1(E) 1 419
M. pertrbans. ........................... 1(C) 1 210
1(E) 2(W)
Cs. melanur ....................... ..... I (H) 1(H) 1(H) 1(E) 2(E) 3(H) 1(E) 13 132

lotal positive pools ......................... 4 1
Number of pools tested ........................ 17 45

1 2 3

5 6

2 32

S 1 I 241 781 135 78 207 1100 125 561 24 21

L 0 i __ 1i L I I II I_ I
*On county line
Letter and number designate positive pools:
W = Western Encephalitis
E = Eastern Encephalitis
C = California
B = Bunyamwera Group (probably Tensaw))
H = Hart Park

m
z
-I
0

O
r-
r-
0

-<

58 ANNUAL REPORT, 1966

PEST CONTROL
The bureau continued for the 19th consecutive year its respon-
sibility for licensing and issuing identification cards to firms en-
gaged in pest control and for enforcing the law and regulations
governing this industry under the Pest Control Act (See Table No.
8). This was the first full year of coverage of the lawn and orna-
mental pest control industry under this same law. New pest control
regulations became effective January 21, 1966.
A notable recent innovation which has proven valuable as an en-
forcement tool is the use of "Notices of Inspection" to cite pest
control licensees and their employees for violations observed by
inspectors in the field. These are returnable "tickets" which certify
correction of the violation cited.
The number of regular licensees' and employees' identification
cards issued increased by 156.2 and 26.6 per cent, respectively,
over 1965. The number of investigations of property owners' com-
plaints, involving licensees, decreased 5.7 per cent over 1965, while
investigations of unlicensed operators climbed by 58.1 per cent. The
Pest Control Commission recorded 1068 certificates in force and
issuance of 204 new certificates during the year.

TABLE 8

SUMMARY OF PEST CONTROL
REGISTRATION AND ENFORCEMENT,
FLORIDA, 1962-66

Registration 1962 1963 1964 1965 1966
State Board of Health Licenses issued............ ... 296 311 329 338 870
State Board of Health Change of Address Licenses issued. 33 34 44 41 31
State Board of Health Licenses revoked* ....... 0 2 1 0 0
State Board of Health Licenses placed on probation* ... 0 3 2 2
Pest Control Certificates revoked, suspended or placed
on probation* .................... .. . . 3 2 9
Employees' Identification Cards issued ........... 2,996 3,391 3,588 3,910 4,963
Employees' Change of Address Identification
Cards issued .............. . ............. 145 160 237 283 179
Employees' Identification Cards revoked or stopped* 7 15 10 12 3
Employees' Identification Cards on probation* ....... 0 2 2 2 1
Thermal-Aerosol Certificates of Authorization renewed*. 9 8 6 5 4
Enforcement

Homeowner complaints investigated .............. 81 82** 83 92 87
Unlicensed illegal pest control operators investigated 21 11 19 31 49
Warrants filed against unlicensed operators ......... 5 5 9 6 6
Letters of warning issued to unlicensed operators. .... 9 4 9 14 29
Enforcement miles traveled (Jacksonville office only) 16,865 17,107 18,608 19,427 27,137
*By Pest Control Commission of Florida
**Corrected from 1963 report
Licenses, identification cards and thermal-aerosol certificates issued are based on 1965-66 licensing year. All
other entries are based on calendar year 1966.

ENTOMOLOGY 59

ENTOMOLOGICAL RESEARCH CENTER

April 8, 1966 was the 10th anniversary of the formal dedication
of the Entomological Research Center. It remains unique in that no
other research center in the world is devoted entirely to the biology
of man-biting insects. Its staff of 25 has been increased to 50 in
1966 through research grant funds from the U. S. Public Health
Service (USPHS). This staff consists of 25 professional entomolo-
gists, biologists and biochemists and 25 technicians, craftsmen,
clerical and custodial workers. The main building has been supple-
mented with a cluster of several smaller structures, bringing the
total to 20,000 square feet of work space and 6500 of storage area.
Over 10 years the research center has enlarged its inventory of
research aids to an investment of approximately $200,000 in scien-
-tific equipment, $50,000 in books and journals, $40,000 in machinery
and other tools, and $35,000 in vehicles. With estimated values of
buildings at $570,000 and land at $40,000, the State Board of Health
now has a total investment in physical properties here of approxi-
mately $935,000.
The 1966 program of research into the biology and vectoring
characteristics of mosquitoes encompassed the same eight major
projects outlined in last year's report. Following is a brief non-
technical account of the current status of each project.

PROJECT 1: BITING CHARACTERISTICS
This is a long-term study of mosquito biting behavior to establish
what, if any, preferences for the blood of certain birds and mammals
there might be in the important species of Florida mosquitoes,
especially those involved in transmitting diseases from wildlife to
man, e. g., arbovirus encephalitides. The project is now in phase 1,
which is the search for preferences by identifying the bloods in
wild-caught mosquitoes, using the precipitin test. In this way it can
be learned whether mosquitoes feed on animals in proportion to their
number or whether they seek out certain birds and mammals.
In 1966, three study areas were set up to establish in each a con-
tinuous census of birds and mammals and a routine of collecting
blood-engorged mosquitoes.
In the precipitin-test laboratory, most of the year was devoted
to completing experiments designed to improve the test technolog-
ically and to increase the stock of wildlife antisera.

PROJECT 2: POPULATION DYNAMICS
This is a study of the technology of measuring mosquito popula-
tions essential to the epidemiology of mosquito-borne diseases and
evaluation of mosquito-control operations. Previous work had fairly
well demonstrated the biases for certain species of mosquito inherent

60 ANNUAL REPORT, 1966

in the commonly used methods of collecting and sampling and in
other methods developed by the project. This year emphasis turned
to the physiological state of the mosquitoes caught, e. g., age, con-
dition of ovary, mated or not.
For all species but Culex nigripalpus, this year's collections had
smaller percentages of females with totally undeveloped ovaries.
Females with more developed ovaries were taken in largest numbers
from their natural daytime resting places in ground litter. This
showed that mosquitoes do very little flying when their eggs are
maturing after a blood-meal. Gravid females fly about more during
twilight periods than in the dark of the night, although a full or near-
full moon in the sky diminishes the difference.
It was also learned that whether or not a mosquito is parous,
i.e., has laid eggs previously, has no bearing on the time of night it
does its flying. Although the power aspirator took the largest per-
centage of blood-engorged mosquitoes, the truck trap (a moving "air
scoop") also took large numbers, especially at twilight when they
have just obtained their blood meals (evening twilight) or when they
are seeking adequate daytime resting places (morning twilight).

PROJECT 3: DISPERSAL CHARACTERISTICS
Release and recapture of mosquitoes is the surest manner of
learning about their flights and the best way of establishing how long
they live. It is extremely important, therefore, that marking methods
not damage them. In 1966 radioactive-marking technology was
thoroughly studied. Toward the end of the year, details of a satis-
factory method were worked out so that mosquitoes can now be
adequately marked with no discernible radiation damage. The new
method will work with the majority of mosquito species.
The salt-marsh mosquito nursery plots were greatly improved
by repairs to dikes and water-control structures and by the sinking
of an artesian well to provide fresh water. This work did not inter-
fere with the nursery's production schedule, and several million
adults of Aedes taeniorhynchus and Aedes sollicitans were produced
for various research studies at the Center.
There were no releases of marked mosquitoes this year; all work
performed on the project was in the line of improving technology.

PROJECT 4: COMPARATIVE BIOLOGY
This project extends to other mosquito species the knowledge
gained from concentration at this laboratory on A. taeniorhynchus
and C. nigripalpus.
Field studies at a temporarily flooded maple grove yielded in-
formation on several mosquito species. This included observation
on mating length of life, host preference, biting activity, egg laying
developmental stages and to wing beat frequency.

ENTOMOLOGY 61

Advances have been made in the rearing and colonizing of sev-
eral species. Colonies of each of two species were started with a
new technique, stimulation to mate by introduction of another species
into the cage. Another species mated for the first time in the lab-
oratory when a live oak branch was introduced into the cages.

PROJECT 5: REPRODUCTION
During 1966 studies on reproduction concentrated on the hormone
produced by the medial neurosecretory cells of the mosquito's brain,
called for convenience the mnc-hormone. Experiments, comparing
four species of mosquitoes, were completed which showed that: 1)
the removal of the mnc stopped the egg development which normally
occurs after a blood meal, and 2) implantation of one pair of mnc,
into a mnc-ablated animal, was nearly always effective in restoring
egg maturation.
The anatomical study of the neuroendocrine system was con-
tinued, utilizing both the light and electron microscopy. The nerve
pathways from the various groups of neurosecretory cells have been
traced through the brain to their terminations in the head or thorax.
The content of neurosecretory material in these pathways is being
compared before and after blood-feeding.

PROJECT 6: GROWTH
Growth from egg to adult mosquito has two aspects of concern to
control-- how long it takes and what kind of adult results. This pro-
ject is concerned with these aspects of growth as they are affected
by the six known variables in the environment of the growing stages
(egg, larva, pupa): (1) temperature, (2) humidity, (3) food, (4) salinity
of water, (5) light conditions, and (6) population density. The basic
work on all these growth problems was completed for A. taenior-
hynchus in 1966; it had been started in 1961. Considerable work was
done on C. nigripalpus but the analysis is incomplete.
The effects of these rearing conditions on the newly-emerged
adults may be summarized as follows: (1) Wing length increases
with food quantity and decreases with increasing temperature, salin-
ity and crowding; it is least in continuous dark and nearly alike in
continuous light or alternating light and dark. (2) Dry weight in-
creases with food quantity, is greatest at 30 C., least at 340 C., and
intermediate at 240 C., decreases with increasing salinity and crowd-
ing; it is least in continuous dark, most in alternating light and dark,
and intermediate in continuous light. (3) Fat reserves, which are
not used in flight but contribute greatly to longevity, increase with
food quantity, decrease with increasing salinity and crowding, are
greatest at 28o-30 and least at 340; they are least in constant dark,
most in alternating light and dark, and intermediate in constant
light. (4) Glycogen reserves, which can be mobilized for flight before

62 ANNUAL REPORT, 1966

the new adult feeds, increase with food quantity, decrease with in-
creasing salinity and crowding, are greatest at 300C. and least at
34; they are greatly decreased in total darkness and are greatest
in alternating light and dark. (5) Autogeny, or ability to lay eggs
without a previous blood-meal, increases with food quantity, de-
creases with increasing salinity and crowding, and increases with
temperature up to 320C.; it is least in continuous dark and most in
alternating light and dark.

PROJECT 7: ENERGETIC
This project is concerned with the flow of energy in the adult
mosquito. Unfed mosquitoes live only so many days and fly only so
many hours, depending on the amounts of fat and glycogen with which
they emerge. Thereafter they must synthesize energy reserves
from their food, which is mostly sugars in nectar and proteins in
blood. Most of the work in 1966 was concerned with the amount of
glycogen mosquitoes can synthesize from a single meal of different
kinds of sugar. Glucose and fructose were shown to be absorbed at
the same rate, yet twice as much glycogen is synthesized from glu-
cose as from fructose.
The hormones usually associated with the regulation of glycogen
metabolism in vertebrates, including man, were found to have no
effect in mosquitoes. However, glycogen synthesis was strongly
influenced by any manipulation of the acidity or alkalinity of the in-
ternal environment of the female mosquito.

PROJECT 8: LARVIVOROUS FISHES
The year was devoted to completing a major biological study of
one of the salt-marsh minnows, Rivulus marmoratus, which in ad-
dition to being a predator on mosquito larvae is the only naturally
self-fertilizing fish known in the world, and for this reason its re-
production was studied in great detail. It will almost certainly be-
come one of the most valuable experimental fish, for it offers unique
possibilities for research in genetics, embryology, physiology, en-
docrinology and many other biomedical sciences. Its unique breeding
behavior may also adapt it to special mosquito-control techniques.
Being closely related to many of the other salt-marsh larvivorous
fishes, e.g., Fundulus, Ciprinodon; much of its ecology and biology
serves as indicator of what can be generally expected of fish pred-
ators on salt-marsh mosquito larvae.

WEST FLORIDA ARTHROPOD RESEARCH LABORATORY
This laboratory occupied new buildings March 1, 1966. It is lo-
cated on a 10-acre tract near Panama City. The site is a peninsula
on St. Andrews Bay donated by the Panama City-Bay County Airport
Authority and construction was financed in part with matching funds

ENTOMOLOGY 63

obtained through a building grant from the U. S. Department of
Health, Education, and Welfare.
The staff consists of the director, three entomologists, three
biologists, five biological aides, a secretary, one semi-skilled
laborer and one custodial worker.
The overall function and responsibility of the laboratory is to
develop more effective methods for the controlof arthropods of pub-
lic health importance in the state. To accomplish this objective, the
research program is divided into two major sections: mosquito con-
trol and control of biting flies. Progress and accomplishments for
1966 are outlined by specific projects in the remainder of this report.

MOSQUITO CONTROL SECTION
Insecticide Resistance Studies
Late in the summer of 1965 resistance to malathion was detected
in the salt-marsh mosquito, A. taeniorhynchus, from Lee County.
As a result, research to determine the extent of this resistance
throughout the state was continued in 1966. Insecticide susceptibility
tests were conducted in the laboratory with the larvae of various
species of mosquitoes, with mosquitoes from several areas of the
state and with several insecticides.
These data confirm the resistance of A. taeniorhynchus to
malathion in Lee County, as reported last year. Data obtained in
1965 indicated that A. taeniorhynchus also is resistant to malathion
in Sarasota County and in the peninsula of Hillsborough County oc-
cupied by MacDill Air Force Base. Mosquitoes from these two areas
were not included in the 1966 studies. Of the mosquito species
tested, only A. taeniorhynchus appears to have developed any signif-
icant degree of resistance. C. nigripalpus, the vector of St. Louis
encephalitis in the 1962 Tampa Bay epidemic, has been shown to be
susceptible in all areas tested.
Limited data also were obtained on resistance using adult mos-
quitoes in field tests. In general, these tests supported the findings
obtained with larvae in the laboratory tests.

Adulticide Studies
A continuing program of the laboratory is the testing of new
chemicals as mosquito adulticides. Extensive field testing was con-
ducted with Dursban, a new organophosphate, and limited testing was
done with Baygon, a carbamate pesticide, using thermal aerosols
against caged adults of both A. taeniorhynchus and C. nigripalpus.
With the acquisition of an aircraft by the laboratory, much needed
research on the aerial application of insecticides for mosquito con-
trol is possible now for the first time. During 1966 considerable
time was spent in equipping the aircraft for both high-volume and

64 ANNUAL REPORT,

low-volume spraying. It is expected that the aircraft will be used
extensively during the next year in mosquito control studies.

Droplet Size Research
This was the last year of a USPHS grant for the study of insecti-
cidal aerosols and sprays used in mosquito control. Owing to dif-
ficulty in filling vacant positions, research was limited primarily to
studies of droplet size of thermalaerosols and deposition of droplets
on insects. Some studies on droplet size also were conducted with
nonthermal aerosols and low-volume aerial sprays.
Highlights of this study were: (1) development of a camera which
photographs at high magnification aerosol droplets naturally sus-
pended in air, and the subsequent use of this equipment to demon-
strate that the droplet size produced by thermal aerosol generators
is about two microns in diameter, a size considerably smaller than
previously believed; (2) development of a portable meteorological
tower for studying the effects of weather on the behavior of aerosol
droplets; and (3) development of a laboratory thermal aerosol gen-
erator for studying the effects of controlled environment on droplet
size and deposition on insects.
With this equipment, it was found that droplets one to two mi-
crons in diameter can deposit on mosquitoes in sufficient numbers
to cause mortality. This was demonstrated using a fog in which the
largest droplet was 2.8 microns in diameter. It appeared that most
droplets deposit on the wings of the insects.
It was shown that oils of high viscosity produce a more obscuring
fog of a slightly larger droplet size than oils of low viscosity. How-
ever, fogs of diesel oil, an oil of low viscosity, gave a greater deposit
of droplets on flies in the light than fogs of higher viscosity oils.
There was no difference in deposit between oils of high and low vis-
cosity on flies or stationary microscope slides when placed in the
dark. Flies picked up more droplets at low humidity than at high
humidity, but with stationary microscope slides there was no dif-
ference in deposit between high and low humidity. Thus it appears
that insect activity is an important factor in droplet deposition.
These results represent some of the later findings in the studies of
droplet size and deposition on insects.

BITING FLIES SECTION
Dog Fly Studies
The stable fly, Stomoxys calcitrans, is a serious pest of man
and livestock in the coastal areas of west Florida, where it is known
as the dog fly. This fly reproduces in animal manures and decaying
animal feeds, such as hay and grain on farms, and in deposits of
marine plants, which accumulate on the shores of the large bays of
west Florida during late summer and fall. The importance of this

1966

ENTOMOLOGY 65

pest in the Florida Panhandle, especially to the summer tourist
business, was the motivation for establishing this laboratory in west
Florida.
There was one minor outbreak of dog flies in Walton County the
first week of June, 1966, much earlier than usual. The first major
outbreak occurred simultaneously from Franklin County westward
to Okaloosa County, August 23. Escambia County reported an out-
break on August 17.
While heavy deposits of seaweed were observed on the bay shores
in Franklin County as early as May, the other counties reported only
light grass deposits before late August, which were the conditions
observed in Bay County by laboratory personnel. Thus, there ap-
pears to be some circumstantial evidence that the early populations
of this fly during 1966 might have originated in sources other than
marine plants. However, this observation is not in agreement with
previous findings of federal research groups and only serves to point
up the need of further definition of the problem. This will be a major
future objective of this laboratory.

Thermal Aerosol Tests
The testing of insecticides against the dog fly under a research
grant received from the U. S. Department of Agriculture in 1965 was
continued; this grant expires in 1968. During 1965, Dibrom was
shown to be an effective adulticide against caged dog flies when ap-
plied as thermal aerosols. These tests were continued during 1966,
using DDT as the test insecticide. These showed that 4.8 per cent
and 7.0 per cent DDT produced 68 and 69 per cent kills respectively.
It is obvious from these results that DDT is not an effective in-
secticide as a thermal aerosol against adult dog flies. Since this
insecticide has been used extensively for spraying grass deposits to
control this pest in west Florida, these results suggest a certain de-
gree of DDT resistance in the fly population. However, field tests
of DDT as a residual spray on marine grasses during 1966 seem not
to support this conclusion. Therefore, all that can be said of the
thermal aerosol tests of DDT at this time is that the results did not
show satisfactory kill, the reason not being apparent.

Insecticide Tests Against Natural Population of Dog Flies
Several tests were made during 1966 of ground thermal aerosols
of Dibrom against natural populations of dog flies. As in previous
tests against natural populations of this insect, the results were
erratic. These results are typical of this kind of testing and probably
reflect the dynamic behavior of this insect. Population levels in a
given area, especially on open beaches, change rapidly with shifts in
wind direction.

66 ANNUAL REPORT, 1966

Residual Sprays on Marine Grasses
Early in 1966, this laboratory reserved six experimental areas
of one-half to one mile each along the shore of St. Andrews Bay for
the testing of insecticides as residual sprays on marine grass de-
posits for control of dog flies. The plan was to spray natural grass
deposits, but the grass was deposited late in the season and was
washed so frequently by waves that this method of testing proved to
be unsatisfactory. No dog fly larvae were found in any of these ex-
perimental areas; therefore, they were abandoned for research pur-
poses about October 1.
For these residual tests, fresh marine grasses were collected
and placed at random in blocks of four plots each above the normal
high water mark on the bay shores.
DDT was highly effective for the duration of each experiment.
Baygon was nearly as effective, the per cent control falling below 95
only after 25 days in Experiment No. 2. Dibrom was ineffective as
a residual treatment on marine grasses. The dosage of DDT used in
these tests was the same as presently recommended for use by the
dog fly control districts. Owing to the high level of control, 99 per
cent overall in both experiments for this dosage of DDT, this pesti-
cide will be tested at a lower dosage during 1967.

Trapping of Dog Flies
In an effort to obtain data on the origin and movements of dog
flies in the west Florida area, fly traps were set along Gulf beaches,
on the shores of St. Andrews Bay, and at inland points near roadways
and on the shores of freshwater lakes.
While the traps did not function as well as expected based on
previous experience, the number of flies captured or observedat the
trap sites decreased sharply in relation to distance from the beaches
and bays.
These data might reflect the areas of fly concentration rather
than origin; more data are needed to clarify this problem.

Sand Fly Studies
Owing to the poor results of a large-scale test for the control of
salt-marsh sand flies (Culicoides) in the Panama City area (see the
SBH Annual Report, 1965), small plot tests were established in
March, 1966 to determine the most effective insecticide and dosage
level for control of sand fly larvae in this area.
Based on results of the small plot tests in 1966, several large-
area tests will be made at Panama City early in 1967 and at a later
date in the Vero Beach area.
Species of sand flies previously collected at Panama City are

ENTOMOLOGY 67

listed in the 1965 Annual Report. No new species were collected
during 1966, but collections from two light traps operated from
April, 1965 through March, 1966, showed that sand flies were active
each month of the year in this area, and that the period of highest
populations was from February through June, with a peak in April.

WINTER HAVEN MIDGE CONTROL LABORATORY
March 31, 1966 was the completion date of USDI FWPCA Grant
WP-00216-06, Causes and Relief of Hypereutrophication of Lakes.
The aims were an investigation of the limnology of local hypereu-
trophic lakes, an attempt to reverse the trend to hypereutrophy by
artificial aeration and nutrient removal and the biology of Glypto-
tendipes paripes.
Nuisance quantities of midges instigated this study. It was early
believed that man's influence on the natural waters by sewage and
industrial wastes, agricultural drainage, etc., probably contributed
to the lake trophic level and, therefore, midge production. Past
limnological studies and the literature indicated that certain chirbn-
omids had a special ability to endure anaerobic and certain accom-
panying conditions, such as the production of methane and hydrogen
sulfide, and that normal predators were lacking in this ability.
Therefore, artificial aeration should improve conditions for pre-
dators and possibly reduce midge populations. It was also assumed
that aerobic conditions would enhance precipitation of certain nu-
trients and in effect remove them from the lake metabolism and,
therefore, lower the overall productivity. Although overturn was
evident in the lakes studied, by temperature and dissolved oxygen
criteria, there was no evidence of reducing phytoplankton popula-
tions, gross primary productivity or midge populations. Therefore,
it was concluded that lowering the trophic level of a lake by artificial
aeration was not practically possible.
In another attempt to remove nutrients from the ecosystem,
water hyacinths were harvested from some artificial pools. For
control pools, the harvested hyacinths were dried, ground and re-
turned to those pools. From the results, that test pool productivity
was clearly below the control pool productivity, it can be expected
that harvesting from natural waters would reduce the productivity
of those waters.
Egg laying by old females, emergence of new adults and mating
of new females by old males takes place during a short period after
sunset. Copulation is effected by means of a spermatophore. The
adults follow the wind to shore where they spend the following day on
land within 100 feet of the shoreline. The adult life is one to perhaps
three days. Analysis of emergence data by moon age reveals a pro-
nounced lunar rhythm. Emergence traps recovered three times the
numbers of G. paripes during the dark of the moon as during the
light. Seasonally spring and fall are the peak emergence periods

68 ANNUAL REPORT, 1966

followed by summer and winter. The majority of egg masses are
laid between 25 and 100 feet from the shoreline. The eggs hatch in
one to five days. The pupal stage appears to last one day. Time-
wise the most variable stage is the larval stage. Sand bottom lakes
at water depths of five to 10 feet are most productive of G. paripes
adults. In general, the studies through the years have shown that the
greater nutrient content of a lake, the greater the plankton produc-
tion, the greater the G. paripes production, and the greater the
overall productivity.

Continuing Programs
After termination of the Grant, biological studies of adults were
again concentrated in the Winter Haven chain-of-lakes to include one
lake where control operations were being conducted by the Polk
County Mosquito Control District, and one lake where control oper-
ations were not being conducted. Larval sampling continued in eight
lakes to provide the seasonal and annual information necessary for
basic biological and control studies.
This is the first year of successful rearing of G. paripes. Al-
though colonization was not the original aim of this particular pro-
ject, fourth generation adults were reared.
Other species of nuisance midges were reared by three high
school students of the Polk County Science Research Program. This
is the third year this laboratory has cooperated with the Polk County
Board of Public Instruction in this program for outstanding junior
and senior students.

BUREAU OF FINANCE AND ACCOUNTS 69
FRED B. RAGLAND, B.S.
Director
PAUL R. TIDWELL, B.B.A.
Assistant Director
The business and financial management of the State Board of
Health (SBH) requires a close working relationship with the program
directors in planning maximum utilization of funds that have been
provided from federal, state, county and private sources for the
various health programs for the citizens of Florida. Since each of
these sources has its own set of rules and regulations as to the ad-
ministration and expenditure of the funds, particularly with regard
to federal funds used in many budgets for research and special pro-
jects grants, this sometimes becomes quite involved. A logical sys-
tem of accounting for these funds and issuance of reports concerning
their expenditure is necessary once the funds are provided and
properly budgeted, and this, along with the dissemination of proper
budget control information to all concerned, is accomplished by the
bureau. In addition to budgeting and financial management of the
agency, the bureau is responsible for purchasing, property control,
duplicating services, mail, shipping, receiving, automobile control
and assignment, and buildings and grounds maintenance.
The fiscal year ended June 30, 1966, was the first year of the
1965-67 biennium for which the 1965 Legislature made available to
the agency state funds through the General Appropriations Act.
Operating appropriations were generally based upon maintaining
present programs at the same level. Capital outlay and improve-
ments appropriations provided for purchase of adjacent property in
Jacksonville, a sizable administration building addition in Jackson-
ville and completion of a regional laboratory in Tampa.
Total program expenditures for fiscal year ended June 30, 1966,
amounted to $36,400,000; this was $3,800,000 over the previous fis-
cal year. A marked portion of this increase can be accounted for
from the 1966 continuation and expansion of the Aedes aegypti pro-
gram, the Dade County Maternity and Infant Care program, the gen-
eral increase in the programs of the county health departments
(CHDs), and the capital outlay buildings and improvements such as
the new regional Tampa Public Health Laboratory and the West
Florida Arthropod Laboratory.
The 1965 Legislature provided for the Mental Health program to
be transferred to the Division of Mental Health under the Board of
Commissioners of State Institutions. This transfer was gradually
accomplished and completed as of January 1, 1966.
The number of state-owned and operated automobiles was 113 at
the close of fiscal year June 30, 1966. These were driven approxi-
mately 1,793,565 miles during the year. In addition, the agency
owned 30 trucks or special-purpose vehicles; these units traveled
approximately 191,736 miles during the year.

70 ANNUAL REPORT, 1966

This bureau continues to give assistance and guidance to the
overall financial planning of the health department activities.

PURCHASING AND PROPERTY SECTION
The Purchasing Department, fulfilling its responsibility for the
procurement of the agency supplies, equipment and services in ac-
cordance with rules and regulations of the State Purchasing Com-
mission, continues to cooperate with other state agencies in the ex-
change of information pertaining to contracts for volume purchases
which enable this agency to buy certain items under contracts
negotiated by other state agencies and to arrange for purchases
under State Board of Health contracts by others.
During 1966 the Purchasing Department issued 4418 separate
purchase orders which totaled in excess of $1,430,000 and laboratory
equipment and office furniture were purchased to equip the new
Tampa Regional Laboratory. Purchase of office furniture and clinical
equipment for the Tampa Diagnostic and Evaluation Clinic and the
North Central Florida Maternal and Infant Care Project was initiated
during 1966 and continues. CHDs normally handle purchases locally
within the organizational framework of the CHD; however, their pur-
chasing procedures must also conform to the Florida Statutes gov-
erning purchase, such as obtaining bids and advertising for bids
where required.

Property Control
The property section carries out the responsibility of recording,
marking and inventorying all of property owned by this agency (fur-
niture, office and scientific equipment). The state statutes prescribe
records that must be maintained and the frequency of physical in-
ventories.
This section processes annual inventories on over 185 locations,
handles fire insurance on buildings and contents and assigns prop-
erty numbers to capital outlay items. A total of 888 pieces of equip-
ment valued at $183,132 was added to the inventory. Two new lab-
oratory buildings were completed during 1966; one in Panama City
and one in Pensacola, for a total value of $318,034. Land and old
buildings at 1214 Pearl Street, Jacksonville were purchased for
$200,000.
Property values reflected in the SBH Plant Ledger as of June 30,
1966 were as follows:
Buildings............................. $3,267,914
Land............... ........... ... 144,000
Furniture and Equipment ................ 1,568,678
Automotive Equipment and Trailers .......... 312,983
Books and Film ....................... 389,244
TOTAL ....................... $5,682,819

FINANCE AND ACCOUNTS

Insurance
Fire insurance on buildings and contents is carried in the State
Fire Insurance Fund under the supervision of the State Fire Insur-
ance Commission. Coverage on boilers and heating equipment is
carried in a master policy supervised in the office of the State Fire
Insurance Commissioner. Scientific equipment, dental equipment
and X-ray equipment in various mobile units is insured under a
"Floater" or "Transportation" policy. Automobiles, trucks and
other special purpose vehicles owned by this agency are covered by
a fleet policy to include public liability, property damage, fire, theft
and comprehensive. The agency acts as self-insurors for collision
damage. Boats and outboard motors owned by the agency are insured
under marine policies to include public liability and property dam-
age as well as protection against damage or loss of the boats and
motors. Other major insurance coverages include: money and se-
curities, broad form, loss inside and outside of premises; position
schedule bond for narcotic inspectors; public employees honesty
blanket position; Workmen's Compensation.
During 1966 the bureau was notified by the insurance companies
that claims amounting to $5,791.48 were settled under the agency's
fleet automobile liability policies. This includes claims for accidents
during 1965 and 1966 which were settled during 1966 and includes
accidents involving vehicles on loan from the Federal Government
for use in the Aedes aegypti Eradication Program, as well as SBH
vehicles. Damages to SBH vehicles caused by others were settled
for $2,671.83. The agency as self-insuror for damages caused by
collision paid $948.96 for repairs. This figure is less than the cost
of carrying collision coverage in the fleet automobile policy. Pay-
ment of $265.25 was received from the State Fire Insurance Fund as
a result of lightning damage to air conditioning equipment and re-
frigerators at the Encephalitis Research Center in Tampa.

BUILDINGS AND FACILITIES SECTION
During the year this section initiated a training program in con-
nection with the Neighborhood Youth Corps (Office of Economic Op-
portunity). A number of underprivileged youth were included in this
new undertaking and considerable supervision was given by the core
staff of the section. Wherever possible these youth were used in
various activities of buildings and facilities responsibilities. These
activities include buildings and grounds maintenance, shipping and
receiving, mail, security, duplicating, ditto and addressograph oper-
ation.
Almost a thousand work requests, large and small, were pro-
cessed. Some of the major accomplishments included: completion of
caulking; waterproofing and exterior painting of buildings; refin-
ishing of older furniture to harmonize with newer furniture; elec-
trical alterations and services to meet needs of the laboratory and

72 ANNUAL REPORT,

other departments where additional modern equipment required
greater electric service; alterations in the plumbing and steam lines
in the boiler rooms; and elimination of a serious sewerage deficiency.
The shipping and receiving activity continued to serve the agency
well but was handicapped by lack of adequate space. A good bit of
the workload includes a variety of materials and specimens proces-
sed to and from the CHDs, branch laboratories, private physicians
and tuberculosis hospitals.
The duplicating operations include offset machines, mimeograph,
ditto and addressograph. Wherever the best interests and efficiency
of the agency are better provided by use of contract printing, the
printing industry is invited to bid on job requirements. Many needs,
however, are best performed by the agency.

FISCAL SECTION
The essential function of this section is the determination of the
legality and propriety of payments under the various programs of
the agency, processing all bills and vouchers for payment, the finan-
cial record keeping and preparation of required financial reports.
The financial transactions of the SBH for the fiscal year ended
June 30, 1966, as reflected by the records of the bureau, are pre-
sented in a condensed form at the end of this section. A detailed fi-
nancial report for the fiscal year ended June 30, 1966, has been pre-
pared and distributed to the Governor, members of the Board of
Health and all bureaus, divisions and CHDs. The funds received
(or appropriated) for the fiscal year ended June 30, 1966, were from
the following sources:

State appropriations ......................
From local agencies for county health units.......
From federal grants-in-aid ..................
From research and project grants ..............
From local and state agencies-hospital services
for the indigent ......................
From state and federal for building ............

$ 9,906,702.00
8,775,282.84
3,520,626.97
5,127,849.22

8,176,127.47
1,855,853.25
$37,362,441.75

The expenditures by the SBH in summary, were for:
Personal services (salaries and other personal
services)................. ......... $18,131,120.48
Contractual services (repairs, utilities, travel
expense, hospitalization) ................. 13,027,841.90
Commodities (office, medical, laboratory and
mosquito control supplies) .... . ...... 1,489,437.91
Current charges (rent, insurance, registrar fees) .. 836,560.51
Capital outlay (equipment and fixed assets)........ 1,305,949.32
Grants to counties and mosquito districts ......... 1,465,970.40
Miscellaneous (education aids and subsidies) ...... 144,927.01
$36,401,807.53

26.5%
23.5%
9.4%
13.7%

21.9%
5.0%
100.0%

49.8%

35.8%

4.1%
2.3%
3.6%
4.0%
.4%
100.0%

1966

FINANCE AND ACCOUNTS

In addition to funds reported in the annual financial report and
summarized above, certain other funds and services were made
available by the U. S. Public Health Service (USPHS) to the activities
of the Board but were not paid directly to the State Board of Health.
They include USPHS personnel on loan to the Board in the Bureaus of
Preventable Diseases and Adult Health and Chronic Diseases. Fiscal
operation followed a budget plan of 194 departmental budgets. These
budgets were periodically revised as required.

SUMMARY OF RECEIPTS AND DISBURSEMENTS AND BALANCES

FOR THE FISCAL YEAR ENDED JUNE 30, 1966

RECEIPTS

FROM STATE APPROPRIATIONS

General Public Health:
Salaries.................................. $ 3,387,532.00
Other personal services ....................... 10,620.00
Expenses ................................. 1,340,583.00
Operating capital outlay ................. .... .. 100,712.00
Grants to localities............. ............. 1,650,000.00
Purchase of polio and combined vaccines ............ 125,000.00
Dental scholarships ...... ........... ......... 40,000.00
Medical scholarships ......................... 40,000.00

Air pollution control..........
Encephalitis research and control. .
Mental health council . .
Hospital services of the indigent .
County health units . . .
Total state appropriations. .

169,365.00
110,761.00
147,760.00
956,000.00
2,120,000.00
S. $10,198,333.00

FROM OTHER STATE SOURCES. ................... $ 1,867.00

FROM FEDERAL GRANTS-IN-AID
Public Health Service:

General health ............................. $
Chronic illness and care of aged ..................
Venereal disease............................
Tuberculosis control ..........................
Heart disease ..............................
Cancer control .............................
M ental health ..............................
Water pollution..............................
Radiological health ..........................
Cuban health services .........................
Dental health..............................
Home health services .........................

292,836.00
435,432.81
265,402.45
80,357.00
219,054.00
97,859.00
105,702.00
125,900.00
66,330.00
581,435.45
16,865.00
15,500.00

74 ANNUAL REPORT, 1966

Children's Bureau:
Maternal and child health. ................... .. $ 1,217,953.26
Total federal grants-in-aid .................. $ 3,520,626.97

FROM GRANTS AND DONATIONS .................$ 5,127,849.22

FROM LOCAL AGENCIES FOR COUNTY
HEALTH UNITS .............................. $ 8,775,282.84

FROM HOSPITAL SERVICES FOR INDIGENT
Local sources .................. ............$ 392,685.76
State Welfare Board ............................ 7,783,441.71
Total hospital services for indigent .............. $ 8,176,127.47

FROM STATE AND FEDERAL FOR BUILDINGS .......... $ 1,855,853.25
TOTAL RECEIPTS ......................... $37,655,939.75
Less transfers from general public health to
Division of Mental Health:
Salaries ........................$217,000.00
Expenses ........................ 76,498.00
Total transfers............................... $ 293,498.00
NET RECEIPTS ........................... $37,362,441.75
BALANCE July 1, 1965, $5,542,827.97 (Less expired
appropriations of $366,714.30) ...................... $ 4,176,113.67

TOTAL RECEIPTS AND BALANCES .................. $41,538,555.42

DISBURSEMENTS

OPERATING EXPENSES
Personal services:
Salaries................................ $17,401,176.07
Other personal services-individual. ................ 572,278.45
Other personal services-other ................... 157,665.96
Contractual services:
Travel expenses, including subsistence and lodging ...... 1,572,235.94
Communication and transportation of things. ......... 478,521.99
Utilities ................................. 195,571.36
Repairs and maintenance ...................... 147,685.26
General printing and reproduction service............ 125,140.15
Subsistence and support of persons. ............... 10,161,471.52
Other contractual services ...................... 347,215.68

Commodities:
Bedding, clothing and other textile products . ... 3,522.12
Building and construction materials and supplies. ....... .. 8,500.29
Coal, fuel oil and other heating supplies. . . .... 8,768.92

FINANCE AND ACCOUNTS

Educational, medical, scientific and mosquito
control materials and supplies . . . .
Maintenance materials and supplies . . .
Motor fuel and lubricants . . . . .
Office materials and supplies. . . . .
Other materials and supplies . . . .
Current Charges:
Insurance and surety bonds. . . . .
Rental of buildings ................... ..
Rental of equipment . . . ...
Other current charges and obligations . . .
M erit System .........................
Total operating expenses . . . ..

CAPITAL EXPENSES

. $ 1,077,900.01
S 114,238.89
S 57,314.87
207,594.11
S 11,598.70

84,599.97
216,142.00
S 130,891.67
322,463.36
82,463.51
. .$33,484,960.80

Books . . . . . . . . $ 13,332.85
Buildings and fixed equipment .................. .. 702,923.84
Educational, medical, scientific and mosquito
control equipment ........................ 166,280.39
Motor vehicles-passenger . . . ... .. 73,820.20
Motor vehicles-other ................... ...... 489.36
Office furniture and equipment. . . . ... 146,718.04
Land ................... ............... 200,000.00
Other structures and improvements. . . . ... 1,876.59
Other capital outlay ................... ...... .508.05
Total capital expenses . . . . ... $ 1,305,949.32

GRANTS, SUBSIDIES AND CONTRIBUTIONS
Grqnts to counties and mosquito control districts ....... $ 1,465,970.40
Other educational aids and subsidies . . ..... 144,927.01
Total grants, subsidies and contributions . . $ 1,610,897.41
Total program expenses. . . . ... $36,401,807.53

NON-OPERATING DISBURSEMENTS

Transfers ...........................
Refunds ............................
Total non-operating disbursements . ..
TOTAL DISBURSEMENTS. . . ..
BALANCE June 30, 1966 ...................

TOTAL DISBURSEMENTS AND BALANCES ..

...... $ 289,722.03
..... 63,297.12
. $ 353,019.15
. .. $36,754,826.68
...... $ 4,783,728.74
..... ..$41,538,555.42

. .

76 ANNUAL REPORT, 1966

SCHEDULE OF EXPENSES
BY PUBLIC HEALTH PROGRAM ACTIVITY

Health services to mothers, infants, pre-school
and school children ..........................
Statewide venereal disease control, diagnosis and
referral of infectious venereal disease patients
to treatment clinics-also operation of program . .
Mosquito and pest control programs, including
pest control law enforcement . . . .... ...
Indigent hospitalization . . . . . . .
Statewide sanitary engineering and environment sanitation .
Statewide cancer control program . . . ... .
Statewide tuberculosis control, x-ray survey and
follow-up work............................. .
Mental health program ...........................
Statewide narcotics drug, medical practice law enforcement .
Chronic illness and care of the aged . . . . .
Heart disease program.. ..........................
Research and special projects . . . . . .
Building construction ............................
Other health programs and administration . . . .
Total expenses ...........................

$ 4,893,378.00

1,229,000.00

6,172,767.07
9,268,759.48
3,026,380.76
762,525.00

1,112,900.00
1,170,375.00
242,036.76
1,634,685.00
819,305.00
2,812,025.59
908,163.37
2,349,516.50
$36,401,807.53

SCHEDULE OF EXPENSES
BY FUNCTIONAL ACTIVITY

General public health (also includes miscellaneous
health activities and training) . . . . ... $ 2,364,957.33
Vital statistics ........ ............... ........ 435,064.65
Health education..... .............. ........... 103,930.79
Sanitary engineering ............................ 707,324.36
Entomology and mosquito control. . . . ..... ....... 4,899,337.32
Tuberculosis control ................... ......... 505,421.62
Laboratories ................... ............... 1,071,581.61
Preventable disease (excluding tuberculosis control) ........ 987,819.03
Mental health ................... ............ 221,666.79
Narcotics ................... .............. 196,985.10
Maternal and child health ......................... 1,082,450.30
Local health services ............................ .. 290,843.45
Hospital services for the indigent . . . . 9,268,749.48
Chronic diseases ............................... 622,031.12
County health units ............................. 12,735,481.01
Building construction ............................ 908,163.57
Total expenses ........................... $36,401,807.53

TABLE 9

FUNDS RECEIVED BY COUNTY HEALTH UNITS FROM FLORIDA STATE BOARD OF HEALTH AND

LOCAL SOURCES, FOR THE FISCAL YEAR ENDED JUNE 30, 1966

STATE BOARD OF HEALTH LOCAL FUNDS

COUNTY Total Board
Funds Total State Federal Total of County Board of Fees and
Commis- Public Cities Miscello-
sioners Instruction neous

Alachua ............................
Baker ..................................
Bay .................. ..........
Bradford .............................
Brevard ..............................
Broward................................
Calhoun .............................
Charlotte .............................
Citrus ...............................
Clay ................................
Collier ...............................
Columbia..............................
Dade ... .............................

Duvl. ............... ............................
Escambia.. ................... ........
Flagler ..............................
Escambia .............................

agler ................. ...........
Franklin .............................

Gadsden................... ...........

Hamilton. . . . . . . .
HGilaristd.............................
H land s ..............................
Gulf ..... ..........................

Holmelton .............................
Hardee...............................

endian River................ ........
ernando .. ................ ...........

Jefferson. . . . . . . .
Highla ndsyette. ............................
HLaleoro. gh......... ....................
Indian River............................
Jackson ..............................
Jefferson..............................
Lafayette:.............................
Lake ................................

$ 213,171
24,822
108,572
35,958
340,208
634,921
24,543
77,856
37,317
62,956
92,099
63,030
1,659,802
44,743
16,666
325,710
392,389
28,846
28,395
79,715
15,670
18,665
38,673
25,611
52,671
56,928
27,486
67,331
1,141,438
31,525
78,948
88,255
31,579
15,961
116,849

$ 76,606
10,181
43,831
15,434
75,114
132,051
11,390
21,747
22,948
22,997
34,694
26,624
342,456
23,568
6,329
143,737
91,729
8,639
10,896
35,244
5,835
4,451
11,901
11,682
15,634
14,634
16,073
35,174
162,357
14,567
28,167
50,451
13,991
5,456
39,974

$ 48,798
10,181
43,831
15,434
70,074
127,011
11,390
21,747
22,948
22,997
34,694
26,624
146,815
23,568
6,329
60,900
70,254
8,639
10,896
35,244
5,835
4,451
11,901
11,682
15,634
14,634
16,073
35,174
57,042
14,567
28,167
41,091
13,991
5,456
39,974

$ 27,808

5,040
5,040

195,641

82,837
21,475

105,315

9,360

$ 136,565
14,641
64,741
20,524
265,094
502,870
13,153
56,109
14,369
39,959
57,405
36,406
1,317,346
21,175
10,337
181,973
300,660
20,207
17,499
44,471
9,835
14,214
26,772
13,929
37,037
42,294
11,413
32,157
979,081
16,958
50,781
37,804
17,588
10,505
76,875

$ 99,236
14,504
58,428
14,843
253,512
487,387
12,000
49,188
10,649
34,535
53,206
35,602
1,176,472
19,504
7,728
140,699
178,946
20,143
17,423
39,318
4,980
14,180
23,665
12,634
34,869
21,379
7,442
31,759
730,353
7,833
39,114
33,045
10,500
10,500
74,903

$ 6,375

2,800

600
1,000
3,600

2,600

43,370

3,930
4,800

3,000

500

3,500

8,500
3,000
3,600
6,000

$ 23,225

2,400

2,740

2,400

3,960
32,500

750

1,155

3,805

4,500
800
1,000

1,500

$ 7,729
137
6,313 "T
481 -
11,582 Z
12,743
553 >
5,921 Z
120
3,024 0
4,199 m
804
140,874
1,671
9
37,314 Z
45,844
64
76
473
55
34 0
107 0
140
1,668 0
20,915 C
471
398 Z
244,923
625
4,167
359
88
5
472 -4
.4

TABLE 9 (Continued)

FUNDS RECEIVED BY COUNTY HEALTH UNITS FROM FLORIDA STATE BOARD OF HEALTH AND

LOCAL SOURCES, FOR THE FISCAL YEAR ENDED JUNE 30, 1966

STATE BOARD OF HEALTH LOCAL FUNDS

COUNTY Total Board
Funds Total State Federal Total of County Board of Fees and
Commis- Public Cities Miscella-
sioners Instruction I neous

Lee ..................................
Leon. .............. ... ..........
Levy. . . . . . . . .
Levy ...............................
Liberty ..............................
Madison ............. ...............
Manatee ...........................
Marion ..... ......... ............
Martin ..............................
Monroe ... ...........................
Nassau ..............................
Okaloosa. .............................
Okeechobee. ...........................
Orange ..............................
Osceola .............................
Palm Beach ...........................
Pasco ...............................
Pinellas. ..............................
Polk. ... ............................
Putnam ................. .........
Santa Rosa ............................
Sarasota ........ ...... ..........
Seminole ... ........................
St. Johns. .............................
St. Lucie .... .........................
Sumter ..............................
Suwannee ............................
Taylor................................
Union................... ...........
Volusia ............................
Wakullo ........... ...........
Walton ..............................
Washington ...........................
County Health Units, State at Large............

Totals. ................... .

$ 138,866 $ 48,101
244,210 77,021
38,096 16,199
16,208 6,792
35,342 17,237
204,721 53,466
114,479 43,686
46,292 24,202
118,531 47,350
72,615 23,296
134,436 43,092
26,592 10,773
671,901 131,211
41,378 22,107
704,936 130,784
55,666 24,888
1,197,222 172,731
497,226 96,540
96,255 39,592
66,902 30,276
279,137 66,007
102,742 40,829
68,316 27,950
135,973 48,786
32,159 16,536
38,072 19,711
29,244 15,899
20,131 8,439
373,222 97,990
27,950 14,912
51,361 20,945
32,497 14,591
106,514 106,514

$11,918,501 $ 3,145,015

$ 48,101 $.......
62,921 14,100
16,199 ....
6,792 .....
17,237 ....
53,466 .. ..
43,686 ....
24,202 .....
41,590 5,760
23,296 ........
43,092 ....
10,773 .....
98,766 32,445
22,107 ....
101,478 29,306
24,888 ....
90,736 81,995
64,375 32,165
39,592 ....
30,276 ....
62,407 3,600
40,829 ....
27,950 ....
45,156 3,630
16,536 .....
19,711 ....
15,899 ........
8,439 ........
89,290 8,700
14,912 ....
20,945 .....
14,591 ....
106,514 ...

$ 2,480,798 $ 664,217

$ 90,765
167,189
21,897
9,416
18,105
151,255
70,793
22,090
71,181
49,319
91,344
15,819
540,690
19,271
574,152
30,778
1,024,491
400,686
56,663
36,626
213,130
61,913
40,366
87,187
15,623
18,361
13,345
11,692
275,232
13,038
30,416
17,906

$ 8,773,486

$ 83,959
120,384
14,737
9,393
18,022
120,464
56,493
19,750
51,361
49,035
67,079
15,443
411,477
16,650
449,493
26,000
808,658
324,978
53,875
27,449
173,572
45,197
33,204
44,030
14,920
18,205
12,750
11,674
207,062
12,000
20,921
17,818

$ 7,136,532

$.......
11,473
7,075

10,250
4,000
750
8,667

10,000

23,833
2,400
30,146

3,236
41,413

1,034

14,000.
6,850
7,620

500

12,900
1,000
7,000

$ 301,322

$ 130
5,000

5,600

3,000

9,557

3,300

10,000

2,400

$ 119,722

z
z
C

I-

$ 6,676 ;
30,332 m
85
23
83 0
20,541
4,700
1,590 -I
8,153
284
14,265 -
376 ,
95,823 0O
221
94,513 0"
4,778
212,597
30,995
2,788
8,143
39,558
2,716
312
25,537
703
156
95
18
55,270
38
95
88

$ 1,215,910

__ u __ .5 __ 5_ _ _

BUREAU OF HEALTH FACILITIES AND SERVICES 79

C. L. NAYFIELD, M.D., M.P.H.
Director
This bureau was established at the December 5, 1965, meeting of
the Board of Health as a result of the designation of the State Board
of Health (SBH) as the single state agency to administer Title XVIII
of the "Medicare" Law. At the next meeting the name of the bureau
was adopted. For the administration of Public Law 89-97 financial
support was provided through the Social Security Administration.
The hospitalization program was greatly curtailed due to the
termination of the Medical Assistance for the Aged program and the
impact of the Medicare law on the Old Age Assistance group. This
is described in more detail in the section on Hospital Services for
the Indigent. The special services section was extremely active in
developing informational programs with special emphasis on medi-
care benefits and function. The hospital and nursing home licensure
programs followed patterns of previous years. The numbers of
licensed institutions remained almost constant but the number of
beds available showed the expected increase. Difficulties of nursing
home owners in securing financing due to a tight financial market
prevented the rebuilding and remodeling program from reaching its
predicted level and resulted in bed shortages in several areas.

SPECIAL SERVICES SECTION
This Section serves as a resource and depository of current in-
formation for bureau programs and activities. Its functions include
program planning, organization and activation; development and co-
ordination of specialized consultation services; preparation of rec-
ommended laws, regulations and standards; program and activity
evaluation; presentation of institutes, conferences, seminars and
training courses; preparation of conduct of studies, surveys and
investigations in areas of need; development of educational, tech-
nical and promotional materials, manuals and information pieces;
and liaison activities with official and voluntary organizations.
Educational services took on new proportions and were accel-
erated during the year because of the Health Insurance for the Aged
Program (Medicare). This program was the focus of the Eighth
Annual Nursing Home Short Course conducted by the Division of
Continuing Education, University of Florida, in cooperation with the
SBH and the Florida Nursing Home Association. One hundred and
ten administrators and other nursing home personnel participated.
Its purpose was to assist operators in qualifying their institutions
for participation as extended care facilities. Increased attention
also was given the subject at the Tenth Annual Convention of the
Florida Nursing Home Association.
Because a significant number of nursing home applications for
participation in Medicare were found to be deficient, a series of

80 ANNUAL REPORT, 1966

one-day special area seminars were organized and presented to
provide county health department (CHD) personnel and nursing home
administrators additional specific information and resolve problems
in areas of concern. They drew a total attendance of 108 CHD rep-
resentatives from 39 counties in morning sessions, and 312 nursing
home personnelfrom 206 homes in 31 counties in afternoon sessions.
An in-depth seminar on "Medicare and Long Term Care Facilities
Administration" was conducted by the Center for Continuing Educa-
tion, University of South Florida, Tampa, under a U. S. Public Health
Service (USPHS) short term traineeship grant, in cooperation with
the SBH and the Florida Nursing Home Association.
Planning sessions on the development of a statewide continuing
education program for nursing home personnel were held during the
year. In a two-day conference with representatives of the Florida
Nursing Home Association, State Department of Education and the
state's university system, a proposed program incorporating a plan
for voluntary certification was structured. It is to be implemented
through community junior colleges in selected centers of the state.
To facilitate arrangement of appropriate curricula, a survey of
categories of nursing home personnel was made. It revealed that
169 physicians, 942 registered nurses, 1006 licensed practical
nurses, 3711 nurse aides, 541 attendants and 2642 other personnel,
or a total of 9011 persons, were reported by administrators to be
staff members of homes licensed under Florida's nursing home law.
Although no student architectural plans were offered under the
cooperative undergraduate program introduced in 1962 with the Col-
lege of Architecture and Fine Arts, University of Florida, and con-
tinued in 1963 and 1965, a proposal was developed to expand the
arrangement to include graduate assistant offerings in 1967. The
plan is to extend the scope to provide design instruction in housing
for the elderly.
A seminar for professional architects, engineers, administrators
and public health officials, on the functional design of medical care
and related facilities was conducted at the SBH May 26-27. A total
of 105 persons attended. Featured was an exhibit of competitive
nursing home designs executed by 22 University of Florida fourth
year architectural students who participated in the cooperative
undergraduate program the prior year.
Liaison was maintained with Florida fire services through as-
sistance and participation in programs of the annual convention of
the Florida State Firemen's Association, the State Fire Marshal's
17th Annual Fire Prevention Conference, a statewide fire department
contest, one day health facility fire safety seminars at Tampa and
Pensacola, and meetings with district deputy state fire marshals.
The bureau also is represented on the State Fire Marshal's advisory
committee on fire prevention in hospitals, nursing homes and related
facilities.

HEALTH FACILITIES AND SERVICES

Institutional nutrition consultation services were provided 26
nursing homes in eight counties and 16 hospitals in nine counties. In
addition, regional nutrition consultants made 46 consultation visits
to these institutions. A total of 27 counties were covered by these
combined services. In Hillsborough, the county nutritionist, as a
member of the CHD licensure team, participated in 58 surveys of
nursing homes and made 28 consultation visits. In Dade County the
nutritionist cooperated with the CHD surveillance team in the evalu-
ation of nursing home dietary services and providedwritten analyses
and recommendations to 18 nursing home administrators.
Construction plans for food service departments of 21 proposed
nursing homes and nine proposed hospitals were given critiques by
the bureau's senior institutional nutrition consultant. Conferences
were undertaken with architects, engineers, equipment representa-
tives and sponsors in the development of dietary components of
health care facilities.
Food service educational activities andprograms were expanded.
Aid was given professional dietitians and educational leaders in the
establishment of campus-based food services supervisor courses in
August at community junior colleges in St. Petersburg, Fort Laud-
erdale and Miami.
A project was developed with the Florida Dietetic Association,
Florida Hospital Association, Florida Nursing Home Association,
and SBH Division of Nutrition, to identify available dietitians for
part-time consultation work in hospitals and nursing homes. A
Dietary Consultation Workshop was conducted by the Center for Con-
tinuing Education, University of South Florida, in St. Petersburg in
November with the sponsorship of the bureau and the aforementioned
organizations. It was designed to provide orientation and refresher
training for dietitians interested in furnishing consultation services
to nursing homes and small hospitals. The workshop was presented
under a USPHS Short Term Traineeship grant. More than 60 pro-
fessional dietitians participated.
Nurse consultation services accounted for 81 visits to nursing
homes and six visits to hospitals in 34 counties. These services
were provided to assist CHDs and administrators in the evaluation
and development of quality nursing service in institutions. Activities
supplemented licensure and medicare certification responsibilities,
particularly in the presentation of recommendations related to staf-
fing, patient care policies, patient care plans, administration of
medications, maintenance of nursing records and organization of
in-service education programs. Lectures on nursing and communi-
cations were given in six successive monthly workshops conducted
in Orange County by Districts II and III of the Florida Nursing Home
Association.
Assistance was provided the planning committee of the Florida
Division, American Cancer Society, in the organization of a pilot

82 ANNUAL REPORT,

educational program in cancer nursing for the nursing personnel in
nursing homes. Thirty-six professional nurses, licensed practical
nurses and aides participated.
A nursing Survey Guide for Nursing Homes was prepared to aid
CHD nurses in their evaluation of nursing care in these facilities.
The itemized guidelines correlate SBH nursing home regulations and
Medicare "Conditions of Participation for Extended Care Facilities"
and may be used as bases either for licensure or certification rec-
ommendations. The instrument was tested by public health nurses
in selected counties and is available upon request.
Forty-two visits were made to 13 counties to provide consultation
to church organizations, clergy and lay leaders in their development
of nursing homes and nursing care units in retirement housing ar-
rangements. Particular attention was given northwest Florida be-
cause of the relatively few nursing homes in the area. A total of 16
projects was planned during the year. Two church-related nursing
homes went into operation in Brevard and Broward Counties. Sim-
ilar facilities are in the process of construction in Hillsborough,
Indian River, Lee, Polk and Volusia Counties. Services included
consultation with CHDs, Division of Community Hospitals and Medi-
cal Facilities of the Board of Commissioners of State Institutions,
Federal Housing Administration and Small Business Administration,
to correlate community needs for facilities and assist in the ar-
rangement of financial support for them.
Assistance was provided the Florida Council on Aging and the
University of South Florida in the organization and presentation of a
workshop on protective services for the elderly. Aid was provided
Dade CHD and Miami-Dade Junior College in the organization and
conduct of a six-week course of 12 sessions for nursing home ad-
ministrators.

HEALTH SERVICES FOR THE INDIGENT
Utilization of health services by the indigents under the state
programs decreased during the year. This was largely due to the
start of the Social Security Medicare program for those persons age
65 and over. The Medicare program resulted in the termination of
the MedicalAssistance for the Aged (MAA)program on June 30,1966.
Total expenditures under all programs were lower at $11,044,299,
the days of care rendered were only 363,247 and admissions dropped
to 41,988.
On December 31, 1966 there were 176 hospitals participating in
the Hospital Services for the Indigent (HSI) and Public Assistance
Recipient (PAR) programs, one more than a year ago. Hospitals
submitting cost statements to establish a patient per diem rate in-
creased from 149 to 155. The average per diem rate for all hos-
pitals with established rates was $33.17, an increase of 4.7 per cent
from the figure of $31.67 for 1965. The maximum per diem rate

1966

HEALTH FACILITIES AND SERVICES

allowed under the Rules, State Board of Health, Chapter 170-E in-
creased to $42.70 on August 1, 1966.
Hospital Service for the Indigent (State-County) Program
The HSI program was established by an act of the 1955 Legis-
lature to provide hospitalization, visiting nurse care and outpatient
clinic services for the acutely or chronically ill or injured, med-
ically indigent persons. Funds have never been provided for other
than inpatient hospitalization; therefore, visiting nurse care and out-
patient services have never been offered under the program.
The Legislature appropriated funds of $994,000 for the fiscal
year 1966-67 to match the required 50 cents per capital for each
county. It is interesting to note that actual expenditures under the
program for the fiscal year ending June 30, 1966, for state funds
amounted to only 20 per cent while county funds total 80 per cent.
Many counties appropriated more funds than required by law. During
1966 all counties except Gadsden, Glades, Gulf, Holmes, Wakulla and
Washington participated in the HSI program.
Tables 10 and 11 provide statistical and financial data. Utilization
as reflected by admission and days of care again remained at ap-
proximately the same level as last year. Expenditures for services,
however, increased about nine per cent. The average cost per day
and cost per admission were again up with 5.3 per cent and 7.5 per
cent increases over the previous year.
Public Assistance Recipient Program
The SBH administers the PAR program of hospitalization under
the terms of agreement with the Florida State Department of Public
Welfare. On July 1, 1966, all public assistance recipients age 65 and
over were shifted from this hospitalization program to the Medicare
program which started on that date. Since approximately 60 per cent
of the public assistance recipients are of age 65 and over it has had
a substantial effect on decreasing the size of this program.
The number of days of hospitalization allowed for the PAR pro-
gram remained at 12. Due to the limited number of days allowed a
recipient, many counties were forced to care for them under the HSI
program whenever a person's allotted days were exhausted under
the PAR program.

Medical Assistance for the Aged Program
The implementation of the Medicare program caused the MAA
program to be terminated on July 1, 1966, having served its purpose.
The MAA program of hospitalization and visiting nurse care for the
medically indigent 65 years of age and over had its beginning on
July 1, 1963. Utilization of services and expenditures increased
during each year of its operation. Admissions for the six month
period total7,219 with 89,224 days of care. Cost experience for MAA

84 ANNUAL REPORT, 1966

recipients were higher than other indigent patients, caused pri-
marily by the age of the patients.

Advisory Committee to the Hospital Service for the Indigent
Florida Statute 401 provides for an advisory committee to the
Hospital Service for the indigent program. A new member appointed
to the 11-man Advisory Committee was Honorable Lamar Hancock,
of Live Oak. Don S. Evans, of Orlando was reappointed to the com-
mittee. Other members are: H. Phillip Hampton, M. D., Tampa,
chairman; Nelson Zivitz, M.D., Miami; State Senator Beth Johnson,
Orlando; State Senator Robert M. Haverfield, Miami; State Repre-
sentative Ray Mattox, Winter Haven; Joseph F. McAloon, Coral
Gables; Frank Kelly, Miami, and Ben P. Wilson, Ocala. The vacancy
created by the resignation of State Representative Phil Ashler has
not been filled at this time. All meetings during the year were
largely devoted to the study, discussion and development of Title
XIX of the Social Security Amendment of 1965, providing for medical
care of the needy.

Reservation Indian Medical Care Program
The program was continued under contract with the USPHS with
$70,500 provided for fiscal year 1965-66. Amendments were nego-
tiated during the year to make an additional $11,000 available when
it became apparent funds would not be sufficient to cover services
required. Even with the additional amount funds were exhausted in
early June forcing curtailment of all services until the new fiscal
year on July 1, 1966. Rising medical cost, together with an ever in-
creasing number of Indians being granted tribal membership in the
new Miccosukee Tribe were the reasons for the increased program
costs. Medical care benefits under the contract are hospital in-
patient and outpatient service, physician service, ambulance service,
prescribed drugs from contract stores and prosthetic appliances.

TABLE 10

MAJOR EVALUATION INDICES, BY TYPE OF
HOSPITALIZATION PROGRAM, FLORIDA, 1966

Public Hospital Medical
Evaluation Index Assistance Service for Assistance
Recipients the Indigent for the Aged*
Number of admissions . . . ....... ... 19,250 15,519 7,219
Days hospitalized . . ....... ....... ...129,234 144,789 89,224
Total payment-State and Federal . . ..... $3,819,257.90 . $2,645,218.55
Total payment-State and County . . ..... .......... $4,579,822.26 ..........
Average cost per day . . . . ... 29.55 31.63 29.65
Average cost per admission ................... .198.40 295.11 366.42
Source: Applications processed and approved for payment reports.
*Program terminated 6/30/66.

TABLE 11

APPLICATIONS PROCESSED AND APPROVED FOR PAYMENT
BY HOSPITALIZATION PROGRAM, BY COUNTY,
FLORIDA, 1966

Public Assistance Recipients Hospital Service for the Indigent Medical Assistance to the Aged*
County No. of Days Total Payments No. of Days Total Payments No. of Days Total Payments
Admissions Hospitalized State & Federal Admissions Hospitalized State & Local Admissions Hospitalized State & Federal

TOTAL ................. 19,250 129,234 $3,819,257.90 15,519 144,789 $4,579,822.26 7,219 89,224 $2,645,218.55

Alachua ................ 282 2,018 72,116.50 254 1,580 59,070.43 52 528 18,591.16
Baker ................. .. 44 288 7,648.61 30 147 4,466.35 15 137 3,725.28
Bay ................... 182 1,229 37,174.18 82 916 29,567.72 22 213 6,376.92
Bradford ............. 118 827 22,920.01 32 210 6,636.79 10 146 4,713.70
Brevard ................. 188 1,272 45,824.38 471 4,970 183,089.84 135 1,450 53,100.85
Broward ................ 586 4,237 138,047.13 569 8,950 288,581.46 460 5,905 170,532.80
Calhoun ................ 166 942 23,711.55 12 53 1,465.34 9 54 1,594.12
Charlotte ............... 82 577 18,562.21 58 477 15,100.05 51 554 15,487.73
Citrus ................. 49 302 8,651.39 31 250 7,728.45 29 386 11,561.06
Clay ................ 75 491 13,675.06 45 317 9,373.39 11 72 2,014.52
Collier ...........69 396 13,766.70 57 433 16,722.32 40 414 14,640.41
Columbia ................ 272 1,643 39,530.84 107 765 20,322.37 18 229 6,111.34
Dade ................ 2,342 18,552 684,947.58 2,096 23,541 864,589.85 1,925 26,329 912,483.61
DeSoto ................. 71 476 11,167.89 49 473 11,640.09 7 74 2,119.75
Dixie ................. 43 296 9,500.63 19 81 2,962.26 5 48 1,865.60
Duval .................. 1,097 7,564 217,262.31 1,698 11,423 318,270.30 394 4,273 122,073.45
Escambia ................ 987 6,015 185,102.71 357 3,636 120,037.71 174 1,852 52,124.27
Flagler ................. 22 188 4,654.42 13 106 2,861.54 9 100 2,376.61
Franklin ................ 128 597 15,016.95 42 191 5,468.60 18 110 2,582.74
Gadsden ................ 220 1,421 32,547.31 .... ... . ..26 250 5,752.49
Gilchrist. .............. 37 238 7,887.34 20 62 2,218.49
Glades ................. 9 64 1,698.40 ...... .... ..... 2 23 600.19
Gulf .................. 57 366 9,622.12 ......4 38 1,142.76
Hamilton ................ 127 824 20,616.72 21 98 2,583.00 11 93 1,806.28
Hardee ................. 31 231 6,011.87 34 353 8,901.18 5 59 1,803.37
Hendry ................. 31 195 5,090.38 85 686 10,672.96 17 224 5,481.70
Hernondo. ............... 130 706 21,565.30 19 125 3,886.37 35 361 10,182.11
Highlands ............... 89 542 16,305.13 ....... ... ....... ..33 324 9,350.34
Hillsborough. .............. 1,646 11,427 247,867.68 1,570 14,297 363,844.41 579 7,180 147,363.47
Holmes ................. 378 1,991 49,083.21 .......... ........... 36 271 5,693.90
Indian River ............. 102 631 20,641.89 71 626 20,760.50 53 509 14,378.42
Jackson. ................. 565 3,448 81,456.01 82 540 14,208.01 26 316 6,952.45
Jefferson ................ 51 369 10,117.62 14 149 3,539.30 5 69 2,193.19
Lafayette. ................ 37 226 4,542.14 9 56 1,827.29 2 11 345.01

TABLE 11 (Continued)

APPLICATIONS PROCESSED AND APPROVED FOR PAYMENT

BY HOSPITALIZATION PROGRAM, BY COUNTY,

FLORIDA, 1966

Public Assistance Recipients Hospital Service for the Indigent Medical Assistance to the Aged*
County No. of Days Total Payments No. of Days Total Payments No. of Days Total Payments
Admissions Hospitalized State & Federal Admissions Hospitalized State & Local Admissions Hospitalized State & Federal

Lake. .................. 267 1,548 $ 47,470.21 220 1,866 $ 56,672.69 106 1,184 $ 33,480.91
Lee .................. 129 872 31,354.78 127 1,518 58,339.45 102 1,170 42,343.28
Leon. ................... 405 2,690 73,618.55 198 1,720 51,764.99 53 531 14,131.91
Levy. .................. 100 703 23,454.18 3 21 804.20 13 94 3,299.22
Liberty .. .............. 58 295 7,546.47 18 84 2,231.42 14 115 2,969.26
Madison ................ 137 894 26,396.10 25 207 6,423.54 19 136 3,957.59
Manatee ................ 265 1,698 50,262.19 170 1,749 53,918.21 100 T,396 40,935.60
Marion ................. 343 2,463 75,667.25 111 1,233 38,778.86 84 907 26,264.49
Martin ...... .......... 56 395 14,081.31 51 399 14,631.23 41 418 13,144.12
Monroe ................. 130 1,020 34,012.94 108 922 32,731.31 28 351 11,682.91
Nassau ................. 106 646 19,433.65 78 415 12,281.76 17 145 3,784.19
Okaloosa. ............... 505 2,633 76,183.13 266 1,375 40,632.86 28 263 7,248.41
Okeechobee. .............. 49 331 9,149.88 20 166 4,727.82 6 63 1,667.01
Orange. ................. 854 6,132 179,827.89 841 9,267 288,455.36 426 5,352 143,827.37
Osceola ................ 203 1,311 26,960.14 165 1,256 32,421.16 57 593 12,066.89
Palm Beach ............. 545 3,746 127,545.95 1,441 13,370 455,170.94 330 3,835 122,927.06
Pasco .................. 151 977 26,076.23 135 847 23,686.33 58 671 18,569.54
Pinellas................. 943 6,904 212,352.76 1,188 12,694 394,370.99 549 7,926 211,009.76
Polk. ................... 270 1,952 53,798.08 755 3,673 100,802.92 105 1,265 34,359.70
Putnam ................. 233 1,341 43,949.90 90 554 20,024.43 29 333 11,955.63
St. Johns. ................ 117 795 20,804.91 161 1,579 39,073.99 64 685 17,253.75
St. Lucie ................ 174 1,228 37,180.77 180 2,885 86,622.02 97 1,197 28,436.52
Santa Rosa............... 430 2,374 68,445.66 64 762 22,794.57 56 549 14,962.90
Sarasota .............. 182 1,313 43,796.88 453 4,773 159,851.86 98 1,421 42,696.38
Seminole ................ 277 2,017 60,648.39 132 1,523 45,890.72 82 976 28,335.10
Sumter ................. 87 558 17,311.48 65 320 9,714.82 34 381 11,341.47
Suwannee ............... 195 1,262 25,599.83 65 409 9,569.76 11 89 3,018.01
Taylor .................. 82 486 15,530.53 35 192 6,893.84 31 244 6,808.71
Union .................. 96 632 11,392.34 28 186 4,682.20 5 53 1,313.80
Volusia.. ............... 710 4,766 146,337.50 339 3,030 97,654.33 314 3,869 104,324.69
Wakulla ................ 65 386 10,645.74 ........... ..... 2 10 301.18
Walton ................. 438 2,334 53,007.57 40 283 7,807.31 23 226 5,303.22
Washington .............. 335 1,943 45,080.54 .......... ........... 19 174 4,376.37

*Data for six months only; program terminated, June 30, 1966.

z
z
C

r
I-

m
-u
0
70
-I

0

HEALTH FACILITIES AND SERVICES

HOSPITAL LICENSURE PROGRAM
The Advisory Hospital Council actively assisted the State Board
of Health in the administration of the hospital licensing law. Council
members, appointed by the Governor, are James H. Sweeny, Jr.,
attorney and State Legislator, Deland; William W. Richardson, M.D.,
Graceville; Autha W. Forehand, director, Division of Community
Hospitals and Medical Facilities, Tallahassee; John F. Wymer, ad-
ministrator, Good Samaritan Hospital, West Palm Beach; Walter D.
Griffin, pharmacist, Jacksonville; Richard C. Cumming, M.D., Ocala;
with the State Health Officer as Chairman ex-officio. Messrs.
Sweeny, Richardson, Forehand and Wymer have served continuously
since the Council was first organized in late 1957.
Considerable activity centered around an "Atomedic Hospital," a
windowless structure in the round. The structure was purchased
from the New York World's Fair Authority where it was used as a
medical dispensary for two years. At the Council's annual meeting
held April 7, 1966, a decision was made to advise denial of the re-
quest for licensure based on the many deficiencies in the type of
construction, and design features contrary to normal construction
standards and hospital licensure regulations. Subsequently the State
Health Officer appointed three members of the Council to serve as
Board of Hearing Examiners. The hearing was held July 29, 1966.
On November 22, 1966, application was denied again. However, the
applicants' request to address the SBH at its regular meeting, De-
cember 11, 1966 was granted. At the Board's direction a provisional
license was issued, effective December 12, 1966, which excluded
surgical, obstetrical and orthopedic services.
Six licensed hospitals ceased operation during the year, making
a total of 50 hospitals that have closed since the licensure program
began in 1957; 16 closed voluntarily, 16 were replaced by new facil-
ities, 11 reverted to "clinic" status, six became nursing homes and
one was closed following a legal hearing. With few exceptions, these
hospitals were unable to meet and/or maintain minimum licensure
standards, or efforts judged necessary to conform were not feasible.
During the year consultants reviewed 143 hospital construction
plans having an approximate value of $75,000,000. Of these, 86 were
approved for a total of 3795 beds. Consultants surveyed 207 hos-
pitals, and held 126 consultations with architects, administrators
and others, particularly directors of CHDs.

88 ANNUAL REPORT, 1966
TABLE 12
HOSPITAL EVALUATION STATISTICS, FLORIDA, 1966

Licensure Status Hospitals Beds Bassinets
Licensed at beginning of year. . . ..... .......... ... 188 23,136 2,663
Ceased to operate during year ............................ 6 492 82
Accessions during year ................................. 7 683 74
Licensed at end of year ................................. 189 23,747 2,566
Unlicensed at end of year ............................... 1 27 4
Total subject to licensure at end of year . . ........ ... 190 23,774 2,570

HEALTH INSURANCE BENEFITS FOR THE AGED

In November, 1965, the Governor designated the SBH as the sin-
gle state agency to administer the functions prescribed by Section
1864 of the Medicare Act. These functions involve the certification
of providers of services which include hospitals, extended care fa-
cilities (nursing homes) and home health agencies. In addition, this
bureau also certifies the participation of independent laboratories.
The purpose of certification is the determination of whether such
health care facilities meet the requirements of the conditions of
participation. Other functions include consultative activities to pro-
vide advisory assistance to facilities to qualify for participation; to
establish and evaluate the effectiveness of utilization review pro-
cedures; the coordination of Medicare Program activities with its
other activities concerned with the provision of similar services,
facilities and personnel required to provide such services, and im-
proving the quality of such services.
The hospital certification program resulted in 172 hospitals
being approved for participation in the program, which consisted of
approximately 94 per cent of the general hospital short term beds in
the state. Six hospitals were recommended for denial. Of the num-
ber of hospitals approved, 99 were accredited by the joint Commis-
sion on the Accreditation of Hospitals which were deemed to be in
compliance with the conditions of participation except for having a
utilization review plan. Approvals of this group were effected with-
out site visits upon receipt of the plan. Hospital consultants made
127 visits to non-accredited hospitals requesting participation, to
conduct extensive surveys to determine their compliance with the
conditions of participation.
The new concept of a formalized utilization review plan required
for participation in this program presented the most serious obstacle
at the onset, particularly with the smaller hospitals, but was largely
overcome through consultative efforts.
The extended care facility certification program resulted in 89
nursing homes and distinct parts of two hospitals being approved by
year's end for participation in the program. The distinct part of a
hospital designated as an extended care facility must be readily

	Cover
	Title Page
	Letter of transmittal
	Members of the Florida state board...
	Directors of county health...
	Official staff Florida state board...
	List of Tables
	Table of Contents
	Tenure of state health officer...
	Administration
	Bureau of adult health and chronic...
	Bureau of dental health
	Bureau of entomology
	Bureau of finance and accounts
	Bureau of health facilities and...
	Bureau of laboratories
	Bureau of local health service...
	Bureau of narcotics
	Bureau of preventable diseases
	Bureau of research
	Bureau of sanitary engineering
	Bureau of vital statistics
	Articles and publications by state...

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