Annual report - State Board of Health, State of Florida

FLORIDA
STATE BOARD
OF
HEALTH

1967

ANNUAL REPORT

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Report

State Board of Health

State

Of

1967

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

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The Honorab e 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
81, 1967.

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

May 1, 1968
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, 1967, to
December 31, 1967, inclusive.

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

May 1, 1968
Ocala, Florida 32670

Members of the

FLORIDA STATE BOARD OF HEALTH

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

T. M. CUMBIE, Ph.G.,
Quincy

Vice-President

LEO M. WACHTEL, M.D.
Jacksonville

FRED J. ACKEL, D.D.S.
Fort Lauderdale

L. RALPH POE, JR., D.V.M.
Winter Park

DIRECTORS OF COUNTY HEALTH DEPARTMENTS

(as of December 31, 1967)

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 .........................Peter G. Kroll, M.D., (Acting)
Dade ..........................William R. Stinger, M.D., M.P.H. (Acting)
Duval ..........................Patricia C. Cowdery, M.D. (Acting)
Escambia ....................... Harvey G. Tousignant, M.D., M.P.H.
Hillsborough ....................John S. Neill, M.D., M.P.H.
Lake ..........................J. Basil Hall, M.D., M.P.H.
Lee ...........................Joseph W. Lawrence, M.D.
Leon .........................Clifford G. Blitch, M. D.
Manatee ........................George M. Dame, M.D.
Marion ........................James B. Stapleton, M.D.
Monroe ........................Philip H. Isacco, M.D.
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 ..........................William F. Hill, Jr., M.D., M.P.H.
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 .........................Hubert U. King, M.D.
Baker-Nassau ...................B. F. Woolsey, M.D.
Flagler-Putnam .................. J. Culpepper Brooks, Jr., M.D.
Gadsden-Liberty ................. B. D. Blackwelder, M.D., M.P.H.
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.
Calhoun-Jackson-Gulf .............Terry Bird, 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 .........J. Dillard Workman, M.D., M.P.H.
Holmes-Walton-Washington .......William G. Simpson, M.D., M.P.H.
Jefferson-Wakulla-Franldin .........P. H. Smith, M.D.
Martin-Okeechobee-St. Lucie ...... Neill D. Miller, M.D.
Suwannee-Dixie-Lafayette ......... Owen R. Hunt, M.D.

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
(as of December 31, 1967)
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 ..........G. Foard McGinnes, M.D., Dr.P.H.
Encephalitis Research Center .... James O. Bond, M.D., M.P.H.
Division of Health Education .... G. Floyd Baker, M.P.H.
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 ..........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.
West Florida Arthropod Research
Laboratory .................. Andrew J. Rogers, 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. (Acting)
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.
Division of Nutrition ........... Mildred Kaufman, B.S., M.S.
Division of Sanitation ..........A. W. Morrison, Jr., R.S.
Bureau of Maternal and Child
Health .....................E. Henry King, M.D., M.P.H.
Bureau of Narcotics ..............Frank S. Castor, Ph.G.
Bureau of Preventable Diseases .... C. L. Nayfield, M.D., M.P.H.
Associate Director ..............E. Charlton Prather, M.D., M.P.H.
Division of Epidemiology ........E. Charlton Prather, M.D., M.P.H.
Division of Radiological 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 .............. Howard W. Carter, M.D., M.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 Page

1 Employees health service cases and visits, by type of service,
by month ........................................... 14
'2 Employees in the Florida State Board of Health and county
health units ......................................... 25
3 Personnel in administrative units of the Florida State Board
of Health (excluding county health departments) ....... 26
.4 Personnel in county health units ........................ 28
5 Personnel in the Aedes aegypti mosquito eradiction program 30
'6 Employment termination and turnover rate ............... 31
7 Average cost of time required for selected nursing services .. 35
8 Patient visits, Florida tumor clinics ...................... 42
9 Glaucoma screening program data ...................... 50
10 Arthropod-borne virus isolations from mosquitoes ......... 64
11 Summary of pest control registration and enforcement .... 66
12 Funds received by county health units ................... 90
13 Major evaluation indices by types of hospitalization program 100
14 Applications approved for payment by hospitalization pro-
gram .......................................... 101
15 Hospital evaluation statistics ........................... 105
6 Extended care facilities and number ceasing operations with
number of beds ..................................... 108
17 Homes licensed by Florida Nursing Home Law by type and
bed capacity ....................................... 110
G18 Homes licensed under Florida Nursing Home Law with num-
ber of beds and by type of ownership .................. 111
19 Examinations performed by Florida State Board of Health
laboratories ......................................... 123
20 Specimens submitted to State Board of Health laboratories 125
21 Examinations performed in tuberculosis hospital laboratories 127
22 Viral and rickettsial diagnosis findings for 1446 patients .... 127
23 Per cent of enteric pathogens recovered from 5616 fecal speci-
mens by age group ................................ 128
24 Per cent of enteric pathogens recovered from 5616 fecal speci-
mens by source .......... ............................ 129
25 Permitted establishments and facilities ................... 182
26 Major activities of local health units ..................... 183
27 Postgraduate obstetric-pediatric seminar registration ...... 203
28 Practitioners registered with the State Board of Health ..... 206
29 Reported syphilis cases and rates per 100,000 population .. 221
30 Reported venereal disease morbidity ................... 222
31 Sources of radiation by county ........................ 228
32 Summary of X-ray surveys and consultations ............. 228

LIST OF TABLES (Cont'd.)

Number Page

33 New active tuberculosis cases and deaths ................. 231
34 Reported active cases of tuberculosis ...................... 232
35 Results of 70mm X-ray screenings ..................... 233
36 Results of state X-ray survey units ....................... 234
37 Tuberculosis cases in central register ................... 235
38 Tuberculosis case register statistics ...................... 236
39 Number of cases of animal rabies ....................... 244
40 Engineering laboratories basic water quality data .......... 261
41 Industrial waste and incinerations projects approved ...... 266
42 Summary of activities relating to shellfish and crustacea plants 272
43 Sewerage projects approved ............................ 275
44 Existing sewage treatment plants by types and capacity .... 277
45 Water projects approved with capacity increase and esti-
mated cost .......................................... 283
46 Permits issued for swimming pools, natural bathing places,
water wells and plans approved for proposed public swim-
ming pools .......................................... 284
47 Water plants visited, number of visits and existing plants .. 285
48 Water and sewage work operators short schools ........... 286
49 Sanitation of water supplies serving interstate carriers ...... 287
50 Activities of the Division of Vital Records ................ 296
51 Midyear population estimates and resident birth and death
rates per 1000 population ............................ 296
52 Twenty leading causes of death ........................ 297
53 Resident deaths and death rates (preliminary 1967) ........ 298
54 Resident deaths and death rates (final 1966 figures) ....... 300
55 Estimated population and resident births, deaths and infant
deaths (preliminary 1967) .......................... 302:
56 Estimated population resident births, deaths and infant
death rates (final 1966 figures) .................... 303.
57 Marriages by race, divorces and annulments by county .... 304
58 Vital statistics scoreboard .......... ........................ 305

Figure Page

1 Reported syphilis case rate per 100,000 population ........ 220'
2 Sewage treatment plants approved .................... 276

TABLE OF CONTENTS

Page

Administration (including Program Planning; Activities of the
Board; Training Coordination; Scholarships; Employees Health
Service; Encephalitis Research Center; Divisions of Health
Education, Personnel and Public Health Nursing) .......... 1
Bureau of Adult Health and Chronic Diseases ............... 36
Bureau of Dental Health ................................. 53
Bureau of Entomology (including Entomological Research
Center and West Florida Arthropod Research Laboratory) 57
Bureau of Finance and Accounts (including Purchasing and
Property) ......................................... 82
Bureau of Health Facilities and Services ................... 92
Bureau of Laboratories .................................. 112
Bureau of Local Health Services (including Health Mobiliza-
tion, Home Health Services; and Divisions of Nutrition and
Sanitation) .................................. ... .... 130
Bureau of Maternal and Child Health .................... 199
Bureau of Narcotics .................................... 204
Bureau of Preventable Diseases (including Occupational Health;
Accident Prevention; Divisions of Epidemiology [Venereal
Disease Control Program], Radiological Health, Tuberculosis
Control and Veterinary Public Health) .................. 207
Bureau of Research ..................................... 245
Bureau of Sanitary Engineering (including Divisions of In-
dustrial Waste, Special Services, Waste Water and Water
Supply) .............................................. 249
Bureau of Vital Statistics (including Divisions of Data Process-
ing, Public Health Statistics and Vital Records) ........... 288
Articles by Staff Members ............................... 306

TENURE 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., 1940-1942
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

WILSON T. SOWDER, M.D., M.P.H.
State Health Officer
Disraeli said, "The health of the people is really the foundation
upon which all their happiness and all their powers as a State
depend." Public health, then, might be considered action by the
State to increase the happiness and powers of its people, and good
strides were made toward this end in 1967.
Over 75,000 children were immunized in mass measles programs
conducted in 16 counties during the year. If we can continue such
success, there is a promise that measles-like polio-can be eradicated
in Florida.
Our family planning clinics have been well received about the
state. They provide a great service in enabling a number of women,
child-bearing age, to attain better lives for themselves and their
offspring by regulating the size of their families. The state has been
experiencing a decreasing birth rate for six successive years. There
were 1706 fewer children born to Florida residents in 1967 than
in 1966.
As the year drew to a close, we made arrangements to hire the
first male public health nutritionist in the nation. He will perform
much needed nutritional work with the Migrant Health Program,
and will bring to a total of 25 our number of health nutritionists
working throughout the state.
Our almost unique State-County partnership has earned Florida
the reputation of having one of the best public health systems in the
nation. This partnership of 35 years is providing us with the health
structure not only to keep up with our continuing duties but also
to now engage efficiently in new federal programs such as rodent
control, the model cities program, home health services and others.
Many states are not so fortunate.
On the other side of the ledger, our excellent State-County
partnership is being endangered by the fact that the state is not
keeping up with its share of the cost of public health while county
and federal governments have been contributing more. The counties
are becoming tired of putting up most of the public health money
and taking most of their orders from the state. This situation is put-
ting a strain on the State-County partnership-and we cannot look

2 ANNUAL REPORT, 1967

to federal dollars to solve the problem because they are usually
categorized and limited by time, geography and specific programs
and do not cover all health needs. We have asked, and will continue
to ask, for additional funds to bolster the state's share of public
health in the counties because a rupture in the State-County partner-
ship would be a far more costly event. To go back to the time when
school boards, counties, cities and the state all went their own ways
would be more expensive and far less efficient; it would virtually
be a return to the Dark Ages for public health in Florida and this
must not be allowed to happen.

Even though there have been no cases of polio in Florida since
1964, we were forced, this year, to issue a warning that the disease
could reappear in force when we found that as a fear of polio de-
creased, so did immunizations. Our investigations showed that in
March, 10.6 per cent of children 18 months of age and under had
received no vaccine at all. By October, that figure climbed to 22.7 per
cent. An extremely dangerous trend.

In other upsetting news this year, Florida was second in the
nation in reported tetanus cases, and third in reported diptheria.
That both of these diseases are totally preventable through im-
munizations makes the situation sadly exasperating.

Transitions
Narcotics control, long considered a health problem, was trans-
ferred by the legislature to the Florida Bureau of Law Enforcement
this year.
In another transfer, responsibility for air and water pollution
control were given to the newly created Air and Water Pollution
Control Commission. Vincent D. Patton, Director of our Division
of Industrial Waste, became Acting Director of the new Commission
early in 1968.
The legislature also passed the "Clinical Laboratory Law". This
law, placing responsibilities on State Board of Health (SBH) without
accompanying funds, requires that we regulate and license clinical
laboratories and their personnel.
Another new piece of legislation, the "Hearing Devices Law",
requires us to register those who are fitting and selling hearing aids,

GENERAL ADMINISTRATION

to adminster qualifying exams in this regard, and to inspect testing
equipment and facilities of those registered.
Under a new federal law, the office for Comprehensive Health
Planning may be placed within the state health department, or in
another agency-at the option of the state. In Florida, it was decided
this year that it would be placed in the Governor's Office.
Major difficulties have been experienced in finding qualified
personnel willing to accept the salaries we are able to pay. The re-
cruitment picture does not seem to brighten, and again it is com-
pounded by the loss of key personnel:
Dr. Albert V. Hardy, who was Acting State Health Officer for
14 months in 1961-62 and also served in a number of other valuable
capacities in the State Board of Health, retired as Director of the
Bureau of Research on March 27 to accept a post in the Southern
Branch of the APHA. Another long time SBH director, Frank S.
Castor, retired September 30 as head of the Bureau of Narcotics
after some 35 years with the agency. Dr. Hubert U. King, Assistant
Director of the Bureau of Local Health Services, left May 1 to
become County Health Director of Volusia County; and Dr. Vincent
Granell left the directorship of the Divison of Health Education
on March 8 to accept a post in Washington, D.C.
Our Board, also, met with some changes. The terms of William
O. Shumpert, D.D.S., of Ft. Lauderdale, and W. S. Horn, D.O., of
Palmetto expired. In their places, the Governor named Fred J. Ackel,
D.D.S., of Ft. Lauderdale, on November 14, and L. Ralph Poe, Jr.,
D.V.M., of Winter Park, on November 22. Both were named to four
year terms.

Staff Activities
The internal auditor and his assistant examined the accounts
of 89 health departments to insure that spending was in accordance
with state and local laws.
The Legal Section composed of two resident staff attorneys and
one part-time staff attorney, continued to experience an increasing
case load, with 44 cases pending before administrative examiners
and circuit courts on December 31, 1967. A survey made of this
section by the Attorney General's Office and the Florida Bar, at the

4 ANNUAL REPORT, 1967

request of the State Health Officer, indicated the section was under-
staffed for its total work load. While responsibility for enforcement
of air and water pollution cases was transferred to the Florida Air
and Water Pollution Control Commission in 1967, the decrease in
pollution cases will be offset by the increased case referral of environ-
mental sanitation cases referred to the section during the last half of
1967.

A total of 75 news releases related to SBH activities was sent
to newspapers, magazines, television and radio. Various news media
were assisted 66 times and 21 special interviews, stories or photos
were set up.

PLANNING
G. FOARD McGINNES, M.D., Dr.P.H.
Assistant State Health Officer

A major function of the office is review of administration and
program content of existing programs for the purpose of modification
or additions to these programs. During the year, reviews were con-
ducted on the Division of Radiological Health and the Vaccination
Assistance Program. Such reviews are an on-going and current activ-
ity within the department.

A second function is the administrative coordination of the
grants-in-aid, project grants, contracts and cooperative agreements
currently in force with the State Board of Health (SBH) and other
health agencies. These include 29 federally financed projects, nine
contracts and agreements with the federal government, and 20 proj-
ects awarded to local and voluntary agencies, or to state or private
institutions other than the SBH.

Allocation of federal funds requires both regular and special
reports from the Grantee. These reports, the narrative portions of
the State Plan, and information for the State Health Officer were
prepared as needed.

For part of the year, this office had the responsibility as project
director for special pesticides studies and during the latter part of
the year, the directorship was transferred to the Bureau of Research.

GRANTS-IN-AID, PROJECTS, CONTRACTS AND AGREEMENTS
FLORIDA, 1967

Description of Program

Health Services For Migrant Farm Workers
Health Services For Migrant Farm Workers
Health Services For Migrant Farm Workers
Medical Care For American Indians

Medical Care For Cuban Refugees
Prevention of Blindness
Health counseling, referral & follow-up
for the aged
Medical Self Help Training
Planning for air pollution control
Planning for air pollution control
Planning for air pollution control
Planning solid wastes disposal
Control of spread of venereal diseases
Control of venereal diseases among migrant
farm workers
Training federal VD investigators
Vaccination Assistance through birth
certificate follow-up
Intensified tuberculosis control
Epidemiology of unclassified mycobacterial
infections
Research on effects of pesticides in humans
Eradication of aedes egypti mosquitoes

Area

Statewide
Dade County
Palm Beach County
Broward, Glades,
Dade & Hendry
Counties
Dade County
Statewide
Dade County

Statewide
Hillsborough County
Manatee County
Palm Beach County
Statewide
Statewide
Statewide

Statewide
Statewide

Statewide
Statewide

South Florida
Statewide

Grantor
U. S. PUBLIC HEALTH SERVICE
Bureau of Health Services
Bureau of Health Services
Bureau of Health Services
Division of Indian Health

Bureau of Health Services
Bureau of Health Services
Bureau of Health Services

Bureau of Health Services
National Center for Air Pollution Control
National Center for Air Pollution Control
National Center for Air Pollution Control
Division of Solid Wastes
National Communicable Disease Center
National Communicable Disease Center

National Communicable Disease Center
National Communicable Disease Center

National Communicable Disease Center
National Communicable Disease Center

National Communicable Disease Center
National Communicable Disease Center

Amount

$ 399,133
116,868
150,549
169,850

0
1,645,898 m
18,480 Z
18,480 m

9,908 r-
56,250
29,118
14,375
26,418
280,000 Z
27,155
-I
192,000
341,700 >
-I
791,787 O
30,064 Z

327,827
8,814,469 tn

GRANTS-IN-AID, PROJECTS, CONTRACTS AND AGREEMENTS
FLORIDA, 1967

Description of Program
General Research Support
Research for Mosquito Control
Research on eutrophic water insect breeding
Research on epidemiology of St. Louis
encephalitis
Health Education-Smoking and Health
Early detection of cervical cancer
Early detection of oral cancer
Research of radionuclides in milk
Library Facilities Support

High risk maternity and infant medical care
High risk maternity and infant medical care
High risk maternity and infant medical care
High risk maternity and infant medical care
High risk maternity and infant medical care
Health services for low income family children
Clinic services for mentally retarded children
Clinic services for mentally retarded children

Medicare certification services

Research on dog fly control

Area
Statewide
Statewide
Statewide
Statewide

Statewide
Dade County
Statewide
Statewide
SBH Library

14 northeast counties
Broward County
Dade County
Orange County
Palm Beach County
Dade County
Dade County
Hillsborough County

Statewide

Northwest Florida

Protection and safety with radioactive isotopes Statewide

Grantor
National Institutes of Health
National Institutes of Health
National Institutes of Health
National Institutes of Health

Comprehensive Health Planning
Comprehensive Health Planning
Bureau of Health Manpower
National Center for Radiological Health
National Library of Medicine
U. S. CHILDREN'S BUREAU

U. S. SOCIAL SECURITY
ADMINISTRATION

U. S. DEPARTMENT OF AGRICULTURE

U. S. ATOMIC ENERGY COMMISSION
Re

Amount
88,791
278,820
6,607
176,904

15,877
28,093
23,180
28,881
8,249

505,000
290,000
1,350,000
330,000
488,500
786,279
171,255
75,000

224,724

80,480

asonable cost

$12,905,819+

GENERAL ADMINISTRATION

ACTIVITIES OF THE BOARD
February 1 Jacksonville
1. Approved the appointment of G. Floyd Baker as director of
the Division of Health Education.
2. Heard a report by W. W. Rogers, M.D., on the Employees'
Health Service Program.
3. Heard a report by John D. Milton, M.D., on the activities
in the Planned Parenthood Program of the Bureau of Maternal
and Child Health, and welcomed A. F. Caraway, M.D., ob-
stetrical consultant, as a member of the staff in that Bureau.
4. Heard a status report on the Ercildoune Hospital by Chester
L. Nayfield, M.D.
5. Approved a recommendation to the Board of Commissioners
of State Institutions to accept the low bid of the 0. P. Wood-
cock Company for the construction of the new administration
building of the State Board of Health (SBH) to be built in
Jacksonville.
6. Approved the placement of Floyd H. DeCamp, D.D.S., tem-
porarily in the position of assistant director of the Bureau
of Dental Health, and the promotion of Delmar Miller, D.D.S.,
assistant director, to the position of director of the Bureau.
7. Approved a study to be made by the Florida Bar Association
of the SBH legal problems and staff needs.
8. Discussed retirement of Albert V. Hardy, M.D., director,
Bureau of Research, and approved the appointment of Howard
Carter, M.D., as director of that Bureau upon his return from
postgraduate training around August 1, 1967.
9. Approved the appointment of E. Henry King, M.D., as director
of the Bureau of Maternal and Child Health effective about
June 1, 1967, upon completion of his postgraduate training.
10. Discussed appointment of Advisory Committee Veterinary
Public Health.
11. Discussed and made recommendations of salaries of public
health dentists.
12. Discussed and approved legislation of SBH.

8 ANNUAL REPORT, 1967

13. Approved increasing various fees collected by the SBH.
14. Directed that a study be made regarding laboratory con-
tainers and their distribution to see whether or not it would
be feasible to charge for this service.

March 29 Jacksonville
1. Discussed resignation of Mr. Louis Frost, attorney.
2. Approval appointment of Mr. John Palmer, part-time attorney.
3. Approved amendments Chapter 170C-5 "Pollution of Waters".
4. Adopted a resolution in behalf of services, Dr. Hardy.
5. Discussed recommendations State-Local Relations Study Com-
mittee.
6. Approved candidates for postgraduate training 1967-68.
7. Held hearing with members of Board of Optometry, Florida
Medical Association, County Health Officers and others.
8. Approved revised regulations Chapter 1701-2 "Pest Control".
9. Approved awarding ten year pins for employees-State Board
of Health and County Health Departments.
10. Approved membership of Advisory Committee Veterinary
Public Health.
11. Discussed with Mr. W. E. Grissett, Jr., member of Board of
Governors of Florida Bar, study made regarding SBH legal
problems and staff needs.
12. Discussed licensure of proposed surgical wing addition to
Ercildoune Hospital.
13. Approved a request by the State Health Officer to take a
three week vacation in September 1967.
14. Gave final approval on legislation to be submitted to the
Legislature by the SBH.

May 13- Bal Harbour
1. Clarified Board action school health form.
2. Approved certain revisions of water quality standards.

Organizational Chart of the

Florida State Board of Health

67 County Health Departments

*Effective October 1,1967, narcotic law enforcement
transferred to Florida Bureau of Law Enforcement;
Bureau of Narcotics abolished; other responsibilities
under new unit designated as Office of Registration
and Drug Administration.

DEC/1967

GENERAL ADMINISTRATION

3. Approved certain revisions in plumbing code.
4. President of Board advised members of Mr. T. M. Cumbie's
illness.
5. Approved a provisional general hospital license for Ercildoune
Hospital.
6. Approved a recommendation made by the State Health Officer
regarding distribution of state funds to sixty-seven county
health departments.
7. Heard a report by Mr. Fred B. Ragland of legislative actions
affecting the SBH.
8. Heard a report by W. O. Shumpert, D.D.S., on salaries for
public health dentists.

June 25 Jacksonville
1. Adopted a resolution in behalf of Dr. DeCamp.
2. Approved the appointment of Dr. Nayfield as director of
Bureau of Preventable Diseases and temporarily acting di-
rector of Bureau of Health Facilities and Services.
3. Approved the appointment of Charlton Prather, M.D., as as-
sociate director of the Bureau of Preventable Diseases.
4. Discussed problems in the Orange County Health Department.
5. Approved Board of Dental Examiners Scholarship Commit-
tee's recommendations for recipients of dental scholarships.
6. Approved Marjorie G. Depew, Dade County, for postgraduate
training.
7. Heard a status report by Mr. Robert Eisenberg regarding
SBH legal actions.
8. Approved action by legal staff to proceed with litigation
against City of Okeechobee.
9. Heard report by Mr. A. W. Morrison regarding health laws
passed by Legislature and bills pending.
10. Heard discussion by State Health Officer regarding financial
and budgetary problems relating to State and Federal ap-
propriations for new fiscal year and biennium.

10 ANNUAL REPORT, 1967

August 27 Jacksonville
1. Welcomed Mr. Cumbie back after illness.
2. Discussed the passage of the Clinical Laboratory Law and
approved the appointment of the membership of an advisory
committee for this program.
3. Discussed the law passed by the Legislature establishing an
Air and Water Pollution Control Commission.
4. Approved certain revisions Chapter 170C-5 "Pollution of
Waters".
5. Discussed the law passed by the Legislature for the licensure
of those dealing in the sale of hearing devices to be enforced
by the SBH.
6. Discussed the law establishing a Bureau of Law Enforcement
and abolishing the SBH's Bureau of Narcotics.
7. Discussed Mr. Frank Castor's retirement as director of the
Bureau of Narcotics and adopted a resolution in his behalf.
8. Appointed Senator J. Emory Cross as a member of the Advisory
Committee on Hospital Services for the Indigent.
9. Approved the recommendations of Advisory Committee on
Hospitalization Services for the Indigent on reimbursable
costs for hospitals.
10. Approved the granting of a provisional license for fiscal year
July 1, 1967 for eight hospitals.
11. Discussed the law passed by Legislature requiring SBH to
charge fees for reviewing plans for hospitals and nursing
homes.
12. Adopted a resolution in behalf T. E. Cato, M.D., deceased, for
outstanding service in the field of public health.
13. Approved out-of-state trips for W. S. Horn, D.D., and Dr.
Shumpert.
14. Welcomed Dr. King as director, Bureau of Maternal and Child
Health, upon his return from postgraduate training.

GENERAL ADMINISTRATION 11

October 22 Miami Beach
1. Discussed plan for the administration of Florida Law, Chap-
ter 67-423, Fitting and Selling of Hearing Aids.
2. Heard a report regarding activities of new Air and Water
Pollution Control Commission.
3. Discussed retirement of Mr. David B. Lee, director of Bureau
of Sanitary Engineering.
4. Heard report by State Health Officer regarding new Bureau
of Law Enforcement as it affects Bureau of Narcotics, SBH.
5. Approved recommendations of attorney regarding legal actions
against the City of Okeechobee and City of Green Cove
Springs.
6. Discussed the SBH's services in the Implied Consent Law
passed by the Legislature giving the State Department of
Public Safety authority to adopt rules and regulations re-
lating to chemical tests for intoxication of persons operating
a motor vehicle within this state, etc.
7. Discussed the SBH public relations program.
8. Approved change in policy on travel expenses for SBH em-
ployees.
9. Recommended that SBH not delegate authority to Division
of Community Hospitals and Medical Facilities to review
architectural and engineering plans for hospitals under the
licensure program.
10. Approved the fees to be charged by SBH to review plans
of hospitals and nursing homes.
11. Suggested SBH have regulations on the inspection of laser
beam facilities.
12. Drs. Horn and Shumpert expressed their pleasure in serving
as members of the Board over the years and advised that in
all probability they would not be appointed at the expiration
of their term, November 7, 1967.
13. Advised of retirement of Dr. DeCamp around November 15,
1967.

12 ANNUAL REPORT, 1967

December 17 Jacksonville
1. Introduction and welcoming of L. Ralph Poe, Jr., D.V.M, re-
placing Dr. Horn, and Fred Ackel, D.D.S., replacing Dr.
Shumpert, as newly appointed Board members.
2. Discussed the licensure problem Magnolia Towers Nursing
Home, Orlando.
3. Approved certain waivers requested by Cathedral Townhouse
Apartment Building and Riverside Presbyterian Apartment
Building for their licensure.
4. Heard a report from Mr. Lee on the status of the Air and
Water Pollution Control Commission.
5. Adopted a resolution in behalf of Mr. Lee, director, Bureau of
Sanitary Engineering, upon his retirement.
6. Heard a report on the development of the Hearing Aid Pro-
gram.
7. Adopted an emergency regulation in connection with the
Clinical Laboratory Licensure Act.
8. Report on transfer Bureau of Narcotics personnel to Florida
Bureau of Law Enforcement.
9. Adopted a resolution in behalf of each member of the staff
of the Bureau of Narcotics for their service to the SBH.
10. Heard a report on laser beam control regulations throughout
the country.
11. Authorized the negotiation with owners of property adjacent
to SBH for purchase within limits of funds released by Bud-
get Commission.
12. Discussed dedication of Tampa Laboratory Building.

EMPLOYEES HEALTH SERVICE
The statistical data shown on Table 1 represent the work of
this service through its first full year of operation and reflect con-
siderable increase in activities, as well as acceptance and utilization
by the employees.

GENERAL ADMINISTRATION 13

The facilities and services have been expanding commensurately
with the evident needs of the employees, and the efficiency of the
service is improving as the routines, record systems, and division of
labor are perfected.
During the year the Employees Health Service assumed the
administrative functions of the Employees Blood Bank and assisted
in the administration of the influenza immunization service to the
employees and their families. This was in addition to and apart from
the routine immunization program for dependents.
Preparations for the multi-phasic screening program were com-
pleted preparatory to the actual inauguration of this service im-
mediately after the holiday season.
The sick leave and maternity leave regulations were refined in
such manner as to foster the conservation of both leave time and
work time, which, it is thought, will ultimately be advantageous
to the employees and to the State Board of Health.
A designated representative of the Employees Activities Com-
mittee is now a member of the Employees Health Service Advisory
Committee, and this has proven to be quite helpful in improving
liaison with the employees, and devising new methods for further
improving the services.

Z
Z
c

r-
TABLE 1
rn
EMPLOYEES HEALTH SERVICE CASES AND VISITS, BY TYPES OF SERVICE, BY MONTH, FLORIDA STATE BOARD o
OF HEALTH, 1967 O

Type of Service Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Totals
OCCUPATIONAL
Cases 1 9 8 6 8 8 9 6 10 15 7 6 93 %0
Visits 1 11 15 10 10 13 10 10 14 17 8 6 125
NON-OCCUPATIONAL O0
Cases 90 94 117 102 142 148 128 141 142 151 142 153 1550 4
Visits 139 153 187 150 209 240 187 197 237 208 198 189 2294
Dependents' Immunization 15 12 25 16 24 23 29 42 38 12 7 9 256
TOTAL VISITS 155 176 227 176 243 276 226 249 279 238 213 204 2662
EMPLOYEES' SERVED
FOR FIRST TIME 33 30 27 20 33 30 30 29 19 20 18 13 302

GENERAL ADMINISTRATION 15

TRAINING COORDINATION
JEROME N. CONGER, M.P.H.
Chief Health Program Specialist
During 1967 activities in this program remained virtually un-
changed from previous years. Responsibility for administration was
assigned to the Chief Health Program Specialist, who is employed
in a newly created position on the State Health Officer's staff.
Scholarships for the study of medicine, other than one scholar-
ship in osteopathic medicine, were not awarded in 1967. Twenty
recipients who received scholarships in former years continued to
receive payments. Processing payments and maintaining contact
with the many other recipients of previous years who have not yet
reimbursed the state for their scholarships required considerable
staff time. This activity is expected to diminish as the program is
gradually phased out. The State Board of Health (SBH) has been
designated by the U. S. Public Health Service to administer the
Florida component of the federal loan program for medical, dental,
optometric and osteopathic students. This has required little activity
to date.
In addition to the one osteopathic scholarship routinely awarded
by the SBH upon recommendation of the State Board of Osteopathic
Medical Examiners, five dental scholarships were awarded in 1967.
Dental scholarships are administered by the Bureau of Dental Health
and each award is made upon recommendation of the State Board
of Dental Examiners.
Since 1935, SBH employees in the professional categories have
had the opportunity to further their education through accredited
training scholarships supported by federal funds. These scholarships
are available to career employees showing promise for future posi-
tions of leadership. The program has been invaluable in developing
and maintaining skilled and knowledgeable employees, and is sig-
nificant long range benefit. However, there was some difficulty
during the year in obtaining a sufficient number of qualified em-
ployees to take advantage of the number of available scholarships.
Seventeen scholarships were awarded in 1967, two for undergraduate
training and 15 for graduate work.
Non-accredited training programs, including the summer student
program, management of student work-study activities, and partic-

16 ANNUAL REPORT, 1967

ipation and consultation in various inservice training programs for
SBH personnel, are also administered by this unit. Preliminary
work was begun this year in studying requirements and methods
needed for additional and improved inservice training and em-
ployee orientation programs.
MEDICAL
Scholarships Awarded in 1967:
*Thomas E. Abbey................................................ Duval
Continuing Scholarships Awarded Prior to 1967:
Awarded 1964: Julia Carolyn Revell
Jack Benson Owen Harrison Denison Williams
*Orville Leon Barks, Jr. Wayne Raymond Johnson

Elizabeth Orene Vaughan
Edmond DeLaney Robinson
Dale Miner Braman

Awarded 1965:
Louis B. St. Petery
Monica Anne Minyard
(Maternity Leave 1966-67)
*Donald L. McBath
George L. Sanders
* Osteopathic Scholarship

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

DENTAL
Scholarships Awarded in 1967:
Robert B. Blair, III.................................................Dade
Terry C. Blanks ................................................. Volusia
Harold E. Howard, Jr ...........................................Lake
W ayne S. M aris ..................................... .............. Orange
George A. Jackson, II .............................................Duval
Continuing Scholarships Awarded Prior to 1967:
Awarded 1964: John L. Ricks, Jr.
Wayne D. Bradley Drew H. Turner, Jr.
Roger E. Gibson Richard H. Waldbart, Jr.
James R. Hoover John W. Shannon

Ronald J. Marien
James E. Owens
William A. Thompson

Awarded 1965:
Melvin C. Beard, II
Albert J. Endruschat
Richard L. Finkbeiner
Nathan A. Graddy
Leonard W. Peterson
David W. Rawson

Awarded 1966:
William O. Bolton, Jr.
Douglas W. Booher
Harvey I. Cohen
H. J. Emmons
Alan J. Frank
Robert E. Hirschfield
Owen B. Lovejoy
James E. Moore, Jr.
Conrad C. Theiss, Jr.

GENERAL ADMINISTRATION 17

PUBLIC HEALTH PERSONNEL
Miss Angeline Beard ................ Public Health Nurse II...........Broward
Jack H. Curry ......................Sanitarian............. ... ....... Leon
Marjorie DePew....................Public Health Nurse Supervisor II.... Dade
Miss Barbara Jean Finger............ Public Health Nurse Supervisor II.... Dade
Ralph B. Gray......................Health Field Worker II..............SBH
Mrs. Laura Jean Hall ................Public Health Nurse II...........Broward
**Dorothy L. Harris................. Public Health Nurse II............ Marion
*Mrs. Judith R. Jackson............ Nutritionist Consultant.............. SBH
Wallace B. Johnson, Jr............... Sanitarian Supervisor II......... Escambia
James L. Keys, Jr .................. Sanitarian Supervisor ............. Pinellas
Mrs. Myra Mott Lentz.............. County Nursing Director......... Broward
**Mary Anne Marshbourne...........Field Nutrition Coordinator..........SBH
C. G. Mauriello.................... Sanitary Engineer V.................SBH
Charles E. Melchar.................. Sanitarian .....................Broward
**Barbara Moulton.................. Consultant, MCH Training Programs. .SBH
Mrs. Catherine Ann (Jensen) Rhode... Nutritionist Consultant I............SBH
Henry F. Sutter .................... Health Educator II .......... Hillsborough
Miss Irma Taylor ................... Public Health Nurse
Supervisor II.............. Hillsborough
Mrs. Hilda Walden................. Public Health Nurse III............. Leon
**Ben Frank Watkins ................Sanitary Engineer II................ SBH
*Withdrew, Scholarship Discontinued
**Continuing Scholarship Awarded in 1966

ENCEPHALITIS RESEARCH CENTER
JAMES O. BOND, M.D., M.P.H.
Director

Beginning in December, 1963, the Encephalitis Research Center
(ERC) staff has repeatedly isolated a viral agent from Tampa Bay
area cotton rats; seven such recoveries occurred during 1967. The
agent has been intensively studied at the University of Pittsburgh,
the Yale-Rockefeller Laboratories, and at the U.S. Public Health
Service's Communicable Disease Center (CDC). During the year, it
was identified by the latter laboratory as a member of the Tacaribe
group of viruses, very closely related to an agent recovered from
rodents in the Everglades region of Florida and given the name
"Tamiami" virus by the CDC investigators. These viruses are mem-
bers of a larger group recovered in Central and South America and
associated with hemorrhagic disease in humans. In South America
these viruses apparently have no arthropod vector and are trans-
mitted by direct contact with rodent urine or other excretions. The

18 ANNUAL REPORT, 1967

public health significance of the newly identified Florida members
of this group of viruses is under investigation.

California Encephalitis Epidemiology
The continued absence of St. Louis encephalitis (SLE) virus
in the Tampa Bay area has permitted the ERC team to concentrate
its efforts on a study of California encephalitis (CE) epidemiology.
During 1967, no CE human cases were detected; however, 72 CE
viruses were recovered, most of these from the freshwater Aedes
mosquitoes, A. alanticus and A. infirmatus. Both species have been
successfully experimentally infected in the laboratory, but so far
attempts to demonstrate transmission of CE viruses by either of these
species to suckling mice have been unsuccessful. Sentinel rabbits
exposed to mosquito biting in the swamp study site were again in-
fected with CE viruses during the summer months of 1967. Mos-
quitoes attracted to and feeding on these rabbits were collected,
speciated, and examine for CE virus. Two such pools of A. atlanticus
mosquitoes collected in September were positive. Precipitin tests on
engorged mosquitoes, obtained from several different sites around
the swamp, confirmed the 1966 findings that A. infirmatus and A.
atlanticus feed more often on mammals than on birds. In a further
search for the specific vertebrate host of CE virus, two recoveries
were made from cotton rats. An effort to infect Blue Jays in the
laboratory with a CE virus, obtained from this same species of bird
elsewhere in the State, was unsuccessful.
Serologic typing done by the University of Pittsburgh demon-
strates two distinct strains of CE virus in Florida, described as "Key-
stone" and "Trivittatus." The present evidence suggests that each
may have a different epidemiologic cycle.

Surveillance Activities
Although 488 human cases were referred to the ERC for vital
diagnostic studies, no acute arbovirus infections were detected dur-
ing 1967. Fifty-one other viral infections were identified among these
individuals, including Coxsackie, adenovirus, mumps, herpes, simplex,
and respiratory viruses. No evidence of SLE virus activity was de-
tected in wild birds, sentinel chickens, or any other vertebrates
examined during the year. Approximately 600 migrant birds, passing
northward through the area in the spring, were collected and their
heart tissue inoculated into suckling mice. No arboviruses were re-

GENERAL ADMINISTRATION 19

covered. The routine surveillance for equine encephalitis resulted in
six investigations of illness in horses. No virologic or serologic evi-
dence of arbovirus infection was present. One Eastern encephalitis
virus isolate was made late in the year from a pheasant brain sub-
mitted by the Poultry Diagnostic Laboratory of the Department of
Agriculture in Dade City.
An intensive surveillance for SLE virus in Culex nigripalpus
mosquitoes was carried out during the summer months in conjunc-
tion with the County Mosquito Control Districts. Among 33,364
C. nigripalpus selected and tested, no viral isolations were obtained.
This was the fifth successive year in which no SLE virus was ob-
tained from mosquitoes in the Tampa Bay area.

Special Studies
Most of the activities in 1967 involved special studies. They are
listed here under the various sections of ERC which were principally
responsible for their completion.
The laboratory section evaluated the effect of protamine sulfate
in removing nonspecific inhibitors from various mammalian sera
employed in the HI test; developed a neutralization test for Key-
stone virus to be carried out by the microtechnic using BHK-21 cell
culture; evaluated the usefulness of filter paper discs for collecting
blood to be tested for arbovirus isolations and antibodies; assisted an
outside laboratory in the production and evaluation of arbovirus im-
mune sera produced in germ free animals; assisted the other sections
of ERC in carrying out laboratory infection experiments with CE
and SLE viruses.
The entomology section continued its intensive studies of the
biology of A. infirmatus and A. atlanticus mosquitoes in a freshwater
swamp. This included the ovarian dissection of 6349 mosquitoes,
processing and analyzing special collections from CDC lights traps
with dry ice, from Lumsden bait traps and Malaise traps; perform-
ance of a variety of experiments artificially infecting Aedes mos-
quitoes in the laboratory, either from in vitro or in vivo sources.
In conjunction with the Vero Beach Laboratory engorged mosquitoes
were tested to detect the source of their blood meal.
In the biology section, laboratory infection experiments were
performed, attempting to infect Blue Jays with SLE and Keystone

20 ANNUAL REPORT, 1967

virus; domestic rabbits were experimentally infected with Keystone
and trivittatus virus; a technic for the collection of wild marsh rab-
bits was developed and evaluated; wild marsh rabbits were experi-
mentally infected with Keystone and Sawgrass virus; special sentinel
animals, including hamsters and whitefooted deer mice, were evalu-
ated for the detection of arbovirus antibodies in natural settings;
special collections of migrant birds were processed for arboviral
isolations.
In the epidemiology section, a five-year follow-up of SLE cases
and matched controls was completed; a two-year study on cross
protection between dengue and SLE viruses in both humans and
laboratory mice was finished; special serologic studies were per-
formed on human sera searching for antibodies to group B arbo-
viruses, Venezuelan encephalitis (VE), and varicellaherpes zoster;
a study of sequelae to mumps meningoencephalitis was initiated.

Administrative Changes
The year 1967 was one of major administrative changes for the
Encephalitis Research Center in Tampa. The chief financial support
from NIH research grant was renewed for another five years. How-
ever, the state appropriation for encephalitis research was discon-
tinued, resulting in a 20 per cent reduction of staff and fiscal resources
of the ERC. Staff losses included the assistant epidemiologist, assist-
ant entomologist, chief serologist, and statistician. Added to the staff
on a temporary assignment was an epidemic intelligence service of-
ficer from the U. S. Public Health Service.

DIVISION OF HEALTH EDUCATION
VINCENT GRANELL, Ed.D.
Director (to February 1)
G. FLOYD BAKER, B.S., M.P.H.
Director (from February 1)
During the year numerous requests for programs and speakers
were filled for civic, service and professional groups. A continuing
close relationship was maintained with the State Department of Edu-
cation, State PTA, Florida Education Association, individual county
education offices, county PTAs, and local schools and PTAs where
time and personnel would permit.

GENERAL ADMINISTRATION 21

The position of health education consultant was vacant from Feb-
ruary to November. Since the employment of the health educator on
November 1, much of his time was spent in becoming familiar with
the general operations. Two trips were made to a county health de-
partment (CHD) to photograph its activities and prepare a slide
lecture for its use. A total of 127 slides was produced at the county's
expense. This was a successful pilot project which may be offered to
all CHDs in the future.
The division was given the responsibility of directing and co-
ordinating the activities of the 12th annual Health Project in Teacher
Education. There were 111 teachers from 29 counties enrolled at five
universities for the course. This was the greatest number of teachers
to participate in any single year. The State Board of Health (SBH)
and the State Department of Education jointly sponsor the project
with the universities.
Orientation programs were conducted by the division in January,
March and May. These covered all phases of SBH and CHD public
health activities. Personnel from the SBH, CHDs and health related
agencies attended. The enrollment for each program was limited to
50 participants; every session was oversubscribed.
Assistance was given to all CHDs on requests for health education
activities. There were 17 health education positions in nine CHDs or
on local projects at the year's end. Among there there were five vacant
positions. Two part-time Neighborhood Youth Corps students on the
federal project were assigned to the division.
The medical library and the audio-visual library received a grant
of $8249 from the National Library of Medicine, U. S. Public Health
Service (USPHS). The funds are to be used for purchasing books,
journals, audio-visual materials, binding services, library and audio-
visual equipment to update and improve both facilities.
The division compiled and prepared the material submitted by
the SBH for a USPHS grant on aging. The grant is basically designed
to educate public school teachers in methods of teaching the subject of
aging to high school students. It is hoped that the grant will be ap-
proved during the coming year.

Medical Library
This facility lost its librarian in May and was without a cataloger
during September and October.

22 ANNUAL REPORT, 1967

A total of 1673 new books and bound journals was added bringing
the number of shelved volumes to 24,559, an increase of six per cent.
There were 356 unbound articles, publications and miscellaneous
reference materials added to the vertical file and 160 obsolete books
withdrawn from circulation.
The most extensive use of the library was made by the personnel
of the SBH and the CHDs. The number of loans made through the
Jacksonville Hospital Education Program was next. Local physicians,
nurses, lawyers and students were also among the regular borrowers.
A total of 2468 books was checked out with 1217 on indefinite
loan. Three hundred and twenty-four unbound articles were checked
out of the vertical file. There were 1766 daily loans made for use in
the library. Interlibrary loans totaled 105. There were 11,948 routings
of journals to SBH staff members. A number of bibliographies were
compiled, 2200 reference questions answered and 3200 photocopies
made. A new bulletin typewriter was purchased.

Audio-Visual Library
The circulation of motion pictures and other audio-visual aids
increased eight per cent to 13,139. The number of booking orders
processed reached 10,236 compared to 8164 in 1966. Audio-visual aids
were used a total of 27,286 times.
New booking equipment was purchased and a new system of
booking films was put into effect. At the end of the year booking of
films was on a current basis for the first time in several years. Films
were also being inspected when they were returned to the rack rather
than just before being shipped out as in the past. Other bureaus and
divisions paid for the purchase of three new film projectors.
On December 31, 619 motion picture titles were listed with 1563
prints available for distribution. There were 243 other aids in the in-
ventory. Nine prints of films were placed in the library on indefinite
loan by outside agencies. Bureaus and divisions of the SBH bought 88
prints through the library. Fifty films were obtained for previewing or
used in special training courses.
Two films were reported to have been shown on television to an
estimated audience of 25,000 people. Only two films were lost; these
were replaced by the borrowers. Damage and obsolescence caused the
removal of 12 motion pictures and 16 other types of aids.

GENERAL ADMINISTRATION 23

Pamphlets
There were 357,801 pamphlets distributed. Communicable dis-
eases, nutrition and safety were the subjects of greatest demand. Re-
quests for materials on the subjects of planned parenthood, smoking
and health and chronic diseases greatly increased.
A total of 540 persons inquired for materials. In addition 2519
other persons called in the division for health related information
and were directed to the appropriate office.
New pamphlets on the subject of child growth and development,
sanitation, safety, communicable diseases and nutrition were de-
veloped. Special packets of information were distributed for several
meetings attended by health and education workers. More than 70,000
pamphlets on the subject of planned parenthood were purchased with
Maternal and Child Health funds and distributed to CHDs.

Publications, Radio and Television
Twelve issues of Florida Health Notes were published with the
average press run increased to 21,500. Subjects included: water and air
pollution control; foods and nutritionists; the work of the clerk, public
health nurse and sanitarian; mosquito control and encephalitis; public
health in the 1890s; mobile home living; solid wastes; food surveillance
by laboratories; careers in public health; a memorial to T. E. Cato,
M.D., the late director of the Dade County Department of Public
Health; and a simplified annual report.
Printing specifications were written for Florida Health Notes and
27 other books, pamphlets, posters, fliers and folders, including the
Annual Report, which were commercially printed. Twelve other small
pamphlets were prepared for printing by SBH's duplicating depart-
ment. Nine trips were made to do research and take photographs for
Florida Health Notes and other publications. Photographic and con-
sultative services were supplied to bureaus and divisions of the SBH
and some CHDs.
Television spot announcements on air and water pollution were
produced and distributed in cooperation with a committee from the
administrative office. Special assistance was given to the Florida Com-
mittee on Smoking and Health in circulating a video taped half-hour
program on smoking to six educational television stations.

24 ANNUAL REPORT, 1967

The 12-month calendar of meetings and events of interest to
public health and a quarterly publication relating to personnel news
were produced and distributed to all bureaus and divisions as well as
CHDs and other health related agencies.

Exhibits and Illustrations
This section created over 50 pieces of display material and was
involved in a dozen exhibits at fairs and meetings which was a rela-
tively minor part of the workload. Many CHDs are producing effective
exhibits now with minimal assistance from this section.
The major portion of time, however, was spent on maps, charts
and other visuals. Work on layouts for reproductions or slides and
illustrations continued strong. Over 500 units were completed with
each including from one to 50 pieces of work.

DIVISION OF PERSONNEL
MILES T. DEAN, M.A.
Director

This division is responsible for the administration of the personnel
program of the State Board of Health (SBH). Among the routine
duties, changing little from year to year, are consultation with ad-
ministrative officers about personnel practices and staff development;
implementation of procedures for carrying out approved personnel
policies; participation in the preparation and administration of the
approved Classification and Compensation Plan; administration of the
leave regulations; maintainance of adequate personnel records on all
persons employed in the agency; continuation of contact with the
Florida Merit System regarding requests for certificates and reporting
on the selection of eligibles, promotions, salary advancements, salary
adjustments, demotions, transfers, dismissals, lay-offs and resignations;
provision of a service rating system; and preparation of state and
federal reports. Payroll operation, also a responsibility of this division,
includes the administration of leave accounting, the employee insur-
ance, retirement and Social Security programs, and the preparation of
the administrative payroll and distribution of warrants. The salary
portion of the Legislative Requesting and the Operational Budgets is
also prepared by this division.

GENERAL ADMINISTRATION 25

The total number of employees in the SBH declined slightly
during the past year. There was an increase in employment due to
the increase in turnover rate. Employments for the year reached 2001.

Turnover continues to be a substantial problem. Recruitment of
the entire spectrum of health workers continues to be very difficult and
it has been necessary for us to make appointments of a considerable
number of employees above the minimum salary range.

A program on Pre-retirement Planning was developed and pre-
sented throughout the state.

The State Legislature adopted a State-wide Personnel Program
which extends uniform classification, pay, attendance, and leave and
other personnel rules throughout state employment. There was an
adjustment in salary for most of the professional classes.

TABLE 2
EMPLOYEES IN THE FLORIDA STATE BOARD
OF HEALTH AND COUNTY HEALTH UNITS
AS OF DECEMBER 31, 1958-1967

Year State County Health Total
Departments Employees
1967......................... 822 2832 3654
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

Z
TABLE 3 Z

PERSONNEL IN ADMINISTRATIVE UNITS OF THE FLORIDA STATE BOARD OF HEALTH, C
(EXCLUDING COUNTY HEALTH DEPARTMENTS), BY CLASSIFICATIONS,
DECEMBER 31, 1967

rn
m
-0

-4

*o
O

Labora-
Publi Publitory Other Pro-
Physi- Public Public Sanitary Sani- Wkrs. fssional andAll
Administrative Unit Totals Health Health Enineers taran fesio ad Clerical Others
cAdministrative Unit cNurses nans Dents(Prof. and Technical
Tech.)

Grand Total........................ 822 30 10 57 24 22 194 123 295 67
Administration
Research........................... 18 1 2 5 9 1
State Health Offeer.................. 26 6 5 15
Registration & Drug Administration.... 4 2 2
Health Education ................... 15 7 6 2
Personnel.......................... 21 6 15
Nursing................. .......... 12 9 3
Encephalitis Research Center.......... 6 1 4 1
Adult Health & Chronic Diseases........ 20 3 2 5 10
Dental Health ........................ 15 10 2 3
Entomology
State and Regional Office............. 17 1 11 1 3 1
Research Center-Vero Beach......... 20 11 1 3 5
Anthropod Laboratory in West Florida. 11 7 2 2
Finance and Accounts
Fiscal .............................. 15 8 7
Purchasing and Property............ 8 2 5 1
Building and Facilities .............. 33 1 12 20
Laboratories
Central-Jacksonville................ 62 53 1 8
Miami.............................. 22 17 5
Orlando ............................ 11 10 1
Pensacola ........................ .. 9 7 1 1
Tallahassee ......................... 6 5 1
Tampa ............................. 24 21 2 1
West Palm Beach .................... 7 6 1
Epidemiology of St. Louis Encephalitis. 19 1 15 1 2

TABLE 3 (Continued)

Labora-
Public Public tory Other Pro-
Administrative Unit Totals Physi- Health Health Sanitary Sani- Wkrs. fessional and Clerical All
cians Dentists Nurses Engineers tarians (Prof. and Technical Others
Tech.)

Local Health Services
Bureau of Local Health Services....... 6 2 4
Sanitation....... ..................... 8 6 2
Nutrition ........................... 10 8 2
Civil Defense ....................... 3 2 1
Maternal and Child Health............. 82 7 32 10 1 10 19 3
Preventable Diseases ................ ..
Bureau of Preventable Diseases........ 11 3 1 1 6
Radiological and Occupational Health.. 12 1 5 4 2
Tuberculosis Control................. 24 2 9 5 8
Venereal Disease Control ............. 18 14 4
Veterinary Public Health............... 2 1 2
Vaccination Assistance Project......... 46 10 1 18 17
Sanitary Engineering and Air Pollution
Control................................. 81 23 3 13 5 27 10
Health Facilities and Services 1
Bureau of Health Facilities & Services.. 31 1 1 1 1 11 16
Vital Statistics 1 4
Bureau and Division of Vital Records ... 46 1 45
Statistics..................... .. 5 4 1
Data Processing ..................... 15 4 10 1

0
m
z
m

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TABLE 4
00
PERSONNEL IN COUNTY HEALTH UNITS, BY CLASSIFICATION
FLORIDA, DECEMBER 31, 1967

e
--< ad
-a -

COUNTY g 1 g
06 P a a $, .
md*D d ca
a ~~ aB aa 'e -U 03~4
Grand|TotalI I 22 12 7 |
___________ ______ __ gi 11 ___ a__ __ uF u2 __
Grand Total............. .. .... .. ...... .... ...... ...... .... 2832 112 17 854 21 367. 56 91 526 788

Alachua ................................................... 45 1 1 16 ...... 7 ...... 5 11
Baker..................................................... 5 ...... ...... 2 ...... 1 ...... ...... 1
Bay................. ................................... 18 1 ...... 8 ...... 4 ...... ...... 3
Bradford................................... ............... 8 1 ...... 3 ...... 1 ...... ...... 2
Brevard.................................................. 65 2 ...... 19 2 16 3 2 17
Broward..................................... 135 3 1 42 3 19 3 4 34
Calhoun................................................. 5 ...... ....... 1 2 ...... 1 ...... ...... 1
Charlotte.............................. ................... .. 16 1 ...... 6 ...... 3 ...... 1 4
Citrus ............. ...................................... 5 1 ...... 2 ...... 1 ...... ...... 1
Clay................................... ............. ...... 12 ...... ...... 7 ...... 2 ...... ...... 2
Collier......................................................... 11 ...... ...... 2 ...... 4 ...... ...... 4
Columbia .................. ............................... 12 1 ...... 3 ...... 4 ...... ...... 3
Dade..................................................... 434 47 3 171 5 57 20 25 74
D e Soto ........................................ ........... 6 ...... ...... 3 ...... 1 ...... ...... 2
Dixie. ................................................... .. 3 ...... ...... 1 ...... ....... 1
Duval ..................................................... 73 2 1 24 1 12 2 ...... 13
Escambia.................................... ............. 80 3 1 27 ...... 11 2 2 16
Flagler ................................................... 4 ...... ...... 2 ...... 1 ...... ...... 1
Franklin .................................................... 3 ..... ...... 1 ...... 1 ...... ...... 1
Gadsden..................................................... 13 1 ...... 5 ...... 3 ...... ...... 3
Gilchrist ............... ................... .................. 3 ...... ...... 2 ...... ...... ...... ...... 1
G lades ....... ........................ .................. 2 ...... ......... 1 ...... ...... 1
Gulf ....................................................... 5 ..... ...... 1 ...... 1 ...... ......
Hamilton ....................................................... ...1 ... ...... ...... ...... 1
Hardee ......7 3 1. ..................................................... 1 3 ...... 1 ...... ...... 1
H endry............................ ...................... 12 ...... ...... 4 ...... 1 ...... ...... 4
H ernando ............ .................. .................... 4 ...... ...... 2 ...... ...... ....... ...... 2
Highlands.............................................. .. .. .. 1 ..... 3 ....... ...... 2
HiBsborough ..................................... ...... 205 6 1 77 2 33 5 8 36
Holmes................ ... .................. 7 ...... ...... 3 ...... 1 ...... ...... 1

1 -
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1
1
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2
18
18

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z
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TABLE 4 (Continued)

COUNTY

Indian River ........................................
Jackson...................................................
Jefferson .................. ..........................
Lafayette................. .........................
Lake ...................................................
Lee....................... ...... ......................
Leon.................. .............................
Levy.................... .. .. .. .......... ......
Liberty ......................................... **** ..
Madison ...................................... ......
Manatee.............................. ........
Marion............................ .............. .
Martin .............................................
M onroe ................. ....... ............................
N assau .. ............ ... ... .........................
O kaloosa............ .......................................
Okeechobee............. ...........................
Orange. ............... .............................
Oseeola.................. ...........................
Palm Beach ................... .......................
Pasco................ .....................................
Pinellas.......................... ......................
Polk.... ...................................... .. ......
Putnam ................................. ......
St. Johns. ................... .......................
St. Luceie............. .........................
Santa R osa. ................................ ................
Sarasota............... ...........................
Seminole............. .... .. ...................
Sumter.... ......................................
Suw annee .. ........................ .. .................
Taylor ............... ........... :::.....
Union. .... .... ................... .....
Volusia ............................................. .
Wakulla ................... .......................
W alton .............. ..... .... .....................
Washington .........................................

A

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70

2
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1
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6
8
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9
4
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4
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4
1
18
2
21
2
28
12
3
2
4
2
11
3
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1
1
1
10
1
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1
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1

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1
1

1
1

3
8
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1

2

1
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8
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1

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1

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1
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2

4

2

2
3
1
1
4
9
11
2
1
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9
6
1
5
5
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3
30
2
41
22
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7
3
17
5
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TABLE 5
PERSONNEL IN THE AEDES AEGYPTI MOSQUITO ERADICATION PROGRAM, BY CLASSIFICATION
BY COUNTY, FLORIDA, DECEMBER 31, 1967

COUNTY io

." d 28 4 84

Total ................................................. .. 17 28 484
Brevard .................................................. 2 2
ward ......................... ...... .... ........ .. ..... .1 41
ade .......................................... 26 7 ...... ...... ...... ...... ......::: ...... i 2 23
Duval ................................................. 23 2 10 1
Eseambia ............................................ ..... 8 ............ ...... ...... ...... ...... ......8
Highland ................................................... 49 ...... ...... ...... ............ ............1 48
H i onsborough ............................................... 70 ...... ...... ...... ...... ...... ...... 2 3 65
Lee .......................................................21 1 20
an atee ................................................. 1 18
rion s.......... .... ........................... ....... ...... .. ..... .... ...... ............
Monroe ................................................... 35 ...... ...... ...... ...... ...... ... ......... 1 4
ara ionge ................................................... ...... ...... ...... ...... ...... ...... ...... .....
Palm Beach ................................................ 5 ...... ...... ...... ...... ...... ...... ...... i 4
Pinellas....................... 59 ........... ...... ...... ...... ...... ...... ...... 1 58
Polk ... .......................... . . . 93 ...... 1 92
St. Luc ie .. .. .... .......... .... .... .. ................. .7 ...... ...... ...... ...... 1 46
Sarasota .................................. 17 1 16
V usia ................. :... . . . . 7 . . . . . .

TABLE 6
EMPLOYMENT TERMINATIONS AND TURNOVER RATES BY CLASSIFICATION AND SALARY,
FLORIDA STATE BOARD OF HEALTH AND COUNTY HEALTH UNITS, 1967
(FULL-TIME EMPLOYEES ONLY)

SALARY

CLASSIFICATION Under 200- 300- 400- 500- 600- 700- 800- 900- 1000
Total 199 299 399 499 599 699 799 899 999 over

TERMINATIONS 1967

Total-All Employees.............................. 1732 17 221 1134 148 113 37 11 12 5 34
Physicians............... .................... 29 ................. ............ 1 28
Dentists .......................................... 17. 6 2 5 2 2
Sanitarians ........................................ 56 ...... ...... 6 32 13 5 .
Sanitar Enineers................................. 10 ...... ... .. .. ... i .....
Public health Nurses........................... .. 162 ...... .. .. 12 4 70 6
Laboratory Workers proff. and Techn.) ............... 65 ...... 19 27 7 7 5
Other professional andtechnical...................... 58 .... ...... 3 7 21 10 8 6 .2 1
Clerical .......................................... 241 1 109 121 8 2
All others........................................ 1094 16 93 965 20 ...

TURNOVER RATE*

Total-All Employees... ................ ......... 46.8 17.7 57.0 91.9 21.5 15.9 13.8 14.3 17.4 16.7 24.3
Physicians.................. ................... 26.1 ............ .. ......... ....... .......... 14.3 26.7
Dentists........................................... 77.3 ........... ..... ............ 66.7 66.7 166.7 100.0 33.3
Sanitarians ........................... .......... 8.9 ............ 9.2 12.4 6.6 5.5 14.3
Sanitary En eers........ ... ... ...... ..... .... .. 17.9 .. .. .83.3 ...... 9.1 ...... 16.7
Public health Nurses............................... 25 ... ... .. .. 200 0 56 1 17. 7
Laboratory Workers proff. and techn.)................ 21.7 ...... 42.2 35.5 12.7 17.6 13.5
Other professional andtechnical...................... 26.7 ............ 30.0 18.9 35.6 22.2 29.6 27.3 22.2 20.0
Clerical.......................................... 28.7 5.9 55.1 23.0 8.6 40.0 ...
All Others....... ............................... 122.6 20.3 65.5 175.1 18.0 ......

Per cent of full-time employees terminating by classification during 1967

32 ANNUAL REPORT, 1967

DIVISION OF PUBLIC HEALTH NURSING
ENID MATHISON, R.N., M.P.H.
Director
The division is responsible for providing leadership and consulta-
tion for professionally prepared people who render essential nursing
services for the implementation of public health programs and evalu-
ate nursing programs in local health departments.
An important function of the division is consultation and co-
ordination with other bureaus and divisions of the State Board of
Health (SBH) concerning programs and projects which require nurs-
ing services. Advance planning of such projects and consultation
during development greatly increase their chances for success.

All consultants except one have assigned districts of approxi-
mately eight counties. They interpret SBH policies as they relate to
nursing, discuss new trends in nursing programs and assist in the
evaluation of the overall nursing program in the counties in their
districts. Each consultant also has responsibility for some specialized
area such as rehabilitation nursing, maternal and child health, mental
retardation, or continuing education. Approximately 50 per cent of the
time is spent in the district and the remainder in specialty consulta-
tion in all parts of the State. The hospital nursing consultant has no
district, but works with hospitals statewide.
Nursing consultants made 253 visits to counties, assisting local
health departments in planning and evaluating their total nursing
programs, and emphasizing generalized family-centered service. The
hospital consultant made 81 visits to hospitals and nursing homes in
25 counties to certify them for participation in Medicare.

An excessive amount of consultant time has been required this
year in the Home Health Services Program. Six additional agencies
have received certification as providers of service, making a total of
63 in the State. Much time has been spent in surveying, re-surveying,
attempting to interpret new regulations released by the fiscal inter-
mediary and the Social Security Administration, and assisting the
agencies in doing cost and time studies to validate the cost of the
services rendered. Thirty-five agencies completed such studies in
1967. Consultants will be relieved of much of this detailed work by
the recent employment of additional clerical personnel in the office
of the Home Health Services.

GENERAL ADMINISTRATION 33

Table 7 shows the overall average of the cost and time of nursing
services for Florida agencies certified for Home Health Services.
The assistant director of the division assumes the major re-
sponsibility for promoting, organizing, planning and supervising semi-
nars, workshops, short courses, and continuing local inservice educa-
tion programs. A series of workshops for nurses who would be giving
more direct care to the sick under Medicare was conducted in several
areas in the State, because many of the nurses had not given direct
nursing care to the sick for several years. The programs included
theory, demonstration and practice of techniques and procedures. A
12 hour refresher course in maternity and infant care was held in
three areas of the North Central Florida Maternity and Infant Care
Project. The services of the maternal and infant care faculty of the
College of Nursing, University of Florida, Gainesville, were secured
to teach the courses.

Eleven newly employed nurses who had not had preparation or
experience in public health attended one of the five field teaching
centers for the eight weeks planned orientation program as a pre-
requisite to permanent appointment. These nurses were from smaller
counties where the local staff did not meet the criteria recommended
for teaching the course.

The Continuing Education Committee (CEC), composed of a
public health faculty member from a college of nursing, and directors,
supervisors and staff nurses from local health departments, met six
times. This CEC is an integral part of all the program planning done
by the division; it aids in preparation of materials for distribution and
designing of continuing education programs. The committee revised
the Public Health Nursing Manual, which includes Sections on general
information, personnel, education, planning and organization, record-
ing and reporting, procedures, and community resources and relation-
ships. It also set up criteria regarding personnel, program and re-
sources for local agencies which give the approved orientation course
to their own public health nurses who have not had preparation and
experience in public health. The CEC sponsored a meeting for public
health nursing faculty members from all the collegiate schools of
nursing and the directors of nursing in agencies used by the schools
for public health field experience.
Seven orientation programs, planned by the consultant in mental
retardation and conducted at the Sunland Training Centers in Gaines-

34 ANNUAL REPORT, 1967

ville and Orlando were attended by 170 public health and institutional
nurses, social workers, vocational counselors and educators. A brief
information period on maternal and child health and mental retarda-
tion, followed by a tour in the Center in Gainesville, brought together
150 teachers, student, professional and practical nurses and nurses in
graduate school programs.
The number of midwives licensed to practice continues to de-
crease each year; it dropped from 168 in 1966 to 148 this year. Only
two young women completed the training program, a prerequisite for
licensure, at the Marie Francis Maternity Home in Sanford. A definite
need for a midwife in a particular area is established by the local
health officer and private physicians before a trainee is accepted.
A small study has been initiated in a nearby county, entitled
"Investigation of Patient Characteristics who are referred to public
health nursing service and the determination of effectiveness of this
service." The study is divided into three phases. The first was a review
of hospital records (according to certain criteria) of all patients who
were discharged from the hospital in May and June. In Phase II (in
November) each patient was interviewed prior to discharge to de-
termine his apparent health status at the time, and the patient's phy-
sician was asked to provide a prognosis. Phase III will be completed
the eighth week after discharge by interviewing the same patients at
their homes to determine his health status at that time. The physician
will be asked if the progress of the patient has been as expected and
if he feels the patient's needs have been met since his discharge from
the hospital.
Classes with demonstrations and practice were conducted by the
rehabilitation nursing consultant in nursing homes in many areas of
the State. It appears that the majority of the homes are really making
an effort to improve the quality of care given patients. Educational
programs were conducted for public health nurses in local health de-
partments, and there was participation in seminars and workshops
jointly sponsored by the SBH and Florida Heart Association.

GENERAL ADMINISTRATION 35

TABLE 7
AVERAGE COST OF TIME REQUIRED FOR SELECTED
NURSING SERVICE, FLORIDA, 1967
Average Average Time
TYPE OP SERVICE BY AGENCY ACostge Ave(Mes
Home Visit-Maternal/Child/Adult Health Supv. $ 6.27 71 mins.
Home Visit-Disease and Disability 7.89 83 mins.
Office Visit-Maternal/Child/Adult Health Supv. 4.85 54 mins.
Office Visit-Disease and Disability 5.81 65 mins.
Clinic Session (3 day) 41.22 472 mins.
Nursing Home/Day Care Center Visit 12.93 149 mins.
Visit to School 16.14 188 mins.
Classes/Group Teaching 12.16 185 mins.

36 ANNUAL REPORT, 1967

BUREAU OF ADULT HEALTH AND
CHRONIC DISEASES
J. E. FULGHUM, M.D.
Director
The nature and extent of the problems of various chronic diseases
which present themselves as public health problems have continued
to be examined by the bureau. Education and training programs have
played a large part in the activities of the staff of the bureau. Progress
has been made in increasing the knowledge and awareness of the
public about chronic disease; active participation in coordinated ef-
forts has been successful in bringing to the physician an awareness and
appraisal of the newer methods of prevention, diagnosis, treatment
and rehabilitation of patients with chronic diseases. Health Profile
Screening to encourage early detection of disease has been emphasized
where such programs met the needs of a community.
The active ongoing programs within the bureau are programs in
aging, cancer, hearing aids act, heart disease, diabetes, prevention of
blindness and smoking and health.

Consultation Visits
During the year the staff of the bureau provided field consulta-
tion visits as follows: cancer, 34; diabetes, 39; hearing aids, 4; heart,
81; prevention of blindness, 50; smoking and health, 27; other special
projects, 30; with a combined total of 265 trips or other visits.

Relationship with Other Organizations and Agencies
The bureau is represented on the Florida Cancer Council, the
Florida Coordinating Council for Cardiovascular Diseases, the Ameri-
can Cancer Society, Florida Division, Inc., Public Health Cancer As-
sociation of America, Florida Committee on Smoking and Health,
Florida Diabetes Association, Florida Society for the Prevention of
Blindness, Florida Tuberculosis and Respiratory Diseases Association,
and Advisory Council on Hearing Aids. These activities contribute to
a good working relationship with the major voluntary health agencies
within the state.
A U.S. Public Health Service (USPHS) staff assignee, an oph-
thalmologist, was assigned to the Prevention of Blindness Program.

ADULT HEALTH AND CHRONIC DISEASES 37

Health Education
The bureau attempted to determine the level of knowledge con-
cerning coronary risk factors in three communities of widely different
social, educational and economic characteristics. There was little
difference in the level of knowledge of school children in the seventh
and twelfth grades. Men in civic clubs, to whom knowledge of coro-
nary risk factors should be most desirable, were least well informed.
The best informed were members of the women's clubs. The test
served as a stimulus to sensitize the group for a learning experience.
As a result of this testing program, a new health education tech-
nique has been developed, and is to be used in schools, women's clubs
and civic clubs. Packaged educational programs encompassing all the
bureau activities in the field of chronic diseases will be made available
to county health departments (CHD) as they are completed.

Osteoporosis Study
Many retirement communities in Florida have been plagued with
orthopedic problems related to severe osteoporosis. Some communities
seem to be spared to a limited extent so that the problem of osteo-
porosis seems to be much greater in some areas than in others.
A preliminary survey of nine retirement communities shows that
10 to 15 per cent of the residents can expect to have some disabling
fracture each year. In three communities, the leading causes of death
for 1966 and 1967, were complications from disabling fractures.
The number of asymptomatic fractures is not known and the de-
gree of asymptomatic osteoporosis in these communities has never
been determined. The survey shows that deafness, coronary heart
disease and broken bones are often found in the same person. As a
result of this survey, the bureau is making plans to investigate the
significance of these conditions in several retirement communities in
Florida.

AGING
Health problems of an aging population are well known and
identifiable. Responsibility for their health programs is vested in the
bureau. Close liaison is maintained with the Commission (official)
and Council (voluntary) on Aging and the Florida Medical Associa-
tion Committee on Aging. Health services for the aging are provided

38 ANNUAL REPORT, 1967

by the CHD as a part of the general health services which are avail-
able to the population at large.
Health education, preventative screening, early casefinding and
physical rehabilitation programs are desirable components of an active
program on aging and are planned for and implemented whenever
staff and time permit.
A survey of the states and territories has been made to determine
the extent of programs in aging as was conducted in state health de-
partments. Results of this survey have been compiled and are sub-
mitted for study.

Survey Results-States and Territories Programs on Aging
The results are as follows: 45 out of 49 or 92 per cent of the
states responded to the questionnaire. Fourteen states have organized
staffed programs on aging in the state health departments; 14 states
have plans for the health of the aging and a similar number have staffs
and budgets for implementation of aging programs; 30 states had
commissions on aging or similarly named authorities; 27 state health
departments having close liaison with commission on aging and were
represented on the commission membership. The programs for the
health of the aging in a majority of the states is a shared responsibility.

CANCER CONTROL PROGRAM
Malignant neoplasms or cancer continued in 1967 as the second
leading cause of death for Floridians. Deaths attributed to cancer in
Florida over the past decade rose from 5706 in 1956 to 10,779 in 1966.
In 1967, it is estimated that in Florida 11,350 persons will succumb to
cancer. The provisional death rate per 100,000 population for 1967 in
Florida was 189.3 and the national rate was 159.1. Both of these rates
reflect an increase over 1966.
Cancer mortality trends by anatomical sites remained relatively
the same for 1967 as they have for the past decade. In general most
sites reflect very little or a slight increase. The large increases in
cancer mortality rates are attributed to increases of the digestive and
the respiratory systems. Cancer of the lung represents the largest
growth in cancer mortality from a single anatomical site reflecting an
increase of 81 per cent in the past decade 1956-1966. It is the leading
cause of death due to cancer in the male population.

ADULT HEALTH AND CHRONIC DISEASES 39

A major factor for the increased rates of cancer mortality in
Florida, when compared to the national figures, may be attributed to
the older person. An estimate for the year 1965-1966 shows Florida's
increase in the 65 and older group to be 2.3 per cent while the U.S.
reflected a 1.7 per cent increase.

Tumor Clinics
The major expenditures and effort in the cancer control program
is directed to the support of the Florida tumor clinic system. The
bulwark of the clinic operation is provided at the community level
through the physician providing his professional services to the in-
digent cancer victim at no cost for the patient under 65. The hospital
provides its facilities, services and staff in support of the tumor clinic.
A diagnostic fee schedule is provided to the hospital for determining
costs for diagnostic studies, x-ray and radium rental costs to indigent
tumor clinic patients. Major assistance is provided by the Cancer
Control Program for the clinics through consultant services to the
clinic secretaries, registry clerks and tumor clinic directors. Approxi-
mately 47 per cent of the ancillary clinic personnel is provided by
the SBH.
The CHDs throughout the state provide invaluable assistance to
the tumor clinics. Many public health nurses serve the tumor patient
both in and out of the clinic. A major factor in the management of the
cancer patient is the "follow-up" or maintaining contact with the
patient. The public health nurse also provides nursing service for the
tumor patient as directed and ordered by the patient's physician.
During 1967 the CHDs admitted to cancer service 4394 persons, pro-
vided 18,231 field visits, and had 12,163 office visits with the cancer
patients.
The impact of medicare upon the tumor clinic patient load was
not as great as expected in the light of the large number of tumor
clinic patients 65 and older. There are 26 active tumor clinics presently
operating throughout the state. In 1967 the total patient visits were
33,268 for 25 reporting clinics (Table 8). The Tumor Clinic at Lee
Memorial Hospital, Ft. Myers, Florida, was closed June 1, 1967.

Cervical Cytology
The natural growth of the cervical cytology program continued
and currently there are 49 counties participating in the program. The

40 ANNUAL REPORT, 1967

value of the "Pap" smear technique is well established and these pro-
grams can expand on their own merit without much promotional
effort. Over the past three years the program has grown from 26
counties screening 11,362 women in 1965, to 49 counties screening
33,382 women in 1967. The suspicious and positive smears are re-
ferred to the tumor clinic for diagnosis, treatment and follow-up. Full
participation by all counties may easily come about in the near future,
funds and personnel permitting. Funds from the Cancer Control Pro-
gram, Maternal and Child Health (MCH) and the American Cancer
Society, Florida Division, support the program while many county
health officers have been able to obtain slide interpretations free,
through project grants or local monies.

Statistical Tabulating Center
The statistical tabulating center of the cancer control program
continued growing with 18 reporting hospital registries. The present
statistical storage banks have collected data since July, 1963, and now
contain 24,402 case histories. Within the next year, the number of
cancer abstracts will exceed 35,000 cases. Staff limitations presently
prevent the addition of other registries.

Quality control and continuous upgrading of the individual reg-
istry remains a major objective of the center. The ability of the center
to monitor the individual reporting registries and provide feed-back
information on an individual or collective basis is a great advantage
in the improvement of the individual registry. Local registry personnel
also receive some continuing educational benefits from this supervision
by the center. Annual follow-up listings continue to be provided to
the individual center on a monthly basis. This listing provides a
check for the local registry on their follow-up cases, and updates the
center's files. Currently, the center is maintaining a 96 per cent
follow-up on eligible cases.
Publication of an annual report is now an established part of the
center's program. A three-year survival report has been prepared,
and will be published in early 1968.
An increasing activity of the staff of the statistical tabulating
center is assisting many individual hospital registries from outside the
state of Florida with follow-up information. This year 520 individual
inquiries from 20 states were received requesting survival information
for their records.

ADULT HEALTH AND CHRONIC DISEASES 41

Tumor Clinic Secretaries Workshop
A Tumor Clinic Secretaries Workshop was held November 30.
This workshop is co-sponsored by the bureau, and the American
Cancer Society, Florida Division. The workshop included tumor clinic
secretaries and registry clerks from 17 of the 26 approved Florida
tumor clinics. Twenty-eight ladies attended representing 60 per cent
of the total number of secretaries and registry clerks. The workshop
is a vehicle for inservice training, the exchange of ideas between clinics
and an educational approach designed to bring clinic personnel up-
to-date.

1967 Southeastern States Cancer Seminar
The thirteenth bi-annual conference of the Southeastern States
Cancer Seminar was held in Miami Beach, April 28 and 29. This
seminar was co-sponsored by the American Cancer Society, Florida
Division, the Dade County Medical Society and the State Board of
Health (SBH). A total of 157 physicians attended, each earning nine
hours of credit in general practice.

Polk County-Pap Smear Information Survey
In late December 1966, an information survey was conducted in
liaison with the Polk CHD and the State Department of Public Wel-
fare. The results of that survey were compiled in early 1967. The in-
formation being sought was two-fold! Was the low socio-economic
population being reached by promotional efforts such as recently
conducted by the American Cancer Society? Did it motivate this female
populace of Polk County to obtain a Pap smear?
There were 265 questionnaires returned out of 513 mailed, or a
51.7 per cent response. The survey did indicate that of those respond-
ing, 78.8 per cent had some knowledge of the Pap smear and 53.5 per
cent claimed to have heard of it during the year the promotional
drive had been conducted. There was a strong indication that both
health and welfare departments were very influential in motivating
these women to participate in cytology programs.

Florida Cancer Council
Meetings of the Florida Cancer Council were held on May 12, in
Miami Beach, and November 18, in St. Petersburg. The council con-
tinues as a major coordinating body of cancer affairs in the state. It is

42 ANNUAL REPORT, 1967

jointly supported and sponsored by the American Cancer Society,
Florida Division and the SBH. Its members are from the Florida
Medical Association, Association of Florida Tumor Clinic Directors,
American College of Surgeons, American Cancer Society, Florida
Division, and the SBH.

TABLE 8
PATIENT VISITS, FLORIDA TUMOR CLINICS, 1967

Clinics 1967
Alachua General Hospital...................... 141
Bay County Tumor Clinic................. 33
Brevard County Tumor Clinic.................. **
Broward County Tumor Clinic................. 464
Duval Medical Center ........................ 4618
Escambia County Tumor Clinic................ 1268
Halifax District Hospital ...................... 193
Hollywood Memorial Hospital ................. 225
Jackson Memorial Hospital.................... 3270
Lee Memorial Hospita Tumor Clinic............
Lake County Tumor Clinic..................... 9
Manatee County Tumor Clinic................. 205
Marion County Tumor Clinic.................. 213
Mercy Hospital............................. 305
Mt. Sinai Hospital.......................... 1493
Orange Memorial Hospital..................... 2122
Pinellas County Tumor Clinic.................. 2967
Polk County Tumor Clinic ................... 1484
Sarasota County Tumor Clinic................. 243
St. Francis Hospital .......................... 562
St. Lucie County Tumor Clinic ................. 209
St. M ary's Hospital ........................... 830
St. Vincent's Hospital ......................... 2871
Tallahassee Memorial Hospital................. 1198
Tampa General Hospital........................ 3820
University of Florida......................... 3047
Variety Children's Hospital.................... 978
TOTALS............................... 33268
Tumor Clinic closed June 1967
** No reports

DIABETES CONTROL PROGRAM

Florida's popularity as a retirement area has caused an increas-
ingly steady rise in the state's median age with a corresponding in-
crease 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, 1967, it is estimated that 975
Florida residents died of diabetes during 1967.

In 1967, diabetes ranked as the tenth leading cause of death
among Florida residents. The average death rate per 100,000 popula-
tion rose from 13.0 between 1954 and 1956 to 15.7 between 1964 and
1966. This rise in the average death rate per 100,000 population when
compared by race and sex was found to have increased: in white
males from 11.6 to 14.6; in white females from 12.9 to 14.6; in non-

ADULT HEALTH AND CHRONIC DISEASES 43

white males from 10.6 to 11.8; and non-white females from 21.8 to
26.7. It is obvious that intensive research is needed to determine why
the average death rate from diabetes for the non-white female is higher
than the average for the entire state of Florida.
Diabetic retinitis ranks a close third as a cause for blindness
within the state. Only cataracts and glaucoma are greater causal fac-
tors for blindness at this time.
The diabetes control program was organized into three areas:
insulin distribution, casefinding, and education.

Insulin Distribution
The state appropriation for insulin to be distributed to the
medically indigent diabetics of the state was cut to $60,000 for 1968.
A total of 3757 medically indigent patients is now receiving all or
part of their insulin from state sources through the CHDs. The
average annual cost per patient under this program decreased from
$15.87 in 1966 to $14.12 in 1967, primarily due to the decrease in the
cost of insulin.
The insulin distribution program has local diabetes registries
which are used for follow-up, for relative case-finding programs and
as a reliable source of data for program evaluation.

Casefinding and Service to the Patient
Most cases of diabetes can be controlled by early and proper
treatment. This treatment is most effective among those cases which
are diagnosed at an early stage of this disease. All persons over the
age of 40 are encouraged to have periodic two-hour postprandial
blood sugar determinations. Testing of the non-white females should
begin at age 30 due to the peculiar early rise in death due to diabetes
among these women. All relatives of known diabetics should have
blood sugar determinations made annually because of the higher
incidence of the disease among this group.
Casefinding is primarily the responsibility of the CHD, with as-
sistance from the community and the SBH in the areas of consultation,
program planning and limited financial aid for conducting diabetic
surveys. Casefinding activities were reported in 53 counties throughout
the state. Well over 28,232 persons were screened in these screening

44 ANNUAL REPORT, 1967

programs during 1967, with approximately 1598 persons being referred
to their family physicians for diagnosis.
Casefinding activities have been primarily in three areas, offices
of private physicians, community diabetes screening programs and
relative testing programs.
An evaluation of the special screening program for women re-
ceiving ovulatory suppressant drugs under the MCH programs in
certain selected counties in Florida did not indicate an increased rate
of new cases. It is felt, however, that care should be exercised and
that this group should be watched closely for signs of abnormal sugar
tolerances. Monies have been made available to the migrant program
to provide hospitalization for the migrant. Newly found diabetics may
now be hospitalized for regulation under this program.
The three methods for determining blood sugar levels currently
being utilized now allow greater flexibility in casefinding and routine
patient care. The speed and ease of the Dextrostix method make it
extremely useful and popular in conducting mass screening programs.
The accuracy of these sticks has been found to be sufficient for
screening for both hyper and hypoglycemic conditions within the
general population.
Screening programs for diabetics is another method of conduct-
ing extensive public education. Large coordinated community diabetes
screening programs are being conducted during Diabetes Week,
health fairs and clinics at other times. Postprandial blood sugar deter-
minations, two hours after a test meal, is considered to be the
method of choice. Relative testing programs are the most productive;
the CHDs and communities are encouraged to conduct such screening
programs at regular intervals.

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

ADULT HEALTH AND CHRONIC DISEASES 45

cation. The purpose of the classes was to inform the nurses of the
latest techniques of screening and patient education and to review
symptoms, 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 dia-
betics, relatives of diabetics, friends of the diabetic, or have a genuine
interest in diabetes control.

Patient Education
A number of CHDs are carrying on fine programs involving
patient education. This can be achieved best by a coordinated pro-
gram co-sponsored by the CHD, the local medical society, and
the local society for diabetic laymen. This approach has been most
beneficial to the patients, their families and the physicians. The
standard pamphlets on diabetes continue to be distributed in consid-
erable numbers.

Other
An autoanalyzer was obtained from the U. S. Public Health
Service in 1967 by the Pinellas CHD to assist in the continuing
exploration of hypoglycemia and its treatment by this CHD. Blood
sugar screening is conducted through the County's Division of Chronic
Illness and Adult Health. Those individuals with elevated blood
sugar levels are referred to their family physicians for diagnosis
and treatment. Those with abnormally low levels are studied further.
This exploration is still in progress.
The Adult Health Maintenance Program being conducted by the
Dade CHD, limited to those persons living on South Miami Beach
who are over the age of 65, has referred some 370 suspects to their
private physicians for diagnosis and treatment. A total of 1492 was
tested with a referral rate of 24.8 per cent. After the tests the persons

46 ANNUAL REPORT, 1967

return for counseling with the physician in charge of the project
and, where needed, referral or diagnosis and treatment.
In 1967, the Diabetes Foundation of Florida leased a large van
type truck to the Broward CHD for use as a mobile detection center
for diabetes. This clinic is operated by a public health nurse in
various parts of the county, referring 246 of the 5002 persons tested
to their family physicians for diagnosis and treatment. This clinic
which began operation in March, was obtained to insure equal test-
ing opportunities would be afforded all of the residents of Broward
County and was the culmination of several years of meetings and
fund drives by the Diabetes Foundation of Florida. The cost of
operation has been borne by both the Foundation and the CHD.
The Manatee CHD has obtained laboratory equipment which
will allow its staff to conduct routine blood sugar screening of the
high risk groups. The effectiveness of this equipment for diabetes
screening is being tested to determine the feasibility of using it
where state laboratories are not readily available.

HEARING AID PROGRAM
In 1967 the Legislature passed Chapter 67-423 entitled, "Fitting
and Selling of Hearing Aids Act," which designated the SBH as the
agency to enforce this act. This bureau was made responsible for
its implementation.
The law requires all persons engaged in fitting and selling
hearing aids in Florida to register with the SBH and be issued a
Certificate of Registration (license) on or after January 1, 1968.
It has been estimated that there are about 350 individuals who
engage in fitting and selling hearing aids in Florida. The law further
provides for the annual renewal of this certificate or license.
At the close of 1967 all administrative procedures had been
developed and employed to issue the first certificates of registra-
tion to fit and sell hearing aids in Florida. Plans extending into 1968
for examination, apprenticeship training and registration, educational
activities, ethics and many others far reaching and ongoing pro-
visions of this act are under development. The intent of the law and
the challenge of this bureau is the protection of the public from im-
proper practices related to the fitting and selling of hearing aids.

ADULT HEALTH AND CHRONIC DISEASES 47

HEART DISEASE CONTROL PROGRAM
The overall objective of this program is the reduction of mor-
tality and morbidity from disease of the cardiovascular system. The
area of interest embraces developmental defects, infections, metabolic
disorders, immune mechanisms and atherosclerosis.
In 1967, the death rates per 100,000 population for the leading
causes of cardiovascular deaths were arteriosclerotic heart disease,
304.8; cerebrovascular disease, 119.5; hypertensive cardiovascular
disease, 25.7; general arteriosclerosis, 16.8; chronic rheumatic heart
disease, 9.0; congenital heart disease, 5.9; viral carditis, 2.1; and acute
rheumatic heart disease, 0.1. Hypertensive cardiovascular disease
and both chronic and acute rheumatic disease show a decrease.

Cooperation with other Agencies
Most of the accomplishments of this program are reached
through the cooperation of a variety of official and non-official
agencies. The Florida Medical Association, with the associated county
societies and the CHDs, are operating units through which these
goals are attained. The Florida Heart Association and the State
Department of Education are the most effective media for raising
the level of health information of the community. The Division of
Vocational Rehabilitation and the Florida Crippled Childrens Com-
mission have been very effective in the diagnosis and care of pa-
tients with congenital heart disease.
The problems of cardiovascular disease are attacked through four
types of activities: 1) education, 2) prevention, 3) early detection, and
4) prophylactic treatment.

Education
Great emphasis is placed on health education. The principle of
using test procedures to sensitize the individual for a learning ex-
perience has been tried in schools and civic clubs and has empha-
sized the relative ineffectiveness of previous health education activi-
ties and the improved value of the testing technique. In addition
to this technique, the program staff has contributed to the publication
of a health resources bulletin for the public school system, the cur-
riculum for a short course for nurses in the home care of the cardiac,
and has participated in the planning of the 10th Biennial Cardio-
vascular Seminar to be held in Miami in June, 1968.

48 ANNUAL REPORT, 1967

Prevention
The prevention of congenital heart disease depends upon selec-
tive breeding as exercised by the individual and the prevention of
virus infections and drug toxicity in the early stages of pregnancy.
The evidence today suggests that the early treatment of arterial
hypertension has, in fact, reduced the incidence of stroke and con-
gestive heart failure. The prophylactic treatment of rheumatic
fever patients has materially reduced the incidence of rheumatic
heart disease. The 1967 rheumatic fever death rate reached an all
time low of 0.1 per 100,000.

Early Detection
Congenital heart disease is detected by the pediatrician in his
private office or in health department well baby clinics. Those not
detected in the early months of life may be detected in the pre-
school examination. Rheumatic fever and rheumatic heart disease
usually attracts attention by the acute clinical symptoms of the
disease. The early detection of arteriosclerotic heart disease poses a
difficult problem because early signs of atherosclerosis are not recog-
nized until the acute clinical manifestations of an occluded vessel
produce recognizable symptoms. Because of the inability to diagnose
asymptomatic atherosclerosis, patients are considered to be in a high
risk category if they exhibit certain traits and habits known to be
associated with the disease. These traits and habits are used to
identify patients that should be referred to their physician for pro-
phylactic treatment. The heart disease control program attempts to
establish cardiovascular screening centers under the supervision of
CHDs. Only two counties have established screening centers to date.
Five others are in the process of doing so. Approval for the screen-
ing program has been obtained from the Florida Medical Associa-
tion, the Florida Society of Pathologists and the Florida Heart
Association. The early detection of arterial hypertension is part of
the cardiovascular screening program and is being done on a small
scale in several CHDs and one hypertension clinic has been estab-
lished in the Duval Medical Center.

Prophylactic Treatment
The prevention of secondary infections with Group A Hemolytic
Streptococcus to prevent recurrent rheumatic fever has been well
established in Florida and 1274 patients were receiving prophylactic

ADULT HEALTH AND CHRONIC DISEASES 49

penicillin through the SBH by December 31, 1967. The death rate
from acute rheumatic fever and chronic rheumatic heart disease
has continued to decline since this program was initiated in 1958.
Prophylactic treatment to prevent the acute clinical manifesta-
tions of atherosclerosis is being done by many clinicians in their
private offices over the state. Diet, exercise, the control of diabetes
and arterial hypertension and attempts to persuade patients to stop
cigarette smoking are considered essential by many physicians. Large
numbers of patients do not consult their physicians until the acute
attack demands medical attention. It is these asymptomatic high risk
people cardiovascular screening programs are designed to identify.

Treatment
General treatment of cardiovascular disease is not attempted by
the CHDs except in those areas where the public health nurses and
county health officer supervise treatment of indigent patients at the
request of private physicians. Attempts to treat large numbers of
patients with arterial hypertension is done only in clinics established
in larger medical centers. The need for clinics to treat arterial hyper-
tension in the medically indigent patient in rural areas seems to be
increasing as more and more physicians leave these areas for the city.
The surgical treatment for chronic rheumatic and congenital heart
disease is accomplished through the facilities of the Florida Crippled
Children Commission.

PREVENTION OF BLINDNESS PROGRAM

Glaucoma
The primary concern of the Prevention of Blindness Program has
been an on-going glaucoma screening project under the auspices
of the SBH and through a cooperative agreement with the USPHS.
This has been a particularly successful effort toward uncovering a
relatively common cause of preventable blindness. Glaucoma screen-
ing has special relevance in a state which realizes substantial gains
yearly in its older-aged population. It is the nature of chronic glau-
coma to occur insidiously in the over 40 age group and special em-
phasis is placed on educating the public in this regard. Glaucoma
screening is presently being conducted in five populous counties in
Florida.

50 ANNUAL REPORT, 1967

During 1967, 49,852 persons were screened bringing the five year
total to 149,717. Of this yearly total, 1385 (2.78%) were referred for
diagnostic evaluation. Follow-up of referred suspects is considered
excellent and only 4.4 per cent have been lost.

Summary (April, 1962-December, 1967)

1. Total screened, all ages ...........................149,717

2. Number referred to ophthalmologists for diagnosis .... 4231

3. New cases diagnosed glaucoma .......................... 1829

4. Cases diagnosed borderline ...................... 426

5. Diagnosed negative for glaucoma ................. 1465

6. Suspects being followed ......................... 324

7. Lost to follow-up:

a. Cannot locate ............................... 57

b. Uncooperative ............................... 109

c. Illness or Deceased ........................... 21

8. Number persons not able to read 20/40 ............ 21,490

TABLE 9
GLAUCOMA SCREENING PROGRAM,
FLORIDA, 1967

County and Age Persons Persons Per cent
Examined Referred Referred
TOTAL........................ 49,852 1385 2.8
COUNTY
Broward ...................... 8372 345 4.1
Duval ........................ 14,222 348 2.5
Pinellas...................... 12,819 421 3.3
Polk......................... 9624 195 2.0
Volusia ....................... 4815 76 1.6
AGE
Under35..................... 9563 77 .81
35-44 ........................ 7678 129 1.7
45-54......................... 8098 200 2.5
55-64 ......................... 9171 284 3.1
65-74......................... 11,109 500 4.5
75-84 .................. ..... 3814 174 4.6
85+................... ....... 419 21 5.0

Glaucoma detection with referral and follow-up makes an ideal
public health program. The screening procedures are easily per-
formed and inexpensive, and appropriate treatment usually halts

ADULT HEALTH AND CHRONIC DISEASES 51

further disability. Many other diseases of the eye will also be de-
tected and referred for corrective treatment. This is an example
of how screening for one disease may result in discovery of another.

School Visual Screening
The Prevention of Blindness Program is serving as consultant
to the Comprehensive Child Care Project of the Department of
Pediatrics, University of Miami (in cooperation with the Dade
CHD and the Children's Bureau of the U. S. Department of Health,
Education and Welfare). During the school year 1967-68, it is
anticipated that 10,000 children in 14 public schools will undergo
critical visual screening by technicians trained in the Department
of Ophthalmology, University of Miami. The facilities of the Bascom
Palmer Eye Institute are being utilized for referral and diagnostic
follow-up, as well as private eye specialists. A report of epidemiologic
relevance is anticipated. In the first two months of operation 2885
school children were screened. The facilities of the computing
center of the University of Miami will be utilized for detailed analysis
of the findings in this study, and special forms suitable for pro-
gramming have been prepared.

New Projects
A proposed study is currently underway to determine the efficacy
of utilizing the Mackay-Marg electronic applanation tonometer in
glaucoma screening, as compared with the Schiotz tonometer which
is presently used. Parameters of this comparison will include:
1. Mean differences in ocular tension per individuals, by age
group.
2. Incidence of false-negative readings due to Schiotz-Mackay-
Marg disparity.
3. Incidence of chronic open-angle glaucoma as determined by
electronic vs. Schiotz tonometery.

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
Association, SBH, Florida Heart Association, American Cancer Society,

52 ANNUAL REPORT, 1967

Florida Division, Florida Tuberculosis and Respiratory Disease Asso-
ciation 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
consultant services when requested. It does not in any way try to
supersede existing programs, active joint committees or duplicate
work being done by other groups.
The committee has been instrumental in the preparation and
distribution of much informational and educational material. One
of the publications most in demand is a pamphlet entitled "The
Logical Move" which is aimed at the adult smoker. Over 40,000
pamphlets have been distributed to physicians, CHDs, and hospitals.
Two other items, a Bibliography of Basic Materials on Smoking and
Health and a Teacher's Guide for fifth and sixth grades have been
reprinted and distributed throughout the schools.
The Florida Committee has assisted in youth workshops and has
been involved in presenting smoking facts and information to health
coordinators during pre-school workshops.
Another major activity of the smoking and health program has
been that of assisting in the organization of local councils, and in
some cases assisting with the plans for their local programs. Five new
local councils have been established and negotiations are underway
for the establishment of councils in other counties. The basic mem-
bership of the present 21 local interagency councils corresponds closely
to that of the state and national councils on smoking and health,
but is open to other interested community groups.
The local councils have had many programs, such as smoking
and health teacher and youth conferences, school assembly pro-
grams, fair exhibits, adult informational programs, establishment
of reference files in community and school libraries, programs over
educational television and preparation or distribution of spot an-
nouncements to commercial broadcast stations. These interagency
councils are most effective and by giving continued support and
effort to the smoking problem have greatly assisted in the total edu-
cational effort.

DENTAL HEALTH 53

BUREAU OF DENTAL HEALTH
FLOYD H. DeCAMP, D.D.S.
Director (to June)
DELMAR R. MILLER, D.D.S., M.P.H.
Director (from June)
The function of the bureau is to promote improvement in dental
health for all citizens of the state by carrying on programs designed
to increase dissemination of dental health educational information and
utilization of preventive and corrective dental services. Consultation on
each of these areas is provided to county health departments (CHD),
county school systems, colleges, universities, dental organizations, civic
groups, community action groups, parent-teacher organizations and to
other bureaus and divisions.

DENTAL PRECEPTORSHIP PROGRAM
This program was established in 1957 to enable CHDs to staff
their dental clinics. Dentists who participate must be approved by the
Florida State Board of Dentistry. Their work is supervised by a com-
mittee of local dentists, dentists from this bureau, and the directors of
CHDs in which they are employed. They are usually new graduates
not yet licensed. Preceptorship contracts are for one year but may be
extended for a second year under special circumstances.
Dental preceptees served in 12 counties during 1967. These were
Alachua, Broward, DeSoto, Charlotte, Collier, Flagler, Marion, Polk,
Putnam, Santa Rosa, Sarasota, and Volusia. In addition, a preceptee
served in the Jacksonville City Health Department. All attended a post-
graduate course for one week sponsored by the bureau.

DENTAL SCHOLARSHIP PROGRAM
The Dental Scholarship Law was amended in 1967 to provide for
only five dental scholarships each year with an annual stipend of $2000
for up to four years. Formerly, 10 scholarships having stipends of
$1000 per year were awarded annually. Each recipient is required to
practice in an "area of need" one year for each year of scholarship
received.
A total of 126 scholarships have been awarded since 1955, five of
which were declined prior to utilization. During the year, 33 scholar-

54 ANNUAL REPORT, 1967

ship students were attending 10 dental schools. Of these, six graduated
during the year and three discontinued use of scholarship.
Disposition of scholarship graduates to date:
Completed compensatory practice 23
Serving in "areas of need" 15
Repaid stipend in full 27
Repaying stipend 5
In military service 9
Florida licensed-obligated to repay 2
Obligated to repay-not qualified for
Florida licensure 4
85

DENTAL CLINICS
Counties served by full-time, licensed public health dentists were
Dade, Duval, Glades, Hendry, Highlands, Hillsborough, Jackson,
Liberty, Manatee, Orange, Palm Beach, Pinellas, St. Johns, and Semi-
nole. Of the two mobile dental clinics maintained by the bureau to
serve eligible schoolchildren in areas having few or no practicing
dentists, only one could be staffed during the year. More than 2100
patient visits were made to this mobile clinic. These patients received
1449 extractions, 995 fillings, 278 prophylaxes, and 228 topical fluoride
treatments.
A new dental clinic was activated in the Collier CHD and a clinic
was equipped in Columbia County. A mobile dental clinic was ob-
tained and began operating in the rural areas of Palm Beach County.
Stimulated by the support and interest of civic and professional groups,
many new areas requested and received consultative assistance from
the bureau regarding the possibilities of establishing dental clinics or
improving existing clinics.

FLUORIDATION
The bureau responded to a continuing flow of requests for in-
formation and assistance with matters relating to community water
fluoridation. Eau Gallie began fluoridation and North Miami Beach
completed the necessary arrangements to begin.
Forty-two cities and towns having an estimated population of
about 1,060,000 are now using water supplies with controlled fluorida-

DENTAL HEALTH 55

tion. Another 26 cities having an estimated population of nearly
310,000 are served by community water supplies having approximately
the correct amount of fluoride as a natural component. In all, a popu-
lation of some 1,370,000 are now receiving the benefits of fluoridation.

LACTOBACILLUS PROGRAM
The dental profession continued to utilize the Lactobacillus acido-
philus caries susceptibility testing service as an adjunct to preventive
dental practice during 1967. This service, made available to dentists
by the bureau in conjunction with the Bureau of Laboratories, pro-
vides a method of saliva analysis which may be used as an indicator
of the caries activity level of patients at any given time. Proper low
carbohydrate diets can then be prescribed to reduce tooth decay rates.

ORAL CANCER DIAGNOSIS PROJECT
The program was initiated in 1964, with grant support from the
U.S. Public Health Service. Because it has continued to receive
increasing support and participation by the dental profession, the
supporting grant was extended beyond the original three year period
to include all of 1967.
During the year, 874 oral cancer diagnostic kits were distributed.
Since the program began, 793 smears and 667 biopsies have been sub-
mitted. Nineteen of the smears and 38 biopsies were diagnosed as
malignant. All patients with malignant or premalignant lesions are
periodically followed up by the bureau, local dentists, and physicians.
Three orientation programs for participating dentists were held
during the year.

CONSULTATION SERVICE
Bureau staff members, including a dental hygienist, a health edu-
cator, and two public health dentists carried on a heavy schedule of
field visits during the year. In-service training programs for public
health nurses were conducted in two counties. Similar programs for
teachers were presented in many of the junior colleges as well as the
colleges and universities.
Staff members participated in preschool workshops sponsored by
the Florida State Department of Education in more than 30 counties
during August. Assistance in dental health education was provided to

56 ANNUAL REPORT, 1967

the Teachers Project in Health Education at five university centers
during the summer. Many consultation and demonstration services
were given to the dental programs of Migrant Projects, Headstart
Projects, Children and Youth Projects, Comprehensive Care Projects,
Maternal and Infant Care Projects, and other federally sponsored
health programs in the state. Included in these activities were more
than 2000 dental inspections and over 400 topical fluoride applications.
Courses on Public Health Dentistry were presented in the three schools
of dental hygiene in the state and more than 50,000 health education
pamphlets, leaflets, and informational sheets were distributed.

ENTOMOLOGY 57

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 anthropod research laboratories located in
Panama City, Vero Beach and Winter Haven; operation of the arthro-
pod identification laboratory and an encephalitis surveillance program;
and administration of the Pest Control Act.
The federally-supported A. aegypti Eradication Project continued
throughout the year. State contract funds expended in 1967 amounted
to $3,294,865.93. Other federal funds expended in Florida during 1967
amounted to $1,129,962; these funds were for federal personnel
services, rental of equipment, travel, supplies and insecticide. Total
funds for the year amounted to $4,424,827.98.

An average of 714 state personnel was employed on the project.
Operations, including inspection and treatment, were carried out in 20
counties. A total of 1,286,663 premises was inspected, and 1,283,243
were found negative. There were 1,264,000 premises treated. At the
end of the year there were 846 operational zones; 724 were reported to
be negative.

As of December 1967, the counties in the "Attack Phase" were:
DeSoto, Hardee, Highlands, Indian River, Martin, Polk and St. Lucie.
The counties in the "Surveillance Phase" were: Brevard, Charlotte,
Collier, Glades, Hillsborough (urban only), Hendry, Lee, Manatee,
Monroe, Okeechobee, Osceola, Pinellas and Sarasota.

ARTHROPOD CONTROL

General
Hendry County entered the state-aid program, on October 1, 1967,
making a total of 58 participating counties and mosquito districts.
Local funds budgeted for this fiscal year, ending September 30,
1967, totaled $6,548,685, an increase of $223,000 over the previous
year. The State II fund matching rate was 16.0 per cent during this
period.

58 ANNUAL REPORT, 1967

The 1967 legislature approved the usual appropriation of $3,-
300,000 for aid to counties and districts during the 1967-1969 bi-
ennium; however, beginning July 1, 1967, the budget commission
initiated withholding three per cent of all state budgets. If these funds
being withheld are not subsequently released, the $1,650,000 made
available on an annual basis, will be reduced to $1,600,500.

Pinellas County Mosquito Control was removed by law from the
county board of health, October 1, 1967, and placed under the board
of county commissioners.

Source Reduction Accomplishments
Diking-Work continued throughout the year in diking the
Tomoka Marsh in Volusia County. Unstable soil conditions have made
progress much slower than was originally anticipated.

The proposed construction of a 1500-acre impoundment in Lee
County, expected to have been started in 1967, has been delayed
until such time as the owner of a large tract of land within the
impoundment area grants the mosquito control district permission to
construct dikes and ditches on his property.

Hydraulic Dredging
Dredging operations were discontinued in Indian River County,
September 30, 1967, and the dredging equipment was subsequently
sold. This ends a 18-year era of hydraulic dredging by mosquito
districts-Volusia and Brevard Counties having disposed of their
dredges in recent years.

The following is a summary of the source reduction work accom-
plished during the year by counties and mosquito districts. Where
field costs are shown, the cost does not include capital investment in
equipment, depreciation or amortization, or supervision above the level
of field supervisor or foreman.

1966 1967
Machine Ditching and Maintenance
Number of counties participating ................. 34 37
Miles of ditches dug or maintained............... 460.82 446.61
Cubic yards earth excavated..................... 3,690,550 3,794,626
Total field cost ................................ $575,643 $625,185
Field cost per cubic yard........................ $0.156 $0.165

ENTOMOLOGY 59

Construction and Maintenance of Dikes
Number of counties participating ................. 5 5
Miles of dike constructed or rebuilt ............... 39.44 52.42
Cubic yards earth placed in dikes................ 740,300 956,566
Total field cost................................. $78,994 $86,600
Field cost per cubic yard ........................ $0.107 $0.091

Hydraulic Dredging
Number of counties participating.................. 1 1
Number of dredges operated ..................... 1 1
Acres mosquito breeding area filled ............... 27.3 42.2
Cubic yards earth fill placed ..................... 112,808 173,932
Field cost per cubic yard ........................ $0.269 $0.138

Deepening and Filling (Draglines and Bulldozers)
Number of counties participating ................. 3 2
Acres mosquito breeding area improved............ 67.03 74.48
Average labor cost per acre ...................... $74.37 $114.51
Sanitary Landfills
Number of counties operating landfills ............ 40 41
Total number of landfill sites operated ............ 160 175
Total field costs in all counties ................... $742,564 $864,028
Cubic yards of garbage disposed of............... 6,872,618 8,576,457
Total field costs per cubic yard.................. $0.108 $0.101

Temporary Control Measures

Seven counties and/or districts own one or more aircraft for
mosquito control purposes, and an additional six counties hired air-
craft, on a contract basis, to carry out control methods. Near the close
of the year, another district had purchased a new helicopter for in-
spection and treatment work, and another county was repairing an old
airplane with the expectation of using it in 1968.

Two serious accidents occurred in district-owned aircraft during
the year. In Volusia County, the Bell helicopter crashed during routine
larval inspection operations, killing both the pilot and an inspector. In
Lee County, a Piper PA-18 airplane crashed while larviciding an area,
killing the pilot.

Ground adulticiding work with thermal aerosol machines was
carried out in 53 of the 58 participating counties. The summary of
ground fogging operations includes direct field costs. In aircraft opera-
tions, the "cost per acre" has necessarily been omitted this year, due to
failure of one large district to show a breakdown of costs.

60 ANNUAL REPORT, 1967

1966 1967
Ground Fogging
Number of counties participating. ................ 53 53
Number of hours fog machines operated........... 49,253 48,363
Number of miles fogged......................... 329,532 324,912
Gallons of insecticidal formulation used ........... 2,511,679 2,538,641
Total field cost ..................... .......... $1,138,910 $1,176,602
Average cost per mile for fogging................. $3.46 $3.62

Aircraft Operations (Fogging)
Number of counties participating ................. 5 5
Gallons of insecticidal formulation applied......... 239,860 354,000
Acres treated...................... ............ 1,892,793 3,185,815
Gallons applied per acre (average) 0.1267 0.1111

Aircraft Operations (Spraying)
Number of counties participating.................. 6 8*
Gallons of spray formulation used ................ 234,424 195,245*
Acres treated ..................... ........... 730,856 259,872*
Average gallons applied per acre ................. 0.321 0.75*

Aircraft Operations (Larviciding)
Number of counties larviciding with paris green.... 5 8
Pounds of paris green granules applied............ 723,111 975,700
Number of acres treated ........................ 45,819 62,291
Pounds applied per acre (aver. 6% formulation).... 15.78 15.66

* Figures do not include Polk County, which failed to submit reports.

Dog Fly Control

Control of dog flies consists of inspections, and spraying the
marine grass deposits that are stranded on the bay shoreline with
DDT at approximately two-week intervals. Counties carrying out
these control measures are: Bay, Escambia, Franklin, Gulf, Okaloosa,
Santa Rosa, and Walton.

The following is a summary of the control work performed by
these seven counties:

1966 1967
Total miles of shoreline treated.................... 1,033 1,487
Gallons of DDT concentrate used.................. 6,563 6,084
Average labor cost per mile ........................ $8.68 $10.03
Number of man-hours labor required ............... 6,028 9,727

ENTOMOLOGY 61

'Engineering

The engineering section checked for accuracy all monthly prog-
ress reports from every county and district and maintained files which
are frequently referred to for information.

Solid waste problems required considerable time in investigations,
and the preparation of recommendations for improved methods of dis-
posal. County and district detailed work plan budgets were carefully
reviewed, and comments and recommendations made when deemed
appropriate. Visits were made throughout the state to check on the
progress of the program and to assist wherever possible in accomplish-
ing program objectives. Numerous reports have been prepared and
specifications prepared and/or reviewed for the purchase of insecti-
cides, materials, and heavy equipment.

Counties Participating and Local Fund Budgets

Counties participating in the State Arthropod Control program in
1967 and the amounts of local funds budgeted by these counties
and/or districts for the fiscal year October 1, 1966 through Septem-
ber 30, 1967 follow:

COUNTY
Alachua
Bay Co. Comm.
Bay (Gulf Dist.)
Bradford
Brevard
Broward
Charlotte
Citrus
Collier
Columbia
Dade
Duval (East)
Duval (Northeast)
Escambia
Flagler
Franklin
Gadsden
Gulf
Hardee
Hendry
Hernando

LOCAL
FUNDS
$ 74,753.00
112,000.00
58,850.68
17,273.67
486,756.90
97,665.00
65,000.00
148,167.34
264,862.80
14,500.00
261,186.00
116,056.12
193,369.00
140,942.00
15,232.00
15,000.00
18,246.58
55,060.80
4,000.00
6,700.00
17,404.77

COUNTY
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lake
Lee (County)
Lee (Ft. Myers Bch.)
Leon
Levy
Madison
Manatee
Marion
Martin
Monroe
Nassau
Okaloosa
Orange
Osceola
Palm Beach

LOCAL
FUNDS
$ 3,800.00
558,096.00
4,925.00
188,742.98
3,962.89
10,478.26
108,000.00
613,000.00
90,400.09
63,665.00
17,000.00
787.40
141,053.00
45,020.00
48,112.55
285,605.98
70,316.86
45,138.50
53,000.00
49,500.00
370,485.51

62 ANNUAL REPORT, 1967

Pasco (West) 103,465.00 Suwannee 18,751.00
Pinellas 854,768.00 Taylor 11,400.00
Polk 245,001.00 Volusia 868,064.55
Putnam 29,769.00 Wakulla 16,000.00
St. Johns 96,678.42 Walton 8,750.00
St. Lucie 191,252.83 Walton (South) 84,268.81
Santa Rosa 63,000.00 Washington 3,450.00
Sarasota 75,000.00
Seminole 80,000.00 TOTAL $6,548,684.69
Total Local Funds Budgeted................................. $6,548,685.00
Total State Funds Appropriated .............................. 1,600,500.00*

TOTAL FUNDS FOR ARTHROPOD CONTROL $8,149,185.00
Based on the anticipated appropriation after a 3 per cent reduction.

REGIONAL ENTOMOLOGISTS
There has been no change over the preceding year in the duties
and assignment location of regional entomologists. Enforcement of the
provisions of the Pest Control Act requires most of the time of the
Miami and Tampa-based entomologists, although the entomologists
based at Orlando and Panama City also devote time to this work.
(See Table 11 under Pest Control for activities.)

Assistance continues to be given counties and mosquito districts
in all phases of their program activities, including the preparation in
some instances, of monthly reports and annual budgets. Emphasis is
being given to upgrading the quality of sanitary landfills through in-
spections and recommendations for improvement.
The regional entomologist of the Jacksonville office participated
in the training programs for sanitarians by presenting entomological
information on arthropods, methods of control, and taking the trainees
on field trips to observe arthropod control programs in action.

A number of public health officials from foreign countries were
received during the year, and orientated concerning the Bureau of
Entomology's arthropod control program in conjunction with counties
and districts.
Meetings have been held with real estate developers, city and
county officials to discuss and advise them concerning existing, or
potential, problems regarding the control of insects affecting the
health and comfort of citizens in the particular area being discussed.

ENTOMOLOGY 63

The regional entomologist of the Jacksonville office continued, up-
on request, to calibrate airplanes and helicopters for applying the
correct dosage rates of paris green granules. Aircraft were calibrated
in Brevard, Volusia, Monroe, Pinellas, and Lee Counties. New plastic
trays were designed, and manufactured by contract, for this type of
work.

ARTHROPOD IDENTIFICATION LABORATORY
The laboratory identified 775,915 adult mosquitoes, by species
and numbers, captured in light traps which were run twice weekly
throughout the year in 49 counties. A publication "The Florida Salt
Marsh Mosquitogram," showing the number of female salt marsh
mosquitoes caught in 43 light traps located in 29 coastal counties, was
prepared and mailed weekly to mosquito districts and other interested
persons.
The laboratory also continued the identification and pooling of live
mosquitoes captured in CDC traps for virus isolations. A total of
96,807 mosquitoes obtained in 359 collections was identified, and
made up into 2475 pools by species. These pools were then sent to
the State Board of Health (SBH) virus laboratory in Jacksonville
where virus isolations by pools were done. This study makes possible
a surveillance of the level of arbovirus activity present in the state,
and yields useful information on viral vectors, and the seasonal and
geographical density of the different viruses and their hosts. Of the
2475 pools sent to the virus laboratory, only 485 pools had been
tested at the end of the year. The results of these arbovirus isolations
are shown in Table 10.
The amount of rainfall throughout the state was considerably
below average. The exceptionally dry year resulted in a low overall
mosquito population, with the exception of Culex mosquitoes, which
was the highest recorded since 1962. The circulation of encephalitis
virus in mosquitoes was also the lowest since the surveillance pro-
gram was started in 1964.

MIDGE STUDIES
During 1967, research on the ecology, life histories and classifica-
tion of the chironomid fauna of Florida, was continued under a Na-
tional Institutes of Health grant. Twenty-two collections from streams,
rivers, ponds, lakes and ditches were made, with a total of 2121 larvae

TABLE 10

ARTHROPOD-BORNE VIRUS ISOLATIONS FROM MOSQUITOES, FLORIDA,
JANUARY 1, 1967 THROUGH DECEMBER 14, 1967

COUNTIES WITH VIRUS ISOLATIONS

POSITIVE MOSQUITO SPECIES g a l

An. crueians................... ..................... 1(B) 1(B) 1(B) 3 168
M perturbans.............. ..................... 1(E) 1 145
A. atlanticus........................................ .1(E) 1(C) 2 28
A.taeniorhvnchus .................................. 1(C) 1 28
Cs. melanura ........... ............................ (E) 1(H) 1(E) 3 116
Total positive pools ................................. 1 1 1 2 1 1 1 1 1 10
Number of pools tested .............................. 33 11 39 70 27 33 61 131 5 485

Letters designate type of positive pool:
B = Bunyamwera Group
C = California Group
E = Eastern Encephalitis
H = Hart Park

ENTOMOLOGY 65

for rearing collected, and 409 adults emerging. Publications on the
results of this work are in preparation. In addition, about 75 adult
chironomids from emergence traps were identified for the Midge Re-
search station at Winter Haven, and several specimens of midge larvae
were also identified for water treatment plant operators.

PEST CONTROL
At the close of 1967, the bureau completed 20 years of uninter-
rupted service to the citizens of Florida and to the now multimillion
dollar pest control industry of this state by way of discharging its
duties and responsibilities under the Pest Control Act (see Table
11). Issuance of licenses and identification cards to firms engaged
in pest control, answering complaints, and carrying out an active in-
vestigative and enforcement program more than occupied the bureau's
minimal pest control task force.
Legislation affecting commercial pest control during 1967 was
surprisingly limited to an amendment increasing the identification
card fee from one dollar to two dollars. The lone amendment to the
Pest Control Regulations in 1967 greatly simplified identification card
application procedures which now include the filing of fingerprints
and a photograph by each applicant.
The number of regular licenses and identification cards issued
decreased, for the first time in many years, by 5.0 and 1.3 per cent,
respectively, under 1966. The number of investigations of property
owners' complaints, involving licensees, increased sharply 46.0 per
cent over 1966, while investigations of unlicensed operators climbed
18.4 per cent. The Pest Control Commission recorded 969 certificates
in force and good standing, 145 inactive certificates due to non-
payment of fees, and issued 39 new certificates during 1967.

ENTOMOLOGICAL RESEARCH CENTER
The 1967, program of research into the biology and vectoring
characteristics of mosquitoes continued along the same lines as last
year, i.e. the work was organized into the same eight major projects.

PROJECT 1: BITING CHARACTERISTICS
This is a long-term investigation of mosquito biting behavior. The
first phase is a search for host preferences by identifying the bloods

TABLE 11
SUMMARY OF PEST CONTROL REGISTRATION AND ENFORCEMENT, FLORIDA, 1963-67

Registration 1968 1964 1965 1966 1967

State Board of Health Licenses issued (4)........................ 311 329 888 872(3) 831
State Board of Health Change of Address Licenses issued........... 84 44 41 31 58
State Board of Health Licenses revoked (1)...................... 2 1 0 0 4
State Board of Health Licenses placed on probation (1)............ 0 3 2 2 1
Pest Control Certificates revoked, suspended or placed on probation*. 3 2 9 6
Employees' Identification Cards issued (4)....................... 3,391 3,588 3,910 4,965(3) 4,899
Employees' Change of Address Identification Cards Issued......... 160 237 283 179 180
Employees' Identification Cards revoked or stopped(l)............ 15 10 12 3 98
Employees' Identification Cards on probation(l).................. 2 2 2 1 29
Thermal-Aerosol Certificates of Authorization renewed(1) .......... 8 6 5 4 8

Enforcement

Homeowner complaints investigated.............................. 82(2) 83 92 87 127
Unlicensed illegal pest control operators investigated .............. 11 19 81 49 58
Warrants filed against unlicensed operators........................ 5 9 6 6 8
Letters of warning issued to unlicensed operators .................. 4 9 14 29 31
Enforcement miles traveled (Jacksonville office only)............... 17,107 18,608 19,427 27,137 33,130
"Notices of Inspection" citing violations issued ................... 138

(1) By Pest Control Commission of Florida.
(2) Corrected from 1963 annual report.
(3) Corrected from 1966 annual report.
(4) Licenses, identification cards and thermal-derosol certificates issued are based on 1966-67 licensing year. All other entries are
based on calendar year 1967.

ENTOMOLOGY 67

in wild-caught mosquitoes in three different types of land, hammocks
along salt marsh, orange grove, and fresh-water swamp and hammock.
Since this would be meaningless without knowing what warm-blooded
hosts are available and in what density, the collecting of blood-
engorged mosquitoes is routinely paralleled by a running census of all
birds and mammals. This study, by the end of the year, had 19 months
of record accumulated. Preliminary results have indicated the hosts
utilized by several different species of mosquitoes but complete analy-
sis must await more field work and the testing of all specimens still in
storage. A seasonal switch from bird to mammal feeding is already
demonstrated for the St. Louis Encephalitis (SLE) vector, Culex
nigripalpus, both in Vero Beach and in Tampa areas. This is a phe-
nomenon recently uncovered in the western states in their local SLE
vector, Culex tarsalis. In Florida it appears that the timing of this
switch over to mammals may have special epidemiological significance
as it apparently varies from year to year.
The actual or relative densities of warm-blooded vertebrates are
being determined in each study area on a monthly basis. Marked
seasonal changes in the population levels of several mammals and
birds have been characterized already. The numbers of certain species
vary widely in differing habitats, so that the same mosquito species
is certainly faced with a different array of available bloods in each
type of habitat.
Probably the most important 1967 contribution to methodology
was the development and successful use of a diurnal resting box to
collect engorged specimens of mosquitoes seldom taken in vehicle-
mounted aspirator collections, notably the vector Culiseta melanura.

PROJECT 2: POPULATION DYNAMICS
This is a study of the technology of measuring mosquito popula-
tions. The 1967 work fell into three categories, with accomplishments
as follows.
Field studies of collecting methods have further demonstrated
Aedes sollicitans, A. vexans, and Psorophora confinnis to be field
species relatively seldom occupying wooded habitats, while C. nigri-
palpus and A. infirmatus (vector of California virus) are primarily
woodland species. Aedes teniorhynchus, Florida's predominant mos-
quito annoyance, appears to be intermediate. Field species are more
attracted to light than woodland species. These and other findings of

68 ANNUAL REPORT, 1967

a completed three-year study were published in 1967. The laboratory
force on this project in 1967 completed the dissection work to further
analyse three years of collections by age, condition of ovary, and
mated state.
Studies were continued with "captive broods" of A. taeniorhynchus
in the outdoor 48-foot diameter cage. Such broods are always highly
synchronized, the thousands of mosquitoes in each experiment having
emerged all in less than four hours. Flight activity tended to increase
with age, but light-trap collections of females declined on days three
and four. In proportion to their numbers, males were more attracted
to light than females. Males were more active during twilight while
females were more active during the dark period next to twilight.
These "captive brood" studies add much to understanding collecting
in "wild" populations of mosquitoes.
In the field much of the 1967 effort went into preparing a leased
swamp west of Vero Beach for intensive studies of fresh-water mos-
quitoes, especially the disease vectors C. nigripalpus, Culiseta melanura,
and A. infirmatus.

PROJECT 3: DISPERSAL CHARACTERISTICS
Emphasis in the study of migration in A. taeniorhynchus is being
directed toward factors which determine whether migration will occur
in the first place. Evidence was gathered during the year that the
migratory urge in adults is related to larval factors, particularly crowd-
ing, as in migratory locusts, butterflies, etc. Equipment is being
built which will measure the migratory urge.
Radioactive yeast, prepared by fermenting dried yeast in the
presence of p32 as inorganic phosphate, was found to be an excellent
larval food to produce tagged C. nigripalpus for dispersal studies. At
the levels of radio-activity necessary for a lifetime marking in females
laying three egg rafts, no effect of radiation damage could be shown
in the hatching of eggs or the percent of p32 lost to oviposition. More-
over, the uptake of p32 from radio-active yeast was four times as
efficient as the direct uptake from inorganic phosphate. It was evidence
of radiation damage from the use of inorganic phosphate which led
to these studies.

PROJECT 4: COMPARATIVE BIOLOGY
Mosquito colonizing methods involving interspecificc stimulation"
have proved so effective in obtaining mated females of C. melanura

ENTOMOLOGY 69

that eventual establishment of laboratory colonies of this important
vector species is assured. From a colony of C. nigripalpus thus estab-
lished here, material has been sent to establish colonies at the West
Florida Arthropod Research Laboratory and at the Atlanta laboratories
of the U. S. Public Health Service (USPHS) Communicable Disease
Center.

Much progress was made in the sound recording of flight activity
periods in three species of twilight-active mosquitoes, viz. A. taeni-
orhynchus, C. nigripalpus, and C. pipiens quinquefasciatus. It is
hoped that this type of electronic actograph will be useful in learning
about spontaneous flights, i.e. flights not initiated by environmental
factors.

PROJECT 5: REPRODUCTION
Our main objective continues to be an explanation of the physio-
logical mechanisms underlying the ability of some female mosquitoes
to mature eggs without a blood meal (= autogeny). Histological
studies have revealed differences in the neurosecretory systems of
autogenous and anautogenous females as well as sugar-fed and blood-
fed adults. Investigations with the electron microscope have also pro-
vided valuable information for comparison with materials prepared
using conventional histological techniques.

Experiments with a strain of Culex pipiens pipiens demonstrated
that a high proportion of the females were refractory to biting when
pupae and newly emerged adults were exposed to low temperature
(150C) and short days (eight hours light). No decrease in biting
activity was detected when pupae and young adults were exposed
to combinations of high temperature (270C) and short day length or
low temperature and long day length (10 hours light). The results
of these experiments provide a basis for physiological experiments
intended to identify the mechanisms that inhibit biting under these
conditions.
The rate of egg maturation was determined for four species of
mosquitoes: At 270C, the rate of follicular growth was approximately
the same in A. sollicitans, A. aegypti, and C. nigripalpus. In both
anautogenous and autogenous A. taeniorhynchus an additional 24
hours was required for egg maturation. The rate of growth was tem-
perature dependent in all four species.

70 ANNUAL REPORT, 1967

PROJECT 6: GROWTH
The pupation rhythm in A. taeniorhynchus was proven in 1967 to
be a true endogenous (built-in and independent of environment) and
circadian (daily repeated) rhythm. The endogenous and circadian
nature of this rhythm assures that, regardless of temperature, food,
length of day, etc., pupation and consequently emergence will come
in pulses close to a day apart. This further assures the synchroni-
zation of adult populations which is prerequisite to migration. These
studies in 1967 also uncovered the rearing methods which will pro-
duce maximum synchrony of development, a desirable feature in
rearing mosquitoes for all kinds of experimental purposes. The vector
species C. nigripalpus was also shown to exhibit an endogenous, circa-
dian rhythm of pupation. Analysis of all rearing factors now enables
us to proceed with studies of these species knowing how to achieve
maximum similarities, in any direction, within experimental groups.
Larvae of 16 species of Florida mosquitoes have been successfully
reared on the same standard basic ration used for A. taeniorhynchus,
thus showing that the basic qualitative nutritional requirements of
different species of mosquitoes are similar. Of these 16 species, six
showed a distinct rhythm of pupation, similar to what was intensively
studied in A. taeniorhynchus, and 10 showed no synchrony of pupation
at all. Although much work has yet to be done, we believe the testing
for the existence of a pupation rhythm may serve eventually to dis-
tinguish those mosquito species which can migrate, given the proper
circumstances, from those which constitutionally cannot.

PROJECT 7: METABOLISM
This project, in 1967, continued its investigation of important
energy transformation, or metabolism, in the mosquito. Thus in its
study of sugar metabolism it was found that highly active enzymes
for oligosaccharides existed outside of the alimentary canal in mos-
quitoes and several other insects. This suggests that oxidation of such
sugars outside the "food tract" may be more common in insects than
heretofore suspected.
Synthesis of fats from sugars in mosquitoes preparing to hibernate
has long been known but there has been some question of the nature
of hibernating fat. It was found that neither temperature nor length
of day, factors affecting hibernation, had any effect on the composition
of triglyceride fatty acids, synthesized initially from sugar in the hiber-
nating mosquito, C. pipiens pipiens. In the course of these sugar

ENTOMOLOGY 71

studies, a new method for determination of fructose, in which glucose
and other aldohexoses do not interfere, and a direct, highly specific
method for the microdetermination of sucrose in the presence of a
large excess of other carbohydrates was developed. Such refinements
of techniques for the study of insect biochemistry have become a con-
tinuing contribution of this project.
It was also established in 1967 that in Florida's predominant
sandfly, Culicoides furens, as in many mosquitoes, the female can
synthesize fat from sugar while the male does not. Both sexes, again
as in mosquitoes, synthesize glycogen from sugar.

PROJECT 8: BIOLOGY OF LARVIVOROUS FISHES
The salt-marsh mosquito-eating fish Rivulus marmoratus proves
to be the only naturally self-fertilizing fish known. Its one-parent
eggs normally yield hermaphrodites, but if incubated the last few
days before hatching at or below 200C(=680F), primary males
are produced instead. Under conditions now being studied, sec-
ondary males may arise late in life from hermaphrodites which have
long produced the usual fertilized eggs. There are no females and
the roles of males are problematical. Daily temperature lows in pen-
insular Florida form a "plateau" throughout the warm season, keep-
ing water temperatures above 200C for most or all of the spawn-
ing season, thus disfavoring the production of primary males. This
strange fish may prove useful in controlling mosquitoes in small
catchments where one-parent propagation might adjust to area and
food abundance.
Research on Rivulus is being supplemented with a new program
of investigation into the biology of fresh-water larvivorous fishes.
Future concern will be also with fish preying on those flood-water
mosquitoes which are vectors of arbovirus diseases.

Other Activities
In addition to the eight basic projects, staff members of the
Entomological Research Center (ERC) were involved in 1967 in
other matters.
The ERC continues its involvement in the reconciliation of
mosquito control practices with conservation of natural resources.
The Director participated in a symposium on management of estu-
aries at Louisiana State University in July, and presented a paper

72 ANNUAL REPORT, 1967

entitled, "Managing Impounded Salt Marsh for Mosquito Control
and Estuarine Resource Conservation" which will be published. The
symposium was sponsored nation-wide by federal and private agencies
concerned. The ERC began an investigation aimed at learning how
to impound salt marsh for mosquito control without killing out black
mangrove, an important wildlife asset. The work is being done in
collaboration with the Indian River Mosquito Control District.
The ERC's research on the biology of the common salt-marsh
sandfly, Culicoides furens was resumed. A study of larval develop-
ment is in progress and also an investigation of the effects of diet
in regulating autogeny. Dietary information will be used to estab-
lish the best procedure for rearing larvae with a view to coloniza-
tion. The seasonal emergence of C. furens adults in the field is being
monitored. Newly emerged females from the field are continuously
collected and allowed to mature eggs in the laboratory in order to
study autogeny in the field populations.
A few years ago a new disease of mosquitoes, an iridescent
virus, was found on our marsh. Work is currently in progress to
investigate this disease, and in particular, its mode of transmission.
Those larvae showing advanced (visible) symptoms of infection al-
most always die before pupation and since infection rates of over
50 per cent have been produced in the laboratory, the disease may
prove of some interest as a means of control.
The SBH, in cooperation with the Florida Anti-Mosquito Asso-
ciation, sponsored a three-day training program on mosquitoes and
their control on November 6-8. Three of these programs have been
presented at the ERC during the past six years, and have provided
an excellent opportunity for direct contact between the ERC staff
and the directors and employees of the mosquito control districts.
Field trips, lectures, USPHS films, and laboratory instruction are
presented, dealing with the biology, medical importance, control,
and identification of mosquitoes. In addition to the Bureau of En-
tomology staff, directors of the control districts and a representative
of the National Communicable Disease Center in Atlanta assumed
a major role as instructors for the 77 students enrolled in this year's
program.

WEST FLORIDA ARTHROPOD RESEARCH LABORATORY
The function of this laboratory is to develop through research
effective control methods for insects of public health importance.

ENTOMOLOGY 73

The research program is divided into two sections, mosquito control
research and control of biting flies. The biting flies section also con-
ducts biological studies of some insects, especially the dog fly,
Stomoxys calcitrans.
Results of the research program are translated into practicable
recommendations which are distributed in memorandum form to all
arthropod control districts of Florida.

MOSQUITO CONTROL SECTION
Adulticide Studies
Studies of low volume aerial sprays of naled showed promise for
the control of adults of the salt-marsh mosquito, A. taenorhynchus,
and the encephalitis vector, C. nigripalpus, in tests simulating resi-
dential areas; but similar tests in wooded areas did not give satis-
factory results with the dosage and application techniques tried. It
is expected, however, that considerable advancement will be made in
this study in 1968.
Comparative cage tests with ground aerosols for the control of
adult mosquitoes conducted on the same nights showed that a new
fog machine which produces an insecticidal aerosol without heat
gives the same degree of adult mosquito control as the thermal
aerosol generators now in general use throughout Florida.
In tests of new insecticides for the control of adult mosquitoes
by the use of ground thermal aerosol generators, Dursban at two and
one-half weight ounces per gallon gave 95 per cent kill of A.
taeniorhynchus (average of six tests) but only 70 per cent kill of
C. nigripalpus. Limited tests were conducted with Baygon, a carba-
mate insecticide. At a dosage of one weight ounce per gallon this
insecticide gave an average kill (three replications) of 98 per cent
for A. taeniorhynchus and 99 per cent for C. nigripalpus.
Laboratory testing of new insecticides as potential adulticides
was initiated in 1967 using a laboratory thermal aerosol generator.
In these preliminary tests, it was determined that a dosage of Bromo-
phos 10 times that of malathion was necessary to give satisfactory
control of adult A. taeniorhynchus.

Larvicide Tests
Laboratory larvicidal tests of several organo-tin impregnated
rubber compounds gave excellent control of A. taeniorhynchus and

74 ANNUAL REPORT, 1967

C. nigripalpus for periods up to 12 weeks. However, when these ma-
terials were placed in pans containing leaf trash in the field poor
results were obtained. No further testing of this material is planned.
Small plot field tests were conducted with two experimental
larvicidal materials, Chevron F-159 and CS-5913. Neither of the two
materials at the high dosages tested gave adequate control of larvae
within a period of 48 hours from the time the treatment was applied.
No further testing of these materials is contemplated.

Insecticide Resistance Studies
In a continuing program of surveillance of Florida mosquitoes
for insecticide resistance, seven species of mosquitoes from many
areas of the state were tested against malathion and naled using the
World Health Organization (WHO) larvicidal test procedures. No
new areas of resistance or no increase in degree of resistance was
noted with any of the mosquitoes tested. An increase in suscepti-
bility to malathion of A. taeniorhynchus from Sanibel Island in Lee
County was noted when compared to results obtained in 1966. An
increase in susceptibility was also noted in 1966 from the 1965
level initially determined. This may represent a gradual reversion to
susceptibility of the mosquitoes of this area which were determined
to be quite resistant in 1965.
Thermal aerosol tests conducted in the field and in the lab-
oratory in 1966 and 1967 showed that malathion was not as effective
against C. nigripalpus at eight weight ounces per gallon as it was
in similar tests conducted in 1963. Malathion continued to give good
results against A. taeniorhynchus in these tests; therefore, resistance
of C. nigrapalpus to malathion was suspected. WHO larvicidal tests
failed to confirm any resistance of this species, the LC0s for the
various years being .034 for 1964, .045 for 1966 and .030 for 1967.

C. nigripalpus were also collected from other areas of the
state and tested in the field against a thermal aerosol of malathion at
eight weight ounces per gallon. The results of these comparative
tests with laboratory colonies of A. taeniorhynchus and C. nigripalpus,
with C. nigripalpus from other areas of the state and with other
species of Culex mosquitoes showed that while A. taeniorhynchus and
C. quinquefasciatus remain highly susceptible to malathion, poor
results were obtained with all C. nigripalpus tested, irrespective of
their origin.

ENTOMOLOGY 75

BITING FLIES SECTION
Dog Fly Studies
The pattern of activity of the dog fly in West Florida during
1967 was similar to that of previous years, except that adult flies
appeared in numbers earlier in the season than is usual. A minor out-
break was reported at the community of Holley in Santa Rosa County
and on Santa Rosa Island during the latter part of May, and 23
flies were collected from a trap on the shore of North Bay, Bay
County, on May 29, an unusually early trap record. Fly activity was
at a very low level during June and July, following this minor flurry
of activity.
Since significant grass deposits were not observed on the bay
shores until June, it seems highly unlikely that the adult flies ob-
served during May could have been produced in new grass deposits.
It seems more likely that these early spring outbreaks originated
either from livestock operations or from overwintering flies. The pos-
sibility of flies overwintering in marine grass deposited late in the
previous season will be investigated.
The next significant fly activity occurred the week of August 6,
being observed on the bays and at fresh-water lakes up to approxi-
mately 20 miles north of St. Andrews Bay during that week. These
flies could easily have been produced in marine grass deposits, which
were plentiful in St. Andrews Bay at the end of June. Spraying of
this grass by local authorities in Bay County did not commence until
about the last week of July, therefore could not have been completed
before early August.
Some flies were observed on the Gulf beach in Walton County
August 4 and 5, and a few were seen at Panama City Beach August
14; however, the first general outbreak did not occur on the Panama
City Beaches until September 13. After this date, flies invaded the
Gulf beaches on northerly winds at periodic intervals through Oc-
tober.
Observations indicated that new grass deposits diminished
rapidly after October; however, owning to the unusually mild fall,
dog flies were still active late in December.

Breeding of Dog Flies in Marine Grasses
Personnel of this laboratory have found dog flies breeding in
marine grass deposits every year since the laboratory was estab-

76 ANNUAL REPORT, 1967

lished in 1964. During 1967 extensive breeding was found in grass
deposits along the Intra-coastal Waterway at West Bay, Florida, on
August 31, and at Goose Point in West Bay, Bay County, on Sep-
tember 11. Two emergence cages, each two feet by two feet, were
placed over the infested grass at the latter site on September 19,
and 59 adult dog flies were collected from these two cages between
that date and September 27.

Trapping of Dog Flies
As in the previous two years, a trapping program for adult dog
flies was conducted during the 1967 season, and, as in previous years,
the highest counts of flies were found on the shores of bays and at
Gulf beaches, the fly density at inland sites being the lowest by far.
Traps were inspected twice weekly, data being recorded as the
number of flies captured in the trap since the last inspection. In ad-
dition, a landing rate count was made at each trap site at each
inspection. Gulf beach traps averaged 12.5 flies per trap day and a
landing rate of 1.2 flies per count; bayshore traps averaged 3.2 flies
per trap day and 0.4 flies per landing count; whereas, traps located
at fresh-water lakes approximately 20 miles north of the bays only
averaged .04 flies per trap and .05 flies per count.
These data show either that the flies are more numerous or
more concentrated near the bays and Gulf beaches, but data of this
type appear to be useless for showing migrations or movement of
flies, assuming that such mass movements do occur. It appears that
release and recapture of marked flies will be required to demon-
strate the extent and rate of such movements.

Survey of Potential New Sources of Flies
During 1967, surveys of potential sources of dog flies were made
whenever personnel could be spared for this purpose. This work was
commenced in the spring in the farming areas of Washington, Oka-
loosa, and Santa Rosa Counties.
Crop residues were tentatively eliminated as a source as a
result of discussions with the agricultural agents. Peanuts are har-
vested by a different method than they were 25 years ago and no
litter piles result from modern methods of harvesting. Some winter
wheat is grown in these counties, but the straw is baled and used
or stabilizing loose soil of new road construction. Some crops are

ENTOMOLOGY 77

harvested green and put in silos. Fly breeding was not found in up-
right silos, but some trench-type silos were found breeding dog
flies in small numbers. These will be checked again at a different
season to see if their potential is important.
Concentrations of dog flies were found at several dairy farms
and chicken farms. It was estimated that one chicken farm had a
production potential of 127,000 dog flies when inspected, and ap-
proximately 75,000 dog flies were estimated in the wash waste from
one dairy. These breeding sites are located 40 to 50 miles north of
the Gulf beaches. A sanitary land fill was included in the survey, for
adult dog flies always seem to be present at these sites, but no pro-
duction was found.
Undoubtedly, many dog flies are produced by farming and live-
stock operations in West Florida as in other sections of the state,
but these areas are concentrated at considerable distances from
the dog fly trouble spots along the Gulf beaches. Another strange
aspect of this problem is that dog flies seem not to be a special
problem in the farming areas where this survey was made. It will
take much more study to determine the true role of farm-produced
flies in the Gulf beaches fly problem.
Surveys also were made in swamps, bays, and along streams in
the search for new breeding sites. Many specimens of plant material
were examined in the field but all proved negative for dog flies.
Materials examined were algae, sphagnum, fruits of the tupelo gum
tree and others. Flies were reared successfully in tupelo fruit and in
algae in the laboratory but not out of doors.

Tests of Residual Sprays on Marine Grasses
Small-plot tests of residual sprays on marine grasses, as de-
scribed in the 1966 report, were continued during 1967, there being
four replications of each treatment in randomized blocks.
Marlate (methoxychlor) and DDT were tested as emulsion
sprays at 774 and 387 milligrams per square foot of grass (DDT
at 774 milligrams per square foot is the standard treatment), Cygon
(dimethoate) was applied at 200 and 100, and Baygon at 100 milli-
grams.
These tests were commenced October 4, 1967. Owing to a
scarcity of fresh grass available for the plots at that time, all blocks

78 ANNUAL REPORT, 1967

were not started the same date. As of December 31, Block I had
been treated 87 days, Blocks II and III 77 days, and Block IV 66
days.
Both DDT and methoxychlor were still more than 95 per cent
effective as of December 31; Cygon was ineffective (less than 95
per cent control) in all blocks the first day after treatment, and Bay-
gon was effective for an average of 18.5 days, with a range of 6 to
31 days.
DDT and methoxychlor will be tried in large-scale field tests
during 1968 in the hope that a reduced dosage of DDT might be
recommended and that methoxychlor might prove to be an effec-
tive substitute for DDT.

Thermal Aerosol Tests
Baygon was tested as a ground thermal aerosol against caged
adult dog flies at rates of 1.0, 1.6, 2.0, and 3.2 weight ounces per
gallon. Methods were as described in previous reports. The only
effective dosage was 3.2 ounces per gallon, which gave an average
kill of 95 per cent with a range of 86 to 100 per cent. Average kills
of the three lower concentrations all were less than 90%.

Tests of Low Volume Aerial Sprays Against Caged Adult Dog Flies
Tests of low volume aerial sprays using naled (Dibrom) were
initiated during 1967 by exposing caged flies to various experi-
mental operations to determine the most effective swath, dosage,
and nozzle size. The airplane used was a Stearman PT-17 owned
by the SBH.
In early tests, technical naled, although effective at one to two
fluid ounces per acre, proved to be too corrosive on equipment.
This problem was solved later in the season by use of a concen-
trated formulation of naled in diesel oil which was developed at this
laboratory. Limited tests of this formulation applied at volumes of
four to eight fluid ounces per acre (.07 to .0875 pounds of naled
per acre) on swaths of 150 to 200 feet, gave 97 to 99 per cent control.

Tests of Insecticides Against Natural Populations of Dog Flies
Adult dog flies quickly invade Gulf resort beaches on northerly
winds and quickly vacate the beaches on southerly winds. When

ENTOMOLOGY 79

present, the flies often appear to be concentrated in a strip only a
few hundred feet wide near the water. Obviously this is the most
opportune time to apply insecticidal sprays for control. However,
the response of the flies to wind direction is so rapid that they
might invade the beaches in early morning and then be gone or
more widely dispersed within three to four hours as the wind direc-
tion reverses from north in the morning to south in the afternoon.
This is the usual wind pattern in this area of Florida in the fall. This
condition creates a serious problem for testing of insecticides, be-
cause flies too frequently are not present long enough to permit
proper evaluation of the treatment, both treated and untreated areas
being vacated by the flies at the same time. Also, winds of low
velocity seem to result in a wider distribution of flies, making the
infested area too extensive for practicable control procedures. But
there are occasional periods when moderate northerly winds will
persist for several days, causing the flies to remain on the beaches
and permitting evaluation of test results.
Two thermal fog tests were conducted during 1967, one in Wal-
ton County and one at Panama City. In the Walton County test, the
insecticidal fog was discharged at 40 gallons per hour, speed of
five miles per hour, using a formulation of 3/2 weight ounces of
naled per gallon of diesel oil. Unfortunately, the number of access
roads was not adequate to assure complete coverage and reduction
of the fly population was only 25 per cent when compared with pre-
treatment counts. Post-treatment counts were made the morning after
fogging. In the test at Panama City Beach, the same formulation
was applied at 80 gallons per hour, speed of 10 miles per hour. Caged
flies also were placed on the beach during this test. Results showed
99 per cent kill of the caged flies and 91 per cent reduction of the
natural population. Only the beach and two or three adjacent blocks
were treated, showing that with proper timing and adequate access
roads, fogging only the beach and adjacent streets can be effective.

Aerial spray tests also were attempted against natural popula-
tions of flies during the year. Low temperature at dawn, resulting in
no fly activity, and shifts in wind direction just prior to application,
causing flies to vacate the beach, caused cancellation of several of
these tests. In an effort to avoid these problems, a test was flown on
October 1, at noon; however, winds were too strong at this hour and
the spray did not come down well in the plot; only 26 per cent reduc-
tion of flies was obtained in this test. One additional test conducted

80 ANNUAL REPORT, 1967

in late afternoon using a total volume of 16 ounces per acre resulted
in good coverage of the beach area, as indicated by dye cards, and
many dead flies were observed on the beach sand. However, counts
the next day showed an increase of 55 per cent over pre-treatment
counts. It was concluded that more flies moved into the area before
post-treatment counts were made. This assumption was supported by
similar increase in flies in the untreated area.
Needless to say, much remains to be learned about the effective
use of aerial sprays for control of natural populations of dog flies on
Gulf resort beaches.

Sand Fly Studies
A large-scale test for the control of salt marsh sand fly larvae
(Culicoides) was established in the Woodlawn area of Panama City
during February, 1967. Panasol AN-5 emulsion was used at the rate
of 12 gallons per acre in a total volume of 400 gallons of dilute spray
per acre. The spray was applied by a boat-mounted hydraulic sprayer,
using two spraying systems Company Vee-Jet % U.-5050 nozzles fitted
on a "T" and attached to a boom to obtain a wide swath. This treat-
ment gave 90 per cent or more reduction of sand fly larvae for three
weeks. Samples collected the fourth week showed an increase in larvae
at several stations, while others continued to show 90 per cent reduc-
tion up to seven weeks, suggesting that spotty coverage might have
been a factor in the results.
Similar tests were made at Pretty Bayou and at Poston Bayou,
Panama City. Half the shoreline in each test was treated with Panasol
AN-5 at 20 gallons per acre and half with creosote oil emulsion at
12 gallons per acre; total volume was 400 gallons per acre.
Panasol reduced larval populations by 90 per cent or more for
three weeks and four weeks at Pretty Bayou and Poston Bayou, re-
spectively, whereas coal tar creosote gave 90 per cent control for 10
weeks at Pretty Bayou and six weeks at Poston.
During 1967, light traps were operated at three locations at
Panama City, for collection of adult sand flies. Similar collections were
made and reported in the 1965 and 1966 SHB Annual Reports. No
difference was shown in the seasonal occurrence of adult sand flies and
no new species were collected during 1967.
During the week of November 14-18, a survey was made of the
breeding sites of sand flies at Jupiter Island to determine the feasibility

ENTOMOLOGY 81

of using this area for a large-scale field test of the new larvicides.
Owing to certain physical features and recent treatments with dieldrin
by others, the area was found to be unsatisfactory as a test site.

WINTER HAVEN MIDGE RESEARCH LABORATORY
The year began the tenth year of operation of this facility. Re-
quests for information and assistance indicated continued interest in
what to do about overabundance of chironomid and chaoborid midges.

Biological Studies
Another year's data was collected on seasonal and annual emer-
gencies in two Winter Haven area lakes and larval numbers from
four lakes. Included were selected physical and chemical determina-
tions. This provides additional information necessary for further basic
biological and control studies. Laboratory rearing of Glyptotendipes
paripes continued in two constant temperature rooms. During the
summer a student trainee assisted with identification of biological
specimens. For the fourth school year, four high school students from
the Polk County Science Research Program attempted the rearing of
other species of midges.

Control Studies
A small room in the storage area, removed from the main laboratory,
was equipped with shelves and an aeration system as an aid in screen-
ing and evaluating insecticides. A simple hood was constructed for
safety in handling and formulation of materials. Air stones were not
found to accumulate the pesticides rapidly, allowing their use for
several tests before replacement. Aeration without the stones was not
found to influence the tests. Plate samplers were tried and found to be
an effective and simple means of handling larvae for tests. Preliminary
tests indicated the presence of algae reduced the effectiveness of
larvicides and will be considered in future studies. Laboratory tests
with a new larvicidal oil showed it to be effective in preventing
emergence and resting of adults on the water surface. Preliminary
field tests were not conclusive.
In order to have a uniform supply of test organisms, a colony of
Chironomus cars and one of Glyptotendipes paripes were started.
These were continuous cycle colonies 93 days old on December 31.

82 ANNUAL REPORT, 1967

BUREAU OF FINANCE AND ACCOUNTS
FRED B. RAGLAND, B.S.
Director
PAUL R. TIDWELL, B.B.A.
Assistant Director
The primary function of this bureau is to see that the business
and financial management responsibilities of the State Board of Health
(SBH) are met and carried out in accordance with appropriate state
and federal laws, rules and regulations. Modern business methods are
constantly reviewed to insure management of prompt, accurate and
meaningful financial data so necessary to the efficient provision of
public health services to the people of Florida. The sources of public
health funds are varied: state, federal, county and private. Each
source has its own set of rules and regulations governing the ad-
ministration and expenditure of the funds. The increasing complexity
of the financial requirements and reporting of results has required
constant revision in the accounting systems. This has been particularly
true in the area of federally financed special and research projects.
The bureau carries out its functions of budgeting, accounting, pur-
chasing, property control, duplicating services, mail, shipping, receiv-
ing, automobile control and assignment, and buildings and grounds
maintenance through the following sections: bureau director's office,
purchasing and property, buildings and facilities, and fiscal.
The fiscal year ended June 30, 1967 was the second year of the
1965-67 biennium for which the 1965 Legislature made state funds
available to the agency through the General Appropriations Act.
Generally, funds were appropriated to maintain programs at the
current level.
Program expenditures for the fiscal year ended June 30, 1967,
amounted to $35,500,000; this was $900,000 less than expended in the
previous fiscal year. The decrease is a net result of increases and
decreases in several major areas of expenditure. Primarily, increased
expenditures in federally financed special and research projects. The
major emphasis of these increased expenditures was in the maternity
and infant care program which was expanded to 16 additional coun-
ties. A new type of project for comprehensive health services for
children and youth was initiated in Dade County. Other expenditure
increases occurred in the general program of county health depart-
ments. The major expenditure item that decreased from last year was

FINANCE AND ACCOUNTS 83

hospitalization under the Medical Assistance to the Aged program.
This program was phased out after the initiation of Medicare. Fixed
capital outlay expenditures were considerably less than those of the
previous year.
Automobiles owned and operated by the SBH totaled 111 on
June 30, 1967. These vehicles were driven 2,533,304 miles during the
year. The agency also owned 33 trucks or special purpose vehicles
which were driven 276,908 miles during the year. Efficient use and
assignment of vehicles are constantly reviewed.
The bureau continues to strive to furnish the State Health Officer
and program directors with the best financial and business manage-
ment advice necessary for the efficient planning and performance of
public health services. Detailed comments on the year's activities by
bureau sections follows.
PURCHASING AND PROPERTY SECTION
During 1967, the Purchasing Department issued 4074 separate
purchase orders for supplies, equipment and services needed by the
various programs and activities of the SBH. The total dollar value
of orders issued exceeded $1,428,000 with purchases being made in
accordance with rules and regulations of the State Purchasing Com-
mission.
In addition to the normal operating needs of the agency, addi-
tional clinical and office furniture was purchased for the Tampa
Diagnostic and Evaluation Clinic and the North Central Florida
Maternity and Infant Care Project to further complete equipment
needs for each facility. County health departments (CHDs) normally
handle purchases locally within the organizational framework of the
CHD, however, their purchasing procedures must also conform to the
Florida Statutes governing purchase, such as obtaining bids and ad-
vertising for bids where required.
The offices of the Purchasing Department were moved during
1967 to a location adjacent to the Shipping and Receiving Depart-
ment. This has proved an advantage due to the close working
relationship between the two departments.
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

84 ANNUAL REPORT, 1967

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 compre-
hensive. 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 damage as well as
protection against damage or loss of the boats and motors. Other
major insurance coverages include: money and securities, broad form,
loss inside and outside of premises, public employees honesty blanket
position bond, workmen's compensation.
During 1967, claims amounting to $13,406 were settled by the
insurance company handling the agency's fleet automobile liability
policies. This total includes claims resulting from accidents during
prior years as well as 1967, which were settled during 1967, and
includes accidents involving vehicles on loan from the Federal Gov-
ernment for use in the Aedes aegypti Eradication Program as well as
SBH owned vehicles. Damages to SBH vehicles caused by others
were settled for $646. The agency, as self-insuror for.damages caused
by collision, paid $2906 for repairs. Payments of $748 were received
from the insurance company for losses included under comprehensive
coverage afforded by policies.

Property Control
The responsibility of this section is to see that capital outlay
items are assigned property numbers, maintain records, process an-
nual physical inventories for over 200 locations and handle fire in-
surance coverage on buildings and contents. During the year, 1305
pieces of equipment valued at $221,393 were added to the inventory.
A total of 156 property items valued at $22,373 was deleted from
the records.
Property values reflected by the SBH Plant Ledger as of June 30,
1967 were as follows:
Real Property............. .......... .................. $3,217,914
Land............................. ............ 144,000
Furniture and Equipment. .............................. 1,767,698
Automotive Equipment and Trailers ...................... 322, 88
Books and Film ....................................... 415,240

Total $5,867,140

FINANCE AND ACCOUNTS 85

Control of property and maintenance of records as required by
Florida Statutes continues to be a job of considerable magnitude, not
only because of the dollar increase, but as the SBH continues to
grow and departments acquire new quarters, property records must
be adjusted for accountability and insurance purposes.
The importance of accurate maintenance and control of property
is continually stressed within the agency to insure that the records
reflect the current status of all property owned by the agency.

BUILDINGS AND FACILITIES SECTION
Use of workers provided through the Neighborhood Youth Corps
(Office of Economic Opportunity program) was continued during the
year. Considerable turnover in the trainees assigned was experienced,
however, two of the three youths remaining throughout the period
improved sufficiently in education and skill to merit absorption into
the regular staff when vacancies occurred. The program continues
and trainees, when available, are used in most of the activities of this
section.

Some 800 work requests were processed, a reduction of 200 from
last year. However, man hours and fiscal expenditures were above
those of the previous year. Major electrical alterations were accom-
plished in the laboratory and the newly acquired property at 1214
Pearl Street, Jacksonville.
Building and equipment maintenance requirements have become
greater because of increased population within the limited area and
the increased age of the equipment.
The shipping and receiving activity was moved into more spacious
quarters at 1214 Pearl Street and it is expected that better service
will be provided in the immediate future. The workload includes
handling of a variety of materials and specimens processed to and
from the CHD's, branch laboratories, private physicians and tuber-
culosis hospitals.
The duplicating operations include addressograph, ditto, photo-
copy, mimeograph and offset machines. Contract printing is utilized
whenever the best interests and efficiency of the agency can be
provided. Many needs, however, are best provided by agency
equipment.

86 ANNUAL REPORT, 1967

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 financial
record keeping and preparation of required financial reports.

The financial transactions of the SBH for the fiscal year ended
June 30, 1967, as reflected by the records of the bureau, are pre-
sented in a condensed form at the end of this section. A detailed
financial report for the fiscal year ended June 30, 1967, has been
prepared 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, 1967, 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........

$ 9,582,559.25
10,784,919.81
4,472,702.70
8,537,753.38

3,723,424.41
71,866.75

$37,122,726.25

The expenditures by the SBH in summary, were for:

Personal services (salaries and other
personal services) ................... .
Contractual services (repairs, utilities,
travel expense, hospitalization) ..........
Commodities (office, medical, laboratory
and mosquito control supplies).........
Current charges, (rent, insurance, registrar
fees).................................
Capital outlay (equipment and fixed assets).
Grants to counties and mosquito districts..
Miscellaneous (education aids and
subsidies)............................

$19,868,176.71 55.9

10,397,070.15 29.3

1,675,035.29 4.7

1,137,674.57 3.2
867,098.64 2.4
1,502,985.67 4.2

82,229.91 .3

$35,530,270.94 100.0

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 activi-

25.8%
28.9
12.0
23.0

10.1
.2

100.0%

OJo

FINANCE AND ACCOUNTS 87

ties 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 192 depart-
mental budgets. These budgets were periodically revised as required.

SUMMARY OF RECEIPTS AND DISBURSEMENTS AND BALANCES FOR
THE FISCAL YEAR ENDED JUNE 30, 1967

RECEIPTS

FROM STATE APPROPRIATIONS
General Public Health:
Salaries................ ........................... .. $ 3,530,586.00
Other Personal Services ................................ 10,870.00
Expenses.............................................. 1,366,713.00
Operating Capital Outlay ................ .............. 71,746.00
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....................................... 176,035.00
Encephalitis Research and Control........................... 113,211.00
Mental Health Council .................................... 150,690.00
Hospital Services for the Indigent............................. 994,000.00
County Health Units .................................. .2,200,000.00

Total State Appropriations ................................ $10,468,851.00

FROM OTHER STATE SOURCES..........................$ 3,078.25

FROM FEDERAL GRANTS-IN-AID
Public Health Services:
Categorical Grants ...................................... $ 1,540,000.00
Cuban Health Services ................................... 1,215,749.50
Children's Bureau:
Maternal and Child Health............................... 1,716,953.20

Total Federal Grants-in-Aid ..........................$ 4,472,702.70

FROM GRANTS AND DONATIONS........................$ 8,537,753.833

FROM LOCAL AGENCIES FOR COUNTY HEALTH UNITS $10,734,919.81

88 ANNUAL REPORT, 1967

FROM HOSPITAL SERVICES FOR THE INDIGENT
Local Sources....................... ...............$ 390,010.91
State Welfare Board..................................... 8,333,413.50

Total Hospital Services for the Indigent ................$ 8,723,424.41

FROM STATE AND FEDERAL FOR BUILDINGS .........$ 71,366.75

TOTAL RECEIPTS ................................$38,012,096.25

TRANSFERS
From General Public Health to Division of
Mental Health........................... $882,914.00
To Operating Capital Outlay for Purchase of
IBM Unit Record Equipment .............. 6,456.00

TOTAL TRANSFERS ............................$ 889,870.00
NET RECEIPTS....................................$37,122,726.25

BALANCE July 1, 1966, $4,783,728.74 (Less expired
appropriation of $1,530.93).................................. $ 4,782,197.81

TOTAL RECEIPTS AND BALANCES...................... $41,904,924.06

DISBURSEMENTS

OPERATING EXPENSES
Personal Services:
Salaries...................................... ....... $18,971,079.94
Other personal Services-Individual ......................... 689,390.44
Other Personal Services-Other............................ 207,706.33

Contractual Services:
Travel Expenses, including subsistence and lodging........... 1,661,287.71
Communication and transportation of things ................ 537,572.24
Utilities ..................... ............ ............. 222,558.26
Repairs and Maintenance ................................. 159,395.67
General printing and reproduction service ................... 133,453.63
Subsistence and support of persons ......................... 7,050,980.47
Other Contractural Services............................... 631,822.17

Commodities:
Bedding, clothing and other textile products................. 5,095.97
Building and construction materials and supplies.............. 4,537.35
Coal, fuel oil and other heating supplies ................... 7,878.88
Educational, medical, scientific and mosquito control materials
and supplies ........................................... 1,230,439.65
Maintenance materials and supplies ........................ 121,754.25
Motor fuel and lubricants............................... 64,139.56

	Front 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 maternal and child...
	Bureau of narcotics
	Bureau of research
	Bureau of sanitary engineering
	Bureau of vital statistics
	Articles by staff members

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