THE HEALTH SITUATION IN FLORIDA
Summary Report of a Study
THE AMERICAN PUBLIC HEALTH ASSOCIATION
January 1 to June 30, 1939
The field staff conducting the study of public health
administration in Florida presents this outline as a
summary of the larger report -- "The Health Situation
The summary contains those facts which are of general
interest and those recommendations which need public
sympathy and support. Certain detailed technical
phases, pertaining to specific services, are not in-
cluded in this short report.
1 9 3 9
thA 6I.I o2 09'1
* a .: a
The modern concept and progressive broadening of the public health pro-
gram are placing new demands on official health agencies. Fundamental
and radical changes in the health program must be accompanied by care-
ful and intensive study of the facilities for health administration,
federal, state, and local. Studies of health administration facilities
and inter-relationships are needed most urgently at the state level.
Realizing this need, the American Public Health Association has made
provision for comprehensive health studies in a few carefully selected
states.* To determine states for study and to provide general supervi-
sion and guidance in the conduct of the studies, the Committee on Ad-
ministrative Practice of the American Public Health Association appoint-
ed a subcommittee on State Health Studies. The selection of a state for
study is determined, first, by the invitation and its sponsorship; sec-
ond, by the need for a study; and third, by the possible utilization of
the findings and recommendations of the study. Florida was granted a
study because the subcommittee on State Health Studies believed the state
met these conditions and had sufficient leadership and general interest
to apply the expression of the report to the lives of the people.
THE HEALTH SITUATION IN FLORIDA is a report of the study of Florida's
state health administration which study was made at the request of the
State Health Officer and the Board of Health. The invitation was en-
dorsed and approved by the Florida Medical Association, the Florida Pub-
lic Health Association, the State Department of Public Instruction, the
State Planning Board, and the Florida Congress of Parents and Teachers.
A field survey staff of the American Public Health Association was de-
tailed to Florida to conduct the study, at no cost to the state.
In Florida the study has had the help and cooperation of the State-Wide
Public Health Committee.** Some twelve hundred prominent and public
spirited citizens compose the voluntary membership of this committee.
*The Florida and other studies of state health administration have been
made possible by a grant from the Commonwealth Fund to the American
Public Health Association.
**The pages following this foreword give a list of the membership of the
State-Wide Public Health Committee and a map showing its organization
The committee has stimulated an interest in and a more universal under-
standing of the importance of the public health movement in Florida.
Some of the findings of the study, relating to the health needs, pro-
loms and facilities of the state, wore presented to the membership of
this Stato-Wide Public Health Committee at a series of meetings held
in Jacksonville, Pensacola, Tallahassee, Orlando, Tampa, Fort Myers,
West Palm Beach and Miami. It was emphasized that if there were to be
a progressive development of public health activities to meet the needs
of the state and control its problems, the committee must be organized
on a continuing active basis.
After all, public health in Florida is for the people of Florida, and
its fullest utilization requires understanding and cooperation from
those whom it serves. Health leadership and organization are truly
effective when people realize the need of group and community action
and the application in every day life of the known facts concerning
the prevention of needless suffering and premature death, and the so-
cial and economic waste of preventable disease.
The findings of the survey will improve the health of the citizens of
Florida only in so far as major recommendations are enthusiastically
accepted by health officials and public leaders and are merged into an
active program. The effective use of the report, its searching analy-
ses and its recommendations, will depend upon the progressive interest
and activity of the State-Wide Public Health Committee in presenting
the facts to the people of Florida.
The field staff gratefully acknowledges the splendid help and untiring
efforts of the Stato-Wide Public Health Committee. The Committee and
the field staff wish to express their sincere appreciation of the splen-
did cooperation and assistance of the entire Florida State Board of
Health, the local health departments, the State Department of Public In-
struction, the State Planning Board, the State Board of Agriculture and
its Extension Service, the University of Florida, the state and local
medical societies, the state and local dental societies, the Florida
Public Health Association, the State Tuberculosis and Health Association,
the Florida Crippled Children's Commission, the State Congress of Pa-
rents and Teachers, the local Parent-Teacher Associations, the State
Tuberculosis Board, the State Welfare Board, the Florida Federation of
Women's Clubs, the state and local Chambers of Commerce, the Junior
Chambers of Commerce, the Florida Social Hygiene Council, the Women's
Field Army for the Control of Cancer, the United States Public Health
Service, the United States Children's Bureau, the American Legion and
its Auxiliary, the numborous civic luncheon clubs and fraternal organi-
zations, and all others who have so generously and willingly assisted
in the various phases of the study.
The purpose of the study was to consider the public health problems of
the state, to evaluate activities and facilities and to made recommenda-
tions for improving structural organization, opei'ation and inter-rela-
tions. The data and recommendations reveal the strengths and weaknesses
of health administration and indicate vulnerable points where the con-
centration of effort will produce the best results.
Without plan there is confusion of responsibility. Therefore, there is
an attempt to present the data in orderly fashion, to make the recommen-
dations as direct as possible, to enunciate duties and responsibilities,
so that the study may be a guide to plan progressively and well for the
health future of the people.
The study takes into account the financial ability of the state to im-
plement recommendations. It also recognizes the principle that public
health is a part of general government and must be so related to other
component governmental units as to preserve the balance of the whole.
FLORIDA STATE-WIDE PUBLIC HEALTH COMMITTEE
(As of July 1, Organization not yet completed.)
John P. Ingle, Sr., State Chairman, Jacksonville Mrs. Malcolm McClellan, Co-chairman, Jacksonville
Thomas E. Buckman, M.D.
Leigh, Robinson. M.D.
Mrs. John G. Kellum
Harold Colee Mrs. Thurston Roberts
Dan Redford W. C. Brooker
George C. Willings Charles B. Mabry, M.D.
Mrs. Willis M. Ball
Miss Verdie Selman
John S. Turberville, M D.
Marion T. Gaines, Dist. 1, Pensacola Celestino C. Vega, Jr., Dist. 5, Tampa
F. A. Rhodes, Dist. 2, Tallahassee J. G. Hoist, Dist. 6, Fort Myers
Clifford A. Payne, Dist. 3, Jacksonville A. J. Cleary, Dist. 7, Miami
Edward M. Newald, Dist. 4, Orlando
Marion T. Gaines, Chairman, Pensacola
Mrs. H. E. Norton, Co-chairman, Pensacola
Mrs. J. A. Seale, Chairman, Panama City
Thorne Lane, Co-chairman, Panama City
Dougherty, C. L.
Gray, Mrs. Vesta
Rushing, Mrs. Coy
Wiggins, Mrs. Myrtle
Adams, D. M. M.D.
Adams, Mrs. 6. M.
Appleberg, Mr. & Mrs.
Barrett, Mrs. E. A.
Baymiller, B. R.
Blackshear, W. J., M.D.
Blackshear, Mrs. W. J.
Boykin, Miss Delree
Brown. Prof. Merritt
Byrd, Mrs. W. O.
Chi ds, Rev. & Mrs. Porter
Coker, Dr. R. P.
Cooper, Mrs. W. H.
Davenport, C. D.
Fraser, D. S.. M.D.
Guy, Mrs. Mary
Hardy, Prof. & Mrs. A. L.
' Hardy, Prof. H. L.
Harrison, Prof. Billy
Hawkins, Mrs. M. B.
Henderson, Mrs. O. E.
Hobbs, Mrs. W. B.
Hodges, Mrs. F. P.
James, D. B.
Jinks, Mrs. Guy
Johnson, Mrs. W. C.
Jones, Major (Salvation
Lisenby, A. H. M. D.
Luster, Mrs. U. L.
McDaniel, Rev. E. D.
McKinnon, Miss Christian
Martin, Miss Katherine
Mathis, Mrs. C. R. Sr.,
Mizell, H. N.
Mootes, Mrs. Felix
Moore, Mrs. V. V.
Nixon, J. M.,M D.
Nixon Mrs. J. M.
Polk, Mrs. J. D.
Pope, Mrs. J. D.
Porter, Mrs. Mary
Roberts, W. C., M.D.
Rogers, A. R.
Rowell, W. W.
Rowland, W. W.
Russ, C. P. (Mayor)
Russ, Mrs. Custer
Sapp, Mrs. H.
Sapp, Mrs. J. M.
Sawyer Miss Louise
Scott, Mrs. John
Sellers, Rev. James
Smith, J. A.
Still, Mrs. J. E.
Sutherland, Miss Velma
Words, Mrs. John
Williams, Mrs. S. A.
Wilson, Mrs. J. S.
Brown, Mrs. J. Will
J. W. Alfred, Chairman, Pensacola
Mrs. O. A. Lund, Co-chairman, Pensacola
Century Clubbs, Miss Occie
Abbott, Mrs. Charles Harvey, Louise
Turberville, Jno. S., M.D. Landram, W. E.
Taylor, Mrs. J. W. Lipscomb, Edward
Pensacola McAdom, Mrs. Sherry T.
Alsip, G. T. McCormick, J. H.
Atkinson, Miss Ethyle McSween, J. C. M. D.,
Barlow, Lyndae Miss Malone, Paul Mrs.
Blount, A. C. Webb, C. C.,MD.
Bryans, H. L. M.D.
L. H. Paul, M. D., Chairman, Bonifay
Mrs. Brooks Padgett, Co-chairman, Bnnifay
N. C. Brackin, Chairman, Crestview
Mrs. Bess Outlaw, Co-chairman, Crestview
Osborne, Judge Wilbur Crestview
SANTA ROSA COUNTY
P. M. Caro, Chairman, Milton
Mrs. Zena Elder, Co-chairman, Milton
Freeman, Mrs. Shelia Krentzman, Mr. Ike
A. Graham Campbell, Jr., Chairman, DeFuniak
Mrs. W. E. Bryant, Co-chairman, DeFuniak Sprgs.
Gillis, Mrs. A. Stuart Jennings, Mr. Melvin
M. S. Huggins, Chairman, Chipley
Mrs. O. G. Shivers, Co-chairman, Chipley
Chipley Carter, Mrs. G. W.
Bennett, Mrs. Fred T. McRae, L. D.
Blue, Neal Wells, Lee
F. A. Rhodes, Chairman, Tallahassee
Mrs. Fred Moor, Co-chairman, Tallahassee
Gainey, Mrs. J. C. Knight, Mariam B.
Apalachicola Oliver, Mrs. H. L.
Montgomery, Mrs. S. E. Sheip, Stanley
Rev. R. C. Holmes, Chairman,Quincy
Covington, Jack Weddes, Joe
Love, Mrs. Meade Wilhoit, Mrs. Alice C.
Port St. Joe
Kenney, Mrs. Basil
Berry, F. W., Jr.
Davidson, Mrs. Millard
Tapper, Mrs. Geo.
Watson, M. Ross
Hightower, W. B.
McKinnon, Mrs. D. A.
Rhyne, Mrs. Cecil
Carter, Robert Gordon
Conradi, Dr. Edward
Deahi, Mrs. U. S.
Gramling, Mrs. Ralph W.
Kellum, Mrs. J. G.
Ashley, Mr. Gordon
Beggs, Mrs. Tom
Ezell, J. E.
Loughridge, Mrs. Earl
Moor, F. C, M.D.
Palmer, Henryl E., M.D.
Rhodes, B. M M. D.
Rosenberg, Mrs. Sam
Thorpe, Mrs. A. L.
Trocy, Miss Anna M.
Weaver, R. H.
McConts, L. A.
Westberry, H. J.
McGouley, F. L.
TAYLOR COUNTY (Cont'd.)
Smith, S. E. Summers, Rev G. E.
Perry Swanson, T. J.
Bowman, Prof. C. J. Whiddon, W. S.
Buttler, Byron Judge Wilson, S. L.
Ca,licott, C. J. Salem
Clark, L. B. Holt, A J.
Courtney, J. W. Scanlon
Gibson, Carr Collins, Mrs. A. H.
Greene, Mrs R. J. Shady Grove
Hutchings, E. W. Lewis, G. C.
Huxford, Mrs. J. O. Jones, Mrs. J. P.
Kansinger, J. H. Morgan, J. Pasco
McCracken, Ben Steinhatchee
Maxwell, Mrs. M. A. Jeffords, Jessie
Sco'es, Mrs J. H. Webb, D. E.
Rehwincle, H. C.
Cli ord A. Payne, Chairman, 120 Julia Street
Mrs. Camille S. L'lngle, Co-chairman, 2755 Oak
Street, Jacksonville, Florida
Dean Walter J. Motherly, Chairman, Gainesville
Mrs. W. J. McCollum, Co-chairman, Gainesville
Archer Tigert, Dr. Jno. J.,
Jones, E. U. Warren, Mrs. Grace
Morper, Leo C. Zetrouer, Horace
Atwood Mrs. Rolin S. Johnson, Mrs. Frank
Beaty, Mrs. R. C. Thomas, J. Harry P,
Black, Dr. A. P. High Springs
Broyles, Mrs. J. MacQueen Donald
Conova, Mrs. F. A. McGrady, Mrs. H. Mcl
Conner, Mrs. F. W. Paul, Mrs. James
Eustler, Dr. R. B. LaCross
Griffith, Mrs. W. T. Pridgen, Leonard
Kraft, Fred Newberry
Maines, Jno. E., Jr., M.D. Hill, J.
Newell, Mrs. Wilmon Waldo
Pepper, Mrs. W. W. Ambrose, John P.
B. R. Burnsed, Chairman, Macclenny
Mrs. S. Fogelberg, Co-chairman, Glen St. Mary
Glen St. Mary Knabb, Mrs. Wm.
Burnsed, Mr. & Mrs. J. D. Milton, W. H.
Hurst, J. M. Platts, Mrs. Geo. F.
Kirsopp, Mrs. W. Wells, W. F.
Kline, Mrs. Chas. Olustee
Knabb Mrs. Leona Croft, J. S.
Sapp, Miss Ruth Stone, Mrs. Cora
Steele, E. L. Sanderson
Tabor, Geo. L. Jr., Burnett, John
Macclenny Dobson, Mrs. Joe
Dobson, Mrs. W. A. Harvey, J. I.
Gause, Miss Olive Taylor, E. V.
Rev. Frank Robinson, Chairman, Starke
Brooker Moore, J. H.
Dyol, T. D. Morrow, Prof. M. W.
Hazen, Mrs. Fred Wadsworth, G. P.
Hargraves, Mrs. Effle Warren, C. A.
Lewis, Eddie Lawtey
McGauley, Mrs. G. E. Carradine, Mrs. Pearl
Graham Edwards, Hal
Frazier, Mrs. C. J. Hill, Mrs. L. H.
Nimmo, Mrs, Ado Plummer, Mrs. M. B.
Roberts, Mrs. C. B. Storke
Wosdin, Riley Adkins, Mrs A. Z.
Hampton Alvarez, Mrs. J. M.
Harper, Mrs. C. E. Andrews, A. 0.
Home, Mrs. J. W. Beasley, Mrs. O. L.
Johns, Mrs. L. A. Burns, Mrs. Edward
May, Claude Carpenter, D. P. & Mrs:
Wm. Scruggs, Chairman, Monticello
Judge S. D. Clarke, Co-Chairman, Monticello
Mrs. George Y. Mills, Secretary, Monticello
BRADFORD COUNTY (Cont'd.)
Chapman, Mrs. L. F. Jones, Mrs. J. C.
Chaulker, Mrs Emma Nasworthy, C. H.
Connor, Lawton Middleton W. E., M.D
Darby, Mrs A. M. Parks, W. B.,M.D.
Davis, Mrs. Ellery Perryman, Judge E. K.
Davis, Mrs. L. A. Reddish D. P.
Duncan, Mrs. K. G. Ritch, Mrs. Evelyn
Green, Hon. Lex Smith, W. P.
Griffis, A. J. Struth, Elmo
Herlong. M. B., M.D. Thomas, A J.
Inman, George Vining, L. D.
Johns, Carl Williams, Prof. E. L.
Johns, Charley Yerkes, Rev. Fred '
Green Cove Springs Tilley, Mr. &. Mrs. R. L.
Smith, Slater Orange Park
Tarplee, Rev. C. C. Allen, Mrs Annie
R. B. Harkness, M.D., Chairman, Lake City
Mrs. J. R. Tomlinson, Co-chairman, Lake City
Burns, Mrs. J. P.
Milton, Mrs. Robert
Arnold L. J., Jr., M.D.
Bates, T. H., M.D.
Brown, E. F. M.D.
Black, Mrs. A. K.
Branner, Judge Brantley
Brown, Mrs. Annie
Durenberger, Miss Ruth
Groover, B. H.
Hackney Walter, Sr.
Halstead, Rev. W. T.
Ho mes, 0. K.
Witt, Mrs. C. E.
Young, Fred H.
Kinny, Mrs. L. L.
Cross City Feagle, W. B.
Anderson J. M .D. Redding, Ben
Campbel., Mrs. Myrtle Shamrock
Coke Crosby, J. E.
Kenneth A. Merriell, Chairman, Jacksonville
Mrs. G. Emmett Batey, Co-chairman, Jacksonville
Howell, Mrs. Leo
Beard, Judge James
Johnson, V. C.
Arnold W. D.
Bail, Mrs. David
Bayes, Harry H.
Bal, W. M.
Barker, Mr.& Mrs. R. D.
Barton, Quinn R.
Bennett, Chas. E.
Blume, Geo. C.
Brown, Mr. & Mrs. W. T.
Bryan, Sarah Judge
Bryant, Mrs. Frank
Buchanan, J. C.
Buckman, Thomas E., M.D.
Butler, Sen. J. Turner
Carrison Mr. & Mrs.
Carswell, Mrs. Verdie
Cary, J. G.
Cheek, Leon T.
Clark, James B.
Clarkson, Dr. E. H.
Coleman, W. I
Croom, Mrs. Hardy
Daniels James T.
Drew, J. G.
Dixon, J. Eldon
Elliott, J. M.
Erskine Jas. M.
Font, Mr. & Mrs. Julian
Ferrara, J. D., M.D.
Fouraker, Mrs. N. B.
Goodrich, C. H.
Hall, B. K.
Harrell, John W.
Holcombe, J. H.
Howe, Phil G.
Inglis, Clifford T.
Ira, Gordon M. D.
Jacobs S S.S
Jones, Warren L.
Juhan, Bishop F. A.
Kyle, Mr. & Mrs. Allen
Kaplan, Rabbi Israel
Laney A. H
Larze(ere, L. J.
Lockhart, Rev. Malcolm W.
Leath, Mrs A. S., Jr
Lesher, Rev. E. B.
Lyons, Rev. D. A.
Mann, Harrison C.
MacDonell, Mrs. Vida
McGehee C. G.
Mabry, Charles, M. D.
Masters, Dr. C. J.
Mathews, John E.
Martin, E. L.
Marx, Cyril A.
Norris, Frank W.
Osborne H. Plant
Paulk, V/. K.
Perrin, Mr. & Mrs.
Phillips, Dr. W. Glenn
Powell Jefferson D.
Purcell, Mrs. Anna(JaxBch.)
Reed, Mrs. Richard
Ricker, C. B.
Roberts, Mrs. Thurston
Robinson, Dr. A. B.
Saucer, J. M.
Sampley, Julia May
Sanders, Gold V.
Shulenberger, Mrs. T. L.
Simons, Georg- Jr
Sirmans, Miss Pearl
Taylor, Mr. & Mrs. John
Taylor, R. P., Jr., D.D.S.
Vincient, Mrs. D. 0.
Voughn, E. R.
Wand, J. Ben
Wilson. Rev. George
Nickel, Mrs. Ivy
J. B. High, Chairman, Bunnell
Mrs. O. F. Alford, Co-chairman, Bunnell
Allen, Mrs. Geo Hoffman Father C.
Biddle, Geo Murray, Mrs. H. H.
Clegg, Harry Raulerson, Mrs. R. W.
Eisenbach, Hon H A: Rodgers, A. C.
Fuller, Mrs. M. B. Stricklond, M. C.
Henderson, J. A. Tolon, Christine Mrs.
Houck, J. F. Thompson, Alex
Hamilton, Bert Wadsworth, Louis
Hooper, Mrs. Ella Mae Wickline, George
A. F. Driskell, Chairman, Trenton
Mrs. Earl Miller, Co-chairman, Trenton
Trenton Henderson, Ruby E. (Mr.)
Hardee, S. B. Land, Miss Lucy
Jasper White Springs
Black, Graham Borrett, Mrs. John
Bland, Mrs. Horace Nalley, Joel
Harrell Rep. F. Bamberg Saunders, Mrs. Lillian
Reid, 1Harry T.
Mrs. Lewis Lamb, Chairman, Mayo
Breare, Mrs. George Hatfield, Mrs. Exie
Birchfield "r- 'rm M cClain, Mrs. Guy
Edwards, "': :.',-i Taylor, Mrs. Tom
Mrs. Emma Rutland, Chairman, Williston
Mrs. T. J. Stokes, Co-chairman, Bronson
Richardson, Miss Wilma
Meeks, J. L.
Waldron Rev. Ray
White, H. A.
Andrews, Mrs. George
Boothby, J. A.
Murphy, Mrs. Tim
Turner, J. W., M.D.
Davidson, Mrs. Fred
Young, Dr. J M.
Myers, Mrs. Jack
Turner, Mrs. Cherry
Mills, Mrs. Leo:a
Briton, Mrs. D. B.
Ennis, Mrs. W. J.
Gaines, Rev J. P.
Harney, Mrs. J. A.
Jackson, Mrs. G. G.
Mills, DrJ. M.
Smith, J. G.
Smith, Rev. Ray
Turner, S. L., M.D.
W. J. Deegon, Jr., Chairman, Fernandina
Rev. Wm. F. Dunkle, Jr., Co-chairman, Fernandina
Bryce, Mrs. Ruth
Bryce Mrs. Ellie I.
Fouraker, T. J.
Hodges, K. W.
Jones, Mrs. Ben
McArthur, A. H.
Stokes, Mrs. G. H.
Wel's, Mrs. T. B., Jr.
Epting, Prof. R V
Cochran, Mrs. N. L.
Ferreria, John T.
Fishier, H. W.
Green, M. B.
Hardee, Mrs. Noble
Herring, T. C.
Humphreys, D. G., M.D.
Ingram, Mrs. Elizabeth
Kelly, Dan Jr.,
LaViere, James C.
Merrow, S. R.
Millican, M. V.
Shave, Thos. J. Jr.,
Wolfe, G. R. D.D.S.
Wood, Rev. oDvid L.
Wooten, N. J.
Mathias, C. R.
Mathias, Mrs. Mable
Powell, Mrs. Ben
Haddock, P. B.
Stillwell, V. C.
Rev. E. Watkins Tayloe, Chairman, Palatka
Mrs. W. M. Dunson. Co-chairman, Welaka
Williams, J. Mart
Ford, Dr. J. C.
Williams, E. H.
Brantley Z., M D
Brown, W. E.
Brush, C. E.
Brown, Mrs. J. Emmett
Frazer, Mrs. Harry
Gale, Mrs. James
Hyde, C. H.
Merrill, Mrs. F. T.
Richard, Mrs. Clinton
Ryan, Mrs. C. H.
Tucker, Rev. Harry
Walton, Mrs. J. V.
Wolfenden, Mrs.H. Cary
Ye'vington, Mrs. Herbert
Keller, Norman W.
Dunson, Mrs. W. M.
McLeod, L. H.
ST. JOHNS COUNTY
Judge Charles Mathis, Chairman, St. Augustine
Miss Anna Heist, Co-chairman, St. Augustine
Hastings Frazier, Walter B.
Bailey, H. H. Griffith, 1. Bernie, M.D.
Hall, Mrs. Ansley Hawkins, Nina
Maltby, Mrs. Ansley Hamblen, Miss Evelyn
St. Augustine Lockwood, Mrs. E. A.
Butler, Col. H. L. Middleton S. C.
Cook, Helen Smith, C. S.
Davis, Mrs. J. P. Spencer, J. J,, M.D.
Devlin, E. I. Spengler, Col. J. H.
Dickman, Mrs. R. N. Veill, Mrs. Fred
Felkel, Mrs. Herbert Webb, Walter D., M. D.
B. W. Helvenston, Chairman, Live Oak
Helvenston, Mrs. B. W. Thompson, Thomas A.
Mueller, Mrs. Tsacios, Mike
John E. Mines, Ml D., Chairman, Lake Butler
Mrs. Annie Reichard, Co-chairman, Raiford
Driggers, Mrs. C. H. Strickland Mrs A. C
Geiger, Mrs. M. P. Williams, Mrs J. H.
Graham, Mrs. Non Raiford
King, Seeber, M.D. Conner, James
Mann, Mrs. J. M Shepherd, Rev. L. A.
McGill, DeWitt T. Worthington
Priester H F Dukes, Drew H.
Rivers, Mrs. C. F. Miller, Mrs. Albert H.
Scarborough, Mrs. J. H. Newbern, Mrs. C. D.
Edward M. Newald, Chairman, Orlando
Mrs. C. R. Whittaker, Co-chairman, Eustis
Lieut. Col. G. Thomsen von Colditz, Chairman,
McGinnis, Almeda C. Mullins, Mrs. J. F.
Wells, Mrs. Stanford J.
George L. Singletary, Chairman, Leesburg
Mrs. C. R. Whittaker, Co-chairman, Eustis
Bowman, S. H. Wilson, Rev. E. C.
Fleshman, Mrs. A. D. Mt. Dora
Harper, Mrs. H. R. Brown, Mrs. Chas. J.
Eustis Overhiser, Mrs. H. D.
Block, Arthur Pease, Mrs. J. D.
Crumley, Mrs. D. B. Tavares
Garvin, Mrs. H. B. Burleigh, E. I.
Harrison, Julius Duncan, Mrs. H. C.
Hartley, Mrs. L. W, Lehmann, Karl
Groveland Pace, M. C.
Mrs. George Myers Pearce, Mrs. C. M.
Howey Treadway, Chester B.
Taylor, Dodge Umatilla
Leesburg Browning, Mrs. Hughes
Edmunds, Mrs. H. Reed Embry, Mrs. Charles
Hanford, Mrs. George
Mrs. C. C. Simpson, Chairman, Ocala
Bennett, Mrs. C. C. Mayers, Mrs. J. B.
Cummings, Dr. R. C. Osborne, Mrs. E. A.
Dudley, George Ott, Mrs. Roy
Duval L. W. Rawlings, Mrs. Marjorie
English, Colin Kinnan
Ferguson, Bruce Russell, Dr. Ralph
Hampton, Mrs. H. M. Scott, Dr. Laurie
McKenzie, Rudy Skipper, Mrs. Lola
W. R. Wood, Chairman, Orlando
Lawrenc, Mrs. E. S. Tildon, Judge W. L.
Orlando Thornal, Campbell
Alexander, Mrs. H. R. Turner, Rev. A. Fred
Carrington, W. A. Turner, George E.
Clapp, Mrs. Eldridge Veasey, Mrs. H. N.
Comer,Wm. T. Voorhis, Mrs. H. M.
Guernsey, Hon. S. Kendrick Walker, Mrs Judson
Johnson, Dean Melville E. Way, S. Y.
King, Dr. W. F. Whitman, Mrs. A. B.
Lane, Mrs. W. M. Pinecastle
Lee, O. P.,M. D. Hall, Rev. O. G.
McLaughlin, Mrs. G. W. Strickland, W. E.
Maguire, Raymer F. Winter Park
Muzum, W. 0. Chose Joshua C.
Ricker, Mrs. H. L. Cole, Dr. Helen
Shitman, Mrs. A. B. Frink, Lays
Smith, Rev. E. Lee Hanna, Alfred J.
Dr. G. W. Hankins, Chairman, Kissimmee -
Kissimmee Crosby, Mrs. A. S
Mrs. J. Ingley, Chairman, Sanford
Chuloota Adams, Mrs. F. Ross
Wilson, Mrs. James Holly, Mrs. R. J.
Sanford Leffler, W. A.
Center Hill Webster
Lee, Mrs..Lily Bell McElyea, Mrs. S. D.
Hooks, Mrs. C. A. 1lie, Mrs. Ed.
Mrs. 8. B. Baggett, Chairman, Volusia County,
Mrs. Roland Stevens, Co-chairman, East Volusla
County, Daytona Beach
Mrs. Chester Strawn, Co-chairman, West Volusia
Daytona Beach Tatum, Mrs. Monso
Campbell, Mrs. C. E. New Smyrna
Donovan, Mrs. E. A. Pooser, Mrs. A. 1.
Dunn, Mrs. Blair Vaughn, Mrs. R. O.
Rose Mrs. J. R., Jr. Ormond Beach
Wells, Mrs. J. Ralston Camp, Mrs. Victor
DeLand Stevens, Miss Jessie
Allen, Mrs. W. S. Port Orange
Carson, Mrs J. Prentice Sparkman, Mrs. R. D.
Celestino C. Vega, Jr., Chairman, Tampa
Mrs. J. Austin Williams, Co-chairman, St. Petersburg
Mrs. M. Sand, Co-chairman, Bartow
Mrs. C. A. Miller, Chairman, Crystal River
W. C. Scofield, Co-chairman, Inverness
Crystal River -Moon, W. B., M.D.
Mrs. Bess N. Hull, Chairman, Brooksville
Mrs. W. B. Gittings, Co-chairman, Brooksville
Ashbrook, Chose Hull, Mrs. H.
Ellis, Mrs. Wm. Kennedy, Mrs. R. L.
Anderson, Mrs. M. K.
Cribble, Mrs. R. L.
Hatchen, Mrs. Elsie
Kickliter, Mrs. H. G
Ramsey, Mrs. J. Reid
Miller, Mrs. Julia P.
Moody, Mrs. Mary N.
Young, C. T., M.D.
Thomas, Mrs. Wayne
Blake, W. C., M. D.
Brooker, W. C.
Brorein, Carl, Jr.,
Carlton, Doyle E.
Fielder, Mrs. Wm.
Holloway, Mrs. Rose B.
Lombright, E. D.
McEochern, J. R., M. D.
McMaster, Mrs. R. J.
Mickler, Miss Marion J.
Shackleford, Mrs. T., Jr.
Silva Chas. E.
Stallings, O. Mitchell
Tarantinto, J. P. Jr.,
Smith, Mrs. Malcolm
Mrs. C. F. Parvin, Chairman, Manatee
Mrs. Wiggins, Co-chairman, Manatee
Bradenton Knowles, Gordon B.
Harrison, M. M., M. D. Rogers, Mrs. Charles
J. H. Price, Chairman, Zephyrhills
Mrs. Grace Chappell, Co-chairman, New Port
Crystal Springs San Antonio
Veasey Mrs. Annie Kahler, Mrs. A. H.
Dade City Zephyrhills
Jones, Wardlaw Mrs. Jones, J. E. Rev.
McCray, Mrs. R. A. Price, Mrs. J. H.
Tittmon, Mrs. T. L.
Allen C. Grazier, Chairman, St. Petersburg
Mrs. George Warren, Co-chairman, Clearwater
Grace Whitford, M.D., Co-Chairman, Ozona
Coachman, Mrs. S. S. McMullen, Mrs. W. A.
Chestnut, John Pyatt, Mrs. Ben
Cox, Mrs. Jesse Palm Harbor
Dann, Mrs. Ida Coleman, Mrs. James H.
Fuguttt, G. B. Hereford, Miss Adah K.
Dunedin Hood J S M.D.
Merrell, Mr. & Mrs. G. B. Lee, Mrs. Ruth
Roesel, Tillie Leo, Fred J.
Largo Ruder, Lucius
Ashton, Rev. G. Ruperti, Mrs. Justus
Bainum, Miss Mary
Brophy, Mrs. Nat
Brown, Mrs. Charlotte
Burkew, Mrs. E. G.
Davis, Miss Nellie
Ellison Mrs. M. B.
Griffith, Mrs. Tom
Holey, Mrs. Jason A.
Hazel, Miss Mattie Lee
Hood, Mrs. Emmett
Kumm, F. F., M.D.
MacCordy Mrs. Earl
Miner, Mrs. Sidney
Minshall, S. C.
Moe Mrs. O. R.
Roberts, Mrs. R. W.
Roush, Mrs. Franklin
Rudd Mrs. Constance
Sterchi, Miss Martha
White, Paul L., M.D.
Wood, A. J., M.D.
York, Fred M., D D.S.
Richter, Mrs. Ralph
Cobb, Mrs. Ernest
Emanuel, George M.
Feagle, W. B.
Mrs. E. E. Brigham, Chairman, Winter Haven
Mrs. Guy Empie, Co-chairman, Frostproof
Mrs. S. L. Frisbie, Co-chairman, Bartow
J. W. Hawkins, Co-chairman, Winter Haven
Mrs. Code Long, Co-chairman, Lakeland
Mrs. L. Moore, Co-chairman, Haines City
Mrs. R. B. Naylor, Co-chairman, Frostproof
Mrs. O. C. Schimmel, Co-chairman, Lakeland
Mrs. William Steitz, Co-chairman, Lakeland
Holland, Spessard L. Colton, Miss Lucretia
Haines City Vonnoy, Mrs. C. A.
Dewell, Mrs. R. T. Pierce
Lake Alfred Loomis, Burdette Jr.,
Hawkins, 0. R. Winter Haven
Lakeland Race, Mrs. Austin T.
Bentley, Ed. R. Tillman, Mrs. Rolls
LeMoyne, P. G., Co-chairman, Fort Myers
Punta Gorda Hancock, Mrs. J. H
Blount Dr. B. B. Jones, Miss Sallie
Daniels, Mrs. Elizabeth Jordan, Esther O.
Evans, Hugh B. Price, Mrs Charles
Hewitt, Mrs. Norman C. Rich, Mrs. H. L.
Collier City Frankenhoff, F.J.
Barfield. Tommie C. McLeod, D. W.
Bedell, Harriett M. Fish, Judge Sam
Collier, C. H. Naples
Copeland, D. Graham Frederick, Mrs. Ruth
Johns, Mrs. T. M.
Fender, M. S., M.D.
Cause, J. N.
Draughn, D. M., M.D.
Draughn, Mrs. D. M.
Flanders, F. F.
Pender, Mrs. M. S.
Burton, Mrs. Grady
Forr, Latimer C.
Wi'liams. Mrs. O. L.
Bowling Green W'ouchula
Hilton, Mrs Leroy T. Moore, Mrs. Nina L.
Se'lers. Mrs. D. P.
Clewiston Wri-ht, Mrs. F N.
Duff, F. D. LaBelle
Shelly, Tom Gravely, Mrs. O. L.
Avon Park Sebring
Betts, Mrs. Walter Bailey, Col. F. M. K.
Lonier, Mrs Hoddl Miss Dorothy
McNichols, Judge Sebring, Mrs. Jane
Touchton, Fred Vanua, Miss Charlotte
Lake Placid Venus
Bowers, Mrs. Swain Jackson, N. B.
Crews, Mrs. Lee
Lester H. Baker Chairman, Fort Myers
Mrs. Clarence Z'immerman, Co-chairman, Fort Myers
Keen, J. E.
Alderman, Mrs. Frank C.
Bartleson, Fred, M.D.
Belcher, Mrs. D. B.
Bostelman Ernest, M.D.
Case, H. C.
Daniels, Lee O.
-Davis, L. M.
Griffin, E. D.
Guy, Rembert A.
Halgrim, Mrs. C.
Hanson, Mrs. W. Stanley
Harwen, Mrs. Stanley
Houston, Mrs. J. G.
Hoist, J. G.
Ireland, D. W.
Jernigan, Mrs. J. G.
Johnson, M. F.
Laycock Mrs. Mary
Longbrake GuyA. M.D.
Nay, Mrs. Fay
Ransom Mrs. I
Robb, Virgil C
Sailer, Dr. M.
Sherri l, Margl
Twiss, Prof. Ge
Tice, Bruce Sor
Dial, Mrs. How
Harris, W. S.
Butler, Mrs. To
Curry, Mrs Bar
Davis, Mrs. J.
Fox, Mrs. W. G
Eva \,.j .,. A.T.
E'. 1' .-., Mrs. Felida
Weed Harry J.
uerite Whisnant, Baker, M.D.
aorge R. Pjneland
rter Stringfellow, H. M.
Gocio, Mrs. Harry
Mary Hall, Lucy Monroe
Hart, Mrs. Frank
risen Hart, Wm.
Hughes, Mrs. Carl
ward Oxnam Mrs. Geo. L.
Reid, Mrs. Carrie
Mary Silverbooth. Mrs. James
Dons Stafford, Mrs J. J.
Stockbridge, Mrs. Wm.
m Strode, C.C.
A. Y. Warner, Geo.
W Bowden, Mrs H.
Crandall, Bruce V.
A. J. Cleary, Chairman, Miami
Mrs. J. A. Austin, Co-chairman, Miami
Dania Dahman, Mrs. Margaret
Ryan, Mrs. A. J. Stirling. Frank
Fort Lauderdale Hollywood
Behrens, Mrs. Herbert Steele, Mrs. E. O.
Mrs. Leonard Haskins, Chairman, 1950 S. W.
9th. St., Miami
Mrs. Sophie Lutz, Co-chairman, 2352 S. W.
5th. St., Miami
Brick, P. M. Landohl, Mrs. B. F.
Schmidt, Mrs. Ben McCoffrey, Mrs. L. J.
Wittichen, Mrs. M. F. Monk, Anle
Homestead Marvin, Mrs. L. A.
Rhuley Dr. John Moore, Mrs. T. V.
Miami Moyer, Mrs. Wm. Goff
Barry, Mrs. Cecil T. Mugford, Mrs. Geo.
Beazzell, Mrs. A. L. Norcross R. E.
Britton, Mrs. R. J. Nyson, Mrs. J. J.
Chase, Mrs. E. D. O'Neal, Mrs. E. H.
Christian, Mrs. W. H Pearce, Mrs. E. D.
Cushman, Chas. F. Pearson, B. L.
Davidson, Mrs. J. B. Pearson, Mrs. Colquitt
Dickhans, Mrs. R. G. Phillips, Kenneth, M.D.
Dickinson, Edith H. Rickel, Mrs. P. G.
Doabe, Albert L. Robinson, Mrs. Paul
Ector, Mrs. Virgil A. Stepchurch, Mrs. L.
Findley Mrs. C.S. Stevens, Mrs. T. T.
Fewer, Mrs. N. L. Terry, Royal P.
Gallacher Robert E. Toomer, R. E. S.
Graham, Mrs. R. C. Tour, Mrs. N. L.
Green, Clarissa Tregg, Mrs. H. C.
Harwood, W. H. Tutan, Mrs. C. B.
Hisey, Mrs. L. R. Tyson, Mrs. J. J.
Isaac, Abert L. Upchurch, Mrs. L. S.
Johnson, Mrs. Frank Way, Mrs. R. W.
Kelley, Mrs. J. Lawrence Wilson, James T.
INDIAN RIVER COUNTY
Mrs. Francis Glenn, Chairman, Vero Beach
Mrs. W. C. Cox, Chairman, Vero Beach
Klima, Wilma M. Tyler, Miss Edna G.
Thatcher, E. G. Wycott, Mrs. B. W.
Merritt, Mrs. W. L DeMoya, P. P.
Rev. Jos. A. Tolle, Chairman, Key West
Mrs. SebastianrCabera, Jr., Co-chairman, Key West
Brevaldi, Carl Harris, Minnie Porter
Douglas, Mrs. Stephen Spotswood, Robert
Okeechobee City Roe,John
S. R. Raifsnider, Chairman, Okeechobee
Mrs. Van Burkum, Co-chairman
PALM BEACH COUNTY
Mrs. T. P. Riggs, Chairman, West Palm Beach
Belle Glade Baldwin, Mrs. Porter
Wells, Arthur Johnston Harry A.
West Palm Beach Perry, John H.
ST. LUCIE COUNTY
Dewey Crawford, Chairman, Ft. Pierce
Adams, Alto Mcllwaine, W. T., Jr.
Hawkins, Mrs. E. L. Zuvor, Mrs. Harry
PUBLIC HEALTH COMMITTEE OF FLORIDA
LO D A
Scope of Study . .. . .. .
Important Factors Affecting Public Health Administration 3
Problems . . . .* * 7
Needs . . . . . . 17
Health Progress in Florida .. .. . .. 24
Principles and Responsibilities of Health Administration 26
The Medical Profession and the Public Health . 32
Major Recommendations . . .. 35
Tuberculosis .. . ....... 43
Health in the Schools . .. . ... 49
The Care of Crippled Children ........... 56
The American Legion . . . ..... 58
Generalities . . . 60
THE HEALTH SITUATION IN FLORIDA
Scope of Study
This study of public health administration in Florida attempts
a comprehensive scrutiny of what has been achieved and suggests what may
yet be done to extend and improve health services in the state.
The study defines the major health problems of the state. It
evaluates the facilities and services organized to meet these problems
and determines whether the available services and programs are linked
together and administered for the better development of general health
protection. It does not pretend to evaluate the detailed technique of
the various services.
Suggestions and definite recommendations will be found through-
out the report. Recommendations considered of particular significance
have been assembled in a special section under the caption "Major Recom-
The study deals with activities commonly regarded as the mini-
mal essentials in a modern public health program.* The report recognizes,
however, that these constitute a limited definition of public health and
*Vital Statistics and Records; Communicable Disease Control and Preven-
tion -including Tuberculosis, and Syphilis and Gonorrhea; Public Health
Laboratory Services; Maternal and Child Health including Prenatal, Deli-
very, Postnatal, Infant, Preschool and School Health Services; Environ-
mental Sanitation including water supplies, sewage disposal, the control
of milk, meat and other foods and food products; Industrial Hygiene in-
cluding public health aspects of plumbing and some attention to housing;
general as well as specific Health Education or health information; Pub-
lic Health Dentistry. Nutrition, and Public Health Nursing are assumed
to be necessary integral parts of the program.
that a true concept must include medical and dental care, general and
special hospital'facilities, the health aspects of the entire educa-
tional system, mental hygiene, the prevention of accidents, and the
control or alleviation of such diseases as cancer, heart disease, and
diabetes. Pneumonia must also be considered, but as part of the com-
municable disease program. The broad administrative aspects of pro-
viding state-wide public health services on this basis to the people
of Florida are discussed in these pages. The cities of Jacksonville,
Miami and Tampa have independent full-time health departments and
therefore are not included in the study.
Important Factors Affecting Public Health Administration
The results of an idea or plan depend upon many factors some
of which are subject to constant mutation and variability, such as cli-
mate, population, industry and per capital wealth. For the optimum in
development and progress, there must be a just appraisal of these de-
terminants and an appreciation of the results of economic, physical,
industrial, mental and racial environments. These observations are
particularly relevant in a discussion of the Important Factors Affect-
ing Public Health Administration in Florida.
In Florida there appears to be a definite affinity between
low economic levels and acute health problems. This is particularly
true of many areas where full-time health departments cannot be main-
tained without considerable monetary assistance from state and federal
sources. Related to this there are comparatively prosperous areas hav-
ing health problems but no full-time health service.
It is interesting to note that per capital wealth, based on
the assessed valuation of 1938, varies from $70.00 to $481.00, the
average being .,314.00 (see map, page 4). The concentration in the
northeastern and northwestern parts of the state of the counties with
low assessed valuation approximates closely the distribution of major
health problems. The assessed valuation or per capital wealth as shown
by these figures is very low and indicates a necessity for heavily
subsidized local health departments by state and federal funds, if the
people are to have the health protection services they need and have a
O I I D A
PER CAPITAL WEALTH ACCORDING TO
400 TO A H16H OF $1481
SF300 TO $ 399
\':.::: $ 200 TO $ 299
I I FROM THE LOW OF $70 TO #193
AVERAGE $ 314
right to expect. It is obvious, taking into consideration the small
population of some of the counties, that in certain areas health units
providing a combined service to two or more counties will have to be
developed, rather than individual county health departments.
From a study of the map on per capital wealth, it is apparent
that the northwestern area of the state is the least prosperous. It
is interesting to note that the highest incidence of hookworm is found
in this area and that the general incidence bf infestation is maintained
at a high level. Malaria is also a serious problem in this area. Ex-
cept in a few local instances, economically well developed industries
do not exist in the northwestern part. This area has possibilities in
the tung oil field, paper pulp, Sea Island cotton, tobacco and probably
other agricultural developments.
The central part of the state in which the principal indus-
tries.are citrus fruit-growing and truck gardening depends considerably
on the winter tourist trade and is more prosperous than the two northern
areas. IHookworm-and malaria are found to some extent in this central
Lumber, particularly cypress, is one of the most.important
products-in the state of Florida. The pine trees found so extensively
provide the natural products necessary for the turpentine and resin in-
dustry, commonly known as naval stores, of which Florida is said to be
the largest-producer in the United States.
The cigar industry once employed large numbers of people of
mixed races. The use of machinery in making cheaper grades of cigars
has closed some factories and reduced employment.
The "gold of Florida" is the wealth of orange trees, grape
fruit and lime groves and other citrus fruits found almost generally
throughout the state.
One of the chief sources of wealth in the state is the winter
tourist trade. The areas along the south Atlantic and Gulf of Mexico
coasts are particularly popular. The season is short but nevertheless
it has a definite influence on the entire economic, civic and social
structure of the state. During this period rents are high and affect
the year-round housing problem of the lower income groups. The better
type of tourist is beginning and will continue to have considerable ...
influence on health services. He regards housing, proper water supply
and sewage disposal, adequate control of the communicable diseases,
adequate school health services and sanitation as health needs. In
some of the local health departments there are letters on file from
prospective visitors asking for definite, unbiased information on the
type of health protection services available.
If the remunerative tourist business is to be maintained, ex-
tended and further developed, it is imperative that visitors be given
assurance that health hazards are well under control through adequately
developed and staffed local full-time health departments.
The white population of Florida, particularly in the north-
eastern and northwestern portions of the state, is of old southern
stock. With hookworm infesting such a large proportion of the white
rural population, many of these people find it difficult to wrest a
living from their environment.
In common with other southern states, Florida has a large
Negro population which is in itself a major health problem and an eco-
nomic problem. Many of the poorer whites and the Negroes disregard
proper sanitary conveniences or are not supplied with them. This cre-
ates a health problem of major significance and helps to explain the
incidence of diarrhea and enteritis, typhoid fever, dysentery and other
intestinal diseases. According to a Report on Economic Conditions of
the South, prepared for The President by the National Emergency Coun-
cil in 1938, living conditions in rural Florida and in the slum districts
of the cities are of low standard.
The population of Florida increases appreciably during the
winter months. The semi-tropical climate attracts not only the wealthy
tourist but the low income wage earner and the indigent. This seasonal
movement of transients increases the hazard of communicable diseases
and other illnesses and intensifies the economic burden of existing
health services. Apparently this problem has not received sufficient
Indubitably Florida's natural privileges and blessings are
linked with many health hazards. Proper recognition and utilization
of these benefits with practical application of health principles should
build toward making the people of Florida healthier, happier and more
The major ho.lth problems are:
SHookworm. While not recognized by many lay people, hookworm
exists to an alarming extent and is a public health problem
of real significance. Although this disease is concentrated
in certain areas of the state, it affects the economic com-
plexion of the whole state as perhaps no other single disease.
A study, completed in 1938 by the Department of Preventive.
Medicine and Public Health of Vanderbilt University Schpo6 of
Medicine, in collaboration with the State Board of Health of
Florida and with the aid of the International Health Division
and the Division of Medical Sciences of the Rockefeller Foun-
dation, shows a rather startling incidence of hookworm in the
state of Florida (see map, page 9).
Of the total of 67 counties in the state, 56 were studied.
Three counties showed a hookworm incidence of over 70 per cent
of the rural white population. In the remaining counties
studied, the incidence showed a gradual downward trend to 7.1
per cent, the lowest in any county. Of the 29,064 persons
examined, 10,126, or 34.8 per cent, were found to be infested
with hookworm. The highest infestation is found in western
Florida. In the northeastern section 38.0 per cent was
positive, in the central section 25.2 and in the southern sec-
tion 23.3 per cent. The study in the southern section of the
state did not include the nine southernmost counties. The
soil in this area is of coral origin and interferes with the
extra-host cycle of the hookworm.
Rarely is hookworm a direct cause of death but it does
have profound and devastating effect upon the general health
INCIDENCE OF HOOKWORM
PER CENT OF RURAL WHITE POPULATION
::.. 71 29 %
.I NOT STUDIED
34 % AVERAGE FOR STATE
.,l o .
and efficiency of the infested persons often causing anemia,
heart disease, jaundice, and stunting growth. In the age
group 15-19 years is found the greatest prevalence, with age
groups 5-9 years and 20-24 years next in order. This defin-
itely affects the progress of the school child and the work-
ing capacity of the young adult. The Negro rate was found to
be about one-half that of the white. It is estimated that at
least 186,500 persons in the rural areas of Florida are in-
fested with hookworm. This does not include the unknown in-
cidence among people now resident in the larger cities.
Hookworm can be eradicated and it is a public health and eco-
nomic problem of major importance to the people of Florida.
' Malaria. The high incidence of malaria in certain areas of
Florida is related to the many thousands of small lakes and
swamps where mosquito control is difficult. There are four
counties with a malaria death rate of over one hundred per
hundred thousand population, an exceptionally high rate. In
sixteen counties, the malaria death rate exceeds fifty per
hundred thousand population (see map, page 11, prepared by
the Bureau of Epidemiology of the State Board of Health).
Annually, in the whole state, there are 340 deaths from
malaria--an average over a five year period. LApplying the
conservative estimate of 300 cases per death, there are at
least 102,000 cases of malaria in the state. I Malaria and
hookworm are responsible for a staggering waste of man-powe?
I D A
- AVERAGE REPORTED MALARIA DEATH RATE!
(1928 1937 -- -- INCLUSIVE)
W 100 OR MORE DEATHS PER 100,000
30,000 OR MORE CASES PER 100,000- ESTIMATED
75-100 DEATHS PER 100,000
22,500-30,000 CASES PER 100,000-ESTIMATED
|g| o0-75 DEATHS PER 100,000 a
15,000-22,500 GASES PER 100,000-ESTIMATED e
wF/ 25- 50 DEATHS PER 100,000
7,500-15,000 CASES PER 100,000-ESTIMATED .
liii l 10o- 25 DEATHS PER 100,000
3,000-7,500 CASES PER 100,000- ESTIMATED
S|I LESS THAN TEN DEATHS PER 100,000
LESS THAN 3,000 CASES PER 100,000- ESTIMATED
NOTE CASES ARE ESTIMATED BY MULTIPLYING DEATH RATES BY 300
f- L 0 .
and consequent economic loss. Malaria is a preventable di-
sease and presents a serious problem.
Syphilis and Gonorrhea. It is stated, and by reliable sources,
that the case rate of syphilis and gonorrhea in Florida equals
if not exceeds that of any state in the Union. The definite
figures to substantiate or refute this assertion are not avail-
able, but it is reasonable to assume that Florida has a ve-
noreal disease problem of importance and magnitude. It has
been estimated that about 7,000,000 persons in the O'ited
States have syphilis at any given time. On the basis of fi-
gures released by the United States Public Health Service,
applying to the country as a whole, syphilis will infect one
out of ten of the adult population in Florida. In addition,
there are many thousands of cases of gonorrhea. Only a rela-
tively small proportion of these cases receives adequate medi-
cal treatment. This fact may be attributed to the following:
a) Failure of the infected person to recognize
his or her condition, and the lack of suitable
diagnostic services, particularly in small
communities and rural areas;
b) Lack of easily accessible treatment facilities,
again deficient in small communities and rural
c) The tendency to seek treatment from quacks or
from the drugstore on prescription of the pa-
tient's own making.
It is almost impossible to estimate the eSonomic loss
due to unchecked venereal disease, but it is logical to con-
clude that this loss is tremendous. Oslor called syphilis
"The great imitator". Syphilis can cause blindness, heart
disease, insanity, miscarriages, abortions, stillbirths,
joint conditions and can assume the guise of many other di-
y / Tuberculosis.' The tuberculosis death rate in Florida, though
not extraordinarily high is nevertheless considerably higher
than in the United States as a whole, and is showing a gradu-
al increase. In 1937, a total of 966 persons died from tuber-
culosis in Florida. It follows that there were at least 7,700
cases of tuberculosis in the state in that year. Many of these
infected persons are not known to the State Board of Health or
to local health departments. The result of unrecognized cases
of tuberculosis spreading disease to others needs no comment.
It is interesting to note that the first state sanatorium for
the care of the tuberculous was opened in 1938.
h* Pneumonia. It is the common belief that pneumonia is not
present to any extent in Florida. In 1937 pneumonia was re-
sponsible for the death of 1,227 residents of the state. For
four years previous to 1938, it was the fifth leading cause of
death. The number of deaths from pneumonia can be greatly re-
i Infant Mortality. Over a five-year period, an average of
1,790 infants died annually during their first year of life.
As a conservative estimate fifty per cent of these lives
could have been saved by the application throughout the state
of available scientific information.
Maternal Mortality. A few years ago Florida held the unen-
viable position of having the highest maternal mortality rate
of any state in the Union. Recently this has been reduced
and in 1937 Florida's maternal death rate was fifth from the
highest among the forty-eight states. At least 40 per cent
of these lives could have been saved if extensive and satis-
factory public health services had been organized throughout
the state and had joined forces with the medical profession
to attack the problem.
Diarrhea and Enteritis. In 1937, diarrhea and enteritis were
responsible for 280 deaths, of which 183 were children under
two years of age. Those also are definitely preventable di-
Pellagra. This is a disease associated with inadequate and
unbalanced diet, more commonly found among the indigent and
low income groups, and accounted for 103 deaths in 1937. The
reporting of cases is inadequate and it is difficult to make
an estimate of the number of people incapacitated by this pre-
Typhoid Fever. In the past the typhoid fever incidence was
used as a criterion for determining the effectiveness of pub-
lic health services. Although Florida has made progress in
typhoid fever control, nevertheless, there has been an average
of 50 deaths annually over the past five years.
Typhus Fever. In Florida typhus fever exists to some extent
and was responsible for twelve deaths and 107 reported cases
\Yellow Fever. More than any other state in the Union Florida
is faced with the possibility of the introduction of yellow
fever into the United States. The main factors responsible
for such an assertion are:
a) The existence in Florida in large numbers of
the Aedes egypti mosquito which is the inter-
mediary host in the spread of yellow fever.
The climate, the moisture and the topography
are such that these mosquitoes have ideal con-
ditions in which to breed and' multiply;
b) The existence of an international air base at
Miami to which in a few hours passengers can
fly from South Americe-and its yellow fever
ports or districts to enter the United States;
c) The transportation of passengers by boat from
the upper part of South America to the port of
The State Board of Health, the United States Public Health
Service and the City Health Department of Miami are aware
of this potential danger and cooperatively have established
an extensive program of mosquito control. To be effective,
this work must be continued and extended.
In considering the foregoing health problems of Florida, which
are wholly or partially preventable, a number of factors must be taken
1) Malaria, hookworm, typhoid fever, diarrhea and enteri-
tis, and typhus, for their prevention depend upon a
cooperative attack by public health engineering, lab-
oratory and epidemiologic service and public health
2) The incidence of malaria and hookworm is higher among
the white population than among the Negro;
3)' Syphilis, pneumonia, tuberculosis, diarrhea and enteri-
tis, and maternal and infant deaths show higher rates
in the colored people than in the white. The Negro
lives in close association with white people and is
found in all industry and supplies most of the domestic
labor. A domestic having tuberculosis or other commu-
nicable diseases is a menace not only to the Negro race
but to white people with whom he comes in contact.
4) Although some of the diseases are localized in cer-
tain parts of the state, citizens in one part are as
valuable as those in any other. The economic loss
in one area must be met by the tax payers in other
If these problems are to be met satisfactorily, it is obvious
that the preventive activities must be designed to control the problems
in both white and colored.
A review of the official records of the State Board of Health
shows that during the year 1937 a total of 11,950 persons in Florida
died from diseases or conditions wholly or partially preventable. With
the application throughout the state of scientific information and pre-
ventive methods, it is conservatively estimated that at least 3,500 or
30 per cent of these lives could have been saved.
There are many other health problems requiring preventive
services. These include the prenatal and maternal periods, the infant,
the preschool child, the school child, preventive dentistry, nutrition,
milk and food supervision, sewage disposal, housing and others.
Public health authorities are agreed that the most effective
means of applying scientific preventive and public health principles
is through full-time local health departments staffed with persons
trained and qualified in public health. To be effective, these local
health departments must provide to the people leadership in the fight
against preventable disease and death.
The successful public health program is one that stimulates
an appreciation of the problem and an active desire for its solution.
This is applicable to the state and community leaders as well as to the
people as a whole. The leaders must have the vision to realize that the
health of the people must be more adequately protected if the present
wastage im human life is to be materially reduced.
At this point it seems logical to summarize some of the out-
standing needs of health administration in Florida.
Stabilization. Continuity of sound philosophy and policy,
confidence in leadership and a reasonable sense of personal security
among workers are vital to any enterprise. For a progressive improve-
ment in public health administration, it is essential that a long-range
plan of activities bG forniulat'ud. It is not possible to implement a
long-range plan where personnel changes are frequent. The fact that
the State Health Officer is appointed directly by the Governor and may
be removed by a succeeding administration, for no reason other than
political change, results in lack of efficiency and in a periodic 'ow-
ering of the morale of the entire personnel of the department.
One of the most important needs to permit of the expansion of
adequate and progressive health programs is stabilization of all health
services including the State Board of Health and all local health depart-
ments. It is obvious that if local services which depend upon the state
department of health for guidance, stimulation and advice, are to be
established on a sound basis, the state department of health itself must
set the example in stability. To achieve this stability it is necessary
a) The State Health Officer be appointed by the Board of Health,
providing he meets the qualifications as recommended by the
Conference of State and Territorial Health Officers.* A
Board of Health withthe responsibility of appointing the
State Health Officer naturally itself must be organized on a
basis that will permit of continuity of thought and direction.
This anticipates the next need, which is:
b) The appointment of the members of the Board of Health for
long, overlapping terms of office, by the Governor, with
sufficient membership to carry a majority over from one
governor's term to the next. It must be understood that
the state department of health should consist of the Board
of Health--the policy-forming, judiciary body--and the State
Health Officer and his staff--the executive body.
To permit of the appointment of trained and qualified technical
and other personnel in the health department it is imperative:
c) That the State Health Officer be given the authority to
appoint the personnel required in the state department
of health, provided that such personnel meets the qualifi-
cations recommended by the Conference of State and Terri-
torial Health Officers. Such appointments should have the
*An organization composed of the Health Officers of the forty-eight states
and the territories of the United States.
approval of the Board of Health.
Employed personnel is entitled to some assurance of tenure of
office; therefore, the next need is:
d) That adequately trained personnel oe assured of reasonable
tenure of office and adequate remuneration with periodic
promotion for meritorious service.
The state department of health must recognize the need for:
o) Suitable training for personnel newly added to the health
services in the state;
f) More comprehensive curricular education of employees who
have had some training in public health but whose value
to the department would be increased by further training;
g) A plan of continuous staff education for all professional
and technical personnel, including opportunities to attend
short academic courses in addition to the usual refresher
and other courses of a few days' duration.
Confusion frequently arises because it is thought by many
that a good physician makes a good health officer, a good nurso a good
public health nurse, a good engineer a good public health engineer, and
so on. It should be understood that public health is a definite spe-
cialty just as surgery and pediatrics are specialties. Public health
has its own methods, techniques and principles which cannot be acquired
without intensive courses of public health training followed by field
experience. Public health training should be in addition to the basic
professional training of physicians, nurses, engineers and other tech-
nical personnel required in the health services. Personnel, properly
qualified, trained and experienced, returns a great deal more in terms
of service than personnel without these qualifications. Therefore, it
is economically sound to employ only those persons who are properly
equipped. It is not sufficient that health authorities realize these
principles, but there is a definite need in Florida, as'in many other
states, that persons elected to public office, members of the various
professions, and the public as a whole insist that only properly
trained and qualified personnel be appointed to professional and tech-
nical positions in all health departments.
Funds used for official health services are tax monies or pub-
lic funds and should be so expended as to provide the best return pos-
sible in terms of improved services for the people. Incompetency means
inefficiency and a consequent waste of tax monies.
The principles already outlined in a, b, c, d, etc., must be
extended.to full-time local health service. Provision is made in the
Florida constitution for the establishment of county boards of health
and, although they are definitely needed, so far only one has been
organized, and that very recently. A county board of health should
appoint the local health officer providing he meets the qualifications
and has the training necessary to fill the position and the appointment
receives the approval of the State Health Officer.
As in the state department of health, the county health de-
partment, or health unit, should consist of a board of health--the
judiciary policy-forming body--and the health officer and his staff--
the executive body. The state department of health has the authority
to make rules and regulations for the guidance of county health de-
The county health officer should have the authority to appoint
the members of his health unit staff, again with the proviso that they
have the qualifications and training specified by the state department
of health. Appointments should be approved by the county board of health
and the State Health Officer. Tenure of office and periodic promotion
for meritorious service are of incalculable significance and importance
in formulating a health program projected over a period of years, in
encouraging outstanding personnel to remain in the state, and in pro-
viding the best possible health service for the people.
Strengthening Health Units. In Florida one of the outstand-
ing needs is to strengthen existing health units by more adequate state
supervision, consultation and advisory services and, in many instances,
by increased local budget and personnel.
Extending Local Full-Time Service. The gradual extension of
full-time health services to all counties in the state, with an in-
crease in the supervision and advisory services of the state department
of health, is another outstanding need. Adequate monetary help should
be provided from state and Social Security funds to assist the counties
in proportion to their economic abilities to provide local health service.
Elimination of district health departments. Florida is divided
into five Health Districts, each of which has a so-called health depart-
ment. Generally speaking, state district health departments should not
attempt to provide local health services for the extensive areas and
large populations they embrace. In Florida the district health depart-
ments attempt to do this. Local health services should be the duty and
responsibility of the local governments. The state department of health
should supply only advisory consultation supervision and those special-
ized services not economically possible of local development. There
is a definite need to eliminate these expensive and ineffective state
district health departments. The money thus saved should be used to
strengthen the Bureau of Local Health Service and full-time county
Increase in Health Budgets. The expansion of health ser-
vices to supply the public demand and need entails a simultaneous in-
crease in budget for an effective and progressive program. In Florida,
with the budget of the state department of health stationary and limit-
ed by the collection of one-half mill, it has been impossible to keep
pace with the improved services that should be made available to the
people. Much of the progress in Florida's health service has been due
to contributions from outside sources, particularly Social Security
funds from the United States Public Health Service and the United States
Children's Bureau. The Rockefeller Foundation has also contributed
funds for specific programs and surveys. Health units are limited to
some extent by a fixed mill rate. The principle which applies to the
state department of health budget is also applicable to the budget of
local full-time health departments. Provision must be made for prow
gress increases when warranted.
A well organized health department can improve the health,
happiness and welfare of the people only if the people understand the
objectives of the program and are willing to assist in its application.
The fullest utilization of good health service requires understanding
and sympathetic cooperation from those whom it serves.
As a logical sequence to the needs already outlined,it is
a) That persons elected to public office have an under-
standing of the extent and technical nature of public
health and the consequent need for adequately trained
public health personnel, and an appreciation of the
economic value of health services to the state, the
community and the people;
b) That the medical and allied professions appreciate
their part in the health program and work in reci-
procal cooperation with the health departments and
the people in the sound application of public health
c) That the people comprehend the extent of the pro-
gram and its value in their every day lives and the
part their organizations and the community's facil-
ities play in animating the health program.
If these three important groups work in close sympathy and harmony with
health departments and receive in return a sympathetic and understand-
ing cooperation, the objectives of a well-planned health program should
be much more rapid and effective.
Health Progress in Florida
Since the organization of the State Board of Health fifty years
ago, Florida has made creditable progress in the development of public
health and preventive services, and rapid progress in certain activi-
ties during the past few years. From what was in reality an emergengcy
organization established to combat the ravages of yellow fever, the
health department has carried out the original narrow provisions of
the law which founded it, and through the years has expanded.toin-
cludo many of the functions required by changing conditions.
The first executive staff consisted of the State Health Officer
and a clerk. The department has gradually added laboratory and en-
gineering services, epidemiology, maternal and child health, public
health nursing, district and county health work, public health educa-
tion, vital statistics, dental hygiene, syphilis and gonorrhea con-
trol and tuberculosis control.
The Divisions of Public Health Education, Dental Health, Vunureal
Disoaso Control and Tuberculosis Control have been added within the
last three years and mark important steps forward.
Considerably more emphasis has been placed on the formation of
full-time county health departments during the last three years. There
were three such units in 1936 and now Florida has sixteen health units
providing health services to seventeen counties under the direction of
full-time personnel. There remain fifty,_Florida counties without bene-
fit of full-time health service.
The present Bureau of Public Health Nursing is an outgrowth of an
itinerant tuberculosis nursing service started in 1914.
The Bureau of Vital Statistics had its beginning in the early
attempts of the first State Health Officer to collect some statistics.
Florida entered the United States Death Registration Area in 1920, and
the United States Birth Registration Area in 1924.
In 1916 the Legislature passed a law permitting the State Board
of Health to employ the services of a sanitary engineer whenever in
the opinion of the Board such services were needed. From this law
has grown the present Bureau of Engineering.
For many years there was on the statute books a law permitting
the formation of county boards of health. In 1931 the Legislature
passed the present permissive County Health Unit law on the basis of
which all full-time county health units are established.
A 1915 law required that the State Board of Health give annual
medical examinations to all school children. For obvious reasons this
has never been implemented, and it is hoped that a new and more
reasonable law will be passed by the Legislature.
** * ** .* '.'.
Principles and Responsibilities of Health Administration
Before discussing public health administration as specifically
applied to Florida, it is pertinent to outline briefly some of the gen-
erally recognized principles and responsibilities of public health ad-
ministration and the possible relationships between the various agencies
Fundamentally in any state the authority of the public health
program rests with the state department of health and involves allied
organizations. Mutual understanding and harmony profoundly affect the
functioning of the health program. The authorities and responsibilities
of these organizations and their relationships, one to another, are
necessarily part of this report.
SFederal Agencies. The United States Public Health Service,
Sthe Children's Bureau and the Bureau of Census are the focal points
of national health activity. By natural evolution and by internal
policy, the Bureau of Indian Affairs, the Department of Agriculture and
the Office of Education participate in public health. The Department
of Agriculture and the Bureau of Indian Affairs render directly a con-
siderable measure of health service. The work of the other bureaus
is multifarious but largely advisory, stimulating and coordinating in
character. Both the Public Health Service and the Children's Bureau
aid materially in the development of local health work through grants
made to state health departments. Neither of these federal health a-
gencies attempts to dictate programs and policies but both have been
....able ton s e ad l l h ...
able to effect .far-rqachihg Imp'iovflorr in state and local health
-- '. ".:.i .". :i ..i ..
*:,: *: o:' : : .
administration through consultant service and insistence upon effec-
tive use of funds granted.
S The State Department of Health. An important function of
state government is to organize that body to which is entrusted the
health of the people. The structure on which this responsibility rests
is the state department of health. The ideal of any state department
of health is to develop a program planned to meet the health problems
of the state and to control and prevent unnecessary disease and death.
Primarily, _a_state department- of health--should be an educa-
tional, advisory, stimulating, coordinating and stabilizing agency.
In addition to effective leadership, it should provide laboratory and
vital statistics facilities on a state-wide basis, certain aspects of
public health engineering, such as the supervision of the design and
construction of water supply and sewage disposal plants, special epi-
demiologic investigations, the more technical aspects of industrial
hygiene, and x-ray and other consultation services where those are
not feasible of local development.
Although the organizational structure of state departments
of health will vary somewhat, a satisfactory department may well con-
sist of a Board of Health and the Commissioner of Hsalth and his staff.
The Board of Health should be composed of a small number of members
appointed by the governor for overlapping terms of office. The choice
of these members should not be influenced by political considerations.
The Board should have reasonable medical representation and the members
should serve without remuneration except for expenses incident to at-
tending meetings. The Board of Health should constitute the policy-
forming, judiciary branch, and the Commissioner and his staff the
executive branch of the Department.
-The better organized state health departments have assumed
the r ani ability for the development of at least those activities
cor ns ltre as the minimum essentials of a balanced public health pro-
gram (See footnote, page 1). Many state departments of health em-
brace in their services mental hygiene, and some include pneumonia,
cancer, and diseases of the heart. In certain parts of the country
malaria, pellagra, hookworm and trachoma constitute important phases
of a state-wide public health program.
As already indicated, the function of the state department
of health should be advisory, stimulating and coordinating, with the
-providing of direct services only for those activities which cannot
be rendered satisfactorily in local health departments. The effec-
tiveness of any state health department depends upon the extent to
which it has been successful in establishing full-time local health
departments with competent personnel conducting balanced local pub-
lic health programs.
The state health department, other governmental and volun-
tary agencies, the physicians, the dentists and the people are the ele-
ments in a dynamic state health movement. The health department acts
as the leader, operating in effect as an educational agency and render-
ing such services as will augment and put to constructive use the fa-
cilities of state and community--its physicians, dentists, teachers,
nurses and other professional and lay groups. Health departments should
be prepared to accept the valuable contributions which other governmental
and the voluntary agencies are equipped to make, and to-give advice
and counsel on the public health aspects of their work. They in turn
should seek the direction of the health department to the end.that the
utmost in value may be extracted from every attack on health problems.':
The health department is not and should not be in comIpeition
with private practitioners of medicine:;and dentistry. As a corollary.
it may be accepted that a well-planned public health program will bene-
fit the people and aid the physicians and dentists in private practice.
-'i The Local Health Department. The local health officer has
the responsibility for influencing and in many cases for directing and
developing the following health services in the area under his juris-
a) The accurate recordingEand analysis of births, deaths
and reportable diseases, and the proper recording and
analysis of services performed;
b) The control and prevention of communicable diseases,
including hookworm, malaria, tuberculosis, syphilis
and gonorrhea, and immunization against those di-
seases for which this procedure is an aid to preven-
c) Laboratory aids to the diagnosis of communicable di-
seases forv which such aids are helpful, and labora-
tory tests for water, milk, meat and other foods and
d) The protection of maternal and child health includ-
ing adequate medical and nursing, prenatal, obste-
trical and postnatal 'services, and infant, preschool
and school health services; public health dentistry,
nutrition, and mental hygiene should be integral
parts of the program.
e) Tho sanitation and protection of water supplies, ex-
creta disposal, and the inspection and protection of
milk, meat and other foods and food products, with
some control of housing conditions, and in the larger
centers, industrial hygiene;
f) The prevention of accidents, particularly automobile,
home and industrial accidents.
It should be understood that these are minimal authorities. In many
instances the health officer's responsibility will be much broader in
While it is the duty of the health officer to assure the a-
vailability and adequate provision of these services to the people of
the area under his jurisdiction, the specific agency or method of pro-
vision is not prescribed. That they are supplied is his obligation,
though he need not necessarily supervise them directly.
The successful administration of such responsibilities ne-
cessitates an adequate, well-trained staff, particularly of qualified
public health nurses, and a continuous program of health education.
Of paramount importance is a capable health officer, equipped by edu-
cation, training and inclination for public health administration.
Community Interest and Cooperation. The most potent force
in the projection of the community public health program will be the
individuals and groups, both lay and professional, who have or who
can be persuaded to have an interest in public health. The health de-
partment should endeavor to enlist the active cooperation of physicians,
dentists, nurses, hospitals, teachers, parent-teacher organizations,
women's clubs, civi cliunchoon clubs, chambers of commerce and other
civic organizations, voluntary health agencies, other governmental a-
gencies, the newspapers and the clergy. Lay groups may be coordinated
and stimulated through the formation of a public health council or com-
mittee. Pro4'ssional interest and participation may be elicited by the
appointment of a public health committee in the local medical society.
The local health officer should plan the health program in consultation
with these groups.
The health department has the dual task of creating a desire
in the community for established preventive measures and public health
procedures, and of seeking an equitable source of supply. It should
make no attempt to duplicate an existing service where there is no prob-
lem of supply and the demand is adequate. When the balance is unfavor-
able, it is the duty of the health department to supplement an existing
service so that it may be available to all who need it. Frequently
public desire for a new procedure can be stimulated aiy by actual dem-
onstration. When reasonable popular acceptance has been achieved and
the service is provided elsewhere, the health department may abandon its
service except for those people who cannot be provided for otherwise.
Abandonment in whole or in part does not lessen the responsibility of
the health department to continue to educate and encourage the public
to seek such service elsewhere.
The Medical Profession and the Public Health
More and more the private practitioners of medicine are be-
coming an integral part of all health services. In his own practice,
the modern physician is changing the emphasis from treatment to the pre-
vention of disease among the people he serves. All health agencies,
whether official or voluntary, must depend to a great extent on the
services of the private practitioners of medicine if their programs
of health betterment are to fulfill their end. Not only is it neces-
sary that central leadership vested by law in the state and local de-
partments of health coordinate the skills, energies and interests of
the many and varied agencies, but this central leadership must interest
itself in an equitable working relationship with the medical profession.
To emphasize the ramifications of this the medical profession can and
should take in the modern health program.
Sound and continued health progress depends upon closer co-
operation between the medical profession and the public health group
and upon a coordination of their services. An apathetic or hopid at-
titude on the part of the medical profession militates against and re-
tards the development of effective public health. Where this situation
obtains, the people and the health services suffer as well as the pri-
vate practitioners of medicine. Today, more than over before, there is
a greater knowledge and understanding on the part of people of the need
for and the value of public health. Therefore, any indifference and
lack of understanding of the necessity for an effective public health
program on the part of the medical profession reflects against that
Private practitioners of medicine do not always fully rea-
lize the high esteem and respect in which thinking citizens today hold
the physician who is conscientiously and actively making available to
his patients the best preventive information and service.
A long-range effective program of public health offers many
opportunities to the well-qualified physician, and the physician must
have an appreciation of his vital part in the program. In other words,
any full-time health department, staffed with personnel experienced and
trained in modern public health, cannot help but be of real benefit to
both the physician and the community alike. The ethics of medicine and
the tradition behind the medical profession have always stimulated the
members of the profession to do everything in their power to prevent
suffering and death. In what more effective way can this be accomplished
than by helping people to keep healthy and by protecting them against
those diseases for which there are effective immunizing agents?
The medical profession is, for the most part, composed of
men and women who are guided by the fine ethics and principles that
have as their objective the protection of health and life.
The Florida Medical Association has done much to stimulate
the development of effective health services and to support and improve
these services. Unfortunately, there are members of the profession
who have not had the advantage of public health courses as part of their
medical training and who since that time have had little opportunity to
study and appreciate this important field of endeavor. Misunderstand-
ing and indifference are often due to either lack of exposure to any
sort of public health or exposure to the wrong type of public health
In many instances, cooperation between the medical profes-
sion and interested agencies has facilitated the organization of full-
time local health units in Florida. After the establishment of these
health units, most local medical societies have worked in conjunction
with them for the betterment of the health of the people. There are
still areas in the state where satisfactory relationships have not de-
veloped and where sufficient leadership and interest are lacking on
the part of the county medical society. The Florida Medical Association
and the State Department of Health should strive to foster an enthusias-
tic working relationship, one with the other. It is essential that
there be group planning between the medical profession and the official
health agencies and a willingness on the part of both to solve the
health problems of the state.
Principles of Relationships. Equitable and effective rela-
tionships between the medical profession and public health group, both
state and local, will be assured if the following principles govern:
a) The betterment of the health of the people must be
the objective of both groups;
b) The health department must agree to preserve and
promote the invaluable physician-patient relation-
c) The medical profession must agree to assume respon-
sibility for supplying adequately to the people of
the area the services which are agreed upon by the
medical profession and the health group as desirable
for the protection and promotion of the public health)
d) The health department must endeavor to create a desire
among the people for the services thus agreed upon.
Thus far the report has explained the scope of the study and
summarized the most important health problems and specific needs in
Florida. Philosophy governing administration of public health practice
has been interpreted, emphasizing the practical relationships between
the various official and voluntary agencies, the medical and allied
professions, and the people.
Recommendations are the conventional media for accenting
needs and presenting measures to improve services. Frequently mean-
ing expressed in generalities lacks precision, therefore the terse pre-
sentation of needs in the form of recommendations adds clarity and force.
It is recommended:
1) THAT THE STATE BOARD OF HEALTH BE INCREASED TO FIVE
MEMBERS APPOINTED BY THE GOVERNOR FOR LONG OVERLAPPING
TERMS OF OFFICE.
2) THAT THE STATE BOARD OF HEALTH BE MADE RESPONSIBLE FOR
THE APPOINTMENT OF THE STATE HEALTH OFFICER SUBJECT TO
THE APPROVAL OF THE GOVERNOR AND FURTHER SUBJECT TO THE
CANDIDATE'S QUALIFICATIONS WHICH MUST MEET THOSE RECOM-
MENDED FOR HEALTH OFFICERS BY THE CONFERENCE OF STATE
AND TERRITORIAL HEALTH OFFICERS.
3) THAT THE STATE HEALTH OFFICER BE GIVEN THE AUTHORITY TO
CHOOSE AND APPOINT THE PROFESSIONAL, TECHNICAL AND OTHER
PERSONNEL OF THE STATE DEPARTMENT OF HEALTH, SUCH AP-
POINTMENTS TO MEET WITH THE APPROVAL OF THE STATE BOARD
OF HEALTH PROVIDING THE CANDIDATES HAVE THE QUALIFICA-
TIONS OF TRAINING AND EXPERIENCE AS RECOMMENDED BY THE
CONFERENCE OF STATE AND TERRITORIAL HEALTH OFFICERS.
4) THAT THE NAME OF THE STATE BOARD OF HEALTH BE CHANGED
TO THE STATE DEPARTMENT OF HEALTH, AND THE STATE HEALTH
OFFICER BE KNOWN AS THE STATE COMMISSIONER OF HEALTH.
5) THAT LEGISLATION BE ENACTED AUTHORIZING THE STATE DE-
PARTMENT OF HEALTH TO PREPARE RULES AND REGULATIONS
DEALING WITH ALL SANITARY AND HEALTH PROBLEMS REGARD-
LESS OF THE AGENCY OR AGENCIES RESPONSIBLE FOR THEIR
ENFORCEMENT: IT SHOULD FURTHiER FOVIDE.TIL.T THE EN-
FORCEMENT SHALL BE A FUNCTION OF THE DULY CONSTITUTED
LOCAL HEALTH AUTHORITIES IN THOSE AREAS HAVING FULL-
TIME HEALTH DEPARTMENTS.
6) THAT WHERE FULL-TIME LOCAL HEALTH SERVICE IS AVAILABLE
THE PUBLIC HEALTH ASPECTS OF THE CONTROL AND SUPERVI-
SION OF THE FLUID MILK SUPPLY BE TRANSFERRED FROM THE
DEPARTMENT OF AGRICULTURE TO THE STATE DEPARTMENT OF
HEALTH, AND THAT A BUREAU OF MILK AND FOOD SUPERVISION
BE ESTABLISHED IN THE SECTION OF ENVIRONMENTAL SANITA-
TATION OF THE STATE DEPARTMENT OF HEALTH.
7) THAT ALL STATE HEALTH LAWS BE INTENSIVELY STUDIED AND
REWRITTEN TO CONFORMi WITH THE MODERN PRACTICE OF PUBLIC
8) THAT THE STATE APPROPRIATION TO THE STATE DEPARTMENT OF
HEALTH BE INCREASED TO PROVIDE:
a) STATE FUNDS IN MORE REASONABLE PROPORTION
TO THE FEDERAL GRANTS AND FLORIDA'S PUB-
LIC HEALTH NEEDS:
b) EXTENSION OF THE PROGRAM OF SYPHILIS AND
c) ASSISTANCE FOR THE DEVELOPMENT OF ADDITION-
"\ AL COUNTY HEALTH UNITS.
The state legislative appropriation for health services has
remained stationary to all intents and purposes. The continued contri-
bution of money for health activities from the Federal Government cannot
be expected to go on indefinitely. This money was granted by federal
agencies in an attempt to stimulate the states to develop more adequately
and rapidly their public health services. It was expected that the
states would gradually increase their appropriation for health so that,
if the time comes when federal grants must be curtailed, the states
will be in a better position to maintain independent health services.
By that time the value of health activities should be appreciated by
the people and their elected representatives. At present a reduction
in grants from federal sources would be disastrous to the state and
local health services in Florida because both state and local govern-
ments have not yet assumed their obligations for the provision of
adequate health services for the people.
It should be understood that health services in.Florida have
a long way to go before they can meet the needs of the people. For
the last three years, the federal gQoernment,by 1its generous grants,
has made possible a rapid improvement in health services and if the
state is to retain this advance and progress on a sound basis, it is
necessary that it assume a much greater monetary responsibility for
the extension of the vital health services.
The RockofelJgr Foundation, in cooperation with the United
States Public Health Service, the State, and some local health depart-
ments, has made available considerable sums of money for studies of
the hookworm-and malaria problems. This expenditure and the resulting
valuable information will be of little use unless Florida, through its
state and local governments, provides the health services necessary to
attack these problems intelligently,
It is recommended:
9) THAT A PARTICULARLY WELL-QUALIFIED PUBLIC HEALTH ADMINIS-
TRATOR BE EMPLOYED AS DEPUTY COMMISSIONER AND EXECUTIVE
10) THAT A SUBSTANTIAL INCREASE IN ALLOTMENTS FOR THE TRAIN-
ING OF PERSONNEL BE MADE EACH YEAR UNTIL ALL PROFESSION-
AL AND TECHNICAL PERSONNEL HAVE RECEIVED ADEQUATE TRAIN-
ING IN PUBLIC HEALTH.
11) THAT THE SO-CALLED HEALTH DISTRICTS BE DISCONTINUED AND
THE MONEY THUS SAVED BE DEVOTED TO THE ESTABLISHMENT OF
A STRONG SECTION OF LOCAL HEALTH SERVICE IN THE STATE
DEPARTMENT OF HEALTH AND THE FURTHER DEVELOPMENT OF FULL-
TIME COUNTY HEALTH DEPARTMENTS.
Some thirty years ago the state was divided into five health dis-
tricts in each of which was a so-called district health department.
These were organized and still operate as district branches of the
State Department of Health and are supposed to stimulate a desire for
full-time health units in their respective areas and to render emergency
service. Actually, they are attempting to provide local health service
in unorganized counties. Obviously, the usual district staff of one
full-time physician, two supervising nurses, a sanitarian and one clerk
cannot possibly operate a satisfactory health service for the average
district of approximately 300,000 population. It is just as unreason-
able to expect the State Department of Health to operate local health
service as it is to expect the federal government to operate state
Full-time health units are the most practical and logical means of
supplying local county health service. This type of organization pro-
vides an opportunity for local government and the people to take an
active part and interest in the health program. The monetary contri-
butions from the county or counties create the needed feeling of local
possession. Full-time county health units, linked with other health
services and with one another, receiving monetary assistance from state
and federal sources, and consultation and advisory service from the
State Department of Health, are a definite force leading the concerted
attack on all health problems.
At present some $68,000 are being expended on relatively useless
district health services Not only is the service of doubtful value but
it is detrimental to the establishment of adequate full-time health
service. In many areas, the people and their elected representatives
do not realize the value of full-time local health departments and,
Consequently, they are satisfied with this mediocre district service.
This type of service is ineffective and extravagant.
It is further rccommnndod:
12) THAT LOCAL APPROPRIATIONS FOR HEALTH UNITS BE IN-
CREASED WHERE COUNTIES ARE IN A POSITION TO MEET
A LARGER PROPORTION OF THE COST OF THEIR LOCAL.
13) THAT A CAPABLE, WELL-TRAINED AND EXPERIENCED
EPIDEMIOLOGIST BE ADDED TO THE STAFF OF THE BUREAU
OF EPIDEMIOLOGY TO UNDERTAKE FIELD STUDIES AND TO
ACT AS ADVISOR AND CONSULTANT TO FULL*TIME LOCAL
HEALTH OFFICERS THROUGH THE SECTION OF LOCAL HEALTH
14) THAT THE BiOGRAM OF THE DIVISION OF TUBERCULOSIS.
CONTROL ABANDON ITS GENERAL TUBERCULIN-TESTING PRO-
CEDURE AND EMPHASIZE A PROGRAM OF FOLLOW-UP OF ALL
CASES, CONTACTS AND SUSPECTS: AND THAT THE DIVISION
STIMULATE THE IMPROVEMENT OF TEIE TUBERCULOSIS
PROGRAMS IN FULL-TIME LOCAL HEALTH DEPARTMENTS
THROUGH THE SECTION OF LOCAL HEALTH SERVICE.
15) THAT THERE BE ADDED TO-THE FIELD STAFF OF THE BUREAU
OF MATERNAL AND CHILD HEALTH A WELL-,QUALIFIED FULL-
TIME PEDIATRICIAN WITH SPECIAL TRAINING IN PUBLIC
16) THAT A BILL BE PREPARED FOR SUBMISSION TO THE
LEGISLATURE REQUIRING ALL PHYSICIANS AND MIDWIVES
TO PUT SILVER NITRATE SOLUTION (OR ITS EQUIVALECLT)
IN THE EYES OF NEW-BORN INFANTS.
17) THAT THE TEN DISTRICT PUBLIC HEALTH NURSE SUPER-
VISORY POSITIONS BE ABOLISHED AND THAT THREE OR
FOUR PUBLIC HEALTH NURSES WITH EXCEPTIONAL PUB-
LIC HEALTH TRAINING BE APPOINTED AS SUPERVISORS
AND BE ASSIGNED TO THE FIELD CONSULTATION AND
ADVISORY STAFF OF THE SECTION OF LOCAL HEALTH SER-
18) THAT EVERY EFFORT BE MADE TO INCREASE THE :!t(.EER
OF QUALIFIED PUBLIC HEALTH NURSES IN FULL-TIME
19) THAT A WELL-TRAINED AND EXPERIENCED PUBLIC HEALTH
ENGINEER BE ADDED TO THE BUREAU OF GENERAL PUBLIC
HEALTH ENGINEERING, AND THAT THE BUREAU IMMEDIATELY
PLAN A BROAD PROGRAM TO IMPROVE COMMUNITY AND RURAL
SANITATION, AND ASSIST FULL-TIME HEALTH I'E'R.J:T;LliTS
IN THE APPLICATION OF THIS PROGRAM.
20) THAT AN INTENSIVE STUDY BE MADE OF THE HOUSING
PROBLEM IN FLORIDA WITI THE OBJECT OF DRAWING UP
A LONG-RANGE PLAN OF IMPROVEMENT.
21) THAT THE RESPONSIBILITY FOR ADMINISTRATION OF MA-
LARIA AND MOSQUITO CONTROL BE PLACED IN A SEPARATE
BUREAU OF MALARIA AND MOSQUITO CONTROL AS PART OF
THE SECTION OF ENVIRONMENTAL SANITATION, AND A PHY-
SICIAN QUALIFIED IN PUBLIC HEALTH BE ADDED TO THE
STAFF OF THE DEPIRTI.'EHT TO UNDERTAKE EPIDEMIOLOGIC
STUDIES OF MALARIA'AND ASSIST THE BUREAU OF MALARIA
AND MOSQUITO CONTROL AND THE FULL-TIME LOCAL HEALTH
DEPARTMENTS IN ESTABLISHING AND MAINTAINING CONTROL
22) THAT PRACTICAL HEALTH COURSES BE COMPULSORY IN ALL
SCHOOLS FROM THE ELEMENTARY TO THE UNIVERSITY LE-
VEL, INCLUSIVE, AND TIL-T A NEW CURRICULUM BE DEVEL-
OPED JOINTLY BY THE STATE DEPJARTii.i;T OF PUBLIC IN-
STRUCTION AND THE STATE DEPARTMENT OF HEALTH, PRE-
SENTING MODERN METHODS OF HEALTH TEACHING.
23) THAT ALL TEACHERS BE REQUIRED TO HAVE AN ADEQUATE
COURSE IN HEALTH TEACHING, AND THAT CAPABLE TEACHERS
BE APPOINTED BY TEACHER TRAINING SCHOOLS AND COLLEGES
TO INSTRUCT TEACHERS IN HEALTH TEACHING METHODS.
In Florida there are four groups active in the control of
tuberculosis on a state-wide basis: the Division of Tuberculosis Con-
trol of the State Department of Health, the State Tuberculosis Board
which operates the State Sanatorium, the Florida Tuberculosis and
Health Association, and the Florida Medical Association.
With so many groups, official, voluntary and professional,
sharing some responsibility for the control and final eradication of
a disease as widespread as tuberculosis in Florida, there must be close
cooperation and coordination of services in order that the results of
the combined programs will be as effective as possible.
Cooperation and coordination are two words used extensively
but unfortunately these terms are not usually translated into the ac-
tion necessary to animate a program. To be effective a public health
program must be planned on a long-range basis by all agencies having
any responsibility or interest in the matter. When such a program has
been developed there must be the closest possible relationship between
the groups accepting responsibility for its various phases. Individually,
the paths of these groups are beset by many problems and barriers but,
working together, they should surmount these difficulties and advance the
program more rapidly toward the dusirod goal.
By law, tuberculosis is a responsibility of the official
health agencies. However, this does not preclude the possibility of
other organizations developing, in cooperation with the official agencies,
phases of the program that cannot be met immediately by the latter.
There are many features of the tuberculosis problem, for which suitable
activities have not yet been developed to the extent where they can be
accepted as part of the official program. This provides an opportunity
to voluntary agencies to organize activities to meet some of these prob-
lems. Eventually the activities should demonstrate their value, at
which time they should be incorporated in the official program. Volun-
tary agencies can also assist by continued research and general public
health education. Unless public health education and the demonstration
phases of the problem are coordinated with the official tuberculosis
program in the state, they and the official program become less effec-
tive than would otherwise be the case.
The medical profession has an important part to play in the
tuberculosis program as well as in every public health undertaking,
but here again there must be willing cooperation and interest and a
desire to help meet the problems so that the program will advance more
The tuberculosis sanatorium or hospital is only one factor
of a state-wide program of tuberculosis control. Without cooperation
from the local health agencies, in discovering patients and arranging
admissions, and without interest on the part of the sanatorium in local
tuberculosis problems, the fullest results cannot be expected from the
sanatorium. When a patient is ready for discharge, the sanatorium must
have an avenue through which it can reach the home of the patient to
prepare for the return to the community of this still potential source
of tuberculosis infection. The person must be watched in the home and
assisted in adjusting himself to the environment of the home and the
community. He may need refill pneumo-thorax and other services, advice
and help. What better way to provide this avenue, this service, this
education in the home, this watchfulness, than through cooperation of
the sanatorium with the full-time local health department? The ultimate
aim of a sanatorium is to return to the community arrested or cured
cases which will in time be able to resume responsibilities and become
an economic asset to the family and to the community. This presupposes
as short a stay in the sanatorium as possible which means that the case
must be admitted in the early stages of the disease when the chances of
cure are much better. If a sanatorium can reduce its average length of
stay from a year and a half to iine months, it has thus been able to
provide at the same cost accommodation for double the number of tuber-
It is therefore recommended:
1) THAT A BROAD LONG-RANGE PROGRAM OF TUBERCULOSIS
CONTROL BE DEVELOPED BY THE THREE OTHER INTERESTED
AGENCIES IN COOPERATION WITH THE DIVISION OF TUBER-
CULOSIS CONTROL OF THE STATE DEPA.;Ti,'IIT OF HEALTH.
It is clear that only by round-table discussion can programs
be developed to solve a problem involving the interests of various and
In Florida over the past five years there has been an average
of 953 deaths per year from tuberculosis. Until last year there was
no stato sanatorium. At present there is a State Sanatorium with 400
beds, 300 for white and 100 for Negroes. Moreover, there are about
250 beds in other institutions in the state, listed as for the trcat:ont
of tuberculosis. On studying these figures, it is apparent that Florida
is in dire need of increased sanatorium or tuberculosis hospital accom-
modation of a high caliber. According to the number of deaths, the in-
cidence of tuberculosis is highest among the Negroes, yet comparatively
little provision is made for the hospitalization of colored patients.
As long as tuberculosis is permitted to continue its ravages in the col-
ored race, the rate among the white population will continue high. The
colored maids found in so many homes in Florida are one example of the
possibilities of the spread of tuberculosis from the colored to the
whites. Public health recognizes neither color, race nor creed. It
must attack communicable disease wherever it exists in the human race.
It is recommended:
2) THAT AS SOON AS POSSIBLE MORE MODERN HOSPITAL
ACCOMMODATIONS BE DEVELOPED FOR THE TREATrENT OF
Until such time as there are beds waiting for tuberculosis
cases, it is essential that the admission of patients to tuberculosis
institutions be on a basis of:
a) The public health problem presented in the home
and community; and
b) The need of the patient and the possibility of
curing or arresting the disease.
This necessitates the recommendation:
3) THAT RULES AND REGULATIONS FOR THE ADMISSION OF
PATIENTS TO TUBERCULOSIS SANATORIA OR HOSPITALS
BE PREPARED AND STRICTLY ENFORCED.
It is essential that local full-time health departments
cooperate in arranging admissions to and discharges from tuberculosis
institutions, and provide the necessary follow-up and control of cases
and contacts in the home.
At present many patients must be retained in tuberculosis
sanatoria because of the lack of local facilities for pneumo-thorax
refills under competent medical and public health supervision.
It is recommended:
4) THAT A PLAN BE DEVELOPED FOR PROVIDING PNEUAMO-THORAX REFIL
SERVICES IN VARIOUS PARTS OF THE STATE.
Due to the small number of physicians trained to interpret
chest x-ray films some additional facilities must be developed to pro-
vide this service in various parts of the state.
It is recommended:
5) THAT THE DIVISION OF TUBERCULOSIS CONTROL OF THE STATE
DEPARTMENT OF HEALTH, IN COOPERATION WITH THE FLORIDA
MEDICAL ASSOCIATION, iT'RiJ::. FOR TIE CONSULTATION SER-
VICES OF THREE OR FOUR ROENTGENOLOGISTS IN STRATEGIC
LOCATIONS TO FURNISH CHEST X-RAY INTERPRETATIONS FOR
PRIVATE PHYSICIANS AND LOCAL FULL-TIME HEALTH OFFICERS.
This service should be developed in cooperation with the pri-
vate practitioners of medicine specializing in tuberculosis. It is ob-
vious that the interpretation of chest x-ray films requires, in addition
to the film, an adequate history of the case.
Generalized tuberculin-testing is of most value when the known
cases, suspects, and contacts to cases and tuberculosis deaths, have been
found and placed under control. A generalized tuberculin-tesing program
may help to focus the attention of the public on the tuberculosis prob-
lem but it is an expensive method of case-finding and health education.
Health in the Schools
Health leadership is inanimate, fruitless and inept without
the active participation of the people and application by them of prac-
tical public health principles in their every-day lives.
A sound method of individual participation in the health pro-
gram is through the teaching of the child and young adult in schools
and colleges. By reaching these groups some definite impression can be
made on the thinking of the adults of the future.
The ideal of all education may be epitomized as follows: To
equip all with the training, information and attitudes necessary to
meet the actual demands of life. Practical health teaching, including
the development of health habits and attitudes, presenting health in-
formation with the why and wherefore, and the stimulation of ideals in
health, should be part of every elementary, junior and senior high school,
college and university course. Health teaching should develop from the
simplest practical basis to the more complicated knowledge of and inter-
relationship between health services and the people. To bring this about
it is necessary that a suitable and practical curriculum be developed
as a guide to teachers, with particular emphasis on the elementary schools,
the junior and senior high schools. Such curriculum is of little value
unless teachers are equipped with methods and subject matter to put it
into active practice in the schools. Diverse elements make up the suc-
cessful teaching program, i. c., knowledge of the subject, liking for
the subject, psychology and principles of teaching in general, psychology
and principles of teaching health in the schools, sympathy, imagination,
ingenuity, experience, methods of teaching the subject, suitable material,
proper basal texts, competent supervision, sound health programs, and
joint cooperation and participation of responsibility by health and edu-
New teachers should be required to have suitable qualifications
in health teaching. There should be as much insistence on qualifications
for health teaching as for the teaching of primary reading or arithmetic.-
In teacher training schools health should be taught as a sub-
ject on the student level as applicable to the individual and also on the
teacher level including methods and principles. Those teachers now em-
ployed, as well as new teachers, should be required to prepare themselves
for health teaching by taking special courses in the subject. This prin-
ciple should apply to all teachers in elementary schools and junior and
senior high schools.
In the past, not only have curricula in many states been
poor, impractical and of the old anatomy-physiology type, but the tea-
chers have not been taught health by those capable of arousing an in-
terest and liking for the subject. Today, the proper teaching of health
involves a new curriculum, modern teaching methods and properly trained
health teachers on the staffs of normal schools and teachers' colleges.
Here it mst be pointed out that health teaching methods must be pre-
sonted by especially qualified teachers and not by physicians, nurses
and health officers.
It is recommended:
1) THAT PRACTICAL HEALTH COURSES BE COMPULSORY IN ALL
SCHOOLS FROM THE ELLir"UTARY TOME UNIVERSITY LEVEL,
2) THAT A NEIT CURRICULUM BE DEVELOPED FOR ELEMENTARY
SCHOOLS AND JUNIOR AND SENIOR HIGH SCHOOLS, PRE-
SENTING MODERN METHODS OF HEALTH TEACHING. The
preparation of such a curriculum as regards subject
matter should be the joint effort of' the Department
of Public Instruction and the State Department of
3) THAT ALL TE':ACi'RS--BOTH NEW AND THOSE NOWI EMPLOYED
IN THE STATE--BE REQUIRED TO HAVE Ak ADEQUATE COURSE
IN HEALTH TEACHING AS PART OF THEIR QUALIFICATIONS.
4) THAT CAPABLE TELCHJ.S BE APPOINTED BY TEACiHR TRAIN-
ING SCHOOLS AND COLLEGES TO INSTRUCT TE.i.n IN
HEALTH TE.'LHIIUG :.TFODS. If teachers with adequate
qualifications are not available, likely candidates
should be chosen and sent to schools of higher
learning for specialized courses in health teaching.
In the beginning it may be possible to have only
one teacher responsible for the program in two or
three teacher training schools.
5) THILT COMPETENT SUPERVISORY SERVICE BE PROVIDED FOR
HEALTH TEACHING IN ELEMENTARY SCHOOLS. Supervisory
visits should be made at regular intervals by persons
engaged in health teaching in teacher training schools
and colleges or on the staff of the State Department
of Public Instruction. Their duties should include
not only the direction of health teaching but that im-
portant part of the teaching progrca-n-tho time table.
Health Service. Health services, including the physical ex-
amination of pupils, public health nursingservice, communic;bil dis-ase
control, environmental sanitation, and the many other phases of a modern
health program, assist the child to get the most from the educational
facilities. It should be remembered, however, that the school is a part
of the community and that health conditions of school children reflect
the health conditions of the homes and the community as a whole. A
school child with bad teeth, with hookworm, who is malnourished, or who
shows other defects and health deficiencies, is merely a sample from a
home where these conditions are likely to exist in some or all of the
If definite progress is to be made in health promotion, it is
obvious that health activities must start in the prenatal period and con-
tinue through the infant and preschool periods. Health principles ap-
plied at these stages should bring to the school a child in better phy-
sical and mental health. This presupposes that there must be developed
a suitable full-time local health service to protect the homes and the
community if the schools and the school children are to be protected.
Health services designed only for schools spend too much time
and energy on the physical defects which could have been prevented by
the application of public health activities in the home and the community.
School health service should be part of the modern full-time local health
department program and should be planned jointly by the public health
and educational authorities. The cost of this school service should be
shared by school boards and county commissioners. A full-time trained
health officer can assist in organizing school health services and take
active part in .the physical examination of school children. Physical
examinations should be performed to demonstrate their value with the
object of developing an interest in and a desire for annual examinations
by a capable family physician.
A well-qualified and trained health officer with his modern
health organization--the public health nurses and sanitarians--can as-
sit in communicable disease control, environmental sanitation and the
supervision of the health of the children. The teacher should play a
definite part in the school health program and should be trained and
encouraged to undertake health services, such as rendering first aid,
teaching first aid, the testing of eyesight and hearing, and the ob-
servation of children for signs of communicable disease and other con-
ditions affecting health. The teacher should also be sufficiently in-
terested in the health of th,; pupils to study their health records and
to present to the health authorities any problems which may be related
The public health nurse is not a certified teacher and should
not be expected to teach in the schools, nor should she spend too much
of her time in the schools. She is the important linkbetween the school,
the home and the community. It is a waste of tax payers' money and an
imposition on an already overcrowded health service to require public
health nurses to remain in the schools waiting to give first aid. It
may be necessary for public health nurses to instruct teachers in first
aid who in turn should teach this as a subject to the pupils, utilizing
the opportunities of rendering first aid as a demonstration. To conduct
independent school health nursing service is not in conformity with modern
public health thought and principles.
The most effective method of providing satisfactory health
services in local areas, towns and small cities, is the full-time health
unit. A health unit is simply a modern health department for rural areas
with full-time personnel adequately trained in modern public health.
It is recommended:
6) THAT ALL SCHOOL HEALTH SERVICE BE MADE PART OF THE
FULL-TIME LOCAL HEALTH SERVICE.
If health services are to result ultimately in the prevention of disease
and the improvement of health, the program of the local health department
must be so balanced as to provide the needed service to the entire com-
munity and not to a particular group. When schools receive more than
their share of the available service, they do not get desired results
in their own institutions and definitely hinder the progress of public
health in the community or area as a whole.
It is recommended:
7) THAT WHERE FULL-TIME LOCAL HEALTH SERVICE IS NOT NOW
ESTABLISHED, THE ENDEAVOR OF THE EDUCATIONAL AUTHORI-
TIES BE CONCENTRATED, IN COOPERATION WITH HEALTH
AUTHORITIES, ON THE ESTABLISHMENT OF FULL-TIME LOCAL
To attempt to provide new school health services without a complete
health service, i. e., the full-time local health department, influences
the people to believe that they have all they need in the way of public
health services and, furthermore, prevents the satisfactory development
of adequate facilities.
Full-time local health personnel should have the authority to
supervise the environmental sanitation of the school. The educational
authorities should insist that suggestions and recommendations be en-
forced, respecting the school and the health of the child.
The proper teaching of health in schools, supplemented by the
services of adequate full-time health departments, supported by the
people and the community, should greatly improve the health of the com-
munity and the health of the future men and women, mothers and fathers,
of the community, state and nation.
The Care of Crippled Children
The Florida Crippled Children's Commission was created by an
act of the Legislature in 1929. The Commission has a membership of
five, appointed by the Governor, three for a four-year term of office
and two for a period of two years. The Commission appoints an Execu-
tive Secretary-Director. The present incumbent is a physician who has
had some experience and training in public health. Authority is given
to the Commission to obtain service and treatment for crippled children.
The Commission accepts as a "crippled child" the literal
meaning of the term. That is, it accepts responsibility for treatment
of any child under twenty-one years of age whose physical functions are
impaired by accident, disease or congenital deformity.
For the administration of the Crippled Children's Act, the
state is divided into four districts in each of which has been established
a district office under the direction of one of the commissioners. In
the Jacksonville district, there is employed, on a part-time salary
basis, a Senior Orthopedic Surgeon, and in all but one district, a
Junior or Assistant Surgeon. The Senior Surgeons are members of the
National Orthopedic Board. With the exception of one district, there
are two nurses in each district. In addition, the services of a clerk
or secretary are made available.
Each district organization is more or less self-contained and
operates with little if any provision for supervision or direction from
the Executive Secretary-Director. Hero is an incongruous situation in
which Commissioners, who should be members of a policy-forming judiciary
body are permitted or expected to assume executive authority. This
implies that the Executive Secretary-Director is a director in name
only and is not vested with sufficient power and authority to fulfill
the functions of an Executive Director. A physician was appointed to
this position in order to meet the requirements necessary to obtain
grants from the Federal Government.
If the administration of the program of the Florida Crip-
pled Children's Commission is to produce the best results, it is essen-
tial that there be a definite clarification of responsibilities and a
differentiation of the duties of the Commission and the Executive and
It is recommended:
1) THAT THE COMMISSION BE THE POLICY-FORMING JUDICIARY
BRANCH OF THE CRIPPLED CHILDREN'S SERVICE AND THE EX-
ECUTIVE SECRETARY-DIRECTOR BE AUTHORIZED TO ASSUME THE
AUTHORITY AND RESPONSIBILITY IMPLIED IN HIS TITLE AND
WITH HIS STAFF BE THE EXECUTIVE BRANCH OF THE SERVICE.
The Executive Secretary-Director should supervise the entire
program and act as consultant and advisor to the field staff in adminis-
trative and related matters.
The Commissioners should make their wishes known to the Execu-
tive Director as a body and not as individuals. The Executive Secretary
Director should be responsible to the Commission for the authorized
program of which he should be in complete charge.
An office is maintained in Jacksonville apparently the logical
location for a central office. In addition, an office in charge of the
Chairman of the Commission is operated in Tallahassee. The relation-
ship of these two offices is not clearly defined and it seems an un-
necessary use of funds so needed for actual provision of service for
It is recommended:
2) THAT ONE CENTRAL OFFICE BE MAINTAINED FOR THE
FLORIDA CRIPPLED CHILDREN'S COMMISSION.
Any reorganization which can reduce overhead should be worthy
of consideration and trial.
Many of the nurses employed in districts are nurses who served
in the World War and have not had special training in orthopedics and
the care of crippled children.
When the district plan is reorganized, the Senior Surgeon
should be responsible to the Executive Secretary-Director for the staff
and the crippled children services in his district.
The American Legion
The American Legion was instrumental in presenting the problem
of the crippled child to the people of Florida. Through the activities
of the Legion, the Crippled Children's Act was passed by the Legislature.
Since the establishment of the Commission, the Legion has continued to
support the program and to make the needs of the crippled child better
known. The Women's Auxiliary to the Legion takes an active part in the
local programs and in many instances assists the Crippled Children's
field staff and provides transportation of children to and from hospital.
The Auxiliary has made possible many services and has satisfied many
individual needs of the children. Entertainments, Christmas parties,
and special treats, have been given for them. The Legion never forgets
the weak and those who cannot help themselves.
The old Greek conception of. "a sound mind in a sound body"
remains the ideal-of-_education, and healthy people are the real wealth
of any community, state or country. Those in good health.have an op-
portunity of taking advantage of everything that our modern civiliza-
tion can offer and are an asset to any community. Efficiency, intel-
lectual acumen, zest for life and clean living are natural companions
of buoyant good health.
\It is a tactical mistake to suppose that the individual alone
bears the consequences of poor health and disease. The care of the sick,
the mentally ill, the tuberculous patient, and the housing, feeding,
clothing and the supervision of disease derelicts are responsibilities
shared by all and the burden falls on the people--the tax payers' A
unique part of the world's patrimony should be good health, and the
facilities established for promotion of health and prevention of disease
must become part of a communal driving effort if the heirs are to come
into their own.
A great deal of knowledge is extant today on the prevention of
disease and the promotion of health. If this knowledge were applied to
one-half of its possibilities, many of our economic burdens would be
lifted and some of our economic problems solved.
iConsidorable has been done in the state of Florida and the
country as a whole for the protection of the lives and health of animals
--hogs, cattle, fowl, and so on. This has demonstrated tho value of
preventive measures in promoting a healthier and more valuable group of
domestic animals for man's use. This service is of little value to
mankind if, in carrying it out, it is forgotten that it is man and
man's health which must benefit in the long run.
Health services have received a very small proportion of the
tax dollar and yet they are expected to safeguard the health of the
people who provide the taxes. In the state of Florida, the appropria-
tion from the state legislature has remained the same since 1933 and
yet the appropriations for the care of animals, for the provision of
roads, for the construction of buildings, for the provision of education,
for agriculture, for parks, and for many other things which are only of
value to man have been consistently increased--yet man to utilize these
things must be healthy. The progress made by Florida in public health
has been due in great part to an increased realization by some communi-
ties and counties of the importance of health service and provision by
them of some monies for health services augmented by extensive funds
from federal sources.
Health is purchasable and if the people in Florida want health,
they themselves must collectively purchase it--and the compensation--
S* i 7 1