• TABLE OF CONTENTS
HIDE
 Front Cover
 Front Matter
 Foreword
 Roster
 Table of Contents
 Scope of study
 Important factors affecting health...
 Health progress in Florida
 Medical Profession and the Public...
 Major Recommendations
 Tuberculosis
 Health in the Schools
 Care of Crippled Children
 Generalities
 Back Cover














Group Title: The health situation in Florida : : summary report of a study
Title: The health situation in Florida
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00075586/00001
 Material Information
Title: The health situation in Florida summary report of a study
Physical Description: iii, 61 p. : maps ; 28 cm.
Language: English
Creator: American Public Health Association
Publisher: The Association
Place of Publication: New York
Publication Date: 1939
 Subjects
Subject: Public health administration -- Florida   ( lcsh )
Public health -- Florida   ( lcsh )
Genre: non-fiction   ( marcgt )
 Notes
Statement of Responsibility: made by the American Public Health Association, January 1 to June 30, 1939.
 Record Information
Bibliographic ID: UF00075586
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 06333935

Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    Front Matter
        Front Matter 1
        Front Matter 2
    Foreword
        Page i
        Page ii
        Page iii
    Roster
        Page iv
        Page v
        Page vi
        Page vii
    Table of Contents
        Page viii
    Scope of study
        Page 1
        Page 2
    Important factors affecting health administration in Florida
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
    Health progress in Florida
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
    Medical Profession and the Public Health
        Page 32
        Page 33
        Page 34
    Major Recommendations
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
    Tuberculosis
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
    Health in the Schools
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
    Care of Crippled Children
        Page 56
        Page 57
        Page 58
        Page 59
    Generalities
        Page 60
        Page 61
    Back Cover
        Page 62
Full Text













UNIVERSITY
OF FLORIDA
LIBRARY















THE HEALTH SITUATION IN FLORIDA




Summary Report of a Study

made by

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
in Florida".

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


*.

.. ..S*.


* .

.* .


.'




thA 6I.I o2 09'1

As13K























* a .: a









FOREWORD


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
by districts.


ii3b1~9









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.







iii


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.









ROSTER

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


EXECUTIVE COMMITTEE
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.


STATE DIRECTORS
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


DISTRICT 1
Mrs. H. E. Norton, Co-chairman, Pensacola


BAY COUNTY
Mrs. J. A. Seale, Chairman, Panama City
Thorne Lane, Co-chairman, Panama City


Bay Harbor
Dougherty, C. L.
Kuhe, D.
Millville
Blackwell, Mrs.
Gray, Mrs. Vesta
Rushing, Mrs. Coy
Wiggins, Mrs. Myrtle
Panama City
Abbot, Charlie
Adams, D. M. M.D.
Adams, Mrs. 6. M.
Appleberg, Mr. & Mrs.
A. .G
Barrett, Mrs. E. A.
Baymiller, B. R.
Bishop Fred
Blackshear, W. J., M.D.
Blackshear, Mrs. W. J.
Boykin, Miss Delree
Brown. Prof. Merritt
Byrd, Mrs. W. O.
Chi ds, Rev. & Mrs. Porter
Christo, John
Coker, Dr. R. P.
Cooper, Mrs. W. H.
Davenport, C. D.
Dean, Rev.
Doffkin, Doc.
Fraser, D. S.. M.D.
Fowlkes, Mrs.
Guy, Mrs. Mary
Honey,Tom
Hardy, Prof. & Mrs. A. L.
' Hardy, Prof. H. L.
Harris, Casper
Harrison, Prof. Billy
Hawkins, Mrs. M. B.
Henderson, Mrs. O. E.
Hobbs, Mrs. W. B.
Hodges, Mrs. F. P.
Hogrey, Tom
Holis, Mrs.
Holly, Mrs.


James, D. B.
Jinks, Mrs. Guy
Johnson, Mrs. W. C.
Jones, Major (Salvation
Army)
Lisenby, A. H. M. D.
Luster, Mrs. U. L.
McDaniel, Rev. E. D.
McKenzie, Andrew
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, Sam
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.
Spencer, Susie
Still, Mrs. J. E.
Studebaker, Mrs.
Sutherland, Miss Velma
Words, Mrs. John
Williams, Mrs. S. A.
Wilson, Mrs. J. S.
St. Andrews
Brown, Mrs. J. Will
Sherah, Rev.


ESCAMBIA COUNTY
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.

HOLMES COUNTY
L. H. Paul, M. D., Chairman, Bonifay
Mrs. Brooks Padgett, Co-chairman, Bnnifay

OKALOOSA COUNTY
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
Milton
Freeman, Mrs. Shelia Krentzman, Mr. Ike


WALTON COUNTY
A. Graham Campbell, Jr., Chairman, DeFuniak
Springs
Mrs. W. E. Bryant, Co-chairman, DeFuniak Sprgs.
DeFuniak Springs
Gillis, Mrs. A. Stuart Jennings, Mr. Melvin

WASHINGTON COUNTY
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
DISTRICT 2
F. A. Rhodes, Chairman, Tallahassee
Mrs. Fred Moor, Co-chairman, Tallahassee

CALHOUN COUNTY
Blountstown
Gainey, Mrs. J. C. Knight, Mariam B.

FRANKLIN COUNTY
Apalachicola Oliver, Mrs. H. L.
Montgomery, Mrs. S. E. Sheip, Stanley

GADSDEN COUNTY
Rev. R. C. Holmes, Chairman,Quincy
Quincy
Covington, Jack Weddes, Joe
Love, Mrs. Meade Wilhoit, Mrs. Alice C.

GULF COUNTY


Port St. Joe
Kenney, Mrs. Basil

JACK
Marianna
Berry, F. W., Jr.
Davidson, Mrs. Millard


Tapper, Mrs. Geo.
Watson, M. Ross

SON COUNTY
Hightower, W. B.
McKinnon, Mrs. D. A.
Rhyne, Mrs. Cecil


Tallahassee
Carter, Robert Gordon
Conradi, Dr. Edward
Deahi, Mrs. U. S.
Gramling, Mrs. Ralph W.
Kellum, Mrs. J. G.
Mann, Reed
Moor, Frank


LIBER
Bristol

MAD
Madison
Ashley, Mr. Gordon
Beggs, Mrs. Tom

TAY
Athena
Ezell, J. E.
Boyd
Loughridge, Mrs. Earl
Carbur
Mangum, Frank
Clara
Tennell, Carl


Moor, F. C, M.D.
Moore, Walker
Palmer, Henryl E., M.D.
Rhodes, B. M M. D.
Rosenberg, Mrs. Sam
Thorpe, Mrs. A. L.
Trocy, Miss Anna M.


.TY COUNTY
Weaver, R. H.

ISON COUNTY

McConts, L. A.
Messer, Henry

LOR COUNTY
Fenholloway
Westberry, H. J.
Foley
Crouch, Elmer
Foley, Joe
Lake Bird
McGouley, F. L.


TAYLOR COUNTY (Cont'd.)
Lamont
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.


Crawfordville
Porter, Judge
Revel!, Walter


WAKULA COUNTY

Rehwincle, H. C.


DISTRICT 3
Cli ord A. Payne, Chairman, 120 Julia Street
Jacksonville, Florida
Mrs. Camille S. L'lngle, Co-chairman, 2755 Oak
Street, Jacksonville, Florida

ALACHUA COUNTY
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
Gainesville Hawthorne
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.

BAKER COUNTY
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.
BRADFORD COUNTY
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:


JEFFERSON COUNTY
Wm. Scruggs, Chairman, Monticello
Judge S. D. Clarke, Co-Chairman, Monticello
Mrs. George Y. Mills, Secretary, Monticello

LEON COUNTY










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 '

CLAY COUNTY
Green Cove Springs Tilley, Mr. &. Mrs. R. L.
Smith, Slater Orange Park
Tarplee, Rev. C. C. Allen, Mrs Annie

COLUMBIA COUNTY
R. B. Harkness, M.D., Chairman, Lake City
Mrs. J. R. Tomlinson, Co-chairman, Lake City


Columbia City
Collins, Otis
Fort White
Burns, Mrs. J. P.
Jasper
Milton, Mrs. Robert
Lake City
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
Cox, Guy
Chalker, Mrs.
Douglas, George
Durenberger, Miss Ruth


"Red" Davis
Goldberg, Leo
Goodbread, Ed
Groover, B. H.
Hackney Walter, Sr.
Halstead, Rev. W. T.
Ho mes, 0. K.
Means, David
Miller, Wayne
Williams, Vasco
Witt, Mrs. C. E.
Young, Fred H.
Lulu
Scott, Gillin
Watertown
Kinny, Mrs. L. L.


DIXIE COUNTY
Cross City Feagle, W. B.
Anderson J. M .D. Redding, Ben
Campbel., Mrs. Myrtle Shamrock
Coke Crosby, J. E.

DUVAL COUNTY
Kenneth A. Merriell, Chairman, Jacksonville
Mrs. G. Emmett Batey, Co-chairman, Jacksonville


Arlington
Howell, Mrs. Leo
Baldwin
Beard, Judge James
Dinsmore
Johnson, V. C.
Jacksonville
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.
Jordan
Carswell, Mrs. Verdie
Cary, J. G.
Cheek, Leon T.
Clark, James B.
Clarkson, Dr. E. H.
Cohn, Harold
Coleman, W. I
Croom, Mrs. Hardy
Daniels James T.
Drake, Kenyon
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.
Jordan, Leland
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
Lester
McGehee C. G.
Mabry, Charles, M. D.
Masters, Dr. C. J.
Mathews, John E.
Martin, E. L.
Marx, Cyril A.
Merrill, Jim
Morton, Oliver
Norris, Frank W.
Osborne H. Plant
Paulk, V/. K.
Parsons Kenyon
Perrin, Mr. & Mrs.
Wayne
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.
Safay Emmet
Sampley, Julia May
Sanders, Gold V.
Shulenberger, Mrs. T. L.
Simons, Georg- Jr
Sirmans, Miss Pearl
Stratford, Henry
Sweat, Rex
Taylor, Mr. & Mrs. John
Taylor, R. P., Jr., D.D.S.
Vincient, Mrs. D. 0.
Voughn, E. R.
Walker, Fred
Wand, J. Ben
Warren, Fuller
Well, Nathan
Wilson. Rev. George
Mandarin
Nickel, Mrs. Ivy


FLAGLER COUNTY
J. B. High, Chairman, Bunnell
Mrs. O. F. Alford, Co-chairman, Bunnell
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

GILCHRIST COUNTY
A. F. Driskell, Chairman, Trenton
Mrs. Earl Miller, Co-chairman, Trenton
Trenton Henderson, Ruby E. (Mr.)
Hardee, S. B. Land, Miss Lucy

HAMILTON COUNTY
Jasper White Springs
Black, Graham Borrett, Mrs. John
Bland, Mrs. Horace Nalley, Joel
Harrell Rep. F. Bamberg Saunders, Mrs. Lillian
Reid, 1Harry T.
LAFAYETTE COUNTY
Mrs. Lewis Lamb, Chairman, Mayo
Mayo
Breare, Mrs. George Hatfield, Mrs. Exie
Birchfield "r- 'rm M cClain, Mrs. Guy
Edwards, "': :.',-i Taylor, Mrs. Tom

LEVY COUNTY
Mrs. Emma Rutland, Chairman, Williston
Mrs. T. J. Stokes, Co-chairman, Bronson


Bronson
Richardson, Miss Wilma
Meeks, J. L.
Waldron Rev. Ray
White, H. A.
Cedar Key
Andrews, Mrs. George
Boothby, J. A.
Murphy, Mrs. Tim
Havens, Hugh
Hughes, Trinnell
Roland, Ben
Turner, J. W., M.D.
Chiefland
Davidson, Mrs. Fred
Young, Dr. J M.
Gulf Hammock
Camack, Dr.


Myers, Mrs. Jack
Turner, Mrs. Cherry
Morriston
Mills, Mrs. Leo:a
Williston
Briton, Mrs. D. B.
Ennis, Mrs. W. J.
Gaines, Rev J. P.
Harney, Mrs. J. A.
Jackson, Mrs. G. G.
Johnson, Dr.
Mills, DrJ. M.
Smith, J. G.
Smith, Rev. Ray
Turner, S. L., M.D.
Yankeetown
Knotts, Eugene


NASSAU COUNTY
W. J. Deegon, Jr., Chairman, Fernandina
Rev. Wm. F. Dunkle, Jr., Co-chairman, Fernandina


Bryceville
Bryce, Mrs. Ruth
Bryce Mrs. Ellie I.
Fouraker, T. J.
Callahan
Hodges, K. W.
Jones, Mrs. Ben
McArthur, A. H.
Stokes, Mrs. G. H.
Wel's, Mrs. T. B., Jr.
Hilliard
Epting, Prof. R V
Fernandina
Brooks, Bryan
Cochran, Mrs. N. L.
Ferreria, John T.
Fishier, H. W.
Goldstein, Louis
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.
Hilliard
Mathias, C. R.
Mathias, Mrs. Mable
Powell, Mrs. Ben
Kings Ferry
Haddock, P. B.
Yulee
Goodbreod, John
Lotspeich, Mrs.
Stillwell, V. C.


PUTNAM COUNTY
Rev. E. Watkins Tayloe, Chairman, Palatka
Mrs. W. M. Dunson. Co-chairman, Welaka


Bostwick
Williams, J. Mart
Crescent City
Ford, Dr. J. C.
Williams, E. H.
Grandin
Brantley Z., M D
Brown, W. E.
Interlachen
Brush, C. E.
Palatka
Atkinson, Ralph
Brown, Mrs. J. Emmett
Frazer, Mrs. Harry
Gale, Mrs. James
Gray, Frank


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
San Mateo
Keller, Norman W.
Satsuma
Owens, Fred
Welaka
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.
Francis, Fred

SUWANNEE COUNTY
B. W. Helvenston, Chairman, Live Oak
Live Oak
Helvenston, Mrs. B. W. Thompson, Thomas A.
Mueller, Mrs. Tsacios, Mike

UNION COUNTY
John E. Mines, Ml D., Chairman, Lake Butler
Mrs. Annie Reichard, Co-chairman, Raiford
Lake Butler
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.
DISTRICT
Edward M. Newald, Chairman, Orlando
Mrs. C. R. Whittaker, Co-chairman, Eustis

BREVARD COUNTY
Lieut. Col. G. Thomsen von Colditz, Chairman,
Cocoa
Cocoa Melbourne
McGinnis, Almeda C. Mullins, Mrs. J. F.
Wells, Mrs. Stanford J.

LAKE COUNTY
George L. Singletary, Chairman, Leesburg
Mrs. C. R. Whittaker, Co-chairman, Eustis
Clermont Montverde
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

MARION COUNTY
Mrs. C. C. Simpson, Chairman, Ocala
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

ORANGE COUNTY
W. R. Wood, Chairman, Orlando
Gotha
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.











OSCEOLA COUNTY
Dr. G. W. Hankins, Chairman, Kissimmee -
Kissimmee Crosby, Mrs. A. S

SEMINOLE COUNTY
Mrs. J. Ingley, Chairman, Sanford
Chuloota Adams, Mrs. F. Ross
Wilson, Mrs. James Holly, Mrs. R. J.
Sanford Leffler, W. A.

SUMTER COUNTY
Center Hill Webster
Lee, Mrs..Lily Bell McElyea, Mrs. S. D.
Oxford Wildwood
Hooks, Mrs. C. A. 1lie, Mrs. Ed.

VOLUSIA COUNTY
Mrs. 8. B. Baggett, Chairman, Volusia County,
Daytono Beach
Mrs. Roland Stevens, Co-chairman, East Volusla
County, Daytona Beach
Mrs. Chester Strawn, Co-chairman, West Volusia
County, DeLand
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.
Dreka, Godfrey
DISTRICT 5
Celestino C. Vega, Jr., Chairman, Tampa
Mrs. J. Austin Williams, Co-chairman, St. Petersburg
Mrs. M. Sand, Co-chairman, Bartow

CITRUS COUNTY
Mrs. C. A. Miller, Chairman, Crystal River
W. C. Scofield, Co-chairman, Inverness
Crystal River -Moon, W. B., M.D.

HERNANDO COUNTY
Mrs. Bess N. Hull, Chairman, Brooksville
Mrs. W. B. Gittings, Co-chairman, Brooksville
Brooksville
Ashbrook, Chose Hull, Mrs. H.
Ellis, Mrs. Wm. Kennedy, Mrs. R. L.

HILLSBORO COUNTY


Lithia
Anderson, Mrs. M. K.
Cribble, Mrs. R. L.
Hatchen, Mrs. Elsie
Kickliter, Mrs. H. G
Lutz
Ramsey, Mrs. J. Reid
Plant City
Miller, Mrs. Julia P.
Moody, Mrs. Mary N.
Young, C. T., M.D.
Seffner
Thomas, Mrs. Wayne
Tampa
Blake, W. C., M. D.
Brooker, W. C.
Brorein, Carl, Jr.,


Carlton, Doyle E.
Deuber, Wm.
Fielder, Mrs. Wm.
Holloway, Mrs. Rose B.
Howell, George
Lombright, E. D.
McCartney, Harry
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.,
Thonotasassa
Smith, Mrs. Malcolm


MANATEE COUNTY
Mrs. C. F. Parvin, Chairman, Manatee
Mrs. Wiggins, Co-chairman, Manatee
Bradenton Knowles, Gordon B.
Harrison, M. M., M. D. Rogers, Mrs. Charles

PASCO COUNTY
J. H. Price, Chairman, Zephyrhills
Mrs. Grace Chappell, Co-chairman, New Port
Richey
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.

PINELLAS COUNTY
Allen C. Grazier, Chairman, St. Petersburg
Mrs. George Warren, Co-chairman, Clearwater
Grace Whitford, M.D., Co-Chairman, Ozona
Clearwater
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


St. Petersburg
Bainum, Miss Mary
Brophy, Mrs. Nat
Brown, Mrs. Charlotte
Burkew, Mrs. E. G.
Davis, Miss Nellie
Ellison Mrs. M. B.
Griffith, Mrs. Tom
Grounds, Earl
Holey, Mrs. Jason A.
Hazel, Miss Mattie Lee
Hood, Mrs. Emmett
Kumm, F. F., M.D.
Marsh, Perry
MacCordy Mrs. Earl
Miner, Mrs. Sidney
Minshall, S. C.
Moe Mrs. O. R.
Phillips, Charles


Roberts, Mrs. R. W.
Roush, Mrs. Franklin
Rudd Mrs. Constance
Sterchi, Miss Martha
Tillinghast.. W.L.
Walden Robert
White, Paul L., M.D.
Wood, A. J., M.D.
York, Fred M., D D.S.
Safety Harbor
Richter, Mrs. Ralph
Seminole
Cobb, Mrs. Ernest
Tarpon Springs
Emanuel, George M.
Feagle, W. B.
Jukes, Harry
Tarapain, Mr.


POLK COUNTY
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
Bartow
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
DISTRICT 6
LeMoyne, P. G., Co-chairman, Fort Myers
CHARLOTTE COUNTY
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 COUNTY
Collier City Frankenhoff, F.J.
Barfield. Tommie C. McLeod, D. W.
Everglades Immokalee
Bedell, Harriett M. Fish, Judge Sam
Collier, C. H. Naples
Copeland, D. Graham Frederick, Mrs. Ruth
DESOTO COUNTY


Arcadia
Johns, Mrs. T. M.
Fender, M. S., M.D.

GLA
Moorehaven
Cause, J. N.
Draughn, D. M., M.D.
Draughn, Mrs. D. M.
Flanders, F. F.


Pender, Mrs. M. S.
Smith, Rupert

DES COUNTY
Wachula
Burton, Mrs. Grady
Forr, Latimer C.
Wi'liams. Mrs. O. L.


HARDEE COUNTY
Bowling Green W'ouchula
Hilton, Mrs Leroy T. Moore, Mrs. Nina L.
Se'lers. Mrs. D. P.

HENDRY COUNTY
Clewiston Wri-ht, Mrs. F N.
Duff, F. D. LaBelle
Shelly, Tom Gravely, Mrs. O. L.
HIGHLANDS COUNTY
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
LEE COUNTY
Lester H. Baker Chairman, Fort Myers
Mrs. Clarence Z'immerman, Co-chairman, Fort Myers


Alva
Keen, J. E.
Bonita Springs
Gibson Will
Fort Myers
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.
Gorton, Alvin
Griffin, E. D.
Guy, Rembert A.


Halgrim, Mrs. C.
Hanson, Mrs. W. Stanley
Hanton, Carl
Harwen, Mrs. Stanley
Houston, Mrs. J. G.
Hoist, J. G.
Ireland, D. W.
Jernigan, Mrs. J. G.
Johnson, M. F.
Judd, George
Larimer, Florence
Laycock Mrs. Mary
Longbrake GuyA. M.D.
Nay, Mrs. Fay


LEE COUNTY
Ransom Mrs. I
Robb, Virgil C
Sailer, Dr. M.
Sherri l, Margl
Twiss, Prof. Ge
Tice, Bruce Sor


Englewood
Zeigler, Mrs.
Sarasota
Barringer, Har
Bee Ridge
Dial, Mrs. How
Harris, W. S.
Brandon, Mrs.
Brownell, Miss
Brownell, 0.
Butler, Mrs. To
Carleton, Mrs.
Curry, Mrs Bar
Davis, Mrs. J.
Fox, Mrs. W. G


(Cont'd.)
Eva \,.j .,. A.T.
E'. 1' .-., Mrs. Felida
Weed Harry J.
uerite Whisnant, Baker, M.D.
aorge R. Pjneland
rter Stringfellow, H. M.

SARASOTA COUNTY
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.
*nett Venice
W Bowden, Mrs H.
Crandall, Bruce V.


DISTRICT 7
A. J. Cleary, Chairman, Miami
Mrs. J. A. Austin, Co-chairman, Miami

BROWARD COUNTY
Dania Dahman, Mrs. Margaret
Ryan, Mrs. A. J. Stirling. Frank
Fort Lauderdale Hollywood
Behrens, Mrs. Herbert Steele, Mrs. E. O.
Burghard, August
DADE COUNTY
Mrs. Leonard Haskins, Chairman, 1950 S. W.
9th. St., Miami
Mrs. Sophie Lutz, Co-chairman, 2352 S. W.
5th. St., Miami
Coral Gables
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
Vero Beach
Klima, Wilma M. Tyler, Miss Edna G.
Thatcher, E. G. Wycott, Mrs. B. W.
MARTIN COUNTY
Salerno Stuart
Merritt, Mrs. W. L DeMoya, P. P.
Kanner, Arthur
MONROE COUNTY
Rev. Jos. A. Tolle, Chairman, Key West
Mrs. SebastianrCabera, Jr., Co-chairman, Key West
Key West
Brevaldi, Carl Harris, Minnie Porter
Douglas, Mrs. Stephen Spotswood, Robert
Okeechobee City Roe,John

OKEECHOBEE COUNTY
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
Fort Pierce
Adams, Alto Mcllwaine, W. T., Jr.
Hawkins, Mrs. E. L. Zuvor, Mrs. Harry






STATE-WIDE


PUBLIC HEALTH COMMITTEE OF FLORIDA


LO D A


District 1
District Chairmaz
co-chairman, and
county chairmen


County Chairman,
co-chairman, an<
committee

















CONTENTS


Page
1


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-

mendations".

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
in Florida



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

ASSESSED VALUATION

1938


400 TO A H16H OF $1481

SF300 TO $ 399

\':.::: $ 200 TO $ 299

I I FROM THE LOW OF $70 TO #193


AVERAGE $ 314


,1*











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

area.

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.






7 v


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

attention.

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

prosperous.

Problems

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











SD A


INCIDENCE OF HOOKWORM
PER CENT OF RURAL WHITE POPULATION
INFESTED


0 71.1%


::.. 71 29 %

.I NOT STUDIED

34 % AVERAGE FOR STATE


.,l o .


f- L


1-7888











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
I '*-*-
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!
BY COUNTIES
(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
Coi ::'
|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
areas;

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-

seases.



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-

duced.



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-

seases.



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-

ventable condition.











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

in 1937



\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
Miami.

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

into account:

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
education;

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
areas.

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.



Needs

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

that:

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-

partments.

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
f~











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

health units.


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

imperative:

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
procedures;

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

concerned.

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-

diction:

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-
tion;

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
food products;

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

scope.

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










profession.


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

effort.

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-
ship;

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.










Major Recommendations



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

HEALTH.



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

GONORRHEA CONTROL:

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

OFFICER.



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

government.

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.

HEALTH SERVICE.



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

SERVICE.



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

HEALTH.

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-

VICE.

18) THAT EVERY EFFORT BE MADE TO INCREASE THE :!t(.EER

OF QUALIFIED PUBLIC HEALTH NURSES IN FULL-TIME

HEALTH UNITS.

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

PROGRAMiS.

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.









Tuberculosis



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

rapidly.

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-

culosis patients.

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

diversified groups.

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

TUBERCULOSIS.

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







48



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-

cational agencies.

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,

INCLUSIVE.










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

Health.

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

other children.

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

to health.

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






54

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

HEALTH UNITS.

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







55



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

his staff.

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

crippled children.

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.







59



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.











Generalities



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--

life itself.





Date Due
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