Title Page
 Letter of transmittal to the governor...
 Letter of transmittal to the president...
 Table of Contents
 Division of accounting
 Building manager and technical...
 Bureau of dental health
 Central organization, district...
 Division of drug inspection narcotic...
 Bureau of engineering
 Bureau of epidemiology
 Bureau of health education
 Malaria research
 Maternal and child health
 Multigraph department
 Public health nursing
 Vital Statistics

Title: Annual report - State Board of Health, State of Florida
Full Citation
Permanent Link: http://ufdc.ufl.edu/AM00000243/00008
 Material Information
Title: Annual report - State Board of Health, State of Florida
Series Title: Publication - Florida. State Board of Health
Physical Description: v. : ill., ports. ; 23-29 cm.
Language: English
Creator: Florida -- State Board of Health
Florida -- State Board of Health
Publisher: State Board of Health.
Place of Publication: Jacksonville Fla
Frequency: annual
Subject: Public health -- Periodicals -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
Dates or Sequential Designation: Ceased in 1968.
Numbering Peculiarities: Report year for 1893/94 ends Mar. 31; for 189<7>-1968, Dec. 31.
Numbering Peculiarities: Reports for 1923-32 combined in one issue.
General Note: Reports for 1910-<17> issued as its Publication.
 Record Information
Bibliographic ID: AM00000243
Volume ID: VID00008
Source Institution: Florida A&M University (FAMU)
Holding Location: Florida A&M University (FAMU)
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 01569394
lccn - 07039608
 Related Items
Succeeded by: Annual report - Division of Health, Department of Health and Rehabilitative Services, State of Florida

Table of Contents
    Title Page
        Title Page
    Letter of transmittal to the governor of the state of Florida
        Page i
    Letter of transmittal to the president of the state board of health
        Page ii
        Page iii
    Table of Contents
        Page iv
        Page v
        Page vi
        Page vii
    Division of accounting
        Page 1
        Page 2
        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
        Page 24
    Building manager and technical assistant
        Page 25
        Page 26
        Page 27
    Bureau of dental health
        Page 28
        Page 29
        Page 30
        Page 31
    Central organization, district and county health work
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Broward county health unit
            Page 39
            Page 40
            Page 41
            Page 42
        Escambia county health unit
            Page 43
            Page 44
            Page 45
        Gadsden county health unit
            Page 46
            Page 47
            Page 48
            Page 49
        Hillsborough county health unit
            Page 50
            Page 51
            Page 52
            Page 53
            Page 54
            Page 55
        Jackson county health unit
            Page 56
            Page 57
            Page 58
        Leon county health unit
            Page 59
            Page 60
            Page 61
            Page 62
            Page 63
            Page 64
            Page 65
        Monroe county health unit
            Page 66
            Page 67
            Page 68
            Page 69
            Page 70
        Orange county health unit
            Page 71
            Page 72
        Pinellas county health unit
            Page 73
            Page 74
            Page 75
            Page 76
            Page 77
            Page 78
            Page 79
            Page 80
            Page 81
        Taylor county health unit
            Page 82
            Page 83
            Page 84
    Division of drug inspection narcotic service
        Page 85
    Bureau of engineering
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
    Bureau of epidemiology
        Page 100
        Page 101
        Page 102
        Page 103
        Morbidity report, following
            Page 104
            Page 104a
            Page 104b
            Page 104c
            Page 104d
            Page 104e
            Page 104f
            Page 104g
    Bureau of health education
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
    Malaria research
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
    Maternal and child health
        Page 132
        Page 133
        Page 134
    Multigraph department
        Page 135
        Page 136
    Public health nursing
        Page 137
        Page 138
        Page 139
        Page 140
        Page 141
        Page 142
        Page 143
        Page 144
        Page 145
        Page 146
        Page 147
        Page 148
        Page 149
        Page 150
        Page 151
        Page 152
        Page 153
        Page 154
        Page 155
        Page 156
        Page 157
        Page 158
        Page 159
        Page 160
        Page 161
        Page 162
        Page 163
        Page 164
        Page 165
        Page 166
        Page 167
        Page 168
        Page 169
        Page 170
        Page 171
        Page 172
        Page 173
        Page 174
        Page 175
        Page 176
        Page 177
        Page 178
        Page 179
        Page 180
        Page 181
    Vital Statistics
        Page 1
        Page 2
        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
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
        Page 136
Full Text





March 1, 1938

His Ezcelloncy, Fred P. Cone
Governor of Florida
Tallahassee, Florida


I beg to hand you herewith a report of the Florida State Board of Health
for the period of January 1, 1937 to Deceaber 31, 1937, inclusive.

Rospoctfully submitted,

N. A. Baltsell, MN D., President
Florida State Board of Health


March 1, 1938

Hon. N. A. Balteoll, M. D., President
Florida State Board of Health

My dear Dr. Baltzell:

Tho work of the State Board of Health for 1937 has been in general a
continuation of the expansion program outlined in 1936. With the aid
of Social Security funds each department of the State Board of Health
has been able to carry on a much more extensive program than was form-
erly possible.

Much emphasis has been placed on the necessity for local health ser-
vice in Florida. During 1937 twelve new county health units have been
established and ground work laid for several additional units. It is
realized that health conditions now prevalent will not materially
change until the state as a whole is receiving local health service.
Health education of the public to this idea has been stressed through-
out the year.

With the expansion of local health service the need for trained per-
sonnel became apparent, Every local health unit which has been, or
will be established in Florida must conform to the minimal standards
for local health service as specified by the United States Public
Health Service. This means adequately trained, full-time personnel.
During 1937, the State Board of Health aided by the Social Security
funds sent twenty-nine public health workers for training courses in
accredited schools of public health. This personnel consisted of
doctors, nurses, and sanitarians. Upon completion of training each
trainee has been placed in a county health unit. The results of this
have been most satisfactory, and the practice will continue as funds


One of the two new additions to the State Board of Health Building in
Jacksonville has boon finished, and the second addition will be com-
pleted early in 1938. The first addition provided vitally needed
space for the Central Laboratory, some office space, and now quarters
for the library and meeting room. The second addition will house the
Bureau of Vital Statistics and the Administration offices. There are
fire-proof vaults in this building for the storage of vital statistics

The organisation of the Central Office has remained the same as in 1936,
in which year several new bureaus were established* I feel that the
work of each bureau has gone forward creditably. The idea of coordinat-
ing the work of one bureau with all others has been stressed, and I feel
that this cooperation has done much to give meaning and direction to our

Respectfully submitted,

W. A, McPhaul, M. D.
State Health Officer




Letter Qf transmittal to the Governor of the State of Florida

Letter of transmittal to the President of the State Board
Table of contents- 9 .

Accounting 0
Building Manager and Technical AssJ
Dental Health .
District and County Health Work
Broward County .
Escambia County .
Gadsden County .
Hillsborough County .
Jackson County ,
Leon County .
Monroe County .
Orange County
Pinellas County .
Taylor County .
Drug Inspection Narcotic Service
Engineering .
Epidemiology .
Morbidity report, following .
Health Education .
LaBoratories .
Library .
Malaria Research .
Maternal and Child Health
Multigraph Department .
Public Health Nursing .
Sanitation .
Tuberculosis .
Vital Statistics .
Annulments granted, by months and


of Health II
0 IV

* 9 9 9 9 9 0 1
stant P 25
* 9 9 9 28
* 32
* ., 0 0 0 0 0 39
9 0 9 0 9 43
9 46
S .* 50
9 56
** 9 0 0 0 9 59
9 66
* 9 071
* 9 0 0 0. 9 73
9 0 0 0 9 82
* 0 0 9 0 85
* 86
9 0 9 9 0 0 100
* 104
* 9 9 0 9 105
9 0 0 0 107
* 9 9 *9 ,0 122
S9 123
9 9 0 9 9 9 132
9 9 9 0 9 135
* 0 9 0 9 0 9 137
, 159
* 178
* V-1
I by counties. Florida, 1936 V-28

Automobile accidents, deaths from, recorded, resident and death
rates per 100,000 population, by color, Florida, 1932-1936,
Births (exclusive of stillbirths) and birth rates per 1,000
population, by color, Florida, 1932-1936 ,
Births (exclusive of stillbirths) recorded, resident and birth
rates per 19000 population, by color, Florida, 1933-1936 ,
Births (exclusive of stillbirths) recorded, resident and rates
per 1,000 population, by color, by cities, Florida, 1936 *
Births (exclusive of stillbirths) recorded, resident and rates
per 1,000 population, by color, by counties, Florida, 1936.
Births, illegitimate, and stillbirths, by color, Florida, 1932-
1936 0 0 0 0 9 9 9 0 9 0
Births, illegitimate, and stillbirths recorded and resident, by
color, Florida, 1933-1936 .
Cancer (all forms) deaths recorded, resident and death rates per
100,000 population, by color, Florida, 1932-1936 .










Death, twenty leading causes of, Florida, 1936 V-26
Death, twenty leading causes of, Florida, 1926 V-25
Deaths (exclusive of stillbirths) recorded, resident and rates per
1,000 population, by color, by cities, Florida, 1936 V-17
Deaths (exclusive of stillbirths) recorded, resident and rates per
1,000 population, by color, by counties, Florida, 1936 V-16
Deaths from each cause by color and by cities, 1936

Arcadia .
Avon Park
Bartow .
Coral Gables
Daytona Beach
Deluniok Springs
DeLand .
Fort Landerdale
Fort Myers
Fort Pierce
BH'inee City
Key West .
Kiseimmee *
Lake City .
Lakeland *
Lake Wales
Lake Worth
Live Oak .
Miami .
Miami Beach
New Smyrna
Ocala .
Orlando .
Palatka a
Panama City
Pensacola .
Perry .
Plant City

0 0 0 a 0 0 0 0 V-120

* 6 0
* 0 0 9 0 0
* 6 0 0 9 0

* 0 0 0 0
* 0 0 0 0
* 0 0 0 0 0 0
* 0 0 0 0 0
* 0 0 0 0 S S
* 0 0 0 0 0 0
* 0 0 0

* 0 0 0 0
* 0 0 0 0 0 0
.0 0 0 0 0 0

* S 0 0 0 0 0

* 0 0 0 0 a
* 0 0 S 0 0 S
* 0 *. 0 0 0 0

* 0 0 0 5 0

* S S 0 0 0

* 0 0 0 0 9. 0
. .



.o .




* V-121
S V-96
S V-.97
* 7-126
. V-126
. V-97
V -127
* V-128
. V-129
* V-130
. V-130
, V-92
. V-113
. V-131
. V-99
* V-132
, V-116
, V-116
. V-117

Pompano .
cQincy ,
River Junction
St. Augustine
St. Petersburg .
Sanford .
Sarasota .
Sebring 0
State Hospital .
Tallahassee .
Tampa a
Tarpon Springs
Wanchula .
West Palm Beach
Winter Haven .
Winter Park .
Deaths from each cause
Florida .


* .o 0 *

* .0

* *

0 9 *

Se 0 *

* 0 0 0 *
* 0 9 .9 0 .
* 9 9 9
* 0 0 9 *
* 0 0 0 9 0

by color

* .

* *S


Counties (alphabetically by county) *
Deaths recorded, resident and death rates per.1,000 population, by
color, Florida, 1932-1936 *. .
Deaths under one year classified, 1935-1936 a *
Diarrhea and enteritis (all forms) deaths recorded, resident and
death rates per 100,000 population, by color, Florida, 1932-
1936 a 0 0 0 *
Diphtheria deaths recorded, resident and death rates per 100,000
population, by color, Florida,. 1932-1936 9 9
Divorces and annulments, 1935-1936 *
Divorces granted, by months and by counties, Florida, 1936 ,
Heart disease (all forms) deaths recorded, resident and death
rates per 100,000 population, by color, Florida, 1932-1936 ,
Infant mortality deaths of infants under one year of age and
rates per 1,000 live births, by color, Florida, 1932-1936 *
Infant mortality deaths of infants under one year of age record-
ed, resident and rates per 1,000 live births, by color, by
cities, Florida, 1936 *
Infant mortality deaths of infants under one year of age record-
ed, resident, and rates per 1,000 live births by color, by
counties, Florida, 1936 .
Infant mortality deaths of infants under one year of age record-
ed, resident and rates per 1,000 live births by color, Flori-
da, 1933-1936 *
Influenza deaths (all forms) recorded, resident and death rates
per 100,000 population, by color, Florida, 1932-1936 ,
Malaria deaths recorded, resident and death rates per 100,000 pop-
ulation, by color, Florida, 1932-1936 .
Marriages performed, by months and by counties, Florida, 1936
Nephritis (all forms) deaths recorded, resident and death rates
per 100,000 population, by color, Florida, 1932-1936 .

9 9 9
0 .
0 9 0
and by counties, 1936















Pellagra deaths recorded, resident and death rates per 100,000
population, by color, Florida, 1939-1936 V-8
Pneumonia (all-forms) deaths recorded, resident and death rates
per 100,000 population, by color, Florida, 1932-1936 V-8
Population, estimated, by color, by cities, Florida, 1936 V-13
Population, estimated, by color, by counties, Florida, 1936 V-12
PrognancyA childbirth and the puerperal state, deaths from diseases
of, and death rates per 1,000 live births, by color, Florida,
1932-1936- V-9
Pregnancy, childbirth and the puorperal state, deaths from diseases
of, recorded, resident and rates per 1,000 live births, by
color, by cities, Florida, 1936 V-24
Pregnancy, childbirth and the puerperal state, deaths from diseases
of, recorded, resident and rates per 1,000 live births, by
color, by counties, Florida, 1936 V-23
Pregnancy, childbirth and the puerporal state, deaths from diseases
of, recorded, resident and death rates per 1,000 live births,
by color, Florida, 1933-1936 V-10
Babies V-6
Scarlet fevor deaths recorded, resident and death rates per 100,000
population, by color, Florida, 1932-1936 V-5
Stillbirths and illegitimate births recorded and resident by color,
by cities, Florida, 1936 V-22
Stillbirths and illegitimate births recorded and resident by color,
by counties, Florida, 1936 V-21
Syphilis deaths recorded, resident and death rates per 100,000
population, by color, Florida, 1939-1936 0 V-7
Tuberculosis (all foms) deaths recorded, resident rnd death rates
per 100,000 population, by color, Florida, 1939-1936 V-6
Typhoid deaths recorded, resident and death rates per 100,000 pop-
ulation, by color, Florida, 1932-1936 V. V-4
Whooping cough deaths recorded, resident and death rates per
100,000 population, by color, Florida, 1932-1936 V-5


0. Wilson Baltsell, Auditor

The financial report following this page is for the period beginning
July 1, 1936 and ending June 30, 1937.

At the end of each fiscal year a complete and detailed financial re-
port is rendered to the Members of the State Board of Health and to
the State Health Officer, and copies are sent to the Governor, the
State Comptroller, and the State Auditor.

As the scope of all activities is now so large and varied a detailed
financial report of all our activities would be too voluminous to be
incorporated in the annual report of the State Board of Health, which
is the reason that the figures arc condensed here.

In addition to the State Board of Health proper, reports are also
given for Receipts and Disbursements of Punds from the United States
Public Health Service and Children's Bureau; also our special fee
accounts, visz Centralization of Marriage and Divorce Records,
Registration of Doctors and Midwives, Drug Store Inspection, thb '.' .:
two projects financed entirely by the Rockefeller Foundation-Divi-
sion of Malaria Research and Special Study of Hookworm Disease-and
the Insulin fund which expired at the end of this fiscal year.

There are also included consolidated statements of the County Health
Units showing all contributing agencies.


JULY 1, 1936 TO JUNE 30, 1937




The State Board of Hoalth Receives its funds from 1/2 mill of State Taxes
(Laws of 1933, Chapter 16169). The Logislature of 1935, while continuing the
millago, limited the expenditures (Chapter 16772, Laws of 1935) as follows

Necessary and Regular Expense

$ 100,000.00

225 000.00

---- -------------------- --------------

As compared with Appropriations Bill, results
Juno 30, 1937:

for fiscal year ending

Annual Allotment
Brought forward from last year
of Bionnium (1935-1936)

Unexpended balance of
Salaries transferred to
Noe. & Reg* Exp.


5 100,000,00

1000 48090


Balance fram 1935-1936
Miscellaneous Refunds
Cancelled Warrant


& Regular

$ 125,000.00







Balance June 30, 1937

$ 4.94


JULY 1, 1936 TO JUNE 30, 1937


Balance Brought Forward from last Fiscal Year
Receipts 1936-1937
Taxes and Miscellaneous Revenue
General Revenue

Necessary and Regular .Epe.nses ..

From State Board of Health's Millage was
deducted by State Comptroller for Commis-
sion Fund for Tat Assessors and Collectors -

Balanc June 30, 1937
Which is the Comptrollors balance as no
current Vouchers wro unpaid.

$ 23,004.55

# 196,336.35

... ..... 150,237.35




# 5,051.24



JULY 1, 1936 TO JUNE 30, 1937


Tax Redemptions

Miscellaneous Refunds
Sale of Pellagra Yeast and othor Medioinos

Rents Tampa Laboratory (City of Tampa)
Cancellod Warrants




Warrants paid from General Revenue





NOTE: As income from taxes did not produce the amount
appropriated by the Legislature, supplements wore
made from General Revenue when needed to meet


JULY 1, 1956 TO JUNE SO, 1937




May *


Taxes and
Miao. Rev.

* 7,854.53




$ --


$ 45,378,08
--- i


$ 7,854.53


$ 241,714.43

Paid In

* 20,545.52



t 251,086,25

* Cancelled Warrant
** Paid in June




$ 1,272.73

$ 8 581.49




JULY 1, 1936 TO JUNE 30, 1937



#ital Statistics
Public Health Nursing
District Field Unit Number
District Field Unit Number
District Field Unit Number
District Field Unit Number
District Field Unit Number

$ 19,699.98
1 5,344.33
2 4,449.94
3 2,537.50
4 5,812.50
5 5,102.50



Addition to Building
Vital Statistics
Public Health Nursing
District Field Unit Number 1
District Field Unit Number 2
District Field Unit Number 3
District Field Unit Number 4
District Field Unit Number 5
Central Organization County Health Work
Assistance to Cotnty Health Units

Total Operating Expenses

Total Disbursements



$ 251,086.25


JULY 1, 1936 TO JUNE 30, 1937



Balance from Juno 30, 1936

Ront Office
Rent Equipmont
Postage and Supplies
Travel Expenses

Balance Juno 30, 1937

S 7,108.45

* 9,177.05



$ 10,807.95

~~~~~~~------~~-- ----- ~ --------------
- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- ---


Balance from June 30, 1936 $ 1,905e53
Doctors' Fees 2,091.00
Midwives' Foes 717.00













5 2,320,61

Balance June 30, 1937

H E me


JULY 1, 1936 TO JUNE 30, 1937



Balance brought forward from June 30, 1936
Receipts s
Reimbursement Auto
Liability Insurance

Disbursements t
Traveling Expenses
and Evidence
Postage and Supplies
Automobile Replacement

$ 837.04






Balance June 30, 1937


As this is strictly a Rockofollor Foundation Activity and all funds con-
tributed by them, and only disbursed through State Comptroller, in accordance
with Rockefeller Foundation Budget, the Statement given here is the last one
rendered the Rockofeller Foundation for period January 1, 1936 to December 31,
1936, which is their fiscal year.

Balance Brought Forward

Rent, Fuel, Etc.





Balance January 1, 1937

* According to agreement with Rockefeller Foundation,
the balance of $8.37 from 1936 Budget was returned
to thon.


$ 404.43




JULY 1, 1936 TO JUNE 30, 1987

Funds Deposited with Stato Treasurer and Disbursed by


Balanoo brought forward from June 30,
First Quarter
First Quarter Refund
Sooond Quarter
Third Quarter

Oral Hygiene
District Field Units
Mobile Health Unit
Tuberculosis Field Unit
Central Organization -
County Health Work
County Health Units
Itinerant Sanitary Officers
Venereal Disease Control
Dade County Anti-~paqwpio Control
Traini~ Coursesa
Medical Officers
Sanitary Officers

Venereal Disease Wash-
ington Conference



$ 17,355893








Balance June 30, 1937
Detailed quarterly reports are rendered
to United States Public Health Service.




JULY 1, 1"36 TO JUNE 30, 1937

Funds Deposited with State Treasurer and Disbursed by


Balanoo Brought Forward from June 30, 1936
First Quarter
Second Quarter
Third Quarter
Fourth Quarter

8 19,493.73



Salaries and Travel-State
Professional Eduoation -
Fees for Lectures
Equipment Supplies -
Printing and Binding -
Arsenicals Biologicals
Dental Health
Participation in County
Health Units

Balance Juno 30, 1937
Comptroller shows Balance as of June 30, 1937
which does not take into account the follow
ing vouchers not paid until July: '
Vouchers 675-676 Fees for Lectures
Revealing Operating Balance as Above


- 225.00


* 37,062.94

$ 37,062.94

Detailed quarterly reports are rendered to Children's Bureau.








JULY 1, 1936 TO JUNE 30, 1937


0 7,500.00

The 1936 Legislaturo appropiated the sun of
for "Purchase and Distribution of Insulin"
Chapter 17068.


For Insulin
Express and Postage Distri-
buting Insulin to Counties



$ 7,500,00

This was a special appropriation not connected with funds for Stato
Board of Health, but purchase and distribution was made by the State Board
of Health.



JULY 1, 1936 TO JUNE 30, 1937



Contributed By

State Board of Health
C Brovard Co. Comnsrs.
Broward Co. School Bd.
Cy. of Ft. Lauderdale
Cy. of Hollywood
U. S. P. H. 8.
Children's Bureau

From Last

Funds Re-
ceivod or
Paid Direct
Deficit From
Last Year

- 36.34 1,113.66
- 153.01 1,846.99
-- 977.50
- 60.00 1,640.00

bursed Balance
a ,l .



--- m

or Paid


Paid In
Less Than
Budget Budget






10,811.75 166.40 10,978.15 12,820.00 1,841.85

Funds Received Under Budget Allotment
Funds Disbursod Under Budget Allotment
Balance June 30, 1937




rrr rr~ rrr



JULY 1, 1936 TO JU11E 30, 1937



Funds Re-
ceived or Dis-
Paid Direct buried

Funds Re-
ceived or
Balance Paid Direct Budget

Paid In Paid In
More Than Less Than
Budget Budget

State Board of Health
Escambia County
City of Pensacola
U. S. P. H. S.
Children's Bureau






---_ 26,639.68



30,118.00 349.92

Funds Received Loss than Budget
Funds Received Over the Budget
Total of funds received less
than Budget Allotment




[ [ i






JULY 1, 1936 TO JUNE 30, 1937




Contributed By

State Board of Health
U. S. P. H. S.
Children's Bureau

or Paid


Dis- or Paid
buried Balance Direft


403.36 3,200.00
44.35 5,275.00
-- 2,173.68
-- 633.50


Paid In
Less Than

- 100.00
- 33.50

ll,282. 10ob834.47 447.71 11,282.18 18,500.00 7,217.82

Funds Received Under Budget Allotment
Funds Received Over Budget Allotment

Funds Disbursod Under Budget Allotment
Balance June 30, 1937
Budget on annual basis -
But Unit did not begin
operating until October 1, 1936.






01 9 OI~iTHS B.SIS




Total Budget
Paid In


Paid In










Paid Over




2 900.W



JULY 1, 1936 TO JUNE 30, 1937



Funds Re-
coivod or
Paid Diroot
Balance Including
From Last Balance From Dia-
Year Last Year bursod Balance

or Paid

Paid In
Loss Than
Budget Budget

o State Board of Health
" Gadsden County
U. S. P. H6 S.
Children's Bureau

20.98 1,420.98
429.31 4,494.25
--- 3,491.65
--- 1,019.75


201.23 1,420.98
- 150.40 4,494.25
-- 3,491.65
--- 1,019.75

450.29 10,426.63 10,375.80 50.83 10,426.63 12,320.00 1,893.37
L L I ~ u a J I -- -, un n n I iI

Funds Received Under Budget Allotment
Funds Received Over Budget Allotment

Funds Disbursed Under Budget Allotment

Balance June 30, 1937

Contributed By


- 419.75






JULY 1, 1936 TO JUNE 30, 1937



Contributed By

State Board of Health
Highlands County
IT. S. P. H. S.
f- Children's Bureau

or Paid Dis-
Direct bursed Balance




or Paid




Paid In
Less Than


2,160.00 2,059.23 100.77 2,160.00 2,800.00 640.00
--- __ I

Funds Received Less Than Budget
Funds Disbursed Less Than Budget


Balance June 30, 1937




JULY 1, 1936 TO JUNE 30, 1937



Contributed By

State Board of Health
Hillsboro County
U. S. P. H. S.
Children's Bureau

or Paid


bursed Balance


-" L

or Paid




Paid In
Less Than



Paid In
More Than


19,448.87 14,135.26 5,313.61 19,448.87 23,770.00 4,626.03 304.90

Funds Received Under Budget
Funds Received Over Budget


Funds Disbursed Over Budget

Balance June 30, 1937



The Budget is sot up on an annual basis which
accounts for Contributions showing so much loss
than budget, as the Unit was only in operation
eight months.



JULY 1, 1936 TO JUNE 0S, 1937



Contributed By

C State Board of Health
Jackson County
City of Marianna
U. S. P. H. S.
Children's Bureau

Prom last

or Paid
From last

397.01 2,547,01
1,711.52 8,211,52
--- 600,00
"-NN 40200.00
221083 217.60
2.108.63 17.707.13





or Paid

2 248.60




Paid In
Less Than

Paid In
More Than

S2.99 -M
--- 1,011.52
.-- 500.00
200.00 m0
W-- 98.60

156484.32 2 222.81 17707,1S 16 300.00 202.99 1,610.12
16 48[*32 2 2 l" '! -

Funds Received Over Budget Allotment
Funds Reoeived Under Budget Allotment

Funds Disbursed Under Budget Allotment
Balance June 30, 1937

NOTEs Jaokson County had $1,711.52 left over from last fiscal
year and during this year paid in $1,011.52 more than
budget, which accounts for large balance on hand June
30th, 1937. However that will bo a credit to Comnit-
ments noxt fiscal year.






JULY 1, 1936 TO JUNE 30, 1937



Contributed By

g PAID (
INTO ( **
STATE ( ***


( City of

From Last

or Paid
From Last

-*m. 3,440.00
202.75 6,240.16
--- 3,40000
--* 1,614,80



202.75 14,694.96 12,061.36

--. 7,23481 7,234.81




or Paid




14,694.96 12,815.00

Paid In
Loss Than

Paid In
SMore Than

--- 80,00
-- "2,365.16
500.00 --
6520 -

565.20 2,445.16

- 7,234.81 9,311.00 2,076.19 _-
m,~110 eim ,p6 O

0275 21929.77 19,29616 263361 21929.77 2212600 2,641.39 2,445.16
-~uvv -r --( -~r~

* State Board of Health
** Leon Co. Commissionors
& Bd. of Publ. Instr.
*** U. S. P. H. S.
**** Children's Bureau

Funds Received Over Budget Allotment
Funds Received Under Budget Allotment

Funds Disbursed Under Budget Allotment
Balance June 30, 1937





JULY 1. 1936 TO

JUNE 30. 1937



Contributed By

State Board of Health
State Board of
Dooial Welfare
U. S. P. H. S.
Children's Bureau

or Paid Dis-
Diroot bursod

2,200.00 2,164.59



or Paid
Balanoe Direct


36.41 2,200.00 2,310.00



Paid In
Less Than



8,119.63 8 084.22 35.41 8,119.63 12,152,00 4,032.37
A pe __te

Funds Received Loss Than Budget Allotment
Funds Disbursed Less Than Budget Allotment

Balance Juno 30, 1937




-- -



JULY 1, 1936 TO JUNE 30, 1937



Contributed By

State Board of Health
Pinellas Co. Com.
U. S. P. H. S.
Children's Bureau

or Paid


bursed Balance Deficit

2,430.00 20.00 --
13,648.30 --- 163.30
4,375.00 W
2,640.01 --

or Paid




Paid In
Less Than


Paid In
More Than


22,950.01 23,093.31 20.00 163.30 22,950.01 22;884.00 1,504.99 1,571.00

Funds Received Over Budget Allotment
Funds Receivod Under Budget Allotmont

Funds Disbursed Over Budget Allotmont
Operating Deficit Juno 30, 1937
NOTE 'Whilo a deficit operating balance of $143.30 is shown
for the County a remittance of $163.61 was received
from thon on July 3rd, but as the fiscal year closed
Juno 30th, it was not included in this year's re-
ceipts, but will be in next fiscal year.


- 143.30




JULY 1, 1936 TO

JUKE 30, 1937



Contributed By

State Board of Health
Taylor County
U. S. P. H. S.
Children's Bureau

From Last


or Paid
From Last
Yar -





or Paid

9".45 1,123514
32450 3,932.50
-- 3,000.00



Paid In
Loss Than

Paid In
More Than

.M 223.14

900.00 --

--- MM _4.M--

1,000.64 80655.64 7,927.69 127.95

Funds Roocivod Under Budget Allotment
Funds Roooived Over Budget Allotment

0,055.64 8,70C.00 900b00 255.64
i ii.iNo



Funds Disbursod Under Budget Allotment
Balance June 30, 1937


I l I [



JULY 1, 1936 TO JUNE 30, 1937



Contributed By

Stato Board of Health
Wakulla County
U. S. P. H. S.
Children's Buroau

or Paid

bursed Balanoe. Dofloit

1,975.00 777.45 1.197566 --
525600 1,403.19 078.19
1,189.35 1,109.53 --
..- -**

or Paid
Direot Budget



Paid In
Less Than


Paid In
Moro Than


3,689.36 3,369.99 1,197.55 878.19 3.689.35 6600.00 2,705.65 075.00
3 68936 1199 6 3man"3

Funds Received Over Budget Allotment
Funds Received Under Budget Allotment

Funds Disbursed Under Budget Allotment
Balanoe Juno 30, 1937




NOTEI The balance for 8tate Board of Health means that the State actually
paid in $1,197.55 more than obligated under the Budget; but this
had to offset the shortage of County and School Board funds of


frank M. Whiddon

The department of the Building Manager and Technical Assistant cooperates
with every bureau of the State Board of Health in an effort to assist
them in conducting the routine activities of their departments. With the
organization of new bureaus during the past year, the work of this depart-
ment has greatly increased.

An efficient mailing service has been established since the consolidation
of the mailing department under the Building Manager and Technical Assist-
ant, and much time and postage has been saved. During the year there were
1,973 in-coming and 2,123 out-going shipments by express.

Specimen containers pecked and wrapped for mailing distribution during
1937 are compared with the preceding year as follows:

1936 197 193637
January 10,688 15,195 July 8,418 18,431
February 11,154 11,514 August 9,057 15,304
March 8,249 9,867 September 11,981 16,549
April 8,090 18,423 October 15,566 17,558
May 7,164 10,367 Novamber 12,318 19,192
June 3,065 14,191 December 8,803 11,444

Total 1936: 117,523 Total 1937: 178,035

Biologicals packed and wrapped for mailing distribution during 1937 are
compared with the preceding year as follows:

1936 1937
Diphtheria antitoxin 981 919
Schick 34,920 50,910
Toxoid 18,564 21,074
Typhoid vaccine 34,629 44,334
Vaccine virus 15,470 28,482
Antirabic virus 426 1,360
Tuberculin tests 336 783

In preparing specimen containers for distribution throughout the state,
the following routine is observed:

Kahn containers: tubes cleaned and sterilized; corked and
placed in double containers with data blank for same.

Diphtheria containers: swabs rolled, sterilized and placed in
tubes which have been sterilized; corked with cotton plugs and placed in
double containers with data blank.

Hookworm and sputum containers: bottles labeled, disinfectant
added, corked, and placed in double containers with data blank.

Malaria, typhoid and gonorrhea containers: glass slides
cleaned, polished, and sterilized; placed in containers with data blank.

All material returned with specimens for examination are cleaned, storili-
zed and placed in mailing containers, labeled, packed and wrapped in vari-
ous amounts for shipment. Specimen containers are shipped to every city
and town in Plorida.

Each laboratory test made requires the use of from one to ten pieces of
glassware which must be washed and sterilized before using.

101,034 Kahn tests were made in the laboratory during the year in com-
parison with the 72,123 tests made in 1936. Each test required 5 tubes
and 2 pipettes, a total of 505,170 tubes and 202,068 pipettes. Tubes
and pipettes are rinsed twice in tap water and boiled 15 minutes in a
soap solution, rinsed again twice in soft water, and then kept in
Dichromic Acid (cleaning solution) overnight. They are then rinsed again
twice in soft water, twice in distilled water, and dried in the usual

Throat specimens for diphtheria also require the use of tubes. 8,646 of
these tests were made, using one tube for the swabs and one tube of
media, a total of 17,292 tubes.

3,303 tests were made of milk. Each sample requires the use of ten
pieces of glassware, and this meant the preparation of 28.340 pieces of
glassware for the procedure.

Typhoid and other agglutination tests require both slides and tubes.
22,466 of these tests were made and 14,888 malaria tests were made, each
requiring the use of one or more slides. Many other examinations were
made, all requiring slides and tubes.

The total number of animalsexamined for rabies during 1937 was 676, while
only 239 were examined in 1936. The heads of these animals wore all
opened and prepared for examination by this department.

All media used in the Central Laboratory and the four branch laboratories
and by the sanitation department are made in this department. Part of
the specimen containers for use by the branch laboratories are assembled
here and shipped to them for distribution in their territory.

The consolidation of the water and engineering laboratories with the
Central Laboratory has made it possible for the department to serve them
with much less effort.

In connection with the service given the Bureau of Engineering, it may be
said that the express shipments of standard water sample cases, as well

as parcel post wrapping and mailing of the small water bottle boxes, is
an important part of our service. A single sample of water requires
eleven pieces of glassware during the process of examination and whcn it
is realized that 5,456 samples of water were received during the year,
it will be seen that 60,005 pieces of glassware were necessary for such

During the quarterly sample months-February, May, August, and Novenber
-considerable tint is required to care for spnple boxes received by
express and to arrange for their repacking with bottles for shipment the
following day.

Glassware and media necessary in conducting all water and oyster oxanina-
tionsare prepared by this department.

The Building Manager and Technical Assistant makes it possible for the
Laboratory, the Bureau of Sanitation and the Bureau of Engineering to
make examinations promptly; a delay in material or nedia would mean a
delay in examination; and sterilization of laboratory material plays a
very important part in making laboratory tests.

This department is also responsible for the cleaning and ninor repairing
of the buildings, the care of the grounds and the guinea pigs, and the
supervising of all shipments wiich are later checked by the auditor.,

One wing of the new addition to the State Board of Health was completed
in 1937, and with the completion of the second wing, the Bureau of Vital
Statistics will be moved from its downtown headquarters. When all bu-
reaus are under one roof, the work of this department will be much simpli-


3. C. Geiger, D. D. S., Director

The report of the activities of the Bureau of Dental Health, submitted
January 1937, dealt largely with organization plans, as the Bureau was
organized only four months before, in September 1936.

It is the province of the director of dental health education to en-
courage and lay plans for community dental health activities throughout
the state, Realising that the first step in laying the foundation for
a dental health program is education of the school children, teachers
and parents to the definite value of dental health as an aid to pre-
ventive medicine, close attention and study was given to the best meth-
ods of presenting such a program to the schools. The primary avenue of
approach in this work is through organized county health departments
into the schools; however, every county in the state has been con-
sidered as far as the Bureau's budget permitted.

The program of dental health education has been carried out, with some
additions and variations, as originally outlined, and with gratifying
results. From some thirty thousand letters received in this office
from school children throughout the state it would seem that many
school children of Florida are now mdental-minded" and "tooth-conscious";
that they realize the care of their teeth and the proper diet for good
sound teeth go hand in hand with other health measures toward making
healthy bodies, keen minds-and preventive medicine.

The personnel of the Bureau of Dental Health is composed of a consult-
ing director, director, secretary and one itinerant dentist.

During the summer months much time was spent in laying new ground for
the continuance of the dental health program in the schools for the
coming regular session. (The work done in the summer schools is given
later.) The program was approved and endorsed by the State Superin-
tendent of Public Instruction, and the Florida State Dental Society.

A series of lectures on dental health was conducted at the University
of Florida for teachers attending the summer session. The audiences
manifested much interest in the subject; this seems to be a valuable
aid to dental health education in the elementary school class room.

The first step in preventive dentistry should begin with sub-primary
children. To teach the importance of prophylaxis, proper diet, to re-
move the impression so many have of the horror of the dental chair, or
the dentist himself, to unfold the true story of dental care and health,
a booklet entitled te Jive littlee Pigs was published by this Bureau and
distributed to thousands of children in kindergarten, first and second
grades. Demands for this educatithal booklet have been so great that
the Bureau can no longer furnish them to the various schools requesting
them. The plates for the illustrations and tho titlo in tho.booklot were

borrowed from the Mississippi State Board of Health, and the rhymes were
written by Vonice Taylor, secretary of the Bureau of Dental Health.

A similar plan was carried out in the transposition of the lyrics of a
welliknonm song, "Billy Boy" to a dental health lesson. Other material
such as inspection slips, dental honor rolls, warning blanks, a booklet,
Dentistry and Public Health, distributed by the Bureau of Public Rela-
tions, American Dental Association, Chicago, and another booklet. Jimy
Ce.w, from the Good Teeth Council for Children, Chicago, was distributed
to the teachers and nurses throughout the state.

Cooperating with the Division of Public Health Nursing. State Board of
Health, this Bureau has issued about 8,000 pre-natal and post-natal
letters pertaining to dental health.

The interest of local dental societies in the program has been most en-
thusiastic. There are now 17 private practitioners serving as dental
health education chairmen in their respective counties. This enables
the Bureau of Dental Health to promote interest anong local dentists, and
to readily determine the reaction of the public through interest in cor-
rection by the program. To date there is more interest and more offers
of cooperation among organized dentistry than the Bureau is equipped to
accept. However, each county requesting a program has been included in
some phase during the winter months.

An exhibit of all materials used in the dental health educational pro-
gram was presented during the annual meetings of the Florida State Nurses'
Association, Florida State Dental Society, and the Florida Public Health
Association. The exhibit included a map relative to the prevalence of
mottled enamel over the state, and the incidence and concentration of
fluorine im drinking water supplies. A five foot drawing of a skeleton,
with neon gas tubing to trace the course of the blood stream, and show-
ing the node of transmission of dental infection, was demonstrated also.
This striking exhibit caused much interest as it spectacularly reflects
the necessity for dental health. A descriptive leaflet is issued to each

The Bureau of Sanitation, under the direction of Major Fred A. Safay,
collected water samples from every supply in the stateand analyses were
done in the laboratories of the Department of Chemistry, University of
Florida, under Dr. A. P. Black. A standardized method of determining the
concentration of fluorine in drinking water was made by Dr. Black and has
been accepted nationally. The laboratory results were correlated by this
Bureau with dental findings and were remarkably consistent. The county
of Sarasota was concluded to be endemic for fluorides and mottled enamel
as a result of this investigation.

During the spring and fall terns of school a Puppet Show was presented
through the cooperation of the Good Teeth Council for Children, Chicago, in
59 counties in the state. This performance, depicting the four points of
dental health in a dramatic, entertaining, and interesting manner, was pre-
sented to about 140,000 elementary school children, parents and teachers.

30,000 children wrote to "Little Jack", the main character in the Puppet
Show, in response to his request that they tell what they had learned; and
if they included the four points of dental health which were emphasized in
the show, a reply forn Jack would be forthcoming. The reply was immediately
sent in answer to each letter and expanded the four dental health points.

Plans through the cooperation of Dr. George Wood Clapp with this Bureau
were completed to carry the story of dental health to the advancing grades
through the program "The Dentist Sayo, This program is in the form of a
written travelogue for the purpose of mimic broadcasts by school children,
and embodies history, geography, and dental health principles. It was
issued to about 2,000 classrooms weekly nnd continued for a series of 13
week, T.Tc-cers found this method of instruction valuable.

The Director of the Bureau as Chairman of the Cor.ittee of Public Relations
submitted a report of the activities of the Bureau of Dental Health to the
Executive Council and to the General Assembly at the Florida State Dental
Society meeting in Hollywood, November, 1937. He also presented a clinic
and paper on the subject, "Juvenile Psychodontia", at the annual meeting of
the American Dental Association in Atlantic City. A similar paper was pre-
sented to the Florida State Dental Society in November. An address was given
over station WSUM, St. Petersburg, and one over WIJ Gainesville. Five
dental society meetings were attended. The Director attended the annual
meeting of the Good Teeth Council for Children, Chicago, upon the invitation
and at the expense of the Council.

The State Superintendent of Public Instruction, county superintendents,
school nurses, public health, Red Cross, and county nurses of 65 counties
were contacted for some phase of the program. The splendid cooperation re-
ceived from then, along with the work of the field dentist, enabled the
Director to carry a dental health program to a large majority of the coun-
ties in the. state.

A demonstrative method of teaching the value of dental health was created
during the past quarter, and plans were made for a mobile dental unit to be
operated by the itinerant dentist of the Bureau and.rented on a .-oekly basis
to interested counties. This, it is believed, would solve the local pro-
blem of indigent children, yet the counties would be required to pay for
their own problem. This would result in a safe clinical outlet for indi-
gents-which problem arises after any public health education program has
been in effect.

Dr. Turner, itinerant dentist, used the dental inspection slips, dental
certificate, honor roll plan in 9 counties,beginning this phase of the
program in August 1937. During the month of August inspections were made
among "Strawberry Schools", so called as they are open during the summer
months in order to permit the children to be free in mid-winter to pick the
strawberries. 4000 children were inspected at that time.

Beginning with the fall tern of school Dr. Turner contacted the county
nurse from this office, arranged schedules, and visited 133 schools, in-
specting 8,232 school children. Before the inspection program was

conducted the nurse was asked to contact the local dentists and r-in their
cooperation. The school nurse aided in tabulating the findings, and her
service proved invrluable. Dental health booklets,as well as lectures,
were given to the children during the inspection program. A circular of
information on the care of children's teeth was sent to those parents whose
children required dental attention. Following is a sunnary of the findings
of this inspection as reported by Dr. Turner:

Schools visited 133
Mouths inspected 12,232
Mouths without defects 4,472
Defects in primary teeth 6,142
Defects in secondary teeth 3,431
Diseased guns 406
Mottled onamel 267
Conferences with teachers 55
Talks made to P. T. A. 7
Classroom talks 249

We are pleased with the response of the public to the dental health educa-
tion program, with their eager acceptance of dental health information.
We believe that the 92.5. average of dental caries in school children, which
a cross section survey of the state reflected when the Bureau of Dental
Health was organized, points toward a decided reduction.


A. B. McCreary, M. D., Director

Within the past few years public health in Florida has made gigantic
strides. It has come a long way, but it is still faced by a long and
arduous journey.

The results of health education seem slo% but the greatest progress can
be achieved along these lines and thb Bureau of District and County
Health Work has devoted much of its time to an extensive statewide pro-
gram of health education designed to acquaint the people with the value
of full-time health service under properly trained personnel, The re-
suits have indeed been gratifying.

There is not a county in Florida which has not shown a growing interest
in the program. The fact that Florida only had three counties with such
service at the beginning of 1936 and 15 counties at the present time in-
dicates the strides that have been made. There are many other counties
desirous of the work and it only remains to set up a satisfactory bud-

The department has adhered strictly to the United States Public Health
Service ruling regarding qualified trained personnel.

Florida, like several states in the New England and Middle Atlantic
groups, is plagued with part-time set-ups which not only are woefully
inadequate but are a distinct handicap to the promotion of full-time
service, because of the false sense of security on the part of unlab
formed people; leading them to believe that they have health protection
when statistics show that they do noti

The expansion and supervision of adequate local health service is the
primary function of a state health department. The cooperative health
unit supervised by the state health department and approved by the
United States Public Health Service is recognized by medical and pub-
lic health authorities as offering the most modern and efficient type
of local health service. The standardization of health units accord-
ing to modern methods assures the recognition of the unit and its ser-
vice throughout the state and nation, just as the efficiency of medical
schools and hospitals are based on the approval of the Council of Medical
Education and Hospitals of the American Medical Association and the ap-
proval of this council means that the medical school or the hospital has
met the requirements for equipment as well as efficiency and competency
of personnel.

The necessity for special training of the personnel in administration
and other phases of health work is recognized as a mandatory requisite
of an efficiently operated health service. The actual control of the unit
is vested in the local community through the medical society and the
county commissioners with the State Board of Health acting purely in an

advisory and supervisory capacity to assure qualified personnel and the
application of uniformly accepted methods of public health procedure.
The cooperative health unit is supported by funds from local sources,
the State Board of Health, the United States Public Health Service and
The Children s Bureau of the Department of Labor.

The first full-time unit in Florida was organized in Taylor County, Sep-
tember 1, 1930, and continued to operated until August 1933, when it was
discontinued because of lack of funds. However, the county had learned
to appreciate the value of the unit and it was reorganized in March,
1936. Leon County 1931, Bscambia County 1932, Jackson County 1935, were
organized in the order named. 1936 saw the return of Taylor and the
addition of Broward, Gadsden, Monroe, Hillsborough and Wakulla Counties
and the Franklih-Gulf-Calhoun, tri-county health unit, with headquarters
in Apalachicola. In 1937 the Orange County and the Highlands County
Units were organized. Of these counties having the service only one was
discontinued and it was reinstated within two and one-half years.

After having had full-time health service a community is in much the
same position as the individual who gives up his automobile and goes back
to the ox cart; he soon realizes he is not getting anywhere fast, and
so does the community. Heretofore, Florida has relied upon a loosely
woven district scheme with the state divided into five districts, each
district having a district health officer, sanitation officer, public
health nurse and a clerk, all having headquarters at some central point
in the district. As these districts usually comprised from twelve to
fifteen counties embracing a vory large area and more than 300,000 pop-
ulation, it is entirely obvious that such a set-up would be inadequate
to administer health protection to such a large and populous area. Con-
sequently, these organizations were little more than complaint shooters
and pacifiers forming a buffer substance for the myriad, autonomous,
part-time, so-called health set-ups. Naturally, there were no standards,
and the regulations in many instances were dependent upon the mood of
the connunity.

The qualifications of the local part-time health officer varied from the
busy M. D. to the veterinarian and the untrained layman. Such conditions
exist today in some of the unorganized counties in Florida. It is diffi-
cult to understand the psychology that prompts a conunity to place the
health of its children in the hands of a veterinarian or an untrained
layman. That the veterinarian has a definite place in public health in-
sofar as the inspection of milk and neat are concerned, is not denied,
but the untrained individual certainly has no right to a place in such a

For years local governmental bodies have discharged their obligations with
regard to health by appropriating a meagre sun as a salary and naming a
part-time officer who was either too busy to give the matter any attention
or one who was.wholly unqualified. But public health is a full time job,

A medical society in a Florida county has addressed a communication to the
county commissioners in their county in which they close with the following

summary: "To sunmarize, we believe that this is the most important
position in the county. The proper health officer cad accomplish more
than any individual doctor. Let us get a man, properly trained, con-
scientious, and stand by him. If you decide on this, we suggest that
you consult with the State Board of Health. If you decide on an im.
properly trained nan, let us quit making a pretense, abolish the job
and save the money."

It is obvious that the application of sciences of medicine and engi-
meering to the problems of life and health-are mot only humanitarian
but of great economic value to the community.

It is difficult to appreciate why any community would subject its citi-
zens year after year to the continued ravages of preventable diseases
and the enormous losses of life, health, time and money.

The part-time set-up compares in efficiency with the cooperative full-
time health service just as the volunteer bucket brigade compares with
nodem fire fighting equipment. Surveys made in many of the counties
reveal that morbidity statistics are very misleading in counties with-
out full-time service. Reporting of disease is so lax that it is
practically useless.

One issub of the weekly morbidity report showed that 422 cases of
communicable disease were reported in the fifteen counties having full-
time health service, while a total of only 88 were reported by the 52
counties not having full tine service.

So one is misled for a moment into believing that there is actually
more disease in full-time counties. It is obvious that disease is re-
ported and some attempt made to control the spread in the organized
counties, while the unorganized counties as a rule ignore disease and
control measures.

A typical occurrence in an unorganized county is only two cases of
diphtheria reported but four deaths from diphtheria for that period.
In one county over a three-year period only once case of tuberculosis
was reported while the death certificates showed that 47 persons died
with the disease during that period* Authorities estimate ten active
cases for every death from tuberculosis, which means that there were
470 active cases of tuberculosis unrecognized, unrestrained and un-
treated. Another unorganized county reports five cases of typhoid
fever with eleven deaths.

With this in mind, and fully recognizing the inability of the district
organization to cope with the situation, the State Board of Health
through its Bureau of District and County Health Work' is directing
every effort toward an extensive program of health education for the
expansion of full-time cooperative health service in Florida.

During the months of February and March many cities throughout Florida
and eight counties rere visited in the interest of future full-time

county health units. Also, the Social Welfare Conference was attended
in Ocala, the Director appearing on the program in Dr. McPhaul's place.
Numerous lectures were given to many civic organizations on various
subjects, including "Syphilis" as well as "County Health Units", for
without full-time health service syphilis or any other communicable
disease cannot be proper controlled.

Since April the following counties have become very much interested in
full-time health service; Bay, Charlotte, Lake, and Orange. At a moot-
ing in Punta Gorda (Charlotto County) a talk was given on the functions
of a health unit and "What We May Do in Our County to Obtain This Ser-
vice." Through invitation numoron. talks wore given to practically
every civic organization throughout Lake County in the interest of a
county health unit for Lake County.

The class on Sociology at the University of Florida was given a lec-
ture at the request of Dr. L. I. Bristol, director of the department,
on the subject "Public Health and Its Relationship to Sociology"* This
lecture was followed by a talk before the Alachua County Medical Society
relative to the creation of a county health unit for Alachua County.

The last of April found Polk County inquiring as to the functions of
a county health unit, and Orange County forming groups to further the
organization of a county health unit for their county along with the
wholehearted support of the Orange County Medical Society, Also Duval
County added its name to the list of interested counties desiring to
know the merits of full-time county health service.

From time to time the Director has lent his efforts in making various
investigations and during May assisted in the investigation made rel-
ative to an epidemic of colitis in one of the south Florida cities.

A meeting well worthwhile was attended when the DeSoto-Hardee-High-
lands County Medical Society met in Wauchula. A very interesting
paper was red by Dr. N. L. Spengler of Tampa on "Medical Economics".
The Director in his talk "The Relationship of the Private Practitioner
and Public Health", made the statement that public health could become
the greatest ally of organized medicine, but in order for organized
medicine to take advantage of this ally they must give to this ally
their undivided support.

The Jacksonville Woman's Club requested the Director to address their
club in May on the subject "The Benefits of the Local Health Unit", as
they are vitally interested in securing full-time county health service
for Duval County and are lending their best efforts toward that goal.

Manatee County became another interested county in May when the Diroetor
delivered an address on "Health Education", to the 9th District Congress
of the Parent-Teachers Association in Bradenton, in place of Dr. McPhaul
who was unable to attend.

Also the possibilities of a health unit were discussed when the Director
accepted an invitation to appear at a meeting of the Public Welfare Coun-
cil and the League of Women Voters of Palm Beach County, in West Palm

As the month of June closed our fiscal year the majority of the month was
spent in the office except for a few trips to the various counties rela-
tive to and working on the preparation of new fiscal year budgets for
the county health units already organized and functioning in the State.

A new county to make inquiry as to full-time health service was Dade
when the Redlands District Lions Den was addressed in Homestead on the
subject "A Health Unit for Dade County".

July first started the now fiscal year and at this time it was decided
to change the name of the department from the Bureau of County Health
Work to that of Central Organization, District and County Health Work,
due to the fact that it covered the activities of the department more
fully. During the month various health officers were transferred and
many visits made to the counties in cooperation with the organized
health units and making the unorganized counties "health service con-
scious". Lake County was again addressed on the subject "The Value of
a Health Unit" at the request of the Eustis Kiwanis Club.

The inquiries of Lake County wore continued in the month of August re-
garding a full-time health unit and the Diroctor nra iAvito c to appear
before practically every civic organization in the county, including
the Rotary, Lions, Kiwanis and others. This is another county we ex-
pect to add to our list of organized health units before another year
has passed.

The Director again filled Dr. McPhaul's place when he lectured to a
state meeting of teachers at Camp Roosevelt on the subject "What Price
Ignorance" in August.

Polk County Kiwanis Club invited the Director in August to address a
group of prominent members of the Rotary, Lions and other civic organi-
zations on the subject "Syphilis",and under the subheading "Control"
the fact was brought out that syphilis could only be controlled through
adequate health service such as was rendered by a full-time county health
unit. Also at this meeting, the point was stressed that the Kiwanis with
their Safety Patrol Program, their Underprivileged Child Program and
Crippled Children's Program, could not have a greater project than that
of adequate health service for every county in Florida and urged that
they bring this matter to the attention of their District Convention to
see if they could not incorporate this as one of the major projects in

Orange County was the new county to enter our group of county health tinits
for the month of September, with the Orange County Medical Society co-
operating to the fullest extent. It was agreed in drawing up their

budgetary contract that the following items be included: MThat it is
agreed that all parties enter into the contract, that all personnel must
be approved by the State Board of Health and meet the minimal require-
ments laid down by the Social Security Act and approved by the United
States Public Health Service and further that no personnel will be ap-
proved in Orange County that does not meet with the approval of the
Orange County Medical Society, as expressed through their committee
which will act as a nominal Board of Health, that no program will be in-
augurated which does not meet with the approval of the Orange County
Medical Society and the State Board of Health."

The fall term for the course in Public Health at the University of
North Carolina, Chapel Hill, North Carolina, opened in September and
Florida sent three trainees for this course.

Baker County and Manatee County displayed a great deal of interest in
October relative to the establishment of a full-time health unit, how-
ever, duo to local misunderstandings as to U. S. Public Health Service
requirements by which a county must abido if they are to participate in
federal funds, they wore unable to organize at that time, but we look
forward with anticipation to the straightening out of their differences
and the entrance into the work within the next year when new budgets
are made*

In November the Polk County Medical Society invited the Director to
address them on the subject of full-time health service and they uront
on record as heartily favoring the health unit and appointed a commit-
tee of five doctors to work with interested groups of the various civic
organizations towards stimulating public opinion and the laying of the
foundation for full-time county health service for Polk County in the
very near future.

The Southern Medical Association was attended in New Orleans, Louisiana,
in November and the Florida Public Health Association in Tallahassee in

The year closed with a bright outlook for 1938 for the organization of
many new county health units and we feel well repaid for all efforts
spent in the interest of same. 196 conferences were held during 1937,
63 lectures given during the same period and three counties were sur-
veyed-Alachua, Duval and Manatee Counties. We appreciate the whole-
hearted cooperation of the medical profession throughout the state and
consider them our greatest ally in the establishing and maintaining
full-time health service for eveiy county in Florida. Too, the civic
organizations have been most helpful with their spirit of cooperation
and may we add here the resolution passed at the Florida District Con-
vention of Kiwanis held in St. Augustine in October as one of the high-
lights. We quote from the October issue of FLORIDA HEALTH NOTES:

"Leon County (Tallahassee) having the oldest continuous cooperative unit
in the state made it logical for the Tallahassee Club to sponsor such a

program before the florida District Ki[anis Convention. After present-
ing the plan to Ktwanians Graves, Doyle, Davis and Meginnis of the
Tallahassee lub,. the Director was asked to present it to the club,
which was done at their regular meeting October 5. Tho plan was favor-
ably received by the Club and it was moved, seconded and passed that a
resolution to that effect be drawn up and their delegates instructed
to present the folloviag resolution to the Florida District Convention
at St. Augustine:

*"WHREASs Public Health Work as represented by the Unit Plan fostered
by the State Board of Health is recognized by the medical and public
health authorities as being the best and nost adequate forn of health
service, and

"WHiERHS: As nost of the Kiwanis projects pertaining to health, such
as the safety patrol, underprivileged child and crippled children s
work would be covered fully by such a nove,

"BI IT THBEFORE BSOLVED: That the Florida District make the creation
of full-tine health service through the unit plan under the supervision
of the State Board of Health one of the najor projects of Kiwanis,

"AND FUBTHER: That such a plan be recomnende and sponsored before
Kiwanis International as a National and International project.

The resolution was unanimously adopted and Kiwanis has again set the
pace. Kiwanis history as well as public health history was made at
St. Augustine, the old city, already clothed in the richest habiliments
of early American history."


J. V. McMurray, M. D., Director

The personnel of the Broward County Health Unit for 1937 was composed of
Dr. Paul G. Shell, Director, Mrs. Mary F. Herndon, R. R,@ Mrs. 1E C.
Geiger, R. N., Mr. L. E. Johns, County Sanitary Officer, Mr. George Aq
Warren, Sanitary Officer for the City of Fort Landerdale, and Miss Margaret
Fisk, secretary. On November 15, Dr. Paul G. Shell resigned as Director
and was replaced by Dr. J, W. McMurray who was transferred from the Frank-
lin-Gulf-Liberty and Calhoun County Health Unit to Broward County. During
the surner Mrs. Geiger resigned and was not replaced until December 1, 1937.
Mrs. Audrey Gollion, R. N., was then assigned to the department. On Decen-
ber 1, Miss Madge Padgctt was assigned to the Hollywood office as clerk
on the state TPA nursing project.

During the year 1937 all of the civic organizations in the county were
visited and at least one health talk given before each body. A total of
135 meetings were attended rrith an estinnted attendance of 5,000 people
at these meetings. During 1937 one hundred, thirty-three cases of communi-
cable diseases were rdnitted to service. The usual childhood diseases
accounted for practically all of these visits.

Communicable Disease Report

Measles 14
Syphilis 399
Gonorrhea 7
Tetanus 1
Typhoid fever 1
Scarlet fever 9
Malaria 1
Diphtheria 6
Infantile paralysis 1
Tuberculosis 3
Chickenpox 84
Meningococcus noningitis 2
Whooping cough 21
MuWps 32
Hookworm disease 20

During the year, 1609 Tasserman's were taken and 138 individuals were
admitted to the medical service, and 41 cases were transferred to pri-
vate physicians. Nine hundred, nine clinic visits were made during the
year, and 371 field visits were made urging patients to continue troat.
ments. Practically all of these patients were either food-handlers or
prenatal cases. One hundred, twenty-five field nursing visits were mado
to tuberculosis patients.

During the year, 300 maternity cases were adnittod to the medical and
nursing services, with 48 cases visiting their own physicians. The
total 794 visits were made to medical conferences, and 495 field nurs-
ing visits were nade to antepartun nursing service, also, 378 post-
partun nursing visits were made. Regular monthly meetings of the mid-
wives, registered to practice in the county, were held. At the present
tine we have 12 midwives registered for instruction. A total of 12
meetings with r.n attendance of 130 were held during the year. Two
hundred, thirty-four nursing visits were nade for midwife supervision.

One hundred, oighty-five infants were admitted to nursing service with
612 field nursing visits, and 295 office nursing visits. Four hundred,
thirty-four nursing visits were made to preschool children, and 110 pre-
school children examined at the sunner round-ups. Eleven summer round-
ups wore hold throughout the county during the year.

The county school board and the health department has established a
ruling that no child may enter school unless he has a certificate from
a physician stating that he is free from communicable disease. This
only applies to children who have been out of the state,. During the
year 14,500 inspections were nade; 1472 examinations by physician;
1364 nursing visits; 1328 school visits were made and 367 children
excluded front school; 48 athletic certificates were issued, and 507
classroom health talks were given during the year.

Approximately 1,100 individuals wore examined for health certificates
during the year; 15 hone hygiene classes vere held under the sponsor-
ship of the American Rod Cross,

Four hundred, twelve field nursing visits were nnde to 60 individuals*
The following defects were corrected: 8 visual; 234 dental; 17 tonsil
and adenoid operations.

The health depprtnent cooperated very closely with the Crippled Children's
Conaission and assisted with the clinics held twice a year in Broward
County. Twenty-nine individuals reported for examinations; 166 follow-
up nursing visits were nade, and all orthopedic care being given under
the Crippled Children's Comnission in Miami.

The sanitary division of the county health unit has nade considerable
progress during the course of the year 1937, and while this county has
increased in population sono 13% with a corresponding increase of the
work of the department, it is the consensus of opinion of all interested
parties that general sanitary conditions are far better than they were
during the initial year of our work here. As an example, we cite the
dairy situation which in 1936 had a rating of 84% and now enjoys a rat-
ing of 92% Percentage of pasteurized milk has risen front 68% to 83%.
This department also has under supervision: 7 bakeries; 5 bottling plants;
5 canneries; 7 dairies; 203 groceries and markets; 4 ice crean manufactur-
ing plants; 5 municipal water plants; 2 municipal pools; 18 public schools;
12 private schools; 257 eatin- places; 2 sewerage systems; 13 trailer canps;
and 18 tourist canps.

We have been forced to close 1 bakery, 3 tourist courts, 1 bottling
plant, 3 dairies, 1 slaughter house; but the remaining establishments
are completely sanitary and are under regular supervision and inspection
by this department. They meet in every respect the requirements of the
municipal, state and federal ordinances. The slaughter house that was
closed was remodelled and is now, we believe, the best in all of south
Florida, and the owner of the establishment admits his business has
trebled since making the required changes. Tourist camps in the county
have increased from six in 1936 to thirteen during 1937; Our tourist
camps are generally acknowledged to be the best in the whole state and
have been a great asset to the county. During our stay here it has been
necessary to have only six court cases all of which were decided in our

By special request we are citing just one example of what en efficient
health department can do for a county such as this; namely, the matter
of the unincorporated town of Davie. To found this conrunity in very
bad sanitary condition, and subject to recurrent epidemics of connuni-
cable diseases due entirely to this condition. We immediately took the
necessary steps to correct the various faults existing there including
condemnation and demolition of a large and insanitary structure in the
center of the connmnity. Since then, this community has prospered ex-
ceedingly, and one hundred thousand dollars worth of new buildings has
been spont there. This community gives the health department complete
credit for this very satisfactory situation.

One of the worst sanitary nuisances this department has had to contend
with is the Hinmarshee Canal here in Fort Lauderdale. This canal was
originally installed %s a drainage basin for that section of the city,
but many sanitary hook-ups were permitted by previous administrations
and so at the present tine this waterway is to all intents and purposes
nothing more or less than an open sewer. It would have been possible for
this department to order these sanitary hook-ups discontinued and new
waste disposal installed, but we knew that sanitary sewers were going in
which would correct the situation. Today some 25% of this nuisance has
been abated and steps are beinc taken so that we can safely say that with-
in three months the situation will be entirely corrected front a sanitary
point of view.

We have now gotten through a government project for the building of sani-
tary privies throughout the county with a government appropriation of
some twelve thousand dollars. We expect to start work on this project on
or about May 1, and our plans call for the erection of approximately 350
sanitary privies throughout the county, mostly the poorer rural districts.
These are very badly needed to prevent the spread of communicable diseases.

There has been inspected and approved 181 private water supplies; 125 new
privies erected; 50 privies restored to sanitary condition; 185 septic
tanks restored to sanitary condition; 564 private house inspections made;
219 inspections of tourist camps nade; 67 sanitary inspections of schools
made; 5 inspections of public water supplies made; 12 inspections of

sewerage plants nade; 8 inspections of bottling plants made; 25 inspec-
tions of canneries made; 14 inspections of public buildings made; 439
complaints handled; 767 follow-up inspections made; 389 nuisances
corrected; 654 buildings mosquito proofed; 59 .nopheles mosquito breed-
ing places eliminated; 30 other such places were placed under control;
1,100,000 artificial containers destroyed; 36 unsanitary buildings
condemned, of which.11 were demolished and the balance restored to
sanitary condition; 138 inspections made of animals suspected of rabies;
1,096 inspections made of food handling establishments; 164 inspections
made of dairies; 6,836 cows tuberculin tested; 40,762 cows Bang' s tested;
8,790 cows mastitis tested; 5 tuberculosis reactors destroyed; 61 mastitis
reactors destroyed; 2,293 Bang' s reactors destroyed.

A total of 2,359 diseased dairy cattle were destroyed by order of this
department to insure the county a safe and pure milk supply. For the
past 19 months there has not been a single case of tuberculosis anong
the cattle of the county. Bang's disease and mastitis have bean practi-
cally eliminated. We have condemned in whole or in part 251 carcasses
of slaughtered animals as unfit for human consumption, have made 22
inspections of slaughter houses, have made 44 water analysis, and 1,138
milk analyses and prepared 14 articles on sanitation and milk inspection
situations in the county, some of which articles were widely circulated
and have gone far to establish the reputation of Broward County as a
safe and healthy place in which to live.


1h. H. Pickett, M. D., Director

In addition to the statistical report of the Escanbia County Health Unit
for the year 1937, I wish to note the following general activities;

1. Me e stblishnent of a malaria control program under the direc-
tion of the Rockefeller Foundation in the City of Pensacola and the county.

2. The establishment of community health clinics at Centruy, Molino
and at the office in Pensacola.

3. Extensive inprovenents in sewage disposal systems throughout the
un-sewered areas of the city and county.

4. The improvement in individual or private water supplies outside
the city water main areas, through field and laboratory inspections and

5. Exceptionally fine improvement in general sanitation of all
dairys throughout the county was due to two separate detailed sanitary
surveys of dairy, equipment, methods etc., conducted by Dr. McCreary and
assisted by the state dairy inspector. All milk now sold in Pensacola is
either grade W'A raw or pasteurized milk as determined under the regula-
tions of the standard nilk ordinance.

6. The typhoid immunization campaign conducted in all city and
county schools was completed during the first part of the year and six
thousand, three hundred, twenty-six persons completed the three doses.

7. The entire week of April 4 was devoted to assisting with Negro
Health .leek.activitLeo. The program received honorable mention by the
National Negro Health Week Committee in Washington, D. C. for outstand-
ing accomplishment.

8. Sunner round-up physical examinations and immunizations were
conducted during the month of May at seventeen different points througb-
out the city and county and with the result that Io hundred, fifty-one pre-
school children were serviced. These round-ups were held in cooperation
with the local, state and national parent-teacher's summer round-up

9. An extensive hookworm survey was conducted in rural areas of the
county by Mr. Davis of the State Board of Health, and all positive cases
followed up with advice to build and use sanitary pit privies, also with
treatment. One hundred, twenty-nine privies were installed during the
year with assistance from WPA; approximately twenty families constructed
and erected their own.

10* A first aid station was established for army and navy personnel
at the city hall.

11 The children of all schools in the city and county up to the
age of twelve were examined for evidence of latent malaria infection as
as manifested by enlarged sploens by Dr. lmendorf who was assisted by
two or nore nurses in each school*

12. A field training school for student nurses from the Pensacola
Hospital was established for the purpose of giving each student nurse a
six weels field training in public health nursing. Two nurses are assigned
at a tine and they are under the immediate supervision of Mrs. Nancy
Lawlor, R. N.

13. A complete sanitary survey was made of each and every home and
place of business in the city.

14. A complete sanitary survey (using score cards) of all food es-
tablishments was completed*

15. All tourist camps and public eating places in the county were
systematically inspected and re-inspected when necessary.

16. All food handlers were required by the city clerk to have
health certificates before new licenses were issue. This resulted in
finding several communicable disease cases, which otherwise might have
been missed.

17. WPA officials also cooperated by requiring that all food hand-
lers in ghool lunch rooms have health certificates before starting work.

18. The physical examination of first, third, and fifth grade
pupils in all schools was begun during the fall of 1937 and will be com-
ploted in 1938. Referred children from other grades are also examined.

19. Approximately 1,154 babies and children received diphtheria
toxoid during the year.

20. Approximately 1,365 babies and children were vaccinated
against smallpox.

21. Following the tuberculosis testing of high school pupils in all
white and colored high schools, an intensive program of home visits to
positive reactors was carried on by the nurses. Many of them applied for
end received x-rays as a result of the visits.

22. The preventorium was completed and filled to capacity with
children. The children are for the most part from homes where they have
been exposed to open cases of tuberculosis. Each of these have positive
reactions to the tuberculin test and are otherwise under par physically.


28. In cooperation with the State Bureau of Dental Health an
intensive education campaign was put on in public and parochial
schools. A puppet show was put on bringing out in a visual and en-
tertaining way the pertinent facts about 'dental health, An inspec-
tion of the children's teeth was nade by the dentist with notifica-
tion to parents.. Following this, dental honor roll clubs were or-
ganijed by the nurses along with follow-up visits in the homes. This
program is being carried on with good results.


K. K. Watering, M. D., Director

During the year 1937, several changes have taken place in the staff of
the Gadsden County Health Unit, which now consists of the following
personnel: Director, X. K. Watering, M. D.; public health nurses, Mary
L. Harrison, R. N., Thais W. Pope, *R N", and Pannie Munroe, R. N.;
sanitary officer, Graham McKeown; and secretary-clerk, Inez Payne.

In addition to the official staff and through the interest of the Board
of Social Welfare, it has been possible to add two NTA workers, who
have relieved the nurses of much office routine. These lay-workors not
only prepare and maintain supplies, but also assist the nurses at the
various clinics and conferences. Through the same agency, a IPA Janitor
has been obtained, who has proved very handy and useful. In the near
future it is expected that the services of a part-time clerk will be

The county has been re-districted into two nursing districts, divided
by a line running north and south Just west of Gretna. Plans have
been formulated for the establishment of a Health Centre at River
Junction, which are well near completion.

The nurses carry on a generalized nursing program. It is a tribute to
the nursing staff of the Health Unit to have carried on as extensive
a program as is shown by our statistics. There are only two full-time
nurses to cope with a population of over 27,000 whose public health
needs are as acute as any community in Florida.

Communicable Disease Control

A genuine effort was made during the latter half of the year to im-
prove the reporting of communicable disease. All the physicians and
registrars in the county were visited either by the Health Officer or
by one of the nurses with this specific end in view. As a result,
thore has been an improvement in the reporting of communicable diseases,
though we realize that much remains to be desired in this respect.

Our major problems in communicable disease are hookworm disease, malaria,
tuberculosis, syphilis, and diphtheria.

Our efforts in diphtheria control have been directed towards immunization
of the preschool group of children. Notices are sent to parents, when
the physician visits the schools, that an opportunity to protect the pro-
school child is offered. Consequently, a larger number of preschool
children have been immunized this year. However, there have been more
cases of diphtheria reported this year and two deaths during the last six
months. All cases are investigated thoroughly for the source of infec-
tion, isolated, and contacts quarantined.

With the cooperation of the.State:'oart of Health and the Rockefeller
Foundation at Vanderbilt University, an extensive intestinal parasite
survey was conducted in the county under the direction of Mr. L. P.
Davis. Over 1',600 specimens were collected from the various schools
with the following results:
Positive Hookworm
Hitson .(white) 76.06
Havana High School (whitc) 54.7
Concord (white) 68.0%
Mt. Pleasant High (white) 58.6%
S Oeensboro High (white) 45.7%
Chattahbochee High (phit ) :26.7
Midway (colored) 24.
Stevens High coloredd) 22.7

All the positive cases are offered an opportunity to obtain treatment
by the health department if they are unable to consult a private phy-
sician and with the permission of their parents.

The Malaria Control. Project was approved in the surmer of 1937. Due to
scarcity of. PA laborers in the county, it was impossible to start work
on the project, which has been scheduled for February, 1938. The pro-
ject includes the drainage of several large ,pools. north' of Qincy and
smaller ones sr6und Hinson. It will greatly benefit the community if,
once completed,' it wiil-, receive prgpqr maintenance.

With the approval of local physicians, a concerted effort was made to
establish weekly venereal disease clinics for the treatment of the in-
digent and neb-indigent. At present, three 'clinicseare hold every
weok at Quincy, Havana, and River Junctio; .treating an average of 200
patients per week.- This program has received-the whole-hearted support
of the community and with its inception, educational articles and talks
have been given by members of- the staff.

All cases of tuberculosis reported have been investigated, isolated, and
aided in every way possible. A constructive program on a broad basis was
not initiated during 1937 and will be one .of our cbjecotives for 1938.
We have received 'ad front the FloFrda Tuberculosis and Health Assotiation
in paying for the .examination of indigent patients. This organization
contemplates the establishment of a local tuberculosis committee, which
should enhance the development of some constructive work in this field.

Immnizations have been carried out in the schools and at various points
throughout the county. Both white and colored school children have been
given the imnunising sera to the numbers indicated in our statistics.

The Gadsden Count chapter of the Anorican Red Cross has been very active
in aiding us to combat pellagra. Over 130 pounds of yeast were distri-
buted by the nurses during the year.

Maternity Service

There are three maternity conferences hold monthly throughout the county.
The conferences at Quincy are held every two weeks. They are well attend-
ed and are under the direction of local physicians. A complete physical
examination, including blood-pressure reading, pelvimetry, urinalysis, and
Kahn tests are given to each patient. Patients are taught the essentials
of prenatal care and are referred to private physicians whenever indicated.

Midwife conferences are held every month and under the direct supervision
of the health department. There has been an improvement in the quality
of the midwife in her work and much credit is due Miss Graves and Mrs.
Munroe for this change. The Midwife Institute held by Miss Graves was
well attended. At the end of the year, we find that we have twenty-three
registered midwives and four iho are not registered. All midwives have
been examined by the health officer and have been tested for typhoid,
hookworm, and syphilis,

School Hygiene

There are five large white schools in the county. The health department
examines the first three grades in the larger schools and all the grades
in the smaller ones. All white schools are visited yearly and as many
of the colored as time will allow. Besides the routine examination,
children are tested for hookrorm disease and are offered an opportunity
for immunization. Local P. T. A. groups have been most cooperative in
providing lay help for these occasions.

Both white and colored school teachers have been urged to take the
serologic test for syphilis. Practically all colored school teachers
have submitted to this test. A chock-up is maintained to see that appro-
priate treatment is instigated and continued.

The following is a brief suamary of other activities of the health depart-

administrative visits 1,275
Visits to communicable disease 230
Smallpox immunizations 1,016
Diphtheria immunizations 557
Typhoid immunizations 752
Schick tests 621

Venereal Disease Control:

Clinic visits 5,189
Kahn tests 3,009
Trentncnts 2,937

Tuberculosis Control:

Admissions to service 16
yield nursing visits 158

Maternity Service:

Cases admitted to service 211
Field nursing visits 451

School Hygiene:

Inspections by nurses 1,186
Examinations by physicians 1,464
Classroom health talks 97
Attendance 1,986


During the year 1937, 405 visits nere made to private premises. Orders
for toilets have exceeded the visits made to private premises, due to
contacts outside the hone and orders obtained in bulk. Twenty-six con-
plaints were investigated and fifteen nuisances corrected, necessitating
follow-up visits totaling eighty-nine.

Pood handling establishments have received close attention and the general
standard has been raised. All food handlers are now holding health cer-
tificates which includes a typhoid specimen us well as a Kahn test.

Dairies have received closer attention than ever before. Two milk
houses are under construction at the present time; two others have been
screened and glassed; two water supplies have been protected and one seni-
protected. Several small improvements have been made here and there. The
Wnirynen, on the whole, are very cooperative and usually are desirous of
complying with our wishes. All nilk handlers hold health certificates.

Eighty-nine visits were made to the schools and numerous toilets were
built. Satisfactory water supplies have been installed in several, and
with the now construction progrnn in the offing, more of these will be
installed. While making these inspections, health certificate blanks iere
distributed to teachers throughout the county. Other activities that de-
serve attention are: new winter connections, 8; U.S.P.H.S. privies in-
stalled, 165; septic tanks built, 13.

The negotiations incident to the promotion of the Malaria Control Project
have occupied a good deal of the time and efforts of this department. The
realization of this project has been the objective of this department
throughout the year.

Other routine activities are listed in the statistical report.


Joseph S. Spoto, M. D., Director

The end of the calendar year 1937, marks the first anniversary of the
Hillsborough County Health Unit. Previously no provision had been made
for the prevention of disease, however, for many years the county had
amply provided for the care of the sick. The organization of this de-
partment was made possible through the efforts of the Florida State Board
of Health. It is my opinion that the contribution of funds by the federal
and state agencies was a major deciding factor in the establishment of
this department.

The greater part of the past year was spent in organization of the de-
partment, and in the education of the people to a better understanding
of the functions and services rendered. It is our opinion that we have
been able, during the past year, to "sell" the people to the type of
organization such as ours.

Hillsborough County covers an area of approximately 1,067 square miles,
with the exception of the City of Timnpa which has a population of
approximately 7,200, the remaining 60,000 inhabitants live in rural
areas. Due to the large area covered by the county, we attempted in
our organization to make our services as readily available as possible
to the people in the rural areas. It was with this thought in mind,
that the county was arbitrarily divided into five districts in which
seven Health Centers have been established. The central administrative
offices were located in the State Board of Health building in Tompa.
The Health Centers were distributed at strategic places in the county,
where they would be readily accessible to the largest proportion of
people. Health Centers are established in the following communities:
Ballast Point, Sulphur Springs, Belmont Heights, Oak Park, Riverview,
Plant City, and Timaumm.

The various divisions of this department utilize the Health Centers as
a hub in the conduct of their respective duties. It is our belief, that
not only have the Health Centers facilitated the administration and
placed our services within easy reach of the people, but have also been
of an inestimable value in creating intense interest in the various
communities throughout the county.

Whatever success we may have hcd during the first year of operation
could not have been possible without the whole-hearted cooperation of
the mnny civic organizations, voluntary health agencies, official govern-
mental units, nnd the medical and allied professions. We, in the Hills-
borough County He.lth Unit feel greatly indebted to these organizations.

Communicable Disease Control

The following comunicable diseases were reported to the Health Unit dur-
ing the calendar year: chickenpox, 22; diphtheria, 18; malaria, 8;

meningitis, 3; measles, 9; mumps, 43; scarlet fever, 21; typhoid fever, 7;
undulant fever, 1; syphilis, 71; whooping cough, 32: and typhus fever, 1.

It has been gratifying to note that we are securing better reporting of
communicable diseases in our county, and that the physicians are appreciat-
ing more and more whatever services are rendered in this respect.


During the first year of operation, we have stressed immunization against
smallpox and diphtheria. As many individuals as possible were immunized
with the meager funds available for this work. Out statistical report in
this respect indicates that in proportion, the number of diphtheria in-
oculations given to the age group under one year was low. It is hoped
that with the coning year : more immunizations can be done in this age

Since August 1937, we have been confronted with a rabies epidemic among
the dogs in the county, which is still prevalent, On September 4, a dog
quarantine was declared in Hillsborough County by the State Board of
Health. It was necessary to employ an individual to enforce the quarantine.

It is with regret that we report, that on September 27, a white female, age
42, died of hydrophobia. The source of infection was traced to a dog which
was proven rabid by the Laboratory on August 18, 1937. Although the di-
seased patient was not actually bitten by the rabid dog, she had attempted
to force nourishment and medicine into the dog's throat on August 15, at
which time she had numerous scratches on her hands. Very effort is being
made to cope with the existing situation and it is hoped that the epidemic
will subside in the very near future.

Following is the number of positive rabid dogs since the epidemic began in
August, 1937:
August 12
September 15
October 11
November 17
December 8
Total 63

Tuberculosis Control

During this year efforts have been made toward a tuberculosis control pro-
gran. The Unit in cooperation with the Hillsborough County Tuberculosis
Association has conducted tuberculin test clinics in the various schools of
the county, limiting such tests to the older age group of the school popu-
lation. Those found tuberculin positive are being x-rayed with funds avail-
able from the Hillsborough County Tuberculosis Association.

At the present tine efforW are being nade by the Unit to coordinate what-
ever work is being done in tuberculosis control by the various agencies
interested in the problem. It is hoped that in the very near future nore
effective neans will be devised in copeing with the tuberculosis problem.

Syphilis Gontrol

Due to the lack of funds our syphilis control program is necessarily
limited. We have sought and received the nost excellent cooperation front
the local nodical profession. It has been agreed that any syphilis case
discovered by the Unit be referred to the family physician. All indi-
gent cases would be treated by the family physician, if the Unit would
furnish the necessary anti-syphilitic medication. One of the pathologists
in Hillsborough County has agreed to do all dark-field examinations,
supplmennting the serological done by the State Laboratory in Tampa. Up
to the present tine this plan has not with a marked degree of success, and
to the best of our knowledge most syphilis cases carried on our records
are receiving adequate treatment.

Maternal and Child Health

Monthly, sixteen child health and twelve maternal health conferences were
conducted in the seven Health Centers in the county. We have received
the most excellent cooperation front the local medical profession. The phy-
sicians holding these conferences are paid on an hourly basis through
funds nade available by the Children's Bureau and the county.

There has been a gradual increase in the attendance of the conferences,
necessitating the establishing of nore conference days to prevent over-
crowding. Ve are striving in these conferences to do'qualityN instead of
*quantity". 'e are very proud of the quality of work done in our con-

Early in the year one of our nurses was assigned as Midwife Supervisor.
This places more emphasis on the nidlwife .ork, and is a step forward
towards the goal of "Safer Midwivcs" for the county.

"Division of Public Health Nursing"

This first year of the Health Unit service has been marked by changing
attitudes, particularly on the part of the public. An air of doubt and
indifference which prevailed at the first of the year has gradually
changed to one of confidence and enthusiasm? The group of Unit and WPA
nurses have played their part in helping to bring about this changed
attitude. By their services of education in the prevention of illness
and by their demonstrations in the hones of the care of the sick, as
well as by their classes in the schools and with the adult groups in
Hone Hygiene, First Aid and Prenatal care. These contacts have been
permeated with the spirit of kindness and understanding of the problems
found in tho hones, Results have been obtained by persuasion and not by
dictation, .and by the ability of the nurses to put themselves in the

others place, a good vantage point to view problems with a tolerant un-
prejudiced mind.

Some tools of publicity which were employed to further the idea of better
health for all,,were the mothers and the Christmas parties sponsored by
the Mothers' Aid .Chainan o't the five district Health Councils. The
mother's party held the Friday before Mother' s Day not only connemoratod
Mother's Day, but also instilled the idea of "Safe Motherhood". Although
these were the first parties of this type held in the county, they went
over in a big way, as over 1,066 persons attended. The Christmas parties
embodied the Christmas spirit in a practical way by providing layettes
and other necessary articles for the needy mothers, and some 250 persons
enjoyed this event. The communities, especially the church groups took
part in these festivities and the spirit of conradship that prevailed has
done much to create a better understanding and to develop a broader
community spirit.

An original skit entitled, "All in a Day's 8Work" was presented by the
staff nurses the first part of the year to four different groups. This
also added its bit to help clarify nany hazy points concerning the health

The intelligent work done by the county and district Health Councils has
been of inestimable value in promoting and interpreting the service of
the people, and also in assisting the nurses throughout all the districts
with their work. Such unselfish team work is bound to spell health pro-
gress for the county in the future.

"Division of Dental Health"

The Division of Dental Health of the Hillsborough County Health Unit was
inaugurated on March 8, 1937. This division has for its purpose, the
elimination of all dental defects in the school children of our county,
We know that out of an enrollment of 10,000 children in the county schools,
about 85% or 8,500 have some type of dental defect. So with this in mind,
we have attempted to develop a program, with the limited personnel, that
would be most beneficial to the greatest number of children. Our program
must then be one of education. The method of education is both didactic
and demonstrative.

The educational program includes the inspection of all elementary school
children, at which time if dental defects are found a card is sent to
the parents of the child notifying them that defects were found, and
that the child be taken to their family dentist. On the reverse side of
the card there is a space for the dentist to record his corrections, he
then signs this card and it is returned to the school from whence it
originated. By this system of control cards, we are able to determine the
number of children who do receive the proper dental care. This card is
then returned to the main office to be filed with our inspection card. By
the use of this system we are directly responsible in a great many in-
stances for the child's first visit to the dentist. This system has been
so effective in some schools, that we have been able to reduce the in-

cidence of dental defects to 8% of the enrollment in one of the largest
of our county schools.

We have been instrumental in the establishment of tooth brush drills
once a week in the schools, At the time of the inspections in the schools,
we give short talks to the teachers and pupils on the importance of pro-
per care of the mouth, and other important dental problems. We have
addressed the P. T. A.'s of various schools, and also the district Health
Councils. Our greatest problem is the educating of the lay people to the
fact that the baby teeth are as important to the child as the permanent
teeth are to the adult. Too many of our people still harbor the belief,
that inasmuch as the baby teeth will be shed there is no need for their
care. They are not aware of the harmful effects that ma ensue, if atten-
tion is not given to the dental defects in early childhood. With this in
mind, we have established two demonstrative clinics, one for each section
of the county where we put into practice our theory of the care of child
teeth. In these clinics we do the corrective work on the indigent child-
ren, up to and including twelve years of age. Besides correcting the
defects of children we instruct them in the proper use of the tooth brush,
and point out to the parents the importance of proper dental care, parti-
cularly explaining to them the importance of the six year molar, and that
it is a permanent tooth and not a baby tooth as is the general belief.

The one great disappointment of this demonstrative clinic, is in the
number of broken appointments. Our county is large and some of the commu-
nities being a great distance from the clinic makes it somewhat difficult
to make proper arrangements. One community is a distance of thirty-five
miles from the nearest clinic. It would be inconvenient for one with
means to travel that distance, so with the indigents it is almost impossi-
ble. In some of the schools that have active P. T. A. groups with well
organized committees, this does not constitute a problem but these are in
the minority. The principals and teachers as a whole have been very
cooperative. In one particular instance the principal of one of our more
remote schools furnished the transportation for his children and we have
been able, due to his enthusiasm, to do very excellent work. If this was
the general attitude throughout the county, we would be able to do the
most good where it is really needed.

Our transportation problem will be solved in the very near future, when
the "Dentomobilo*, a dental office on wheels is completed. Then we will
be able to go directly to the schools and do our work there. A schedule
will be worked out and the school principals will be notified long in
advance of the proposed visit of the "Dentomobile* to the particular
school, so that all preliminary arrangements will have been completed be-
fore our arrival and there will be no loss of time.

We wish at this time to thank the school authorities, teachers, P.T.A.,
and Health Councils throughout the county, the school physicians and
nurses, and all other parties, who through their unselfish support and
excellent cooperation have contributed toward the successful execution
of our program.

Following is a brief statistical report of the Division of Dental Health:

Total number treated 1,178
Total number fillings 2,216
Total number extractions 774
Total number prophylaxis 309
Total number treatments 26
Total number school inspections 2,V13

"Division of Sanitationy

One of the most outstanding accomplishments of this division for the
calendar War 1937, was the following: the installation of 530 approved
sauitary pit privies throughout the county, the repairing of 52 privies;
and the installation of 15 approved septic tanks.

During the past calendar year a PA Malaria Control Project was secured
for the Hopowell section. This section of the county is relatively
thickly populated with a high malaria incidence. On a preliminary survey
it was found that ten per cent of the children in the Hopewell school
showed a positive blood smear. A physical survey revealed that nost.of
the ponds, marshes and phosphate pits in that section were breeding the
anopheles mosquito.

During the course of the year several sewer breaks have occurred in the
Palna Ceia area of the county, constituting a serious health menaco. The
developing company that installed the sowers and formerly maintained them
is now bankrupt. On the other hand, the Board of County Comnissioners is
not responsible for the maintenance of the sewer system This has created
quite a difficult problem, for no one could be nade responsible for the
necessary repairs.

During the last Legislature a bill was passed creating a sanitary district
for that area, It now requires the vote of the people in that section to
establish a permanent setup. We hope that then this is done, that every
effort will be made to eliminate this health hazard. Incidentally, the
last Legislature also enacted a bill creating a sanitary district for the
Sulphur Springs section, where sanitary conditions are probably worse
than the Palna Ceia area.

We are confronted in this county with quite a tourist'and trailer camp
problem, and a great deal of tine and effort has been spent in controlling
the sanitation of these camps. In this respect every effort has been nade
to cooperate with the State Board of Health and the Hotel Cormissioner of
this district.


R. N. Joyner, M. D., Director

During 1937 the health department secured the passage of the Standard
Milk Ordinance in Marianna. Since that time grades have been announced
twice, and each dairyman has met all the requirements for the production
of Grade A milk. There has been no illnesses directly attributable to
a contaminated milk supply for a number of years. The cooperation of
all local dairymen has been excellent.

In February 1937 Dr. F. L. Fort of the Florida Crippled Children's
Commission held a clinic at the health department offices. 45 patients
were examined at that time and two were admitted in the hospital at
Jacksonville for hospitalization. The American Legion, the health de-
partment and the Crippled Children's Commission have cooperated in the
location, examination and treatment of 55 children. Practically all of
these were, prior to treatment, unable to take care of themselves, but
have been rehabilitated and are now able to enjoy the privileges of the
more fortunate individuals.

Then the health department was first established, all the offices were
in Marianna. A great deal of travel was necessary in order to adequately
cover the county with our nursing service. In April, offices were opened
in Sneads and Graceville, one nurse being located in each community and
having as their district a small area with Sneads and Graoeville their
respective centers. It was felt that this move would provide a more ex-
tended service throughout the county. Following the establishment of these
offices, Health Councils were organized in the various districts. The
purpose of these Councils is to advise and cooperate with the health de-
partment in health matters effecting their own communities.

Communicable Disease Control

The control of typhoid fever should be a relatively simple problem. How-
ever, in rural communities much effort must be expended in order to pre-
vent the occuranoe of this disease. A total of 3.348 typhoid injections
were given during 1937. This brought the total typhoid immunizations,
since the establishment of the health department, to within slightly more
than one-third of the entire population of the county. Despite this fact,
two typhoid fever deaths were reported in 1937.

Insofar as the prevention of communicable diseases is concerned, diphtheria
is our most easily handled problem. The prevention of this disease has
far reaching significance, and upon it, indirectly, rests the entire founda-
tion of public health service. Two deaths from this disease were recorded
during the past year. 914 children, between the ages of six months and six
years, were given diphtheria toxoid. It has been the experience of most

health departments that when approximately one-half-the population
in this ago group is immunized, diphtheria disappears.

There has been a steady decline from deaths in pellagra since 1933.
The charitable distribution of food, the cultivation of lands former-
ly used to plant cotton, tobacco, etc. for gardens, and the distri-
bution of yeast and hydrochloric acid by the health department, have
all played a part in reducing these needless deaths.

For a great many years malaria has ranked third in the causes of death
in Jackson County. Deaths from this cause have been reduced from 24 in
1936 to 14 last years The problem of malaria is almost entirely one of
sanitation. There are four measures, the adoption of any one of which,
if thoroughly followed, would entirely eradicate malaria. These four
methods are; the distruotion of mosquito breeding places by drainage or
oiling; the screening of homes and destruction of weeds about dwelling
places, the complete eradication of malaria in human beings by treatment,
and fourth, the prophylactic use of anti-malaria drugs. Since any one
of these procedures alone, is not practical, we utilize all four.

Tuberculosis deaths have also been reduced. Thirteen were recorded in
1937. During the latter part of the year the Woman's Club of Marianna
became interested in tuberculosis control, and donated funds for the
construction of two Burr Cottages. This action met with much approval,
and resulted in the construction of Burr Cottages by Health Councils.

Treatment of diseases has never been one of the duties of any health
department. However, circumstances and conditions alter policies. An
exception to this established policy of non-treatment is syphilis. There
are a number of reasons why health departments should interest themselves
in the control of this disease, the cost of treatment and the prevalence
of syphilis being not the least. There were 298 patients admitted to the
venereal disease clinic in 1957. These patients made a total of 4,920
visits for treatment.

154 maternity cases were admitted during 1937. These cases were followed
for an average of about four months. Medical treatment was available for
all cases in need of attention. Perhaps the best index to the concern of
any community about the health and well being of its constituents is the
number of maternal and infant deaths occurring in that community. Practi-
cally every municipality with a high maternal death rate will be found
lacking in any well organized health service.- Maternal mortality can
only be reduced by finding prenatal cases early in pregnancy, and super-
vising them until delivery; by constant supervision and instruction of
midwives; and by cooperation with practising physicians before, during, and
after delivery of cases at home. Three maternal deaths were recorded in
1957 in Jackson County. Two of these cases have received no prenatal care

by the health department. The midwives are under lose supervision,
48 of them being, 1eensed and registered. There are, of course, a
few midwives who practise without license and who refuse supervision
by the health department. There will always be midwives who take
this antagonistic attitude until stringent and forcible laws are passed.

The Department of Sanitation reports 357 sanitary pit privies installed
in 1937, and 23 septic tanks. 1,357 private premises were visited; 175
visits were zmde to food.,handling establishments, 55 to dairy farms.

As has been pointed out, the Health Officer takes oognizance of the
fact that a health department is not a treatment agency. In Jackson
County, however, it is expedient that the health officer treat a great
many indigent eases for any condition for which they apply to him for
relief. It is the policy of this department, at the request of local
physicians and the Board of County Commissioners, to treat these cases.
Accordingly, a great many services not covered by our statistical report,
have been rendered.


L. J. Graves, M. D., Director

It is the task of health education to give basic knowledge relative to
prevention of disease and the conservation of well being. Realizing the
importance of this in a generalized public health program, many strides
have been taken to develop a well-rounded health education program in
Leon County. In presenting our work to the public we have utilized the
press, the radio, various organizations and the schools.

The Health Councils, both white and colored, meet monthly. Their aims
are to arouse interest among the general public in health matters from
the standpoint of prevention rather than curative measures, to furnish
milk for the underpriviledged children in the schools and layettes for
indigent expectant mothers.

Educational classes were held in various communities by the nurses and the
dental hygienist in an effort to arouse interest among the parents of the
preschool groups. Following these classes infant and preschool clinics
were conducted. An effort was made to have a physical examination of
each child before he entered school for the first time this year. A well
balanced advertising campaign was carried out, including posters, radio
talks, and news articles. Of the 150 children examined, many of thcn were
found to have defects. The local physicians assisted with the physical
examinations and the dental hygienist inspected their mouths. Since the
education of parents in the health needs of their children is one of the
main objectives in school nursing, strong emphasis is placed upon their
presence at the time of the examination. Individual conferences with par-
ents often stimulate them to have defects corrected, as well as to apply
measures for promotion of better health habits, Opportunity is given the
parents to consult privately with the doctor and nurse when they desire to
do so* It is obvious, then, that personal contact with parents affords an
opportunity for the development of better cooperation between the school,
the home, and the nurse for the benefit of the child. Much time was spent
in making home visits in an effort to get as many defects corrected as
possible before the child entered school.

An education program is being carried out with the pellagra cases. Dis-
tribution of yeast furnished by the State Board of Health is a part of the
program, Diet and its relation to health is especially stressed among those

Another phase of the health education program is the weekly staff confer-
ences. The fact that every staff requires constant educational ititiulus
has long been recognized. An effort is being made to bring before the
staff material that will be of value to this work.

Communicable Disease Control

There has been no outbreak of communicable diseases of any consequence.
Only a few mild cases of scarlet fever, chicken pox, measles, and diph-
theria have occurred in the county. Six hundred, seventy-three complete
typhoid inoculations have been given; 75 persons have been successfully
vaccinated against smallpox. Six hundred, seventeen toxoid treatments
have been given, and 945 Schick tests were made during the year.

Blood testing has played a big part in the venereal disease program this
year. Within the year 1,418 specimens of blood were taken for Kahn test.
Of this number 368 were positive. All white prenatal cases gave negative
test. The negroes having positive tests were either referred to their
family physician or to the venereal disease clinic which was organized
four years ago and is held weekly at the Florida A. & M. College Hospital.
Indigent cases receive the treatment free, and those able to pay are re-
quired to pay $1.00 per treatment. One thousand, one hundred eighteen
treatments have been given during the year. It is hoped that another
clinic will be organized at an early date, this one to be sponsored by the
local physicians. An educational program is being carried on to stimu-
late the interest of the general public in the control of venereal di-
sease. Much interest has been displayed by the private physicians since
many indigent cases are treated by them. This is a routine examination
upon entrance to the maternity clinic and many cases are found that other-
wise would never be discovered. The housewives are showing a great deal
of interest by requiring their maids and cooks to have blood tests be-
fore being employed. We are striving to make home visits to all positive
cases in order to show other members of the family the importance of hav-
ing a test and treatment if necessary.


Tuberculosis control is another phase of our public health service. During
the year 541 visits were made to tuberculosis patients. Individual atten-
tion was given all contacts and suspects and akin tests were urged for all.
X-ray pictures were made of the positive reactors. Isolation in some of the
poorer hones has been very difficult, but the Tuberculosis Association is
now furnishing Burr cottages for all cases that need them.

For several months our tuberculosis program was pushed with the idea of
having the State Board of Health bring its portable x-ray machine to our
county. All of the children from the tenth to twelfth grades, inclusive,
had been tuberculin tested in addition to many contacts and suspects. The
x-ray clinic was held early in October at which 185 whites and 465 negroes
were x-rayed. A large percent of these were students; yet, the response by
those who were contacts or suspects was excellent. Not a single active case
of tuberculosis was discovered among the students, white or colored, and
only two found in colored adults. We consider this an unusually good showing.

The Leon County Tuberculosis Association has shown splendid interest and has
been very cooperative. They have furnished 3 Burr cottages, milk for 4
tuberculosis patients, paid for 13 x-rays and 45 pneumothorax treatments.

An educational program was carried out by the Association through the
schools. This was in the form of a tuberculosis study contest. Both
white and colored schools participated. Their originality as shown by
posters and displays proved that they had gained considerable knowledge
of tuberculosis. Prices were awarded for the best exhibits, plays, and
posters pertaining to tuberculosis. During May two public exhibitions
were held. The white schools used the County Court Room, the colored,
the City Hall.

Maternity Clinics

Maternity clinics are held in the health department conducted by the
local physicians and all of the nurses. Clinics for the colored are
held weekly, and for the whites semi-monthly, The necessity for these
clinics and the opportunity for doing good can be fully realized only
by visiting the clinic. During the year 745 visits were made to the
clinics. The response by these women clearly shows that they appreciate
the service.

All cases are urged to attend the clinic as early in pregnancy as possi-
ble. The average case-finding time for this year was 6 months. We are
urging all expectant mothers to have a thorough physical examination by
their doctor as soon as they find that they are pregnant.

On admittance to the prenatal clinic a complete history of the patient is
made which includes past pregnancies, as well as the present, blood
pressure, urinalysis, and blood for Kahn test. Then, the patient is
given a complete physical examination by the attending physician. Classes
are held during the clinic period for the expectant mothers, using the
safer methods of preparation for home delivery. The classes are conducted
by the nurses, using demonstration, discussion and lecture methods. To
make sure that all preparation necessary for delivery have been made,
these cases are given close follow-up visits in the home, especially
during the last few months of pregnancy. Monthly maternity letters from
the State Board of Health are given to the patients as they visit the
clinics. Pamphlets on "Prenatal Care" are issued on the first visit to
the clinic. Layettes, which are donated by various church organizations
and the WPA, are furnished the indigent, and obstetrical packs are loaned
to the ones needing them.

Before a midwife is allowed to accept a case the patient must have a
thorough physical examination by a doctor. This encourages the midwives
to see that all their patients visit the clinic regularly. In this way
we are able to keep a closer check on the midwives and the patients as well.
There are 30 registered and 4 student midwives in Leon County. Classes are
conducted monthly and instruction is given by the nurses. Visual material
and demonstration methods are used in the discussions with the midwives.
Miss Julia 0. Graves, Supervisor of Midwives, State Board of Health, cona
ducts an institute for the midwives every three months and gives very
valuable instructions.

there are two nursery school n tin- s county, with 25 white and 40
colored attending. A physical examination of each ohild is required
upon entrance. Weekly inspections are made by the nurses. A thorough
physical examination is given annually by the local physicians. 3ach
school has its pareft-teachet association meetings, which the nurse
attends, discussing communicable disease control and any outstanding
defects that the children may have. A hookworm survey of all nursery
school children was made and no positives were found.

School Health Program

Our modern school nursing program has been expanded bpfond the pre-
vention and control of communicable disease and the correction of phy-
sical defects. To these very necessary activities has been added the
bore constructive program of health education, The objective of health
work, for the child of school age, is to secure through his own in-
telligent participation the naximan of physical, mental, emotional, and
social health. Reaching these objectives requires the understanding
and sympathetic team work of the entire school staff, community, health
and social workers, parents and the child himself. The public health
nurse may be the captain of this team and provide leadership necessary
to reach the goal.

A complete health education program for the entire year was submitted
to each school when it opened, A great deal of interest has been shown
in this program. One of the important factors in school nursing is to
help the teacher see her opportunity for health teaching and for under-
standing the health problems of the children, which will give her a
better conception of her own environment, A complete health inventory
is being made of the schools this year, which will be used next year
for comparative purposes,

The physical examination of school children was begun when the schools
opened in the fall, All were completed with the exception of the Leon
County High School, and these students were examined during the latter
part of the last school year. The examinations in the white schools
are made by the Director of the Health Unit, assisted by the-nurses and
the dental hygienist. Of the 1,738 children examined, the following
defects were found to be outstanding: 145 vision defects, 126 tonsil
defects, and 762 dental defects. Hone visits are being made with an
effort to get as many defects corrected as possible. The local civic
clubs are sponsoring tonsil clinics, fitting glasses, and furnishing
milk to indigent children. As a result of this, many corrections have
already been made, and a great improvement is being noted in the children.

Since most of the defects found among school children include defective
teeth, defective vision and diseased tonsils, it can be seen that the
indigent children have received an unusu=a amount of attention. We wish
to acknowledge the excellent cooperation of the civic clubs, dentists,
doctors, and various other organizations for their excellent services

The colored physicians examined 1,240 negro school children. The colored
nurses visit the schools, weighing and measuring the children and at the
sane time giving individual instruction. One Hone Hygiene and Care of the
Sick class is being conducted in the colored high school.

May Day programs

During the nonth of May nuch time was devoted to the schools in prepara-
tion for, and attending Child Health Day programs. Ivory school, indivi-
dually, took part in some type of a Child Health Day program. Some had
plays, others talks given by interested individuals in the community, and
some preferred to have outdoor programs with all children participating,
At the close of the program health certificates were awarded by the Director
of the Health Unit to all children meeting the 8 Point Requirements, which
consist of: annual physical examination; immunization against typhoid,
diphtheria, smallpox; dental, tonsil and vision defects corrected, if
necessary; and a normal gain in weight. each student receiving a health
certificate seemed to appreciate its real meaning, and we hope that this
will encourage other children to work harder for one next year. Present
plans are to award the certificates as soon as a child complies with the
requirements, and the first class in each school attaining 100 per cent
will have the leading part in the Child Health Day excercises. We hope
this new plan will bring the requirements before the children each month,
and that they will not wait until the last minute to have the corrections

Hookworn Control

A hookworm survey sponsored by the Rockefeller Foundation and the State
Board of Health cooperating with the County Health Unit was made. Twenty-
six schools, white and colored were selected in various parts of the
county. One thousand, two hundred, thirty-three specimens were examined;
of this number 234 were from whites and 999 front negroes. Among the
whites 35.5 per cent was positive for hookworms, none for ascaris or
other parasites, except one had dwarf tapeworm. Among the colored 26.3
per cent was positive for hookworm and 8.5 per cent positive for ascaris,
and one had dwarf tapeworm. According to the egg count the infestation
anong the whites was much higher than anong the negroes. Among the whites
41 per cent of the positive cases showed an egg count of 20 or more, while
among the negroes it was only 22 per cent. One negro child was found to
be infested with approximately 700 ascaris and 500 hookworns. A similar
survey was nade in 1932 anong practically the same colored schools at
which time 66 per cent of the children were found positive for hookworm
as compared to 26.3 per cent in this survey.

Morbidity Service

All norbidity services are being conducted by the WPA white nurse. A
total of 1,278 visits have been made during the year.

Crippled Children's Clinic

A crippled children's clinic was conducted by Dr. P. L. Forte, Orthopedic
Surgeon of the Crippled Children's Comnission, Jacksonville, in May. Thirty-
seven children front Leon County were examined. With the aid of the local
American Legion all indigent cases needing innediate hospitalization have
received attention.

Meetings, Conventions

Several meetings have been attended in the interest of health education.
Anong then were the Florida Tuberculosis and Health Association, Miami,
Florida State Nurses Association, Tampe, Florida Public Health Association,
Tallahassee, the monthly district nurses meetings, the annual meetings of
the Florida State Dental Society, the Florida Dental Hygienists Association
in Hollywood, and the district meeting of the Kiwanis Club in St. Augustine.
The Kiwanis Clubs included as one of their najor projects for 1938 the
sponsoring of full-tine county health units for every county in Florida.

Dental Progran

Every white child from the first grade through the high school was given
a dental inspection, a total of 3,199. Among the grammar grade children
the incidence of decay was found to be 44 per cent this year as compared
with 75 per cent in 1936. The children in the WR nursery school and in
the kindergarten were inspected. Indigent children received prophylaxis
by the hygienist while the operative work was done by the local dentists.
More than 200 children were transported to these clinics by the hygienist
and the nurses. The dentists gave 70 hours to the clinics, treating 300
permanent and 213 decidious teeth.

A dental education program has been carried on throughout the year.
Health talks, dealing with such subjects as oral hygiene, dental anatomy,
and diet were made in every school room.

Two May Day Health programs devoted to dental subjects were give. The
closing program of one rural school was given over wholly to dental health
subjects; the entire community attended.

A dental education puppet show, furnished by the State Board of Health,
was presented to the schools during the last semester of last year and
again this fall. The attendance at these shows was more than 3,000; the
puppotters presented this in a very interesting and instructive way.

Approximately 3,000 pieces of literature on mouth hygiene have been dis-
tributed among both white and colored children.

During the sumner months talks were made to various adult groups over the
county. Many posters were made for future use, and a series of short
lessons in dental health were prepared.

The hygienist assisted in organising preschool clinics and made the in-
spections at the tine of the examinations.


Sanitation in its broadest sense is the basic foundation updn which all
public health work is built. Safe Water, safe milk, safe foods, proper
excreta disposal, all are included under this. In the control of typhoid
fever, hookworm and kindred diseases the proper disposal of human excreta
is essential. Where flush toilets are not used, the sanitary pit toilet
will serve a useful purpose.

During the year the City of Tallahassee has extended the sewer system,
laying 42.6 miles of pipe, so that practically every home now is in reach
of a eage line. With the completion of this work there will be approxi-
nately 2,200 houses to be connected to the sewer system.

A small WPA crew has been working throughout the year in the construction
of sanitary toilets. During the year 318 sanitary pit toilets and 59
septic tanks were installed in the county.

The area within the three mile limits of Tallahassee was dusted for malaria
control; and all local places in the city where pestiferous mosquito breed-
ing occurred were oiled. Systematic house-to-house inspection was carried
on the year round.

In September the .PA approved a project for malaria control, and we were
given a small crew which has done some effective maintenance work and

The dairies have been inspected at intervals and milk samples taken

Samples of city water were sent to the State Board of Health Laboratory,
Jacksonville, each month. Every sample showed a low bacteria count with
no B coli present.

All neat and oyster markets were inspected regularly and found to be
operating in a satisfactory manner.

Owing to several cases of rabies in the city and county during the year,
quite a little of the inspector's time was required in efforts to check
its spread. A county-wide quarantine on dogs was declared by the Live
Stock Sanitary Board; while there was no definite means of enforcing
the quarantine, it served a useful purpose. In as nuch as rabies seems
to be so prevalent, we recwond and urge that some state-wide means be
instituted to curb it.


James B. Parrmore,. N. D., Director

The Monroe County Health Unit has been carrying on its work earnestly.
The cooperation that has been shown to us is greatly appreciated. Listed
below are the activities of our department for the year 1937:


Meetings attended 27
Attendance at meetings 122
MAdinistrative visits 1,322
Staff conferences 23

The meetings attended were held by the State Board of Social Welfare to
discuss matters regarding the future, namely; amount of money in treasury,
new rulings as to hospitalization at the Marine Hospital and other minor
details. Administrative visits were made by the health officer, sanitary
officer and nurses, dealing with problems concerning the health department,
sanitation and community clinic. Staff conferences were held and problems
discussed fluently by the employees with their Director, at which time the
former were advised to their entire satisfaction.

Communicable Disease Control

Field Visits
Diphtheria 49
Scarlet Fever 3
Measles 11
Trachoma 27
Chickenpox 11

In visiting the above cases the health officer and nurse gave necessary
instructions as to the welfare of the patient. These cases were all re-
ported to the Collaborating epidemiologist.

Imunni at ions

Smallpox 1,032
Diphtheria 478
Typhoid 323
Schick Tests 461
Tetanus 18

Many of the parents are realising the importance of having.their children
imoanizod against smallpox, diphtheria and typhoid. There are still a few
who are afraid of the word "needleU*

Venereal Disease Control

Admissions to medical service 17
Clinic visits 292
Field visits 44
Conferences 19
Office nursing visits 26

Every Wodnesday morning Venereal Disease Clinics are held and some of
the patients are very faithful in reporting. We are endeavoring to
examine the blood of as many people as possible to determine whether
or not they have syphilis, as we consider this a very important part
of our work in public health

Tuberculosis Control

Individuals tuberculin tested 854
Inspection of tuberculosis tests 854
Cases 11
Contacts 13
Suspects 3
Individuals admitted to nursing service 5
Physical examinations in clinics 73
Office nursing visits 69
Field nursing visits 75

Visits have been made to tuberculosis cases and special attention paid
to contacts and suspects. These have been requested to report to the
health department for a tuberculin test. Many have complied with the
request. Tuberculosis pamphlets have been left at many homes for the
instruction of the family as to the dangers of tuberculosis.

Maternity Service

Cases admitted to antepartum medical service 54
Cases admitted to antepartum nursing service 70
Visits by antepartum cases to medical conferences 216
Field nursing visits to antepartum cases 231
Office nursing visits'by .nteprtun cnsos 217
Caeos ndnittod to postp.rturi nursing service 33
ufrsing aLits to postpartum cases 95
Kidwifo noetings 12
Attendance at meetings 66

Prenatal conferences are held every Thursday afternoon and attendance is
increasing weekly. The midwives are showing very good cooperation by bring-
ing the patients themselves to these conferences and instructing the mothers
as to the importance of a blood test for syphilis infection during pregnancy.
All cases have had urinalyses made and their blood pressure recorded.

Infant and Preschool Hygiene

Individuals admitted to medical service 49
Individuals admitted to nursing service 62
Visits to medical service 105
Visits to physicians B6
Field nursing visits 276
Office nursing visits 96

Individuals admitted to medical service 78
Individuals admitted to nursing service 79
Visits to medical conferences 12
zcaminations 77

Much interest has been shown on the first Friday of every month when our
Well-Baby Conferences are held. All babies are examined by the health
officer and cod liver oil and milk issued to them according to their needs.
Instructions have been given to the mothers both by the health officer and
the nurse as to the welfare of the baby.

General Sanitation

New privies installed (rural) 12
New privies installed (urban) 2
Privies restored to sanitary conditions
(urban) 14
New septic tanks installed (urban) 1
Septic tanks restored to sanitary
conditions (urban) 5

Field Visits

Private premises 547
Canp sites 91
Schools 72
Canneries 17
Public buildings 6
Complaints investigated 35
Follow-up inspectors 18
Nuisances corrected 9

Protection of food and Milk

Food handling establishments registered for supervision 16
Field visits to food handling establishments 632
Field visits to dairy farms 133
Field visits to milk plants 12
Cows tuberculin tested
Tuberculosis 215
Bang's disease 239

Visits were node for the purpose of obtaining health certificates and to
check up on previous inspection.

Thorough inspections wore node by the health officer and sanitary officer
of the following camps every nonth and their insanitary conditions were
corrected: Thonas F. Kinney Construction Camp, Bahia Honda; Bngineers
Canp, Pigeon Key; Thonason Construction Camp, Oonch Key; S. J. Groves Con-
struction Camp, Hog Key; Wisconsin Bridge and Iron Works, Bahig Honda; No
Name Lodge, No-Nane Key; and Dry Tortugas.

School Hygiene

Visits to schools 422
Inspections by physician or nurses 2,351
Field nursing visits 76
Office nursing visits 335
Inspection by dentists or dental hygienists 51
Trachoma treatnonta 91

The health officer and nurse have been frequent visitors to the schools
during the school months. Children found with any ailments were referred
to their private physician or to the Ooanunity Clinic physicians. Many
cases of pediculosis were found anong the school children and it was
necessary to exclude a number of then while treatments were given.

Adult Hygiene

Complete physical examinations were nade of the following, and blood was
withdrawn to determine if they had syphilis:

Sewing roon 208
Mattress factory examinations 28
Sewing roon inspections 150
NYA examinations 135
Milk handlers examined 11
Other food handlers 201

Morbidity Service
Oonnunity Clinic

nisoiono.to-nedicnl service 3,873
Admissions to nursing service 68
Clinic visits 4,339
Field medical visits 17
Field nursing visits 539
Office nursing visits 214
Admissions to hospitals 127
Corrections of defects secured (dental) 118
Tonsils and adenoids 23
X-ray examinations 16
Accidents receiving attention 15


School water supply 20
Other water specimens examined other than
school 63
Milk or milk products 41
Diphtherta cultures 29
Syphilis 474
Gonorrhea 15
Tuberculosis 11
Urinalyses 374

Water samples have been collected from the different hotels and restau-
rants. Whenever laboratory reports showed contamination the cisterns were
chlorinated and additional samples taken.

Mosquito Control
WPA Project No. 1335

Minor drainage, linear feet completed 9,481
Domestic breeding places eliminated 33
Domestic breeding places controlled culex and aedes
aegypti 34,830
Artificial containers destroyed (Est) 14,826

The health department has been active supplying cisterns with gambusia
affinis in order to control aedes aegypti breeding in a large portion of
the city.

Hone Hygiene classes have been recently held at the health department and
the school girls have shown great enthusiasm in attending these valuable

If has been the policy of the Unit to preach prevention of disease when-
ever it could be done, especially stressing the value of innlnizations and
personal cleanliness, We have also stressed the value of sanitation as
applied to water, nilk, sea foods, and raw vegetables.


W. P. Rice, M. D., Director

The Orange County Health Unit was established September 1, 1937.
However operation with the complete personnel did not start until
October 1, 1937. The personnel is composed of a full time He<h
Officer, Sanitary Officer, throe public health nurses, three part
time W. P. A. nurses, a part time dentist and his assistant, and
a clerk. The activities of the department are under the super-
vision of the Orange County Medical Society.

During the month of October an extensive educational program was
conducted through newspaper channels, talks, to P.T.A.'s and civic
groups in order to acquaint the public with our generalized public
health program. An intensive school program has been launched. A
number of examinations by physicians and inspections by nurses have
been completed in many of the schools.

The Orange County Dental Society has been most cooperative in their
assistance with the mouth health program. Seven thousand, nine
hundred and sixty-eight dental examinations have been made and six
hundred and sixty-seven corrections recorded. Plans have been laid
for a dental and health radio program to be started in January and
to continue for thirteen successive weeks. Additional contests will
be held in one hundred school rooms to encourage spontaneous dental
corrections during this radio program.

Since November, many physicians have called on the nursing service
for pre and post-natal classes and visits. Loan closets are being
distributed in various sections of the county in an effort to supply
the doctors with sterile packs for home deliveries in the rural communi-

Five goups were shown the tuberculosis film "Behind the Shadows" with
supplementary remarks being given by members of the Medical Society.
Teaching units have been formed in the high schools among the physical
education teachers preparatory to the tuberculin testing program.

In an effort to stimulate the reporting of communicable diseases, a
monthly morbidity and statistical report is being sent each month to
the physicians of the county and to other citizens who are interested
in our program. The reporting of diseases has been markedly improved
since this plan has been instituted.

In the field of sanitation, activities have been directed along several
lines, all of which deal directly or indirectly with public health


The inspection of the physical equipment of public schools is well
under way* Many defects have been found and called to the attention
of those responsible for school maintenance.

Due to the unusually high hookworm rate in Orange County, lectures
on hookworm disease have been delivered and are being delivered to
school children, P.T.A.'s and other interested groups. In order to
give direct and material aid in the elimination of the source of
hookworm infestation, a project has been initiated with the aid of
W.P.A. for the construction of sanitary pit privies. These privies
are being built at a central plant and hauled out to location for
installation. The only cost to the property owner being the whole-
sale boost of material used in the construction* In order to carry
out this privy building program effectively, house to house sanitary
surveys are being made. It is obvious that it would take several
years to complete such a program*


W. H. Pickett; M. D., Director

The Director of the Pinellas County Health Unit resigned on November 20,
1937, and the department was without a director until February 1, 1938.
The new director was asked to write this narrative report for the former
director, and since there are no narrative reports, monthly or quarterly
of the activities of the department as a whole, it will be difficult to
be concise and do the department Justice. -

There is no doubt that the department in this county carried on a splendid
health program, and if this narrative fails to show this, it will be the
unintentional fault of the writer.

The department has a personnel of one medical director; one school dentist
and a dental assistant; one supervising nurse, five white and two colored
nurses; one sanitarian; one secretary and one clerk. There are two offices
-one in the Court House, Clearwater and the other in the Vocational School,
St. Petersburg. The population of the county is approximately 62,500, about
ten per cent of which are colored.

Public Health R1ucation

Realizing the need of getting general information concerning public health
matters to the public, we have used the newspapers, distributed pamphlets
issued by state and national organizations, and given numerous talks to
the civic clubs, the Federation of Woman's Clubs, schools and various
parent-teacher groups, endeavoring to make the public more health con-
scious, and to create better understanding regarding those things which
make better living conditions.

An effort has been made to acquaint parents with the importance of having
their children immunized, and the rco.son for doing immunizations during
the infant and preschool age*

Many talks to woments organizations were made, during which the necessity
for prenatal care was stressed, and what constitutes a thorough physical
examination for an expectant mother was explained.

The National Negro Health Week program was carried on as it has been in
the past three years, and there seemed to be more interest among the
negroes this year. Health talks were given and programs were held in all
sections of the county..

National Child Health Week was observed throughout the county: the various
organizations and schools planned their own programs. At the annual May
Day luncheon, which is open to all interested persons in the county, talks
were given concerning the health problems of the county.

Red Cross Home Hygiene classes were taught in two Junior high schools and
to one parent-teacher association group. Plans are being made to increase
the classes during the year. The local chapter of the American Red Cross
was assisted in holding an adult class in first Aid. The chapter's coopera-
tion with the department is very good.

Over five thousand pamphlets concerning the tuberculin testing and tuber-
culosis were distributed in the Junior and senior high schools prior to the
tuberculin testing in the county.

The local schools participated in the essay contest on tuberculosis sponsored
by the County Medical Auxiliary.

Communicable Disease Control

The protection of the general public from the spread of communicable disease
was an important function of the health department. In order to carry this
out, it was necessary to have the cases reported promptly, particularly those
diseases which were highly fatal and, by the node of spread, became contagi-
ous to not only those in close contact but to the mass of people*

All cases reported were investigated and isolated until a diagnosis was made.
The quarantine period depended upon the disease, and the regulations adopted
by the American Public Health Association and the State Board of Health were
followed. After the acute illness passed, the vexing problem of handling
carriers arose. The average layman is yet unable to realize that a child
who has recovered clinically from diphtheria may still be a menace to his

All cases of the minor infectious diseases, e.g., measles, mumps, chicken-
pox and respiratory infections were excluded from the schools by the nurses,
and hone visits were made on the unusual or complicated cases. These cases
constituted the major portion of the communicahle diseases.

Venereal Disease

Syphilis and gonorrhea have never been more prevalent, nor received more
consideration than at present in this county and elsewhere. Plans were
formulated and three treatment clinics were established to carry on a
constructive pro:-ran in the county against syphilis particularly. This
disease was brought out of hiding, ani through the medium of radio, moving
pictures, newspapers, educational program, and with some additional finan-
cial assistance, we hope to extend adequate treatment for the indigent
cases through the cooperation al.mI assistance of the local physicians who
served at the clinics.

Our records do not give a true picture of the incidence of the disease.
However, the mere examination of all maternity cases and their families
did provide enough active cases to over-load our clinical facilities. The
clinics were operated in St. Petersburg, Clearwater and Tarpon Springs.


This rcnains an outstanding problem in the county, Through the coopera-
tion and financial assistance of the Florida Tuberculosis and Health
Association, it has been nade possible to establish a tuberculosis clinic
service whore all indigent cases, suspected cases and contacts can be
seen, a physical examination made and a tuberculin test given, and an x-
ray made when indicated. Case work was done by nurses in the homes of all
known active indigent cases and those admitted to the tuberculosis ward at
the county hoero. There were twenty-five beds available at this insti-
tution, and plans were nade to hospitalize thirteen cases at the State
Tuberculosis Sanatoriun.

Being aware of the fact that tuberculosis is one of our greatest pro-
blens, and that this is a childhood, as well as an adult problem, a
systematic method w-s started, having the students from the seventh grades
in the schools tuberculin tested* Tuberculosis positive reactors were x-
rayed by Dr. A. J. Logie, State Board of Health, and the results of the x-
rays were sent to the patients' family physicians.

A survey was nade of the entire county in order to dotercine the amount
of tuberculosis prevalent. This was made with the cooperation of local
physicians by Miss Clio McLaughlin, State Board of Health, assisted by
our nurses.


Students tested over 15 years of age 4,215
Students tested under 15 years of age 469
Individuals x-rayed 1,063
X-ray positive cases 7


Number of contacts and suspects
admitted to clinics 229
Number tuberculin tested 229
Positive reactors 77
Physical examinations at clinics 119
Number of individuals x-rayed 50
X-ray positive cases 11

Nursing Service

The county was divided into eight nursing districts and the nurse in
each district carried on a generalized public health program. This pro-
gran included maternity, infant and preschool, school, communicable di-
sease, morbidity, adult health, vital statistics, sanitation and group
instruction. There were several changes in the nursing staff and we did
not have the present number r the entire year.

Clinics wore established in Tarpon Springe, Clearwator and St. Peters-
burg. The clinic in St. Petersburg was equipped by the Junior League.
Woman's clubs and individuals helped with the equipment in Tarpon Springs
and Clearwater clinics. Linens used in these clinics were furnished by
the VPA Sewing Roon and the Junior League.

The work in the clinics was carried on by local physicians and the
county nurses.

Maternity Service

The objectives of tho maternal program were as follows:'
1. To get in touch with all prospective others as early as possible.
2. To see that they were provided with both medical and nursing super-
vision throughout the maternity cycle.
3. To instruct others in maternal hygiene and infant care.
4, To instruct in the preparation for delivery if the patient planned
to be delivered at hone.
5. To have physical examination of newborn babies.
6. To have medical examination for others, both prenatal and post-
7. To eliminate venereal disease'

A thorough physical examination was given to the natornity cases attending
the clinics, and they attended at least once each month during the first
seven months of pregnancy, and every two weeks during the last two months.
They were told some of the danger signs in pregnancy, and they were in-
structed to get in touch with the doctor or nurse if any of these synptons
were found.

Mothers' classes were held in which they were taut the proper care of
themselves including food, rest, exercise, clothing and bathing. They
wwro also taught what to have on hand for the expected baby and the care
and training of a new baby. Hone visits were nado to all expectant others
attending the clinics.

If delivery was nade in the hone, the nurse went into the home and gave
instructions as to the necessary preparation. Xach clinic center had a
loan closet and, when necessary, bed linens, gowns and towels were lent
for the period of confinement. This department had a supply of sterile
obstetrical packages on hand which were available for these cases upon
request of the attending physician.

Training of the midwives was under the supervision of Mrs. Martha Stetson.
Meetings were held once each nonth, when instruction and demonstrations
were given. They took their work very seriously and nost of then felt that
they were "called to catch babies"n They had overcome practically all of
their old superstitions. ]ach midwife was asked to bring her prenatal cases
to the maternity clinics. Midwives were allowed to deliver only those cases
which appeared to be able to have a normal delivery.

When it was not considered safe for a maternity case to be delivered in
the hone, the services of the welfare departments were enlisted to in-
sure hospitalization for the case.

It is the responsibility of any coznnnity to see that the others in the
community get the care that nakes motherhood safe.

Infant and Preschool

1. To assist in procuring medical supervision including a physical
examination for every child*
2. To assist in securing complete birth registration.
3. To instruct the another in the importance of proper feeding with
emphasis on breast feeding of infants,
4. To instruct the t:other in the hygiene and daily regime of the child.
5. To assist in comnunicable disease control by the recognition of
early symptoms.
6. To assist in procuring correction of defects.

Clinics for infants and preseho6l children in St. Petersburg (age limited
to three years) were hold under the direction of the county health depart-
ment, and the work in the clinics was carried on by local physicians and
the county nurses.

The county health department absorbed the Infant Clinic previously carried
on nost successfully for several years by the St. Petersburg Junior League.

Home visits were made to all infants and preschool children attending the
clinics, the number of calls made depending upon their attendance at clinics
and the health progress.

Mothers who attended our Maternity Clinics were requested to bring their
children to the clinics. Local physicians and the welfare departments also
referred children to the clinic. Many cases were found by the nurses dur-
ing their work in the field.

Besides the physical examinations given the infants, they were immunized
against diphtheria and smallpox, when parents desired such immunization.

Some milk and cod liver oil was furnished to needy cases.

School Service

The health education program in the schools was carried on by the teachers,
They also weighed and measured the children and tested their vision. The
weight record was put on the report cards each month. The teachers held
inspection every morning, and a child with any sign of illness was sent

Two Red rQess Hone Hygiene classes were taught in the junior high schools:
the nain objectives of the school health service were:

1. Control of coummIeable diseases
(a) By recognition of early symptoms of communicable disease
(b) By immunization program
(c) By education
2. Finding the physical defects of the pupils and, when necessary,
assisting in having correction nade,
3. Supplementing the teachers' work in health education.

Routine school nursing was carried on in the forty-three elementary
schools. Each school was visited weekly on a regular day. Galls from
the schools, including the Junior and senior high schools were answered
in addition to the weekly visits.

Medical Ezanination

Local physicians examined the children in the elementary schools. The
nurses assisted with these examinations and sent notices hone concerning
the results of the examinations.

Follow-up Work

The nurses visited the homes as much as their tine permitted to encourage
and assist parents in having physical defects corrected. Children with
the most serious defects were selected and those calls.were nade first.

Corrective Work

The local physicians donated their services for indigent cases* The county
dental clinic took care of the indigent children. The Lions Clubs furnished
nany indigent children with glasses. Two children were fitted- each with
a glass eye,

Thirty-four of the fifty-three schools in the county have a cafeteria where
warm meals are served. Arrangements were made with the Parent-Teacher
Associations and the teachers to feed children who did not take lunches to
school, and they also supplemented lunches that were insufficient.

Intestinal Parasites

In sections of the county where hookworn was prevalent, hookworm specimen
bottles were distributed to all children in the schools, and in sections
where hookworn was not prevalent, selected children were given specimen con-

Sunner Round Up

A clinic for the examination of children who expected to enter school for
the first tine last fall was held for twenty schools that had requested it.
Members of the Parent-Teacher Association assisted.

The children were weighed and measured and their vision was tested by the
nurse, after which they were given a physical examination by the county

health officer. A parent was present during the examination, and when
a defect was found, the importance of having the correction nade was ex-
plained by the doctor.

Children who had not already been inmmnised against diphtheria, typhoid
and smallpox, were given the needed inmmnization upon request of the

The importance of the child entering the school with all remediable defects
corrected was stressed. In cases where parents were financially unable to
have corrections nade, the nurses nade arrangements as far as possible.

Dental Service

Since the Pinellas County Health Unit was organized, the dental clinic
has been under its direction. The clinic has a full tine dentist and a
dental assistant. The dental department operates two clinics, one in the
Vocational School Building, St. Petersburg, which is open on Mondays, Thurs-
days, Fridays and Saturdays; the other in the Junior High School Building,
Clearwater, which is open on Tuesdays nnd Wednesdays.

The dental clinic is sponsored by the local dentists-a committee of three
directing the work of the department-for the purpose of serving the in-
digent children of the county. However, the clinic serves all, inasmuch
as each year dental inspections are nade in the schools by the clinician
with the assistance of the local dentists. Notices were sent out to the
parents advising then to take their children to their family dentist.

The children were given the best of care: first a thorough prophylaxis
was given, then a careful examination was nade to determine the corrections
needed. A child returns to the clinic as nnny tines as it is necessary to
put his nouth in a healthy condition. Tooth brushes were furnished to those
who had none, with instructions on how to brush the teeth. The parents
wore instructed in nouth hygiene and were encouraged to help the child along
this lino. The school grade of each child who visited the clinic was pro-
cured, for it was found that the school record improved in every way after
the child's nouth was put in a healthy condition.

The clinician made talks before the Parent-Teacher Association, the midwives,
and at the March nesting of the St. Petersburg Dental Society, he held a
clinic on children's dentistry and talked about the clinic.

During the year, Dr. E. C. Geiger, Director of the Bureau of Dental, State
Board of Health, brought to the county a dental visual educational puppet
show, which was sponsored jointly by the State Board of Health and the
Good Teeth Council for Children. The little show entertained the children,
and, at the same tine, taught then the importance of mouth hygiene.

Sanitation Activities

Sanitation is the basic foundation for the protection of the public health.
The chief objectives of a sanitation program were to provide safe drinking

water, a clean and adequate nilk supply and a safe disposal of human ex-

An active sanitation program has been carried on by the county health de-
partnent since its estnblishncnt in July, 1936, in cooperation with the
sanitation departments of the various municipalities. The City of St.
Petersburg has a sanitation department, a chief of sanitation and ten
sanitary inspectors.

Public Water Supplies

The City of St. Petersburg's water supply cones front artesian wells lo-
cated in Odessa, Florida. This supply is piped to a softening plant and
chlorinated. The City of Gulfport uses the same supply, Clearwater,
Lamro, Dunedin, Tarpon Springs and Safety Harbor arc supplied front drilled
wells with chlorination at intervals. Samples are submitted at regular
intervals to the state laboratory for bacteriological analyses, Samples
from private supplies were submitted for analyses when it was deemed

A water plant was constructed at Indian Rocks to supply suitable drinking
water for all the Greater Gulf and Indian Rocks Beaches,

The snall percentage of our rural population that depends upon private
supplies has a water supply far above the average, Open wells are un-
known in the county. However, there are still a great number of unde-
sirable shallow wells with pitcher pumps being used in the county, and
we are eliminating these.

Frequent inspection of the water plants in the county were made by the
county health department and the engineers of the State Board of Health.

Sewage Disposal

The Cities of St. Petersburg, Clearwater, Dunedin, Largo, Tarpon Springs
and Safety Harbor have sewerage systems installed under the supervision
of the State Board of Health, The outlying sections of these cities and
the rural communities have private systems; the better homes have septic
tank installation; about three hundred of the rural homes have sanitary
pit privies; and about 2,000 homes still maintain various insanitary types
of disposal, usually open-back surface privies. This is one of our major
sanitation problems, and demonstrates the importance of our Connunity Sani-
tation Progran which was begun in the county December 1, 1936. This work
is being done through the cooperation of the Board of bounty commissioners,
the Works Progress Administration, the State Board of Health and the county
health department. Up to the present time, three hundred of these sanitary
pit toilets have been placed in Pinellas County, The total cost to the
property owner is sixteen dollars, and this covers the complete cost of
the *atorial that goes into the pit, slab and house.

Milk Spply

From the standpoint of public health, milk is by far the nost important
of all food products, and special precautions are essential in order that
its safety nay be assured.

Promotional activities were conducted for adequate control in the titles
which called for the passing of the Standard Milk Ordinance. Milk control
in Florida is under the supervision of the Milk Control Board, Department
of Agriculture, the State. Board of Health and the Livestock Sanitary Board.
The county health department is acting in an advisory capacity to the
dairies in the county. Each municipality has its own milk ordinance and
we are desirous of having all municipalities adopt the Standard Milk Ordin-
ancoe. niich would assure a better, nore uniform supply. Tarpon Springs
has adopted the Standard Milk Ordinance, and its supply is under the super-
vision of the county health department.

Restaurants and Food Handling Istablishments

Routine inspections could not be made in restaurants and all food handling
establishments in an endeavor to have then maintained in a healthful condi-
tion and meet the sanitary requirements of the State Board of Health and the
county health department, because of the fact that we had only one sanitarian
for the entire county.

Shell Fish Control

Inspections have been made in all oyster and scallop houses in the county.
State Board of Health permits have been issued to the operators and the
products .are sold only in certified containers stamped with the permit num-
ber. Certified houses must be properly screened, have running water and
sanitary toilets as approved by the State Board of Health and the county
health department. Every employee working in a certified house must have
a health certificate issued by a licensed physician.

Swinning Pools

There are very few public swimming pools in the county as most of the pub-
lic bathing is done at the beaches. All the pools are the fill and draw
type. These pools are drained and refilled twice each week with chlorine

Tourist Camp Control

Routine inspections have been nade of all tourist and trailer camps in the
county. Up to the present tine, forty-seven camps have been- issued State
Board of Health pemits and classed as certified camps*



C. A. O,'linn, M. D., Director

Twenty-nine meetings have been attended by the personnel of the Taylor
County Health Unit. Also twenty-nine administrative visits have been
made, and nine staff conferences held. The meetings included the Florida
Public Health Association convention, the short courses held in Tallahas-
see on Maternal and Child Health, the Floiidn BItto:Conference of Social
Work, Ocala, and the Florida KMdical Association.

There were five cases of diphtheria reported and investigated by the health
officer. No deaths occurred from this disease in this county. Other commu-
nicable diseases reported and investigated on the requests of the local
physicians woro: 1 case smallpox, 1 case measles, 1 case scarlet fever, 4
cases pellagra and 40 cases malaria.

Special permission was secured from the state office to give toxoid in
Lafayette County after two diphtheria deaths in that area had been re-
ported. All schools not visited by Dr. Rice were included in the clinics
conducted, and 250 children were immunied against diphtheria.

Immunization clinics have been held in the rural communities of the county.
One hundred, sixty-four persons have been vaccinated for smallpox, 598 have
been iamunized against diphtheria, 20 have had the Schick test and 535 have
received typhoid immunization.

A general clinic is held each week in the office of the health department.
This includes a large maternity service, both white and colored.

Twenty-two venereal disease cases have been admitted to the medical service.
There were 105 clinic visits and 4 field visits made to these cases for

Four tuberculosis cases were admitted to the medical service, and one sus-
pect. One of these cases died.

An extensive educational program on tuberculosis was carried out in the high
schools of the county. A tuberculosis essay contest was held in the high
schools of the county on "The Problem of Ridding Florida of Tuberculosis*,
Thb state contest .-.s sponsored by the Woman's Auxiliary to the Florida
Medical Association and the health department sponsored the county contest.
The school board agreed to give prices for the three best essays. The first
prise essay in the county won third prise in the state contest*

Following this educational program tuberculin tests were given to all students
from the seventh through the twelfth grades who wanted it. Nine hundred,
twenty-eight were tested. One hundred, ninty-three positive reactors were x-
rayed. Due to defects in the current these x-rays could not be read, and
arrangements were made for these to be re-taken. One hundred, forty-five
came for x-rays the second time. Only two active cases 6f tuberculosis were

found. This work was done through Dr. Logie of the Division of Tuberculosis.

There wero 46 maternity cases admitted to the medical service and 37 to the
nursing service. One hundred, thirteen visits to clinics and 62 office and
field nursing visits to antepartum cases, were made, There were 107 office
and field visits to postpartum cases.

Monthly meetings are held for the instruction of the midwives. There are
ten licensed midwives in this county, two white and eight colored.

Twenty-five infants have been admitted to the medical service and 127 to
the nursing service. One hundred, four home visits have been made by the
nurse to infants.

Five hundred, fifty-nine .inspections of school children were made by the
nurse and health officer. Three hundred, nineteen physical examinations
were made The balance of the school children were examined the latter part
of the last year. When defects are found, the school nurse notifies the
parents and refers then to their family physician for correction.

A hookworm survey was made of all schools in the county. One thousand, seven
hundred, eighty-eight specimens were examined; about 75% of these being
positive. Each positive case was given four treatments. The treatment is
furnished by the State Board of Health. The percentage of positive cases
next year will probably be much lower due to the number of sanitary pit
privies built in the county this year.

Several pictures and lectures have been shown and given to the school
children on different phases of health.

As the work of this health department includes the care of the prison and
Jail inmates and the county indigents, some time has been devoted to nor-
bidity service.

A Crippled Children's Clinic sponsored by the American Legion was held in
October. The nurse and health officer assisted the field nurse in locat-
ing many children who should attend this clinic. They also assisted in the
clinic, Sixty cases were examined.

The main work of the sanitarian has been the installation of sanitary pit
privies and the clearing and drainage of Spring Creek running through the
county. One thousand, three hundred, twenty-seven sanitary privies have
been constructed in rural districts and where sewer connections are not
available* Approximately 25,000 feet of minor drainage has been completed,
and several ..cres cleared. This work is being done by UPA labor, but is
under the supervision of the health department. Three hundred, ninty-four
hours were spent in supervision of these projects.

Six septic tanks have been restored to sanitary conditions and seven new
sewer connections have been nnde. Five thousand, fiae hundred, thirty-four
field visits have been made to private premises, camp sites, swimming pools,
schoq.s, etc.

A complete survey was made of each school. Findings and recommendations
were sent to the school board.

Three hundred, eighty-eight field visits were made to 93 food-handling
establishments registered for supervision. All food-handlers who have
not health certificates have been instructed to get them.

Sevanty-throe field visits have been made to the four dairies and 14
visits to the one pasteurization nilk plant. Two of the dairies neet
the grade A requirements. Three hundred, five cows were tested for tuber-
culosis. Milk samples have been collected regularly and submitted to the
laboratory for examination.-

SDuring the year the following specimens were sent into the laboratory for
examination: water, 64; milk, 62; typhoid blood cultures, 134; typhoid
stool cultures, 1; diphtheria cultures, 23S0 syphilis, 126; gonorrhea, 12;
tuberculosis, 13; feces for parasites, 2,236; malaria, 136;

Miss Lalla M. Goggans of the Mobile Health Unit spent two weeks with the
health department. She succeeded in having three YTA workers added to the
personnel and did other useful things.

The Health Council neets once each month. There is an average attendance
of ten each meeting.

The Red Cross Loan Closet has been contributed to. Sheets, pillow cases
and other things have been added. Plans are being nade to further en-
large this in 1938.

The Taylor County Health Unit had a large exhibit at the county fair in
November* This included displays on syphilis, hookworm, maternity and
infant mortality rates, and sanitary pit privies. Posters were shown on
statistical reports of maternal deaths, infant deaths, and positive hook-
worm cases in the schools, also a spot map showing the number of sanitary
pit privies built in 1937. Literature on many phases of health was dis-
tributed to interested people. It is estimated that 10,000 persons saw
this exhibit. Some member of the health department personnel was always
present to explain this display.



Marshall Hi Doss, Chief Inspector

The Division of Drug Inspetion Narcotic Service has cooperated dur-
ing the past year with the executive department of the State Board of
Health and the State Board of Medical Examiners in the investigation
of the illegal practice of medicine in this state.

The officers of this division are Marshall H. Doss, Chief Inspector;
Frank S. Castor, Inspector, located at Tampa, Florida; and Robert A.
George, Inspector, located at Lake City, Florida.

The following is the annual report of the Division of
Narcotic Service:

Drug stores registered with State Board of Health

Open inspections

Pharmaceutical surveys

Drug Inspection


. . 1,464

*0 0 0


Violations corrected where no legal action was taken. .

Criminal warrants, informations and indictments .

Convictions in criminal courts *

Prosecutions resulting in an acquittal

Criminal cases nolle pressed

Cases resulting in mistrial

Criminal cases pending

0.0 0 0 0

* 0 0 S

* 0 00 0

*- 0. S0

An investigation of the reCords of this division was conducted by a
committee from the State Pharmaceutical Association, and this commit-
tee recommended an additional appropriation of not loss than ten thous-
and dollars per year for the employing of additional agents.

BCO-MIBNDATION: Due to the size of the state and the volume of work
necessary for the proper functioning of this division, an additional
appropriation of not less than ten thousand dollars per year is recom-

* 0 0 *


'.- ; Catletti Director

The Bureau of Engineering first instituted in 1916, was abolished as
such by the Board in July, 1935, at which time no engineer was included
in its personnel. In its place was continued the Bureau of Sanitation
with Dr. T. S. Kennedy as Director. This Bureau assumed, as far as
practicable, the duties of the old Bureau of Engineering.

In January, 1936, the U. S. Public Health Service loaned the present
Director of the Engineering Bureau to act as engineer to the Board and
supervise WPA Malaria Control and Comunity Sanitation projects. He
was officially appointed by the Board of Health as State Sanitary Engi-
neer, and in May, 1936, transferred to the state pay roll.

At the September, 1937, meeting of the Board, a Bureau of Engineering
was reconstituted with a budget to become effective October 1, 1937.
This included the State Sanitary Engineer as Director, three assistant
engineers, and a secretary. However, to December, 1937, only one assis-
tant engineer was provided, though two additional ones were appointed to
begin January 1, 1938. The secretary previously serving with the State
Sanitary Engineer was transferred to the new Bureau

Duties of the Bureau

From the minutes of the Board, September 23, 1937, the duties of the
Bureau were defined:

rThe duties. of the Burenu of Public Health Engineering will
be as follows:

"State Sanitary Engineer will be charged with the respons-
ibility of strictly engineering work of the State Board of
Health, including all matters pertaining to public water sup-
ply, sewerage systems, protection of stream and other water
pollution, have designation of structures and systems that may
be furnished or recommended by the State Board of Health and
prepare all literature of a sanitary nature. He shall act in
an advisory capacity on all sanitary engineering projects
throughout the state of Florida in connection rith all bureaus
of the State Board of Health."

As the State Sanitary Engineer until the Bureau of Engineering was organi-
zed, conducted his activities in cooperation with the Bureau of Sanitation,
very much along the lines of these responsibilities, the Bureau of Engineer-
ing report will include these activities for the first nine months of the

Upon beginning his connection with the Board in January, 1936, the State
unitary Engineer also acted as Assistant Director (the State Health

Officer is officially Director) of WPA Malaria Control Drainage and
Community Sanitation Projects. Personnel in connection with this is
furnished by the U. S. Public Health Service to the State Board of
Health for cooperative technical supervision of these health projects
as provided in IPA Bulletin #23. In July, 1936, there was furnished
an assistant director and the two district supervisors increased to
three. There was also continued the office engineer, utilized for
preparing maps and other drawings connected with Malaria Control Drain-
age. This same organization was continued through the year 1937.

As three district supervisors were inadequate to cover the State of
Florida in supervising projects in operation, and promoting and or-
ganizing new projects, it has been necessary for the Assistant Di-
rector, A. C. Newman, to spend most of his time in the field, super-
vising and assisting district man and spreading his activities, as
far as possible, over the area where no district supervisor was pro-

For this reason, the State Sanitary Engineer and later the Bureau of
Engineering was required to devote a large percentage of time to these
IPA projects in writing and lining up data for reports, preparing pro-
jects, correspondence, making up pay rolls and expense accounts con-
nected with this work.

This personnel-one assistant director who is a very competent drain-
age engineer, three district supervisors, and one officer engineer-
has served to supplement the normal staff of the Bureau of Engineer-
ing. However, the personnel can only be used in connection with WPA
projects, is temporAry and can only be expected to be provided during
the life of the WPA.

public Watqr Supplies

Probably the most important of the public health engineering activities
are those in connection with insuring the proper protection of public
water supplies. For several years back the State Board of Health has
lacked sufficient and proper personnel to maintain the relations with
public water supplies usual with such an organization. Contacts with
municipal officers had been lost to considerable extent. No detailed
survey of physical condition of plants had been conducted since this
was done by Messrs. Filby and Lnmeroux in 1929.

Routine bacteriological examination of water samples was continued by
the Bureau of Sanitation, but as there was no correlation of these re-
sults with field contacts, a large part of their value was lost. The
basic work to be done, therefore, was to restore contacts and relations
with officials and to conduct a survey of physical conditions through-
out the state. The program to date has largely been consumed with such

An important objective of any state health organization is to secure
technically trained operators on treatment plants, During the year

technically trained operators have been employed at St. Augustine,
Daytona, Fort Myers, and on the plant of the Pinellas County Water
Works near Clearwater. Dr. Aw P. Black has been retained as consul-
tant on these plants and the employment of a technical operator was
largely due to his efforts. This represents a distinct and important
advance in practice on Florida plants and a large contribution to the
objective of the State Board of Health.

There are still large numbers of smaller towns where it has been ne-
cessary to treat the public water supply, but where the small popula-
tion has not been able to afford the services of a technical nan. In
many cases the treatment problem is as difficult or more difficult than
that of the larger and more wealthy city. A large part of the activi-
ties of the Bureau has been devoted to assisting the operators of these
plants and improving operation.

The following new plants, most of them PWA projects, have been put in-
to service during the year: Daytona Beach, Arcadia, Pinellas County,
Port St. Joe, St. Augustine, Punta Gorda, Belle Glades, Marine Studios,
Sarasota, Fort Myers, Moore Haven, Live Oak, Hollywood. Plans were
submitted and approved during the year for water supply at Port St. Joe
,nd Marine Studios.

Florida Section, American Water Works Association

No report on municipal water supply activities would be complete with-
out mention of the Water Works Association and its convention held at
Camp Roosevelt, April, 1937. Such an organization is the most valua-
ble single aid in securing the objectives of the State Board of Health.
Through this cooperation is obtained in shaping policies and securing
interest of the water works men; in education for improved public health
protection; and in securing the good will of the municipalities towards
our work. The Chief Engineer of the State Board of Health has served
on the executive committee, on the program, and other committees, and
has backed the organization with all the facilities of the Engineering
Bureau. Proceedings of the convention were mimeographed for distribu-
tion on account of its educational advantages,

School for Water and Sewage Plant Operators

Under the auspices of the University of Florida, the Water Works Associa-
tion, and the State Board of Health, a school for operators of water and
sewage treatment plants was conducted at Camp Roosevelt. By taking advan-
tage of the WPA project for short course education conducted by the Ex-
tension Division of the University, funds were provided for adding nation-
ally known authorities to the faculty. No charge was made for tuition and
roon and board was at nominal cost. A very large attendance was secured.
The State Board of Health contributed to promotion and assisted on the

Sewerage and Sewage Disposal

Florida is reaching the stage where concentrations of population no
longer make it feasible to discharge sewage into inland and coastal
waters with nominal or no treatment. Quite a few communities are fac-
ing serious difficulty in this respect. The statutes forbid discharge
of such material into waters of the state and designate the State
Board of Health as enforcing agency. The difficulty is that the muni-
cipalities in most cases are unable to legally finance treatment works.
Should the statute be invoked to compel sewage treatment, legal ob-
stacles would be plead to financing the works substantiated by the

Many municipalities in the state unable to finance sewage works, tried
to take advantage of PWA grants and an enabling act was passed by the
Legislature making possible sewer rental charges that would liquidate
bonds for municipal contribution. However, the.State Supreme Court
ruled that even then, bonds could not be legally sold without a vote of
the people. Only a few towns were able to carry such an election.
Where treatment has been applied, it has usually consisted of septic
tanks, which for municipal use, are negligible as treatment.

Some new legislation may be necessary but the most important necessity
is educating the people to the need for sewage treatment, of what proper
treatment consists, and promoting a sentiment on their part for such
work. The program of activity for the Bureau is boing conducted along
this line.

Plans for sewerage and sewage treatment were submitted and approved
during 1937 for the following: Sarasota; State Tuberculosis Hospital,
Orlando; Jacksonville (2); Neptune Beach; Escambia Farms (Resettlement);
Port St. Joe; Clearwater Beach; Federal Prison, Tallahassee; Miami Beach;
Ocal. (2); Lakeland (2); Sanford.

Sewerage extensions were listed by the WPA at: Jacksonville, St. Cloud,
Fort Meade, Ormond, Paln Beach, Key West, Starke, Arcadia, Manatee, Sarasota,
Plant City, Quincy, Panama City, Apalachicola, Milton, Jacksonville Beach,
Lakeland, Haines City, Okeechobee, West Palm Beach, Waldo, Williston, Ft.
Myers, Palmetto, Tampa, Chattahoochee, Monticello, Blountstown, Cottondale,
Chipley, Crescent City, Bartow, Sanford, Delray Beach, Ft. Pierce, Gaines-
ville, Ocala, Bradenton, St. Petersburg, Tanpa Terrace, Havana, Madison,
Pensacola, Crestview, Neptune Beach.

Disposal plants were put in operation at Milton, Crestview, Apalachicola,
Crescent City, and Brooksville, and the Ibrt Lauderdale activated sludge
plant built in 1926 but never used, was altered and arranged so that sedi-
mentation could be secured without aeration. An outfall to this was com-
pleted, sewers extended and pumps installed. Key West sewerage system, a
1PA project, was completed with disposal. The most outstanding treatment
plants were at Pensacola and Port St. Joe. At the former, two outfalls were
equipped with separate sludge digestion type of sedimentation with chlori-
nation of effluent. The purpose was to clean up the harbor and protect

bathing beaches and shellfish bodas At Port Stt Joe there was installed
sedimentation with separate sludge digestion, followed by high rate, rer
circulating trickling filters. Both of these installations will be ready
for operation early in 1938.

Industrial Wastes

Citrs Canning Wastes: Difficulties continued during the year to be ex-
perienced with the waste fron ciutas canning plants, This industry is
growing rapidly and has solid wastes in the form of rind and "rage, and
a liquid waste high in sugar with considerable suspended matter. As a
solution to the solid waste disposal six plants were built in the state
to convert the material into stock feed. These have been successful,
but themselves produce a liquid waste in considerable quantity having a
total solids content of 6%, 0.5 of which is suspended, and disoplved
solids consisting of sugars. The B, 0. D. runs approximately 40,000 p.p.m.

Both of these liquid wastes are peculiar and no treatment applicable has
been developed. Considerable experimentation must be done before ex-
penditure for a treatment plant would be Justified, When discharged raw
into municipal sewerage systems, trouble is experienced at the disposal
plant, and if waste is discharged into the lakes' that abound in the citrus
section, oxygen is exhausted and a nuisance is created with a destruction
of fish life,

Fine screening will undoubtedly remove suspended solids and it was re-
commended that such be installed. Most plants are furnishing screens
for the current season. However, very few commercial screens were pur-
chased, most plants attempting a honemade affair whose efficiency will
be very doubtful.

The screened waste from the canning plants can probably be handled by
trickling filters, particularly with the rapid rate, recirculating type.
Rates and capacities, however, will have to be worked out by experimenta-

To meet this need, an agreement was entered into, in December, 1937, by
the Canners Association, the U. S. Department of Agriculture, and the
Bureau of Engineering, State Board of Health. The Canners Association
agreed to supply $1,500 to defray cost of seperimental plant and opera-
tion. The Bureau of Chemistry, Department of Agriculture, which has a
citrus experiment laboratory at Winter Haven, agreed to supervise ex-
periments and do laboratory work. The Bureau of Engineering agreed to
furnish engineering, and design the plant. Such plan was developed and
furnished by the TBreau.

The liquid waste from stock feed plants offers a much more difficult pro-
blem. Prospects for its handling by any of the usual methods of treatment
are discouraging. It does not respond to any usual coagulants and it con-
tains too high percentage of dissolved sugars with high oxygen demand to
be amenable to the usual sedimentation and oxidation methods applied to
sewage and wastes. Experiments are being inaugurated at the Kuder Plant,

Lake Alfred, and the Suni-Citrus Company plant at Haines City with lagoon-
ing of the waste with hopes that soil absorption with the sun will dewater
the solids and they may be removed in dry state for burial.

The solution of this problem is very difficult with the limited technical
personnel available in the Bureau. There is no experience available with
disposal of this waste and the solution could only come by assigning a
competent man for some time for experimental work in cooperation with the
plant owners. This we are unable to do.

Paper Mi Wastes: During the year construction has been under way on
four new paper pulp nills. Kraft nills using sulphate process are build-
ing at Port St. Joe, Fernandina, and Jacksonville. At Fernandina there is
also under construction a sulphite process mill for producing pulp for
rayon manufacture. These, with the Kraft Mill at Panama City that has been
in operation for some tine, constitute quite a problem in waste disposal.
Practically no data is available on the condition of waters into which
these wastes discharge, or on the effect upon fish life. The U. S. Bureau
of Fisheries has made two reports on the effect of paper mill wastes on
oysters. One was in connection with a sulphite mill in Washington State,
and the other on York River, Virginia, where a sulphate mill was said to
damage the oyster industry. Both reports showed a deleterious effect on
the growth and development of the oyster. Nothing has been determined on
the effect on other fish life in tidal waters. Application was made to
the State Board of Health by lack of the two mills at Fernandina and the
one at Jacksonville for approval of the discharge of wastes, as follows

Fernandina Kraft Mill constructed an earth holding tank with capacity
sufficient to hold a 24 hour flow of waste. Discharge was into the har-
bor only on ebbing tides.

Fernandina Pulp and Paper Company (sulphite mill): Discharge was to be
by ocean outfall 2,000 foet into the Atlantic Ocean. Only "white waters
waste was to be discharged into the harbor.

National Container Corporation, Jacksonville: Discharge was direct from
plant to the St. Johns River.

In each case approval was given only insofar as the public health was
affected* As insufficient data was available it was not possible to give
any approval covering possible damage to the fish industry.

These wastes will require considerable study as to their effect on
sewage disposal, by using up available oxygen, on bathing beaches and
resort activities, as well as on the fish industry and fishing.

Streak Pollution

Before it will be possible to determine intelligently what type and de-
gree of treatment is needed on sewage and wastes discharged into streams
and tidal waters, the safety of bathing beach and shellfish beds, the
suitability of surface waters for public water supplies, and even for

adequate protection of underground waters, it is absolutely essential that
pollution surveys be conducted on the waters of the state concerned, the
nature of the sewage and wastes, and treatment applied to them.

All waters of the state from which shellfish are taken must be surveyed and
polluted waters condemned for this purpose. A small, very limited start
was made upon this work which was sufficient to indicate the time consuming
job it amounts to. If one complete survey could be made on all concerned
waters, the mainenanco of the required information would be very simple.
The Bureau needs sufficient personnel for intensive work on this. There is
also the need for special laboratory facilities. Our present laboratories
are not very accessible to points of survey and the cost of the shipment of
iced samples would be rather high. Even should the samples be shipped to an
available laboratory, no personnel is now provided to handle the work. The
most effective method would be by use of a mobile trailer laboratory. Assis-
tant engineers suitable for use on this work would necessarily have proper
qualifications for doing this field laboratory work, without employment of
additional laboratory personnel.

Laboratory Service

Previous reference to laboratory work under oyster pollution surveys dealt
only with bacteriological work needed in those particular surveys, For super-
vising the efficiency of sewage treatment works, checking pollution of waters
to determine their suitability for public uses and determining required treat-
ment of sewage and wastes certain chemical determinations are essential, such
as total solids, settleable solids, suspended solids, ash, dissolved oxygen
and biochemical oxygen demand. Some of this work is field work and some on
samples that may be brought to a central laboratory. Sewage disposal plants
for larger towns may be expected to have laboratory equipment as in case of
water treatment plants, and personnel of the Bureau may work with their
operators there. Smaller towns will not have this.

The Bureau purchased in December, 1937, equipment for doing this labora-
tory work and installed it in Jacksonville, However, since water and
sewage work in general has been neglected for so long, we were swamped with
requests for help involving the use of this laboratory service. For basic
work along this line the Central Laboratory at Jacksonville should be
equipped with personnel to handle the work.

Malaria Control Work

The Bureau budget as set up included one assistant engineer to be used on
mosquito work. However, one was only appointed to begin work January 1,
1938. Practically all malaria control work done during 1937 was that cover-
ed by IPA projects to the best advantage due to the lack of preliminary medi-
cal, entomological and engineering data to be secured by proper survey, and
upon which must be based drainage work or other control procedures. Malaria
control must, to be effective, be based on and carried out through and under
the direction of a local health unit. However, in the county units, most of
which have been recently organized, the health officer is unable without
assistance to conduct the medical survey locating malaria foci in the county.

University of Florida Home Page
© 2004 - 2010 University of Florida George A. Smathers Libraries.
All rights reserved.

Acceptable Use, Copyright, and Disclaimer Statement
Last updated October 10, 2010 - - mvs