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Members of the Florida state board... | |
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Table of Contents | |
Administration | |
Bureau of dental health | |
Bureau of entomology | |
Bureau of finance and accounts | |
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Articles by staff members |
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Front Cover
Front Cover Title Page Page i Letter of tranmsittal Page ii Page iii Members of the Florida state board of health Page iv Official staff Florida state board of health Page v Directors of county health departments Page vi Table of Contents Page vii Administration 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 Plate 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 Bureau of dental health Page 37 Page 38 Page 39 Bureau of entomology 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 Bureau of finance and accounts Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Bureau of laboratories 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 Bureau of local health services 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 Page 137 Page 138 Page 139 Page 140 Page 141 Page 142 Page 143 Page 144 Page 145 Bureau of maternal and child health Page 146 Page 147 Page 148 Page 149 Page 150 Page 151 Page 152 Page 153 Page 154 Page 155 Bureau of mental health Page 156 Page 157 Page 158 Page 159 Page 160 Page 161 Page 162 Page 163 Bureau of narcotics Page 164 Page 165 Page 166 Bureau of preventable diseases 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 Page 182 Page 183 Page 184 Page 185 Page 186 Page 187 Page 188 Page 189 Page 190 Page 191 Page 192 Page 193 Page 194 Page 195 Bureau of research Page 196 Page 197 Bureau of sanitary engineering Page 198 Page 199 Page 200 Page 201 Page 202 Page 203 Page 204 Page 205 Page 206 Page 207 Page 208 Page 209 Page 210 Page 211 Page 212 Page 213 Page 214 Page 215 Page 216 Page 217 Page 218 Page 219 Page 220 Page 221 Page 222 Page 223 Page 224 Page 225 Page 226 Page 227 Page 228 Bureau of special health services Page 229 Page 230 Page 231 Page 232 Page 233 Page 234 Page 235 Page 236 Page 237 Page 238 Page 239 Page 240 Page 241 Page 242 Page 243 Page 244 Page 245 Page 246 Page 247 Page 248 Page 249 Page 250 Page 251 Page 252 Bureau of vital statistics Page 253 Page 254 Page 255 Page 256 Page 257 Page 258 Page 259 Page 260 Page 261 Page 262 Page 263 Page 264 Page 265 Page 266 Page 267 Page 268 Articles by staff members Page 269 Page 270 Page 271 |
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FLORIDA STATE BOARD OF HEALTH 1964 ANNAL EPOT ,Aucae Report State Board of Health State of 4 orida 1964 The following reports will be published separately: SUPPLEMENT I FLORIDA VITAL STATISTICS, 1964 SUPPLEMENT II FLORIDA MORBIDITY STATISTICS, 1964 WILSON T. SOWDER, M.D. STATE HEALTH OFFICER JACKSONVILLE, FLORIDA e.- The Honorable Eugene G. Peek, Jr., M.D., President Florida State Board of Health Ocala, Florida Dear Dr. Peek: I herewith enclose the annual report of the Florida State Board of Health for the year ending December 31, 1964. Sincerely yours, WILSON T. SOWDER, M.D., M.P.H. State Health Officer May 1, 1965 Jacksonville, Florida His Excellency, Haydon Burns Governor of Florida Tallahassee, Florida Sir: I herewith submit the report of the Florida State Board of Health for the period of January 1, 1964, to December 31, 1964, inclusive. Respectfully, EUGENE G. PEEK, JR., M.D. President May 1, 1965 Ocala, Florida Members of the FLORIDA STATE BOARD OF HEALTH EUGENE G. PEEK, JR., Ocala T. M. CUMBIE, Ph.G., Quincy M.D., President Vice-President LEO M. WATCHEL, M.D. Jacksonville WILLIAM O. SHUMPERT, D.D.S. Ft. Lauderdale W. S. HORN, D.O. Palmetto OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH (December 31, 1964) DIRECTORS State Health Officer ........................................Wilson T. Sowder, M.D., M.P.H. Deputy State Health Officer ........................Malcolm J. Ford, M.D., M.P.H. Deputy State Health Officer ........................Elton S. Osborne, Jr., M.D., M.P.H. Encephalitis Research Center Assistant State Health Officer ............James O. Bond, M.D., M.P.H. Coordination of Training .......................... Robert V. Schultz, M.D., M.P.H. Division of Health Education ....................Elizabeth Reed, R.N., B.S. Librarian ...................................... Tomma Pastorett, B.S., M.A. Division of Personnel ............................Miles T. Dean, M.A. Division of Public Health Nursing ............Enid Mathison, R.N., M.P.H. Bureau of Dental Health .........................Floyd H. DeCamp, D.D.S. Assistant Director ........................... Delmar R. Miller, D.D.S., M.P.H. Bureau of Entomology ..............................John A. Mulrennan, B.S.A. Entomological Research Center ..............Maurice W. Provost, Ph.D. Bureau of Finance and Accounts ................ Fred B. Ragland, B.S. Assistant Director ................................... Paul R. Tidwell, B.B.A. Purchasing Agent ........................ ..... Frank E. Craft, B.S., B.A. Bureau of Laboratories ............................Nathan J. Schneider, Ph.D., M.P.H. Assistant Director .....................................Warren R. Hoffert, Ph.D., M.P.H. Miami Regional Laboratory ......................Dwight E. Frazier, M.S. Orlando Regional Laboratory ....... .......Max T. Trainer, M.S. Pensacola Regional Laboratory ................Emory D. Lord, Jr., M.S. Tallahassee Regional Laboratory ..............Robert A. Graves, M.S., M.P.H. Tampa Regional Laboratory ..............H. D. Venters, B.S. West Palm Beach Regional Laboratory ....Lorraine Carson Bureau of Local Health Services Assistant State Health Officer ....................L. L. Parks, M.D., M.P.H. Assistant Director .....................................Hubert U. King, M.D. Division of Nutrition (Acting) ..............L. L. Parks, M.D., M.P.H. Division of Sanitation ...............................A. W. Morrison, R.S. Bureau of Maternal and Child Health ........David L. Crane, M.D., M.P.H. Bureau of Mental Health (Acting) ..............Elton S. Osborne, Jr., M.D., M.P.H. Associate Director ................................Wade N. Stephens, M.D., M.P.H. Assistant Director ...................... .............Edward L. Flemming, Ed.D., M.P.H. Bureau of Narcotics ..................................... Frank S. Castor, Ph.G. Bureau of Preventable Diseases Assistant State Health Officer ....................C. M. Sharp, M.D. Division of Epidemiology ............................E. Charlton Prather, M.D., M.P.H. Division of Radiological and Occupa- tional Health .................................Edwin G. Williams, M.D. Division of Tuberculosis Control ..............Dwight Wharton, M.D. Division of Veterinary Public Health ......James B. Nichols, D.V.M. Bureau of Research ......................... Albert V. Hardy, M.D., Dr.P.H. Bureau of Sanitary Engineering ................David B. Lee, M.S.Eng. Assistant Director ..................................Sidney A. Berkowitz, M.S.Eng. Division of Industrial Waste ......................Vincent D. Patton, M.S.S.E. Division of Special Services .......................Charles E. Cook, C.E. Division of Waste Water ...........................Ralph H. Baker, Jr., M.S.S.E. Division of Water Supply ..........................John B. Miller, M.P.H. Bureau of Special Health Services Assistant State Health Officer ...............Simon D. Doff, M.D., M.P.H. Division of Chronic Diseases ....................J. E. Fulghum, M.D. Division of Hospitals and Nusing Homes..C. L. Nayfield, M.D., M.P.H. Bureau of Vital Statistics ..........................Everett H. Williams, Jr., M.S. Hyg. Division of Data Processing ................ Harold F. Goodwin Division of Public Health Statistics ..........Oliver H. Boorde, B.S., B.A. Division of Vital Records (Acting) ..........Everett H. Williams, Jr., M.S. Hyg. DIRECTORS OF COUNTY HEALTH DEPARTMENTS (As of December 31, 1964) Alachua........................................................ Edward G. Byrne, M.D., M.P.H. Bay................................ ...... .........................A. F. U llm an, M .D . Brevard..............................................................T. Paul Haney, M .D., Dr. P.H. Broward................................ .......................Paul W. Hughes, M.D., M.P.H. Collier.. ........................... ....................... Clyde L. Brothers, M .D. Dade....................................................... T. E. Cato, M.D., M.P.H. Duval................................ .........................T. E. Morgan, M.D., M.P.H. Escambia. ...................................................E. E. M etcalfe, M .D. Hillsborough ................................................John S. Neill, M.D., M.P.H. Lake.................................. ................ ..........J. Basil Hall, M .D., M .P.H. Lee........................... ........ ...... ............. J. W Lawrence, M .D. Leon........ .......... .......... ........... Clifford G. Blitch, M.D. Manatee............................... .............George M. Dame, M.D. Marion........................ ........................L. L. Parks, M.D., M.P.H. (Acting) Monroe......................... ...........................John L. Ingham, M.D. Okaloosa............. ......................-- Henry I. Langston, M.D., M.P.H. Orange.............................................Wilfred N. Sisk, M.D., M.P.H. Palm Beach...................................................C. L. Brumback, M.D., M.P.H. Pinellas............. ..... ....... .. ........ John T. Obenschain, M.D., M.P.H. Polk......................... .. ..............James F. Cason, M.D. St. Johns......................... ........ ......James C. Loranger, M.D. Santa Rosa..................... ................A. E. Harbeson, M.D. Sarasota............... .........................R. H. Veldhouse, M.D. Seminole.................. ...... ................ Frank Leone, M.D. Volusia................................ D. V. Galloway, M.D., M.P.H. Baker-Nassau.......................... B. F. Woolsey, M.D. Calhoun-Jackson............................................Terry Bird, M.D., M.P.H. Flagler-Putnam........................................ James R. Sayers, M.D. Franklin-Gulf....................................Willa Dean Lowery, M.D., M.P.H. Gadsden-Liberty.........................................B. D. Blackwelder, M.D., M.P.H. Jefferson-W akulla................................ ....... H. Smith, M .D. Madison-Taylor............................ .......... L. L. Parks, M.D., M.P.H. (Acting) Osceola-Indian River..-............................ C. C. Flood, M.D., M.P.H. Pasco-Sumter........................ .............Walter E. Sharpe, M.D. Bradford-Clay-Union ............. .... ..A. Y. Covington, M.D., M.P.H. Charlotte-DeSoto-Hardee......... ........E. J. McLaughlin, M.D. (on educational leave) Francis R. Meyers, M.D. (Acting) Citrus-Hernando-Levy......................................H. F. Bonifield, M.D., M.P.H. Columbia-Hamilton-Gilchrist......... ............F. Barton Wells, M.D. Glades-Hendry-Highlands.............. ... William F. Hill, Jr., M.D., M.P.H. Holmes-Walton-Washington............................L. L. Parks, M.D., M.P.H. (Acting) Martin-Okeechobee-St. Lucie..........................Neill D. Miller, M.D. Suwannee-Dixie-Lafayette.............................L. L. Parks, M.D., M.P.H. (Acting) TABLE OF CONTENTS Page Administration (including Activities of the Board; Training Co- ordination; Scholarships; Encephalitis Research Center; Divisions of Health Education, Personnel and Public Health N ursing) ........................ .. .. .. .......... .......... .......... 1 Bureau of Dental Health ............. ................... .. ............. 37 Bureau of Entomology (including Entomological Research C enter) .............................. ..................... ............................... 40 Bureau of Finance and Accounts (including Purchasing and Property) .............................................................. ................... ... 62 Bureau of Laboratories .........................--..........---------- 74 Bureau of Local Health Services (including Accident Prevention and Health Mobilization Programs; and Divisions of Nutri- tion and Sanitation) ........................................... ... ........ 90 Bureau of Maternal and Child Health ......................................... 146 Bureau of Mental Health (including Florida Council on Train- ing and Research in Mental Health) .................................. ........ 156 Bureau of Narcotics ......................-- ------------------------ 164 Bureau of Preventable Diseases (including Divisions of Epi- demiology [Venereal Disease Control Program], Radiological and Occupational Health, Tuberculosis Control and Veteri- nary Public H health) ....................... ................................ ..-- 167 Bureau of R research .................................................................. ....... 196 Bureau of Sanitary Engineering (Including Divisions of Indus- trial Waste, Special Services, Waste Water and Water Supply) .................................................................----- --. .. 198 Bureau of Special Health Services (including Divisions of Chronic Diseases and Hospital and Nursing Homes; and Hospital Service for the Indigent Program).................................... 229 Bureau of Vital Statistics (including Divisions of Data Process- ing, Public Health Records and Vital Records) ............................ 253 Articles by Staff M embers ....................................... ......... ........... 269 GENERAL ADMINISTRATION 1 WILSON T. SOWDER, M.D., M.P.H. State Health Officer Annual Reports serve many functions. The historical value of these became very apparent in 1964, the 75th Anniversary of the founding of the State Board of Health (SBH). The first State Health Officer, J. Y. Porter, M.D., was a prolific and interesting writer. The early reports pro- vide a fascinating picture of the problems and developments of that era. But now only the memory of persons still active can provide much of the history of county health departments (CHD). It is a matter of concern that often there are no local annual reports which will provide in the years to come an adequate picture on the early history and the subsequent development of these local units. Hence, the added importance of this Annual Report. The year under review provided a strengthening of administrative organization which has long been desired. Two Deputy State Health Officers were authorized, both with a background of experience in local and state public health work in Florida, as well as at the national and foreign service levels. Malcolm J. Ford, M.D., has responsibility for pro- gram planning and Elton S. Osborne, Jr., M.D., for operations. Dr. Os- borne has also served as acting director of the Bureau of Mental Health. One additional organizational change established a Bureau of Re- search. This was designed to give greater prestige to research and greater assurance that it will continue in the future as an essential part of public health. Much of the work previously handled by the coordinator of research is the responsibility of this bureau. The director of this newly established bureau is Albert V. Hardy, M.D., who was previously the coordinator of research. An outstanding problem in 1964 was the consideration being given to the future place of mental health within the general public health pro- gram. There are strong outside pressures for the establishment of a State Department of Mental Health which will bring together community health and mental hospital activities. Thus, on the one hand there was the view that public health at the community level should be concerned with total health, physical and mental, and on the other that all curative and preventive mental health activities in hospitals, community centers and community programs should be under one direction. The highly important decision concerning this will be made by the Legislature. A Legislative Committee during the year has devoted much attention to this question. Problems involved with the increasing use of project grants have increased. It appears that the future distribution of federal funds may be predominantly through project grants, rather than categorical or general public health grants-in-aid. The preparation of grant requests is de- manding a disturbing amount of the time of senior staff members. The initiation of individual projects requires the establishment of new posi- tions which call for the approval of both the Florida Merit System and 2 ANNUAL REPORT, 1964 the State Budget Commission. The time interval between the beginning of planning for a project grant and the initiation of needed activities is on the order of approximately six months or more. While highly desirable public health activities have been supported for several years through project grants renewed annually, still, this method of support provides no assurance of continued financing or for constructive long-range plan- ning. Since a high percentage of the financial support of CHDs is derived from local sources, there is understandable irritation when state pro- cedural requirements appear to delay the initiation of essential activities for which support is available. Thus, there has been some questioning of the relationships between the SBH and CHDs. Through the years the cooperative program under the county health units has worked well and has contributed to the achievement of total coverage of the state by county health units. Legislative action may also determine to what extent this well established plan will be modified because of the counties' desire for freedom from what appears to them to be undesirable obstacles to local planning and action. Multiple problems in the environmental field emphasize the im- portance of these public health activities in this area. There is the increas- ing volume of industrial waste and detergents which persist as objection- able pollutants in water supplies. There is an increasing concern with possible long-term significance of pesticides on human health and there is the increasing problem of air pollution. Of concern is the possibility that through federal legislation the authority for control of water pollu- tion may be assigned to other than public health agencies. The nature of federal as well as state legislation will have substantial influence on the future of Florida's public health programs. Florida experienced an unusually high incidence of measles along with the rest of the nation but no severe disease emergencies. Fortunately, the state was free of epidemic disease in 1964. There was a disturbing threat of encephalitis, the eastern rather than the St. Louis type. This infection was shown to be widespread in Florida involving unvaccinated horses. The virus was also isolated on numerous occasions from mosquitoes. Four human cases occurred: two of these were fatal and a child who recovered has irreparable brain damage. The intensive studies of these infections are providing information which will make the preventive programs increas- ingly effective. There was continuing difficulty in employing and retaining the highly trained professional and technical personnel the SBH needs in large numbers. The Florida Merit System and the Cabinet, however, approved new salary scales for budgeting purposes subject to legislative approval, which should give some relief from the problem. During the year, the SBH lost, by resignation, Wayne Yeager, M.D., the director of the Bureau of Mental Health. It acquired a new director of the Bureau of Maternal and Child Health, David Crane, M.D., pre- viously with the Dade County Department of Public Health. GENERAL ADMINISTRATION STAFF ASSISTANCE The internal auditor, the staff attorney and the press secretary pro- vide direct assistance to the State Health Officer. The internal auditor plans, directs and coordinates the internal au- dits of the SBH, including the 67 CHDs. He has one assistant. He con- ducts post audits of the financial transactions of the agency to determine that fiscal matters are in accord with state and local laws and the policies of the SBH. Accounts of 10 CHDs, a bureau and a special project were audited during 1964. Also, audit work papers were prepared on the accounts of nine additional CHDs. The collected fees audited in 1964 aggregated approximately $575,000. The staff attorney provides legal advice on problems related to ad- ministration and operations and participates in the formulation of the agency's legislative and regulatory programs. He works with bureaus, divisions and CHDs, and upon request or on referral of cases, gives technical assistance to state attorneys, county prosecutors and attorneys for municipalities. In 1964, 18 cases were brought to litigation, three to administrative hearings and 12 were under investigation at the close of the year. During 1964, the press secretary sent 80 news stories to newspapers, radio and TV stations and magazines. Assistance was given these media on 98 occasions: supplying information; initiating stories, photos and interviews; and aiding representatives to obtain their own material for stories, photographs, interviews, TV sound and film footage and edi- torials. ACTIVITIES OF THE BOARD February 9-Jacksonville 1. Eugene G. Peek, Jr., M.D., welcomed William O. Shumpert, D.D.S., newly appointed member of the Board replacing F. P. Meyer, D.D.S., whose term expired November 15, 1963. 2. The Board adopted a resolution in behalf of Dr. Meyer's services to the Board of Health and Florida's public health program. 3. Dr. Peek advised the Board that W. S. Horn, D.O. had been re- appointed as a member of the State Board of Health (SBH). 4. The Board reelected Dr. Peek as president and Mr. T. M. Cumbie as vice-president of the Board of Health. 5. The members of the Board discussed with Wilson T. Sowder, M.D., and C. M. Sharp, M.D., the format of the health card and recommended certain changes in it. 6. Discussed the progress of the proposed construction of the Pensa- cola and Tampa laboratories and the transfer of the present Tampa site to the Board of County Commissioners, Hillsborough County; and accepted a site next to the future Hillsborough County Health Department (CHD). 4 ANNUAL REPORT, 1964 7. Approved the appointment of Chester Nayfield, M.D., as direc- tor, Division of Hospitals and Nursing Homes. 8. Approved revisions in the regulations for nursing homes. 9. Discussed revisions for the control of radiation hazards and ap- proved them. The Board designated March 31, 1964, as the effective date for the registration of X-ray machines and other radiation-producing equipment. 10. Approved the acceptance of a low bid of the Stenson Electrical Company at $73,997 for alterations of the electrical system facili- ties of the SBH, Jacksonville. 11. Approved the release of $6000 for Clay County Commissioners for the construction of a health center. 12. Adopted a resolution commending Miss Ruth Mettinger for her outstanding work with the SBH for the past 30 years as director of the Division of Public Health Nursing; further expressed its gratitude for this fine service and gave her their best wishes for the future. 13. Approved the appointment of Miss Enid Mathison as director of the Division of Public Health Nursing. 14. Discussed the report of the Advisory Committee on Public Health Nursing. 15. Discussed the resignation of William Ballard, M.D., the Pinellas County Health Officer, and the appointment of John Obenschain, M.D. as acting director. 16. Discussed the proposed duties of Elton Osborne, Jr., M.D., who reported for duty on January 1, 1964. 17. Discussed the assignment of David Crane, M.D., and his return to duty March 16, 1964. 18. Approved extension beyond 70 years of age for certain employees. May 9-Bal Harbour 1. Approved a statement of policy of the SBH on the Administrative Structure of Future Programs in Mental Health and Mental Retardation. 2. Approved the establishment of a Bureau of Research with Albert Hardy, M.D., as director; and further approved the appoint- ments of Malcolm Ford, M.D., and Dr. Osborne as Deputy State Health Officers. 3. Discussed the appointment of John Milton, M.D., former Board Member and employee of the Dade County Department of Public Health, as obstetrical consultant in the Bureau of Mater- nal and Child Health. 4. Heard an interim report by Dr. Osborne on the salary supple- mentation problem. GENERAL ADMINISTRATION 5. Discussed the appointment of Delmar Miller, D.D.S., assistant director, Bureau of Dental Health. 6. Approved the naming of the arthropod laboratory in Panama City as the West Florida Arthropod Research Laboratory. 7. Approved the name of the new laboratory to be built in Tampa as the Homer D. Venters Laboratory Building. 8. Approved nine students to be awarded state medical scholarships. 9. Approved persons for postgraduate training. 10. Discussed payment for laboratory and other diagnostic services in heart clinics and referred the matter to the Florida Medical Association for study. 11. Approved the appointments of members to a Florida Coordi- nating Council for Cardiovascular Disease as an advisory body to the SBH in its heart program. 12. Discussed the policy for the purchase of books for distribution to physicians with reference to the Venereal Disease Control Pro- gram. 13. Approved appointments of members to the Advisory Committee for the Hospital Service for the Indigent. 14. Approved the appointments of consultants for the Radiological Health Program. 15. Approved resolutions for the Pensacola and Tampa laboratory buildings for the acceptance of federal grant-in-aid funds for the construction of these buildings. 16. Discussed the extension of employment of unlicensed physicians beyond two years. 17. Abolished the Consultant's Leave Policy established by the group on July 1963. 18. Approved an Addendum to Section II of the Memorandum of Agreement between the Southwest Florida Tuberculosis Hospital and the SBH regarding the Encephalitis Research Center at the Southwest Florida Tuberculosis Hospital. 19. Approved a recommendation of the Florida Committee on Smoking and Health that county health officers take an active role in an educational program on smoking and health. 20. Discussed an invitation from Dr. Guillermo Arbona, secretary of health, San Juan, Puerto Rico, to visit the health department and discuss health programs. May 10-Bal Harbour 1. Discussed action taken by the House of Delegates of the Florida Medical Association regarding the future administration of men- tal health programs. 6 ANNUAL REPORT, 1964 July 26-Jacksonville 1. Approved the appointment of Dr. Crane as director, Bureau of Maternal and Child Health. 2. Welcomed Emily Gates, M.D., former employee of the SBH, on her return to the staff of the Encephalitis Research Center in Tampa. 3. Heard a report by James O. Bond, M.D., on the work being carried on at the Encephalitis Research Center. 4. Discussed a policy on publicity regarding encephalitis cases. 5. Discussed the detergent problem with Mr. David Lee. 6. Approved revisions of Chapter 170 C-10, Garbage and Rubbish. 7. Heard a report by Mr. Lee on the Air Pollution Control Pro- gram. 8. Confirmed telephone action regarding amendments to Chapter 170 C-8, Sanitary Facilities for Buildings Serving the Public and Places of Employment. 9. Approved the appointment of Dr. Osborne, as acting director of the Bureau of Mental Health, effective August 1, 1964. 10. Approved a bill providing for the establishment of a Planning and Coordinating Commission for Mental Health and Mental Retardation; and further that Dr. Sowder present this bill to the Interim Legislative Committee in behalf of the Board. 11. Approved the contents of a letter to Mr. William G. O'Neill, chairman, Subcommittee No. 12, Committee on Governmental Reorganization and Efficiency, regarding the proposed bill de- signed to transfer to the SBH the present functions of the Flor- ida Development Commission relating to the administration of Federal Hill-Burton Hospital Construction Funds. 12. Confirmed their mail approval of two amendments to Chapter 170 E-9, Medical Assistance for the Aged (MAA); (1) Time limit on processing hospital claims and (2) Visiting nurse serv- ices in MAA. 13. Approved the release of $6500 County Health Units Funds to Indian River County Commissioners for the construction of a new health center. 14. Approved naming of laboratory to be built in Pensacola as the Herbert L. Bryans Building. 15. Approved extension of 16 months postgraduate training for Maude Speakman, public health nurse, Highlands County. 16. Discussed the problems existing regarding Cuban dentists in the Miami area. 17. Discussed a letter from Homer Pearson, M.D., executive secretary of the State Board of Medical Examiners, regarding the un- licensed physicians employed by the SBH. GENERAL ADMINISTRATION 18. Approved the appointment of members to serve on the Advisory Committee to the SBH for the Medical Scholarship Program. 19. Approved a budget for the biennium 1965-67 to be submitted to the Legislature in 1965. 20. Dr. Peek presented a citation to Mrs. Astrid J. Ballard, executive secretary to the State Health Officer, for 20 years of service with the SBH. The Board adopted a resolution expressing to Mrs. Ballard their appreciation for the fine service rendered the SBH and the members of the Board. September 13-Jacksonville 1. Heard a report by Dr. Sowder on a conference he had with Governor Bryant. 2. Discussed Dr. Milton's status with the SBH. 3. Heard a report by Dr. Shumpert on a proposed bill on fluorida- tion being discussed by the State Dental Society. 4. Heard a report by Dr. Ford on the Poverty Bill. 5. Welcomed Warren Hoffert, Ph.D., assistant director of the Bureau of Laboratories, to the central office and as a member of the SBH. 6. Discussed the Hospital Licensing and Hospital Construction Pro- gram with various members of the central office staff. 7. Approved certain editorial changes in the regulations on nursing homes. 8. Approved a revision in the regulations on the control of com- municable diseases. 9. Approved revisions in the salary ranges of the exempt classes under the Merit System. 10. Heard a report by Dr. Osborne on the Mental Health Planning Program. 11. Discussing licensing of special hospitals including dual licensure. 12. Approved the release of $2000 to the Board of County Commis- sioners of Lake County for the construction of a health center in Clermont. 13. Approved the appointment of Senator Beth Johnson as a mem- ber of the Advisory Committee on Hospital Services for the Indigent. 14. Discussed the matter of local Board's of Health or Advisory Boards to the CHDs. December 4-San Juan, Puerto Rico 1. Met with Dr. Arbona, secretary of health, San Juan, Puerto Rico, and members of his staff and discussed various health programs and also visited many health facilities in Puerto Rico. 8 ANNUAL REPORT, 1964 2. Heard a report on the information received by Edward Byrne, M.D., director of the Alachua CHD, from the county health officers regarding local Advisory Public Health Committees. 3. Directed the State Health Officer to call attention of all county health officers to the recommendation of the Executive Council of the State Dental Society whereby they establish and maintain some suitable liaison machinery with the organized dental pro- fession and particularly with respect to the development and operation of public health dental programs. 4. Approved a letter to Samuel Day, 'M.D., president of the Florida Medical Association, regarding the routing of MAA patients through Tumor Clinics. 5. Approved the appointment of Mr. Harry Goodwin as director, Division of Data Processing. 6. Approved the reappointment of several members to the Public Health Nursing Advisory Committee and also the appointment of new members to the Committee. 7. Approved a resolution in behalf of F. P. Meyer, D.D.S., former Board Member, deceased. 8. Discussed certain regulations in Chapter 170 E-7, Transportation, Storage and Disinterment of Dead Human Bodies and recom- mended that a committee be appointed to study this problem and its report be brought before the Board. 9. Discussed a nursing home form recently circulated to nursing home operators. 10. Expressed appreciation to Dr. Arbona, secretary of health and members of his staff, for their many kindnesses to the members of the Board; and also for the very informative discussions regarding the health program of Puerto Rico. ENCEPHALITIS RESEARCH CENTER JAMES O. BOND, M.D., M.P.H. Director For the second consecutive year Florida experienced no epidemics of human infection with arthropod-borne viruses. This past year did, how- ever, represent a year of increased activity in the state for eastern and western equine encephalitis viruses which produced severe clinical illness in horses and man. Infection with these viruses was also detected in both wild and domestic birds sentinel bird flocks and mosquitoes. Such activity is neither new nor unusual for Florida, and has occurred in irregular cycles for many years. The enlarged staff of arbovirus investigators in the state, most of whom were in the Encephalitis Research Center (ERC) in Tampa, made it possible to study this activity with an intensity and pre- cision that had not previously been possible. GENERAL ADMINISTRATION At the ERC, western encephalitis (WE) virus was recovered from the brain of a sick horse, the first such recovery in Florida and probably east of the Appalachian Mountains. Eastern encephalitis (EE) virus was re- covered five times from moribund horses. Both viruses were isolated re- peatedly from Culiseta melanura mosquitoes which have long been in- criminated as the vector of these viruses between birds. However, for the first time, the EE and WE viruses were also obtained from a species of fresh water Aedes mosquitoes (Aedes infirmatus). This may prove to be the first identification of a vector carrying this virus from birds to horses or to man. There were four confirmed human cases of EE in Florida in 1964. In three of these, laboratory studies at the ERC in Tampa assisted in the diagnosis. There was one each from Polk, Hillsborough and Putnam counties. Of the four cases, two were fatal, and the sur- vivors were severely damaged, emphasizing again the serious import of this virus for the human population should an epidemic occur. Activity of EE and WE viruses was readily demonstrated in wild and domestic birds in the Tampa Bay area and in sentinel chicken flocks maintained by the ERG to measure arbovirus transmission to birds. Again in 1964, as in 1963, there was virtually no evidence of activity of St. Louis encephalitis (SLE) virus in the entire state, or in the Tampa Bay area. The negative evidence included observations for clinical disease in man, for inapparent infection in man, virus isolation studies in mosquitoes, and virologic and serologic observations in wild and do- mestic birds, chickens, wild mammals, amphibians and reptiles. This ap- parent disappearance of SLE virus was made doubly enigmatic by the fact that 1964 represented the year of the largest SLE epidemic in the U.S., involving the states of Texas, Colorado, Tennessee, Kentucky, Indiana, Illinois, New Jersey and Pennsylvania. The intensive search for arboviruses by ERG did however result in the recovery of a number of other agents. These included arboviruses belonging to the California complex, Tensaw virus, Hart Park virus and unidentified viral agents recovered from two species of ticks and cotton rats. The public health significance of these other viral agents is as yet undefined. However, early information indicates that the viruses belonging to the California complex may represent a new and significant arboviral cause of human disability and disease, not only in Florida but in a large area of the country. A nine-member Encephalitis Advisory Committee of nationwide ex- perts, was appointed to advise the State Health Officer on statewide research, surveillance and control activities, including those carried out by ERC. The committee was composed of W. McD. Hammon, M.D., University of Pittsburgh; John P. Fox, M.D., Public Health Research Institute of the City of New York, Inc.; Oscar Sussman, D.V.M., State Department of Health, New Jersey; George T. Carmichael, Chatham County Mosquito Control District, Savannah, Georgia; Joel Ehrenkranz, M.D., University of Miami School of Medicine, Miami; Carroll N. Smith, Ph.D., U.S. Department of Agriculture Research Branch, Gainesville; Carlton M. Herman, Ph.D., U.S. Fish and Wildlife Service, Laurel, 10 ANNUAL REPORT, 1964 Maryland; Telford Work, M.D., Communicable Disease Center (CDC), U.S. Public Health Service (USPHS), Atlanta, Georgia, and Archie Hess, Ph.D., USPHS, Greeley, Colorado. A separate report of the major activities of each of the four sections of the ERC follows. VIROLOGY In early 1964 a mouse-breeding colony was established adjacent to the ERC to permit the production of suckling and weanling mice for the virology laboratory. Approximately 125-175 litters of suckling mice are produced each week and are utilized for virus isolation attempts, passages and neutralization tests. An additional serologist was added to the staff during 1964 to permit extension of serologic studies to include the diffi- cult but more precise neutralization tests. From 3926 specimens processed in the laboratory for viral isolation, 75 were considered positive for viral agents (Table 1). There were 3564 pools of mosquitoes tested (some collected in 1963) from which 55 recoveries of viral agents were obtained in the 1964 collections. The type of virus found in each species of mosquito is also shown in Table 1. Of 73 tick pools examined, seven have yielded viral agents. These viruses are presently undergoing identification studies at the University of Pittsburgh Arbovirology Laboratories by Miss Gladys Sather under the direction of William McD. Hammon, M.D. This year's most significant virologic findings have been the recovery of WE virus from a horse, the isolation of both EE and WE virus from A. infirmatus mosquitoes, which may be a newly recognized vector, and the repeated recovery of two apparently different and distinct members of the California complex in the Tampa Bay area. Although the detection of Hart Park virus in the Tampa Bay area is new, it is not considered to be particularly significant since this virus has been found widely distributed along the eastern seaboard and Gulf coast areas and is presently thought unrelated to any human illness. The final identification of the tick viruses may also contribute new and signifi- cant information; however, their importance cannot be assessed at the moment. The serology section utilizes the hemagglutionation-inhibition (HI), the complement fixation (CF) and the serum neutralization (NT) tests for the identification of arbovirus antibodies in human and animal serum. A total of 6556 sera were tested during 1964, all by the HI test, 47 by the CF test and 11 by the NT. These sera classified according to source were: human diagnostics, 688; human survey, 388; sentinel chickens, 431; wild birds, 2187; and mammals, 477. The significance of the findings and interpretation is presented in subsequent portions of this report. The laboratory section cooperated with other sections in carrying out special studies during the year. The first was related to the problem of nonspecific inhibitors in chicken sera to EE hemagglutionation (HA) GENERAL ADMINISTRATION 11 antigens. A similar study of the problem of nonspecific inhibitors for Cali- fornia encephalitis HA antigen in human sera was undertaken with the University of Pittsburgh. In cooperation with the biology section, an experiment was performed to measure the transovarian-transmission of HI antibodies against SLE virus in chickens. Such transmission was demon- strated to occur; however, most of the passively acquired antibody had disappeared by the end of the fourth week of the chick's life. EPIDEMIOLOGY The activities of the epidemiology section were directed during the first half of the year by Donald T. Quick, M.D., assigned from the CDC. During the last half of the year, Emily H. Gates, M.D., assumed the position of chief epidemiologist and assistant director. In cooperation with the County Health Departments (CHD) in Hillsborough, Pinellas, Manatee and Sarasota Counties, and hospitals and physicians, a surveillance program for viral infections of the central nervous system (CNS) was continued throughout 1964. During the year, a total of 340 human cases was studied (Table 2). Of these 101 (29.7 per cent) were considered to represent true cases of infectious encephalitis, aseptic meningitis or paralytic disease. There was no proven case of acute SLE virus infection. However, one human case of EE was confirmed in a resident of Hillsborough County, and one case of dengue fever imported from Puerto Rico was identified. A third case of clinical encephalitis occurring in Sarasota County had serological evidence of possible recent California virus infection. This case, however, is still under study. In the remaining 98 cases with clinical evidence of viral CNS infec- tion, etiologic diagnoses were finally established for 35. Mumps was the most common cause of this type of illness and was diagnosed in 30 indi- viduals. For each of the following there was one diagnosed case: varicella, rubeola, poliovirus Type I, Coxsackie virus, Group B-4 and infectious mononucleosis. There was one confirmed CNS infection due to lepto- spirosis. Serologic or virologic tests for the nonarboviruses were per- formed by the Virology Section of the Central Laboratory by the State Board of Health (SBH). These cases in which an etiology was considered to be firmly estab- lished, either on clinical or laboratory evidence, represented 37.6 per cent of the entire group of 101 viral CNS infections. However, studies upon this group of patients are not yet complete, and further reports from either the Central Laboratories, SBH, or from the CDC will undoubtedly provide additional etiologic information. Among the total of 340 individuals brought under surveillance, 21 were identified with SLE-HI antibody titers of 1:20 or above, which remained at the same level on subsequent specimens except for three from whom only single specimens were submitted. These results were inter- preted as indicative of infection with a Group B arbovirus at some unde- termined time in the past. These individuals undoubtedly represent a 12 ANNUAL REPORT, 1964 group of persons who have had previous infection with either SLE or dengue or some other member of the arbovirus Group B complex. How- ever, there is suggestive evidence that some Group B arbovirus, at present unidentified, may have been active recently in the Tampa Bay area, since the proportion of these positive sera changed markedly between 1963 and 1964. There were three individuals with EE-HI antibodies detected in paired sera and interpreted as indicating past infection with a Group A arbovirus at some undetermined time. Similar observations were made on two other persons utilizing the California antigens. Four of the above were residents of Hillsborough County. The ERC maintains a close liaison with the epidemiology and labora- tory services of the SBH in establishing diagnosis and epidemiologic infor- mation for the population in the Tampa Bay area, and to a lesser extent in the entire central Florida peninsular portion of the state. A total of 56 patients received epidemiologic and virologic consulta- tion from the ERC, although they lived in counties outside of the four surrounding Tampa Bay. Among these were three in which diagnosis of current infection with EE was established by serologic studies in the laboratories in the ERC, Jacksonville and CDC. The virus of EE virus was recovered from both the brain and the cerebrospinal fluid of one of these patients. A measure of the inapparent human infection with arboviruses is main- tained by re-bleeding a sample of sentinel human households throughout the Tampa Bay area. After the 1963 summer season, a total of 313 individuals was re-bled, and during the current 1964 season re-bleedings on the same households are currently in process. These studies supply information on the occurrence of silent, inapparent human infection with EE, WE, SLE, California and, to a lesser extent, Tensaw viruses. A special follow-up examination clinic for post-encephalitis cases was held in cooperation with the USPHS Accident and Aging Study Center in St. Petersburg, and with the Pinellas CHD. During the period March 11 through June 19, 224 persons were examined. Ninety-six (96) of these were recovered encephalitis patients from the 1962, 1961 and 1959 epidemics, and 128 were normal individu- als matched by age, race, sex, education and occupation for comparison with these cases. Tests on all individuals included those for psychomotor and psychologic performance, vision, static and dynamic balance, Cornell Index, and an accident history. Serologic studies for the persistence of HI, CF and NT antibodies to SLE virus were carried out in the ERC laboratory and the University of Pittsburgh. It was found that CF antibodies persisted much longer and at higher titers than had originally been anticipated; however, the HI antibodies declined more rapidly than anticipated. All but three of the tested survivors had serum neutralizing antibodies to SLE virus, indicating that the initial diagnoses were cor- rectly made in the majority of cases. Further analyses of the extensive information collected in this study are in process., GENERAL ADMINISTRATION Following the 1962 epidemic of SLE, statistical studies of stillbirth, neonatal, perinatal and congenital malformation death rates in Pinellas County yielded suggestive evidence of some prenatal damage as a result of maternal SLE virus infection. Accordingly, a retrospective study was initiated to determine whether there was any significant excessive preva- lence of SLE antibodies in the mothers of 58 infants who were recorded as neonatal deaths associated either with congenital malformations or stillbirths. Of the 58 mothers, 26 were located and serum specimens ob- tained. In none were antibodies detected against SLE virus using the HI test. It was concluded that there was no evidence from this study to indicate any damaging effect of SLE virus in utero. ENTOMOLOGY An assistant entomologist, Carl Vickery, was added to the staff in early 1964. Twelve (12) standard bait traps were maintained throughout the year in Manatee, Hillsborough and Pinellas Counties with the Co- operation of their respective Mosquito Control Districts. These were sup- plemented with special collections from two areas in Hillsborough County which later were added as standard collection sites. Other collections using truck-traps, light-traps and aspirators were made in areas of suspected arboviral activity as determined by the presence of equine or human cases. From all collections, a total of 234,138 mosquitoes was obtained during 1964 as indicated in Table 3. Of these, 130,544 have been tested for virus isolations in 2717 pools representing most of the collections through October. From the special collection sites in Hillsborough County, there were nine recoveries of EE and five of WE. Eight of the EE viruses and three of WE were obtained from C. melanura mosquitoes and one eastern and two western from A. infirmatus. One of the recoveries of WE from A. infirmatus was of special interest since the mosquitoes were obtained by aspirator collections from the arm of a man in a suburban area of Tampa. The EE and WE virus recoveries were made during the period April-July, with 75 per cent in the month of May. Viruses belonging to the California complex were obtained in 26 pools, all from A. infirmatus or Aedes atlanticus mosquitoes. All of the re- coveries from A. atlanticus were from swamps of Hillsborough County, whereas all but one of the California complex viruses found in A. in- firmatus were from a swamp in suburban Pinellas County. Trapping techniques and variations in preferred habitat for these two species of mosquito explain some of this difference. However, there were certain biological differences between the two types of California virus obtained, and further strain identification studies are in process. The California viruses were found in every season of the year, although there was a slight increase in the frequency of recoveries in August with a large col- lection of A. atlanticus. There were nine recoveries of virus belonging to the Tensaw group, all from Anopheles crucians mosquitoes. Due to selective methods of col- lection, large numbers of A. crucians were not obtained. Six viral agents presumptively identified as Hart Park were obtained from five pools of 14 ANNUAL REPORT, 1964 C. melanura, and one pool of Culex nigripalpus. These viruses were found only during May, June and July, partially reflecting both the seasonal changes in C. melanura density and the type of collection methods employed. It was of interest that of the total 55 recoveries of virus from mos- quitoes, only nine were obtained from the 12 standard trap sites. The remainder was detected as a result of special collections made in areas where there was presumptive evidence of arbovirus activity. Since this was chiefly related to the occurrence of equine encephalomyelitis in Hills- borough County, most of the collections and therefore most of the identi- fications of virus were in that county. During the period January through May, special weekly truck-trap collections were made in each of the three counties to estimate mosquito densities and to obtain Culex mosquitoes for oviparity dissections. From 120 collections, 12,845 mosquitoes were obtained and a sample examined for oviparity studies. Portions of the gravid mosquitoes from the truck-trap collections were also processed for virus isolation in 208 pools. Viral agents were obtained from three pools; two from C. melanura and one from A. crucians. During the period January through May, a sample of the bait-trap col- lections of Culex mosquitoes was also reserved for oviparity dissections. From Hillsborough, 202 were dissected; from Manatee, 333; from Pinel- las, 340, and from Sarasota County, 218. The proportion of parous and nulliparous mosquitoes from both truck- and bait-trap collections of Culex species has been determined and the data are being analyzed by the En- tomological Research Center in Vero Beach as part of a special study of production and survivorship of Culex mosquitoes under natural condi- tions. Special entomological studies have included observations on the relationship of larval production and adult mosquito densities to rainfall, temperature, groundwater level and other ecological variables in a special swamp site study area in Pinellas County. Host preference studies in the field have been carried out with a number of different bait animals including a donkey, chickens, various species of wild birds and mammals, toads and turtles. A study comparing CDC light traps and chick-baited traps involving 65,231 collected mosquitoes is in process. With the Georgia Institute of Technology, a special study evaluating an experimental method of tagging mosquitoes with boron or decaborane compounds was also initiated. Meteorologic information was collected at each of the standard bait trap collection sites and supplemented by rain- fall data from official weather bureau stations and other cooperators in Hillsborough, Pinellas, Manatee and Sarasota Counties. In anticipation of precipitin tests in engorged mosquitoes for host preference studies, 1368 mosquitoes have been collected and preserved for this special study. All of the above activities were carried out in close coordination with the mosquito control districts in Pinellas, Hillsborough and Manatee Coun- ties, and were under the general consultive guidance of scientists from the Entomological Research Center at Vero Beach. ORGANIZATION Lt CHART OF TEr FlORID SmTAE 80ARD OF HAERTH BOARD O? ........... .... ... ... """ .. " i -J'-T- -!_, S r- MEDICAL DENTAL COUNCIL HOSPITAL COMsMITT I SCHOLRSIP SORSHIP ON TRAINING HOSPITAL 1 -CONT ADVISORY ADVSORM RESTA ADVISORT SEAMECE FR CONTROL PCOISTTE COMMITTEE IN MENTAL COUNCIL I THE MINDIGONT N STATE HEALTH OFFICER DEPY.STATE HEALTH OFFICER PROGRAM & PLANNING U I DIVISION OF DIVISION OP HEALTH PERStNSSL EDUCATION (Library) IBS A P BU i EAU OP BU:E-lU O MENTAL I LABORATORIES *PI FIMMCE EaTSI I (Regional I MAND cliic) RLaboratories) ACCOUTS BUREAU OF ESTOMOLOGY (Research Center, West Florida Arthropod Research Laboratory, Mosquito Control Districts eodes Aegypti Eradication) I BUREAU' OF SANITARY ENSINEERING (Stream Sanitation, Waste Treatment Construction) DIVISION OF INDUSTRIAL WASTES (Air Pollution) DIVISION OF SPECIAL SERVICES (Bedding Law, Subdivision Planning, Shellfish) DIVISION OP WASTE WATER DIVISION OF WATER SUPPLY (swiSming Pools) BUREAU OF VITAL STATISTICS DIVISION OF VITAL RECORDS DIVISION OF PUBLIC HEALTH STATISTICS DIVISION OF DATA PROCESSINo DEPUTY STATE HEALTH OFFICER OPERATIONS I ENCEPHALITIS DIVISION OP RESE IROCH PUBLIC HEALTH C RTER NURSING 1~,i BREAU O SUREAU OF BUREAU OFr ESEABCH DS.TAL NARCOTICS Li LJT I I ----- b - BUREAU OF LOCAL HEALTH SERVICES (CiVil Defense, Accident Prevention) DIVISION OF SANITATION DIVISION OF NUTRITION T' BUREAU 0OF MATERNAL CHILD HEALTH (Migratory Labor) BUREAU OP PREVENTABLE DISEASES DIVISION OF RADIOLOGICAL OCCUPATIONAL HEALTH DIVISION OF VETERINARY PUBLIC HEALTH (Milk Sanitation) DIVISION OF TUBERCULOSIS CONTROL DIVISION OF EPIDEMIOLOGY BUREAU OP SPECIAL HEALTH SERVICES DIVISION OP CHRONIC DISEASES (HeartCancer. Diabetes) DIVISION OF HOSPITALS AND NURSING HOMES (Indigent Care, Hospital & Nursing Home LicSnure) 67 County Health Departments N UNNOr I EG ~9-- a _,, I _ GENERAL ADMINISTRATION BIOLOGY During the latter half of 1964, an ornithologist was added to the staff. The major efforts of this section during the year were devoted to the study of equine encephalomyelitis in Hillsborough County. By mid-May, an epizootic become evident among the horses in this coun- ty, although the first case was reported in late March. A special effort was made to obtain clinical and epidemiological information on all horse cases reported to the ERC. In addition a sample survey of the horse population was carried out by a veterinarian, Reuven A. Kathein, D.V.M., assigned to the project during the summer months by the Univer- sity of Pittsburgh. From the 22 clinical cases of encephalomyelitis in horses which came to the attention of the ERC staff, 14 brains were obtained. Six isolations of virus have been made from these brains; one identified as WE and five as EE. It was of special interest that the WE isolation was the first such recovery from a horse with a clinical illness diagnosed as encephalomyelitis in Florida, and probably is the first on the eastern seaboard of the United States. The equine population sample indicated that there were some 6400 horses in Hillsborough County, of which 40 per cent were unvaccinated. A sample of the vaccinated and unvaccinated horses was bled for further serological studies. The latter are incomplete; however, early findings suggest that the horse is a much more sensitive indicator of SLE virus inapparent infection than had pre- viously been suspected. As mentioned previously, the recovery of EE and WE virus from Aedes mosquitoes in the areas adjacent to the horse cases is strongly suggestive evidence that a vector of these viruses from birds to horses has been identified for the first time. The activity of both EE and WE viruses was also demonstrated by studies in sentinel chicken flocks which were maintained throughout the year at 14 different stations in the three counties. These sentinels were supplemental at different times and in different places with sentinel guinea pig, pigeon and opossum systems. Eastern and western virus activity was identified at a sentinel chicken station in Hillsborough County in May and at two different stations in the same county in June. It was also identified in sentinel chickens in Pinellas County in August. An additional sentinel system for the actual recovery of virus was utilized by exposing one-day-old chicks for an overnight period in areas where mosquitoes were biting heavily. Of 903 chicks thus exposed, four yielded arbovirus isolations, two identified as EE and two as WE. These were recovered during the month of May in the swampy area of northern Hillsborough County adjacent to the horse cases. Serologic evidence of arbovirus activity was also measured in sera collected from 2187 wild birds, 477 mammals and 22 reptiles and amphibians (Table 4). Special attention was given to rookery species nesting in and around Tampa Bay and the dove population in St. Petersburg. There was no evidence of recent SLE virus activity in any of these animal sera. Evidence of both eastern and western virus activity was found in the wild bird population of Sawgrass Swamp near St. Peters- burg, and at the swamp site in northern Hillsborough County. Eastern 16 ANNUAL REPORT, 1964 virus was also active in urban birds within St. Petersburg, but WE virus activity was not detected there. From 3003 vertebrate specimens screened for SLE, WE and EE virus by inoculation into one-day-old chicks, three viral agents were re- covered. All failed to become established by further passage in suckling mice; however, from cotton rats collected in December 1963, two viral agents have become established and are presently undergoing identifica- tion studies at the University of Pittsburgh. A preliminary survey of 200 rodent sera for Powassan antibody was carried out by Donald McLean, M.D., of the Toronto Hospital for Sick Children. Five sera were found to have HI antibodies against Powassan viruses; one was confirmed by NT. With this presumptive evidence of possible Powassan virus activity in the area, tick collections were made. Of 105 pools collected, 73 have been tested to date. Seven have yielded viral agents, six from the common dog tick, Dermacentor variabilis, and one from the common rabbit tick, Haemaphysalis leporis-palustris. These are undergoing further identification studies at the University of Pitts- burgh. Ornithologists from the University of South Florida led by Glen Woolfenden, Ph.D., continued their census of the breeding bird popula- tion in both a large swamp and an urban area of St. Petersburg. Several species, notably immature mockingbirds, were noted to move between the swamp and residential area during the summer months. This prompted a special study of bird dispersal in Pinellas County using the fledgling mockingbird as a model. Of 200 mockingbirds marked and released in the swamp during the month of July, 31 were reported as sighted within the ensuing two week period in an area of at least 15 miles radius. This indicated a potential mechanism for transport of a virus from the swamp into urban areas, and further studies on this hypothesis are being initiated. Laboratory infection experiments utilizing SLE virus and a variety of wild birds including the dove and sparrow, and one mammal, the cotton rat, were carried out. It was found that both the house sparrow and the dove developed a relatively prolonged viremia and readily developed HI antibodies after experimental infection. They can therefore serve as effective reservoirs of the virus in nature. Cotton rats in contrast did not develop HI antibodies one month after infection, so are presumed to be relatively poor hosts for the SLE virus. A special study on the transovarian transmission of HI antibodies against SLE virus in chickens has already been mentioned. TABLE 1 VIRAL ISOLATIONS BY TYPE OF SPECIMEN COLLECTED AND EXAMINED, ENCEPHALITIS RESEARCH CENTER, TAMPA, FLORIDA, 1964 Viral Agent Isolated Estimated Type of Specimen number of Eastern Western California Presumptive Presumptive specimens Encephalitis Encephalitis complex Cal. complex Tensaw Hart Park Unidentified Total examined Human ........................ 2 ............ ............ ............ 2 99 Pheasant ...................... 1 ............ .......... ...................... 1 Equine .....5 1 ......... ........... ..... ....... ............ ............ 6 903 Exposure chicks ............... 2 2 ............ ............ ................... ..... 100.. .4 (pools) Culex nigripalpus .. 1 100 (pos... .. .... . : I 1 1004 (pools) Aedes infirmatus ............... 1 ............ .... ... ......... ............ ..12 285 Aedes infirmatus ............. 1 2 12 31.. Aedes atlanticus ............... ........... ."... 12 3 ..................... ................. 15 55 " Aedes atlanticus 5 12 22 Culiseta melanura ..... .... 8 3 .. .. ...... ...... 1 Aedes species ......................................... 9 124 ........................ Anopheles crucians ............ ............ .... ........ ............ ............ .. ...... ...... ........ .... 6 ) 124 Dermacentor variabilis ......... . .................................................. ) 7 Haemaphysalis leporis palustris....... .. ............ ............................................... .... 1 1 Total................... 19 8 19 7 9 6 7 75 TABLE 2 CLASSIFICATION OF HUMAN CENTRAL NERVOUS SYSTEM SURVEILLANCE CASES, ENCEPHALITIS RESEARCH CENTER, TAMPA, FLORIDA, 1964 County Disease Combined 4-County Totals Hillsborough Pinellas Manatee Sarasota Classification Total Confirmed Probable Conf. Prob. Conf. Prob. Conf. Prob. Conf. Prob. CENTRAL NERVOUS SYSTEM DISEASE Viral.......................................... 101 38 63 ....... ................ Arboviral ................... .............. (3) (3) (0) 2 0 0 0 0 0 1 0 Other-(Rubella, mumps, varicella, Cox. B4, etc.) (98) (35) (63) 16 22 10 20 4 3 5 18 Bacterial ............. ........................ 12 6 6 5(c) 1 0 4 1 1 0 0 Non-infectious (Tumor, stroke, multiple sclerosis, etc.) ............................... 119 97 22 81 13 9 4 4 1 3 4 SYSTEMIC DISEASE Viral......................................... 50(b) 2 48 2 19 0 3 0 8 0 18 Bacterial, parasitic ... ........................ 11 5 6 3(c) 1 0 1 1 3 1 1 Non-infectious (Tumor, trauma congen. defect, poison, etc.)..... .......................... .. 32 21 11 11 8 5 1 3 0 2 2 UNCLASSIFIED (Data lacking, healthy Lontacts, etc.)............ 16 16 0 11 0 4 0 1 0 0 0 Total ............................. 341(a) 185 156 131 64 28 33 14 16 12 43 LEGEND: (a) 340 cases (2 confirmed diagnosis for one patient). (b) None due to arboviruses. (c) Leptospirosis. TABLE 3 MOSQUITOES COLLECTED BY ALL METHODS IN THE TAMPA BAY AREA, ENCEPHALITIS RESEARCH CENTER, TAMPA, FLORIDA, 1964 Number of Mosquitoes Collected Number Total Month Culex Aedes Anopheles Culiseta Aedes of Mosquitoes nigripalpus infirmatus crucians melanura atlanticus- Others Collections Collected tormentor January..................... 3,000 290* 31 40 2 5,103 (281) 8,466 February.................... 884 1,665 36 153 2 12,939** (356) 15,679 March...................... 2,307 1,245* 105 988 0 8,635 (459) 13,280 April... .... ............ 422 701* 175 486* 4 3,594 (541) 5,382 May........................ 551 2,236* 599* 1,150* 654* 3,861 (475) 9,051 June....................... 2,026 1,231* 937* 215* 101* 3,770 (645) 8,280 July. ....................... 14,857* 4,968* 560 496* 730* 4,672* (553) 26,283 August ..................... 28,724 1,405 1,646 445 1,702* 3,736 (505) 37,658 September................... 36,553 1,092 3,152* 331 224 5,640 (490) 46,992 October. .................... 16,120* 996* 597* 218 11 3,942 (532) 21,884 November................... 17,086 77 440 424 0 5,753 (428) 23,780 December ................... 11,194 229 90 465 0 5,425 (468) 17,403 Totals.......... 133,724 16,135 8,368 5,411 3,430 67,070 (5,733) 234,138 *Virus isolations obtained from these groups. ** 9,881 of these were Cu. salinarius 20 ANNUAL REPORT, 1964 TABLE 4 VERTEBRATE SERA COLLECTED AND TESTED FOR ARBOVIRUS ANTIBODIES, ENCEPHALITIS RESEARCH CENTER, TAMPA, FLORIDA, 1964 Specimens Specimens Type of Specimen Collected Serologically Examined Sentinel chickens .............................. 431 431 Exposed chickens .................. .......... 903 847 Sentinel pigeons .............................. 34 24 Total .................................. 1,368 1,302 Wild Birds Rookery species............................. 376 288 Mourning doves. ........................... 1,202 1,024 Mockingbirds.......... ................. .212 204 Blue jays.................................. 117 101 House sparrows ............................. 94 41 Other species ............................... 657 529 2,658 2,187 Mammals Sick bats................................... 269 None Rodents............................ ...... 406 277 Possums ................................... 87 77 H orses ..................................... 134 123 Total............................ 896 477 Reptiles and Amphibians Turtles................ ...................39 12 Snakes. ................................. 47 10 Lizards..................................... 25 None Frogs and toads ............................ 268 None Total............................ 379 22 Grand Total ..................... 5,301 3,988 TRAINING COORDINATION ROBERT V. SCHULTZ, M.D., M.P.H. Coordinator of Training This activity is within the office of the State Health Officer. It func- tions under the general direction of the Deputy State Health Officer for Program and Planning. The activities are primarily concerned with co- ordinating and providing assistance in planning, program development and arrangements incident to undergraduate and postgraduate training for eligible employees in all disciplines and departments of the State Board of Health (SBH) and county health departments (CHD); short courses supported by the SBH, the U. S. Public Health Service (USPHS) or special grant funds available for this purpose; meetings; seminars; work- shops and other inter- and intra-mural training situations; special projects, such as the Florida State Medical and Dental Scholarship Programs created by the 1955 Florida Legislature and administered by the SBH; and an American Medical Association (AMA) approved Residency GENERAL ADMINISTRATION Training Program offering qualified physicians one to three years indoc- trination and postgraduate training in preparation for recruitment in public health activities in Florida. To achieve these objectives, the coordinator, where indicated, explores the potential and reviews the established curricula of junior colleges, un- dergraduate and postgraduate institutions of higher learning; the Florida Institute for Continuing University Studies; training programs available through established facilities of the USPHS; special courses and projects conducted and supported by federal grants, private foundations, hospitals and health-related professions, organizations and institutions. Where ap- propriate, he provides close working relationships among faculty members and others concerned with registration of personnel for the desired train- ing, assists in developing and establishing new courses designed to meet specific training requirements and arranges for resource personnel and mutually suitable sites and facilities for these purposes. The services of the coordinator are available on request to SBH and CHD directors, program supervisors and all personnel concerned with training. He administers a Summer Student Training Program under general plans and operational procedures proposed by a committee formed for this purpose. Biannually, in April and October, this office issues a Calendar of Events a mimeographed listing of national, state and local meetings deemed of interest or concern to personnel in all disciplines and activities of the SBH and CHDs. This list projects the scheduled dates and sites of meetings a year or more in advance. It is distributed to all concerned with public health activities in Florida. The coordinator is responsible for appropriate distribution of an- nouncements, brochures, pamphlets, catalogs, fliers and other material concerned with a wide variety of training courses available in all parts of the United States. These publications are forwarded to CHDs for information purposes only as the SBH assumes no responsibility or obliga- tion to provide for fees, per diem or travel incident to attendance. At- tendance is a matter for local decision by directors of departments concerned, and support for such training must be from funds available locally for this purpose. This office develops appropriate programs for indoctrination of new employees (carried out by the Division of Health Education) and con- ferences and meetings for special guests and visitors to the SBH. It also maintains a file of catalogs of Schools of Public Health and other in- stitutes and facilities for reference purposes, and information concerning these items is available upon request. Public Health Residency Training Program The Council on Medical Education of the AMA has approved the following five Florida CHDs for residency training in public health: Dade 22 ANNUAL REPORT, 1964 (Miami), Alachua (Gainesville), Hillsborough (Tampa), Pinellas (St. Petersburg) and Palm Beach (West Palm Beach). The residency consists of one or more years of intensive training under the guidance of the director of the CHD to which the resident is assigned. The program conforms with the requirements of the Council on Medical Education, AMA, to which reports are regularly forwarded and is under the general administration and supervision of the coordina- tor. It provides a framework of reference for physicians interested in public health careers and is oriented to prepare them for employment in Florida public health facilities. In 1964, John J. Woodward, M.D., was appointed to a public health residency in Hillsborough County. The following four physicians have recently completed their residency training: R. Christopher Brown, M.D. Palm Beach June 1964 Antonio L. Court, M.D. Hillsborough June 1964 Richard A. Morgan, M.D. Hillsborough June 1964 Frank Leone, M.D. Seminole June 1964 Student Traineeship Program Each summer for a number of years, the SBH has offered temporary employment to a limited number of college and postgraduate students during the summer months. They are assigned to positions in activities related to their indicated or proposed careers in medicine, dentistry, sanitary engineering, the allied sciences and health-related professions. During their period of employment, they assist in ongoing programs and in addition receive special training and supervision designed to orient them with the specific and over-all functions of the SBH and CHD programs and activities. In 1964, there were 205 applications for this program. Of these, 55 were selected for employment at the central office and in the regional laboratories of the SBH, the several regional offices of the Bureau of Sanitary Engineering, the Encephalitis Research Center in Tampa and divisions or activities of the following counties: Alachua, Broward, Dade, Duval, Escambia, Gadsden, Hillsborough, Leon, Orange, Palm Beach, Polk and Sarasota. SCHOLARSHIPS FOR PROFESSIONAL EDUCATION The scholarship programs created by the 1955 Legislature for the study of medicine, dentistry and the several disciplines concerned with mental health were continued. Scholarships for the study of medicine were awarded upon the recom- mendation of a seven-man advisory committee authorized by statute. The seven members were: Hugh M. Hill, M.D., Assistant Dean for Students, College of Medicine, University of Florida; John C. Finerty, Ph.D., Assistant Dean of the School of Medicine, University of Miami; Arthur J. Wallace, M.D., Tampa; E. B. Hardee, Jr., M.D., Vero Beach; David GENERAL ADMINISTRATION W. Goddard, M.D., Daytona Beach; Homer L. Pearson, Jr., M.D., Miami; and James T. Cook, M.D., chairman, Marianna. As authorized by the Legislature in 1959, one scholarship was awarded for the study of osteopathic medicine. The recipient was recommended by the State Board of Osteopathic Medical Examiners. Scholarships for the study of dentistry were awarded by the SBH upon the recommendations of the State Board of Dental Examiners. Scholarships in the several disciplines of mental health were awarded upon the recommendations of the Florida Council on Training and Re- search in Mental Health. Through the Federal Social Security Act of 1935, the SBH receives federal funds which are used to provide stipends to its employees and those in affiliated CHDs for specialized professional training. These stipends are awarded to career employees who evidence a potential for growth and service in specialized areas of public health. MEDICAL Scholarships Awarded in 1964: Daniel Leslie Benboe ........Tallahassee Dale Miner Braman ........Gainesville Clarence Monroe Harris III ........Indian Rocks Beach Jack Benson Owen ........Port Orange Elena Suzanne Rose ............Orlando Orville Leon Barks, Jr.* ........Sanford James Patrick O'Leary ....Gainesville Elizabeth Orene Vaughan ......Bartow Charles Edward Walbroel .....Orlando Rosetta Mae Bush ..................Miami Edmond Delaney Robinson ..................Ft. Lauderdale Continuing Scholarships Awarded Prior to 1964: Awarded 1961: Jack Denby Bergstresser* George Duncan Finlay Buford Gibson, Jr. Hubert Warren Wingate Awarded 1962: Richard Julian Bagby Leonard Channing Bass Lloyd Dale Gauvin* Joseph William Haddock Donald Gammon Hall Gordon David Onstad Laurie Miles Pardee Richard Thomas Roby, Jr. Howard Todd Willson *Studying osteopathic medicine. Awarded 1963: Kenneth L. Beckett Calvin Collins, Jr. Beatrice Alfreda Denefield Samuel Boykin Hunter Ronica Mahoney Kluge Bodo Eitel Pyko* Kathleen Mary Santi Shirley Rose Simpson Ira Harmon Wenze Phillip Eugene Wright DENTAL Scholarships Awarded in 1964: Wayne D. Bradley ..............Escambia Roger E. Gibson..........................Lake Charles L. Graves, III....Palm Beach James R. Hoover..............Hillsborough Ronald J. Marien....................Broward Conrad A. Mora.........................Dade James E. Owens......................Gadsden William A. Thompson......Palm Beach 24 ANNUAL REPORT, 1964 Continuing Scholarships Awarded Prior to 1964: Awarded 1961: Clement W. Barfield George Dorris Guy R. Estes John T. Griffin, Jr. Charles A. Harrell Edward L. Peters Ivan Beryl Roberts David M. Strimer *Scholarship surrendered Awarded 1962: George Wallace Boring, Jr. Robert R. Burch *James V. Ferdinand Ronald E. Molinari William W. Motley, Jr. Alvan Carlton Smith Emory T. Cain in September 1964. MENTAL HEALTH Clinical Psychology Awarded 1963: John F. Bembry Norman M. Bevan, Jr. Frederick A. Booth, III Robert L. Ferdinand Anthony B. Frilingos George D. Sanchez Michael R. Kennedy Judith L. Anderson...............Lakeland Charles E. Buchanan..........Gainesville Carol W. Cardoza...............Plantation William T. Dillon........St. Petersburg Larry W. Dupree......................Tampa Charles E. Moan......West Palm Beach Jacqueline C. Raulerson......Bradenton Carolyn B. Richards ........Jacksonville Richard P. Toister........Coral Gables Dorothy B. Ward ............Winter Park Psychiatric Nursing Analie J. Buchler........Pompano Beach Carol Jean Delcher............Gainesville Clytee C. Lally..................Avon Park Psychiatric Social Work First Year Myron W. Bedgood..........Jacksonville Bernard Blackburn ............Homestead Woodrow W. Bryant, Jr...........Tampa Donna Cornea ......................Lakeland Thomas P. Holland .................Bartow Loreta S. Howard .................Orlando Sally K. Jackson..............Tallahassee James O. Lasher................Jacksonville Mary Jean Laycock..............Rockledge Jan Mundorff ...........................Starke Jonnie F. McCormac......Crawfordville John A. Walker................Tallahassee Roger L. Wallace....................Seffner Second Year George K. Bond* ....................Miami Berlin G. Jones ..............Tallahassee Jefferson Lee Townsend ....................Tallahassee *Withdrew in October-scholarship granted to Townsend beginning No- vember. Public Health Personnel M. Depew........................ Public Health Nurse III...........Broward L. A. Dutton.....................Public Health Nurse II.............Escambia H. V. Gayles.....................Public Health Nurse II.............Sarasota D. L. Hilderbrand..............Public Health Nurse IV............State Board of Health D. B. Jones..........................Public Health Nurse II.............Manatee M. M. Lentz.....................Public Health Nurse III...........Broward L. D. Lukin......................Sanitary Engineer V...............Palm Beach P. A. Maher.....................Public Health Nurse II.............Palm Beach E. J. McLaughlin...............Health Officer III.....................Charlotte-DeSoto- Hardee Unit M. A. Shirley.............Health Educator II................ State Board of Health A. J. E. Wilson.................Assistant Social Scientist...........Pinellas R. S. Wright.......................Sanitary Engineer IV.......... ......State Board of Health M. H. Speakman................Public Health Nurse II...........Highlands GENERAL ADMINISTRATION DIVISION OF HEALTH EDUCATION ELIZABETH REED, R.N., B.S. Director This division continues to serve and work with all other bureaus and divisions, county health departments (CHD), voluntary health agencies, health-related professions and the general public. Florida's burgeoning population increases the number of requests received for assistance from all sources. Positions for health educators on the local level are increasing with a total of 13 and three vacancies at the year's end. Several more CHDs are considering inclusion of health educators in their budget in spite of the difficulty in recruiting suitable candidates at the present salary levels. There is more interest in working with people in small groups versus the campaign type of approach. Increased emphasis has been placed on adequate planning for the health education aspects of all State Board of Health (SBH) programs. There has also been added cooperation with the many persons who function as program representatives and health field workers as well as with those classified as health educators. Medical Library In 1964, 1717 new books were added and 385 worn-out or obsolete editions were withdrawn bringing the collection to a total of 20,922 on December 31. The library is used extensively with SBH personnel making up the majority of borrowers, followed by those from CHDs. The Jacksonville Hospitals Educational Program's (JHEP) libraries were next. Local physicians, nurses, dentists, lawyers and students also are patrons. The library contains an excellent collection of the latest editions in the areas of maternal and child health, chronic diseases and psychiatric nursing. This is primarily due to the availability of categorical funds. New editions and additions are needed in other fields, particularly engineering and sanitation. A total of 1857 books was checked out; 536 issued on indefinite loan and 10,489 journals were circulated. Many of the latter were mailed out of town. A policy of restricting borrowing privileges to professional per- sonnel while permitting on-premise use by others resulted in 2341 books and journals being recorded as day loans. Other statistics: 67 interlibrary loans of materials were borrowed from larger libraries; 282 local interlibrary loans were made to the JHEP libraries and 1839 photocopies were made. The year 1964 saw the birth of a publication, Book Bulletin, which gives the title of new books received. Circulation: SBH personnel, CHDs and local libraries. Also a supplement to The Bibliography of Articles by State Board of Health Personnel was compiled. 26 ANNUAL REPORT, 1964 Audio-Visual Library Again as in 1963 the audio-visual library circulated more materials than ever before in its history. The increase amounted to over 18 per cent for the past year. There was also an increase in the number of times materials were used. In 1963 all aids on which reports were received were used 15,136 times; in 1964 they were used 17,935 times, an increase of 2799. Motion pictures continue to lead the field in types of aids used. There is a record of only one film being televised to an estimated audience of 10,000 persons in Miami. Thirty-three prints of motion pictures were removed and 136 other aids were removed primarily because of obsolescence, damage or surplus titles. The latter included filmstrips, filmstrips with sound, 35mm slides, tape recordings and one complete category; radio transcription tapes. During the year 52 prints of motion pictures were placed on loan in the audio-visual library. Purchases included 176 motion pictures. The inventory presently totals 1170 prints of motion pictures and 135 other aids. Other purchases consisted of: a rear projection system for display purposes, two tape recorders, a lantern slide projector, motion picture projector, two 35mm slide projectors, automatic filmstrip projector, a splicer and screen. A new postage meter and scales were purchased. The major problems continue to be insufficient space and personnel to conduct an operation of this magnitude. Plans are presently being made to further curtail circulation until these problems have been solved. Exhibits and Illustrations An exhibit made several years ago for an American Public Health Association meeting in Miami called "The Patio of Public Health" has now been seen by over 250,000 people and is still in demand. Other exhibits and displays totaling 56 items were completed, revised or re- furbished during 1964. Additional activities of the illustrator were: 56 exhibits and displays, 213 illustrations, 137 slides (photographs only), 101 charts-graphs-maps, 66 signs, 59 reproductions, 11 miscellaneous illustra- tions, 42 conferences and three field trips. Pamphlets A record high of 330,000 pieces of material was distributed. This increase was due in part to the publication of a "Guide for Teachers Wall Chart" and a new "Public Health Flip Chart" (a speaker's aid), many pamphlets on smoking, family planning and a number of leaflets in Spanish. "The Sick Child in School" which describes the activities of volunteer health workers in schools was revised and continues to be popular. Many students visit the pamphlet room and others write or call for assistance with school projects. This division has a lobby which is not the main entrance to the SBH yet almost 5000 visitors were received there last year. GENERAL ADMINISTRATION 27 Publications, Radio, Television The circulation of Florida Health Notes (published 10 months a year) continued to climb in 1964 until 19,000 are now being printed each month. Only budgetary reasons restrict promotion of this popular publica- tion. The mailing list was cleared during the year with over 56 per cent of the cards being returned. Subjects covered in 1964 were: health and exercise, medical quackery, death regulations, diabetes, mental retarda- tion, communicable diseases, shellfish sanitation, animal diseases trans- missible to man, health of Florida's Indians and a simplified annual report. Monographs number 6 and 7, Hillsborough County Oral Polio Vac- cine Program and Millstones and Milestones, were published. Assistance was given with 30 other books, pamphlets, brochures, etc., as well as the Annual Report. There were over 140 photographic assignments. This included the making of many slides. Approximately 190 radio stations received 53 new spot announce- ments. Subjects included heart disease, cancer, accidents, etc. Thirteen TV spots were provided and an informal survey showed that they were used approximately four times a week. A fruitless effort was a proposed venereal disease spot announcement campaign. Other nonroutine activities included preparation of a flip chart for speakers on laboratory services and a slide series in ascaris. Miscellaneous Activities The health education activities of the staff health educator and the director were multitudinous and included: numerous talks and attendance at many meetings throughout the state, three regular SBH Orientation Programs and a Firearms Safety Program for the Seminole Indians at Brighton and Big Cypress Reservations in cooperation with the Florida Game and Fresh Water Fish Commission. Assistance was given the Health Project in Teacher Education (See report of Bureau of Maternal and Child Health elsewhere in this Report). There was participation in a number of workshops sponsored by the Bureaus of Maternal and Child Health and Mental Health. The pos- sibility of educational TV health programs for junior colleges and uni- versities was explored with the Florida Institute for Continuing Univer- sity Studies. One rural Health Council was assisted in its planning. Consultation was offered to CHDs in the selection, orientation and routine visits to local health educators. Personnel of the SBH are in- creasing the number of their requests for assistance in planning the health education aspects of their programs. A new set of slides prepared in the division entitled, "How to Reach the Hard-to-Reach," and given at various meetings in other states, created much interest. Although prepared primarily for the immuniza- tion program, it has been found they have many applications to other public health programs. 28 ANNUAL REPORT, 1964 The major problems of the division are lack of space and the need for an assistant to the director. DIVISION OF PERSONNEL MILES T. DEAN, M.A. Director Under the general direction of the State Health Officer, this di- vision is responsible for the administration of the personnel program of the State Board of Health. This includes advising administrative officers con- cerning personnel practices and development; putting into effect pro- cedures for carrying out approved personnel policies; participating in the preparation and administration of the approved Classification and Com- pensation Plan; administering the leave regulations; maintaining ade- quate personnel records on all persons employed in the agency; acting as liaison official with the Florida Merit System involving requests for cer- tificates and reporting on the selection of eligibles, promotions, salary advancements, salary adjustments, demotions, transfers, dismissals, lay- offs and resignations; providing and administering a service rating sys- tem; and the preparation of state and federal reports. Payroll operation, also a responsibility of this division, includes the administration of leave accounting, the employee insurance program, retirement and Social Security, as well as the preparation of the administrative payroll and distribution of warrants. Preparation of the salary portion of the Legisla- tive Requesting and the Operational Budgets is also a responsibility of the Division of Personnel. During the year, the number of employment soared to 1226 in com- parison with 776 during 1963, a 58 per cent increase. This increase in employment was due to increased turnover and especially to new project grants, with the Aedes aegypti Eradication Program contributing the largest number. Revision of the Classification Plan for health officers, dentists, nurses, sanitarians and nutritionists was proposed and is practically completed. A classification section was added to this division. Liaison with the Florida Merit System improved and a better work- ing relationship has been developed. Salary range changes were proposed and approved by the Merit System Council to begin on July 1, 1965, provided necessary funds are made available by the Legislature and other fund sources. Turnover continues to be a problem particularly among sanitary engineers, laboratory workers and mental health workers. GENERAL ADMINISTRATION 29 TABLE 5 NUMBER OF EMPLOYEES IN THE FLORIDA STATE BOARD OF HEALTH AND COUNTY HEALTH UNITS AS OF DECEMBER 31, 1955- 1964 State County Health Total Year Office Departments Employees 1964......................... 843 2326 3169 1963......................... 762 1918 2680 1962......................... 692 1821 2513 1961......................... 626 1593 2219 1960......................... 604 1534 2138 1959 ....................... 586 1396 1982 1958. ....................... 558 1821 1879 1957......................... 528 1234 1762 1956................. ....... 481 1127 1608 1955. ....................... 442 1057 1499 TABLE 6 DISTRIBUTION OF PERSONNEL, FLORIDA STATE BOARD OF HEALTH (OTHER THAN COUNTY HEALTH DEPARTMENTS) DECEMBER 31, 1964 ADMINISTRATIVE UNIT 2 0 l a0 " Grand Total. ................................... 843 26 10 59 33 18 130 12 130 243 182 Administration Training.. ... ................................. 22 2 ........ 7 1 ........ ........ 3 1 3 5 State Health Officer.............................. 20 2 ........ ........ ....... ... ..... ................ 5 9 4 H health Education........................ ....... 14 ......... ........ ............... ......... ........ ........ 7 6 1 Personnel.................. .................... 18 ...................... ....... .. ...... ................ 6 12 Nursing....13...................................... 13 ................ 11 ............................................ Encephalitis Research Center................... .. 9 2 ....... ......... .... 2 ... ... 1 4 Research ....................................... 18 1 ........ ........ ........ ......... 2 1 2 6 6 Dental Health ... ................................ 14 ....... 10 ........ ........ ...... ...... ........ 1 2 1 Entomology State and Regional Offices........................ 20 ........................ 1 ........ 2 ........ 9 5 Research Center-Vero Beach ..................... 62 ........ .......................... 28 ........ 8 4 22 Finance and Accounts Fiscal ......................................... 14 ........ ........ ....... ........ ................. ........ 5 7 2 Purchasing and Property ......................... 7 ....................................... ...... ......... ........ 4 3 Building and Facilities ............................ 35 ...................................................... 1 1 33 Laboratories Central-Jacksonville ............................ 60 ........ ........ ........ ........ 1 38 ........ ........ 9 12 Miami................. .... .... ....... 23 ........ ................. ...... .. ....... 16 ................. 2 5 Orlando ....................................... 10 ........ ........ ..... .... ................ .............. 1 4 Pensacola ..................................... 6 ........ ........ ........ ........ ........ 3 ........ ........ 1 2 Tallahassee............................ .......... 7 ........ ............ ..... .. ......... 4 ........ ........ 1 2 Tampa ......................................... 23 .................... ..... ... ........ 11 ........ ......... 2 10 W est Palm Beach........................ .. .... 6 ....... ....... .... ......... ........ 4 ........ ........ 1 1 Epidemiology of St. Louis Encephalitis. ............. 19 ....... ........ 1 ................. 7 ........ 1 2 8 Local Health Services Bureau of Local Health Services ................... 14 4 ........ 1 ........ 1 .............. 2 6 Sanitation................ ......................... 6 ........ .......................... 5 .............. .......... 1 Nutrition ....................................... 10 ................................. ....................... 8 2 Civil Defense............................................... 2 ......................... ............. 1 1 Accident Prevention.... .......................... 2 1 ........ ........ .................. ....... ....... 1 ....... TABLE 6 (Continued) DISTRIBUTION OF PERSONNEL, FLORIDA STATE BOARD OF HEALTH (OTHER THAN COUNTY HEALTH DEPARTMENTS) DECEMBER 31, 1964 ADMINISTRATIVE UNIT a Maternal and Child Health ....................... 47 5 ........ 17 ....... 2 ....... 4 3 12 4 Mental Health. .................................. 18 1 ...... 1 .............4 3 8 1 Narcotics ......................................... 18 ................................................................ 5 13 Preventable Diseases Bureau of Preventable Diseases................... 6 2 4 Radiological and Occupational Health.............. 25 1 ...... 1 ........ ........ 12 6 3 Tuberculosis Control ............................. 26 2 ......... ............... ........ 12 10 Veneral Disease Control .......................... 20 ........................................... 16 4 Veterinary Public Health ......................... 5 ...2 ....................... 2 1 Vaccination Assistance Project.................... 36 ............... 19 .... ..... 1 ........ 4 9 3 Sanitary Engineering and Air Pollution Control... 86 ........ ................4 3 ........ 3 1 22 25 Special Health Services Bureau of Services for Indigent................... . 6 ........ ...................... 3 3 Hospitals and Nursing Homes ..................... 11 1 ..... ...... ............... 5 4 Chronic Diseases................................. 19 2 ........ 1 1 1 11 Community Cancer Demonstrations................ 3 ........ ................ .................. .... ....... 1 2 Vital Statistics Bureau and Division of Vital Records.............. 44 ........ ......... .. ..... ............... ................ 3 39 2 Statistics................................... .. 6 ..................... .. 4 2 Data Processing ................................. 13 ........ ........ ........ .... :: ........ .. .. ........ 3 10 32 ANNUAL REPORT, 1964 TABLE 7 DISTRIBUTION OF PERSONNEL IN COUNTY HEALTH UNITS, FLORIDA, DECEMBER 31, 1964 Baker 4 ...... ...... 1 ..... 1 .....1 1 . Bay ... .. 16 1 ...... 6 ..... 3 ..... 2 ...... 2 2 Bradford...... 7 1 ...... .... .... 1 1 Brevard..... 45 1 .... 14 1 8 .. 2 1 15 3 Broward a.... 236 19 27 2 19 3 9 4 18 10 Alachua....... .44 2 1 12 ...... 1 ..... .... 10 7 Charlotteker .......... 4 .... 1..... ..... ...... 1 1. Citrus........ 6 1 ...... 2 ...... 1 ...... ..... 1 ..... Bay........... 16 1 6 ...... 3 ...... 2 ...... 2 2 B radford....... 7 1 ...... 3 1 ...... 1 ..... 3 1 ColuBrevard....... 14 1 ...... 14 1 8 ...... 1 1 Browarde ........ 8 1 27 2 19 7 13 4 82 31 Calhounto ....... ..... 1 ..... ...... 2 ...1 DixiCharlotte...... .. 12 14 ......... ......... ...... ...... ..... 1 Citrusal........ 6 1 ...... 1 ........ 1 ...... 1 11 4 Escambia ... 68 4 ...... 19 ...... 13 ...... 4 2 17 9 Clagler.......... 2 ...... ...... ...... ....... ..... ...... 1. 1 Colankliner.... ..5... 12 1 1...... 1.... ...... 2 1 Columbia...... 10 1 4 3. 1 1 Dadde.......... 426 47 14 1 57 4 7 13 2 82 31 Gilchrist .... 7 ...... ...... 2 ............ 1. .... .. ... .. 1 2 D ixie ........... 4 ...... ... .... ...... 1 ..... .... 1 .. Duval ......... ...... 16 ...... 1 ...... ...... ... 2 11 4 Escambiat ...... 68 4 ...... 19 13... 4 2 17 9 F a lee...... .. ... ................. ... .... .. 2 1 Gadden....... 14 1 .... 7 ...... 1 .................. 2 Gilheristnando...... 2 3 ...... ...... 2 ...... ..... ................ .1 . Highlades........ 2 ... ...... 4 ... ... ..... ...... 2 .1 Gulf........... .5............ .. ......... 1 ................. .2 Hillsborough .... 196 6 2 71 2 38 1 4 6 35 31 Haoe ...... 5 ...... ...... 2. ...... 1 ..... ..... ...... 1 Hnde ... 10 ..... .......... 1 ................ 2 1 Jakesondy........ 15 1 ...... 5 ...... 12 .................. 2 4 Jeffernando...... 2 1 ........... 1 ...... ...... ..... ...... ... ... 1 Highlands...... 10 .1...... .......... 1 ..... ...... 1 1 Hillsborough.... 196 6 2 71 2 38 1 4 6 35 31 Home ........ 1 1 1 7 ...... 3 ...... ...... ..... 4 1 Indian River... 10 1 ...... 6 ...... 4 ...... 1. ..2 1.. Leckson... ....... 1 ...... 1 ...... 2 ...... 1 11 4 Jeferson...... ...... 2 ...... 1 ...... ...... ...... 1 2 Lafayette .... 4 ...... ...... 1 ...... ... .... ....... 1 1 L ake.dison ....... ....... ...... 3 ...... ...... .. 4 2 Manatee....... ... 17 1 ...... 1 6...... 6 ...... 2 7 3 Leon.......... 39 3 ...... 11 ...... 6 ...... 3 1 11 4 M arioLevy ......... 1 ...... ...... 3 1 ...... .. 1 3 2 Libertin ........ 3 ...... ...... ............ ...... .... .... 1 Madonroe....... 622 1 ........ ...... 1 1 1.... Manatee........ 32 1 ...... 4 11...... 2 ...... .... 3 OMarion....... 1. ........ ....... .3 .......1 1 3 2 OkeeMartin..........hobee.... ..... ...... 3 ...... ...... ...... 1 1 Monroe........ 22 1 1..... 7 ......4 1 .. 4 Nassau. ......... 13 1 ...... 4 ...... 2 .................... 3 3 Okaloosa....... 15 1 5...... 6 ...... 3 ............. .. 1 3 2 Okeechobee..... 6 ............. .. 3 ...... 1 . . 1 1 Orange......... 91 4 ...... 26 1 16 ...... 4 4 22 14 Osceola ..... .. 5 ...... ...... 2 ...... 1 ...... ...... ...... 2 . Palm Beach ... 111 6 2 32 1 20 ...... 9 5 23 13 Pasco.......... 9 1 ...... 3 ...... 1 ...... ...... ...... 3 1 Pinellas........ 181 9 1 71 3 30 3 5 8 36 15 Polk........... 95 3 ...... 39 1 12 ...... 4 2 19 15 Putnam ........ 15 1 ...... 5 ...... 4 ...... 1 ...... 3 1 St. Johns....... 10 1 ...... 4 ...... 2 ...... ...... ...... 2 1 St. Lucie....... 19 1 ...... 3 ...... 5 ...... 4 ..... 5 1 Santa Rosa..... 12 1 ...... 5 2...... 2 ...... ........ 2 2 Sarasota ....... 44 1 1 15 ...... 8 ...... 2 ..... 14 3 Seminole....... 18 1 ...... 8 ...... 3 ...... 1 ...... 3 2 Sum ter........ 4 ...... ...... 1 ...... 1 ...... ...... ...... 1 1 Suwannee...... 9 ............ 4 ...... 1 ............ ...... 2 2 Taylor......... 5 ...... ...... 2 ...... 1 ...... .... ...... 1 1 Union......... 3 ...... ..... 1 ...... 1 ...... ..... ...... 1 . Volusia........ 58 3 1 20 .. 8 ...... 7 ...... 10 9 Wakulla....... 3 .. ...... 1 ...... ............ 1 ..... 1 W alton........ 7 ...... ...... 2 ...... 1 ...... ...... 1 1 2 Washington.... 5 ...... ...... 2 ...... 1 ...... .............. 1 1 GENERAL ADMINISTRATION 33 TABLE 7 (Continued) DISTRIBUTION OF PERSONNEL IN COUNTY HEALTH UNITS, FLORIDA, DECEMBER 31, 1964 Bowrd A A. 4 5 1 4 COUNTY I i S Eradication of Aedes Aegypti M osquitoes..... 8 ...... ...... ...... ..... ............ ..... 2 6 ..... Broward A.A... 45 ........................ ........................ .... 1 44 Dade A.A...... 107 ..... ..................... .................. 2 105 Hillsborough A.A.......... 49 ......... ................ ....... ........... 1 48 Manatee A.A.... 23 .......... ......................... ... 1 22 M onroe A.A.... 15 ...... ...... ...... ...... ...... ............ ...... 1 14 Palm Beach A.A.......... 19 ...... ..... ...... ...... ...... ........ ..... ...... 1 18 Pinellas A.A.... 40 ...... ......... ....... ................40 Polk A.A....... 1 ........................ ...... ..................... 1 TABLE 8 PERSONNEL TURNOVER BY POSITION CLASSIFICATION, FLORIDA STATE BOARD OF HEALTH AND COUNTY HEALTH UNITS, 1964 CLASSIFICATION TERMINATIONS TURNOVER RATE Physicians. ...................................... 29 20.0 D entists ......................................... 2 6.0 Public Health Nurses .......................... 107 14.2 Sanitary Engineers.................................... 9 18.8 Sanitarians...................................... 30 8.6 Laboratory Workers (Prof. and Tech.) ............... 27 17.8 M ental Health ................................... 23 22.8 Other Professional and Technical................... 34 20.0 Clerical............................... .... 143 21.8 All Others..................................... ..195 29.7 Total. .......................................... 599 20.8 Not including persons employed on a temporary or for a specific duration. There were 208 such terminations. 34 ANNUAL REPORT, 1964 TABLE 9 EMPLOYMENT TERMINATIONS AND TURNOVER RATES BY CLASSIFICATION AND SALARY, FLORIDA STATE BOARD OF HEALTH AND COUNTY HEALTH UNITS, 1964 (FULL-TIME EMPLOYEES ONLY) SALARY CLASSIFICATION Total Under 200- 300- 400- 00- 600- 700- 800- 900- 1,000 199 299 899 499 99 9 9 799 899 999 Over TERMINATIONS 1964 Total-All Employees....... 541 24 152 239 68 19 19 4 3 3 10 Physicians ................. 18 ....... 1 . 2 10 Dentists................... ..... 2 ... Sanitarians................ ..... ..... 1 16 1 . Sanitary Engineers..... ....... ...... ... ...... 5 2 ..... ..... .. Public Health Nurses....... 107 ......... 28..7. 1 1.............. Laboratory Workers (Prof. & Tech.)........... 15 ..... 8 3 4 ..... Mental Health................ .... .... ... 5 4 6 1 2......... Other Professional and Technical................ 25 ..... 2 9 3 6 Clerical.................... 134 3 100 29 2 .... . All Others ................. 186 21 42 112 4 4 1 1 TURNOVER RATE-(ANNUAL PERCENTAGE) Total-All Employees....... 18.6 57.1 31.3 22.1 9.8 8.2 12.9 9.8 7.7 23.1 10.4 Physicians................. 15.9 .............. .... .... 50.0 ..... 10.0 12.8 Dentists................... 6.0 ..... ..... ..... .... ..... 10 .. Sanitarians................. 9.2 .......... 23.6 8.9 ..... 2.8 ................... Sanitary Engineers.......... 16.0 ..... ..... ..... ... 50.0 20.0 .. .... 20.0 .... Public Health Nurses ....... 14.6 ..... ..... 22.6 8.1 ..... 12.5 10.0 .............. Laboratory Workers (Prof. and Tech.)....... 13.5 ..... 44.4 9.1 13.8 26.7 ........................ Mental Health............ 22.5 .............. 55 11.1 26.1 25.0 33.3......... Other Professional and Technical................ 15.6 ..... 83.8 28.8 16.1 9.7 22.2 ................. Clerical.................... 20.8 88.8 32. 9.9 7.1 ..... ... ... .... All Others ................. 28.3 42.9 27.5 3.4 8.7 22.2 4.2 8.3 9.1... ... DIVISION OF PUBLIC HEALTH NURSING ENID MATHISON, R.N., M.P.H. Director The responsibility of this division is to plan, promote, develop and administer a statewide public health nursing service through the county health departments (CHD). This involves continuous correlation and coordination with the programs of other bureaus, divisions and related health agencies. The consultants participate in planning for and implementing studies and research relating to nursing, assist CHDs in integrating and co- ordinating services to provide for continuity and improvement of public health nursing and nursing care of the sick at home programs, promote GENERAL ADMINISTRATION 35 continuing education and inservice training for nurses and interpret State Board of Health policies to nursing personnel. Plans are being developed for additional field teaching centers in the state to conduct a two months' orientation in public health nursing for all newly employed nurses who have not had preparation in public health in their basic nursing program. A U.S. Public Health Service Short-term Traineeship Grant made possible a three weeks' workshop at the School of .Public Health, University of North Carolina, in June. One consultant, one university faculty member and two supervising nurses participated in the workshop, designed to develop course material for use in the orientation programs. The nursing consultants assume a very active role in the inservice education programs in counties. This includes assistance in planning, conducting and evaluating. Much emphasis is given to the coordination of the resources of other health agencies in the area of education and service. Joint planning committees are encouraged and consultants serve on many of these on a state level. Nursing care of the sick at home is being more widely accepted as an important component of comprehensive care. There has been a gradual increase in the expansion of CHD programs to include this service. Forty-two areas in the state have included this in their generalized public health program. This is done in cooperation with, and in many areas partially supported by, community nursing councils incorporated as non- profit bodies. Fees collected from patients are administered by the community nursing councils; these are adjusted to the ability of the patient to pay for nursing care. No one is denied service because of in- sufficient funds. In the smaller counties where there is not yet a formally organized program, care is being given on a limited basis. Referrals from a physician are required for continuing care of the sick in the home. Six of the larger metropolitan areas in the state have independent voluntary visiting nurse associations. A method for determining the time and cost of units of nursing activities was devised. Directors, supervisors and senior nurses were in- vited for a two day conference to learn the method. A primary reason for the studies was to validate the cost of nursing care of the sick at home for Medical Assistance to the Aged patients. Five CHDs have completed the study and seven more are in the planning or tabulating stage. Six visiting nurse associations have completed cost studies. The average cost of nursing visits in counties which have reported is approximately $5.62. The division schedules visits by public health nurses to mental and tuberculosis hospitals and Sunland Training Centers on a year-round basis. All fields of nursing are represented, making it possible for them to see the improved facilities available in Florida for the care of people with long-term illnesses and learn of the advances in the care and treatment of chronic diseases. The nursing consultant assigned to the mental retardation program assumed major responsibility for scheduling and planning orientation programs at the four Sunland Training Centers. (See Bureau of Maternal and Child Health elsewhere in this Report.) 36 ANNUAL REPORT, 1964 In July a position was assigned to the division for a consultant in the nursing home program. This nurse works closely with the Division of Hospitals and Nursing Homes, receiving her technical guidance from there. She has made 15 visits to CHDs and 31 visits to nursing homes. Orientation for this consultant included participation in an Institute on Home Care in Cincinnati, Ohio, and an Institute on Administration of Nursing in Medical Care Programs at the University of Michigan. Programs of 12 hours each entitled, "The Role of the Nurse in Re- habilitation of the Patient with a Stroke," were held in nine areas of the state in cooperation with the Florida Heart Association. The rehabilita- tion consultant has conducted 17 educational programs in 12 nursing homes and 15 inservice study groups for public health nurses. The gradual decrease in the number of midwives licensed continues; in 1964 they were reduced to 191. The number of counties without a midwife has risen to 15. Despite the decease in number of midwives and births attended by them, 12.8 per cent of the nonwhite mothers are de- livered by midwives. New candidates for midwifery are required to attend the trainee program at a maternity home in Sanford. Supervision of the program is provided by the maternal and child health consultant and CHD personnel. Fifty-five visits to 22 counties were made in the interest of the midwife program. BUREAU OF DENTAL HEALTH 37 FLOYD H. DeCAMP, D.D.S. Director DELMAR R. MILLER, D.D.S., M.P.H. Assistant Director In 1964, this bureau began its 15th year which has been the most successful in its history. PRECEPTORSHIP PROGRAM This program continued to fulfill its primary purpose as a method of recruiting dentists to staff dental clinics in county health departments (CHD). Since the beginning of the program in 1957, nearly 100 qualified young dentists from out-of-state have been employed. A major portion are now engaged in private practice in the state and maintain a keen in- terest in the public health problems of their respective communities as a result of previous experience in the CHDs. Dental preceptees are selected by the Florida State Board of Dental Examiners and supervision of their work is provided by a dental con- sultant from this bureau, a committee of dentists from the local dental society and the director of CHDs in their respective areas. Counties served by dental preceptees during all or a portion of the year were Alachua, Broward, Collier, Flagler, Glades, Hendry, Highlands, Hillsborough, Lake, Manatee, Marion, Palm Beach, Polk, Putnam, Sarasota, Santa Rosa and Volusia. DENTAL SCHOLARSHIPS The dental scholarship law, as amended in 1961, provides a stipend of up to $1000 a year for as many as four years for recipients who must agree to practice in "areas of need" (where there are few or no dentists) for 12 months for each $1000 received. Under certain circumstances, students may repay the funds received. Since 1955, 101 scholarships have been awarded with four cancellations before becoming effective. Disposition of the 59 graduates to date: Serving in areas of need ......................................... ......... 26 Repaid scholarship in full............................... .............. 13 Completed compensatory practice ........................................ 5 In military service .................................... ............... ......... 9 Repaying scholarship ...................................... ................ 4 Unable to qualify for Florida licensure ................................---- 2 59 DENTAL CLINICS An increased number of counties were served by full-time licensed public health dentists. These counties were Alachua, Broward, Dade, Duval, Liberty, Jackson, Orange, Palm Beach, St. Johns and Volusia. Two fully equipped mobile dental clinics are maintained to serve underprivileged children in areas having few or no practicing dentists. 38 ANNUAL REPORT, 1964 During 1964, one clinic operated for a period of seven months. The other clinic was operated by a dental preceptee for a period of 10 months. A summary of services performed follows: School dental inspections .................................................... 743 New patients ...................................................................... 1743 Repeat patients .................................................................... 927 Prophylaxes ................-...........---- .......... ............................. 470 Fillings (all types) .......................................... 4290 Extractions................................................................................. 1416 Miscellaneous treatments ........................................... 265 Topical fluoride applications ....................................... ..... 5 Talks given to school and civic groups .......................... 22 Pamphlets distributed ...................................................... 150 In addition to routine dental services, one mobile clinic was utilized for one month to provide dental services for underprivileged children attending a special school for the handicapped. The results obtained were satisfactory and indicate a need for further effort in this area. New dental clinics began operating this year in Collier and Jackson CHDs. The Hardee CHD completed equipping a dental clinic and a dental preceptee was employed to begin work in January 1965. Plans were initiated to establish clinics in Charlotte and DeSoto CHDs also. New CHD buildings completed in Highlands and Putnam Counties in- clude dental clinic areas. Plans were made in 1964 to acquire the additional equipment neces- sary to ready the Palm Beach CHD dental clinic facilities to provide training tours for students at nearby Palm Beach Junior College, School of Dental Hygiene. Plans for a dental clinic are included in the proposed new health unit scheduled for Venice in Sarasota County. A licensed dental hygienist was employed for 11 months of 1964. Working in seven different counties, she gave dental inspections to 9740 children in 23 schools. She also lectured and engaged in other health education work. Special work was done for students at the Florida School for the Deaf and Blind at St. Augustine and 4-H Club girls at the state encampment in Marion County. More than 200 prophylaxes and stan- nous fluoride treatments were given. Strong support was received from civic and professional groups by many local dental health programs. Contributions of money, equipment, materials and volunteer assistance helped sustain operation of clinics. The bureau received and responded to many requests for consultative services in connection with plans for establishing or modifying dental clinics in CHDs. FLUORIDATION This important means of reducing dental decay continued to be of great interest to many communities in the state during 1964. Pensacola and Palatka began fluoridating their water supplies during the year. Active programs to secure fluoridation continued through the year in DeLand and North Miami Beach. DENTAL HEALTH 39 Currently, 26 Florida cities with a combined population of 813,000 are fluoridating water supplies. An additional 27 cities with 325,000 people, including Jacksonville and Sarasota, have water supplies con- taining approximately the correct amount of fluoride as a natural com- ponent. In all, areas having a total population of nearly 1,138,000 are now receiving benefits of water fluoridated at near optimal level. LACTOBACILLUS LABORATORY PROGRAM An increased number of dentists utilized this service during the past year. In all, 103 dentists participated in the program this year, and a total of 2935 specimens was tested by the Central Laboratory and reports were made to individual dentists by this bureau. EDUCATION The distribution of the State Department of Education's Bulletin No. 7 A Guide-Design for Teaching Dental Health in Florida Schools in 1963 was followed in 1964 by activities which would encourage its further distribution and use. The Florida State Dental Society initiated a plan by which private dentists are appointed to serve as dental ad- visors to schools, to initiate and encourage the use of this Bulletin by the teachers. This bureau conducted meetings in cooperation with the dental advisors, CHD personnel, county school administrators and teachers to demonstrate dental teaching materials and develop channels of communi- cation for the interchange of information between the key persons in school and community health programs. The dental health educator continued to work with dental health programs on a local and state level and acted as consultant and lecturer to schools of dental hygiene, universities, 4-H club groups, the Florida School for the Deaf and Blind, etc. ORAL CYTOLOGY PROGRAM This bureau applied for funds to the U. S. Public Health Service and was granted sufficient funds to initiate a study program to obtain further information on the effectiveness and reliability of exfoliative oral cytology as a means of early oral cancer detection. This program in its initial phase was limited to the Northeast Dental District and began in June 1964 with an orientation session held for all dentists practicing in the 17 counties of the district, participating general pathologists and members of the Florida Division of the American Cancer Society. Cooperating pathologists began examining the smears (and in some instances, biopsies) submitted by participating private dentists in July 1964. These services are paid for by this bureau. This program was designed to include service to recipients of public assistance and to patients of private dentists since it is intended to test the applicability of the technique for both groups. 40 ANNUAL REPORT, 1964 BUREAU OF ENTOMOLOGY J. A. MULRENNAN, B.S.A. Director This has been a year of bureau reorganization and the initiation of the federally supported Aedes aegypti Eradication Program. Plans were started in February to secure federal funds to assist in the construction of the West Florida Arthropod Research Laboratory at Panama City. On August 21 a construction grant was received of $45,600 from the Research Facilities and Resources Section of the Na- tional Institutes of Health. It is expected that by the first part of 1965 construction will be started on three structures to house the laboratory facilities to carry out the applied research on all arthropods affecting the health and comfort of man. The 1963 Legislature appropriated $65,000 for the construction and equipment of this laboratory. With the additional funds obtained from the federal government the facility needs in this field will be projected for many years to come. The federally-supported Aedes aegypti Eradication Program was started in May in the following counties: Monroe, Dade, Broward, Palm Beach, Manatee, Pinellas and Hillsborough. The program, for the most part, has consisted of spraying with 2/2 per cent DDT all types of con- tainers on the premises in the residential and industrial areas of the counties. The first contract for this operation with the U. S. Public Health Service (USPHS) was for the period April 1 to September 30, and was extended to December 31 and carried $607,475 in funds. This contract authorized the employment of 281 inspectors, 31 supervisors, seven clerks and two clerk-supervisors. During the year the eradication program met with excellent reception from the public. At the year's end over one-half million premises had been inspected or sprayed. The Aedes aegypti in- dices were highest and most persistent in Broward and Dade Counties. The lowest indices following treatment have been found in Pinellas, Hillsborough and Monroe Counties. ARTHROPOD CONTROL Source Reduction Accomplishments The number of counties and/or mosquito control districts participating in the state aid program for the control of arthropods totaled 57 pro- grams operated in 53 of the 67 counties in the state. Holmes County withdrew temporarily from participation this year due to legal difficulties; a new district was formed in south Walton County and began participa- tion as of October 1; and, two city programs in Osceola County were combined under one operational plan with the county when the county budgeted funds for arthropod control work. Two separate programs are now being operated in individual areas of Bay, Duval, Lee and Walton Counties. ENTOMOLOGY 41 Source reduction methods consisted of the construction of dikes to impound water on salt-marsh mosquito breeding areas; drainage and ditch maintenance; hydraulic filling of mosquito breeding areas using two 10-inch hydraulic dredges; deepening and filling, using draglines and/or bulldozers; and, the operation of sanitary landfills. The following tabulation shows the amount of source reduction work performed, based on reports made to this office by counties and districts. A gradual change in reporting program costs is being made, which will account for unit cost differences in sanitary landfill operations when compared with figures shown in previous annual reports: 1963 1964 Machine Ditching and Maintenance Number of counties participating .......................... 32 33 Miles of ditches dug or maintained .......................... 466.43 447,164 Cubic yards earth excavated ........................ .......3,856,172 3,604,286 Average labor cost per cubic yard ............................ $0.094 $0.1032 Construction of Dikes (Draglines) Number of counties participating ............................ 5 4 Number of miles of dike constructed ...................... 51.86 47.54 Cubic yards earth placed in dikes ............................ 773,442 937,037 Average labor cost per cubic yard .......................... $0.070 $0.0615 Hydraulic Dredging (Two 10-inch Dredges) Number of counties participating .......................... 2 2 Number of dredges used .......................................... 2 2 Cubic yards earth fill placed .................................. 523,073 1,023,298 Average labor cost per cubic yard ...................... $0.108 $0.0575 Deepening and Filling (Draglines and Bulldozers) Number of acres improved ........................................ 67 97.631 Average labor cost per acre .................................. $192.85 $132.21 Sanitary Landfills Number of counties operating landfills ................... 34 35 Total number landfill sites operated........................ 92 121 Number of cubic yards garbage buried ..................5,248,533 4,989,121 Average labor cost per cubic yard .......................... $0.069 $0.075 Total field costs per cubic yard .............................. $0.121 Temporary Control Measures This method consists of repetitive application of chemical insecticidal formulations by ground and aerial equipment in an effort to provide tem- porary relief from mosquitoes, midges, dog flies and occasionally other arthropods of public health importance. Dibrom and Malathion continued to be the principal insecticides used against mosquitoes. Baytex was not used, since only one bid was re- ceived and the bidder could not furnish material directly. Both Dibrom and Malathion were made available for delivery in bulk quantities for the first time this year, at some savings in cost to the purchaser as compared with the cost of drum quantities. 42 ANNUAL REPORT, 1964 The following is a summary of the temporary control work performed in controlling mosquitoes by the 46 counties and/or mosquito districts: Adulticiding with Ground Equipment 1963 1964 Number of miles fogged .......................................... 377,516 372,537 Gallons of insecticidal formulation used ................2,733,711 2,559,085 Labor cost per mile .................................................. $0.513 $0.570 Beginning on October 1, 1964, revised reporting procedures for ground fogging operations were placed in effect. The cost of the insecticidal for- mulation used, plus labor and all other direct field costs, is reported and used to compute fogging costs on a per hour and per mile basis. The following is a summary average of the fogging work performed by the 41 counties and/or districts doing this type of control work during the October-December 1964 period. All reporting in the future is expected to be on the basis of field costs. (October-November-December 1964) Number of counties or districts doing ground fogging........................ 41 Total hours fogged .................................................................................. 5,205 Total miles fogged ................................................................................ 31,473 Gallons insecticidal formulation used ................................. .... 219,127 Average cost per hour fogged .............................................................. $22.00 Average cost per mile fogged ............................................... .... $ 3.64 Adulticiding and Larviciding with Airplanes 1963 1964 (1) Airplane Fogging Gallons of insecticidal formulation used.................. 84,905 227,041 Acres treated .............................................................. 881,321 2,706,840 Gallons applied per acre .................................. .0963 0.10235 Labor cost per acre treated ..................................... $0.0117 $0.0112 (2) Airplane Spraying Gallons of insecticidal formulation used.................. 185,757 160,124 Acres treated .............................................................. 301,421 221,864 Gallons applied per acre ........................................ 0.6163 0.7217 Labor cost per acre treated ................................. $0.134 $0.125 (3) Airplane Larviciding Pounds of paris green pellets used ................... 149,286 236,465 Acres treated ................................. ........... 9,523 22,779 Pounds applied per acre (average 5 per cent mix).. 15.67 10.38 Labor cost per acre treated ................................. $0.413 $0.4945 Dog Fly Control Dog fly control work carried out in the eight most western Florida counties bordering the Gulf of Mexico consisted of patrolling the shoreline at seven to 10-day intervals from July until sometime in October, and spraying windows of marine grasses deposited along the shoreline. A high velocity stream of salt water, containing five per cent emulsifiable DDT, was used as an insecticide to prevent breeding and emergence of dog flies from these windows. The program was reasonably effective, as only one or two minor outbreaks were noted, and these were of short duration and local in extent. Authorities in charge of the large fish and wildlife refuge in Wakulla ENTOMOLOGY County did not permit any treatments to be made on their properties this year. Since no inspections were made along the 25 to 30 miles of shoreline on this property, it is not known at this time how much this treatment omission affected the remaining part of the county. The following is a summary of the dog fly control work performed: 1963 1964 Total miles of shoreline treated ................................ 1,284 962 Gallons 35 per cent DDT concentrate used ............ 8,456 12,634 Average labor cost per mile .................................... $6.71 $8.33 No. man-hours labor required .................................... 6,308 5,686 Counties Participating and Local Fund Budgets The following counties participated in the State Arthropod Control Program during the year. The amounts of local funds budgeted for arthropod control activities during the fiscal year October 1, 1964 through September 30, 1965, are (as of December 31, 1964), as follows: Local Local Amount Amount County Budgeted County Budgeted Alachua ..........................$ 54,240.00 Leon ...............................$ 60,000.00 Bay (Co. Comm.) ........ 90,799.00 Levy ................................ 15,000.00 Bay Co. (Gulf) .......... 47,900.20 Madison ................... 1,953.00 Bradford ................ 13,024.64 Manatee ................ 90,465.91 Brevard ........................ 306,851.15 Marion ...................... 15,000.00 Broward ................. 68,247.00 Martin .................... 40,800.00 Calhoun ........................ 2,500.00 Monroe ................... 241,838.82 Charlotte ...................... 63,106.83 Nassau ..................... 55,749.00 Citrus ............................ 98,278.40 Okaloosa ............... 38,803.19 Collier ......................... 143,119.22 Orange ...................... 74,000.00 Columbia ...................... 15,228.06 Osceola ..................... 46,830.26 Dade ........................ 241,458.00 Palm Beach ............. 273,278.00 Duval (East) ............ 91,840.50 Pasco ..................... 62,249.00 Duval (Northeast) ........ 110,565.00 Pinellas .......... 247,577.90 Escambia ...................... 133,311.90 Polk ......................... 207,683.78 Flagler ..................... 14,303.54 Putnam .................... 25,000.00 Franklin ................... 15,000.00 St. Johns ................ 75,693.62 Gadsden ........................ 11,710.00 St. Lucie ................... 135,553.00 Gulf .............................. 37,500.00 Santa Rosa .............. 32,565.53 Hardee .......................... 4,700.00 Sarasota .......................... 166,408.59 Hernando ...................... 6,242.16 Seminole ................ 15,000.00 Highlands ...................... 4,483.00 Suwannee ................ 9,490.24 Hillsborough .................. 313,400.00 Taylor ...................... 5,000.00 Indian River .................. 320,496.22 Volusia .......................... 289,000.00 Jackson ........................ 4,060.38 Wakulla ..................... 18,000.00 Jefferson ...................... 10,255.58 Walton ...................... 6,800.00 Lake ................................ 82,065.40 Walton (South) ........... 18,544.24 Lee (District) ................ 337,554.00 Washington .................... 2,800.00 Lee ( Beach) .............. 60,325.03 Total local funds appropriated .......................... .............$4,973,649.29 Total state funds appropriated ............................................ 1,650,000.00 TOTAL........................................................ ............$6,623,649.29 Engineering Assistance was given a considerable number of counties and districts in reviewing their proposed specifications for the purchase of heavy 44 ANNUAL REPORT, 1964 equipment, and offering suggestions for changes in these specifications where needed. Considerable time was given to the review of all proposed work plans and budgets submitted by the counties and districts. Field reviews of programs and construction of projects were made. In cooperation with the Division of Sanitation a survey was made of Broward County's garbage and refuse disposal problem in December. Based on field survey work and consultation with the design engineers, recommendations were made to the City of Punta Gorda pertaining to clearing of the Shell Creek water storage reservoir, for mosquito control purposes, prior to impounding. The gates were closed in the late fall. However, the reservoir had not reached the designed operating pool elevation by the end of the year. A survey of a proposed impoundment near Middleburg in Clay County was made, construction plans reviewed, and an approval was issued. Regional Entomologists Regional entomologists have maintained headquarters and serviced their respective areas from Panama City, Jacksonville, Orlando, Tampa and Miami. Mosquito control and landfill operations are standard year- to-year functions, requiring services from the regional entomologists in planning, budgeting, consulting on operational methods, evaluating and reporting activities of the 57 local programs. These men guide and co- ordinate the state and local interests, so that the field work gives the best results to all concerned. They are also on call for any entomological or special allied program that develops within the state. Special duties this year have included meeting with county com- missioners to discuss organization of mosquito districts; inspecting hurri- cane disaster areas and advising on emergency fogging or control measures and restoration of ditches; supervising the construction, design, operation and location of new bird-baited traps being used in encephalitis studies; locating, relocating, arranging for new construction and repairs of equip- ment and hurricane-damaged areas, training and securing cooperators (who man mosquito collecting stations), and handling correspondence for the salt-marsh mosquito trapping program; assisting in the structural pest control program (particularly in the Orlando, Tampa and Miami areas); writing and distributing pest control leaflets; collecting and assisting in collecting mosquitoes for encephalitis studies reported elsewhere; and, otherwise helping people who telephone or visit the bureau with their insect and pest problems. During this year Putnam, Marion and Levy Counties were added to the Northeastern Region (Jacksonville), and Collier County to the Southern Region (Miami). ENTOMOLOGY 45 Arthropod Identification Laboratory This basic work evaluating the salt-marsh mosquito populations for the effectiveness of mosquito control, includes the identification of mosquitoes caught in 43 traps near salt marsh areas around the coastal margin of the state (as recorded in the weekly "Salt Marsh Mosquito- gram"), fresh water mosquito collections from 70 other traps operated at Woodruff Dam, North Bay Impoundment, Shell Creek Impoundment and special locations distributed over the entire state. In addition, identi- fications and information were frequently furnished to the general public on all kinds of arthropods and miscellaneous pests. The laboratory identified 10,063 adult and 33 larval collections, con- taining a total of 856,706 adult and 608 larval specimens respectively in connection with the regular program. For the bird-baited trapping program 23,611 specimens from 2158 collections were identified from samples taken in 47 counties from March through December. During 1964 it has been necessary to increase the services at Jackson- ville to include the identification of mosquitoes caught in bird-baited traps from all sections of the state and from specially selected locations where encephalitis is known or suspected. The laboratory has undertaken the identification of mosquitoes col- lected live by regional workers for processing in the SBH virus labora- tory. In the period May 19 through December 31 the arthropod labora- tory identified as to species 750 pools of mosquitoes, each pool containing 50 to 75 mosquitoes of a single species. Forty-nine (49) of these pools have been found positive for a virus. A total of 42,825 mosquitoes were identi- fied from suspected encephalitis areas. These were collected in 20 coun- ties between Polk and Jackson Counties with one collected from Dade. Midge Studies The study of the life history and ecology of the Chironomidae of Florida was continued, supported by a grant from National Institutes of Health. Thirty-six (36) collections totaling 2247 larvae from various parts of the state were put out to rear. From these, 465 adults (20.7 per cent) emerged. A total of 22,501 nuisance midges was identified from light traps in four counties. An additional 311 miscellaneous insects from pri- vate collections and 202 sandflies (Culicoides) were identified. STRUCTURAL PEST CONTROL The bureau continued for the 17th consecutive year its responsibility for licensing and issuing identification cards to structural pest control firms, and enforcing the law and regulations governing this industry. Enforcement functions under authority of the Structural Pest Control Act of 1959 and SBH Structural Pest Control Regulations adopted June 30, 1962, continued satisfactorily. The former prohibits issuance of a license unless the structural pest control activities of a licensee are "in charge of" an operator certified in the categories of structural pest control performed by the licensee. Failure of the law to define 46 ANNUAL REPORT, 1964 "in charge of" has been and remains a sorely vexing problem for en- forcement personnel. There were no public hearings in 1964 to consider regulatory changes or to adopt minimum standards. Minimum standards were given con- tinuing evaluation as a possible additional means of bringing to the public worthwhile, effective termite control based on irreducible, minimum norms of treatment. The need for official action has become less urgent as a result of the Florida Pest Control Association's adoption in 1962 of approved termite control guidelines for its membership. Serious con- sideration is being given by the Association and others outside the SBH toward amending the law by the addition of a fourth category of pest control to be known as "lawn and ornamental pest control." The SBH would continue as the enforcing agency under this proposal. The bureau was host on February 25 and 26 in Jacksonville to the fifth annual meeting of the State Pest Control Regulatory Officials. Eleven (11) states were represented. Both the number of licenses and employees' identification cards issued increased by six per cent over 1963. The number of investigations of property owners' complaints (involving licensees) remained unchanged, whereas investigations of unlicensed operators increased by 72.7 per cent over 1963. The Structural Pest Control Commission renewed 472 certifi- cates and issued 17 new certificates during the year. TABLE 10 SUMMARY OF STRUCTURAL PEST CONTROL REGISTRATION AND ENFORCEMENT, FLORIDA, 1960-64 Registration 1960 1961 1962 1963 1964 State Board of Health Licenses issued... 261 274 296 311 329 State Board of Health Change of Address Licenses issued...................... 39 29 33 34 44 State Board of Health Licenses revoked* 2 0 0 2 1** State Board of Health Licenses placed on probation*.................... .. 5 1 0 0 3** Employees' Identification Cards issued... 2,854 2,818 2,996 3,391 3,588 Employees' Change of Address Identification Cards issued ........... 340 136 145 160 237 Employees' Identification Cards revoked or stopped*.................................. 0 7 15 10 Employees' Identification Cards on probation*......................... .......... 5 0 2 2 Thermal-Aerosol Certificates of Authorization renewed*............... 12 12 9 8 6 Enforcement Homeowner complaints investigated..... 87 94 81 82*** 83 Unlicensed illegal pest control operators investigated ...................... 15 35 21 11 19 Warrants filed against unlicensed operators........................... 5 15 5 5 9 Letters of warning issued to unlicensed operators.......... ................. 6 10 9 4 9 Enforcement miles traveled (Jacksonville office only)......................... 16,647 18,222 16,865 17,107 18,608 *By Structural Pest Control Commission of Florida. -"Excluding one certificate revoked and two placed on probation. ***Correction from 1963 report. Licenses, identification cards and thermal-aerosol certificates issued are based on 1963-64 licensing year. All other entries are based on calendar year 1964. ENTOMOLOGY 47 ENTOMOLOGICAL RESEARCH CENTER The transfer of the Control Research Section to the new West Florida laboratory in Panama City was the most significant event of the year. The consequent reorganization is bringing about a new Vector Section in this Center which will concern itself with the immediate biological problems of disease spreading by mosquitoes. This new section is occupying the laboratory building vacated by the Control Research Section. Its 1964 researches are incorporated below, and for the last time, under the Ethology Section. Before the end of the year, three new National Institutes of Health research grants had been awarded to Entomological Research Center (ERC) personnel. However, these will not be activated because they, along with the ongoing research grants will be brought under a new Program-Project grant. This grant was designed to encompass all the mosquito-biology researches at the ERC. The Program is called "The Natural History of Mosquitoes." Approval for five years and the first year's grant of $225,608 were received in early December. ETHOLOGY SECTION Salt-Marsh Mosquito Research Before resuming dispersal studies with Aedes taeniorhynchus it was necessary to develop more refined techniques for mass rearing in the field. The main problem is control of energy reserves at emergence when rearing is under crowded conditions because of radioisotope demands for marking. Laboratory studies showed that larvae could be reared to adulthood at a density of three larvae per cc of water, with less than 10 per cent mortality. An unexpected but valuable bonus effect brought on by crowding was better synchronization of pupation and adult emer- gence. These same tests demonstrated brewers' yeast and powdered beef liver to be the best larval food. It was also soon apparent that the size, stored reserves and expressed autogeny (developing eggs without a blood meal) of adults could be greatly affected by the amount of food given the fourth-instar larvae. A single low-diet feeding of the latter resulted in small adults, low in stored reserves and in expressed autogeny. How- ever, in order to obtain an equally good recovery (i.e., low mortality) of large adults, high in stored reserves and in expressed autogeny, it was necessary to renew the food supply and provide clean water every 12 hours until pupation. With the preceding information from the laboratory, a pilot study was designed for one section (2 x 6 feet) of the concrete, bottom-heated trough in the field plots. Over 800,000 larvae were reared successfully, with 90 per cent pupating within a three-hour period. Adult emergence occurred over an eight-hour period with very low mortality. The next and final step is the determination of precise amounts of food required under concrete-trough conditions to produce mosquitoes at either end of the nutritional scale. ERC Research Grants-1964 Summary Source Investigator Investigation Sum PHS..............Harrington..............Biology of larvivorous fish......................$ 19,072 PHS..............Lea...........................Autogeny in mosquitoes ........................ 26,450 PHS..............Rathburn...................Insecticide aerosols .................................. 9,043 PHS................Yount.......................Lake limnology ...................................... 36,035 PHS..............Lum...........................Mosquito larval nurture ........................ 32,528 PHS..............Provost......................Field production of mosquitoes ......... 22,195 PHS.............Bidlingmayer.............Mosquito populations .............................. 25,295 PHS........ Van Handel..............Lipid synthesis in insects ........................ 45,103 FWS.............Trost/Provost............Wildlife effects of salt-marsh flooding.... 3,000 $218,721 Applied for in 1964 and approved for 1965 PHS................................................ Continuing grants ....................................$ 56,829 PHS----........................................ New grant (program) ............................ 225,608 Approved 1965 Total ......$282,437 Pending ............................ (none) Time Status 7th year, 3 to go 5th year, end 4th year, 1 to go 4th year, 2 to go 3rd year, 2 to go 3rd year, end 2nd year, 3 to go 2nd year, 3 to go 4th year, end ENTOMOLOGY 49 Techniques for estimating numbers of pupae produced and numbers of adults emerged for release in dispersal studies were refined. A light tray was developed within which pupae can be weighed dry and the total number calculated very accurately. These trays, each with a 50,000 capacity, can be stored on moist toweling at cold temperatures so that any desired emergence time can be manipulated and calculated. A monogram was developed for calculating the emergence time of pupae at several temperatures. At a predetermined hour the pupae (on trays) are trans- ferred to the emergence site. Here they are submerged in specially de- signed water vats and emergence cages placed over them. After emer- gence, the cages of mosquitoes can be marked with fluorescent dyes and transported to the exodus site for release. Three releases of A. taeniorhynchus were made this year to study the initial take-off during twilight. Special attention was given the factors of light, wind and temperature, and a photographic method of monitoring both adult emergence and exodus was developed. It was demonstrated that adults as young as four hours could take part in the twilight exodus, while individual departures during the night involved only mosquitoes over eight hours old. Culex nigripalpus Research A special study of the cylindrical bait trap with funnel entrances was made to learn whether this trap would perform more efficiently if aligned with the wind. The interior of the experimental traps was divided into two compartments to show which end the mosquitoes had entered. The fact that mosquitoes approach these traps by flying upwind was abun- dantly confirmed. Analysis of the data also showed that in four different orientations (held at 0 or 90 from the wind direction; set in a fixed, randomly selected direction; or continuously revolved), the traps caught very similar numbers of C. nigripalpus. Most interesting was the fact that pointing a trap in the direction of the wind not only reduced the total catch, but increased its variability. This is fortunate because there appears to be no economical way to construct a trap that is self-orientating at low wind velocities. It is sometimes necessary to identify large numbers of mosquitoes, leaving them in the same physiological condition as before; for example, equally ready to take a blood meal. Previous work had demonstrated that subsequent biting activity would be affected both by CO2 anesthesia and by exposure to cold after chloroform knockdown. Attempts have been made this year to develop a method of immobilizing C. nigripalpus by chilling alone. No satisfactory results have yet been achieved. It may be that even minimum chilling will delay the return of normal blood-feeding activity far beyond the period required for the mosquito to warm up. The energy reserves of C. nigripalpus, both field-collected and fed on various diets, were tested by their survival in humid incubators set at 27 C. Water, but no food, was available during the holding period. Females reared from pupae taken in two different habitats differed 50 ANNUAL REPORT, 1964 slightly in their survival; females raised in the laboratory lived somewhat longer. Reared females given sugar at different intervals after emergence exhibited very low mortality after they had been fed. Reared females that were kept on a diet of 10 per cent sugar for one, two or three days after emergence reached 50 per cent survival levels at four, 12 and 15 days respectively. In another test, reared females were offered blood but no sugar. Regardless of the age at which they fed, the 50 per cent survival level was reached in three to four days, approximately the period required to mature eggs. These tests have affirmed the great importance of sugar in the diet of adult mosquitoes, also the inadequacy of blood as a sub- sistence food. Collections made in bird-baited traps from November to March were tested in the same way. They had a 50 per cent survival period ranging from 70 to 92 hours. No reason could be found for the wide spread in survival times. Survival was apparently not related either to the size of the holding container or the age of the females. It might have been due to the availability of sugar sources in the field. Oviposition by C. nigripalpus in prepared infusions of oak leaves con- tinued throughout the winter of 1963-64. After December, the observed rate of oviposition was much lower, possibly due to a change in the infusions which were being prepared outdoors. In connection with this study, characters were found in first-instar larvae of the four prevalent species of Culex that permitted rapid identification of live material. Observation of the oviposition behavior of wild adults of C. nigri- palpus brought to the laboratory was concerned mainly with the recogni- tion of infusions. The results of testing an infusion at full, two-thirds and one-thirds strength were nearly identical with those of an earlier test made in the field. The largest numbers of egg rafts (41 and 55) were laid on the undiluted infusions, about half as many were laid on each of the two dilutions, and very few (three and nine) on dishes of water. Indoors, C. nigripalpus seemed in general less capable of distinguishing infusions from water, even laying as many as 20 per cent of its rafts on water in- stead of an infusion. The female oviposited similarly on infusions in Petri dishes and in solid hexagonal clumps of shell vials with approximately the same surface of exposed fluid. When nine vials filled with infusion and nine vials filled with water were arranged in regular patterns, as many as 15 per cent of the rafts were laid on water. When shell vials similarly prepared and arranged were separated from each other by their diameter, the per cent of rafts laid on water was only six per cent. This suggests that accurate recognition of infusions is improved by their spacing, and has important implications for laboratory studies of this type. Spacing has also been investigated with respect to concentrations of salt, thus far without conclusive results. In the field, C. nigripalpus de- posited egg rafts on an infusion containing one-half per cent sodium chloride, but not one or two per cent sodium chloride. In small cages in the laboratory a few rafts were deposited on each of these higher concentrations. ENTOMOLOGY Comparative Biology of Mosquitoes Colonization studies have continued with C. nigripalpus, Aedes infir- matus and Aedes atlanticus three species implicated in virus transmis- sion in the Tampa Bay area. A. atlanticus was found to mate as readily as A. aegypti in small cages, while A. infirmatus is very refractory to mating even in a four-foot cage. A. atlanticus lay only 40-60 eggs, but these are very large and much more desiccation resistant than the 100 or more eggs laid by A. infirmatus. C. nigripalpus, on the other hand, lay 150 to 325 eggs per raft and at 27 C these hatch 30 hours after laying. All three species survive in fair numbers up to 60 days at 270 C on 10 per cent sugar solution. Techniques for egg hatching and larval rearing of A. at- lanticus and A. infirmatus have been only partially worked out, but C. nigripalpus now frequently give a 95 per cent return of pupa from the number of larvae hatched. The stimulation of C. nigripalpus mating by the sound of A. taeniorhynchus male swarms broke the initial refractori- ness to mating. The C. nigripalpus colony is now in its 14th generation and is still very vigorous. The Caribbean Culex bahamensis, common in the Florida Keys, was studied because of its possible disease-spreading properties. It was found the easiest species of the subgenus Culex to colonize. It mates in both daylight and twilight, with or without swarming, in small cages. Larvae thrive in either fresh water or 25 per cent sea water, and adequate larval diets have been worked out. Observations of mosquito behavior during two total lunar eclipses and one solar eclipse were made this year, the latter during a vacation at Mt. Desert Island, Maine. The results are still under study. A new light meter has been developed which can be used for measuring twilight and moon- light illumination in the field or low light intensities in laboratory experi- ments. ECOLOGY SECTION Biology of Larvivorous Fish The extensive data on food habits and seasonal reproductive cycle of the important mosquito-eating marsh killifish, Fundulus confluentus, cited in the preceding report, have been fully analyzed and are available for reference pending their preparation for formal publication. Preliminaries to the investigation of the other end of this problem, viz. marsh productivity, have advanced to the selection of the study area, its subdivision by stakes into a grid corresponding to that marked on a completed vegetation map of the area, and include determination of contour lines with regard to progressive flooding or dewatering, according to season. A sod-sampler has been designed and fabricated that will cut unit areas of marsh of one-liter volume. These can be flooded to learn the productivity of subregions of the marsh in terms of numbers and kinds of organisms hatching, with reference to vegetation, soil-solution salinity, marsh profile and dewatering timetable. 52 ANNUAL REPORT, 1964 The above projects have been kept in abeyance, however, by the demands of maintenance and systematic recording of vast amounts of observational and experimental data resulting from the continuing study of the hermaphroditic killifish, Rivulus marmoratus. A paper has been published reporting results of tissue-transplantation tests made on this material. A generating series of integrated observations and experiments have been and are being carried out on material seldom, if ever before, equalled in genetic homegeneity. The most recent experiments used ani- mals all from the same genetic clone (group of organisms all having the same genotype, i.e., heredity make-up, as do identical twins). A low per- centage of males among laboratory populations of hermaphrodites raised the question of the cause or causes of their sudden appearance, in view of the fact that out of hundreds of fish examined no females were found. A preliminary experiment testing the possible effect of several environmental factors on sex determination or differentiation gave strong presumptive evidence of a critical temperature effect. Such experiments on fishes are of long duration over a year, sometimes unlike those on insects. Owing to mortality under the rigorous conditions, it was im- possible to decide with finality between a selective mortality of opposing sex types and a differential induction of males. To remove this dilemma, these experiments were repeated the following year with variations to pro- vide additional information, and there can no longer be doubt that by manipulation of rearing temperature a statistically significant preponder- ance of males can be produced at will. Concurrent studies of histological serial sections of hermaphrodites and males have been made. An addi- tional series of observations supplemented by experiments have been conducted on a group of fish hatched late in 1961 and still with survivors, because some of these underwent a "sex inversion" from hermaphrodites to secondary male gonochorists (separate male or female animals, antonyn of hermaphrodite). This study has required the daily monitoring of these fish since 1961. It has proved most rewarding and when completed (prob- ably during 1965) will provide the first clear-cut evidence of the effects of extrinsic factors on sex inversion in a vertebrate animal. The fruitful- ness of the above series of interrelated researches may be apprehended by the estimate that it will take approximately 10 to 14 separate journal articles to adequately report them, and will, of course, take considerable time and effort to examine in the context of present biological knowledge. Mosquito Sampling Studies The mosquito flight study described in the Annual Report for 1963 was continued through 1964. The two field stations were operated from April through October. As the different collecting methods will yield collections more rapidly than they can be processed, the mosquitoes are stored in a freezer so that no deterioration of the internal organs will occur. These collections are then dissected and examined during the winter months. Preparations are being made to continue the program during the coming year. The power aspirator developed the previous year was operated on a ENTOMOLOGY 53 regular schedule during the current season. It has confirmed its earlier promise of becoming a valuable tool for obtaining a random sample of the constituents of a mosquito population. Since this unit is an integral part of a jeep, the jeep cannot sample every type of habitat because of its size. In order to develop a more versatile power aspirator, a miniature tractor has been secured and it is planned to adapt the power aspirator to this vehicle. Research on Control of Lake Productivity The two methods of reducing lake productivity under study, aeration and nutrient removal, were investigated further in 1964. Excessive pro- ductivity is a limnological disease, in a sense, and it is responsible for many unhealthy and unwanted lake conditions in Florida, of particular concern here being the over-abundance of chironomid midges. The cure can only be some drastic measure which will reduce the basic richness or productivity. Background studies on Lake St. Clair and the two Lakes Tangerine were continued in preparation for the aeration experiment planned for early spring 1965. The aeration equipment compressors, plastic air lines, etc. have been assembled and placed and will be ready for use on Big Tangerine. Lake St. Clair will be used as a control for this study, while Little Tangerine was slated for the hyacinth nutrient-removal study. More than a ton of water hyacinths were placed at various intervals in an enclosure in Little Tangerine as a preliminary experiment in nu- trient removal, with hopes of fast growth. The work, however, was vitiated by damage to the plants eventually traced to the feeding of pond turtles. Nurtrient-removal studies on small, plastic-lined pools were also plagued with trouble from wild animals. Nevertheless the methodology for such studies involving the removal of lake nutrients by hyacinths was worked out in considerable detail and the investigations of 1965 should not be as frustrating as the exploratory studies. PHSYSIOLOGY SECTION Pupation Studies Studies on the factors affecting larval development were continued with particular emphasis on the phenomenon of daily synchronous pupa- tion. Experiments were made at 320C to determine how light of various intensities, wave lengths and duration stimulated the photoperiodic re- sponse resulting in a 24-hour rhythm of larval pupation. The experi- ments showed: 1) A five-second light period, at an intensity of 9000 lux, repeated every 24 hours, was sufficient to cause slight synchrony of pupation. Synchrony became sharper as the duration of the light period was extended up to 12 hours out of every 24 hours. Tests with longer light periods showed that a minimum four-hour dark period was also necessary; 2) Light in the blue region was responsible for the synchronous 54 ANNUAL REPORT, 1964 pupation, so that light in the green, yellow and red portion of the spec- trum was comparable to a dark period; 3) A reduction of the light intensity from 9000 to 300 lux was shown to be equivalent to complete darkness. Endocrine Studies The main objective of this work has been to investigate the hormonal regulation of egg development, and to date experiments have shown that two hormones are involved, one produced by a pair of glands in the neck (the corpora allata) and the other by groups of cells in the brain (the neurosecretory cells). During the past year an attempt has been made to find reliable hosts into which these organs could be implanted in order to test the activity of the organs from mosquitoes of different species, ages and phases of the reproductive cycle. The histological studies, men- tioned earlier, will give clues as to the most appropriate animals to test, as well as when to test in order to show the greatest differences. Experiments with A. aegypti showed that even a female which was observed to copulate must have attained a certain age before she will become inseminated. Young females will mate repeatedly but fail to re- ceive sperm. The age at which females will be inseminated is temperature dependent and varies between strains of aegypti. A hormone from the corpora allata influences the insemination of females. Older females which had their corpora allata removed fail to receive sperm during mating, whereas the implantation of corpora allata into such females restored their ability to become inseminated. This provides another criterion by which to judge the activity of the corpora allata, and may lead to other experi- ments showing a relationship between the behavior of mosquitoes and their physiological state. BIOCHEMISTRY SECTION During the year 1964 two projects in technique development were concluded and accepted for publication: the determination of small amounts of glycogen and the separation of glycogen, lipids and sugar. The work on the effect of increasing sugar doses on fat and glycogen storage at constant temperature has been concluded and submitted for publication. The work on the effect of temperature on sugar disappear- ance, fat storage and glycogen storage has been continued and is now being mapped for seven temperatures between 100C and 350C. With these two studies (the temperature and the nutrition factor) it will be possible to predict, from a known set of conditions, the life expectancy of any brood of any mosquito species in the resting stage, for males and females separately. To round off this program, it will be necessary to study the energetic of the mosquito in flight and the energy derived from proteins. With the aid of an unbiased sample (a problem studied by the ecology section) some behavior characteristics (studies by the ethology section), some simple analysis described in the above-mentioned method papers, and available weather data, life expectancy of a brood can be calculated with a simple empirical formula. ENTOMOLOGY 55 Studies of blood-fed mosquitoes have shown that almost all of the blood protein is used for egg development and after egg laying very little energy is left to prolong metabolic life expectancy. Of course, mosquito broods are also affected by non-metabolic death, (studied in other projects), but the metabolic and non-metabolic death will always be intimately related: In other words, more precise informa- tion will become available anent the most efficient moment to institute adulticiding. WEST FLORIDA ARTHROPOD RESEARCH LABORATORY The West Florida Arthropod Research Laboratory of the Bureau of Entomology was established at Panama City in August 1964. The research staff of this laboratory formerly comprised the Control Research Section of the Entomological Research Center at Vero Beach. The 1963 Legislature provided funds for the construction of this laboratory for the purpose of investigating public health insect problems in the West Florida area and developing effective abatement methods. The stable fly, Stomoxys calcitrans, known as the dog fly in West Florida, is the principal problem insect. However, since West Florida also is confronted with the other public health insect problems that occur throughout the state, i.e., mosquitoes, sand flies, deerflies, etc., it was decided for reasons of economy to consolidate the research on control of all insects in this new laboratory. During 1964 the laboratory was housed in temporary quarters leased from the U. S. Navy Mine Defense Laboratory at Panama City. New buildings will be constructed on 10 acres of land located on North Bay, Panama City, during the first half of 1965. The land was located by the Panama City-Bay County Airport Authority. Matching funds in the amount of $45,600 for the construction of the laboratory were secured from the USPHS. Because of the limitations imposed by temporary quarters and pres- ently budgeted funds, the laboratory will not be fully staffed and pro- grammed until late in 1965. The 1964 Annual Report covers the period January to August, during which time the staff was at the Vero Beach laboratory, and the short period at Panama City near the end of 1964. Dog Fly Studies The biting stable fly, S. calcitrans, is a severe pest of the human population and domestic animals along the coastal area between Pensa- cola and Cedar Key. The problem is especially severe along the 200 miles of Gulf Coast between Carrabelle and Pensacola. This fly, known as the dog fly in West Florida, is a vicious blood-sucking parasite which is responsible for large economic losses both to stockmen and the tourist industry in the affected areas. Intermittent studies of the problem by various research workers since about 1934 have established that the windows of marine grasses (com- 56 ANNUAL REPORT, 1964 only called seaweed) which are deposited by high tides on the beaches of inland bays and sounds is the principal source of the flies in West Florida. Studies by the U. S. Department of Agriculture and the USPHS from 1939 to 1946 resulted in the development of abatement measures to pro- tect military personnel stationed in the West Florida area during World War II. The most effective control method developed by this group was the application of DDT residual sprays on the marine grasses to kill emerging adult flies. This program was terminated by the federal agencies in 1946, and there has been no sustained research program since that time. Local abatement districts were organized in the several counties concerned beginning in the early 1950's. Basically, these local abatement programs have utilized the control procedures established by the federal agencies about 20 years ago. Results of the local control programs have been less than satisfactory. The first objective of this laboratory will be to evaluate present control procedures, and the long-range objective will be to develop improved methods of control. The dog fly problem normally is most severe from August to Novem- ber. A moderate outbreak of flies occurred along much of the West Florida coastal area in late August and early September 1964. Field observations by laboratory staff members were begun in September. Infestations of dog flies in advanced stages of development were found in marine grass deposits at three locations in Bay County on September 21, 22 and 26 respectively. The latter infestation was in a grass deposit which measured over 1800 feet in length and averaged five feet in width. This grass probably was washed ashore by high winds of Hurricane Dora, which passed near Panama City on September 10, 11 and 12. This infestation was used in the first attempt by this laboratory to evaluate current methods of spraying with DDT. The infested grass was sprayed on September 29 by the spray crew of the Bay County Pest Control District, using five per cent DDT emulsion at the rate of about 50 gallons per mile. Emergence cages were placed over the treated grass and a short portion that was left untreated. Un- fortunately, Hurricane Hilda uprooted the cages and scattered the grass on October 3, thus ending the observations. Results during the three days after spraying showed, however, that the treatment was not effective. Observations indicate that the volume of spray and the type of spray nozzle used might have resulted in inadequate coverage of the infested grass. On December 17 pupae from a colony of dog flies established in the laboratory were "planted" in old grass deposits along the shore of West Bay, Bay County, and treated with DDT at two rates of application. This test was not completed in 1964 but results indicate that dog flies in the West Florida area are still susceptible to DDT sprays. ENTOMOLOGY 57 Mosquito Adulticiding Studies The principal area of investigation in 1964 was research dealing with the aerial application of insecticide sprays for adult mosquito control. From these studies it was determined that a dosage of 0.05 pounds per acre of Dibrom (naled) applied at a gross volume of one quart per acre in No. 2 diesel oil using a 200-foot swath, produced an excellent kill of both the salt-marsh mosquito, A. taeniorhynchus, and the enceph- alitis vector, C. nigripalpus, in grass areas. In brush areas, 0.1 pounds per acre Dibrom at the same gross volume and swath produced excellent kill of both species of adult mosquitoes; however, neither application proved to be effective in heavily wooded areas. Results obtained in 1963 indicated that a gross volume of one to 1-/2 gallons per acre was necessary to give satisfactory kill in heavily wooded areas. In 1963 satisfactory kill of adult mosquitoes with aerial fog was ob- tained only in open areas, indicating that the fog did not reach the ground in areas with overhead cover. Therefore, tests were conducted in 1964 with a high viscosity fog oil with the hope that larger and heavier particles would be produced which would penetrate tree canopies and reach the ground. However, based on comparative kills of caged mosquitoes placed on the ground, the fog oil was no more effective than diesel oil. In aerial fog tests comparing discharge rates of 150 and 320 gallons per hour, significantly better kills were obtained with the 320 gallon per hour rate. However, even at the higher rate of application satisfactory kills of caged mosquitoes placed in grass in open areas were not obtained at 165 feet from the line of flight. Aerial fog tests with Malathion and Dibrom at a discharge rate of 600 gallons per hour failed to give satis- factory kill of caged mosquitoes on the ground or at a height of six feet from the ground in heavily wooded areas. Research with both aerial spraying and aerial fogging will continue in the coming year. Large scale tests are planned using natural populations as well as caged mosquitoes. Research on ground fogging in 1964 was primarily confined to a series of tests designed to compare the effectiveness of diesel oil and fog oil as diluents in insecticide formulations. Many claims have been made by both manufacturers and users as to the superiority of fog oil as a diluent for insecticides in ground fogging. However, tests designed to demonstrate any difference between fog oil and diesel oil indicated that: fog oil and diesel oil were equally effective in killing caged adult mosquitoes placed above the ground at distances up to 1320 feet; neither fog oil nor diesel oil gave satisfactory kill at ground level or in low grass; neither fog oil nor diesel oil gave satisfactory kill at a 20-gallons per hour discharge rate; fog oil was no more effective than diesel oil against A. taeniorhynchus or C. nigripalpus with either six ounces per gallon or eight ounces per gallon formulations of Malathion; and there was no difference between the two oils in regard to the formation of sludge when formulated with Malathion or Dibrom in the absence of sludge inhibitors. Since both A. taeniorhynchus and C. nigripalpus rest on the ground during daylight hours and poor results were obtained with both 58 ANNUAL REPORT, 1964 oils where caged mosquitoes were exposed at ground level, neither oil would be effective for fogging during daylight hours. Results of ground thermal aerosol tests with Baytex to determine ef- fective dosage for use against C. nigripalpus were complicated by low temperatures. It is planned to continue these tests with Baytex and some new insecticides in 1965. A test was conducted in 1964 in the Tampa Bay region of Florida to determine the effectiveness of residual insecticide spray applications against the encephalitis vector, C. nigripalpus. Individual premises, in- cluding the lawns, shrubs and houses to a height of four to five feet, were sprayed to run-off with a two per cent solution of Malathion. Only one premise per city block was sprayed since it was desired to determine the degree of control obtained if a single homeowner sprayed his property while the rest of the block remained unsprayed. The effectiveness was determined by counts of adult C. nigripalpus taken in chick-baited traps before and after treatment. No reduction in the population of adult mosquitoes was noted in the sprayed premises as compared to unsprayed premises located in the same block. Therefore, it was concluded that residual spraying of this type would not be effective in protecting individual homes from encephalitis mosquitoes. Basic Research on Particle Size In 1964 much time was spent developing a laboratory thermal aerosol generator and wind tunnel which could be used in particle size investi- gations. The amount of liquid and the rate of injection of the insecticide formulation, the temperature at which the formulation is vaporized as well as the wind velocity at which the aerosol particles are transported can be varied to meet test conditions. Through the use of this generator in 1964, it was demonstrated that there is: an increase in the number of large particles produced with a decrease in generator temperature; an increase in the number of large particles produced with an increase in viscosity and density of the spray solution; an increase in the deposition of aerosol particles on flying insects as compared to dead or non-flying insects; and an increase in particle deposition with an increase in particle size. The laboratory thermal aerosol generator also offers the additional advantage of a quick and accurate method of screening insecticides against adult mosquitoes which will eliminate much of the time- consuming field testing of new insecticides as presently conducted. The spectacular appearance of the density of thermal aerosols of fog oil (oils of high viscosity and density) as compared to diesel oil is being investigated. This difference has been measured photo-electrically by light transmission and is currently being investigated relative to the dif- ferences in particle number and spectrum, optical density and refractive index, and density and viscosity between the two oils. It appears that this study may be able to define the importance of some of the physical factors involved in thermal aerosol formation. ENTOMOLOGY 59 Additional meteorological data acquired in 1964 by means of the portable 40-foot meteorological tower developed in 1963 demonstrate the great importance of wind in the satisfactory application of thermal aero- sols. The rise of the fog cloud to a height of 10 to 50 feet resulting in no fog and therefore no mosquito kill up to this height is a condition that prevails during the summer months in many areas of the state. Con- cerning this condition, it appears from observations made in 1964, that the fog cloud will not rise vertically as long as the speed of the lateral air movement is uniform with height. However, if there is a pronounced increase in the speed of the lateral air movement at a certain height, the fog cloud will rise and form a layer, the base of which is at the intersec- tion of the slow moving and fast moving air currents. These observa- tions do not preclude the importance of temperature in this phenomenon. More research of this type is necessary to define the meteorological factors responsible for poor fogging conditions resulting in poor mosquito control. The accumulation of data on meteorological factors affecting fog behavior will be continued during the coming year. In 1965 it is planned to test in the field some of the hypotheses formulated as a result of the laboratory experimentation on particle size and kill of adult mosquitoes. Laboratory studies of the relationship of particle size to deposition on insects also will be continued. Water-Management Studies The long-range water management plots at Vero Beach were main- tained for experimental purposes until August 1964, at which time the project was terminated. Although most of the original objectives of the project were attained by the end of 1963, studies were extended into 1964 to investigate the effectiveness of salinity on controlling the growth of certain aquatic plants, and to determine the feasibility of delayed artificial flooding of the seasonal plots. Unfortunately, rainfall during the period of study was well below normal; however, it was shown that under abnormally dry conditions flooding of the seasonal plots could be delayed until June with no serious threat of producing a brood of salt-marsh mosquitoes from rainfall. Flooding of plots (overgrown with cattails) with salt water showed that this weed can be controlled in managed plots by varying the salinity. It was noted also that cattails were severely damaged in plots from which flooding was withheld for long periods. Salinity of the soil water increased in the latter plots but whether or not the increased salinity or lack of flooding, or both, damaged the cattail growth is not known. Results of the water-management studies conducted at Vero Beach are applicable only to the east coast of Florida. Additional studies will be necessary to evaluate impounding as a method for controlling salt- marsh mosquitoes on the west coast of Florida. Sand Fly Control Studies This project was continued in 1964 at Vero Beach with the field testing of several formulations of creosote and aromatic solvents as sand 60 ANNUAL REPORT, 1964 fly larvicides. In selecting compounds for testing, an effort was made to select only those chemicals that seemed less likely to create a resistance problem in the sand fly and mosquito populations. A total of 25 test plots were arranged to test the larvicidal effectiveness of creosote and aromatic solvent formulations applied at the rate of four and eight gallons per acre in calm and rough water conditions at low and half tides. Results showed that the creosote formulation applied at a four gallons per acre dosage will control sand fly larvae for five weeks in soil heavily washed by waves and eight weeks in calm water. In calm water, emulsions of aromatic solvents AR-60 and Panasol AN-5 were effective for two and five weeks respectively. But in plots heavily washed by wave action the AR-60 lost its effectiveness in one week and the Panasol AN-5 in two weeks. Before recommendations are made, additional testing will be con- ducted in the Panama City (Bay County) area. These tests will include large plots in order to evaluate the effectiveness of the creosote formula- tion when applied under operational conditions. WINTER HAVEN MIDGE CONTROL LABORATORY Most of the work in control research during 1964 was devoted to the further development of larvicides for chironomid midge control. Of the numerous chemicals tested as potential midge larvicides, a one per cent granular formulation of American Cyanamid 52,160 and a three per cent granular formulation of BHC showed the most promise. Applied at the dosage rate necessary to control midge larvae, both of these insecticides are safe to fish. Baytex applied at the rate of 0.25 pound per acre in a one per cent granular formulation gave excellent control of midges for at least eight weeks in four large lakes. Population studies indicate that it may take from six months to a year for the chironomid population to stabilize itself again in a lake following an application. No detrimental effects were noted to the common aquatic biota following the insecticide treatments. Since most of the midge larvae are concentrated in the peripheral areas of the lake bottom, an attempt was made to apply granular Baytex only to these heavily infested areas; it proved to be very successful. While the duration of larval control was not as long as when the entire body of water was treated, there was a large reduction in the amount of material and man-hours used in application. A research project has been set up to determine if there is a definite correlation between the kind and amount of plankton available in the lake to that found in the gut of midges throughout the year, also to establish if there is a relationship between the amount of plankton avail- able in a lake to the level of midge breeding in a lake. The data ac- cumulated thus far are insufficient to show any seasonal food preference in the larvae; however, it does show that the algal content of the gut does not fluctuate exactly the same as that of the lake water. ENTOMOLOGY 61 Laboratory rearing experiments were tried this past year. Unfortunate- ly, little success was noted. A culture of Chironomus fulvipilus was es- tablished through two generations. Also, a few successful emergences of Tendipes decorus were recorded. All the experiments trying to establish a laboratory culture of Glyptotendipes paripes were negative. Chemical analyses were run on algae to determine if they were capable of tying up insecticides in the lakes rendering them ineffective as midge larvicides. While the results are not conclusive, it would appear that algae does absorb a noticeable amount of the phosphates from insecticides in a relatively short time. 62 ANNUAL REPORT, 1964 BUREAU OF FINANCE AND ACCOUNTS FRED B. RAGLAND, B.S. Director PAUL R. TIDWELL, B.B.A. Assistant Director Major responsibility rests with this bureau for the business and finan- cial management of the agency, and includes: accounting, budgeting, purchasing, property control, duplicating services, mail, shipping, receiv- ing, automobile control and assignment and buildings and grounds main- tenance. The business and financial management requires a close work- ing relationship with the State Board of Health (SBH) program di- rectors in planning maximum utilization of funds that have been pro- vided. This means sound budget preparation of the various health pro- grams designed to cover a future period of time. Once the funds are provided and properly budgeted, then a logical system of accounting for these funds and issuance of reports concerning their expenditure is necessary. This, along with the dissemination of proper budget control information, is accomplished by the bureau. Sometimes this becomes quite involved due to the complexity of the various sources of funds: federal, state, county, private, etc. Each of these sources bears its own set of rules, laws and regulations as to the administration of expenditure of the funds. The fiscal year end June 30, 1964 was the first year of the 1963-65 biennium for which the 1963 Legislature made available to the agency state funds through the General Appropriations Act. These appropria- tions were generally based upon maintaining present programs at the same level; however, there were a few instances where additional financial support was included. These additions were: 1. State fund grants to county health units were increased from $3,320,000 to $4,070,000 and represented the first increase to counties since 1958. 2. Appropriated for statewide encephalitis research and control, $200,000. This is a new program and complements work pre- viously started by a federal grant in the Tampa Bay area. 3. Provided a lump sum appropriation of $116,600 for an air pollu- tion control team in central Florida. This complements the current air pollution program. 4. General Public Health appropriation provided for 26 new posi- tions and, also, implementation of the Florida Merit System biennial pay survey 1963-65. 5. Provided for arthropod research laboratory in West Florida- $65,000 (to match federal funds). 6. Provided for regional laboratory in Tampa-$300,000 (to match federal funds). Architectural planning is underway and contract will probably be let in February 1965. FINANCE AND ACCOUNTS 63 7. Provided for regional laboratory in Pensacola-$120,000 (to match federal funds). This project is under contract, having been let in September 1964. 8. Provided for an appropriation for Medical Assistance for the Aged (MAA). The appropriation may be used for hospital serv- ices and visiting nurse care. Of major importance to the agency was the legislative act passed to exempt the disbursement of county health units trust funds from the limitations on salary, positions and Budget Commission approval required by Chapter 282.051, Florida Statutes. Total program expenditures fiscal year ended June 30, 1964, amounted to $27,800,000; this was $3,400,000 over previous fiscal year. This in- crease can be accounted for in three program areas. Half of it was in the Indigent Hospital Program due to the hospitalization for Public Assistance Recipients and MAA. County health department (CHD) expenditures accounted for one-fourth of the increase and finally the general increased cost of ongoing programs and some increase in special grants and dona- tions accounted for the remainder. It is important to note the ever-increasing number of special projects and grants from the federal agencies. The most significant one during 1964 was the "best efforts" contract for eradication of the Aedes aegypti mosquito. This contract is at a level of about one and one-fourth million dollars per year. The duration of the project will be approximately five years. At the close of the fiscal year June 30, 1964, the number of state- owned and operated automobiles was 97. These were driven approxi- mately 1,500,000 miles during the year. In addition, the agency owned 35 trucks or special-purpose vehicles. These units traveled approximately 275,000 miles during the year. Assignment and use of all vehicles is continually reviewed to insure that they are used in the most effective and economical manner in carrying out the agency's travel responsibilities. During 1964, 18 old vehicles were traded and 24 new units acquired. The bureau director and his staff continue to give assistance to the overall planning of the health department activities, particularly in the area of coordinating financial plans. PURCHASING AND PROPERTY SECTION The purchasing section is responsible for the procurement of the agency's supplies, equipment and services. Purchases are made in ac- cordance with rules and regulations issued by the State Purchasing Com- mission covering the solicitation of bids, advertising for bids under cer- tain conditions, printing regulations, etc. Requests for equipment and supplies are reviewed by the purchasing section and purchases are made under contracts and maximum price regulations negotiated by the State Purchasing Commission where applicable. The purchasing section con- tinues to cooperate with other state agencies in the exchange of informa- tion pertaining to contracts for volume purchases which enables this 64 ANNUAL REPORT, 1964 agency to purchase certain items under contracts negotiated by other state agencies and to arrange for purchases under SBH contracts by others. The property division of this section carries out the responsibility of recording, marking and inventorying of all property owned by this agency (desks, chairs, office equipment, scientific equipment, etc.). The Florida Statutes prescribe records that must be maintained and the frequency of physical inventories. During 1964 the purchasing office issued 4361 separate purchase orders which totaled $1,262,048.48. CHDs normally handle purchases locally within their organizational framework; however, their purchasing procedures must also conform to the Florida Statutes governing pur- chases, such as obtaining bids and advertising for bids where required. The following of good business practices in procuring materials through competitive bids is advocated. The purchasing agent at the SBH assists the CHD wherever possible with their purchasing requirements. Property Control The responsibility of this section is to see that capital outlay items are assigned property numbers, maintain records, process annual physical inventories on over 160 locations and handle fire insurance coverage on buildings and contents. Property value reflected by the SBH Plant Ledger as of June 30, 1964 was as follows: Real property ....................................................... $2,824,795 Furniture and equipment ................................... 1,280,732 Automotive equipment and trailers .................... 277,920 Books and films ...................................................... 321,514 Total ........................................................... $4,704,962 One new steel building was constructed for the Encephalitis Research Center, Tampa. Control of property and maintenance of records as required by Florida Statutes continues to be a job of considerable magnitude, not only because of the dollar increase but as the SBH continues to grow and depart- ment acquire new quarters, property cards have to be changed or cor- rected for insurance purposes on any change of location. The importance of correct maintenance and control of property is continually stressed within the agency to insure that the records reflect the current status of all property items owned by this agency. Insurance Fire insurance on buildings and contents is carried in the State Fire Insurance Fund under the supervision of the State Fire Insurance Com- mission. Coverage on boilers and heating equipment is carried in a master policy supervised in the office of the State Fire Insurance Com- missioner. Scientific equipment, dental equipment and X-ray equipment in various mobile units is insured under a "Floater" or "Transportation" FINANCE AND ACCOUNTS policy. Automobiles, trucks and other special-purpose motor vehicles owned by this agency are covered by a fleet policy to include public liability, property damage, fire, theft and comprehensive. The agency acts as self-insuror for collision damage. Boats and outboard motors owned by the agency are insured under marine policies to include public liability and property damage as well as protection against damage or loss of the boats and motors. Other major insurance coverages include: money and securities, broad form, loss inside and outside of premises; position schedule bond for narcotic inspectors; public employees honesty position bond; Workmen's Compensation. During 1964 nine claims amounting to $1,871.77 were settled under the agency's fleet automobile liability policy. Damages to SBH vehicles caused by others were settled for $2,736.74. Claims amounting to $533.87 for repairing damages to SBH vehicles under the comprehensive clause were paid by the agency's insurance company. The SBH as self-insuror for damages caused by collision paid $502.35 for repairs. This figure is considerably less than the cost of carrying collision coverage in the fleet liability policy. This agency received $346.71 as reimbursement for losses under the marine insurance coverage during 1964. BUILDINGS AND FACILITIES SECTION Maintenance-During the year 728 written work requests were received. Of these 17 were uncompleted at the end of the year. The uncompleted requests are divided as follows: two cancelled, two await- ing funds, one awaiting material, four in work, three held in abeyance and five in planning status. Due to sickness and annual leave requirements only 11,250 "maintenance" man hours were available this year. Of these hours 10,630 were expended in connection with the work requests; the remaining 620 man hours were expended in the preventive maintenance program. During the year an additional and parallel electrical primary feed circuit was installed to obviate the electrical overloads in the Bureau of Laboratories and Division of Data Processing. In addition, an extensive and larger emergency power system was installed. Branch circuits are being installed in the Laboratory. Structural and utility alterations were made in the greater portion of the Laboratory's second and third floors. In addition, a new "Butler" type building was erected on the east side of and as an addition to the animal house. This new building was air condi- tioned, electrified and equipped by this section. The preventive maintenance program is not in full operation. This deficiency is largely due to the pressure of work requests upon a limited staff. A new concrete floor was installed in the shop area of the Julia Street Building. The old floor was damaged by Hurricane Dora. Shipping and Receiving-The remarks made in last year's report con- tinue to apply regarding working and storage space. The following 66 ANNUAL REPORT, 1964 figures illustrate some of the work performed in this section. General requests filled: regional laboratories 250, CHDs 2000, tuberculosis hos- pitals 600 and private physicians 3000. Seventy-two hundred (7200) items were picked up within the agency, wrapped and mailed. More than 300 vehicle trips were made to local bus stations for pickup and delivery service. There were 4560 drug and 3815 form requisition written requests honored. No record is maintained on local telephone orders. A total of 3400 waybills were executed in the year's business. Storage space is critically overloaded. Mailing-A signature log is maintained on all registered, certified and insured mail. This office handled the following quantities of mail during the year: outgoing U.S. Mail 218,799 pieces, incoming U.S. mail 383,000 pieces and interoffice mail 93,500 pieces. The annual postage meter expenditure approximates $54,000. Mail distribution is hampered by both the increased requirements imposed at the agency's local rental spaces and of inadequate space in the central office. Ditto Room-The output of this activity amounted to: addresso- graph impressions 612,242, addressograph plates embossed 9497 and total of operations 621,739. This figure represents an increase of 60,922 opera- tions over that of the previous year. Duplicating-This department is charged with fulfilling the dupli- cating requirements of the central office, branch laboratories and research centers. The offset duplicating section, composed of three machines, all of which are over or near 13 years in age, bear the bulk of the workload. A transfer unit was purchased during the year. The cost of the machine has been greatly offset by the savings in labor and materials over previous methods. The department performs the additional duty of stocking and supplying envelopes, plain and copy paper, index cards and interoffice material of the above nature. The bindery section continues to operate economically in jobs requiring the use of machinery such as the folder, stitcher, cutter, punch and perforator, thereby reducing outside costs. As required by Florida Statutes, a cost record is maintained relative to the individual requisitions for production. Supplies necessary for the functioning of this department are obtained through the purchasing agent on a bid basis or through state contracts. The department output this year was: 2286 job requisitions for a total cost of $39,967.46. These requisitions involved the handling of 4431 offset plates and 3138 stencils. Total machine impressions were 9,574,526. Security-Vandalism of buildings and equipment continues to be a problem in this area. More than 1700 parcels, of which 40 were considered legal evidence, were received during nonworking hours. In addition, there were 20 emergency issues of vaccine or serum. Testimony in seven court cases was given by members of the security force. FINANCE AND ACCOUNTS FISCAL SECTION The essential function of this section is the determination of the legality and propriety of payments under the various programs of the agency, processing all bills and vouchers for payment, the financial record keeping and preparation of required financial reports. The financial transactions of the SBH for the fiscal year ended June 30, 1964, as reflected by the records of the bureau, are presented in a condensed form at the end of this section. A detailed financial report for the fiscal year ended June 30, 1964, has been prepared and distributed to the Governor, members of the Board of Health and all bureaus, divisions and CHDs. The funds received (or appropriated) for the fiscal year ended June 30, 1964 were from the following sources: State appropriations and funds ....................$ From local agencies for county health departments ...... ...................... From federal grants-in-aid ......................... From research grants ......................... From hospital services for the indigent *Local sources .................................. State Department of Public Welfare...... From state for building ....... ................... 9,375,180.00 7,338,399.84 3,752,864.15 1,640,862.58 352,083.07 7,060,301.49 420,000.00 $29,939,691.13 31.3% 24.5% 12.5% 5.5% 1.2% 23.6% 1.4% 100.0% *These funds deposited with and disbursed through the State Treas- ury. Does not include $2,457,402.91 disbursed locally. The operating and capital expenditures by the SBH were for: Personal Services (salaries and professional fees) .................. ..... Contractual Services (repairs, utilities, travel expenses, hospital program).......... Materials and Supplies (office, medical, laboratory, mosquito control, educational) ......................... ..-..- Current Charges (rent, insurance, merit system cost, registrar fees) ................... Capital Outlay (equipment and fixed assets) ................ Grants to Counties and Mosquito Control Districts ........................................... Miscellaneous (education aids and subsidies) ........................................ $13,387,758.82 10,769,675.33 1,289,871.54 403,187.71 48.1% 38.7% 4.6% 1.7% 471,053.60 1.7% 1,359,735.87 4.9% 130,766.90 .3% $27,812,049.77 100.0% 68 ANNUAL REPORT, 1964 In addition to funds reported in the annual financial report and summarized above, certain other funds and services were made available by the U. S. Public Health Service (USPHS) to the activities of the Board but were not paid directly to the SBH. They include USPHS personnel on loan to the Board in the Bureaus of Preventable Diseases and Special Health Services. Fiscal operation followed a budget plan of 196 departmental budgets. These budgets were periodically revised as required. SUMMARY OF RECEIPTS AND DISBURSEMENTS AND BALANCES FOR THE FISCAL YEAR ENDED JUNE 30, 1964 RECEIPTS FROM STATE APPROPRIATIONS General Public Health: Salaries .................................. .... .........................$ 2,855,890.00 Other Personal Services ............................................................ 10,250.00 Expenses .................................. ..... ........................ 1,156,310.00 Operating Capital Outlay ........................................................ 68,360.00 Grants to Localities .................................................................... 1,650,000.00 Encephalitis Research and Control .................................. 100,000.00 Purchase of Polio and Combined Vaccines ....................... 125,000.00 Dental Scholarships .................................................................. 40,000.00 Medical Scholarships ................................................................ 40,000.00 Arthropod Laboratory in West Florida ................................ 65,000.00 Air Pollution Control ....................................... 196,110.00 Mental Health Council .................................. ............. 147,360.00 Hospital Services for the Indigent .............................................. 885,900.00 County Health Units .................................................................. 2,035,000.00 Total State Appropriations....................................................$ 9,375,180.00 FROM FEDERAL GRANTS-IN-AID Public Health Service: General Health ............. .................. .....................$ 423,222.00 Chronic Illness and Care of Aged ................................... 433,552.84 Venereal Disease ........................................................................ 199,420.00 Tuberculosis Control ................................................................ 70,335.00 Heart Disease ........................................................... 197,116.00 Cancer Control .......................................................................... 99,912.90 Mental Health .......................................................................... 177,422.50 Water Pollution ............ .................................... 127,111.00 Radiological Health .................................... ........ ............ 59,205.00 Mental Health Planning ............................................................ 71,400.00 Cuban Health Services .................................. ............ 917,502.10 Children's Bureau Maternal and Child Health...................................................... 976,664.81 Total Federal Grants-in-Aid ....................................................$ 3,752,864.15 FINANCE AND ACCOUNTS 69 FROM GRANTS AND DONATIONS........................................................ $ 1,640,862.58 FROM LOCAL AGENCIES FOR COUNTY HEALTH UNITS...........................$ 7,338,399.84 FROM HOSPITAL SERVICES FOR INDIGENTS Local Sources ..........................................------ ----.... .$ 352,083.07 State Welfare Board .................................................................. 7,060,301.49 Total Hospital Services for Indigent .......................................$ 7,412,384.56 FROM STATE FOR BUILDINGS ............................ .......................... $ 420,000.00 TOTAL RECEIPTS ......................................-.......--..............---$29,939,691.13 Balance July 1, 1963, $3,405,294.34 (Less expired appropriation of $304,454.95)..............................$ 3,100,839.39 Total Receipts and Balances ------------.........-$33,040,530.52 DISBURSEMENTS OPERATING EXPENSES Personal Services: Salaries ....................................................................................$12,648,247.75 Other personal services-individual ........................................ 584,149.00 Other personal services-other ........................................ 155,362.07 Contractual Services: Travel expenses, including subsistence and lodging ................ 1,433,348.97 Communication and transportation of things ....------.................... 389,608.69 U utilities ........................................ ...... .......... 146,151.42 Repairs and maintenance ........................................................ 167,545.55 General printing and reproduction services ............................ 73,181.37 Subsistence and support of persons ........................................ 8,370,127.20 Other contractual services ..................................................... 189,712.13 Commodities: Bedding, clothing and other textile products ...........------............... 3,419.90 Building and construction material and supplies.................... 9,982.73 Coal, fuel oil and other heating supplies .............................. 11,675.03 Educational, medical, scientific and mosquito control materials and supplies ........................................................ 942,877.34 Maintenance materials and supplies ...................................... 79,856.59 Motor fuel and lubricants ....................................--- .... .. --- 51,274.66 Office materials and supplies ........................................-----......... 184,221.18 Other materials and supplies .................................................... 6,564.11 Current Charges: Insurance and surety bonds ................................................... 37,110.15 Rental of buildings .................................................................... 147,622.77 Rental of equipment .............................................. 43,889.11 Other current charges and obligations ..................................... 99,858.18 M erit System ............................................. ... ............... 74,707.50 Total Operating Expenses.................................................. $25,850,493.40 CAPITAL EXPENSES Books ........................................ ............................................... $ 15,882.90 Buildings and fixed equipment .............................................. 26,092.16 Educational, medical, scientific and mosquito control equipment ........................................................... 220,175.49 70 ANNUAL REPORT, 1964 Motor vehicles-passenger ........................................................ 58,420.58 Motor vehicles-other .......................................................... 142.00 Office furniture and equipment ..................................... 148,295.50 Other capital outlay ................................................................. 2,044.97 Total Capital Expense........................................................... $ 471,053.60 GRANTS, SUBSIDIES AND CONTRIBUTIONS Grants to counties and mosquito control districts....................$ 1,359,735.87 Other educational aids and subsidies ...................................... 130,766.90 Total Grants, Subsidies and Contributions..............................$ 1,490,502.77 Total Program Expenses ............................ ............ $27,812,049.77 NON-OPERATING DISBURSEMENTS Transfers ..................................... ......... $ 127,111.00 Refunds ........................................ ................................. 108,013.17 Total Non-Operating Disbursements ............. ..... .............$ 235,124.17 Total Disbursements ............................... ............... $28,047,173.94 Balance June 30, 1964............................. ---...... ........$ 4,993,356.58 Total Disbursements and Balances.............. ........ ..............$33,040,530.52 SCHEDULE OF EXPENSES BY PUBLIC HEALTH PROGRAM ACTIVITY Health Services to mothers, infants, preschool and school children....$ 3,690,000.00 Statewide venereal disease control, diagnosis and referral of infectious venereal disease patients to treatment clinics- also operation of program .......................................................... 1,153,200.00 Mosquito and pest control programs, including pest control law enforcement ....................................... ... 3,353,334.95 Indigent hospitalization .................. ........................................................ 7,796,544.42 Statewide sanitary engineering and environment sanitation ................ 2,342,955.64 Statewide cancer control program ................................... 604,800.00 Statewide tuberculosis control, X-Ray survey and follow-up work...... 1,145,500.00 Mental health program ................................................................... 1,341,400.00 Statewide narcotic drug, medical practice law enforcement........... 216,320.48 Chronic illness and care of the aged ......................................... 1,532,835.00 Heart disease program ...................................... .... ........... 498,250.00 Other health programs and administration ...................................... 4,136,909.28 Total Expenses ............................. .................................. $27,812,049.77 SCHEDULE OF EXPENSES BY FUNCTIONAL ACTIVITY General public health (also includes miscellaneous health activities and training) .................................. ...... ..... $ 1,550,516.98 Vital statistics ................................................................ 346,904.19 Health education ................................... ........................................... 98,171.15 Sanitary engineering .............................. ..................................... 682,184.74 Entomology and mosquito control ....................................... ......... 2,246,154.31 Tuberculosis control ................................................ 284,273.86 Laboratories ........................................................... 944,261.19 FINANCE AND ACCOUNTS 71 Preventable disease (excluding tuberculosis control) ........................ 733,822.27 Mental health ........................................................................................ 408,875.88 Narcotics .................................................................................................. 169,107.42 Maternal and child health .................................................................... 560,158.38 Hospital service for the indigent ........................................................ 7,796,544.42 Local health service .............................................................................. 463,460.42 Chronic diseases .................................................................................... 455,808.10 County health units .............................................................................. 11,071,806.46 Total Ex enses .... ............. .................................................. $27.812.049.77 TABLE 11 FUNDS RECEIVED BY COUNTY HEALTH UNITS FROM THE FLORIDA STATE BOARD OF HEALTH AND LOCAL SOURCES FOR THE FISCAL YEAR ENDED JUNE 30, 1964 STATE BOARD OF HEALTH LOCAL FUNDS COUNTY Total Board Funds Total State Federal Total of County Board of Fees and Commis- Public Cities mis- sioners Instruction cellaneous Alachua....................... Baker... ....................... Bay.......... ............... . Bradford..................... Brevard ....................... Broward..................... Calhoun....................... Charlotte.................. .... Citrus ........................ Clay................. ........ Collier ....................... Columbia..................... Dade... ..... ............... DeSoto........ ................ Dixie........................... Duval............... ....... Escambia.................. .... Flagler ...................... Franklin........... ............ Gadsden....................... Gilchrist ...................... Glades........................ Gulf........................... Hamilton .... .................. Hardee ........................ Hendry......................... Hernando .... ................. Highlands..................... Hillsborough .................. Holmes ...................... Indian River ................... Jackson............... ....... Jefferson ... .................... Lafayette ... ................... Lake......................... $ 215,886 22,682 96,230 35,003 266,026 476,894 23,416 79,573 33,745 46,690 81,026 53,473 1,691,885 36,385 17,153 314,617 338,830 18,406 25,707 79,000 13,657 16,118 30,149 23,810 45,642 51,970 26,017 57,823 785,508 29,463 60,364 83,009 26,078 17,247 98,951 $ 75,730 10,194 46,506 15,496 73,973 131,042 10,929 20,335 20,157 21,634 33,229 24,704 332,494 21,433 7,490 150,055 102,517 7,328 9,400 37,766 4,575 5,242 12,445 10,194 15,496 12,710 11,877 29,172 166,401 14,404 28,450 47,682 12,180 7,237 35,262 $ 68,525 10,194 43,866 15,496 69,713 126,658 10,929 20,335 20,157 21,634 33,229 24,704 168,855 21,433 7,490 101,840 83,456 7,328 9,400 37,766 4,575 5,242 12,445 10,194 15,496 12,710 11,877 29,172 79,244 14,404 28,450 39,162 12,180 7,237 35,262 $ 7,205 2,640 4,260 4,384 1636.........39... ""4'8',2i6 19,061 87,157 48,520 ............ $ 140,156 12,488 49,724 19,507 192,053 345,852 12,487 59,238 13,588 25,056 47,797 28,769 1,359,391 14,952 9,663 164,562 236,313 11,078 16,307 41,234 9,082 10,876 17,704 13,616 30,146 39,260 14,140 28,651 619,107 15,059 31,914 35,327 13,898 10,010 63,689 $ 108,099 12,237 48,306 14,199 185,644 340,159 10,925 55,018 9,775 22,513 39,768 28,100 1,241,525 13,503 7,655 131,200 156,670 10,941 16,248 35,186 4,438 10,836 14,608 12,167 27,929 17,150 11,976 27,887 404,949 7,500 20,141 30,969 3,500 10,000 61,669 $ 7,650 . .. . . 2,86' 600 4,600 3,600 4,000 ............ 3,000 ....... 666.. 3,000 3,000 6,000 $ 15,760 2,740 ............, ............' ............ 2,400 4,210 35,000 ............ 1,250 600 600 1,000 1,650 z C2 $ 8,647 4 251 1,418 108 6,409 2,953 962 4,220 213 0 143 O 8,029 669 - 117,866 1,449 8 29,152 44,643 10 137 59 O< 540 4 44 40 96 189 1,717 22,110 414 764 214,158 59 4,273 758 3,398 10 520 TABLE 11 (Continued) FUNDS RECEIVED BY COUNTY HEALTH UNITS FROM THE FLORIDA STATE BOARD OF HEALTH AND LOCAL SOURCES FOR THE FISCAL YEAR ENDED JUNE 30, 1964 STATE BOARD OF HEALTH LOCAL FUNDS COUNTY Total Board Funds Total State Federal Total of County Board of Fees and Commis- Public Cities mis- sioners Instruction cellaneous Lee ........................... Leon.......................... Levy.......................... Liberty................... ...... Madison............. ......... Manatee ........................ Marion.......................... Martin ........................ Monroe ...................... Nassau ........................ Okaloosa....................... Okeechobee ................... .. Orange ....................... Osceola.. .................... Palm Beach .................. . Pasco .......................... Pinellas ..................... . Polk .......................... Putnam ............... ........ Santa Rosa .................... Sarasota ....................... Seminole .................... . St. Johns ...... ................ St. Lucie ..................... Sumter ......................... Suwannee .................... Taylor ........................ U union .......................... Volusia ......................... Wakulla ....................... Walton ... ..................... Washington...................... County Health Units, State at Large Totals ................. $ 91,314 246,675 32,982 16,350 34,827 182,558 101,064 41,285 107,481 63,704 85,563 24,237 475,744 41,559 852,323 42,325 1,045,234 423,022 82,201 54,407 226,653 92,189 58,836 108,313 30,369 37,345 29,873 17,812 344,400 26,117 36,372 30,583 95,440 $ 39,732 90,011 14,616 7,104 18,429 63,157 45,332 21,742 45,999 22,030 33,311 10,194 132,542 21,841 135,890 21,562 188,633 114,500 37,782 25,675 61,603 39,025 31,343 46,939 15,360 18,861 16,200 10,273 120,440 13,882 19,170 14,828 95,440 $ 39,732 78,825 14,616 7,104 18,429 63,157 45,332 21,742 40,719 22,030 33,311 10,194 112,722 21,841 112,048 21,562 111,641 89,480 37,782 25,675 58,363 39,025 31,343 46,939 15,360 18,861 16,200 10,273 112,880 13,882 19,170 14,828 95,440 $ ... ..... 11,186 5,280 19,820 23,842 76,992" 25,020 3,240 7,560 . ... .. .. . $ 51,582 156,664 18,366 9,246 16,398 119,401 55,732 19,543 61,482 41,674 52,252 14,043 343,202 19,718 716,433 20,763 856,601 308,522 44,419 28,732 165,050 53,164 27,493 61,374 15,009 18,484 13,673 7,539 223,960 12,235 17,202 15,755 . ... .. ... $ 50,992 83,973 11,194 9,239 16,313 102,052 44,320 17,644 45,716 41,496 45,000 13,873 256,607 16,650 587,477 18,465 702,681 247,337 42,506 24,175 144,582 40,148 24,092 39,186 14,405 17,355 12,750 7,515 167,937 12,000 7,700 15,694 . .. . $. .......... 10,786 5,700 ......4,066 4,000 750 6,000 22,000 2,600 29,415 1,744 30,000 10,084 1,920 1,000 800 12,900 7,0006 $.......... 5,000 5,600 3,667 8,470 7,200 1,250 10,000 2,400 $10,497,590 $3,159,185 $2,641,164 $ 518,021 $7,338,405 $6,034,464 $ 196,357 $ 116,807 hi 1-1 $ 590 56,905 1,472 7 z 85 17,349 C' 1,812 tl 1,149 6,099 178 7,252 170 56,125 468 99,541 2,298 152,176 23,985 1,913 4,557 20,468 0 2,932 231 0 12,188 604 129 123 24 43,123 235 E/n 102 61 $ 990,777 1 1 W 74 ANNUAL REPORT, 1964 BUREAU OF LABORATORIES NATHAN J. SCHNEIDER, Ph.D., M.P.H. Director WARREN R. HOFFERT, Ph.D., M.P.H. Assistant Director This bureau has the responsibility to provide laboratory services to the local county health departments (CHD) and to the bureaus and divisions at the state level relating to their broad and varied public health programs. In addition, assistance is provided to licensed practitioners of the healing arts to diagnose and treat infectious diseases. There are also the responsibilities, as charged by state regulations, to approve private and hospital laboratories for the performance of syphilis serology on prenatal and premarital patients, to assist the Board of Examiners in the Basic Sciences in the regulation of medical technology in laboratories owned and operated by lay (nonmedical) personnel and to provide services in the regulation of the sale of drugs, cosmetics and devices in Florida. It was reported in the Annual Report of last year that the legislature had appropriated money for construction of replacement laboratory facilities in Pensacola and Tampa. Construction of the Pensacola labora- tory was begun in September. When completed early next year, it will have 8000 square feet of laboratory space. More time has been required to complete the plans of the Tampa laboratory, a larger facility of ap- proximately 16,000 square feet. Elsewhere, 800 square feet of additional space was allocated to the Jacksonville laboratory for expanded virological facilities. New animal facilities were provided by the erection of a prefabricated building to house a small mouse-breeding colony. Further, it was possible to re- arrange space for a much needed dehumidified room to house certain electronic instruments for the chemistry section. There were several important personnel changes made during the year under review. Warren R. Hoffert, Ph.D., was designated as assist- ant director of this bureau and given the specific responsibility of plan- ning and directing the special laboratory studies in encephalitis sur- veillance and routine operation of the virology section. Replacing Dr. Hoffert as director of the Miami Regional Laboratory was Dwight E. Frazier. Two main administrative changes were made which affected some- what the responsibilities of the bureau. Jurisdiction of the Marine Labora- tory in Apalachicola (Franklin County) was transferred to the Bureau of Sanitary Engineering and the clinical laboratory operated in the Jefferson CHD was placed administratively under the Healthyways Foundation. The bureau continued to provide technical consultation to both of these laboratories when requested. LABORATORY SERVICES DIAGNOSTIC SERVICES The nature and extent of diagnostic laboratory services offered during the year under review were essentially similar to those in previous years. Considering the general public health services only as shown in Table 12, there was a total of 2,809,275 examinations performed in 1964 as compared to 2,802,583 (excluding Franklin and Jefferson County labora- tories) examinations in the preceding year. Overall increases in workload in Jacksonville, Miami, West Palm Beach and Pinellas County laboratories offset a small reduction in the Tampa, Tallahassee, Pensacola and Or- lando regional laboratories. The major increase was noted in the number of examinations of throat specimens for diphtheria and streptococcal infections, sputum specimens for mycobacteria, cervical and urethral microscopic smears for gonococci, blood specimens for leptospiral anti- bodies, miscellaneous bacteriological cultures for isolation and identifica- tion and food specimens involved in food poisoning episodes and chemistry specimens for blood sugar and toxicology and narcotics. The trend of increased demands for sanitary bacteriology in the examination of dairy products and drinking and swimming pool water continued as in past years. Milk and dairy products examined in 1964 numbered 165,274, as compared to 164,796 in 1963; much of this increase was due to a closer surveillance of tanker milk shipped from within the state or imported from milk producers outside of Florida. Drinking water and swimming pool specimens increased considerably from 183,914 samples in 1963 to 193,400 during the year under review. By using the membrane filter procedure to test these specimens and by establishing the capability of carrying out this procedure in certain of the CHDs, the demand for this service from the bureau has been some- what alleviated. Nevertheless, this service continued to be widely used throughout the state. The number of bacteriological pollution surveys declined from 83,060 samples in 1963 to 71,070 during 1964. This decrease was noted in the Tampa, Orlando, Pinellas County and Pensa- cola laboratories. The remaining laboratories experienced an increase in the number of samples tested, and it is anticipated that this trend will carry over to all of the laboratories as the population and the use of recreational areas increase. The results of examinations by findings are presented in Table 13; a total of 715,662 blood specimens was examined for syphilis of which 31,029 were found to be reactive. Excluding the specimens unsatisfactory for testing, the proportion reactive was 4.4 per cent, as compared to 5.6 per cent in 1963. This continued a downward trend from a high of 6.2 per cent in 1962. Special attention was given to blood specimens from problem cases of suspected syphilis and/or biologic false positives. Each of 96 specimens were examined by five standard serologic tests and the findings compared. In order of reactivity, the results were as follows: VDRL 88.5 per cent, Kolmer (1/5 vol.) 87.5 per cent, Treponema Pallidum Immobilization (TPI) 58.3 per cent, Fluorescent Treponema Antibody (FTA-200) 56.2 per cent and the Kolmer Reiter Protein (KRP) 50 per cent. The findings confirm those obtained by others in 76 ANNUAL REPORT, 1964 that the VDRL and Kolmer (1/5 vol.) are comparably the most sen- sitive, and next the TIP and FTA (200). The KRP was found to be so undersensitive that serious consideration to abandon this procedure is indicated. This bureau participated in a nationwide study to evaluate a modified fluorescent antibody procedure (FTA-abs) which shows promise of having greater sensitivity and specificity comparable to that of the TPI. The number of diagnostic specimens found positive for diphtheria in 1964 was 66; this continued the downward trend in proportion of positives which was 4.5 per cent in 1963 and 1.0 per cent in 1964. In contrast, there appeared to be a slightly higher percentage of associated throat infections, particularly streptococcal. In the year under review there were 1205 positives (17.9 per cent) as compared to 901 (17.3 per cent) in 1963. A total of 46,498 specimens was examined for tuberculosis during 1964. Excluding the unsatisfactory specimens, there was a total of 3300 or 7.4 per cent positive cultures of M. tuberculosis or atypical mycobac- teria found as compared to 2491 or 5.9 per cent positives in 1963. The numerical increase of isolations in 1964 was particularly striking as the number of positive specimens for the preceding five-year period from 1959 through 1963 averaged only 2421 positives. During that period there appeared to be a gradual reduction in the number of specimens found positive. The reversal of this trend in 1964 may be explained, in part, on the introduction of a modification of the digestion procedure for process- ing tuberculosis specimens. For the past 15 years, sputum specimens have been subjected to an incubation procedure with equal parts of 23 per cent trisodium phosphate (TSP) solution for a period of 18-24 hours at 37 degrees centigrade. This lengthy incubation seemed appropriate to digest the mucoid specimens and eliminate most of the contaminants normally found in most sputum specimens. It has been appreciated that this procedure was somewhat toxic to the acid-fast bacilli, but this could be tolerated because of the large number found in most positive speci- mens. In recent years, it had been noted that tuberculosis infections were being found in earlier stages of the disease before large numbers of or- ganisms might be shed. In May 1964 a modification of the digestion procedure was introduced which called for the use of 23 per cent solu- tion of TSP containing 1:3000 concentration of zephiran chloride. In addition, the digestion time was reduced to two hours at 25 degrees centigrade. The findings are tabulated for six comparable months in 1963 and 1964 in Table 14. Approximately 15,000 specimens were examined in each of these two periods. There were 836 cultures positive for M. tuberculosis and 938 atypical organisms in 1964 as compared to 451 and 153, respectively, in 1963. This is almost a twofold increase in positive M. tuberculosis and sixfold increase for the atypicals. Admittedly, this comparison was based on findings from different specimens submitted during the two different time periods; nevertheless, the apparent increased sensitivity of the modified digestion procedure makes it worthwhile to continue its use. It is noted that there was a 50 per cent increase in cultures lost through contamination by using the new technique. This loss LABORATORY SERVICES could be minimized by submission of freshly collected specimens on a daily basis rather than to hold such specimens until a series of three more 24- hour specimens have been collected. This latter practice is used to save on postage but in actual fact, it often results in the overgrowth of con- taminants which mask the presence of acid-fast bacilli. Microscopic smear specimens submitted for the presence of gonococci and associated infections increased moderately from 40,690 in 1963 to 43,617 specimens in 1964. In contrast, the number of specimens cultured and/or studied by the fluorescent antibody technique for N. gonorrhea decreased during the year as compared to 1963. A modified chocolate agar culture media (Thayer-Martin) was used for the culture examination in the regional laboratories; the fluorescent antibody procedure was used in the Jackson- ville laboratory only. Although there was only a moderate increase in the number of fecal specimens submitted for examination for enteric pathogens, the number isolated increased substantially. A total of 1067 Salmonella other than typhoid and 218 Shigella were found in 1964 as compared to 867 and 164, respectively, in the preceding year. Among the miscellaneous examinations, there was an increase in the number of positive darkfields found. In 1964, a total of 81 lesion speci- mens was found to contain T. pallidum as compared to only 64 for the previous year. A total of 2626 miscellaneous bacteriological cultures was submitted to the laboratory for identification and characterization. This service is of value to hospital and private clinical laboratories which, because of limited facilities or lack of specialized reagents, request assistance in identifying or confirmation of identification of bacterial cultures made in their laboratories. Apparently this service has been considered useful judging from the increase in submission of such specimens totaling 1176 in 1960 as compared to 2626 in 1964. Included in the miscellaneous special diagnostic services totaling 2684 specimens with positive findings were coagulase positive straphylococci of patients involved in food poisoning, urine counts from patients with chronic urinary infections, cultures of animal tissues and environmental sources submitted in connection with the Division of Veterinary Public Health and tests for sterility of biological reagents or solutions. There was little change in the number of saliva specimens examined for lactobacillus counts. The dentists in Florida have used this service in close consultation with the Bureau of Dental Health which provided pro- fessional interpretation of findings on all specimens as reported. The number of stool specimens examined for intestinal parasites de- creased moderately during the year. Positive findings for hookworm, ascaris and trichuris decreased; enterobius pinwormm) findings increased slightly. There were no positive malaria smears found in 1964. In the chemistry section, a total of 35,352 blood specimens was examined for various determinations including blood sugar, cholesterol, 78 ANNUAL REPORT, 1964 hemoglobin, cholinesterase inhibition, phenylalanine, barbiturates, am- phetamines and alcohol. Urine specimens were examined in the Miami Regional Laboratory for pesticide intoxication as a special service to the Dade County Department of Public Health. The number of water chemis- tries increased markedly; from 1292 specimens in 1963 to 2750 in 1964. These chemical analyses of water from municipal supplies included an assay of the sodium ion content. The latter determinations were carried as part of a nationwide study to determine the association of heart disease and hypertension with the presence of the sodium ion in drinking water supplies. Toxicology and narcotic specimens examined in 1964 totaled 1998 specimens as compared to 1710 in the previous year. The radiological chemistry laboratory in the Orlando laboratory carried out analyses of water, air, milk and selected tissue and other environmental specimens for radioactive nuclides. The responsibilities assigned to this section were related to the radiological surveillance pro- gram of the Division of Radiological and Occupational Health. Two U.S. Public Health Service (USPHS) research projects which were con- cerned with background radiation in Florida and the relative proportion of Cesium-137 and Strontium-90 in milk were included in the specimen load reported herewith. Findings from these projects are of concern to the general public as an indication of the amount of radiation exposure present in the environment. Diagnostic services for viral and rickettsial infections were provided on a statewide basis from the Jacksonville laboratory. As compared to the preceding year, there was a moderate decrease in the number of specimens on which viral serology was performed. This was due, in part, to the ap- parent reduced incidence of encephalitis during the current year and a more careful screening of specimens submitted from the Encephalitis Re- search Center Laboratory in Tampa. Close liaison was maintained be- tween the two laboratories to minimize duplication of diagnostic tests on suspect encephalitis cases. Specimens found negative for St. Louis en- cephalitis and certain other selected arboviruses were examined in Jack- sonville for the enteroviruses and other appropriate central nervous system viral agents. The number of animals examined for rabies increased from 2965 in 1963 to 3669, representing an increase of 23.8 per cent. There were also more animals found positive, particularly raccoons and bats. The fluores- cent rabies antibody (FRA) procedure for diagnosing rabies virus in animal brain tissue was carried out in the Jacksonville, Tampa, Miami and Tallahassee laboratories. Viral and rickettsial diagnostic findings on 1220 patients examined in 1964 are presented in Table 15. A total of 158 patients was found with positive laboratory diagnostic evidence of viral infections which included mumps, dengue, Eastern encephalomyelitis, Herpes simplex, measles, polio and other enteroviruses. There were an additional 237 patients who were found to have antibodies against certain viral agents, but these findings were considered equivocal; due to the submission of a single blood speci- LABORATORY SERVICES men or paired convalescent sera in which evidence of a fourfold rise or decrease in titers of paired sera were not demonstrable. The cooperative laboratory diagnostic and special study program established between the State Board of Health (SBH) and the State Tuberculosis Board completed its ninth successful year. This arrangement has contributed immeasurably to the success of the control of tuberculosis in Florida by providing a coordinated laboratory program which made possible more standardized diagnostic procedures for the diagnosis and treatment of tuberculosis. It also served to strengthen the follow-up given to each patient upon being discharged from the hospital to return to his home community. The nature and extent of the studies performed in the hospital laboratories are given in Table 16. A total of 40,834 bacteriologi- cal examinations for tuberculosis was performed and 3803 cultures of M. tuberculosis and atypical mycobacteria were tested for drug suscepti- bilities. This is a 10.9 per cent decrease over last year. The other labora- tory sections of the hospitals also performed large numbers of other bacteriological, mycological, chemical and hematological examinations, as requested by the medical staff. SPECIAL STUDIES The bureau continued its active program in special studies as listed in Tables 12 and 13. Identification of bacteriological cultures belonging to the Salmonella arizona family was carried out on a total of 1254 isola- tions, as compared to only 432 cultures in 1959. An increased interest and awareness of the widespread incidence of Salmonella infections in man and animals have contributed to the continuing rise of such cultures being submitted for identification to the central Salmonella typing center in Jacksonville. It is recorded with pride that a new serotype, subsequently named Salmonella seminole, was found by the bureau and subsequently reported in the scientific literature. The laboratory participated in the nationwide Salmonella surveillance program by furnishing listings of the Salmonella typed each week to the USPHS, Communicable Disease Cen- ter (CDC), in Atlanta. The diarrheal disease studies were carried out in the Miami Regional Laboratory in this terminal year of a contract with the Armed Forces Epidemiological Board. They were concerned with observations made in determining the potentiality of utilizing the marmoset monkey as a test animal for the study of experimental Shigella infections. Enterovirus studies in Jacksonville and in Miami were concerned with the collection and examination of sewage as a means of determining the enteroviral flora in Dade County and selected communities in Florida. Both of these studies have been completed during the current year. Report of the statewide project was published during the year under review. Statewide surveillance for arthropod-borne viral infections was ini- tiated during 1964. These studies, supported by state funds, were carried out in the panhandle and peninsular part of Florida to complement the surveillance carried out by the Encephalitis Research Center Laboratory 80 ANNUAL REPORT, 1964 (ERC) in Tampa. A total of 714 pools of mosquitoes and selected animal tissues was inoculated into suckling mice; also human and animal blood specimens were examined for hemaglutinating antibodies against viral antigens prepared from St. Louis Encephalitis, Eastern Encephalitis (EE) and Western Encephalitis (WE) agents. Results of virus isola- tion attempts from 681 pools of mosquitoes, six horse brains and tissues from a duck and a dove are presented in Table 17. A total of 47 arboviral agents was isolated from the mosquitoes and two agents identified as EE from horse tissues. Among the mosquito isolations, 40 agents were identified to include EE, WE, two different agents belonging to the California complex and five serologically similar agents belonging to the Bunyamwera group (Cache Valley). There were nine arboviral agents not identified. These isolations do not include agents recovered from collections made by the ERC in Tampa. The mosquito collections made for the Jacksonville laboratory were carried out by the Bureau of Entomology and the human and animal sera were collected by the Divi- sions of Epidemiology and Veterinary Public Health. Counties yielding arboviral isolates included Duval, Madison, Jefferson, Levy, Wakulla, Leon, Franklin, Marion and Polk. The total number of counties wherein collections were made numbered 20. A new three-year research grant by the USPHS concerned with a study of the Sanitary Quality of Salad Type Foods was initiated in 1964, in cooperation with the Division of Sanitation. The first year of the study was concerned with establishing standardized bacteriological procedures and to obtain baseline data as to the quality of salad type foods being marketed in Duval County. Simultaneously with the laboratory studies, the Division of Sanitation initiated plans to study the sanitation facilities associated wth the processing and marketing of these salad type foods. The USPHS supported a study to determine the usefulness of the Sabin-Feldman Toxoplasmosis dye test in diagnosing chronic eye disease was continued during the year under review. A total of 279 serum speci- mens was tested for toxoplasma antibodies. Findings seems to indicate that the dye test results are difficult to interpret because of the wide- spread presence of antibodies in apparently healthy adults. To further complicate the interpretation, the absence of antibodies or very low titers cannot be taken as an indication that the Toxoplasma gondii may not be the causative agent in producing chronic eye disease. Very often the parasite may be present and produce a damaging lesion in the eye but fail to stimulate antibody production because of the relative paucity of vas- cularization in the eye. The fluorescent inhibition procedure was also investigated as another diagnostic tool in toxoplasmosis infections. This part of the study was carried out in cooperation with CDC in Atlanta. Studies of the atypical mycobacteria were carried out during the year, under the guidance and direction of the Division of Epidemiology (See report of that division for report of findings). The Miami Regional Laboratory established the capability of perform- ing the Guthrie technique to screen sera and urine specimens from new- born infants to detect early cases of phenylketonuria (PKU). This study, LABORATORY SERVICES carried out by the Dade County Department of Public Health, has provided for the screening of over 80 per cent of the births in Dade County. Quantitative determinations of serum phenylalanine in the PKU cases under treatment were carried out in the chemistry section of the Jacksonville laboratory. A special study to determine the extent of Q fever infection present in apparently healthy dairy workers was carried out in cooperation with the Division of Veterinary Public Health. A total of 1938 test and control sera was collected and examined for Q fever antibodies. A total of 59 of 1874 sera tested by the capillary agglutination test and 12 of 64 sera tested by the complement fixation test or 3.6 per cent was positive for Q fever. Special studies to determine toxin in oysters and airborne pollen were carried on a small scale during the year. Both of these activities will be continued in order to maintain the capability of carrying out these special tests as needed. Although they are not enumerated separately in the tables, each of the regional public health laboratories carried out limited special studies during the year. These included evaluations of various laboratory proce- dures and/or bacteriological culture techniques, such as the direct sen- sitivity test for tubercle bacilli in the Tallahassee laboratory and a comparison of the Thayer-Martin gonococcus (GC) media with the routine GC media in the Tampa, Miami and Pensacola laboratories. Also, studies on the use of the membrane filter for testing of drinking water were carried out in the West Palm Beach and Pensacola regional laboratories. In addition, all of the laboratories carried out special Q fever studies on raw milk collected from dairy farms. CONSULTATIVE AND EDUCATIONAL SERVICES Four technical workshops were held during the year; these consisted of a parasitology and a darkfield microscopy workshop in Jacksonville and parasitology and mycology workshops in Miami. A total of 73 medical technologists and 15 venereal disease investigators attended these classes. Technical and consultative guidance was provided to four health officers, three physicians (residents), one veterinarian, 10 medical tech- nologists and 32 sanitarians in the form of short periods of training and/or orientation in the laboratory. The Venereal Disease Research Laboratory (VDRL), CDC, USPHS, carried out a visitation and program review of the syphilis serology sec- tions in the Jacksonville, Orlando, West Palm Beach and Miami labora- tories. This is done periodically in all of the state laboratories in order to assure standardization of reagents and test procedures for syphilis. The Jacksonville laboratory examined 200 sera sent from the VDRL for syphilis test procedures as a comparison with all other state laboratories and many federal laboratories. It is on this basis that the bureau at- tempted to provide similar technical guidance to local governmental and private laboratories in Florida. 82 ANNUAL REPORT, 1964 A total of 17 additional clinical laboratories was approved to perform serological tests for syphilis for premarital and prenatal patients. There was a total of 290 approved laboratories as of the close of 1964. The bureau carried out the registration of 57 medical laboratories and assisted the Board of Examiners in the Basic Sciences to license 432 medical technologists and 141 medical technologist directors as provided by Chapter 483 of the Florida Statutes. Continuing visits and inspections were made to 23 commercial and public health dairy laboratories to certify the performance of bacteriologi- cal and related tests in accordance with Standard Methods and USPHS requirements for interstate shipment of milk. Similarly, the senior sanitary bacteriologist performed certification of water testing procedures per- formed in six regional public health laboratories, seven county labora- tories and 25 municipal water plant laboratories in the state. Evaluations of parasitology specimens were sent out to medical labora- tories in an attempt to improve the level of proficiency in the recognition and identification of parasitological ova and cysts. Following this series of unknowns, technicians needing assistance were provided with special training by means of workshops or visitations to the central and regional public health laboratories. Similarly, a series of evaluation specimens in blood glucose determina- tions were sent out to 60 public health and private clinical laboratories registered under Chapter 483 of the Florida Statutes. The comparative findings were circulated among the participating laboratories. Technical assistance was provided when this was needed. A total of nine members of the staff took training and refresher courses in medical bacteriology, anaerobic bacteriology, botulism, toxicology of pesticides, milk laboratory procedures, syphilis serology, shellfish water testing, salmonellosis, virology and radiological chemistry, offered by the USPHS in Atlanta, Washington, D. C., and Cincinnati. Revision 1964 of previously published list of laboratories approved for premarital and prenatal serology: ADDED Bio-Med Clinical Laboratory, 815 W. Flagler Street, Miami Christian Hospital, 4700 N. W. 32nd Avenue, Miami Pan-American Hospital, 5959 N. W. 7th Street, Miami Caldwell Medical Laboratories, 555 Biltmore Way, Coral Gables Osteopathic General Hospital, 1750 N. E. 167th Street, North Miami Beach Professional Medical Laboratory, Euclid at McGregor, Fort Myers Tice Medical Clinic, 4909 Palm Beach Boulevard, Fort Myers Drs. Gibson and Gibson, 680 South Broadway, Bartow Venice Medical Center Laboratory, 620 The Rialto, Venice Clark and Daughtry Medical Group, 130 Pablo Street, Lakeland St. Cloud Hospital Laboratory, 1501 Columbia Avenue, St. Cloud LABORATORY SERVICES 83 Marion County Blood Bank, 1410 S. Orange Street, Ocala Holly Hill Hospital Laboratory, Holly Hill Trollie Lane Medical Laboratory, 2732 Trollie Lane, Jacksonville Paul Duffe, D. O., Medical Center Laboratory, 2811 Riverside Avenue, Jacksonville Gadsden County Hospital Laboratory, 339 E. Jefferson Street, Quincy Elga B. Waite, M.D., Blountstown REMOVED Sterns Medical and Research Laboratory, 1110 N. E. 163rd Street, Miami Hymen Merlin, M.D., 2933 S. W. 3rd Avenue, Miami Little River Medical Laboratory, 8340 N. E. 2nd Avenue, Miami Coral Gables General Hospital, P. O. Box 610, Coral Gables New Port Richey Medical Laboratory, New Port Richey Forsyth Memorial Sanitarium & Hospital, 805 N. Gadsden Street, Tallahassee TABLE 12 EXAMINATIONS PERFORMED BY FLORIDA STATE BOARD OF HEALTH LABORATORIES, 1964 Jackson- West Palm Pinellas Examination ville Tampa Miami Pensacola Tallahassee Orlando Beach County TOTALS GRAND TOTALS ... .................. 1,013,619 593,375 600,411 127,969 114,623 167,789 139,974 51,515 2,809,275 SEROLOGY Syphilis ............................. Agglutinated & related tests............. Blood typing (Rh) ...................... DIAGNOSTIC BACTERIOLOGY Diphtheria & associated infections........ Tuberculosis. .......... ............ G.C.--smear................ ...... -culture ....................... -fluorescent antibody............. Enteric............................. Blood culture... ................. Leptospirosis ....................... Miscellaneous. ........ .. ..... SANITARY BACTERIOLOGY Dairy Products........................ Water, drinking & Pools ................ Pollution surveys...................... Food (sanitary quality tests)............. Food Poisoning .. ...................... Utensils. .............................. DENTAL CARIES BACTERIOLOGY..... PARASITOLOGY Intestinal parasites................. ..... Malaria................ .......... MYCOLOGY ........................... CHEMISTRY Blood. ................. .............. Spinal fluid............................ U rine .................................. Toxicology & narcotics.................. Drugs & Cosmetics .................... Water ................................. Other ............................... 386,174 2,209 4,726 25,180 104,511 18,448 32 9,360 75,318 576 2,576 104,895 19,956 33,256 20,530 3,040 698 89 5,820 52,346 28 12,447 14,975 580 2,144 47 5,039 2,272 348,873 117 3,302 1,982 . .. ....." .. 25,146 11,459 ...........2 6 52,550 . .. .... ..., 22,611 46,890 35,522 7,940 . .. .... .. . 320 219 22,578 18 69 8,711 ..... ...... 378,075 649 3,147 3,025 18,186 23,090 4,161 24,888 32 4,106 24,828 27,146 12,760 854 1,048 12,325 26 129 2,287 115 574 1,549 247 ....462 9,462 49,245 53 1,448 2 .... ....... 5,746 2,630 13,414 408 805 16,744 12,282 5,280 56 284 40 30,090 145 742 . 10,684' 10,428 1,761 21,208 64 1,274" 13,914 11,050 2,840 224 108 93 61,241 98 819 97 ..... ...... 3,054 28,864 192 ."18,338" 8,664 22,248 1,005 518 2,122 1,102 13,702 8,013 12,188 S. ........12.. 42...... 6 5,323 .......... ... . .. .. . ... . ... . 976 13 . ........... 919 ........ i 11... . 53,632 18 933 877 9,774 760 8,396 240 2,616 20,214 26,772 10,335 . .......... 1,923 2 15 3,001 464 14,064 25,124 10,380 .. ... .. .. 1..... 224 619 1,307,330 3,289 15,117 31,163 143,155 86,672 20,043 9,360 224,638 1,512 2,576 154,645 165,274 193,400 71,070 4,692 4,542 1,647 5,820 123,075 74 13,179 36,192 708 1,039 3,693 47 6,510 12,353 TABLE 12 (Continued) EXAMINATIONS PERFORMED BY FLORIDA STATE BOARD OF HEALTH LABORATORIES, 1964 Jackson- West Palm Pinellas Examination ville Tampa Miami Pensacola Tallahassee Orlando Beach County TOTALS RADIOLOGICAL CHEMISTRY Water (ground precipitation) ............. .......... .......... ......... .. 1238 ......... 1,238 Air.............................. ..... 2,898 ...................... 2,898 Milk (Sr90, Ce137,I131, etc.)............. 643 ..................... ............................... 643 Other ..................................410 ........ ............ 410 VIRAL SEROLOGY Hemagglutination-inhibition .............. 3,516 .................................... ................... 3,516 Neutralizations......................... 20 ...................................................... ................... 20 Complement fixation .................... 19,148.... ...... ....... 19,148 VIRAL ISOLATIONS (except rabies)....... 4,434 .... .. 662,204 638 Rabies-microscopic ................... 2,720 2,086 706 476 178 694 ........6,860 -fluorescent antibody.............. 6,951 2,982 516 81 .......... ......... ........... 10,530 -mouse inoculation................ 1,441 .................................... .......... .......... 1,441 SPECIAL PROJECTS Salmonella typing ....................... 7,524 ........... ........................ 7,524 Diarrheal disease studies (AFEB)...... ..... 1,370 ...................... ........... .. 15,370 Enterovirus studies ..................... 2,680 ........... 15,394 ............................. ........ 18,074 Arthropod-borne surveillance Isolations ............................ 3,710 .. ....... ........... ........... ......... ........... ........... ........... 3,710 Serology ............................. 36,452 .......... 36,452 Sanitary quality salad-type foods ......... 3,840 ........ ........ .. .......3,840 Toxoplasmosis dye test .................. 4,185 ...... ....1................... 4,185 Mycobacterium studies .................. 959 .................... .......... 725......... ......... ......... 1,684 PKU infant screening study..... ....... .. ...... ............ 18,512 .................................. .................... 13,512 Q fever study............................ 7,704.. ......... 7,704 Toxin in oysters........................ .. 99 .................................... ....................99 Airborne pollen studies .................. 964 ........... ........... ............. .... 964 86 ANNUAL REPORT, 1964 TABLE 13 SPECIMENS SUBMITTED TO FLORIDA STATE BOARD OF HEALTH LABORATORIES BY TYPE OF EXAMINATION, 1964 Number of Specimens Positive Specimens EXAMINATION Negative Unsat. Total One or Positive More for Positive Findings Findings Indicated SEROLOGY Syphilis ......................... 31,029 .......... 674,994 9,639 715,662 Agglutinated & related tests......... 349 .......... 2,591 104 3,044 Typhoid........................ ........... 41 ........ ... ....... Typhus...................... ....... ............................... Brucellosis................... .... .......... ............................ Tularem ia...................... .......... 2 ................ Heterpohile................................. 299 ..................... Blood typing (Rh).................. ....... ... .... .. .......... .......... 14,113 DIAGNOSTIC BACTERIOLOGY Diphtheria & associated infections.... 2,887 .......... 3,859 3 6,749 C. diphtheria................... .......... 66 ............................ Vincents ............ 2 ............................... Streptococci ........ .. .... .... ........ 1,205 ............................. Other ............... .. .... ......... 2,402 ......... ........... Tuberculosis ................... ... 3,300 ......... 41,130 2,068 46,498 Sputum ........ ........... .......... ..... 2,980 ............................. Aerosol............. ....... .......... 250 ............................ Urine. .................... .. ... ..... 8 ........ ........... Gastric........................... ....... 37 .. ........... Other fluids & exudates........... ......... 21 ............................. Animal inoculations (G.P.) .................. 0. Gonorrhea-smears ................. 25,127 .......... 18,209 281 43,617 Intracellular Gram negative diplococci............... ........... 7,189 ............................. Extracellular Gram negative diplococci...................... ........... 341 .............................. Trichomonad .................... .......... 4,489 ..... Yeasts............................... ..... 2,272 ............................. Vincents organisms............... ........... 361 ............................. Many pus cells.................. ..... 11,646 .... Gonorrhea-cultures............... 1,121 ....... 17,744 376 19,241 Fluorescent antibody ............. 61 ......... 1,811 ......... 1,872 Enteric infections .................. 1,487 .......... 52,442 179 54,108 S. typhosa.................. .......... .. .111.. Other Salmonella................. .......... 1,067 ... Shigella (flexneri & sonnei)....... ....... .. ... 218 .. Other........................... .......... .. 83 Blood cultures ................. .. 3 ......... 156 ....189 B rucella ......................... .......... 0 ...... .... O their ........................... ........... 45 ...... ... Leptospirosis................... 11 .......... 633 644 Miscellaneous .................... 12,513 ......... 7,413 50 19,976 Darkfield-T. pallidum ........... .......... 81.......... .......... ....... Chancroid-Ducrey's. ............ ..5......... Granuloma-Donovan bodies ...... ......... 21 ......... ............. Gonococcus in eye............ .... .......... 11 ............................ Other eye smears........... ........... 107 ... .................... Other eye cultures ......... ................. 67 ................. Urine cultures ............................ 1,205 ................. Other fluids & exudates ........ ......... .. 4,707 ............................. M ycological examinations......... .......... 1,180 ............................. Organisms for identification........ .......... 2,626 ............................. Sensitivity testing ............... .......... 309 ................ Other examinations............... .......... 675 ................ Miscellaneous special services ...... .......... 2,684 ........................... SANITARY BACTERIOLOGY Dairy products .......... ......................27,150 Water, drinking & pools........ .. ... ............ ....... ... 96,963 Water, pollution surveys........ ..... .. ........... .......... 14,657 Foods (sanitary quality tests) ..... .......... .......... ............ ... 747 Food poisoning ..... .......... .......... ................ ..... 725 Utensil swabs ......... .. ........ .... ......... ............... .... 1,685 LABORATORY SERVICES 87 TABLE 13 (Continued) SPECIMENS SUBMITTED TO FLORIDA STATE BOARD OF HEALTH LABORATORIES BY TYPE OF EXAMINATION, 1964 Number of Specimens Positive Specimens EXAMINATION Negative Unsat. Total One or Positive More for Positive Findings Findings Indicated DENTAL CARIES BACTERIOLOGY. .................... .................. 3,029 PARASITOLOGY Intestinal parasites ................. 20,774 .......... 102,301 1,722 124,797 Hookworm................................ 5,609 ........................... Ascaris................................... 4,999 ............................. Enterobius....................... .......... ,733 .............. Trichuria ................... ..... .......... 1,647 ................ Other helminths................... ......... 157 ............................. E. histolytica. ... ............... ........... 125 ............................. Nonpathogenic amoeba............ ........ 5,079 ............................. Flagellates ...................... .......... 3,176 ............... O their ........................... .......... 17 ............... Malaria............................ ........ .... ...... ......... 37 CHEMISTRY Blood .......................... ......................................... 35,352 Spinal fluid ............................... .......... .......... .......... 412 U rine................ .......... ... ...... ............. ......... .... ... 1,039 W after .................. ....... ......... ........... ......... .......... 2,750 Toxicology & narcotics ............ .......... .......... .......... .......... 1,998 Drugs & cosmetics ............... .......... .......... ........... ......... 12 Other........................ ........... ......... .......... .......... 2,091 Radiological chemistry W ater (ground & precipitation)... .......... .......... .......... .......... 608 Air......................... .. ..... ............................ 1,050 M ilk (Sr90, Ce137, 1131, etc.).... .......... .......... .......... .......... 308 Other. ................ .................... ............ ............. 196 VIRAL SEROLOGY Hemagglutination-inhibition ........ .......... .......... .......... .......... 879 N eutralizations..................... .......... .......... ... ...... .......... 2 Complement- fixation.............. .......... .................... .......... 4,925 VIRAL ISOLATIONS (except rabies)... .......... .......... .......... 1,958 Rabies (microscopic) ................ 10 ............ 3,509 55 3,669 D og..................... ....... .......... 1 ............................. Cat............................. .......... 5 ............................. R accoon ......................... .......... 48 ............................. Skunk ......................... .......... 6 ............................. Bat ............................. .......... 42 ............................ W ildcat ......................... .......... 2 .............. B obcat.................................. 1 ................. Mouse inoculations .............. ... ...................................... 1,441 SPECIAL PROJECTS Salmonella typing.................. .................... ........... ......... 1,254 Diarrheal disease studies (AFEB)..... .......... ..................... ......... 3,943 Enterovirus studies ................. .......... .......... .......... ......... 8,035 Arthropod-borne surveillance Isolations....................... .......... ......... .......... .......... 714 Serology...... .................. ......... ................... ........... 9,113 Sanitary quality salad-type foods..... .......... .......... .......... .......... 384 Toxoplasmosis dye test .............. .......... .......... .......... ........ 279 M ycobacterium studies.............. .......... .......... ... ...... .......... 175 PKU Infant screening study.......... .......... .......... .......... .......... 14,042 Q fever study ...................... ......... .......... .......... .......... 1,938 Toxin in oysters ................... .......... .......... ..................... 99 Airborne pollen studies .............. ......... .......... ........ ........... 36 TOTAL ........................................................ 1,294,205 88 ANNUAL REPORT, 1964 TABLE 14 FINDINGS ON SPECIMENS CULTURED FOR M. TUBERCULOSIS BY MODIFIED TRISODIUM PHOSPHATE TECHNIQUES, FLORIDA STATE BOARD OF HEALTH LABORATORIES, COMPARABLE SIX-MONTHS PERIOD DURING 1963 AND 1964 1963* 1964** Number Per cent Number Per cent Positive cultures M. tuberculosis ............... ........... 451 8.0 886 5.4 Unclassified mycobacteria ...................... 153 1.0 938 6.0 Negative cultures .............................. 13,811 91.9 12,890 82.4 Contaminated cultures.......................... 621 4.1 972 6.2 Total specimens cultured........................ 15,036 100.00 15,636 100.00 * Digestion with 23% Trisodium Phosphate for 18-24 hours at 37C. ** Digestion with 23% Trisodium Phosphate plus Zephiran chloride 1:3000 for 2 hours at 250C. TABLE 15 VIRAL AND RICKETTSIAL DIAGNOSTIC FINDINGS FOR 1220 PATIENTS EXAMINED BY FLORIDA STATE BOARD OF HEALTH LABORATORIES, 1964 Etiology Positive Equivocal* Total Lymphocytic chorlomeningltis........................ ........ ...... ... .. Mumps... ...... ....................... 82 87 169 Dengue. .. ................................ 2 ............ 2 Eastern encephalomyelitis ............................ 3 3 6 Western encephalomyelitis ............................................................. St. Louis encephalitis.............. ...... ... ......... 2 2 Herpes simplex. ................... .............. 4 12 16 Measles...... ........ ...... ............... 8 26 34 Vaccinia-variola. ................. .......... ... Psittacosis-LGV......... ............ ....... ....... 1 18 14 Murine typhus............... .............. ........ 2 4 6 Rickettsialpox-Rocky Mt. spotted fever....................... ....................... Q fever......................... ........ .. ........... .... .. Influenza A...................................................... 60 60 Influenza B ......................................... ........ ........... Parainfluenza 1 & 3.................................. ..... .... ............ Respiratory syncytial......... ................................. Adenovirus ...................................... 2 14 16 Poliovirus 1. ......................................... 13 8 21 Poliovirus 2 ......................................... 6 2 8 Poliovirous 3 ........................................ 7 6 18 ECHO virustypes2,3,7, 8, 11..............11 ........... 11 Coxsackie virus types A9, Bl, B4 and B5.... ......... 12 ........... 12 Other undetermined viral agents .......................5 ........... 5 TOTALS ..................................... 158 237 395 * In the case of a single serum submitted, or in the absence of a rise or fall in the antibody titers of paired sera, no interpretation possible as to etiology. LABORATORY SERVICES 89 TABLE 16 EXAMINATIONS PERFORMED IN TUBERCULOSIS HOSPITAL LABORATORIES,* FLORIDA, 1964 Tampa Lantana** Tallahassee** Totals Totals-excluding special studies.......... 48,716 81,865 23,570 104,160 Tuberculosis Diagnostic........................... 16,565 12,820 11,449 40,834 Drug susceptibility .................... 2,010 794 999 3,803 Mycology .............................. 382 133 79 594 Miscellaneous bacteriology ............. 2,153 1,726 2,026 5,905 Hematology............................ 11,852 6,932 4,615 23,899 Chemistry............................. 11,300 7,515 2,434 21,249 Urine analysis.......................... 3,583 1,942 1,607 7,132 Other................................. 876 7 361 1,244 Special studies and reference tests......... 3,000 Unclassified mycobacteria (human).... Unclassified mycobacteria (soil)....... Mouse infection experiments: Dual infections with M. tuberculosis and UM III-A.................... Effect of UM infection on alcoholic mice Comparison of various UM III-A strains isolated from different sources Comparison of H37RU and UM III-A strains in INAH treated mice....... *Operated under direction of Bureau of Laboratories; budgetarily supported by State Tuberculosis Board. ** Combined regional public health and hospital laboratories. TABLE 17 ARBOVIRUS ISOLATIONS FROM SPECIMENS COLLECTED IN STATEWIDE ENCEPHALITIS PROGRAM, BY SOURCE OF SPECIMEN, FLORIDA STATE BOARD OF HEALTH LABORATORIES,* 1964 SOURCE OF SPECIMENS Mosquito Findings Total Pools Horse Other TOTAL .................................... 691 683 6 2 Number of Positives............................. 49 47 2 0 Eastern Encephalitis .......................... 10 8 2 0 W western Encephalitis .......................... 1 1 0 0 St. Louis Encephalitis......................... 0 0 0 0 California Complex........................... 20 20 0 0 Bunyamwera Group......................... 6 5 0 0 Hart Park ................................... 4 4 0 0 Unidentified........................... ...... 9 9 0 0 Number of Negatives............................ 642 636 4 2 * Does not include isolations made at Encephalitis Research Center, Tampa, which are reported elsewhere. 90 ANNUAL REPORT, 1964 BUREAU OF LOCAL HEALTH SERVICES L. L. PARKS, M.D., M.P.H. Director HUBERT U. KING, M.D. Assistant Director Included within the organizational structure of this bureau are the Divisions of Sanitation and Nutrition, the Accident Prevention Program and Health Mobilization (Civil Defense) Program. In addition, the bureau has a small staff of clerical consultants who give consultation and assistance to the counties. There was little change during 1964 in the major responsibilities and functions of the bureau. However, considerably more emphasis was placed on field visits to county health departments (CHD) to give administrative advice and assistance. In keeping with this change in program emphasis, there were 151 visits made to all but four of the county health units (CHU) in the state. The bureau was responsible for the direct supervision of CHD pro- grams without a health officer of which there was a large number during the year. This responsibility was considerably facilitated by the appointment of a health officer, to the standby staff in July. He visited and gave medical direction to departments without health officers. Among other important activities of the bureau are included con- sultation to local health officers and staffs on general administrative problems; assistance in the preparation of budgets and budget control; in the recruiting of personnel, processing of personnel papers and training of new employees; in local program planning and evaluation; and coordination of local programs throughout the state with the cooperation of other bureaus and divisions. CLERICAL SECTION Fifty-two (52) visits were made to 42 counties for general consultation and 27 visits were made to 21 counties primarily for the purpose of assist- ing with budget preparation and control. Activities included consultation and assistance in training new clerical personnel especially in smaller CHDs; reorganization of filing systems; assistance with establishing and maintaining bookkeeping ledgers, personnel manuals, etc.; help on vital statistics, payroll and personnel problems; special assistance in budget preparation and control; processing of indigent hospitalization forms; and related matters. Considerable time was spent in the central office in checking Monthly Reports of Activities and securing corrections. Much time was also devoted to review and revision of records with one con- sultant serving as coordinator of these activities and as secretary to the Health Officers Records Committee. During the year, 20 records and instructions were reviewed with 16 approved for adoption. The Monthly Report of Activities and Instructions was revised and reprinted. Con- LOCAL HEALTH SERVICES tinuous work and plans have gone into development of an up-to-date Records Manual. COUNTY HEALTH DEPARTMENTS There were no changes in the basic organization of CHUs during the year. There were 25 single county departments, nine bi-county units and eight tri-county units for a total of 42 county health units for the 67 counties. During the year, there were some 72 physicians employed full-time in CHDs. Three local directors resigned, one retired, five new local directors were appointed, and one director transferred to another unit. At the end of the year, there were five health officer (director) vacancies in the state. Financing: Budgets for fiscal year 1964-65 total $11,574,014 with $8,186,418 from local contributions, $1,957,660 from state formula funds, $664,224 from other state funds, $600,349 from federal funds and $165,363 from local budgeted reserve funds. Although the increase in state funds appropriated by the State Legislature in 1963 of $750,000 for the biennium ($375,000 increase per year) improved the financing of CHD programs, there is still a real need for additional state appropria- tions to restore the balance in joint state-local financing and to provide adequate funds for further program development. (For details, see Bureau of Finance and Accounts elsewhere in this Report.) Health Center Construction: New headquarters centers were com- pleted in the following counties during 1964: Clay (Green Cove Springs), Gadsden (Quincy), Highlands (Sebring), Putnam (Palatka) and Her- nando (Brooksville) Auxiliary health centers were constructed or ac- quired in Alachua (Newberry), Dade (North Miami and Miami Beach Centers), Gadsden (Gretna), Duval (Woodland Acres area), Lake (auxiliary health center at Clermont and Arthropod Control, Tavares), Nassau (Yulee) and Okaloosa (Niceville-Valparaiso area). HIGHLIGHTS OF LOCAL PROGRAMS Table 19 gives a complete statistical report of CHD activities and indicates the number and. type of various services provided by these departments. However, the summary which follows is designed to present some of the more unusual or outstanding program developments of these CHD during 1964: Alachua-Highlights of this department include a full year's ex- perience in the home nursing care program, expansion of the child- spacing program, construction begun on the headquarters annex at Gainesville to provide some 2700 square feet of additional office space and the acquisition of a newly remodeled rural clinic at Newberry through efforts of the local Lions Club. Baker-The nursing program was expanded to include the Vaccina- tion Assistance Program (VAP). Local doctors have been very coopera- tive. On visits in this program, other unimmunized children have been |