FLOI
STATE
0
HEN

IIDA
BOARD
F
LTH

1968

ANNUAL REPORT !I~rl

..4awme

State Board of Health
State of 7loida

1968

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

Report

(ciJ

The Honorable Eugene G. Peek, Jr., M.D., President

Florida State Board of Health

Ocala, Florida 32670

Dear Dr. Peek:

I herewith submit the annual report of the
Florida State Board of Health for the year ending
December 31, 1968.

Sincerely yours,

WILSON T. SOWDER, M.D., M.P.H.

State Health Officer

May 1, 1969

Jacksonville, Florida 32201

His Excellency, Claude R. Kirk, Jr.

Governor of Florida

Tallahassee, Florida 32301

Sir:

I herewith present the report of the Florida
State Board of Health for the period of January 1,
1968 to December 31, 1968, inclusive.

Respectfully,

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

President
Florida State Board of Health

May 1, 1969

Ocala, Florida 32670

Members of the

FLORIDA STATE BOARD OF HEALTH

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

T. M. CUMBIE, PH.G., Vice-President
Quincy

LEO M. WACHTEL, M.D.
Jacksonville

A. B. GALLOWAY, D.D.S.
Fort Walton Beach

WILLIAM J. WEBER, D.V.M.
Leesburg

TENURE OF STATE HEALTH OFFICERS

J. Y. PORTER, M.D., 1889 1917

W. H. COX, M.D., 1917 1919

R. N. GREENE, M.D., 1919 1921

R. C. TURCK, M.D., 1921 1925

B. L. ARMS, M.D., 1925 1929

HENRY HANSON, M.D., 1929 1935

W. A. McPHAUL, M.D., 1935 1939

A. B. McCREARY, M.D., 1939 1940

W. H. PICKETT, M. D., 1940 1942

HENRY HANSON, M. D., 1942 1945

W. T. SOWDER, M. D., 1945* -

A. V. HARDY, M. D., 1961 1962 (Acting)

W. T. SOWDER, M. D., 1963 -

* On leave October 1961 to December 1962

DIRECTORS OF COUNTY HEALTH DEPARTMENTS
(as of December 31, 1968)
Alachua ................. John J. Bianco, M.D., M.P.H.
Bay .......................... A. F. Ullman, M.D.
Brevard ................... T. Paul Haney, M.D., Dr. P.H.
Broward .................. Paul W. Hughes, M.D., M.P.H.
Collier ......... ........... Charles F. Bradley, M.D.
Dade ............ William R. Stinger, M.D., M.P.H. (Acting)

Duval (until September 30) .
Escambia . . . .
Hillsborough . . . .
Jacksonville (from October 1) .
Lake ... ..............
Lee . . . . .
Leon .................
Manatee . . . .
Marion . . . .
Monroe ................
Okaloosa . . . .
Orange . . . .
Palm Beach . . . .
Pinellas . . . .
Polk . . . . .
St. Johns . . . .
Santa Rosa . . . .
Sarasota . . . .
Seminole ...............
Volusia ................
Baker Nassau . . .
Flagler Putnam . . .
Gadsden Liberty . . .
Madison Taylor . . .
Osceola Indian River . .
Pasco Sumter . . .
Bradford Clay Union . .
Calhoun Jackson Gulf . .
Charlotte DeSoto Hardee .
Citrus Hernando Levy . .
Columbia Hamilton Gilchrist .
Glades Hendry Highlands .
Holmes Walton Washington .
Jefferson Wakulla Franklin .
Martin Okeechobee St. Lucie .
Suwannee Dixie Lafayette .

Patricia C. Cowdery, M.D. (Acting)
Harvey Tousignant, M.D., M.P.H.
. .John S. Neill, M.D., M.P.H.
. . Edward R. Smith, M.D.
.... J.Basil Hall, M.D., M.P.H.
... Joseph W. Lawrence, M.D.
..... .Clifford G. Blitch, M.D.
. ... George M. Dame, M.D.
. . James B. Stapleton, M.D.
....... Philip H. Isacco, M.D.
.Henry I. Langston, M.D., M.P.H.
. Wilfred N. Sisk, M.D., M.P.H.
. C. L. Brumback, M.D., M.P.H.
John T. Obenschain, M.D., M.P.H.
William F. Hill, Jr., M.D., M.P.H.
...... Mason Morris, Jr., M.D.
....... A.E. Harbeson, M.D.
. David L. Crane, M.D., M.P.H.
........ Frank Leone, M.D.
....... Hubert U. King, M.D.
........ B. F. Woolsey, M.D.
.... J. Culpepper Brooks, M.D.
..... Howard G. Krieger, M.D.
.Luther A. Brendle, M.D., M.P.H.
.... C. C. Flood, M.D., M.P.H.
...... .John L. Ingham, M.D.
S.A. Y. Covington, M.D., M.P.H.
..... Terry Bird, M.D., M.P.H.
..... Francis R. Meyers, M.D.
... Stanley A. Hirchfield, M.D.
....... F. Barton Wells, M.D.
J. Dillard Workman, M.D., M.P.H.
William G. Simpson, M.D., M.P.H.
...... Patrick H. Smith, M.D.
........ Neill D. Miller, M.D.
....... Owen R. Hunt, M.D.

OFFICIAL STAFF FLORIDA STATE BOARD OF HEALTH
(as of December 31, 1968)

State Health Officer . . ..... Wilson T. Sowder, M.D., M.P.H.

Deputy State Health Officer .....
Planning ..............
Operations ..............
Epidemiology Research Center .
Division of Health Education .
Librarian ............
Division of Personnel . .
Division of Public Health Nursing
Bureau of Adult Health and Chronic
Diseases ...............
Bureau of Dental Health . .
Bureau of Entomology .
Entomological Research Center .
West Florida Arthropod Research
Center .. ...........

Bureau of Finance and Accounts .
Assistant Director . . .
Purchasing Agent . . .

Bureau of Health Facilities and
Services . . . .
Assistant Director . . .

Bureau of Laboratories .....
Assistant Director .
Miami Regional Laboratory ...
Orlando Regional Laboratory .
Pensacola Regional Laboratory .
Tallahassee Regional Laboratory
Tampa Regional Laboratory ..
West Palm Beach Regional Laboratq

Bureau of Local Health Services
Deputy State Health Officer .
Division of Nutrition . .
Division of Sanitation . ..
Bureau of Maternal and Child Health
Bureau of Preventable Diseases .
Associate Director . . .
Division of Epidemiology . .
Division of Radiological Health ..
Division of Tuberculosis Control
Division of Veterinary Public Healt

Bureau of Research . . .

Bureau of Sanitary Engineering ...
Assistant Director ...
Division of Industrial Waste ..
Division of Waste Water . .
Division of Water Supply . .

Bureau of Vital Statistics . .
Division of Data Processing .
Division of Public Health Statistics
Division of Vital Records . .

. .... .Malcolm J. Ford M.D M.P.H.
Wade N. Stephens, M.D., M.P.H. (Acting)
S. James O.Bond, M.D.,M.P.H.
........... G. Floyd Baker, M.P.H.
...... Carolyn Gray Hall, B.A.,M.L.S.
............. Miles T. Dean, M.S.
........ Enid Mathison, R.N.,M.P.H.

............. J.E. Fulghum, M.D.

......... John A. Mulrennan,B.S.A.
......... Maurice W. Provost, Ph.D.
.......... Andrew J. Rogers, Ph.D.

............ Fred B. Ragland, B.S.
........... Paul R. Tidwell, B.B.A.
.......... Frank E. Craft, B.S.B.A.

...... Walter E. Deacon, M.D., M.P.H.
............ Warren M. Kirk, M.D.
......... Nathan J. Schneider Ph.D.
..... Warren R. Hoffert, Ph.D., M.P.H.
...... Robert A. Graves, M.S., M.P.H.
............ Max T. Trainer, M.S.
............ Emory D. Lord, M.S.
............ E. Ann Roberts, B.S.
......... E. Charles Hartwig, D.S.C.
ory ............ Lorraine Carson

...... .Malcolm J. Ford, M.D., M.P.H.
........ Mildred Kaufman, B.S., M.S.
.......... A. W. Morrison, Jr., R.S.

........ C. L. Nayfield, M.D., M.P.H.
..... E. Charlton Prather, M.D., M.P.H.
..... E. Charlton Prather M.D., M.P.H.
.......... Edwin G. Williams, M.D.
........... Dwight Wharton, M.D.
h ........ .James B. Nichols, D.V.M.

..... .Howard W. Carter, M.D., M.P.H.

...... Sidney A. Berkowitz, M.S. Eng.
...... George T. Lohmeyer, M.S. Eng.
........... .Nick Mastro, M.P.H.
........ Ralph H. Baker, Jr., M.S.S.E.
........... .John B. Miller, M.P.H.

.... .Everett H. Williams, Jr M.S. Hyg.
......... Harold F. Goodwin
.......... Oliver H. Boorde, M.P.H.
.............. .Charles H. Carter

LIST OF TABLES
Number Page

1 Practitioners registered with the State Board of Health .24
2 Employees in the State Board of Health
and county health units . . . . ... 29
3 Personnel in administrative units of the
State Board of Health
(excluding county health units) . . ... 30
4 Personnel in county health units . . ... 32
5 Employment terminations and turnover rates ...... ..33
6 Comparison of time and cost for
nursing health supervision
visits and home visits .................... 36
7 Patient visits, Florida tumor clinics . . ... 44
8 Diabetes screening project, Broward County . ... 49
9 Death rates from heart disease
for age 64 and under;
age65andabove ...................... 51
10 Deaths from acute rheumatic fever
and chronic rheumatic heart disease
and persons receiving prophylactic
penicillin and sulfodiazine . . . .... 55
11 Acute rheumatic fever patients
receiving prophylactic therapy . . . ... 56
12 Glaucoma screening program . . ..... 57
13 Arthropod-borne virus
isolations from mosquitoes . . . ... 74
14 Summary of pest control
registrations and enforcement . . .... 76
15 Funds received by county health units . . 101
16 Major evaluation indices by
types of hospital programs . . . ... 111
17 Applications processed and approved
for payment by hospitalization program . ... 112
18 Hospital evaluation statistics . . . 114
19 Nursing homes and related facilities
licensed and number ceasing operations
with number of beds .................... 118
20 Homes licensed under Florida
Nursing Home Law by type of home
and by type of ownership . . . ... 119
21 Examinations performed by State
Board of Health laboratories . . . ... 134
22 Specimens submitted to State
Board of Health laboratories . . . ... 136
23 Viral and rickettsial diagnostic
findings from 1659 patients . . . . 138

LIST OF TABLES

24 Laboratories registered and
personnel licensed under the
Florida Clinical Laboratory Law . .
25 Permitted establishments and facilities .
26 Major activities of local health units . .
27 Post-graduate obstetrical-pediatric
seminar registration . . . .
28 Persons receiving certain maternal
or child health services
compared with estimate of
indigent persons needing service . .
29 Infant immunization surveillance
and per cent of 18-month-old children
in population at risk immunization
against selected diseases . . .
30 Reported syphilis cases
and rate per 100,000 population . .
31 Venereal disease morbidity . . ..
32 Excretors of pathogenic
unclassified mycobacteria. . ...
33 Source of radiation by county . . .
34 Summary of X-ray survey
and consultations ...............
35 New active tuberculosis cases
and deaths with rate
per 100,000 population . . ..
36 Reported active cases of tuberculosis . .
37 Results of 70mm screening . . .
38 Results of state X-ray survey units . .
39 Tuberculosis cases in central register . .
40 Tuberculosis case register statistics . .
41 Number of cases of animal rabies . .
42 Engineering laboratories basic
water quality data ... ............
43 Summary of activities relating to
shellfish and crustacea plants . . .
44 Industrial waste and incinerator
projects approved . . . .
45 Sewerage projects approved . . .
46 Sewage treatment plants
by types and capacity .............
47 Water projects approved with
capacity increase and estimated cost .
48 Permits issued for swimming pools
natural bathing places, water wells and
plans approved for public swimming pools
49 Water plants visited,
number of visits and existing plants . .
50 Water and sewage works
operators short schools . . .

Page

.138
.193
.194

.221

. . 22

. . 235

. . 242
. . 243

. . 246
. . 252
252

255
256
257
. . 259
....... 260
. . 261
. . 271

. . 288
.......292
. . 292

. . 298
. . 301

..... 302

. . 309

. . 310

. . 311

. . 312

1 1 1 II 1

LIST OF TABLES

Page

51 Sanitation of water supplies
serving interstate carriers ... .
52 Activities of the Division of Vital Records
53 Resident births and deaths
with rate per 1000 population . .
54 Ten leading causes of death . .
55 Resident deaths and death rates
(preliminary 1968) ............
56 Resident deaths and death rates
(final 1967 figures) ............
57 Estimated population and resident births,
deaths and infant deaths
(preliminary 1968) ............
58 Estimated population and resident births,
deaths and infant deaths
(final 1967 figures) ............
59 Marriages by race,
divorces and annulments . .
60 Vital statistics scoreboard . . .

313
.... 322

322
323

. . . 324
.........324

. . . 325

........ 326

....... 327

. . . 328
. . . 329

Figures

1 Measles Seasonal incidence .
2 Reported total syphilis
and primary and secondary
syphilis case rates
per 100,000 population .
3 Waste water treatment facilities

Page

.234

........ 244
..... .. 303

TABLE OF CONTENTS

Page

Administration
(including Program Planning; Activities of the Board;
Training Coordination; Scholarships;
Employees Health Service; Epidemiology;
Office of Registration
and Drug Administration; Divisions of Health Education,
Personnel and Public Health Nursing) . .. ..

Bureau of Adult Health
and Chronic Diseases .............

. . . . 37

Bureau of Dental Health ................... ......... 61

Bureau of Entomology
(including Entomological Research Center
and West Florida Arthropod
Research Laboratory) ............
Bureau of Finance and Accounts
(including Purchasing and Property) .

. . . . 65

. . . . 93

Bureau of Health Facilities and Services . . . ... 103
Bureau of Laboratories ............................. 120

Bureau of Local Health Services
(including Health Mobilization,
Home Health Services;
and Divisions of Nutrition and Sanitation) .

. . . . 139

Bureau of Maternal and Child Health . . . . .. 215

Bureau of Preventable Diseases
(including Accident Prevention;
Divisions of Epidemiology
[Venereal Disease Control],
Radiological Health, Tuberculosis Control
and Veterinary Public Health) . .

. . . . 223

Bureau of Research ................... ............ 272
Bureau of Sanitary Engineering
(including Divisions of
Industrial Waste, Waste Water,
and Water Supply) ............................. 276
Bureau of Vital Statistics
(including Divisions of Data Processing,
Public Health Statistics and Vital Records) . . . ... 314

Articles and Publications by Staff Members .

. . 1

. . . . 330

OFFICE OF STATE HEALTH OFFICER

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

The successes of past years continue to change the present day
face of public health. Since its inception, the State Board of Health
(SBH) has waged and won battles against such epidemic enemies as
malaria and yellow fever, and has fought tuberculosis, hookworm
and many other diseases with great success.
Last year we saw the effective end of poliomyelitis as an
epidemic threat in Florida. This year we were able to point our
forces toward diseases that once were considered relatively minor.
Measles is one of these, and its incidence for 1968 was the lowest
ever recorded in Florida. The 534 cases reported for the year were
about one quarter the number recorded in 1967 and one eighth the
number in 1966. What probably will be Florida's last measles
rubeolaa) epidemic was occurring in Jacksonville at the end of the
year.
Whooping cough is another serious though relatively "minor"
disease, in which success was witnessed. Only 98 cases were recorded
in 1968 as compared to 271 in 1967.
Tetanus, another of the totally preventable diseases, is finally
yielding to health efforts. The eleven cases of 1968 presented Florida
with a record low year. Diphtheria is not faring so well.
Unfortunately, following last year's record all time low, 1968 was an
"epidemic year." Sixteen cases of this totally preventable disease
were reported.
There were over 29,000 cases of influenza in 1968. More than
18,000 of these occurred during the first three months. Hong Kong
flu was identified in June and spread to all parts of the world,
including Florida where some 11,000 cases occurred between
October and December.
Malaria, a disease from out of the past, began what looks like a
come back this year. Specimens submitted to State Board of Health
laboratories indicated a three fold increase of malaria with all 25
cases occurring in servicemen returning from Vietnam. The danger,
with even as few as 25 cases, lies in the fact that mosquitoes capable
of spreading the disease throughout Florida still exist in this state.
Compounding the mosquito problem is the fact that the Aedes
aegypti project was eradicated before the mosquito. This project,

2 ANNUAL REPORT, 1968

designed to eliminate the "yellow fever mosquito" fell victim to a $6
billion cut back in federal expenditures. Of the Florida project,
funded for $3.3 million, only a small research project remained.
Following the trend begun last year, Florida showed a
significant decrease of 17.4 per cent in reported cases of primary and
secondary syphilis this year. This new and heartening trend reflects
the effectiveness of the health department-private physician
cooperative work against this disease, but it is offset by an alarming
state-wide growth in epidemic gonorrhea. The estimated number of
gonorrhea cases treated during fiscal year 1968 in Florida totals of
50,000. It is apparent that there is a gonorrhea epidemic in the entire
nation, as well as Florida, and there is need for stepped-up planning
and major increase in financing for gonorrhea control on the federal,
state and local levels.
An equally alarming increase in disease is that of hepatitis.
Infectious hepatitis sharply rose this year: 1,149 cases reported as
compared to 639 in 1967. Even greater numbers of cases are likely to
occur next year. While the number of serum hepatitis cases are not so
large 128 cases were reported this year the circumstances of this
disease do have alarming implications. While the extent of
self-administered and illicit drug usage cannot be easily assessed, it is
felt that this is playing an ever larger and most unfortunate role in
the increase of serum hepatitis.
An increase in wild animal rabies was also witnessed this year -
112 cases compared to 82 for 1967. This change is accounted for
largely by an increase in raccoon rabies throughout the state. This is
a situation that will be watched closely by the State Board of Health.

Many of the communicable diseases seem to be under control,
but new problems have arisen to take their places. Chronic diseases
have now become important causes of disability and death. We do
not know how to prevent many of them, but one that can be
prevented, is malnutrition. Its prevention is difficult, because it is
hard to change peoples' eating habits even when a balanced diet is
available. Plans were laid during 1968 for a scientific study of
malnutrition in Florida, which, it is hoped, will provide better
methods of attacking this difficult and nebulous problem.
Heart, cancer, stroke, diabetes and the other chronic diseases
continued to assume increasing importance as we move from the

GENERAL ADMINISTRATION

"fire fighting" era of reacting to epidemics into this modern age of
seeking out and preventing or controlling the more difficult chronic
diseases. Over 65 per cent of all deaths in Florida are now caused by
some form of vascular disease, with cancer the second leading cause
of death in this state. Much work is being done but there is need for
much more.
Legal enforcement of health rules and regulations is also
assuming increasing importance as people continue to flood into the
state, and as our social environment becomes more and more
complex. Enforcement is often an unpleasant task for an agency
concerned with health and well being, but it is a vital task where the
elderly, the innocent, or the unsuspecting public is concerned.
Assuring the elderly and the public of safe and medically adequate
health facilities and nursing homes is an example. This is one of the
areas in which we are having to rely on stronger legal enforcement
when informed persuasion fails. Pollution hazardous to health is
another area.
The agency was given the responsibility for the new clinical
laboratory law, enacted in 1967. This requires the registering of
laboratories and the licensing of laboratory personnel. This year 467
laboratories were registered, with 3,626 personnel licensed. In
addition to this, our laboratories performed over 3,000,000
examinations, an increase of 6.1 per cent over last year.
On the tragic side, the agency lost first through retirement,
then by death the irreplaceable services of its internationally
known sanitary engineering pioneer, David B. Lee.
However, there are two areas in which this agency was
extremely fortunate this year. The first was the completion of the $1
million office addition in Jacksonville. The occupancy of this four
story building enabled the agency to bring together, in one location,
activities which had been occupying leased space in other sections of
the city. The other area is in recruitment of county health directors.
At the year's end every position was filled. Of these 41 physicians,
nine are diplomats of the American Board of Preventive Medicine;
one possesses the degree of doctor of public health; and 18 possess
masters of public health degrees. It must be reassuring to the people
of Florida to have personnel of this quality in the forefront of
Florida public health work.

4 ANNUAL REPORT, 1968

EMPLOYEES HEALTH SERVICE

Work volume continued quite high during 1968, as evidenced by
the number of first aid or emergency care treatments rendered -
3534, or an average of about 300 per month. Multiphasic screening
examinations were completed on 261 employees, and E. Charlton
Prather, M. D., was assisted in his annual program of immunizations
against influenza for personnel and their families.

The tabulation below summarizes this work except for the
influenza immunizations:

Occupational Visits 110
Non-Occupational Visits 3262
Dependent Immunizations 158

TOTAL 3534

Multiphasic Screening Tests 261

A survey of the employees by questionnaire was conducted during
the latter part of the year to determine as nearly as possible, how
they regarded this facility, and to what extent it was used. The
answers returned indicated overwhelming approval, and extensive use
of the services. Some of the suggestions offered are being considered
in our efforts to improve the program.

INTERNAL AUDITING
The internal auditor plans, directs and coordinates the internal
audit program of the State Board of Health (SBH), including the 67
county health departments (CHD), and performs such other staff
duties as may be assigned. Since October 21, 1968, he has had two
permanent assistants. The internal auditor conducts post audits of
the financial transactions of the CHDs to determine that fiscal
matters are in accord with state and local laws and the policies of the
SBH. Audit reports of 49 CHDs were released in 1968. The accounts
of four other CHDs were audited during 1968 and audit reports were
in process at the end of the year. Audit work papers were prepared
on the accounts of four additional CHDs.

GOVERNOR

I

BOARD OF HEALTH
( 5 Members )

I

STATE HEALTH OFFICER
1 (Planning,Operations,
ILegal, Registration,
Epidemiology J & Drug Administration Division of
Research | Public Health
Center | i Nursing

I L DEPUTY STATE HEALTH r
| ~ OFFICER & DIRECTOR
| I OF BUREAU OF LOCAL
Division of | HEALTH SERVICES. Division of
Sanitation | (Hpme Health Services) Nutrition

I Division of
Health
Education

Div'1on 1of
Personnel

BUREAU OF
DENTAL HEALTH

BUREAU OF
ENTOMOLOGY
(Research Ctr.,
West Florida
Arthropod
Research Lab.)

BUREAU OF

Division of Division of
Radiological Tuberculosis
Health Control BREAUOF
PREVENTABLE
DISEASES
(Occupational
Health,
Division of D Accident Prev.)
Veterinary Division of
Public Health Epidemiol ogy
(Milk Sanit.) (V.D. Program)

Division of
Data
Processing
BUREAU OF
VITAL STATISTICS

Division of Division of
Public Health vital Recordsf
Statistics

BUREAU OF
S ADULT HEALTH
S AND CHRONIC
DISEASES

BUREAU OF
MATERNAL AND
CHILD HEALTH
(Migratory Labor,

BUREAU OF
S FINANCE AND
ACCOUNTS

BUREAU OF
RESEARCH

IDivision of
Industrial

Water Supply

ta(Swiing ad Nursig Home

LicBUREAUOFe)
SAND SERVICESTARY

(Medicare Certifi-
isincation, HSI, Hospi-of
(Swimmingtal and Nursing Home

Licensure)

/7 County Health Departments\

Organizational Chart of the

Florida State Board of Health

OCT/68

GENERAL ADMINISTRATION

LEGAL SECTION

The Office of General Counsel holds the responsibilities of legal
enforcement of health rules and laws; legal counselling of the Board
and staff; legal assistance in drafting laws, regulations and
documents; and responding to public inquiries that are legal in
nature.

The Office was reorganized in July, 1968, and presently consists
of three full-time attorneys and one part-time attorney-consultant.

Its method of handling of enforcement duties is to attempt
resolution short of litigation where advantageous; to resort to
administrative litigation when a problem cannot be resolved
informally; and to litigate in court only when administrative action is
unavailing.

NEWS, PUBLIC RELATIONS AND PUBLICATIONS

A total of 38 statewide news releases were sent to all
communication media in Florida. Thirteen other stories were
released to newspapers of specific areas and 96 news requests were
filled with wire services, television, radio or newspapers. Other
informational services included seven television shows on health
subjects; 21 health information and historical columns distributed to
weekly newspapers; 65 health fillers were sent to daily and weekly
newspapers; and over 11,000 news clippings relating to State Board
of Health and County Health Departments were procured and
disseminated to affected persons. A story on the 25th anniversary of
the Polk County Health Department was researched and published in
several newspapers of the county.
The staff also edited Florida Trends in Public Health, gave
assistance on the preparation of the Manasota-88 Report, and helped
prepare the State Board of Health's 1967 Annual Report.
Florida Health Notes was transferred in January from the Division
of Health Education to the staff of the State Health Officer. Topics
for the 12 issues of 1968 were: immunizations, the first hospital of
the United States at St. Augustine, health examinations, radiation
and atomic energy, geriatrics, obesity, rodent control, juvenile
diabetes, maternal and infant care, venereal disease control, the role
of the State Board of Health in protecting the consumer, and a
simplified annual report. Circulation was approximately 22,000
copies a month.

6 ANNUAL REPORT, 1968

PLANNING

G. FOARD McGINNES, M.D.
Assistant State Health Officer
(to November)
WADE N. STEPHENS, M.D.
Acting Director (from November)

Planning is one of the many responsibilities of the State Health
Officer. The Office of Planning assists him.

Major functions of the office are the compilation of program plans
and reports required by the federal government and the state,
administrative coordination and plan review of projects, contracts
and agreements, periodic review of ongoing programs and their
administration and the collection of specific information requested
by the State Health Officer.

Plans were prepared for the U.S. Public Health Service and the
Children's Bureau as a requisite for annual renewal of federal
funding. The first steps were taken in the formulation of plans and
information to be used by the Planning and Budget Commission and
its Office of Comprehensive Health Planning in developing the annual
State Development Program now required by state law.

During the year 30 projects, 10 contracts and one agreement, all
federally financed, were in force (list on next page). Four projects
terminated and one new agreement went into effect.

The Vaccination Assistance and Venereal Disease Casefinding
Projects and the Division of Veterinary Public Health were reviewed
and recommendations made for the improvement of their programs.

The Bureau of Maternal and Child Health was requested to include
in this Annual Report a new table based on one which has been of
value in evaluating the progress of the Family Planning Program
(Table 28 page 222). Modifications of the Dryfuss-Polgar formula,
from which is derived the index used in the family planning tables,
have been applied to other aspects of the Maternal and Child Health
program. It is hoped that similar indices can be developed for other
programs.

GRANTS-IN-AID, PROJECTS, CONTRACTS AND AGREEMENTS
FLORIDA, 1968

Description of Program

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

Medical Care For Cuban Refugees
Health counseling referral &
follow-up for the aged
Medical Self Help Training
Air Pollution Control
Air Pollution Control
Air Pollution Control
Solid Waste Disposal Planning
Research on Effects of Pesticides
in humans
Eradication of aedes aegypti mosquitoes
Control of spread of venereal disease
Training federal VD investigators
Control of venereal diseases among
migrant farm workers
Intensified tuberculosis control
Epidemiology of unclassified
mycobacterial infections
Vaccination Assistance through birth
certificate follow-up
General Research Support
Arbovirus Research
Research for Mosquito Control
Smoking and Health Education

Early detection of cervical cancer
Early detection of oral cancer
Apprenticeship Training for Medical &
Dental Students

Area

Statewide
Dade County
Palm Beach County
Broward, Dade, Glades
Hendry & Highlands
Counties
Dade County
Dade County
Statewide
Hillsborough County
Manatee County
Palm Beach County
Statewide
South Florida
Statewide
Statewide
Statewide
Statewide
Statewide
Statewide

Statewide
Statewide
Statewide
Statewide
Statewide

Dade County
Statewide
Statewide

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

Bureau of State Services
Bureau of State Services
Bureau of State Services
National Center for Air
Pollution Control
National Center for Air
Pollution Control
National Center for Air
Pollution Control
National Center for Urban
& Industrial Health
National Communicable
Disease Center
National Communicable
Disease Center
National Communicable
Disease Center
National Communicable
Disease Center
National Communicable
Disease Center
National Communicable
Disease Center
National Communicable
Disease Center
National Communicable
Disease Center
National Institutes of Health
National Institutes of Health
National Institutes of Health
Comprehensive Health
Planning
Comprehensive Health
Planning
Bureau of Health Manpower
Bureau of Health Manpower

Amount

$ 594,307
116,868
197,413
173,485

1,650,000
46,269*
16,235
56,250
29,118
51,787
26,418
453,541
3,366,107***
255,085
192,000
26,355**
787,206
45,950

$ 286,543
198,674
176,904
277,316
18,090

31,457
23,130**
5,790

GRANTS-IN-AID, PROJECTS, CONTRACTS AND AGREEMENTS, (Continued)
FLORIDA, 1968

Description of Program
Medical Library Resource Support
Research on blind mosquitoes
Research on radionuclides in milk

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

Medicare certification services

Research on dog fly control

Protection and safety with
radioactive isotopes

Hypertension Screening Program

Water Pollution Control

Area
SBH Library
Statewide
Statewide

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

Statewide

Northwest Florida

Statewide

Washington, Walton &
Holmes Counties

Statewide

Grantor
National Library of Medicine
National Institute of Allergy
& Infectious Disease
National Center for
Radiological Health
U. S. CHILDREN'S BUREAU

U. S. SOCIAL SECURITY
ADMINISTRATION
U. S. DEPARTMENT OF
AGRICULTURE
U. S. ATOMIC ENERGY
COMMISSION

FLORIDA ADVISORY
COUNCIL FOR REGIONAL
MEDICAL PROGRAMS

U. S. DEPARTMENT OF
INTERIOR

**Terminated 6/30/68 ***Terminated 9/30/68

Amount
6,873
6,607
28,831****

57,553
183,828
535,000
700,000
1,283,000
320,000
300,000
450,000

211,764

25,000

Reasonable cost

80,260

252,300
$13,543,314+
****Terminated 3/31/68

*Terminated 5/31/68

GENERAL ADMINISTRATION

ACTIVITIES OF THE BOARD
February 13 Jacksonville

1. Meeting was called but for lack of quorum it was cancelled.

February 18 Jacksonville

1. Re-elected Eugene G. Peek, Jr., M.D., president, and Mr. T. M.
Cumbie, vice president, of State Board of Health (SBH).

2. Approved appointment Walter E. Deacon, M.D., director of the
Bureau of Health Facilities and Services, who would be available
June 1, 1968.

3. Transferred Chester Nayfield, M.D., acting director of the Bureau
of Health Facilities and Services, to his regular position as director,
Bureau of Preventable Diseases.

4. Discussed the licensure status of Magnolia Towers, Home for
Aged, Orlando, Florida.

5. Approved the appointment of Sidney Berkowitz, director of the
Bureau of Sanitary Engineering.

6. Approved rules and regulations for the Homes for the Aged.

7. Approved leave of absence for six months for Vincent Patton from
his position as director of the Division of Industrial Waste.

8. Approved leave of absence for six months for K. K. Huffstutler,
regional engineer, with understanding he be allowed to return to
any suitable position in the Bureau of Sanitary Engineering that
might be open.

9. Approved leave of absence for 30 days for Mrs. Anita B.
DeLaMare, secretary to the director of the Division of Industrial
Waste, Bureau of Sanitary Engineering.

10. Approved the appointment of Nick Mastro as acting director of
the Division of Industrial Waste, Bureau of Sanitary Engineering.

11. Approved nineteen postgraduate scholarships for 1968-69.

10 ANNUAL REPORT, 1968

12. Discussed the ambulance control program and directed that
regulations be drawn up and sent to them. Also asked that
information regarding the program in North Carolina be sent
them.

13. Discussed parathion deaths and possible control measures with
members of the staff. Advised staff to draft proposed bills as
necessary and present them.

14. Held a hearing on proposed regulations Clinical Laboratories Act.
Referred matter to Advisory Committee for study and brought up
before this body at later date.

15. Ralph Poe, D.V.M., and Fred J. Ackel, D.D.S., discussed visit with
Robert Roesch, director of the Comprehensive Health Planning
Program of the Governor's Office. Suggested that a special
invitation be given Mr. Roesch to attend SBH meetings. Agreed to
by all members.

16. Approved policy regarding payment of fees to dentists for services
purchased in accordance with that of the Florida State Dental
Society.

17. Heard request by Leo M. Wachtel, M.D., that rules for the
regulation of laser beam equipment be sought by the SBH so that
this group consider the matter.

May 11 Bal Harbour

1. Discussed proposed regulations Clinical Laboratory Act and
approved certain ones with recommendations by the Advisory
Committee for amendments.

2. Directed the State Health Officer to ask the Advisory Committee
on the Clinical Laboratory Act to appoint an Ad Hoc Committee
to study the question of education for those qualifying under this
Act.

3. Approved regulations for the Implied Consent Law.

4. Discussed proposed regulations for Homes for Aged (HUD 202
Projects) and postponed them for further study.

GENERAL ADMINISTRATION

5. Discussed the relationship of new consolidated health department,
Jacksonville and Duval County, to the SBH.

6. Discussed resignation of dental director, Delmar Miller, D.D.S.,
and approved the employment of Derl G. Stallard, D.D.S., as
consultant until director could be found.

7. Approved appointment Representative Ted Alvarez, Jr., and
Representative Richard Hodes as members of Advisory Committee
for Hospital Services for the Indigent.

8. Heard a report by State Health Officer on administrative actions
and problems; preparation of proposed budget for biennium
1969-71; Dr. E. Henry King's, director of Bureau of Maternal and
Child Health, request for transfer; Dr. Edward Byrne's resignation
as director, Alachua County Health Department (CHD);
employment of attorneys for legal section; legislative
sub-committee meetings; proposed legislation by SBH; vacation
plans for State Health Officer; and proposed study by Arthur
Young and Company, Washington, D.C., regarding Data Processing
Services.

May 12 Bal Harbour

1. Discussed actions by House of Delegates of Florida Medical
Association regarding public health programs.

July 14 Jacksonville

1. Approved appointment Mr. Mastro, director, Division of Industrial
Waste, Bureau of Sanitary Engineering.

2. Heard discussions by staff and CHD representatives regarding
contract arrangement for one year with the new Consolidated
Government (Jacksonville) for health services and approved it in
principle to be considered at next meeting of group.

3. Discussed revision of regulations Homes for the Aged with
interested parties and postponed final action and requested these
be circulated for further comment and brought before the Board
at next meeting.

12 ANNUAL REPORT, 1968

4. Approved policy per diem $17.00 both in state and out-of-state
for travel by SBH and CHD employees.

5. Approved appointment D. E. Cooperrider, D.V.M., as member of
Public Health Veterinary Advisory Committee, replacing William
L. Sippel, D.V.M.

6. Discussed Legislative Auditor's report for the Orange CHD.
Postponed action with regard to it until word received from
Orange County Commissioners.

7. Approved proposed regulation regarding midwifery.

8. Heard a report by J. N. Conger regarding proposed legislation by
SBH.

9. Approved seeking legislation to make available to veterinarians
two scholarships limited to the study of wild life diseases.

10. Confirmed the recipients of dental scholarships approved by State
Health Officer and Dr. Ackel.

11. Approved proposed Legislative Budget for 1969-71 biennium with
exception of one item concerning a salary increase for State
Health Officer.

12. Approved Maurice W. Provost's, Ph.D., director, Entomological
Research Center, request for foreign travel.

13. Approved the dismissal of legal action regarding the complaint by
F. H. Horrigan against Charles Cron as no provable violation exists
pursuant to provisions of Chapter 468.131 (2) F.S.

August 18 Jacksonville

1. Approved amendments to Chapter 170D-3, Homes for the Aged,
regulations.

2. Discussed letter from chairman of the Board of County
Commissioners of Orange County concerning its investigation of
certain phases of the report of the Legislative Auditor for the
Orange CHD. Directed State Health Officer to write County

GENERAL ADMINISTRATION

Health Director, Wilfred Sisk, M.D., regarding certain deficiencies
in the operation of the Orange CHD as pointed out by the
Legislative Auditor's Report.

3. Discussed licensure problem in regard to Osceola Inn, Clearwater,
and denied the request for an exception in order that this Home
for the Aged be licensed.

4. Approved a one year contract, effective October 1, 1968, and
negotiable annually, with the new Consolidated Government of
the City of Jacksonville, and the SBH services.

5. Discussed a proposal by Nathan J. Schneider, Ph.D., regarding
extension of exemption Laboratory Personnel Licensure from
December 31, 1967 to December 31, 1968 under Clinical
Laboratory Law, Chapter 483, and took no action but suggested
an attempt be made to get the law modified in the next
Legislature.

6. Approved in principle a draft of a scholarship bill for
veterinarians to be brought before Board at later date.

7. Approved an item to be included in the Legislative Budget for the
biennium 1969-71 for the salary of $33,990 for the State Health
Officer.

8. Approved the reappointment of Phillip Hampton, M.D., and Frank
Kelly to the Advisory Committee for Hospital Services for the
Indigent.

9. Heard a status report of legal cases by Robert Eisenberg.

10. Heard a report on public relations activities of State Board of
Health by Mark Austin.

11. Approved the holding in abeyance for further study the
amendment passed at the last meeting on Chapter 170E-6,
Midwifery.

November 24 Jacksonville

1. Discussed resignation of Dr. Ackel, dental member of the Board,

14 ANNUAL REPORT, 1968

to accept appointment on the Racing Commission and the
appointment of A.B. Galloway, D.D.S., to fill his unexpired term.

2. Report by Dr. Poe, veterinarian and member of the Board,
regarding his election as County Commissioner of Orange County
and his resignation from the Board.

3. Discussed the status of Mecca Convalescent Home and its licensure
and directed that the staff of the Bureau of Health Facilities and
Services inspect the Mecca Convalescent Home within the next
week to see if all requirements are met for a conditional license.
The Board further asked that all the deficiencies be corrected
within one year.

4. Discussed and approved the trial use of aerosol spray for some of
the population of Hillsborough County by the University of
Florida, SBH, and the Hillsborough CHD.

5. Discussed and approved proposed legislation to be sponsored by
the SBH.

6. Heard a discussion by Dr. Poe regarding a bill for the regulation of
pet shops and asked that a draft of such a bill be made and
presented to the Board at its next meeting.

7. Approved revisions in the rules on fitting and selling of hearing
aids.

8. Approved revisions of the regulations for vital statistics.

9. Approved the appointment of Charles Manthey, M.D., on the
Advisory. Committee for the Hospital Service for the Indigent
Program.

10. Approved the appointment of Don Laurent as a member of the
Advisory Committee for Clinical Laboratory Program.

11. Adopted a resolution regarding the estate of Delores Ruthenberg
whereby certain proceeds of the estate will be collected by the
SBH for public health work.

GENERAL ADMINISTRATION

TRAINING COORDINATION
JEROME N. CONGER, M.P.H.
Chief Health Program Specialist

Activities of the training office during 1968 included the
Academic Training Program for employees, administration of the
remaining work in the Medical Scholarship Program, Summer
Student Training, the Orientation Program for new employees and
other training functions of a coordinating nature.
Work associated with the Medical Scholarship Program
continued to decline as the only scholarship now awarded each
year is for the study of osteopathic medicine. Eleven recipients
who received scholarships in former years continued to receive
scholarship payments. Activity continued relative to those
individuals who had received scholarship awards in previous years
and who have not yet discharged their remaining obligation to the
state. Seven physicians discharged their obligations to the state
during 1968 by completing scheduled payments, reimbursing the
state in full for the value of the scholarship grant, or by entering
practice in an area of approved need.
Five dental scholarships were awarded in 1968. These
scholarships are administered by the Bureau of Dental Health and
each scholarship is granted upon recommendation of the State
Board of Dental Examiners. One osteopathic scholarship was
awarded by the State Board of Health (SBH), upon
recommendation of the State Board of Osteopathic Medical
Examiners.
The SBH Academic Scholarship Program for employees resulted
in 20 SBH employees in professional categories being awarded
scholarships in 1968, to continue their professional education.
These training awards are available to career employees showing
high promise for positions of future leadership in Florida's public
health program. Unlike the previous year, when the SBH
experienced some difficulty in finding an adequate number of
employees interested in further training, more applications were
received than there were scholarships available. It is anticipated
that this trend will continue. Additional scholarships will need to
be provided in coming years, if the SBH is to meet the needs for
professional leadership in a growing and more sophisticated public
health program in Florida.

16 ANNUAL REPORT, 1968

Summer student training activities resulted in the employment
and training of 66 well qualified students in the central office,
regional laboratories and county health departments. Eligible
students for this program were required to demonstrate a
combination of economic need and future potential for health
careers. It is felt that this program continued to provide practical
training in the sciences and public health for qualified Florida
students and will result, in future years, in more Florida health
manpower and a better understanding of health needs and
activities in our state.
Three orientation programs were conducted for 167 employees
in 1968. These employees received a thorough orientation on the
statewide public health program and their role and responsibility
in the effective and efficient conduct of this program. As a result
of a study of orientation needs, the program was modified during
1968 to increase the number of employees attending. The length
of each orientation program was also reduced. In addition to the
three major programs, one experimental session relying heavily
on audio-visual aids was conducted in a county health
department and a similar one-day program, using newly developed
audio-visual materials, was presented to the summer students in
training at the central office in Jacksonville.
Other activities of the Training Office included the coordination
and disbursement of training information, consultation and
participation on in-service training programs conducted during the
year, and the study and planning for training programs for SBH
clerical and management personnel.

GENERAL ADMINISTRATION

MEDICAL
Scholarships Awarded in 1968:

*John Cleveland Mayes ................... Pinellas

Continuing Scholarships Awarded Prior to 1968:

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

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

Awarded 1967:
*Thomas E. Abbey (recipient canceled 9/5/68 repaid)
still in school

*Osteopathic scholarship
**Recipient canceled scholarship 8/23/68 still in school
***Withdrew from school 8/68

DENTAL
Scholarships Awarded in 1968:
Walter W. Aichel ...................
Dale K. Christensen . . . . .
Thomas E. McRae ..................
Clifford B. Ward ...................
Robert W. Ward ...................

. .Dade
. Orange
S. Duval
.Manatee
. .Bay

Awarded 1965:
Melvin C. Beard II
Albert J. Endruschat
Richard L. Finkbeiner
Nathan A. Graddy
Leonard W. Peterson
David W. Rawson
John L. Ricks, Jr
Drew H. Turner, Jr.
Richard H. Waldbart, Jr.
John W. Shannon

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

Roger B. Blair, III
Terry C. Blanks
Harold E. Howard, Jr.
Wayne S. Maris
George A. Jackson, II

18 ANNUAL REPORT, 1968

PUBLIC HEALTH PERSONNEL

William M. Bostick .....
John L. Buckingham, M.D..
Peter Paul Baljet ......
David L. Cusic .......
Jean Dolan .........
Graham M. Hairr ......
Harry G. Hall ........
Roger Alvin Heupel ....
Roger I. Hope ........
Charles T. Kekich, D.D.S..
Vernon E. Keys .......
Charles Everett Lattimer .
*Dolores McAdoo ......

Vera Geraldine McRae .
Linda Gail Ray .......
John C. Reagan .......
Joseph Shumlansky .....
Sam T. Simpson, M.D ...
Fred R. Usher, Jr ......
Elizabeth C. Yawn .....

.Sanitary Engineer III ....
.Physician III ........
.Sanitary Engineer II ....
.Health Field Worker II .
.PHN Supervisor I ......
.PH Physicist IV .......
.Assistant San. Director .
.Sanitarian ..........
.Health Field Worker III .
.Clinical Dentist .......
.Sanitation Consultant .
.Sanitarian ..........
.Assistant County
Nursing Director I .....
.Nutritionist Consultant II .
.Public Health Nurse ....
.Health Field Worker III .
.Senior Sanitarian ......
.Public Health Physician III
.Special Agent ........
.Assistant Director .....

.SBH
.SBH
.Dade
.SBH
.Dade
.SBH
.Pinellas
.Hillsborough
.SBH
.Highlands
.SBH
.Pinellas

.Sarasota
.SBH
.Broward
.SBH
.Brevard
.Brevard
.SBH
.Miami Reg. Lab.

*Resigned after one quarter, scholarship discontinued

EPIDEMIOLOGY RESEARCH CENTER

JAMES O. BOND, M.D., M.P.H.
Director
The Encephalitis Research Center was renamed the
"Epidemiology Research Center" during 1968. The name change
reflected a broadened area of interest including viral diseases other
than those caused by arboviruses. Special studies of influenza,
mumps, measles, and Tamiami virus characterized these extended
interests.

The principal financial support for the center, however,
remained with the National Institutes of Health grant entitled
"Arbovirus Epidemiology in Florida." These investigations,
therefore, received first priority. The center's staff assisted in the
investigation of the first recognized human infection with
Venezuelan encephalitis (VE) on the North American continent
which occurred in Homestead, Florida, 250 miles south of the

GENERAL ADMINISTRATION

Tampa Bay area. Careful surveillance in the Tampa Bay area
suggested that there was no evidence of VE activity in central
Florida during 1968.
California encephalitis (CE) viruses are still the most prevalent,
and, therefore, most investigated of the arboviruses in the Tampa
Bay area. Fifty-five recoveries were made during 1968, all from
mosquitoes. Forty-six of these were from Aedes infirmatus, eight
from Aedes atlanticus, and one Anopheles crucians. Biological
studies strongly implicated the cotton rat as the vertebrate reservoir
for CE viruses in the Tampa Bay area. Marsh rabbits were also
shown susceptible to experimental infection in the laboratory. For
the third consecutive year we again failed to demonstrate
transmission in the laboratory using Aedes infirmatus mosquitoes
and Keystone virus. A plaque reduction neutralization test in
VERO cell culture was perfected by the laboratory and
considerably improved the serologic tools available for study of
Keystone virus. The immunodiffusion technique for identifying
sub-strains of CE virus was evaluated during 1968. The
complement fixation (CF) test remains the cheapest, quickest, and
simplest identification procedure.

For the sixth successive year there was no evidence of St. Louis
encephalitis (SLE) activity either in humans, vertebrates, or
arthropods. Physicians and hospitals in the area referred 589
human cases for viral diagnostic studies. None gave evidence of
recent arbovirus infection. Sentinel chickens and pauperized dove
flocks were again found negative for SLE serologic activity;
31,074 Culex nigripalpus mosquitoes were tested and found
negative for SLE virus. Follow-up studies of surviving SLE patients
from the 1959, 1961, and 1962 epidemics were completed in
1968. Survivors maintained hemagglutination inhibition (HI)
and serum neutralizing (SN) antibodies, but most had lost their CF
antibody by the fourth or fifth year. Many of the survivors had
neuroasthenic complaints which differed from those of their
matched controls and there was some minimal difference in their
ability to perform finely coordinated movements of the hand and
postural balance muscles.
The newly identified Tamiami viruses from cotton rats were
successfully grown on VERO cell culture and a plaque reduction
technique developed for assaying serum neutralizing antibodies.
Laboratory infected rodents were found to produce CF antibody

20 ANNUAL REPORT, 1968

titers. It was concluded the most likely method of transmission
between rodents was via virus-contaminated urine. Again there was
no evidence of human infection with Tamiami viruses. Since
Tamiami virus is a member of the larger hemorrhagic fever group
which produces serious illness in Central and South America,
further careful surveillance for human infection is necessary.
Other arboviruses identified and studied during the year
included Tensaw, Western encephalitis (WE), Sawgrass, and
Eastern encephalitis (EE). The new study site near the University
of South Florida (USF) was unusually productive of Anopheline
mosquitoes and a large number of Tensaw virus isolates were
recovered from these. A small serologic survey of students revealed
less than two per cent reactors with the Tensaw antigen. A newly
identified Florida tick virus termed "Sawgrass" was recovered
from five tick pools during the year. As in the past, these were
either Dermacentor variabilis or Haemaphysalis leporispalustris.

A pre-medical student performed an experimental infection of
water snakes with WE virus. The virus was found to circulate in
the snake during the first week after laboratory infection.
Artificial hibernation was then produced and the snakes checked
again for virus circulation; none was detected. Two other students
carried out significant research activities. A co-operative education
student from University of South Florida performed an
experiment to determine the distribution and biological half-life of
radioactive iron (Fe 59) in the blood of the mourning dove. A
pre-medical student from Tulane University participated in an
extensive seroepidemiologic study of mumps in a group of 72
families in Hillsborough County. Important data was obtained
which will be useful in the public health indications for live
attenuated mumps virus vaccines.
The EIfidemiological Investigation Service officer assigned to
the center participated in a large measles vaccination campaign in
Hillsborough County, and in a virus immunity survey of 2900
individuals in the Tampa Bay area; assisted in the investigation of
an important dual epidemic of meningococcal meningitis and
ECHO-9 viral meningitis in Manatee County; directed the study of
mumps epidemiology in the families described above; participated
in a study of the neurologic and psychologic sequelae following a
mumps viral central nervous system (CNS) infection; and assisted
in a large-scale mass field trial of aerosol influenza vaccination.

GENERAL ADMINISTRATION

The latter was conducted in conjunction with the University of
Florida, College of Medicine, Gainesville; State Board of Health,
Jacksonville; Hillsborough County Health Department; and
Hillsborough County Tuberculosis and Health Association.
Other special studies conducted during the year included
continuation of the immunization and cross challenge experiments
with dengue-2 and SLE viruses, the development of an
immunodiffusion technique for identification of EE, and a
cooperative study with St. Joseph's Hospital and USF in
characterization of arboviruses under the electromicroscope.

OFFICE OF REGISTRATION AND DRUG
ADMINISTRATION
EMBRY L. COALSON, B.S., Pharm.
Director

The functions and responsibilities of this office are to render
adequate administration, inspection and enforcement throughout
the state with reference to the following laws: The issuance of
permits to persons to perform alcohol tests under Chapter 322;
the registration of practitioners of the healing arts under Chapter
381; the issuance of narcotic licenses as required by Chapter 398;
the inspection of drugstores under Chapter 465; the registration of
clinical laboratories, personnel, etc., as required by the laboratory
law, Chapter 483; the administration and enforcement of the drug
and cosmetic division of the food, drug aAd cosmetic law, Chapter
500; and the administration and enforcement of the bedding law,
Chapter 556.

Chapter 322, Implied Consent Law
This program requires that permits be issued by the State Board
of Health (SBH) to individuals to perform alcohol breath tests
and/or other tests to determine the alcohol content on all persons
suspected of being intoxicated. The Act provides that the
enforcement will be done by the State Department of Public
Safety, and that the instruction be supervised by the State
Department of Education with the instructors completing a course
approved by the State Department of Education and the SBH
consisting of 40 hours of instruction. The approval of equipment
is the responsibility of the Bureau of Laboratories.

22 ANNUAL REPORT, 1968

Chapter 381, Registration of Practitioners of the Healing Arts
This is a continuing program which requires the registration of
all Florida licensed practitioners of the healing arts annually.
Assistance is given to the official boards involved, which, when
combined with the responsibilities under Chapter 500, the Florida
Food, Drug and Cosmetic Act, is quite effective in combating
medical quackery. This registration is programmed by the Division
of Data Processing and the information is available for use by
other bureaus and divisions.

Chapter 398, Uniform Narcotic Drug Law

It was originally felt that this chapter in its entirety was
transferred to the newly established Bureau of Law Enforcement.
The general impression now is that only the criminal provisions
were transferred and that the administrative responsibilities are
still charged to the SBH. Certain administrative agreements have
been reached and the registration required under this chapter is
being continued by the SBH; however, an amendment to the law
will be necessary during the 1969 legislature. Plans are being made
for this registration to be programmed by the Division of Data
Processing.
Chapter 465, Pharmacy
Although the registration fee under this law was repealed in
1967 by the legislature, this office is still responsible for assisting
the Board of Pharmacy in the enforcement. The responsibility is
carried out by the field inspectors during their inspections of
pharmacies which is required under Chapter 500, the Florida
Food, Drug and Cosmetic Act. Any violations noted are reported
to the Florida Board of Pharmacy.
Chapter 483, Clinical Laboratory Law
Under this law, all clinical laboratories and personnel are
required to register with the SBH annually. This registration is
programmed with the Division of Data Processing and the
information is available for use by other bureaus and divisions.
Chapter 500, The Florida Food, Drug and Cosmetic Law
This law requires the annual registration of all products bearing
a Florida address. The program is a growing one which is
evidenced by the fact that the Federal authorities in 1969 plan to

GENERAL ADMINISTRATION

devote 52 per cent of their field inspectors to drug work. At the
present, the Federal Food and Drug Administration has 17
inspectors assigned as follows: Miami, nine; Tampa, three;
Jacksonville, three; and Tallahassee, two. This office has three
inspectors (one each in Tampa, Miami and Orlando) involved in
the enforcement of this act. They gather samples which are
forwarded to the chemist for analyses.
Chapter 556, Bedding Inspection Law

Under this law, manufacturers, renovators and retailers are
required to register annually. This program was transferred to this
office February 26, 1968, and is a continuing one with five field
inspectors, a supervisor and a chemist. This registration is in the
process of being programmed by the Division of Data Processing.

Summary of Activities

Field
Talks made ........................ 64
Inspections made ....... .............. 6877
Items found in violation . . . ... 3896
Outdated merchandise found . . ... 8449
Physical and chemical analyses performed 735
Registration
Drugstores registered for 1967-68 . . ... 1776
Pharmacists registered. . . . 4050
Wholesalers registered . . . ... 45
Drug products registered . . . ... 2799
Clinical laboratories registered . . ... 469
Laboratory directors registered . . ... 222
Laboratory supervisors registered . . ... 847
Laboratory technologists registered . ... 1725
Laboratory technicians registered . . ... 835
Bedding manufacturers registered . . ... 937
Bedding renovators registered . . ... 558
Bedding retailers registered . . . ... 5067
Physicians registered (See Table 1 for breakdown) 11540
Implied consent permits issued . . ... 1216

TABLE 1
PRACTITIONERS REGISTERED WITH THE STATE BOARD OF HEALTH,
BY COUNTY OF RESIDENCE, FLORIDA
DECEMBER 31, 1968

v a-
0 0W

OS W
S0

Alachua ................. 278 258 1 4 2 13
County 4 ... 2
< 4 0 0 0
Bradford .9 7 1 1

o t 0 fi
F. 0 o .

B reward . . . . 772 574 79 48 11 23 37
Brevard .................. 89 159 4 14 1 31
Broward ................. 772 574 79 48 11 23 37
Calhoun ................... .. .3 3 . .2 35 48
Charlot . . . ... 9 1 1 ... .......
Citrus ................. 1 ... 1 .............

Collar .... .. ..... . 6 10 29 10 1

Escam ia .................. 167 150 ...10 6 1 2 5
Columia ................. 25 21 .. .... 2
DFade ................. 2251 1898 110 102 35 58
DeSoto . . . .7 16 1 1 ... ... ....
Dixiest .................. 1 1 ......... .

Glades .................. 1 1 1... ... ...1
aGulf ................... 4 4 ... 10 .. 2. 5
Hamileton ................. 2 2 ............ .
H ardeei ......... ......... . . . 2 5

Hernanido ............... 1 ...10 9 1 .... .......
Hla dse .......... 5 1 . 1

FrankHillsborough in ............... 542 418 28 41 22 14 19
Gilchrist .................1 1 . . . .

Glades .. .. ... .. .. 1 . . .. .. .
IndianRiver ............... 42 2 2 6 .
Hackston . . . . 18 15 .
Hardee ................ .. ... ......
HeLafandryette ................5 5

Highlands ...............29 25 1 2. ... ... 1
Hillsborough ............... 542 418 28 41 22 14 19
Holmes . . 3 3

Lee .................... 105 85 1 10 3 3 3
Indian River . . . 42 32 2 6 1 1
JaLevyckson . . . ... .18 15 3 . .. ....
Jefferson ................. 5 5 ... ... ... ... ..
Lafayette . . . . .

Nassau .................. 8 8 ..3 73... 1
Leeoos ................ 3105 85 1 10 3 3 3
Leonkee.o ... .............. 101 89 2 3 1 2 4
Levy .................. 42 3 7 5 .. 23
Liberty.......................................... .
Madison ................6 .. .

Palm Beach . . . 448 349 19 38 5 13 24
Manateeso .................. 9632 18 10 3 1
Marine ................. 7 64 51 4 6 .. 2 1 2

MartinPolk ................... 266 220 5.. 21 2 5 13
MoPutn ................. 21 19 .. ...

St.MJohnsroe . . . . 20 17 2 1 .
Nassaue ................. 8 8 .
Okalo osa .............. .35 30 .. ..
Okeechobee . . . ... .6 6 ...........
Orange . . ........ 492 377 9 4 19 4 1430
Osceola ................. 416 3 1 7 1 1
Palm Beach ............... 448 34 19 38 5 13 24
asc e .. ..... .. ......... 5 32 18 10 3 ... 1
Tinelas .................. 724 503 86 66 16 20 33
Polk ................... 266 220 5 21 2 5 13
Vutnama .................. 19 14 3 21 3
St.Johns ................. 20 17 .. 2 1
St Lucie ................. 38 286 2 ... 1 1
Santa Rosa .............. 3 17 . ... .... 1
Sarasota . . . ... 186 139 4 19 4 6 14
Seminole . . . ... 44 33 1 7 1 1 1
Suotera ............. .. 3 28 13 12 1 66 8...
Suwannee 1 9 6 ................5 1 2 ... 1
Taylor .................... .7 6 1 .........
Union ..................... .... 1 1 ...........
Volusia ..... ................. 214 148 32 18 1 3 12
Wakulla .......... ................. 1 1 . . . .
Walton .......... .................. 8 6 2 .........
Washington ..............3 2 ..........
Out of State .... .............. 3336 2873 173 142 1 66 81

GRAND TOTAL 11,540 9449 635 696 126 243 392

GENERAL ADMINISTRATION

DIVISION OF HEALTH EDUCATION

G. FLOYD BAKER, B.S., M.P.H.
Director
The division continued its philosophy of helping people help
themselves by filling requests as personnel, time and materials
permitted on a first come, first served basis. These requests from
throughout the state include personnel for program planning,
speakers, development of pamphlets and exhibits, educational
assistance to schools and other community groups, library services,
requests for audio-visual materials and equipment, producing and
distributing radio spot announcements and numerous health
publications.
A close liaison was maintained with the county health
departments (CHD), State Department of Education, voluntary
and official health agencies, local county schools, PTAs,
universities, colleges, junior colleges, hospitals, schools of nursing,
professional groups, church and civic groups and many other
interested groups and individuals. Inservice education of the staff
is a continuing need and function in order to serve as resource
people for planning and carrying out health education programs.
A medical librarian was secured in September after a vacancy of
15 months. A health educator from the Bureau of Dental Health
was transferred to the division in July, and a health educator
position was filled in December on an emergency basis. The
position of school health consultant was also transferred to the
division from the Bureau of Maternal and Child Health in July.
This position has not been filled because of the lack of interested,
qualified applicants. Two part-time Neighborhood Youth Corps
students were assigned to the division. A new procedure of
rotating the three secretaries was initiated to give them a better
understanding of the overall function of the division and to be
able to use their services to the fullest. There were 17 health
educator positions in 10 CHDs or on local projects at the end of
the year. Four of these were vacant.
The division helped develop and direct a first-in-the-nation
program for school health intern teachers to provide experience in
the field of public health education. This was done in conjunction
with the College of Physical Education, Health and Recreation,
University of Florida, and the Duval County School System. At

26 ANNUAL REPORT, 1968

year's end five students had participated in this program spending
five weeks of their 10 weeks of internship in the division.
Evaluation of the program by the students, faculty advisors and
division staff proved encouraging, and it is anticipated that this
will be a continuing cooperative venture.
The division directed the Health Project in Teacher Education
for the second year holding planning sessions with the universities
and colleges and assisting many CHDs in planning- their work for
the participating teachers. Despite internal problems in the school
system, the project was held at six colleges and universities with
97 teachers participating in 31 CHDs. Personnel from the Venereal
Disease Control Program, Division of Nutrition, and Bureaus of
Adult Health and Chronic Diseases, and Dental Health assisted in
carrying out the project.
Members of the division along with CHD personnel acted as
resource people to the State Department of Education's School
Health Education Study demonstration project which is funded by
a federal grant. Division personnel participated in a two-weeks
planning workshop for carrying out the first year's activities. The
project is being conducted in Duval, Seminole and Broward
Counties and is designed to evaluate materials developed and based
on the National School Health Education Study. Numerous State
Board of Health (SBH) materials were furnished to the project
staff.
The medical library and the audio-visual library received a
continuation of the National Library of Medicine Library Grant
amounting to $6875 for the second fiscal year of the five-year
period to update and improve both facilities. The funds were used
to purchase binding for journals, new books, additional shelving
and stacks, new library and audio-visual equipment and films.
Medical Library
There were 1587 new books and bound journal volumes added
to bring the current total to 26,086. There were 87 unbound
articles, publications and miscellaneous materials added to the
vertical file. Sixty outdated books were withdrawn from the
collection.
SBH and CHD personnel were the most frequent users of the
library. Next were the libraries participating in the Jacksonville
Hospital Education Program. Students and professional health
personnel from throughout the state were frequent users.

GENERAL ADMINISTRATION

Books checked out totaled 1843 with 921 on indefinite loan.
There were 92 interlibrary loans requested for patrons. SBH
personnel were routed 14,036 journals. Several bibliographies were
compiled, 1800 reference questions answered and approximately
4000 photocopies made.
Using Library Grant funds a backlog of 588 volumes was bound
at an average cost of $4.75 per volume. Between 250 and 300
volumes should be bound each year to maintain a public health
resource library. Grant funds provided new books and individual
journal issues missing from the collection.
Audio-Visual Library
The circulation of motion pictures and other audio-visual aids
increased by 16 per cent over the preceding year reaching 15,295
items used. The booking orders processed increased by 12 per cent
to an all-time high of 11,280.
The aids were used 31,180 times, an average of two uses per
shipment. As of December 31 there were 627 motion picture titles
listed with 1617 prints and 131 other aids available for
distribution. This is a reduction of 147 outdated or damaged
motion pictures and other aids removed from circulation.
From the Library Grant, the division and other division and
bureau budgets, 23 prints of motion pictures were added to the
library and 69 placed in the library on indefinite loan from official
and voluntary health agencies and commercial sources.
A new 1969 Audio-Visual Catalog was compiled and 8000
printed.
Pamphlets
There were 372,273 pamphlets distributed, an increase of
14,472 over the previous year. The most popular subjects included
nutrition, chronic diseases, communicable diseases, maternal and
child health and safety.
There were 565 people who called for pamphlets and assistance
was given to 1985 who called for other health related information.
Twenty pamphlets, posters, booklets and fliers were printed
outside the SBH, and 24 new or revised pamphlets were printed in
the SBH print shop.
Radio And Publications
The division was given the responsibility of preparing and

28 ANNUAL REPORT, 1968

distributing a new publication, "Florida Trends in Public Health,"
devoted to program material. There were nine issues published on
a monthly basis. Other publications produced during the year
included "Intelligencer," a quarterly personnel newsletter and the
12-month calendar published semi-annually. Twelve new radio
spot announcements were written and distributed to over 200
stations.
Exhibits And Illustrations
The work of the creative services section continued to increase
at a rapid rate. The one-man staff completed 769 units of work, an
increase of five per cent. The work ranged from a single piece of
work in a unit to more than 50 pieces in others.
A large per cent of time was spent on illustrations and signs.
Other types of work included displays and exhibits; reproduction
for layouts, maps, charts and graphs; photographic layouts and
serving as consultant to many other projects.
Photography
Photographs were taken at numerous sites throughout the state
in response to 57 requests. These included several hundred color
slides for one CHD, color photographs for exhibits and
publications, reproduction of charts and maps. There has been a
great increase in the demand for color photography in pamphlet.
and exhibits.
DIVISION OF PERSONNEL
MILES T. DEAN, M.A.
Director
Under the general direction of the State Health Officer, this
division is responsible for the administration of the personnel
program of the State Board of Health (SBH). This includes
advising administrative officers concerning personnel practices and
development; putting into effect procedures for carrying out
approved personnel policies; participating in the preparation and
administration of the approved Classification and Compensation
Plan; administering the leave regulations; maintaining adequate
personnel records on all persons employed in the agency; acting as
liaison official with the State Personnel Board in matters involving
requests for certificates 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 system; and the preparing of state

GENERAL ADMINISTRATION

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
Legislative Requesting and the Operational Budgets is also a
responsibility of this division.
There were several major changes in the Personnel operation
during 1968. New leave regulations were established by the State
Personnel Board, effective January 1.
On March 1, the payroll procedure was changed to biweekly.
Employees voted almost two to one for this change.
A new Classification and Pay Plan was established by the State
Personnel Board, effective July 1. This included a new concept in
pay, with more flexibility for employment, as well as salary
increases. The new Classification and Pay Plan provided uniform
pay and classification for practically all state employees.
On September 30, there was a curtailment of the Aedes aegypti
Mosquito Eradication Project, requiring, with one month's notice,
the layoff of over 600 employees.
Turnover of personnel continues to be high. Difficulty in
recruitment and retention of employees continues to increase.
Recruitment and retention of nurses, dentists, and sanitary
engineers continues to be a real problem.
TABLE 2
EMPLOYEES IN THE FLORIDA STATE BOARD
OF HEALTH AND COUNTY HEALTH UNITS
AS OF DECEMBER 31, 1959-1968

YEAR STATE COUNTY HEALTH TOTAL
DEPARTMENTS EMPLOYEES

1968 ...... 858 2517 3375
1967 ...... 822 2832 3654
1966 ...... 929 2769 3698
1965 ...... 914 2647 3561
1964 ...... 843 2326 3169
1963 ...... 762 1918 2680
1962 ...... 692 1821 2513
1961 ...... 626 1593 2219
1960 ...... 604 1534 2138
1959 ...... 586 1396 1982

TABLE 3

PERSONNEL IN ADMINISTRATIVE UNITS OF THE FLORIDA STATE BOARD OF HEALTH
(EXCLUDING COUNTY HEALTH DEPARTMENTS), BY CLASSIFICATIONS,
DECEMBER 31, 1968

Administrative Unit

Grand Total .....
Administration
Research .......
State Health
Officer .......
Registration &
Drug
Administration .
Health Education ..
Personnel ......
Nursing .......
Encephalitis
Research Center .
Adult Health &
Chronic Diseases .
Dental Health ....
Entomology
State and
Regional Office .
Research Center
Vero Beach .....
Arthropod
Laboratory
in West
Florida .......
Finance & Accounts
Fiscal ........
Purchasing &
Property . .
Building &
Facilities . .
Laboratories
Central -
Jacksonville .
Miami .......

Totals

Physicians

28

1

5

1

2
1

Public
Health
Dentists

4

Public
Health
Nurses

Sanitary
Engineers

Sanitarians

Laboratory Other Pro-
Wkrs. (Prof. fessional and
and Tech.) Technical

Clerical

-4 4 -4- + -4 4 -,

24

9

1

39

14

1

254

14

1

1

11

36

11

62
1Q

144

11

11

10
7
4

5

2

2

1

4

2

1

282

14

17

4
4
10
3

10
3

3

3

2

8

6

14

All Z
Others Z
C
69 >
I-

m

O
-uI
0
4 -

2 0
0
. . 00

6

8

2

2

1

38

. --. - ~ . .- .. . .19

TABLE 3 (Continued)

Public Public Laboratory Other Pro-
Administrative Unit Totals Physicians Health Health Sanitary Sanitarians Wkrs. (Prof. fessional and Clerical All
Dentists Nurses Engineers and Tech.) Technical Others

Urlanao ......
Pensacola ......
Tallahassee ...
Tampa ........
West Palm Beach
Epidemiology of
St. Louis
Encephalitis .
Local Health Services
Bureau of Local
Health Services .
Sanitation ......
Nutrition ......
Civil Defense ..
Maternal & Child
Health . .
Preventable
Diseases
Bureau of
Preventable
Diseases .......
Radiological &
Occupational
Health ........
Tuberculosis
Control .......
Venereal Disease
Control .......
Veterinary
Public Health .
Vaccination
Assistance
Project .......
Sanitary Engineering
and Air Pollution
Control .. .....
Health Facilities
& Services
Bureau of Health
Facilities &
Services . .
Vital Statistics
Bureau &
Division of
Vital Records .
Statistics .......
Data Processing .

2

6

3

1

4

1

12

7

1

2

3

1

12

1

1

...... rn
...... Z

1 r

r-

0

. .. =z
--I

--I

2 Z

CA

1

TABLE 4

PERSONNEL IN COUNTY HEALTH UNITS (BY CLASSIFICATION)
FLORIDA, DECEMBER 31, 1968

a 0

COUNTY a -

CBradford ...... 9 1 4 1 ... .. 2 1
Broward .... 144 3 3 49 3 21 4 6a 41 14
a .- a 0 o

Calhoun ....... 5 ...... 2 ... 1 ... 1 ..... 1 1
BChart . 1. 1 6 4 1 4 2
BCitrua . 5 1. 4 1 ..... 1 .

CBlay . . 11 .. 6 2 . 2 1
Collier ........ 26 1 .. 9 .. 6 .. .. 6 42 1
Brevard ... ... 5473 1 1 22 2 14 3 2 20 8
Broward ....... 144 3 3 49 3 21 4 6 41 14
Calhouni .... ... 3 . 2 1.. .......... 1 1
Charlotte...... 163 1 6.. 3. 1 4 2 4

Escambia itrus......... .. 80 21. 1 27 1......3 2 2 19 14
Clat er ....... .. .. 1 .. . 2

CollFrankin ....... 3 ........ 1 .. 1 9....... 1 4
ClGa d . .. 1 1 ... 6 2 . ... 3 1

Collierist . 3 .26 2 . 6. . 6 4
CoGladesumbia . 3 . 1 1 . a 1
Dade.... .........548 56 11 185 2 62 14 36 139 44
DeSotol ....... ..... ... 3 1 . .. 2 .
Dixielt ...... 4 ... 3...1... 1.. ....... 1 1
Duvalrdee 63 27 .. 3 1 .14 14 4
Escambia . 80 2 1 27 13 2 2 19 14
Flagler . ....... 1 . .. .
Franklin . ... . .. 1 ...... .
Gadsdends ...... 14 1 6 3 ... ... 3 1
Gilchrist...... .. .. ... 2 . . 1
Glad es ..... 3 ...... 1 .. ..
GulfJa . 6 1. .. 1 .. .. .
Hamilton . .. .. . .. 1 . 1 1
Hardete . .. . .. 3 1 .. .. 1
Hendry .. .. 1 1. .. ... .. .. 4 4
Hernando.... .. 7 . 1 1 1 2 ..
Highlands...... 1 14 1 .... 1 12 3
Hillsborough . 208 6 68 2 34 7 10 43 38
Holmes .. .... ... 8 .. .. 4 .. 1 .. ... 2 1
IndianRiver 2. 3 .. 1 . ....... 1 2 1
Jackson ...... 516 1 1 .. ... 13 3

JeffManateerson . .45 1 1 13 1 7 4 12 6
aJefferon ....... 6 ... .. 12 1 ..... 1 21
Lakert ...... 8 ... 74.. 1 .. . 1
Lee . 37 2 17 1 11
Leon....... ... .44 2 14 11 ... 1 12 4
Levy . . 8 . 1 . .. 2 2
Liberty .... 3... . 4. 1
Madison ...... 5 1 1 ... 1 1
Mandate ..... 345 1 1 13 1 7 4 12 6
Marion . .. 26 . .. 12 4 1 7 2
Martin B. ... .165 9 2 49 4 23 2 14 236 26
PM onro ...... 20 1 8 4 ...... 2 3
Nassau . ... 13 1 1 4... 2 1 .... 25 1
Okaloosa . .. 22 1 9 1 . 4 3
Okeechobee 41 1 . 15 . . 1 1
Orange . .134 3 1 46 21 2 5 39 17
Osceoa a. . 6 . 2 2 ... 2 ...
Palm Beach ....... .165 9 2 49 4 23 2 14 36 26
Pasco .l ..... 26 ... 1 8 2 .. .... 2 2
Pinellas . .. 95 4 2 82 3 30 7 6 47 14
PolkS ....... 97 1 1 44 2 10 2 2 22 13
Putnamy r ....... 5 2 .. ... 1 4
St.John . .. ......1 ...... 1 2 1
St. Lucie . 22 1 9 6. .... ... 5 1
Santa Rosa . 16 1 8 1... ... . 4 2
Sarasota . 66 1 24 11 3 19 7
Seminole . 26 . 14 4 ... 6 2
Sumter ....... 4 .. ... 1 .. 1... ... .. 1 1
Suwannee ...... 1 1 . 1 .. ... 3 2

Washington . 5 . 2 1 . .. 1 1

GRAND TOTAL 2517 118 27 913 20 395 52 92 622 278

EMPLOYMENT TERMINATIONS AND TURNOVER RATES BY CLASSIFICATION AND SALARY,
FLORIDA STATE BOARD OF HEALTH AND COUNTY HEALTH UNITS, 1968
(FULL-TIME EMPLOYEES ONLY)

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

TERMINATIONS 1968

Total All Employees .. ....... 2164 .. 139 1399 279 193 100 26 7 1 20
Physicians ................... 19 .... .... .... .... .... ..... ..... ... ..... .. 19
Dentists .................. 2 .... .... .... ..... .. .. 1 .... ... 1
Sanitarians ................ 53 .... .... ... 6 30 15 2 .... ........
Sanitary Engineers .... ....... 15 .... .... ...... .... 6 4 4 1 .... ....
Public Health Nurses ......... 199 .... .... .... 33 110 46 10 .... .... ....
Laboratory Workers
Professional & Technical ........ 90 .... 42 15 17 12 4 .... ..
Other
Professional & Technical . . 67 . . ... 16 22 21 5 3 .... ....
Clerical .................. 356 .... 74 221 51 10 .. .. ........ ....
All Others ................. 109 .... 65 37 7 .... ... .... .... .... ....
(Aedes aegypti Eradication
Project)* ................. 1254 .... .... 1099 151 4 ... .. .. ..

TURNOVER RATE**

Total All Employees ........ 67.4 .. 34.6 214.2 81.3 22.7 19.5 21.3 6.3 2.0 10.9
Physicians ................. 16.5 .... .... .... ...... .... .... .... .... .... 16.5
Dentists1 ............... 60.2 .... .... .... .... .... ... 100.0 .... .... 16.6
Sanitarians ................ .. 13.2 ........ ... 20.0 17.4 11.5 5.9 .... .... ....
Sanitary Engineers ......... 24.6 ........ .... ... ... 200.0 44.4 37.6 14.3 ....
Public Health Nurses .......... 21.8 ........ ... 41.3 19.2 21.2 38.4 .. ........
Laboratory Workers
Professional & Technical ....... 29.4 .... .... 56.0 27.3 62.9 28.6 16.7 ... .. ....
Other
Professional & Technical . ... 29.3 . . ... 100.0 61.1 29.2 17.9 6.8 . ....
Clerical . . . ... 40.5 ... 42.8 42.2 31.7 45.4 .. .... .... ...
All Others ................ 37.8 .... 33.3 77.1 35.0 ............ .... .... ..
(Aedes aegypti Eradication
Project)* ................ 152.9 .... .... 157.0 126.8 .... .. .... .. ....

1Does not include Dental'Preceptees
*Project terminated September 30, 1968
**Per cent of full-time employees terminating by classification during 1968

34 ANNUAL REPORT, 1968

DIVISION OF PUBLIC HEALTH NURSING
ENID MATHISON, R. N., M. P. H.
Director
The division is the immediate representative of nursing within
the State Board of Health (SBH). It provided guidance and
leadership for public health nursing throughout the state.
Consultation is available for continuous evaluation of programs
and services necessary to fulfill the responsibilities of public health
nursing in the county health departments.
Special effort is made to identify closely with all bureaus and
divisions in the coordination and correlation of public health
nursing services. The consultant who has an interest and
preparation in a specialty relates directly to that respective bureau;
example: maternal and child health, mental retardation, geriatrics,
and chronic diseases. Public health nursing is the organizational
instrument through which the programs and projects of the SBH
are implemented.
The consultants offer assistance in the definition and solution
of problems, pointing out the relationship of individual problems
to the larger public health concepts. The role of the nurse at the
local level is to give direct service to the community, to interpret
and teach health principles, give care to the sick in the home, and
to introduce new programs in such a way that they will be
acceptable to the community. The division, through its
consultants, offers knowledge and support of resources in all
phases of the nursing program.
Today, possibly more than ever before, the role of public health
nursing requires responsive and creative adaptation to a constantly
changing environment. The promotion and assistance in the
implementation of inservice education programs has been given
high priority by the division. The need for more assistance than
the limited staff can provide is urgently needed, particularly in the
50 smaller counties.
Consultation to agencies providing Home Health Services,
approximately 60, continues to require an undue percentage of
the time of the consultants. A considerable amount of time is
devoted to surveys and resurveys, necessary for certification of the
agency. Validation of the charges for service necessitates
time-consuming time and cost studies. Table 6 gives some

GENERAL ADMINISTRATION

comparisons of the amount of time spent and the cost for health
supervision and nursing care of the sick in the home visits.
The Continuing Education Committee, an integral part of all
program planning and preparation of educational materials for use
in the counties met six times. This committee is a very vital link
between the division and the county health departments (CHD).
The membership of the committee represents directors and
supervisors from medium and small counties and a public health
faculty member from a college of nursing.
A sharp decrease was noted in midwife educational and
supervisory programs. The number of midwives licensed was 135,
a decrease of 13 from 1967. A corresponding decrease in births
attended by midwives is reflected in the 1967 vital statistics. For
the first year no new applicant was licensed to practice midwifery.
At the request of the University of Michigan School of Public
Health three graduate nurse students were given a two weeks
observation of the public health nursing program in the state.
Twelve newly employed nurses from diploma programs, which
do not include preparation in public health, had the eight weeks
orientation in the four Field Teaching Centers. These nurses are
from small counties where the local staffs do not have the time or
qualifications for giving the orientation.
The 15 orientation programs at the six Sunland Training
Centers were attended by 344 professional workers, including
public health nurses, teachers in special education programs, social
workers, and vocational counselors. These programs are planned
and presided over by the consultant in mental retardation.
Professional staff members in the centers are now, in their
presentations, giving attention to the need for more community
services for the mentally retarded.
A six hour course for nurses on Post Hospital Care of the
Patient with Myocardial Infarction was held in five areas of the
state. They were jointly sponsored by the division and the state
and local heart associations. The total attendance was 322.
The consultants made 346 visits to CHD's, hospitals, nursing
homes and prospective or certified home health agencies. The
visits vary in length from a few hours to four days, the longer visits
being in small health departments where nursing supervision is not
available.

TABLE 6
COMPARISON OF TIME AND COST FOR NURSING HEALTH SUPERVISION VISITS
AND HOME VISITS FOR GIVING CARE FOR DISEASE AND DISABILITY (sick)
IN 1963-64 and 1966-67

1963-1964 1966-1967

COUNTY HEALTH SUPERVISION DISEASE AND DISABILITY HEALTH SUPERVISION DISEASE AND DISABILITY
Home Visits Home Visits Home Visits Home Visits

Time (Min) Cost Time (Min) Cost Time (Min) Cost Time (Min) Cost

MANATEE 30 $ 3.45 49 $ 5.58 57 $ 7.90 56 $ 7.75

MARION 31 $ 4.82 31 $ 4.82 31 $ 5.26 31 $ 5.25

POLK 33 $ 4.02 46 $ 5.48 44 $ 7.11 55 $ 8.87

SARASOTA 38 $ 4.97 54 $ 7.10 44 $ 9.61 44 $ 9.39

SUWANNEE 23 $ 2.91 34 $ 4.31 49 $ 8.53 58 $10.11

Division of PHN
1969 Annual Report

BUREAU OF ADULT HEALTH AND
CHRONIC DISEASES
J. E. FULGHUM, M. D.
Director
The nature and extent of the problems of various chronic
diseases which are public health problems continued to be
examined by the bureau. Education and training programs have
played a large part in the activities of the staff. Progress was made
in increasing the knowledge and awareness of the public about
chronic diseases; active participation was successful in bringing to
the physician an awareness and appraisal of the newer methods of
prevention, diagnosis, treatment and rehabilitation of patients
with chronic diseases.
The active ongoing programs within the bureau are programs in
aging, cancer, hearing aids, heart disease, diabetes, prevention of
blindness, and smoking and health. Detailed reports of these
programs will follow under their respective sections. Every effort
has been made to evaluate and strengthen the present programs
during the past year.
Florida Regional Medical Program (RMP)
The staff has devoted considerable time in working with the
Florida Regional Medical Program. The State Board of Health
(SBH) was represented on the Task Force for Heart and the Task
Force for Cancer. The State Health Officer is a member of the
Florida Advisory Council.
The following project grant requests have been prepared and
submitted to the RMP for consideration of funding:
Rural three county hypertension program (funded);
Cardiovascular screening program in four rural counties;
Stroke survey and rehabilitation;
Computerized EKG screening program;
Coronary care unit program for North Florida; and
Computerization of coronary care units a pilot study.
The Demonstration Hypertension Control Program has been
funded and is in operation. The remaining proposals are still going
through the administrative machinery of review and evaluation.

38 ANNUAL REPORT, 1968

Approved grants are funded by awards made to the Florida
Advisory Council. The Council in turn negotiates a contract with
the SBH to carry out the provisions of the grant application.
Payments are made in monthly increments.
Dealing with RMP has been a complicated procedure, but it is
felt that it has many desirable features. One of the most
outstanding, is that of insisting on the involvement of all related
agencies in the area. This insures community-wide participation in
the program.
Health Profile Screening
Health profile screening to encourage early detection of disease
has been emphasized where such programs met the needs of a
community.
In Florida, screening programs for tuberculosis, the venereal
diseases, carcinoma, diabetes and glaucoma have been conducted.
Most patients with these early, and previously unknown, chronic
conditions have been successfully treated in physicians' offices, or
outpatient clinics, and the need for hospitalization for advanced
stages of the disease reduced.
Screening is the identification of unknown and unrecognized
disease or defects by tests of examination that can be applied with
ease and rapidity on apparently healthy persons. Screening tests
are not diagnostic but direct the screenees to their own physicians
for further medical workup. Health profile screening examinations
may well be carried out by monophasic or multiphasic procedures
in the offices of physicians, hospital outpatient settings, or in
special centers operated under the direction of the local
physicians, and with the cooperation of the volunteer societies, the
county health departments (CHD) and other community agencies
interested in the health of the people. Through screening, those
people most likely to need medical attention are referred to their
physician. Thus, the busy physician's time can be better utilized
for early diagnosis and treatment.
Early identification, diagnosis, and treatment obviously prevent
suffering, disabling conditions in later life, and prolong useful life.
Consultation Visits
During the year the staff of the bureau provided field
consultation visits as follows: cancer, 43; diabetes, 81; hearing

ADULT HEALTH AND CHRONIC DISEASES 39

aids, 7; heart, 176; .prevention of blindness, 45; smoking and
health, 37; other special projects totaled 44; with a combined total
of 432 trips or other visits.
Relationship with Other Organizations and Agencies
The bureau is represented on the Florida Cancer Council; the
Florida Coordinating Council for Cardiovascular Diseases; the
American Cancer Society, Florida Division, Inc.; the Public Health
Cancer Association of America; the Florida Committee on
Smoking and Health; the Florida Diabetes Association; the Florida
Society for the Prevention of Blindness; and the Florida
Tuberculosis and Respiratory Diseases Association. These activities
contribute to a good working relationship with the major
voluntary health agencies within the state.
U. S. Public Health Service (USPHS) assigned an
ophthalmologist and a public health advisor to the Prevention of
Blindness Program.
AGING
Aging might be defined as a series of developmental stages or
processes occurring from birth to death. However, for this report,
aging or aged will refer to those persons over 65 years of age.
The aged population is a special risk group from a health
standpoint. According to a U. S. National Health Survey (1961 -
1963), 81 per cent of the persons 65 and over reported one or
more chronic conditions. Forty-nine per cent reported a chronic
condition that limited their activities, and 16 per cent were unable
to carry on major activity.
Health problems of an aging population are well known and
identifiable. There are presently 806,300 persons over 65 in
Florida who are afflicted with the usual infirmities of the aging.
Many of these people are on fixed incomes and have been caught
up in the increased cost of living, high taxes, and of the disabilities
resulting from the chronic diseases. They find themselves with
depleted resources and become dependent on the community for
assistance. Florida has more than its share of these individuals
because it is a favorable retirement state.
Responsibility for this program is vested in the bureau. Close
liaison is maintained with the Commission and Council (the
voluntary health agency in Florida) on Aging and the Florida

40 ANNUAL REPORT, 1968

Medical Association's Committee on Aging. Health services for the
aging are provided by the CHD's as a part of the general health
services which are available to the population at large.
Health education, preventative screening, early casefinding and
physical rehabilitation programs are desirable components of an
active program on aging and are planned for and implemented
whenever staff and time permit within the bureau.

Osteoporosis
Many retirement communities in Florida continue to be plagued
with orthopedic problems relating to severe osteoporosis. A
preliminary survey of nine retirement communities showed that as
high as 10 15 per cent of the residents have some disabling
fractures each year. Complications of disabling fractures are
frequently mentioned as one of the leading causes of death in the
elderly.
The Needs of the Aging with Regard to Hearing Aids
An investigation involving 290 older persons was carried out to
gain information concerning the use of hearing aids by these
individuals. The investigation was carried out in three parts: gather
data, referral of suspects, and analysis of data obtained.
Those persons screened completed a comprehensive
self-administered history sheet. For those who had used or owned
a hearing aid, another questionnaire was also filled out. Following
this, the ears were examined by an otoscope and an audiogram was
given. The average hearing loss was computed. If the individual
had evidence of otic disease or moderate hearing loss, the patient
was referred to his physician.
A detailed analysis of the accumulated data is presently being
carried out.

CANCER CONTROL PROGRAM
The impact of cancer on the population and economy of
Florida continued its upward trend during 1968. These malignant
neoplasms continue as the second leading cause of morbidity and
mortality not only for Florida but for the nation as well. The rates
for both mortality and morbidity increased over the previous year.
It is estimated that 11,800 persons died of cancer in Florida

ADULT HEALTH AND CHRONIC DISEASES 41

during 1968. In 1967, there were 11,187 cancer deaths.
Comparative figures for cancer deaths over the past decade reflect
6101 deaths in 1957, or about half the number for 1967.
Provisional figures in Florida during 1968 indicate a cancer death
rate per 100,000 population of 191.1, while the national rate was
estimated as 158.8.
A consideration of great importance in studying the cancer
problem in Florida is the age factor. Florida, the ninth most
populated state in the nation, has not only increased its
population drastically in recent years, but its older population is
increasing over the national rate.
The final mortality figures for cancer in 1967 reflected the
trends of the past decade. Cancer of the respiratory system rose
from 2387 in 1966 to 2500 in 1967. This rise is due primarily to
the fact that lung cancer in men has increased more than 15 times
in the past 35 years and is now increasing in women. Breast
cancer, a major cause of death in women ages 40-44, rose from
867 in 1966 to 878 in 1967. Cancer of the female organs
continued to decline. An influencing factor is the early detection
method of cervical cytology screening being used by most CHD's
and the majority of physicians. A rise from 610 cancer deaths due
to female organs in 1957 to a high of 813 in 1965, and a decline
to 748 in 1967, reflects this trend. The rate of 24.2 in 1967 is
lower than the rate in 1957 of 28.3. Cancer of the large intestine,
while improved over the years, remains as a major site along with
cancer of the rectum. The digestive system, especially cancer of
the stomach, still shows a slight downward trend. Cancer of the
pancreas is moving slightly upward.
The overall cancer mortality trends have been influenced greatly
by the rise of lung cancer in men, an almost wholly preventable
disease and the largest decline in cancer of the uterus through
early detection techniques. Except for these factors the cancer
mortality trend is generally downwards.

Tumor Clinics
The 26 approved tumor clinics continued their cancer control
services for their communities and the adjacent areas throughout
the state. Support for this coordinated program is largely derived
from the hospital, the individual physician, the American Cancer
Society, Florida Division, Inc., and the SBH. Through these

42 ANNUAL REPORT, 1968

clinics, the indigent and medically indigent cancer victim may
receive the necessary diagnosis and treatment. Clinic activities are
reflected in the total patient visits as shown in Table 7. Through
the SBH, some of the material costs to the institution for
diagnostic studies for the indigent were defrayed from a special
budget. Half of the ancillary personnel that staff the tumor clinics
are budgeted through funds provided by the SBH to the CHD.
Consultation services are provided from the Cancer Control
Program to the tumor clinic directors, secretaries, registry clerks
and the institution.
Cancer control throughout the state receives valuable assistance
through the CHD. The county health officer provides the liaison
medium through which indigent services are coordinated, tumor
clinic admission may be gained, and hospitalization is afforded to
the indigent patient. The public health nurse is utilized in the vast
majority of tumor clinics. She helps staff the clinic and provide a
wide variety of nursing services to the indigent cancer patient as
instructed by the referring physician. A major problem with the
cancer patient follow-up program is greatly reduced through the
public health nurse and her ability to maintain contact with and to
persuade the patient to continue therapy or return for treatment.
The tumor clinic operations generally did not change during
1968. Medicare has affected the tumor clinic operation in various
ways. The anticipation of Medicaid or Title XIX programs
expected to be enacted in 1969 is a matter of great speculation.
The combined effect of these programs to eliminate the
indigent patient will not eliminate the Cancer Control Program.
The year represents a period of evolution for the tumor clinic in
that a major shift of program emphasis has begun. The increasing
scope of third party (indigent medical insurance) programs is
greatly reducing the indigent problem, and therefore, reduces that
portion of clinic operations. This does not remove the need for the
tumor clinic concept. To emphasize the change in imagery, the
"Approved Tumor Clinic" will become the "Approved Hospital
Cancer Control Program." The implementation of the RMP
(Heart, Cancer and Stroke) and its philosophy of continuing
education is providing the basis for this expanding of an indigent
tumor clinic service into a broader hospital-wide "modus
operandi" of Cancer Control. Such a program encompasses the
tumor clinic, the hospital-wide cancer registry, the tumor board or
conference, and broader staff involvement of review of cancer

ADULT HEALTH AND CHRONIC DISEASES 43

treatment at the hospital. The Hospital Approved Cancer Control
Program is aimed at bringing the highest expertise and
sophisticated treatment possible to the patient regardless of his
status in life.
Cervical Cytology
The major reduction in a cancer site is cancer of the cervix
uteri. This has been accomplished by the early detection technique
of the Papanicalou (Pap) smear or cervical scrape. Cervical
cytology conducted by the CHD has grown in recent years and
during 1968, the vast majority of the counties screened their
indigent female population through their ongoing local programs.
Cervical cytology screening was conducted in 57 counties,
screening 40,233 women. Among those screened, 507 women
were suspected to have cancer and 120 were positive, the total is
an increase of 6851 over 1967 when 33,382 women were
screened.
The ease of implementation of the cervical cytology screening
program at the CHD is made possible by three basic factors. First
is the dedicated support of the Florida Society of Pathologists who
established a state-wide minimum fee of $2.75 per slide
interpretation. This fee is not for professional services but is to
offset the costs of processing the slides and for other materials.
The second feature is that the population to be screened is easily
reached through the existing CHD programs such as postpartum
care and family planning clinics. The third and most important
feature is the ability of the CHD to provide follow-up and
follow-through on the suspicious and positive cases brought to
light by these screening activities. Repeat smears are performed
and patients are referred for diagnosis or treatment. The tumor
clinics are able to provide the final steps of diagnosis and
treatment as determined by the physician in charge.
Statistical Tabulating Center
The Statistical Tabulating Center collected cancer information
from 18 tumor registries throughout the state. Through 1968,
there were 33,100 primary cancer cases recorded in the center.
The number of cases will probably reach 43,000 to 44,000 during
the coming year 1969.
The major functions of the Tabulating Center are to provide
administrative supervision of the local tumor registries through

44 ANNUAL REPORT, 1968

review of abstract information being submitted. In its review of
these abstracts the Center is able to provide a limited measure of
quality control over the local registry. Collectively these local
registries will provide some indices as to the state-wide picture of
cancer morbidity. Cancer mortality is readily available from death
records filed at the SBH. The Center provides feedback to assist
the local registry by providing two monthly IBM lists. They are an
alphabetical listing of all reported deaths where cancer is listed as
the cause of death and an alphabetical listing according to the
individual clinic of their eligible follow-up cases for the month.
These IBM listings provide a check to the local registry as well as
potential time-saving in their record work.

TABLE 7

PATIENT VISITS, FLORIDA TUMOR CLINICS, 1962, 1964, 1966, 1968

CLINICS 1962 1964 1966 1968

Alachua General Hospital ..... 198 185 125 127
Bay County Tumor Clinic ..... 494 647 616 498
Brevard County Tumor Clinic ... ..... .15 50 **
Broward County Tumor Clinic 563 500 325 517
Duval Medical Center ....... 5028 6318 5496 4641
Escambia County Tumor Clinic 2462 2380 2187 990
Halifax District Hospital ...... 204 550 146 **
Hollywood Memorial Hospital ............ ... 225 296
Jackson Memorial Hospital .... 3482 3823 3246 3228
Lake County Tumor Clinic ... ... .. .. ...... .11 7
Manatee County Tumor Clinic 243 146 149 151
Marion County Tumor Clinic ... 150 187 288 185
Mercy Hospital ........... ...... ....... 338 199
Mount Sinai Hospital ........ 1238 1383 1359 1426
Orange Memorial Hospital ..... 2819 2923 3144 2197
Pinellas County Tumor Clinic ... 1829 2595 2095 1661
Polk County Tumor Clinic .... ..... 1767 1622 1530
Sarasota County Tumor Clinic 297 369 237 246
St. Francis Hospital ........ 830 799 662 501
St. Lucie County Tumor Clinic 129 246 215 197
St. Mary's Hospital ......... 919 996 984 464
St. Vincent's Hospital. ...... 1670 2120 2433 3223
Tallahassee Memorial Hospital 1280 1487 1300 1136
Tampa General Hospital ...... 3961 3618 3653 3859
University of Florida ....... 3162 3371 3612 3514
Variety Children's Hospital .. .. 710 688 1047 850

TOTALS .......... 31668 37113 35565 31643

**No Reports for 1968

ADULT HEALTH AND CHRONIC DISEASES 45

To date, the Center has published three annual reports. These
reports reflect information on the state's population and
population growth. Cancer mortality figures according to site are
published in tables and graphs. Morbidity figures collected from
the individual 18 registries are also presented. The fourth report
for the period July 1963 through December 1968 will be
published in early 1969.
Florida Cancer Council
The Florida Cancer Council continued as a major coordinating
body for its member agencies on cancer affairs throughout the
state. Meetings were held on May 10 in Miami Beach and
November 9 in Fort Lauderdale. The Council met with the
Association of Florida Tumor Clinic Directors in a special meeting
September 28 in Tampa. This meeting was called to provide
special emphasis to the upgrading and improvement of tumor
clinic programs and functions. Sponsoring this meeting were the
Florida Chapter of the American College of Surgeons; the
American Cancer Society, Florida Division, Inc.; and the SBH. A
special meeting of the Council was held on December 9 in Tampa
to establish guidelines and liaison with the RMP in Florida.
DIABETES CONTROL PROGRAM
Florida's popularity as a retirement area has caused a
corresponding increase in the number of both known and
unknown diabetics in Florida. Based on preliminary data obtained
during the period January 1, to September 30, it is estimated that
1100 Florida residents died of diabetes during 1968. This is an
increase of 14.9 per cent in the number of deaths due to diabetes
over 1967. This increase may be due in part to better reporting of
the causes of death by physicians but this should not be
considered as the only reason for such a large increase.
In 1968, diabetes was ranked as the tenth leading cause of death
among Florida residents. The non-white female continues to have
an average death rate almost twice as high as the average death rate
for the entire state. More intensive casefinding is needed among
this group to find and bring undetected diabetics under the
treatment of their physicians.
Diabetic retinitis ranks a close third as a cause for blindness
within the state. Only cataracts and glaucoma are greater causal
factors for blindness at this time.

46 ANNUAL REPORT, 1968

The Diabetes Control Program is organized into three areas:
insulin distribution, casefinding and education.

Insulin Distribution
The state appropriation for insulin to be distributed to the
medically indigent diabetics of the state is $60,000 for the fiscal
year 1968-69. Approximately 4247 medically indigent patients are
now receiving all or part of their insulin from state sources
through the CHD's. The average annual cost per patient under this
program decreased from $14.12 in 1967 to $13.22 in 1968,
primarily due to the decrease in the cost of insulin. However, the
increase in the number of patients under this program during the
six months of 1969 shows that the $60,000 per year budget may
not be adequate to provide this service to the same degree as it has
been offered in the past unless additional funds are obtained.
The insulin distribution program has local diabetes registries
which are used for follow-up, for relative case-finding programs
and as a reliable source of data for program evaluation.

Casefinding and Service to the Patient
Most cases of diabetes can be easily controlled by early and
proper treatment. This treatment is most effective among those
cases which are diagnosed at an early stage of this disease, and a
vigorous program of patient education, including thorough
coverage of the diabetic diet by qualified persons, is being offered
in classes and the home. All persons over 40 years of age are
encouraged to have periodic two-hour post-prandial blood sugar
determinations. Testing of the non-white females should begin at
age 30 due to the peculiar early rise in death due to diabetes
among these women. All relatives of known diabetics should have
blood sugar determinations made annually because of the higher
incidence of the disease among this group.
Casefinding is primarily the responsibility of the CHD, with
assistance from the community and SBH in the areas of
consultation, program planning, and limited financial aid for
conducting diabetic surveys. Casefinding activities were reported
in over 50 counties throughout the state. Approximately 45,000
persons were given screening tests in these programs during 1968,
with approximately 2100 persons being referred to their family
physicians for diagnosis. The breakdown of relative and

ADULT HEALTH AND CHRONIC DISEASES 47

non-relative screening programs conducted through the various
participating CHD's is shown in Table 26.
Programs in the CHD clinics are especially useful as they screen
not only persons who do not regularly visit their physicians but
also are able to test large numbers of the non-white population.

In 1967, the Diabetes Foundation of Florida leased a large
van-type truck to the Broward County Health Department for use
as a mobile detection center for diabetes. This clinic was operated
by a public health nurse in various parts of the county in 1967 and
1968. A final evaluation of the operation of this program during
the period from March 1967 through December 1968, in terms of
the number of persons referred and the follow-up data are listed in
Table 8. These figures indicate that 2.4 per cent of the persons
tested were referred. Of those persons who were referred, 57.2 per
cent were found to be either new cases of diabetes or old cases
who had stopped going to their physicians but who now are back
under treatment as a result of this program.

Casefinding activities have been primarily in three areas, offices
of private physicians, community diabetes screening programs.
With the availability of monies to provide for the hospitalization
of migrants, casefinding programs among the migrant population
of the state have now become feasible and active. Migrants who
are newly found diabetics may now be hospitalized for regulation
of their condition.
The three methods for determining blood sugar levels currently
being utilized in Florida allow greater flexibility in casefinding and
routine patient care. The speed and ease of the Dextrostix method
make it extremely useful and popular in conducting mass
screening programs. The accuracy of these sticks has been found
to be sufficient for screening for both hyper- and hypoglycemia
conditions within the general population. The Unopette method
involving capillary blood now makes it possible to obtain
sufficient blood for autoanalyzer determinations from persons
who have badly scarred or thrombosed veins without undue
discomfort to these persons. The Vacutainer method of
conducting venous blood sugar evaluations is still the most popular
for determining the degree of control known diabetic patients are
maintaining.
Screening programs for diabetics is one method conducting

48 ANNUAL REPORT, 1968

extensive public education. Large coordinated community
diabetes screening programs were conducted in Florida during
Diabetes Week. Health fairs and special clinics were also held
throughout the year. Postprandial blood sugar determinations, two
hours after a test meal, are stressed as the method of choice.
Relative testing programs are the most productive, and CHD's and
community organizations are encouraged to conduct such
screening programs at regular intervals.

Professional Information
The Florida Diabetes Seminar was held on September 26 and
27, in Miami Beach. The Florida Diabetes Association, the
University of Miami Medical School, the Post-graduate Education
Branch of the University of Florida College of Medicine and the
SBH cooperated in the planning and presentation of this
professional seminar. Over 125 physicians attended this two-day
meeting.
Classes were held for CHD nurses, stressing the importance of
diabetes screening, methods of casefinding and patient education.
The purpose of the classes was to inform the nurses of the latest
techniques of screening and patient education and to review
symptoms, treatment and complications. A manual was prepared
and distributed on conducting screenings using the Dextrostix and
Unopette methods in casefinding programs. This manual was
accepted by the Division of Public Health Nursing, SBH, and was
made a permanent part of its nursing manual.

Public Education
Societies for diabetic laymen are a most important means of
promoting lay and patient educational activities as well as
casefinding. During the past year, the Diabetes Control Program
staff has assisted the Florida Diabetes Association and its local lay
societies in disseminating pertinent information. At the present
time there are 14 societies, for diabetic laymen within the state.
Timely Topics, a monthly bulletin for diabetics, is prepared and
distributed to over 4000 persons per month. These persons are
diabetics, relatives of diabetics, friends of diabetics, or have a
genuine interest in diabetes control. The publication represents an
economical way to get timely information to the diabetics. Copies
are available on request.

ADULT HEALTH AND CHRONIC DISEASES

Patient Education

A number of CHD's are carrying on fine programs involving
patient education. This can be achieved best by a coordinated
program co-sponsored by the CHD, the Division of Nutrition, the
local medical society, and the local society for diabetic laymen.
This approach has been most beneficial to the patients, their
families and physicians. There is a definite need for increased diet
counseling classes utilizing SBH nutritionists by the CHD's. The
standard health pamphlets on diabetes have continued to be quite
popular.

TABLE 8
DIABETES SCREENING PROJECT, BROWARD COUNTY,
MARCH 1967 DECEMBER 1968

SCREENING RESULTS 1967 1968 TOTAL

Screening for Diabetes

Persons screened 4,178 6,121 10,299
Suspects referred
for diagnosis 134 109 243
Per cent suspects referred 3.3 1.8 2.4

Physicians' Diagnosis

New cases 59 37 96
Old cases returned
to treatment 32 11 43
Per cent positive referrals 67.9 44.0 57.2
Not diabetes 31 3 34

Per cent Referrals completed 91.0 46.8 71.2

Referrals not completed

Declined examination 5 7 12
Unable to locate 3 12 15
Others not yet examined 4 39 43

50 ANNUAL REPORT, 1968

HEARING AID PROGRAM
The 1967 Legislature passed Chapter 67-423, converted to
Florida Statutes 468, Part III, entitled, "Fitting and Selling of
Hearing Aids Act." Responsibility for implementation of this Act
was assigned to this bureau.

The law requires all persons engaged in fitting and selling
hearing aids in Florida to register with the SBH and be issued a
Certificate of Registration (license), which is to be renewed
annually. Individuals not engaged in fitting and selling hearing aids
must apply for a Temporary Trainee Certificate and serve a six
months apprenticeship under a registrant before becoming eligible.
All fitters and sellers of hearing aids must pass a qualifying
examination prior to January 1, 1970.

During the first full year in which the law has been in effect, the
main objectives for the program have been to issue certificates of
registration to those eligible; issue temporary trainee certificates to
persons in the trainee program; administer qualifying examinations
as required by law; and investigate complaints filed by hearing aid
dealers and consumers.
This year 394 individuals were issued Certificates of
Registration, and 61 individuals were issued Temporary Trainee
Certificates. During the year, two examinations were given to 263
applicants. The total passing the examination was 235, while 28
failed, a passage rate of 89.3 per cent. Six of the individuals taking
and passing the examination were trainees under a training
program as provided for by the law.

Complaints investigated have been minimal. Most of the
complaints filed were those by hearing aid dealers against other
dealers. A few consumer complaints have been filed, which
indicates that some of the public is aware of the new law.

Goals and objectives for the next year are to continue the
registration and examination of hearing aid dealers and trainees;
for the protection of the public, continue to investigate
complaints pertaining to improper practices; initiate an inspection
program of the business establishment of all individual hearing aid
fitters and sellers; develop an educational program to inform the
public of hearing problems, and what assistance they should seek;
and continue to inform the public about the hearing aid law.

ADULT HEALTH AND CHRONIC DISEASES 51

HEART DISEASE CONTROL PROGRAM
The problem of cardiovascular renal disease covers several
separate and distinct etiological areas. The magnitude of the
problem and the public health approach to each are quite
different.
The leading causes of death from disease of the vascular system
as listed in 1967 Florida Vital Statistics are arteriosclerotic
cardiovascular disease, vascular disease of the central nervous
system, hypertensive cardiovascular renal disease, rheumatic heart
disease, and congenital heart disease. Current statistics indicate
65.4 per cent of all deaths in Florida are caused by some type of
vascular disease.
The greatest community health problem produced by
degenerative vascular disease is that of stroke and myocardial
infarction in people under 65 years of age. Some idea of the
magnitude of the problem may be obtained from the following
tabulation:
TABLE 9
DEATH RATES FROM HEART DISEASE
FOR AGE 64 AND UNDER; AGE 65 AND OVER,
FLORIDA, 1960, 1965 AND 1967

AGE GROUP 1960 1965 1967

Death rate
Under 64 125.0 119.1 116.0

Death rate
Over 65 2069.1 2102.1 2137.7

The next most important community health problem has been
that of rheumatic fever. The great economic advantage of
preventing rheumatic heart disease as compared to expensive
medical and surgical treatment of chronic valve disease has been
recognized and is the basis for the prophylactic treatment program
which has been in operation since 1958. Table 10 shows the
number of deaths from acute rheumatic fever in Florida from
1950 to 1968 and the number of persons receiving prophylactic
drug treatment. Table 11 shows the number of persons receiving
prophylactic drugs by age groups.

52 ANNUAL REPORT, 1968

Congenital heart disease is thought to be the third most serious
health problem. The public health approach has been through the
Florida Crippled Children's Commission which has treated 1651
cases during 1968.
Community Service Programs
A very effective approach to the prevention of cardiovascular
renal disease is that of raising the level of health information in the
population. The Heart Disease Control Program attempts to
acquaint the public with up-to-date information on all categories
of vascular disease. The educational activities of this program are
carried out in cooperation with the CHD's, the Florida Heart
Association and the State Department of Education. Speakers,
audio-visual materials, pamphlets and brochures are provided to all
who participate in this educational program. Professional
education efforts are directed toward short courses for public
health nurses and the Biennial Cardiovascular Seminar for
physicians.
Prevention and Early Detection
The prevention of congenital heart disease requires a much
more complete knowledge of the causative factors than now
exists. The effects of drugs given to a pregnant woman in the first
trimester of pregnancy have been emphasized by the recent
publicity given to the teratogenic effects of thalidomide. Just how
many of the established drugs now on the market are capable of
producing developmental defects under certain conditions is not
known. For this reason, women in the childbearing age who are
susceptible of becoming pregnant are advised to avoid all drugs
except those specifically prescribed.
The earliest detection of congenital heart disease is done by the
pediatrician or the obstetrician. The medically indigent cases of
congenital heart disease are discovered in well baby clinics and also
by preschool examinations.
The prevention of rheumatic heart disease involves the
prevention of acute rheumatic fever. The detection of rheumatic
heart disease is hopefully made by the private physician at the
onset of the acute illness. The SBH offers a free streptococcal
typing service for the identification of the Group A Beta
Hemolytic streptococcus. Penicillin or sulfadiazine is furnished
free of charge by the SBH to certified medically indigent patients
to prevent the recurrence of acute rheumatic fever.

ADULT HEALTH AND CHRONIC DISEASES 53

Prevention of arteriosclerotic disease involves the correction of
numerous metabolic abnormalities and alteration of complex traits
and habits that begin in childhood. Epidemiological studies have
shown that the acute clinical complications, i.e., heart attacks and
strokes, can be favorably influenced by diet, exercise and drugs.
Prevention of these complications on a community-wide basis
demands the identifying of high risk individuals and motivating
them to seek prophylactic guidance from their personal physician.
Efforts to detect advanced atherosclerosis and its complications
have been shown to be related to certain traits and.habits termed
"risk factors." Screening centers have been established in
cooperation with CHD's and local medical societies in Nassau,
Baker and Columbia Counties. Other counties are considering this
service. High risk people are identified by the presence of these
risk factors and referred to their physician for prophylactic
treatment. These screening centers are being established only when
the full participation of the majority of physicians in the county
has been assured.
Treatment
There is no known prophylactic treatment for congenital heart
disease at this time. Patients with congenital heart disease are
diagnosed and given appropriate surgical treatment through the
Florida Crippled Children's Commission. There were 1287 children
examined in cardiac diagnostic centers in 1968 and 162 of these
were given necessary surgical treatment. A total of 1651 patients
with cardiac defects was cared for by this agency and 1300 of these
were referrals from CHD's.
Prophylactic treatment to prevent secondary attacks of acute
rheumatic fever is carried out under the supervision of personal
physicians. A total of 1266 medically indigent patients received
free penicillin or sulfadiazine furnished by the SBH.
The treatment of patients discovered in risk factor screening
centers is done by the person's private physician. The elimination
of categorical funds has caused the closing of some cardiac clinics
for the indigent and these patients are now seen in general
treatment clinics.
SPECIAL PROJECTS
Jefferson County Multiphasic Screening Program
This pilot project was initiated in 1963 by this bureau in an
effort to prove the case for health profile screening. The

54 ANNUAL REPORT, 1968

acceptance and endorsement of the program by the general public
and the local physicians is noted in the fact that the Jefferson
County health officer has requested the program be continued
each year since its initiation.
Since its inception, the program has provided screening
examinations to 3975 individuals in Jefferson County. During
1968, 510 persons were screened for a total of 8275 separate tests
which produced 1197 test results outside normal limits. The
general success of this program has actually provided the bureau
with a basis for establishing cardiovascular screening clinics in
other counties.
Cardiovascular Screening Programs
Two counties are now actively engaged in cardiovascular
screening programs. These screening programs are operated by
volunteer workers under the supervision and direction of the CHD.
The screening tests involved are a medical history, height and
weight, blood pressure and pulse rate, an electrocardiogram, and
lab analysis of blood samples.
The Heart Disease Control Program provides orientation and
training sessions for workers who staff these clinics and
consultation is available on request. The laboratory does the blood
analyses and the director of the Heart Disease Control Program
interprets the EKG tracings. The reaction of local physicians to
the establishment of such screening programs in their area has
been quite favorable.
Hypertension Control
The recent cooperative clinical study done by the Veterans
Administration has proven so conclusively the value of controlling
arterial hypertension in the prevention of stroke, heart attacks and
malignant hypertensive renal disease, the SBH has initiated a study
to explore the public health methods of attacking this problem on
a community-wide basis. The project is funded through a grant
from the RMP and is being tried in Holmes, Walton and
Washington Counties.
The project was approved by a local RMP committee including
the county medical societies, civic clubs, county health officer,
nursing association and the county commissioners.

ADULT HEALTH AND CHRONIC DISEASES 55

Coronary Care Units

The Florida Heart Association, in cooperation with the SBH, is
attempting to develop a computerized bookkeeping system to
handle clinical data from coronary care units over the state.

The objectives of this program are: to furnish a standard data
form for recording clinical information; to provide clinicians with
tabulations of clinical data as they request it; and to serve as a
medium of self-evaluation and continued education for those
responsible for the operation of coronary and intensive care units.

TABLE 10

DEATHS FROM ACUTE RHEUMATIC FEVER
AND CHRONIC RHEUMATIC HEART DISEASE
AND PERSONS RECEIVING PROPHYLACTIC
PENICILLIN AND SULFADIAZINE
THROUGH THE STATE BOARD OF HEALTH,
FLORIDA, 1950- 1968

NUMBER OF DEATHS
Persons receiving
YEAR prophylactic drugs
Acute Rheumatic Chronic Rheumatic for prevention
Fever Heart Disease of secondary
attacks

1950 26 327
1951 13 313
1952 27 337
1953 19 373
1954 15 491
1955 23 332
1956 18 408
1957 11 411
1958 15 481 98
1959 28 448 112
1960 9 502 125
1961 9 461 130
1962 15 460 250
1963 14 456 370
1964 14 479 508
1965 12 467 701
1966 12 483 1211
1967 12 475 1253
1968* 8 589 1266

*I.D.D.A. Changes in 1968 affects comparability with previous years.

56 ANNUAL REPORT, 1968

TABLE 11

ACUTE RHEUMATIC FEVER PATIENTS RECEIVING PROPHYLACTIC THERAPY
TO PREVENT SECONDARY ATTACKS, BY AGE,
FLORIDA STATE BOARD OF HEALTH, 1966-1968

AGE GROUP 1966 1967 1968

0-4 11 13 16
5-14 576 572 561
15-24 390 421 435
25-34 91 97 99
35-44 67 74 77
45-54 46 46 47
55-64 23 24 26
65-74 6 5 4
75-84 1 1 1
85+ 0 0 0

TOTALS 1211 1253 1266

PREVENTION OF BLINDNESS

The cooperative agreement with the USPHS terminated June
30. Under this agreement five glaucoma screening centers were
established. These are located in Broward, Duval, Pinellas, Polk
and Volusia Counties. These screening centers are continuing their
operation under funds appropriated by the CHD's and community
resources. The response has been excellent from residents of these
five populous counties. Six full time nurses, trained in the
principles and practice of tonometry, perform the actual screening
examination under the supervision and direction of local
ophthalmologists.
During 1968, 47,320 persons were screened bringing the six
year total to 197,037. Of this yearly total 2.28 per cent were
referred for diagnostic evaluation.

ADULT HEALTH AND CHRONIC DISEASES

Summary (April, 1962 December, 1968)
1. Total screened, all ages . . . .
2. Number referred to ophthalmologists for diagnosis
3. New cases diagnosed glaucoma ...........
4. Cases diagnosed borderline ..............
5. Diagnosed negative for glaucoma ..........
6. Suspects being followed ..............
7. Lost to follow-up:
a. cannot locate ....................
b. uncooperative ...................
c. illness or deceased .................
8. Number persons not able to read 20/40 . .

TABLE 12

GLAUCOMA SCREENING PROGRAM
FLORIDA, 1968

197,037
5,308
2,325
542
1,758
479

56
124
24
27,167

Persons Persons Per cent
County and Age Examined Referred Referred

TOTAL ..... 47,320 1077 2.28

COUNTY
Broward . 6979 165 2.36
Duval ...... 16,043 381 2.37
Pinellas . 9204 258 2.80
Polk ....... 9918 202 2.04
Volusia. 5176 71 1.37

AGE
Under 35 .... 6415 63 .98
35-44 ...... 7114 94 1.27
45-54 ...... 8716 185 2.12
55-64 ...... 9687 237 2.45
65-74 ...... 11,490 368 3.20
75-84 ...... 3657 124 3.39
84+ ....... 241 6 2.49

58 ANNUAL REPORT, 1968

The Seminole CHD initiated a glaucoma screening program in
October, 1965. A total of 1988 persons have been screened since
the program began and 44 (2.21 per cent) persons were diagnosed
positive glaucoma by their medical eye doctors.
The screening procedure for glaucoma is.easily performed and
inexpensive. The treatment usually halts further disability. Many
other eye diseases will also be detected and referred for corrective
treatment.
School Visual Screening
The Prevention of Blindness Program has provided a consultant
to the Comprehensive Child Care Project of the Department of
Pediatrics, University of Miami (in cooperation with the Dade
County Department of Public Health and the Children's Bureau of
the U.S. Department of Health, Education and Welfare). A special
pilot project was conducted in 1967 1968, during which time
9150 school-age children were screened for visual defects and
other ocular abnormalities. Over 2000 children were referred for
further evaluation. The facilities of the Bascom Palmer Eye
Institute were made available for referral examination and
follow-up; 1200 children were examined in this facility. In
addition, some 300 referrals have been seen by private eye
specialists. The facilities of the Computing Center of the
University of Miami are being utilized in a detailed analysis of the
accrued data and a report of epidemiologic relevance is anticipated
in early 1969.

NEW PROJECTS
Blood-relative Glaucoma Project
A contract proposal has been submitted to the USPHS Regional
Office. The project is entitled "A Survey of Blood Relatives of
Glaucoma Patients," and will include participation of screening
centers in Polk, Volusia, Broward and Pinellas Counties. The
objectives of this program are to identify and screen relatives of
known glaucoma cases, and to establish the incidence of chronic
glaucoma in the family members.
An Additional County Glaucoma Screening Center
Preliminary proceedings are now underway to investigate the
establishment of a sixth glaucoma screening center, to be located
in a CHD in South Florida.

ADULT HEALTH AND CHRONIC DISEASES 59

SMOKING AND HEALTH
The single most important health measure available today for
the prevention of disease and premature death in Florida and in
the United States is the elimination of cigarette smoking.
An educational program has been outlined by the Florida
Committee on Smoking and Health to inform citizens of the
effects of cigarette smoking to health, to influence persons not to
start, and to encourage discontinuance by those now smoking. The
bureau houses the staff and continues to lend support and
direction to the committee whose members are: Florida Medical
Association; Florida Heart Association; American Cancer Society,
Florida Division; Florida Tuberculosis and Respiratory Diseases
Association; the State Department of Education and SBH.
The committee serves in an advisory capacity and furnishes
consultant services when requested. It does not in any way try to
supersede existing programs or active joint committees or to
duplicate work being done by other groups.
Smoking and Health cuts across all agency programs, thereby
making it an ideal project for community action. Some 22
countywide committees have been established with other counties
conducting some type of program through their school, CHD or
civic organizations.
The local councils have had many programs, such as Smoking
and Health teacher and youth conferences, school assembly
programs, fair exhibits, adult informational programs,
establishment of reference files in community and school libraries,
programs over educational television, and preparation or
distribution of spot announcements to commercial broadcast
stations. Councils have encouraged dentists, physicians, hospitals
and CHD's to permit no smoking in patient waiting or clinic areas
and have provided signs free to those participating. These
interagency councils are most effective and by giving continued
support and effort to the smoking problem have greatly assisted in
the total educational effort.
The Florida Committee has assisted in the coordination of the
State P-TA Smoking and Health Project and in P-TA Leadership
Conferences. The committee has exhibited at various state
meetings, worked with health coordinators and at youth
conferences. Continued support of new school accreditation

60 ANNUAL REPORT, 1968

standards has resulted in a required semester of health education
at junior high and a semester at senior high level. The Fifth and
Sixth Grade Teacher's Guide on Smoking and Health and other
materials have been mailed to each school.
A major program for the year has been the planning and hosting
of a Tri-Regional Conference on Smoking and Health. Some 150
persons from 35 various states participated in an
informational-motivational working conference. The
knowledgeable faculty and the exchange of ideas among leaders in
Smoking and Health activities from throughout the nation resulted
in a most outstanding and profitable conference.
The Florida Committee is looking to the future in hopes of
providing more information through local committees to more
people who desire to know of the harmful effects of smoking. The
providing of guidance to those who wish to stop smoking and
service to those communities capable of conducting their own
programs are aspirations of the state committee.

BUREAU OF DENTAL HEALTH

DELMAR R. MILLER, D.D.S., M.P.H.
Director (to July)

DERL G. STALLARD, D.M.D.
Acting Director (from July)
The function of the bureau is to promote improvement in
dental health for all citizens of the state by carrying on programs
designed to increase dissemination of dental health educational
information and utilization of preventive and corrective dental
services. Consultation on each of these areas is provided to county
health departments (CHD), county school systems, colleges,
universities, dental organizations, civic groups, community action
groups, parent-teacher organizations and to other bureaus and
divisions.
DENTAL PRECEPTORSHIP PROGRAM
In 1957, the State Board of Health (SBH) in cooperation with
the Florida Dental Association and Florida State Board of
Dentistry established the dental preceptorship program whereby
recent dental graduates, upon the approval of the dental board and
its issuing a dental permit, could practice in public health clinics
for a period of one year. The "preceptee" dentists would be
jointly supervised by this bureau, a committee of local dentists
and the director of the CHD in which they were employed.
During the year, dental preceptees served in the following
counties: Alachua, Broward, Charlotte, Collier, Dade, DeSoto,
Duval, Hardee, Lake, Lee, Manatee, Marion, Palm Beach, Polk,
Sarasota, Seminole and Volusia. In addition, a dental preceptee
was utilized in the Jacksonville City Health Department.
The future of the program is presently in question since the
Florida State Board of Dentistry has elected to discontinue it. This
program which served the state for over 10 years from the days
when many dental clinics were standing idle due to lack of dentists
- now faces the possibility of returning to those days.
DENTAL SCHOLARSHIP PROGRAM
The Dental Scholarship Law, as amended in 1967, provides for
only five dental scholarships each year with an annual stipend of

62 ANNUAL REPORT, 1968

$2000 for up to four years. Each recipient of a dental scholarship
is required to practice in an "area of need" designated by the SBH
one year for each year of scholarship received, or participate in the
state's public health dental program on the same basis.
A total of 130 scholarships have been awarded since the
beginning of the program in 1955, five of which were declined
prior to utilization. During the year, 31 scholarship students were
attending 11 dental schools. Of these, nine graduated during the
year and one discontinued use of scholarship funds.

Disposition of scholarship graduates to date:

Completed compensatory practice . ... 28
Serving in "areas of need" . . ... 13
Repaid in full ...................... 31
Repaying stipend ................... 4
In military service ................... 8
Florida licensed obligated to repay . . 4
Obligated to repay not qualified
for Florida licensure . . ..... 6
TOTAL ................ 94
DENTAL CLINICS
Counties served by full-time licensed public health dentists were
Brevard, Dade, Duval, Escambia, Highlands, Glades, Hendry,
Hillsborough, Jackson, Liberty, Orange, Palm Beach, St. Johns,
Santa Rosa, Sarasota, Seminole and Pinellas.
One of the two mobile dental clinics maintained by the bureau
to serve eligible school children in areas having few or no
practicing dentists was staffed for approximately three months
during 1968. More than 325 patient visits were made to this
mobile clinic, Treatment included 176 extractions, 199 fillings and
13 prophylaxes.
Since it has become increasingly difficult in recent years to
attract qualified dentists to operate the mobile dental clinics, the
decision was made to assign the equipment in these clinics to
CHDs where it could be used more effectively.
ORAL CANCER DIAGNOSIS PROJECT
This program was initiated in 1964, with grant support from the
U.S. Public Health Service. Because it has continued to receive

DENTAL HEALTH 63

increasing support and participation by the dental profession, the
supporting grant was extended beyond the original three-year
period to July, 1968.
During the year, 233 biopsies and 150 smeas were submitted
for examination. Eight of the biopsies and four of the smears
submitted were diagnosed as positive for cancer. Dentists continue
to use the oral cytology smear technique even though the program
under the grant has been discontinued.

LACTOBACILLUS PROGRAM
In 1968, dentists throughout the state continued to use the
state laboratories for analyzing saliva specimen to determine the
caries susceptibility index of patients. There were 2097
lactobacillus kits requested by participating dentists. The
laboratory analyzed 1442 specimen. This program has been in
operation since 1955 and is a joint endeavor between this bureau
and the Bureau of Laboratories.

CONSULTATION SERVICE
Although the bureau staff was decreased during the past year,
the staff members, including the dental hygienist, health educator,
and two dentists had a full schedule of field visits.
As in previous years, the dental hygienist continued to conduct
dental health programs in various elementary schools and a
number. of day-care centers throughout the state. In each of these
programs, a lecture on proper dental hygiene procedures and diet
were presented, along with toothbrushing demonstrations and the
showing of a dental health film.
Although most of the programs were conducted for the
elementary grades, some were presented to the junior and high
school age groups. In these instances, not only proper dental
hygiene, but the many dental career opportunities were discussed.
The dental hygienist assisted the dental director in making dental
inspections of approximately 2500 elementary school children in
several counties.
The health educator continued to provide consultative services
to CHDs, county school systems, universities, colleges, dental
organizations, civic groups, and PTAs, in an effort to promote
dental health education.

64 ANNUAL REPORT, 1968

Preschool workshop consultation was given in 14 counties at
the request of the Florida State Department of Education. Also,
in-service programs for public health nurses were conducted in two
counties.
Continued efforts in the recruitment of future dental personnel
was made by participation in a number of career day programs.
Both the health educator and dental hygienist served as
representatives of the SBH in the annual Health Project in Teacher
Education at the University of Florida and Bethune-Cookman
University.

BUREAU OF ENTOMOLOGY

J.A. MULRENNAN, B.S.A.
Director

The major activities of this bureau are administration of the
state aid arthropod control program involving 58 counties and
mosquito districts; supervision of the Entomological Research
Center in Vero Beach, West Florida Arthropod Research
Laboratory in Panama City, and Midge Research Laboratory in
Winter Haven; operation of the arthropod identification
laboratory in Jacksonville; administration of the Pest Control Act,
including enforcement of its provisions; operation of an
encephalitis surveillance program; and technical supervision of the
federally financed and supervised Aedes aegypti Eradication
Project in Florida until late October, 1968 when the program was
phased out.
The A. aegypti Eradication Project was discontinued because
Congress had to make drastic reductions in expenditures before the
President's requested 10 per cent surtax on income taxes could be
enacted. The objective of the program had been attained in 20
counties, and work was in progress in other counties. State
contract funds expended through the phasing out period in
calendar year 1968 amounted to $2,397,448; federal funds of
approximately $1,283,000 provided personnel services, rental of
equipment, travel, supplies and insecticide. Total funds through
this period amounted to about $3,680,448.

ARTHROPOD CONTROL
General
As of October 1, 1968, the city limits of Jacksonville were
expanded to include practically all of Duval County. Among the
many changes made by law was the abolishment of the Northeast
Duval County and the East Duval County Mosquito Control
Districts. These districts and the City of Jacksonville mosquito
control program were amalgamated into one unit, which is now
called Jacksonville Mosquito Control. Responsibility for
supervision and direction was vested in Edward R. Smith, M.D.,
chief, Public Health Division, City of Jacksonville.

66 ANNUAL REPORT, 1968

The consolidation of these districts decreased the number of
counties and mosquito districts participating in the state aid
program from 58 to 57 on October 1, 1968. The total amount of
local funds budgeted for the fiscal year ending September 30,
1969 was $7,225,658, an increase of $676,973 over the previous
fiscal year. The total reported local fund expenditures for the
fiscal year ending September 30, 1968 were $6,161,284, and state
fund expenditures were $1,717,830, a total of $7,879,114. The
state matching rate was 14.50 per cent for State II funds.
On July 1, 1968 the budget commission released the three
per cent which had been withheld from all state budgets, so that
the full $1,650,000 was made available to counties and districts in
fiscal year 1967 1968.

Counties Participating and Local Fund Budgets

Counties participating in the State Arthropod Control
program in 1968 and the amounts of local funds budgeted by
these counties and/or districts for the fiscal year October 1, 1968
through September 30, 1969 follow:

COUNTY LOCAL COUNTY LOCAL
FUNDS* FUNDS*

Alachua $ 37,056 Brevard $459,916
Bay (Comm.) 125,600 Broward 130,438
Bay (Gulf) 63,938 Charlotte 116,199
Bradford 18,863 Citrus 145,314
Collier 310,966 Manatee 162,005
Columbia 15,500 Marion 42,200
Dade 276,292 Martin 55,914
(Duval) Jax. 492,526 Monroe 337,842
Escambia 178,580 Nassau 63,700
Flagler 17,150 Okaloosa 52,869
Franklin 15,000 Indian River 155,349
Gadsden 17,460 Jackson 4,847
Gulf 57,500 Jefferson 10,478
Hardee 4,000 Lake 118,000
Hendry 7,999 Lee (District) 674,104
Hernando 37,047 Lee (Beach) 95,226
Highlands 4,829 Leon 75,779
Hillsborough 415,162 Levy 20,000
Holmes 4,925 Madison 550

ENTOMOLOGY

Counties Participating and Local Budgets (Continued)

COUNTY LOCAL COUNTY LOCAL
FUNDS* FUNDS*
Orange 218,861 Suwannee 23,000
Osceola 56,400 Taylor 21,600
Palm Beach 351,836 Volusia 390,954
Pasco (West) 107,926 Wakulla 21,000
Pinellas 365,384 Walton 8,700
Polk 314,627 Walton (South) 28,258
Putnam 35,300 Washington 2,700
St. Johns 101,591
St. Lucie 150,104 TOTAL $7,225,658
Santa Rosa 69,000
Sarasota 98,934
Seminole 38,360

*Net amount budgeted.

Total Local Funds Budgeted .
Total State Funds Appropriated

. . . $7,225,658
........... 1,650,000**

TOTAL FUNDS FOR ARTHROPOD CONTROL $8,875,658

**Based on the anticipated appropriation.

Source Reduction Accomplishments
Diking Volusia and Brevard Counties are the only counties
constructing any substantial amount of new dikes. Work in Indian
River, St. Lucie, and Martin Counties has been principally
maintenance of existing dikes.
The work in the Tomoka Marsh in Volusia County is about
90 per cent complete. Water control structures are planned for
installation in fiscal year 1968 1969.

Diking

1967

Number of counties participating . .
Miles of dikes constructed or rebuilt .
Cubic yards earth placed in dikes . .
Total field cost . . . .
Field cost per cubic yard . . .

5
52.42
956,566
$86,600
$ 0.091

1968

5
31.38
671,206
$67,740
$ 0.101

68 ANNUAL REPORT, 1968

Machine Ditching and Maintenance The construction of
new ditches continues to decrease, as the point has been reached
in several counties where maintenance of ditches previously
constructed requires all available heavy equipment. In many
counties operating sanitary landfills, the dragline time is used
almost entirely on landfill operations and ditch maintenance.
Funds generally are not available to purchase all of the heavy
equipment needed in a county or district.

Machine Ditching and Maintenance 1967 1968

Number of counties participating .. 37 38
Miles of ditches dug or maintained . 446.61 410.93
Cubic yards earth excavated . ... 3,794,626 3,178,814
Total field cost .. . . ... $625,185 $580,940
Field cost per cubic yard . ... $ 0.165 $ 0.183

Grading, Deepening and Filling Heavy equipment is used to
alter the topography of mosquito breeding areas through filling, or
deepening and filling, when drainage is not feasible. Volusia
County continues to have numerous areas where this type of
control is used. A lesser amount is done in some other counties.

Grading, Deepening, and Filling 1967 1968

Number of counties participating . 2 1
Acres mosquito breeding area improved 74.48 37.64
Average field cost per acre . ... $114.51 $180.46

Sanitary Landfills The amount of garbage and rubbish to
be disposed of continues to increase, requiring more landfills and
expenditures of the county's or district's funds for this purpose.
On July 1, 1968, the federally-financed composting plant
constructed in Gainesville began accepting all garbage generated in
Gainesville and its suburbs. Alachua County discontinued
operating a sanitary landfill for the city of Gainesville as of this
date, and the city purchased the landfill tractor from the county
for $20,000. During the remainder of the year the tractor was
used frequently to bury material which could not be composted,
as well as some composted material which could not be otherwise
disposed of.

ENTOMOLOGY 69

The following is a summary of sanitary landfill operations by
counties and districts that are participating in the state aid
program:

Sanitary Landfills 1967 1968

Number of counties operating landfills 41 40
Total number of landfill sites operated 175 179
Total field costs in all counties . $864,028 $1,001,961
Cubic yards of garbage buried ...... .8,576,457 9,879,378
Field cost per cubic yard . ... $ 0.101 $ 0.101

Temporary Control Measures
Temporary control measures are the application of
insecticides or related chemicals for temporarily controlling
arthropods in the larval and adult stages. Thermal aerosol fogs are
applied by both ground equipment and fixed wing aircraft, and
wet sprays or ultra low volume mists are applied by aircraft for the
control of adult mosquitoes and midges.
Fuel oil mixed with a spreading agent and/or Paris green
granules are used in larviciding for the control of mosquitoes in
the larval stage.
Dade, Broward, Palm Beach, East Duval, Indian River, and
Pinellas Counties performed mosquito control work by contract
aircraft in 1968. Brevard, Volusia, Northeast Duval, Polk,
Hillsborough, Lee, Collier, Monroe, and Osceola Counties carried
out their aircraft control work with their own airplanes and
helicopters.
Volusia County purchased a Bell helicopter to replace the
one destroyed in 1967. Northeast Duval owns and operates a
Hughes helicopter. Brevard, Lee, and Monroe Counties use
helicopters obtained by leasing.
The following is a summary of temporary control work
accomplished during the year by counties and mosquito control
districts:

70 ANNUAL REPORT, 1968

Adulticiding Ground Fogging

Number of counties participating ....
Number of hours fog machines operated
Number of miles fogged ..........
Gallons of insecticidal formulation used
Total field cost ...............
Average cost per mile for fogging ....

1967 1968

S 53 53
S 48,363 44,770
. 324,912 305,429
. 2,538,641 2,478,454
.$1,176,602 $1,144,275
S $3.62 $3.75

Adulticiding with Aircraft

Fogging with malathion

1968

Number of counties participating .........
Gallons of malathion formulation applied as fog
Pounds of (actual) malathion in formulations .
Number of acres fogged . . . .
Average application rate (lbs. malathion per acre)

Spraying with malathion

Number of counties participating . . .
Gallons of malathion formulation sprayed . .
Pounds of malathion in formulations . . .
Number of acres sprayed . . . . .
Average application rate (lbs. malathion per acre) ..

Fogging with naled (Dibrom 14)

Number of counties participating ............
Gallons of naled formulation applied as fog ......
Pounds of naled in formulations ............
Number of acres sprayed .................
Average application rate (lbs. naled per acre) .....

5
. 145,182
. 152,570
.. 1,231,083
0.1239

1968

2
43,555
13,362
75,036
0.1781

1968

2
63,944
12,270
118,865
0.1032

ENTOMOLOGY 71

Spraying with naled (Dibrom 14)

Number of counties participating . . .
Gallons of naled formulation sprayed . . .
Pounds of naled in formulations . . .
Number of acres sprayed . . . . .
Average application rate (lbs. naled per acre) .....

Ultra Low Volume Misting with naled (Dibrom 14)

Number of counties participating . . .
Gallons of Dibrom (85% naled) applied . . .
Pounds of naled applied . . . . .
Number of acres treated . . . . .
Average application rate (lbs. naled per acre) .....

Fogging with Baytex

Number of counties participating ..........
Gallons of Baytex formulation applied as fog .....
Pounds of active ingredient in formulations ......
Number of acres fogged ................
Average application rate (lbs. A.1. per acre) ......

Spraying with BHC (1.0 lb. gamma/gal.)

1968

5
67,940
14,435
118,865
0.1214

1968

5
345
4,106
73,328
0.0560

1968

3
73,509
16,008
574,514
0.0278

1968

Number of counties participating . . .
Gallons of BHC formulation sprayed . . .
Pounds of BHC gamma in formulations .......
Number of acres sprayed ................
Average application rate (lbs. BHC gamma per acre)

1
20,012
3,302
10,006
0.330

Larviciding with Aircraft 1968
Spraying with diesel oil containing spreader
Number of counties participating ............ 5
Gallons of Diesel oil sprayed ............... 81,539
Number of acres sprayed .................. 9,454
Average application rate (gals. per acre) ........ 8.62

72 ANNUAL REPORT, 1968

Larviciding with Paris green granules 1968
Number of counties participating . . 9
Pounds of Paris green granules applied ...... ..1,143,121
Pounds of technical grade Paris green in granules 76,401
Number of acres treated . . . ... 72,054
Average application rate (lbs. Paris green per acre) 1.060

Dog Fly Control
This type of control work is limited to the counties west of
Wakulla County that border on the Gulf of Mexico and its
embayments. The participating counties are Franklin, Gulf, Bay,
Walton, Okaloosa, Santa Rosa, and Escambia. Control consists in
spraying the green and decaying marine grass deposits that are
stranded on the bay shoreline with DDT at approximately
two-week intervals during the summer and early fall months.
Despite intensive inspection and control work, almost every year
there have been one or two localized and unexplainable outbreaks
of dog flies along the beaches. The research staff of the West
Florida Research Laboratory in 1968 located heretofore unknown
breeding areas in inland lakes in Bay and Gulf Counties. These
lakes, no doubt, contributed substantially to the outbreaks.
Control procedures were immediately instigated in these areas.

The following is a summary, of the dog fly control work
performed by the seven counties:

1967 1968
Total miles of shoreline treated . ... 1,487 1,288
Number of man-hours for inspection
& treatment .................... 9,727 6,616
Gallons of 35% DDT concentrate used . 6,084 2,050
Average labor cost per mile . . ... $10.03 $ 9.11
Engineering
The engineering section received and checked for accuracy
approximately 200 reports each month from the counties and
mosquito districts and analyzed the county's or district's activities
based on their reports. These reports were subsequently tabulated
into a statewide total by particular activities.
Assistance was given counties and districts in the preparation

ENTOMOLOGY 73

of work plans and budgets; review and approval of same;
preparation of specifications for purchase of equipment; review of
program application in the field; inspection of areas proposed for
permanent control measures; and approval of plans. Field
investigations of proposed sites for large scale landfill operations
were made in Pinellas and Palm Beach Counties, and the locations
subsequently approved.

REGIONAL ENTOMOLOGISTS
Five regional entomologists are stationed throughout the
state and assist counties and mosquito districts within their
respective areas in all phases of their program application and
administration. A considerable portion of each entomologist's
time, with the exception of the northeast Florida area, is devoted
to enforcement of the Pest Control law.
The entomologist stationed in Orlando for many years was
replaced, and the regional office moved to Winter Haven. This
change in personnel caused some loss of accomplishments
temporarily, but resulted in more work being done as the successor
became more familiar with his territory and job requirements.

ARTHROPOD IDENTIFICATION LABORATORY
The laboratory identified 390,925 adult mosquitoes,
captured in light traps run twice weekly at 94 locations
throughout the state. "The Florida Salt Marsh Mosquitogram,"
showing the number of female salt marsh mosquitoes caught in 43
light traps located in 29 coastal counties, was prepared and mailed
each week to mosquito districts and other interested persons.
In the continuing program of encephalitis surveillance, the
laboratory identified 94,706 live mosquitoes from over 800
collections, placing them in 1439 pools to be tested for virus
isolations by the State Board of Health virus laboratory in
Jacksonville. This surveillance study yields useful information on
the prevalence and the seasonal and geographical distributions of
the different viruses and their host mosquitoes. Only 534 of the
1439 pools had been tested by the end of the year, yielding a
single positive: Shark River virus from Culex (Melaniconian) spp.
collected in Dade County, east of Black Creek Canal. Table 13
shows the revised results of virus isolations from 1967 collections.

TABLE 13
ARTHROPOD-BORNE VIRUS ISOLATIONS
FROM MOSQUITOES, FLORIDA
JANUARY 1, 1967 THROUGH DECEMBER 31, 1967*

COUNTIES WITH VIRUS ISOLATIONS

POSITIVE MOSQUITO SPECIES
0 0
= l O-i

An. crucians ........................1(B) 1(B) 2(B) 2(B) 6

M. perturbans .......... ... .. ... 1(E) 1

A. atlanticus ................... ..... 1(C) 1(B) 1(C) 4
1(E)

A. taeniorhynchus ..................... 1(C) 1

Cs. melanura .............. .. ....... 1(E) 1(E) 1(HP) 1 (E) 6
1(W) 1(HP)

P.ferox ................ .......... 1(C) 1

Total positive pools ................... 2 1 1 6 1 1 2 1 2 1 1 19

Total pools tested: 1077

Letters designate type of positive pool:
B = Bunyamwera Group (7 positives)
C = California Group (4 positives)
E = Eastern Encephalitis (5 positives)
H = Hart Park virus (2 positives)
W = Western Encephalitis (1 positive)

*Because there was only one isolation in 1968 (see page 73), no table for that year will be published.

ENTOMOLOGY 75

These are included, because testing was not complete at the time
the 1967 annual report was prepared.
In addition, the laboratory identified approximately 25
different insects for county health departments, pest control
operators, and private citizens.

MIDGE STUDIES
A study of the chironomid fauna of the state was continued
under a National Institutes of Health grant during 1968.
Twenty-two collections containing over 2100 live midge larvae
were brought into the laboratory from streams and lakes in 12
counties. From these collections 566 adults were reared, yielding
new information on the life history and ecology of each species.
One paper was published with the support of this grant, and a
second paper, dealing with the nuisance species of chironomids in
Florida, will appear early in 1969.
Over 100 adult chironomid midges were also identified to
species for the mosquito control districts and for the Midge
Research Station at Winter Haven.

PEST CONTROL
For the 21st consecutive year the bureau carried out its
responsibility of service to the public and the commercial pest
control industry, as defined under the Pest Control Act, Chapter
482 Florida Statutes, and regulations, Chapter 1401-2 FAC.
Two entomologists working on a state-wide basis and assisted
by the regional entomologists stationed in Miami, Tampa, Winter
Haven, and Panama City investigated complaints of 116
homeowners pertaining to pest control companies or individuals.
Continuous checking on persons or companies engaged in pest
control activities is one of the many services performed for the
protection of the citizens and also the licensed pest control
operators. Forty-five unlicensed pest control operators were found,
and 14 warrants for arrest were filed. Twenty-one letters of
warning were issued to unlicensed operators, resulting in either a
license being obtained, discontinuing pest control operations, or
subsequently arrests for violation of the law.
Over 800 licenses and over 5100 employee identification
cards were issued to the pest control industry. Total fees collected

76 ANNUAL REPORT, 1968

TABLE 14
SUMMARY OF PEST CONTROL
REGISTRATION AND ENFORCEMENT
FLORIDA, 1964-68

REGISTRATION

1964

1965

1966

1967

State Board of Health Licenses issued 329 338 876** 835**
State Board of Health Change
of Address Licenses issued . .... 44 41 31 58
State Board of Health Licenses revoked* 1 0 0 4
State Board of Health Licenses
placed on probation* . . .... .. 3 2 2 1
Pest Control Certificates revoked,
suspended or placed on probation* ..... 3 2 9 6
Employees' Identification Cards issued 3,588 3,910 4,968** 4,904**
Employees' Change of Address
Identification Cards issued . ... 237 283 179 180
Employees' Identification Cards
revoked or stopped* . . ... 10 12 3 98
Employees' Identification Cards
on probation* . . . ..... .. 2 2 1 29
Thermal-Aerosol Certificates
of Authorization renewed* . . 6 5 4 3

ENFORCEMENT

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

*By Pest Control Commission of Florida.
**Revised from 1966 and 1967 annual reports.

Licenses, identification cards and thermal-aerosol
certificates issued are based on 1967-68 licensing year.
All other entries are based on calendar year 1968.

1968

802

53
3

3

10
5,104

160

19

16

4

116

45

14

21

36,412

184

r 1 1

ENTOMOLOGY 77

for deposit in the state general revenue fund for the licensing year
was $27,089. This compares with $26,166 for the previous year.
The Pest Control Commission recorded 1049 certificates in
force and good standing and issued 36 new certificates in 1968.
ENTOMOLOGICAL RESEARCH CENTER
The mission of this institution is to investigate the biology and
vectoring characteristics of mosquitoes and other biting flies.
Nevertheless, this mission is unique enough that investigators and
operators in the control of mosquito-borne diseases from all over
the world visit the center as a depository of the most advanced
knowledge in the biology of medically important insects. In 1968
there was an unusually large number of visitors, and more than
ever, they came for prolonged stays and in sizable groups, such as
those organized by the World Health Organization. Also in 1968
the director had an opportunity to visit several of the
better-known European centers of research in medical
entomology, in connection with a trip to attend the 13th
International Congress of Entomology in Moscow, assisted by a
travel grant from the Entomological Society of America. It was
reassuring to learn that in these laboratories, the work going on in
Vero Beach was indeed well known and appreciated.
In recent years, research has been organized into eight major
projects. These were described and elaborated upon in the Annual
Reports for 1966 and 1967. They are all long-term studies, where
truly notable advances cannot be expected consistently on a
year-to-year basis. The following accounts will, therefore, be
briefer than those of the past two years, which may be referred to
for background.
PROJECT I: BITING CHARACTERISTICS
A histological technique for determining the presence of
multiple blood meals was further developed and the collection of
wild Culex nigripalpus for sectioning and evaluation was started.
The capacity of this mosquito to immediately refeed, if repeatedly
interrupted while in the act of probing or feeding, was
investigated. Individuals having more than one-half of a complete
blood meal were still persistent in their attempt to refeed under
conditions where they were confined near the host. The problem
of multiple feeding by mosquitoes is important to the
epidemiology of mosquito-borne disease, since vectoring capacity

78 ANNUAL REPORT, 1968

is necessarily proportional to numbers of hosts bitten by the same
mosquito.
The second phase of this project was initiated this year, viz.
studies of interactions between certain mosquito species and
potential blood hosts in large mosquito-proof aviaries. A pilot,
pre-fabricated, sectional aviary was designed and built, and
preliminary work has already proved the feasibility of such
studies. Thus a pioneering investigation showed that different
heron species react differently to mosquito attack, apparently
with direct influence on the success of the mosquitoes trying to
obtain a blood meal.
PROJECT 2: POPULATION DYNAMICS
In 1968 the voluminous data from a three-year study of the
relationship of mosquito sampling methods to the age and
physiological state of the mosquitoes were completed and
prepared for analysis. The latter was begun by the Department of
Statistics and the Computer Center at the University of Florida,
under supplementary support from the National Institutes of
Health.
During 1968, the leased Neville swamp was prepared for studies
of flight pathways in Culiseta melanura and Culex nigripalpus (and
other spp.), and the investigation itself was begun. The edges of
the swamp were sharply defined by clearing, and over 1200 feet of
boardwalks were installed to give easy access into the swamp
without disturbing it. Weather stations were established inside and
outside the dense swamp. Twenty-five suction traps, each powered
by 24-inch fans, were installed. Forty large container-grown shrubs
(for mobility in experimental design) were prepared. A 50-foot
trailer, with electricity and water, serves as a field laboratory, close
to the swamp. Preliminary review of one year's data revealed no
evidence that the edge of the swamp acted as a barrier to flight for
either swamp or outside breeders. Studies with mobile shrubs are
already giving clues to distinct flight pathways.
PROJECT 3: DISPERSAL CHARACTERISTICS
Emphasis was shifted to the biology of the most important
sandfly in Florida, Culicoides furens. It was successfully colonized,
a major breakthrough. Field study and collections also
demonstrated the species, at least in the Vero Beach area, to be
entirely autogenous, i.e., able to mature a first egg batch without a

ENTOMOLOGY 79

blood meal. The seasonal pattern of productivity was also
investigated.
PROJECT 4: COMPARATIVE BIOLOGY
To explain the apparent restriction of Aedes taeniorhynchus
breeding to salt-marsh habitats, the possibility that gravid females
might be oriented by air-borne salt was investigated by exposing
panels of cheesecloth at different distances inland from the
brackish water of the Indian River. It was found that generally
decreasing amounts of salt were deposited on the panels up to 3.3
miles from the river.
A study of the sources of carbohydrate food of mosquitoes was
begun with the identification of over 150 plants, observations of
their flowering periods, and investigation of their nectar-secreting
capacities. Honeydew production by Homopterous insects,
abundant in Florida and also used by mosquitoes, was studied in
field and laboratory.
A monograph was prepared summarizing all known observations
and information on the natural history of Culex nigripalpus.
PROJECT 5: REPRODUCTION
The interplay between MNC (medial neurosecretory cells, in
brain) and corpora allata hormones and the maturation of ovaries
in autogenous and an-autogenous mosquitoes was greatly
elucidated this year as a result of an exhaustive study of the
corpus cardiacum, a hormone-storage organ whose activity
apparently determines whether or not a blood meal is necessary to
the promotion of egg growth. It took much careful histology and
electron microscopy to settle this vital issue.
PROJECT 6: GROWTH
A detailed study of environmental factors in the production of
synchronous development in 12 mosquito species in addition to
Aedes taeniorhynchus and Culex nigripalpus (see previous annual
reports) showed that pupation could not be synchronized in A.
triseriatus and C. salinarius. In C. bahamensis lessened food
synchronized development in contrast to increased food necessary
in A. taeniorhynchus, A. sollicitans, C. nigripalpus, Psorophora
confinnis and P. ferox. Higher larval densities synchronized
development in A. infirmatus and A. vexans, whereas lower
salinities and higher temperatures synchronized development in

80 ANNUAL REPORT, 1968

almost all the species studied. Light cycles aided synchronization
in only 5 species: A. taeniorhynchus, A. sollicitans, A. crucians
bradleyi, C. bahamensis and P. confinnis.
Further evidence was established that larval density affects not
only aggregation behavior but adult behavior in A.
taeniorhynchus. The controlled production of migratory and
non-migratory phases in this mosquito appears feasible, as in
certain locusts and other insects.
During the year a highly insulated, specially designed 12 by 12
foot building was erected to house the several cages in which
spontaneous flight is recorded acoustically through electronic
apparatus. Early use of these sound-recording cages demonstrated
their tremendous possibilities in the study of spontaneous flying in
the lifetime of a mosquito as affected by age, physiological state,
environmental conditions, and so on.
PROJECT 7: METABOLISM
Studies of the pathways between dietary hexoses and their
products showed that glucose is not an intermediate between
fructose mannose or galactose and the products trehalose and
glycogen.
The polyalcohol sorbitol, on which many nectar-feeding insects
can be maintained, enters the metabolic chain as fructose, not
glucose.
The recent finding of saccharidases other than trehalose in the
hemolymph of the mosquito and other insects led in 1968 to the
discovery of trehalose and maltose in the serum and kidney of
many vertebrates, including man. The diagnostic potential of these
findings will be explored, both clinically and experimentally.

PROJECT 8: BIOLOGY OF LARVIVOROUS FISHES
A many-sided study of the biology of the salt-marsh
mosquito-eating fish, Rivulus marmoratus, has been emphasized,
because alone among fishes it has proved to be naturally
self-fertilizing and alone among vertebrates to exist naturally in
the wild in the homozygous state, viz. having two identical sets of
genes.
Effects on the fish fauna and on the productivity of fish food
organisms are being assessed before and after impoundment of salt

ENTOMOLOGY 81

marshes for mosquito control. These conditions after prolonged
impoundment are being evaluated by comparing specimens
collected nine to ten years apart in the same impoundment.
A preliminary study of such conditions is being made in a
fresh-water flooded Maple-Bay swamp, currently under study with
regard to the biology of potential vectors of of arboviruses.
WEST FLORIDA ARTHROPOD RESEARCH LABORATORY
The function of this laboratory is to develop through research
effective control methods for insects of public health importance.
The research program is divided into two sections, Mosquito
Control and Biting Flies. The Biting Flies section also conducts
biological studies of some insects, especially the dog fly, Stomoxys
calcitrans (L.).
Results of the research program are translated into practicable
recommendations which are distributed in memorandum form to all
arthropod control districts of Florida. Accomplishments during
1968 and plans for 1969 are outlined in the remainder of this
report.
MOSQUITO CONTROL SECTION
Aerial Adulticide Studies
Studies of ultra low volume aerial sprays (ULV) for the control
of the salt-marsh mosquito, Aedes taeniorhynchus, and Culex
nigripalpus, a vector of encephalitis, were continued during 1968.
The test plot was 132 acres, having a sparse cover of planted pines
and scrub oak about four feet high and no tree canopy. Because of
rather poor results with four fluid ounces per acre during 1967,
the volume was increased to 16 fluid ounces per acre. At this rate,
considerably better kills of caged adult mosquitoes were obtained.
This research also included a study of the effects of cage type,
height above ground and distance downwind of the caged test
mosquitoes from the sprayed area. The number, and in some cases
the size, of droplets deposited was assessed by the use of dye cards
and slides coated with magnesium oxide. Results showed no
difference in kill between flat cages (eight inches in diameter and
one inch thick) and cylindrical cages (three inches in diameter and
six inches high), but the height at which the cage was placed above
ground and the position of the flat cage, whether vertical or
horizontal, was of great importance. Considerably poorer kill of
mosquitoes was obtained in cages placed close to the ground in

82 ANNUAL REPORT, 1968

either the horizontal or vertical position than at six feet above
ground, and less kill was obtained in the flat cages placed in a
horizontal position than cages placed vertically at six feet above
ground. Also, a greater number of droplets was obtained on dye
cards placed vertically at six feet than at any of the other heights
or positions. These data indicate a horizontal movement of spray
droplets above the low vegetation in the test area. This is of
importance because the species of mosquitoes used in these tests
rest on or near the ground during daylight hours, the time at
which aerial sprays are usually applied. It was further
demonstrated that the small droplets in the spray drift a long
distance from the point of application. Good kill of caged
mosquitoes was obtained at 2000 feet downwind from the sprayed
area at a height of 15 feet, but kill at ground level was very poor at
this distance, showing that the ultra small droplets do not deposit
well at ground level.
From these studies, it is evident that many factors must be
considered in research of this type. Refinements in application
techniques dealing with swath, altitude, nozzle size, droplet size,
and volume of spray applied still need to be explored further.
However, it is expected that a recommendation of aerial ULV for
control of the above species in open or residential areas can be
made in 1969.

Ground Adulticide Studies
Tests of insecticides for the control of adult mosquitoes by the
use of ground thermal aerosol generators is a continuing program.
As in 1967, the 1968 tests included Dursban and Baygon.
Although good results were obtained with these insecticides during
1967, very erratic results were obtained in 1968. Further testing is
needed before recommendations for their use can be made. Tests
of dosage rates 20 per cent above the recommended dosages of
malathion, naled and fenthion were initiated during 1968 and will
be continued during 1969. The object of these tests is to develop a
more reliable operation for good mosquito kill under adverse
environmental conditions.
Laboratory Adulticide Studies
Tests of potential new adulticides for use as ground thermal
aerosols are carried out in the laboratory prior to field testing.
Completion of tests begun in 1967 with Bromophos showed that

ENTOMOLOGY 83

this insecticide has no value as a thermal aerosol for the control of
adult Aedes taeniorhynchus or Culex nigripalpus. In preliminary
tests, new insecticide CIBA-9491 also showed little promise.
Insecticide Resistance Surveillance Program
As in previous years mosquitoes were collected from various
sections of the state and tested to determine their susceptibility to
malathion and dibrom. No new areas of resistance were
discovered, and for the third year in succession Aedes
taeniorhynchus from previously resistant areas in Lee County
continued to show an increase in their susceptibility to malathion.
In order to eliminate variations in test procedures and obtain
more reproducible results, a study of the factors affecting
laboratory larval tests was initiated in 1968. This study showed
that the temperature and salinity of the testing water and type of
test vessel (paper, plastic or glass) may greatly affect the results
obtained with the standard World Health Organization test
procedures. With the utilization of this knowledge it is expected
that future tests can be more standardized, which in turn should
produce more reliable results.
Larvicide Studies
Since development by personnel of this laboratory in 1957 of a
granular formulation of Paris green for control of mosquito larvae,
some of the materials used in this larvicide have been modified or
discontinued; therefore, it has been necessary to maintain a study
program for evaluation of various ingredients used in the
formulation. This procedure is required for quality control in this
larvicide, which has received broad acceptance for control of both
resistant and non-resistant mosquitoes in Florida and other states.
Since some of the more useful oils originally used in the
formulation have been discontinued by the produce, several new
oils were tested during 1968. Two spray oils that gave satisfactory
results in these tests are Standard Oil Company No. 341+ and
FAXAM40 (Formula No: 1305) produced by Humble Oil and
Refining Company. In storage tests of the formulated larvicide,
the No. 341+ oil performed especially well for more than six
months, which is adequate time to assure satisfactory overwinter
storage of granular Paris green manufactured in the fall.
A cooperative project for the testing of the effects of granular
Paris green on desirable marine organisms was conducted in

84 ANNUAL REPORT, 1968

cooperation with the Biological Field Station, U.S. Fish and
Wildlife Service, at Gulf Breeze, Florida. This laboratory furnished
the insecticide, and the Gulf Breeze laboratory conducted the
study.
Populations of grass shrimp, Palaemonetes pugio, and a fish,
Ciprinodon variegatus, were established in shallow, saline ditches
adjacent to Santa Rosa Sound. Treatments of 15 pounds per acre
of 5 per cent Paris green were made in the plots containing the test
organisms at two-week intervals, starting May 24 and ending
August 2. Dr. Charles W. Miller, project leader, reported that
populations of both organisms increased during the test period and
concluded that this larvicide does not constitute a hazard to either
species.
In recent times, there has been a revival of interest in petroleum
oils as mosquito larvicides. Personnel of this laboratory initiated
studies of these products at Vero Beach during 1963. These
studies were temporarily discontinued when the laboratory was
moved to Panama City but were resumed on a limited scale during
1968. The objective of this project is to reduce the volume of oil
required for good kill of mosquito larvae by the addition of
spreading agents. Results of laboratory work during 1968 were
encouraging and it is expected that several products of this type
will be tested in the field during 1969.

BITING FLIES SECTION
Dog Fly Studies
Except for some rather high counts of adult dog flies on bay
shores during January, 1968 was an average dog fly year,
commencing just before Labor Day and ending about November 1.
Personnel of this laboratory observed up to 30 adult flies landing
on a man on the shore of St. Andrews Bay near Lynn Haven,
Florida, January 9, 1968. However, flies were generally scarce
between January and August.
The earliest report received of flies appearing on bays in
significant numbers after January was at Choctawatchee Bay in
South Walton County. Flies were reported to be numerous enough
to bother dogs on August 4, but these flies disappeared next day
and apparently did not reach the Gulf beaches. The earliest report
of flies at a Gulf beach also was in Walton County near Inlet Beach
on August 17, but flies were not numerous at that time. A major

ENTOMOLOGY 85

outbreak occurred in this same area August 27, which is one of the
earliest dates that flies have been found in large numbers on Gulf
beaches by personnel of this laboratory. Flies were intermittently
plentiful in this area of southeastern Walton County from August
27 through October.
The Gulf Mosquito Control District at Panama City Beaches
greatly increased its fogging program at the Panama City beaches
this year and appeared to do a good job of killing adult flies on the
beaches. However, it also appeared that adult flies never invaded
these beaches during 1968 in as large numbers as those observed at
Inlet Beach only a few miles to the west. No sound evidence to
explain this observation is available at this time.
A highlight of 1968 was the discovery by personnel of this
laboratory on September 6 of a large number of dog fly larvae in
eel grass, Vallisneria americana, at Deer Point Lake, Bay County.
While this is not the first report of this fly breeding in eel grass, it
is the first time that large numbers have been found in deposits of
this grass on the shores of freshwater lakes. Three square feet of
the infested grass, transported to the laboratory as a sample,
yielded 1008 adult dog flies over a period of about three weeks.
Following this discovery, a similar condition was found at Lake
Wimico in Gulf County on September 12. It was estimated that
flies were breeding heavily in eel grass along approximately seven
miles of shore at Deer Point Lake and 14 miles at Lake Wimico.
Surveys of other counties are being made to determine the
extent of this previously unknown source of dog flies in West
Florida. Eel grass is especially well adapted to conditions in
slightly brackish water areas such as tidal streams and nearby
estuaries and other waters of high mineral content.
An interesting observation during 1968 was the apparent
feeding of adult dog flies on the nectar of a dune plant, Solidago
pauciflosculosa Michx. This plant and sea oats dominate the
vegetation of the beach dunes of West Florida. Hundreds of adult
dog flies were observed resting on the Solidago and probing the
flowers with their proboscis, presumably sucking nectar.

Tests of Residual Sprays on Marine Grass Deposits

Residual sprays on marine grass deposits were tested using
methods similar to those described in previous reports. The

86 ANNUAL REPORT, 1968

principal objective of the tests during 1968 was to develop a marker
for these sprays which will permit identification of treated grass
for several months after the initial spraying. It is known that bay
grass deposits will not attract dog flies after they have aged for 30
days during summer; therefore, if treated grass can be identified it
need not be resprayed, because present insecticidal treatments are
effective for at least 30 days.
The marker tested was DuPont Oil Red Dye. A sticker furnished
by Chevron Chemical Company also was tested to see if this
product would prolong the life of the dye marker on the grass.
DDT, methoxychlor, and Baygon were applied as emulsion
sprays at dosage rates of 387, 387, and 100 milligrams, re-
spectively. One treatment of DDT and one of methoxychlor in
each block contained dye and sticker and the other one contained
dye without a sticker. The Baygon treatment was included only to
repeat the previous tests of this chemical against the dog fly;
therefore, neither dye nor sticker was added to this treatment.
Dye was dissolved in the insecticide concentrates at rates that
would result in one-half or one gram of dye per gallon of diluted
spray. Sticker was added to dilute spray just prior to application at
a rate of 300 milliliters per 100 gallons.
Bioassay of tests established in July was not possible because
imported fire ants destroyed .the fly pupae that were added to
each plot. The entire 10 acre property of the laboratory was
treated with granular Mirex but it was October before the ants
were controlled to a point where bioassay of these tests was
possible. This, of course, did not affect longevity evaluation of the
dye marker.
Both DDT and methoxychlor were 95 per cent effective against
dog flies for at least 60 days in all plots; therefore, the dye had no
effect on the toxicity of these materials to the dog fly. Baygon
was 95 per cent effective only for 18 days; these results confirm
previous tests.
Longevity of the dye marker was evaluated at biweekly intervals
by placing a handful of treated grass on a white paper towel, then
wetting the grass with acetone from a plastic squeeze bottle. When
dye was present it was dissolved by the acetone and a red stain was
left on the towel. This is a simple test that can be done by a field
inspector any place on the bay shore.

ENTOMOLOGY 87

As of December 31, dye was still detectable in plots treated in
July at the one-half and one gram per gallon rates, and the
treatments containing the sticker were not better than the others.
During this five-month period, the dye treatments withstood
rainfall of 22.7 inches. Tests of tidal washing of the dye
treatments are planned for 1969; however, it appears that the oil
red dye will be a successful marker for these grass sprays.
Late in the year, tests of DDT and methoxychlor residual sprays
on grass were initiated in a large walk-in cage measuring eight feet
by eight feet by six feet high. The object of this test was to give
emerging dog flies more opportunity to escape exposure to
treated grass after they emerge. It was reasoned that the smaller
cages normally used in these tests might force the flies to stay in
contact with treated grass for a longer period than they would
under natural conditions, thus reflecting more mortality than the
treatment might actually produce under field conditions. These
tests will be continued during 1969.
Tests of Aerial Sprays Against Caged Adult Dog Flies
Ultra low volume (ULV) aerial spraying would appear to be an
ideal method of controlling adult dog flies on the Gulf beaches of
West Florida. However, the problem is to successfully adapt this
method to the conditions of high winds and temperatures that
usually prevail on the beaches when flies are present there.
Preliminary tests of ULV aerial sprays of naled against caged
flies were initiated at inland test plots during the spring and early
summer. Owing to the small average size of droplets of ULV
sprays, these tests were designed to evaluate the drift
characteristics of the spray. An inland site was used because wind
direction at the beaches is not favorable for these tests in late
spring and early summer.
Stakes 15 feet in height were placed in a line down a dirt road
in an open area. They were spaced at various intervals from 0-feet
to 2300-feet downwind of the nearest flight center. Cages of flies
were placed on the stakes at one foot, six feet, and 15 feet above
ground level. The aim of these tests was to find an operation that
would give at least a 90 per cent kill for a given distance
downwind of the flight center, as in thermal aerosol tests.
When winds were less than six miles per hour and temperatures
80 degrees F. or less, 90 per cent or better kill was recorded at

	Front Cover
	Title Page
	Letter of transmittal
	Members of the Florida state board...
	Tenure of state health officer...
	Directors of county health...
	Official staff Florida state board...
	List of Tables
	Table of Contents
	Office of state health officer
	Bureau of adult health and chronic...
	Bureau of dental health
	Bureau of entomology
	Bureau of finance and accounts
	Bureau of health facilities and...
	Bureau of laboratories
	Bureau of local health service...
	Bureau of maternal and child...
	Bureau of preventable diseases
	Bureau of research
	Bureau of sanitary engineering
	Bureau of vital statistics
	Articles and publications by staff...