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FLORIDA
STATE BOARD
OF
HEALTH
1966
ANNUAL REPORT
Hi
rCOn^DA STATS OBRXRY
a4,
nnua
/9e
*pori
State Board of Health
t^iatc or J-loriaa
1966
ril
WILSON T. SOWDER, M.D.
STATE HEALTH OFFICER
JACKSONVILLE, FLORIDA
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, 1966.
Sincerely yours,
WILSON T. SOWDER, M.D., M.P.H.
State Health Officer
May 1, 1967
Jacksonville, Florida 32201
His Excellency, Claude R. Kirk, Jr.
Governor of Florida
Tallahassee, Florida 32301 ^ ^
'Sin ■■■'■"
I herewith present the report of the Florida State
Board of Health for the period of January 1, 1966, to
December 31, 1966, inclusive.
Respectfully,
EUGENE G. PEEK, JR., M.D.
President
May 1, 1967
Ocala, Florida 32670
The Honorable YMgene 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, 1966.
Sincerely yours,
WILSON T. SOWDER, M.D., M.P.H.
State Health Officer
His Excellency, Claude R. Kirk, Jr.
GkDvemor of Florida - \
Tallahassee, Florida 32301
Sir:
I herewith present the report of the Florida State
Board of Health for the period of January 1, 1966, to
December 31, 1966, inclusive.
Respectfully,
EUGENE G. PEEK, JR., M.D.
President
May 1, 1967
Jacksonville, Florida 32201
-.4
May 1, 1967
Ocala, Florida 32670
DIRECTORS OF COUNTY HEALTH DEPARTMENTS
(as of December 31, 1966)
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. WATCHEL, M.D.
Jacksonville
WILLIAM O. SHUMPERT, D.D.S.
Ft. Lauderdale
W. S. HORN, D.O.
Palmetto
., . „ Edward G. Byrne, M.D., M.P.H.
Alachua ? VT ttii -kk t\
T> . A. F. Ullman, M. D.
l%;ard: : :::::::: : : : : : t. Pa.i Ha„e;. m d d^p a
Broward. P=^l *• «"6''f ' "-^-'n**-^-
Comer Clyde L- B'-oJhers M D
T^j T. E. Cato, M.D., M.P.n.
^^1 :::::: Patricia c: Cowdery, M.D. (Acting)
Hillsborough Jo^ S Nei , M.D., M.P.a
LjQ^g J. Basil Hall, M.D., M.P.H.
y .... J. W. Lawrence, M.D.
J^o; \\ Clifford G. BUtch, M.D.
Manatee*. \V. George M. Dame M.D.
Marion James B. Stapleton, M.D.
Monroe * * ' • J^se T. Sanchez, Jr., M.D. (Acting)
Okaloosa * Henry I. Langston, M.D., M.P.H.
O^ge Wilfred N. Sisk, M.D., M.P.H.
Palm Beach C. L. Brumback, M.D., M.P.H.
Pinpllas John T. Obenschain, M.D., M.P.H.
^^^ ; : . Malcolm J. Ford, M.D., M.P.H. (Actmg)
St. Johiis !!'.'. Mason Morris, Jr., M.D.
Santa Rosa A. E Harteson, M.D.
Sarasota David L. Crane, M.D., M.P.H.
Seminole Frank Leone, M.D.
Volusia D. V. Galloway, M.D., M.P.H.
Baker- Nassau B. F. Woolsey M.D
Calhoun-Jackson Terry Bird, M.D., M.P.H.
Flagler- Putnam J- Culpepper Brooks, Jr., M.D.
Fi^Un-Gulf Malcolm J Ford, M D M^Pp"* ^^'*'^^^
Gadsden- Liberty B. D. Blackwelder, M.D., M.P.H.
Jefferson- Wakulla P. H. Smith, M.D.
Madison- Taylor Luther A. Brendle, M.D M.P.H.
Osceola-Indian River C. C. Flood, M.D. M.P.H.
Pasco-Sumter John L Ingham, M.D.
Bradford- Clay- Union A. Y. Covington, M.D., M.P.H.
Charlotte-DeSoto-Hardee . . . Francis R. Meyers M.D.
Citrus-Hernando- Levy H. F. Bonifield, M.D M.P.H.
Columbia- Hamilton-Gilchrist. F. Barton WeUs, M.D
Glades- Hendry- Highlands . . . WiUiam F. Hill, Jr., M.D., M.P.H.
Holmes- Walton- Washington. . WilUam G. Simpson MD., M.P.H.
Martin-Okeechobee-St. Lucie. NeiU D. Miller, M.D.
Suwannee- Dixie- Lafayette. . . John S. WiUiams, M.D.
OFHCiAL STAFF FLORIDA STAH BOARD OF HEALTH
(as of December 31, 1966)
State Health Officer
Deputy State Health Officer
Program and Planning
Assistant State Health Officer
Encephalitis Research Center
Assistant State Health Officer
Division of Health Education
Librarian
Division of PersonneL
Division of Public Health Nursing. . . .
Bureau of Adult Health and
Chronic Diseases
Bureau of Dental Health.
Assistant Director
Bureau of Entomology
Entomological Research Center
Bureau of Finance and Accounts
Assistant Director
Purchasing Agent
Bureau of Health Facilities and
Services
Bureau of Laboratories
Assistant Director
Miami Regional Laboratory
Orlando Regional Laboratory
Pensacola Regional Laboratory
Tallahassee Regional Laboratory. . . .
Tampa Regional Laboratory
West Palm Beach Regional
Laboratory
Bureau of Local Health Services
Deputy State Health Officer
Assistant Director
Division of Nutrition
Division of Sanitation
Bureau of Maternal and Child Health . . .
Bureau of Narcotics
Bureau of Preventable Diseases
Assistant State Health Officer
Division of Epidemiology
Division of Radiological and
Occupational Health
Division of Tuberculosis Control . . . .
Division of Veterinary I>ublic Health. .
Bureau of Research
Assistant State Health Officer
Bureau of Sanitary Engineering
Assistant Director
Division of Industrial Waste
Division of Special Services
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
Wilson T. Sowder, M.D,, M.P.H.
Malcolm J. Ford, M.D., M.P.H.
G. Foard McGinnes, M.D., Dr.P.H.
James O. Bond, M.D., M.P.H.
Vincent Granell, B.S., Ed.D.
Mildred T. Clark, B.A., B.S., M.A.
Miles T. Dean, B.S., M.A.
Enid Mathison, R.N., M.P.H.
J. E. Fulghum, M.D.
Floyd H. DeCamp, D.D.S.
Delmar R. Miller, D.D.S. , M.P.H.
John A. Mulrennan, B.S.A.
Maurice W. Provost, Ph.D.
Fred B. Ragland, B.S.
Paul R. Tidwell, B.B.A.
Frank E. Craft, B.S.B.A.
C. L. Nayfield, M.D., M.P.H.
Nathan J. Schneider, Ph.D., M.P.H.
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.
Lorraine Carson
Malcolm J. Ford, M.D., M.P.H.
Hubert U. King, M.D.
Mildred Kaufman, B.S., M.S.
A. W. Morrison, Jr., R.S.
J. E. Fulghum, M.D. (Acting)
Frank S. Castor, Ph,G.
Albert V. Hardy, M.D., Dr.P.H. (Acting)
E. Charlton Prather, M.D., M.P.H.
Edwin G. Williams, M.D.
Dwight Wharton, M.D.
James B. Nichols, D.V.M.
Albert V. Hardy, M.D., Dr.P.H.
David B. Lee, M.S.Eng.
Sidney A. Berkowitz, M.S.Eng.
Vincent D. Patton, M.S.S.E.
Charles E. Cook, C.E.
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
UST OF TABLES
Page
Number
1 Employees in the Florida State Board of Health and ^^
county health units • • • * • * *
2 Employees in administrative units of the Florida
State Board of Health (excluding county health ^^
departments) 25
3 Personnel in county health units
4 Employment, terminations and turnover rate ^*
5 Patient visits, Florida tumor cUnics ^*
6 Glaucoma screening program data
7 Arthropod-borne virus isolations from mosquitoes. .... oi
8 Summary of pest control registration and enforcement . . 5b
9 Funds received by county health units
10 Major evaluation indices by types of ^^
hospitalization program •
11 AppUcations processed and approved for payment
by hospitalization program
12 Hospital evaluation statistics •
13 Number of extended care faciUties Ucensed and ^^
number ceased operations • •
14 Examinations performed by Florida State Board of ^^^
Health Laboratories '/ * * A/
15 Specimens submitted to State Board of Health ^^^
Laboratories ;*.*'/* 'I '1
16 Examinations performed in tuberculosis hospital ^^^
laboratories •
17 Viral and rickettsial diagnostic findings for ^^^
1885 patients ^^g
18 Arbovirus isolations by specimen source ^
19 Permitted estabUshments and facilities ^^^
20 Major activities of local health units
21 Postgraduate obstetric- pediatric seminar ^^^
registration ^ ' * j
22 Practitioners registered with the State Board ^^ ^^^
of Health * * * ' i An' nnn
23 Reported syphilis cases and rates per 100,000 ^ ^ ^^^
population * ^70
24 Reported cases of early syphiUs by age and race . . i^y
25 Sources of radiation by county
26 Summary of X-ray surveys and consultations ao^
27 New active tuberculosis cases and ^^^
tuberculosis deaths -g.
28 Reported active cases of tuberculosis
29 Results of 70mm X-ray screenings
30 Results from state X-ray survey units JJ^
81 Tuberculosis cases in central register ^^^
32 Tuberculosis case register statistics.
UST OF TABLES (cont'd.)
Numier
Page
33 Cases of animal rabies 205
34 Engineering laboratories basic water quality data 215
35 Industrial waste and incinerator projects approved 223
36 Summary of activities relating to shellfish and
Crustacea plants 229
37 Sewerage projects approved 232
38 Sewage treatment plants by types and capacity 234
39 Waste water projects processed locally with
estimated cost 234
40 Water projects approved with capacity increase and
estimated cost 240
41 Permits issued for swimming pools, natural
bathing places, water wells and plans approved
for proposed public swimming pools 241
42 Water plants visited 242
43 Water and sewage works operators short schools 243
44 Sanitation of water supplies serving interstate
carriers 243
45 Activities of the Division of Vital Records 253
46 Resident births and deaths with rates per
100,000 population 253
47 Twenty leading causes of death 254
48 Resident deaths and death rates (preliminary 1966) .... 255
49 Resident deaths and death rates (final figures 1965) .... 256
50 Estimated population and resident birth, death and
infant deaths (preliminary 1966) 257
51 Estimated population and resident birth, death and
infant death rates (final figures 1965) 258
52 Marriages by race, divorces and annulments by
county 259
53 Vital statistics scoreboard 260
FIGURES
Numier
Page
1 Reported syphilis case rate per 100,000 population 178
2 Sewage treatment plants approved 233
Organizational Chart of the
Florida State Board of Health
r
I
MEDICAL SCHOLARSHIP
ADVISORY COMMITTEE
I
DENTAL SCHOLARSHIP
ADVISORY COMMITTEE
GOVERNOR
BOARD OF HEALTH
( 5 Members )
I
r
I
STATE HEALTH OFFICER
HOSPITAL LICENSURE
ADVISORY COUNCIL
ADVISORY COMMITTEE
FOR HOSP'L SERVICE
FOR THE INDIGENT
1
DEPUTY STATE HEALTH OFFICER
Bureau of Local Health Services
(Civil Defense & Accident Prev.)
BUREAU OF
FINANCE &
ACCOUNTS.
BUREAU OF
ADULT HEALTH
AND CHRONIC
DISEASES
■
BUREAU OF
LABORATORIES
(Regional Labs.
ASSISTANT
STATE HEALTH
OFFICER
Operations.
BUREAU OF
PREVENTABLE
DISEASES
(Occupational
Health)
Division of
Radiological
Health
Division of
Veterinary
Public Health
(Milk Sanit.)
Division of
Epidemiology
(Cotnniunicable
Diseases ,
V. D. Control)
Division of
Tuberculosis
Control .
BUREAU OF
ENTOMOLOGY
(Research Ctr. ,
West Florida
Arthropod
Research Lab. ,
Mosquito Cont' 1
Districts.
A.Aegypti Erad.
Project. )
BUREAU OF
RESEARCH
ASSISTANT
STATE HEALTH
OFFICER
Prog. Planning
BUREAU OF
NARCOTICS
BUREAU OF
DENTAL HEALTH
BUREAU OF
HEALTH
FACILITIES
i SERVICES
BUREAU OF
MATERNAL &
CHILD HEALTH
(Migratory
Labor)
_1
ENCEPHALITIS
RESEARCH
CENTER
Division of
Personnel
T
Division of
Health
Education
(Library)
BUREAU OF
VITAL STATISTICS
Division of
Vital Records.
Division of
Public Health
Statistics
Division of
Data
Processing
Division of
Public Health
Nursing
Division of Sanitation
Division of Nutrition
\
67 County Health Departments
AIR POLLUTION
CONTROL COMMISSION
BUREAU OF
SANITARY
ENGINEERING
(Stream San.
Waste Trtmt.
Construction'
Division of
Industrial
Waste
(Air Pollution)
Division of
Waste Water
Division of
Water Supply
(Swimming
Pools)
Division of
Spec. Services
(Subdivision,
Shellfish)
DEC 1966
TABLE OF CONTENTS
Page
Administration (including Activities of the Board; Train-
ing Coordination; Scholarships; EncephaUtis Research
Center; Divisions of Health Education, Personnel and
Public Health Nursing) ^
Bureau of Adult Health and Chronic Diseases 30
Bureau of Dental Health *^
Bureau of Entomology (including Entomological
Research Center) ^"
Bureau of Finance and Accounts (including Purchasing
and Property ^^
Bureau of Health Facilities and Services '^^
Bureau of Laboratories ^^
Bureau of Local Health Services (including Accident
Prevention, Health Mobilization and Home Health
Services; and Divisions of Nutrition and Sanitation) 107
Bureau of Maternal and Child Health 162
Bureau of Narcotics • • • • 169
Bureau of Preventable Diseases (including Divisions of
Epidemiology [Venereal Disease Control Program],
Radiological and Occupational Health, Tuberculosis
Control and Veterinary Public Health) 172
Bureau of Research ^^^
Bureau of Sanitary Engineering (including Divisions
of Industrial Waste, Special Services, Waste Water
and Water Supply) ^08
Bureau of Vital Statistics (including Divisions of Data
Processing, Public Health Statistics and Vital Records) ... 244
Articles by Staff Members ^61
\
OFFICE OF STATE HEALTH OFFICER
I
TENURES 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., 1941-1942
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
WILSON T. SOWDER. M.D.. M.P.H.
State Health Officer
Each year brings new problems, and 1966 had its share. Some
of them are still far from solved, but satisfactory progress has
been made.
The year saw the beginning of a trend that may result in sweep-
ing changes in public health practice. Many new activities or expan-
sions of existing programs featured comprehensive medical care for
considerable portions of the population. While health departments in
Florida usually do not themselves provide complete treatment, den-
tal care and hospitaUzation, the administration of programs mvolv-
ine comprehensive care demands new relationships with physicians,
dentists, hospitals and other state agencies. New discipUnes notably
social service, are becoming involved. Every public health worker
will have additional responsibilities in community planmng and co-
operative action. The principal factors causing this trend are Med-
icare and comprehensive care projects financed through federal,
state and local funds.
Environmental health was a subject of great popular interest
especially air and water pollution. The issues of Florida Health
Notes for January and February 1967, describe State Board of Health
(SBH) activities in these fields. Florida's air was found by a federal
survey to be cleaner than that of any state except New Hampshire
Wyoming and Hawaii. The state was fifth in the amount of nonfederal
funds spent to abate the pollution that does exist.
Communicable diseases remain a primary concern of all health
agencies. Foremost among problems is venereal disease. After
eight consecutive years of increase, infectious syphiUs showed a
slight decline in 1966. There is need for continued active pursuit
and treatment of those infected.
Another of Florida's Tuberculosis Hospitals closed during the
year leaving only two in operation. This reflects an improvement m
home treatment of the disease, not a decrease in incidence The
number of new cases found has increased every year since 1959, in-
cluding the past year.
Quick epidemiological investigation may have presented the
estabUshment of bubonic plague in the wild rodents of Florida. Four
iackrabbits brought from New Mexico, where the disease exists,
were traced to a Marion County farm and destroyed. The premises
were fumigated. , . . ^ ^.u u^«ifK
A new disease was discovered by pathologists and the health
officer in Orange County. It is an encephalitis caused by infestation
with an amoeba that is commonly found in freshwater lakes. Ap-
parently it enters the body through the nose while swimming. Four
confirmed cases have been identified, and doctors in the area are on
the lookout for more.
2 ANNUAL REPORT. 1966
Not a single case of polio was reported in 1966. It now seems
possible to reduce measles in a similar way. Measles immunization
was emphasized in all counties, and mass immunization programs
for measles were carried out in six counties.
In Maternal and Child Health the outstanding event of the year
was the approval of five Maternal and Infant Care Projects in the
state. At the time of approval Florida had 10 per cent of the total of
such projects in the country.
All but one of the counties now have active family planning pro-
grams, but the service is reaching only about 20,000 women, ap-
proximately 10 per cent of those who should have an opportunity to
make use of it.
The cooperative phenylketonuria (PKU) testing program, the re-
sponsibility for which the SBH was given by the 1965 legislature, has
progressed so that about 70 per cent infants born are being tested.
In the area of aging and chronic disease the most important
event was the advent of Medicare on July first. Florida has shown
greater than average progress in the certification of institutions and
agencies for participation. Of the 189 hospitals licensed by the SBH,
172, containing 94 per cent of all beds, were certified for Medicare.
Two hospitals also have certified extended care facilities, and 89 of
the 350 nursing homes in the state were certified. Fifty-seven home
health agencies in 49 counties were certified for home health care.
Most of these were county health departments (CHD).
Heart disease, the first cause of death in Florida, continued to
find more victims. Emphysema— bronchitis has increased 3-1/2
times in the past decade. Many authorities consider smoking to be
a factor in both the above diseases as well as lung cancer. Renewal
of a federal grant which supported an educational program on Smok-
ing and Health was requested for 1967.
Program consultation in the Bureaus and activities in the CHDs
continued to increase, although in many programs the volume of
service provided was not keeping up with population growth.
During 1966 there were 42 research, demonstration and service
projects operated by the SBH and CHD's, involving over $12 million
in federal and $2.5 million in local funds. The only state funds that
supported these projects were the comparatively small amounts
used to help operate the three research laboratories in Tampa, Vero
Beach and Panama City.
The organizational structure was changed during the year. A
Deputy State Health Officer was placed in charge of Local Health
Services and the two original Deputy State Health Officer positions
were changed to Assistant State Health Officers. On November 1,
G. Foard McGinnes, M.D., Dr.P.H., was appointed Assistant State
Health Officer for Program and Planning. The position. Assistant
State Health Officer for Operations, is still vacant. The immediate
Office of the State Health Officer included a health program analyst,
GENERAL ADMINISTRATION 3
two internal auditors, two attorneys and a press secretary. Organi-
zational units directly responsible to the State Health Otficer were:
Program and Plamiing, Operations, the divisions of PubUc Health
Nursing, Personnel, Health Education, the Encephalitis Research
Center and the Coordinator of Training.
The Bureau of Special Health Services, aboUshed in December
1965, was replaced by a Bureau of Adult Health and Chronic Diseases
and a Bureau of Health FaciUties and Services.
Among those who resigned or retired during the year were
Clarence M.Sharp, M.D., Director of the Bureau ^^^/2^^''^^^?\^'
eases. Deputy State Health Officer Elton Osborne, M.D., and Robert
Schultz, M.D., Coordinator of Training. David L. Crane, M.D.,
Director of the Bureau of Maternal and Child Health, transferred to
Sarasota County as Director of the Sarasota CHD These positions
remain open because we have been unable to fill them with per-
manent personneL
There has always been difficulty in obtaining qualified personnel
for key positions. The general recruitment picture looks worse than
ever, because the comprehensive care projects and similar pro-
grams under other agencies require physicians, nurses, nutrition-
ists, social workers and others who otherwise might be employed
for more general programs at state or county level. At the end of
1966 salaries in general were not competitive either with private
employment or other state health departments.
Staff Activities
A pubUc health analyst was added to the State Health Officer's
staff in 1966. His assignments may take him into any aspect of pro-
gram or operation. While the Coordinator of Training position was
vacant in the latter part of the year he has been in charge of train-
ing and recruitment.
The internal auditor and his assistant examined the accounts of
35 health departments to insure that spending was in accordance with
state and local laws.
A second full-time attorney was employed in 1966 because of the
continuing increase in enforcement Utigation. Water and air pol-
lution control of drugs, hospital and nursing home licensure, vital
rerrds tSthe disposition of dead bodies, Florida Merit System
appeals and the Sanitary Code infractions are among the legal prob-
lems The SBH intervened in a Federal Power Commission hearing
on a petition to allow the building of additional natural gas Imes into
Florida, The examiner disapproved the petition, and the case has
been appealed to the full commission.
A total of 75 news releases relative to SBH activities was sent
to newspapers, magazines, television and radio. Various news
me^aTeTe assisted 67 times, and 26 special interviews, stones or
photos were set up.
4 ANNUAL REPORT. 1966
PROGRAM PLANNING
MALCOLM J. FORD. M.D.. M.P.H.
Depu+y State Heahrfi Officer
(tfirough October)
G. FOARD McGINNES. M.D., Dr.P.H.
Assistant State Health Officer
(from November)
The broad general purpose of this office is to encourage and aid
in the imaginative planning of new programs and the evaluation and
replanning of existing ones at all levels.
The review of project grant applications occupies a large pro-
portion of the staff's time. At the end of 1966, 42 active projects
were being operated by the State Board of Health (SBH) and county
health departments (CHD) involving over $12 million in federal funds
and $2.5 million of state and local moneys. Fifteen hundred workers
who are paid from project funds would probably not be employed in
CHDs if these projects did not exist. Eighteen other federally-
financed projects are being operated or have been applied for by
other state or voluntary organizations with the approval of the SBH.
Fourteen agreements with state, federal, local and voluntary agen-
cies or with institutions were in effect.
During 1966, Program Planning conducted reviews of the Occu-
pational Health program and the Bureau of Maternal and Child
Health, and was responsible for the administration of the latter for
a part of the year. It was responsible for the narrative portion of
the State Report and Plan on the basis of which federal funds are
allotted to the state, and for special reports requested from many
sources. In all its activities it worked in close cooperation with
bureau, division and program directors.
The Assistant State Health Officer also served as project direc-
tor for study of the effects of pesticides on humans continued under
a contract with the U. S. Public Health Service. Both acute poison-
ings and long term effects are being explored. Persons occupation-
ally exposed to pesticides from several counties have been examined
and will be followed. Included are workers from formulating plants,
flower farm workers, spraymen, painters and agricultural workers.
Under a subcontract with the University of Miami special biochem-
ical studies have been made in kidney function and amino acid me-
tabolism. Studies in possible association of pesticides with certain
diseases are also being studied under the subcontract. Under a
subcontract with the Dade County Medical Examiner's office studies
of acute pesticide poisonings are being made.
A long term statewide study of individuals employed in the pest-
icide applicating industry for general health conditions over the past
20 years and more intensively in the future has been continued. Also
GENERAL ADMINISTRATION 5
observations on the use of pesticides among the general population
in Dade County have been made through questionnaire survey of
households. In addition monitoring studies of water and human tis-
sue obtained at autopsy have been instituted. The problems of labor-
atory analyses are being worked out and tests are being done m the
Central Laboratory in Jacksonville as well as the Miami Branch
Laboratory. While no conclusions have been reached in aU these
studies several interesting leads have developed for further study.
Joint meetings with other state agencies interested in pesticide
use and control were held. These provided a useful exchange of m-
formation and lead to better coordination of efforts in this field.
ACTIVITIES OF THE BOARD
January 30 — Jacksonville
I. Re-elected Eugene G. Peek, Jr., M.D., as President of the
Board and Mr. T. M. Cumbie as Vice President.
2 Discussed the woridng relationship of the Air PoUution Con-
trol Commission and the State Board of Health with George
Westbrook, Ph.D., Chairman of the Commission.
3 Discussed the latest draft of the Multi- County Maternal and
Child Health Project and approved it with certain changes.
4. Heard a report on the purchase of land in Jacksonville by
Wilson T. Sowder, M.D.
5. Heard a report by Dr. Sowder on the status of the Medicare
Program, Title XVm.
6 Heard reports by Dr. Sowder and Malcolm J. Ford, M.D.,
on the Home Health Services Program and approved the
operation of this program through the county health depart-
ments (CHDs); and further authorized them to accept reim-
bursement for Medicare services rendered in this program.
7. Accepted the information on the resignation of David Crane,
M D director of the Bureau of Maternal and Child Health,
an'd iproved the appointment of Dr. Ford as Acting Director
temporarily.
8. Accepted the information about the illness of C. M. Sharp,
M.D.
9 Approved Dr. Sowder's acceptance of an invitation to the
Seventh International Congress of the International Associa-
tion of Gerontology in Vienna, Austria, June, 1966.
10. Heard a report on the law regarding the examinations of
ambulance drivers.
II. Conducted a hearing with interested persons from the City
of Hialeah on the problem of septic tanks.
ANNUAL REPORT. 1966
12. Approved a revision of Chapter 170C-4, "Standards for In-
dividual Sewage Disposal Facilities" of the State Sanitary
Code.
13. Approved the issuance of conditional licenses to appropriate
Homes for the Aged implying for licensure until such a time
that the Board adopted regulations.
14. Adopted a policy for employees traveling by air when using
federal or matching funds.
15. ^proved the abolishment of the Bureau of Mental Health.
16. Approved the change in names of two bureaus to Bureau of
Health Facilities and Services and Bureau ^-^du It Health
and Chronic Diseases.
17. Heard a report by Leo M. Wachtel, M.D., on the meeting of
the Florida Advisory Council for Heart, Cancer and Stroke.
18. Approved the ^pointment of the I>irector of Local Health
Services as ex- officio member, State and Local Relations
Committee.
19. Discussed the policy on the licensure of dentists and physi-
cians employed by the State Board of Health (SBH).
20. Approved the publication of the booklet — "Guidelines A
Ready Reference To Current Obstetric Practice."
March 27 — Jacksonville
1. Discussed proposed regulations for homes for the aged and
recommended that further study be given them; and they be
brought back before the Board when this has been done. The
Board approved of continuing to issue conditional licenses
to those homes where necessary until such a time as agreed
upon regulations could be submitted.
2. Approved the revision of the policy on air travel to include
special consultants to the SBH and that their travel not be
restricted to tourist but that they be allowed to travel first
class.
3. Approved an equipment list in connection with the enforce-
ment of the ambulance law; and further that permit and
certificate forms be approved for use in this program.
4. Discussed regulations under Chapter 170-D with members
of the Home Builders Association.
5. Approved a proposed letter to Senator Lister Hill regarding
Senate Bill S-3008.
6. Approved the creation of a position of Deputy State Health
Officer for Bureau of Local Health Services and the renam-
ing of the two deputy positions to that of Assistant State
> GENERAL ADMINISTRATION 7
Officer with rank and salary equivalent to that of bureau
directors.
7. Approved the employment of W. W. Rogers, M.D., for the
development of an employee health service.
8 Approved the appointment of A. V. Hardy, M.D., as Acting
Director of the Bureau of Preventable Diseases upon the
retirement of Dr. Sharp.
9. Presented a twenty year pin to Dr. Sharp, Director of the
Bureau of Preventable Diseases, and expressed appreciation
for his excellent service to the SBH.
10. Approved candidates for postgraduate training for 1966-67.
11 Discussed the estabUshment of an Advisory Committee on
' Independent Laboratories for the Medicare Program and its
m.embership.
12 Discussed the request of the Pest Control Association for
' the eUmination of the regulation by the SBH requiring the
fingerprinting of pest control operators but took no action.
13 Heard of resignation of Elton Osborne, M.D., to accept the
' position of deputy state health officer with the Georgia State
Health Department and presented him with a certificate of
appreciation.
May 14 — Hollywood
1 Heard a report by Dr. Sowder that the Home Builders As-
sociation did not at this time have any suggestions for
changes in the regulations for septic tanks.
2 Approved recipients for medical scholarships and adopted a
resolution by the Advisory Committee to phase out the med-
ical scholarship program but continue the osteopathic
scholarship; and further that it be increased from $1000
to $2000 per year.
3 Agreed to support legislation proposed by the State Board of
Dental Examiners which would reduce the number of dental
scholarships awarded amiually from 10 to ^i^ and mcr^^^^^^^
the annual value of each scholarship from $1000 to $2000.
4 Discussed requests for Ucensure of Automedic Hospital by
* citizens in the Vero Beach area in view of action taken by
the Advisory Council on Hospital Licensure not to grant a
Ucense. The Board directed the staff of the Bureau of
Health FaciUties and Services to study this matter and
present a report to the Board.
5. Approved the employment of an additional attorney to assi^
the Bureau of Sanitary Engineering with its various legal
problems.
8 ANNUAL REPORT. 1966
6. Approved revisions in the Air Pollution Regulations, Chap-
ter 170C-9.
7. Approved an amendment in Chapter 170D-2, Nursing Homes
and Related Facilities, regarding the mailing of narcotics.
8. Discussed proposed regulations on pathological wastes in
hospitals and directed that the Florida Hospital Association
be consulted prior to their submission to the Board for
adoption.
9. Approved the inclusion of two additional accountants posi-
tions for the office of the internal auditor.
10. Heard a report from Dr. Ford regarding the preliminary
report of the State- Local Relations Committee.
May 15 — Hollywood
1. Discussed action taken by the House of Delegates of the
Florida Medical Association regarding public health pro-
grams carried on by the SBH.
July 24 — Jacksonville
1. Discussed in open hearing the proposed regulations on
homes for the aged with various groups including the Flor-
ida Nursing Home Association and recommended that these
be studied further and be referred to the Commission on
Aging for study.
2. Approved the ^pointment of an Advisory Committee for
Independent Laboratories for the Medicare Program the
membership of which to be determined later.
3. Discussed with Floyd Hurt, M.D., the part of the radiologist
in the Medicare Program.
4. Discussed the licensure of the Atomedic Hospital with Kip
Kelso, M.D., and the staff of the Bureau of Health Facilities
and Services and directed the staff to report at the next
meeting on their findings in view of this discussion.
5. Discussed the preliminary report of the State- Local Rela-
tions Committee with the members of the Committee.
6. Approved revisions in Chapter 170C-4, Standards for Inde-
pendent Sewage Disposal Facilities.
7. Discussed the proposed constitutional revision and directed
Dr. Sowder to express the opinion of the Board that the
Board of Health should be included in this revision.
8. Approved an amendment to the Narcotic Law whereby legis-
lation be prepared for submission to the legislature in 1967
for the control of LSD.
^
GENERAL ADMINISTRATION 9
9 ADproved the postponement of postgraduate training for
Mr Paul Tidwell because of illness of Mr. Fred Ragland
until the fall of 1967.
10. Approved postgraduate training for Mr. Alfred Mueller, Jr.,
Sanitarian, Palm Beach CHD.
11 Discussed a proposed project on Maternity and Infant Care
in Tampa and directed that it be operated in cooperation
with the SBH and the CHD.
12 Discussed with the Florida Pest Control Association pro-
cedures for fingerprinting under the regulations and adopted
some simpUfications in them.
13 Approved a poUcy on dual employment for drafting and
directed that Dr. Sowder contact the Attorney General prior
to formalizing this proposaL
14 Approved a legislative budget to be submitted to the Legis-
lature in 1967 for the SBH and the CHDs.
15 Authorized and directed Dr. Sowder to oppose any legisla-
'• tlont'at would transfer the responsibiUty for the air and
water pollution control programs outside of the bBH.
16. Discussed the State Audit Report of the SBH.
October 2 — Jacksonville
1 Approved a new Section 170C-10.11, Disposal of Pathological
Wastelbe added to Chapter 170C-10, Garbage and Rubbish.
2. Discussed the licensure of the Ercildoune H^SP^^I (^^-
medic) and took no action until a report of the Hearing Body
is received.
3. Adopted a statement of poUcy regarding air and water
pollution.
4. Approved the membership of the Advisory Co'nmittee o„
Independent Laboratories in connection with the Medicare
Program.
5. Confirmed the mail vote for the postgraduate training of
Howard Carter, M.D., for the period 1966-67.
6. Held a hearing with resident of Lake Shadow, Orlando, Flor-
ida, regarding pollution of the lake.
7. Approved a poUcy on dual employment for employees of the
SBH and CHDs.
8 ADoroved a per diem rate for persons serving on various
commissions'! councils, etc., who are appointed by the Gov-
ernor to advise the SBH.
10 ANNUAL REPORT. 1966
9. Reaffirmed the policy on the licensure of physicians.
10. Approved the appointment of Foard McGinnes, M.D., for the
position as Director of the Office of Planning.
11. Discussed salary ranges proposed by the Merit System for
dentists and directed to write the Merit System about the
inadequacy.
12. Approved the sending of a memorandum to all CHDs en-
couraging their participation in the Home Care Programs in
their communities.
13r^Spproved the payment of eight days per diem to Edwin G.
Williams, M.D., Director of the Division of Radiological and
Occupational Health, while attending a meeting in Rome,
Italy.
14. Approved the taking of legal action against the City of Ever-
glades.
December 11 ^Jacksonville
1. Heard a report from Dr. Sowder on the investigation of the
Lake Shadow situation.
2. Discussed amendments to the Narcotics Laws and directed
that these proposals be submitted to the Board in writing
for their study.
3. Approved the granting of a provisional license for a special
hospital to the Ercildoune HospitaL
4. Approved an organizational plan for Civil Defense.
5. Approved the separation of the Occupational Health Program
from the Division of Radiological Health and to place it under
the direct supervision of the director of the Bureau of Pre-
ventable Diseases; and further that the present laboratory
personnel engaged in occupational health work be placed in
the Bureau of Laboratories.
6. Approved the re- appointment of Mr. Don Evans and the ^-
pointment of Mr. Lamar Hancock to the Advisory Committee
for Hospital Services for the Indigent.
7. Directed Dr. Sowder to prepare a bill on air and water pol-
lution in line with the Board's statement of policy regarding
this subject.
8. Endorsed the sending of a communication to Governor Hay-
don Bums, and Governor- Elect Claude R. Kirk, Jr., regard-
ing the Comprehensive Planning Law.
GENERAL ADMINISTRATION II
ENCEPHALITIS RESEARCH CENTER
JAMES O. BOND. M.D.. M.P.H.
Director
studies of the epidemiology of California encephaUtis contmued
to occupy the major attention of the EncephaUtis R^^ff^h Center
(ERC) staff. No new infections with this virus were detected in the
eiShuman surveillance cases examined. Of the ^our previously de-
tected cases, three were shown by serologic and epidemiologic ev-
dence to have acquired their infections in the resort areas of west-
ern North CaroUna. Of 426 individuals examined in the household
rebleeding surveys, no serologic conversions were detected in 1966
using CaUfomia encephaUtis (CE), St Lo"i^.«"<=«Ph^^t^^f^LEj.
Western (WE) and Eastern encephaUtis (EE) antigens. New labora-
to^ ^dence accumulated during the year, however, strongly
suggest" that the serologic tests being used for CaUforma encepha-
lufs are relatively insensitive in detecting infections with local
strLns of CE viruses. Three separate laboratory infection expen-
meTts were carried out with domestic rabbits <l"7;^the year using
the original prototype CaUfornia encephaUtis strain (BFS-ZBJ), a
local tfivittatus and a local Keystone strain. The serologic tests
which have been used routinely for CE studies were not able to de-
Tea UectlonTn the rabbits with the trivittatus and Kevf - f ;--
of virus, although the rabbits developed viremia. The conclusion
aDoears warranted that the extensive negative serologic evidence
accumuJed in man and mammals. Insofar as CE infections are
concerned does not adequately represent the amount of infection
occurS' wUh local strains of CE virus. These findings have
°nmated an extensive laboratory research program attempting to
deveTop a more sensitive serologic test for detection of infections
with the local CE strains.
There is no question of the abundance of these CE viruses in
nature Seventy-nL isolations were made during 1966, chiefly from
?he fresh wate'r Aedes genus of mosquitoes. However, an >mPortan
new observation was the six CE virus recoveries from the blood of
sentinel rabbits placed in a rural swamp study site to detect the
occurrence of vi-rtis in mammals. Extensive ecological studies m
tMs sue during 1966, demonstrated that the f ^.s mosqujoes
emerged very soon after the heavy spring rains in June, rapidly
became ir^eaed with the CE viruses and maintained unusually high
Son rates through August, g'^adually mminishing hrough C>:-
tober. Host preference studies indicated they fed on both mammals
and birds during this period of time, with a sUght preference for
mammals. An ecological survey by a ^"'"'"f „^^^'^!"* ^i^'i^i^ 1^
same period demonstrated very few mammal species available in
the swamp, thus, narrowing down the Ust of potential mammaUan
reservoirs for this virus.
The surveiUance for human cases of arbovirus infection was
12
ANNUAL REPORT. 1966
again completely negative in 1966, although 613 cases were referred
for laboratory diagnoses. This concludes the fourth successive year
in which no human cases of SLE occurred in the Tampa Bay area.
However, other viral infections were frequently detected. In con-
junction with the virology section of the Bureau of Laboratories,
Jacksonville, 30 viral isolations were made; 25 of them, entero-
viruses. This was the highest total of enteroviruses for anyone year
in the four successive years of surveillance. Fifteen ECHO viruses
were isolated (Types 5, 7, 9 and 29), nine Coxsackie viruses (Types
A 9, B2, B3 and B5) and one polio virus (Type II). Also recovered
were two adenovirus strains, one herpes simplex and two for which
the identification is incomplete. Of the viral diseases identified by
serologic tests, mumps again was the most prevalent with 13 cases.
Herpes simplex or zoster accounted for four, infectious mono-
mucleosis one and rubeola two. The Tampa Bay area experienced a
marked increase of viral respiratory illnesses in early 1966, along
with the rest of Florida and the United States. A special study of a
junior high school in Pinellas County was carried out in conjunction
with the Pinellas County Health Department and influenza B virus
recovered. A number of serologic conversions to influenza virus
also were identified in these pupils. The increased interest in
respiratory illness also resulted in the identification of seven
Mycoplasma pneumoniae cases in the Tampa Bay area. This sur-
veillance and diagnostic service for viral infections has developed
into one of the major activities of the ERC.
The special studies of humans who had serologic evidence of
previous infection with dengue fever of SLE were continued. Epi-
demiologic and serologic data were collected on a group of 29 per-
sons, most of whom were infected with dengue fever sometime in
early life and maintained high titers of antibody. Dengue antibodies
cause considerable crossing in the SLE serologic tests, and precise
information is required to differentiate the two infections. The ob-
servation of immunologic crossing led to further studies of the pos-
sible protective effect of prior dengue fever infection against the
subsequent development of SLE, if exposure to the latter virus
occurs. Epidemiologic or serologic data and laboratory cross chal-
lenge experiments have shown a modest amount of cross protection
between these two viruses.
The biology and entomology sections again had the opportunity to
study an epizootic of Eastern encephalitis in the Tampa Bay area.
Thirty-three clinical cases in horses were reported by practicing
veterinarians. Brains were obtained from 13 of these, and seven
yielded viral isolates all identified as EE virus. Combined sero-
logic and viro logic data indicated that at least 12 cases of EE, two
of WE and nine of undetermined viral etiology occurred in horses
during July, August and September, 1966. Six recoveries of EE virus
from mosquitoes, all Culiseta melanura^ supplemented these data
from horses. The year-round transmission of EE virus in Florida
GENERAL ADMINISTRATION 13
was emphasized by the demonstration of serologic ^°;;;!^L^i^^^^
sentinel chickens in November accompamed by -^;^7^^/ P^J^^^
f,.nm C melanura mosquitoes at the same time and place, a
summary of t^Tour y^rs experience with EE virus in this area
fn™e7 it ca;. be recovered at any season of the year rom njos-
Quitoes, and has been recovered from horses (at either ERC lab
Si^ or others in the state) during all major seasons. Wild birds
^mammals, sentinel chickens, sentinel rabbits and sei^me
^eeons wTre kgain used extensively to detect serologic evidence of
rxlov'rura'ti^ty in the region. All were negaUve -cept for th^
nreviously described evidence of CE and EE viruses. Attempts were
S S^Tn 1966 to recover virus from northward migrating birds
U^nfon the Dry Tortugas Islands at the very southernmost tip of
Florida. Two hundred mnety-three birds were collected repre-
LS 45lfferent species; however, none yielded any arbovinis
The l^ng term studies of small mammals in the Big Bend area of
mLborWh^ounty continued. There was no serologic evidence of
K B vfrus activity in 1966; however, two additional viral iso-
U^s from cotton rats were made. These appear to be jdenticaUo
those found previously and, despite extensive studies in the Um
versity of Pittsburgh, these are as yet umdentified.
Project entomologists continued their studies ^^ ^^e basic biology
and behavior of the Aedes and Culex mosquitoes shown to be arbo-
^L vectors in this area. Precipitin tests of engorged mosquitoes
we7e carried out in conjunction with the Entomological Research
Center at Vero Beach. During June, July and August, special col-
lections of engorged mosquitoes were made to ^mcf ^^^^^^
maximum activity of CE viruses. Aedes infirmaius fed on mammals
m^e oTen than on birds and Aedes atlanticus fed equally on both
groups Both species also fed on turtles. Incidents of more than .
one host per feeding were encountered in both species, often mixing
mLmaliS^ and aviln sources. In the late winter and early spring
S^L studies were made on Odex ntgnpalpus and Odex
laitr^^. During that time of the year, these species appeared to
feed i^tly on mammals. Later in the year (September through
December), C. nigripalpus appears to feed on avian sources. C
melanura is principally an avian feeder year round, although oc-
casional mammal and turtle feedings were detected,
A vear long study was conducted during the year to determme
which orf've^feren'combinations or types of attractants was most
Ifncfent i!. collecting large numbers of arbovirus vector mosquUoes
Attractants compared were chicken, ^^^^njli^^^^^' ^^^ "^^^^^^^
and carbon dioxide in combination, CDC Ught ^rap, and CDC light
trap and caii^on dioxide in combination. The CDC hght tr^ a^^
carton dioxide combination was shown to be the most e^ect ve
means of collecting large numbers of these ^^sqintoes It coUect^d
more varieties of species and was more consistent throughout the
changing seasons.
14 ANNUAL REPORT. 1966
A colony of C. nigripalpus has been established in the insectary
and carried through more than 25 generations. A. infirmatus were
also successfully reared from eggs in the insectary and used for two
different laboratory transmission experiments. In September, do-
mestic rabbits were infected with the local Keystone strain of CE
virus and attempts were made to transmit this to A. infirmatus
mosquitoes and back to suckling mice. The rabbits, unfortunately,
did not develop a high enough viremia to infect the mosquitoes and
no transmission was demonstrated with this experiment.
The virology and serology laboratories continued to support all
of the above field activities. Of 4338 specimens examined for virus,
118 separate recoveries of arthropod-borne viruses were made.
These included the following groups of arboviruses, California— 79,
Eastern encephalitis— 13, Bunyamwera-13, Hart Park-like— 11, and
cotton rat agents— two. Recoveries of one or more arboviral agents
were made each month of the year, except December, for which
testing results are not yet complete. Maximum recoveries were
during the period June, July and August, when California group
viruses were most active.
In conjunction with the University of Pittsburgh, the laboratory
continued its studies of the new tick agent, termed Sawgrass virus,
which was recovered from the tick Dermacentor variabilis taken
from a raccoon in 1964. Nine separate recoveries from ticks found
on either raccoons, opossums or rabbits have been compared by the
CF test and all are shown to be identical. Serologic studies for CF
antibodies to this agent have been performed in the University of
Pittsburgh on a group of representative human and mammalian sera
from the Tampa Bay area; all were negative. A group of sera was
collected from tick infested dogs by a summer student during the
year, and a preliminary screening of these for serum neutralizing
antibodies to the Sawgrass virus has also been negative.
With the support of General Research monies, the laboratory
has undertaken an extensive program to develop a microtechnique
for assaying serum neutralizing antibodies using cell cultures. Pre-
liminary work has been with EE and WE viruses, although once the
technique is established, it will be useful in examining sera for CE
antibody.
The laboratory section moved to the new space provided on the
third floor of the Tampa Regional Laboratory of the Florida State
Board of Health. Constructed primarily for virus research, the
space provides the most modem equipment and facilities in contrast
to the renovated space in a dormitory the laboratory has been using
for the past three years.
In June of the year under discussion, the ERC co- sponsored a
symposium or arbovirus research with the University of South
Florida. Over 100 scientists and interested persons attended this
seminar to hear 30 different scientific presentations. The meeting
GENERAL ADMINISTRATION 15
was held in conjunction with the amiual meeting of the Encephalitis
Idvisory Committee of the Florida State Board of Health J^
EnceplmUtis Research Center staff had interesting mternationa
conUcts during the year. A medical student from the Umversity of
Sheffield in Sheffield, England, spent the ^^^J^^^r months in theERC^
Paners were presented by different members of the ERC stall to a
ryrposiumon"^ California viruses in Bratislava, Czechoslovakia, to
the American Society of Tropical Medicine and Hygiene m Puerto
mco^d to the Western Society for Pediatric Research in Call-
fo^a A major amount of staff time in the fall months was devoted
o™e* pre^amtion of a new National Institutes of Health grant re-
quest to^end the project for another five years after the termi-
nation of the current grant in November, 1967.
TRAINING COORDINATION
R. V. SCHULTZ. M.D.. M.P.H.
Coordina+or of Training
This program consists of two major functions: providing plan-
ning g^ldLcl, and participation in in-service training Programs or
Sc health persomiel throughout Florida; and the admimstration
'and coordination of the agency's academic traimng Prog-m ^^
addition, the Coordinator functions as the fo^al point for receiving
and disseminating training information aiid adv^^.|' „^^ ^^^^^^^^^
Uaison services between the State Board of Health (f ») ^^^^^^^^^^^^
tions of higher learning, federal training programs ^^^^^^
fessional educational efforts related to public health The Trainmg
CooXation Program is within the office of the State Health Officer.
Professional Education Scholarships
The SBH administers scholarship programs for the study ^^
medfctne dentistry, and for graduate and undergraduate education
for career pubUc health employees.
Scholarships for the study of medicine are awarded and admin-
isteredTy the SBH in cooperation with the seven members of he
MeTcal scholarship Advisory Committee The Commmee Ch^r-
man is David W. Goddard,M.D.,of DaytonaBeach The aw govermng
this program provides for one scholarship for the study of osteo
pathic mldicine. This scholarsMp recipient is recommended by to^
^ate Board of Osteopathic Medical Examiners. Jh«J^i"^"fi,P"i
visions of the medical scholarship program have been inadequate.
Sther schoLrship sources are now available -^J -„-'°r/^-^°';,^°^
the Droeram-training, and placement of physicians in Florida areas
of m^eSneed-has^not been effective. The fH^" ^-^e de
the Medical Scholarship Advisory Committee has, therefore, ae
cided to discontinue awarding medical scholarships.
Seven medical scholarships were awarded in 1966. This is the
16
ANNUAL REPORT. 1966
final year of the program. Provision has been made to continue all
scholarships granted in 1966 and earUer so that all recipients still
in school may complete their medical training. The one osteopathic
scholarship, unlike the others, will continue to be awarded each year
by the SBH.
Dental scholarships are awarded by the SBH upon the recom-
mendations of the State Board of Dental Examiners. This program
is administered by the Bureau of Dental Health. The SBH will con-
tinue this activity, but because the financial aspects of these schol-
arships are also too Umited, plans have been developed to decrease
the number of scholarships in future years so that funds for each
remaining scholarship can be increased.
Other professional training scholarships are granted to public
health personnel in order to develop highly trained and appropriately
specialized career employees in the county health departments and
the central office of the SBH. Federal funds for this program are
provided through the Social Security Act of 1935.
MEDICAL
Scholarships Awarded in 1966
Alvin Bryant ^°j«
James Thomas Dawsey • * ; • • '^^ ®
Jack Earle Maniscaico Hillsborough
Charles Wilson Moore, Jr Broward
Elliott Craig Raby P^I"*^'"
Rudolf Bernard Wenleder ^"^^
*David Douglas Asmussen '-*°"
Continuing Scholarships Awarded Prior to 1966:
Awarded 1963: Awarded 1964:
Calvin Collins, Jr. ***Dan.el Les 'e Benboe
♦♦Beatrice Alfredo Denefield **Clarence M. Harris, III
Ronica Mahoney Kluge Jack Benson Owen
*Bodo Eitel Pyko **Elena Suzanne Rose
Kathleen Mary Sonti *Orville Leon Barks, Jr.
Ira Harmon Wenze **James Patrick O Leory
**Phi lip Eugene Wright ..^I'^^.^^cP'^C^vxy'lu^ T
**Charles Edward Walbroel
Rosetta Mae Bush
Edmond Delaney Robinson
Dale Miner Braman
Awarded 1965: ,^ , ^^ ^ .
♦♦Gordon Charles Finlayson ♦Donald L. McBath
Louis B. St. Petery George L. Sanders
Monica Anne Minyard Jul'o Carolyn Revell
(Maternity Leave 1965-66) Harrison Denison Williams
♦♦William Clark Morgan Wayne Raymond Johnson
♦Osteopathic scholarship
♦♦Scholarship surrendered
♦♦♦Dropped from school
GENERAL ADMINISTRATION 17
DENTAL
Scholarships Awarded in 1966:
... . . . .Pinellas
William O. Bolton, Jr Pinellas
Douglas W. Booher *.!!*.!*.*.'.*.**.. .Dade
Harvey I. Cohen *..*..*. Broward
H. J. Emmons i *.*.*.*.'.*.*.*... • .Dade
Alan J. Frank ^ ^ ^ .Dade
Robert E. Hirschfield *.*.*.*.*.*.*... Polk
Owen B. Lovejoy Duval
James E. Moore, Jr Charlotte
Conrad C. Theiss, Jr
Continuing Scholarships Awarded Prior to 1966:
X J J lOA-j Awarded 1964:
Awarded 1963: ^ ^ ^^^ley
John F. Bembry ^ ^^ ^ q.^^^
♦Norman M Bevan Jr ^ ^^^,^^ ^^ ^^^^^^^ ,„
♦♦Robert L. Ferdinand j^^^^,^ j ^^.^„
Anthony B.Fnlingos James E. Owens
Sf^.T.R,' t? i William A. Thompson
Michdel R. Kennedy
Awarded 1965:
Melvin C. Beard, II
Albert J. Endruschot
Richand L. Finkbeiner
Nathan A. Groddy
Leonard W. Peterson
♦Dropped from school
♦♦Surrendered scholarship
David W. Rawson
John L. Ricks, Jr.
Drew H. Turner, Jr.
Richard H. Waldbart, Jr.
John W. Shannon
SBH
PUBLIC HEALTH PERSONNEL
Mnrk Austin Procedures Analyst. . ^^
Wrtn ^^om . Health Field Worker I . SBH
H W Carter M D Public Health Physician III • • • ^B"
^J!; B Earle .... County Sanitation Director Hernando
James B. Earle Public Health Nurse II ^Ma^'O"
E'nt'r, King M.6.- *. ! *. '. '. *. Assistant County Health Director Brov^^
^Mi^sXAn^ne ^rshboume . Nu.itian Held C-dinator . . .... . S«^
Mrs Grace Berry Brown .... Nutrition Consultant .
^Is S^Xara M^ulton, R.N. . . Consultant, MCH Training Program . .^^ .^. ^BH
Alfred Mueller, Jr Sanitarian . . ••••;• ^k^
Charles E. Oxar, D.D.S Dental Division Director.. ^
Milton S. Soslaw, M.D Research Director ^^<^
Ben Frank Watkins Sanitary Engineer II
Arthur C. Stanley Sonitarian
William W. Mahoney Sanitarior*
Harry S. Wein Sanitarian •
. . . SBH
.Pinellas
St. Lucie
. . .Dode
r
18
ANNUAL REPORT. 1966
DIVISION OF HEALTH EDUCATION
VINCENT GRANELL. Ed.D.
Director
The division has enjoyed a banner year in exemplifying the phi-
losophy of service to all. Each section of the division has increased
activities in a supreme effort to satisfy as many requests as pos-
sible from the bureaus and divisions in the State Board of Health
(SBH), county health departments (CHD), voluntary health agencies,
PTAs, schools, other health related professions and the general
public. A total of 15 health educators is employed in CHDs and
there are three vacancies.
Medical Library
The library enjoyed a year of unprecedented growth reflected by
an increase in user population and a larger number of books and
journals circulated. There were added 2206 new books and bound
journals bringing the total number of volumes to 23,046 at the end of
the year. Seven hundred and eight outdated books were withdrawn—
a record number for one year. The vertical file of unbound publi-
cations was increased by 100. ^^
The library was used extensively by the personnel in the SBH
and CHDs. Through interlibrary loans to the libraries of the Jack-
sonville Hospitals Educational Program many local physicians and
others were served. Among professional persons using the library
were physicians, nurses, teachers, lawyers and public welfare per-
sonnel. Other users were students working on term papers and
science projects.
A total of 2432 books was checked out, 1155 on yidefinite loan
and 338 pamphlets. Journals circulated throughout the state totaled
11,045. The library made 2030 day loans (books and journals used
in the library) and 79 interlibrary loans. Thirty-nine bibliographies
were compiled, 2242 reference questions answered, and 3544 photo-
copies made. Seven issues of the "Book Bulletin" were published
announcing the newest additions to the collection.
A complete renovation of library materials shelved in the attic
was accomplished. There are 3770 bound journals, prior to 1945,
shelved in order readily available upon request. A journal shelf list
available in the library permits rapid appraisal of the material in
the attic.
An extensive program of binding of the journal collection was
undertaken for the volumes from 1963 to date. A determined effort
was made to obtain copies of the missing issues so sets could be
completed. The vertical file on pamphlets was brought up-to-date
and a second supplement to the "Bibliography of Articles Written by
Personnel of the State Board of Health" was printed and widely
distributed.
GENERAL ADMINISTRATION 19
A new photocopier was placed in the Ubrary which permitted
more prompt and effective satisfaction of the numerous requests for
photocopies.
The staff worked diligently in the development of a grant pro- ^
posal for participation in the Medical Library Resource Grant hoping
to enhance greatly the service abiUty of the library.
Audio-Visual Library
The Audio- Visual Library had an increase in ^IJ^activities for
1966. Circulation figure of motion pictures and other aids was
12 157 an increase of 1692 over the previous year, or 16.1 per cent.
There were 8164 booking orders processed which represents an in-
crease 0^6. 3 per cent o'ver the 1965 figure A|^^-^^^^^^^
24 774 times reflecting an increase over the 1965 total of 11.4 per
cekt Threquipment used outside the confines of the ^dio-visua
physical pllnt amounted to 348 pieces, an increase of 9.7 per cent
over last year.
The Ubrary added 301 prints of motion pictures to its collection,
some purchased and some on permanent loan from bureaus divi-
s°oTs or outside agencies. Twenty-five prints were removed from
circulation because of obsolescence or excessive tomage Fito
«unDUers loaned 127 prints for preview or use withm the SBH.
Mory as of January 1, 1967 included 1593 prints of motion p.c-
h^res with 580 separate Utles and 259 items of other visual aids
fuch ariilmstrips^d slides. A catalog supplement and the amiual
circulation survey were printed and distributed.
Pamphlets
Pamphlet distribution showed an increase of 90,646 from the
previZ^year flgure of 324,475 for a total of 415,124. The categories
moJt frequently requested In pamphlets were commumcable dis-
eases nSon', s:?ety. Chronic diseases, maternal a^d^^^ hea^^
Florida Health Notes, health careers and sanitation. Reading packets
were prepared and distributed to the teachers.enroUed m the Health
Project in Teacher Education.
Publications, Radio and Television
Eleven issues of Florida Health Notes were printed during the
year with an average pr^ss run of 21,000 copies Subje^s for te
various issues were sewage and water plant operators family p^
nine swimming pools, birth certificates, county health officers
Teven^n^^ghway accidents, Medicare, heart disease, home
health se^ices a simplified amiual report and a special summer
fssue on f^od hy'giene. A total of 42 other books, pamphlets, posters,
fliers and folders was printed.
!f
20
ANNUAL REPORT. 1966
The information specialist made eight trips for the purpose of
doing research and making photographs for Florida Health Notes.
Photographic assignments were covered for the Suwannee CHD,
Division of Nutrition, Project Manasota-88, 3rd Annual Industrial
Editors' Learning and Development Day and the Florida Public
Health Association convention. Consultative services were rendered
to various bureaus and divisions of SBH and a few of the CHDs.
Radio spot announcements were kept current and 14 new spots
were developed and distributed to 201 radio stations.
A 12-month calendar of events of interest to public health per-
sonnel was produced and distributed to all bureaus and divisions as
well as CHDs and other health related agencies. A quarterly publi-
cation specialized in the light side of the news related to personnel
at the SBH, CHDs and voluntary health agencies.
Exhibits and Illustrations
The exhibits consultant had a 15 per cent increase of items ac-
complished over the previous year. He completed 44 exhibits and
displays during the year, made 103 reproductions, 43 illustrations
and also produced 127 charts, graphs and maps, 227 signs plus
photographic materials for 78 slides and made 50 miscellaneous
projects. He was involved in 70 conferences and made 12 trips for
consultation on exhibits and other creative productions.
Educational Activities
The health consultant was active in a variety of educational pro-
grams with PTAs, CHDs, voluntary health agencies and other lay
organizations. Three general orientation programs were held during
the year, each for a duration of four and one- half days. Workshops
on communications problems were conducted for CHDs. Human re-
lations workshops were planned and conducted in cooperation with a
university and nursing students of hospitals. Action snapshots were
taken at migrant workshops, and talks given at adult basic education
conferences. A three-day workshop was attended in Houston, Texas,
on "The Small Group: Its Role in Decision Making in Public Health."
The 10 "Education for All" conferences sponsored by the State
Department of Education were attended by the health education con-
sultant and the director of the division. Many CHD personnel also
attended the conference scheduled in their area. The consultant
participated in the development of the Health Project in Teacher
Education (see report of the Bureau of Maternal and Child Health
elsewhere in this report) and woiiced with the universities and the
CHDs to develop an effective program.
GENERAL ADMINISTRATION 21
DIVISION OF PERSONNEL
MILES T. DEAN. M>.
Director
This division is responsible for the administration of the per-
soJefpr" o the late Board of Health (SBH). This includes
^S^inistrative officers concerning persomiel practices and
^Sment; putting into effect procedures for carrying out ap-
Dr3lSersoLl poUcies; participating in the preparation and
X^stSn of L approved Classification and Compej^atio^
Plan; administering the leave regulation; mamtaimng adequate per
sM^^Tds on all persons employed in the agency; acting as
Sn official with the Florida Merit System involving requests for
certTf^c^t^s and reporting on the selection of eUgiblespro^tions
saSry advancements, salary adjustments, .^^-^^^^^'^^^f^"^
dismissals, lay-offs and resignations; providing f;";^/^"^^^
a service rating system and the ^^^^^^'^'^l.^'.^^^^l^^^
reDorts Payroll operation, also a responsibility of this division,
includes the administration of leave accounting, the employee msur-
ance tojram™ ^ ^ Social Security, as well as the prepa-
ratTonoTth^ administrative payroll and distribution of warrants
P^' par^Uon of the salary portion of the ^f^^^^f^^^^^^^ ^'^^
the Operational Budgets is also a re^onsibility of this division.
The total number of employees in the SBH continued to increase
duri^ng'^theCt year. There'was a considerable inc^e^^
ments due to a degree, to the increased turnover rate. There were
mf employments' duAng this year. An incre^ in personn^^^^^
made in the Grants and Donations category, especially i^^. tne^^.^^\
r^L^irn<uru.e''^rrtrry7erir1:on. s. /o„t. to one
year.
Turnover of personnel continued to be a substantial Pr<*lem.
The^ was a si Acant increase in the turnover «te fo/ -" ^m-
Dlovees during the year. Only approximately 67 per cent of the
«„Ua^ eSer positions werefiUed despite continuous and exten-
sfvf re^Sent Lthis area. Recniitment of the entire spectrum
of heaUh^orers continued to be very difficult with ever increasing
employments above the minimum salary range being necessary.
22 ANNUAL REPORT. 1966
TABLE 1
EMPLOYEES IN THE FLORIDA STATE BOARD
OF HEALTH AND COUNTY HEALTH UNITS
AS OF DECEMBER 31, 1957-1966
GENERAL ADMINISTRATION 23
Year
State
Office
County Health
Departments
Total
Employees
1966
1965
929
2769
3698
1964
1963 ;; ■
1962
914
843
762
2647
2326
1918
3561
3169
2680
1961
692
1821
2513
1960
626
1593
2219
1959
604
1 1534
j 1396
2138
1958
586
1982
1957
558
( 1321
1879
528
1234
1762
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24 ANNUAL REPORT. 1966
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^5
GENERAL ADMINISTRATION
TABLE 3
PERSONNEL IN COUNTY HEALTH UNITS, BY CLASSIFICATION,
FLORIDA, DECEMBER 31, 1966
Alochua
Baker . .
Bay . . .
Brodford
Brevard
Broward.
Gilhoun
Chorlotte
Citrus. .
Cloy
Collier
Columbia.
Dode
DeSoto
Dixie
Duva I . .
Escambia
Flagler .
Franklin
Gadsden
Gilchrist
Glades .
Gulf
Hamilton
Hardee
Hendry
Hernando.
Highlands
Hillsborough.
Holmes . . . ■
Indian River.
Jackson. . . .
Jefferson . . .
Lafayette. . .
Loke
Lee
Leon
Levy
Liberty . . . .
Modison . . .
Manatee . . .
Marion . . . .
Martin . . . .
Monroe . . . .
Nassau . . . .
Okoloosa. .
Okeechobee
Orange . . .
Osceok] . .
Palm Beach
Pasco
Pinellas
Polk . .
Putnam
St. Johns.
St. Lucie.
Santa Rosa
Sarasota
Seminole .
Sumter . .
Suwannee
Taylor. . .
Union. . .
Volusia
Wakulla
Walton
Washington
25
26
ANNUAL REPORT. 1966
TABLE 3 (Continued)
PERSONNEL IN COUNTY HEALTH UNITS, BY CLASSIFICATION,
FLORIDA, DECEMBER 31, 1966
■£
■£
I'I
H
o g
COUNTY
S
o
}
!
i'i
s
X
JO S
«/( UJ
s
0
o
J
p.
8
i
u
S
6
<
Aedea aegypti moaquito
Erodicotion Program Totol
583
8
30
545
Alochoa A. A
15
Brevard A. A
22
1
14
Broward A. A
34
1
21
Dod« A. A
82
1
33
Duval A. A
33
2
3
77
Escambia A. A
u
4
10
19
Hillsborough A, A
92
••••••
1
13
Le« A. A
32
2
3
87
L*of> A. A
10
1
31
ManatM A. A
22
1
9
Monroe A. A
J2
22
Orange A. A
15
i
11
Polm Bwich A. A
25
1
14
Pinellas A. A
73
1
24
Polk A. A
36
I
72
Sf. Lucie A. A
32
1
3S
Sarasota A. A
21
1
31
Volusia A. A.
13
1
20
■
1
1
12
GENERAL ADMINISTRATION 27
TABLE 4
EMPLOYMENT, TERMINATIONS, AND TURNOVER RATES BY
CLASSIFICATION AND SALARY, FLORIDA STATE BOARD OF HEALTH
AND COUNTY HEALTH UNITS, 1966
(full-time employees only)
CLASSIFICATION
Total— All Employees .
Physicians
Dentists
Sanitarians
Sanitary Engineers. . .
Public Health Nurses .
Laboratory Workers
(Prof. & Technical).
Other Professional
and Technical ....
Clerical
All Others
Total— All Employees .
Physicians
Dentists
Sanitarians
Sonitory Engineea. . .
Public Health Nurses .
Laboratory Workers
(Prof. & Technical).
Other Profeuional
end Technical . . . .
Clerica
SALARY
Total
Under
199
200-
299
300-
399
400-
499
500-
599
600-
699
700-
799
800-
899
900-
999
1,000
Over
TERMINATIONS 1966
1,495
13
16
43
5
137
39
122
208
913
35
9
26
231
10
15
135
71
932
" 2
" 29
25
17
60
799
185
37
' 92
1
35
4
16
47
i
1
13
2
27
" i
35
14
1
1
1
1
17
TURNOVER RATE*
43.0
12.7
69.6
5.3
9.4
36.4
14.5
62.2
26.6
Aildthers! . I ^^-^
29.9
49.0
0
33.3
29.2
82.0
22.7
500.0
47.4
50.7
1.8
580.6
37.3
154.5
15.1
145.5
19.7
11.9
7.1
63.0
1.9
62.5
5.6
20.3
2.0
12.5
9.2
4.8
54.0
0
50.0
20.8
11.5
116.7
3.6
11.1
1.8
3.2
54.8
20.0
0
16.7
9.1
17.4
0
17.4
20.0
0
0
33.3
37.5
13.0
12.5
0
14.3
0
0
25.0
•Terminations os a per cent of averoge 1966 full-time employment, by salary within each classification.
12
11
10.3
11.7
0
8.3
DIVISION OF PUBLIC HEALTH NURSING
ENID MATHISON. R.N.. M.P.H.
Director
The division attempts to ensure that the highest quality nursing
service possible is available in each of the county health depart-
ments (CHDs). Information, advice and assistance in connection with
the pubUc health nursing aspects of P^2^^*^o^'''^r%^fh7sRHT
vided all bureaus and divisions of the State Board of Health (SBH).
PubUc health nursing, available to every member of the commum^,
is integrated and coordinated with all services of the total public
health prograih. The nurse has specific professional functions as a
member of the health team; guidance for the direction of nursing
programs and services on the local level is provided by the division.
PubUc health nursing in a rapidly changing society requires con-
stant re-evaluation so that it may adapt into programs and services
at all levels. Consultants from the division work closely with the
111
28
ANNUAL REPORT. 1966
personnel in CHDs to assist them in establishing priorities for
nursing programs. When services must be curtailed in some areas,
as new programs are initiated without the addition of new staff mem-
bers, assistance is given in making decisions as to which services
will be reduced or dropped.
A very serious handicap to the work of the division this year has
been the inability to fill four vacant positions. One of the consultants,
with the longest experience in the state, became coordinator of the
Home Health Services Program. The advent of Medicare and num-
erous new special projects which require nursing services for im-
plementation have made it necessary for the staff members to re-
direct their activities.
The first two months (January and February) were devoted al-
most exclusively to surveys of local health agencies, both official
and voluntary, to determine their eligibility for recommendation for
certification as providers of services under Medicare. Revisits to
give assistance in meeting the conditions of participation were nec-
essary in most of the agencies, sometimes as many as three visits
were made. It was gratifying that 57 agencies were eligible for
certification by the end of the year.
In July a hospital nursing consultant joined the staff; she has
worked most effectively in the nursing home program.
In cooperation with the School of Nursing at Florida State Uni-
versity, a short-term traineeship grant was obtained for a five-day
workshop on Public Health Nursing Supervision. Forty-five super-
visors and potential supervisors participated; five were from
Georgia, South Carolina and Tennessee.
Under the leadership of the assistant director of the division, the
Continuing Education Committee, composed of local directors of
nursing, supervisors, staff nurses and public health faculty from
two colleges of nursing, published a GUIDE FOR ORIENTATION
OF NURSES NEW TO PUB UC HEALTH and a GUIDE FOR A
HOME HEALTH AIDE PROGRAM. Numerous requests for these
have been received from other states. All consultants have given
additional attention to the continuing education groups on local levels
to help them prepare for Medicare, special maternal and infant care
projects and other special programs. In 50 of the counties there are
regularly scheduled in-service education programs, 17 have either
intermittent or no programs.
To meet the requirement, an eight-week planned orientation is
given new public health nurses who have not had preparation or ex-
perience in public health, prior to receiving permanent status. Four
field teaching centers are available to nurses from counties which
do not have a qualified and adequate staff to provide the approved
orientation. Sixteen nurses received the training away from their
GENERAL ADMINISTRATION 29
homes. Stipends were provided for them during the orientation
pS. The larger counties conduct courses for their staffs.
Soecial emphasis has been devoted to the overall home health
aide pi^gram^ith careful attention given to the estabhshment of a
^roner^mage of this new member of the nursing team in the eyes of
S S^es and the pubUc. Because of the very successMex-
Ser ence^ the St. Petersburg Visiting Nurse Association has had in a
Some health aide program (estabUshed in September, 1964), th s
Ttouv Seed to provide a five-day orientation for nurses who would
iupSe the service in other agencies throughout t^^^^^^^^
nubUc health nurses attended and 12 certified Home Health Services
are using the home health aide on their team. All aides receive the
course al outUned in the Guide prepared by the Continuing Education
Committee.
To meet the requirements of Medicare for estabUshing a valid
cost for Services rendered recipients served through Home Health
Agencies c^sulLts are giving concentrated help to the nurses in
doTng ^eir t"me ax>d cost Studies. The average cost per home visit
for lilease and disability is $5.59 and for heath supervision ^17
aher average costs are: cUnic session $33.11, visit to a schoo^
$15.94, visit to a nursing home or day care center $9.92 and class
or group teaching $15.69.
Efforts to improve and extend '".^.^^^l/^^A^ff '°tftot'"ucen'i*d
^,ti»nt« have been rewarding as evidenced by the fact that licensea
Sves are nTpracticing in 18 counties. The total number of
m Ss Ts 11 less than last year; 168 were Ucensed this year
wort in the form of a stipend is still provided by the Bureau of
Maternal and Child Health for new midwife trainees to attend^
"ree week training program made possible by the Semino^^ J^™
and the Marie Francis Maternity Home m Sanford. Applicants are
^re^llv selected and after a need is estabUshed, and recom-
menced'by both the CHD and the maternal and child health nursmg
consultant.
Ei^ht orientation programs for protessional workers were
scheiled by the consultant in the Mental Retardation Program at
the four Sunland Training Centers; attendance was 106. Over 100
persons SrtSated in 'two community educational programs on
mental retardation.
Reauests for programs and workshops in rehabiUtation nursing
exceed the time Available by the consultant in this specialty. Forty
Droer^swer™ conducted for pubUc health nurses and nursing home
^erlorel. There is urgent need for this service in the nursing
homes throughout the state.
The consultants made 400 visits to CHDs and voluntary health
agencies.
30
ANNUAL REPORT. 1966
BUREAU OF ADULT HEALTH AND
CHRONIC DISEASES
J. E. FULGHUM. M.D.
Direcior
The nature and extent of the complexities of various chronic dis-
eases which present themselves as public health problems continue
to receive the attention of this bureau. Education and training pro-
grams have played a large part in the activities of the bureau staff
Progress has been made in increasing the knowledge and awareness
of the pubUc about chronic diseases. Active participation directed
to the professional level has been successful in bringing to the
physician an awareness and appraisal of the newer methods of pre-
vention, diagnosis, treatment and rehabiUtation of patients with
chrome diseases. Health profile screening has been emphasized
where such programs met the needs of the community.
The active ongoing programs within the bureau are programs in
aging, cancer, heart disease, diabetes, prevention of blindness and
smoking and health.
Consultation Visits
During 1966, the staff of the bureau provided field consultation
visits as foUows: cancer 74, heart 32, diabetes 90, prevention of
bUndness 45, smoking and health 10, and other special projects 23
with a combined total of 274 trips or visits. '
Relationship with Other Organizations and Agencies
The bureau is represented on the Florida Cancer Council the
Florida Coordinating Council for Cardiovascular Diseases and the
American Cancer Society, Florida Division, Inc., the Florida Com-
mittee on Smoking and Health, Florida Diabetes Association, Florida
Tuberculosis and Respiratory Disease Association and the Florida
Society for the Prevention of BUndness. These activities contribute
to a good working relationship with the major voluntary agencies
within the state.
Health Profile Screening
At the request of the Charlotte County Medical Society, made
through the Charlotte County Health Department (CHD), the bureau
conducted a Health Profile Screening Program in Port Charlotte one
week in 1966. The purpose of this program was to provide screening
examinations, at no cost, to the general public. Positive screenees
were referred to their private physicians for diagnosis and treat-
ment. Persons over 35 were accepted for the following screening
examinations: 1) medical history, 2) height and weight, 3) visual
acuity, 4) tonometric examination, 5) blood pressure, 6) X ray and
1) blood sugar determination. A total of 1824 persons was screened
ADULT HEALTH AND CHRONIC DISEASES 31
and 706 suspects were found and referred to the physicians in Char-
lotte County. From the number referred, 46 suspects or 2.5 per
cent were referred for glaucoma and 176 or 9.6 per cent were re-
ferred for diabetes.
AGING
Health problems of the aging are weU known and identifiable.
There are presently 750,000 older (over 65) persons in Florida who
are affUcted with the usual infirmities of the aging. This total of
older Floridians will be increased to an estimated 1,000,000 per-
sons by 1970. Many of these people are on fixed incomes and have
been caught up in the increased cost of Uving, high taxes and dis-
abiUties resulting from the chronic diseases. They find themselves
with depleted resources and become dependent on the commumty for
assistance. Florida is above the national average in proportion of
older persons because it is a favorite retirement state.
ResponsibiUty for the health programs for aging is vested in
the bureau. Close Uaison is maintained with the Commission and
Council (the voluntary health agency in Florida) on Aging and the
Florida Medical Association Committee on Aging. Health services
for the aging are provided as a part of the general health services
which are available to the population at large.
It is desirable to estabUsh an active program on aging in the
bureau so that health education, preventative screening, early case
finding and physical rehabiUtation programs can be planned for and
implemented.
A survey of the states and territories has been made to deter-
mine the extent of health programs in aging being conducted m state
health departments. Results of this survey are being compiled and
studied.
CANCER CONTROL PROGRAM
During 1966 maUgnant neoplasms or cancer maintained aposition
as the second leading cause of death for Floridians and thus remains
a major health problem for Florida. Cancer mortality continues up-
ward from 9701 Floridians in 1964 to 10,352 in 1965 and it is esti-
mated that it will exceed 10,700 for 1966.
The provisional cancer death rate per 100,000 in 1966^0^ Florida
was 179.9, while the estimate for the United States was 160.0. This
large variance of rates is understandable in view of the nse in
Florida's population over 65 years of age.
In the past decade, 1955 to 1965, cancer mortaUty in Florida for
most sites experienced only a slight increase or in some cases a
tendency to level off. The large increase in the overall mortality
rate of 141 9 in 1955 to 179.9 in 1966 was substantially due to
32 ANNUAL REPORT. 1966
increased rates for a few sites. The sites mainly responsible for
this rise were cancers of the lungs, the digestive system and the fe-
male breast. Cancers of cervix uteri continued to lead in the down-
ward trend for cancer mortality and gives evidence of the fruitful
results for the doctrine of early detection. The need for cancer con-
trol has never been greater and this need continues to grow with the
techniques and the advancement of knowledge in the management and
control of the cancer patient.
Tumor Clinics
The Cancer Control Program continued during the year to lend
its full support to the Florida tumor clinic system. The tumor clinic
at White- Wilson Clinic, Fort Walton Beach, Florida, was closed on
June 1, 1966. No new clinics were approved during 1966, however,
interest and inquiries for forming new clinics remains strong. There
are presently 27 approved tumor clinics operating throughout the
state. It is conjecture at this time to say whether Medicare was the
cause for the drop in patient visits to the clinics from 39,655 in 1965
to 35,596 in the past year. The private physician serving without
compensation continues to be the mainstay of the tumor clinic. The
hospital furnishes without charge supplies, equipment, space and in
some instances personnel to support the clinic. Approximately 50
per cent of the ancillary clinic personnel, such as tumor clinic sec-
retaries and registry clerks, is furnished by the State Board of
Health (SBH) Cancer Control Program. The American Cancer Society,
Florida Division, Inc., also lends support to the tumor clinics and
sponsors some clinic personnel. Volunteers serve in many clinics
on part-time positions. The SBH furnishes limited fees for diag-
nostic work, radium and X-ray treatment for the indigent outpatient.
Cervical Cytology Program
The County Cervical Cytology Program experienced excellent
growth during 1966. These programs are planned around ongoing
programs of the local CHDs by introducing the "Pap smear" tech-
nique along with other examinations being conducted in the Bureau
of Maternal and Child Health (MCH) programs of "Family Planning,"
"Postpartum Care" or other allied clinics. Twenty- six counties
engaged in cervical cytology during 1965, screening 11,362 women.
Through December, 1966, there were 39 counties engaged in cervical
cytology screening 21,042 women. From those screened, 438 sus-
picious or positive cases or 2.1 per cent were referred to tumor
clinics for further examination or treatment.
Statistical Tabulating Center
The Statistical Tabulating Center originated as a federal project
grant from July, 1963 through December, 1965. This center was
formed at the recommendation of the Florida Cancer Council and the
ADULT HEALTH AND CHRONIC DISEASES 33
Florida Association of Tumor Clinic Directors. The project became
Tperma" the Cancer Control Program in 1966 and is now
L ongoing program. There are currently 19 registries reporting to
the center.
The value of the center in improving and maintaining quality
control of cancer case records has proven Itself. The center is able
to monitor and assist the independent member registries towards
uoewdin^ their registry, cancer records and follow-up Procedures
A lysTem of providing^ amiual follow-up Usting during the month
of follow-up for each registry has been instituted. This will aid the
r^stry as a checkUst and should result in a mimmum of "lost to
follow-up" cases.
The center publishes an annual report reflecting the information
and statistics in its case files. The detail of data being coUected is
™ehensive Interest in the central registry is expected to grow
wit" the ^ticipated production in 1968 of a five-year survival re-
porf. A preUminary three-year report is under consideration.
Professional interest remains strong in the center its reports
and progress. The Florida Cancer Council and the Florida Associa-
Uon of lumor CUnic Directors continue active support of the center,
and have provided steering committees for the center in its growth
1 current committee by the tumor cUnic directors is making a study
of oresentirdata from the center in sUde form for educational ,
ptoses tL center in the future will provide professional and lay
groups with the cancer facts for Florida.
Polk County-Aid to Dependent Children Survey -Cytology
The Cancer Control Program conducted a survey of Aid to De-
pendent Children recipients of Polk Countj in cooperation with the
^olk CHD. From January 1, 1966 through SePt^ber 1966 113^
women were screened, and seven positive and 33 suspicious cases
were found.
j# ANNUAL REPORT. 1966
TABLE 5
PATIENT VISITS TO TUMOR CLINICS
ASSOCIATED WITH CANCER CONTROL PROGRAM,
FLORIDA, 1966
1966
Alachua General Hospital 125
Boy County Tumor Clinic , .' ^}^
Brevard County Tumor Clinic 50
Broward General Hospital •....♦ ;^y^
Duval Medical Center _ ^ ^ 5496
Escambia Getwrol Hospital 2187
Halifax District Hospitol 14^
Hollywood AAemorial Hospital 225
Jockson Memorial Hospital 3246
Lee Memorial Hospital •
Leesburg General Hospital U
Manatee Memorial Hospital )49
Mercy Hospital 33g
Mf. Sinai Hospital 1359
Munroe Memorial Hospital 288
Okaiooto County Tumor Clinic ••3]
Orange Memorial Hospital 3I44
Pinellas County Tumor Clinic 2095
Pblk County Tumor Clinic ]622
St. Francis Hospital ^2
St. Lucie County Tumor Clinic 215
S*. Mory's Hospital 9g4
St. Vincent's Hospital 2433
Sorosoto County Tumor Clinic 237
TalloKossee Memoriol Hospital 1300
Tompo General Hospital 3653
University of Florida 3612
Variety Children's Hospital '[ JO47
TOTAL 35596
• Clinic patients treated in private physician's office — no report.
•• Closed during 1966 (June 1),
HEART DISEASE CONTROL PROGRAM
Heart disease continues to be Florida's most serious health
problem. Mortality statistics show heart disease to be the main
cause of death in the state. The death rate per 100,000 rose from
324.5 in 1956, to 379.2 in 1956. While some of this is undoubtedly
due to the increasing number of older people, the rate has also in-
creased for the age group between 45 and 64 years. The SBH has
continued to work with the Florida Heart Association and maintains
its supporting role with the Florida Heart CounciL
Rheumatic Fever Prophylaxis
The prophylactic treatment of all patients with documented rheu-
matic fever has been an effective method of reducing the incidence
of chronic rheumatic heart disease. The SBH provides penicillin
and sulfadiazine through CHDs to medically indigent patients upon
request of their family physician. The registry shows 1228 people
were receiving prophylactic treatment through this program at a
cost of $11,028 or $9.17 per person per year.
Heart Clinics
Heart clinics are supported through CHDs from heart funds.
ADULT HEALTH AND CHRONIC DISEASES
35
Medically indigent patients are provided with specialized care
through these clinics which are staffed by private physicians serving
without compensation. Most of the clinics are supported jointly by
the Florida Heart Association, the Crippled Children's Commission
and the SBH. CHDs report 7825 patients admitted to heart disease
control activities in 1966.
Health Education
Probably the most effective pubUc health activity in the Heart
Disease Control Program is health education. The CHDs and local
heart association offices act as distribution centers for pamphlets,
brochures and other literature concerning heart disease. The SBH
cooperates with the Florida Heart Association in the distribution of
educational materiaL Speakers are made available and audio-visual
aids are furnished to civic organizations and schools on request.
A resource bulletin, "The Heart and Circulatory System," is being
prepared jointly by the Florida Heart Association and the SBH.
prevention
The prime pubUc health goal in the realm of heart disease is
prevention. Congenital heart defects can be prevented only when the
responsible factors are well understood and an informed public is
given the choice of preventing pregnancies under conditions known to
yield a high per cent of defects. Some progress is being made in
that certain virus infections and some drugs are known to contribute
to the per cent of infants bom with defects. Rheumatic heart disease
is beginning to respond to the prophylactic treatment program which
prevents secondary streptococcal infection. Arteriosclerotic heart
disease is still not completely understood, however, the medical
profession has agreed that certain factors are so closely related to
the disease that they can be used as criteria for detecting those
most likely to develop an acute heart attack. Cigarette smoking,
inactivity, obesity, diabetes, hypertension and hypercholesterolemia
are factors thought to be amenable to manipulation by the combined
efforts of the patient and his physician. Screening programs for
these factors are being developed to identify the high risk person
and refer him to his private physician for a personalized prophy-
lactic treatment program.
Symposium on Coronary Intensive Care Units
The director of the bureau made the plans for a symposium on
the operation of intensive care units for coronary patients. It was
held on January 16, 1966, in Cocoa Beach, with the professional as-
sistance of the Florida Heart Association and financial support of
the U. S. PubUc Health Service (USPHS). Legal and admimstrative,
as weU as professional problems related to the operation of this
specialized type of intensive care units were discussed.
in
1 i
m
m
36
ANNUAL REPORT. 1966
Intensive Coronary Care Units
Until some method of preventing myocardial infarction has been
developed, the profession will be able to reduce the death rate from
this disease by treating patients with acute coronary disease in
intensive care units designed specifically for these patients. The
SBH is interested in helping hospitals find financial support for such
units. Eight hospitals have coronary care units separate from gen-
eral intensive care units, and three others are planned for 1967.
Stroke Rehabilitation Project
A special rehabiUtation project for stroke patients was started
in Escambia County where patients are treated in group sessions.
The project has demonstrated the marked improvement in patient
motivation when rehabiUtation efforts are made in small groups of
patients with a similar degree of disabiUty. The stimulus of com-
peting with other patients has been a strong positive motivatmg
influence.
Cardiovascular Seminar
The SBH and the Florida Heart Association co- sponsored the
Ninth Biennial Cardiovascular Seminar which was partially financed
through contributions from the SBH. The session was of great value
in bringing Florida cardiologists together to share in the recent
advances in the field.
DIABETES CONTROL PROGRAM
Florida's popularity as a retirement area has caused a steady
rise in the state's median age and a corresponding increase in the
number of both known and unknown diabetics who are now residents
of Florida. Based on preliminary data obtained during the period
January 1, to September 30, it is estimated that 933 Florida resi-
dents died of diabetes during 1966.
In 1966, diabetes ranked as the tenth leading cause of death
among Florida residents.
Diabetic retinitis is one of the important causes of blindness
within the state. Only cataracts and glaucoma are greater causal
factors for blindness at this time.
The Diabetes Control Program is organized into three major
areas as follows: Insulin distribuUon, casefinding and education.
Insulin Distribution
State funds are used to furnish insulin for the medically indigent
patients of the state. Approximately 3309 medically indigent diabetic
patients are now receiving all or part of their insulin from state
sources through the CHDs. The average annual cost per patient
ADULT HEALTH AND CHRONIC DISEASES 37
under this program increased from $15.05 in 1965 to $15.87 in 1966,
primarily due to the increase in cost of insulin.
The insulin distribution program has a local diabetes registry
which is used for follow-ups, for relative casefinding programs and
as a reliable source of data for program evaluation.
Casefinding
Casefinding is primarily the responsibiUty of the CHD, with as-
sistance from the community and the SBH in the areas of consul-
tation, program planning and limited aid for conducting diabetic
surveys. Casefinding activities were reported in counties throughout
the state. Well over 32,402 persons were reported screened in
programs during 1966, with approximately 1167 persons being re-
ferred to their family physicians for diagnosis.
Casefinding activities have been primarily in three areas: office
of private^hysicians, community diabetes screening programs and
relative testing programs.
Diabetes screening has been introduced into most of the migrant
clinics in the state utilizing the rapid blood stick method for those
individuals who fall into the "high risk categories." Suspects are
then given further diagnostic evaluation before a diagnosis is made
by the physicians.
Two new types of blood testing, Destrostix and Unopette, were
phased into the program during 1965 and 1966, which allow greater
flexibility in casefinding and routine patient care.
The screening forms for use in mass screening programs were
simplified and condensed during the year. These forms, combined
with the use of "Diet Check List," developed by the director of the
Division of Nutrition, have greatly facilitiated the registering of the
screenees and the determination of the approximate amount of car-
bohydrate each has consumed prior to the administration of the test.
Screening programs for diabetics is another method of con-
ducting extensive public education. Large coordinated commumty
diabetes screening programs are being conducted in Florida during
Diabetes Week, health fairs and at other times. Postprandial blood
sugar determinations, two hours after a test meal, is considered to
be the method of choice. Relative testing programs are the most
productive and CHDs and communities are encouraged to conduct
such screening programs at regular intervals.
Professional Information
The Florida Diabetes Seminar was held on September 29 and 30,
1966, in Miami Beach. The Florida Diabetes Association, the Um-
versity of Miami Medical School, the Postgraduate Education Branch
of the University of Florida College of Medicine and the SBH
38 ANNUAL REPORT. 1966
cooperated in the planning and presentation of this P^Jessior^l
seiSnar. Over 100 physicians from Florida attended this two-day
meeting.
Several classes were held for CHD nurses, stressing the impor-
tance of diabetes screening, methods of casefinding and Patient eA,-
cation. The purpose of the classes was to inform nurses of the latest
techniques of screening and patient education and to review symp-
toms, treatment and complications.
Public Education
Societies for diabetic laymen are a most important means of
promoting lay and patient educational activities as well as case-
'i^S D^rin, the past year, the ^^'^^^."^^^^^Kl^^^^^
has assisted the Florida Diabetes Association and their local lay
societies in disseminating pertinent information. At the Present time
there are 14 active societies for diabetic laymen within the state.
Timely Topics, a monthly bulletin for diabetics, is prepared and
distributed to over 4000 persons per month, ^jiese P^^^^^°^^^^^^^
diabetics relatives of diabetics, friends of the diabetic, or have a
femTine interest in diabetes controL Timely To/ncs represents an
Economical way to get timely information to the diabetics. Copies
are available on request.
Patient Education
Brevard, Broward, Dade, Escambia, Highlands, ffiUsborough
Lake, Manalee, Orange, Palm Beach, Pinellas, Polk. Sarasota ^d
Volusia CHDs are carrying on programs Involving patient educatioru
These are coordinated programs, co-sponsored by the CHD, tne
local medical society and/or the local society for diabetic laymen.
Two new pamphlets, one for the lay pubUc entitled, Here is a
QuJlame That my Save Your Life and the other Screemjand
biaenosis in Diabetes Mellitis for the Physician, were made avail-
able for distribution during the year. Both were well received and
have proved to be quite popular.
Other Studies
A special study is still being conducted by the Pinellas CM) to
explore the causal factors and treatment of hypoglycemia and its
reLtionship to alcohoUsm. Blood sugar levels are measured before
r challenge meal and at intervals one, two or three hours post-
prandially! These tests are conducted among volunteers of the local
branch for Alcoholics Anonymous and the results are recorded on
^dividual graphs for comparison and evaluation of he hypothesis
Itat -the alcoholic may be induced to imbibe due o the rapid fluc-
tuation in blood sugar from hyperglycemia to hypoglycemia.
ADULT HEALTH AND CHRONIC DISEASES 39
PREVENTION OF BlINDNESS PROGRAM (GLAUCOMA)
Glaucoma is the second ranking cause of bUndness in Florida,
and accounts for about 15 per cent of aU bUndness in the state.
Glaucoma affects two per cent of the population over 40 years of age
and a significant number of persons under age 40. The state and
federal government spend at least $300,000 per year through the Aid
to the BUnd Program to persons bUnd due to glaucoma. Because of
the continued increase of senior citizens moving to Florida for re-
tirement, it is expected that bUndness due to glaucoma wiU uicrease
more thi. the national average. Loss of vision caused by glaucoma
can usuaUy be prevented if the disease is detected early and ade-
quately treated. Glaucoma occurs most often after the age of 4U,
and the disease increases in incidence with age.
The objectives of this program are to support the estabUshment
and operation of glaucoma detection centers in populous areas of the
state in conjunction with the assistance of the local ophthalmologists
and the community resources; to screen the population for g^-
coma and refer those uidividuals found with increased ocu^r ten-
sions to ophthalmologists for diagnosis and treatment when mdicated,
to do operational research on newer methods and techniques of glau-
coma screening; to compile, study and utiUze the multitude of data
available as a resuU of screening acUvities; to encourage profes-
sional education of interns, residents, general practitioners and in-
ternists of the state in appropriate screening methods and tech-
mques of ophthaUnological examinations so that these physicians can
then incorporate such screening methods as a routine Procedure in
their private practices; and to promote pubUc information and lay
education societies.
Most of the effort and expenditures during 1966 were directed
toward the early detection of glaucoma in the estabUshed screening
centers throughout the state. Four counties conducted fuUtime
screening pro|rams, wiU, the financial assistance and consultation
of the Neurological and Sensory Disease Service Program, USPHS,
the SBH, and the many community resources. These screemng
centers continue to have excellent response from the residents of
these areas. During 1966, 32,672 persons were screened fof glau-
coma and 1044 (3.2 per cent) were referred to medical eye doctors
for diagnostic evaluation. Since the first screening program was
initiated in 1962, nearly 100,000 persons have been screened for
glaucoma and 2846 (2.9 per cent) suspects were referred tor diag-
nostic evaluation. The exceUent toUow-up of the suspects continues
to be a highlight of the program. The screening centers have re-
ferred over 2800 suspects to local ophthaUnologists for diagnosis
and lost less than five per cent to follow-up.
40
ANNUAL REPORT. 1966
Established Programs
Polk County Eye Clinic^
The Polk County Eye CUnic, initiated April, 1962, was the first
to conduct a glaucoma detection program. This past year, 858b
persons were screened for glaucoma, and 167 (2 per cent) were re-
ferred to medical eye doctors for diagnostic evaluation. The c lime
has screened a total of 47,004 since it was opened and referred 1107
(2.4 per cent) glaucoma suspects to medical eye doctors.
The staff at the Polk County EyeCUnic conducts ^ family -relative
study on those persons who have been diagnosed with glaucoma. To
date 197 relatives of known glaucoma patients have been screened,
and 21 of these (10.7 per cent) have been referred as suspects. The
results of this family- relative study further indicate the need for
blood relatives to be examined for glaucoma. Although tlus type of
casefinding is more time consuming, it does appear worthwhile if
the schedule will permit.
The Polk County Eye Clinic has served as a training center for
workers from other counties that are interested in the prevention of
bUndness. Personnel from the Polk County Center have assisted with
the initiation of several other programs around the state. This serv-
ice allows more stability and continuity in training other persons.
Volusia County Eye Clinic
The Volusia County Eye CUnic has been in operation since Sep-
tember 1963. The cUnic, located in Daytona Beach, is known as the
Halifax' District Hospital Eye CUnic. This cUnic offers glauconja
screening and other complete eye services. During the year, 47J9
persons were screened for glaucoma, and 85 (1.8 per cent) were re-
ferred to medical eye doctors for diagnosis. A total ^^ 24, 5bO per-
sons has been screened since the clinic opened, and 567 (2.d per-
cent) have been referred to the medical eye doctors. It is of interest
to note that the referral rate for the nonwhite (5.8 per cent) is con-
siderably higher than the white population (2.2 per cent). Further
study will be carried out on the nonwhite group to determme if this
high rate will remain constant.
Broward County Glaucoma Detection program
A glaucoma screening program was initiated in Broward County,
January, 1965. A nurse is assigned to the CHD and is supervised by
the director of the Broward CHD and a Fort Lauderdale ophthalmol-
ogist. This program has demonstrated excellent cooperation between
the CHD, the ophthalmologists and the Broward County Medical
Society.
The Broward County Program has been very successful to date.
A total of 15,989 persons has been examined for glaucoma and 689
(4 4 per cent) of these have been referred to medical eye doctors for
ADULT HEALTH AND CHRONIC DISEASES 41
^•o<mo<.is Screening clinics have been scheduled in aU areas of the
Srto'provide^^^^ opportunity for more citizens to benefit from
this service.
Pinellas County
The Pinellas County Glaucoma Screening Program was initiated
r. * wit 1 0fi^ This Droeram is supervised by the Pinellas CHD,
with assi Unce f^om^he' mnellas County ophthalmologists and the
P nelLs Courty Medical Society. The response to this new program
by thf local citizens has been excellent. Because of the great de-
mand for glaucoma screening, it was necessary to emPloy ^^-
itional nurse to assist with the program. A total of 12,312 persons
tr been screened for glaucoma since the program was imtiated,
and 474(3.9 per cent) suspects have been referred for diagnostic
evaluation.
Duval County
An eve cUnic has been estabUshed at the Duval County Medical
Cenfer fn Jacksonville. This cUnic provides total eye care or the
Sent population of Duval County. A nurse l^^^ bee" Pro^^^^f^*;
assist in the cUnic and to screen for glaucomain the medical center.
Ibout 500 patients are being foUowed In the gl^"<=oma cUmc Ap-
nrnximatelv 10 new cases are found each month. This cUnic con
Ces to provide eye care to a needed group of persons that other-
wise would not be able to obtain such care.
Seminole County
A oart-time glaucoma screening program was estabUshed in
Seminole Courty in 1965. The health director obtained approval from
tlTsrmtnolTcounty Medical Society -d then support from the U^ns
Club and two ophthalmologists from Orange County Screemng
cUnics are conducted two afternoons ^^fZ^^^'^^l^so^C
ophthalmologists have instructed nurses £j-°i" ^he cro stafl so y
can assist with the screening P^^^ J'^^^tene" ^Jpr^imately
each time they were conducted and have screenea w
700 persons, of which 10 were positive for glaucoma.
Short Term programs
Glaucoma screening programs of one to fije <^y«. f J^^°" ^^
been conducted as special projects in some a«as 1*^ centers are
Tf °^ ■'bL^^nrsic^^gTrwrrrte^^^
not feasible. One sucn progiaiu wo. «;prp rpferred for
and a total of 1826 ^rsons was screened and^^^^^
^^^^fca^r ofg-Jcra rdlii^e als^o ilelped make the pubUc
more aware of the disease.
ii
42 ANNUAL REPORT, 1966
Other Activities ^
Survey of Screenees with Less than 20/40 Visual Acuity
A special activity that three of the screening centers undertook
this past year was a survey of 518 persons that were not glaucoma
suspects but could not read 20/40 when tested at the glaucoma
screening clinics. The three centers mailed a total of 518 letters to
persons that could not read 20/40, and asked if they had visited an
eye doctor since they had been made aware that their vision was
less than 20/40, and what type of doctor they visited. A total of 327
(63 per cent) persons returned the questionnaire which indicated that
198 (61 per cent) had their eyes examined by an eye doctor after
being made aware that their vision was less than 20/40. Since the
program was initiated, 17,606 persons have been found with vision
less than 20/40.
Special Studies
A Double Study of 106 Screenees
A special glaucoma project was carried out at the Halifax Dis-
trict Hospital to determine the number of glaucoma patients missed
in Glaucoma Detection Programs and to evaluate the present testing
methods of glaucoma screening. Single tonometry measurements
were compared to other accepted tests used to diagnose glaucoma,
such as disc evaluation, tonography, visual fields and applanation
tonometry. A total of 106 patients was tested and seven persons
were found to have early signs of glaucoma. This project confirmed
the suspicion that with single tonometry measurements up to 50 per
cent of the screenees with glaucoma may be missed. However, this
cannot be helped since in the early stages of glaucoma, the intra-
ocular pressure may be normal at the time of day that the tension is
chocked, but may go up at night or other times of the day. Only
through repeated tension checks can patients with glaucoma be de-
tected and this is the reason for the recommendation that patients
return for annual rechecks.
Examination of 65 Diabetic Children
Another special project was to examine an entire camp of dia-
betic children to determine evidence of diabetic involvement of the
eye at an early age and whether there is a greater incidence of
glaucoma in diabetic children as reported in the literature. This
project was carried out atCampImmokalee. Sixty ^ive children were
examined and no abnormal intraocular pressures were found. Only
one child had evidence of early diabetic involvement of the fundus.
ADULT HEALTH AND CHRONIC DISEASES 43
to diagnose data for all glaucoma detection programs is sum-
marized as follows:
Total screened, all ages ........... 99,865
2,846
1,309
261
975
Number referred to ophthalmologists for diogrK>sis. .
New cases diagnosed glaucortKi
Cases diagnosed borderline . .
Diagnosed negative for glaucoma ^^
Suspects being followed
Lost to follow-up:
a. Cannot locate ^
b. Uncooperative *
c. Illness or deceased J^
Number persons not able to read 20/40 I/,«K)
TABLE 6
GLAUCOMA SCREENING PROGRAM DATA,
FLORIDA, 1966
County ond Ag«
Persons
Examined
Persons
Referred
Per cent
Referred
TOTAL
32,672
1044
3.2
COUNTY
8968
10,379
RSR6
4739
389
403
167
85
4.3
3.9
2.0
1.8
Broward
Pin«lias
Polk
Volusia '
AGE
Under 35
35-44
3928
3RR2
4829
7073
98RS
2880
195
16
51
109
238
464
153
13
.4
1.3
2.3
3.4
4.7
5.3
6.7
45-54
55-64
65-7*
75-84
85+
J 1
Summary
Since the beginning of this program in April, 1962, the follow-up
N
SMOKING AND HEALTH
The bureau has continued to lend its full support and direction to
the activities of the Florida Committee on Smoking and Health. The
committee consists of representatives from: Florida Medical As-
sociation, SBH, Florida Heart Association, American Cajicer So-
ciety, Florida Division, Florida Tuberculosis and Respira ory Dis-
ease Association and Florida State Department of Education. An
office for the committee is maintained in the bureau.
The committee serves in an advisory capacity and furnishes con-
sultant services when requested. It does not in any way try to super-
cede existing programs, active joint committees or duplicate work
being done by other groups.
The committee has been instrumental in the preparation and dis-
tribution of much informational and educational materia . Some of
the most recent materials and publications are: a pamphlet entitled
•The Logical Move" which is aimed at the ^duU smoker Every
physician in Florida was sent a copy of the pamphlet. Since that time
44 ANNUAL REPORT. 1966
physicians have requested 10,000 additional copies for their office
use.
A "Teacher's Guide for Fifth and Sixth Grades" was compiled
and released in November. Two thousand copies have been sent to
interested teachers on request.
One of the concerns has been giving guidance in the organization
of local committees throughout the state as well as assistmg loca
committees and councils with their plans and programs LQcal
committees are currently estabUshed in 17 counties and negotiations
are currently in action for estabUshment of committees in other
counties. The basic membership of the local committees correspond
closely to that of the state and national committees on Smoking and
Health, but is open to other interested community groups.
The local committees have had many programs, such as, smok-
ing and health conferences, school programs, joint showings of
available films and establishment of reference files i" the school
Ubraries. These committees are giving continued support and effort
to the smoking problem.
BUREAU OF DENTAL HEALTH
45
FLOYD H. DeCAMP, D.D.S.
Director
DELMAR R. MILLER, D.D.S., M.P.H.
Assistant Director
The review of program activities of the Bureau of Dental Health
indicates steady progress despite the fact that due to recruiting dif-
f"c*mes severL county health department (CHD) dental cUmcs were
not staled Also, for most of the year, only one of the two mobile
SentafcUn cs was staffed. This seriously handicaps the dental ser-
vices usually rendered to underprivileged children in counties with
lew or no, practicing dentists. There are six counties in Florida
wW^h though they hTve a sufficient population to support a private
dentist, are unable to secure one.
Special Programs
The bureau contributed to the Operation Headstart Program of
the U.S. Office of Economic Opportunity in Duval County by assign-
in^ a full-time pubUc health dentist and dental hygiemst to the
iS^bile u^t f^r a period of six weeks. The bureau also assisted in
r soeci^l mater^ty and infant care projects (see Maternal and
CMld HeaUh^lsewhere in this report) through assistance in planmng
and inception of alUed dental programs.
The bureau, through its mobile dental unit assigned to Highlands
Glades and Hendry Counties, made dental /---^„„7„^^*'Ve ?
some of the inhabitants of the Big Cypress and Brighton IndiM res
eZtions under a contract with the U.S. Public Health Senace
(iSpHsT The services provided by the State Board of Health (SBH)
l™n\JmUon to those usually provided to undexprivUegedr^^^^^
dents of Glades, Hendry and Highlands Counties. The ""i* assigned
for 30 working days to the reservations and the distribution of the
time aUotted to each depended upon the dental needs of the people.
During 1966, large numbers of school children of migrant work-
ers SveddeV care in CHDcUnics. During this year, the bureau
assimed a dental hygienist to some of these areas to give dental ex-
TmTSilons to both 'adults and children In a few areas, stamious
fluoride was appUed to the children's teeth.
In February, a dental cUnic was started at the Migrant Health
Cen er 'rT B^wkrd County. The members of the Broward County
Dental Society donated many of the dental '"stj^-"^"^^;. !T,\o'" '1^
were employed to work on alternate evemngs to work three hours an
Iveiui This became an important part of the total service offered
the migrant.
Lee County also served emergency treatment to migrants but on
a very Limited basis.
II
46 ANNUAL REPORT. 1966
PRECEPTORSHIP PROGRAM
A major percentage of CHD dental clinics continued to be staffed
by preceptorship dentists. About 135 qualified young dentists have
served in the preceptorship program since its inception in 1957.
These men are selected by the Florida State Board of Dental
Elxaminers and their work is supervised by dental consultants from
this bureau, a committee of dentists from the local dental society
and the directors of CHDs in their respective areas. After comple-
tion of their preceptorship contracts, most preceptees enter private
practice in Florida and continue interest in the public health prob-
lems of their communities. Counties served by dental pfeceptees
during all or a portion of 1966 were: Alachua, Broward, Charlotte,
Collier, DeSoto, Duval, Flagler, Glades, Hardee, Hendry, Highlands,
Hillsborough, Lake, Manatee, Marion, Palm Beach, Polk, Putnam,
Sarasota and Santa Rosa. Two mobile dental clinics from this bureau
and Jacksonville City Health Department also were served by pre-
ceptees. In addition to the group of dental preceptees who served
throughout the state, there were 13 other dentists engaged in full-
time dental public health work on county and state levels.
DENTAL SCHOLARSHIPS
Ten dental scholarships were awarded in 1966, of which one was
declined. Scholarships are awarded in accordance with the dental
scholarship law which provides a stipend of up to $1000 a year for
as many as four years for recipients who agree to practice in "areas
of need" (where there are few or no dentists) for 12 months for each
$1000 received. A total of 121 scholarships have been awarded
since 1955, five of which were declined. During the year, there were
37 students attending nine various dental schools. Of these 37 stu-
dents, five graduated in June.
Disposition of scholarship graduates to date:
Serving in "areas of need" 18
Repaid scholarships In full 23
In milifary service 10
Completed compensatory practice 19
Repaying stipends received 3
Obligated to pay but not qualified for
Florida licensure 5
TOTAL 78
DENTAL CLINICS
There were 39 public health dental clinics operated in 29 counties
during 1966. Dental services were concentrated on underprivileged
children in elementary grades with some services being provided
for underprivileged expectant mothers. Three clinics were staffed
by local dentists who volunteered their services.
DENTAL HEALTH 47
Full-time licensed public health dentists served all or a portion
of the year in the foUowing counties: Broward, Dade, Jackson,
Uberty, Orange, Duval, Pinellas, Hillsborough, Volusia, Manatee
and Palm Beach. In addition, several other counties received dental
services from the two completely equipped mobile dental clinics
operated by the bureau and assigned on request and as time per-
mitted to counties having few or no practicing dentists. These mobile
cUnics are supervised by bureau dental staff, local preceptorship
committees and county health officers in counties or areas where
the cUnics are assigned. One mobile cUnic operated two months and
the other operated six months during the year. Following is a sum-
mary of the services performed:
School dental inspections ^
New patients ^
Repeat patients ^
Prophylaxes • [i'l
Fillings (all types) • 2675
Extractions -V ^^
Miscellaneous treatments * 212
Topical fluoride applications 32
Talks given to school and civic groups 12
Pamphlets distributed 350
A new dental cUnic was equipped and began operation in Leon
County with local dentists volunteering their services. In Clay
County, a new clinic equipped in 1965, began operation with local
dentists providing services on a volunteer basis. New equipment
was installed in the DeSoto County cUnic, replacing equipment found
to be antiquated and inadequate. Broward County and Lee County
acquired equipment for additional dental clinic facilities.
The services of a fuU-time dental hygienist were utilized for the
entire year. Through her efforts, 2206 denUl inspections, 516
prophylaxes and 481 topical fluoride treatments were given under-
privileged children. In addition, 39 lectures were given with a com-
bined attendance of 1624. The hygienist participa^d in local Head-
start Programs in three counties and in the migrant health program
of one county.
FLUORIDATION
Interest in fluoridation of community water supplies continued at
a high level during the year. Daytona Beach, Melbourne and San-
ford began fluoridation and the measure was approved for EauGaUie.
Sebring held a pubUc referendum on fluoridation and a negative de-
cision resulted.
At the close of 1966, 35 Florida cities with an estimated popu-
lation of 1,033,654 were fluoridating water suppUes. A total of 26
other cities having a combined population of over 309,486 is served
by water supplies containing approximately the correct amount of
V
48 ANNUAL REPORT. 1966
fluoride as a natural component. A total estimated population ex-
SS U43,140 now receive the benefits of water contaimng
fluori^ at near optimal level to control dental decay.
lAaOBACILLUS LABORATORy PROGRAM
In conjunction with the Bureau of Laboratories, the lactobaciUus
acidophilus caries susceptibiUty tesUng service was conUnued
throueh the year. This simple saUva test provides dentists with a
reliable n^cator of the caries activity level of patients a any given
Umets men possible to prescribe '^^''"'1^ <^°-'!;°^''l'Z"rlies
hydrate diets for specified periods to reduce tooth decay rates.
riLiring the year, nearly 100 dentists utilized this service.
HEALTH EDUCATION
Activities to improve dental health through education centered
chieYly Tround the teacher who is responsible for helping children
developing proper habits, practices and attitudes about their denta
h^Itth. Keh the PTA, parents were encouraged to use present
Sl^oSe'a^d research to improve their own dental health and
that of their children.
r irls^*^ irufT^ES^^^^ TEACHING DENTAL HEALTH
IN FLORIDA SCHOOli. A total of 590 bulletins was distributed
tSs^t year by the bureau to CHD personnel and church schoo^
UTaddition! a total of 17,886 pieces of materials was distributed
to the total educational program.
Some 1200 local dentists in accordance with the Florida State
DenUl Liety poUcy, served elementary and secondary schools as
^nUl aSrs These doctors are sought in increasing numbers
vearlv bTthe urban schools to work particularly with the teachers
I^stressii dental health education of parents and students doing
^enUlL^ctfons of particular grades and promoting career day
»nH science fair activities. In cooperation with this program, 12
Troup meetiis' as well as many individual office meetings, were
held'in 20 o^the counties with the dentists to orient them on their
schools and education materials available from the county and SBH
to use in the schools.
The health educator visited 29 junior coUeges and the u>^versity
health classes at least once a term. Visits were also made to the
three schools of dental hygiene.
For the purpose of recruiting future dental persoimel, 10 exhibits
were st^ed f^r career day programs, and every high school having
In es^Ushed career day was helped to have dental careers pre-
sented by local dentists and dental hygiemsts.
DENTAL HEALTH 49
The dental health educator worked with the district nutritionist
in two pilot nutritional programs. Needed work was begun with six
counties to encourage earUer dental care for the mentally retarded
child Visits were made to four Florida Sunland Training Centers to
determine the value of certain dental educational materials to their
program.
Thp dental health educator worked as SBH consultant at the Uni-
versity of South Florida in the Florida Health Project in Teacher
Education again last summer. She continued to serve as consultant
to leaders in the 4H summer program and 12 visits were made to
local 4H Clubs on request during the year.
ORAL CANCER DIAGNOSIS PROJECT
The bureau, in cooperation with the Florida State Dental Society
and the Florida Northeast District Dental Society, initiated m 1964
an Oral Cancer Diagnosis Project in a 17-county area of Northeast
Florida. It was funded by the U. S. Public Health Service with the
understanding that it would later be evaluated and considered for
expansion on a statewide basis if the project was successful.
The evaluation committee, consisting of four dentists, a phy-
sician, an oral surgeon and a pathologist, decided to expand the
program statewide after observing the satisfactory results obtained
in the local area the first year.
During 1966, six oral cancer orientation programs for dentists
were given throughout the state.
A total of 581 oral cancer diagnostic kits was distributed to par-
ticipating dentists during the year. Medical pathologists in most
areas of the state examined the smears and biopsies submitted by
the dentists.
In the project thus far, 131 dentists have submitted a total of 494
smears and 281 biopsies. From these pathological specimens, 17
maUgnancies were discovered; many in the early stages. AH patie^ts
with premaUgnant or malignant lesions have been penodically fol-
lowed post -ope rati vely by the bureau, local dentists aiid physicians.
Many other infectious, benign and premaUgnant oral lesions have
also been diagnosed since the start of this program.
I
!
50 ANNUAL REPORT. 1966
BUREAU OF ENTOMOLCXSY
ENTOMOLOGY
51
J. A. MULRENNAN. B.S.A.
Director
The major responsibiUties of this bureau are: administration of
the state aid arthropod control program; technical supervision of
the federally financed and supervised Aedes aegypti Eradication
Project in Florida; supervision of arthropod research laboratories
located in Panama City, Vero Beach and Winter Haven; operation
of the arthropod identification laboratory and an encephaUtis sur-
veillance program; and administration of the Pest Control Act.
The federally- supported Aedes aegypti Eradication Project con-
tinued throughout the year. State contract funds expended in 1966
amounted to $3,364,656. An average of 729 state personnel was em-
ployed on the project. Operations, including inspection and treat-
ment, were carried out in 23 counties. A total of 1,978,820 premises
was inspected, and 1,959,270 were found negative. At the end of the
year there were 407 operational zones; 236 were reported to be
negative.
ARTHROPOD CONTROL
General
Fifty- seven counties and districts participated in the State Aid
program. In Bay, Duval, Lee and Walton Counties two separate
programs were operated, which gives a total of 53 of Florida's 67
counties having one or more program elements for the control of
arthropods. >
These 57 counties and districts budgeted $6,325,659 in local
funds for their fiscal year ending September 30, 1966. The state
matching fund rate for source reduction was 18.0 per cent for this
period which gave the counties and districts $966,413 in State n
funds plus an additional $721,406 in State I funds. The total funds
budgeted amounted to $8,013,478. The state fund matching rate, be-
ginning October 1, 1966, was reduced to 14.0 per cent.
Source Reduction Accomplishments
DikiTJg - St. Lucie County completed construction of dikes around
the major salt-marsh mosquito breeding areas, purchased three new
18,000 gallon per minute (GPM) portable pumps, and used these with
two older pumps to keep the marshes flooded. Excellent control of
salt-marsh mosquito breeding was obtained, this being the first year
the district was able to keep all diked marshes under water.
Brevard County, in cooperation with National Aeronautic and
Space Administration (NASA), made substantial progress with NASA
machines and personnel constructing dikes around many hundreds of
acres of breeding area near the missile sites. Approximately 22
miles of dikes were rebuilt or constructed this year.
Martin County, in cooperation with the Town of Jupiter Island
reconstructed dikes around about 50 acres of salt marsh adjacent to
the town. The town purchased a new 18,000 GPM portable pump to
keep the marshes flooded.
Diking of Tomoka Marsh in Volusia County was begun but not
completed during the year. Difficulties are being experienced with
the completed sections; in some areas, these are slowly sinking in
the unSable soil to almost the original ground elevation. This area
of this marsh is several hundred acres.
Diking and flooding one area of about 1500 acres in Lee County
is expected to be initiated in 1967.
Machine Ditching - Thirty-four counties and districts were en-
gaged in machine ditching programs. In Indian River and Pinellas
rvMinties all major ditching projects have been completed. These
^'o coun^^^^^^^ ar^^Lgaged p^n'cipU in a stand-by ditch maintenance
operation. Most other counties have sufficient new ditching work to
keep them busy for many years.
Hydraulic Dredging - Indian River County continued dredging
operations throughout 1966; however, only the last six months were
productive. During this time 27 acres were filled.
The following summarizes source reduction work during the
vear Where field costs are shown, capital investment, depreciation,
or supervision above the level of field supervisor or foreman are
not included.
1965
Machine Ditching and Maintenance
Number of counties participating
Miles of ditches dug or maintained aao^oq
Cubic yards of earth excavated J,ooz,oyo
Total field cost ^
Field cost per cubic yard
Construction and Maintenance of Dikes
Number of counties participating
Miles of dike constructed or rebuilt aqA -U^
Cubic yards earth placed in dikes oy4,^o
Total field cost ^
Field cost per cubic yard
Hydraulic Dredging ^ j
Number of counties participating • • •
Number of dredges operated ^g
Acres breeding area filled
Cubic yards earth fill placed in 057
Average labor cost per cubic yard >u.u;j/
♦Figures not available due to revised reporting procedures.
1966
34
460.82
3,690,550
$575,643
SO. 156
5
39.44
740,300
$78,994
$0,107
1
1
27.3
112,808
$0,269
52
ANNUAL REPORT. 1966
3
167.03
574.37
40
160
$742,564
6,872,618
$0,108
Deepening and Filling (Draglines and Bulldozers)
Number of counties participating ^^'\r^
Acres breeding area improved . . » too 47
Average labor cost per acre >yz.4/
Sanitary Landfills , .r-ii -58
Number of counties operating landfills ^o
Total number of landfill sites operated c^co loo
. Total field costs in all counties ^tyAoi
Cubic yards of garbage disposed of tn iTa
Total field costs per cubic yard $0. 116
Temporary Control Measures
The counties and/or districts reporting the use of aircraft for
arthropod control were Brevard, Broward, ColUer, Dade, ffiUs-
borough, Indian River, Lee, Monroe and Volusia.
Lee County aircraft, including six planes and one helicopter, re-
ported a total of approximately 950 hours in larviciding and adulti-
ciding work. Paris green, Abate, methoxychlor, Baytex, Dibrom,
1 5 per cent BHC and malathion were appUed. It was first noted in
this county that salt-marsh mosquitoes were showing a high re-
sistance to malathion when appUed as a fog. For this reason various
insecticides were used this year. Emphasis is now being placed on
larvae inspection work, which will be followed by appUcation of
Paris green pellets where found needed.
Ground adulticiding work continued inmost participating counties
and districts. The following summarizes this work and direct field
costs, which do not include capital investment, depreciation or
supervision and overhead expenses.
1965
Ground Fogging (Using malathion and/or Dibrom Formulations)
Number of counties participating ^
Number of hours fog machines operated QQl^^
Number of miles fogged ll/iLl
Gallons of fonnu lotion used *^' rVX^
Total field cost ^^'^ci^^
Average cost per hour for fogging to'ol
Average cost per mile for fogging $3.26
Aircraft Operations (Fogging)
Number of counties participating ^
Gallons of insecticidal formulation applied .... 303,40b
Acres treated ^'^\ ilfl
Gallons applied per acre (average) 0. 1 I4«
Labor cost per acre Incomplete
Aircraft Operations (Spraying)
Number of counties participating |
Gallons of spray formulation used q 00
Acres treated nd\}
Average gallons applied per acre 0.6951
Labor cost per acre treated Incomplete
1966
53
49,253
329,532
2,511,679
$1,138,910
$23.13
$3.46
5
239,860
1,892,793
0.1267
$0.0141
6
234,424
730,856
0.321
$0.0757
ENTOMOLOGY 53
ircroft Operations (Larviciding) . , „ . a
Number of counties larviciding with Pans green . /^
Pounds of Paris green pellets applied 18 541
Number of acres treated '■'•••/-';'''.'' Wo
Pounds applied per acre (Aver. 5% formulation). . J^ ^
Labor cost per acre treated Incomplete
5
723,111
45,819
15.78
$0,221
Dog Fly Control
Dog ny control activities were conducted in Bay, Franklin GuU
OkaS.sa Santa Rosa and Walton Counties. No work was reported
Ui ESbia or Wakulla Counties. LocaUzed outbreaks of fairly
short d^aUon occurred, which appears to indicate some deficiencies
m i^sp^ctL and the application of control measures may have
occurred.
Treatment consists of spraying the grass deposits strandedon
the Gulf of Mexico shoreline with DDT at approximately 10-day
intervals.
The foUowing is a summary of control work performed by six
^^^^^^^- 1965 1966
, . 963 1,033
Total miles of shoreline treated 12 219 6,563
Gallons of DDT concentrate used ^^^^ ^^^
Average labor cost per mile .... ^ ^^ ^q2Q
Number of man-hours labor required '
Counties Participating and Local Fund Budgets
Counties participating in the State Arthropod Control program in
1966 Tid the amounts of local funds budgeted by these counties
Sor^stricts for the fiscal year October 1, 1965 through Sep-
tember 30, 1966 follow:
COUNTY
Alachua
Bay (Comm.)
Bay (Gulf)
Bradford
Brevard
Broward
Charlotte
Citrus
Collier
Columbia
Dade
Duval (East)
Duval (Northeast)
Escambia
Flagler
LOCAL
FUNDS
$ 78,490.00
101,407.00
59,088.32
15,075.10
393,416.26
92,174.00
31,105.65
122,224.36
268,059.87
14,541.63
271,417.00
101,978.90
134,797.00
180,576.22
15,173.30
COUNTY
Franklin
Gadsden
Gulf
Hardee
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lake
Lee (District)
Lee (Beach)
Leon
LOCAL
FUNDS
J 15,000.00
13,246.53
46,255.44
3,000.00
19,858.00
4,440.00
387,250.00
4,400.00
319,229.20
5,285.62
10,727.23
■ 120,500.00
539,875.65
73,150.15
82,500.00
54 ANNUAL REPORT. 1966
Levy
Madison
Manafee
Marion
Martin
Monroe
Nassau
Okaloosa
Orange
Osceola
Palm Beach
Pasco
Pinellas
Polk
S 17,000.00
2,000.00
157,269.73
30,223.43
46,535.61
290,911.00
61,249.00
45,138.50
94,536.00
48,500.00
351,888.00
97,248.00
350,388.37
246,669.00
Putnam
St. Johns
St. Lucie
Santa Rosa
Sarasota
Seminole
Suwannee
Toy lor
Volusia
Wakulla
Walton
Walton (South)
Washington
$ 26,000.00
92,000.00
173,554.20
52,698.43
143,871.32
19,600.00
15,750.00
5,050.00
380,647.86
19,010.72
7,500.00
23,477.31
2,700.00
Total
$6,325,658.91
Total Local Funds Budgeted $6,325,659.00*
Total State Funds Remitted to Counties 1,687,819.00**
TOTAL BUDGETED FUNDS FOR ARTHROPOD
CONTROL $8,013,478.00
*The local budgeted funds contain some items not matchable with
state funds.
**The total state fund allocation of $3,300,000 for the 1965-67
biennium is adjusted on the basis of over and under allocations each year.
Engineering
The engineering section provided assistance to counties and dis-
tricts in program planning and execution, budgeting, and the prepa-
ration of specifications for the purchase of heavy equipment. A
survey of the garbage and waste disposal problem was made for
Palm Beach County; but the report and recommendations had not
been completed at the end of the year. A similar survey was made
in Lee County, and a report and recommendations were furnished
the Board of County Commissioners. Waste disposal problems
throughout the state have required considerable time of this office.
Regional EntonH>logists
There has been no change in regional entomological activities
during the year except coordination with the U.S. Corps of Engineers
in dredging and trapping operations. New personnel includes one
man, shared part-time with the Winter Haven Midge Laboratory,
used for encephalitis mosquito trapping. Entomologists were sta-
tioned in Miami, Tampa, Orlando, Jacksonville, Marianna and Pan-
ama City and maintained liaison between the state officer, research
centers, districts and counties. As the season and problem neces-
sitated their activities extended into all activities connected with the
mosquito control operations in the 57 counties and mosquito control
districts and into regulatory activities concerning 1247 pest control
operators in 790 businesses.
ENTOMOLOGY 55
Regional entomologists are, directly or indirectly, concerned
with budget planning, project approval, inspections, or regulatory
phase of the mosquito and pest control programs.
Expansion was noted in several activities. These included the
increases: of World Health Organization personnel sent to Florida
for training, educational activities concerned with the estabUshment
of mosquito districts; in requests for assistance to caUbrate equip-
ment for Paris green pellet application by airplanes and particularly
by heUcopter; in requests for Boards of County Commissioners for
information and explanation of the proper methods of budgeting and
details of fund matching; and in the South Florida workload, due to
the new law including applicators in the Lawn and Ornamental Shrub
field as a category in the Structural Pest Control law. The prob-
lems of repair, location, relocation and maintenance of mosquito
traps for all programs continue. A new survey for trapping sites
around and near impoundments connected with the Florida Barge
Canal has been undertaken in cooperation with the U. S. Corps of
Engineers. Trapping and sampling will evaluate malaria mosquito
production, as this area is suitable for Anopheles production; how-
ever, the major effort will be directed to encephaUtis surveillance.
Numerous substantial dredging operations performed by con-
tractors for the Corps of Engineers along the St. Johns River ajid
Intracoastal Waterway have been coordinated by regional ento-
mologists and the districts concerned in an effort to obtain placement
of spoil areas where they will cause a minimum of mosquito breeding
and be mutually beneficial to all.
Arthropod Identification Laboratory
The primary interest of arthropod identification in the bureau's
Jacksonville laboratory is mosquitoes; however, it is called upon to
determine the identity of nearly everything that annoys, bites or
stings The work is vitally important in our encephaUtis surveil-
lance program and in the evaluation of the effectiveness of county
and district mosquito control operations. •
The 1966 season has been slightly above normal in overall mos-
quito production. The increase in encephaUtis work has continued
on a sporadic basis, with bursts of activity in the early summer and
for 10 days or more following rainy periods. The weekly informa-
tional pubUcation, "SaU-Marsh Mosquitograms," has been continued
as an advisory to mosquito districts and other interested Persons
Identifications from freshwater collections at Woodruff Dam, North
Bay and 54 other selected fresh and saU water locations throughout
the state have been continued on a research basis.
The programmed collections to find the mosquito vectors of
encephalitis have continued in areas of known and suspected equine
cases throughout the state. All encephaUtis mosquito collections for
I
86 ANNUAL REPORT. 1966
this laboratory were made with CDC traps, used in conjunction with
CO2 in areas where available. This trap has proven to be more
efficient in sampling a broad spectrum of mosquitoes.
The technicians identified 8919 coUections containing 796,164
adult mosquitoes in the regular program and 91 other collections
from special locations for an additional 4168 adults. Four hundred
and twelve larvae were identified from 15 collections submitted.
In the encephalitis program, 685 collections from CDC Ught
traps four sweep nets and one aspirator collections taken from 26
counties, contained 132,431 mosquitoes, were processed aUve, and
pooled for virus studies. The details of these collections are re-
ported by the SBH virus laboratory.
Midge Studies
Research was continued during 1966 on the chironomid midges
of Florida, their Ufe histories, biology, ecology, and classification.
Sixteen collections of Uve chironomids were made in streams,
ponds, ditches, lakes and rivers. A total of 1245 larvae were
brought into the laboratory for rearing, and 404 adults emerged.
Three collections of adult chironomids (approximately 175 speci-
mens) were identified for the Midge Research Laboratory at Winter
Haven and one collection submitted by a water plant operator. Mis-
cellaneous insects were identified for 10 individuals who brought
them to the laboratory.
ENTOMOLOGY 57
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58
ANNUAL REPORT, 1966
PEST CONTROL
The bureau continued for the 19th consecutive year its respon-
sibility for licensing and issuing identification cards to firms en-
gaged in pest control and for enforcing the law and regulations
governing this industry under the Pest Control Act (See Table No.
8). This was the first full year of coverage of the lawn and orna-
mental pest control industry under this same law. New pest control
regulations became effective January 21, 1966.
A notable recent innovation which has proven valuable as an en-
forcement tool is the use of "Notices of Inspection" to cite pest
control licensees and their employees for violations observed by
inspectors in the field. These are returnable "tickets" which certify
correction of the violation cited.
The number of regular licensees' and employees' identification
cards issued increased by 156.2 and 26.6 per cent, respectively,
over 1965. The number of investigations of property owners' com-
plaints, involving Ucensees, decreased 5.7 per cent over 1965, while
investigations of unlicensed operators climbed by 58.1 per cent. The
Pest Control Commission recorded 1068 certificates in force and
issuance of 204 new certificates during the year.
ENTOMOLOGY 59
ENTOMOLOGICAL RESEARCH CENTER
Aoril 8 1966 was the 10th anniversary ol the formal decUcation
of the Entomological Research Center. It remains unique in that no
o her research center in the world is devoted entirely to the biology
of man-biting insects. Its staff of 25 has been increased to 50 in
196T^hrough research grant funds from the U. S. PubUc Health
Service (USPHS). This staff consists of 25 professional entomolo-
gists b ologists and biochemists and 25 technicians craftsmen,
Clerical and custodial workers. The main building has been supp e-
men ed with a cluster of several smaller structures, brmging the
t"Ll to 20,000 square feet of work space and 6500 of storage area.
Over 10 years the research center has enlarged its inventory of
°esearcV"ds to an investment of -PP-^-f ^^ ^o°°' n mTc^er^
tific equipment, $50,000 in books and journals, $40,000 n machmery
i^d other tools, and $35,000 in vehicles. Withfstimated values of
buildings at $570,000 and land at $40,000, the State Board of Health
now has a total i^nvestment in physical properties here of approxi-
mately $935,000.
The 1966 program of research into the biology and vectoring
characteristics of mosquitoes encompassed the same eight major
projects outUned in last year's report. Following is a brief non-
technical account of the current status of each project.
I
TABLE 8
SUMMARY OF PEST CONTROL
REGISTRATION AND ENFORCEMENT,
FLORIDA, 1962-66
Registration
State Board of Health License* issued
State Board of Health Chonge of Address Licenses issued.
State Boord of Health Licenses revoked*
State Board of Health Licenses placed on probation* . . .
Pest Control Certificates revoked, suspended or placed
on probation*
Employees' Identification Cords issued
Employees' Chonge of Address Identification
Cords iuued
Employees' Identificofion Cords revoked or stopped* . . .
Employees' Identification Cords on probation*
Thenna I -Aerosol Certificates of Authorization renewed*.
Enforcement
Homeowner complaints investigated
Unlicensed illegal pest control operators investigated .
Warrants filed against unlicer«ed operators
Letters of woming issued to unlicensed operators
Enforcement miles traveled (Jacksonville office only) .
1962
296
33
0
0
2,996
145
7
0
9
81
21
5
9
16,865
1963
311
34
2
0
3,391
160
15
2
8
82**
11
5
4
17,107
1964
329
44
1
3
3
3,588
237
10
2
6
83
19
9
9
18,608
1965
338
41
0
2
2
3,910
283
12
2
5
92
31
6
14
19,427
1966
870
31
0
2
9
4,963
179
3
1
4
87
49
6
29
27,137
*By Pest Control Commission of Florida
•'Corrected from 1963 report ,«.,c^^i. • aii
Licenses, identification cords and thenna l-oerosol certificates issued are bosed on 1965-66 licensing yeor. AM
other entries ore based on calendar year 1966.
PROJECT 1: BITING CHARACTERISTICS
This is a long-term study of mosquito biting behavior to estabUsh
what if any, preferences for the blood of certain birds and mammals
^h^e might be in the important species of Florida mosquitoes
especially those involved in transmitting diseases from wUdUfe to
mL e E arbovirus encephaUtides. The project is now in phase 1,
wMch Is the search for preferences by identUying the bloods in
wUd caught mosquitoes, using the precipitin test. In this way i ca^
be learned whether mosquitoes feed on animals m proportion to their
number or whether they seek out certain birds and mammals.
In 1966, three study areas were set up to establish in each a con-
tinuous census of birds and mammals and a routine of collectmg
blood- engorged mosquitoes.
In the precipitin-test laboratory, most of the year was devoted
to completing e^eriments designed to improve the test technolog-
ically and to increase the stock of wildlife antisera.
PROJECT 2: POPULATION DYNAMICS
This is a study of the technology of measuring mosquito popula-
tions essential to the epidemiology of mosquito-borne diseases and
evaluation of mosquito- control operations. Previous work had fairly
well demonstrated the biases for certain species of mosquito mherent
60
ANNUAL REf>ORT. 1966
in the commonly used methods of collecting and sampUng and in
other methods developed by the project. This year emphasis turned
to the physiological state of the mosquitoes caught, e. g., age, con-
dition of ovary, mated or not.
For all species but Culex nigripalpiLS.ihis year's collections had
smaller percentages of females with totally undeveloped ovaries.
Females with more developed ovaries were taken in largest numbers
from their natural daytime resting places in ground Utter. This
showed that mosquitoes do very little flying when their eggs are
maturing after a blood-meal. Gravid females fly about more durmg
twiUght periods than in the dark of the night, although a full or near-
full moon in the sky diminishes the difference.
It was also learned that whether or not a mosquito is parous,
i.e., has laid eggs previously, has no bearing on the time of night it
does its flying. Although the power aspirator took the largest per-
centage of blood- engorged mosquitoes, the truck trap (a moving "air
scoop") also took large numbers, especially at twilight when they
have ]ust obtained their blood meals (evening twilight) or when they
are seeking adequate daytime resting places (morning twilight).
PROJECT 3: DISPERSAL CHARACTERISTICS
Release and recapture of mosquitoes is the surest manner of
learning about their fUghts and the best way of establishing how long
theyUve. It is extremely important, therefore, that marking methods
not damage them. In 1966 radioactive- marking technology was
thoroughly studied. Toward the end of the year, details of a satis-
factory method were worked out so that mosquitoes can now be
adequately marked with no discernible radiation damage. The new
method will work with the majority of mosquito species.
The salt-marsh mosquito nursery plots were greatly improved
by repairs to dikes and water-control structures and by the sinking
of an artesian well to provide fresh water. This work did not inter-
fere with the nursery's production schedule, and several million
adults of Aedes taeniorhynchus and Aedes sollicitans were produced
for various research studies at the Center.
There were no releases of marked mosquitoes this year; all work
performed on the project was in the Une of improving technology.
PROJECT 4: COMPARATIVE BIOLOGY
This project extends to other mosquito species the knowledge
gained from concentration at this laboratory on A. taeniorhynchus
and C. nigripalpus.
Field studies at a temporarily flooded maple grove yielded in-
formation on several mosquito species. This included observation
on maUng length of life, host preference, biting activity, egg laying
developmental stages and to wing beat frequency.
ENTOMOLOGY
61
Advances have been made in the rearing and col^^^^^Jje ^^^.^I
eral species. Colonies of each of two species were started with a
new teSue, stimulation to mate by introduction o/ another species
^to the cage. Another species mated for the first time m the lab-
oratory when a live oak branch was introduced into the cages.
PROJECT 5: REPRODUCTION
During 1966 studies on reproduction concentrated on the hormone
nroduced by the medial neurosecretory cells of the mosquito s brain,
ca^ed for convenience the mnc-hormone. Experiments, conipanng
four species of mosquitoes, were completed which showed that: 1)
ZMZ^lloi the mnc stopped the egg development which nornaally
occurs after a blood meal, and 2) implantation of one pair of mnc
^to a rmic ablated animal, was nearly always effective in restoring
egg maturation.
The anatomical study of the neuroendocrine system was con-
tinued utilizing both the light and electron microscopy. The nerve
oXays from the various groups of neurosecretory cells have been
trlcld throuSi the brain to their terminations in the head or thorax.
The content of neurosecretory material in these pathways iS bemg
compared before and after blood- feeding.
PROJECT 6: GROWTH
Growth from egg to adult mosquito tos two aspects of concern to
control- how long it takes and what kind of ^^"" ^f""^! T^^/^t",,
iect is concerned with these aspects of growth as they are aHectea
%\^ s'known variables in the environment o^ the^""-^^^^^^
iLs larva Dupa): (1) temperature, (2 humidity, (3) food, (4) salimty
Kte7 (Sought conditions, and (6) population density. The basic
worTon all thfse growth problems was completed for .1. taemor-^
h^tZ in 1966; it Ld been started in 1961. Considerable work was
done on C. nigripalpus but the analysis is incomplete.
The effects of these rearing conditions on the newly-emerged
adulls may^ summarized as follows: (1) Wing length increases
with looTqu^tity and decreases with increasing temperature, salm-
Uvi^d crowding; it is least in continuous dark and nearly aUke in
coV?::uous Ught or alternating tight and^rk i^ Dry -^« -
creases with food quantity, is greatest at 30 C-. leas at 34 C ana
intermediate at 24° C, decreases with increasmg salimty and crowa
iTts leas^n continuous dark, most in alternating Ught and dark
^ intermediate in continuous Ught. (3) Fat reserves, which are
^ u^d Tn fUght but contribute greaUy to longevity, Increase with
?^^antity decrease with increasing saUnity and crowding are
e^atesrl 28°-30° and least at 34°; they are least in constant dark
roTt alternating Ught and dark, and -te^^/f^f/ ^ ^'S*
U0»t. W Glycogen reserucs, which can be mobiUzed for fb^t before
62 ANNUAL REPORT. 1966
the new adult feeds, increase with fcxxi quantity, decrease with in-
creasing salinity and crowding, are greatest at 30° C. and least at
34°; they are greatly decreased in total darkness and are greatest
in alternating light and dark. (5) Autogenyf or ability to lay eggs
without a previous blood-meal, increases with food quantity, de-
creases with increasing salinity and crowding, and increases with
temperature up to 32 °C.; it is least in continuous dark and most in
alternating light and dark.
PROJECT 7: ENERGETICS
This project is concerned with the flow of energy in the adult
mosquito. Unfed mosquitoes live only so many days and fly only so
many hours, depending on the amounts of fat and glycogen with which
they emerge. Thereafter they must synthesize energy reserves
from their food, which is mostly sugars in nectar and proteins in
blood. Most of the work in 1966 was concerned with the amount of
glycogen mosquitoes can synthesize from a single meal of different
kinds of sugar. Glucose and fructose were shown to be absorbed at
the same rate, yet twice as much glycogen is synthesized from glu-
cose as from fructose.
The hormones usually associated with the regulation of glycogen
metabolism in vertebrates, including man, were found to have no
effect in mosquitoes. However, glycogen synthesis was strongly
influenced by any manipulation of the acidity or alkalinity of the in-
tejrRal environment of the female mosquito.
PROJECT 8: LARVIVOROUS FISHES
The year was devoted to completing a major biological study of
one of the salt-marsh minnows, Rimdus marmoratuSf which in ad-
dition to being a predator on mosquito larvae is the only naturally
self- fertilizing fish known in the world, and for this reason its re-
production was studied in great detail. It will almost certainly be-
come one of the most valuable experimental fish, for it offers unique
possibilities for research in genetics, embryology, physiology, en-
docrinology and many other biomedical sciences. Its unique breeding
behavior may also adapt it to special mosquito- control techniques.
Being closely related to many of the other salt-marsh larvivorous
fishes, e.g., FujuhduSj Ciprinodon, much of its ecology and biology
serves as indicator of what can be generally expected of fish pred-
ators on salt-marsh mosquito larvae.
WEST FLORIDA ARTHROPOD RESEARCH LABORATORY
This laboratory occupied new buildings March 1, 1966. It is lo-
cated on a 10- acre tract near Panama City. The site is a peninsula
on St. Andrews Bay donated by the Panama City- Bay County Airport
Authority and construction was financed in part with matching funds
ENTOMOLOGY 63
obtained through a building grant from the U. S. Department of
Health, Education, and Welfare.
The staff consists of the director, three entomologists, three
biologists, five biological aides, a secretary, one semi-skilled
laborer and one custodial worker.
The overall function and responsibiUty of the UJjoratory is to
develop more effective methods for the control of arthropods of pub-
Uche^th importance in the state. To accompUsh this objective, the
research program is divided into two major sections: mosquito con-
trol a^d control of biting fUes. Progress and ''.'^compUshments for
1966 are outlined by specific projects in the remainder of this report.
MOSQUITO CONTROL SECTION
Insecticide Resistance Studies
Late in the summer of 1965 resistance to malathion was detected
in the salt-marsh mosquito, A. taemorhynchus, from Lee County.
AS a result, research to determine the extent of this resisUmce
ihrouehout the state was continued in 1966. Insecticide susceptibibty
ests were conducted in the laboratory with the larvae of various
sj^cies of mosquitoes, with mosquitoes from several areas of U,e
state and with several insecticides.
These data confirm the resistance of A. taeniorhynchus to
malamon in Lee County, as reported last year. Data obtained m
ms Indicated that A. taeniorhynchus also is resistant to malathion
Lsaras^t^ County and in the peninsula of Hillsborough County oc-
^upierbVMacDiU Air Force Base. Mosquitoes from these two areas
were not included in the 1966 studies. Of the mosquito species
TeJ^ed only A. taeniorhynchus appears to have developed any signif-
c^t degree oi resistaTe. C. nigripalpus, the vector of St. Lou^
enTephaUtis in the 1962 Tampa Bay epidemic, has been shown to be
susceptible in all areas tested.
Umited data also were obtained on resistance using adult mos-
quit^r rfietd tests, in general, these tests supported the fmdings
obtained with larvae in the laboratory tests.
Aduhicide Studies
A continuing program of the laboratory is the testing of new
che,^c"sTm'osqU adulticides. Extensive ^f^^estingw- con-
ducted with Dursban, a new organophosphate, and l^^^'ted testmg was
done with Baygon, a carbamate ^^^^}^' ^V^^.'^^^'^^i'^^
against caged adults of both A. taemorhynchus and C. mgrtpaipus.
With the acquisition of an aircraft by the laboratory, much needed
research on th'e aerial appUcation of insecticides »' -"^-^o c^n-
trnl is Dossible now for the first time. During 1966 consideraoie
tli^e waT sS^it ^ equipping the aircraft for boti. high- volume and
I 1
1 .
64 ANNUAL REPORT. 1966
-^
low- volume spraying. It is expected that the aircraft will be used
extensively during the next year in mosquito control studies.
Droplet Size Research
This was the last year of a USPHS grant for the study of insecti-
cidal aerosols and sprays used in mosquito control. Owing to dif-
ficulty in filling vacant positions, research was limited primarily to
studies of droplet size of thermal aerosols and deposition of droplets
on insects. Some studies on droplet size also were conducted with
nonthermal aerosols and low-volume aerial sprays.
Highlights of this study were: (1) development of a camera which
photographs at high magnification aerosol droplets naturally sus-
pended in air, and the subsequent use of this equipment to demon-
strate that the droplet size produced by thermal aerosol generators
is about two microns in diameter, a size considerably smaller than
previously believed; (2) development of a portable meteorological
tower for studying the effects of weather on the behavior of aerosol
droplets; and (3) development of a laboratory thermal aerosol gen-
erator for studying the effects of controlled environment on droplet
size and deposition on insects.
With this equipment, it was found that droplets one to two mi-
crons in diameter can deposit on mosquitoes in sufficient numbers
to cause mortality. This was demonstrated using a fog in which the
largest droplet was 2.8 microns in diameter. It appeared that most
droplets deposit on the wings of the insects.
It was shown that oils of high viscosity produce a more obscuring
fog of a slightly larger droplet size than oils of low viscosity. How-
ever, fogs ofdiesel oil, an oil of low viscosity, gave a greater deposit
of droplets on flies in the light than fogs of higher viscosity oils.
There was no difference in deposit between oils of high and low vis-
cosity on flies or stationary microscope slides when placed in the
dark. Flies picked up more droplets at low humidity than at high
humidity, but with stationary microscope slides there was no dif-
ference in deposit between high and low humidity. Thus it appears
that insect activity is an important factor in droplet deposition.
These results represent some of the later findings in the studies of
droplet size and deposition on insects.
BITING FLIES SECTION
Dog Fly Studies
The stable fly, SXomoxys calcitrans, is a serious pest of man
and livestock in the coastal areas of west Florida, where it is known
as the dog fly. This fly reproduces in animal manures and decaying
animal feeds, such as hay and grain on farms, and in deposits of
marine plants, which accumulate on the shores of the large bays of
west Florida during late summer and fall. The importance of this
ENTOMOLOGY 65
* in fhP Florida Panhandle, especially to the summer tourist
Z^TssX^Zto^^Tn ior est^Ushing this laboratory in west
Florida.
to Sosa county, August 23. Escambia County reported an out-
break on August 17.
While heavy deposits of seaweed were observed on the bay shores
marine plants. «°J^^"' '?i° ^ groups and only serves to point
^urtrneidtfTrttr1:frni"^^^ This will be amajor
future objective of this laboratory.
Thermal Aerosol Tests
The testing of insecticides against the dog fly under a research
, Jt'rec:rr/irom the U.S. ^^^^^^^'^f^^TZZ' ITs
rr:o\f ^ %T.:.T:::.d:i''iJ^rieZi mes when ap
^^-^H-a^rtrteSe!^^^^^^^^^^
"a^"f oTr fenTvmlrolce, 68 and 69 per cent Kills respectively.
Tf is Obvious from these results that DDT is not an effective m-
^[ddT as a residual spray °" --j^/^frtLf ^^%'e'sJd o" ^e
show satisfactory kill, the reason not being apparent.
I„s«^kide Test. Agoinsf Noturol Population of Dog Flies
wind direction.
66
ANNUAL REPORT. 1966
Residual Sprays on Marine Grasses
Early in 1966, this laboratory reserved six experimental areas
of one-half to one mile each along the shore of St. Andrews Bay for
the testing of insecticides as residual sprays on marine grass de-
posits for control of dog flies. The plan was to spray natural grass
deposits, but the grass was deposited late in the season and was
washed so frequently by waves that this method of testing proved to
be unsatisfactory. No dog fly larvae were found in any of these ex-
perimental areas; therefore, they were abandoned for research pur-
poses about October 1.
For these residual tests, fresh marine grasses were collected
and placed at random in blocks of four plots each above the normal
high water mark on the bay shores.
DDT was highly effective for the duration of each experiment.
Baygon was nearly as effective, the per cent control falling below 95
only after 25 days in Experiment No. 2, Dibrom was ineffective as
a residual treatment on marine grasses. The dosage of DDT used in
these tests was the same as presently recommended for use by the
dog fly control districts. Owing to the high level of control, 99 per
cent overall in both experiments for this dosage of DDT, this pesti-
cide will be tested at a lower dosage during 1967.
Trapping of Dog Flies
In an effort to obtain data on the origin and movements of dog
flies in the west Florida area, fly traps were set along Gulf beaches,
on the shores of St. Andrews Bay, and at inland points near roadways
and on the shores of freshwater lakes.
While the traps did not function as well as expected based on
previous experience, the number of flies captured or observed at the
trap sites decreased sharply in relation to distance from the beaches
and bays.
These data might reflect the areas of fly concentration rather
than origin; more data are needed to clarify this problem.
Sand Fly Studies
Owing to the poor results of a large-scale test for the control of
salt-marsh sand flies (Culicoides) in the Panama City area (see the
SBH Annual Report, 1965), small plot tests were established in
March, 1966 to determine the most effective insecticide and dosage
level for control of sand fly larvae in this area.
Based on results of the small plot tests in 1966, several large-
area tests will be made at Panama City early in 1967 and at a later
date in the Vero Beach area.
Species of sand flies previously collected at Panama City are
ENTOMOLOGY 67
Usted in the 1965 Anmml Report. No new species were collected
Se 1966 but collections from two Ught traps operated from
InrU 1965 through March, 1966, showed that sand fUes were active
eac" month of thf year in' this area, and that the period of highest
^opulaTons was from February through June, with a peak m April.
WINTER HAVEN MIDGE CONTROL LABORATORY
March 31 1966 was the completion date of USD! FWPCA Grant
WP-^one-Oe, Causes and ReUef of Hype reutrophi cation of Lakes.
The ^s were an investigation of the Umnology of local hype reu-
^rnnh^lak^s an attempt to reverse the trend to hypereutrophy by
IrtSlerat'n ^^^^ removal and the biology of Glypto^
tendipes paripes.
Nuisance quantities of midges Instigated this study. It was early
beUev^niLt m^'s influence on the natural waters by sewage and
Ldustrial wastes, agricultural drainage, etc., probably contributed
to the iLtropWc level and, therefore, midge production. Past
bmnolo?cal studies and the Uterature indicated that certain chiron-
•T= ^H a .ioeclal ability to endure anaerobic and certain accom-
r?ng con'ditTns'suchas'the production of methane and hydrogen
Se and that normal predators were lacking in this ability.
Therefor" artificial aeration should improve conditions for pre-
dators and possibly reduce midge P"?"!^*'""^-.. " *f /^"rtL™
that aerobic conditions would enhance precipitation of certain nu
ments^d in effect remove them from the lake metabolism and
therefore Cer the overall productivity. Although overturn was
^h!;^ fn hP lakes studied by temperature and dissolved oxygen
rrUert the": :^s no evrdencJ of reducing phytoplankton popula-
tionreross primary productivity or midge populations. Therefore
ft waL concluded th^lowering the trophic level of a lake by artificial
aeration was not practically possible.
In another attempt to remove nutrients f"'"'^,*'?^ "°f ^^^p"^;
w,t<>r hvaclnths were harvested from some artificial pools, tor
was clearlv below the control pool productivity, it can be expeciea
That ha "estiS from natural waters would reduce the productivity
of those waters.
Egg laying by old females, emergence of new aduUs and mating
of new females by old males takes place during a shor^ penod after
= J rnnnlation is effected by means of a spermatophore. The
Zus foUow t^e wind to shore where they spend the following day on
l^d witl^ 100 f ee tof the shoreline. The adult life is one to perhaps
H^ee davT Analysis of emergence data by moon age reveals a pro-
nouncet'lunar rh'ythm. Emergence traps --veredjhree ^^ me
1- ^ r.f r- f^n'triii£><: Hiirinff the dark of the moon as aurmg uic
n^'^.^M^rsP^J^^^^^ are the peak emergence periods
hi
*
i!
68
ANNUAL REPORT. 1966
followed by summer and winter. The majority of egg masses are
laid between 25 and 100 feet from the shoreline. The eggs hatch in
one to five days. The pupal stage appears to last one day. Time-
wise the most variable stage is the larval stage. Sand bottom lakes
at water depths of five to 10 feet are most productive of G. paripes
adults. In general, the studies through the years have shown that the
greater nutrient content of a lake, the greater the plankton produc-
tion, the greater the G. paripes production, and the greater the
overall productivity.
Continuing Programs
After termination of the Grant, biological studies of adults were
again concentrated in the Winter Haven chain- of- lakes to include one
lake where control operations were being conducted by the Polk
County Mosquito Control District, and one lake where control oper-
ations were not being conducted. Larval sampling continued in eight
lakes to provide the seasonal and annual information necessary for
basic biological and control studies.
This is the first year of successful rearing of G. paripes. Al-
though colonization was not the original aim of this particular pro-
ject, fourth generation adults were reared.
Other species of nuisance midges were reared by three high
school students of the Polk County Science Research Program. This
is the third year this laboratory has cooperated with the Polk County
Board of Public Instruction in this program for outstanding junior
and senior students.
BUREAU OF FINANCE AND ACCOUNTS 69
FRED B. RAGLAND. B.S.
Director
PAUL R. TIDWELL, B.B.A.
Assistant Director
The business and financial management of the State Board of
H.oUh%nHTreQuires a close working relationship with the program
Kc^ors "i plSg maximum utiUzation of funds that have been
provided' from fedefal, state, coux^y and P-^-te sources for the
various health programs for the citizens of Florida. Smce each oi
riap sources has its own set of rules and regulations as to the ad-
mmTstrXn aiid* e=i' "'^it"'-^ of the funds, particularly with regard
roTderllTunTs u^d in many budgets £°'. ---^f^^S sys"-
prts erants this sometimes becomes quite involved. A logical sys
em of a^oi for these funds and issuance of reports concerning
th^ir e^enm u?e is necessary once the funds are provided and
proper7budgeted, and this, along with the dissemination of proper
budget control information to all concerned, is accomplished by he
burlau r addition to budgeting and financial management of the
agency the bureau is responsible for purchasing, property control
dupUcating services, mail, shipping, -reiving automobile control
and assignment, and buildings and grounds maintenance.
The fiscal year ended June 30, 1966, was the first year o the
l^^erS^pt^V^s wer .nera^ly^ ^sed u n^^^^
Ss appXtt ofs provTdTd foTpurch/se of adjacent property in
racksonvme a sizable' administration building addition in Jackson-
vUle and completion of a regional laboratory in Tampa.
Total program expenditures for fiscal year ended June 30, 1966,
rB^\ b^b^T^^^:^ - =r f°''
fT'lncrease in the programs^f the county health departments
tcrosri^d the cilta? outlay buildings and improvements such as
!he new regional Tampa PubUc Health Laboratory and the West
Florida Arthropod Laboratory.
The 1965 Legislature provided for the Mental Health program to
be tr^sferred S the Division of Mental Health under the Board of
Comr^Tstoners of State Institutions. This tr^sfer was gradually
accompUshed and completed as of January 1, 1966.
The number of state-owned and operated automobiles was 113 at
the Ilo'seorffscal year June 30, 1966. These -re d^ve" apP^
«*«!„ 1 nQ'\ f^fiS miles during the year. In addition, tne agency
Tn^d^O ti^cks oT s'pectl-purpose'vehicles; these units traveled
approximately 191,736 miles during the year.
70
ANNUAL REPORT. 1966
This bureau continues to give assistance and guidance to the
overall financial planning of the health department activities.
PURCHASING AND PROPERTY SECTION
The I^urchasing Department, fulfilling its responsibility for the
procurement of the agency supplies, equipment and services in ac-
cordance with rules and regulations of the State F>urchasing Com-
mission, continues to cooperate with other state agencies in the ex-
change of information pertaining to contracts for volume purchases
which enable this agency to buy certain items under contracts
negotiated by other state agencies and to arrange for purchases
under State Board of Health contracts by others.
During 1966 the I^irchasing Department issued 4418 separate
purchase orders which totaled in excess of $1,430,000 and laboratory
equipment and office furniture were purchased to equip the new
Tampa Regional Laboratory. Purchase of office furniture and clinical
equipment for the Tampa Diagnostic and Evaluation Clinic and the
North Central Florida Maternal and Infant Care Project was initiated
during 1966 and continues. CHDs normally handle purchases locally
within the organizational framework of the CHD; however, their pur-
chasing procedures must also conform to the Florida Statutes gov-
erning purchase, such as obtaining bids and advertising for bids
where required.
Property Control
The property section carries out the responsibility of recording,
marking and inventorying all of property owned by this agency (fur-
niture, office and scientific equipment). The state statutes prescribe
records that must be maintained and the frequency of physical in-
ventories.
This section processes annual inventories on over 185 locations,
handles fire insurance on buildings and contents and assigns prop-
erty numbers to capital outlay items. A total of 888 pieces of equip-
ment valued at $183,132 was added to the inventory. Two new lab-
oratory buildings were completed during 1966; one in Panama City
and one in Pensacola, for a total value of $318,034. Land and old
buildings at 1214 Pearl Street, Jacksonville were purchased for
$200,000.
Property values reflected in the SBH Plant Ledger as of June 30,
1966 were as follows:
Buildings $3,267,914
Land 144,000
Furnifure and Equipment 1,568,678
Aufomotlve Equipment and Trailers 312,983
Books and Film 389,244
TOTAL $5,682,819
FINANCE AND ACCOUNTS
71
Insurance i.u cs* ♦
Fire insurance on buildings and contents is carried m the State
Fire l^suTance Fund under the supervision of the State Fire Insur-
Ze commission. Coverage on boilers and J^^f "Jf. ^^^e^kre
carried in a master poUcy supervised in the office of the State Fire
Lsur^ce commissioner. Scientific equipment, dental equipment
a^dTray equipment in various mobile units is insured under a
^loate?' or 'Transportation- poUcy. Automobiles, trucks and
oUier special purpose vehicles owned by this agency are covered by
a^eet^Ucy to delude public liabiUty, property damage, fire theft
Ld cor^rehensive. Th^ agency acts as self-insurors for colUsion
^m^e Boats and outboard motors owned by the agency are m^red
^"e? marine poUcies to include public Uability -d Property dam-
age as well as protection against damage or loss of the boats and
motors Other major insurance coverages include: money and se-
Trities broad form, loss inside and outside of premises; position
TcheZte t^nd for narcotic inspectors; pubUc employees honesty
blanket position; Workmen's Compensation.
During 1966 the bureau was notified by the insurance companies
that cl^s amounting to $5,791.48 were settled under the agency s
k'Tet^obile Uabilfty poUcies. This includes claims f-acciden^^^
during 1965 and 1966 which were settled durmg 1966 and mcludes
TccTdlnts involving vehicles on loan from the Federal Goyernnaent
Lr use in the Aedes aegypti Eradication Program, ^ ^ell as SBH
vehicles. Damages to SBH vehicles caused by others were ^ttled
Lr $2,671.83. Ihe agency as self-insuror ^<>^daIna^es cau^d by
colUsion paid $948.96 for repairs. This figure is less than^^^^^f
of carrying collision coverage in the fleet automobile policy Pay-
ment o7^65.25 was received from the State Fire Insurance Fund as
^result of Ughtning damage to air conditioning equipment and re-
frigerators at the Encephalitis Research Center in Tampa.
BUILDINGS AND FACILITIES SECTION
During the year this section initiated a training program in con-
nection ^th the Neighborhood Youth Corps (Office of Economic Op-
^rti^Uy) A number of underprivileged youth were mcluded m this
^w^dertaking and considerable supervision was given by the core
ation.
Almost a thousand work requests, large and small, were pro-
cess^^me of the major accompUshments included: ^mp^et^on of
raulkine- waterproofing and exterior paintmg of buUdings, reiin
is£ oi older fumitufe to harmonize with newer furmture; elec-
tS alterauons and services to meet needs of the laboratory and
72 ANNUAL REPORT, 1966
other departments where additional modem equipment required
neater e^rtric service; alterations in the plumbing and steam bnes
L the boiler rooms; and eUmination of a serious sewerage deficiency.
The shipping and receiving acUvity continued to serve the agency
well but was handicapped by lack of adequate space A good bit of
toe workload includes a variety of materials and specimens proces-
sed to^d from the CHDs, branch laboratories, private physicians
and tuberculosis hospitals.
The dupUcating operations include offset machines, mimeograph
dittoed addressogra^h. Wherever the best interests and emciency
of the agency are better .provided by use of contract printing, the
printLg industry is invited to bid on job requirements. Many needs,
however, are best performed by the agency.
FISCAL SECTION
The essential function of this section is the determination of the
lewlity and propriety of payments under the various Programs of
t^fagencT, Processing all bills and vouchers for payment, the finan-
cial record keeping and preparation of required financial reports.
The financial transactions of the SBH for the fiscal year ended
June 30, 1966, as reflected by the records of the bureau, are pre-
IZel in a condensed form at the end of this section. A ^eUiled fi-
nancial report for the fiscal year ended June 30, ^f ^^.^^^^^^^^ P/^^^
nared and distributed to the Governor, members of the Board of
^'eali" d all bureaus, divisions and CHDs. ^he funds re ce,v^^^
(or appropriated) for the fiscal year ended June 30, 1966, were from
the following sources:
. $ 9,906,702.00 26.5%
State appropriations •,•*,:.**'.; ft 775 282 84 23.5%
From local agencies for county health un.ts 3 520 626 97 9.4%
From federal grants-in-aid s'l 27^849 22 13.7%
From research and project grants ^' '
From local arid state agencies-hospital services ^ 176,127.47 21.9%
for the indigent • /q«;';'r'^V9S 5 0%
From state and federal for building ^-^^^-^^'^^ -^^^
$37,362,441.75 100.0%
The expenditures by the SBH in summary, were for:
Personal services (salaries and other personal ^^^ ^^^^^ ^^ ^^
services) • •. , ' '
Contractual services (repairs, utilities, travel i3^027,841.90 35.8%
expense, hospitalization) ^'"'^ '
Commodities (office, medical, laboratory and ^ ^^^ ^^^ ^^ ^^^
mosquito control supplies) .......... 'p^'czv% c^ 23%
Current charges (rent, insurance, registrar ees) .... ^J^'^'^J^ ^'^
Capital outlay (equipment and fixed assets) 'ils 970 40 40%
Grants to counties and mosquito districts . 'm'^7 01 4%
Miscellaneous (education aids and subsidies) ]U,927.0} _^^
$36,401,807.53 100.0%
FINANCE AND ACCOUNTS 73
In addition to funds reported in the annual financial report and
summarized above, certaiT other funds and services were made
avSSblTby the U.S. PubUc Health Service (USPHS) to the activities
IJ^^Zlldhui were not paid directly to the State Board of Health
They include USPHS personnel on loan to the Board in the Bureaus o
PreLnt^le Diseases and Adult Health and Chronic Diseases. Fiscal
operruS; foUowed a budget plan of 194 departmental budgets. These
budgets were periodically revised as required.
SUMMARY OF RECEIPTS AND DISBURSEMENTS AND BALANCES
FOR THE FISCAL YEAR ENDED JUNE 30, 1966
RECEIPTS
FROM STATE APPROPRIATIONS
General Public Health:
, , . $ 3,387,532.00
Salaries. 10,620.00
Other personal services ^ 1,340,583.00
Expenses • • • 'l00,712.00
Operating capital outlay ' 1,650,000.00
Grants to localities ...........; '^2^ qqq qq
Purchase of polio and combined vaccines • • 4o'^000.00
Dental scholarships 40,000.00
Medical scholarships
, . . 169,365.00
Air pollution contro . ••••••• 110,761.00
Encephalitis research and control 147,760.00
Mental health council 956^000 00
Hospital services of the indigent 2,12o',000.00
County health units '. '. '. —
, . ,. , S10,198,333.00
Total state appropriations
FROM OTHER STATE SOURCES I ]j^^^
FROM FEDERAL GRANTS-IN-AID
Public Health Service:
,^ ,. $ 292,836.00
General health •••••••;••• 435,432.81
Chronic illness and care of aged • 265,402.45
Venereal disease . * * * * 8o',357.00
Tuberculosis control 219 054.00
Heart disease * * * ] 97^,859.00
Cancer control 105,702.00
Mental health 125^,900.00
Water pollution. . ' 66,330.00
Radiological health ^^ 435,45
Cuban health services 16'865.00
Dental health * Is'^SOO.OO
Home health services
if
74 ANNUAL REPORT, 1966
Children's Bureau:
Maternal and child health $ 1,217,953.26
Total federal grants-in-aid $ 3,520,626.97
FROM GRANTS AND DONATIONS $ 5,127,849.22
FROM LOCAL AGENCIES FOR COUNTY
HEALTH UNITS • • • ^ 8,7/:),iJaii.tt4
FROM HOSPITAL SERVICES FOR INDIGENT
, , ,^^. $ 392,685.76
Local sources * -,QrJ A.-i -ry'
State Welfare Board 7,783,441.71
Total hospital services for indigent $ 8,176,127.47
FROM STATE AND FEDERAL FOR BUILDINGS $ 1,855,853.25
TOTAL RECEIPTS $37,655,939.75
Less transfers from general public health to
Division of Mental Health:
Salaries ^217,000.00
Expenses 76,498.00
Total transfers ^ 293,498.00
NET RECEIPTS $37,362,441.75
BALANCE July 1, 1965, $5,542,827.97 (Less expired
appropriations of $366,714.30) $ 4,176,113.67
TOTAL RECEIPTS AND BALANCES $41,538,555.42
DISBURSEMENTS
OPERATING EXPENSES
Personal services:
Salaries ^'^'t^H^l^^
Other personal services— individual Tc^ lie oa
Other personal services— other 157,665.y6
Contractual services:
Travel expenses, including subsistence and lodging 1,572,235.94
Communication and transportation of things 'f^?'?? '??
Utilities 195,571.36
Repairs and maintenance ^o^'t^n ?^
General printing and reproduction service 125,140.15
Subsistence and support of persons ^^'ilT'o^S Aft
Other contractual services. 347,2 lD.6«
Commodities:
Bedding, clothing and other textile products o'c^'io
Building and construction materials and supplies q ^zo oo
Coal, fuel oil and other heating supplies 8,768.92
FINANCE AND ACCOUNTS 75
Educational, medical, scientific and mosquito < i n77 900 01
control materials and supplies > nl'oTft ftO
Maintenance materials and supplies ct ^ia ft7
Motor fuel and lubricants on7 ^ol 11
Office materials and supplies ii ?Qft 70
Other materials and supplies U,oyo./u
Current Charges:
Insurance and surety bonds 9?1'?42*00
Rental of buildings. • • • • fin poi A7
Rental of equipment ioo aaV^A
Other current charges and obligations oo'^zo o
Merit System ^^^^^^'^^
Total operating expenses $33,484,960.80
CAPITAL EXPENSES
^^^^^ $ 13,332.85
Buildings and fixed equipment 702,923.84
Educational, medical, scientific and mosquito
. I •^.^^.»*. 166,ZoU.3y
control equipment 70 Qon 90
Motor vehicles-passenger 489 36
Motor vehicles— other • 71 ft* 04
Office furniture and equipment • ^*;^;^
Land , q^^ cq
Other structures and improvements crjp O^
Other capital outlay ^""'^^
Total capital expenses ^ 1,305,949.32
GRANTS, SUBSIDIES AND CONTRIBUTIONS
Grants to counties and mosquito control districts $ ^'^^^'^^^'l?
Other educational aids and subsidies 144,yi;/.Ul
Total grants, subsidies and contributions $ 1,610,897.41
Total program expenses $36,401,807.53
NON-OPERATING DISBURSEMENTS
T r $ 289,722.03
Jrnd?: ::;:::::::::: :::::::::: ^3.297.12
Total non-operating disbursements $ 353,019.15
TOTAL DISBURSEMENTS $36,754,826.68
BALANCE June 30, 1966 $ 4,783,728.74
TOTAL DISBURSEMENTS AND BALANCES $41,538,555.42
1
*
V
76 ANNUAL REPORT. 1966
SCHEDULE OF EXPENSES
BY PUBLIC HEALTH PROGRAM AaiVITY
Health services to mothers, infants, pre-school
and school children •
Statewide venereal disease control, diagnosis and
referral of infectious venereal disease patients
to treatment clinics — also operation of program .
Mosquito and pest control programs, including
pest control law enforcement
Indigent hospitalization ^ ^ •* »•
Statewide sanitary engineering and environment sanitation
Statewide cancer control program
Statewide tuberculosis control, x-ray survey and
follow-up work
Mental health program *,**'%
Statewide narcotics drug, medical practice law enforcemen
Chronic illness and care of the aged
Heart disease program
Research and special projects
Building construction . . .
Other health programs and administration
t .
$ 4,893,378.00
1,229,000.00
6,172,767.07
9,268,759.48
3,026,380.76
762,525.00
1,112,900.00
1,170,375.00
242,036.76
1,634,685.00
819,305.00
2,812,025.59
908,163.37
2,349,516.50
Total expenses . .
• • • •
$36,401,807.53
SCHEDULE OF EXPENSES
BY FUNaiONAL ACTIVITY
General public health (also includes misce
health activities and training) ....
Vital statistics
Health education
Sanitary engineering
Entomology and mosquito control
Tuberculosis contjrol
Laboratories • •
Preventable disease (excluding tuberculos
Mental health
Narcotics
Maternal and child health
Local health services
Hospital services for the indigent
Chronic diseases
County health units
Building construction
Total expenses
I laneous
• •••••
control)
$ 2,364,957.33
435,064.65
103,930.79
707,324.36
4,899,337.32
505,421.62
1,071,581.61
987,819.03
221,666.79
196,985.10
1,082,450.30
290,843.45
9,268,749.48
622,031.12
12,735,481.01
908,163.57
$36,401,807.53
FINANCE AND ACCOUNTS 77
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78
ANNUAL REPORT. 1966
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BUREAU OF HEALTH FACILITIES AND SERVICES 79
C. L. NAYFIELD, M.D., M.P.H.
Director
This bureau was established at the December 5, 1965, meeting of
the Board of Health as a result of the designaUon of the State Board
of Health (SBH) as the single state agency to admimster Title XVm
of the "Medicare" Law. At the next meeting the name of Uie bureau
was adopted. For the administration of Public Law 89-97 financial
support was provided through the Social Security Admimstration.
The hospitaUzation program was greatly curtailed due to the
termination of the Medical Assistance for the Aged program and the
impact of the Medicare law on the Old Age Assistance group. This
is described in more detail in the section on Hospital Services for
the Indieent The special services section was extremely active in
developing Informational programs with special emphasis on medi-
care benefits and function. The hospital and nursing home Ucensure
programs followed patterns of previous years The numbers of
licensed institutions remained almost constant but the number of
beds available showed the expected increase. DifficulUes of nursing
home owners in securing financing due to a tight fmancial market
prevented the rebuilding and remodeling program from reaching its
predicted level and resulted in bed shortages in several areas.
SPECIAL SERVICES SECTION
This Section serves as a resource and depository of current in-
formation for bureau programs and activities. Its functions include
orogram planning, organization and activation; development and co-
ordination of specialized consultation services; P^^^^''''^'^'' f'^^'
ommended laws, regulations and standards; program and activity
eSion; presentation of institutes, conferences, seminars and
training courses; preparation of> conduct of studies, surveys and
i^^esulations in areas of need; development of educational, tech-
Scal ^d promotional materials, manuals and information pieces,
and liaison activities with official and voluntary orgamzations.
Educational services took on new proportions and were accel-
erated during the year because of the Health Insurance or the Aged
Program (Medicare). This program was the ^ocus of the Eighth
Annual Nursing Home Short Course conducted by the Division of
Continuing Education, University of Florida, in cooperation with the
SBH and the Florida Nursing Home Association. One hundred ^d
ten administrators and other nursing home personnel participated.
Its puT^ose was to assist operators in qualifying their institutions
for pa^cipation as extended care faciUties. Increased attent on
also was ^ven the subject at the Tenth Amiual Convention of the
Florida Nursing Home Association.
Because a significant number of nursing home appUcaUons for
participation in Medicare were found to be deficient, a series of
iO ANNUAL REPORT, 1966
one-dav soeclal area seminars were organized and presented to
provWe coLy health department (CHD) personnel and nursmg home
^«tra"/s additional specific info™»tion and resolve proWems
in areas of concern. They drew a total attendance of 108 CHD reP
resentatives from 39 counties in morning sessions, and 312 nursmg
h^me pirsonnelfrom 206 homes in 31 counties JT^ften^oon sessions.
An in-deoth seminar on "Medicare and Long Term Care FaciUties
^iniSion" was conducted by the Center for Continuing Educa^
tion University of South Florida, Tampa, under a U. S. PubUc Healtn
Service (USPHS) short term traineeship grant, in cooperation with
the SBH and the Florida Nursing Home Association.
Planning sessions on the development of a statewide continuing
educatZ program for nursing home P-"°""^l 7'^^,'>„f ^,^"""^,^:
vear In a two-day conference with representatives of the Flor da
Nursin? Home AsI>ciation, State Department of Education and the
state's university system, a proposed program mcorporating a p^
?or voirtary certification was structured. It is to be ^^P^^'^-J^^f
through community junior colleges in selected centers of the state
TO "aciUtate arrangement of appropriate -"icu a, a survey o
catecories of nursing home personnel was made. It revealed that
169 ph^s'cians, 942 registered nurses, 1006 licensed practical
nurses 37 fnurse aides, 541 attendants and 2642 other personnel,
or a total of 9011 persons, were reported by administrators to be
staf^ members of homes Ucensed under Florida's nursing home law.
Although no student architectural plans *"e offered under the
cooperative undergraduate program introduced m 1962 with the Col-
leTof Architecture and Fine Arts, University of Florida, and con-
Unued in 1963 and 1965, a proposal was developed to e^and the
arrangement to include graduate assistant offermgs in 1967. The
p[^isTo extend the scope to provide design instruction in housmg
for the elderly.
A seminar for professional architects, engineers, administrators
and pubUc health officials, on the functional design of medical care
and related facilities was conducted at the SBH May 26-27. A total
S^ 105 persons attended. Featured was an exhibit of competitive
nursing home designs executed by 22 University of Florida fourth
year arclTectural students who participated in the cooperative
undergraduate program the prior year.
Uaison was maintained with Florida fire services through as-
sistance and participation in programs "^^he^ual convention of
the Florida State Firemen's Association, the State Fire Marshal s
17th Annual Fire Prevention Conference, a statewide fire department
crteTone day health facility fire safety seminars at Tampa and
I^nLcoU and meetings with district deputy state fire marshals.
?^ture1u ^so is represented on the State Fire Marshal's advisory
committee on fire prevention in hospiUls, nursing homes and related
facilities.
HEALTH FACILITIES AND SERVICES
81
Institutional nutrition consultation services were provided 26
nursing homes in eight counties and 16 hospitals in nme counties. In
addmon «^onal nutrition consultants made 46 consultation visits
L ihese institutions. A total of 27 counties were covered by these
comtn:d services. In Hillsborough, ^he. county nutrmomst as a
member of the CHD Ucensure team, participated in 58 surveys ol
TrTrng homes and made 28 consultation visits. In Dade County he
nSoiUst cooperated with the CHD surveillance team m the evalu-
ation of^ursing home dietary services and provided written analyses
and recommendations to 18 nursing home admimstrators.
Construction plans for food service departments of 21 pressed
nursing homes and nine proposed hospitals were given critiques by
toe burears senior institutional nutrition consultant. Conferences
were imdertaken with architects, engineers, equipment representa-
tives ^d sponsors in the development of dietary components of
health care facilities.
Food service educational activities and programs were expanded.
Aid was gTv7n professional dietitians and educational leaders m the
^tawfshSof campus-based food services supervisor courses in
lu^slarcommunity junior coUeges in St. Petersburg, Fort Laud-
erdale and Miami.
A project was developed with the Florida Dietetic Association,
Florid^ Hospital Association, Florida Nursing Home Association,
I^d SBH Dmsfon of Nutrition, to identify available dietitians for
^rt-time consultation work in hospitals and nursing homes A
me ary Consultation workshop was conducted by the Center for Con-
Hm.ln/ Education University of South Florida, in St. Petersburg in
r "^ber wTth th; sponsorsLp of the bureau -d toe ^-menti^^^^^^^
organizations. It was designed to provide o."entation and refresher
training for dietitians interested in furnishing consultation services
to nursfng homes and small hospitals. The workshop was presented
mder a USPHS Short Term Traineeship grant. More than 60 pro-
fessional dietitians participated.
Nurse consultation services accounted for 81 vi^tsjo nursing
homes and six visits to hospitals in 34 counties. These services
we?e provided to assist Ch6s and administrators in the evaluation
Ld development of quality nursing service in institutions. Ac™s
Splemented licensure and medicare certmcation responsibiUt^s
pa^cularly in toe presentation of "^"'"■"^"'^^""".^tttrltion of
fine patient care poUcies, patient care plans, admimstration ol
medications maintenance of nursing records and organization of
Tse^ice education programs. Lectures on nursing and communi-
^ation^ were g'ven in s& successive monthly workshops conducted
m Sge Counly by Districts H and m of the Florida Nursing Home
Association.
Assistance was provided toe planning committee of the Florida
Divit'on!Xerican "^Cancer Society, in toe organization of a pilot
82
ANNUAL REPORT. 1966
educational program in cancer nursing for the nursing personnel in
nursing homes. Thirty- six professional nurses, licensed practical
nurses and aides participated.
A nursing Survey Guide for Nursing Homes was prepared to aid
CHD nurses in their evaluation of nursing care in these facilities.
The itemized guidelines correlate SBH nursing home regulations and
Medicare "Conditions of Participation for Extended Care Facilities"
and may be used as bases either for licensure or certification rec-
ommendations. The instrument was tested by public health nurses
in selected counties and is available upon request.
Forty-two visits were made to 13 counties to provide consultation
to church organizations, clergy and lay leaders in their development
of nursing homes and nursing care units in retirement housing ar-
rangements. Particular attention was given northwest Florida be-
cause of the relatively few nursing homes in the area. A total of 16
projects was planned during the year. Two church- related nursing
homes went into operation in Brevard and Broward Counties. Sim-
ilar facilities are in the process of construction in Hillsborough,
Indian River, Lee, Polk and Volusia Counties. Services included
consultation with CHDs, Division of Community Hospitals and Medi-
cal Facilities of the Board of Commissioners of State Institutions,
Federal Housing Administration and Small Business Administration,
to correlate community needs for facilities and assist in the ar-
rangement of financial support for them.
Assistance was provided the Florida Council on Aging and the
University of South Florida in the organization and presentation of a
workshop on protective services for the elderly. Aid was provided
Dade CHD and Miami-Dade Junior College in the organization and
conduct of a six-week course of 12 sessions for nursing home ad-
ministrators.
HEALTH SERVICES FOR THE INDIGENT
Utilization of health services by the indigents under the state
programs decreased during the year. This was largely due to the
start of the Social Security Medicare program for those persons age
65 and over. The Medicare program resulted in the termination of
the Medical Assistance for the Aged (MAA) program on June 30, 1966.
Total expenditures under all programs were lower at $11,044,299,
the days of care rendered were only 363,247 and admissions dropped
to 41,988.
On December 31, 1966 there were 176 hospitals participating in
the Hospital Services for the Indigent (HSI) and Public Assistance
Recipient (PAR) programs, one more than a year ago. Hospitals
submitting cost statements to establish a patient per diem rate in-
creased from 149 to 155. The average per diem rate for all hos-
pitals with established rates was $33.17, an increase of 4.7 per cent
from the figure of $31.67 for 1965. The maximum per diem rate
m-
HEALTH FACILITIES AND SERVICES 83
allowed under the Rules, State Board of Health, Chapter 170-E
creased to $42.70 on August 1, 1966.
Hospital Service for the Indigent (State-County) Program
The HSI program was estabUshed by an act of the 1955 Legis-
lature to provide hospitalization, visiting nurse care and outpatient
clinic services for the acutely or chronically ill or injured, med-
ically indigent persons. Funds have never been provided for other
than inpatient hospitaUzation; therefore, visiting nurse care and out-
patient services have never been offered under the program.
The Legislature appropriated funds of $994,000 for the fiscal
year 1966-67 to match the required 50 cents per capita for each
county. It is interesting to note that actual expenditures under the
program for the fiscal year ending June 30, 1966, for state funds
amounted to only 20 per cent while county funds total 80 per cent.
Many counties appropriated more funds than required by law. Durmg
1966 all counties except Gadsden, Glades, Gulf, Holmes, Wakulla and
Washington participated in the HSI program.
Tables 10 and U provide statistical and financial data. Utilization
as reflected by admission and days of care again remained at ap-
proximately the same level as last year. Expenditures for services,
however, increased about nine per cent. The average cost per day
and cost per admission were again up with 5.3 per cent and 7.5 per
cent increases over the previous year.
Public Assistance Recipient Program
The SBH administers the PAR program of hospitalization under
the terms of agreement with the Florida State Department of PubUc
Welfare On July 1, 1966, all public assistance recipients age 65 and
over were shifted from this hospitalization program to the Medicare
orogram which started on that date. Since approximately 60 per cent
of the public assistance recipients are of age 65 and over it has had
a substantial effect on decreasing the size of this program.
The number of days of hospitaUzation allowed for the PAR pro-
gram remained at 12. Due to the limited number of days allowed a
recipient, many counties were forced to care for them under the HSI
program whenever a person's allotted days were exhausted under
the PAR program.
Medical Assistance for the Aged Program
The implementation of the Medicare program caused the MAA
program to be terminated on July 1, 1966, having served its purpose.
The MAA program of hospitalization and visiting nurse care for the
medically indigent 65 years of age and over had its beginmng on
July 1 1963. Utilization of services and expenditures increased
during' each year of its operation. Admissions for the six month
period total7,219 with 89,224 days of care. Cost experience for MAA
H
'^ !
84
ANNUAL REPORT. 1966
recipients were higher than other indigent patients, caused pri-
marily by the age of the patients. I
Advisory Committee to the Hospital Service for the Indigent
Florida Statute 401 provides for an advisory committee to the
Hospital Service for the indigent program. A new member appointed
to the 11-man Advisory Committee was Honorable Lamar Hancock,
of Live Oak. Don S. Evans, of Orlando was reappointed to the com-
mittee. Other members are: H. Phillip Hampton, M. D., Tampa,
chairman; Nelson Zivitz, M.D., Miami; State Senator Beth Johnson,
Orlando; State Senator Robert M. Haverfield, Miami; State Repre-
sentative Ray Mattox, Winter Haven; Joseph F. McAloon, Coral
Gables- Frank Kelly, Miami, and Ben P. Wilson, Ocala. The vacancy
created by the resignation of State Representative Phil Ashler has
not been filled at this time. All meetings during the year were
largely devoted to the study, discussion and development of Title
XIX of the Social Security Amendment of 1965, providing for medical
care of the needy.
Reservation Indian Medical Care Program
The program was continued under contract with the USPHS with
$70 500 provided for fiscal year 1965-66. Amendments were nego-
tiated during the year to make an additional $11,000 available when
it became apparent funds would not be sufficient to cover services
required. Even with the additional amount funds were exhausted in
early June forcing curtailment of all services until the new fiscal
year on July 1, 1966. Rising medical cost, together with an ever in-
creasing number of Indians being granted tribal membership in the
new Miccosukee Tribe were the reasons for the increased program
costs. Medical care benefits under the contract are hospital in-
patient and outpatient service, physician service, ambulance service,
prescribed drugs from contract stores and prosthetic appUances.
TABLE 10
MAJOR EVALUATION INDICES, BY TYPE OF
HOSPITALIZATION PROGRAM, FLORIDA, 1966
Evaluotion Index
Number of admissions
Days hospitalized
Totol payment— State and Federal
Total payment— State and Cownty
Average cost per day .
Average cost per admission ....
Public
Assistance
Recipients
19,250
129,234
$3,819,257.90
29!55'
198.40
Hospital
Service for
the Indigent
15,519
144,789
ii ,579^22126
31.63
295.11
Medical
Assistance
for the Aged*
7,219
89,224
J2>*5,218.55
29!65
366.42
Source: Applications processed ond approved for payment reports.
•Program terminated 6/30/66.
HEALTH FACILITIES AND SERVICES
85
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HEALTH FACILITIES AND SERVICES
87
HOSPITAL UCENSURE PROGRAM
The Advisory Hospital Council actively assisted the State Board
of Health in the administration of the hospital Ucensing law. Council
members, appointed by the Governor, are James H. Sweeny, Jr.,
attorney and State Legislator, Deland; WilUam W. Richardson, M.D.,
Graceville; Autha W. Forehand, director, Division of Community
Hospitals and Medical FaciUties, Tallahassee; John F. Wymer, ad-
ministrator. Good Samaritan Hospital, West Palm Beach; Walter D.
Griffin, pharmacist, Jacksonville; Richard C. Gumming, M.D., Ocala;
with the State Health Officer as Chairman ex-officio. Messrs.
Sweeny, Richardson, Forehand and Wymer have served continuously
since the Council was first organized in late 1957.
Considerable activity centered around an "Atomedic Hospital," a
windowless structure in the round. The structure was purchased
from the New York World's Fair Authority where it was used as a
medical dispensary for two years. At the Council's annual meeting
held April 7, 1966, a decision was made to advise denial of the re-
quest for Ucensure based on the many deficiencies in the type of
construction, and design features contrary to normal construction
standards and hospital licensure regulations. Subsequently the State
Health Officer appointed three members of the Council to serve as
Board of Hearing Examiners. The hearing was held July 29, 1966.
On November 22, 1966, application was denied again. However, the
appUcants' request to address the SBH at its regular meeting, De-
cember 11, 1966 was granted. At the Board's direction a provisional
Ucense was issued, effective December 12, 1966, which excluded
surgical, obstetrical and orthopedic services.
Six Ucensed hospitals ceased operation during the year, making
a total of 50 hospitals that have closed since the Ucensure program
began in 1957; 16 closed voluntarily, 16 were replaced by new facil-
ities 11 reverted to "cUnic" status, six became nursing homes and
one was closed following a legal hearing. With few exceptions, these
hospitals were unable to meet and/or maintain minimum Ucensure
standards, or efforts judged necessary to conform were not feasible.
During the year consultants reviewed 143 hospital construction
plans having an approximate value of $75,000,000. Of these, 86 were
approved for a total of 3795 beds. Consultants surveyed 207 hos-
pitals, and held 126 consultations with architects, administrators
and others, particularly directors of CHDs.
h i
^ii
ANNUAL REPORT. 1966
TABLE 12
HOSPITAL EVALUATION STATISTICS, FLORIDA, 1966
HEALTH FACILITIES AND SERVICES
89
Licensure Status
Hospitols
Beds
Bassinets
188
6
7
189
1
23,136
492
683
23,747
27
2,663
Licensed at beginning o* yeor
82
Ceased to operate during yeor
74
Accessions during year
2,566
Licensed at end ot year
4
Unlicensed at end ot year
Total subject to licensure at end of year
190
23,774
2,570
HEALTH INSURANCE BENEFITS FOR THE AGED
In November, 1965, the Governor designated the SBH as the sin-
gle state agency to administer the functions prescribed by SecUon
1864 of the Medicare Act. These functions involve the certification
of providers of services which include hospitals, extended care fa-
cilities (nursing homes) and home health agencies. In addition, this
bureau also certifies the participation of independent laboratories.
The purpose of certification is the determination of whether such
health care faciUties meet the requirements of the conditions of
participation. Other functions include consultative activities to pro-
vide advisory assistance to facilities to qualify for participation; to
estabUsh and evaluate the effectiveness of utiUzation review pro-
cedures; the coordination of Medicare Program activities with its
other activities concerned with the provision of similar services,
facilities and personnel required to provide such services, and im-
proving the quaUty of such services.
The hospital certification program resulted in 172 hospitals
being approved for participation in the program, which consisted of
approximately 94 per cent of the general hospital short term beds in
the state Six hospitals were recommended for demal. Of the num-
ber of hospitals approved, 99 were accredited by the joint Commis-
sion on the Accreditation of Hospitals which were deemed to be in
compliance with the conditions of participation except for having a
utilization review plan. Approvals of this group were effected with-
out site visits upon receipt of the plan. Hospital consultants made
127 visits to non-accredited hospitals requesting participation, to
conduct extensive surveys to determine their compUance with the
conditions of participation.
The new concept of a formaUzed utiUzation review plan required
for participation in this program presented the most serious obstacle
at the onset, particularly with the smaller hospitals, but was largely
overcome through consultative efforts.
The extended care facility certification program resulted in 89
nursing homes and distinct parts of two hospitals being approved by
year's end for participation in the program. The distmct part of a
hospital designated as an extended care facility must be readily
\
identifiable as a separate unit, such as a wing or ward which pro-
vides a level of care distinguishable from the intensive care pro-
vided in the hospital. Eighteen nursing homes were recommended
for denial. Hospital consultants made 157 visits to facilities to con-
duct extensive surveys to determine compliance with the conditions
of participation.
As in the hospital program, the requirement for a formal utiU-
zation review plan presented a serious obstacle, but to a greater de-
gree inasmuch as it was a completely new concept, and was further
compUcated by the inabiUty of certain nursing homes to obtain at
least two physicians to serve on the committee.
Additional problem areas were encountered in the lack of com-
prehensive written patient care poUcies, transfer agreements with
hospitals, and lack of quaUtied personnel. In an effort to assist in
resolving these problems, seminars were conducted by the bureau
staff in four major population areas for CHD personnel and the
nursing home operators. It is felt that this effort materially aided
in the resolution of such difficulties.
Extended care benefits became available on January 1, 1967, at
which time approximately 70 per cent of the certification workload
was completed. The program will be continued to substantial com-
pletion by, it is estimated, February 1, 1967.
The certification of home heaUh agencies was delegated to the
Home Health Services Program in the Bureau of Local Health Serv-
ices. An account of that activity appears in that bureau's report.
In addition to the above providers, the certification of labora-
tories and X-ray facilities as independent laboratories was conducted
on an interim basis from questionnaires 1-eceived from applicajits
by the Bureau of Laboratories and the Division of Radiological Health.
The site visits to determine the final acceptance of these facilities
will be conducted during the coming year.
The final regulations for independent laboratories exclude diag-
nostic X-ray tests; therefore, certitication procedures will be re-
stricted to the cUnical laboratories which have appUed for partici-
pation.
The assurance of continued compUance with the conditions of
participation, and investigation of the progress being made in the
correction of previously reported deticiencies, will be the responsi-
biUty of this bureau.
NURSING HOME LICENSING PROGRAM
Combined nursing home, home for the aged, and home for special
services facilities totaled 350 homes with 21,212 beds licensed at
the end of 1966 as compared with 344 homes with 17,574 beds U-
censed at the end of 1965. The number of Ucensed nursing homes
decreased from 277 homes in 1965 to 276 homes in 1966, but reflected
90
ANNUAL REPORT. 1966
an increase in number of beds with 14,983 at the end of 1965 and
16,657 at the end of 1966. In homes for the aging there was quite
an increase from 55 homes with 2192 beds at the end of 1965 to 62
homes with 4155 beds in 1966. This increase in homes for the aging
beds was precipitated by many of the church- related non-profit re-
tirement homes adjusting to meet home for the aged licensure re-
quirements.
Applications for approval of plans for construction continued at
approximately the same rate as 1965 with 96 preliminary reviews
and 52 reviews of final working drawings, for a total of 148, covering
5746 beds at an estimated construction cost of $18,674,500 with 2889
beds having final construction plans approved.
The nursing home consultant made a total of 89 field surveys and
consultations which included surveys for renovations; special prob-
lems encountered by the CHDs in the consultative and administrative
fields; and Medicare surveys when Medicare problems became en-
tangled with problems of licensure. All surveys were made at the
request of the local health authorities. There were also approxi-
mately 250 office consultations on design, location and feasibility.
The proposed home for the aged regulations were still under
consideration at the end of 1966. Evaluation and upgrading of sub-
standard facilities continued with the closing of 12 nursing homes
and one home for the aged.
/
HEALTH FACILITIES AND SERVICES
91
TABLE 13
NUMBER OF EXTENDED CARE FACILITIES LICENSED
AND NUMBER CEASED OPERATIONS, WITH BED CAPACITY,
BY COUNTY, FLORIDA, 1966
COUNTY
Alachua . . . .
Boy
Bfodford . . . .
Brevard . . . . <
Browvd. . . . c
D«U . . . .
Dixi*
DuYol
Escambia . . .
Hardee ....
Hernar>do. . .
Highlond* . .
Hillsborough.
Holmes ....
Indion River.
Jeffenon. . .
Lake
Lm
Uon
Levy
Manatee . . .
Marion ....
Martin ....
Monroe ....
Otceechobee.
Orange ....
Osceola . . .
Palm Beach .
Pasco
Pinellos. . . .
Polk
Putnam . . . .
St. Johrtt. . .
St. Lucie. . .
Sarasota . . .
Seminole . . .
Sumter . . . .
Suwannee . .
Volusia . . . .
Washington .
SUBTOTALS.
Nursing
Homes
1
2
1
3
15
1
40
1
28
3
1
1
30
1
3
1
6
5
2
2
6
2
1
1
13
2
21
5
49
11
3
2
1
6
1
1
1
15
288
NUMBER OF HOMES
Homes for
the Aged
1
12
5
2
1
Homes for
Spec. Serv.
2
2
1
3
3
3
3
9
3
1
2
2
1
2
63
3
2
12
Total
2
2
1
4
17
1
54
1
33
6
1
1
1
32
1
3
1
8
5
2
2
10
2
1
1
1
16
5
24
8
59
14
4
4
3
7
6
1
1
17
1
363
BED CAPACITY
Nursing
Homes
Homes for
the Aged
72
116
SO
210
1219
21
3297
12
1510
264
37
24
1414
36
136
50
242
307
105
47
310
87
60
9
' 671*
93
1312
88
3243
482
65
125
79
422
35
25
44
773
11
10
42
606
73
27
24
64
23
174
17,092
10
421
38
151
22
1615
113
11
288
44
343
50
4,162
CEASED OPERATIONS IN 1966
Homes for
Spec. Serv.
63
47
52
1
28
42
18
150
400
Total
82
116
50
252
1282
21
3952
12
1583
343
24
37
24
1506
36
136
50
265
307
105
47
484
87
60
9
10
1092
131
1463
110
4900
595
76
413
123
765
103
25
44
923
11
21,654
Broward
Dode
4
3
2
1
1
4
3
2
1
1
1
1
139
174
40
3
30
"49
• ••-•••
7
139
174
40
3
30
Hillsborough
Loke
Orange
Pa$co
1
7
49
Polk
SUBTOTALS
12
1
13
435
7
442
TOTALS
276
62
12
350
16,657
4,155
400
21,212
92
ANNUAL REPORT. 1966
Ji
BUREAU OF LABORATORIES
NATHAN J. SCHNEIDER. Ph.D.. M.P.H.
Director
WARREN R. HOFFERT. Ph.D.. M.P.H.
Assistant Director
The major responsibility of this bureau is to provide laboratory
support required by the various services, regulatory and research
activities of county health departments (CHD) and bureaus and di-
visions of the State Board of Health (SBH). Diagnostic and reference
services are also rendered to licensed practitioners of the healing
arts and law enforcement agencies. Legal responsibilities include
the approval of private and hospital laboratories for the performance
of premarital and prenatal syphilis serology tests, assisting the
Board of Examiners in the Basic Sciences in the administration of
the Florida law on the practice of medical technology, the Bureau of
Narcotics in the regulation of the sale of narcotics, drugs, cosmetics
and devices, and more recently, assisting the Bureau of Health Fa-
cilities and Services in the certification of independent laboratories
under the Health Insurance for the Aged (Medicare) program.
Several important organizational changes were made during 1966.
The new $750,000 Tampa Regional Laboratory building was com-
pleted and occupied on September 8, replacing the obsolete structure
which this unit had occupied since 1910. This modern facility of
19,800 sq. ft., located adjacent to the site of the new Hillsborough
CHD building, also houses the Encephalitis Research Center (ERC)
virology laboratory and offices for regional SBH narcotics, sanita-
tion and bedding inspection programs, thus bringing together inter-
related state and county public health agencies. The new quarters
will permit the expansion of services to include narcotics and other
chemical analyses. In April, Eldert C. Hartwig, Jr., who recently
completed his Sc.D. studies at the University of Pittsburgh School of
Public Health, was assigned as director.
Dwight E. Frazier, director of the Miami Regional Laboratory,
resigned and Robert A. Graves, who has been in charge of the Tal-
lahassee Regional Laboratory for the past 17 years, was assigned as
his replacement. E. Ann Roberts, formerly assistant director of the
Tallahassee laboratory, was promoted to the position of director.
With the closing of the W. T. Edwards Tuberculosis Hospital in
November, the cooperative laboratory program established by the
State Tuberculosis Board and the SBH in 1955 was terminated for this
hospital, although it continues to be in force in Lantana and Tampa.
In Orlando, Siegfried Mueller resigned as chief chemist of the
radiological laboratory section. Max T. Trainer, director of the
Orlando Regional Laboratory, has assumed administrative responsi-
bility for the section.
LABORATORIES 93
In the SBH Central Laboratory, Elsie E. Buff, who joined the
staff in February, 1985, took charge of the virology section.
A second CHD (Brevard) established a laboratory in newly built
faciUties to serve its sanitation program. As was the situation m
the Pinellas CHD, both laboratories provided speciaUzed testmg
milk and other dairy products, drinking and poUution water sanaples,
and market foods and utensil swabs. This bureau provided techmcal
and consultative services to both laboratories.
DIAGNOSTIC SERVICES
In general, the laboratory offered the same types of diagnostic
services in 1966 as in preceding years. Considering only the general
pubUc health diagnostic services, as shown in Table 14, there was a
total of 2 714,832 examinations performed, a 2.9 per cent mcrease
over last year. Much of this change occurred in diagnostic bacteri-
ology, parasitology, mycology, sanitary bacteriology forensic and
water chemistries, virology and phenylketonuria (PKU) screemng.
Streamlining of test procedures in syphiUs serology accounted
for a reduction in the number of examinations performed despite a
substantial increase in the number of specimens examined. TheKol-
mer Reiter Protein (KRP) and other 'battery" tests were discon-
tinued The VDRL sUde flocculation test has proven to be the most
satisfactory screening test for use on a routine basis. Problem
cases not resolved by the VDRL test can be studied further by means
of the FTA-ABS (fluorescent treponemal antibody absorption testj.
This procedure was instituted in the central laboratory and Miami
laboratory in 1966, with the availabiUty of dependable reagents from
commercial sources. Plans are underway to extend this procedure
to the remaining regional laboratories during the next year.
Due to a streamlining of laboratory procedures, the number of
examinations of nose and throat specimens for diphtheria and other
throat infections was reduced from 1965 to 1966, even though the
number of specimens submitted in 1966 increased by 21 per cent.
Tuberculosis diagnostic bacteriology increased substantially due
in part to increased efforts by the Division of Tuberculosis Control,
the CHDs and private medicine to detect and control this disease.
There was a 15.7 per cent increase in the number of examinations
performed on 14.8 per cent more specimens. Mycobacterial iso-
lations for more detailed characterization also increased. The up-
ward trend in other years of diagnostic bacteriology was also
noticeable in tests for gonorrhea, enteric pathogens and miscel-
laneous smears and cultures.
In sanitary bacteriology, the number of examinations of dairy
products decreased in all of the regional laboratories. The Central
Laboratory initiated the testing of milk samples from the Ci^ of
Jacksonville, therefore showing an increase in this category. Most
u
94 ANNUAL REPORT. 1966
noticeable was a 15.3 per cent increase in examinations of stream
and bathing beach pollution waters from 70,985 in 1965 to 81,865 in
1966. Examinations of food specimens suspected of causing food
poisoning increased by 86 per cent, i.e., from 1545 in 1965 to 2873
examinations.
There was a 28 per cent decrease in the number of lactobacillus
counts made on saliva as part of the dental caries prevention pro-
gram. Reports of lactobacillus counts were sent to the dentists
through the Bureau of Dental Health, leaving the interpretation to
individual dentists.
Demands on the chemistry section in providing examination of
blood specimens were greatly increased. A total of 51,704 blood
examinations was made in 1966, an increase of 29.4 per cent which
is largely due to an increase in blood sugars and hemoglobin de-
terminations requested by CHDs.
The Guthrie test procedure to screen newborn infants for de-
tection of early cases of PKU was first offered in the Miami
Regional Laboratory because of the special interest in this pro-
gram by the Developmental Evaluation Clinic of the Dade County
Department of Public Health (CDPH). The number of tests in-
creased from 14,042 in 1964 to 24,471 in 1965 and 33,584 in 1966.
Stimulated by legislation passed in 1965, the demand for this service
became statewide. The Central Laboratory instituted PKU testing in
1965, performing 192 tests; in 1966 this increased to 11,064. There
being approximately 120,000 births in Florida annually, it is antici-
pated that the demand for this screening procedure will continue to
increase.
The radiological chemistry section continued to function in the
Orlando Regional Laboratory. The demands for examinations leveled
off during 1966.
In virology, there was a marked increase in the number of ex-
aminations performed during 1966. There was also an increase in
the number of rabies examinations performed statewide. The fluor-
escent antibody test now performed in five state laboratories speeds
up the reporting of positive tests.
The results of examinations for all laboratories are indicated in
Table 15. A total of 774,154 specimens was examined for syphilis
and 36,875 were reactive. Excluding specimens unsatisfactory for
testing, the per cent reactive was 4.8. This compared to 4.4 per cent
in each of the two preceding years.
The number of diagnostic specimens found positive for diphtheria
in 1966 was 21 or 0.25 per cent, compared to 1.0 in 1964. This con-
tinues the downward trend that has been present since 1960. The
small amount of diphtheria remaining is in a few areas where there
is a considerable number of susceptibles. The proportion of throat
specimens positive for streptococcal infections decreased markedly
LABORATORIES 95
from 17.5 per cent in 1965 to 11.0 per cent in 1966. Similarly, there
was a decrease in the number of nose and throat specimens positive
for other potentially pathogenic bacteria. In 1965, 62.4 per cent were
positive, while in 1966 only 47.6 per cent yielded staphylococci,
pneumonococci and/or H. influenzae.
A total of 62,293 sputum specimens was examined for tubercu-
losis and other mycobacteria. During the past two years, there has
been an increase of 34 per cent in the number of such specimens
submitted. Excluding unsatisfactory specimens, there was a total of
5473 or 9 2 per cent cultures positive for M. tuberculosis or atypical
mycobacteria as compared to 5.9 per cent in 1963. A modification
in the digestion procedure reported in the 1964 annual report ac-
counts for the increased sensitivity of the cultural procedure.
Smear specimens examined for the presence of gonococci (GC)
continued to increase during the year. In 1966 a total of 54,879
specimens was examined as compared to 48,058 in 1965. There was
a decrease in proportion of positives for GC by smear examinations
from 16.1 per cent in 1965 to 10.3 per cent in 1966. In contrast,
there was an increase in proportion of positive cultures from 8.0 per
cent in 1965 to 8.7 per cent in 1966. The reUabiUty of the smear test
is questionable, when examining urethral and cervical specimens
from females. However, the cultural test can only be provided to
clinics located in the same city as the laboratory.
There was a moderate increase in fecal specimens from 57,758
in 1965 to 58,781 in 1966. The proportion positive for typhoid and
other Salmonella decreased from 2.5 per cent in 1965 to 1.9 per cent
in 1966. In contrast, the per cent positive for Shigella increased
from 0.45 per cent in 1965 to 0.58 per cent in 1966. That there were
more Shigella seen in Florida during the year was further confirmed
in the increased number of Shigella cultures submitted from hospital
and other laboratories. In 1965 a total of 376 ShigelUi cultures was
received and identified while in 1966 there were 646 such cultures.
Shigellae seen were Sh. boydii, Sh. dysenteriae, Sh. sonnet and Sh.
flexneri.
Included in the miscellaneous specimens for diagnostic bacter-
iology reported in Table 15 was a total of 105 darkfield positive (T.
pallidum) lesions, all reported from the Miami laboratory as part of
the Dade CDPH Venereal Disease Clinic. A total of 311 specimens
was examined and 34 per cent were positive.
The finding of gonorrhea organisms in 13 eye specimens indi-
cated the importance of treating the eyes of all newborns in order to
prevent blindness due to this infection.
A total of 1744 specimens was found positive for various patho-
genic fungi which included Candida albicans, the Trichophytons,
Microsporums, Nocardia, Cryptococcus neoformans, etc. Tins
service has been on the increase during the past three years; 1180
positives in 1964, 1248 in 1965 and 1744 in 1966.
96
ANNUAL REPORT. 1966
The number of bacteriological cultures submitted to the labora-
tory for identification has increased from 2670 in 1965 to 3551
organisms during 1966. This service is useful to smaller labora-
tories with limited facilities.
The number of stool specimens examined for intestinal parasites
increased moderately from 118,289 specimens in 1965 to 124,360
specimens in 1966. The proportion of positive hookworm has de-
creased from 4.1 per cent in 1965 to 3.4 per cent in 1966; in con-
trast, that for ascaris has increased from 3.6 per cent in 1965 to
4.7 per cent in 1966. Positive findings for enterobius (pinworm),
trichuria and E. histolytica have decreased. Three malaria positive
diagnostic specimens were seen in the laboratory during the year.
One Plasmodium ovale was from a 25-year-old male Peace Corps
worker who had contracted the infection in Liberia; another was
Plasmodium vivax from another 25-year-old Peace Corps worker
who had contracted the disease in Nigeria. The third case which
terminated fatally was a 50-year-old male who was a medical mis-
sionary from Liberia; the positive seen in smears was identified as
Plasmodium falciparum .
In the chemistry sections of the bureau, a total of 42,984 blood
specimens was examined for glucose (diabetes), hemoglobin, chol-
esterol, cholinesterase, phenylalanine, tyrosine, barbiturates, am-
phetamines and alcohol. There was a 10.7 per cent increase m the
number of blood sugars examined; 19.118 specimens in 1965 as
compared to 21,182 in 1966.
The chemistry staff examined a total of 2348 toxicological and
narcotics specimens. A chemistry section was established in the
Tampa Regional Laboratory in 1966. This should result in reducmg
the amount of travel time required for chemists to appear m court
in the Tampa Bay area.
The radiological chemistry section examined water, air, milk,
vegetation, soil and biota specimens to determine the amount of
specific radionuclides present. There was approximately a 23 per
cent overall increase in the number of specimens examined. Con-
tinued upgrading of the use of automatic data processing made it
possible to meet the increasing needs of this section.
Diagnostic services for viral and rickettsial diseases were pro-
vided on a statewide basis from the Central Laboratory. Such serv-
ices were coordinated with studies carried out in the Tampa Bay
area by the ERC (See Bureau of Research and ERC elsewhere in
this report). Specimens found negative by ERC for St. Louis
encephaUtis (SLE) and certain other selected arboviruses were
examined in the Central Laboratory for the enteroviruses and/or
other appropriate central nervous system viral agents as mdicated.
There was a 43.6 per cent increase in the number of specimens
examined. The major portion of this increase was related to the
statewide arthropod- borne virus surveillance program carried out
LABORATORIES 97
during 1966 as an adjunct to the activities of the ERC.
The number of animals examined for rabies increased from 3667
in 1965 to 3701 in 1966. As in the previous year, a total of 79 posi-
tive animals was found; however, there was an increase in the
number of positive raccoons and foxes while there were fewer posi-
tive bats and skunks.
Viral and rickettsial diagnostic findings in 1885 patients studied
are shown in Table 17. These findings represent an mcrease of
24 1 per cent over the 1519 patients studied in 1965. Among the
patients studied for respiratory viruses, there was a marked in-
crease in the number of Influenza B cases due to an outbreak m the
Pinellas County area. In contrast, 1965 had seen a greater number
of Influenza A viral infections. Mycoplasma pneumoniae (Eaton
Agent) infections also increased. Utilizing a newly described com-
plement fixation test for Rubella, two of 25 pregnant patients studied
were found positive. Considering viral cases associated with cen-
tral nervous system symptoms, there was a five-fold increase m
those of ECHO etiology. One case of poUo and five cases of Eastern
encephaUtis (EE) were confirmed in the laboratory.
The cooperative laboratory diagnostic and special study program
established between theSBH and State Tuberculosis Board completed
its nth successful year. The nature and extent of work performed
are presented in Table 18. A total of 128,236 examinations were
performed in 1966 as compared to 125,173 examinations m 1965.
There was a decrease in the actual number of diagnostic examina-
tions for tuberculosis but this was offset by a marked increase m
the cUnical chemistry examinations. There ^^^ an increase m the
category of "other" specimens in the Lantana hospital. This was
accounted for by the fact that in 1966 a large number of histopatho-
logical and cytology specimens was processed, mounted and sent
forward to a local pathologist in West Palm Beach for examination.
SPECIAL STUDIES
The bureau continued its program of special studies during 1966,
which are Usted in Tables 14 and 15.
The complete identification or typing of Salmonella cultures has
become an estabUshed routine in the Central Laboratory As he
salmonella typing center for the state it typed a tot^of 1337 cul-
tures during 1966 as compared to 1439 in 1965 and 786 m 1960. In
addition, 71 salmonella typhosa and 339 Shigella cultures were con-
tirmed ^d/or identified. Special studies on diarrheal diseases pre-
viously carried out in the Miami Regional Laboratory as Part of a
research contract between the University of Miami School of Med^^
cine, the U.S. Armed Forces Epidemiological ^oard (AFEB) and the
bureau were curtailed during 1966. The contract with the AFEB was
in its terminal year.
i
m
98
ANNUAL REPORT. 1966
1 \
The statewide arbovirus surveillance program has been in oper-
ation for the past four years since the occurrence of the SLE epi-
demic in the Tampa Bay area. The laboratory examination of human,
biological and entomological specimens collected throughout Florida
served to maintain a current index of arthropod- bo me virus activity.
At the time of preparation of this report, 32 arboviruses had been
isolated from 1497 of 2200 pools of mosquitoes collected in 1966.
These included seven EE, two Western encephaUtis (WE), four
Bunyamwera group (GB), 13 California encephaUtis (CE) and six
Hart Park- like viruses (HPL). EE was diagnosed in a four-week-
old girl born in Jacksonville in August 1966. There was a history
of mosquito bites and possible exposure to the virus on three brief
trips to Darien, Georgia, prior to developing symptoms of central
nervous system disease. In September, there was an outbreak of
EE in a flock of 65 pheasants in North Florida. Extensive EE
activity was also evident in the central portion of the state from
May to September. A total of 145 cases of encephaUUs in horses
was reported for the year.
Presented in Table 18 is a summary of the number of arthropod-
borne viruses reported to have been isolated from human, biological
and entomological hosts for the period 1952 through 1966. A total of
775 isolations of more than 14 different types of viruses (seven
groups) was reported; 97 per cent since 1960. Historically, yellow
fever and dengue had been diagnosed clinically in Florida but no
viral isolation had been reported.
Studies on the sanitary quality of salad-type foods, a three year
research grant funded by the U.S. PubUc Health Service (USPHS)
were continued. This project, carried out in cooperation with the
Division of Sanitation, was in its terminal year. Findings have shown
that most of the indicator bacteria were introduced from the raw
vegetables used in preparing the salads. To reduce the number of
bacteria in the finished product, blanched vegetables were used. It
was also found that the low pH of the salad, due in part to the pres-
ence of mayonnaise or salad dressing, tends to slow down the growth
of organisms. No evidence of Salmonella or other potential patho-
gens was found in the salads tested during the study.
The laboratory completed its three year project to determine the
usefulness of the Sabin-Feldman dye test in diagnosing chronic eye
disease. It was reported last year that the dye test results are dif-
ficult to intrepret because of the widespread presence of toxoplasma
antibodies in apparently healthy adults. In contrast, the absence of
antibodies may not be indicative of toxoplasmosis etiology because
of the poor vascularization in the eye. Thus, there may be tissue
damage but insufficient stimulation to produce antibody response.
Studies were carried out to investigate the usefulness of the hemag-
glutination (HA) test as a diagnostic tool. PreUminary analyses of
the data accumulated during the year indicate that the HA test has
LABORATORIES 99
the same inherent limitations as the dye test in that antibody findings
cannot be readily interpreted. However, the test procedure is less
complicated and more reproducible.
The level of budgetary support from the USPHS for the atypical
mycobacteria studies was reduced and this resulted in a proportional
decrease in the laboratory work associated with this project. The
culturing of soil samples for acid-fast baciUi was terminated in
August.
The airborne pollen study was Umited to the coUection and ex-
amination of exposed microscopic sUdes from two sites; one in
Jacksonville on the roof of the SBH building and the other in Orlando
in the vicinity of the Orange CHD. These studies provided an indi-
cation of the seasonal trend of airborne pollen in a given location.
Although not Usted separately in the tabular data, each of the
regional laboratories and, in turn, each of Uie sections within the
central laboratory performed Umited special studies during the
year. These included evaluations of various laboratory procedures
and/or bacteriological culture techniques.
CONSULTATIVE AND EDUCATIONAL SERVICES
Four technical workshops were conducted: (1) Medical Bacter-
iology in the Hospital Laboratory - held at the Teaching Hospital,
University of Florida, CoUege of Medicine, GainesviUe. Fifteen
bacteriologists and/or medical technologists attended this five-day
course. (2) CUnical Chemistry and Spectrophotometry - held m the
Miami Regional Laboratory. This four-day course was attended by
20 medical technologists from hospital laboratories throughout the
state (3) PKU - Detection and Management - held in cooperation
with the Florida Association of Pathologists at the SBH in Jackson-
viUe. A total of 75 pathologists, technologists attended the work-
shop and symposium which was two days in length. (4) Dairy
Technology Laboratory Procedures - held in Miami. Thirty-one
from dairy and regulatory laboratories attended this five-day
workshop.
Technical bench training was provided to 15 medical technol-
ogists and/or microbiologists in specific clinical laboratory pro-
cedures.
Twenty additional cUnical laboratories were approved to perform
premarital and prenatal serological tests for syphiUs, bringing the
1966 total to 285.
The bureau carried out registration of 67 medical laboratories
and assisted the Board of Examiners in the Basic Sciences in U-
censing 416 medical technologists and 140 medical technologist di-
rectors as provided in Chapter 483 of Florida Statutes, Inspections
were made of 21 commercial, pubUc health and dairy laboratories to
r
100
ANNUAL REPORT. 1966
certify their performance of bacteriological and related tests in ac-
cordance with Standard Methods and the USPHS requirements for
interstate shipment of milk. The senior sanitary bacteriologist per-
formed certification of water testing procedures in one regional
pubUc health laboratory, one CHD laboratory and 13 municipal water
plant laboratories in the state.
Evaluation specimens for cholesterol determinations were sent
out to 381 pubUc health, hospital and private cUnical laboratories
which participated on a voluntary basis. The comparative findings
were circulated among participating laboratories. Technical as-
sistance was provided where needed.
The allocation to the bureau of the responsibility to certify inde-
pendent laboratories wishing to participate in Title XVIH (Medicare
Program) has opened an area of opportunity which will allow for ex-
pansion of the proficiency testing programs on a more routine basis.
It will make it possible to provide consultation and training pro-
grams leading to the upgrading of laboratory performance.
REVISION 1966 OF PREVIOUSLY PUBLISHED LIST OF LABORATORIES
APPROVED FOR PREMARITAL AND PRENATAL SEROLOGY:
ADDED
Broadway Medical Laboratory, 135 Broadway, Daytona Beach
Clinical Pathology Laboratory, 920 Hickory Street, Melbourne
Crespi Medical Laboratory, 874 S. W. 8th Street, Miami
Escambia Blood Bank, 2201 North 9th Avenue, Pensacola
Golden Isle Hospital Laboratory, 301 Golden Isle Blvd., Hollandale
Hancock's Laboratory, Medical Building, Tallahassee
Heart of Florida Hospital Laboratory, P. O. Box 1166, Haines City
Highlands General Hospital Laboratory, P. O. Box 1017, Sebring
Hillsborough County Hospital, 5906 30th Street, Tampa
Hollywood Hills Medical Laboratory, Inc., 921 North 35th Avenue, Hollywood
John F. Kennedy Hospital Laboratory, P. O. Box 1489, Lake Worth
Medical Arts Laboratory, 2210 S. Atlantic Avenue, Cocoa Beach
Medical Arts Laboratory, North Causeway, New Smyrna Beach
North Dade General Laboratory, 16951 N. W. 2nd Avenue, North Miami Beach
Park Medical Center, 18140 N. E. 19th Avenue, North Miami Beach
Plantation Medical Laboratory, 25 S. W. 40th Avenue, Plantation
Professional Service Laboratory, New Port Richey
Riverside Clinic Laboratory, 2005 Riverside Avenue, Jacksonville
Starke Nursing Home Laboratory, 808 South Colley Rood, Starke
West Pasco County Hospital Laboratory, 500 Indian Avenue, New Port Richey
REMOVED
Kenneth B. Babcock, M.D., 1940 N. E. 45th Street, Ft. Lauderdale
Brewster Methodist Hospital Laboratory, 1640 Jefferson Street, Jacksonville
Doctors Hospital, 300 W. Call Street, Starke
LeJeune Road Hospital, 393 Aragon Avenue, Coral Gables
W. R. Ploss, M.D., 638 United, Key West
Professional Medical Laboratory, 1 1 1 S. John C. Sims Highway, Niceville
a*
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LABORATORIES
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ANNUAL REPORT. 1966
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LABORATORIES
103
TABLE 15
SPECIMENS SUBMIHED TO STATE BOARD OF HEALTH LABORATORIES
FOR EXAMINATIONS BY FINDINGS, FLORIDA, 1966
Numb«r of Specimen*
EXAMINATION
Positive Specimens
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3
CO
:I2 : ^t
■c>
8.
E
o
• • • «A ^B
. . . >- «
•♦r^
K 0« •* -O rt O-^CM O "O 'S.f^'".'" ■ ■*
— ^ ^ \a ^ o^ '■* ^^irt
O' •♦ «o
SEROLOGY
Syphilis
A^aglu*"'"*'®" *■ '«•<»♦•** ***^
T/phoid
Typhus
Brucellosis
Tularemia
Heterophile
Blood typing (Rh) • • ••••■•
DIAGNOSTIC BACTERIOLOGY
Diphtheria & associated infections
C. diphtheria
Streptococci
Other
Tuberculosis
Sputum
Aerosol
Other
Gonorrhea— smeors .'. 'i' ' ' * •"
Introcellulor Gram negative d.plococci
Extracellular Gram negotive diplococci
Trichomortods
Yeosts
Vincents organism*
^Aony pus cells
Gonorrhea— cultures
Fluorescent antibody
Enteric infections
S. typhoso
Other Solmooello •
Shigella (flexneri & jonnei)
Other
Blood cultures
Brucella
Other
Leptospirosis
Miscellaneous
DorkfleW— T. pallidum
Chancroid— Ducrey's
Gronolomo— Donovan bodies
Gonococcus in eye
Other eye smears
Other eye cultures
Urine cultures
Other fluids & exudates
Mycological examination*
Orgonians for identificotion
Sensitivity testing
SANITARY BACTERIOLOGY
Doiry products
Woter, drinking & pools
Water, pollution surveys
Foods (sanitary quality tests)
Food poisoning
Utensils-fwobs • • • • •
DENTAL CARIES BACTERIOLOGY.
Oi>e or
More
Positive
Findings
36^5
343
Positive
for
Findings
Indicated
Negative
4^2
39
4
6
2
296
5,473
31,862
1>44
52
1,550
38
31
12,068
21
929
4,002
'5^59"
127
84
'5,600'
395
5,698
3,033
448
15,489
71
339
73
■ ' 0
51
105
3
11
13
10
178
758
5,391
1744
3,551
304
Unsotis-
foctory
725,839
1,915
Total
11/440
74
4,368
54,632'
■ ••■•■
22,685
774,154
2,332
10
2,788
332
17,949
1,041
57/)62
109
816
7,342
15,564
8,420
62^93
• •••■•
54,879
421
' i69'
1
63
20/)14
1,093
58,781
151
' "848
19,473
' I
25,472
105,026
16,460
581
376
2,877
2/452
104 ANNUAL REPORT. 1966
TABLE 15 (Continued)
SPECIMENS SUBMITTED TO STATE BOARD OF HEALTH LABORATORIES
FOR EXAMINATIONS BY FINDINGS, FLORIDA, 1966
EXAMINATION
PARASITOLOGY
Intestinal porasife*
Hookworm
Atcorit
Entefobiut
Trichuria
Other helminths
E. hijtolytico
Nonpathogenic omoeba
Flogellate*
Malaria
CHEMISTRY
Blood
Spinal fluid
Urine
Woter
Toxicology & norcotics
Drugs & cosmetics
Other
Radiological chemistry
Water {ground & precipitation). . . .
Air
Milk (Sr90, Cel37, 1131, etc.)
Vegetation
Soil
Biota
PKU SCREENING
VIRAL SEROLOGY
Hemogglutination-inhibition
Neutrolizatiorts
Complement-fixotior». . . .'
VIRAL ISOLATIONS (except rabies) . . .
Rabies (microscopic)
Dog
Cat
Cattle
Fox
Raccoon
Skunk
Bat
Hog
Arouse inoculations
SPECIAL PROJECTS
Salmonella typing & diarrheal diseases
Community pesticides study
Arthropod-borne turvei I lar>ce
Sonitary quality solod-type foods. . . .
Toxopkismosit studies
Atypical mycrobocteria studies
Motemoi & infant care— Heodstort . . .
Airborne pollen studies
Radionuclides in milk
TOTAL
Number of Specimens
Positive Specimens
Or»e or
More
Positive
Findings
19^77
79
Positive
for
Findings
Indicated
4,200
5,803
3,421
1,368
149
63
4,641
2,865
4
3
1
9
38
2
21
1
Negative
102,560
29
3,584
Unsatis-
factory
1,923
Total
124,360
34
42,984
645
2,431
2,445
2,348
10
4
952
1,093
305
276
271
69
43,570
2,196
95
8,872
1,148
3,701
240
2,958
3/455
8,765
428
345
85
3,497
498
259
1,429,585
LABORATORIES
TABLE 16
EXAMINATIONS PERFORMED IN TUBERCULOSIS
HOSPITAL laboratories; FLORIDA, 1966
105
Toto Is— excluding speciol studies
Tuberculosis
Diognostic
Drug susceptibility
Mycology • • • •
Miscellaneous bacteriology
Hematology
Clinical chemistry.
Urine orw lysis.
Other
Speciol studies and reference tests. .
Unclassified mycobocterio studies
Mouse & guineo pig virulence test
BCG animal studies
Cooperative AFB studies
Airborne infection studies in mice
4,059
••Siibi~d r^;o~l public h~lth ond hovlol lobo-oto.....
TABLE 17
VIRAL AND RICKETTSIAL DIAGNOSTIC FINDINGS FOR 1885
PATIENTS EXAMINED BY FLORIDA STATE BOARD OF HEALTH
LABORATORIES, 1966
Etiology
RESPIRATORY
Adenovirus '
Influenza A
Influenxo B ;,' ' ' "a* ' '.\
Mycoplosmo pneumonioe (Eaton AgentJ
Poroinfluenzo 1 & 3
Respiratory syncytial
EXANTHEMS
Measles (rubella)
Measles (rubeola)
Murine typhus
Psittacosis— LGV
Sckemiolpox-Rocky Mountain' Spotted Fever
Voccinio-variolo
CENTRAL NERVOUS SYSTEM
California •"«•?*«' '^'' ••; ,V :,; -V mk' ' '
Coxsockie virus types A9, AlO, B2, B3, 85 . - •
Dengue
Eastern encephalitis ... . • • • • • ' * " ;^ ' ' '
ECHO virus types 1,5,7,8,9, \\, I/, rr . . .
Herpes simplex
Lymphocytic choriomeningitis
Mumps '
Polio virus
St. Louis encephalitis '
Western er>cephalitis ' ' '
Positive
5
4
32
25
3
2
1
Equivocal*
100
164
109
28
9
1
2
1
15
Total
TOTALS
5
28
3
3
34
1
153
79
224
' 7
1
742
105
168
141
53
12
0
3
3
1
15
0
2
0
0
7
0
5
28
82
3
258
1
7
1
895
•In the case of a single serum sobmitt*!, or
interpretotion possible as to etiotegy.
the obs^^c. of a rise or fall in the antibody titers of pair«J sera, no
106
ANNUAL REPORT. 1966
TABLE 18
ARBOVIRUS ISOLATIONS, BY SPECIMEN SOURCE, FLORIDA, 1952-1966*
Specim«n Source
Human
Equin«
Other animals
Birds
Pheasont-Chukar . . .
Wild birds
Mosquitoes
Aedes of lonficus. . . .
Aades infirmoKis. . . .
Aedes toeniorhynchus
Aedes sp
ARBOVIRUS TYPE
EE
ArK>pf)eles crucions.
Anopheles sp
Culex nigripalpus
Culex (Melonoconion) sp.
Culex sp
Culiseta melonura
Monsonio perturbans
Psorophora sp
TOTALS
1
SO
1
31
11
2
2
i
1
15
2
4
37
1
WE
160
3
4
VE
SLE
CE
11
1
18
22
22
41
1
2
BG
131
53
41
9
3
4
3
2
54
250
1
5
54
148
4
HPL
J-
226
z
TOTAL
9
5
27
41
7
51
2
34
17
134
62
98
11
156
4
72
25
11
79
3
9
775
'Isolation date for 1966 partially completed.
c
BUREAU OF LCXAL HEALTH SERVICES 107
ELTON S. OSBORNE. JR.. M.D.. M.P.H.
Acting Director (to March)
MALCOLM J. FORD. M.D.. M.P.H.
Director
HUBERT U. KING. M.D.
Assistant Director
The Division of Sanitation, Division of Nutrition, Accident Pre-
vention Program, and Health Mobilization- Civil Defense Program,
continued as administrative subdivisions of the bureau. A significant
development was the addition of the Home Health Services Program
to the bureau during the year. In addition, the bureau was given re-
sponsibiUty in February for assisting in phasing out the State Board
of Health (SBH) Mental Health Program. The program was trans-
ferred to the newly created Division of Mental Health on July 1.
With the steady growth of county health departments (CHD) the
work of the bureau increased. The addition of a health program
analyst and a records consultant to the staff helped handle this load.
Other personnel were added to the special programs. Strong em-
phasis continued to be placed upon contacts with and visits to CHDs.
Medical consultants made over 100 visits during the year.
Other general duties aside from those specific ones of the var-
ious divisions and programs outlined later in this report were con-
sultation to county health directors and their staffs on general ad-
ministrative problems; assistance in recruitment of local staff
members, processing of personnel papers and in the orientation and
training of these employees; guidance and assistance in program
planning and evaluation and continued efforts to improve local pubUc
health programs throughout the state in cooperation with local pro-
gram directors as well as other bureau and division directors and
staff.
Activities included the traditional ones such as training new
clerical personnel, especially in the smaller CHDs; budget prepa-
ration and control; reorganization of filing systems; assistance m
maintaining bookkeeping ledgers, personnel manuals and similar
documents; and assistance with problems relating to vital statistics.
Assistance is also given to local staffs on personnel, budgets and
activity reporting matters. The consultants worked closely with the
Records Committee of the Florida Association of County Health
Officers A study regarding possible mechanization of the Monthly
Report of Activities continued during the year with the cooperation
of several bureaus. The bureau maintains essential data for each
CHD for budget control items, CHD budgets and a table of orgam-
zations.
In addition consultation in social science fields was given and
several in-service training programs were conducted.
108
ANNUAL REPORT. 1966
LOCAL HEALTH SERVICES
109
ii
The SBH both directly and through the CHDs has cooperated with
the Office of Economic Opportunity (OEO). Thirty-four CHDs co-
operated with Headstart programs by assisting with physical exami-
nation, immunization and dental examination. Dental treatment was
given to children through the dental clinics and mobile units. A
special project in health education and services was instituted in
Washington, Holmes and Walton CHDs but at year's end the funds
were withdrawn by OEO. The Clay, Union, Bradford and Baker CHDs
participated in a program for training of home health aides. Dade
and Escambia CHDs participated in a project for day care centers,
while 12 other CHDs participated in day care and housing and sani-
tation programs for .migrant health workers. Dade County Depart-
ment of Public Health (CDPH) also participated in a family planning
program.
COUNTY HEALTH DEPARTMENTS
Although considerable study was given to the organization pattern
of CHDs in the state during the year, there were no changes in the
basic organization. There were 25 single CHDs, nine bi-county units,
and eight tri-county units — for a total of 42 County Health Units for
the 67 counties. All counties in the state continued to have local
public health programs directly affiliated with the SBH.
During the year, 110 physicians were employed full-time in local
general public health programs. In addition, with the development of
a number of special programs financed by both state and federal
funds, a significant number of additional physicians were employed
and assigned to local CHDs. Two local directors resigned, one re-
tired, one new director was appointed and one transferred from the
SBH to a local unit. At the end of the year, there were three health
officer (director) vacancies in the state.
Financing: Budgets for fiscal year 1966-67 total $13,579,754 with
$9,740,310 from all local sources and $3,159,317 distributed through
the state formula. State formula distribution includes federal funds
for general formula distribution.
Total local funds of $9,740,310 included the following sources of
funds: Contributions from Boards of County Commissioners—
$7,895,887; Boards of Public Instruction- $3 18,901; Cities and Mu-
nicipalities-$140,769; and All Other Sources-$l,384,753. Other
sources includes various fees, arthropod control funds, reimburse-
ment for Medicare, funds from PL 89-10, OEO and other funds.
Some $680,127 was obtained from the budgeted reserve. The bud-
geted reserve includes both state and local funds. Neither the bud-
geted reserve nor other miscellaneous funds are matched under the
state formula.
HIGHLIGHTS OF LOCAL PROGRAMS
Table 20 gives a comprehensive statistical report of CHD pro-
eramf with a^ inLation of the types and number of sertfices pro-
^A^/ ThP following is intended to present in summary form some
Tit Tre ^ura? ^d outstanding local program developments
during the year.
KAKFR CO WT-r - Although aU nursing programs showed an
incr^a^durmg 1966, the following are those programs where major
TmphasL was placed. In the Vaccination Assistance Program^
a^rage completion rate o£ 85-95 per cent was '«P°'^!f ' ' Jl^^h^^^e
munltv Nursing Program continued to expand. A Home Health Aiae
TervLe was incor^rated into this program with fo"' t;^"^'»
workers employed. .The Planned Parenthood Program also contin-
A local physician holds a monthly prenatal '=1^.'"<=, f^^ *^"„ ^™- "e^nl
''\zr xstdrprogTai^ !:uiTicZ2i::i\iTse::^
^^ear 'L- hlsle^n^^tccelstul. Vol^^eers complete the^Stan-
^ tor VoZeer-^A TLZ' aTsl'sW ^1h theTsual^scrLni^g
SS pTr^sitr U^^atrfere^v. in |U school as indi
^^^p'^U tests were done on ess^nti^lya^^^^^^^^^^^^ -th
negative results. . .The SBH dental ^J^^^ remodeled
317 inspections being made. . .The CHD quarters wexe
during the year.
m^AnrnRD COUNTY^ The Combination Nursing Service moved
^^Pr^ :ct°or1h:fou7counties. This P^:; r^''l7vlJ^)''^^n-
A Lr fhP OFO and U S. PubUc Health Service (USPHS). beven
te°en1raL?s wer^e ^llroUedinthe first class with on-the-job tramng
no
ANNUAL REPORT. 1966
to continue for a number of months. The CHD also cooperated with
OEO in the Headstart Program including visual screening, tests for
IPs, immunizations and follow-up of medical defects found. . .Other
special projects included participation in the Maternity Infant Care
Project (MIC), a cooperative pilot project of the SBH and the Uni-
versity of Florida, which includes 13 counties. . .Last year, Brad-
ford became the largest egg producing county in Florida. This has
created a number of sanitary nuisances because of fly breeding and
odors. The CHD working with the SBH and University of Florida
has begun an educational program with producers to solve these
problems. In the Rabies Control Program, the City of Starke,
through planning and with direction from the CHD, hired a dog
warden and built a dog pound. The dog warden impounded some 285
animals and destroyed 243. No cases of rabies were reported in the
city during the past year. . . Through the efforts of the CHD, the
County Commission has appointed a planning committee to study and
adopt a building code.
BREVARD COUNTY- In January, a new headquarters building
for the Brevard CHD was completed at Rockledge. The total cost of
the building was some $260,000 with approximately $70,000 for equip-
ment. The new Titusville Health Center was completed in September
at a cost of approximately $165,000. This building houses 12 mem-
bers of the staff. The health center at Melbourne, now under con-
struction, will be approximately the same size and cost of the Titus-
ville building. Planning was begun for the Headstart and Medicare
Programs. . .The Brevard Home Nursing Advisory Council has been
certified as a Home Health Agency with the staff working in a gen-
eralized program including visiting home nursing services. . .Many
major accomplishments and new programs began with the Environ-
mental Health Division. A solid waste study was completed for the
entire county and results are now being studied for action by the
County Commission. A sanitary district, the first in Brevard County,
was established in the unincorporated area west of Eau Gallie.
Certification of ambulance firms by the CHD was initiated. Water
quaUty studies on all water have been started and made a routine
part of the overall program. New laboratory facilities, equip-
ment and a boat, have enabled the staff to expand these studies.
Definite policies and procedures on septic tank systems and a vacant
lot nuisance resolution adopted by the Board of County Commis-
sioners have been put into practice. . .An Environmental Health Sur-
vey Report was released in February. Many recommendations made
in this study have been and are being implemented at this time. The
County Commissioners established a 10- member Environmental
Control Committee, which evaluates environmental health problems
and reports and makes recommendations to the County Commis-
sioners regarding needed improvements. . .Other highlights include
publication of the first Quadrennial Report covering the years
1962-65.
LOCAL HEALTH SERVICES
III
BROWARD COUNTY- Very rapid growth in all directions, due
to Broward County's 500,000 resident population, has mvolyed ex-
tension of pubUc water suppUes, sanitary sewers, ^jeatment p^s
and outfalls. Avery comprehensive survey was made of all naUiral
bodies of water used for bathing, and a report published ^or the lead-
ing governmental bodies in the county. Some extension of work in
the field of air and water pollution surveillance was accomplished ..
To provide better food protection, all major grocers were mvited to
meetings with the sanitation staff. Some night inspections were done
since the staff considers the evening hours to present greatest dan-
ger of overloading of faciUties. Also all mobile food service umts
l^d venTng macWnes were placed under a single saratarian One
sanitarian also covers all of the migrant labor camps. . . To ac
c^DhsruMformity of enforcement of some sanitary regulations
Xl75 cMWcare centers and 68 kindergartens were placed under a
single Tartarian for sanitary supervision. . .Nine nursing homes
^d four hospitals were certified for Medicare. An intensive com-
munity cleanup program was accomplished in the area of Flamingo
vSe tJ^rough cooperative efforts of some community leaders and
the Cro Sanitation Department. A Solid Wastes Study Committee
was organized for Broward County. Considerable progress has been
made in making plans for the proper disposition of these trouble-
"ome items. . .Deerfield Beach has expanded its treatment plant a^^
provided sanitary sewers in all newly developed subdivisions. Pom-
D^o Beach has presented a master sanitary sewer plan for all of
fhTcreater Pompano Beach Area and is providing sanitary sewers
for a sTz^le development in the Palm Aire Country Club area F^
Lauderdale has embarked upon a $4.5 miUion bond issue which wiU
Sn providing sanitary sewers in all of Ft. Lauderdale east o the
FE^ ^Iroad and is now working on plans to expand another plant.
The C^ of Dania is completing a $1.3 milUon sanitary sewer pro-
tvL with discussions underway to provide sewers in other sections
oims city. Freeholders in Hollywood approved an $8 million oce^
outfall project which is sized to provide sanitary sewage disposal
for all of the lower section of Broward County including Hallandale.
At the end of the year, 18 pubUc water supply systems had sub-
mitted complete chemical analysis reports on raw water being
Zelted from a total of 126 supply wells. The CHD issued an official
memo to an pubUc water supply systems to investigate and expedite
rm™cy intercomiections between adjacent distribution hnes. R.
Lauderdale continued to expand its water distribution system m the
uS^co™^ of the county providing city water for numerous
h"me owners previously supplied by individual wells. Simi^^^^^^^^^^^
ress is being made in other parts of the county. Considerable efforts
Sue to be made to educate the public in moving toward fluorida-
tion of public water suppUes. . .During the spring. Problems oc-
curred with overcrowded conditions in some trailer parks due to a
h^a^ i^ux of travel trailers. The ^^^'^^^'^^^^^^^^^
all trailer park owners and operators notifying them that acceptance
112 ANNUAL REPORT. 1966
of trailers in excess of permitted numbers was cause for revocation
of permit. Several park operators submitted plans for additions to
their parks. . .Tuberculin skin tests were done, involving several
thousand children enrolled in day care centers with an intensive
study of all child care centers and one junior high school where an
active case of tuberculosis was found in a student. The high risk
maternal and child program was begun with screening of patients
and arrangements made for care indicated. A diabetes detection
mobile unit is being provided by some of the leading citizens in the
community. The Diabetes Foundation will supply materials for oper-
ation and the CHD will employ the operator, The staff participated
in the Headstart Program and assisted in coordinating immunization
and skin testing of children enrolled in this program. The staff also
participated in a trial run of mechanical tabulation of nursing activ-
ities for the SBH. The Nursing Staff assisted in providing observa-
tion and experience for nursing students from Broward Junior Col-
lege and health education students from the University of North
Carolina. . .The dental program now involves three full-time den-
tists, plus a new dental clinic in Pompano and part-time dental
services. Dental services are now afforded to some migrant patients.
Financial support to the dental program was received from the
Junior Woman's Club of Pompano Beach as a continuing community
service project. A field training program in school health education
has developed from the 1966 Headstart Program.
CHARLOTTE COUNTY- The Charlotte CHD has been in the
process of implementing a building program for CHD facilities at
Punta Gorda with an auxiliary unit at Englewood. The County Com-
mission has committed some $125,000 to this undertaking. . .The
Sanitation Department conducted a Food Handlers Service School in
November. A total of 41 persons representing 16 establishments
attended. The staff completed preliminary survey work on county
waters with regard to shellfish harvesting during the year. . . A
countywide multiphasic screening program was conducted in July
with some 1827 persons screened. This program was co- sponsored
by the Charlotte County Medical Society, Charlotte CHD and as-
sisted by the SBH. Some 1624 persons received chest X-rays. Ten
new cases of glaucoma and 29 new cases of diabetes were discovered.
Two hundred and fifty volunteers, including Gray Ladies, members
of the Legion Auxiliary and citizens helped throughout the week. A
clinic was held in September for follow-up studies of epidemic
neuromyasthenia cases reported in epidemic proportions in 1956.
This was the second occurrence of the disease in Florida and in-
volved some 150 diagnosed cases. Since neither the etiology nor the
long-term prognosis has yet been defined, it seemed opportune to
make a ten-year follow-up study of the cases which occurred in
Punta Gorda.
DADE COUNTY — Nearly every program conducted by the Dade
CDPH expanded during 1966. The most notable increases were in
LOCAL HEALTH SERVICES
113
maternal and child health activities. The Children's Bureau- spon-
rored^o^ct for high-risk maternity and infant patients became
fTlfo'p^rational anf over 3000 patients received -mpreh^^^^^^^^
care under this program by the end of the year. . .The CDPH also
enSg^Tn three maternal and child health activities ^^er the Cona-
Sty Action Program of the OEO. Largest of these was the Head-
s' Prog r^ wiL over 3000 children receiving intensive health
screeidng and follow-up services. The CDPH also added a spec al
progr^ orchild spacing services to «^% ^^.^^^^ ^^^^
operated by the CDPH and OEO Program of the county Jomt oper
Xn of a mobile dental unit in poverty areas was contmued. . .The
Developmental Evaluation Clinic expanded its program in several
Sions In close association with the University of Miami this
S has' become a major center for research, training and direct
se^ces in ^e field of mental retardation. Dermatoglyphic and
ch^mosomal investigations, PKU studies and genetic counseUng are
™ies of the unique activities it offers. The Pioneering efforts of
t™linic have led to approval for construction of a $6^00 000
mental retardation center for the University -\f^^''^^\f^,
Cuba-Miami airlift in continuous operation, some 50,000 Cuban rei
u^ees Sed during 1966, and the CDPH provided their imtial health
screer^r^d contLed to provide out-patient medical care for in-
S^ub^::' With an average daily clinic attenc^ce ^^PJ-
matelv 400 patients. . .With a contract from the USPHS Gerontology
bS X CDPH began a new program of adult health mamtenance
atX^Mf^i Beach Lnter. It provides -;^^JiP^^^^^^^^
the elderly and follow-up services as mdicated. . .The CDPH con
HnnPd to ooerate special projects in tuberculosis control, migrant
health air' rS^^tion control,^ heart disease control and re-ar^h
studies Regarding effects of various pesticides on the health of the
JopuUtion'. .in Environment health and ^^'^^^^^^^^^^^^
progress could also be seen. The cities of Miami, Coral Gables
?>^/C)cka a^d North Miami improved their sewerage systems, and
^ar^tlf^f the P^^^ of Dade County was served by pubhc
seweragTsystems ty the end of the year. Extension of public wa er
suDPUefalso continued with several more water improvement dis-
tricts i^der^arOne of the noteworthy events that added to the san-
it"r L" w^k was the discovery in October of - ^^^^1^/3-^^^^^^^^^
'4tch" of apple juice and the subsequent search for 3000 bottles
of it.
DUVAL COUNTY - Family planning is burgeoning and has out-
;Krr.^rPnr maternitv clinic program to which it originally
grown the parent "^^^^"^^^^ ^^'^., ^ p^.i^ Planning of Northeast
'^l!rTu:\^C^^el^^^TcZ^oJ^^ enLe count, ajjd
^Tpt^f for' Saturday and evening sessions to rah ,^
unreachables. Women who presented ,">en>selves for deuvery
114 ANNUAL REPORT. 1966
planning and well baby care and have increased the clinic load. Over
500 Pap smears and two diagnosed cancers are a byproduct. . . The
Tuberculosis Control Project has expanded. In following contacts of
just one case, all 200 employees of a poultry plant were checked with
40 PPD reactors and two new active cases found. The semi-annual
countywide survey turned up 17 new cases, and 104 more are await-
ing definite diagnosis. . .A school health committee was formed with
representatives from the City Health Department, Board of Public
Instruction, CHD and school officials. . .Of the county's 1183 li-
censed nursing home beds, approximately 750 will be certified.
Many do not wish to participate or cannot meet requirements. The
CHD staff is working closely with the Health Facilities Planning
Council in attempting to predict future needs. Two older homes
totaling 72 beds were closed and 150 new beds have been opened. . .
The CHD furnished vaccines, records and hours of coordinating
time to various anti-poverty programs to minimize both duplications
and omissions. Staff members have been used less in actual service,
but more in training home health aides, homemakers, nursery teach-
ers, etc.. . .In sanitation, garbage remains a major problem since
service is not mandatory and some 12,000 people still do not sub-
scribe to any franchised pick-up service. Emphasis was placed on
rodent control by prevention of harborage and elimination of food
source as well as by distribution of poison bait. . .Intensive sampling
of shellfish waters continued. Approximately one-third of the har-
vesting area was closed because of tidal pollution from the St. Johns
River. . .Fruit and vegetable vendors continue to be a problem. The
Court has rules that they are not food outlets even though they op-
erate from a specific location. Much more emphasis on operation
and maintenance of food- catering services has been placed. Re-
ported food-borne illness decreased except for a major outbreak of
Shigellosis traced to a bottling operation of a local dairy. . .The
CHD is assisting the Welfare Department in its attempts to get many
previously unlicensed nurseries and child care centers upgraded
and under supervision.
ESCAMBIA COUNTY — A new position was created in the Nurs-
ing Division to meet liaison needs between the Medical Society, Hos-
pitals and CHD. Application for incorporation of the newly formed
Accident Prevention Corporation of Escambia County is pending.
The CHD spearheaded formation of a citizen's group to coordinate
preventive efforts of many local and state groups concerned with the
rising rates in all forms of accidents. . .Programs which were ex-
tended this year include the comprehensive tuberculosis skin testing
program for school children. Last year the CHD tested approxi-
mately 5000 first grade children from both public and private
schools. This year the program was extended to include testing of
young adolescents at the junior high school seventh grade level.
Also, for data purposes to assist generally in program planning for
schools, follow-up testing was done on last year's first graders to
LOCAL HEALTH SERVICES
115
see how much conversion from negative to positive has taken place
Senior high students were also screened. This year's program will
not be completed until early 1967, but it is estimated tl^tson^^^^^^^^
schools will have participated in the program by ^^^^^f^"^^^^^^
than 25,000 students will have been screened. • -Activities in the
fVpTrl of sanitation this year include new central water systems at
^nz^ez M^o and Bluff Springs and installation of a fully auto-
matic 2000 ga^Ln per minute well for Pensacola. City water and
TewaJ lines w^^^^^ to include the Brent area and by this
acUon si^ malfunctioning package sewage treatment plants were
: ^Tnat'd. A new package sewage P^^^^ ^^^^^^^^^^^^^^^
division and the sewage treatment plant for the Umversity of We st
Florida is under construction. Water treatment facilities for this
^ivefsity ^re completed. . .Early in the year, ^ successful ix)dent
^ntrol program was jointly conducted with the Aedes aegyptt Erad-
cTonrolram. A one- day Fire Safety Seminar for^^^^^^
pmnlovees of nursing homes was conducted. This program was weu
received with more than 50 employees attending. .The county be-
came the second one in Florida to begin fuU Participation in the
wnsine-inspection program of radioactive materials. Members of
^he section Sung raLlogical health programs all served on the
I^dioloScai Emergency Network Team for tMs area^d partic -
mted in the three statewide drills, one of which was a full scale
mock-up of an accident involving radioactive materials.
HENDRY COUNTY- The auxiliary health center at Clewiston
movefTS^ new^uarters in the County A<taiinistr^ionBuil^^^
September. Regular cUnics are now conducted m adequate, moaern
facilties.
HILLSBOROUGH COUNTY- The Visiting "^^^^^^^.^^^'^^ZS^
Hillsborough County. Inc., which is <=7^i"^„^j;*^l^tth A™
CHD, became certified as a participating Home Health Agency w
health insurance under Social Security on July 1- • .-^^ ''°"|f^,^i"^
agreement The CHD estabUshed generalized public health climc
sfr^c^s ; the Neighborhood Service Centers, and an ^ti- Poverty
pS i^der the Erection of the HiUsborough County Hospita^ and
wXreXrd...The CHD continued to accept school dropout
weuare ''oaru. . assienees for work experience. . . A
LtrcS o'^S^e ^d'^UnTcT/estabUshed at Bethune Apart-
menls, a low socioeconomic, high-rise housing apartment for the
elderly.
HOI MES COUNTY - The county began using the federal funds
orovWed through the OEO and had a direct impact on the CHD pro-
gram Admt°o.Ll staff members and operating funds were provided
f f hi rm hroueh the Tri- County Council. The additional staff
to^LT^elZ'n^^ ^or probJm i<>entificatior. deveiopmen^^^^
new programs and expansion of other programs for the econoraically
deprived Many heSth and economic problems contributing to
116 ANNUAL REPORT, 1966
poverty were discovered by survey of private premises made by
staff members. This survey was made on about one- sixth of the
homes in the county which represented a cross- section of the area,
both rural and urban. One outstanding development in this pro-
gram was the provision of dental service to the indigent for the first
time. A working agreement was established whereby local den-
tists provide service on fee basis paid from OEO funds. All third
grade students in the schools were given topical application of
fluoride. . .A tuberculin skin testing program which included first,
sixth and twelfth grade students as well as family members of posi-
tive reactors was initiated. As a result of this program, two active
minimal tuberculosis cases were brought to treatment and prophy-
lactic treatment was begun on two other suspicious close contacts
and thirteen other contacts reactors. . . Maternity and family plan-
ning clinics expanded this year. The number of people given service
more than doubled. A comprehensive family planning service was
developed that included medical examination; Pap smear; screen-
ing for tuberculosis, diabetes, anemia, intestinal parasites, cardio-
vascular evaluation; and education as well as dispensing contra-
ceptive drugs. . .Well baby clinic attendance increased. A limited
amount of medical service was provided for the medically indigent
children in need of treatment. . .The CHD began participation in the
Vaccination Assistance Program. There was an overall increase in
number of children immunized. . .The sanitary landfill program has
progressed to the point that almost all areas of the county now have
a sanitary garbage disposal facility.
INDIAN RIVER COUNTY — The Home Nursing Service continues
to expand and with the increased utilization by Medicare patients
has become a major program. A training course for home health
aides- homemakers has been completed and this service is now
available. Planning for a volunteer ambulance and setting up a
training program required a great deal of time and effort. During
the year, the CHD took part in a trial run of the proposed mechanical
tabulation activities report.
JEFFERSON COUNTY— The sanitation program in the county
was marked by few dramatic achievements. The Aedes aegypti
Sanitary Survey was completed for Monticello and Lloyd. The re-
sults of this survey were presented to a number of civic and social
clubs, the Monticello City Commission and the County Commission.
The City moved ahead with financial negotiations to extend public
water and sewer lines into the blighted areas pinpointed by the sur-
vey. The Jefferson County milk shed maintained its high rating on
the USPHS survey. The annual rabies clinic protected an estimated
25 per cent of the pet population. The County Commission sponsored
a water resources survey with the Farmers Home Administration
. . .The child- spacing services clinics have progressed. During the
year, 53 intrauterine devices (Lippes Loop) were inserted. Seven
have been removed for various reasons (probably psychological).
LOCAL HEALTH SERVICES 117
At the end of the year there were approximately 152 patients con-
Unufng with birth control pills. . .The Health P-file Screerung Pro-
gram continued to be an active one with an ^gg^/g^^/.^^ Af'^^^Vpnts
^ ^,^^H A total of 723 abnormalities was found in 460 patients.
X ravs one revealed a case of tuberculosis which is now hospita - .
TherTwrre some sb 2omal EKCs! Of these, 50 have been con-
^Ju^^TainraiX^-^^^^
Z r^co1^eai:n";irhto;n°etu^s^rinh: Home Nursing Care
^ o^^^ rm served 12 cancer patients; admitted one patient
t^oTK; c^lo's^hrsSand continu'ed six ^^l^er patientson dr.g^
rendered service to 24 diabeUcs; 13 stroke patients; 25 Parents wUh
mental healS^ problems; and eight morbidity patients. In the VD
clinics, 25 paUents were seen.
r FF COUNTY- A Public Health Nursing Advisory Council was
infpn«5ive work is planned in inis progi«tui. x^^ f^foi
^n first Jd seventh graders in the high incidence areas with a total
n? ^4 n^Uive tubercuUn reactors being found in one jumor high
T FON COUNTY -1966 was an important year £«' the ?^°°Jr™?
in tKe'strmoved into f^^^X^^ls'^^lttll
^^^\for:^7:::t:rcrSoSg^nl cS^n was included in the
technicians free of charge. . -J^^^ "'.^^.''^'^ In Aucust the Leon
existing Visiting Nurse Services to receive th^^^^^^^^^ ri^Lu'Le
cal professional services. . . The I'^Pi^'"^"?"" " y.^u „. the five
Service Law presented no problem m Leon County. ^^^°^^^^^l
local funeral homes decided to contmue ambulance service ana pu
III
118
ANNUAL REPORT. 1966
LOCAL HEALTH SERVICES
119
i !
inspection were found in full compliance with the law and were li-
censed. Among the five fimeral homes licensed, there were 10
vehicles and 26 attendants certified. A majority of the attendants
qualified after completion of the standard first-aid course. Most of
them have now completed or are in the process of taking the ad-
vanced course. . . The Division of Environmental Health improved its
services by installing two-way radios in six sanitarians' cars. . .
Progress was made during the year relating to the operation of the
Rabies Control Program. Ground work was laid for the consolidation
of the city and county dog pound into one operation. A Tallahassee-
Leon animal shelter was planned by the cooperative efforts of the
Tallahassee, Leon County and local Humane Society. . . A big asset
to the Leon CHD and its Mosquito Control Program was construction
of a new building at a cost of approximately $31,000. This new mod-
ern building to house equipment, pesticides and fogging machines
will undoubtedly add to the improvement and progress of the Mos-
quito Control Program,
MANATEE COUNTY — A new school health program was estab-
lished in cooperation with the local Board of FHiblic Instruction.
Funds from the Elementary and Secondary Education Act were
placed in the CHD budget. This made possible the purchase of
$14,000 mobile health clinic. . .The Nursing Division began the Med-
icare Home Health Services Program on July 1. Physiotherapy,
occupational therapy and speech therapy are provided by contract
with Happiness House Rehabilitation Center, Inc. . .In cooperation
with the local medical and dental societies and Suncoast Progress,
Inc., the Nursing Division participated in Operation Headstart serv-
ing some 600 children. The Palmetto Multiservice Day Care Center,
operated by Suncoast Progress now serves 170 children. A similar
facility called South County Year Round Headstart Child Care and
Family Service Center recently opened at the old Gulf Coast Experi-
ment Station and is now serving 150 children. . .A two year environ-
mental health demonstration project, Project Manasota 88, for
Manatee and Sarasota Counties began in June. Nine technical com-
mittees are making intensive studies of air pollution, water pollution,
water supply, liquid and solid waste disposal, environmental sanita-
tion, recreation facilities and housing under direction of a steering
committee which reports to public and local governing bodies. The
initial phase began with a one-week workshop with some 90 partici-
pants and faculty of 29. The project is sponsored by the Planning
Department, Boards of Commissioners of Sarasota and Manatee
Counties, local CHDs, Florida State University, the SBH and USPHS
. . . Several training courses were offered by the CHD and were well
attended. Two different courses for sewage treatment plant oper-
ators, swimming pool operators school and school for dairy oper-
ators were held. The Environmental Engineering Director is giving
a 20-hour course in mathematics and chemistry to sewage and water
treatment plant operators. . .A $20 million county water supply
system has been completed and will be operational as soon as the
water level in the reservoir rises a few more feet. . .A new addition
to the CHD building, Bradenton, has increased floor space from 4400
to 8400 square feet including 2000 square feet for the pollution con-
trol lab The new Environmental Engineering Department, directed
by a saiiitary engineer, has a staff of seven. Part of the e^ense of
the program was defrayed by a $23,000 Federal Air Pollution Con-
trol Program Grant. During the past year, the county has commi-
ted some $155,000 for pollution control. A 13-member Citizen s
Pollution Control Advisory Council, appointed by the Board of County
Commissioners, on recommendation of the health officer, with tech-
nical advisors, has developed a pollution control ordinance for pres-
entation at the next Legislature. A Subcommittee of the Planning
Board, with technical advisors, has developed mining regulations to
be incorporated in zoning regulations. This is beUeved to be the
first of its kind in this area.
MARION COUNTY - The Marion CHD experienced the largest
erowth in personnel, programs and activities in its history. . .
During the summer months, the Board of PubUc Instruction spon-
sored the Headstart Program. Medical and dental programs were
planned by the director of the CHD. The CHD director, with approval
of the Board of County Commissioners, became acting medical
director for this program which was a most successful adjunct to
the public health program. Approximately 500 children were en-
roUed in the program. Physical examinations were accomphshed
at the CHD by physicians of the Marion County Medical Society and
necessary corrections of abnormaUties were accompUshed by the
family physician. The organization and operation o servi^s of the
Home Health Agency under Medicare Act and of the l^C Pro-
gram have been uncertain and frustrating due to complexities of
regulations and instructions. However, both programs are off the
grS and in full operation. . . Early in the year it was learned
Uiat the school system would receive federal funds under PL
89-10 and that some of this money could be spent on health pro-
grams. School officials were contacted and requested if any funds
were available for health personnel that they be Placed under the
direction of the CHD. This plan was agreed to by school officials.
Earlv in the year the CHD was advised that federal funds would be
available to employ nurses in the Tuberculosis Control Program.
Money for this project was cleared and a pubUc health nurse began
work in October. . .The MIC Project, involving 13 counties sur-
rounding the University of Florida Medical Center, including Marion
County, was written early in 1966. The CHD was assigned one nurse
for tMs program. . .The CHD has maintained three rural cUmcs
during the year. . .A cost study was retabulated for 1965 and 1966
This study showed the cost of a nursing visit for nursing care to the
I/^k ZtL home to be $5.13 in comparison to $4.82 in 1964. Under
the Medicare Program, the CHD is charging $5 per visit. . . The
120
ANNUAL REPORT. 1966
LOCAL HEALTH SERVICES
121
Dental Program continued to be an active one during the year.
Under the Dental Preceptor Program, services were rendered
to indigent patients in the county. In February, during National
Children's Dental Health Week, the dentist and his assistant visited
a number of schools. A considerable amount of Uterature was dis-
tributed, movies were shown and approximately 500 dental kits were
given to these students to motivate better dental hygiene at home.
Over 300 new patients were added to the Dental CUnic Program in
addition to some 1420 repeat patients. . . The objective of the En-
vironmental Health Section was directed toward providing better
services to the county. The Environmental Sanitation Program has
increased its scope and additional emphasis is being placed upon
arthropod control, rabies control, water bacteriology, laboratory
work, custodial care of the civil defense hospital and in-service
training. . .Improvement of water suppUes continued to be a priority
program. Continued development of fringe area and scattered build-
ing in subdivisions not served by central water and sewage collection
systems require much effort toward assuring acceptable individual
water supply wells and septic tank installations. The largest water
supply systems installed served motels, restaurants, service sta-
tions, camps, institutions and Interstate-75 rest areas. A total of
576 visits was made in the interest of water supply and/or sample
collection. Over 1100 lab examinations were made by the Marion
CHD laboratory in addition to some 1550 samples tested by the SBH.
Attention was given to flooding of low- lying residential areas ad-
jacent to the lakes in the county. Problems encountered pointed up
the need for control measures to be estabUshed to prevent such
conditions. . .Over 700 visits were made in the interest of sewage
disposal. This included both central sewage plants as well as septic
tanks. Aerobic digesting plant installations were inspected to serve
motels. To date, there are no subdivisions outside incorporated
communities with any form of central sewage collection or disposal
.Much education and enforcement is needed to cope with the
ever-increasing problem of garbage and refuse disposal. There is
no organized collection operating outside Ocala, DunneUon and
Mcintosh. Private garbage collectors serve part of the county. With
the increase in staff, added emphasis was placed on the food and
milk programs, but improvement is needed. Investigation of animal
bites required much time on the part of the staff. A total of 141
specimens was submitted to the SBH lab for rabies examinations.
With additional staff members, closer supervision was executed
over operation of the county animal pound. There were two cases of
rabies confirmed in wildlife, but none in domestic animals. . .The
continued increase in mobile home use required much time to be
devoted to mobile home sites and parks to attain compUance with
regulations. Popularity of camping brought on much interest in de-
velopment of camping areas. The staff held conferences with pro-
spective developers and reviewed requirements and plans to attain
acceptable camp areas. These developments are largely outside
areas covered by zoning, building and plumbing codes. . .Complaints
of sanitary nuisances resulted in 762 inspections.
MONROE COUNTY - The pubUc health program in this county
has increased in scope and volume with a number of long-range
n^s for adcUtional services. Valuable assistance from the local
'mTdfcarand dental societies, Community Volunteer HealUj^Associ^
tion Monroe County PTA Council, as well as significant support
from local officials have made this possible. . .A screening program
foHchool children was initiated with suppUes made available by the
Dade-Xnroe Tuberculosis and Respiratory Disease Association.
EducaS programs for intensifying immunizations were begun
and are stiU in progress. A workshop on venereal disease for phys-
^al education a^d science teachers was held in thelocal high school
The part time VD investigator has facilitated follow-up of contac s
A local pediatrician held monthly clinics for examination, treat-
ni^kf ^d re'Terrals of patients. The yearly screemng Pro^-am ^Y
local dentists continues with ^-^^^^^^^ ^'ll'^^^^^
completed for a cytology program by a local OB-Gyn specialist wim
folTow up of suspicious cases. A case registry has been estabhshed
or carc^ovascular disease. The local medical association ^
ated a diabetic screening program durmg the year. ^lUi assistaiice
from the Florida Mental Health Association a ^^ll-^ime.,^^^^^
heaUh worker is continuing to render valuable service to the CITO
a^d community. . . The CHD had an active in-service training and
Tduc^ti^nal program during the year ^^^/^ .^^^.^^^^^^^^^^
other community agencies organized and presented a successiui
alcohoUc rXbiUtation workshop. . .Progress has been made m the
fteldTenvironmental sanitation through consultation and supervision
with the cooperation of the zoning department and engineers m the
Ilistallation of sewage treatment plants. A sanitarian trainee was
added to the staff to serve the Middle Keys.
NASSAU COUNTY" Groundbreaking ceremonies for the com-
bined^4 Defense and Auxiliary Health Unit in the County Buil^g
at Hilliard were held in September. Construction work is Progres-
finf rSV ^d it is anticipated that the staff will move into the
n^w%uSs in June, 1967. . . The Medicare Program ^as been set
up wUh all six local doctors participating ^^ ^^^ P/?^^;^^^^^^
estimated that some 1200 elderly people are f^^^j^^l""^^^^^
benefits The only local hospital has been duly certified by the biJH.
The hfspitafadministrator reports that about 10 ^^-^^^^^P^,^
hPds are being utiUzed for Medicare patients, and that it has not
made muchTm'pact yet on overall hos^ntal services Home H^^^^^^^
Services have also been organized, with a Home Health Services
?ssSion' t^ing legally inc'orporated and o^cially certif^i^^^^ by the
qRH During the year new services were added to the t^onc
HeaihNuS Progran. and old ones were en^rged ^dsren^-
ened. The nursing staff cooperated closely with the Home HeaU^
Service Association, Inc., in organizing nursing services for home
* ^1
(I
122 ANNUAL REPORT, 1966
bound patients as part of the generalized program. The nursing
staff cooperated with the Board of PubUc Instruction on PL 89-10
m securing needed assistance for many children in special exami-
nations, treatments and corrections. . . A six-week recheck for
water pollution was conducted in the approved oyster- gathering
areas. The sanitation staff worked with teams from the Taft Sani-
tary Engineering Center, Cincinnati, Ohio, and the USPHS, Atlanta,
Georgia, in servicing the testing stations and completing field work
on the air and pollution survey which was begun in November, 1966.
The sanitarians took over the sampUng of eight bulk milk plants in
the county. This had formerly been done by the City of Jacksonville
since most of the bulk raw milk from these plants is trucked to and
processed for retailing in JacksonviUe. As a result of a ruling by
the city attorney of Jacksonville stating it was illegal for Jackson-
ville to spend money collecting these samples outside Duval County
the sanitation staff in Nassau County had to assume this duty. '
OKALOOSA COUNTY - Significant program hi^hUghts include
establishment of an Animal Control Program and appropriation of
local funds for construction of a new central office in Crestview.
The Animal Control Program was established for the purpose of
rabies control through vaccination, surveillance and investigation.
This program was initiated as a cooperative project with the sev-
eral veterinarians and Play Ground Humane Society with financial
support from the County. .. This year's local appropriation of
$54,000 was approved for construction of a new central office at
Crestview. This local amount will be matched by Hill- Burton funds
which should be adequate to house all personnel and functions for
several years to come.
ORANGE COUNTY - The most extensive program development
in Orange County has been in the field of maternal and infant care.
The Orange County MIC Project is designed to provide prenatal
care, delivery and postpartum care (including family planning) to
medically indigent residents. There are 36 maternity cUnics, 40
child health conferences, 48 family planning clinics and four ma-
ternity and pediatric specialist consultations per month. Admission
of patients to the project began in September. As of December 31,
there were 47 pediatric cases and 111 maternity cases with 38 de-
Uveries. There are some 400 women participating in the family
planning program, 252 of which use intrauterine devices, 143 using
oral contraceptives and six using other contraceptive methods. Of
significance is the Tuberculosis Project which is in its third year.
The CHD has instituted a tuberculin testing program for all first
graders throughout the county. The goals of the program are two-
fold: to find inapparent sources of tuberculosis infection and stop
the spread of the disease and to protect the health of the first
graders themselves. Community- wide support has been achieved
through participation of the PTA, Medical Society, TB Association
LOCAL HEALTH SERVICES
123
and school personnel. . .In order to meet the SBH regulations de-
sT^ed to control radiation hazards in Florida, the CHD instituted an
active Radiological Health Program in 1966. With the mcreased use
of nuclear power, radioactive materials and ^^di^ proc^ucin^^^
machines in recent years in industry and research, it is felt that
Se Kest degree of control can be achieved through a regulatory
program admi^stered at local level. The CHD offers assistance to
the County Civil Defense Agency in the instruction of radiological
monitoring.
PALM BEACH COUNTY- 1966 was a year of major change and
reorganization of public health services for the PaUn Beach CHD
Sevefal programs are in the early developmental stages or being
planned. The reorganization of medical care /"^i^^^f. i" ^^^f •
through which these activities were transferred from the County
wS Department to the CHD, has helped the staff take advantage
of Title xnn benefits. The staff has been able to coordinate hos-
Dital nursing home, outpatient and home care services using public
health e^^erience in pLning and conducting programs for older
Sple, a?well as other age groups. Outpatient clinics were nioved
Lorn the Welfare Department to renovated miUtary buildings which
hTbeen transported from the airport to the bounty Home^d Hos-
pital area. Clinic nursing services were reorganized and Placed
under supervision of the Public Health Nursing Division of the CHD.
Records are being centraUzed and made uniform. QuaUty of care is
being evaluated and improved. . .Another major program initiated
during the year was the MIC Project. Due to the great variafaon
m resources for care throughout the county, there have been
some problems to overcome, but definite benefits seem to be on
the way The staff expects improved care made possible through
this program will result in lower infant morbidity ^^ /norta ity . .
The last five year Migrant Health Project fmanced by the Children s
Bureau terminated in 1966. This project has served as a demon-
stration of comprehensive health services for agricultural migrants
™s been ac^pted for use in other parts of the "ation. The serv-
ices will continue under a combined program financed through the
USPHS. . . Cooperation with local OEO programs continues Major
™;is has been given to development of h^.^l* ^nronosed^d
ject Headstart. Health services in conjunction with proposed and
operating day care centers are also receiving "^^^1°=^ ^f ^^^^Xm
A new home nursing service was organized in 1966 ^e Northern
Palm Beach County Home Nursing Service, Inc. This completes
coverage of Palm Beach County with home nursing services. AnoUier
mifor Change in this program was the assumption of ^nd^gen pati^
care from the VNA in the central coastal area. This '^^^^''^^^f^
nurses will take care of those patients who cannot pay as well as
those not covered by Medicare. . . Environmental he^lU^/^^^^^^
continue to take on a new look-with 'naJ"^ emphasis being ^ven to
pollution control of air and water. The Air Pollution Control
4
I
124 ANNUAL REPORT. 1966
Program is achieving significant accomplishments, with an excellent
staff, equipment and facilities. Much attention is being ^ven to
problems of waste disposal, both liquid and solid. A countywide
water supply and sewage disposal program is under consideration
and this will receive major emphasis during the coming year.
PINELLAS COUNTY - Plans for a new six- story health building
to be located in St. Petersburg have been completed. Construction
is expected to begin in the spring of 1967. This will be part of a
planned medical complex in the Mound Park Hospital area. A com-
prehensive instruction manual has been written for personnel as-
signed to work in Vital Statistics. . .School health services, allocated
to 129 schools with an enrollment of 85,000 children, accounted for
the largest percentage (40 per cent) of services rendered in the
CHD's nursing program. Seventeen nurses were awarded a certifi-
cate of achievement by the Pinellas County Civil Defense for com-
pleting a 16-hour course in Radiological Monitoring. . . Children
enrolled in the summer program for Operation Headstart were pro-
vided immunizations against polio, diphtheria and tetanus. A total of
1335 immunizations was given. . .The Nursing Division participated
in a three-week orientation program in health for teachers. . . At the
end of 1966, the VNA had five supervisors, 14 staff nurses and 43
health aides. Effective January, 1967, the two VNAs in the county
will consolidate to become the Visiting Nurse Association of
Pinellas County. Nursing services under the VNA increased 33 per
cent since July 1, with 89 per cent of visits to Medicare bene-
ficiaries. The VNA, at the request of the SBH, has served as a
training center for public health nurses in Florida for orientation
to homemaker-home health aide services. . . The Dental Division
had a busy year with the admission of some 690 new patients. Den-
tal inspections in schools totaled 8975. . .In the Chronic Illness and
Adult Health Program, screening clinics for glaucoma and diabetes
are held several times weekly at various locations. A study was
made of hypoglycemia particularly among alcoholics. A total of 53
members of Alcoholics Anonymous participated. A three-to-four
hour glucose tolerance test was completed on each one. All had a
typical pattern— above the normal range at the first hour and signifi-
cantly below at the second, third or fourth hour. Those suffering
from hypoglycemia were almost evenly distributed in various age,
sex and social groups. Corrective measures included a high protein-
low carbohydrate, caffein-free diet, including snacks at times of day
when an alcoholic most desires a drink. No medication was pre-
scribed. The results were surprising. In the past few months, the
staff has assembled evidence suggesting that alcoholism tends to
occur more frequently in some families than others and that the
disease tends to reappear one generation after another. Hypo-
glycemia also has been found in children of alcoholic parents. Pre-
vention, therefore, appears to be possible. . .A Stroke Rehabilitation
Service was organized and now is being conducted largely by a
LOCAL HEALTH SERVICES
125
pubUc health nurse with special training in this field ^^/ ^^S
is designed to prevent disabling contractures of limbs and generally
to assSt stroke patients in nursing homes in gammg an early re-
coveA The stroke rehabiUtation nurse conducts classes and dem-
onSons in the 48 Ucensed nursing homes in this area teaching
uDto-^te techniques. Patients are taught how to move about inde-
pendenUy and tofeed and dress themselves with a '"i^i'"""; °^„f °^
There were a number of highUghts in the Enviromnental Health
;;d EnLneeri^g Program. A new 15-ft. boat with a 40 hp motor was
^rchr/wMfh'^Lnc'reased the volume of wa^erpol^sur^^^^^^^^
r^r^A r-ociiitPd in several square miles of additional sneimsn waieia
^fngfpj/oved. "xhe stSf also planned and conducted a two-week
tr^ning program for six sanitarian trainees from the SBH In
l;"vTI Tr^fning Course. Food service saniUtion courses we
o^«H„nf*.H fnr all new employees in school cafeterias, l-ooa service
o^™i trL^^g courses Lre conducted on location at food serv-
^e es^UshTents, in the Adult Vocational Educat-n^Program ^d
for students enrolled at the School of CuUnary Arts St. Petersburg
A total of 29 training courses was conducted with &y( personnel
rece ving tr^Sinfood service sanitaUon. An exhibit was provided
wnrkcihoD- Hotel-Motel Management Class, St. petersDurg juuiu
Co°Uee 'personnel for Mease ^^^l^^^J^^^rJ:^^:i^or
Association; Food Service Supervision C ass S^ Petersburg J
in<5nections were made with the SBH shellfish consultant of all sea
rdtstribut": in Pinellas County, includ^ a su-y^^ the^^,
ling and storing of scallops in freezer plants Pinel^s County
seafood distributors handle approximately 65 per cent of^^^^
distribution of scallops in Florida. . .The CHU conii"
active programs in housing and rodent control. ,C°°I^e/7°" *"ss£ui
qnH Ldes aeevbti Eradication Project resulted in a successiui
sewers. . .m i PubUc Instruction in conductmg a
supervisory staff o£ the Board ox ^^ program received ap-
operation with the SBH, a teacner w<t=» .^J^Qj^y^ for teachers en-
126
ANNUAL REPORT. 1966
Division had an increase in the number of samples tested and exami-
nations performed. Total number of examinations reached a new high
of 56,735 for the year. Examinations in water and wastes chemistry
reached 3152, almost double the total for the preceding year. A num-
ber of food samples for routine bacteriological analysis increased
sharply. Testing for food poisoning organisms was undertaken for
the first time. Perhaps the most notable event of the year was isola-
tion and identification of food poisoning bacteria from a food sample.
POLK COUNTY— Seven persons died in the county as a result
of tornadoes which hit the county on April 4, 1966. The public health
nurses were attending a staff meeting in Winter Haven when word
came the disaster had struck. The nurses immediately left for their
areas to give assistance where needed. The Lakeland nurses gave
assistance to injured at the Lakeland General Hospital and a school
which had damages estimated at some $100,000. Sanitarians sur-
veyed the situation and assisted Civil Defense personnel in correct-
ing health hazards caused by insanitary conditions. A major prob-
lem was the result of the destruction of two chicken farms involving
some 50,000 chickens. All dead chickens were disposed of within 24
hours. Water supplies in subdivisions and sewage disposal facilities
were checked and restored to satisfactory operation. The public was
informed by news media and by personal contact by sanitarians re-
garding instructions for the safety of unrefrige rated food after
power failure. . . The community nursing service underwent an
organizational change during the year. The six programs formed an
association of councils which was chartered as the Greater Polk
County Community Nursing Services. . .The $90,000 two- story ad-
dition to the central office at Winter Haven was completed in May.
The expanded facilities provided additional office space for admin-
istrative and sanitation personnel, a classroom, a small conference
room and a laboratory. With extra space in the existing building,
health education facilities were improved to include a library. . .In
October, the Third Annual Youth Conference on Smoking and Health
was held in cooperation with the public schools and voluntary health
agencies.
SANTA ROSA COUNTY - Plans are being made for an addition
to the present CHD building at a cost of approximately $80,000 from
local funds. In addition, a new county nursing home is planned. Funds
collected from Medicare patients since the beginning of this program
is some $923 for 221 visits to 22 patients. The Santa Rosa Health
Council is administering this program in cooperation with the CHD.
The Santa Rosa County Health Council appropriated funds for apart-
time nurse to help in the Home Health Services Program in the Jay
area for four months. In addition, a nursing station has been
established at Jay and Gulf Breeze. A Measles Eradication Pro-
gram was initiated with approximately 300 children vaccinated.
No reactions have been reported to date. Some financial support
for the CHD dental clinic was received from the Whiting Officers
LOCAL HEALTH SERVICES
127
Wives' Club which put on a variety show for the benefit of tMs
Himc men funeral directors decided to discontinue ambulance
ser^i^e' kTrivate f'rm was licensed. . . In the Arthropod Con rol
Pi^eram mosquito activity was relatively Ught during the entire
S^d summer months. However, there was somejnosquito
nrS)lem Ungering on until late in November. Larviciding m early
Aori S felt to have contributed to the decreased mosquito popu-
tuon Four fog trucks were used dispensing some 19 946 gallons
^ mixed ^secticide and traveled over 11,000 miles. . .The sanitary
of mixea msecuciue <u artive with seven landfills now in
landfill program continued to be active ^^^'^/f J^ ^t.^ ., ^
operation. The vehicles traveled approximately 21,262 mU^s and
Ssed of over 102,500 cubic yards of refuse at a cost of 13 cents
^r^cubic yard'. .The control of dog fUes continued with very
Uttle activity recorded on the fly population early in the season.
Very Uttle grass was found on the beaches and this in all proba-
S a counted for the small population. However he t^o-m^
crew covered some 103 miles of beaches and put over IMOO ga^
ons of ^secticide. A dragUne ^^^^^^^^^ "^^^^^'^^^^
i^feliSed approximately 1500 acres of breeding area at a cost
of 21 cents per cubic yard.
CT rnHNS COUNTY- Special emphasis was placed on school
ST, JOHr^b L.UUIS11 ^F uppifh Services was initiated.
^eys centered around salmonella investigations following reports
obSined from health card appUcations and from referrals to local
phS-s There were 17 investigations made, -^W Cas a ^o-
LLcts, With treatment and ^°/« ^^^f, * ^^^.^^^^^^^
nounced increase m number of patients receiving
tr Tubrcrsirc:ntU%rogram re^rts ljaicate<l^- new
rases all of which were hospitaUzed. Four o^^^^^^/^if^ ''''^
r;:i;«r.r.oAS-'T ™ s r^- ^=3 ;.S su
some time in this household prior to diagnosis. . .In the Chronic
128
i !
%
^
m
ANNUAL REPORT. 1966
Disease Program, in July the CHD was certified as a Home Health
Agency. Requests for services are gradually increasing. All pre-
natal patients now have routine blood sugars done. . . Periodic in-
spections were made by nurses and assistance was furnished to
local nursing homes in preparation for their participation in the Ex-
tended Care FaciUties Program. . . The health director and nurses
attended organizational meetings for the "Mock Disaster Drill" as
well as participating in the drill itself. . .In the Maternity Program,
the number of patients receiving prenatal services tripled this year!
Special attention was given to delivered cases. These were followed
closely until after the postpartum checkup and family -planning con-
ference. Two complicated maternity cases received close attention.
The midwife in the county attended a six-week course on midwifery
at Sanford. The midwife had only three deliveries during the year.
In the Child Health Program, the number of children served in-
creased. Routine PKU testing on all newborns was begun, but to date
no new cases have been discovered. Immunizations were given in
several local nursery schools as a part of the preschool program
. . . Some 200 children were enrolled in the Headstart Program.
These children all underwent complete physical examination and
follow-up for treatment and referrals were indicated. Measles
vaccine was also given to this group along with polio vaccine and
tuberculosis testing. The staff feels this program has been most
beneficial, not only to the children, but also to the teachers and
nurses. Health records were transferred to the schools where
children enrolled for the first grade. . . The nursing staff partici-
pated in just 14 programs with talks and visual aid presentations to
organizations such as schools, home demonstration clubs and local
civic clubs. In addition, a number of seminars, workshops and other
in-service activities were held. In the Sanitation Program, the
present staff now consists of a Director of Sanitation, one sanitarian
trainee and one sanitarian aide. . . Staff members attended the
Florida Association of Sanitarians short course, shellfish seminar,
nursing home short course and ambulance workshop. Three food
handling schools were conducted for the food service industry. A
swimming pool short course was arranged for pool operators. . .
In the area of food sanitation, a monthly inspection routine has been
started and is now part of department policy. This has resulted in
considerable improvement in the industry and industry cooperation
is steadily improving. The USPHS conducted a survey of the oyster
industry. All shucking houses were approved and the heat- shock-
shucking method approved for the county. . . Bacteriological studies
were done on the waters of the intracoastal waterway and its tribu-
taries. These showed considerable improvement over previous
studies conducted in 1965. Approximately 10 miles of additional
water has been requested to be opened for shellfish harvesting.
Bacteriological studies were made of waters adjacent to St. Aug-
ustine. Areas connected to the sewage treatment plant revealed
moderate pollution due to the dispersion of heavy pollution load on
LOCAL HEALTH SERVICES
129
the western shore. Completion of the eastern part of the "tY system
drawn.
cADAcnTA rnuNTY - The year was an eventful period for the
aeve'^nt'of'p'ogr'LJpub^lic healU, P-J^^„,™f,rr
<?arasota CHD. During the summer, the first phase of a two year
^n'^rrmen^l Health'study was undertaken -^-^^^^^H P^".
Trnur^n'g st^Trovldel'both services in the homes of the com-
mlityT order to overcome certain administrative 9,^ob\ems the
SXchose to have the VNA assume certain responsibility for the
H^e Health Se^^ce Program (HHS) under Medicare. The nursing
S^Tf wafstrenrtrened; an assistant nursing director and a nurse
fcfrdTnlVr' w"^e%p,i,inted. and home f,f ^^h ai^^y^l^fl
rarontTa^ttir^lth^eT'^^c:!':^^^^^^^^^
feclfv:- a^p'^v^fasTcu^aUiied HHS Pu-xor Prov.<^g all r^-
A^A coT-vifPt; After a slow month m August, me servn^c owii^o
I'^rtional Zl re^^rr r^grr/ a« all incUd in develop-
county courthouse Aanex m &.uth Vemce was ^^ ^^
nurses and one home ^^f "f .^/^' ^/^^jthSuarters in the new
sanitarians are assigned to the ^'^^ *"" "^^^Unic program wiU
center. As soon as Possible, a comprehensive cUmcprog
get underway through the new ff^J,^^*'^^^- J^ f ^^^^^^^^^^^^ ^sease and
^^^tllTrvtr Aa^^Uoral^ -r^g^s" wm' Z introduced in the
months ahead.
130
ANNUAL REPORT. 1966
m
LOCAL HEALTH SERVICES
131
SEMINOLE COUNTY" Highlights from Seminole CHD include
the following: A clinic for migrants was opened in July in the center
of the Midway farming district. Two day clinics and two night clinics
are staffed by the nursing staff and a clerk. Evening clinics are
serviced by five physicians rotating their services. Response to this
has been very good. . .In the first and second grades, 2304 children
were tuberculin tested with the Stemeedle technique. To date, two
cases of tuberculosis have been found. Positive reactors are still
being followed. New first graders will be tested soon. Some 850
children have received measles vaccine. A countywide measles
vaccination campaign with the support of local pediatricians is
scheduled for early 1967. An oral polio drive was completed in the
southern part of the county with very good results. . . With the help
of a recorded tape on glaucoma on a local radio station, 776 persons
were screened in the Glaucoma Clinic, which meets twice monthly,
with 20 cases of glaucoma found. The nursing staff screened some
164 persons for visual defects at the Annual Lions Club Fun Fair in
July— with 51 per cent of adults and 35 per cent of children failing
who were referred for further care. . .A future nurses' day program
for junior and senior high school students sponsored by the CHD and
District Nurses Association was well received. . .The Home Nursing
Service has made 2437 visits since its beginning and services of a
speech therapist have been added to the staff. . .The Planned Parent-
hood Program has been expanded to include three other health clinics
. . . Considerable emphasis was placed on health education by the
staff during the year. Recorded tapes on venereal disease, cervical
cancer, glaucoma, and tuberculosis were played by the local radio
station as a reminder to people of the county to see their family
physician or visit the CHD for necessary examinations. The director
also arranged a complete health program with speakers and audio-
visual aids for the new Seminole Junior College for the entire school
year upon request. . .All participating ambulances, their drivers
and assistants have met the new ambulance law requirements and
have been certified. Medical Self-Help training has been added to all
Red Cross First-Aide Courses. . . Sanford began adding fluorides to
its water supply. Water lines have been extended some four miles
east of Sanford to serve approximately 2000 residents previously
using individual wells. In addition, water lines were extended
three miles south to serve another 1500 residents who were being
served by a community system containing high chlorides. . .The
Orange-Seminole Planning Commission has engaged an engineering
firm to review existing water and sewage facilities in the two- county
area and develop a master plan for providing adequate facilities to
all areas. This report is expected within a year. The CHD staff will
assist in providing data on existing systems. In cooperation with
Volusia County, a travel trailer camp has been opened on the St.
Johns River. The project was financed by Seminole and Volusia
Counties and is equipped with all modem facilities and equipment.
By amendment to the Seminole County zoning regulations, rules have
been prepared governing the construction and operation of aU
t^"er ^ps. Adoption of these rules is expected in January.
SUWANNEE COUNTY - The County Commissioners have re-
iterated their desire to cooperate with the CHD in construction of a
^ew health cUnic with assistance from Hill-Burton f-^s. l^d for
.hie n„mo«P has been riven by the Suwannee County Hospital Board
"" M^chaUengrs a?e being welcomed by the CHD in the county
;s 'foU^ws: The construction of a $6,000,000 poultry processmg
pLt ^d hatchery near Live Oak and the development of a
$3 000 000 recreation park on the Suwannee River should have a
SSc^t impact on the community. . . Both PhV^i-l '^erapj ^^
siSech therapy were added to regular services in the Home Health
Services Program. Intensive programs were conducted m the jumor
f^^semor w|h schools on communicable diseases with emphasis on
venereal disease controL
VOLUSIA COUNTY -For 15 years t^e Volusia CHD tested a
program of home nursing, but it was °"ly'".l»^V, 60^(^0 "pie
was made available to the entire population of 160 000 ^ople
InDr^mately 15,000 home visits annually are now bemg made by
fws s^rvfce in the county. . . In July, 1966, a special Tuberculosis
Prelect wal begun. One of the first projects is a skin test survey
of all first grai: children in the county A l»UuUon --ey "f ^
HaUfax River and Indian River was made. The Halifax Kiver, me
uTreeTt ^y of polluted water in the county, is approximately 35
miles long and one-haU mile wide. None of it is approved for
erow^ng shemish. It was also found ttet 16 miles of the In-ian
K south of Edgewater, is the last remaining area where shell-
nsh crbe safely grown in this county. . . During the early part of
he veTr the PUots Club of New Smyrna, Daytona Beach and Deland
'sf^-n'sored a diabetic screening survey. Some 3723 ^ope were ex-
oTvTinoH in this survey and 355 people were referred for lurtner
TaXs toTheir famay physici^. This was 9.53 per cent of those
tested.
WAK-ULLA COUNTY - The Wakulla CHD joined in the SBH Vac-
cinaU^ri'^slanTprogram with anincrease -/---j-^-^;:!
last year. Measles vaccine tes also been introduced ^^ immurn^
lions aeainst this disease tave increased monthly. . .In the School
Heafth^roBram the CHD completed physical examinations on 150
firs eraS^ Stents with foUow-up. This was done by the counQr
heaUh'^rtctortcause there is no P'^^f^^y^^i^,'^,,^J,lTZ;
AU vision and hearing tests were completed in five ^^^"^^^h^^^!
county. For the first time in 17 years the county h^d the SBH Den
tal Mobile Unit. All chUdren in grades one, three and fiv^ as well
as part of the --th ^d eighth w^re screen f;^<^ental^f^^^s
with referrals to the mobile umt. inere weic xoa « c^^^
7o treatment with 58 patients completing f "^^ '^^f//^,^2i
73 students ted been referred for treatment. There were Ul total
132
ANNUAL REPORT. 1966
fillings and 85 extractions. The Wakulla Board of PubUc Instruc-
tion made a significant contribution to the CHD budget during the
year. . .During 1966, a Planned Parenthood Program was initiated
with 51 women participating. Twelve lUDs were inserted and other
patients were furnished with birth control drugs. . . In cooperation
with the SBH mobile X-ray unit and the TB Health Association in
August, the CHD had this unit for one day. Some 286 people were
X-rayed. This consisted primarily of food handlers and school per-
sonnel. . . Much study and planning for implementation for the Medi-
care Program was given during the year. A Visiting Nursing Serv-
ice and Public Health Advisory Council was organized in July. . .
A water system was put into service in the Panacea area during the
year. Significant progress was made in advancing plans for the St.
Marks public water system. Preliminary studies were completed
for the Sopchoppy public water system. . . An estimated 20 per cent
of pet dogs in the county were immunized during the annual rabies
clinic. Approximately 20 square miles of bay water was opened
for oystering with only a portion of Dickerson Bay being closed.
The seafood industry maintains a high rating in the USPHS survey
. . . The County Commissioners appropriated funds to carry through
a Farmer Home Administration Water Resources Study which
will be of significant value in future water systems planning.
WALTON COUNTY — The Walton CHD continued to participate
in the Tri- County OEO Health Program involving Walton, Washington
and Holmes Counties during the year. However, this program was
terminated at the end of the year due to a cut-back in funds at the
federal level. Much planning and effort was devoted to this program
by the various staff members. . . Highlights in the Sanitation Pro-
gram was an Environmental Health Survey of Defuniak Springs. A
total of 1752 homes was surveyed with emphasis on the following
items: physical structure of home; sewage disposal; water supply;
garbage and litter disposal; general condition of premises; and
rodent and mosquito breeding conditions. . .This report was pre-
sented to the City Council using pictures, charts and diagrams. Each
member of the Council was given a copy of the report. Private
premise visits were made on all positive hookworm reports through-
out the county. Family folders, including sanitary survey records,
were made. Follow-ups were accomplished as indicated.
WASHINGTON COUNTY - During 1966, the Washington CHD
continued participation in the Tri- County OEO Program. The county
health director spent much time in planning and guiding the staff in
implementation of this program. An extensive tuberculin skin testing
program was done in the schools. . . All new infants were given PKU
tests including private physician referrals. . . A new Dental Service
Program was established with many indigent school children receiv-
ing dental care. . .The Family Planning Program increased from 10
patients in 1965 to 95 patients in 1966. . .School health examinations
LOCAL HEALTH SERVICES
133
crease. The f ™ ^1^° ^""'"'Xdvisory Committee was organized in
Program. . .A Community Aaviaui> Q,„4f!,rv <5urvevs were
connection with the Medicare P'^°f/-^^'"„ "„: ^^a\*^[e, of the'county.
made on all P"vate premises in he mumcipaUtiesot^
Summaries of sanitary ^^'^^^yJ^^^%^^lZ^!Zon 3X.<i C^ryyille
^^eVinfo^ri^alL^rithrd"^^^^^^^^^^ to -lire grants for
constructing and expanding sewerage and water faciUties.
ACCIDENT PREVENTION PROGRAM
and industrial safety continues to ''f^*7^ "fP°ueFio/icia Indus-
sr?r»';Lfr„'aT"ro«i"iS''p:;s>';?H-;, . ». p.-
motion of safety. , . ^ , ;„
The Automotive Crash W Re-i^c^ ^ 'n^irMed^cTA"
Florida in 1964 has continued with^^^^^^ cooperating in
sociation FMA) and the ^^lorida nospiwi -ccidents in which
six-month periods of .investigations oiJ-^y^-^-y^^^^^- ^^^^^^^^^ .^
late model cars are involved. The program nas
five troop areas and is in progress in a sixth area.
gestions for local programs.
Cheniical education ^^-^t^H^^Tl^t ^
^TdesTgliLraf arau^uLTl^isrn control center, bringing the
total to 33. „^f^r,c •♦
The "Guide for Teaching Poison Prevention ^^^^^^^^^^Ik
made available last year, conUnued to be l^^y^l^^^seA by the
thousand copies have been distributed. It is now being
Office of Economic Opportumty (OEU).
A » *oi nf -^oa bites was reported during 1966 in the snake bite
A total of 308 bites *^^ ' /.ggg ^tf these, 191 were reported
survey, compared with 331 tor laoa.
134 ANNUAL REPORT. 1966
as bites by venomous snakes. In each case, the physician who
. treated the case forwards a cUnical history to the FMA Subcom-
mittee on Venomous Snake Bites. A total of 182 questionnaires was
returned by snake bite victims and approximately 110 clinical re-
ports were received from physicians who treated patients.
The survey of deaths due to drowning begun in 1965 in cooperation
with Edward Press, M.D., Medical Assistant, IlUnois Department of
Public Health, has continued. A total of 440 drownings was investi-
gated between July 1, 1965 and June 30, 1966. A study of the data
continues.
In February a two-day seminar on accident prevention was con-
ducted in Orlando. Although personnel of the Division of Accident
Prevention, U. S. Public Health Service, Washington, D. C, and
this staff participated, emphasis was upon local talent in the pres-
entations.
The 1965 Legislature enacted a law delegating to the State Board
of Health (SBH) responsibility for specifying minimal equipment for
ambulances and certification of ambulance drivers by the county
health officer. In March the Board adopted a minimal equipment list
patterned after that recommended by the Trauma Committee of the
American College of Surgeons. A certificate for ambulance owners
and a card for ambulance drivers was also adopted.
In June a series of meetings was held for personnel of CHDs at
which this list of equipment was explained and methods of certifi-
cation were discussed. Since American Red Cross (ARC) first aid
training was considered the basis of certification of ambulance at-
tendants, it became necessary to set up classes and train those at-
tendants who had not completed ARC first aid courses.
The law became effective July 1, 1966, but permitted a 30-day
delay in enforcement at the option of the county health directors
which was exercised by several. *
The last tabulation shows that 169 establishments and 339 am-
bulances have been certified. A total of 1001 attendants has been
certified on the basis of the ARC Advanced First Aid Course, 286 on
the basis of Standard First Aid and 108 on the basis of equivalent
training.
A survey conducted during the June meetings showed that am-
bulance service had been provided by funeral directors in most
areas of Florida. A few communities had private ambulance service
companies. The law resulted in the establishment of a number of
good primary ambulance services and enabled many funeral direc-
tors to discontinue this service.
The Committee on Injuries of the American Academy of Ortho-
paedic Surgeons conducted a second course on Emergency Medical
Care of the Sick and Injured in Miami in December. This office
LOCAL HEALTH SERVICES
135
assisted in the pubHcizing of the course. Over 200 ambulance at-
tendants from throughout Florida attended the three-day course.
All had already completed the ARC Advanced First Aid Course. An
interest in further improving emergency medical care was evident.
HEALTH MOBILIZATION PROGRAM
The Health MobiUzation Program (HMP) is concerned with the
survival of the citizens of this state in time of natural or man-niade
disaster Through various facets of the program, professional and
non-professional persons receive training enabling them to meet
medical emergencies.
As a delegate agency of the State Office of Civil Defense (CD)
the State Board of Health (SBH) through the Health Mobilization
Program is responsible for formulating emergency health and
medical plans, and plans for the emergency maaiagement of health
resources, including manpower, which are included m the State CD
Plan as Annex VI to Parts One and Three thereof.
The HMP was expanded this year through an employee respon-
sible for full-Ume promotion of the Medical Self-Help Trainmg
Program (MSH).
Medical Self-Help Program
In February, Governor Haydon Burns issued a proclamation de-
signating that month as "MSH Training Month." Responding to the
proclamation, several state agencies organized classes for their
employees. The goal of the MSH program is to train at least one
adult member of every family in the state.
Conferences are now underway to obtain the endorsement of the
State Superintendent of PubUc Instruction in support of both MSH
and Red Cross First Aid training or a combination of both courses.
These negotiations are a joint enterprise of the American Red
Cross (ARC) and the HMP.
MSH was accepted by five colleges, five junior colleges and 19
school systems for incorporation into their curricula. The Westing-
house Peace Corps Training Center, Key West, participated in this
training with 185 Peace Corps volunteers trained who will use this
training in Micronesia.
In cooperation with the State Agricultural Extension Service,
Home Demonstration Division and the Pinellas CHD, arrangements
have been made for MSH to be offered to the general public in
Pinellas County via educational television early in 1967. This com-
bination of sponsorship is beUeved to be a national first.
Requests from the state, county and local levels of goyernment
for MSH exhibits and demonstrations were filled by the MSH
136
ANNUAL REPORT. 1966
coordinator, who also visited each school system, college or other
agency teaching MSH and advised the instructors on the proper
utilization of kits and student materials.
The employment of two county level HM coordinators in Orange
and PineUas Counties has greatly increased the implementation of
MSH in Central Florida.
The State Reform Schools for Boys in Marianna and Okeechobee
agreed to incorporate MSH into their training programs.
Some 95,000 persons have received MSH training in the state
to date.
Packaged Disaster Hospital Program
Early in the year, a community training program for hospitals
having an affiliated Packaged Disaster Hospital (PDH) was instituted.
This program is designed to assist these hospitals in maximum
effective use of the PDH in the event of a disaster by actual use of
the components, some of which are part of a PDH Training Unit
housed in a mobile trailer. All phases of disaster medical care
from admitting procedures to sorting are incorporated in this
training. To add realism to the exercise, 15 to 25 "victims" are
portrayed by volunteers organized by a health mobilization staff
member. This training, consisting of seven phases, has been con-
ducted in Orange, Highlands and Martin Counties and is scheduled
for several others in the near future. PDH training has met with
great success, aided by the loan of an additional PDH Training Unit
Trailer from the U. S. Public Health Service (USPHS). A similar
do-it-yourself program is being planned as a supplement for addi-
tional training in community hospitals which have had training
and/or as a semi -independent unit for use in communities with only
a minimum of assistance from the HMP.
Ninety- six consultation visits to communities where PDHs are
prepositioned were made. Included are inspections made following
tornadoes and hurricanes which struck during the year necessitating
use of PDH components.
Emergency Plans
A change in federal guidelines required the rewriting of Annex
VI to the State CD Plan. This Annex, concerned with the provision
of emergency health and medical services, has been written and ap-
proved by both the state CD Agency and by the SBH.
Natural Disasters
In April, a series of tornadoes struck the central portion of the
state, leaving widespread destruction. The State Director of CD
LOCAL HEALTH SERVICES
137
assigned a member of the HM staff to the Damage Assessment
Survey Team.
An early hurricane (Alma) struck the coast in June necessitating
the fse of components of six PDHs to care for injured and infirm
citizens.
The HMP was instrumental in instituting a series of Natural
Disaster Planning Conferences for the purpose of outlming specif c
duties of the various state agencies. The SBH, ARC, CD, State
WeUare and other agencies participated by describing their par^ic-
^lar responsibilities during natural disasters. The most important
suggestion made to the 500 persons attending was that local govern-
ments fn cooperation with the local ^'^'^'^'f ^.f^^'^^'^ZZ
Ste natural disaster plans and arrange coordination Follow up
^Lrences are scheduled for early 1967 when assistance will be
^vln bythe participating state agencies to create local natural dis-
aster plans and programs.
Education
Prot.sfloml ..d clencl member, ol Ih. "» •'^' "^tSl'
Ft. Sani Housion, ic ' . ^.j .^ Dgjgnse Management,
New Orleans, La., and bavannan, ua., ^"'"
Jacksonville; and Casualty Make-up Course, Miami.
A oaoer written by an HMP staff member entitled "PubUc Re-
actions t^Di^rster" Ld published by the State Civil Defense News-
tetter receded Lternational acclaim. Civil Defense organizations
rom throughout the United States, as well as Sweden England, and
cZda have asked and received permission to copy this paper.
HOME HEALTH SERVICES
Functions of the office of Home Health Services, established In
1966 are to assist in developing, expanding, and coordinating home
heath services ^counties, Lid^'to administer activities reUted^o
certification by the Social Security Admmistration (SSA) of home
health agencies participaUng in the Health Insurance for the Aged
Program.
<?t!,ff activities related to these functions are participating m
educIuonalpi^gramsTproviding consultation services; disseminating
t,Sat"on wncernikg the Health Insurance Program to health de-
SmentrvisXg nufse associations hospitals nursir^gjio^es
of ^blic Health Nursing elsewhere in this report); and preparing
records and reports for certification purposes.
FUty-seven agencies in 49 counties are certified by the SSA as
138
ANNUAL REPORT. 1966
home health agencies. Provision of therapeutic services, other than
nursing, by certified home health agencies is primarily through
contractual agreements. Fifty-four agencies provide physical
therapy as compared to six in 1965; 19 provide occupational therapy
as compared to none in 1965; 19 provide speech therapy as compared
to none in 1965; nine provide medical social services as compared
to one in 1965; and 12 agencies provide home health aide services
as compared to one in 1965.
A training center has been established at the Pinellas County
Visiting Nurse Association to orient potential nursing supervisors
and clerks about the mechanics of developing and administering
home health aide programs. During 1966, 19 pubUc health nurses
and 13 clerks attended five orientation programs scheduled for the
year.
DIVISION OF NUTRITION
MILDRED KAUFMAN. M.S.
DIrec+or
This division plans, directs and provides nutrition and dietetic
services as essential components of the many state and county pub-
lic health programs. The increasing awareness of the influences of
nutrition on human growth, development and aging, and the manage-
ment of a variety of inborn metabolic errors and chronic conditions
create many more requests for nutrition services. Priorities con-
tinue W be pregnant women, infants, preschool and school age child-
ren, persons with chronic conditions, the aged and families with
limited incomes.
During 1966 recruitment of qualified nutritionists was a major
objective. Ten were recruited to fill vacant or newly created
positions. For most of the year, state programs were served by a
director, a half-time training coordinator, five regional consultants
and one institutional consultant. In August a second institutional
consultant was added. ^
During 1966 nutritionists provided services to 59 counties. This
included regularly scheduled services to 21 counties and services as
requested to an additional 38 counties. Routine services to county
health departments (CHD) included individual and group diet coun-
seling to paUents attending maternity cUnics, crippled children's
clinics, well child conferences, diabetes and general medical clinics.
Nutritionists conducted classes for persons with diabetes in three
counties and in two counUes participated in screening programs for
various chronic diseases. Home visits were made with pubUc health
nurses to provide dietary guidance to famiUes of children with
phenylketonuria or to chronically ill paUents with diets prescribed
by physicians. Assistance was also provided with family meal plan-
ning, food budgeting and use of donated commodity foods. In indi-
LOCAL HEALTH SERVICES
139
vidual and staff conferences with county health ^p^^^t^j^J;^^^
department staff, nutritionists discussed current "^o;;^f^^;^^ j;^
nutrition during pregnancy and for various age groups, diet therapy,
^Tr^l^mT^A^s^^n^ use of nutrition education techniques and
'^'^^te^^^Xplernent.tion of Medicare, nutritionists were
aled to present inservice education programs for nurses on
Stric nutrition and diets for a number of chrome diseases. In
IL cooties nutritionists trained home health aides m nutrition and
food management.
Nutrition consultants oriented teachers to nutrition education in
five o"Se Six ^versities and in the cooperating CHDs participating
n the Teacher Project in Health Education. Nutritiomsts assisted
locS teachers to incorporate nutrition content into their c^ssroom
ieafhing fo 4o counties, special education teachers worked with
nutrmon consultants to develop and test a curriculum on foods and
nu ri ion sm4ble to the unique needs of their students. Assistance
was riven as requested to school feeding programs. Coun^ and
reioSI nutrition consultants helped small institutions and Head-
sta^Trograms. A simple illustrated nutrition flyer is being pre-
oared i^ E^sh and Spanish and a series of sUdes with narrative
was developed for'use in health education programs for groups of
agricultural workers.
f-^nc.uation was eiven to the five counties planning and devel-
oping rteS^dWa^t Care Projects. This included defining ,ob
rest^nsfbiUUes and qualifications for the nutritiomst positions and
IssE witTrecruitment. The division provided ongomg consulto-
Uon iTc^rdination to nutriUonists employed by the projects.
The institutional nutriUon consultants visited 26 counties maimg
ifi n„r<;inff home visits and 21 visits to small hospitals. The second
Lst"t^Uoil nutriUon consultant, who joined the staif in Au^st, has
tended dietary consultotion to child caring institutions and day
cfre progr^s for children. Seventeen children's institutions tove
r: :ived'some dietary assistance. Nutritionis^J^ve participat^
with programs and exhibits at two meetings of the Florida Associa
tion of Children Under Six.
Medicare has shifted emphasis of the institutional nutrition con-
sutotTon progrL. Instead of as much direct assistance to hospiWs
^d el^ended care faciUties, consultants provide more consultation
to Ucfnsure" ^d certification staff and work on the recruiting and
orienUtion of qualified dietitians for the direct se^ices U> co
ooeration with the Florida Dietetic Association (FDA), a maiiea
questio^aire identified qualified dietitians willing to help srn^
hospftals and extended care facilities not employing l^^^^^"^ J^«
division with the FDA, Florida Hospital Association, Florida Nursmg
Ho^TA^^ociation and the University of South Florida plamied and
CO s^nsoreTa Thr" -day workshop on dietary consulUtion for ap-
proximately 60 dietitians desiring refresher training.
140
ANNUAL REPORT. 1966
An institutional nutrition consultant worked with the American
Dietetic Association Correspondence Course for Food Service Sup-
visors which this year trained 13 nonprofessional food service sup-
ervisors in Florida. Consultants worked with dietitians and junior
college faculties to initiate courses for food service supervisors at
St Petersburg Junior College, Junior College of Broward County
and Miami-Dade Junior College. Several other counties are begin-
ning to plan such courses.
In 1966 one nutritionist completed the one year residency pro-
gram for public health nutritionists. She will be assigned to Lee and
Collier Counties to provide general nutrition services with emphasis
on the migrant health program. Two beginning nutritiomsts em-
ployed in September and December of 1966, after a period of orien-
tation, have been assigned to work in county public health programs
under the supervision of a senior nutrition consultant. Field exper-
ience in pubUc health was provided by the division for two graduate
students in nutrition.
During the year staff of the division prepared in addition to six
issues of "Nutrition in a Nutshell" various materials on nutrition
for pubUcation cooperatively with other divisions of the State Board
of Health. A program plan was prepared with the Bureau of Maternal
and Child Health for nutrition services to mothers and children and
a plan was developed for more effective nutrition services and dis-
tribution of Lofenalac to families having children with phenylke-
tonuria. During this year at the request of the State Department of
PubUc Welfare a tabulation and analysis was done of food prices in
relation to food requirements of various age groups.
To coordinate field nutrition services in Florida, the division
was represented at monthly meetings with the nutrition specialists
of the Agricultural Extension Service, State School Lunch Program,
State Department of Education and other agencies. This group is to
sponsor a statewide Youth Nutrition Conference to consider with
representatives of youth organizations how to help the teenage pop-
ulation understand and meet their nutritional needs. Nutritiomsts m
several counties provide leadership on local nutrition committees.
DIVISION OF SANITATION
A. W. MORRISON. JR.. R.S.
Director
Activities of this division continue to serve the broad objective
of further development and improvement in local environmental
health programs. The professional staff again devoted major time
and efforts toward the provision of effective consultation services
LOCAL HEALTH SERVICES
141
and other supporting assistance for the county health departments
?ShD) Corrective responsibiUties involve recruitment and train-
neof CHD sanitarians, administration of statewide enviromnental
health programs and food research activities. Contacts are mam.
toied with other local, state and federal agencies in areas of mutual
interest.
Consultation Services
Assistance was provided to county health officers and sanitarians
in all areas of environmental health. Members of the staff made 330
^isUs to the counties in 1966. Local problems covered a broad
s^ctrum ranging from isolated minor nuisances to major Program
o^rh^uT Trnvilual program evaluations were made m a number of
counties.
The sanitation consultants continue to assist in <:o°jf "^ting
other State Board of Health (SBH) programs "'^"['^^""fu^vJ^^fty
participated in the summer teacher tramingprojert at th^ University
of Florida, Florida Atlantic University, Umversity of South Florida
^d Bethune-Cookman College. OUier activities "J^olved program
TresenUtions at Aedes aegypti Eradication Project workshops and
serving as examination panelists on aU Florida Merit System oral
boards for sanitarian trainee appUcants.
Training
All staff members are involved in training activities. Con-
s.,Zs'SLr^^Cm>s in planning and inducting local ^raim^^^
Drograms for health department personnel and outside mdustry
groups They also assist professional organizations in addition to
rSating'in the SBH sanitarian -— i-J^fgle"^
Two 12-week general sanitation courses were offered in 19bb. inese
Curses p'vfded comprehensive coverage of e-iro-imenUl h^^^^^^
wifh pia<r^room and laboratory instruction at SBH headquarters m
Sson^Ue^d tield work in'selected CHDs. Eighteen saniUrians
successfully completed this course.
ThP nroeram on Urban Planning for Environmental Health was
^ ^!H'^hv the fomation of Project Manasota-88. This project
'cfverinj ManateiTd Sarasota Counties, started witii a one-week
trS'c^uTse^d bi-county survey attended by 68persons in June
Fu^r study and community action on environmental problems wiU
Furtner siuay ^' Architects, engineers, cmc
le°atr cuy ^d'co^ty officials have joined professional planners
'^d pubUc he'th workers in this endeavor. More .^ 100 persons
^ere actively involved in committee work on this project at Uie
close of the year.
Food-worker training programs were conducted in 14 counties
!l
142 ANNUAL REPORT. 1966
(Alachua, Brevard, Broward, Charlotte, Columbia, Dade, Duval,
Escambia, Hillsborough, Orange, Palm Beach, Pinellas, Polk and
St. Johns) with a combined total of 4671 persons completing courses
in 1966.
The division continued to coordinate enrollment in U. S. Public
Health Service (USPHS) home study courses for sanitarians. A new
17 -lesson course in environmental sanitation was added to the three
original offerings.
Program Administration
The division is responsible in whole or part for administration
of 16 statewide environmental health program areas, five of which
include legal requirement for SBH license or operating permit:
trailer parks, food processing plants, camps, bottled water plants
and rendering plants; and another which involves official recom-
mendations to USPHS for required federal certification. Field activ-
ities associated with these programs are conducted by CHD sani-
tarians. Staff consultants provide technical assistance to the counties
in these and other environmental health program areas.
Trailer Parks
The 2523 permitted trailer parks, ranging in size from two
spaces to more than 1000, provided 110,351 trailer coach spaces at
the close of 1966. This represents a net increase of 110 parks and
5657 spaces for the year. Park quality characteristics continue to
improve as evidenced by an increasing ratio of those with utilities
to those served by central bath houses, lesser percentages of new
spaces served by septic tanks and an increasing rate of spaces
served by municipal and other central sewerage systems. Currently,
57 per cent of the total spaces are served by municipal water and 44
per cent by municipal or other central sewerage systems. The
division's 353 permit transactions for the year included: 134 new
parks, 24 parks closed, 76 park expansions and 119 changes in
ownership, park name or reduction in number of spaces. CHD sani-
tarians made 3887 visits to the trailer parks during 1966 in order to
insure compliance with sanitation standards and maintenance of
satisfactory conditions.
♦
Food Processing Plants
Operating permits were issued to 752 plants in 42 counties rep-
resenting an increase of 19 plants in 1966. Food technology con-
tinues to advance at a rapid rate spurred on by consumer demand
for convenience foods including ready-to-eat varieties. New food
mixtures, changing processes, food packaging and several factors
associated with the storage and transportation of food products
present challenging public health problems. CHD sanitarians made
4887 visits to food processing plants during the year to insure sani-
tary conditions and operations.
LOCAL HEALTH SERVICES
143
Camps
A total of 382 camps with faciUties for the housing of 50,480
persons was Ucensed during the year. This represents ^increase
of 14 camps and 2402 facilities compared to 1965. The 323 migrant
labor camps provided space for 42,976 persons and 59 recreational
camps had a combined capacity of 7504. CHD sanitarians contmued
their extensive efforts to upgrade the camps which again resulted in
the abandonment or renovation of a number of old camps and the
construction of new faciUties. Sanitarians made 5527 visits to the
camps in 1966 in order to effect physical improvements and insure
proper operational procedures during periods of occupancy.
Bottled Water Plants
Operational permits were issued to 27 Florida plants and three
out-of-state bottled water shippers in 1966. This represents a de-
crease of three Florida plants and one outside shipper who discon-
tinued business. Improvements are continuing in the older Pjants as
two were renovated this year. A total of 371 visits was made to the
plants and all bottled waters were regularly sampled for laboratory
examination.
Rendering Plants
Operating permits were issued to 12 rendering plants in eight
counties. Studies indicate the continued presence of salmonella
organisms in these plants and in the finished products which are
utilized in animal feeds. Findings have lead to recommendations
involving plant layout and operating procedures in order to prevent
contamination of the products. Sanitarians maintain close surveil-
lance of the plants to insure that satisfactory cleaning practices are
carried out, waste products are properly handled and odors are held
to minimum levels.
Common Carriers
The division continued cooperative agreements with USPHS in
connection with the Federal Interstate Carrier Certification Pro-
gram. This includes water and food placed aboard aircrafts, steam-
ships, railroad trains and buses and the handling and disposal of
liquid and soUd wastes from these commercial carriers. CHD sam-
tarians made periodic surveys of these operations and facilities
with reports to this division. These reports serve as a basis for tJie
division's semi-amiual recommendations to USPHS. The 127 facil-
UiTs recommended for approved status in 1966 include: 24 airline
catering and watering points, 14 airline servicing areas, four rail-
road commissaries and catering points, 17 railroad watering pomts
and 68 vessel watering points. Staff consultants and USPHS per-
sonnel provide assistance to the counties in this program.
144 ANNUAL REPORT. 1966
Food Hygiene
Major food hygiene activity directed toward the prevention and
control of food-bo me illness and disease has again emphasized
improvement in practices involving the preparation, storage and
handUng of potentially hazardous foods. Prompt attention is given
and careful investigation is made of all reported food outbreaks.
Staff consultants along with epidemiologists, other personnel and
all necessary laboratory facilities are readily available to assist
the CHDs in these investigations. All counties are involved in this
program which included the recording of 30,181 food estabUshments
of several types: eating and drinking (food service) - 20,360; food
processing - 843; abattoirs - 146; shellfish and Crustacea - 167;
grocery and meat markets (food outlets) - 7384; others - 1281.
CHD sanitarians made 172,803 visits to the food estabUshments
in 1966.
li
Other Programs
The CHDs conducted a number of additional environmental health
activities involving: water supplies, Uquid and solid waste disposal,
school sanitation, housing, swimming pools, nuisance control, rabies
control, hospitals and nursing homes, child care centers, recre-
ational areas and other facilities (for further details see Table 20,
Major AcUvities of Local Health Units). Staff consultants provided
assistance to health officers and sanitarians in all of these program
areas throughout the year.
LOCAL HEALTH SERVICES 145
TABLE 19
PERMITTED ESTABLISHMENTS AND FACILITIES, FLORIDA, 1966
Cowoty
Alochuo . . . .
Mcer
B«iy
Brodford . . ■ •
Brevard
Broward
CoHtoun . . . .
Owrtott*. . . .
GtTU«
Cloy
ColUer
Columbia. . .
Dode
DeSota ....
Dixi.
Duval
Escon^io . . .
Flogl«f ....
Fronklin . . .
GodKien . . .
Gilc>»i»». . .
Glodes
GwK
Horn 'ton ...
Hardee . . . .
Hendry . . . .
Hernondo. . .
Highlond* . .
Hillsborough.
Holetes . . . .
Indian Riwr.
Jockion. . . .
Jefferson. . .
Lofoyefte. . .
Lake
Uon
Levy
Liberty
Madison ....
Monotee ....
Marion
Martin
Monroe
Hmaou
Oicoloota. . . .
OkeecKobee. .
Oran0e
Osceola . . . .
Palm Beach . .
Potco
Plnellot. . . . .
Polk
Putnoffl . . . . •
St. Johns. . . .
St. Lucie . . . .
Santa Roto . . .
Sorosoto . . . .
Seminole. . ■ .
Sumter
Suwannee . . .
Taylor
Union '
Volusia. ...
Wakulla ...
Walton ....
Washington .
Out-of-Stote
Trailer
Paries
TOTAL
38
4
57
96
125
2
25
3
16
27
6
103
6
77
92
n
7
8
. . .^.
6
16
10
6
3
17
178
1
24
9
2
49
77
59
12
■ • • •
1
78
32
34
59
9
54
25
121
23
119
64
277
132
45
21
29
19
77
4
10
4
6
' '94'
1
3
3
2523
Food
Processing
Plants
27
* V
• ■ •
3
40
100
4
'41
. . .^.
2
1
63
1
1
5
17
10
33
4
4
V
3
57'
2
19
4
78
52
4
12
10
55*
9
' • • •
1
2
35
2
2
3
ComfM
1
V
6
8
1
7
79
' V
1
2
1
1
4
1
• ■ •
22
' 4
2
" V
6
7
2
9
1
102
11
4
24
5
'"5*
" V
9
2
BottM
Wotw
Plants
Rendering
Plants
1
1
4
1
2
1
V
752
382
30
2
V
12
146 ANNUAL REPORT. 1966
TABLE 20
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
Total
AlocKwo
ftoker
Boy
Bradford
Brevard
Broword
Gilhoun
Charlott*
Citrus
Cloy
Colliar
Columbia
Dad*
OSoto
Dixie
Duval
Escambia
Flagkr
Franklin
Godsden
GilcJwist
GlodM
Gulf:
Hamilton
Hord##
Hondry
HerrMndo
Highlands . . .
Hillsborough. . ,
Holmes
Indian River. .
Jockson
Jefferson ....
Lofayette. ...
Lake
Lee
Leon
Levy
Liberty
Modison ....
Manatee ....
Marion
Mortin
Monroe
^k]stau
Okaloosa. . . .
Okeechobee. .
Orange
Osceok] . . . .
Palm Beach . .
Pasco
Pinelkn. . . . .
Polk
Putrtom
St. Johns . . . .
St. Lucie . . . .
Santa Roea. . .
Sarasota . . . .
Seminole . . . .
Sumter
Suwannee . . .
Toylor
Uniov^ ..••■■
Volusia
Wakulla . . . .
Walton
Washington . .
A. COMMUNICABLE DISEASE CONTROL
2
§
5315
>
e
6141
71
7
29
87
198
240
0
3
7
44
19
0
743
41
2
127
38
2
126
13
13
62
23
3
5
170
14
7
1597
13
0
35
2
3
12
62
35
28
35
19
33
14
0
119
19
74
0
129
0
223
30
175
201
28
17
0
54
75
35
12
70
23
16
22
1
1
9
O
3
3607
II
39424
IX
0
29
25
142
457
0
13
7
22
15
0
1743
41
2
182
85
0
24
4
7
21
7
5
6
87
6
18
927
2
0
25
2
1
41
59
5
21
24
15
51
8
0
43
19
10
0
132
0
787
25
109
295
16
16
0
0
237
37
9
2
46
24
68
0
4
3
8
7
16
87
100
54
0
3
0
47
35
0
398
34
0
15
36
14
119
9
9
49
23
0
0
141
10
4
1258
12
0
16
0
2
1
45
34
20
11
4
3
24
0
119
3
70
0
38
0
115
23
257
139
19
6
0
54
6
9
9
69
3
1
10
0
1
8
Immunizations Completed
I
109215
1980
450
203
170
378
1458
337
23
87
132
619
155
591
195
212
217
17»
293
263
5294
538
69
869
146
255
197
338
138
1602
674
405
1020
297
221
100
435
123
371
497
570
206
891
429
7
1044
387
6
346
69
598
1951
59
796
592
248
1
248
145
4695
621
574
339
84
370
81
544
439
178151
2197
1134
2122
218
1741
4698
501
302
168
200
307
2217
26116
319
141
1689
6350
200
175
2965
212
178
633
168
121
419
541
323
11734
455
396
1229
213
43
236
1425
1686
305
196
507
522
2485
939
1288
1340
1432
106
3735
205
3296
1232
2581
5329
1337
1376
723
955
587
1524
545
234
552
95
801
65
667
484
1
I?
103339
3780
860
2492
611
2854
8565
630
395
691
528
926
2340
29544
703
542
3945
10196
270
426
4393
284
497
901
318
845
1329
655
739
20800
957
787
1229
242
134
973
2062
3629
1410
302
735
1037
4384
1915
1169
1312
3687
464
8759
901
6548
2776
5445
10462
1562
2234
1145
1515
1225
1929
775
686
881
249
1060
290
1277
908
5
I
e
►-
8
213891
2674
509
1865
347
1662
4571
504
272
297
217
569
1834
19642
385
323
3150
5772
180
396
1391
193
217
648
266
379
612
300
515
8241
367
576
1000
409
110
675
1460
1734
365
174
435
779
1208
829
618
726
2532
257
4889
563
4495
1102
3842
6705
996
507
558
1137
855
1363
582
543
600
160
1032
287
513
425
-Pc
611
±
5095
1584
4709
671
3253
8509
1006
417
755
699
940
3741
36660
725
660
4535
13098
323
547
6328
642
503
1504
411
952
1369
1104
736
21883
1034
886
3075
678
262
977
2908
4083
1478
692
1032
1354
5056
1848
1573
2357
4328
385
7854
901
7181
2776
6085
12124
1930
2191
1362
1706
1488
2326
806
1537
1527
277
1277
860
1283
1033
i.
U
10
142315
0
0
0
0
11
0
0
0
0
0
0
0
0
0
0
16
5
0
0
0
0
0
0
0
0
0
0
0
2
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
475
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
i
11
63437
3601
610
1683
269
1557
4729
133
324
996
390
811
634
19481
847
363
4325
7571
88
326
1709
251
202
1462
435
821
717
1120
382
18261
936
412
597
511
80
1029
2198
2800
538
134
352
621
1553
2505
1899
1530
4591
184
10180
661
3491
2561
4518
12101
849
1715
663
1069
773
2253
248
653
1190
186
922
699
269
746
Is
12
178
503
946
5833
54
482
300
1404
94
158
17
80
1536
3313
11
535
87
5708
17
219
4096
503
306
1222
58
13
714
5
386
587
665
561
1857
403
205
0
821
1846
1062
562
407
177
4514
33
1278
3558
2704
283
4451
173
336
169
189
255
16
1830
6
693
60
901
517
755
181
175
73
566
1107
916
•i
13
75010
0
0
0
0
66
0
0
0
2
3
0
0
2
0
0
11
20
0
0
2
0
0
2
0
0
0
2
0
19
1
2
0
1
1
0
0
0
0
0
0
0
1
0
2
0
0
0
0
0
0
1
0
22
14
0
2
0
0
0
1
0
0
0
0
1
0
0
14
25701
0
147
0
0
0
0
0
0
0
449
1166
0
0
0
0
0
8103
0
0
0
0
0
0
199
0
0
0
0
35522
0
0
0
242
0
0
0
0
0
0
0
4910
0
0
0
471
0
0
3890
0
0
0
22
11405
0
0
0
0
8242
0
0
0
242
0
0
0
0
0
2454
4
599
48
307
1783
184
53
22
0
0
0
5519
0
42
1139
1983
0
132
394
26
37
120
0
7
5
14
2
0
287
16
417
52
57
0
179
404
890
54
47
0
85
304
141
103
50
0
2029
0
863
79
697
1075
5
219
23
292
209
881
162
311
75
53
227
25
360
156
LOCAL HEALTH SERVICES
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
147
COUNTY
8. VENEREAL DISEASE CONTROL
Total
2
I
o
39805
Alachua
Baker
Boy
Brodford
Brevard ......
Broward
Calhoun
Charlotte
Citrus
Clav
Collier
Columbio. ...
Dode
DeSoto
Dixie
Duval
Escambia ....
Flogler
Franklin . . . .
Gadsden . . . .
Gilchrist. . . .
Glades
Gulf
Hamilton. . . .
Hardee
Hendry
Hernando. . . .
Highlands . . .
Hillsborough. .
Holmes
Indian River. .
Jockson. . . ". .
Jefferson ...
Lafayette. . .
Lake
Lee
Leon.
Levy
Liberty
Modison . . .
Monatee . . .
Marion . . . .
Martin . . . .
Monroe ....
Nassau . . . •
Okaloosa. . .
Okeechobee.
Orange . . . .
Osceola . . .
Palm Beach .
Pasco
Pinellas. . . .
Polk
Putnam . . . .
St. Johns. .
St. Lucie. .
Santo Rosa .
Sorosota . .
Seminole. .
Sumter . . .
Suwanrtee .
Taylor. . . .
Union ....
Volusia . . .
Wakulla . .
Walton . . .
14492
"8
II
Washington
163
7
186
41
452
1613
4
9
34
18
151
70
9816
100
11
12299
1766
13
18
248
9
20
38
11
19
39
8
87
3795
13
301
61
64
9
15
386
942
40
2
24
499
574
27
189
3
92
17
810
40
1287
50
1181
742
63
191
69
11
116
483
95
24
62
4
240
4
12
18
2r
III
ZOZ
>
-o
7901 11537
65
6
145
27
201
954
1
3
13
5
104
65
3238
33
6
1315
1081
13
15
121
9
20
10
10
11
15
8
24
1858
4
237
60
55
9
12
269
581
15
2
10
272
263
21
96
1
61
0
168
40
1036
50
489
459
47
129
58
11
80
236
95
20
35
3
169
3
12
8
37
2
69
20
187
872
1
2
13
1
49
16
1564
90
10
524
57
6
16
59
3
20
6
10
23
12
8
47
957
10
239
29
35
2
0
184
35
11
2
10
303
266
19
72
1
64
0
170
35
324
59
441
206
42
130
19
11
71
95
125
4
33
0
150
2
6
15
39720
>
e
u
E
O
85742
67
2
105
9
391
1016
0
2
33
1
24
14
2180
75
1
1371
153
1
12
80
0
7
6
6
39
12
2
59
1273
11
167
21
45
0
0
170
52
10
0
7
200
558
14
108
1
63
0
471
64
521
64
605
464
87
115
32
5
94
339
132
1
7
0
159
0
1
8
252
187
2
13
200
251
92
53
1403
669
5121
2847
1
6
4
13
27
24
10
39
34
213
52
70
12234
46588
334
151
0
11
5375
12581
473
2274
8
19
28
25
345
542
0
11
26
38
13
64
0
15
59
29
15
47
21
10
148
134
2478
6165
1
29
69
342
57
85
179
111
0
13
12
7
454
788
629
1159
29
38
0
2
99
8
531
627
627
569
50
33
341
395
4
1
26
127
18
38
2016
1179
32
130
1623
1971
82
113
1348
1538
982
1203
111
114
64
306
242
97
0
20
385
201
298
528
235
163
20
35
70
84
9
9
317
543
*
1 5
1
17
1
25
J
148 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
Totol
Alachua . . . •
Baker
Boy
Bradford ....
Brevard
Broward
Gilhoun . . . .
Chorlott*. . . .
Citrus
Cloy
Collier
Columbia. . . .
Dode
DeSoto
Dixie
Doval
Escambia. . . .
Flagler
Franklin . . . .
Gadsden . . . .
Gilchrist. . . .
Glodes
Gulf
Hamilton. . . .
HardM
Hendry
Hernando. . . .
Highlar>ds . .
Hillsboroogh.
Holmes ....
Indian River.
Jackson. . . .
Jefferson. . .
Lafayette. . .
Lake
Lee
Leon
Levy
Liberty ....
Modison . . .
Manatee . . .
Marion . . . .
Martin . . . .
Monroe. . . .
Nossou . . . .
Okaloosa. . .
Okeechobe*.
Orang* • . . •
Osceola . . .
Palm Beach .
Pasco
Plnellot. . . .
Polk
Putnam . . . .
St. Johns. . .
St. Lucie . . ,
Sonta Rosa. .
Sarasota . .
Seminole . .
Sumter ...
Suwanr>ee .
Taylor. . . .
Lirtion. . . .
Volusia . . .
Wakulla . .
Wolton . . .
Washington
C. TUBERCULOSIS CONTROL
Admissions to Service
Persons
X-Rayed
u
<
c
e
2331
Oo
2
5
3
891
25
4
10
5
27
106
7
4
1
9
28
5
440
9
2
104
100
2
4
13
0
7
0
6
8
11
2
17
407
6
16
12
1
5
31
59
47
7
1
3
39
33
14
14
10
11
4
81
9
199
13
80
106
6
9
21
5
26
15
9
8
5
1
52
3
6
1
6612
hi
o
u
24807
8
4
2
5
13
37
3
7
8
8
6
3
51
6
6
100
15
1
2
2
1
2
2
6
0
4
0
1
136
4
4
8
0
1
14
13
22
5
0
2
5
6
23
5
6
7
0
32
1
128
17
30
42
7
4
0
1
5
13
6
8
7
1
16
1
3
5
49
4
78
10
97
308
27
13
20
19
47
12
1271
25
6
641
226
5
4
40
1
12
25
10
16
55
18
43
806
16
13
64
8
1
141
96
101
18
5
13
64
70
32
35
25
14
18
175
7
548
53
268
489
45
27
47
17
46
73
27
12
12
1
59
2
46
37
5
e
3
iiiz
6
630 509593
140
39
80
30
2283
1705
42
82
34
88
251
23
6268
85
212
675
384
31
28
168
4
124
55
30
9
141
37
79
3351
353
31
304
31
14
245
405
765
163
16
68
92
97
95
120
97
108
0
718
22
861
238
607
1405
102
71
53
50
178
315
206
45
13
15
250
23
61
92
3
U
62029
3
0
3
2
4
35
1
3
0
2
11
0
50
0
1
142
3
2
3
0
0
3
2
1
0
8
1
1
39
1
4
2
3
1
16
9
19
1
0
1
1
1
4
3
25
5
0
28
1
56
29
0
36
9
6
2
2
11
7
4
5
0
1
17
0
0
0
10419
0
0
742
2
56246
0
0
1296
1134
6874
489
86904
0
177
6767
17682
0
0
6091
0
1059
0
338
0
2185
2581
2840
68588
0
0
0
0
0
9067
15626
11759
2853
366
335
7741
2826
4327
0
631
0
0
17845
300
51242
6658
28618
22999
1243
1
352
0
20503
0
2085
638
744
48
26076
286
216
1494
3 e
»— »—
8
>
112834
477
83
641
157
2768
3433
78
1708
57
74
427
71
10735
584
33
3797
983
81
98
96
31
113
499
33
658
240
51
648
4985
168
531
494
511
0
471
737
276
72
12
75
315
407
210
1028
153
X38
17
2684
100
3124
337
2262
2748
4X
141
263
352
574
724
138
144
32
19
5536
4
176
87
46258
215
180
134
256
9476
17553
368
257
25
133
1117
1422
2436
68
205
1632
23485
547
13
554
152
416
54
350
9
576
63
303
5181
1390
937
1844
310
21
104
3814
3435
1205
34
85
671
660
1060
1208
96
1758
374
4056
3995
439
3121
4820
228
252
972
639
465
2026
718
153
157
25
1185
144
1678
1831
u
£
O
10
"8
M
78368
731
40
103
103
507
3453
153
154
22
150
314
46
5096
179
373
1196
3280
72
33
661
16
108
83
75
66
226
35
233
8112
31
148
414
87
12
966
450
1009
147
20
127
559
642
155
411
323
511
25
1994
52
2159
525
2631
3560
65
107
154
125
681
1033
256
54
25
17
1022
34
32
75
to-
X
11
1703
51
54
225
46
2854
7885
116
272
78
309
725
205
19885
278
74
2600
515
50
63
379
7
228
48
54
48
250
139
230
9874
593
34
709
78
29
500
953
1106
144
33
168
609
208
129
370
189
198
39
4507
265
2184
978
6028
5231
246
108
297
43
508
1953
497
144
181
18
760
32
162
595
25
6
8
6
24
135
3
6
0
9
22
4
425
9
1
63
93
2
4
13
0
5
33
5
0
6
1
6
153
5
8
9
1
4
22
35
29
2
1
1
9
17
14
18
0
3
3
1
5
184
6
53
71
3
11
23
3
27
12
8
4
11
2
26
0
2
3
LOCAL HEALTH SERVICES
149
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
D. ^AATERNITY SERVICE
c E 5
Total
Alachua ...<••
Baker
Boy
Bradford
Brevard
Broward
Calhoun
Chorlotte
Citrus
Cloy
Collier
Columbia
Dode
DeSoto
Dixie
Duval
Escambia
Flagler
FrorUilin
Gadsden
Gilchrist
Glades
Gulf
Hamilton. . . .
Hardee
Hendry
Hernando. . . •
Highlands . . .
Hillsborough. .
Holmes
Indian River. .
Jackson
Jefferson . . . ■
Lafayette. . . .
Lake
Lee
Leon
Levy
Liberty
Madison . . . .
Manatee . . . .
Morion ....
Mortin ....
Monroe. . . .
Nassau ....
Okaloosa. . ■
Okeechobee.
Oronge ....
Osceob . . .
Palm Beach .
Pasco
Pinellas
Polk
Putnam . . . .
St. Johns. . .
St. Lucie . . .
Santo Rosa . .
Sarasota . . ■
Seminole . . .
Sumter . . . .
Suwonnee .
Taylor. . . .
Union. . . .
Volusia . . .
Wakulla . .
Walton . . .
Washington
1-2
I
is
<5 5
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3
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I
<
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15465
at
c
3
Z
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6
3
Z
o>
7
I
u
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Z5
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c
o
I!
49623
7413
--
211
0
100
51
151
815
18
0
2
108
178
187
4540
1
80
138
64
47
19
506
7
43
18
64
35
185
10
17
424
10
0
100
27
860
0
100
134
1261
1193
54
0
3
333
572
187
17303
0
181
340
156
183
32
1225
7
25147
106
0
0
2
226
283
10
0
0
0
40
101
2172
0
28
110
33
20
4
106
0
50663
13
132
377
83
120
17
56
120
0
0
44
0
99
0
1169
69
1079
49
1170
1543
106
120
185
0
189
107
52
37
38
45
225
25
12
28
98
31
57
40
520
20
19
1398
38
0
136
61
22
270
419
222
294
32
124
443
0
0
50
0
100
0
3777
262
3259
66
5804
4590
375
286
574
0
696
317
62
74
58
99
690
65
21
30
0
20
31
4
15
4
0
191
7
0
55
1
5
64
159
31
47
8
125
94
0
0
9
0
58
0
592
50
603
10
583
848
61
38
27
0
126
94
14
21
2
65
62
19
5
24
611
81
152
41
607
1140
39
2
1
143
36 I
177 '
8359
11
78
616
455
55
28
683
20
43
155
88
52
212
13
36
1814
25
89
244
74
33
155
476
192
121
25
138
131
86
37
99
44
142
1
84363
1937
101
375
88
2009
2302
123
2
1
502
164
341
17022
5
90
830
638
69
52
678
30
150
85
271
68
327
16
73
2765
26
141
1516
77
188
40
2429
2383
138
2
0
384
786
378
27159
10
475
877
248
257
65
1354
31
146
1105
586
194
816
18
58
1926
75
1
89
1094
103
870
1975
169
155
220
0
155
320
114
66
47
62
257
17
33
97
86
363
129
34
188
814
678
213
17
206
667
238
7
224
59
196
1
1182
76
4140
277
2162
4174
176
193
277
0
955
509
161
64
47
43
772
24
39
132
326
773
87
68
322
2041
268
140
49
689
566
10
28
507
11
375
0
5741
333
7272
498
6837
8115
1006
369
825
0
698
610
318
486
109
104
797
5
62
197
816
0
0
0
0
2
1
4
0
0
0
0
12
5
0
0
7
0
3
0
10
0
^"8
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ai
c ^
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O.U
J! >-
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11
E. CHILD HEALTH
SERVICES
c
c
o
E
o
12
Admissions to Well
ChiW Med. Service
440
0
3
3
1
0
0
1
0
0
0
2
0
2
0
4
10
0
0
4
0
1
0
1
2
0
0
34
1
0
0
0
0 I
9
8
0
0
0
1
1
0
1
0
4
0
4
0
6
2
10
9
22
0
13
0
0
0
4
47
4
0
0
7
11
0
0
198
2
0
9
1
6
0
3
3
2
1
0
78
2
1
24
15
31
0
0
5
0
12
0
0
30
1
0
30
0
0
3
0
9
10
1
2
0
0
130
29
2
6
0
24
4
4
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
2
0
0
0
0
0
0
0
0
1
0
1
23987
12
0
0
0
0
0
0
0
0
78
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
271
0
7
0
0
0
0
0
59
2
0
0
0
0
0
0
0
0
c
o
la, 2a
19310
523
533
0
165
356
730
81
22
17
120
356
236
3054
54
91
3484
717
79
74
1124
13
130
152
67
68
517
73
73
1876
47
159
224
215
128
117
545
199
30
<
1b,2b
1
o
19930
96
92
219
202
0
106
32
95
0
816
607
921
8
671
1558
248
213
0
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164
156
172
95
292
53
397
51
179
95
86
0
145
50
119
777
19
0
1
47
54
129
8391
0
42
651
573
32
5
422
0
10
13
31
15
56
9
0
2284
29
0
53
19
7
33
158
71
63
6
15
29
0
lc,2c
8247
4
0
13
28
16
45
0
0
1
7
26
53
12609
0
18
50
196
3
0
541
0
0
3
2
0
60
10
1
3171
50
0
7
2
13
0
734
53
1392
3
899
1095
64
27
0
1
0
78
13
27
3
63
335
25
17
15
0
23
15
3
2
12
60
13
2
0
28
1
0
5
2
1
0
343
13
425
4
1441
158
11
16
0
2
0
25
0
4
0
44
323
8
3
36
2
0
3
5
2
14
2
0
0
183
26
32
3014
0
1
218
9
7
0
247
0
0
5
1
0
31
0
8
2844
8
0
13
3
2
0
8
18
12
5
2
35
0
0
8
1
0
0
279
9
336
8
376
122
19
13
0
2
0
33
0
19
0
31
100
1
98
32
150 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
ToTal
Alochua . .
Baker
Boy
Brodford . .
Brevord . . .
Broward. . .
Calhoun . . ,
Charloft«. . ,
Cifrus . . . . ,
C»oy
Collier
Columbia. . ,
Dade
DeSofo . . . .
Dixie
DxTfO]
Escambia. . .
Flogler
Franklin . , ,
Godtden . . .
Gilchrist . , .
Glades
Gwlf
Hamilton. . .
Hardee
Hendry . . . .
Hernondo. . .
Highlonds . .
Hilliborough.
Holmes . . . .
Indian River.
Jockson. . . .
Jefferson . , .
Lafoyefte. . .
Loke
Lee
Leon
Levy
Liberty ....
Modison . . .
Manatee . . .
Marion ....
Martin ....
Monroe ....
Nassoo ....
Okaloosa. . .
Okeechobee.
Orange ....
Osceolo . . ,
Polm Beach .
Posco
Pinellos. . . .
Polk
Putrtom ....
St. Johns ...
St. Lucie ...
Santa Rosa. . ,
Sarasota . . . .
Seminole . . . ,
Somter
Suwannee . . .
Toylor
Uhion
VokiHo
Wdcwllo
Walton
Washington . .
E. CHIID HEALTH SERVICES (ConHnued)
Visits to
icol Conferences
c
c
37482
102
0
458
78
265
1106
19
0
1
61
66
129
17488
0
52
1450
2179
47
5.
746
0
10
14
26
16
82
9
0
2923
45
0
68
22
7
30
166
75
71
9
16
30
0
0
8
2
13
0
1561
93
2906
6
1810
2212
62
35
1
1
0
125
13
34
3
87
571
27
19
18
28672
14
0
32
44
46
120
0
0
1
11
36
54
18314
0
18
103
563
12
0
791
0
0
3
0
0
140
13
1
3893
60
0
23
17
4
2
13
72
13
2
0
24
0
0
5
3
2
0
519
51
795
7
1804
271
11
24
3
2
0
37
0
5
0
68
569
8
4
45
>
f
m
KM
<
10906
3
0
3
7
3
21
4
0
0
188
34
32
4180
0
2
238
18
15
0
355
0
0
5
0
0
84
0
6
3461
12
0
19
3
3
0
9
43
13
5
2
23
0
0
8
1
0
0
363
9
683
8
441
161
20
13
18
2
0
56
0
35
0
43
160
1
44
49
Admiskioru to
Nursing Service
3
c
42749
735
119
904
58
1167
2503
57
20
8
161
221
157
12039
37
66
1500
1737
68
53
923
41
46
29
124
49
163
87
141
4885
49
71
237
142
34
222
454
617
113
19
124
303
182
9
352
92
689
0
2587.
76
1869
189
1276
2X1
383
76
225
72
185
626
107
73
X
82
578
46
36
125
5b
45X3
259
197
343
119
1142
765
21
33
17
172
274
177
19699
0
M7
578
55
77
1462
118
18
31
233
14
118
49
58
7376
117
20
174
235
61
366
330
1055
69
20
98
774
170
15
768
189
247
0
1080
40
544
290
2175
1155
99
48
12
21
109
121
47
110
28
120
606
20
49
165
P
&
<
Field Nursing
VisiH
107754
972
239
501
372
1648
1355
244
448
31
1606
496
86
39977
229
81
973
1831
171
41
567
386
46
99
188
107
81
39
120
13062
1550
574
314
139
54
615
176
1205
114
50
236
1701
484
145
722
449
318
28
2752
40
3498
136
13671
52M
121
98
35
553
876
1190
56
99
71
96
2719
107
771
773
c
o
&
<
6b
72697 77155
2368
173
1591
128
2712
3663
146
15
17
454
127
170
22979
46
108
1876
2379
104
133
1026
18
146
61
417
88
289
96
171
3963
25
186
405
296
50
320
953
1438
200
35
99
563
555
14
496
127
747
0
2345
63
5557
342
3170
4619
432
206
227
79
725
1499
159
86
55
58
826
44
55
177
1108
321
787
213
3579
1008
114
60
24
260
92
185
38382
0
77
410
1072
67
191
1787
32
205
62
507
21
2»
25
51
4932
29
68
352
200
76
428
602
3283
110
38
93
474
434
25
1074
281
384
0
1305
29
2328
696
4269
2128
169
57
28
48
408
330
72
200
40
168
843
16
28
240
&
<
79109
1377
329
921
172
4992
1592
370
418
53
902
207
111
16643
299
109
951
2374
103
80
509
85
213
107
226
166
206
35
130
10329
56
180
398
65
79
692
188
2847
155
40
133
1183
667
186
525
594
729
20
2130
62
6842
304
7691
3700
109
134
33
251
1949
733
44
146
148
179
1664
47
96
81
Office Nursing
Visits
r
7a
51178
320
8
490
10
396
1455
14
14
0
141
329
132
16491
4
38
3146
1867
114
9
815
75
31
36
113
13
96
218
23
7122
84
30
141
77
35
108
576
113
4
18
63
9
0
233
21
39
0
3062
115
3676
151
2385
4510
89
44
0
1
12
272
97
54
21
93
880
5
61
115
<
7b
47660
64
24
79
22
260
21
19
0
103
483
76
20527
0
14
363
567
77
1
838
213
126
48
144
0
281
431
58
10355
241
2
56
175
36
166
280
205
5
9
6
1415
10
0
647
25
56
0
1762
55
1580
247
2385
1174
45
23
0
10
17
115
77
43
9.
76
889
9
55
117
?
&
<
165360
454
55
2493
505
741
1060
70
567
0
2154
671
56
73494
117
29
768
3404
219
3
529
668
159
100
103
21
338
453
126
15669
3214
480
196
144
35
337
301
469
31
24
266
1858
371
19
1025
420
212
10
2241
113
6811
165
25749
7100
116
68
0
472
244
1705
76
110
27
53
4127
104
883
758
LOCAL HEALTH SERVICES
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
151
COUNTY
Total
Akichua . . . .
Baker
Boy . . .
Vodford
Brevard
Broward
Calhoun . . . .
Charlotte. . . .
Gtrus
Cloy
Collier
Columbia. . . .
Dade
DeSoto
Dixie
Duval
Escambia. . . .
Fkigler
Franklin . . . .
Gadsden . . . ,
Gilchrist. . . .
Glades
Gulf
Hamilton. . . .
Hardee
Hen<^
Hernando. . .
High kinds . .
Hillsborough.
Holmes ....
Indian River .
Jackson. . . .
Jefferson . . .
Lafoyette. . .
Loke
Lee
Leon
Levy
Liberty . . . .
Modison . . .
Monatee . . .
Morion . . . .
Mortin . . . .
MoTMoe. . . .
Nassau . . . .
Okoloota. . .
Okeechobee.
Orange . . . .
Osceola . . .
Palm Beach .
Posco
Pinelkis. . . .
Polk
Putnam . , . ,
St. Johns. . .
St. Lucie . . .
Santa Rosa . .
Sarasota . . ,
Seminole . . ,
Sumter . . . ,
Suwannee .
Toylor. . . .
Uhion. . . .
Volusia . . .
Wokulki . .
Walton . . .
Washington
F. SCHOOL HEALTH
Pupils Examined by Physiciora
Porent Present
II
la
16783
o
2^
lb
1865
2
165
205
240
93
335
0
2
75
266
14
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56
254
43
119
70
41
98
178
252
42
4391
416
8
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291
53
854
1
644
179
53
0
0
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108
233
124
62
74
133
69
106
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152
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7
66
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215
0
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37
115
0
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319
139
368
193
:^
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a. t
1c
Parent Not Present
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w e
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Z UJ
1424 38321
0
0
4
7
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1270
103
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217
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156
X
■o
• _«
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a.t
H
2c
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e c
515
0
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80
2
151
4
0
31
0
4
79
29
0
88
1
2
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86
6
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98
77
0
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6
18
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3
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c
So s
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387^
1268
12037
323
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4683
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14244
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188113
294
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1011
496
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19616
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19403
756
1854
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634
8833
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194
36
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Art
85
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1934
55
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59
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h
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0
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0
3
3
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5
0
0
0
0
1
7
0
6
11
2
9
0
0
0
461
1
3
4
0
4
7
0
60
0
0
0
0
1
1
16
10
0
0
71
0
19
0
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52
0
0
0
0
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1
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0
0
2
4
4
0
2136
74
1453
81
1501
5882
352
438
217
961
826
27
26518
793
49
1391
4992
48
38
799
425
127
216
271
410
419
24
235
14738
97
186
445
125
23
617
183
1182
169
42
0
2282
1195
163
769
536
374
62
2790
337
85X
39
14210
7733
251
353
309
175
1846
1148
153
259
227
28
312
194
41
104
152 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
G. DENTAL HEALTH
;Dentis» Only)
Dental Inspections
Number Requiring Treatment
3
£
1
1
4
o IZ
5
if
o X
t— UJ
6
COUNTY
1
T
8
la
r<s
>o
••
<
lb
II
u
1c
r
w
1
6
Id
T
1
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T
m
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2b
2c
2d
1
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u
11
< 0
_ 3
t- 0
7
Total
415
63044
30
53
160
34844
118
149
10453
26809
66466
23860
1915
Alachua
0
0
0
0
0
0
0
6
0
0
0
0
0
0
121
1
0
0
0
0
0
0
0
0
13
5
0
1
0
0
0
0
0
0
0
0
0
1
0
0
3
0
0
0
0
0
0
0
0
0
0
0
200
0
0
0
3
9
50
0
0
0
0
2
0
0
0
5172
317
0
0
0
148
0
171
0
56
2680
0
306
467
0
584
0
0
0
0
0
106
0
0
536
1551
0
2400
10184
357
0
303
0
0
0
0
0
117
185
0
793
0
0
3073
0
0
0
16386
0
0
0
8975
680
0
0
2355
3811
ai8
37
0
0
0
0
434
22
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
23
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
53
0
0
0
0
0
0
0
0
0
8
41
0
1
0
0
0
0
0
0
0
0
0
1
0
0
3
0
0
0
0
0
0
0
0
0
0
0
30
0
0
0
4
8
6
0
0
i
1
0
0
0
3041
170
0
0
0
1
0
55
0
56
868
0
0
240
0
1161
0
0
0
0
0
85
0
0
236
1206
0
1645
6493
237
0
283
0
0
0
0
0
110
182
0
637
0
0
16a5
0
0
0
6079
0
0
0
3991
334
0
0
1609
3201
683
49
0
0
0
0
434
73
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
84
0
0
0
4
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
19
0
0
4
0
0
0
0
0
0
0
0
0
0
0
70
0
0
0
52
0
0
0
0
0
0
0
0
0
0
60
149
0
0
0
156
0
83
0
49
112
0
1561
48
0
525
293
26
0
0
0
34
0
0
152
65
0
108
2774
0
0
64
0
0
0
0
0
75
42
0
156
0
0
0
0
0
0
496
0
1434
0
729
386
64
0
1
30
429
49
0
0
0
0
245
58
0
0
1297
176
0
0
0
1189
0
78
0
53
530
0
4107
21
0
1057
343
82
0
0
0
63
0
0
187
142
0
247
2260
0
0
360
0
0
1203
0
69
130
284
0
351
1771
0
40
0
0
0
2389
0
4383
0
690
1231
354
0
0
462
580
103
0
0
0
0
436
139
0
2
793
193
0
0
0
4059
0
429
0
168
1594
0
24628
62
0
2092
1345
94
0
0
0
89
0
0
731
277
0
481
2939
0
0
1169
0
0
3027
0
48
219
654
0
2042
2449
0
0
0
0
0
4164
0
4084
0
3410
852
340
0
0
988
1037
143
0
0
0
0
1437
427
0
2
1276
267
0
0
0
2441
0
116
0
86
739
0
3577
19
0
545
621
88
0
0
0
32
0
0
211
209
0
246
2443
0
0
329
0
0
563
0
45
283
117
0
259
899
0
0
0
0
0
2539
0
2053
0
449
1395
280
0
0
765
313
70
0
0
0
0
498
85
0
2
0
60
0
0
0
Baker
Boy
Brodford
Brevard ..•••••••••
Broward
156
Calhoun
0
Charlotte
15
0
Citrus
Cloy
0
Colli«r
109
Columbia .
0
Dade
0
DeSoto
0
Dixie
0
Duval ,
3
Escambia
225
Flagler
38
Franklin
0
Gadsden
0
Gilchrist
0
Glades
0
Gulf
0
Hamilton
0
Hardee
0
Hendry
0
HerrKir>do . . .
0
Highlands
0
Hillsborough
Holmes , • . . .
1
293
Indian River
Jackson
0
0
Jefferson ..........
0
Lofoyette . .
0
Loke
49
Lee
0
Leon
0
Levy
0
Liberty
0
Madison
0
Manatee
59
Marion
0
0
Monroe
0
Nassau
0
Okaloosa . . .
0
Okeechobee
Orange
0
133
Osceola
0
Palm Beach
Pasco
203
0
Pinelkis.
0
Polk
0
Putnam
134
St. Johns
0
St. Lucie
0
Santa Roto
232
Sorosoto
1
Seminole
0
Sumter
0
Suwannee .........
0
Toylof
0
Uhion
0
Volusia
204
Wakulla
0
Walton
0
Washington
0
LOCAL HEALTH SERVICES 153
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
Total
Alachua ....
Baker
Boy
Brodford ....
Brevard
Broward
Calhoun ....
Charlotte. . . .
Citrus
Cloy
Coiner
Columbia. . . .
Dade
DeSoto
Dixie
Duval
Escambia . . . .
Flagler
Franklin . . . .
Godsden . . . .
Gilchrist. . . .
Gkides
Gulf
Hamilton. . . .
Hardee
Hendry
Hernando. . . .
HighkirvJs . . .
Hillsborough.
Holmes ....
Indian River.
Jackson. . . .
Jefferson. . .
Lafayette. . .
Lake
Lee
Leon
Levy
Liberty ....
Modison . . .
Manatee . . .
Marion . . . .
Martin . . . .
Monroe ....
Nassau . . . .
Okaloosa. . .
Okeechobee.
Orar>ge . . . .
Osceola . . .
Point Beach .
Pasco
Pinellas. . . .
Polk
Putnam . . . ,
St. Johns. . .
St. Lucie. . ,
Santo Rosa .
Sarasota . .
Seminole. .
Sumter . . .
Suwannee .
Taylor
Union. . . .
Volusia. . .
Wakulla . .
Walton . . .
Woshirtgton
H. CHRONIC DISEASES
Cancer Services
8
< to
>
5293
17330
O
3
9
o
>. c
Ui2
Diabetes Services
Cardiovascular Disease Control
13476
43
4
18
42
104
28
28
11
9
36
66
19
102
36
7
14
567
2
38
32
6
19
26
13
18
21
5
19
788
42
38
50
12
4
56
18
112
13
12
9
24
22
13
105
50
34
12
719
10
178
70
482
635
17
17
18
20
65
28
48
22
34
7
77
22
33
342
7
88
88
653
76
170
87
50
319
352
15
1085
140
7
24
1969
5
75
139
68
44
92
31
97
68
24
78
868
40
217
175
125
8
110
41
224
23
5
17
366
72
23
234
131
281
57
33
20
1267
219
2757
788
80
183
80
141
445
243
110
156
56
12
1200
142
116
72
21042
■I-
8 u
I"!
5256
21
1
0
16
64
5
54
5
6
25
187
23
9
54
9
13
1194
4
40
16
12
40
131
11
10
47
3
6
3656
76
14
20
11
0
16
8
207
1
14
3
1
1
6
220
26
12
8
2964
23
160
179
2145
1132
11
6
166
16
8
23
72
11
59
26
92
5
41
31
483
0
82
11
288
1292
0
0
0
0
224
0
7913
0
163
553
844
0
0
0
0
18
5
0
0
61
0
35
1587
38
62
0
320
18
0
375
239
150
0
0
124
0
0
20
0
65
0
951
82
1728
0
1124
1621
0
0
53
0
137
186
11
52
0
0
14
20
50
43
>
22549
74
37
60
15
83
37
33
42
31
25
26
65
84
30
8
37
349
11
25
70
29
16
52
25
16
38
12
28
1195
166
53
46
24
10
21750
73
28
75
46
15
17
92
48
12
83
24
32
5
114
19
389
105
265
268
33
77
35
75
25
31
51
27
17
13
170
17
57
66
746
17
218
312
258
66
73
243
38
127
101
37
329
8
7
42
1941
73
11
68
34
54
27
37
8
120
9
65
2801
36
1083
64
23
44
143
16
398
156
12
11
748
297
21
164
154
293
13
81
5
1777
180
520
1452
42
104
40
200
227
63
21
83
25
9
6065
36
57
16
>
Of
2459
• "O
.t S.
ZO
594
86
28
17
244
29
143
166
83
77
82
334
15
243
64
51
1677
40
70
245
96
125
277
130
33
231
34
178
5773
432
37
355
174
79
50
91
240
41
87
224
396
107
22
189
24
48
64
373
79
1823
403
1019
1304
166
209
213
377
1
117
116
53
137
95
775
30
375
260
12249
0
16
0
0
0
0
4
0
1
28
0
0
0
0
4
30
184
0
17
18
8
17
1
10
0
123
0
5
186
99
1
120
34
0
0
3
2
331
1
0
45
8
0
35
1
0
0
78
0
1
27
835
106
0
37
0
9
0
1
6
7
0
0
2
3
8
7
o
O k.
X o
UJ to
10
2319
c
o
a 8
I I
11
0
1
1
77
2
0
0
0
2
360
0
2
0
0
0
308
46
4
46
41
25
23
27
98
0
463
0
1
191
337
0
54
496
0
0
262
1
587
28
0
295
0
0
749
0
0
0
1445
0
0
8
4545
30
13
7
1
17
600
0
5
1
0
0
1042
2
1
5
10670
37
0
0
0
102
32
0
1
1
0
0
5
384
0
0
0
0
18
9
273
0
0
6
0
0
11
0
0
0
463
0
41
526
0
0
0
0
0
0
10
0
0
0
29
0
0
0
0
0
11
0
302
28
27
1
0
0
0
0
0
0
0
0
0
2
0
0
>
iZ
12
44419
170
94
54
100
265
238
98
57
94
105
44
8
2929
7
43
27
471
105
12
240
118
32
r
>
£^
o
13
14891
30
63
11
41
11
20
820
71
59
100
225
45
47
32
74
106
217
11
87
135
6
106
73
99
3
115
16
556
70
630
383
77
23
3
173
122
54
24
70
15
31
308
23
67
27
1226
39
208
1174
1313
155
477
987
8
816
124
4
597
4
45
41
3056
854
38
989
257
54
18
103
16
184
6
134
5106
176
434
212
92
192
81
54
878
290
715
18
760
750
8
251
176
1879
3
367
4
4159
175
6618
1654
561
94
146
1495
674
584
23
442
184
8
1849
58
290
32
207
187
80
41
231
355
153
85
315
100
73
2
0
11
311
5
805
164
26
1133
674
80
303
266
15
96
29
19
190
198
28
160
243
117
31
65
0
255
1239
61
67
45
12
74
13
214
23
172
115
2078
125
553
623
425
21
66
459
4
202
52
316
19
81
242
68
435
34
154 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
Total
H. CHRONIC DISEASES (Continual)
Glouconta
11
it
O k
X o
uj «/i
14
19835
Alachua . . . .
Baker
Boy
Bradford . . . .
Brevard
Broward. . . . .
Calhoun . . .
Chorkjtte. . .
Citrus
Clay
Collier ....
Columbia. . .
Dode
DeSoto ....
Dixie
Duval
Escambia . . .
Flagler ....
Franklin . . .
Gadsden . . .
Gilchrist . . .
Glades ....
Golf
Hamilton. . .
Hard«e ....
Hendry ....
Hernando. . .
Highlarnis . .
Hillsborough.
Holmes ....
Indian River .
Jockson. . . .
Jefferson . . .
Lofayette. . .
Lake
Lm
L«on
Levy
Liberty . . . .
Modison . . .
Marwtee . . .
Marion . . . .
Martin . . . .
Monroe . . . .
Nassau . . . .
Okaloosa. . .
Okeechobee.
Orange . . . .
Osceola . . .
Palm Beach .
Pasco
Pinellas. . . .
Polk
Putrwm . . . .
St. Johns. . .
St. Lucie. . .
Santa Rosa. .
Sarasota . . .
Seminole . . .
Sumter . . . .
Suwannee . .
Toykx
Union
Volusia . . . .
Wakulla . . .
Walton . . . ,
Washington
3
15
0
0
0
0
0
8887
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
10350
0
0
1
0
0
0
589
0
0
0
0
0
0
0
0
875
9
C
1§
16
797
0
0
0
0
0
433
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
0
0
404
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
Other Chronic Diseases
8
o
aS
li
17
13313
0
0
0
0
0
356
0
0
0
1
0
0
15
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
47
365
0
0
0
0
0
0
11
0
0
0
0
0
0
0
0
>
iZ
18
72614
162
14
197
130
425
610
28
73
20
167
93
45
178
62
48
63
554
49
22
168
88
107
71
56
17
135
25
59
1934
100
108
191
10
28
141
64
84
121
229
43
165
253
8
246
242
233
31
505
22
897
149
1516
969
91
12
60
98
253
11
60
67
30
82
380
82
74
58
>
u
£
O
19
18105
1215
25
662
1040
1863
848
174
958
0
879
410
112
631
153
48
79
4429
510
24
867
187
186
96
433
29
282
21
188
8473
235
1190
324
7
73
254
133
1205
273
292
^1
1264
1531
9
477
638
3800
195
857
36
5128
403
11434
4239
748
16
449
1137
2380
317
110
315
253
43
7127
96
528
215
J. MENTAL HEALTH
Admissions to Service
i
3
IE
u
1
6049
77
181
118
74
269
305
24
150
40
267
114
43
10
38
241
17
168
256
85
449
383
277
145
94
39
283
7
53
366
592
41
200
14
23
76
24
5
291
818
55
721
86
8
257
165
2454
17
155
19
741
304
1282
2238
887
7
68
70
13
189
60
423
10
161
426
178
232
222
a
h
5992
298
1
2
0
49
55
40
31
25
128
92
1
2821
53
12
49
23
13
4
12
3
18
5
2
52
42
26
36
375
10
0
96
12
5
14
53
5
16
5
1
25
46
21
65
39
35
31
492
4
136
28
48
77
102
2
238
8
16
80
12
9
32
2
0
10
5
1
3
<
■£
O
5934
275
9
189
25
126
162
44
2
35
28
85
33
713
9
3
234
256
6
16
124
6
3
21
21
12
14
22
36
696
33
21
110
18
6
53
151
9
32
15
14
122
74
20
118
27
71
4
306
3
495
50
290
210
83
45
105
16
52
59
18
33
29
0
0
15
39
41
Field Visits
(S
4
22130
21828
208
4
26
3
86
102
9
7
22
32
151
0
874
14
10
112
68
6
4
6
1
8
6
9
11
10
3
94
376
5
5
54
13
3
12
106
13
2
0
2
108
653
8
198
14
35
1
53
10
244
22
1129
138
132
10
182
12
406
68
0
11
6
1
0
8
2
6
1913
5
287
54
447
531
106
21
88
177
194
12
2995
42
9
628
928
30
18
73
3
4
11
86
10
23
37
131
2548
22
54
305
22
11
45
155
147
55
2
8
315
3384
12
360
127
503
4
446
28
906
141
1834
425
207
39
18
49
709
162
8
50
77
1
0
25
39
24
Office Visits
c
(E
6
23722
2478
1
95
22
584
367
110
25
163
103
934
10
3988
24
12
626
631
57
24
67
2
6
25
41
95
25
127
155
2070
7
28
382
101
8
58
236
73
62
2
17
434
568
81
426
197
379
30
502
14
636
164
1712
419
925
32
291
38
517
287
61
49
99
0
0
97
20
9
r
c
i
<
27233
8
10376
3448
18
111
8
124
51
58
51
48
254
779
140
5621
60
67
46
26
56
52
309
3
28
78
28
120
75
9
67
76
84
13
332
11
44
59
600
8
42
90
37
178
2066
22
156
41
138
67
497
47
866
217
338
405
570
50
2778
5
1273
245
55
129
151
22
0
19
184
72
1033
19
182
5
232
31
120
134
77
184
466
48
7627
98
14
71
14
64
18
141
16
18
123
17
100
66
25
196
140
68
7
•462
45
18
117
736
12
43
17
75
194
805
114
589
59
59
87
1348
42
946
348
3236
423
1803
32
1662
84
1690
270
64
86
145
2
0
42
40
184
382
0
0
0
0
5
145
44
148
41
198
0
3236
31
4
1053
1
5
0
30
5
15
0
0
27
21
95
42
111
1
0
393
95
1
0
119
5
131
0
0
249
1011
6
250
29
13
3
15
25
228
0
489
14
515
7
914
0
0
115
0
2
3
1
0
103
0
0
LOCAL HEALTH SERVICES
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
155
K. MISCELLANEOUS
M. NURSING HOMES
Morbidity Service
•
5 .?
>'o<
1
COUNTY
Admissions to
Service
Field
Visits
Office
Visits
8
• s
Oi2
-8
u
S.
U
Z.S
M
*M S
.1
Ml
is
Is
3
b
3
JS
Is
3
6-^
lo
lb
2o
2b
3a
3b
4
5
6
7
8
1
2
3
Total
12460
2849
8315
9379
22852
4403
123449
260822
2485
1355
3458
391
6326
1434
Alachua
Baker
Boy
Brodford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clav
Collier
Columbia
Dode
DeSoto
Dixie
Duval
72
40
32
12
7
1
272 '
21
59
47
13
2
10
86
10
14
8
0
514
1
106
4107
194
1976
4
0
56
13
1
21
132
2
39
2
0
4
37
0
19
0
0
5
20
244
778
27
16
27
135
2
40
25
4
10
49
16
32
362
207
15
40
66
134
30
148
41
1
64
13
47
12
136
1262
30
29
52
83
1
3
9
3
6
129
10
4
1
1561
29
7
59
51
325
5900
28641
124
1290
453
414
5
29
26
6
0
9
14
2
13
1
0
12
6
12
10
124
229
3
3
0
2
1
5
24
0
0
0
1
14
48
414
0
0
0
3
1
9
132
0
0
0
0
4
1
118
0
4
15
570
18
1243
19
116
48
33
19
71
1
2
8
246
24
601
27
18
50
34
22
287
2
1
15
960
4
3831
0
132
16
58
3
45
0
2
2
98
9
99008
2
92
1551
1036
463
33356
440
351
8628
4
43
47
6
75
1
2
17,
49
20
7
296
16
0
441
13
1
321
1
1
54
0
1
31
0
1
821
0
4
552
104
127
297
398
10
0
914
12849
39
12
209
7
93
0
0
0
0
2
0
9
0
0
0
0
2
0
0
2
0
0
0
138
0
14
0
9
0
0
Flagler
Franklin
Gadsden
Gi Ichrist . . . ^ .
105
28
5
312
37
16
9
38
76
36
7
110
111
96
11
16
196
12
7
561
55
13
6
72
80
5
42
44
282
916
938
107
28
8
800
3
5
0
22
0
0
1
0
0
0
0
0
0
Glodes
136
9
204
34
397
29
61
98
0
1
1
1
Gulf ...
82
44
61
48
224
116
9
321
367
3
4
0
Homilton
Hardee
Hendry
118
25
242
50
3
23
71
39
143
101
3
30
269
7
642
143
0
76
16
14
41
340
639
273
0
12
22
8
0
2
2
5
1
0
1
0
0
19
0
6
18
1261
3
24
0
27
0
48
10
23
4
5
8
32
347
475
3
1
0
2
Highlands ....
Hillsborough. . .
Holmes
Indian River. . .
Jackson
85
158
58
21
71
2
5
17
65
260
4
10
21
33
147
4
8
33
92
4
66
2
6
19
2
4
5
1
22
1132
76
94
92
469
37118
263
1052
745
107
1
4
0
22
11
14
0
0
0
5
753
0
0
1
1
34
1
3
0
Jefferson
Lofoyette
Lake
2
62
2
6
42
1
15
60
1
21
109
2
0
116
2
0
107
0
53
3
5
216
38
1228
45
0
0
0
1
0
0
0
3
1
0
9
Lee
251
36
57
167
623
46
856
5958
7
0
29
4
49
7
6
2
0
0
2
1
0
9
0
0
0
296
3
2
18
Leon
134
15
286
55
113
9
283
2937
10
26
72
2
23
Levy
Liberty
Madison
Momtee
117
27
0
102
15
5
0
33
104
2
0
137
6
2
0
43
91
25
1
11
25
4
2
0
197
73
0
177
713
128
148
5682
1
67
2
4
0
0
4
19
6
1
0
89
2
0
0
10
24
0
0
104
10
8
5
0
0
11
697
25
Marion
18
12
142
54
13
0
61
1784
131
18
21
2
Mortin
6
10
4
61
41
17
0
613
21
14
1
1
Morvoe
167
28
58
29
195
19
124
1297
17
15
3
1
Nassau
61
16
78
28
20
1
43
686
97
48
3
0
Okaloosa
371
19
105
23
377
30
10
2697
9
97
0
0
Okeechobee. . .
Orar>ge
Osceola
0
242
8
0
9
2
0
230
6
0
8
2
0
297
29
0
11
10
0
216
64
224
19433
1090
0
7
0
18
13
0
0
177
11
1
18
7
Palm Beach . . .
2464
1027
918
4202
7782
2821
9299
13511
40
7
349
21
236
75
Pasco
75
31
81
53
56
24
19
2728
9
2
6
6
Pinellas
1319
243
1124
992
785
23
4938
24782
13
369
125
56
667
223
14
19
21
0
571
31
1
2
0
0
14
0
1
0
0
0
5
0
0
0
Polk
1119
84
546
146
1347
74
301
10412
61
19
55
18
3
Putrwm
189
51
42
6
455
140
182
1061
0
4
3
St. Johrw
41
19
20
33
32
9
19
1440
7
10
18
4
St. Lucie
0
0
0
0
0
0
0
935
1
20
5
5
Santa Rosa ....
42
19
48
53
94
21
46
604
0
18
1
0
Sarasota
79
83
235
509
0
4
0
2111
22
63
92
9
80
62
5
16
0
0
Semirwie
198
3
33
5
312
5
149
948
40
2
15
7
1
Sumter
56
21
51
23
73
25
0
575
8
9
6
Suwanrtee . . . .
85
23
45
50
274
74
5
229
4
4
0
1
Taylor
Union
20
68
2
11
50
9
6
4
10
72
1
14
0
56
513
65
11
41
0
2
1
0
0
0
Volusia
186
171
219
817
404
12
0
10341
62
0
48
25
0
526
0
0
Wakulla
38
9
> 16
4
34
£
1 22
151
i
2
0
Walton
0
c
0
0
0
C
I 72
585
7
0
0
c
Washington . . .
14
£
1 11
21
12
1
94
376
t
' 0
0
^
12
156 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
Totol
Alachua . . .
BdMT
•oy
Brodford . . .
Brevard . . . .
Broward. . . .
Gilhown . . .
OKvlotte. . .
Citrus
Cloy.
Collier . . . .
Columbia. . ,
Dade
DeSohs . . . .
Dixie
Duvol
Escambia . . .
Flagler
Franklin . . .
Gadsden . . .
Gi Ichrijt . . ,
Glades
Gulf
Homilfon. . .
Hardee . . . .
Hendry . . . .
Hernando. . .
Highlands .
Hilkborough
% . . . .
I Rivar
Ml. . . c
Jefferson . . ,
Lafayette. .
Lake
Lee
Leon. ....
l^vy
Liberty
Modiion . .
Monotee ■ •
AAorion ...
tin ...
rM
h4aaau
Okolooea. . .
Okeechobee,
Orartge . . . .
Osceolo . .
Palm Beoch
PoKO . . . . .
Pinelkn. . .
Polk
Putnam ...
St. John. .
St. Lucie. .
Santo Roto.
Sarasota . .
Seminole . .
Sumter ...
^uwanne9 •
Taylor
Union ....
Volusia. . .
Wdcullo . .
Walton ...
Washington
P. SANITATION
Water
Public
Water
Systems
1
1
I
2793
143
27
21
2
126
42
5
5
5
14
27
24
311
10
14
30
102
5
5
16
0
12
3
25
24
2
11
8
252
7
1
7
3
7
21
3
195
21
26
20
309
24
57
2
2
45
4
157
22
31
13
68
11
42
16
13
12
108
39
41
1
27
2
146
3
to
6
17855
1261
131
248
15
470
578
58
47
8
175
82
141
2536
22
72
141
586
86
104
181
0
62
13
129
142
41
30
17
1439
28
2
47
3
40
87
51
292
49
327
144
706
303
216
25
9
91
34
2524
57
294
39
869
206
275
76
164
21
559
173
437
7
106
30
580
53
57
55
Private
Woter
Plants
2
"8
8242
42
19
140
0
131
159
32
259
78
6
44
42
905
54
27
569
645
1
9
35
0
2
73
11
59
19
25
187
210
22
2
66
4
11
90
0
153
38
6
10
702
129
61
10
17
31
0
28
6
1012
16
101
319
85
ISO
84
56
541
59
50
0
71
5
106
8
164
246
r
>
147»
187
11
241
0
313
253
54
399
78
54
53
49
2201
93
35
788
752
1
10
79
0
7
147
38
121
70
55
198
348
48
4
128
7
26
121
0
165
83
9
18
800
273
91
16
49
40
0
111
71
1215
24
181
549
163
191
126
57
2493
135
101
0
121
24
157
33
195
270
Bottled
Water
Plants
3
-o
2
1
<
63
2
0
4
0
0
1
0
0
1
0
8
0
13
0
0
4
0
1
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
1
2
0
0
0
3
4
1
0
0
0
0
2
1
4
1
3
0
0
0
1
0
2
0
0
0
0
1
1
0
0
0
r
>
376
5
0
4
0
0
5
0
0
1
0
10
0
92
0
0
17
0
1
0
0
0
0
0
0
0
0
0
0
2
0
10
0
0
0
0
5
6
0
0
0
38
10
6
0
0
0
0
13
27
53
8
24
0
0
0
11
0
5
0
0
0
0
1
17
0
0
0
Sewoge
Public
Sewerage
Systems
4
1463
9497
89
0
14
1
46
57
1
4
1
9
18
10
70
1
1
37
88
2
5
11
0
1
3
14
2
1
3
11
83
2
2
4
2
0
8
34
7
1
1
2
102
14
23
16
1
18
5
68
9
2
4
359
69
4
7
8
6
60
8
9
1
1
1
19
0
2
1
229
9
42
12
395
722
7
43
1
71
47
112
294
2
1
402
491
11
87
54
0
4
16
77
35
16
6
22
859
22
22
43
9
0
28
217
25
3
1
11
472
111
311
57
15
101
S3
1195
25
4
5
1631
355
5
29
144
12
265
67
35
5
1
23
112
0
7
9
Private
Sewerogc
jystems
5
1283
1
0
11
0
6
86
0
11
6
2
1
28
168
2
0
27
0
0
3
2
0
4
0
0
1
1
1
12
6
1
2
1
0
0
0
0
0
0
0
0
1
11
0
13
9
3
0
46
8
0
0
83
78
5
16
0
0
2
10
6
0
1
0
15
0
0
593
3049
3
0
31
0
7
785
0
66
6
21
1
201
225
2
0
70
0
0
3
7
0
9
0
0
8
5
1
16
48
3
3
2
0
0
0
0
0
0
0
0
27
14
0
23
26
5
0
139
55
21
0
272
195
9
39
2
0
12
13
32
0
1
0
25
0
0
616
New Specifi-
cation Septic
Tanks Instolled
6
■o
t
I
<
20601
743
19
479
97
804
1145
44
343
42
284
481
199
0
23
5
1190
1279
74
7
97
41
61
42
47
120
107
101
319
1346
29
10
65
5
11
518
1240
270
96
3
20
400
485
523
6
80
338
64
904
203
733
1075
466
878
332
51
211
73
759
470
37
20
17
40
666
7
108
49
34688
1044
38
498
98
1063
1661
63
343
42
304
1232
720
0
60
7
1655
3965
83
15
225
259
119
49
60
288
236
158
375
1381
29
26
91
9
12
1079
1480
307
116
4
26
722
574
727
9
191
446
118
1329
296
1131
1239
791
1365
1204
73
347
74
2349
534
68
29
21
83
1540
9
137
52
LOCAL HEALTH SERVICES 157
TABLE 20 (Continued)
MAJOR AQIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
P. SANITATION (CooHnoed)
New Specifi-
cation Privies
Installed
Totol
<
713
Alachua . . . .
B<^er
Boy
Brodford . . . .
Brevard
Broward
Calhoun . . . ,
Chorlotte. . . ,
Citrus
Cloy
Collier
ColiMnbia. . .
Dade
DeSoto ....
Dixie
Duvol
Escombio. . .
Fkigler
Franklin . . .
Gadsden. . .
Gilchrist. . .
Glades
Gulf
Hamilton. . .
Hvdee
Hendry
Hemortdo. . .
Highlofftds • .
Hillsborough.
Holmes . . . .
Indian River.
Jackson. . . .
Jeffenon . . .
Lofayette. . .
Lake
Lee
Leon
Levy
Liberty . . . .
Madison . . ,
Marion
NOSMM . .
Okaloosa.
Okeecl-
Oronge . . . .
Osceola . . .
Palm Beoch ,
Pasco
Pinellas. . . .
Polk
Putnam . . . ,
St. Johra...
St. Lucie . . .
Santa Rosa. .
Sorasoto . .
Seminole . .
Sumter . . .
Suwofwce .
Taylor
Union
VolMia...
Wakulla . .
Walton .. .
Woihington
1
0
0
0
1
0
0
0
5
0
30
0
0
0
0
0
24
0
0
102
0
3
0
1
1
6
2
0
14
0
0
0
1
0
0
0
0
0
0
0
24
1
0
0
0
0
1
0
0
0
0
1
3
0
0
0
0
488
0
4
0
0
0
0
0
0
Miscelkaneous
Garbage
Disposal
Syst«
8
906
<
21
0
0
0
1
0
0
0
5
0
45
0
0
0
0
0
26
0
0
116
0
5
0
1
1
8
2
0
47
0
0
0
2
0
0
0
0
0
0
0
83
1
0
0
0
0
2
0
0
0
0
1
14
2
0
2
0
517
0
4
0
0
0
0
0
0
0
371
26
0
2
4
9
21
1
3
0
1
3
1
31
0
2
23
7
4
7
4
1
3
0
4
2
3
12
2
7
11
1
4
3
1
1
5
8
7
0
5
3
16
1
4
5
8
1
19
5
3
3
12
11
2
1
2
1
6
4
0
0
7
2
8
12
5
1
I Perco-
Sub- I lotion
division I & Soil
Ana lysis! Log
< Test
9 i 10
Pollution
Survey
-(-
11
-r
Bathirtg
Areas
Surveyed
12
Public
Swimming
Pools
13
7051
1
I
Z
i
J3
■o
e
E
"O
<
342 ! 11821 I 402 5375
E
-o
<
631 I 1678
»3
4
4
171
56
116
7
63
0
20
5
211
691
0
4
80
2985
70
179
87
50
6
0
58
24
31
39
18
193
63
9
38
22
1
1
24
38
12
0
10
15
174
8
18
19
67
3
138
123
17
6
63
163
1
32
20
16
67
0
0
78
S9
81
23
21
58
54
0
2
0
38
95
0
0
0
10
20
19
0
0
0
7
3
0
0
0
1
1
0
0
0
1
0
2
19
0
3
0
0
0
2
0
0
3
0
1
1
1
2
0
2
0
0
23
0
0
0
2
3
0
0
0
0
17
8
0
0
0
0
2
0
0
0
617
3
256
16
1198
33
0
27
3
628
208
0
0
19
2833
131
0
0
10
4
0
3
0
1
0
16
0
150
59
22
73
2
15
49
0
95
7
0
9
29
38
548
0
11
SO
79
1478
149
2
26
1570
568
19
65
83
0
130
271
25
13
17
2
43
6
68
0
•I
It
95
18
0
1
0
64
0
1
7
0
1
0
2
0
2
0
0
0
3
2
2
0
3
0
0
0
1
1
0
0
0
0
2
6
3
1
1
4
0
14
1
5
0
41
2
4
3
9
4
10
2
0
2
1
0
5
3
5
0
2
0
32
1
342
214
0
89
10
0
1
0
3531
0
4
63
0
7
0
23
0
3
0
0
0
8
9
2
ISO
0
21
0
0
0!
1
I
0
0
Oi
0
24
11
31
1
45
19
2
120
1
41
0
285
34
4
29
56
15
100
3
0
2
6
0
18
5
9
0
9
0
0
0
7
274
0
5
0
1
0
0
29
0
0
2
5
0
0
3
1
1
0
0
0
0
1
0
125
0
0
0
0
0
0
1
10
0
1
0
2
5
7
2
1
2
0
4
6
0
0
53
21
1
4
1
3
4
29
1
4
0
0
4
2
0
0
1
-o
<
4033 21174
37
0
0
0
80
274
0
135
0
1
0
0
369
0|
0
2
30
0
0
11
11
1
0
0
0
0
2
0
182
0
0
0
0:
0
0
4
70
0
1
2
13
12
14
4
3
7
0
22
17
0
0
132
97
18
9
1
3
10
52
12
24
^ 0
0
12
4
0
0
43
430
1
5
78
590
0
0
113
517
1116
3849
0
0
5
32
5
9
3
10
20
37
2
19
1083
5609
2i
8
Oi
0
14 '
28
40;
814
l!
1
0
0
2
11
0
0
0
0
0
0
2
13
1
3
2
2
4
4
7
8
139
711
0
0
3
10
2
3
2
4
0
0
2
2
75
209
34
77
0
0
0
0
5
9
21
97
11
57
6
25
7
28
20
49
22
84
4
11
115
867
3
18
333
3466
1
2
284
182S
34
1 104
5
8
28
149
18
101
1
1
106
293
7
11
3
17
3
11
13
23
G
0
16f
} tn
i
> 6
3 9
3 11
158 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
P. SANITATION (ConHnued)
Misce 1 kirteous
Schools
14
Mobile
Home Porki
15
Camps
16
Tourist
Courts or
Motels
17
Child Core
Centers
18
Comploints
Investigated
19
COUNTY
■ \ .
1
1
>
1
1
••
*••
>
1
i
<
r
m
>
1
i
<
••
>
1
1
m
m
>
1
1
r
>
Totol
1768
4239
1922
9021
577
5519
176
497
1823
5733
47108
104323
Alochua
X
7
31
5
36
127
4
6
2
17
8
1
244
1
3
70
104
0
4
16
2
2
0
5
1
2
8
4
141
7
13
4
1
1
11
29
31
6
2
8
33
30
1
16
11
30
5
137
10
87
1
129
105
9
6
0
16
26
21
4
11
3
1
56
1
14
7
178
67
81
5
81
196
12
34
2
34
11
4
434
7
8
93
173
0
61
160
2
15
0
5
6
*5
15
33;
25
24
10
9
4
11
33
56
12
10
12
146
95
8
46
70
100
9
296
34
144
7
345
218
40
7
0
26
46
67
25
21
9
11
119
5
39
32
41
4
46
0
113
114
2
17
10
16
24
2
85
0
0
58
101
11
5
3
1
7
1
11
5
14
7
41
223
1
4
2
0
0
22
35
41
4
1
1
29
8
22
31
3
69
21
15
13
101
22
242
34
36
5
32
10
60
11
6
4
4
0
63
2
3
3
257
20
185
0
366
201
16
67
10
X
51
6
236
0
0
106
285
66
55
31
1
16
1
56
70
54
15
95
1057
6
16
7
0
0
40
56
75
5
4
1
143
43
43
56
14
195
86
630
85
256
99
2664
282
252
10
225
23
112
23
20
26
4
0
133
8
11
7
24
0
7
0
7
29
0
1
2
8
127
0
40
0
1
4
2
3
0
4
0
4
0
0
7
5
8
12
11
0
2
2
0
1
8
23
6
1
10
0
30
2
0<
2
3
2
0
13
2
80
12
3
20
4
4
9
1
6
7
2
0
0
1
10
3
2
0
62
0
24
0
25
499
0
17
2
13
291
0
1671
0
2
9
9
23
0
36
0
86
0
1
39
234
15
22
325
0
7
2
0
2
15
304
9
1
37
0
70
5
0
7
13
5
0
140
10
974
61
25
171
78
21
36
1
59
11
8
0
0
1
26
9
4
0
28
0
8
0
0
6
0
1
0
3
0
0
0
19
0
1
0
4
0
5
0
0
0
1
1
3
3
0
1
4
0
0
' 4
0
10
0
1
1
0
5
0
6
2
1
0
3
7
2
3
0
9
0
1
0
0
0
0
9
5
5
0
5
0
0
2
65
0
16
'7
0
0
11
0
5
0
17
0
0
0
28
0
1
0
51
0
16
0
0
0
39
1
3
4
0
2
6
0
0
7
0
15
0
3
1
0
13
0
8
3
2
0
27
24
3
4
0
33
0
1
0
0
0
0
15
31
7
0
7
0
0
15
14
0
0
0
29
246
0
5
0
1
2
0
224
2
2
242
68
0
0
5
0
3
0
0
3
4
2
6
220
1
1
0
0
1
15
36
38
0
0
0
23
3
11
2
0
1
0
188
4
126
1
32
76
5
1
11
0
47
40
0
2
2
0
78
0
0
0
70
0
0
0
47
948
0
8
0
2
3
0
463
2
3
344
591
0
0
12
J
0
0
4
6
2
9
nil
1
5
0
0
1
57
60
62
0
0
0
103
8
29
1
0
3
6
379
6
463
2
45
457
5
1
40
0
122
89
0
22
3
0
134
0
0
0
707
23
119
69
1017
4248
12
440
59
144
294
50
10741
82
29
3339
3216
25
40
223
2
53
60
14
26
122
32
118
2562
30
30
9
570
3
109
256
481
18
0
10
1481
294
119
324
30
520
35
Iir
109
2411
117
7413
755
210
143
130
33
1460
258
20
15
42
19
546
26
47
37
1273
Baker
fciy
Bradford
Brevord
28
177
94
1709
Broward.
Calhoun
OwrloMa
Citrus
6899
17
795
60
Cloy
238
Col ier
Columbia.
Dade
DeSoto
Dixie
584
173
26715
302
31
Dwval
ElOMbiO
FlaeUr
Fronklin
7297
5805
43
65
265
Gilchrirt
3
Glode«
101
Gulf
146
Hom i 1 ton
17
Hardee
57
Hendry
283
94
Highlands
Hilldboroogh
179
6060
Holme*
Indian River .............
38
228
Jockjon
Jefferson
Lofoyette
Lake
Lm
44
1133
3
214
482
Uo«.
l^
Liberty
938
19
0
17
^jrwjtee
2228
Morion ................
452
i^irtin
233
A^orwoe ................
498
NklSMU
Okalooao. ..............
72
1047
Okeechobee
Orange
Osceoki
Palm Beach
Posco
Pinellas.
71
4641
313
4315
185
20212
Pblk
Pwtnam
S». John*
1712
483
204
St. Lucie
250
43
Sarasota
Seminole
Sumter
Suwannee ..............
2749
417
50
20
Taylor
Uhion .................
51
22
Volusia
1264
Wokulhl
33
Wolton
Washington
78
54
LOCAL HEALTH SERVICES
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
159
COUNTY
P. SANITATION (ConHnued)
Miscelkmeous (Continued)
Protection of Food ar»d Milk
Nui-
Cor-
rected
20
Plumbing
21
Total
Atochuo . . . ■
Bdcer
Boy
Brodford
Brevord . . . . .
Broward. . . . .
Calhoun . . . ,
Chark>tte. . .
Citn*
Ckiy
Collier
Columbia. . .
Dode
DeSoto ....
Dixie
Duval
Escombia. . .
Fktgler
Franklin . . .
Godsden. . .
Gilchrist. . .
Glades
Gulf
Hamilton. . .
Hardee . . . .
Hendry . . . .
Hernando. . .
Highlonds . .
Hillsborough.
Holmes . . . .
Indian River.
Jockion. . . .
Jefferson. . .
Lofoyette. . .
Lc*e
32976
Leon
Levy
Liberty . . . .
Modison . . .
Monotee . . .
Marion . . . .
Mortin . . . .
Monroe. . . .
Nassau . . . .
Okolooto. . .
Okeechobee.
Orange. . . .
Osceoki . . .
Palm Beach .
Posco
Pinellas....
Polk
Putnam . . . ,
St. Johrv. . .
St. Lucie . . .
Santa Rosa. ,
Sarasota . . ,
Seminole. . ,
Sumter . . . ,
Suwormee . ,
Toykjr
Uhion. ...
Volusia ...
Wakulk) . .
Wolton . . ,
Woshington
<
2585
587
5
62
49
482
2175
15
306
19
90
162
29
4809
62
6
3251
2460
3
35
173
3
26
3
7
38
27
61
3359
12
2
5
14
0
66
262
290
16
0
2
916
160
73
156
15
310
24
664
60
1041
53
8302
460
60
92
134
31
865
109
9
11
12
14
327
11
28
20
r
>
Rabies
Animal
Bites
2?
7173
0
0
0
0
0
0
0
0
0
0
2
0
0
1
0
0
2582
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
t
I
<
26849
39
8
0
0
3
0
0
0
0
2
3
0
0
1
0
0
6931
0
0
0
0
27
0
0
0
62
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
52
0
0
0
0
7
0
0
0
0
0
30
0
0
1
r
>
Eating ortd
Drinking
Establish-
ments
23
E
<
81490
672
23
129
49
872
2132
6
47
21
110
157
103
6216
39
10
1977
1479
35
26
25
9
24
55
11
28
28
25
80
3354
16
68
28
19
3
26
218
473
69
1
12
375
184
53
158
34
403
27
1655
72
463
43
1549
1352
42
IX
166
97
556
259
28
3
34
6
415
13
24
33
20360
789
167
232
51
1922
4601
7
90
22
239
549
150
23558
113
11
1977
5647
80
75
57
12
71
139
19
44
88
39
98
18555
32
221
87
28
3
44
437
1389
150
1
39
1250
370
106
325
rood
Processing
Plants
24
115595
781
49
3459
194
1274
91
3278
3956
112
256
433
150
1427
469
80
11
73
21
1268
18
58
60
458
0
271
54
558
1616
24
83
43
84
102
197
3919
28
12
670
631
64
30
55
5
19
62
32
19
39
35
116
1680
55
53
130
26
3
145
474
244
43
22
28
253
199
92
110
58
140
58
983
96
1170
141
1729
608
137
339
196
68
403
166
52
58
62
15
951
16
74
57
I
<
880
2106
0
816
249
2356
4941
215
381
92
539
162
819
29034
85
47
2537
3535
234
249
536
174
61
374
227
80
158
104
263
18690
237
236
649
49
20
557
1445
1796
47
118
61
771
869
263
214
275
1147
260
6041
332
4760
318
11066
3849
865
681
2063
172
1014
393
177
716
128
117
3880
99
559
247
4887
30
0
4
1
10
45
0
7
0
2
7
0
161
7
0
32
28
1
4
1
1
0
0
0
0
0
1
0
66
1
3
4
0
0
1
30
11
0
0
0
34
7
4
4
1
3
0
69
4
29
6
66
55
2
14
11
0
39
25
0
1
1
0
41
2
1
3
115
0
16
1
67
105
0
30
0
2
10
0
1192
12
0
64
264
2
29
1
4
0
0
0
0
0
5
0
722
5
8
13
0
0
2
60
206
0
0
0
210
14
8
5
2
6
0
261
8
77
15
472
293
8
45
127
0
133
54
0
4
2
0
189
9
4
6
Abattoirs
25
<
147
Shellfish and
Crustacea
26
5
0
0
0
0
2
0
0
0
0
1
0
54
0
0
1
4
0
0
1
0
0
0
0
2
0
0
0
0
0
4
2
0
0
0
2
0
0
0
1
0
0
2
0
0
0
1
0
1
0
2
5
1
0
1
0
1
0
1
4
0
0
2
0
1
2
1034
E
<
r
>
167
17
0
0
0
0
9
0
0
0
0
1
0
380
0
0
2
18
0
0
10
0
0
0
1
16
0
0
0
434
0
0
9
1
0
0
0
16
0
0
0
5
1
0
2
0
0
0
1
0
1
0
11
27
4
0
8
0
1
0
18
12
0
0
19
0
4
6
2
0
7
0
13
1
0
7
7
0
1
0
12
0
6
3
4
0
0
1
0
0
0
0
0
0
0
0
2
0
2
0
0
0
0
5
0
14
0
0
2
0
0
1
2
2
0
1
0
3
2
4
0
1
7
0
3
8
0
0
2
1
0
23
13
5
0
1174
12
0
86
0.
30
1
0
72
11
0
1
0
50
0
55
5
67
0
0
4
0
0
0
0
0
0
0
2
64
0
28
0
0
0
0
47
0
59
0
0
10
0
0
2
16
4
0
2
0
3
8
22
0
18
89
0
8
57
0
0
2
6
0
151
166
16
0
u^
160 ANNUAL REPORT. 1966
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
COUNTY
Totol
Alachua . . .
Bolter
Boy
Brodford . . .
Brevard ....
Broward. . . .
Colhoun . . .
Otorlotta. . .
Citrus
Clov
Coiner . . . .
Columbia. . .
Dade
DeSoto . . . .
Dixie
Duval
Escambia. . .
Flogler
Franklin . . .
Godsden. . .
Gi legist. . .
Glades
Gulf
Hamilton. . .
Hvdee . . . .
Hendry . . . .
Herr>or>do. . .
Highlands . .
Hillsborough.
Holmes . . . .
Indian Riv«r .
Jackson. . . .
Jefferson . . .
Lofoyette. . .
Lake
Leon
Levy
Liberty . . . .
Modison . . .
MonotM . . .
Marion . . . .
Mortin . . . .
Monroe . . . .
Nassau . . . .
Okalooso. . .
Okeechobee.
Orortge. . . .
Osceolo . . .
Palm Beach .
Posco
Pinellas. . . .
Polk
Putnam . . . .
St. Johns. . .
St. Lucie . . .
Santa Rosa . .
Sarasota . . .
Seminole. . .
Sumter . . . .
Suwarmee . .
Taylor
Uhion
Volusia . . . .
Wokulb . . .
Walton . . . .
p. SANITATION (ContimMd)
Protection of Food or<d Milk (Continued)
Grocery and
AAeat Markets
■o
<
7384
41531
204
32
68
21
207
490
14
38
11
56
20
48
1281
8
0
380
188
16
5
7
0
12
47
3
3
6
19
39
838
30
19
1
8
0
25
86
165
0
0
1
46
24
18
13
7
102
31
462
42
534
6
716
289
72
49
101
0
109
5
31
2
5
8
231
40
21
24
Other Food
Establishments
I
<
1282
1037
242
132
155
851
1738
87
135
19
327
38
69
OOOO
29
0
1795
1294
94
5
14
0
29
294
3
7
33
39
94
8882
147
61
1
32
0
84
182
412
0
0
1
127
53
61
39
35
671
107
2337
112
1816
8
3771
1906
475
81
854
0
255
5
78
2
22
86
1261
41
136
144
34
0
1
0
9
23
0
0
0
0
2
3
493
4
0
5
42
0
0
0
0
1
0
0
1
6
3
0
464
0
8
1
0
0
0
16
0
0
0
0
3
1
0
3
0
1
0
70
10
21
0
14
10
1
1
1
0
5
0
0
1
2
0
20
1
1
0
8522
rood
Hon-
dlers
Trained
_22_
87
0
18
0
25
87
0
0
0
0
2
3
3458
15
0
5
248
0
0
0
0
1
0
0
2
7
4
0
3925
0
10
3
0
0
0
17
1
0
0
0
11
1
0
14
0
5
0
191
13
79
0
44
46
3
1
3
0
7
0
0
8
2
0
163
3
10
0
%
Z
4671
Dairy
Farms
30
e
30
0
0
0
»
533 J
0
37
0
0
0
18
2681
0
0
30
81
0
0
0
0
0
0
0
0
0
0
2
35
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
527
0
153
0
345
75
0
94
0
0
0
0
0
0
0
0
0
0
0
0
537
9680
11
3
4
2
1
0
8
0
3
7
0
0
26
1
0
1
41
1
0
3
1
6
0
0
5
2
3
4
71
13
3
15
7
13
14
9
11
0
0
5
21
17
8
0
7
1
27
15
9
25
22
9
17
4
1
4
10
4
5
6
4
0
2
11
0
5
9
Milk and
Milk Products
Plants
^1
-o
e
<
425
155
27
15
16
4
0
166
0
16
96
0
0
694
20
0
3
1090
22
0
78
1
58
a
0
57
63
26
58
2041
185
24
248
137
229
59
199
41
0
0
64
451
309
19
0
46
14
317
200
182
424
143
166
59
5
39
110
45
63
100
56
0
48
236
0
54
256
r
>
6784
3
0
2
2
10
12
0
0
0
1
0
1
177
0
0
1
5
0
0
3
0
0
0
0
1
01
0
0
9
0
1
3
1
0
0
10
6
0
0
1
8
1
1
2
1
0
1
23
1
39
0
69
4
0
1
6
0
2
0
0
1
0
0
14
0
1
1
Cowl
Bor>gs
Tested
J2.
i
I
z
8155
46
0
8
16
20
137
0
0
0
8
0
5
3065
0
0
3
149
0
0
31
0
0
0
0
12
0
0
0
817
0
18
27
1
0
0
73
54
0
0
1
78
42
2
4
1
0
10
291
1
464
0
1083
71
0
1
46
0
14
0
0
16
0
0
165
0
3
1
Cows
Tuber-
culin
Tested
33
Dairy
Forms
Llnder
Mostiris
Control
Progrom
i
I
z
66458
855
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
594
223
0
0
28
2
0
0
0
0
0
41
0
1
0
0
1
0
0
0
0
0
0
6152
0
0
0
0
228
0
0
0
30
0
0
0
0
0
0
1696
0
0
0
0
84
0
0
0
0
84
0
2494
0
0
0
835
0
0
410
0
0
0
0
977
0
0
1719
19066
209
0
0
687
781
0
0
7
0
0
558
5435
1886
3909
0
0
0
13996
0
1083
0
4813
1580
0
0
0
2059
0
374
3
445
30
0
0
0
0
638
600
1
Z
672
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
71
0
0
0
0
2
0
7
0
0
0
0
18
0
502
0
0
0
4
0
0
24
0
9
29
0
0
0
0
0
0
0
0
0
0
0
0
5
0
LOCAL HEALTH SERVICES
TABLE 20 (Continued)
MAJOR ACTIVITIES OF LOCAL HEALTH UNITS, FLORIDA, 1966
161
II
ii\
162
ANNUAL REPORT, 1966
MATERNAL AND CHILD HEALTH
163
BUREAU OF MATERNAL AND CHILD HEALTH
DAVID CRANE. M.D.
Director (through January)
MALCOLM J. FORD. M.D.
Acting Director (to October 12)
JAMES E. FULGHUM. M.D.
Acting Director (through December)
The function of the Bureau of Maternal and Child Health (MCH)
is the prevention of illness, injury and death among the mothers
and children of Florida. Of great importance is the effort to im-
prove the total health of this segment of the population through pre-
ventive measures such as immunization, optimum nutrition, and
accident prevention. A wider understanding and utilization of avail-
able health services are being developed through evaluation and
remedial programs.
The bureau is organized into the Maternal Health Program,
Child Health Program and Special Projects Section which includes
the growing and important Migrant Health Program. Detailed re-
ports of these programs follow under their respective sections.
A renewed effort has been made during the year to extend serv-
ices for family planning to women who need and can qualify for this
service. It is estimated that the service is now being utilized by
approximately 20,000 women, as compared with 15,000 in 1965. All
but one of the counties in Florida offered this service with the as-
sistance of this bureau. Oral contraceptives and intrauterine de-
vices are made available in the clinics.
The staff has maintained a close relationship with many official
and nonofficial agencies in the state. This includes the State De-
partment of Education (SDK); State Department of PubUc Welfare;
Florida Medical Association (FMA) with its School Health Medical
Advisory Committee and Committees on Child Health, Maternal
Health and Vision; local medical societies; Florida Pediatric So-
ciety; Florida Congress of Parents and Teachers; Division of Men-
tal Retardation; and Florida Crippled Children's Commission.
The bureau participates in the summer student training program
by providing opportunities for students to participate in special
MCH projects in areas throughout the state.
MATERNAL HEALTH
A marked increase in obstetrical consultation has done much to
increase program interest and activity. Among medical organiza-
tions, county health departments (CHD) and community agencies,
prenatal, perinatal, and postnatal care integrated with home life and
its environment received emphasis. Through a multidisciplined
approach, comprehensive maternal care which does not cease with
the postpartum check-up is being accomplished.
Even with this improvement there is still room for much greater
advances especially in some of the rural counties. These are
hampered by many situations which include the lack of personneL
A brochure entitled "A Ready Reference to Current Obstetric
Practice" was developed with the cooperation of the State Board of
Health (SBH). This is being distributed to aU CHDs and to inter-
ested practitioners.
Preliminary figures and current trends indicate that almost 97
per cent of all state births were delivered in hospitals during 1966,
a noteworthy increase from the 91 per cent and 94 per cent recorded
for hospital births in 1956 and 1960, respectively. By 1956 the white
race had attained such a high percentage of hospital- delivered births
that gains during the past 10 years have been necessarily smaU. But
the nonwhite race with only 72 per cent of infants bom in hospitals in
1956 shows a substantial rise to an estimated 90 per cent in 1966.
Nonwhite deliveries occurring outside of a hospital remain almost
nine times higher than similar white births. This problem needs
further study. Over 80 per cent of non- hospital births are handled
by midwives. The number of licensed midwives and midwife deliv-
eries are declining each year; however, the 168 midwives who held
licenses in 1966 delivered about 3000 infants.
The Midwife Program is the direct responsibility of the bureau,
but this responsibility has not been exercised and now is the subject
of study by the Obstetrical Consultant.
Illegitimate and early teenage pregnancies, which are high risk
groups from a maternal health standpoint, continue to account for a
significant proportion of state births. In 1965 there were 12,678
illegitimate births and 3837 births to teenage mothers under 17 (both
figures include the 2005 illegitimate births to mothers under 17);
these groups represented 12 per cent and four per cent of total
births, respectively. The ratios between white and nonwhite were
1:2.6 for illegitimate births and 1:1.3 for births to mothers under 17.
Preliminary figures indicate that maternal deaths will reach 40
in 1966, this is a decline from the 44 in 1965 and the 60 reported in
1964. This would yield a current maternal mortality rate of 3.9 per
10,000 live births compared with rates of 4.1 in 1965 and 5.3 in 1964.
The stillbirth incidence remains above desired and attainable
levels but with increased surveillance it is hoped that a marked de-
crease will soon be noted. Stillbirths for 1965 amounted to 1694;
1894 were reported in 1964 and 1794 in 1963. Prematurity is ever
present and seems to be on the increase; 9.4 per cent of all births
were considered premature (less than 2500 grams) in 1965, com-
pared with 9.3 in 1964 and 9.0 in 1963. This maybe secondary to
the reduction in the average age of mothers. A solution to this high
164
ANNUAL REPORT. 1966
MATERNAL AND CHILD HEALTH
165
premature rate may be forthcoming as we push forward on compre-
hensive maternity care.
The bureau working with the CHDs has been quite active in child
spacing. At least 65 of the 67 counties are participating in the pro-
gram. A pamphlet entitled "Standards and Operating Procedures for
Family Planning Services and a Guide for County Health Depart-
ments" was developed for appropriate distribution.
The bureau distributed to the CHDs sufficient drugs and ma-
terials to give child spacing coverage to 14,282 persons not includ-
ing Dade, Okeechobee and Santa Rosa Counties. It is important to
note that only six per cent of the indigent potential contraceptors
have been reached; therefore, ways and means for reaching the
other segments must be planned and implemented.
In a special study utilizing summer students, data was compiled
in four counties, (three urban and one rural). It was found that 6626
women were started on some type contraceptive, and that in a two
and one-half year period over 50 per cent had discontinued its use.
This would indicate the necessity for a good follow-up system in any
Family Planning Program.
CHILD HEALTH
The primary responsibility for the health of the child rests with
the parents. The SBH and SDE, through the CHDs and boards of
pubUc instruction, are responsible by law to protect the health of
the school-age child. Efforts are focused on assisting the schools
to assume the legal and moral responsibilities to their community
in the most effective and efficient manner possible. The approach
emphasizes a community health program developed through the
existing local agencies.
Infant and Preschool Health
Preliminary field surveys have shown the need for additional
health screening, service and monitoring programs utiUzing avail-
able funding by the Social Security amendment and related acts.
Preliminary figures indicate that there were 102,542 resident
live births in 1966 and a provisional birth date of 17.3 per 1000 pop-
ulation. ThefalUng birth rate of the past several years has continued
despite the high proportion of young adults in the general population.
Many factors obviously contribute to this trend, but certainly wider
application of family planning must be considered as one of the
factors responsible for this decline.
There were 2773 reports of infant deaths in Florida during 1966
with a resultant provisional mortality rate of 27.0 for each 1000 live
births. The most significant contributory cause for these deaths
continues to be prematurity. It has also been noted that congenital
malformations are being reported more frequently as a cause of
morbidity and mortality.
School Health
The response by county health officers to the announcement of
the appointment of a Vision Screening Consultant in March was im-
mediate. Since that time there have been 22 conferences with CHD
personnel and 11 workshops for nurses on vision screening. Train-
ing programs were instituted, and during the year three vision tech-
nicians and 43 volunteers received such training. (16 in Highlands
County, 23 in Charlotte, and four in Sarasota). These training pro-
grams include: the subjects of growth of vision, refractive errors,
amblyopia, muscle balance and techniques of vision screening. On
the final day of the course, there is an instructional screening ses-
sion in one of the schools. The volunteers and vision technicians
then work under the supervision of the CHD.
The mechanisms for vision screening of school children are al-
ready in existence, and these are being gradually expanded to en-
compass preschoolers. The screening of preschool children is
aimed primarily at detection of amblyopia which may lead to blind-
ness in one eye. Treatment, to be successful, must be started in the
years before starting school.
The Health Project in Teacher Education is another effort to
give teaching personnel assistance with health problems. There
were 102 teachers from 42 counties enrolled during the summer of
1966 at the five participating universities. An evaluation of the
course was held in the fall and the consensus of the group was that
the course should be offered again in 1967. At this evaluation ses-
sion, nursing supervisors and health officers from selected counties
were invited to attend with representatives of the universities.
School health programs were promoted through the existing local
agencies in the many facets of screening, service and monitoring.
Some schools carried out special screening programs for tubercu-
losis and hookworm infestation. Information on mass poliomyeUtis
immunizations was disseminated through the schools and many
schools were used as the clinic site for administration of the vaccine.
The FMA's School Health Medical Advisory Committee has been
joi great assistance. It serves in an advisory capacity to the SDE and
SBH in matters relating to health problems confronting the school
system.
PubUc health nurses, sanitarians and educators at the local level
serve as resource persons for teachers and other school personnel
and work diligently toward the improvement of school health pro-
grams. Efforts have been made to encourage all schools to offer
health education as an integral part of the curriculum. A health edu-
cation course can give proper emphasis to universal areas of con-
cern such as venereal disease, dental and mental health, alcohol,
smoking, narcotics and sex education, as well as a variety of unique
health problems that may confront individual communities at one
time or another.
166
ANNUAL REPORT. 1966
M
ATERNAL AND CHILD HEALTH
167
Premature Program and Nurse Training
The Premature Demonstration Center (PDC), Jackson Memorial
Hospital, Miami, completed 16 years of service and demonstration
and nine years as a training program in premature care. Twenty
registered nurses attended the regional seminar which was held in
June; 16 were from Florida and four from Alabama. Faculty for the
seminar was provided by the Departments of Pediatrics and Ob-
stetrics of Jackson Memorial Hospital and the University of Miami
School of Medicine and the Dade County Department of Public
Health. This program was phased out June 30, 1966.
SPECIAL PROJECTS
Maternity and Infant Care Projects
These are special projects supported jointly from local, state,
and federal Children's Bureau sources. At the beginning of 1966 one
project was located in Dade County. This is the largest project in
Florida. It initially opened in 1965 and got into full operation during
latter part of the year, with high risk maternity patients being ad-
mitted and delivered along with the high risk infants. During this
year the project services have increased markedly.
In June, the Children's Bureau approved and funded the following
four Maternity and Infant Care Projects: Orange, Palm Beach and
Broward Counties, and North Central Florida, comprised of 13
counties: Alachua, Baker, Bradford, Clay, Columbia, Dixie, Gil-
christ, Hamilton, Lafayette, Levy, Marion, Suwannee and Union.
Health Services for Migratory Agricultural Workers
During 1966 progress continued toward the goal of bringing more
comprehensive health services to Florida's 100,000 agricultural
migrants. The grant for this purpose was once more increased by
the United States PubUc Health Service (USPHS) thus enabUng a total
of 14 CHDs to actively participate in the State Migrant Health
Project. During the latter part of the year, two additional counties
expressed the desire to participate, which will bring the total to 16
counties. These two counties are expected to initiate their pro-
grams during the early part of the coming year.
The Health Service Index and Referral Form System, which is
designed to facilitate referrals of agricultural migrants for health
service continuity, was strengthened during the year by increased
participation both within and outside the state. - A majority of the
state's 44 migrant counties either initiated or received and evaluated
referrals received from 22 other states. Of the more than 2000
processed, 52.4 per cent of the patients received direct service.
During the latter part of the year, recommendations designed to
simplify the referral form were considered and the resultant sample
was circulated among public health personnel in 10 states.
The increased grant from the USPHS resulted in a consequent
incrlfseTthe sco% and quaUty of services offered to the migran
workers ^d their dependents. The --^^f.^^ ^^^/^^^^^^
riinics rose- evening dental cUnics were mitiated, mcreased em
nS was Placed on nutritional services; additional public health
'pfrs^nnerneCssary for an expanded program J- employed -^^^
mor^ private physicians and dentists rendered care to migrants
either in cUnics or in their offices.
,„ addition to the CHD. ,.«clp«M U. '^'S?? "'S"ciS?W
the USPHS and the Children's Bureau.
Beeinning in 1965 the Dade County Maternity and Want Care
Pror/c?Tr^C^a care ^or^i.r^i-%lTX^s\^^^^^^^^
aaidpediatr c care mciuamg j^ comprehensive care for migrant
rcriivitrS^n^raU^nrofmirrVoS.
During December aMigrant Health Conference '"'^ ^eld at M^ami
Ttl Thf co^ren^e ^ ^n^sor d^fL^m^rroi^cJ^'ar C
:!.f ^as^ cU°de/edTy Zse 'Attending to be both informative and
interesting.
MENTAL RETARDATION
The Dade County Evaluation Clinic was restudied and a plan Pre-
implemented early m 1967.
The Tampa Diagnostic and Evaluation Clinic was ^f^ded by a
Children's Bu«au ^ant to the SBH begimung July 1. F^ve of the
s^ of SU were recruited and operation was begun m quarters pro-
vided at MacDonald Training Center.
screening for phenylketonuria (f^U) ^.^^^P^fJ^^^J^L nori<^
survey this year shows the annua -"f ^"^.^"'"trltton ler^ces and
faciUtles to be about 70 per cent of births. Nutrition series
^fenaLc are provided as needed and requested m Florida. (See
Division of Nutrition elsewhere m this report.)
A state nurse consultant with special training "-e^n^i^f .^Jf^Xr
,t the GainesviUe Sunland Training Center. Employees of the four
• ^teT^^ centers and community service programs and lay
il
168
ANNUAL REPORT. 1966
leaders received training. Beginning in June, this nurse also as-
sumed the responsibility of providing consultive services to the
generalized public health nursing program of six counties.
As the family planning program grows, particularly in those 17
counties served by Maternity and Infant Care Projects, the number
of mentally retarded infants is expected to decrease.
POSTGRADUATE OBSTETRIC-PEDIATRIC SEMINAR
For the first time since its beginning in 1961, six states partici-
pated in this year's annual conference for physicians and nurses.
The seminar has proven to be an outstanding professional edu-
cational event for those interested in the care of mothers and in-
fants since the latest information in these fields is presented by
outstanding specialists. The table below summarizes attendance at
the 1966 session.
TABLE 21
POSTGRADUATE OBSTETRIC-PEDIATRIC SEMINAR
REGISTRATION, BY STATE, 1966
STATE
Doctor
Nurws
Other
Total
Alobona
17
STJ
56
6
38
2
4
6
52
2
0
0
0
0
0
6
0
0
0
0
0
23
155
58
6
38
2
4 ,
Florida
Georgia
Mississippi
Sootfi Gjrolino
Tennessee
Ofhw Sh>t«
TOTAL
220
60
6
286
BUREAU OF NARCOTICS
169
FRANK S. CASTOR. Ph.G.
Director
The year was one of growth and accompUshment mixed witii new
The y^^J/*^^ There was an increase in the number of
'cafesTroSt'f: couTrea^dll^e^s, and a scarcity of cases involving
practitioners of the healing arts.
The bureau is charged by law with administration of Florida
staJtes ^veming the sale, possession and use of narcotics and re-
statutes ^je™'^ registration of practitioners admimstermg or
drugs and cosmetics produced within the state.
Total arrests amounted to 611 \''^^^'f^°V''^J^l^^ltZ^
ported in 1965. These cases were handed ^V 12 ^n^pe^^^r^.^ne
^'T rs^J^rin^S J heK°eLTb;VbS^^^^ p'Sarma-
reut^anve" rc^'^Td^g manufacture -es -d^^^Mro-
practic cases. Of the total cases '"entioned 370 were disposed oi
by court action and Uie remainder were pending at year s end.
A new and serious problem came to the -Mention of the bureau
to cover hallucinogens.
There were 19 persons sent to state institutions for treatment of
addirtfon The number of unscheduled inspections of pharmacies and
are made where suspicion exists as a ^esuii oi u e ^
promise of compUance, which is usuaUy kept.
The slow and insidious rise in the number of cases involving the
youtns. mere we I e ^"^ * inrrpa<5inff oroeram of education
with 133 in 1965. A continuing and increasing prugi**^
is sorely needed in this field.
Fducation of the pubUc continues to be a prime effort of the
Education oi ine P"" before civic and academic
bureau. Its inspectors made 164 talks oeiore ^^^^
groups, an inc^ase of 60 over the previous year s total. The
ii^
170
ANNUAL REPORT, 1966
program stresses an approach to younger age groups to alert them
to the dangers of addiction and illicit drug use. It strives to reach a
proper balance between punitive and preventive action in this grow-
ing problem.
^
SUfAfAAfty OF AaiVITIES, BUREAU OF NARCOTICS,
FLORIDA, 1966
Investigations. . . 1690
Open inspections 2103
Arrests 611
Violations corrected where no legal action was taken 67
Cases disposed of by courts 370
Narcotic addicts confined to state or federal institutions
for treatment 19
Talks made 164
Drugstores registered for 1966-67 1718
I '
NARCOTICS 171
TABLE 22
PRAQITIONERS REGISTERED WITH THE STATE BOARD OF HEALTH,
BY COUNTY OF RESIDENCE, FLORIDA,
DECEMBER 31, 1966
COUNTY
Total in State.
Alachua . . . .
Boker
Bay .......
Brodfora . . . .
Brevard
Bfoword
Colhoon . . . .
Charbtte. . . .
Citrus
Clay
Collier
Columbia. . . .
Dode
DeSoto ....
Dixie
Duval
Escambia . . .
Flogler ....
Front lin . . .
Gadsden . . .
Gilchrist. . .
Glades ....
Gulf
Hamilton. . .
Hardee . . . .
Heridry ....
Herrando. . .
Highlands . .
Hillsborough.
Holmes
Indion River . .
Jackson
Jefferson ....
Lafoyette. . . .
Lake
Lee
Leon
Levy
Liberty
Modison . . . .
Manatee . . . .
Morion
Martin
Monroe . . . . .
Nassau
OkakMsa. . . .
Okeechobee. .
Orange . . . . .
Osceoki . . . c
Palm Beach . .
Posco
Pinellas. . . .
Polk
Putnam ....
St. Johns. . .
St. Lucie. . .
Santo Rosa . .
Sarasota . . .
Seminole . . .
Sumter ....
Suwarwee . .
Taylor
Union
Volusia . . . .
Wakulla . . .
Wolton . . . .
Washir>gtoo .
Out of State.
o
o
_u
■8
2
8,050
287
5
51
8
192
701
4
20
11
18
33
22
2,170
9
1
591
173
2
4
18
1
2
3
2
10
9
7
29
549
4
34
17
5
"66
92
99
8
• • ■ • •
6
100
64
20
40
8
31
4
496
19
436
30
732
248
20
24
38
17
170
43
2
7
9
1
216
9
3
3,556
GRAND TOTAL 11,606
6,386
270
5
41
7
160
507
4
17
6
16
24
19
1,796
7
' *5i4
152
2
1
17
3
2
9
7
6
25
420
3
26
15
5
" " ' 47
74
84
5
6
66
50
18
34
8
27
3
383
11
336
18
505
206
15
20
30
15
132
34
1
6
7
1
146
■ ■ 8
2
3,040
9,426
I
478
4
84
114
1
1
13
1
28
4
2
3
8
5
35
3
19
7
80
4
1
35
200
678
u
S
%
584
4
1
15
49
2
2
6
1
110
1
31
13
1
1
2
45
1
4
2
10
10
3
3
14
6
2
1
4
1
39
4
45
5
65
21
3
2
5
1
17
5
19
1
1
167
751
1
o
3
O
Z
138
11
1
45
24
8
5
20
2
2
139
I
u
168
3
19
45
8
2
14
1
3
2
2
9
12
26
4
5
1
61
229
8
2
296
11
3
10
31
2
60
17
6
1
18
2
2
6
7
2
22
1
19
36
11
1
11
12
87
383
II
I!
il
ii
-a
172
ANNUAL REPORT. 1966
BUREAU OF PREVENTABLE DISEASES
C. M. SHARP. M.D.
Director (to February 15)
A. V. HARDY. M.D.. Dr.P.H.
Acting Director (from February 15)
This bureau is an association of four divisions, all under com-
petent senior leadership. These incorporate programs which also
function rather independently. Thus, the annual report of activities
will be found predominantly in the summaries prepared by the
division and program directors. This report will call attention to
activities warranting particular emphasis.
Early in the year, C. M. Sharp, M.D., the previous bureau
director, retired for reasons of health. For most of his 20 years
with the State Board of Health (SBH) he had been associated with the
bureau either as head of the Division of Tuberculosis Control or as
director of the bureau. For most of the year under review, an acting
director was assigned to the bureau.
Though not a major activity, the Immunization Assistance Pro-
gram demanded more administrative and planning time than any
other. This is supported entirely by federal project funds and con-
siderable discussion has ensued relative to accounting for use of
these funds.
Partly because of the confidential nature of information on
individuals involved, few appreciate fully the magnitude and gravity
of the venereal disease problem. The incidence of infectious
syphilis has been increasing progressively and substantially. It is
involving more teenagers. Changes in social and ethical codes are
disquieting. The venereal diseases constitute a persistent and stub-
born public health problem which is not yielding to present control
procedures.
The general epidemiology program has been strengthened under
the leadership of the director of the Division of Epidemiology and
through the assignment of a medical officer from the U. S. Public
Health Service (USPHS). The work predominantly is a succession of
smaller problems though episodes of major interest are brought to
attention from time to time. The most recent was a particularly
unusual epidemic of shigellosis spread through milk distributed in
glass bottles which were contaminated during the filling process.
Though the outbreak is an event of the past, the study of it was not
completed at the year's end.
The tuberculosis program was expanded during this and the pre-
ceding year through project funds. These specialized activities are
fitting smoothly into the county health departments (CHD).
Veterinary public health, though the smallest of the four divisions
of the bureau, has maintained an active program. Particular
PREVENTABLE DISEASES 173
attention has been given to the surveillance of Eastern EncephaUtis
in horses and to rabies, particularly in wildlife, and to salmonel-
losis of animal origin. The division contributed effectively to ecolo-
gical studies of arbovirus infections. The program of the milk
consultants has continued without material modification and with no
unusual problems.
The magnitude of the Radiological Health Program was sur-
prising to one who had not previously had close contact with it.
Nationally and in the state these activities were initiated to prevent
problems before they occurred. This preventive program appears
to be as effective in practice as it was sound in concept. The in-
spection of X-ray installations continues to be desired, well accepted
ajid very time demanding. The Ucensing of isotopes is expanding
rapidly as the use of these increases. This too calls for inspections
of facilities.
Occupational health is the underdeveloped activity of the bureau.
The senior position of industrial hygienist has continued to be vacant
throughout the year. Looking to the future, this program received a
critical study by the Office of Planning staff. A re -organizational
decision has separated Occupational Health from the Division of
Radiological Health and the laboratory activities will be transferred
to the Bureau of Laboratories. A substantial expansion of staff has
been requested through state appropriations and independent division
status is anticipated when the staff and activity reach a scope more
appropriate for division designation.
DIVISION OF EPIDEMIOLOGY
E. CHARLTON PRATHER. M.D.. M.P.H.
Director
This division has as its goal promotion of community health
through control of communicable diseases. Collection and collation
of weekly communicable disease data from the 67 counties is a
major responsibility. Through the appUcation of epidemiologic tech-
niques, the public health significance of various infectious diseases
is ascertained and control measures instituted as indicated. The
division provides accurate and current information on preventive
procedures and practices for the communicable diseases, informs
the public of infectious disease hazards, and advocates preventive
medicine principles. This division is administratively responsible
for the Venereal Disease Control Program, Vaccination Assistance
Program and the special research project on the Epidemiology of
Unclassified Mycobacterial Infections.
n
II
I
M
174 ANNUAL REPORT. 1966
Measles
An outstanding event in 1966 was the beginning of the immuni-
zation program for measles. While 3970 cases were reported, vir-
tually unchanged from 1965, increasing interest in and demand for
measles vaccine was noted. Mass county-wide programs were held
in Alachua and Levy Counties. Other counties are planning to assist
in eradicating measles in 1967.
German Measles
The 1447 cases of German measles (rubella) in 1966 represents
the highest total in the past ten years except for the epidemic year
of 1964 when 8661 cases were reported. This year's cases were
rather evenly distributed throughout the state. It may be that the
reporting of cases of rubella is improving as a result of the em-
phasis being placed on reporting of rubeola.
Salmonellosis
For the first time in the past 10 years, the number of cases of
salmonellosis has decreased. Compared to the 1295 cases in 1965,
1167 cases were reported in 1966, which is not, however, a sub-
stantial difference. Improved surveillance techniques which included
the withdrawal from commercial markets of foodstuffs contaminated
with salmonella helped protect the public from this ubiquitous haz-
ard. Continued emphasis on control of the salmonella group infec-
tions will continue in 1967.
Shigella
A striking increase in the number of cases of bacillary dysentery
occurred in 1965. The 777 cases represents the highest figure in 10
years and is 264 more than last year, an increase of more than 50
per cent. Isolated outbreaks continued, especially in day care cen-
ters, hospitals for retarded children and among the low socio-
economic groups. A common source outbreak of dysentery caused
by Shigella flexner Type 2 occurred in the Duval County area toward
the end of 1966. A total of 101 cases were identified; contaminated
milk being implicated as the source.
Hepatitis
Infectious hepatitis continues to be a serious public health haz-
ard. In 1966, 653 cases were reported, a decrease of 113 from the
previous year and the lowest since the epidemic years in the early
1960s. No common source outbreaks were identified in 1966.
Surveillance of serum hepatitis becomes more important with
the increasing administration of biological materials taken from one
PREVENTABLE DISEASES 175
or many individuals and given to others. This is the second year
that serum hepatitis has been specifically reported and the 29 cases
represent no major change from the 37 reported in 1965. Increased
effort will be placed on identifying cases of serum hepatitis and de-
termining the source so that further cases from the same source
may be prevented.
Viral Encephalitis
While only one case of arthropod-borne encephaUtis occurred in
1966 (Duval County), continued emphasis was placed on prompt in-
vestigation of any suspect cases. Other etiologies accounted for 115
cases of viral encephaUtis and as yet methods have not been de-
veloped for determining the cause of a great number of these.
Diphtheria
Only six cases of diphtheria were reported and these were
SDoramc This figure is the lowest reported in the history of
Zlt^: As emphasis continues to be placed on immunization, this
disease should be eliminated.
Tetanus
The 16 cases of tetanus represents an all-time low for Florida;
however, this was the third largest number in the country, only
Texas and CaUfomia reporting more cases. The high mortality
rate from this infection (75 per cent in 1966) makes imperative
protection through immunization.
Leprosy
The 13 cases reported represents a greater than five-fold in-
crease over the average of the last 15 years. This increase is ac-
counted for by the arrival of refugees already infected. Almost aU
newly-found cases are treated at the National Leprosonum m Car-
ville Louisiana, and do not represent a hazard to the remamder of
the population in Florida, thanks to modern antibiotic therapy.
,1)
VENEREAL DISEASE CONTROL
The Venereal Disease (VD) Control Program is dedicated to the
control and eventual eradication of the five venereal diseases:
syphiUs, gonorrhea, chancroid, lymphogranuloma venereum and
granuloma inguinale. Most effort is concentrated upon the two most
common venereal diseases, syphilis and gonorrhea, with particular
attention to infectious syphiUs. Major program activities include
epidemiology, information- education, laboratory surveillance and a
private physician visitation program.
176
ANNUAL REPORT. 1966
Epidemiology
Venereal disease epidemiology, the science of tracing and lo-
cating source and spread cases of VD, remains the most valuable
tool in the attempts to eradicate these diseases.
Procedures of contact interviewing and investigation underwent
modifications during 1966 to include a program of 'Intensified Epi-
demiology." This new concept has improved the older program by
reducing the time required to locate and bring to medical exami-
nation persons known to have been exposed to infectious syphilis;
finding infectious cases of syphilis that otherwise might have gone
undetected; and bringing known cases of infectious syphilis to treat-
ment earlier. Under this new program a larger portion of the in-
fected person's socio- sexual peer group becomes involved in the
epidemiologic process, thereby affording both rapid discovery of
existing infections and reducing the chance for spread.
Syphilis morbidity (all stages) in Florida during 1966 totaled
5699, a seven per cent decrease over 1965. Infectious syphilis (pri-
mary and secondary) cases totaled 1890, a 20 per cent decrease
over 1965, reversing an eight year trend of consecutive increases.
Control efforts were less than desirable due to a personnel shortage.
This accounts in part for the decreased infectious syphilis mor-
bidity. There are no indications suggesting that a real decrease in
the reservoir of syphilis has occurred.
SyphiUs rates per 100,000 population (by stage) for the past nine
years are indicated graphically in Figure 1. Numerical totals by
stage and rate per 100,000 population are listed in Table 23. Early
syphilis morbidity in 1966 by age and race is shown in Table 24.
Private physicians reported approximately one- half of all the known
cases of syphilis in Florida during 1966. Gonorrhea epidemiology
continues to be Umited to miUtary cases and special requests by
private physician.
I nf ormotion-Educotion
The information- education program is aimed at all levels of the
society. It is hoped that the public will acquire a factual knowledge
of VD, develop more healthful attitudes toward it and develop sexual
practices less conducive to the spread of VD.
The program was expanded during 1966 to provide a wider range
of information to a greater portion of the population. Through close
cooperation with the State Department of Education and county school
systems, state and local parent-teacher associations, medical so-
cieties and other community groups VD Control personnel continued
to provide activities directed toward a solution to the increasing VD
problem. These activities included arranging and presenting VD
programs for community groups; coordinating and conducting
teacher workshops; encouraging the mass media toward programs
for community awareness; presenting a unit on VD education with
PREVENTABLE DISEASES 177
«,nh^^m on eoidemiology for state pubUc health nursing staffs and
^bC health nS stSents; continuing to cooperate with county
Se^t^ off^ers and p^bUc health nurses in laying the groundwori. for
wo^k^hopsri^d attending and participating in conferences and
meetings with personnel in allied fields.
During 1966 VD Control personnel assisted CHD officials in pre-
«ntlnJ countvwide VD educational workshops for selected junior
^rslni'orS sch^l instructors in ^fO". «-ff "l^-^::.'
Columbia, Lafayette, Dixie, Putnam, mgler, Volusia, O'^^ge. B^^
vard Pom, Hillsborough, Pinellas, Sarasota, Lee, Palm Beach,
Mon;>e ^de and Gilchrist Counties. Each of these 20 counties is
" ve^plnrus own program of student instruction and VD education
aeyeiopmg h 6 communicable disease unit by the
:Z^r ctst^m inst^ctor, both at the junior high and the senior
high level.
The VD Control staff participated in numerous activiUes with
alUed fie™s. These included attendance -» Teacher Project in HeaWi
Fducatlon (sponsored by the Bureau of Maternal and ChildHealth),
Education r^l Conference (sponsored by the State Department of
Iduca ion); State Parent-Teacher Association; Sofern Branch ^^^
the American Public Health AssociaUon and the Florida PubUC
Health Association.
Private Phytician Visitation Program
The Private Physician Visitation Program received less em-
Dhasis during 1966 due to epidemiologic priorities. AU new phy-
Ss as ^11 as key physicians (general practitioners, dermatol-
orisTs urologists, proctologists, internists, osteopaths) were visited
to soUcU theS co^^ration in reporting VD and to utiUze epidemiol-
ogic services.
Free porUble darkfield service is offered to all Florida phy-
sicians. This service was expanded in Miami to mclude 24-hour
service via radio-telephone communication.
laboratory Surveillance Program _
Total reporting of positive serologies remains the goal of the
laboratory p^gr2. The majority of pubUc and private laboratories
TfIoI°^ re^rt positive serologies. All miUtary laboratories now
report in accord^ce with a new armed forces regulation The d^
rector of the Division of Epidemiology personally caUed on several
[rboratories that were not reporting and encouraged their coop-
e ration.
The procedures tor the epidemtologic toUow-up of persons with
positive ^^logical tests were changed during 1966. Older patien s
^o^ng reactions of low litre were eUmiiiated "^^ f°»°*;"P:^^!
resulted in an increase in available man-hours for the more produc
tive infectious syphilis epidemiology.
178
ANNUAL REPORT. 1966
!l
PREVENTABLE DISEASES 179
TABLE 23
REPORTED SYPHILUS CASES AND RATES PER 100,000 POPULATION,
BY STAGE, FLORIDA 1958-1966
1966
1965
1964
1963
1962
1961
1960
1959
1958
1966
1965
1964
1963
1962
1961
1960
1959
1958
YEAR
STAGE
TOTAL
Primory
and
Secondary
Early
Latent
Nymber of Cose*
5699
6132
5908
6945
6004
5324
4115
4332
3186
1890
2356
2005
1883
1632
1118
639
344
201
Rates Per 100,000 Population
95.9
105.6
103.6
123.1
112.2
103.2
82.1
91.3
70.8
31.9
40.6
35.1
33.4
30.5
21.7
12.7
7.3
4.5
16.3
17.9
17.7
17.7
28.1
30.3
20.9
19.3
16.5
Late &
Late Latent
45.3
43.5
46.9
66.3
50.0
48.3
45.0
60.6
45.7
Congenital
972
2692
1037
2527
1011
2677
999
3742
1505
2676
1561
2493
1047
2254
916
2875
741
2056
145
212
215
321
191
152
175
197
188
2.4
3.7
3.8
5.7
3.6
2.9
3.5
4.2
4.2
TABLE 24
REPORTED CASES OF EARLY SYPHILIS, BY AGE AND BY RACE,
FLORIDA, 1966
Primary and Secondary
Early Latent Syphil
s
Syphilis Cases
AGE
Total
White
Nonwhite
Total
White
Nonwhite
Under 14
12
12
8
23
45
46
71
93
501
389
235
123
70
106
6
4
1
• • • •
5
4
14
15
16
17
18
19
20-24
25-29
30-34
35-39
9
24
45
47
76
97
540
426
251
145
1
1
• • • •
1
5
4
39
37
16
22
10
23
13
41
36
256
181
147
96
72
1
7
• • • •
6
4
34
16
5
10
8
9
16
13
35
32
222
165
142
86
64
40-44
45+
86
132
16
26
87
12
75
TOTAL ALL
AGES
1890
168
1722
972
104
868
ill
ii*
U
180
ANNUAL REPORT. 1966
i|
PREVENTABLE DISEASES
181
VACCINATION ASSISTANCE PROGRAM
This program, partially supported by a U. S. Public Health
Service (USPHS) grant, has been in operation for three years. Forty
county health departments are conducting routine follow-up of three-
month-old and 15-month-old infants and their families. Tabulation
of data after completion of follow-up shows that immunization levels
are being increased. Since the greatest increases are among the
nonwhite chUdren, it is beUeved that the program is an effective
"casefinder" for non-immunized children.
Measles was added as one of the program diseases during 1966,
the others being poliomyelitis, diphtheria, pertussis, tetanus and
smallpox. More than 40,000 doses of vaccine were distributed. Six
counties conducted mass measles eradication programs late in the
year and others are planned for 1967.
UNCLASSIRED MYCOBACTERIA RESEARCH PROGRAM
The number of persons found excreting unclassified mycobac-
teria during 1966 was 1700, exceeding all previous years and sur-
passing the number of newly identified tuberculosis cases by some
200. This reflects largely the efficiency of the Zephiran tri- sodium
phosphate sputum digestion technique initiated as a routine labor-
atory procedure during mid- 1965.
The clinical significance of the increased findings is a matter of
much investigation. The Tween 80 hydrolysis test is now applied to
all new isolations of Groups n and ni in all the state laboratories.
The preliminary study of early data formed the basis for a paper
submitted to the American Thoracic Society for presentation to the
annual conference in 1967.
The accession of large numbers of cases to the register, now
containing a total approaching 7000, has raised serious problems of
follow-up with the limitations imposed by staff and space. As of
January 1, 1967, individuals excreting Group n and Group EI organ-
isms shall be added to the Register only if the organisms are found
to be Tween negative. The procedure will permit many Tween posi-
tive excretors to remain on the Register, and yet permit more time
for the epidemiologic follow-up of the excretors of the more likely
pathogens.
The 1965 study of 360 cases with a pathology due to unclassified
mycobacteria was presented at the annual convention of the Ameri-
can Thoracic Society. At the Houston meeting of the Southern Branch,
American Public Health Association, a paper was presented based
upon the analysis of new cases reported in 1965.
Close liaison with the University of Florida resulted in the ac-
quisition of a mycobacterial culture from a wild wood duck with ex-
tensive granulomatous disease. The organism was identified by the
Communicable Disease Center as a Battey, Group m Type. This is
the first known case of granulomatous disease in a wild bird due to
Battey organisms nonpathogenic for chickens. It will be the subject
of a forthcoming paper.
Agreement has been reached with the Veterans Administration
HospUals that all acid-fast niacin negative cultures wiU be submitted
to the State Board of Health laboratories for identification, and by
this procedure gain automatic reporting of the respective cases to
the Register.
In cooperation with the USPHS Hospital, CarviUe, Louisiana,
studies have been set up with the Department of Dermatolop, Um-
versity of Miami, for the isolation and identification of mycobacteria
from skin lesions.
The chief bacteriologist for the State of Victoria, Australia,
visited Jacksonville in November to study the research program and
the methods of mycobacterial identification.
DIVISION OF RADIOLOGICAL AND OCCUPATIONAL HEALTH
EDWIN G. WILLIAMS. M.D.
Director
The appUcations of radiation in medical, industrial, research
academic fields are continuing to increase and expand rapidly; the
rate of industrial expansion has far exceeded expectations and ser-
iously dwarfs our diminishing capability to cope with it. It is the
legal and moral responsibility of this division to design and conduct
a program to insure that these increases do not become inconsistent
with the health of the pubUc. The continued cooperation andcom-
bined efforts of the Florida Nuclear and Space Commission (FNbC;,
U. S. PubUc Health Service (USPHS), Atomic Energy Commission
(AEC), Florida Industrial Commission (FlC), State Board of Health
(SBH) and several county health departments (CHD) have continued
toward the realization of these responsibilities.
Of the 15 AEC Agreement States, Florida is fourth in the total
number of byproduct, source and special nuclear material Ucenses.
An Agreement State is one in which the governor has signed an
agreement with the AEC for the transfer to the state of regulatory
responsibilities for byproduct, source and less than critical mass
quantities of special nuclear materials.
Training
The division continued to utiUze educational and training oppor-
tunities available to state and county radiological health personnel.
Twelve formal courses, from four days to two weeks "^J^ngth, were
attended by seven staff members. An intensive techmcal health
}
> {
i t
\i4
182
ANNUAL REPORT. 1966
physics course of 10 weeks duration, especially prepared by the AEC
and conducted by the Oak Ridge Institute of Nuclear Studies, Oak
Ridge, Tennessee, and was attended by a senior member of the staff,
making a total of six people in the program (county and state) to
have completed this course.
Two courses were co- sponsored by the division and the Uni-
versity of Miami with the cooperation of the USPHS and the AEC. In
April a four-day "Public Health Conference on the Use of X rays in
Medicine and Industry" was attended by approximately 140 persons
and in June a week-long course and workshop on "Radiation Protec-
tion for Industrial Radiographers" was conducted for state and county
radiological health personnel. Staff members presented formal and
informal lectures at various grade schools. Central Florida Junior
College, to special groups from the State Road Department, FNSC,
civic and industrial groups and other professional organizations!
The staff promoted and assisted in organizing the Florida Chap-
ter of the Health Physics Society. The Society is an organization of
international scope composed of professionals from several scien-
tific disciplines whose goal is the protection of man and his environ-
ment from unwarranted radiation exposure. An objective of the
Florida Chapter is to promote professional and public understanding
of the need for radiation protection.
RAOIOLCX^ICAL HEALTH
For convenience of description the radiological health activities
are divided into program areas. Although not considered a program
entity, specific effort is devoted to encouraging and assisting local
health units in establishing proficiencies and in sharing certain re-
sponsibilities under the "Agreement" with the AEC. Three counties
have reached this degree of proficiency and several more are
making substantial progress.
Licensing of Radioactive Materials
Radioactive materials including radium are licensed. Several
hundred thousand curies of radioactive materials are presently
authorized for use in Florida by 473 separate license documents.
This number includes 233 medical, 136 industrial, 24 academic, 71
Civil Defense and nine special nuclear and source material licenses.
In 1966, 90 new licenses were issued, 42 were terminated and 288
were amended in part or in entirety. The present poUcy is to incor-
porate, where possible and practical, aU individual Ucenses author-
ized at a given facility into one license document. This follows the
practice adopted earUer this year to include radium along with other
licensed material instead pf issuing a specific radium license.
PREVENTABLE DISEASES
183
Registration of Radiation-Producing Machines
Under the authority of the Florida Nuclear Code, the "Rules and
Regulations for Control of Radiation Hazards" stipulate that the
owner or person having possession of radiation-producing ma-
chine(s) shall register such machine(s) every two years. To date,
7697 radiation-producing machines located in 4480 installations have
been registered. This program facilitates the consultation efforts
and aids in program planning and scheduUng of priorities. The pro-
gram is now computer oriented and assisted by the Division of Data
Processing. The distribution of sources of radiation in some specific
counties is presented in Table 25.
Survey of X-ray and Radioisotope Facilities and Consultation
with Radiation Users
The field activities for this portion of the program are central-
ized in the office in Bartow.
The survey of X-ray machines and consultation with users is
continuing with emphasis upon all radiation- producing machines. In
1966, the survey and consultation staff aided by county personnel in
Dade, Escambia, Hillsborough, Orange and Pinellas surveyed 810
radiation- producing machines located in 439 facilities. Beam size
and filter corrections were needed in 96 and 124 machines respec-
tively. Where practical, and on request, these were corrected by
the survey team. In the 439 facilities, 643 recommendations were
made which would reduce unnecessary radiation exposure to the
patient or the machine operator (physician or technician) or both.
A complete summary of the X-ray survey and consultation program
activities is presented in Table 26.
Survey and consultation visits to radioactive materials licensees
in 101 facilities were made as a continuing effort to insure a high
degree of radiation hygiene practice.
During 1966, a study was begun as the first phase of a project
to determine the extent of the health hazard resulting from the use
of radium in luminous compounds in aircraft instrument mainten-
ance facilities and watch repair shops in the state. In those facilities
where radioactive contamination was detected, consultation and guid-
ance was given in techniques and procedures for decontamination.
Upon request from the Bureau of Health Facilities and Services,
the division made radiological safety surveys and evaluations of 37
facilities for Medicare certification.
'^
184 ANNUAL REPORT. 1966
TABLE 25
SOURCES OF RADIATION, BY COUNTY, FLORIDA, 1966
COUNTY
Dad.
Broword. . , .
Pinellas. . . .
Duval
HillibofQwgh.
Polm B«ach .
Orange ....
Polk
Escambia . . .
Volusio ....
Brevard ....
Sarasota . . .
Alachuo . . .
Leon
Radiotion-
Prodwcing
Mochines
1836
«a6
5tt
410
473
447
230
210
53 OtHer Counties
1f9
192
1J0
132
1279
TOTAL
Radioactive
Materials
Licenses
71
36
33
34
27
30
44
29
19
4
22
7
19
21
90
7697
473
TABLE 26
SUMMARY OF X-RAY SURVEYS AND CONSULTATIONS
FLORIDA, 1966
Type
of
Installation
Medical . . ,
Dentol . . . .
Hospital . . ,
Chiropractic.
Veterinarian.
Osteopathic .
Podiotric . , .
Ir>dustrial. . .
Oher
Number
of
Installations
TOTAL
86
244
21
23
23
8
5
14
15
Number
of
Tube Heads
439
169
387
150
23
23
9
4
22
21
Beam
Corrections
Needed
27
38
12
2
3
5
2
2
5
Filter
Corrections
Needed
810
96
18
68
13
4
7
4
5
0
5
Recommendations for
Reducing Personnel
Exposure
124
149
341
33
22
25
6
14
16
643
Environmental Radiation Surveillance
The division continued to operate the Florida Radiation Surveil-
^ce Network (FRSN) stations for air and precipitS^ocated L
^"St'pt; Tallahassee, TitusviUe, Cocoa, Melbourne, Orlando an"
TsL 1 ! ^'*^, ^"^^OMgYi the cooperation and assistance of the CHDs
t^i'n. n'^n '"^' ^'''''T ^''''^'^ ''' '"^ ^'^ ^^ precipitation m^-'
toring program are located in Jacksonville and Miami (operated by
the division and the CHD respectively) and are units of ^e USPhI
national nebvork. The FRSN for milk continued operation throuS
the cooperation aiid assistance of 29 CHDs and the Regional Laborf-
^n^n r?"" °i Laboratories at Pensacola, Tallahassee, Jackson-
ville, Orlando, Tampa, West Palm Beach and Miami. The USP^
PREVENTABLE DISEASES
185
has a national milk network and a national total diet network, both
operated by the Hillsborough CHD with official division cognizance.
China and France conducted nuclear weapons tests in the atmos-
phere in 1966. The FRSN detected intrusion of fresh fission product
debris (fallout) especially from the China detonation of May 9. (The
French nuclear tests were conducted in the Southern Hemisphere;
consequently, no noticeable increase in fission product debris in
environmental samples was detected from these tests.) Monitoring
of milk for Iodine 131 from the Tampa station was increased from
once to twice weekly. The Tampa station is part of the USPHS
Pasteurized Milk Network. Samples from this station are also used
for quality control. The six regional composite milk samples con-
tinued on a monthly schedule. There is at present no noticeable in-
crease in Cesium 137 or Strontium 90 levels. The FRSN determi-
nation of gross beta in air was continued on a schedule of three
samples per week for each of the seven stations. Peak air activity
of 3.27 pCi/M^ was measured on the St. Petersburg sample of
May 25. The average statewide increase during May and June, over
the March and April average, was 200 per cent. After July, air
activity levels decreased to comparable levels before the May 9
detonation. Peak gross beta activity of 481 pCi/L was measured in
the St. Petersburg precipitation sample of May 27. The Pensacola,
St Petersburg and Orlando station average for March and April was
14.7 pCi/L, 17.8 pCi/L, and 11.7 pCi/L, respectively. The May ajid
June gross beta average was 56.9 pCi/L, 145.9 pCi/L and 122.8
pCi/L, respectively. The greatest deposition occurred between
May 23 and June 10. By July the individual station average was
higher than the March- April average by a factor of two to three.
The averages for August, September and October were back to the
levels present before the May nuclear detonation.
The Cape Kennedy Off- Site Radiation Surveillance Program con-
tinued on a routine schedule. Through cooperation of the USPHS,
National Aeronautics and Space Administration, several CHDs, SBH
and others, 327 samples were collected and analyzed for gamma and
gross beta concentration and elemental berylUum, boron and fluor-
ine. The SBH Radiological Laboratory performed radioanalysis of
30 of these samples per month. Samples are collected in Indian
River, Osceola, Brevard, Orange and Volusia Counties.
Two nuclear power plants will be constructed by the Florida
Power and Light Company at Turkey Point. A radiological environ-
mental monitoring program to establish baseline data to determine
the area's radiological characteristics has been established and is
operationaL Fifteen samples from this program are analyzed by the
SBH Radiological Laboratory monthly.
Coordinating activities with the division, the USPHS has initiated
a long-range program to study the questions of deposition of radio-
active materials from fossil fuel power plants. Effluent concen-
tration data from the two types of power plants will be correlated.
186
ANNUAL REPORT. 1966
PREVENTABLE DISEASES
187
The division continued to operate the film badge personnel moni-
toring service for state and CHD personnel occupationally exposed
to radiation. Film badges processed in 1966 totaled 2244. Investi-
gations requiring five man days were made of five apparent over-
exposures or incidents and recommendations were made for the
prevention of such incidents.
t
Instrumentation and Maintenance
This segment of the program supports all the other radiological
health activities.
Six radiation survey instruments were purchased. Twenty-nine
new high-volume air sampler motors were procured through ex-
change and eight new ones were purchased. Weather housing for 15
air samplers was constructed. Complete inspection for operation
and calibration was made on 160 radiation detection instruments; 75
instruments were completely recalibrated. Forty- two instruments
with electronic circuit malfunctions were repaired. Two radiation
detection instruments and one low-volume continuous air sampler
were completely reconditioned. Twenty- three high- volume air
sampler motors were used in maintenance of the FRSN air stations.
Radiological Health Research
The second year of the investigation of radionuclides in Florida
milk has been completed. Higher than normal levels of Cesium 137
and variation of these levels with geographic location have been
substantiated by this study. Continued efforts are being made to
explain this anomaly and to determine causative factors.
Emergency Planning
Substantial progress was made during 1966 to improve the oper-
ational readiness of the Florida Radiological Emergency Network
Teams. The division assisted the FNSC and the Florida Highway
Patrol (FHP) in conducting three test exercises of each team, located
in Pensacola, Tallahassee, Jacksonville, Gainesville, Bartow and
Miami. Efforts also were made to inform all local governments of
the existence and responsibilities of the emergency teams. A 60-
second color motion picture on the management of radiation ac-
cidents was made by cooperative efforts of the FNSC, FHP and the
division. The film for showing between regularly scheduled TV pro-
grams has been distributed to educational and commercial tele-
vision stations throughout the state. With the cooperation and as-
sistance of the Florida Civil Defense organization, there have been
established degrees of emergency and have improved instrumen-
tation availability with which to meet them.
The Intragency Emergency Action Program Plan, developed by
an interagency committee with representation from the Florida State
f
4
M
.''S
Department of Agriculture, Florida Dairy Farms Federation, Florida
Dairy Products Association, University of Florida, Florida Feed
Retailers' Association and the SBH, is in standby status.
OCCUPATIONAL HEALTH
ResponsibiUties of the occupational health section of the Division
of Radiological and Occupational Health include the provision of
technical support and consultation to the Workmen's Compensation
Division of the Florida Industrial Commission (FIC), performing
industrial hygiene surveys and technical studies of industrial plants
to determine environmental atmospheric concentration of potentially
toxic materials and the measurement of physical agents to which the
worker is exposed. Services also are supplied to people in occu-
pations outside the industrial plant category. Requests for technical
assistance are received from a variety of sources including the FIC,
management, labor groups, private individuals and state and federal
agencies.
Field Activities
In cooperation with authorities of the local Post Office Depart-
ment a technical study was performed to determine the carbon
monoxide levels present in the cab of a certain type mail delivery
vehicle when cab doors were closed and the engine runmng. The
survey was prompted by newspaper reports from other sections of
the country of defects found in the vehicle heater systems which
utilized engine exhaust gases as a source of heat. Forty-five tests
for carbon monoxide were made on 39 vehicles. Four defective
heaters were found. Action was taken by the postal authorities to
correct the mechanical defect.
The quality of compressed air suppUed for scuba diving con-
tinues to be a topic of interest and of individual concern. The
division has provided technical assistance to determine the presence
of condensed water vapor, the concentrations of carbon monoxide,
carbon dioxide, oxygen, oil mist and particulates present in com-
pressed air. As reported previously, many of the air suppliers are
actively engaged in professional or sport diving and maintain a high
rate of personal interest in the quaUty of their compressed air.
Compressed air from 14 air supply stations was checked and 76
tests run to determine air quality. Offensive odors are the most
common cause of complaints received.
With the assistance of the CHDs and other state agencies, a sur-
vey was made to determine the disposition and usage of over 27,000
pounds of surplus mercury donated by the AEC and distributed to
schools and higher institutions of learning throughout the state by
the Surplus Property Office at Starke. It was concluded from in-
formation obtained from the survey that there was Uttle health
'
188
ANNUAL REPORT. 1966
^
hazard to teachers and students from mercury poisoning based on
the use and handling of the metal in classroom experiments and
demonstrations.
Since 1957 a continuing in-plant study has been carried on in the
phosphate industry in the Polk -Hillsborough County areas to evaluate
the workers' environmental exposure to gaseous and particulate
fluorides. During the previous year a urinalysis program was
initiated to determine the correlation between the worker's exposure
and urinary fluoride levels. This study of the phosphate industry is
essentially at a standstill because of the lack of personnel.
Although 102 plant visits by division personnel constitutes an in-
crease over the 79 made the previous year, 63 of them were in con-
junction with the SBH Office of Planning Study of the occupational
health situation. These 63 plants are not included in the tabulation
of the number of persons or establishments given service.
Division personnel and the industrial hygienist from Hillsborough
County participated at the Fifth Annual FIC Safety Conference held
at Jacksonville in February with an exhibit of sampling equipment
and direct reading instruments employed in industrial hygiene lab-
oratory and field practices.
Laboratory Activities
The total number of samples received and analyzed in the lab-
oratory was 416 compared to 646 the previous year, reflecting the
lack of an active in-plant program in the phosphate industry. Eight
samples were analyzed for fluorides as against 217 in 1965. Bio-
logical, atmospheric and other type samples submitted for lead
analysis increased from 299 the previous year to 327. A total of 153
samples was submitted by CHDs, state or federal agencies.
CHDs have continued to display an increasing interest in the
field of occupational health. Personnel from CHDs spent two weeks
for training and orientation in industrial hygiene instrumentation
and methodology at the occupational health laboratory.
The laboratory again participated in the special study carried on
by the Committee on Environmental Factors in the Pneumoconiosis,
American Conference of Governmental Industrial Hygienists, to
evaluate and standardize analytical methods for the determination of
free silica in dust and other materials.
PREVENTABLE DISEASES
SUMMARY OF OCCUPATIONAL HEALTH AaiVITIES
FLORIDA, 1966
FIELD ACTIVITIES
189
Number of persons or establishments given
Workers employed
PERSONNEL VISITS TO PLANTS
Self-initiated /3
Requests or complaints 24
Agency referrals 3
Revisits 2
Total 102
service
65
4330
SERVICES RENDERED
Routine inspection 4
Industrial hygiene survey ... 75
Technical study 30
Consultation 21
Follow-up 10
Discuss report 8
Non-occupationa I
investigation 2
150
FIELD DETERMINATION OF
ATMOSPHERIC CONTAMINANTS
Trichloroethylene 12
Carbon Monoxide 64
Carbon Dioxide 13
Hydrogen Sulfide 3
Oxygen 12
Moisture 12
Nitrogen Dioxide 2
Hydrogen Chloride 1^
Total 119
PHYSICAL CONDITIONS
Noise measurement 36
Ventilation 10
Illumination 9
Total 54
Total
SAMPLES COLLECTED FOR LABORATORY ANALYSIS
Lead (Biological-16,
Ceramic-4) 20
Dust for free silica 8
Air for dust counting 9
Fluoride in air 4
Welding rod for fluoride 1
Particle sizing 4
Oil mist-particulotes 12
Solids for identification 2
Total
60
LABORATORY ACTIVITIES
Materials Type of Sample Source Ana\yses
Lead Human fluids and
tissue Physician, hospital,
industry, state and
federal agency 297
Atmospheric, ceramic,
water and other . . . . CHD, state agency 20
Fluorides Biological fluids,
water, welding rod . . Physician, state
agency, industry 8
Chromium, copper,
iron, magnesium
manganese,
vanadium, zinc .... Biological fluids .... water Jl
Oxygen Air ''^
190
ANNUAL REPORT. 1966
PREVENTABLE DISEASES
191
Free silica Settled dust,
welding, sand . . . ^ . Industry 11
Dust counts Atmospheric Industry 9
Boiling points, pH,
specific gravity. . . . Biological fluids,
solvents Industry, state agency 10
Microscopic
examination,
miscellaneous Materials of unknown
composition 27
^ Total 416
Blanks, controls, reagents, starxiards 243
Total 659
OCCUPATIONAL DISEASE REPORTS RECEIVED THROUGH
FLORIDA INDUSTRIAL COMMISSION, 1966
Dermatitis by cause 272
Detergents or other chemicals 58
Cement 39
Plants and vegetables 9
Citrus 20
Agricultural chemicals 20
Larva migrans, fungus 10
Seafoods, other foods 26
Paint, petroleum products, solvents 28
Miscellaneous 62
Systemic poisoning by cause 23
Parathion 22
Chemical, excluding parathion 1
Conjunctivitis by cause 128
Welders 125
Other * 3
Miscellaneous ]2
DIVISION OF TUBERCULOSIS CONTROL
DWIGHT J. WHARTON. M.D.
Director
Eradication of tuberculosis in the state is the objective of this
division. A control program started more than 20 years ago has
been enlarged in scope over the past four years. The function of the
state program is to give assistance to county health departments
(CHD) each of which develops a program suited to the needs of its
population and the capacity of CHD personnel.
At the end of the year the W. T. Edwards Hospital at Tallahassee
was closed. The two remaining hospitals in Tampa and Lantana have
a combined capacity of approximately 1040 beds which is ample for
current needs. Northwest Florida is remote from the Tampa hos-
pital and this will cause inconvenience to patients and their families.
Meetings have been held during the year with representatives of
the two medical schools, the Florida Thoracic Society and others,
with a view to developing teaching facilities to provide training in
tuberculosis to young physicians.
The statewide special tuberculosis project which is funded by
the U. S. Public Health Service (USPHS) was enlarged during the
year. This project, started in 1962, now is carried out on a state-
wide'basis with sub-projects in nine CHDs. Two additional CHDs
had projects approved by USPHS and will become active during the
next year. The program provides funds for the employment of some
90 persons and purchase of suppUes and services to be used ex-
clusively in the tuberculosis control program. For several years
three standard drugs, INAH, PAS and streptomycin, have been sup-
pUed to CHDs. Newer drugs are now available for special cases.
A program to prevent infection of children was started during
the year. The principal objects of this program are to identify in-
fectious persons most likely to infect children, to provide protection
by prophylactic chemotherapy to tubercuUn reactors, and to expand
tubercuUn testing programs for pre-school, kindergarten, and/or
first grade children, and selected groups of older children. Prophy-
lactic chemotherapy is increasingly used throughout the state. One
CHD reported 1766 persons on drug therapy at the end of the year
compared to 855 a year ago, the increase being due principally to
prophylactic therapy. This measure is reported to be 85 per cent
effective in preventing disease in recently infected persons.
Morbidity and Mortality
Table 27 gives data on morbidity and mortality for the past 10
years. In 1959 the USPHS established new reporting procedures to
provide nationwide uniformity. Using the new procedure 1271 new
cases of active tuberculosis were reported in Florida that year.
Each year, save one, since 1959 there has been an increase in the
number of new cases reported, reaching a provisional total of 1573
this year. The case rate has not changed significantly over this
eight year period.
The number of cases reported does not present an entirely true
picture. The Isoniazid prophylactic program and increase in serv-
ices to children has resulted in more youngsters being given a diag-
nosis of tuberculosis than in former years. In 1959 there were 75
diagnoses of primary tuberculosis compared to 171 this year. While
reporting procedures have been uniform since 1959, there were
changing situations which introduced variables in assessing data.
I;
lit
i1
192
ANNUAL REPORT. 1966
The immigration of Cuban refugees was greater than in recent years
and 47 new cases were found among them. Better identification and
follow-up of contacts and associates of new cases has been possible
under the special tuberculosis project. More personnel were em-
ployed full time in case detection than in previous years.
The provisional total for 1965 was 1521 new cases reported.
During the year further study caused 72 of these to be removed from
the total because they were previously counted or were non-tubercu-
lous. Each year a similar number of previously reported cases have
been deleted from the total because another diagnosis is proven.
There have been few inactive or quiescent cases of tuberculosis
in which a reactivation of the disease has occurred. Only 50 inactive
cases and two quiescent cases were reported to have reactivated
during 1966. The USPHS states "every year about 10,000 persons
who have previously had active tuberculosis and recovered have a
reactivation of disease." The reactivation rate in this state is far
below the USPHS estimate.
Case Detection
During 1966 there were 36, photofluorographic (70mm) X-ray
units operating in the state. Four of these are owned and operated
by SBH, three by tuberculosis associations and 29 by CHDs. The 36
units produced a total of 786,697 satisfactory films with 6952 being
interpreted as suspicious of tuberculosis. Suspicion of other patho-
logies were 1102 with tumor, 3421 with cardiovascular abnormalities
and 8019 with other pathology. At the end of the year a diagnosis of
tuberculosis had been established on 342 of those who had suspicion
of tuberculosis reported and 965 remained under study with "diag-
nosis reserved." Table 29 gives results of all 70mm units and
Table 30 has data from the four State Board of Health (SBH) units.
In the follow-up of suspects from SBH Mobile Units the names
are retained at the SBH and all "diagnosis reserved" suspects re-
main under study. In 1966 there were 27, five, and two new cases
reported from these reserved diagnosis suspects for the years 1965,
1964, and 1963, respectively. In the three years, 677 suspects had
diagnosis reserved and a total of 86 was diagnosed finally as tuber-
culosis after the years of the survey.
Identification and examination of contacts of newly reported
cases are important phases of a tuberculosis control program.
These have not received comment previously. In the first six months
of 1966 the project counties reported 539 new active cases. It was
possible to identify 4412 contacts of the new active cases and 88 per
cent of these were examined. As a result, 84 additional new cases
of tuberculosis were found and 393 more were placed on prophylac-
tic chemotherapy.
PREVENTABLE DISEASES
193
Other X-ray Services
SBH provides X-ray film and interpretation to CHDs for 14x17
and 70mm films. Some CHDs interpret their 14x17 films. One CHD
has read its 70mm films for several years and a second one started
late this year. All other 70mm interpretations are done by SBH
physicians. CHDs submitted 40,205 films of 14x17 size and ap-
proximately 41,000 were interpreted by CHDs. SBH processed and
interpreted 661,546 films of 70mm size. A state 14x17 mobile X-ray
unit provides services to CHDs not having such facilities. Thirty-
seven CHDs used this service in 1966, some having monthly visits
and others at two and three month intervals. A total of 4126 films
was made by this unit.
Activities of CHDs
Table 20, Section C, gives data on the major tuberculosis control
activities of CHDs. The CHDs work directly with the tuberculosis
cases, their contacts and associates. The tuberculin testing pro-
grams continue to increase in scope with 110,919 tests being done
in 1966.
Central Case Register
The workload of record keeping for the central case register
increases each year with the increase in home care of tuberculosis
patients and the emphasis on life time follow-up. Table 31 gives
case register data for the end of the year and Table 32 has a com-
parison of case register data for the years 1962 to 1966 inclusive.
Residents of other states who moved to Florida during the year
increased the case register total by 85 active, 28 quiescent, and 116
inactive cases. These were previously counted in other states but
receive the same follow-up and case register recording as other
Florida residents.
:
i
m>
lit
194 ANNUAL REPORT. 1966
TABLE 27
NEW ACTIVE TUBERCULOSIS CASES AND TUBERCULOSIS
DEATHS WITH RATE PER 100,000 POPULATION,
BY RACE, FLORIDA, 1957-1966
YEAR
Cose*
Reported
Cote
Rate
TOTAL
WHITE
NONWHITE
Deaths
Rate
Deaths
Rate
Deaths
Rate
1966*
1965
1964
1963
1962
1961
1960
1959
1958
1957
1573
1521
1407
1563
1439
1359
1295
1271
1553
1716
26.5
26.2
24.7
28.3
26.7
26.1
25.9
26.5
34.4
40.8
213
211
212
242
216
217
205
233
287
257
3.6
3.6
3.8
4.4
4.0
4.2
4.1
4.9
6.4
6.0
125
126
133
151
136
146
128
161
193
165
2.6
2.6
2.9
3.3
3.1
3.4
3.1
4.3
5.4
4.8
88
85
79
91
80
75
78
65
94
92
8.4
8.3
7.9
9.2
8.3
8.1
8.7
7.4
11.1
11.5
•Provisiorwl totals
TABLE 28
REPORTED ACTIVE CASES OF TUBERCULOSIS BY STAGE
OF DISEASE, RACE, SEX, AGE, AND SOURCE OF REPORT
FLORIDA, 1965 AND 1966
Stage of Disease, Roce ond Sex,
1966
1965
Age, and Source of Report
Case
Per Cent
Cose
Per Cent
TOTAL ACTIVE CASES
1,573
100.0
1,521
100.0
STAGE OF DISEASE
Primary
171
216
582
470
112
22
10.9
13.7
37.0
29.9
7.1
1.4
121
194
567
496
113
28
8 0
Minimal
12.7
37 3
Moderotely advanced
Far advanced
32.8
7 4
Noo -9u Imonary
Not stated
1.8
RACE AND SEX
White mole
614
242
464
251
2
39.1
15.4
29.5
15.9
.1
589
254
465
212
1
38.7
16.7
».6
13.9
.1
White femole
Nonwhite mole
Nonwhite female
Not stated
AGE
Under5
84
96
102
432
575
281
3
5.3
6.1
6.5
27.5
36.6
17.8
.2
63
57
124
432
592
249
4
4.1
3.8
8 1
5-14
15-24
25-44
28 4
45-64
38 9
65 and over
16 4
Not stated
.3
SOURCE OF REPORT
Health department
996
377
110
15
5
8
62
63.4
ii'.o
7.0
.9
.3
.5
3.9
807
110
384
110
18
22
8
62
53 1
Sanatoria
7 2
Private physicians
25 3
General hospitols
7.2
1.2
1.4
.5
4 1
Stote mental hospitals
Deoth certificates.
Other states
Other
PREVENTABLE DISEASES
TABLE 29
RESULTS OF 70mm X-RAY SCREENINGS, FLORIDA, 1966
195
70mm XRAYS
FOLLOW-UP STUDIES
m
s
X
"o
o
►—
FINDINGS
STAGE OF NEW CASES FOUND
SCREENING UNITS
o o
1*
51
u —
k. —
• o
ZU
o *
£ >
1
c
5
5<
■o
•
o
. >
•
■£
O
«
TOTALS
786,697
6,952
89.6
342
965
81
143
93
26
AlnrKua HD
10,419
9,789
634
53,870
5,324
1,642
2,561
1,059
6,874
489
141,272
2,309
4,267
175
6,659
30,000
43,789
18,127
25,518
1,781
4,210
1,059
338
2,185
2,581
236
2,838
68,593
230
2,268
753
277
7,205
1,830
9,523
5,691
11,761
2,786
366
335
7,930
3,312
4,327
2,682
620
4,771
934
45,0a')
1,673
202
45,883
9,508
4,941
1/04
51,604
22,999
4,900
1,214
1,419
316
9,182
3,599
16,922
2,761
1,567
2,085
638
744
27,362
286
216
1,494
7,943
4,351
47
62
8
486
45
24
23
10
49
4
2,281
30
38
5
44
204
306
113
199
28
29
9
3
17
17
1
20
33.5
6
26
4
0
49
6
78
55
67
18
2
4
44
23
32
13
2
38
5
139
17
1
298
67
51
14
495
106
31
3
2
5
84
28
132
10
9
12
3
6
202
1
1
27
258
41
100.0
100.0
100.0
93.8
91.1
100.0
100.0
100.0
95.9
100.0
93.0
93.3
100.0
100.0
88.6
100.0
95.4
79.6
9Z4
100.0
62.0
100.0
100.0
1X.0
94.1
100.0
100.0
99.7
83.3
100.0
100.0
0
83.7
100.0
92.3
98.2
100.0
100.0
100.0
100.0
100.0
100.0
100.0
92.3
100.0
78.9
100.0
97.8
100.0
100.0
91.6
98.5
94.1
100.0
78.8
81.1
100.0
100.0
100.0
100.0
95.2
89.3
90.9
100.0
100.0
100.0
100.0
83.3
97.0
100.0
100.0
92.6
96.9
95.1
5
5
1
27
5
0
0
0
6
0
52
3
1
1
3
16
27
13
5
0
2
0
0
0
0
5
34
1
2
0
0
2
1
n
6
6
1
0
0
4
2
1
1
0
2
1
6
1
0
24
1
0
0
9
6
2
0
0
1
8
1
5
1
1
0
0
0
9
0
0
2
11
5
13
10
2
47
0
0
8
3
0
1
206
0
7
0
11
63
66
13
37
3
5
0
0
0
0
0
3
81
1
6
1
0
0
0
27
3
18
3
0
0
11
5
3
1
0
7
0
21
2
0
37
8
21
0
108
32
1
2
0
0
12
13
5
0
1
8
1
0
17
0
0
9
0
2
2
2
1
0
0
0
0
0
0
0
3
0
0
1
2
9
8
4
1
0
0
0
0
0
0
0
0
12
1
0
0
0
0
0
2
1
2
1
0
0
0
2
1
0
0
1
0
2
1
0
9
0
0
0
0
2
0
0
0
1
2
0
0
0
0
0
0
0
2
0
0
1
4
1
1
1
0
12
0
0
0
0
3
0
32
1
0
0
1
6
13
6
2
0
1
0
0
0
0
0
1
10
0
1
0
0
1
1
5
0
3
0
0
0
0
0
0
1
0
0
1
3
0
0
9
0
0
0
3
2
2
0
0
0
3
0
4
1
1
0
0
0
5
0
0
1
6
0
1
2
0
12
2
0
0
0
2
0
16
2
1
0
0
0
5
2
1
0
1
0
0
0
0
0
1
12
0
1
0
0
1
' s
4
1
0
0
0
3
0
0
0
0
1
0
1
0
0
5
1
0
0
1
2
0
0
0
0
3
1
1
0
0
0
0
0
2
0
0
0
1
1
1
Atnr~Kitfi Survev ......■•■••
0
Rrru4fnrH Survcv- .....•••••-
0
Rrnword HD
3
3
Charlotte Survey
r;»ni» HD & Assn
0
0
0
^/>lli^r 5ijrvev .....••■•••
1
r'/\litf¥ittia 5orvev .......•••■
1
rvv4« HD & Assn
1
0
0
Dixie Survey
Diival HD
0
0
Jacksonville City HD
1
1
Esconhia HD
1
1
Godsden HD
0
Godsden Survey
0
0
0
0
H^Tnando HD & Aisn
0
0
HinkLiryK SurvCV ......••••
0
Hillsborough HD & Assn
Holmes Survev .....•■••••
0
0
Indion River HD
0
0
0
Lake HD & Assn
0
Lake Sorvev .......••••••
0
Lee HD
1
Lee Survey ••...•••■■•■>•
1
Leon HD
Lew HD & Assn
0
0
LiDertv Survev ......••••
0
Modisoo Survey
Mooatee HD
0
1
0
0
Monroe HD & Assn
0
0
0
Okeechobee Survey
Oonae HD & Assn
0
0
Osceola HD & Assn
0
Osceola Survey
Palm Beoch HD
0
1
Palm Beach Survey
Pasco HD & Assn
0
0
Pasco Survey
Pinellas HD & Assn
0
5
Polk HD
0
Polk Survey
Putnam HD
0
0
St. Johns Survey
St. Lucie HD
St. Lucie Survey
0
0
0
Sorosota HD
Sarosoto Survey
0
0
Seminole HD & Assn
0
Seminole Survey
Sumter HD & Assn
0
0
Suwonnee Survey
ToyloT Survey
Volusia Survey
Wakulla Survey
Walton Survey
Woshington Survey
0
0
0
0
0
0
Mentol Hospitals
0
State Prisons
3
'Includes: primary, military, other, and stoge unknown
196
ANNUAL REPORT. 1966
TABLE 30
RESULTS OF STATE X-RAY SURVEY UNITS, FLORIDA, 1966
70 mm X-RAYS
14" X
17" X-RAY FOLLOW-UP
5L
?
X
5
o
• -
u
FINDINGS
NEW CASES
BY STAGE
RACE AND SEX
AND AGE
a£
Minimal
Moderately
Advanced
■D
1
•*-
O
St
TOTAL
236,955
1877
115
199
32
25
48
10
48.5
RACE AND SEX
White mole
85,067
96,915
28,435
23,458
3,080
883
470
368
129
27
35
14
51
11
4
84
51
44
15
5
8
1
18
5
0
10
4
9
1
1
13
8
22
3
2
4
1
2
2
1
41.1
White female
14.4
Nonwhite male
179.4
Nonwhite female
46.9
Not stated
129.8
AGE
0-24
32,937
39,806
45,495
44,785
37,202
35,069
1,659
75
99
241
387
460
599
16
10
15
26
29
24
10
1
9
7
34
40
51
55
3
2
3
7
15
3
2
0
0
7
5
4
6
3
0
4
3
13
10
13
4
1
4
2
1
0
2
1
0
30.4
25-34
37.7
35-44
57.1
45-54
64.7
55-64
64.5
65 and over
28.5
Not stated
60.3
PREVENTABLE DISEASES 197
TABLE 31
TUBERCULOSIS CASES IN CENTRAL REGISTER, BY COUNTY, STAGE
OF DISEASE AND ACTIVITY, FLORIDA, 1966
Pulmonory Tuberculosis
Active Coses
J
J
1
u
<
•
m
1
1
^
.1
a.
I
i
z
At Home by
Soutum Status
COUNTY
2
1
I
_c
.1
1
J
0
?
Z
z
STATE
7165
1489
1029
4226
298
123
763
210
421
95
110
15
63
31
120
551
18
18
12
17
68
23
1121
28
10
687
232
10
9
55
5
6
18
15
21
20
13
65
701
22
69
62
7
5
94
no
86
17
8
23
83
76
47
40
14
57
6
234
23
489
50
415
327
47
44
111
19
98
78
24
24
19
3
172
6
17
23
54
22
4
4
6
20
78
3
5
1
5
21
3
266
5
1
159
44
2
4
9
1
2
1
1
6
7
2
18
132
2
11
5
. . .^.
11
33
24
2
1
5
14
10
9
10
1
11
1
50
9
72
10
132
65
6
8
34
3
22
16
8
6
4
' '44'
. . y
4
12
12
3
1
8
16
74
4
7
4
2
12
2
39
6
2
111
36
1
1
9
1
2
1
4
4
2
4
13
122
3
9
9
1
3
14
21
12
2
1
4
22
22
7
5
2
7
1
41
3
111
12
39
49
12
8
28
3
12
18
4
4
2
1
24
1
4
3
2
74
7
57
16
80
283
11
6
7
10
32
18
745
16
4
380
149
6
4
37
3
2
16
10
11
10
7
29
432
17
47
45
5
1
63
52
45
11
6
14
42
42
31
24
10
38
4
122
8
263
28
235
198
29
25
45
13
58
40
12
12
11
2
97
5
12
15
37
2
1
1
. . .^.
109
• • y
' '37'
1
2
20
3
1
4
9
. . .^.
1
1
* " '5'
3
4
• • • •
• • • •
3
2
"V
• • • •
1
• . • •
12
1
30
"V
8
■ ■ '3'
4
" *3*
3
• • • •
1
1
" "6*
• ■ • •
. . y
■ • . •
34
. . y
17
• ■ ■ •
• ■ * •
1
"V
6
. . y
2
5
3
3
3
11
44
. . .^.
• • -2'
14
1
161
3
1
82
28
2
3
5
• • • •
1
5
4
1
5
70
■ ■ '3'
2
6
1
1
4
10
1
1
1
2
2
" 48
1
" iV"
7
. . y
2
17
1
1
2
11
. . .^.
1
4
22
2
3
. . .^.
5
2
54
1
' "53
8
. . .^.
3
. . y
' ' V
3
1
5
42
1
6
. . . .
|UL»r
....
RrtV
• . • .
1
^^7
1
2
r*/ilk/vin .....>•••••••
....
....
....
riav
....
rAlliar
....
■ * 3'
H/vU
n«V«fn
....
niviA .......••■••••••>
• • • .
7
1
Floaler
....
. . .^.
f^ilrhritt .......••••••
• • • •
GImU.
. ■ • •
Gulf
• • • •
Hnmilfron .....•••••••••
• " " •
Hardee ^
H*ndrv
::::
■ ■ 6'
3
Hinhlnnds .....>••••••>
Hi 1 IcKoroiiaK ......«••••••
. . y
Jackson
1
Jefferson
V
1
1
2
• • • .
2
• • • •
• ■ « a
. . y
• • • .
• . • •
9
2
13
• • • •
2
7
• • • •
■ • • •
3
1
• • • •
1
1
. . y
• • • •
• • • •
1
5
10
17
4
9
5
2
3
1
5
' '26'
3
42
4
41
34
2
4
14
' *lV
5
6
3
2
■ • • •
26
■ • • •
1
" '12*
, . y
7
2
1
• • • •
3
3
'4'
' ' 5'
2
6
2
20
9
1
1
3
1
1
1
2
• • • .
■ ■ '5"
• • ■ »
2
• • • •
5
14
3
1
. . .^.
5
5
3
• y
1
19
' '2*4'
4
41
19
2
3
8
1
6
6
2
2
' iV
• ■ • •
1
Lake
2
Lee ] i [
Laon
' ' V
1
1
•^'X
Liberty
Modison
....
• • • •
1
• • • a
....
OkeecKobee
• • * •
Oronoe ••••••••••••
• • • •
4
Osceola
Polm BeocK
....
3
1
Pinellas
Polk
St. Johnt
• • y
St. Lucie .
1
4
4
Seminole • •••••
Sumter ««••••««•••*
• • ■ •
1
Toy lor
• • • •
Union , •••••■••*•>•••
■ ■ ■ •
2
Volusia
Wolcullo
• • > •
Wolton
• • • •
1
Woihinaton
Florida Prisons
198 ANNUAL REPORT. 1966
TABLE 32
TUBERCULOSIS CASE REGISTER STATISTICS, FLORIDA, 1962-1966
PREVENTABLE DISEASES
199
Tuberculosis Cases
by Activity, Location
ond Sputum Status
Number of Cases
Per Cent Distribution
1966
1965
1964
1963
1962
1966
1965
1964
1963
1962
TOTAL CASES IN
REGISTER
Active pulmonary
Quiescent pulmonary
Inoctive pulmonary
Primary pulmonory
Non-pulmonary
7165
1489
1029
4226
298
123
7195
1449
954
4378
291
123
7502
1552
98/
4525
304
134
7620
1688
896
4589
324
123
7694
1790
817
4765
250
72
100.0
20.8
14.4
59.0
4.1
1.7
100.0
20.1
13.2
61.0
4.0
1.7
100.0
20.7
13.2
60.3
4.0
1.8
100.0
22.1
11.8
60.2
4.3
1.6
•
100.0
23.3
10.6
62.0
3.2
.9
ACTIVE PULMONARY
Hosoi tali zed
1489
763
726
1449
860
589
1552
1026
526
1688
1202
486
1790
1240
100.0
51.2
48.8
100.0
59.3
40.7
100.0
66.1
33.9
100.0
71.2
28.8
100.0
69.3
At home
30.7
ACTIVE CASES AT HOME . . .
Positive sputum
hJeoative sDutum
726
210
421
95
589
212
294
83
526
198
256
72
486
140
274
72
550
130
298
122
100.0
28.9
58.0
13.1
100.0
36.0
49.9
14.1
100.0
37.6
48.7
13.7
100.0
28.8
56.4
14.8
100.0
23.6
54.2
Undetermined sputum
22.2
DIVISION OF VETERINARY PUBLIC HEALTH
JAMES B. NICHOLS. D.V.M.. M.S.
Director
The responsibilities of the division continued to be centered
around the control of animal diseases transmissible to humans. In
order to successfully accomplish this mission, statewide surveil-
lance of all known diseases in this specialized field is maintained.
Consultant services are continually provided by the division staff to
county health departments (CHD) and to private veterinarians and
physicians. Close liaison is maintained with state and federal
agencies in an effort to cooperate in matters of mutual interest
pertaining to animal health, and the production and handhng of foods
of animal origin.
Contact with private veterinarians through the animal morbidity
reporting system continues as an important function. In an effort
toward improving this important program, a new form was designed
to simplify reporting.
Arthropod-Borne Encephalitis
The program of surveillance and study involving this disease
continued to be one of the most important in the division. Viral
activity was continually monitored by the use of an effective sentinel
system. Animals used were horses, chickens and many different
species of wildlife. Specific details concerning the latter named
category are related under the activities of the biologist.
An early warning system for viral activity was provided for the
Jacksonville, Daytona and Orlando areas by placing small flocks of
chickens at strategic locations around those cities. These birds
were bled every three weeks throughout the summer and fall for
hemagglutination- inhibition (HI) testing. Sentinel horses located m
Broward and Palm Beach counties were likewise bled every three
weeks. While in general Eastern equine encephaUtis (EEE), Western
equine encephaUtis (WEE) and St. Louis encephaUtis (SLE) antigens
are included in the test battery for all species used as routine
sentinels, these vaccinated horses were tested for SLE only. Sentinel
coverage was provided by personnel of the University of Miami for
the Miami area, and for the Tampa Bay area by the EncephaUtis
Research Center. The division staff covered the remainder of the
peninsula.
So as to have a more complete statewide surveillance system,
privately owned smaU backyard chicken flocks were again selected
and permission obtained to coUect blood specimens for arbovirus
testing This program was conducted during the fall and winter, with
emphasis on rural areas, in an attempt to locate viral activity which
may have taken place during the past summer. Extensive coUections
were made from birds in 22 counties. A total of 375 chickens was
bled from 43 different flocks for HI testing.
Private veterinarians were again asked to report by telephone
aU clinically diagnosed cases of encephaUtis in horses. This effective
feature of the system provides im'ormation to the division director
which is of immeasurable value in determining when this disease
reaches epizootic proportions. AU veterinarians were encouraged
to submit serum to the State Board of Health (SBH) labora ory,
Jacksonville, for HI testing. This diagnostic aid has proved to be
quite valuable. As has been noted many times in the past, central
Florida was again the location of an epizootic in horses. An out-
break occurred during May and June in an area generally east of
Orlando. Cooperative action immediately taken by mosquito control
personnel in the affected area was considered responsible for pre-
venting the spread to humans.
The total number of reported horse cases increased from 46 in
1965 to 145 in 1966. Since the new reporting system by veterinarians
has been in effect for several years, the number of cases is con-
sidered to be an actual increase rather than better reporting.
Although EEE and WEE reactivity was greater, no SLE was
found during the year.
Brucellosis
Only three human cases were reported. The sources of infection
remain unknown aUhough each case was carefully investigated. One
of the victims was employed by a rendering plant where he was re-
peatedly exposed to the remains of Uvestock. A second victim had
recently Uved in Spain and had frequenUy consumed unpasteurized
miUc and cheese. The third case involved a person who had no
I
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200
ANNUAL REPORT. 1966
PREVENTABLE DISEASES
201
i
contact with farm animals but who had recently taken a trip and had
eaten in numerous restaurants where it is possible that raw milk
may have been served.
It is interesting to note that an active brucellosis control pro-
gram has finally started in several counties with a view of obtaining
certification where this status did not formerly exist. It is expected
that the work will progress so that the entire state will eventually
become a modified- certified area.
Leptospirosis
Nine human cases were reported with the majority occurring
during June. Three of the victims reported frequent contact with
dogs. Surveillance reports indicated that three additional cases
were probably contracted from dogs. The source of infection in two
of the cases was probably rodents while the cause of one was un-
determined. Tabulations from animal morbidity reports revealed
that there were 78 cases in large animals and 418 cases in small
animals. The slight decrease in large animals and the increase in
small animals quite likely reflects the population trends in these
species.
Rabies
The number of laboratory diagnosed cases in all species exam-
ined totaled 78. This is exactly the same number which was re-
corded last year. The total number of dogs and cats remained quite
low as was the case in recent years. There was a slight increase in
the number of positive raccoons and a notable decrease in the num-
ber of bats.
In August, a raccoon rabies investigation was conducted in
Pinellas County, after three rabid raccoons were found in the vicin-
ity of Lake Tarpon. There was some concern that a rabies epizootic
might develop and spread to the large populations of raccoons in
both Howard and DeSoto Parks. All animals trapped during this in-
vestigation were negative for rabies upon laboratory examination.
As a result of eight laboratory confirmed cases of fox rabies in
Jackson County during November and December, the decision was
made to determine the population levels of foxes in that area and
adjacent counties. Random-track count surveys initiated in Decem-
ber will continue through the spring of 1967. If this high incidence
of fox rabies continues and begins to spread to other counties, these
surveys will aid in the formulation of an organized control program.
The previously mentioned new form for animal morbidity re-
porting contains a space for the listing of rabies vaccinations ad-
ministered. If this form is adopted it will enable CHDs to determine
the number of animals vaccinated and at the same time calculate the
level of immunization. Measures to increase the vaccination rate
can then be taken whenever necessary. Personnel of CHDs and pri-
vate veterinarians were encouraged during meetings and by personal
contact to promote the annual vaccination of pets at every available
opportunity. Various promotional methods were offered for their use.
The SBH distributed sufficient rabies vaccine for 553, l^-dose
treatments. Of the total, 152 were of nervous tissue origin, and 401
were duck-embryo. In addition, 225 vials of hyperimmune serum
were distributed.
Salmonellosis
A new phase of surveillance in the zoonotic field was inaug-
urated early in the year when the decision was made to Participate
in a program sponsored by the Communicable Disease Center (CDC),
U S PubUc Health Service (USPHS). Surveillance personnel of CDC
specified the food or food product to be sampled. Each month from
20 to 60 specimens were obtained from retail and wholesale outlets
throughout the state and submitted to the Veterinary Public Health
Laboratory, CDC, for testing. Even though Salmonella was the prin-
cipal microorganism of concern, tests were also conducted for other
enteric pathogens.
Frequently incriminated foods were the ones selected for testing.
Since powdered milk has been known te be contaminated with Sal-
monella, this item and several other food items including milk,
cocoa mixes, and cake mixes that contain powdered miU. were col-
lected and submitted for tests, aher products selected were head
cheese, ground beef, food coloring and frozen eggs.
Of \he 324 food samples collected in different parts of the state
that were tested by CDC, the only noteworthy contamination occurred
in frozen eggs.
There has been a great deal of concern nationwide in respect to
the presence of Salmonella, organisms in dried milk products m
consumer packages. One of the division milk consultants is on a
commiUee of the National Conference on Interstate Milk Shipments,
studying the need for further regulations for the production aJid Pro-
cessing of these products. All data gathered thus far indicate there
is a necessity for immedmte action in this area. This is to be con-
sidered at the National Conference in Miami during April, 1967.
Bovine Tuberculosis
The bovine tuberculosis control program of the state was con-
ducted by the U. S. Department of Agriculture (USDA), and the Flor-
ida State Department of Agriculture (FSDA). CHDs cooperated m
this program insofar as dairy cattle were concerned in connection
with their local dairy inspection programs.
202
ANNUAL REPORT. 1966
During the year a total of 1569 herds consisting of 169,760 head
of cattle was TB tested. There were 129 reactors. The annual test
required by the FSDA dairy division has been responsible to a large
degree for the low rate of bovine TB which the state has been
privileged to have.
Other Zoonoses
A laboratory confirmed case of psittacosis in a parakeet in Palm
Beach County and the concurrent illness of several members of the
family that owned the bird was investigated. Serologic tests per-
formed did not reveal that the illness in the family members was
due to psittacosis. The supplier was contacted in an effort to de-
termine the source of infection, and local retail outlets were kept
under surveillance while this case was studied. No additional cases
were diagnosed.
Late in the year it was learned that rabbits used for training
greyhounds had been shipped to Florida from New Mexico. A ship-
ment from an area where plague was known to exist was stopped,
and a general alert relating the dangers involved was sent out to
CHDs, private veterinarians and users of these suspect animals.
Cooperation was excellent, and it is felt that this incident will serve
as a reminder that a real danger may exist with rabbits obtained
from plague -infected areas.
A complaint about persons contracting ringworm from dogs pur-
chased from a pet shop was investigated. Animals examined revealed
numerous lesions which were later confirmed to be caused by a type
of fungus which is transmissible to man. Similar incidents have
prompted the Florida State Veterinary Medical Association to adopt
a resolution requesting that the SBH promulgate regulations per-
taining to the health of animals sold and the general sanitation of pet
establishments.
WILDLIFE BIOLOGY
The biologist's efforts continued to be directed primarily toward
the arbovirus control program. In addition to assisting in epidem-
iologic investigations and surveillance activities, the wildlife popu-
lations of two special study areas were periodically sampled. An
attempt was made to detect an increase in EEE activity in selected
foci of infection, and to identify avian, mammalian and reptilian
species that might be serving as amplifying hosts or over- wintering
reservoirs.
This year approximately 400 blood specimens from wild birds,
mammals and other vertebrates were HI tested by the SBH Central
Laboratory for evidence of arbovirus infection. Nine different
species of birds revealed serologic evidence of EEE and/or WEE
infection. Evidence of past SLE infection was found in only one
animal, an armadillo of undetermined age.
PREVENTABLE DISEASES
203
In a special survey of wildlife populations across the southern
part of the state, blood specimens were collected from birds ^d
mammals and the sera were HI tested for the presence of antibodies
to Venezuelan encephalitis. No reactivity was noted.
A number of virus isolation attempts were made on tissue speci-
mens collected throughout the year. On one occasion EEE virus was
isolated from the heart of a loggerhead shrike obtained during the
previously mentioned epizootic in Central Florida. As a result of a
routine investigation of an outbreak of encephalitis in a group of
pheasants at a game farm, tissue specimens were collected from
two bluejays. One of these yielded the first isolation of California
encephalitis virus in a bird.
In February, Encephalomyocarditis (EMC) virus was found to be
responsible for a high rate of mortaUty in a herd of garbage-fed
swine in Polk County. Inasmuch as this disease has public health
implications, an epizootiologic study was conducted in cooperation
with the Animal Disease Diagnostic Laboratory, FSDA. EMC virus
was isolated from swine, cotton rats and a raccoon. Serum-
neutralization antibodies could not be demonstrated in the sera of
the owner, his family, the wild animals or any domestic livestock
other than swine.
During May and June the division had occasion to investigate a
suspected outbreak of toxic algal poisoning. At least two dogs from
a lake shore community in Polk County had died after drinking lake
water. Histopathologic studies of these animals showed an acute
toxic hepatitis and nephritis of undetermined etiology. Samples of
the blue- green algae Microcystis aeroginosa collected from this
lake killed test animals in experimental feeding trials. This study
was in cooperation with the Animal Disease Diagnostic Laboratory,
FSDA.
MILK SANITATION
There has been a continuation of programs which were in pro-
gress last year with some expansion in certain areas. The benefits
of repeated emphasis on high sanitation compliance by producer
dairies and processing plants are becoming much more apparent
each year.
A 'T)irectory of Sanitation Compliance of Milk Plants" was com-
piled and made available to all CHDs and tax- supported institutions
in the state. Only those plants and producers having a 90 per cent
compliance rating were placed in this directory. A total of 42
establishments attained this status and was listed in 1966. In ad-
dition to the state directory, eligible plants (and producers) must
also appear in the "Interstate Milk Shippers List," published by the
USPHS, in order to be considered for contracts by the U. S. Armed
Forces. This listing will become mandatory January 1, 1967. An
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ANNUAL REPORT. 1966
awareness by industry of the importance of these developments has
greatly implemented the accomplishment of better milk sanitation
control programs statewide.
Considerable time has been devoted to working with CHD milk
sanitation personnel in the development of a bovine mastitis screen-
ing test. This is in keeping with an interstate milk shippers' agree-
ment that all states would be conducting an active program for
mastitis detection by July 1, 1967.
The division director and the milk consultants have been engaged
in a cooperative effort with FSDA in the preparation of a proposed
statewide milk law. This will encompass the essentials of the 1965
Grade A Pasteurized Milk Ordinance recommended by the USPHS.
SUMMARY OF AaiVITIES
OF MILK CONSULTANTS FOR 1966
Visifs to counties 121
Dairy farm inspections 799
Processing plant inspections 66
Frozen desserts plant inspections ^2
Dairy form plarw reviewed • '
Processing plant plarw reviewed 3
Participation in training schools 5
PREVENTABLE DISEASES
TABLE 33
CASES OF ANIMAL RABIES BY COUNTY,
BY SPECIES AND MONTH, FLORIDA, 1966
205
COUNTY
Dog
Cat
Fox
Raccoon
Skunk
Bat
Hog
Total
1
I
2
A\f*r\uta
" 'l '
1
1
1
Brodf ord
2
1
CitTU*
1
3
3
Cloy
2
2
Dode
0«Soto
1
3
' * *l' "
1
5
1
1
1
3
1
Escambia
FloflUf
■ *3 ■ *
' 'l* * *
Gilchrist
1
Gutf
Horde*
Hemondo
1
2
2
3
"{"
1
1
2
' " 13* *
2
2
16
Hillsborough
Jackson
Jefferson
Lak«.
L«oo
Modison
" "l"
"i"
' 'l' ' '
1
9
1
1
1
3
2
Monatee
1
2
* * 'l* ' *
2
1
Marion
Orong*
"i"
5
1
4
Pinellas
Polk
1
' * 1* * '
3
8
2
Putnam
Sf . Johns
1
1
MONTH
January
1
1
1
1
February
6
1
March
April
" i"
7
2
4
May
1
1
4
Jwn*
1
1
2
7
2
July
' "l" "
8
16
August
4
3
1
September
October
"{"
* 2
' "l' '
10
November
1
5
1
2
7
December
2
3
TOTALS
4
3
10
37
2
21
1
78
ii
206
ANNUAL REPORT. 1966
BUREAU OF RESEARCH
ALBERT V. HARDY. M.D.. Dr.P.H.
Director i
During the year under review, ongoing research was continued
without expansion. The director of the bureau served concurrently
as acting director of the Bureau of Preventable Diseases. This
proved a demanding assignment leaving limited time for research
interests.
The coordination of all studies of vector borne viral encephalitis
had highest priority. The Encephalitis Research Center at Tampa
continued its well designed investigations. It was a time of patiently
adding observations. There was no outbreak or evidence of St. Louis
encephalitis activity. Substantial numbers of suspect cases of viral
encephalitis were reported most of which after investigation were
still classified as etiology undetermined. Both Eastern and Western
encephalitis were in the state though manifest chiefly by the charac-
teristic disease in unvaccinated horses. Outside the four county
area of Hillsborough, Pinellas, Manatee and Sarasota, in Jackson-
ville, an Eastern infection was identified in an infant under one
month of age with resulting marked brain damage. Members of the
California group of viruses were found frequently and these infec-
tions are the focus of increasing attention.
In the Entomological Research Center at Vero Beach, the host
preference studies became well established. By cooperative agree-
ment, mosquitoes collected by the staff of the Encephalitis Research
Center are accepted for examination. The biologist in the Division
of Veterinary Public Health had a productive year of collecting
material from wildlife. Mosquitoes trapped by workers in the
Bureau of Entomology yielded a variety of viral agents. The viral
diagnostic unit of the Jacksonville Laboratory increased its capacity;
that portion of the Encephalitis Research Center moved into new and
expanded quarters in the Tampa Regional Laboratory. The year's
work again emphasized that Florida is in a strategic site for the
study of arboviral diseases and that a cooperating staff of high
competence has been developed in the State Board of Health (SBH).
A fatal case of encephalitis in a young adult male in Orange
County directed attention to another possible etiological agent. This
was the fourth case in that county within the past four years caused
by Acanthameba , a free living ameba found in fresh water lakes.
Initial identification in all cases was made by Cecil G. Butt, M.D.,
pathologist at Orange Memorial Hospital. The accuracy of the diag-
noses has been confirmed by other authorities. The case records
suggest that the hazard may be limited to those spending prolonged
periods in freshwater lakes, with much deep diving. The Acan-
thameba presumably gains entrance through the nasal passage. That
four cases of this rarely diagnosed infection occurred in one county
RESEARCH 207
raised a question as to whether there may be a particular hazard in
Central Florida lakes. A conference of interested physicians and
scientists was convened at Orlando to discuss this interesting entity.
It served to make more widely available information on this con-
dition. It was agreed that all those concerned with the diagnosis or
study of encephaUtis needed to be alerted to the possibility of meet-
ing this infection. Biological studies of the distribution of this free
living ameba in Florida lakes warrant consideration. A majority
opinion held that in view of the limited knowledge and the rarity of
the condition, no closing of lakes to swimming would be justified at
the time. . , . , i.-
The ongoing studies of the unclassified mycobacterial infections
were a source of continuing interest. There was an impressive in-
crease in the number of cases identified with a small modification
in technique of preparing sputum specimens for cultural examination.
That these organisms are rather common in sputum is increasmgly
evident. Their role in disease production, however, is not yet se-
curely clarified. Hopefully the analysis of the massive amount of
accumulated data will provide answers.
The Bureau of Research had the responsibiUty for recommending
on the expenditure of General Research Support funds. The alloca-
tions have been approximately $100,000 annually. The purpose is to
use these to foster the favorable development of research in the
agency or institution. During the year this support had high impor-
tance in continuing an investigation in the Division of Radiological
Health during an interval between one research grant period and the
beginning of a subsequently approved terminal grant. It also per-
mitted the expansion of studies in the EncephaUtis Research Center,
for which continuing support is being requested from both state ap-
propriations and federal research grant funds. Research equipment
and, to a Umited extent, suppUes have been purchased. Throughout
the year a total of 22 persons received support for limited or more
extended periods.
One of those whose services is made available through Oenerai
Research Support is the science writer and editor who is a staff
member of the Bureau of Research. His time is in increasing de-
mand for the review, editing and often rewriting of reports of re-
search findings. Two monographs were published during the year
and a third is in preparation.
Another writing task has been assigned to the bureau. The editor
of The Journal of the Florida Medical Association proposed that each
monthly issue would have one page in the editorial section devoted to
subjects of concern to the SBH and of interest to physicians in pri-
vate practice. Content for these is being collected from senior staff
members. The editorials are being written by the director of the
Bureau of Research, edited by the science writer and signed by the
staff members concerned with the programs or problems under re-
view. While the series is to begin in the January, 1967, issue, it was
necessary to prepare in 1966 the copy for four months in advance.
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208
ANNUAL REPORT. 1966
BUREAU OF SANITARY ENGINEERING
DAVID B. LEE. M.S.. Eng.
Direc+or
SIDNEY A. BERKOWITZ. M.S.. Eng.
Assis+ani Director
The division and field functional program reports which follow
summarize the basic activities undertaken and the achievements.
Considerable effort was devoted to preparation of material re-
lating to staffing and other needs, with particular emphasis on air
and water pollution control programs. Much time was devoted to
meetings and hearings of the Governor's Advisory Committee on
Water Pollution, which was appointed to develop a response to the
Federal Water Quality Act of 1965.
REGIONAL OFFICE ACTIVITIES
Central Region
A survey of Silver Springs was conducted with fluorescein dye
tests being carried out during the month of February and a sampling
program for chemical analysis throughout the year. Surveys and
reports were made on Lake Shadow in Orange, a portion of South
Lake County Chain of Lakes in Lake County and Lake Fairy in Sem-
inole County. Sampling and chemical analyses to update the 1962
Howell Branch- Lake Howell Survey report were completed. Field
visits and spot checking were done in various lakes in Orange County
in response to reported fish kills.
Laboratory personnel conducted a program of assistance to
sewage treatment plant personnel with regard to proper procedures
for routine analyses. Personnel also composited samples at various
waste treatment plants for analysis in the engineering laboratory.
The backlog of unpermitted swimming pools was considerably re-
duced. Considerable progress was made in obtaining operational
reports from waste treatment facilities. Reports are received from
160 installations. We reviewed, acknowledged and commented on 585
reports from sewage treatment plants other than municipal and sub-
division types.
Assistance was given in setting up a bacteriological sampling
program in Citrus County shellfish waters. County health depart-
ments (CHDs) were assisted in setting up bacteriological sampling
programs for proposed bathing areas. All sewage disposal facilities
in the region under the jurisdiction of the Division of Corrections
were inventoried.
Some major activities of the regional staff included visits to 139
water treatment plants, 42 industrial waste treatment plants and 362
sewage treatment plants. Inspections were made on 221 swimming
i
SANITARY ENGINEERING 209
pools and 53 water supply well sites. A total of 175 radiological
samples was collected. Of the 60 various types of plans reviewed,
19 were approved. The staff also handled 7276 bacteriological re-
ports and 6988 sanitary chemical analyses were made.
Staff participated in the twelfth annual short school for Region 3
in Ocala and participated in planning for the first annual short
school for Region 9 to be held in Orlando.
Northeastern Region
As pointed out in last yearns annual report, stream pollution
surveys were conducted on the Ribault River, Intracoastal Waterway,
Lake Wonderwood and Suwannee River and its tributaries. This
year follow-up surveys were made to accomplish the recommenda-
tions as outlined in the original surveys. Fortunately, there was
considerable success in working with the industrial plants found to
be polluting the Ribault River though many conferences and discus-
sions with threat of legal action were necessary in some instances.
Samples have been collected from the Suwannee River as well as
other rivers and streams throughout this region as part of the
routine monitoring survey. A very limited survey was conducted in
the St. Johns River in the vicinity of Palatka and at the confluence
of Rice Creek and the St. Johns River. In addition, surveys in the
St. Johns River in the vicinities of Green Cove Springs and Orange
Park were conducted; a survey of Doctors Inlet was continued. More
water and sewage treatment plants were visited in an effort to ob-
tain better operation and more efficient treatment. To a degree,
this has been accompUshed, but much still needs to be done.
The interstate highway extension and the expanded development
of motels, restaurants and other estabUshments all along these
highways still demand attention. The staff has been successful m
consoUdating some of these developments into water and sewage
treatment plants, but due to the rate of expansion and growth, many
of the companies involved are reluctant to commit themselves smce
they could possibly be delayed pending negotiating with the owners
of these utilities.
Personnel from this office participated in the regional short
school conducted in Jacksonville for training of water and sewage
treatment plant operators.
Due to the emphasis by all news media on water and air pol-
lution, the number of telephone calls this office has received re-
questing information, complaints, etc., has greatly increased. The
staff attended many meetings and made several talks to various
groups in regard to this subject.
The swimming pool program continues to grow. The staff in-
spected and issued permits on 36 pools this year. The issuance of a
*fr
210
ANNUAL REPORT. 1966
1 ;;
permit requires one or more visits. Inspection of old pools in ad-
dition to the newer pools continuously increase the daily workload.
The review of plans and specifications of septic sand-filter in-
stallations continues to be a function of this office. Last year a total
of 87 projects was reviewed of which 72 were approved. This repre-
sents an estimated $150,000 worth of treatment facilities constructed.
Northwestern Region
The water quality program of the Northwest Florida area is de-
signed around a continuous surveillance program of its various
drainage basins. This program operates by the use of continuous
monitoring stations, routine surveillance stations and surveys. All
of these methods include chemical, biological and bacteriological
analyses.
A survey of the Perdido Basin was initiated with the general
findings being that water quality in the Basin is acceptable. Eleven
Mile Creek is still considered polluted, but is becoming less so each
year. Minor problems were created by the county- ope rated landfill
program but with changes in the procedures these problems were
eliminated. A considerable amount of work was completed on the
Escambia River. The collected information is appropriately com-
piled and available for study. Assistance was given the Federal
Water Pollution Control Administration (FWPCA) during its investi-
gation of alleged changes in the upper reaches of the Escambia
River. Pensacola Bay continues to have a bacterial pollution prob-
lem, but with the completion of construction of the City of Pensacola
sewage treatment plant, this problem will be eliminated. The bac-
teriological quality of the Blackwater River near Milton indicated
considerable improvement. With the contemplated use of the Deer
Point Impoundment as a public surface water supply, surveillance of
the Econfina Creek and the intake of the pumping station were the
major considerations in the St. Andrews Bay area. In general, con-
ditions are excellent in this area. Surveillance and monitoring of
Attapulgus Creek and the Ochlockonee River indicate no major prob-
lem in the Ochlockonee Basin. In the Apalachicola Basin the Chipola
River has fair water quality. With the completion of the Marianna
secondary treatment plant, further improvement will be forthcoming.
Investigation following report of a fish kill in Lake Seminole indi-
cated that the cause was related to mosquito control spraying rather
than industrial or domestic wastes. Due to a proposed new paper
mill at Sneads, the river below the Jim Woodruff Dam received con-
siderable attention. The water quality is excellent as of this date.
The start up of a hardboard mill operation in Blountstown has not
affected the river.
In the continuing shellfish harvesting area program, surveillance
was carried out in Escambia Bay, Choctawatchee Bay and in the
Apalachicola Bay region.
SANITARY ENGINEERING 211
An air poUution potential study began in lower Escambia County.
High volume samplers, equipment of the U.S. PubUc Health Service
(USPHS) and Air QuaUty Network Program are in use at Pensacola.
and in Panama City. The sampling schedule has been conducted by
the regional staff in Pensacola and the Bay CHD. Several small air
pollution problems exist. These are, Floridin Company i^ Qumcy
with dust from a diatomaceous earth operation, Michigan Chemical
Company with dust from a small sawmill operation in Caryville.
The odors from the Escambia Chemical Company mills have created
a nuisance problem.
Approval was given for 15 new water supply systems, 11 im-
provements or extensions to existing water supply systems, 31 new
waste water systems, 13 improvements or extensions to existing
waste water systems. A total of 20,669 chemical biological and
bacteriological analyses was made in addition to 5210 bacteriolog-
ical reports processed.
Southeastern Region
Most of the activities this year have been conducted at the re-
quests of the various CHDs and in cooperation with their personneL
While no great accompUshments have been obtained, considerable
progress has been made in defining some of the more important
problems and in redirecting the activities of this region to handle
some of these problems.
One of the major sources of trouble has been the shellfish pro-
gram. Some progress has been made in delineating the areas that
are suitable for the safe harvesting of shellfish and some degree of
pubUc acceptance of this has been achieved. There remains a great
deal of work in defining the pollution problem and estabUshmg a
truly effective control program.
The problem of agricultural drainage became very controversial
in the case of the Loxahatchee River and a number of state agencies
became involved. It appears that this problem may be at least
partially solved so far as the Loxahatchee is concerned.
A different type of agricultural drainage and industrial waste
problem has appeared in Okeecho.bee County where an expanding
dairy industry has brought on a manure disposal problem from large
herds of cows. This case illustrates the impact of economics on
pollution. Since it is cheaper to buy fertiUzer and have the fertilizer
vendor spread the material, the manure is simply washed into the
nearest stream as the easiest way oi disposing o it instead c>f
spreading it back on the fields for its fertilizer value. Attempts
were made to persuade the dairy owners to go back to spreadmg this
material. Some are already doing this with equipment developed for
the purpose.
Another problem involving this office was the very insanitary
sewage conditions at the Grand Prix auto race at Sebring. Some pro-
gress has been made on this but not a completely satisfactory solution.
II
II
212 ANNUAL REPORT. 1966
A new problem has arisen in the area served by this region and
steps were made to bring it under control. The boom in camping and
travel trailers has created sanitation needs in recreational areas
far removed from water supply and waste disposal facilities. Not
only is there a need to provide these facilities for the use of the
campers, but also to protect the pristine conditions that made the
campsites so desirable. There has been considerable recognition
of the need for these facilities, and it is hoped that the problem will
be brought under control before it becomes serious.
Southwestern Region
This year has been one of many great changes. In the latter part
of 1965 Manatee CHD employed a sanitary engineer, and by Janu-
ary 1, Manatee County was no longer considered part of the South-
western Region. This change removed a great load from this office.
The Southwestern Regional office was moved from Bradenton to
Punta Gorda. This change was made possible by the combined
efforts of the Charlotte County Board of County Commissioners and
the Charlotte CHD.
Some of the backlog of unpermitted swimming pools have been
handled during this year. New permits were issued to 38 swimming
pools in the eight counties of this region and swimming pool permits
were reissued to several establishments which have public swim-
ming pools. During the year there were 85 visits to public swim-
ming pools and bathing beaches.
There have been some outstanding and unusual projects in the
field of public water supply in this area. One of the most outstanding
is the new water system developed to serve water to Pine Island,
Matlacha, Sanibel and Captiva Islands. The drinking water quality
for the City of Sarasota has been greatly improved from water ob-
tained near the DeSoto and Manatee County lines. Public water
supply projects that have been proposed or were under development
during the year include a system to serve Vanderbilt Beach, Col-
lier County; mainland water supply for Fort Myers Beach and Boca
Grande in Lee County and a central water system for the community
of Immokalee in Collier County. Work is also being done on a county
water system for Sarasota County.
There were 79 visits to public water systems, a number which
is inadequate for proper surveillance of this responsibility. Site in-
spections for water wells location entailed 21 visits.
In the area of sewage collection and sewage treatment, the activ-
ity also has been quite heavy in expansion of existing plants and in
building of new ones. Those sewage treatment plants that were
grossly overloaded were at Kensington Park in Sarasota County, City
of Naples in Collier County and Punta Gorda in Charlotte County.
I>unta Gorda has employed consulting engineers to work on the
SANITARY ENGINEERING 213
problem. The equipment for the Kensington Park plant is to be
ordered in January, 1967. The Naples sewage treatment plant ex-
pansion will probably be completed by May, 1967. A total of 74 visits
were made to sewage plants but many more need to be mspected.
Stream pollution problems stiU existing due to untreated sani-
tary waste are the City of Everglades dumping into the Barron
River, Boca Grande dumping into Charlotte Harbor, La Belle, the
Russell Park subdivision and the Twin Palms areas dumping into the
Caloosahatchee River. La Belle is presently arranging financing to
solve the sewage problem; legal action against the City of Ever-
glades has been instituted.
Other poUution problems involved are those caused by industrial
plants such as a citrus plant at Wauchula in Hardee County and a
citrus plant at Arcadia in DeSoto County. The canals around Lake
Okeechobee are being affected periodically, and in some cases con-
tinuously, during the time of operation of the sugar mills m Hendry
and Glades Counties. These sugar mills need to up-grade their
treatment processes to handle their industrial waste in a much more
satisfactory manner. There is also industrial waste being dumped
into Peace River by a naval stores plant at Nocatee in DeSoto county.
Nine visits were made lo industrial waste plants.
In the field of air pollution the problems have not been bad but
they do exist. Three air pollution problems were investigated with
personnel from the central or Winter Haven office. Complaints were
received on smaller incinerators during the start up of incmeration.
The particular air pollution problem caused by the sugar mill m-
dustry around Clewiston stiU continues. The odor problems around
some of the sugar mill plants are extremely bad and it is rather
difficult to teU people that odor is not a serious air pollution prob-
lem. An air pollution problem also exists at Boca Grande m Lee
County from the phosphate loading docks.
There has been one regional short school for water and sewage
plant operators held in Fort Myers. A four-hour short school on
operation of the smaller package sewage treatment plants was held
in Sarasota County with the cooperation of both the Sarasota and
Manatee CHDs. Similar training schools appear necessary in the
future and will be appropriately scheduled.
A great deal of effort was put into the ManaSota 88 Project in the
Manatee and Sarasota areas. During the latter part of Uie year a
survey was run on the PhilUppi Creek Drainage Basin m Sarasota
County. This creek receives many gallons of treated sewage waste
and untreated waste from septic tanks. The report should be com-
pleted during the early part of 1967.
Demonstration work was initiated in using a pre-determined
amount of herbicide (2, 4-D) for hyacinth control in the freshwater
impoundment of FHmta Gorda.
;i
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214 ANNUAL REPORT. 1966
WINTER HAVEN REGIONAL STAFF
The Winter Haven regional staff continued its program in the
two basic disciplines— water quality control and regional engineering
assistance. The staff conducted 22 special studies, emplojring bio-
logical, bacteriological and chemical analysis. These investigations
included potential or suspected pollution caused by municipal sewage
treatment plants, natural factors, aquatic weed control, and in the
fertilizer, citrus, insecticide and dairy industries. These studies
took place in Citrus, DeSoto, Glades, Hardee, Hillsborough, Martin,
Okeechobee, Orange, Pasco, Pinellas, Polk and Sarasota Counties.
Eight fish kills were investigated in Polk and surrounding coimties.
Kills were attributed to agricultural waste, citrus waste, sugar mill
waste, fertilizer waste, weed control and natural causes. The USPHS
was assisted in a three-week survey for radioactivity in well water
surrounding a phosphate plant.
In addition to the special activities noted, routine sampling of
the Alafia, Hillsborough, Peace and Withlacoochee Rivers was con-
ducted. Also, the watersheds which make up these rivers were
sampled. The sampling periods vary from weekly to quarterly, de-
pending on the pollution potential of sources present.
Cooperation with the Winter Haven High School Research Science
Program was continued. Two students were accepted by the labora-
tory as part of their chemical, physical and biological curricula.
They spent three afternoons a week on special projects assigned by
the supervising chemist. Personnel from the Winter Haven office
taught in one short school for sewage plant operators and late in the
year began teaching chemistry and mathematics in a continuing
school for water and sewage plaiit operators.
Staff personnel provided training and consultation to several
CHDs: Hillsborough, Manatee, Pinellas, Polk and Sarasota. In ad-
dition, advice and consultation were provided on laboratory pro-
cedures to the Pasco Packing Company, Minute Maid Company,
Occidental Agricultural Chemical Corporation, Adams Packing
Company, Florida Phosphate Council, Game and Fresh Water Fish
Commission, University of Florida, U. S. Geological Survey and
Florida Forestry Service.
Monthly meetings of the Peace River Basin Board and the South-
west Florida Water Management District were attended in order to
maintain liaison with their current activities. The staff also de-
livered talks to various organizations in order to disseminate
information and develop public relations.
The survey of the Winter Garden Citrus Co-op, Orange County,
was the final one of several over a period of three to four years.
This survey resulted in the filing of legal action against the company
to abate pollution of Lake Apopka.
SANITARY ENGINEERING 215
TABLE 34
ENGINEERING LABORATORIES,
BASIC WATER QUALITY DATA, FLORIDA, 1966
LABORATORY
ll
50
^ o o
200
^
••
•
J
S c-o
ill
-c J5 •
uOq
•
_o
S
Zo
••
I
i
o
o
••
1
c
_o
"•
u
1
Jacksonville
Winter Haven
Orlando
Pensocola
193
768
960
847
217
1210
559
506
300
2127
826
528
809
991
333
320
109
1681
' iV
192
35
65
315
252
82
322
430
569
4516
1039
185
172
2130
295
27
17,000
16,200
1768
4586
2589
1293
TOTALS . . . .
2768
2492
3781
2453
1808
607
1086
6309
2624
33,200
10,236
•Miscelloneoo* includes: phenols, cyanides, sorfactonts o»>d other specialized onolyses.
FINANCIAL AID FOR WASTE TREATMENT CONSTRUCTION
The financial aid provided through the FWPCA continued to be an
impetus to the construction of sewage treatment facilities for mu-
nicipalities. Data on this program for the fiscal year 1966-67,
follows:
Federal allotment for fiscal year 1966-67 $ 3,097,400.00
Unencumbered funds from allotments for
previous fiscal years 544,800.00
Total amount available to applicants qualifying
for a grant for the current fiscal year 3,642,200.00
Number of applicatiorw received 43
Estimated costs of overall projects 35,427,900.00
Federal grants requested 7,262,471.00
Assistance provided from this source was made by the FWPCA to
Pensocola, Fort Walton Beach, Coral Gables, Milton, Pohokee, Dania,
St. Petersburg, South Miami, Clearwater, Homestead, Oakland Park,
Holmes Beach, Titusville, Doytona Beach, Umatilla, Fort Pierce,
Gainesville, Avon Park, Fort Meade, Crestview, Cape Canaveral and
Cross City. .
DIVISION OF INDUSTRIAL WASTE
VINCENT D. PAHON. M.S.S.E.
Director
This division has as its primary responsibility the control of the
quality of liquid waste from industrial plants, air pollution, the
facilities for mechanical refuse disposal and regulation of the in-
stallation of drainage wells. It is also concerned with obtaining
background radiological data.
These responsibilities are discharged through the avenues of
plan review, air and water sampling and technical assistance to
local governmental agencies.
if
it',
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216 ANNUAL REPORT, 1966
Personnel of the division were involved in joint presentation with
the University of Florida and an instrument company in putting on a
gas chromatography course for both chemists and other technical
personnel designed to provide familiarization with this analytical
technique. In addition, a one-week course on Elements of Air Quality
was presented jointly with the U.S. Public Health Service (USPHS) in
Tampa. This provided certain basic knowledge to those attending,
which included personnel from the State Board of Health (SBH),
county health departments (CHD) and industry.
A considerable amount of time has been spent with personnel in
reviewing proposed ordinances and legislation intended to be pre-
sented for better local pollution control. Much effort has also been
expended to try to help counties provide improved environmental
conditions, such as solid waste handling and disposal.
WASTE TREATMENT FACILITIES APPROVAL
The number of waste treatment facilities approved decreased
considerably in 1966. However, it should be pointed out that the
estimated cost as well as the population equivalent was considerably
greater than during the previous year. The decrease in numbers
was due to a smaller number of laundry waste treatment plants. The
approvals also included waste treatment for two large phosphate
processing plants, plating plants, the expansion of a synthetic fabric
producer and a variety of other plants. Work was almost completed
on expansion of Leesburg's sewage treatment plant designed to pro-
vide treatment for process waste water from Minute Maid citrus
concentrate plant. It is expected that construction will be completed
during the early portion of 1967.
Some difficulties continue to be encountered on the follow-up of
previous work on the Ribault River, Jacksonville. A meat packing
plant built and placed into operation a satisfactory waste treatment
plant. Legal action was instituted against one firm and it is expected
that it and the other companies involved will continue to make satis-
factory progress in the near future, culminating in the provision of
adequate sewage treatment plants.
EKiring the previous processing season, one sugar company in-
stalled and operated an experimental waste water treatment plant
designed to provide treatment for cane wash waters. The washing of
cane was discontinued and with it, the operation of the experimental
facility, at the start of the 1966 season. Since the sugar industry is
one which is in a fairly concentrated area and has a large pollution
potential, work was continued as far as surveillance of this industry
and its waste disposal practices, and continuing attempts to attain
improvement in the quality of waste waters released are being car-
ried on. One of the oldest mills in the state was closed down be-
cause of economic reasons.
SANITARY ENGINEERING 217
Preliminary information was furnished this agency concerning
possible location of a large pulp and paper plant. The suggested site
is on the Apalachicola River. Air and water criteria were furnished
to the representatives of the owners and subsequently another con-
cern proposed the location of a similar installation in close prox-
imity. It now appears that only one of the two facilities or plants
will be built in this general location. If the proposed construction
becomes a reality, the miU wiU be required to provide an extremely
high degree of treatment to protect the downstream water users,
including the shellfish harvesting areas at the mouth of the river.
An administrative hearing was held in Winter Haven concerning
the failure of a phosphate company operation in the Central Florida
area. This failure resulted in the release of a small amount of
phosphate mining waste to adjacent waters. During the course of the
hearing, it was brought out that the failure was caused by the col-
lapse of a valve. There was no previous record of any such failure.
The company, as a result, has instituted new protective measures to
prevent such unauthorized release of waste waters.
Because of a high build up and concentration of dairy industry in
the South Florida area, a meeting was held to explore possible so-
lutions to disposal of soUd and Uquid waste resulting from such
operations. The dairy industry has been requested to take steps as
soon as possible to properly dispose of such waste materials so that
the waters of the state will be protected.
As previously reported, a new type of detergent material was
placed on the market, which is claimed to be biologically degradable.
A Umited amount of surveillance work has been continued in this
field and indications thus far are that the degree of biodegradabiUty
is not as great as claimed and anticipated.
Continuing difficulties are experienced with small waste treat-
ment plants, such as laundries, due to improper operation. Failure
of communities and areas to provide central sewers and waste treat-
ment will continue to deter the proper development of many areas of
the state.
Surveillance has been continued concerning the waste water dis-
posal practices of the citrus industry. In one instance legal action
was initiated against a citrus processing plant and this action was
still pending at the year's end. Information was received from one
of the largest citrus processing plants that it is proceeding toward
development of a treatment faciUty to handle all of its waste waters.
Several small citrus plants have been built and have been given ap-
proval to use spray irrigation as a means of disposing of their
waste waters.
The personnel of the division are continuing to work with various
plating companies throughout Florida to obtain improvement in the
quality of the waste water discharge. It should be pointed out that
^
!i
218
ANNUAL REPORT. 1966
this is one of the worst types of waste as far as possible toxicity
is concerned.
STATEWIDE AIR POLLUTION PROGRAM
A smoke generator was built by a private contractor who was
the lowest bidder and this equipment was used in a training course
conducted for personnel for the SBH and CHDs. A total of nine per-
sons was certified as a result of the training obtained through this
course. It is anticipated that additional training of health department
personnel will be provided so that they will be in a better position to
determine compliance with Chapter 170C-9 Florida Administrative
Code. Without certification of the observer, observations of opacity
are of doubtful legal validity in legal proceedings.
Testimony was prepared and was presented during the course of
proceedings held before the Federal Power Commission (FPC), con-
cerning the possible installation of a second pipeline to bring ad-
ditional natural gas into Florida. Under the initial contract, if
approved, gas would be supplied to power generating stations of the
Florida Power and Light Company primarily along the east coast.
The hearing examiner denied the application, without prejudice, and
the matter is before full commission.
The air pollution program in Dade County was expanded with a
supplemental grant under the federal Clean Air Act. Activities in
Palm Beach County were carried on under a similar program which
started June 1, 1965. Additional grant applications were submitted
by the CHDs of Hillsborough and Manatee Counties with the latter
application being approved. The Hillsborough application had not
been acted on by year's end.
The new Occidental Company phosphate processing complex be-
gan operations during the year. However, personnel were not
available to monitor the air in the vicinity of the plant for fluorides
and sulfur oxides. Some expressions of concern have been received
from the area.
Forty- six projects involving air pollution control devices were
approved.
FLORIDA AIR POLLUTION CONTROL COAAMISSION
Activities of the Polk-Hillsborough Air Pollution Control District
(the only one in the state) are carried out under rules promulgated
by the Florida Air Pollution Control Commission (FAPCC). During
1966, the FAPCC consisted of the following: J. O. Bond, M.D.; M.
W. Chesson; Curtis A. Cox; Henry M. French; E. R. Hendrickson,
Ph.D.; Paul B. Huff; Raymond E. Parks, M.D.; Bruce C. Thomas;
Ledley H. Wear; G. F. Westbrook, Ph.D.
Drs. Bond and Parks were reappointed during the year.
SANITARY ENGINEERING 219
Dr. G. F. Westbrook was elected chairman and Dr. J. O. Bond,
vice chairman.
The FAPCC held five meetings during the year. One hearing,
covering a period of two days, was held to determine the need for
regulations concerning the effects of fluorides on citrus as well as
sulfur oxides. At a subsequent meeting, it was found that citrus is
affected by fluorides but no agreement was reached about harmful
levels of fluorides in citrus leaves. The matter remains under study
and advisement. A spokesman for the phosphate companies stated
demisters would be installed by them to reduce the emission of sul-
furic acid mist. It was determined there was no need for regulations
covering sulfur dioxide at present.
POLK-HILLSBOROUGH AIR POLLUTION CONTROL
District Activities
During 1966 the maximum allowable fluoride emission limit sys-
tem was appUed to the phosphate industry. Of the 16 plants covered
by the regulation, seven have been permitted, three are awaiting the
mechanics of permit issuance, while the remaining six have been
delayed. Three of the six delayed hold Limited Permits to Operate.
It is anticipated that all will be permitted by March or April, 1967,
or shortly thereafter.
Work by the district staff resulted in the Polk County phosphate
industry declaring they would install sulfuric acid mist eUminators
in their sulfuric acid plants and meet suggested effluent standard.
Public relations and dissemination of information increased in
1966 by the district staff. Approximately 15 talks were given.
Ambient Air Monitoring
Activities within the district but outside manufacturing plants
continued with ambient air monitoring, vegetative sampUng, metero-
logical studies, special surveys and sample analysis. The ambient
air monitoring program used a total of 18 individual sampling sta-
tions for various periods of time. A total of 1524 days of operations
was accomplished. The pasture grass monitoring network consisted
of 49 stations from which samples are obtained each four weeks. No
changes were made in the station locations for the year. The glad-
ioli monitoring program for the Ruskin area has continued on a bi-
weekly basis as reported in the 1964 and 1965 reports. A special
survey was initiated in December to define ambient conditions near
a supposedly well- controlled plant which was the object of com-
plaints. The ambient work is necessary to confirm complaints.
Following the previous year's experience, two additional automatic
incremental air samplers were purchased and put into service.
I
f I
"I
220
ANNUAL REPORT, 1966
Source Sampling
The permit system that applies to the phosphate industry has
required an accelerated rate of source sampling and resulted in
sampling 262 sources in 16 plants owned by 13 separate companies.
To accomplish this, 759 samples were obtained and analyzed. An
additional 210 samples were required to characterize fertilizer
storage building emissions, which were considered as single
sources. Measurements of emissions from two run-of-pile triple
super- phosphate storage buildings were made, each requiring five
days' time and considerable equipment and manpower. In addition,
a mono- ammonium storage building and a triple super- phosphate
granular manufacturing building were sampled which required less
time and effort. Personnel of the source sampling team conducted
ambient air sampling and collected and analyzed weather data.
Industry Expansion and Inspection
Regulation changes made in 1965 continued to affect the primary
function of plant inspections and, indeed, source sampling. Twenty-
nine plant inspections were performed, of which seven were permit
inspections. Plan review included 36 separate evaluations. These
included the entire scope from a single scrubber installation to a
complete new fertilizer complex. Eighteen were for complete pro-
duction units, while 18 were for other installations. The complete
production units approved included a power plant, a granular triple
super- phosphate plant, a di-ammonium phosphate plant, a super-
phosphoric acid plant, two defluorinating plants, a phosphate rock
dryer plant and a run-of-pile triple super- phosphate quick cure
system. Other plans represented new, additional or replacement
scrubbers to existing operations, such as for dry rock screens,
grinders and rock storage, triple super- phosphate and di-ammonium
phosphate handling and manufacture and phosphoric acid production.
The accelerated expansion of 1965 was sharply decreased in
1966. However, the 1966 construction activities resulted in one
complete fertilizer complex, a power plant, a granular triple super
plant, one super- phosphoric acid plant, one defluorinating plant and
one di- calcium phosphate plant. Additions to existing facilities
which went into operation in 1966 although construction started in
1965 were one di-ammonium phosphate plant, one defluorinating
plant, one di- calcium phosphate plant, one dryer plant and run-of-
pile cure systems. These new constructions and expansions have
required an average of more than one conference per day between
company representatives and district personnel.
Special Activities
Unusual surveys and special studies were small in number
SANITARY ENGINEERING 221
during the year. In response to complaints of particulates emitted
by citrus peel dryers, several stacks were studied. In addition, the
organic content of the stacks was determined. An insecticide prob-
lem in Orange County was studied by inspection and sampling. A
crate mill burning scrap wood was inspected in order to begin
compliance procedures. Several field tours and training missions
were conducted by the staff for the USPHS, Georgia-South Carolina
air and water pollution control groups and SBH staff. Several staff
personnel attended an air pollution school presented by the USPHS.
Laboratory staff members attended a chromatographic school.
NUMBER OF AIR POLLUTION SAMPLES ANALYZED BY TYPE
FLORIDA, 1966
Ambient sulfur dioxide. . ^848
Ambient fluorides 4647
Grass fluorides 1017
Source samplir>g fluorides 1004
Miscellaneous (citrus, gladiolus, etc.) 457
Autometer tests (sulfur dioxide and trioxide) 3675
REFUSE DISPOSAL
The disposal of solid waste continues to pose a serious problem
for the state and particularly for the cities and urban areas. The
SoUd Waste Amendment to the federal Clean Air Act has sUrred a
considerable amount of interest in this matter throughout Florida.
The primary concern of many of those interested in such matters is
the possibiUty of obtaining construction grants. To date, this amend-
ment does not provide for such construction grants but makes the
Umited amount of money available for new and unique methods of
solid waste disposal. One grant has been approved by the USPHS for
a composting plant to serve Gainesville and environs which is in-
tended to provide certain design criteria of an engineering nature.
A total of 85 incinerators was approved in 1966, with an esti-
mated cost of $461,659. Table 35 gives a breakdown of approvals by
counties.
During the past year a new incinerator was placed in operation
in St. Petersburg. Work was started on an incinerator in Tampa and
discussions were held between the City of Tampa, Hillsborough
County and SBH toward possibiUty of additional faciUties for other
parts of the urban areas of this county. It is indicated that this might
lead to submission of a planning grant applicatioft for the area in
question. The Orlando incinerator ceased operation when difficulties
were experienced and engineering evaluations are being carried out
to determine what changes need to be made.
A compost plant to serve St. Petersburg was placed in operation
222 ANNUAL REPORT. 1966
and has experienced some difficulties as judged by the odor com-
plaints which have been received. Work is presently being carried
on to determine what corrections are required.
DRAINAGE WELLS
A total of 246 well permits was issued in 1966. These wells
were primarily to serve air conditioning and swimming pool drain-
age. The well designed to receive industrial waste water from a
furfural plant in South Florida was completed after experiencing
considerable difficulty and was placed in operation late in the year.
RADIOLOGICAL HEALTH
Work was continued during 1966 in cooperation with the Bureau
of Laboratories and Division of Radiological Health in securing
samples for radiological analysis. Approximately the same levels
of sample collection and analysis for gross alpha and gross beta
activity were maintained. There continued to be emphasis on the
collection of samples in the vicinity of Cape Kennedy. A portion of
the activities has been coordinated with the Air Force- US PHS pro-
gram based at the Cape. In addition, certain background sampling
has been started in the vicinity of the new Turkey Point plant of the
Florida Power and Light Company after announcement was made
that it was expected that Units 3 and 4 of this facility would use
nuclear fuels. It is anticipated that this program will be expanded
within the laboratory capability until such time as the facilities are
constructed and placed in operation.
SANITARY ENGINEERING 223
TABLE 35
INDUSTRIAL WASTE AND INCINERATOR PROJECTS
APPROVED WITH POPULATION EQUIVALENCE AND COST,
BY COUNTY, FLORIDA, 1966
CCXJNTY
Alachua
Boy
Brevard
Broward
Citrus
Collier
Dade
Duvoi
Escambia
Gadsden
Hamilton
Hillsborough
lake
Lee
Levy
Manatee
Marion
Monroe
Okaloosa .
Orange .
Osceola
Palm Beach
Pinellas
Polk
St. Lucie
Santo Rosa
Sarasota
Volusia
TOTAL
NA— Not applicable
INDUSTRIAL WASTE PROJECT
Number
Approved
12
4
1
Population
Equivalent
NA
2
NA
NA
209
NA
313
109
1
2
4
1
1
3
3
49
NA
6,025
206
Cost
58
41,500
NA
8,831
460
368,000
120
2,034
427,865
4,800
8,500
5,000
600,000
428,490
80,000
1,200
'456,060
91,000
11,500
521,500
80,000
10,000
295,683
5,000
289,000
17,000
39,500
$2,938,173
INCINERATOR PROJECT
Number
Approved
3
755
11"
' '3330'
1
100
1 ■ ■
300
2
1100
2
540
1
550
1
330
12
1
5
1
3
3
3
1
1
1
16
7
2
85
Population
Equivalent
5065
300
1550
30
830
1290
800
400
200
300
4613
1925
720
100
1750
26,878
Cost
$ 14,700
60,666
3,900
3,066
8,000
11,000
3,500
3,800
" Vl 6,260
2,800
30,375
2,300
17,700
13,100
9,695
3,200
5,200
2,800
64,011
46,400
8,200
2,700
34,418
S 461,659
DIVISION OF SPECIAL SERVICES
CHARLES E. COOK. C.E.
Director
Principal activities of the staff of this division continued to be in
the administration and enforcement of the state bedding law; the
supervision, inspection and control of all shellfish harvested, pro-
cessed and sold by the industry within the state; the review of new
land subdivisions involving federal mortgage insurance, with rec-
ommendations for satisfactory water supply and sewage disposal
facilities; the review of reports of inspection of individual water
supply and sewage disposal installations for homes constructed
under federal mortgage insurance; and technical assistance to
county health departments (CHDs) for septic tank regulations and
plumbing regulations of the State Sanitary Code.
Responsibilities assigned the division were unchanged, with
activities routine, and no new or unusual problems experienced.
n
11
i!
ii
224 ANNUAL REPORT. 1966
BEDDING LAW ADMINISTRATION
Activities of this program as of January 1, 1966, were reoriented
in compliance with, and for enforcement of, the revised law as en-
acted by the 1965 Legislature. The new law eliminated the previous
requirement for use of a bedding inspection stamp affixed to the
label attached to each item of bedding and parcels of filling material
when sold or offered for sale in the state. This revision simplified
clerical and accounting procedures and has resulted in much more
efficient field inspection services by decreasing the time formerly
involved in enforcing use of stamps. It has also been possible to
increase the number of inspections with the same field staff and
caused a notable decrease in number of violations found. The re-
vised law has been favorably accepted with few complaints by most
of the industry.
Principally, the bedding law regulates the trade practices of all
segments of the bedding industry by requiring accurate and mean-
ingful labeling of all items of bedding, used or intended for sleeping
purposes, to reveal truthfully the actual filUng contents and to pre-
vent fraudulent practices in the misrepresentation of concealed
filling materials as to type and quality. The required law label as
attached to the item, and to all bulk filling materials, must clearly
reveal to the consumer the proper description or name, and the type
and quality, of the concealed material. The law requires annual
registration with the State Board of Health (SBH) for each establish-
ment in all segments of the industry and specifies payment of reg-
istry fees. The registry fees, which are collected and audited by
the division, were increased in the revised law to compensate for
the former revenue received from the sale of inspection stamps.
Routine activities of the program are shown by the following
itemized summary:
Registrotlons Revenue
948 manufacfurers $ 56,830.00
497 renovators 12,396.50
4721 retailers 47,210.00
Total 6166 $116,436.50
Adjustments 375.00
Total Annua! Revenue $116,061.50
Inspections
Total number of inspections made 6,862
Total items found in violation 18,195
Total number of items placed off sale 10,777
Number of items in violation allowed to be corrected 17,949
Number of items condemned or returned
to manufacturer 246
S A NITARY ENGINEERING 225
The total number of items found in violation includes approxi-
mately 9000 pillows of one lot shipment from a new out-of-state
manufacturer, which were inadvertently, through error, labeled with
the wrong label. A factory force was dispatched to the storage point
and made proper corrections. Under policy procedures, items
found in minor or nonserious violation may be relabeled by the
manufacturer without penalty. Such violations, which constitute a
majority, are normally due to use of unacceptable terminology or
words and phrases in descriptive terms.
The total number of registrations denotes a slight increase over
the previous year, while the total revenue was sUghtly less than the
previous year. Indications are, however, that the industry did in-
crease in growth and sales as the reported revenue for last year in-
cluded a 13-month period due to effective date of the revised law.
A total of 215 separate samples of bedding items, and from bulk
filling materials, was submitted to and analyzed in the laboratory,
requiring 1228 analyses to be performed.
SUBDIVISION PLANNING
This program continues to provide an essential technical serv-
ice directly to CHDs and indirectly to land developers regarding
proper and adequate sanitary facilities for water supply and waste
water disposal in new land subdivisions. Reviews of analyses data
are made on subdivisions for housing and lot sales when submitted
by the CHDs and recommendations made for adequate community
utiUties, or the suitabiUty of individual sanitary faciUties. The pri-
mary purpose of the program is directed toward restricting wide
and indiscriminate use of septic tank systems and individual wells
in urban growth and in areas having a potential for development with
a high concentration of population.
The Federal Housing and Urban Development Act of 1965, which
required health department certification of the economic feasibiUty
of municipal or community sewerage faciUties for all new sub-
division developments involving federal mortgage insurance, was
effective to some extent in Umiting wide use of septic tanks. Where
sewerage is determined to be economically feasible, any proposed
use of septic tanks is not acceptable to the federal insuring agencies.
The policy of the federal insuring agencies is to accept the required
certification of feasibiUty from, and as determined by, the local
CHDs. Although this procedure is considered less effective than
hoped for due to lack of uniformity in method and of engineering
personnel inCHD operations, the division offers and frequently gives
technical and advisory services to the CHDs in this function.
Detailed activities in the subdivision planning program during
the year include the review of data on 34 specific subdivisions re-
ceived from 13 CHDs, which included a total of 1084 homesites.
il
226 ANNUAL REPORT, 1966
Approximately 500 of these lots were endorsed for septic tank in-
stallations and sewerage recommended for the others. Only 34 of
the lots were considered suitable for use of individual water supply
systems and all others were to be supplied from community or ex-
isting public water supply systems. These subdivisions probably
represent only a small portion of total land developments in the
state during the year, however, it does represent worthwhile activ-
ities in protecting environmental conditions for some of the people.
Assistance, given federal mortgage insuring agencies in the re-
view or reports of inspection of individual sanitary facilities instal-
led for individual homes constructed under federally insured mort-
gages, totaled 558 cases received from 37 CHDs. All of the homes
were served by an approved septic tank installation in compliance
with the regulations of the sanitary code, and 316 provided with an
individual water supply system constructed in compliance with good
public health standards. Normally, these homes are located in rural
areas or sparsely developed urban areas where service from central
utilities is not available. This part of the program assures con-
struction of the sanitary facilities in accord with minimum health
standards and provides for a tested and approved water supply both
bacteriologically and chemically.
SHEURSH AND CRUSTACEA CONTROL
The primary activity of this program is the administration, in
cooperation with various CHDs, of adequate regulatory controls over
the shellfish industry within the state to assure that marketed shell-
fish have been grown, harvested and processed in a sanitary manner.
Requirements are to conduct water quality surveys and evaluations
of growing areas, classify and delineate water areas, issue certi-
fication for and make inspections of shellfish plants, conduct labora-
tory investigations and such other control measures as may be
necessary.
A comprehensive sanitary survey is made of each growing area
prior to initial approval and includes an evaluation of all sources of
actual or potential 4X)llution on the estuary or its tributaries, and
the distance of such sources from the growing areas; effectiveness
and reliability of sewage treatment works; presence of industrial
wastes, paralytic shellfish poisons, pesticides or radionuclides
which would cause a public health hazard to the consumer of the
shellfish; and the effect of hydrographic conditions and variations in
distributing polluting materials over the growing areas. Bacterio-
logical examination of the waters is an essential component and part
of the sanitary survey. The sanitary quality of an area is reap-
praised at least biennially and if necessary a resurvey is made. A
file containing all sanitary survey data is maintained for each clas-
sified area. Areas classified as approved, restricted or condemned
SANITARY ENGINEERING 227
are delineated on coastal charts, reproduced and distributed to the
shellfish plants, CHDs, conservation agents and other interested
agencies.
Annual operating permits are issued each shellfish plant on the
recommendation of the CHD with evidence of compliance with the
shellfish regulations of the State Sanitary Code, Sanitary inspections
of all shellfish plants are made on monthly intervals, or more fre-
quently as necessary, by personnel of the division in Franklin County
and by CHDs in counties having shellfish plants.
The U. S. PubUc Health Service (USPHS) makes an annual review
of the shellfish sanitation control program and if standards meet the
minimum requirements as recommended, national certification is
granted. This evaluation for the year was satisfactory in each of the
eight program elements and the overall rating increased substan-
tially over the previous year.
Collecting of sanitary survey data on approved waters, particu-
larly on the hydrographic aspects, was continued and emphasized
during the year. The surveys required the assistance of CHD per-
sonnel, regional engineers and county engineers. A USPHS team
made extended study on two areas. The inspection activities of pro-
ducing plants in the Franklin County area were increased. The
USPHS continued to present requests for stricter requirements,
expressing greater concern for the safety of shellfish products,
which materially increased the workload of all staff members.
Sanitary surveys were made on three new areas and re- evaluation
with bacteriological surveys on 13 existing areas.
The approved shellfish growing area maps were updated again
this year and new maps were printed and distributed, in which the
approved, unapproved and conditionally approved areas were delin-
eated by different colors. The Gulf Coast Shellfish Sanitation Re-
search Center and the shellfish consultant of the USPHS provided
personnel and equipment for a detailed survey of waters in Brevard
and Charlotte Counties during 1966. These surveys provided in-
valuable guidance and ejq)erience for members of this staff, as well
as the personnel from the CHDs concerned. Two members of the
division staff attended a National Shellfish Depuration Workshop at
the Northeast SheUfish Sanitation Research Center in July. In ad-
dition to routine bacteriological sampling program, the monitoring
program for radionuclides, heavy metals and pesticides, and shell-
fish toxins continued in force.
Preliminary data compiled by the U.S. Fish and Wildlife Service
indicates a substantial increase in shellfish production over the
previous season. These figures list Franklin County as still leading
the state in production with approximately four million pounds re-
ported. The overall production figure for the state was listed as
approximately 4.2 5 million pounds, with over 90 per cent of the state
production occurring in Franklin County.
'i
228
ANNUAL REPORT. 1966
All persons engaged in the production of shellfish and Crustacea
were issued a valid health card for the year and these health cards,
and harvester permits as required by tongers, were issued to the
shellfish workers by the CHDs. A total of 1500 health cards and
harvester permits were issued during the year and of these, about
900 health cards were issued in Franklin County. There were 166
shellfish houses permitted during the year, including both shellstock
and processing plants, located in 24 counties, with 55 of these being
located in Franklin County.
The production of crabmeat was unchanged this year even though
the minimum wage increase prompted the closing of at least three
plants during September.
Table 36 summarizes items of the shellfish and Crustacea con-
trol program activities performed by the division personnel. Activ-
ities performed by the CHDs in the shellfish control program are
not included.
TECHNICAL ASSISTANCE
Several conferences were held with CHDs, and other authority
groups, in reference to application and enforcement of the sanitary
code septic tank regulations. The new septic tank regulations, as
adopted in 1965 and applied in most counties on January 1, 1966,
were most favorably received and very effective throughout the year
in restricting wide and indiscriminate septic tank use in many areas.
Two minor revisions to these regulations were prepared for, and
enacted, by the Board. Liaison and technical service was provided
through the year to CHDs on the septic tank regulations, sewage
disposal for new school plant construction and on the State Plumbing
Code. New criteria for sewage flow rates from schools were agreed
upon with the State Department of Education and adopted by the
Board. This action successfully culminated the extensive survey of
a study of sewage flows from schools, as sponsored by the State De-
partment of Education.
SANITARY ENGINEERING 229
TABLE 36
SUMMARY OF ACTIVITIES RELATING TO SHELLFISH AND
CRUSTACEA PLANTS, FLORIDA, 1966
Type of Operation
Shellfish shucking and packing.
Shellfish shellstock only
Shellfish repacking
Shellfish reshipping
Scallop processing
Crabmeat processing
Operating
Certificates
Issued
90
56
12
2
6
28
State
Visitations
Mode
894
24
40
6
12
36
New
Plants
Constructed
8
18
Plants
Remodeled
Related Shellfish and Crustacea Activities
Oyster growing water samples bocteriologically tested
Oyster meot samples bocteriologically tested
Crabmeat samples bocteriologically tested
Plant water samples bocteriologically tested . .
Number of new water areas approved for shellfish harvesting.
644
375
70
530
3
DIVISION OF WASTE WATER
RALPH H. BAKER. JR.. M.S.S.E.
Director
The division's responsibilities and activities in 1966 centered
around review of plans, consultation and evaluation of operation for
domestic waste facilities.
MUNICIPAL WASTES
A total of 937 projects was processed and approved as com-
pared to 822 projects in 1965. The construction dollar volume of all
projects processed was $44,402,529, an increase of approximately
$6 million when compared to the volume of the previous year, which
was $38,292,039. This increase was greatest in the area of collec-
tion systems and lift stations, and there was a decrease of approxi-
mately $2 milUon in plant construction (Table 37). It will be noted
in Figure 2 that the number of sewage treatment plants approved
was approximately the same as in 1965. This resulted in 216 ap-
proved new sewage treatment plants, plus five treatment systems in
which the degree of treatment was upgraded, 13 commercial systems
which were enlarged and nine municipal and subdivision systems
which were expanded in capacity. Also during the year, five primary
sewage treatment plants were upgraded to secondary.
A number of incorporated municipalities provided new treatment
facilities or major improvements to existing facilities during the
year. The most notable ones were Coral Gables' construction of an
interceptor sewer to eliminate the existing sewage treatment plant
by connection to the City of Miami's system; St. Petersburg's main
plant with a capacity of 20 million gallons per day; Leesburg's sys-
tem, which was designed to treat both domestic and citrus waste;
and projects in Pensacola, Naples, Winter Park and Titusville.
t
230
ANNUAL REPORT. 1966
i I
M
It will be noted from Figure 2 that during the past decade there
has been a tremendous increase in sewage treatment plants within
the state. It will be noted from Table 38 there is a total of 1755
sewage treatment plants of various types and sizes within the state.
Of the 364 incorporated municipalities reported in the 1960 census,
164 have sewage treatment systems. Among the remaining 1591
treatment plants serving commercial installations, institutions and
subdivisions are 328 privately owned systems, with the balance
serving commercial installations, motels, schools and subdivisions.
Operation reports are received and reviewed on only the major
municipal and subdivision systems. The remaining commercial in-
stallation reports are reviewed by the regional and county engineers.
A total of 207 visits and field investigations was conducted on a
cooperative basis with the regional and county engineers. These
visits covered some 31 counties. Forty-eight preliminary engi-
neering reports covering sewerage projects were submitted during
the year.
Inventories of federal and state institutions were undertaken, as
well as one of public sewerage facilities. The state and federal in-
ventories were completed, with those on federal installations being
forwarded to the U.S. Public Health Service (USPHS). The state in-
stitution surveys were also completed and forwarded to the Com-
missioner of State Institutions. A joint meeting of all directors of
state institutions was held in Tallahassee, where a concurrence with
the report was obtained. Data were also compiled and furnished to
the Division of Water Resources on sewerage facilities located
within the St. Johns River Basin.
Due to the recent federal legislation and the need for water
quality hearings within the state, information on all sewerage treat-
ment facilities and points of discharge were compiled and evaluated
for the 15 drainage basins located. Based on this information and
that obtained from the public sewerage inventory, as well as the in-
formation submitted to the Conference of State Sanitary Engineers
on priority needs, a complete priority listing of all municipalities
was compiled and submitted to the bureau director. It was interest-
ing to note that in the three priority groupings, i.e., immediate
needs, secondary needs which would be those before 1970 and ulti-
mate needs which would be those after 1970, the total cost of these
priorities was estimated at being approximately $258 million. Of
this total, $110 million is for immediate needs, $111 million for
secondary and $37 million for ultimate needs.
SANITARY ENGINEERING 231
Some of the more notable meetings attended during the past year
dealt with the Okeechobee -Taylor Creek studies and the Lake Shadow
water quality studies. The Lake Shadow meetings were attended at
three different levels— before the County Commissioners of Orange
County, the Board of the SBH and the Governor's Advisory Commit-
tee on Water Quality at Tallahassee. Public hearings were attended
and court testimonies given with reference to Doctors Lake and
Westwood Utilities. Public hearings were attended on Lake Alfred,
Daytona Beach Shores and Venice Gardens.
The division during the past year provided instruction at five
regional short schools and the annual short school, as well as ar-
ranged the programs for the annual short school; compiled and
processed examinations for the voluntary certification program;
participated in Manasota-88, which was the Urban Planning and En-
vironmental Health Course; provided instruction for the sanitarians*
training course; planned the program for the Florida Pollution Con-
trol Association's annual meeting, as well as the Engineering Sec-
tion's meeting of the Florida Public Health Association. One member
attended the National Symposium on Water QuaUty in Ann Arbor,
Michigan.
ADDITIONAL ACTIVITIES
Division staff members attended several meetings dealing with
water quality, eutrophi cation of lakes and public meetings for mu-
nicipal improvements which are required prior to referendums.
M
232 ANNUAL REPORT, 1966
TABLE 37
SEWERAGE PROJECTS APPROVED WITH DESIGN POPULATION
AND ESTIMATED COST, BY COUNTY, FLORIDA, 1966 .
COUNTY
Alachua
Boker
Boy
Bradford
Brevard
Broward
Charlofte. ....
Citruj
Cloy
Collier
Columbia
Dad«
Dixie
Duvol
Escambia
Franklin
Glodes
Hamilton
Hoidee
Hendry
Hemor»do
Highlands ....
Hillsborough. . .
Indian River . . .
Jackson
Lake
Lee
Leon
Levy
Manatee
A^rion
Mortin
Monroe
Nassau
01(0 loose
Okeechobee. . .
Orange
Osceola
Palm Beach . . .
Pasco
Pinellas
Polk
Putnam
St. Johm
St. Lucie
Santa Rosa. . . .
Sarasota
Seminole
Sumter
Taylor
Volusia
Wokullo
Woshington . . .
TOTALS
Approved
fVojects
12
2
5
1
84
90
13
4
12
14
12
114
2
55
20
1
1
6
1
4
3
4
33
12
1
19
26
2
1
31
7
6
10
2
11
1
60
6
57
9
61
23
3
9
4
3
37
7
6
1
26
1
2
Design
Popu lotion
M54
74
3,885
5,500
105,727
178,829
1,018
2,717
3,445
3,171
1,152
106,716
3,000
85,312
5,767
937
56
1,212
45
721
3,545
3,041
6,446
342
1,000
4,222
20,842
450
60
3,920
805
718
2,703
300
28,81 1
30
25,567
1^1
108,331
773
85,91 1
102,514
445
250
13,297
686
24,808
1,550
1,994
ESTIMATED COSTS
Sewers
297,610
2,262
241,900
20,000
2,294,011
5,189,636
133,304
330,390
96,291
363,420
27,255
4,082,105
278,000
606,433
347,360
1,150
45,100
4,000
174,900
206,515
481,726
901,584
78,800
1,000
151,000
711,027
20,000
183,941
33,166
34,800
191,100
2,000
697,109
112,851
180
1,014
1,068,868
1,412,582
40,400
2,724,187
59,125.
2,369,063
441,137
28,220
5,500
1,446,334
44,105
820,800
77,928
118,150
528,268
1,200
500
28,346,394
Lift Station
135,000
i8,2ob'
10,000
606,100
1,156,958
42,800
76,000
39,645
53,000
10,500
1,047,790
63,000
449,215
44,000
9,000
1,200
65,500
125,200
21,000
79,746
2,700
23/450
41,500
80,535
9.200
9,200
43,000
8,000
152,432
343,674
3,500
792,300
7,000
231,962
130,893
7,800
594,500
8,000
151/X)0
15,900
550
68,500
6,779,450
Plant
441,700
14,900
27,100
i, 466,100
842,182
70,500
113,000
144,312
80,500
61,480
782,125
222,000
350,211
162,000
750
101,000
5,000
59,100
93,775
65,250
12,000
10,000
72,675
343,500
9,000
136,500
63,500
14,600
83,200
33,000
451,300
10,000
100,500
14,000
357,000
35,000
181,100
218,750
16,000
37,500
713,500
'l8l',600'
8,000
19,000
1,095,475
14,000
3,000
9,276,685
Total
874,310
17,162
287,200
30,000
4,306,211
7,188,776
246,604
519,390
280,248
496,920
99,235
5,912,020
563,000
1,405,859
553,360
1,900
155,100
10,200
299,500
425,490
502,726
1,046,580
93,500
11,000
247,125
1,096,027
20,000
9,000
400,976
105,866
58,600
317,300
43,000
1,300,841
10,000
1,856,756
57,900
3,873,487
101,125
2,782,125
790,780
52,020
43,000
2,754,334
52,105
1,153,400
101,828
137,700
1,692,243
15,200
3,500
44,402,529
SANITARY ENGINEERING 233
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234 ANNUAL REPORT. 1966
TABLE 38
SEWAGE TREATMENT PLANT BY TYPES AND CAPACITY,
FLORIDA, 1966
Type of Sewage
Treotment Plont
CAPACITY
Less thon
50,000 GPD
50,000 to
500,000 GPD
500,000 to
1,000,000 GPD
Over
1,000,000 GPD
Total
3
102
956
97
23
0
25
70
47
212
42
0
9
10
0
38
11
0
29
6
1
49
17
8
66
188
ExtAf^ftd oir .......>■■■•••
1004
Tricklina filter
396
93
Ocean ouffalls
8
Totals
1181
^
68
110
1755
GPD— gallons per day
TABLE 39
WASTE WATER PROJECTS PROCESSED LOCALLY
WITH ESTIMATED COST, BY AREA, FLORIDA, 1966
AREA
REGIONS
Northwest . ,
NortKeost . ,
Central . . . .
Southwest . ,
Southeast. . ,
COUNTIES
Brevard . . . ,
Broward. . . .
Dode ....
Hillsborough
Manatee . .
Palm Beach
Pinellas. . .
Polk
Estimoted
Cost
S 54,300
150,000
62,500
77ftS0
42,500
10,000
34,375
334,090
0
400,037
14,700
0
32,750
SANITARY ENGINEERING 235
DIVISION OF WATER SUPPLY
JOHN B. MILLER. B.S., M.P.H,
Director
With continuation of water utilities expansion in the state to
serve its rising population, and construction of water contact re-
creation facilities closely related to the state's important tourism
economy factor, the staff of this division was again primarily en-
gaged in review and appropriate approval of water works and public
swimming pool projects during the year. By the year's end, a com-
bined total of 957 of these projects had been approved in the central
office to about equal the high level of previous year's activity in this
facet of the program.
Surveillance was continued at Tampa to determine carbon chlor-
oform extractables and pesticide fractions present in water supply.
This is a continuing background study for information and control
involving the Hillsborough River and tributaries as a source of sup-
ply for Tampa.
Limited sampling was conducted for a similar study of the Man-
atee River in Manatee County. This stream is being impounded by
the Board of County Commissioners as a source of supply for a
countywide water system which was nearing completion at year's
end.
These projects are undertaken in cooperation with water depart-
ment personnel, and county and regional health department staffs,
with coordination by the central office. Laboratory analyses are
performed by the Southeast Water Laboratory of the Federal Water
Pollution Control Administration (FWPCA) located at Athens,
Georgia.
In conjunction with these studies, a unique situation was brought
into focus. Despite widespread use of chemical herbicides, by sev-
eral agencies, for control of aquatic plants, no compound had been
Ucensed, labeled, approved or accepted for use in domestic water
supplies. In one instance, due to size and nature of a relatively
small impoundment and watershed serving the City of Punta Gorda,
it was deemed advisable to request agencies engaged in aquatic plant
control to cease operations in this particular impoundment. This
action precipitated much concern among numerous local, state and
federal agencies and also action toward a solution on a region-wide
basis. At Punta Gorda, regrowth of aquatic plants brought about
much pubUc reaction and, following assimilation of data, clearance
of the aquatic plants from the impoundment was allowed under con-
trolled herbicides application, added treatment techniques at the
water plant, and monitoring of water quality. Once again, the South-
east Water Laboratory was relied upon for analytical work.
!!
I!
i !
;
236 ANNUAL REPORT. 1966
It is significant to note that work in this area of pesticide mon-
itoring was and is extremely hampered by the lack of adequate lab-
oratory faciUties in the department. Special and costly techniques
and equipment are required in this work, and, while the Southeast
Water Laboratory willingly assists, it can handle only a small
amount of work from any one state. At year's end, results had not
been obtained on a number of samples collected several months
previously, and the Southeast Water Laboratory could give no as-
surance as to when results would be forthcoming.
While it is expected that, with sufficient study, clearance of cer-
tain herbicides for use in domestic water supply sources may
eventually be forthcoming, it is nevertheless anticipated that the
need for monitoring of water supplies will increase with a corres-
ponding increase in the need for rapid analytical capabiUty.
Updating of water works inventory of facilities serving cities of
25,000 population or larger was accomplished. This was a coopera-
ative activity with FWPCA.
Construction of Public Water Works and Systems
Activity in proposed new construction of public water supply
faciUties involved handling a total of 905 projects during the year by
the division. There were 110 projects brought forward from 1965
added to 795 received currently. Of the total, there were 745 ap-
provals (including revisions), 33 placed in record file for informa-
tion 26 project plans and papers returned to the respective consult-
ing engineers due to apparent prolonged dormancy (or other reasons)
of the projects, and at the year's end 101 projects were carried over.
Approved projects (there were 45 revisions) included 371 mu-
nicipal (53 per cent) facilities, among these being 50 proposed plant
expansions for over a total of 59 milUon gallons per day (MGD in-
creased rated capabiUty. There were included 13 (two per cent) new
county district and rural community systems with plans including
ahnost 19 MGD rated plant capability, these water supply projects
being for Bay County (to include supply for Panama City and Tyndall
Field), Lee County, Okaloosa County, AlUgator Point, Baker, Bron-
son CaryviUe, Central (Bluff Springs and Byrneville), Farm HiU,
Holt, Lake Panasoffkee, Lagood (Escambia County) and MoUno.
Projects for realty subdivision systems totaled 202, these in-
cluding 24 for plant expansion to add over 12 MGD rated capabiUty
for service, and the remainder for extensions. These together with
113 new water systems for subdivisions, larger motels, trailer or
mobile home parks, etc., propose additional 27.6 MGD plant rated
capabiUty when completed.
Table 40 shows by county the rated plant capabiUty in MGD,
from the consulting engineers' estimates. In this table are also seen
the engineers' estimates of construction costs, the total of which
SANITARY ENGINEERING 237
continued in the high range for recent years. A considerably larger
fraction (nearly 33 per cent) is estimated for "supply" than in the
previous year (13 per cent), with the remaining two-thirds dollar
volume estimated for "distribution" construction.
Water Supply Well Construction
Table 41 shows number of wells permitted for construction as
sources of pubUc water supply, by county grouping. There were 10
per cent more counties active in this respect during the year, and
the total number of permits issued over the state was only sUghtly
(seven per cent) less. This represents continuing development of
the by far, predominant type source of pubUc supply in the state.
About one-half (50.6 per cent) of the permits were issued for wells
in only about 16 per cent of the total number of active counties.
Operation of Public Water Works
There still was devoted a relatively minor part of the division's
effort to sanitary supervision of water works operation. Table 42
shows by county the number of existing water plants, and also shows
this distribution of number of plants visited by central office pro-
fessionals and the number of such visits. Compared with previous
years it shows the continued unsatisfactory situation as to operation
surveillance, although about 11 per cent more plants were visited
than in 1965.
New plants placed in service during the year include Blounts-
town Cedar Key, Gonzalez, Haines City, Horseshoe Beach, Panacea,
South Bay, Steinhatchee, Suwannee, Waldo and a number of systems
for subdivisions.
Operator in-service training continued to claim much effort and
attention of the division staff. Table 43 shows numerical data on tius
activity related to water (and sewage) works operator training.
Fluoridation of Public Water Supplies
Cities and towns in the state continuing their fluoridation pro-
grams under technical supervision of the division were Belle Glade
Clewiston, Cocoa (also serving Rockledge, Cocoa Beach, Canaveral
and other island and coastal areas), Fort Pierce, Gainesville, Key
West (this and ottier communities of the Florida Keys suppUed
fluoridated water from United States Navy plant at Flori^ City),
Miami (also serves Coral Gables, Hialeah, Miami Beach, Surfside,
Bal Harbour, Biscayne Key, Sweetwater and special water tax dis-
tricts in Dade County), Naples, Ocala, Orlando, Ormond Beach and
Palatka.
During the year tiiese additional cities commenced their water
fluoridation programs: Sanford (February 15), Daytona Beach (June
15) and Melbourne (November 8), which letter also serves India-
lantic, Indian Harbour Beach, Canova Beach and Melbourne Beach.
238
ANNUAL REPORT. 1966
SANITARY ENGINEERING 239
'!
Installation of fluoridation facilities was completed at Eau Gallic
new filter plant and starting the practice awaited hiring of required
personnel at year's end. At Leesburg, the city had to discontinue
fluoridation July 30 owing to separation of the operator qualified to
carry out the procedure, and this situation continued to year's end.
Interstate Common Carrier Water Supplies
In the sanitary control of water supplies providing potable and
culinary water to interstate carriers, additional stress was placed
upon need for programs to detect and eliminate cross-connections
and other hazards to the water system. The total program is con-
ducted under a cooperative agreement with the U. S. Public Health
Service (USPHS) on the basis of Interstate Quarantine Regulations
and Drinking Water Standards. It involves establishing and main-
taining adequate bacteriological sampling and health hazards elimi-
nation programs, surveillance of chemical and physical quality of
water, inspection of supply, treatment and distribution facilities,
and review of analysis results. All these are followed by appropriate
action to correct deficiencies, remove hazards and insure safety of
the water supply.
During the year, four representative supplies were surveyed
jointly by central office engineers in company with representatives
of the USPHS. A special investigation of one supply was accom-
plished by central office personnel. Routine surveys of all others,
including initial surveys of two newly added supplies, were con-
ducted by personnel at the county or regional level. This work also
included follow-up visits to assure correction of deficiencies where
found. Personnel of the Bureau of Laboratories continued a program
of review of laboratory facilities and personnel at water plants
equipped for bacteriological work. All activities were coordinated
by and reported to the division, where final reports, with recom-
mendations, were compiled and forwarded to the regional office of
the USPHS in Atlanta.
At year's end, 33 supplies were active in providing service to
interstate carriers. Of these, 18 were in approved status, 14 were
provisionally approved and one was a supply previously deleted and
then returned to service with no current report. One other supply
was deleted from classification. Details of numerical data and
actions taken are indicated in Table 44.
Public Swimming Pools
A total of 269 engineering plans and project documents for pro-
posed construction of public pools was handled in the division during
the year, including 17 brought forward from 1965. Ultimate dis-
position was 212 new pool projects approved and 15 revisions, eight
filed for information, 15 returned to the respective designated con-
sulting engineers for various reasons, and the remaining 19 carried
forward to the new year.
Additionally, in accord with long-standing arrangement with
county health departments (CHDs) having engineers and which agree
to handle them, a representative fraction (about one-fifth) of the 299
pool projects approved in such counties, were reviewed in detail for
consistency of the program.
The volume of construction of public pools continues high for
utilization at such places as apartment complexes, hotels, motels,
etc. Some numerical data are entered in Table 41, showing number
of pool projects approved by county location, and totals as to num-
ber and consulting engineers' estimated costs. The total number for
the state was slightly higher than for 1965. A little lower (7.9 per
cent) average estimated construction cost total, reduced the average
($10,800) by several hundred dollars under the 1965 average; but it
was still in the low range, confirming the fact that many smaller
pools are being built at the type place referred to, important in the
"tourism" factor of the state's economy.
UtiUzation of the designated consulting engineers' services in
supervision of construction and certification of this as being done in
accord with departmental approved plans, is so far an advantage in
getting new pools placed under operation permit. Definite procedure
for this was instigated in late 1965, and is nearing implementation
to the fullest. Table 41 shows statistical data on pubUc pools per-
mitted, there being now well over 4100 total in the state. After being
checked for equipment operation involving filtration rates, disinfec-
tion procedures and water recirculation, they become program re-
sponsibility for routine operation surveillance in the CHD involved.
Assistance was given by the division with pool operator training
short schools developed by CHDs in these counties, with attendance
as stated: Alachua 39, Escambia 23, Hillsborough 80, St. Johns 18,
and Sarasota-Manatee 50, for total attendance of 210 pool operators
and owners.
Natural Bathing Places
Another permit issued for a bathing place in Volusia County
brought the total to 59 of these permitted places in the state, the re-
mainder continuing vaUd and shown as to county location in Table
41. A memorandum on the need for inventorying all natural bodies
of water over the state which are made available for bathing and
swimmmg by the pubUc was distributed to departmental agencies
and field professionals in the latter part of the year. Specific ref-
erence was made to safety in water contact recreation faciUties and
the need for tt as shown in incidence of tragic occurrences reported
by Division of PubUc Health Statistics. Response already noted
includes complete inventory of beaches reported by Broward CHD
and their further attention to the problem, and similarly the work
reported by Palm Beach CHD.
240 ANNUAL REPORT. 1966
TABLE 40
WATER PROJECTS APPROVED, WITH CAPACITY INCREASE,
AND ESTIMATED COST, BY COUNTY, FLORIDA, 1966
CCXJNTY
Alochuo . . . .
Baker
Boy
Brodrocu . . . <
Brevard
Broward. . . . .
Calhoun . . . .
Chorlorte. . .
Citrvn
Cloy
Collier ....
Columbio. . .
Dode
DeSoro ....
Dixie
Duvol
Escambia . . .
Flogler ....
Fronklin . . .
OoOMen . . •
Gilchrist. . .
Glades . . . .
GuK
H«snilton. . .
Hardee . . . .
Hefwlry . . . .
Hernando. . .
Highlands . .
Hillsborough.
Holmes . . . .
Indian River.
Jockson. . . .
Jefferson. . .
Lofoyette. . .
Lake
Lee
Leon
Levy
Ub^
Madison . . .
Manatee . . .
tin
nnorvoe • . • • .
Nassau
Okaloosa. . . .
Okeechobee**
Orange
Osceola ....
Palm Beach . .
Pasco
Pinellas. . . . .
Polk
Putnam
St. Johns. . . .
St. Lucie. . . .
Sorrto Rosa** .
S^rosoto . . . •
Seminole . . . .
Sumter
Suwannee . . .
Toylor
VolMsio . . .
Wokwlb . .
WoWon . . .
^aihin^on
TOTALS
Projects
Approved
•Million Gallons Per Doy Rating
**Estimoted Cost Omitted
13
76
72
11
8
1
27
4
1
9
24
4
2
1
20
7
4
6
1
10
1
11
6
49
12
29
10
1
2
4
1
32
16
6
Copocity
Increase
MGD*
0.070
"i'o!o7b
ESTIMATED COST
Water
Supply
0.103
6.400
4
0.158
8
0.144
15
0.037
4
0.212
97
3.294
1
0.600
37
10.419
9
1.706
1
0.432
1
0.2X
$ 2,000
' ' 1,600,500
390'.20b
198,765
6,7S0
35,200
72,577
29,000
2,019,815
'76,148
189,200
169,350
70,000
4,000
Distribution
Totol
2.028
0.720
*l!525
2.454
'o!288'
2.994
6.042
0.288
1.468
255,020
90,000
87,350
4V,85b
$ 585,970
" '87*1 job
' '3,223)284
2,814,745
i 80,370
88,150
116,493
305,958
10,296
1,539,644
39,168
292,818
528,8X
i 71,000
22,500
i 36, 150
96,000
i8B',09b
765,981
'4,500
0.135
0.070
1.149
0.265
2.044
0.194*
2.668
31.335
4.165
1.440
10.246
0.070
2.492
7,500
21,800
1,236,000
3,900
52,000
2,000
168,200
28,621
7,100
392,100
'2,600
30,300
3,995,000
60,000
45,000
119,000
16,441
9,000
$ 587,970
' '2,47 1,600
' '3,61*3,484
3,013,510
1*80,370
94,900
151,693
378,535
39,296
3,559,459
il*5*,3'l6
482,018
698,180
70,000
U5fiOO
22,500
391,170
188,000
275,440
815,831
4*500
7,500
53,077
4,897,499
40,598
176,000
'4,000
3,259,169
36,952
71,500
375,842
6,300
539,680
* 48,475
101,778
732,550
101,630
373,902
78,540
9,252
429,710
227,873
217,555
74,877
6,133,499
44,498
228,000
6/»b
3,427,369
65,573
78,600
375,842
6,300
931,780
*»/4'75
132,078
4,727,550
161,630
418,902
197,540
25>93
9,000
1,351
542',7'lb
255,373
270,555
168,000
1,222,945
5,000
SANITARY ENGINEERING 241
TABLE 41
PERMITS ISSUED FOR SWIMMING POOLS, NATURAL BATHING PLACES,
WATER WELLS AND PLANS APPROVED FOR PROPOSED PUBLIC
SWIMMING POOLS, BY COUNTY, FLORIDA, 1966
STATE.
Alochuo .
Baker . . .
Boy . . . .
Brodford .
Brevard . .
Broward. .
Colhoun .
Chorlotte.
Citrus. . .
Cloy
Collier . .
Columbia.
Dade . . .
DeSoto . .
Duval
Escombio . . . .
Flagler . . . . ,
Franklin . . . ,
Godsden . . . .
Gilchrist . . . ,
Glades ....
Gulf
Hamilton. . .
Hardee ....
Hendry ....
Hernando. . .
Highlands . .
Hillsborough.
Holmes ....
Indian River .
Jockson. . . .
Jefferson . . .
Lafayette. . .
Lake
UBV ■■••>•
Leon
Levy
Liberty . . . .
Modison . . .
Monotee . . .
Marion . . . .
Mortin . . . .
Monroe. . . .
Nossou . . . .
Okaloosa. . .
Okeechobee.
Orange . . . .
Osceola . . .
Palm Beach .
Pasco
Pinellas
Polk
Putnam . . . .
St. Johns. . .
St. Lucie . . .
Santa Rosa . .
Sorosoto . . .
Seminole . . .
Sumter . . . .
Suwannee . .
Toylor
Union . . . . ,
Volusia . . . .
Wakullo . . ,
Wolton
Woshington
COUNTY
Swim-
ming
Pools*
4177*
36
1
86
7
37
1048
6
9
8
27
9
1087
2
36
47
3
2
2
3
92
12
6
2
'27
46
37
5
1
2
21
53
10
47
19
22
4
75
4
348
8
306
64
10
39
20
4
115
11
4
3
14
* 179*
1
3
3
PERMITS ISSUED
Notural
Bathing
Places*
59
1
8
2
3
5
3
2
4
2
1
Water
Supply
Wells
385
4
2
27
5
1
1
3
2
10
4
6
3
1
8
7
12
2
29
2
11
10
24
2
10
4
29
2
Swim-
ming
Pools
446
10
' 21*
* *5*
143
* *2
2
1
2
1
96
1
* 16
6
* * i *
' * 14 '
23
1
21
"6*
•j"
.....
16
13
5
9
6
4
42
3
• ■ • • •
5
3
■ • • • •
. ..y
"2'
9
1
29
1
11
1
2
16
1
1
31
Plons opproved for Proposed
Public Swimming Pools
*Accumulotive toto Is- Ad justed on bosis of oil-county Swimming Pool Inventory.
**County Approvals
***Cost omitted on one or more approvals.
Number
511
10
17
11
118**
1
8
2
126**
25
7
19
i
Estimated
Cost
$5,523,471
129,050
' 1 56,1*00*
* 421^50
1,053,604***
11,800
76,500
23,000
1,251,304
231,500
60,000
UflOO*
2
1
II**
25,000
6,500
135,600***
. . . . .
3
12,000
73,000
.....
11
9
2
}5jo6o
106,800
66,400
26,500
.....
4
1
4
ii^soo
51,500
7,500
29,200***
•j'
i2*,5(»****
'15 *
1
38**
3
23
6**
221,400***
12,200
365,875
16,500***
268,100***
188,500
.....
4
17
1
1
50,600*
32,938***
122,100
7,500
12,000
.....
201,250
* 1*7,600
4
242
ANNUAL REPORT. 1966
TABLE 42
WATER PLANTS VISITED, NUMBER OF VISITS,
AND EXISTING PLANTS, BY COUNTY, FLORIDA, 1966
COUNTY
STATl.
Alachua . . .
Davier . . • • •
Boy
Brodford**. .
Brevard** . .
Broward** . .
CalKoun . . .
Owrlort*. . .
Citru*
Clay
Coliiar
Columbia. . .
Dade**
DeSoto . . . .
Dixie
Duval
Etcombia. . .
Flogler ....
Fronklin • • •
Godtden . . .
Gilchrist. . .
Glades . . . .
GulF
Hamilton. . .
Hardee . . . •
Hendry . . . .
Hernando. . .
Highlands . .
Hillsborough'
Holmes . . . .
Indion River.
Jackson. . . .
Jefferson . . .
Lofoyette. . .
Lxik*
Leon. ......
Levy
Liberty
nnodison . . * .
Manatee . . . .
Morion
Martin
Monroe
F^ssou
OVolooM. . . .
OtteecKobee. .
Orange
Otceolo . . . .
Palm Beach**.
Posco
Pinellas** . . .
Polk**
PutnoRt . • • ■ I
St. Johni. . .
St. Lucie . . .
Santo Rosa . .
Sarasota . . .
SemirwU . . .
Sumter ....
Suwannee . .
Toylor
Utnion .....
Volusia ....
Wakulla . . .
Walton . . . .
Waihir«gton
•Visits by Central Office personnel except where otherwise noted.
••Visits by County Heolth Departmenh hoving engineering personnel.
9
2
3
2
2
2
2
2
2
1
4
1
9
1
3
1
1
2
2
12
1
2
4
1
1
1
' 5
1
11
16
3
3
4
3
2
4
2
3
1
8
5
19
1
3
4
2
6
4
30
1
4
6
1
1
5
'lb'
6
22
2
14
3
10
37
4
5
12
13
8
4
51
3
6
98
26
3
6
6
1
3
4
3
4
2
23
9
25
2
8
12
1
1
52
15
34
13
2
6
33
16
12
1
5
19
4
92
5
61
49
13
38
6
5
8
9
22
35
13
2
3
2
23
8
5
4
A
4
SANITARY ENGINEERING 243
TABLE 43
WATER AND SEWAGE WORKS OPERATORS SHORT SCHOOLS*
FLORIDA, 1966
Short School
Annual (Univ. of Flo.)
(l)CloM "A" . . . .
(2) Class "B-
Reciprocity "8"
Regionol CUm "C"
Voluntary Certification Examination
Applicants
Water
13
12
3
Region
Region
Region
Region
Region
Region
Region
Region
Region
Region
1
2
3
4
5
6
7
8
9
10
Sewage
22
20
4
Proctored Class "C". .
Reciprocity Closs "C".
Total Ckw "C".
Total Classes "A"
"C" ....
0
7
19
13
6
6
7
5
tvJew Region
hvJew Region
7
0
70
99
5
3
13
10
2
5
8
2
Formed in
Formed in
Number Taking Exam.
Water
11
12
3
Sewage
22
20
4
r4umb«r Passing Exam.
Water
196
196
18
0
0
7
13
12
6
6
7
5
6-No Short S
6-No Short S
7
0
5
3
13
10
2
5
8
2
chool in 1966
chool in 1966
9
9
3
18
0
66
112
63
89
66
112
0
2
8
3
4
3
3
5
Sewage
14
14
3
5
2
12
9
2
5
7
2
5
0
33
15
0
59
90
— — . ^.. . j,_- -hjdv under the oegis of the State Board of Health carried out jointly
'-' :^:^ Esr^Drswr 7ni::ii^f ^^^^^^e f.^^^^^^^ g^r^A^^rtlcT "^ "^"^
7\an: Florida Section, American Woter Work, As^Kiotion; and Flor.do Pollution Control As.ociot.on.
TABLE 44
SANITATION OF WATER SUPPLIES SERVING
INTERSTATE CARRIERS, FLORIDA, 1966
Number
Typ«
rnrrler Served
Ownership
of Supply
Stahjs of Suppli«
at Year's End
COUNTY
ot
Supplies
Air
Roil
Vessel
Municipal
Private
2
1
2
X
1
Approved
»oy
• " ■
X
Approved
Brevard
« • •
X
• • •
X
Provisional
Broword
• • e
X
Approved
Collier
Qode
1
1
' "x
X
X
Approved
Provisional
Approved
Approved
Approved
DeSoto
Quvol
1
2
' x'
X
X
X
X
Escambia
1
1
X
X
X
X
Gulf
• • »
• > •
2— Approved, 1 Provisional
Provisional
Approved
Hillsborough
|.e«
3
1
2
2
X
X
X
X
X
X
2
Leon
Oonge
X
X
X
X
X
2
3
Approved
2-Provisional, 1-NCR*
Palm Beach
Pasco
3
1
1
' X
X
' 1
Approved
Approved
Pinellas.
...
X
1
Provisiorwl
Polk
1
1
• • •
X
1
Provisiorwl
St. Lucie
X
X
X
X
2
1
Provisional
Sorosota
2
...
Provisiorwl
Seminole
1
1
1
. . .
■ • •
1
ProvisioTKil
Sumter
Volusia
'x
• ■ •
'x
1
1
Approved
ProvisioTMil
Wolton
1
• • •
. . .
TOTALS
33
28
5
*?slCR-No current report.
244 ANNUAL REPORT. 1966
BUREAU OF VITAL STATISTICS
EVERETT H. WILLIAMS. JR., M.S.. Hyg.
Director I
The year 1966 was a good one for the Bureau of Vital Statistics.
Many improvements were made in data processing methods. One
noteworthy change was the coordination of all existing computer
programs involving personnel which included their pay and personal
particulars. This permitted more efficient production of payroll,
personnel data, telephone directory, budget projections and other
data relating to employees. A method was devised to compute radia-
tion background results directly from the nuclear analyzer housed
in the Orlando Laboratory. Improved methods were effected for
birth indexes and a cooperative procedure was established with the
State Department of PubUc Safety to purge the names of deceased
persons from the files of persons licensed to drive motor vehicles.
There was Uttle change in the total efficiency for collecting birth
and death records (Table 54). Last year, 94.4 per cent of the birth
records were received on time representing a sUght improvement
over the 93.9 per cent for 1965. The improvement in birth regis-
tration was offset by a decrease in promptness of death registration
from 97.6 per cent in 1965 to 97.3 per cent in 1966. Forty-three
counties were able to score 95 per cent or better in promptness of
birth registration. Unfortunately, there were 14 counties which re-
ceived less than 80 per cent of the births on time. This indicates
the need for some positive action to improve registration methods
in those counties. In death registration, 42 counties had at least 95
per cent of the records in on time while 16 counties showed great
need for improvement with a score of less than 90 per cent.
Our special commendation is extended to the following regis-
tration areas which comprise the top 10 on the Vital Statistics
Scoreboard: Jacksonville- Duval, Escambia, Sarasota, Manatee,
Volusia, Citrus, tie-Broward and Martin, Orange, St. Johns.
DIVISION OF DATA PROCESSING
HAROLD F. GOODWIN
Director
This division's main responsibility is to provide systems and
data processing support to all other bureaus, divisions and county
health departments (CHD). These activities cross organizational
Unes and the resultant products are used on an agency-wide basis,
and in some cases by other state agencies. More will be said about
this further in the report.
VITAL STATISTICS 245
The responsibilities of this division can be placed in two main
categories: Systems and Procedures, and Data Processing.
SYSTEMS AND PROCEDURES
Data processing systems are designed to take advantage of highly
accurate electronic equipment which has the capabilities of proces-
sing large volumes of data rapidly and more economically than if
done by manual means. Therefore, this area must concern itself
with present manual applications to determine if a procedure or
project could, in fact, be accomplished more effectively by com-
puters. Some of the responsibilities connected with this area are the
design of forms and coding schemes which are adaptable to computer
processing, proposing changes or modifications to the collection of
data and flow of work, and the necessary computer programming to
produce the desired results.
During the past year many systems were revised to take advan-
tage of more advanced techniques and the computer's speed. The
more important of these were:
Personnel - Many files relating to personnel were combined to
eliminate redundant information contained in each, and to establish
a master record for each employee which will be the basis for a
total personnel information system in the near future. This one
master record contains current payroll, year-to-date payroll, sick
and annual leave accounting, personnel statistics and personnel
directory data.
At present, a master record is estabUshed for each currently
employed person, whereas plans are being made to establish a
master record for each authorized position. This will make possible
in depth job class studies, and provide a much needed position index
file.
The system of reporting administrative payroll information to
the Comptroller's Office in punched card form has been eliminated,
and these data are now forwarded in magnetic tape form and fed
directly into the computer system for issuance of warrants.
Finance and Accounts — An important part in the production of
the 1967-69 Legislative Budget Request was accomplished last fall
by applying the problem of salary projections for the biennial period
to a computer. This procedure was successful enough to allow
generated results to go directly to the Printing Department, thereby
eliminating the need for interim manual typing of results. The sys-
tems staff designed unique computer programs which made pos-
sible the computing of thousands of calculations in a matter of hours.
Radiological Health - The system of computing background
radiation results in samples processed by the nuclear analyzer
housed in the Orlando Laboratory underwent major modifications
246 ANNUAL REPORT. 1966
J^nfnM ^''' deprogramming resulted in speeding up calculation time
tenfold over old methods. Manual calculation of one of these sam-
ples has been set at approximately 20 minutes, whereas the com-
puter can process and print 400 results in this same period of time.
Vital Records - A procedure was estabUshed early in the vear
TsDPS^r 1 '^'7 r' "^'"^^^ '^^^^ Department of ClSety
hRff H . ^^"^ '*^ ^"^^"^^ ^'^^^ °^ deceased drivers on a routine
basis and from one source. Each month this division forwards^
alphabetical Usting of deceased Florida residents 14 yea7s of a^
suDDlv thP^H^ft n ^^ 7^ computer, it will be in a position to
supply these data on magnetic tape for direct input into their system.
This computer-to-computer flow of data will also be possible
from this agency to the Florida State Department of Public Welfare
^ ^.tT Hospitalization processing and the Merit System S
in reporting personnel actions. v^in^e
DATA PROCESSING
This area is responsible for computer and unit record ooer-
H!i°"n ^"^ "^^^ reduction and verification. This has been an excep-
vertPd'frn'' 'T ^"'^""^ "' '^" "^^y P^^J^^^^ th^t have been con-
verted from umt record to computer, as well as large volume
?r^"r't] r'""'' K^' '"^^'^^^ ^^'^y h^^^« ^f overtime usage I
special five year birth index for the Division of Vital Records re-
quired sequencing and listing over one-half million names-^ oper-
17 hon'!^^' "Ik '^i^.nV ^^^^' ^"^^^ ^^* ^^^^^^ equipment, but only
17 hours usmg the 1401 computer system.
yea ^1965-16!'^^°'^ '^ ^'''''*^ °^ utilization by function for the fiscal
1401 Computer System , ,,^
Key Punching/Verification .I'lH
Peripheral Unit Record .'.'.*.*.'.*.' i 625
Planning, Programming and Clerical Operations.* .' .* .* .' .* .' * * .' .* 8'993
Total Hours Expended 30~830
VITAL STATISTICS' 247
DIVISION OF PUBLIC HEALTH STATISTICS
OLIVER H. BOORDE. M.P.H.
Director
This division has two prime responsibilities: presentation and
analyses of data obtained from vital records and special studies and
provision of statistical support and consultation to all bureaus and
divisions of the State Board of Health (SBH) as well as the County
Health Departments (CHD).
During the year the division publishes the Monthly Statistical
Report, which presents the latest available data on births, deaths,
marriages and divorces. Accompanying these bulletins are articles
written by the division staff concerning various subjects of public
health interest. They are distributed to CHDs, hospitals, libraries,
schools and those expressing a desire for this type of information.
At the end of each year, the division publishes a complete sum-
mary and analysis of data from vital records entitled Florida Vital
Statistics. This division also assists the Bureau of Preventable
Diseases in the preparation of Florida Morbidity Statistics^ a. review
and analysis of cases of reportable diseases.
In addition to these formal reports, throughout the year the
division provides vital statistics data from unpublished sources to
physicians, faculty members, students of educational institutions
and others.
In the area of statistical consultation, the division has exper-
ienced a continually increasing demand for its services. These
services consist of assistance in practically every phase of con-
ducting a special study or survey: design of forms, sample frame-
work, data collection systems and data tabulating procedures;
statistical analysis and interpretation; and presentation of the final
report.
The division has provided assistance on a number of special
studies conducted during 1966. Three special programs are worthy
of particular note as they have taken up a substantial portion of the
time: the Statistical and Tabulating Center for Cancer Registry Data
(SCCR), the Immunization Program and the Community Study of
Pesticides.
The SCCR program was begun in July, 1963, and its principal
objective is to assemble the vast amount of valuable data being col-
lected by the approved tumor clinics throughout the state into a
central data collection and analysis unit. The unit is equipped to
present and interpret summarized data to the medical staffs of the
tumor clinics. This information should also prove invaluable in
evaluating the effectiveness of the state's cancer research and
service programs. An annual report of data gathered by the center
is available upon request.
248
ANNUAL REPORT. 1966
The Immunization Program under the direction of the Bureau of
Preventable Diseases was initiated in 1963. The objective is to
raise the immunization level of preschool children against polio-
myelitis, diphtheria, whooping cough, tetanus and smallpox. Ad-
dress information from birth certificates filed with the Bureau of
Vital Statistics is utilized to contact parents of young children. This
division has been given the responsibility for designing procedures
to determine the pre- and post-program immunization levels of 15-
month-old children in counties participating in the project. The de-
termination of these levels will provide a means of evaluating the
effectiveness of the program.
The Community Pesticides Study was started in 1965 and is ad-
ministered by the Office of Program and Planning. Its objective is
to determine whether pesticides constitute a hazard to human health.
This division provides general statistical consultation and services
and is responsible for designing and initiating studies to investigate
the relative morbidity and mortality among persons occupationally
exposed to pesticides. Pest control personnel registered with the
Bureau of Entomology are being used as the basic study group.
VITAL STATISTICS SUMMARY
The following is a brief summary of preliminary vital statistics
for 1966. A more detailed analysis of final data will be presented in
Florida Vital Statistics, 1966, Preliminary 1966 birth and death
figures have been used in this report because of a time lag in re-
ceipt of records from the counties and the extensive processing re-
quired to summarize the data in final form.
POPULATION - Florida's population was estimated at 5,941,000
as of July 1, 1966, making it the ninth most populous state in the
union. During the past year the state's population has increased by
about 136,000 persons or slightly more than two per cent, compared
with a three per cent average annual gain recorded since the 1960
U. S. Census. The state experienced an average growth of 11,300
persons per month between 1965 and 1966. Of this, 3850 persons
(33 per cent) per month were added by natural increase (the dif-
ference between resident births and deaths) and the remaining 7550
persons per month (67 per cent) were added as a result of in-
migration. This compares with monthly gains of 5075 and 8350 re-
corded for natural increase and in-migration, respectively, during
the 1960-65 period.
Latest estimates placed Florida's white population at 4,892,400
and the nonwhite at 1,048,600. The white race which accounted for
82.1 per cent of the state's total population in 1960 now represents
82.3 per cent. The age group which includes all persons 65 years of
age and over has shown the greatest relative increase between 1960
and 1966, rising from 11.2 and 12.5 per cent of total populations.
VITAL STATISTICS
249
BIRTHS — According to preliminary data there were 102,542 infants
delivered to Florida residents during 1966, a drop of 4062 births
(down four per cent) from final 1965 figures. This is the fifth year
in succession that state births have shown an over-the-year decline.
The birth rate per 1000 population, presently at 17.3, reveals a con-
tinuous downtrend since 1956 when it stood at a peak rate of 24.7.
The downward spiral in the number of resident births and the birth
rate for the state is consistent with the pattern experienced through-
out the United States. There are no doubt many reasons for the cur-
rent trend of restricted family size with modern methods of oral
and mechanical contraceptives having an important effect.
Florida's birth rate has been declining more rapidly than the
rate for the United States as a whole; this state, due to its attraction
as a retirement center, has a relatively larger, and continually
growing segment of its population outside of the childbearing ages.
Both race groups have contributed to the falling birth rate. The
white rate has plunged from a peak of 22.2 in 1953 to its current
level of 15.0. Similarly the nonwhite rate shows an almost unbroken
year-to-year drop from a peak of 37.3 in 1956 to the present rate of
27.8. During the past 10 years, the white birth rate has been declin-
ing more rapidly than the nonwhite rate, down an average of 3.1 per
cent per year for white and 2.5 for nonwhites. A substantially larger
proportion of the white population is in non- childbearing age groups
as a result of in-migration of retirees. Also this race, because of
its advanced socio-economic status, may also be taking more ad-
vantage of new contraceptive methods.
DEATHS — Based on preliminary data there were 61,945 deaths of
Florida residents in 1966. This is the 20th year in succession that
a new record death figure has been set. The death rate per 1000
population was also slightly above last year's (10.4 versus 10.2) and
continues the slowly rising trend that has been in effect since the
mid-1950s. Most of this uptrend can be attributed to an increase in
the percentage of Florida citizens in the older age groups where
age- specific death rates rise sharply. An analysis of 1965 death
figures revealed that after eliminating the effect of age differences,
this state experienced slightly lower death rates for white and
slightly higher rates for nonwhite than the United States as a whole.
There is no reason to suppose that this situation has been altered
over the past year.
The white and nonwhite preliminary death totals were 51,600 and
10,345, respectively; both are new all-time highs. The 1966 death
rate for whites was 10.5 compared with 10.4 in 1965. This is a con-
tinuation of the uptrend that has been in effect during the past decade
largely because of the in-migration of retirees. The rate for non-
whites also shows an increase from 9.5 in 1965 to 9.9 in 1966. How-
ever the death rate for nonwhites has not experienced a long range
rising trend. The unadjusted death rate for whites is about six per
250
ANNUAL REPORT. 1966
VITAL STATISTICS
251
5 i
i t
li
cent above the rate for nonwhites; but after eUminating the age dif-
ferences of the two groups, the age-adjusted rate for nonwhites is
over 50 per cent above the age-adjusted rate for whites.
Table 47 presents the 20 leading causes of death in 1966 with
comparative rankings for 1956. There has been very Uttle change in
the top six positions during the past decade. In general, chronic type
diseases, in which the risk of death is closely related to aging, have
shown rising rates, while there has been a decUne or stability in
rates for causes where this relationship is not so strong.
Emphysema recorded the most startUng rise, jumping from 15th
position in 1956 with a rate of 8.3 deaths per 100,000 population to a
rank of seventh with a rate of 21.2 in 1966. On the other hand
chronic nephritis experienced the greatest decUne, falling from 14th
to 19th position as its death rate sUd from 9.4 to 4.8. Tuberculosis
was the only disease falling out of the top 20 causes during the
decade (from 18th to 21st position) and it was replaced by infections
of the kidney (from 21st to 15th position).
There are substantial differences between the races in the rela-
tive importance of some of the causes of death. For example,
emphysema and suicide which are the sixth and 10th ranked causes
of death among the white hold 12th and 25th positions, respectively,
among the nonwhite; whereas homicide is the seventh most fre-
quently Usted cause of death for nonwhite but ranks only 18th among
the whites.
INFANT MORTALITY - Preliminary figures show a total of 2773
infant deaths (under one year of age) in Florida during 1966. This
yielded an "all-time" low infant mortality rate of 27.0 per 1000 Uve
births. Both races contributed to this by estabUshing record "low"
rates of 21.2 for whites and 41.7 for nonwhites. Since 1956 the rate
for whites has dropped from 23.7 (down 11 per cent) and the rate for
nonwhites has fallen from 52.2 (down 20 per cent).
In spite of these decUnes, infant death rates for both races dur-
ing the past decade remain substantially above rates for many Scan-
danavian countries, most of whom report rates in the 14.0 to 17.0
range.
MARRIAGES AND DIVORCES - There were 52,425 marriages per-
formed in Florida during 1966. This is the highest number since
1943 when a record 53,912 marriages were reported. However the
current marriage rate of 8.8 per 1000 population is much less than
the peak rate of 25.4 recorded in 1943. In the past year 44,303 mar-
riages were reported for white and 8,122 for nonwhite, yielding rates
of 9.1 and 7.8, respectively. For the past decade, rates for both
races have hovered around 8.0. Rates for nonwhites exceeded those
for whites until 1959. Since then the rates for whites have been
slightly higher than rates for nonwhites.
Final data for 1966 show 25,801 divorces (including annulments)
recorded in Florida, the highest number since 1941 when 26,112
were reported. The 1966 totals were a record for the period since
1957, when Florida's divorce law was changed from a residency re-
quirement of 90 days to 6 months. The divorce rate has shown a
very slowly rising trend during the past eight years, but the present
rate of 4.3 divorces per 1000 population ranks with the lowest rates
for any period in Florida's history. In addition, in the past nine
years state ratios of marriages to divorces have revealed little
variation from two marriages for every divorce. Race is now shown
on the divorce report.
DIVISION OF VITAL RECORDS
CHARLES H. CARTER
Director
The primary responsibility of this division is the collection,
protection, preservation, legal amendment and issuance of certified
copies of those documents defined as vital records. Vital records
are made at the time the event occurred, by one who has knowledge
of the facts recorded, and by one required by law to make the
record. They consist of records of births, deaths, stillbirths, mar-
riages, divorces, adoptions, annulments and legal changes of name.
During 1966 a total of 243,738 certificates of all kinds were re-
ceived, processed and filed in permanent binders. Of 100,735 birth
certificates filed, 94.4 per cent were submitted on time. Of 63,786
death certificates filed, 97.3 per cent were received within the re-
quired period (see Table 45 and also Table 53).
The increased use of vital records is underscored by the fact
that a total of 139,349 requests for searches or for certifications of
personal records were processed during 1966. This represents an
increase of 8.0 per cent over 1965.
A total of 8838 records was amended or corrected during the
year. The majority of these required multiple exchange of corres-
pondence. When properly done, the correction of vital records is an
exacting task (see Table 45).
The processing of adoptions continues to increase. A total of
5554 final decrees of adoption was processed during the year and at
the end of 1966 adoption reports were being processed at the rate
of 125 per week.
In processing of adoptions it is necessary to work and have
liaison with parents, attorneys, welfare and child placement organi-
zations, clerks of the circuit court, physicians, hospital adminis-
trators and others.
ii
fi
M
252
ANNUAL REPORT. 1966
Requests from welfare agencies for birth certifications or birth
record information totaled 9568 during the year. Increased Social
Security and other benefits stimulated increased demands both for
copies of existing certificates and for assistance in the filing of de-
layed birth certificates. As could be expected, veteran administra-
tion offices and armed services recruiting offices continued to make
increased demands for certifications. Tabulation at the year's end
showed that of 139,349 searches of vital records, 24,249 or 17.4 per
cent were for agencies for which no charge was made.
The much needed project of the reindexing of old records
reached a commendable milestone. Work was completed during the
year to permit preparation of a badly needed new index for birth
records for the years 1926 through 1935. When printed this revised
index will include all delayed certificates placed on file, all new
certificates prepared for adoptions and legitimations as well as all
corrections made since the original record was placed on file. A
revised index for all birth records for the years 1865-1915 was
also completed.
To aid in the evaluation of the relative efficiency between regis-
tration districts, the Vital Statistics Scoreboard is pubUshed an-
nuaUy (see Table 53). To further stimulate interest in this worth-
while evaluation tool, an annual award of a certificate of merit is
made. This certificate is presented to the registration district with
the best performance as shown on the scoreboard.
Three persons were recipients of the first annual Merit Certifi-
cate award for excellence in vital statistics. Award of the merit
certificate is based on promptness and completeness of vital rec-
ords certificates filed, as shown on the Vital Statistics Scoreboard.
The division commenced pubUcation of a quarterly newsletter
for vital statistics registrars and others interested in vital statis-
tics. In addition to publication of items of general interest in the
vital statistics field, this newsletter is intended as a forum for ap-
propriate questions and answers or other expressions of opinions on
the problems of registrars.
VITAL STATISTICS 253
TABLE 45
ACTIVITIES OF THE DIVISION OF VITAL RECORDS, FLORIDA,
1965 AND 1966
ACTIVITY
Current certificates filed
Delayed birth certificates filed
Amended certificates filed for odoptiont
Adoption reports forwarded to other states. . . .
Legifimotioru processed
Legal chonges of nome received
Requests for certificotiorts or Marches
Total
Fee paid
Free
Photostat certificatiorw mode ,
Birth registration cards mode
Fees collected ond forwarded to State Treasurer
1965
241/04
2,199
5,110
917
564
888
128,971
102,100
26,871
153,282
23,969
$209,045.34
1966
243,738
2,119
5,554
1,167
916
1,201
139,349
115,100
24,249
157,998
27,102
$232,280.33
Per Cent
Chor>ge
♦ 0.9
- 3.6
+ 8.7
+ 27.3
+ 62.4
+ 35.2
8.0
12.7
9.8
11
13.1
11.1
TABLE 46
RESIDENT BIRTHS AND DEATHS WITH RATES
PER 1000 POPUATION, FLORIDA,
1920, 1930, 1940, 1950, AND 1956-1966
Yeor
Midyear
Population
Estimates
Births
Birth
Rate
Deaths
Death
Rate
1966*
5,941,000
5,805,000
5,705,000
5,531,000
5,392,000
5,205,000
4,999,000
4,790,000
4,571,000
4,245,000
3,941,000
102,542
106,604
113,966
114,729
115,248
116,683
115,610
112,733
108,014
103,806
96,320
17.3
18.4
20.0
20.7
21.4
22.4
23.1
23.5
23.6
24.5
24.7
61,945
59,231
56,753
55,609
52,639
48,690
47,937
44,179
43,353
39,937
36,705
10.4
1965
10.2
1964
9.9
1963
10.1
1962
9.8
1961
9.4
1960
9.6
1959
9.2
1958
9.5
1957
9.4
1956
9.3
1950
2,821,000
1,915,100
1,457,100
992,800
64,370
33,696
26,991
19,540
22.8
17.6
18.3
19.7
26,525
21,458
18,215
12,674
9.4
1940
11.2
1930**
12.3
1920*«
12.8
•Provisional data.
"Recorded rather than resident data.
254 ANNUAL REPORT. 1966
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VITAL STATISTICS
255
TABLE 48
RESIDENT DEATHS AND DEATH RATES BY CAUSE, BY RACE,
FLORIDA, 1966 (PRELIMINARY)
•All Causes per 1000 populaH(x«, specific causes per 100,000 population,
•*Per 10,000 live births.
••*Per 1000 live births.
CAUSE OF DEATH
DEATHS 1
DEATH RATES
*
(Numbers in parentheses refer to the
Non-
Non-
Intemationol List of Causes of Death)
Total
White
white
Total
White
white
ALL CAUSES
61,945
51,600
10,345
10.4
10.5
9.9
TiiK*rriilo«it all forms (001-019)
213
125
88
3.6
2.6
8.4
^^nkilk and ifs seaueloe (020-029)
98
50
48
1.6
1.0
4.6
DioKHieria (055)
0
0
0
0.0
0.0
0.0
WKoooina Couah (056)
0
24
0
17
0
7
0.0
0.4
0.0
0.3
0.0
0.7
Tfftnmis <061 )
14
4
10
0.2
0.1
1.0
Acute Poliomyelitis (080)
0
0
0
0.0
0.0
0.0
Arthropod-borne Encephalitis (082.0)
0
0
0
0.0
0.0
0.0
Other acute infectious Enceoho litis (082.1-082.3)
11
8
3
0.2
0.2
0.3
Meosles (085)
5
4
1
0.1
0.1
0.1
Infectious Hepatitis
32
28
4
0.5
0.6
0.4
Other infective and parasitic diseases (001-138 excluding
163
10,687
121
9,399
42
1,288
2.7
179.9
2.5
192.1
4.0
Mallartant ne<x>lasins (140-205)
122.8
Riircal cavitv and oKarvnx (140—148) •
260
237
23
4.4
4.8
2.2
Digestive system, not spec, as secondary (150-15M, 157-159)
3,141
2,749
392
52.9
56.2
37.4
Respiratory system, not spec, as secorxkiry (160-164)
2,366
2,121
245
39.8
43.3
23.4
Breost (170)
864
772
92
14.5
15.8
8.8
Genital oroons (171-179)
1,392
1,155
237
23.4
23.6
22.6
Urinorv oroons (180-181)
490
431
59
8.2
8.8
5.6
Other ond unspecified sites (156.B, 165, 190-199, 200-205). .
2,174
1,934
240
36.6
39.5
22.9
Benign neoplasms ar>d neoplasms of unspecified rKJture
(210-239)
175
155
952
132
143
112
744
88
32
43
208
44
2.9
2.6
16.0
2.2
2.9
2.3
15.2
1.8
3.1
Asthma (241)
4.1
Diabetes mellitus (260)
19.8
Anemias (290-293)
4.2
Meningitis, except Meningococcal ar>d Tuberculous (340)
89
42
47
1.5
0.9
4.5
Major cardiovascular-renal diseases (330-334, 400-468,
592-594)
32,445
28,195
4,250
546.1
576.3
405.3
Vasculor lesions affecting central nervous system (3X-334) . .
7,052
5,798
1,254
118.7
118.5
119.6
Diseases of Heart (400-443)
22,531
20,031
2,500
379.2
409.4
238.4
Rheumatic fever and chronic rheumatic heart
diseose (400-416)
532
486
46
9.0
9.9
4.4
Arteriosclerotic heart disease, includir>g cororwry
disease (420)
17,976
16,434
1,542
302.6
335.9
147.1
Non-rheumatic chronic endocorditis and other
mvcardial deoeneration (421 422)
1,185
1,011
174
19.9
20.7
16.6
Hypertensive heart diseose (440-443)
1,509
1,000
509
25.4
20.4
48.5
Other diseases of heart (430-434)
1,329
1,100
229
22.4
22.5
21.8
Other hypertensive diseose (444-447)
381
268
113
6.4
5.5
10.8
General arteriosclerosis (450)
991
887
104
16.7
18.1
9.9
Aortic ar>eurysm (rwnsyphilitic) ond certain
circulatory disease (451-468)
1,207
1,027
180
20.3
21.0
17.2
Chronic and unsoecified neohritis (592-594)
283
184
99
4.8
3.8
9.4
Influenza (480-483)
33
1,865
16
1,422
17
443
0.6
31.4
0.3
29.1
1.6
Pneumonia, excluding pneumonia of newborn (490-493)
42.2
Bronchitis (500-502)
152
140
12
2.6
2.9
1.1
Emphysemo (without bronchitis) ond certain
bronchopulmonary disease (525-527)
1,257
1,125
132
21.2
23.0
12.6
Ulcer of stomoch and duodenum (540, 541)
344
302
42
5.8
6.2
4.0
Appendicitis (550-553)
46
355
35
300
11
55
0.8
6.0
0.7
6.1
1.0
Hernia and intestinal obstruction (560. 561, 570)
5.2
Gastritis, duodenitis, enteritis and colitis.
excluding diarrhea of newborn (543, 571, 572)
270
191
79
4.5
3.9
7.5
Cirrhosis of liver (581)
890
758
132
15.0
15.5
12.6
Cholelithiasis, cholecystitis ond cholangitis (584, 585)
139
132
7
2.3
2.7
0.7
Acute nephritis and nephrosis (590-591)
39
28
11
0.7
0.6
1.0
Infections of kidney (600)
467
331
136
7.9
6.8
13.0
Hyperplosio of prostate (610)
93
76
17
1.6
1.6
1.6
Complications of pregrKincy, chilcibirth and puerperium
(640-689). .T r
40
18
22
3.9**
2.5"
7.5**
Congenital malformations (750-759)
540
404
136
9.1
8.3
13.0
Birth injuries, postnatal asphyxia ond atelectcsis (760-762). . . .
600
342
258
10.1
7.0
24.6
Infection of newborn (763-768)
125
61
64
2.1
1.2
6.1
Other disease peculiar to newborn ornJ immaturity
unqualified (769-776) .
929
1,401
560
918
369
483
15.6
23.6
11.4
18.8
35.2
Symptoms, senility, and ill-defined causes (780-795)
46.1
All other diseases (residual)
2,015
1,566
449
33.9
32.0
42.8
Motor vehicle accidents (E810-E835)
1,737
1,405
332
29.2
28.7
31.7
All other accidents (E800-E802 E840-E962)
1,990
1/446
544
33.5
29.6
51.9
Suicide (E963, E970-E979)
779
644
739
205
40
439
13.1
10.8
15.1
4.2
3.8
Homicide (E964, E980-E985)
41.9
Infant mortality (Deaths under one year of oge)
2,773
1,555
1,218
27.0***
21. 2»**
41. 7*"
i
256 ANNUAL REPORT. 1966
TABLE 49
RESIDENT DEATHS AND DEATH RATES BY CAUSE, BY RACE,
FLORIDA, 1965 (FINAL FIGURES)
CAUSE OF D€ATH
(Numben in parentt>«se« refer to tfie
International Lift of Causes of Death)
ALL CAUSES
Tuberculosis, all fom» (001-019)
Syphilis ond its seqoeloe (020-029)
Diphtheria (055)
Whooping Cough (056)
Meningococcal infections (057)
Tetonui (061 ) . . . ,
Acute Poliomeylitis (080)
Arthropod-borne Encephalitis (082.0)
Other ocute infectious Encephalitis (062.1-082.3)
Measles (085)
Infectious Hepatitis
Other infective and porositic diseos«s ((X)1-138
excl. above causes)
Malignant Neoplasms (140-205)
Buccal covity ond phorynx (140-148)
Digestive system, not spec, as secondory (150-156A, 157-159)
Respiratory system, not spec, os secondary (160-164)
Breast (170)
Genital organs (171-179)
Urinary organs (180, 181)
Other and unspeciHed sites (156.B, 165, 190-199, 200-205)
Benign neoplasms and r>eoplasms of unspecified nature (210-239)
Asthma (241)
Diobetes Mellihjs (260)
Anemias (290-293)
Meningitis, except meningococcal and tuberculous (340) ....
Major cardiovascular-rer>al diseases (330-334,
400-468, 592-594)
Vascular lesioru effecting central r»ervous system (330-334) .
Diseoses of heart (400-443)
Rheumatic fever and chronic rheumatic heart
disease (400-416)
Arteriosclerotic heart disease, including
coronary disease (420)
h4on-rheumatic chronic endocarditis ar«d other
my cardial degeneration (421, 422)
Hypertensive heart disease (440-443)
Other diseases of heart (430-434)
Other hyperterwive disease (444-447)
Gerteral arteriosclerosis (450)
Aortic af»eurysm (rH>n-syphilitic) ar>d certain
circulatory disease (451-468)
Chronic arid unspecified r>ephritis (592-594)
Influenza (480-483)
Pneumonia, excluding pneumonia of newborn (490-493)
Bronchitis (500-502)
Emphysema (without bronchitis) and certoin
bror>chopu Imonory disease (525-527)
Ulcer of stomach and duoder>um (540, 541)
Appendicitis (550-553)
Hernia and intestinal obstruction (560, 561, 570)
Gastritis, duodenitis, enteritis and colitis, excluding
diarrhea of newborn (543, 571, 572)
Cirrhosis of liver (581)
Cholelithiasis, cholecystitis and cholangitis (584,585)
Acute nephritis and nephrosis (590-591)
Infections of kidney (600)
Hyperplasia of prostate (610)
Complications of pregnortcy, childbirth and puerperium
(640-689)
Congenital molformatiorv (750-759)
Birth injuries, pottryjtol asphyxia and atelectasis (760-762). . .
Infection of newborn (763-768)
Other disease peculiar to riewbom and immaturity
unqualified (769-776)
Symptoms, senility, or>d ill-defir>ed couses (780-795)
All other diseases (residual)
Motor vehicle accidents (E810-E835)
All other accidents (E800-E802, E840-E962)
Suicide (E963, E970-E979)
Homocide (E964, E980-E985)
DEATHS
Total
59,231
Infant mortality (Deaths ur«ier one year of oge)
211
58
1
0
30
14
1
2
18
10
36
201
10,352
245
3,002
2,163
847
1,427
490
2,178
157
179
868
133
95
30,807
6,917
21,174
479
16,728
1,198
1/464
1,305
409
881
1,094
332
74
1,775
149
1,137
299
57
312
290
778
149
45
471
117
613
710
137
949
1,174
1,852
1>48
1,817
877
564
White
49,435
3,027
126
26
0
0
20
6
0
1
14
4
30
151
9,116
219
2,622
1,960
759
1,159
450
1,947
118
127
686
90
39
26,746
5,669
18,841
425
15,362
993
963
1,098
267
793
943
233
47
1,357
129
1,026
265
42
259
201
680
140
26
343
97
18
440
456
63
574
767
1,460
1,348
1,347
831
219
Non-
white
9,796
1,732
85
32
1
0
10
8
1
1
4
6
6
50
1,236
26
380
203
88
268
40
231
39
52
182
43
56
4,061
1,248
2,333
54
1,366
205
501
207
142
88
151
99
27
418
20
111
34
15
53
89
98
9
19
128
20
26
173
254
74
375
407
392
300
470
46
365
DEATH RATES*
Totol
10.2
1,295
3.6
1.0
t
0.0
0.5
0.2
t
t
0.3
0.2
0.6
3.5.
178.3
4.2
51.7
37.3
14.6
24.6
8.4
37.5
2.7
3.1
15.0
2.3
1.6
530.7
119.2
364.8
8.3
288.2
20.6
25.2
22.5
7.0
15.2
18.8
5.7
1.3
30.6
2.6
19.6
5.2
1.0
5.4
5.0
13.4
2.6
0.8
8.1
2.0
4.1"
10.6
12.2
2.4
16.3
20.2
31.9
28.4
31.3
15.1
10.1
White
10.4
2.6
0.5
0.0
0.0
0.4
0.1
0.0
t
0.3
0.1
0.6
.2
.9
.6
.9
.0
.9
.3
28.4*
3.
190.
4.
54.
41.
15.
24.
9.4
40.8
2.5
2.7
14.4
1.9
0.8
560.0
118.7
394.5
8.9
321.7
20.8
20.2
23.0
5.6
16.6
19.7
4.9
1.0
28.4
2.7
21.5
5.5
0.9
5.4
4.2
14.2
2.9
0.5
7.2
2.0
2.3**
9.2
9.5
1.3
12.0
16.1
30.6
28.2
28.2
17.4
4.6
Non-
white
22.5*
9.5
8.3
3.1
0.1
0.0
1.0
0.8
0.1
0.1
0.4
0.6
0.6
4.9
120.1
2.5
36.9
19.7
8.6
26.0
3.9
22.4
3.8
5.1
17.7
4.2
5.4
394.6
121.3
226.7
5.2
132.7
19.9
48.7
20.1
13.8
8.6
14.7
9.6
2.6
40.6
1.9
10.8
3.3
1.5
5.1
8.6
9.5
0.9
1.8
12.4
1.9
8.8**
16.8
24.7
7.2
36.4
39.5
38.1
29.1
45.7
4.5
35.5
43.7*
VITAL STATISTICS 257
TABLE 50
ESTIMATED POPULATION AND RESIDENT BIRTHS, DEATHS, AND
INFANT DEATHS, BY RACE, BY COUNTY, FLORIDA, 1966
(PRELIMINARY)
COUNTY
STATE
Atochuo . .
Baker
Boy
Bradford . .
Brevard. . .
Broward. . .
Calhoun . .
Chorlotte. .
Citrus. . . .
Cloy
Collier . . .
Columbia. .
Dode ....
DeSoto . . .
Dixie ....
Duval ....
Escambia. .
Flogler . . .
Fronklin . .
Gadsden . .
Gilchrist. .
Glodes . . .
Gulf
Hamilton. .
Hardee . . .
Her>dry . . .
Hernando. .
Highlar>ds .
Hillsborough
Holmes . . .
Indian River
Jackson. . .
Jefferson . .
Lofoyette. .
Loke
Lee
Leon
Levy
Liberty . . .
Modison . .
Monotee . .
Morion . . .
Mortin ...
Monroe . . .
Nassau . . .
Okaloosa. .
Okeechobee
Oronge . . .
Osceola . .
Palm Beach
Pasco ....
Pinellas. , .
Polk
Putnam . . .
St. Johns. .
St. Lucie. .
Santo Rosa .
Sarasota . .
Seminole . .
Sumter . . .
Suwannee .
Taylor. . . .
Lkiion. . . .
Volusia. . .
Wokulkj . .
Wolton . . .
Washington
Popula-
tion
1966
Prov. Est.
5,941,000
88,900
8,400
68,300
13,100
197,700
450,300
8,300
20,600
13,800
22,000
28,600
24,600
1,100,000
13,700
5,400
511,600
192,600
5,300
7,400
45,000
3,200
3,700
9,600
8,000
14,400
12,300
13,000
25,700
451,500
11,500
32,200
36,000
9,700
3,000
64,500
76,400
85,000
12,000
2,900
14,800
80,100
63,200
22,900
60,600
19,300
79,800
9,500
305,500
22,100
288,900
46,900
433,400
231,400
33,700
32,500
49,400
34,900
95,200
70,000
14,500
17,200
12,700
6,600
162,300
5,700
15,800
11,900
BIRTHS
Totol
102,542
1,828
163
1,423
232
4,308
7,142
137
196
222
511
513
547
17,584
222
146
10,309
4,143
98
149
930
47
67
184
185
264
306
234
448
8,328
150
569
575
201
37
1,044
1,320
1,539
215
67
271
986
1,215
373
1,178
352
1,677
218
5,702
309
4,851
572
4,802
4,268
628
526
985
853
1,085
1,384
259
274
247
88
2,336
100
209
211
Whit*
73,341
1,290
120
1,164
149
3,661
4,756
112
181
155
424
406
347
12,213
139
115
7,206
3,023
39
106
187
38
41
134
85
224
175
157
286
6,640
138
359
351
54
29
685
956
971
132
50
89
699
696
240
1,032
246
1,454
185
4,290
248
3,038
485
3,757
3,185
401
327
468
791
850
958
151
186
174
54
1,673
57
166
139
White
29,201
538
43
259
83
647
2,386
25
15
67
87
107
200
5,371
83
31
3,103
1,120
59
41
743
9
26
50
100
40
131
77
162
1,688
12
210
224
147
8
359
364
568
83
17
182
287
519
133
146
106
223
33
M12
61
1,813
87
1,045
1,063
227
199
517
62
235
426
106
88
73
34
663
43
43
72
DEATHS
Total
61,945
687
77
486
156
1,016
4,978
81
360
193
181
284
238
11,171
142
38
4,376
1,392
64
95
371
30
35
68
76
132
99
188
318
4,430'
120
357
317
103
26
862
900
575
151
28
169
1,236
682
278
433
154
313
85
2,708
375
3,227
776
7,427
2,179
346
382
543
226
1,457
570
140
186
111
57
2,344
59
150
129
White
51,600
419
54
394
119
875
4,331
59
347
172
146
230
152
9,696
110
28
3,003
1,022
40
82
137
24
21
52
41
118
76
153
258
3,739
112
281
194
46
21
737
774
346
111
23
90
1,115
459
230
372
110
283
60
2,275
343
2,572
730
7,074
1,768
218
289
405
206
1,362
386
107
135
79
43
2,066
41
131
106
Non-
While
10,345
268
23
92
37
141
647
22
13
21
35
54
86
M75
32
10
1,373
370
24
13
234
6
14
16
35
14
23
35
60
691
8
76
123
57
5
125
126
229
40
5
79
121
223
48
61
44
X
25
433
32
655
46
353
411
126
93
138
22
95
184
33
51
32
14
276
18
19
23
INFANT DEATHS
Total
2,773
54
4
35
13
91
225
5
4
5
16
18
15
413
10
7
315
98
3
3
57
1
2
5
1
14
10
6
18
214
1
18
7
8
1
23
31
40
5
0
11
19
23
17
X
11
29
7
157
9
136
17
115
107
28
10
35
24
36
45
10
2
6
4
74
1
5
5
White
1,555
24
2
20
7
64
103
2
4
3
14
11
6
218
4
5
170
57
1
1
5
0
1
3
0
11
6
3
11
159
1
6
2
0
1
16
16
17
2
0
1
10
8
5
25
10
26
3
98
8
69
8
74
74
10
5
13
23
23
26
2
2
5
1
40
0
5
3
Non-
White
1,218
30
2
15
6
27
122
3
0
2
4
7
7
195
6
2
145
41
2
2
52
1
1
2
1
3
4
3
7
55
0
12
5
8
0
7
15
23
3
0
10
9
15
12
5
1
3
4
59
1
67
9
41
33
18
5
22
1
15
19
8
0
1
3
34
1
0
2
*AII causes per 1,000 population, specific causes per 100,000 population.
••Per 10,000 live births.
•••Per 1,000 live births.
)Less than 0.05.
258
ANNUAL REPORT. 1966
TABLE 51
ESTIMATED POPULATION, RESIDENT BIRTH AND DEATH RATES PER
1000 POPULATION AND RESIDENT INFANT DEATH RATES PER 1000
LIVE BIRTHS, BY RACE, BY COUNTY, FLORIDA, 1965 (FINAL FIGURES)
\
COUNTY
STATE TOTAL
Alachuo**. .
Boker**
Boy
Brodford . . .
Brevard ....
Broward. . . .
CalKoun . . .
Charlotte. . .
Citrut
Cloy
Collier
Colufnbio. . .
Dade
DeSoto". . .
Dixie
Duvol
Escambia. . .
Flagler . . . .
Franklin . . .
Godiden**. .
Gilchrist . . .
Glodes
Golf
Hamilton. . .
Hardee . . . .
Hendry . . . .
Hernando. . .
Highlands . .
Hillsborough
Holmes . . . .
Indian River.
Jackson. . . .
Jefferson. . .
Lafayette. . .
Loke
Uon"
Levy
Liberty . . . .
Madison . . .
Marwtee . . .
Morion . . . .
Martin . . . .
Monroe . . . .
l^lasMu . . . .
Okaloosa. . .
Okeechobee.
Orange. . . .
Osceola . . .
Palm Beach .
Pasco
Pinellas. . . .
Polk
Putnam . . . .
St. Johns. . .
St. Lucie . . .
Santa Rosa . .
Sarasota . . .
Seminole. . ,
Sumter . . . .
Suwanrte* . ,
Toylor
Uhion** . . .
Volutio. . . .
Wokulla . .
Walton ...
Washington
Midyear
Population
Estimate
5,805,000
1
88,300
8,000
68,400
12,800
192,200
423,800
7,700
19,700
11,800
20,700
25,200
23,400
,089,200
13,600
4,900
511,500
192,400
5,700
7,500
44,000
3,200
3,600
9,500
8,000
13,400
11,300
12,900
25,000
441,900
11,400
31,800
36,400
9,700
2,900
62,600
71,800
83,000
11,500
2,900
14,600
78,100
62,200
22,900
59,500
19,300
78,500
9,000
302,200
21,300
279,900
40,800
425,500
214,300
32,800
32,700
46,700
35,800
92,800
69,800
13.900
17,000
13,700
6,500
157,900
5,700
16,000
12,000
BIRTH RATE
Total
18.4
22.3
22.8
22.9
17.0
22.9
17.1
.7
.2
.5
.2
.7
.2
19
9.
17
25
20
21
16.0
15.2
29.0
21.3
23.5
17.2
17.7
23.2
16.9
16.7
19.8
23.3
20.4
26.5
18.1
17.6
20.0
13.2
19.1
16.0
18.5
13.1
17.7
17.7
20.0
19.4
18.3
18.8
13.8
20.3
16.2
22.7
19.3
25.5
25.9
20.3
16.1
17.6
14.6
12.4
19.5
22.8
16.5
21.3
25.1
12.6
20.6
19.1
18.8
19.6
13.5
15.2
15.6
13.1
17.7
White
16.1
20.3
20.2
22.1
15.4
21.3
13.8
18.6
8.9
14.9
24.1
18.6
20.4
13.4
13.6
25.7
19.7
21.9
8.1
19.5
12.5
16.4
19.5
17.7
17.7
19.3
23.0
16.1
14.2
18.5
12.8
15.8
14.6
14.1
12.0
15.0
14.9
18.5
15.6
16.8
12.6
11.4
17.5
13.9
22.6
18.0
24.4
24.6
18.5
14.2
14.3
13.8
10.6
17.9
20.3
14.1
16.4
24.8
11.1
18.5
16.4
17.3
17.3
10.9
13.2
12.0
11.6
14.9
Uon-
white
28.8
28.9
31.7
27.4
22.0
37.7
33.3
25.4
16.3
33.5
32.6
36.3
22.9
30.0
21.0
48.6
26.7
29.3
42.7
11.3
30.3
20.0
12.7
26.8
30.0
30.8
35.8
25.4
30.6
28.7
24.0
31.5
19.0
21.4
20.0
28.5
33.2
23.2
27.8
27.5
25.6
27.2
26.4
26.4
23.5
23.9
40.9
32.9
M.2
32.2
29.3
21.5
30.1
26.2
28.3
23.8
31.1
29.2
27.0
28.9
26.5
23.0
27.4
20.6
26.7
25.0
22.7
28.8
DEATH RATE
Total White
10.2
7.2
10.3
7.3
11.1
5.1
10.8
9.9
17.1
14.7
9.4
10.4
10.3
9.6
10.5
10.8
8.4
7.4
8.6
9.9
8.0
10.6
9.2
8.7
11.5
11.4
7.4
15.3
11.4
10.0
9.7
9.9
9.5
11.8
12.8
13.2
11.6
6.5
10.2
10.7
10.0
14.8
10.2
12.8
6.8
8.3
4.0
9.3
8.0
16.4
10.9
1&6
16.7
9.7
10.9
12.5
10.7
6.4
14.3
8.5
11.7
10.5
9.3
6.9
14.3
8.9
10.8
10.1
10.4
5.8
10.2
7.0
11.3
4.8
11.5
8.8
17.2
15.9
9.4
9.5
8.3
10.0
10.4
9.5
7.5
7.0
7.1
9.5
7.7
9.6
10.0
7.7
10.7
11.2
5.7
17.2
11.9
9.9
9.5
10.6
9.2
13.6
14.0
14.5
11.9
5.2
10.5
11.6
9.3
15.7
10.4
13.2
6.4
6.8
3.8
8.4
8.1
16.6
11.2
20.2
17.5
10.0
10.3
11.8
11.9
6.1
14.9
7
11
9
8
7
14.5
9.8
11.2
9.8
.3
.7
.5
.2
.2
Non-
white
9.5
11.9
10.6
9.4
10.3
8.0
7.7
15.4
13.8
7.6
9.6
17.0
14.7
7.8
11.0
18.6
11.4
8.8
12.7
11.3
8.3
17.5
8.0
12.3
12.5
13.1
11.9
8.2
9.6
10.3
14.0
7.5
10.0
10.5
5.0
7.8
9.7
9.1
9.4
5.0
10.7
9.8
9.9
11.0
10.5
13.4
6.5
14.3
7.5
14.8
9.7
6.5
9.1
8.8
12.1
14.9
8.5
9.6
8.9
12.9
11.6
13.0
13.2
6.1
12.8
6.9
8.2
11.3
INFANT DEATH RATE
Total
28.4
White
22.5
27.9
33.0
24.3
32.3
27.5
28.6
39.5
16.6
19.3
30.7
44.1
40.4
27.4
33.8
21.1
27.7
29.7
30.6*
30.1
47.9
18.5*
16.7*
37.2
43.0
36.6
X.O
42.7
49.9
25.5
46.4
34.5
22.3
27.9
26.3*
29.8
30.6
24.7
22.4
18.9*
50.9
24.1
37.9
27.0
28.1
26.8
20.0
30.0
25.3
46.6
29.2
25.1
24.2
30.0
29.4
39.0
X.2
22.2
32.5
30.4
26.4
37.5
26.1
11.4*
36.1
22.5*
42.9
14.2
19.0
16.0
19.5
19.9
25.9
18.7
16.8
17.9
26.7
30.0
43.6
15.2
22.2
20.5
18.5
22.6
25.4
29.4*
26.1
27.6
0.0*
0.0*
38.8
25.6*
38.6
15.9
18.4
39.0
21.6
36.0
27.9
19.1
0.0*
33.3*
30.5
25.4
18.2
8.1
0.0*
41.7*
17.2
33.8
23.1
24.9
0.0
19.1
Non-
white
43.7
.7
.2
.2
.0
.1
26.
23.
37.
17.
24.
17.1
26.0
17.6
25.7
21.6
23.0
28.0
26.4
24.0
37.4
21.9
0.0*
26.7
0.0*
37.5
14.0
47.9
70.2*
46.1
60.6*
35.7
48.6
121.2*
0.0*
0.0*
34.1*
45.9
90.9
39.6
65.6*
29.4*
40.2
41.5
31.3*
55.6*
53.4
125.0*
52.6*
33.9*
55.6
25.0*
54.1
98.6*
69.2
40.9
166.7*
46.7
27.9
40.3
0.0*
28.1
43.4
35.7
40.0
90.9*
55.9
40.5
43.8
36.0
54.8
95.2
26.7
43.5*
32.4
81.1*
50.2
».3*
48.4
41.5
47.6
63.8
39.2
13.7*
50.0
50.5
30.6*
37.7
35.3*
27.0*
62.0
50.0*
60.0*
14.5*
VITAL STATISTICS
TABLE 52
^AARRIAGES BY RACE, DIVORCES AND ANNULMENTS,
BY COUNTY, FLORIDA, 1966
COUNTY
STATE
Alachua . . .
Baker
Boy
Bradford . . .
Brevard . . . .
Broward. . . .
Calhoun . . .
Charlotte. . .
Citrus
Clay
Collier
Columbia. . .
Dade
DeSoto . . . .
Dixie
Duval
Escambia . . .
Flagler
Franklin . . .
Godsden . . .
Gilchrist. . .
Glodes
Gulf
Hamilton . . .
Hardee . . . .
Hendry
Hernando. . .
Highlands . .
Hillsborough.
Holmes . . . ,
Indian River.
Jackson. . . ,
Jefferson . . ,
Lofayette. . .
Lake
Lee
Leon
Levy ,
Liberty . . . ,
Madison . . .
Manatee . . .
Marion . . . ,
Martin ...
Monro*. . .
Nossau . . .
Okaloosa. .
Okeechobee
Orange . . .
Osceola . .
Palm Beoch
Pasco ....
Pinellas. . .
Polk
Pufrwm . . .
St. Johns . .
St. Lucie . .
Santa Rosa .
Sarasota . .
Semir>ole . .
Sumter . . .
Suwannee .
Toylor
Union. . . .
Volusia. . .
Wakulla . .
Wolton . . .
Waihir>gton
MARRIAGES
Total
52,425
741
112
625
111
1,668
4,093
45
158
119
201
296
246
10,295
138
54
3,767
1,847
68
50
194
41
71
91
61
182
137
168
227
4,304
87
324
224
81
25
508
784
613
124
13
77
757
575
231
626
Ul
541
100
2,719
261
2,573
502
3,411
2,253
265
300
505
271
871
574
147
129
142
42
1,311
49
83
106
White
44,303
563
104
533
94
1,506
3,450
40
147
101
169
268
198
8,869
105
47
2,996
1,482
54
40
90
35
43
80
43
163
96
146
188
3,779
84
254
181
42
22
408
682
453
93
13
55
643
413
198
558
96
501
85
2,373
218
2,088
451
3,095
1,866
202
244
333
250
792
451
115
101
120
31
1,151
45
74
91
Nonwhite
8,122
178
8
92
17
160
643
5
11
18
32
28
48
1,426
33
7
771
365
14
10
104
6
28
11
18
19
41
22
39
525
3
70
43
39
3
100
102
160
31
0
22
114
162
33
68
15
DIVORCES
25,5»
322
85
349
56
926
1,777
63
67
56
98
109
98
4,924
48
22
2,055
^0
125
37
81
10
11
48
23
250
72
43
90
2,131
71
143
94
134
7
1,133
311
247
57
12
35
257
125
109
289
56
259
ANNUL-
MENTS
271
1
0
3
0
4
20
0
2
0
0
1
0
80
3
0
20
13
3
0
1
0
0
1
0
0
0
2
0
18
0
0
0
1
0
15
1
4
0
0
0
6
0
1
2
0
40
478
5
15
54
0
346
457
0
43
98
3
485
1,004
7
51
137
2
316
1,695
20
387
979
14
63
346
2
56
240
1
172
206
3
21
108
4
79
463
4
123
318
1
32
130
1
28
47
1
22
46
0
11
30
1
160
587
0
4
0
0
9
56
0
15
25
0
*Bosed on leu than 100 live births, which limits the significonce of the rotes.
**Large irwtitutiorHjl population segment included in population bose.
260 ANNUAL REPORT. 1966
TABLE 53
VITAL STATISTICS SCOREBOARD
BASED ON PROMPTNESS AND COMPLETENESS OF
CERTIFICATES FILED, FLORIDA, 1966
COUNTY
Rartk
Per Cent of
Certificates
Filed on Time
Per Cent of
Complete
Certificates
Per Cent of
Monthly
Reports
Submitted
on Time
Total Score
(Maximum
= 500)
Change
from 1965
Total Score
Births
Deaths*
Births
Deaths**
STATE
94.4
97.3
99.8
99.6
96.1
487.2
+ 0.7
Jacksonville-Duval
Escambia .
1
2
2
4
5
6
7
7
9
10
11
12
13
14
15
16
17
18
18
20
21
22
23
24
25
26
27
28
29
30
31
31
33
34
35
36
37
38
39
40
40
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
100.0
99.5
99.5
99.6
99.7
99.5
98.9
99.6
99.1
100.0
99.0
99.9
99.6
99.3
97.8
100.0
98.0
97.4
95.5
98.5
95.6
96.2
97.3
98.9
96.5
96.5
95.3
97.8
97.2
100.0
97.7
96.2
98.7
95.9
97.1
89.5
95.0
97.9
88.7
95.0
95.7
92.5
94.7
86.1
98.0
82.2
89.7
95.2
94.5
74.7
100.0
82.7
100.0
71.0
79.6
67.0
60.8
83.3
69.5
73.8
60.7
73.7
66.7
59.2
65.1
69.0
0.0
100.0
99.9
99.7
99.5
99.3
100.0
99.9
98.9
99.1
99.1
98.9
99.6
98.4
98.4
99.3
95.9
98.8
98.7
100.0
97.9
99.8
98.9
98.2
95.4
99.0
97.8
98.1
94.8
96.1
100.0
94.9
99.2
99.0
96.2
100.0
98.6
93.8
97'.0
96.1
98.9
89.1
98.6
82.9
91.6
98.8
92.6
91.7
97.4
95.8
95.2
85.7
84.8
88.2
94.3
88.2
89.9
92.9
91.7
79.4
76.2
86.5
80.0
84.6
74.4
76.9
65.1
74.1
100.0
100.0
100.0
100.0
99.7
98.9
99.8
100.0
99.9
100.0
99.6
99.5
99.6
100.0
99.7
IW.O
98.6
99.7
99.9
99.6
99.7
100.0
98.9
99.4
99.1
100.0
99.8
99.9
99.6
100.0
100.0
97.5
96.8
99.1
99.4
99.3
97.5
98.3
99.7
99.8
99.3
98.4
100.0
99.9
96.0
99.8
99.6
98.0
98.7
99.6
100.0
100.0
100.0
98.7
99.4
98.0
99.5
100.0
99.3
96.7
98.3
97.1
100.0
100.0
99.1
100.0
100.0
99.8
99.7
99.9
99.6
99.8
100.0
99.6
99.7
99.9
98.5
99.8
98.2
99.5
98.9
99.4
100.0
100.0
99.3
99.7
99.0
99.7
99.6
99.4
100.0
99.0
99.2
99.9
100.0
99.0
100.0
98.0
97.7
95.9
98.2
99.4
99.7
100.0
100.0
100.0
98.4
99.7
99.3
100.0
99.7
98.9
99.9
100.0
98.6
97.0
99.7
100.0
100.0
100.0
98.4
98.9
98.5
98.7
91.7
99.9
98.5
98.9
100.0
100.0
99.3
99.3
97.8
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
91.7
100.0
100.0
100.0
100.0
91.7
100.0
100.0
91.7
100.0
91.7
100.0
91.7
100.0
100.0
83.3
100.0
91.7
83.3
83.3
100.0
83.3
100.0
75.0
100.0
91.7
100.0
100.0
83.3
100.0
100.0
100.0
91.7
83.3
100.0
75.0
66.7
91.7
499.8
499.1
499.1
498.7
498.5
498.4
498.2
498.2
498.0
497.6
497.3
497.2
497.1
496.6
496.2
495.9
495.4
495.1
495.1
495.0
494.8
494.7
493.8
493.7
493.6
493.5
493.1
492.5
491.9
491.7
490.6
490.6
490.4
489.4
487.6
487.1
486.3
484.9
484.5
483.8
483.8
480.5
477.6
477.3
475.0
474.5
472.7
472.5
469.3
469.2
469.0
467.5
463.2
462.4
457.8
453.4
451.9
450.0
448.1
445.2
444.4
442.5
434.6
432.9
415.4
398.6
365.8
+ 0.3
+ 2.1
Sorasota
+ 8.7
Manate«
+ 0.3
Volusia
+ 1.3
Citrus
-0.9
Broward
+ 3.2
Martin
- 1.1
Orangs
- 0.1
St. Johns
- 0.5
Polk
+ 1.8
Swninole
+ 0.6
Brodford
+ 0.3
Hernando
+ 6.5
Brsvard
+ 3.1
Flagler
+17.2
Baker
+ 4.3
Alochoa
- 2.0
Dade
- 1.4
Jefferson
- 1.3
Lee
+ 4.0
Hillsborough
- 2.5
Charlotte
- 0.8
Washington
- 1.7
Cloy
+ 6.3
DeSoto
+34.2
Palm Beoch
0.0
Bay
- 0.2
Marion
+ 8.8
Glades
+10.0
Holmes
+17.1
Nassau
- 2.1
Haidee
+ 6.1
Gulf
- 1.2
Osceola
+26.1
Pasco
+23.9
Levy
+18.6
Hendry
+16.1
Suwannee
+ 4.4
Monroe
-12.9
Putnom
- 3.1
Madison
- 3.4
Walton
- 0.6
- 1.2
Franklin
-16.7
Pinellas
- 1.8
Taylor
+ 9.0
Indian River
-18.6
Santa Rosa
-13.9
Highlar>ds
+24.5
Gilchrist
-24.8
Homi Itpn
+16.8
Wakulla
+17.2
Collier
- 1.1
Okeechobee
+59.7
Columbia
+28.5
Gadsden
+16.7
Lafayette
+41.5
Lake
- 5.1
Sumter
- 9.7
Calhoun
- 0.9
Jackson
+10.6
Liberty
+14.3
St. Lucie
- 7.7
Okaloosa
-15.4
Union
-45.3
Dixie
-116.3
261
ARTICLES AND PUBLICATIONS BY STATE
BOARD OF HEALTH STAFF MEMBERS, 1966
ADMINISTRATION
Azar, Gordon J.; Bond, James O.; Chappell, G. Lindsey, and Law-
ton, Alfred H. Follow-up studies of St. Louis encephalitis in
Florida: sensorimotor findings. Amer. J. Public Health 56:
1074-1081, July 1966.
Azar, Gordon J.; Bond, James O., and Lawton, Alfred H. St. Louis
encephalitis: age aspects of 1962 epidemic in Pinellas County,
Florida. J. Amer. Geriat. Soc. 14: 326-333, April 1966.
Bohley, Ora. Inservice education and organization of nursing serv-
ice. Newsletter, Florida Nurs. Home Ass., Feb. 1966.
Bond, James O. St. Louis encephalitis, Nurs. Outlook 14: 26-27,
Oct. 1966.
Bond, J. O.; Hammon, W. McD.; Lewis, A. L.; Sather, G. E., and
Taylor, D. J. California group arboviruses in Florida and re-
port of a new strain. Keystone virus. Public Health Rep. 81:
607-613, July 1966.
Bond, James O.; Hammon, William McD.; Lewis, Arthur L.; Sather,
Gladys E.; Azar, Gordon J., and Lawton, Alfred H. Follow-up
studies of St. Louis encephalitis in Florida serologic findings
eighteen months to five years after epidemics. Amer. J. Trop.
Med. 15: 91-95, Jan. 1966.
Bond, James O.; Quick, Donald T.; Lewis, Arthur L.; Hammon,
William McD., and Sather, Gladys E. The 1962 epidemic of St.
Louis encephalitis in Florida. XL Follow-up serologic surveys
for prevalence of group B arbovirus antibodies. Amer. J. Epi-
dem. 83: 564-570, May 1966.
Hammon, W. McD.; Sather, G. E.; Bond, J. O., and Lewis, A. L. Ef-
fect of previous dengue infection and yellow fever vaccination
on St. Louis encephalitis virus serological surveys in Tampa
Bay area of Florida. Amer. J. Epidem. 83: 571-585, May 1966.
Jennings, William L.; Allen, Raleigh H., and Lewis, Arthur L. West-
ern equine encephalomyelitis in a Florida horse. Amer. J.
Trop. Med. 15: 96-97, Jan. 1966.
Kale, Herbert W. E and Jennings, William L. Movements of immature
mockingbirds between swamp and residential areas of Pinellas
County, Florida. Bird-Banding 37: 113-120, April 1966.
Lawson, A. H.; Seabury, C. J.; Branch, N.; Azar, G. J., and Bond,
J. O. Follow-up studies of St. Louis encephalitis in Florida:
comparison of 1964 and 1965 health questionnaire findings.
Southern Med. J. 59: 1409-1414, Dec. 1966.
'includes all death certificates and stillbirth certificates.
'•Includes all incomplete death and stillbirth certificates and unreturned couse-of-deoth queries.
262
Lewis, Arthur L.; Schneider, Nathan J.; Bond, James O., and Hardy,
Albert V. The 1962 epidemic of St. Louis encephalitis in Flor-
ida. V. Serologic diagnosis of cases. Amer. J. Epidem. 83:
24-32, Jan. 1966.
McMullan, Patricia. Rehabilitation nursing. Newsletter, Florida
Nurs. Home Ass. June 1966.
Meadows, Karen E. Gynandromorphism in Culex (Linnaeus) mosqui-
toes, Tampa Bay area, Florida, 1965. Mosq. News 26: 587-589.
Dec. 1966.
Schoonover, Robert A. "Working relations of faculty advisers to stu-
dent staffs on collegiate newspapers," m Freedom and censor-
ship of the college press, ed. by Herman A. Estrin and Arthur
M. Sanderson, Dubuque, Iowa, Wm. C. Brown, 1966. pp. 81-97.
Seabury, Corinne J. A nurse's observation on post -encephalitis
patients. Nurs. Outlook 14: 28-29, Oct. 1966.
Sowder, Wilson T. The impact of the Social Security amendments on
the Florida State Board of Health. Medical Care under Social
Security Potentials and Problems 15: 99-104, Feb. 1966.
Sowder, Wilson T. The problem of illegitimacy, J. Florida Med. Ass.
53: 513-514, June 1966.
Taylor, Doyle; Meadows, Karen, and Branch, Nina. Gynandromor-
phism in Culex (Linnaeus) mosquitoes collected in the Tampa
Bay area 1962 through 1964. Mosq. News 26: 8-10, Mar. 1966.
Taylor, Doyle J.; Meadows, Karen, and Baughman, Ingrid E. Com-
parison of a chick-baited trap with the CDC minature light
trap. Mosq. News 26: 502-506, Dec. 1966.
Vickery, Carl A., Jr.; Meadows, Karen E., and Baughman, Ingrid E.
Synergism of carbon dioxide and chick as bait for Culex nig-
ripalpus, Mosq. News 26: 507-508, Dec. 1966.
BUREAU OF ADULT HEALTH AND CHRONIC DISEASES
Frydman, Joseph E.; Clower, James W.; Fulghum, James E., and
Hester, Marion W. Glaucoma detection in Florida; analysis of
67,193 persons examined. J. A.M. A. 198:1237-1240, Dec. 19,
1966.
Fulghum, James E. Glaucoma and you. Age Wise 7, July 1966.
Fulghum, James E. Smoking and health: Florida's approach to the
problem. Southern Med. J. 59: 1161-1164. Oct. 1966.
Groover, Marshall E., Jr. et al. "Alteration in color preference on
the Kenya baboon during minor illness," "The influence of the
mature male on the menstrual cycle of the female baboon,"
'The effects of environmental manipulation of psychological
parameters," "Electrophoretic patterns in the baboon," in The
baboon in medical research, proceedings. International
263
symposium on the baboon and its use as an experimental ani-
mal, 1st ed. by Harold Vagtbord, Austin, University of Texas,
1966.
Groover, Marshall E., Jr. and Stout, C. "Neurogenic myocardial
necrosis," in Prevention of ischemic heart disease, ed. by
Wilhelm Raab, Springfield, IlL C. C. Thomas, 1966.
Groover, Marshall E., Jr. and Stout, C. Physiochemical properties
of blood in post- myocardial infarction patients and controls.
Angiology 17: 85-95, Feb. 1966.
BUREAU OF ENTOMOLOGY
Bidlingmayer, William L. Use of the truck trap for evaluating adult
mosquito populations. Mosq. News 26: 139-143, June 1966.
Harrington, Robert W., Jr. Changes through one year in the growth
rates of tarpon Megalops atlanticus Valencinnes, reared from
mid-metamorphosis. Bull. Marine Sci. 16: 868-883, Dec. 1966.
Nayar, Jai K. A method of rearing salt-marsh mosquito larvae in a
defined sterile medium. Ann. Entom. Soc. Amer. 59: 1283-
1285, Nov. 1966.
Patterson, R. S.; von Windeguth, D. L.; Glancy, B. M., and Wilson,
F. L. Control of the midge Glyptotendipes paripes with low
volume aerial sprays of malathion. J. Econ. Entom. 59: 864-
866, Aug. 1966.
Patterson, R. S. and Wilson, F. L. Fogging and grandule applications
are teamed to control Chironomid midges on Florida lake-
fronts. Pest Control 34: 26-32, June 1966.
Patterson, R. S.; Wilson, F. L.; Ratledge, E. L., and Metzger, H. E.
A technique for checking deposition of aerosol fogs. Mosq.
News 26: 441-442, Sept. 1966.
Rathburn, C. B., Jr. The arsenic content in soil following repeated
applications of gradular Paris green. Mosq. News 26: 537-539,
Dec. 1966.
Van Handel, Emile. Temperature independence of the composition of
triglyceride fatty acids synthesized de novo by the mosquito.
J. Lipid Res. 7: 112-115, Jan. 1966.
Van Handel, Emile. The thermal dependence of the rates of glycogen
and triglyceride snythesis in the mosquito. J. Exp. Biol. 44:
523-528, 1966.
von Windeguth, D. L. and Patterson, R. S. The effects of two organic
phosphate insecticides on segments of the aquatic biota. Mosq.
News 26: 377-380, Sept. 1966.
Yount, James L. A method for rearing large numbers of pond midge
larvae with estimates of productivity and standing crop. Amer.
Midland Naturalist 76: 230-238, July 1966.
In
2M
BUREAU OF HEALTH FACILITIES AND SERVICES
Knapp, Marjorie A. Planning for dining and serving areas in nursing
homes. Hospitals 40: 140-142, Nov. 16, 1966.
BUREAU OF LABORATORIES
Kaiser, M. H.; Cohen, R.; Arteaga, I.; Yawn, E.; Mayoral, L.; Hof-
fert, W., and Frazier, D. Normal viral and bacterial flora of
the human small and large intestine. New Eng. J. Med. 274:
500-505, 558-563, Mar. 1966.
BUREAU OF LOCAL HEALTH SERVICES
Hall, James B. Do's for the health director. J. Florida Med. Ass.
53: 517-518, June 1966.
Hughes, Paul W. Contamination can be caused by many unsuspected
elements common to water suppUes. The Overflow, p. 19-20,
Jan.-Feb. 1966 and p. 13-14, 28, Mar.-Apr. 1966.
Kaufman, Mildred. A food preference questionnaire for counseling
patients with diabetes. J. Amer. Diet. Ass. 49: 31-37, July
1966.
Milton John D. The pubUc health physician and the private prac-
tioner. J. Florida Med. Ass. 53: 491-494, June 1966.
Pafford, B. C. Student housing survey. J. Amer. College Health Ass.
14: 182-195, Feb. 1966.
Walker, Claudius J. Civil defense emergency hospital. J. Florida
Acad. Gen. Practice 16: 18-19, Apr. 1966.
Walker Claudius J. Public reaction to disaster. Civil Defense News-
letter (Florida) 3, June 1966. Also appeared in Civil Defense
Newsletters in Wyoming, Montana, North CaroUna and in the
newsletter. Civil Defense-The Fourth Arm, Institute of Civil
Defense, London, Eng.
BUREAU OF PREVENTABLE DISEASES
Ferguson, Sydney H. Unclassified mycobacteria. Brit. Med. J. 1:
612-613. Mar. 5, 1966.
BUREAU OF SANITARY ENGINEERING
Beck, William M., Jr. and Beck, EUsabeth C. 'The Chironomidae of
Florida: a problem in international taxonomy," Proceedings of
the First International Symposium on Chironomidae, p. 89-
102, 1966.
Beck, WilUam M., Jr. and Beck, EUsabeth C. Chironomidae (Diptera)
' of Florida. I. Pentaneurini (Tanypodinae). Bull. Florida State
Mus. 10: 305-379, 1966.
BUREAU OF VITAL STATISTICS
Taylor, G. Dekle and Williams, Everett. Acoustic trauma in the
sports hunter. Laryngoscope 76: 863-879, May 1966.
PUBLICATIONS
Florida State Board of Health, Bureau of Local Health Services,
Division of Sanitation, Report of an environmental health sur-
vey of Brevard County, Florida, November 1-6, 1965. Jack-
sonville, Florida, 1966.
Hicks, Martha Beth, Lassiter, Peggye Guess, and Crawford, Annie
Laurie. Mental health and psychiatric nursing. Jacksonville,
Florida, Florida State Board of Health, 1966.
FLORIDA STATE BOARD OF HEALTH MONOGRAPHS
Carter, Howard W. and Webber, Irving L. The aged and chronic
disease: research in a local health department. Monograph 9,
Florida State Board of Health, 1966.
Sowder, Wilson T.; Bond, James O.; Williams, Everett H., Jr., and
Flemming, Edward L. Man to man talk about women. . . and
men. Monograph 10, Florida State Boarj^ of Health, 1966.
Hi
IJii
•I!
MM
III
I
264
BUREAU OF HEALTH FACILITIES AND SERVICES
Knapp, Marjorie A. Planning for dining and serving areas in nursing
homes. Hospitals 40: 140-142, Nov. 16, 1966.
BUREAU OF LABORATORIES
Kaiser, M. H.; Cohen, R.; Arteaga, I.; Yawn, E.; Mayoral, L; Hof-
fert, W., and Frazier, D. Normal viral and bacterial flora of
the human small and large intestine. New Eng. J. Med. 274:
500-505, 558-563, Mar. 1966.
BUREAU OF LOCAL HEALTH SERVICES
Hall, James B. Do's for the health director. J. Florida Med. Ass.
53: 517-518, June 1966.
Hughes, Paul W. Contamination can be caused by many unsuspected
elements common to water supplies. The Overflow, p. 19-20,
Jan.- Feb. 1966 and p. 13-14, 28, Mar.- Apr. 1966.
Kaufman, Mildred. A food preference questionnaire for counseling
patients with diabetes. J. Amer. Diet. Ass. 49: 31-37, July
1966.
Milton, John D. The pubUc health physician and the private prac-
tioner. J. Florida Med. Ass. 53: 491-494, June 1966.
Pafford, B. C. Student housing survey. J. Amer. College Health Ass.
14: 182-195, Feb. 1966.
Walker, Claudius J. Civil defense emergency hospital. J. Florida
Acad. Gen. Practice 16: 18-19, Apr. 1966.
Walker, Claudius J. PubUc reaction to disaster. Civil Defense News-
letter (Florida) 3, June 1966. Also appeared in Civil Defense
Newsletters in Wyoming, Montana, North CaroUna and in the
newsletter, Civil Defense-The Fourth Arm, Institute of Civil
Defense, London, Eng.
BUREAU OF PREVENTABLE DISEASES
Ferguson, Sydney H. Unclassified mycobacteria. Brit. Med. J. 1:
612-613. Mar. 5, 1966.
BUREAU OF SANITARY ENGINEERING
Beck, William M., Jr. and Beck, EUsabeth C. "The Chironomidae of
Florida: a problem in international taxonomy," Proceedings of
the First International Symposium on Chironomidae, p. 89-
102, 1966.
Beck, William M.,Jr. and Beck, Elisabeth C. Chironomidae (Diptera)
' of Florida. I. Pentaneurini (Tanypodinae). Bull. Florida State
Mus. 10: 305-379, 1966.
- ;., 265
BUREAU OF VITAL STATISTICS
Taylor, G. Dekle and Williams, Everett. Acoustic trauma in the
sports hunter. Laryngoscope 76: 863-879, May 1966.
PUBLICATIONS
Florida State Board of Health, Bureau of Local Health Services,
Division of Sanitation, Report of an environmental health sur-
vey of Brevard County, Florida, November 1-6, 1965. Jack-
sonville, Florida, 1966.
Hicks, Martha Beth, Lassiter, Peggye Guess, and Crawford, Annie
Laurie. Mental health and psychiatric nursing. Jacksonville,
Florida, Florida State Board of Health, 1966.
FLORIDA STATE BOARD OF HEALTH MONOGRAPHS
Carter, Howard W. and Webber, Irving L. The aged and chronic
disease: research in a local health department. Monograph 9,
Florida State Board of Health, 1966.
Sowder, Wilson T.; Bond, James O.; Williams, Everett H., Jr., and
Flemming, Edward L. Man to man talk about women. . . and
men. Monograph 10, Florida State Board of Health, 1966.
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