Public health in Arizona

              p U 8 L C
I ' I r
HfAlTH
N
ARIZONA
PH 0 EN I X. A R I ZO N A
MARCH I, 1938
Co IT I. HUGHES, M.D.
SUPERINTENDENT OF HEALTH
STATE OF ARI ZONA
PHOENI X, Ani ZO NA
DE:AR DR. HUGHES:
SHORTLY AFTER BECOMING ASSOCIATED WITH THE STATE: BOARD
OF HEALTH ON SEPTEMBER 1ST, I FELT THE NEED OF COLLECTING CERTAIN DATA
UPON WHICH TO BASE ANY FUTURE PLANS FOR THE FURTHER DEVELOPMENT OF LOCAL
HE,~LTH SERVICE IN THIS STATE.
WHILE CERTAIN BASIC ESSENTIALS EXIST WHICH ARE COMMON TO
AND ESSENTI AL IN ALL SOUND PUBLIC HEALTH PLANNING, IT IS NECESSARY TO
KNOW HOW MUCH OF THESE HAVE ALREADY BEEN SUPPLIED, WHAT ADDITIONAL SPECIAL
PROBLEMS THERE MAY BE, AND WHAT FACILITI ES MAY 8E MADE AVAILABLE FOR
MEETING THE COMBINED PUBLIC HEALTH NEED.
IN ORDER TO SECURE THIS INFORMATION, CERTAIN MEMBERS OF
THE STAFF H,WE BEEN ENGAGED, AS TIME PERMITTED DURING THE P,~ST TWO MONTHS,
IN ASSEMBLING INFORMATION, LARGELY STATISTICAL, FROM HECORDS IN THE
DEPARTMENT AND FROM THE VARIOUS COUNTIES, FROM WHICH AN ANALYTICAL STUDY
MI GHT BE MADE.
THE FIGURES AS SECURED ARE ACCURATE, AND THE DEDUCTIONS
PRESENTED ARE AN ATTEMPT TO PRESENT FOR YOUR INFORMATION RECOMMENDATIONS
WHI CH, I TIS HOPEO, ARE SOUND AND MAY BE USEFUL TO YOU.
AN ACKNOWLEDGEMENT I S MADE TO THOSE IN THE DEPARTMENT WHO
PAINSTAKINGLY AND WITH UNDERSTANDING ASSISTED IN THIS WORK.
RESPECTFULLY SUBMITTED,
JDD/s
-C_O.N.... _TE-N-T-S-PAGES
I. LETTER OF TRANSMITTAL TO SUPERINTENDENT OF PUBLIC HEALTH
2. INTRODUCTION •••.•••••••••••..••.••••••.•.•••••••••.•..••.••..••••
3. HISTORY OF THE STATE OF ARIZONA ••••••.••••••••••••••.••••••••••••
4. TOPOGRAPHY , •••••••••
I - 3
5
5 - 7
5. RESOURCES ••••• , t 11 •• 7 10
6. THE STATE BOARD OF HEALTH •.••.....••.••.••.•••••••••.•••.••••••
(WITH CHART GIVING ORGANIZATION AND ADMINI STRATtON, BUDGET SHOW­ING
DERIVATION OF FUNDS AND MAP OF WHOLE TIME HEALTH UNITS.)
II 13
7.
8.
SANITATION PROBLEMS OF THE STATE ••
VITAL STATISTICS .
14 - 25
26 - 28
9. MATERNAL AND CHILD WELFARE ••••....•••.•.•.• ' •••••.••..•••••••.•• 29 - 30
I O. 0ENT AL CARE ••••.•••••••••.•.• ..••.•••••.•..••••••.••.•••••••..•• 3 I
36 - 37
1 I i
12.
PUBLIC HEALTH NURSING
HYGIENIC LABORATORIES
....... ~ ~ " .
..... .. .. . .. .. .. .. . .. . ..
32 35
13.
14.
SPECIAL HEALTH PROBLEMS
TUBERCULOS I S
VENEREAL DISEASE
AFTERWORD ••••.•••••.•.
~ 2E INDIVIDUAL COUNT IES
APACH E
COCHISE
COCON 1NO
GILA
GRAHAM
GREENLEE
MARICOPA
MOHAVE
NAVAJO
PIMA
PINAL
SANTA CRUZ
YAVAPAI
YUMA
38 - 49
50 - 52
53 - 55
-IN-T-R-O....D_U--C_T.. _IO......N--
THE FIRST SURVEY OF OFFICIAL PUBLIC HEALTH ADMINISTRATION IN ARIZONA WAS
MADE IN 1930 BY OR. PLATT W. COV'NGTON~ FIELD AGENT FOR THE INTERNATIONAL HEALTH
DIVISION OF THE ROCKEFELLER FOUNDATION, UPON THE INVITATION OF DR. R. J. STROUD,
WHO WAS STATE SUPERINTENDENT OF HEALTH AT THAT TIME.
THE SUMMARY OF RECOMMENDATt ONS MADE BY DR. COVI NGTON UPON COMPLET I ON Of'
THIS STUDY WAS AS fOLLOWS:
A. RECOMMENDATIONS INVCLV ING NO ;\00 IT IONAl EXfE~l:
I. AN AMENDMENT TO THE LAW ProVIDING FOR A STATE BOARD OF HEALTH OF
SEVEN MEMBERS WHOSE TERMS OF OFFICE WILL BE AF<RANGED TO EXPIRE IN
ALTERNATE OR IN DIFFERENT YEARS.
2. AN AMENDMENT TO PROVIDE FOR THE APPOINTMENT Of' THE STATE SUPERINTEND­ENT
OF PUBLIC HEALTH BY THE STATE BOARD OF HEALTH.
3. AN AMENDMENT WHICH WOULD REQUIRE THE STATE SUPERINTENDENT OF HEALTH
TO DEVOTE HIS ENTIRE TIME TO THE POSITION,
4. A PERMISSI VE OR ENABLING COUNTY-HEALTH··UNIT LAW.
5. SPECIFIC LEGISLATION AUTHORIZING THE STATE TREASURER TO ACCEPT AND
DISBURSE THE FUNDS GIVEN THE STATE BY EXTRA-STATE PUBLIC HEALTH
AGENCI ES.
B. RECOMMENDATIONS INVOLVING A2QllIONAL EXPENSE:
I. THE EMPLOYMENT OF SIX PUBLIC HEALTH NURSES BY THE STATE.
2. THE EMPLOYMENT OF A SANITARY ENGINEEH BY THE STATE.
3. THE EMPLOYMENT OF THE EPIDEMIOLOGIST BY THE STATE.
4. THE MAINTENANCE BY THE STATE OF THE BRANCH PUBLIC HEALTH LABORATORY
IN THE STATE BUILDING
THE ONLY ONE OF THESE RECOMMENDATIONS MADE UNDER "A" WHI CH HAS BEEN CARRIED
OUT IS NUMBER 5, WHICH PERMITS THE STATE TREASUr<ER TO ACCEPT EXTRA-STATE FUNDS AND
DISBURSE THEM FOR "HEALTH DEMONSTRtlTION PURPOSES."
THE RECOMMENDATIONS UNDER "B" HAVE BEEN CARRIED OUT.
2.
THE NEXT SURVEY OR STUDY WAS MADE IN 1937 BY DI~. CARL E. BUCK, F'I ELD
DIRECTOR OF" THE AMERICAN PUBLIC HEALTH ASSOCIATION. THIS STUDY WAS MADE AT THE
REQUEST OF" A PUBLIC HEALTH COMMITTEE APPOINTED JOINTLY BY THE STATE SUPERINTENDENT
OF" PUBLIC HEALTH AND THE CITY MANAGER OF" PHOENIX AND SPONSORED BY THEM. IT WAS
FINANCED BY THE STATE BOARD OF" HEALTH WITH SOCIAL SECURITY FUNDS OBTAINED THROUGH
THE U. S. PUBLIC HEALTH SERVICE AND BY THE CITY OF" PHOEN IX.
PUBLIC HEALTH CONDITIONS AND PUBLIC HEALTH ADMINISTRATION WERE STUDIED
AND COMMENTED UPON IN DETAIL IN THIS REPORT, AND THE FOLLOWING CONCLUSION
PRESENTED :
I. THAT THERE BE A STRONG STATE HEALTH DEPARTMENT WITH FULL TIME WELL
TRAINED COMMISSIONER OF HEALTH AND AN ADEQUATE STArF Cr WELL
TRAINED PERSONNEL, AND A NON-PARTISAN BOARD CF H8ALTH HAVING, NOT
ONLy REASONABLE MEDICAL REPRESENTATION, BUT ALSO ADEQUATE LAY
REPRESENT AT ION.
2. THAT CERTAIN BASIC PUBLIC HEALTH LEGISLATION BE PASSED, GIVING
HEALTH DEPARTMENTS ADEQUATE AUTHOnlTY TO DEAL WITH SUCH PrlOBLEMS
AS WATER SUPPLY AND SEWAGE DISPOSAL, AND PROVIDJ NG THAT BOTH STATE
AND COUNTY on DISTRICT BOARDS OF" HEALTH MAY MAKE RULES AND REGULA­TIONS
FOR THE PRVTECTJON AND PROMOTION OF THE PUBLIC HEALTH, WHICH
SHALL HAVE THE EFfECT OF" LAW.
3. THAT THERE I3E ESTABLISHED STRONG lOCAL, COUNTY OR DiSTRICT HEALTH
DEPAJITMENTS, WITH WELL QUALIF"lED FULL TIME TRAINED AND EXPEfHENCED
PERSONNEL, AND WITH STRONG COUNTY OR DISTR ICT BOAnDS OF" HEALTH
APPOINTED ON A NCN-PARTISAN BASIS AND HAVING THE SAME AUTHORITY
LOCALLY AS IS GIVEN THE STATE BOARD OF" HEALTH.
THE WRITER AGREES WITH THE CONCLUSIONS ,OR RECOMMENDATIONS MADE IN 80TH
OF THESE REPORTS, AS PHEVIOUSLY QUOTED, AND CONSI DErlS THAT THE PRINCIPLES ANNUN-CIATED
ARE FUNDAMENTAL F"OR THE EF"FICIENT ADMINISTRATION OF" PUBLIC HEALTH IN THIS
OR ANV OTHER STATE.
HE fURTHER AGREES THAT "THE GREATEST PUGLI C NEED IS rOR A I3ETTER WI DE-SPREAD
UNDERSTANDING OF PUGLIC HEALTH PROI3LEMS AND NEEDS," AND THAT "CHANGES IN
PUGLIC HEALTH PCLICIES AND PROGRAMS CANNOT DE DROUGHT ADOUT \JNTIL THEFIE IS A
REASONADLY WIDESPREAD UNDERSTANDING AND APPRECIATION CF THE NEED FOR SUCH CHANGES."
THESE STATEMENTS MAY WELL DE /\PPLIED WITH TRUTH TO EVERY PUGLIC WELfARE; ACTIVITY.
UPON DECOMING ASSOCIATED WITH THE MIZONA STATE BOArm OF" HEALTH IN
SEPTEMBER 1937 THE wnlTER FELT IT INCUMGENT UPON HIM TO CAREF"ULLY REVIEW THE TWO
PREVIOUS STUDIES WHICH HAD BEEN MADE AND TC I3ECOME AS fAMILIAR AS POSSIBLE WITH
COND!TIONS !N THE STATE WHICH 130RE UPON THE PROI3LEM OF" PUBLIC HEALTH.
3.
THEREfORE, THE FACTS AND COMMENTS PREPARED IN THE FOLLOWING PAGES WERE
ASSEMOLED FOR THE PURPOSE or PRESENTING A PICTURE OF THE TOPOGRAPHY, RESOURCES,
INDUSTRIES, AND CONDITIONS UNDER WHICH THE PEOPLE Of ARIZONA LIVE IN THEIR RELATION
TO THE HEALTH Of ONE ANOTHER AND TO THEIR NEI GHDORS OF' OTHER STATES.
IN THESE DAYS OF RAPID TRANSPORTATION AND CONSTANTLY SHIFTING POPULATION
EVERYONE IS TRULY A NEIGHOOR AND NO MAN LIVES UNTO HIMSELF'. LIKEWISE DISEASE
DOES NOT RECOGNIZE MAN MADE OOUNDARIES. GOOD HEALTH IS A MATTER DEPENDENT ON THE
INTELLIGENT APPLICATION OF HYGIENIC PRACTICES.
STANDARDS OF' LIVING ARE NOT APT TO DE IMPROVED IF' StLF' SATISfACTION
EXISTS GASED UPON WISHFUL THINKING RATHER THAN PRIDE OF' ACHIEVEMENT THROUGH SEARCH
F'OR TRUTH AND CONSCiOUS EfF'ORT F'OR GETTERMENT.
WITH THESE THOUGHTS IN MIND AN EFfORT WILL DE MADE TO PRESENT MATERIAL
FOR SELF ANALYSIS IN THE HOPE THAT IT MAY lEAD TO GETTER UNDERSTANDING ANO CON-STRUCTIVE
ACTION.
THE fOREPART Will DEAL WITH STATISTICS AND PROGLEMS Of THE STATE AS A
WHOLE AND WILL GE fOLLOWED DY A STUDY Of EACH INDIVIDUAL COUNTY.
J. D. DUNSHEE, M. D.
F .;"I.P.H.A.
It•E:E.E"El IRRIGATED AN D DRY rARMING
1~mI PROPOSED IR RI GAT ION ''''JECTO
GRAZING LAND
~.Q_R_I_C_U.!:.!.U_ R_ A L - -
5.
!:il'§'IQtl.Y. OF l!:il '§'1~11 OF ~B.1I.Ql!~
ARIZONA WAS THE L.AST OF THE TERRITORIES WITHIN THE GORDERS Of THE
UNITED STATES TO GE ADM'TTED TO STATEHOOD. IT WAS FIRST ORGANIZED AS A TERRITORY
ON FEGRUARV 24TH, 1863 WITH THE CAPITOL AT PFlESCOTT. AT THAT T'ME THE TERRITORY
WAS DIVIDED ,NTO fOUR COUNTIES. THE CAPITOL WAS MOVED TO PHOEN'X IN 1889 WHERE
'T HAS SINCE REMAINED.
FOR 49 YEARS ARIZONA REMAINED A TERRITORY AND DURING THIS PERIOD THE
POPULATION INCREASED FROM 581 TO 334,000. ARIZONA GECAME A STATE IN 1912. IN
,930 THE ~ENSUS GIVES THE POPULATION AS 435,833 WHICH SHOWS AN INCREASE OVER THE
PREVIOUS DECADE OF' 30.4%. THE AVERAGE INCREASE fOR THE UNITED STATES AS A WHOLE
DURING THE SAME PERIOD HAVING GEEN 16.1%.
ARIZONA, WITH AN AREA OF 113,.956 S~UARE MILES, RANKS AS FIFTH IN ~IZIi
IN THE UNION, ApPr<OXIMATELY SO% OF THE TOTAL AREA OF THE STATE IS GOVERNMENT
OWNED LAND.
TOPOGRAPHV OF ARIZONA
MANY OF' THE TOPOGRAPHICAL FEATURES Of THE SHTE HAVE A DEfiNITE GEARING
ON PUGLIC HEALTH CONDITIONS. IF THE COUNTRY 'S ARJD~ MOSQUITOES WILL NOT GREED.
IF' THE COUNTRY IS SPARSELY SETTLED WITH MANY INACCESSIDLE PORTIONS, PEOPLE WIL.L
NOT DE AS SUDJECT TO COMMUNAL DISEASES AS THEY MIGHT IF' LIVING IN A CONGESTED
URDAN COMMUNITY. MANY OF THE DISEASES OF' MAN ARE DEPENDENT ON ENVIRONMENT. ToPO­GRAPHY
INFLUENCES ENVIRONMENT.
THE STATE MAY DE C.LASSIFIED AS A MOUNTAINOUS ONE. MANY PORTIONS ARE SO
RUGGED, THAT THEY ARE INACCESSIDLE EXCEPT ON HORSEOACK. THESE PORTIONS ARE SO
SPARSELY SETTLED THAT THEY DO NOT PRESENT PUGLIC HEALTH PRODLEMS OF ANY SIGNIFI­CANCE.
DUE TO THE GEOLOGY OF' THE STATE, ORE DEPOSITS ARE rOUND ONLY IN CERTAIN
Af<EAS, AND AGRICULTURAL DEVELOPMENT I S LIMITED TO OTHEf, AREAS. jHjS HAS A TENDENCY
TO CONCENTRATE THE POPULATION IN COMPARATIVELY DENSELY SETTLED MINING, FARMING OR
INDUSTRIAL COMMUNITIES.
6.
IN THE NORTHERN PORTION, tHE TERRAIN IS MOSTLY HIGH P~AT£AU LAND,
CORRUGATED WITH CANYONS OF' GREAT OEAUTY AND GREAT MAGNIFICENCE~ THERE ARE OROAD
SWEEPS OF' COUNTRY LY IN G OETWEEN NEI GHOOR INa CANYONS. ITIS OVER T HI S HIGH PLATEAU
LANO tHAT LARGE HERDS OF' CATTLE RANGE. IT ISIN THE ltlDES OF' MANY OF' THESE
CANYONS THAT MINES ARE DISCOVERED.. THE HIGHEST ELEVATIONS ARE FOUND IN THE
NORTHERN PORTION Of THIS STATE, REActlJNG A MAXIMUM Of" OETTER THAN 12,000 fEET.
ACROSS THE CENTRAL PORTION IS F'OUND THE MOGOLLON R~M, WHICH IS THE
TRANSITIONAL SECTION GETWEEN THE NORTHERN ,~ND SOUTHERN PORTIONS OF THE STATE.
HERE THE HIGH PLATEAU LAND OREAKS INTO INNUMERAOLE CANYONS, WHERE THE VAFl! OUS
FORCES OF NATURE ARE ERfWDING THE HIGH PLATEAU lAND THAT ONCE COVERED THE ENTIRE
STATE, INTO THE "LOWLAND" THAT NOW COMPOSES THE SOUTHERN PORTION. THE TERM
"lOWLAND" IS USED RELATIVELV F'OR THE AVER/\GE ELEVATION OF' THE ENTIRE STATE IS
APPROXIMATELY 4000 FEET AOOVE SEA LEVEL.
NUMEflOUS MOUNTAIN CHAINS HAVE WITHSTOOD THE ERriODING PROCESS TEMPORAR­ILY,
TO LEAVE RIDGES THAT GENERALLY GROSS THE SOUTHERN POflTION OF' THE STATE IN A
SOUTHEASTERLY DIRECTION, WHICH IS THE GENE:RAL DIRECTION THAT THE MOGOLL.ON RIM
TAKES ACnoss THE CENTRAL. PORTION. BETWEEN THE I~OUNTAIN RANGES Of SOUTHERN ARIZONA
liE Of<OAD F'LAT VALLEYS fED oy R1VERS HAVING THEIR ORIGIN IN THE HIGH LANDS. HERE
IS F'OUND THE MAJOR AGRICULTURAL AREA.
IN THE DflOKEN MOUNTAIN RANGES OF THE SOUTH, IN THE ERRODED TRANSITIONAL.
AREA OF' THE CENTRAL. ponTloN, AND IN THE DEEP CANYONS TO THE NOf<TH , ARE FOUND MANY
eJUT...cROPPINGS OF ORE. THESE VEINS HAVE 0 EVf.LOPED SOME OF' THE EXCEL.L.ENT MINES
Or THE COUNTRY. IT IS F'ROM Tl-lESE DEVELOPMENTS THAT Ani ZONA HAS TAKEN I TS PLACE
lN THE SUN AS A MAJOR MINING STATE OF' THE UNION. ARIZONA RANKS rlRST AS A PRODUCER
OF COPPER. IT RANKS FIftH AMONG ALL THE STATES IN THE VALUE OF MINERAL PRODUCTS
PRODUCED, AND NINTH IN THE NUMOER OF' WAGE EARNERS EMPLOYED IN MINING AND QUARRYING
OPERATIONS.
WITH THE MINING DEVELOPMENT, THE POSSIOILITIES Of AGrl/CULTUflAL DEVELOP-MENT
WERE REALIZED. DAMS OF INCREASING Slzt HAVE OEEN DUILT THAT HAVE IMPOUNDED
VAST ~UANTITIES OF WATER TO HOL.D DACK FLOODWATEns RUSHING OF'F" OF' THE PRECIPnous
LAND. THESE ART!F'IC!AL LAKES ARE SYSTEMATICALLY DflAINED TO IRRIGATE THE VAL.LEV
LANDS OEL.OW THEM. THEY fORM THE HOL.DINGOASlNS THAT HOLD THE FLOODS TO THAT POINT
7.
THAT THEY FURNISH A UNIFORM Pl.OW OVEn A PERIOD OF YEARS, AND THRCUGH MANY
DROUGHTS.
CATTLE AND LI VE STOCK RAISING HAS LONG DEEN A SOURCE OF" ECONOMIC INCOME.
OVER-GRAZING OF SOME OF" THE l.ft.lD HAS CAUSED OMlREN AflEAS, ERROSION, AND POVERTY IN
SECTIONS. IT IS ANTICIPATED THAT WITH FEDE:RALCCNTfiOl., THIS EVIL WILL DE
MINI MI ZED TO THE PO INT THAT ALL POSSIOLE GRAZING L.AN D WILL ONCE AGAIN YIELD ITS
RICH HARVEST.
IN ADDITION 'to THE STORAGE OF wATm OEHIND DAMS TO FORM ARTIFICIAL LAKES,
NATUHE HAS PROVIDED VAST UNDERGROUND STOflAGE CAPACITY IN THE VALLEYS. WAtER HELD
IN THE UNDERGROUND STRATA IS AVAILAOLE TO MOST OF" THE POPULATION AS A SOURCE OF
DOMESTIC WATER. THESE UNDERGROUND STRATA ARE SLOWLY EXHAUSTED, AND THEN REPLENISHED
DURING THOSE YEARS OF" HEAVY PHECIPITATIONS.
WIDE RANGES OF" TEMPtFlATURE MAY De: DOSERVED. FOR THE MOST r'ART THE
CLIMATE IS EXCEEDINGLY DRY. THE TEMPERATURE VARIES WITH THE ALTITUDE. IT GENER-ALLY
PARTAKES OF THE SEMlTf,OPICAL AND TEMPERATE. IN WIN\' ER THE HIGH TEMPEF<ATUHES
RANGE F"ROM 32 AOOVE TO 32 GELOW ZERO IN THE NORTHERN PORTI ON, WHEI,EAS THE TEMPER-ATURE
IN THE SOUTHERN PART RARELY GO DELOw THE FREEZING POINT. THE WINTER TEM-PERATUR
ES IN THE DAYT I ME ARE CCMFORTAOLY WAf<M IN THE SOUTHERN PART, AND ARE
USUALLY QUITE COOL. rF NOT COLD IN THE NORTHERN PART. THE SUMMER TEMPERATURES ARI:::
USUALLV COOL IN THE MOUNTAINOUS OR HIGH PL.ATEAU AREAS, WHERE;AS THE TEMPERATURES
IN THE SOUTHERN PART MAY [(EACH A POINT AS HIGH AS 125 DEGREES.
RESOURCES
lAXAOLE REAL WEALTH: FROM A STATEMEN'I" OF COMPARATI VE VALUES AS PREPARED OY THE
ARIZONA TAX COMMissIoN FOR THE YEAR 1937, THE TAXAOLE WEALTH CF THE STATE HAS OEEN
PREPARED IN A PAMPHLET FORM. THE I NF"ORMATI ON HAS OEEN PROCURED FROM THE COUNTY
ASSESSOR'S OFF! CE OF" EACH COUNTY. INASMUCH AS A DIFFERENT SET OF VALUES IS USED FOR
A OASIS OF COMPAF<lSON IN EACH COUNTy, THE INF"ORMATION, PRODUCED IS PROOADLY NOT THE
TRUE VALUE OF EACH INDUSTRY. F'or~ THE PURPOSE OF" THIS [<EPORT, THIS STATEMENT HAS
OEEN CONVERTED INTO THE FOLLOWING CLASSIF'ICATION WITH THE ATTEMPT TO ORHJG OUT A
COMPARATIVE STATEMENT OFTHE f<ELATIVETAXAOLE WEALTH OF' EACH INDUSTRY.
8.
TAXAOLE REAL WEALTH - CONTID
I. CITY PROPERTY
2. MINING INDUSTRY
3. RAI LROADS
4. FARMING
5. PERSONAL PROPERTY
6. PUGLIC UTILITIES
7. LIVESTOCK RAISING
8. AUTOMOOI LES
9. OTHER PROPERTY
10. MISCELLANEOUS LANOS
II. LUMOER I NG
TOTAL
VALUE
8 96;i'6i;958
91,244,751
84,324,032
37,114,038
29,802,030
25,774,326
19,455,566
17,147,385
12,052,061
7,441,762
740,226
-mi,258, 135
PERCENT TOTAl.
~-.8
21.07
20.0
8.8
7.1
6.1
4.6
4. I
3.0
1.6
.2
100.0
TOURIST INDUSTRY: AFTER THE INITIAl. DEVELOPMENT IN THE MINING AND AGf<ICULTURAL
INOUSTRI ES, IT WAS APPARENT THAT THERE WAS A GREAT NEED FOR GOOD HIGHWAYS THROUGH-OUT
THE STATE. THE RAI LROADS WERE OONSTRUCTED AND WErlE EACH YEAR OnlNGING AN EVEr;
INCREASING NUMDEfl OF VISITORS WHO CONTRIOUTED TO THE WEALTH. ApPROXIM/\TEJ..Y 20
YEARS AGO, HIGHWAY DEVELOPMENT OEGAN IN Et,RNEST WHICH HAS HAD A DEFINITE TENDENCY
TO AUGMENT THE NUMDER OF VISITORS AL1<EADY OEING DROUGHT IN OY THE RAILROADS. UNDER
THI S INFl.UENCE MOST OF THE STi'TE HAS SINCE OEEN "OPENED up" OY GOOD TRANSPORTAT ION
FACILITIES. DURING THIS DEVELOPMENT PERIOD APPROXIMATELY 13,607 MILES OF HIGH
QUALITY ROADS HAVE 0 EEN CONSThUCTED.
A SUMMARY OF THE TYPES AND QUALITY OF ROADS IN ARIZONA IS PRESENTED AS
FOLLOWS:
{A MIl.ES OF FEDERAL AID SYSTEM HOADS 2220
{G MIl.ES OF STATE ["{OADS 1216
(C MILES OF MAIN COUNTY r,OADS \0,71 13,607 {D MILES OF SECONDARY COUNTY ROADS 13802
TOTAL MILES OF ALL TYPES IN ARIZONA -27469
Of THE 13,607 MILES OF HIGH QUALITY ROADS, THERE IS AN APPRECIADLE
PORTION OF THIS MILE:,GE THAT IS PAVED. WITH THE EXCEPTION OF THE NATIONAl. MONU-MENTS
IN THE EXTREME NORTHERN SECTION Pf,ACTI CALLY ALL POINTS OF I NTEREST AilE
ACCESSIGLE GY G008 ROADS.
THERE Af\E FOUR MAJOR TRANSCONT I NENTAL HI GHWAYS THA T ORO SS An IZONA
fROM EAST TO WEST, AND ONE MAJOR HIGHWAY THAT CROSSES fROM NORTH TO SOUTH. A
TREMENDOUS STREAM OF TOURISTS VISIT THE PLACES OF INTEREST AND SPEND TIME AND MONEY
IN THE SOUTHERN PORTION DURING THE WINTER, ENJOYING THE RATHER MILO WI~JTER WEiHHER.
THIS LARGE INFLUX Of TOURISTS AND VISITCf<S GRING WEALTH TO THE EXTENT THAT IT HAS
OEEN ESTI MATED THAT THE TOUR'ST INDUSTRY I S THE MAJOR INDUSTRY I NSOFAR A~ YEARLY
INCOME IS CONCEnNIID.
CITY PROPERTY:
...
ACCORDING TO THE INFORMATION AS PRESENTED BErORE IN THIS REPORT,
THERE ARE SEVENTY COMMUNITIES IN THE STATE WITH POPULATION o~ 500 OR MORE. THE
TOTAL POPULATION rOR THESE COMMUNITIES IS 225,473, OR 51.8% O~ THE TOTAL POPULATION
ACCORDING TO THE 1930 CENSUS. THIS PERCENTAGE or THE POPULATION AND THE PRESENCE
OF" VISITORS CONTRIGUTE TO THE VALUE or CITY PROPERTY TO PLACE IT FIRST IN THE LIST
OF TAXAeLE PROPERTY.
MINING INDUSTRY: THE MINING INDUSTRY IS NEXT IN THIS eLASSIF!CATION.WITH ITS.
MINES, SMELTEHS, REFINEfllES, AND OTHER DEYELOPMENTS CONTRIDUTING TO ITS WEALTH.
ACCORDING TO THE LAST MINING CENSUS OF" 1929, THEf<E WERE 138 MINES IN OPERATiON.
Ol'" TH IS NUMOER THERE WEnE 68 COPPER, 13 LEAD, 25 GOLD AND SILVER, 7 ASGESTOS, AND
A F"EW OTHER MINES OF DIFFERENT CLASSIFICATIONS. DURING THIS CENSUS YEAR (1929) THE
MINING INDUSTRY EMPLOYED 18,134 PERSONS, PAID A TOTAL WAGE OF $32,323,957, AND
PRODUCED PRODUCTS VALUED AT $116,477,536. THE AVERAGE YEARLY WAGE PER WORKER,
ACCORDING TO THESE F"IGURES, IS $1,782 50.
RAILROADS: Two MAJOR RAILROAD LINES CROSS THE STATE. THE DEVELOPMENT OF THESE
RAILROADS HAS OEEN THE DEVELOPMENT OF" THE STATE. IIHERE RAIL HEADS HAVE GEEN
ESTADLISHED, WHERE CATTLE, ORE, AND PRODUCE MAY DE LOADED, THERE HAVE APPEARED ~MALL
COMMUNITIES THAT IN MANY CASES HAVE DEVELOPED INTO SIZAOLE TOWNS. iHE TOTAL
INVESTMENT OF THESE RAILROADS WOULD GE AN APPRECIAOLE PORTION OF A GILLION DOLLARS.
AT THE PRESENT TIME, THE SANTA FE THAT SERVES THE NORTHERN PART EMPLOYS 2500 MEN,
AND THE SOUTHERN PACIFIC THAT COVERS THE SOUTHERN PORTION EMPLOYS 2550 MEN ON ITS
LINES.
AGRICULTURE: FARMING AND LIVESTOCK: M MAY DE OGSEI<VED mOM THE LISTING AOOVE,
FARMING AND LIVESTOCK RAISING ARE LISTED INDEPENDENTLY. THEY HAVE OEEN INDEPENDENT
INDUSTRl ES UP TO THE PAST FEW YEAr/S. Now IT HAS DEEN FOUND THAT RANGE STOCK RA I S~D
ON ARIZONA RANGES MAY GE FATTENED ON ARIZONA FARMS AND SHIPPED DIRECTLY TO MARKET.
THIS COMOINATION HAS IMPROVED DOTH INDUSTRIES. BESIDETHIS TYPE OF" COOPERATIII!:
OPERATION, COTTON, C ITl<US, LETTUCE, HAY, GRAIN, AND A NUMDEfi OF OTHER CROPS, AS
WELL AS ALL TYPES OF LIVE STOCK RAISING, PRUVIDE SUSTENANCE FOR APPROXIMATELY
ONE-FOURTH OF" THE POPULAT iON iHERE ARE 18,824 FAi<MS iN THE STATE, WiTH . r.." r..n"'\ /vu,vo.;>
I~
PEOPLE ON THESE FARMS, OR AN AVERAGE or 5.3 PERSONS PER rARM ACCORDING TO THE
1935 CENSUS or THE U. S. DEPARTMENT or COMMERCE.
PUBLIC UTILITIES: TELEPHONE, TELEGRAPH, POWER, GAS AND WATEIi LINES ARE THE. SOURCE
or REVENUE rOR THIS CLASSlrICATION. A GAS LINE SERVES THE SOUfHERN PART or THE
STATE WITH NATURAL GAS, WHICH ORIGINATED IN WESTERN TEXAS. HVDRo-ELECTRIC.POWER 'S
UTILIZED IN A NUMBER or COMMUNITIES. DURING THE CONSTRUCTION or THESE VARIOUS
ENTERPRIZES VAST NUMBERS or MEN ARE EMPLOYED. IT IS NOT KNOWN HOW MANY MEN ARE.
EMPLOYED BY THE UTILITIES DURING THE COURSES or ORDINARY MAINTENANCE ANO OPERATION.
MANurACTURING: THE MANNER IN WHICH THIS INDUSTRY IS LISTED IN THE TAX SUMMARV IS
NOT APPARENT, FCR IT APPEARS IN SUCH ITEMS AS OTHER PROPERTY, MISCELLANEOUS LANDS,
AND PERSONAL PROPERTY. INASMUCH AS THERE IS NO MANNER IN WHICH THESE ITEMS MAY
BE INTEGRATED TO PRODUCE THE DESIRED INFORMATION, THE VALUE or THE PRODUCTS
PRODUCED IS USED AS A STANDARD. ACCORDING TO THE 1935 CENSUS, 355,929,000 WORTH or
PRODUCTS WERE PRODUCED, AND 4965 MEN EMPLOYED. THE INDUSTRY 15 LIMITED TO SMALL
PLANTS SPREAD Acnoss THE ENTIRE STATE.
LUMBERING: LUMBERING PROBABLV RANKS IN THE NEXT ORDER OF IMPORTANCE. ACCORDING TO
THE 1935 CENSUS, APPROXIMATELY 1000 MEN ARE EMPLOYED IN THE LUMBERING CAMPS, SA~MILLS;
PLANING MILLS, AND BOX FACTORIES, THE VALUE or THE PRODUCTS PRODUCED IS $1,8~2,800.
MOST OF THE LARGE SCALE OPERATIONS OF THIS INDUSTRY ARE CONrlNED TO THE COUNTIES or
APACHE, COCONINO AND NAVAJO.
DISTRIBUTION OF POPULATtON
BY NUMBER AND RACE
i
./v1/"'·'..... I ,r "--, I ( ~ ....
L.-. 1
-------. f -., \ I
_____.,s ---\. ;O;'~::'053---11·. r--11
MAR I COP A \:.-, r f'
POP. 150,623 \ r-- /./,1 6 ~ I
I
.\ ..,.../"..J "-... "0 \ r ~. :~'-'.J \\} I' ~:'l'
I PIN A L \/JI 1\ ~ ~ !
I POP. 22
1
106 I \1 ~ I
: I GRAHAM '\11
----_.- ~__. I' POP. IO,4J 3
---- .. ._ i
,\PACHE
POP. 17,805 III
I N A V AJ 0--
1 --I
j pop.21,242 r
I I
II
co CON I NO
POP. 14,101
YAVAPA
POP. 28,504
\
"
',.-~
'(
-\_'_n__,... ..
I
I
"--
··----·f;-··-·- ---- '--'--",,_c_~._----,,--,---.
I
MOHAVE
POP. 5, 61 I
" {
I
1
/
Y U MA
pOP. 17,792
f'
!
.~~. .............."---........~ .....
COCHISE
POP. 41,003
iI
_.__.__..~_.".- .....~ ..._---'.._.~-,_....- ..~}
I
-...·...._.l-l~N TA CRUZ J
--·J'9 p • 9,684 I - "'-,. 1.
P I M A
POP. 55,680
"-""
1930 U.S. CENSUS
STATE POPULATION 435157;'·......~,.
INDI AN II U.S. 332,397 -....,~_...._
POPULATION PERCENT STATE POP~~,
264,378 60.~ - '......
114,173 26.21
43,726 10.04
10,749 2.47
2,547 0.69
WHITE
MEXI CAN
INOI AN
NEGRO
OTHER
I OKINGi\i,\N
~ <"'U,',TlVif,N
)
,/
U ,\JO
TOWNS IN ITH POPUL;,T ICi'J Cf 500 OR MO RE
1- --,
----_..__._--_..
14
13
{2
TOTAL POPULAT ION
~ _ ~--.-.-_ _..- -.
-._._._.-.---_._._----- --_.._._-,----_.
ARIZONA
POPULATION PERCENTAGES BY AGE GROUPS
Fe h SEX AND RURAL AND URBAN DIVISIONS
CHART BASED ON U.S. 1930 CENSUS FIGURES
All PCPULATION CLASSES
RURAL POPULAT1CN
LEGEND
f71 MALE
i_-...i.. FEMALE
URBAN PO PUlAT ION
I
I
I
IIIIII
14
I
1
13
12
II
10
"U
fTl
::0
(J
~
-i
C-~--NNww~~rn~c
~lb?~?~?f~~~~~
--NNW~~~~~
~~~8~~~~~
._----,-_.._-
..................................................................................................................................I 9
C-Ul"'-- NNWW-.~lnOJ--....jC-
~ ~l b ? If ? If ? ~J1 Y1 '(' 'in Ul ?;
-- NNu.)-{'~lJlrn~
-f.::..'...C) +~ ~) -:::"->~ ~ -r~ ...;':":-,.
\GC' Gf~OU~'S 1:~ YC,'R:
o
."
-I o
-i
~
"U o
;g
r
~
o
z
-.. ,- " ;:-~ i" L CD (L, t'! H(J ~'i ,'. f~ D, G .• Djp~CTCE, ~-'IMi\ C;('UNTY HE/\LTH S~:::R\/l·r~F
I/.
OF .t!f~.!:l!!
THE BOARD OF' HEALTH WAS CREATED OY AN ACT OF" THE TERRITORIAL LEGISLATUiE
ON MAflCH 19" /903. REGISTRATION OF" OIRTHS AND DEATHS AND THE CONTROL. OF" COMMUNIC/\-
OLE DISEASE WERE THE FIRST FUNCTIONS OF" THE BOARD IN 1909 SEVERAL CHANGES WERE
MADE" THE MOST IMPORTANT OF" WH ICH WAS THE PASSING OF THE MODEL REGI STRAT ION LAW AS
RECOMMENDED OY THE BUREAU OF THE CENSUS.
THE STATE BOARD OF HEALTH IS roMPOSED OF" THE GOVERNOR" PRESIDENT,
THE ATTORNEY GENERAL, VICE-PRESIDENT, AND A PHYSICIAN OF" THE STATE OF" ARIZONA, WHO
ACTS AS SECRETARY OF" THE BOARD. H,S APPOINTMENT" MADE BY THE GOVERNOR, AND APPROV-ED
OY THE SENATE, IS F"OR TWO YEARS. HE IS SUPERINTENDENT OF" PUOLIC HEALTH AND THE
STATE REGISTRAR OF" VITAL STATISTICS. THE ONLY QUALIFICATION REQUII~EO OY LAW IS
A LICENSE TO PRACTICE MEDICINE IN THE STATE OF ARIZONA.
ORIGINALLY THE HEALTH WORKERSOF THE STATE CONSISTED OF" A SUPER INTENDENT
OF" HEALTH AND ONE HEALTH OrFICER IN EACH COUNTY, APPOINTED OY LOCAL OFF"ICIALS. THE
SUPERINTENDENT RECEIVED IN SALARY $',000.00 PER YEAR AND AN ADDITIONAL $300.00 FOR
CLERK HIRE, OFFICE SUPPLIES AND INCIDENTALS.
FROM THE TIME OF" THE ESTAOLISHMENT OF THE BOARD OF" HEALTH IN 1903" UNT IL
THE REVISION OF" THE LAWS IN 1909, COUNTY HEALTH OFFICERS REPORTED BIRTHS AND DEATHS
TO THE STATE OY NUMOER. THE FIRST PUOLISHED SUMMARY WAS MADE IN NOVEMOER 1907.
REPORTS WERE PUBLISHED AT IRREGULAR INTERVALS F"OR THE NEXT FEW YEARS BEF"Of-iE THE
BULLETIN WAS MADE A REGULAR PUOLICATION. IN 1909, THE MODEL LAW FOR REGISTRATION
OF VITAL STATISTICS, AS RECOMMENDED BY THE BUREAU OF" THE CENSUS, WAS PASSED AND
SINCE THEN EACH YEAR HAS OROUGHT MORE COMPLETE REPORTS. THERE AnE ONE HUNDRED-
12.
FIFTEEN LOCAL REGISTRARS IN THE STATE6 APPOINTED BY THE SUPERINTENDENT OF PUBLIC
HEALTH, WH0 6 EACH MONTH, TUHN OVER TO THE STATE, CERTIF'lCATES FOR GIRTHS ANO DEATHS
OCCURRING IN THEIR DISTRICT THE MONTH Pi'EVIOUS.
NATURALLY, THE VITAL STATISTICS RECORDS FOR EARLY TEHRITORIAL DAYS ARE
FAR FROM COMPLETE. THE EARLIEST GIRTH f,ECORD ON FILE IS FOR 1855, THE EArlLIEST
DEATH" 1878. COUNTY RECORDS TURNED ovm TO THE STATE BOARO OF HEALTH START IN MOST
CASES WITH THE YEAR 1887. STATE RECORDING BEGAN AFTER HE PASSAGE OF THE MODEL LAW
IN 1909. IN 1925 A SURVEY OF THE VITAL STATISTICS REPORTING IN ARIZONA WAS MADE
BY THE BUREAU OF THE CENSUS, AND THE STATE WAS ACCEPTED INTO THE U. S. REGISTI<ATION
AREA IN 1926.
IN 1907 THERE WERE6 FOR THE QUARTER ENDING JUNE 306 292 DEATHS AND 276
BIRTHS REPORTED TO THE STATE. THERE IS NOW A MONTHLY AVERAGE OF NEAFlLY 600 DEATHS
AND MORE THAN aoo BIRTHS. THERE ARE ON FILE MORE THAN 207,000 CEI1TIFICATES OF
GIRTH AND '37 6 000 CERTIFICATES OF DEATHS, THESE ARE FILED EACH MONTH GY COUNTY
AND DATE AND ARE PERMANENTLY GOUND. CERTIFIED COPIES FOR CH 1LOREN ENTER'NG SCHOOL
AND VETERANS APPLYING FOR COMPENSATION MAY GE OOTAINED FREE. FOR ALL OTHERS THERE
IS A REQUI RED STATE FEE OF FIFTY CENTS. IN 19366 1'"1 VE THOUSAND FOUR HUNDRED TEN,
(5,,410) CERTIFIED COPIES WERE ISSUED FROM THIS OFfiCE.
THE STATISTICAL REPORTS OF THE BUREAU OF VITAL STATISTICS APPEAR IN THE
BULLETIN PUOLISHED OV THE BOARD OF HEALTH. ON NOVEMOER ' 6 1907, THE FIRST ISSUE
OF THIS OULLETIN APPEARED. IT WAS CALLED THE QUAf:TEflLY BULLETIN6 AND CONTAINED
THE NUMOER OF 0 JRTHS, DEATHS AND COMMUN 1CAGLE 0 I SEASES REPORTED TO THE BOARD FOR
THE TWO PREVIOUS QUARTERS" AND REMARKS URGING OETTE:R REPORTING. FROM THIS TIME
THE OULLETIN APPEAHED AT MORE OR LESS IRREGULAR INTERVALS UNT IL 19136 WHEN ITS
PUOLICATION WAS ESTAGLISHED. IN 1930 IT WAS MADE INTO A MONTHLY MAGAZINE AND IN
1931 THE NAME WAS CHANGED TO ARIZONA PUGLIC HEALTH NEWS. IN ADDITION TO THE
BULLETIN6 THE OIENNIAL REPORT TO THE GOVERNOR, WHICH CONTAINS A SUMMARY OF THE WORK
DONE IN THE PAST TWO YEARS6 THE MOf,TALITY AND MOROIDITY REFORTS IN ORIEF6 AND THE
STATE LAOORATORY REPORT HAS BEEN PUGLISHED EVERY TWO YEARS S IN(;E 1913" WITH THE
EXCEPTION OF 19'6-17, 192'-22" AND 1933-34.
IN THE f'lnST QUM,TEn Of' 1907, THEnE WERE 253 COMMUNICAOLE DISEASES
REPORT~D TO T HE BOARD OF HEA LTH. THESE REPORTS WERE MADE OY COUNTY HEALTH OFF ICERS.
13,
TUOERCULOStS WAS THE CHIEF DISEASE THEN ~S NOW. TVPHOID, SCARLET FEVER, AND
DIPHTHERIA WERE ALSO PREVALENT. TOTAL DISEASES REPORTED IN 1936 WERE 18,486. THEY
ARE NOW REPORTED DIRECTLY TO THIS OFfiCE; OY EVERY PHYSICIAN IN THE ST,nE ON F'RANKED
~~es~WHICH ARE FURNISHED OY THE UNITED STATES PUOLIC HEALTH SERVICE AND MAILED TO
DOCTORS EACH WEEK, HEALTH OFFICERS SEND IN SUMMARiEs EACH WEE!< AND MONTHLV REPORTS
WEEKLY REPORTS ARE MADE OV TELEGRAPH TO THE UNITED STATES PUOLIC HEALTH SERVICE
AND OULLETINS SENt TO ALL HEALTH OFfiCERS IN THE STATE. MONTHLY!'ND YEAHLY REPORTS
ARE MADE TO THE UNITED STATES PUOLIC HEAt..TH SERVICE AND SUMMARIES ARE PUOLISHED IN
THE PUOL! C HEALTH NEWS.
THE STATE BOARD OF HEALTH IS NOW IN fIVE OUREAUS: ADMINISTRATION,
DIVIS/ON OF MATERNAL AND CHILD HEALTH, DIVISION Of VITAL STATIST'CS, DIVISION OF'
LOCAL HEALTH ADMINISTRATION, AND DIVISION OF' SANITARY ENGINEERING. THERE IS ONE
HEALTH DISTRICT CONSISTING OF COORISE: lND SANTA CRUZ COUNTIES, AND FOUR OTHER
COUNTIES WITH FULL T 'ME WORK, COCONINO, MARICOPA, PIMA AND YUMA.
THERE ARE SEVERAL PUOLIC HEALTH wCRKERS IN TRAINING, AND ON SPECIAL
PROJECT - THE HEALTHMOOILE.
THE STATE HAS 115 LOCAL REGISTRARS, 15 DEPUTV STATE HEALTH OFF'I CERS
AND IN HEALTH GROUPS NOT AFFILIATED WITH THE STATE DEPARTMENT THERE ARE
APPROXIMATELV 30 CITY HEALTH OFFICERS, ,4 COUNTY HEALTH OFFICERS, 21 DEPUTY COUNTY
HEALTH OFFICERS, AND 17 SCHOOL NURSES.
PUBLIC HEALTH ORGANIZATION IN ARIZONA
IN COOPERATION WITH
UNITED STATES PUBLIC HEALTH SERVICE
AND
FEDERAL CHILDkEN'S BUREAU
STATE BOARD OF HEALTH
GOVERNOR - SUPERINTENDENT OF,HEALTH - ATT'Y GENERAL
•, . ,
, LOCAL HEALTH MATERNAL • SANITARV VITAL
AND '
,'ADMINI STRATtON' CHI LD HEALTH' ENGINEERING' STAT IST ICS . . ,
•,
, ,
LOCAL HEALTH
SERVICE
Ep IDEMIOLOGY
P.H. NURSING
COMMUNICAOLE
D1SEASi: CON­TROL
MATERNAL
AND
CHILO HEAUH
GENERAL
SANITA:rION
WATER suP-
.P4V"
SEWAGE DIS­POSAL
BIRTHS
DEATHS
,
, STATE UNIVERSJTV
, AND
STATE BOARD Or HEALTH
'HEALTHMOOILE •
'STATE BOARD OF •
, HEALTH & ' HYGIENIC
'AMERICAN LEGION'
,, COOPERATION 'LABORITORIES ,,
TUBERCULOSIS FREE SERVICE
CASE FINDING, IN ALL COM-AND
HEALTH MUNICAOLt
EDUCATION DISEASE,
(SCHOOL CHILD- WATER,
REN & CO~- FOOD AND DRUG
TACTS.) EXAMINATION
SUPERVISING PROGRAM, MAINTAINING
STANDARDS AND COOPERATING WITH •,
LOCAL HEALTH UN ITS AN 0
COUNT1 COOPE~ATIVE PUOLIC HEALTH
NURSING SERVICE NOT
CONNECTED WITH
HEALTH UNITS •
DIVIDED COST
STATE & FEDERAL GOV'T
DIRECTOR OF'
LOCAL UN IT
(ADMINISTRATION.)
t
SANItATION - NURSING - MATERNAL AND - CLERICAL AND
. CHILD HEALTH STATISTICAL
DIVIDED COST
COUNT 1ES
OTHER AGENC IES
COMMUNICABLE DISEASE
STATE ARIZONA COUNTY SUMMARY
SOCIAL SECURITY ACT BUDGET
PERIOD COVERED BY BUDGET JULY', 1937 - JUNE 30, 1938
I
I T E M SOU R C E o f fUN 0 S
ALLOTMErlrS
12 MONTHS I A CHILDREN'S B CHILDREN'S
NO. DESCRIPTION STATE LOCAL USPHS
BUREAU BUREAU
~
I ADM IN ISTR/iT ION 17933 15575 2008
1
400
I D IV IS leN OF MATERNAL AND CH IlD HE/ILTH 9300 4050 5250
D/VISICN OF VITi~l SHTISTICS 4300 4300
DIVISleN OF LOCAL HEALTH ADMINISTRATION ,2300 2200 7950 2150
DIVISleN CF ENGINEERING AND SANITATION 6000 3000 3000
•
TOT l\L 49863 29125 12958 7400 400
THAINING 6000 6000
MOBILE UNIT 24196.65 24196.65
COUNTIES I
o ISHl lCT - GCCHISE 28543 2550 15413 6380 4200
S/INT ,\ CRUZ 9900 5400 3300 ,200
CCCCNINCo I 1'1'0 ,400 4700 3800 1200
MAR fCC Pi\ 44470 2500 22320 10800 8850
PIMA 36508 1500 22668 7340 5000
PINAL ,0600 5300 5300
YUMA 19960 800 9330 6530 3300
TCTAl i6,081 8750 85131 43450 23750
GRAND TOTAL 241150.65 37875 85131 62408 27596. ,8 24596.65
,
CREDITED TO THE STATE F"ROM 1936-37 3553.82
31,150.00 --- ...._...._---~_ ...__._.,,--_._-._~ ..~ .
POPULAT ION
APACHE
C(QI-II SE:
COCONINO
GILA
GRAHAM
GREENLEE
MARICOPA
Mr'HAVE
NAVAJO
PIMA
PINAL
SANTA CRUZ
YAVAPAI
YUMA
TCTALS
TOTAL POPUlAT ION
Fe R THE ST ATE
1930
435,573
~
3,786
25,857
6,650
18,026
7,613
5,042
108,284
4,0CJ7
8,136
32,726
10,164
3,833
19,047
_.!..!.L.!..t2
264,378
435,573
1920 19~0
334,162 204,354
,930 CENSU S
MEX ICAN INO IN~
1,908 11,732
13,044 108
3,025 4,247
/0,771 2,0/6
1,981 724
4,769 5
32,494 3,845
784 66'
2,760 10,126
16,093 5,305
8,175 3,425
5,016 41
8,685 433
4,668 1,058
1,4,173 43,726
1900
122,931
NEGRC &
OT!:if.!L
339
1,989
.42
203
55
70
6,347
30
180
1,552
317
794
305
973
13,296
INCLUDES: CHINESE, JAPANESE, NEGRO, FILIPINO, HINDU, KOREAN,
HAWAI IAN AND MALAY
AREA:
STATE OF An IZONA
INDIAN RESERVATIONS
NATIONAL FORESTS
NAT 1ONAL PARKS
NATIONAL MONUMENTS
MILITARY RESERVATIONS
VACANT, UNSURVEYED, UNRESERVED
GOV ERNMENT LMJD S
PROPOSED WITHDRAWALS OY FEDERAL
GOVERNMENT ALONG GRANO CANYON
AND AROUND BOULDER DAM
reT ALS
STATE OF" ARIZONA
GOVERNMENT LANDS
LAND OWNED OY THE STATE & ITS
CITIZENS
72,93' ,840
17,828,093
12, J 18,680
643,356
457,145
56,521
15,180,000
10,800,000
57,083,795
72,931,840
57 ,083,795
15,848,045
SQUARE
MILES
27,857
18,935
1,005
714
88
23,719
/6,875
89,193
113,956
89,193
24,763
PEflCENT
TeT ill
100.0
24.5
16.6
0.9
0.6
0,1
20.8
14.8
.00.0
78.3
21.7
FULL TIME HE/\LTH UNITS Nml OPER,\T§
.c;~0
I)\
liZ::1 FULL TIME HEALTH UNIT
N;;t~~ll!f FULL TIME [)16t1R'I'CT HEALTH UNIT
IL
\
1
..- .- ,.._--...--.....
AM
FOREIGN TRAFFIC FLOJ
OVER
\RIZONA ST,\TE HIGHVV,W SYSTEM
'\CCORDING TO 1935
STlfE HIGHWW D(P,,\RHiENT ~t\P
LOCAL TRAFFIC NOT SHOWN
/ ' -----·...,i...------,r------- ! I--~: _:~.
\; ;
I
/ GRANO CANYON '" ,.._ _...•.......
I
I
I
ii
CARS PER 24'HOURS
9ICB:R'~1000 3~ ~OOO
t"·. (~ . . _._. -..--...---- -_. -._._.. ._...._1
14.
o F THE -S -TA-T--I.:
BEFORE ATTEMPTING TO ENTER INTO THE EVALUATION Of THE VARIOUS SANITATION
PROBLEMS OF THE STATE, SOME CONSIDERAT ION IS OFFERED ON THE POSSIBILITIES OF INAUG-URATING
CORRECTIVE MEASURES TO ALL PHASES OF THE SANITATION PROBLEM. THE POSSIBIL-ITIES
OF IMPROVING THE CONDITION ARE EXCELLENT FOR THE FOLLOWING REASONS:
I, THE PEOPLE PRIDE THEMSELVES ON THEIR PROGRESSIVENESS, THEY ARE
EASILY APPROAOHED ON THIS BASIS AND WELCOME NEW IDEAS,
2, THEY EXPEND IN TAXES fAR MORE FOR HEALTH THAN IS ACTUALLY
NECESSARY TO PLACE GOOD CORRECTIVE SANITATION MEASURES INTO FORCE,
3. IT IS FELT THAT PUBLIC HEALTH LEGISLATION WOULD MEET WITH SUCCESS
IF PROPERLY PRESENTED.
THE OBSTACLES IN THE PATH OF ANY CORRECTIVE MOVE TO IMPROVE SANITATION
CONDITIONS ARE THE f"OLLOWING:
I. A LACK OF UNDERSTANDING BETWEEN THE VARIOUS PUBLIC HEALTH AGENCIES
WITHIN THE STATE.
2. A FULL AGREEMENT OF ALL PUBLIC HEALTH AGENCIES ON A DEFINITE PROGRAM
OF CONSTRUCTI VE IMPROVEMENT.
3. PROPER CHANNELING or FUNDS EXPENDED FOR PUBLIC HEALTH PURPOSES.
PRINCIPAL PROBLEMS
THERE ARE TWO MAIN PROBLEMS IN THE Fl ELD OF SANITATION IN ARIZONA, THAT
IF CORRECTED, WOULD RESULT IN IMMEDIATE I MPROVEMENTS OF SANITATION CONDITIONS:
I. ADEQUATE LEGISLATION ENACTED BY THE STATt- LEGISLATURE.
2. SUFFICIENT NUMBERS OF WELL TRAINED SANITARIANS TQ ENFORCE THE
LEGISLATION.
ALTHOtlGH THE INDIVIDUAL SANITATION PROBLEMS OF EACH COUNTY WILL BE
TREATED UNDER THE INDIVIDUAL COUNTY HEADING, THE GENERl\L PROBLEMS OF THE STATE
WILL 8E PRESENTED IN THE FOLLOWING OUTLINE:
IS,
I. WATER SUPP~Y AND SEWAGE DISPOSAL SANITATION
I • COMMUN I TY wATEr, S UPP~Y PRODLEM
2. COMMUNITY SEWAGE DISPOSAL PROD~EMS
3, RURAL WATER SUPP~Y AND SEWAGE DISPOSA~
4. STREAM POLLUTION
I I. MILK AND FOOD SANITATION
I. MILK SANITATION
2, SANITATION O~ MANUFACTURE OF rOOD PRODUCTS
3. FOOD HANDLING SANITATION
I If. ENVIRONMENTA~ AND GENERAL SANITATION
I. INDUSTfll AL HVG I ENE
2. Hous ING
3. PLUMO ING
4. SWIMMING POOL
5. TOURisT CAMP
6, COMMON DRINKING OUP AND DRINKING FOUNTAIN
7. GARDAGE DISPOSA~
8. RODENT CONTROL
COMMUNITY WATER SUPPLY: THERE ARE 70 COMMUNITIES IN THE STATE WITH POPULATIONS OF
500 OR MORE; .ITH AN AGGREGATE POPULATION OF 225,430 ApPROXIMATELY TWENTY OF THESE
HAVE ACCEPTADLE SYSTEMS AND OPERATIONAL CONDITIONS. 66 HAVE COMMUNITY WATER SUPPLY
SYSTEMS. SERVING A TOTAL POPULATION OF 222, 776, OR 51, J% O~ THE TOTAL POPULATION
ACCORDING TO THE ,930 CENSUS. DURING THE PAST FEW YEI\RS , THE STATE BOARD OF HEALTH
AND THE COUNTY HEALTH SERVICES HAVE D EEN MORE OR LESS R Esr'ONS IOLE FOR IMPROVEMENTS
TO 27 O~ THESE COMMUNITIES, OR 40.9% OF THE TOTAL STATE POPULATION. THIS HAS OEEN
EFrECTED IN THE AOSENCE OF THE STATE LAW.
IN THE PAST FEW VEARS A SYSTEM O~ WATER SAMPLING HAS DEEN INAUGURATED
IN WHI CH THE OPERATOR OF A SYSTEM MUST SUOMIT AT LEAST TWENTY SAMPLES PER VEAR TO
THE STATE LAOORATORY OEFORE THE WATER SUPPLY ',JILL OE GIVEN CONSIDERATION FOR
F"AVORAOLE APPROVAL, THIS HAS HAD A TENDENCY TO FOCUS THE OPERATOR'S ATTENTION ON
THE QUALITY OF" HIS WATER SUPPLY SYSTEM. MANY IMPROVEMENTS HAVE OEEN EFFECTED OV
TH I S INT EREST.
LEGI~LATION IS NEEDED GOVERNING COMMUNITy WATER SYSTEMS.
FLOURINE IN DRINKING WATER: THE PRESENCE OF FLOURINE IN DRINKING WATER IS OF PUOLIC
HEALTH IMPORTANCE OECAUSE OF THE D ISCOVEiW OY DR. H. V. AND MARGARET CAMMACK SMITH
AREAS IN WHI CH MOT TLED ENAMEL
HAS DEEN FOUND - NOT COMPLETE
(,
(
NAVAJO
L,
jIII
AP,\CHE
'6.
OF tHE UNI VERSITY OF AnlZOUA THAT IT IS THE CAUSE OF MOTTI,.ED ENAM~l. IN TEETH AND
IN DII,.UTIONS AS HIGH AS 0.72 - 2.0 PARTS PER MILl.ION. Fl.OURINE IN WATER IS QUITE
WI :)El.Y D I 5T RlOUTED OVER THE \II ORl.D 0 UT I T WAS NOT UNT I L 1931 THAT IT \II AS PROVE;N TO
DE T HE CAUSE OF MOTTl.ED E;NAMEL.
A SURVEY DISCI,.OSED ADOUT 45 TOWN 01, RURAL DISTRI CTS IN AHIZONA IN WHICH
MOTTLED ENAMEL IS ENDEMIC. ANALYSES or 110 PUOLIC AND 75 PRIVATE: WArtn SUPPLIES
SHOW A Fl.OURIDE CONTENT fiANGING FROM 0.0 1'0 18 PARTS PER MILLION. A MAP SHOWING
THE DISTRIDUTION IS ATTENDED.
CONTINUED RESEARCH FeR A PRACTICAL MI::THOD OF REMOVING THIS SUDSTANCE
FROM DRINKING WATER HAS CEEN CARRIED ON WITH PROMISING RESUl.TS OY THE WORKms MEN-TIONED.
AS THIS CONDITION OF THE WATER IS WIDESPREAD IN MANY AREAS OTHER THI'N
ARIZONA, ITS SOLUTION IS OF GREI~T IMPORTANCt. IT WOULD APPEAl, FEOM THE FACTS
TAcUL,nED I N THE S TUDI ES OF THE SM ITHS THAT EXPOSURE OF THE CH ILD TO THI:: ENVI RON-MENTAL
FACTORS OF Fl.OURINE IN DRINKING WATER OF OVER 0.9 PARTS PER MILl.ION DU~ING
THE YEARS OF GHOWTH OF THE ENAMEL OF THE PEHMANENT TEETH IS CERTAIN TO RESULT IN
MOTTLING.
IN ORDEn TO INSURE THE DELIVEf,Y OF WATEn OF UNQUESTIONADLE QUALITY TO
USERS OF" COMMUNITY WATER SYSTEMS THE FOLLOWING ITEMS ARE NECESSARY:
I. FREQUENT SUPEf,VISION OF' ALL COMMUNITY WATER SYSTEMS.
2. SUOMISSION OF" PLANS TO THE STATE B0ARD OF HEALTH CEFOf,E MOUIF'ICA-TIONS
OF EXISTING SYSTEMS AflE ADOPl'ED. LEGISLATION IS NEEDED TO
EFFECT TH IS.
3. ELEVAT I ON OF T HE MORAL AND TECHN I CAL STAND I NG OF' WATER WORKS
Of'EFIATORS OVER THE STAT E. C'p(:;f-;ATor,s' SCHOOLS AND FREQUENT
CONTACT ARE NECESSARY.
To ADEQUATELY HANDl.E THIS CONDITION IT IS SUGGESTED THAT A OILL DE
ENACTED WHICH WILL REQUIRE THE INDIVICUALWATER COMPANY TO CARRY A NOTICE ON THE
FACE OF EACH WATER OIl.L THAT THEY PRESENT THEIR VARIOUS CUSTOMERS, SHOWING THE
LATEST STATEMENT OF THE STATE gOI\f;D OF HEALTH ON THE QUALITY OF" THEIR WATER SUPPLY.
IN THE AOSENCE OF" A 01 LLI NG SYSTEM OY THE WATEF~ COMPANY, A NOT I Cf:: SHOULD DE ATTACHED
TO THE CAGE OR PLACE WHERE THE WATEr, 01 LLS ARE PAID. THE STATEMENT OF THE STATE
17.
BOARD OF HEALTH WOULD INDICATE ITS APPROVAL OR NON-APPROVAL OF THE CURFlENT CONDI-TION
OF THE WATER SUPPLY, THE ONLY PENALTY TO DE ENFORCED IS THE NON-PRESENTA-TION
OF SUCH INFORMATION TO THE CUSTOMER BY THE WATER COMPANY OFFICIAL.
COMMUNITY SEWAGE DISPOSAL:
OF THE 70 COWMUNITIES WITH POPULATIONS OF 500 OR MOrlE ACCORDING TO THE
1930 CENSUS, 47 HAVE SEWAGE COLLECTION ~YSTEMS SERVING A POPULATION OF 200,906
OR 46.1% OF THE TOTAL STATE POPULATION. MOST OF THESE SYSTEMS NEED ADDITIONALS
OR EXTENSIONS TO ADEQUATELY SE:flVE THEIR RESPECTIVE COMMUNITIES, OR ADEQUATELY
HANDLE THEIR SEWAGE DISPOSAL PROOLEMS. DURING THE PAST rEW YEARS 17 COMMUNITIES
HAVE ADDED TO THEIR SEWAGE DISPOSAL PLANTS, HAVE DUILT NEW PLANTS, on HAVE
REPLACED OOSOLETE TYPES. THESE J7 COMMUNITIES CONTAIN 83,323 PEOPLE, OR 19.1%
or THE ENTIRE STATE POPULATION.
THE PROOLEM YET TO BE SOLVED /S THE COMPLETE INSTALLATION or SEWAGE
COLLECTION SYSTEMS SEHVING AT LEAST 100% OF EACH COMMUNITY'S POPULATION AND ALL
70 COMMVNITIES HAVING POPULATIONS OF 500 on MonE, HAVING ADEQUATE COLLECTION AND
01 SPOSAL.
As FUNDS PERMIT IN THE COMMUNITY'S OUDGET, EXTENSIONS AND E~LAf<GEMENTS
AHE OEING MADE. THIS IS AN EVER CHANGING SITUATION THAT MUST DE FOLLOWEr.' BY "mE
PUOLIC HEALTH OFFIC IAL, TO SEE THAT Tf-E COMMUNITY RECEI VES A MAXIMUM OF OENEFIT
THROUGH PUGLIC HEAlJ'H PfwrECTION FROM THE EXPENDITURE OF' FUNDS INI.CLVEO.
STATE LAW ON THIS PARTICULAR SUBJECT IS OF PARAMOUNT IMPORTANCE. ALL
MODIFICATIONS OF EXISTING SYSTEMS, OR INSTALLATIONS OF NEW SYSTEMS &lOULD CARRY
THE APPROVAL OF THE STATE BOARD OF HEALTH.
RUf<AL SANITATION: THE SANITATION OF' nur~AL WATEr, SUPPLIES AND RURAL SEWAGE DISPOSAL
ARE SO CLoslLY INTER~OCKED THAT THESE TWO PROGLEMS WILL GE TREATED COLLECTIVELY.
FROM THE PRECEDING SECTIONS, IT I S APPARENT THAT 48.~ OF THE TOTAL STATE POPULA­TION
DEPEND ON THE INDIVIDUAL WATER SYSTEM AND 53.9% OF THE POPULATION DEPENO ON
THE INDIVIDUAL MEANS OF SEWAGE DISPOSAL.
IN ORDER TO COMOAT THIS <XJNDITION, THE: UNITED STATES PUOLIO HEALTH
SERVICE, THE ARIZONA STATE BOARD' OF HEALTH, AND THE W. P A. HAVE JOINED TO CREATE
THE COMMUNITY SANITATION PROJECT. THIS ORGANIZATION HAS~~~ED 10,254 USPHS
18.
PRIVY UNITS IN THE STATE. BY ACTUAL COUNT, THESE UNITS SERVE 74,018 PERSONS. IF
THE TOTAL NUMOER OF PEnSONS HAVING SEWERAGE AVAILAOLE AND THE TOTAL NUM8EH OF"
PERSONS SERVED OY PRIVIES ARE JOINTLY SUOTRACTED mOM THE STATE TOTAL; THERE ARE
160,649 PEOPLE NOT SERVED OY EITHER COMMUNITY SYSTEM OR STANDARD PRIVY. A LARGE
PERCENTAGE OF THESE PEOPLE DEPEND ON THE INDIVIDUAL WATER CARRIAGE SEWAGE DISPOSAL
SYSTEM; WHICH IS USUALLY THE CESs-POOL.
IT IS ESTIMATED THAT THERE ARE POSSIOILrT'ES OF CONSTRUCTING NOT OVER
10,000 ADDITIONAL PRIVIES IN THE STATE. THE OALANCE OF" THE POPULATION WILL
REQUIRE SEPTIC TANKS AND TILE FIELDS.
THE MOST SERIOUS SANITATION PROOLEM FACING THE RURAL DISTRICTS IS THE
ALMOST UNIVERSAL USE OF THE CESS-POOL F"OR THOSE RURAL HOMES USING A WATER CARRIAGE
METHOD OF SEWAGE DISPOSAL. THE CESS-POOL IS USUALLY EXCAVATED TO A POROUS UNDER­LYING
STRATUM, THAT OESIDE$ ADEQUATELY DRAINING THE CESS-POOL, ALSO SERVES AS AN
EXCELLENT UNDERGROUND SEWER THAT DRAINS THE CESS-POOL INTO THE WELL. THIS IS
PARTICULARLY TRUE OF THE IRRIGATED FARMING DISTRICTS, WHICH MIGHT EASILY ACCOUNT FOR
THE HIGH TYPHOID AND DYSENTAf,Y DEATH RATES IN THESE SECTIONS OF' THE STATE. PROPER
WELL CONSTRUCTION IS OF LITTLE IMPORTANCE IF THE UNDERLYIr-.G STRATA ARE POLLUTED.
THIS POSSIOILITY SHOULD DE INVESTIGATED OY A CAREFUL STUDY ON SELECTED CROSS
SECTIONS OF" THE TERRITORY.
THE PROPER CONSTRUCTION OF' RURAL WATER SUPPLY SYSTEMS IS NOT OF AS
SER 10US A NATURE AS MI GHT OE EXPECTED. THE GREATEST PERCENTAGE OF RURAL WELLS ARE
DRILLED, DUE TO THE DEPTH TO WHICH THEY MUST GO rOR WATER. A SHALLOW WATER IN THIS
STATE IS ONE AT A DEPTH OF THIRTY rEET. SURFACE RUN-OfF IN THIS ARID STATE DOES
NOT PRESENT THE DEGREE OF" DANGER TO THE f/URAL WATER SUPPLY THAT IT DOES IN A MORE
MO 1ST CLI MATE. HOWEVER, THE DANGER SHOVLD NOT DE OVERLOOKED, FOR TORRENT IAL
SEASONAL STORMS MAY CAUSE PERIODIC DANGEROUS CONDIT IONS, RESERVOIRS SHOULD DE
COVERED TO PREVENT THE INGRESS OF" DUST, WHICH IS ALWAYS A PROOLEM IN THE STATE.
THE SCREENING OF HOMES1 IRRADICATION OF DUMPS, AND OTHER METHODS TO
MINIMIZE FLY GREEDING SHOULD DE EMPLOYED.
AN EDUCATIONAL PROGRAM WITH AN ADEQUATE NUMOER OF" WELL-TRAINED, INTELLI­GENT
SANITARIANS SHOULD DE ADLE TO MAKE GREAT INROAO~ INTO THIS PROOLEM or RURAL
SANITATION, RESULTING IN DETTER LIVING CONDITIONS, LOWER DEATH AND MOROIDITY RATES,
19.
AND THE OENEFITS ACCRUING THEHEF'ROM.
A CORP OF SANITAHIANS SHOULD EFfECT THE FOLLOWING RESULTS OVER THE STATE:
I, MAINTENANCE OF THE PRESENT PRIVIES NOW CONSTRUCTEO.
2. EOUCATION OF RURAL POPULATION IN PROPEn METHODS OF SEWERAGE
CONSTRUCTION.
3. PROPER FLV CONTROL MEASURES.
4. MosQUITO AGATEMENT.
5. SUPERVISION Of CONSTRUCTION OF RURAL WELLS AND WATER SUPPLI ES
TO INSURE MAXIMUM MEASURE Of PRECAUTION TO PROCURE SATISFACTORY
WATER SYSTEMS.
STREAM POLLUTION: MOST Of THE STREAMS OF THE STATE ARE S£ASONAL ONES. IN TIMES
OF FLOOD VAST QUANT IT I ES OF WATER GUSH DOWN T HE WATER COURSES. AT OTHER TIMES THE
RIVERS OR CANYONS MAY DE QUITE DHY. THEnE ARE A fEW NOTADLE EXCEPTIONS: THE
COLORADO, VERDE, (USUALLY SOME FLOW), GILA, SALT, LITTLE COLORADO, AND ONE OR TWO'
OTHER STREAMS. WITH THE CONSTRUCTION OF THE VARIOUS DAMS ON THESE WATER COURSES,
THE V WILL EVENTUALLV DE DRV fOn LONG PEnt ODS OF' TIME. IN MANY CASES THE ONLY FLOW
IN A CANYON OR STREAM DED ISTHAT ORIGINATING AT THE SEWAGE DISPOSAL PLANT OR
INDUSTR I AL WASTE PLANT.
THE DANGER OF THIS TVPE Of' FLOW IN A C/INVON OR RAVINE IS CONSIDERAGLE
IF' IT IS NOT PROPEf?LV TREATED. PHOOAGLY THE SITUATION IS TVPICAL ONLY IN THE ARID
SOUTHWEST. IT APPEARS TH,.\T THE EVENTUAL STAND/IRDS THAT WILL DE REQUl [,ED OF ALL
SEWAGE DISPOSAL PLANTS WI II Q E TREASURV 0 EPARTMENT STANDARDS F'OR All DR t NK I NG wATEn.
THE ENF'ORCEMENT AND SETT ING OF THESE STANDARDS IS MANV VEAHS IN THE F'UTU, E, DUE TO
THE ECONOMIC CONDITIONS OF MANY OF' THE TOWNS AND COMMUNITIES.
THE POLLUTION OF' THE EXISTING STREAMS IS NOT EXTENSIVE. THE DISCHAflGE
OF MINE AND SMELTER WASTES INTO MANV WATER COURSES SHOULD OE CURTAILED. THIS
PHOCEDURE IS NOT PRACTICED GENERALlV OVER THE STATE. IT IS ANTICIPATED THAT THE
PRESENT STREAM POLLUT tONAL PROOLEMS MAV OE ern RECTED WITHOUT ADDI T IONAL PEilSONNEL
AND A MINIMUM OF ADDITIONAL LEGISLATION.
MILK SANITATION: AT THE PRESENT TIME THE STATE SUPEHVISION OF MILK SUPPLIES IS
UNDER THE CONTROL OF' TH.E STATE DAHlV eOMMISS10NER. ,'\S SET FORTH IN THE STATE LAW,
20.
THE DAlr;y CiMMISSiONEf< HAS f"ULL AND COMPLETE CONTROL eVER THIS INDUSTRY. THE
DISADVANTAGES TO THIS GOVERNMENTAL O~GANIZATION ARE LISTED AS f"OLLOWS:
I. THE STATE BeAflD Of" HEALTH IS CHA,;GED WITH THE IMPWVEMENT AND
MAINTENANCE Of" GOOD PUJLlC HEr\LTH CONDITIONS IN THE STATE.
2. THE MONEY APPHOPHIATED TO THE DA IRY COMMI SS/ON COULD DE MOi~E
ECONCMIC/\LLY SPENT If" IT wmE ASSIGNED AND USE::J IN THE REGULAI1
PUOLIC HEALTH CHANNELS. TRAINED MEN THEN WOULD HANDLE THE SITUA-TION
WITH A MAXIMUM Of" ACCOMPLISHMENT AND A MINIMUM Of" CRITICISM
f"ROM THE PUCLIC AN::' THE DAIRY IN::lUSTRY. A GREATER PLCLIC CONFI_
DENCE WOULD RESULT IN AN INCREASED MILK CONSUMPTION, WITH AN
INCREASED AMOUNT Of" COOPERATION OY THE INDUSTRi.
3. THE f)AIRY COMMISSIONER, AS DlflECTEiJ DY STATE LAVI, ISSUES A YGd,LY
LICENSE T G MILK PfWDUCEf(S ON THE P,WMENT OF THE Ll CENSE FEE. THE
COLLECTION Of" SUCH LICENSE SHOULl FORM NO PAnT Cf" A SANITATICN
PIWGf-1AM.
4. DUE TO THE MANNER TH,~T THE PEHSONNEL OF THE COMMISSIONEf<'S OFFICE
AFiE SELECTED, NO Tf,AINING OR CUCATION IS NECESSAI\Y FOR EMPLOY-MENT
IN THIS 'f"FICE. f\ P,JLITICAL nATHEI~ THAN A FJUJLlC HEALTH
COMPLEXION IS GIVEN ITS ACTIVITIES.
5. THE [{EASON For, A DAliW COMMISSIONER'S OFFICE IS FCR 111E PUWOSE
Of" IMPnOV/Nl: ECONOMIC CONdTIONS IN THE DAIRY INDUSTny, SUCH AS
THE IMPt10VEMENT OF DAIi,Y HErmS AS TO orlEEDING, pnoDUCTICN, ANJ
AND THE UTILIZATION OF CJAIfN PFiO.JUCiS. No GRANa-! OF THE ST;,T£
GCVEllNMENT IS C>\ftRYING ON THIS WORK AT THE i~RESENT TIME, OUTSIJE
Of" THAT WORK JONE OY THE UNIVERSITY OF ARIZONA.
6. IN THE ['AST THmE HAVE CEEN CONSIDEHADLE OCJECTIONS cY THE
CCMMISSIONEH TO ANY MILK INVESTIGATIGN WOi<K DONE GY THE STATE
BCAR:) OF HEALTH. THESE FEW INVEST IGATIONS THAT THE BOAl,', HAS
CARf<IED OUT INDICATED THAT THE QUALITY OF MILK SUPPLIES IS SADLY
IN NEED OF IMPi,OVEMENT,
UNDEH THE EXISTING MILK LAW Of" THE STATE, STAN:"AIWS ARE SO LAX WITH
RESPECT TO OACTERIAL. AND SANITATION STAN:)MnS THAT A SAFE QurJ..ITY Of" MILK IS NOT
ASSURED, A SHOiH ENAQLING ACT THAT WOUL;) ALLOW THE STATE BOAf1D OF HEALTH TO SET
STANDAlDS f"ROM TIME TO TIME, THAT WOUL' ALLO\~ THErvl TO Ci,EATE D I STld CTS WHEflE GRADE
A MILK WAS TC DE SOLD; THH WOUL:', A LLOW THEM TO cilEr,TE DEPUTY INSPECTORS; THAT
WOUL:) ENcc:ur,AGE LOCATION INSPECTION OY McnE f"GOI~OUS AN COMPETENT STATE tNSPECT-ION,
WOULD RESULT IN A SAVING TG THE STATE GOTH IN rvUNEY ExPENC)EO AND nESULTS
OGTAINED,
THE PRESENT STATUS OF MILK SUPPLIES OF THE STATE IS APPROXIMATELY AS
FOLLOWS:
Of" THE TOTAL STATE POPULATION, 51.8% LIVE IN COMMUNITIES. CF THOSE
LIVING IN COMMUNITIES, 78.7%, Ofl TWENTY Of" THE COMMUNITIES, HAVE THE STANDAf<D MILK
CRDINANCE, C'F THE URDAN POPULATION 50,2% EMPLOY MILK INSPECTOFlS, THEflE AIlE SEVEN
21.
FULL TIME INSPECTORS WHO HAVE OTHER DUTIES GESIDE MILK INSPECTION, AND EIGHT PART-TIME
INSPECTORS WHO MAV OR MAV Nor INSPECT THE MILK SUPPLY F"OR THEIR COMMUNITY
:}EPENDING ON THEI R PERSONAL INTEi;EST.
ApPROXIMATELV 46.7% OF THE URDAN POPULATION OR 24.2% OF THE TOTAL STATE
POPULAT ION HAVE WHAT MIGHT DE TERMED A SAFE MILK SUPPLV, IT IS EXTHEMELV DOUOTFUL
IF' MonE THAN ONE COMMUNI TV OF" THE STATE COULD RATE 90}t OR GETTER ON THE UNITED
STATES PUDLIC HEALTH SERVICE STANDARD MILK RAT:NG.
SANITATION OF" THE MANUF"ACTURE OF' Foo,] PRODUCTS: CUTS:DE OF" THE INSPECTION WORK
THAT IS DONE IN A F"EW OF THE LAnGE TOWNS AND CITIES (,r THE STATE, THEf'E IS NO
SYSTEMATIC INSPECTION OF" F"OOD M~UF"ACTURING PLANTS. THERE IS CONSIDERAOLE WORK
THAT MIGHT DE DONE ON THOSE PROCESSING PLANTS F"01< ['AIRV PROD\.CTS, F'OR GRAIN i~F<O-
:JUCTS, F'OR VEGETADLE PRODUCTS, AND F"on PRACT I CALLY EVERY OTHER M~UF" ACTUFdN G OR
PfWCESSING PLANT IN THE STATE.
THERE ARE THREE OR F"Oun CHIEf" REASONS WHV THIS TYPE OF" WORK IS IMPOR-TANT
IN THIS STATE:
I. AN APPRECIACLE PERCENTAGE OF" THE STATE POPULATION HAS COME TO
THE STATE f"OR RESPIR,HOr,Y TROUDLES. If" ANV Of" THIS POPULATION
I S EMPLOYED I N THESE PLANTS EXTREME IORECAUT IONS AhE N ECESSARV.
2. THE STATE DORDERS ON MEXICO. THE MAIN SOURCE Of" COMMON
LADOR ARE THOSE IMMIGRANTS OR THEIR DESCENDANTS f"ROM THE SOUTH.
THE STANDARD Of" LI VING AMONG THESE PEOPLE ,S LOW, If" EMPLOYED
IN PROCESSING PLANTS OF" THI S NATunE, ALL SAf"EGUAfWS SHOULD DE
ODSEnVED.
3. DUE TO THE ARID CONO ITION OF" THE ST/\TE, DUST IS A MAJOR PROOLEM.
IT MAY CARRY ALL MANNER 0 f" POLLUT I NG SUOSTANCE.
fOOD HANDLING SANITATION: THIS SUBDIVISION REFERS TO RESTAURANT, GROCERY STORE,
AND THE SANlTAT ION OF' ALL PLACES WHERE FOODS M1E HANDLED. By liN;) LARGE, THEHE IS
LITTLE SANITATION Of" nilS NATURE CARRIED OUT IN THE STATE. A NUMDER OF THE CITIES
AND TOWNS HAVE INSPECTION OF THESE PLACES, DUT THERE IS NO STATE SUPEflVIS JON, AND
NO CHECK UP ON LOCAL INSPECTION.
F'Iny-oNE CXiMMUNITIES WITH POPULATIONS OF" 500 on MOllE, DO NOT HAVE!1!!.
INSPECTION Of" ~ SORT, NINETEEN HAVE SOME INSPECTION. THREE COUNTIES HAVE SOME
WAYSIDE STAND INSPECTION, THE DAUNCE OF THE STATE IS NOT INSFECTED. IN THE
INTEr,ESTs Of" THE TOURIST INDUSTRY, IT WOULD DE ECONOMICALLV ADVANTAGEOUS TO THE
22.
STATE TO HAVE REGULAR EATING ESTAOLISHMENT INSPECTIONS. WITH THE STATE'S HIGH
TUDERCULOSIS INCIDENCE1 THIS TYPE OF SANITATION IS IMPOnTANT.
INDUSTR IAL HYGI ENE: ACCORDING TO THE 1930 CENSUS THEilE WERE 1651304 PEnSONS
CLASSIFIED AS GAINFUL WORKERS IN THE STATE 1 Ot< 33.0(0 OF THE TOTAL STATE POPULATION.
A TOTAL OF 451 81 I ARE EMPLOYED IN MANUFACTURING1 MECHANICAL AND MINERAL INDUSTRIES.
171 376 ARE EMPLOYED IN MINES AND QUARnIES.
IT IS THE IMPRESSION OF AUTHORITIES IN THE FIELD CF PUDLIC HEALTH THAT
THERE IS AN APPRECIADLE PEnCENTAGE Of- THE PERSa-JS ENGAGED IN THOS:: /NDUSTfliES TH ..n
HAVE DUST AND SOOT HAZARDS1 THAT HAVE SILICOSIS. MANY INSTANCES OF' SUCH DISADILITY
HAVE DEEN REPORTED. MINE AND SMELTER WORKERS D ECOME UNEMPLOYAOLE W! TH THI S TYPE OF'
DISORDER.
THIS COI\O IT ION PLACES A FINANC IAL DURDEN ON THE VAR/OUS GOVERNMENT6$ TO
PROVIDE EMPLOYMENT FOR THESE PERSONS WHO HAVE DECOME UNEMPLOYADLE THROUGH THEIR
ACTIVITIES IN THESE INDUSTRIES.
THIS CONn/TloN MAY DE CORRECTED OY INTELLIGENT SUPEHVISION OF WORKING
CONDITIONS THROUGH AN INDUSTRIAL HYGIENE PHOGf1AM. THE AMOUNT CF MONEY NECESSARY TO
CORRECT POOR WORKING CONDITIONS IS SMALL IN COMPAHISON TO THE AMOUNT NECESSARY TO
REHADILITATE WORKERS WHO AnE AFfECTED. ACOORDING .!.2. D.!.£.§.!ill INDUSTRIAL COMMISSION
!':!£ INDUSTRIAL ~ OCCUPATIONAL D/SEASE ~ COMPENSADLE.!.!:!.!.!:!£ ~ £[ ARIZONA.
HOUSING: THE SANITATION OF' PUDLIC OUILDINGS IS AN IMF)OnTANT ONE IN A STATE THAT
CONTAINS THE VAST' NUMDER OF TUCERCULOSIS VICTIMS THAT THE STATE OF ARIZONA 80ES.
VENTILATION AND AIR-CONDITIONING ARE OErr~G DEVELOPED TO A MAJOR EXTENT IN THE
SOUTHERN PORT/ON OF THE ST!"TE.
IT WAS fOUND IN ONE RLR AL SCHOOL THAT MORE THAN 50'% OF" T HE ENROLLMENT
SUffERED F'FOM EYE TROUOLE. UPON AN INVESTIGATION OF THE LIGHTING CONDITIONS Of THE
SCHOOL ROOM IT WAS DISCOVERED THAT THE LIGHTING WAS THE WORST POSSICLE 1 AN;)
PROOADLY WAS THE CAUSE OF' EYE-5THAIN THAT CAUSED THE TfiQUOLE.
ACCORDING TO INVESTIGATIONS IT HAS OEEN F0UNDTHAT THERE ARE ACTI\€:
CASES OF TUOERCULOSIS IN VARIOUS eCHOOLS1 UNKNOWN TO COTH THE VICTIMS AND CLASSMATES.
If VENTILATION CONDITIONS WEllE GGOD THE POSSIOILITY OF PASSING THE DISEASE ALONG COULD
DE MINIMIZED, UNTIL SUCH TIME AS THE'CASE COULD DE DISCOVERED.
EACH YEA R.
RECREATION.
23.
THEATERS, AUDITORIUMS, SCHOOLS, CHURCHES, AND OTHER PUOLl C ASSEMOLlES
OR DUILDINGS SHOULD DE CONSTRUCTED ALONG LINES OF THE DEST SANITARY PRINCIPLES.
SWIM~AING~: OF THE 65 POOLS LISTED IN THE STATE BOAfW CF HEALTH OFFICES, 15
POOLS ARE OF SATISF'ACTORY COf£TRUCTlON AND OPERATION, THE OALANCE OF' THE
POOLS OF THE STATE RANGE FROM EXTREMELY POOR TO MODERATELY GOOD.
THE CITY OF PHOENIX HAS PASSED AN ORDINANCE. OF' SUCH A TYPE AND STANDARD
THAT ANYONE USING THE SWIMMING POOLS IN THIS CITY MAY DE ASSURED OF SAFE SWIMMING
CONDITIONS. IN PIMA COUNTY AND TUCSON CONSIDERAOLE SWIMMING POOL SANITATION HAS
OEEN CARRIED OUT. THE STANDARDS OF' THESE POOLS AilE ADOVE THE AVERAGE FOF< THE
STATE. MARICOPA COUNTY THROUGH ITS HEALTH SERVICE HAS CARRIED OUT A PROGRAM OF
SWIMMING POOL SANITATION IN THE PAST YEAR. IT IS ANTICIPATED THAT roME EXCELLENT
RESULTS WILL ACCRUE DUE TO THIS ACTIVITY.
THERE IS NO STATE AGENCY THilT HAS JURISDICTION OVER THE CONSTi{UCTION
OR OPERATION OF THIS TYPE OF ESTAOLISHMENT. AS NEW POOLS AnE CONSTRUCTED OR
ALTERATIONS MADE, THE CONSTIiUCTION SHOULD DE fJt\DE ALONG RECOMME£\OED LINES.
SWIMMING ~S A MOST POPULAR SPORT IN WHI(}i THOUSANDS OF PERSONS ENGAGE
THE ARID CLIMATE AND VERY WARM SUMMERS ARE CONDUCIVE TO THIS TYPE OF
BETTER SWIMMING FACILITIES THROUGHOUT THE STATE SHOULD DE movl OED.
TOURIST CAMPS: OUTSIDE OF MARICOPA, PIMA, SANTA CRUZ, YUMA AND POSSIDLY COCONINO
COUNTIES NO TOURIST CAMP INSPECTION IS CARRIED OUT. THE MARICOPA HEALTH SERVICE
HAS ACCOMPLISHED AN OUTSTANDING PIECE OF' WOflK IN THIS FIELD RECORDS HAVE OEEN
MADE AND MAINTAINED ON THE CHARACTER OF' THESE PLACES. FROM THE FINDINGS IN THI S
PART I CULAR COUNTY I T IS MOST EVI DENT THAT THI S TYPE OF' WORK SHOULD DE OF STATE­WIDE
NATURE.
TOURIST CAMP SANITATION WORK IS IMPERATIVE IN THE INTERESTS OF THE
ECONOMIC WELFARE. UNLESS IT IS DONE THE TOURIST WILL LOSE INTEREST IN THE STATE
AS A RECREATIONAL CENTER.
UNDER THE PRESENT CONDITIONS THERE IS NO STATE AGENCY THAT HAS SUFFI-CIENT
PERSONNEL TO ADEQU,HELY HANDLE THIS SITUATION. WITH AN ADEQUATE STATE
INSPECTION, AND SUFF'lCIENT LOCAL PERSONNEL TO OARRY OUT THE PROGf,AM, THE IMPRGVE­MENT
OF THI S TYPE OF ESTAOLISHMENT SHOULD DE IMMEDIATE.
24.
THE STATE BOAfW uF' HEALTH, IF THIS IS THE AGENCY DESIGNATED TO CARRY
OUT THIS WORK, S;OULD DE EMPOWERED TO GflADE THESE ESTADLISHMENTS FOR THE INFORMA-T
ION AND au I DANCE OF T HE TOUR I ST • THE TOUR I ST COULD THEN CHOOSE A SUPE n 101< TYPE
OF ESTADLlSHMENT WITH PEf,FECT CONF'lOENCE, AND AN INFERIOR TYPE OF ESTAOLISHMENT
AT HIS OWN RISK. THE INFORMATION WOUL) DE AVAILAOLE TO HIM FROM THE SIGN OF
APPROVAL AND GflAJING AT THE tNTf',ANCE OF THE TOURI ST COURT.
COMMON DRINKING CUP, DRINKI~FoUNTAIN AND COMMON TOWEL: THE COMMON DRINKING CUP
ANQ COMMON TOWEL ARE OUTLAWED ACCORDING TO THE STATE LAW. UNDER THE LAW THE
PRESENCE OF THESE TWO ARTICLES COULD DE COMPLETELY ELIMINATED IF THERE WG;E
SUF'F"ICIENT PEFlSONNEL TO ENFORCE IT.
ADDITIONAL LAW ANi) PERSONNEL WOULD DE NECESSARY TO CORRECT THE Df<INKING
F'OUNTAIN CONDITIONS OF THE STATE. LAW IS A MINOR ITEM ON THIS SUGJECT, AS THE
REQUIREMENTS FOR AN ADEQU/HE Df11NKING FOUNTAIN ARE SO SIMPLE THAT THEY MAY DE MET
WITH A MINIMUM OF EXPENSE AND A MINIMUM OF" AI<GUMENT AS FAR AS ,THE INSPECTOR IS
CONCERNED.
GAROAGE DISPOSAL: GAROAGE DISPOSAL CONDITIONS Vr,flY F'ROM THE VERY COMPLETE INCIN-ERATGR
FOR TUCSON OR THE GRAND CANYON, TO THE DUMP THAT IS USED IN MANY TOWNS AND
CITIES. THE AVERAGE GARDAGE DUMP IS A F'LY-RIODEN UNSIGHTLY MASS, THAT IS USUALLY
SUPERVISED OY SOME INDIVIDUAL WHO MAKES HIS LIVING PICKING OVER THE DUMP. THE
USUAL DUMP IS LOCATED ON THE DANKS OF A CANYON OR WASH, THAT IN FLOOD CARRIES THE
DEORIS DOWN ITS COURSE.
No CONSISTENT PROGRAM OF' SANITARY GAfWAGE DISPOSAL HAS DEEN CARRIE] CUT
OY THE STATE BOARD OF HEALTH. Twa OR THREE OF THE LOCAL HEALTH SERVICES HAVE DONE
CONSTRUCTIVE FLY CONTROL WOFlK, IN ATTEMPTING TO MODIF'Y LOCAL METHODS.
ONE OF THE GREAT DIFFICULTIES WITH GARDACE COLLECTION IN A NUMOER OF THE
TOWNS I S THE PRESENCE OF SCAVANGEf\S WHO REGULARLY PATROL THE ALLEYS FOR WHAT THEY
MAY FIND IN THE INDIVIDUAL GARDAGE CANS. AF'TEI< LOOKING OVER THE GARDACE CAN THE
AVEr,AGE SCr,VANGER TURNS THE CAN OVER AND CnEATES A FLY OREEDING CONDITION IN THE
ALLIES DEHIND HOMES OF HIGH 0[< LOW QUALITY.
EACH GAROAGE CO LLECT I ON AN D DI SPOSAL PROOLEM FOR ANY OF THE COMMUN IT I ES
IS AN INDI VIDUAL ONE THAT TAKES TIME AND THOUGHT TO ADEQUATELY 00 LVE.
RODENT CONTROL:
25.
OUTSIDE OF" THE PREDATORY ANIMAL CONTROL SERVI CE OF" THE U.S.
DEPARTMENT OF" MRICULTUI1E, LITTLE RODENT CONTROL IS PRACTI CEO IN THIS STATE. IT
HAS :~EEN STATED OY AUTHORITY THAT THE STATE IS SUOJECT TO SYLVATIC PLAGUE THROUGH
THE MIGRATION OF GROUND SQUIRRELS F"ROM THE NORTH. TULAREMIA HAS OEEN IDENTIF"lED
IN ONE on TWO INSTANCES IN THE STATE. THIS PROOLEM MAY STAN:) INVESTIGATION TO SEE
THAT THESE CONDITIONS DO NOT GAIN A F'OOTHOLD. ONE SlnVEY WAS CARRIED OUT IN PIMA
COUNTY fJY A MEMOEn OF" THE HEALTH SERVICE. CUTCREAKS OF RADIES ARE OECOMING MOllE
PREVALENT AND UNDOUDTEDLY F'OCI OF INFECT luN AMONG WILD ANIMAL LIF'E CONTRIOUTE THE
MAIN SOURCE FOR SUCH EPIDEMICS.
PLUMSING: THE PRINCIPLES UPON WHICH GOC'D PLUMOING [(EGULARIONS REST Al(E:
I. THE PROTECTION OF THE QUALITY OF A MUNICIPAL WATER SUPPLY.
2. THE PROTECTION OF THE INDIVIDUAL HOME OR PUGLIC OUILDING AGAINST
INROADS OF VERMIN LIVING IN SEWERS.
3. THE PROPER CONVEYANCE OF SEWAGE AWAY F"ROM THE PREMI SIS TO PFiOTECT
THE HOME OR [:lJ ILDING.
OUTSIDE OF" ONE OR TWO ';'OWNS Of~ CITIES THERE ARE NO PLUMOING I<EGULATIONS
IN THE: STATE. A NUMOEn OF" WIHEr, SUPPLIE" OF THE STATE ARE DEFINITELY JEOPARDIZED
DUE TO FAULTY PLUMOING INSTALLATIONS. THE CLIMATE OF THE STATE PROMOTES THE
GROWTH OF" INSECTS LI VHJ G IN THE SEWEI1S. THESE INSECTS !,RE ENCOUNTERED OVEr; THE
ENTIRE SOUTHERN PORTION OF THE STATE; AND Af,E AT P[;ESENT IN THE NORTHERN pcnTION
OF THE ST/ITE IN THE SUMMER TIME. PLUMOING 00NSTRUCTION IS OF SUCH A UNIVmSALLY
POOR QUALITY THAT THESE CONDITIONS Ar~E ALWAYS NOTICEADLE.
'F" PLUMOING Wt.S PROPERLY INSTALLED OR CORnECTED AS MODIFICATIONS WEf,E
MADE, T HE DANGERS FROM IMPROPER TYPES OF" PLUMC INO Fl XTUi,ES ANi) PRACT ICES WOULD
RAPIDLY ELIMINATE THEMSELVES OVER A FE\? YEAfW.
THE PLUMOING SUPPLY HOUSES IN RESPONDING TO THE UNINFORMED DEWNDS OF
THE PUOLIC ARE FonCED TO MEF~CHANDISE ARTICLES THIIT WHEN INSTALLED JEOPAfWIZE THE
HEALTH OF THE USEns. THESE DEALEflS WOULD WELCOME CONSTRUCTIVE LEGISli'.TION. IT
WOULD ENAOLE THEM TO MATEr< I ALLY REDUCE THEIR STOCK, WI TH I TS ATTENDANT OVERHEAD
TO THE DENEFIT OF" THE GENEilAL PUGLle.
THE PLUMiJERS AS A PROFESSION WOULD WELCOME THIS TYPE OF REGULATION, Fon
IT WOULD FlAISE THE STANDAf:DS OF THEIR PROFESSION, THE ATTENTION OF" THE PUGLIC WOULD
OE FOCUSED ON THE NECESSITY FOR GOOD PLUMfJlNG INSTALLATIONS, AND WOULD DEMAND THEM
FROM THEIR PLUMOERS.
1---
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YEARS
I ~_t3..l.--...:.'.Ol.34Z__.l.33.._-...:.'.Ol.34:z..-_.,-,'3"-5.....-....t..3......'1.
MOHAVE
_.:
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..:.j ----l
o
75
25
50
25
25
o
25
0-
'0
50
25­o
"
75­5
RATES
50
,. 50
75
5
-. 25
o
150 ..
I- ·IOC
75
50
25
0
75
50
25
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UN: TED STn ES -- ~L\T ION;L TO,_T'\,_L,. I --·--1 1---.1 -l
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GRAHAM,
YEARS
t-J.......-'""'-ll.----'3",,2__ ' 3;;\ ' 34 " , 35 , 3G
L __....J , ...... /"./
/~1=-/ J
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I=::::;':::±-_~==JL..._J::!'_==;:--­GILA
PREPARED GY: ENGINEERING
l::::~=:::l~---:-f;:=~'~--'~_-:-';:I--:;';;"=-:::'-~-+:;"_--:-~=:f- 0 -.,- --" '-- l '--'
30 '31 '32 '33 '34 '35 '36 RinES '30 '31 '32 '33 '34
YE~RS YEARS
REPORTED TYPHOID AND DYSENTARY CASE RATES PER 100,000 POPULATION BY
COUNTIES WITH NATIONAL AND STATE TOTALS FOR
COMPARISON, FOR THE YEARS 1930 TO 1936 INCL.
D' VISION- A~ZONA ,STATE OOARD Of HEALTH
'35 '36
-V -I -T -I~ -L -S-T-A-T-IS--T-IC-S-
"VITAL SHTISTICS ARE USEFUL FOR MANY PURPOSES, TO THE HISTORIAN THEY
SHOW THE NATION'S GROWTH AND MARK THE FLOW AND EBB OF PHYSI CAL LIFE; TO THE ECONO-MIST
THEY INDICATE THE NUMBER AND DISTRIBUTION OF THE PRODUCERS AND CONSUMERS OF
WEALTH; TO THE SANITARIAN THEY MEASURE THE PEOPLE'S HEALTH AND REFLECT THE HYGIENIC
CONDITIONS OF THEIR ENVIRO.NMENT; TO THE SOCIOLOGIST THEY SHOW MANY THINGS RELA'TING
TO HUMAN BEINGS IN THEIR RELATIONS WITH ONE ANOTHER," WHIPPLE,
VITAL STATISTICS PROPERLY CONSIDERED IS THE ACCURATE RECORDING AND
ANALYSIS OF BIRTHS, DEATHS, AND SICKNESS.
BIRTH RECORDS ARE VALUABLE TO INDIVIDUALS WHOSE BlfnHS ARE RECORDED
FROM THE STANDPOINT OF GIVING LEGAL PROOF OF CITIZENSHIP, AGE, AND Pt,RENTAGE,
FROM A PUBLIC HEALTH STANDPOINT BIRTH REGISTRATION IS OF IMPORTANCE AS
IT ENABLES HEALTH AUTHORITIES TO INrELLIGENTLY COMBAT MATERNAL AND INFANT MORTALITY,
DEATH f~ECORDS A I DIN THE DETECT ION OF CR IME; ASS 1ST I N THE TRANSFER OF
INHERITED PROPERTY 01< LIFE INSURANC£; INDICATE THE EXTENT AND CHANGES IN POPULATION
PRODUCED BY DEATH AND HAVE SOME VALUE IN THE CONTROL OF DISEASE BY INDICATING THE
FREQUENCY AND RATE OF DEATH OF THE VARIOUS DISEASES, THEY ALSO SERVE AS A CHECK
ON THE COMPLETENESS OF MORBIDITY REPORTS,
FROM THE STANDPOINT OF PUBLIC HEALTH, STATISTICS OF SICKNESS ARE THE
VITAL STATISTICS OF GREATEST IMPORTANCE. THEY SHOW THE OCCURRENCE OF DISEASE AND
Irs RELATIVE PREVALENCE IN DIFFERENT LOCALITIES AND AT DIFFERENT TIMES,
BY THEIR STUDY HEALTH OFFICIALS AnE ENABLED TO KEEP THEIR F'INGERS UPON
THE PULSE OF DISEASE PREVALENCE, RECOGNIZE EPIDEMICS IN THEIR INCIPIENCY AND THUS
DEAL MORE EFFECTIVELY WITH THEM,
27.
IN ONLV ONE COUNTY, PIMA, IS THE HEALTH OFFICER THE COUNTV REGISTRAI
OF VITAL STATISTICS. BECAUSE OF THE VALUE OF HAVING THESE STATISTICS READILV
AVAILABLE TO THE HEALTH OFFICER IT IS RECOMMENDED THAT IN "..OSE OOUNTIES OR
DISTRICTS WHERE THERE IS A WHOLE TIME HEALTH SERVICE THE DIRECTOR BE MADE THE CHIEF'
REGISTRAR or THEIR COUNTV OR 01 STRICT.
THERE ARE 8 INDIAN RESERVATIONS WITHIN THE STATE WITH AN INDIAN POPULA­TION
OF SOMETHING OVER 40,000. INASMUCH AS THE FEES rOR LOCAl. REGISTRARS ARE PAID
BY T HE COUNTY AND THE COuNT IES WI Ll. NOT PAY FOR THE REG ISTRAT ION OF' VIT AL STAT IS­TICS
UPON A RESERVATION, IT IS IMPOSSIBLE TO HAVE ACCURATE STATISTICS fROM THESE
RESERVAT IONS EXCEPT THROUGH THE BUREAU or THE CENsUS VH ICH MEANS THE LAPSE OF
APPROXIMATELY 1/2 YEARS AF'TER THE OCCUnRENCE OF' THE INCIDENT RECORDED.
tT IS RECOMMENDED THAT A CAREFUl. STUDY or THE PRESENT SYSTEM OF
DISTRICTING AND APPOINTING REGISTRARS 8E MADE WITH A VIEW OF' IMPROVEMENT.
IT IS ALSO RECOMMENDED THAT AT LEAST ONE tNNUAL VI SIT BE MADE BY THE
ACTING STATE REGISTRAR TO EACH LOCAl. REGISTnAR SO AS TO CREATE: A BETTER UNDER­STANDING
OF THE REASONS rOR V1TAl. STATISTICS AND TO ASSIST IN SECURING MORE COM­PLET
E AND ACCURATE REPO RT INO.
A BETTER APPRECIATION OF THE rACT THAT VITAL STATISTIC IS SOMETHING
MORE THAN THE SIMPLE BOOKKEEPING or BJl1THS AND DEATHS AND THAT IT REQUIRES NOT
ONLY ACCURACY BUT UNDERSTANDING rOR ANALYSIS WHICH IS NECESSARY BErORE MARKED
IMPROVEMENT CAN BE MADE.
As IN OTHER DIVISIONS or pue~lc HEA~TH ADMINISTRATION Ir TRAINED
PERSONNEL CANNOT BE OBTAINED THOSE IN SUCH POSITIONS SHOULD HAVE PROVISION MADE rOR
THEI R TRAIN ING.
THERE IS CERTAIN EQUIPMENT WHICH rACILITATES THE SPEED AND ACCURACY Or
THIS TYPE OF WORK.
A PUNCH CARD MACHINE AND f"lLES, A SORTING AND TABULATING MACHINE IS THE
MOST ESSENTIAl.. A PUNCH CARD MACHINE PUNCHES A CARD USING A CODE FOR INrORMATION
ON THE ORIGINAL BIRTH AND DEATH CERTIFICATE. ONCE THE CARD IS PUNCHED BY THE CODER
AND PUNCH CARD OPERATOR IT IS TURNED OVER TO THE SORTING AND TABULATING MACHINE
OPERATOR WHERE THE INrORMATION IS TABULATED AND COUNTED FOR EACH CARD THAT IS RUN
THROUGH THE MACHINE, THIS PERMITS A QUICK COl.LECTION OF INrORMATION WITHOUT SORT-ING
THROUGH INDI VI DUALLY EACH CERTI nCATE.
28.
IT MUST BE TAKEN INTO (X)NSIDERAT,ON THP,T THEI-<E ARE AT PRESENT APPI<CX'­MATELY
'0,000 BIRTHS AND 6,000 DEATHS I~ECEIVED BY THE DEPAI,TMENT FROM WHICH THE
CONTAINED INFORMATION MUST BE BI<OKEN DOWN BEFORE STUDY CAN BE MADE OF IT.
IT IS ALSO SUGGESTED THI\T IF A NOT ICE OF THE RECORDING OF 1\ BIRTH
CERTIFICATE's AV;\ILA8LE FOR PRESENT,H'ON TO THE PARENTS BY A FIELD N::RSE WITHIN
A REASONABLE TIME AF'7ER IT I S RECORDED TH-\T THE PAI1ENTS WCULD APPliECI,\TE THE
SERVICE AND 'T WOULD ALSO ACT AS A FAVOHAGLE INTRODUCTION FOfl THE NURSE.
AT THE PHESENT TIME, BECAUSE OF NEEUED CLErUCAL ASSI STANCE. THESE
NOT I CES ARE AT LEAST S I X MONTH SIN AImEARS.
SQUARE MILES
ACRES (STATE LAND
(FEDERAL LAND
NET VALUAT ION
TOTAL TAX PAID
113,810
72,838,400
$382,327,743.00
15,090,387.00
POPULATION
TOTAL 1920
1930
RACE:
WH ITE
MEX I CAN
INOI AN
OTHER
334~162
435,573
264,378
114,173
43,726
, 3,296
SCHOOL ENROLLMENT
ELEMENT ARY SCHOOLS
JUNIOR HIGH SCHOOLS
H' GH SCHOO LS
ACCOMMODAT 1ON SCHOO LS
TOTAL
61,263
2,384
14,73B
600
78,985
1936 .
NO. I 935RATE NO.
,9
§4RATE No. I 933RATE
1932
BIRTHS No. RATE No. RATE
"""'TOTAL 9386 21.55 9026 20.72 0;::93 ,9.04 7fl/2 17 93 7('46 18.24
WH ITE 5005 18.93 4617 .7.46 4125 15.60 4190 15.85 4428 16.75
MEX I CAN 3006 26.33 2988 26.17 3093 27 09 2535 22.20 2714 23.77
INOI AN go, 20.61 961 21.98 670 15.32 639 14,61 460 10.52
OTHE F< 474 35.65 466 35.05 405 30.46 448 33.69 344 25. [37
.
INFANT
DEATHS
TOTAL 1136 12 •. 03 ,004 I II .23 868 104.67 871 II 1.50 762 95.90
WH ITE 360 71 93 267 57 .83 215 52.12 242 57 .76 237 53.52
MEXICAN 5.5 171.32 491 164.32 474 153.25 473 186.59 420 154.75
INOI AN 225 249.72 229 238.29 156 232.84 .35 211.27 78 169.57
OTHER 36 75.95 17 36,48 23 56.79 21 46.88 27 7ll.49
DEATHS
ALL CALGES
TOTAL 6488 14.90 6002 13.78 5599 12.85 5429 12.46 5156 I I .81'r
WHITE 3782 14.31 3362 12.72 3174 12.01 3031 11.46 2986 It .29
Mc:xl CAN 1619 .4.18 1511 21.99 1549 13.57 1617 14.16 1525 13.36
INOI AN 839 19.,9 912 20.86 635 14.52 547 12.51 396 9.06
OTHER 248 18.65 217 16.32 241 18.13 234 17.60 249 I D. 73
-==
T. 8. e ,007 2.31 1479 3,40 1178 2.70 957 2.20 1027 2.36
0 110, 2.53 1053 2.42 ,058 2,42 1073 2.46 1150 2.64
PNEU- "" 1262 2.90 849 1.95 571 1.31 219 .50 294 .67 MaNIA 0 658 I. 51 633 1.45 557 1.28 524 I 20 557 1.28
DIPH_ C 2/1 .48 161 .37 126 .29 174 ,40 160 .37
THEFiIA 0 24 .06 17 .04 23 .05 16 .04 22 .05
TYPHOID C 104 .24 96 .22 185 .42 152 .35 98 .22
0 30 .08 16 .04 36 .08 23 .05 16 .04
==
29.
IT WILL BE SEEN FROM A CASUAL GLANCE AT THE ACCOMPANYING MAP OF THE
STATE SHOWING MATERNAL AND INFANT MORTALiTl( Fon THE VAf1l0US POLITICAL SUDDIVISIONS
THAT THERE IS ROOM FOR MATEHIAL IMPROVEMENT IN MEASURES SAFEGUARDING THE LI VES OF
MOTHERS AND CHILDREN.
SUCH CONDITIONS HAVE OEEN UNIVEf,SAL IN ALL STATES UNTIL UNITED ,~CTION
WAS DIRECTED AT THE REMOVAL OF PREVENTA8LE HAZAHDS TO LIFE AND HEALTH.
THE APPLICATION QF PREVENTIVS MEASURES HAS DEMONSTRATED IN EVERy
INSTANCE THAT MATEF<NAL AND INFANT MORT/loLITY CAN DE REDUCED VERY MARKEClLV THROUGH
PROPER PRENATAL AND MATERNAL CAflE AND EASILY APPLIED METHODS FOR INFANT CARE AND
FEED INC.
"NONE OF THESE METHODS AflE DIFFICULT OF APPLICATION! I" A GENERAL INTEflEST
IN THEM IS INCUHf,ED AND A REASONABLE EFFORT MADE TO APPLY THEM.
A DEFINITE P~GRAM FOR THE PROTECTION OF MATERNAL AND CHILD HEALTH Oy
MEANS OF PUOLIC HEALTH EDUCATION AND NURSING SERVICE IS BEING CARRIED ON BY THE
DIVISION 01" MATERNAL AND CHILD HEALTH. THIS IS AN ACCEPTED PART 01" ANY WELL
ORGANIZED PUDLIC HEI~LTH PROGRAM GUT IT IS NCT TO DE FOflGOTTEN THAT ANY ONE
ACTIVITY WILL NOT OF ITSELF SOLVE THIS PROBLEM.
ITS SOL.UTION LIES RATHER IN A GENEf<ALIZED HEALTH PROGRAM WHICH IMPROVES
ENVtRONMENTAL SANITATION THROUGH PROVIDING A SAF'E WATER AND MILK SUPPLY" SANITARY
DISPOSAL OF SEWAGE AND CONTROL OF COMMUNICABLE DISEASES WITH DUE CON·SIDERATION TO
THE IMPf~OVEMENT OF ECONOMIC CONDITIONS WHICH AFFECT HOUSING AND NUTRITION.
IT IS F'ELT THAT COMOINING THE AVAILAGLE r,ESOURCES FOR THE CRGANIZATICiN
OF WELL ROUNDED WHOLE lIME HEALTH SEHVICES FOr: THE ENTIRE STATE OFF'EnS THE OEST
30,
MEANS FOR REDUC ING T HE HEALTH HAZARDS FOf( THE ENT I f,E POPULAT ION OF MEN, WOMEN "ND
CH I LDf'EN. IT IS FELT THAT MEASURES WHICH PROTECT THE DREAD WINNER ARE EQUALLY
IMPORTANT WITH THAT FOr; THE REMAINDEr: OF THE FMI,.IL'.' f\~IC) HI,",T .\Ii.. L1N!<S OF THE CHAIN
MUST BE STRONG IF TilE HEALTH OF THE MOTHEF1 I\:.JD (~bl;D r'.;'E TO =:F: ,:.)~I".E;:''JE').
IN THE ENTHUSI ASM FOR A SPECI ilL IZED ,f\TERc-:;-;T 1 :iESE it,CH, !\fiE !IF'T TO l3E
OVEf'LOOKED.
THE SHORT PERIOD OF HOSPITALIZATION FOr, INDI2n~'1' :;".s:~s \IHIGi Ai,E f:.::r.; Wl~f~\ I~ :T;,Jr.1
ONE TO THREE D,iVS.
IN THE HOME AN:) IN onDER TO fiEDUCE THE EXPEN,SE ,)1'" '-!CSFi"'(,L1Z;IION i'HE TIW:: IS
SHOflTENED.
BIRTH lIND DL\TH RATE FOR ,'RIZON,; BY COUNTIES 1936
A P ,; C H E
* 320
I) 50
X 156,25
Jh:f 14 Ixx 43.75
17?-:}1:~ 2
xxx 6.25
GRAHAM
• 352
7l 42
X J 19.32
Iii:' 13
xx 36.93
fh:?// 9
XXX 25.57
NAV/\JO
'" 472
II 98
X 207.63
JUI 43
II)~~ 91. ,0
1/#;;' 17 IXXX 36.02
I
trW! 16
XXX 33.06
1 L A
* 510
57
J 11.76
l~f~ 31
xx 64.05
\ JI "", 0 _J--\\':.~X:9.67
PIN A L ,
'" 4&'j.
{J 85
X /15.62
7h:~ 3 J
'XX 64."5
o CON I N 0
* 321
~I 41
X 127.73
r:~l'~ 16
xx 49.84
Nil 3
xxx 9.35
MAR
*3479
/,! 395
X 113.54
INf 121
XX 34.78
jN~! 116
XXX 33.34
Y,\VAPAJ
* 495
;;1 47
X 94.95
/,Ii/ 16
XX 32.32
/,Iili? 17
XXX 34.34
-----~-----,-r___---
leo P A
MOHAVE
Y U M r\
'" 3["30
# 66
X 173.68
1M 23
xx 60.53
Ih1
{ 14
xxx 36. &1-
*123
#7
X 56.91
#11 2
XX 16.26
## 4
32.52
BIRTHS - Sr:\T E - 9386
P I M A
INt 55
/I 143 XX 39,45 * 683
'___ X 102.58 /,I;;'I,! 42 If 46
-....., _............... XXX 30.13 X 67.35
~ #/1 24
'_" XX 35.14
~ #;/;119
ANT,A CRUZ XXX 13.18 r. 234
26 ' .:; 19 ~.~--~---------_...
7;~t 8
XX 3'1-.19
7
xxx 29.91
1,1 INFAN T OEAITHS - 5T :,TE - ) 1 10
X INFANT DEATH RATE - STATE - 118
iff! NEONAHL DEATHS - SHTE - 387
XX NEONATAL DEATH RATE - STATE - 41.23
IflHI 5TI LLBlf,1HS - ST:\TE - 227
xxx STILLBIRTH RATE - STATE - 29 51
3 I.
NEED FOR AND LACK or DENTAL CARE APPEARS TO OE Mffi E OOVIOUS THAN THAT
OF MEDICAL CARE APPARENTLY FOR TWO REASONS. IN THE LOWER INCOME GROUP THE
ECONOMIC DETERRENT IS A MAJOR ONE.
IN THE SMALLER POPULAT I ON CENTERS WH I CH COMPRI SE A MAJOR I TY or TH E
TOWNS IN A RURAL STATE SUCH AS THIS, DENTISTS ARE CONSPICIOUS OY THEIR AOSENCE
EVEN IN THOSE COMMUNITIES WHICH HAVE ONE OR MORE PHYSICIANS,
IT HAS [jEEN A RECOGNIZED FACT FOR roME TIME THAT ORAL HYGIENE IS A
VERY IMPORTANT PART or f4'JY HEALTH PI~OORAM AND IT WOJLD SEEM A WISE PROCEDURE TO
NOT ONLY INCWDE IT IN THE HEALTH EDUCATION PI,.ANS or THE STATE, OUT TO PROVIDE
SOME SORT or, AT LEAST TEMPORARY1 TREATMENT WE ASUR ES IN T HOS E AREAS WHERE
DENTISTRY IS NOT AVAILAOLE.
IT MIGHT DE POSSIGLE TO WORK OUT SUCH A PLAN WITH THE STATE DENTAL
ASSOCIATION. A MOOILE CLINIC WITH FACILITIES toR SHOWING EDUCATIONAL rlLMS AND
GIVING TREATMENT TO CH ILDREN WITH EMERGENCY NEED MIGHT OE OF ASSISTANCE IN
ORINGING TO ATTENTION THE IMPORTANCE f4'JD NEED OF DEN1AL CARE UNTIL SUCH A TIME
THAT OOTH A DEMAND AND FACILITIES ARE AVAILAOLE.
IN ONE RURAL AREA A DENTIST SUCCESSrULLY TRIED OUT A PLAN rOi< ITINERANT
SERVICE.
THERE ARE APPROXIMATELY 135-140 DENTISTS IN THE STATE PRACTICALLY ALL
or v.tlOM ARE LOCATED I N THE LARGER POPULAT ION CENTERS.
IN AN EARL IER PART or THI S REPORT ATTENTION IS GIVEN TO THE PRESENCE
OF rLOURINE IN DRINKING WATER IN A NUMDER or AREAS. IT IS IMPORTANT THAT PEOPLE
SUOJECT TO TH I S HAZARD DE THOROUGHLY AWARE or ITS DANGER TO ENAMEL DEVELOPMENT or
THE PERMANENT TEETH.
32.
t .!:!!l. 1. 1 .£ !:!. So ~ 1: .! !:! -N-U-R-S-IN-G-PUOLIC
HEALTH NUF/SES IN ARIZON,; ACCORDING TO LATEST F'IGURES, NUMOER
105 OF' WHICH 38 ARE UNDEr, THE ADMINISTflATION OF' THE STATE BOARD OF' HEALTH AND
COUNTY AND DISTRICT HEAl.TH UNITS. THREE OF' THI S NUMDEP ARE DIRECTLY CONNECTED
WITH THE STATE BOARD OF' HEALTH; ONE I S THE CHI EF' CONSULTANT NURSEj ONE
CONNECTED WITH THE TUGERCUlOSIS UNIT, AND THE THIRD NURSE IS WORKING WITH A SURVEY
CONDUCTED DY THE U.S.P.H.S. IN CONJUNCTION WITH THE STATE BOARD OF HEALTH. THREE
MonE NunSES WILL DE ATTACHED TO THIS SURVEY WITHIN THE NEXT FEW DAYS. (HOWEVEFli
THIS IS ONLY A TEMPORAI<V PROJECT AN') THE NUMOEr<S AFIE GIVEN F'OR ACCURACY OF"
CENSUS ONLY. )
TH I RTY-TWO (32) Nur;SES AflE DIRECTLY CONNECTED WITH COUNTY AND 0 I STR I CT
HE,;LTH UNITS. THREE NURSES AnE WORKING IN COUNTIES HAVING NO FULL TIME HEf,LTH
UNIT AND AHE UNDEf-l THE DlnECTION OF THE STATE BOAFlD OF' HEALTH.
OF" THE THIRTY-SIX (36) NunSES AF"F'ILIATED WITH EITHER THE SUITE BOARD
OF HEALTH OR WITH THE COUNTY AND DISTRICT UNITS, TWENTY (20) HAVE ONE SEMESTER
OF MOI;E OF' GF/ADUATE PUGLIC HEAL.TH NUF/SING IN AN ACCREDITED SCHOOL OF PUOLIC
HEALTH NURSING; FOUF~ HAVE HAD PUGLIC HEAL'TH EXPEI\lENCE EIH£R 'M-l1LE: A STUDENT
NURSE Of? WITH AN ORGANIZED STAFf-" AND TWO HOLD CEf~TIF'ICATES IN PUClLIC HEALTH.
EIGHTEEN (IS) OF THE TWENTY RECEIVED FOUR MONTHS TRAINING UNDER SOCIAL SECURITY
fUNDS.
NURSES CONNECTED WITH THE COUNTY HEALTH UNITS CARRY ON A PROGRAM OF'
GENERALIZED PUrlLIC HEALTH NURSING. IT IS ESTIMATED THAT F'ROM 60 TO 75 PER CENT
OF' THE TIME OF' THESE NURSES IS SPENT IN THE MATEFiNAL CHILD HYGIENE PROGRAM WITH
INCREASING EMPHASIS ON THE PROOLEMS OF' TUClERCULOSIS CONTROL, SANITATION AND
VENEflEA\. DISEASE CONTROL.
33.
GILA COUNTY WITH NO ORGANIZED COUNTY HEALTH UNIT, EMPLOYS A rULL TIME
NURSE, WHO IS DEVELOPING A GENERALIZED PROGRAM, PIMA COUNTY BOARD or SOCIAL
SECURITV tND WELfARE EMPLOV A NURSE AS MEDICAL-SOCIAL VIORKER 1'iH0 DEVOTES MOST or
HEr< TIME TO THE TUOERCULOSIS CeNTROL PROGRAM, THESE TWO INSTANCES ARE THE TWO
EXCEF'T IONS IN ARI ZONA Of PUOLI C HEALTH NURSES EMPLOVED tROM COUNTY fUNDS OUT NOT
UNDER THE DIRECTION or THE STATE OR COUNTY HEALTH DEPARTMENTS.
THE CITY Of PHOENIX WHICH HAS NO PUGLIC HEALTH NURSE CONNECTED WITH
THE BO;\RD Of HEALTH, IS SERVED ONLY OY NURSES CCNNECTED WITH SOCIAL SERVICE
CENTtFlS. FOUR NURSES ARE EMPLOYED OY THE SOCIAL SEflVICE CENTER AND ONE OV THE
SANTA MONICA MISSION, THE WORK Of THE FDRMEf< IS CONfiNED CHIEfLV TO THE VARIOUS
MEDICAL AND SURGICAL CLINICS aJNNECTED WITH THI S OFWANIZATION, HOWEVER, THESE
NURSES 00 SOME VISITING AND INSTRUCTION IN THE HOMES. THE fifTH NURSE, CONNECTED
WITH THE MISSION, ASSISTS IN PRENATAL, INrANT, INfANT AND PRESCHOOL HVGIENE
CLINICS, AS WELL AS A LARGE VENEREAL DISEASE CLINIC. SHE ALOO CARRIES ON AN
INTENSIVE PROGRAM or HOME VISITING. SHE GIVES DELlVEHV SERVICE TO THE GROUP
SERVED OV THE CLINIC AND SUPERVISES THE POST-PARTUM CARE IN THE HOMES.
THE SERVICE PROVIDED THE CRIPPLED CHILDREN UNDEr< THE STATE BOARD Of
SOCIAL SECURITY IS DIRECTED OY A PUGLIC HEALTH NURSE. HER STAfr WI LL SOON DE
STRENGTHENED WITH THE ADDITION OF A PUGLIC HEALTH NURSE WITH ORTHOPEDIC TRAINING.
FIVE NURSES ARE EMPLOVED IN ,\RIZONA OV THE W.P.A. OF THESE; ONE DOES
GROUP AND INDIVIDUAL TEACHING IN AN ISOLATED AflEA OF MAntCOPA COUNTY, ONE ACTS
AS RECREATIONAL DIRECTOR IN ONE or THE EDUO/IT/ONAL PHOJECTSj ONE SUPERVISES THE
HEALTH OF WOMEN CONNECTED W/TH THE VARIOUS SEWING AND OTHER PROJECTS AND THE
OTHEfl TWO ARE CONNECTED WITH NURSERY SCHOOLS. THESE NURSES ARE NOT lNC"LUDf::/N THE
ROSTER Of ,05 NURSES,
THE U. S. INDIAN SERVICE PfWVIDES, ACCORDING TO LATEST INFORMATION,
17 PUOLIC HEALTH NURSES LOCATED IN TEN CENTERS OVER THE STATE WITHIN INDIAN
RESERVATIONS.
tORTV-TWO (42) NURSES WORK UNDER THE ADMINISTRATION OF THE BOARD OF
EDUCATION, A NUMOER OF THESE ARE PAf~TIALLY SUPPORTED DV THE TOWN IN WHICH THEY
WORK, THUS MAKING A COMOINATION OF SCHOOL COMMUNITV SERVICE. Of THE FORTY-TWO
THREE HAVE ATTENDED SUMMER SESS IONS IN PUDLIC HEALTH NURSING; fiVE HAVE HAD
34.
ONE SEMESTEf, on MOI,E OF" Gf;ADUATE WORK 1 TWO HOl.!"J PUOL I C HEALTH CErn 1F"1 C,HES1 AND
or,E HAS HAD F"OUR MCNTHS EXPErnENCE WITH AN OHGANIZED NURSING STIIF"F". THE INf"CRMA-TION
OF" THE HlAINING OF" THESE NunSES, IF" COMi"LETE, WOULD PfWDi\DLY REVEIIL AN EVEN
HIGHER NUMGER WiTH SOME PUGLIC HEALTH TflP.INING.
THE SCHOOL AND COMMUNITY NURSES IN THE STATE, WHILE CONCERNED CH1EF"LY
WITH THE HEIILTH CF" THE SCHOOL CHILD, MAKE A DEF'INlTE CONTRIOUTlON TO THE GENEfL~L-IZED
PROGRAM IN SUCH ACTIVITIES AS THE SUMMER ROUND-UP AND PRESCHOOL CLINIC;
THE COtHROL OF" OOMMUNICAOLE DISEASE IN THE COMMUNITY, AND VACCINATION ;\ND IMMUNIZA-TION
OF' THE PRESCHOOL AND INF'ANT GROUP IN THE COMMUNITY. SOME HAVE AT TIMES
CONDUCTED PRENATAL CLINICS. NEEDLESS TO SAY, HEALTH EDUCATION AND ADULT HYGIENE
Af,E DOTH TOUCHED DY EVERY SCHOOL NURSE.
THE NURSES IN ARIZONA ARE RENDEnlNG A F'INE TYPE OF SERVICE AGAINST SUCH
COOS AS
I. OISTr;ICTS COVERING V,,\ST ARE,\S AND ENTAILING ENDLESS AND EXHAUSTING
TRAVEL WITH AN ALMOST INTOLERADLE HEAT THPOUGH THE WARM MONTHS.
2. A Li\RGE MEXICAN AND INDIAN i'OloULATION.
3. INADEQUATE NUPSING STAFF' TO ADEQUATELY COVER THE AREA AN,) POPULAT ION.
4. INADEQUATE MEDICAL1 SURGICAL AND DENTAL FACILITI ES.
F'INALLY, IMMEDIATE NEEDS IN PUOLIC HEALTH NURSING HAVE TO [;0 WITH THE
FOLLOWING POINTS IN GENERAL:
1. PHOMOTION OF PHEPARATION, THHOUGH MUCH r"EEDED ADDITIONAL FUNDS F"OR
THAINING.
2. A CLOSER WOHKING RELArlON WITH SCHOOL NURSES AND OTHERS NOT
CONNECTED WITH THE OF'FICIAL HEALTH AGENCY.
3. PROMOTION OF STAND;\f,OS OF PREPARATION TO DE REQUIRED DY SCHOOL
DOARDS lN THE EMPLOYMENT CF THE SCHOOL NunSE.
PUBLIC HEALTH NURSES IN ARIZONA
C Hel
\-
I
IiIII
II
P A
J
J 01 II
X
COCHISE
xxx Xxx
N A V A
##
X
o N I N a
P I M A
XXXXXXXX
I
•
MARICOPA
11#f,"##f,I##tftl##il#IJ###
XXXXXXXXXXXXXX
00000
1III
o
YAVAPIII
#####
X
'- C 0 C . ###
\..-.. XX ~-~
---,
MOHAVE
#
Y U M A
#
XXX
~~-~'~-J
~
# SCHOOL AND COMMUNity NURSES ~~"~
X STATE BOARD O~ HEALTH NURSES
o SOC I AL SEf,V ICE NURSES ---, __ ~ 1------....· ............ ~-
I W.P.A. NURSES
() CRIPPLED CHILDREN DIVISION ~',._., ,--S;;NTA CRUZ
• COUNTY NURSES - OTHER THAN STATE BOARD OF HEALTH .,,~ XX
, ....._----~----------- .'
STATE WIDE CRG,\N IZ:IT ION TO BE EFFECTED - FISCAL YE,;R 1937 - 1938
x
w
W
..J
x
i\PACHE
;\ J 0
C 0 CHI S E
GRAHAM
X
x X N Ii V
COG 0 N , N 0
PIN ,\ L
X X X
MARICOPA
xxxxxx
XXXXXXXXXX J
X///// X,~_X_..
YAV,\P,\
Y U MA
x
MOH/\VE
HEALTH SERVICE NURSES NOT INCLUDED IN ORGANIZED PUOLIC HEALTH UNITS ••••• X
OOJECTIVE : To COORDIN/\TE THE ACTIVITIES OF THESE WORKEr,s WITH THE /iCTIVITIES OF
THE STATE mD LOCAL HEALTH DEf'AI1TMENTS.
35.
PUGLIC HEALTH NURSES LISTED IN THE rOREGOING ARE DISTRIOUTED AS rOLLOWS:
(INDIAN SERVICE NURSES NOT INCLUDED)
COUNTY
APACHE
GOCHISE
COCONINO
GILA
GRAHAM
GREENLEE
MARICOPA
MOHAVE
NAVAJO
PIMA
PINAL.
SANTA CRUZ
YAVAPAI
YUMA
STATE OR COUNTY
BOARD OF HEALTH
6
2
14
8
2
3
38
STATE &: SOC­IAL
SECURITY
BOARD OF
EDUCAT ION
3
3
2
3
18
2
4
5
42
COUNTY
illONE )
2
SOC IAL
SECURITY
5
5
4
5
.NOT INCLUDED IN ROSTER Or ,05 NURSES.
36.
-S -TA-T--E
THE ARIZONA STATE LABORATORY, IN ADDITION TO THE EXAMINATION OF WATER,
DAI'RY PRODUCTS AND FOODS, OFFERS LABORATORY SERVICE TO ALL PHYSI ClANS FOR THE
DIAGNOSIS Or COMMUNICABLE DISEASES. THE LABORATORY AT TUCSON AND THE BRANCH LA80R-ATORY
AT PHOENIX ARE EQUIPPED TO UNDERTAKE PRACTICALLY ANY EXAMINATION, WITH THE
EXCEPTION OF BLOOD CHEMISTRY. VIRULENCE TESTS AND TESTS REQUIRING THE USE OF
ANIMALS ARE MADE BY SPECIAL ARRANGEMENT ONLY.
IN ORDER TO TAKE ADVANTAGE OF TRANGPORTATION FACILITIES, THE STATE HAS
BEEN ARBITRARILY 01 VIDEO INTO TWO SECTIONS, PHYSICIANS RESIDING IN COCHISE, PIMA,
PINAL, GRAHAM, GREENLEE, GILA, SANTA CRUZ AND YUMA J (SOUTHERN PORTION) ARE REQUESTED
TO SUBMIT THEIR SPECIMENS TO
ARIZONA STATE LABORATORY
UNIVERSITY OF ARIZONA
POST OFFICE Box 4694
TUCSON, ARIZONA.
PHYSICIANS RESIDING IN THE OTHER COUNTIES ARE REQUESTED TO SUBMIT THEIR
SPEC IMENS TO
PHOENIX BRANCH, STATE LABORATORY
ARIZONA STATE BUILDING
PHOENIX, ARIZONA
DUE TO THE TIME REQUIRED FOR THE TRANSPORTATION OF SPECIMENS FROM THE
NORTHERN PART OF THE STATE, IT SEEMS DESIRABLE TO ESTABLISH, AT AN EARLY DATE, A
BRANCH LABORATORY IN NORTHERN ARIZONA IN ORDER TO EXPEDITE EXAMINATIONS AND REPORTS.
DURING THE YEAR OF 1937 APPROX IMATELY 45,000 EXAMINATIONS WERE MADE. THE:
NUMBER OF' SPECIMENS WERE FAIRLY EQUALLY DIVIDED BETWEEN THE TWO LABORATORIES.
SEROLOGICAL TESTS ,OR SYPHILIS ,ORMED A LARGE PORTION or THESE.
37.
B~CAUSE or MANY REQUESTS, AND WITH THE ASSISTANCE or THE STATE BOARD OF
HEALTH, A SEROLOGIST HAS BEEN ADOED TO THE STAFF Of THE PHO~NIX LABORATORY. IN
THE NEAR FUTURE, THE WASSERMAN TEST WILL BE MADE UPON ALL SPECIMENS SUBMITTED fOR
THE LABORATORY DIAGNOSIS OF SYPHILIS, IN ADDITION To THE KAHN AND KLINE TESTS.
FOR THE PRESENT, THE KAHN AND KLINE TESTS WILL BE MADE AT TH~ TUCSON LABORATORY
AND WHEN THE WASSERMAN TEST IS REQUESTED, THE SERUM WILL BE fORWARDED TO THE
PHOENI X LABORATORY. THIS LABORATORY WILL ALSO MAKE GONOCOCCUS FIXATION TESTS UPON
REQUEST.
THE STATE LABORATORY WILL RENDER ALL POSSIBLE ASSISTANCE TO PHYSICIANS
AND ATTEMPT TO MAINTAIN THE HIGHEST STANDARDS IN LABORATORY WORK. CRITICISM AND
SUGGESTIONS FOR THE IMPROVEMENT Of SErlVICE ARE INVITED.
:38,
TUBERCULOS IS p
THE PROBLEM 01'" TUBERCULOSIS APPEARS TO STANO OUT AS THE MAJOR HEALTH
HAZARD TRANSCENDING ALL OTHERS IN THIS STATE,
fOR YEARS CLIMATE HAS BEEN ASSOCI ATED IN THE PUBLl C MI NO AS A MAJOR
I'"ACTOR IN THE "CURE" or TUBERCULOSIS, AND SOME LOCALITIES, NOTABLY ARIZONA, HAVE
BECOME ALMOST SYNONYMOUS WITH THE TRADITIONALLY NEEDED CLIMATE. IT IS ALMOST
A BYWORD WHEN THERE IS A SUSPICIOUS COUGH TO SUGGEST ARIZONA. THERE IS NO GAIN-SAYING
THE rACT THAT THE CLIMATE OF ARIZONA ADDS IMMEASURABLY TO THE PLEASURE AND
COMFORT or LIVING, AND THAT ITS LURE HAS BROUGHT MANY THOUSANDS OF PEOPLE TO THE
STATE WHO HAVE REMAINED TO ADD TO ITS ECONOMIC AND CULTURAL DEVELOPMENT.
UNrORTUNj~TELV, THIS SAME TREND HAS GIVEN THE STATE ITS GREATEST PUBLIC
HEALTH PROBLEM, tOR LIFE IS SWEET TO ALL, AND RiCH MAN, POOR MAN, BEGGARMAN, THIEF,
DOCTOR, LAWYER, MERCHANT, CHIEt, HAVE FLOCKED ACROSS THE BORDER INTO THE LAND OF
SUNSHINE IN ALL STAGES or TUBERCULOSIS. THAT THIS IS NOT IDLE METAPHOR IS PROVED
BY THE VITAL STATISTICS FILES ANO BY CASE FINDING STUDIES SUCH AS THE ONE CONDUCTED
BY THE HEALTHMOBILE WHICH HAS BEEN ENGAGED IN rlELD SURVEY WORK FOR THE PAST
18 MONTHS.
DURING THE TEN YEAR PERIOD ENOED DEOEMBER 31ST, 1935, THERE WERE
12,067 CASES Of TUBERCULOSIS REPORTED WITH 13,114 DEATHS. ACCORDING TO STANDARDS
ADOPTED tOR APPRAISAL OF RURAL HEALTH WORK THERE SHOULD 8E TWO NEW CASES FOR EACH
DEATH AND I'" I VE KNOWN LI VING CASES f'OR EACH DEATH, THERE WERE 12,067 NEW CASES
REPORTED DURING THE PERIOD WHI CH ACCORDING TO THIS ACC£PTED STANDARD SHOULD HAVE
SHOWN 26,228 NEW CASES, ACCORDING TO THE SAME STANOARDS THERE WOULD BE 65,570
Ll VING CASES,
39.
HOWEVER, WITHOUT A CAREfUL STUDY IT IS IMPOSSIBLE FROM THE USUALLY
ACCEPTED FIGURES TO ESTIMP,TE THE NUMBER OF NEW OR LIVING CIISES AS THERE ARE 1,428
BEDS fOR THE CARE OF TUBERCULOUS CASES IN THE STATE (NOT INCLUDING PRIVATE NURSING
HOMES) MANY OF WHICH ARE UNDOUBTEDLY FILLED WITH PATIENTS NOT HAVING CONTACT
RELATi VES IN THE STATE. TUBERCULOSIS IS ESSENTIALLY A fAMILY DISEASE IN THAT THE
INTIMACY OF FAMILY LifE IS LARGELY RESPONSIBLE FOR ITS SPREAD.
STATISTICS STATING WHETHER THE DISEASE WAS CONTRACTED WITHIN THE ST/\TE
OR OUTSIDE ARE ONLY AVAILABLE fOR THE FOUR Y,EAR PERIOD ENDING DECEMBER 31, 1936.
THESE FIGURES SHOW THAT 42.2% ORIGINATED OUTSIDE THE STATE. 35.81% WITHIN THE
STATE, AND 22% WERE UNSTATED. IT WOULD SEEM FROM THESE FIGURES TO BE FAIRLY
OBVIOUS THAT WHILE PEOPLE I LL fROM TUBERCULOSIS WHO COME TO THE STATE CRCHE A
SERIOUS PROBLEM WE WOULD CONTINUE TO HAVE A PURELY LOCAL PROBLEM WITHOUT THE
ADD/TION OF SUCH C,\SES. (THIS INFORMATION /S OBTAINED FROM DEATH CERT1FICP,TES /\ND
ITS RELIABILITY IS DEPENDENT UPON THE ACCURACY OF STATEMENTS THUS SUBMITTED.)
UNDOUBTEDLY MANY, POSSIBLY MOST, Of THE CASES GIVEN AS ORIGINATING FROM WITHIN THE
STATE DID SO IN FAMILIES WHO CAME HERE 8ECAUSE OF TUBERCULOSIS, THERE ARE NO FACTS
AT PRESENT AVAILABLE TO EITHER PROVE OR DISPROVE THIS,
FOR A FI VE YEAR PERIOD DEATHS SEGREGATED BY RACE GIVE 65.6% AS WHI TE.
THE DE;\THR,UE FROM TUBERCULOSIS FOR ARIZONA IS M'PROXIMi\TELY FIVE
TIMES AS HIGH AS THAT FOR THE COUNTRY AT L,~RGE, RECENTLY RELEASED STATISTICS SHOW
THAT THE AVERAGE DEATH RATE FKOM THIS DISEASE FOH THE UNITED ST,~TES REGISTRATION
AREA IS 55.4 PER HUNDRED THOUSAND POPULATION. THE DEATH RATE FOR AnlZONA IS 271.2
PER HUNDRED THOUSAND POPULATION. THIS IS NOT SURPRISING CONSIDERING THE LARGE
NUMBERS WHO COME TO ARIZONA FOR THE "CURE", OFTEN, UNFORTUNATELY, IN TOO ADVANCED
A STAGE OF THE DISEASE TO OFFER HOPE OF ARREST,
FOR THE FIRST TIME IN MANY YEr,RS THERE WAS A SLIGHT INCREASE IN THE
DEATH RATE FKOM TUBERCULOSIS, THE RATE FOR 1936 BEING SLIGHTLY HIGHER THAN THE
RATE FOR 1935 OVER THE COUNTRY AS A WHOLE, THIS INCREASE FOR THE COUNTRY AS A
WHOLE WAS .9 %WHILE THE INCREASE IN THE TUBERCULOSIS DEATH RATE FOR ARIZONA FOR
THE SAME PERIOD WAS II.~.
THE SURVEY SHOWS THAT THE POS IT IVE REACTORS TOT HE TUBERCULI N TEST WERE
APPROXIMATELY TWICE AS HIGH AS THOSE FOUND IN THE SAME AGE GROUPS IN STATES WITH A
40.
WELL ESTABLISHED CONTROL PflOGRAM. THE RATIO OF CASES SHOWING X-nAY eVIDENCE OF
ADULT TYPE TUBERCULOSIS IN STATES WICH SUCH A CCNTroL PfWGRAM IS ABOUT ONE To EVERY
TWO HUNDRED X-RAYED FOR THE HI GK SCHOOL Group; HERE ONE OUT OF EVEFN 84 X-RAYED
REVEALED EVIDENCE OF ADULT TYPE TUBERCULOSIS. IN THE HIGH SCHOOL ,~ND COLLEGE Gf<OUPS
WERE FOUND THE LARGEST PERCENTAGE OF REACTORS TO THE TUBERCULIN TEST, THE AVERAGE
BEING 63%
THE RESULT OF THE SURVEY OF THIS Group IS OF RELATIVELY MORE IMPOFH­ANCE
AS REVEAL! NG THE INCJDENCE OF THE 01 SEASE DURI NG THE MOST Di\NGEliOUS AGE tND
PRESUMABLY AMONG A FIXED POPULATION THOUGH THI S Group SHOULD HAVE CLOSEF< STUDY, AS
TO LENGTH OF RESIDENCE.
IN VIEW OF THE LACK or ORGANIZED MEi\SURES fOr~ THE pnEVENTION OR
CORRECTION OF THI S CONDITION THESE Fl GURES MIGHT WELL SERVE AS AN INDICTMENT AGAINST
SUCH DEFICIENCY, HOWEVER, THEY ARE NOT PRESENTEQ AS SUCH BUT RATHER AS fACTS FOR
SERIOUS CONSIDERATION IN THE APPROACH TO A SOLUTION OF A CONDITION, ONLY POSSIBLE
THROUGH MENTAL AND SOCIAL INTEGRITY.
TUOEflCULOSIS IS A PF<EVENTAOLE COMMUNICABLE 01 SEASE PROVED CONTROLLA­OLE
THROUGH ORGANI ZED EFFORT.
By MEANS OF THE TUOEHCULIN TEST AND THE X-RAY EVERY C;,\SE OF TUBERCU-LOSIS
CAN OE DIAGNOSED IN AN EARLY AND CURA8LE STATE. THE OLDER METHODS OF PHYSICAL
ot AGNOSI S ALONE ARE 08S0LETE. THE OLDER METHOOS Of rr,E,HMENT OEPENDENT UPON MODI F I EO
OED f~EST, GOOD 'DOD, AND FRESH A IR ALONE ARE LIKEWISE INSUFFICIENT.
PRESENT ACTIVITIES FOR PREVENTION OC tUBERCULOSIS
UNDER THIS HEADING IS INCLUDED O,FICIAL ACTIVITIES QNLY. THIS. DOES
NOT IMPLY DISREGARD OF THE VALUABLE CONTRIBUTION OF PRI VATE PHYSICIANS WHICH IS
OMITTED BECAUSE OF LACK OF ACCUHATE INFOnW,TION.
1. COOPERATIVE HEALTHMOBIL~
A MOBILE TUDERCULOSIS SERVICE VIAS INAUCiURATED IN.1936 BY THE STATE
BOARD OF HEALTH FOR THE SPECIFIC PURP,OSE OF TUBERCULOSIS CASE FINDING "MONG SCHOOL
CHILDf,EN AND Fen HEi\I.TH EDUCATION, PARTICUL/\RLY AS REGAfWS PREVENT ION AND CONTROl­OF
THIS DISEASE.
THE MODI LE PAr<T OF THE UNI T, CONS' ST I NG OF T r,UCK AND TRA I LER, VIAS
THE GIFT OF THE 40 & 8 OF THE AMERICAN LEGION.
41.
THE INITIAL EQUIPMENT WAS PAID F"Ol< THHOUGH A SPECIAL GRANT OF THE
CHILDREN'S BUI<EAU OF THE LJ. S. DEPP,RTMENT OF LAGOR.
THIS EQUIPMENT CONSISTS OF A COMPLETE X-RAY LM;f)f(ATOl<Y, tNCl.UDING
F"LOUROSCOPE, DARK rWOM, aJtvlPLETE ELECTRIFICATION Fon LIGHTS, FANS, STERILIZERS,
FIRST AID KIT, MOTION PICTURE SOUND EQUIPMENT, SOUND I\ND SILENT FILM, DRESr..,ING ROOM
AND OFFI CEo
THE COST Cf" OPEnATION WAS FINANCE') DURING THE FtF,ST YEAnS BY FUNDS
FROM THE CHILDREN'S BUIlEAU GUT DURING THE PF~ESENT YEAn IS PMlTJ,\LLY DORNE BY THE
STr,TE AND FUNDS FROM THE U. S. PUBLI C HE,\LTH SEF1VICE.
THE STAFF CONSISTS OF" A DIRECTon, TECHniCIAN, i\SSPjT,\NT TECHNICI,\N
AND NURSE. THE WORK OF THIS UNIT HAS 8EEN ABLY DONE ,\ND RECEI VES THE WHOLEHE,\RTED
SUPPOIH OF THE rUDLIC ,\S EVIDENCED ClY THE DEMIlND Fon ITS SERVICE WHICH IS MUCH IN
EXCESS OF ITS ADIi..ITY TO MEET.
THE 40 8,8 H!\VE MA1NTPdNED ,\ SUSTAINED I~JTEf,EST IN THE OPCH,HION OF
THIS UNiT AND {\HE CONTINUING TO ASSIST IN F'IEL.D f,RRANGEIVIENTS AND IN THE ACTU,\L
[,AI SING OF MONEY FOR iIDDIT tONAL FILMS.
IN ADDITION TO THE SPl.ENOID EDUCATIONAL WORK CONE THE FOLLOWING IS
CONCRETE EVI OEtJCE OF THE licr, VITY OF' PERSONNEL CUNNECTED WITH THIS SERVICE.
DURI~G THE 18 MONTHS OPERATION:
SCHOOi.- CHILDf'<EN GIVEN MANTOUX TEST
POSITIVE REACTO~S
(POSITIVE 49.82%)
22,383
" , I 51
PPESCHOOL AGE
Gr,,\DE SCHOOL
HIGH SCHOOL
By r,ACE, ALL GROUPS:
WHI TE
MEXICAN
CeLCiRED
It:DI AN
YELLOW
POSI T I VE 24,4%
pas ITt VE 44.B4;;b
POSITIVE 60.4%
pO SIT I VE 46. 6 %
POSITI VE 54.54%
Pos 111 VE 64.0 %
POSI TI VE 70.0 %
POSHI VI:-: 58.0 %
ALL GROUPS: OF THE POSITIVE REACTOPS TO THE MmTOLiX THO,E WERE: X-RiWED 1.1,109.
OF THOSE X-RAYED THEkE WU'<E 2'i.6% WITH POSITIVE FINDINGS.
IN THE HIGH SCHOOL GrWUp ~ OUT OF EVEF<Y 84 X-flAYED F<EVEc\LEO EVI-DENCE
or ADULT TYi)[ PULMONAIW TUl3EI,CULOSIS, (NOT ONE Or THIS GhOUl', EVEN WITH
EVIDENCE OF ADV,\NCED TunERCULOSIS, HAD nL~L1ZED THAT ANY PULMONARY DISi\E1ILITY
EXIGTED, NOR HAD PNY OF THEM CCNSULTED A PHYSICI,\N PREVIOUSLY.)
42.
IN THE r·)RESCHOOl GROUP, WHilE THERE WAS AN INCREASED NUMBER SHOWING
CALCI PI ED GLANDS A~JD OTHER EVIDENCE OF PRI MAriY INFECTION, NONE UNDEP 10 YEARS .OF
AGED SHOWED X-R,W EVIDENCE OF ADULT TYPE OF TUBERCULOSIS, AND JUST 5, AT THE AGE
OF 10, REVEALED EVIDENCE OF REINFECTION OR ADULT TYPE.
FROM 10 YE,~RS UPWARD THE NUMBER SHOWING RAlHOGFMPHIC EVIDENCE OF
CLINICAL TUBERCULOSIS GRADULLY AND CONSISTENTLY INCREASED.
III i\!:DI, I I),! TO THE GRADE AND HIG H S CHDOl CH I LDREN TESTED AND X-RAYED
SINCE THE BEGINNING OF THIS FISCAL YEAR X-RAY FILMS OF 776 SCHOOL TEf,CHERS ,~ND
OTHEIi SCHOOL EMPLOYEES HAVE BEEN T tl.KEN
ALSO p, COMPLETE SURVEY OF OUR STATE TEACHEliS COLLEGE AT FLAGSTAFF
HAS BEEN MADE.
EDUCATIONAL R~SUL~:
IN ADDITION TO EXAMINATIONS MADE, AJ\JD IN WHICH ,~CTIVE C,~SES HAVE
BEEN BROUGHT UNDER MEDIC,~L CM,E, IN EVEf<Y COMMUNITY WHERE THE: HEALTHMOBILE HAS
OPERATED ONE or, MOPE Pi:1 V!\TE PHYSICl ,,\NS HAVE BEEN INDUCED TO T!UdN ,AND EQU IP THEM­SELVES
FOR GI VING PNEU[rOTHOR,~X T PEATMENTS WHERE I NDI C;\TED. IT IS FELT THAT THI S
CONSULTATtON SErlVICE WITH P"IV/ITE PHYSICIANS ;\ND THE SPI,EADING OF THE CONCEPT OF
COLLAPSE THEf<APY IS Pf<OVlrlG TO BE ONE OF THE MOST VALUrlBLE AIDS IN A GENEnAL TUBER­CULOSI
S CONTROL PROGR\r,1.
By Cf<t:,UIiI A SMJE TUBEr,CULOSIS CONSCIOUSNES l\j!UCH HAS BEEN DONE TO
CRE,~TE A MOHE WHOl.ESOME PUBLIC HEiILTH MINDEDI,jESS WITH A GR[/\TER RESPONSE TO ANY
PUBLIC HEALTH ACTIVITY.
IT HAS DEEN THE POLICY TO USE THE f<ESULTS OF THE SCREENING PROCESS
AS AN INDICATOf< OF THE SOURCES OF OPEN INFECTION WITH THE RESUL.T TH,AT MANY CASES
IN PARENTS i\[~D GP,\NDCHILDI,EN IN THE S,~ME HOusEHOLD HAVE 13EEN FaJl\lD WITH FAr,
ADVANCED TUBERCULOSIS.
MEDICAL CARE.
IN EACH INSTMJCE THESE ALSO HAVE BEEN BnOUGHT UNDER
2. PHYSICAL EXAMlr~ArION.CF TEACliEHS AND OTHER sClloqL ATTEND;~IHS:
BEFORE THE OPENING OF THE fALL TERM OF SCHOOL IN 1937 THE STATE
SUPERINTENDENT OF PUBLIC HEALTH ISSUED A '-ETTEi' TO ALL SCHOOLS CALLING ATTENTION
TO SECTION ,045 OF THE f,EVISED CODE OF ,ARIZO'J/\, 1920, WHICH FORtllCJS SCHOOLS TO
43.
EMPLOY ANY TEACHERS AFFLICTED WITH TUBERCULOSIS, SCHOOL BOARDS WERE ASKED TO
REQUIRE STRICT MEDICAL EXAMINATION OF ALL TEACHERS, TO REQUIRE EXAMINATION OF ALL
OTHER PERSONS EMPLOYED BY THE SCHOOLS, WHO C~E IN CONf ACT WI TH THE CH ILDREN, AND
TO FILE A COpy OF THE EXAMINIR'S REPORT FOR EACH PERSON WITH THE ST/\TE BOARD OF
HEALTH. THE SERVICES OF THE HEALTHMOBILE WERE OFFERED FOR CHEST X-RAYS, THESE
EXAMINATIONS ARE STILL IN PROGRESS tND STATISTICS ARE t\OT YET AVAILABLE AS TO
FINDI NGS. STUDIES OF TEACHERS IN LARGE GROUPS OVEr, THE COUNTRY I-lAVE SHOWN AS HIGH
AS ONE IN 46 TO BE SUPFERI NG mOM THE DISEASE Af\O IT MAY BE REASONABLY PRESUMED TH,n
A NUMBER PROPORTIONATE TO THE INCIDENCE IN THE POPULATION MIGHT BE FOUND. SINCE THE
STATE MAKES ATTENDANCE I N OUR SCHOOLS COMPULSORY PARENTS MAY RI GHTLY DEMAND THAT THE
SCHOOL PROVIDE A HEALTHFUL ENVI RONMENT FOR THE! R CHILDREN.
3. BURR COTTAGES
RECOGNIZING THE IMPORTANCE OF PROPER I SOLATION OF ACTI VE OPEN CASES,
PART! CULARLY WHERE CHI LDREN ARE CONTACTS, THE NAT ONAL YOUTH ADMINI STRATION INAUG­URATED
A PROJECT FOR THE CQ\JSTRUCTION OF ISOLATION COTTAGES TO BE PLACED UNDER THE
SUPERVISION OF THE STATE BOARD OF HE!~LTH. THESE COTTAGES WILL BE USED FOR THOSE
CASES WHERE THERE ARE CHILDREN IN THE FAMILY AND PROPER SUPERVISION MAY BE GIVEN
THROUGH ORGANI ZED HEALTH UNIT PERSONNEL. A LIMITED NUMBER WILL BE AVAILABLE WITHOUT
COST AND THE BALANCE WILL BE CONSTRUCTED AND FURNISHED TO PATIENTS AT ACTU/IL COST OF
CONSTRUCTION. THEY WILL BE FURNISHED INSIDE WITH COTS, BEDDING, ETC., F[;'OM SUPPLIES
OF THE STATE BOARD OF HEALTH GIVEN BY THE C.C.C UNITS WHICH HAVE BEEN DISBANDED.
THIS PROGRAM SHOULD SERVE IN A LIMITED WAY IN SECURiNG ISOLt,TION MJD IN A L/\RGEFl
WAY THROUGH VISUAL EDUC,Hl0N IN METHODS OF ISOLATION.
4. 5T ATE ANT I-TUBE~JS ASSOCI AT ION
THE ACTI VITIES OF THIS ASSOCIATION Af1E PRINCIPALLY EDUC!HION,~L
THROUGH OBTAINING THE INTEREST OF LAY PERSONS IN PUBLIC I-EALTH PR08LEM~), PARTICULAR-LY
TUBERCULOSIS. THE FUNDS AV,~ILABLE ARE LIMITED, THE TOTilL FOR THE PflESENT YEI~R
BEING $3616.00. THE ORG,~NIZATION, HOWEVER, REPRESENTS THE ACTIVITIES OF A STP,TE
CHAI RMAN, AND 46 LOC.~L CHAt RMEN. THE FUNDS ARE S PENT IN VAFil OUS W,~YS DEPENDI NG
ON THE VOLUME OF THE LOCAL SP,LE' SOME FUNDS AHE USED IN PROMOT ING TUBERCULIN
TESTING AND X-RAY wor'K. IN PRESCOTT AND TUCSON ASSI STANCE IS GIVEN IN FINANC1NG
44.
IN PART THE SERVICES OF FULL TIME VISI TING NVRSES. THE STATE ASSOCIATION'S OFFICE
IN PHOENI X MAINTAINS ACTIVE CORRESPONDENCE WITH MOST OF THE SCHOOL AUTHORiTIES IN
ARI ZCI\IA AND AIMS TO PPOMOTE PROGRI~MS DEr,LING WI TH TUBERCULOSI S Pf,EVENT10N AND THE
PROMOTION OF CHILO HEALTH. SUCH AN ORGANIZATION, THROUGH CLOSE COOPERATION WITH
DEPf,RTMENTS OF HEf,LTH AND UNOFFICIAL AGENCIES IS OF GREi\T VALUE IN DEVELOPING STATE
WIDE PU6LIC HEALTH OHGANIZATION.
5. ORGM--lIZED HEi\PH ;\CENCIES AND SERVICES
THE FIVE FULL TI ME HEALTH UNI TS C,\RRY ON A CCI\I T INUOUS PROGRAM OF
CASE FINDING AND FOLLOW UP OF CONTACtS AND ,nTEMPT .TO SECUfiE PROPEl< ISOLATION OF
ACTIVE CASES WITH TRE!;TMENT THflOUGH THE USE OF !,WIILABLE RESOUriCES. IN A NUMBER
OF COUNTI ES A PUBLI C I-IEf,LTH NURSE HAS BEEN I\SSI GNED TO DEMONSTFi,HE PUBLf C HEALTH
METHODS AND BRING TO THE roMMUNI TY MOfiE OF AN AWARENESS OF HEALTH NEEDS THROUGH
CASE FHWING, I\CTU,~L SERVI CE AND COORDIN,HI ON OF LOC,~L RESOURCES.
SEFOHE RECOMMENDING ,~NY ADDITIONS TO THE PRESENT PROGfiAM IT WOULD
SEEM ADVISABLE TO r,EVIEW flRIEFLY PRESENT CONCEPTIONS AND CHMJGING ATTITUDES.
FIf~ST OF ALL THERE frlOULD BE NATIONAL COOPERATION IN THE PREVENTION
OR 01 SGOURAGEMENT OF THE PRACTICE OF REFERRING PEOPLE SUFFERII'!G FROM TUBERCULOSI S
TO ArilZONA FOR CLIMtlTlC PE"SONS UNLESS THEY lIRE ABLE TO Mi\lNTAIN A STANDAfW OF
LIVING NECESSAHY FOR THE PfWMOTION AND MAINTENANCE OF HEi\LTH AND Fon SECURING
PROPER MEDICAL CARE. IN LI El:/ OF THI S PREr,EQUI SITE THEr<E SHOULD BE PI REGOeNI T ION
OF' PESPONS\f31L1TY BY THE FEDEi:ALGOVERNMENT FOP THE MOVEMENT OF DISEASED PERSONS
FROM STATE TO SLHE WITHOUT PROVISION rOR MAINTENANCE AND CARE. THIS IS AT
LEAST CDMPi\R,~BLE TO THE MOVEMENT OF' 01 SEASED L' VESTOCK Of< AGF!lCULTUf,AL Pf<ODUCTS
AND SHOULD BE PREVENTED OR COMPENSATED F'OR. WITHOUT SOf;1E SUCH PROTECTION THE
HE,\LTH HAZARDS TO THE CITIZENS OF THE ST,~TE ARE IMMEASUfiABLY INCR[;~SED AND THE
ECONOMIC flURDEN BECOMES UNBEARABLE.
IN VIEW OF THE NEED OF' ACCURATE STATISTICS ON WHICH TO BASE ANY
HECOMMEND,nION FOR DEALING WITH THE INDIGENT II1IGFiP,TOr;y SUFFEr,m FROM TUBERCULOSIS
I T IS RECOMMENDED THi\T A C;URVEY OF THE ACTUAL EXTENT OF THE PRESENCE OF SUCH
CASES BE MADE IN THOSE AREAS WHERE THEY ARE KNOWN TO BE MOST PREVALENT. THI S \\\)ULD
BE THE SALT RIVER VALLEY AND GI LA AND THE REGION IN ,~ND ABOUT TUCSON. IT J S
EXPECTED THAT SUCH 1\ STUDY M,W BE MADE TH f S SPRI NG UNDER THE SUPEPVI SI ON OF THE
U.S.PUBLIC HEALTH SEriVICE WITH THE COOPERATION ,,;ND ASSISTANCE OF THE STATE BOARD
45.
OF HEi\LTH.
/\BOUT 1923 SUCH A STUDY WAS MADE OF COLORADO SPRINGS, OENVER, EL P,~SO,
SAN /\NTONIO, PHOENIX AND Los ANGELES, BY JESSAMINE S. WHITNEY, STATISTICIP,N Or- THE
NATI ONA L TU8ERCU LOSI S ,'SSOCI AT I ON.
OF' THE SIX CITIES STUDIED, THE INDIGENT MIGRATORY PROBLEM SEEMED
MOST ACUTE IN PHOENI X. THE RECOI,~S AT THAT TIME REVE,\LED 499 Cf\SES. THE POPlIL~-
TION OF PHOENIX THEN WAS 29,000 WHICH GAVE ONE INDIGENT FOR EVERY 58 '~F THE
POPULATION.
IF THESE PROPOnTIONS AHE VAllO AT THIS TlME.WITHA POPULATION IN
MARl COPA COUNTY OF 150,000, THEFE WOULO BE APPROXIMATE;LY 2,585 SICK WANDERERS
SUFFERING FROM TUBERCULOSIS WHO ARE UNASLE TO Ct,RE FOR THEMSELVES, AND IN ADDITION
TO THE ECONOMIC BURDEN UPON THE COMMUNITY ALSO PRESENT A SERIOUS PROBLEM IN
COMMUNICABLE DISEASE; TO THE RE;ST OF THE POPULATION.
AT THE TIME THIS STUDY WAS MADE THE HIGHEST COST OF TUBERCULOSIS
ACTIVITY IN ANY OF THE CITIES SUFVEYED WAS IN PHOENIX. THE RESULT SHOWED THAT THE
COST OF SUPPORT AND RELI EF OF THE TUBERCULOUS WAS $1.75 AN'JUALLY F'OR EACH MEMBER
OF THE COMMUNITY, MEN, WOMEN AND CHILDREN,
IN THE SECOND PLJ~CE, WHILE THE STETHOSCOPE STILL PLAYS A PROMINENT
PM,T IN THE DIAGNOSIS OF TUBERCULOSIS IT HAS GI VEN WAY TO TU8EnCULIN TESTING
AND THE X-RAY WHICH HAVE DEMONSTRATED A SENSITIVITY TO RECOGNITION OF" THIS
INF"ECTION IN AN EARLY ;\ND CURABLE ST,~GE OF" THE DISEf,SE. THIS METHOD NO LONGER
SUGGEST JUST CONTINUED OBSERVATION OF' THE INDI VIDUAL CASE AND THE APPLICATION OF'
MODER'J METHOD S OF TREATMENT, BUT f<ATHER FLR NI SHE S A VERY DEF" I NIT E eLU E TO THE
SOU RCE OF" I NFECTI ON. THflOUGH THESE MEANS UNKNOWN CASES AnE FERRETED OUT,
THE SPEEMl OF THE INFECTION PF,EVENTED, AND TREATMENT INSTITUTED,
IN ADOI T ION, WHI LE REST ST ILL REMAI NS THE KEYNOTE OF SUCCESSFUL
TREATMENT IT IS NO LONGER CONFINED TO POSTURAL REST IN BED BUT TO BRINGING ABOUT
THE ADDITIONAL I<EST TO THE DISEASED TISSUE !;REA THROUGH SURGICAL PfWCEDURE.
PNEUMOTHORAX, PHHENIC£CTOMY, THOHACOPLASTY HAVE CHANGED THE pnOCEDUfiE OF S,\NITORIUM
CARE SO TH/\T S10RTER PERIODS OF HOSPITALI ZiHI ON MiE REQUI RED SHOFlTENI NG THE LENGTH
46.
OF TIME NEEDED FOR RECOVEnY AND LESSENING THE SPREAD OF INFECTION. THESE METHODS
Af<E HESPONSIBLE FOR A VAST ECONOMIC SAVING THROUiH RETURNING THE PATIENT TO A
LIFE OF USEFULNESS AND SELF SUPPORT. IT. t S e;STIM,qED THJ?lT OOME TYPE OF LUNG
COMPRESSION IS NEEDED IN 75% TO 85'/0 OF ALL ACTIVE CASES.
SOME RECOMMENDATIONS FOR CONSIDERATION IN
A PROGRAM OF PREVENTION AND~ROL OF TUBERCULOSIS
I. ~ION OF THE H~~: IT IS THE BELIEF OF THE WRITER THAT WHILE THE
HEALTHMOBILE IS PROVIN3 OF INESTIMABLE VALUE fROM AN EDUCATIONAL STANDPOINT IN
BRINGING TO ATTENTION, THROUGH CROSS SECTIONS OF (IN IMPORTANT AGE GROUP, CERTAI N
CONDI TlONS HELATIVE TO TUBERCULOSIS IN THI S $Tt,TE, PERMANENT ACTIVITY MUST BE LOCAL
WITH FACI LIT IES PRESENT 365 DAYS Of THE YEi\F'.
SUCH TUBEnCULOSIS CeNTROL SHOULD BE AN INTEGI<AL PAnT OF THE GENERAL­IZED
HEALTH PROGRAM AND DIAGNOSTIC FACILI TIES SHOULD BE DEVELOPED LOCALLY IN
COOPERATION WTH THE PRACTICING PHYSICIAN. PENDING DEVELOPMENT OF ADEQUATE LOCAL
SERVICE THE HEALTHMOBILE FILLS A VERY IMPORTANT GAP. A CAREFUL STUDY OF THE
MICHIGAN PROGR/\M IS RECOMMENDED AS ONE WHICH MIGHT PROVE MOST APPLICABLE To THIS
STATE.
[VERY EFFOIH SHOULD BE MADE TO INCREASE SANATORIUM BED fACILITIES
FOR THE SEGREGATION, EDUCATION AND PfWPER Tf~EtHMENT OF ALL OPEN CASES. WHILE
AWAITING THIS MUCH NEEDED ADDITION OF BEDS, MUCH CAN BE DONE BY COOPERATION WITH
PRIVATE PHYSICIANS, LOCAL HEALTH UNITS, AND WITH THE ADDITION OF MORE NURSES FOR
FOLLOW-UP OF CONTACTS. THE PROGRAM OF THE "HEALTHMOBILE" AND THE HOSPITAL AT
TEMPE, MAINTAINED BY THE STATESECURITY BOARD, SHOULD BE MORE CLOSELY INTEGR/\TED.
2. HEALTHMOBILE SERVICE:
ABLE AS FO LLOWS :
THE SERVICE OF THE HEALTHMOBILE SHOULD BE MADE AVAIL-A.
To EIGHTH GRADE, HIGH SCHOOL AND COLLEGE STUDENTS.
47.
B. RENDER THE SAME SERVICE.TO THE STUDENT iN THE LOWER GRADES ~
WHEN THERE ARE KNOWN CASES OF TUBERCULOSIS IN THE F~ILY, OR WHEN
A WRITTEN REQUEST, STATING GOOD REASONS, IS RECEIVED FROM THE
FAMI LY.
C. MAKE THE SAME SERVICES AVAILABLE TO ADULTS IN FAMILIES WHERE THE
CHILDREN ARE POSITI VE REACTORS WHEN THI S SEEMS ADVISABLE FOR THE
PURPOSE OF SCREENING SUCH FAMILIES AND WHEN REQUESTED BY THE FAMILY
PHYSICIAN. IN EVERY EVENT FOLLOW-UP WORK FOR OETERMINING THE
SOURCE OF INFECTION SHOULD BE DONE AND ACTIVE CASES ISOLATED AND
TREATED.
D. THE SAME SERVICE SHOULD BE RENDERED ALL OPEN OR SUSPECTED CASES OF
TUBERCULOSIS WHEN THE FAMILY PHYSICIAN SO REQUESTS, OR IF THERE IS
NO FAMILY PHYSICIAN, WHEN REQUESTED BY THE PROPER HEALTH OFFICIAL.
WITHOUT SUCH A CASE FINDING PROCESS IN WH; CH PRI VATE PHYSICIANS
SHOULD PARTICIPATE NO CONTROL PROGRAM CAN BE SUCCESSFULLY OPERATED.
WHILE THE PROBLEM OF TUBERCULOSIS EXISTS IN ALL PARTS OF THE STATE
IT IS GREATEST IN AND ABOUT PHOENIX AND TUCSON. THE HEALTH UNIT
IN TUCSON IS EQU IPPED WITH X-RAY, BUT THE MARICOPA COUNTY HEALTH
UNIT IS NOT. IF' IT IS TO ATTEMPT TO WORK ON TUBERCULOSIS CONTROL
IT IS ESSENTIAL THAT IT HAVE X-RAY F'ACILITI ES. THESE SHOULD BE
AVAILABLE TO EVERY PHYSICIAN FOR USE WHEN PATIENTS ARE UNABLE TO
PAY fOR THE SERVICE. IN OUTLYING PARTS OF THE STATE, PHYSICIANS
SHOULD BE ASSISTED IN MAKING ACCURATE DIAGNOSES BY SUPPLYiNG THEM
WITH FILMS AND CONSULTATION SERVICES WITHOUT COST FOR THE LOWER
WAGE AND INDIGENT CASES.
3. COMMUNITY COOPERATION: IT SHOULD BE THE DUTY OF THE DIRECTOR OF THIS CONTROL
PROGRAM TO CONTACT THE PHYSICIANS EITHER INDIVIDUALLY OR COLLECTIVELY AND TO
MUTUALLY WORK OUT WITH THEM A PROCEDURE BEST SUITED TO THEI R NEEDS, BEFORE BEGIN-NING
WORK IN ANY OOMMUNITY.
4. ~lliONAL PROGflAM: IT SHOULD BE THE DUTY OF THE DIRECTOR OF THI S PROGRAM TO
MEET WITH VARIOUS CIVIC ORGANIZATIONS AND TO IMPART TO THESE THE MODERN CONCEPTS
OF TUBERCULOSIS CONTROL. SUCH AN EDUCATIONAL CA\1PAIGN WOULD HELP EVENTUALLY TO
BRING ABOUT THE NEEDED LEGISLAT ION AND COOPERAT ION FOR A BIGGER AND BETTER CONTROL
PROGRAM.
5. HOSP ITAL I ZATl ON AND COLLAPSE THERAPY: IT SHOULD BE THE DUTY Of THE DIRECTOr<
TO STIMULATE THE INTEREST OF LOCAL PHySICIANS IN TUBERCULOSIS CONT~OL AND TO ENCOUR-AGE
AND HELP THEM TO ACQUIRE SUFFICIENT TRAINING IN SELECTIVE COLLAPSE THERAPY TO
ENABLE THEM TO CONTI NUE PNEUMOTHORAX TREATMENT FOR PAT tENTS WHO Ht\VE HAD SUCH
INSTITUTED IN A SANATOfHUM. By SUCH AN ARRANGEMENT THE STAY IN A SANATORIUM MIGHT
BE REDUCED TO A MINIMUM IN EACH INSTANCE, POSSIBLY TO TWO OR THREE MONTHS, WHILE
EACH CASE WAS RECEIVING pnOPER TRAINING REGARDING THE PflEVENTION OF' THE SPREAD OF
THE DISEASE AND AT THE SAMET IME HAVING THE PROPER TYPE OF OOLLAPSE THERAPY
48.
INSTITUTED. SUCH r, RAPID TUIlNOIJEi, I~J SANATORIUM P,\TIENTS WOULD f,L~KE THIS SEJ,VICE
AVr, I LABLE TO M,~NY TIMES THE NUMBm OF PAT I ENTS WHO OJ UL[l DE I\CCOMMODATED IF
REQUII,ED TO f,EMi\lN UNTIL THE CU!,E Wr,s COMf'LETED. THIS WOULD HEl.P 3JI-VE OLR
SCi\F<CITY OF SANr,TORIUM BEDS AI~D WOULD CAUSE PHI VinE PHYSICI/,NS TO CONSIDER THEM-SELVES
A PART OF THE PROGRAM.
SOME PFWVI S ION SHOULD BE MADE TO PAr<TI,~LLY COMPENSATE THESE
PRIVATE PHYSICIANS IN A MEASURE AT LEAST FOR THE SERVICES THEY RENDER.
6. S,\NITM,Y CONTHOL: AN I~JTENSI \IE CAMP/\IGN SHOULD BE CONDUCTED FOf, THE PVPPOSE
OF HAVI NG ENACTED AND ENFORCED CERT,\I N IlCGULr,T IONS FO 1', THE CONT I,OL OF TUijERCULOSI G:
(A) ;; MOI,E HIGID REGUL,\TION f;HOULD DE ENFOf,CED FOE [,[["ORTING
,~LL i\CTIVE CASES OF TUBERCULOSIS, /IND ,\LL DU,THS Ff<OM THIS
DI S£::,\SE.
(B) REGULATION FO H THE SAFE DI SPOS,\L OF SPUTUM FilOM ALL (WEN
C!\tiES SHOULD BE STI~I CTLY ENFOfiCED.
(C) [<EGUL/,TION FOH PhOPEI< I NSPECTI ON fIND T H:: NECEGSM<Y STG;I L­IZ,
HION OF ALL DI~INKING ,I\NG EATINO UTENSILS USED IN
FOUNTAINS, HOTELS, 80,;r;DING HOUSES AND r,EST HOMES, SHOULD
DE ENFOPCEO. ALL. SUCH PLIICES ,\CCOMMCDATING HErd-TH SEEI<ERS
SHOULD BE SUBJECT TO THE GENERAL INSPECTION OF THE
HL\LTH OFFlctl' AND HE CoHOULD BE EMPOWEHE!) WITH rUTHORITY
TO CORRECT, OR HAVE CORRECTED, ANY DISCREPANCIES IN
S,~,N IT ;\RY CODes AFFECT 11')0 THESE.
(D) LOC,\L HE,\LTH OFFiOEr;s SHOt..!..D BE EMPOWEf~ED WITH THE
,;UTHoriiTY TO HAVE EX/\MINED A,'\JD TO pr,OPEFLY INSTRUCT
ANY HEALTH SEEKE:; KfJO\V~,1 TO HiWE TUiJ::RCULOS1Ci WHO tei NOT
UNDEr< THE CM,E OF A PI,I Vt,TE PHYSICIAN. IT WOULD SEEM
A SAFE AND ECOI~OMI CAL PROCEDURE TO M)V ISE iHJ.. ,\DVi\NCED
C,\SES or· TUBEf<CULOSIS COMING INTO THE STi,TE WITH
I~WUFFICIENT FUNiJS Fon M"\INTENANCETO f~ETunN TO THEin
t"r,T IVE ST/HE, EVEN TO DEFIl'W HIE I R EXPENSECi FOr-< SUCH /"
I;ETUr;f\! IF NECESSAIW.
THE SELF suPPOnTING HEALTH SEEKEE WHO IS BENEFtTED HAS
PI,OVED r;N ,"SSET TO ANY COMMUNI TY > HE SHOULD BE ENCOUFI­AGED,
HIS STAY ~MDE PLEASANT, BENEFlel/IL !\ND PERMANENT
IF POSSIBLE, THE I~WIGENT, crilTICt,L HE!\LTH SEEKEr< BECOMES
LIABILI TY AN~ A MENACE; WHETHER HIS ECONOMIC AND PHYSICAL
STATUS HAS BEEN SELF-INFLICTED OR UNAVOI DABLE, THE PESPONG1­UILITY
,"Or< HIS CARE SHOULD REST WITH THE STr,TE IN WHICH HE
HOLDS LEGAL [<E"IDENC£, NOT ONLY IS THIS ,\ FAlf; C;JSTfllBUTION
OF RESPONGI BILITY, OUT WHETHER SUCH AN INDIGENT SICK PERSON
REt\L1ZES IT 01; NOT, HIS CM,E IS DETTEr, r\ HIS CH/,NCES OF
RECOVErN It,JCf<EM,Ei) flY f,EMAINING AND T,\r:I:~G ,iOV,\NTAGE
OF F,\CILITIES\ OFFEI,ED FOr HIS C,\RE Ii! HIS HOME SLiTE.
BASED ON THIS VIEWPOINT, MANY OF THE ILL-,\DVISEO, HOPELESS
SICK COMING tNTC :\RI ZON" cm BE PEf,SUADED AND HAVE llEEN
PEPSU,\DED DUhlNO THI S PAST YErd" TO ilETUHN TO THEIf, HeME
ST /\ T E.
49.
BEFORE ENTERING UPON ANOTHER YEAR'S PROGRAM FOA PU8LI C HEALTH
A CAPEFUL APPRAISAL OF THE RELATIVE VALUE OF ACTIVITIES AS APPLlCADLE TO THE
HEALTH PROOLEMS OF TH I S STATE SHOULD DE MADE WITH A V I EW OF CONCENTRAT ION UPON
THOSE WHICH GIVE THE GREATEST MENACE TO THE STATE AS A WHOLE.
DELI EVE THAT THE STATISTICS SHOWN IN THIS REVIEW CONCLUSI VELY
PROVE TUGERCULOSIS TO DE A MAJOn HEALTH PROGLEM IN ARIZONA 1 PARALLELED IN NO
OTHEF, STATE. THE nECOMMENDATI')NS MADE H,\VE BEEN OF A GENERAL NATUr,E OUT SHOULD
DE Pf<ESENTED IN ~)ETA'L AS TO PLAN1 PEfHiONNEL, AND ESTIMATED COST OF OPEnATlCN
WITHIN THE NEXT SIX MONTHS SO THAT THE LEGISLATURE AND THE FEJEfU,L GOVEr,NME:NT
MAY CONSI DER THE DESI RAOILITY OF GIVING THE NEEDED ASSISTANCE IN ORINGING THIS
PROOLEM UNDEf, CO NniO L.
-V-E-N*E!-R'-E-A--L
50.
DIS E A S E
REPORTING OF" CASES OF" VENERE:AL DISLi\S: I~ THIS S IHE, A8 IN OTHmS, H,·,G
BEEN TOO SCATTERED AND INSUF"F",CI ENT F"OR AN ACCURiHE.. ESnM,HE 0 FITS r'REVALENCE,
LIMITED STUDIES IN RESTRICTED GROUPS INDICATE THAT IT MAY AVERAGE UP TO 5% AM'JNG THr
GENERAL POPULATION, IT ~S IMPOSSIBLE TO ESTIMATE THE NUMBER OF CASES WHO N:VER
CONSULt A PHYSICIAN EITHER F"OR DIAGNOSIS OR TREATMENT..
THE WRITER MADE A STUDY OF ONE THOUSAND INLUNTARV PHYSICAL EXAMINATIONS
AMONG W.P.A. WORKERS DURING 1936 AND FOUND 22 POSITIVE WASSERMANS. NINETEEN OF THiS
NUMBER HAD NOT AT ANY TIME CONSULTED A PHYSICIAN. NATURALLY THIS CAUSES ONE TO
WONDER HOW PREVALENT SUCH A CONDITION IS.
THE ACTIVITY OF THE SURGEON GC;NERAL IN THE CONTROL OF" VENEREAL DlseSE
HAS STIMULATED THE PUflLIC INTEREST IN THIS PROBLEM AND R0v10VED THE "TABOO" UPON ITS
STUDY AND DISCUSSION TO A REMARKABLE EXTENT.
UP TO THE PRESENT YEAR THERE HAS BEEN NO OFTICI,\l ATTEMPT TO ORGANIZE
A METHOD OF" CONTROL IN THIS STATE. PRECEDING SEPTEMBER 1937 A SEROLOGICAL SERVICE
WAS NOT AVAILABLE GENERALLY TO EITHER HEALTH DEPAHTMENTS OR PRIVATE PHYSICIANS EXCEPT
ON A F"EE BASIS FROM A PRIVATE LA80RATORY. DURING SEPTEMBER ANNOUNC~MENT WAS Mi\DE
BY THE SUPERINTENDENT OF PU8LIC HEALTH THAT LABORATORY SERVICE FOR THE DIAGNOSIS AND
CONT ROL OF' AL L COMMUNI CABLE DI SEASES WOULD BE A VA I LA8lE WITHOUT CHARGE TO Al L
PHYSICIANS AND HEALTH DEPARTMENTS. IT WAS F'UF;THER ANNOUNCED THAT DRUG6\;FOR THEi\TMENT
WOULD BE FURNISHED WITHOUT CHAr,GE WHERE CASES WERE REPORTED, ADEQUATELY :TREATED, AND
ACCURATELY RECORDED. THROUGH THE COOPERATION OF" HEALTH UNITS, PRI VATE PH~SICIANS,
AND WELF"ARE AGENCIES, SIX Cl IN ICSARE OPERATING AND MATERl Al HAS GEEN FU RNl I SHED TO
MANY PRIVATE PHYSICIANS. PRESENT INDICATIONS ARE THAT IT WILL BE NECESSARY TO
51.
ENLARGE THE rACILITIES or THESE CLINICS VERY SOON IN ORDER TO MEET THE INCREASING
DEMAND rOR SERVICE,
RECOMMEND,n IONS EQB. ~ VENERE:>.L DISEASE PROGRAM:
I. LABORATORY SERVICE: "ADEQUATE AND AVAILABLE LABORATORY SERVICE rOR
DARKFIEL'ir"AND TESTS IS THE rlRST ESSENTIAL IN THE CONTROL or SYPHILIS"
To A LIMITED EXTENT THIS HAS BEEN MADE POSSIBLE THROUGH rURNISHING ,~
FREE SERVICE FOR THE CONTROL OF ALL COMMUNICABLE DISEASES BY THE STf,7E
LABORATORY AND ITS BRANCH AT PHOENIX. THIS SERVICE SHOULD BE MADE
AVAILABLE TO PHYSICIANS AND HEALTH WORKERS IN THE NORTHERN PART OF
THE STATE BY THE ESTABLI SHMENT Of AN ADDI T 'ONAL BRANCH LABORATORY AT
fLAGST AFf.
IN ORDER TO SUCCESSFULLY CARRY OUT SUCH A PROGRAM, WHI CH HEQU I RES
THE APPROVAL AND sUPPORT Of THE PRIVATE PHYSICIAN IT IS ESSENTIAl_
THAT THE STANDARD Of THE ST,\TE LABORATORIES BE RAISED AND MAINTAINf:.D
IN A MANNER TO COMMAND THE FULL RESPECT OF THE QUAL! FI EO MEDI CAL
PliOFESSION. THESE SUGGESTIONS ARE NOT TO DE CONSTRUED AS A
CRITIC/SM OF EXISTENT LABORATORIES OR THEIR PERSONNEL, BUT RATHER
AS A YARDSTICK FOR CHECKING THEIR Ef"F'ICIENCY. IT IS SUGGESTED THA"I
THE FOLLOWING STANDARDS RECOMMENDED BY THE ADVISORY COMMITTEE TO THE
U. S. PUBLIC HEALTH SERVICE BE ADOPTED AND MAINTAINED,
(A) A DIRECTOR WHO, BY APPROPRIATE THEORETICAL AND PRACTICAL
EXAM INAT ION, CAN DEMONSTflATE A SAT ISFACTORY KNOWLEDGE OF
SEROLOGY Or SYPHILIS AND ITS RECENT ADVANCES.
(0) A STABLE, EXPERIENCED TECHNICAL PERSONNEL,
(c) ADHERENCE TO ACCEPTED STANDARDS Of MAINTENANCE OF GLASSWARE,
ANIMAL MATERIAL, INCUBATORS, AND OTHER EQUIPMENT.
(0) THE PERIODIC ptRrORMANCE Or INTER-LAOORATORY CROSS CHECKS ON
IDENTICAL SPECIMENS, THESE TO INCLUDE SPECIMENS TO BE SENT
TO THE CENTRAL STATE LABORATORY.
(E) THE MAINTENANCE Or A PERIODIC CLINICAL CONTROL Of SEROLOGIC
RESULTS BY MEANS OF CROSS CHECK AGAINST HE DIAGNOSIS MADE
AT SYPHILITIC CLINICS CONDUCTED UNDER THE STATE OR OTHER
AUSPICES.
2 •. STATE REGISTRATION OF LABORATORIES: "THE TYPE or SERVICE SHOULD OE
IMPROVED I3Y SETTING STANDARDS FOR TESTS TO CCl\JTROL THEIR ACCURACY,
AND TO SEE THAT CONDITIONS ARE MAINTAINED WH CH ARE ESSENTIAL FOR
ACCURATE TECHNIQUE AND SERODIAGNOSTIC WORK." FOR THIS REASON, IN
ADDIT ION TO THE "fULLEST POSSIOLE DEVELOPMENT Of THE STATE LAQORATORY
FACILITIES TO SUPPLEMENT THE PRIVATE ONES, IT IS RECOMMENDED THAT A
SYSTEM OF STATE LICENSURE OR APPROVAL FOR HOSPITAL, INSTITUTIONAL,
AND OTHER PRI VATE LAOORATORI ES BE OliGANI ZED,"
3. ROTATING CLINIC SERVICE TO PHYSICIANS: "IT IS AN OBLIGATION OF THE
HEALTH DEPARTMENT TO FURNISH THE PHYSICIANS WITH SPECI,\L INrOR,AAT ION
OF VALUE IN THE CONTROL OF VENEREAL DISEASE." IHIS MAY DE DONE IN
A VERY PHACTICAL MANNER THROUGH ROTATING TERMS OF CLINIC SERVICE UNJER
EXPERT SUPERVISION. THE INTEREST AND COOPERATION OF THE MEDICi\L
PROFESSION WILL DEPEND UPON THE EXTENT TO WHICH PHYSICIANS PARTICIPATE
IN FORMULATING AND CARRYING OUT CONTROL PROGRAMS.
SPECIFIC SUGGESTIONS FOR THE HEALTH DEPARTMENT IN THIS RESPECT ARE:
(A)
(0)
(C)
52.
"PROVISION FOR FREE DIAGNOSTIC SERVICE."
"fREE DISTRIOUTION OF ANTI-SYPHIL.ITIC DRUGS fO PRIVATE
PHYSICIANS FOR USE IN THE TREATMENf OF PRIVATE PATIENTS
WHO ARE, OR WHO MAY GECOME, A DANGERTO THE PUBLIC HEALTH,
"PROVISION FOR CONSULTATION SERVICES, INCLUDING ROENTGENO­L.
OGIC, AND OTHER EXPENSIVE LABORATORY EXAMINATIONS PARTICU­LARLY
F~ PATIENTS WHOSE FINANCIAL CrnCUMSTANCES 00 NOT
PERMIT SUCH EXPENSIVE STUDIES IN PRIVATE PRACTICE."
LAOORATORY SERVI CE HA S OEEN OFFERED AND THE SERVI CE I S NOW BEl NG
IMPROVED AND DRUGS ARE AVAI LAOL.E TO PHYSI CI ANS AS RECOMMENDED, SO HliH
A PART AT LEAST OF THESE SERVICES HAVE BEEN MADE AVAILAOLE WITHIN
THE PAST THREE MONTHS.
4. IMPROVED REPORTING NECESSARYt EVERY EFFORT SHOULD BE MADE TO SECURE
COMPL.ETE AND CORRECT REPORTS ON MORTALITY AND MORBIDITY FROM VENEREAL
DISEASES.
5. ROUTINE TESTS FOR PREGNANT WOMEN: EVERY EFFORT SHOULD BE MADE TO
HAVE SEROL.OGIC TESTS OF EVERY PREGNANT WOMAN AND SUCH TESTS SHOULD
BECOME ROUTINE PRACTICE AS A PART OF PHYSICAL EXAMINATION.
6. PROPHYLAXIS: ENCOURAGEMENT SHOULD OE GI VEN TO THE PRACTICE OF
PROPHYL.AXIS OF THESE DISEASES BY CHEMICAL AND MECHANICAL ~EANS.
7. EDUCATIONAL PROGRAM: THE MORAL. AND SOCIAL ASPECT OF THESE DISEASES
SHOULD CONTINUE TO BE STRESSED, BUT EXPERIENCE HAS DEMONSTRATED THAT
THIS METHOD ALONE APPEARS TO HAVE A LIMITED DELETERIOUS EFFECT ON
THE SPREAD OF THE DISEASE.
8. SPECIAL TRAINING FOR HEALTH OFFICERS: BECAUSE THE FACTORS IN THE
PREVENTION AND CONTROL OF VENEREAL DISEASE REQUIRE SOCIAL UNDERSTAND­ING
AND THEIR TREATMENT SPECIAL. MEDICAL TRAINING AND EXPERIENCE NOT
POSSESSED BY THE AVERAGE MEDICAL PRACTITIONER OR HEALTH OFFICER IT
IS RECOMMENDED THAT:
(A) A QUALIFIED FUL.L-TIME PHYSICIAN SHOULD BE ADDED TO THE STAFF
OF' THE STATE BOARD OF HEALTH. HE SHOULD ORGAN IZ E AND SUPER­VISE
VENEREAL DISEASE CLINICS AND CONTROL WORK, AND GIVE
DIAGNOSTIC AND CONSULTATION SERVICE TO PHYSICIANS.
(6) ALL OJ RECTORS OF LOCAL HEALTH SERVICE SHOULD BE SENT TO A
RECOGNIZED SCHOOL FOR AN INFORMATIVE COURSE IN THE RECOG­NITION
AND TREATMENT OF VENEREAL DISEASES SO THAT THEY MAY
BRING TO THEIR RESPECTIVE UNITS AND PHYSICIANS IN THEIR
COMMUNITIES A DEPENDABLE TYPE OF CONSUL.TATIVE SERVICE.
IN MAKI NG THIS SUMM,~RY REFERENCE HAS BEEN MADE TO RECOMMENDAT IONS
OF THE ADVISORY COMMITTEE TO THE U.S.P.H S. CONTAINED IN A
"VENEREAL DISEASE CONTROL PROGRAM."
53.
IN THE PRECEDING PAGES THE STATE HAS BEEN CONSIDERED AS A WHOLE, WHEREAS
IN THE REMAINING SECTIONS EACH COUNTY IS PRESENTED SEPARATELY AND IN ALPHABETICAL
ORDER.
IT WILL HAVE BEEN NOTED THAT THERE ARE FIVE FULL TIME COUNTY HEALTH
UNITS. ONE OF THESE INCLUDES AN ADDITIONAL COUNTY UNDER THE ADMHHSTRATION OF ONE
HEALTH OFFICER. THUS SIX COUNTIES OF THE TOTAL OF 14 ARE UNDER FULL TIME HEALTH
ADMINISTRATION,
OF THE STATE POPULATION 64% IS WITHIN THE MIEA UNDER FULL TIME HE,\LTH
ORGANIZATION.
OF THE TOTAL STATE POPULATION 35% IS WITHIN MARICOPA COUNTY. (THIS IS
ACCORDING TO THE 1930 CENSUS AND AT THE PRESENT TIME IT IS POSSI BLE THAT THE PERCENT­AGE
MAY BE AS HIGH AS 45.)
DISREGARDING, FOR THE MOMENT, THE PUBLIC HEALTH NEEDS OF THE CITY OF
PHOENIX, THE COUNTY SEAT, THE COUNTY AREA OUTSIDE OF PHOENIX CONTAINS 100,000 PEOPLE
(1930 CENSUS) WITH A HEALTH UNIT COMPOSED OF ONE HEALTH OFFICER, TWO CLERKS, THREE
SANITARIANS AND TEN NURSES. THIS IS IN THE PROPORTION OF 10,000 PEPPLE FOR EACH
PUBLIC HEALTH NURSE.
IN ADDITION TO THEIH DISTRICT WORK THE NURSES ASSIST IN THREE CLINICS
IN PHOENI X AND CONDUCT EI GHT PRENATAL AND I NFANT WELFARE CONFEHENCES WHOSE MEDI CAL
SUPERVISION IS GIVEN FOR THE MOST PART BY VOLUNTEER PHYSICIANS SERVING WITHOUT PAY.
CONSIDERING THESE HANDICAPS AN EXCELLENT WORK IS BEING DONE. As HEALTH
WORK IS DISCUSSED FOR EACH COUNTY THIS IS PRESENTED HERE AS AN EXAMPLE.
54.
THE GREATEST HEALTH PROBLEMS IN TEMPERATE ZONES EXIST WHERE THE POPULA­TION
IS CREf,TEST FOR THE REASON THAT DISEASE IS Tf~ANS~,~ITTED FROM DISEASED PERSONS
01 RECTLY OR INDt RECTLY. THEREFORE, THE BEST RESULT S rOR THE MOST PEOPLE AND FOH THE
LEAST EXPENDITURE PER CAPITA MAY BE HAD BY GIVING ADEQUrHE HEALTH SERVICE IN THE LARGER
POPULATiON CENTERS, HEALTH WORK IN SPARSELY SETTLED COUNTIES or LARGE AREA IS DiFFI­CULT
AND COSTLY.
IT WOULD, THEREFORE, SEEM MORE PRACT IC/\L TO CONCENTR,\TE ON RURAL S,\NI­TATION
PROGRAMS (SUCH AS SANITARY PRI VY CONSTRUCT10N) AND IMMUNIZATION OF CHILDREN IN
GROUPS IN RURAL SCHOOLS.
CONSIST£NT PUBLIC HEALTH EDUCATION SHOULD BE CARRIED ON THROUGH ALL
AVAILABLE CHANNELS. THE DISTRICT NURSE CAN AND DOES RENDER VALUABLE SERVICE IN SUCH
AREAS AND IS or NECESSITY MOHE OF A "JACK or ALL TRADES" THAN HER SISTER IN THE CITY,
PHYSICIANS ARE SCARCE AND SHOULD BE ENCOURAGED AND FINANCIALLY ASSISTED
Hi DOING PREVENTIVE MEDICINE AND SANITATION. UNDER SUCH CIRCUMSTANCES AND WITH
OCCASION,~L CONSULTMH ASSISTANCE, GOOD WORK SHOULD r3E POSSIBLE. IT IS BELIEVED THAT
WITH SJCH ENCOURAGEMENT AND ASSISTANCE IT WOULD NOT BE SO DIFFICULT TO RETAIN
MEDICAL MEN IN THOSE AREAS.
THE PRACTICE or APPOINTING COUNTY HEALTH OFFICERS WITH A MERE PITTANCE
FOR SALARY Fon A pr\RT 11 ME JOB I S PREVALENT 1N MANY ST {\ TES AND WHI LE MUCH GOOD WORK
HAS BEEN DONE IN INOI VI DUAL INSTANCES THE SYSTEM ON THE WHOLE IS NOT ENCOURAGING.
THAT A DISTRICT HEALTH OFFICER F"OR TWO 01< MORE COUNTIES WHO IS A WELL
TRAINED MAN IN PUBLIC HEALTH PRACTICES COULD SUPERVISE LARGE AREAS1 AND BE A COMPETENT
CONSULTANT TO PHYSICIANS OF HIS DISTRICT, IS OF"FERED AS A POSSIBLE SOLUTION OF THIS
PROBLEM.
INDIAN RESERVATION~:
THERE AI<E EIGHT INDIAN RESERVATIONS WITH A POPULATION or APPROXIMATELY
40,000. THE INDIAN BUREAU MAINTAINS A REL~TIVELY GOOD MEDICAL SERVICE, AND IS
COOPERATIVE WITH THE STATE BOARD OF" HEALTH,
SANITATION IS ONE OF THE MAIN PROBLEMS AND REQUlf,ES EVEN BETTER MUTUAL
COOPERATION. MANY OF" THE TRIBES ARE NOMADIC, WHICH ADDS TO THE DIF"FICULTY OF RURAL
SANITATION ON RESERVATIONS.
55.
A RATHER SERIOUS TYPHOID EPIDEMIC OCCURRED ON ONE RESERVATION BUT WAS
WELL TAKEN CARE OF BY THE DIRECTDR OF MEDICAL SERVICE F'OR THE At'ECTED AREA.
TRA INED PERSONNEL:
CONSIDERABLE KNOWLEDGE HAS BEEN OBTAINED IN THE PAST THROUGH THE SLOW
~
PROCESS OF' TRI AL AND ERROR, BUT UNDOUBTEDLY BETTER PROGRESS CAN BE MADE BY A STUDY OF'
THE RESULTS OF' DJ'FERENT METHODS, THEI R SUCCESSES OR F'AILURES, AND AN INTELLIGENT
APPLICATION OF' THE LESSONS LEARNED.
IT IS ON SUCH A BASIS THAT STANOARDS OF' METHOD AND STANDARDS FOR
PERSONNEL HAVE BEEN RECOMMENDED BY THE STATE AND TERRITORIAL HEALTH OF'FI CERS AND
APPROVED BY THE SURGEON GENERAL AND THE CHILDREN'S BUREAU. IT IS TO ASSIST IN MAKING
AVAILABLE SUCH PERSONNEL FOR MAINTAINING THESE STANDARDS THAT THESE FEDERAL AGENCIES
F"URNISH rUNDS TO STATES F'OR TRAINING ,.URPOSES.
IT IS RECOMMENDED THAT THESE STANDARDS BE CONSI STENTLY UPHELD, THAT
PERSONNEL BE TRAINED AS RAPIDLY AS POSSIBLE AND RETAINED IN THEIR POSITIONS ArTER
TRAINING HAS BEEN GI VEN EXCEPT WHEN DISCHARGED F'OR JUST CAUBE.
IN VIEW OF' THI S RECOMMENDATION IT IS OBVIOUS THAT TRAINEES BE SELECTED
WITH EXTREME CARE IF' THE INVESTMENT IN PUBLIC HEALTH FOR THE FUTURE IS TO BE ASSURED.
POSITIONS IN PUBLIC HEALTH ADMINISTRATION ARE NOT "JUST JOBS." THEY
ARE POSITIONS OF RESPONSIBILITY WITH DEFINITE OBLIGATIONS TO THE PUBLIC WHOM THEY
SERVE AND WHO PAY FOR THE SE RVI CE.
AREA TAX
SQUARE MI LES 1937
ACRES
STATE LAND
FEDEflAL LAND 5,429.• 087
NET VALUAT10N
TOTAL TAX PAID
PERCENTAGE OF TOTAL TAX
208,442
POPULA T JON SCHOOL EN RO LLMEIH
TOT AL
1920
1930
13,196
17,765
1935-1936
ELEME:NT ARY SCHOOLS
RACE
WHITE
MEXICPJ\l
INOI AN
OTHERS
3,786
1,908
11,732
339
HIGH SCHOOLS
ACCOMOOATION SCHOOLS
TOTAL
256
11
1,,493
~ STATISTICS
(ALL RATES PER 1,000 POPULATION EXCEPT INFANT DEATHS WHICH Ar,E PER 1,000 LIVE Blf:THS)
1936 1935 1934 1933 1932
NO RATE No RATE No RATE No RATE No RATE
BIRTHS
TOTAL 320 18.01 i 297 16.72 320 18.01 ·262 14.75 257 ]<1-.47
WHITE 116 30.64 ! 9i 25.09 101 26.68 88 23.24 120 31.70
ME:XICAN 53 27.78 i 65 34.07 72 37.74 65 34.07 32 16.77
INDIAN 135 11.51 i118 10.06 136 11.59 96 8.18 99 8.44
OTHERS 16 47.20 19 56.05 11 32.45 13 38.35 6 17.70
INF ANT
DEATHS
----r(fTAl 55 171.88 69 232.32 • 58 169.59 48 1EJ3.21 23 H9.49
WHITE 6 51.72 8 84.21 . 2 19.80 3 34.09 3 25.00
MEXICAN 8 150.94 13 284.21·; 10 1S8.90 2 30"17 3 93.75
INDIAN 40 296.30 47 398.31 • 45 330.88 43 477.92 17 171.72
OTH ERS . 1 62.50 1 52.63 • 1 90.91
DEATHS ALL
CAU SES
TOTAL 192 10.81 ;216 12.17 ;208 11.71 121 6.81 110 6.19
\~H IT E 42 11.10 36 9.51 30 7.92 20 5.28 23 6.08
MEX I CAN 21 11,,01" 31 16.25 26 13.63 9 4.72 18 9,,45
INDIAN 125 10~65 146 12.44 147 12.53 91 7.76 67 5,,71
OTHERS 4 11.80 3 8.85 5 14.75 1 2.95 2 5.. 90
COMMUNICABLE 01 SEASES
1936 1935 1934 1933 1932
No RATE NO RATE NO RATE No RATE No RATE
TUBER- CASES 22 1.2~ 54 3c 04 17 ,"96 30 1.69 1 .06
CULOS IS DEATHS 33 1.• 86 32 1,,80 28 1.58 12 .68 33 1.86
PN8l1I- CASES 102 5.74 72 4.05 46 2.59 20 1.13 52 2.93
IvlON I A DEAIHS 34 1.91 45 2.53 41 2.31 23 1.29 20 1.13
01 PH- CASES 6 .34 4 .23 2 .11
THER I A DEATHS - 1 .06
TYPHO 10 CASES 11, .62 4 .23 3 .17 4 .23 7 .39
DEATHS 6 .34 1 .06
-C -0 -U-N-T-Y
WITH AN AREA OF 11,379 SQUARE MILES, APACHE COUNTY HAD A POPULATION
OF 17,765 IN 1930. OF THIS POPULATiON 11,732 WERE INDIANS LIVING CHIEFLY ON
THE LARGE AREA OF MORE THAN' ONE-HALF THE COUNTY INCLUDED IN NAVAJO AND APACHE
RESERVATIONS. THERE WEr~E ',908 MEXI C,;NS AT THE TIME OF THE CENSUS. THE '
CENTERS OF POPULP,TlON ARE SMALL AND SCATTERED. ST, JOHNS, THE COUNTY SEAT,
HAS A PRECINCT POPULATION OF 1,~86~ SPRINGERVILLE 565 AND EAGER 562. AT
GANADO, LOCATED ON THE RESERVATION, IS A VERY FINE, INDI AN HOSPITAL AND SCHOOL
OF NURSING FUNCTIONING UNDER THE ~RES8YTERIAN MISSIONS. THE PRINCIPAL
INDUSTR IES OF THE COUNTY ARE LUMBERI NG AND C:\TTLE RAI SING.
PUBL IC HE/\LTH PERSONNEL
RECENTLY A PUBLI C HEALTH NURSE, FINANCED BY THE COUNTY AND STATE
BOARD or HEALTH, HAS BEEN PLACED IN THIS COUNTY, WITH HEADQUARTERS AT ST. JOHNS,
TO DEVELOP A GENEPALIZED PUBLIC HEALTH NURSING PROGRAM IN THE WOST POPUlOUS
CENTERS OF THE COUNTY. THEHE I S A COUNTY HEALTH OFFICER AND COUNTY PHYSICIAN
(ONE OFfiCE) PART TI ME. i\ COUNTY HOSPITAL WITH A CAPACITY OF 17 BEDS HAS BEEN
ERECTED AT SPRINGQIVILLE THROUGH W.P.A. PROJECT, QUT'TITLE HAS NOT YET BEEN
ACCEPTED BY THE COUNTY, THERE IS NO EQUIPMENT Fon IT, AND IT IS NOT YET,IN
OPERATION MEDICAL SERVICE IS INSUFFICIENT FOR THE SOUTHERN AHEA OF THE COUNTY
WHERE ONLY FOUR PHYSICIANS ARE LOCATED, TWO IN ST JOHNS AND TWO IN SPHINGERV!LLE.
THERE A rlE NO DENT I STS IN TH IS AREA.
SANl Tn ION
IN FlECENT YEARS DUE TO THE ENTr,ANCE Of H'GH QUALITY RO,\DS INTO THE
COUNTY, IT HAS BECOME A SUMMER RESORT AREA FOR THE POPULATION OF THE STATE LIVING
ON THE LOWER LEVELS. DUE TO THE PRESENCE Of TWO CROSS CONTINENTAL HIGHWAYS THE
COUNTY IS FAST DEVELOPING INTO A TCURIST AREA. PRACTICALLY ALL PHASES OF SANI~
TATION NEED IMPHOVEMENT. SEWAGE COLLECTIO~; AND DISPOSAL AF'E NEEDED IN THE THREE
COMMUNITIES WITH POPULATION OF 500 OR MORE, McNM1Y HAG A SMALL SEWAGE COLLECTION
SYSTEM THAT IS NOT EXTENSI VE ENOUGH TO SERVE THE ENTIRE AREA. THE SEPTIC TANK
METHOD THAT THEY EMPLOY SHOULD GE ENL;\fWED SPnlNGmVILLE j S NOW CONTEMPLATING
A W.P.,\. PI,OJECT FOR A COMPLETE SEWEHAGE SYSTEM. IN CASE THIS IS SUCCESSFULl.Y
COMPLETED 1TIS ANTI CI P,c,rED THAT OTHEr, COMMUNI TI ES MAY FOLLOW THEI R LEAD. MCNARY
AND ST. JOHNS HAve MUNICIPAL W,HEr; SYSTEMS. THE ONE AT ST. JOHNS IS DEVELOPING
A NEW AND ADEQUATE SOURCE OF SUPPLY WITH A COMPLETE TREATMENT PLANT TO SUPPLANT
THE PRESENT SPRING wrlTEI; SUPPLY. MI LK, RESTAURANT, Tour" ST CAMP, RURAL WATER
SUPPLY AND OTHEII TYPES OF COUNTY INSPECTION AilE ABSENT. THE COMMUNITY SANITATION
PROJECT HAS CONSTRUCTED A LARGE NUMBER OF PRJ vy UNITS THAT SHOULD BE REGULAR~
INSPECTED. THEilE M~E NO INCOI,POI,ATED TOwr'IS IN THIS COUNTY.
EXPENDI TunES FOR HEALTH 1937-38
---roT'AL AMOUNT
,',MOUNT FOR FULL TIME HEALTH PEHSONNEL
STATE AND FED. FUNDS ALLOCATED TO CO.
---------~,---
NUMOER OF PHYSICIANS IN THE~~,
HEALTH SERVI CES
FULL T I ME NUHSE
ADDITIONAL COUNTY SEr;VICE
HEALTH OFFICEfl, PAf;T TIME
CONT I NGENT
rNDI GENT 51 CK
565
Vn,NON 25
CAPACITY
118
75
Ie
26
TOWNS POPULATION
ADAMANA 50
ALPINE 25
CHAMGERS 50
CHIN LEE 25
--------- CONCHO 200
EAGER 50
FT.OEFIANCE 100
GANADO 75
GREER 20
HOUCK 100
HUNT 40
LUKACHUKA I 100
MC~!AiW 50
NUTniOSO 75
ST.JOHNS 1386
ST.MICHAELS 100
SANDERS 25
Spr;INGEr;VILLE
, ,580.
$6,680, PER CAPITA .38
',580. n .09
880. It .05
300
150
---it£?2
6.680.
CONT FlO L
INDI ANS
CHUflCH
INDUSH" AL
INDI AN
~-II.~.!.2
"
T.8,
TYPE OF SEhVI CE
GENEF,AL
"
HOSPITALS:
NUM8EiI
2
HOSPITAL BEDS 237, 1/75
AS IN MOST OF THE RUHAL COUNTIES THE HEALTH SERVICE IS CURAYI VE RATHEr; THAN
Pf<EVENTIVE. EXCELLENT COOPEf1ATlON IS DEING GIVEN THE PUGLIC HE,\LTH NUHSE IN
ESTAOLISHING PI;EVENTIVE SErIVICE, SUCH AS IMMUNIZATION,
S;\N IT AU,9l!
o STREAM POLLUTION
--YX;:ENT OF PROBLEM
STREAMS AFFECTED
NATUHAL WATER SUPPLY CaNOl T IONS
---rROBLEM -----------LIMITED
CAUSED BY - SMALL AGRICULTURAL AREA
MAIN HIGHWAY TRAVEL AND MOTTLED
TEETH IN SIX AREAS,
FOOD HANDL! NG ESTABLI SHMENTS NO INSPECTION
HOUSING (PUBLIC BUILDINGS)
--mmAL ONLY
NONE
NONE
NONE
LUMBER I NG
VERY SMALL
LITTLE COLORADO
WHITE RIVER
GARBAGE DI SPOSAl
PROBLEM LIMITED - RURAL
SWIMMING POOLS
MILK SUPPLY
~I~ OR INSPECTION
INDUSTRIAL HYGIENE
~USTHI ES INVOLVED
TOURI ST CAMP SAN IT AT ION
2
1886
10.6
I
565
3.2
I
500
208
2
1951
10,9
PRESENT INSPECTION SERVICE
COMMUNITY WATER SUPPLY SYSTEMS
NUMBER
POPULATION SERVED
PERCENT OF COUNTY POPULATION
*COMMUN IT IES WITHOUT SYS TEMS
POPULATION THEREIN
PERCENT COUNTY POPULATION
COMMUNITY SEWERAGE SYSTEMS
NUMBER
POPULAT ION SERVED
PERCENT OF TOTAL COUNTY
COMMUNITIES NOT SERVED
POPULATION THEREIN
PERCENT OF TOTAL COUNTY
SEWAGE O"ISPOSAL (RURAL)
u.s.r.R:S. PRIVY UNITS
POPULATION SERVED
PEf<CENT - TOT AL RURAL
POPULATION TO BE SERVED
578
3733
11381
GEOG RAPHY
TERRAIN: HIGH PLATEAU, DEEP CANYONS
MOUNT,~IN CHAINS
TOTAL
2. PEHCENT OF TOT AL
4. PERCENT OF TOTAL
TOPOGRAPHY
£LEVATIONS: MAXIMUM
(APPROX) MINIMUM
AVERAGE
RRECIPITATION: MAXIMUM
MINIMUM
AVERAGE
POPULATION CLASSIFICATION
I. COMMUNITY POPULATION
4, RURAL POPULATION
9,000'
4,9001
6,0001
20.60"
8.78"
12.47"
2,451
15,324
STATE TAX COMMISSION
ClASSI FICATION
I. RA ILROADS
2. LIVESTOCK
3. OTHER PF<OPERTY
4. PEfiSONAL PROPERTY
5. LUMBEr,ING
6. CITY PROPErny
7. PUBLIC UTILITIES
8. FARMING
9. AUTOMOBIU:S
10. MISC. LANDS
I I. MI