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David Crane oral history interview

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David Crane oral history interview
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University of South Florida -- Library. -- Special & Digital Collections. -- Oral History Program

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interviewed by E. Charlton Prather.
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Full cataloging of this resource is underway and will replace this temporary record when complete.

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University of South Florida Library
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usfldc doi - C53-00007
usfldc handle - c53.7
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COPYRIGHT NOTICE This Oral History is copyrighted by the University of South Florida Libraries Oral History Program on behalf of the Board of Trustees of the University of South Florida. Copyright, 2014 University of South Florida. All rights, reserved. This oral history may be used for research, instruction, and private study under the provisions of the Fair Use. Fair Use is a provision of the United States Copyright Law (United States Code, Title 17, section 107), which allows limited use of copyrighted materials under certain conditions. Fair Use limits the amount of material that may be used. For all other permissions and requests, contact the UNIVERSITY OF SOUTH FLORIDA LIBRARIES ORAL HISTORY PROGRAM at the University of South Florida, 42 02 E. Fowler Avenue, LIB 122, Tampa, FL 33620.


xml version 1.0 encoding UTF-8 transcript
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text E. Charles Prather: Dr. Crane, its a pleasure to have you here today.
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David Crane: Thank you.
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CP: And were grateful that you would come. The guideline is that I hoped that you would just share with us anything that you want to, and that you want to remember about your great career in public health. I think itd be useful, for our audience, to tell us a little bit about yourself. How did you get involved in public health?
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DC: Well, its kind of interesting; I started out in private practice in Miami. Doing general practice, and in about two years time, a had a nice peptic ulcer.
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CP: Oh, boy.
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DC: And that was not too pleasant; and when I started coughing up and spitting up blood, I decided it was about time to do something a little less stressful. So, at that point in time, with Dr. Cato, who was the director of the Dade County Department of Public Health in Miami, was looking for an M.C.H. Director
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CP: Yes?
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DC: And I had done some schoolwork and things like that for the health department.
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CP: Whats M.C.H.? Forgive me.
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DC: Maternal and Child Health, sorry.
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CP: Thank you.
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DC: And school of health work; and so, Dr. Cato contacted one of the physicians that I was in practice with, and asked if there was anybody out there that might be interested, and so, I went down to change hats, if you will; and youre dealing with the community. And it took me a little bit oflittle time, so, when I first started out, I was, as I said, Director of Maternal and Child Health down there; and so, I did a lot of clinic work.
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CP: Yeah.
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DC: It also healed my ulcer.
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CP: Congratulations.
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DC: Which was very appreciated. (CP laughs) But, yeah, that was exciting; and then, I had the opportunity, of course, under the old program of the state board of health, giving scholarships to able people, who wanted to progress into thedeeper into public health, to go on and get their degreetheir master degree in public health; and so, I had the opportunity to do that with Dr. Sauder and Dr. Catos approval.
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CP: Yes.
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DC: And went over to Tulane, and they have a wonderful school of public health over there, and I did tropical medicine and public health. Which, fortunately
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CP: That was appropriate for Miami, was it not?
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DC: Yeah, it was, and fortunately, came in, later on, very handily when I went overseas for my foreign mission experiences. So, anyway, I enjoyed that a whole lot, and had a really good experience down there, and spent a year; and when I came back, I felt like, well, I think I really know what this business is all about now.
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CP: Good, good.
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DC: And so, that, incidentally, was where I first saw the famousnow famous studies on smoking and health
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CP: Yes?
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DC: Cancer and all those things, and thats when I stopped smoking.
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CP: Congratulations.
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DC: And I said, Okay, thats it. It convinced me. So, came back to Miami; and then, by that time, there was a Dr. Madda who had taken over the M.C.H. department. And Dr. Mathis, I believe it was, had just left and gone up to state board of health for a tour up there. And so, Dr. Cato asked me to be his deputy director, which I did; and I stayed on there then for, well, that was 57, 58, so I stayed a year; and then, incidentally, interestingly enough, a sanitarian, guy named Jack Greenly, had been in Dade County, and he was on my team that inspected nursing homes. Those were back in the days when we first got the nursing home inspection program. And Dade County had a lot of them. I think well over a hundred.
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CP: Really?
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DC: And some of them were in pretty bad condition; and so, we proceeded to shut down around one-third of that group.
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CP: Wow.
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DC: Just because they were negligent, and they werent providing any good care, so forth and so on.
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CP: Do you remember the year that law providing for the inspection was passed, approximately, just for the record?
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DC: I think it was right aroundprobably right around, 1950, 51.
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CP: Okay.
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DC: And it resulted from a big fire in a nursing home in Largo, Florida.
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CP: Oh.
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DC: Where a number of people died as a result of the fact that there was inadequate personnel to assist these people to get out; the doors were not conveniently arranged so the people could get out, particularly people who had multiple handicaps; and quite a few people died in that fire; and that was when the legislature said, Okay, weve got to regulate these nursing homes. And, of course, they gave us the job, which was the proper thing to do.
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CP: Yes.
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DC: And I think, statewide, we did an excellent job of putting the marginal operators out of business.
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CP: Good.
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DC: And assisting those who were doing a good job. And while, at first, there was a lot of resistance, but, finally, when we really worked through this thing, one of the major people down there, in the nursing home business, Manning Rice, who owned about two or three nursing homes down there, and was doing a good job, finally came to me, after we warred about this for a long time, and he said, You know, he said, One of the best things that could ever have happened to our work is that you people got in the business and cleaned out the scumbags that were operating nursing homes simply so they could make dollars off these poor folks.
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CP: Oh, great.
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DC: And so, we felt very good about that, and that was a good experience.
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CP: That was an aside; you were talking about the sanitarian thats part of your team.
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DC: Yeah, Jack. In the meantime, after Iwhen I went away to school, Jack had been contacted; he was a public health serviceUS Public Health Service Officer. He had been contacted by I.C.A., the International Cooperation Administration, and he was asked to go out to Indonesia; and as the head sanitarian on a team that was being established out there for rural health training; and we were trainingthe purpose of the program was to train sanitarians; public health nurses, particularly nurse midwives, which in Indonesia, are called ducums.
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CP: Power of personality.
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DC: Getting out there and talking to these men, and explaining the values of a health department, what the health department could do for their community; to reduce the morbidity and mortality, to cut down the people who were too sick to work, and had to be put on welfare or whatever, to assist them with their hospital expenses, and so forth; a lot of hospitals, in those days where there were hospitals, of course, you know, several counties didnt have any; a lot of the hospitals in the counties were supported, a lot, to a large extent, by the boards of county commissioners. They put money in there; take care of uninsured patients; and, along with that, went the many physicians all over the state of Florida who gave of their own time and efforts and never saved a dollar; taking care of patients who couldnt afford to pay; couldnt afford to pay the doctor or the hospital or anything else.
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CP: But they were ill and needing care.
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DC: Yeah, they needed care, sure.
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CP: (Affirmative murmur)
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DC: Subsequent to that, of course, you know, the state entered into a program which we participate in, in what was called the Hospitalization Program for the Indigent, and we helped to pay their hospital bills, which helped to relieve some of the expenses on the counties, which they appreciated. That came a little later on, but it did come down the road. But anyway, the physicians who were in those district offices, Dr. Dane and others, plus Dr. Sauder, workingand other Health OfficersState Health Officers; Dr. Henry Hanson and others who were very well respected by the medical communities where they were, and in the Florida Medical Association. They worked with the physicians, and got them to encourage the boards of county commissioners to do these things. So, it wasnt just public health. It was private practice; it was working with the boards of county commissioners; it was worthworking through PTAs, through the schools, the school wanted school health programs. The children came to school notmaybe not sick enough to stay in bed, but not well enough to learn what was being taught.
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CP: Ah, yes.
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DC: They had hookworm disease; they had all kinds of problems. They were anemic, et cetera, et cetera; and so, the kids really couldnt do very goodvery well in school; as a consequence, school boards got involved. So, they helped with the pressure. The local PTA groups, local teacher associations, the State Education Association of Florida, all these groups got together; and not only them, but then the private health agencies; E.B. Association, you know, Cancer Society, Heart Association, et cetera, et cetera, et cetera. All the groups that were out there that are interested in the health of people were working on these things, you know; just kinda keep the pot boiling constantly, and encouraging and working with commissioners and letting them know that they expected the commissioners to do something about health conditions in their community, and that, you know, ultimately, they had to get reelected (CP laughs), and the way to get reelected is to keep everybody happy; and the way to keep everybody happy is to help your health problems.
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CP: Yes.
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DC: Thats one way. (CP laughs) So, anyhow, thats kind of the way it went; and gradually, worked at it and worked at it over the years, and we built the County Health Unit system.
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CP: About 1960, it was in place and going.
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DC: It was in place and under full steam; and, I dont know, I think St. Augustine up there, I think they kind of enjoyed keeping us on the hot seat for a few years there before they finally decided to have their health department in 1960; I think they kind of enjoyed the fact that St. Johns County didnt have a health department.
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CP: It was the only hold out?
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DC: Everybody else had one, you know? They were the last ones, you know?
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CP: Do you recall the sixty-sixth came in? What was the interval between the sixty-sixth and the sixth-seventh?
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DC: Well, I just happen to have a piece of paper here thatll tell us that.
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CP: Im curious.
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DC: I dont remember exactly, but I can tell you very quickly.
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CP: Oh, look at all this data you have here!
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DC: Here they are. Here they all are. Well, it was quite a while. Collier County was the next to the last.
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CP: Yes?
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DC: And Collier County started its health department in 1950.
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CP: Oh.
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DC: So, it was ten years before St. Johns finally got off their high horse and said, Okay, fellas, we need a health department.
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CP: And join(CP and DC laugh)
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DC: And Dr. Sauder; when he used to have a meeting with health officers every year, as you remember.
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CP: Yes.
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DC: He used to call that the state of the state meeting.
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CP: Yes.
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DC: And every year, prior to 1960, every year, Dr. Sauder would get up and say, Well, theres only county in the state of Florida that doesnt have an organized county health unit, and thats St. Johns County; and I want you people to remember that, and you all go back and talk to your people, and tell them, Whats wrong with St. Johns County, out there? You know they need a health department. (CP and DC laugh) So, finally
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CP: What finally convinced them?
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DC: They finally got convinced, yep, and I dont think that there was any big epidemic or anything like that in St. Johns County; that I ever heard of, at least. I was in the state, working, at that time, so, I dont think I ever heard of that; but anyway, they decided that it was time, and so, they came into the program, and I think Dr. Mason Morris was the first County Health Director there. And a nice guy, he was. He was a navy retiree. And quite a few of our physicians came out of the military; not surprisingly, really; because, in the military, not only do you have individual health programs for people, on the military bases, the military people themselves, but also their families and so on, you know, that kind of thing; but, in addition to that, you have to have camp sanitation, you have to have food control, clean food in those mess halls, et cetera, et cetera, et cetera. You have dispose of human waste
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CP: Arthropod control. Yeah, sewage disposal.
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DC: And get rid of that. You got mosquitoes out there; you know thats not good, so you gotta get rid of them. So, you got a health department operating on a military base; and a lot of our Health Officers were former military, because they saw, on those military bases where they were, both in this country and abroad, that they needed
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CP: They need the public health action.
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DC: They needed a public health action; and when they came back from the war, they said to themselves, Heck, I know about this stuff now. Im gonna go ahead out there, and get a job in public health, and Im going to do something for these communities. And thats what they did.
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CP: Great.
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DC: There was a bunch of them. We had quite a few of them. I cant name them all, of course, cause, you know, the old memory doesnt do all that well; but there were a lot of them, and it was a joy working with them, cause you didnt have to educate em first.
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CP: Ah, yes. Did you have a special orientations/educational program for new physicians coming into the system?
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DC: They had several educational efforts, actually. Many of the physicians that came to us came from out of state.
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CP: Yes.
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DC: As you know. And the first thing they had to do was get a license, because we didnt employ physicians in Public Health as County Health Directors without a license in the state of Florida.
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CP: I like that.
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DC: So, most of those guys had to get a license. So, that was one of the big courses we had, was a class on getting your Florida license. (CP laughs) Because you and I remember well, those Florida license exams were tough.
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CP: I remember em too well.
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DC: Yeah, yeah. I could spend an hour on that, but Im not going to. Anyway
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CP: Yeah, thank you. Thats(CP laughs)
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DC: We hadwe ran courses for them. There were several people involved in that; and I was one of them, later on, when I came up to Bureau of Local Health Services; because that was one of the other courses we ran, was a course in public health.
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CP: Oh.
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DC: Yeah. And some of the new guys that came inof course, that had been going on before I got there. Every year, we had a seminar; two or three day seminar, I think; and the new men who camenew people who came in, and were either awaiting an assignment to a health department or who had already been assigned to a health department were invited
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CP: Yes. Most of them came, I suspect?
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DC: I think all of them came; it was a little more than an invitation. Dr. Sauder said, Come on up and sit in on this class. But in any event, we tried to really just kind of summarize; and we had public health nursing come in, had environmental health come in, we had sanitary engineering come in, we had your shop come inpeople in disease control come in, had all the specialists that we had at State of Board of Health came in; and spoke to them briefly about their particular programmatic activities, what was going on, what the problems were, especially if they were already assigned to a county, what the problems were in their particular county, to give them a little bit of background on that;
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CP: You know, I carry the memory that the county commissioner really was involved with the employment of the local Health Officer.
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DC: Yes, they were. Yes, they were.
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CP: Speak to that.
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DC: Yes, they were. Legally, as far as the law is concerned, the County Health Officer in each county is appointed by the Board of County Commissioners.
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CP: Oh.
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DC: Yes, is appointed by the Board of County Commissioners; hes their man, but he has to be approved by the State Health Office.
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CP: Oh, okay.
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DC: So, Dr. Sauder had to give a letter of approvalstamp of approval for each Health Officer that was employed. Now, Im not gonna say that werent times when we recommended Health Officers to various counties in the state.
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CP: Yes.
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DC: Someone had died, someone had left, someone had retired, whatever.
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CP: Yes.
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DC: And we had a good person, who was maybe in a smaller health department or something, and we felt that they were capable of taking on larger responsibilities and that sort of thing; and we would recommend people to boards of county commissioners.
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CP: That seems appropriate. You were the recruiting agency, really.
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DC: Oh, yeah, yeah.
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CP: You could recruit
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DC: The Bureau of Local Health Services, we handled; I dont know how many thousand, I wish I knewcould remember; we handled thousands of letters every year, written to physicians all over the United States of America and some abroad.
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CP: Theres your recruiting effort.
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DC: Who wanted to come to Florida.
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CP: Oh.
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DC: Yeah. They wanted to come down here to this beautiful land we live in, and they wanted to know what the opportunities were in public health.
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CP: Yes.
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DC: Some of them had been Health Officers where they were, and, of course, we loved that.
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CP: Yes.
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DC: Others of them had worked in totally different environments. They were either in private practice, and they were kind of; you know, private practice could beat you to death, back in those days; and they were kind of really tired of private practice, wanted to get into something that just took just a little less energy; and a lot of them came down thinking public health took a little less energy, and then found out it didnt.
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CP: But your stresses were different.
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DC: But anyway, thats the important thingOh, we stressed the sunshine, and the fishing, and all those good things, you know. We didnt talk about hurricanes or anything else.
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CP: Or the fourteen hour days.
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DC: No, we didnt mention those. But anyway, yes, we did a lot of recruiting, and I would say that ninety-five percent of the County Health Directors in the state of Florida were recruited through the Bureau of Local Health Service.
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CP: Yeah. Im also recalling, seems to me that the Alachua County Health Department had a special grant to provide a special orientation to physicians who were employed, but had never had public health experience. Do you recall anything about that?
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DC: Youre right about that, and also, Dr. Hall
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CP: Yes?
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DC: Down therewho was County Health Director down there for years, and years, and years
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CP: Yes?
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DC: Dr. Hall also ran an excellent program down there for county sanitarians.
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CP: Oh, same thing?
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DC: Yeah. Same thing.
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CP: Same process?
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DC: And you know that the county sanitarians, in the early days, they were simply men who had graduated from college.
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CP: Yes.
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DC: Some of them had been in the service.
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CP: I doubt there was any specialized training in environmental health available to them, was there?
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DC: No, and there wasnt any specialized training required. The requirements for sanitarians were they graduated college, period.
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CP: Okay, they could read and write.
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DC: Period. So, you could graduate as ain
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CP: Business major?
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DC: In world literature.
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CP: Oh.
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DC: See? But you had a degree, and then you could go out and get a job with it, see?
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CP: As a sanitarian.
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DC: And, of course, there wasnt a lot of call for people interested in world literature at that point in time. So, you went to work as a county sanitarian. (CP laughs) Well, wed take those fellas; ship em up to Dr. Hall, up in Gainesville; and he would put them through the works for about two weeks; and I mean he would give them a workout. Theyd be down there, sticking their head in the sewers and everything else, to find out just how these things worked; and, of course, those little communities around Gainesville were beautiful training areas for sanitarians, because there must have been two or three thousand outhouses in the area; all of them had to be inspected to see what was going on, and whether they were good or not, whether they were doing their job, and most of them werent.
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CP: Was the director there.
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DC: Was the director of that program, and she was one grand old public health nurse; and she put those gals through their paces, too
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CP: And I love her to death.
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DC: She put them through their paces. They learned what public health nursing was about. And, of course, a lot of them came out of hospital exposure and things like that, and they didnt know anything about that kind of stuff.
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CP: About the community as a patient.
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DC: Yeah, yeah.
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CP: And Dr. Hall taught physicians also, I want to remember.
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DC: Yes, he did.
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CP: That, to makehelp them make that psychologic[al] transition that you spoke to.
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DC: Yes, he did.
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CP: And the schools of public health were not up and running, and we couldnt afford to send them at the time, so this was our public health training sites, yeah.
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DC: Sure it was, yeah. And those physicians, also, during that three day tour when they came up to state board of health, they also went to each of the divisions, and sat down with the division director, whoever it was, the bureau within divisions at the State Board of Health, and had a nice little chat about what was going on in those programs, in addition to their little formal presentation.
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CP: That was part of training, too, was it not?
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DC: Yeah, they made the rounds; they went through the state lab up there in Jacksonville, and they saw what was going on up there. They saw what all the work that Dr. Hardy and all the followers were doing up there, and that helped them get a better feel, a better grip on the kinds of things they needed to keep their eyes on when they got back to the local level, again, working in the community with their programs and all that down there.
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CP: How do you view this excessivehow did healththese new personsnew physicians to public health, how did that work out? How did they do?
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DC: By and large, they worked out beautifully.
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CP: Great.
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DC: By and large, they worked out beautifully, and I think that there were several reasons; first of all, they fell in love with the community where they went, that was the first thing.
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CP: Very important.
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DC: That was very important, cause they really realized the tremendous need there was in that community for health service activities, and they became torch bearers with their county commissioners, with their city people, with their legislators, with whoever they could get their hands on, they became
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CP: And the State Board of Health, I suspect.
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DC: Yeah, they became the torch bearers to say, Weve gotta have so and so in this county. And thats where some of that eight million bucks came from; was those guys out there, working in the field, going to those commissioners on a regular basis, see, they saw them every week. Had to. They had to go to county commission meetings, and mostly, they were every week; now, some small communities only met once or twice a month; but, for the most part, every week. And they were down there, and they were telling the commissioners, This is whats going on out here: these pig farms, these chicken ranches, all this stuff; this is terrible! Were spreading flies, were creating a terrible problem, and youve gotta help us do something about this. And they did. Thats where the money came from. (CP laughs) So; and of course, you know; the state put up few dollars, but the state didnt get into it like the counties.
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CP: Thats my impression.
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DC: Yeah, let me tell you a little bit here, quickly.
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CP: Please do.
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DC: Nineteen thirty-five. Local money: twenty-four thousand, three hundred and eighty-three dollars.
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CP: Oh. (CP laughs)
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DC: Local money. 1935. State money: three thousand, eight hundred and sixteen dollars.
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CP: Really?
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DC: So, the counties were putting up, what, eight times
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CP: Eight times.
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DC: Eight times as much money as the state, at one time; and then, as I said, by 1965, it was eight million dollars from the counties, and a little less than twelve million total; and of course, there was federal, the state money in that was two million seven. Sixty-five, compared to county money of eight million. So, you see, counties got into this thing in a big way.
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CP: Yeah, big way.
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DC: And they wanted things done, and the only way to get it done was put up the money; and then, of course, youll recall, Im sure, over the legislators sessions, over the years, that the legislature had a very, very clever way of passing little laws, and saying, The county will take care of this.
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CP: Uh-oh.
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DC: He passed a whole lot of those things, you know?
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CP: Uh-oh, yes.
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DC: The county will do this. And so, no money went with the law
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CP: State didnt appropriate money?
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DC: No money went with the law. The law was passed, the county was responsible, and there wasnt anything to do it with. So, the county had to put up the money to do it.
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CP: How did they react to this?
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DC: And they didnt like that one little bit. They used to really fuss about that; all these county things that areI mean, these state things that are being put on us to carry out at the local level. Then it was the job, of course, of the diplomat, the County Health Director, to get in there and explain to those guys, We understand what youre talking about, because were asked every day to do stuff we cant do, because we dont have any staff. You give us the staff, well go out and take care of that stuff for you, so you wont have to worry about it, see?
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CP: Yes.
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DC: So, we sold the programs that way; but that happened a lot in Florida, and it still does happen in Florida a whole lot; but anyway, (CP laughs) that was a building block, even though you could say, Well, you know, thats not very nice to do things like that. That was a building block for public health in the state of Florida.
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CP: Yes, it was.
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DC: Cause if they hadnt passed those laws in the first place, it wouldnt have happened. The commissioners at the local level probably either wouldnt have thought of it or would have said, Well, if we pass this law, its gonna cost us a bundle of bucks.
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CP: Were gonna have to pay for it.
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DC: Yeah, We got to pay for this. So, you know, lets just let that sleeping dog lie. And then the state legislature comes along, passes the law, Uh, okay, we gotta do it. So, begrudgingly, they did it; but eight million bucks worth by 1965, Id like to know what the figures were in 1975, when things kind of came to a screeching halt; you know, before they divided everything up, said, Youll take care of these things, and well take care of these things, all that stuff. I dont know how much went in there, cause I dont have the access to the figures.
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CP: Im very impressed with the figures you got. I hope youre going to leave a part of that as your figures as a part of your taping today. Can we make a photocopy of that?
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DC: Well, you can if you want to; its all in the seventy-five-year history; you know, this all came out of the seventy-five-year history. So, if you have the monograph, Seventy-Five Years of Public Health, youll find it.
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CP: Oh.
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DC: Sixty-six through seventy-one.
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CP: Okay, and for the records, Millstones and Milestones.
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DC: Millstones and Milestones.
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CP: Published by Pynchon and Hardy.
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DC: Yep, yep, Dr. Albert Hardy and May Pynchon, yep.
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CP: Thats very good. For the record, we need to note that. Thank you.
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DC: Thats an excellent book; anybody who really wants to know a whole lot about health, especially about the early years, what I call the infectious disease years.
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CP: Yes.
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DC: You know, prior to 1930, when they had all yellow fever and all the rest of the stuff, and when Dr. Sauder was called down from the state to go to Pensacola and wipe out the red light district, and all the interesting things that happened, you know, we have venereal disease all over the place, and we had soldiers and sailors and marines training in the state of Florida, and they were all having bar girls and so on (CP laughs), and they were all polluted, I mean it was something else; and not only that, not only that, but interestingly enough, and that comes out in here, I believe on the VD sectionthe call section.
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CP: Yes, yes.
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DC: I wish I had brought the figures with me, but I didnt; but anyway, just accept this as very rough figures.
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CP: Okay.
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DC: One-third of all the young men who are brought up through the draft system
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CP: For World War II or I?
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DC: For inductionWorld War II.
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CP: Okay.
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DC: For induction into the army, in 19aroundno, I guess it was World War I. I guess it was World War I, come to think of it; I had to look that up, but I guess youre right, World War I; one-third of all the young men were infected with syphilis.
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CP: Really?
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DC: In the state of Florida.
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CP: Really?
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DC: Yes. All the guys who were brought up; and they had to be put into those rapid treatment centers and so forth, to try to get them cured, and that wasthe cure was almost as bad as the disease. Not quite, the long term effects, but immediately, it was worse.
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CP: Yes.
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DC: Cause once the sore heals, you know, you dont know you got anything until you start going nuts or whatever.
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CP: Until you end up in Chattahoochee.
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DC: Yeah, right. But that rapid treatment thing was something, you know? You use the fever therapy, and they used neoarsphenamine, A yellow powder containing arsenic that was formerly used to treat syphilis and yaws. and they used all that stuff, and, my gosh, that was horrendous.
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CP: Yeah, the fever
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DC: That was torture.
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CP: Just for the record, you mentioned it, the fever ship that was in Jacksonville for a period of a time, just to give fevers for the treatment of syphilis. That was before your time.
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DC: Yeah, yeah.
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CP: But it was there, and its useful to have that it on the record that it was there.
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DC: And it was still a problem, even World War II, do you remember? Because we didnt have penicillin.
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CP: Yes, thats right.
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DC: Penicillin didnt come out until after the war was well into its second or third year. So, in the early forties
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CP: We the public didnt get it. We got penicillin in late 45.
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DC: Yeah, I know; and in the early forties, when these people were being brought up for the draft and stuff, gonorrhea and syphilis were still serious problems. Even that late.
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CP: Thats shocking. Can you address what local health departments did, in reaction to that? How did we, Florida, from a local health unit point of view, what did we do about it?
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DC: Well, you know, to tell the truth, venereal disease had been a serious problem in the state of Florida from practically year one; you know, you know about the Bible, its in the Bible, you know that; but anyway. We wont go into that (CP laughs)the first profession? (CP laughs) Anyhow, the State of Florida has always had a relatively obnoxious history, as far venereal disease is concerned.
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CP: Yes.
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DC: And so, one of the early things that health departments had to do was to do venereal disease control.
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CP: Oh.
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DC: It was right up there with TB control, and all these other programs, you know? For communicable disease control, even environmental health wasnt quite as bad as the VD situation; so especially in the major centers of population: Miami, Tampa, Jacksonville, Pensacola, you know, the big cites, Orlando, the big, urban populations. Place was rampant, and still isits still there unfortunately.
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CP: And synonymous with venereal disease.
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DC: But anyway
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CP: Thats where our AIDS is too, by the way.
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DC: So, in the early days, of course, we didnt have a really strongalthough, Dr. Sauder, that was one of his first assignments in Florida, as you know, was to wipe out the red light district and clean up venereal disease in Pensacola, which he did.
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CP: First part of the Second World War.
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DC: Yeah, he lived through it, too.
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CP: Yes, he did.
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DC: He wasnt sure there, for a while, but he did live through it. He started closing down the houses, thats when he started running into some problems. But he survived it, anyhow. The public health service was ourUS Public Health Service was our strong supporter in that area, because this isnt just Florida, you know, its all over the United States; Florida just happens to be a bad place for it, but its all over the country; and there are other states, Im sure, that were worse off than we were. I just didnt work there, so I didnt know about it. But, in any event, the Public Health Service gave us Public Health Service Officers, both at the state level and to go out into the community to, particularly, these major centers, and do venereal disease control; and we ran VD clinics, and we drew I dont know how many thousand samplesblood samples every year for VD control, but I know we kept the laboratory busy. Right on, just with that alone.
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CP: Case finding. You did serologic surveys for case finding.
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DC: Maybe three or four hundred vials and samples a year, just on that alone. So, thats pretty big.
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CP: Youre in maternal and child health, speaking of that, neonatal syphilis, can I just kind of stimulate you a minute? Whatd you do about that?
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DC: Well, we had it
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CP: Uh, what was your focus?
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DC: We had it, believe me, we did. I started out, as you know, in Dade County, and Dade County was one of the places where we had plenty of syphilis, and all the other VD, but particularly syphilis, of course, thats the one so damaging to newborns and kills many of them; and, course, what we did was we got almost all of the indigent women, because, you know, the indigent women who wanted a midwife delivery had to come to the health department clinic. They could not obtain a midwife delivery unless they came through the health department clinic.
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CP: Did local health concerns govern-regulated midwifery?
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DC: Oh yes. Oh, yeah, yeah, yeah. It was a law passed, I would say, in the forties.
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CP: All right.
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DC: Cant tell you the exact time, but in the forties; and there were, at one time, you know, there were about three thousand midwives in the state of Florida busily engaged in their practice.
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CP: I remember.
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DC: Some were very good. Some werent. When I went into Dade County, we had, I would say, we had somewhere in the neighborhood of thirty.
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CP: Just working in Dade County?
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DC: In Dade County. Just in Dade County alone. And they were granny midwives; none of them had ever been to school anyplace to get any special training.
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CP: They werent nurses.
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DC: No, they werent nurses. No.
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CP: Okay.
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DC: And they worked with an older midwife, who either was a grannya grandmother, who had trained these young girls in midwifery, or they worked with a neighbor or friend or somebody; they got interested in that kind of work, they went out and they learned their trade, and then they were regulated by the health department.
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CP: Okay.
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DC: In that county and in every other county in the state of Florida, we had to inspect them; I did the physical examinations on all the midwives that we had, and we didfortunately, I had a certified nurse midwife working in the health department.
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CP: Very good.
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DC: She was their supervisor. She actually went out on deliveries. Selected various midwives, and she would go out on five or six deliveries a month, and sit with them and see what they were doing.
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CP: Excellent. Excellent.
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DC: Make sure that it was being done right; and that happened pretty much throughout the state, especially in the urban areas, where you could have that kind of a staff onboard in your health department.
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CP: Yeah. I remember the state board employed a nurse midwife that did just that for the smaller counties.
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DC: Yes, indeed. Yes, indeed.
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CP: One of those was VelmaAlma Voss. Miss Voss. Do you remember her?
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DC: Yep. Yeah, I do.
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CP: Thats beside, but this is important local health
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DC: I remember her; I was trying to think who the
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CP: Alma Voss.
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DC: Who the main, main one was, though. I was at her party when she retired, and I cant remember her name, but she was a nice lady too.
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CP: Yeah.
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DC: Yes, they did do that. And I can
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CP: We were talking about neonatal syphilis, and I got you off, Im sorry.
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DC: And so that, we had control of the patients that they delivered, cause they couldnt deliver, so we got all those patients first. We did physical examinations on all of them before the midwife oversaw them. Did all that. Did all their blood work and so forth; if anybody had syphilis, they were yanked out immediately and treated. See, by that time, course, that was 53, when I went down there, you know? So, by that time, we had penicillin, we could treat them in a hurry and get em cured; before they ever got to the point where it was dangerous for the baby; and if you can treat them in the first trimester of pregnancy, particularly, youre all right.
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CP: Yes.
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DC: After that, then youve got some possible problems. The abnormal teeth, you know, some of that stuff, even if you treat them. But anyway, so, we did all that. Then, in addition to that, of course, and this is not just in Dade County; its just that Im more familiar with Dade County and Sarasota than anyplace else, cause I was there six years.
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CP: Thats where you were working.
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DC: Yeah.
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CP: I understand that.
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DC: But anyway, all the counties, the indigent patients were taken care of through the health departments.
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00:59:19.7
CP: Yes.
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DC: There wasnt any other source, really.
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00:59:23.0
CP: Of maternal care.
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00:59:23.5
DC: Now, the private physicians in the communities, for the most part, were willing to deliver these girls free of charge; didnt charge a nickel for it, and they were willing to deliver; and that was a tremendous help, because, of course, we didnt have people who were trained to deliver babies. You know, you need to be an obstetrician.
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CP: Yes.
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DC: We didnt have people trained like that; we had a few around the state, but very few. Anyhow, but they didnt want to provide the prenatal care. Because, you know, thats a regular thing; its every month; and then, after you reach a certain point, its every two weeks; and then, after you reach a certain point, its every week; you had to be seen, and examined, and so forth; and you have to have, nowadays, sonograms, and in those days, we didnt have sonograms; nowadays, you listen with a little meter that you put on their tummy, you know? Nowthose days, we had to put on the delee forceps, you knowI mean, headset, and listen with the stethoscope to hear the babys heartbeat and all those things. Anyway, we took care of those girls; and, in fact, theres some babies in Dade County that are named after me.
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CP: (CP laughs) Congratulations.
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DC: I didnt deliver em, but I took care of their mamas. (CP laughs) Several times. Repeatedly.
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CP: Yeah, I think of the eye infection secondary to gonorrhea, and eye prophylaxis. Give us a paragraph on the early days of eye prophylaxis.
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01:00:46.2
DC: Okay. We had a lot of problems with the gonorrhea infection of the eyes, gonorrhea otitis; I guess youd call it.
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CP: Ophthalmia neonatorum.
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01:00:58.3
DC: Yeah, and some of those babies were blind.
300
01:01:1.4
CP: Oh, really?
301
01:01:1.5
DC: In the early days, yeah; but, early on, and, again, I cant bring into focus when it was, it was long before I came into public health; a law was passed in the state of Florida that said that every child, every newborn, had to have treatment.
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01:01:18.0
CP: Ah, for their eyes, for gonorrhea.
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DC: Immediately after the birth, had to have treatment for the eyes, for gonorrhea. Specifically. Because there was so much of that. And we, of course, we kept track of the midwives, and they had to write their little report on every birth they did, and they had to specify that they had put the drops into the babies eyes, and that was all provided by the state board of health; and then, of course, later on, they went to addition of tetracycline and some other things that they were using, but, in the early days, it was silver nitrate. Everybody got silver nitrate, and people used to wonder why the white kids had little black spots on the corners of their eyes; because silver nitrate does that, it turns your skin black; but thats okay.
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01:02:0.5
CP: Better than being blind.
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DC: You bet, you bet; and, of course, the seventy-five percent of the patients we saw, the indigent patients were black anyway, so they didnt have to worry about black spots on their faces, because they had em. (DC and CP laugh) So, it was no problem. But anyway, yes, that saved a lot of children from blindness, a whole lot of children from blindness; and prenatal testing, the measurements that we did, the examinations that we did, and giving them treatment for the various kinds of illnesses that they had; you know, there were women in our program who had had six, seven, eight babies, and we were giving them treatment for that, we were on top of all those problems, and we kept thewe got the maternal and infant mortality rate down pretty low. When I first went to Dade County, Dr. John Milton, you probably remember Dr. John Milton, he was the director of Bureau of Internal and Child Health, for a while.
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01:02:57.5
CP: Also, a member of the State Board of Health.
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01:02:58.5
DC: And he was chairman of the State Board of Health for a while, I think just before Dr. Eugene Peak, who I remember with great fondness, because he was there the whole time I was up there; a great guy. Dr. John Milton sat with me on the committee of the health departmentof the medical society; Dade County medical society on Maternal and Child health in Dade County, believe it or not; and this was, you know, were talking 1950s.
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CP: Yes.
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DC: Youd say, Well, by that time, my gosh, that stuff should all have been taken care of. Well, it wasnt. We were still losing about ten mothers per thousand live births.
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CP: Oh, boy.
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01:03:36.8
DC: Thats high. Thats high.
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01:03:37.2
CP: That is high.
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01:03:38.4
DC: Now, I dont know what the most recent statistics are, but Im guessing were down to somewhere around one mother per twenty thousand live births.
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01:03:47.7
CP: If that frequent.
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01:03:48.3
DC: If its that
316
01:03:49.2
CP: Its very rare today.
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01:03:50.7
DC: Exactly, yeah; and our infant mortality rates, you know, Florida was very high; in fact, we were once castigated by the American Public Health Association for being something like twenty-seventh in the nation, some such thing as that. The highest mortality rates amongst infants were way up in the thirties, thirty per thousand; and I think thats down somewhere now, I think, around six, six-and-a-half, seven, somewhere in that area.
318
01:04:15.8
CP: Thats correct.
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01:04:17.3
DC: In that ballpark.
320
01:04:18.0
CP: Yeah.
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01:04:18.6
DC: So, a lots been done, and I cant say that Public Health is to blame for all of it. Were not, obviously.
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01:04:27.3
CP: But you were part of the picture.
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01:04:29.3
DC: Yeah. The practice of medicine has changed tremendously in the state of Florida, over the years; and now, fewer and fewer and fewer women are being treated through health departments. More and more and more, we have worked out relationships with the local physicians, obstetricians in the community; and with the availability of funds, specifically, some state money thats being made available through Medicaid and so forth to pay for these deliveries and that type of thing, plus physicians willingness to accept less for an indigent patient than they would for their own private practice.
324
01:05:7.1
CP: Ah, of course.
325
01:05:8.2
DC: Much less.
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01:05:9.7
CP: So, the quality of service is improved
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01:05:10.9
DC: So, the quality of service has gone up tremendously
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01:05:13.7
CP: And its shown in the statistics.
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01:05:15.4
DC: Most of theseMost of the patients, I would say, at least in the urban areas in Florida, most of the patients are being delivered by private practicing physicians in the community, who are doing that and getting paid through Medicaid or other sources; the health department, also, in some instances. For instance, in Orlando, the Orange County health department pays physicians when the patient is not eligible for Medicaid. They pay the physicians for deliveries.
330
01:05:39.4
CP: Really?
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01:05:41.0
DC: And thats being done a lot more, now.
332
01:05:42.5
CP: Yeah, thats great. You mentioned Sarasota; were you in Sarasota?
333
01:05:46.6
DC: Yeah, I was there six years. One of the more enjoyable tours that I had
334
01:05:50.3
CP: As the local Health Officer.
335
01:05:51.9
DC: Beautiful place.
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01:05:52.7
CP: Director of Local Health, right?
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01:05:53.8
DC: Oh, yeah. Beautiful, wonderful place to work.
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01:05:57.3
CP: When did you get there? You were director of local health services, for a season, with the state board of health.
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01:06:2.4
DC: Yeah, yeah, I was.
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01:06:3.6
CP: And you was director of Maternal and Child Health.
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01:06:5.5
DC: Yeah, I was. I was in maternal and child health from 64 to 66, and then I went down to Sarasota; there was a little brouhaha about the health officer down there (CP laughs), and he bought some furniture for the health department from his wife.
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01:06:25.7
CP: Oh. (CP laughs)
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01:06:27.2
DC: And that is not acceptable in Florida.
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01:06:30.9
CP: Oh, that wasthat looked bad.
345
01:06:33.1
DC: Yeah. You buy from the lowest bidder, in the state of Florida; you dont buy from your family.
346
01:06:37.8
CP: Okay. (laughs)
347
01:06:38.1
DC: If youre a Health Officer, unless you dont want your job anymore.
348
01:06:41.4
CP: And thats what happened there.
349
01:06:42.8
DC: Yeah. Thats what happened.
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01:06:44.2
CP: He was tired of his job.
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01:06:45.6
DC: He was tired of his job, yep. So, I went down to Sarasota, and, really, I had a wonderful experience down there; I enjoyed it, no end at all; and it was really great.
352
01:06:56.1
CP: As director of the health department, youre now accountable for all those programs and their integration.
353
01:07:1.2
DC: Yeah, right; and we had our own sanitary engineer; and we had, of course, the Environmental Health Program, it was quite big, extensive; we had, I dont know, maybe twenty-five public health nurses; and we did a lot of work in school health, and that sort of thing, down there; and health educator, full-time on the staff; nutritionist, full-time on the staff
354
01:07:27.0
CP: So, you didnt know what to do with such a variety of staff, coming from Indonesia to that, thats some gap.
355
01:07:30.8
DC: But all those things are very, very important to a total public health program in a community; because theres so muchso many things to be thought about, besides just polluted water and stuff like that, which we have plenty of; but theres so many other things to be thought about; andfor instance, your nutritionist works with all of the nursing homes in the community, gives them guidance on proper food for those people that live in those homes; theyre entitled to a decent, adequate diet; and thats one place where nursing home directors, operators, like to cut corners; is to feed cheap. If you can feed cheap, you make more money for yourself.
356
01:08:21.9
CP: I can understand that.
357
01:08:23.2
DC: So, we didnt let them feed cheap (CP laughs), we made em feed right.
358
01:08:26.7
CP: Good.
359
01:08:27.0
DC: And theres a difference.
360
01:08:27.9
CP: Yes.
361
01:08:28.6
DC: And health education, course, was desperately needed. You probably remember the program that we worked all over the state for several years, teaching teachers in the school system to understand health, cause most of them didnt.
362
01:08:45.5
CP: Yes, thats correct.
363
01:08:46.9
DC: And health educators worked heavily on that. Elizabeth Reed started that program when she was State Health Educator, you remember that, probably; and that was a very important program every summer; teachers from all over the state used to enroll in that program.
364
01:09:2.7
CP: Called The Teachers Summer Workshop in Health.
365
01:09:4.4
DC: Yeah, right, right, and it was excellent; and those people went back into their schools, and became real sparkplugs for improving the health, and they were able to observe the kids in their classrooms, and pick out children that had health problems after that.
366
01:09:23.3
CP: Yes, yes.
367
01:09:23.7
DC: I mean, they werent doctors, they werent nurses, but if they saw a kid back there with his head on the desk all the time, it wasnt because he stayed up til two o clock in the morning, it was because he wasnt getting fed right, or something was going on in his system.
368
01:09:34.9
CP: Yes.
369
01:09:35.5
DC: And they picked those kids out, and theyd get those kids into the health department to be seen and find out why, so
370
01:09:41.8
CP: Excellent program.
371
01:09:42.2
DC: That was an important program, that was one of the big ones.
372
01:09:43.9
CP: Yeah, I thank you for mentioning that. Do you know when that started? An Approximate?
373
01:09:50.0
DC: Early fifties.
374
01:09:50.8
CP: That was going when you came?
375
01:09:52.6
DC: Early fifties. It was going
376
01:09:53.6
CP: And it was a dominant part of your program in Sarasota?
377
01:09:55.0
DC: Yeah.
378
01:09:57.0
CP: Yeah, what was the highlight of your service as a local health officer? And whats the downside to
379
01:10:6.7
DC: Okay, Ill tell you a couple of highlights.
380
01:10:9.0
CP: Okay.
381
01:10:9.3
DC: Not as local health officer, though.
382
01:10:11.5
CP: Oh.
383
01:10:12.8
DC: But as M.C.H. director. Miami Childrens Hospital
384
01:10:14.9
CP: All right.
385
01:10:17.3
DC: The highlight there wasthat was in 1963, 64.
386
01:10:21.7
CP: Yes.
387
01:10:22.3
DC: Okay? And youll remember we lost a president about that year, the year before, 62, 63, somewhere along in there.
388
01:10:31.1
CP: Sixty-two, I think.
389
01:10:31.9
DC: We had a president assassinated, and his family was very, very much interested in mental retardation.
390
01:10:38.2
CP: Yes.
391
01:10:38.7
DC: By virtue of the fact that one of the members of the family was mentally retarded. DC is referring to President John F. Kennedys sister, Rosemary Kennedy (1918-2005). Considered to be psychologically unstable by her family, she underwent a prefrontal lobotomy at age 23, which left her permanently incapacitated.
392
01:10:42.4
CP: Yes.
393
01:10:42.9
DC: And they put a lot of pressure on, up at the federal level, and grants became available for mental retardation programs, and we helped to get the program started out of Dade County called the Mental Retardationits now the Mormon Mental Retardation Center, I believe, out of the University of Miami School of Medicine.
394
01:11:5.1
CP: Okay.
395
01:11:5.7
DC: But in those days, it was called the Developmental Evaluation Clinic.
396
01:11:9.6
CP: Ah, yes, okay.
397
01:11:12.1
DC: Carol Shear and a guy named Smith, Dr. Smith, one of the Smith boys, they ran that clinic, and they had five or six members on their staff, and they did a terrific job. Not only in Dade County, but we got an itinerary worked up for them where they went to the smaller counties that couldnt afford to have that kind of a staff, particularly south of the lake; south Florida; and they held clinics in those counties, evaluated these children and so forth. They were tremendous help. That, I thought, was a very outstanding program that got started.
398
01:11:45.4
CP: Thats kind of the forerunner of the state level organization for mental retardation. Was that kind of the daddy of the state function?
399
01:11:56.4
DC: Yeah, sort of. There was, at that same period of time, there was a committee appointed state wide, and I sat on that committee. Franklin Fort, crippled childrens commission, he sat on the committee, and maybe fifteen or twenty other people. We had a nurse from over in Gainesville, at the Gainesville Sunland Center, sat on that committee, and others; and parents of mentally retarded children were also involved. And we did a lot of the planning for mental retardation activities in the whole state of Florida; we assisted the McDonald Training Center over inright here, in Tampa, we developed their program a little bit, got help to get them some federal dollars to build their program up, and they have a sheltered workshop overI guess its still in operation, I dont know.
400
01:12:46.4
CP: I think it is.
401
01:12:47.3
DC: And, yeah, that was a rich period for that sort of thing. The other program that I liked very much was our activity of when I was down at the Bureau of Local Health Services; we got together with people over at the University of Florida, in Gainesville; there was a guy over thereIll never be able to remember his name, but it doesnt matter, at this stage of the game, who was very much interestedhe had once been a Health Officer in the state of Florida, and he was in the medical school over at the University of Florida; he later became dean, but I cant remember his name. Anyway, he was very much interested in doing something in those communities immediately surrounding Gainesville; because, A: they needed more material for the students, the medical school was growing.
402
01:14:25.9
CP: He was the original director of it, I think.
403
01:14:28.5
DC: For about five or six years, he ran that program, and his name is Charles Mahan.
404
01:14:32.6
CP: Whos the current dean of our School of Public Health.
405
01:14:34.5
DC: Hes now the Dean of the School of Public Health. He ran that program magnificently.
406
01:14:37.2
CP: Its a small world, isnt it?
407
01:14:39.0
DC: And as a result of that, probably, he was nominated to be the State Health Officer, which he was, as you know, for a while; and then, subsequently, came here as the dean of this school, which Im very glad of.
408
01:14:50.7
CP: Yes.
409
01:14:51.1
DC: Cause Charlies a great guy.
410
01:14:52.4
CP: Those are two outstanding highlights that had mentioned to us.
411
01:14:55.5
DC: Those things, I really think, meant something in the health of people to the state of Florida.
412
01:15:1.7
CP: Not to beto embarrass you or make your face red, can you underlight? What are some underlights, in contrast to the highlights of your career in local health services?
413
01:15:14.9
DC: Well, I really, I really dont have any adverse
414
01:15:20.1
CP: Any underlights?
415
01:15:20.9
DC: No, not really, not in public health. I had a wonderful time in public health; its a wonderful profession, and I think its done a tremendous, tremendous amount of good; saved unnumbered lives in the state of Florida, and all over the country. The only concern I have now; and I realize now we have a new regime in the state of Florida, quote, unquote, hopefully itll mean something in the future; but, after 1975, when the legislature, in its wisdom, decided to do away with the State Board of Health, and to have a division of health in with a big social service agency, you know, thats known as HRS.; Health and Rehabilitative Services and, since that time, in my humble opinion, public health has gone downhill.
416
01:16:9.3
CP: Yeah, keep talking.
417
01:16:9.9
DC: Substantially.
418
01:16:11.2
CP: Yeah. That was a lowlight, in your career, then. You would have been
419
01:16:13.5
DC: Yes, that was the lowlight.
420
01:16:15.5
CP: (Affirmative murmur)
421
01:16:15.9
DC: That was when I began to think about getting out of public health, was back then. Took me, what, thirteen years, to getting around to do it, finally left in 88, but anyway, thats neither here nor there. The big thing I saw wrong with it was that the first and biggest step, that I could see, was not that there wasnt money there, but there was not a desire there to see the public health of the people adequately protected. The desire wasnt there. And the reason that was, I believe is, because the majority of the people who were in seats of power, in the department, were social scientists.
422
01:17:3.7
CP: This is the department of health and rehabilitation services?
423
01:17:5.6
DC: Department of health and rehabilitation services.
424
01:17:8.7
CP: And the leadership was social scientists, okay.
425
01:17:10.8
DC: And their primary thrust was to do something about welfare in the state of Florida; and welfare, dont get me wrong, is tremendously important, no question about that; but healthfare is even more important.
426
01:17:26.0
CP: Yes.
427
01:17:26.2
DC: And if you aint got healthfare, you aint got welfare. I dont care what you do.
428
01:17:30.5
CP: Yeah, you worry about the priorities.
429
01:17:32.6
DC: Yeah, the priority turned around; and, you may remember, you may not, one of the stateone of the meetings atin Jacksonville, a very well known state legislator got up before the health officers assembled, and he said, Physicians are a dime a dozen. We dont need doctors running health departments; we need doctors taking care of patients.
430
01:18:0.0
CP: I remember that.
431
01:18:1.0
DC: Im not gonna say who that was, cause I dont want to embarrass anybody, even if he is still alive, and I dont know if he is, and I dont really care. (CP laughs) But that was a statement that really spelled, for me, what was going to happen to public health; because it wasnt long after that before physicians were downplaced in public health; they became clinicians, not public health physicians.
432
01:18:24.2
CP: Thats correct. To take care of the ill, they became technicians for the treatment of illness
433
01:18:29.5
DC: Illness care.
434
01:18:31.3
CP: Yeah.
435
01:18:31.8
DC: And thats one of the things that has really reduced the efficiency and function of public health in the state of Florida; and part and parcel to that is that Floridas public health departments have more and more gone into clinical medicine, and got out of the old fashioned home care that we delivered. Our nurses went out into the homes; they knew Grandpa had tuberculosis, they knew this child wasnt quite right upstairs, they saw these things on a day to day basis, out in the homes; and as the clinics got bigger, and the money got smaller, and they said, We dont want doctors anymore, we want you people to take care of sick people, the nurses couldnt go in the homes anymore, they didnt have the time to go into homes anymore
436
01:19:17.6
CP: No, they were busy in the clinics.
437
01:19:18.8
DC: They were spending all their time in the clinics, and had nothingno time to spend out there doing that health education, that nutrition education with that mother, that looking after the other family members, that really helping families to getto stay together and to pull together, thats lost.
438
01:19:36.0
CP: Focusing on early intervention and prevention.
439
01:19:39.2
DC: Right, exactly. That was lost.
440
01:19:41.2
CP: Yeah, youll remember that the legislature did pass the Indigent Health Care Act, in which the health departments were admonished and charged, and their budget was duly done in order tofor them to become sickcare clinics.
441
01:19:59.1
DC: And not just admonished, if you recall, but really pressured.
442
01:20:3.0
CP: Oh, forced through budget.
443
01:20:4.3
DC: By people sayingby people saying to them, This is where your source of money is, from now on. If you dont get on the car and ride with us, youre gonna be out there trying to thumb with somebody that isnt gonna pick you up.
444
01:20:16.7
CP: Thats right. We do what the money is.
445
01:20:17.4
DC: And thats what pushed usthats what pushed us into the corner of getting into clinic care.
446
01:20:21.9
CP: Do you think that public health leadership somehow failed to properly inform, properly motivate, educate the legislative process?
447
01:20:32.9
DC: I think, by the time that came along, the water was already over the dam. I really do. Cause that was really came after reorganization, and after the division was set up, and the department was dispersed.
448
01:20:47.9
CP: Well, just to remind you, part of that 76 act youre speaking to, it was declared by a secretary of the department that a library was not pertinent to the current charge of this.
449
01:21:2.9
DC: I remember well.
450
01:21:3.6
CP: That a health education was no longer pertinent; and by the flip of a pen, Ill remind you that the Public Health Library, and its film library, and its entire health education function were abolished.
451
01:21:18.0
DC: Which was tremendously assistive to the County Health Department.
452
01:21:21.1
CP: Yeah, in that, Im recallingI dont want to put words in your mouth, but I want to continue to address that our charge is not that preventive medicine, we have so many sick people here that need care; so, from now on, that shall be your charge, you are the doctors and nurses of this umbrella agency; and doctors and nurses are supposed to take of sick people, so I declare thats what thou shalt do. Now, you were around when all verbiage was taking place.
453
01:21:54.5
DC: Oh, yeah, I was around, yeah. You remember, we went over to Tallahassee and we tried to do something about that, but nobody was listening, because somebody over there had made a decision that this is the way things were going to be in the future, and this is the way they are.
454
01:22:12.0
CP: Yep.
455
01:22:12.5
DC: So, Im hoping
456
01:22:13.7
CP: And they were the bosses, were they not?
457
01:22:15.7
DC: Oh, yeah, they sure were. (DC and CP laugh) But Im hopeful, now, that we have a department and we have a physiciantrained physician, as head of that department; and we have this good school here
458
01:22:33.9
CP: With a properly trained dean.
459
01:22:35.8
DC: You said it. You bet. And Dr. Mahans special knowledge, because he had an opportunity to see himself, out in those twenty-one counties
460
01:22:49.9
CP: In the Starks, in the Greencoast Greens, yes.
461
01:22:52.5
DC: This is exactly how that the conditions were really hurt. And he found out quickly that public health was very important; and maybe he already knew that, I dont know; but I remember when I graduated from medical school, I didnt know anything about public health at all. We had public health for one week, and three and a half days of that was spent in venereal disease clinic, cause that was public health. The other day and a half was in TB control, because that was public health. (CP laughs) Thats about how much we knew about it, you know? Back in those days, VD control and TB control were important. Still are.
462
01:23:28.4
CP: Yes, yes, they are.
463
01:23:29.4
DC: Cause TB is going up. VD aint never gone down. Well, it went down for a short period, but we have people working on it like mad all over the state of Florida; and when the money drained, the program more or less collapsed. So, VD is very much back again, in a big way.
464
01:23:48.4
CP: I can see some relationships between the dissolvent of the venereal disease staffing core which occurred, and the rise of the incidents. Theres a direct relationship.
465
01:23:58.9
DC: Oh, yes, theres no question about it. Every health department in the state
466
01:24:2.9
CP: Refocus of attention.
467
01:24:4.4
DC: Either had their own VD man on staff that was large enough; for instance, I did in Sarasota, and we do that in several of them in Dade. Every health department that was large enough had their own VD control man, but health departments that didnt were able to draw on the regional VD control people; and they go into health departments, they hold clinics, they go out and they do investigations, they go out and find these people in the barrooms, in the halls, in the tenements, in the alleyways, wherever they have to find them; they corral em, and they say, Come on in and get treated. And they get a list of who their contacts are; course a lot of them dont know, It was just Betty, thats all I know. It was Betty.
468
01:24:45.4
CP: But a little point for the VD investigators, Well, where did you meet Betty? And those investigators would find Betty.
469
01:24:50.7
DC: Theyre sharp. Theyre sharp.
470
01:24:53.4
CP: They are sharp.
471
01:24:54.1
DC: Yeah, they got out there; in many cases, they did find Betty. Screaming and wailing, she didnt want to come in, but she came, cause Betty didnt know she had anything wrong with her.
472
01:25:3.0
CP: You mentioned 76 as a highlight in thein public health history in Florida, wont you address that further? The 76 nidus; what else went wrong then, Dr. Crane?
473
01:25:19.6
DC: Well, it seems to me, that besides this total change in attitude, about what Public Health ought to be doing, which is not preventive medicine by any stretch of imagination, but by treating people and so forth; and getting rid of the library, getting rid of public health education and a lot of other things, Im sure, went with it.
474
01:25:39.9
CP: Youre aware, in retrospection; most of the environmental health stuff is now in other departments now, too.
475
01:25:44.6
DC: That went the way of all flesh, yeah, that went to another department, which has never done it as well as we did it. It was done well when we were doing it. Those people are too associated with the restaurant business themselves to ever, reallyI mean, thats like, you know, putting a fox to guard the henhouse. Anyhow, so many things of that type, but, to me, it was the attitude.
476
01:26:7.2
CP: Of the leadership?
477
01:26:7.8
DC: The attitude and the leadership in the state of Florida simply said, We dont really need these people anymore; and, particularly, we dont need doctors. And think how many doctors have gone out of public health in the last
478
01:26:18.7
CP: Yes, ten years.
479
01:26:19.8
DC: In the five years immediately after 1975, just think about the number of doctors that went out. A lot. A lot of them.
480
01:26:25.2
CP: Oh, lots.
481
01:26:28.3
DC: Right after that. Because we all saw the handwriting on the wall: they dont want physicians running health departments anymore; they want physicians to treat patients.
482
01:26:36.5
CP: Yes.
483
01:26:37.3
DC: And, theoretically, thats what were supposed to be doing; but when the community is your patient, youre just as important and just as busily engaged as the guy whos looking out there, looking at kids tonsils.
484
01:26:47.8
CP: Yes.
485
01:26:48.9
DC: And its just as important.
486
01:26:50.7
CP: Uh, I like to think its a little more important, cause we can prevent
487
01:26:54.2
DC: You know it is. You know it is.
488
01:26:55.3
CP: Yeah.
489
01:26:55.1
DC: And I know it is. Yeah, kids need their tonsils looked at, sure; you know, Im not saying anything against private medicine; theyve been tremendous supporttremendously supportive of public health; and they wereI have many friends in the business.
490
01:27:8.2
CP: Yes.
491
01:27:8.6
DC: But, and if we had public health established like we used to have in the old time, in the old days, I could get a lot of those guys out of private practice, cause they hate it. (CP laughs) They dont like it anymore, with Medicare and all the rest of it, theyre eaten alive by paperwork; theyre going nuts. They say, We spend more time doing paperwork than we do doing patient care.
492
01:27:27.9
CP: And their liability.
493
01:27:29.7
DC: And its disgusting, and theyre unhappy.
494
01:27:30.2
CP: The question of frivolous lawsuits.
495
01:27:31.0
DC: I could recruit more than one health officer for every county in the state of Florida in no time at all.
496
01:27:37.6
CP: Yes.
497
01:27:38.6
DC: Cause they want out.
498
01:27:39.3
CP: Yes.
499
01:27:40.1
DC: And I can understand that. I can understand it fully.
500
01:27:42.9
CP: Thats too bad.
501
01:27:43.3
DC: But the attitude has changed. Theres no longer a desire at the uppermost levels, at least, there hasnt been; maybe now, there will be again.
502
01:27:52.9
CP: I see it coming back. I see it coming back.
503
01:27:54.0
DC: But up to now, there has not been a desire, at that level of government, to make public the most important activity of the counties in the state of Florida. It hasnt, no. Welfare and treatment of patients; thats the two most important things.
504
01:28:10.1
CP: Okay. What do you see as a solution? You want to talk about the future a little bit? What would you like to see to come back, from your experience, in those early days when Florida public health was really at itsat the pinnacle, and I recall, was accoladed [sic] by the Public Health Service and the World Health Organization as the place to see, if you want to develop a local health service, go to Florida; I remember many foreign health officials
505
01:28:40.2
DC: Plenty of them. Plenty of them. Yeah.
506
01:28:41.0
CP: I could name some specifics that came here; sent by the World Health Organization to learn, in Florida, as to how to establish a public health service; and that was the focus on local health services, always. And you were there, David.
507
01:28:57.7
DC: Well, I will say, categorically, and I dont think Dr. Sauder, or you, or anybody else that knows anything about public health would dispute this; we had, in the state of Florida, in 1975, one of the finest public health organizations in the United States of America or anywhere in the world. One of the finest.
508
01:29:17.1
CP: I believe that, and I think the record supports you.
509
01:29:19.6
DC: Absolutely, I believe it; and we wereour folks were out there doing the work. They were out there, where the rubber meets the road. Now, you said, What would I like to see for the future? You cant go back; that Ive learned over a long life; you cant go back. Id love to see us go back to State Board of Health, but you cant do that, okay? So, what I would like to see is a really strong department of public health, in the state of Florida, that really was going to work on providing public health services to the people of state at the local level; through the County Health Unit System, with physicians in charge, and multiples of that basic staff, and multiples of that basic staff weve already talked about, to get out there and do the job where it needs to be done. Thats what Id like to see.
510
01:30:5.0
CP: Yeah, you used the word strong. The strong state health department. Define strong for me, here. Or talk about that a little bit. What wouldhow would you
511
01:30:14.0
DC: By strong, I mean, a strong leadership.
512
01:30:16.4
CP: Strongoh, so important.
513
01:30:17.6
DC: Somebody thats up there that can talk to these guys at the legislature and make them listen. Strong leadership. Secondly, youve got to have funding; youve got to have money. You cant run anything these days without money.
514
01:30:29.3
CP: Cause money is staff.
515
01:30:30.5
DC: Money is staff. Money is program. You havent got money, youve got nothing; you might as well wrap it up and go home.
516
01:30:36.5
CP: Yes, yes, yes.
517
01:30:37.8
DC: And, a real, basic understanding on the part of our legislators, not only at the state level, but the local level: county commissioners, mayors, city commission, so on and so forth, all the way down the line, okay? A real, basic understanding of what is this stuff called public health; we dont know what that means.
518
01:30:57.2
CP: Yeah.
519
01:30:57.7
DC: What is it?
520
01:30:58.5
CP: Havent we confused with our use of the word healthcare? Thats one of my favorite sermons: separate healthcare from medical care. Those are two separate things. Excuse me, go ahead.
521
01:31:10.2
DC: Sure, yep, thats it.
522
01:31:12.6
CP: This is not my preaching day, Im sorry.
523
01:31:14.0
DC: No, but youre right, and that needs to be preached; and thats where we needwe need the grass levelgrassroots support, which only comes from understanding and education, we gotta have that. Weve gotta have an understanding at the point where the money is handled; that means the legislature and boards of county commissioners, theyve got to really believe, in their heart, that this is important; cause if they dont, than its not important.
524
01:31:38.0
CP: Thats true.
525
01:31:38.3
DC: And weve got to have the leadership to make them believe that.
526
01:31:42.3
CP: All right. Those are good pearls.
527
01:31:46.2
DC: We may have to take off the glove and put on some brass knuckles, because theres some hard heads, like the one that came to our meeting and said, We dont need doctors in public health. We need doctors out there taking care of patients. Thats when it all started going downhill. Right there.
528
01:32:3.5
CP: Its interesting that yourethat that is a highlight in your memory; and I remember that, too.
529
01:32:8.7
DC: Ill never forget that. The part that almost killed me was he was standing in front of sixty-seven health officers, saying that. You know?
530
01:32:18.9
CP: Well, he was chair of a rather dominant committee; he controlled the money, what can we say to him?
531
01:32:24.8
DC: He sure did.
532
01:32:26.0
CP: Do you remember?
533
01:32:27.0
DC: Yeah.
534
01:32:28.2
CP: Yeah, what can you say? Hes got the first paints.
535
01:32:30.8
DC: Yeah, too bad we werent in Russia; wed all have jumped up and (imitates gunshots). (CP laughs)
536
01:32:36.6
CP: Now, the Russians dont do that anymore.
537
01:32:37.8
DC: No, I know they dont. They never really did. (DC and CP laugh)
538
01:32:43.5
CP: Well, any summarizing points that you want the record to reflect?
539
01:32:51.5
DC: Well, the only summarizing point I have is that public health is a great profession; its a wonderful program; a wonderful effort that we made do to something really, really worthwhile for the people that live in the state of Florida. And we did a lot worthwhile, because, at one point in time, this state was regarded as one of the very most dangerous places in the world to be; because of mosquitoes, because of disease, because of all the other things; and even the hurricanes, nobody worried too much about, and I lived through a lot of them down in South Florida, and I didnt worry about them either. Theyre not dangerous. Its the people that are dangerous. But yeah.
540
01:33:35.1
CP: Yeah, there are those, some others who wouldpublic health workers, who would say had it not been for the public health program, Florida would be uninhabitable.
541
01:33:44.3
DC: You bet. Absolutely. Thats absolutely fact.
542
01:33:47.6
CP: I think thats worth noting, and if we neglect the matters of the publics health in the future, we may return, we may regret it. Even more than we regret now.
543
01:33:59.8
DC: Yep. Thats very true.
544
01:34:1.5
CP: Well, Dr. David L. Crane, on behalf of the University of South Florida, and the School of Public Health, were grateful for your willingness to come and share with us today.
545
01:34:11.5
DC: It was fun. It was fun.
546
01:34:12.9
CP: And its enlightening; and I hope the future historians will get the undercurrent of a lot that you said today. And we thank you. And Im Skeeter Prather.
547
01:34:25.9
DC: That was fun. I enjoyed that.
548
01:34:27.4
CP: Good, good.