MINNESOTA 
LEGISLATIVE RESEARCH COMMITTEE 
COUNTY UNIT HEALTH PLAN 
Publication No. i4- 
November I&ikj MINNESOTA LEGISLATIVE RESEARCH COMMITTEE 
Lawrence F. Haeg, Chairman 
Thomas P. Welch, Vice Chairman 
Louis C. Dorweiler, Jr., Secretary 
Claude H. Allen Representative 
A. L. Almen Senator 
Claude G. Baughman Senator 
A. L. Boze Representative 
E. J. Chilgren Representative 
Joseph J. Daun Representative 
Frank E. Dougherty Senator 
Daniel S. Feidt Senator 
Floyd O. Flom Representative 
George A. French Representative 
Lawrence F. Haeg Representative 
John A. Hartle Representative 
Archie H. Miller Senator 
Everett L. Peterson Senator 
Herbert Rogers Senator 
Walter F. Rogosheske Representative 
A. 0. Sletvold Senator 
Thomas P. Welch Senator 
RESEARCH DEPARTMENT 
Louis C. Dorweiler, Jr., Director 
The Legislative Research Committee is a joint committee of the legislature, meeting quarterly 
at the State Capitol and giving advance consideration to problems expected to confront the next 
legislature. 
The Committee (1) acts as a clearing house for current legislative problems by receiving pro- 
posals for research studies; (2) determines and directs the study and research necessary for 
proper consideration of all proposals; (3) disseminates advance information on these problems 
to other legislators, the governor and the public by means of committee and research reports; 
and (4) reports to the legislature one month in advance of the regular session. 
The Research Department of the Legislative Research Committee is organized to provide an un- 
biased, factual source of information with regard to problems which may be acted upon by the 
legislature. This department is engaged in objective fact finding under the general supervision 
of members of the Committee. MINNESOTA 
LEGISLATIVE RESEARCH COMMITTEE 
COUNTY UNIT HEALTH PLAN 
Research Report issued pursuant to Proposal No. 17; 
A PROPOSAL that a study be made of the various aspects 
of the County Unit Health Plan. 
Publication No. 14 
November 
1948 MINNESOTA STATE HEALTH DISTRICTS 
DISTRICT OFFICES 
Plan put into effect 7/1/48 
Source - Minnesota Dept, of Health TABLE OF CONTENTS 
Page 
Briefly 
Introduction 
Local Health Units Throughout the Nation « , , . 1-7 
State Public Health Services in Minnesota 8-10 
Local Organization for Public Health 
in Minnesota , 11-19 
Public Health Nurses 20-21 
Present County Health Units. . 22-32 
Elements of Full-time Local Health Units 33-38 
Need for Full-time Local Health Units 
in Minnesota 39-47 
Possible Shape of Enabling Legislation 48-50 
Statistical Appendix ............ 1-25 BRIEFLY . . . . 
No state prohibits the joint action of its sub- 
divisions in the field of public health although methods of effecting 
joint action vary from state to state* 
Minnesota is one of eleven states which do not have specific enabling 
legislation for the creation of county, city-county, or multi-county 
health units. However, counties in Minnesota could act under the law 
providing for joint exercise of common powers, although the complexity 
of agreements with all the townships in a county makes such action un- 
likely. 
Counties are not important units of government in the Hew England 
states, therefore, it is not surprising that there are no county health 
units in that area. 
In the southern and the western states where the count)/ is the important 
unit of government in rural areas, more states have enacted enabling 
legislation which has been utilized by more counties than in any other 
group of states. 
The middle group of states with both townships and counties have for the 
most part enacted enabling legislation only to find that few counties a- 
vail themselves of the grants of authority. 
Of the states adjacent to Minnesota, Iowa is the only one not having 
specific enabling legislation; the other three have enacted laws which 
have been utilized only slightly by the counties. 
Other states’ experience indicates that enabling legislation is not 
enough to secure the establishment of local health units on a county 
basis. Positive sentiment and action must spring from the citizenry 
of the counties themselves. 
Two counties in Minnesota, Olmsted and St. Louis, have shown that local 
sentiment coupled with action can create county and city-county health 
units in the absence of specific enabling legislation. The Twin Cities 
Metropolitan Area in Hennepin and Ramsey Counties is largely served by 
full-time local health units. INTRODUCTION 
As society has grown more and more complex, government has "been 
expected to take on more and more functions. Public health is among the 
most important of the functions undertaken by the government of a modern 
state. 
There are certain broad areas within which it is generally con- 
sidered proper for a public health agency to carry on its program. How- 
ever, not all possible public health functions have achieved social ac- 
ceptability, and these give rise to conflicts of philosophy and ideology 
In contemporary America, it is generally considered proper for 
public health to limit itself to preventive medicine while the field of 
curative medicine is considered the proper province of the private prac- 
titioner. Since modern medical science is becoming ever more complex, 
it is not surprising that the distinctions between preventive and cura- 
tive medicine are breaking down, making it more difficult to define the 
proper sphere of public health. 
Not only are there differences of opinion with respect to what 
are the proper functions of a public health agency, but there are also 
differences of opinion as to what level of government - federal, state 
or local - should perform those functions. Some exponents of economy 
and administrative efficiency support centralized operation and control, 
while some adherents of grass roots democracy favor local control even 
though the locality may not be able to operate a public health program 
without financial assistance from the central government. 
It is the purpose of this study to examine the experience of 
other states which have enacted enabling legislation for the creation 
of county, city-county or multi-county local health units; and to point 
out some of the implications of such enabling legislation already con- 
sidered by the Minnesota Legislature as well as other possible forms of 
enabling acts. 
It is not the purpose of this study to favor a particular point 
of view about any of the many policy questions involved, but rather to 
give a factual framework within which these policy questions may be con- 
sidered by those charged with the duty of policy determination. LOCAL HEALTH UNITS THROUGHOUT THE NATION 
federal, state and local governments generally participate in the 
provision of public health services in the local community. The pattern 
of local government is not uniform throughout the nation, and the varying 
concepts of local government have an important hearing on the means of pro- 
viding public health services in the community. 
In New England, local government is centered in the traditional 
town meeting. New England "towns” range from highly urbanized communities 
to rural hamlets. The county is either non-existent, or of little im- 
portance. 
In the South, the county or parish is the important unit of local 
government for rural areas. Both the South and the Far West make little 
or no use of the township form of organization. 
Beginning in the Middle Atlantic States and extending westward 
throughout the Middle West, local government includes both counties and 
townships. The latter are often called "towns”, and confusion often occurs 
because of its dual meaning as township and village. 
EXTENT OF HEALTH UNIT ENABLING LEGISLATION 
Early in 1948, 37 states had enabling legislation for the cre- 
ation of county, city-county, and multi-county health departments and 11 
states did not (see Table I and Appendix Table A). Minnesota is one of 
the states which does not have specific enabling legislation for the 
creation of county, city-county, and multi-counth health departments. In 
his comprehensive study of local health units, Dr. Haven Emerson called 
attention to the fact that no state prevents voluntary action on the part 
of the localities. He stated, "It should be noted, however, that there 
is in no sense any legal hindrance to the voluntary co-operative or col- 
laborative action of contiguous counties, cities, or other smaller Juris- 
dictions of local government by which their common interests in health 
may be served through a local health department Jointly supported by the 
participating communities. Tnere is in some states a provision of law 
which forbids the receipt of more than one salary from official sources 
by one person".^ 
LEGAL AUTHORITY TO ESTABLISH HEALTH UNITS IN MINNESOTA 
Section 471.59 of Minnesota Statutes 1945 provides for the 
joint exercise of common powers by political subdivisions of the state. 
1. Haven Emerson, M. D., Local Health Units for the Nation, p. 332. TABLE I 
COUNTIES COVERED BY LOCAL HEALTH UNITS IN STATES GROUPED BY 
TYPE OF LOCAL GOVERNMENT AND BY INCIDENCE OF ENABLING LEGISLATION 
States 
Counties Taking Advantage 
of Enabling Laws 
Number $ of Total 
Total No. 
of Counties 
United States 
1034 
33.8 
3,060 
37 States With Enabling Laws 
1034 
43.0 
2,407 
11 States Without Enabling Lavra 
0 
0. 
653 
6 Township States 
0 
0. 
62 
3 States With Enabling Laws 
0 
0. 
33 
3 States Without Enabling Laws 
0 
0. 
24 
26 County States 
868 
49.4 
1,758 
22 States With Enabling Laws 
868 
61.9 
1,403 
4 States Without Enabling Laws 
0 
0. 
355 
16 Township and County States 
166 
13.4 
1,240 
12 States With Enabling Laws 
166 
17.2 
966 
4 States Without Enabling Laws 
0 
0. 
274 
Sourcess Questionnaire sent to State Health Departments and William 
Anderson, The Units of Government in the United States, p. 33. Thus there is legal authority for the voluntary creation of joint local 
health units.. However, the fact that townships have numerous powers and 
duties with respect to public health and the difficulty of getting them 
to act together has hindered action under this statute* Neither the 
Rochester-Olmsted County Health Unit nor the St* Louis County Health De- 
partment has been created under this statute - both are based on informal 
agreements. The bill proposed in the 1947 Session of the Minnesota Legis- 
lature provided that all powers and duties (except vital statistics - one 
of the six essential functions of a local health unit) of all local health 
bodies in the area under its jurisdiction would be transferred to the 
county or multi-county health unit. Such units would be formed either by 
action of the county board or by petition of five per cent of the voters 
calling for an election. Cities of the first and second classes would be 
included only after a referendum at a municipal election. 
It is apparent that while existing law permits the creation of 
county, city-county, or multi-county health units in Minnesota, action 
is not probable because of the complexity of agreements with all the 
townships in a county. 
HEALTH UNITS IN OTHER STATES 
Thirty-seven states have enabling legislation permitting the for- 
mation of county, city-county, or multi-county local health units. In two 
of these states, Maryland and New Mexico, such legislation is mandatory 
rather than permissive. As of March 19480 34 per cent of the 3,060 coun- 
ties in the nation were served by local health units created under such 
legislation. In addition to the local health units created under these 
laws, information obtained from the American Public Health Association 
indicates that other counties are served by local health units either on 
an informal basis or a different legal foundation. In 1947 it was re- 
ported that two-thirds of the nations population was served by full-time 
local health units in 1,372 counties (45 per cent of all counties).1 (See 
Appendix Table B). This indicates that such units are predominately in 
urban areas. 
Thus study is concerned primarily with the incidence of and the 
effect of enabling legislation for county, city-county, and multi-county 
health units. Thus the emphasis is on units created under enabling 
legislation. 
1. American Public Health Association, Proceedings of the National Con- 
ference on Local Health Units. September,, 1947n facing p. 1. As of March 1948, as pointed oat in Table I, 34 per cent of the 
counties in the nation were served by local health units created pursuant 
to enabling legislation in 35 states and mandatory laws in two states. The 
Ip034 counties thus served comprised 43 per cent of the 2,407 counties in 
the 37 states having a statutory basis for county, city-county, and multi- 
county health units. While the degree of coverage varies from state to 
state, less than half of the counties in the nation which have the author- 
ity to do so have either established a single county health unit or en- 
tered into a city-county or multi-county health unit. 
ACTION IN THE NEW ENGLAND STATES 
In the six New England States the counties are not important 
units of government. Therefore it is not surprising to learn that in 
March 1948, none of the 62 counties in these states were covered by coun- 
ty, city-county, or multi-county health units created under grants of au- 
thority in enabling legislation. (See Appendix Table C). Three of the 
states, Connecticut, Maine, and Massachusetts, have laws permitting the 
formation of joint local health units. However, since the county is not 
an important unit of government in these states, emphasis is placed upon 
joint action of towns rather than counties to form local health districts 
New Hampshire has no law permitting the formation of joint local health 
units; although the state board of health, upon request of the board of 
selectmen of the towjs, is authorized to appoint a health officer to 
serve several towns. Counties are not organized in Rhode Island and the 
state is divided into four health districts. Vermont has no permissive 
laws for county or district health units. 
Thus, not a single county is served by a county health unit in 
New England. However, provision is made in four of these states for the 
towns to act together and one other state is completely covered by four 
health districts. Conditions in these states are hardly comparable to 
those in Minnesota, because of differences in urbanization, population 
density, traditions, and the like. The main point is that there are no 
county, city-county, or multi-county health units in New England because 
the county is unimportant in these states. 
ACTION IN THE SOUTHERN AND WESTERN STATES 
In the 26 southern and western states which do not have town- 
ships, as of March, 1948, 22 states had enabling legislation for county, 
city-county, or multi-county health units. (See Table I and Appendix 
Table D). Of the 1,758 counties in these 26 states, 868 or 49 per cent 
1. Haven Emerson, Local Health Units for the Nation, p. 187 have acted pursuant to such legislation. These 868 counties are 62 per 
cent of the 1,403 counties in the states having enabling acts. Thus 
states where the county form of local government predominates have the 
vast majority of all local health units so created. 
In these states in which the county is the only local govern- 
ment in rural areas it was almost inevitable that the counties would 
act in the field of public health. Thirteen of these states passed en- 
abling acts prior to 1940, one, Georgia,, as early as 1914. Two states9 
Maryland and New Mexico9 have mandatory laws. Every county in Maryland 
must have a county health department9 and the county health officer also 
serves as a deputy state health officer. The New Mexico act groups the 
31 counties into 10 districts with the district staffs appointed and paid 
jointly by the State and the district. The proportion of counties served 
by local health units created pursuant to permissive or mandatory legis- 
lation ranges from one out of 58 in California to all counties in Alabama, 
Maryland, New Mexico,, and South Carolina. It is noteworthy that two of 
the four states which have complete coverage are states which have man- 
datory rather than permissive legislation. 
These four states are the only ones which have statewide cover- 
age through either permissive or mandatory legislation.. In County Fi- 
nances. 1944 prepared by the Bureau of the Census of the U. So Department 
of Commerce, it was reported that per capita expenditures for public 
health services in 1944 by the counties in Alabama ranged from $.30 to 
$1.00 per capita; in Maryland, from $.14 to $.81; in New Mexico, from $.14 
to $.76; and in South Carolina, from $.04 to $.65 per capita. The figures 
are obtained through a sampling process, and there may be counties in 
these states with higher or lower expenditures for public health than in- 
dicated. However, the figures do indicate that statewide coverage means 
little if money is not available to finance local health units. 
It is not surprising that these states, organized on a county 
basis for local government, have taken the lead in the creation of county, 
city-county, and multi-county health departments. Their form of local 
government predisposed them to act on a county basis. Several diseases 
are more prevalent in the rural South than in other parts of the country, 
and this fact, together with the greater economic need of some areas, 
prompted the Federal government to lend financial assistance for public 
health programs during the last depression.. This probably stimulated 
action by southern counties because the most expedient means of trans- 
mitting federal funds to a locality is through the county. These southern 
and western states which do not have townships have proceeded furthest in 
county action in the field of public health. ACTION IN THE MIDDLE ATLANTIC AND MIDDLE WESTERN STATES 
Beginning in the Middle Atlantic States and proceeding westward 
through the Middle West, local government combined the pattern of New 
England with that of the South and organized both counties and townships. 
The presence of townships has hindered the development of public health 
functions at the county level, because the township has been considered 
the proper unit of government to have jurisdictions over health matters 
in rural areas. 
The role of the township with respect to public health in rural 
areas has been set forth as follows; “Until full-time, well-rounded 
health organizations were recognized as the most satisfactory mechanism 
for ensuring effective local health service, it is likely that the town- 
ship system, with a part-time health officer for each small community, 
was the more productive. Other things being equal, this health officer 
had the advantage of a small jurisdiction, from no part of which could 
he be very distant. In many instances, though, he was a lay person 
rather than a physician, and this had its drawbacks. The county system 
of the southern states provided a part-time physician for the entire 
county. He served as health officer and not infrequently as jail and 
poorhouse doctor. His great disadvantages were that he had a very large 
territory and was paid from nothing to a couple of hundred dollars a 
year.wl 
Twelve of the 16 states which have both townships and counties 
as important units of local government have enacted enabling legislation 
for county, city-county, or multi-county health units- (See Table I and 
Appendix Table E). Minnesota is one of the four township-county states 
which as of March 1948, had no specific enabling act- In these 16 states 
166 counties, comprising only 13 per cent of the total of 1,240, were 
served by local health units created pursuant to such enabling acts. The 
166 counties were only 17 per cent of the 966 counties in the 12 states 
with enabling laws. 
It is apparent that the township-county states have, as a group, 
had relatively slight use made of their enabling legislation. As of 
March 1948, Michigan had 71 of its 83 counties served by local health 
units created under the authority of its enabling act. Michigan has 
greater coverage than any other state in the township-county group. At 
the other extreme was Wisconsin with only one of its 71 counties taking 
1. Harry S. Mustard, Government in Public Healths p, 123. advantage of its permissive legislation. North and South Dakota had 14 
out of 53 and 2 out of 64 counties, respectively, which had taken advantage 
of their laws. Iowa, like Minnesota, had no specific enabling act. 
While Minnesota has no specific permissive legislation, the great- 
er part of the population of Hennepin and Ramsey Counties, which contain 
Minneapolis and St. Paul, is served by full-time local health departments. 
In addition to this metropolitan area, there is also a city-county unit 
serving Rochester and Olmsted County, and a county health department serv- 
ing rural St. Louis County - the City of Duluth has its own health depart- 
ment. Thus, a total of four counties in the state have, in a large measure, 
already achieved full-time local health services without specific enabling 
legislation. In 1947, almost one-third of the population of the state was 
served by full-time local health units.-1- 
The preceding analysis of what has "been done throughout the nation 
was aimed at establishing the incidence of enabling legislation for county, 
city-county, and multi-county health units, and the extent to which such 
permissive legislation has been utilized by the counties in the various 
states. It did not, and was not intended to measure the extent to which 
various areas are served by full-time local health units. The latter is 
set forth in detail in Appendix Table B, which reveals that in 1947, two- 
thirds of the people in the country were served by full-time local health 
units. Such health units may or may not have been created under grants of 
authority in specific enabling legislation. Since more counties are listed 
as being served by local health units, in Appendix Table B than in Appendix 
Table A, it follows that the difference is due to counties acting informal- 
ly or under a different type of law. 
1. American Public Health Association, Proceedings of the National Con- 
ference on Local Health Units. September. 1947. facing p. 1. (Ap- 
pendix Table B.) STATE PUBLIC HEALTH SERVICES IN MINNESOTA 
The Minnesota Department of Health is the one state agency pri- 
marily concerned with public health. For the most part, it is not a 
direct service agency, but rather serves in an advisory and supervisory 
relationship with local health departments and in a cooperative relation- 
ship with other state agencies. Federal and state grants-in-aid to local 
health agencies are channeled through the State Health Department. 
Preventable disease control is a major function of the Depart- 
ment. This involves such communicable diseases as tuberculosis and ve- 
neareal diseases. 
Environmental sanitation is a second broad phase of the Depart- 
ments program. This includes hotel and resort inspection, supervision 
of plumbing installations, industrial health programs, municipal water 
supplies, and control of water pollution. The inspection of hotels and 
resorts is a direct service program, which often overlaps with the sani- 
tary inspections of the Department of Agriculture, Dairy and Food. 
As its main laboratories in the Twin Cities and its branch lab- 
oratories in Duluth, the Department provides an extensive direct service 
program. Specimens are sent to the laboratories and reports are made to 
assist in the diagnosis of diseases as well as to check the safety of 
water supplies and the like. Biologicals for immunization and treatment 
may also be obtained from the laboratories. 
Public health education is another important phase of the De- 
partment’s program. This involves advising local health agencies as 
well as conducting broad publicity programs. The Department works 
closely with the University Medical School in training doctors and 
nurses for public health services. 
Vital statistics is another basic function of the State Health 
Department. This involves the collection, analysis, and exchange of 
data relating to sickness, accidents, births and deaths. 
The State Health Department works closely with public health 
nurses employed by counties and municipalities. The Division of Public 
Health Nursing provides advice and supervision as well as financial as- 
sistance to the county nursing programs. 
There are also maternal and child health services and dental 
health services which are mainly of an advisory and supervisory nature. Another direct service program is the licensing of hospitals as 
well as the licensing of embalmers and funeral directorso 
STATE HEALTH DISTRICTS 
Interspersed between the central offices of the State Department 
of Health and local health departments are State Health Districts. As of 
July 1, 19480 the entire State was covered by eight State Health Districts 
which in a real sense are field offices of the State Department of Health, 
although not all state-local contact is channeled through them.. 
Each of the eight district offices serves from six to thirteen 
and two-thirds counties (Cass County is divided and served hy two districts) 
The population in each district is well over 200„000 and the area of the 
districts ranges from 4C000 to 20„000 square miles. Figure I shows the 
location and composition of the State Health Districts.. 
The authorized staff of each of these district offices is com- 
posed of a medical health officer, a sanitary engineer, a public health 
nurse, and clerical help. However, not all district offices are fully 
staffed because of the shortage of trained personnel* It is apparent 
from the size of the area served and the population served that such a 
limited staff can not give intensive service to everyone in the district. 
Direct service is not the objective of these State Health Districts. 
Rather, their function is to advise, coordinate, and assist the existing 
local health agencies. Thus, it is not a direct service program, but an 
indirect program aimed at improving local health services. The profess- 
ional members of the staff cooperate with their counterparts in local 
health agencies. 
State Health District activities are financed by the State and 
Federal Governments on a matching basis under The Public Health Service 
Act of 1944. 
One might well wonder what would be the role of these State 
Health Districts if enabling legislation for county, city-county, or 
multi-county health units were enacted. In all probability their function 
would not be materially altered. Much depends on how many local health 
units would be created under such legislation, and funds available for 
staffing and services to the people. Experience in' other states in- 
dicates that counties are slow to act under enabling laws. If some 
counties utilize such legislation while others do not, there would be 
a need for the State Health Districts to carry on in those areas not 
served by local health units. There are indications that even if per- 
missive legislation would result in statewide coverage by local health 
units, there may be more than the ten local units outlined for Minnesota in Dr. Haven Emerson's Local Health Units for the Nation. The more local 
health units there are, the greater the necessity for State Health 
Districts to coordinate local health work and serve as a point of con- 
tact between the state and local health departments. The Department of 
Health has indicated that it has no desire to expand State Health 
Districts into a direct service program, hut that it would curtail 
district functions when local health units are able to meet the needs. LOCAL ORGANIZATION FOR PUBLIC HEALTH 
IN MINNESOTA 
Minnesota has a total of 2,700 counties, cities, villages, and 
townships, each of which is permitted by law to have its own public health 
organization. At the beginning of August 1948, 57.8 per cent of these 
overlapping jurisdictions were reported to have medical health officers, 
most of whom were on a part-time or fee basis. There was a total of 687 
medical health officers serving 1,561 local units of government in the 
state - many doctors serve as health officers for more than one political 
subdivision. All but two of the 87 counties had medical health officers 
as required by statute. Le Sueur County had no health officer, and Carver 
County had neither a health officer nor a county board of health. Medical 
health officers served all of the 100 cities, 634 of the 668 villages, and 
only 742 of the 1,845 organized townships in the state.^ 
TABLE II 
MEDICAL HEALTH OFFICERS IN POLITICAL SUBDIVISIONS IN MINNESOTA 
(August 1948) 
Unit of Gov8t. 
Kind 
Number 
Medical Health 
Officers 
Per Cent 
Served 
County 
87 
85 
97.7 
City 
100 
100 
100.0 
Village 
668 
634 
94.9 
Township 
1.845 
742 
40.2 
Total 
2,700 
1,561 
57.8 
Source; Minnesota Department of Health 
COUNTY BOARDS OF HEALTH 
All counties are required by Section 145.01 of Minnesota Statutes 
1945 to have a county board of health composed of two county commissioners 
and a resident physician,, all of whom shall be chosen yearly at the annual 
meeting of the county commissioners. The physician shall be the county 
health officer and executive of the board. The compensation of county 
health officers is prescribed by the county board of health or county board 
of commissioners and„ together with their necessary expenses,, is paid by 
the counties. 
1. Minnesota Department of Health, data as of August 5, 1948. County boards of health have jurisdiction over all unorganized 
towns within the county* They are vested with such other powers and 
duties with reference to public health as are prescribed in the regu- 
lations of the State Board of Health. Those regulations which pertain 
to county boards of health follows 
HReg. 5. The several county health officers shall make 
quarterly reports to the Minnesota State Board of Health 
as to the general sanitary condition of their counties, 
such reports bearing especially upon matters relating to 
communicable diseases* Especial attention must be given 
to the reporting of rabies and glanders. 
wReg. 6, The several county health officers shall keep 
close watch over apparent epidemic or endemic diseases 
existing within their jurisdiction, and if a question 
arises as to the proper care of such diseases, they 
shall notify the secretary of the State Board of Health 
in order that an investigation may he made. 
wReg. 7. If a county health officer has knowledge of, or 
a reasonable belief that the returns of births and deaths 
for his county are not being made as required by law, he 
shall immediately report such fact or suspicion to the 
secretary of the State Board of Health, 
wReg, 8. The several county health officers shall note 
the condition of slaughter houses, rendering establish- 
ments, starch factories and paper mills within their 
jurisdiction, and shall report such conditions to the 
secretary of the State Board of Health from time to 
time, as necessary, or upon the request of said secre- 
tary. 
wReg. 9. County boards of health shall at all times 
bring to the attention of the secretary of the State 
Board of Health any conditions which they may deem in 
need of sanitary regulation. 
nReg.. 10. The county health officers shall assemble at 
the call of the Minnesota State Board of Health once a 
year to discuss general sanitary problems and to present 
at such conferences the special sanitary needs of their 
individual districts. MRef;. 11. County health officers shall make such investi- 
gations and reportss and obey such direction relating to 
sanitary problems# as shall be prescribed from time to 
time by the State Board of Healtho 
12. Upon the application of not less than five (5) 
county health officersa the State Board of Health shall 
call a special conference to discuss special or local 
sanitary problems, the time and place of meeting to be 
determined by the State Board of Health.11'*’ 
From the above it would appear that county boards of health, have 
broad powers with respect to public health. In addition to the above, the 
county boards of health may be vested, "with such other powers and duties 
in reference to the public health as the state board shall by its publish- 
ed regulations, Thus, the State Board of Health at present 
has the power to exercise considerable authority over local health functions 
through the county boards of health. However, it is reported that these 
regulations of the State Board of Health are generally not enforced or ad- 
hered to. 
MUNICIPAL BOARDS OF HEALTH 
Section 145.01 of Minnesota Statutes 1945 requires every city and 
permits every village to establish a board of health having jurisdiction 
within the corporate limits of the municipality. It further provides that 
at least one member of each local board of health must be a physician who 
shall be the local health officer and executive of the board. Compensation 
of local health officers is determined by the local board of health or 
municipal governing body and both compensation and necessary expenses are 
to be paid by the municipalities which they serve. 
TOWNSHIP BOARDS OF HEALTH 
"....Every town board shall be a board of health within and for 
the town and have Jursidiction over every village within its boundaries 
wherein no organized board of health exists. ... At least one member of 
every local board shall be a physician,, who shall be the local health of- 
ficer and executive of the board. If no member of a town board is a 
physician,, it shall appoint a health officer for the town. ..."® Town 
boards are authorized to compensate health officers for their services 
and expenses incidental to the performance of their duties. 
1. Minnesota State Health. Laws and Regulations,, p. 15 f. 
2o Minnesota Statutes, Section 145o01o 
3. Minnesota Statutes 1945, Section 145.01, DUTIES COMMON TO ALL LOCAL BOARDS OF HEALTH 
"All local "boards of health and health officers shall make such 
investigations and reports and obey such directions concerning communica- 
ble diseases as the state board may require or give; and, under the gen- 
eral supervision of the state board they shall cause all laws and regu- 
lations relating to the public health to be obeyed and enforced. 1 "All 
local health boards of each county shall cooperate so far as practicable 
and the state board by written order may require any two or more local 
boards to act together for the prevention or suppression of epidemic 
diseases. 
"Section 145.05. Powers of health officer in assuming 
jurisdiction over communicable diseases. The health 
officer in a municipality or the chairman of the Board 
of supervisors in a town shall employ, at the cost of 
the health district over which his local Board of health 
has jurisdiction and in which the persan afflicted with 
a communicable disease is located, all medical and other 
help necessary in the control of such communicable dis- 
ease, or for carrying out, within such jurisdiction, the 
lawful regulations and directions of the state Board, 
its officers or employees, and, upon his failure so to 
do, the state Board may employ such assistance at the 
expense of the district involved. Any person whose 
duty it is to care for himself or another afflicted with 
a communicable disease shall Be liable for the reasonable 
cost thereof to the municipality or town paying such 
cost, excepting that the municipality or town constitut- 
ing such district shall Be liable for all expense in- 
curred in establishing, enforcing, and releasing quaran- 
tine, half of which may Be recovered from the county, 
as provided for under sections 145.06 and 145.07."3 
LOCAL UNITS OF GOVERNMENT MAY ACT JOINTLY TO PROVIDE PUBLIC HEALTH SERVICES 
The Minnesota Department of Health in January of 1948 issued the 
following statement pointing to a lack of legal authority for the creation 
of a multi-county public health units 
"The Hospital Survey and Construction Act provides a State 
allowance of public health centers within a maximum of 
1* Ibid., Section 145.03. 
3. Ibid., Section 145.01. 
3. Ibid., Section 145.05. one per 30,000 of population which would permit 94 such 
centers for Minnesota. However, a plan for the con- 
struction of public health centers in Minnesota cannot 
be completed until such time as the Minnesota statutes 
are modified to allow for the development of local 
health Jurisdictions. These Jurisdictions should con- 
tain areas and populations of sufficient size so as to 
permit the organization of efficient and economical 
full time health services. To accomplish such organi- 
zation new legislation must be enacted so as to enable 
counties to establish or Join together in the establish- 
ment of local health departments, to provide for the 
financing of such units and to provide for the promul- 
gation and enforcement of reasonable regulations of 
local application for the preservation of the public 
health.111 
However, in a compilation of state health laws and regulations 
issued by the Health Department in January of 1948, it cited the follow 
ing statute; 
11 Sec. 471.59. Joint exercise of powers. Subdivision 
1. Agreement. Two or more governmental units, by 
agreement entered into through action of their govern- 
ing bodies, may Jointly exercise any power common to 
the contracting parties. The term ’governmental unit’ 
as used in this section includes every city, village, 
borough, county, town, and school district. 
"Subd. 2. Agreement to state purpose. Such agreement 
shall state the purpose of the agreement or the power 
to be exercised and it shall provide for the method 
by which the purpose sought shall be accomplished or 
the manner in which the power shall be exercised. 
”Subd. 3. Disbursement of funds. The parties to such 
agreement may provide for disbursements from public 
funds to carry out the purposes of the agreement. 
Funds may be paid to and disbursed by such agency as 
may be agreed upon, but the method of disbursement 
shall agree as far as practicable with the method 
provided by law for the disbursement of funds by the 
parties to the agreement. Strict accountability of 
all funds and report of all receipts and disbursements 
shall be provided for. 
1. Minn. Department of Health, 1948 Minnesota Flan for Hospitals and 
Public Health Centers, p. 21. “Subd. 4. Termination of agreement. Such agreement may 
be continued for a definite term or until rescinded or 
terminated in accordance with its terms. 
MSubd, 5. Shall provide for distribution of property. 
Such agreement shall provide for the disposition of 
any property acquired as the result of such joint ex- 
ercise of powers, and the return of any surplus moneys 
in proportion to contributions of the several contract- 
ing parties after the purpose of the agreement has been 
completed. 
MSubd. 6. Residence requirement. Residence requirements 
for holding office in any governmental unit shall not 
apply to any officer appointed to carry out any such 
agreement. 
"Subd. 7. Not to affect other acts. This section does 
not dispense with .procedural requirements of any other 
act providing for the joint exercise of any govern- 
mental power."! 
It would seem that the grant of authority to combine for joint 
exercise of powers contained in Section 471.59 of Minnesota Statutes 1945 
is broad enough to permit the establishment of multi-county public health 
units. Authority to act in the field of public health is common to all 
local governmental units in Minnesota. It would, therefore, seem that 
multi-county public health units would come within the scope of the law 
even as interpreted in the following manner; 
“According to an opinion given unofficially by the at- 
torney general's office, this provision must be con- 
sidered both as an authorization and a limitation - 
that is, it allows for joint administration of those 
services, and only those services, which are 'common 
to the contracting parties'; it does not afford a 
blank check for the joint exercise of authority, re- 
gardless of whether the activities are related or 
not."2 
Although the law provides ample authority for the creation of 
full-time county, city-county, or multi-county health units, it is ap- 
parent that great difficulty would be experienced in getting the govern- 
ing bodies of the various units of local government to enter into stable 
contractual agreements. 
1. Minnesota State Board of Health, Minnesota State Health Laws and Regu- 
lations, p. 16o 
2. Council on Intergovernmental Relations, A Study of Public Health Adminis- 
tration in Blue Earth County. Minnesota, p. 82. INTERGOVSRNMSNTAL COOPERATION IN PROVIDING PUBLIC HEALTH SERVICES 
As indicated in the above examination of statutes dealing with 
public health activities of local units of government, such services are 
a product of state-local cooperation. In addition, the federal govern- 
ment cooperates with state and local units of government in the provision 
of public health services. Furthermore, there may be cooperation among 
various local units of government to provide these services. Thus the 
provision of public health services in the local community involves inter- 
governmental cooperation of varying degrees of effectiveness and complexity. 
Some idea of the impact on a community of this multiplicity of 
effort may be gained from the following excerpt from the Council on Inter- 
governmental Relations study of public health administration in Blue Earth 
County. This county was selected by the Council as a representative county, 
and the observations might well apply in general to many other counties in 
the state. 
’’The weakness of the existing system of public health adminis- 
tration is not due to lack of organization by any single unit 
or agency in the field of public health, but rather, to the 
disconnected operation of the many agencies engaged in similar 
activites. Adequate means of harnessing the energies and re- 
sources of each in a common endeavor is lacking, thus causing 
an inevitable duplication of effort in like service. 
’’Federal-state administrative relations in the field of public 
health can be traced without too much difficulty. Of the two 
approaches generally used in administration grants-in-aid and 
direct action in the field, the former has been put to most 
frequent use. The U. S. Public Health Service, the Children's 
Bureau, the Office of Indian Affairs, and the Social Security 
Board have left most of their actual health work in the hands 
of state and local governments, and exist to establish and 
maintain standards and supervise aid in the administration of 
federal funds. On the other hand, the Food and Drug Adminis- 
tration and the Farm Security Administration operate their 
own action programs in the field, and by-pass state and local 
organization. 
"State-local relations have been clearly provided for in the 
statutes. Local health hoards are directly responsible to 
the state hoard for the enforcement of health laws. In 
practice, however, the state hoard considers the actual en- 
forcement of these laws to he the special duty and responsi- 
bility of the local hoards of health, the health officers of villages and cities, and the chairman of town hoards of 
healtho Local hoards of health are also required to col- 
laborate with the State Livestock and Sanitary Board in 
matters relating to disease among animals. Again, in 
practice, .... these lines of control are not effective, 
due partly to the strong spirit of independence among 
local units and partly to the hands-off policy arrived at 
hy the State Board of Health. 
"The community, the meeting-point of the various health pro- 
grams, is where the disconnected operations of the various 
health organizations are most evident. 
“It is true that the state listrict Health Unit, supported 
hy federal funds, represents a significant attempt to gear 
the state health department more closely in the community 
hy cooperative rather than compulsory methods. The district 
health unit has succeeded in decentralizing some of the 
State11 s services and in establishing close relationships 
with nursing staffs of the various counties. It has not, 
however, nor was it intended, to provide the over-all co- 
ordination needed under the present system of community 
government. 
"It is also true that there are statutory provisions which 
might serve to offset the isolation in which local health 
"boards continue to operate. The first (Chapter 145, 
Minnesota Statutes 1942) states that °all local health 
"boards of each county shall cooperate as far as practicable 
and the state board by written order may require any two 
or more local health boards to act together for the pre- 
vention or suppression of epidemic diseases1. The second, 
(Chapter 557 of the Laws of Minnesota for 1943) provides 
that 11 two or more local governmental units, by agreement 
•entered into through action of their governing bodies, may 
Jointly exercise any power common to the contracting parties' 
That neither of these provisions has been called into play 
so far is due, first, to absence of any severe epidemics or 
acute health problems in the community, and second, to the 
fact that local boards of health are very seldom active."^ 
1. Council on Intergovernmental Relations, A Study of Public Health 
Administration in Blue Earth County„ Minnesota, p. 74 f. ADMINISTRATIVE COMPLEXITY 
The foregoing indicates to some extent the problems involved in 
local public health administration in Minnesota. Administration of public 
health services in Minnesota is extremely decentralized. Every city must 
and every village may create a local board of health and appoint a health 
officer, who usually serves part time. For rural areas, every town board 
is the board of health for the town as well as for villages within it 
which have not exercised their option of creating a village board of 
health. County boards of health have jurisdiction over unorganized town- 
ships plus a few other powers and duties. 
Many State Agencies in the Public Health Field 
Not only is there a multitude of units of local government in the 
field of public health, there is also an overlapping of jurisdiction and 
function of state agencies. Of prime importance is the Minnesota Depart- 
ment of Health which serves mainly as a supervisory and coordinating 
agency rather than direct-service activity. Several other state agencies 
have an interest in the health of particular segments of the population: 
the Department of Education is interested in the health of school children 
and teachers, the Department of Labor and Industry is concerned with the 
health of industrial workers, the Railroad and Warehouse Commission with 
the health of Railroad employees and the traveling public, the Division 
of Social Welfare is interested in the health problems of recipients of 
public assistance and certain categories of handicapped persons, and the 
Division of Institutions is responsible for the health needs of the in- 
stitutional population. In addition, the Live Stock Sanitary Board deals 
with animal health problems which may affect human health, the Department 
of Agriculture, Dairy, and Food serves to insure that food supplies are 
safe, and the Department of Conservation and the Water Pollution Control 
Commission are also concerned with the pollution of streams and waterways. 
Absolute functional organization is difficult to achieve. In 
fact there are reasons why it may not be desirable. From the standpoint 
of functional organization, such an extreme dispersal of the health func- 
tion as exists in the State of Minnesota is undesirable. The situation 
where the Department of Health and the Department of Agriculture, Dairy, 
and Food both inspect public eating places is particularly poor from the 
standpoint of integrated and economical administration. 
The present organizational structure for the provision of public 
health services in Minnesota is cumbersome,, unintegrated, and uncoordinated. 
Benefits could be derived from an effective, simple organizational structure 
to administer public health activities in the State. PUBLIC HEALTH NURSES 
Since 1919, there has been statutory authority for units of local 
government to hire public health nurses.^- Sections 145.08-12 of Minnesota 
Statutes 1945 deal with public health nurses. Section 145.08 authorizes 
local governing bodies ”to employ and to make appropriations for the com- 
pensation and necessary expenses of public health nurses, for such public 
health duties as may be deemed necessary”. Public health nurses must be 
registered in Minnesota,, and, in addition, must have a minimum of one 
year of special preparation in public health nursing. The State Board of 
Health is directed to furnish local governing bodies with a list of nurses 
qualified for public health work; and it is also directed to aid and advise 
public health nurses, who in turn are to make written reports through the 
board employing them to the state and local boards of health in such form 
and at such times as prescribed by the state board. 
Section 145.12 provides that the board of county commissioners 
may detail county public health nurses to act under the direction of the 
three-member county board of health or a nursing committee composed of 
at least five members, as follows; 
1. The county superintendent of schools; 
2. the county health officer or a physician appointed hy the 
county commissioners; 
3. a county commissioner appointed "by the hoard of county com- 
missioners ; 
4. two residents of the county appointed hy the county com- 
missioners. 
It is noteworthy that the county commissioners, in addition to the County 
Board of Health, nay create a special nursing committee to advise and 
supervise the county public health nurses. Sound principles of organi- 
zation would provide that county nurses perform their duties under the 
immediate supervision of one supervisory body. While this is the situ- 
ation under the provision of the law, it is possible that County Nurses 
would not be under the supervision of the County Health Officer. 
The counties have not been quick to act in this field. By 1936, 
there were 33 county nurses in 25 counties; by 1945, there were 48 in 35 
counties; and, as of June 30, 1948, 64 of the 87 counties had made pro- 
visions for the employment of 93 public health nurses, and, as of that 
date, 50 counties employed 74 public health nurses — 19 nursing positions 
were vacant because of a widespread shortage of trained personnel. As of 
1. Session Laws of Minnesota 1919, Chap. 38, Sec. 1. July 1, 1948, five of these vacancies were scheduled to he The 
extension of county nursing services was much more rapid from 1945 to 
1948 than it was during the decade preceding 1945. However, in 1948 there 
were still 23 counties with no definite organization for rural nursing 
service. (See Appendix Table F) 
A factor of considerable importance in connection with this 
recent activity is Chapter 54 of Session Laws 1947, which provides for a 
grant-in-aid of $1,500 per year from the State to each county maintaining 
a public health nursing program. Since the enactment of this law, 12 
counties established nursing services because of assistance from state 
aid; eight counties with services established prior to 1947 have increased 
their nursing programs by employing additional nurses through assistance 
from state aid; and three other counties have acted to employ an addition- 
al nurse but have not been able to fill their vacancies. (See Appendix 
Table G). 
In addition to the above financial assistance from the State, 
county nursing activities may receive grants-in-aid for cancer, tuber- 
culosis, venereal diseases, and maternal and child health. (See Appendix 
Table H). For the most part these are distributions to the localities of 
funds received by the State as grants-in-aid from the Federal Government. 
In addition to these grants from public funds some private agencies, such 
as the American Cancer Society, allocate funds for support of county public 
health nursing programs. 
In addition to public health nurses employed by counties, there 
are also nurses engaged in public health services conducted by munici- 
palities and schools as well as by private groups. Appendix Table I 
shows that as of April 1, 1948, only about one-tenth of all nurses engaged 
in public health and industrial health activities were in the employ of 
counties. Thus the bulk of public health nursing activities in the State 
is carried on by agencies other than the counties. Since the county is 
the only one of the listed organizations likely to carry on a generalized 
public health nursing program in rural areas, it follows that rural 
Minnesota is least adequately served by public health nurses. 
The public health nurse bears a relation to public health that 
is similar to the relation of the professional social worker to the 
social welfare program. It is the public health nurse who enters homes 
in the community and is the direct contact between the public health pro- 
gram and the citizen. A public health nurse is a professional person 
who, v/ith adequate community support and cooperation, can do much to 
elevate health standards in the community. 
1. Minnesota Department of Health. PRESENT COUNTY HEALTH UNITS 
THE ROCHESTER-OLMSTED COUNTY HEALTH UNIT 
The City of Rochester, home of the Mayo Clinic, is in a unique 
position with respect to resources for and community interest in health 
services. It is unique also in the extent of its public heslth problem 
because of the large transient population, many of whom are potential 
spreaders of disease. It is, therefore, not surprising that, in Minnesota, 
the only approach to a city—county health unit is found in Olmsted County. 
It is highly unlikely that any other community in the State could utilize 
the same approach toward providing community health services. It is also 
unlikely that any other community in the State would need a local health 
program as comprehensive as that of the Rochester-Olmsted County Health 
Department. Nevertheless, the Rochester-Olmsted County Health Unit does 
demonstrate what can be done under existing statutes as a result of local 
interest and initiative. 
Organization 
The Rochester-Olmsted County Health Unit is not a true city- 
county health department. It is essentially a voluntary feneration of 
public health agencies functioning in the community. The Rochester Board 
of Public Health and Welfare and the Rochester Board of Education in 1943 
agreed to combine their nursing services under a qualified supervisor. 
In 1946, the four rural nurses of Olmsted County were brought into the 
central nursing office to serve under the supervision of the nursing 
director. Administrative unity of this nursing program was provided by 
appointing the city health officer as county health officer and director 
of school health services in the city. 
In 1944 the Rochester Child Health Institute was created to 
carry on a project of service, education, and research in child health 
for all children in the community. The services of the Institute are 
furnished to the community without charge through funds provided by the 
Mayo Association and various other outside agencies. Pay clinics are 
conducted at St. Mary's Hospital. The Institute provides a more com- 
prehensive preventive medical program than had earlier been offered 
in child health clinics held in the clinic rooms of the City Hall. 
In order to coordinate and integrate the various public health 
services in the community, the Hochester-Olmsted County Health Unit was 
formed in 1946 by resolution of the various official bodies concerned. 
The city-county health officer is permanent chairman of an adminis- 
trative council of three members. The city superintendent of schools 
and the director of the Child Health Institute are the other members of 
the council. In addition to the administrative council there is an advisory 
committee composed of: the nursing supervisor; the public health educator; 
the public health engineer; school principals; the county superintendent 
of schools; a local practicing physician; specialists from the Child Health 
Institute; and representatives from the official welfare bodies, the pa- 
rochial schools, and the district office of the State Board of Health. 
This group meets occasionally to discuss new projects and common needs. 
Financing 
The looseness of the federation is pointed out by the fact that 
the Rochester-Olmsted County Health Unit does not handle any funds. 
Salaries and expenses are paid individually by the various organizations 
participating. For 1947, as shown in Appendix Table J, a total of 
$812,648.75 was expended by the seven participating agencies. This total 
does not include the operating costs of the Child Health Institute nor 
the value of the contributed medical services of the Mayo Clinic. The 
seven agencies are; The Rochester Board of Health and Welfare, the 
Rochester Board of Education, the State Board of Health, the University 
of Minnesota, Olmsted County, the Mayo Clinic, and the W. K. Kellogg 
Foundation. The Rochester-Olmsted County Health Unit serves a population 
of about 52,000 which is slightly greater than the minimum size of a local 
health unit according to the American Public Health Association’s stan- 
dards. Therefore, the expenditures cited above represent a per capita 
amount of approximately $1.60 of which $1.20 comes from public funds and 
$.40 comes from private sources. Funds received from the State amounted 
to over $.17 per capita; while those from city and county sources were 
over $1.02 per capita, with the County’s share amounting to just $.12 per 
capita. Information pertaining to the operating costs of the Child Health 
Institute was not available and therefore the per capita costs cited above 
are lower than they would otherwise be. 
In view of the fact that more than one-fourth of the costs of the 
public health program carried on by the Rochester-Olmsted County Health 
Unit are financed privately, it is apparent that few, if any, other com- 
munities in the State could hope to organize a local health unit along 
the same lines. Other communities just do not have comparable medical 
resources to draw upon. 
Staff 
At the head of the Rochester-Olmsted County Health Unit is the 
Medical Director who is a medical health officer for the City of 
Rochester and for Olmsted County. A public health engineer and two 
sanitarians (one for food and general sanitation, the other for milk) 
make the sanitation staff of the unit stronger than the minimum standards make the sanitation staff of the unit stronger than the minimum standards 
of the American Public Health Association. The nursing staff is composed 
of a public health nursing supervisor, an assistant supervisor, and 12 
nurses. The nursing staff also exceeds the A.P.H.A.5s minimum standards. 
The clerical staff of nine is three times the size of the minimal 
standards. However, one clerk devotes nearly full time to the records 
of the Rochester city hog feeding farm and garbage collection services, 
the personnel and finances of which are not included in this description. 
In addition there are a social service worker and a part-time venereal 
disease investigator as well as a public health educator. 
The above listed personnel provide general public health services 
to the community. Specialized child health services are furnished by the 
Rochester Child Health Institute. These services are given at the City 
Child Health Clinics and St. Mary*s Hospital Clinics. The Child Health 
Institute is staffed by; a medical director, an assistant medical di- 
rector, two medical doctors serving as child psychiatrist and clinic pedi- 
atrician, two child psychologists, a nutritionist, a statistician, and a 
director of preschool activities. 
The Mayo Clinic provides medical services for the health unit 
maternity and child health clinics, school health examinations and the 
mental health program now under development, also X-ray services and inter 
pretation, routine and special laboratory facilities, and in addition, 
gives the health program wholehearted support in many ways including 
technical advice in the various basic sciences and medical specialties. 
It is apparent that the staff outlined above is considerably 
larger and more varied than that of; a medical health officer, a sani- 
tary engineer, a sanitarian, ten public health nurses, and three clerks 
considered minimal by the American Public Health Association. It would 
seem that the staff is rather heavily weighted toward child health 
services. While this appears to distort somewhat the provision of well- 
rounded public health services in the community, a more proper conclusion 
is that comprehensive services are provided with additional emphasis on 
child health. In addition to the child health services, the Institute 
conducts extensive research and teaching programs in child growth and 
development. There are now five Mayo Foundation Fellows and two medical 
assistants to the Institute regularly participating in these programs. 
It is reported that without these responsibilities the Institute staff 
could be decreased to one-third the present size. 
Functions 
The Rochester-Olmsted County Health Unit carries on the six 
functions of a local health unit, namely; (l) vital statistics, (2) sanitation, (s) control of communicable and preventable diseases, 
(4) laboratory service, (5) maternal and child health, and (6) public 
health education. 
The Health Officer is the administrator and is responsible for 
communicable disease control, budgets, purchasing, personnel, statistical 
studies, and the like. 
Minnesota Statutes provide that local registrars of vital sta- 
tistics shall be town and village clerks and city health officers. Ex- 
cept in cities of the first class, local registrars transmit original 
certificates to the county clerks of court.1 Thus state law prevents 
the complete integration of the collection of vital statistics for Olmsted 
County by the City-County Health Unit. The Health Officer is the regis- 
trar of vital statistics for the City of Rochester and the staff collects 
and analyzes morbidity and mortality data. 
Sanitation is the special concern of the public health engineer 
and the two sanitarians. The public health engineer is in charge of the 
sanitation program including? milk control, water sanitation, public 
health aspects of sewage treatment and plumbing, restaurant sanitation, 
other food handling, insect and rodent control, and nuisances. The food 
sanitarian works with food handling in general including; eating and 
drinking places, supervision of water supply, rodent control, and 
nuisances. The milk sanitarian administers milk control under the 
standard U. S. Public Health Service Milk Ordinance adopted in 1939. Six 
pasteurization plants and about 125 farms come under his supervision. 
The program of communicable and preventable disease control is 
carried on under the direct supervision of the health officer. He is 
assisted by public health nurses, staff doctors of the Mayo Clinic, and 
independent physicians practicing in the county. Through the Health 
Unit, immunizations for smallpox, diphtheria, tetanus, and whooping cough 
are offered to all infants and pre-school children in the county, and 
once every year to all school children, with the exception that whooping 
cough immunization is not given in the schools. Recent surveys have 
shown that the percentage of protection ranges from 70 to 90 per cent. 
In connection with the tuberculosis diagnostic and follow-up program, 
chest clinics are held quarterly, and chest X-rays are avilable at cost 
through the Mayo Clinic. Every attempt is made to keep active cases and 
contacts under supervision; at present, about 140 cases and a larger 
number of contacts are being followed. Tuberculin tests are also given 
1. Minnesota Statutes 1945. Sections 144.156 and 144.191. to certain groups. In connection with venereal disease control, no rou- 
tine blood testing is done in any group although such tests are available 
through the Health Unit for diagnosis and the follow-up of treated cases. 
Laboratory service is purchased principally through the Mayo 
Clinic to meet the needs of the various programs carried on by the Unit. 
Additional services are available from the State Health Department. 
Maternal and Child Health is the strongest program of the Unit. 
This is largely because of the privately financed Rochester Child Health 
Institute with its staff doctors and other specialists. Also, the ma- 
ternal health program is materially assisted by obstetricians of the 
Mayo Clinic who serve in the health department prenatal clinics at the 
City Hall. Much of the work of the public health nurses deals with this 
program - - in homes, in schools, and in clinics. Bach nurse serves a 
district and provides all types of public health nursing services within 
that district. Formerly, nurses providing specialized services met only 
those needs, and a home might have several nurses coming in - each pro- 
viding a separate service. As indicated above, much of the communicable 
disease control program is directed at children. The large number of 
rural schools in the county (99) has made it impossible to give the same 
school health services in the rural area as in Rochester. In addition 
to the functions already listed, the public health nursing staff con- 
ducts activities in the fields of dental health, mental health, and bed- 
side care in the home which accounts in part for the relatively large 
number of nurses. 
Public health education is the direct responsibility of the 
public health educator on the staff, although in a real sense every 
member of the staff is engaged in public health education. The educator 
carries on a broad program involving all agencies in the city having an 
interest in health. In carrying out the program, the educator works with 
the schools, participates in meetings, supplies educational materials to 
organizations, and plans publicity and educational programs. 
The above refers to the education of the public about its own 
health- In addition, the Hochester-Olmsted County Health Unit provides 
field training for students of public health. It works in cooperation 
with the University of Minnesota, the Mayo Clinic, and the Minnesota 
Department of Health. This important responsibility requires a degree 
of development and quality of administration not necessary in a local 
health department giving routine services. A large part of the funds 
for this phase of the program come from a W. K, Kellogg Foundation 
Grant. Relation with Other Units of Government in Olmsted Count 
Under Minnesota law, township governments are officially responsi 
ble for communicable disease control in rural areas. Therefore, there 
is a rather cumbersome arrangement under which the Health Officer of the 
Unit and the nurses carry out quarantine measures through the chairmen of 
the town boards of supervisors. No townships are able to carry on any 
planned public health programs but the nursing and medical services from 
the Unit are given throughout the rural area. No tovmships, cities, vil- 
lages, or school districts in Olmsted County conduct regular health pro- 
grams aside from those furnished and supervised through the Unit. 
Relation to State Health District Number Three 
Olmsted County is one of 11 counties in State Health District 
Number Three. Rochester is the headquarters of the District and is the 
operating base of the staff of? a medical officer of health, a public 
health engineer, an advisory public health nurse, and a secretary. 
Services performed by them in Olmsted County are similar to those per- 
formed in other counties of the District, and tend to be confined to 
larger public health problems. 
The district engineer has been working mostly with municipal 
water and sewer plants and with some school and private sanitation prob- 
lems. Some of the smaller communities need help with sewage treatment 
plants and with improvements in their water supplies. 
The district advisory nurse confers with the Rochester-Olmsted 
County Health Unites nursing service on problems of personnel and records 
as they concern state services and other outside nursing services. 
It is reported that there is no overlapping of function between 
the Rochester-Olmsted County Health Unit and the State District Health 
Office.^- Since the Unit is able to provide services that other communi- 
ties do not have, there is a tendency for District Three personnel to 
spend more time in other communities. However, the Unit has found that 
the District is of great aid at times, particularly in the handling of 
difficult problems involved in enforcement procedures. 
Role of State Inspectors in Olmsted Count 
During the year of 1947, inspectors from the State Department 
of Health made 482 inspections of most of the 442 establishments listed 
1. F. M. Feldman, M. D., Dr. Public Health, former Medical Director of 
the Rochester-Olmsted County Health Unit, letter to Minnesota LRC 
dated April 30, 1948. for the CountyInspectors from the State Department of Agriculture, 
Dairy, and Food made 252 inspections during the same year. (See Ap- 
pendix Tables K, L and, M). 
The Rochester-Olmsted County Health Unit carries on a rather 
complete supervisory service over eating and drinking establishments, 
but does not inspect hotels and rooming houses except on specific com- 
plaint. During 1947, inspectors from the State Department of Health 
made only 31 inspections among the 145 hotels listed for Olmsted 
County; while, during the same year, they made 260 inspections among 
the 133 lodging and boarding houses. Since the local health unit makes 
no regular inspections of hotels, it is apparent that they are inade- 
quately supervised. The situation with respect to lodging and boarding 
houses is much better. Thus, in the area of the State which has proba- 
bly the best local health services, lack of coordination between state 
and local agencies results in a rather serious gap in coverage. 
Restaurants and places of refreshment are reported to he 
closely supervised by the Rochester-Olmsted County Health Unit. They 
also received rather close supervision by the Division of Hotel and 
Resort Inspection of the State Department of Health which in 1947 made 
107 inspections among the 73 restaurants and 84 inspections among the 
80 places of refreshment. In addition, the Department of Agriculture, 
Dairy, and Food made 252 inspections during the same year in Olmsted 
County. Some of these inspections were made at the same establishments 
inspected by the Olmsted County Health Department and the Division of 
Hotel and Resort Inspection of the State Department of Health. Thus, 
some of these establishments are subject to inspection by three dif- 
ferent agencies. 
If local health units are to operate effectively, there is 
need for coordination between them and state agencies in the same field. 
In this one respect, at least, the district office of the State Health 
Department was not an effective coordinating agency because of dupli- 
cation provided by law. However, the impact of duplication could have 
been lessened by administrative order to coordinate the inspections 
carried on by the Rochester-Olmsted County Health Department and the 
Division of Hotel and Resort Inspection of the State Health Department. 
Perhaps cooperative agreements could be worked out with the Department 
of Agriculture, Dairy, and Pood. 
THE ST, LOUIS COUNTY HEALTH UNIT 
St, Louis County is the only county in the State which has 
created a county health department. However, it is not a true county 
1« Minnesota Department of Health 
2o Minnesota Department of Agriculture, Dairy and Food. health department in that it does not provide county-wide coverage. It 
does not serve the City of Duluth, and is limited to the unorganized town- 
ships and those organized townships and municipalities which have re- 
quested the County Health Department to administer their health programs. 
It serves about one-fifth of the total population of the County or about 
40,000 persons, a number which is reasonably near the 50,000 standard of 
the American Public Health Association - especially in view of the low 
density of population in rural St. Louis County. 
Organi zation 
The St. Louis County Health Department is organized under exist- 
ing statutes providing for county boards of health, county health officers, 
and county nursing services. Thus, the St. Louis County Health Department 
has a formal organization much more precise than that of the Rochester- 
Olmsted County Health Unit. It is entirely a public organization - not a 
federation of public and private agencies. It is an integrated unit with 
centralized control over finances and personnel. 
Financing 
The St. Louis County Health Department is financed by appropri- 
ations from the Board of County Commissioners. The State Health Depart- 
ment supplements the County appropriations to the extent of paying for 
one full-time nurse, one half-time nurse, and one clerk. The total amount 
budgeted for the calendar year 1948 was $36,120, including state aid. 
This amounted to approximately $.90 per capita for the 40,000 persons 
served. However, county funds came from county-wide levies so that in a 
limited sense, four-fifths of the people in the county were subsidizing 
a service available to only one-fifth. The budget of the Health Depart- 
ment amounted to about $.18 per capita throughout the County. Inasmuch 
as county taxes are levied on property, and property is not uniformly 
distributed among the population, it follows that property taxes are not 
spread uniformly among the population and that per capita expenditures 
of property tax revenues are of use mainly in comparisons between different 
units of government. The cost per person served by the St. Louis County 
Health Department is $.90 as compared with $1.60 per person served by the 
Rochester-Olmsted County Health Unit, which has a broader program. 
No financial contribution for the support of the Department is 
made by any of the townships or villages served by it, except through 
the general tax levy for the support of county affairs. Private con- 
tributions are neither provided for nor prohibited by lav/, and none have 
been made. Staff 
There are nine full-time and three part-time employees in the 
St. Louis County Health Department. At the head of the Department is a 
part-time health officer who is the director of activities and advisor 
to staff members and local health officers. There is a part-time public 
health engineer who carries on a general environmental sanitation program. 
Both the director and the engineer are on the staff of the state district 
office in Duluth, and the engineers’ services are paid for entirely by 
the State. There are six public health nurses, one of whom is part-time 
only, who provide a generalized public health nursing program in St. Louis 
County under the immediate supervision of a public health nurse super- 
visor who also plans and directs programs and policies. In view of the 
fact that the St. Louis County Health Department's program consists main- 
ly of public health nursing and that the health officer serves only part- 
time, the public health nurse supervisor is, in a sense, the administrator 
of the program. In addition, there are three clerical workers on the 
staff. The part-time staff members (the director, the engineer, and one 
nurse) are engaged full-time in public health activities although their 
services are divided between various agencies. Thus, these persons are 
not engaged in part-time public health work and part-time private prac- 
tice, which is considered by some to be particularly undesirable. The 
present budget makes provision for the employment of physicians as needed 
to carry out the physical examinations and immunizations which are con- 
ducted annually by the Department. 
The staff of the St. Louis County Health Department does not 
meet the minimal standards of the American Public Health Association for 
a unit serving a population of 50,000. The health officer is part-time 
rather than full-time as recommended. The engineer serves only part- 
time and there is no sanitarian as considered necessary. The nurses are 
three short of meeting the standard of one to every 5,000 population. 
However, the clerical workers more than meet the criterion of one for 
each 15,000 population. 
Functions 
Vital statistics are the Joint responsibility of town and village 
clerks, city health officers, and the county clerk of court in St. Louis 
County as in other counties of the State. In addition, the Department 
collects and tabulates morbidity reports weekly from all of the County 
except Duluth and submits the information obtained to the State Depart- 
ment of Health. 
Sanitation is the responsibility of the part-time public health 
engineer. No inspections are made of hotels, restaurants, and the like "by the Departmental staff. The engineer serves mainly in an advisory 
capacity to political subdivisions and to individuals in matters affect- 
ing water supplies, sewage disposal and the like. In the course of their 
duties, the public health nurses also promote sanitation. 
Communicable and preventable disease control is carried on by 
the health officer and the nursing staff. The Department works in co- 
operation with Nopeming Sanatorium, the Tuberculosis and Health Associ- 
ation, and county schools in providing chest X-rays and Mantoux tests 
for tuberculosis. The nursing staff carries on a follow-up program for 
tuberculosis cases and contacts as well as for former sanatorium patients 
Immunization clinics for diphtheria and smallpox are conducted for pre- 
school and school children in rural St. Louis County. No clinic service 
is provided for venereal diseases which are followed by the Division of 
Preventable Diseases of the Minnesota Department of Health. 
Laboratory services are not provided by the St. Louis County 
Health Department. However, they are available from the Duluth branch 
of the State Department of Health. St. Louis County and the City of 
Duluth each pay $60.00 per month toward the support of the laboratory. 
This sum is not included in the budget of $36,120. 
Maternal and child health services are provided by the public 
health nurses. The St. Louis County Health Department does not stress 
this phase of its program to an extent that even approaches the wealth 
of child health services provided by the Rochester-Olrasted County Health 
Unit. However, it must be remembered that in the latter case, many of 
the services are privately financed. 
Public health education is not a special phase of the St. Louis 
County Health Department11 s program although it is carried on incidental 
to the other work of the staff. In a real sense, public health education 
is the very foundation of a successful program. 
Relation with Other Units of Government in St. Louis County 
The St. Louis County Health Department does not serve the city 
of Duluth, and is limited to the unorganized townships and the organized 
townships and municipalities which have requested the County Health De- 
partment to administer their program. 
The Department cooperates with all other health agencies - 
official and non-official - working within Sto Louis County. Five vil- 
lages with populations under 600 not having local health departments 
are served directly hy the County Department. The county health officer 
and a supervising nurse give advisory service to public health personnel in the range municipalities. The range towns and villages have t>art-time 
health officers, and four towns employ public health nurses. In the range 
municipalities, the school hoards employ public health nurses, two of 
them employ physicians full-time and othe is employ physicians part-time. 
Nurses on the staff of the County Health Department conduct programs and 
give services to all rural schools in St. Louis County. 
Relation to State Health District Number Four 
St. Louis County is one of six counties in State Health District 
Number Four. Duluth is the headquarters of the District and is the oper- 
ating base of the staff which is the same as that of other State Health 
Districts. However, the director and the engineer also serve the 
St. Louis County Health Department. The relation between the district 
staff and the County Health Department is similar to that in Olmsted 
County. The district staff serves mainly in an advisory and consultative 
capacity while the county staff provides direct services to the community. 
Role of State Inspectors in St. Louis County 
During the year of 1947, inspectors from the State Department of 
Health made 1,227 inspections among the 1,207 establishments listed for 
the (See Appendix Tables K, L, and M.) The chief deficiency 
was in the inspection of resorts; only 51 inspections were made among the 
200 resorts listed for the County. Inspectors from the State Department 
of Agriculture, Dairy and Food made 914 inspections in St. Louis County 
during the same Since there is no sanitarian on the staff of 
the St. Louis County Health Department, and since the public health engi- 
neer by the very nature of his position does very little in the line of 
making inspections of sanitary conditions, it follows that rural St. Louis 
County relies mainly on state inspectors for checking on sanitary con- 
ditions in hotels, eating and drinking places, and food preparation and 
food handling establishments. The health department of the City of Duluth 
makes such inspections so that within the City there is both state and 
local supervision. 
1. Minnesota Department of Health 
2. Minnesota Department of Agriculture, Dairy, and Food ELEMENTS OE FULL-TIME LOCAL HEALTH UNITS 
FUNCTIONS OF LOCAL HEALTH UNITS 
The American Public Health Association has outlined six basic 
functions of local health units; (l) vital statistics; (2) sanitation; 
(3) control of communicable and preventable diseases; (4) laboratory 
service; (5) protection of health in maternity, infancy and childhood; 
and (6) public health education. The scope and nature of these functions 
have been summarized by the Association as follows; 
1. "Vital statistics: the collection, tabulation, analysis, in- 
terpretation and publication of reports of births, deaths 
and notifiable diseases. 
2. "Sanitation; safeguarding all water supplies; securing the 
sanitary disposal of human and industrial wastes; super- 
vision of the production and distribution of milk and milk 
products and of foodstuffs; supervision of housing; control 
over the environmental sanitation of recreation areas and 
other public properties; control of insects and vermin as 
they effect the public health; control over the environ- 
mental conditions of employment; and control over atmos- 
pheric pollution. 
3. "Control of communicable and preventable diseases; pro- 
vision for the reporting of cases, the isolation of patients, 
and immunization of susceptible persons; systematic effort 
to find cases of infection; and provision for diagnostic, 
consultative, and treatment facilities where necessary. 
4. "Laboratory service; for the diagnosis of communicable 
diseases, for control of foods, and other features of 
general sanitation. 
5. "Protection of health in maternity, infancy, and childhood; 
concern with the health status of the man and woman pre- 
paring for marriage, of the expectant mother, of the new- 
born, the infant, the preschool and school child; and super- 
vision of the conditions of work and the fitness to work of 
young people. 
6. "Public health education; to make health knowledge access- 
ible to the average man in a form that he can understand 
through newspapers, magazines, books, pamphlets, lectures, 
personal and group demonstrations, pictures, and exhi- 
bitions, the film, and the radio. 
It is apparent that all these functions are provided completely 
in only a few localities in the State. Such units of government as a 
1. Harry S. Mustard, Government in Public Health, p. 128 ff. township or village are not likely to have the resources to finance such 
a broad program;, nor are they likely to have a sufficient population to 
justify employment of the various types of trained personnel necessary to 
conduct a comprehensive local public health program* Using the above 
enumerated six basic functions as points of reference,, it is evident that 
rural areas in the state have inadequate public health services. 
Some may feel that not all of these services are essential for 
a local public health program. That is a policy question which is beyond 
the scope of this report to answer. However, it may be stated that the 
six-point program outlined above represents the cyrstallized thinking of 
many persons intimately concerned with public health. 
All of the six functions are carried on with varying degrees of 
effectiveness at present in Minnesota. Some are handled by the State, 
and others by the localities. There is much reliance on localities to 
carry out duties which to a large extent are actually not performed. 
Administrative integration is largely lacking in the local communities. 
The objective of the proponents of local health units is to integrate 
and effectively provide public health services in the local community. 
STAFF OF A LOCAL HEALTH UNIT 
Dr. Haven Emerson, Chairman of the Sub-committee on Local Health 
Units, Committee on Administrative Practice of the American Public Health 
Association, in 1945 outlined the staff requirements of a local health 
unit for carrying on the basic local health functions outlined above. In 
order to efficiently utilize trained personnel and in order to secure an 
adequate tax base for financing the services, it was felt by the APHA 
group that the minimum population served by a local health unit ought to 
be 50,000. Counties having less than the minimum population, it was 
felt, ought to combine with other counties in the interests of adminis- 
trative efficiency and economy. 
For a population unit of 50,000, the APHA group recommended a 
health department staff of 16 full-time employees as follows? 
One medical officer of health 
One sanitary or public health engineer 
One non=professional sanitary assistant 
Ten public health nurses, one of them of supervisory grade 
Three office, secretarial or clerical personnel 
For population units larger than 50,000 additional personnel 
in the same ratio would be needed, namely? medical officers - 1 to 50,000; sanitarians - 1 to 25,000; public health nurses - 1 to 5,000; and 
clerks - 1 to 15,000.^ 
A previous section of this report has listed the number of full- 
time city-county, county and multi-county health units throughout the 
nation. When appearing before the House Committee on Interstate and 
Foreign Commerce, hearings on bills to assist the states in the develop- 
ment and maintenance of local public health units, held April 8, 1948, 
Dr. Leonard A. Scheele, Surgeon General of the United States Public Health 
Service, stated, HThus, there are about 54,000,000 people now living in 
areas which still have no full-time local health services. Furthermore, 
it should be noted that a large percentage of the local organizations 
which are now operating on a full-time basis require an expansion in staff 
and activities to assure meeting even minimum standards of operation.11 
In the smaller units, 11 It is expected that part-time medical 
services will be needed in most such units of population for diagnosis 
and control of tuberculosis and venereal diseases, and for prenatal, in- 
fant, preschool, and school health services. It is assumed that special- 
ist or consultant and advisory services will be available to such a 
local health department from the state health department in statistical 
procedures, in public health engineering, in public health laboratory 
work, in epidemiology, for veterinary purposes, for dental health, for 
health education, and for other local health services.M2 In larger units 
some of the more specialized services could be economically undertaken 
by the local health unit. 
ESTIMATED COST OF PROPOSED LOCAL HEALTH UNITS IN MINNESOTA 
Dr. Haven Emerson in an address "before the National Conference 
on Local Health Units held at Princeton University in September 1947, 
estimated that such units would require, MTax support of at least $1.00 
per capita for local health services and preferably $2.00. At least 50 
per cent of tax support should be from local sources, grants of state 
funds to supplement local tax monies if necessary, and federal aid to 
be not more than 25 per cent of total cost and preferably to be devoted 
to additional or exceptional services rather than for basic health 
activities. 
In the hearings before the House Committee on Interstate and 
Foreign Commerce held April 8, 1948, on H. R. 5644 and H. R. 5678, bills 
1. Haven Emerson, Local Health Units for the Nation, p. 2 f. 
2. Ibid., p. 3. 
3. APHA Proceedings of the National Conference on Local Health Units. 
September 1947, p. 5. to assist the states in the development and maintenance of local public 
health units, the United States Public Health Service and the Association 
of State and Territorial Health Officers estimated that local health 
units would cost about $1.50 per capita. H. R. 5644 was reported favor- 
ably to the House on June 12, 1948, but it was not passed by the House. 
Thus, there are still no federal grants-in-aid for local health units as 
such. Some local health units have been assisted by federal grants for 
venereal disease control, maternal and child health, public hea,lth edu- 
cation, and the like; but these are special program grants, not specifi- 
cally intended to assist in the maintenance of full-time medically 
directed local health units. 
The calendar year of 1945 is the latest year for which infor- 
mation about experditures for health services by the political sub- 
divisions of the State is available. Information regarding expenditures 
was obtained from reports of the Public Examiner and reflects expendi- 
tures for conservation of health by the State, counties, and municipali- 
ties over 2,500 population. The term ’'conservation of health" as defined 
in the Public Examiner’s reports closely parallels the functions of a 
local health unit - expenses of sewage and waste removal are not included. 
Since expenditures for conservation of health were lumped together with 
costs of sanitation for municipalities under 2,500 population, the health 
conservation expenditures of these smaller municipalities are not included 
in the following analysis. It is reported by the supervisor of municipal 
reporting in the Public Examiner's Office, that generally these smaller 
villages spend only about $10 annually for health conservation purposes, 
so their exclusion from the subsequent analysis will not materially af- 
fect its validity. Expenditures by township health officers were also 
not available, but in general would also be of such small amount as not 
to be of much importance. Estimated population figures as of July 1, 
1945, were obtained from the recent population study, Measuring Minnesota, 
issued by the Minnesota Department of Business Research and Development. 
The taxable value of real and personal property, the 1944 assessment on 
which taxes were payable in 1945, was also found in the Public Examiner's 
reports for 1945. 
In 1945 all units of local government in Minnesota spent a 
total of $820,905 for health conservation, and this amounted to 21.3 
cents per capita. In order to have spent $1.50 per capita for a total 
of $3,928,428 an additional $3,107,523 would have had to he spent - an 
additional $1,187 per capita. In order to finance such expenditures 
from property taxes, the chief revenue source of local governments, the 
increase would amount to 2.4 mills on the total taxable value of real 
and personal property of $1,304,899,706 assessed in 1944 for taxes pay- 
able in 1945. In order to raise $1.50 per capita on this valuation the 
mill rate would have to be 3.0 mills. However, property taxes for the support of local governmental functions are not levied on a statewide 
basis. Appendix Table N shows the mill rate necessary for each county 
to finance a local health unit at $lo50 per capita for the 1945 estimated 
population, and, assuming that the tax is levied by the county and that 
every county would be in a unit of sufficient size to operate at a cost 
of $1.50 per capita. 
The mill rate necessary for counties to raise $1.50 per capita 
in 1945 ranged from a low of 1.5 mills in Rock and St. Louis Counties 
to a high of 11 mills in Clearwater County - 50 counties were in the group 
which would have to levy from 2.0 to 3.9 mills. (See Appendix Table 0). 
The variation in mill rates necessary to raise $1.50 per capita bears an 
inverse relation to per capita wealth in the counties. 
The difference between the amount spent in 1945 by counties and 
municipalities over 2,500 population for health conservation and expendi- 
tures at the rate of $1.50 per capita would have required an additional 
levy ranging from a low of 0.7 mills in St. Louis County where $.786 was 
spent per capita in 1945 to a high of 10.9 mills in Clearwater County 
which spent 1.3 cents per capita for health conservation in 1945. Again 
50 counties were in the range from 2.0 to 3.9 mills. (See Appendix 
Table P). The per capita expenditures for health conservation by the 
counties and the larger municipalities within them (over 2,500 popu- 
lation) ranged from a low of one-half cent per capita in Grant and 
Kanabec Counties to a high of $1,016 per capita in Cook County. Con- 
tributions from Federal and/or state grants-in-aid would reduce the 
necessary levies set forth above. In all probability, a program of aids 
to local health units would be necessary. 
It must be remembered that these estimates are based on 1945 
data - the latest available. While the estimates of per capita expendi- 
tures and mill rates necessary to finance them are not exact with respect 
to present conditions, they are indicative of what full-time local health 
units would cost the citizenry of the various counties in Minnesota. It 
is readily apparent that many counties would be unable to finance such 
programs even on the assumption that they join with other counties to 
form units of efficient size* 
The recent session of Congress did not bring federal grants-in- 
aid for local health units. In the absence of federal action the question 
is raised whether the State can help the counties finance a program which 
would cost over three million dollars more than has been spent for health 
conservation in the past. With present rising costs and other demands 
upon government0 it is doubtful that the State would be in a position to 
materially eaqoand its already considerable expenditures for public health. In 1945 the State expended $1,731,043 for conservation of If 
the State would match county expenditures in financing a county unit 
health program (estimated expenditure $1.50 per capita) it would re- 
quire approximately two million dollars annually - making a total of 
almost four million dollars for financing the state public health 
program and for grants to local health units. 
1. Minnesota Public Examiner’s Heport for 1945. NEED FOR FULL-TIME LOCAL HEALTH UNITS IN MINNESOTA 
The need for fall-time local health anits in Minnesota is in- 
timately linked with a "basic policy consideration; namely, the proper 
scope of public health services. Policy questions are properly matters 
of legislative action. It is not the purpose of this report to favor 
any particular course of action, hut rather to point to the various pos- 
sibilities and their implications. 
In an address before the National Conference on Local Health 
Units held at Princeton University, Princeton, New Jersey, September 
8-10, 1947, Wilson G. Smillie, M. D., of the Department of Preventive 
Medicine and Public Health, Cornell University Medical College, defined 
public health as followsi ”... What do we mean by public health? It 
is a terra that has been variously interpreted and widely misused. -Many 
health authorities believe that the responsibilities of government in 
public health affairs is (sic), basically, to protect the individuals 
in the community against the special hazards of communal life. This 
includes, of course, communicable disease control, environmental sani- 
tation in all its aspects, housing, health education, recording and 
interpreting of vital data, etc. In contrast to this concept, there is 
the theory that the community has a direct responsibility for the pro- 
motion of health of each and every individual within its boundaries. 
Thus, all matters that relate to adequacy of medical care, such as hospi- 
tal facilities, community-wide plans for prepayment of medical services, 
programs for periodic health examination of well children and also well 
adults, as well as many other accepted phases of preventive medicine, 
become a direct community responsibility. 
HThis concept implies that these facilities should be sponsored 
by, directed by, and, in part at least, paid for by local government. 
Between these two extremes, there is a great variety of opinion and 
shading of concept. In fact, many health activities are often initiated 
v/ithout a clear concept as to where the given practice fits into our 
governmental theory. 
It is apparent from the above that the need for full-time local 
health units is closely related to what is expected of a local health de- 
partment. It follows that the existing local health agencies more near- 
ly meet the criteria of health departments intended to treat the problems 
arising out of communal living, than they meet the criteria of health 
departments concerned with the health of every individual in the community. 
1. APHA, Proceedings of the National Conference on Local Health Units. 
September. 1947. p. 7. Since the former is the traditional concept of the role of public health, 
it will be the standard applied to existing health services in the State. 
It, therefore,, follows that if a policy of further health services is 
deemed advisable, existing services are likely to be found inadequate to 
the extent that policy goes beyond the desirability of meeting health 
problems arising out of communal living. 
In the past, health activities designed to meet the problems 
arising from communal living have given rise to full-time public health 
programs in areas where population is concentrated. This explains the 
lag of rural areas behind the urban regions. It also contributes to the 
fact that in 1947, two-thirds of the nation's population was served by 
full-time local health units covering only 45 per cent of the counties. 
Do present public health services carried on by state and local 
governments in Minnesota meet the health problems arising out of communal 
living? Neither an unqualified yes nor an unqualified no is the correct 
answer;1 the truth lies somewhere between these extremes. TABLE III 
THE TEN LEADING CAUSES OF DEATH, DEATH RATES PER 100,000 POPULATION 
AND PER CENT OF TOTAL DEATHS, MINNESOTA, 1947 
Rank 
Number of 
Cause of Death Deaths 
Death 
Rates* 
Per Cent 
of Total 
Deaths 
1 
Heart Disease 
8,972 
309.7 
31.6 
2 
Cancer 
4,294 
148.2 
15.1 
3 
Cerebral hemorrhage, Cerebral embolism 
and thrombosis, Softening of the brain, 
Hemiplegia and other paralysis, cause 
unspecified (total) 
2,975 
102.7 
10.5 
(a) Cerebral hemorrhage 
(2,515) 
(86.8) 
(8.9) 
(b) Cerebral embolism and thrombosis 
(379) 
(13.7) 
(1.4) 
(c) Softening of the brain 
(32) 
(1.1) 
(0.1) 
(d) Hemiplegia and other paralysis, 
cause unspecified 
(31) 
(1.1) 
(0.1) 
4 
External Causes (total) 
2,330 
80.4 
8.2 
(a) Accidents 
(1,974) 
(68.1) 
(7.0) 
(b) Suicide 
(323) 
(11.2) 
(1.1) 
(c) Homicide 
(33) 
(1.1) 
(0.1) 
5 
Pneumonia (all forms) 
1,201 
41.1 
4.2 
(a) Broncho 
(779) 
(26.9) 
(2.7) 
(b) Lobar 
(308) 
(10.6) 
(X.l) 
(c) Pneumonia, unspecified 
(114) 
(3.9) 
(0.4) 
6 
Diseases of the circulatory system 
other than diseases of the heart 
923 
31.9 
3.3 
7 
Nephritis 
894 
30.9 
3.1 
8 
Diabetes 
809 
27.9 
2.9 
9 
Premature birth 
804 
27.8 
2.8 
10 
Tuberculosis (all forms) 
587 
20.3 
2.1 
(a) Pulmonary 
(524) 
(18-1) 
(1-9) 
(b) Other forms 
(63) 
(3.2) 
(0.2) 
All other causes 
4,598 
158.9 
16.2 
Total Deaths (all causes exclusive 
of stillbirths) 
28,387 
980.1 
100.0 
* Rates based on population estimate of 
the Federal 
Census 
Bureau 
for the year 1947 - (2,897,000) 
Source - Minn. Dept, of Health,Division 
of Vital Statistics, May 13, 1948. A primary consideration is the fact that not all persons in the 
State are equally served "by public health agencies either state or local. 
The rural population is generally less adequately served than the urban 
population. It is no doubt true that there are less problems arising 
from communal living in rural areas than in urban areas, but the rural 
population does have health problems which need attention. Moreover, 
since farms are the source of food products consumed in the cities, 
urban populations also have an interest in rural environmental sanitation. 
In an attempt to measure the need for full-time local health 
units in Minnesota, the following analysis of pertinent vital statistics 
are presented. 
As indicated in Table III, heart disease, cancer, intracranial 
lesions of vascular origin (cerebral hemorrhage, etc.), and external 
causes (accidents, homicide and suicide) were the four leading causes of 
death in Minnesota in 1947. None of these can properly be classified as 
health problems arising out of communal living, and would, therefore, be 
beyond the scope of the traditional public health service with the pos- 
sible exception of an educational program. It is significant that of 
the ten leading causes of death in Minnesota in 1947, only two, pneumonia, 
which ranked fifth, and tuberculosis, which ranked tenth, were communic- 
able diseases. These ten leading causes of death accounted for 83.8 per 
cent of all deaths in the State in 1947. 
The latest year for which comparative data for other states is 
available is 1945. Table IV shows the ten leading causes of death in 
the nation for 1945 and compares Minnesota's death rate from those 
causes with that for the nation. Also the number of states which had 
lower death rates than Minnesota for these causes are indicated. It 
must be remembered that fluctuations from year to year in the incidence 
of death due to various causes make it hazardous to generalize from 
what happens in any one year. While a comparison based on one year may 
not be absolutely correct, it is sufficiently correct to be indicative 
in a general way of how Minnesota compares with other states. For the 
ten leading causes of death in the United States in 1945, Minnesota had 
a higher death rate for six and a lower death rate for four than did the 
country as a whole. TABLE IV 
COMPARISON OF MINNESOTA AND OTHER STATES WITH RESPECT TO 
THE TEN LEADING CAUSES OF DEATH IN THE UNITED STATES 1945 
Cause 
U.S. 
Rate* 
Minn. 
Rate* 
No. of States 
With Rate 
Lower than Minn. 
lo Diseases of the heart 
321.5 
333.8 
30 
2. Cancer and other malignant 
tumors 
134.5 
155.9 
38 
3. Intracranial lesions of 
vascular origin 
97.9 
111.4 
37 
4. Nephritis 
66.7 
39.2 
1 
5. Pneumonia and influenza 
51 o 8 
54,6 
29 
6. Accidents0 except motor 
vehicles 
51.4 
56.2 
30 
7, Tuberculosis 
40.1 
24,9 
9 
8, Diabetes mellitis 
26.6 
31.3 
36 
9o Premature birth 
24.0 
23.1 
20 
10. Motor vehicle accidents 
21.3 
19.2 
18 
* Rate per 100,000 Estimated Population 
Notes The death rates from these causes in Minnesota does not follow 
the same rank order as in the United States. 
Sources Federal Security Agency, U. S. Public Health Service, Nation- 
al Office of Vital Statistics - Special Reports, National 
Summaries. Deaths and Death Rates for Selected Causes United 
States, Each Division and State. 1945. Volume 27, Number 3, 
July 24, 1947, p. 31 ff. 
In comparison with other states, Minnesota was in a relatively 
poor position on heart disease, cancer, intracranial lesions of vascular 
origin, pneumonia and influenza, accidents (except motor vehicle), and 
diabetes mellitis. The Minnesota death rates for nephritis, tuberculosis 
43 premature "birth, and motor vehicle accidents were relatively low. Only 
two of these ten leading causes of death were communicable diseases and 
Minnesota was below the national rate for one (tuberculosis), and above 
it for the other (pneumonia). 
Table V shows that' the 1945 Minnesota death rates for polio, 
scarlet fever, goiter, and ulcers were relatively high. The State was 
in a relatively favorable position in comparison with other states on 
such diseases as typhoid, cerebrospinal meningitis, syphilis, dysentery, 
diarrhea, enteritis, measles, whooping cough, and acute rheumatic fever 
as well as for deaths due to alcoholism and diseases of pregnancy. 
Malaria, spread by a species of mosquito not common in Minnesota and 
pellegra, attributable to diet deficiencies, are not significant in 
Minnesota. In common with other states in this area, Minnesota is in 
what is popularly termed the "goiter belt". 
TABLE V 
COMPARISON OF DEATH RATES FROM SELECTED CAUSES IN 
MINNESOTA AND OTHER STATES 1945 
U. S. 
Rate* 
Minn. 
Rate* 
No. of States 
With Rate 
Lower than Minn 
A. COMMUNICABLE DISEASES? 
1. Poliomyletis and polio 
encephalitis 
0.9 
1.2 
37 
2. Scarlet fever 
0.2 
0.4 
34 
3. Acute rheumatic fever 
1.0 
1.1 
22 
4. Whooping cough 
1.3 
1.0 
20 
5. Measles 
0.2 
0.2 
17 
6. Diarrhea* enteritis 
8.7 
4.8 
14 
7. Diphtheria 
1.2 
0.8 
14 
8. Dysentary 
1.2 
0.3 
13 
9. Syphilis 
10.7 
6.9 
9 
10. Cerebrospinal meningitis 
1.3 
0.7 
6 
11. Typhoid and paratyphoid 
fever 
0.4 
0.0 
0 
12. Malaria 
0.3 
0.0 
0 
B. OTHER SELECTED CAUSES? 
1. Exophthalmic goiter 
1,9 
2.4 
39 
2. Ulcer of stomach or duodenum 
6.8 
7.0 
30 
3. Alcoholism 
1.7 
1.5 
19 
4. Diseases of pregnancy 
4.3 
3.0 
8 
5. Pellegra 
0.7 
0.0 
0 
* Rate per 100,000 Estimated Population 
Source? Federal Security Agency - ibid. In 1945, six states had lower infant and maternal mortality 
rates than Minnesota. Table VI shows that the Minnesota infant mortality 
rate of 31.1 deaths under one year of age per 1,000 live births was con- 
siderably lower than the national rate of 38.3. For the whole nation 
the rural rate of 39.1 was higher than the urban rate of 37.7, while in 
Minnesota the situation was reversed with the rural rate 27.1 and the 
urban rate 34.8. Minnesota with a higher infant mortality rate in urban 
areas than in rural areas follows the pattern of its neighboring states. 
TABLE VI 
INFANT MORTALITY RATES* BY URBAN AND RURAL AREAS 
IN MINNESOTA AND OTHER STATES 1945 
Area Total Urban Rural 
United States 38.3 37.7 39.1 
Minnesota 31.1 34.8 27.1 
Rote: Six states had lower infant mortality rates than 
Minnesota in 1945. 
* By place of residence - exclusive of stillbirths - deaths 
under 1 year per 1,000 live births. 
Sources Federal Security Agency, U. S. Public Health Service, 
National Office of Vital Statistics, Vital Statistics - 
Special Reports. National Summaries. Infant Mortality 
bv Race and bv Urban and Rural Areas United States. 
Each Division and State. 1945, Volume 27, Number 4, 
August 19, 1947, p. 53. 
Table VII reveals that the maternal mortality rate of 1.4 deaths 
per 1,000 live births in Minnesota is also considerably lower than the 
national rate of 2.1. For the United States the rural maternal mortality 
rate of 2.2 was higher than the urban rate of 2.0 and Minnesota followed 
the national pattern with a rural rate of 1.7 and an urban rate of 1.1. 
Thus, in Minnesota, chances of an infantas surviving the first year of 
life are greater in rural areas than in urban communities, and, on the 
other hand, the chances of a mother's surviving child-birth are slightly 
greater in urban than in rural areas of the State. TABLE YII 
MATERNAL MORTALITY RATES’*1 BY URBAN AND RURAL AREAS IN 
MINNESOTA AND OTHER STATES 1945 
Area Total Urban Rural 
United States 2.1 2,0 2.2 
Minnesota 1.4 1.1 1*7 
Note; Six states had lower maternal mortality rates 
than Minnesota in 1945. 
* By place of residence - rates per 1,000 live births 
in the specified area. 
Source! Federal Security Agency, U. S. Public Health 
Service, National Office of Vital Statistics, 
Vital Statistics - Special Reports. National 
Summaries. Maternal Mortality by Race. Aee. 
and Urban and Rural Areas: United States Each 
Division and State. 1945. Volume 27. Number 13. 
February 2, 1948, p. 244. 
In an attempt to arrive at a determination of whether or not 
additional local health services are needed in the State, the Department 
of Health was requested to supply information indicative of needs. No 
incontrovertible evidence was presented. 
Various surveys covering only a part of the State at various 
times have indicated that by and large the water supplies and sewage 
disposal systems of rural schools do not meet the standards of the 
Department of Health. How great a problem this represents is not deter— 
minable. 
It is apparent that rural areas of the State do not have the 
seine level of public health services as the urban areas. Since many 
public health problems arise from concentrations of population, perhaps 
rural areas do not need as extensive public health programs as cities. 
The most valid conclusion to be drawn from available evidence is that 
the whole State could benefit from an expanded public health program. 
Whether or not such expansion is needed is closely linked with policy 
considerations of the role of a public health service in a community. Public health, has been described as a purchasable commodity by 
some writers. However, the economic law of diminishing returns is ap- 
plicable so that as more and more is spent, the results tend to diminish 
until a point is reached where no amount of money can alter the situation 
Furthermore, there are limitations on scientific knowledge - the modern 
medicine man doesnH know all the answers. However, available evidence 
indicates that Minnesota can still benefit from an expansion of public 
health services, although it is a policy question of whether this ex- 
pansion should be at the state or local level. Relative to the larger 
cities, rural areas and small municipalities are deficient in respect to 
local health services which might be provided with beneficial results by 
some level of government or private agency. POSSIBLE SHAPE OF ENABLING LEGISLATION 
In another section of this report, available evidence indicated 
that although Minnesota is relatively well off in relation to other 
states, it could benefit from an extension of public health services. 
Evidence also indicated that coordination and integration of public 
health services at all levels of government would be highly desirable. 
The hills considered at the last legislature provided that any 
county or two or more adjacent counties, hy voluntary action could es- 
tablish and maintain a health department headed by a full-time medical 
officer of health. Such health departments could be created through reso- 
lution of the county board or boards concerned or by vote of the people 
in the county or counties. Cities of the first and second classes locat- 
ed within counties electing to establish such health departments would 
not be within the jurisdiction of the department unless the city govern- 
ing body should by ordinance subject to referendum take action to be in- 
cluded. Existing powers of local health departments were to be trans- 
ferred to departments created under the new law, with the exception that 
vital statistics were still to be collected by town clerks and city 
registrars. Thus, these bills did not provide for all of the six funda- 
mental functions as outlined by Haven Emerson. 
Rather detailed provisions regarding selections and tenure of 
hoards of health, rule-making powers, powers of recommendation, budget- 
ing, personnel, and financing were also included in the hills. It is 
noteworthy that there were no limits on the taxes to he levied to sup- 
port these health departments; such taxes were to he MA separate levy 
over and above the limits now imposed for the general fund of the county.1’ 
It is customary for the legislature to place limits on taxing powers of 
local governmental units. 
Thus, the bills before the Legislature at its last session would 
enable counties to establish full-time county, city-county, or multi- 
county health departments. Provisions were made for accepting financial 
assistance from the state and federal governments as well as from pri- 
vate contributions. 
The above points are the major provisions of the bill con- 
sidered at the last legislature. Enabling legislation to provide better 
local health services need not necessarily take this precise form. 
If a policy of extending health services in the rural areas 
through enabling legislation as considered at the last session is 
decided upon, based on evidence in other states, it is doubtful that health services would he expanded,, consolidated,, or coordinated to any 
great extent in the near future<> Experience in the 16 states including 
Minnesota which have the township-county form of local government in- 
dicates that relatively few counties take advantage of such enabling 
legislation to create full-time local health units. As pointed out pre- 
viously, only 166 counties out of the 1,240, or 13 per cent,had created 
full-time local health units pursuant to such legislation. These 166 
counties were 17 per cent of the 966 counties in the 12 states with en- 
abling laws. Thus, 83 per cent of the counties which could have taken 
advantage of enabling legislation had not seen fit to do so. Establish- 
ment of full-time local health units in these states is entirely volun- 
tary and must be voted for by the people or their duly elected repre- 
sentatives. 
As has been pointed out in another section of this report, the 
increased taxes, "based on a recommended expenditure of $1.50 per capita 
and units of 50,000 population, would he extremely expensive and prac- 
tically prohibitive to many counties. In addition, getting counties to 
act together to form units of 50,000 population would hinder development 
of local health units in rural areas. Counties by tradition extending 
back to the time of their formation consider themselves as separate en- 
tities and are inexperienced in working together. Rivalry for location 
of the district health unit headquarters could preclude the formation of 
such units. In fact rivalries between cities of the same county are 
often very pronounced. It will be recalled that at the 1947 session of 
the legislature a certain area and city of one county wanted to be an- 
nexed to another county as a result of establishment of a county hospi- 
tal at the county seat. 
In sparsely settled rural areas, the combination of counties to 
achieve units of 50,000 population may result in areas so large that 
travel and per diem expenses of staff- members bringing the services to 
the people may take a substantial part of the revenue available for 
local health services. There are only four counties in Minnesota with 
a population over 50,000. On the other hand, there are 16 with a pop- 
ulation less than 10,000? 37 with a population of 10,000 to 19,999; 22 
with a population of 20,000 to 29,999; 6 with a population of 30,000 to 
39,999; and 2 with a population of 40,000 to 49,999. It is evident 
that areas would have to be great in order to achieve the recommended 
economical unit of 50,000 population. 
Another form which enabling legislation might take would be a 
simple transfer of health functions from townships and municipalities 
to the county with appropriate provisions for financing whatever pro- 
gram is considered necessary. Since townships generally have small pop- 
ulations and limited resources, it would appear to be illogical to at- 
temp to build up their role in a public health program. Municipalities are important in any public health program, but they do not meet the needs 
of people in rural areas. Therefore, it remains that either the State or 
the counties are the only units of government within the State which can 
provide complete geographical coverage. 
Local public health services could also be expanded by the 
State Health Department’s embarking upon a comprehensive direct service 
program. However, with State action also goes centralized control. 
Still another approach could he the expansion of the supervisory 
and advisory functions of the district offices of the Minnesota Health 
Department coupled with an expansion of the direct service program of the 
county nurses. It may also he desirable to expand such semi-direct 
service programs of the district offices as provided hy the sanitary en- 
gineer. This joint approach would perhaps give the most comprehensive 
local health services throughout the State in a short time. 
Available evidence indicates that the people of Minnesota would 
benefit from more and better public health services. However, two policy 
questions remain to be answfered: first, will the benefits match the 
costs?:' and second, if it is accepted that benefits will justify the costs, 
where shall the expansion occur? STATISTICAL APPENDIX 
Table 
Subject 
Page 
A 
The Incidence of Enabling Legislation for Formation 
of County* City-county and Multi-county Health Units 
2-3 
B 
Number of Full-time Local Health Units (Counties and 
Per Cent of Population Served Each State) 
4-5 
C 
The Incidence of Enabling Legislation in "Town" States 
6 
D 
The Incidence of Enabling Legislation in "County" States 
7 
E 
The Incidence of Enabling Legislation in “County and 
Township" States 
8 
F 
County Nurses in Minnesota 
9-11 
G 
County Nursing Services Established Since Passage 
of Bill to Provide State Aid 
12 
H 
County Aid Grants to County Nursing Programs 
13 
I 
Public Health Nurses in Minnesota 
14 
J 
Operation Expenditures of Rochester-Olmsted County 
Health Unit for 1S47 
15 
K 
Inspections Made by Department of Health 
16-19 
L 
Inspections by Department of Agriculture 
20-21 
M 
Comparison of State Inspections Made in Counties 
With Local Health Services With Those Made in 
Neighboring Counties 
22 
N 
Estimated Cost of Full-time Local Health Units 
in Minnesota 
23-24 
0 
Estimated Mill Rate Necessary to Raise |lo50 Per Capita 
25 
P 
Estimated Increase in Mill Rate Necessary to Finance 
Full-time Local Health Units in Minnesota Counties 
25 STATE 
ENABLING LEGISLATION 
PASSED 
NUMBER OF COUNTIES 
ACTING UNDER SUCH LAW 
COUNTIES IN 
STATE 
TOWNSHIPS 
IN STATE 
Alabama 
1919 
67 
67 
— 
Arizona 
1947 
3 
14 
— 
Arkansas 
None 
— 
75 
-- 
California 
1917, Amended 1947 
1 
58 
— 
Colorado 
1947 
18 
63 
— 
Connecticut^- 
1947 
None 
8 
154 
Delaware 
None 
— 
3 
— 
Florida 
1930. 
62 
67 
— 
Georgia 
1914 
82 
159 
— 
Idaho 
1947 
15 
44 
Illinois 
1943 
22 
102 
1,434 
Indiana 
1935 and 1947 
4 
92 
1,010 
Iowa 
None 
— 
99 
1,608 
Kansas 
1943 
15 
105 
1,524 
Kentucky 
1918 
104 
120 
Louisiana 
1921 as Amended 
57 
64 
— 
Maine^ 
1919 
None 
16 
482 
Maryland^ 
1922 
23 
23 
— 
Massachusetts^ 
1927* 
— 
14 
312 
Michigan 
1927 
71 
83 
1,265 
Minnesota 
None 
—— 
87 
1,884 
Mississippi 
192# 
67 
82 
— 
Missouri* 
1946 
2 
114 
329 
Montana 
1945 
5 
56 
— 
Nebraska 
1943 
7 
93 
476 
Nevada 
1931* 
1* 
17 
— 
New Hampshire6 
No 
— 
10 
223 
New Jersey*^ 
No 
— 
21 
235 
New Mexico6 
1919 and 1935 
31 
31 
— 
New Yorky 
1921 For County Units 
12 
62 
932 
TABLE A 
THE INCIDENCE OF ENABLING LEGISIATION FOR FORMATION OF COUNTY, CITY-COUNTY, 
AND MULTI-COUNTY HEALTH UNITS  
' enabling TecHS LAtTon number of cchItoiBs 
■— 
foMsTTPS 
STATE 
PASSED 
ACTING UNDER SUCH LAW 
STATE 
IN STATE 
North Carolina 
1935 
96 
100 
North Dakota^ 
1943 
14 
53 
1,399 
Ohio 
1920 
7 
88 
1*339 
Oklahoma 
1941* 
39* 
77 
*=»» 
Oregon 
1948 
7 
36 
Pennsylvania 
None 
n ks 
67 
1,575 
Rhode Island^ 
None 
0 
32 
South Carolina 
1938 
46 
46 
South Dakota^ 
1939 For County Units 
• 
2 
64 
1,128 
Tennessee 
Yes* 
74* 
95 
— 
Texas 
None 
MM 
254 
ol3 
Utah 
Vermont^ 
1945 
1 
29 
None 
— 
14 
239 
Virginia 
1924 
68 
100 
— 
Washington 
1945 
9 
39 
68 
West Virginia 
1945 
1 
55 
oa 
Wisconsin 
1947 
1 
71 
1*271 
Wyoming 
None 
MM 
23 
— 
TOTAL 
37 Yes 
1,034 
3*060 
18*919 
*As of 1942* From Haven Emerson®s Local Health Units For The 
Nation (these 
states did not return questionnaire) 
Sources ~ Questionnaire sent to State Health Departmentse 
Number 
of counties and townships - William Anderson* The Units of 
Government in the 
United States* 
(City-county units are counted as counties)© 
1c Multi-town deptso to be formed - counties not 
important © 
2© Multi-town 
districts to be formed - counties 
not important« 
3« Mandatory Law© 4© Multi-town 
units to be 
formed* - counties not important 
© 5© 7 counties 
to vote on units 
in 1948© 6© 1 district office supported by state « counties not important© 
7© Bill in 
legislature 3/48 
© 8© 31 counties in 10 district 
s - Mandatory Law© 9© One county in process© 
10© Organized 
in 3 deptsc 11o 
Field offices of State Health Dept© 12© 4 
district health depts© in state — 
counties not 
organized© 13* ' 
There were 9 county units in the 
past© 14© 
1 city-county unit at El Paso and 
46 multi- 
county units - therefore 47 plus* 15© Counties ; 
not important© 
3 STATE 
Total 
Local Full Time 
Health Units 
Counties 
Served 
Per Cent of 
Population Served 
Counties 
1942 
1947 
1942 
1947 
1922 
194£ 
1947 
TOTAL 
3,070 
1,084 
1,172 
1,220- 
1,372- 
35.6'' 
62.2 
66.6 
Alabama 
67 
61 
67 
67 
67 
46 e? 
100 o0 
100,0 
Arizona 
14 
6 
5 
6 
5 
— 
68.3 
66.4 
Arkansas 
75 
62 
26 
30 
65 
7c0 
87.2 
90.8 
California 
58 
38 
40 
27- 
31- 
43.5 
87.2 
91.6 
Colorado 
63 
3 
7 
3 
8- 
27,3 
12.6 
51.4 
Connecticut 
8 
12 
13 
5- 
5- 
40 o0 
51.0 
52.4 
Delaware 
3 
3 
4 
3- 
3 
49*4 
57.8 
100.0 
Florida 
67 
31 
33 
36- 
53 
17o8 
71.6 
88.4 
Georgia 
159 
47 
49 
59 
87 
30o6 
62.8 
84.7 
Idaho 
44 
5 
5 
10 
14 
18.3 
42,6 
46.7 
Illinois 
102 
11 
22 
8- 
17 
47.1 
57.0 
63.9 
Indiana 
92 
1 
3 
1- 
3- 
11.7 
11.3 
16.8 
Iowa 
99 
— 
2 
—- 
2 
10.8 
— 
2.2 
Kansas 
105 
17 
16 
19- 
15 
22.6 
38,0 
39.5 
Kentucky 
120 
66 
58 
98 
102 
20.4 
89.9 
91.7 
Louisiana 
64 
49 
54 
55 
57 
15.9 
93.9 
96.7 
Maine 
16 
8 
6 
5- 
4- 
23.1 
31.8 
21.3 
Maryland 
23 
24 
24 
23 
23 
56.8 
100.0 
100.0 
Massachusetts 
14 
14 
56 
9- 
11- 
51.6 
43.9 
68.3 
Michigan 
83 
55 
56 
69- 
72— 
42.2 
79.5 
89.6 
Minnesota 
87 
4 
4 
4- 
4- 
26.4 
32.5 
32.5 
Mississippi 
82 
56 
57 
65 
66 
17.5 
84.1 
85.0 
Ms souri 
114 
17 
18 
14 
16- 
35.7 
39.3 
48.1 
Montana 
56 
5 
5 
5 
5 
20.2 
21.7 
22.4 
Nebraska 
93 
7 
5 
15- 
7- 
4.2 
33.5 
32.6 
TABLE B 
NUMBER OF FULL- TIME LOCAL HEALTH UNITS COUNTIES AND PER GENT 
OF POPULATION SERVED EACH STATE, 1922, 1942, 1947) 
4  
Local Full 
Time 
Counties 
Per Cent of 
Total 
Health Units 
Served 
Population Served 
Counties 
1942 
1947 
1942 
1947 
1922 
1942 
1947 
Nevada 
17 
1 
1 
1 
1 
14*9 
14*9 
New Hampshire 
10 
4 
10 
4~ 
6“ 
31o8 
34*7 
44*5 
New Jersey 
21 
42 
53 
15“ 
14- 
41 ©6 
49*2 
50*8 
New Mexico 
31 
10 
10 
31 
31 
33o3 
100*0 
100*0 
New York 
62 
22 
22 
22° 
24“ 
63c2 
76*5 
78*7 
North Carolina 
100 
61 
68 
85 
95 
47o3 
92*9 
97*6 
North Dakota 
53 
2 
4 
2- 
14“ 
106 
10*1 
23*5 
Ohio 
88 
51 
72 
56- 
61“ 
62*2 
68*1 
74*1 
Oklahoma 
77 
28 
28 
39« 
39“ 
5 ©6 
60*2 
67*4 
Oregon 
36 
19 
20 
18 
25 
33 c0 
86*6 
91*5 
Pennsylvania 
67 
22 
15 
29- 
24“ 
39e4 
49*4 
43*6 
Rhode Island 
5 
4 
5 
3“ 
3« 
44 «3 
54*5 
68*1 
South Carolina 
46 
33 
35 
46 
46 
24*4 
100*0 
100*0 
South Dakota 
69 
1 
2 
1 
2 
8*6 
3*7 
12*3 
Tennessee 
95 
49 
39 
69 
54 
10*0 
86*1 
79*1 
Texas 
254 
43 
48 
64 
56“ 
10*4 
54*9 
53*9 
Utah 
29 
1 
1 
1 
1 
9*7 
2*9 
2*9 
Vermont 
14 
— 
— 
~~ 
Virginia 
100 
33 
43 
49 
59 
36*1 
45*8 
78*6 
Washington 
39 
17 
21 
19 
24 
45*8 
80*0 
84*3 
West Virginia 
55 
20 
24 
17“ 
38“ 
13*4 
57*7 
75*1 
Wisconsin 
72 
17 
14 
12- 
12“ 
29*4 
40*4 
37*4 
Wyoming 
23 
■ 1 
1 
1 
1 
18*2 
13*4 
13*4 
Notes: Minus sign 
indicates that 
some of the 
counties 
lack complete population coverage© 
Sources American 
Public Health Association* 
Proceedings of the National 
Conference 
on State and 
Local 
Health Unitss September 1947* Facing pc 1* 
5 TABLE C 
THE INCIDENCE OF ENABLING LEGISLATION FOR FORMATION OF COUNTY, CITY-COUNTY, 
AND MULTI-COUNTY HEALTH DEPARTMENTS IN STATES IN WHICH THE TOWN IS THE IM- 
PORTANT UNIT OF LOCAL GOV'T. (AS OF MARCH, 1948) 
STATE 
ENABLING 
LEGISLATION, 
WHEN PASSED 
NO. OF COUNTIES 
TAKING ADVANTAGE 
OF LEGISLATION 
NO. OF 
COUNTIES 
IN STATE 
NO. OF 
TOWNS 
IN STATE 
1« Connecticut 
1947 
None 
8 
154 
2, Maine 
1919 
None 
16 
482 
3* Massachusetts 
1927* 
None 
14 
312 
4. New Hampshire 
No Legislation 
— 
10 
223 
5. Rhode Island 
No Legislation 
— 
0 
32 
6 • Vermont 
No Legislation 
— 
14 
239 
Total 
* As of 1942 
Source - Table A 
3 Yes 
0 
62 
1,442 TABLE D 
THE INCIDENCE OF ENABLING LEGISLATION FOR FORMATION OF COUNTY, CITY-COUNTY, 
AND MULTI-COUNTY HEALTH DEPARTMENTS IN STATES IN MICH THE COUNTY IS THE 
IMPORTANT UNIT OF LOCAL GOVERNMENT o (AS OF MARCH, 1948) 
STATE 
ENABLING 
LEGISLATION5 
WHEN PASSED 
NO, OF COUNTIES 
TAKING ADVANTAGE 
OF LEGISLATION 
NO, OF 
COUNTIES 
IN STATE 
NO, OF 
TOWNS 
IN STATE 
Alabama 
1919 
67 
67 
__ 
Arizona 
January 1947 
3 
14 
«■» 
Arkansas 
No Legislation 
75 
— 
California 
1917 As Amended 
1 
58 
Colorado 
March 1947 
18 
63 
— 
Delaware 
No Legislation 
3 
Florida 
1931 
62 
67 
Georgia 
1914 
82 
159 
-- 
Idaho 
1947 
15 
44 
-- 
Kentucky 
1918 
104 
120 
<aao 
Louisiana 
1921 As Amended 
57 
64 
Maryland 
1922 
23 
23 
Mississippi 
1924 
67 
92 
—. 
Montana 
1945 
5 
56 
— >1 
Nevada 
1931* 
1919 County 
1* 
17 
— 
New Mexico 
1935 District 
31 
31 
— 
North Carolina 
1935 
96 
100 
Oklahoma 
1941* 
39* 
77 
Oregon 
1948 
7 
36 
— 
South Carolina 
1938 
46 
46 
Tennessee 
Yes* 
74 
95 
Texas 
No Legislation 
— 
254 
—- 
Utah 
1945 
1 
29 
«... 
Virginia 
1924 
68 
100 
West Virginia 
1945 
1 
55 
Wyoming 
No Legislation 
23 
— 
Total 
* As of 1942 
Source “ Table A 
22 Yes 
868 
1,758 TABLE E 
THE INCIDENCE OF ENABLING IE GISIATION FOR FORMATION OF COUNTY, CITY-COUNTY, 
AND MULTI-COUNTY HEALTH DEPARTMENTS IN STATES IN WHICH BOTH THE 
COUNTY AND TOWNSHIP ARE IMPORTANT UNITS OF LOCAL GOVERNMENT 
(AS OF MARCH, 1948) 
STATE 
ENABLING NO* OF COUNTIES 
LEGISLATION* TAKING ADVANTAGE 
WHEN PASSED OF LEGISLATION 
NO. OF 
COUNTIES 
IN STATE 
NO. OF 
TOWNS 
IN STATE 
Illinois 
July* 1943 
22 
102 
1,434 
Indiana 
1935 & 1947 
4 
92 
1*010 
Iowa 
No Legislation 
— 
99 
1,608 
Kansas 
1943 
15 
105 
1,524 
Michigan 
1927 
71 
83 
1,265 
Minnesota 
No Legislation 
«.» 
87 
1*884 
Missouri 
1946 
2 
114 
329 
Nebraska 
1943 
7 
93 
476 
New Jersey 
No Legislation 
— 
21 
235 
New York 
1921 (County Units) 
12 
62 
932 
North Dakota 
1943 
14 
53 
1,399 
Ohio 
1920 
7 
88 
1,339 
Pennsylvania 
No Legislation 
— 
67 
1,575 
South Dakota 
1939 (County Units) 
2 
64 
1,128 
Washington 
1945 
9 
39 
68 
Wisconsin 
1947 
1 
71 
1,271 
Total 
12 Yes 
166 
1*240 
17,477 
Note; "In Illinois, Missouri* Nebraska 
.* and Washington* township organization 
is optional with the counties* 
As a result* 
85 counties of 
“ 102 in 
Illinois* 24 of 114 in Missouri* 27 of 93 in Nebraska* and 
39 in Washington have organized townships*”^ 
Source - Table A 
only 2 of 
1, William Anderson, The Units of Government in the United States, p. 33. TABIE F 
COUNTY NURSES IN MINNESOTA AS OF JUNE 30, 1948 
County Nurse 
Program 
.Positions 
County Nurses 
Employed 
Vacancies 
Aitkin 
Yes 
1 
0 
1 
Anoka 
Yes 
2 
2 
0 
Becker 
No 
— 
-- 
— 
Beltrami 
Yes 
1 
1 
0 
Benton 
No 
— 
— 
— 
Big Stone 
No 
Blue Earth 
Yes 
2 
2 
0 
Browi 
Yes 
1 
1 
0 
Carlton 
Yes 
2 
2 
0 
Carver 
No 
— 
— 
— 
Cass 
Yes 
1 
1 
0 
Chippewa 
No 
— 
— 
Chisago 
Yes 
1 
1 
0 
Clay 
No 
— 
— 
— 
Clearwater 
No 
— 
— 
— 
Cook 
Yes 
1 
1 
0 
Cottonwood 
Yes 
1 
1 
0 
Crow Wing 
Yes 
1 
1 
0 
Dakota 
Yes 
3 
2 
1 
Dodge 
Yes 
1 
1 
0 
Douglas 
No 
__ 
Faribault 
Yes 
1 
1 
0 
Fillmore 
Yes 
2 
2 
0 
Freeborn 
Yes 
2 
1 
1 
Goodhue 
Yes 
1 
1 
0 
Grant 
No 
MM 
»•» 
Hennepin 
Yes 
8 
8 
0 
Jiouston 
Yes 
1 
1 
0 
Hubbard 
Yes 
1 
1 
0 
Isanti 
Yes 
1 
1 
0 
Itasca 
Yes 
2 
2 
0 
Jackson 
Yes 
2 
1 
1 
Kanabec 
No 
—. 
— 
— 
Kandiyohi 
Yes 
1 
1 
0 
Kittson 
Yes 
1 
0 
1 
Koochiching 
Yes 
1 
1 
0 
Lac Qui Parle 
No 
mm m 
— 
MM 
Lake 
Yes 
1 
0 
1 
Lake-Woods 
No 
— 
— 
-- 
Le Sueur 
Yes 1 
(continued next page) 
1 
0 TABLE F (continued) 
County Nurse 
Program 
Positions 
County Nursfts 
Employed 
Vacancies 
Lincoln 
No 
-- 
— 
Lyon 
No 
— 
— 
— 
McLeod 
Yes 
2 
2 
0 
Mahnomen 
No 
— 
— 
— 
Marshall 
Yes 
1 
1 
0 
Martin 
Yes 
2 
2 
0 
Meeker 
Yes 
1 
1 
0 
Mille Lacs 
Yes 
1 
1 
0 
Morrison 
Yes 
1 
1 
0 
Mower 
Yes 
2 
2 
0 
Murray 
No 
— 
— 
Nicollet 
Yes 
1 
1 
0 
Nobles 
Yes 
2 
1 
1 
Norman 
Yes 
1 
0 
1 
01msbead 
Yes 
4 
4 
0 
Otter Tail 
Yes 
1 
1 
0 
Pennington 
Yes 
1 
0 
1 
Pine 
Yes 
1 
1 
0 
Pipestone 
Yes 
1 
1 
0 
Polk 
Yes 
1 
1 
0 
Pope 
Yes 
1 
0 
1 
Ramsey 
Yes 
3 
2 
1 
Red Lake 
Yes 
1 
0 
1 
Redwood 
No 
— 
— 
-- 
Renville 
No 
— 
— 
— 
Rice 
Yes 
1 
1 
0 
Rook 
No 
— 
— 
0 
Roseau 
Yes 
1 
0 
1 
St. Louis 
Yes 
5 
5 
0 
Scott 
No 
— 
— 
— 
Sherburne 
Yes 
1 
1 
0 
Sibley 
Yes 
1 
1 
0 
Stearns 
No 
__ 
Steele 
Yes 
1 
0 
1 
Stevens 
Yes 
1 ' 
0 
1 
Swift 
Yes 
1 
0 
1 
Todd 
Yes 
1 
1 
0 
Traverse 
No 
mmm. 
Wabasha 
Yes 
1 
0 
1 
Wadena 
Yes 1 
(continued next page) 
1 
0 TABLE F (continued) 
County Burse 
Program 
Positions 
County Nurses 
Employed 
Vacancies 
Waseca 
Yes 
1 
0 
1 
Washington 
Yes 
1 
1 
0 
Watonwan 
Yes 
1 
1 
0 
Wilkin 
Yes 
1 
1 
0 
Winona 
Yes 
1 
1 
0 
Wright 
No 
Ota 
<•— 
Yellow Medicine 
Yes 
1 
0 
1 
Total 
64 Yes 
23 No 
93 
74 
19 
Source - Minnesota Department of Health TABLE G 
COUNTY NURSING SERVICES ESTABLISHED SINCE PASSAGE OF BILL TO PROVIDE 
STATE AID - CHAPTER 54, LAWS 1947 - AS OF JUNE 4, 1948 
The following list giving name of service, date appropriation was 
made, and the date on which service was started, constitute the number of 
counties that have actually organized a nursing service because of supple- 
mental assistance through state aid# 
Service 
Appropriation Made 
Service Started 
lo 
♦Brown County 
7/46 
9/47 
2. 
Cass County 
4/47 
9/47 
3. 
♦Chisago County 
6/46 
7/47 
4. 
♦Cottonwood County 
6/46 
9/47 
5. 
Lake County 
5/48 
7/48 
6 e 
Marshall County 
4/47 
4/48 
7. 
Ottertail County 
4/47 
1/48 
8. 
Stevens County 
11/47 
7/43 
9. 
Waseca County 
4/47 
9/47 
10. 
Steele County 
4/47 
(No nurse as yet.) 
11. 
Wabasha County 
1/47 
ti n 11 n 
12. 
Yellow Medicine County 
6/47 
t» it 11 it 
The three starred counties Brown, Chisago, Cottonwood first con- 
sidered making appropriation for a nursing service in 1946. However, the 
appropriation was made dependent on supplemental aid. Note that these three 
counties did not actually start their services until 1947. 
The following established county nursing services have through 
assistance from state aid increased their nursing service by adding an 
additional nurse. 
1. Anoka County l/48 
2. Blue Earth Co0 6/48 
3. Dakota Co« 5/47 
4. Hennepin Co. 4/48 
5. McLeod Co. 6/47 
6. Martin Co. 10/47 
7. Mower Co. 6/47 
8. Ramsey Co, 7/47 
9, Freeborn Co, (2nd nurse vacancy) 
10, Jackson Co. " ” " 
11. Nobles Co, " " " 
The following counties have active committees working with the 
respective county boards of commissioners regarding making county appropri- 
ation to establish a nursing service for the county# 
Becker Clearwater Murray 
Benton Grant Rock 
Carver Lyon Wright 
Source - Minnesota Department of Health TABLE H 
COUNTY AID GRANTS TO COUNTY NURSING PROGRAMS 1946 - 47 
COUNTIES 
CANCER 
MCH* 
T«B, 
Anoka 
200 ,00 
600,00 
Beltrami 
266,67 
Blue Earth 
200o00 
Carlton 
200,00 
600,00 
Cook 
200o00 
1,300,00 
Crow Wing 
200o00 
Dakota 
200o00 
900,00 
Dodge 
200o00 
300,00 
Faribault 
200o00 
Fillmore 
100,00 
Freeborn 
200o00 
Hennepin 
200o00 
Houston 
60,00 
500,00 
Hubbard 
733,33 
Isanti 
200cOO 
512,50 
Itasca 
200oOO 
600.00 
Kittson 
500,00 
Koochiching 
200oOO 
508,70 
Le Sueur 
167o80 
200,00 
Martin 
200oOO 
Meeker 
200oOO 
Mills Lacs 
371,11 
Morrison 
200,00 
500,00 
Mower 
- 
200,00 
Nicollet 
200,00 
366,67 
Nobles 
169,57 
Olmsted 
200,00 
Pipestone 
63,78 
300,00 
Polk 
200,00 
Ramsey 
200,00 
Rio© 
200,00 
400,00 
Sherburne 
200,00 
600 .00 
Todd 
200,00 
Wadena 
200,00 
Washington 
200,00 
400,00 
Wilkin 
100,00 
450,00 
Winona 
200,00 
TOTALS 
5,991,58 
7,003,18 
4,376,37 
Total Cancer Aid 5,991,58 
Total County Nursing Aid $11,378,55 
♦ MCH - Maternal and Child Health 
Source - Minnesota Department of Health TABLE I 
PUBLIC HEALTH NURSES IN MINNESOTA AS OF APRIL 1, 1948 
There are 72 nurses doing generalized public health nursing in 50 
counties. 
County 
72 
USIS & State Health Dept* 
4 
Sanatoria Field (l Part-time) 
6 
City & School 
15 
School, Teachers College 
94 
City and Private Agencies 
11 
202 
Special Capacity 
32 
Minneapolis Public Health Nurses 
City Health Department 
44 
Community Health Service 
36 
Board of Education 
53 
133 
St* Paul Public Health Nurses 
City Health Department 
20 
Family Nursing Service 
33 
Board of Education 
27 
Wilder Clinic 
1 
81 
Duluth Public Health Nurses 
City Health Department 
7 
Board of Education 
8 
Other 
4 
19 
TOTAL 
467 
Industrial Nurses: 
Minneapolis 
71 
St* Paul 
55 
Duluth 
6 
Rural 
27 
159 
TOTAL (incl. Industrial) 
626 
Source - Minnesota Department of Health  
(Does not 
include collection of garbage) 
Totals 
Board of 
Health arid 
Welfare 
Univ. 
Board of State Board of 
Education of Health Minn. 
Olmsted W. Ke 
County Mayo Clinic Kellogg 
Salaries 
73*181.99 
33*512.81 
8*360.46 7*209.66 
5*338.39 1*674.18 17*086.49 
Travel 
2*804.12 
722.20 
14.92 410.48 
672.35 984.17 
Office Equipment 
and Expense 
2,734.21 
2*169.95 
47.10 
83.20 433.96 
Clinic Equipment 
and Expense 
Laboratory Equipment 
and Supplies 
1*339.78 
478.74 
1*261.68 
478.74 
78.10 
Isolation Hospital 
138.76 
138.76 
Student Fees 
1*424.75 
1*424.75 
Miscellaneous and 
Printing 
Totals 
546.40 
82*648.75 
334.37 
38*618.51 
8*500.58 7*620.14 1*424.75 
212.03 
6*093.94 1*674.18 18*716.65 
The totals do not include any estimate of the invaluable services of 
by the Rochester Child Health Institute* given to the public health program 
and Mayo Association® 
many physicians and others employed 
free of charge by the Mayo Clinic 
Source « Rochester-Olmsted County Health Unit 
TABLE J 
OPERATION EXTENDITURES OF ROCHESTER-OLMSTED COUNTY 
HEALTH UNIT FOR 194/ 
15 COUNTY 
HOTELS 
RESTAURANTS 
PLACE OF 
REFRESHMENT 
LODGING AND 
BOARDING HOUSES 
RESORTS, CABINS 
& TOURIST ROOMS 
TOTALS 
No.of 
Est • 
No. of 
In op. 
No .of 
Est. 
No.of 
Insp« 
No • 
Est 
of No.of 
* Insp. 
No.of 
Est.* 
No.of 
Insp. 
No.of 
Est.* 
No .of 
Insp. 
No.of 
Est. 
No.of’ 
Insp. 
Aitkin 
10 
29 
29 
18 
45 
61 
3 
0 
176 
152 
263 
260 
Anoka 
5 
5 
50 
60 
36 
43 
2 
0 
14 
9 
87 
117 
Becker 
12 
21 
40 
60 
58 
56 
6 
7 
95 
76 
211 
220 
Beltrani 
22 
13 
38 
34 
5 
48 
5 
3 
132 
88 
202 
186 
Benton 
1 
1 
14 
34 
47 
65 
1 
1 
1 
1 
64 
102 
Big Stone 
4 
4 
24 
18 
27 
27 
1 
2 
8 
2 
64 
53 
Blue Earth 
6 
4 
61 
79 
102 
66 
8 
7 
6 
0 
183 
156 
Brown 
13 
9 
34 
39 
82 
94 
2 
2 
' 5 
4 
136 
148 
Carlton 
17 
8 
32 
51 
64 
129 
9 
11 
9 
1 
131 
200 
Carver 
4 
5 
25 
18 
59 
70 
1 
1 
4 
2 
93 
96 
Cass 
19 
5 
100 
23 
57 
26 
2 
2 
230 
248 
408 
304 
Chippewa 
14 
3 
28 
30 
26 
27 
3 
2 
1 
1 
72 
63 
Chisago 
7 
6 
32 
42 
40 
25 
9 
1 
25 
22 
113 
96 
Clay 
17 
6 
56 
64 
52 
46 
3 
4 
0 
6 
128 
126 
Clearwater 
4 
7 
16 
17 
38 
33 
0 
0 
7 
3 
65 
60 
Cook 
5 
19 
10 
36 
108 
75 
3 
8 
15 
120 
141 
258 
Cottonwood 
6 
4 
17 
21 
19 
29 
4 
1 
2 
2 
48 
57 
Crow Wing 
20 
32 
65 
71 
80 
140 
16 
50 
410 
289 
591 
582 
Dakota 
18 
13 
88 
62 
90 
91 
9 
10 
6 
4 
211 
180 
Dodge 
4 
5 
18 
16 
20 
21 
0 
0 
0 
0 
42 
42 
Douglas 
8 
19 
39 
46 
46 
41 
11 
8 
92 
80 
196 
194 
Faribault 
11 
16 
45 
80 
54 
100 
5 
1 
3 
5 
118 
202 
Fillmore 
19 
12 
49 
41 
45 
56 
5 
1 
2 
4 
120 
114 
Freeborn 
8 
6 
54 
74 
69 
67 
0 
1 
1 
0 
132 
148 
Goodhue 
2 
16 
60 
35 
65 
94 
7 
3 
6 
8 
140 
156 
TABLE K 
SUMMARY OF LICENSED ESTABLISHMENTS AND NUMBER OF INSPECTIONS MADE BY 
MINNESOTA DEPARTMENT OF HEALTH 
DIVISION OF HOTEL AND RESORT INSPECTION COUNTY 
_ _ HOTELS 
RESTAURANTS 
PLACE OF LODGING AND 
REFRESHMENT BOAR DENG HOUSES 
RESORTS, CABINS 
& TOURIST ROOMS 
TOTALS 
NOoOf Nooof 
Est* Insp* 
NOeOf 
Est* 
NOeOf 
Insp e 
No* 
Est 
of NOeOf 
© Inspe 
Nooof 
Est* Insp* 
NcoOf 
Est* 
No* of 
Insp c 
No 0cf~Noeof 
Estc Insp e 
Grant 
5 
3 
21 
22- 
15 
10 
1 
3 
2 
4 
44 
42 
Hennepin 
265 
22 
670 
132 
522- 
88 
88 
10 
40 
11 
1585 
263 
Houston 
11 
5 
23 
12 
31 
37 
2 
2 
1 
2 
68 
58 
Hubbard 
15 
6 
27 
43 
48 
43 
1 
2 
148 
154 
239 
248 
Isanti 
2 
2 
16 
18 
17 
14 
1 
0 
5 
2 
41 
36 
Itaaca 
22 
13 
52 
48 
83 
122 
9 
6 
217 
30 
383 
219 
Jackson 
8 
4 
26 
18 
40 
33 
2 
1 
1 
5 
77 
61 
Kanabec 
4 
3 
12 
11 
18 
21 
0 
0 
11 
8 
45 
43 
Kandiyohi 
19 
18 
55 
48 
27 
35 
7 
4 
50 
43 
158 
148 
Kittson 
7 
6 
24 
17 
9 
14 
1 
2 
0 
0 
41 
39 
Koochiching 
20 
3 
43 
9 
56 
14 
5 
0 
98 
15 
222 
41 
Lac Qui Parle 
4 
5 
29 
32 
31 
26 
0 
0 
1 
0 
65 
63 
Lake 
8 
1 
84 
20 
24 
34 
5 
2 
28 
29 
149 
86 
Lake of Woods 
2 
1 
7 
7 
10 
10 
2 
2 
19 
6 
40 
26 
Le Sueur 
5 
7 
35 
52 
65 
135 
10 
10 
13 
6 
128 
210 
Lincoln 
3 
5 
17 
19 
20 
15 
4 
2 
4 
7 
48 
48 
Lyon 
8 
7 
51 
45 
55 
56 
7 
4 
2 
1 
123 
113 
McLeod 
10 
6 
28 
55 
42 
30 
1 
1 
1 
1 
82 
93 
Mahnomen 
3 
1 
10 
14 
17 
16 
0 
O 
18 
15 
48 
46 
♦Marshall 
6 
10 
28 
0 
21 
0 
4 
0 
0 
0 
59 
10 
Martin 
11 
10 
47 
40 
51 
59 
2 
2 
3 
4 
114 
105 
Meeker 
4 
4 
30 
35 
35 
25 
0 
0 
19 
10 
88 
74 
Mille Lacs 
11 
5 
38 
42 
31 
24 
7 
3 
59 
74 
146 
148 
Morrison 
9 
7 
53 
36 
62 
79 
1 
0 
27 
1 
152 
123 
Mower 15 
* No inspections in 
21 
1947* 
56 
90 
68 
142 
16 
6 
0 
18 
155 
m 
17 COUNTY 
HOTELS 
RESTAURANTS 
PLACE OF 
REFRESHMENT 
LODGING AND 
BOARDING HOUSES 
RESORTS, CABINS 
& TOURIST ROOMS 
TOTALS 
No .of 
Est • 
No .of 
Insp. 
No. 
Est 
of No.of 
• Insp. 
No. 
Est 
of No.of 
. Insp. 
No. 
Est 
of No.of 
. Insp. 
No. of 
Est. 
No .of 
Insp, 
No .of 
Est. 
No. of 
Insp. 
Murray 
3 
4 
18 
29 
36 
51 
2 
2 
2 
2 
61 
88 
Nicollet 
4 
2 
18 
14 
28 
30 
1 
1 
2 
2 
53 
49 
Nobles 
6 
6 
22 
26 
42 
50 
7 
3 
0 
3 
77 
88 
Norman 
6 
1 
30 
43 
20 
9 
2 
1 
0 
0 
58 
54 
Olmsted 
145 
31 
73 
107 
80 
84 
133 
260 
11 
ffi 
442 
482 
Otter Tail 
18 
20 
77 
276 
63 
100 
5 
9 
134 
125 
297 
530 
Pennington 
8 
5 
19 
24 
28 
12 
1 
1 
0 
1 
56 
43 
Pine 
9 
6 
32 
44 
45 
44 
2 
2 
20 
26 
108 
122 
Pipestone 
6 
4 
29 
3 
38 
31 
2 
1 
4 
3 
79 
4$ 
Polk 
17 
15 
73 
52 
108 
84 
6 
6 
10 
3 
214 
160 
Pope 
2 
8 
11 
25 
12 
18 
0 
0 
16 
21 
41 
70 
Ramsey 
67 
29 
614 
171 
442 
213 
87 
20 
5 
12 
1215 
445 
Red L^ke 
4 
3 
8 
15 
25 
16 
1 
0 
0 
0 
38 
34 
Red Wood 
6 
0 
40 
3 
63 
14 
2 
0 
2 
0 
113 
17 
Renville 
9 
11 
50 
57 
55 
56 
11 
3 
11 
2 
136 
129 
Rice 
7 
8 
38 
34 
63 
65 
6 
4 
14 
10 
128 
121 
Rock 
5 
3 
15 
21 
32 
24 
2 
2 
2 
0 
56 
50 
Roseau 
4 
6 
19 
9 
24 
26 
1 
1 
0 
0 
48 
42 
St* Louis 
137 
128 
293 
358 
488 
540 
89 
73 
200 
128 
1207 
1227 
Scott 
2 
3 
36 
30 
70 
75 
1 
2 
9 
4 
118 
114 
Sherburne 
7 
6 
17 
44 
20 
26 
4 
0 
9 
13 
57 
89 
Sibley 
4 
8 
26 
47 
38 
71 
3 
6 
0 
1 
71 
133 
Stearns 
26 
35 
108 
243 
185 
281 
4 
4 
80 
60 
403 
623 
Steele 
7 
15 
30 
55 
54 
54 
8 
0 
1 
1 
100 
125 
Stevens 
3 
2 
24 
18 
17 
21 
0 
0 
1 
1 
45 
42 
Swift 
6 
6 
25 
36 
13 
23 
1 
0 
3 
0 
50 
65 
Todd 
4 
6 
33 
31 
50 
53 
1 
0 
17 
19 
105 
109 
Traverse 
4 
3 
14 
16 
20 
15 
1 
1 
1 
0 
40 
35 
Wabasha 
9 
5 
29 
26 
70 
74 
9 
3 
15 
18 
132 
126 
Wadena 
8 
9 
34 
45 
28 
31 
1 
4 
10 
8 
81 
97 COUNTY 
HOTELS RESTAURANTS 
PLACE OF 
REFRESHMENT 
LODGING AND 
BOARDING HOUSES 
RESORTS, CABINS 
& TOURIST ROOMS 
TOTALS 
NOeOf 
Est o 
NOeOf NOeOf No ©of 
Inspo Estc Inspe 
Noc 
Est 
of NOeOf 
e Insp © 
No© 
Est 
of NOeOf 
o Insp© 
No©of No ©of 
Estc Insp c 
No ©of 
Est © 
No ©of 
Insp© 
WaSCOd 
3 
2 23 
23 
49 
47 
2 
,1 
1 
1 
78 
74 
Washington 
7 
8 21 
41 
75 
76 
3 
5 
14 
19 
120 
149 
Watonwan 
3 
3 25 
24 
30 
34 
3 
1 
1 
2 
60 
64 
Wilkin 
3 
9 25 
56 
33 
51 
4 
3 
1 
3 
66 
122 
Winona 
27 
16 59 
40 
119 
130 
b 
6 
7 
15 
217 
207 
Wright 
7 
5 52 
64 
65 
65 
5 
2 
54 
50 
183 
186 
Yellow Medicine 11 
7 31 
38 
43 
41 
1 
2 
1 
1 
87 
89 
Grand Total 
1337 
881 4575 
4120 
5405 
5237 
707 
617 
2675 
2127 
14699 
12982 
♦ In most cases the number of cabins and tourist 
Sources Minnesota Department of Health 
rooms is 
not 
included in the 
number of establishments © 
19 TABLE L 
SUMMARY OF SANITARY INSPECTIONS 
BY 
STATE OF MINNESOTA 
DEPARTMENT OF AGRICULTURE, DAIRY AND FOOD 
JANUARY 1, 1947 - DECEMBER 51, 1947 
NO. OF 
NO. OF 
COUNTY 
INSPECTIONS 
COUNTY 
INSPECTIONS 
Aitkin 
256 
Koochiching 
104 
Anoka 
61 
Lac Qui Parle 
171 
Becker 
266 
Lake 
43 
Beltrami 
179 
Lake of the Woods 
26 
Benton 
182 
Le Sueur 
116 
Big Stone 
126 
Lincoln 
62 
Blue Earth 
331 
Lyon 
130 
Brown 
199 
McLeod 
175 
Carlton 
162 
Mahnomen 
65 
Carver 
230 
Marshall 
50 
Cass 
306 
Martin 
183 
Chippewa 
227 
Meeker 
249 
Chisago 
161 
Mille Lacs 
131 
Clay 
371 
Morrison 
347 
Clearwater 
87 
Mower 
141 
Cook 
49 
Murray 
71 
Cottonwood 
52 
Nicollet 
173 
Crow Wing 
845 
Nobles 
75 
Dakota 
64 
Norman 
168 
Dodge 
98 
Olmsted 
252 
Douglas 
196 
Otter Tail 
454 
Faribault 
159 
Pennington 
44 
Fillmore 
125 
Pine 
206 
Freeborn 
314 
Pipestone 
61 
Goodhue 
211 
Polk 
155 
Grant 
118 
Pope 
106 
Hennepin 
3415 
Ramsey 
2609 
Houston 
62 
Red Lake 
29 
Hubbard 
162 
Redwood 
43 
Isanti 
100 
Renville 
113 
Itasca 
501 
Rice 
81 
Jackson 
53 
Rock 
65 
Kanabec 
61 
Roseau 
35 
Kandiyohi 
279 
St. Louis 
914 
Kittson 
14 
Scott 
62 TABLE L (Cont.) 
NO* OF 
NO. OF 
COUNTY 
INSPECTIONS 
COUNTY 
INSPECTIONS 
Sherburne 
82 
Waseca 
188 
Sibley 
75 
Washington 
56 
Stearns 
746 
Watonwan 
101 
Steele 
261 
Wilkin 
109 
Stevens 
95 
Winona 
184 
Swift 
202 
Wright 
289 
Todd 
459 
Yellow Medicine 
160 
Traverse 
98 
Wabasha 
49 
Wadena 
261 
TOTAL INSPECTIONS MADE - 21,146 
Source - Minnesota Department of Agriculture, Dairy and Food TABLE M 
COMPARISON OF STATE INSPECTIONS MADE IN COUNTIES WITH 
LOCAL HEALTH SERVICES WITH THOSE MADE 
IN NEIGHBORING COUNTIES 
COUNTY 
HEALTH 
AGRICULTURE 
EST . 
INSP. 
%* 
.INSP. 
OLMSTED 
442 
482 
109.0 
252 
Mower 
155 
277 
178.7 
141 
Dodge 
42 
42 
100.0 
98 
Goodhue 
140 
156 
111.4 
211 
Wabasha 
132 
126 
95.5 
49 
Winona 
217 
207 
95.4 
184 
Fillmore 
120 
114 
95.0 
125 
ST. LOUIS 
1207 
1227 
101.7 
914 
Aitkin 
263 
260 
98,9 
256 
Itasca 
383 
219 
57,2 
501 
Koochiching 
222 
41 
18.5 
104 
Lake 
149 
86 
57.7 
43 
Carlton 
131 
200 
152.6 
162 
* The number of establishments and the number of inspections are totals for 
all categories such as restaurants, hotels, resorts, etc. Therefore 100$ 
coverage in the table may not necessarily mean 100$ inspection of all 
categories. 
Source - Tables K and L COUNTY 
“ ESfTUiTKb 
POPULATION 
1945 
rwrsfiaBERJSg 
FOR HEALTH CONSERVATION 
jssm—:— 
COST OF LOCAL 
HEALTH UNIT AT 
|1.60 PIE CAPITA 
ADDlTldNAl' AMbtfNT NEED® 
TO REACH fl.SO PER CAPITA 
AMOUNT : PER CA?>TtI 
TAXABLE VALUE OF REAt 
AND PERSONAL PROPERTY 
1944 ASSESSMENT 
INCREASE 
IN MILL RATE 
(IN MILLS) 
BTHTRAfl 
TO RAISE ♦l.SO 
PER CAPITA 
Total For State 
And Local Ex- 
penditure* 
Total For All 
Local Units of 
Government 
2*618,952 
2,618,952 
12,551,948 
820,905 
1 .974 
.313 
13,928,428 
♦3,107,523 
♦1.187 
♦1,304,899,706 
2.4 
3.0 
Aitkin 
12,951 
480 
.037 
19,427 
18,947 
1.465 
1,802,128 
10.5 
10.8 
Anoka 
25,822 
2,594 
.100 
38,733 
36,139 
1.400 
5,826,858 
6.2 
6.6 
Beoker 
22,242 
975 
.044 
33,363 
32,388 
1.456 
6,349,710 
5.1 
5.3 
Beltrami 
21,590 
3,675 
,170 
32,385 
28,710 
1.330 
3,570,324 
8.0 
9.1 
Benton 
14,804 
182 
.012 
22,206 
22,024 
1.488 
4,439,752 
5.0 
5.0 
Big Stone 
8,893 
146 
.016 
13,540 
13,194 
1.484 
5,048,877 
2.6 
2.6 
Blue Earth 
32,612 
7,805 
.239 
48,918 
41,115 
1.261 
20,072,310 
2,0 
2.4 
Brown 
23,955 
1,586 
.066 
35,933 
34,347 
1.434 
13,397,893 
2.6 
2.7 
Carlton 
21,377 
8,163 
.382 
32,066 
23,903 
1.118 
7,027,475 
3.4 
4.6 
Carver 
15,971 
156 
.010 
23,957 
23,801 
1.490 
8,716,898 
2.7 
2,7 
Cass 
15,693 
248 
.016 
23,540 
23,292 
1.484 
2,372,760 
9.8 
9.9 
Chippewa 
14,198 
549 
.025 
21,297 
20,948 
1.475 
7,733,329 
2.7 
2.7 
Chisago 
11,507 
126 
.011 
17,261 
17,155 
1.489 
4,298,928 
4.0 
4.0 
Clay 
23,292 
2,351 
.101 
34,938 
32,587 
1.399 
10,020,728 
3.3 
3,5 
Clearwater 
9,126 
125 
.013 
13,688 
13,565 
1.487 
1,244,738 
10.9 
11.0 
Cook 
2,506 
2,546 
1.016 
3,759 
1,213 
.484 
627,972 
1.9 
6.0 
Cottonwood 
13,421 
355 
.026 
20,132 
19,777 
1.474 
9,685,151 
2.0 
2.1 
Crow Wing 
27,022 
8,325 
,308 
40,533 
32,208 
1.192 
8,447,930 
3.8 
4.8 
Dakota 
43,530 
6,460 
.149 
64,995 
58,535 
1.351 
17,295,405 
3.4 
3.8 
Dodge 
11,543 
1,988 
.175 
17,015 
15,027 
1.325 
7,153,708 
2.1 
2.4 
Douglas 
19,165 
746 
.039 
28,748 
28,002 
1.461 
6,954,121 
4.0 
4.1 
Faribault 
22,874 
615 
.027 
34,311 
33,696 
1.473 
13,774,187 
2.4 
2.5 
Fillmore 
23,236 
2,612 
.112 
34,863 
32,241 
1.388 
12,217,301 
2.6 
2.9 
Freeborn 
31,420 
10,007 
.318 
47,130 
37,123 
1.182 
15,268,393 
2.4 
3.1 
Goodhue 
29,263 
8,707 
.298 
43,895 
35,188 
1.202 
16,181,979 
2.2 
2.7 
Grant 
8,840 
46 
.005 
13,260 
13,214 
1.495 
4,723,571 
2.8 
2.8 
Hennepin 
580,253 
315,612 
.544 
870,380 
554,768 
.956 
264,498,687 
2.1 
3.5 
Houston 
13,243 
1,516 
.114 
19,865 
18,349 
1.386 
5,098,184 
3,6 
3.9 
Hubbard 
9,299 
2,998 
.322 
13,949 
10,951 
1.178 
1,754,786 
6.2 
7.9 
Isanti 
11,064 
2,837 
.256 
16,596 
13,759 
1.244 
3,177,096 
4.3 
5.2 
Itasoa 
28,980 
7,665 
.264 
43,470 
35,805 
1.236 
17,303,238 
2.1 
2.5 
Jackson 
14,911 
3,293 
.221 
22,367 
19,074 
1.279 
12,089,624 
1.6 
1.9 
Kanabec 
8,731 
48 
.005 
13,097 
13,049 
1.495 
1,874,749 
7.0 
7.0 
Kandiyohi 
25,346 
3,400 
.134 
38,019 
34,619 
1.366 
12,270,621 
2.8 
3.1 
Kittson 
9,283 
130 
.014 
13,925 
13,796 
1.486 
4,460,964 
3.1 
3.1 
Koochiching 
14,693 
2,453 
,167 
22,040 
19,587 
1.333 
3,443,857 
5.7 
6.4 
Lao Qul Parle 
13,543 
125 
.009 
20,315 
20,190 
1.491 
10,223,180 
2.0 
2.0 
Lake 
6,730 
1,046 
.155 
10,095 
9.049 
1.345 
1,572,147 
5.8 
6.4 
Lake of the Woods 
4,172 
54 
.013 
6,258 
6,204 
1.487 
616,006 
10.1 
10,2 
Le Sueur 
17,702 
115 
.006 
26,553 
26,438 
1.494 
9,326,406 
2.8 
2.8 
(oontinued next page) 
TABLE N 
ESTIMATED COST OF FULL-TIME LOCAL HEALTH UNITS IN MINNESOTA BT COUNTIES COUNTY 
HOTWr ■ 
POPULATION 
1945 
IS'4'5 BffHftlfflEgS 
FOR HEALTH CONSERVATION 
aBoCSt—:—FSTcaFTta 
■■ tost ornm 
HEALTH UNIT AT 
$1.50 PER CAPITA 
” TDDITTcm AMounT WM)Jd) 
TO REACH $1.50 PER CAPITA 
amount - SaPIta 
TAXABLE VAUJE OF real 
AND PERSONAL PROPERTY 
1944 ASSESSMENT 
IncHSSS 
IN MILL RATE 
(IN MILLS) 
■nrsns 
TO RAISE $1.50 
PER CAPITA 
Lincoln 
9,477 
157 
.017 
14,216 
14,059 
1.483 
5,949,619 
2.4 
2.4 
Lyon 
19,404 
2,101 
.108 
29,106 
27,005 
1.392 
11,986,838 
2.3 
2.4 
McLeod 
20,108 
2,518 
.125 
30,162 
27,644 
1.375 
11,286,558 
2.4 
2.7 
Mahnomen 
6,489 
95 
.014 
9,734 
9,641 
1.486 
1,232,040 
7.8 
7.9 
Marshall 
15,783 
210 
.013 
23,675 
23,465 
1.487 
5,085,943 
4.6 
4.7 
Martin 
22,487 
7,399 
.529 
33,731 
26,332 
1.171 
16,064,893 
1.6 
2.1 
Meeker 
18,111 
2,498 
.138 
27,167 
24,669 
1.362 
9.546.855 
2.6 
2.8 
Mille Laos 
15,543 
128 
.009 
20,315 
20,187 
1.491 
3,105,333 
6.5 
6.5 
Morrison 
23,942 
1,412 
.059 
55,913 
34,501 
1.441 
7,056,903 
4.9 
5.1 
Mover 
37,435 
9,677 
.258 
56,153 
46,476 
1.242 
18,179,507 
2.6 
3.1 
Murray 
12,962 
137 
.011 
19,443 
19,306 
1.489 
10,256,166 
1.8 
1.9 
Nicollet 
16,713 
2,248 
.135 
25,070 
22,822 
1.565 
7,753,077 
2.9 
3.2 
Nobles 
20,107 
1,572 
,078 
30,161 
28,589 
1.422 
14,104,046 
2.0 
2.1 
Norman 
11,506 
1,422 
.124 
17,259 
15,837 
1.376 
5,174,252 
5.1 
5,3 
Olmsted 
39.109 
34,605 
.885 
58,664 
24,059 
.615 
22,548,590 
1.1 
2.6 
Otter Tail 
44,959 
3,084 
.069 
67,439 
64,355 
1.431 
14,147,190 
4.5 
4.8 
Pennington 
10,953 
1,334 
.122 
16,430 
15,096 
1.378 
3,626,821 
4.2 
4.5 
Pine 
17,549 
165 
.009 
26,324 
26,159 
1.491 
3,584,711 
7.7 
7.8 
Pipestone 
13,608 
2,014 
.148 
20,412 
18,398 
1.352 
7,744,291 
2.4 
2.6 
Polk 
32,271 
5,501 
.170 
48,407 
42,906 
1.330 
13,319,022 
3.2 
3.6 
Pope 
11,945 
1,285 
.108 
17,918 
16,633 
1.592 
6,291,642 
2.6 
2.8 
Ramsey 
307,283 
138,376 
.450 
460,925 
322,550 
1.050 
144,944,024 
2.2 
3.2 
Red Lake 
6,401 
37 
.006 
9,602 
9,565 
1.494 
1,997,404 
4.8 
4.8 
Redwood 
20,868 
660 
.032 
31,302 
30,642 
1.468 
13,810,015 
2.2 
2.3 
Renville 
22,144 
141 
,006 
33,216 
33,075 
1.494 
14,881,997 
2.2 
2.2 
Rloe 
29,652 
2,693 
.091 
44,478 
41,785 
1.409 
12,404,693 
3.4 
3.6 
Rook 
9,388 
130 
.014 
14,082 
13,952 
1.486 
9,331,668 
1.5 
1.5 
Roseau 
13,413 
790 
.059 
20,120 
19,330 
1.441 
2,447,341 
7.9 
8.2 
St* Louis 
187,540 
147,377 
.786 
281,310 
133,933 
.714 
192,803,503 
0.7 
1.5 
Scott 
15,646 
165 
.011 
23,469 
23,304 
1.489 
6,221,599 
3.7 
3.8 
Sherburne 
8,453 
82 
.010 
12,680 
12,598 
1.490 
2,625,282 
4.8 
4.8 
Sibley 
12,254 
1,564 
.111 
18,381 
17,017 
1.389 
11,030,487 
1.5 
1.7 
Stearns 
61,483 
10,261 
.167 
92,225 
81,964 
1,333 
19,681,299 
4.2 
4.7 
Steele 
18,972 
1,347 
.071 
28,458 
27,111 
1,429 
9,834,253 
2.8 
2.9 
Stevens 
10,708 
325 
.030 
16,062 
15,737 
l.*70 
6,848,679 
2.7 
2.7 
Swift 
14,183 
2,264 
.160 
21,276 
19,011 
1.340 
6.603,473 
2.9 
3,2 
Todd 
22,746 
2,089 
.092 
34,119 
32,030 
1.408 
7,168,434 
4.5 
4.8 
Traverse 
7,128 
81 
.011 
10,692 
10,611 
1.489 
5,033,097 
2.1 
2.1 
Wabasha 
15,598 
243 
.016 
23,397 
23,154 
1.484 
7,921,744 
2.9 
3.0 
Wadena 
11,701 
3,305 
.282 
17,552 
14,247 
1.218 
2,611,748 
5.5 
6.7 
Waseca 
13,310 
735 
,055 
19,965 
19,230 
1.445 
8,452,887 
2.3 
2.4 
Washington 
27,438 
820 
.030 
41,157 
40,337 
1.470 
8,610,123 
4.7 
4.8 
Wa/tonwazi 
12,851 
3,160 
.246 
19,277 
16,117 
1.254 
7,707,081 
2.1 
2.5 
Wilkin 
9,521 
349 
.037 
14,282 
13,933 
1.463 
5.871,813 
2.4 
2.4 
Winona 
34,109 
15,295 
.448 
61,164 
35,869 
1.052 
16,653,862 
2.2 
3.1 
Wright 
25,304 
218 
.009 
37,956 
37,738 
1.491 
10,188,340 
3.7 
3.7 
Yellow Medicine 
15,755 
176 
.011 
23,633 
23,457 
1.489 
10,408,824 
2.3 
2.3 
Sources - Population Data r Minnesota Department of Business 
Research and Development, Measuring 
Minnesota, 
March 1948, p. 26 f. 
State 
and Local Expenditures and 
Taxable Value of Property - Reports of Minnesota Publ 
io Examiner for 1946. 
TABLE H (continued) TABLE 0 
ESTIMATED MILL RATE NECESSARY TO RAISE 
50 PER CAPITA 
Mill Rate 
Counties 
0 - 1.9 
5 
2 - 3©9 
50 
4 ~ 5o9 
16 
6 *“ 7© 9 
10 
8 <=■ 9©9 
3 
10 -11«9 
3 
Total 
87 
Source =• Table N 
TABLE P 
ESTIMATED INCREASE IN MILL RATE NECESSARY TO FINANCE FULL** 
TIME LOCAL HEALTH UNITS IN MINNESOTA COUNTIES 
Mill Rate 
Counties 
0 “ 1 ©9 
8 
2 - 3,9 
50 
4 - 5,9 
17 
6 - 7,9 
7 
8 — 9,9 
2 
10 -11c9 
3 
Total 
87 
Source Table N