History of public health in Georgia, 1733-1950

HISTORY
OF
PUBLIC HEALTH
IN
GEORGIA
1733 - 1950
BY T. F. ABERCROMBIE, M. D.
c
Director-Emeritus Georgia Department of Public Health

CONTENTS

CHAPTER l-IN THE BEGINNING (1733-1870) ....... ..................... 10
~~c;l~~i~e!;e~l~~..:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ~~
Significant Early Settlers ...................................................... 12 Other Early Settlements ....................... .......................... ..... 14 Further Pioneer Health Reports ........................... ......... ...... 14 Colonial Physicians ........... ...................................... ............... 16
Midway Settled ... .. -- -- - 17 The Smallpox Scourge ....................... ............ .... ................... 17 Analysis of Early Health Records ....................... ......... .... .. 18 Early Vital Statistics .................................................... .. ...... 19 Malaria in Colonial Georgia ................................................ 21 Early Plantation Health ......... .............. .... ................. ... ...... 22
"First Public Health Law ...... ---------- - 24 ~ealth in Revolutionary Days ... ... .. ............................. ....... 27
orne Health "Firsts" ... ... ......... ... .................... .. ..... ...... .... ..... 27 Smallpox Vaccinations ... ................................... 28 Health Officer .......... .. ..................... ..... ....... ..... .. 28 City Board of Health ........... ............................. 28
Dr. Turner Reports ... ....................... ......... ... ... .... .... .... ......... 29
Health in 1809-1823 -- ----- -- -- ------ ------ ----- --- 30 Yellow Fever Appears - -- -- ------- - ----- - 30
More Plantation Health --------- -- - --------- ------- ----------- - 33 Asylum Established ------------------------- --- ------- 33 Yellow Fever Again --- -- ---- ------- ---------- ---- --- - -- .. 34 Plantation Medicine ---- ---- --------- - -- - ... ..... .... 35

CHAPTER II-HEALTH IN RECONSTRUCTION DAYS
(1875-1900) ---- ----------- ------ --- -- 38 First State Board of Health ........... ....................................... 38 Comparison with Michigan .......................... ........... ...... ....... 42 Early Local Boards of Health .. .......................... ........... ....... 43 Initial Efforts Disappointing ........................... .................... 45 "Derry's Guide" ...... ...... ........ .................. .................... ......... . 46

CHAPTER III-THE SECOND STATE BOARD OF

HEALTH (1903-1917)

.................. ...................... .......... .......... 54

Antirabic Measures Instituted ... .... .............. .................. .... 59 Diphtheria Antitoxin Produced .... ............... ............. ..... .. 60 Other Antitoxins and Vaccines ... ........ .... ...................... .... 60 Fourteen Years of Laboratory Work ......... ........... ... ........ ... 61 Other Activities and Problems .............. ..... ................. ..... ... 61 Dr. Harris Resigns .... ........... ............... ........... ...... ........ ....... 63 Drug Addicts Treated ......................................... .................. 64

CHAPTER IV-REVIEW OF HEALTH PROBLEMS IN
EARLY 1900 - - -- 65 Typhoid Fever ............. ........................................................... 65 Malaria ........... ................................. ............ ........................ .. 67

Hookworm Disease ... ... ..... ......... _ ..... ... ...... .. . . .. . .. ... ...... 73

Pellagra ___

........ .... .

Studied at Milledgeville

75
_ .... __ ___ .. . ..... 77

Harris Theory Vindicated _ _-- -- ---- --- --- -- .... 77

Trachoma

___ _... .... ........... .. .. _. .... . .

......... .. . 78

Mitchell County Epidemic _ _. .. . .. .

78

Clinic Established ..... .. _. __ .

79

School Children Examined _. _.. ... __ ._

80

Southwest Georgia Epidemic ......... . ___ ____ . ... .. 81

Venereal Disease ....... ................ Tuberculosis ..... .... .........

.... .... ... ..... .

... 82

.____ _______ .. ...... ...

83

CHAPTER V-STATE HEALTH WORK (1917-1937 )

86

Appropriation Increased

__________ __

86

Increased Demand for Laboratory Facilities

87

Tularemia Appears

87

Yeast Distribution Begun

89

Typhoid Tribulations ..

89

Expansion Continued .. _____ .. ___ .......

93

Venereal Disease Control Begun

93

Serologic Tests Made

.. . ... . ... .. ... ...... .... 94

VD Education Activities

95

First Film Shown

95

Progress Reported

96

Local Health Work Established .... ........ . ...

97

Division Established

98

Commonwealth Demonstration ..... ....... ........ 100

Additional Tuberculosis Facilities Provided

......... 101

Collection of Vital Statistics Initiated

104

Early Maternal and Child Health Efforts

Phi Mu Healthmobile ... ... ... .. ................

Midwife Supervision

.. . .. .... ... .

First MCH Clinics .......... . .... .

Activities Varied

.... 106 . 106
107 108 108

Sparta Child Health D emonstration .. ... ..... .

110

Demonstration Activities

112

Initial Findings

. .... ... .. ..... .

112

Diets Studied

.. . 11 3

Vitamin A Deficiency Studied

. .114

Food Habits Studied .

... ..

114

Special Nutritional Study

.... 115

Many Problems Present .. ___ .. . ______ .. .

.... 116

Summary of Accomplishments

.117

Public Health Engineering Added ___ ........... .

.118

Division Established ... ... _.. .. ...... ____ .... ..... .. .....120

Training School for Mental Defectives 'Founded ... ... ...... .122 Early Dental Health ... .... .. ...... ... - ---------------- __ ... .... .. ... .126
Mobile Unit Loaned State .. ..... ........ __ ___ .....127

Commonwealth Dental Project ----- ------ - 127 Oral Hygienist Employed ... ..... ................ .... .127
Supervisor of Mouth Health Added .... ..... .......128

Tuberculosis Control Begun .. .... ..................... ... ...... ......... .. .129 Early Epidemiological Efforts ......... ..................................... 131
Chronic Typhoid Carriers Found .. ...... ... ......... 132 Malaria Investigations Made .......................... 132 Epidemic Amebic Dysentery ........................... 133 Typhus Fever Appears ........... .. .. ...... .. .... ........... 134 Health Survey Project ........ ........................... .. 134 Widespread Public Health Nursing Initiated .......... .........134 Summing Up in 1935 .............. .... ..................................... ... .. 137 Revenue Reduced ....... ........... ............. ............... 138 Looking Backward ..... .... ............. ........... ...........139
CHAPTER VI-STATE HEALTH WORK ( 1937-1947) ..... ........ ... 140 Health Funds Available ............... .... .. ... ......... ... ....... ............ 144
Health Record for 1940 .. ........................... .... ................... .144 Twenty Years of Health Progress ................... 144 Eleven Causes of Death Low ... .... ............ .. ...... 145
Cancer Control Initiated ...... ...... .. ......... ..... ......... ................ .150
Local Health Organizations .. ..... ...................................... ..155 Development Board Appointed ......... .............. 158
Sanatorium Facilities Expanded ........ ................................ .. 160
Maternal and Child Health ........... .......... ........... ............ .164 Venereal Disease Control .... ..... ... ...... ............................. .. ... 170
Three Counties Against Syphilis .................... 170 Rapid Treatment Begun ... ..................... ......... 171 Mass Testing Initiated ..................... ............... 172 Dental Health .. .. . .. ..... ........ .. .. .. ... ... ....... ..... ... .... .173 First Statewide Inspections .. .. ........................ 173 Refresher Course ................. ..... ... ....... .............. . 174 Dental Clinics ........... ......... .............................. 174 Dental Caries Study ...... .............. ... .................. 175 Application Sodium Fluoride ... ................. ......175 Statistics Grow ................... .......................................... ........ .175 Public Health Nursing ...... .................................................. .177
Tuberculosis Control ......... ..... ..... ... .. ... .. ............................ ...178 1944 Achievements ............. .............. ....... ...... .... ............. .. ..... 182
Industrial Hygiene Service ..... .......... ... .................. ... ......... 186 The Petrie Clinic ........................ ............... .. ... 192
Hospital Services Available .... ..... ...... .. ..................... .. ...... . .192
Laboratory Services Grow ...... .... .. ......... .............................. 197
Epidemiology Expanded ....... ...... ............... .................. .. ..... 199
Public Health Engineering Up-To-Date ............. ............ .. 200 Summing Up .................................................................. .. .. .. 202
Members of the State Board of Health, 1875-1876 .. ......... 210 Members of the State Board of Health, 1903-1950 ........ 210 Advisory Board of Health, 1932-1933 ....... ....... ... ............. 212
' Executive Officers, Georgia State Boardof Health ......... 212
Chairmen, Georgia State Board of Health, 1903-1950.... 213

Local Health Officers, 1914-1950 .

.... 213

Superintendents, State Tuberculosis Sanatorium ........... 220

Ten Year and More Employees ..... .

. .. . ... 220

Appropriations for Public Health, 1903-1953

. 224

Population in Georgia, 1752-1950 .

.... 228

ILLUSTRATIONS

Henry Fauntleroy Harris, M. D.

. ...... .... ... .... . ..... ..

3

Thomas Franklin Abercrombie, M. D.

... ... . . . 4

Thomas Fort Sellers, M. D. .................. ................................................. 5

Entrance State Department of Public Health, 1940 . .. ... ..

9

State Health Department Office, 1910 .

.... 53

State Tuberculosis Sanatorium, Alto, Ga., 1911 . ..............

84

Pellagra Case and Death Rate, Georgia, 1920-1950

88

Typhoid Case and Death Rate, Georgia, 1920-1950 .......

92

State Office Building, 1940 ... ... ... .... .. ..

.......... ... ... .. ... ... ... ........ 143

Whooping Cough Case and Death Rate, Georgia, 1920-1950 ... 146

Measles Case and Death Rate, Georgia, 1920-1950

... 147

Scarlet Fever Case and Death Rate, Georgia, 1920-1950 .. .. ..... .148

Cancer Death Rate, Georgia, 1920-1950 ...

.......... . . . ... 154

State Tuberculosis Sanatorium, 1937 . . . ... .. .. ....... ..

..161

Battey State Hospital, 1946 ........................

.. .163

Infant Mortality Rate Per 1,000 Live Births, Georgia, 1920-1950...... 167

Maternal Mortality Rate Per 1,000 Live Births, Georgia, 1920-1950.168

Stillbirth Rate Per 1,000 Live Births, Georgia, 1920-1950

. .. .169

Number of Live Births and Deaths, Georgia, 1920-1950

.. .. . 176

Tuberculosis Case and Death Rate, Georgia, 1920-1950 ............ 181

Diphtheria Case and Death Rate, Georgia, 1920-1950

183

Dysentery Case and Death Rate, Georgia, 1920-1950

.............. 184

Influenza and Pneumonia Case and Death Rate, Georgia, 1920-1950. 185

Per Cent of Live Births Occurring in Hospitals in Georgia,

. 1920-1950

..............

. .. ... .. ......198

Malaria Case and Death Rate, Georgia, 1920-1950 .

.... ...... 201

Typhus Case and Death Rate, Georgia, 1920-1950 .

. ...... 203

Heart Disease Death Rate, Georgia, 1920-1950 ....

. ......205

Cerebral Hemorrhage, Embolism and Thrombosis Death Rate, Georgia .... . ................................ ..... ....... ... ................. ..........206

Diabetes Death Rate, Georgia, 1920-1950 ..................................... 207

Death Rates from Motor Vehicle Accidents, Georgia, 1920-1950 .......208

Homicide and Suicide Rates, Georgia, 1920-1950 . ......................209

Georgia Population 1760-1950 ........ .................

................. 223

HENRY FAUNTLEROY HARRIS, M.D. State Health Director 1903-1917
3

THOMAS FRANKLIN ABERCROMBIE, M. D. State Health Director 1917-1947

THOMAS FORT SELLERS, M.D. State Health Director 1947-

ACKNOWLEDGMENTS
In the early years of state health work funds and personnel were meager but potentialities for improvement unlimited. In the absence of adequate State resources, valuable contributions in money and the loan of trained persons were made by The Rockefeller Foundation, The U. S. Public Health Service, The American Red Cross, The Commonwealth Fund, and The Georgia Tuberculosis Association.
The physicians of Georgia have always been an integral part of the public health program. They have initiated valuable health projects and supported the activities of the State Department of Public Health. The State Board of Health was established at the insistence of members of the medical profession. The profession was also instrumental in establishing a State Tuberculosis Sanatorium. A history of public health would be incomplete without grateful acknowledgment of their valuable contributions to the effectiveness of the public health program.
Since the first local health officer was appointed in Savannah, in 1888, there has been a veritable legion of health officers, sanitary engineers, nurses and other health personnel that have made the numerous activities and accomplishments possible. To them this brief account is dedicated with the hope that the next public health historian will be able to more adequately describe their individual contributions.
The Georgia Historical Society, at Savannah, was particularly helpful in supplying records of early health activities and reports of conditions existing in Colonial days. The University of Georgia Library furnished a list of the early settlers, and Colonial Records, by Candler, were utilized to gain a picture of initial health conditions in the Colony. The staff of the Georgia State Library supplied helpful records and reports and was generous in the loan of valuable material. Mrs. Margaret Cate Davis, of Sea Island, was the source and inspiration of early data concerning the Brunswick area.
The author wishes to express his personal appreciation to the Director and staff members of the State Department of Public Health who have been helpful in the preparation of the historical data, and to his secretary, Miss Erna Lee Mason. Without their assistance, the final results could not have been accomplished.
6

PREFACE
Since the beginning of recorded time, there have been attempts to practice preventive medicine. Savage and barbarous races used magical charms and incantations to ward off disease, supplemented by the medicine man's meager knowledge of therapeutics or primitive sanitary measures.
In the earliest civilizations, there was evidence of public health work. In ancient times Assyria, Babylonia, Egypt, Crete, Greece and Rome made use of sanitary science.
Cyrus the Great who showed concern for soldiers of the Persian Army, was advised by his father: "Thy chief anxiety should be to provide for health, for thou oughtest to take care to prevent the army from falling into sickness at all."
Hippocrates, called the father of medicine, advocated boiling or filtering all drinking water. The Tigris and Euphrates valley inhabitants had drains and sanitary conveniences.
Jerusalem was well sewered and had a good water supply; Carthage had the oldest known cisterns; and Rome had sewers as early as 800 B.C. Egypt had some of the oldest wells, and China had the deepest.
Moses, about 1600 B.C., advocated and enforced many hygienic laws of preventive rather than curative nature, as recorded in Deuteronomy and Leviticus.
These early advances in hygiene and sanitation were apparently lost after the fall of Rome. During the dark ages that followed, plagues resulting from the abandonment of sanitary science swept Europe again and again, at times wiping out as much as a quarter of the population of whole countries.
The beginning of the modern public health movement dates from a sanitary awakening which took place in England. A report of Lemuel Chadwick, in 1842, on the "Sanitary Conditions of the Laboring Population of Great Britain" led to a general campaign for environmental sanitation which spread rapidly from England to America and to other countries of the civilized world.
There are no known data on vital statistics prior to the sixteenth century. All of the data available for the sixteenth, seventeenth, and eigh-
7

teenth centuries, unreliable and incomplete as they may be for those periods, furnish impressive evidence of excessive sickness and death as compared with those of the twentieth century.

It was reported by the Anthropological Institute of Great Britain and Ireland, in 1872, that "considerable cqanges have accordingly taken place in the average duration of life in England during the last hundred years. At the early part of this period it was 28 years. According to more recent tables it was 32 years; and it has been calculated that it may fairly be expected to extend to 40 years."

Edward Mallet reports the expectation of life at birth, based on Geneva mortality records, as follows:

16th century-- -- -- -- -- --- --- --- ------ --- -- --- _____ ________ 21.21 years

17th century __ __ -- --- - --- - - - ---- -- -- -------- ------ - ____ 25.67 years

18th century_____________________ __ _______________________

__ __ __ __ ___ 33.62 years

Dr. Edmund Halley constructed mortality tables from records in Breslau, Silesia, in 1693, that indicated a life expectancy of 33.5 years at birth. The Bre~lau tables arc regarded as more reliable than the earlier tables.

These figures give no uncertain record of the helplessness of the individual, the home, and the society of the time in the struggle for life and health. Before the 19th century, the best expectation could promise the infant at birth only an even chance that he would live to be almos! 34 ycars of age.

8

Chapter I
IN THE BEGINNING
1733-1870
Georgia's public health history began when the first contingent of 114 brave souls signed an agreement with the Trustees of the Colony of Georgia to come to the new country at their expense. The success of the undertaking necessarily depended upon the health condition and survival of the pioneer colonists. That they were hardy is apparent from the record that only two deaths, and those of children one year of age, occurred on the first ship, the good ship Anne, during its journey from November, 1732, until its passengers landed at Yamacraw Bluff in February, 1733. One child was born on shipboard.
With this first group that embarked, there were one apothecary and one midwife. The Trustees gave the colonists thirteen guineas ($66.43) for the relief of the sick and child-bearing women in their passage. Dr. Hans Sloane, the King's physician, was among those in England who were interested in the health of the Georgia colonists. He solicited contributions with which to pay the salary of a botanist who was sent to Spain to secure and transplant to Georgia valuable medicinal herbs. The Rev. Dr. Stephen Hales, a member of the Board of Trustees, also solicited money from the church people of England for the embarking colonists. Among the drugs furnished the early settlers were "bears oyl," sea rod, snake root, sassafras, sumac, and contra-yerva.
The colonists arrived at the beginning of the spring months at a spot that must have been at its height of primeval beauty. They received their land lots and began establishing wilderness homes with high courage. In Jones' History of Georgia, published in 1883, the Yamacraw site is described as: "A high and dry plain, overshadowed by pines, interspersed .~ith live oaks and magnolias, with small creeks affording satisfactory drainage. The yellow jessamine was already mingling its delicious perfume with the breath of the pine and the trees were vocal with the voice of song birds. Everything was quickening into life and beauty under the influence of the returning spring. The temperate rays of the 11un gave no token of summer's heat and in the balmy air lurked no suspicion of malaria fevers."
Oglethorpe described the location in a letter to the Trustees as: "Our

people are all in perfect health. I choose the situation for the town upon high ground, forty feet perpendicular above high water mark; the soil dry and sandy; the water of the river fresh and springs coming out of the hill. I pitched upon this place not only for the pleasantness of the situation, but because, from the above mentioned, and other signs, I thought it healthy."
PRE-COLONIAL HEALTH
For a description of health conditions in previous years in the locality chosen by Oglethorpe for the early settlers, the crusading Spaniards of the sixteen century give some sparse reports. In 1540 when DeSoto left his Florida winter camp and crossed the Altamaha into Georgia, he encountered the Indian town of Cofitachequi. He described the locality: "In the vicinity of this settlement were large vacant Indian towns, vacated in 1538 due to a recent pest. There were many new sepulchers or tombs in which were found pearls and figures carved from shells."
In 1566, another Spaniard, Menendez, landed at St. Catherine's Island off the Georgia coast and established a settlement. Jesuit missionaries joined the group to teach Christianity to the Indians. One of these, Brother Domingo, who translated the catechism and prepared an Indian grammar, died during a fever epidemic in 1568.
In 1573, Franciscan missionaries settled on other coastal islands. These missions reported that '"a great epidemic of disease" was experienced in 1612. Reference was made to wholesa.e baptisms, medical aid to the sick, and last rites to the dying. By 1655, there were five Spanish missions on the Georgia coast. Disease referred to as "fever" was pJ'evalent and the mortality was high.
The original site chosen for the Georgia colonists was occupied by a tribe of friendly Creek Indians commanded by Chief Tomo-Chi-Chi. Of this Indian village, John Wesley wrote: "The place is beautiful be~ yond imagination and, by all I can learn, exceedingly healt~ful even in the summertime."
That river water was being used for drinking purposes is attested by Stephens in his Colonial Records for 1733: "We arrived on Friday morning an hour before day at Yammacraw, a place so called by the Indians, but now Savannah, in the Colony of Georgia. * * * The river water is very good and Mr. Oglethorpe has proved it several ways and thinks it as good as the River Thames.*** And coming down the river, we found the water perfectly fresh six miles below the town."
11

THE FIRST YEAR

For an understanding of health conditions in Colonial Georgia that first year, a review of the situation in neighboring colonies .gives pertinent data. Malaria had made its appearance in the records of the Jamestown Settlement as early as 1607. Smallpox was recorded in The South Carolina Gazette of January, 1733, as existing in Charleston and the Georgia colonists first landed there. Yellow fever was also present in Charleston at the same time. The colonists had come from a mosquito-free environment to a section that had all the elements conducive to the spread of malaria, typhoid fever, diarrhea, dysentery, and yellow fever.

In a partial list of causes of death for the first year in the Colony, only one person, though, was listed as dying of a disease and that was "consumption." Other deaths specified during the first year were:

11 killed by Spanish 3 drowned 1 hit by falling tree 1 lost in the woods 2 shot

buried alive 1 by duel 3 homicide 1 consumption 3 hanged.

These death records are incomplete, as the colonists were too busy building homes and fighting off attacks by the Spaniards to keep accurate birth and death records.

The Colonial Records show that 31 of the first shipload of 114 colonists died during the first year, or 27.19 per cent of the total. An additional 24 are listed as having quit the colony during that period. Within the first seven years of colony life, 54.38 per cent of the 114 passengers on the Anne had succumbed!

SIGNIFICANT EARLY SETTLERS
The first person on the alphabetical list of the first shipload of Georgia settlers was Paul Amatis, an Italian, who was brought to Georgia to introduce the production of silk. Of him, it is recorded: "He took a disgust and settled chiefly at Charleston, where he died in 1736."
Others among the first colonists arriving on the Anne were Henry Close, a cloth-worker, and Hannah, his wife, with their daughter Ann listed as being under two years of age. In Colonial Records for 1733, there is this notation: "Mr. Hume gave a silver boat and spoon for the first child born in Georgia which being born of Mrs. Close were given accordingly."
12

Of "the first child" there is recorded this poignant report: "Georgia Close, daughter of Henry and Hannah, born in Georgia March 17, 1733; died December 28, 1733." Of Henry Close, it is further recorded: "He received Land Lot 40 in Savannah. His lot was swamp overflo'd. He died December 17, 1733." It is possible that Henry Close succumbed to malaria as a consequence of his lot being "swamp overflo'd." Georgia Close, with her silver spoon, survived the first summer of sickness among the colonists only to succumb three days after her first Christmas. Hannah Close re-married on 'February 8, 1734. On April 2 of that same year her other daughter, Ann, died. Hannah left the colony with her new husband to settle in Scotland.
Paul Amatis' decision to leave the colony and the Close family tragedy were apparently repeated many times during the first desperate year of Georgia's beginning. The first child born among the colonists, Georgia Close, lies in an unmarked, long-forgotten coastal grave, presumably beside her father and older sister. Her story, alone, gives a vivid picture of conditions that first year among the colonists when deaths occurred at a rapid rate and people remarried accordingly.
The most prominent physician in the early colonial period was Dr. Noble Jones who accompanied Oglethorpe in 1733. Dr. Jones was the surveyor for the colony as well as physician. He played an important part in the colony's development and records indicate he discharged his duties with distinction.
Other pioneers joined the colonists that first year. Abraham and Abigail Minas and their two daughters arrived July 10, 1733 with a contingent of Jewish colonists. There was agitation about the ship's landing since the Trustees had not authorized their coming. Oglethorpe persuaded the Trustees to allow them to settle in the colony. Only two days after landing, a son Philip, was born to the Minas'. He is recorded as the first male child born in the colony. From the records, it is apparent that the Minas family established a successful home in the coastal wilderness that was Georgia. In 1736, it is specified in Colonial Records that Abraham Minas "produced 36 bushels of Indian corn" on his five acres of property.
Philip Minas, the first male child, lived to be 55 years of age and his death was reported in The Georgia Gazette of March 12, 1780. "He died on Friday, the 6th of March, and was buried in the Jewish burial place on Sunday morning, attended by a large number of respectable citizens, who by their solemn attention evinced how seriously they felt the loss the community had sustained in so valuable a member."
13

Dr. Ribera Nunis, an eminent Jewish physician, practiced among the colonists. His services were such that Oglethorpe praised him in reports to the Trustees and they authorized a gratuity for him.
OTHER EARLY SETTLEMENTS
Of Frederica, the colony's fortification against the Spaniards and Oglethorpe's home, Frances Moore, the town recorder, wrote: "Despite the hard work, long hours and night exposure of carpenters and soldiers in building this settlement all kept healthy so that often no man in the camp ailed in the least." However, in 1739, after a trip in the vicinity of what is now Columbus, Oglethorpe is reported to have "come down with malaria fever."
Ebenezer, meaning "Stone of Help," the Salzburgers' first haven in Colonial Georgia, was established in 1734 and flourished temporarily. But the fertility of the soil was disappointing and Rev. P. A. Strobel, in "The Salzburgers," reports: "Much sickness prevailed among them, superinduced no doubt by exposure and excessive fatigue in a warm climate. The mortality which ensued was very distressing and death was making inroads upon the infant town." It was General Oglethorpe's opinion that as soon as the forests should be cleared and the lands brought under cultivation in another location, they "would be subject to the same disease (apparently malaria) which seemed peculiar to that country and climate."
William Stephens, who was "President of Savannah and Frederica Counties," reported on health conditions in December, 1737: "Walked out to see my people, how they were getting along with their work; where only four were employed, three of them being ill at home; and ever since my arrival some or other of them were ailing every day, which required a Doctor's continual attendance and like to prove very
chargeable. * * * Called on Mr. Bradley. Found him in bed complain-
ing of his Want of Health; which he attributed to his living so much on salt Provisions, having no money to get fresh provisions."
FURTHER PIONEER HEALTH REPORTS
Colonial Records for 1740 supply a brief description of health conditions among the colonists at that time: "This Fall of the Leaf produces :a sickly Season with us in various Kinds, viz. Fluxes, dry Gripes, lingeriing Fevers, etc., that within two Months past has carried off seven or eight People, which is more than died in one whole year before: And . from Charles-Town we hear of a dangerous Distemper raging there,
14

which they call the yellow fever, from the Corpse immediately so changing, after Death; and it is observed to have proved fatal to new Comers, whereof many have been taken off; such as we have lately lost have been weakly People, and Children for the most part."
From the diary of the First Earl of Egmont comes this revealing report: "Mrs. Stanley, the public midwife of Savannah, to whom we allow a crown for every woman she lays, came to (England) us. She lately come over to lie in herself, not caring to trust herself to the other midwives of Georgia. She told us she had brought into the world since her going over 128 children, of whom 40 were dead." Mrs. Stanley was listed among the colonists on the first shipload that came to Georgia and she returned to England in October 1736.
Some of the chiefs of the Chickasaw and Cherokee Indians complained, in 1739, that "the smallpox and rum carried up last winter by unlicensed traders, had slain near one thousand warriors and hunters among them."
Disillusionment preyed on the colonists. In 1740, the settlers were not prospering. Silk and wine culture were abandoned, and rice and corn grown in small quantities. Malaria lurked in the swamps and "flux" was a prevalent ailment from which almost all of the colonists suffered at one time or another. Many suffered from swollen feet and nausea. This was attributed, by some, to the drinking water. The summers were wiltingly hot. Some reports indicate that the colony was reduced to one-sixth of its former population, and that it was "in a starving and despicable condition."
George Whitfield, after a visit to England, started an orphanage in Georgia, in 1740, and his own account of it says:
"I chose to take over only a Surgeon and a few more of both sexes, that I thought would be useful in carrying out my design. These cheerfully embarked with me, desiring nothing for their pain but food and raiment. I likewise erected an Infirmary, in which sick people were cured and taken care of gratis. I have now by me a List of upwards of a hundred and thirty patients, which were under Surgeon's Hands, exclusive of my own private family. This Surgeon I furnished with all proper Drugs and Utensils which put me to no small expense."
The hospital orphanage est~blished by Whitfield was at Bethesda, a Moravian settlement. The surgeon referred to in his report was a Dr. Hunter from Bristol, England.
15

COLONIAL PHYSICIANS
Dr. Patrick Tailfer, the third physician to arrive in the colony, came in 1734 and settled at Savannah. He was described as "a proud saucy fellow and a ringleader for allowance of Negroes and change of tenure." Although Doctor Tailfer served the colony well as a physician, he did not tarry long. When the Spaniards attacked Amelia, in 1739, he is reported to have left for Charleston. From there, he published a tract, in 1741, about his opinion of conditions in the colony, which reported, in part:
"The failing of timber was a task very unequal to the strength and constitution of white servants, and the hoeing the ground, they being exposed to the sultry heat of the sun, insupportable, and it is well known that this labor is one of the hardest upon the Negroes, even though their constitutions are much stronger than white people, and the heat in no way disagreeable or hurtful to them; but in us it created inflammatory fevers of various kinds, both continued and intermittent, wasting and tormenting fluxes, most excruciating colics, and dry bellyaches, tremors, vertigoes, palsies, and a long train of painful and lingering nervous distempers, which brought on to many a cessation both from work and life, especially as water without any qualification was the chief drink, and salt meat the only provision that could be had or afforded. And so general were these disorders that during the hot season, which lasts from March to October, hardly one-half of the servants and working people were able to do their masters or themselves the least service, and the yearly sickness of each servant, generally speaking, cost his master as much as could have maintained a Negro for four years. These things were represented to the trustees in the summer of 1735 in a petition for the use of Negroes, signed by about 17 of the better people of Savannah."
Upon health conditions, Doctor Tailfer further comments: "Wells and pumps were made at a great charge, but they were immediately choken up, and never rendered useful, though this grievance was frequently represented both to the General and magistrates; the want of wells obliging the inhabitants to use the river water, which all summer is polluted with putrid marshes and the numberless insects that deposit their ova there, together with putrified carcasses of animals and corrupted vegetables, and this no doubt occasioned much of the sickness that swept off many."
Dr. Thomas Hawkins arrived on the some boat with John and Charles Wesley and Colonial Records show that he rendered valuable assistance
16

to the passengers on the long sea journey. Doctor Hawkins was regimental surgeon at Frederica, physician to General Oglethorpe, and correspondent to the Trustees about affairs there. Upon landing, he wrote: "God be praised, all the people are in health, nor has one passenger died at sea, either on board us, or Captain Dunbar." The following year, his letters to the Trustees included: "Very few of us have died, & none sickly; we have great increase of children, & women bear, that in Europe were thought past their time. ***My wife was brought to bed of a John in July last, a fine thriving child, & little Susan grows apace." An item of significance in Doctor Hawkins' letters is the notation that he was allowed 4 yearly for expense of "rejoicing days." Food and drink at Frederica must have been plentiful for the colonists to require the services of a physician after feast days.
Dr. Hugo Anderson arrived in Savannah, in 1737, and was made inspector of the public garden and mulberry plantations. He was reported as "falling dangerously ill by reason of the unhealthy situation where he placed his dwelling," and left for Carolina. He also collaborated with Doctor Tailfer in criticizing the unhealthfulness of the locality of the early Georgia settlement.
A Doctor Thylo accompanied the Salzburgers as surgeon, arriving in 1737, and settled at Ebenezer.
MIDWAY SETTLED
In 1751, the Midway district between Savannah and Darien was settled by a colony from South Carolina. The settlement was located on the edge of the swamp and the culture of rice was the principal occupation. As a consequence, much sickness and great mortality was attributed to: "a miasmatic soil exposed to the action of the sun at their very doors." Mortality was recorded as greatest during September, October, and November. The progress of both Ebenezer and Sanbury (in the Midway district) was badly disrupted by disease.
The Trustees surrendered their charter in 1752, and the colony of Georgia became a province.
THE SMALLPOX SCOURGE
Smallpox has been reported to have caused one-tenth of all the early deaths among mankind. The disease was always present, in one section or another throughout the world, filling the churchyards with corpses and leaving on whose lives it spared the hideous traces of its power.
17

Reports of early medical practices in the East among the Hindus, dated about 700 B. C., include reference to smallpox, which "was also very common." Inoculation against smallpox was practiced in China from ancient times; dried crusts from a smallpox patient were insufflated into the nose.
One of the earliest records regarding smallpox in Georgia is from Stephens Journal, in Colonial Records: "June 26, 1738. Went to Old Ebenezer, finding one, Sommers (a servant) with the smallpox out full upon him, walking about doing his ordinary business." Stephens writes that he rebuked the Salzburgers and urged them to isolate any cases found infected with the disease. He reports they "gave him surly answers and heeded him not."
In Colonial Georgia, smallpox cruelly and fearfully scourged the people. Whole tribes of Indians were swept out of existence by the disease. At its peak, it was the most terrible of all the monsters of death.
ANALYSIS OF EARLY HEALTH RECORDS
A statistical study of the early settlers of Georgia shows that 1,675 persons came to the colony at the expense of the Trustees during a 13 year period, 1733-1746. The colonists who came at their own expense from 1733 through 1742 numbered 1,304.
All was certainly not "rejoicing" among these colonists. The struggle for existence against disease, climatic conditions, and the coastal wilderness must have tried the hearts and patience of those first settlers many times. Attacks by the Spanish and trouble with the Indians took a heavy toll.
By 1746, of the total 2,979 early settlers 484 ( 16.2%) had died; 210 (7.1%) returned home or migrated; 90 (3%) had run away; and 2,195 (73.7%) remained. Another tragic early statistic revealed shows that of 37 births recorded during 1733-1734, 20, or 54.05 per cent died within a year. On this basis, the colony's first infant mortality rate was 540.5 deaths per 1,000 live births for the first two years.
The estimated average death rate in the colony, 1733-1746, was 25.5 deaths per 1,000 population for the 13 year period.
Only 12 children under five years of age died during passage to the colony. The length of time required in passage with crowded and unsanitary conditions on the vessels took a small toll of the 2,749 hardy pioneers.
18

The age distribution of the 909 colonists whose age was recorded shows :
Under 15 ......................................... ....................... .. 29.5 per cent 15- 24 ................................ ............................ ........ 29.1 per cent 25- 34 ............................................ ...... .................. 17.5 per cent 35 - 44 ............ .. ............................ .. ...... .................. 15.5 per cent 45- 54.................................. ......................... ......... 7.5 per cent 55 - and over ...... ......... ....... ....... ........ ............. ...... .9 per cent

A figure of 33.5 years was found by Wigglesworth as the average length of life based on death records in Massachusetts and New Hampshire for a period before 1789. Climatic and other conditions would probably have prevented the Georgia colonists from attaining even that average length of 'life.

The Bureau of the Census, in "A Century of Population Growth, 1790-1900," gives the following summary estimate of Georgia's population in the eighteenth century:

Year 1752 1760 1766 1773 1786 1790

Total 5,000 9,000 18,000 33,000 50,000 82,548

White
6,000 10,000 18,000
52,886

Colored
3,000 8,000 15,000
29,662

The year 1773, which was made memorable by the "Boston Tea Party," shows the comparative population of Georgia and her neighboring colonies to be:

Virginia ...... ....................... ................. ............................... . 40,000

North Carolina ........................... ..................... ................. . 230,000

South Carolina --------------- ------- -- ------------------- 140,000

Georgia

33,000

EARLY VITAL STATISTICS
According to Rosenau, "Vital Statistics may be defined as statistics relating to the life histories of communities and nations. They pertain to those events which have to do with the origin, continuation, and termination of the lives of the inhabitants. They include statistics of population, births, marriages, deaths, and occurrences of disease and the conditions attending these events."

19

The first registration of vital statistics required in the Colony of Georgia pertained to the colored population. In 1750, the Trustees of the Colony petitioned the King for permission to allow the Colony to require: "That all and every Negro and Negroes Black and Blacks which shall be imported into or born within said Province of Georgia shall be registered in public office, or offices to be kept for that purpose within the said Province and that no sale of any such Negro or Negroes Black or Blacks shall be good or valid unless the same be duly registered as aforesaid, etc."
In 1754, included in the Draft of a Commission for John Reynolds, Esq., to be Governor of His Majesty's Province of Georgia, dated August 6, are these instructions: "You shall send to our Commissioners for Trade and Plantations by the first Conveyance, in order to be laid before us, an account of the present number of planters and inhabitants, men, women and children as well as masters and servants, free and unfree, of the slaves in our said Colony, as also yearly account of the increase or decrease of them, and how many of them are fit to bear arms in the militia of our said Colony, you shall cause an exact account to be kept of all persons born, christened and buried; and you shall yearly send fair abstracts thereof to our Commissioner. for Trade and Plantations, as aforesaid."
The Colony, in 1758, was divided into parishes, each was provided with wardens and vestrymen, and records of births, marriages, and deaths were kept. No such records, however, are now known to be in existence. A letter from the Public Record Office, Deputy Keeper of the Records, June 14, 1948, London England, in response to an inquiry says, "An unsuccessful search has been made, and it would appear, therefore, that the Governor did not compile the statistics as required by higher authority, or that they were subsequently lost or destroyed."
In_1823, the Georgia General Assembly acted to establish an "office for recording of births of the citizens of the State in each county of the said State." The object was "to obtain testimony of the ages of persons interested in questions of rights before our courts and whereas embarassing difficulties frequently impede the correct administration of justice on this subject." The clerks of the courts of ordinary were to keep the records. The law did not require these records to be filed in a central state office, but were to be kept in the county ordinary's office.
A search of the early county records has revealed several compilations of these records. Photostatic copies have been made of some of these
20

and are on file in the State Health Department. The earliest recorded birth was on April 7, 1805. The name of the child was George A. B. Walker, and the place of birth, Augusta. This record was included in a book entitled "Birth Registry under act of December 19, 1823." This record was found in the ordinary's office, Augusta, Richmond County.
The Colony of Virginia adopted an act requiring the keeping of "Christening, wedding, and Burial in 1631." The State Registrar of Vital Statistics of Virginia writes that he knows of no such records in existence today. Massachusetts Colony, in 1639, required the registration of births, marriages, and deaths. The Secretary of the Commonwealth writes, "The first returns of such records were made in 1841. Complete records began about 1850."
From the facts available, it would indicate that Georgia has the first record of a birth recorded under state law.
In 1875~ the law creating a State Board of Health carried a provision requiring physicians to file certificates for every birth and death they attended, wi~ the ordinary of the county in which the event occurred. By 1876, 85 counties were making such returns. No appropriation was made to continue the 1875 health records and the work was abandoned.
MALARIA IN COLONIAL GEORGIA
Hippocrates, born in 460 B.C., in his writings describes a case that modern medicine says was blackwater fever, a form of malaria. Some historians believe that malaria played an important part in the fall of the Roman Empire.
The name malaria is derived from the Italian "mal'aria," meaning bad air, owing to the early theory that its cause was swamp eminations. The disease malaria was derived from African slaves brought to the new country, as carriers of the disease. They had developed some racial immunity and rarely suffered as seriously as the white man from the disease.
The first evidence of malaria in Colonial Georgia was in the unhealthfulness of the Old Ebenezer settlement which had to be abandoned as a consequence. There was malaria in the swamp lands and the upland settlements did not entirely escape.
Malaria first made its appearance in the interior of the State around Milledgeville in 1807. The Indians had just vacated the territory and the white men cut down the forests and opened up the soil. Dr. Tom-
21

Iinson Fort who went there to practice medicine, says: "Billious fever appeared as suddenly as the face of nature was changed by the hand of man. For 18 years it was a formidable epidemic. No tables of mortality were kept but I cannot be mistaken in placing the deaths from billious fever alone as five per cent of the whole population in each year from 1808 to 1813. This mortality happening in a few months each year gave the disease the terror of pestilence."
John B. Godman, in his "Medical Account of the Middle Regions of Georgia," says: "The eye of the stranger now visiting the cemetery of our capitol (Milledgeville) is struck with the vast disproportion of the infantile sepulchers. Indeed early after the settlement of Milledgeville, as noticed, death watched constantly around the cradle to plunder. First, he struck furiously at posterity, but afterwards began to strike at all. Then the mother lay together with her infant in the tomb; the father close by their side; the school boy and his little sister. Then sabbath days, came moving slowly into the church the dark trains of the drapery in mourning, the long black .veils darkening where they approached. But what, I ask, has produced this happy revolution, has curbed the furious power of death and spread abroad the joy and tranquility of public health since 1826. It can only be the state of the atmosphere has been resolved, the cause, purely atmospheric, which forments the action of miasma, has disappeared, and that the country is becoming drier, warmer and more naked from culture, has become freer from local causes."
EARLY PLANTATION HEALTH
The importation of slaves was granted the Georgia colonists in 1749. The act permitting slavery provided the regulation: "Owing to the number of infected ships bringing the Negroes or Blacks with contagious Distempers, (particularly the Yellow Fever), be it further enacted that a Lazaretto be forthwith built within such Province under direction and inspection of the President and Magistrates thereof on the west side of Tybee Island in the said River Savannah for the use and convenience of the said colony where the whole crews of such infected ships and the Negroes brought therein may be conveniently lodged and assisted with medicines and accommodated with Refreshments for their more speedy recovery, such medicines and Refreshments to be provided at the expense of the Captain of the Ship. And in any case any master of a ship shall attempt to land any Negroes in any part of the colony except as aforesaid mentioned he shall for the said offense forfeit the Sum of Five Hundred Pounds sterling money of
22

Great Britain and in case he shall land any negroes before his ship is visited and the proper certificate of health obtained or not perform the full quarantine directed he shall for the said offense not only forfeit
the like sum of 500 but also the Negroes on board ship, etc., to
which the common seal was affixed the Eighth day of August, 1750." The results of bringing the Negro to the colony were far-reaching.
He was the bearer of new and terrible diseases fatal and debilitating to ~th white men and red. In the slave ships came the seeds of terrible epidemics and pandemics, which undoubtedly resulted in a considerable slowing up of the process of wilderness conquest. The first slaves were ~ld in Jamestown, Virginia, in 1519.
John Thompson wrote that dysentery, worms, and dirt eating (hookworm cachexia) were common among the slaves, as was smallpox, despite the fact that the Negroes practiced inoculation, calling it "buying" the disease. A low nervous fever (probably typhoid) was a very serious ailment, lockjaw and yaws common, and syphilis rare. He also wrote: "The Negroes are so incident to the smallpox, that few ships that carry them escape without it, and sometimes it makes vast havoc and destruction among them but tho' we had 100 at a time sick of it, an~ .that it went thro' the ship, yet we lost not above a dozen by it."
While the early settlers in the Georgia colony had been plagued by disease since their arrival, the importation of slaves increased their illness troubles. In 1750, there were about 5,000 people in the Colony. At the time the Trustees surrendered their charter, in 1753, there were yrrlyaliOut 3,000-about 2,000 white people and 1,000 slaves.
By 1760, the smallpox scourge had wrought such havoc among the colonists that a stringent quarantine law was passed, the first public health law enacted in the province of Georgia:
23

AN A c T

AS it is highly neceO"ary for the health of this provinte, p,...51e,

perfons or merchandiz.c:s coining from places infdtcd with

fmall-pox, or other epidemical dillempcrs, fhould pcrf,)rm

qwrantain, We therefore humbly pray your facred Majclly,

that it '!!_IJ bc enatted, Bnll be it Q)nnell, by his Excellency Eutw_

!IENllY Fl.LIS, Elquire, Captain-General and Governor in Chief of the

province of Gtwgi.. by and with the advice and confent of the honourable

councll ud commons houfc of al!i:mbly of the faid province, in general

alfembly met, and by the authority of the fame, That during the prefent That lbip rce infeaion in the neighbouring province, and in all future time when any comio&fro:..pl~

,0.:w1f:= country or place fball be infetted y.rith the pbgue, fmall-pox, or any other in~ed.withriclc

epidemical diftemper, all lhips or vell"cls and boats of what burthen foever, coming into tb!s J;>rovince from fuch ~laces infcttcd, !hall be obliged

dillr.cmpcn o r a ,. . .

to perform quaranta1n 1n fuch plaee and m furh manner; and for furh

Jime, as OWl be diretkcd by.the Governor or c:omlllll)llcr in chief for the

time being, by and with the advice and con~nt of his Majdly's honourable

"council~ and during that time, and until the rcfpettive !hips, velTds or

lloats fball be difcharged of fuch quarantain, no perfon or perfons coming, NoperCr.u-u.c
u......-.. ~r goods imported in furh .Dlip, vdTc:l or boat, .Dlall come on .Dlore, or or ROGel
ao on board any othCT fhip or veO"d, or boat, or be landed or put into ia fuel!. O.ip, .~
any other. fhip or vc:O"el, or boat, in any place within this province, ~thcr tot or be_ bniui~ than fuch ptaee as fball be appointed iOr that purpofe, nor fball any perfon :=ac~" wtlllooat li

go on board any fuch .Dlip or veiTd, or boat, without licence firft had and

obtained in wnting, under the hand of fuch perfon or perfons who fhall

....i';;n..;.:':rnu<r 'Lc appointed to fee quaran:ain performed; and the faid fhips or veiTels,
or bOats, and the pe~ons and ~~ coming an~ imponcd in <?" going on

511

Icc

p>da

IMard the fame, dunn$ the time of quarantam, and all 11nps, vcO"els, IJ<IUUtaia. ~.itlll

lloats, and perfon' rece1ving any perfons or $oods under quarantain, fball to the orcl<n ol t~e lle fubjca to fuch orders, rules and dirctl1ons touching quarantain, as ~jrtu~toaol

Jaall be IDade br the Governor or commander in chief for the: time bting, c

tiy

24

by and with the advice and confent of his Majefty~ honourable council,

and notified by proclamation.

Pnalty oamaller& II. i1111J be ac funf)er ((lnaeb, by the authority aforefaid, That if'

or veli'els g>ing 3 any commander or mafter, ot other penon, taking the charge of any fhip

1\ore,or permitting
so o t h. .sfotodo,wiU. so oat li.c.:Dcc.

or vell'el, or boat, coming from any place infeCted IS aforefaid, fhall
himfelf, or permit or fuffer any feaman or pall'enger to on ibore, or on boa~ any ~ip or vcll'el, or boat whad~ver, during the quar'l!'rain,. or

unul fuch llup or vell'cl or boat, fhall be difcharged from quarantaan, wuh-

out fuch licence IS aforefaid, then, and in all fuch cafea. the penon of..

fending fhall forfeit and pay for every fuch offence die fum of one hundred

pounds Sttrlint, to be recovered by ~on of d,ebt,. bill, plaine. or infor.

mation, in his Majelty>s general court of this proVince, and to. be to his

Penalty how to II. Majefty, his heirs and fuccell'ors, for the building of a peft-houfe ' and the

ap~ed.

juftices of the faid court are hereby impowered to allow fuch reward to the

Jo men reward. informer or informers, (if any there fhall be) out of the faid fine, IS in dreir

judgment they fhall fee fit, fo IS the fame fhall not ezceed moiety of

PaR"eagcn oiFencl- the fine levied; and if any penon or penons whatfoever, who fhallarrive ~ow to be dealt in any port ~lace within this province, in any fhip, vr:ll'el, or boat, w}lir.h



fhall, by reafon of his coming from any country or place infe&d with any

contagious diftemper, be obliged to keep quarantatn, fhall quit fuch fhip

or vell'el, or boat, by coming on fhore, or going on board any other fhip

or vell'el, or boat, bCfore, or while under quarantain, it fhall and. may be

lawful for the penon or penons appointed to fcc fuch quarantaindulj'

performed, and they are hereby required to compel fuch penon or pcrfons

to return on board fuch fhlp or vefiel, or boat, and there to reniain during

the rime of quarantain; and fuch penon or penons fo leavin~ fuch fhip or

vell'cl, or boat, and being thereof, after the expiration of hiS quar.antain,

conviCl:ed by oath ofone or more credible witncfs or witnell'es, before any one juftice of the ~e living ncar the plac~ w~ere the offence fhllll be com-

mitted, OJall forfeit and pay into the hand of the faid juftlce the fum of fifty pounds s,trli1fK, OftC third thereof fhall be for the informer, and th~

rematnder, after the necdfary expences are dif<:harged, !hall be applied IS

herein before provided; and in default of fuch payment it fhall be lawful

f" for the !aid juffice to commit fucb offender to the publick goal of this
province for any time not exa:cdins twdve monthS, nor lefs than

en_,, months.
PerlbnJOln~Oit I! I. inQ lie ft ftarfl'er

by the authority aforefaid, That it an;

.o..boud (uch llips,
Ire. to perform ~-taio, rctGrJJ iDe without licence

perfon or penons whatfoever fhall prctume to go on board, and return from
fuch fbip or vell'c:l, or boat, reJUired to perform quarantain, before: or dur,. ing Jhe time of quarantain, w1thout a licence IS aforefaid, every fuch of.

to "' 4calt fender thall be co:npelled, ~P~d. in cafe of refJftance, by force: and 'violence

witla.

be compelled, by the per('on or penons appointed u afurefaid, to return o

board fuch fhip or veOH. or boat, and there: to remain duri11g tile time of

her quarancajn. and fhall afterwards be liable to the fine or imprifonP~~:Rt aa

herein before direCl:ed, in cale of pc:nons q!littin~ a fhip or vell'el, or boac.

performing quarant11in, and to be. difpofed of a 1n that cafe provided ancl chc: rnaftc:r of fuch lbip or vell'el, or boat, is hereby obliged to receive ~

Pewen or the o._

maintain fuch ~non on board accof!lingly.







IV. In~ \IC jr fprtflcf ~naatJ, by the authonty ~orefaid, That at lhaU

cen appointee! to (ec that qaarantaia be J'Cffoiincd.

and may be lawful for any officer of the cuftoma, or fucb IS fhall be appointed to !ake care that fuch qua':lntain be duly pe!*Ormed, to fei~ anr
boat or fkiff' belonsins to fuch fhiJ> ~ vcfi"el, or which tball thereWith tfe

found.

25

' fOund, and to rlrtain the (arnr until the quarantain lhall be performed t and
.in cafe any officer or other perlons, intrulled as aforefaid, fhall voluntarily Penal?'"~ olict"'

fulfer any feaonen belonging to fuch lhip or velfd, or boar, or any p:ill'en- Gll'cndiug.

ger therein, to quit fuch !hip or velfel, or boat, while under quarantain,

every fuch olfender lhall forteit and pay the fum of one hundred pounds

Surli"l for every fuch offence, one third thereof to the informer, and the

remaining part thereof to be applied as herein before direCted, to be reco-

vered at his Majefty's general court at Stn~a11114h, with co!\s of fuit.

V. Slnll llr k furt!in ~nNtn, by the aforefaid authority, That, after the quarantain lhall have been duly performed, according to the proclama-

After quar.a.ntain performed, and proof that there is

tion to be ilfued as aforefaid, and this ac!\, and upon proof to be made by no inf<Bion ~~n

oath of the mafkr or other perfon having charge of the faid lhip.or velfel, or board, not to be

boat, and two o( the before any one of his

perfons belonging to the faid lhip or velfc:l, or boat, Majefty's juftices of the peace for this province, that

under any further rcClrainc ..

fuch lhip or veiTel, or boat, and all and every perfon therem, have du!r

performed the quarantain as aforefaid, and that the lhip or vclfel, or boat,

and all the perfons on board, are free from any infeaious dillemper, then,

in fuch cafe, fuch juft.ice is hereby required to give a certificate (gratis)

thereof, and thereupon fuch lhip or vdfcl, or boat, and all and every per-

Cons therein, lhall no~ be liable to any further reftnint by reafon of any

matter or thing contained in this aCt.

VI. protlibfll nrtlcrt[)rltff, Slnll it if ~lap en~Utrb, That the g~ods Gooduo beairt4.

imported in fuch lhips or velfels, or boats, lhall, after fuch GUarantain

performed, be opened and aired in fuch place or places, and for fu'h time

as lhall be direCted by fuch proclamation as aforefaid.
VII. Slnb he itl\rrtfln en~Utrll, by the authority aforefaid, That when- wy,., th Gonm.,.

ever the Governor, or commander in chief for the tirre being, with advice and c. uncil may d

of his Majelly's council,

lhall

find it

necelfary to give any orders or direc-

to pre vent frread.. ing of conta&io81

tions for preventing the fmall-pox, or other contagious diftemper, being dillampcu.

brought into this province, or from any part of this province infeCled

therewith, into any uninfec!\ed part of this province, by perfons uavelling

by land or by water, it lhall and may be lawful for the faid Governor or Pomrorpnrono

commander in chief, with the advice and confent of his Majelly's council, appointd by the

byJroclamation for that /:,rpofe to be ifi'ucd. to prohibit all and eYcry

pe

oo or perlo ns conung

rom

r. h
1UC

I_JUre.~oc. ed

places,

to enter mto, or come

within fuch bOunds, limits or lines at fhall be in fuch proclamation de-

Govoraor to ....

ccpcMn1>t1e&aihlati~

oforrdenno,t tloc&.

a.D.4,

!cribed, for and during fuch time at !hall be therein mentioned, and to

appoint boats and centineb to put the fame in due execution 1 and the

perfons appointed, and every of them, !hall have the farnr power to com-

pe or

l any perlon attempting
lines, to mum. at is b

ytothpiasfsaathrgoiuvgehn

or within (uch bounds, limits to the perfons to be appointed

for feeing quanmtain duly performed. and lhall be liable to the fame

penalties for fufFering perfons wilfully to pal's through or within the fame;

Uld all and rrery perfon or perfons wilfully palling through or within the Ofreadtn apinll !aid bounds, limits or lines, lhall be liable to the fine or impriionment this clau(e ~~- herein before direc!\cd, in cafe of perfons Guiuin~ any lhip, velfel or boat be dal& willa.

performing quaranuin, and to be difpofcd of as 111 that cafe provided.

&-iJ.C'-'hr, 24/i
Jllrl/, I 76o

BJ wtkr of tht c--u Hft f ,AffnMiy, DAVID MONTAIGUT, Sptutr.

.Afl711d 1#,
HEN~Y EUJS.

11] wtkr of lht Upptr Hlltlfr, JAMES HABERSHAM. Prq;Jat.

26

HEALTH IN REVOLUTIONARY DAYS
Two outstanding Revolutionary physicians were Dr. Noble Wymberley Jones and Dr. John Houston. Dr. Jones, as a child, accompanied his father when the latter came to Georgia with Oglethorpe, and was trained in the practice of medicine by his father. He was active in political affairs of the province. The attention of the son for the father during his last illness is reported to have prevented his attendance at the Continental Congress; otherwise he would have been a "signer." In 1770, he issued a call for the Assembly at Tondee's Tavern, and was the principal leader in the organization of the "'Liberty Boys." In 1775, he planned the seizure of the powder magazine and secured rounds of ammunition, some of which is reputed to have reached Washington's army. Dr. Jones was elected speaker of the Rebel Assembly, in 1777, and, later, was chosen a delegate to Congress.
Dr. John Houston came into political prominence with Dr. Noble Wymberley Jones. The two doctors remained active in politics and worked together for a number of years. Their views were generally parallel. Doctors Jones and Houston were two of four signers of the article appearing in The Georgia Gazette for all lovers of liberty to meet in front of Tondee's Tavern. Doctor Houston became the second "rebel governor" and led an unsuccessful attempt to capture St. Augustine. He was for a time Surgeon General of the Army, and made an appeal to the Council for the use of the church in Augusta as a hospital.
Dr. Lyman Hall, a native of Connecticut, who had migrated to Georgia with a group of Puritans that had settled at Midway, was an active practitioner who also followed the culture of rice as a sideline. He attended the Continental Congress, and shipped 160 barrels of rice for the Boston sufferers. He later became Governor.
This brief sketch of Revolutionary doctors is included to show that while little was known about the causes of the majority of diseases they were to encounter, such as smallpox, malaria, yellow fever, and the intestinal diseases of typhoid and dysentery, still the province had intelligent medical men available to give the best medical treatment known to the profession at that time.
SOME HEALTH "FIRSTS"
The Georgia House of Assembly in 1768 passed a law prohibiting the inoculat1on against smallpox subject to a forfeit of 100. Inoculation against smallpox had been introduced into England, in 1718, by
Lady Wortl~y Montagu, wife of the Ambassador to Turkey. She wrote:
27

"They take the smallpox here by way of diversion, as they take the waters in other countries." The Chinese, Hindoos, and Caucasians had used inoculation ir ancient times. The purpose of the inoculation was to produce a modified form of smallpox which would afterward confer upon the subject so treated exemption from a malignant attack of smallpox. Inoculated smallpox lost none of its fatal power of conveying malignant smallpox to unprotected persons. It was the means of keeping up a constant source of contagion. Before inoculation there were estimated to be 74 smallpox deaths per 1,000 from other causes. After the practice became widespread, the smallpox deaths increased to 95 per 1,000 deaths from other causes.
Edwaxd Jenner ( 1749-1823) heard a rumor that dairy maids who had been inoculated with the cowpox were not capable of having smallpox. He pursued this theory diligently, was theatened with expulsion from his medical society, without money or encouragement, and gave to mankind one of the greatest of health gifts. He tested the theory, proved it to be true, and established the procedure of smallpox vaccination. Benjamin Waterhouse, a Harvard professor, made the first vaccination in America for his children. By the middle of 1801, smallpox vaccinations were being done in Savannah and at Sanbury. The method came into general use in 1802. In 1805, the medical profession of Savannah offered to perform vaccination of indigent persons without charge.
In 1786, a law was enacted creating a health officer for the Port of Savannah. This is the first time the word health officer appears in Georgia health laws. A name was not mentioned in the records available, however, until 1790 when Dr. Ignatius Geoghagan was reported as health officer for Savannah.
In 1803, the first official records of deaths and burials in Savannah were begun. In 1804, the first City Board of Health was established, also in Savannah. That same year the Georgia Medical Society was incorporated, "for the purpose of lessening the fatality induced by climate and incidental causes, and improving the science of medicine."
Dr. Joshua White, who was a prominent physician practicing medicine in Savannah in 1803, took an interest in improvement of health conditions. He reported unhealthful conditions among slaves to the medical profession in Savannah:
"The fatality of our climate in the winter and spring months to new Negroes, is of melancholy notoriety, and forms a very considerable drawback to their increase. Unused to the cold which is sometimes experi-
28

enced here, and with their thin and scanty clothing, bad lodging and impoverished diet, they are incapable of resisting the effects resulting from those combined causes; and hence they fall easy victims to inflammatory diseases, particularly of the lungs. Interest and humanity both urge a greater attention to their comfort; thus, not only to ameliorate the pains of slavery, but to guard against the disease; often the greatest foe to the planter's hopes. The constitution of the African Negroes is as unfit to guard against the effects of our climate in the cold months, as that of Europeans, and our northern brethem in the
hot. .A residence of one or more years is equally necessary in both, to
assimilate the syste~ to its versatile nature, and to shield them from its unfriendly influence. Winter and spring are the enemies of the former; summer and fall of the latter. The one should be guided by obvious rules, founded in experience, dictated by prudence and their own judgment; the other from an incapacity to judge aright, should be governed and directed."
Among others advocating better medical and hygienic care for slaves was Dr. James Ewell, also of Savannah. He recommended hospital buildings for their care with someone appointed to attend the sick.
DOCTOR TURNER REPORTS
Dr. Daniel Turner, a physician, resided at St. Marys, in 1804. He wrote that "planters were offering $1500 to $2000 a year for the practice of physicians among the blacks," and that his books for the year would be between $3000 and $4000. His letters also disclosed that "in three weeks in this season (winter) he had had no calls as this part of Georgia is as healthy as any part of the world." Doctor Turner's letters show, though, by 1805 economic and health conditions among the planters in that section were not so good:
"I suppose in all Camden County there is scarcely a planter with a hundred dollars by him and perhaps his plantation and slaves worth $100,000. Provision is extremely scarce, no fresh meat. Fish, hominy and salt beef and pork are the articles on which we exist and those difficult to obtain. I believe there is not sufficient grel!.se in this town to fry a pancake. I have not seen milk and scarcely butter. Com, potatoes and almost all other articles of provision hardly to .be obtained at all. It is natural to inquire the reason of this want in a country by nature and with half the industry required with you is capable of producing all the necessities and most of the luxuries of life in abundance. In the first place the inhabitants are extremely indolent depending on
29

the exertion of slaves for everything. The universal object of these exertions is the production of cotton. If unsuccessful as has been the past two or three years back, the poor creatures are in danger of starving. If crop is destroyed the planter has no method of meeting his engagements with his merchant who has supplied him on credit and on some articles receives a hundred per cent profit."
In 1808, there was an epidemic of yellow fever in St. Marys, in which three physicians, among others, died. Doctor Turner was among those expiring.
HEALTH IN 1809-1823
By 1810, the population of Georgia had increased to 252,433.
About 1809-1810, a hospital for white persons was built and put into operation in Savannah. The need had been felt much earlier and various means had been used to raise funds, including the holding of a lottery.
In 1809, after the occurrence of a considerable amount of "malignant fever" in Savannah, following the epidemic of yellow fever in St. Marys the previous year, agitation was begun for the control of the drainage used in the culture of rice near Savannah, as it was thought this illness came from the rice fields.
In 1817, the Savannah City Council authorized bonds for $70,000 to cover cost of drainage of the rice fields and promote the "dry culture" of rice crops. The drainage was credited with reducing the prevalence of malaria but had no influence on the incidence of yellow fever. A committee reported to City Council that same year: "A more vigorous health than before prevailed even among inhabitants who escaped positive disease. Nothing formerly was better calculated to impress upon the mind of a stranger arriving here in November the melancholy character of our climate than the bleached and sallow faces of our inhabitants. The remark is now general that of late the faces are quite as indicative of health as those of persons residing in cities to the north reputed to be more salubrious."
YELLOW FEVER APPEARS
Yellow fever originated in West Africa, Dr. H. R. Carter found in his studies of its early history. He says: "The African Negro contracts yellow fever so far as we know, as readily as other races but has it more mildly and rarely dies of it." Apparently, yellow fever was brought to North America by the slave trade, probably by those brought in by
30

the Spanish. While yellow fever appeared in recognizable form in Yucatan, Central America, in 1648, there is much description of sickness to indicate the disease was prevalent in West Africa many years priOI to this time.
Dr. Eugene Foster, writing his '"Memoirs of Georgia," says: "'The earliest records of yellow fever in the colony were of epidemics in 1807, 1808, 1817, 1818, and 1819." David Ramsay, in his History of South Carolina, says yellow fever raged in Charleston, in 1733, the year Oglethorpe arrived with the first settlers. As Charleston was the port of arrival and there was constant communication between Savannah and Charleston, it is not likely that. the colony at Savannah entirely escaped everT-earlier infection than is recorded.
A most devastating epidemic of yellow fever occurred in Savannah. On January 11, 1820, a very disastrous fire swept the city and the people had hardly recovered when a vessel arrived from the West Indies with yellow fever cases on board. In a population of 7,523, nearly 6,000 left the city. In five months, 695 deaths from yellow fever had occurred.
pr. W. R. Waring, January 17, 1821, made a report to city council which included, in part: ". . . The causes of fever have been: A general epidemic condition of the atmosphere ... either proved to exist, or produced by an uncommon deficiency of the electric fluid . . . the reduction of the winters 1819-1820 to the temperature of spring, and the reduction of spring to the heat of summer ... the prevalence of easterly winds . . . the unnecessary luxuriance of the trees by the shade and protection which they afford to dews and fogs . . . the great number of small wooden houses in a complete state of putrescence. Uncovered vaults and cellars, the consequence of the fire . . . All these causes together give a compound origin to the disease, which is internal and external."
The medical profession and the clergy were conspicuous in their devotion to the plague-stricken city, most of them remaining at their posts of duty and several fell while battling the disease. Ten physicians and three medical students were numbered among the dead while many others were sick. Of the clergy, three died and every one of their number who remained was attacked. Of the editorial corps, all of them remained at their posts until attacked, and two died.
Niles Weekly Register, published in Philadelphia, reported regularly on the yellow fever epidemic at Savannah. On September 30, 1820, the Register published a proclamation of T.U.P. Charlton, Mayor: "I
31

feel it my duty to announce to my fellow citizens, and to whom it may concern, that a malady prevails in this city, never before experienced and that the character and type of the fever, the malignancy, which renders it prudent for any person who can make it convenient, to remove beyond the limits of the city's atmosphere. I feel myself authorized to say, that the fever which is carrying off our people, is not contagious, and that no apprehension ought to be entertained of its being communicated by persons leaving the city."
On the same date, the Register further comments: "The disease at Savannah appears to be uncommonly malignant. Nineteen persons are said to have died in one day. Natives and strangers seem to be equally attacked. Nineteen out of twenty are reported to die! We suppose this is an exaggeration but the disease is doubtless very severe. May he who commandeth the pestilence, order 'that the uplifted hand be staid.' "
Another edition of the weekly newspaper, October 14, reports: "'The fever rages with uncommon malignity in this City (Savannah), though nearly all of the white population has left it. Between the flames and the pestilence, this place has had a large portion of suffering, indeed. No business is being done in consequence of the unprecedented sickness. God only knows where its ravages will stop; more persons of remarkably steady and temperate habits have suffered than any other class of society."
The November 18th edition of the Register says: "It is with great pleasure we learn of the discontinuance of the terrible pestilence which largely ravaged Savannah, and of the return of our fellow citizens to their homes."
Beginning the dry culture of rice brought improved health conditions to Savannah. In 1821, a year after the disastrous yellow fever epidemic, the day September 15 was set aside as a day of thanksgiving for the unusual health Savannah had enjoyed. Deaths dropped from 820 to 380.
In 1834, though, more than 600 slaves were reported to have died from cholera on Savannah River plantations alone. Losses on some farms were one out of three.
32

MORE PLANTATION HEALTII
The status of health conditions in Georgia, in 1837, was published in Sherwood's Gazateer, May 29: "The two particular diseases of which any considerable number of persons die, are Bilious fever and Pleurisy. Fever and ague, rheumatism, dysentery, etc., obtain but are seldom fatal. Dyspepsy occurs in some; consumption, or breast complaint, as it is termed, affects some persons; but where it proves fatal in one instance, our mild climate restores a hundred invalids with that disease from more northern latitudes. A case or two of cholera obtained among the blacks on the Ogeechee some years past, but none of our cities or towns have been visited by that dreadful scourge. Bilious fever, our most common complaint in the fall months, is not so frequent as formerly. Ten years ago, persons from the middle dared not visit the southern section in the sickly season; nor those of the upper, or middle; but now they travel without apprehension of danger. Hundreds of families from the upper and middle regions have settled themselves permanently in the southern section."
ASYLUM ESTABLISHED
The State of Georgia commenced work on an asylum near Milledgeville for lunatics in 1837. It was opened for the inception of patients in October, 1842. It had on December 1, 1875, 587 patients. Of these there were 260 males and 237 females, all white; and blacks 45 of each. The asylum had 3,000 acres of land which was used for raising stock, vegetables and other produce to partially supply the institution. In 1847, there was $13,000 worth of produce raised consisting generally of vegetables; and 5,635 garments were made in the matron's department, according to a report of activities. The cost of maintenance was in \he neighborhood of $100,000.
In 1839, the cause of malaria was given by Bartow: "Malaria caused by exposure of muddy surface of low grounds to the action of the sun." Three doctors in Augusta reported on the epidemic of Augusta of that year ( 1839) and it was their opinion that the disease was not contagious nor was it introduced from other cities. Their belief was that removing a load of trash and debris from what was known as the trash wharf, thus uncovering a great area of the earth's surf~ce, and exposing it to the hot season of the months of May and June, was really the cause of the epidemic.
A search of plantation records, letters of the period 1850-1860, indicates that the main concern was the weather, the crops, and the health
33

of the slaves. After the epidemic of cholera, in 1834, which claimed a large number of slaves on Savannah River plantations, a number of the planters secured camps in the upland country where the slave3 and children might stay in the summer months.
The year 1850 was remarkable for the widespread prevalence of dengue in epidemic form, in various localities, pertaining principally to the south and ~outhwest. Its occurrence in Augusta was preceded, as it was in other places, the same year by a protracted period of unusual heat and drought. Cases were recognized as early as the twentysecond of August, but not until about the lOth of September did the epidemic become fully manifested in its unique and indubitable individuality. From this period until late in the autumn, the disease prevailed throughout the city with the most distressing severity. The number of cases in Au~usta alone was estimated between eight and nine thousand, the majority of which did not receive the attention of a physician. Of this vast number, not a death was reported from the epidemic uncomplicated.
Other sections, apparently, were experiencing difficulty in maintaining healthful cOnditions. A letter from a Central Georgia overseer, in 1852, reports: "The Negrows on this place is verry Sicly & have ben all the while since you left us & the disease Is growin wors all the while as well as the attacks more numerous. 18 on the Sick list today 16 of that nombr Filed hands too out of the croud Bilious fevers & very Bad caises the Ballance chils & Fevers. Those that are out some of them unwell & unable to doo much all of them has Ben Sic & some of them has Bin sick twice & Several of them down the third time. I hav so much Rain that It is hard mater to get one of them well As Soon as one Gets out It Rains on him or he Is In a large due or in a mud hole & Back he comes again this is the way I'm gettin on. . . . I have
used 2Y2 Gallons caster oile & Y2 Spts turpentine & four ounces quinine
up to the present I am doin the best I can with them. Barron has ben here fifteen times." The overseer concludes by saying '"I nearly have a chill my Self."
YELLOW FEVER AGAIN
Savannah was again severely scourged by yellow fever. The disease made its appearance on the 12th of August 1854 in the eastern district. It soon spread over a larger surface and by the first of September was diffused in every direction, and the mortality reached its maximum height about the 12th of that month, on which day 51 interments were
34

reported. Decline of the sickness began about the 20th of September, and on October 29th the last case was reported.
In the summer and autumn of 1876, yellow fever was epidemic in Macon, Brunswick, Savannah, and in the nearby Isle of Hope where many people from Savannah had taken refuge.
In 1893, Brunswick was quarantined because of a few deaths from yellow fever.

PLANTATION MEDICINE

Every large plantation had a well stocked medicine chest. Among the home remedies used were castor oil, spirits of turpentine, blue mass, quinine, laudanum, paregoric, liniment, vermifuge, and epsom salts. A home medical book was also considered a necessity.
The early records indicate great care was exercised in efforts to preserve the health of the slave workers. The best physicians available were employed to attend the sick on most of the plantations. Bills for drugs and medical attention were large. In 1852, in Houston County, one yearly bill for medical service on a large plantation was $550.75.
Some of the larger plantations had sick houses. One was described as having separate wards for men, women, and lying-in women. A tenroom tabby hospital was erected on Retreat Plantation, on what is now Sea Island. Two women lived there as nurses to care for the sick slaves. A doctor from Darien treated the acutely ill persons. The ruins of this hospital remain-mute evidence of the medical care given by Georgia plantation owners.

From the record book of Retreat Plantation, at Sea Island, which

was kept by the owner, Anna Matilda Page King, comes revealing data

on the health conditions of about 224 slaves at this place for the period

1852-1860:

.

In 1852, "paying the doctor" at Retreat Plantation accounted for $528.82. Mrs. King also kept a careful record of the births and deaths occurring on the plantation for the period 1857-1859.

"Mary Ann died 23rd of June. "Herbert died suddenly.

"My good and faithful servant, Hannah, after years of suffering, expired on the night of the 3rd of August. For honesty, moral character, and perfect devotion to her owner, she had not her equal. She died

35

resigned with firm trust in her Redeemer. "Norton was drowned on Monday, the 14th of August. "Peggy's boy child, age 12 hours, died 18th of August. "Maria's infant daughter, September 11. "Almarene, died July. "May M., died February. "Delilah's first child, of lockjaw, October 7. "Nancy's stillborn son, November 2. "Old Cupid, honest and true to his earthly owners, departed this life
at 4:00A.M. on the night of the ninth of January, 1857. "Ellen's son, 2 days old, 1857. "Lydia's daughter, 8 days old, March. "Christinian's daughter, died after 3 days ill. of conjestive fever, No-
vember 9. "Delilah's child stillborn, 8th of March, 1858. "Little Emoline died the 8th of July very suddenly. "Little Painer died the 11th of September. "Peggy's infant, dead born, August. "Julia Ann, infant, lockjaw, 1858. "Amy's twins, 28th of September, premature. "My valued servant, Annie, died of fever, October 5. "Delia's child, sudden}y, 1859. "Lynda's child, suddenly, 1859. "Liddy's child, premature. "Milly died of fever, October 1859.
"Quamina, most honest and true, a faithful servant and good man, after a short illness of 24 hours, departed this life, the ninth of March, 1860."
About the time Georgia was becoming known as "The Empire State of the South" there were, in 1860, 2,004 physicians practicing medicine
36

in the State. Doctors had been licensed as early as 1825, and the first school to teach the healing arts was established three years later in Augusta.
The Civil War took a heavy toll in Georgia. About 40,000 of her best citizens either died from disease or battle wounds in the conflict, or were scattered beyond recovery. Orphan asylums had to be established to care for the large number of homeless children.
Health in postwar days presented a dark picture indeed. The scarcity of food w~kened the people and prolonged the process of recovery. Disease took a heavy toll. In 1870, 772 Georgians succumbed to typhoid fever, 705 to malaria, in a population of about 1,184,000. Dysentery and di~rrhea took a heavy toll.
37

Chapter II
HEALTH IN RECONSTRUCTION DAYS
1875-1900
FIRST STATE BOARD OF HEALTH
By 1875, health had again edged to the forefront. The General Assembly created a State Board of Health, bravely, in the face of limited revenue and some opposition from a segment of the medical profession. Only $1500 was a'\Jpropriated for yearly expenditure of the Board. Ten physicians, together with the Attorney-General, Comptroller-General, and State Geologist constituted the Health Board.
The law establishing the health board specified that it was: "An Act to create a State Board of Health for the protection of life and health and to prevent the spread of disease." The ten physician members, one from each Congressional District, acted also as sanitary commissioners in their respective districts. The President and Secretary were elected from the membership of the Board, the secretary to act as executive officer at a $1,000 yearly salary. Among the Board's duties specified by the law were "to make inquiries in respect to the causes of diseases, and especially epidemics, and investigate the sources of mortality, and the effects of localities, employments, and other conditions upon the public health."
Supervision of the collection of records of births, marriages, and deaths was also provided, as well as the establishment of county boards of health upon recommendation of the commissioners of roads and revenue. The Act was approved February 25, 1875.
Dr. J. G. Thomas, of S'avannah, was elected President of the State
Board of Health, and Dr. V. H. Taliaferro, of Atlanta, was Secretary. Doctor Thomas' report to the Governor, of health conditions for the year 1876 follows:
''In complying with the law which established this organization, I beg leave to call your Excellency's attention first to the report of the Secretary of the Board, to the various and timely suggestions therein contained. It will be observed that the collection of vital statistics has not been as successful as is desired, though perhaps as much so as could have reasonably been expected. It is very evident, however, that regis-
38

tration of births and deaths by the Ordinaries is not appreciated as it should be. The officers who are required by the law to keep these records, do not fully appreciate their importance, and in some instances have refused to perform the duty. It is equally evident that its importance is not fully realized by those whose duty it is to report the births and deaths to the Ordinaries. Everybody is familiar with the old custom, which has been handed down to us for many generations, to record all births and deaths whi~b occur, in the family Bible. This is a family record which is kept by all judicious and thoughtful parents for their private use. The Good Book is often lost or destroyed, or at any rate does not descend very far along the family line. This apparently very simple habit, which enlightened people have kept up for many years, is very suggestive. The State is commonly called tfle mother of her citizens; and yet she does not keep any record or take any such notice of the death and birth of her children.
"Her wisest statesmen rise up and serve her throughout life, and depart; and yet she does not, in any official way, recognize their birth or death any more than if they had never existed. Does it not seem reasonable and right that the State should make provision and require that all the children born unto her should have their birth recorded in the county in which they are born, and that the same notice should be taken of their death? How else can the State consider them her legal children unless they are registered? From this point of view it would . appear that a more general interest should be manifested in making these records. It is a more or less prevalent belief that they are kept and sought alone for some supposed benefit to the medical profession. There is another idea abroad, too, that they are solely for the use of the State Board of Health. To all those acquainted with the value of such things, this must be considered an unfortunate error, and, if possible, should be dispelled from the public mind. It has been well said .that such records form a part of the 'anat01:py of the Nation,' and no country's history is complete unless it5 vital statistics are well studied. Sanitary organizations, such as the State Board of Health, find these records the most definite way of arriving at the conditions of the health of the people, and from them is derived the most correct knowledge of the localization of disease.
"The Registration of vital statistics is, by universal acknowledgment of enlightened sanitarians, of fundamental importance to the operations of a State Board of Health. The yearly number of births, as compared with the annual mortality, is of the greatest importance in estimating the ravages of disease in various parts of our State or throughout the
39

State as a whole. Without such registration, the Legislature, the people, even the Board, itself, cannot have the data by which to estimate the evils of neglected sanitary measures, nor, on the other hand, to judge of the value and efficiency of the application of even the most judicious efforts for the prevention or quelling of disease.
"This great interest, however, has been demonstrated to be an enterprise perhaps too far advanced in enlightment ~or the progress of the age in the State of Georgia. It has been found as entrusted to the Board itself, to bring this body in unpleasant conflict with the medical profession of the State and to excite antagonisms which are injurious to the interests of registration, and specially to the more legitimate objects of the Board. We propose, therefore, that the duty of collection of vital statistics-births, marriages, and deaths-be committed to some other department of the State Government, and that to the Board for the present be committed the duties which more strictly pertain to the investigation of epidemics, the sanitary condition of cities, public institutions, rural districts, and to the prevention of disease throughout the State, according to the system of enlightened sanitation at present offe.red in the advanced state of the science of State medicine throughout the world.
"In the course of time, the collected statistics may be submitted to the Board and the results worked up by them for the instruction and government of the people. Many years are required to collect the statistics necessary to these results for the consideration of the Board, but, in the meantime, the Board regards sanitary measures for the preservation of the health of the people too important to be neglected, and suggests to the government that this clause of the act should be perfected by provisions under it, giving plenary power, and sufficient pecuniary means to be used or not, according to the necessities of the situation, to put it into the highest position for efficiency.
"I beg to call your Excellency's especial attention to the report of the Board made upon the subject of the epidemic of yellow fever, which prevailed during the last summer and fall in the cities of Savannah and Brunswick. This report has been made at great cost of time and labor on the part of the Board. They have spared no pains which would enable them to arrive at correct conclusions as to the origin of the disease. The suffering which the people of those cities have undergone, and the great cost in life and wealth, admonish the entire people of the Commonwealth, to aid in avoiding a like catastrophe in the future. It has been well said the 'epidemics are' nature's protests against her violated sanitary laws.'
40

"The epidemic (yellow fever) forms no exception to the above rule, which I trust has been made clear in our report. The State is largely interested in preventing a repetition of such scourges upon her sea coast, and, therefore, the recommendations which are there made should meet with the most serious attention of the next General Assembly. Public hygiene is fast becoming one of the great questions of this age, and Legislatures will have to meet it sooner or later. Small local communities, or municipalities, can no longer be left alone to work out the problem of their own healthfulness.
"It must be taken hold of by the States, and in time, perhaps by the general government, in order to wrestle successfully with such pestilences as have invaded our State this year. The great loss in population, which is more severely felt than loss in trade or wealth, demands the powerful interference of State governments in all matters pertaining to the health of the people. The wisest statesmen of the day are waking up to the realization of these facts. The oldest and most enlightened governments of Europe are taking the lead in the inauguration of vast measures having the sole object to promote the health of their subjects. Large expenditures of money are annually made to this purpose, and experience and close calculation has proved that it is returned many times over, not only by the saving of life, but by the increased power of the people. Our sanitary law is but a beginning in the right direction, and if our law-makers are wise, they will add to it until it is nearer perfection. But they must first realize that no great sanitary scheme, such as is contemplated by the present law, can ever be perfect in its operation or highly beneficial in its results without a large increase in ~he appropriation set apart for this purpose.
"The work of our Board has been greatly hampered this year by the great lack of means to carry out their designs. The members of the Board have been, and are still willing to give their time and talents to the work without compensation; but they are not willing to go further unless ample contingent means are provided to carry out such measures as are contemplated by the law under which they are acting. It is believed that in no great lapse of time, there will be a general feeling that this department of the State government is of as much importance as any other, and that it will prove itself indispensable to the welfare of the people. Until it is understood and appreciated, the Board are willing to make any sacrifices, feeling that all such things have to be nursed until their value is made apparent to those for whom the benefit is designed. But, on the other hand, even in the short time of its existence, the Board has found that very much is expected of them, and
41

that they cannot fulfil public expectation without a very large increase in the power as well as the appropriation. Therefore, they feel that they would be doing themselves a great personal injustice, and perhaps inflict a heavy injury upon the cause they represent, if they did not make this fact clear to the representatives of the people."
COMPARISON WITH MICHIGAN
Dr. V. H. Taliaferro, Secretary of the State Board of Health of 1876, compared Georgia's death rate with that of Michigan. Both states had approximately the same population, 1,184,000. He computes that if the death rate in Georgia in the last census year, 1870, had been that of Michigan at the same time, the number of deaths would have been 11,130 instead of 13,606, as reported, a difference of 2,476 deaths, representing 49,520 cases of sickness, costing $1,980,800, which added to $49,529, cost of burying the extra number of dead, would make a total of $2,030,320 in a single year lost to the State of Georgia, through the difference between a death rate of 1.15 per cent in Georgia and one of .94 per cent in Michigan.
Registration of births, marriages, and deaths provided under the original act of the Legislature creating the State Board of Health, was put into practice in August, 1875, and the law was amended in 1876. Under the original law the doctors complained of the penalty of $10.00 levied for failure to make reports and the ordinaries complained of "no renumeration" for the work required of them. In 1876, the penalty clause was struck out of the law and five cents pay provided the ordinaries for registering births and deaths. That year, 85 counties made returns of such records.
The Secretary, Dr. Taliaferro, reported that the State had been remarkably healthy and free from disease with the exception of the yellow fever epidemics. A commission composed of members of the Board made a thorough investigation of the yellow fever outbreaks occurring and reported their findings in detail.
Members of the Board contributed their time and defrayed their expenses in the comprehensive yellow fever investigations. They studied topography, meterological records, sanitary conditions, and previous history of the disease. They assembled evidence in favor of the importation of the disease and of it<> "malarial origin." An intensive study of food conditions in the cities affected was also made.
The city hardest hit by yellow fever, in 1876, was Savannah. Over
42

8,000 refugees left the city and the disease was estimated to have cost the City $500,000. Deaths totaled 910. Doctor Taliaferro's report showed that sailors on the "Maria Carlina" who had moved their bedding to a boarding-house, brought the fever to Savannah. At that time, sanitary conditions were poor and played an important part in the spread of the disease.
Twenty-one counties reported the organization of boards of health. Dr. Taliaferro complained that "commissioners of roads and revenue and grand juries had sadly neglected the requirements of the law in this particular." Some of the ordinaries wrote that the grand juries refused or failed to make appointments when requested to do so.
The 1876 State Board of Health also made an investigation and report on "Lunacy in Georgia." They recommended supplementing the present hospital, or erecting others in the State.
No appropriation was made to the State Board of Health for continuing the work, in 1877. Dr. Eugene Foster expressed his opinion of the failure of the Legislature to provide funds for the work in his book, "From Memories of Georgia," written in 1877, as follows:
"Utterly devoid of appreciation of the possibilities and economy of a better public health service, the Georgia Legislature in 1877, blotted the State Board of Health out of existence by refusing to vote the paltry sum of fifteen hundred dollars a year for its maintenance. This one act resulting from shameful ignorance has done more to retard the prosperity of the State than any other act since the establishment of the Colony."
EARLY LOCAL BOARDS OF HEALTH
When the City of Savannah was incorporated, in 1790, the charter provided for the appointment of a health officer by the Governor, who served part-time in this capacity. Other early city charters contained similar provision.
The first city ordinance creating a Board of Health was also enacted in Savannah, in 1804. This local board, though, had a brief existence and was replaced by a city council health committee, in 1808.
The first activity of especial significance among early part-time health officers was the promotion of the "dry culture" of rice to prevent much of the "autumn sickness" that was believed to be the result of undrained lands adjacent to Savannah's border. The first commissioners of health of dry culture were appointed in 1818. The mayor had been empowered
43

to sign and execute contracts with .proprietors of the low lands partially surrounding the city. By 1829, these dry culture contracts entered into with land owners aggregated $72,537.18.
Considerable opposition to the change from wet to dry culture was encountered anwng the coastal rice planters. Ari epidemic of yellow fever, in 1820, had exacted a terrific toll in Savannah. But the determination to drain the low areas persisted and by 1824 significant mortality reduction had been attained. A report to council of "the proportion of persons dying of autumnal diseases to the population" showed that:
Under wet culture, in 1815, the proportion was 1 in 14.
Under dry culture, in 1833, the proportion was 1 in 32.
That these early health workers' efforts were fruitful is indicated by this council report.
The health law of 1876 establishing a State Board of Health also provided for county boards of health and twenty-one were organized that year. These boards were composed of the ordinary and two prac.ticing physicians chosen by the commissioner of roads and revenue, or by the grand jury. The 1876 annual report of the State Board of Health defines the duties of county boards of health as:
"The collection of vital statistics should constitute the paramount object of the board. Every available means should be used to stimulate those whose duty it is to make reports, to the discharge of their duty, and, in case of failure, the causes inducing such failure should be carefully studied and noted, and the facts observed, gathered and embodied in the annual report of the board to this office.
"Should any county be visited by an epidemic or endemic, or any unusual disease of malignant type, it should be made the subject of earnest study, and investigation by the board, and, as far as possible,
the causes of such diseases determined. * * * Should such epidemic or
prevailing disease be considered alarming in character, then it should be made the subject of a special and immediate report to this office.
"The class of zymotic diseases, the board should carefully study and observe, with reference especially to causes and preventive measures.
"Diseases of a malignant type can frequently be traced to their legitimate sources, as in vegetable, animal, and excrementitious decomposition. Indeed, these are the sources from which comes poison to our
44

atmcsphere and o.-r water suppiies, dysentery, cholera infantum, etc.; diseases to which are attributable a large percentage of our mortality, and which are largely, if not absolutely, preventable, especially more epidemic or malignant types.
"Annual report of the county boards to the State Board of Health should be made promptly by the 1st of September next, and annually thereafter. These reports should embrace, in addition to special matters already mentioned, all sanitary measures adopted or proposed by the board for the prevention of disease or the improvement of the health of the people.
"The county boards of health should pass such rules and regulations as would secure regular meetings at stated intervals. The work of the board should be systematized, so that definite duties may fall to each member.
"It is earnestly hoped that these boards will take a positive and active interest in the purposes of their organization, both in the matter of vital statistics and sanitary medicine, and that we may have, as a result of their labors, a marked decrease in the sickness and the mortality of their respective counties."
Initial Efforts Disappointing
The members of the 1876 State Board of Health had hoped that every county would immediately organize health units, and they were disappointed at the end of the first year that so few counties established boards of health. It was recognized that lack of interest in the counties was the main reason for failure to comply with the law. The Board, then, recommended that the appointing power reside in the State Board and that the county boards should be under the supervision of the State Board of Health.
After two years of existence, the State Board of Health concluded that it could not carry out the duties imposed upon it by law nor meet public expectations with the funds and personnel at its command. It had no power to enforce sanitary laws or the collection of vital statistics, and its appropriation was not sufficient to meet indispensible necessities. As a consequence, a committee of members was appointed to present the problem to the Legislature. The committee was instructed to urge the necessity of appropriate legislation and funds if the work wa5 to continue.
When the Legislature, which met in 1877, failed to make an appro-
45

pnat10n for continuing the state health work it automatically ceased to function. The county boards of health, established under this law, soon ceased their activities also.
It was 26 years after the demise of the first state and county boards of health before Georgia enacted additional legislation providing for such health authorities.
In the meantime, a number of the larger cities had begun employing health officers on a full-time basis. Savannah employed the first fulltime health officer in 1888. lk~!th.-.dePl!_r!_ments, as such, grew out of the early practice of having a practicing physician in the community designated as the health officer on an honorary or part-time basis. Later, such physicians were employed on a full-time basis.
Atlanta established a health department in 1901. Others of the larger cities followed the early health movement.
"DERRY'S GUIDE"
That Georgia did make an effort to promote the State's progress at this period is attested by the publication, in 1878, of "Georgia: A Guide
To Its Cities, Towns, Scenery, And Resources," by J. T. Derry, who
was historian and professor at the Academy of Richmond County. Derry's guide was prepared as a publication to be used in inducing persons to come to Georgia to live. His chapter on "Climate and Health" includes :
"Persons seeking homes in Georgia can select any climate which they may prefer. If they prefer a cool, bracing atmosphere, they can find it in the lovely valleys that nestle at the foot of the mountain ridges of Northern Georgia. If a climate yet milder is preferred, it can be had amid the hills of Middle Georgia; or in the southern section of the State one can find a region where winter scarcely comes ere it is gone again.
"The following letter from Dr. Wm. H. White, formerly surgeon of the First and Twenty-Second Iowa Volunteers, but for many years since the war a resident of Atlanta, will be found interesting. It speaks particularly of the climate of North Georgia, and is certified to by several leading physicians:
"'Atlanta-Gentlemen,-North Georgia is about eleven hundred feet above the ocean, as recently demonstrated by Captain Boutwell, of the United States Coast Survey. The atmosphere is invigorating, and not subjected to marked unexpected changes, as will be seen by meteoro-
46

logical tables from the official records of the military post at this place.
"'Our coldest day in 1873 was 15 d. above zero, in 1874, 12 d. above, and in 1875, 4 d. making our mean winter weather about 45 d. above zero; the mean heat of summer about 75 d. above, which is an average of from ten to fourteen degrees less than that of the Middle and Western States; while our atmospheric changes at all seasons are more gradual and less extreme, and, as a rule, a quilt or a blanket is required summer nights.
"'We are not subject to epidemic disease. Not even in Atlanta, with a population of thirty-six thousand, with daily arrivals from all sections, has yellow fever or cholera ever prevailed, and but few cases of dysentery or smallpox have been developed. As to chills and fever, when they have occurred (as a rule), the cause could be traced to a visit to, or former residence in, some miasmatic district. This bracing atmosphere oxygenates the blood without oppressing the brea~hing apparatus, and is, therefore, peculiarly adapted to persons from a northern or more rigorous climate-especially those suffering from chronic weakness of the lungs. In the winter months we have some rainy weather, requiring the usual precautions against these atmospheric changes.
"'Having passed my early life in New York, practicing my profession in the Northwest for fourteen years, and being stationed in and having passed over most of the South during the war, I have had opportunities of experiencing and observing the climatic effects of the several portions of the United States, rarely enjoyed. My conclusion is that the climate of North Georgia, taking all seasons together, is the finest in America; and this is the opinion of all intelligent travellers I have ever met.
"'I have found that pleurisy, pneumonia, catarrh, and all affections of the respiratory organs are rare here, as compared with those generally met with in the North and West; so with epidemic and typhoid forms of fever. I have also found that persons coming from those sections suffering from any weakness of the lungs, or catarrh, or a tendency to consumption, or suffering general nervous prostration, be the cause what it may, are almost certain to be benefited-yes, get well, by coming to this region of country. As illustrative of this fact, there are hundreds of old citizens and old persons in North Georgia enjoying, and who have enjoyed, good health, who came here years ago as a last resort, and they were believed by their friends to be consumptive. I can but think that these marvellously pleasant results are owing, in part, to the vast number of mineral springs which are everywhere to be found in Upper Georgia.
47

"'We have long been satisfied, and we believe results warrant us in saying, this part of the country is far better for invalids than that of Florida, as it is less liable to sudden changes, free from unpleasant, depressing ocean and gulf breezes, loaded, as they are, with the chloride of sodium absorbed from the salt waters, and miasma of its vast swampy bottoms and marshes; and, above all, there is constant want of a bracing strength-giving atmosphere. I also say, without intending to detract from the reputation of Aiken as a noted and fine winter home for Northern invalids, that I can but think, and that others must, when the fact is considered that we are five hundred and fifty feet higher than that city, and free from its fine white sand, which fills the nose and airpassages every time the wind stirs it, that ours is decidedly the safest and best for this class of persons. For years past, Atlanta, Marietta, Stone Mountain, Athens, etc., have been the summer resort of many persons from the southern portion of this State, Alabama, Florida, and Louisiana, and, during the last season, of many Northern persons. Lassitude and languor ar~ not experienced here, even as much so as in many portions of the North.
" 'I am not practicing, but shall be glad to extend any courtesy to Northern visitors.
(Signed) "Wm. H. White, M.D., "Late Surgeon First and Twenty-Second "Iowa Volunteer Infantry.
"'We fully concur with Dr. White as to what he has stated in the above letter, as to epidemics, chills and fevers, as to our climate and its effects generally on persons coming from the North.
"H. V. M. Miller, M. D. "W. G. Owens, M. D. "B. B. Ridley, M. D. "A. M. Calhoun, M. D.
Professor Atlanta Medical College.
"J. T. Todd, M. D.,
Vice-President, Atlanta Academy of Medicine. "Wm. Abram Love, M.D., Professor Atlanta Medical College. "W. F. Westmoreland, M. D., Professor Atlanta Medical College. "Charles Pinckney, M. D. "G. G. Crawford, M. D. "H. B. Lee, M. D.' "
48

"The Sand Hills, two and a half miles from Augusta, in the extreme eastern part of Middle Georgia, on whose summit stands the pretty town of Summerville, are a continuation of the same ridge on which Aiken, South Carolina, is situated; hence the same causes which make Aiken such an excellent resort for invalids from the North, render Summerville an equally healthy abode for such persons. Summerville possesses one great advantage over Aiken in its proximity to Augusta, which city the invalid can reach by a short ride on the street railway, and there he can procure many comforts that cannot be obtained in the town of Aiken. Summerville was originally only a summer resort of the wealthy citizens of Augusta; but many of them, pleased with its healthful and bracing winter air, have made it their permanent abode. It is regularly laid out with broad streets shaded by elms and other trees, and contains many handsome residences surrounded by lovely gardens. The population of the town is about one thousand. The views from the various prominent points in the town are fine; that from the plateau, on which stands the residence of Colonel Milledge, is especially so, and this spot would be a splendid site for a first-class hotel. There can be no doubt that an enterprise of this character would pay well, for during the winter and spring months there have been hundreds of unsuccessful applicants for accommodations at the few houses open for the reception of boarders. Such a hotel would attract to Summerville many of those who now resort to Aiken to avoid the bleak climate of the North. With regard to the healthfulness of these Sand Hills and the country adjacent, including the city of Augusta, I cannot do better than give several extracts from a little pamphlet, by Dr. S. E. Habersham, on 'Hilly Pine Region of Georgia and South Carolina,' published in Augusta in 1869. Speaking of the Sand Hills, he says, 'This plateau is properly speaking the true summit of the hills in this State, being the highest point attained by it, and on its eastern terminus is situated a portion of the village, including the United States Arsenal and grounds. The gradual slope of this plateau to the south and east, the sandy nature of the soil, with the pine and oak growth (blackjack), make it extremely dry and well adapted for those pulmonary sufferers who require a very dry climate and low dew-point; while the sides of the ridge being nearer the valley are better adapted to those for whom a semi-humid atmosphere is necessary. This condition can be increased or diminished by approaching to or receding from the valley, which fact makes the village of Summerville more suitable as a residence for the pulmonary sufferer than any locality I am aware of, since it is well known that though the great proportion of phthisical patients require a dry climate, yet th<!re are occasionally those who are
49

benefited by a comparatively humid atmosphere. This is particularly the case with asthmatic patients, who, in the great majority of cases, are benefited by residing here. As this peculiarity of constitution can only be determined by actual experiment, we have, in the close proximity of these two hygrometrical conditions, an easy and convenient means of determining the fact.'
"In the pamphlet from which I have just quoted, I also find the following letter from Dr. L. A. Dugas, one of the most prominent physicians of Georgia. This letter is addressed to Dr. Habersham, and dated July 2, 1869:
"'My dear Sir,-In a note recently received from you, I find the following request: Will you do me the favor to give me the results of your experience and observation as to the influence exerted by this climate upon tubercular consumption and kindred diseases? I will endeavor to make my reply as brief as possible.
"'Having commenced the practice of my profession in 1831, after spending several years in preparing myself for it in the colder sections of our country and in Europe, where :.ubercular affections and typhoid fever constitute a great majority of the cases treated in hospitals, I was very soon forcibly impressed with the rarity of those diseases in this section, in comparison with what I had seen elsewhere. Indeed, some six or seven years elapsed before I saw the first case of genuine typhoid fever, when this form of fever first began to show itself here. I need scarcely add that since that time typhoid fever has gradually invaded and extended over all Southern States. Tuberculosis, in its various forms, and especially phthisis pulmonalis, was scarcely ever seen, except in those who fled from the north in order to escape it, and among the negroes imported from Maryland and Virginia, where they had inherit~ed the tendency. Such a radical change in the field of my observation could not fail to attract my attention, and to impress me as before stated.
"'In 1826 I had occasion to examine the mortuary records of the city sexton as far back as they could be found, for the purpose of preparing an article on the subject for the Southern Medical and Surgical Journal, published in this city. The result of this, as well as of subsequent researches, furnishes a striking confirmation of the correctness of my impressions.
"'It seems to me that the best test of the influence of climate upon the development of tuberculosis must be found in the relative frequency
50

of such cases among the natives of this and of other sections who remain at home. Judged by this standard, it will readily be ascertained that, while phthisis plumonalis is very common in our Northern States among the natives, it is quite rare here among our own people. I know of very few native families in Augusta who have ever suffered from consumption, and these have only lost one or two members by it. I doubt that there are exceeding ten families who have been thus even partially affected within my recollection.
" 'Again, if we confine our observation alone to those who have migrated from the north of the United States and from Europe, it will be found that, although many bear with the hereditary taint, comparatively few will experience its fatal development. The conclusion is, therefore, irresistibly forced upon us that this climate does exert a most beneficial influence over this class of affections.
"'Is there any difference in the several sections of Georgia with regard to this comparative immunity from phthisis? There is a marked difference. I find that in 1852 I made the following remarks in an editorial article of the journal above alluded to:
"'The value of removal to the South of persons affected in the Northern States with consumption has been heretofore very generally admitted; but it is now asked whether much, if any, advantages are to be derived from merely spending the winter months at the South, and returning to the North in the spring; and it is added that if a temperate atmosphere be all that is needed, this may be obtained in New England by means of a well-regulated system of artificial heat. We believe it to be an error to suppose that the Southern States owe their immunity from phthisis alone to the mildness of their winters. If such were the fact, all mild climates ought to be equaly exempt, and all cold latitudes alike unfavorable. Yet phthisis is much more common upon the seaboard and in the mountainous districts of the Southern States than at intermediate points, and it is comparatively rare in the northern portions of Canada and Russia, whilst it makes frightful havoc in milder England, France, and our Northern States.
" 'That a temporary sojourn in the Southern States is advantageous, we doubt not; but that a permanent residence is still more so, we feel quite certain. Every practitioner of experience, and who is acquainted with the means of accurately determining the state of the lungs, must have often observed how wonderfully large abscesses will heal here, which would have certainly proved fatal in a less genial climate. The writer knows persons in this State who had tubercular abscesses as long
51

as twenty years ago, which healed kindly, and have left them ever since in the enjoyment of apparently good health. That all are not equally fortunate, is too true; yet we feel assured that it is only by remaining in the South, both summer and winter, sufficiently long to acquire the peculiarities of a Southern constitution, that lasting benefit may be expected. The best locations are obviously those in which the disease originates most rarely; and these are unquestionably to be found midway between the mountains and seaboard.

"'This favored belt commences at the termination of the primitive region, where the rivers of the Atlantic slope tumble over the last ledges of granite rocks,-that is to say, at Augusta, Milledgeville, Macon, and Columbus, and varies from thirty to sixty miles in width below the shoals.

" 'This so-called Sand Hills, with pine forests which characterize this belt, are only a few hundred feet above the sea; are supplied with pure water, and have a healthy atmosphere, peculiarly adapted to those threatened with or suffering from pulmonary disease. I must say, however, that some cases do better in the valleys of Augusta than upon the adjacent heights, and vice versa. Why this is so I cannot determine.

" 'Yours very truly,

(Signed) L.A. Dugas.'"

Political reconstruction occupied the stage in Georgia for a number of years after the Civil War, culminating in home rule being established again. The State Capitol building was completed in 1890, and the importance of manufacturing was highlighted with the International Cotton Exposition, in Atlanta, in 1881. The State prospered financially but no further attempt was made to re-establish health work during the latter part of the century.

52

STATE HEALTH DEPARTMENT OFFICE, 1910

Chapter lll
THE SECOND STATE BOARD OF HEALTH
1903-1917
In 1903, a continuous state health program was initiated by legislative action. Twenty-six years had elapsed since abandonment of the work of the first State Board of Health, in 1876, because of insufficient funds and inadequate public support. The second State Board of Health was established as a result of the interest of a few physicians in Georgia who recognized the need for public health work. Other doctors regarded the movement with disfavor. Professional and public support of the new movement was slow in developing. As a consequence, progress in organizing and operating a State Health Department was considerably hampered.
Dr. Charles Hicks, who was President of the Medical Association of Georgia at the time, advocated passage of the bill creating the Board of Health and was a motivating power behind the movement. The bill was drawn by Judge Meldrim, of Savannah, and introduced in the General Assembly by Whitley, of Douglas, November 15, 1902. The bill passed the House on August 7, 1903, with only eleven votes against it. The Senate unanimously approved the measure and it was inacted into a law by the signature of Governor Terrell, August 17, 1903.
The 1903 health board law was similar to the one enacted in 1876, showing that the medical profession of that early period had a comprehensive idea of what the composition of a health board should be.
The 1903 health law provided for a board consisting of twelve members, a majority of whom were physicians. One member was appointed from each of the eleven congressional districts. The term of two members expired every year for six years and subsequent appointments were made for six years. A president was elected from the membership of the board but no member was eligible for the position of secretary. The secretary, who was the executive officer, was required to be a qualified physician and held office for six years. His salary was $2,000 a year, and board members were paid $5.00 a day for expenses when on duty ordered by the board.
The newly created State Board of Health had supervision over all matters relating to the preservation of the life and health of the people
54

and was given supreme authority in matters of quarantine, and could make and enforce reasonable orders and regulations to prevent the spread of contagious or infectious diseases.
The first meeting of the board was held at the State Capitol on September 10, 1903. The members had received their appointments from the Governor in August.
An' appropriation of $3,000 yearly was made for the work of the State Board of Health. Dr. H. F. Harris, of Atlanta, was elected as secretary. After his salary of $2,000 was paid, there was little left with which to establish an office, outfit it, and carry on public health work. But with much enthusiasm and a broad conception of their duty, the board members made a very brave beginning.
A published report of ten years of health work in Georgia from September 10, 1903 to December 31, 1913, made by Dr. Harris gives pertinent data concerning the early conditions, trials, and tribulations:
"No greater indictment could be lodged against the effectiveness of our boasted free institutions than a simple statement of the deaths annually caused by preventable disease in the United States. But this leaves the story only half told, for when we call to mind the frightful sufferings produced by the same causes in at least ten times as many others who recover, and when we add still to this the anguish and sorrow of those who are near and dear to the victims and the poverty and misery which in many instance~ ensues, the horror grows beyond all bounds, and would excite to pity the most hardened of mankind. But who knows about it, and who cares?
"The subject is an unpleasant one as is always pain and suffering and death, and when by chance any reference to it occurs in the newspapers we are in no mood to read it, and naturally prefer the gruesome but not wholly uninteresting details of the latest murder, or the still more satisfying and delectable details of the marital troubles of our next door neighbor. Besides, we do not look upon it as any of our business. Herein really lies the crux of the situation for if in a republic the most vital of all questions, the life and happiness of its citizens, is not the business of each and every Yoter, in Heaven's name to whom shall the burden be assigned? The truth of the matter in the subject is one which is highly special, and can only be dealt with intelligently by men who have made it their life study, and even where mildly interested the average man feels this, and naturally shifts the burden to other shoulders-with the result that nobody does anything.
55

"It is unquestionably further true that with the increased complexity of a civilization far in advance of that of our forefathers there have arisen in connection with our government many great and almost inextricably intricate problems with which the average man is as fit to grapple as his simian cousins in the wilds of equatorial Africa, and in the hubbub created by the howlings of the self-seeking demagogue, the always-more-modest voice of those who have a right to opinions from intellect and study remains completely unheard.
"We are all beginning to realize in a dim sort of fashion that thing3 in our country are by no means as they should be in many cases, but unfortunately the number is small which really understands the natur<' of the trouble and the remedy. In no other sphere does this apply with greater force and in none with such disastrous results as in the case of public health. To his superlative ignorance of all things connected with his own body and its preservation the average man, particularly where he is disposed to think for himself, adds a deep and abiding distrust of the medical profession. Such persons always have a small stock of more or less well-authenticated cases where this, that or the other doctor was entirely wrong, to be dragged forth when occasion permits and recited with appropriate sarcastic comments, and always winding up with the fit and appropriate deduction that medicine is all "bosh," or words to that effect, and at the same time beautifully illustrating the devil-given tendency of the ignorant to jump at conclusions on the flimsiest evidence. What the average man seem> incapable of understanding is that it can hardly be that there is any other profession in the world the members of which differ so much in knowledge, training, and original capacity, as in medicine. The average person thinks if a man has the degree of Doctor of Medicine that he knows just as much and is just as capable in every way as any other individual similarly equipped, believing them as much alike as one brick is like another. How woeful is the error-an error which has its roots in the innate imperfections of the individual, to be fostered through life by the fact that the public at large offers no inducements for high attainment.
"It is perhaps true that about one in five hundred who studies medicine has a mind thoroughly capacitated to take in and appropriate the lessons taught him. and after he graduates he is at once put on a par with his less capable brother; not infrequently he is at a positive disadvantage for the reason that, like most men of unusual capacity, he is apt to be solitary and fail as a social success, and as a natural consequence gives place to his more suave and unctuous colleague, who
56

studies the whims and prejudices, likes and dislikes, of his patients rather than the accumulated stores of knowledge gained in the past. We have no examinations to go by, no standards by which to gauge the abilities of our medical men; if the:r patients d!e they say "Providence,"
and if they recover they protrude their chests and tell the family that
they were just sent for in the nick of time. Our only test of our doctor's fitness is whether or not we like him, and where this is the only standard up to which he has to measure, is it any wonder that he makes mistakes, and is it curious that they are now and then detected? The real wonder is that a large but happily diminishing contingent of our profession is not constantly seeking tall timber eagerly pursued by the rt'mnant of their former clie11tele, whose constitutional vigor is attested by the fact that they refused to die; and yet our wiseacres judge the science of medicine, as wonderful and great and beautiful as it is, by the miserable doings of such misrepresentatives. The facts are that the !::est and most learned specialists in the wor ld perhaps never in a single case bring to bear every bit of the real knowledge and wisdom which has been gleaned by others, and it would therefore be folly to ask anything more than a reasonable acquaintance with the principal facts of the average doctor. The lack of confidence in the medical profession engendered in the laity by these and various other causes has certainly produced most baneful effects. It has made the people as a whole indisposed to accept the advice of really competent hygienists, and has prevented them from seeking men of real character and ability, and putting them in such official positions as would redound to the infinite good of the country at large.
"Such unquestionably was the attitude of the public of Georgia at the time of the creation of the State Board of Health. Although the writer had no active part in the creation of the board, he was informed by those who were in the van of the movement that the idea was received with anything but general favor, and was indeed almost laughed at as being a joke which would likely prove too costly to be considered. As the result, however, of much pleading on the part of the better element in the medical profession of our State, the Legislature in the summer of 1903 appropriated the sum of $3,000.00 as a fund to maintain a board of health for the balance of that year and a similar amount for 1904. One thousand dollars for each year was to be expended in the general work of the board, while the secretary was paid at the rate of $2,000.00 a year from the time of organization, which was September 10, 1903. Having been honored by the board by being elected to the position of its secretary, I promptly called on Gov. Joseph M. Terrell, and asked that he assign an office for my use, but was at once told that
57

every room in the Capitol had been pre-empted by the departments already in existence, and that he saw no possibility of my securing quarters of any kind at that time.
"Feeling, however, that it was absolutely essential that a beginning should be made as early as possible, and it having already been determined that it would be the policy of the board to develop along laboratory lines, I succeeded after some months of rather delicate negotiation in securing a small room in the basement, from which I had to move a large number of old books. The floor consisted of cement with large holes here and there, and the walls of rough brick covered with spiders' webs and marvelously dirty. As there would remain but little money for other purposes after paying the expenses of the two yearly meetings of the board made mandatory by the act creating it, the flooring and plastering of the walls of the room secured and the purchase of furniture for it became a rather serious matter, and it was only after having inquired around for some time that I got an old veteran of the Civil War, living in the Soldier's Home, to do the necessary work for the money which we had to expend for the purpose. It was well along into the year 1904 before these simple preparations were completed and I was enabled to move into our new quarters. Fortunately, practically nothing was known of our board, as we did not have the necessary apparatus to do good work at that period. I had, however, a microscope of my own and some little apparatus of other kinds, and toward the end of the year was occasionally getting specimens to examine from doctors in various parts of the State.
"Up to this time the board had certainly done nothing to justify its existence, but during the session of the General Assembly in the summer of 1904, through the influence of the various members of the board and with the help of the intelligent physicians over the State and some friends who believed that there was a future in the work, the Legislature was persuaded to appropriate the sum of $7,500.00 for the years 1905 and 1906, to which was added, on account of the unusual expenditures incident to a State quarantine on account of yellow fever in 1905, an extra appropriation of $2,829.69.
"With the prospect of this appropriation ahead of us it was determined to begin the equipment of a bacteriological laboratory, and this may be said to have been formally opened on the first of January, 1905."
In the beginning, the laboratory was the Health Department. It was uphill work to induce the doctors over the State to submit specimens
58

for examination. Through circular letters and articles in the newspapers, physicians and the general public were acquainted with the fact that the laboratory had been opened for the free examination of specimens of all kinds of bacteria and animal parasites which might produce disease in man or domestic animals by being conveyed from one to another. Realization on the part of physicians and the general public that the laboratory was prepared to furnish this service came with "exasperating slowness." Ten years after the laboratory was opened, the secretary reported that occasionally he found physicians in the State who were unaware of its existence.
The majority of the first laboratory specimens were for examination for tubercle bacilli, diphtheria bacilli, and the eggs of the hookworm. In addition to examination of dis:ase-producing agencies, water analyses were frequently made.
The board was encouraged by evidence of appreCiation on the part of a majority of the medical profession for the work being done, in 1907, to seek additional funds for the enlargement of the laboratory and for the establishment of a unit for the preventive treatment of hydrophobia. As a consequence of this move, the appropriation was increased to $11,000.
Antirabic Measures Instituted
Progress in rabies control was unseemingly slow. Hydrophobia (from the Greek words meaning "fear of water") was a disease of antiquity. Plutarch asserted it was observed in man in the days of the first descendants of Aesculapius, the Roman god of medicine. Celus, in the first century, gave a description of the infection in man, first using the term hydrophobia. Toward the end of the eighteenth century, several important scientific observations among physicians of the period led to the work of Pasteur which resulted in the first human inoculation of antirabic vaccine, in 1885.
In 1900, a private laboratory for antirabic treatment was established in Atlanta by a group of Georgia physicians. Previous to this project, Dr. Benjamin W. Hunt, of Eatonton, had gone to the famed Pasteur Institute, in Paris, for treatment of a rabid cat bite. Dr. Hunt was the first person in Georgia to receive antirabic treatment. Upon his return from France, in 1898, he was instrumental in helping get the Atlanta laboratory established.
The State Department of Health, in 1908, took over the work of the priv?tc Pasteur laboratory. The antirabic treatment was prepared and
59

distributed and examination of brain tissue for diagnosing the disease was begun. On June 19, 1908, the first treatment for the prevention of rabies was furnished by the Health Department. A large number of "troublesome" examinations of the brains of animals supposed to be subjected to rabies were made that first year, too.
From 1908 through 1913, 3,348 cases were treated for the prevention of rabies. At the time the work was begun, the regular price charged for administering the treatment by the private laboratory in Atlanta was $140.00 for each case. Many patients also had to pay their transportation and living expense while in Atlanta for this purpose. Dr. Harris estimated that Georgians had been saved $334,800 by establishment of the rabies service unit. His report for the period included:
"It is certainly a sad commentary on our civilization and an alarmin-; evidence of the almost savage disregard of our people for human life when we permit a lot of worthless curs to yearly cause all the trouble, suffering, and even death for which they have been for years, and are at present responsible, when the whole trouble could be done away with in a month or six weeks by the simple act of the Legislature commanding that they be muzzled and public sentiment seeing to it that thc law was obeyed."
Diphtheria Antitoxin Produced
The manufacture and distribution of diphtheria antitoxin was begun in April of 1909. The laboratory services as a whole were rapidly expanding and the problem of housing a new section was troublesome. The original quarters in the basement of the Capitol were woefully madequate and not suited to laboratory needs.
Although water analyses were made from the time of the organization of the laboratories, funds did not permit the creation of a water laboratory with proper equipment until 1910.
Other Antitoxins and Vaccines Made Available
Since its inception, the Department has supplied smallpox vaccine. During the first ten years of the Department's operation, 180,850 smallpox vaccine points were furnished at a total cost of $11,442.44. Lack of laboratory facilities prevented the manufacture of this vaccine by the Health Department, and it was purchased for use in the State from pharmaceutical companies.
The manufacture and free distribution of typhoid vaccine was begun July 1, 1912. At that time, the disease was rampant within the State.
60

Several small epidemics of cerebrospinal meningitis occurred in 1912 and, as a consequence, the laboratory began the manufacture of this antitoxin. Previous to this service, much difficulty was experienced in securing the product. The next year, the manufacture of a vaccine to prevent meningitis was attempted and 520 doses were distributed that year.
In 1913, the laboratory bought and began supplying tetanus antitoxin. No attempt was made to prepare this antitoxin in the laboratory because of lack of space in which to handle the product safely.
Tuberculin, for use in detecting the presence of tuberculosis by skin testing, was manufactured by the Department in its early days.
First 14 Years of Laboratory Work

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447 7 941 11 983 16 10 1,523 95 202 2,115 111 324 3,536 181 218 7,249 343 234 7,025 291 270 7,260 295 317 8,604 95 319 7,209 383 356 11,664 375 493 6,771 263 555 5,389 346 472

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1,737 11,592 30,224 52,628 108,267 115,500 120,300

3,400,000 7,769,300 5,634,000 9,414,500 12,719,000 13,524,000 13,717,000 19,279,000 14,070,000 11,996,000

Although the first state health activities were principally bacteriological and other laboratory examinations, efforts were made by Doctor Harris to institute other badly needed services.
Other Activities and Problems
Georgia was threatened with an epidemic of yellow fever again, in 1905. A case was brought into Atlanta, from outside the State, with

61

the disease already developed. The new State Board of Health promptly instituted a rigid quarantine procedure within the State. Doctor Harris and the Board recognized their responsibility and acted with commendable courage in the face of some opposition from Atlant:l authorities. While several of the surrounding states had outbreaks, Georgia escaped further infection.
The next year, the infant board was confronted with a puzzling outbreak of "slow-fever." A temporary branch laboratory was established at Albany for the study of this disease which was later designated as paratyphoid fever.
In 1908, the first health education material was prepared by Doctor Harris and issued in pamphlet form. Comprehensive bulletins were issued on hookworm disease, rabies, tuberculin, and one to physicians 0:1 free laboratory examinations.
After having been partially routed, smallpox returned with renewc:.l vigor, in 1910. The next year, Doctor Harris reported it "was prevalent in every part of the State and nothing is being done to check its ravages."
Conflict, unfortunately, developed between Doctor Harris and thl' President of the State Board of Health, Doctor Westmoreland. At a meeting of the Board on September 25, 1911, Doctor Westmoreland charged Doctor Harris with neglect of his duties and other irregularities and concluded his attack by asking for his resignation. He concluded his remarks by asking that his charges be filed as a matter of record. The Board agreed to this with the understanding that Doctor Harris would be allowed to reply to the charges. When Doctor Harris' rebuttal was completed a committee reviewed the report and completely exoneratt'd Doctor Harris.
About this time, malaria moved into North Georgia. An electric power company constructed a dam northeast of Jackson where the Yellow, Alcovy and South Rivers converge to form the Ocmulgee. The reservoir created by the dam flooded parts of Butts, Jasper, and Newton Counties. Previous to this time, there was no record of malaria in the northern part of the State. The flooding of these low lands provided ideal breeding places for the malaria mosquito. Soon people in that section of the State began suffering from malaria. There is no record of how many cases actually occurred but there were enough of them to arouse righteous indignation among the people adjacent to the reservoir. At the September, 1911, meeting of the Board, this situation was studied and attempts to alleviate the problems were made. The
62

malaria situation there was not improved, though, for many years and cases continued to spread among the population.
By 1912, Doctor Harris was urging the Board to take steps to collect reports of births, deaths, and illnesses. He also reminded the members that they had no authority to enforce any regulations except quarantine.
Doctor Harris was also seriously concerned about the spread of pellagra and was urging the Board to sponsor legislation to prohibit the sale of "spoiled corn products" in the State. He had been engaged in considerable research work on this disease and believed it was caused by eating spoiled corn products.
Dr. Harris Resigns
Doctor Westmoreland continued his fight against Doc Harris and, in 1912, carried his charges to the Governor. Although the Board continued to uphold Doctor Harris' actions and exonerated him to the Governor, Doctor Harris tendered his resignation and agreed to serve until a successor could be secured.
Money, or the lack of it, still plagued the Health Department. Doctor Harris reported, in 1913, that the Department had a deficit of $10,000 and that the Governor was very much disturbed about it.
An epidemic of cerebrospinal meningitis occurred at Midville in December 1913. The public was ill informed concerning the disease and much confusion developed concerning this outbreak. The Board did not have an epidemiologist to study the situation and to take charge of control measures and some criticism resulted as a consequence. Finally the Board secured the services of an Atlanta physician temporarily and he managed to get the situation under control. This occurrence showed how inadequately prepared the Department was to meet serious epidemic conditions at that time.
The General Assembly of 1914 passed the Ellis Health Law, and en.: acted a vital statistics law. Both of these measures were of prime importance in establishing a broad approach to environmental health problems. The Ellis Health Law served as the framework for the State and County health departments. Vital statistics record human events and enable health workers to forecast and detect impending disease outbreaks. The Legislature, though, failed to provide additional funds to the State Board of Health for putting the vital statistics law into operation.
Laboratory work was increasing steadily and demands were constantly being made on the Health Department to institute other badly
63

needed services. The $10,000 deficit still faced the Board. Efforts to economize, in the face of overwhelming needs for expanding services, were not entirely successful and the deficit remained for several years to harass the early public health officials.
Drug Addicts Treated With the chaotic financial-health conditions existing, the Legislature appropriated $10,000 specifically for treating pauper drug addicts. The law provided that such patients could be treated in any of the existing hospitals and the hospitals be reimbursed for the cost through the State Board of Health. This method proved unsatisfactory as few o( the hospitals were equipped or cared to handle such cases. Consequently, a small hospital for treating drug addicts was established at 81 Washington Street (On the lot now occupied by the City Hall) by the State Board of Health, using a method of treatment developed by Dr. Charles Stokes of New York. This hospital was discontinued two years later. While many drug addicts were relieved of the necessity for taking narcotics, no means were available for preventing recurrence of the condition. Doctor Harris continued his interest in research on pellagra and other diseases. He reminded the State Board of Health, from time to time, of his desire to be relieved of his duties so that he could devote his entire time to this activity. A definite awakening of interest in health work was apparent on the part of many interested persons and agencies but no facilities were available for expanding the existing health services. Colonel Ellis was disappointed that no attempt was being made to extend the provisions of the law enacted mainly through his efforts to bring health service to all the people. At a meeting of the State Board of Health on July 16, 1917, Dr. H. F. Harris' resignation was accepted. Dr. T. F. Abercrombie, health officer of Brunswick and Glynn County was elected as his successor.
64

Chapt=r IV
REVIEW OF HEALTH PROBLEMS IN EARLY 1900
Public health, at the turn of the century, was struggling to emerge from years of neglect as a necessary part of a rapidly growing state. Agriculture was slowly giving way to industry and, as a consequence, cities were gaining in population. Concentration of population increased the already existing health problems.
Typhoid Fever
The prevalence of typhoid fever increased along with the population and progress of the Colony of Georgia:
In 1850 there were 557 typhoid deaths; In 1860 there were 887 typhoid deaths; In 1870 there were 772 typhoid deaths; In 1880 there were 987 typhoid deaths; In 1890 there were 1000 typhoid deaths; In 1900 there were 1766 typhoid deaths; In 1920 there were 549 typhoid deaths.
At its peak in 1900, the disease was the fifth cause of death in Georgia and its sickness toll was about 17,000 cases yearly. Nearly one person in every 300 contracted typhoid fever that year. Illness from typhoid was lengthy as was the convalescent period.
"Typhoid fever was confused for centuries with other continued fevers, such as recurrent fever, septic infections and typhus fever. The first full description of what was probably typhoid fever was written by Thomas Willis, an English physician, who, in 1643, described an epidemic that occurred in parliamentary troops. Bretonneau, in 1826, further described the clinical characteristics and called it 'dothienenteritis,' or abscess of the small intestine, a name it frequently bears in French literature. Louis, the distinguished French clinician, in 1829 gave the name typhoid fever to the malady to distinguish it from typhus fever. In 1836, William Gerhard, of Philadelphia, a pupil of Louis, showed the difference in the lesions between these two fevers, which established typhoid fever as a distinct disease, but it was n'ot until after the middle of the nineteenth century that the disease became widely
65

known under this name in the United States, even to the medical profession.
"William Budd in 1856 pointed out that the disease is transmitted by the patient's excreta. He stated that: 'The living human body, therefore, is the soil in which this specific poison breeds and multiplies; and that most specific of processes which constitutes the fever itself is the process by which the multiplication is effected.' The first water-borne outbreak carefully studied and described was at Lausen, Switzerland, in 1872; the first water-borne outbreak to attract attention in the United States occurred in Plymouth, Pennsylvania, in 1885. In 1~75, Murchison traced an epidemic to contaminated milk supply. Elberth in 1880 saw the Bacillus typhosus in the tissues, and four years later Gaffky grew it in pure culture. Metchnikoff and Besredka, in 1900, finally established the etiological relation by producing the disease in anthropoid apes with pure cultures. In 1894, Pfeiffer and Kolle first gave small su~cutaneous inoculations of dead typhoid bacilli. About the same time, and independently, A. E. Wright began similar inoculations in British
solr~iers.
"Typhoid fever has a world-wide distribution. It is indemic almost everywhere but the level of prevalence varies within wide limits both geographically and in relation to time. With the industrial revolution and the tendency of population to congregate in cities during the eighteenth and nineteenth centuries, it became a major pestilence in Western Europe and in North America. In many countries it is still a public health problem of great importance.
"In cities of the United States, death rates of more than 50 per 100,000 were not uncommon and in a few the figure was over a hundred. Prevalence was correspondingly high in the smaller towns and rural districts of the country but during this "period somewhat lower than the adjacent urban areas. In the U. S. Registration Area as a whole, typhoid fever was fourth among the communicable diseases as a cause of death. In 1900, the death rate was 31.3 per 100,000 population. 'From that figure it has decreased steadily. In some parts of the country the progress has been more rapid than in others. The downward trend in the cities was paralleled by a downward trend in the
rural areas but these lagged behind somewhat." **
In 1921, only 12 counties in Georgia showed no deaths from typhoid fever. Six ~f these counties, in the Federal examination of reporting,
**From Maxcy, K. F.-Rosenau PREVENTIVE MEDICINE AND HYGIENE, 7th ed., 1951. Courtesy of Appleton-Century-Crofts, Inc.
66

State Board of Health BUREAU OF VITAL STATISTICS
MORTALITY RECORDS 1921
DEATHS DUE TO TYPHOID FEVER By Counties
Not included in Bibb Co. 13 Clarke Co. 6 Fulton Co. 24
fell below the average for the State. It 1s probable that no county actually escaped the ravages of typhoid.
MALARIA Malaria was a major problem in Georgia. Although it was not the State's worst killer, "chills and fever" retarded the growth and economic development of sections of Georgia more than any other one disease with which health forces had to contend. Dr. H . R. Carter, outstanding malariologist, wrote: "It is not in its death rate that the gravest injury of malaria lies; It is in its sickness rate, in the loss of efficiency it causes, rather than the loss of life. One drath from malaria corresponds to from 2,000 to 4,000 sick days. This loss of efficiency may really be doubled or trebled, for the man infected with malaria is frequently half-sick all the time.
67

Homes actually had to be abandoned in many severely stricken areas of the State, and many industries refrained from coming to Georgia because of the prevalence of malaria. In some sections of the State children were expected to have chills and fever "off and on" during their early years. After childhood a partial immunity was often acquired and the disease was less common.
Primarily the first decreases in malaria in Georgia were due to economic conditions-rise in the price of cotton and fall in the price of quinine. Prosperity for the farmers led to better living conditions with more houses screened, and the clearing and drainage of more land and more people could afford the purchase of quinine.
From the annual report of the State Board of Health for 1919 comes this assertion: "Malaria through the southern part of the State constitutes one of the greatest sanitaty problems with which the State Board of Health has to deal." Again in 1920, the yearly report concludes: "Malaria in the South is one of the greatest problems of the State Board of Health. In many localities in South Georgia malaria is from fifty to eighty per cent of all the disease a doctor is called upon to attend."
In Maxcy's Rosenau PREVENTIVE MEDICINE AND HYGIENE, 7th edition (See p. 66) G. F. Otto says:
"Malaria is really a closely related group of diseases caused by four different protozoan species, Plasmodium vivax, P. ovale, P. falcipanun, and P. malariae. Although these diseases differ one from the other biologically, pathologically, clinically, and epidemiologically, there is a common core of similarity among them so that the group may be conveniently discussed as. a unit. The characteristic clinical manifestations of malaria are those resulting from the recurrent, intermittent or remittent, destruction of erythrocytes or the sequelae of such destruction.
"Although malaria has been known since antiquity and the early Greeks and Romans appear to have associated 'the intermittent fevers' with the swamplands during the summer, it was not until the latter part of the past century that there was any definite clue to the nature of that association. Laveran, in 1880, was the first to describe Plasmodium in the blood of malarious patients, and shortly thereafter Manson developed his mosquito theory of transmission; it seemed to Manson a reasonable postulate that mosquitoes became infected by feeding on the malarious patient and then disseminated the infection in the water as they died. Under Manson's stimulus Ross, in 1897, 1898 and 1899, demonstrated not only that mosquitoes became infected
68

by feeding upon malarious individuals but that the parasite underwent an obligatory development (sporogony) in the mosquito host and, transcending Manson's theory, demonstrated in the case of a bird malaria that it was thereafter transmitted to the next individual as the culicine mosquito fed again. Ross's discoveries were quickly confirmed by a number of workers, including Koch, who had early subscribed to the 'mosquito theory.' Biganimi, Bastianelli, and Grassi not only confirmed Ross's findings but worked out further details of development of the infection in the mosquito and, in 1898, were the first to actually demonstrate the transmission of malaria to man by the bite of the infected anopheline mosquito. Manson, in 1900, produced the infection in volunteers in London who were bitten by anopheline mosquitoes which had been infected by Bastianelli in Italy, and, in the same year, three of Manson's colleagues lived in a screened hut during the malaria season in the Roman Campagna without contracting malaria, while the local population in unscreened houses suffered severely.
"Thus, by the turn of the century, it seemed simple enough to eradicate or, at least, reduce and control 'the scourge of the tropics' by the simple expedient of eliminating or reducing the mosquito population. Despite some skepticism, plans were enthusiastically discussed, and some were actually launched in various parts of the world. The outstanding early success was that which attended the efforts of Gorgas and his staff. Although the daring and thoroughness of this program is most commonly remembered and cited in relationship to the dramatic effect upon yellow fever, it was equally successful against malaria. First in Havana, Cuba (between 1901 and 1904), and later in the Panama Canal Zone, the annual attack rate of approximately one case per inhabitant dropped in a few years to a few dozen per 1,000 as the transmission of malaria by Anopheles albimanus was interrupted. Larval breeding places were filled, drained, or periodically treated with oil; adult mosquitoes were killed in houses and known cases were isolated behind screens for treatment. In the Federated Malay States, Watson was equally successful in eliminating malaria by destruction of anopheline breeding sites. Clearing the jungle and draining the swamplands near the town of Klang eliminated A. urnbrosa and freed the town of malaria.
"Elsewhere in the world various lesser degrees of success, and even failure, resulted from similar efforts. In the meantime, malaria in Europe was gradually receding to its Mediterranean stronghold without any appreciable attempt at control, leaving in its wake isolated pockets of persistent malaria, as, north Holland, which showed no sign of
69

yielding to the most persistent frontal attack by health agencies. Anopheline reduction in north Holland had no demonstrable effect upon the prevalence of malaria, and, conversely, elsewhere there was no discernible diminution of anopheline mosquitoes associated with the rapidly receding malaria. Experiences in World War I were discouraging. While armies both Allied and Teutonic, were immobilized by malaria in southeastern Europe during 1916, and re:urning personnel after the- war provide-d the sred for severe epidemics of malaria in northern Europe-. The- disea~e even extende-d into the Arctic, at Archangel. Again, howe-wr, it spontaneously disappeared from some areas and gradually receded southward through most of Europe ; and again without any evident decrease in the anopheline population. Thus, the enigma of 'anophelism without malaria,' became a challenge, almost a battle cry, to the frustrated malariologist.
"Even the apparent success of the antilarval me:1sures and screening of houses in some p:1rts of the southern United States was not without its ambiguities. The League of Nations Malaria Commission, which visited the United States in 1927, noted that the disea~e had a definite downward trend, had already disappeared from large areas, and seemed to have reached a point at which it was of very little importance as a cause of sickness and deat!1 before the initiation of antimosquito campaigns. As in Europe, there was no appreciable diminution of Anopheles in large areas where malaria had disappeared and the decline of the malaria rate was often not accelerated in local situations with intensified efforts at mosquito control.
"Furthermore, it was soon recognized that conditions in Europe and North America were vastly different from those in many tropical areas and it became equally evident that within the tropics there were marked differences in the epidemiology of the disease; that, for instance, rural malaria in the foothills of the Philippines must be handled differently from urban malaria in Calcutta. Nevertheless, the net result was to cast a great deal of doubt on the value of the early magic formula 'reducing malaria by antimosquito measures.' Thus, the Second General Report of the Malaria Commission of the League of Nations in 1927, while recognizing the 'limited value of antilarval measures,' stressed the value of 'bonification' and less direct measures. James, Swellcngrebcl, and others advocated the liberal use of quinine which would reduce the duration and severity of the illness, although it could not be expected to reduce the attack rate. The destruction of mosquitoes, particularly swatting blood-e-ngorged mosquitoes, resting in houses was the only antimosquito measure which appeared to offer any prospect of immediate
iO

value in control, at least in Europe. It was pointed out that bonification, i.e., improved housing, farming practices, and general living, had done more in the temperate zones to reduce malaria than all the antimosquito measures combined. The resulting confusion was aptly discussed in 1937 by Hackett in the first chapter of his book (Malaria in Europe) under the title 'A House Divided.' In 1936, Russell noted that, although measures were available for malaria control in organized communities, such as ::ities, 'the longer one observes malaria in the tropics the more one is forced to conclude that, so far as the average rural areas are concerned, the problem of control is still unsolved.'
"The League of Nations Malaria Commission in its several reports during the 1920's and 1930's echoed the sentiment of some malariologists that the discovery of the insect vector of malaria had not solved the problem of malaria control; that intensified research on all phases of malariology was still needed to pr~vide the answers. Investigations were already in progress the world over, and the attack continued with rcne,.-cd vigor through the late 1930's, World War II, and the postwar period. The life history of the parasite and their bionomics in both the insect and vertebrate hosts and the host responses to infection have been critically studied in the laboratory; the mode of attack of old and new therapeutic agents against various stages of the infection, the basic pharmacology of these agents, and their relative value in mass treatment and suppression have been investigated. Of fundamental importance in control has been the detailed information garnered on the recognition and biology of different species, and subspecies, of Anopheles, with particular reference to their relative roles in transmission of malaria. Evaluation of control projects and field studies over the past half century helped significantly in clarifying the confusion.
"It is safe to say that in the half century since the discovery of the mosquito transmission of malaria the pendulum has completed an arc from ( 1) Ross's and Manson's 'malaria control through destruction of mosquitoes' and Grassi's 'modification' through the destruction of Anopheles, (2) to the point where, in 1927, the League of Nations Malaria Commission 'considers the treatment of malaria-infected persons to be one of the most important measures even from the point of view of prevention,' (3) back to major emphasis on antimosquito measures. In the intervening years the formulae have been further sharpened to 'species control' and 'species eradication.' Thus, the attack is directed not against anophelines in general but against that species, or those species, which within a given area are most likely to be the principal vectors of malaria. Furthermore, with the development of effective use of
71

residual spraying, antilarval measures have been largely abandoned in favor of attacking the adult female in human habitations where it commonly transmits malaria.
"Distribution of Malaria. Despite the fact that significant malaria control, and even eradication, has been accomplished in some areas, malaria still remains the single most common cause of debilitation and death throughout the world. In addition to the early success in eliminating malaria in local situations such as Havana, Cuba, the Panama Canal Zone, the town of Klang in Malaya, from the 'fish pond areas' of Java, and the more recent elimination of 'gambiae-transmitted malaria' from Brazil, the past decade has seen similar successes over the much wider geographical areas. The natural recession from 'bonification' accompanied by intensified control procedures appears to have eliminated endemic malaria from the United States (Symposium on Malaria Eradi-
State Board of Health BUREAU OF VITAL STATISTICS
MORTALITY RECORDS 1921
DEATHS FROM MALARIA
By Counties
72

cation, 1951). Measures of attack have all but eliminated malaria from Chile, British Guiana, Venezuela, Sardinia, and parts of Western Europe.
"Nevertheless, malaria is still one of the most important health hazards in large areas of tropical America, southeastern Europe, and Asia Minor. In much of tropical Africa, southern Asia from India to China, and the Western Pacific Islands as far north as Formosa, malaria continues undiminished by control measures. It has been estimated over 300,000,000 people still suffer malaria and 3,000,000 die annually from the disease and its complications. Thus, between 5 and 10 per cent of the world's population appear to suffer from malaria. It is still the most prevalent disease in most of the tropical areas of the world and in the temperate zone of Asia and parts of Europe."
The annual report of the State Bo~rd of Health for 1921 shows that malaria caused the death of 468 persons in Georgia. The report concludes: "Practically no county in the State is immune but the death rate is much higher in counties lying below a line drawn across the State from the northern border of Richmond to Muscogee Counties. Below this line 87 per cent of the entire malaria mortality was found."
HOOKWORM DISEASE
Dr. Claud A. Smith, who at the time was pathologist to Grady Hospital and acted as demonstrator of pathology and bacteriology at the Southern Dental College, reported a case of hookworm disease to the American Medical Association meeting at Saratoga, N. Y., in 1902. In a reprint of a paper read by Dr. Smith at Selma, Alabama, November 1903, he says:
"It was my fortune to encounter the first case (hookworm) in Georgia of which there is any authentic record. This was in December 1901, and upon inquiry into the history of that case, I found that the patient had not been out of the south, and from this investigation I was forced to the conclusion that the disease must be endemic in this country, and through the cooperation and kindness of Dr. S. H. Green, of Bolton, Georgia, I made an examination of the stools of twenty convicts who worked in the clay pits in the brick yards at Bolton, and among these I found two infected with the disease. These investigations were made in January and 'February of 1902, immediately after discovery of the first case. These three cases were reported by me at the meeting of the American Medical Association, in 1902."
To Doctor Smith goes the honor also of being the first to demonstrate
73

the actual mode of infection in human beings. At a joint meeting of the section on practice of medicine and the section on pathology and physiology at the meeting of the American Medical Association, in 1905, Dr. Smith described his findings on the mode of infection in hookworm disease.
An experiment was conducted in which Doctor Smith applied soil containing the hookworm larvae on the wrist of a patient for an hour, removed it, and the wrist was found reddened. Intense "itching" and some swelling followed. An examination of the feces was made which showed a few eggs of the parasite and after this subsequent examinations showed an increasing number.
The American Medical Association gave Doctor Smith recognition for his work at the time of the publication of his papers concerning hookworm disease.
The Rockefeller Sanitary Commission was organized in 1909 "for the eradication of hookworm disease. To do this involved undertaking three definite tasks: To determine the geographic distribution of the infection and to make a reliable estimate of the degree of infection for each infected area; to cure the present sufferers; and, finally, to remove the source of infection by putting a stop to soil pollution," according to the First Annual Report of the Commission.
Hookworm control work began in Georgia in April 1910, with Dr.
A. J. Fort directing the activities. The work was performed under the
auspices of the State Board of Health. Doctor Fort assembled a staff of inspectors including Drs. C. E. Pattillo, C. H. Dobbs, P. H. Fitzgerald, S. H. Jacobs, W. C. Thompson, and T. F. Abercrombie.
The first efforts of the Georgia hookworm force were in making sanitary surveys of school buildings and grounds, as well as private homes, to determine the status of disposal of human excreta; examine school children in order to find those infected. Reports of those found infected with hookworm disease were sent to the childrens' parents with a note urging them to have the infection treated by the family doctor. The State Board of Health had ruled that the sanitary inspectors could not institute treatment.
One of the inspectors, Dr. T. F. Abercrombie, who was working in Tift County, became discouraged over the fact that few of the children found infected with hookworm disease were actually being carried to a physician for treatment.
Governor Hoke Smith attended a county fair m Tifton and m con-
74

versation with Doctor Abercrombie learned of the difficulties in secur-

ing treatment for the large number of children being found with .hook-

worm disease. He became interested in the problem and promised his

support. As a consequence of his intervention, the State Board of Health

reversed its ruling and a treatment dispensary was opened in Tift

County. The sum of $150.00 was obtained from the county for drugs

and other expense. The first year, 587 children were adequately treated

for hookworm disease in the Tift County dispensary. Other treatment

centers were established, and this phase of the Commission's objective

was well under way.



The five-year report of the Rockefeller Sanitary Commission shows that 76,776 Georgia children and adults received hookworm treatment. Thousands of children who were otherwise doomed to stunted physical growth were restored to normal development.

At the time of the hookworm work in Tift County, one of the town's leading lawyers, Col. R. C. Ellis, became very much interested in the school examination and treatment program. Several years later, in 1914, while a member of the Georgia General Assembly, Colonel Ellis was instrumental in having prepared and enacted the present state health law which bears his name.

The far-reaching effect of the hookworm control work in Georgia was to establish the groundwork for an active statewide public health program. It served to awaken the people of the State to the need for more health work.

PELLAGRA
Dr. H. F. Harris, the first executive officer of the State Board of Health established in 1903, reported the first authenticated case of pellagra in the United States in April 1902.
Pellagra was known in Europe as early as 1730. It was existing in Spain and Italy at about that time. It was first called "rose disea5e" because of the color of the skin of pellagrins. Later it was termed pellagra, meaning "rough skin."
Doctor Harris, in his book published in 1919, had this to say about pellagra in the United States:
"As regards the history of pellagra in the United States it may be said that here,. as elsewhere, our knowledge respecting the period of its appearance is more or less vague, but that it has occurred for some time

75

to a greater or less extent in the southern part of the United States 1s highly probable.
"So far as the records go it seems likely that the first case of undoubted pellagra originating in the United States was reported by the author in April 1902. It is true that in 1864 Gray, of New York, and Tyler, of Massachusetts, reported cases, but from the clinical records they would appear to conform much more closely to those uncertain types of symptom-complex which the author has together called 'parapellagra' rather than to those forms of the malady so commonly found in Italy and our Southern States, and that in 1883 and in September, 1902, Sherwell, of New York, published the records of cases originating in Italy, but these could have no interest of an historical or epidemiological character, since they were in no way associated with the endemic pellagra of the southern portions of the United States."
Dr. G. A. Wheeler, Surgeon, United States Public Health Service, m a bulletin of the Public Health Service issued September 18, 1931, writing A Note on the History of Pellagra in the United States, says: "Considerable information of historic interest has been accumulated from various sources. As early as 1864, Gray of New York and Tyler of Massachusetts each reported a case of pellagra. Sherwell of New York reported cases in 1882 and 1902. Harris, of Georgia, reported a case complicating hookworm disease in 1902.
"In 1912, Babcock, a pioneer student of pellagra in this country, from a study of the clinical records of the South Carolina State Hospital for the Insane, and from personal interviews and correspondence with practitioners, asylum authorities, and others concerned, reached the conclusion that the disease had been continuously present in South Carolina at least since 1828."
Doctor Wheeler gave substantially the same information as Doctor Harris but Harris considered the Gray and Tyler cases as "parapellagra." If this be true then, it leaves Doctor Harris as the reporting the first case of pellagra in the United States.
Doctor Harris was a \igorous advocate of the "poisoned corn theory" as the cause of pellagra but practically every scientist in the country disagreed with him about this. Many claimed pellagra to be a communicable disease. Dr. Joseph Goldberger, in his bulletin The Transmissibility of Pellagra, U. S. Public Health Service Reprint No. 376, Nov. 17, 1916, says: "There is a widely held belief in the United States that pellagra is a communicable disrase."
76

Pellagra Studied in Milledgeville
Later, Doctor Goldberger worked at the cotton mills in South Carolina and at the Milledgeville State Hospital and proved beyond any doubt that pellagra was not a communicable disease but was a diet deficiency ailment.
Studies of pellagra at Milledgeville State Hospital began in 1910. It was found that 21 per cent of the deaths at the hospital from 1910 to 1913 were caused by pellagra. Hospital records for June 10, .1915, showed that 8.9 per cent of the total 3,796 patients were pellagrins.
Of the insane pellagrins studied at the Milledgeville hospital, 72 were kept on an appropriate diet and not a single case showed evidence of recurrence of pellagra. Of a control group of 32 pellagrins not receiving the modified diet, 47 per cent had recurrences during the period. These results clearly indicated that pellagra could be prevented by an appropriate diet.
The exact element in a deficient diet that caused pellagra was not worked out until nearly 25 years later. It was then found by scientific workers that corn, because it lacked a substance known as "tryptophane" was an antagonist of the pellagragenic factor in corn. To make this clear, it appears desirable to quote some of the evidence:
"Corn and the Etilogy of Pellagra-Nutrition Reviews, November 1946--0lder evidence that corn may contain some positive agent in producing pellagra was supported by the newer experiments of W. A. Krehl, L. J. Teply, and C. A. Elvehjam in 1945 in which growth inhibition was produced by feeding corn to rats, a species which does not suffer from pellagra on a niacin free diet. Of particular significance was the fact that tryptophane (as well as niacin) could reverse this effect of corn. It was postulated that corn in the diet provided an unfavorable medium for intestinal organisms to synthesize niacin, and that tryptophane promoted the growth of these organisms. The role of tryptophane, at least in the indirect manner, was thus emphasized. Corn protein is low in tryptophane.
Harris Theory Vindicated
"The long postulated 'toxic' theory of pellagra therefore gains some basis in fact, and appears to be an instance of anti-metabolite action. Although tryptophane might act directly as an antagonist of the pellagragenic factor of corn, it appears more likely that its favorable action is as a precusor of nicotinamide. The high incidence of pellagra
77

among 'corn eaters' appears to be therefore to the relatively low content of niacin in corn, a lack of the precusor tryptophane in corn protein, and to the special occurrence of a niacin anti-metabolite in this grain."
While doctor Harris did not know the causative agent in corn that was producing pellagra, his early theory of corn as a factor in the disease has been vindicated by recent findings.
A few cases of pellagra were recognized and reported by physicians after 1916 but by 1920 it had become a serious cause of illness and death in Georgia. There were 432 deaths reported from pellagra in 1920 and it continued to increase in prevalence, for a number of years.
TRACHOMA
A survey was made by the U. S. Public Health Service, in 1913, of 25 counties in North Georgia and 31 counties in Tennessee to determine the prevalence of trachoma. Only seven cases of trachoma were found in the Georgia counties and these were in three counties. In the 31 adjoining counties in Tennessee, there were 341 cases discovered which showed that the foci of infection was in that state.
In a bulletin published by th.e U. S. Public Health Service, September 18, 1914, Dr. Charles A. Baily reports: "The disease was probably introduced into the United States from Europe many years before the passage of the law prohibiting the admission of any alien immigrant afflicted with trachoma and has since been widely disseminated, by means of the common hand towel, hand basin, bed clothes, etc., owing to lack of observance of the principles of hygiene."
In 1921, the State Health Department received reports from an eye specialist in Thomasville that he was having a few cases of trachoma coming to him for treatment from Mitchell County. The U. S. Public Health Service was called on for assistance and the Service detailed an epidemiologist to Georgia to conduct an investigation. His report follows:
Mitchell County Epidemic
"The infection was thought to be most general in the southwestern portion of the county, and the investigation was accordingly commenced there. The actual survey in the schools occupied only one day, September 15, 1921. On this day two schools were examined and a number of homes in that section of the ccunty were visited. One of the schools was very small, and only a few suspicious cases were found. The other school, however, had about 130 pupils and was found to be heavily in-
i8

fected with trachoma. Of the homes visited, one consisted of the parents and six children-the parents were about 40 years of age and the ages of the children ranged from 2 to 18 years, all suffering from positive trachoma. The mother had completely lost the right eye as a result of trachoma, and vision in the left was reduced to the ability to count fingers at a few feet. Practically all of the sequelae were present and the entropion. and trichiasis were very marked. Another family visited consisted of five members-all suffering from positive trachoma, with the exception of the father. The mother, aged 25, had had trachoma for years and was unable to care for her children on account of her eyes. Her three children suffered from well-marked cases of this disease.
"Other cases of trachoma were found in the various neighborhoodsa total of 30 cases being found and examined during the day. These cases left no room for doubt as to diagnosis, since the majority of them already had the sequelae of the disease, including cicatricial contraction of the conjunctiva, pannus, photophobia, etc. A subsequent examination some months later showed many more trachoma cases, some of whom had lost both eyes from trachoma; others had been blinded in one eye, and a considerable number of others had had their vision greatly reduced as a result of this disease. Many of these showed the cicatricial contraction of the conjunctiva, leukoma, and other undoubted sequelae of trachoma.
"Further preliminary investigation was deemed useless, as the first day of the survey showed an extremely serious condition in Mitchell County, and one which demanded immediate and drastic action on the part of local authorities. The county commissioners and persons locally interested were informed of the findings of the survey. A report was made also, both personally and in writing, to the State health officer in Atlanta. He was advised of the seriousness of the situation and urged to see that some action was taken by the county commissioners without delay. There was no health officer in Mitchell County at that time. In undertaking this public health work, it was believed to be most essential that the county have a fulltime health officer to cooperate, and this matter was brought to the attention of the State health officer.
Clinic Established
"The plan outlined for the relief of the situation was a trachoma clinic-the public health service to furnish a medical officer and two nurses experienced in trachoma work and the county commissioners to supply the hospital building and pay al' expenses incident to the
79

"The origin of the trachoma in Mitchell County dates back at least several generations, and apparently is found in the ancestors of the first family visited in the original survey. Mrs. F., aged 70 years, two sons (one of whom is blind), and their families, all have trachoma. Mrs. F.'s sister, Mrs. S., aged 67 years, is totally blind from trachoma. These people are sturdy, honest farm folk, of true American stock, whose ancestors settled this country, and their physical condition is excellent but for this terrible handicap. The history is obtained from Mrs. F. and Mrs. S. that their mother, had chronic sore eyes. She apparently had lived in Mitchell County most of her life, but some of her younger days were spent in Florida. If history is to help in tracing the genuine cases of trachoma, I believe we can go back to this mother but there the chain is lost in the fourth generation.
"The cases treated have practically all been cured, and it is believed that almost all trachoma cases in Mitchell County have been treated. A few cases of the old chronic type of trachoma, which showed a disposition to relapse, were probably not entirely cured. These cases have been turned over to the county health officer for further treatment. The county health officer acted as understudy to the medical officer in charge for some weeks in order that he might learn the proper procedure and treatment in dealing with these cases.
"Trachoma is a chronic contagious disease of the subepithelial tissue of the eye, characterized by inflammation resulting in the hypertrophy of discrete masses of lymphoid tissue causing the formation of yellowish granules which under necrosis, followed by clouding of the cornea and impairment of vision or blindness, and later by cicatrization and deformity of the eyelid. It is probably a specific infection.''
As is indicated in the Public Health Service report, the trachoma clinic in Mitchell County resulted in the employment of a health officer by the county, in addition to the treatment of cases found with the disease.
Southwest Georgia Trachoma
In September, 1930, again a large number of cases of trachoma were found in Southwest Georgia. Again the Public Health Service assisted in conducting a survey of conditions in Mitchell and Decatur Counties and found several hundred cases of the diseases.
To combat this menace, the State Health Department established a trachoma field unit for finding and treating cases of this ailment and secured from the General Assembly a special appropriation for this purpose. As an aid in securing the additional funds, the county health
81

officer brought a number of children to the State Capitol who were suffering from the effects of trachoma and had them circulate through the vicinity so that the members of the Assembly could see the debilitatmg consequences of the menace.
During a two year period of operation, 1931-32, 21,033 people in Southwest Georgia were examined for trachoma and 3,046 positive cases of trachoma were located and treated; 16.32 per cent of these had impairment of vision.
VENEREAL DISEASE
Rosenau, in his Preventive Medicine and Hygiene, says, "As a dan~ ger to the public health, as a peril to the family, as a menace to the vitality, health and physical progress of the race, the venereal diseases are justly regarded as the greatest of modern plagues, and they are a prime cause of physical and mental disability and reduced economic efficiency."
The history of the beginning of the disease is shrouded in mystery. The first records mention it in the late 1400's as being spread over the world and everywhere endemic. Some Europeans claimed it was carried to Europe by the crew of Columbus on his first voyage from Espanold or Haiti.
Francastorius, an Italian physician and poet (1478-1553) in his poems, "Syphilis, or the French Disease," after discussing the reports of its western world origin says, "No it is not in this manner that this disease has developed itself. Incontestable testimony proves that it is not of a strange or foreign origin and that it was not necessary to cross the ocean to arrive in our midst."
He gives an interesting story of the origin of the name Syphilis. During the time when Alcithaus was King a shepherd named Syphilis drove his oxen and sheep to pasture. It was a hot, dry summer. The fields and trees were parched. He called upon his God, the Almighty Sun, for relief. Getting none, he cursed the sun and worshipped his king and made sacrifices to Alcithaus. The sun became angry at this and sent forth the deadly rays of disease towards the earth and a pestilence, unknown before, sprang up on all lands. Syphilis being the first to suffer the disease, took its name from him.
The sexual nature of the infection was not recognized until some time after the European epidemic outburst of 1494-96. Civilization and syphilis have been close companions ever since the late 1400's. After
82

it was found to be a disease spread principally by sexual intercourse, it became something to be ashamed of and was not discussed in polite society. That fact delayed it from being brought under intelligent treatment.
That venereal disease was present in Georgia from the beginning, there is no doubt. The extent of its early prevalence was not revealed.
TUBERCULOSIS
Archeologic discovery of sk~letons bearing the marks of tuberculous lesions indicate that the disease existed in remote antiquity. Described in the earliest medical records, it was called consumption or phthisis because of its most conspicuous feature, wasting.
Laennec, a French physician, born in 1781, contracted tuberculosis and devoted his life to a study of the disease. His knowledge of the disease led to further findings. Robert Koch, a German physician, first isolated the tuberculosis germ, in 1882. The first practical use came when Koch made a substance known as "tuberculin." At first tuberculin was hailed as a panacea, a sure cure for tuberculosis. After thorough trial, though, it was found beneficial in some lesions and harmful in others. As a method of treatment tuberculin was discarded but its use as a diagnostic agent gained in popularity through the years.
In 1840 an English physician, Dr. George Bodington, first advocated rest and fresh air for the treatment of tuberculosis. The first tuberculosis sanatorium, though, was established in t.he Black Forest in the southern part of Germany about twenty years later. Life in the open, rest, and carefully supervised exercise was the treatment given.
The 1900 Census gave the death rate from tuberculosis in the United States as 128.1 per 100,000 population. The first death from disease reported in Colonial Georgia was from "consumption" in 1733. The disease was prevalent during the early days of the colony and was known as breast complaint, lung fever and other names culminating in The Great W~ite Plague.
Georgia was in on the early vanguard against tuberculosis. In the early 1900's effort to control tuberculosis was by treatment of those infected. Private agencies were the first to inaugurate a campaign for treatment facilities. In 1903, the King's Daughters operated a hospital on South Boulevard, in Atlanta, for incurables and provided a ward of about 14 beds for people sick with tuberculosis. So far as it can be ascertained, this was the first hospital provision for tuberculosis patients in Georgia.
83

In 1904, the Medical Association of Georgia appointed a committee to study tuberculosis and recommended a method of control. At the next year's meeting of the Association, the committee's report showed that the profession was aware of the seriousness of the tuberculosis situation and was approaching it in a practical manner. The work of this committee. constituted the first organized effort in the crusade against tuberculosis in Georgia. It instituted a vigorous educational campaign by issuing seven bulletins on the cause, cure, and prevention of tuberculosis and gave them wide distribution.
The Medical Association'~ work led to the General Assembly adopting a resolution authorizing the Governor to "Raise a medical commission to consist of one physician from each congressional district and ten from the State-At-Large, who shall make a thorough investigation touching the proposition hereinafter set forth and numbered and embody the same in a report to be submitted to the next session of the General Assembly of Georgia."
In 1906, the Medical Association's committee on tuberculosis was incorporated into the National Tuberculosis Association and was responsible for a bill being introduced in the General Assembly to establish "The Georgia Sanitarium for Incipient Tuberculosis."
Private tuberculosis hospitals were operated m Georgia during this period. Camp Yonah Sanitarium was opened at Turnersville. There
STATE TUBERCULOSIS SANATORIUM, ALTO, 1911 84

was one at Pinedale, and Peachtree Heights Sanitarium was treating tuberculosis patients in Atlanta. Another hospital called Pine Ridge was also in operation.
Finally, an act of the Legislature authorized the establishment of a sanatorium for the treatment of tuberculosis in 1908. The act carried with it an appropriation of $25,000, and provided that the" sanatorium should be under the management of a Board of Trustees appointed by the Governor.
During the summer of 1909, the site for the sanatorium was selected on the Southern Railroad in Banks County, 72 miles northwest of Atlanta and six miles southeast of Cornelia. The property consisted of 257 acres with an altitude of 1600 feet. At the time, the greater part of this land was in original forests of pine, hickory, and poplar. Construction was soon begun.
In 1910, $30,000 additional was appropriated for completion of buildings. The sanatorium was completed and opened in April 1911 with seven patients. At that time, the buildings consisted of an infirmary building, three ten-bed cottages, a small house for employees, and a barn.
85

Chapter V
STATE HEALTH WORK
1917-1937
Georgia's second state health officer, Dr. T . F. Abercrombie, assumed ofiice in August 1917. The $10,000 State Board of Health deficit in accounts was still pending and the amount appropriated annually for public health was $30,000.
One of the first activities of the new health director was to arrange for taking care of the muchly publicized deficit from funds accumulated to the credit of the Board and to institute measures of economy to compensate for this payment. It was found that diphtheria antitoxin could be purchased from existing pharmaceutical houses at less than it was costing the Board to manufacture. This together with other minor economies served to alleviate the deficit of long standing. Eliminating it as a source of friction improved working relationships between the state health officer and the board members as well as with the Governor and General Assembly, and helped pave the way for expanding the laboratory services of the department to include field work in a rapidly expanding health jJrogram.
Appropriations Increased
In 1918, minimum plans for a basic health program were presented to the General Assembly and the appropriation for public health was promptly doubled. By coordinating forces already in action, vigorous and far-reaching health reforms began to take definite shape.
With the increased funds, the systematic collection of births and deaths was begun and venereal disease control activities initiated. The First World War was imposing new health problems of malaria and venereal disease control for protection of soldiers stationed in Georgia encampments.
In addition to the heavy demands ou health forces as result of war conditions, an epidemic of smallpox and an outbreak of cerebrospinal meningitis occurred in the early part of 1918. During the latter part of the year, the influenza epidemic which swept the Nation took a heavy toll in Georgia. Through Federal and American Red Cross funds, services of doctors and nurses were furnished stricken communities upon
86

requc5t to the state health officer. Twenty-five doctors were temporarily employed for this purpose and were sent at various times to 38 different Georgia towns to aid influenza victims.
Increased Demand for Laboratory Faciliti!s
In 1918, the Wassermann test for syphilis was instituted.
In 1923, the manufacture of one per cent silver nitrate ampules for the prevention of ophthalmia neonatorum (blindness in the newborn) was initiated. About this time, the laboratories began the free distribution of oil of chenopodium for the treatment of hookworm disease.
In addition to routine laboratory examinations for rabies, tuberculosis, diphtheria, typhoid and paratyphoid, dysentery, gonorrhea, syphilis, malaria, intestinal parasites, the examination of specimens for typhus fever was begun in 1926.
Through institution of the Wcil Felix test, the laboratory was able to recognize a comparatively large number of cases of typhus fever, some of which had previously been diagnosed by physicians as typhoid fever. In 1928, this test was begun in a routine manner on all liquid blood specimens, except those submitted for a serological test, with the result that 51 positive cases of typhus fever were determined that year.
Tularemia Appears
The same year, tularemia was recognized in Georgia as being contracted by persons handling infected wild rabbits. , About 20 cases were diagnosed in the laboratory that year and warning was issued regarding the dangers of handling wild rabbits.
The diagnosis of undulant fever was made exclusively by laboratory test, the technique for which was introduced in 1928 and 25 positive reactions were observed. There was evidence that milk of cows infected with contagious abortion was the source of some of this infection. Four strains of the causitive organism isolated from blood cultures from human cases were found to be of the porcine type.
The laboratory quarters were completely rebuilt and re-equipped in 1928, and during the five months of rebuilding the work proceeded without interruption.
There was considerable variation m the amount of. work required for each type of laboratory specimen. Certain speciJhens were subjected to a number of separate tests called procedures. For example, the average specimen to be examined for diphtheria requires two pro-
87

PELLAGRA CASE AND DEATH RATE
GEORGIA 1920- 1950
30r---------------------------------------------------------~30

25

z
0 ~
~ 20
~
A. 0 A.

ccoo

0
~ 15

0

2

.a.:.
A.
... 10
.a~c:

5

25

----~

\

'\ \

20

\\CASES

\ \

15

\

\

\

\

10

\

\

\

\

\

5

o~--------~------~~------~--------_.--------~---------0

!920

1925

1930

1935

1940

1945

1950

Number of Coses Not Avoiloble Prior to 1925

Coses Poorly Reported Prior to 1935

cedures. A specimen of liquid blood required about five procedures in examining the serum fraction and four for examining the clot fraction.
Yeast Distribution Begun
In 1929, the distribution of brewer's yeast for the prevention and treatment of pellagra was begun. A few cases of this disease were reported by physicians after 1916 but by 1920 it had become a serious cause of death in Georgia. In 1920, there were 432 pellagra deaths and the disease increased until by 1928, 846 deaths were reported. The years of 1927-1930 were the peak years. By 1931, the deaths had dropped to 563 and thereafter showed a steady decline. In 1948, only 79 deaths were recorded.
The number of pellagra deaths in the depression era caused great concern among physicians and public health workers particularly. About that time, it was found that brewer's yeast contained an element that would cure as well as prevent pellagra. In 1929, the State Health Department launched an intensive educational program advising people to eat more fresh vegetables, lean meat, and fruits. At the same time, brewer's yeast was bought in large quantities at reduced prices and distributed as a ~emedy to cure and prevent pellagra. The first purchase was made in September 1929. By the end of the year, nine tons had been distributed. It was offered at cost to those that could afford to pay, and free for those that could not.
In 1930, 60,000 lbs. were distributed; in 1931, 100,400 lbs. Thereafter, the amount consumed declined until in 1948 only 15,187 lbs. were distributed by the State Health Department.
Typhoid Tribulations
In 1906, an attempt was made by the State Health Officer to study "slow fever" which was prevalent in the State. Of 30 cases studied, typhoid bacilli were isolated in 19.
The manufacture of typhoid vaccine was begun in the State Health Department laboratories, in 1912, after Army investigations had revealed its efficiency. Over 220,000 persons were vaccinated against typhoid fever from 1912 through 1918. Vaccine was the only preventive measure used until about 1914 when health departments were established in a few Georgia counties and began a campaign for construction of sanitary privies.
A water-born outbreak of typhoid fever occurred at Baxley in 1924,
89

as a result of an accident to the municipal water supply. About 25 or 30 cases were involved but no fatalities occurred. The source of the infection was discovered in a catch basin. Examination of the water showed it to be free of contaminating organisms. The water had been infected after it was pumped from one of the wells and distributed to the water mains. As a precaution to prevent further spread of the disease, 1,000 doses of typhoid vaccine were sent to the area.
The situation at Baxley was the indirect means of improving municipal water supply conditions in the State. The publicity in connection with the outbreak resulted in numerous requests from other municipalities for careful surveys of their supplies and frequent bacteriological examination of water samples.
Sporadic cases of typhoid fever were occurring regularly throughout the State from the time the State Board of Health was organized until the approach of the half century.
In 1928, a milkborn epidemic of typhoid fever occurred at Marietta among employees and their families in a textile mill. Over 20 cases occurred with a high mortality rate. Investigation revealed all were customers of one dairy. The owner was building a new barn and had
a moved his dairy to a vacant pasture and improvised shack for han-
dling the milk and employed a woman living nearby to help with the milking and handling of the milk. Once circumstantial evidence pointed to this dairy, the county health officer went to the improvised plant and attempted to get a specimen of stool from the new woman employee for examination. While explaining the importance of the examination to the woman, one of her sons who had recently been released from the county jail, walked up and became enraged upon hearing the conversation between the health officer and his mother. He pulled out a knife and attempted to attack the health officer. The dairyman standing nearby intervened. Later the specimens requested were obtained but much to the surprise of the health officer all were negative for typhoid bacilli. He was suspicious of the outcome but was unable to make further investigation.
Two years later, the county comm1sswners asked the health officer to go see an old woman who was applying to the county for financial assistance. When he arrived at her cabin in the woods, he was startled to find the woman who was the central figure in the milkborn outbreak of typhoid fever. She was ill. He told her one of the things he suspected was wrong with her was hookworm and requested a stool specimen for confirmation. She complied, and the speciman he brought
90

to the State Health Department laboratory was "reeking with typhoid germs."
The county agreed to furnish the elderly woman a cabin and groceries provided she would stay in that spot. Later she left and several other cases of typhoid fever were traced to her as she traveled over North Georgia.
In 1934, 10 cases of typhoid fever occurred in East Point. All were customers of a community grocery store on the veranda of which was an ice box from which soft drinks were dispensed. When it was found all cases were customers of the grocery store, the employees were tested and one young man was found to be a carrier. One of his functions in the store was to keep the box stocked and when a customer wanted a drink to dip his hands in the box and get it. The aftermath of this was that the young man refused to submit to a cholecystectomy and gave up his job in the grocery store and went to work in a filling station. Years later, he came to the director of the State Health Departmeut laboratory and said the episode was responsible for his success in life. He had worked up to owning the station and bought others in the vicinity and was financially well fixed.
Cholecystectomy was recognized as the only curative measure of any merit in the treatment of typhoid carriers. Oral and parenteral administration of drugs, dyes, and vaccines were uniformly unsuccessful. Deep x-ray therapy was tried and failed . Even cholecystectomy often failed, particularly in cases where the infection involved the common bile duct. The op~ration itself was by no means devoid of danger, in that many gall bladder carriers were poor surgical risks.
Cholecystectomy was too drastic a procedure to play a very important role in public health control of typhoid fever. From the standpoint of the individual carrier, who was faced with a life long stigma as a public health menace, it offered the only avenue of escape so far known to medical science at that time. Five chronic carriers submitted to cholecystectomy in Atlanta.
Prior to 1932, typhoid fever had been known to be prevalent in certain sections of West End, Atlanta, but while some effort was apparently made by the local health department to locate the source, the records were not clear as to what was found or what conclusions were drawn. That milk was suspected is indicated by the statement of one of the city sanitary officers who recalled that the dairies supplying West End were investigated.
91

TYPHOID CASE AND DEATH RATE
GEORGIA 1920 - 1950

75

75

70

\
\

70

\

\

60

\
\

60

\

sz
0
... 50
::::ll

\ \ \

50

L 0

\

L

\

0 40

<.0 r-.:1

0 0
0

~

\......._ CASES
.............. ..............

40

a:

"' ~ 30

30

' ' ...... ' ca:

' 20

20

' ' ' ' ........

' 10

........ ........

10

........

----- oL-----~------~-------L------~======:;==----Jo

1920

1925

1930

1935

1940

1945

1950

Number of Cases Not Available Prior to 1926

In June, 1932, 7 cases of typhoid fever developed in West End. In July six cases occurred and in August, two. There were two deaths. A more systematic investigation was conducted by the City Health Department. This revealed that all 15 victims were consumers of raw milk from a dairy located near Fairburn.
The following year 24 cases and one death occurred. All except one were supplied milk from the Fairburn dairy. Another inspection was made of the dairy and stool specimens obtained from all employees and Sl"nt to the State Health Department laboratory for examination. Specimens froin the dairyman and his wife showed numerous colonies of typhoid bacilli on the culture plates. They left the dairy under the management of their sons.
After the dairyman and his wife left the dairy, they sought every means of cure. His only chance was surgical removal of the gall bladder which he finally consented to have.
Expansion Continued
The State Tuberculosis Sanatorium, at Alto, whic~ had been struggling along with inadequate buildings, equipment, and maintenance under a Board of Trustees, was transferred to the State Board of Health in 1918 for operation by legislative action.
The story of state health work in Georgia has been one of continual growth and widespread expansion with limited perso:mel and financial resources. Without the help of outside agencies in the beginning, such as the Rockefeller 'Foundation and the U . S. Publi~ Health Service, much of the work accomplished in the early days would have been slower in developing.
VENEREAL DISEASE CONTROL BEGUN
The first blood test for syphilis was described by a German bacteriologist, August Von Wassermann, in 1906. Arsphenamine, a mercury compound, had proved effective in treating the disease. German firms, though, held the patent rights for the manufacture of arsphenamine and only a limited supply could be obtained in this country.
A ten-page bulletin on The Venereal Diseases had been published by the State Board of Health, in 1913, with "the hope that a more intimate knowledge of these diseases will cause a decrease in their prevalence." The American Federation of Sex Hygiene, at that time, estimated that $3,000,000 a year was spent for immorality and treating venereal disease.
93

World War I and the examination of young men for the armed forces first brought the prevalence of venereal disease in the United States into the limelight. For the first time, the country had an opportunity to learn the facts about this health problem. In Georgia, 13.3 ' per cent of those examined for the armed forces were found infecte::l with a venereal disease.
Statistics on the prevalence of venereal disease in the general population were meagre, as the disease was not generally reported by physicians. One study, though, by Jeans showed that from 10 to 20 per cent of married women were syphilitic and that 75 per cent of the offspring of a syphilitic family would be infected. At that time, gonorrhea was blamed for 90 per cent of the blindness in the newborn, 60 per cent of the abdominal operations on women, and 70 per cent of the childless marriages.
Early in the war effort, Federal funds were provided for a venereal disease educational and treatment program, in an effort to send uninfected men to the armed forces, and to protect them from infection in the cities surrounding various military cantonments. After a difficult fight by national health authorities, arrangements were made for the manufacture of arsphenamine in this country and the supply was greatly increased.
Serologic Tests Made
Since the State Board of Health had no funds with which to begin a campaign against venereal disease, the U. S. Public Health Service cooperated by providing funds for the establishment of the serologic test for syphilis. The Public Health Service detailed a laboratory technician to Georgia for the purpose of training someone for making the blood tests. The present associate director (1952) of the laboratories was the first person in Georgia trained to perform the serologic test.
The first group of eight blood specimens was tested on May 28, 1918. The first blood specimen tested was taken from a patient at the State Tuberculosis Sanatorium and it was negative. The testing procedure used at that time was a modification of the Wassermann test as used in the National Hygienic Laboratory at Washington.
All of the facilities used in the first blood testing were improvised. The water bath necessary in this procedure was set up in an old copper pan in the laboratory incubator room. The guinea pigs, rabbits, and sheep used in the testing were first housed in a building back of the capitol. To prepare the sheep cells required for the tests, it was neces-
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sary to take them all the way across the Capitol basement (then undeveloped) to a corner room on the other side of the building to borrow the use of the centrifuge in the chemical laboratory of the Department of Agriculture.
Demands for the new blood testing service grew slowly at first. From May 28 through the rest of the year 1918, 798 specimens of blood were examined for syphilis. The following year, the war having ended, the Public Health Service withdrew financial support of this particular function and it was taken over as one of the regular testing services of the state laboratory.
VD Education Activities
A venereal disease educational program was launched in Georgia the first week of June, 1918. The beginning efforts were initiated on a district basis, using the congressional districts as a pattern. One city in each district was selected for the establishment of a free clinic for venereal disease treatment of young men to be drafted for service in the armed forces. The support of local people and organizations was enlisted and local physicians agreed to undertake the clinic work.
At the 1918 meeting of the General Assembly, venereal disease laws recommended by the U.S. Pu.blic Health Service were enacted, in order to make reportable cases of venereal disease and to make punishable the deliberate spread of the infections.
After the men drafted for military service were classified as the first to be called, they were ordered to report to the county seat for venereal disease instruction. Physicians from Georgia military camps were assigned to help deliver these lectures.
First Film Shown
For the first time, in 1918 moving pictures on venereal disease subjects were shown in Georgia. A film, "Fit to Fight," was shown to the draftees principally, although a special showing was arranged for women in Atlanta.
The records show that in this first large scale venereal disease program, the people of Georgia cooperated wholeheartedly. County officials arranged for the expenditure of local funds for the treatment clinics, and civic and church groups supported the new movement.
After the war ended, federal funds for venereal disease control were available on a matching basis only. The state appropriation was not
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sufficient to take advantage of ali the federal money available to Georgia. Consequently, some of the early activities had to be curtailed.
Physicians were still furnished free arsphenamines and keidel tubes for diagnosis and treatment of infected persons unable to pay for the drugs. Seven general clinics were established in Atlanta, Augusta, Brunswick, Columbus, Macon, Rome, and Savannah. Educational efforts were continued. A special "Keeping Fit" campaign was conducted for boys in the 14 to 20 age group.
Strenuous efforts were made to enlarge venereal disease control activities. The 1919 annual report of the State Health Department estimates that "One person in every 69 in Georgia was infected with a venereal disease during the year." The early efforts were directed toward "building up public sentiment and educating Georgians to the point where they would become so aroused to the menace of venereal disease they would end conditions conducive to infection."
Several "red-light districts" were open and operating in defiance of a Lewd House Law enacted in 1917. Three detention homes were established for isolation and treatment of delinquent women infected with venereal disease.
In 1920, a bill was introduced in the General Assembly requmng freedom from venereal disease in the male before a marriage license could be issued. Two days of heated debate culminated in a tie vote of 21 for and 21 against the premarital examination requisite. Another bill prohibiting advertisement by "quack doctors" was also introduced but did not gain immediate consideration.
Progress Reported
In 1921, an institute clinic for venereal disease instruction was conducted in cooperation with Emory University where intensive education was provided at no expense to the 145 physicians attending from 71 counties. This clinic was conducted annually for many years thereafter.
From 1918 through 1923, 68,767 ampules of arsphenamine, commonly called "606" were distributed to physicians in Georgia. One of the largest red light districts in the State was forced to cease operations, in 1923, by an enlightened public opinion.
By 1924, Federal funds for venereal disease control had dwindled to $685.00 and only $10,000 in State funds was available for laboratory and office expense. Educational features of the work were continued, though, and arrangements made for the purchase of drugs for treatment
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at reduced rates for those unable to pay. Seven venereal disease clinics continued operation.
Studies showed that in 1918, 15.8 per cent of the new admissions to Milledgeville State Hospital had positive Wassermanns. By 1929, the percentage had declined to 9.7, a reduction of 40 per cent. This study indicated substantial progress in the limited control program.
In 1930, the incoming Surgeon General of the U. S. Public Health Service initiated the modern venereal disease control program. About seven years later this program was stimulated to new achievement by publication of an article in a leading digest magazine of the country, entitled "Why Don't We Stamp Out Syphilis?" A torrent of public interest was aroused by this and subsequent publications of the book, "Shadow On The Land," by Dr. Thomas Parran. From these, the people as a whole heard about syphilis and gonorrhea publicly for the first time.
LOCAL HEALTH WORK ESTABLISHED
The most far-reaching provision of the Ellis Health Law, adopted in 1914, was its establishment of a board of health in each county consisting of the county school superintendent, chairman of county commissioners, and one physician appointed by the grand jury. Upon two successive grand jury recommendations, it became obligatory on the county board of health to organize a county health department and on the county commissioners to provide the necessary funds. The county health department staff usually consisted of a commissioner of health, nursing and sanitary assistants, and such other personnel as may have been assigned to the department.
The Ellis Health Law also provided that upon the request of the boards of health of two or more counties, the State Board of Health could combine these countie& to form a health district, thereby reducing the cost of health work to each county.
A Glynn County grand jury made the first recommendation for adoption of the Ellis Health Law in December, 1914, and its second recommendation in May, 1915. Previous to this time, the county and city had had a joint health department. Glynn County was the first county to adopt the Ellis Health Law and to have a combined citycounty health department created by law.
Floyd County was a close runner-up to Glynn in adopting the provisions of the Ellis Health Law. A health department was established there after two successive recommendations in July, 1915, and a com-
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missioner of health was elected m September who assumed full time duties the following year.
In 1915, public health was a r.ew term in Georgia. The physicians of the State did not recognize the work for its full possibilities and many felt that the movement posed a threat to their fields of private practice. County commissioners could not visualize the benefits the law provided for the people and were slow to make appropriations for health work. The grand juries were reluctant to recommend health work under the circumstances.
During the first three years of the Ellis Health Law's operation, only three counties took advantage of its provisions-Glynn, Floyd, and Tift. In 1916, four Georgia counties had organized health departments and their combined budgets totaled $12,960. All of these funds were from county sources. The next year, the International Health Board (of The Rockefeller Foundation) granted $500 for matching county health work funds. This was the first grant-in-aid for local health organizations. The following year, the International Health Board allocation was $7,650.
Division Established
A division of rural sanitation (now local health work) was established by the State Health Department with the employment of a director on September 15, 1918.
That same year, the International Health Board financed fifty per cent of the cost of "an intensive health campaign in three counties." This project was to demonstrate what could be accomplished in the prevention of soil pollution diseases. Tift, Hart, and Troup Counties were selected for the health demonstration. In addition to the examination of school children for evidence of hookworm disease, the early rural sanitation program also included assistance in installation of sanitary privies, septic tanks, and other sanitary features. Typhoid and smallpox immunizations were administered.
Floyd County's early public health work included the first children's clinic where facilities were arranged for the treatment of a~y child without charge whose parents were financially unable to provide medical service.
In 1919, the Federal government, through the United States Public Health Service, made their first matching contribution to local health organizations with the allotment of $5,000. By this time, the organized counties had climbed to 13.
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In the first full year of the local health division's activity, six counties maintaining health organizations under the Ellis Health Law were increased to 14 and 10 additional counties had made the second grand jury recommendation. By 1921, the county health budgets totaled $130,714, and 19 counties operated health departments.
The local health division supervised the work carried on in the counties and promoted the extension of full-time health services to other counties. Efforts were begun to secure a State subsidy.
In the two year period 1922-1924 typhoid fever decreased 18 per cent in the counties operating health departments, in comparison with a decrease of only three per cent in the other counties.
In 1924, the first health district was formed with Decatur-SeminoleMiller Counties organized into a health unit. They employed a health officer, three sanitary inspectors, and a clerk. Malaria was the major health problem attacked in these counties at that time.
A study of the tax valuation of Georgia counties was made in 1925 which showed that approximately 130 counties had revenues insufficient to finance an adequate health organization without State and/or Federal aid. Recommendations were made that counties combine their resources for conducting health work.
In the first 30 years of the State Board of Health's history $4,012,759 was expended for local health work by the counties, State, U. S. Public Health Service, International Health Board and other health agencies. Of this amount, the counties furnished the bulk.
For the ten-year period, 1926-1935, the typhoid death rate was 50 per cent higher, the malaria death rate 30 per cent higher, and the diphtheria rate 20 per cent higher in non-health-officer counties than in health-officer counties. The tuberculosis death rate decreased 23 per cent in non-health officer counties and 37 per cent in health-officer counties in the same period.
By 1930, 32 counties were operating health departments and 42 per cent of the State's population was being served by local health organizations. Financial conditions prevented expansion of county health work but combinations of counties in health districts were gradually being formed.
From 1919-1930 inclusive $88,898.67 was expended for county health units, exclusive of central administration costs, in Georgia by the International Health Board. Cooperation with Georgia had been con-
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tinuous since 1919, and although there were periods when very little aid was furnished for local projects, the aid for central supervision, in order to insure its competency, continued.
In 1930, trachoma was again found in Southwest Georgia. The United States Public Health Service assisted in surveying the area and over 3,000 cases of trachoma were found and treated, qnder a special State appropriation secured for this purpose.
The average annual deaths for the period 1927-1931 in counties operating full time health departments was less than those without organized public health work. The average annual death rate from typhoid fever in organized counties was 14 per 100,000 population. In unorganized counties the rate was 20 per 100,000.
A study of the average age at death during 1931 showed that in organized counties the average age was 43~ years in comparison with 41 years in unorganized counties.
Commonwealth Fund Child Health Demonstration
During the five years 1924-1928, by subsidy and technical service, the Commonwealth Fund aided in the expansion and strengthening of public health work in Clarke County and Athens. This aid took the form of a child health demonstration.
Forty southern communities applied for such a demonstration when it was offered by the Fund, and the award to Athens was made in the face of active competition from at least thirty of them. Planned as a city project, the work in Athens was at once extended to the surrounding county in so far as the larger area was already served by the health officer, who was primarily a county official.
Clarke County's population was 24,000 with 16,000 in Athens. More than half of the residents of the county were white millhands and Negroes. A full-time health officer, beginning work in 1920, had begun a progressive public health program before the demonstration was opened.
During the demonstration an enlarged public health staff offered the public new services, stressing preventive medicine and health education, and designed to strengthen both the health department and the private practice of medicine and dentistry. These services were introduced with the official approval of local authorities and after informal counsel with community leaders.
Between 1924 and 1928. an ~dequate nursing service, better com-
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municable disease control, tuberrulosis service, and out-patient service at the hospital contributed materially to the public health resources of the county. Comparative statistics of children's deaths showed an apparent saving of 124 lives during the demonstration years.
Twelve thousand medical examinations, 10,000 dental examinations, and 17,000 nursing visits were made to guard the health of school children. They led to 2,000 dental treatments, 3,000 oral hygiene treatments, and 600 corrections of other physical handicaps. In 1,000 families the parents reported children's health bettered as the result of systematic health teaching in the schools.
Health centers offered mothers an opportunity to learn from a cioctor how to keep their children well and to discover special needs for treatment. Nurses taught good child care in the homes. A quarter of the children under six years of age had such service. Between one month and one year of age, the death rate for white babies under care was only one-sixth of the rate for those not under care; for colored babies under care, one-third the rate for those not under care.
The formal appraisal of public health performance in Clarke County for each year from 1923 to 1928 showed that the general rating of county health work, according to the Rural Appraisal Form of the American Public Health Association, increased by 168 per cent-from 331 points to 889 out of a possible 1,000.
ADDITIONAL STATE TUBERCULOSIS SANATORIUM FACILITIES PROVIDED
In 1918, the General Assembly passed a law abolishing the Board of Trustees of the State Tuberculosis Sanatorium and naming the State Board of Health as the agency for management of the Tuberculosis Sanatorium. This move was sponsored by the Raoul Foundation which had been instrumental in establishing the Sanatorium in the beginning.
On September 1, 1918, the institution, located at Alto, was transferred to the State Board of Health. At that time, there were 39 patients in the hospital although there were more than 100 beds available.
The hospital buildings had been allowed to deteriorate since they were constructed in 1910, and no funds were available for building maintenance. The first efforts of the State Board of Health were concerned with renovations to the buildings. The services of an experienced hospital superintendent who had had training in hospital administration were secured. In 1919 there were 82 patients in the sanatorium.

In 1923, the General Assembly passed an Act placing a 10 per cent tax on cigars and cigarettes and making the first $500,000 available for the construction of a new tuberculosis sanatorium. The Act was contested in the courts by the tobacco interests but the Supreme Court rendered the decision on July 3, 1924, upholding the law's constitutionality. Contract was awarded for a building of 150 bed capacity in 1925 and on March 10, 1927, a four-story building of fire-proof construction was completed and opened for medical service.
The original sanatorium building was made available for colored patients and received the first patient on March 12, 1928. This was the first time that institutional facilities for the treatment of tuberculosis in the colored race had been made available in Georgia. In all, 250 beds were available for both white and colored patients.
A children's cottage was constructed on the sanatorium property by Masonic contributions including the donations from the Order of Eastern Star and the Grand Chapter of Royal Arch Masons. The building was completed and turned over to the State with impressive ceremony on April 3, 1930, and was accepted by the Governor on the part of the State. The building had a capacity for 85 children and was considered ideally suited for the treatment of childhood tuberculosis at the time of its construction.
It soon became evident to the hospital management and the State Board of Education that school facilities were badly needed for the children under treatment in the institution for tuberculosis. With funds contributed by the school children of Georgia augmented by a considerable donation by Dr. and Mrs. John A. Rhodes, of Crawfordville, a small school building was erected and dedicated on April 24, 1931.
In 1933, when the governmental re-organization act went into effect, the Tuberculosis Sanatorium was turned over to a State Board of Control along with other eleemosynary institutions. This board operated the institution until 1937 when the State Welfare Department was organized and the supervision of the State Tuberculosis Hospital was again transferred to the State Board of Health.
The purpose of the tuberculosis hospital has always been to treat patients ill with tuberculosis. In the beginning, it was realized that Georgia was not sufficiently endowed with JllOney enough to build an institution large enough to take care of all the people in the State with tuberculosis. At the time the first hospital was erected, there were around 5,000 deaths each year from tuberculosis. Knowing there
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was somewhere in the neighborhood of five to ten cases of active tuberculosis for each death, it is obvious there must have been at least 25,000 active cases of pulmonary tuberculosis in Georgia when the sanatorium was first established.
As a consequence, one of the primary aims of the institution was that of education of the patient and the general public concerning tuberculosis. The patient was taught how to live with his tuberculosis, how to cure it, and how to prevent infection among his close associates. As soon as it was felt that a patient was indoctrinated, he was allowed to go home to continue the "cure" and another patient was permitted to take his place. In the early days of the hospital, the length of stay averaged three months. This meant that the patient who had complications and who necessarily had to stay longer brought the average up considerably. It is estimated the majority of the patients, in the beginning days, stayed only 30 to 60 days.
Every patient who came to the sanatorium and received benefit from the treatment was a zealous advocate of more hospital treatment for the tuberculotic. As the patient was sent back into his own community, he became a crusader. Correspondence in the early days indicates that this was the philosophy of the superintendents at that time, as well as the patients.
The early treatment consisted of bed rest with the addition of cod liver oil and other dietary supplements that were thought to be of value. Some other treatments of short lived duration are indicated in the early records, such as treatment with tuberculin and other toxic substances.
Nursing service was scarce throughout the early period, as the records show only three or four nurses for as many as 80 or 90 patients. Presentday standards for treatment require at least 15 or 20 nurses for this number of patients.
In 1931, with increased popularity of collapse measure, the institution began to treat patients with pneumothorax. After such treatment they were sent home to be followed up by the health department and private physicians. Numerous efforts were made to secure physicians interested in coming to the sanatorium and learning the management of collapse therapy in tuberculosis.
About 1938, thoracoplasty became more popular as a method of treatment, and at the time a large number of patients were being given permanent collapse by means of thoracoplasty and sent home as rapidly as possible.
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COLLECTION OF VITAL STATISTICS INITIATED
A comprehensive vital statistics law was enacted in 1914, along with the statewide health law, but it was not put into effect until 1919 because of previous lack of funds with which to establish a State Bureau of Vital Statistics called for in the law. Organization of this bureau was accomplished on January 1, though, with the employment of a director and four clerical assistants.
The law provided that the State Board of Health have charge of registration of births and deaths throughout the State. There was to be the central bureau of vital statistics under a State Registrar. The state was divided into primary registration districts in which city clerks, county clerks, justices of the peace, and notary publics were to act as local registrars. The local registrars received 25 cents for each birth and death certificate registered, to be paid from county funds.
The first undertaking was the appointment and instruction of 2,674 local registrars for the collection of birth and death records. During the first year, though, the number of registration districts was reduced to 1500 for more efficient reporting. The registration fee was also raised from 25 to 50 cents. Over 50,000 birth and death certificates were filed the first year of the bureau's opet ation. Increase in the number of records filed the first year is indicated by figures showing 15 per cent of the births and 21 per cent of the deaths filed in January, as compared with 66 per cent of the births and 69 per cent of the deaths in November.
In 1922, Georgia was admitted to the U.S. Registration Area for deaths, indicating the Department was getting 90 per cent of the records filed. As the law specified no corpse could be buried without a permit, it was easier to secure more adequate registration of deaths. The State was not admitted to the U. S. Registration Area for both births and deaths until 1928.
The vital statistics law required the county to pay a fee of 25 cents to the local registrar who was the justice of the peace named in the law. Many counties objected to the payment of this fee and that added to the difficulty of getting complete records.
Finally, the Houston County authorities refused to pay the prescribed fees claiming that the law in that respect was unconstitutional. The State Board of Health, in 1924, filed a test suit in the Superior Court of Houston County to compel the county to pay the fees due local registrars. The judge ruled that the State law was constitutional.
Houston County appealed the case to the Supreme Court, and in
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1925, the Supreme Court reversed the opinion of the county superior court declaring the payment of the fees was unconstitutional.
This decision resulted in a disorganization of the vital statistics system. Registration declined about 30 per cent and the State was dropped from the U. S. Registration Area as a consequence. This was a serious blow to the efforts of public health workers in the State.
An intensive educational and publicity campaign was conducted throughout the State emphasizing the importance of birth and death registration. A constitutional amendment was submitted to the Legislature, in 1926, to legalize county payment of fees to Local Registrars, and was passed.
The constitutional amendment was submitted to the voters in the General Election of November 1926 and was approved by the people by an 87 per cent majority, said to represent the largest majority any constitutional amendment had received up to that date. The entire law was resubmitted to the General Assembly in 1927 for additions and corrections and was signed by Governor Hardman on August 22, 1927. It was such a long and difficult struggle to reestablish the vital statistics law and public health officials concerned were so jubilant that the pen used by the Governor was preserved in the State Board of Health vault.
An active campaign was waged to secure complete birth and death registration and it culminated in the State being admitted to the U. S. Registration Area for both births and deaths, in 1928.
The first statistical study of birth and death records in Georgia was made in 1920. It was found that there was a death in Georgia every 15 seconds that year. For the first time, it was also found that 33.5 per cent of all deaths occurred before the tenth year of life:
Under 1 year of age............... ..................... ........... 61.0 per cent 1 to 3 years of age.............. .. ...................... 15.4 per cent 2 to 5 years of age.... ........ .......... ....... .. .... ... 13.3 per cent 5 to 9 years of age.......................... ............ 10.2 per cent
That year, the leading cause of death was influenza. Tuberculosis was second and pneumonia third.
The first study of illegitimacy, in 1921, showed that 1.1 per cent of the white births and 10.5 per cent of the colored were illegitimate.
A statistical study of 797 deaths from typhoid fever, in 1921, revealed only 12 counties in Georgia free of the infection. That same year,
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malaria accounted for 468 deaths and was reported "much higher in counties lying below a line drawn across the State from the northern border of Richmond to Muscogee County. Below this line 87 per cent of Georgia's malaria was found."
In 1922, the three leading causes of death were, in the order named, Bright's disease, diseases of infancy, and tuberculosis.
The percentage of preventable deaths during the first quarter of the century was estimated at from 40 to 70 per cent, although there was no fixed list of preventable causes of death. Among the list of ten leading causes of death in the 1920's only tuberculosis and diarrhea were considered preventable. The chief preventive measures were directed towards typhoid, malaria, diphtheria, whooping cough, and scarlet fever. Pellagra was prevalent but its exact nature was not understood. There were between 400 and 500 deaths yearly from this disease. .
EARLY MATERNAL AND CHILD HEALTH EFFORTS
A campaign to organize a Federal Children's Bureau was begun m 1905 and culminated in its establishment by Congress in 1912.
One of the first efforts to improve child health in Georgia was the passage of a law, in 1918, making it mandatory to use prophylactic measures to prevent blindness in the newborn from gonococcus infection. Ampules of silver nitrate were furnished for this purpose by the department.
The Maternal and Child Health Division of the State Health Department was established in 1920, with assignment of a temporary director from the staff of the U. S. Public Health Service. The primary objectives of this division have been prenatal and postpartem care of mothers and children.
A Federal bill to match State funds for maternal and infant care was passed by Congress in 1921, known as the Sheppard-Towner Law. This law was sponsored by the Children's Bureau and it was under its appropriation that Georgia secured its first public health nurse in 1922. She was assigned to work on the "Healthmobile."
Phi Mu Healthmobile
Phi Mu, a national fraternity, had its origin at Wesleyan College. For this reason the Fraternity chose Georgia for initiating and participating in a type of health service which would be helpful to a great many people. When the Georgia Health Department was approached
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with the plans, in 1921, it was suggested that a traveling clinic be operated for the benefit of expectant mothers, mothers, and young children.
In 1922, the Phi Mu fraternit}' gave to Georgia a doctor's office on wheels. This truck-equipped traveling clinic was known as "The Healthmobile." On June 1st, it started on its first trip in charge of a woman physician and a nurse, and visited 35 counties that first year.
The Healthmobile went from town to town, contacting mothers and babies living in rural communities. Physical examinations were made of the children, and individual conferences were held with parents in regard to their children's health. Health movies, showing the prevention of diphtheria, hookworm, malaria, and smallpox and on the care of the teeth and good posture were also a part of the program.
To numerous Georgians, the Healthmobile was the first concrete evidence of State health service. As a result of this program, the first movies numerous rural Georgians saw were on health subjects shown on the Healthmobile.
The prenatal work on the Healthmobile consisted of a history of each expectant mother, examination of throat, teeth, and blood pressure, and a discussion of diet, exercise, clothing, and preparations for the baby.
At the close of 1925, the Healthmobile truck was worn out. Four others were provided for the work in succeeding years. In addition to the gift of the first Healthmobile, the Phi Mu Fraternity made annual contributions for the purchase, maintenance, and services of each succeeding Healthmobile. Contributions were discontinued in July 1944, when war conditions limited the program.
In 1923, the Maternal and Child Health Division engaged the first Negro nurse for State service and assigned her to work among midwives practicing in Atlanta. A donation of $1200 was received from the Methodist Woman's Missionary Society of the North Georgia Conference for this purpose.
Midwife Supervision and Instruction
In 1925, the Medical Association of Georgia adopted a resolution asking the State Board of Health to supervise the practice of midwifery in Georgia. The resolution, in part, specified: "Realizing that the midwife problem is a most serious one, and wishing to be of service to all our people, we recommend that the State Board of Health be requested to give such instruction and adopt such regulations as they think best."
The number of midwives practicing in Georgia at that time was
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estimated to be somewhere about 5,000, as over 4,000 were registered and it was realized that many others were not. They attended about one-third of the births occurring in the State.
Eighteen nurses, employed under Sheppard-Towner funds and assigned as a part of this work, were responsible for midwife supervision and instruction. The nurses promoted cleanliness, application of silver nitrate in the babies' eyes to prevent blindness, and proper registration of all such births. The ages of the midwives ranged from about 40 to 70.
In 1930 midwives delivered 40.7 per cent of the births that occurred. Since that time, the percentage has declined steadily. In 1949 only 21.6 per cent were delivered by midwives. Over half, though, of the colored births still had midwife attendance in 1950. In 1930, 73.2 per cent of the colored births had midwife attendance.
First Clinics
The first health clinics in Georgia were for children. Each city and county health department set aside a particular time for medical examination of children. The year the Maternal and Child Health Division was organized (1920) there were 16 uch clinics in operation.
One of the urgent needs for MCH clinic service was indicated by the terrific summer child mortality in Georgia. In July of 1920, 59.3 per cent of all the deaths that occurred were of children under 10 years of age.
Children examined in Georgia in 1921 averaged .8 defect per child. Only about 15 per cent of the defects found were reported as corrected. The principal defects found were in nutrition, vision, hearing, and teeth.
State sponsored dental clinics were held for the first time in 1923. The U. S. Public Health Service detailed a "mouth hygiene unit," a traveling dental clinic, to Georgia for temporary demonstration purposes. This unit visited 21 schools and examined 1,939 children's mouths. Defects were found in 1,352.
Georgia lost a large part of the Federal appropriation under the Sheppard-Towner Law because of inability to match the fund dollar for dollar. In 1924, over $19,000 was still unavailable in Washington because it remained unmatched. Only $5,000 was made available for matching purposes.
Activities Varied
Little Mother's Leagues were organized by the public health nurses,
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giVmg 10 lessons on child care to young girls who have much of the responsibility of the care of still younger children in the family.
The MCH Division edited and published The Georgia Baby Book; the first edition of 50,000 was printed in 1920. Since that time over 500,000 copies of this book have been furnished Georgia mothers, and it has been revised and reprinted many times.
The first statewide diphtheria immunization campaign was initiated in 1927, with cooperation of the Georgia Pediatric Society and the Congress of Parents and Teachers. Approximately 100,000 children were successfully immunized against diphtheria that year.
The following year, 1928, a cooperative arrangement was made with 27 Georgia hospitals throughout the State to take children that had physical defects and were unable to pay regular charges, and have the corrections made for a minimum charge of $7.50 each. The principal corrections accomplished under this plan were removal of tonsils and adenoids. The work was done upon recommendation of the county school superintendent.
By 1930, results of the MCH activities began to appear. Only five states showed a reduction in infant mortality that year and Georgia was among the five.
Also in 1930, the first State sponsored post-graduate course for physicians was arranged in connection with Emory University and the professor of obstetrics. Seven. five-day lectures were held over the State.
Special child health emphasis was promoted on May Day, beginning in 1930.
The first well-baby health centers were organized in 1932, with a volunteer Atlanta woman physician giving her time for this purpose. Since that time this has become a standard procedure in all local health departments. This project was for adequate health supervision of supposedly well babies.
By 1933, the public health nurses on the State staff had dwindled to four because of insufficient appropriation to cover nursing services. Early the following year, a Federal public health nursing project was established for utilizing the services of unemployed nurses. Forty were assigned the Maternal and Child Health Division for public health work. The project was enlarged from time to time.
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SPARTA CHILD HEALTH DEMONSTRATION
A child health demonstration was established in Hancock and Glascock Counties in 1936, utilizing Social Security Funds. The purpose of the demonstration was to provide a well-rounded public health program with special emphasis on child health and nutrition. An important feature of the program was the services rendered by cooperating agencies. The public health personnel for the project consisted of a pediatrician, a pediatric nurse, five staff nurses, a sanitarian, and a stenographer.
The State Health Department, in cooperation with the medical and dental professions, examined the school population and x-rayed all tuberculosis suspects. Treatment of those found ill was promoted through the local physicians as was the correction of physical defects.
This part of the program was initiated by sending into the territory a pediatrician and nurse to conduct the examinations, organize prenatal and post-natal clinics, well-baby health centers, provide for the treatment of venereal disease, and arrange other details of the project.
The five staff nurses were assigned to do follow-up work in order to get the mothers and children to the clinics, educate the people by organizing classes for young girls and women in first-aid and the home care of the sick. They supervised and instructed midwives, and assisted in obtaining specimens for laboratory examination, and in the immunization of the people against smallpox, typhoid fever, diphtheria.
The sanitarian assisted in the control of hookworm disease, dysentery, typhoid fever, and malaria by promoting the construction of sanitary privies, particularly in areas shown to be heavily infected with hookworm larvae through laboratory examinations; the screening of houses; and the elimination of mosquito breeding places.
The University of Georgia Extension Service supplied the child health demonstration project with:
1. A chemist who was a soil expert, to survey the area, analyze the soil, ascertain the crops most adaptable, and recommend the best practical method to increase fertility. Primary consideration was given to what the people had to eat and how far the deficiencies in the essential elements of diet could be supplied from the local soil.
2. Farm demonstration agents for each county to encourage the application of the findings of the chemist, and other specialists, as well as promote crop rotation, animal husbandry, and other phases of county agent work.
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3. Specialists in nutntion to study the present dietetic possibilities .:>f the territory, recommend the most satisfactory regimes from the material at hand, and improve upon the foods available as the project developed .
4. Home demonstration agents for each county to instruct the housewives in balanced diets and the preparation and preservation of foods. They were assisted by instructions from specialists as follows:
Food preservation and utilization specialist Clothing specialist Rural social life specialist Home improvement specialist.
The State Department of Education supplied special teachers for children and adults in physical education and recreation.
The area served by the child health demonstration was largely rural. Other than about five per cent employed in the lumber industry and perhaps ten per cent living in towns, its people were engaged in farming. Seventy-five per cent of Hancock farmers were tenants with 35 per cent of these on a share-crop basis. It was estimated that tenancy would not exceed forty per cent in Glascock. About fifty per cent of the soil in Hancock was clay or clay-loam, and the remainder sandyloam. Glascock was probably ninety per cent sandy-loam. Hancock had about 30 miles of hard surface roads and Glascock about four miles, the remainder being improved by grading and top soiling.
In addition to the towns of Sparta, Gibson, and Mitchell, country stores were located conveniently at five to ten-mile intervals. Rolling stores served about 70 per cent of the people on one-third of the principal road system, with regular schedules to each community one day a week. These stores served as markets which took in exchange for goods any farm produce that was salable.
Tractors were used on a few farms; about one-half had good work stock; a small per cent plowed with a single ox as the motive power. Transportation of lumber, goods, and people was principally by truck and automobile, yet a one-horse wagon, oxcarts, and buggies were still in evidence. Many people walked from three to ten miles to town. White children were transported to consolidated schools by buses, while the Negro schools were located so as to be in walking distance of all pupils.
Dependency for the two counties, at the beginning of the demon-
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stration, closely resembled that for the state-at-large. Public welfare statistics indicated that in Glascock 4.8 per cent, Hancock 4.2 per cent, and for the State 4.1 per cent of the population were either recipients or applicants for direct relief. Recipients of surplus commodities were far in excess of the State average in point of number and were allotted in value nearly two-thirds as much as for direct relief purposes in Hancock and almost three times as much in Glascock. Each county was well represented in the Civilian Conservation Corps. Approximately ten per cent of the farm familie~ of each county were Farm Security Administration clients.
There was no hospital in either county. There were hospital facilities available at Milledgeville, Sandersville, and Augusta, within 50 miles of any section of either county. No free beds were provided for Hancock or Glascock residents at any hospital.

Demonstration Activities Begun
The child health demonstration was put into operation July 1, 1936. At the end of June 1941, it had been in operation five years. At the beginning, surveys of sanitary conditions were made and measures for improving sanitation were carried out. Eighteen health centers, 14 in Hancock and 4 in Glascock, were established. Clinics were held at these centers monthly for both white and colored. In Sparta, Gibson, and Mitchell clinics were held weekly.
Nutrition was emphasized in all conferences with mothers of infants, preschool children. and in prenatal cases.

Initial Findings
At the end of the first school year, the pediatrician had examined 1,804 children in the two counties. A resume of the findings follows:

WHITE

COLORED

Number Per Cent Number Per Cent

Nutrition:

1,312 100 492 100

Good

384 29.26 112 22.76

Fair

507 38.64 200 40.65

Poor

421 32.08 180 36.58

10% Underweight

for height-age

328 25.00 134 27 .23

20% Overweight

for height-age

25 1.89

6 1.21

Anemia (Pale M.M.) 151 11.50 132 26.82

Enlarged Thyroid

28 2.12 20 4.06

Dental Caries

943 71 .85 338 68.69

TOTAL Number Per Cent
1,804 100
496 27.49 707 39.19
601 33.31

462 25.60

31 283
48 1,281

1.86 15.68 2.66 71.00

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A brief analysis of these figure;; emphasize some pertinent facts. The per cent of well-nourished white children-29.26, was only 6.5 higher than that of the colored children-22.76; in the groups classified as "fair" there were approximately two per cent more colored children; and among the poorly and very poorly nourished groups, there were only 4.5 per cent more colored than white children.
Only 29.47 per cent of the 1,804 children examined could be said to be well nourished and the nutritional status of many of these could not be classified as excellent. Approximately one-third of the total number, 31.31 per cent, were poorly or very poorly nourished.
Diets Studied
During the spring of 1938 a study was made of the diets of a selected group of 44 children, ranging in age from three to five years, with about an equal number of white and colored. These children were selected on the basis of having nutritional defects not apparently associated or caused by disease, and whose mothers were believed to have sufficient interest for cooperation. The study was made by the state extension nutritionist from the University of Georgia. Data were collected by demonstration staff nurses under direction of the nutritionist.
Analysis of the diet records showed: 1. A deficiency of the bone building materials, calcium (41%), phosphorus (24%), appeared to have existed, the lack of calcium being the most serious. Iron was generally lacking, with a deficiency of 77 per cent.
2. Vitamin A was more plentifully supplied than the other vitamins because of the quantities of sweet potatoes, collards, and turnip greens used. Information indicated that lean pork and peas and beans were excellent sources of vitamin B and that corn meal is also a good source. Because of the quantities of these foods used, vitamin B seemed to have been more nearly adequately supplied than some of the other vitamins.
3. One of the most serious deficiencies (82%) seemed to have been Vitamin C.
4. Vitamin G was deficient in 80 per cent of the diets.
5. In general the diets studied seemed to have been adequate in quantity but poor in quality. They were least plentifully supplied with those materials necessary to build bones and teeth-calcium, phosphorus, and vitamin C.
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Vitamin A Deficiency Studied

During the early part of 1938, a Hudy of the vitamin A deficiency by use of a biophotometer was made on a group of 250 children in the Sparta white schools by a representative of the Georgia Experiment Station.

During the testing period of each individual, records were taken by the questionnaire method on personal food habits, family food supply, and brief family history.

Eighty-five of the pupils with the lowest biophotometer readings were divided into two groups, 25 of which were retained as negative controls and 60 given 17,000 units of haliver oil five days a week for four weeks. Upon re-testing, the oil subjects had gained significantly over the negative control, indicating that vitamin A intake was beneficial.
Food Habits Studied

Beginning in May 1938, the staff nurses of the demonstration were instructed to obtain information from mothers when making regular homes visits as to what food was available for family use on the previous day and to record this on case cards of the individuals visited. During September, analysis of the information gained revealed:

Glascock County-150 Families

Milk Corn bread only Wheat bread only Both breads Eggs Peas Beans Cabbage Corn

. 80 per cent

4

"

. 53 " "

40

"

55 " "

34 " "

16 " "

. 2.6

"

. 1.3

"

Turnips Irish potatoes

13 " " 10.6 " "

Sweet potatoes Tomatoes Fat meat only Lean meat Chicken Fruit

10.7 " "

27 " "

43 " "

10 " "

. 56
18

"

,"

Hancock County-130 Families

.. Milk

42 per cent

Corn bread only 80 "

. Wheat bread only 13 " "

Both breads

6"

Eggs Peas

.. 10 " "
39 "

Beans Cabbage Corn

14 " "
.. 15 " "
14 "

Turnips

14 " "

Irish potatoes

17.7 " "

Sweet potatoes

7.7 " "

Tomatoes

25 " "

Fat meat only Lean meat Chicken

60 " "
. .. 10 " "
8

Fruit

10.7 " "

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Special Nutritional Study
In November 1938, a study of hemoglobin, calcium, and phosphorus content of the blood was begun in a group of sixty children, white and colored, representing farm families ranging in the economic bracket from rehabilitation clients to among the wealthier and most outstanding people of Hancock County.
Hemoglobin estimation was done with the Sahli hemoglobinometer and calcium and phosphorus determinations made at the central laboratory. Physicial examinations were made and recorded when blood specimens were taken. Matthews Physiological Chemistry gives the calcium control of normal blood serum at 9 to ll mg., the phosphorus content at 5 in children, 3. 7 in adults.
Nine per cent of the white children were low in calcium; 27% m phosphorus;
Seven per cent of the colored children were low in calcium; 32.5 per cent of the colored children were low in phosphorus; Nine per cent of the white children were low in hemoglobin; Fourteen per cent of the colored children were low in hemoglobin.
Along with this study, county farm and farm security agents made studies and analyses of the garden soils and vegetables with reference to mineral content. They supervised the growing of plants, including recommendation of specific fertilizers for each garden. These studies were undertaken with the hope of determining to what extent mineral content of soils might be reflected in vegetables and if vegetables with optimum minerals improve the calcium, phosphorus, and vitamin status of children using them.
In June, 1939, the wrists of the children in the group studied were x-rayed for evidence of pathological development of the bones. At the first examination, about one-third showed a low phosphorus content of the blood and about the same percentage were low in calcium. This low phosphorus content confirmed previous figures from physical examinations that from one to two-thirds of the younger children showed evidence of rickets. This was brought out further by the x-rays, which showed an osteoporosis of the bones which Karsner states may be due to a rachitic condition.
The soil of the gardens from which the children received most of their food also showed a low calcium and phosphorus content. Many of the soil samples showed a high degree of acidity. It seemed to be an established agricultural fact that highly acid soils will not give up their
115

calcium and potassium to vegetable matter grown upon them. This was borne out by the fact that the vegetables taken from these soils showed a lack of these materials. The proper fertilizers were added to the soils before the summer gardens were planted. A summary of the results on calcium and phosphorus determinations showed:
Calcium34 cases, 66 per cent, with significant increase 14 cases, 27 per cent, with no significant change 4 cases, 7 per cent, with significant decrease
Phosphorus20 cases, 41 per cent, with significant increase 23 cases, 47 per cent, with no significant change 6 cases, 12 per cent, with significant decrease
Ratio calcium to phosphorus- 10 cases, 21 per cent, with increased ratio calcium over phosphorus 32 cases, 67 per cent, with no significant change in ratio 6 cases, 12 per cent, with decreased ratio calcium to phosphorus.
Many Problems Present
The demonstration was handicapped from the beginning by frequent changes in personnel. Six directors served on the project, and in 1939 it was necessary to reduce the staff to one physician, and two nurses. Glascock withdrew participation at this time. In 1941, a garden project supervisor was employed.
A vast amount of health information was required to improve the health and nutritional status of the people in the demonstration area. Some source of vitamin D was considered necessary to be made available to the masses of the people during winter months to supplement the too common diet of fat back, gravy, and bread. Too, there was the improper use of food supplies tc be overcome. Many of the colored people traded eggs and other valuable farm produce for candy and other such commodities of much less nutritional value. Some of the tenants were not using and handling properly the milk and milk products after being supplied with cows.
Small surveys of blood specimens of laborers showed that one out of eight in the area had syphilis. There were many recognized and subclinical cases of pellagra. The results of these conditions were evident in the seemingly indifferent attitude of a majority of the laboring class. This contributed to the low economic status of some of the people.
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While 17 per cent of the homes were sanitated, in comparison with
four per cent in the beginning of the demonstration, the showing was incomplete.

Summary of Accomplishments
Examinations of all classes represented in the demonstration area pointed to a better nutritional condition. The Farm Security Administration cooperated by seeing that all of their 204 families had one or more milk cows. More vegetables were grown and canned, and the grocers reported that more vegetables and fruits were being purchased than formerly and less fat back and white flour.

Hot lunch projects were established in all of the white schools and in a few of the colored. School gardens were cultivated with seeds furnished by the Red Cross, and fertilizers contributed by commercial firms.

During the first two and one-half years of the demonstration, all school children were examined by pediatricians.

Hancock County showed great interest in dental corrections. There
were 86.4 per cent of the school children with cavities in 1936, with only 40.2 per cent in 1939.

A vast number of the physical defects among school children were
corrected through the efforts of local physicians. At one time 86 tonsil
and adenoid operations were performed in the demonstration offices.

Too, there was a gradual decrease in children repeating their school grades each year after the demonstration work began. In the school
year 1935-1936, 16 per cent repeated grades; in 1938-1939 only 9.6
per cent repeated their grades.

A review of 100 prenatal case.; visiting the maternal centers revealed an improvement in their food habits:

MILK

Qts. Daily
1938 1941 19 30

Pts. Daily
1938 1941 17 11

Occasionally
1938 1941 22 35

None
1938 1941 42 24

EGGS

Had Eggs
1938 1941 11 69

Had no Eggs
1938 1941 89 31

MEAT

Fat Back
1938 1941 64 5

Other Meat
1938 1941 34 30

None
1938 1941 65

117

Daily

Vegetables 1938 1941

other than

potatoes

32 89

Occasionally
1938 1941
33 11

None
1938 1941
35 0

PUBLIC HEALTH ENGINEERING ADDED
It has been aptly stated that public health engineering deals with the application of sanitary science to the problem of man's environment; that human life can survive only when the environment affords certain fundamental needs. Some of the factors to be considered in the control of the environment are food, watu, air, light, body wastes, heat, gaseous products, by-products of industry, smoke, dust, refuse, and insect control.
In the history of public health engineering in Georgia, the control of some of these environmental factors antedates the establishment of an engineering division. The principal environmental factor in early Georgia history was the insect-borne diseases of malaria, yellow fever, and typhoid.
As early as 1826, malaria was so prevalent in Macon that the Georgia Legislature passed a law "to pre5erve the timber in the vicinity of the town of Macon for the preservation of the health of the inhabitants thereof." This procedure is closely related to modern impounded water control, though, at that time the mosquito had not been incriminated in these diseases. Yellow fever and typhoid were particularly prevalent in the early days and the pioneers were powerless to prevent their devastation. The history of the State is replete with epidemics which could not be controlled because of the lack of knowledge of sanitary science.
In 1910 though, the State Board of Health established a laboratory for the chemical and bacteriological examination of samples of water taken from the public water supplies existing at that time.
At Athens, in 1914, the first water and sewerage conference in the State was held. The conference was devoted to discussion of ways and means of providing purer water supplies and more satisfactory methods of sewage disposal. The following resolution was adopted: "It is the sense of this meeting that legislation should be enacted looking to the wise oversight by a competent state agency whereby programs for water supply and sewerage shall be approved before construction, and whereby methods of operation and purification may be similarly guarded by

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reasonable regulation and adequate and regular scientific examination by the said agency."
In 1918, a serious outbreak of malaria occurred in Mitchell County. The State Health Department -was operating on a small budget with limited personnel. The problem was so intense that the U. S. Public Health Service cooperated by assisting in an epidemiological investigation and in the instigation of control measures. An investigation was conducted in Mitchell County to determine the loss sustained from malaria by residents in an area of 25 square miles of farming territory. The amount lost in the area under observation, because of inability to cultivate and gather crops plus the amount paid out for doctor bills and drugs, averaged $11.50 per acre under cultivation during 1918. In a nearby control area of similar size, the economic loss from malaria amounted to $15.50 per acre during 1919, while the loss in the original area under investigation was reduced to $1.50 that year, mainly through quinine supportive treatment.
Effort was made to extend qumme treatment to a large proportion of the rural inhabitants of Mitchell County through establishment of free dispensaries located at convenient points throughout the county. Ten permanent dispensaries were established and the standard treatment for malaria, as recommended by the National Malaria Committee, was administered to 4,000 people, 71 per cent of whom gave a history of having had malaria within the past three years. Of that group only 34 developed acute attacks of malaria.
The original program of this work contemplated the selection of a small rural area and there making a careful investigation of losses from malaria and an intensive study of malaria control through education, screening, and quinine treatment. This was done in 1919. The following year, though, the demand from the people of Mitchell County, as a whole, for relief from the malaria situation became so urgent that this program was converted into a project for the eradication of malaria infection carriers through the general administration of quinine throughout the county.
During 1920, 600,000 doses of quinine were distributed free of cost to the applicants for treatment. The drug was furnished by state and local authorities; 10,239 applicants were treated out of a rural population of 18,952 and a total population of 25,254 in Mitchell County. Fourteen free dispensaries were established for the distribution of quinine. The total cost to the cooperating agencies was $15,418.89, of which $7,054.46 of the funds were spent for quinine and supplies, and
119

$1,500 for transportation. The per capita cost for each person taking the treatment was approximately $1.50. It was conservatively estimated that the elimination of carriers by this demonstration in Mitchell County brought about an economic gain during 1920 of $270,000, or about 17 times the amount invested.
The Mitchell County epidemic brought the malaria problem to the attention of health authorities so forcibly that it could not be ignored as a major public health problem any longer. Facts were brought out there that forced Georgians to face the problem as one causing untold human suffering as well as tremendous economic drain on the state. The first concern was to give relief from the suffering and quinine was used for this purpose throughout the areas in which malaria was prevalent. Health department worker~ realized this was not the complete answer to the problem, but it helped to get the sick back on their feet and facilities for prevention of the disease were inadequate.
The Rockefeller 'Foundation was interested in a real scientific approach to the eradication of the disease in the South. In 1922, the Foundation set up a station for field studies in malaria at Leesburg, in Lee County. The research work at the station, in 1925, included: Treatment of paretics by inducing malaria, experimental infection of Anopheles mosquitoes, dissection of wild mosquitoes to determine natural infection, observation on mosquito dispersal, study of the results of intensive medication with quinine, observation of the periodicity of malaria parasites in the peripheral blood, study of Halteridium infection of pigeons, observation of the characteristics of Anopheles ova, recognition of the sex of Anopheles larvae, and study of the parasites of Anopheles mosquitoes.
The Mitchell County experiment and the work at the Leesburg Station set the stage for the eradication of malaria in Georgia. The problem was of such magnitude that in one county, in 1919, 82 per cent of the population had malaria infection.
Sanitary Engineering Division Established
A sanitary engineering division was established, in 1920, and the first efforts were directed toward field studies and a comprehensive analysis of the many public water supplies. Within a short time all of the supplies were listed with a brief analytical description of each supply concerning type of design, construction and deficiencies in operation. The water laboratory, which had already been established, was expanded to provide for receiving monthly samples of water for bacteriological examination from each public supply. In addition a pro-
120

motion program was initiated, aimed at the objective of consultative engineering service leading to better engineering design and construction of the supply plants.

The engineering division came into being about the time there had begun an active period of research and development of various processes of treatment and disposal of human and industrial waste. The problem of furnishing water in quantity and in quality and the disposal of waste became problems of large proportion.
The engineering division was established less than a quarter of a century after the cause of malaria was established. At this time, malaria ranked near the top of diseases prevalent in the State. It was not until 1923 that an engineer with previous experience in malaria control was employed to devote the greater portion of his time to this problem. With the largest state east of the Mississippi River and such a large proportion of it so malarious, it was a bold undertaking.

The first efforts were directed to the towns, cities, and counties recording malaria as most prevalent. Trained and experienced administrative personnel was always deficient in the early malaria control days but labor was fairly plentiful.

During the days of the Federal Works Progress Administration, thousands of men were employed in drainage projects for eliminating mosquitoes in malarious areas.

In 1939 a modest beginning was made in operating a food inspection 'service. World War II, with the greatly increased patronage of eating and drinking establishments, emphasized the need for considerable expansion in this type of service. After a few years, this service was considerably expanded to include act~vities of local health departments in the sanitary supervision of over 1600 school lunchrooms.

In 1937, the Gent'ral Assembly passed legislation known as "An Act

to improve the sanitary condition of the manufacture of mattresses and

bedding." This work was placed 1n the engineering division. It has

been developed to include a statewide service demanding attention in

every community, town, city, and county.

'

Shellfish sanitation was delegated to the State Department of Agriculture previous to 1943. Because of depleted sanitary conditions prohibiting Georgia shellfish from the markets in other states by action of the U. S. Public Health Service, the shellfish industry succeeded in having this service transferred to the State Health Department. After

121

several years of operations, the sanitary conditions have improved to the extent that Georgia now ranks close to the top in the sanitary quality of shellfish and is eligible for marketing such products in all other states.
TRAINING SCHOOL FOR MENTAL DEFECTIVES FOUNDED
Draft record findings in the first World War period highlighted the seriousness of feeble-mindedness as a public health problem. It was realized by a group of Georgians dealing with juvenile delinquents and prostitutes that the State was neglecting a segment of society. As a consequence of this many individuals were drifting into crime without any effort being made to prevent it or to reclaim them. This was the basis of an appeal made to the Legislature in 1918, with the result that the following resolution was adopted:
"WHEREAS, Statistics that are available, but incomplete, show that there are many per~ons in Georgia, minors and adults, who are feebleminded and as such are a menace to the schools and to the communities in which they reside, there being now some six thousand or more in our State who may be so classed; and
"WHEREAS many have been reclaimed from the disability under which they have lived by the sane and scientific care, training and education furnished by state institutions and many who are now detained in the State Asylum for the Insane for lack of a better suited institution, could be transferred to an environment that would be more helpful to relieve them and enable them to earn at least a good part of their own livelihood and stop a larger part of the drain upon the State treasury required under existing conditions.
"BE IT RESOLVED by the Senate, the House of Representatives concurring therein, That the Governor be requested to appoint a committee of five citizens of Georgia who will serve without compensation therefor, to investigate fully and prepare statistics from all available sources, from the city school system of the State, from the State asylum, from the court records, from the county school commissioners, or other places where information may be obtained, and after full investigation as to the numbers and conditions of the feeble-minded persons in Georgia who are now, or who may be likely to become charges upon the public, to report such facts and figures as they may secure and make such recommendation as may seem to them suitable to relieve the State of the menace of the uncared-for feeble-minded who are such a fertile source of crime, poverty, prostitution and misery not only to themselves, but to all with whom they are brought in contact.
122

"BE IT FURTHER RESOLVED, That the report of this commission on the feeble-minded in Georgia made to the Governor before the next General Assembly shall be transmitted by him in full or in substance, with such recommendations in his message as may seem advisable to him."
The report of the Commission, in part, showed that 40 per cei).t of the inmates of almshouses investigated were feeble-minded. Certain pauper feeble-minded families were found that had been supported by church and organized charity for four and five generations. These investigations showed that feeble-minded families were allowed to live in the communities and propagate their kind, were nurtured and cared for by philanthropic efforts and, in this way, encouraged to leave behind them a large progeny of feeble-minded.
One study of a typical orphanage showed that 28.7 per cent of the children were feeble-minded. If these statistics hold good in other orphanages throughout the State, then it was felt there were at least 810 feeble-minded children in orphanages needing special care and training in a school for feeble-minded.
The male inmates of the State Prison Farm at Milledgeville showed 17.5 per cent feeble-mindedness. The striking problem at this institution was not so much the presence of feeble-mindedness, which was expected to exist in a larger proportion than was found, but that great numbers of mental abnormalities, mental disease and deterioration, epilepsy and such existed. Undoubtedly the able-bodied mental defectives were placed out on the chain gangs. In all, 65.8 per cent of the male inmates of this institution were classified in terms of deviation from normal mental health.
Among the women inmates of the State Farm, 42.8 per cent were found to be feeble-minded. It was realized that nothing could be more stupid than the _return to the community over and over again of these feeble-minded women.
Two typical county jails were selected that might represent fairly well the mentality of the average jail inmate of Georgia. It was found that 34 per cent of the inmates of these jails were feeble-minded persons, with the mental level of children of 10 years, or under.
In the studies of 122 immoral women, it was found that 43.5 per cent were feeble-minded. The investigations showed that the policy of treating these women for venereal disease and then turning them out into the community to acquire the infection over again was a costly one.
123

In order to determine the relationship of feeble-mindedness to juvenile vice and delinquency, a group of 100 cases in the Juvenile Court in Atlanta were examined. All of the inmates of the Georgia Training School for Girls, the Fulton County Reformatory for Boys, and the State Reformatory for Boys were examined.
Of the Juvenile Court cases 17 per cent were found to be feebleminded; 15 per cent of the 'Fulton County Reformatory for Boys were feeble-minded; 24.1 per cent of the inmates of the State Reformatory for Boys were found to be feeble-minded. Among the inmates of the Georgia Training School for Girls, 27 per cent were feeble-minded.
In a series of school surveys, 3.5 per cent of the children examined were found to be feeble-minded. The Commission reported that "These are the feeble-minded children who are to become the 'grist' of our future courts, jails, reformatories and State prisons, and to form the very backbone of the vast and grim procession of paupers, criminals and prostitutes of tomorrow."
Acting upon the report of the Commission, "The General Assembly, at its 1918 session, requested the appointment of a committee to investigate and report such facts and figures as they may secure and make such recommendations as may seem to them suitable to relieve the State of the menace of the uncared-for feeble-minded, who arc such a fertile source of crime, poverty, prostitution and misery, not only to themselves, but to all with whom they are brought now in contact."
Based on the recommendations of the committee, the General Assembly that same year enacted a law authorizing the establishment of a Georgia Training School for Mental Defectives. A temporary Board of Control was appointed to establish the training school and $100,000 was provided for this purpose. The Tuttle Newton Home, an institution for orphans, near Augusta, at Gracewood, was purchased for the training school. The law specified that the temporary Board of Control secure the institution and turn it over to the State Board of Health for operation.
The newly acquired Georgia Training School for Mental Defectives was turned over to the State Board of Health but there was no money aw.ilable at that time for its operation. It was not until 1921 that $5,000 was made available to get the school in condition for opening. The following year $25,000 was provided for maintenance and operation. With this meager amount of money, the institution was bravely opened in May, 1921. The first child was received on July 4, 1921.
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The superintendent's report includes: "The year 1922 is the first full year of operation for the Georgia Training School for Mental Defectives. The period from May to December, 1921, may be looked upon simply as time of preparation and organization, a time during which the needs of the school were felt out and the possibilities ascertained. During 1922 we have had an opportunity to test out our views, and to see how well the school is fulfilling its duty to the State, the duty of caring for the feeble-minded of the State of Georgia.
"In spite of many vicissitudes certain definite progress has been made, although, at the time, some shortcomings have become more clearly evident. The most evident shortcoming is our inability to cope with the volume of work demanded of us. We began the year 1922 with 129 applicants for admission on our waiting list, and on January 1, 1923, we had 216 on the list. This means the boy entitled to the next vacancy in the school has had his name on our waiting list since January 6, 1922, and the next girl since August 1922. Under these conditions it is clearly impossible for us to take care of any emergency cases. Almost daily applications are made by charitable organizations, courts, and welfare workers for places for defective children, with the statement that there is no other possible place to send them. Our only answer, at present, is that we will place them on the list, and may have a place for them within six months. Obviously the school is not large enough to fulfill the demands made of it."
The needs of the school and the demands made upon it soon outgrew the facilities. In 1930, the General Assembly provided $75,000 for the purpose of building additional buildings or purchasing additional property. The soil at the original property was of a sandy character and inadequate to produce crops needed at the school. For this reason additional property was purchased consisting of 500 acres of fertile land and the Jacob Phinizy Home, known as Circular Court. The wisdom of this purchase was soon evident by the production of abundant crops of all kinds on the rich soil.
At the end of the first four years of operation, the school was caring for 64 children. At the end of ten years this number had gradually climbed to 326. There were many obstacles overcome in the early years and the school's problems were always paramount. At no time was space to house all the applicants adequate, and facilities for training the students were insufficient. But the school was the only home and the only personal consideration man} of the students ever had.
The continued appeals for admission of children was a factor that
125

gave much concern. The financial depression materially interfered with the school's progress. The continued drouth during the summer of 1929 made farming operations rather unsuccessful. The following year the maintenance appropriation was not available in full and it was necessary to curtail expenditures. Teaching personnel was reduced.
On December 31, 1931, there were 234 children in the institution at Gracewood. The population was increased by 22 during the year, 16 were discharged, and five deaths occurred. There were filed more than 700 applications for admission. Quite a number of these applicants had been examined and it was felt that at least 500 should be institutionalized.
The per capita cost for 1931 was about 85 cents.
The Georgia Training School for Mental Defectives was placed under supervision of the newly created State Board of Eleemosynary Institutions at the close of 1931.
EARLY DENTAL HEALTH
In 1921, a few Georgians were thinking and talking in terms of dental health for children. Several years prior to this time, a number of Atlanta dentists had gone to one of the City schools and examined children's teeth. They found that 96 per cent of those examined had defective mouth conditions.
A patient and friend of one of the Atlanta dentists was interested in his accounts of the mouth conditions among these children. Through a donation of $1500 this dental patient made possible the first demonstration school dental service in Georgia.
At that time, the public had little conception of dentistry as a health service and the dental profession had no conception of education as a professional obligation.
The Superintendent of Schools of Atlanta was pioneering in the idea of making health the first objective and attainment in education. He organized a demonstration dental health project in the Grant Park School. The plan, approved by the District Dental Society, was later adopted for the entire school system.
By 1925 approximately 40,000 Atlanta school children had certificates from dentists stating that all necessary dental corrections had been made. This achievement was the result of much enthusiasm and hard work on the part of school officials, Parent-Teacher Associations, and
126

members of the dental profession. Holidays were g1ven classes attaining one hundred per cent dental corrections.
About this time there was a clinic provided in the Atlanta City Hall, including one dentist and two hygienists, which could not begin to care for even the charity patients. The solution to the problem of getting 30,000 children's teeth corrected was an educational campaign, with the slogan: "Go to your own dentist." As a consequence Atlanta dentists cared for both pay and charity cases.
Mobile Mouth Hygiene Unit Loaned State
The first dental health activity attempted on a statewide basis was the function of a mouth hygiene unit detailed to Georgia by the U. S. Public Health Service. The unit visited 17 counties from September, 1923, through July, 1924. The records show that 5,606 children's mouths were examined in this project.
Commonwealth Fund Dental Project
One of the features of a child health demonstration held in Athens and Clarke County in 1924-28, was employment of an oral hygienist to help develop health resources in the schools. One of the elements of this demonstration was a system of health supervision for school children which included dental examinations, and some prophylactic treatments by an oral hygienist.
The City of Athens was awarded a certificate of appreciatiOn for its service in dental health by the Georgia Dental Association in 1927. The Association also unanimously recommended establishment of a dental hygiene service in the State Health Department. In the Commonwealth Fund project 2,044 teeth were filled or extracted and 3,009 cleaned.
Oral Hygienist Employed
The next step in dental health was the employment of an oral hygienist whose services for three years were offered to counties to assist with dental inspections and education programs. There was little chance for such a program to expand to include Georgia's 159 counties and 500,000 white school children.
In 1928, though, nine months of oral hygiene work was done in 24 counties. The hygienist employed for this purpose visited the counties and in 12 of them made dental examinations of all the white school children. In the other 12 counties, only city schools were included. In a total of 196 schools, 25, 971 children were given dental examinations.
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Results of this work showed from 65 to 95 per cent of the children had defective teeth.
While the extent of dental caries was generally known, it was thought the dental examinations would create interest among the teachers, children, and parents and that many corrections would be made as a consequence.
The limitations of this dental service were apparent from the beginning as the time required for making the dental examinations made it impossible for the one person to organize permanent mouth health programs. Securing corrections of the dental defects presented a paramount problem.
Supervisor of Mouth Health Employed
It was soon realized the only possible way to reach so large a group and scattered territory was to organize in a cooperative project all dentists, schools, and parent-teacher associations. As a consequence, in 1932 such a program was initiated by the employment of a supervisor of mouth health with special training in health education. Her activities were confined to education and organization.
The Georgia Dental Association had become actively interested in the public health program, and two dentists were appointed as members of the State Board of Health in 1925.
Special emphasis was given in talks to teachers and to county school superintendents. The teachers of a county were requested to meet at some centrally located place in the county and a lecture on mouth hygiene given. Outline of the procedure for establishing a dental program in the schools was also given. Blanks were furnished to each school for recording the examination of each child's mouth. The dentists in the county were visited, an outline of the school program furnished them and their cooperation requested in the dental program.
All examinations were made by local dentists and much of the success of this program is due to their cooperation. More than 200,000 school children were examined free during the two year period, 19311932, and thousands of dental defects were corrected at small or no cost to the school children.
A curtailment of all actlvrtles of the State Health Department became necessary in the fall of 1933, as a result of rapidly declining state revenue. No provisions seemed possible for continuing the mouth hygiene activities for the last two months of the year. The Georgia
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Dental Association, through subscriptions of members, assumed the temporary financial responsibility of this dental project at an important stage in its initial development.
TUBERCULOSIS CONTROL BEGUN
In 1900, deaths from tuberculosis in the Registration Area of the United States occurred at the rate of 201.9 per 100,000 population. While tuberculosis education activities were a part of the early state health program and strenuous ehorts were made to establish treatment facilities, a definite program aimed at prevention of the disease was not possible until the latter part of 1930. That year the death rate from tuberculosis in Georgia was 74.6.
The tuberculosis control service was inaugurated by the provrswn of a mobile x-ray unit designed for the examination of those known to have contact with tuberculosis or who had symptoms which were suspicious indicat'ors of the disease. A one and one-half ton truck was provided for this traveling unit by the Phi Mu Fraternity. This organization had been participating in the maternal and child health work of the State Health Department and had furnished the first "Healthmobile" to the state in 1922. The interior of the truck was fitted as an x-ray laboratory, with dark room equipment for development of exposed films, and facilities for their study.
That first year, from October 13 through December 31, 1930, a total of 419 physical examinations were made for tuberculosis. Three clinics were conducted, the first in Valdosta and the others in Waycross and Brunswick.
This auspicious program was begun on a "financial shoe-string" in the midst of the economic depression period, and was the pride of the State Health Department. At the end of the year 1930, it was apparent that the tuberculosis control program could not be continued unless some additional revenue could be secured. An increase in funds was out of the question under the financial circumstances, so a reduction in salary of all State Health Department employees was made in order to keep this service operating. This move had the unanimous approval of the department personnel and when the next year 5,157 persons were examined and x-rayed for tuberculosis, it was considered eminently worth-while.
From a very modest beginning, the tuberculosis control servrce was quickly built up so that in April, 1932, it consisted of a traveling diagnostic unit composed of a clinician from the State Tuberculosis Sana-
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torium, an associate clinician assisting with organization work and doing tuberculin testing, an x-ray outfit fully equipped for making and developing chest x-ray films in the field, an x-ray technician, and a clinic nurse.
The field of operation was limited to health-officer counties and to those counties having public health nurses, as it was considered unwise to attempt control work in tuberculosis without siutable follow-up. In April, 1932, however, a follow-up nurse was added to the personnel, and other counties were added until the unit was operating in 50 counties.
The object of the tuberculosis control program was the discovery, cure, and prevention of tuberculosis, with special emphasis on discovery of early tuberculosis, for it was known that tuberculosis in its earliest stage was most amenable to proper management and that such discovery could be made only with methods of highly technical skill.
A policy of making reports to the physician of the patient's selection and of offering no suggestions of treatment to the patient except through his physician, was strictly adhered to. This project had the approval of the Medical Association of Georgia and physicians throughout the State cooperated in making it a success. It was realized that the home treatment of tuberculosis could not be accomplished with assurance of success in any other way and the proportion of success in the fight against tuberculosis was in direct ratio to the interest the local physicians had in the undertaking. It was also realized that patients who went to a sanatorium for treatment, with the time limit too short for cure, usually returned to their homes only to lose whatever they gained unless a satisfactory supervision of their cases under a physician could be accomplished.
Besides assisting physicians in the counties in which tuberculosis clinics were held, a number of physiciam were induced to use collapse therapy and perform lung-collapsing operations with gratifying life-saving results. This service began when a physician in Albany expressed interest in observing the work at the State Tuberculosis Sanatorium.
In November, 1933, the portable x-ray equipment was accidentally destroyed by fire, and it was not until February that a new unit could be secured. The Phi Mu Fraternity assisted in this purchase financially.
Through the Federal Emergency Relief Administration ten tuberculosis nurses were secured for follow-up work, tuberculin testing, organizing clinics, and to act as advisory nurses to county public health nurses.
This with the elimination of physical examinations by the clinician
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and the clinic being based on good histories, x-ray pictures, sputum examinations, and tuberculin tests permitted more than twice the number previously examined annually to be scheduled for examination.
EARLY EPIDEMIOLOGICAL EFFORTS
Previous to the establishment of a division of epidemiology in 1932, the investigation of epidemics and epidemic conditions was carried on by members of the staff of the State Health Department. After the employment of an experienced epidemiologist he assumed a large part of the responsibility for furnishing carefully collected and scientifically accurate data as to when, where, and under what conditions cases of disease occurred. The work of the epidemiologist was described by Dr. Haven Emerson before the American Public Health Association Meeting in Washington, in 1932:
"The epidemiologist is entitled to the distinction of a specialist in public health. In fact, he is a master of natural history of disease as it expresses itself in groups of persons, related by some common factor such as age, sex, race, occupation, or geographic distribution, as well as by development of disease.
"Without necessarily being a practitioner of any of the basic sciences of medicine and sanitation, he must be able to use them in arriving at his own objectives. Epidemiology is a science insofar as its theories and laws of disease performance are based on accumulated facts, and objective reasoning, and to an increasing degree upon planned experiment, both upon man and upon the lower animals."
For a number of years, the U. S. Public Health Service had outlined plans and procedures to improve morbidity reporting throughout the country. It was felt that prompt, complete, and accurate reporting of disease was one of the foundations for efficient public health work.
In order to improve reporting generally throughout the country, the U . S. Public Health Service set up a Morbidity Reporting Area. Under this plan, states were rated with reference to reporting of disease. Before Georgia could be admitted, considerable improvement in morbidity reporting was necessary. A plan was instituted, early in 1932, for sending morbidity forms to physicians weekly to stimulate interest in reporting. The response to this measure was gratifying.
A reporting service showing the morbidity, and fatality rate was begun. Since the fatality rate is the ratio between the number of cases reported and the number of deaths recorded, decrease in fatality rate indicates improvement in treating cases or improved morbidity. This
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service emphasized to the physician the importance of complete morbidity reporting.
Chronic Typhoid Carriers Found
Search for chronic and convalescent typhoid carriers constituted an early objective of the epidemiology service. Obtaining specimens for examination was not an easy matter ordinarily, but with the assistance of an influential person in the community and exercise of tact, satisfactory results were encountered. Seven chronic typhoid carriers were detected the first year of the division's operation. Fifty-five cases were recorded as having been caused by these carriers. Carrier years for these individuals totaled 43.5, and if the carriers infected as many individuals as were infected in 1932, they could have caused 2,392 cases of typhoid fever in the 43.5 years.
After the carriers were detected, their control became an obligation of the local and state health authorities. The only known means of rendering carriers non-infectious was surgery-the removal of the gall bladder of typhoid carriers ridded them of typhoid bacilli.
Since universal control of carriers was at that time impossible, and owing to unsanitary conditions in many areas, vaccination on a large scale was attempted for the prevention of typhoid fever.
Malaria Investigations Made
For every death from malaria that was reported, it was estimated that there were two to four hundred cases. In the fall of 1932 a blood index was taken in two counties where malaria constituted a problem to establish a base line of malaria incidence and then institute corrective measures. Blood indices were made of school children in the counties and tabulated by schools. They ranged from zero to 87.5 per cent positive for malaria. Spot county maps showed a considerable grouping of cases in certain areas.
County commissioners used convicts for drainage work in some of the most heavily infected areas. There were other sections, though, where drainage projects were prohibitive on account of the cost. In these, a plan was instituted for systematic treatment with Plasmochin and Atabrine for the prevention and treatment of malaria.
The value of Plasmochin in the prophylaxis of malaria had been recognized for some time, and a number of physicians in the state had reported its use with good results. It readily and effectively destroyed the sexual forms of the malaria parasite in the blood, and was con-
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sidered to be of value in a malaria preventive program, for it was the "carry over" of sexual form from season to season that infected anophelene mosquitoes and made possible the continuation of the malarial cycle between man and the mosquito.
Atabrine (originally called Erion) was a new drug synthetically prepared in Germany. Preliminary experiments with the drug had proved its highly curative qualities in the treatment of bird malaria. A report of the United Fruit Company for 1931 indicated that the drug had proved eminently satisfactory in the treatment of malaria in man in several of the company's hospitals. Several trial packages of the drug were furnished the State Health Department for experimental purposes and the physicians using them gave favorable reports. This drug, after experimental use, occupied an important part in the treatment and prevention of malaria.
Sufficient amounts of both of these drugs were obtained to carry on studies throughout the corning malaria season in an area comprising a population of 1,325 people in Calhoun and Mcintosh Counties. At regular intervals during the season blood indices were made, and in the late fall final blood indices indicated the value of these two drugs in the control and prevention of malaria in population groups where drainage was not feasible.
At the end of the 1933 malarial season the rate in the treated area was reduced from 80.1 to 10.9 per cent, as compared with a rate of 60.3 in the untreated area.
Atabrine was found particularly effective in the sterilization of malaria carriers.
Epidemic Amebic Dysentery
For many years, it was believed that amebic dysentery was contracted only in the tropics and then under gross unhygienic conditions. In 1933, the Health Section of the League of Nations reported that the disease was extending itself into the more temperate regions. That same year, a definitely established area of infection was found in and around Bethlehem, Georgia. The entire population of this town was examined and 18 carriers were found, all of whom received treatment.
The widespread outbreak of screw worm infestation among animals in South Georgia during the summer and fall of 1933 focused the attention of physicians and health officials of the state to the possibility of occurrence in man. Before the season passed, actually three cases were reported in areas where its menace to livestock had become a
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major problem. The following year, a questionnaire to physicians revealed that 38 cases occurred.
Typhus Fever Appears
Increase in typhus fever, beginning in 1930, was observed with apprehension. By the end of 1933, 625 cases were reported.
Inasmuch as two species of rat fleas, commonly found in the Norway rat, were the known vectors from which the disease spreads, destruction of rats on a large scale was attempted. The Biological Survey of the U. S. Public Health Service obtained funds to carry on this work. The Biological Survey poisoned rats, using red squills, in 70 South Georgia counties. The Public Health Service, being particularly interested in the epidemiology of the disease, requested the State Health Department to direct operations in the counties of Chatham, Glynn, and Fulton, using traps to catch rats alive, from which fleas were combed for study.
Unfortunately the Civil Works Administration was discontinued before the full effects of the rat destruction program could be realized. It was believed, though, that the program was beneficial. In 1938, a study of every reported case of typhus fever was begun, and 480 were investigated that year.
Health Survey Project
In order to obtain definite information as to health conditions of people on the public relief rolls in the State, arrangements were made to cooperate with the Emergency Relief Administration in making a health survey in three representative counties-Cherokee, Glynn, and Randolph. The survey finding was a sad commentary upon the need for better medical and dental care for this social strata of society within the state. Seven per cent were found to have syphilis.
In December, 1936, the State Board of Health adopted the report and recommendations of a committee of the American Public Health Association on the control of communicable diseases. A copy of this bulletin was sent to all the physicians in the State.
WIDESPREAD PUBLIC HEALTH NURSING INITIATED
Nurses were among those who suffered acutely from the economic depression of the early thirties. Services of private duty nurses were dispensed with whenever possible in order to cut the family budget and hospitals and public health nursing organizations were forced to operate with decreasing staffs.
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In the fall of 1934, hundreds of nurses in Georgia were unemployed and actually in need. When projects of all kinds were being set up to provide work for the unemployed, the Georgia Emergency Relief Administration sought useful ways of putting nurses to work and in so doing to make their services available to thousands of men, women, and children who would otherwise have been uncared for.
The services of 80 nurses were provided for the State Health Department. At the time, this service constituted the only public health nursing service available through the State Health Department. The nurses were assigned to 124 rural counties in the State. They made 115,000 visits to prospective mothers, babies, and young children, and tuberculosis patients. They conducted classes for some 4,000 midwives who were delivering about 42 per cent of all babies born in the State. These nurses also assisted in the control of communicable diseases through immunization clinics; located some 600 crippled children, and helped make a survey of maternal deaths and the distribution of cancer.
The emergency nursing staff organized tuberculosis clinics in practically every county in the state where more than 10,000 individuals were examined.
Due to the need for economy in the use of public funds, many local health departments had to discontinue public health nursing services. Such service was restored in 15 counties through nurses assigned by the Georgia Emergency Relief Administration.
With the assistance given through nursing projects created under the Georgia Emergency Relief Administration, nurses for the first time had been made available to every county in the State. They found their way into remote parts of the state, into mountainous coves, swampy backwater country, and to isolated farmhouses.
The work of the nurses had to be done under high pressure. Services had to be developed quickly or not at all. There was not time for careful preparation of the nursing staff for the responsibilities that were theirs. Without exception, though, they served with an admirable spirit, met emergencies with resourcefulness, and served faithfully and unselfishly.
When the writers of the Constitution undertook to lay the foundation of the country they included a guarantee of life, liberty, and the pursuit of happiness which succeeding generations of law-makers long overlooked. A guarantee of life naturally means a guarantee of health for the individual citizen. It remained for the Emergency Relief Adminis-
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tration to give meaning and emphasis of this important constitutional guarantee by providing a volume of medical and nursing service for the state hitherto undreamed of.
The horrors of the Crimean War gave the world the blessing of the International Red Cross. The first World War gave the health committee of the League of Nations. Out of the hardships of the eoonomic depression of the early thirties came permanent health and social services which help guarantee healthy bodies and minds to all people.
By 1935, the only nursing service available through the State Health Department was provided by a Works Progress Nursing project which gave employment to from 95 to 200 public health nurses. This greatly enlarged service was available for a short time only. With improvement in economic conditions, nurses began leaving the project to accept permanent places. In May, 1936, the project was suspended entirely.
That same year the Social Security Bill was passed. This legislation marked a tremendous step forward in social progress providing approp~iations to the States which enabled them to give aid to the aged, the unemployed, and dependent children. This law also carried an appropriation to the U. S. Public Health Service and the Children's Bureau which enabled them to give assistance to states for general public health work and maternal and child health services.
On April 15, 1936, the State Health Department qualified for assistance through Social Security Health Funds, and on this date a division of public health nursing was established with a staff of a director, assistant director, and 18 field advisory nurses. Social security funds were also available for the training of public health nurses and by the end of the year 25 had been trained for health work.
At the beginning of 1938, 51 counties were covered by local health departments and 11 additional counties employed a nurse only. The remaining 95 counties were grouped into 18 districts. In each district, an itinerant nurse was placed for the supervision of nurses in the district and for direct service to the people, except that of tuberculosis control which was covered by a special staff of nine nurses.
The State Board of Health, existing under and by virtue of the 1903 health law, was abolished in 1931 and the powers, duties and functions of the Board were transferred to and vested in a Department of Public Health. The director of the Department of Public Health was authorized to appoint not less than five and not more than ten persons to serve at his pleasure as an Advisory Board of Health. The director of the Department was to be appointed by the Governor.
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This reorganization of the State Board of Health did not meet with approval of the medical and dental professions and was contrary to the trend of public health departments in other progressive states.
In 1933, as a consequence of general dissatisfaction, a State Board of Health was reestablished. In addition to medical and dental representation, two pharmacists were added to the Board. The law specified that the professional organizations of each profession to be represented on the Board should submit two names for each place to be filled and the Governor should name one of the two. Each of the fourteen members' appointment was for six years, with the approval of the Senate. The members' terms were staggered so that not more than two vacancies would normally occur each year.
From 1903 to 1931 the director of the Department of Public Health was a member of the Board. When the Board was reestablished, though, in 1933 the director was removed from membership on the Board. The 1933 law also specified that the Governor should be an ex-officio member. In 1945 the new State Constitution provided that the Governor should not be a member of any State board.
The function of the State Board of Health is to establish matters of policy, and adopt rules and regulations by which the Department of Health operates. The Board selects the director who serves for a term of six years. . The salary of the director is fixed by State law.
SUMMING UP IN 1935
In November, 1933, when the Federal Civil Works Administration was created, the President of the United States said that four million people must be put back to work. Immediately, there was created a new order of things. The old idea that everyone be left to work out his own economic salvation was swept aside and the Biblical injunction that "we are our brother's keeper" was adopted. Under the new order health officials were asked to create work for men and women.
In Georgia, Federal projects were set up for the drainage of malarious areas, for sanitation, public health nursing service, the control of typhus fever, and for other purposes. Health work was stimulated beyond all previous anticipations. Projects long contemplated were carried out under the new order of things. Public health workers cooperated in putting people back to work and health work was accomplished that might otherwise have been impossible for many years to come.
The question of medical service for relief clients was the cause of
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much concern by physicians, health officers, relief administrators, and welfare workers. Many of the counties in Georgia were not given enough money to provide medical service for those on relief, in addition to supplying emergency food, shelter, and other necessities of life. Physicians in many sections were not paid for their services to relief clients, and in numerous instances payment was long delayed. The physicians had to carry an increasing burden of medical service to the indigent.
In order to secure some idea of the problem of medical relief and the possibility of grouping employables and unemployables, a survey was made of people on relief rolls in three counties. Physical examinations were made of 4,925 people on relief rolls by physicians in the counties surveyed. It was found that only 31 per cent of the people had been immunized against typhoid fever, 19 per cent against smallpox, and 8 per cent against diphtheria. It was found that 52 per cent of these families were not using milk of any kind. Approximately 75 per cent were in need of medical care, and 89 per cent were in need of dental care. This survey showed just how far public health, medicine, and dentistry had yet to go in order to serve adequately all the people.
Realizing there should be no conflict between the practicing physicians and public health workers, the Medical Association of Georgia appointed a liaison committee composed of practicing physicians and health officers to work out approved public health policies. The result was a workable program satisfactory to all concerned in accomplishing the greatest good for the largest number of people. This committee established an approved nursing service policy governing the activities of public health nurses working in counties without health officers, placing the responsibility of their work upon the medical profession. In addition, a policy for administering county health departments was established. These documents set forth in detail the relationship of each group to the local medical profession. The authority of the public health officer was recognized in the control of communicable disease by educational campaigns, isolation and quarantine, sanitation, immunization, and sterilization of carriers by drugs and other measures. The policies also recognized the responsibility of the physician in the immunization program and in clinics of all kinds whether conducted by public health officers or nurses.
Revenue Reduced
The revenue of Georgia fell more than 30 per cent short of the appropriations made by the Legislature in 1933 and the extent of the
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shortage was not determined until all but three months of the year had passed. This resulted in the dismissal of a good many employees and the discontinuance of a number of services.
In order to accept a proposed reduction of $1,000, or 33Y3 per cent in Rockefeller Foundation aid, it was found that the State Health Department would have to restrict its services and it was out of the question for the Department to absorb a larger amount.
An emergency grant was made at the October 1933 meeting of the Rockefeller Foundation of $5,004.50 to enable the State Health Department to meet the payroll of the personnel retained over the fourth quarter of 1933. The outlook for financing health or other services in Georgia early in 1934 was not promising at that time.
Later in 1934, however, there was obtained in Georgia for the first time a sight of the benefits to be derived from a broad program of public health activities through resources of the Federal emergency relief program. For the first time, every county in Georgia was given public health nursing service, tuberculosis diagnostic x-ray clinics, and sanitary engineering service. The result was an awakening of vision of the full possibilities of service by an enlightened government to the masses who have first claim upon its powers and securities, not only in health but in every other field that touches human existence. These emergency aids were not expected to continue and with their withdrawal there necessarily followed a lessening of public health safeguards and benefits.
Looking Backward
In order to get a perspective of Georgia's public health problems in 1936, it was necessary to take a retrospective view of health work in the State. Georgia had had health work continuously since 1903 and had spent $2,155,351 from the State Treasury for that purpose. Actually, 71 cents per person per year had been spent for health work in 33 years, less than two and one-half cents per person per year.
The over $2,000,000 expendi~ure had helped to purchase a bare minimum of public health protection. If the same death rate had prevailed in Georgia in 1935 as in 1903, there would have been 14,658 more deaths than actually occurred.
The figures on the distribution of income from State revenue in 1936 showed that public health work received only 55/100 of one per cent, or the paltry sum of there cents per capita.
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Chapter VI
STATE HEALTH WORK
1937-1947
The vitality of a state can be measured by the health of its people. Their accomplishments reflect in marked degree their physical condition. In 1937 health conditions were measured:
One-sixth of all deaths from malaria in the United States during the past ten years had occurred in Georgia. For years Georgia had ranked from first to third place in malar:a deaths.
One in every ten persons in the mental hospitals was estimated to be there because of syphilis of the brain. It was costing Georgia taxpayers approximately $150,000 annually to support and care for them.
Only 170 out of 593 incorporated towns in Georgia had public sewer systems. And in these towns onl) 41 per cent of the homes were connected with available sewers. Out of 402,603 rural homes in Georgia ( 1930 Census), it was estimated that less than 100,000 had any means of sanitary sewage disposal.
During 1938-39, dental inspection of 161,343 school children in 98 counties of the State revealed that 72 per cent needed dental treatment
Only one town in Georgia had a milk supply which was on the accredited list of the United States Public Health Service.
It was estimated that communicable diseases accounted for 1,296,551 days of disablement among Georgians during 1938. This was equivalent to 3,552 years. The cost of illness in the State was estimated to exceed $135,802,289 annually.
It was granted that all problems confronting Georgia were interrelated. It was conceded that solution of the health problem was essential to the most effective attack on all other problems responsible for the economic and social ills that beset the State.
Georgia's primary health need was more money to spend for public health and medical care. The situation.... that caused this made it difficult to provide the funds. The low per capita income of Georgians resulted in a vicious circle of which health was an important part. Low income necessitated low standards of living. Many of the people were
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handicapped at the outset by malnutrition. They were unable to provide for themselves good housing or sanitary surroundings, were unable to afford adequate medical attention or to promote preventive health measures, were unable to have access to educational facilities so as to learn the way to better health. This situation restricted the ability of the people to increase their income. Further, those families least able to provide necessary advantages for their children were rearing a relatively high proportion of the oncoming generation-children who, inescapably, were poorly developed, malnourished, and insufficiently educated. Even a casual view of the health situation indicated that this vicious cycle must be interrupted.
Lack of adequate income was no new condition in Georgia, and constantly had been a factor in restricting investment in health. It was realized that human capital was Georgia's greatest asset. While it was impossible to give the definite economic results of disease in the State, the following estimates were significant:
The cost of disabling ailments was estimated by reviewing the cost of medical and nursing attention. The amount of money paid to physicians, nurses, midwives, chiropractors, osteopaths, and hospitals was estimated to be $29,000,000 annually. The annual loss in wages amounted to $14,746,280, allowing an average of $1.00 a day for earnings.
The cost of minor ailments was difficult to determine. Reports indicated that 50 per cent of the persons applying for physical examinations had certain impairments. Other surveys presented evidence that 30 per cent of the people suffered from minor respiratory diseases. Accepting a conservative estimate that 20 per cent of those gainfully employed in Georgia had physical defects, then 358,349 people were restricted in doing efficient work. Estimating that they were only 75 per cent efficient, the economic loss amounted to $33,000,000, provided the average value of their services was $1.00 a day.
The average per capita expenditure for medicine, including physicians' prescriptions, home remedies, and patent medicines, was estimated to be $5.50 per year. Using the estimated 1938 population, it was found that Georgians spent annually approximately $17;048,619 for medicines.
The cost of premature deaths was also difficult to evaluate. Assuming that the loss to Georgia for each preventable death averaged $2,500 and that 50 per cent of the de~~ths could be prevented or postponed, the 33,617 deaths in Georgia during 1938 were equivalent to a loss of $42,021,250.
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Most of the authorities believed that a minimum public health service could be had for approximately $1.00 per capita annually, exclusive of the cost of institutional and medical care programs. On that basis the health service for Georgia would have required about $3,000,000. Only about half of that amount was available.
It was recognized that for this State to have an adequate health program, such a program would have to be financed to a large extent out of 'Federal funds. This need for national assistance was due to the fact that the wealth of the South had long been drained away by national economic policies. It was also considered that local governments could not lay the whole burden on the Federal government.
The prevention and control of communicable disease was the primary objective of every health department. Each year from 75,000 to 80,000 cases of communicable diseases and a resulting 7,000 deaths were reported to the Department of Public Health. It was estimated this probably represented about two-thirds of the cases that occurred.
While sufficient funds were not available to employ persons especially trained in epidemic prevention to be on guard at all times in every community of the State, the State Health Department was in position to give prompt consultative service when problems demanded it. It was still necessary, though, to establish local health departments with trained personnel in every area to attack successfully the problem of disease control.
Nutrition studies showed that the average Georgia diet was below the standard necessary for the maintenance of a satisfactory state of health. It consisted too largely of grain products, fats, and sweets, and contained too little of the protective foods-milk, eggs, fruits, and vegetables. Because of the lack of these foods, the outstanding deficiencies in Georgia diets were found to be minerals and vitamins.
When compared with diets from other sections of the country, Georgia diets ranked low. In 1936 the Bureau of Home Economics, in cooperation with other Federal agencies, made a study of the nation's diet. It was found that a larger proportion of the population in the Southeast had poorer diets than in any other section of the country.
In Georgia and Mississippi, the average income was lower than in other states studied. Likewise, the amount of money spent for food was less than in other states, being $100 per person per year. Low income, though, was found not to be the entire cause of poor diets in the Southeast. Many families with an adequate income selected poor diets.
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STATE OFFICE BUILDING, 1940

Health Funds Available
In 1937, the sum of $444,000 was made available for public health work in Georgia from the State Treasury. That, with what could be matched from Social Security funds through the United States Public Health Service and the Children's Bureau, gave a health budget of approximately $1,000,000. Jumping from a few thousand dollars annually to a million involved great administrative responsibility.
Excellent Health Record For 1940
Although the year 1940 did not set a new low mark for mortality in Georgia, it ranks with the best health years on record. The mortality rate that year was 1033.5 per 100,000 population, an increase of 1.3 per cent over 1939. This slight increase is in agreement with the experience for the general population of the United States. There were 32,285 births, with a rate of 20.7 per 1,000, and 64,695 deaths that year. It was, indeed, reassuring that in this period of international crisis the health of our people-the first line of defense-was remarkably good.
Twenty Years of Health Progress
The year 1940 marks a milestone in the record of mortality among Georgians, completing a downward trend which began twenty years earlier. That these two decades have witnessed great strides in the advancement of the public health is clear from the fact that the death rate from all causes fell 7.2 per cent between 1920 and 1940. This decline in the general mortality has resulted in a rich harvest of lives saved. If the death rate of 1920 had continued in 1940, there would have been 2,488 more deaths in this one year only than the number that actually occurred.
This downward sweep of mortality in the past twenty years is reflected in an increasing length of life. The average length of life in the United States has now reached an all-time high of 62, a gain of 10.9 years in two decades.
The retreat of death has been much more rapid among the urban people than for the rural-population as a whole. The 1939 figures reveal that there were 11,053 deaths in urban areas as compared with 20,772 deaths in rural areas.
The drop of mortality since 1920 has been little short of remarkable at certain ages. In the group of children under one year of age, the present rate of 57.8 per 1,000 was the lowest on record at that time and has decreased 34.6 per cent since 1920.
144

Eleven Causes of Death Established New Low Records
In 1940 no less than eleven diseases and conditions-typhoid fever, malaria, diphtheria, tuberculosis, pellagra, pneumonia, diarrhea and enteritis (under two years), accidents and other violence (exclusive of motor vehicle accidents), infant mortality, maternal mortality, and stillbirths-recorded lower rates than any previous year.
For seven additional causes-namely, typhus fever, scarlet fever, whooping cough, dysentery, influenza, suicide, and homicide-the mortality improved m 1940, although the rates did not establish new minima.
Tuberculosis Declines Steadily
The successful battle against tuberculosis, the major public health problem, continues and 1940 may be added to the long series of years which have witnessed improvements in the death rate from this cause. To measure the degree of success which has attended the campaign against tuberculosis, it is necessary to indicate that the death rate from this scourge in 1920 was 81.6 per 100,000 as against the 1940 rate of 49.1. Giant strides have been made in bringing this disease under control, and wholehearted support should now be given to the program of official and private agencies to eradicate the disease in the next two decades. Tuberculosis led all other preventable diseases in the number of deaths, with 1,533 last year.
Pneumonia Being Conquered
Ranking in importance with other developments in public health for the year was the sharp decline in the mortality from pneumonia. The rate for 1940 was 65.8 per 100,000, having declined from 100.2 in 1935 and 73.6 in 1939. The increasing control over pneumonia in the last few years followed the introduction of highly effective serums and drug therapy which have revolutionized the clinical treatment of the disease. This development illustrates what can be done in the conservation of human life when specific weapons are forged for the campaign against individual diseases.
Influenza Mortality Declines
Despite the epidemic of influenza which swept large sections of the State near the close of the year, the death rate from this disease in 1940 was 29.6 per 100,000_ as compared with 30.4 in 1939, a decrease of 2.8 per cent. This favorable mortality experience reflects the fact that the outbreak had been comparatively mild in contrast with the disastrous epidemics of 1918 and 1919.
145

WHOOPING COUGH CASE AND DEATH RATE
GEORGIA 1920- 1950
60 P---------------------------------------------------------~60

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1920

1925

1930

1935

1940

1945

1950

Number of Cases Not Available Prior to 1925

MEASLES CASE RATE
GEORGIA 1925 1950

180

180

160 1-

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1925

1930

1935

1940

1945

1950

Note: Death Rote is too low to show Qrophicolly

SCARLET FEVER CASE RATE
GEORGIA 1925- 19!50
45r-------------------------------------------------------~4!5

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1930

193!5

1940

194!5

19!50

Note: Death Rote Is too low to show graphically

Mortality From Principal Communicable Childhood Diseases At Minimum
The principal communicable diseases of childhood-measles, scarlet fever, whooping cough, and diphtheria, declined from the' previous minimum of 3.1 per 100,000 to 2.2 in 1940, a decline of 29.0 per cent in a single year. The total death rate for these diseases was much less than the deaths from diphtheria alone twenty years ago. The extraordinary success achieved with diphtheria was sufficient to warrant that the objective of these causes could be nothing less than their complete suppression.
Diarrheal Disease At New Low
The downward trend in the mortality from diarrhea and enteritis was a triumph for the public health movement. Only two decades ago this condition recorded a figure of 43.2 deaths per 100,000. By 1940 the rate had dropped to 12.6, a new low mark and a decrease of 70.8 per cent. The progress in this field may be attributed to the advances in sanitary science, to the general rise in the standard of living, the pasteurization of milk, the better refrigeration of foods, and the purification of water supplies.
Childbearing Safer
Life was becoming safer not only for infants and children but also for mothers. The maternal mortality rate had fallen 43.2 per cent since 1920 to establish the lowest rate ever obtained, 5.3 per 1,000 in 1940. Marked progress has been made in this field, and the campaign against the needless sacrifice of women in childbirth is going forward toward its goal.
Motor Vehicle Accidents Rise
Reversing the downward trend in accident fatalities prevalent the past few years, the number of deaths from motor vehicle accidents in 1940 increased from 21.4 in 1939 to 25.7 in 1940. While this material increase must be regarded as a set-back in the campaign to reduce the number of deaths, there has undoubtedly been an increase in auto travel.
Suicides, Homicides
Fewer Georgians committed suicide in 1940 than in the year before. In fact, the suicide rate of 8.9 per 100,000 for the year just concluded was the lowest in the past ten years.
Homicides have shown a slight increase from 17.9 in 1939 to 19.8 in . 1940.
149

Unfavorable Record For Diseases of Later Life
The increase in mortality which occurred in 1940 was limited almost altogether to the chronic diseases characteristic of middle and later life. The crude death rates from heart disease, cerebral hemorrhage (embolism, and thrombosis), nephritis, and cancer were at high levels. Heart diseases with a rate of 197.7 in 1940 were at the highest level ever recorded. Cerebral hemorrhage showed an increase from 46.1 in 1920 to 97.2 in 1940. Nephritis increased from 76.0 in 1920 to 107.2 in 1940. Cancer had increased from 38.8 in 1920 to 62.7 in 1940.
To a large degree the upward trend in mortality from these diseases reflects the increased proportion of people at the older ages. These causes of death will probably increase in relative importance in the next few decades. Public health and medical practice in the future must be directed more and more toward the prevention and postponement of these disabling diseases. The adequate instruction of all the people in the methods for combatting the heavy toll of chronic illness in later life is one of the paramount issues facing medical practitioners and public health workers.
CANCER CONTROL INITIATED
The Georgia Department of Public Health officially entered the field of cancer control in 1937 when the State Legislature passed a cancer law making it mandatory for the Department to provide facilities for the treatment of indigent cancer patients. On October 1 of that year, a division of cancer control was established in the Department.
A cooperative arrangement which was set up for the purpose of developing a smooth working relationship between the Medical Association of Georgia, the Department of Public Health and the Georgia Division, American Cancer Society was highly effective and became a model for many other states. An executive committee of the Cancer Commission acts in an advisory capacity to the Cancer Control Service, Georgia Department of Public Health. The same group, plus additional members, acts in an advisory capacity to the administrative officer of the Georgia Division, American Cancer Society. Thus, the activities of all interested groups are coordinated without any overlapping of services.
Following the organization, a survey was made of existing facilities in the state. In addition to the organized clinics certain facilities (such as varying amounts of radium and deep x-ray therapy units) were available in Americus, Columbus, LaGrange, Rome and Savannah.
150

There had been some sentiment in favor of the construction of a central state hospital. This would have had the advantage of a uniformly efficient staff, greater uniformity with respect to surgery and radiation and greater efficiency in the matter of record keeping and follow-up service. The great disadvantage at that time appeared to be the initial cost of construction and the annual operating expense. Subsequently, the decentralized program which was decided on with the organization of local clinics has been shown to have other advantages: each organized clinic has acted as an educational center for physicians and has stimulated lay interest; moreover, indigent patients did not have far to travel. These combined effects have tended to result in earlier diagnoses.
Regulations were established under which state-aid clinics would be approved. These were essentially similar to the minimum requirements recommended by the American College of Surgeons. Clinics were approved as soon as they were able to meet the requirements.
It was also necessary to establi~h the conditions of approval for stateaid. It was decided to have the local family physician make application for state-aid on an official form and certification as to eligibility was to be made by the county welfare department. The administrative aspects concerning the referral of patients was assigned to the Division of Cancer Control.
With reference to payment for clinic services, it was decided that the staff physicians would donate their services free of charge and other services would be paid for at cost. A committee was appointed to work out a schedule of fees for certail'. hospital services, x-ray examinations, radium therapy and x-ray therapy.
Within certain limits, it was necessary to define from a medical standpoint the type of case which would be acceptable under the program. These and many other details had to be considered in formulating a plan of operation. When finally the plan was complete, the physicians of the state were notified that eligible patients could be referred for treatment. The first state-aid cancer case reported to the Thomasville Clinic on November 15, 1937.
During the period when the program was in the planning phase, it was decided that the Department of Public Health should provide a state-wide service for the microscopic examination of neoplastic tissue in indigent cases. This would involve a pathology laboratory and a full-time pathologist who would also serve as director of the division.
In January, 1938, plans for a pathology laboratory were completed
151

and a pathologist was employed on a full-time basis. He served for more than a year in this capacity and as director of the division.
The tissue diagnostic service was not successful for a number of reasons: 1. A large number of the specimens submitted were tissues removed during surgical operations at local hospitals, consisting of gall bladders, appendices, uteri, etc., in which there was no reason to suspect malignancy. 2. The method proved to be much more expensive than the examination of tissues by private pathologists on a cost basis. The latter method involved only the examination of tissues secured at the state-aid clinics. 3. It is highly desirable for the pathologist who examines a specimen to be a member of the clinic staff and participate in the discussions concerning the patient.
The number of patients seen in the clinics has increased greatly since the war. The cost of the program increased even more rapidly.
The initial appropriation of $50,000.00 per year was not sufficient to carry the program and for a period of 6 months in 1939 no money was available to provide state-aid. Since that time, however, there has been no interruption in the service.
Originally a rate of $3.50 per day was paid for hospital board plus certain fees for anesthetics, dressings, operating room service, etc., which, on an average, amounted to an additional $1.00 per day. As prices rose, of course, it was necessary from time to time to raise the rates for hospital board. By 1950 a flat rate of $7.00 per day, including accessory services, was being paid to all the hospitals participating in the program. Some of the hospitals were losing heavily with that rat~ while others were breaking even. The wide variation in hospital costs was taken into consideration and on July 1, 1951, a rate schedule went into effect which now pay~ for hospitalization at 75 per cent of actual cost.
During the time the state-aid program has been in operation and particularly in recent years, certain undesirable tendencies have been observed. In many rural counties there is a tendency to use the clinics as general diagnostic clinics and to refer patients with obscure symptoms for the purpose of getting a diagnosis. Also, in many areas there is an increasing tendency to pay less and less attention to the patient's ability to pay. Steps are now under way to modify to some extent the method by which patients are approved for state-aid and to give more direct supervision in that respect to the cancer control service. It is felt that this will materially reduce the patient load and to a similar extent, the cost of the program.
152

Georgia State-Aid Cancer Clinics

According to Year of Approval

Year 1937 1937 1937 1937 1937
1938 1938 1938 1938

Clinic
Augusta Tumor Clinic University Hospital Macon Tumor Clinic Macon City Hospital Robert Winship Memorial Clinic Emory University Hospital Sheffield Tumor Clinic Georgia Baptist Hospital Thomasville Tumor Clinic John D. Archbold Memorial Hospital Columbus Tumor Clinic City Hospital Dalton Tumor Clinic Hamilton Memorial Hospital LaGrange Tumor Clinic City-County Hospital Savannah Tumor Clinic 612 Drayton Street

Year Clinic
1938 Waycross Tumor Clinic Ware County Hospital
1939 Americus Tumor Clinic Prather Clinic Building
1940 Canton Tumor Clinic Coker's Hospital
1946 Athens Tumor Clinic Athens General Hospital
1947 St. Joseph's Tumor Clinic St. Joseph's Infirmary
1947 . Valdosta Tumor Clinic Little-Griffin Hospital
1948 Crawford Long Tumor Clinic Crawford Long Hospital
1948 Rome Tumor Clinic Floyd County Hospital

The Steiner Clinic, Grady Memorial Hospital, is an approved clinic but by agreement accepts all patients from Fulton County without

charge to the state.

Georgia State-Aid Cancer Program

Number of Patients and Cost By Years

Year

Number Patients

Cost

1938 (including Nov., Dec., 1937) 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949

1,419 647
1,616 2,057 2,226 2,047 1,917 2,010 2,360 2,893 3,618 4,054

$100,000.00
65,893.76 78,826.14 91,181.37 84,694.91 83,275.64 88,845.13 116,321.32 161,442.03 214,472.82 255,030.08

The number of patients listed for each year includes both malignant and nonmalignant cases.

The average cost per cancer patient treated was $54.22.

153

CANCER DEATH RATE
GEORGIA 1920 - 1950

95

95

85

85

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1920

1925

1930

1935

1940

1945

1950

LOCAL HEALTH ORGANIZATIONS
For the first time, in 1937, funds became available under the Social Security Act sufficient for grants-in-aid to all the counties in the State for use in local public health work. Eleven new counties began operating health departments immediately as a consequence of this aid.
On July 1, 1939, a plan for the decentralization of the services rendered by the State Health Department was put into operation whereby six regional health departments were established. The personnel of these regional departments consisted of a medical director, a consultant nurse, two sanitary engineers, and a cle~k. The organization of these regional offices was accomplished without additions to the payroll, with the exception of three clerks. The other staff members were taken from the various divisions of the central administration.
The regional health personnel took over initial investigation of reported communicable diseases and complaints regarding insanitary conditions. The regional personnel rendered aid and advice where emergencies arose and conducted promotional and educational programs in the unorganized counties. They also supervised and directed the work of public health nurses in those counties having nursing service only.
The small counties unable to undertake the establishment of fulltime health departments were offered grants-in-aiA forpublic health nursing service. These grants were arranged according to the population of the county: in counties with less than 7,000 population, the State agreed to pay two-thirds of the cost of nursing service; in counties with a population of 7,000 to 10,000, one-half; in counties within the population range of 10,000 to 14,000, one-third. In each instance the counties paid the remainder of the nurse's salary and travel, plus a small amount for a contingent fund, and furnished office space and equipment. For counties having a population over 14,000 no financial assistance was offered, except toward establishment of a complete health department.
A personnel training program was inaugurated by the State Health Department and through 1939 had included public health training for 54 medical officers, 40 sanitarians, 150 public health nurses, and six laboratory technicians. This was necessary for promoting local health work for the reason that qualified commissioners of health, nurses, and other personnel were not available.
The total number of counties having fulltime health service in 1940
155

was 55. The population served by these departments was 1,893,441, or 60.7 per cent of the State's population. This, with the population served by nursing counties, totaled 74.5 per cent of the population of Georgia with some type of local health service.
In 1939 there were 510 persons employed in organized counties, while in 1940 there were only 498. By 1941, all the county health departments in the State met the requirement~ of the State Health Department and the U. S. Public Health Service for financial participation.
The advent of the national defens~ program brought an increase in the responsibilities and obligations of public health departments. Several large defense projects and military camps were located in the State. An influx of laborers created acute problems of housing and sanitation. Food and milk supplies were found to be inadequate and unsatisfactory in several places.
In addition to increased responsibilities and duties resulting from the defense efforts, the problems were further augmented by the loss of public health personnel. Many of the medical men and sanitary engineers held reserve commissions in the armed forces. Numerous calls to duty depleted the already inadequate personnel.
Added services and responsibilities consequent to the large number of war projects located in Georgia since 1940 were assumed by the affected local health departments with cheerfulness and zeal. The fact that no epidemic occurred as a result of the concentration of population bears witness to the effectiveness of the labors of public health workers, despite the shortage of personnel who continued to resign to enter military service.
In 1941, 9 public health physicians, 20 engineers and sanitarians, and 10 nurses resigned to serve in the armed forces. Replacements were possible for only a few of these vacancies.
Local health personnel also planned effectively for civilian defense and gave freely of time and effort to get the plan of emergency medical service in readiness. The Surgeon General of the U. S. Public Health Service, in January of 1942, said:
"The United Nations fighting for freedom face a new year begun in sorrow because it brings widespread destruction of human life rather than the continuing effort to save life and lessen suffering. Important as has been the task of public health workers in the past, it is transcendent urgency now in the battles to defend our freedom. Not only must we hold the lines against preventable disease in the population sustaining
156

the armed forces and producing the essentials of war; we must also translate scientific fact into positive action for three-thirds of our people in order to raise the level of strength, endurance, and morale for the grim work ahead. Let us reappraise our own efforts, having the patriotism to discard from our plans whatever contributes little to national needs, and the courage to move ahead boldly where we can add to national strength. Ours is the responsibility for leading the fight against the weakne~ses within which impede attacks upon the enemy without."
For this reason, many public health workers in Georgia remained at their stations, performing the tasks for which they were prepared, rather than following their desires to don the uniform of one of the armed forces. For this they deserve the gratitude of the State and the Nation.
In the beginning, the principal objective of the local health division was the promotion of county health departments. Much of the time and effort was spent trying to convince the people of the need for and the value of public health service. Often it was harder to get local authorities to appropriate the necessary funds than it was to convince the people of the need for such service.
Twenty years after the passage of the Ellis Health Law, only 31 counties with a population of 1,413,663 had departments of health. By 1942, 59 counties with a population of 1,960,851 had such departments.
From the passage of the basic health law in 1914, providing for local health departments, until 1943 no major changes were made in the law. The Ellis Health Law, in 1943, was amended to facilitate the establishment of county departments by eliminating the necessity for two successive grand jury recommendations; to establish a single board of health for the county, including the towns and cities therein, permitting or requiring members of the board appointed by the towns or cities and providing for financial participation by the towns and cities, and by the State; to permit the formation of health districts of two or more counties without regard to population; and to enlarge and liberaliz~ the duties of the commissioner of health. That same year, a new law was passed placing the State and county health departments under a statewide public health merit system.
157

County Health Work in Georgia, 1915-1942

Year
1915 1920 1925 1930 1935 1940 1941 1942

Number organized Population counties served

2

17,545

18

4::\6,106

23

59R,107

34 1,011,974

31 1,327,018

55 1,893,441

56 1,920,119

59 1,960,851

Total budget
$ 4,637.00 72,695.00 179,812.00
451,217.00 459,292.00 1,066,126.20 1,124,729.00 1,370,304.90

Per capita

County budget

Per capita

.26 $ 4,637.00 .26

.17

70,895.00 .16

.30 168,272.00 .28

.45 440,904.00 .44

.35 399,256.00 .30

.56 785,049.20 .41

.59 818,065.59 .42

.70 956,863.05 .49

Development Board Appointed

In 1943, the General Assembiy authorized the appointment of an Agricultural and Industrial Development Board to further study conditions of the State and to make recommendations for the more efficient use of the State's resources and for the improvement of the moral, physical, and financial status of all citizens. A panel of this Board was appointed to make a survey of public health work, hospitals, physicians, and other facilities for medic.al care, and to make recommendations.

Every county in Georgia was visited and surveyed by trained persons selected by this panel. The study was thorough and exhaustive. The conditions found were far from satisfactory or adequate to meet the minimum needs of the people, and recommendations were made for their correction.

The plan called for considerable increase in appropnat1ons. The most difficult part was to get approval of the expenditure of the necessary funds. An Advisory Council to the State Board of Health was of inestimable help in convincing the "powers that held the purse strings" to provide the increase. The appropriation for the Health Department was $600,000, at that time. To finance the expanded program some $2,000,000 would be required.

But with the sympathetic help of the State Auditor and the Budget

Commission, the budget for the Health Department was set up for

'

$2,100,000 and was eventually accepted by the General Assembly. The

plan had strong support from many organizations and the farsighted

vision of the State Auditor was a deciding factor in this achievement.

158

In the overall expanded health plan was a project for hospitals and health centers which was completed in 1944. The Hill-Burton Hospital Construction Bill was not proposed and enacted until 1946. A study of the plan recommended by the Health Panel in 1944 shows that the national program provided under the Hill-Burton Bill is similar. It is apparent that Georgia helped set the pattern for a national hospital building program.
The long awaited termination of World War II permitted the gradual demobilization and return of some of the service men and women to public health work. Salaries received by personnel in the armed forces made the compensations offered by public health work seem inadequate to many. This was particularly true of nursing and engineering personnel. Numerous well qualified and experienced individuals whose primary interest had been public health returned from the war to find that when increased living costs and the needs of their own families were taken into consideration they must leave public health and enter other fields. Frequently the new field was one which required less training and experience and yet paid a salary more commensurate with the worth of the individual.
Despite the fact that doctors, nurses, and sanitary personnel were returning to Georgia, there were fewer counties getting local health service at the end of 1945 than at its beginning.
Increasing requests from counties for the establishment of local health or nursing service were being received. Communities that had previously been indifferent to their needs for community organization relative to the furtherance of public health repeatedly expressed themselves as desirous of doing everything possible in order to obtain the services of public health personnel.
In view of the fact that Georgia has 159 counties and 132 of these have a population of 25,000 or less people, any efforts made in furthering public health activities were directed toward the formation of multiple county units each having a population as near 50,000 as possible.
Over a third of a century had passed since the first two county health departments were organized in Georgia. Only two other states had county health departments at that time and both of these county health departments were organized because of acute emergency.
Georgia was among the first of the states to enact laws authorizing single county and multi-county health departments.
It is generally recognized that local health departments arc the
159

foundation and bulwark of efficitnt and effective health protection. It is the concensus of opinion of public health authorities that a minimum efficient local health department should consist of one medical officer to each 50,000 population, a public health engineer or sanitarian t;> each 20,000, a public health nurse to each 5,000, and sufficient clerical personnel, or one to each 15,000 to 20,000. To this could be added one or more part-time medical clinicians, a part-time dentist, a public health educator, and a nutritionist. The State Health Department adopted the policy of giving financial assistance on this basis.
This means that a county having a population of less than 50,000 may unite with another county or other counties to form a health district. As of December 31, 1947 there were budgetary arrangements for eight two-county, ten three-coqnty, and two four-county health districts, although only eight of the&e counties operated continuously with a medical officer in charge.
Few local health departments had adequate staffs. In 1947, the need was for 40 public health physicians, 200 nurses, and at least 25 sanitarians to implement public health programs in Georgia.
SANATORIUM FACILITIES EXPANDED
In 1937, when the State discounted rentals on the Western & Atlantic Railroad, 10 per cent of the money received from the discount was assigned to construct an additional tuberculosis hospital building at Alto. Matched with national funds, an additional fire-proof building was constructed and opened for patients. This made a total of 525 beds available.
In 194.5, with the cessation of hostilities, negotiations were started by the Federal government to secure one of their military hospitals for the use of tuberculosis patients for the Veterans' Bureau. The Bureau objected to this move for providing tuberculosis hospital services for veterans, and the effort was abandoned.
When this became apparent, immediate efforts were made by the State Health Director to secure the military hospital at Rome for the use of State tuberculosis patients. After many difficulties, Georgia secured the hospital at Rome, 'Which has a capacity of approximately 2200 beds and was opened by the State on June 20, 1946.
All patients then at Alto were transferred by special train and Battey State Hospital, as it is now known, became the official state tuberculosis sanatorium. With increased maintenance appropriations, the hospital was opened with approximately 475 patients.
160

STATE TUBERCULOSIS SANATORIUM, AT ALTO, 1937

Battey Hospital, with an enviable war record of service to the Nation's fighting forces, was effectively converted to peacetime duty as a State tuberculosis hospital. This hospital provided a potent weapon against tuberculosis in Georgia which claimed more than 1,000 lives yearly at that time.
The Battey property was composed of 160 acres with 121 buildings of brick and tile construction. In addition to five groups of inter-connected hospital buildings, there are administration buildings, personnel quarters, recreation building, a guest house, gymnasium, auditorium with theatre facilities, an attractive chapel, and a bath house. Physical therapy facilities are included in the hospital property. On the hospital grounds were located an athletic field and swimming pool.
With the additional facilities for treatment of tuberculosis made possible by the acquisition of Battey Hospital and a greatly expanded program of x-raying apparently well people and suspected cases of tuberculosis, the menace of the disease was dealt a crushing blow.
Beginning in 1941 and 1942, pneumoperitoneum (the introduction of air into the abdominal cavity) was tried at the tuberculosis sanatorium and it soon became a very beneficial measure of treatment. Its value was recognized in the treatment of tuberculosis of patients in rural areas where training of physicians and the management of pneumothorax was incomplete and where a less complicated procedure could be used.
The philosophy of treatment from 1931 up through 1945, when the institution was moved to Rome, was that of getting in as many patients as possible, start collapse treatment and attempt to reverse the sputum and thereby cut down the number of sources of infection throughout the State. That procedure existed and was made necessary by the fact that there were not enough bed~ available for every patient, although the ideal was being more nearly approached from year to year.
In 1946, antibiotic streptomycin became available and was seized upon by the staff at the state sanatorium as an answer to their prayers. There are hundreds of lives that have been saved by the use of this drug and hundreds of patients who are living and for whom sanatorium care is necessary that would have died without the use of the drug.
From 1911 through 1949, 19,175 patients had been admitted to the sanatorium and 16,731 had been discharged. Of those discharged 25 percent were quiescent or arrested, 38 per cent improved, 27 per cent unimproved, and 10 per cent deceased.
It is estimated that five years, at least, have been added to the life
162

BATTEY STATE HOSPITAL, 1946

of each patient admitted to the sanatorium and about 100,000 years to the lives of Georgians throughout this period. The death rate from tuberculosis, in 1922, was 92.6 per 100,000 population, or a total of 2,683 deaths. In 1949, there were around 900 deaths, a reduction of two-thirds.
In the early years of the sanatorium history, minimal and moderately advanced cases were admitted far more frequently than were far advanced cases. With the advent of mass survey techniques, the number of minimal cases gradually increased. With the use of the newer drugs and newer methods of treatment, more far advanced cases were admitted for treatment and isolation purposes.
There has been a gradua! shifting of the population group admitted with tuberculosis from the very young to the older age group. In 1916, 88 per cent of all admissions were under 40 years of age. In 1941, this percentage had dropped to 56 and the number over 40 years of age had risen from 12 to 44 per cent.
The treatment of tuberculosis is a long term problem. In 1916, the average patient stayed 156 days. This has been increased through the years until in 1949 the average stay was 610 days. In the beginning the hospital was primarily for education to teach the patient how to "take the cure" and how to take care of himself. In 1941, hospitalization was primarily for treatment. Education still holds an important place but every effort was made to carry all patients to the point where they could be discharged with three to four hours exercise, or light work privileges.
MATERNAL AND CHILD HEALTH
In 1937, when Social Security funds became available for maternal and child health work, both an obstetrician and a pediatrician were added to the MCH staff. Soon both infant and maternal rates showed sharp declines.
Maternity and infant health centers were established on a greatly expanded scale throughout the State. By 1940, these totaled 310. Private physicians were engaged to participate in the work of these clinics on an honorarium basis.
A special maternal health demonstration was established in Tift County, in 1938, and the maternal deaths declined steadily as a consequence. By 1940, home delivery nursing service was given over 94 per cent of the cases.
164

A nutrition section was added to the MCH staff in 1940, and a survey of special nutritional problems was the first activity. That same year, audiometers were provided local health departments for testing school children's hearing.
The staff pediatrician perfected plans for an economical incubator for premature infants. Construction was arranged under a Works Progress Administration project and 189 were built the following year. These were assigned to local health departments throughout the State for immediate availability in time of need.
Continuous efforts were made to improve the services offered at MCH clinics. Standards for the provision and maintenance were adopted for appropriate quarters, fixtures, and medical equipment. A manual of operation was also prepared. Standard record forms were adopted.
By 1942, the staff had been depleted by the death of its director and the call to active duty in the armed forces of other physician staff members. Only one physician remained and he was assigned to parttime duty as chief of emergency medical services for civilian defense.
The problem of illegitimacy was highlighted in 1943 at the Georgia Social Welfare Conference. It was noted that for the past 20 years, the white illegitimacy rate increased from 11 to 14 per 1,000 live births and the Negro rate from 120 to 171 per 1,000 live births.
A plan for providing emergency medical care for wives and children of men in the lower pay grades of the armed services was instituted in Georgia on September 15, 1943. By the end of 1947, 24,310 mothers and/or infants had been approved for medical and/or surgical care, at a cost of $1,605,534.38.
Lack of medical personnel in the state office greatly handicapped the maternal and child health work, and shortage of local commissioners of health further complicated expansion of these activities.
Much new equipment was furnished the maternal and child health centers. Audiometers, slide projectors and vision and hearing testing machines were placed in the six regional health offices for use in the schools.
The laboratory of the Department was equipped to do Rh factor testing and blood group determinations on prenatal cases. There was a gradual reduction in premature deaths per 1,000 live births. In 1946 premature infant deaths were 12.1 per 1,000 live births as compared with 15.2 in 1942.
165

For the ten year period 1937 through 1946, infant mortality and deaths in children from one to four years of age showed a marked decrease from all causes except measles and congenital malformations. Infant mortality declined from 62.0 deaths per 1,000 live births in 1937 to 35.8.

Number of Deaths and Rates Per 100,000 of The Age Group 1-4 Years by Cause of Death For 1937 and 1946

Cause of Death
All Causes _________ . -----
Measles -- --- ----------- Whooping Cough ........... ........ ..... Diphtheria .... ...... ___ .......... .. ..... Influenza ......... .. .................. ......... .. Dysentery ............. ______ .. .. .... . ... .... .
Poliomyelitis ----- Men. Meningitis __________ ...... ....... .. Tuberculosis .... .. ......................... . Pneumonia ........ ...... .............. .... .. . Diarrhea & Enteritis _______ ........... .. Scarlet Fever _______________ ......... ... .....
Tetanus .............. .... .... ... ... ... .......... .
Syphilis ---- ------ -- ----- Congenital Malformations .. .. ..... .

1937 Deaths Rates

1122 414.35

3

1.10

47

17.35

70

25.85

71

26.22

26

9.60

8

2.95

10

3.69

25

9.23

217

80.13

195 72.01

6

2.21

2

.73

4

1.47

9

3.32

1946 Deaths Rates

559 220.84

18

7.11

19

7.50

31

12.24

27

10.66

2

.79

5

1.97

8

3.16

14

5.53

82 32.39

23

9.08

1

.39

2

.79

2

.79

19

7.50

A nurse-midwife demonstration service was established in Walton County in connection with the county hospital, and the two nurse-midwives assisted the doctors with the labor and delivery of 303 private cases in 1947, and delivered 64 cases or. the nurse-midwife program. A home delivery service was also begun in Thomas County with two nursemidwives in attendance. They delivered 15 cases in a six-month period.

The place of nutrition in a public health program was beginning to be recognized, in 1947, as a basic part of almost every phase of public health work. The extent of malnutrition in Georgia was not adequately known, but it was believed that subclinical states of malnutrition were much too prevalent.

The hemoglobin level is generally considered a fair index of the nutritional status of the individual. In 1945, hemoglobin readings were made on over 3,500 school children in the State. Of this number eight per cent had readings of 14.5 gms. or more.

166

INFANT MORTALITY RATE PER 1,000 LIVE BIRTHS
GEORGIA 1920 - 19!50

eo

80

70

70

60

60

50

!50

40

40

30

30

oT~------~'------~~------~------~'--------~'------~To

1920

192!5

1930

193!5

1940

1945

19!50

MATERNAL MORTALITY RATE PER 1,000 LIVE BIRTHS
GEORGIA 1920- 1950
It ATE
12r--------------------------------------------------12

10

10

8

8

6

6

4

4

2

2

o~------~------_.------~~------._------~------~0

1920

1925

1930

1935

1940

1945

1950

STILLBIRTHS- RATE PER 1,000 LIVE BIRTHS
GEORGIA 1920 - 19!50
RATE 70~--------------------------------------------------~70

60

60

50

50

-C'l

40

40

t.O

30

30

20

20

10

10

o19-2-0------'1-92-5---__,j~19o3.0..-----1.9.3.5.-------1-9'4-0-----...1.9_4!5_------1-95o0

In one county dietary studies were made on 1,367 school children. Of this number, only 16 per cent scored as having adequate or good diets. In 1946, there were 93 dea,ths from pellagra in Georgia.
Poor diets were attributed to lack of knowledge, lack of interest, and inadequate income. The greatest handicap was considered to be lack of interest or poor eating habits. Many persons who could afford to buy adequate food and who knew what they should eat were found to have poor diets through lack of interest. Although nutritionists considered the diet of the American people as a whole the best that had ever been attained, there was much evidence available showing considerable room for improvement.
VENEREAL DISEASE CONTROL
Beginning in 1937, Social Security Funds also became available in sufficient amounts to initiate a concentrated attack on the venereal disease problem. It was prophesied for the first time that substantial victory over venereal disease could come within the present generation.
The distribution of free antisyphilitic drugs was made possible by the increased Federal funds for the treatment of all indigent and semiindigent patients. By October 1938, a total of 225 doctors in 79 counties of the State were participating in a venereal disease clinic program.
Three Counties Against Syphilis
A mobile venereal disease clinic was established in Glynn, Mcintosh, and Camden Counties in 1937 and 1938 that attained national recognition for its work, principally among the colored population. The "Blood Wagon" as it was called helped popularize venereal disease control in Georgia and led to a concentrated attack on the problem in all sections of the State. Blood testing was completed on more than eighty per cent of the Negro population. Adult males showed a positive test for syphilis in 32.2 per cent of the results; adult females showed a rate of 33.6 per cent positive.
The clinic on wheels drove an average of 519 miles a week to treat 529 patients at 24 stops. It was fully equipped with electric sterilizers, refrigerators, treatment tables, and office desk. Behind a curtain in the rear was a room for the administration of treatment drugs.
By 1939 sufficient funds were available to supply antisyphilitic drugs for treatment of all syphilitic patients, regardless of their financial status. The following year alone, 1,646,401 doses of these drugs were distributed.
170

Results of the first million blood tests on selective service registrants showed that of the 18,102 Georgians examined 13.4 per cent were found to be infected with syphilis. When further analyzed, these figures revealed that the rate for the colored selectees was approximately ten times as high as for the whites; 31.3 per cent, as compared with 3.3 per cent for the white.
When the first two million selectee blood tests for syphilis were reported, Georgia had the third highest rate in the Nation. According to this tabulation, 145 out of every 1,000 male Georgians of draft age were infected with syphilis, as compared to the national average of 45 per 1,000. Further study showed that 275 out of every 1,000 colored draftee had syphilis, as compared to 34 out of every 1,000 white. Cooperation with Selective Service Boards was begun and all selectees with positive syphilis reports were followed up through local and other field personnel.
Rapid Treatment Begun
At the American Public Health Association meeting in October 1943, a dramatic episode in the fight against syphilis occurred when announcement was made of the first successful treatment by penicillin of four early cases of syphilis. After sixteen hours of this treatment, no spirochetes were observed.
The U. S. Public Health Service, with cooperation of the State and local health departments, began the operation of two intensive treatment centers for venereal disease in Georgia-the Southeastern Medical Center in Savannah and the Piedmont Medical Center in Augusta. The hospitals were operated primarily to treat primary, secondary and early latent (under two years duration) syphilis and untreated or chemoresistant (resistant to sulpha drugs) gonorrhea. The penicillin panel of the National Research Council designated the two centers to act as a unit of evaluation of penicillin in the treatment of syphilis. Injections were given every three hours for thirty doses providing a total dosage of 2,400,000 Oxford units over a period of four days.
Until the advent of the rapid treatment centers, the average person with syphilis was faced with the prospect of undergoing weekly treatments for a period of 15 months to two years. Such therapy gave way to the one-shot treatment for gonorrhea and the four day rapid treatment for syphilis.
Study of 1605 syphilis cases admitted to State clinics showed that 20.2 per cent had transferred to private physicians, left State; or entered
171

the armed forces, or died. Of the remammg 1279, 251 (19.6%) received maximum benefit; 954 had lapsed (74.6%) their treatment; 887 (69.4%) had received less than 20 arsenicals and 20 heavy metals, the required minimum to make them permanently non-infectious. More than 4,000 visits and 5,000 letters were written in follow-up work. These figures show the inadequacy of routine clinic treatment. Of the 1445 early cases admitted to the rapid treatment centers 1387 (96%) were discharged as having received maximum benefit. Of these 85 per cent of the admissions were voluntary.
In ,February 1944, approximately 45,000 individuals with syphilis were under treatment in Georgia. The two special treatment centers established at Augusta and Savannah were still in operation. Individuals who refused to be treated for their disease could be sent to these centers and kept until treatment was completed. Others who wished to undertake a rapid treatment for syphilis were also admitted to these centers.
There was evidence to believe that the venereal program had finally begun to catch up with the huge backlog of neglected cases with which it was saddled in the beginning. By this time, 71.7 per cent of venereal disease cases reported by clinics were early cases of public health significance.
Mass Testing Initiated
Beginning in October 1945, the State Health Department, and the U. S. Public Health Service sponsored a 45-day mass blood testing and tuberculosis case-finding survey in Savannah and Chatham County. In the project, 71,149 blood tests were made and 12,420 or 17.4 per cent were found positive.
In the mass blood testing program, an intensive publicity campaign was utilized to acquaint the people with the dangers of untreated syphilis, the symptoms of the disease, and the possibilities of cure. Feature articles, editorials, schedules of testing stations, and full page advertisements appeared in all local newspapers. Radio stations broadcast dramatic sketches, spot announcements, and talks on venereal disease. Sound trucks were used in selected sections, with popular records played between announcements. Splendid cooperation was received from local churches and from industrial, social, and civic organizations.
This mass testing program has been expanded to accomplish 324,520 blood tests since October 1945.
The policy of referring to rapid treatment centers all infectious or
172

potentially infectious cases gave the local health workers more time for case-finding, reduced the spread of the disease by isolating the infectious persons, and resulted in a higher percentage of cases adequately treated.
In 1947, local venereal disease clinics were discontinued and gonorrhea cases were encouraged to secure treatment from private physicians. This year a possible trend downward was indicated in the incidence and prevalence of syphilis in Georgia.
A communicablf' disease investigation program was inaugurated in . Georgia during thf' latter part of 1947, in cooperation with the U. S. Public Health Service. Because of the large number of counties having the services of a public health nurse only and those having no service at all, investigation of the contacts of infectious syphilis could not properly be done. It was decided that young men with a college background, trained in the clinical and epidemiological aspects of venereal disease and in the technique of contact investigation could handle the work in unorganized counties, working through the regional health offices.
Georgia led the nation in the number of infectious syphilis cases brought to treatment, although some of the neighboring states have treated a much larger number of syphilis patients. This indicated that the program was well directed from the standpoint of controlling the spread of syphilis and also reflects the fact that during the past few years a large percentage of the backlog of syphilis prevalence has been removed through effective case-finding and treatment procedures.
Venereal disease is too complex to be confined alone to medicine and public health. The problem of its solution reaches out into law, religion, social work, education, economics, and into every aspect of culture.
DENTAL HEALTH
In 1937, the dental health unit was reorganized into a separate service with a part-time dentist in charge whose time was given to administration and the promotion of the program through the dental profession of the State. At this time, two !'ducational workers were devoting their time to the organization of counties for dental inspections, and to educational work with schools, parent-teacher associations, 4-H clubs, teachers, and other groups.
First Statewide Dental Inspection
The first statewide dental inspection was made in 1934-35 with 87,901)
173

children in 28 counties inspected. State, district, and county chairmen were furnished by the Georgia Dental Association for the purpose of making yearly dental inspections.
County health de'partments, schools, public health nurses, and parentteacher associations prepared for and sponsored the school dental inspections. Printed materials for the inspections were furnished by the State Health Department and the inspection blanks were returned to the Department for tabulation.
Because dental corrections were made in dental offices and not in clinics, it was difficult to estimate the number of corrections. Indications were that an increasing number of children received dental corrections.
Three years after the dental inspections were initiated, the total number of children inspected had reached 167,588.
Refresher Coune in Children's Dentistry
A refresher course in children's dentistry was given, in 1938, for the dentists in Georgia. Suitable programs were arranged in five localities with an attendance of 220 dentists.
A second refresher course for white dentists was held in 1939, with 225 in attendance. This same year, a two-day dental program was presented for the Negro dentists at their annual meeting, at which 26 attended.
Dental Clinics
Local committees and counties were encouraged to provide dental corrections for indigent children. Without financial aid from the State, 10 counties, in 1940, were operating free dental clinics.
The following year, five counties ~ere selected in which to experiment with dental clinics for indigent children. From information gathered in these experimental clinics, a method of paying honoraria to clinicians conducting dental clinics was adopted. Under this plan, all organized counties that qualified were offered dental clinics. By the end of the year, 13 counties had begun dental clinics under this arrangement.
The primary objective of the dental health education program was to stimulate dental corrections; to encourage people of self-supporting families to secure dental corrections regularly and to prevent the accumulation of dental defects by beginning a regular program of dental care for the child.
174

The dental clinic plan, adopted in 1940, operated in 27 counties by 1942.
Dental Caries Study
A study of 24,092 Georgia children in 12 communities was made in 1946, to determine dental caries prevalence and tooth mortality. It was found that the prevalence of dental caries in permanent teeth varied in the different places studied. The annual increment of dental caries in permanent teeth also varied from place to place.
Evidence was presented which indicated that no significant variation in caries experience could be attributed to economic status. There was some evidence, though, that the prevalence of dental caries in permanent teeth was increasing.
Individuals in the high economic strata experienced significantly lower tooth mortality rates than those persons in the lower economic levels, except where concerted efforts were made to save teeth by dental care.
Application of Sodium Fluoride Begun
Approval and endorsement of topical application of sodium fluoride as a dental caries preventive by the U.S. Public Health Service and the American and Georgia Dental Associations was a feature of dental health progress in 1947. Studies had previously shown the possibility of reducing dental caries attack rate by 40 to 50 per cent. Many dentists began using this treatment routinely in their practice.
Dental health education has benefited greatly by new and effective educational publications prepared for primary grade children. A booklet, "Frank Visits the Dentist" and dental health bookmarks were prepared for use in schools and public libraries.
STATISTICS GROW
A demand for certified copies of birth and death certificates began soon after the division was organized and increased gradually until 1940. That year Federal regulations made necessary the establishment of citizenship, which meant a birth certificate for the majority of native born Georgians. Arrangements were made for delayed registrations of births, as few births were recorded in Georgia previous to 1920. Over 10,000 certified copies of birth and death certificates were issued in 1940. After the Pearl Harbor attack the division was deluged with demands for certified copies of birth certificates. Nearly 20,000 were
175

NUMBER OF LIVE BIRTHS AND DEATHS
GEORGIA 1920 - 1950

85

85

-.,

--...!
0'1

.~c, 65
~
0

2:

.!:

a:: 55

Ill
:1
z~

45

75
65
LIVE BIRTHS 55
45

35

25 oT , .
1920

I I

I

1925

DEATHS

I I

I

1930

II
1935

' II 1940

I

II

1945

35
25
To
1950

issued in 1941. In 1942 nearly 75,000 were issued. It was necessary to expand both quarters and personnel for this purpose.
A new vital statistics law was passed by the 1945 Legislature providing improvements in registration methods and more accurate personal and medical information on birth and death certificates. The method of making amendments and corrections to certificates was simplified and improved by the new law.
There are more than three ond one-half million records on file at the State Health Department-approximately 93,000 births, 30,000 deaths, and 2,000 stillbirths are filed annually. They serve many useful purposes, many of which are vital to the operation of a modern health department and necessary for essential civilian uses.
The first activity of the vital statistics division is the registration, preservation, and certification of birth and death records so that a person or his family may obtain a copy when needed. This function involves no statistical compilations and is an administrative service for the people. It is designed to serve the legal and social functions which birth and death certificates have acquired.
The other important function of this division is the utilization of these records in order to protect the health of the people and save lives. Vital and other public health statistics provide a variety of basic data necessary to define and locate local public health problems and assure sound planning for optimum health. This includes information about the characteristics of the population, the incidence and prevalence of disease, impairment and disability and mortality resulting from them. The careful study of birth and death records informs the health officer of those babies that need the especial services of his department and results in visits by the public health nurse. Death from an unreported communicable disease results in an investigation of the family to urge medical examination and chest x-ray of those exposed to tuberculosis.
PUBLIC HEALTH NURSING
In 1939, when financial participation by the State in a full-time county nursing service was offered to all counties with a population of less than 14,000, reorganization of the nursing service was accomplished by a plan for the decentralization of all state health services. When the six regions were established, a consultant nurse was added to each and was responsible for the supervision of nursing service within the area.
177

A polio epidemic in 1941 necessitated that the public health nurses devote extensive activities to its control. Special instruction in the care of polio cases was given public health nurses, and over 700 cases were cared for.
In 1943, the nursing service began to feel deeply the impact of war conditions. Shifting of population with serious overcrowding in areas where military camps and war industries were located, increase in birth rates, overcrowded hospitals with early dismissal of patients, the withdrawal of doctors to military service, urgent need to control venereal disease, importance of reducing absenteeism in industry due to illness, all made new demands on public health nurses.
Many of the Georgia public health nurses as well as private duty nurses joined the armed forces, and a serious shortage of nursing service developed. Efforts were made to increase the supply of nurses by establishing a Cadet Nursing Corps. Under this arrangement, applications for training in hospitals throughout the country increased.
In the public health nursing service, efforts were made daily to hold the gains made in previous years with a rapidly decreasing staff. In 1944, 43 counties were without nursing service. By 1946 there were 125 vacancies for nurses in Georgia. The following year the vacancies had decreased to 113.
The census of nurses showed a total of 408 at the end of 1947, as compared with 362 at the end of the previous year. There were also about 140 industrial nurses.
At the end of the year there were approximately 113 vacancies in public health nursing positions in Georgia, for which there were budgetary provision. These included all types of positions as assistant director, local supervisory and staff nurses.
Recruitment activities were stepped up and the opportumt1es for scholarships to prepare nurses for the public health field were presented at every opportunity. Fifty-two nurses received training in public health in 1947.
TUBERCULOSIS CONTROL
By 1937, nearly 15,000 x-ray pictures yearly were being made.
Because of the scarcity of sanatorium beds, the people who had tuberculosis could be offered very little sanatorium care and had to depend upon securing most of what was necessary for recovery in their com-
178

mumt1es. The medical care of these families was directed by the family physician aided by whatever local facilities there might be for lung compression. By this time, more than 150 physicians in the State had qualified themselves to perform these services and practically all physicians in the State were aiding ir. the care of tuberculosis in some way.
Upon request, the Georgia Tuberculosis Association began furnishing fees for pneumothorax refills and special x-ray pictures and other medical services, paying the physicians who performed these services a comparatively small fee.
A survey of destitute tuberculosis patients was made, in 1938, and it was found that 354 were homeless and 1,382 destitute. While provision for their care, even food and shelter, was not possible in every case, effort was made with existing facilities to do everything possible to isolate them properly for the protection of members of their families, associates, and the general public.
In August, 1939, a change was made in tuberculosis clinic methods. The x-ray unit was replaced with a portable fluoroscopic machine arranged so that x-ray pictures may be taken with it. The apparatus was carried in a passenger car by the clinician who used the fluoroscope to screen out unnecessary x-ray pictures. X-ray pictures were made only of persons shown by the fluoroscope to have pathology. This resulted in a 75 per cent saving in x-ray films and developing cost and permitted the dispension of services of the x-ray technician. The saving amounted to about $16,000 annually.
The gap between the number of tuberculosis cases in the State and the comparatively few beds that were availab),_e for them was partly filled by the tuberculosis control seH"lCes' efforts' ~o have all of the patients requiring assistance taken care of in some fa/;hion . This was doo.c through local welfare departments, tuberculosis seal sale committees and associations, local civic groups, and other sources.
Another service initiated in tuberculosis control was the interpretation of consultation films sent in by physicians over the State. In 1940, 579 such interpretations were made.
In September, 1942, survey work in industrial plants was begun as a part of a program promoted by the division of industrial hygiene and 12,861 35 mm. chest x-ray films were made. The purpose of this phase of case finding was to carry a comparatively cheap x-ray serv:ce to large groups such as industrial plants, colleges, and high schools. The film cost was only about one twentieth of that of regular x-ray films.
179

Under this method, 400 to 500 pictures daily were possible.
During the latter part of that same year, 30 fluoroscopic x-ray machines with which chest and other x-ray pictures may be made were purchased by the State Health Department and placed in as many county health offices. They were used to further tuberculosis case finding and other health services.
By 1943, the number of x-rays for tuberculosis interpreted by the tuberculosis control service was 70,221. Of these 2,087 were consultation x-rays made by physicians in the State and sent in for interpretation; 39,255 of these x-rays were 35 mm. fluorophotographic pictures made in 34 industrial plants.
Considerable difficulty in operation of the tuberculosis control service was encountered during the war years. The difficulties consisted chiefly of shortage of personnel and equipment of all kinds and difficulty of transportation of people to clinic centers.
In a Chatham-Savannah survey, approximately 400 cases of tuberculosis were found in a group supposedly free of the disease. This survey indicated the great value of x-ray of the entire population. On this basis, it was estimated there might be as many as 15,000 undiscovered cases of tuberculosis in Georgia.
The tuberculosis control program was again expanded, in 1946, and resulted in the x-ray and interpretation of 173,775 persons. Combined tuberculosis-venereal disease surveys were conducted in other counties, following the Chatham project.
A central tuberculosiJ' register was begun in 1947, tabulating information secured from State Health Department records, the reports of
, ,-ph)l5icians, the sanat~(iums, local health organizations, and the Veterans'
Administration. Within two years, this register contained records of 9,795 cases of tuberculosis in Georgia.
A tuberculosis case wl;)rk appraisal was begun, the object of which is to find out the needs of the tuberculosis patients-medical, social, economic, and rehabilitation.
A study has been conducted by the U. S. Public Health Servi~e in Muscogee County of the efficiency of BCG vaccine against tuberculosis.
Since October, 1930, a dragnet x-ray campaign in Georgia has resulted in over 1,300,000 chest x-rays being made by tuberculosis control workers of the State Health Department. Local health departments have made many others. Mass surveys, x-ray and diagnostic clinics
180

TUBERCULOSIS CASE AND DEATH RATE
GEORGIA 1920 -1950

120

100

z
0 j:
c
~
~ 80
0 IL

-00

0 0 0
~ 60

.a.:.:
IL

~ ac::

40

20

/',

120

I '\.

I

' I

I
CASES

I
I

- I

''''' ' ' ' ' '

/

100 80

I

60

I

I

I

""""

""""

I
-....../

40

20

0 ~------~--------~--------~--------_._________ .________~0

1920

1925

1930

1935

1940

1945

1950

Number of Cases Not Avoilobfe Prior to 1925

Cases Poorly Reported Prior to 1935

are utilized for finding early cases. The goal is to make immediate chest x-ray and other diagnostic features easily available to everyone in all sections of the State.
Battey State Hospital, an excellent treatment facility offering splendid service to about 1700 patients, cannot meet the needs of all the communities of the State as a whole in many tuberculosis problems that exist.
Responsibility for the care of about 75 per cent of the patients with tuberculosis rests on the patients themselves and the community, because only about 25 per cent of the entire case-load can be cared for in existing State and Federal institutions.
1944 ACHIEVEMENTS
Georgia recorded a decline of 5.1 per cent in mortality despite wartime conditions prevailing during 1944. There were 75,002 births and 27,987 deaths recorded and the deaths declined to 9.0 per 1,000 population, the lowest rate ever recorded in Georgia. The birth rate was 24.0 per 1,000 population.
Further evidence of the progress achieved was shown by the 9.3 per cent decline in maternal and the 6.1 per cent decline in infant mortality. It is only in the past few years the State has shown any appreciable decrease in theoe rates.
It is noteworthy that all of the diseases considered readily amenable to specific public health measures, except typhus fever, showed declines ranging from 51.1 per cent in malaria to 17.3 per cent in tuberculosis. Typhus deaths increased 7.1 per cent.
Heart diseases, nephritis, and cerebral hemorrhage, the principal causes of de::tth in the order named, all showed slight declines. Cancer records a 5. 7 per cent increase.
Only 134 deaths from pellagra were reported in 1944, in comparison with 781 in 1929. With the easing of the depression years pellagra began to decline. In five years the rate was cut in half and has been reduced from 30 deaths per 100,000 population to 4.3.
There has been an 11.9 per cent decline in pneumonia. Influenza, l:owever, increased 16.7 per cent. Deaths from diarrhea and enteritis (uncer two years) also increased 13.1 per cent, although there was a 21.4 per cent decline in dysentery deaths. (See Graphs.)
In the r;eography of mortality improvement in the whi~e race during
182

35

30

z 25

.2..

.c.a

::I

L

0
L 20

.....
00

0 0

(.>)

~

0

2

...II: 15

L

Ill
li
II: 10

DIPHTHERIA CASE AND DEATH RATE
GEORGIA 1920-1950

35
/\

' ' ' ' ' ' ' 'v/ / / / / /

\ \
\ \
\ \

30

\

25

\CASES

\

\

_......"\

\

............. \

20

\.\ / ..........

\ \

\

\

1!5

\

\

\

\ 10

5

!5

0~------~~------~--------~--------~------------------~0

1920

1925

1930

1935

1940

1945

1950

Number of Cases Not Available Prior to 1925

DYSENTERY CASE AND DEATH RATE

GEORGIA 1920- 1950

36 ~------~----------------------------------------------~36

\

\

\

\

30

\

30

\

\

\

~ 25
;:
Cf

\ \

25

...J
;::)

\

-00

A. 0
A. 20

~

0

0

0

0

!:!

.D..: 15

A.

"c ~ '
a: 10

\

' CASES
' ' , .............. ' , ' ..............
' ' ' ,..,......./

20 15

-- ''' ' --- 10

5

5

0~------~--------~--------_.--------~--------~------~0

1920

1925

1930

1935

1940

1945

1950

INFLUENZA AND PNEUMONIA CASE AND DEATH RATES
GEORGIA 1920- 1950

600~--------------------------------------------------~soo
,.. \ ...............

.,......,..

\

500

\

I

\

500

\

I

\

z

\

I CASES

\

s0 400
:.:.J

\ \

I I

\ \

400

-00
(J1

CL 0 CL 0
~ 300

0

2

\

I

\

I

\

I

\

I

\

\

\ \

300

.c...
CL
....... 200
c
II:

\\ II
\\ I

\

\v ""

200

100

100

o~------~------~~------~------~--------~------~0

1920

1925

1930

1935

1940

1945

1950

Number of Cases Not Available Prior to 1925

the past ten years the midwestern states have led the country. In other parts of the United States, the largest relative declines in mortality occurred in areas where the room for improvement was greatest. In the white population of the South, the record of improvement was somewhat more varied. Less than average reductions were scored between 1930 and 1940 in Kentucky, Tennessee, Alabama, Mississippi and in a few of the other states. On the other hand, there are states with outstanding records of improvement, such as North Carolina, with a reduction of 19.2 per cent; South Carolina, of 16.8 per cent; and Georgia, of 16.3 per cent. Contrary to popular impression, the recorded mortality among white persons in many Southern states is close to, or even below, the national average.
INDUSTRIAL HYGIENE SERVICE
The national defense production effort served to stimulate the inauguration of an industrial hygiene service in the State Health Department, in 1941, with a medical director who had taken a special course in industrial hygiene preparation, and a chemical engineer.
The objectives of this service were to keep as many workers at as many machines as many days as possible and to keep the productive capacity of each individual worker at his maximum level. Two fields of preventive effort were involved-personal hygiene and environmental health. Effort was made to protect the workers from communicable diseases, filth borne diseases, insect and rodent borne diseases, nutritional deficiencies, and all other preventable illnesses ordinarily combated by the health departments.
The industrial worker was also protected from noxious dusts, gases, fumes, vapors, mists, smokes, etc., and from other unhealthy influences in the industrial environment which may have resulted in mechanical injuries, burns of all kinds, electric shock, and any other injury or illness.
Adequate protection of the industrial worker from all such harmful influences hinged on broad experience and knowledge. Such knowledge embraced the usual fields of public health and highly technical knowledge of the medical engineering, and chemical problems of each industrial environment.
An industrial hygiene laboratory was equipped to make physical and chemical determinations. It provided facilities for the quantitative and qualitative investigation of air contaminants such as dusts, fumes, gases, vapors, mists, smokes, etc., as well as other toxic materials which may
186

be present in the industrial environment. Laboratory facilities were also made for the ~tudy of blood, urine, and other biological samples taken in connection with plant studies. Laboratory findings were correlated with the engineering and medical investigations. Field equipment was also provided for the collection of samples and for certain field demonstrations. A station wagon was secured for the transportation of bulky equipment.
The industrial hygiene service resolved itself into two categories: (1) promotional, and (2) technical and professional assistance. Among the preventive health measures promoted by the service were:
1. Pre-employment examinations of all applicants and assignment of each applicant to an occupation in accordance with his physical and mental capabilities. The examination recommended included chest x-ray and blood test.
2. Periodic examination of all employees, including any special medical and laboratory studies indicated as a result of exposure to specific industrial hazards. If signs of toxicity were found, the worker was recommended reassignment to work not dangerous to him.
3. Lunchroom facilities on a cooperative basis to teach and provide the fundamentals of a balanced diet.
4. Mid-morning and mid-afternoon recess periods for all workers to provide opportunity for relaxation and refreshment.
5. Control measures for cancer, tuberculosis, venereal disease, and other communicable diseases in cooperation with the established policies of the health department.
6. Thorough investigation of all known and suspected hazards and suitable control measures devised and applied.
7. Provision for a system of recording and following through each case of absenteeism resulting from illness or injury. This entailed home visiting by the plant nurse.
8. A practical system of case records and reports was necessary, similar to the records used in other public health activities. These were so designed as to yield statistical information when desirable.
9. Health education through talks, movies, educational pamphlets, posters, etc.
10. Rehabilitation service so that suitably trained cripples could
187

make reliable workers and become more stable employees than some of the so-called physically perfect group.
The technical and professional services made available to Georgia industries included:
1. Surveys a. To estimate the cost of illne3s to both employer and employee. b. To gain information as to absenteeism from illness, whether it be of occupational or non-occupational origin. c. To gain information relative to the medical, sanitary, safety, and welfare facilities available to plant employees. d. To evaluate the potential health hazard and the existing control of preventive measures in the plant.
2. Quantitative Studies a. Studies of toxic dusts, fumes, vapors, gases, mists, or other air contaminants. b. Illumination studies. c. Humidity and temperature studies. d. Studies of any other environmental condition which might affect the health of the worker.
3. Control Measures a. Recommendations for corrective measures. b. Reviewing plans and specifications for new installations. c. Checking the effectiveness of corrective devices through quantitative field determinations after they have been put into operation.
1. Records a. Assistance in developing and maintaining physical examination and absenteeism records, and assistance in statistical analyses of such records.
5. Consultative Service a. Medical, nursing, engineering, and chemical problems which relate to the health and productive ability of workers.
188

The estimated 8, ')()() industrial employees of Georgia were tabulated by industries, and records made of all occupational disease reported and all investigations made. At this period, special attention was given to those industries with defense contracts.
All plant studies, surveys, investigations, etc., were conducted in an advisory capacity. All data, including reports, recommendations, opinions, etc., were considered confidental records of the Board of Health and not open for public inspection. Studies were also made in cooperation with local health departments and industrial physicians.
Regulations concerning the reporting of occupational disease and investigations covering them were adopted October 16, 1941.
Industrial hygiene courses were developed at Georgia Tech and the University of Georgia, with personnel of the industrial hygiene service assisting in presenting lectures..
In 1942, there were approximately 2,400 industrial plants concerned with manufacturing and transportation, including shipyards, plants manufacturing artillery shells, bombers, and airplane assembly parts, as well as naval ordinance materials, chemicals, munitions, 'and other essential war materials.
Of outstanding importance was the investigation and prompt control of an explosive water-borne outbreak of typhoid fever and bacillary dysentery in a cotton mill village in southwest Georgia. The outbreak involved 81 cases of typhoid fever and 79 cases of dysentery, with four deaths. There were no secondary cases discovered, although several hundred might have been anticipated if no trained public health personnel had been available.
In the first two years of its operation, the industrial hygiene service promoted chest x-rays in 30 manufacturing plants at which 12,861 chest x-rays were taken.
Considerable time was spent with shipyards of Georgia, in 1942, in developing an engineering approach to the control of metal fume fever. This occupational disease had caused considerable loss of time and productive ability on the part of skilled welders. Studies for the control of this situation involved detailed measurements of exhaust systems used by the various shipyards, including a great number of individual measurements covering velocities, air flows, and other pertinent data on ventilation. The observed data were carefully analyzed and a detailed report of findings and recommendations for adequate control were made
189

to the shipyards. Time was also spent with the welding schools of the State demonstrating safe welding practices.
Much time and effort were expended with designing ventilating equipment for the control of toxic dusts such as asbestos. This involved the correlation of existing dust concentrations with current engineering practice employed for the control of these dusts.
Assistance' was also rendered plants manufacturing artillery shells, which required study of plant operations and study of atmospheric samples. The exposure to dusts, organic solvents, gases, and cutting oils appeared to be the principal problems observed in these plants.
The medical program at the Bell Aircraft Corporation was surveyed in 1943, and.promotional efforts to improve it bore fruit. The medical department was reorganized; more adequate dispensary facilities were provided, sickness absenteeism records were instituted, company-owned and operated cafeteria service was provided, and an x-ray machine was secured for routine pre-placement and periodical chest x-rays, as well as venereal disease and dental control programs arranged.
A series of food poisoning and food infection outbreaks were investigated in several industrial feeding establishments, causing hundreds of lost man-days of production.
The promotion of an organization, formed for the purpose of answering the problem of adequate health service for small industry, was ac~ complished for industries in Winder, Georgia. Six cooperating plants formed a board of directors, and, under written standing order of local physicians, employed a full-time industrial nurse. Their program included pre-placemc:-nt and periodical physical examination, chest x-ray service, a first-aid room in each plant operated by trained first-aid workers, home visiting and counseling by the nurse, and over-all coordination with the local health program.
Lead poisoning is one of the principal occupational diseases and it sometimes occurs in the manufacture of storage batteries. Detailed industrial hygiene surveys of battery manufacturing plants in the Atlanta area were made, with excellent cooperation from the plants. Much was done to alleviate the possibilities of lead poisoning in these industries. One of the largest of these battery plants submitted the industrial hygiene service's report to their home office and in turn the home office presented copies to each of their branch plants throughout the country.
At request of the major granite industries in the Elberton area, assistance was rendered these plants in the control of silicosis. In 1944,
190

when this effort was first initiated, shortage of industrial hygiene personnel and materials for exhaust ventilation prevented much progress, although exposure to silicia dust incident to quarry and stone operations presented an important industrial hygiene problem. After V-J day, the proper surveys were made and exhaust equipment became available in 1947. Chest x-rays were made of all personnel.
Conditions in 29 of the granite sheds in the Elberton area have ber-n studied, and 101 recommendations made for improvements. The City adopted an ordinance requiring all granite sheds in the City to be equipped with dust collectors in addition to exhaust ventilation.
Of considerable importance has been the engineering work done with the tubize rayon industry in controlling solvent vapors incident to the production of viscose rayon. Detailed study of these operations was conducted by engineering personnel of the industrial hygiene service and recommendations made for the control of atmospheric contaminants. The recommendations were adopted, and the rayon corporation engineering staff has done some fundamental research work in the proper design and installation of control equipment. These activities resulted in a final design which reduced atmospheric concentration of solvents well below the proposed limit for this material.
A considerable amount of work was done by medical and nursing industrial hygiene personnel in promoting an adequate medical program and facilities for a rubber plant at Hogansville. A number of the employees at this plant were exposed to asbestos dust and although engineering control was provided on the various operations, a periodic chest x-ray was indicated for such exposed individuals. As a consequence of this promotional work, the company secured and installed facilities for taking x-ray pictures routinely.
From the time the industrial hygiene service was organized in 1941 to July, 1946, service had been rendered to 508 plants in 65 counties with a total employee population of 202,051. This number was equivalent to about one-third of the estimate of non-agricultural employment in the State-608,000.
It was estimated there were 5,000 factories and 15,000 mercantile establishments in Georgia. More than 725,000 non-agricultural workers were employed. It was also estimated that less than 10 per cent of these workers enjoyed the benefits of in-plant health maintenance service in 1947.
For minimum protection of industrial health, it was considered that
191

the industrial medical department was a necessity. It was also considered necessary to match the physical capacities of the worker with the physical demands of the job.
In order to promote an adequate industrial health service, a public health team was formed of doctors, nurses, engineers, and chemists, and on occasion other specialists in such fields as radioactivity, noise, and lighting. This con<~ultative service was made readily available at the State Health Department for Georgia industries.
The Petrie Clinic
There were a few full-time industrial medical departments in Georgia in 1950. These were usually found only in larger industries even though it was estimated that the smaller plants employed 90 per cent of the workers. One of the most significant developments in the industrial hygiene program was the promotion of full-time industrial health clinics for small plants on a cooperative basis-each full-time clinic giving specialized health maintenance service to a number of small plants. It was realized there were no better facilities to serve as nuclei around which to develop civilian medical defense than were afforded by modern industrial clinics staffed by specialists in industrial health maintenance. Such clinics were recommended throughout the State, to be established by the industries themselves in every industrialized area. Such clinics provided an effective answer to the demand on the part of employed people for better distribution and application of medical knowledge ; and they were within the framework of private enterprise and divorced from government bureaucracy.
The industrial hygiene service continued to be active in the stimulation of smaller industries to form cooperative health centers. As a consequence, the first industrial health center in Atlanta, under this plan, began operation August 7, 1951. It was named the Petrie Clinic in honor of the director of the industrial hygiene service. All costs were borne by the participating industries. They have provided clinic facilities, full-time nursing service, and have employed a physician on a retainer fee basis. This was the fruition of over eight years of preparation toward this objective. There were three industries partic-ipating with an employee population of 750.
HOSPITAL SERVICES AVAILABLE
During 1941 immediately preceding the entrance of the U . S. into World War II, a widespread feeling of concern was manifested among health and hospital officials throughout the nation regarding the prob-
192

lems of public health and medical care that were beginning to develop in communities or areas affected directly by population influx attributable to activities in defense plants and military installations. The State Health Officer of Georgia was one of the public health officials early to become aware of the importance of proper planning for a critical defense and military area.
As an outgrowth of this nationwide concern, the Community 'Facilities Act (Lanham Act) was enacted by the Congress; it was approved by the President on June 28, 194( This Act made funds available to be used for construction, purchase, rental or renovation of community hospitals, nurses' quarters, and health centers. In August, 1941, the United States Public Health Service established a Hospital Facilities Section, which was concerned with the certification of need for construction or procurement of hospitals, health centers, and related facilities.

A summary anaiysis of the projects in Georgia under the provisions of the Lanham Act follows:

Construction of or addition to hospital facilities.. ... ..... .. Construction of or remodeling of nurses' homes.. .. Construction of or improvements to public health centers .

..10 8
.. .13

Construction of or improvements to venereal disease facilities ...... 4

The General Assembly of Georgia, in 1943, authorized the appointment of an Agricultural and Industrial Development Board to further study conditions of the State and to make recommendations for the more efficient use of the State's resources and for the improvement of the moral, physical, and financial status of all citizens. A panel or committee of this Board, known as the Health Panel, was appointed to make a survey of public health work, hospitals, physicians, and other facilities for medical care and to make recommendations to the Board. This group obtained the services of a physician who had special training and experience in public health, to serve as director of the Health Panel.

The study undertaken by the Health Panel was thorough and extensive. Every county in Georgia was visited and surveyed by trained persons selected for that purpose. The conditions found were far from satisfactory or adequate to meet the minimum needs of the people, and recommendations were made for their correction.

These recommendations were contained in the published study, "A Public Health Program for Georgia," which was released by the Health Panel of the Agricultural and Industrial Development Board in May,

193

1945. The basic standards for a statewide developmental health program recommended were:
l. Three beds per 1,000 persons for general hospital facilities.
2. A general hospital within 35 miles of every patient.
3. General hospitals of not less than 100 beds in size.
4. Maternity shelter and emergency hospital beds in each county.
5. A well-developed medical center at each of the two medical schools.
6. Modern out-patient health center facilities including dental in all towns of more than 500 population.
7. Tuberculosis hospitals in each of the nine areas, to furnish two beds per annual tuberculosis death.
Public meetings, in various communities arranged through the several district medical societies, served as an avenue by which the Health Panel presented and explained the findings and recommendations of the survey.
The General Assembly of the State adopted a resolution commending the work of the Agricultural and Industrial Development Board and officially gave_recognition to work of the Health Panel.
As a direct result of the work of the Health Panel, the Georgia Department of Public Health in December, 1945, employed a Hospital Consultant who immediately prior to joining the staff of the Georgia Department of Public Health was Assistant Director of the Johns Hopkins Hospital in Baltimore, Maryland.
In February, _1946, the General Asse~bly ,o! Georgia enacted the
Hospital Regulations Act, a law relative to hospitals and other institutions providing facilities for the care of the sick. This Act authorizes "The State Board of Health to make and promulgate reasonable rules and regulations for the protection of the health and lives of inmates and patients of hospitals and to prescribe the kind of hospital facilities which hospitals shall have to properly care for patients."
Public Law 725, the Hospital Survey and Construction Act, was signed by the President, August 13, 1946. The three fundamental purposes of the law are to provide for: first,. the inventory of present hospital facilities; second, the development of a plan which would provide hospital facilities to serve all people; and third, a construction program
194

in which funds would be granted to the several states to build the most needed facilities.

During 1946, the hospital consultant visited and addressed the medical, hospital and civic groups in many communities throughout the State for the purpose of reviewing with local officials the hospital needs of their respective area. He also gave counsel and advice to several hospitals regarding administration and management. The latter part of the year was utilized in explaining the philosophy and provisions of the Federal Hospital Construction Act, and in planning for the development of a hospital program for Georgia.

Early in 1947, the Hospital Survey and Construction Section was created within the Division of Administration of the Georgia Department of Public Health and the hospital consultant was designated as Chief of the Section. Shortly thereafter, an accountant was transferred from the Accounting Department to assume responsibility far the fiscal, statistical and routine administrative affairs in the program. Also, an arrangement was worked out with the Division of Public Health Engineering whereby the services of an architect were made available to the program.

To assist in making the field survey of hospital facilities, three recent medical graduates awaiting the beginning of their intern training were employed April through June.

The survey involved one or more visits to approximately 220 hospitals and the interviewing of officials of these institutions regarding the facilities, management, and organization of their respective institutions. Specific items included were area served, physical plant, patient service data, organization of medical staff, administration of hospital, financial data, education and research activities.

This survey revealed and measured the acute need for all types of hospital facilities within the State. A summary of the number of existing acceptable beds by category was as follows :

Category

Existing Acceptable
Beds

General ----- ------- -- ---- --- --- -- ------- ---- ------- -- ---- ---- ----- --- --------- -- ---- -- -- 6,906 Tuberculosis .----- ........ __ __ .... __ ______ .__ _____ ..___ ... .....------ -- -. __ ..---... 2,338

Mental ----- --- --- ---- --- -------- ---- -- -------- ---- -- --- - --- ---- ---- --- ----- 9,351 Chronic --- --- -- -- ---- -- -- -- - ------ ---- -- -- --- --- ---------- - -- - - - 1,085

The survey also disclosed that 60 counties had no hospital facilities

195

whatever, and that 23 more counties had no acceptable facility within their borders.

A comprehensive study of the socio-economic conditions relative to hospital planning was undertaken during the spring and summer of 1947. This summary included studies of population increases, characteristics and trends; effective buying income, average standard of living, distribution of physicians and nurses, and many tabulations relating to health conditions or vital statistics data.

The above study, after being tabulated and analyzed, was correlated with field data obtained through the survey of hospital facilities. The conclusions thus formulated served as a guide in preparing the first draft of the State Hospital Plan.

The initial State Hospital Plan was prepared by the Section in September, 1947, and included such major items as the geographic division of the State into hospital areas, determination of relative need for facilities, development of a system of priorities, and formulation of basic principles of administration of the program.

On October 9, 1947, the State Advisory Council reviewed the Plan and recommended its approval to the State Board of Health. The State Board of Health, at the regular meeting on October 16, 1947, officially adopted the Plan. The Public Hearing on the State Hospital Plan was held in Atlanta, Georgia on October 30, 1947.

Approval of the Georgia Hospital Plan by the Surgeon General of the United States Public Health Service made it possible for sponsors of publicly-owned or non-profit hospital and public health center projects in the state to obtain a Federal grant-in-aid and one-third of the total cost of construction and equipping of such projects.

The $2,976,228 Federal funds allotted to Georgia for the first fiscal year (1947-48) made possible the preparation of the following Construction Schedule:

Type of Project

Number

Communities

New Facilities ----- --- ------- -- --- -- -------- 11 Columbus, Carrollton, Greensboro, Royston, Thomaston, Gainesville, Sylvester, Camilla, Elberton,

Additions & Alterations to Existing Facilities ---------
Equipment only --- -- ----- ---- ----- Public Health Centers -- -------- Auxiliary Public Health Centers... .

Richland, Marietta.
2 LaGrange, Macon Franklin Decatur
6 Fulton County

196

In December, 1947, the program obtained full divisional status by the establishment of the Division of Hospital Services. The Division was organized for the purpose of: administration of the grants-in-aid construction program under the provision of Public Law 725, 79th Congress (Hill-Burton Act); administration of the Georgia Regulation Act, No. 623, 1946; conducting periodic surveys and studies to determine relative need for medical facilities in the various sections of the State; and rendering various types of consultative services to existing l:ospital and potential project sponsors.
During 1947, a considerable amount of work was done by the Division in assisting the State Board of Health in establishing certain basic principles which are requisite in a licensure program. This, of course, involved, in addition to individual study of specific items, the review of tentative rules and regulations for other states, conferences and informal discussions with the Hospital Advisory Committee on Rules and Regulations, the State Advisory Council, the Hospital Committee of the State Board of Health, representatives of various hospital, medical and civic groups, and the staff of other Divisions of the Georgia Department of Puhlic Health. Many hospital administrators and owners also were ask~d to express their opinions regarding what they thought should be required or desirable in such a program.
In order to develop the Hospital Licensure Program, three field representatives were added to the staff. These men were concerned with the detailed study, research and editing that was necessary for the preparation of the first draft of Rules and Regulations for hospitals in the state. In addition, they spent considerable time in drafting necessary forms and establishing tentative working relationships with other agencies.
In January, 1948, the Division approved the first application for grant-in-aid funds to assist in construction of a hospital. This project was the 40-bed Tanner Memorial Hospital at Carrollton, Georgia.
LABORATORY SERVICES GROW
The demand for laboratory services has mounted along with the expansion of other phases of the public health program. In ten years' time the total number of specimens examined annually increased from 355,514 in 1938 to 724,300 in 1947. Branch laboratories have been established in Albany and Waycross, to better serve the southern section of the State.
The qualifications of laboratory workers have been raised, in order
197

PERCENT OF LIVE BIRTHS OCCURRING IN HOSPITALS
GEORGIA 1920- 1950 PERCENT
100 .......-------------------~----: 100

80

80

-~

60

60

40

40

20

20

o~----~------~--------~-------~o

1930

1935

1940

1945

1950

to keep pace with highly technical skills necessary for modern public health laboratory activities. There has been a continuing scarcity of trained technicians and other laboratory personnel, and the Department has maintained a training program for such workers since the laboratory was first established.
The different laboratory procedures have been evaluated by the State staff and by the U . S. Public Health Service, from time to time. New laboratory techniques have been studied and adapted from other public health laboratories. Others have been initiated and developed by the Georgia laboratory staff.
Biological supplies consisting of antitoxins, vaccines, serums, drugs, and other items are stocked by the laboratory for convenience of health officers and physicians. Numerous specimen outfits have also been furnished for collecting and submitting laboratory specimens for examination.
The laboratory functions as an aid to physicians and public health workers in the diagnosis and control of disease of public health signifi. cance. The list of such diseases has increased along with new discoveries in prevention and treatment.
EPIDEMIOLOGY EXPANDED
Epidemiological activities of the State Health Department have varied along with the prevalence of disease. The first such achv1t1es were initiated with typhoid fever. Each reported case was investigated by state and local public health workers, and the list of typhoid carriers discovered has grown to over 200. Outbreaks have been studied with infinite care. By 1947, the deaths from typhoid fever had dropped from 139 in 1937 to nine.
In 1938, a protozoologist, medical epidemiologist, engineer and biologists were assigned specifically to malaria investigation activities. The object was to promote county-wide malaria control. This unit functioned efficiently and contributed materially lo' the reduction of malaria in Georgia, along with the regular engineering staff. In 1937, there were 325 deaths from malaria in Georgia; in 1947, there were only thirteen.
About the time typhoid and malaria were first showing some signs of diminishing, typhus fever began to appear in increasing proportions. As a means of prevention, rat proofing of buildings was recommended. This was found to be effective but was time consuming and expensive
199

as a control measure. A system of vent stoppage was later developed by the State Health Department engineer assigned responsibility for this activity. This measure proved to be less expensive and was effective. With the advf'nt of post war rodenticides, rat eradication became more effective and as a consequence the number of typhus fever cases was drastically reduced. The number of deaths decreased from the peak of 63 in 1944 to 31 in 1947.
Epidemiological activities have been the combined responsibility of State, regional, and local public health personnel.
PUBLIC HEALTH ENGINEERING UP-TO-DATE
Public health engineering in Georgia has been made available from the State Health Department, regional, county, and district health departments. Municipal engineers function in the larger cities. The general activities of the State Health Department are concerned with a number of major engineering services.
In water, sewerage and related problems, studies have been made of needs for satisfactory development of water and sewerage facilities. Approval of engineering design and ~anitary supervision of the operation of municipal, institutional, public and semi-public recreational and industrial water and sewerage plants and systems is a part of this program. Supervision of swimming pools, operation of the engineering laboratory, stream pollution control, and other related activities are also important phases of public health engineering.
Malaria surveys and plans for malaria control have been made, including larviciding, drainage, impounded water permits and control of such areas. The program was coordinated with that of the U. S. Public Health Service on insecticiding of homes and other places.
School sanitation services were concerned chiefly with water supplies and sewerage, food and milk sanitation and grading of school lunchrooms, in accordance with regulations adopted by the State Board of Health. Plans for school sanitary facilities were examined and approved.
Sanitation was promoted in community and rural housing. Plans for subdivisions were reviewed where public water supplies and sewerage were not available. Standard plans for home sewage disposal and water supplies were distributed.
Camp sanitation was promoted through inspections of camps and proposed camp sites. Tourist camps were also inspected and issued permits.
200

MALARIA CASE AND DEATH RATE
GEORGIA 1920- 1950

150

150

-- /___ \

125

/

\

125

z

/

\

0 ~

//CASES

\\

~100
:::)

/

\

100

L 0

/

L

-0

~

0

0 ~ 75

0

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!2

\ ',

\ \

75

\

Ill: Ill

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c

\

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25

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25

DEATHS

\

~--------------------~

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o L----'-----l----..l..--_::::z======.___.:'::.::.J o

1920

1925

1930

1935

1940

1945

1950

Number of Gases Not Available Prior to 1925

Public health mapping services were provided for sanitation and other general purposes for state, county, and municipalities. Planimetric maps developed from aerial photographs were provided for malaria control and environmental sanitation.
Milk sanitation services were provided for counties and municipalities, particularly those operating under approved milk ordinances. Regular field inspections have been made of milksheds, dairies, pasteurization and other milk plants, rcndering advisory service to the milk industry in design and construction of smh plants. The operation of a mobile milk laboratory has been an important feature of this activity.
Food sanitation was promoted for public eating and drinking establishments, school lunchrooms, including inspection and grading. Certification was provided of both food and milk supplies for interstate carriers. Promotion of adoption, interpretation and enforc!'ment of local milk ordinances and general assistance to local health departments was also achieved.
Shellfish sanitation surveys have been made, as well as im-cstigations and maps for determining sanitary areas for shellfish production. Approved shellfish areas have been certified to the U. S. Public Health Service for interstate shipment.
Recruiting and training personnd activities have been conducted continuously for development of an adequate public health engineering force.
In 1947, 16,590 bacteriological, chemical, sewage and stream pollution water samples were examined in the engineering laboratory. Fiftyone counties participated in extended malaria control. Sixteen Georgia cities had adopted the standard milk ordinance.
SUMMING UP
The average death rate for the first thirteen years of the Colony's existence was calculated to be 25.5 deaths per I ,000 population; in 1947, it was 10.8. The first appropriation for public health was thirteen guineas in 1733; in 1947, more than $2,000,000 in State funds was made available for health work.
In less than fifty years, the State Health Department has grown from one employee, a borrowed microscope, and a basement room to a complex organization housed in numerous modern buildings and employing approximately five hundred trained persons. Yellow fever,
202

TYPHUS CASE RATE
GEORGIA 1925- 1950

40

40

/ /"\

/

\

~30 ~
.... c_.
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/ / I
/ / /

\ \
\
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II: Ill L

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\ \\
\

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II: 10-

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/

\ \
,_ 10

/

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----_,/
o~~-----------~--------~~--------~1~--------~'~------~o

1925

1930

1935

1940

1945

1950

Note : Death Rate is too low to show graphically

smallpox, malaria, and typhoid fever have been eliminated as public health problems.
There remains, though, a great deal of illness and disability that could be avoided if the benefits of modern medical and public health science were available to everyone in all sections of the State. The mortality among battle casualties in the second World War was reported to have been one-half of what it was in the first such conflict. But the percentage of rejections in the selective service system, as a result of physical and mental disability, was about the same in both war periods.
Degenerative diseases resulting from the lengthening life span and the consequent agi:r1g of the population offer a challenge to public health in the future. These diseases are the joint responsibility of both the medical and public health professions. They offer a relatively untouched field of endeavor to both groups.
204

HEART DISEASE DEATH RATE
GEORGIA 1920- 1950

240

240

~200

c~

~

!:)

IL

c1\J

0
IL 160

U

0 0 0
0

2

120
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200 160 120 80

40

40

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1920

1925

1930

1935

1940

1945

1950

CEREBRAL HEMORRHAGE, EMBOLISM AND THROMBOSIS DEATH RATE
GEORGIA 1920 - 1950

z 85

85

,2_

c

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A.

0
0)

0
A. 75

75

0 0 ~ 0
2

65

65

II:

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A.

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c II: 55

55

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1g2o

1925

1930

1935

1940

1945

1950

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.......
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207

DEATH

RATES FROM MOTOR VEHICLE ACCIDENTS AND FROM ALL OTHER ACCIDENTS
GEORGIA 1920 1950

70~------------------------------------------------------~70

60

60

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50

50

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ALL OTHER ACCIDENTS

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40

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________ o~------_.

- L_ _ _ _ _ _ _ _. __ _ _ _ _ _~~------_.--------~0

1920

1925

1930

1935

1940

1945

1950

HOMICIDE AND SUICIDE RATES
GEORGIA 1920- 19eO

25

25

20

20

z
0
5_,

:)

~ 15

15

1\;)
0

a.

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0~--------~------~~--------~--------~------~~------~0

1920

192e

1930

193e

1940

194e

1950

MEMBERS OF THE STATE BOARD OF HEALTH OF THE STATE OF GEORGIA, 1875-1876
J. G. Thomas, M. D., President. ------- ----------- ----- .......... ...............Savannah N. J. Hammond, Attorney-General ----------- -- -- -- - _____ __ __ __ _______ _____Atlanta
W. L. Goldsmith, Comptroller-General _____ ___ ________ _____ ______ ________ _______ Atlanta
George Little, State Geologist .............. ................. ...... .... .. ..... .. ......... Atlanta Benjamin M. Cromwell, M. D. ___ ______________ ____________ _____ _____________ _________ _Albany George F. Cooper, M. D, ___________________________ _________ ______ __ _______ _____ ________ Americus P. A. Stanford, M. D. _. __________________________________ ____ ___ ___________ _____ _______ ____Columbus Joseph P. Logan, M . D...... ________ __ ______________ ____________ __________________ _____ _____ Atlanta G. E. Sussdorff, M. D.______________ __ __ __ _____ ______________ __ ___ ......... .. .... .. ............Macon
G . W. Holmes, M . D. ........... ---- -- --- -- ------ -- -- - ------ -------------------------------- .Rome Henry F . Campbell, M. D .... ............................... ................. ............. Augusta H. H. Carlton, M. D.................... ................................... .. ................. ..Athens V. H. Taliaferro, Secretary.. .. .. ... ______ ________ ____ ______________ __ ____________________Atlanta

MEMBERS OF THE STATE BOARD OF HEALTH 1903-1950

Morgan, J . B., M.D. ............. 1903-1910 Taylor, A. P., M.D. ........... .......1903-1912 Harbin, R. M., M.D.......... ........... .1903-1914 Benedict, S. C., M.D. ............... 1903-1910 Westmoreland, W. F., M.D......... .. 1903-1914

lOth District .......... .. .....Augustl>. 2nd District.. ..........Thomasville 7th District........................Rome 8th District.............. ...Athens 5th District... .... ........... .Atlanta

Hicks, Chas., M.D.

............. 1903-1913

Williams, H. J., M.D....................1903-1917

Stewart, W. W., M.D................. .. 1903-1909

Hathcock, Giles, M.D.....................1903-1913

Brown, M. S., M.D.......................l903-1931

11th District........ ...........Dublin 6th District...... .. ..............Macon 4th District.. ..............Columbus 9th District.. .................... Belton 3rd District................Ft. Valley

Owens, W. W., M.D.....................1903-1912
McDuffie, J. H ., M.D ................... 1909-1933
Doughty, W. J., Jr., M.D......... .. .. 1910-1928
Teasley, . B. C., M.D..................... .. l91 0-1922
Weaver, J. D ., M.D....................... l910-1916

lst District.. ................Savannah 4th District................Columbus lOth District................. Augusta 8th District.................Hartwell

Richardson, C. H., Jr., M.D......... 1911-1929 Crittenden, A. L., M.D................. l911-1923 McArthur, T. J., M.D................... 19ll-l917 Little, A.D., M.D........................... l912-l930 Daniel, J. W., M.D. ................... .. 1912-1930
Verner, J. C., M.D........................1913-1925 Walker, J. P., M.D..... __ ............. 1913-1925
Shamblin, A. C., M.D........ ........ .. 1914-1932

6th District.....................Macon 2nd District.. .............Shellman 3rd District.. ............. .... Cordele 2nd District............Thomasville lst District.. ............... Savannah
11th District............... Waycross ith District.. .... .................Rome

210

Maddox, Mr. R. F.___ __

---- --1914-1948

Funkhouser, W. L., M.D..

..1914-1920

Brittain, M. L., M.D.. Bahnsen, P. F., M.D.. .
Hailey, W. 1., M.D...
Rhodes, J. W., M.D.
Ballard, Mr. N. H ... .

1922 .. .1922-1927 .... 1922-1928 - --- .1922-1933 ... 1923

Patterson, F. W., M.D. Land, Mr. F. E.. Lawry, A. A., D.D.S... Brice, C. R., M.D..
Sutton, J. M., M.D...

____ __ 1923-1929 _____ __ 1925
...1925-1931 ___ ___ 1925-1931
... 1927-1931

Duggan, Mr. M. L.

.... ..... 1927-1931

Carter, D. M., M.D.

------ 1928-1933

Ridley, C. L., M.D.... . 1929-1933; 1939-1950

Dean, J . G., M.D... ...

_ 1929-1933

Neal, Mr. W. R ... ___ _-- ---- --- 1930-1931

Williams, J .G., D.D.S. 1931-1933; 1935-

Rivers, W. A., M.D.

1931-1933

Parks, M. M., D.D.S..

____ 1931-1933

Thompson, Cleveland, M.D...... .. 1933-1945

Sharp, C. K., M.D. ..

... 1933-1951

Ellis, R. C., esq.

__ ___ ______ 1933-1945

Hearl, M. M., M.D. __ 1933-1937; 1950-

Rozar, A. R., M.D. ..

______ 1933-1938

McCord, M. M., M.D. _

... 1933-1938

Clements, H . W., M.D. __ ___ _1933-1944

Allen, L. C., M.D. . __ --- --- ___ __ 1933-1939

Mulherin, W. A., M.D.

..1933-1937

Varn, M. H., D.D.S. _

____ 1933-1934

Sullivan, R. F., D.D.S.

___ _1933-1934

Marshall, T. C., Ph.G.

... 1933-1935

Rountree, Claude, Ph.G. Winston, William, D.D.S. McGee, Paul, D.D.S.. Edmunds, W. T., Ph.G. Hodges, M.D., Ph.G. - --

.1933-1935 ... 1935-1940 .... 1935-1946 .... 1935-1941 --- .. . 1938-1941

Thompson, D. N., M.D...
Corry, J. A., M.D....
Harbin, W. P., Jr., M.D.
Ayres, C. L., M.D..
McMichael, J. R., M.D. .

-- - 1938-1949 .. 1938-1949 1939-1950
-- 1939-1940 ----- - 1939-1940

211

5th District.............. ... .. Atlanta 5th District --- --------- Atlanta

State School Supt....... .. Atlanta State Veterinarian......Americus 8th DistricL ........ ........Hartwell 1Oth District........Crawfordville State School Supt... .......Atlanta

3rd District ... ........ ..... .Cuthbert State School Supt........ .Atlanta
----- ---- - Gainesville 5th District.. ...... ....... .Atlanta State Veterinarian.... ....Atlanta

State School Supt.........Atlanta lOth District.......... ......Madison 6th District......... .............Macon 3rd District -- ------ .......... .Daws~m
..... ..... .. ....... . Savannah

State-at-Large

.... ...Atlanta

lst District .. .. .. ......... .Glenwood

lst District .. ...................Millen

2nd District..

.Arlington

3rd District

...... Americus

4th District..

.... ..Zebulon

6th District ... ..... .............Macon

7th District . --- ---- -------- Rome

8th District

__ Adel

9th District....

__ Hoschton

lOth District .. ............. .Augusta

State-at-Large ..............Atlanta

State-at-Large ........ ..Savannah

State-at-Large .. ......... ...Atlanta

State-at-Large ........Thomasville

State-at-Large

.... .. Rome

State-at-Large

... Waycross

State-at-Large

. Augusta

State-at-Large

..Marietta

1Oth District.. ... .... ...... Elberton

4th District................Barnesville

7th District .... ......... .. .... . Rome

9th District..

.. ..Toccoa

2nd District... .... ...... .. ..Quitman

Holliday, Pope B., D.D.S. __ ___ _____ _1940-1946

Rogers, R. L., M.D .... ...... ____ ... 1941-

White, W. K ., D .D.S.

____ ____ 1941-1949

Metts, J. C., M.D....... ..... . .... .1941-1945

White, J. W., Ph.G... ... .. ... ..... ... 1941-1947

Wright, G. A., Ph.G........ ... _____ ____ 1943-1950

Minchew, B. H. M.D. ..... ...... 1944-1950

Byne, J. M., Jr., M.D. ... .. ...... 1944-

Patterson, J. C., M.D. ..

..1945-1948

Butts, J. B., Ph.G. ........

.1947-1950

Kirkland, S. A., M.D. _ ____ .1949-

Montgomery, R. C., M .D. ...... ... ..1949Haw1ey, J. M., D.D.S. ____ ________ ____ 1949-

Goodwin, T. W., M.D. ..

.... 1950-

McRae, A. T., Ph.G.. .

... 1950-

Sumner, Preston, Ph.G.

_____ 1950-

Bramblett; Walter, M.D. ___ ___ _1950-1951 Maloy, D . J ., M.D. __ ___ _________ ___ ,____ __1950-

Sim.onton, Fred H ., M.D. ...... 1950-

Phillips, A. M., M.D.... .. . ____ ...... .. 1951Funderburk, A. G., M.D. ___ _______ _1951-

State-at-Large ... ---- -- ----- Athens 9th District......... ___ _Gainesville State-at-Large __ ___ __ _Savannah lst District... .. ... ___ _____ Savannah
State-at-Large .......Thomasville

State-at-Large . ____ ___ _______Tifton 8th District _________ ________ Waycross
lst DistricL ............Waynesboro 3rd District........ ___ Cuthbert State-at-Large ___ Milledgeville

5th District ...... ... .. ...Atlanta 3rd District........ ___________ __ Butler
State-at-Large ____ Columbus 1Oth District ...... ___ _____ ___ Augusta State-at-Large ___ _____Douglas

State-at-Large .. ..... .. .East Point 6th District...... ___ _____ ___ __Forsyth

8th District ------

. McRae

7th District ....... .. Chickamauga

6th District .. ....... .. .... .. . Macon

2nd District ......... . ____ _Moultrie

ADVISORY BOARD OF HEALTH, 1932-1933

Hon. R. B. Russell, Jr., Governor of Georgia .. ...... . ---- ---- -- ---- -- Atlanta

Hon. Robert F. Maddox ............................. ... ..... .............. ... ------- --- -- Atlanta

Col. R. C. Ellis ........----- --- - - - ----- -- ---- --- ----- - - -- -- ----Americus J . A. Redfearn, M . D ..... .. __ ------ - ------ ___ __ ..... . - --- -- -- --- ---- --- Albany

H . L . Erwin, M.D.... .. ....... ..... .................................... ..... ................. Dalton

W. H. Myers-- ------------ ----- ---- --- --- ------ -- - -- -- -- --- -- -- - --- ---- -- ------ __ Savannah

J. G. Williams, D. D. S. .... ....... ................ .. -- ---- .... _.... ... ..

Atlanta

A. J. Fort, M. D ... ... _______ --- ---- _____ ... .. .

_----- ----- __ Atlanta

C . L . Ridley, M . D ... -- -- ------- --- --- __ ___ ....... ..

___ _. ..... ..... _. .. Macon

Mrs. R. H. Hankinson, President, Georgia Congress

of Parents and Teachers ---- --

.. __ . ___ McDonough

EXECUTIVE OFFICERS GEORGIA STATE BOARD OF HEALTH 1903-1950

H . F. Harris, M. D ... .. __ ____ ____ _... T . F. Abercrombie, M. D. T . F. Sellers, M . D. -- .

.... - .. . 1903-1917 ... .1917-1947 1948-

212

CHAIRMEN GEORGIA STATE BOARD OF HEALTH

Dr. W. F. Westmoreland ------ - ----- --- ---- -- ---- --- ----- ----- -- - --- 1903-1911

Dr. S. E. Benedict --- --- ---- ---- -- . --- --- - --- ---- -- - -- --- - 1911-1914

Dr. Howard J. Williams

.... ... _... --- - - - ----- --- --- ----- 1914-1918

Dr. W. H . Doughty, Jr... .... ... __ ____ --------- ------ ----- 1918-1923

Robert F. Maddox ____ __... .. .... -- -- ---- -- -- --- - ---- -- 1923-1931, 1933- 1944

Dr. C. L. Ridley.--- . - --------- - ----- -- --- - ... .. ..... ___ .. .... 1944-1948

Dr. R. L. Rogers __ ___ _--- --- ......... ..... --- ---- -- ---- ____... .... 1948-

LOCAL HEALTH OFFICERS 1914-1950

City or County

Commissioner of Health

Dates

City of Atlanta

J. P. Kennedy, M.D.......... ---------------- --1901 - April 1943
J. F. Hackney, M.D-- ------ ------------ ---- ----------- April 1943

Appling County . .. 0. E. Ham, M.D.............................March 1941 - April 1941

Atkinson County .. _J. E. Morris, M.D............. ..................June 1946 - June 1948

Baldwin

County .......H. A. Herring, M.D.

June 1919- July 1920

H . P. Carr, M.D .. ......................July 1920 - September 1920

H. D. Allen, Jr., M.D.........September 1920 - January 1924

Sam A. Anderson, M.D................... ..April 1924 - June 1929

John D. Wiley, M .D ................ .. .......June 1929 - May 1930

L. A. Bailey, M.D............... ..........July 1930 - December 1930

0. F. Moran, M.D.........................January 1931 - July 1939

S. P. Vandiviere, M.D.... ................ -July 1939 - August 1939

James H. Litton, M.D... ..............August 1939 - March 1941

Herbert M. Olnick, M.D.....................July 1942 - June 1943

Banks County............ . "J" Gregg Smith, M.D..----------------- - ---------- - May 1948

Bartow

County ... ... George W. Dupree, M.D........... ..February 1920 - June 1920 W. H . Bryan, M.D........................ June 1920 - March 1921 W. H. Enneis, M.D......... .. ..December 1921 - February 1922 H. E. Felton, M.D............... .. February 1922 -December 1925 D. H . Monroe, M .D........ .. ... .. ..January 1926 - August 1928 Homer C. Pearson, M.D.......November 1928 -January 1930 A. C. Shamblin, M .D .................July 1930 - November 1938 R . F. Young, M .D.........................January 1939 - May 1939 0. W. Jenkins, M.D... ... .. ........June 1939 - September 1939 0. E. Ham, M.D......... .. ........ .. January 1940 -February 1941

213

City or County

Commissioner of Health

Dates

Berrien County ________.]. E. Morris, M.D.

--------- .... June 1946 - June 1948

Bibb County...............C. L. Ridley, M.D. ---------- ______January 1924 - May 1926

H. G. Weaver, M.D.

_________ May 1926 - June 1926

J. D. Applewhite, M.D.........

_____ July 1926 - July 1944

R. Frank Cary, M.D.-------------------------------- _____ July 1944

Bleckley County....... H. T. Adkins, M.D. _________________January 1938 - March 1940 C. A. Hicks, M.D. __________ August 1940 - November 1941 T. H. Stewart, M.D. __________________January 1942 - August 1942

Brooks County________ ... M. A. Fort, M.D. _______________ .September 1920 -February 1922

R. E. McClure, M.D. ________________September 1926 - July 1932
J. H. Crooks, M.D. ___________________ July 1932 - September 1932

J. R. McMichael, M.D.........October 1932 - December 1932

0. L. Von Canon, M.D................ January 1933 - July 1933

M. E. Groover, Jr., M.D. _____________ July 1936 - October 1941 J. P. Ward, M.D. ________________________ August 1946 -October 1947

T. E. Morris, M.D. _-----------

June 1948- May 1949

J. D. Stillwell, M.D._____________________ ---------------- ______ May 1949

Bryan County____________ W. D. Lundquist, M.D.......December 1947- December 1949
Bulloch County.......... H. E. McTyre, M.D................ January 1938 - January 1939 0. F. Whitman, M.D.............January 1939 - October 1942 D. C. Steelsmith, M.D...............December 1944 - July 1945 W. D. Lundquist, M.D.....December 1947 - December 1949
Burke County.............. A. J. Davis, M.D. ____________________ March 1937 - December 1939
W. D. Lundquist, M.D. ________January 1940 - November 1947

Calhoun County........ G. M. Anderson, M.D............. ______ August 1937 - July 1939

Charles R. Smith, M.D.

_____ January 1940 - June 1940

Camden County .M. E. Winchester, M.D.

-----------------November 1934

Chatham County

____ Victor H. Bassett, M.D. _____ March 1927 - November 1938 H. T. D. Griffiths, M.D. _______November 1938 - April 1939 C. D. Hart, M.D... _____ -- ______ April 1939 - April 1939 Charles C. Hedges, M.D. ___________ May 1939- November 1943 C. A. Henderson, M.D... --------------- ______________ December 1943

Chattooga County ____ James J. Croley, M.D.

______ April 1948 - January 1949

Clarke County__________ J. D. Applewhite, M.D.

.September 1920 - July 1926

B. B. Bagby, M.D. _______________ ...September 1926 - July 1929

T. H. Johnston, M.D.

_____ August 1929 - August 1931

W. W. Brown, M.D.

. _________ January 1932

Clinch County__________ .J. H. Sessions, M.D.

______ March 1929 - August 1931

F. A. Brink, M.D.---------------- .. September 1937 - June 1941

G. E. Atwood, M.D.

_____ July 1949 - September 1949

Cobb County _____________ E. R. Anthony, Jr., M.D. __________ January 1920 - June 1920 R. W. Todd, M.D.______________ June 1920- March 1923

214

City or County

Commissioner of Health

Dates

L. L. Welch, M.D.
J E. Lester, M.D....

.. . April 1923 - December 1925 .......... ... .... January 1926

Coffee County....

.. T. H . Johnston, M .D.

.July 1927 - August 1929

J. W. Wallace, M .D.

.. October 1929 - July 1932

R. L. Johnson, M.D.. . ....... January 1938 - October 1940

I. E. Simmons, M.D.. . .. December 1940 - October 1942

A. R. Marsicano, M.D... . ... .... January 1942 - June 1942

J. E. Morris, M.D...

June 1946 - June 1948

Colquitt

County.... ...L. T . Patillo, M.D. .. . . . ..... . . .

.... 1918

G. M. Anderson, M.D.

........ ....... ...1919- 1920

T. B. Harper, M.D..

..April 1927 -May 1928

D. W. Register, M.D. ..

May 1928- August 1928

Victor M. Roberts, M.D.... September 1928 - October 1928

T. H. Chestnutt, M.D...

. January 1929 - June 1946

J. P. Ward, M.D.

... August 1946 - October 1947

J. E. Morris, M.D.

.. ...... June 1948 - May 1949

J. D. Stillwell, M.D.

.........May 1949

Columbia County..... A. J. Davis, M.D.

..August 1946

Crisp County............. Guy G. Lunsford, M.D.... .... ... ... .April 1928 -January 1931

E. S. Armstrong, M.D.

.. ..... June 1938 - June 1940

C. W. Harrell, M.D.

..January 19H

Dade County............. James J. Croley, M.D.... .. ...April 1948 - January 1949

Decatur County.....

.F. W. McCorkle, M.D.

........... May 1920- April 1921

J. Allen Johnson, M.D.

.. . May 1921 - July 1924

0. L. Sharp, M.D.

..July 1924 - September 124

J. Allen Johnson, M.D. .... October 1924 - December 1924

M. A. Fort, M.D...

.. January 1925

DeKalb County..........Warren A. Harrison, M.D. ... ... January 1924- August 1925

J. R. Evans, M.D...

.August 1925- December 1949

T. 0. Vinson, M .D.

..... ....... .. January 1950

Dodge County...........J. L. Gallemore, M.D. ..... ......January 1938 - July 1938

L. Brendle, M.D.

.. ..August 1938 - September 1939

G. M. Anderson, M.D. ...... .September 1939 - December 1939

C. A. Hicks, M.D. ..

..August 1940 - November 1941

T. H. Stewart, Jr., M.D.......... January 1942 - August 1942

Dougherty County..... H. C. Robles, M.D.

... February 1920 - August 1920

Hugo Robinson, M.D.

. ... .......November 1920 - ?

Thomas W. Collier, M.D . .. January 1937 - September 1937

W. B. Buckner, M.D.

... June 1939 - December 1943

D. M. Wolfe, M.D...

... .May 1944

Effingham County.....W. D. Lundquist, M.D. ...December 1947 -December 1949

Emanuel County........ Charles E. Duffin, M.D... .... October 1928 - November 1929

215

Cit y or County

Commissioner of Health

Dates

J. R. Dykes, M.D....... .... December 1929 - September 1930
N. M. Akers, M .D..... ... . ... ...... June 1938 - December 1938

Evans County.............W. D. Lundquist, M.D.. . December 1947 - December 1949

Floyd County..... .. ..... .M. M. McCord, M.D.

............. 1915 - 1919

R. L. DeSaussure, M.D.

.. 1919 - August 1920

F.u~~:ene 0 . Chimene, M.D..........August 1920- March 1921

B. V. Elmore, M.D. .. ................... .. .................April 1921

Fulton County............W. N. Adkins, M.D. .............February 1932 - January 1934

W. L. Gilbert, M.D.

...... _January 1934 - June 1938

R. W. McGee, M.D..

....... ... .................... .. June 1938

Glynn

County ...........T. F. Abercrombie, M .D.. ..March 1914 - August 1917

C. B. Greer, M.D.. .

............ ....

..... ...... .1917

R. W. Todd, M.D... ............... .. .. .. .... .... ......... 1918 - 1920

R. L. DeSaussure, M.D. ...... August 1920 - January 1923

H . L. Akridge, M.D.

..........June 1923- Decembor 1933

M. E. Winchester, M.D.

........... ........ ... January 1934

Grady

County...........J. R. Dykes, M.D. ........... September 1928 - December 1929

R. A. Berry, M.D.

..........January 1930- January 1931

J . R . Dykes, M .D.

....February 1931 - August 1934

H . P. Rankin, M.D ............ September 1934 - November 1943

A. W. Hill, M .D. ... ....... ..... ....... March 1946 -January 1948

J. D. Stillwell, M .D ...

...March 1948 - April 1949

Greene County..........Joseph A. Johnson, M.D.. ....... June 1939 - November 1940 John R. Cain, M.D............... .February 1941 - March 1942 W. R. Richards, M.D...............June 1942 - February 1946

Gwinnett County.......W. B. Trammell, M.D........February 1942 - February 1944

Habersham County ... J. A. Johnson, M.D....... .....November 1940 - October 1941
C. R. Arp, M.D.................. .. August 1942 December 1943
R. J. Settle, M.D................ .... .October 1947 - May 1948
W. E. Baldwin, M.D .................. ...January 1949 - June 1949

Hall County...... ........ ..B. D. Blackwelder, M .D....... ..January 1921 February 1926 C. J. Wellborn, M.D.......... ............. .............March 1926 ? W. D. Cagle, M.D.................... .July 1936 February 1940 W. B. Harrison, M.D.......... ...........February 1940 July 1942 "]" Gregg Smith, M.D...... .................... .. ... ....... ..... May 1948

Hancock County....... Paul R . Ensign, M.D.........................:.July 1939 July 1940 I. H. Moore, M.D....... ..........August 1940 September 1943 W. R. Richards, M.D........ November 1943 February 1946

Harris County............ <;. L. Harp, M.D.. .

......June 1942 - November 1943

Margaret Peeples, M.D.. ........ .. .May 1947 - September 1949

Hart County....... .......E. B. Pool, M.D............ ... ..September 1918 -December 1919

L. J. Page, M.D.

....January 1920 - June 1920

216

City or County

Commissioner of Health

Dates

Jefferson County

.. W. K. Stewart, M.D.

..November 1929 - August 1930

L. R. Bryson, M.D.... ...... ...

.... November 1930 - ?

S. C. Ketchin, M.D. ' _January 1939- December 1941

W. D. Martin, M .D. __ ___ _______ __ ____ June 1942 -August 1943

Jenkins

County ______ __.s. H. Haddock, M.D. ..

. April 1929 -July 1930

F. C. Story, M.D.. ... .....

....July 1930 - December 1930

Guy G. Lunsford, M.D..... ....January 1931 -December 1934

H. B. Senn, M.D... ....

__ ___ ___ ____ January 1935 - ?

Jenkins County.. .. .....Glenn J. Bridges, M.D. .... .. .

.......July 1937 - May 1939

lsbin S. Giddens, M.D. .. .. ..

...July 1939- October 1941

W. D. Lundquist, M.D. ....... January 1942- November 1947

Jones County.... .. ...... ]. D. Applewhite, M.D..... .......October 1937 - June 1944

R. Frank Cary, M.D.. .

______ _July 1944- June 1945

Lamar County.. .. __ __ __ _T. 0 . Vinson, M.D...

.. April 1946 - December 1949

Laurens County .........0. H . Cheek, M.D..

.. ___ .. ...... .August 1919

Liberty County .........C. 0 . Rainey, M.D...... ... ...December 1940 - February 1941 H. J. Bush, M.D .. .... ________ -- ---- -- ----- March 1941 -May 1942 M. G. Frich, M.D. .. .... .. ______ ___ _June 1942 - October 1944

Long County............. M. G. Frich, M.D........... ... __November 1943 -January 1944

Lowndes County... ... ..Marcus Mashburn, M.D.. March 1919 - December 1919
J. D. Applewhite, M.D............January 1920 - August 1920
Gordon T. Crozier, M.D.......August 1920- September 1949

Mcintosh County......M. E. Winchester, M.D.. --- - --- ---- November 1934

Meriwether County.. S. L. Harp, M.D... .. ....... .... --- June 1942 - November 1943 Margaret Peeples, M.D.... _... . July 1947 - September 1949

Mitchell County........H. L. Akridge, M .D...... .... ........ ..January 1922 - June 1923

C. 0. Rainey, M.D. .

. _____ June 1923 -May 1943

A. D. Knott, M.D.. ... .. ........... ...July 1945 - March 1947

Montgomery County..T. W. Collier, M.D.... ...... September 1937- November 1938 A. G. LeRoy, M.D... ----- ----January 1939 - February 1939

Murray County.. .. .. ....]. H. Venable, M .D..... .. ..

_____ .. .... ..... .... .January 1949

Muscogee County .... .R. L. Williams, M.D... ...... W. E. Mayher, Jr., M.D... J. A. Thrash, M.D..... .. .... ... ... ......

-- --- --- _____ 1932 ........ 1932 - 1934 .........January 1940

Pike County......... ......T. 0. Vinson, M.D.. ........ .. ...... ...April 1946- December 1949

Pulaski County...... ....T. H . Stewart, Jr., M .D .......... .January 1942 - August 1942

Rabun County....... .....J. A. Johnson, M.D...... ...... .Novcmber 1940 - October 1941 :C. R. Arp, M.D....... .... .. ........August 1942 - December 1943

217

Cit}' or County

Commissioner of Health

Dates

R. J . Settle, M.D... .. ... W. E. Baldwin, M.D.

... ....October 1947- May 1948 January 1949- June 1949

Richmond

County ..H . B. Nl'a gle, M .D . .

... .... .....November 1922 - ?

R. W. Todd, M.D. .

?

L. L. Dozier, M.D.. ------------------ --- - -- - -

?

.T. V. Route, M.D.

Latter part of 192 7 - 1929

H. H . Blanchard, M.D...

. _.........August 1929 - ?

H . G. Callison, M.D.

. . _ May 1933 -June 1935

T. B. Phinizy, M.D..

_ ....... .July 1937 - May 1942

C . A. H enderson, M .D.

... July 1942 -November 1943

F. C. Hunter, M.D .

___December 1943 - March 1944

A. J. Davis, M .D ...

........ ...... ... March 1944

Scrl'\"en County_ .. W. D . Lundquist, M.D. ..... ..January 1944- November 1947

Sj:.<tlding County

W. C. Humphries, M.D...

. June 1926 -July 1937

T . 0. Vinson, M .D . .

..... .. July 1937- December 1949

Stephens County .....J. A. Johnson, M.D.
C. R. Arp, M .D.
R. J. Settle, M.D. .
W. E. Baldwin, M .D.

.November 1940 - October 1941 August 1942 - December 1943 ....October 1947 - May 1948 ____ January 1949- June 1949

Sumter

County... ....... B. F. Bond, M.D...

? - September 1923

J . W. Payne, M .D.

......January 1924- September 1925

W. H . Houston, M .D. ..

January 1926- January 1931

R. A. Berry, M .D. ..

.. February 1931 - November 1931

A. J. Davis, M .D ....... . . _____ _.January 1932 - January 1937

W. F. Castellaw, M.D.

January 1937- Augu5t 1939

S. P. Vandiviere, M.D ........ September 1939 - January 1940

H. T. Adkins, M.D. ---------------- April 1940- April 1947

Telfair County___________ W. L. Shepeard, M.D..
J. D. S:il!wt>! l, M.D.

_ . ..January 1937 - June 1938 July 1938 - September 1940

T errell County.. ... ....... R . F. Cary, M.D.

.... January 1936 - October 1937

J. R . Cain, M .D. ..

. . November 1937 -June 1938

C. A. Henderson, M.D....... ___.October 1938 - August 1939

0. W. Jenkins, M.D.

... . September 1939- June 1940

C. R . Smith, M.D. ..

.... July 1940 - October 1941

Thomas County........John Schreiber, M.D.

__ _____ ... _ .. 1916 -August 1921

H. L. Pearson, M.D.

. August 1921 -September 1922

M. E. Winchester, M.D....... February 1923 - August 1925

Thomas County..........J. W. Wallace, M.D.

_____ .January 1926 - October 1929

H . B. Jenkins, M .D.
J. R. Dykes, M.D.

January 1930 - August 1934 ..... .September 1934- July 1937

H . F. Readling, M.D. ____ _____July 1937 -November 1945

A. W. Hill, M.D. --- - --- --- March 1946 - January 1948

J. D . Stillwell, M .D .

. -- .........March 1948

218

City or County

Commissioner of Health

Dates

Tift County.. .

... ..A. G. Fort, M .D .

...March 1916- December 1916

T. C . Whittle, M.D... ... . January 1917 - December 1917

R. W. Todd, M .D . ...... .. ... ..... . December 1917- July 1919

W. L. Wood, M .D ...

July 1919- May 1920

R. Floyd Payne, M.D ...

January 1937- December 1937

R. H. Haralson, M .D . ....... ..January 1938 - September 1939

A. G. LeRoy, M .D ...

October 1939 - August 1942

A. G. LeRoy, M.D...

:-<ovember 1945- January 1946

Toombs County .

T . W. Collier, M .D . .... .. September 1937 - November 1938 A. G. LeRoy, M .D ....... ..... January 1939 - September 1939

Troup County ...... .. ..M . F. Haygood, M .D ... B. D. Blackwelder, M .D ... C. S. Kinzer, M .D . . S. C. Rutland, M .D . . R. A. Berry, M.D .
W. J. Peeples, M.D . .

January 1918- August 1918 August 1918- January 1921 .. .. February 1921 - June 1925
August 1925- June 1947 ..... ..Last half of 1929 May 1947- May 1949

Walk er

County ... .... . H. F. Hope, M.D .. .. ... ... ~0\ember 1919 - June 1920

J. Allen Johnston, M .D.

September 1920 - May 1921

J. H. Hammond, M .D . .

..... July 1921 -July 1932

Fred H. Simonton, M.D ...

........... ... . .. ? -July 1934

R. Floyd Payne, M .D ...

.. . July 1934 -June 1935

S. P. Hall, Jr., M .D .. .

June 1935 - November 1935

Charles W. FoLom, M.D. No,ember 1935 - April 1936

R. C . Shepard, M .D ...

July 1936 - April 1939

Paul M. Golley, M .D ....

June 1939 - February 1944

Janes J. Cro.ey, M.U. .

April 1948 - January 1949

Walton County .... ... John L. Dorough, M.D ... Ernest Thompson, M .D.

January 1938 - June 1938 .. ....... June 1938

Ware County ... ....... ...George E. Atwood, M.D... May 1925 - September 1949

W. C. Hafford, M .D ...

... ......O ctober I949

Washington County .. Eugene A. Harri s, M .D .

May 1928 - June 1928

H . B. Jenkins, M .D . .... ... ....... October 1928 - January 1930

0. L. Roger, M .D. .

......... . February 1930

Wayne County..

F. C. Story, M.D. Guy V. Rice, M.D. 0. E. Ham, M.D. ............ .. ..

... August 1928 - July 1930 .. June 1938 - June 1940
March 1941 - April 1941

Wheeler County. W. L. Shepeard, M .D .
J. D. Stillwell, M .D...

January 1937 - June 1938 July 1938 - September 1940

Whitfield County ... C. F. Engelking, M.D. ... February 1937- November 194.'>

W. D. Cagle, M .D ...

March 1946 - May 1946

John H. Venable, M .D . .

.... .... February 1947

Wilkes County .

W. R . R ichards, M.D. ... ... l'<o\embl'r 1943 - February 1946

219

City or County

Commissioner of Health

Dtdll

Worth County............R. W. Taylor, M.D.......................April 1919 - March 1922 W. C. Tipton, M.D............... ..............July 1928 - July 1930 A. G. Hendrick, M.D.....................March 1937 - June 1941 C. W. Harwell, M.D.....................................November 1941

SUPERINTENDENTS STATE TUBERCUWSIS SANATORIUMS

Dr. E. W. Glidden.. ............ ................................................ ... ....................... 1910-1911

Dr. W. P. Parramore... .. ....... ................. .............. ....... ........... c.... .. 1911-1916

Dr. R . E. McClure.................. .. ............. ........................................ .............. 1916-1918

Dr. W. C. Schroeder... ....

................. .................. .. ...........................1918-1919

Dr. E. W. Glidden........................................................................................1919-1930

Dr. M. F. Haygood............................. ...........................................................l930-1933

Dr. D. T. Rankin ......................................................................................... 1934-1937

Dr. C. M. Sharp........... .................................................-................. .............. 1937-1942

Dr. J. F. Busch................... ............ ... ......... ........ ............... ........ .................... 1942

Dr. John W. Oden .................... ................. ...................................................l942

Dr. H. C. Schenck............. ............... ...... ...................... ............................... l943-1944

Dr. R. F. Payne..................................................................... ......................... 1945-1952

Dr. R. C. Corpe.......................................................................................... .. 1953

PEllSONS WHO HAVE BEEN WITH THE DEPARTMENT OF PUBLIC HEALTH TEN YEAllS OR LONGER AND HAVE MADE VALUABLE CONTRIBUTIONS TO PUBLIC HEALTH IN GEORGIA:

Name

Division

Employed

Mr. C. L. Tinsley............................Administration................................June 1, 1911

Dr. T. F. Abercrombie ........... ......... Administration........... .....................Aug. 1, 1917

Dr. T. F. Sellers.............................. Administration............................ ..Mar. 15, 1918

Dr. Joe P. Bowdoi~1 .. .... ................Maternal and Child Health....... ... .... ..April 1918

Mr. E. L. Webb..............................Laboratories................................. .]une 12, 1918

Miss Janie F. Morris...................... Laboratories............. .. ...................July 15, 1918

Mrs. Winnie B. Purdy................ Maternal and Child Health..........Nov. 4, 1918

Miss Germaine Crumbaugh1 . . .... . . . . Laboratories......... ..... ....... .......... .....Jan. 1, 1920

Miss Margaret McClure................Vital Statistics........................... .....Feb. 15, 1920

Miss Mildred F. Selman.................. Public Health Engineering............Aug. 23, 1920

Mr. N. M. deJarnette.................. .. Public Health Engineering..........Sept. 21, 1921

Mrs. Mayme A. Johnson................Central Tabulating UniL .............Oct. 31, 1921

Mr. E. J. Sunkes................. .. .. .... ..... Laboratories...,............................... .June 1, 1922

Mr. Lee M. Clarkson .................. Public Health Engineering...... ....... .Ju1y 1, 1923

Miss Katie L. Calhoun....... ...........Laboratories ...................................... June 1923

Miss Marie Price............................Administration................................Mar. 1, 1924

Miss Erna Lee Mason ....

Administration................................July 15, 1924

Mrs. Evelyn B. Vaske ......

Laboratories................... ........... ......Oct. 1, 1925

Mr. Louis N. Kiene 2 .. .. . .. .

Administration............................ ....... ...Oct. 1926

Miss Ethel Mae McMichael . . Vital Statistics ....................... ..... Dec. 15, 1927

Mr. W. H. Weir.......... ........ . Public Health Engineering........... .. Jan. 1, 1928

Dr. Clara B. Barrett.............

Tuberculosis ControL ... ............. .. .Feb. 1, 1928

220

Name

Division

Employed

Miss Ollie Duncan: __

.... ..... Vital Statistics..

... .Feb. I, 1928

Miss Elizabeth McEntire.. . ... Public Health Engineering.. . Oct. I, 1928

Miss Madge Reynolds

... Laboratories

... ......... .July 1, 1929

Mrs. Elinor H. Springfield . .. Administration .

.. ... .Feb. I, 1930

Mr. E. G. Eggert .

.. Local Health Organizations ... .May 22, 1931

Mr. H . B. Starr, Jr.

.Public Health Engineering.

June I, 1931

Mrs. Jessie S. Culbertson .

.. Venereal Disease Control.. .. . ..July I, 1931

Dr. H. C. Schenck..

..... .Tuberculosis ControL

.. ..Jan. I, 1932

Miss Annie J. Taylor

.. ... Dental Health ..

Feb. 15, 1932

Mr. Tom Beavers: ..

...... Administration

..... ..Dec. 12, 1932

Mrs. Christine M . Jolly.

...... Laboratories....

..... Nov. 1933

Mrs. Abbie R. Weaverl ... .. ... ... Public Health Nursing

.... ... ..... .Jan. 1934

Miss Frances Godbee:. .

.. Laboratories .

. .Feb. 1, 1934

Mrs. Margaret Patterson . Mrs. Nora Sullivan2 .

.Epidomology ..Laboratories ..

. Mar. I' 1934 .......... ... Mar. 1934

Mr. Edwin P. Dawkins 2

.Vital Statistics.

... .. ... Mar. 1934

Mrs. D. C. Livsey Anderson2 ... . ... Tuberculosis Control..

.....Apr. 1, 1934

Mrs. Margaret Faith2

.. Public Health Nursing

..... Apr. 1934

Mrs. Edna M. Killibrew

.. Laboratories..

. .May 2, 1934

Mr. Lacy H. Garvin ...... ........ ..... Central Statistical Unit..

.... .May 29, 1934

Mrs. Natalie B. Hughie 2 ....... .... .. . Administration ..

.. June I, 1934

Mrs. Jea nnette L. Franklin 2 . .... .... Laboratories ..

. June 12, 1934

Mr. Forrest W. Rhodes

. Local Health Orgbanization .. .... .June 30, 1934

Mrs. Martha H. Knox

.. ..... .Central Statistical Unit.. .. . . Sept. 14, 1934

Miss Roxie Nevil ..... ... . ..... .Laboratories

......... .... Sept. 1934

Mr. Reuben R. Taylor.

...... Laboratories

... ....... .... Sept. 1934

Miss Elizabeth Butt . .... ... ... ..... ..... Laboratoreis Mrs. Edith C. Thomas ................. Local Health
Organizations

... .1934-1946; 1948-1950 . .1934-1947 ; 1949-1950

Miss Lena May Jones

..... Administration .

..... Oct. 1934

Dr. Guy G. Lunsford3 .

......... Local Health Organizations ...... Nov. 24, 1934

Mr. Roy J . Boston..

.... Epidemiology ..... ... .. .... ... ....... Dec. 1, 1934

Mr. John B. Black

... .... Local Health Organizations .. ..... ........Jan. 1935

Mrs. Elizabeth Fulcher

........ Tuberculosis Control .. ... .. ... ......... .Jan. 1, 1935

Dr. C. D . Bowdoin ..

Venereal Disease ControL .... .... ... ...Oct. 1, 1935

Mr. Tilden D. Adkins

.. .... Hospital Service .......... ...... ...... .....Oct. I, 1935

Mrs. Maurine Tinsley

... .Administration

... .. Nov. I, 1935

Miss Florence Davis ... . ... .. .. ... Central Statistical Unit .

. .Nov. 4, 1935

Miss Martha H. Pattillo

.. Vital Statistics..

. . Apr. 8, 1936

Mr. Frank H. Stubbs, Jr.

..... Laboratories ..

.. ... . May 15, 1936

Mi~s El~ie Crosby

...... Local Health Organizations . July 16, 1936

Miss Gertrude Sheppard

Local Health Organizations .. ....... .July I, 1936

Mr. Gilbert R . Frith ...

... Public Health Engineering .... .. .Mar. 1, 1937

Mr. Wm. L. Avrett, Jr. 2

Public Health Engineering ....... .... Mar. 1, 1937

Mrs. Inez R. Riley..

..... .. .Tuberculosis Control..

. ...... Mar. 16, 193 7

Miss Lillie Mae Avrett

. Laboratories..

. . .May I, 1937

Miss Emily C. Wade

__ I.oral Hl"alth Organizations .. ....... Aug. 1, 1937

Mr. Carl Adams 2

Laboratories .

. ..Sept. 7, t9:l7

221

Name

Division

Employed

Miss Mary Sanders.......................... Laboratories .... ------------------------Sept. 7, 1937

Mrs. Chloe A. Jackson ................. Laboratories... ------- ...... 1917-1920; 1940-1950

Dr. Lester M . Petrie .. --------------Industrial Hygiene............................Oct. 1, 1937

Mr. Louva G. Lenert .... ...

Public Health Engineering ...______ ____Nov. 1, 1937

Mr. Clyde N. Eldridge ........... ...... .Public Health Engineering -------- --.Jan. 3, 1938

Mr. Ernest B. Davis ------- -------Administration

Mar. 21, 1938

Mr. James M. Sitton ---- -- -----------Hospital Service... ----------- .. .,::____,Dec. 20, 1938

Mr. Felix C. Pickron...... .

Local Health Organizations. ____ _____July 17, 1939

Miss Mariemma Jackson ......... ... Local Health Organizatiom........Sept. 25, 1939

Mrs. Elizabeth B. Phillips..............Vital Statistics...... ..... -- -------------- Nov. 6, 1939

Mrs. Elizabeth S. Lassetter.......... Laboratories.. ---- ---- ------ 1929-1935; 1943-1950

1 Deceased. 2 Resigned. 3 Retired.

222

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223

APPROPRIATIONS FOR PUBLIC HEALTH 1903-1953

1903-1904 -- ----- -- -- ----- ----- ---------- ------- ..$ 1905-1907 ----- - -- ------------- -------- ---- --- ----

3,000.00 7,500.00

p,er

annum
"

1908-1909 ---- ----- --- -- --- -- -- -- ---- ---- ----- -------- 16,000.00 ," ",

1910-1911 ------- -- ----- ---------- - --- - --- ---- -- - ----- 21,500.00 ,

1912-1918 -- ----- ------- ---- ----- - ---- -- -- -- -- ------- 30,500.00

1919

----- -- -- ------- - -------- ----- ---- ---- ------ 60,000.00 "

," ,

1920-1921 ------- -- ----------- -- ------------ -------- ----- 90,590.00 " "

1922-1927 ---- --- ------- -- ------- -- - -- --------- ----- 96,431.00 ",
1928-1929 ---- -- --- ---- --------------- ----------------- 125,000.00

" "

1930-1931 ------- -- ------- -- --- --- ----- ------ -- ------- 165,000.00 " "

1932

-- ---- --- --- ---- --- ----- ---------- -- -------- - 150,880.00 " "

1933 1934 1935

-- -------- -------- -- ------------- ---- -- -- ------ 107,600.00 ", ----- -- ----- --- -- ---- - ------- ------ ---------- 95,230.00 ,
-- --- -- -------- ---- --- -- -- ---- ----- --- ------ --- 104,375.00

" " "

1936

-- -- -- --- --- --- ---- -------- -- - --- -- -- --- 121,875.00 " "

The foregoing appropriations were for the calendar year January 1 to December 31. In 1937 the State fiscal year was changed to July 1 to June 30, and for the half year January 1 to June 30, 1937 the appropriation was $125,000.00.

1938 (7-1-37 to 6-30-38) ______ _____ ___.$ 444,000.00 per annum 1939 (7-1-38 to 6-30-39) ____ _______ ______ 396,000.00 " "
1940 (1-1-39 to 6-30-40) ----- ---- ---- ---- 410,000.00 " " 1941 ( 1-1-40 to 6-30-41) ---------- - __ __ 327,000.00 " " 1942 (1-1-41 to 6-30-42) ----- -- -- --- ---- -- 600,000.00 " " 1943 ( 1-1-42 to 6-30-43) ---- -- ------------ 544,050.00 " " 1944 ( 1-1-43 to 6-30-44) ----- ---- -- -- ----- 600,000.00 " " 1945 ( 1-1-44 to 6-30-45) _____ __ ____ _____ 600,000.00 " "
1946 ( 1-1-45 to 6-30-46) ---- 700,000.00 " " 1947 (1-1-46 to 6-30-47) ------ - ---- 2,100,000.00 " " 1948 ( 1-1-47 to 6-30-48) ---- 2,100,000.00 " " 1949 (1-1-48 to 6-30-49) ----- -- - 2,100,000.00 " "

Federal funds under the Social Security Act became available to the Department of Public Health on February 1, 1936. Grants by the United States Public Health Service and the Children's Bureau are as follows:

U.S.P.H.S.

1-1-36 to 12-31-36 ___ __ _ $ 196,250.87

1-1-37 to 6-30-37

151,714.21

7-1-37 to 6-30-38 ____ ___ _ 303,400.00

7-1-38 to 6-30-39 _____ ___ 343,569.00

7-1-39 to 6-30-40 __ __ __ __ 440,883.00

7-1-40 to 6-30-41 ---- --- 547,200.00 7-1-41 to 6-30-42 _______ _ 720,100.00 7-1-42 to 6-30-43 ___ ___ __ 831,026.51

7-1-43 to 6-30-44 __ __ __ __ 884,054.53

7-1-44 to 6-30-45 __ _____ _ 907,826.68

Children's Bureau
$115,238.63 78,664.05 125,283.84 127,808.27 161,236.41 187,773.00 197,937.00 177,868.00 537,946.00 ("E" 365,321.00) 854,150.00 ("E" 663,975.00)

224

7-l-45 to 6-30-46

I ,008,940.00

7-l-46 to 6-30-47 ...... .. I,273,358.00

7-l-47 to 6-30-48 ... .. ... I,439,5I2.40

7-l-48 to 6-30-49 1,878,5I6.13

646,366.00 ("E" 455,271.06) 456,500.00 ("E" I58,338.00) 562,725.00 ("E" I29,I00.56) 490,770.00 ("E" I2,339.73)

The increase in the Children's Bureau funds beginning with the fiscal year ending June 30, I944, was due to the Emergency Maternal and Infant Care program which has ended.

" Ear Marked" funds by the U . S. Public Health Service started with the fiscal year ending June 30, I939. For your information, the following is a schedule giving the purpose for which the U. S. Public Health Service funds were granted to Georgia:

7-1-38 to 6-30-39.

..Title VI

$266,435.00

VD Act I938 77,134.00

$ 343,569.00

7-1-39 to 6-30-40

Title VI

286,481.00

VD Act I938 I54,402.00

440,883 .00

7-1-40 to 6-30-41.

..Title VI

329,900.00

VD Act I938 2I7,300.00

547,200.00

7-1-4I to 6-30-42..... ... ..Title Vl VD

359,500.00 360,600.00

720,100.00

7-I-42 to 6-30-43.

.Title VI VD

362,626.5I 468,400.00

831,026.51

7-I-43 to 6-30-44 ... ......Title Vl VD

399,071.00 484,983.53

884,054.53

7-I-44 to 6-30-45.. ... ......Title Vl VD Tuberculosis

394,026.68 464,000.00 49,800.00

907,826.68

7-1-45 to 6-30-46. ...... ..Title VI VD Tuberculosis

420,420.00 432,340.00 156,180.00

1,008,940.00

7-1-46 to 6-30-47.. ... ......Title VI VD Control R .T.C.Tuberculosis Hospitals

410,405.00 377,329.00 196,937.00 26I,I69.00 27,5I8.00

1,273,358.00

7-I-47 to 6-30-48. .. .......General Health 3I0,940.00

V.D. Control 364,953.00

R.T.C.

395,881.40

Tuberculosis 255,735.00

Industrial

Hygiene

27,521.00

225

7-1-48 to 6-30-49 . ..

Cancer Control 48,028.0u Mental Hygiene 36,454.00

General Health 276,644.00

V.D. Control 409,496.00

V.D. Case

Finding

13,000.00

R.T.C.

348,126.00

Tuberculosis 250,829.00

Industrial

Hygiene

30,483.00

Cancer Control 64,280.00

Mental Hygiene 89,729.00

Heart Control 16,000.00

Hospital

Construction 379,929.13

,439,512.40 1,878,516.13

As stated, no part of the State Appropriation is "ear-marked" for local health service development. 'For your information, listed below are the amounts spent for local health services for the last several years:

Period:

Central Administration Direct State funds Local Health Department To Local Units

1-1-34 to 12-31-34 ... $ 2,387.63

1-1-35 to 12-31-35

5,649.75

1-1-36 to 12-31-36

8,551.86

1-1-37 to 6-30-3 7

4,881.16

7-1-37 to 6-30-38

13,703.11

7-1-38 to 6-30-39

12,627.60

7-1-39 to 6-30-40 ... 11,532.37

7-1-40 to 6-30-41 .. 10,649.99

7-1-41 to 6-30-42

13,323.33

7-1-42 to 6-30-43

13,178.35

7-1-43 to 6-30-44

13,835.87

7-1-44 to 6-30-45

13,436.64

7-1-45 to 6-30-46

15,481.08

7-1-46 to 6-30-47

26,667.68

7-1-47 to 6-30-48

32,745.54

7-1-48 to 6-30-49 . 33,926.32

7-1-49 to 6-30-50

35,743.65

$
52,169.32 52,497.78 149,987.04 213,489.44 243,463.26 284,809.02 289,977.27 383,952.59 378,636.11 397,870.97 438,785.75 561,091.95 666,581.38 761,089.95 848,156.11

Health Districts & Regions
$
45,660.54 38,425.41
117,249.49 127,211.74 165,998.57 191,972.50 162,417.65 150,487.10 154,373.50 180,343.42 272,923.81 311,624.96 258,806.26

Object of Appropriations

Appropriations 1950-51

Ga. Dept. of Public Health:

State Appropriation .

. $ 2,102,500

U. S. Public Health Service:

General Health . .. .... ..

390,078

Venereal Disease Control

217,627

Appropriations 1951-52
$ 3,030,000
410,700 119,300

226

Venereal Disease Casefinding ..... . ... .
Tuberculosis Control Heart Disease Control . Cancer Control ............. . Mental Hygiene Water Pollution Control U. S. Children's Bureau: Maternal & Child Health Fund A. 'Fund B Fund RB . ..... .. ..

114,040 208,807 55,009
79,523 81,331 19,600
150,990 308,499
75,000

Funds Available for Department $ 3,803,004

Alto Medical Center: Rapid Treatment Center Funds Direct Services ... Special Training Project

.. $ 588,560 132,595 74,900

Funds Available for Alto . .. $ 796,055

Battey State Hospital: State Appropriation

$ 3,050,000

Funds Available for Battey . $ 3,050,000

Hospital Construction: State Appropriation ... Federal Appropriation

.. $ 3,000,000 2,609,914

Funds Available for Hospital Construction

$ 5,609,914

Funds Available for Institutions and Hospital Construction $ 9,455,969

New Programs: Crippled Children's Services:
State Appropriation
U. S. Children's Bureau: Crippled Children's Fund A Crippled Children's Fund B

Funds Available for Crippled Children

227

139,000 184,600 40,900
75,600 74,100 19,800
143,500 229,249
75,000 $ 4,541,749
$ 522,000 129,000 75,000
$ 726,000
$ 3,050,000 $ 3,050,000
$ 3,000,000 2,786,528
$ 5,786,528
$ 9,562,528
$ 450,000 131,000 200,038
$ 781,112