Annual report of the Georgia State Board of Health for 1919 [1920]

ANNUAL REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR 19 19
ATLANTA, GA.
ATLANTA, GA. BYRD PRir TING CO., State Printer!
1919

ANNUAL REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR 1919
ATLANTA, GA.
ATLANTA, GA. BYRD PRINTING CO., State Printers
1919

Atlanta, Georgia, January 13, 1920
To His Excellency,
HoNORABLE HuGH M. DoRSEY,
The Governor of Georgia Dear Sir:
I have the honor to transmit, through you, to the General Assembly, a report covering the activities of the State Board of Health for the year 1919, this being the s~xteenth annual report, and the third since my incumbency.
The volume of work done through all departments of the State Board of Health for the year 1919 has exceeded by far any previous year. The Labora~ory examined a total of 18,313 specimens during the year 1919, whereas in 1918 only 6,185 were examined.
At the beginning of the year the Bureau of Vital Statistics was organized. The work of this department has exceeded my expectations. In January only 15% of the births and 23% of the deaths were filed, whereasinNovember 66% of the births and 69% of the deaths were filed with this department. Under the efficient management of Dr. Davis, I believe that Georgia will be admitted to the registration area for deaths at least within the period of one year or eighteen months.
The Venereal Disease. Department has been contin' ued along the same lines as in 1918. Up to November 1st,
all funds for the maintenance of this' department were supplied by the United States Interdepartmental Social Hygiene Board. Since November 1st the State has been sharing the expense of this work on a fifty-fifty basis. This department is now launching an educational campaign to reach all of the high school boys in Georgia.
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Believing that education is one of the best weapons to wipe out these diseases, we are putting forth every effort possible to carry the message of right living to the people of Georgia. The campaign for the eradication of venereal disease in Georgia is proceeding along the following lines, first, education, second, law enforcement, and third, treatment for those infected. There are at present seven clinics in the larger centers of population in the State and a representative in each of 142 counties. The Interdepartmental Social Hygiene Board has loaned to the Georgia State Board of Health a sufficient personnel to carry out the law enforcement en<Yof this campaign"
RuRAL SANITATION AND ELLIS HEALTH LAw.
At the beginning of 1919 there were only six counties that were operating under the Ellis Health Law. At the close of the year there were fourteen counties. Ten other counties have had the necessary grand jury recommendations, and we anticipate that these and many others will have a full time commissioner of health during 1920 if men can be secured to fill the places. , The interest in the county health work throughout the State has been phenomenal. Counties have adopted the Ellis Health Law faster than we can -secure trained men to fill the places.
EPIDEMIOLOGICAL DEPARTMENT.
This department was organized January 1, 1919, in conjunction with the Department of Rural Sanitation. A total of 29,379 diseases have been reported to the State Board of Health through this department. This by no means is the total number of communicable diseases that have appeared in this State, but the encouraging feature of this work is that the doctors throughout the State are gradually becoming accustomed to making reports either to their local Boards of Health or to the State. For the
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year 1920 this department will be under the direct supervision of Dr. W. S. Bean, of the United States Public Service. Dr. Bean has been loaned to us for a period of twelve or eighteen months for the purpose of working up this department, and we have every reason to believe that within a short time, through his efforts, we will at all times have a fair index of communicable diseases. Unless we know where diseases are occurring before they become epidemic we cannot take measures to prevent epidemics.
TuBERCULOsis SANITARIUM
I am glad to state that the Tuberculosis Sanitorium . at Alto has undergone thorough reorganization during the year 1919, and is now in as good shape as could be expected with our present appropriation. The legislature appropriated $3,750.00 to buy 48 acres of additional land. The farm house on this land has been converted into a superintendent's cottage. I wish to call special attention to Dr. Glidden's recommendations in his report. The institution is at this time accommodating 82 patients, its full capacity under present conditions. If the additional equipment, nurses' homes, etc., can be had, which Dr. Gliden asks for in his recommendations, the institution can care for 120 patients.
MALARIA.
Malaria through the southern part of the State constitutes one of the greatest sanitary problems with which the State Board of Health has to deal. In co-operation with the United-States Public Health Service and the International Health Board we undertook in a limited way an anti-malarial campaign in southwest Georgia in Au- . gust, 1919. The survey made during this campaign disclosed the fact that malaria is causing a serious economic loss to the citizens of our State (See report). I believe
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that it is of tremendous importance that the Board take steps towards reducing this loss from malaria.
The United States Public Health Service has loaned to the State Board of Health during the year Dr. W. S. Bean, who has been making epidemiological studies, and Dr. C. C. Applewhite, who has been working in the State in the interest of rural sanitation and whose efforts have been of great value to the Board in interesting the counties in the Ellis Health Law. His services have also been of inestimable value to the Commissioners of Health in the various counties. Recently Mr. Sol Pincus, Sanitary Engineer, of the United States Public Health Service, has been loaned to the State Board of Health to make a survey of water and sanitary engineering problems of the state. The services of all of these men have been of tremendous value to the Board during 1919.
ENGINEERING DEPARTMENT.
I believe that the time has arrived when the Board sho1,1.ld consider plans for re-organizing the Water Analysis Department and broaden its scope to take in all phases of sanitary engineering work. This can be done at a very small additional cost and can be handled on our present appropl!iation.
CHILD HYGIENE AND NuRSING DEPARTMENT.
In presenting our budget for 1920-21 to the legislature we included an item for Child Hygiene and the legislature granted this increase in appropriation. The American Red Cross has agreed to help the State Board of Health in organizing and establishing a Division of Child Hygiene and Nursing and also agrees to help us financially to the extent of $5,000.00
LEGISLATION.
The legislature passed an act creating a Training School for Mental Defectives. The establishment of this school was placed in the hands of a temporary Board of
6

Control, composed of the Governor, Attorney General and Secretary of the State Board of Health. When the school is established the temporary Board of Control goes out of existence and the school will be turned over to the State Board of Health for operation. The temporary Board of Control has not made selection of the site for the school up to the present time.
The Vital Statistics Law has been amended, giving the State Board of Health authority to appoint a registrar in counties having no justice of the peace, and authorizing the State Board of Health to combine districts in counties where it is to the best advantage in collecting vital statistics.
The Boys' Reformatory at Milledgeville was changed to a Training School for Boys, and the Secretary of the State Board of Health was made a member of that board.
APPROPRIATIONS.
The legislature appropriated for the maintenance of the State Board of Health for the years 1920-21, $75,590.00; for venereal disease control, $15,000, for the support and maintenance of the State Tuberculosis Sanitorium at Alto, $36,000.00.
Attached to and forming a part of my report is a detailed report from each of the departments.
I wish to take this occasion to thank the employees of the State Board ofHealth for their loyalty and faithfulness. I sincerely believe that there cannot be found anywhere a more loyal, enthusiastic and hard-working personnel. I wish also to thank the members of the State Board of Health for their support and confidence. I wish especially to thank the Governor for his hearty cooperation and advice during the year.
Respectfully submitted, T. F. ABERCROMBIE, Secretary
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Division of Laboratories
Dr. T. F. Abercrombie, Secretary,
Georgia State Board of Health.
Dear Doctor :
I beg to submit herewith the Annual Report of the Department of Laboratories for the year 1919. This report summarizes the work of all departments, including the Bacteriological, Water, Serological and Pasteur I...~abora tories.
REPORT OF LABORATORIES.
(1) Sputum Examinations for Tuberculosis:
1 ~~~!\I!e -=======~==========================================1,~~:
Doubtful -------------------------------------------------- 4
Total ----------------------------------------------------.2,462 (2) Throat Swabs for Diphtheria:
Positive ___ ------------------------------------------------ 622 Negative ------------------------------------------ ________1,546 Doubtful -------------------------------------------------- 38
Total -----------------------------------------------------2,206 (3) Widal Tests for Typhoid Fever:
Positive ------------------------------------------- _- ------- 259 Negative -------------------------------------------------- 530 Doubtful ------------------------------------------------- 6
Total ----------------------------------------------------- 795 (4) Pus Smears for Gonococci:
Positive ---------------------------------------------- _____ 490
DN~oguabttifuvle ------------------------------------------------------~--------------------------------1-,133591 No Diagnosis :...------------------------------------------- 22
Total ------------------ _- ---------- ___________:._ ___ ----- .2.002 (5) Blood Smears for Malarial Parasites:
Positive ----------- ------.---------------------------------- 107 Negative ----------------------------------.--------------- 728 Suspicious ------------------------------------------------- 5
Total ------------------a---------------------------------- 840
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(6) Animal Brains for Rabies: Positive _______ ---------------------- ___ ----- __ ____ ________ 222 Negative ----------- ___ ---------- ___ ----- ___ ___ _____ __ ____ _ 168 Doubtful ______ ---------------------- ___ ------ __ --- _____ - _- 44 Too Badly Decomposed ------------------------------------ 52
Total ------------------------------------------------------ 486 (7) Feces for Intestinal Parasites:
Positive ______ -------- __ --- --- _- _- -------- _____ - ----------- 593 Negative ~-------------------------------------------------1,216
Total ------------------------------------------------------1,809 (8) Blood Smears for Differential Counts:
Total - ___ ---------------------- __ ---------------------- _--- 352 (9) Miscellaneous Examinations:
Total --------- _---------------------------------- ____ ------ 51 i
(10) Specimens of Blood for Wassermann Test.
Positive ---------------------------------------------------1,672
Negative _---------- ____ - ------- --------------------------_4,534
Doubtful ____ ----- __ ----------------------------------- ____ 101
Total _------- ________ -------------------------------------6,301
(11) Bacterial Water Analyses --------------------------------- 465 Chemical Water Analyses _---------------------- _------- ___ _ 34 Chemical and Bacteriological Analyses----------------------- 31 Sewage Analyses------------------------------------------- 7
Total Analysei -------------------------------------------- 537 Total Examinations for the year 1919 ----------------------18,313 Total Examinations for the year 1918 ---------------------- 6,185 Increase over 1918 _---------- __ - ____ ._ __ ------------------12,128
A review of the 1918 report, or of any preceding year, will reveal by contrast the tremendous expansion of laboratory work during the past year, 1919. The following factors may have been responsible for this ex~ pansion:
First. Activity on the part of the Secretary and his co-workers in educational and publicity work, thereby popularizing the laboratory.
Second. Growing popularity of the Ellis Health Plan operating through the Department of Rural Sanita.._ion.
Third. Widespread operation of the Venereal Dis'aSe Department, the eager response to which emphasizes the need for this new phase of health work.
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Fourth. Constructive co-operation of all departments and increasing confidence of the medical profession in the quality of the laboratory work.
Fifth. Restoration of the normal distribution of physicians over the State, many of whom have been discharged from military service early in 1919.
Sixth. Increase in certain infections due to the mild winter of 1918 and long wet summer of 1919.
Seventh. Earnest and efficient work of laboratory personnel in all epartments. The laboratory is exceedingly fortunate in this respect.
(1) The increase in the percentage of positive sputum examinations for B. tuberculosis may be of interest in the study of influenza sequalae: It was anticipated that an increase of active cases of tuberculosis would follow the recent intensely widespread /respiratory infection. Many factors may influence this increase, but none is so obvious as this one. It is gratifying to note, however, that under the able and vigorous leadership of Mr. J. P. Faulkner the white plague status in Georgia is being rapidly exposed. Among the various means to this end I wish to compliment the "Big Dee" pamphlet which Mr. Faulkner is now circulating to every patient showing positive laboratory evidence of infection. In the microscopic study of nearly 2,500 sputums it was rather interesting to note the gradual disappearance of the bacterial flora usually accompanying or following "flu."
(2) Diphtheria has been considerably epidemic during the past summer and fall months, but the curve of incidence dropped quickly to normal in November and by December 15th only a few cases were reported. The mortality was low. Proportionately the Biological Department distributed twenty-nine million units of antitoxin as compared with twelve million for the year 1918.
(3) Typhoid fever has been quite prevalent and widespread. The mild winter of 1918-19 and the excess
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of rain throughut the year have been more responsible

\

than all other factors combined in causing this increase.

The figures presented in this report relating to the Widal

test are not indicative necessarily of the distribution of

typhoid fever in Georgia. As stated above, the interest

and patronage of an increasing number of physicians in-

fluence greatly the number and character of specimens

submitted to the laboratory.

(4) Of the 2,002 pus smears examined for gonococ-

cus, 85.7 per cent were submitted by the Atlanta Venereal

Clinic and the city physicians of Atlanta. Many of these,

however, were release tests from the same patients, in

some instances as many as twelve slides being submitted

over a period of two months from the same patient. The

majority of slides were from females and the difficulties

encountered in microscopic diagnosis were very great at

first. Later, a special technique of staining was devised

and the differentiation of the gonoccus from contaminat-

ing bacteria was greatly facilitated. This technique will

be submitted in a separate report.

(5) The long summer season and the rainy weather

have been favorable for the breeding of mosquitoes and a

consequent increase of malaria resulted. Positive smears

have been submitted from all parts of the state but the

two principal foci were apparently between Augusta and

Savannah near Waynesboro, and in extreme South Geor-

gia near the counties of Cook and Sumter. Here again

the interest of a few local physicians may accaunt for the

great increase of positive slides from these defined dis-

tricts. The report of the epidemiologist may show just

as marked an evidence of malaria in sections of the state

from which we received very few specimens. Apparently

all these types of malaria abound, although the aestivo

autumnal type is seriously prevalent in South Georgia.

(6) Rabies is apparently on a gradual decrease.

This is suggested by the decrease in the number of posi-

12

tive animal brains (222 as compared to 260 for the preceding year), and also by a decrease of 96 in the total number of Pasteur treatments for the year. Material is abundant for an interesting special report on the status of rabies and Pasteur work in the state. We cannot help but rejoice, however, over the fact that out of 1,399 complete human treatments not one contracted rabies. We cannot say as much for the animal treatments. Figures pertaining to the rate of mortality among animals are not yet available; but it is probable that the immunity conferred through treatment is very uncertain in lower animals, especially dogs.
(7) Of the 593 positive specimens submitted for intestinal parasite examinations, 537 were positive for hookorm; 29 for taenia nana, or tape worm; 19 for ascaris lumbricoides, or stomach worms; 3 for amoeba hystolytica; 2 for taenia saginatta or beef tape worm; 2 for flagellates and 1 for oxyuris vermicularis, or seat worm.
The brine flotation method of concentration is used exclusively in examining for hookworm ova. Since this technique was installed the percentage of positive findings has been considerably increased.
Considerable hookworm index work was done from time to time during the year. In one school district in South Georgia 38 per cent of the school children were found infected. Rural sanitation and the institution of the sanitary surface closet will probably figure more largely than oil of chenopodium or thymol in finally stamping out hookworm.
(8) We have adopted a routine of making a differential blood count on every blood slide whether submitted for malarial examination or whatnot. A negative malarial blood slide becomes very monotonous under the microscope and the blood count furnishes a profitable diversion, quite frequently throwing light on some hitherto unsuspected condition.
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(9) Under the head of ''Miscellaneous'' are included all examinations not otherwise listed. There were principally reJpiratory exudates examined for any significant or predominant organisms. Under this head, also, may be mentioned the laboratory diagnosis of a case of human anthrax at Calhoun, Georgia, evidently contracted from the use of a cheap shaving brush. Virulent anthrax spores were found also in a series of cheap ten cent shaving brushes found at Rome, Georgia.
SERIOLOGICAL LABORATORIES.
(10) The growth of this department has been phenomenal. The serologist, Mr. E. L. Webb, conducted the work unassisted until September, 1919, at which time he was given an assistant technician, Miss Laura Bell Brewster. Mr. Webb endeavored to preserve a strictly uniform technique, using the unmodified Wassermann complement fixation and the sheep-rabbit hemolytic system. The accuracy and consistency of Mr. Webb's results are partly responsible for the monthly increase in the number of specimens submitted. While included in the annual laboratory report of the State Board of Health, the Wasserman work is supported and financed by the U. S. Public Health Service operating through Major J. P. Bowdoin.
(11) Mr. R. C. Werner, director of the Water Laboratory, submitted the heaviest report in the history of his department. This department has always been handicapped by a lack of support and insufficient equipment and personnel. In February of this year Mr. Werner was given an assistant laboratory technician, thereby relieving him of the technical laboratory work in order that he migt spend more time in field work. Unfortunately this plan had hardly adjusted itself when the assistant resigned in favor of a better position. Since then Mr. Werner has had no assistant and is at the present time
14

greatly handicapped. From the laboratory point of view, Mr. Werner has presented a splendid report.
In this connection the time is ripe for the launching of a new but very important Dep~rtment of Sanitary Engineering, under which would be grouped these subheads: (1) Control of Water Supplies, (2) Municipal Sewage Disposal, (3) Drainage and Malarial Control Work. This department should be under the direction of a chief sanitary engineer of extensive training and experience. The Department should have sufficient author- ity, equipment and personnel to functio::~. as one of the most important departments of State health work.

PASTEUR DEPARTMENT.

The following table gives the distribution of Pasteur treatment as compared to the year 1918:

Year 1919 Human Treatments --------------- ___ ------- _____ -1,399
Dogs treated -------------------------------------- 302 Hogs treated -------------------------------------- 46 Cows treated -------------------------------------- 21
1ules treated ------------------------------------- 35 Horses treated __ ------------------------------ ____ 3

Year 1918 1,425 266 101
71 29 10

Total for the year -------------------------------1,806

1,902

Among the 1,399 persons treated not one death from

rabies has resulted. We consider this a remarkable record. In fact, it is unprecedented both in the history of

our department and in that of any laboratory treating over a thousand persons. Pasteur Institute at Paris boasts of an efficacy of 99.7 per cent. On the other hand,

there have been two human deaths from rabies during the year, neither case receiving Pasteur treatment. The

incubation period iri both instances was three weeks. The animal treatments were not nearly so successful
and it is roughly estimated that not more than fifty per cent of the animals treated were immunized. It was sug-

gested that the human treatment be used for animals as un experiment. Beginning November lst all new animals

15

were treated accordingly, but at this writing sufficient data have not been obtained to enable us to draw a conclusion.
It is hereby recommended that, should the human treatment for lower animals prove reasonably successful, a nominal charge of five or ten dollars per treatment be collected for each animal treatment, the proceeds going to the maintenance of the Pasteur Department.
It is high time that some constructive measures be put in operation to reduce the incidence of rabies in Georgia. Such need is quite pertinent when we stop to realize that Georgia reports a higher incidence of rabies in animals than any other state in the Union.

BIOLOGICAL PRODUCTS. Number c.c. Plain Typhoid Vaccine Distributed______________ ,Number c.c. Triple Typhoid Vaccine Distributed ------------

106,885 74,734

Total c.c. Typhoid Vaccine Distributed ---------------------- 181,619 Number c.c. Strepto-Pneumococcus Vaccine Distributed------- 66,813 Number Units Diphtheria Antitoxin ___ ----- __ --------------29,047,000
Under the supervision of Miss Cloe Allen, assisted by Miss Janie Morris, the vaccine department is the pride of the laboratory. The manufacture of a saline typhoid vaccine may be considered a relatively simple matter, but, in the matter of sterility and of potency, the Hygiene Laboratory at Washington can vouch for the relative excellence of our vaccine. The technique employed in the manufacture adheres very closely to the U. S. Hygiene Laboratory method. A representative sample is sent periodically to Washington for examination, and in every instance a favorable report was returned. Chiefly through the efforts of Dr. Haygood the demand exceeded by 61,000 c; c., or 34 per cent, the 1918 figure. Plain typhoid vaccine is much more popular than mixed or triple typoid paratyphoid vaccine, because of the relatively less severe reaction. The laboratory diagnosis of

16

f..
several cases of paratyphoid fever emphasizes the advantage of mixed vaccine.
The etiology of Spanish Influenza remained yet to be determined, but the preponderance of research points more and more strongly to the hemolytic streptococcus' and certain nondescript types of pneumococcus as the most important secondary invaders. The so-called broncho-pneumonia was responsible for over ninety per cent of the mortality. Hence, while the conservatism of the U. S. Hygienic Laboratory is justified, we firmly believe there is some value in a. streptococcus pneumococcus saline vaccine prepared, if possible, from local strains, and used as a prophylactic and not a therapeutic for acute respiratory complications of this kind. At any rate the plan referred to in the 1918 report was perfected early in January, 1919, and during the year nearly 70,000 c.c. have been distributed, the major part during the first three months of the year. Anticipating a recurrence of the epidemic this winter, the demand for vaccines was revived in September, but when the alarm subsided, so did the demand. It is probable that we may not have any further need for it. Here again, however, the Vaccine Department has proved conclusively its ability to meet an emergency on a large scale.
The relative increase of diphtheria during the summer and fall of 1919 is responsible for the greater demand for antitoxin. The carelessness and indifference of physicians in collecting the cost price marked on each package has resulted in a large item of overhead expense.
Freqent demands came in for other vaccines and biological products not listed above, as, for instance, tetanus antitoxin, antimeningitis serum, etc. It is really within the function of the State Board of Health to be prepared to furnish these products, but most are of such perishable nature that the uncertain demand does not warrant the _xpense. The commercial houses have reduced prices to
17

within a reasonable scale, probably much lower than the' expense of manufacture by our labratory on a small scale.
The laboratory has been exceedingly fortunate in the character of its personnel of workers. Congeniality and harmony have prevailed at all times. Co-operation and loyalty have rendered discipline comparatively unnecessary. To Charlie, Aleck and Sallie, the three colored helpers, the laboratory is particularly indebted for faithfulness and efficiency.
The laboratory is indebted to all departments of the State Board of Health for the splendid co-operation and activity in promoting the interest of the work. Doctors Haygood and Davis and Bowdoin have contributed quite largely in their personal interest and many valuable suggestions.
I am sure that the heads of all departments join me in thanking Dr. T. F. Abercrombie for his attitude of trust and confidence, his patience, diplomacy and wise supervision over us.
Respectfully submitted, T. F. SELLERS,
Director of Laboratories.
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Bureau of Vital Statistics
To the Georgia State Board of Health, Through Dr. T. F. Abercrombie, Secretary
Atlanta, Ga., January 9, 1920. In pursuance with former plans, the organization of the Bureau of Vital Statistics was begun January 1, 1919. Since that date the 2,674 local registrars have been supplied with the necessary blanks. Every physician and undertaker whose name and postoffice address could be secured has been furni13hed the blank birth or death cer tificates. The records have not been handled as they should have been, for with no experienced assistants, except those trained in the bureau, the organization has, of necessity, been slow. There has been since January 1st, 1919, a complete change in the personnel of the bureau, but with the assistants now employed, it is hoped that the coming year will show a marked improvement in the method of handling the records. Acting under the authority granted the board at the last session of the Legislature, the registration districts are being combined when such combinations will facilitate registration. The number of districts has been reduced from 2,674 to approximately 1,1500. When the system of correction of certificates was begun, a correction slip was returned on more than 26 per cent of all records filed; this percentage has dropped during October and November to 12 per cent, indicating more care on the part of physicians and undertakers in completing, and the registrars in correcting certificates. Certain counties have refused to pay the fees to the registrars. Officials cannot be expected to do this work
19

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without renumeration and after a reasonable time the Attorney General will be requested to institute mandamus proceedings for the purpose of forcing the payment of the fees.
The personnel of this Bureau is: Director, Stenographer, Tabulating Clerk, Index Clerk, Mailing Clerk
and extra help about half time.

Outside the salaries, the main expense of this Bureau

has been furniture and fixtures. Coming next is the

matter of postage, amounting to between $75.00 and

$100.00 a month. For example: During the past Decem-

ber 2,047 letters, with more than 240 parcel post pack-

ages, were mailed.

During the eleven months ending November 30th,

the Bureau has handled 34,129 birth certificates and 19,-

058 death certificates, making a total of 53,157 certifi..

cates filed during that time. The number filed by months

is shown as follows:

B.C.
January ----------------------------------- 1,049 February ---------------------------------- 1,801
1farch ------------------------------------- 2,070 April -------------------------------------- 3,063
1fay -------------------------------------- 3,150 .Tune _- ----------------------- _---- _- ------ 3,081 July ------------~------------------------- 2,949 August _________ ----- ____ --------------- ___ 3,582 September ______ ------------------------- __ 4,218
October ----------------------------------- 4,546 November ---- ___:__ ------------------- _-- __ 4,590

D.C. Tot. Certs.

804

1,853

1,154

2,955

1,185

3,255

1,437

4,500

1,954

5,104

2,078

5,159

1,535

4,584

1,987

5,559

2,158

6,376

2,293

6,839

2,403

6,993

Total for 11 months ----------------------34,129 19,101 53,200
Taking 2,975,121 as the estimated population for July 1, 1919, and the birth rate and death rates as computed for the registration area by the Federal Census Bureau, there were during the 11 months 76,351 births

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The shaded space indicates the number of

deaths that were not recorded.

I
23.16~
RECOBDED.

-' '~ ~ ~
' -"'
''''...

'16.24~ NOT RECORDED.
_J
'\:

~
"
'
"""'ii

I
_I _I
1
- --__I

804

DEATH CERTIFICATES FILED IN JAN. 1919,
which is estimated to be 23.16 per cent of the total number of deaths that oc<;mrred.

22

The shaded space indicates the number of deaths that were not recorded.
72.36% RECORDED.
27.64
NOT RECOR!>ED.
2 ,l)ll
DEATH CERTIF,ICATES FILED IN DEC. 1919, which is estimated as 72.36 per cent of the total number of deaths that occurred.
23
I.

and 38,170 deaths, a total of 114,521, or 6,941 births and 3,470 deaths per month, with a total of 10,411.
The increase in the number of records filed is apparent when it is noted that only 15.1 per cent of the births and 23.1 per cent of the deaths were filed in Jannary as compared with 66.1 per cent of the births and 69.3 per cent of the deaths in November.

Births
January ----------------------------------------15.1~ February ---------------------------------------25.9~ darch ------------------------------------------ _29.8o/o April ---------- _------------- __ ----------- ______ 44.1 ~
~ay --------------------------------------------45.3~
June -------------------------------------------44.3~ July _- --------- ____ ----------- _-------- _----- ___ 42.4~ August -------- _------------------------------ __ 51.6~ September --------------------------------------60.7~ October -----------------------------------------65.4~ November _--- __ ----------------------------- ___ 66.1 ~

Deaths
23.1~
33.2~ 34.1~ 41.4~
46.3%
59.8~ 47.1~
57.2~ 61.3~ 66.0~ 69.3~

The number of certificates filed in November was four times as many as the number filed in January. It cannot be expected that the increase during the coming year will be in the same ratio, but it is hoped that a continued growth may be secured.

Respectfully submitted,

W. A. DAVIS, M. D., Director.

Division of Venereal Disease Control.
To the Georgia State Board of Health, Through Dr. T. F. Abercrombie, Secretary. Atlanta, Ga., January 9, 1920.
I have the honor to transmit herewith my annual report" of the work done by the Venereal Disease Control Division of your honorable board.
The work done the past year has not been as dramatic as was the work previously done, owing to the fact that the war, which brought together large numbers of our boys, has ended and our young men are again at home. The work accomplished during the past year, however, has been more constructive and of permanent value. The seven clinics of the State are functioning, besides, the Countv Unit System that we have organized is doing splendid work. We have a venereal disease control center in each of 142 of our counties, which were organized under your sanction at your last annual meeting. The physicians who have this work in hand have been a great aid to us. They furnish free Arsphenamine and Keidel Tubes to the physicians of their respective counties, and being at the very doors of the people, the opportunity to get the best treatment is given the public.
We have been given a special appropriation by the Legislature of $15,000 for venereal disease work annually for two years. This is about half the amount that we asked for and -about half the amount due us from the United States government under the Chamberlain-Kahn Act. The proposition of the Government is on a fiftyfifty basis up to $28,368.56. We will have to be content and do the best we can with the small amount given us, although we ,cannot expand or extend our work as we so
25

much desire; especially will we be handicapped in our educational work. "\Ve did so much desire to be able to reach every young man, woman and child in our State the coming year; this is a great disappointment to us, but the state is not, according to those in authority and who ought to know, able financially to bear half the expense of this campaign of education.
On November 3rd a national conference was held in Washington, D. C., to devise means of reaching the yo_ung boys of our nation between the ages of 14 and 20 with a campaign of ''Keeping Fit.'' This is of the greatest importance in our opinion. We have over 150,000 to whom we would like to carry this message, and so far as: our limited finances will permit we shall re~ch them. We have the consent of Mr. J.P. Faulkner to act as State Supervisor, and under him we hope to have three other gentlemen who will visit the State as far as possible. In each county we will have an organization. The State will be divided into three sections, and the School Boy, the Farm Boy and the Boy in Industry will be taught the lesson of ''Keeping Fit.'' Governor Dorsey and Professor Britain, as well as many of the other leading gentlemen of the State are deeply interested. We will have the support of a number of organizations, among those who have already enlisted in the work being the Red Cross and the University of Georgia.
We fear that our educational program does not start with the child young enough, and we surely hope that very soon the scope of the work will reach bey::; of 9 and 10 years. Not alone should this information be given the boys, but the girls should also receive the wholesome instructions they so much need. Really we feel that the women and girls of our country have been neglected to a certain extent in our educational work.
Other legislation in which we were interested was a bill providing a home for feebleminded; this bill passed,
26

and from it we will get great benefit in taking care of a large percentage of those who go to 'make our prostitutes, as it is estimated that 60 per cent of the female prostitutes are below 10 years in mentality. The marriage law requiring a certificate of the male that he was free from venereal disease at the time his license for marriage was obtaip.ed received a favorable report from both committees of the House and Senate, and is ready for the third reading when the Legislature convenes. This we regard as very important legislation.
The following items may be of interest to you: We have examined about 7,000 specimens of blood at the Laboratory; we have addressed 14 medical societies, delivered 62 public addresses, held 78 conferences on venereal diseases, made 16 inspections of clinics, prepared and sent out to the weekly papers of the State 31 columns of health news; we have distributed 169,416 pamphlets, placards, circulars, etc. We have had 6,915 to see our stereopticon and card exhibits; we have received 1,052 newspaper clippings and have had 10,566 to see the moving picture, ''Fit to Win.'' We have inspected and graded 10 cities of the State, grading them under the rules given us by the United States Public Health Service. vVe have distributed 11,493 a.mpules of Arsphenamine; this means a great many more doses, as we count our ampules at 0.6 gram and in making up the product the size of the dose varies; our estimate on the doses given from the 11,493 ampules would be at least 15,000.
We .have been disapointed in not being able to get the physicians of our State to send in anything like full reports. From our viewpoint we cannot conceive of any reasonable excuse for this failure on their part. The reports are essential to the proper conduct of the Department and the final eradication of the disease. We sincerely hope that the year 1920 will see a marked improvement.
27

We hope that the law enforcement agents of our State may in the near future awake to the terrible menace of venereal diseases, that they may charge the law to our Grand Juries and that those who violate our laws will be vigorously prosecuted. The pimp, the procurer and the prostitute all dread imprisonment, but have little regard for a moderate or even a severe fine. Let all offenders be brought to the bar and prison sentences imposed. Law enforcement is one of the most important of our allies,. and is greatly to be desired. In fact, we consider it the next most important of the trio, Education, Law Enforcement and Medication.
We have in mind the assignment of five people who are now in the pay of the Interdepartmental Social Hygiene Board to our State Board with their salaries paid by the central office. With this addition to our staff we can push the enforcement of the law better and more satisfactorily than before. It will also give us the opportunity to reclaim a great many of the first offenders and restore them to their homes and society.
We hope to see several detention homes completed this year. Augusta has established a splendid institution, Columbus is now taking steps toward this end, and Atlanta is soon to decide the question. We sincerely trust that every city of our State will soon have such an institution.
We would like very much to see venereal disease~ treated in free clinics in all the cities of our State with over 6,000 people. Centers of this size should have free clinics for all patients, especially for children, including dentistry, tuberculosis and venereal diseases. These clinics are not expensive, and we know of no investment that will pay largr dividends. All communities should provide free treatment to those who need and desire it.
In closing I wish to acknowledge my obligation to everyone connected with the Georgia State Board of
28

Health. My Department has been shown every courtesy by the other departments, collectively and individually.
I wish to acknowledge especially my debt of gratitude to Dr. W. A. Davis, who has prepared the statistical part of this report with the necessary graphs.
Permit me also to express my thanks to our able and efficient Secretary, Dr. T. F. Abercrombie, for his advice, guidance and universal kindness during the past year. To him ie due in a large measure our success, and as for that matter, the entire growth and expansion of Public Health work in Georgia.
Respectfully submitted,
JOE P. BOWDOIN, Surgeon (Reserve).

, . :
THE REOORD.
Many of the records were not legible, many more were not complete, while 112 were classified as miscellaneous It was taken that this classification included those reports that did not give the name of the disease. It was not considered worth while to tabulate any of the data contained in these records, as this report gives the percentage of the infection as classified.
The apparent errors occurring in the totals are due to the fact that many of the reports were not complete as to a particular item, such reports are included in the total, but do not appear in the body of the tables and are not included in the percentage of the whole.
This report included 1,068 cases of syphilis, 1,101 cases of gonorrhea and 128 cases of chancroid, a total of 2,297 records of venereal diseases.
GONROBRHEA. 47 9%
30

White
\ Female
\ 9.9%

\
\ Total Whit~ Cases
30.1.1\

\

White ~e \

20.1%

\

Negro Male
39.2%

Total RegrJ,cases 69.~

Negro ~~le 30.?ji

\
\ \
\
\ \ \
\

L

DISTRIBUTION.

L

It will be noted that 46.'5% of the reports were for cases of syphilis, 47.9% were for gonorrhea, while only 5.5% were for chancroid. It is also interesting to note that of all cases of all diseases 38.4% were for whites, with 29.5% males, 8.9% females; 61.6% were negroes, with 40.7% males and 20.9% females, of tlie total number of records included in this compilation. These percentages are better shown in the following graph:

31

Total White ~ea38.~
I
Male \taite 29.5%/

I

emale Negr~

20.9~

I

Male Negro Cases 40.7%

I

Total yegro Cases 61.6~

I I
I
I
I

With reference to syphilis, it will be noted that of the 1,068 cases, 215 or 20.1% ~ere white males, 106 or 9.9% were white females; a total of 321 or 30% were among the whites; while 419 or 39.2% were male negroes, 328 or 30.7% were negro females, a total of 747 or 69.9% among the negroes. This is better shown in the above graph.
While syphilis, according to these reports, is more prevalent among the negroes than among the whites, the reports do not show the same condition with reference to gonorrhea. However, a limited number of reports coming from a population of 2,975,000 would not indicate the incident of either disease among either race.
32

1iale White 39. 5'f,

,/

/
/
Total Male andflFemale }ll'ite -i$.1~

/ //Femaal.e_6_',l,h_lt_e _

/

1

Female Negro lt~/

Total Ma)e/ and Female Ne~ro 51.~

/
/
/

Male Negro 39.6~

/ /

The number of white and negro reports of gonorrhea is more nearly equal than in syphilis. There were 530 or 48.1% white cases; 435 males and 95 females, being 39.5% and 8.6% of the total number; among the negroes 571 cases, 437 males and 134 females, or 39.6% and 12%, a total of 51.8% of all cases of gonorrhea. The distribution of these reports among the different classes of population is shown on the following page.
33
''

. '\0~\ ~cv ~~

\~

25~

'~I

Total Wh.1 te cas~

21. ~ Male Whlte \

14. ~ Female negro 1
I
74.1' ~ Begro Oaseo

I
I
I

While only 5.5% of all reports were cases of chancroid, the data would indicate that the disease is more prevalent among the negroes than among the whites, but this small number can not be taken as a basis for such a conclusion. The 128 cases reported were distributed as follows:
28 male, white; 5 female, white; total white 33 76 male, negro; 19 female, negro; total negro 9i5 The percentage of the total cases reported is as follows: Male whit.P 21.7%, female white 3.9%. with 25% white cases; male negro 59.3%, female negro 14.8%, with a total of 74% among the negroes.
34

OccuPATION.
In the tabulation of the data as to the occupations given on the reports of venereal diseases, it is indeed unfortunate that the reports are not entirely complete. With a complete report it would be possible to estimate the number of those infected in any occupation or profession, but with the report incomplete, it is possible to show only the percentage of the total reports. No rate of any character can be with any acm:acy based alone on these records.
In the following tables will be found a classification as to occupation of 949 cases of syphilis, 1,034 cases of gonorrhea and 82 cases of chancroid out of a total report of 1,068 cases of syphilis, 1,101 gonorrhea, 128 chancroid; 119 reports of syphilis, 67 of gonorrhea and 46 of chancroid did not state the occupation. In table 1 the element of sex and in table 2 the element of color is associated. It is interesting to consider these reports as to sex and color comparing the male white with the male negro, and the female white with the female negro, for each disease as in the following table:

White

Male.

Syphilis -Gonorrhea

-_-_-_-_-_-_-_-_-1_48132

Chancroid ---------- 22

Negro
Male. 398 435 49

Total
Male. 581 847 71

White
Female. 83 65 4

Negro
Female. 285 122 7

Total
Female. 368 187 11

Total ---------617

882

1,499

152

414

566

While occupation varies much as to sex, a classification where the white male is compared with the white female and the negro male with the negro female, is in itself of little value; it is valuable to place side by side the white total with the negro total as is shown below:

White Male.
Syphilies ____183 Gonorrhea __ _412 Chancroid --- 22

White
Female. 83 65 4

Total
White. 266 477
26

Negro Negro Total

Male. Female. Negro.

398 285

683

435 122

562

49

7

56

Grand
Total. 949
1,034 82

Total ----617

152

729

882

414

1,301

2,065

33

Of the 2,065 records showing age, color, sex and occupation, 45.9% were for syphilis, 50.0% for gonorrhea, and 4.1% for chaicroid; 35.3% were for whites, 29.8% male, 5.5% female and 63.7% negroes,,42.7% male 21.07'o female.
Of the 2,065 reports 72.57'o were males, 29.8% white males, 42.7% negro males; 27.4% were females, 7.4% white females, 20.0% negro females.
CHIEF EMPLOYMENT.
Of the 2,065 venereal reports showing the occupation of the individual, 363 were farmers, 455 were laborer~, 150 were housewives, 117 were washerwomen or laundry hands, 109 railroad employees, 107 mechanics, 98 factory employees and the same number of salesmen.
FooD HANDLERS.
This tabulation included 66 cooks, 4 butchers, 6 soda dispensers, 5 candy mak'ers, 21 waiters, and with 2 other food handlers, made a total of 102 or 5% who handled food.
DoMESTICS.
There were 117 washerwomen and laundry hands, 98 salesmen and saleswomen, 70 domestic servants, 60 janitors, 41 chauffeurs, 10 barbers and 8 seamstresses, a total of 404, or 19.5%, who come in close contact with the public.
THE BETTER CLASS.
This tabluation also shows that there were 8 preachers, 2 lawyers, 7 teachers, 61 students, 15 stenographers, 15 nurses, either trained or baby nurses, 8 insurance agents, 4 bookkeepers, 4 cashiers, 3 druggists, and 10 others engaged in clerical work, a total of 137, or 6.6%, which percentage is a sad commontary on what should be considered the better class of society, as well as on the profession.
36

Occupation

Cases.

Farmers ------------------- 363 Laborers ------------------ 455 ]!echanies ----------------- 107 Carpenters ----------------- 33 Telep~one Operators or Elec-
tncians ------------- ____ 15
Barbers ----------------- 10 Chauffeurs ----------------- 41 Launderers ---------------- 117
Drivers -------------------- 28 Railroad Employees -------- 109 Factory Employees --------- 98 Street Car Employees ------- 5 Salesmen ------------------ 98 PPaoirntetersr,s J_a_n_i_t_o_r_s__-_-_-_-_-_-_-_-_-_--::: 608
Tailors -------------------- 4 Other Skilled Labor -------- 25 Preachers ----------------- 8 Lawyers ------------------ 2 Teachers ------------------ 7

Occupation

Cases.

Bookkeepers - ______ ----- ___ 4
. Stenographers ------------- 15 Insurance )lgents ---------- 8 Druggists ------------------ 3 Nurses -------------------- 15 Clerical -------------------- 10 Cooks --------------------- 66 Butchers ------------------ 4 Waiters ------------------- 21 Candy ]!akers-------------- 5 Soda Dispenser ___ ___ _______ 6

Food Dealers --------------- 2 Soldiers ------------------- 7 Sailors -------------------- 2 Convicts ------------------ 10 Housewives ---------------- 150 Domestics ----------------- 70
Cashiers ------------------- 4 Seamstresses --------------- 8 Officials ------------------ 3

Total --------------------2,06'>

Food Handlers ~P " TltE BETTER OLASS" 6.6% Housewives 7. 2'}o
l'ersona.l Service 19.5'j. Laborers 22.0%
All Other Occupations 22.2%
OCCUPATION
38

SYPHILITICS.
In the 949 syphilitics there were 581 (61.1%) males, 368 (38.9%) females, and 266 (28.0%) whites, 683 (72.0%) negroes, approximately 3 negroes to 1 white and 2 males to 1 female. As in other classification the farmers and laborers among the male lead all other occupations with 97 and 18 respectively, while among the females, 8 housewives and 51 domestic servants. There were 56 food handlers, 47 railroad employees, 30 factory employees, 40 students and 87 washerwomen and laundry hands.
GoNORRHEACS.
In the 1,034 cases of gonorrhea, 81.9% (847) were miles; 18:17o (187) were females; 46.0% (477) were white, 54.0% (562) negroes. There were 9 males to 2 females and 5 negroes to 4 whites.
There appears to be a favoritism among negro preachers for gonorrhea, for 7 preachers were reported as having this disease. Among the 949 syphilitics there were 36 female cooks while among the 1,034 cases of gonorrhea there were only 15 female cooks; with these exceptions the classification as to occupation runs about the same for the two diseases.
The outstanding feature of the reports of chancroid is that while 5.8% of the syphilitics, 3.8% of the gonorrheacs were food handlers, the compilation shows that 9.7% or approximately 10% of those having chancroid were in this class. 86.6% of the chancroid cases were males, 3.4% females; 31.7% white and 68.3% negroes.
.Except for this variation the occupations were about the same in percentage of the whole as for the other two diseases.
In the three following tables will be found a detailed statement of the occupations for the three diseases classified as to male, white and negro; female, white and negro, giving the total as shown in each occupation.
39

SYPHILIS.

Occupation

Total.

Farmers 97 ------------------~-Laborers ---------------------232
Mechanics ------------------- 41 Carpenters ------------------- 16
Telephone Operators or

Electricians ---------------- 5

Barbers ---------------------- 2

Chauffeurs ------------------- 15

Launderers ------------------- 87

Drivers ---------------------- 8

Railroad Employees ----------- 47

Factory Employees ----------- 31

Street Car Employees --------- 2

PSoalretesmrsenand--J-a-n-i-t-o-r-s

------------------

27 35

Painters Tailors

-------------------------------------------

8 4

Other Skilled Labor ---------- 14

Preachers -------------------- 1

Lawyers Teachers

------------------------------------------

0 2

Students --------------------- 40

Bookkeepers ----------------- 1

Stenographers ---------------- 3

Insurance Agents ------------ 2

NCCDoulreourrskgiescgsaisl--t-s-----------------------------------------------------------------------------------

1 8 5 42

Waiters --------------------- 1

Candy Soda Food

DMispakenesrsers----------------------------
Dealers ----------------

1 2 1

Soldiers --------------------- 2

Sailors ---------------------- 1

Convicts --------------------- 9

Biousewives ----------------- 84

Domestics ------------------- 51

Cashiers --------------------- 3

Seamstresses ----------------- 6

Officials --------------------- 3

Male White.
27 18 27
8
2 1 5 2 0 17 12 2 12 4 5 0 6 0 0 2 11 0 2 1 0 0 3 0 1 1 2 0 0 1 3 0 0 0 0 3

Total ---------------------949

184

Male Female Female Negro. White. Negro.

70

0

0

168

3

43

14

0

0

8

0

0

0

2

1

1

0

0

10

0

0

0

1

84

8

0

0

28

0

2

5

9

5

0

0

0

5

7

3

31

0

0

3

0

0

4

0

0

8

0

0

1

0

0

0

0

0

0

0

0

10

5

14

0

1

0

0

1

0

1

0

0

1

0

0

0

0

8

2

0

0

6

1

35

0

0

0

0

0

0

0

0

0

1

0

0

2

0

0

0

0

0

6

0

0

0

35

49

0

12

J9

0

3

0

0

2

4

0

0

0

396

82

287

40

GONORRHEA.

Occupation

Total.

Farmers ---------------------258

Laborers --------------------199

Mechanics Carpenters Telephone

O--p--e--r--a--t--o--r--s----a--n--d--------------

62 16

BaErbleecrtsric-i-a-n-s-------------------------------FDSRLCataarhrciiuaevltnureoeodtfrrfaseyedCruea-ErrEr-ssm-mEp---p-lmo--l-o--yp-y--e-loe--e-e--ys-s--e---e----s--------------------------------------------------------

10
8 25 28 16 55 62
2

PPSOTaoaatlhiirenlteosetrmrerssrSesnka-nil--dl---e---dJ---a---Ln---ia---tb---o--o-r---rs-----------------------------------------------------

69 21
0 0 10

LParewaycehresrs----------------------------------------

7
2

IBSDTSntoteresuuaoundcgkroehgkagneienrstrecastspespehr---eis--\-r---s-g----e-----n-----t--s--------------------------------------------------------------------------------

Nurses Clerical Cooks

--------------------------------------------------------------------

Butchers Waiters

------------------------------------------

5 20
3 11
6
2
6
5 22
3 10

FSSCSoooaaodilnlddadoiryeDDsrseiMsa-pla--eek--rn-e-ss--res---r--s---------------------------------------------------------------------------
Convicts ---------------------

1 3 1
4
0
1

ODCHSeaofoafsmuimhcseieisesawtrtlrissiecvsses--se---s--------------------------------------------------------------------------------------------

61 18 1
1
0

Male White.
93 46 51 12
9 5 16 0 1 39 36 2 55 1 0 0 8 0 2 2 14 3 5 2 2 1 5 0 1 2 0 3 1 1 0
0
0
0
0 0
0

Total -------------------1,~34

418

Male Female Female

Negro. White. Negro.

165

0

0

133

0

20

11

0

0

4

0

0

1

0

0

3

0

0

9

0

0

2

0

26

15

0

0

16

0

0

14

7

5

0

0

0

5

8

1

20

0

0

0

0

0

0

0

0

2

0

0

7

0

0

0

0

0

0

2

1

2

2

2

0

0

0

0

6

')

4

0

0

0

0

0

0

1

4

0

0

0

7

2

13

2

0

0

2

5

1

1

0

0

0

0

0

0

0

0

3

0

0

0

0

0

1

0

0

0

28

33

0

3

15

0

1

0

0

0

1

0

0

1

429

65

122

u

CHANCROID.

Occupation

Total.

Farmers --------------------- 8
Laborers --------------------- 22 Mechanics ------------------- 4
Carpenters ------------------- 1 Telephone Operators and
Electricians ---------------- 0
Barbers --------------------- 0 Chauffeurs ------------------- 1 Launderers ------ ----------- _ 2 Drivers --------------------- _ 4 Railroad Employees ---------- 7 Factory Employees ---------- _ 5 Street Car Employees -------- 1
Salesmen -------------------- 2 PPoairntetersrsan_d__J_a_n_i_to__r_s _-_-_-__-_-_--_-_-__- 04

Tailors ______ ---------------- 0
Other Skilled Labor ---------- 1
Preachers -------------------- 0 Lawyers _-------------------- 0
Teachers -------------------- 0 Students --------------------- 1 Bookkeepers ----------------- 0
Stenographers --------------- 1 Insurance Agents ------------ 0 Druggists ------------ ________ 0

}[urses ---------------------- 1 Clerical --------------------- 0
Cooks ----------------------- 2 Butchers -------------------- 0
VVaiters --------------------- 2 Candy Makers --------------- 3 Soda Dispensers ------------ __ 1 Food Dealers _____ - ___________ 0

Soldiers --------------------- 1
Sailors ---------------------- 1 Convicts --------------------- 0 Housewives ____ -------------- 5
Domestics _------------------- 1 Cashiers _-------------------- 0 Seamstresses ----------------- 1 Officials --------------------- 0

Male VVhite.
0 0 4 1
0 0 1 0 0 2 2 1 2 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 0 1 1 0 0 0 0 0 0

Total --------------------- 82

20

Male Female Female

}[egro. VVhite. }[egro.

8

0

0

21

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

4

0

0

4

0

1

1

1

1

0

0

0

0

0

0

3

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

I)

0

0

0

1

0

0

0

0

0

0

1

0

0

0

G

0

0

(

0

1

(

0

0

c

1

0

1

0

0

c

1

1

G

0

0

1

0

0

0

0

0

(

0

0

0

0

0

0

0

0

0

0

1

4

0

0

1

0

0

0

0

0

1

0

0

0

44

5

13

42

CoNJUGAL RELATION.
It is a question of no small importance as to the conjugal relation of those infected with venereal diseases, for the infection of either parent in the family has a most blighting effect upon the children of that family, and the infection of the unmarried may be taken to a certain extent as an index of the moral conditions existing among the people of this State. Since the infection of an individual carries with it strong evidence of the violation of those laws which are the basis and foundation of our social structure, it is of interest to know what percentage of the infection exists among the parents of this State, for the home cannot produce a better child than is the parent in that home. The conclusions based upon this report cannot be taken as accurate, for unfortunately the number of cases does not represent a sufficient percentage of the entire population, but if taken as a basis this compilation would indicate that excluding 41 cases of syphilis, 18 cases of gonorrhea and 24 cases of chancroid, which "\Yere in children under 15, that there were

I

56.7% Single

43.2% J.br!'ied

2161 individuals who were within the marriageable age. Of this number, 1021 were single, 1140 were married,

58.7% l!arried
that is, 52.6% were married while 47.4% were single. This ratio is changed when the whites and negroes are considered separately. Of the 841 white cases, 447
43

(56.7%) were single and 364 (43.2%) were married; among the 1320 negro cases, 544 (41.2%) were single, 776 (58.7%) were married. If syphilis be considered alone, there were 7 single to 8 married infected among the whites, and among the negroes there were twice as many married as single. In the gonorrhea reports there wero 3 single to one married among the whites, and among the negroes the two elements were about equal.
In chancroid the white reports show 18 single to 10 married; the negroes 40 single to 36 married.

AGE.
There were 2,297 reports that gave the age of the individual. Classified as to age periods for the three diseases it will be found that the greatest number of cases reported were between 15 and 50 years of age, th-ere being 60 below this period and 60 above, with 2,117 between 15 and 50. The following table will show a classification as to age periods.

Total. Syphilis. Gdnorrhea. Chancroid.

Under 1 year -------------------- 6

6

0

0

From 1 to 2 ------ _- ------------- 2

2

0

0

From 2 to 4 --------------------- 10

6

4

0

From 5 to 9 --------------------- 22

13

8

1

From 10 to 14 ------------------- 20

14

6

0

From, 15 to 19 ------------------- 398

149

226

23

From 20 to 29 -------------------1,146

493

576

77

From 30 to 39 ------------------- 453

230

202

21

From 40 to 49 ------------------- 179

123

52

4

From 50 to 59 ------------------- 47

26

19

2

From 60 to 69 ------------------- 11

5

.6

0

From 70 to 79 ------------------- 2

1

1

0

Over 80 years ------------------- 1

1

0

0

Total ----------------------- _2,297

1,068

1,101

128

From the preceding table it will be noted that 60 or

2.6% of all cases occurred before 15 years of age and

that the same number after 50 years of age, while 398 or

17.3% between 15 and 19; 1,146 or 49.8% between 20 and

29; 453 or 19.7% between 30 and 39 and 179 or 7.7% be-

tween 40 and 49 years of age. The proportion is better

shown on the following page.

44

49.~
l?.
..2.-6%
Under lb 15 to 20 20 to 30 30 to 40 40 to 50 Veneral Disease Infection by Age Periods.
45

From 15 to 20

50%
from 20 to 30
years of age ..

MALES
For the same age periods, between 15 and 50, classified as to sex, regardless of color, we have the following table:

SYPHILIS.

Male. Under 15 _______ 15 From 15 to 19 ___ 96 From 20 to 29 __ 293
From 30 to 39 __ 146 From 40 to 49 __ 62
Over 50 -------- 22

Fern. 26 53 200 84 61 10

GONORRHEA.

Male 5

Fern. 13

184

42

449

127

162

40

48

4

24

3

CHANCROID.

Male 0
18 64 18
2 2

Fern. 1 5
13 3 2
0

The total venera! disease infection by age periods
. for the male and female with the percentage of .the whole
will be found in the following table:

46

Males. Under 15 _------------------ __ ----- 20- 3% From 15 to 19 -------------------- 298- 18.5% From 20 to 29 ----------~--------- 806- 50 % From 30 to 39 -------------------- 326- 20.2% From 40 to 49 _---------- ___ ----- _ 112- 6.9% Over 50 ~-------------------------- 48- 2.9%
Total --------------------------1,610 100.0%

Females.
4D- 5.8% 100- 14.5% 340- 49.4% 127- 18.4%
67- 9.7% 13- 1.8%
687~100.0%

The following graph will illustrate the percentage and shows that in both female and mai'e approximately one-half of the infection of venereal disease exists among those between the ages of 20 and 30.

From 15 to 20
years.

49.4~
from 20 to 30 years of age.

years.
30 to 40 years.

FEMALES
47

EsTIMATEs.
It is stimated that the population of Georgia for 1919, the year during which these reports were gathered, was 2,975,000. Of this number 54.9% or 1,633,272 were white with 45.1% or 1,341,725 negroes. According to the U.S. Census report of 1910,8.8% of the white population were males, within the ages of 20 to 30 8.7% were females within the same agf'; that is, in 1919 there were in Georgia 143,727 white males and 142,094 white females. According to the same report 9.2% or 123,438 of the negro population were males, 10.3% or 138,197 were females.
In a recent report the Surgeon General of the U. S. Army has stated that 5.8% of the men inducted into the army were infected with venereal disease and that the infection was seven times greater among the negro than among the white soldiers. If this rate be applied to the male element of the population, between the ages of 20 and 30, which include 143,727 whites and 123,438 negroes, a total of 266,165, there were during this year 14,905 men infected with venereal disease; 1,863 of whom were whites, 13,041 were negroes.
The reports received by the Georgia Bureau of VenP.real Disease Control show that for the first 11 months of 1919 49.8% of the infection occurs between 20 and 30 years of age; we may then conclude that among the men of all ages and both colors there were in the same period 29,938 cases of venereal diseases. It must be borne in mind that these figures apply to the male alone and not to the female population.
In the absence of any more reliable data it may give the reader some idea of the prevalence of this disease to take the percentage as a basis and estimate that there were 12,769 cases among the women of Georgia, and when added to the 39,938 male cases, give a total of 42,707 per-
48

sons infected with venereal diseases in this State. If these estimates be true, then,
One person in every 69 in Georgia was infected with a venereal disease during the year of 1919.
\
4D

Report of WassermannDepartment

By Director E: L. Webb, Through Prof. T. F. Sellers, Director of Laboratories.

January 7, 1920.
Dr. Joe P. Bowdoin, Director Venereal Disease Control. Mr. T. F. Sellers, Director of Laboratories.
Dear Sirs: I have the privilege of submitting to you herewith the following tabulated report of the work done in the Wassermann Laboratory during the year 1919, together with a few summary remarks.

TABULATED REPORT OF WASSERMANN LABORATORY. Submitted by the Director, E. L. Webb.

I I I.. .. I

~

~

s c;;-:-~=-------

: -~~'-"-:~~:~-:~:~~:3"....[._1I~~-

_"=.j_'II_._>;-,I1':_:~~_I1~

~ ~~ .8

i"'.
rQ_

9.~o_g'I";~_' _8_~___'~ ~"2


~ o~

Str~~~;~ve ___ _\ 43![ 48 61 74 991961151261621141!1117197 1,179118.7

I \ Positive ------1 8 15 20 17 36 23 25 22 30 22 19 18 255 4.

Weakly positive

_---1I

6[

7

8

6 17134 24 21 15 36 37 27

238

3.8

Total positive -I 57[ 701 89 971152 153 1641169 207 199[173 142 1,672 26.5

Negative -----112811601921331439 400 368 422 5761574,493 4514,534 71.9

I Doubtful ------~
Antieomple-

11

21

41I

21I 10

6

0

6

91 3 I 2

1

56[I

.73

mentary ----1 7~[ 0 31 21 41 91 6[ 121 8[ 1[ 11 21 55[ .87

Total ----[193,1232 288 432 6051568 5381609 800[777[669[596[6,307[100.

You will note that there is a rapid increase in the number of Wassermann tests from January to May, with a slight decrease then until September, when we reached the maximum number of 800. You will recall that the number of tests made during this month exceeded the total number of tests made from the institution of the

50

work, May 28, 1918, to January 1, 1919. You will also observe that since September there has been a gradual decrease in the work, but, judging from the present demand for the Wasserman outfits, there is every indication that the work is going to gradually increase again, and leads us to believe that ere the next six months we will be making 1,000 or more tests per month. Average number of tests made per month in 1918.. 114 Average number of tests made per month in 1919 .. 525.6 Number of tests made from May 28, 1918, to Jan.
1919 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 798 Number of tests made during the same time in 19194,557
This shows a marked increase in the amount of work done in this laboratory during the' past year.
May I also call your attention to the decrease in the number of Doubtful and Anticomplementary results since September, due to the rejection of hemolysed specimens'? This was done because in our experience with them we found that the results of only a small per cent of them could be read with accuracy and confidence in the findings. When a specimen is rejected for any reason, the physician is immediately notified to that effect, with the reason for same, together with our request for another specimen.
Respectfully submitted,
E.L. WEBB, Director Wassermann Laboratory.
51

Division of Rural Sanitation.

I

.

Georgia State Board of Health,

Dr. T. F. Abercrombie, Secretary.

Atlanta, Ga.

Gentlemen: I beg to submit the following report of

the Division of Rural Sanitation for the year 1919.

This Division was created and began operation Jan-

uary 1, 1919, with a personnel of a director and one

stenographer. Because of lack of an adequate appro-

priation, it was deemed advisable to place the Division

of Epidemiology under the supervision of the director

of the Division of Rural Sanitation. On August 27th

Dr. W. S. Bean, of the U. S. Public Health Service, was

detailed to the State Board of Health for the purpose of

making an endemic index of the State, since which time

he has had supervision of this work. His very efficient

services in this connection have been of great value to

the division.

I also wish to acknowledge the very efficient services

of Dr. C. C. Applewhite, of the U. S. Public Health Serv-

ice, who was detailed for duty with this division upon

the closing of the Camp Gordon Extra-Cantonment Zone

Office. His field work along the lines of rural sanita-

tion and in connection with the Ellis health law has been

of incalculable value to the State.

Acknowledgment should also be made of our deep

appreciation of the financial aid rendered by the Inter-.

national Health Board, which has not only co-operated in

financing the central administrative work of this bureau,

but has also, through this division, aided ml:lterially in

maintaining health units in three counties, viz., Troup,

Hart and Worth;

53

It might be of interest to review the fact that on January 1, 1919, only six counties were maintaining health organizations under the Ellis health law. These counties were:

Floyd Glynn Troup

Hart Thomas Sumter

Since that time eight other counties have, under thi.s law, elected full time Commissioners of Health, as follows:

Lowndes, March 14th Colquitt, March 15th Worth, April 1st Baldwin, June 1st

Laurens, August 1st Tift, September 1st Bartow, ~ovember 1st Walker, November 1st

This makes a total of fourteen counties organized and operating with full time health officers on December 31, 1919.

Ten other counties have the two necessary Grand Jury recommendations, one of which, Cobb, has already elected a health officer and will begin operating about January 1, 1920. These counties are:

Clarke DeKalb Harris Dooly Dougherty

Irwin Cobb Pike Decatur Spalding

Two other counties, Mitchell and Brooks, have one Grand Jury recommendation.
The following map shows the status of the Ellis health law on December 31, 1919:

54

...
GEORGIA


IIIIIIIIIHI Ellis Law in op.e.ration: Commiss:!.o.v.er in off1oe.

IBITI?E@ The two ne<leSBIU7 grond .1UZ7 reoollllllf:ildations.

1

1one grand jury -reaormnenda'tion.

It is very gratifying to note that a great aNakening along the line of public health is beginning to sweep the State. This is demonstrated by the fact that so many business men, individually and through their various organizations, and the professions and the people generally, are lending enthusiastic support to public health work. Of particular significance is the fact that the rural population. is becoming as deeply interested in health measures for the protection of themselves and their chil-dren as they are in the prevention of disease among their hogs and cattle. They are buiding sanitary privies as well as dipping vats, and are having their children immunized against typhoid fever as well as their pigs against cholera.
It is also true that practically all classes of mert who are responsible for the economic welfare of our State arebecoming profoundly interested in having the Ellis health law adopted in their respective counties, and supporting it when it is enacted. This is convincing evidence that they have realized that public health work is of great economic value, and that it is much cheaper to. institute measures for the prevention of disease than it is to permit matters to take their usual course.
This department has attempted during the year to supervise the work of the Commissioners of Health in the fourteen counties operating under the Ellis health law, and in addition visit as many other counties as possible in the interest of the public health.
I beg to submit the following resume of some of the work accomplished by the Commissioners of Health in the counties operating under the Ellis health law. This summary, _of course, does not presume to cover adequately the result of the activities of the health officers in these counties, nor is it submitted for the purpose of comparison, as the problems with which these men had to deal were in no wise identical, and there were also con-
56

siderable differences in the population of the various units, but it is hoped that this table, in the absence of reprinting in full the individual detailed reports of thsee men, will serve to illustrate in a concise way some of th<' results of their efforts.
57

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Bartow_______ 4000 2 20 53 4 500 1

----- ----

---

362 404 ---- 2490 229 42 --- 21 78000

Colquitt_ ____ 3500 10 47 159 7 1183 343 1773 1418 ---- 33

130 35 2387

113

Floyd ________ Glynn________ Hart_ ________

-------------

6 12
12

20 100 21 58 ---- --35 ---- 30

164 1234 571 392 ---- --- 27 ---- ----- ---- 10 ----- 1503 773 508 172 135 ---- 4B3 50042 ---- 3505 2608 524 ---- - ----- ---- 78 ---- 278 ----- ---- ----

110
-------

1275 274 --- 1 ---- 35000

2023 1176 --- ---

------

4533

----

Laurens______ 3500 5144 ---- 31 690 137 1309 790 ---- --- ---- 150 ----- ---- ---- ---- 318 562 --- --- ---- ------

Lowndes _____ 8920 4 73 390 11 652 77 671 1316 ---- --- ---- 6 671 ---- ---- ---- 1093 29 --- --- ---- 40000

Sumter_ ______ ----- 12 - - ---- --- 6000 ---- 2258 961 ---- --- ---- ---- ----- ---- ---- ---Thomas ______ ----- 12 78 811 47 9610 985 1553 2000 ---- --- ---- 16 55 ---- ---- ----

3584 250 --- --- ---- -----2168 ---- --- --- ---- ------

TTirfotu_p--_-_-_-_-__-_-_-

-----
7600

4 11 ---- --- ----- 48 12185 2706 67 15070 1304

684 3848

985 ---- --- - __;.,_-

2----- ---- ----

2036 1018 75 500 1691 815 ---- ----

-------

1492 ---- --- --- ---- -----4395 2093 67 --- 46 700000

Walker_ ______ 4000 2 39 - --- 5 365 ---- ----- ----- - ~-- --- ---- ---- ----- ---- ---- ---- ----- ---- --- --- ---- ------

- - Worth________ 4000 9 4f 300 16 5000 ---- 631 424 40 --- ---- 134 ----- ---- ---- ---- 5000 250

- - - -~

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

-~

-~

-~ -~

-~

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---

TotaL _____ 39520 109 759 461E 266 41842 6344 14472 10830 1230 321 559 2767 51587 362 4049 145 30758 4863 109 1 1801853000

--

In view of the importance of publicity in connection with our work, I would like to call attention to some of our educational efforts. Articles from this department have appeared in several thousand issues of small weekly and large daily newspapers, in several of the medical journals, and in a few of the magazines having nationwide circulation. Through this department there have been distributed tens of thousands of bu1letins on malaria, typhoid fever, hookworm disease, sanitary privies, the control of certain communicable diseases, and many other subjects pertaining to the public health, and more than fifteen hundred letters have been written.
Acknowledgement should be made of the services of Mr. \V. J. Langley, an expert in the construction of the Kentucky privy, who was loaned to us about November 1st by the Nursing Service of the Southern Division of the American Red Cross. Mr. Langley's work has been for the purpose of demonstration, and he has visited nine counties, installing a total of 14 privies at schools. These school privies will accommodate 3,800 children. One residence-size tank, sufficient to accommodate 10 people, was costructed in one of these counties. Mr. Langley did not visit the counties merely to construct one or two privies, but endeavored to instruct some one while there so as to leave in the county one or more persons who would be able to continue this work.
I wish also to call attention to the demonstration in malaria control work by means of quinine sterilization which was conducted by the U. S. Public Health Service in Mitchell County in co-operation with the State Board of Health. An area of 25 square miles was selected, where previous surveys had proven the heavy infection of the people with aestivo-autumnal malaria, and where abundant breeding places were furnished the Anopheles mosquito by a large number of cypress ponds. This district lies. immediately north of Sale City and
59

west of the Colquitt County line. The field work was conducted by Miss Ethel Barrier and Dr. W. D. McNeil, of the Public Health Service, the latter being subsequently transferred and was succeeded by Dr. C. P. Coogle. The following report of Miss Barrier is very illuminating and gives an insight into what could be accomplished toward the eradication of malaria bY- the wise employment of adequate funds.
MALARIAL l:t-<vESTIGATIONS IN MITCHELL CouNTY,
GEORGIA, DuRING 1920.
In making a rough survey of conditions in Mitchell County, Georgia, to determine where malaria was most prevalent, a twenty-five (25) square mile area northeast of Sale City was selected for intensive work in malaria investigation.
Owing to the fact that the work was not started until August lOth, 1919, about 82 per cent of the people were having active Estivo-Autumnal malaria at the time.
The type of malaria has been confirmed by microscopic examination of 125 blood smears, 20 of which were found positive Estivo-Autumnal.
The low per cent of positives was due to the fact that many of the people had taken enough chill tonic to kill out the parasites in the cutaneous circulation, so under these conditions undivided attention was given to quinine-sterilization of every person in the territory, whether having active malaria at the time or not, in order that they would be in condition to gather their crops.
This campaign was conducted by making a house to house canvass in the territory, collecting such information as to determine the approximate loss of tim~ in 1918 on account otmalaria, the loss of crops, the amount paid for drug and doctor bills, and the number of acres under cultivation.
60

With these figures it was possible to determine the loss per acre in 1918 on account of malaria.
Taking the first three families as they come in the index are examples of information collected from each family:
Name, C. F. G., family of five (5), thirty (30) acres in cultivation; loss on account of malaria, 2 bales of cot-, ton at $200.00 per bale, 1 ton of peanuts at $100.00 per ton,-totalloss on crops $500.00, plus $175.00 for doctor and drug bills.
Name, N. J., family of eleven (11), fifty (50) acres in cultivation; loss on account of malaria, 1 bale of cotton at $200.00 per bale, plus $200.00 for doctor and drug bills.
Name, W. 0. N., family of seven (7), sixty (60) acres in cultivation; loss on account of malaria, 3 bales of cotton at 200.00 per bale, 150 bushels of corn at $1.50 per bushel, 1:Yz tons of peanuts at $100.00 per ton; total loss on crops $975.00 plus $500.00 for doctor and drug bills.
These figures were given by heads of the families and confirmed by local business men as to their approximate accuracy.
Eighty-one (81) families, averaging five plus (5.68) persons per family, were visited, collecting the same data from each family. Upon condensing this information it was found that there were 3,967 acres of land in cultivation, and on this land $46,520.00 were lost in 1918, that is, lost on account of being unable to cultivate and gather crops, plus the amount paid out for doctor and drug bills. This averages a loss of approximately $11.!50 per acre, or an average. of $574.00 per family.
Out of the 81 families under observation, 78 families were under treatment. A two weeks' treatment of quinine was delivered to each of 444 persons, advising each and insisting that they call for another treatment before the previous treatment was exhausted, so that it
61

would not be necessary for them to miss a dose between treatments.
Of the 444 persons under observation, 400 were supplied with from 4 to 8 weeks' treatment of quinine, and 44 were supplied with 2 to 4 weeks' treatment.
A second survey was made the later part of October and the first of November, in which 48 recurrences of chills and fever were found out of 444 persons under treatment, a reduction of 89.2% in the number of cases under observation.
On October 23, 1919, a control area of similar size and conditions to the territory under observation was selected, with the object of collecting such data as was necessary to compare the loss in 1919 with that of 1918.
This data showed a 5% increase in malaria in 1919 over 1918, that is, 83% of the people gave historie.s of having active malaria in 1918 and 88% in 1919. In the control area 51 families, consisting of 278 persons, or 5.40 persons per family, were visited.
The heads of these families gave information of having lost $34,500.00 on 2,647 acres of cultivated land in 1918 on account of malaria, or approximately $13.00 per acre. During 1919, $43,412.00 were lost on 2,768 acres of cultivated land, or approximately $15.50 per acre.
In the third survey of the territory under treatment in 1919, to collect information relative to the losses on account of malaria, the results were as follows:

Area Before Being Worked 3,967 acres in cultivation in the
year 1918.
Loss $11.50 per acre, Total $46,520.00.

Control Area 2,647 acres in cultivation in the
year 1918.
Loss $13.00 per acre. Total $34,500.00.

Area After Being Worked

Control Area

3,967 acres in cultivation in the 2,768 acres in cultivation in the

year 1919.

year 1919.

Loss $1.50 per acre. Total loss $5,950.50.

Loss $15.50 per acre. Total loss $43,412.00.

G2

Loss due to malaria in area worked in 1918 --------------$11.50 Loss due to malarie in area worked in 1919 -------------- 1.50 Loss due to malaria in control area in 1918 ----------------------$13.00 Loss due to malaria in control area in 1919 ---------------------- 15.50 The actual loss in the area worked in 1919 was $1.50 per acre. $11.50 minus $1.50 equals $10.00 gross economic gain per acre. $10.00 multiplied by 3,967 (number of acres )equals $39,670.00 gross
economic gain. $39,670.00 minus $3,580.00, cost of work, equals $36,090.00 net economic
gain. $36,090.00 divided by 3,967 (number of acres) equals $9.09 net eco-
nomic gain per acre. $39,670.00 divided by $3,580.00 (cost of work) equals $11.08, percent-
age of economic gain to expenditures.
Respectfully submitted,
ETHEL BARRIER, Microscopist.
I wish also to submit the following very interesting report of Dr. W. S. Bean, of the U. S. Public Health Service, on the reporting of communicable diseases to the State Board of Health:
CoMMUNICABLE DrsEASEs.
During the year 1919, 29,379 cases of communicable diseases were reported to the State Board of Health. This figure includes all reports received, whether from County Health Officers, City Health Officers, or private practitioners. While reports have not been anything like so complete as would be desired ,still it is felt that an improvement has been made over the reporting of 1918, although the number of cases reported was not so great in 1919 as in the previous year. Of the 45,000 cases reported in 1918, over 30,000 were due to influenza, whereas in 1919 7,147 of the total was due to influenza, showing that a considerably greater number of the other diseases have been reported.
The following table shows by month the incidence of communicable diseases as reported to the State Board of Health:
63

Disease

Total Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

----------------1---~

Actinomycosis___________________

20

5 ___ __ _ ___ ___ ______ ______ ___ __ _ 1

9 ______ 1

3

1

Ac. Infeet. Conjunctivitis_______ Anchylostomiasis________________ Anthrax_________________________

107

5

5

9

8

583

7

9

5 15

5 ______ ______ ______ 1

16

6

3

16 24 14 2 ______ ______

8 16 17

9

5

66 54 36 89 248 2 _______________________ _

Cerebrospinal Meningitis________

58

7

7

8

4

9

6

3

2

3

2

5

2

Chicken Pox_____________________ 706 35 102 132 133 142 37 16 17

8 21 27 36

Dengue__________________________

8

5

1

1 ____ __ ___ __ _ ______ ___ ___ ______ ______ ____ __ 1 _____ _

Diphtheria_______________________ 1551 19 43 36 13 15 30 46 139.. 377 433 272 128

Dysentery (amebic)______________ 193 ______ 8

4 13 76 31 11 14

4 19

9

4

Dysentery( bacillary)____________ 573

4

9

6 22 182 176 55 28 44 26 20

1

German Measles_________________

95 19

9 21 17

6

2

2

8

3

2

2

4

Gonorrhea_______________________ 3415 121 238 303 287 406 294 355 345 301 330 273 162

Malaria__________________________ 3345 31 64 89 166 349 266 356 435 304 708 402 175

Measles__________________________ 1256 82 210 274 177 197 90 37 20 10 30 52 77

0') Mumps___________________________ 842 30 145 159 141 144 75 40 14 23 35 18 18

~ Paratyphoid Fever_______________

85 ______ 6 ______ 3

7

4 19 13 13 13

7

1

Pneumonia (acute lobar)________ 1218 184 293 160 145 122 40 23 21 27 29 66 108

Poliomyelitis_____________________

23 ______ 1

2

3

1

1

3

1

3

1

5

2

Scarlet Fever____________________ 708 27 52 62 31 47 30 39 46 83 97 87 107

Septic Sore Throat______________ 411 13 26 33 26 38 22 15 20 47 63 49 59

Smallpox_________________________ 1710 101 213 353 272 361 142 57 40 17 40 43 71 Syphilis________________ . __ _____ __ 2312 75 99 159 163 252 211 289 261 276 245 194 88

Tetanus_________________________

14 ______ ______ 1

2

1

1

1 ______ 4

1 3 _____ _

Trachoma-----------------------

16 ------ 2

1

3 ------ 6 ______ ______ 1 ______ 1 2

Tuberculosis (pulmonary)_______ '786 38 64 76 55 95 57 72 65 68 57 70 69

Tuberculosis (other than pul)___

60

3

3

4

9 10

3

9

8

4

1

2

4

E;:::l~~~t~:~~~~~~~~~~ ~~~ ~~~=========~=- - - Typhoid Fever___________________ 1448 11 22 24 24 94 200 243 236 261 171 94 68

Whooping Cough________________ 674 51 44 87 70 81 62 69 40 33 61 35 41

Influenza________________________ 7147 3754 1844 718 178 86

8 28 41 116 165 113 96

Pellagra__________________________

7

1 ______ ----- _ 1 _- _--- _____ _ ___ ___ ______ 2

1

2 _____ _

Lethargic

29 , 37:

In concluding my report, permit me to express my deep appreciation of the thorough co-operation accorded me at all times by the entire personnel of the Board.
Respectfully submitted,
M. F. HAYGOOD, M.D., Director.

State Tuberculosis Sanatorium.
Alt6, Ga., January 1, 1920.
Dr. T. F. Abercrombie, Secretary, State Board of Health, Atlanta, Ga.
Dear Sir:
I have the honor to submit the following report of operations of the Georgia State Tuberculosis Sanatorium for the year ending December 31, 1919.
During the period covered by this report 206 patients have been treated. while this Sanatorium was established primarily for early and hopeful cases I regret to report that the majority of our cases have not proved to be early-partly due, I believe, to the fact that our institution is not sufficiently well known throughout the State by the laity or by the medical profession. Acting upon this belief we have tried to bring it to the attention of both, by personal contact and by means of the mails. A series of letters and reprints have been mailed to practically every physician, public health worker and county superintendent of schools. Results of this are shown in the rapid increase of our waiting list which now contains about 35 applicants-all of these persons are asking immediate admission to treatment. We have cottage space for 20 additional patients, but no funds to purchase equipment for same. It is hoped that the Legislature will thi::; year appropriate additional funds for this equipment.
At the time your present Superintendent assumed his duties (Feb. 19, 1919) there were 39 patients in the Sanatorium. There are at present (Dec. 31), 82 patients, 9 of which are children. This is now the limit of our bed capacity.
67

The number of cases to be reported upon in this report is 118. Two of these were proven to be non-tubercular. The average stay of these 118 patients was 91.1 days. The cost of treatment per capita per diem was $1.89.
Of the cases discharged, 12 had been admitted as incipient cases, of these 9 or 715% were discharged as quiescent, apparently arrested or arrested; 42 were moderately advanced, of these 19 or 45% were discharged quiescent or apparently arrested; and 26 or 42% were improved. During the year there were 10 deaths, all of these patients being far advanced at the time of admission to the Sanatorium.
Inquiry into the ,factors causing the breakdown in our cases seems to show that so-called ''flu'' was responsible in 26 cases ; alcoholic intemperance seems next in importance with 5%%. Overwork 4.6%. Measles, typhoid fever, pneumonia, each about 2%.
TREATMENT.
Treatment has been the usual sanatorium treatment; namely, carefully regulated routine of rest and exercise, diet and sleeping in the open air. Auto-inoculation was employed systematically in a few cases and in every casi.l seemed to be of considerable benefit, although number of cases in which it was employed is too small to justify definite deductions. Tuberculin has been given in a very few cases and has appeared to have been of no practical value. At present we have four apparently arrested cases as regular employees of the Sanatorium. There are under treatment 9 children. These childten are receiving practically the same treatment as the grown-ups and unfortunately are housed in the same type of shack, which makes their care rather difficult and not as satisfactory as if we had a special children's pavilion.
68

Every Sunday morning an informal talk is given by the Superintendent on some phase of tuberculosis They are taught how to combat it as an individual and community problem; especial instruction is given as to .Sanatorium methods, rules and regulations. Patients are urged to ask questions on any problem that is of particular interest to him. In other words, every effort is being made to teach the patient everything that he should know about tuberculosis. We believe that these talks are of value, as evidenced by greater interest and enthusiasm of the patients and more graceful submission to discipline, and the realization of the importance of ''trifles.'' I am happy to report that the discipline at the Sanatorium is entirely satisfactory all<l the spirit of co-operation manifest.
Amusements and entertainments are very necessary adjuncts to Sanatorium treatment and unfortunately we have inadequate facilities for these. I am (under "Recommendations'') calling your attention to the need of a Recreation Building; however, we are observing all the holidays with appropriate ceremonies and amusements. The New Holland Band has given us two concerts and young ladies from Brenau College have entertained us.
We are indebted to Rev. E. P. Ethridge, of Bellton, and Rev. ]'ather Clark, of Athens, for religious services at the Santorium. It is hoped that we may have services for the patients more frequently as the various ministers learn our needs.
GROUNDS.
Upon assuming my duties work was immediately begun with the purpose of cleaning up the grounds and buildings. The barns were cleaned and the grounds thereabouts cleared of cans, manure, etc., which had accumulated. Our dairy herd has been tuberculin tested by the State Veterinarian, and no reactors found, hence
69

we have the satisfaction of knowing that milk furnished our patients is from tuberculosis free cows. The farm has supplied us with part of our meat supply (veal, pork and mutton)-also a small amount of vegetables. The pig lot and sheds which were grouped about the horse barn have been removed, and new sheds of corrugated iron roofing substituted. The pig pasture which at that time extended nearly to the shacks and Infirmary has been removed-the negro servants' quarters, which were then in this pig lot, are now entirely out of this pasturethe fence having been moved some distance in the rear. This pig pasture was sown in grass this fall, which will next year serve the double purpose of making the now repulsive stretch a green, shady, beautiful grove and approach to the Sanatorium and as a pasture for calves. The road leading from station to barn and further to the Sanatorium has been partly regraded and drains cleaned out and regraded so that drain water will probably be better taken care of, and prevent washing of road ,etc. The same is to be said of road leading to cottages, where the rain wash has been so bad that some of the under-pinnings of the cottages have been threatened. A new road from the main road to the ''Loop'' has been built diverting traffic from road around east end of Infirmary, where the hill has been constantly washingthis old road had" been closed by trellises and climbing honeysuckle planted.
On the "Loop" around "the Knoll" about 300 shrubs have been planted, and in a year or two will make an attractive hedge along its whole length. A large number of Dorothy Perkins roses, clematus and wisteria vines have been planted about cottages.; these have already shown a few blooms and as the years pass should make the cottages attractive and cool. In front of the Infirmary a rose bed has been started. Various other plants, flowers and vines have been placed to beautify
70

the grounds. All of these plants have been donated by friends of your Superintendent, and have not been of any cost to the Sanatorium. Efforts have been made to hide the red banks on the roads about the buildings. This is expected to make the buildings cooler, as well as more attractive. Underbrush has been cleared away wherever necessary. The springs have all been cleaned, the valley in which these are located raked and burned over, and underbrush cleared out. I take pleasure in calling your attention to the fact that the waterhas been examined and found to be most excellent with an almost unbelievably low bacterial count. Several cords of pole wood which have been piled at the front door of the Infirmary have been cut into furnace and stove wood and corded. Wood cut on newly cleared land has been utilized for heating the entire Sanatorium and in the laundry until December 31, 1919, thereby saving large coal bill and bridging us over the coal strike. A flag pole has been erected on the front lawn. A grape arbor has been built, and benches put on lawn for the comfort of patients. All cottages have been screened throughout and repainted inside and out.
The kitchen and dining room have been completed, and the ward in the Infirmary returned to the purpose for
which it was intended. The old kitchen has been made into a large glassed-in and screened porch, accommodating eight persons comfortably. Electric fans have been placed in wards and porches, also in isolation rooms -more fdr the purpose of keeping air fresh and in motion rather than to blow on the patient. These have proven to be a comfort already. One cottage has been remodeled and now makes it equal if not superior to any cottage of its size and type. Under this remodeled cottage is a room which, with slight modification and inexpensive equipment, could be made use of as an Arts and Crafts Workshop, where it is hoped we can start
71

this sort of diversion for patients. Already the patients have made fifteen bird boxes, which have been placed on the trees where patients can study birds and their habits while they continue to take the cure. New Laundry Dryroom has been installed and is now taking care of our own laundry, which is all being done at horne. A new ice box has been installed and is giving satisfactory service.
The Gailey property, consisting of about 48 acres, has been purchased and the house thereon remodeled into an attractive bungalow (five rooms and bath) for the Superintendent. The remodeling and equiping of this cottage has been done at the cost of $3,352.57.
Under cottage 1, Women's Department, a large coal bin has been built. This bin has a capacity of nearly two car loads and will prove a saving over the old method of piling coal outdoors, exposed to the elements.
A garage has been built to house the Ford truck and two large fire hose reels, all of which heretofore had not had proper protection from the weather.
RECOMMENDATIONS.
Equipment of Two Cottages: Two ten-bed cottages are vacant because of lack of equipment. The waiting list is large and the Sanatorium is full to its present bed capacity. Had we funds for this equipment we could immediately increase our patient census to 100. I earnestly recommend that the Legislature be asked for funds for this equipment. It is estimated that $1,500.00 will be sufficient.
Remodeling_ Cottages: The heating arrangements in our cottages are most unsatisfactory, and the old shingle roofs leaking (these buildings are nine years old). I would recommend that a new method of heating be installed and fire-proof covering for the cottages. One of the cottages has already been remodeled, is very satis-
72

factory, much more comfortable, and could be used as a model. Remodeling and recovering these cottages is an urgent need. An appropriation of $8,000 would cover the cost of this work.
Nztrses' Home: So long as wo cannot properly and comfortably house our nurses, it is almost impossible to secure and retain a sufficient number of nurses of a desirable type. At present one of our cottages is being used as a Nurses' Home. There can be no home life, and really very few comforts for tired workers in such a building. Further than this, this cottage should be used for patients-the purpose for which it was built. Our orderlies and other male help are quartered in a similar building. A proper home for these workers would not only insure us better and more efficient work but would at the same time release twenty beds for patients. The release of these two buildings and equipment of two vacant cottages mentioned above would bring our bed capacity to 120. Therefore, I most earnestly recommend the construction of a Nurses' Home. For this an appropriation of $12,000 would be needed.
Helps' Cottages: whatever has been said above about the comfort of workers also applies to the comfort of our negro help. The quarters occupied by negro help are inadequate and crowded beyond comfort and proper hygiene. I recommend an addition to this house to cost approximately $3,000.
Dining Room: Our present dining room was only a makeshift and entirely inadequate. Should our Sanatorium grow beyond its present population of 82 patients, we would have to serve our patients' meals in relays. This would necessitate extra help (for which we have no quarters), extra expense, and cause much confusion and dissatisfaction on the part of patients and help. A dining room to seat 100 patients and which could be used as an auditorium for entertainments and church services,
73

should be provided. At present there is no place where patients can find recreation in inclement weather ~x cept on their sleeping porches. An appropriation of $25,000.00 would build and equip dining room, kitchen and recreation hall as an addition to the north of the present Infirmary Building. In my opinion the Sanatorium has no more urgent need than this addition, and I would advise most emphatically that an appropriation for this purpose be asked for in the coming session of the Legislature.
Dairy Houses: A night shed for our dairy herd, with storage space for dairy feed; milk room and wagon shed are badly needed and the lack of these buildings is costing us considerable money each year. An appropriation of $6,000.00 would enable us to construct such buildings.
Negro Sanatorium: Something must be done at an early date, looking toward the care of Negro Tuberculates. They canp_ot be cared for under the existing circumstances. It is my opinion that negroes can be best cared for in a group of buildings in connection with the present State Tuberculosis Sanatorium. By this method the treatment of negroes would be standardized and the overhead expenses of such an annex would naturally be less than if a separate institution at some other point we:t:e established. Necessarily such an annex must be more or less complete in itself and contain infirmary accommodations. As the present Infirmary is hardly adequate for our present requirements it could not be used for treatment of negroes and whites. 11-,or the establishment of such an annex, no less than $50,000.00 would be sufficient.
The plan par excellence would be to turn over tne entire present plant to the care of negro patients and to build a new Sanatorium for whites on the ridge nearer the railroad, from which ridge beautiful views in all di-
74

rections may be enjoyed. Of course, this project would call for a much larger outlay of money, but it seems to me this plan must come sooner or later. In support of these last recommendations, I beg to recall to your mind the very great importance of the negro as a disseminator of tuberculosis, when one considers this, and the proportion of negroes in the Commonwealth of Georgia, a solution becomes more and more insistent.
MAINTENANCE.
In order to increase our daily patients census to 100 an increase of maintenance appropriation is necessary. For this purpose $65,000.00 would be required.
Acknowledgements: We gratefully acknowledge the following:
FLOWERS AND PLANTS-'' A Friend.'' FLOWERS AND PLANTS-Mr. and Mrs. E. G. VonWindger, Mt. Airy,
Georgia. BOOKS-Mrs. J. C. Brown, Elberton, Ga. 300 SHRUBS-Mr. F. R. von Windegger, St. Louis. ROSE BUSHES-Mrs. Alexander Walker, Waycross, Ga. FLOWERS AND GRAPEVINES-Mrs. Downey, Gainesville, Ga. ROSE VINES-Dr. Jeff Davis, Toccoa, Ga. PLANTS-Mrs. John Galstrap, Alto, Ga. MAGAZINES-Helping Hand Guild\ through Miss Anne Turpin, Macon,
Georgia. VEGETABLE'S AND SYRUP-Mr. J. B. Thomas, Waycross, Ga. GRAPHAPHONE RECORDS-Mr. Alva Pearce, Columbus, Ga. STRAWBERRIES AND WATERMELLON-'Mr. A. C. Gibbs, Gaines-
ville, Qa. BOOKS-Miss Lurline Bazemore, Odessadale, Ga. BOOKS-Mr. Noyes, Atlanta, Ga. BOOKS-Mr. C. C. McPhail, Athens, Ga. CLOTHES-Mrs: W. F. Manly, Madison, Ga. RELIGIOUS SERVICES-Rev. E. P. Ethridge, Bellton, Ga. RELIGIOUS SERVICES-Father Clark, Athens, Ga.
I wish to express my appreciation to the entire Sanatorium staff and to the patients who have passed under our care for their co-operation and loyalty during the
75

past year and to you and Mr. Faulkner I beg to express my deepest appreciation for your unfailing support, interest and confidence, during this trying period of reconstruction.
Respectfully submitted, EDSON W. GLIDDEN, 2d, M. D. Superintendent.
76

REPORT
OF THE
DIRECTOR
OF THE
RAOUL FOUNDATION
DIVISION OF TUBERCULOSIS
TO THE
STATE BOARD OF HEALTH
FOR THE YEAR ENDING. DECEMBER 31,
1919

Division of Tuberculosis
The year just closed has been que of readjustments and, as a result, larger effort that might otherwise have resulted in more decided advancement has been expended in holding past gains and planning to meet new conditions. In taking stock, while we find a good many of our plans not yet carried out and some of them abandoned, the balance is on the side of advancement and records a number of substantial achievements.
AT STATE SANATORIUM.
A most significant accomplishment of the year is the fulfillment of our plans for the State Sanatorium. In my last Annual Report, I listed the material improvements then under contract. By the beginning of summer, all of the changes planned had been made. A change uf even greater significance, however, was the selection of Dr. E. W. Glidden for Superintendent. Dr. Glidden took charge on February 18th. His report for the year, just submitted, shows marked improvement in every particular over any previous year.
Despite the high cost of all necessities, the per capita cost per day was only $1.90 in comparison to $1.98 in 1918. Of greater importance, however, is the care and comfort of patients, their morale, in comparison to previous years, and the increase in the numbers. When Dr. Glidden took charge there were only 39 patients. On December 31st, there were 82 with a waiting list of about thirty-five.
Vve have room for the accommodation of these 35, but beds and other necessary equipment are lacking. Furthermore, with the per capita cost nearly $1.00 more than we charge any patient, a larger number cannot be
78

taken until the appropriation from the State is increased or the number of free patients reduced.
NURSING PROGRAM
.Miss Jackson's work in organizing and supervising the nursing forces of the State is perhaps next in importance. In the early part of the year, she was recognized as the Supervisor of ~ursing for the State Board, and on the first of August she became Supervisor of the Nurses of the .Metropolitan Life Insurance Company. She has also worked in harmony with the Red Cross in its nursing activities and had their co-operation in her program.
She has succeeded in co-ordinating the Metropolitan service with the other nursing forces in Columbus, Rome, Griffin, Augusta and, in two or three instances, has practically reorganized it. In Atlanta, the process of reorganization is still under way. In Brunswick, a new staff nurse for the combined service has been secured, while in Macon and Savannah, effective work is being done, harmonious relations existing with the other forces.
The advantage of this supervision lies in the fact that it standardizes the work of ihese nurses and assures more careful attention on their part .to those in whom we are more particularly concerned-the tuberculous. The tendency now in a great many places is to utilize the general public health nurse for the care of the tuberculous as well as those afflicted with other communcable diseases. It is recog:J,lized that this is not the best plan, but in many instances, and particularly with us, it is an economic necessity. Our experience during these four months of trial is that we are getting a great deal of help from these nurses, largely of the kind we want, whereas without the supervision and co-ordination we would get practically nothing, and the field in some insta;nces would not be covered.
79

Our purpose all along has been to co-operate with the Health Officers, both city and county, to have the health organization look after the tuberculous instead of organizing private associations for that purpose. Usnally we find it necessary to have a committee but this committee only co~operates with the constituted authorities. It was with a view to supervising the nurses on the staff of the Health Officers that Miss Jackson was recognized by the State Board of Health. Of the 24 counties that have adopted the Ellis Health Law, 16 have their machinery in operation, and of these six have employed a . nurse.
For a good part of the year, it was a very difficult matter to secure nurses. Miss Jackson found a nurse for Thomas County, and, assisted by the Red Cross, placed one each in Spalding, Cobb, Sumter, Glynn and Lowndes Counties. The nurse secured for Thomas County was allowed to leave, however, and she is now in Troup County working under the School Board. The nurse for Floyd County is the Metropolitan Nurse.
There are a number of Public Health Nurses in the State who are not connected with the health boards, Red Cross, or tuberculosis agencies. A number of cotton mills and other industrial organizations, including telephone and telegraph companies, employ them. Miss Jackson has had conferences with a great many of these nurses. She has made a directory of the Public Health Nurses in the State, and our office is in a position to call upon these nurses for any specific problem _.in their communities that is called to our attention.
The only special tuberculosis nurses that have come under her supervision are in Savannah, Augusta, Macon~ Columbus and Atlanta. In Atlanta, however, the organization is so efficient as to need no supervision. In Macon, a special nurse was retained for only a part of the year, the four public health nurses now being required to
80

look after the tuberculous in their regular rounds. Our tuberculosis committee, however, is paying the salary of one of these nurses, and also administering relief.
Some significant survey work has been done by Miss Jackson during the year. When we began our work four years ago, she made the investigations herself. Now, she is getting practically as good results through local volunteer helpers. Reports of the surveys made in Brinson and Boston have recently been submitted to you.
Incidental to her general program, Miss Jackson h~s been called upon for addresses on nursing, tuberculosis1 and related subjects. In one instance, at the call of the Division of Venereal Diseases, she lectured for a week in the schools in Augusta. She also made several other trips in the interest of this work and other departments of the State Board. On one occasion, she appeared before a Grand Jury and secured the adoption of the Ellis Health Law.
MoDERN HEALTH CRUSADE.
The Modern Health Crusade has been coming into more prominence each year for the last two or three years, and for 1919 the National Association made appropriations to most States for the purpose of developing this work. Upon request, $3,500 was awarded us. Our campaign did not begin until late in the year, however, owing to the difficulty of securing a proper executive. Miss Busha, who was Office Secretary and had most to do with this campaign in 1918, was finally detailed for this particular work. She began her duties September lst.
She has submitted reports of her activities at the end of each month. These reports show untiring efforts with commensurate results. Before the holidays, she had reached most of the important centers in the western half of the State, and she is now planning an itinerary which
81

will cover th~ places most likely to be interested in the crusade in the eastern section.
Letters accompanied by descriptive literature were sent to nearly all of the City and County Superintendents and a g-ood many responses have been received. In some instances, invitations to org-anize certain schools have resulted.
Miss Busha has made a splendid impression in her addresses before teachers' institutes and other organizations, and she is also exhibiting tact and ability in her approach to the authorities. It is her plan to get some one to assume responsibility for the campaign in each city or locality, whenever possible.
It is not possible, at this time, to give any very definite figures as to the number of children enrolled, nor will it be until near the close of the school year. Judging from the orders we have had for literature, however, there are 20,000 or more.
wherever the movement has been given a thorough trial, it has proved not only popular but exceedingly beneficial. It is certainly sound pedagogically and ought, in reality} to become a part of the school curriculum. In fact, it has been placed in the curriculum of two States, and if our campaign proves a success, which now seems likely ,we may approach the Department of Education with a view to its adoption next year.
LEGISLATION.
Our Legislative program is assuming more importance each year. In 1918, we were successful in getting two important measures passed-one taking the State Sanatorium out of the control of a special board of twenty-four and placing it under the supervision of the State Board of Health, and the other providing for local city or county tuberculosis hospitals.
For th~ session of 1919, we had a bill providing for
82

a budget basis .of State appropriations for the State Sanatorium, and also regulating per capita charges; an. other bill providing an appropriation to recoupe for expenditures made, out of the appropriation for maintenance, on repairs and improvements; and another to provide for the purchase of land, which we had been authorized to lease with option.
We withdrew the bill providing for regulation of per capita cost and budget appropriation, feeling that it was better to give another year's study to our problem on practically the present basis. This was done after consultation with the Governor and Chairman of the Appropriation Committee, in which promises were made to give more particular attention to the entire problem of tuberculosis legislation at the session of 1920. The special appropriations to recoupe expenditures and pur'3hase land were passed, and, as a result, 57 acres of farming land have been added to the Sanatorium tract along with two houses, one now being used by the farm helper, while the other-with an expenditure of nearly $3,000-has been converted into a beautiful home for the Superintendent.
As in the session of 1918, I was interested in other legislative measures than those relating specifically to the tuberculosis problem and was frequently called upon to go before committees in the interest of these various measures. I was particularly intere~ed in a bill requiring a health certificate before the issuance of a marriage license, the measure providing for a feeble minded institution, another prov.iding for physical educntion in the schools, and amendments to the Venereal Disease Control Law, the Vital Statistics Law, and the various appropriations for the State Board 9f Health. The bill providing for the feeble minded institution and an amendment to the Vital Statistics Law and most of the appropriation measures were passed.
83

EDUCATIONAL PROGRAM.
Much of the work covered in the preceding paragraphs was wholly educational, but there are enough activities not so included to justify a separate discussion.
We have made no special effort during the year to get publicity, such as for the first two years of my administration, and yet.,.there has been but little less attention given to our work by the press, as articles and notices received from the Clipping Bureau show.
Through the courtesy of Dr. Bowdoin, of the Department of Venereal Disease Control, I have inserted several articles in a page of plate matter which has been used extensively by the weekly press of the State.
A new folder has been added to our list of educational publications. The National Association commented upon it, giving it the title "D" folder. We have had requests for it from many states in the Union. It is being used by the laboratories to send to doctors and patients to accomnany a positive sputum report. Comments by secretaries in the several states lead me to believe that the idea is new. We are receiving requests for further direction and help from persons to whom this circular. has gone from the laboratory, which shows that it is fulfilling the purpose for which it was designed. I have now in preparation a similar folder to be supplied to those who get a negative report from the laboratories.
Our Folder No. 2 has just been reissued and brought up to date. It was one of the two issued shortly after my taking charge of the work, and this is the third edition. I submitted it to Dr. Glidden, of the State Sanatorium, and he returned it without additions or adverse criticism. The State Board of Health assumed the entire cost of the new edition.
84

The records kept by the Office Secretary show that we have sent out 33,477 pieces of literature during the year.
Many of the letters we write are educational in their nature inasmuch as most of them are in response to definite requests for direction and help. "V\re have endeavored to keep count of these letters, and those for which I have been personally responsible number 2,936. Letters written by other members of my staff run into the hundreds.
A significant feature of the educational program is the health addresses given. I have to my credit for the year 71. Miss Jackson and Miss Busha together as many more. The number of people reached by these addresses is at least 30,000. In addition to those listed, we have each given many short talks before committees and meetings, when subjects were open to discussion, which certainly had educational value. With even this record, not half of the requests for health lectures and addresses could be complied with.
IN OTHER STATES.
In January and February, I made two trips to Kentucky and one to Florida to reorganize the work in the former State, and give direction to the program in the latter. It is sufficient to say that a wholly new organi.zation was formed in Kentucky, staff elected, and program outlined. In Florida, the Executive Secretary, recommended by me, was secured. He is doing a splendid piece of work.
LocAL ORGANIZATIONS.
We have all told in the State 102 affiliated organizations and co-operating committees. Twenty of these have had a definite program, parts of which have been
85

regularly carried out. Of the twenty, nine shared in the funds awarded by the National Association for tuberculosis work during the year. Nine others had funds left over from previous years, which have not yet, in every instance, been exhausted. In the other instances, where the nature of the work required, definite expenditures, other organizations were appealed to for the outlay.
The remaining committees are in the smaller cities and towns, and have no definite all-time program. We utilize them to co-operate in the care of individual cases, and as a solution to particular problems to which our attention has been called. Frequently they make the dis, covery of need themselves and seek our help.
It is now generally conceded that private tuberculosis organizations can hardly be maintained in cities with a population of less than 10,000. This is the standard set for the North. For the South, however, it is even
difficult to finance a working organization in pla~es of
20,000 and 30,000. This is due in part to the still prevalent apathy to health work in general and ignorance as to the amount of tuberculosis.
Atlanta has the distinction of maintaining and supporting the best organization in the entire South and the superior of the vast majority in the North. The work of the Atlanta Association was praised recently by the National Conference of Charities, and all their activities highly commended. It was suggested that they should change their name to The Atlanta Public Health Association.
The tuberculosis work in Macon stands next to Atlanta in importance in the State. Augusta, Savannah, Columbus, Brunswick and Rome follow in order. In each of these places, nurses are employed and give all or part of their time to the care of the tuberculous. Clinics and dispensaries are also maintained in these pla,ces.
86

.
LocAL HosPITALS.
No particular advancement has been m,ade during the year in the establishment of local hospitals. Everything is hinging on the outcome of the Macon proposition. A number of attempts have been made to secure a site, aH of which have been thwarted. Just now, we are negotiating with the Macon authorities looking to the establishment of a unit at the State Sanatorium for Macon patients. If this plan is agreed upon, it will be open to every city and county in the State, and will change our program entirely. In our last conference with the Macon Board, it was agreed to further study the proposition and seek definite legislation safeguarding both the State institution and the local authorities, in the event of the plans being accepteq, or provide an optional plan through which the State will subsidize the local hospitals
DISCHARGED SoLDIERS. Through arrangements with the Red Cross, the care of discharged soldiers was taken out of our hands. I volunteered last year to organize the tuberculosis section of the After Care Department of the Southern Division and definitely installed the plans for the care not only of the Georgia men, discharged for tuberculosis, but those in the other four states in the division. We have listed 633 Georgia men for whom the Red Cross is responsible. For a number of months they reported regularly each week, the number with whom contacts were made, the number provided with treatment, etc. But we have not been able to secure reports since early in the year, and, of course, can make no definite statement as to the extent to which these men have received the care due them. I do know, however, that the Red Cross is still working on the problem, and I presume that they have done all that can be done.
87

As to rejected men, the War Department, for some reason never explained, ceased to give out the lists, and so our plans for them came to an end.
TuBERCULOSIS CoNFERENCES.
Two sessions of the Southern Tuberculosis Conference were held during the year, owing to the fact that the one scheduled for October, J 918, was called off because of the ''Flu'' epidemic. The sessions were held in Birmingham in February and Asheville in October. Our organization was represented in the first by two and in the second by the three members of the field staff.
I have attended three meetings of the National Association and, in addition, represented both the Division of Tuberculosis and the State Board at the Southern Medical Association in Asheville in November.
OFFICES WITH THE BoARD.
We are just closing our second year of affiliation with the State Board of Health as the Division of Tuberculosis, but not until the first of April, of the year just closed, were our offices moved to the State Board. Our work has become so inter-related that quarters elsewhere would be out of the question. We miss many of the comforts and conveniences that we had in the Candler Building and the Empire Building, but our lot is no worse than those with whom we associate. Our relations have been so cordial as to minimize the discomforts. No charge is made for office space.
REPORT TO GovERNOR DoRSEY.
Governor Dorsey took part in the Tuberculosis session of the Governors' Conference, held in Savannah, in November, and, that he might be advised of the work being done in the State, I was requested to submit a report
88

of the work of the division /and the State Sanatorium. This I did at some length, taking occasion to give a resume of our activities during the last five years. The Governor used my report as a basis for his remarks on the tuberculosis problem in Georgia, and, after his return, thanked me perRona1ly for the paper.

OFFICE SECRETARY.

The selection of Miss Busha for the position of Cru-

'sader Executive in September made it necessary to em-

ploy a new Office Secretary. Miss Julia Bone, who for.

a number of years was associated with Major Guinn, one

of the trustees of the Foundation, was selected and be-

gan her duties the first of October. She is proving a

very efficient helper, and I think is developing quite a

liking for this kind of work.



REviSING OuR STATISTICS.

investigations made at l''ramingham, Mass., by the

National Tuberculosis Association have shown that in-

stead of estimating six cases of tuberculosis to each an-

nual death, it is more nearly accurate to reckon nine

active cases, or 21 cases when the arrested cases are in-

cluded.

.

A study made of the first 12,246 deaths reported to the Vital Statistics Bureau, made by the Statistician,. Dr. Davis, shows that 7.2% were caused by tuberculosis. This is a little lower than in a great many of the states. Estimating that only 40% of the annual deaths were reported, Dr. Davis concludes that the total deaths from cuberculosis from January to August was 2,195. This would give a death toll for the State for the entire year of .3,763. The Raoul Foundation's estimate, based upon a survey in 1914, was 5,316 deaths per year. Allowing for some improvement in conditions since this survey

89

was made, and for the fact that the statement that only 40% of the total deaths were recorded is a guess, the Foundation's estimate does not seem to have been much too large.

OFFICE ExPENDITURES.
The statement of receipts and expenses for the calendar year, as shown by remittances to the Treasurer and requisitions upon him, is as follows:

Received from the National Association _________ Awards to local organizations -------------------$11,411.02 Refund on expenses for literature sold ---------Total requisition for expenses -------------------- 10,880.03

$20,524.il6 477.78

$22,291.05 Deficit _----- ___ -------- _------------------ ____ $ 1,288.91 Remainder due from National Association _______ Due local organizations ------------------------- 1,308.11

$21,002.11 $ 2,931.20

$ 2,597.02 $ 2,931.20

BALANCE (Credit)

$ 334.18

It thus appears that, when the final amount is received from the National Association and final awards made, the office will have financed itself for the year and have a balance to its credit of $334.18.

STATISTICAL SuMMARY.
Interviews, miseellaneous ------------------------------------- 458 Interviews, patients '----------- ------ __ __ ________ _____ ________ 125 Conferences, Plans and Programs _______________ --------- ______ 526 Board and Committee Meetings ------------------------------- 68 Luncheon Conferences --------------------------------------- .64 Addresses (Faulkner) ------------- ___ ____ _________ ___________ _ 71 LJ,e.ittteerrastu-r-e--_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_~_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-----3--3,24,97376 Records and Reports ----------------------------------------- 2,651
BuDGET PLAss.
Inasmuch as the above is a report of our activities for the year just closed, I refrain from discussing either
90

budget or plans for the coming year. The proper place for these is in a separate statement.
Respectfully submitted, JAMES P. FAULKNER, Director
II
!) I

,.
;
,..

GEORGIA STATE BOARD OF HEALTH EXAMINATION OF ACCOUNTS DECEMBER 31, 1919

Atlanta, Ga., January 10, 1920. Georgia State Board of Health,
Dr. T. F. Abercrombie, Secretary, Atlanta, Georgia.
Gentlemen: In accordance with your instructions we have audit-
ed the books and accounts of the Georgia State Board of Health for the year ended December 31, 1919, and transmit herewith the following exhibits and schedules:
Exhibit A-Receipts and Disbursements. Schedule 1-Reconcilement of account with Atlanta National Bank. Schedule 2-Analysis of Salary Account. Schedule 3-Detail of Travel. Schedule 4--Count of Petty Cash. These exhibits and schedules together with the comments which follow give you the result of our audit.
Respectfully submitted, AUDIT AND SYSTEM COMPANY,
w. ,J. FRASER,
President.
94

CoMMENT.
Bank account was reconciled as is shown by Schedule No. 1. Attention was called in our semi-annual report to an error of one dollar in your bank account and bookkeeper was instructed to have bank 'make correction. This was not done and account is out of balance $1.00.
Petty cash was counted, detail of count is shown by Schedule No. 4.
After paying all bills for the year 1919, the surplus fund amounts to $843.29.
We are preparing a statement of the transactions of the Division of Rural Sanitation and expect to complete same upon our return from Alto.
We consider the financial condition of the Board to be upon a very sound basis, and the management should be congratulated upon the able manner in which the business of this very important State Department has been conducted during the past year.
95

GEORGIA STATE BOARD OF HEALTH

RECEIPTS AND DISBURSEMENTS

jANUARY 1,1919 to DECEMBER 31, 1919
'
RECEIPTS

January 1', 1919, CASH:
In Bank, Schedule No. 1 ----------------$ 75.04 Petty cash, Schedule No.4 -------------- 111.61 Contingent funds __________________ - _-- 160.08 From State Treasurer ------------------ 60,000.00

$60,346.73

DISBURSEMENTS.

Salary, Schedule No. 2 ------------------------- _$28,631.28
Light, power and water ------------------------ 447.08
Telephone and telegr;o.ph ----------------------- 585.60 Freight, express and drayage __ ------------ ____ 72.63 Postage _______ ----------- ___ --- _____ _____ _____ 874. 71

Expense of board meetings --------------------Biological products ---------------------------Laboratory general merchandise ----------------
Live stock -----------------------------------Chemicals and laboratory apparatus ----------Laundry and towel supply ____ ---------------- __ Rent ______ ------------- _________________ ---- _

307.09 6,977.65 2,960.58
1,456.92 941.99 184.47
1,353.33

Books and periodicals -------------------------Office supplies -------------------------------Plumbing, repairs and carpentry ----------------
General supplies ------------------------------Auditing _---------- ___ _____ _____ ______ ________

162.07 2,558.28 1,237.24
626.39 120.00

Travel, Schedule No. 3 ------------------------- 2,493.23

Ins;urance _____ - -------------------- __ ----- ____

7.,50

Printing __________________ ------------- ___ _____ 24.31

Furniture and fixtures ------------------------Accounts payable liquidated -------------------Miscellaneous supplies and expense -------------

447.75 120.38 215.56

RURAL SANITATION.

Troup County ----------------------$ 1.899.96 Hart County ------------------- ___ _ .615.00 Worth County --------- -- -------- __ _ 949.98 Administration expense ------------- 287.07 Malaria treatment ------------------- 1,082.77

4,834.78

Footings forward ____ - ----------------- __ ---$57,640.82 $60,346.73

EXHIBIT ''A,'' SHEET NO. 1.

96

RECEIPTS AND DISBURSEMENTS--Continued.

Footings forward ----------- _----------- __ --$57,640.82 $60,346.73

VITAL STATISTICS:

OPoffsitcaegeSu-p-p-l-i-e-s --_-_-_-_-------------------------_-_-_-_-~$
Travel -----------------------------Carpentry -------------------------VVrapping paper --------------------Furniture and fixtures -------------Disinfectant -----------------------Signs ------------------------------

874.00 198.97 237,35 61.75
15.58 447.30
5.17 22.50

$ 1,862.62

Total disbursements -------------- __ ---------

$59,503.44

Balance to be accounted for -r------------------------------$ 843.29 Accounted for as follows:

Cash in bank ------------------------------$ .Petty cash _____________________ ------------
Contingent fund, Dr. Abercrombie ---------Contingent fund, Dr. Park _---------------Contingent fund, Ray C. VVerner -----------Contingent fund, Dr. Haygood ------------Contingent fund, Mr. VVebb ---------------Check Miss Barrier ------------------------

12.88 300.00
200.00 100.00
12.01 100.00 100.00
18.40 $

843.29

EXHIBIT ''A,'' SHEET NO.2.

97

,

GEORGIA STATE BO~ OF HEALTH RECONCILEMENT OF ACCOUNT WITH ATLANTA NAT'L BANK
DECEMBER 31, 1919.

1919

December 31-Balance as per bank statement ----$ 5,760.49 Add: Error in charge by bank

May 12 -----------------------

1.00 $ 5,761.49

Less Checks Outstanding:

No. 4528 $ 3.60

Fwd.

4885

25.00 No. 4918

4893

25.00

4919

4899

1.25

4920

4900

211.19

4921

4901

11.52

4922

4902

29.90

4923

4903

5.50

4924

4904

44.30

4925

4905

5.00

4926

4906

1.55

4927

4907

48.52

4928

4908

21.40

4929

4909

8.00

4930

4910

1,957.44

4931

4911

54.28

4932

4912

7.09

4933

4913

18.54

4934

4914

29.08

4935

4915

9.35

4936

4916

344.12

4937

4917

74.05

4938

$ 2,935.68 4.50 5.05
13.75 21.60 13.00
2.35 15.57 21.43 3.00 8.00
2.00 2.22 4.70 28.00 158.33 84.61 100.00 14.30 154.05
38.90 5.00

Fwd. No. 4939
4940 4941 4942 4943 4944 4945 4946 4947 4948 4949 4950 4951 4952 4953 4954 4955 4956 4957
4958

$ 3,636.0! 195.85 18.00 15.60 7.30 5.52 295.00 1.50 24.50 20.45 4.80 5.60 6.00 1.40 1.10 31.18 2.42 5.00 802.95 632.40
36.00

Total Checks

Fwd.

$ 2,935.68 Fwd.

$3,636.04 Outstanding $ 5,748.61

December 31, 1919. Balance as per cash book --------------$ 12.88

SCHEDULE NO. 1.

98

GEORGIA STATE BOARD OF HEALTH ANALYSIS OF SALARY ACCOUNT January 1, 1919, to December 31, 1919.

Secretary Board of Health ---------------------- ______ ----$ 2,000.00

State Registrar of Vital Statistics ____ ----------------------- 1,800.00

Bacteriologist ------------------- __ --------------------- __ _ 3,000.00

Assistant Bacteriologist ----------------------------- ___ ___ 1,560.00

Laboratory Assistant Bact. Dept., Miss Morris ------------ 1,090.00

Laboratory Assistant Bact. Dept., C. R. Smith --------------- 243.33

Director Division Rural Sanitation ------------------------ 1,500.00

Director Water Analysis Department ---------------------- 2,400.00

Assistant Water Analysis Department ---------------------- 620.66

Clerk Laboratory --------------- _---------------------- ___ 400.00

Assistant Pasteur Department ______ ---- _----------------- _ 1,155.00

Director Bureau of Vital Statistics ------------------------ 2,669.28

Other Employees Bureau of Vital Statistics ---------------- 4,120.20

Laboratory Assistant Wassermann Laboratory -------------- 147.22

Laboratory Assistant Wassermann Laboratory -------------- 75.00

Bookkeeper ---------------------------------- __ ----------- 1,830.00

Stenographer and Office Assistant ---------------- ____ ----- 1,027.50

Electrician ---------------------------------- ______ ------- 300.00

Janitor --------------------- _____ ------------------- _____ _ 1,023.50

Janitress ------------------------------------------------Animal Keeper ----------------- ___ --------------------- __
Night Watchman __ ------ __ ------------------ ____ ---------

353.50 740.00 195.00

Miscellaneous Help -------------- __ ----- ___ ------- _____ ---- 381.0!

$28,631.28

SCHEDULE NO. 2.

99

GEORGIA STATE BOARD OF HEALTH DETAIL OF TRAVEL
January 1, 1919, to December 31, 1919.

Dr. Abercrombie _--- _- ------------------- ___ --- -----------$ 1,260.6:

Dr. Haygood ____ -----------------------------.------------ 637.00

Dr. Todd ------------- ---------------------------------D~ Sellers ----------------------------------------------Dr. Bird _______:__-- --------------------------------------

5.08 142.10
39.17

Dr. Shamblin _----------------------------------------- _-Miss Barrier ----------------------------------------------
Ray C. VVerner -------------------------------------------Miss Chloe Allen _---------.------------------------------
VV. J. Langley ---------------------------------------------

29.49 83.10 187.99 65.00 43.63

$ 2,493.23

SCHEDULE NO.3.

100

GEORGIA STATE BOARD OF HEALTH COUNT OF PETTY CASH January 10, 1920.

Currency -------------------------------------------------$
Gold ----------------------------------------------------Silver and Pennies _______________ ------ _________________ _
Balance in Atlanta N;;ttional Bank -----------------------Cash Tickets ----------------------------------------------

67.00 5.00 4.34
171.5-! 52.12

$ 300.00

SCHEDULE NO. 4.

101

Atlanta, Georgia, January 13, 1920.
We, the undersigned, the Executive Committee of the GEORGIA STATE BOARD OF HEALTH, approve the report on audit conducted by Wallace J. Fraser, President of the Audit and System Company, on theReceipts and Disbursements made by the GEORGIA STATE BOARD OF HEALTH during the year ended December 31, 1919.
W. H. DOUGHTY, JR., Chairman.
ROBERT F. MADDOX,
M.S. BROWN.
Approved: W. H. DOUGHTY, JR., President.
T. F. ABERCROMBIE, Secretary.
C. L. TINSLEY, Chief Clerk.
102

,
'
GEORGIA STATE BOARD OF HEALTH DIVISION OF RURAL SANITATION AUDIT OF ACCOUNTS Year Ended December 31, 1919

Georgia State Board of Health, Dr. T. F. Abercrombie, Secretary, Atlanta, Georgia.
Dear Sir:
We have completed the audit of the affairs of the Division of Rural Sanitation to December 31, 1919, and transmit herewith detail statements of each unit, identified as follows:
Exhibit ''A''-Central Administration. Exhibit "B "-Troup County., Exhibit "C"-Hart County. Exhibit ''D''-Worth County. Schedule No. !-Recapitulation of Exhibits. Schedule No. 2-Reconcilement of Account with Citizens and Southern Bank. These Exhibits and Schedules, together with the comments which follow each Exhibit, give you the result of our audit.
Respectfully submitted,
AUDIT AND SYSTEM COMPANY, W. J. FRASER, President.
104

~

BUDGET NO. 6458. DIVISION OF RURAL SANITATION-GEORGIA
CENTRAL ADMINISTRATION January 1st, 1919, to December 31st, 1919.

RECEIPTS. From International Health Board ---------------$ 2,700.00 From State Board of Health ------------------- 1,350.00
Total Receipts _________ - ____ ------- _____ ----------------$ 4,050.06

DISBURSEMENTS.
Salary State Director ---------------------------$ 1,500.00 Traveling Expenses Director -------------------- 576.26 Contingent Expenses, State Director ___ _________ 195.25 Salary Stenographer --------------------------- 369.74 Remittance July 15 for refund ------------------ 675:00

$

Divided as follows: To International Health Board ------------------$ To State Board of Health -----------------------

704.37 29.38 ---,$

733.75 733.75

EXHIBIT ''A''

105

CoMMENTS.
The International Health Board paid for full year, whereas the State Board of Health paid for only six months. After deducting $1,350.00 from balance to be divided, there remains $58.75, of which 50% goes to each board.
Unit No.4 did not take advantage of this fund, therefore the $1,875.00 paid into this fund by the I. H. Board will be refunded.
106

Budget No. 6459-Unit No. 1

DIVISION OF RURAL SANITATION-TROuP COUNTY RECEIPTS AND DISBURSEMENTS
December 16, 1918, to December 31, 1919.

RECEIPTS
From International Health Board ---------------$ 2,500.00 From State Board of Health -------------------- 1,899.96 From Troup County ---------------------------- 3,799.92

Total Receipts ---------------------- __ ------- ___________$ 8,199.88

DISBURSEMENTS.
Salary Field Director --------------------------$ 2,700.00
Salary Field Inspector ------------------------ 2,275.00 Salary Stenographer -------------------------- 720.00 Expense Field Director ------------------------ 720.78 Expense, Field Inspector ---------------------- 180.24 Contingent, Field Director __ -------~----- ---- ___ 846.91

Total Disbursements ------------------------------------$ 7,442.93
Balance to be refunded ----------------------------------$ 756.95

Refunded as follows:
To International Health Board ------------------$
To State Board of Health -----------------------
To Troup County.------------------------------

639.24 39.24 78.47 $

756.95

EXHIBIT ''B''

l07

,
'j
CoMMENTS.
The Budget for Troup County for 1919 is as follows: Troup County ------------------$3,800.00 State Board of Health ___________ 1,900.00 International Health Board ______ 1,900.00
As the International Health Board exceeded their budget allotment by $600.00, we credit thdr account with this amount, leaving a balance of $1'56.95 to be divided as follows:
One-fourth to International Health Board. One-fourth to Stat~ Board of Health. One-half to Troup County. Checks have been drawn for amounts shown on Ex-
hibit ''B.''
108

F~~ ./

Budget No. 6460-Unit No. 2.

DIVISION OF RURAL SANITATION-HART COUNTY. RECEIPTS AND DISBURSEMENTS
January 1st, 1919, to December 31st, 1919.

RECEIPTS.
From International Health Board ----------------$ 2,500.00 From State Board of Health ------------------- 615.00 From Hart County ----------------------------- 1,230.00

Total Receipts -----------------------------------------$ 4,345.00

DISBURSEMENTS.

Salary Field Director ----------------.----------$ 1,050.00 Salary Field Inspector _------------------ _____ 275.00

Salary Stenographer -------------------------Travel Field Director -------------------------
Contingent, Field Director --------------------Miscellaneous Expense, Field Inspector ________ _

350,,00 257.44 226.14
10.00

Total Disbursements _------------------------- __________ -$ 2,168.58 Balance to be refunded -------------------------- _________ -$ 2,176.42 Refunded as follows: To International Health Board __ ------------- __ -$ 387.93
To State Board of Health --------------------- 387.93 To Hart County ______ --------------- _________ _ 775.86 $ 1,551.72

Balance ---------------- ------ ___________________ -------$ Amount should have refunded Inter-
national Health Board ____________$ 1,957.85
Amount refunded ------------------- 387.93

624.70

Balance due -----------------------State Board of Health --------------$ 72.86 Amount refunded ------------------- 387.93

$ 1,569.92

Overpaid ------------------------------------
Hart County -------------- _____ ----$ 145.71 Amount refunded _--- ---------~ -- ___ _ 775.86

315.07

Overpaid ------------------------------------ 630.15

$ 624.70

EXHIBIT ''C''

109

CoMMENTs.
The Budget for Hart County for 1919 is as follows : Hart County ................... $2,460.00 State Board of Health .......... 1,230.00 International Health Board . . . . . . 1,230.00
Hart County paid only 6 payments, therefore the I. H. B. have exceeded their Budget allotment $1,885.00, leaving a balance of $291.42 to be divided as follows:
One-fourth to I. H. Board. One-fourth to State Board of Health. One-half to Hart County. In July, 1919, the bookkeeper of the State Board of Health attempted to close the account with Hart County, with the result that he overpaid Hart County $630.15, and the State Board of Health $315.07. Exhibit "C" shows the transaction in detail. Your auditor suggests that a statement of this unit be turned over to Dr. Haygood so that he can collect the amount from Hart County. The State Board of Health have refunded the amount overpaid them.
110

Budget No. 6461-Unit No. 3.

DIVISION OF RURAL SANITATION-WORTH COUNTY RECEIPTS AND DI&BURSEMENTS. May 1st, 1919, to December 31st, 1919.

RECEIPTS.
From _International Health Board ----------------$ 2,500.00
From State Board of Health ------------------- 949.98 From Worth County -------------------------- 1,899.96

Total Receipts ------------------------------- __ --------$ 5,349.94

DISBURSEMENTS.
Salary Field Director ____ - ____ ----------------$ 1,350.00 Salary Field Inspector ------------------------- 966.65 Salary Stenographer --------------------------- 340.00 Travel Field Director ------------------------- _ 360.00 Contingent, Field Director --------------------- 427.98 Miscellaneous Expense Field Inspector --------- 78.00

Total Disbursements ------------------------- _----------$ 3,522.63
Balance to be refunded ------------------------------------$ 1,827.31
Refunded as follows: To International Health Board ----------------$ 1,619.33
To State Board of Health ---------------------- 69.33 To Worth County ----------------------------- 138.65

EXHIBIT "D'

$ 1,827.31

111

l
j
'
CoMMENTS.
The Budget for Worth County for 1919 is as follows: Worth County .................. $3,800.00 State Board of Health . . . . . . . . . . 1,900.00 International Health Board ...... 1,900.00 Worth County paid only 6 payments, therefore
the I. H. B. have exceeded their Budget allotment $1,350.00, leaving $277.31 to be distributed as follows:
One-fourth to International Health Board. One-fourth to State Board of Health. One-half to "\Vorth County. Checks have been drawn to close this Unit.
.'
112

r
INTERNATIONAL HEAL'r.H BOARD RECAP;J:TULATION
Showing by units balances to be refunded at close of year 1919. Troup County, Budget No. 6459-Unit No. 1 ----------------$ 756.95 Hart County, Budget No. 6460-Unit No. 2 ----------------- 1,569.92 Worth County, Budget No. 6461-Unit No. 3 ---------------- 1,827.31 Unused, Budget No. 6462-Unit No. 4 --------------------- 1,875.00 Central Administration, Budget No. 6458 ------------------ 733.75 Balance to be accounted for -------------------------------$ 6,762.93 Accounted for as follows: Balance in bank Dec. 31, 1919 -----------------$ 5,142.71 Deposit Jan. 14, 1920 -------------------------- _ 675.00 Deposit Jan. 15, 1920 to cover error Hart
County ----------------------------$630.15 To cover error State Board of Health ___ 315.07
945.22 $ 6,762.93
SCHEDULE NO 1.
113

DIVISION OF RURAL SANITATION RECONCILEMENT OF ACCOUNT WITH CITIZENS AND SOUTHERN
B.AN.K, ATLANTA. December 31st, 1919.
Dec. 31, 1919. Balance as per bank statement --------------$ 5,045.52 Add: Deposit Jan. 5, not shown on statement --$ 474.99 Deposit Jan. 14, not shown on statement -------- 675.00 Deposit Jan. 15, not shown on statement ------- 945.22 $ 2,095.21

Less Checks Outstanding:
No. 268 ------------------------------------$ 108.25

No. 270 ----------------------------------- 60.00

No. 271 -----------------------------------No. 272 ----------------------------------No. 273 ------------------------- _------- __

19.55 9.85 101.25

No. 274 ---------------------------------No. 275 _--- ~---- ------------------- ---~----

78.90 39.24

No. 276 ------------------------------------ 1,569.92

No. 277 ------------------------------------ 1,619.33

No. 278 ------------------------------------
No. 279 -----------------------------------No. 280 -----------------------------------
No. 281 ----------------------------------No. 282 ----------------------------------No. 283 ---------------------------~-------No. 284 ------------------------------------

69.33 138.65 639.24
78.47 704.37
29.38
1,875.00

$ 7,140.n

$ 7,140.73

SCHEDULE NO. 2.

114

r
STATE TUBERCULOSISSANATORIUM Alto, Georgia
EXAMINATION OF ACCOUNTS Year Ended December 31st, 1919

Atlanta, Ga., January 12, 1920.
Dr. T. F. Abercrombie, Secretary, Georgia State Board of Health, Atlanta, Georgia.
Dear Sir: We have made a complete audit of the books and ac-
counts of the STATE TUBERCULOSIS SANATORIUM, Alto, Ga., for the year ended December 31, 1919, and transmit herewith the following Exhibits and Schedules:
Exhibit ''A' '-Assets and Liabilities. Exhibit "B"-Comparative Statement of Assets and Liabilities. Exhibit "C"-Receipts and Disbursements. Schedule No. 1-Count of Cash. Schedule No. 2-Reconcilement of acc.ount with Cornelia Bank, Cornelia, Ga. Schedule No. 3-Patients' Accounts.
These Exhibits and Schedules, which are full and complete, together with the comments which follow, give you the result of our examination.
Respectfully submitted,
AUDIT AND SYSTEM COMPANY. W. J. FRASER, President.
116

CoMMENTs.

Cash:
Cash in office was counted at 4 P. M. January 12th and found to be correct. We show detail of count in Schedule No. 1. Proper vouchers were found for all disbursements They were properly filed and arranged numerically.
Bank account was reconciled as is shown by Schedule No.2.

Inventories:
No inventories were taken at the close of the year, but Dr. Glidden and the bookkeeper e~timate supplies on hand as follows :

Provisions ______ ---------- _--- _------1--$ 1,800.00

Stock feed ---------------------------- 100.00

Silo ----------------------------------- 150.00

Fuel ---------------------------------- 400.00

Fertilizer -------------------~---------

12.00

--

$ 2,462.00

Equipment:
Inventories of all equipment will be taken at once in order that balances shown on ledger will represent their true value.

Live Stock: This account will be adjusted by physical inventory.

Accounts Payable:

All indebtedness shown on last report has been liquidated and we are pleased to report the institution free of debt.
117

1 !
Exhibit '' B '' shows a surplus at the beginning of the year of $69,422.37 and at end of year $89,214.02, a net increase of $19,791.65. This result is very gratifying to your auditors, as the accomplishment is greater than any previous year by several thousand dollars.
On December 31, 1919, there were 82 patients at the Sanatorium. December 31, 1918, there were only 32 patients. The increase being 50.
The number of hospital days as computed by Dr. Glidden for the year was 19,829. The net operating expenses were $37,560.51. The average per capita cost figures $1.894. We consider this a very low per capita as compared with other State institutions.
The books and records have been well kept and are in balance and if the instructions given verbally to the accountant in charge are carried out, we will be able to compile a statement of operations of Farm and Dairy at the time of the next audit.
The affairs of the institution are in a more satisfactory condition from our viewpoint than we have found them in the past four years and the State Board of Health is to be congratulated upon the results obtained through the able managers of the Sanatorium.
IIH

STATE TUBERCULOSIS SAN'ATOJ.tiUM:, ALTO, GE9RGIA.

STA'l"EMENT OF ASSETS AND LIABILITIES

Y~Jr Ended December 31, 1919.

ASSETS.

C4-SH.
In Office, Schedule No. 1 -------------------$ 199.15 .In Cornelia Bank, Schedule No. 2 ---------- 57.26
$

ACCOUNTS RECEIVABLE. Patients' Accoun,ts, Schedule No. 3 ----------$ Manning & Co. ---------------------------

533.00
53.04 $

256.41 586.04

LIVE STOCK.
Dairy ---------------------------------- ___$ 2,570.74 Farm ----------- ------------------------- __ 1,786.95

$ 4,357.69

INVESTMENTS.
Lands ---- _- ---------------------------- ___$ 6,931.61 Farm Improvements ---------- ________ _____ 1,435.68 Buildings _----------------------- _- _______ 39,473.92 Roads and Drainage ----------------------- 3,341.06 New Construction -------------------------- 9,419.47 Superintendent's Cottage -------------- ____ 2,725.31 Water Plant and Sewerage ----------------- 12,130.70 Electric Plant ----------------------------- 2,463.27

$77,921.02

EQUIPMENT.

Furniture and Fixtures ----------------------$3,422.28

Furniture and Fixtures-Qffice ------------ 619.00

Furniture and Fixtures-Superintendent's

Cottage -------------------------------
Linen -------------------------------------Mattresses --------------------------------Blankets and Comforts ---------------------

691.60 1,636.85
183.80 229.00

Crockery and Glassware -------------------- 314.65

Tableware and Cutlery -------------------- 167.71

Kitchen Utensils -------------------------- 270.97

Medical and Sanitary Supplies ------------ 198.40

Dairy Equipment ------------------------- 464.88

Vehicles, Tools and Implements ----- _------ 1,081.98

Automobile ------------------------------- _ 625.00

$ 9,906.12

Total Assets _---- _--------------------------------------$93,027.28
LIABILITIES. Notes Payable --------------------------------------------$ 3,813.26 Surplus (excess of assets over liabilities) --------- _- ---- _- _ 89,214.02

Total Liabilities ------------------------------------------$93,027.28

EXHIBIT ''A.''

119

STATE TUBERCULOSIS SANATORIUM, ALTO, GEORGIA.

COMPARATIVE STATEMENT OF ASSETS AND LIABILITIES

ASSETS

Years 1918 and 1919.

1918

1919

Increase

CASH:

In office ----------------$ 1,318.03 $ 199.15 $

In Bank ---------------- 157.32

57.26

ACCOUNTS RECEIVABLE: Patients' Accounts ------ 328.00
Other Accounts --------- 625.00

533.00 53.04

205.00

LIVE STOCK:
Dairy -------------------- 1,940.53 Farm ------------------ 1,319.52
INVESTMENT1S:

2,570.74 1,786.95

630.21 467.43

Lands ------------------- 3,003.35
Farm Improvements ----- 1,108.38
Buildings ---------------- 39,324.83
Roads and Drainage ------ 2,972.56
New Construction ------- 783.20
Superintendent's
Cottage ---------------
Water Plant and

6,931.61 1,435.68 39,473.92 3,341.06 9,419.47
2,725.31

3,928.26 327.30 149.09 368.50
8,636.27
2,725.31

Sewerage ------------- 12,130.70
Electric Plant ----------- 2,463.27
EQUIPMENT:
Furniture and Fixtures.. 1,688.68 Furniture and Fixtures-

12,130.70 2,463.27
31..2~.28

1,733.60

Office ----------------
Furniture and Fix.-Super-
intendent 's Cottage ---Linen ------------------Mattresses -------------Blankets & Comforts ----
Crockery & Glassware ----
Tableware & Cutlery -----
Kitchen Utensils -------Medical and Sanitary
DaSiru.pr plEieqsuip--m-e-n--t -----------------
Vehicles, Tools and
Implements -----------Automobile --------------

619.00
550.34 146.30 177.30
86.60 148.09 269.50 192.'01 453.93
640.72 625.00

619.00
691.60 1,636.85
183.80 229.00 314.65 167.71 270.97
198.40 464.88
1,081.98 625.00

691.60 1,086.51
37.50 51.70 228.05 19.62
1.47
6.39 10.95
441.26

Decrease $ 1,118.88
100.06
. 571.96

~73,072.16 $93,027.28

LIABILITIES:

Accounts Payable _______ $ 3,649.79 $

Notes Payable ______ ------

3,813.26

Surplus ------------------ 69,422.37 89,214.02

Decrease Increase $ 3,649.79
3,813.26 19,791.65

$73,072.16 $93,027.28 $25,395.81 $25,395.81

EXWBIT "B"

120

STATE TUBERCULOSIS SANATORIUM, ALTO, GEORGIA.

RECEIPTS AND DISBURSEMENTS

For the Year Ended December 31st, 1919.

1919

RECEIPTS.

Jan. 1 Cash on hand and in bank ---------------$ 1,475.35 From State Treasurer ---------------- __________ 47,000.00

From borrowed money _----- _____ -------------- 3,813.26

From patients --------------------------------- 12,294.16 From various sources --------------------------- 1,794.35

Total receipts --------------------------------------- _____ -$66,377.12

DISBURSEMENTS.

Salary-Staff and Officers ----------------------$ 4,253.79

Salary-Nurses ----------------------------- ___ 2,677.37 Labor and Service _---------- __________ -------- 6,716.11

Provisions _________ --- ------- __ --------------- _ 18,456.56

Postage, Telephone and Telegraph -------------- 361.08

Housekeeping Supplies --------- _----- _-------- 742.38

Medical and Sanitary Supplies ------------------ 1,246.02
Literature -------------------------- _____ ______ 47.94 Fuel and Lights __________________ L_ ___________ 1,045.76

Travel ----- ______ ----- _---- _____ ---- _---- _____ 312.67

Insurance ------------------------------------- 454,62 Repairs --------------------------------------- 335.90 Replacements _------- ___ --- _______ ------- _____ _ 1,687.80

Stationery and Office Supplies -----------------Auto Expense --------------------------------Miscellaneous Expense ---------- ____ - ____ ---- __ _ Farm .: -------- ____________________ ------------
New Construction __ -------- __ ---------- _______ _

125.34 536.25 62.49 1,867.. 82 8,636.27

Dairy Live Stock -----------------------------Farm Live Stock ------------------------------
Lands ----------------------------------------Farm Improvements __ ------------------- _____ _

630.21 467.43 3,928.26 327.30

Buildings ______ ------- ______ ------------------- 149.09

Roads and Drainage ---------------------------- 368.50 Superintendent's Cottage ---------------------- 2,725.31 Furniture and Fixtures ------------------------- 1,733.60

Footings Forward ---------------- __________ $59,895.87 $66,377.12

EXHIBIT "C"-SHEET NO.1.

121

STATE TUBERCULOSIS SANATORIUM, ALTO, GEORGIA. RECEIPTS AND DISBURSEMENTS
For the Year Ended December 31st, 1919.

Footings Forward _------------------ __ --------$59,895.87

DISBURSEMENTs-continued.

Furniture and Fixtures~Supt. Cottage ---------$ 691.60

Linen ----------------------------------------- 1,086.51 Mattresses ------------------------------------- I 37.50 Blankets and Comforts ____ ----------------- ___ _ 51.70

Crockery and -Glassware ----------------------- 228.05

Kitchen Utensils ------------------------------

1.47

Tableware and Cutlery ------------------------- 19.62

Medical and Sanitary Supplies ____ --------------- __ 6.39

Diairy Equipment ----------------------------- 1<\.95

Vehicles, Tools and Implements ---------------- 441.26

Accounts Payable Liquidated ------------------- 3,649.79

$66,377.U

Total Disbursements _____ -------------- __ ----------------$66,120.71
Balance to be accounted for -------------------------------$ 256.41

Accounted for as follows:
Cash in drawer ----------------------------$ Cash in bank ------------------------------

199.15 57.26 $

256.41

EXliiBIT "0"-SHEET NO.2.

122

STATE TUBERCULOSIS SANATOB.IU'M, ALTO, GEORGIA.

COUNT OF CASH AT 4:00 P. M.

JanUary 12th, 1920..

Currency -------- __ ---------------------------$
enver and Nickels ----------------------------Pennies --- ____ --- _____ -------- __ ----------- __ _

255.00 50.05 .72 $

CHECKS:
P. 0. :Money Order -----------------------------$ Hillside Cotton Mills -------------------------Mrs. Theresia Wynne -------------------------C. A. MeCellum ------------------------------- J. 0. Rees -------------------------------------
Due Bills Against January, 1920, Salary: Juliette Brown (cook) -------------------------$ Dr. Edson W. Glidden (supt.) -------------------

5.00 31.00 33.00
5.00 35.00
$
7.00 77.92
$

CASH VOUCHERS:

No. 1 2 3
A-2 A-3 A-4
4 5 6 7 8 9 10 11 12 13 14 15

$ 8.35 1.90 6.00
23.10 1.80 1.20 14.00 12.82 4.65 2.60 1.80 59.71 2.00 13.05 1.25 3.15 2.50 1.00

No. i6 17 18 19 20 21 22 .::3 24 25 26 27 28 29 30 31 Brt. Fwd.

$ 2.94 2.150 5.00
28.39 3.80 212.71 2.05 20.00 3.98 70.86 7.70 3.90 6.24 4.45 5.20 2.06 160.88
$

305.77 109.00
84.92
542.96

Fwd.

$160.88

Total

Cash on hand January 1, 1920 ------------------$
Cash received January 1-12, 1920 --------------

199.15 843.50

$1,042.65 $ 1,042.65

SCHEDULE NO.1.

123

STATE TUBERCULOSIS SANATORIUM, ALTO, GEORGIA. RECONCILEMENT OF ACCOUNT WITH CORNELIA BANK,
CORNELIA, GA. December 31st, 1919.

Dec. 31, 1919, Balance as per bank statement --------------$ 5,407.05

LESS CHECKS OUTSTANDING:

No.

No.

3396 3412 3417 3423 3424 3425 3426 3427 3428 3429 3430 3431 3432 3433 3434 3435 3436 '3437 3438 3439

$ 120.56 565.34 74.00 6.44 10.60
1,347.05 473.95 63.50 18.19 68.40 132.80 134.07 19.62 12.27 6.46 28.63 28.80 110.50 78.93 16.00
---

~'orward
3440 3441 3442 3443 3444 3445 3446 3447 3448 3449 3450 3451 3452 3543 3454 3455 3456 3457 3458

$3,316.11 9.45 6.39
113.00 22.00 82.50 31.07 132.60 23.60 11.55 42.90
7.42 168.03
64.45 49.04 100.00 48.00 172.95 276.32 672.41

Forward

$3,316.11

Total Checks

$ 5,349.i9

Dec. 31, 1919, balance as per cash book ____________________$ 57.26

SCHEDULE NO. 2.

124

r'

~'

.

STATE TUBERCULOSIS SANITARIUM, ALTO, GEORGIA UNCOLLECTED ACCOUNTS.
Year Ended December 31st, 1919.

NAME

Dr.

Mrs. L. A. Covington-Reno, Ga. ______ ------------ ____ -$ 25.00 Miss Ida Copeland-Gainesville _________ ----------- ___ _ 2.50
H. D. Crawford-Cedar Springs ----------------------- 1.00 Mrs. C. A. Dobbs-Gainesville ------------------------- 38.50 Mrs. Lalla Foster-Columbus _------------- ___ -------- 72.50 Hemmie Henderson-Dalton ------- _------------------- 8.00 Mrs. Lillie Harrell-(No address) -------------------- 20.00 Raymond E. McLendon-Dawson ____ ------- __________ _ 97.50
Mrs. Avis L. Nations-/Dalton ------------------------ 4.50 Mrs. Ruth Poole-Atlanta ----------------------------- 15.00 VV. D. Reese--Macon --------------------------------- 18.00 L. H. Skinner-Columbus ______ ------------------ ____ _ 1.00 Noah M. VVhite-Bowden ----------------------------- 31.00 Siller Brannen-(No address) ------------------------- 24.50 Harry VV. Anderson-Atlanta _----- _____ -------------

A. S. Clay_:_Douglasville -----------------------------Mrs. Kate Hilton-VVaycross ------------------------Thomas C. Holliday-Jefferson -----------------------Mrs. Minnie Johnson-(No address) ------------------Miss Veema Kidd-Thomasville ---------------------Cecil T. Miller-Americus ----~---------------------- Caroline E. Miller-Savannah -----------------------Robert E. Porter--'Savannah ------ ___ ---------------Ruth Presley-Atlanta -------------- __ --------- ___ ---

61.00 1.00
15.50 4.50 .50
34.00 4.00

George VV. Richardson-Macon ----------------------Ettie Rogers-Rainville _----- ________ ------- ___ -----Evelyn Shira-Moultrie _---------- ________ ------- ___ _
Joseph Shira-Moultrie ----------- _____ -------------Peder Sandanger-Atlanta ---------------------------Lilla M. Stevens-(No address) ---------------------W. T. Smith-Americus _--- __ --------- __ -------------

5.00 5.00 31.00 .50

Cr. $
3.00 13.00
31.00 6.00 5.00
15.50

Forwarded _--------------------------------- ______$521.00 $73.50

SCHEDULE NO. 3-SHEET NO. 1.

125

STATE TUBERCULOSIS SANATORIUl!r:t, ALTO, GEORGIA. UNCOLLECTED ACCOUNTS.
Year Ended December 31st, 1919.

Dr. Cr. Forwarded ----------------------------- __ --------$521.00 $ 73.50

NAME

Mrs. J. B. Thomas--iWaycross -----------------------$

$ 31.00

Mrs. H. A. Thomas-Cairo --------------------------- 30.00

Pearl Williams-Athens ----------------------------- 15.50

Jno. H. Wood-Macon -------------------------- ___ _ 4.00

Irene Watkins---'Villa Rica ----.------------------

3,00.

G1adys Wymie-B;rewton --------------------------- 11.0()

Carl Wynne-\Brewton _------------------------------- 11.00

Oleta Wynne-Brewton --------------------------- __ - 11.00

F. B. Quarterman-Savannah ------------------------- 31.00

Total --------------------------------------------$637.50 $104.50 Debits ----------------------------------------------~--$637.50 Credits ------------------------------------------------------ 104.50
Net Balance ----------------------------------------------$533.00

SCHEDULE NO. 3, SHEET NO. 2.

126