Annual report of the Georgia State Board of Health for 1923 [1924]

ANNUAL REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR 1923
ATLANTA, GA.
STEIN PRINTING CO. ATLANTA, GA. 1924

ANNUAL REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR 1923
ATLANTA, GA. .
STEIN PRINTING CO , ATLANTA, GA, 1924

STATE BOARD OF HEALTH

Hobert F. Maddox, PresidenL ______ _ _

____ A t l a n t a

James H. McDuffie, M. D., Yice-President ___________Columbus

Chas. H. Richardson, Jr., )1. D. __

______Macon

Arthur D. Little, M.D.

___________________ _______ __ ____Thomasville

John W. Daniel, M.D. ______ ____

_

Savannah

W. I. Hailey, M.D. ___ _

___Hartwell

Fred D. Patterson, l\1. D. ____ _

_______ Cuthbert

John A. Rhodes, M.D.

__ ___ ___ ____

Crawfordville

A. C. Shamblin, M. D. __________________________________ Rome

,J. L. Walker, M.D.

_Waycross

M. S. Brown, M: D.

.Fort Valley

.J. C. Verner, M. D.

_____ ( ',ommerce

K. H. Ballard, Stale Superintendent of Schools, ex-officio _

Atlanta

Peter F. Bahnsen, State Veterinarian, ex-officio__ Atlanta

T. F. Ahererombie, M.D., Secretary, ex-officio_____ Atlanta

2

STATE HEALTH DEPARTMENT T. F. Abercrombie, M.D., Commissioner of Health. Joe. P. Bowdoin, M.D., Deputy Commissioner of Health, and Di-
rector, Division of Venereal Disease Control, and Division of Child Hygiene. T. F. Sellers, Director, Division of Laboratories. H. C. Woodfall, Director, Division of Sanitary Engineering and Water Analysis. W. A. Davis, M. D., Director, Bureau of Vital Statistics. C. E. Waller, M.D., (Surgeon, U.S. P. H. S.), Director, Division of County Health Work. Edson W. Glidden, M. D., Superintendent, State Tuberculosis Sanatorium. ' Geo. H. Preston, M. D., Superintendent, Georgia Training Schocl for Mental Defectives.
3

LETTER OF TRANSMITTAL
Atlanta, Georgia, January 23, 1924.
To Hxs ExcELLENcY, The Governor of Georgia.
Dear Sir: I have the honor to transmit, through you, to the General Assem-
bly, the twentieth annual report of the State Board of Health for the year ending December 31, 1923.
The reports of the State Tuberculosis Sanatorium, at Alto, and the Georgia Training School for Mental Defectives, at Gracewood, will be transmitted separately.
Very respectfully, T. F. ABERCROMBIE, Secretary.
4

GEORGIA STATE BOARD OF HEALTH
In presenting the 20th annlJal report of the State Board of Health, I shall preface it with a brief review of the work done by each department.
LABORATORIES
The Laboratory, as usual, has shown a steady increase in its work and in the number of physicians patronizing it. A comparative statement shows that in 1919 the Laboratory handled a total of 18,313 specimens of all types, as compared to 39,329 during 1923, a gain of over 100 per cent in four years on practically the same appropriation.
Inasmuch as the details are presented under the Laboratory section of this report, I shall only refer here to the value of this work from an economic standpoint. If the service performed by the State Board of Health Laboratory had been done by private laboratories at the usual fees, we have delivered, under a conservative estimate, to the people of this State, through examination of speci~ens, biological products, diphtheria antitoxin, typhoid vaccine, hookworm treatment, silver nitrate, etc., an equivalent of $341,901.00 on a Laboratory budget not exceeding $40,000.00. If the State Board of Health had performed no other service, this one phase of the work alone should justify its existence. One very gratifying feature of the work is that every county in the State except one (Chattahoochee) voluntarily patronized the Laboratory during the year 1923. Of the 3,272 physicians listed in the State of Georgia, 1,125 were served by the Wassermann department alone. It is safe to say that fully 50 per cent of the physicians practicing in the State at some time during the year took advantage of the opportunities offered by our Laboratories.
VENERAL DISEASE DEPARTMENT
This Department, although functioning on less money than heretofore, has done better work as a result of the educational work that has been done in previous years. The drugs distributed for the cure of Syphilis amounted to 19,596 doses. This unquestionably has resulted in making a great many people non-infectious, there-
5

by preventing the further spread of this terrible plague. The work done through this department doubtless is decreasing the number of new cases throughout the State. The educational work alone has been of tremendous value. Through lectures, motion pictures and health exhibits this department has reached over 73,000 people.
The U.S. Public Health Service loaned us Dr. Daisy Robinson, a woman physician, who lectured throughout the State to women's organizations; and Dr. Brown, a colored physician, who visited practically all the cities of the State and worked among the colored schools. Both of these workers were of the highest type-conscientious and thorough in their work.
There are seven clinics located in the largest centers of population for the benefit of those infected. The great need of this work is to have more money to extend these clinics and to extend the educational work. Especially is there a need for expectant mothers to have Wassermann tests made of their blood so as to prevent hereditary syphilis by treatment of those who have this disease.
MoRBIDITY REPORTS
The usual number of diseases were reported to the State Board of Health as in former years, with an increase of only a few hundred.
We are planning to improve reporting for the year 1924 by asking teachers and county school superintendents to cooperate with us in this part of our work. By having the different diseases reported we can at least know when a disease is reaching epidemic proportions in any community and take steps to prevent its spread.
CouNTY HEALTH WORK
No new counties were added to the list operating under the Ellis Health Law in 1923, and none discontinued the work. The work of the Health Officers in the counties operating under the Ellis law, on the whole, has been of a higher type and much more constructive work has been done, as will be seen from the section of this report dealing with county health work.
The great need for the extension of this work is a State subsidy, so that the State Board of Health can supplement the funds of the counties. I think this is the only way that we can ever extend this
6

work very materially. The people in the rural districts of our State will never receive adequate health protection until there is a health organization with a full-time health officer and the necessary assistants in each county. The State can never from a central office give adequate health protection to all of its people.
In this connection acknowledgment should be made of the efficient and valuable service rendered by Surgeon C. E. Waller, of the U. S. Public Health Service, who was detailed to Georgia by the Service to assist us in this important work, and who was associated with us throughout the year.
CHILD HYGIENE DIVISION
The principal work done by the Child Hygiene Department has been through the Healthmobile visiting various counties in the State. This truck is equipped very much as a modern doctor's office. It visited 42 counties during 1923, reaching 200 communities, and through conferences with mothers, teachers and children, with motion pictures at night, reached at least 60,000 people. Most of the work was confined to advice to mothers and work with children of pre-school age.
Besides the Healthmobile unit, working under this Division were two dental hygiene outfits, one loaned to the State Board of Health by the U. S. Public Health Service with two workers, the other outfit being owned by the State Board of Health, the dentists giving their services free in the communities. No one can estimate the amount of good that will eventually result from the personal contact these people have had with the strictly rural population of our State.
In the year 1924 this unit will be concentrated in two sections of the State, encouraging the cooperation of every local agency in carrying out an intensive health' program in strictly rural districts.
SANITARY ENGINEERING
This Department has kept close watch on the public water supplies of the State. The tabulated report from the department shows that there is only one public water supply in the State that is really dangerous. During the year 1922 this department listed 56 water supplies as having excellent water, 53 as having doubtful
7

water, and 11 as having dangerous water. This year 131 had excellent water, 12 doubtful and only one dangerous.
The engineering feature of malaria control is rather interesting. It shows that in 1920, when we began our active malaria campaign, $48,000 were spent in different cities a'nd communities throughout the State, whereas in 1923 there were over $118,000 spent in 32 different communities. No one can estimate in dollars and cents, or even in human lives saved and sickness prevented, the value of this work.
MALARIA
In addition to the engineering work, we have in the field one medical worker on malaria. His investigations have been of great value and his work in the schools has resulted in the education of children in the southern part of the State as to the dangers of malaria and the simple methods of control.
In this connection special mention should be made of the work done by Dr. Samuel T. Darling, of the International Health Board, and his assistants in Lee County. The investigations made by Dr. Darling may result in a much simpler method of finding and elimiinating malaria. For instance, the simple method of determining malaria, especially in children, by an examination of the spleen, which can be done very easily; also the determination to a fair degree of accuracy of the feeding habits of the different mosquitoes, which will give us excellent information. In fact, if his experiments can be verified by further observation, it will be shown that only one species of the anopheles carries malaria in the Southeastern States. He is also working on the breeding habits of these mosquitoes. It has been found that certain waters are detrimental to the particular mosquito that carries malaria, and if some way can be found to change the character of the water economically by chemical means, it may mean that we are on the verge of great strides on controlling malaria in the near future.
In the 1918 annual report to the Board, the importance of taking active measures to stamp out malaria was stressed. As a result of educational work ahd practical demonstrations since that time, the whole State now realizes how much this disease is retarding our economic development. This is evidenced by the fact that instead of having trouble in getting people to want to do malaria
8

work, it is impossible to provide all communities with the expert advice and engineering assistance necessary to carry on the work they have laid out and are willing to do.
VITAL STATISTICS
There were filed during 1923 67,797 birth and 37,489 death certificates as compared with 69,615 births and 35,006 deaths in 1922.
There were 2,483 more deaths in 1923 than in 1922, and 1,818 less births than in 1922. More than one-half of the increase in the number of deaths, that is 1,021, were found in the following four diseases: 161 in Apoplexy; 236 in Bright's Disease; 486 in Influenza and 579 in Pneumonia. The birth records have not been worked over to the extent at present that the cause of the decrease can be stated.
The detailed report of the Vital Statistics Department for 1922 was filed with the state printer, but its publication was prohibited on account of the cost of printing it. This report contains very valuable information. The failure to have this report printed is denying the State information that could be utilized to very great advantage in our health work throughout the State.
TRACHOMA
Special mention should be made of Trachoma work done by the U. S. Public Health Service in Mitchell County. At the request of the county authorities the State Board of Health requested the Public Health Service to open a hospital in Mitchell County the second time. As a result of this 37 cases of Trachoma were cured and a total of 331 people visited the hospital from May to August, the period during which the hospital was open. Most of these people had some sort of eye trouble. The cleaning up again of a focus of infection of Trachoma by the U.S. Public Health Service was of tremendous value.
During the year we had Trachoma reported from Thomas County, but upon investigation and examination of 564 pupils only two suspicious cases were found.
We are indebted to the U. S. Public Health Service for their valuable assistance, not only in the Trachoma work, but in Venereal Disease work, Malaria work and County Health work. It is only
9

by the assistance of the U. S. Public Health Service, the International Health Board, and the Children's Bureau that we are able to show such a large volume of work done on a small appropriation. Just how long we can count on these outside agencies helping us to carry our burdens is a question. It is to be hoped that we shall continue to have their cooperation until the State assumes its obligations in this work.
The outstanding features of the year's work seem to be:
I. The State Board of Health is reaching into and performing some service in every county in the State of Georgia.
~- The State Board of Health is gaining the confidence of the medical profession throughout the State, as evidenced by their taking advantage of the opportunities offered by it.
3. The awakening in the minds of the masses of the people throughout the State of the needs for public health protection.
If the State Board of Health is to perform the service for which it is intended it needs to secure more funds. We have been working on a plan to ask the State, not for an additional tax to raise funds, but to set aside a certain amount of the State's income for health work. The State is giving us 3 cents per capita now, and if it would increase our allotment on a graduated scale, increasing same from year to year on a per capita basis until it gave us 10 or 12 cents per capita, we could perform a real service to the people of the State. Half of this amount would be utilized in developing county health departments.
LEGISLATION
The Act passed in the summer of 19~3, placing a levy on cigars and cigarettes, devotes $500,000.00 to the building of the State Tuberculosis Sanatorium. This is being tied up in courts now, and we shall probably not receive the funds until at least the latter part of this year.
STATE TUBERCULOSIS SANATORIUM AT ALTO
The institution at Alto has handled a total of 360 patients during the year. Considering the financial difficulties under which this institution has been working, the Superintendent has done spelendid work on the small amount of money allotted to the Sanatorium.
10

If we are fortunate in receiving the money from the Tobacco Tax Act this institution will begin to serve the State as it should. A great victory was won for health work in the act of the Legislature giving the State Board of Health $500,000.00 with which to erect the buildings.

GEoRGIA TRAINING ScHOOL FOR MENTAL DEFECTIVEs
AT GRACEWOOD
The school for feebleminded located at Gracewood has had even a harder struggle financially than Alto. Most of you are familiar with the financial difficulties of this institution on account of the technical error in the appropriation for 1923; upon the endorsement of the City of Augusta and Richmond county officials, an Augusta bank loaned us $16,000.00 until the Legislature could correct the technical error, which it did during the 1923 session.

The report of the Superintendent shows the great need of finan-

cial assistance. On an appropriation of $25,000.00 a year no con-

structive work can be done, and the per capita cost is much higher

than would be the case if the appropriation were doubled. The

number of inmates could be increased at least two and one-half

times if an allotment of $50,000.00 a year were granted. It is to be

hoped that this institution will in the very near future receive some

financial aid.



ll

DIVISION OF LABORATORIES

The following table gives a summary of the examinations made in the laboratory during the year ending December 31, 1923:

BACTERIOLOGICAL LABORATORY Positive Negative Total

Sputum examinations for tuberculosis __ Throat swabs for diphtheria _______ ,___ _ Widal Tests for Typhoid ________________ _ Blood cultures for typhoid and para-
typhoid _____________________________ _
Stools and Urine cultures for typhoid dysentery group ____________________ _
Pus smears for gonococci_ _____________ _ Blood smears for malaria _______________ _ Feces for intestinal parasites __________ _ Animal brains for rabies _______________ _ Examinations, miscellaneous ___________ _

486 549 303
24
13 263 117 1,858 423

1,943 1,794 1,043
109
55 492 1,642 4,403 361

2,429 2,343 1,346
133
68 755 1,759 6,261 54* 838 321 321

Total examinations made in Bacteriological Laboratory_________________ _ 4,036 11,842

375 16,253

SEROLOGICAL LABORATORY Blood specimens for Wassermann test __ _ 3,447 14,519 39"' 56$ 18,061

WATER ANALYSIS LABORATORY Water samples for analysis _____________ _
---
Total Laboratory Examinations_________ 7,483 26,361

5,015 5,015 5,485 39,329

A detailed report of the Water Laboratory will be found included in the report of the Sanitary Engineer.

*Unsatisfactory. *Doubtful. 0 Anticomplementary.

12

The year 1923 was rather an uneventful one from the standpoint of the laboratory. Diphtheria and typhoid fever were rather quiescent, comparatively speaking. There were, of course, localized outbreaks here and there over the State, but even these were few and feeble. Nevertheless, the total number of specimens examined increased twenty per cent over the preceding year.

The following table compares the growth of the laboratory work during the past five years:

1919 1920 1921 1922 1923 Bacteriological Examinations____ 11,469 11,862 13,767 12,635 16,253 Wassermann Tests ____________ "-_ 6,307 9,541 12,931 14,804 18,061 Water Analyses __________________ 537 1,017 2,834 3,240 5,015

Total ________________________ 18,313 22,420 29,532 30,679 39,329

DIPHTHERIA

For Diagnosis _____________________________ _

Positive 255

Release from quarantine _____________ _

171

Detection of Carrier_ _________________ _ Virulence Test _______________________ _

119 4

Negative Total

649

904

238

409

901 1,020

6

10

Total _____________________________ _

549 1,794 2,343

BLOOD CULTURES
Physicians are being encouraged to make use of the blood culture in preference to the old Widal agglutination test. The Blood Culture not only permits an earlier diagnosis, but when positive is absolutely diagnostic. The Widal test, on the other hand, cannot be applied until after the disease has partly run its course and is not always specific.
The ideal conditions for the use of the blood culture are enjoyed only in hospitals and institutions where the delay in incubation is reduced to a minimum. For state laboratories its use has only re-

13

cel).tly been rendered feasible after a suitable means of shipping satisfactory specimens had been devised. Outfits for collecting. blood cultures are now available to the physicians free of charge.

INTESTINAL PARASITES
The recent advent of the use of carbon tetrachloride treatment of hookworm has stimulated interest all over the State among physicians and public health workers. As a result the number of specimens submitted for hookworm examination has increased from fl,764 in 192fl to 6,261 in 1923. The following is an analysis of the positive findings:

Hookworm-Necator americana_______________________ Dwarf Tape Worm-Hymenolepis nana________________ Whip worm-Trichuris trichiura_ _____________________ Pin Worm-Oxyuris vermicularis_ __________ ___ ___ ___ __
Round Worm-Ascaris lumbricoides___________________ Beef Tape Worm-Taenia saginata____________________ Strongyloides (species not identified)_________________

1,637 140 30 30 10 8
3

Total positive findings (single infection)____________________

Double Infections (two kinds in the same individual)

Hookworm and Pin Worm_____________________________

2

Hookworm and Dwarf Tape Worm_____________________

58

Hookworm and Strongyloides_________________________

2

Hookworm and Whip Worm____________________________

5

Dwarf Tape Worm and Whip Worm____________________

1

1,858

Total positive findings (double infection)__________________

68

Triple Infections (three kinds in the same individual)

Hookworm, Ascaris and Whip Worm___________________

3

Hookworm, Ascaris and Dwarf Tape Worm____________

1

Total positive findings (triple infection)____________________

4

Total positive findings__________________________________ 1,930

Of especial interest is the number of specimens found to- be positive for the dwarf tape worm, Hymenolepis nana. Recent investigations show conclusively that this little tape worm is by far the most prevalent cestode of man in this country. Little is known as to just how this parasite is transmitted from man to man. We feel that a special study of this subject from every angle is badly needed.
ANIMAL BRAINS FOR RABIES
1919 1920 1921 1922 1923 Number of heads examined_____ _ 485 565 767 1,224 838 Number Positive for rabies _____ _ 222 289 403 487 423 Percentage Positive ____________ _ 4l'i.7 51.1 52.5 39.7 50.4

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It is of interest to note that during the year 1922 a generalized epizootic of so-called "running fits" occurred among dogs throughout the Southern States. This disease, in itself, seems specific for dog and is rarely fatal to the affected animal. But its clinical manifestations as observed by the layman or by one not familiar with the true picture of rabies, are so suggestive that many dogs are killed, and the heads sent to the laboratory to be examined for rabies. As a result an unusually large number of dog heads were received for examination in 1922 but the number found to be positive for rabies was only slightly greater than for the preceding year. During 1923 the "running fits" disease greatly subsided and the situation as regards rabies remained unchanged as is evidenced by comparison with the years 1921 and 1922 in the above table.

CLASSIFICATION OF RABIES EXAMINATIONS ACCORDING TO ANIMALS

Too Badly

Positive Negative Decomposed Total

Dog Heads _______________________ 374

295

49

718

Cat Heads _______________________ 31

48

4

83

Cow Heads__ ____________________ 12

11

1

24

Horse Heads_____________________ 1

0

0

1

Mule Heads______________________ 0

1

0

1

Hog Heads_______________________ 3

3

0

6

Goat Heads______________________ 2

0

0

2

Rabbit Heads____________________ 0

2

0

2

Wolf Heads______________________ 0

1

0

1

Year 1919 1920 1921 1922 1923

Human Patients
1,399
1,461 2,147
2,476 2,082

423

361

PASTEUR DEPARTMENT

Animals 407 501
675 296 249

Total 1,806
1,952 2,822
2,772 2,331

54

838

Human deaths after treatment
0
3 5 1
0

It is gratifying to note that since the institution in March, 1922, of the Dilution Method of preparing Pasteur treatment more than 4,000 persons have received treatment without a single instance of failure. Not only is the new method productive of more perfect results but it is infinitely more simple and economical.

MisCELLANEous ExAMINATIONS

Under this heading are included all laboratory tests which could not be conveniently classified. The total number of 321 examinations may be analyzed as follows:

15

Number

Specimens

Pus to be examined for the causative organism______________ _

5

Urine for special analysis-bacteriologicaL ________________ _ 83 Miscellaneous cultures _____________________________________ _ 13

Animal inoculations ________________________________________ _

8

Dark field exam'ination for Spirochaeta pallida ____________ _ 15

Examinations for Vincent's bacillus and spirochaeta ______ _ 15 Spinal fuid for meningitis __________________________________ _ 10 Differential blood counts-speciaL ________________________ _ 52

Examinations for miscellaneous organisms_________________ _ 76

Examinations for entamoeba histolytica ___________________ _

9

Unclassified ________________________________________________ _ 35

1:otal ___________________________________________________ _ 321

Distribution of 1:yphoid Vaccine Number c.c. plain typhoid vaccine_ ____________________________ 156,945 Number c.c. triple typhoid vaccine____________________________ 59,719

1:otal for 1923 __________________________________ _

216,664

Distribution of Diphtheria Antitoxin 1:otal number of units______________________________________ 34,367,000
Distribution of Silver Nitrate Capsules 1:otal number of capsules distributed___________________________ 14,728

At the request of the Department of Child Hygiene a method was devised for the making and filling of small black wax capsules with one per cent silver nitrate to be distributed free of charge to the physicians and mid-wives for use in the prophylaxis against ophthalmia neonatorum. See special departmental report.
Distribution of Carbon 1:etrachloride 1:otal number c.c. distributed ___________________________________ 13,300

Chemically pure carbon tetrachloride is purchased along with a certificate of purity from a reliable chemical supply house and put in assorted size packages for distribution. This enables the physician to obtain a reliable quality of the drug which in the unrefined state often contains dangerous impurities.

DIVISION OF VENEREAL DISEASE CONTROL
The year 1923 has been one of the best that the Division of Venereal Disease Control has had. The work has been constructive, and we have had the privilege of seeing our former work bearing good fruit.
Our efforts have been directed towards trying to make the infected non-infectious and in educating the entire population. The making
16

of all cases possible non-infectious stops the spread of the disease and has done untold good. This work should be continued, but to do so more money will have to be given for this service. Our funds have not permitted us to furnish free drugs as they should be furnished; our work along this line has been restricted to syphilis and to the one remedy, Arsphenamine, popularly referred to as "606."
Since this department was organized we have distributed 68,767 ampoules. The value of this distribution cannot be told but unquestionably it has prevented much blindness among children and insanity among adults, who otherwise would have been a charge upon our institutions, not taking into consideration the hundreds of lives that have been saved. We would like to distribute the mercury for this disease and supply our physicians with the treatment for gonorrhea. Through the aid of the Division of Maternity and Child Hygiene we have distributed this year the one per cent solution of silver nitrate for use in the eyes of the newborn. We hope every father and mother in our State will see to it that this medicine is dropped in the infant's eyes as soon as it is horn. The law requires it, and many children can be kept from a life of blindness by its use. It is supplied free to the midwives and the physicians who apply for it. About half of the children in our Academy for the Blind are there from being "born blind," as it is called. This blindness is preventable. If the baby develops sore eyes the first few days after birth it is a reflection on the doctor, midwife, nurse and parents. The drops should be used in every case, and no sore eyes resulting in blind babies will follow.
We have used card exhibits freely during the year. Many parentteacher associations have taken this work in hand, as well as teachers. Y. M. C. Associations have made use of them, and the civic organizations have become interested. Moving pictures have been used to splendid advantage; this is one of our very best methods of instruction. We have continued the use of the Attract-0-Scope. It has been sent to a number of our cities and to several of the larger fairs of the State.
One thousand eight hundred columns of newspaper matter have been furnished the smaller papers of our State. We are under lasting obligations to them for their assistance in this method of education. It is indeed far-reaching in its effect; it goes straight to the
17

homes of our people. One hundred papers are on our list; they will avcmge at least 2,000 subscribers and each paper will likely be read by an average of five people, giving us one million readers. Owing to financial conditions this phase of our work was cut down; \Ve desired to get out 1,200 columns more. We trust that this work can be continued, as it is one of the best and most fruitful avenues of approach for the work.
We have used about the usual number of pamphlets in the division the past year. \Ve keep on hand for distribution without charge one for the general public, "Outdoing the Ostrich," for parents, "Sex Education in the Home," for teachers, "Sex Education in the Schools," for men, "Man Power," for women, "Healthy, Happy \Vomanhood," for boys, "Keeping Fit." These are sent out on request and are distributed by the lecturers in the field.
With and through the cooperation of Emory University Medical Department we held our third annual Institute-Clinic on venereal diseases. This annual meeting of the physicians of the State for five days of intensive study has been greatly enjoyed by them and has proven to be of great service in the fight against venereal diseases. \Ve had about 500 physicians here from 86 counties in our State, representing every section, and quite a number from North Carolina, South Carolina, !<'lorida, Alabama, Tennessee and Maryland. The railroads of the State granted reduced fares and many came in their cars. We anticipate an even larger attendance at the Institute-Clinic this summer.
The physicians of the State are not making reports of infectious and contagious diseases to the State Board of Health as they should. There is no reason why these reports should not be 100%. \Ve try to give this kind of service to the men in the field, and simple justice seems to demand that they in turn should give us their best in reporting their cases. Forms are furnished and franked envelopes arc supplied. This is one of the things about the work of the Divisions that should be improved upon; reporting in full, giving complete information, would greatly aid us in eliminating these diseases.
The original seven clinics established in 1918 are all operating, doing splendid work. This work in all the cities could be made of more benefit if more money were given to it. Especially is this true in the need for follow-up work. It is a good thing to make one
18

non-infectious, but how much better it would be if the case were cured. This cannot be accomplished in the vast majority;of cases where we have to depend upon voluntary returning. The patient after a few treatments feels well, all external clinical symptoms are gone and he puts off his visit. Each clinic should have a followup nurse, and each patient should be cured. The larger clinics need a night service. So many need attention and treatment ,vho labor all day, and to attend a clinic have to be excused and get someone to work for them, that if it is repeated too often the employer gets tired of it and the patient loses his or her job. We should have clinics open from 5:00 to 9:00 P. M. in all of our larger cities. All clinics should have men on salary; in many cases the work is done by the physicians as an act of charity.
There are two types of clinic work that should receive more attention than they do, namely, Prenatal and Hereditary Syphilis. Every expectant mother should place hereself under the care of a skillful physician; a blood examination should be made and if positive, treatment should be taken regularly until the baby comes. Every city of any size should have a free clinic for the treatment of syphilitic children, especially babies; every city has infected children, innocent sufferers. Some most excellent work along this line is being done; much more of it awaits and should have attention.
The education given our people has resulted in the recent closing of one of the largest and oldest red light districts in our State, one that stood out and remained open through the war. We greatly rejoice in this action of the authorities. The reports coming from the health officer bear out the claims of all social workers that these districts are a menace to any community.
We have ample laws in our State for the control .of prostitution; in fact, we have as good laws as any State, but they are not enforced as they should be. The laws of 1914 and 1918, if enforced, would go a long way towards the eradication of the Red Plague. This is a matter of education, as no law is stronger than public opinion. If the people of a given community want these laws enforced they can have them enforced. Courts must have evidence to bring and sustain actions. It is the individual citizen's business to assert himself.
19

In l!)QQ we received reports on 4,8S7 cases o syphillis, this year 5,207; last year 3,782 cases of gonorrhea, this year 4,257; last year 414 cases of chancroid, this year 521; last year 2,825 smear examinations, this year 1,682. Last year we supplied 18,218 doses of arsphenamine, this year 19,596.
We had in detention last year 325 males and 548 females; this year 225 males and 223 females, a total for 1923 of 448, about equally divided as to sex.
We discussed face to face with 36,403 people in 1923 the'problems of sex, venereal disease and right living; our motion picture "Venereal Diseases, Their Origin and Results" was shown to 1,800 people; our card exhibits for men, boys and girls have been popular, many teachers having asked for a loan of the cards for high schoolsthis year we had 9,736 to view the cards; it is estimated that the Attract-0-Scope was seen by 25,671 people; this gives a total of 73,610 people who have seen or heard about the control of venereal diseases in 1923. We distributed in person or upon request 10,120 pamphlets on sex and venereal subjects. To reach these people, our representatives have made 41 visits to cities of over 10,000 population and 76 to those under 10,000.
WASSERMANN LABORATORY'
During 1923 the State laboratory made 18,061 Wassermann tests, as compared to 14,804 in 1922, an increase of 3,257, or 22%, over the preceding year. The average number of tests made per month was 1,505, compared to 1,234 in 1922, an increase of 271. Of the tests made this year, 19.1% gave positive reactions, as compared to 21.3% in 1922.
In addition to the 18,061 Wassermann tests made in the State laboratory, 8,608 tests were reported by the clinics, making a total of 26,669.
The laboratory furnished 21,538 Keidel tubes to physicians during 1923, as compared to 17,974 in 1922, an increase of 3,564 over the preceding year.
20

CONSOLIDATED VENEREAL DISEASE REPORT FOR THE YEAR ENDING DECEMBER 31, 1923.

Syphillis j Gonorr-j Cha:n-

1923 MONTH

I hea

Icr01d Arsphen- Wasseramine manns

M. F. M. F. M. F.

D~ten-
I Smears twn M. F.

Audiences

I

Pam-

Total Clip-

phlets

Ij

Attend-1 pings

Lect. Films Cards ance

M - ; ,___ Jan.____ 235 133 209

_j

Feb.____ 217 139 410 83 29 ____

March_ 249 164 295 68 52 2

ApriL_ 414 264 430 124 74 9

May____ 254 166 261 56 35 2

June___ 317 164 321 60 52 2

July____ 227 232 242 110 40____

Aug.___ 232 135 265 53 35 2

Sept.___ 262 165 306 70 23 2

.N...

Oct.____ 240 183 213 48 39 2 Nov.___ 273 195 227 47 43 3,

Dec.____ 213 134 257 48 50 1j

1,520 1,874 1,454 1,710
1,590 1,609
1,673 1,521 1,895 1,788 1,677
1,285

2,305 1,915 2,311 2,343
2,448 2,514
2,272 2,166 2,259 2,350 2,055
1,731

204 16 21 48 19 14 127 10 8 117 19 11
142 2 7 115 2 1
106 35 19 159 44 32 179 35 25 207 12 481 158 15 15
120 16 22

495/ 300 ~ 5,342 5,642 22

1,180 1,155 600 2,420 4,175 52

1,657/ 307 ______ ______

307 _____ _

35212,701______ ______ 12,701 _____ _

804 5,420 ______ 75 5,495 122

1,867 8,965 ______ ______ 8,965 71

2,490 6,980 1,200 ______ 8,180 13

151 ______ ______ 1,750 1,750 40

357 575 ______ ______

575 20

172 ______ ______ ______ ________ 28

395 ______ ______ ______ ________ 53

200 ______ ______ 1491 149 _____ _

Total13,13312,0743,436j 821 498ll2sj

III



I GToratanld 5,207

4,257 1 521

19,5961 1
19,5961

26,6691 1,6821 2251 2231. 10,120136,403 1,800 9,736 47,939 421

1

1

1 Attract-0-Scope 25,671

26,6691 1,6821 448 110,1201

1 73,6101 421

Cities of over 10,000 visited _________ A1 Cities of under 10,CCO visited ________ 76

WASSERMAN LABORATORY SUivlMARY-1928

- - - - - - - . - - - - Apr.l 1 REACTION

-~

Total

i PeT i .Jan.\ Feb. Mch.!

May June I July 1 Aug. I Sept.! Oct. I' Nov.\ Dec.

I Oent ---I~---1 ~--: :--l--.l--Il~-.i-I-1--I '--i--i'--

Str~~gly _201j___2'3i___""~'-231!- 248~.~~~~ ~ Positive__ .
Pos1t1ve. __________ 1

2, 8381 1821

115. 7.1 o2l12_1.-_'9.81:_23:2 .;. ~!~--5~~~~~~'55~i ~~~~~~~~--1-1

2.4~~~~~--"'~-- "_~~~~~-..56~~~~,~~ WeaklyPositive____ l

4271-

.. 85_1__

85

Total Positive ______

I
3,4471

19.1 2471-----=:' _!881_ 24:1_ 3591 8741 2841 _ 3311_ 284 ~~~

240

Negative ___________

14,5191 80.4 9631 940[1,184[1,25011,44211,3701 1,28711,39711,263 1,34811,099 976

DoubtfuL _________

t-:l

t-:l

Anti-

Complementary__

TotaL ___________

391
561
I
18,0611

.2

41

31 41

01 1 1 _ j - 1 1 51

2

91

2_

5

'I ul sl 2! o! ol oj 'I

ol 1a] o o

I

-r,222 100.011,21611,17911,47611,49111,80811,75811,57811,74611,555 1,6551 1,377

COMMUNICABLE DISEASES REPORTED DURING THE YEAR 1923

~
'

.....;_----------'-I--T_o_t_a_1 J"an. Feb. _M_a_r.__A_p_r_I_M_a_y__J"_u_n_e__J"_u_l_y__A_u_g.__s_e_p_t_.l_o_ct_._l Nov. I Dec.

1

Ac. Inf. Conj.________

11

0

0

0

4

1

0

2

0

1

1

1

1

Hookworm___________

815

36

49

74

22 285

67

64

42

54

73

26

23

Brills Disease________

6

0

0

0

0

0

0

0

0

o

0

5

1

Meningitis___________

18

1

3

3

0

3

0

2

3

1

1

0

1

Chicken Pox__ ~------

515

52

75

98

80

54

33

4

4

2

6

26

81

Dengue______________

44

11

8

3

11

0

1

3

1

1

4

1

o

Diphtheria__________ 1,100

68

92

45

64

15

63

46

63 101 301 159

83

Dysentery___________

173

2

2

2

4 62

68

21

5

5

1

1

0

German Measles_____

276

1

2 133

2

4

1

1

0

1

1

3 127

Gonorrhea__________ 1,145

85 222 107 122

79

40 113

86 140

54

55

42

Influenza___________ 7,140 3,426 1,703 1,373 369 102

24

19

5

13

25

31

50

Malaria______________ 1,485

25

29

30

83

81

97 211 283 285 254

78

29

Measles______________ 7,836 175 541 1,566 1,023 1,085 894 307 129 111 214 657 1,134

Mumps______________

220

10

10

11

45

24

33

15

1

7

7

18

39

Paratyphoid Fever___

30

2

0

2

0

6

1

3

6

8

2

0

0

Pellagra_ ____________

31

2

5

0

5

5

3

5

3

1

0

2

0

pneumonia __________ j 1,146 161 157 154 105 114

44

61

28

37

27

90 168

Poliomyelitis_________

4

0

0

0

1

1

0

1

0

o

0

0

1

Scarlet Fever________

394

41

22

29

40

31

22

19

8

37

58

59

28

Septic Sore Throat__

78

11

10

2

7

17

7

7

1

5

2

6

3

Smallpox_____________

673

42

29

52

34

57

68

62

31

7

30

67 194

Syphillis_____________ 1,624 109 127 116 122 136 192 151 138 136 138 135 124

Tetanus_____________

11

2

0

0

0

1

1

1

2

o

0

1

3

Trachoma___________

24

2

5

3

01

3

1

7

3

0

Oj

0

0

T. B: (Pul.)__________ T. B. (Other)________
Typhoid Fever_______ TyphusFever_______

732 112

34

14

656

18

17

0

32 112

46

44[ 46

69

56

4

3

311

01

2

0

3

14 0

161 0

12o1f

231 Oi

94 166

134

2'

0

0

59.

63

41

52

o:

0

4

1

781.

'18.1 30.

23

6

6j

01

3

1 -W-hTo~optianLg

~ Cough____
____-__ __ c _

26

704!

11

,942,-4-,4-1-9

-

3

-

,1-374-15~-4-,0-06-711,,-2-,2-66-84i1_2_,2_85_25[:-l-,8-88-15[i-1-,4-59-99,.-1-,0-7-3271._1_,_122-5l1i

-

. 66i 1,-38-2 1-

701

98

1,5661-2-,3-0-9

-,

DIVISION OF COUNTY HEALTH WORK
The principal aim of the Division of County Health Work, in carrying out its program during the past year, has been to lay a more firm foundation upon which to build, in the extension of full-time county health service over the State, in the future. In laying this foundation, effort has been made by the office of central administration to strengthen the existing county health organization, by seeking improvement in personnel where necessary, advising with the local health commissioners in the planning of their work, urging the importance of concentrating upon the lines of endeavor which will show the greatest return in actual results, and pointing out the necessity for securing and keeping complete mortality and sickness records in order to provide a "measuring stick" to be used in showing what has been accomplished, at the end of each year. To illustrate what may be done in the way of improvement, it may be pointed out that changes for the better were brought about in Thomas County, where an active and competent health commissioner was placed in office and a public health nurse added to the staff, and in Sumter County, where the annual budget was increased from $1,800.00 to $6,000.00 (effeCtive January 1, 1924), a new health officer having been selected and a nurse employed to assist with the work. In connection with the school medical inspection work, several new clinics were opened up for the correction of defects among school children, the personnel consisting largely of volunteers from among the local physicians and dentists.
Although very little progress was made in the extension of the work to new counties it was not discontinued in any county actually operating during the year. The health organizations in Bibb County and the City of Macon were consolidated, to become effective January 1, thus placing the work in that county on a full-time basis. As the result of an intensive campaign lasting over practically the entire year the organization of a full-time health department under the provisions of the Ellis Health Law was brought about in DeKalb County, to become effective on .January 1, and it is probable that a similar campaign carried on in Meriwether County will result in the establishment of a full-time organization there . within the near future. Much other educational work carried on during the year should show material results later.
It is evident to anyone who has had an opportunity to observe existing conditions over the State that rapid extension of full-time
~4

local health service is an absolute necessity. It is difficult to see how any great amount of permanent improvement in health conditions can be effected in any other way. The State Board of Health cannot possibly provide for every community the intensive and continuous health service necessary to furnish real health protection for the individual; nor can it reach the individual with the aid that it has to offer him unless the local machinery is provided through which it may function. The development of full-time county health organizations is one of the most important matters confronting the people of Georgia at the present time, and again it is urged that every thing possible be done to secure an appropriation to be used for the purpose of stimulating the extension of county health work by providing financial aid to our counties.
The accompanying table summarizes the activities carried on and results of the work, in the several counties operating under the provisions of the Ellis Health Law during 1923:

--

----

DIVISION OF COUNTY HEALTH WORK

SUMMARY OF COUNTY HEALTH WORK FOR THE YEAR 1923

--

-----------

----

..>...,.

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ACTIVITH;t>

I. EDUCATIONAL:

Public meetings addressed_ 2 12 43- 163 20 24 6 19 117 140 ---- 42 50 27 15 26 1

Attendance _____ ----------School talks given__________ A t t e n d a n c e _________________

811230 87 37 4014 2128

1645 129 5162

13780 190 5900

2145 16 2364

2655 58 2344

170 45
2748

615 35 1914

12500 132 6550

4180 154 7250

---11
1500

2446 123 4855

---140 2260

3900 115 6412

2515 111 7943

2066 81 4142

50
147 8589

Bulletins distributed_______ Newspaper articles _________

138 8347 4430 8300 7700 6010 7873 8161 2625 6878 12340 2846 3000 1141 13653 14166 43 2 12 192 75 104 33 19 18 156 25 24 ---- 58 27 6

375 36

707 49978 1611
76075 107983
830

Office conferences, general 316 247 611155 1115 47 3272 352 1171 126 1260 174 500 350 2280 8 44 12478

II. COMMUNICABLE DISEASE

31:

CONTROL: Number cases visited_______ 68 33 871 420 424 859 132 261 221 256 539 25 720 30 34 139 99 5131

Total number of visits ______ 600 232 1200 980 612 1198 129 739 617 585 619 222 3747 585 62 258 99 12484

III. CIDLD HYGIENE:

PrIeIonmatealvisits _________________
Office consultations _______ E x a m i n a t i o n s _______________ Cases given advice__________ Midwives instructed________

2 9 26 45 ---- 139
10 111 ---- 54 7 101 10 82 6 6 5 162 10 210 10 90 3 126 4 5 5 ---- 26 16

85 118 13 18
4 ---2 136 2 56

39 145 ---- ---- 1179 ---- 50 148 ---63 197 330 ---- ---- 66 111 1767 ---32 189 213 ---- ---- ---- 53 237 ---55 239 139 ---- 220 ---- 53 387 ---15 177 18 ---- ---- ---- 25 24 ----

1985 2848 999 1680 373

Silver nitrate treatments

distributed_------------ 3 210 2 ---- 52 27 18 105 ---- 346 94 46 ---- ---- 50 315 60 1328

InIfIaonmteavnidsitPsr_e__-_s_c_h_o_o__l _______ 3 2 56 160 78 970 27 593 84 145 ---- ---- 3449 ---- 16 170 ----

5753

Gromupothceornsf_e_r_e_n__c_e_s___w__i_t_h_ ----
Office consultations with

3

3 18

1 53

5 ---- 39 79 ---- 14 ---- ---- ----

3 ----

218

Exammiontahteiorsn_s______-_-_-__-_-_-_-_-_-_-_-_-

8 100 ---- 294 20 31 7 138 115 89 ---- 2112425 ---- 274 167 5 8 99 30 292 17 162 75 363 265 99 ---- ---- 75 ---- 184 2371 5

3694 1911

Cases given advice_--------- 8 so---- 330 101 20 93 508 156 115 36 - --- 553 ---- 71 73 5 2149

~+' '

School Children examined _________ Number defective children_ Total number defects found Follow-up visits ____________

1899 1538 2497 4535 2020

7060 4195 3790

762 4161555 3033 1952 7091405 1918 2093 1908

970 583 2657 35312965 14751588 2689 3690 2749

33 9 125 346 47 5781425 1320 624 395

---

-

2448 2083

6067 2732

3904 1741

3960 675

4788 1610

2039 1406

4373 1897 1299 1953 2118

36 2698

20 656

58681 25998
34547 8312

Nutritional classes Oases attending ____________ ---- ---- 31 ---- 157 New cases ____ ----------- ___ ---- ---- ---- ---- ----

21 ---- ---- 297 1080 ---- ---29 ---- ---- 283 735 ---- ----

16 ---- ---- 148 ---16 ---- ---- ---- ----

1750 1063

rv. IMMUNIZATIONS:

Completed antityphoid vaccinations ________ --- ____ 1056 1509 1246 5978 1848

693 2578 1158 2351 2539

837 9071 ----

934 8394 5841 1376

47409

Comtrpeleattemdetnotxsi_n_-_a_n__t_it_o_x__i_n_
Protective antitoxin, cases_ Curative antitoxin, cases ___ Anti smallpox vaccinations_

----
----
10 468

7 79 65 6 12 12 273 1309

300 ---200 18 80 3 700 205

464 23 4 588

63 ---28 ---32 4 898 723

322
80
16 928

88 360 1072 179 ---166 37 1 ---- 5 38 ---- ---- ---- 2 200 824 41 3264 333

357 646 30 14 11 27 469 2853

663
7 6 121

Antirabic treatments ______ 10 3 140 34 157 127 3 ---- 16 16 124 ---- ---- 69 ---- 64 ----

4600 680 257 14197
763

~
...::!

v. VENEREAL DISEASES:
Suspects examined _________ 318 25

4 60 39 36 227 333 127 138 229 ---- ---- ---- ---- 41 10

1587

Prophylactic treatments ___ ---Number cases treated ______ 236 Number new cases treated_ 140 Total number treatments __ 735

2 ---- ---- ---- 27 8 ---- 57 1 ---4 ---- 38 ---- ---8 ---- 125 ---- ----

16 ---285 248 97 71 862 574

129
100
59 271

69 ---- ---- 16 ---- ---140 256 ---- ---- ---- ---57 116 ---- 255 ---- ---207 776 ---- 5518 ---- ----

7 ---88 ---30 4 114 ----

266 1419
871 9190

VI. HOOKWORM:
Number of examinations ___ 107

2 47 65 786

7

1 175 126 354 829 372 584 ---- ---- 1037 224

4716

Number of cases found _____ 66 2 3 22 321 ---- 2 62 54 210 583 292 320 ---- ---- 507 141 2585

Nummbeenrtsc_o_m__p_l_e_t_e_d___tr_e__a_t_-_ 91 1 ---- 32 376 ---- 2 77 46 336 385 436 308 ---- ---- 302 141

2533

VII. LIFE EXTENSION: Number of examinations ____ Oases given advice __________

26 ---- ---- ---- 197 ---- ---- ---- 80 26 ---- ---- ---- 125 ---- ---- ---- 104

54 ---- 6 ---- ---- ---- ----
56 ---- ---- ---- ---- ---- ----

32 32

395 343

VIII. SANITATION OF FOOD

SUPPLIES:

Inspection of dairies _______ 1 7 70 11 27 37 50 342 74 52 ---- ---- 80 30 48 27 49

Dairies scored ______________ Cows tuberculin tested ____ Inspections of stores_______

---- ---- ---- ---- 12 ----

---- ----
---- 15

353 ---- ---- ---446 18 580 462

19
684 25

140
96 777

8 212 112

52 97

-------

----
----

55 1215

26 ----

7
----

---54

---29

169 ---- 110 1067 108 ---- 77 512

905 319 2740
4478

DIVISION OF COUNTY HEALTH WORK SUMMARY OF COUNTY HEALTH WORK FOR THE YEAR 1923

~
-~ 'd '@ &:Q

!::
0
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ol
0

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ACTIVITIES.-Con tin ued.

Inspections of eating places, ___ _ Examleirnsa__ti_o_n__s_o__f_f_o_o__d__h_a_n__d_-1___ _

1112461 25----

25157912251 5 3 18

27121511321 881 ____ , 97,17291 431 731 18 85 23 276 383 21 ---- ---- ----

621 9

92 31

3644 897

IX. MPAoLnAdRs IaAn:d marshes drained 41 ___ _1 ___ _1 41 ___ _1 ___ _1 ___ _1 41 21 901 ___ _1 21 ___ _1 171 261 521 3

204

Yards of water surface

!\:) 00

Qui~~~~- -tre~tllients --in.~ -~2500 -- --- --- 4170321148801- __ _11292001-- _.132501 3MI 733001 755001 25017000001 260001 18 I 1069474

duced___________________ 3 Homes screened _______________ _

181----1 1111891 221 11----1----16801----18441----17201 2---- ---- 1 ____ ---- 2 65 92---- ---- ---- ----

551 5

231 ___ _ 66 183

2566 416

X. GENERALSANITATION:

Inspections of private premises ________________ 1058 86 6359 52 40888174981 671 423133851 199122281419612721571 902122561 36412980 345098

Schools and other public

buil~ings _______________ 26 53 241 Inspect10n of camps____________________

70 1

38 15 8ll 28 1091156 ---2 ___________ _ 26 25 ----

7~~-~~:1 __ :~1 6~1 3~113~

1249 76

Inspections of swimming

1

pools___________________ 1 6 4 5 2 8 15 ___ _ 141 14 2 Complaints investigated____ 121 71 780 891 75 60 129 110 163 146 101

611 8137511 34321 15821 151151 579

132 3272

XI. LABORATORY: Specimens examined ________ 149 55 336 265 2738 8 12 985,137 7651 36 8J4819 ____ 976 259 117 11665

Specimens sent to State Lab.____________________ 319 12 1 190 105 15 278 249 13 246 327 118 ____ ____ 2e3 24 2 2162

Milk samples, totalc~mnts--,---- ____ ____ ____ 21 78 ____ 184 ____ 62 ________ 716---- 16--------

1077

Water samples examined____ ~---- 61 87----11 5 ____1________ 364 51____ 3 361 ____ 31---- 357 1237

Water samples to State Lab. I 12 3 Others_ ____________________ 22 ____

4 121 12 381 28 1 ________1_______ .I1

311,---8 ____

46311___ 8_I________ _________ ___1_

31 26 35 2 6 ___ _

259 42

I. SANITARY PRIVIES IN-

RESULTS

INSTALLED:

RuraL ______________________ I 41 181213 6 2 22 51 ____ 41 124 2 32 170 ____ 1____ 30 104

819

II Urban ______________________ 4 7 49 21--- - 1 121 21- - -- 1 1341 711- -- - 1 271- -- - 1

201 821 329

740

II. PRIVIES RESTORED TO

SANITARY TYPE:

Rural ______________________ -1- __ -1 7 Urban _____________________________ _

21 881

201----1----1 271 40---- 125----

241 341 1201----1----1 11----1 131 22 1261 60---- ---- ---- 1 300

221 38

13 70

283 870

III. SEPTIC TANKS INSTALL-

ED:

li,l __ j __ j==== RuraL _____________________ -1
Urban______________________ IV. NEWA WATER AND SEWER

2' ___ -1 4 ____
1

4 ___ _ 3 ___ _
1

25) 13)--- -)--- -) 11_--- 21_--- 10 32---- ---- ---- ---- 1 1 ---- 33

74 85

CONNECTIONS:

WSaetwere-r-_-_-_-_-__-_------_-_-_-__----_-_-_--------~--_-_-_-_1 35131 10771J 331 31631 12021_-_-_--_1_--_-_-_1 67501 76901_-_--_-_J 112412263071_-_--_-_J ___5_1 280021117972

849 953

V. WELLS AND SPRINGS IM-

PROVED:

t.:>

WSeplr~mS-g-s--_-_-_-_-_-_-_-_-__-_-_-_-_-_-_----_-_--~_----11 ___5_1_-_--_-_1 34~_--_-_-_~-_-_-_-_~-_-_-_-_~-_-_-_-_1 31351 41841_-_-_--_1_--_-_-_1 __1_0_1_-_--_-_1 311 __1_9_1 47

<:0 VI. FOOD HANDLING ESTAB-

123 44

LISHMENTS:

Dairies improved_______________ 3 41 9 ____ !____ 1 261 381 35 ____ ___ _ 60 ____ 16 9 49

250

'1 Stores improved________________ Eating places improved_____ ____

2 22 10 ____ ____ ____

3 12 12

20 5

3 5

64 63

61 _______ _

34 _______ _

1

1

a2o4l1_-_-_-_-

---1 201

17 15 1

19 17

222 236

VII. CHILD HYGIENE:

I

Infant and Pre-school

Cases improved_____________ . 4j--

9 115 81 140 2 162 2401 188 ________ 500 ____ ----1 64~---- 1432

I School Defective children improved 31

I 9 234 295

49 606 937 460 1 726 553

75 ____ 680 ____ ____ 298 ____

4953

Totaldefectscorrected _____ 15100 437 323 6310571049 79411590 3561018 ____ 814 274 86 713 ____ 8689

Nutritional classes

I

Cases improved_____________ 56____ 97 ____ 142 ____ ____ 2 169 315 ____ ____ 16 ____ ,____ 95 ____

892

VIII. GENERAL SANITATION:

1

Premises improved _________ 800 ____ 6111 32 3251855 12 6420541 360 ____ 407184461 1181471 177 376 19772

Schools improved--.--------,.;____ 12 61 50 8 17 ____ ____ 74 87 ____ ____ 201 51 1 4 16 346

Otherpubllcbldgs.Improveu ____ 4 ____ 12 ____ 6 ____ 1 16 94 ____ ____ ____ 20 ____ 2 ____

155

Camps improved________________________ 21---- 1 ____ I____ 6 20 ____ ____ 21____ ____ 1 4

36

Swimming pools improved__ 1 ____ 21 6 ____ 5 ____ ____ ____ 10 ____ ____ 4 3 ____ 1 3

35

Nuisances abated __________ 829 371 562! 110 221 5I 1361 581 153 2081 ________ '82701 45! 49 1221 248 11053

DIVISION OF CHILD HYGIENE
The scope of the work carried on by the Division of Child Hygiene during 1923 remained practically the same as for the previous year. The educational program, directed toward the development of community interest in matters relating to the health of mothers and infants, was continued, with a view to the establishment, on a permanent basis, of proper facilities for intensive and effective work along this line in every city and county in the State, as a part of its general campaign for the improvement of health conditions. As before, the plan followed called for the holding of demonstration clinics, through the use of the "Healthmobile," supplemented by lectures, conferences and the distribution of literature. A change was made, however, late in the year, in the method of carrying out this plan, when it was decided to concentrate for longer periods on certain districts in the State, in order to make possible a more intensive demonstration in each community. To increase the effectiveness of the demonstration in each locality, it was also decided to place a group of nurses in the field for the purpose of following up the work done by the clinic, and bringing about, as far as possible, actual improvement in the conditions found to exist.
A special demonstration project was inaugurated at Macon, the funds to meet the allotment from the federal government having been supplied locally. The establishment of. other special units of this character is now under consideration.
During the course of the year a total of 189,967 pieces of literature, relating to prenatal care, the pre-school child, school hygiene, care of the teeth and other subjects, were distributed. As a part of the campaign against infant blindness, the division also distributed free nearly 15,000 ampoules of silver nitrate solution for the eyes of the new-born, to physicians, health officers, nurses and others.
Through the cooperation of the Georgia Dental Society, anumber of dental clinics were held in various places over the State, and many valuable lectures and demonstrations on the care of the teeth were given in the schools by speakers furnished by the Society. The State Board of Health is greatly indebted to the members of the dental profession of Georgia for this help and it is hoped that this good work will be continued.
30

The United States Public Health Service also assigned to Georgia, for demonstration purposes, a "mouth hygiene unit," consist- , ing of a traveling dental clinic, under the direction of a specially trained worker. This service is, of course, only temporary, and the unit will be moved on to another State; it is hoped, however, that arrangements can be made for a longer stay, or at least an early return of the clinic, as no undertaking in the field of child hygiene has proved more popular. The attached summary shows the character and extent of the work done.
In July a supervising nurse was added to the staff of the division, under whose direction the public health nursing activities of the State Board of Health are now being carried on. It is hoped that the public health nursing section of the division may be developed into a coordinating agency which will help to bring about the uniformity of practice and cooperation necessary for the utilization to the fullest extent of all nursing services being maintained within the State.
In November a negro nurse was employed for maternity and infancy work among negroes. The sum of $1,200.00 was donated to the Board for this work by the Woman's Missionary Society, North Georgia Conference, through the Commission on Inter-Racial Cooperation.
It is desired to point out here that Georgia is losing each year a large part of the federal appropriation due her under the provisions of the Sheppard-Towner Act, on account of the inability of the State Board of Health to match all of this fund dollar for dollar. Needless to say, the extent of usefulness of the division would be greatly increased in carrying out a work for which there is a crying need in the State, if all of the federal appropriation available to us could be secured.
Exclusive of the work performed by the personnel on the Healthmobile, the medical and nursing staff visited 109 towns, gave 90 lectures attended by 10,379 people, and examined 125 children of pre-school age and 842 school children.
31

GEORGI.A STATE BOARD Of' HEALTH OI~ISION 0~ CHILO NYQIINI

COUNTIES VISITED

BY HEALTHioiOBILE

DURING 1922

38

COUNTIES VISITED

BY HEALTHMOB ILE

DURING 1923

~

TOTAL

80

HEALTHMOBILE
During the year the Healthmobile visited 200 communities in 42 counties. The following summarizes the work done by the Healthmobile staff:
Cqnferences ________________________________________ _ 152 Persons reached through conferences _____________ _ 1,323 Talks or lectures given _____________________________ _ 150 Persons reached through talks and lectures _______ _ 26,832 Motion picture shows given ________________________ _ 165 Attendance at motion pictures ____________________ _ 38,815 Local physicians assisting on Healthmobile ________ _ 44 Pre-asgceho__o_l_e_x__a_m__in__a_t_io__n_s_,_c__h_i_l_d_r_e_n__u_n__d_e_r__2__y_e_a_r_s__o_f _ 772 Defects found in 772 children ______________________ _ 596 Pre-school examinations, 2 to 7 years of age _______ _ 1,949 Defects found in 1949 children _____________________ _ 2,358 School children examined __________________________ _ 3,994 Defects found in school children___________________ _ 8,168
32

NUMBER AND CHARACTER OF DEFECTS AMONG PRE-SCHOOL CHILDREN EXAMINED

I

I

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.a s'Q"')Q~) rn rn
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J_, ~~~~11681_::--=:1~ -"-''I-"-" Under 2 years_ - - - 7'12 -"'

_311_24

596

2 to 7

--1-1--------- -"1_1:1 "'- -"1107118'7 years 1949 147154 553 411295 15 28 202115 14

2358

TotaL

2721.186,195,6514421332

1 1

23

37 233.139

19

56!140 355

83

281 35

2954

NUMBER AND CHARACTER OF DEFECTS AMONG SCHOOL CHILDREN EXAMINED
-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

'0

.as'Q")'Q~)
s<ll ;:ii>1
Zril

bLJ

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3994,2821119,1224,511,13+499:43817124162012461201156216311 11419*,8168

*Other Defects consist principally of ground itch and malaria.

ORAL HYGIENE

The mouth hygiene unit detailed to Georgia by the U. S. Public Health Service visited Spalding, Wilkes, Jackson and Laurens Counties during the period September 1~ to December 31, 19~3. The following summarizes the work of this unit:

Schools visited____________________________________ Talks given_ _______________________________________
Tooth brush squads organized___________________ Consultations_____________________________________ Completed clinical cases_ _______ ___________________ Children examined________________________________

21 95
3 25 54 1,939

Defects: 1 or more caries in teeth__________________ 2 or more teeth missing____________________ 1 or inore first molar
~fscs~~~~:::: =: ~=:==: =::::=====: 1'~~~

2,094 176
1,352

33

Malocclusion: Slight__________________________ 531 Marked_ _______________________ 109
640 Infected gums_____________________________ 701

Total defects found in 1,939 children__________ 4,963

An educational program was put on by the Division, with the aid and cooperation of the Georgia State Dental Society; 47 lectures were given by dentists in various counties before audiences totaling 4,221.

The following work was done by a representative of the division in the rural schools of Bibb County:

Lectures given by Oral HYgienist_________________ School children present at lectures_______________ Teachers present__________________________________ Prophylaxis________________________________________ Dental corrections________________________________

37 1 ,950
70 50 46

DIVISION SANITARY ENGINEERING AND WATER ANALYSIS
The powers of this Division were given in the 1921 and 1922 Annual Reports which are, briefly: The control over water and ice supplies, sewage, trade waste and refuse disposal, supervision of maintenance, alteration, extension, construction and operation of systems and works relating thereto, as provided in regulations setting forth the powers of this Division.

WORK IN THE WATER LABORATORY
Work in the water laboratory for the year 1923 has shown an increase of 1775 analyses, or 54.8% over the year 1922. The number of sample cases owned by cities who have monthly analyses made has shown an increase. At present 144 cities own cases and 5 cities near Atlanta came in at regular periods for bottles.
During the year 1923, 5,015 analyses were made, 4,993 of which were bacteriological and 22 chemical.
Chemical analyses were continued of certain of the river waters in Georgia to obtain data relative to the degree of pollution of these rivers.
Samples from private water supplies could not be analyzed during 1923, due to the lack of appropriation made by the Legislature.
34

Under rules and regulations passed by the State Board of Health in January, 1922, twenty-one private samples were analyzed at five dollars each.
Very excellent cooperation was given the State Board of Health during the year 1923 by cities in sending in monthly water samples for analysis; also a great improvement was noted in the condition of water supplies in 1923 over 1922. This was due to both educational work and to cities following out recommendations made by the State Board of Health.

In the following tables the increases in 1923 over 1922, in both cooperation and safety of water supplies, can be noted:

Table A

Cities giving ex- Cities giving fair Cities givlng poor Cities g1vmg no

cellent coopera- cooperation

cooperation

cooperation

tion

1922 ____________ 55 1923 ___________ 116

18 19

20
11

87 49

Table B

Cities having excellent Cities having a doubt-

water supply

ful water supply

1922 ______________ 56 1923 _____________ 131

53 12

Cities having a dangerous water supply
11 1

SANITARY ENGINEERING

During the year 1923, an assistant engineer for malaria work was added to this Division. This has enabled the State Board of Health to materially increase its activities along malaria control work in 1923.

During the year 1923, 248 surveys were made. Following is a
list of these surveys :
127 Water Works 19 Sewerage Systems, Sewage Disposal and Sanitary Privies
1 Swimming Pool 2 Odors 97 Malaria and Drainage 1 General

MALARIA CoNTROL

During the year 1922, supervision of malaria work was furnished by the State Board to cities carrying on actual malaria or mosquito campaigns, a limited amount of assistance was furnished by the U.S. Public Health Service in cooperation with the State Board of
35

Health. The following table shows the marked increase in new malaria projects in 1923 over the years 1920-1922. This is due wholly to the addition in 1923 of a malaria engineer to the State Board of Health.

Table C

First Year Malaria_____________ 1920 Projects_______________________ 5

1921 3

1922 5

1923 21

During the year 1923, educational, experimental and investigational work was continued by a medical field worker connected with the State Board of Health. During the year 353 public talks were given on malaria and 144 inspections were made on public health work. Several severe malaria outbreaks were investigated in a few of the counties. Experimental work was carried on on the following three matters: First, to produce an oil which could be used in mosquito eradication work that had a high spreading value to be used amongst dense vegetation; Second, the use of an oil that would effectively clear rooms of mosquitoes and flies; Third, the use of creosote in preventing mosquitoes entering a dwelling.

After trying many combinations of oils it was found that by

using the following mixture an oil could be produced that had a high

spreading value which was effective even amongst heavy vegeta-

tion.

Pine oil, crude ______________________ 2 parts Crude petroleum ___________________ 1 part Crude creosote _____________________ 1 part Kerosene ___________________________ 3 parts

In this above mixture, crude creosote was used for the toxic effect it might have on mosquito larvae. This mixture cost approximately 19 cents, and if it will do away with the necessity of clearing vegetation it can be considered as a very economical oil.

The clearing of mosquitoes and flies from rooms was tried by the use of pine oil. It was found that if very thorough spraying is done with refined pine oil that mosquitoes and flies are entirely eliminated from any dwelling. This pine oil, however, badly irritates eyes and nasal passage, and it is believed from this standpoint that it will not become practicable.

A second solution was tried for the above purpose, which consisted of 5 per cent pine oil to a gallon of kerosene, and percolating it through 12 ounces of pyrethrum. This solution is more effective than many of the commercial products and costs considerably less.
36

It does not seem to irritate as a straight solution of pine oil and wa~ found to kill all mosquitoes and flies in a room inside of one hour.
Considerable experimental work was carried out in spraying inside of dwellings with creosote to prevent mosquitoes from entering rooms that were unscreened. After studying this it was concluded that creosote spraying had very little effect on Culex mosquitoes, and also after the first few days has almost no effect on Anonopheles.
During the year 1923, a great many clippings were made in borrow pits along new highways throughout the malaria section of the state. The great majority of these pits were found not to be breeding Anopheles mosquitoes, while in several, very small Anopheles larvae were found. It is believed that these borrow pits, especially in rainy weather, become connected with streams and are artificially stocked with gambusia, which is one of the factors in preventing breeding in these pits.
HYDROGEN-ION INVESTIGATION
The hydrogen-ion concentration has come into prominence of late in sanitary and industrial work. In sanitary work its use has given better control of coagulation at certain places where water is purified by the use of aluminum sulphate and rapid filtration. It is also believed to be of value in determining the comparative corrosive properties of various water supplies. In making the pH determinations the colorimetric method is used, this procedure being based upon methods and data elaborated by Dr. Mansfield Clark.
Briefly, the procedure consists in comparing the color produced by the proper indicator in a known volume of water with standards of known pH concentration. Both hydrogen-ion and hydroxyl-ion concentration are commonly expressed as pH numbers, this being m oreconvenient than using the actual concentration values. pH 7 :00 represents neutrality; values above this figure represents alkalinity or hydroxyl-ion concentration and values below represent acidity or hydrogen-ion concentration. the pH number is the logarithm of the reciprocal of the hydrogen-ion concentration and these pH numbers represent only the dissociated hydrogen and hydroxylIOns.
All hydrogen-ion concentration work of water supplies was done in the field, so any error that might enter in samples being shipped
to the laboratory was eliminated.
37

Special Investigations, 1923: Barnesville __________________________ odor VVaycross ____________________________ vvater S a v a n n a h ____________________________ v v a t e r
ODOR NUISANCE BARNESVILLE
In August a request vvas made of the State Board of Health from the city of Barnesville, through the J. B. McCrary Engineering Corporation, to investigate an odor nuisance at Barnesville.
This odor vvas noticeable to a very limited section of the residential section, and seemed to. arise from a lovv vvet area of approximately 500 by 500 feet. In this area several springs rise, flovving for a short distance through open channels and thence through a 24-inch terra-cotta pipe to an open creek. The underlying ground is a heavy peaty muck overgrovvn for the most part vvith a heavy vegetation.
The odor vvas seldom noticeable through the day but as a rule became very disagreeable about eight to nine o'clock in the evening, and vvas said to disappear again after ten to tvvelve o'clock.
All sources of odors vvere follovved dovvn and on all occasions it vvas determined that the odor vvas due to some cause in the small vvet area.
Mter considerable investigation a vvhite fungus grovvth vvas found, that on close observation resembled the odor previously noticed. After the finding of this grovvth, an expert on grovvths of this kind vvas taken to Barnesville. He immediately identified that the odor occurring in this section was caused by this fungus grovvth. This fungi vvas later identified as Marasmius Foetidus Sovv, vvhich. caused the odor during the time that fruit vvas produced. Recommendations vvere made for the control of this nmsance.
SAVANNAH
BAcTERIOLOGICAL STUDY oF THE OLD GwiNNETT STATION WELLs
In May, a request was made of the State Board of Health to make a bacteriological study of the deep vvells at the Gvvinnett Pumping Station.
The original vvater supply of Savannah vvas taken from the Savannah River. This vvas replaced by a battery of vvells adjacent
38

to the river; later this was replaced by a series of wells at the Gwinnett Station; later by electrically pumped deep wells located at different points over the city. It was found that these electrically driven pumps were expensive to operate, so it was decided to again go back to the Gwinnett Station.
The Gwinnett Station comprises a series. 'of wells discharging by air lift into a six foot brick tunnel. The brick tunnel has numerous leaks and will be replaced by a cast iron pipe line.
Daily samples were collected and analyzed in the city laboratory for a period of a week. From these analyses it was found that this deep well water could safely be used without chlorination, provided the brick tunnel was replaced by a proper size cast iron pipe line.
WAYCROSS
INvESTIGATION oF THE CAusE oF WHITE WoRMS IN WATER SuPPLY
On June 21st, a request was received from the health officer of Waycross for assistance in investigation of the water supply.
It developed that small white worms were in the water. A complete detailed report dated September 8th was written.
In brief, it was found that these worms were introduced into the water supply through a cross-connection with a branch. The worms were very thick in sediment of the elevated tank. The sediment was black and semi-gelatinous. In this mass were dispersed numerous small calcareous ,shells, similar to shells found in the canal. Worms of five different species were found to be present in this sediment in enormous numbers; also a number of organisms of a very low grade.
Proper recommendations were made to the city.
GENERAL REMARKS
Water supply conditions in several towns throughout the State are becoming serious in the summer months when the source of supply is low and the demand high. During this past year the rainfall throughout the summer was below normal which resulted in restrictions being passed by certain towns limiting the daily use of water.
Deep well supplies in a few of the growing cities are becoming inadequate during the summer, making it only a matter of a short while before some other new supply must be placed in operation.
89

At the end of 1923, the water supplies as a whole throughout the State, were in a very excellent condition. Chlorination is being carried out in all cases, with the exception of one, where needed.
Malaria control work has increased so rapidly during the past year that only a limited amount of new work can be started in the future, until additional personnel can be obtained. An appropriation by the State Legislature is greatly needed for this work.
Work in the laboratory has increased nearly 55 per cent in 1923 over 1922. It will be impossible to handle all work in 1924 with the present amount of personnel, if the work during 1924 shows the same average increase as has been shown since 1919.
Tables giving cost data, analytical data, water consumption, malaria data, and all other data connected with this Division are on file in the office of the State Board of Health; information from which can be obtained by applying in person to this office.
STATE BUREAU OF VITAL STATISTICS
In addition to the value of birth and death records in the proper administration of Public Health matters, they carry a legal value as shown by the demand for certified copies, which is increasing rapidly. In 1921 a total of 146 certified copies (76 births and 70 deaths) were issued; in 1922 there were 252 issued (141 births and Ill deaths); in 1923 a total of 298 certified copies of certificates were issued, 145 births and 153 deaths. Of these, 185 copies. were necessary in the settlement of matters relating to pensions, increase in veterans compensation and in insurance claims; 9 were used in the enforcement of the Harrison Antinarcotic Law; 3 in the establishment of the ownership of War Saving Stamps; 3 in the prosecution of the medical attendant, not including those copies necessary in securing passports, admission to school and in the settlement of estates.
The exodus of negroes since 1920 is estimated to be 200,000. Taking into consideration the natural increase, the total negro population in 1923 is probably less than the total shown in the Census of 1920. The increase in the State's population has been in the white race. For this reason, rates applying to the negro population are by no means as accurate as those applying to the whites.
With the limited force of clerks in this Bureau, it is impossible at this time of the year to tabulate the data found on the 67,000
.a

birth records, filed with the State Bureau of Vital Statistics, and the tabulation of the 37,394 death records has not yet been completed.
It has been an easy task for many years to secure accurate statistics relative to crops, minerals and other products of Georgia, but until January 1, 1919, when the Vital Statistics Law which was enacted in 1914, became operative, no statistics of citizens of Georgia were available, except in four cities, Atlanta, Augusta, Brunswick and Savannah, and the reports of the United States enumeration of the census every ten years.
The Statutes of Georgia require the registration of every birth within ten days thereafter and of every death prior to the burial of the body. The medical attendant at the birth must file the complete birth record. The person who wishes to bury the body must secure a burial permit by filing a complete death record, before the body is buried. The City Clerk in the city and the Justice of the Peace in the militia district is the local registrar of births aFtd deaths and the Statutes place on each of these officials the duty of seeing that this law is strictly enforced in his respective jurisdiction. If either a City Clerk or Justice of the Peace fails or refuses to act as Registrar of births and deaths, the Statutes require the State Board of Health to appoint a registrar or to combine the district with another district. The Local Registrar is paid a fee by the county for each complete birth and death record which he secures, and of which he keeps a true and accurate copy for the use of his county. The original birth and death record is filed with the State Bureau of Vital Statistics on the tenth of the following month.
Under this Statute every physician, midwife and undertaker must register his name and post office address with the Local Registrar of births and deaths in the district where such physician, midwife or undertaker resides. Coffin dealers are required to report to the State Bureau of Vital Statistics the sale of every coffin on the first day of each month. Sextons must keep a record of all burials and must prohibit the burial of a body until the burial permit is filed with him.
Where a death occurs without a medical attendant, the registrar of births and deaths is notified and also the coroner if a crime is suspected, otherwise the registrar must investigate the case, write what he finds as the cause of death and sign the record as Local Registrar.
41

Each incorporated town or city and each militia district constitutes a registration district. There are 1,621 militia districts and 506 incorporated towns, making a total of 2,127 registration districts. In the majority of cases the incorporated town and the surrounding militia districts have been combined.

In the State of Georgia there are 3,274 physicians. The State Bureau has the name and post office addresses of 2,271 midwives, whieh possibly represents 60o/o of the total. There is also a record of 767 coffin dealers and undertakers.

The Vital Statistics Law applies to all persons alike and de-

clares the failure to register a birt4 or death as a misdemeanor

prescribing a fine of not less than $5.00 nor more than $50.00 for the

first offense, and for each subsequent offense a fine of not less than

$10.00 nor more than $100.00 with imprisonment at the discretion

of the court. The law specifies that when there is neither physi-

ciltn nor midwife present at the birth, the parents must register

the birth; when there is no undertaker in charge of the burial the

relative or nearest friend must file the death record and secure

the burial permit; and that their failure to do so is a misdemeanor

and they are liable to the fine.

.

It is not probable that a parent after prosecution would fail to register the birth of the next child; or that a relative or friend after one prosecution would fail to secure a burial permit; but many midwives, a very few physicians and undertakers are repeatedly violating this law. It is the intention of this Law that the fine should be light on the parent or relative who violates its provisions but that the physician, undertaker or midwife who repeatedly disregards its provisions should be given the maximum fine with imprisonment if necessary to secure complete birth and death registration.

On account of the records delayed in filing and those in process of correction, all figures in this report are subject to revision, and all totals include those not otherwise classified.

DEATH RECORDS

If the 1920 Census be taken as a basis and the population be estimated in the adopted manner, the population of Georgia July 1, 1923, would be over 2,998,000, but it is commonly known that more than 200,000 negroes have emigrated from the State since January 1, 1920, and this loss must be taken into consideration in
42

computing the death rates. There are no indications that the white population has not increased as in previous years. With the negro emigration deducted, the estimated population July 1, 1923, is 2,799,200, composed of 1,781,878 whites and 1,016,956 negroes. Of the whites, 900,839 were males, 881,039 females; of the negroes 496,225 were males and 52.0,731 females. These estimates will be taken as the basis in computing the death rates for 1923. The 1920 Census shows 211 Chinese, 125 Indians, 9 Japanese and 8 of other races, a total of 353, with an estimated increase of 13, which number is not sufficient to affect the rates.

There were filed during the year 37,394 death certificates, 19,232 for white and 18,152 for negro deaths, with 10 records incomplete as to sex or race. The records of 1923 show ah increase over 1922 of 2,388 deaths, while the report 1922 carried a similar increase of 2,556 over 1921. This increase is probably due to the more thorough enforcement of the Law by the Local Registrars of births and deaths.
Total Total Male Female Total Male Female Year Deaths White White White Negro Negro Negro

1920 34,969 18,524 9,623 8,901 16,321 8,052 8,269 1921 32,450 16,732 8,936 7,770 15,662 7,832 7,823 1922 35,006 17,983 9,564 8,402 16,979 8,516 8,449 1923 37,394 19,232 10,239 8,986 18,152 9,289 8,860
(Totals include records not otherwise classified.)

DEATH RATES
Of the 3'7,394 deaths 8.6% were stillborn as compared with 9% in 1922 and in 1921. Among the whites in 1923 the stillborn composed 7.6% and among the negroes 9.8% of the total deaths.

Exclusive of stillbirths, the 34,143 deaths indicate a rate for the

State of 12.1 deaths per 1,000 population. The rate for the white

population was 9.9 and for the negro 16.1. In 1922, for the total

population the rate was 11.4, for the whites 9.4, and the negroes

15.0. The year 1923 shows an increase of 5 white deaths and 11

negro deaths per 10,000 population over the rates of 1922.

Estimated Population July 1, 1923. Total Population ____________________ 2,799,200 Total White Population_____________ 1,781,878 Male, White____________________ 900,839 Female, White_________________ 881,039 Total Negro Population_____________ 1,016,956 Male Negro____________________ 496,225 Female Negro_ ________________ 520,731

Total Deaths 34,143
17,771 9,371 8,397
16,372 8,240 8,129

*Total population includes 366 Chinese, Japanese, etc.

Death Rates 12.1
9.9 10.4
9.5 16.1 16.6
15.6

43

The death rate among the negroes was 6.~ per 1,000 higher than among the whites; .D higher among the male whites than the females and 1 higher among the male negroes than among the females.
THE STILLBORN The 3,251 stillbirths in 1D~3 indicate a rate of 1.16 per 1,000 population.. Among the whites the rate was .81 and mong the negroes 1.75, as indicated by the 1,461 white and the 1,780 negro stillbirths. While these totals do not represent the actual occurrence, they may be taken as showing that the stillbirth rate among the negro race is approximately twice that among the white. There were 1,917 males and 1.3':20 females in this total report. Taking the male and female population as a basis, the male population shows 1.37 and the female .D4 stillbirths per 1,000. There were 1,449 stillborn males to 1,000 females.
DEATHS BY MONTHS During the year there were on an average more than 10~ deaths each day, that is more than 4 each hour or one death every 14 minutes. While February is the shortest month of the year, it by no means shows the smallest number of deaths in 1923. The least number of deaths occurred in September, when ~.586 deaths were registered. The greatest number of deaths were in January when the total reached 3,767. This was the greatest number of deaths filed in any month since March of 19~0, when the total was 4,153. during the Influenza epidemic of that year. The high record of January, 1923, was preceded by the high record of 19~~ when 3,198 deaths had occurred in December. The December and January death records were increased by the epidemic of Influenza.
44

Deaths by Months

Total

White

Negro

Deaths Total Male Female Total Male Female

TotaL ___________ 34 ,143 17,771

January _________ 3,767 2,161

February ________ March ___________

2,737 2,869

1,455 1,454

ApriL ____________ May ______________

2,758 2,864

1,438 1,478

June _____________ 2,778 July _____________ 2,844

1,475 1,394

August __________ 2,678 1,315

September _______ 2,586 1,301

October__________ 2,631 1,375

November_ _______ 2,799 1,476

December ________
N. o. c. __________

2,825 7

1,431 18

9,371 1,117
756 778 741 763 784
747 692 726 714
774 762
17

8,397 1,044
699 675 697
715 690 647 623
575 660 702
669 1

16,372
1,602 1,280
1,415 1,318
1,386 1,303 1,449 1,361
1,284 1,253 1,322
1,394
2

8,240 808
674 716 641 692 627
728 665
635 638 676
737 3

8,129
794 606 699 677 694
676 720 696 649 615 646
657 0

(*NOT OTHERWISE CLASSIFIED.) (All Totals include those not otherwise classified.)

DEATH RATES 1923
The death rate for the year was 12.1 deaths per 1,000 population, as compared with 10.9 in 1922. In February, 1922, the rate was 9.9, January, April, May, .July and August ran between 10 and 11, while March, June, September, October and November ran between 11 and 11.5, with December 13. In 1923 the lowest rate was 11 in September. February, April, June, August, October and November ran between 11 and 12. :March, :1\<Iay, July and December ran over 12 deaths per 1,000 population, while January showed a rate of 16.1 deaths.

Deaths Excl. of Stillbirths

1923

January_ _ _____ _ ___________ _ February_____________________ _ March ________________________ _ April __________________________ _ May ___________________________ _ June __________________________ _ July __________________________ _ August _______________________ _ September ____________________ _ October ______________________ _

3,767 2,737 2,869
2,758 2,864
2,778 2,844 2,678
2,586 2,631

November____________________ _ December _____________________ _

2,799 2,825

NoTtotoalth__e_r_w_i_s_e___c_l_a_s_s_i_f_ie_d_________ __

7 34,143

1922
2,637 2,413 2,738 2,433 2,550 2,667 2,576 2,553 2,729 2,682 2,674 3,198
31.850

Death Rate
1923 1922
16.1 10.9 11.7 9.9 12.2 11.3 11.8 10.0 12.2 10.5 11.9 11.0 12.1 10.6 11.4 10.5 11.0 11.3 11.2 11.1 11.9 11.0 12.1 13.0
12.1 10.9

45

GEOF<GIA'S MORTALITY RECORD DEATHS B'i MONTHS 1922-1923
400Q---

~
3!)01't

300~

I 1922 ~ ,_ -

1923
\

. .\v"-~ J"~J I I ~

20'00

t"t .J IF IM tIM I Jl "1 AI 8 1 1 Nl O J_l F I MIA I Ml J

A IS I 0 IN I 0

DEATHS BY AGES 1923 Of the errors and omissions found in the death records the greater number relate to the age of the individual. It is impossible to ascertain the exact age in each case, but the undertaker, physician or friend can in almost every case form some idea as to the approximate age and this should be done, for without this approximate age it is impossible to classify the record in any age period. Although these corrections are sent in every case, only 50% are returned and as a result of the failure to reply to these requests, 595 records do not show the age of the deceased. Including the stillborn, in the 37,394 death records 12,250 individuals died in Georgia in 1923 before the end of the tenth year .
46

of life, 1,899 between 10 and 19 years, 3,275 between 20 and 29, 2,964 between 30 and 39, 3,185 between 40 and 49, and 13,226 after the fiftieth year of life. It is noticeable that in the last fifty years of life only 976 more died than did during the first ten years, and that exclusive of stillbirths more than one-fourth of all deaths in all ages occurred in children under ten years of age.
Of the 12,250 deaths prior to the end of the tenth year of life, 3,251 were stillborn, 5,629 during the first year after birth, 1,384 were between 1 and 2 years of age, 1,284 between 2 and 4, with 702 between 5 and 10 years, that is of the deaths under 10 years of age, 26.5% were stillborn, 45.9% were under 1 year, 11.2% between 1 and 2, 10.4% between 2 and 4, with 5.7% from 5 to 10 years, or that of these deaths among the children 72% occurred before the end of the first year.
GEORGIA'S MORTALITY RECORU " 1923
DEATHS BY AGE PERIODS

327&

1899

1881

--

I

10

I

TO TO TO TO TO - TO TO TO OYIII

"' 19 29 39

59 69 79 89 90

47

Deaths by Ages, Race and Sex

Age Period

Total

White

Negro

Deaths Total Male Female Total Male Female

All ages ___________ _ 34,143

Under 1 year_ _____ _ 5,629

From 1 to 2 _______ _ 1,384

From2to4 _______ _ 1,284

From 5 to 9 _______ _ 702

From 10 to 14 ______ _ 679

From 15 to 19______ _ 1,220

From 20 to 24 _____ _ 1,672

From 25 to 29 _____ _ 1,603

From 30 to 34______ _ 1,369

From 35 to 39 _____ _ 1,595

From 40 to 44 _____ _ 1,557

From 45 to 49 _

1,628

From 50 to 54 _____ _ 1,792

From 55 to 59 _____ _ 1,454

From 60 to 64 _____ _ 1,816

From 65 to 69 _____ _ 1,964

From 70 to 74 _____ _ 1 996

From 75 to 79 _____ _ 1,755

From 80 to 84 _____ _ 1,256

From85to89 _____ _ 625

From 90 to 94 _____ _ 316

From 95 to 99 _____ _ 196

Over 100 _______ _

56

Not otherwise classi-

fied___ _________ _ 595

17,771 3,058
795 705 374 295 453 549 608 597 635 657 693 763 730 1,134 1,330 1,410 1,294 823 396 147
44 4
274

9,371 1,737
438 380 198 184 226 236 262 290 288 320 375 465 432 650 752 782 640 339 153
51 12
1
160

8,397 1,321
357 325 176 111 227 313 346 307 347 337 318 298 298 484 578 628 654 487 243
96 32 3

16,372 2,571
589 579 328 384 767 1,120 995 772 960 900 935 1,029 724 682 634 586 461 430 229 169 152
52

111 321

8,240 8,129 1,397 1,174
304 285 289 290 164 164 190 194 341 426 525 595 439 556 325 447 444 516 433 467 477 458 558 471 349 375 375 307 361 273 331 255 263 198 225 205 114 115
79 90 65 87 17 35
175 146

THE TEN CHIEF CAUSES OF DEATH 19!23
In 19!2!2 the chief cause of death was Bright's Disease, with !2,903 out of 35,006 deaths. Diseases of Early Infancy came second with !2,84!2 and Tuberculosis with !2,683. In 19!23 the arrangement changed and Influenza, which was the lowest cause of death in 19!2!2, took the 8th place in 19!23, with 1,500 deaths as compared with 1,014 in 19!2!2, eight of the ten chief causes of death showing a greater number of deaths in 19!23 than in 19!2!2.

Cause
Diarrhea under 2 __ C a n c e r _____________ Influenza __________ Accidents __________ Org. Hrt. Dis. ______ Apoplexy ___________ Pneumonia ________ Tuberculosis _______ Dis. of Early InL __ Bright's Disease ___

Total Total

1,183 1,263 1,500 1,535 1,711 1,724 2,352 2,644 2,878
3,139

698 870 879 832 813 1,002 1,121 967 1,636 1,684

White

Negro

Male Female Total Male Female

383 315 485 248 237

331 539 393

90 303

402 477 620 276 344

581 251 702 492 210

474 338 899 464 435

561 441 722 372 350

589 532 1,236 695 536

421 546 1,677 706 971

965 669 1,240 672 567

931 753 1,454 780 674

48

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The greatest variation in the number of deaths due to these ten causes of death is found in Influenza which dropped from :2,580, the chief cause of death in 1920, to :278 in 1921, 1014 in 1922 and 1,500 in 1923. There is a similar drop off in the number of Pneumonia deaths in 19:20 from 2,142 to 1,393 in 1921, 1,773 in 192:2 and an increase to 2,352 in 1923. With the two exceptions the number of deaths, except for the increase in general death registration, run a regular course during the four years. In cancer, diarrhea under
two years, and accidents, very little difference is found.
4P

THE TEN CHIEF CAUSES OF DEATH 192Q-1921-1922-1923

Cause

1923

All causes _____________________ _ 37,394

_ Diarrhea, 2 years _____________ _ Cancer_______________________ _

1,183 1,263

Influenza.. ____________________ _ 1,500

Accidents _____________________ _ 1,535

Org. Hrt. Dis. _________________ _ 1,711

Apoplexy _____________________ _ 1,724

Pneumonia.. __________________ _ 2.352

Tuberculosis __________________ _ 2,644

Dis. Pee. Inf. _________________ _ 2,878

Bright's Disease ______________ _ 3,139

1922
35,006 1,175 1,212 1,014 1,481 1,703 1,563 1,773 2,683 2,842 2,903

1921
32,450 1,230 1,210
278 1,258 1,359 1,449 1,393 2,531 2,480 2,446

1920
35,575 1,250 1,123 2,580 1,378 1,533 1,332 2,142 2,362 1,868 2,197

DEATHS DUE TO PREVENTABLE DISEASES 1923

The percentage of preventable deaths has been variously estimated at from 40% to 70%, resulting in there being no fixed list of preventable cause of death. Unfortunately the activities of Health Departments are, in the main, restricted to the prevention of those deaths which, with the exception of Tuberculosis, Cancer and Diarrhea under two years, do not appear in the list of the ten leading causes. Some propaganda purposing to reduce the number of deaths from Pneumonia, Influenza, Accidents and Diseases of Early Infancy is distributed but the chief work done in the prevention of disease and death is directed against Typhoid Fever, 1\;Ialaria and other epidemic communicable diseases, which in the general tab~ ulation, show a lesser number of deaths. In 1923, one death in 56
was due to Typhoid Fever, one in 69 to Malaria, one in 124 i~
Diphtheria, one in 134 to Whooping Cough, and one in 1,707 to Scarlet Fever. While this number of deaths seems almost negligable in th~ total87,000, the methods of preventing these communicable diseases is so commonly known that when .mch deaths occur in a community it would appear that someone in authority is guilty of criminal carelessness. It is indeed unfortunate that a Health Department must devote the major part of its time and its ap propriation to the prevention of diseases which are, in fact, the minor causes of death and so easily controlled by local authorities.; and is not able to attack the larger problems in public health work: .

DEATHS DUE TO TYPHOID FEVER

There were 2,662 deaths ascribed to Typhoid Fever in Georgia during the four years, 1920, 1921, 1922 and 1923. Of this total 44.8% were white and 55.07% were negro deaths, while the population is composed of 68 whites to 86 negroes. In 1,000 Typhoid
50

deaths 510 were males and 490 females. In 1,000 white deaths 528 were males and 472 females in 1,000 negro deaths 495 were males and 505 were females.
The deaths in 1923 follow very closely the four years' record, except that in 1922, 40.5% of the deaths were among the whites and 59.5% among the negroes. The proportion of deaths among the sexes of the two races is the same as that for the four years' period.
GEORGIA'S MORTALITY RECORD - 1923
DEATH RATE FROM TYPHOID FEVER
aT 21.5

WHJTI UTI MALl WHITI

13.7
14.7 12.7

NIQRO RATI
s.a
36

In 1922, among the whites the death rate was 19.3 and, among the negroes 32.0 per 100,000 population of the respective races. The 1923 records show a white rate of 13.7 and a negro rate of 35.1, as compared with 9.3 for whites and 19.9 for negroes in North Caro-
51

liha 'in 19~0; 16.4 for whites and ~7.3 for negroes in Tennessee; 11.5 for whites and ~5.1 for negroes in Mississippi; 13.3 for whites and 17.~ for negroes in Florida, with 15.9 for whites and ~8.6 for negroes in South Carolina.

TYPHOID FEVER BY YEARS

Four years _______ _ 1923 _______________ _ 1922 _______________ _
192L ______________ _ 1920 _______________ _

Total Deaths Total
2,663 1,196 602 245 714 326 798 351 549 274

White Male Female Total
631 565 1,466 133 112 357 171 155 387 183 168 447 144 130 275

Negro Male Female
726 740 182 175 191 196 222 225 131 144

TYPHOID FEVER BY MONTHS
Typhoid Fever is typically a seasonal disease, although taking the total state report for the year, some deaths from this disease were found in every month. As indicated by the Mortality Report for the past three years the epidemic began in April and reached its height in August and declined during the fall and winter months. In July, August, September and October 60% of the total deaths for the year were reported.

Vaccination is advisable, followed by the sanitation of all toilets and privies, with the purification of all water supplies, but to produce results and lower the death rate the measures must be started ,early in the spring and completed hefore the coming of summer.

DEATHS FROM TYPHOID FEVER, 1923, BY MONTHS

Grand

White

Negro

Total Total Male Female Total Male Female

'rotal ______________ 601 244 133 111 357 182

175

January___________ 22

12

7

5

10

5

5

February__ ________ 19

11

6

5

8

4

4

March_ ____________ 13

4

2

2

9

6

3

,ApriL_____________ 23

7

3

4

16

8

8

May________________ 33

13

10

3

20

10

10

June_______________ 59

23

9

14

36

20

16

July_______________ 108

33

20

13

75

43

32

August ____________ 119

48

26

22

71

28

43

September_________ 75

ill

16

15

44

22

22

October____________ 62

25

14

11

3,

21

16

November__________ 38

19

9

10

19

10

9

December__________ 31

19

11

8

12

5

7

TYPHOID FEVER BY COUNTIES
In 17 counties no Typhoid Fever deaths were reported in 19~3 as compared with ~0 in 19~~. This does not indicate that these counties were free from this disease, for in these 17 counties there are no County Health Officers to assist in preventing disease, no
52

!Opecial effort was made to protect the people from Typhoid Fever, and the local officials failed to enforce the law which prohibits the burial of a body before a public record of the death was filed, resulting in incomplete death registration. It is probable that under such conditions had these counties enforced the Vital Statistics Law they would have shown as great, if not greater, infection than those counties where death registration is complete and where an effort is made to care for the public health.
In the country and smaller towns where no Health Officers are employed and local ordinances are not enacted for the control of disease, the individual has no protection and runs the risk of catching Typhoid Fever every time he takes a drink of milk or water or swallows any uncooked food.

8T4TI B04RD OF HIALT~
BUREAU OF VITAL STATISTICS

BY COU"T II 8

1923

I~ FULTON COUNTY (45)
~OT SHOWN ON THI M4P

53

In such communities the only safeguard is vaccination, and this must be used before the infection takes place. After the disease has spread over the State as it does during the summer months, there is considerable risk in vaccination.

MORBIDITY AND MORTALITY OF TYPHOID FEVER
In 1922 the Morbidity Records carried a report showing 990 cases during that year while the Mortality Records showed 715 deaths, indicating a case mortality of 72%. In 1923, the reports show 656 cases with 601 deaths, a case mortality of 91%, while the percentage found in hospital records is only 10% and it must be remembered that only the severe cases, as a general thing, are carried to hospitals, the lighter cases, a greater number of which recover, are not included in this percentage. The lack of complete morbidity reports is very apparent and the mortality records of Georgia will never be of full value to the medical profession until morbidity reports are secured.

DEATHS DUE TO MALARIA, 1923

During the four years 1920, 1921, 1922 and 1923, Malaria was given as the cause of death on 2,100 certificates. There were 559 deaths in 1920, the year following the number dropped to 468 or 91 less, in 1922 there was an increase of 116 over 1921 and 25 increase over 1920, while in 1923 there were 486, the lowest record in the four years, except 1921.

Of the total deaths from Malaria, 42.5% were white and 57.5% negroes, 48.1% were males and 51.9% females. Of the 894 deaths from this disease during the four years 455 were males and 439. females; of the 1,203 negro deaths 557 were males and 647 females.

DEATHS DUE TO MALARIA BY YEARS

Grand
Total Total
TotaL _____________ 2 ,100 894 1920________________ 559 242 1921________________ 468 195 1922________________ 584 256 1923________________ 489 201

White

Negro

Male Female Total Male Female

455 439 1,204 557 647

120 122 317 145 172

92 103 273 125 148

131 125 326 151 175

112

89 288 136 152

MALARIA BY MONTHS

Like Typhoid Fever, Malaria is affected by those conditions existing in certain seasons of the year. While deaths from Malaria are reported from some sections of Georgia every month in the year.
54

the disease begins to spread when the mosquito becomes active in the spring, and spreads northward as the summer's heat brings the mosquito out of his winter hiding places.
There were 14 deaths from Malaria reported in January, 15 in February, 10 in March, 23 in April, 22 in May, 38 in June, 64 in July, 74 in August, 75 in September and 85 in October, with a decline in the number during the months of November and December, making a total of 489 for the entire year of 1923. During 1920, 1921 and 1922 the peak of the mortality from Malaria has been reached in September, in 1923 October was the peak.
It is not necessary to study the mortality records to determine the month when the oiling or draining of all standing water should begin, for the singing of the mosquito is furnished the most careless observer and the work should be begun when the mosquito becomes active.

JAN. 14
FEB. 15
MAR. 10
APL. 23 MAY 22 JUN. 38
.JuL. 64
AUG. T4
SEP. 7&
OCT. 85
NOV. 46
DEC. 23 TOHL489

GEORGIA'S MORTALITY RECORD - 1923 DEATHS DUE TO MALARIA
BY UONTHB
/=1\-80
-II _ 60

.. r - _ / - ~~---------~

\ ~0

-v

... 1.... ., ,.B

APL MA'f , . . . oiUL AUG BI P OCT oy Ill

55

DEATH DUE TO MALARIA, 1923

BY MONTHS

Grand Total Total

TotaL __________ -- 489

201

January ___________ 14

5

February _________ 15

8

March _____________ 10

4

ApriL ______________ 23

6

MJuanye_______________________-_-_-_-

22 38

11 12

July _______________ 64

21

August ____________ 74

32

September _________ 75

31

October_ __________ 85

41

November_ _________ 46

19

December __________ 23

11

White

Negro

Male Female Total Male Female

112

89 288 136

152

3

2

9

5

4

5

3

7

3

4

1

3

6

3

3

2

4

17

7

10

7

4

11

4

7

7

5

26

8

18

11

10

43

28

15

21

11

42

24

18

18

13

44

13

31

20

21

44

19

25

12

7

27

17

10

5

6

12

5

7

While the comparison of Georgia's Typhoid Fever rate with the rates of the neighboring states was not favorable to Georgia, the Malarial death rate, 17.4 per 100,000 in Georgia for 1923 was less than the rate in Louisiana, Mississippi, Florida or South Carolina in 1920. The two years may not be comparable in that the deaths from this disease in the four states mentioned may have been reduced by antimalarial measures, for much work of this character has been done in Georgia in the last two years.

MALARIA BY COUNTIES
More than nine out of ten deaths from Malaria during 1923 occurred below a line drawn from the northern boundary of Richmond County across the State to the southern boundary of Muscogee County. The line follows the southern boundary of the Piedmont Plateau. Below the line is found more than 80% of the swamp land of Georgia. The elevation below this line is from the sea level to 300 feet, except in four counties where it reaches 350 and 400 feet, while the land above this line rises rapidly from 400 to the mountains of North Georgia, where an elevation of 2,500 and 3,000 is found.
The 76 counties north of this line contain 23,970 square miles or 40% of the State's total area, with 1,476,556 people, or 52.75% of the State's total population.
The 84 counties below this line contain 34,755 square ~iles or 60% of the State's area and 1,321,998 people, or 47.25% of the State's population.
56

STATf IOAD 0~ HfALTH
BUREAU Of VITAL STATISTICS OEATHSOU TO MALARIA 1923
IY COUNTIII
The State as a whole showed a rate of 17.4 deaths from Malaria per 100,000 population. The counties above this line showed a rate of 3.11 as compared with a rate of 33.28 malarial deaths per 100,000 population in the counties south of this line.
Taking the investigations of the United States Public Health Service as a basis, authorities state that Malaria costs Georgia $1,635,200.00 or 56 cents per capita, or approximately $2.50 per family. If this statement be true, then the citizens and tax payers of the 84 counties in South Georgia are paying an indirect tax of $1,496,862.00 or $1.13 per capita because of Malaria, as compared with $138,338.00 or 9 cents per capita the cost of Malaria in 76 counties located above this line and on the Piedmoat Plateau.
57

76 NORTHERN COUNTIES

STATE BUREAU OF. VITAL STATISTICS

GEORGIA

1,405,940 PEOPLE . 5~ OF THE STATES POPULATION

IHOWINQ THI IOUTHiaN IOuNDaY
or THI PIIOMONT PLATIAU DENSITY Of POPULATION

23z270 S~UARE UILES 4~ tF STATES AREA
63 PEOPLE TO THE SQUARE Ill LE

49 PER SQUARE MILE TAXABLE PROPERTY $354,92 PER CAPITA TAXES PAID

$368.37 TAXABLE PROPERTY PER CAPITA

$ I , 99 PER CAPITA

,2,06 ITATE TAX PER CAPITA

584 DEATHS FROM

&7 DEATHS FROM MALARIA IN 1922

.MALARIA

, - A DEATH RATE OF 3,6 ~ 1000000 POPULATION

,----/ /,

f r 84 80UTHEf<N COUNT I.ES

,-

.

1,390,892 PEOPLE 48~ OF THE POPULATION

34,755 SQUARE MILES 6Q% OF THE AREA

40 PEOPLE PER SQUARE Ill LE

$340,37 TAXABLE PROPERTY PER CAPITA

$1,91 STATE TAX PER CAPITA

527 DEATHS FROM MALARIA IN 1922 A DEATH R~TE OF 36,9 PER 100,000 POPULATIO~
FROM MALARIA

The 76 counties in North Georgia have 61 people per square mile; the 84 Malarial Counties in South Georgia have 38. If the Malarial belt was as thickly settled as the northern counties, the State's population would be increased by 798,057 people.
In 1910 Clarke County, with 114 square miles, had 23,273 people; Houston County, with an area of 585 square miles, had 23,6()9 people. During the ten years following 1910, Clarke County increased 12% in population and Houston County decreased 7% as shown by the 1920 United States Census. Houston County's death rate from Malaria in 1922 was 3.1 deaths per 10,000 population; Clarke County's rate for the same year was less than 1.
In 1880 Sumter County had 18,239 people; Carroll County had 16,901. In forty years Sumter County increased in population
58

to 29,640, or 62%; Carroll County increased to 34,752 or 105%, as shown by the 1920 census. The Malarial death rate in 1922 was three times as great in Sumter County as in Carroll.
From 1890 to 1900 the State increased 20.6% in population, the northern counties 13.7% and the southern counties 29.5%. The ten years from 1900 to 1910 showed the increase in the State to be 17.9%, the northern counties 15.7% and the southern counties 19.9%. The 1920 Census gave Georgia an increase of 10.9%, the northern counties 10.5% and the southern counties 11.4%. During that 30 years the increase in the northern counties had fallen from 13.7% to 10.5%, a loss of 3.5%; the malarial counties had dropped from an increase of 29.5% to 11.4%, a loss of 18.1%, in the gain in population.
The Comptroller's report for 1922 shows the 76 northern counties as paying $2.06 tax per capita while the 84 southern counties paid $1.91; the northern counties had showed $368.37 taxable property per capita, while the southern counties in the malarial belt showed only $340.36 per capita.
No more favorable conditions can be found for the development of any section than exists in South Georgia, fertile land, abundant rainfall and long, pleasant summers, yet South Georgia has not yet held its own in the increase in population. The people own less property per capita and therefore pay the State less revenue. The conditions which have retarded the growth of South Georgia are identical with those which produce malaria and in addition to the natural handicaps the people have had to pay this indirect tax because of this disease. Much drainage has been done in recent years which has decreased the breeding place~ of the mosquito to a great extent, but drainage is a municipal, county or state matter and the individual can accomplish but little in this way. He can, however, look after his own premises and as the mosquito does not fly any great distance can protect his family by screening . the home and stopping the breeding of mosquitoes by oiling the ponds and pools on his land.
DEATHS DUE TO WHOOPING COUGH
The mortality records indicate a marked decrease of Whooping Cough in Georgia during 1921 and 1922 with an increase in 1923. In 1920 there were 373 deaths, in 1921, 183; in 1922, 130, and in 1923, 254 deaths ascribed to this disease.
59

Broncho-Pneumonia frequently follows Whooping Cough as a complication. Where the complication is given as the cause and the primary disease is not stated, it is necessary to classify the death as due to the secondary disease rather than the true cause. For this reason it is probable that the total of 940 deaths during the last four years does not represent the actual number of deaths due to this disease. Whooping Cough is more severe on the white child than the negro, since there were 500 white deaths to 439 negro, and slightly more severe on the female than the male, for there were532 males to 507 females.

DEATHS DUE TO WHOOPING COUGH BY YEARS

1923-1922-1921-1920

White

Negro

Total Total Male Female Total Male Female

Total -------1923_- .. 1922 __________
192L _______ 1920 _____

940 500 235 265 439 197

242

254 116

53

63 138

63

75

130

51

24

27

78

34

44

183

93

46

47

90

44

46

373 240 112 128 133

56

77

DIPHTHERIA
In 1923 there were 199 whites (Ill males and 88 females) and 75 negroes (36 males and 39 females) who died with this disease. Taking both races, diphtheria shows a rate of 9.0 per 100,000 population for that year. The latest available report from the Census Bureau is for 1920, in which year Florida showed 7.1, South Carolina, 11.9; Virginia, 14.4; Mississippi, 15.9; Tennessee, 16.6, and Kentucky, 17.5 deaths from Diphtheria per 100,000 population.

Of the 1,500 deaths from Diptheria in the four years, 1920, 1921 and 1922, inclusive, 400 occurred in 1920, 415 in 1921, and 411 in 1922, indicating an increase of 15 in 1921, a decrease of 4 in 1922 and a decrease of 137 over the previous year. The records in 1923 show 72 white deaths from this disease to 38 negroes. There were 23 more white boys than girls and 3 more negro girls than boys, a total of 20 more males than females. The 1923 records, except for decrease in the number of deaths, follow very closely the trend of the three year's records.

60

GEORGIA'S MORTALITY RECORD 1923
DEATHS DUE TO DIPHTHERIA
8Y MONTHI

JAN, 34

FEB. 16

..AR, 12 APL. g

OCT

..AY 7

JUN. B

JUL. 16

A.U{l, . 23
SEP~ '"32

OCT, 52

NOV, 41

DEC. 24

TOTAL 274

DIPHTHERIA BY YEARS

White

Negro

Total Total Male Female Total Male Female

TotaL_____________ 1 ,500 1 ,052 553 499 448 219 229

1923________________ 274 199 111

88

75

36 39

1922________________ 411 277 151 126 134 1921________________ 415 294 143 151 121

67 67 58 63

1920________________ 400 282 148 134 118

58 60

The mortality from this disease is affected either by the sea-

son or by conditions of the population existing during certain sea-

sons. March, April and May in each of the four years, recorded the lowest number of deaths; September, October and November,

the greatest number. During the last six months 68% of the

deaths occurred with 39l% during the first six. months of each year.

61

The very severe epidemic during the last six months of 1922

extended into January, 1923, causing 34 deaths followed by 16 m

February, 12 in March with 9 in April.

DIPTHERIA BY MONTHS, 1923

Total

TotaL ____________ _ 274

January __________ _ 34

February_________ _ March ____________ _ April ______________ _ May _______________ _ June ______________ _ July ______________ _

16 12 9
7 8 16

August ___________ _ September ________ _

23 32

October __________ _ November_ ________ _

52 41

December _________ _ 24

Total
199 25
8 5 4
3
7
13 15
22 41
36 20

White Male Female

111

88

14

11

6

2

2

3

4

0

2

1

4

3

8

5

10

5

11

11

22

19

20

16

8

12

Total
75
9 8 7 5 4 1 3 8 10 11 5 4

Negro Male Female

36

39

4

5

4

4

3

4

2

3

0

4

0

1

1

2

4

4

6

4

6

5

3

2

3

1

STATI BOAaD or HIALTH
BUREAU OF VITAL STATISTICS
DEATHS DUE TO DIPHTHERIA 1923
1Y COUMTIIS
TOTAL IN rULTON COUNTY (35)
IHIWM 011 THI IIA~

62

During the year, 98 counties or 61% of the counties in Georgia reported from 1 to 35 deaths from this disease. In some of those counties making no report of Diphtheria, the death records were noticeably incomplete. It is probable that few counties, if complete death registration were secured, would not have recorded some deaths from this disease.
DENGUE
The 132 deaths from Dengue in 1922 were reported from 44 counties. Bibb County, in 1922, reported 13, with 12 in the City of Macon; Decatur County, 12; Chatham, 11, with 7 in the City of Savannah; Thomas County reported 10; Ware 9 and Muscogee 5, with 39 counties reporting from 1 to 4 deaths. The first death was reported from Gwinnett County on August 15, followed by one in Savannah on the 17th. On September 7th one death in Berrien and 2 in Ware County occurred, followed on the 8th by the second death from this disease in Savannah, and one in Mcintosh County on the lOth. By this date the disease seems to have secured a foothold as there were 15 additional deaths during the remainder of that month. In October the total deaths reached 43 and in November 42, with a decline to 25 in December.
This epidemic continued into 1923 and January of that year reported 14 deaths with 1 on February. None were reported during March or April when 2 deaths occurred in May, 1 in July, 1 in October and 1 in November. In 1923, of the total deaths, 7 were whites and 13 negroes. There were 7 males and 13 females. In the entire epidemic resulting in 152 deaths, there were 72 whites to 80 negroes, 65 males to 77 females.
Unfortunately the morbidity reports are not complete and the mortality rate cannot be computed. The 5,148 cases reported in 1922 with the 132 deaths would indicate a mortality of 2.5%, the 44 cases with 20 deaths in 1923 would indicate a mortality of 45.4% and neither percentage can be accepted as representing the correct mortality.
63
.

GEORGIA'S MORTALITY RECORD

DEATHS DUE TO DENGUE 1922 - 1923

50-40

~-

MONTH CAS8 DEATHS

1922AUG. 124

2

Sli;P. 1599

20

OCT. 3054

43

NOV. 239

42

DEC. 131

25

1923JAN. II

14

FEB.

8

I

MAR.

3

30

,_,__ -

APL. II

MAY

JUN.

I

2

JUL.

3

I

AUG.

I

SEP.

I

OCT.

4

I

20

..;.. NOV.

I

I

TOTAL 5192 152

1922 10

~- 1923

I

s J.,F lM :A lol 'J

J

A 1

0 N0 1

\ ___l\ r, ,-,-,

J

1 F

1

11o1

A I

1o1 I

1 J I

J

1 IA

1s

1o

Ij'N

1o
I

DENGUE FEVER, 1922

Grand

White

Total Total Male Female Total

TotaL ........ 132

65

28

37

67

August ..... _______ 2

2

0

2

September_ ___ ..... 20

9

6

3

11

October............ 43

24

11

13

19

November..... _.. 42

19

8

11

23

December..... 25

11

3

8

14

1923

TotaL .. 20

7

2

5 13

January .. " 14

6

l

5

8

Cl4

Negro Male Female

30

37

7

4

7

12

10

13

6

8

a5

8 ;

..

PELLAGRA

There are records of 432 deaths from Pellagra in 1920, 512 in 1921 and 527 in 1922, with 444 in 1923, a total of 1,915 deaths in the four years. The 444 deaths in 1923 include 227 whites and 217 negroes. The whites were divided as to sex in the proportion of 68 males to 159 females and the negroes, 40 males to 177 females. Including both races there were 108males to 336 females, indicating that the female is three times as suspectible to Pellagra as the male. This statement holds good as to the records of 1920, 1921 and 1922.

DEATHS DUE TO PELLAGRA BY YEARS

Grand Total

TotaL _____________ 1920 ________________ 1921 ________________ 1922 ________________
1923 ________________

1,915 432 512 527 444

Total
920 210 234 249 227

White Male Female
284 636 60 150 79 155 77 172 68 159

Total
994 222 277 278 217

Negro Male Female
218 776 55 167 56 221 67 211 40 177

In the four years 1920, 1921, 1922 and 1923, there were 1,915 deaths. Of that total, 920 were whites and 994 negroes. Among the whites 284 were males and 636 females; among the negroes 218 were males and 776 females. In the combined races 502 were males and 1,412 females. In this group of 1,915 deaths there was little difference as to race, but the female of both races appeared to be more suspectible than the male to this disease. Approximately 70% of the whites' deaths were among women and 78% of the negro deaths among the same sex.

Pellagra cannot be said to be a seasonal disease as is Malaria, Typhoid Fever, Diphtheria or Pneumonia yet 60% of the deaths occur during the six months beginning June of each year, February showing the lightest mortality.

Pellagra was recognized as an independent or separate disease in 1735 in Spain and was called "Rose Disease" because of the color of the skin. In 1771 it was named Pellagra meaning "Rough Skin." Since that time much study has been devoted to the disease. It is agreed by the greatest number of these students that Pellagra is not inherited, that it is not contagious and that a diet restricted to one or two articles of food may cause Pellagra. Pellagra is con sidered preventable and in many cases may be cured if the proper <;liet is eaten. The diet should be liberal portions of milk, eggs, meat,
85

fresh vegetables, especially beans and peas. The latter are beneficial even when cured or dried.
STAT! BOARD Or HIALTH
BUREAU OF VITAL STATISTICS GEORGIA'S MORTALITY REPORT 1923
DEATHS DUE TO PELLAG~A
BY COUNTUS NOT INCLUOINQ
IN FULTON COUNTY
While some investigators have held that there was a relationship existing between cancer and malaria, the condition producing malaria has never been considered as a prevention of Pellagra. Under the subject of Malaria the State was divided into two equal parts as to population and it was found that more than 90% of the malaria existed below this line, which closely approximates the southern boundary of the Piedmont Plateau.
A classification of the deaths from Pellagra by counties develops the fact that those counties which are most heavily infected with Malaria show the lowest number of deaths from Pellagra. Above the line dividing the northern counties from the Malarial' belt
66

72.5% of the deaths from Pellagra were found, while below this line in the Malarial belt only 27.5% occurred in 1923. The four years record, 1920, 1921, 1922 and 1923 show that in the Malarial, Pellagra is not as prevalent as in North Georgia or at least not so fatal.
TUBERCULOSIS

During the four years from 1920 to 1923, inclusive, 10,220 persons died in Georgia from Tuberculosis. Of this total 3,732 were whites and 6,484 were negroes, being in the proportion of almost two negroes to one white .person.

There were 9,460 deaths ascribed to Tuberculosis of the Lungs or in other words 92% of these cases were in the most catching form, and there is no way of determining the number of cases that developed from these sources of infection.

In the year 1923 there were 2,644 deaths due to this disease, 9,967 whites and 1,676 negroes. Of the whites 421 were males, 546 females; of the negroes, 706 were males and 971 females. There were 1,127 males and 1,517 females including both races. It should be noted that for approximately 10 white males there were 12 females; 10 negro males and 13 negro females who died from Tuberculosis during this year.

DEATHS DUE TO TUBERCULOSIS BY YEARS

TotaL _____________ 1923 ________________
1922 ________________ 1921 ________________
1920 ________________

Total
10,220 2,644 2,683 2,531 2,362

Total
3,732 967 991 892 882

White Male Female
1,672 2,060 421 546 447 544 413 479 391 491

Negro Total Male Female

6,484 1,677 1,692 1,637 1,478

2,734 3,750 706 971 704 988 686 951 638 840

DEATHS DUE TO TUBERCULOSIS, 1923

Grand

Total Total

TotaL _____________ 2,644

967

Tuberculosis of the

, Lungs ____________ 2,472

897

Acute Miliary Tuber-

'culosis ___________

35

8

Tuberculosis Menin-

gitis _____________

33

21

Abdominal Tubercu-

losis _____________

68

25

Pott's Disease _____

9

6

White Swellings ____

9

3

Tuberculosis of

other organs_____

16

5

Disseminated Tuber-

culosis ___________

White Male Female Total
421 546 1,677

389 508 1,575

2

6

27

14

7

12

8

17

43

3

3

3

1

2

6

3

2

11

Negro Male Female
706 971

663 912

9 . 18

6

6

18 25

2

1

2

4

6

5

67

When the deaths due to Tuberculosis are tabulated by race and age periods the disease appears to be more fatal in the early periods of the Negro's life than the White's. The records of the four years follow very closely the curves for 1923.
In the combined races 3.4% occurred prior to the tenth year of life, 11.3% between 10 and 19 years of age, 31.3% between 20 and 29, 21.2% between 30 and 39, 13% between 40 and 49 with 17.7% over 50 years of age.
. ITATI aARD D~ ~~~LTH
BUREAU OF VITAL .STATISTICS OEATHS.DUE TO TUBERCULOSIS 1923.
BY COUNTIII
The records of the white race show 3.4% during the 1st ten years, 6.6% between 10 and 19, 23.1% between 20 and 29, 20.5% between 30 and 39, 14% between 40 and 49, 29% were 50 years of age and over.
68

In the negro race 3.4% were under 10 years of age, 14.0% hetween 10 and 19, 36.0% between 20 and 29, 21.4% between 30 and 39, .12.0% between 40 and 49, with 10.8% over 50 years of age.
While the per cent of deaths under 10 years of age was the same for both races the second 10 year period shows a difference of 8%, the third 13% and the fourth 1%. With the tubercular negro dying in early life the records show a difference of 2% between 40 and 50 and after 50 years of age 19% in favor of the negro.

DEATH RATE FROM TUBERCULOSIS
The death rate from Tuberculosis varies widely as to race and sex, the white males showing the lowest death rate, the negro female the highest. For both races combined the Tuberculosis death rate was 94.4% per 100,000, for the whites 54.2 and for the negroes 164.9. The white males showed a rate of 46.7, the white fEmales 61.9, the negro males 142.2 and the negro females 186.4 per 100,000.

GEORGIA'S MORTALITY RECORD - 1923

-------94.4 ST!TI II!TI

DEATH RATE FROM TQBERCULOSIS
II.!TI Pill' teO~OOt"ltOPWLATIO.

WH ITI II!TI

IUI.f WH ITI P'IYtl.l WHITI

46.T

NICRO lltTI

loltl.l Nl QIIO

~"'t' !1':0

ill .

69

These rates indicate that there were 'no more deaths among the
negroes than among the whites per 100,000, that there were 15 more deaths among the white females than among the white males with 44 more among the negro females than among the negro males, taking 100,000 as a basis.

VENEREAL DISEASES

Since there are no reliable statistics as to Venereal Diseases, statements based on estimates are used. Hospital records arc quoted as showing that 80% of the people have Syphillis and that it is the greatest "killing disease." It should he remembered that the hospital population is many states by no means represents the total population and in no locality does it represent those who are not sick nor those light cases not requiring hospital attention. If Syphillis is the "greatest killing" disease then the physicians have falsified their statements as to the cause of death on the greater part of their certificates, for in the classification of a death the primary disease is accepted as the cause of death. In those cases where Syphilis or Gonorrhoea is given as the contributory condition, the death is classified as due to Syphilis, or Gonorrhoea.

There are 371 deaths ascribed to Syphilis and 19 to Gonorrhoea in the total of 37,394 deaths during 1923. Of the deaths due to Syphilis, there were 23 white females and 50 males, a total of 73 white deaths as compared with 24 females and 46 males and a total of 70 in 1922. There were 115 females and 183 males, a total of 298 negro deaths as compared with 139 females, 211 males in a total of 351, with 1 negro record on which the sex was not stated in 1922. Of the 19 deaths from Gonorrhoea, 4 were white, 1 male and 3 females; 15 negroes, 10 males and 5 females.

DEATHS DUE TO VENEREAL DISEASE BY YEARS

Total

TotaL ____________________ _ 1923 _______________________ _ 1922 _______________________ _

1,291
371 421

1921 _______________________ _ 296

1920- - - -- - -- -- - -- ---- - - -- --- 203

SYPHILLIS

White Negro

233 1,058

73 298

70 351

56 240

34

169

GONNORRHOEA

Total White Negro

99

22 77

19

4 15

43

11 32

31

6 25

6

1

5

DEATHS DUE TO VENEREAL DISEASES, 1923

White

All Deaths Total Male Female

Syphillis_ ____ ___ ___ 371

78

50

23

Gonorrhoea________ 19

4

1

3

Total
298 15

Negro

Male Female

183

115

10

5

70

DEATHS DUE TO CANCER

There was an increase of 51 deaths from Cancer in 19~3 over 19~~ compared with 87 in 19~1 over the 19~0 report and the records for the year 19~~ contained ~ more than 19~1. The four years' records include 4,808 deaths due to this diseas~ and indicate that two-thirds of all Cancers exist among the white population, for each year's records carry the same per cent as to race.

In 100 cases of cancer among the whites, 6~ are females and 38 males; in the same number among the negroes 77 are females and ~3 are males.

DEATHS DUE TO CANCER BY YEARS

TotaL ______ ~ ______ 1923 ________________ 1922 ________________ 1921 ________________ 1920 ________________

Total
4,808 1,263 1,212 1,210 1,123

White Total Male

3,219 870 782 802 765

1,239
331 304 305 299

Female
1,980 539 478 497 466

Negro Total Male Female

1,587 393 429
407 358

358 1,229 90 303
88 341 92 315 88 270

While Cancer is generally considered a disease of advanced age, the records of 19~1 contained a record of 19 Cancer deaths in those under ~0 years of age. These deaths were investigated with the idea in mind of ascertaining any possible error as to age or diagnosis. To these letters 18 replies were received, one physician stating that he had accepted the statement of another person but did not believe that the death was due to Cancer, the other 17 were being verified, both as to age and diagnosis. The 19~~ records carry 34 deaths from Cancer in those under ~0 years of age. Of this number ~7 were whites and 7 negroes. In 19~3 there were ~1 deaths under ~0 years of age. There were two white deaths under 5 years, 10 whites and ~ negroes, between 5 and 15; 7 whites between 15 and ~0; 1.6% of all cancer deaths being under ~0 years.

The Mortality from Cancer in 19~3 among the white male was heaviest between 65 and 70 years of age when 17.~% of the deaths occurred. A similar condition was found in the white females during the 5 years age period just prior to that in the males for 1~.0%, the highest percentage found in any age period, was between 60 and 65 years. In the negro race Cancer was more fatal at an earlier age. In the females 14.8% of the deaths occurred between 45 and 49 and in the males 15.5% between 50 and 55 years of age.

7l

The estimation of deaths from Cancer, if based on any statitics not taken in the community to which the estimate is applied, may be very misleading since the rate varies greatly in neighboring states. In the states east of the Mississippi, the death rate per 100,000 population varies widely from 3~.9 in South Carolina to 1~6 in Vermont, according to the 19~0 mortality report. There is likewise a wide variation in states in the same section. Rhode Island in that year, had a rate of 99.7 while Vermont's rate was 1~6. Pennsylvania 83, New York 101, Maryland 94.1 and Virginia 55.9, while Georgia's rate for 19~3 was 45.1 per 100,000 population. The white rate was 48.8, the negro 38.6 per 100,000 population.

DEATHS DUE TO CANCER, 1923

Total

TotaL _____________ 1,263

Cancer Cavity

_o_f___B_u__c_c_a_l

27

CaLnivceerr_, __S_t_o_m__a__c_h_,_ 338

Cancer, peritoneum,

itnutmest_i_n_e_s__, _a_n__d__r_ec- 66

CatanlceOrr,.f_e_m__a_l_e__g_e_n_i- 324

Cancer of the Breast 115

Cancer of the Skin 90

Cancer, other organs

not specified_____ 303

White

Negro

Total Male Female Total Male Female

870 331 539 393

90 303

23

20

3

4

1

3

238 120 118 100

41 59

55

22

33

11

177

0 177 147

73

0

73

42

81

43

38

9

223 126

97

80

6

5

0 147

0 42

4

5

38 42

DEATHS DUE TO GENERAL DISEASES
Among the minor causes of death are found those general diseases some of which are epidemic in foreign countries but occur sporadically in the United States, along with other systemic diseases found quite infrequently in Georgia. Two white males died of Typhus Fever. There were 51 deaths from Erysipelas, 46 whites and 5 negroes, 18 of the whites and 3 of the negroes were under 1 year of age. One negro woman died of Glanders.
More than 34% of the 58 deaths due to Tetanus were in the newborn. Of the ~3 deaths due to Rickets, 8 were white and 15 negro.
One death was ascribed to Addison's Disease, ~1 to Goitre and 97 to Leuchaemia and Anemia, with 130 to Rheumatism and ~49 to Diabetes.
72

While prohibition of the sale of alcoholic beverages is a constitutional provision, 64 persons, 45 whites and 19 negroes, died of alcoholism during 1923.

DEATHS DUE TO DISEASES OF THE NERVOUS SYSTEM

The classification of deaths due to Diseases of the Nervous System is of little value on account of the inaccuracies of the statement of the cause of death on the certificates. Of the 2,985 deaths in this classification, 1,724 wer~ classified as due to apoplexy, which was one of the ten chief causes of death, with 628 due to paralysis without specified cause and 108 as to convulsions without other cause. Under these three indefinite classifications 2,460 deaths, or 82% of the deaths were due to diseases of the nervous system, were placed, because of no additional information could be secured from the medical attendants. Apoplexy is frequently preceded by arteriosclerosis and if so stated on the record the death is classified as due to that cause and comes under the classification of diseases of the circulatory system. Convulsions in infants are, in a great majority of cases, due to some primary cause which is ascertainable. If so stated the death is classified as due to that cause and with completely written statements of the cause of death, the totals given would be materially reduced.

The 8 deaths due to cerebrospinal meningitis and the 1 due to poliomyelitis included in this classification should be considered with those deaths due to epidemic and communicable diseases. The 16 deaths due to diseases of the eyes and ears include 13 whites and 3 negroes; 1 death being due to disease of the eye and 15 to diseases of the ear.

DEATHS DUE TO DISEASES OF THE NERVOUS SYSTEM BY YEARS

TotaL _____________
11992223__-_-_--_-_-_-_-_-_-_-_-_-_-_-_1921 ________________ 1920 ________________

Total
11,601 2,985 2,822 2,867 2 927

White Total Male Female

6,714 1,692
1,581 1,669
1,772

3,658 920 857 916 965

3,055 772 724
752
807

Negro Total Male Female

4,870 1,293 1,236 1,196 1,145

2,380
650 605
555 570

2,489 643 631 640
575

CIRCULATORY SYSTEM

Much to do is being made over the increase of deaths due to Organic Heart Disease. The failure of physicians to state clearly the cause of death and the fact that the laymen are prone to ascribe
7il

any sudden death to heart trouble has forced those who classify and tabulate the mortality statistics to place under the title of Heart Disease many deaths which, if thoroughly investigated, and the cause clearly defined, would come under other classification. The failure of the heart to beat is, in the majority of cases, the immediate cause of death for, so long as the heart continues to beat, few deaths occur.

The cause of death has not been fully stated when Heart Disease alone is written on the death certificate for there is, in a great majority of deaths, some cause back of the heart failure and that condition or disease is, in fact, the cause of death. So long as physicians, coroners and local registrars are satisfied with Heart Disease as a complete statement of the cause of death, the statistics relating to such deaths will be of no value.

For these reasons the tabulation of deaths due to diseases of the circulation include 73.8% under the title of Heart Disease, 16.9% to Diseases of the Arteries, 7% to Angina Pectoris and 65 deaths due to other diseases of the circulatory system.

DEATHS DUE TO DISEASES OF THE CIRCULATORY SYSTEM BY YEARS

TotaL _____________ 1923 ________________
1922 ________________ 1921 ________________ 1920 ________________

Total
9,719 2,953 2,434 2,097 2,235

Total
5,244 1,542 1,337 1,110 1,255

White

Male Female

2,938 899 767 621

2,306
643 570 489

651 604

Negro

Total Male Female

4,467
1,411 1,095
985 976

2,269 723
540 496 510

2,198 688 555 489 466

DEATHS DUE TO DISEASES OF THE RESPIRATORY SYSTEM

The epidemic of Influenza in 1920 affected the mortality from diseases of the respiratory tract as shown by the mortality report of that year in which 3,338 deaths from diseases of this character were reported.

In 1921 the number fell to 2,311 but the return of Influenza during the latter part of 1922 increased the mortality report to 2,908. This epidemic increased the number of deaths due to respiratory diseases during the early part of 1923 and increased the total for that year to 3,612, the greatest number filed in any one year during the existence of the bureau. Of the total12,169 for the four years, 6,398 were whites and 5,763 negroes. Of the whites, 3,299
74

were males and 3,095 females; of the negroes, 3,085 were males and 2,678, females.

Of the 3,612 deaths in 1923 from this class of diseases, Pneumonia lead with 2,352, Broncho-Pneumonia came second with 847 and Asthma, with 115, came third as the chief causes of death in this classification.

While Pneumonia shows an increase of 579 deaths in 1923 over 1922 there was a falling off of 44 in the number of deaths classified as due to Broncho-Pneumonia, due to the efforts of this bureau to ascertain the primary disease in each case ascribed to BronchoPneumonia.

DEATHS DUE TO DISEASES OF RESPIRATORY SYSTEM BY YEARS

Grand

Total

TotaL ____________ _ 1923 _______________ _

12,169 3,612

1922 _______________ _ 2,908

1921 _______________ _ 1920 _______________ _

2,3ll 3,338

Total
6,398 1,805 1,572 1,246 1,775

White

Negro

Male Female Total Male Female

3,299 916 831 620 932

3,095 889 740 623 843

5,763 1,807 1,335 1,063 1,558

3,085 2,678 987 820 735 600 569 494 794 764

DISEASES OF THE DIGESTIVE TRACT

During the past four years there have been 12,692 deaths ascribed to Diseases of the Digestive Tract, 3,163 in 1920, 3,179 in 1921, 3,142 in 1922 and 3,208 in 1923. The slight variation in the number of deaths by years is due to the variation in the completeness of death registration rather than to any increase or decrease in diseases of this class.

DISEASES OF THE DIGESTIVE TRACT BY YEARS

Grand

White

Total Total Male Female

TotaL ____________ _ 12,692 1923 _______________ _ 3,208 1922 _______________ _ 3,142 1921 _______________ _ 3,179 1920 _______________ _ 3,163

7,259 1,8ll 1,797 1,840 1,8ll

3,894 1,006
966
993 929

3,363 805 831
845 882

Negro Total Male Female

5,429 1,397 1,343 1,337 1,352

2,703 2,723 690 70~ 682 660 690 645
641 7ll

There were 71 deaths caused by diseases of the mouth and Pharnyx with 586 by diseases of the stomach of which 74 were ascribed to Ulcer. Appendicitis was given as the cause of 281 deaths, intestinal obstruction, 171; Hernia, 71; 6 deaths were ascribed to Hookworm and 8 to other Intestinal parastites. Diseases of the Liver was given as the cause of 226 deaths, with 90

75

as Cirrhosis of the Liver. On 142 death certificates the cause of death was given as Peritonitis. Although three requests were made in each case for additional information, no reply was received and these deaths may or may not be properly classified. Undoubtedly some may have been puerperal, others due to Appendicitis or other Acute Abdominal condition but without the cooperation of the physicians no exact classification could be made.
DIARRHOEA IN THOSE UNDER TWO YEARS OF AGE
In the separation of deaths due to Diarrhoea in those under two years from the total, the selection of the age limits is an arbitrary one, based on the dependence of the child upon its parents for the selection of a proper diet. Cholera Infantum and that form of Ileocolitis, commonly called "summer diarrhoea," both of which are due to an infection, are found in children over two, though not so frequently as in those under two years. The difficulty in making a diagnosis in the particular form of Diarrhoea has forced the selection of an age limit rather than a classification of the exact form of the disease.
As the common term "summer diarrhoea" implies, this disease is most common during the summer months, wh~n the child is exposed to an improper diet. The records each year show that the peak of the disease in Georgia is reached in June, while an investigation of the death records covering a period of ten years show that North Carolina reaches the peak in July and Virginia in August. It may be stated with accuracy the number of deaths from Diarrhoea that will occur each summer month for the mortality records of a summer are but the repetition of the previous year.
DEATHS DUE TO DISEASES OF THE GENITO-URINARY TRACT
Of the 3,423 deaths classified under this title, 3,139 were due to Bright's Disease. Of this number 668 were acute and 2,471 chronic nephritis. Acute Bright's Disease is frequently a secondary disease and if the primary disease is stated the death is so classified. As the accuracy of the cause of death increases, the number of deaths due to acute nephritis decreases. Of the deaths in this classification, 91% were ascribed to nephritis.
76

While the death rate from all diseases among the negroes is 6.2 per 1,000 greater than among the whites, this ratio does not hold good when the deaths are classified as to the cause. Bearing in mind that the population is composed of 63 whites to 36 negroes, the difference is evident in the deaths from nonvenereal diseases of the Genito-Urinary Tract. Of the 3,423 deaths from this cause, 1,806 or 52.7% were white and 1,617 or 47.2% were negro. There were 1,859 males and 1,564 females included. For each 100 deaths among the females in 1923 there are 118 deaths among the males from diseases of the Genito-Urinary Tract.
DEATHS DURING THE PUERPERAL STATE
All authorities agree that sanitary measures adopted before, during and after childbirth will prevent all deaths due to puerperal or childsbed fever, and the 171 deaths during 1923 from this cause could have been prevented by the use of such measures. The proper training of the mother before pregnancy would have prevented a certain proportion of the 33 deaths during pregnancy and the 69 during labor which were ascribed to accidents, as well as a part of the 69 deaths during this state, the cause of which were not definitely defined. While these statements are true there is no way of estimating accurately the exact number of preventable deaths included in the total 573 for the year 1923.
With the 558 in 1920 and the 568 in 1921, 658 in 1922, 573 in 1923, a total of 2,357 mothers during the last four years, in the performance of their Godgiven function and in their supreme effort to establish a family and a home, the anchors of our civilization, lost their lives because they went blindfolded into the very shadows of death without, in many cases, scientific help or a competent guide.
The educational system is to be blamed. Girls are taught typewriting, bookkeeping, banking, law, medicine, theology and the trades; she learns physical training calisthenics, public health, music, art, literature and religion, in addition to the usual branches taught in all schools, but little or no attention is given in her education to child bearing and motherhood, the only two functions peculiarly adapted to her sex. Fear of childbearing has lead to low birth rates, childless families and increase in divorces. Woman has selected other spheres than those for which she was intended because childbearing and motherhood offered more trouble, worry, suffering and was attended by greater risk of
77

life than the occupations of man. Her lack of proper training and education have resulted in lowering her ideals and lessening her lifting power in holding up our moral standards.

THE PUERPERAL STATE BY YEARS

Year

Total

White

Total ____________________________________ _
1923 ______________________________________ _ 1922 ______________________________________ _
1921 ______________________________________ _ 1920 ______________________________________ _

2,357
573 658
568 558

1,137 288
316
266 267

Negro
1,219 285 341 302 291

The 1921 records show an increase of 10 'vhen compared with 1920. In 1922 there was an increase of 90, or 15%, over the number of such deaths in 1921, while in 1923 a decrease of 85, 28 whites and 56 negro women. Of the 573 deaths in 1923, there were 288 who were white mothers and 285 negro.

DEATHS IN CHILDREN, 1923
In addition to the 2,878 deaths due to diseases and conditions peculair to early infancy there were 2,793 deaths in infants under 1 year of age, making a total of 5,629 or 16% of all deaths occurring during the year. There were 2,668 deaths in children from 1 to 5 years of age. With this addition the total reaches 8,297 which is one-fourth of all deaths in all ages.
Not including stillbirths, there were 8,999 deaths under 10 year of ago. Of these deaths 62% were babies under 1 year, 29% from 1 to 4 years, inclusive, and 7% between 5 and 10 years of age. If the stillborn be considered in conjunction with those deaths occurring after birth, then 72% of those under 10 years of age were prior to the end of the first year, 21% between 1 and 5 years and less than 6% from 5 to 10 years of age. If maternity and infant welfare work be associated and the prevention of deaths be the ultimate aim of such work, it would seem proper for more than two-thirds of the work to be devoted to the mother and child prior to the end of the first year: of the child's life, one-fourth of the work to those with children between 1 and 4 years of age and less than 10% of the work to those families with children between 5 and 10 years of age, for in the proportion do the deaths occur.

78

.....
2S,84p DEATHS AFTER THE STH. YEAk
GEORGIA'S MORTALITY RECORD - 1923
DEATHS IN EARLY INFANCY During the last four years 10,068 certificates have been filed, giving the cause of death as due to some condition peculiar to early infancy. Of this number 9,667 were ascribed to diseases of early infancy, wiuh 401 as due to deformities. The lack of accuracy in stating the cause of death on these records makes them of little valuefor comparative purposes, for in many such cases, exact diagnosis is impossible. This total includes 57 white to 43 negro babies and the 10,000 records indicate that the babies' risk is about the same, regardless of race. The total"includes 5,710 males and 4,327 females. Out of each 100 deaths due to such causes there were 57 males to 43 females.
79

During the past four years, the number of deaths from deformities has dropped from 110 to 83, a decrease of 27, while the number of deaths from diseases of early infancy has increased from 1,758 to 2,795, and increase of 1,037, which increase of 58.9% is probably due to increase in the registration of infants' deaths.

INFANT DEATHS DUE TO MALFORMATIONS

BY YEARS

White

Negro

Year

Total Total Male Female Total Male Female

TotaL_____________ 401 298 162 134 102

52

50

1923________________ 83

62

34

28

21

12

9

1922 ________________ 101

75

41

32

26

14

12

1921 ________________ 107

80

46

34

26

15

11

1920 ________________ 110

81

41

40

29

11

18

DEATHS DUE TO DISEASES PECULIAR TO EARLY INFANCY

BY YEARS

White

Negro

Year

Total Total Male Female Total Male Female

TotaL ____________ _ 9,667 5,510 3,225 2,279 4,139 2,271 1,864

1923---------------- 2,795 1,574 931 641 1,219 660 558

119922L2_-_--_-_-_-_-_-_-_-_-_-_-_-_--_

2,741 2,373

1,425 1,357

824 807

601 1,308 546 1,008

729 578 546 460

1920---------------- 1,758 1,154 663 491 604 336 268

DEATHS DUE TO OLD AGE

According to the Biblical standard, a life of three score and ten, or seventy years, is to be considered usual and, if by chance, one lives after that age he may be considered old. An arbitrary standard in the past has made the age of seventy as the limit and a death prior to that age cannot be accepted as due to senility. In the old when the human machinery has worn out, it is, in many cases, a most difficult matter to make a diagnosis and to state the exact cause of death.

There were 1,128 certificates on which no cause of death was given other than old age. Of this number 540 were for whites, 588 for negroes. There were 475 males, 193 white and 282 negro; 653 females, 347 white and 306 negroes.

DEATHS DUE TO EXTERNAL CAUSES

In the classification of all deaths there are two general subdivisions, first, deaths due to disease, and second, deaths due to external causes. Under the classification of deaths due to external causes are classified suicides, accidents and homicides. In many cases the facts cannot be ascertained and an exact classification cannot be made, for in such cases, the responsibility of the death

80

must be placed on some individual and a complete and accurate statement would incriminate that individual. If the truth could be discovered in each and every case, it is probable that many infant deaths would come under the classification of accidental or homicidal, rather than "found dead in the bed," or "unknown" or "stillborn."
Dead bodies are found and in such cases unless some wound is easily seen, the death is ascribed to "natural causes." Until coroners and registrars realize that the enforcement of many criminal statutes are dependent upon ascertaining all the facts where deaths are due to external causes and where physicians are not in attendance, the courts will be helpless in administering justice and the statistics of such deaths will be of little value.
GEORGIA'S MORTALITY RECORD - 19~3
2246 DEATHS DUE TO CAUSES OTHER THAN DISEASES
81

While the law provides that where there are eye witnesses to a death due to violence it is not necessary to call a coroner, the local registrar is not relieved of the responsibility and he should in every case refuse to permit the removal or burial of the body until a complete record is made of the death.

During 19~3 there were ~.~46 deaths in Georgia due to causes other than disease, as compared with ~.~11 in 19~0. ~.17~ in 19~1 and ~.~56 in 19~~. In 19~3 there were 166 suicides, 1,535 accidents and 511 homicides. The past year's records show a decrease of 15 suicides over 19~~ and 1 less than 19~1.

Accidental deaths during 19~3 increased 54 over the number in 19~~ and 58 less homicides in 19~3 than in 19~~.

DEATHS DUE TO EXTERNAL CAUSES

Total

Total ____________________ _ Suicides _________________ _

8,885 642

Accidents ________________ _ 5,652

Homicides _______________ _ 2,109

Not otherwise classified__ _ 476

1923
2,246 166
1,535 511 34

1922
2,256 181
1,481 569 23

1921
2,172 167
1,258 551 196

1920
2,211 128
1,378 478 223

SUICIDES
Of the 166 suicides in 19~3. 103 or 6~% were accomplished with firearms, 31 by poison, 9 by cutting instruments, 4 by drowning arid 1~ by hanging.
Of all suicides 89.7% were whites and 84% were males. As to race and sex 75% were white males, 14.4% white females, 84% negro males and 1.~% negro females.

DEATHS DUE TO ACCIDENTS
There were 1,535 deaths ascribed to accidents during 19~3 as compared with 1,481 irr 19~~. 1,~58 in 19~1 and 1,378 in 19~0. Carelessness is not, in all cases, the cause of a fatal accident as such deaths are classified, for there are no known means by which the 31 deaths caused by lightning could have been prevented. The 60 deaths due to the careless handling of machines and machinery, the ~67 caused by automobiles, the 140 by firearms and the 144 by railroads, with the 9 caused by street cars, the 14 by electricity and the 11 due to the absorption of poisonous gases, a total of 645, could have been pren~_nted by the passage and the enforcement of certain statutes.
82

DEATHS BY ACCIDENTS, 1923

Total

White

Negro

Deaths Total Male Female Total

Accidents, TOTAL______ 1,535 832 581 251 702

Poisoning by Food______ 18 4

1

3 14

Other acute poisonings. 62 34 23 11 28

Conflagration __ .. __ . __ . 168 68 23 45 100

BuErxncs.) (__C.o_n__f_l_a_g_r_a_t_i_o_n___ 111 48

25

23

63

Ab(}saosr_p_t_i_o_n__d_e_l_e_t_e_r_i_o_u__s_ 11 3

3

8

Mechanical Suffocation 11 5 4 1 6

Accidental Drowning ___ 108 43 32 11 65

Traumatism by firearms 140 53 46

7 87

Trpaiuemrcaitnigsm__,__c_u_t_t_i_n_g_,___

75

5

2

Traumatism by fall _____ 208 146 65 81 62

Traumatism in mines ___ 3 2 2

1

Trcahuimneasti_s_m___b_y__m__a_-_____ 60 34 34

25

Traumatism (Other) ____ 78 35 32

3 43

Traumatism by Railroad 144 89 75 14 55

ATruatuommoabtiislmes _b_y__S_t_.__C_a__rs_

95 267 189

5 154

35

4 78

Other Vehicles _________ Aeroplanes _____________ Landslides ______________

26 15 11 51

14
1 1

1 11 4

Injuries by animals _____ 18 12 11

1

6

Starvation______________ 6 2

1

1

4

Excessive cold __________ 3 1

1

2

Effects of heat _________ 6 2

1

1

4

Lightning ______________ 31 17

9

8 14

ElEexcctr.)ic_i_t_y__(_L__i_g_h_t_n_i_n_g___ 14 10

9

1

4

Other Accidents ________ 20 8

4

4 12

Male
492 6 18 32
29
6 3 53 67
2 48
24 40 50 2 66 8
3 5 1 2 2 12
4 9

Female 210 8 10 68
34
2 3 12 20
14 1
1 3 5
2
12 3
1 1 2
2 2
3

Of the total accidental deaths m all ages 351 or 27.7% were children under 10 years of age. Of these children 52 were under 1 year, 179 between 1 and 5 and 120 were between 5 and 10 years.

Of the babies under 1 year, 16 were burned, 2 drowned, 2 were killed by firearms and 1 by an automobile.

Of those between 1 and 5 years, 91 were burned, 11 killed by automobiles, 8 by firearms and 7 in railroad accidents.

83

GEORGIA'S MORTALITY RECORD 1923

DEATHS DUE TO CAUSES OTHER THAN DISEASE

HOMICIDES

Of the 511 homicides, 126 were white and 385 were negroes, 440 were males and 71 females. They were in the proportion of I 0 white females to 60 negro females, 10 white males and 26 negro males. Firearms were the instruments used in 379 or 74% of all homicides. There were 6 legal hangings with 126 homicides accomplished by other means.

HOMICIDES BY YEARS

White Total Total Male Female

TotaL ____________ _ 2,109 517 465

52

1923 _______________ _ 511

126

116

10

1922 _______________ _ 569 147 136

11

1921 _______________ _ 551

143

129

14

1920 _______________ _ 478

101

84

17

Total
1,586 385 418 406 377

Negro Male Female
1,305 281 324 61 333 85 347 59 301 76

84

Total 1923 1922 1921 1920

All Means _________________________ _ FirearDls __________________________ _

2,109 1,580

511 379

569 427

551 478 405 369

Cutting or Piercing InstruDlents__ 336 121

97

66 52

Legal Hangings ___________________ _ 16

6

5

2

3

Mob Hangings ____________________ _ Other Means _____________________ _

5 172

0

5

0

0

5

35

78 54

DEATH RATES FROM EXTERNAL CAUSES

The bare statement that a certain number of deaths due to external violence in any city, county or state may be misleading and may not represent the actual conditions. To form an idea as to the comparative number of such deaths the rate based on the population must be considered. The latest available rates for the United States and the individual states are for 1920. In that year the United States had a suicide of 10.2, an accidental death rate of 71.4 and a homicide rate of 7.1 per 100,000 population.

The rates for Georgia in 1923 were, for suicides 5.9, for accidental deaths 54.8 and for homicides 18.2 per 100,000 population. In the comparison of the rate of accidental. deaths the Census Bureau, in addition to accidents, includes other undefined causes while in the Georgia rates only accidents, plainly described, are included.

The highest suicide rates in 1920 were in California (20.1), Washington (18), Colorado (15.7), Montana (15.4) and Oregon (13.8).

The lowest rates were in Louisiana (4.7), Noth Carolina (3.9), South Carolina (3.5) and Mississippi (3.2).
The states showing the highest accidental death rates were Washington (91.4), California (87.4), Pennsylvania (86.6), Colorado (86) and Utah (85.2), with the lowest rates in Kentucky (56), North Carolina (55.9), Tennessee (5!;.7), Missouria (53) and Wisconsin (52.7).
The highest homicide rates were in Florida (20.2), Mississippi (19.8) and in South Carolina (15.2), with the lowest rates in New Hampshire and Rhode Island (1.8), Wisconsin (1.7) and Maine (1.4).
It is noticeable that, if the two years be compared, Georgia stood third in the homicide rate, that is, there were two states, Florida and Mississippi, having a higher homicide rate. If the races be separated then the comparison is quite different. There

85

were eight states, California (8.2), Colorado (9.2), Florida (8.8), Kentucky (9.0), Missouri (7.9), Montana (8.2), South Carolin~ (9.4) and Virginia (7.5) -which had higher homicide rates a~ong the white race than Georgia with 7. The United States Mortality .reports for 1920 does not show the negro rates except in those states having more than 10% negroes, in such states there were but two which had a higher rate than Georgia in 1923. The states having 10% or more negro population and their homicide rate were as follows: Maryland (16. 7), Virginia (19.9), South Carolina (20.8), North Carolina (21.2), Louisiana (25.4), Mississippi (31.7), Tennessee (42.4) and Florida (42.5) as compared with the Georgia rate of 37.8 in 1923.

DEATHS DUE TO UNKNOWN OR ILLDEFINED CAUSES
Of the 37,394 deaths, including the stillborn, the cause on 1,566 (4.1%) were illdefined or not stated. If the stillbirths be excluded there were 4.5% illdefined. Of this number 629 were for whi1es .and 932 for negroes.

.~ The Bureau of Vital Statistics ~as ~rganized January 1, 1919. In that year of 19,702 death records, 1,962 or 9.95% were illdefined.. In 1920 there were 2,762 oi: 8.39% illdefined causes of death. on the 32,881 certificates. The Federal Bureau of Census made a test of the efficiency of 'dettth registration in Georgia and the . state was admitted to the registration area for deaths. With '!'his admission was extended the franking privilege to the Special Agents of that Bureau and he was instructed, so far as possible,, to bring_ the causes of death up to the standard set by the International List. of Causes of J?eath. This
. res.ulted, not only in a great sav-
ing of po~tage to the State

or GEORGIA'S MORTALITY kECORDS
ILLDEriNED CAUSES O~ATH
I'I~CINTAOI 0~ ILLDI~UID
lACK YI-A.
I
l-l - 9%-'

\.

8%---

-

,,
7'f.- - - - - -

6%- -- - - -

5%-- - - - - - - - - .5%

-~ .

1~31 4" 1919 1920 1921 1922

'4%

S6

Bureau and the physicians in replying to such letters but also, in reducing the number of worthless death certificates, and in 1922, of the 31,849 death certificates filed, only 1,494 or 4.69% were illdefined or not stated. The year 1923, the second year in the registration uea, shows a small reduction of these ill-defined, the total being 1,566, or 4.58%, out of a total of 34,143 death certificates.

This record is indeed a compliment to the physicians and registrars of Georgia. Florida's second year in the Registration Area showed 5.1% ill-defined and Mississippi's second year 10.3%. After the 4th year Tennessee had 5.8% ill-defined causes of deltth. After 12 years in the registration area North Carolina had 9.4%.

Year

Total Number Percentage Deaths Illdefined Illdefined

1919_1920_192L_
1922_1923_-

----------
-

-----

19,702 32,881
29,552 31,849 34,143

1,962 2,762 2,466
1,494 1,566

9.95% 8.39% 8.34% 4.69%
4.58%

'I