Annual report of the Georgia State Board of Health for 1924 [1925]

ANNUAL REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR1924
ATLANTA, GA.

ANNUAL REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR1924
ATLANTA, GA.

STATE BOARD OF HEALTH Robert F. Maddox, President.................... Atlanta James H. McDuffie, M. D., Vice-President........ Columbus Chas. H. Richardson, Jr., M. D ................. Macon Arthur D. Little, M.D.......................... Thomasville John W. Daniel, M. D.......................... Savannah W. I. Hailey, M. D............................. Hartwell Fred, D. Patterson, M. D........................ Cuthbert John A. Rhodes, M. D.......................... Crawfordville A. C. Shamblin, M.D.......................... Rome A. A. Lawry, D. D. S........................... Valdosta M.S. Brown, M.D............................ Fort Valley C. R. Brice, D. D. S............................ Gainesville N. H. Ballard, State Superintendent of Schools,
ex-officio................................ Atlanta Peter F. Bahnsen, State Veterinarian, ex-officio ... Atlanta T. F. Abercrombie, 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
Dire~tor, 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 School for Mental Defectives.
3

To His Excellency, Hon. Clifford Walker, The Governor of Georgia.

Atlanta, Georgia June 22nd, 1925.

Dear Sir:-

In compliance with the law, I submit, to be transmitted through you to the General Assembly, the Twenty-first Annual Report of the State Board of Health for the year ending December 31st, 1924. In this report will be found an account of the various health activities in the state for the period mentioned, together with statistical tables and recommendations. The. report is arranged in the following order:

1. Introduction and Summary. 2. Bureau of Vital Statistics. 3. Morbidity Reports. 4. Division of Laboratories. 5. Child Hygiene. 6. County Health Work. 7. Sanitary Engineering. 8. Malaria Control. 9. Field Study in Malaria. 10. Venereal Disease Control. 11. Tuberculosis Sanatorium. 12. School for Mental Defectives.

Very truly yours T. F. Abercrombie, Secretary,
State Board of Health.

4

INTRODUCTION AND SUMMARY T. F. Abercrombie, M. D., Secretary
Fortunately the State did not suffer from any serious outbreaks of communicable diseases the past year. Typhoid fever showed an increase during the typhoid season, but the total number of deaths did not show the advance feared owing to the number of cases. There were sixty-six more deaths in 1924 than in 1923. Reference will be made to the investigations of typhoid under epidemiology.
LABORATORIES
The laboratory did the usual routine work during the year. There was a slight increase in the number of specimens handled over any previous year, the total number being 43,620, an increase of 4,291. The 43,620 specimens handled does not mean the total number of examinations made in the laboratories since frequently a specimen requires several examinations. (See report, page 37.)
VENERAL DISEASE
The Venera! Disease Control Division has done a great amount of work with very little state money. The Federal Government has almost entirely withdrawn its appropriation making it necessary to affix a small charge for the keidel tubes and arsphenamine sent out from this office. Regardlessly of this change the physicians have seemed to appreciate the service the department is rendering, and are patronizing the laboratory more than ever. There were 19,832 wassermanns made, representing all but thirteen counties in the state and ranging from 8,349 in Fulton County down to only one specimen in several counties. The distribution of arsphenamine totaled 26,476 doses.
This Division has carried on a great deal of educational work, which I, personally, think is of greater value, although its results cannot be measured in dollars and cents, than all of the treatments that have been given. The United States Public Health Service detailed two of its educational workers to us for the year, one for the colleges, and the other for women and high school
5

girls. These workers were of an exceptionally high type and very tactful, and no one can estimate the good they have done. "The Science of Life'' was handled by Mr. Ricker in the colleges and universities, and "The Story of Life", by Miss Simpson in the high schools. These same workers during the summer months carried their message to the rural school teachers assembled at the twelve agricultural colleges.
Through this Division we cooperated with Emory University in putting on a medical institute and clinic in the City of Atlanta which were attended by approximately 500 physicians.
The several clinics that were originally started are still in operation and doing good work. (See report, page 142.)

EPIDEMIOLOGY AND MORBIDITY REPORTS

The number of communicable diseases reported to the State

Board of Health during the year 1924 dropped off somewhat. This was due to the fact that we were contemplating a change in

'1

the method of collecting these reports and, during the latter half

of the year, were not active in pushing the matter. We were

delayed in getting our material printed by the United States

Government. However, the number of diseases reported gives

a pretty clear insight into what is happening throughout the

state. (See graphs, pages 34-36.)

As stated in my opening paragraph, there was an inc1ease in typhoid fever throughout the state. No serious outbreaks occurred in large centers of population, though there were several minor epidemics in some of the smaller communities. The State Board of Health was called on in a number of instances to determine the source of infection and help control the epidemic. Blakely had an epidemic early in the year, and the State Board immediately put its forces in the field, and, after a thorough investigation, found the source to be an unsafe water supply due to a cross connection of sewer and water. When this was corrected the epidemic &topped. Another interesting epidemic was at Toccoa where there was an unusual number of cases and several deaths. When the State Board was notified, an expert was immediately sent to determine the cause, and, after a thorough investigation, it was found that there was a dairy in which one

6

of the workers was a carrier of typhoid. When this was determined and the carriet eliminated from handling milk the epidemic ceased. Another epidemic was in a farm community, in the vicinity of Fort Valley, due to a polluted well. Another in the vicinity of Greensboro was also due to a polluted well. These were stopped, as in the other cases, by finding and eliminating the sources of infection.
COUNTY HEALTH WORK
The County Health Work has not made the progress that we would like. We firmly believe that to make satisfactory progress there should be a state fund to be used to subsidize the work in counties. We are trying an experiment in a three county unit in South West Georgia, which seems to solve the problem where one county cannot care for its own health work financially.
If the people of Georgia are to receive adequate health protection it will be through well organized and properly manned county health departments, and not from a central office !lfthe State Boatd of Health. It might be well to consider some changes in the Ellis Health Law to make it more effective and easier to put in operation. Just what these changes should be I am not quite ready to say. The effectiveness of the Law is demonstrated in the reduction in typhoid fever in the counties which have full time health departments as compared to the whole state. (See report, page 59.)
CHILD HYGIENE
The work of the Division of Child Hygiene increased during the year, 1924. This is a very popular type of work, appealing especially to mothers, and owing to its fundamenta nature it is a type of health work that should be done.
The Healthmobile has been in the field its third season. It is impossible to estimate the good from an aducational angle that this unit has accomplished. In fact, the report of each Division of the Board reflects the good effect of this field unit. The number of physicians .--patronizing the laboratory has increased tremendously. Only two counties in the state did not take advantage of the facilities the laboratory offers, Dawson and Union, and it should
7

be observed that these counties were not visited by the Health-



mobile.

At the annual meeting of the Medical Association of Georgia a resoltltion was passed instructing the State Board of Health to prepare a set of rules and regulations for the education and instruction of midwives. (See page 47.) They have been prepared and were recently adopted by the Council of the Medical Association. At the proper time I shall present them for your adoption to give them the effect of law.

The legislature passed a special appropriation giving $5.000 to the Division to be matched by Sheppard-Towner funds. Attention is called to the program of the Division of Child Hygiene beginning on page 49. The Georgia Baby Book was revised and printed during the year. It was almost entirely re-written by the Georgia Pediatric Society and is a book of which the Division is very proud.
SANITARY ENGINEERING 1
The Sanitary Engineering Department was unusually busy during the year 1924. Besides keeping a close watch on publjc water supplies in the state the engineering part of the malaria control work has developed to such an extent that the Department. c.annot render the service required without some expansion. The following list of surveys-in all 292-will give an idea of the amount of work this department has to do:

Water Works ............................... 94 Sewerage System, Sewerage Disposal and Sani-
tary Privies ............................ 22 Swimming Pools. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Garbage and Refuse Disposal. . . . . . . . . . . . . . . . . 1 Malaria and Drainage ................. : ...... 143 General. ................................... 29

In 1922 there were only 56 cities listed as having excellent water supplies. In 1924 the number increased to 143. No one can estimate the amount of sickness prevented by bringing the water supply of these cities from a doubtful and dangerous condition to the point where it is known to be absolutely safe.....
A comparison of the money spent by different municipalities and cities in the state in malaria control will give a fair idea of the

8

increase in this work. In 1J)20 only $48,000 was expended for this service, while in W24 the expenditures amounted to $123,000. This work is all supervised by the Sanitary Engineering Department. (See report, page 70.)
MALARIA
As malaria constitutes one of our major health problems a great deal of attention has been given to it during the past year. There are many agencies and organizations working on this problem, and I firmly believe that we are making progress towards its eradication.
As shown above the Sanitary Engineering Department has had control and supervision of the engineering features in communities doing malaria control work.
Dr. M. A. Fort, employed jointly by the State Board of Health and the International Health Board, has been doing survey and educational work in South Georgia. He has rendered a service in popularizing the need of Malaria control measures that will bear fruit for years to come.
The International Health Board has a station at Leesburg, Georgia,in Lee County, which is making investigations on malaria.
Dr. S. T. Darling lfJ in charge of this Station. Hi,f'! findings are
already of great importance. They will undoubtedly simplify malaria control in the future. (See reports, pagea 123-141.)
Vl'TAL STATISTICS
The Vital Statistics Bureau, with its 390,000 birth certificates and 204,000 death certificates accumulated during the six years of its existence is more and more showing its value to the state. These reports, along with the morbidity reports, coming in every day, keep the Board informed of the conditions in every part of the state and serve somewhat as the gauge in the engine room of a great manufactuling plant. As indicating conditions affecting the health and welfare of the state, thus showing when and where the service of the Board is most needed, the Bureau has already m01e than proved its worth and it is now getting in position to render equally valuable service, though of a different kind, to
9

many individuals in this and other states as is shown by the increase in the call for certified birth and death records in the past four years. One Hundred Ninety-four certified birth records were issued in 1924, ninety-two of these being world war veterans. These were required in securing compensation. Three Hundred Twenty-one certified death records were issued, all of them necessary in securing insurance settlements, pensions or other adjustments of estates, school entrances, mothet's allowances, bond settlements, etc.
Attention is called to the report of the Bureau beginning on page 14 and the suggestions of the Director for the improvement of the service.
ALTO
The Sanatorium at Alto in actual routine work has cared for practically the same number of patients as last year but at a smaller per capita cost. The institution is making its impression on all phases of tuberculosis work in the state. (See report, page 148.)
MENTAL DEFECTIVES
The School for Mental Defectives has cared for about the same number of patients as during the preceding year.
Dr. Preston, the Superintendent, offered his resignation to take effect January 15th, 1925. He has accepted a place in Richmond, Virginia, at a much larger salary and work more to his liking. The state has suffered a serious loss in Dr. Preston's leaving. Out of all of the men considered for the superintendency, when he was selected, he was the only one with a vision of a state wide mental hygiene program. He was just beginning to work his way into the school systems of the state with a view to solving the problem at its source. The real work of a mental hygiene program is to find the mental cases in the schools and homes and plan for their care before they become institutional cases, and that was what Dr. Preston was beginning to do. The work of the institution under such a scheme is to care for extreme and exceptional cases.
10

LEGISLATION
There was only one piece of legislation passed at the last session of the Legislature, and that was an appropriation of $5,000 to match Sheppard-Tower funds for Maternity and Infancy work, which has already been mentioned in this report.
LAW ENFORCEMENT
At the last annual meeting of the Board attention was called to the fact that the Vital Statistics Law was being disregarded by certain counties. Houston County in particular had refused to pay the fees. The Secretary was instructed to start court proceedings to settle the question as to whether the state had the right to enforce the law. Mandamus proceedings were instituted and Judge Mathews rendered a decision upholding the law. Houston County has appealed the case to the Supreme Court, and a decision has not as yet been rendered by that Court.
If we are to retain the Ellis Health Law in its present shape mandamus proceedings against some of the counties that are violating the law should probably be instituted to determine whether the State Board of Health should enforce this law, or allow it to be ignored after the will of the people has been expressed through their Grand Juries.
HEALTH EDUCATION
Health Educational work cannot be measured in actual results accomplished, but I have become more convinced in recent months that proper legislation and proper support from the legislature will only come through the education of the masses. This was brought forcibly to our attention during the summer of the past year when, in cooperation with the State Department of Education, we participated in the program of the summer schools, held at the twelve agricultural schools, in an effort to give the teachers some of the fundamentals of public health. The woeful lack of information among teachers regarding hygiene and sanitation was brought to our attention. Numbers of them did not know that such a thing as the State Board of Health or even a County Board of Health existed. If our teachers do not know the fundamentals of public health, it is unreasonable to expect the people to demand the legislation necessary for public health protection.
11

COOPERATING AGENCIES
The active cooperation of many other agencies has greatly benefitted and extended our work the past year.
The United States Public Health Service made a most valuable contribution, detailing to us Dr. C. E. Waller, head of the County Health Department, and Mr. Ricker and Miss Simpson, who have already been mentioned in this report. The Service has also furnished us much educational material, and franking privileges thus saving an immense amount of postage.
The International Health Board has continued its support financially. This organization is paying half of the expenses and salary of Dr. Fort, and also Mr. Clarkson, Assistant Sanitary Engineer, and some of the office expenses.
The Children's Bureau is giving valuable aid. It is the source of the Maternity and Infancy funds which have already been mentioned.
The Medical Association of Georgia has shown a fine spirit of cooperation, responding to various calls .for help. It is due to their assistance that a great many of our educational programs have been put ove'f. I can say unhesitatingly that we have the full support and confidence of the organized medical profession of Georgia.
The State Department of Education has cooperated with us, and we with them in their educational programs.
The State College of Agriculture through its home and farm demonstration agents is doing effective work in carrying health education to the rural districts. We have recently been asked to collaborate with them on an educational program.
Just before the end of the year a Committee consisting of representatives from the Georgia Educational Association, the Medical Association of Georgia, and the State Board of Health, met for the purpose of formulating plans for better health education in the rural schools. This Committee appointed a subcommittee, of which your secretary is Chairman, to work out a program to be presented to the meeting of the Georgia Educational Association in April. Cooperation of this kind shows that we are beginning to be accorded the leadership in Health Education that the Board has justly coveted.
12

Some years ago I made the statement that the Vital Statistics Department would in a few years tell us whether we are making progress and now, in closing this report, I wish to point to the reduction in the communicable diseases as an evidence of real progres,s. I think that we have now reached the stage where we should not stress through addresses or publicity the dark side of the picture exclusively, but point to the fact that we are making progress. I do not mean to say that we should not recognize and face conditions, for health conditions in the state are far from good in many instances, but in presenting these problems to the public I feel that we are now justified in pointing to our constructive achievements as the best possible stimulus to public cooperation and argument for still better conditions.
The outlook for the usefulness of the State Board of Health is extremely bright.
13

BUREAU OF VITAL STATISTICS
W. A. Davis, M. D., Director
The standard required by the United States Bureau of the Census for admission to the Registration Area for Deaths in Georgia was reached in 1921, as shown by the test in 1922. The Bureau of Vital Statistics has not made the progress that was hoped for in birth registration. A test of the 1922 birth registration was made by the Census Bureau in the early part of 1923, showing that only 85% of the birth records were filed. Not satisfied with the small sample (1,900 out of 11,000 birth certificates filed), secured by the Census Bureau, a second test was begun in 1923 and completf;d in 1924. This test included 6,783 children who were born and who died during the first eleven months of 1923, and showed the same result, 85% filed.
The statute requiring the Justice of the Peace to secure the birth and death records of his district is a wise provision, but these officials are elected every four years, resulting in more than 50% being changed in 1921 and similar disturbance is going on now, following the 1924 election. These new men are elected to office regardless of education or qualification and must be trained in the methods of handling the records. The amendment passed in 1919 was also a wise provision. This amendment is mandatory upon the State Board of Health to remove any registrar when, in its judgment, he is not securing the records from his district and to appoint a registrar who will serve until such time as ,the people elect a Justice of the Peace who will comply with the requirements of the Vital Statistics Law.
In 1920, five counties refused to pay the fees due the local registrars. In twenty-six counties the financial conditions were such that vouchers payable some time in the future and subject to from 10% to 17% discount were issued. Since that year the financial conditions have improved. However, in 1923 Houston County refused to pay the fees due the local registrars. In 1924 mandamus proceedings were instituted in the Circuit Court of that district, with the result that in November Judge Mathews decided that the Law was constitutional and that the mandamus proceedings must be sustained. Houston County then carried the case to the Supreme Court and up to this time the opinion of that Court has not been rendered.
14

Birth and Death Registration is law enforcement. The Bureau must have the assistance of an attorney, since the State's Attorney-General is not in position to render the necessary assistance.
These, and many minor drawbacks, until overcome, will continue to retard registration of births and deaths in Georgia.
At the close of the year 1924, the Bureau, during the six years of its existence, had accumulated more than 390,000 birth and 204,000 death certificates, a ~otal of 594,000 records, available for the use of the public in settling insurance matters, both corporation and Government, in securing compensation and pensions from the Federal and State Governments and in the just adjudication of legal questions relating to persons or property, not to mention the laying of the only firm foundation for future public health work, the only purpose of which is to prevent disease and death.
The issuance of certified copies of birth and death records has increased 252% in the past four years. From 146 certified copies in 1921, the number increased to 252 in 1922, and from 298 in 1923 it jumped to 515 in 1924. As the indexing of the records is just one year behind the reports as filed, this increase in the demand for certified copies requires almost the entire time of one clerk to search the records, issue the copies and attend to the necessary correspondence.
15

INCREASE IN CERTIFIED COPIES ISSUED
1921 TO 1924 INC~USIVE BY ya ARS

76

70

B B 1921

146

I 1922

141
BtRTH

Ill

I I I DEATH

252

145

153

I II 1923

BIRTH

DEATH

I 298

194

I 1924

BIRTH

II

321
OE.&.TH

I 515

Of the 194 certified copies of birth records issued in 1924, 92 were for the use of World War Veterans in securing increased compensation. Of the 321 cettified copies of death records, 132 were necessary in the settlement of corporation life insurance, 68 in Government insurance, 12 in securing pensions and 7 in the settlement of estates. Other reasons given were as follows: passports, school entrance, law suits, release from Navy, mother's allowance in Canada, bond settlement, War Saving Stamps, Georgia Workingmen's Compensation, murder trial, claim against a railroad and a suit against the United States Government for burial expenses.
In addition to this service rendered the citizens of Georgia, the Bureau, through the local registrars, attempts to locate lost friends and relatives.
The three Reid orphans were dependent upon their poverty stricken grandparents in North Carolina. The United States Government was ready to pay the $10,000 insurance which was payable to the parents on account of the death of their brother in France, but the parents could not be found, because they died in
16

November 1918, in LaGrange, Georgia, as shown by the death records of that city. Since the discovery of the death records of Mr. and Mrs. M. E. Reid, the three penniless orphans will receive the $10,000 insurance.
The physicians and undertakers of Georgia do not fully realize the importance of these records. This is shown by the careless manner in which they write them. From 9% to 14% of the certificates show errors or omissions. These carele&:lly written records cost the Bureau much time and money, and are distorting the birth and death rates of the cities and counties ~;o that they do not represent the actual living conditions. A correction is sent to the person responsible for the error but approximately 15% of the errors are never corrected. When an incorrect statement of the place of birth or death is made, unless the local registrar detects such an error, the record remains incorrect.
In January 1923 and again in 1924 the attention of the registrars was called to the possibility of an error in the place of death or birth resulting in the rates of the cities being much higher than the actual conditions indicate. It had been noticed that undertakers and physicians were placing the name of the city as the place of birth or death when in truth the event occurred outside of the city lmits, and the only excuse was that the city was the post office address of the individual. Little attention was paid to these cautionary letters until the published report of the cities mortality rates showed that certain cities had extremely high death rates. The local officials immediately placed the blame on the State and Federal Bureau when in fact the cities had not corrected the original records.
About 10% of the birth certificates are not filed within ten days after the birth as the Law requires, and many local registrars do not see fit to prosecute the physicians resronsible. In fact some go around each month and ask for the records. The handling of these delayed records required twice the time and money of a record filed within the legal time limit. Because of incomplete and delayed records, no statement can be made as to a month's report until from 60 to 90 days after the month's report is received, and one epidemic is over and another in progress before the people can be advised as to the first.
17

When the local registrars adhere strictly to the time limit in filing the records and indict those who violate this provision, then the records may be tabulated within a reasonable time and will be of much greater benefit to those interested in the prevention of disease and death. In addition to that advantage, the local registrar will not be called on to investigate and to secure unfiled records which have been forgotten months before.
On account of the delayed records, the report of the State Bureau of Vital Statistics cannot be prepared until the latter part of June, for at least five months is required to secure and correct and tabulate such records in conjunction with the current report.

Year
1919 1920 1921 1922 1923 1924

BIRTH AND DEATH RECORDS AS FILED.

Births

Deaths

Current Delayed Total Current Delayed

39,268

518 39,786 21,606

34

63,192 1,008 64,200 35,575 127

70,562 3,542 74,104 32,422 748

66,631 3,882 70,513 34,250 713

65,956 2,282 68,238 37,025 677

65,283 1,990 67,273 38,041 544

Total
21,640 35,702 33,170 34,963 37,702 38,585

Since Georgia is not in the Registration Area for births, no birth rates are published although the state shows a much higher rate than certain states whose birth records have been accepted by the United States Bureau of the Census, and are now in the Registration Area. No tests of birth registration will be made in Georgia until the drawbacks previously mentioned are overcome and $2,000, the approximate cost of such a test, is added to the budget for that purpose.

18

The State Board of Health has ordered the Director to submit to each registrar a pledge for his signature and to proceed to secure new registrars in those districts where the local registrar refuses to sign and obey the pledge. The pledge is as follows:
DECLARATINN OF A LOCAL B.EGISTRAR OF BIRTHS AND DEATHS IN GEORGIA
Know All Men By These Presents:
As a citizen, I will obey the laws of this State. As a local registrar of births and deaths, I will inform myself as to the requirements of the Vital Statistics Law and will hold as inviolate the information contained in the birth and death records subject to the general statutes of the state.
As an official, I will obey the law requiring me to secure the birth and death records of my district, to handle these records as required by the State Statutes and will prosecute any individual who with intent violates the provision of the Vital Statistics Law.
Signed ............................ . Local Registrar for District No.... "

BIRTHS

In 1924, there were registered 67,239 births as compared with 38,751 in 1919; 63,291 in 1920; 70,630 in 1921; 69,615 in 1922 and 67,639 in 1923. The high year in birth registration was 1921, while 1923 shows a falling off of 2,991 from the record of 1921 and 1924, a further decrease of 400, when compared with 1923.

The following table shows the decrease by years:

1919 Total Births __________ 38,751

1920 63,:091

1921 70,6W

1922 69,615

1923 67,639

1924 67,239

Total White ___________ 28,045 Male White____________ 14,714

43,314 22,353

46.293 23,944

44,535 22,867

42,889 22,209

43,047 22,063

Female White _________ 13,831 20,961 22,337 21,610 20,667 20,979

TotalNegro __________ 10,302 19,858 24,120 25,042 24,745 24,180

Male Negro ___ -------Female Negro_________

5,429 4,873

10,134 9,724

12,481 11,623

12,773 12,205

12,882 11,850

12,450 11,725

Tot ais show all records not otherwise classified.

19

The registration of births is much more complete among negro midwives than among the white medical profession. of Georgia. This fact was realized when it was found that a marked decrease in birth registration had taken place, with a marked increase in death registration, during the first six months of 1924, and a statement was sent to each registrar showing the number of certificates filed by him and asking the reason for the shortage. The replies were plainly stated. A second statement covering the first nine months of the year was mailed to each local registrar with the same results.
The increase in death registration since the organization in January 1919 has been satisfactory. It i:;;; probable that not over 65% of the deaths were registered during the first year, 1919, and in 1920 more than 4,000 deaths in excess of the usual number were added to the records by the epidemic of Influenz,a that year. In 1921 the report contained 33,170 deaths; in 1922 there were 34,963 and in 1923 the number increased to 37,702, wi~h another increase in 1924 to 38,400.
In the tabulation of deaths, the International List is followed and up to the present time only a partial study has been made of the first seven causes of death.
Of the 38,400 deaths in 1924 in Georgia, 671 were ascribed to Typhoid Fever and 10 to Paratyphoid Fever, which for obvious reasons are considered as a total of 681. There were 550 deaths ascribed directly to Measles, not including those deaths due to complications such as Bronchopneumonia, etc., on which certificates the term measles did not appear. Malaria was given as the cause on 440 certificates, Whooping Cough on 435, with 230 deaths ascribed to Diptheria, 25 to Smallpox and 20 to Scarlet Fever, a total of 2,381 from these seven diseases.
Since January 1, 1919, these seven diseases have killed 11,512 persons in Georgia. Among these victims, 6,036 were white people and 5,471 negroes, and the figures include only the deaths ascribed directly to these diseases, and not those which occurred months after the primary attack and ascribed to the aftermath.
In addition to the seven diseases mentioned in the previous paragraph, the following table includes the tabulation of deaths due to Pellagra, Tuberculosis, Cancer, Diarrhea and Dysentery and Puerperal Septicemia for the years 1920 to 1924 inclusive.
20

MORTALITY RECORDS 1920 TO 1924, INCLUSIVE.

Grand White

Negro

Yea.r Tota.lTotal Ma.le Fe- Total Ma.le Fe-

ma.le

ma.le

l'~' 549 274 144 130 275 131 144 1921 797 351 183 168 446 222 224 Typhoid Fever______ 1922 715 326 171 155 388 191 197
1923 601 244 133 111 357 182 175 1924 681 292 151 141 389 189 200 Total _________________ 3,820 1,715 911 804 2,104 1,044 1,060

1920 559 242 120 122 317 145 172

------------1 Malaria_

r 1921 468 195 92 103 273 125 148
1922 585 257 131 126 326 151 175 1923 489 201 112 89 288 136 152

1924 440 181 84 97 258 117 141

Total _________________ 2,922 1,229 610 619 1,690 779 911

[ 1920 3 2 1 1 1 0 1 1921 19 8 5 3 11 7 4
Smal1Pox___________ ll922 21 10 6 4 11 5 6 1923 2 0 0 0 2 1 1 1924 25 10 8 2 15 12 3
Total _____________ ---- 74 33 22 11 41 26 15

( 1920 60 40 14 26 20
"''"'"-------------! ::: 93 66 31 35 27 52203 1923 347 252 127 125 95 1924 550 359 173 186 191

6 14 12 15 21 45 50 91 100

Total--------~---- ____ 1,089 747 359 388 342 158 184

1920 32 31 13 18 1

1921 28 25 10 15 3

Scarlet Fever_------ [ 1922 24 20 6 14 4

l 1923 20 17 1924 20 16

7 10 79

3 4

Total _________________ 142 127 48 79 15

01 12 13 12 13 4 11

1f 1920 373 240 112 128 133 1921 183 93 46 47 90 Whooping Cough ___ 1922 130 51 24 27 78

56 44 34

77 46 44

1923 254 116 53 63 138 63 75

1924 435 203 87 116 232 104 128

Total_____________ ---- 1,494 767 348 419 726 329 397

400 282 148 134 118 58 60

Diphtheria and

\ m119922o12

415 411

294 277

143 151

151 126

121 134

58 67

63 67

CrOUP-------~----

f~~:

274 230

199 167

Ill
81

88 86

75 63

36 35

39 28

TotaL------------ ---- 1,971 1,418 737 681 553 272 281

21

MORTALITY RECORDS 1920 TO 1924, INCLUSIVE.

Grand

White

Negro

Year TotalTotal Male Fe- Total Male Fe-

male

male

!'~0 432 210

Pellagra____________

~:~

512 527

234 249

1923 444 227

1924 337 181

60 150 222 79 155 277 77 172 278 68 159 217 60 121 156

55 167 56 221 67 211 40 177 28 128

TotaL ________________ 2,252 1,101 344 757 1,150 246 904

\ 119~201 22,,356321

882 892

391 413

491 1,478 479 1,637

638 686

840 951

Tuberculosis-All

1922 2,683 991 447 544 1,692 704 988

Forms____________ 1923 2,644 967 421 546 1,677 706 971

-1924 2-,620

917

437 480 1,702
--

773

929

Total ___________ -- ____ 12,840 4,649 2,109 2,540 8,186 3,507 4,679

\ 119~201 11,,122130

765 802

299 305

466 497

358 407

Cancer ____ --------- 1922 1,212 782 304 478 429

1923 1,263 870 331 539 393

1~4 1,393
--

913

355

558

480

Total _________________ 6,201 4,132 1,594 2,538 2,067

88 270 92 315 88 341 90 303 100 380
458 1,609

757 393 364 493 262 231 \ 1090210 1,'22350 722 407 313 508 287 220 DysenteryandDiar- 1922 1,175 686 394 292 489 269 220 rhea-(2 Yrs.).____ 1923 1,183 698 383 315 485 248 237
-1924 1-,322 736 414 322 586 310 276
Total_________________ 6,160 3,599 1,991 1,606 2,561 1,376 1,184

473 282 142 140 191 76 115 1921 449 271 127 144 178 79 98 Dysentery andDiar- !'o19w23 400 226 97 129 174 77 97 rhea over 2 Yrs,___ 1923 431 258 127 131 173 74 99 1924 567 332 152 180 235 109 126

TotaL ________________ 2,320 1,369 645 724 951 415 535

1920 194 86

fl 1921 189

Puerperal

1922 213

Septicemia________ 1923 171

74 84 69

1924 164 75

TotaL ________________ 931 388

0 86 108 0 74 115 0 84 128 0 69 102 0 75 89
0 388 542

0 108 0 115 0 128 0 102 0 89
0 542

22

DECLINE IN DIPHTHERIA
During the past four years, the mortality from Diphtheria has dropped from 415 in 1921 to 230 in 1924, a saving of 430 children during the three years as shown by the former rate. The record for 1921 was 415 deaths, with 411 in 1922 and 274 in 1923 and only 230 in 1924. If this reduced rate had continued during the past six years, 529 children would I).Ot now be recorded as dead from Diphtheria.

DIPTHERIA DEATHS BY MONTHS.

Grand

White

Negro

Total Total Male Female Total Male Female

1924 ___________ 230

167

January ______ 25

20

81 11

86 9

63 5

35 2

28 3

February _____ March ________ A p r i l __________ May ___________ June __________

17 14 13
5 5

15 11
5 2 2

6 5
5 0 1

9 6
0 2 1

2 3
8 3 3

1 2 4 2 2

1 1 4
1 1

JAuulgyu--s-t -_-_-__-_-_-_-

7 18

5 11

1 8

4 3

2 7

1 4

1 3

September____ 27

18

9

9

October______ 30

28

12

16

9 2

7 2

2 0

Novembe;r_____ 35

22

9

13

13

7

6

DN.ecs.e_m__b_e_r__________

32 2

26 2

14 0

12 2

6 0

1 0

5 0

The tabulation of deaths f;rom Diphtheria by locality shows only that where there are the most people, there are the most deaths. In that group of counties on the Piedmont Plateau, commonly called North Georgia, the 52% of the State's population had 61% of the deaths. South of the Plateau the 48% of the population had 39% of the Diphtheria deaths.

23

,
DEATHS DUE TO DIPHTHERIA J920 TO 1924 INC.
274 221

1920

1921

1922

1923

1924

DEATHS DUE TO MALARIA 1924.

Grand

White

Total Total Male Female Total

1924 ___________ January ______

440 19

F e b r u a r y _____ March ________ ApriL ________ May ___________ June __________ July __________ August _______

18 20 27 26 56 58 63

181 8 10 11 13 9 22 18 21

84 4 4 4 4 5 9 6 10

97 258

4

11

6

8

7

9

9

14

4

17

13

34

12

40

11

41

September____ 54 October ______ 56

21 25

10 14

11 11

33 31

November _____ 19

11

December_ ____ 24

12

8 6

3

8

6

12

Negro Male Female

117 141

5

6

1

7

3

6

7

7

7

10

17

17

14

26

19

22

18

15

14

17

7

1

5

7

24

The mortality from Malaria dropped from 559 deaths"in...1920

~

'

to 440 in 1924. The reduction, although not as marked nor as

regular as in Diphtheria, is sufficient to indicate the results of

the efforts of those engaged in that line of Public Health Work.

The year 1922 showed 585 deaths with a reduction to 489 in 1923.

DUTHS DOE 'TO U4LAR IA ay MOIITIII 1924

JAN F'll MAR APL MAY JUN JUL AUG ali" OCT NOV DEC
However, the 2,922 deaths due to Malaria in Georgia during the last six years is a sufficient number to enlist the interest of every citizen in the malarial belt provided this data can be given him in the proper form.
25

Malaria is a disease almost entirely confined to that portion of the state south of a line drawn between Richmond to Muscogee Counties, which is the southern border of the Piedmont Plateau.
The spot maps for the past six years' mortality from Malaria show this very plainly and at the same time indicate that the group of counties surrounding Appling and Bacon Counties is not so heavily infected as those counties north and west of this group. These maps develop the same condition from year to year, except for slight variations in certain counties.
The 1924 record of Baker County showed a decrease of 8 deaths from 1923, Dougherty from 18 to 13, Chatham from 19 to 11, Wilcox from 16 to 6, Crisp from 22 to 12 and Dooly from 13 to 5, while Early County increased from 15 to 25, Lee from 11 to 17, Miller froni 11 to 23, Worth from 10 to 15, Lowndes from 4 to 8, Camden from 1 to 6 and Glynn, from 1 to 4.
The records for each of the past six years show an increase in Malaria in May or June, the epidemics extending through four months, July, August, September and October, and declining in the fall and winter. Of the total 440 Malarial deaths in the past year, 56 occurred in June, 58 in July, 63 in August, 54 in September, 56 in October, a total of 287 or 67% of the year's mortality from this disease. The greatest number of deaths, (63) occurred in August, the smallest number, (18) in February.
To prevent Malaria, the mosquito breeding places should be destroyed in March and April, before the Malarial epidemic begins.
TYPHOID INCREASE
The 1924 records carry an increase of 81 deaths from Typhoid Fever over 1923, but 34 less than 1922. The greatest number of deaths in any of the last six years occurred in 1921, when the total reached 797, with 715 in 1922. The record dropped to 601 in 1923 and 681 in 1924~ The accumulated records for the six years total 3,820.
26

TYPHOID DEATHS 1924.

Grand

White

Negro

Total Total Male Female Total Male Female

1924 ___________ 679 292 151 141 *38'7 188 199

January ______ 18

8

4

4

10

4

6

February _____ 20

8

4

4

12

6

6

March ________ 15

8

2

6

7

4

3

ApriL ________ 13

3

3

0

10

5

5

May___________ 18

5

3

2

13

6

7

June __________ July __________

51 110

19 48

15 19

4 29

32 62

18 29

14 33

August _______ 163

72

35

37

91

47

44

September____ 124

49

23

26

75

40

35

October ______ 62

26

14

12

36

12

24

November _____ 45

24

13

11

21

8

13

December_____ 39

22

16

N. S, __________ 1

0

0

6

17

0

1

9 0

8 1

*-Subject to revision because of an error which can not be Iocated at this time.

GEORGIA STATE BOARD OF HEALTH BUREAU OF VITAL STATISTICS
TYPHOID FEVER DEATHS 1924
FULTON CO~NTY 48 '(l

27

Typhoid Fever is not restricted to any territory. Of the 160 counties, in 1924, the records show deaths in 140 and.the delayed records when secured, will probably reduce the number of those showing no deaths in that year. The 1924 records, when com-
DEATHS DUE TO TYPHOID fEVEh
BY MONTHS 1924
IIIII
JAN riB MAR APL MAY JUN JU~ AUG SEP OCT NOV DIC
pared with 1923, apparently show a decrease in North and South Georgia, with an increase in the central portion of the state.
There was an increase in Typhoid Fever deaths in Laurens County from 8 in 1923 to 20 in 1924, in Ben Hill County from 5 to 11, in Bulloch County from 3 to 13, in Coweta County from 5
28

to 10, in Johnson County from 4 to 11 and in Elbert County from 1 to 8. While Mitchell County reported 7 Typhoid Fever deaths in 1923 and none in 1924, Spalding's Typhoid record dropped from 17 to 9 and Ware County from 16 to 9.
Typhoid has been known for years to be, like malaria, a seasonal disease. From the table above it will be noted that the increase begins in June, August registering the greatest number of deaths while April had the fewest, 13.
To prevent Typhoid, vaccination should be done in April and May before the greatest number of exposures occur.
MEASLES AND PERTUSSIS The 1,089 deaths from Measles and the 1,494 from Pertussis, a total of 2,583 from these two diseases alone in a six year period, (more than 1,570 of which occurred in the last two years) is a sufficient number to invite the attention of students of preventive medicine and those interested in the convservation of child life in Georgia.
UEATHS UUE TO MEASLES
1919 T1 1924 (INCL) 550
. 347

93

60

34
1919

I
1920

I 1921

-5
lt22

29

The mortality records of the Measles epidemics by years vary more widely than do those of Pertussis. The number of deaths ascribed to Measles jumped from 5 in 1922 to 347 in 1923 and with still an increase to 550 in 1924.

DEATHS DUE TO MEASLES - 1924 BY MONTHS TOTAL550:
TOTAL WHITE NEGRO JAN. 103 7B 25

FEB. ISO 108 42

MAR. 13'7 94 43

APR. 77 42 35

MAY

48 27 21

JUNE

7

3

4

JULY 15

2 13

(

AUG.

4

2

2

SEP.

2

0

2

OCT.

5

2

3

Nov.

0

DEC.

0

The Measles Epidemic followed closely on the heels of the Influenza Epidemic of 1922 and 1923, and in the same chronological order. The greatest number of deaths was recorded in February 1924, the number gradually declining till December, when no deaths were reported.
30


I

DEATHS DUE TO PERTUSSIS 1919 TO 1924 INCLUSIVE
TOTAL I ,482 435
373

254

183

130

119
I

I

1919

1920

1921

1922

1923

1924

Little is done to prevent the spread of Measles and Pertussis, which are erratic in their natures, breaking out like a forest fire, spreading unrestrained and dying out for lack of susceptible material. The foolish belief is still extant that a child should have these diseases in childhood and get over them. Unfortunately they do not all get over them. The 1,494 deaths due to Pertussis in Georgia in the last six years were distributed as follows: 119 in 1919, 373 in 1920, 183 in 1921, 130 in 1922, 254 in 1923 and 435 in 1924.

31

DEATHS DUE TO SMALLPOX, 1924.

Grand

White

Negro

Total Total Male Female Total Male Female

1924 ___________ 25

10

8

2

15

12

3

January ______ 3

2

1

1

1

1

0

February _____ March ________ ApriL ________ May ___________ June __________

2 4 5
6 0

1 2 3 1 0

1 1 3 1 0

0 1 0 0 0

1 2
2 5 0

1 1 2 5 0

0 1 0 0 0

JAuulgyu-s--t -__-_-_-_-_-_-

1 0

0 0

0 0

0 0

1 0

0 0

1 0

September ____ October _______

0 1

0 0

0 0

0 0

0 1

0 1

0 0

November_____ 1

1

1

0

0

0

0

December_____ 2

0

0

0

2

1

1

The record of only 2 deaths from Smallpox in 1923 led to a

circular letter addressed to each registrar, the intent of which was

to locate any unregistered death from that disease, but none

could be found.

.

The six years' records show a total'of 74 deaths which were distributed as follows, 4 in 1919; 3 in 1920; 19 in 1921; 21 in 1922; 2 in 1923 and 25 in 1924.

Smallpox was not scattered over the state but was confined to those counties near Fulton, where there was the greatest number of deaths.

One death was recorded in each of the following counties: Butts, Calhoun, Carroll, Cherokee, Clarke, Cobb, Harris, Henry, Laurens, Newton, Spalding and Upson. Fulton County's toll was 13.
SUGGESTIONS

It would seem fitting for the State Board of Health, if they believe that vaccination will prevent smallpox, if they believe that the proper disposal of human excreta will prevent Typhoid Fever, if they believe that the eradication of the mosquito will eradicate malaria and the Schick test and immuni21ing serum will prevent diphtheria, to advocate publicly and insist on the enactment of a Sanitary Code for Georgia which among other provisions would require:
(1) The vaccination for smallpox of every child born in Georgia during the first thirty days of its life;
32

(2) The use of a sanitary privy at every human habitation and the screening against flies and mosquitoes of every building, camp or tent used or occupied by human beings;
(3) The penalizing of every property owner who permits a mosquito breeding place to exist on his premises within a certain distance of any human home;
(4) The use of the Schick Test and antitoxin before a certain age of life.
There may be some objections to such requirements but the relatives of the 8,787 victims of these four diseases in the last six years will hardly object and the 1,500 yearly obituaries of the victims are unanswerable arguments in their favor.
These epidemics occur with certain regularity every year as shown by the tabulation of the deaths by months. While they exist during the entire year, when the season favorable to their spread comes, the mortality records show the regular annual increase. With the opening of school, Diphtheria deaths begin to increase, reaching the greatest number in August or September and gradually declining as the susceptible material is used up, reaching the smallest number in May and June at the close of the
school~.
There may be some question as to the prevention of Measles. .Scarlet Fever and Whooping Cough, but the 8,787 deaths due to Typhoid Fever, Malaria, Smallpox and Diphtheria are sad commentaries on the intelligence of the lawmaking bodies of the State, and Counties and Cities which hold the purse string of the funds raised by taxes from the citizens of this State, for the first duty of a statesman is the protection of the public.
The increase or decrease of 5 or 10 deaths in a single year in the state means nothing, but the gradual decrease from year to year, though it be small, may be taken as an index of bettered conditions.
33

COIIIUNICABLE DISEASES BEPORTED DURING THE YEAR, 1924. ~~1~1~1~1~1~1~1~1~1~1~1~1~

Acute Inf. Corl.i----------------------------- 20

0

Anthrax..____________________________________

1

0

Brills Disease.------------------------------

2

0

Chancroid-----------------------------------

2

0

Chicken Pox.._______________________________ 818 194

Dengue______________________________________

8

1

Diphtheria.--------------------------------- 1,012

50

Dysentery___________________________________ 197

3

GermanMaasles____________________________ 115

34

~

Gonorrhea___________________________________ 1,161

84

Hookworm.---------------------------------- 507

23

Influenza____________________________________ 1,223 177

Leprosy______________________________________

2

2

Malaria._____________________________________ 763

15

Measles_ ---------------------------------- 3,622 785

MeningitiS.----------------------------------

4

0

Mumps_______________________________________ 861

66

ParatYPhoid Fever..________________________ 21

0

l'ellagra .. --------------'-------------------- 46

3

l'neumonia__________________________________ 1.151 138

l'oliomyelit!s___ ~----------------------------

10

2

1 16

3

0

0

0

0

0

0

1

0

1

52

0

42

56

18

41

19

77

79

131

62

311

12

0

0

55

48

329

83

0

2

163 128

0

2

4

2

171

0

1

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

1

3

0

o

0

21

78

0

0

2

0

0

12

60

30

30

280 137 120

2

2

7

2

0

1

0

0

105 184 146

45

79

56

8

19

46

45

34

4

13

112

24

0

0

oo

204

89

74

37

7

5

26

3

3

96

0

2

0

o

0

13

18

19

69

54

8

3

7

4

oo0

fi

13

1

o1

27

35

79 116

2

0

0

oo0

-------

COMMUNICABLI: DISUSBS Blll'OBTBD DURING TJIJ: YUB, 192,,

Total Jan. l'eb. Mar. April Ma:r June Jul:r Aug, Sept. Oct. Nov. Dec.

Rabies r1n Man)_____________________________ Scarlet Fever________________________________ Sevtic Sore Throat-------------------------

---------

-----------

1 - - -0 - - -1 - - -0 - - -0 - - -0 - - -0 1 -0 - - -0 - - -0 - - -0 - - -0 - - -0

407 50

-

-3-4
'7
--

-

-3-3 - -4

-

-6-0 - -7

-
-

-3-6
- -8

-

-4-2 4

-3-11 1

-

27 o

-

-2-0 4

-

-2-6 2

-

-3-4
4

-
-

-3-6
- -5

-
-

-2-8
- -4

- - - - - - Smallllox. _----------------------------------
SYIJhilis ______________________________________

2,107 - -29-3 - -42-4 583

1,453

-

152
--

-

136
--

-

-12-9

393 145

221 88

106 129

28 2P. - - -5 - - -8 - - -8 - -1-7 28 148 - -16-8 - -9-4 - -13-1 - -10-5

----a Tetanus_____ ---- __ ----------_---------------- 13 - - -0 - - -0 - - -2 - - -1 - - -2 - - -1

- Trachoma._---------------------------------
T.B.IPulmonary) _____________________ ----

-

- -6 652

-

- -0
28

-
-

- -0
-6-2

-

- -3 -5-8

-
-

- -0
-6-9

-

- -2 -4-6 -

- -0 -3-5

-

1

-

-

-2 -0

-
-

- -3
- -1

-

- -1 - -0

-
-

--o--0

-

-

-0 -0

56 - -6-3 - -4-9 - -3-6 - -7-4 - -7-6

<:<>

T. B. (Other)_------------------------------ 14 - - -1 - - -0 - - -1 - - -0

0

0

2

0 - - -1 - - -4 - - -0 - - -5

01

- - - - - - TYIJhoid Fever _____ ------------------------- 601 - -1-0 13

9

12

12

31 134 164 - -9-8 - -6-5 - -3-7 - -1-6

TYIJhus Fever------------------------------

2 - - -1 - - -0 - - -0 - - -1

0

0

0

0 - - -0 - - -0 - - -0 - - -0

- - - Whooving Cough ____ ----------------------- 946 - -19-3 - -23-8 - -17-6

90

46

- - - - - - - - - TotaL ______ -- _________________________ --_ 17,798

2,296

2,961

---
4,946 2,194 1,118

49 825

34

44

689 1,048

7 -- --2--7 ----2--7 -- --1--5
824 872 861 915

-----

MORBIDITY HEPUKT - 1924 TYPHUJO FEVER, MALARIA AND
DIPHTHERIA
CAS IS
WORBIOITY KcPOHT - 1923 TYPHOID FEV~R, MALARIA AND
DIPHTHERIA
BY WONTHS

150 125 100 75
50 25
(
CAS IS

36

DIVISION OF LABORATORIES T. F. Sellers, Director

BETTER QUARTERS NEEDED

The quarters occupied by our Laboratories are badly in need of renovation. The floors are rotting, the walls and ceilings need refinishing and the heating, lighting and ventilation are very inadequate and unsatisfactory. An appropriation of not less than $10,000 would be required for satisfactory repairs. A better solution would be entirely new quarters some where near the capitol.
BRANCH LABORATORIES

A system of branch laboratories established at representative points over the State is badly needed. It is doubtful whether the growth of the central laboratory can continue at the present rate without some means of coming in closer contact with physicians in the more distant sections of the State. The State of Alabama has increased its work from less than 20,000 specimens in 1921 to more than 100,000 specimens in '1924 by means of a system of five branch laboratories. The installation of branch laboratories requires additional funds to the extent of not less than $5,000 for each laboratory.

NATURE OF REPORTS
The work of the Laboratories is of such a character that the reports are of necessily mostly tabular and statistical. The exhibits which follow, and the limited comments thereon, will, it is hoped, give a rather definite idea of the amount of work that is being done and the value of the service of the state.

BACTERIOLOGICAL LABORATORY.

Sputum examinations for Tuberculosis:

Positive________

481

Negative_______ 1,846

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

TotaL______

2,327

Throat swabs for Diphtheria:

Positive________

665

Negative_______ 2,906

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

TotaL______

3,571

37

Widal Tests for Typhoid and Paratyphoid:

Positive________

258

Negative_______ 1,124

Tot

aL

_____

_-

--

--

-

--

-

-

-

--

-

----
1,382

-

--

-

Blood Cultures for Typhoid and Paratyphoid:

Positive________

28

Negative_______

123

To

taL

___

_-

-

-

---

-

-

-

---

-

-

-----
151

-

---

Stool and Urine Cultures for Typhoid

Dysentery Group:

Positive_______ _

9

Negative______ _

58

TotaL _____ _

67

Pus Smears for Gonococci:

Positive_______ _

291

Negative ______ _

613

TotaL _____ _

904

Blood Smears for Malaria:

Positive_______ _

268

Negative______ _ 2,115

TotaL

_____

_-

-

-

---

-

-

--

-

-

---

----
2;383

-

-

--

Feces for Intestinal Parasites:

Positive _______ _ 2,162

Negative ______ _ 3,725

To

taL

_____

_--

-

--

-

--

-

-

-

--

-

-----
5,887

-

--

Animal Brains for Rabies :

Positive_______ _

509

Negative ______ TotaL _____

_
_--

-

-

-5-2-9

-

--

-

-

-

----1,038

--

-

-

Miscellaneous________________________ _ Total for Year_______________________ _

293 17,994

SEROLOGICAL LABORATORY.

Specimens of Blood for Wassermann test:

Positive________ 3,811

Negative_______ 15,903

DoubtfuL_____

41

Anticomple-

mentary____

77

T

otaL

_____

_-

-

-

---

-

-

-

---

-

-

-----
19,832

-

---

SUMMARY. Bacteriological Laboratory__________ _ Serological Laboratory ______________ _

17,994 19,832

TotaL _____ _

37,826

TOTAL WATER SAMPLES FOR YEAR*----------- 5,794

Total Division of Laboratories_______ 37,826

Total Water Laboratory______________ 5,794

Grand TotaL ____________________ _

--------------------43,620

38

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

Bacteriological Specimens ________
Wassermann Tests__ Water Analyses_____

1920
11,862 9,541 1,017

1921
13,767 12,931 2,834

1922
12,635 14,804 3,240

1923
16,253 18,061 5,015

1924
17,994 19,832 5,794

Total ___________ 22,420 29,532 30,679 39,329 43,620

It is to be noted that the figures above indicate the number of specimens examined, but not the number of examinations. Many specimens require several examinations each. For example, in 1924 the number of examinations was probably several thousand in excess of the 43,620 specimens received. While the increase in the number of specimens examined from year to year is not phenomenal, the growth has been consistent and substantial.
The work of the Water Laboratory and Serological Laboratory will be detailed at length in special reports printed elsewhere in this buletin. (See pages 71-145.)

SPUTUM EXAMINATIONS

The following table compares the sputum examination results

for the past five years:

1920 Number Specimens
Examined ___________ 2,537

1921 2,337

1922 2,367

1923 2,429

1924 2,327

Average
2,399

Number Positive______ 557 512 471 486 481 501 Percentage Positive___ 21.9 21.9 19.8 20.0 20.6 20.8

At the present time, as in the past, only the direct method of preparation of sputum specimens has been used-i. e., smears are prepared direct from the sputum, stained and examined, one slide only being examined for each specimen. With this method the average percentage of positive findings has been 20. 8%. Equipment is being installed for a preliminary concentration of the sputa prior to the making of the smear. This change is calculated to increase the percentage of positive findings.

EXAMINATIONS OF CULTURES FOR DIPHTHERIA.

Positive

Negative

Total

For Diagnosis _________ Release from Quarantine ____________ Deriteerc_t_io__n___o_f___O__a_r_Virulence Test__ ~---
Total _____________

262
217
181 5
---
665 39

718
246
1,935 7
2,906

980
463
2,116 12
3,571

The State seems to have experienced a normal year regarding the incidence of diphtheria.-262 cases were diagnosed at the laboratory as compared with 255 in 1923 and 375 for 1922. Physicians have learned to use antitoxin freely in every suspected case, and seem to rely less than ever on laboratory diagnosis. From the epidemiological standpoint, however, we are of the opinion that every case of sore throat should be cultured and all positive for Kleb"s-Loeffler bacillus should be regarded as potentially dangerous carriers until two or three successive negative cultures are obtained.

INTESTINAL PARASITES Out of 5,887 specimens of feces examined for intestinal parasites, 2,162 were positive for one or more parasites, as follows:

SINGLE INFESTATION.

Hookworm-Necator americana______ 1,979

DwarfTapeWorm-Hymenolepisnana

77

Round Worm-Ascaris lumbricoides__

14

Whip Worm-Trichuris trichiura_ ____

7

Beef tape worm-Taenia saginata____

2

Pin Worm-Oxyuris vermicularis_____

9

RadtimTianpuetaW_ o__rm__-_H_ _y__m_e_ n__o_l_e_p_i_s____ ____

1

Amoeba histolytica___________________

1

2,090

DOUBLE INFESTATION.

Hookworm and Dwarf tape worm____

33

Hookworm and Pin Worm __ ----------

33

Hookworm and Round Worm_________

9

Hookworm and Whip Worm___________

2

Dwarf Tape Worm and Round Worm__

1

Whip Worm and Round -- Worm________ -----1----------------

71

TRIPLE INFESTATION.

Round Worm, Hookworm and Pin

Worm_______________________________

1

1

Total specimens positive for ova of hookworm______ _ Tontaanl asp__e_c_i_m__e_n_s__p_o_s__it_i_v_e__f_o_r__o_v_a__o_f__H__y_m__en- _o-l-e_p_i_s____ _ Totlaulmspbercicimoiedness_p_o_s_i_t_i_v_e__f_o_r__o_v_a__o_f_A__s_c_a__ri_s__________ _ Totrtiaclhsipuercaim__e_n__s_p__o_s_i_ti_v_e__f_o_r__o_v_a__o_f__T_r_i_c_h__u_r_i_s_______ _ Tot!'Ll spe?imens positive for ova of Oxyuris verrruculariS------------------------------------------Total specimens positive for ova of Taenia saginata_ Todtiaml isnpuetcaim__e_n__s_p__o_s_i_ti_v_e__f_o_r__o_v_a__o_f__H__y_m__e_n_o_l_e_p__is____ _ Totitcaal _s_p_e_c_i_m__e_n_s__p_o__s_i_ti_v_e__f__o__r_o__v_a__o_f_A__m__o_e_b__a_h__is_t_o__ly_-
40

2,162 2,049
111
26
10
35 2
1
1

BLOOD SMEARS FOR MALARIA
The large increase in the number of blood smears examined was due to the activity the State Malariologist, who has been for the past few months applying the spleen palpation technique as a means of determining the incidence of malaria in a given county or community. A-s a check on the spleen findings the method calls for microscopic blood examinations.

A PROPOSED PLAN FOR IDENTIFICATION OF ANOPHELINE LARVAE
Since it is now fairly well established that of the three species of Anopheline mosquitoes found in Georgia; namely, A. quadrimaculates, A. punctipennis and A. crusians, only A. quadrimaculatus is concerned in the transmission of malaria, it becomes important from an epidemiological standpoint to be able to determine the breeding places of the larvae of this species. Heretofore the close similarity of the larvae of the three species has made identification of A. quadrimaculatus very difficult and laborious. During the year 1924 Dr. Paul Russell, working under the direction of Dr. S. T. Darling, Director of the International Health Board Experiment Station at Leesburg, Georgia, has succeeded in devising a method of larvae differentiation so simple and accurate that it is now feasible to determine the exact distribution of A. quadrimaculatus over the State by collecting anopheline larvae at representatiove geographical points and shipping them alive to the State Board of Health laboratory for identification. We are now prepared for this work and have for distribution special shipping outfits which will be supplied to the health officers and physicians, upon demand.

ANIMAL HEADS EXAMINED FOR RABIES.

1920

1921

1922

1923

Nuammbineerd _h_e_a__d_s___e_x_- 565

767 1,224

838

Number positive for

Negri bodies ______ 289

403

487

423

Percentage positive

for Negri bodies __ 51.1

52.5

39.7

50.4

1924
1,038 509 49.0

41

CLASSIFICATION OF ANIMAL HEADS EXAMINED

FOR RABIES

Kind of Animal

Positive Negative Total

Dog.................... . 455

416

871

Cat .................... . 30

86

116

Cow.................... . 12

6

18

Calf.................... .

6

5

11

Mule ................... .

2

1

3

Horse .................. . 0

1

1

Hog.................... .

3

4

7

Rat .................... . 0

2

2

Rabbit ................ .

0

3

3

Squirrel. ................ . 0

2

2

Wolf ................... .

1

0

1

Chicken ................ .

0

1

1

Monkey ................ . 0

2

2

509

529

1,038

The laboratory diagnosis of rabies is made by exammmg

stained preparations from certain parts of the brain for Negri

bodies. As indicated above, about 50% of all brains examined

give positive findings. The percentage remains fairly constant

from year to year with the exception of 1922, when the sudden outbrea~ of a mysterious disease as ''fright disease'' or "running

fits" resulted in the killing of large numbers of dogs which in many

instances were suspected of being rabid. The symptomatology

of this disease is quite distinct and not in a single instance in our

experience has the brain of a dog presenting a history of uncom

plicated "fright disease" shown Negri bodies. This disease is

still very prevalent, but so also is rabies. MISCELLANEOUS EXAMINATIONS.

Pus and exudates (bacteriological). . . . . . . . . . . . 1

Urines (bacteriological) ...................... 35

Miscellaneous cultures. . . . . . . . . . . . . . . . . . . . . . . 11

Animal inoculations. . . . . . . . . . . . . . . . . . . . . . . . . 3

Dark field examinations for Spirochaeta pallida. . 4

Vincent's angina ............................ 66

Spinal fluids for meningitis. . . . . . . . . . . . . . . . . . . 9

Differential Blood counts . . . . . . . . . . . . . . . . . . . . 27

Felix Weil tests for typhus fever . . . . . . . . . . . . . . 3

Examination for type of organisms ............ 108

Unclassified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

42

MANUFACTURE AND DISTRIBUTION OF ANTIRABIC TREATMENT.

Year

COMPLETE TREATMENTS.

Human Animal

Human deaths from

Total

rabies after treat-

ment.

1919

1,399

1920

1,461

1921

2,147

1922

2,476

1923

2,082

192'

2,569

407

1,806

501

1,952

675

2,822

296

2,772

249

2,331

20D

2,769

0 3
5 1 Feb. 1922. 0
0

2,569 persons received antirabic treatment in Georgia during 1924. This figure surpasses that of the previous record of 1922 by 93 treatments.
Prior to March 1922 we were preparing treatment according to the Pasteur technique. It is to be noted that during 1920 and 1921 there were eight treatment failures, and one in February 1922. On March 15, 1922, we began using the Hogyes dilution method. Up to January 1925, 6,690 people in Georgia have received the Hogyes treatment with not a single instance of failure. Not only is this treatment more efficient, but the labor and expense of preparation is less than half as great as the old Pasteur method.

VACCINATION OF DOGS AGAINST RABIES

We have been watching with much interest the application of the single injection antirabic vaccine for dogs. This product was developed by the Japanese who claim to have vaccinated over 50,000 dogs with excellent results. The procedure calls for a single subcutaneous injection of the vaccine, dosage graduated according to the body weight of the dog. About six weeks is required for the maximum production of immunity. It is not to be used for treating animals after exposure, and many veterinarians are abusing its use in this respect. The cities of Columbus, Albany and Valdosta have instituted compulsory vaccination laws and have vaccinated several hundred dogs. We are watching results in these cities, and our endorsement of the single injection antirabic vaccine for dogs will depend largely on the results obtained.

43

TYPHOID VACCINE
Number c. c. Plain typhoid vaccine distributed ...... 187,100 c. c. Number c. c. Mixed typhoid vaccine distributed ...... 61,294 c. c. Total for 1924 .................................. 248,394 c. c.
Typhoid vaccine distributed 1919 ................. 181,000 c. c. Typhoid vaccine distributed 1920 ................. 109,335 c. c. Typhoid vaccine distributed 1921 ................. 271,035 c. c. Typhoid vaccine distributed 1922 ................. 194,569 c. c. Typhoid vaccine distributed 1923 ................. 216,664 c. c. Typhoid vaccine distributed 1924 ................. 248,394 c. c.
A tabulation has been prepared showing the number of doses of vaccine distributed in each county. This tabulation is too voluminous to be incorporated in this report. It shows, however, that only three of the 160 counties failed to use State Board of Health vaccine. As to quantity used, Fulton County tops the list with 12,886 doses.
Other counties using large quantities were: Dekalb .................... 12,252 doses Troup . ................... . 12,017 " Thomas. .................. . 12,000 " Bartow . ................... 10,914 " Mitchell . .................. 18,666 " Decatur. . . . . . . . . . . . . . . . . . . 9,691 " Carroll. . . . . . . . . . . . . . . . . . . . 7,587 " Baldwin . . . . . . . . . . . . . . . . . . . 6, 772 " Cobb. . . . . . . . . . . . . . . . . . . . . . 6,368 " Dodge. .................... 5,985 " Floyd ..................... 5,142 " Muscogee. . . . . . . . . . . . . . . . . . 5,135 " Hall....... ................ 5,446 " Laurens.................... 4,650 " Glynn. . . . . . . . . . . . . . . . . . . . . 4,600 " Walker . . . . . . . . . . . . . . . . . . . . 4,224 "
Fifty-seven counties used more than 1,000 doses each, and 93 counties used over 500 doses each.
All except two of the counties listed above have full time health officers and it is undoubtedly due to their activity that so many people were vaccinated in these counties.
44

As to the efficacy of typhoid vaccine to protect against typhoid fever, it is an interesting fact that in a series of 105,696 complete vaccinations recorded by eighteen health officers during the period 1921 to 1924, only four cases of typhoid fever have developed. Three of these cases developed two months, and one three years after vaccination.

DIPHTHERIA ANTITOXIN
Number units diphtheria antitoxin distributed 1919 .. 28,908,000 Number units diphtheria antitoxin distributed 1920 .. 28,960,000 Number units diphtheria antitoxin distributed 1921 . .45,304,000 Number units diphthena antitoxin distributed 1922 . .45,948,000 Number units diphtheria antitoxin distributed 1923 .. 34,367,000 Number units diphtheria antitoxin distributed 1924 .. 35,723,000
The 35,723,000 units for 1924 were distributed in 126 counties. A spot map shows that the bulk of the antitoxin went to a triangular shaped group of counties with Stephens County as the northeast apex, Floyd County the northern base angle and Troup County the southern base angle. This is remarkably consistent. with the geographical distribution of the reports of death from diphtheria and also with the positive laboratory examinations.

TOXIN-ANTITOXIN
Records are not available at this time as to the amount of toxin-antitoxin used in Georgia in 1924, but reports from health officers indicate that there was a considerable increase in demand as compared with 1923.
Regarding the efficacy of toxin-antitoxin, records from senventeen full time health officers show that in a series of 6,048 complete vaccinations during the period from 1920 to 1924, there were six cases of diphtheria following vaccination. Three of these cases developed five months after vaccination, one case six months after, one case twelve months after, and one eighteen months after.

SCHICK MATERIAL
Schick material distributed during 1924...... . Schick matierial distributed during HJ23 ..... .

7,500 tests 5,850 tests

45

SILVER NITRATE AMPULES
Silver Nitrate ampules distributed during 1924. 13,658 Silver Nitrate ampules distributed during 1923. 14,728

CARBON TETRACHLORIDE
Carbon Tetrachloride distributed during 1924 .. 11,505 c. c. Carbon Tetrachloride distributed during 1923 .. 13,300 c. c.

TETANUS ANTITOXIN
Tetanus antitoxin distributed during 1924 ..... 1,876,000 units Schick material for testing susceptibility to diphtheria, one percent silver nitrate ampules for use in preventing ophthalmia neonatorum in the newborn and carbon tetrachloride for the treatment of hookworm are distributed free of charge. Tetanus antitoxin is sold at a special board of health price chiefly in the form of...the:1,500..unit prophylatic package.

LABORATORY WORK.

1925 TO 1925.

"'
:~~

.. Posteur Department. Biological Preduct.

r.:
cl
G)
l>t

...
1=1 G) <iS
'!:
G) 0~ GIO
A<il rl.li%1

.
...G)
,..
""=~ G).~..
li=411

~ l.Hi,i.l..~.
=':rC-~:

1=1...; .s<il
=~~

_...;
<il<il
~~
<

...;
,..<il
G)
Eo<
"<
~
0 Eo<

0. <iiO
r:>u
.'C....
OGI
.dl=: .A...' "0 '
Eo<

~a
G) 0 . .c;;:~ ....,;~ ....
.dl=ll=l .~<l:l
A

1905

447 7

1906 ~:t'~ '941 11

1907 ll'o. 983 16 10

1908 1,523 95 202

1909 2,115 111 324 665 0

1910 3,536 181 218 439 23

1911 7,249 .343 231 485 0

1912 7,025 291 270 673 0

1913 7,260 295 317 925 140

1914 8,604 95 319 909 146

1915 7,209 383 356 921 222

1916 11,664 375 493 1,296 204

1917 6,771 263 555 1,583 389

1918 5,839 346 472 1,425 477

1919 17,776 537 486 1,399 407

1920 21,403 1,017 567 1,461 501

1921 26,779 2,834 767 2,151 675

1922 27,439 3,240 1,224 2,476 296

1923 34,314 5,015 838 2,082 249

1924 37,826~,794 1,038 2,569 200

665

3,400,000

462

7,769,200

485

5,634,000

673 *1, 737 9,414,500

1,065 11,592 12,719,000

1,055 30,224 13,524,000

1,143 52,628 13,717,000

1,500 108,267 19,279,000

1,972 115,500 ;14,070,000

1,902 120,200 11,996,000

1,806 181,619 28,908,000

1,962 109,355 28,960,000

2,826 271,035 45,304,000

2,772 194,569 45,948,000

2,331 216,664 34,367,000

2;769 248,394 35,723,000

*-The manufacture of typhoid vaccine began July 1, 1912. t-The manufacture of antitoxin discontinued. Contract made

for commercial product.

46

DIVISION OF CHILD HYGIENE
Joe. P. Bowdoin, M.D., Director
The Division of Maternity and Infant Hygiene for the past year has been busy with educational matters, the physical examination of mothers and children and midwife instruction.
We put on an intensive program in the Eleventh Congressional District, going into each county with the Healthmobile Unit, the nurses later visiting the homes of the people who came to the meetings, and taking with them the physical defect cards and talking with the parents of the children about the defects found, and urging their correction. ~hey also gave such advice as they thought proper about the sanitation of the home and proper food and its preparation. This later resulted in many undernourished children showing great improvement.
We also completed the Seventh Congressional District in the northwestern part of the state which had been partly covered in 1923 and a few counties in the central part of the state.
Our experience last winter, contending with bad roads and inclement weather, showed that it was not best to undertake this work during the winter months. The operations of the unit were discontinued, therefore, from November 1st to April or May.
It will be remembered that the Healthmobile was a gift to the state by the members of the Phi Mu Sorority. They have kept it in repair when notified of the need and have been much interested in its work. A few weeks ago we had a letter inquiring what they could do to make the work more effective and also offering to do any repairs necessary on the machine.
At the annual meeting of the Georgia State Medical Association held in Augusta last May, the following resolution was introduced by Dr. Theo. Toepel and seconded by Dr. J. 0. Elrod:
~ "Realizing that the midwife problem is a most serious one, and wishing to be of service to all our people, we
47

recommend that the State Board of Health be requested to give such instruction and adopt such regulations as they think best; that this instruction be given under the supervision and direction of some physician who is a member of this Association, in each county, and, if such membership is not represented in a given county, then by some other physician in each county".
The House of Delegates passed this resolution by a unanimous vote. Rules and Regulations for the government of midwives were immediately prepared and submitted by Dr Elrod, President of the Medical Association, to the Councillors who approved them.
'
MIDWIFE INSTRUCTION
As stated above the regulations were favorably passed upon by the Medical Association Councillors. When approved by the State Board of Health they will have the authority of law, giving Georgia for the first time, control over midwives. There are over four thousand registered midwives in Georgia and probably many who are not registered. It is safe to E>ay that onethird of the babies born in the state are not attended by a physi.cian.
Realizing the seriousness of this condition, it was decided early in the year to limit the program, chiefly to the instruction of midwives. Sufficient funds were not available to employ the necessary nurses, and reliance had to be placed on outside help. Several cities became interested and, in addition, one colored nurse was furnished by the North Georgia Conference of the Methodist Church.
COUNTY COOPERATION
The women's organizations of the state have beeninterested in the passage of measures to secure funds to match the Federal money available under the Sheppard-Towner Law. The enabling act was passed by the General Assembly making an appropriation of only $5,000.00, available January 1, 1925, and each year thereafter. This left over $19,000.00 in Washington, unavailabecause unmatched. Soon after the enabling act was passed, cooperation on the part of several cities and rural communities
48

was sought in matching these funds with the result that we shall have, beginning January 1, 18 nurses. This additional money was furnished by Fulton, Clark, Richmond, Muscogee, Whitfield, Decatur, Bibb and Chatham Counties. We now have nurses in some of these counties and all will be at work in January 1925. In addition there are three nurses at large for the state and one supervising nurse. All activities, under the SheppardTowner Law, must be confined to prenatal, natal and postnatal cases and children under 7 years of age. The following program gives an outline of the work:
PROGRAM
FOR
MATERNITY AND INFANCY WORK
IN COUNTIES
NOTE 1. This program is intended as an outline for Maternity and Infancy work by Public Health Nurses. It may also be used for follow-up work in counties which have been visited by the Healthmobile.
NOTE 2. Before putting it into operation, the nurse must submit it to the County Medical Association, Local Health Council, County and City Health Officer and all men's and women's organizations in the county for approval. The nurse must always bear in mind that, under no circumstances, must the work be forced in homes where the parent or parents have expressed an unwillingness to accept it.
PRENATAL 1. REGISTRATION: Registering prenatal cases in the Division of Child Hygiene so that literature on prenatal care may be forwarded.
2. CONFERENCES: Group Individual Home
49

3. INSTRUCTION:
1. PrenatalEarly consultation with family physician. Complete urinalysis. Albumen test every month up to seven months. Albumen test every two weeks from seven months up to delivery. Personal hygiene. Diet, rest, exercise, clothing. Daily bowel movement. Avoidance of patent medicines. Care of breasts.
2. PostnatalCare of mother; cleanliness, diet, etc. Care of Baby: Registration of birth. Silver Nitrate, 1% in eyes. Regular feedings. Cool boiled water at intervals. Warm cleansing bath daily. Do not wash eyes and mouth unless ordered by attending physician.
3. MidwivesRegistration with local registrar. Silver Nitrate, 1% in eyes of newborn. Registration of baby's birth. Cleanliness.
INFANT 1. REGISTRATION: Registering of children under six years of age in Division of Child Hygiene so that literature on infant care may be forwarded.
2. CONFERENCES: Group. Individual. Home.
50

3. CLASSES: Home Hygiene and Care of the Sick: Mothers. High School Girls. Little Mothers' League for girls over 10 years of age. Health Crusade in schools.
4. ORGANIZATION: Health Centers.
5. PRESCHOOL: Nutrition. Defects found. Defects corrected.
VARIED ACTIVITIES
The distribution of silver nitrate has been continued. As many ampules as last year have not been supplied owing to the fact that it is now furnished only on request. There was no doubt much loss in the general distribution.
In cooperation with other departments we have been supplying films and furnishing lecturers for educational work. Two of our workers were in the field during July, attending Teachers Institutes, and many meetings, arranged by various women's organi"'ations.
The Healthmobile was sent to five of the District Teachers Institutes and demonstrations given, pictures shown and physical examination made of all teachers, who desired it. Through the cooperation of the Medical Societies in the counties physical examination of school teachers was offered free at the other eight Teachers Institutes.
An activity of much promise has been the organization of
Little Mothers' Leagues and mothers' classes. Our nurses have given some time to this program and we have had the cooperation of the extension service of the University of Georgia. The . Home Demonstration Agents have been doing some splendid work in the schools. The first work undertaken was to cover 12
51

counties. If this proves popular and successful, 48 counties will be undertaken in 1925. The course consists of 10 lessons which we furnish. The lessons are followed with a demonstration by our nurse who immediately gives the examination and awards a certificate and a pin to the successful girls.
The County Health Officers have given much valuable assistance in these programs. The table elsewhere summarizes the work done by their nurses. The physicians have also cooperated splendidly. Without their aid we could not have accomplished much. The State Dental Society has been ever ready to lend assistance in holding clinics and giving lectures on oral hygiene.
The Mouth Hygiene Unit, detailed by the U. S. Public Health Service, visited 13 counties from January 1 through July. This Unit has been most popular and it is hoped that it will be assigned to Georgia for a continuation of this work. A tabulation of their work is submitted. (See page 58.)
52

COUNTY ELEVENTH DISTRICT

.:.
;!::;s:
~
0 0
....3~~
l'lo
.,.~
Po

i
...a 0 0
., .
i
'tl~

-o..,,
~~
.. .,,.~
<>H
".,",.=.f,
"~":0a
IZ;

HEALTHMOBIIJI: WORK. January-November 1924.

Number Examined

..5.,
.~..,,
&

.5.,
.~

...,
:3
0
-.a;,;
""IIQ

Number De-

fectaF ound

..c.~,

.~..,,

5
~

p1'1

~

..
~
Pd.....o.,,...
~:a:soisll
IZ;

.1',1

... . .e:
., 0

'j;: 0

~=.i

.. = Ill. 'E-t+>

.. IIQ

<>ll
-g,g
::SIIQ

~:a:IsIl.oi

IZ;

IZ;

..1'1

~

:f .~ 'uf

..<1
"..",.."a"
u..,.1!1

.<1
.Po, ~ .o:; O>~
~i>

IZ;

IZ;

:aaa:s .
O'tl
0~
..,.,...1!1
"I>
~:!
IZ;

Lowndes..-----------------------_--

I

I 85

I 71 781 ----

6

82 945

7 18

16

Brooks-----------------------------,_4,_2,_96,_13,_831.....:..::.:._1-71_73~~~-7~_121.....:..::.:._1.....:..::.:._1-9

Cook-------------------------------

1 ____

38 10 28 ____

4 35 375

2

8 ____ ____

4

CJl Echois-----------------------------~.....:..::.:._~.....:..::.:._~-251-31-221.....:..::.:._1-21-421~1-31-91.....:..::.:._1--=.:.=,_l5-

Col)

Lanier----------------------------- ---- ____

49 13 36 ____

5 36 200

1

4 ---- ____

5

Clinch ____________________________ _

2

99

18

81

22

2 64 246

8

6

Berrien----------------------------l.....:..::.:._l-=:__l~l-30l~l-111_211_______::r_l~l-51_151-=:__11_1 - 8

Atkinson__________________________ - - -4 - - -1 - -5-3 - - -8 - -4-5 - -1-1 - - -4 - -5-3 - -56-0 - - -8 - - -8 - - -1 - - -2 - - -3

Ware------------------------------- ____

1 235 79 156 31 20 149 1,285

7 16 ____

3 10

Charlton-_------------------------ --=:.__--=:.__ _.:.:._ _ _5____24____4_--=:.__ _ _24_ ~ _ _2____5_--=:.__ _ _2_1_ _2_

BrantleY--------------------------- ---- ____

28

7 21

5

2 15 250

Pierce______________________________ ----

3 154

34 120

23

17 121 775

1 5

I 2 ----

1

8 ---- ____

9

GlYllll------------------------------

1

3 267

62 205

21

19 120 380

6

8 ----

3 12

Oamden____________________________ ____

1 I 54 11 I 43l 4l 2 22l 305l 2l 8 ____

4

Wayne_____________________________ ____

5 185 52 133 10 21 131 1,200

6

8 ____

41 10

AIJIJling____________________________ 1 1 1 ____

106

32

74

13

22

76 425

3

6 1 ____ 1 2

7

cI e
..;!:l
::1

R
0
0

COUNTY

<i.

..~~:~

...... ~ .. ELEVENTH DISTRICT.-Cont'd.

II<

HEALTHMOBILil WORX.-Continued.

.Tce
;!:l ::1
R
0
0
..
=a_..,ll:o
'tl~

-a.c- January November 19:M.

-os..s.
'l'~
~..~R..
..~
~:a
~0

Number Examined.

s.,

.... ... I><

,;

., ce

.. ""pR

I.>.<. I

....
oil
0
.<i
13
""11.1

Number Defecta Found.

...5.,

I><

c.,oil

.. "~"

I>< 'i

'iii
...d....,.
II.<...
~~
::!:II
II;

...,
-~
0
~~ ~_g
::111.1 II;

.R,
~
CJ
...~:.i
...Eo<+>
.s811..i.
::1.0 II;

a
~.....
.01 11<1>0
~~
u,o.l!l
II;

.
R
aoil
O..J.
.01 II<.
too ~.a
.c~
~
II;

aI ss::1 .
o:eO'tl
..<o.D.,I5>.
:!
II;

Bacon. __ -- ___ --- ______ ---- ________ Coffee_____________________________

_ _

_

_

_1 ,~_~_~_1 -_o_34o_5 ,___29_34_~_-25_~2 ~_-_32_9~-_-240-2 ~--~15-6~-~-6~5-0 -I-5--,4 -_-6-5~-~_-___~----~-7~---5-8

Jeff Davis.------------------------

1

77

22

55

5

4

54 275

2

4 ---- ----

4

Irwin______________________________ _

178

41 137

23

625

4

8

4

8

~ *Be:1 Hill--------------------------- _,_,~,~,~,_28/~/~/~1-41-71~/~/-8

*I'ulas~L ---------------------------

121

27

94

16 ---- ----

925

4

6 ---- ----

8

PaulSdEinVgE-N--T--H- _D__I_S__T_R--I_C__T__._____ _ Haralson.-------------------------

--~1-561_871~1-171

35

11

24 ----

1

~ 411~127-541-813~1...6..-:-:--.:.-.--:-_:_1_37

l ---- I Polk_______________________________ _ _ _ _ _ _ _75_ _ _ao___4_5 .....::.:..:_:_ _ _8_ _ _1_0 1,203 _ _8_ _ _1_61~1.....::.:..:..:1_ _1_1

Chattooga _________________________

~----

87

28

59 ____

7

40 1,325

8

14

-----------
**Floyd_----------------------------

o_ _ _ ----------------------~------

_--_--___--_--_ _ _13_ _ _5_ _ _8___--_--_ _ _

5__--_--_--_-- _ _1 _--_--___--_--_', _ _,_ _

Murray____________________________ _

95

25

70

15

57 I 1,600

12

6

Gordon _____________________ ------1.....::.:..:..:1.....::.:..:..:1_4_11_1_11_3_01.....::.:..:..:1_ _81_4_1~~~--31 _ _61----=-=------1.....::.:..:..:1_ _3

Bartow___ --------------------------

79

24

55

17

42 575

16

5

TotaL ________________________ I 18 I 20 I 3,208 I 821 I 2,387 I 259 I 293 I 1,695 I 21.249 I 123 I 257 I 1 I 31 I 195 *-Ben Hill and Pulaski Counties are not in Seventh District. -In addition to the above work in Floyd County, the Healthmobile Unit weighed and measured 120 white and 23 colored babies at the
Floyd County Fair.

MATERNITY AND INFANCY WOI!K OF 'lEE DIVISION OF CHILD BYGEINE INCLUDING BEALTBMOBILE AND COUNTY NURSES UNDER SHEPPARDTOWNER APPROPRIATION.

First Last Total WorkofH. 0.

6 Mo. 6 Mo. 1&24 in co-opera- Total

1924 1921

tion with Div.

Children's Health

Conferences______ 3,386

Prenatal:

Number mothers

in attendance __ 1,626

Number mothers examined _______ 560

Mother's Classes:

Number mothers attending ______ 5,C41

Midwife Classes:

Number midwives

attending_______ 407

Number midwives

completing full

course truction

o__f___in__s_-

384

Listetlse__m__o__th__e_r_s__c_l_a_s_- 159

Cosmtramtuionnitsy__D__e_m__o_n_- 155

HotimoensD__e_m___o_n_s_t_r_a_-__ 12,600

Child Health Cen-

ers established____

5

Prenatal Clinics es-

tablished _________ S u r v e y s _____________

6 22

Talks and lectures

sbtyatemsetamfbLe_r_s____o_f 657

4,815
2,010 168
709
796
796 330 342 6,825
15 23 8
264

8,201
3,636 728
5,750
1,203
1,180 489 497
19,425
-------
30
921

5,328
3,054 506
--------
314
314
---------------------------------------------------

10,143
6,690 1,234
----
1,517
1,'94
I
--'-- i
----
-------
--------
----

55

LITERATURE SENT OUT BY THE DIVISION OF CHILD HYGIENE DURING 1924.

-~

--

------

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

Prenatal 304 728 292 533 229 170

72 324 638 293 233 155 3,971

Preschool 937 2,351 8,783 7,434 7,855 1,231

288 2,484 4,268 10,627 1,479 1,638 49,375

SchooL_ 1,954 3,542 4,357 2,088 427

90 202 1,187 2,855 5,057 4,467 6,135 32,361

DentaL_ --------

1 -------- 78 -------- -------- -------- -------- 108

3 125 -------- 315

Miscel. __

2

28

11

7 --------

1 1,539 505 276 657

5 -------- 3,031

TotaL 3,197 6,650 13,443 10,140 8,511 1,492 2,101 4,500 8,145 16,637 6,309 7,928 89,053
Ql
"'

SILVER NITRATE DISTRJBUTED

1924

NUMBER NUMBER INDIVIDUALS

AMPULES

ORDERING

JANUARY ......... 1,035

39

FEBRUARY........

708

31

MARCH ........... 1,541

42

APRIL ............. 2,092

90

MAY ..............

639

40

JUNE.............. 1,037

70

JULY .............. 1,364

91

AUGUST........... 1,073

55

SEPTEMBER ...... 1,055

42

OCTOBER ......... 1,065

40

NOVEMBER .......

732

86

DECEMBER ....... 1,260

74

13,601

700

There were 700 orders in 1924 against 458 during 1923.

57

DENTAL REPORT-DENTAL UNIT-U. B. P. B. B. January 1 through July Sl, 19M.

COUNTY

.!1
0 0
.1'1

1'1
~".' .;

"f l l .
.. 'tl
~":'!$i
::II>

O~"~'
"'"'a"::IIIII

II: II:

One or More One or More Two or More

Caries

l'illinga Teeth Mlaaing

~
"'1'1.1'1
"~'"~"
.,E-c

to...,
a".,E"""-c''

~
~"':5
~~
.,E-c

~~
a".,E"""-c''

~ !.s:~
"~':"l"
.,E-c

~
~:5
a.",E"."-,c'

"' "' "' E-c

E-c

E-c

One or More l'irst M&locclu-

Mol&rs

aion

.,
C>
A."~,

j""

= 1111
,
...

..,,
:a= ~
IIQ

.a.
.,::1
1'!1
s$.",

';,j
-......0.~.".,,...
o~O=
0

.; :!!1
Cll
E-c

.;
~

- - - Chatham __ ------------
Bulloch_ _______________ Toombs ________________

-7- - -48-0 - -4-9 - -27-3 - - -8 - -1-9 - - -6 - -8-1 - -25-6 24 - -4-4 -17-5 -4-4 -11-4 - -5 -3-0 - -1

-1- - -20-3 - -3-1 - -12-7 - - -9 - -1-0 - - -9 - -4-2 - -13-7 - - -8 - -2-6 -7-3 -1-4 -5-4 - -7 - -4 - -0

-

2-

-

-40-3

-

117
--

-

-14-6

-

-4-2

-

-1-7

-

-1-7

-

-12-2

-

-22-9

-

-5-6

-

-6-2

-17-6

-

3-6

-10-6

-

1-4

-

1-7

-

-3

co
00

MitchelL--------------
- - Thomas ________________ - - - Lowndes._ ______________ - - Glynn_______ -- _________ - - - - Muscogee ______________

-3- - -31-1 - -14-7 - -5-6 - -8-3 - -2-1 - -2-0 - -4-0 - -19-1 - -11-3 - -10-5 -12-7 -3-5 106 -1-3 -2-3 - -2

-4- - -28-8 - -8-9 - -12-1 - -3-5 - -1-1 - - -9 - -5-7 205 - -2-4 - -6-5 -12-1 -1-6 -8-4 - -2 - -9 - -0

-2- - -33-2 - -4-2 - -22-3 - - -3 - -1-5 - - -3 - -14-3 - -22-1 - -1-4 - -5-2 -15-9 -3-8 106 - -7 - -7 - -0

-4- - -5-6 - -1-0 - -2-5 - - -0 - - -1 - - -0 - - -4 - -2-5 - - -1 - - -3 -1-5 - -1 22 0 - -7 - -0

-3-

-

-37-8

-

-13-6

-

-12-5

-

-

-3

-

-

-1

-

-1-4

-

-6-9

-

-31-4

-

-3-2

-

-2-3

-17-0

-3-0

175 --

-2-5

-

2-3

-

-0

- - FloYd------------------
l'ickens ________________

-5- - -51-1 - -27-9 - -8-7 - -10-9 - - -9 - -4-3 - -6-4 - -30-1 - -10-5 - -17-3 -21-4 -2-7 211 -1-5 - -6 - -2 -5- - -21-1 - -6-8 - -11-7 - -1-3 - - -4 - - -1 - -7-4 - -15-6 - -2-0 - -3-6 -7-8 - -6 -7-2 -2-0 -1-4 - -2

- - - - De Kalb (Clinic) ______ - - ------ - -6-6 - -2-5 - -2-5 - - -7 - - -5 - - -4 - -1-9 - -4-9 - - -8 - -2-4 -2-3 4 -2-0 57 - -5 - -0

Baldwin (Normal

Adult

- - School)_------------- -------- - -25-6 - -15-4 - - -6 - -20-6 - - -4 - -6-3 - - -7 - -9-7 - -11-0 - -21-1 -8-9 -2-1 -9-2 -1-8 - -3 0

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CloafrkGea.<)U__n_i_v_e__r_s_it_Y_____ TotaL ______________

--------
39

Adult 172
3,667

132 - - -5
1.279 1,336

142 660

0 117

51 240

2

70

724 2.251

82 597

141 65 -1-2 - 6-1 19 12
965 1,485 284 1,223 202 160

2 12

~--

-

DIVISION OF COUNTY HEALTH WORK
C. E. Waller, M.D., Director
CENTRAL ADMINISTRATION
The organization of this division remained unchanged during the year. Through the cooperation of the U. S. Public Health Service, the detail of an officer of that service to act as director of the division, for the purpose of assisting the State Board of Health With the supervision and development of county health work, was continued, the salary of this officer being paid by the Public Health Service. The International Health Board of the Rockfeller Foundation supplied one-half of the funds required for the other items of expense for central administration, the other half being furnished by the State Board of Health.
In addition to the supervision of local health work carried on in the 21 counties operating full-time health service in the State, the chief activities of the division during the year were embraced in the carrying on of a general educational compaign, the specific object of which was to acquaint the public throughout the whole of Georgia with the nature and extent of our most urgent health problems and the crying need for full-time county health organizations, and the inauguaration of a project which had for its objective the demonstration of the effect of a State subsidy in securing cooperation of counties in establishing new health units and of the practicability of doing effective work with one local organization for asmall group of counties. The Director also visited a number of counties for the purpose of consulting with members of local civic organizations and city and county authorities relative to the establishment of full-time health service, during the year.
The educational campaign included a series of addresses to district meetings of the Georgia Federation of Women's Clubs, at the request of the State President of that organization, and the sending out of a large amount of pertinent educational material in a series of letters to members of women's clubs and Parent-Teacher associations throughout the State.
THREE-COUNTY DEMONSTRATION PROJECT
The demonstration project referred to consisted in a joint health organization for three counties, established through the
59

cooperation of the U.S. Public Health Service, the State Board of Health and the local authorities of the counties. The personnel of the organization includes a full-time medical health officer and a clerk and laboratory technican supported jointly, together with a full-time non-medical assistant health officer for each county. The annual budget called for $12,000, of which $3,000 was contributed by the Public Health Service, $3,000 furnished by the State Board of Health and $2,000 appropriated by each county. Through the investment of its funds in this way, the State Board of Health was able to secure $12,000 worth of intensive local health work for $3,000. Further, the effect of being able to offer a subsidy to the counties in assisting them to provide for adequate health service was clearly demonstrated. Although it was not easy to secure the cooperation of three counties lying immediately adjacent to each other, no difficulty was experienced in securing even more than three counties willing to tcy out the plan, when financial aid was offered. In spite of unusual and unfortunate circumstances which were encountered in securing and keeping a competent medical health officer to direct the project, it is believed that the results up to the present time justify the conclusion that the plan is practicable, and that more and better health service can be obtained for $4,000 expended for each county in the support of a joint organization, than for a like amount expended in one county alone.
PROGRESS UNDER THE ELLIS HE~LTH LAW
At the close of the year there were 18 counties operating full-time health organizations under the provisions of the Ellis Health Law, making a total, with one county operating under a special Act and two others under general authority granted by the health statutes of Georgia, of 21 counties with full-time health service, out of the 161 in the State.
Although at the beginning of the year there were 11 other counties in which the Ellis Health Law had been adopted, and five additional counties adopted the law during 1924, only one new county actually established a health organization, in compliance with the terms of the law, during the year. Moreover, it may be pointed out, that this county-DeKalb-has been the only one in the State to put the Ellis Health Law into effect in over two years, although every means of persuasion short of legal action has
60

been resorted to in an effort to bring about compliance with the law in counties where it has been adopted.
As a result of over two years observation of the progress of county health work in the State under the provisions of the Ellis Health Law, and of previous experience elsewhere, the writer is convinced that the rapid extension of full-time health service on a State-wide scale cannot be brought about through the operation of a local option law alone.
Further, the writer's experience with the working of the law up to the present time leads him to suggest that it might be advisable to recommend the repeal of that provision which has to do with the adoption or rejection of the law by two successive grand juries and the amendment of the law in such manner as to place the option as to the establishment of a full-time health organization in the hands of the county commissioners. The reason for this suggestion is that, although the putting into operation of the law becomes mandatory upon its adoption in a county, experience has shown that, actually, unless the county commissioners themselves desire to put the law into operation, it is ignored and its provisions are not carried out. Moreover, experience has also shown that although the law provides that the work shall not be discontinued except upon the recommendation of two successive grand juries, the commissioners have discontinued the appropriations on several occasions in spite of the fact that adverse recommendations had not been made by the grand juries.
It takes at least six months under the most favorable conditions and often a year or more to secure the adoption of the Ellis Health Law in a county. Since, actually the matter of establishing and maintaining a full-time health organization rests finally in the hands of the county commissioners, it is evident that much time and unnecessary work could be saved by dealing with the boards of county commissioners directly. Naturally the question comes up as to why the problem cannot be solved by taking the matter to ~he courts and compelling county authorities to comply with the law. The writer does not believe that county health work can be established and maintained satisfactorily in this way. Even though the local authorities were made to provide a health organization in compliance with the
61

terms of the law, such an organization could not be expected properly to function or very long to endure in face of opposition on the part of those charged with its maintenance. Community health work cannot be forced upon a county any more effectively than personal hygiene can be enforced upon the individual. After a' I, health work must be "sold'" to the county authorities and it is believed that the most direct method will be the most effective.
Moreover, the answer to the whole question lies in having something to "sell" when we invite our counties to cooperate with us in trying out full-time health sel'vice, and that "something" which has proved to be most effective as an inducement to local authorities is a subsidy from the State Board of Health, through which it shows its faith in the value of the work and offers to share its proper part of the responsibility for the protection of the public health in the community.
It is also suggested that it might be well to amend the law in such manner as to provide definitely for a part-time health officer, at least, in every county in the State. At the present time in most of our counties-other than those provided with full-time health officers-there is no individual charged directly with the responsibility of carrying out the health laws and regulations and there is no one through whom the State Board of Health may extend what service it has to offer, to the community.
62

RESULTS OF HEALTH WORK IN COUNTIES
OPERATING FULL-TIME SERVICE
The accompanying table shows the activities carried on and the results accomplished in the 21 counties which were operating at the close of the year.
A comparison of the deaths from typhoid fever in the counties with full-time health service, as against the mortality from this disease in all other counties in the State, also gives some interesting data. Typhoid fever was chosen for this comparison for the reason that its prevalence probably represents more accurately than that of any other communicable disease the status of health conditions in general in the community. Including even those counties which established full-time health organizations only last year, there has been a consistent decrease in deaths from typhoid fever in counties with full-time health service from 154 in 1922 to 126 in 1924, amounting to a reduction of 18 per cent during two years, while in all other counties combined there was a decrease from 561 to 541, or only a little over 3 per cent for the two years and an increase of 86 deaths, or 19 per cent, for 1924 over 1923.
The decrease in mortality from typhoid fever has been very striking in some of the full-time counties, notably in Mitchell, where the deaths dropped from 12 to 0 in two years; in Walker, where the number was only 4 in 1922 and 1 in 1924; and in Clarke which had only 6 deaths in 1922 and 3 in 1924, as against 13 in 1921.
There was also some improvement in the personnel of the county health organiz~tions during 1924, and the summary of activities and results shows that there was not only a substantial increase in the totals for most of the important items of work, but also a very gratifying increase in several of the individual counties.
63

DIVISION 01' COUNTY BBALTB WORK. Summary of County Health Wor.lt for the Year 1924

t ~

:scil

0
~

..; :2

Ill Ill Ill

.;
!
0

..:

., ..;
,Q

3
ucil

0

0Q

~ l.il,t

'1~.,:

... s .<l
::I

.,,.;.,

0

d
_g

Q Q lko 0

:;
Ill

.~,
!'I
cil
.:I

..,; "1"'1
~ 0 .:I

...,:
~

:;
..<u..l, i

.,;
1'1
0
j ~

.; "0

..,:

-.~, ~

~ I'll

.;
acil
0 .s:l Eo<

. :9 p, ..:

::I

0

cil

Eo< Iii=

....;
0 Eo<

ACTIVITIES.

I. EDUCATIONAL;

~

IA'uttbelnicdaMnceee_t_in__g_s__a__d_d_r_e__s_s_e_d_
SActhteonodlatnaclkes__g__iv__e_n__-_-_-_-_-_-_-_-_-_Bulletins distributed_______ Newspaper Articles _________

11 304
5 804 1046 25

22 1970
45 1640 9100
6

22
-----
185
-----
3426 84

37 85 1305 3930
69 170 1837 6830 3026 4000
19 79

24 41 14 4 1551 3210 789 425
62 313 54 205 2439 9784 1621 7832 2611 2431 3603 6370
29 11 173 37

53 76 192 I 2595 9650 5612 56
112 122 162 I 5070 7456 5411 50 10395 2500 4356 2109
52 12 197 13

11 232 22 730 390 31

Office conferences, general 567 980 161 190 1000 479 1098 25 6402 1205 878 221 601 244

33 71 18 18 1030 1285 654 740
101 435 36 34 4608 14709 1664 2346 6820 2700 760 3407
54 13 5 26 24 122 160 402

48 9 I 8119 925 24
164 71 112 11790 3258 4619 24027 4198 460
83 1 11
8582 ---- 3

791 44.400 2.48( 94.291 97,735
941 23,344

II. COMMUNICABLE DISEASE

CONTROL;

Number of cases visited---- 22 176 1967 1147 547 174 517 206 145 943 108 371 221 16 25 975 ---- 43 241 159 116 8,m

Total number of visitS..----- 26 117 5672 1862 1139 169 517 387 308 3514 267 634 500 16 ------ 1868 ---- 69 481 314 116 17,518

ill. CHILD HYGIENE:

PrHe-onmaetavl:isits________________
OExffaimceincoatnisounlsta__t_i_o_n_s__-------_Cases given advice________ Midwives instructed._____

2 14 22 256 14 349 21 237 44

----- 696 11
31 ----

1a2 ----5-

96 7

247 656

4 ---1-4 . 22 --9-7-

397 I ---- 6 11

78 48 63 ---54---78 16
24 ----

119 6 32 23 4 11 77 16 57----

133 115 116 137 180

----
169 179 117
----

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

------------------
------
63

1672 ----
8----
------ ---812 ----
99 ----

----
-----------45

76 71 ---445 65 ---70 25 ---350 53---112 44 ----

3.034 1.244 1.071 2.687 1.047

Sidlvisetrrinbiutrtaetde__t_r_e__a-tm---e-n--t_s InfHaonmt aenvdisPitrse_-_S__c_h_o__o_l_:______
GMrooutphecros_n_f_e_r_e__n_c_e__s__w__i_t_h_

15 175 13 ---12 2

345 ----- ----
494 204 71
118 4 2

32 23 10 ---210 405 418 4
7 ---- 82 ----

514 ---- 649 22 ---- 264 50---- 82
549 125 81 ---- ---- ------ 4037 ---- ----
5 49 69 ---- ---- 20 43 ---- ----

734 590 112
120 96 ----
24 ----- ----

3.617 6.827
437

Office consultations with

Mothers_______ ----------Examinations __ -----------

11 9

129 70

---3-9-5

147 1054

73 42

Cases given advice-------- 20 55 483 174 81

20 lJ 97 6 14 ---- 153 83
7 416 144 ----

123 152 12 242 667 115

92---91 ---96 123

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

a
------3

355 ---- ---282 ---- ---1154 ---- ----

1029 44 I

93 439

----------

----
3

2.301 2.540 3,980

----------- --------
-Operated for seven months only. EstabllsheaJune!;-f92li.

DIVISION Ol' COUNTY HEALTH WORK. Summary of County Health Work for the Year 1924

---

.s .. ~ e IS
~

~ ,Q

.,;
ol4 ~

IQ IQ IQ 0

,Q
.Q

...u~..,..

0

0Q

~ .,1111
Q

t.~:,

-e. ..;

::s
0 Q

~""'

~
b 0

=;
Ill

l.,i
.~..
.:I

..,;
't!
~
0
.:I

:g
= ..,: .<u1
~~

..;

r:=
a0
.<u1
iii

a .!
..a0s,

..,:
::s

fl I'll

..a.;.
0
.<1 E-o

e:~:s

..,:
~...

E-o ~

'..;.
0 E-o

'

ACTIVITIES. ScChhoiolld:ren examined _______ 152 4545 3306 2662 4330 2057 8711 4191 7377
Nruemnb_e__r_d__e_f_e_c_t_i_v_e__c_h__i_ld__-_ 108 1835 1250 2213 1833 1504 6234 647 2565

1725 5744 2911 2403 10 1091 2562 2178 1697 ----

1747 1361

I 8562 ---- 2960
4767 ---- !602

1365 5866 3570 1079 1912 2400

74,194 33,888

"""'

Tofotaulnndu_m__b__e_r__d_e__f_e_c_t_s_____ Follow-up visits___________

108 2207 4 15

1928 766

4078 3036 1043 80

NOutarsietsioanttaelncdlaisnsge_s_:_________ New cases __ ---------------

--------

-------

---------

---------

-------

2396 9326 1048 3087 70 393 884 1134

1476 1054

3799 653

2370 225

3011
----

--------

2021
------

353 514 43 ----

83 26

-------

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

30 30

300 230

-------

--------

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

6977 3729

--------

2072
----

1541 2183 3324 549 174 1779

1 ---- ---- ------- 75----
15 ---- ---- ------- ----- ----

55,988 12,552 1,356
344

IV. IMMUNIZATIONS:

ComPleted anti-typhoid

vaccinations.------------- 1071 4093 2161 287 2020 1332 793 477 2910

CotrmeaPtlmeteendtsto__x_i_n__-_a_n__t_i_t_o_x__in_ Protective antitoxin. cases. Curative antitoxin, cases... AAnnttiisrmabailclPtorexavtmacecnintsa.t_i_o_n__s_.

6 137 3659 192 41 3 46 30 4 59 3 12 28 ----- 28

46 ---- 149 102 14 ---- 19 ---4 108 5 3

49 516 3626 2545 2785 241 4554 755 1428

2 3 38 4 22----- 18 7 7

V. VENEREAL DISEASES:

2465 3246 4310 441 664 8764 6 591 1708

55 212 55 108 4 45
3 11 17 980 1583 3761 24 6 12

58800 13 55919

-_-__-_-
____
-_-_-_-_

283 138
------
219
------

------
547
------
1453 1

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

1
----8
601 17

11330 3140 1163

891 1020 89

3 4 1810

6 ---33---3284 687

4 27 1

52,972 7,518 1,108
280 31,428
292

--. Suspects examined_.________ 194 Prophylactic treatments... 4 Number cases treated... ____ 155 Number new cases treated. 32 Total number treatments... 189

36 3 20 2 25

7375 68 18 9 12 30

1 5865 617

----13
-----

---18 14

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

----------

----------

9046 8 49 33 64 ----

72 365 137 10 ------ 194 121 275 84 53 43 47 422 509 1305

114 178

79----

106 46

29513

150 985

--------_-_-_-_
----

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

141
---4-0-1-5
166 8438

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

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

Operated for seven months only.

E

s

t

a

b-l

i

s

~
hedJ

t- i n~ e

-
1,1924.

121 17 4

3----- ----

77 14069

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

-----------

8,891 294
11,040 1,119 21,332

DIVlSION OI'ICOUNTY HEALTH WO:&Jt. Summary of County Health Work for the Year 1924.

., ~ ...,. a., -i.a, ACTIVITIES.

.d li

.;

~

.ci .1..4.
:9 ~

Ill Ill Ill 0

III I

~

.ci .s

" .Q

0 0

1=1

.s 114 ::1
0
1=1 1=1

..;
1>.
~

I II I

VI. HOOKWORM:

---- Number of examinations___ 179 ---- 975 56 44

Number of cases found.. ____ 118

69----- 7 575---- 2 ---

~l ' Number completed treat-

L.

g
_e.
0

=;
Ill

a ..= .,
.~s

.,
-.:1 fl: 0

..,;
8

..:1 ..:1 !!I

::.:,1
.<1
":!:l

Jill =..;
0
]
.!! Ill

IIIII 1 I

------ ---- 332 1095
lll 384

483 268

121 153

683 ------
518

407 514 64 250

9

I! I~ .,;

.as

0

.<1

!-<

1

531 95 ---393 61 ----

~..,
0
!-< 6.395 2.973

ments ---------------------- 13 ---- 68 ----- 8 182---- ----- --- 99 293 283 389 175 2011 35 149 ---- 349 61 ---- 4.115

"0>'

VII. LIFE EXTENSION:

NCausmesbgerivoefneaxdavmicine_a_t_i_o_n__s______

50---50----

----------

----------

--------

7 ---- ----- --115---- ----- ---

8 8

74 67

60 62

-------

----
----

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

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

5 ----

-------

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

46 ---46 ----

313 348

VIII. SANATATION OF FOOD

IDnaSsipUreiPecPstiLsocInoErSoef:dd__a_i_r_i_e_s_______________
Cows tuberculin tested_____ Inspection of stores __ ------

26 25
--62

1
1
--i5

884 ----2668 2543

161 22 2000 675

---- 26 7 60 ---

8 6

---------

----

----815

------

44 468 38 1516 ---

---- ---- 391
156 369 843

79 12 126

74---- ---- ------

71 ---- ---- ------

35 161

----

----

119 140

611 5 43

97 ---- 2

424 ----
1843 2

323 71

59 67 30

15 164

----627

--------

41 78 323

2.533 409
7.550 8.987

--- ---- Inpslpaeccetsi_o_n__s_o__f_e__a_t_i_n_g________ 10 38 574 315 29 453 14 397

159 101 83 7 ---- 49 2348

67 112 51 163 4.970

---- ------ Exhaamndinleartsio__n_s__o_f__f_o_o__d_______ 2 28 2 1 8----- 3 103 --- 40 21 143 110

45 ---- ---- 124 4----

634

IX. MPAoLnAdRsIaAn:dmarshesdrained 6--------- ----- -------------

8 ___ ------ 2 57 ____________________ ,____ ,___ _

72 57----

202

Yoaridlesdo_f__w__a_t_e_r__s_u__r_f_a_c_e______ 4200---- 528 252 ____ ---- --- 13800 --- 201500 ____ 1420 8600 ____ 126000 79500~-------- 575000 50000 ____ 1.060.800

Q~~~~ra_~~:-~a~llle~~~!~~---- 19 39 _____ .---- ____ 3---- 45 ___ ------ ____ 727 ---- 202 781 ------ 71 ___ _
Homes screened_____________ 6 2 ----- ----- --- ---- --- 37- - ------ 140 68 ---- ____ 71 ------ ____1___ _

136----- ---13 49 78

2.028 464

-Operated for seven months only. Established June 1, 1924.

DIVISION 01" COUNTY HEALTH WORK. Summary of County Health Work for the Year 1924.

ACTIVITIES.

.sII:
t ~

li
<

.Q .;!

Ill Ill Ill

......;.
~ 0

..Q.,
0 0

.:.:s:
~
r"":l'

~

... :9
<

.l":l'

.,;

lol ::s I

"' 0 .9
r:l r:l llo

,e~.
0

~
Ill

~
.:":.<s'.
.:I

,;

='"t'l ..:

II:
0 .:I

:;"3'
!'l

:;i
.l:l
i"i

I

I

.,;

I! I~I 0=s
-5 iii

il!l

,;
s<
0
...l:..l

~.... ..0..

X. GENERAL SANITATION:

0> -'I

Inpsrpeemctiisoens _s_o__f_p__r_i_v_a__t_e______ 136 240 42153 10272 36 23368 239 3700 ----

Scbhuoioldlsinagnsd___o__t_h_e__r__p__u_b__l_i_c Inspections of camps _______

30 ----

100 ----

---------

107
-----

112 ----

29 136 30---3---- 9

Inspections of swimming

2752 226 180 8400 570 97 35 129 42 6 13 2 43 ---- 7

4706 242414 1244 ----
44 187 54 40
2 8 ---- ----

4956 196 3873 349,661

112 27 80 1,397

3 3 17

110

pools.---------------------Complaints investigated ___

5 12 ----- 10 1 ----24 128 792 368 120 24

2 56

10 3ii2

142 ---2o4

144

15 3 lii3Jl23J

2 2

5 17 ---- ----
44 675 16 49

2 12 7 576 152 149

103 4,293

XI. LABORATORY:

1 Specimens examined ______ _
SpLeacbimoreantos ryse__n_t___t_o____S_t_a__te_

1881801206elu931270I 130 396 22 4 74

1656~----~
106 78

3~----~11371uoalusol5712811------~3660 ____ ___ _
29 141 244 7 252 357 379 ------ ------ 159 26

Milk samples, total counts- 1 ---- 98 346 8 Water samples examined.__ _ 3 ---- 5 152 ----

7 ---- 119 19 169---- 67 ---- ---- ------ 582 71---2 ---- 1 ---- ------ ---- 62 6 ---- lll 252----

Water samples sent to State

:~1--~;:I_-~~ 2 ----- 351

oft~~~~:~_r_y:::::::::::::::: 1--45~--~~1::::: j__ -~l-~~1_ --~~. --5-1,---4-1,---4-8 ~~1:::: 5~1- _~~~--~51:::::: 1--ii55l__ j::::I______~I:::::I__~~

13,437 3,039 1.455
947 351 1,229

XII. OTHER ACTIVITIES:

-- ------- --- -~--- -~-- ---~-- -~-- --~-- ---~----~----~--- -~- -- ---~--- -~--- -~-- --~-- --~-- --- -~-- --- -~----~----~-------~-- ---~-- --~-==== ===~ ===== ===== :::: ::::: :::: ==== :::: :::::: :::: :::: :::: :::: :::::: :::::: :::: :::: ::::::: ::::: :::::::::::::
-operated for seven months only.Establisliecl. -June 1, 1924.

DIVISION OF COUNTY HEALTH WORK. Summary of County Health Work for the Year 1924.

...s~
:9

li
0
~

.,cgi

1111 1111 1111

III

,;
~
.!!!
0

,.;
::s .ci ~
"" .0
0 0Q
I

.. -e :9 .....,,.; .,;

.,1.:1

::s
0

I
.f!

Q Q '"'

= .... 6==

:;;

.,,;

":.=:.s.
..:I

" =~
0
..:I

..,.
9 ~

II

.=0"=: ~"
:1!

.,;
s:l 0
] ~

,;

Jl jl I! IiI "a 0 .0:

Oi
~

E-o

E-o

llll VI. FOOD HANDLING ESTABLISHMENTS: Dairies i.mproved.___________ Stores improved------------ ____ Eating places i!llProved.... 3

~1---2211~1 -I 2 ----- 85 1119921-_-_--_--_-_- 22a11 2141291 _-_-_-_-41-----2-311 8377161 6a21351-__------_-1-_-_--_--_--1-----12-141

1147421--------1--------1 171 ---- ----

1~1 2~116 559tl

402 589 693

0>

VII. CHILD HYGIENE:

~

InOfaansetsainmdpProrev-esdc.h_o_o__l____.. I 11 .... 1 2831 .... 1 261 ..... 1... .1 2651 ... .1 10011281 3231 .... 1 .. .1------1 4081----1---1 601 471----1 1,641

School:

~:~1 !:1 ::;1_~~1-j_::~::l. ~:~tJJ. . ~~~--:~1-~~1 TD~o~t~a~l~dde~f-e~c~t-s~c~o~r~r~e-c~t~e:d......, 6414120511_9__0_1_48851575727171.-_-__-_~_7141381227958139094521 16

6,925 10,379

N~~;!~~~~r~~esa~~--------- ____ ____ _____ _____ ____ ____ ___ 5s ___

385

Vill. GENERAL SANITATION:

Premises i!llProved_________ _ Schools improved__________ _

31411

34071 __1__0_01102251

72311

18a1 32171 998.....

173 1750 17 16

155011-9-5-0-1

4~------
---- 20

606211871 ___ _ 1 2 ----

61
6

1121
2

26109

11,911
297

;il:~~if~il-iiil 01~~~~!~~~~-~~~1-~~~::~-i~-1
~:.T~i~~~ov~l~i.iiiPioviid:

11 2~-----~---- --4 a::::: ----6

Nuisances abated___________ 53 136 165 282

63 8 ----

2640~------------

105

1 ----
90 147

1i "27il"""9

il 575~ ~ 1

61 ~--------~--------~-------1~-----1 6 --i6 -----4i 8}\-itii

100 43 39 7, 719

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

-Operated for seven months only. Established June 1, 1924.

. SANITARY ENGINEERING AND WATER ANALYSIS H. C. Woodfall, Director
Since the establishment of the Division of Sanitary Engineering, Apri11, 1920, the work of this division has consisted almost entirely of the investigation of water-works and advice concerning them, malaria control, mosquito eradication, sewage purification and the elimination of miscellaneous nuisances. There are many other subdivisions of sanitary engineering connected with public health control, but with the limited number of assistants it has been impossible to add to the work of this division.
SANITARY ENGINEERING
The following list gives in detail the 292 surveys made in 1924: Water Works............................... 94 Sewerage Systems, Sewage Disposal and Sanitary Privies.................................. 22 Swimming Pools. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Garbage and Refuse Disposal. . . . . . . . . . . . . . . . . 1 Malaria and Drainage ....................... 143 General. ................................... 29
MALARIA CONTROL
During the year, the State Board of Health continued to furnish supervision over malaria control work. This work is financed wholly by local communities, the State Board of Health advising in methods of mosquito control. A great deal of drainage work has been completed, resulting in a marked reduction of the malaria sick rate in each of these communities.
Tables showing the expenditures by cities for this work during the year will be found at the end of this report.
SPECIAL INVESTIGATION
Special investigations of water supplies, typhoid epidemics, malaria control and mosquito eradication have been made during the year.
70

WATER LABORATORY
The principal work done in this laboratory is for the protection of the water supplies of the state. The amount of work has increased each year since the creation of the division in 1920. Table No. IV gives a comparison of total analyses from June 1910 to December 31, 1924. In the year 1924, 5,794 analyses were made, 5,776 of which were bacteriological and 18 chemical.
On account of the lack of assistants and the large amount of bacteriological work, it has been impossible to continue the chemical analyses of river waters, chemical analyses being made only for the special study of municipal water supplies. In the appendix are tables giving the average results of all analyses made during the year.
Analyses of water from private supplies, required by the rules and regulations of the State Board of Health, have also been carried on during the year.
Most of the cities, towns and industrial enterprises have cooperated in an excellent manner and have sent in mont:Rly samples of water for analysis. A complete list of all water supplies in the state, excepting certain mill supplies, has been compiled during the year and much valuable information has been obtained. This list now includes 219 water supplies. Each of the water supplies should be inspected at least once a year and many of them several times, a task impossible to perform with the present force.
The following tables for the years 1922, 1923, 1924 give, first, a comparative list of the cities cooperating with the State Board of Health by sending in regular monthly samples for analysis, and, second, a comparative list of the safety of the water supplies in the state:

TABLE A

Cooperation given by cities in sending regular monthly

samples for analysis.

Cities giving Cities giving Cities giving Cities giving

excellent

fair

poor

no

co-operation. co-operation. co-operation . co-operation.

1922

55

18

20

87

1923

116

19

11

49

1924

141

9

6

63

71

TABLE B Safety of Water Supplies.

Cities having excellent water.

Cities having doubtful water.

Cities having dangerous water.

Cities sending in no samples or too fewto judge the condition of the water.

1922

56

53

11

60

1923

131

12

I

51

1924

143

7

6

63

GENERAL REMARKS
At the end of 1924, the water supplies of most of the cities were in excellent condition. The number of cities having a doubtful supply have decreased during the year. Of the six cities having a dangerous water supply, two are from deep wells and the pollution is probably introduced through poor protection of well casings or through leaks in the casings. In two other cases the sources from which the water is taken would naturally show pollution. In the remaining two cases no analyses were made previous to 1924. Those made in 1924 indicated pollution but the recommendations of the Board have not been carried out. Chlorination of any of these supplies should make the water safe for drinking purposes.
The number of cities giving little or no cooperation and thus making it impossible to know the condition of the water has increased during the year. This is due mainly to the fact that cities not previously included have been added to the list this year.
The work of the division has increased rapidly in the last four years while the increase in the working force has been small. If the work continues to increase it will be necessary to materially enlarge the force or do less work. The latter alternative should not be considered.

72

TABLE NO.1. Inspections Made by Cities and Towns 1924. CITY

Albany____________ 4

11

-------I-------I-------1-------II-------I-------

Alto________________ 1

1

Americus _________ _ 1

4

Arlington__________ ___ __ ___ ________ ___ _____ _______ _ 1

Athens ___________ _ 1

Atlanta ___________________________ _ 1

1

Augusta __________ _ 3

1

5

Austell_____________________________________________________ 1

Baconton _________________________________________ _ 1

Bainbridge _______ _ 3

3

Barnesville________ ___ __ ___ ___ _____ ___ _____ ______ __ ________ 1

Baxley____________ _ 1

2

Bibb Co. __________________________________________ _ 3

1

Blackshear________________________________________ 1

Blakely___________________________________________ _ 2

Bowdon __________ _ 1

Brinson___________ _ 1

Brunswick________________ _ 1

1

Buford ___________ _ 1

Cairo______________________________________________ 5

Camilla____________ ____ ___ _ ____ ___ _ __ ____ __ _____ ___ 6

Cartersville_______ _ 2 Cedartown _______ _ 1 Chamblee_________ _ 1 Chatsworth ______ _ 1
73

TABLE NO. 1.-Continued. Inspections Made by Cities and Towns 1924. CITY

Chickamauga_____ _ 1

Clarkesville________________________________ -------- ________ 1

--C-l-im--a-x-_-_-__-_-_-_-_-_-__-_1_-

--

----
1

l

--

--

--

-ll-

--

--

--

l

--

--

--

-l-

--

--

--

--

---

--

Cochran__________ - 2

3

Columbus ________ _ 2

6

------------------l-------l-------l--------l--------l------------

Conyers ____ -------

1

Cordele ___________ _ 1

Dalton____________ _ 1

Decatur ___________________________________ -------- 1

DeKalb Co. _______________________________________ _ 3

--------------------l-------l-------ll-------1-------l-------- ---

Donaldsonville____ _ 1

2

Douglas __ --------- ________ -------- -------- -------- -------- 1

-D- -u-b l-i-n-__-_-__-_-__-_-__l _-

-_

-

-

l2

-

-

-

--

l

-

-

-

--

-

1

-

-

-

-

-

-1

-

--2

-

-

-

2

-

East Point________ _ 1

1

Edison____________ _ 1

2

Elberton __________ _ 1

Ellijay_____________________ ---------------- ________ -------- 1

Fairburn___ -- ____ _ 1

Fitzgerald (A B. & A.) _______________ ------------------------ -------- 1
Folkston __________ _ 1

Forsyth____________ ---------------- -------- -------- -------- 1

Fort Benning______ -------- -------- -------- -------- 1 Fort Valley ________ ------------------------ _______ _ 12 Gainesville _______ _ 1

74

TABLE NO. i.-Continued. Inspections Made by Cities and Towns 1924.

CITY

I Q> I

rrlnncb~oer'i":Jn' ~

Cl) ....
-t.=: cbporl2 .., ..
"'.. .,-s:;~l.l~>.
;am .. Q)." as
:_:-PA-P

bll j;:l
a.!ci
.~
r~n

't1 j;:l
"'Cl)cD
..bcc.eCo:.:".IS.)' .oltl 0

'1j:::lC1I)
...ce:f
<;liollo;:tl
:'s;A

-.;. Cl) j;:l Cl)
0

Greensboro _______ _ 1 Griffin ____________ - 6 Guyton ___________ - ______________ -- ____ ---- -------- 1 HartwelL _________ _ 1 Hawkinsville______ _ 1 Hazlehurst _______ _ 1

Jeffersonville _____ _ 1

Jonesboro_-------- 1 LaFayette ________ _ 1 Leary______________________________________________ 5

Lee Pope__________________________________________________ 1

Leesburg _________________________________________ _ 8

1

Louisville _________________________________________ _ 2
--------------1----1----1-----1----1---
Lyons______________ 1

Macon_

_ _____

_____-_1 -

- -1-

-1-

-

---6

1-

--

-

--

1

-

--

--

1-

--

7

--

1

-

---11

-

Madison _______________________________________ - _-- ____ ---- 1

Marietta___________________________________________________ 1

Midville ___________ _ 1 Millen _____________ _ 1 Milltown __________ _ 1 Milledgeville ______________________ _ 1 Milstead__________ _ 1 Monroe ___________ _ 1

2 4
1

Moultrie ___________ ---------------- ________ -------- 5 Newnan _________ _ 7
75

TABLE NO. I.-Continued. Inspections Made by Cities and Towns 1924.

CITY

I Q) I

,; ,..l..d.
0
~ ....
Q)
"o"S'
~

rrPnolbolSO~".s.:.~:. ~

Q) ...
Q) rll ......::: bll oSl-o
... ~to~"S"a"C''"P-D~'.~."..c"ppc'.a.,

absa::l.l!g!l
~p.. rll

'tsS::
oS
Q)4i
.o1c;s.1:.S.".'
.o...SQ~)
0

'.sts::;:SG!>f .ocsSS.::.;:
:s-.;~

~.... sQ::)
Q)
0

Norcross__________ -~ 1 t- ------_I_------ -r- ------ _,_ ------ -r--- -----

+______ ______ Offerman_________ _
oglethorpe _______

1

--------'--------

-~--

________

--------
________

-----4---

-
~-

-_-_-__-_-_-

-_

P

e

l

h

a

m

___________

J_

__

__

______

__

_________________

1

1

_ 1

4

_______ _

Perry-. _____________ ________ ________ ________ ________

1 ,_______ _

Ray C1ty ____ ___ __ __1

1

1________1________1_________1 _______

~-
1

_____

_

Rome (Berry School) _________________ _

10

Rossville__________________ _ 2

Savannah__________ 1 ________ ________ 1 Shellman __________ ________ ________ ________ ________

1 1 _______ _

Smithville___________1________1________1________1_______ 1 1 1--------

Social Circle _______ , Sparta____________ _

~

I~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Statesboro______ ---~

Stone Mountain __ _ Summerville _____ --~

1 ~---~----~-- _____ -~- ______ -~-- _____ -~------- _

Sylvania___________________ ________ ________ ________ 3 _______ _

Tennille ___________ ________ ________ ________ ________ __.______

1

Thomasville________ 1 4 1________ 1________1________ 1 Tifton _____________________________ --.--------------

Toccoa-- _________________ _ 1

Valdosta__________ _ 4

Vidalia ____________ _ Wadley____________ _

2 -------- ,________ ------'--
1

Washington ______ _ 2

Waycross _________ _ 3

Waynesboro ______ _ 1

Whigham _________ _ 1 76

4 1_______ _ 5 1 1
6

TABLE NO.2. AVERAGE RESULTS OF BACTERIOLOGICAL EXAMINATIONS OF WA T IB
SUPPLIES. 1924.

CITY

SOURCE

cB. acc. t3.7p ecr.

Per Cent of Samples Containing B. Coli.

.001 1 .01 1 0.1 1 1.0

10.0

I I I I I Bawl Tap Raw iaaw Raw Raw Tap Raw Tap
-------------~---------:

Abbeville ________ Deev WelL-- 2.200 2,400

Acworth_-------- Deev WelL-AAddaeiLrs_v_i_l_l_e_._._-_-_-_-_- DSvereivnWg-e-l-L______ Albany___________ Deev WelL.. Allenhurst_______ Deev WelL.. Alma _____________ Deev WelL..
Americus_----- { DsvenepngW__e_l_L_}

4 370 10 49
1 900
13

10 38 680 130 24
2.500 7

0

0

0

0

0

5.6

0

0

0 4.0

0 0 2.2 0 0 3.6 0 12.0 18.2 0 13.3 11.7 0 2.0 5.2 0 0 18.4 0 3.3 12.0 0 10.4 4.0

Aragon___________ Svring_ ______ 23 Ashburn _________ Deev WelL.- 5 Atco._____________ Deev WelL .. -----Atlanta __________ River_________ -----Atlanta EXI>osi-

31 ------ ------ 0 40.0 44.5 88.0 88.8

54 -- ------ - 0 0 8.7 11.3

11 --- ------ ------ -- 0

4.8

5 ------ -- --- ------ 0

4.6

ition Cot. Mill Deev WelL-- 16 Augusta __ ------- River. ________ 2,500 Athens___________ River_________ 500

8 ------

------ 0

5 9.1 9.1 63.6 100

6 0 0 38.6 71.5

00 0 100 0 100

0 0
0

Baconton________ Deev WelL__ 60 Bainbridge ______ Deev WelL-- 15

48 8

Barnesville____ { DSvereivngW__e__l_L_}

200

0

0 16.3 18.3

0 0 1.7 5.7

0

12.0

Barwick.--------- Deev WelL.- 1 33

Baxley_---------- Deev WelL.- 1 350

Blackshear.----- Deev Well____ 7 1,000

BBllaukeeRlyid--g-e--_-__-_-_-_- DCreeeevkW___e_l_L__._. 3,9003

470 5

Boston........... Deev WelL.. 17 400

Bronwood....... Deev WelL.-- 16 Brunswick.______ Deev WelL.. ----- 16

Buford--------- { sCvrer!mlkg- .__._._.._}

4

0 0 0 13.8

0 0 0 13.3

0 0 0 5.2

0 0 0 16.7

83.4

0 100

5.2

0 0 0 19.1

0

16.5

0

0

0

2.2

CCaailrhoo.u.n..._._._._._._._.._ Camilla_________ _ Canton __________ _

Deev WelL.. 14 svring. --- 260 Deev WelL.. 5 River_--------- 3,500

Canton Cotton

14 6

:::::: :::::: "iiT

0 85.o

~ -i4T 28.6 "64X 78.g

0 10.0 19.2

0 66.2 8.2

0 6.0 5.2

0 100

0

CaMrriolllsl-t-o-n--_-_-__-_-_-_- CRirveeerk_._-_-__-_-_-_-_--3-,5-0--0Cartersville_____ River. ________ 2, 700
Cave svrings.... Svring_ ______ 26 Cave Svring,

~ -s::r 5o:o -75T 91:7
6 17.6 35.2 82.5 100 37 ------ ------ ------ 0

0

1.0

0 100 10.0

0 100 3.2

000

School for Deaf Svring. ------ -----Cedartown...... Svring. ------ 30 Chatsworth...... Svring_ ------ -----Chamblee..______ Deev WelL.. -----CChhiicvkleaym__a_u_g__a________ SSvvrriinngg.. -_-__-_-_-_- 16280 Claxton__________ Deev WelL.. _____ _
CCoolcQhuraitnt _._-_-_-_-_-___ DDeeeevv WWeell_ll_._._. 88 Columbus.. ----- River_________ l,OOO Commerce.------ River_________ 800 Conyers......... Deev WelL._ 12 Cordele __________ Deev WelL....... Cornelia........ svring. ------ 21 Covington...... Creek.------- 280 CUthbert.. ------ Deev WelL.. 3

3

0

7

0 85.0

12

0

90

0

57 ------ ------ 0 60.0 42.8 88.0

8 630

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

0

0 0

0

29 ---- ...... ------ 0 0 3.1

13 8

------ -----0 8.3

50.0

0 63.4

0

0

0 100

5 23 4 5

- ------ 41.7 83.4 - ------ ------ 0
:::::: :::::: :::::: io:o

0 100 00 0 0 38.0

7

0 20.0 29.2 50.0

0 57.5

8 ..... ------ ------ 0

0

0

0 0 23.2 10.0
34.4 17.3 10.7 5.7 12.2 2.5 2.3 1.7 3.3 4.3
0 4.4

Dalton___________ Creek.-- 1,900 23 Dawson__________ Deev WelL__ ------ 130

0 27.2 72.6 91

--o- ::::=: :::::: :::::: DDoecearutunr..._.__.__._._._.

DCereeevkw.-e-n-_-_-_-_----

--60

2 6

--o- -o- a:2- 54:5 Donalsonville..
Douglas.......

Deev WelL.. 11 1,000 Deev WelL......... 4

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

0

Douglasville..... Creek. . . . . . . . 330 27

Dublin.__________ Deev WelL........ 140

77

0 100 15.2

0

16.2

0

1.9

0 0 14.8

0

0 16.5

0

6.7

0

0

0

9.4

TABLE NO. 2. AVERAGE RESULTS OF BACTERIOLOGICAL EXAMINATIONS OF WATER
SUPPLIES. 1924.

CITY

SOURCE

Per Cent of Samples Containing B. Coli.

Bact. per
c. c. 3?0 c.

III

1-----1 .001 .01 0.1

1.0

10.0

Raw ITap Raw]RawJRawJRawJTapiRaw\Tap

East Lake________ DeeD wen___ 4

Eastman--------- DeeoWelL.- ------

East Point------EEdatiosonnto_l_l_-_-_-_-_-__-_-_Elberton_________

DCreeeeokW___e_l_L__...1,00103

DeeoWelL. Creek. ______

- 160 -30,000

Ellaville--------- Deev WelL..

----~- I
38 :::::: :::::: ::::::

~ --~-110.~

60 ------ ------ ------ 0 0 13.3' 7.8

8 18.2 27.2 36.4 75.0 0 93.8 !0.0

35 ------ ------ ------ 0 18.2 0 37.3

10 33.4 33.4 50.0 91.7 0 100 1.0

360 ------ ------ ------ ------ 0

17.9

Fairburn--------- Creek. _______ 800

FFoitlzkgsetorna.l.d_-_-_-__-_-_-_-

DeeoWelL.. Deev WelL..

250

Forsyth---------- Deev WelL-- 4

Fort Gaines. ____ Deev WelL-- 4

Fort Valley______ DeeoWelL. - ------

55 100 20
8 13

0 9.1 63.6 81.7

-----------

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

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

0
------

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

0 0

0o- 100 0
26.1 0 2.0 00

22 ------ ------ ------ ------ 0

17.7 ll.4 61.7 6.2 19.1 1.0

Glennville_______ Deev Well____ 60 Greensboro______ Creek. _______ !,900

200 9

--9~i-

36.4

ai:9-

0 91.0

Greenville_______ G r i f f i n . . __________

Creek.------------- 10 Deep Well.__ 115 4,300

------ ------ ------ ----------- ------ ------ 0

0

0 5.7

0 100 8.3

0 0

----0-

4.8 2.8

Hapeville________ Deep WelL___________________________________________________ ------

HartwelL------- Creek ________ 2,300 12 10.0 30.0 45.4 63.6 Hawkinsville____ Deev WelL.. I 20 ______ ______ ______ o Hebardsville---- DeeD WelL.. 50 1,100 ______ ______ ______ o Helena___________ Deev WelL.. 2 35 ______ ______ ______ o Hogansville.---- Deev WelL.. 740 520 ______ ______ ______ o

3.7 93.4 24.0

0

o 20.0

0 4.4 8.7

0 0 13.1

0 16.7 10.4

Jackson.. _________ Creek ________ 2,300 Jefferson ________ Creek ________ l,200 Jon6sborO------- Deev WelL.. 6

3 8.3 18.7 41.6 75.0 35 0 16.7 50.0 75.0 15 ______ ______ ______ o

o 100

0

o 100 1.7

0 8.3 5.7

La Fayette_______ La Grange_______ Lavonia__________

svring _______ Creek ________ Deev Well____

300
------
4

LLianwdraelnec_e__v_i_l_l_e_._._- DSvereivnW g __e_l_L_____

0 33

Louisville.------ Deev WelL..

LUDll>kin-------- Deev WelL.. 6

Lyons------------ Deev WelL-- 28

12 7 4 60 30

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

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

---------------------
0

8.3
------
0 0 0

340 ------ ------ ------ ------

45 120

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

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

-----------

0 0

McDonough ___ { Svring_ ----} 10 2 ------ ------ 0 0

DeevWelL

McRae.---------MMaadcoisno.n_.--_-_-_-_-__-_-_-

DRieveevr_W___e_l_L__._. 4,500 Creek. _______ 975

13 9

-----16.7

------
25.0

------
75.0

------
100

20 0 16.7 33.3 75.0

Manchester. _____ Creek. _______ 460 1)0 0 8.3 33.3 66.6

MMeairgise_t_t_a_._________-_-_-_-

Deev WelL __ Deev WelL ..

230 12

Metter----------Midville._-------

Deev WelL-- 9
Deev WelL.. ------

Milledgeville.--- Creek.------- 6,000

100 ------ ------ -----30 ------ ------ -----39 ------ ------ ------

0 0 0

24 130

-----20.0

-----50.0

-----90.0

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

Mi(lSletadtgeesvainll.e)____ Creek. _______ 300 12

0

0

0 IW

M Miillsletena.-d-.-_-_-_-__------MMoonnrtiocee..l.lo--.-_-_-__-_-_-

DsvereivngW__e_l_L__._. Creek ________ Creek. _______

-----------
260 330

---38-

-----------

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

600

16 0 0

-----------
0 0

------
-----83.5 54.6

Moultrie... _----- Deev WelL.. 15 23 ------ ------ ------ 0

Nashville ____ : ___ Newnan---------

Deev WelL .. 3 400 Creek ________ l,OOO

2.000 115

-----0- -----0- --1-6-.6--

58.30

Norcross------- { W svreilnLg-_---------} ______ 240

Norman Park.--- Deev WelL.. ------ 60

0 68.3 12.0

0

6.4

0 20.0 16.7

0 0 18.1

0 25.0 7.8

0

8.6

000

0 16.0 24.2

0 20.0 0

0

5.8

0 100

0

0 100 4.2

0 91.7 26.1

0 2.6 3.3

0 3.6 5.5

0 5.0 5.7

0

6.2

0 100 1.8

0 !CO 6.3
0 ------ --6~7-
0 83.5 3.6 0 91.0 5.2 0 0 4.6

0 15.0 14.2 0 91.6 10.3

33.3

80.0

0

0

78

TABLE NO.2. AVERAGE RESULTS OF BACTERIOLOGICAL EXAMINATIONS OF WATER
SUPPLIES. 1924.

CITY

SOURCE

Per Cent of Samples Containing B. Coli.
cB.acc. t3.7l?ecr.

.001 1 .01 1 0.1 1 1.0

10.0

I I I I I Bawl Tap Raw Bawl Raw Raw Tap Raw Tap

Ocilla,_ ___________ DeeD WelL... ------ ------ ------ ------ ------ ------ ____________ ------

I'earson__________ DeeD WelL __ 60

:IP'eemlhbarmok.-e-_-_-_-_-__-_-_Ferry_____________ :Plains___________ :Porterdale _______

DeeD WelL __

DeeD WelL __

DeeD WelL-- 5

DReiveDer_W__e__l_L_____

3 2,100

140 ------ ------ ------ 0 11.8 10.0 24.7

7 290 25
4 8

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

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

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

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

------ ------ ------ 0

-i6X 33.3

0 58.3 100

0 7.3
00 00 0 100

8.5 52.0
0 1.2
0

Quitman_________ Deep WelL __

22 ------ ------ ------ ------ 0

18.7

R i c h l a n d ________ RRoomckem__a__r_t________________ Rome(McLin
Textile MillsJ.
RgrgN~-~~~:_~ {
RoYston _________

DSDeerDinWg __e_l_L__._.
River... -----
Creek _________ SDring _____ } SCDrereinkg.-_-_-__-_-__

2 11 1,350
------
4,900 680

27 ------ ------ ------ 0

13 11

----0- -i8:2-

8.3 63.6

16.6 90.7

125 ------ ------ ------ ------

50 0 22.2 45.5 90.0
270 ------ ------ ------ 0

0 1.8 14.5 0 41.6 3.6 0 100 1.9

0

18.3

0 100 11.0 0 0 6.5

Sandersville_____ Shellman ________ S m i t h v i l l e _______

Deep WelL __ DeeD WelL __ DeeD WelL--

72 14 100

Social Circle.. { DSDeerDinWg __e_l_L_} 900

SSDDaarrkt as_. _-_-_-_-_-_-_- -----Statesboro_______ Summerville.. ___ Swainsboro______ Sycamore ________ S y l v a n i a _________ Sylvester_________

DeeD WelL __ 4

DeeD WelL __ 3

DeeD WelL __ ------

SDring_ ------ 260

DeeD DeeD

WelL __ WelL __

------
15

DeeD WelL __ 80

DeeD WelL __ 55

150 ------ ------ ------ 0

8 100

-----------

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

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

0 0

18 ------ ------ 0 0

9 12 100

------ ------ ------ 0 ------ ------ 0 0
------ ------ ------ ------

50 ------ ------ 33.3 75.0

480 26

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

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

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

------
0

60 ------ ------ ------ 0

80 ------ ------ ------ 0

0 2.9 11.6 0 16.7 7.6 0 1.6 5.2

0 1.8 1.7

0 0 18.9

0 5.4 1.0

0

8.8

0 96.7 4.3

0

17.6

0

0 1.0

0 3.3 3.3

0 0 20.0

TT he nonmi lalset-o-n- -. -_-_-__-_T h o m a s v i l l e _____ Thomson. ________ Tifton___________ Toccoa___________ Trion._----------

DCereeDekW___e_l_L__-_-

80 57,000

DeeD WelL-- 12

Creek_------DeeD WelL __ Creek ________ SDring _______

-----6
280 140

50 ------ ------ ------ 0 0 0 1.0

43 ll.l 11.1 33.4 55.7 0 89.0 3.6

23 ------ ------ ------ 0 17.4 5.4 34.8

10 24

-----------

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

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

------
0

0

1.0

0 2.0 1.0

90 0 7.7 46.2 53.8 0 84.7 8.0

4 ------ ------ 8.3 41.6 0 63.4 3.5

Valdosta_________ Deep WelL._

VViiednanliaa_.___-_-_-_-_-__-_-_-

DeeD WelL __ DeeD WelL __

12 240 700

75 220 3,000

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

0 0 0

0 5.6 15.9 0 20.0 11.1 0 35.5 33.4

Washington _____ WaYcross _________

Creek-------DeeD WelL._

400 15

WWeasytonne_sb__o_r_o__._-_-_-_West :Point_______

DeeD WelL.. 0 DeeD WelL __ 5 Creek.------- 2,250

WWihnidgehra_m___-_-_-_-_-_-_-_Wrightsville _____

DeeD WelL __ Creek ________

7 825

DeeD WelL __ ------

27 0 9.1 54.5 91.0

25 ------ ------ ------ 0

6 60 7

------ ---------0- 25.0

------ 0
0 50.0 100

aax 18
5

------
0

----0-

0 72.7

11 ------ ------ ------ ------

0 91.0 2.0

0 8.6 13.6

0 0 10.6

0 10.0 9.3

0 100 13.1

0 10.0 10.0

0 100

0

0

18.9

79

CITY

TABLE NO. III.

PHYSICAL AND CHEMICAL ANALYSES OF CITY WATER SUPPLIES 1924.

SOURCE

,...,;,;
...,.!!.!3
~"J~:I.E=!
::z:;lflllkl

~ :!::
:a'tl
.... ::1 roo

Parts Per Million.

~
<..I,l,l
.... lloo

.:9
<Il~l'
~< roo

.;
":!..:.:.
::!z:;:

...,,;
~"'
:z;

.;
'tl
~
0

Alkalinity

= I _gl-~ .,

.<l Po

ill

11<1

=G>J:Io
'~t'l~"0' ~I'll
Ill

..,;,; a
= ~:~::!
0 ~r:1
,!;l t<>8
0

.
0
0..,,
.... llo

..
0
'tl
."e
.0a
1=1

.;
~
I>
Ill
J:lo

-o---:wl10~1501602o8-.2-~~~~~~ Thomasville___________ , Deep Well No. J_ _____ _
Thomasville___________ ) Deep Well No.2. _____ _

- -0 -.0-16 -.0-13 - -0 - .-10-2-ll2-l -0- -130- -13-0 -25-0 -I -.3 - - - - ______ ____ - - - - -
0 .034 .011 0 .108 10 ------ 120 120 188 .2 ------ ------ ------ ------

Thomasv -----

ille. --

. _________ ----l

Deep ---

Wel --

l No.3 ---

.--------

l

-

-

- o - - 1- : w l1 -l--l--l

.023 --

1
l

-

-

1
l

-

-

1

-

-

l

-

-1l

-

-

l1

-

-

l1

-

-

l

-

-

1

-

-

1

-

-



-

-



-

-

-E-as-t -Po-i-nt-..------------"1-- -N-ew--D-ee-p -W-el-L------1-- --1- ,_ _,_ _,_ _,_ _,_ _,_ _,_ _,_ _,_ _,_34_,_.2_,_ _,_ _,_ _,_ _

-N-ew-n-an-_-___-__-___-__-__+ __ -Br-an-c-h N-o-. L-__-__-__-__1_ -1- ,_---_---,,_----_--,,_----_-- ,,__---_-- ,,________ ,,________ ,,________ ,,________ ,,_- ---_--,,_----_--,,-_---_--,,-_---_--,,_13_.0 ,I_3_.3 I,_6_.6

Newnan________________ Branch No.2.--------- 1

1.0 I 2.7 ,_____ _

~ Newnan ______________ Branch No.3________ 1 l------l------1------l------l------l------l------l-----l-- ---1----1--- --1------1 I 1.0 2.61 7.4

Newnan________________ Pond. _________________ _

3.0 3.2 6.6

Newnan________________ Branch No. L ______ _

__ ,____ _ 0 .06 ,_____ _

18

1.8 4.6 6.0 ,_____ _ 6.6

Newnan_______________ Branch No.2.---------

0 ~1==1=:.=1~ ,____ _

1.2 I 3.2 I l 2.0 J______ 6.8

Newnan _____________ . Branch No.3.--------- 1 - - ,_ _,_ _,_ _,_0_,__.16_,,_ _______ ,,_ __ _,_20_,_ _,_ _,_1_ .0 ,_2_ .2 ,_2_ .0 ,,_ ______ _,_6_ .8

1 Newnan _______________ Pond (Uppper End)___

,__,__,__,_0_,_.04_4 ,__,__,_28_,__,__,_1_.8 ,I_10_.8 ,_4_.0 ,__,_6_.8

I -N-e-w-na-n-__-___-__-__-__-__1__ -P-on-d-a-t I-nt-ak-e_-__-__-__1_ - -1- ,_ _,_ _,_ _,_0_,_.04_4 ,_ _,_ _,_28_,_ _,_ _ ,_1_.4 ,_5_.0 ,_5_.0 ,,_______ _,_6_.8

Newnan. ______________ Tap __ --------------

0 .048 )______ )______ ) 45

.4

2.4 I 2.0 J ______ J 7.6

Macon _________________ Tap __ --------------

o I .24 5.0 )______ ) 14

1.2 I 1.9 I 6.0

6.8

Dublin_________________ Well flee Plant) ______ _

50 .15

Dublin.-----------Dublin..

Tap-City Water.----Tap-City Water____ _

==I==I==I==I==I==I==I==I==I~ITracel==l==l==l=:.= 175 ITrace -------

TABLE NO. IV. Comparison of Laboratory Work by Years.
June 1, 1920-December 31, 1924

Year

Bacteriological Analyses

Chemical Analyses

Total Analyses

1910 (June 1 to Dec. 31.)
1911 1912 1913
1914 1915 1916
1917 1918
1919 1920 1921 1922 1923
1924

152
272 276 278 116 398 371 250 322 487 970 2,780 3,106 4,993 5,776

106

258

251

523

236

512

252

530

76

192

97

495

41

412

13

263

36

358

68

555

47

1,017

54

2,834

134

3,240

22

5,015

18

5,794

TABLE NO. V. Liquid Chlorine Installations Made in Georgia 1924.

City

Type Apparatus

Remarks

Atlanta______________ _
BuInfocr.)d__(_B__o_n__a__A__l_l_e_n_,
Canton (Canton Cotton Mills) __________ _
Carrollton___________ _
Col!leurmryb)u_s___(_B_a__r_tl_e_t_t_s_' Cordele ______________ _ Jackson _____________ _ Macon _______________ _
Social Circle _________ _

MSVM
MSAM
MSAM MSAM
MSAM MSAM MDA Jr. MSVM MSAM

Duplicate.
Water Supply.
Water Supply. Water Supply.
Water Supply. Water Supply. Swimming Pool. Duplicate. Water Supply.

81

TABLE NO. VI. Total Liquid Chlorine Installations in Georgia to
December 31, 1924.

City:
Albany. At co. Athens. Athens (University of Ga.) Atlanta. Augusta. Augusta (Y .M. C. A. Swimming
Pool.) Barnesville. Blackshear. Blue Ridge. Buford (Bona Allen, Inc.) Calhoun. Canton. Canton (Canton Cotton Mills). Carrollton. Cartersville. Cave Spring (School for Deaf.) Cloudland. Columbus. Columbus (Bartlett's Ferry.) Columbus (Camp Benning). Commerce. Cordele. Cornelia. Covington. Dalton. Dalton (Crown Cotton Mills.) Decatur. Douglasville. Elberton. Fairburn. Fort Screvens. Gainesville. Greensboro. Griffin.

City:
Hebardsville (Hebard Cypress Co.)
Jackson. Jackson (Swimming Pool.) Jefferson. LaFayette. LaGrange. Lindale (Mass. Cotton Mills.) Lithia Springs (Bowden
Springs Co.) Macon. Madison. Manchester. Milledgeville. Milledgeville (Allen's
Sanitarium.) Milledgeville (State
Sanitarium.) Monroe. Monticello. Newnan. Quitman. Rockmart. Rome. Rome (McLin Textile Mills.) Savannah (Emergency Supply) Social Circle. Stone Mountain. Summerville. Thomaston (Thomaston Cot-
ton Mills.) Thomson. Trion. Washington. West Point. Winder.

82

TABLE NO. VII. Daily per Capita Consumption of Water by Cities and Towns 1924.

City

Estimated Total Daily Population Per Capita Consumption Jan. 1, 1925. Consumption

Abbeville ___________
Adel _________ - __ - --Alamo _______________ Albany _____________
Allenhurst __________ Americus ___________ A r l i n g t o n ___________ Ashburn ____________ Athens _____________ Atlanta _____________ Augusta ____________
Bainbridge _________ Barnesville _________ Blue Ridge __________ B o s t o n ______________
BrunsWick __________ Cairo _______________ Camilla _____________ Canton _____________
C a r r o l l t o n __________ Cartersville _________ Cedartown _________ C l a x t o n _____________ C o c h r a n ____________ C o l u m b u s ___________ Commerce __________ Conyers ____________ C o r d e l e _____________ Cornelia ____________
Covington __________ Cuthbert ___________

50,000 55,000 12,000
1,200,000 70,000 650,000
85,000 300,000 1,750,000
32,0CO,COO 7,250,000
625,000 200,000 60,000 85,000
2,250,000 75,000 175,000 225,000 275,000
525,000 1,000,000
75,000 85,000 4,500,000 225,000
50,000 225,000 75,000
275,000 150,000

1,119

45

1,800

30

700

17

13,200

92

300

230

9,450

69

1,340

64

2,200

114

17,600

100

280,000

120

54,000

134

5,100

12

3,100

65

950

63

1,900

45

16,500

135

2,060

37

2,290

76

3,000

75

4,900

56

4,490

117

4,300

233

1,390

54

2,200

39

36,400

124

2,560

88

1,820
6,870 1,350

.

27
33 56

3,480

79

3,100

48

83

TABLE NO. VII. Daily per Capita Consumption of Water by Cities and Towns 1924.

City

Estimated Total Daily Population Per Capita Consumption Jan. 1, 1926. Consumption

DDoeucgaltausr_______-_-_-_-_-__-_-_-_-

600,000 230,000

8,000 3,430

75 67

Douglasville ________ Dublin ______________ E a s t m a n ____________

130,000
600,000 125,000

2,200 8,660 2,880

59 69 43

East Point__________ E d i s o n ______________ E l b e r t o n ____________

250,000
100,000 525,000

6,200 900
6,500

40 100 81

F i t z g e r a l d __________ F o l k s t o n ____________

525,000 12,000

7,400 410

71 29

Fort Gaines ________

100,000

1,240

81

FGoa irnt eVs vailllleey___-_-_-_-_-_-_-_Glennville __________ Greenville __________ G r i f f i n ______________ H a r t w e l l ____________

325,000 625,000 25,000 60,000
525,000 85,000

3,490 6,450 1,280
760 8,620
2,480

93
97 20 80 61 34

H a w k i n s v i l l e ________

125,000

3,100

40

JHaakzilne_h_u__r_s_t___-_-_-_-_-_-_-_Jesup _______________
La Grange __________

50,000
15,000 85,000
1,000,000

1,480 420
2,200
19,300

34
36 39 52

Lawrenceville _______ Louisville ___________

85,000 65,000

2,300 1,050

35 62

Madison ____________

300,000

2,350

127

Manchester_________ Marietta ____________ Midville _____________

300,000
300,000 60,000

3,000 6,300
1,170

87 48 51

Milltown____ --~ _____

10,000

900

11

Monroe _____________

175,000

3,300

53

MMoonntteice=ll~o-_-__-_-_-_-__-_-_~

185,000 90,000

1,920 1,980

96 45

Moultrie ____________

400,000

8,000

50

84

TABLE NO. VII. Daily Per Capita Consumption of Water by Cities and Towns 1924.

City

Estimated Total Daily Population Per Capita Consumption Jan. 1, 1926. Consumption

Nashville ___________ Newnan ____________ Pelham _____________ P e m b r o k e ___________ Pinehurst __________ P l a i n s _______________
P o r t e r d a l e __________ Richland ___________ Rochelle ____________ RRoomckem__a_r_t______________________

125,000 350,000
150,000 12,000 20,000
15,000 625,000 300,000
45,000 100,000 1,500 000

2,400
7,700 3,000
600 670
700 2,900 1,660 1,140
1,580 13,830

52 45
50 20 30 21 206
180 40 63 108

S a v a n n a h ___________ S y l v a n i a ____________

12,225,000 61,000

85,000 1,420

144 43

Thomasville _________ Tifton ______________ V a l d o s t a ____________ V i d a l i a ______________
Washington ________ Waycross ___________ Waynesboro ________ West Point__________

450,000 475,000
1,000,000 150,000 225,000
2,225,000 325,000
475,000

8,930 3,300 12,350 3,400 4,600
19,850 3,600 2,254

50 144 81
44
49 112
90 210

WWhinigdhera_m________-_-_-__-_-_-_-_-

20,000 250,000

680 3,780

29 66

85

TABLE NO. VIII. Table Showing Expenditures for Malaria Work 1924.

City

Approximate Amount
Spent 1924.

A. B. &A. R. R. (Brunswick) ______ $

312.00

A. B. & A. R. R. (Fitzgerald) ______

71.96

Albany______ --- _____ Americus ___________ Atlanta _____________ Augusta ____________

2,415.17 1,580.00 5,000.00 18,631.00

Baconton____ -------

276,00

Bainbridge _______ --

925.00

Bibb County________ Blackshear _________ B l a k e l y _____________ Brunswick __________ Cairo _______________ Camilla _____________

500.00 250.00 200.00 3,500.00 1,100.00 1,426.16

Central of Ga. R. R.

8,647.78

Chatham County___ Colquitt ____________ Columbus ___________ De Soto_____________

22,150.00 672.96
8,036.33 75.00

D o n a l d s o n v i l l e ______ Douglas _____________

325.00 500.00

Edison______ --- ____ -

150.00

Fort Benning_______

3,740.00

Fort Valley _________

875.62

Population Protected

Approximate Area Con-
trolled Square Mile.

*

0

*

0

13,200

13

9,450

9

280,000

20

54,000

15

700

2

5,100

8

*

0

1,400

4

2,100

3

16,500

15

2,060

3

2,290

3

*

0

*

0

910

4

36,400

8

220

2

1,170

5

3,430

3

900

3

*

0

3,490

4

Note.. *-Population protected cannot be estimated. o-Area under control not obtainable. 86

TABLE NO. VIII.-Continued. Table Showing Expenditures for Malaria Work 1924.

City

Approximate Amount
Spent 1924.

Population Protected.

Approximate , Area Con- ,.
trolled Square Mile

Leslie _______________ $ 475.00

500

2

Louisville ___________

1,150.00

1,050

4

Macon ______________

1,800.00

58,000

15

Milledgeville ________

265.40

4,730

5

Moultrie ____________

7,000.00

8,000

5

Pelham _____________

1,350.00

3,000

3

Quitman ____________

283.53

4,600

4

Savannah___________ 10,864.30

85,000

11

Sumter County_____

2,100.00

*

0

Sylvania ____________

549.00

1,420

4

Thomasville ________

623.20

8,930

8

T i f t o n ______________

920.00

3,300

6

T y b e e _______________

5,811.35

800

2

V a l d o s t a ____________

1,563.59

12,350

7

V i d a l i a ______________

750.00

3,400

3

Waynesboro___ -----

6,175.00

3,600

5

Note. *-Population protected cannot be estimated. 0-Area under control not obtainable.

87

TABLE NO. IX.
TABLE SHOWING EXPENDITURES FOR MALARIA CONTROL WORK BY CITIES FOR FIVE YEARS. 1920-1924.

City A.wBic. k&) _A_.__R_.__R_.__(_B__r_u_n_s_-__

1920 $ ______

A.gBer. a&ldA) _._R__._R__.__(F__i_t_z_-____ Albany__________________ -Americus _________________ ~ Atlanta___________________ Augusta __________________ Baconton _________________ Bainbridge _______________ Bibb County_____________ B l a c k s h e a r _______________ Blakely ___________________

-----3,746.21 ------
------
------
--~---
---------------------

1921
$ ______
-----3,650.00
120.00 4,000.00 ---------------------
------
2,120.00

1922
$ ______
-----2,168.61
-----5,000.00
----------------
------
-----330.70

1923
$ _______
1,500.00 3,842.75
973.00 4,551.43 12,000.00
75.00 853.00 -----400.00 531.75

1924
$ 312.90
71.96 2,415.17 1,580.00 5,000.00 18,631.00
276.00 925.00 500.00 250.00 200.00

TABLE NO. IX.
TABLE SHOWING EXPENDITURES FOR MALARIA CONTROL WORK BY CITIES FOR FIVE YEARS. 1920-1924.

City

1920

1921

1922

1923

1924

Brunswick_______________ _ Cairo __ _

$ -----856.35

$1,000.00 31.85

$2,074.26 678.81

$4,107.00 700.00

$ 3,500.00 1,100.00

Camilla ______ _

1,405.01

1,426.16

Central of Ga. Ry. _______ _
Chatham County_________[
00
<.:> Colquitt _________________ _
Columbus ____ _

6,000.00

----13,200.00
----10,500.00

8,647.78 22,150.00
672.96 8,036.33

DeSoto__________________ _

150.00

75.00

Donalsonville____________ _

1,860.00

217.75

325.00

_ ______,

I

I

I

1-

Douglas __________________ _

500.00

--

Edison ________ ------------

50.00 I

150.00

TABLE NO. IX. TABLE SHOWING EXPENDITURES FOR MALARIA CONTROL WORK BY CITIES FOR FIVE YEARS.
1920-1924.

City

1920

1921

1922

1923

1924

Fitzgerald __ Fort Benning____________ _

Fort Valley __ Leslie ____________________ _

Louisville ________________ _ ~
Macon __

Milledg~ville __

---

Millen ____ ----------------Moultrie_

Pelham__ _ Plains ____ _

$ -----200.00

$ l,l01.97 1,776.39

$ -----7,000.00 1,900.00 80.00
1,800.00 312.40
790.21 50.00

$ -----3,740.00 875.62 475.00 1,150.00 1,800.00 265.40
7,000.00 1,350.00

TABLE NO. IX. TABLE SHOWING EXPENDITURES FOR MALARIA CONTROL WORK BY CITIES FOR FIVE YEARS.
1920-1924.

City

1920

1921

1922

1923

1924

Quitman __________________ Ray City__________________ S a v a n n a h _________________

$ -----------
39,000.00

Sumter County___________

.c..o..

Sylvania __________________

Thomasville ______________

----------4,457.37

Tifton ____________________ T y b e e _____________________ V a l d o s t a __________________ V i d a l i a ____________________ Waynesboro ______________
~otals ________________

------
----------------
-----$48,059.93

$ 200.00 400.00
21,000.00 ----------1,660.00 1, 656.41 ---------------------
$36,038.26

$ -----------
78,897.17 ----------795.92 778.50 -----1,110.30 -----------
$102.472.63

$ ------
------
15,400.00 1,550.00 1,500.00
594.00 550.00 29.500.00 2,319.75 -----503.18 $118,906.23

$ 283.53 ------
10,864.20 2,100.00
549.00 623.20 920.00 5,811.35 1,563.59 750.00 6,175.00 $123 '041. 25

Locality

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.



Range depths

I Popula-

tion

Source of

.

Jan. 1, PublicS upplyiQuahty

of Wells

1925

Jfrom To

Height

Type of Treatment

I I I of water

Date of

above(+) below (-)

WRaatwer

Coagu- Filtra- Sterili- 1 Ilnastitoanl-

Mouth of Storage lation tion zation

Wells

Abbeville____ 1,119 Deep WelL_ Hard ________ 468

-156

1918

Acworth ____ A d a i r s v i l l e __

1,160 845

Deep WelL_________ 335 350 Spring ______ Hard _______________ _

-150

-------- '-------- '--------'--------' 1915 ________ ,________ ,______ {I ti~~s \1906

f

AdeL _______ Alamo _______

1,800 700

Deep WelL__________________ Deep Well___________ ________

590 354

-150 -18

<:>
{'.;)

Albany______ 13,200

A l l e n h u r s t __

800

DDeeeepp WWeellLL ______H_a__r_d______3_0_0____1_,_1_0_0_ _

-40

1908 1917
yes 1892 1909

Alma ________ 1,350 Deep WelL_________________ 600

-90

1915

Alto (State San.) ______

200 Spring _____________________________ _

1909

Americus____ 9,450

Aragon _____ Arlington ___ Ashburn ____ Atco ________

1,800 1,340
2,200
1,000

Athens _____ 17,600 Atlanta _____ 280,000 Augusta ____ 54,000

Springs &D.

WelL _____ Hard 400 1,725

-73

Spring ______ -------- -------- --------

Deep WelL_ Hard ________ 1,300

-70

Deep WelL_________ 350 400

-263

Deep Well & \ ______ ________ 530
River______ f

-8

{

River { yes

River ________________ ________ _______ _

yes

River _______ Soft _______________ _

yes

River________ Soft

________________ ,___________ _

1

1

yes

River { yes yes
yes yes

River { yes yes
yes yes

River yes
yes yes yes

1907 1903
1908
1909
\1903
f
1893 1875

B a c o n t o n ___

700 Deep WelL_I Hard

207

-80

Bainbridge__ 5,100 Deep WelL __ Hard

402

550

-53

1907 1------ 1901

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Locality

Range depths

Popula-

of Wells

tion Jan. 1,

Source of Public Suppl

IQuality

1925

From I To

Height

Type of Treatment

I I / of water
above (+) below (-)

Raw

Date of Co~gu- Filtra- sterili- Ins.tal-

Mouth of Water latwn tion zation latwn

Wells Storage

Barnesville__

3,100

Spring &D. Well _______ Hard

300

375

-35 ________ ________ ________ yes 1890

Barwick _____ Baxley ______

440 1,300

Deep WelL_________________

Deep WelL_ Soft

450

440 600

-20 -150

________ ________ ________ ________ 1913 ________ ________ ________ ________ 1890

Blackshear__ 1,400 Deep WelL_ Hard ________ 825

-60 ________ ________ ________ yes 1913

Blakely_____ 2,100 Deep WelL_ Soft ________ 800

-20 ________ ________ ________ ________ 1903

~ <:

Blue Ridge__

950 Creek_______ Soft ________ ________ ____________ yes

no

no

yes _____ _

Boston______ 1,900 Deep WelL_ Hard ________ 500

-100 ________ ________ ________ ________ 1911

Bowdon_____ 1,100 Spring ______________________________ --------.----________________________________ 1913

Brinson _____

400 Deep WelL_ ________ ___ _____ 126

-22 __ ______ ___ ____ _ ___ _____ ___ _____ 1916

B r o n w o o d __

550 Deep WelL_________ 300

300

-260 ________ ________ ________ ________ 1910

Broxton _____

700 Deep WelL_ ________ _______ _ 500

-265 _____ ___ ___ __ ___ __ _____ _ ____ __ __ 1895

Brunswick__ 16,500 A. WelL____ Hard 600 1,000

+28 _____ ___ ___ ___ __ _______ _ ___ ___ __ 1899

Buena Vista 1,300 Deep WelL_________________ 230

-147 ________ ________ ________ ________ 1906

Buford ______
Bullochville_ Butler_ _____ B y r o m v i l l e __

2,900
375 780 470

Spring & Creek_____ ________ ________ _______ _
Spr~ng _____________________________ _ Spnng ______1________1________1_ ---- __ _

yes yes yes yes 1910 1913
1911

Cairo _______ C a l h o u n ____

2,060 2,100

DSpereinpgW_e_l__L_-_~-H__a__r_d_ -~-______________-~____7_0_0_ _

-150

Camilla _____ 2,290 Deep WelL_ ________ ________ 297

-150

1906 yes 1900
1904

Locality

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

I Range depths Height

Type of Treatment

Popula-

of Wells

tion Source of

.

Jan. 1, Public Supply Quahty

/

1925

From To

of water above (+) / below (-)
Mouth of

I I /Date of
Raw Coagu- Filtra- sterili- InstalWater lation tion zation lation

Wells Storage

Canton _____ 3,000 River_______ _I Soft

no

yes

yes

yes 1908

Canton(Cot-

"""'

ton Mills)_ C a r r o l l t o n __ Cartersville_ Cave Spgs. __ Cave Spring
(S. Deaf) __

600 4,900 4,490
700
400

_______ C~eek

________ ________ ________ ___________ _

R1ver __________________________________________ _

yes yes

Riv Spr

er in

g________________S_o_f_t____________________________________1__________

_

yes

1

1

1

Spring ______ ________ ________ _______ _

yes yes yes

yes yes yes

yes 1923 yes 1906 yes 1886
1916
yes 1884

Cedartown__ 4,300 Spring______ Hard _______________ _

yes 1890

C h a m b l e e ___

320 Deep WelL_ ________ ________ 410

-30

1917

Chatsworth

550 Spring ______1________ 1------- _1_ ---- ---

1914

Cbgiac_k_a__m__a_u_-_ 1,290 Spring______ ___ ___ __ _____ __ _ ___ ____ _ __ _____ __ ___ _______ _ _____ ___ _____ __ _ yes

1908

Chipley _____

730 Spring ______________ ----- _______________ - _- _- -- _ ----- ___ -------- -------- -------- 1921

Claxton_____ 1,390 Deep WelL_ _______ _ _____ __ _ 633

-80 _______________________________ _ 1912

Clayton _____

750 Creek___________________________________________ no

no

yes

no

Climax ______

350 Deep Well___________________ 300

-115 ________ ________ ________ ________ 1913

C o c h r a n ____ College Park

2,200 4,000

Deep WelL_________________ 300

-75 ________ ________ ________ ________ 1907

Deep Well_______________________________________________________________________ --------

Colquitt ____

910 Deep WelL_________________ 380

-165 ________ ________ ________ ________ 1911

Columbus___ 36,400 River________ Soft ________ ________ ____________ yes yes yes yes 1882

Commerce___ 2,560 Creek___________________________________________ yes yes yes yes 1908

Conyers_____ 1,820 Deep WelL_________________ 350

-150 ________ ________ ________ ________ 1913

Cordele_____ 6,870 Deep WelL_________ 500

700

-18 ________ ________ ________ yes 1890

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Locality

Range depths

Popula-

of Wells

tion Source of

Jan. 1, Public Supply!Quality

1925

From I To

Height

Type of Treatment

of water above(+) below (-) Mouth of

Raw Water

I I IDateof
Coagu- Filtra- sterili- Installation tion zation lation

Wells Storage

Cornelia ____ Covington __
Crawford ___ Cuthbert ___

1,350 3,480
800 3,100

Spring ______________ ,________ ,_______ _
Creek & Spring ____ Soft ~--------~---------
~::~ ~:U=== -sort___ ======== ---3~--

--1--------1--------1--------1 yes I 1910

yes yes yes yes 1905

-70

1911

<:0 01

Dallas_______ 1,250 Deep Well___ ________ _____ ___ ______ __ __ _____ __ __ _ ____ ____ __ _____ _ ___ ___ __ ___ ___ __ 1925

Dalton______ 5,300 Spring______ Hard _____ ___ ________ __ ___ ____ ___ ____ ___ _ ____ ____ __ ___ ___ yes 1910

Darien ______

800 A. Well______ ___ ___ __ 500

600

+4 .5 ___ ___ __ _______ _ _____ ___ _____ ___ 1900

Dawson_____ 3,500 Deep WelL __________________________ ------------ -------- -------- ________ -------- --------

Decatur_____ Dexter______ Deerun _____

8,000 470
1,060

Creek_______ Soft ________________ ------------ yes yes yes yes 1907 Deep WelL__ ________ ________ ________ ____________ ________ ________ ________ ________ 1910

Deep WelL_________________ 491

-40 ________ ________ ________ ________ 1912

Dovnilalels_o__n_-___ 1,170 Deep WelL_ Hard ________ 691

-75

1907

D o u g l a s _____ Douglasville D u b l i n ______

3,430 2,200 8,660

Deep WelL_________ 480 500 Creek_______ Soft _______________ _ Deep Wen___ Hard 300 300

-180
-- no
yes

yes yes

yes yes

1903 yes 1911 no 1917

East Lake___ E a s t m a n ____ East Point __ !
Eatonton ___ [

860 2,880 6,200
2,760

g~we~:l!=== -Harc.ci======== ---467--

-- -- ~ ----- ---- --- ------ ---- ------- 1921

-120

1907

I RiSvperri_n_g___________S_o__ft___ ,____2_8_0__ ____6_0_0__ _____-_7__0____ ,---n-o----,---y-e-s---,---y-e-s---,---Y-9-S---

1909 1891

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Locality
Edison ______ E l b e r t o n ____ Ellaville _____

Population
.Jan. 1, 1925
900 6,500
700

Range depths Height

Type of Treatment

of Wells P uSbol iucrSc eu popf l y i Q u a l i t y
From I To

l I of water
above(+) below (-)

Raw

Date of Coagu- Filtra- Sterili- Ins~al

Mouth of Water llation tion zation latwn

Wells Storage

'

DCreeeepk_W__e_ll______ -S--o-f-t---~-_-_-_-_-_-_-_-_~_-_--_-_-_-_-_-_~_-_--_

1909 yes yes yes yes

Deep Well___________ ________ 210

-90

1915

Fairburn ___ Fitzgerald __

1,700 7,400

Creek_______ Soft ,________ ,_______ _ Deep Well __________ _ 550 I 825

-125

no

yes

yes

yes 1911

1898

<0 0>

Flowery Branch ___
F o l k s t o n ____ F o r s y t h _____
Fort Gaines_ Fort Valley_

500
410 2,260 1,240
3,490

Spring___________________________ : _____________________________________________________ _

Deep Well___________________ 500

-13 ________ ________ ________ ________ 1906

Deep WelL_ Soft

300 356

A. Wells (2) __ Soft ________ ________

-75 __ ________ ________ ________ ________ 1908 + ________ ________ ________ ________ 1910

Deep WelL_ Hard ________ 350

-125 ________ ________ ________ ________ 1904

l Gainesville__
Glennville___

6,450 1,280

DCreeeepkW___e_l_L___ _S__o_f_t___ ~_-_-_-_-_-_-_-_-~---5-0-7---

-300

Grantville___ 1,240 Deep WelL _________ -------- 565

-10

c~~kw~E~~~,- -~- Greensboro_ 2,140

Greenville___ Griffin ______

760 8,620

g~:~kweii===

==-=-=-=-=-=-=-,------3-5--6---

-------
---5i2--

-50

G u y t o n _____

530 Deep Well___________________ 465

-16

yes yes yes yes 1899 1914 1920
yes yes yes yes 1898 yes yes yes yes 1910
1913

Hahira ______ Hampton ___

960

Deep Well ___ ________ _______ _

350

930 Deep WelL __1________ 1-------- 275

-130 -100

1915 1910

TABLE NO. X Water Supplies in Georgia, With Sources of Water and Means of Purification.

Locality

Population
Jan. 1, 1925

Range depths of Wells
Source of Public Supply)Quality
From I To

Height

Type of Treatment

I I ! of water
above(+) below (-)

Raw

Date of Ooagu- Filtra- Sterili- Ins~al

Mouth of Water llation tion zation latwn

Wells Storage

Hapeville ___ HartwelL ___

2,100 2,480

g;:~k~~~~= ='- ~~:~---'= == ==== =,_- _:~--

-100

Havwillkei_n_s_-____ 3,100 A. Well______ ---------------- 312

+

Hazlehurst_ 1 480 Deep Well ___ -------- _______ _ 280

-EO

Hebardsville

600 Deep Well___ -------- -------- 509

-20

<:0 -'1

H e l e n a ______

940 Deep Well ___ -------- _______ _ 300

-140

Hogansville_ 1,770 Deep WelL __ ---------------- 365

-12

H o m e r v i l l e __

590 Deep WelL _________ -------- 697

-96

1914 yes yes yes no 1915
1904 1907 1909 1921 1918 1912

Iron City___

510 Deep Well__ ------ ___ ,_______ _ 280

-80

1908

J a c k s o n _____ Jakin _______
Jefferson____ Jevffilelres_o__n_-___ Jesup _______
Jonesboro ___

2,100 420
1,830
890 2,200 1,100

LaFayette __ 2,300 LaGrange___ 19, 00 Lavonia_____ 1,550

Creek ____ ---~--------~--------~------- -I--.

Deep Well ___ Creek_______

---------------Soft ________

---1-2-7--+-

-5

yes yes yes yes

1916

no

yes yes

yes 1915

Deep Well___ ________ _______ _ 510 Deep Well___ Hard _______ _ 820 Deep Well __1________ 1-------- 307
Spring ______ _______ ________ _____ - __ Creek_______ Soft _______________ _ Deep WelL_1-------- 1 160 1 240

286

1905

-32

1912

-210

1918

___ ________ ________ ________ yes

1910

:=1--~~~--1--~~~--1--~-~~--1--~~~-- 1917

Locality

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Popula-
tion Jan. 1,
1925

Range depths of Wells
Source of Public SupplyiQuality
From I To

Height

Type of Treatment

of water

above (+)

Date of

I I below (-) Raw Coagu- Filtra- Sterili- Ins~al-
Mouth of Water llation tion zation 1 latlon

Wells Storage

Lavwilrleen__c_e_-___ 2,300 Deep WelL_________ ________ 311

-20

1912

L e a r y _______
Leesburg____ Lindale _____ Lithonia ____

480 820
3,300 1,300

A. WelL____ _____ ___ _____ ___ 735 D. Wen______ ________ ________ 1000 Spring _____________________________ _ Deep Well__________________________ _

+15 -10

1895 1922 yes 1895 1917

<D 00

Locust

Grove _____ Louisville__ L u m p k i n ____ Lyons ______

550
1,050 1,000
880

1- 1---300- DDeeeepp WWeelll=L=_=___s_()_t"_t_--_-_I=_=_=_=_=_=_=_= 100 -~------+122ii--- -I=_=_=_=_=_=_=__= I=_=_=_=__=_=_=_= I=_=__=_=_=_=_=_= I_=_=_=_=_=_=_=_=,--1i99o18o--

Deep WelL_ ________ ________ 300

-200 ________ ________ ________ ________ 1908

McDonough
McRae ______ Macon ______ Madison ____ Manchester_ M a r i e t t a ____ Marshall-
ville _______ Meigs _______ M e t t e r ______ Midville _____

1,400
1,330 58,000
2,350 3,000 6,300
1,180 1,250 1,100 1,170

Spring &

D. WelL __________________ --------

1912

Deep Well___ ________ ___ ____ _ 287 River _______ Soft _______________ _ Creek_______ Soft _______________ _ Creek_______ Soft _______________ _ Deep WelL ________________________ _

-72 yes yes
-- yes

yes yes yes

yes yes yes

1916 yes 1898 yes 1913 yes 1917

I Deep WelL_ Hard ________ 420

-100

Deep WelL_________ 575 1180

-150

Deep WelL_ ________ ________ 462

-52

Deep WelL_________________ 580

-21

~-------- -------- ________ -------- 1914 ________ -------- ________ ________ 1912 ________ ________ ________ ________ 1922 ________ ________ ________ ________ 1914

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Locality

Popula-
tion Jan. 1,
1925

Range depths of Wells
Source of PublicSupplyiQuality
From I To

Height

Type of Treatment

of water

Date of

I I ! above(+)
below H
Mouth of

Raw Coagu- Filtra- Sterili- Ins~al
Water llation tion zation latwn

Wells Storage

Milledgeville! 4,730 Creek______ _! Soft

yes yes yes yes

~ ~

Milledgeville (St. San.)_
Millen _______
M i l l t o w n ____ Milstead ____ Monroe _____
Montezuma_ Monticello __ Morven _____ Moultrie ____

4,500 2,590
900 750 3,300
1,920 1,980
600 8,000

Creek_______________________________ ------------ yes yes yes yes

Deep WelL_ ___ __ ___ ___ _____ 450

-5 ________ ________ ________ ___ ___ __ 1907

De"P Well___________ 200 300

-85 ________________________ -------- 1913

Springs_____ ________ _____ __ _ _______ _ _____ __ __ __ _ _______ _ ___ _____ _______ _ ___ _____ 1910

Creek_______ Soft ________ ________ ____________ yes yes yes yes 1905

Deep Wells_ Hard 350 500 ____________________________________ -------- 1890

Creek___________________________________________ yes yes yes yes 1907

Deep WelL______________________________________________________________________ 1923

Deep Well___________ ________ 500

-225 ________ ________ ________ ________ 1900

Mnoounnt__V__e_r_-_

780 Deep WelL __ ,________ ,_______ _ 180

--60

1905

N a s h v i l l e ____ New Holland Newnan_____ Norcross ____

2,400 2,300
7,700 1,000

Deep Well___ _______ _ ___ __ ___ 850 Spring ______________ ----- _- _ -------Creek_______________________ --------
Shallow Well & Spring__ ___ __ __ _ ____ ___ _ 28

120

1908

-

-

---yes

-

-



-

-

---yes

--

'

-

-

- ----
yes

-

-

-- --yes

-

-

, __

1-8-9-1-

--

-20 -------- ,_- ---- __ ,_-- -------- ----- 1910

NoPramrkan______

570 Deep WelL_ ________ ,_______ _ 500

200

1898

Ocilla _______ Oglethorpe_

2,260 870

~.eWe~~l:~==1_~~~~- _[=======

400 280

-220 +8

1906 1911

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Locality

Popula-
tion .Tan. 1,
1925

Range depths of Wells
Source of Public SupplyiQuality
From I To

Height

Type of Treatment

of water above(+) I

I

'Dateof

I I below (-) Raw Coagu- Filtra- sterili- Instal-
Mouth of Water lation tion zation lation

Wells Storage

....
8

l P a v o ________
P e a r s o n _____ P e l h a m _____
Pembroke___ Perry _______ Pinehurst___ P l a i n s _______ P o o l e r ______ Porterdale __ Preston_____

1,200 900
3,000 600 690 670 700 490
2,900 250

Deep WelL _________ -------- 300 Deep WelL_________________ 356 Deep WelL_________________ 727 Deep Well___________________ 520 Deep WelL __ Iron _______________ _
Deep Well___________ -------- 218 Deep Well___ So t -------- 287 A. Well______________ -------- 389 River _______ Soft _______________ _
Deep WelL _________ -------- 500

-100 -150 -188 -16
-37 -75 +
-430

1910 1921 1907 1908 no yes yes no 1911 1920
yes yes yes yes 1918 1910

Quitman____ 4,600 Deep WelL-' Hard ,_______ _ 699

yes 1910

Ray City____
Reidsville ___ Reynolds ___ Richland____ Rochelle ____ Rockmart ___ Rome _______

900 600 1,100 1,660 1,140 1,580 13,830

Deep WelL_ ______ ________ 255
Deep WelL_--------________ 300 Deep WelL_ _______ _ ___ __ ___ 520 Deep WelL_________________ 710
Deep WelL_---------------- 3i7 Spring______________ -------- -------River _______ Soft ________ --------

125 -164 -414 -186 -160

-------yes

-------yes

---y-e-s---

yes yes

1922
1905 1921 1910 1913 1911 1892

RoMmiell(sM) _c_L__i_n

200 Creek_______________ j_------ -1------- -I------------ yes

yes

yes

yes 1923

Rome (Shorter Uollege)

600 CrSeperkin&g____ ,________ ,________ ,________ ,___________ _ no

yes

yes yes

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Locality

Range depths

Popula-

of Wells

J at ni o. n1,

j
P

uSboliucrSceu

popflyIQ

uality

1925

From I To

Height

Type of Treatment

oafbowvae

ter
(+)

Date of

I I below (-) Raw Coagu- Filtra- Sterill- Instal-
Mouth of Water llation tion zation 1 lation

Wells Storage

Royston ____ Sale City____

1,800 600

DSpereipngW__e_l_L____-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_--_

1921

Sandersville_ 2,720 Deep WelL_________ 200 400

-75

1902

Savannah___ 85,000 Deep WelL_ Soft

500 1500

1854

.... .0...

Scottdale ___ Shellman ____ Smithville ___
Social Circle

500 1,100
800
1,875

DDeeeepp

WWeelllL_____

-__-_-_-_-_-_-_--

-

-

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

224

480

A. WelL ____ -------- . 950 1000

S. Well & D. Well_______ -------- 55 500

-82----,----------------,----------------,----------------,----------------,---1-9-0-6-+ -------- -------- -------- -------- 1922

-3

1920

Soperton____ 1,315 D. Well______ -------- -------- 312

-210

1920

S p a r k s ______ Sparta ______

800 1,985

D. WelL ____ ---------------D. WelL ____ -------- 300

407 500

-125 -162

1909 1912

St. Marys ___

890 A. WelL ____ ---------------- 450

+16

1900

Statesboro__ 4,200 Deep Well___ -------- 510 600

-100

1902

Stone Moun-

~~~~====== tain_______ 1,360

Summerville_ Swainsboro_

1,180 1,620

Deep Well___ =--=-=-=-=-=-=-_=_=_=_==_=_=_=_= ===6=7=0===1--- -90

yes 1922 yes 1920
1921

Sycamore ___

650 Deep Well___________________ 280

-140

1913

Sylvania ____ 1,420 Deep Well___________________ 310

-90

1910

Sylvester____ 1,600 Deep WelL_--------________ 700

-30

1909

Talbotton___ 1,100 Deep WelL_________ 100 150

-30

1911

Tennille ____ Thomaston_

1,840 2,850

Deep WelL_________________ 87 Creek_______ Soft _______________ _

-40

1917 yes yes yes no 1912

Thomasville_1 8,930 Deep WelL_ Hard 300 500

-185

1906

TABLE NO. X Water Supplies in Georgia, with Sources of Water and Means of Purification.

Range depths Height

Type of Treatment

Locality

Popula-

of Wells

tion

Source of

Jan. 1, Public SupplyiQuality

1925

From I To

of water above (+)

Date of

I I below (-) Raw Coagu- Filtra- Sterili- Instal-
Mouth of Water llation tion zation 1 lation

Wells Storage

----1

I

I

I

1--1----1--1---1

:

1---

Thomson___ _ 2,150 Creek ______ _I Soft ___ l- -------I------- -I-

yes yes yes yes 1904

Thunderbolt______ _
Tifton _____ _ Toccoa_____ _

600 3,300 3,800

Deep WelL_________________ 307

-73 ________ -------- -------- ________ 1922

DCereeepkW__e_l_L_______S_o_f_t __ ___4__8_0__ ___5__4_0__ _____-_6__0____ ---y-e-s--- ---y-e-s--- ---y-e-s--- ---n-o---- ___1_9_16_

Toomsboro__ 430 A. WelL ____________ -------- 300

+1,5 -------- -------- -------- -------- 1912

.g....

Trion ______ _ Tybee ______ _ Ty Ty______ _ Unadilla ___ _

1,500 120 460
1,150

Spring______________________ -------------------------------------------- yes 1913

Deep WelL ___________________ ------- ------------ -------- -------- -------- -------- __ ------

Deep WelL_________________ 300

-40 -------- -------- -------- ________ 1914

Deep WelL_ ________ ________ 175

-70 ________ -------- -------- ________ 1912

Valdosta___ _ Vidalia_____ _ Vienna_____ _ Wadley_____ _
Washington_

12,350 3,400 2,250 1,600 4,600

Deep Well___________________ 450

-135 -------- -------- -------- -------- 1894

Deep WelL_ Hard ________ 800

-90 -------- -------- -------- -------- 1905

Deep Well___ Hard ________ 325 A. Well______________ 185 350

-76 -------- -------- -------- -------- 1910 +2o ________ -------- -------- ________ 1914

Creek_______ Soft ________________ ------------ yes yes yes yes 1901

Waycross___ _ 19,850 Deep Well___________ 750

850

-35 -------- -------- -------- -------- 1885

Waynesboro_ Weston _____ _ West Point__ Whigham___ _
Willacoochee Winder_ ____ _ Woodbury__ _ Wrightsville_

3,600 210
2,254 680
1,300 3,780
930 1,380

Deep Well___________________ 275

-60 -------- -------- -------- -------- 1906

Deep WelL _____._____________ -------- ------------ -------- -------- -------- --------

Creek_______ Soft ________________ ------------ yes yes yes yes 1897

Deep WelL_________________ 432

-45 ________ -------- -------- _______ _ 1914

Deep Well___ Hard ________ 408

-346 ________ -------- -------- _______ _ 1908

SCprerienkg_______________S_o_f_t____________________________________-_-_-_-_-_-_-_-_--_-_-____y_e_s______y_e_s______y__e_s_____y__e_s_ _

1907 1921

Deep Well___________________ 400

-~0 ________ -------- -------- _______ _ 1910

Zebulon

640 Deep WelL __________________ ---------------------------------------------------- 1912

TABLE NO. XI.

TABLE SHOWING NUMBER OF PEOPLE USING WATER FROM MUNICIPAL SUPPLIES, BY TYPES, CHLORINATION, PROTECTION BY ANALYSIS, ETC.

1924. ~
MUNICIPAL WATER WORKS.

Number people drinking water from surface sources, rivers, creeks_____________________________________ 591,374 Number people drinking water from spring supplies----------------------------------------------------- 40,320 Number people drinking water from deep well supplies__________________________________________________ 406,544

Total number people drinking water from Municipal supplies_____________________________________ 1,038,238

Population State of Georgia (Estimated January 1, 1925)------------------------------------------------ 3,043,494 Total number people drinking water from private supplies_____________________________________________ 2,005,256

....

Per cent of People of State drinking water from Municipal supplies____________________________________ 34.1 Per cent of people of State drinking water from private supplies_______________________________________ 65.9

~ Total number of people of State drinking water from chlorinated supplies_---------------------------- 630,009

Per cent of people of State drinking water from chlorinated supplies___________________________________ 20.7

Number people drinking water from chlorinated river supplies__________________________________________ 578,594

Number people drinking water fron unchlorinated river supplies_______________________________________ 12,780

Number people drinking water from chlorinated spring supplies________________________________________ 23,470

Number peCJple drinking water from unchlorinated spring supplies___________________________________ 16,850

Number people drinking water from chlorinated deep well supplies ________ ---------------------------Number people drinking water from unchlorinated deep well supplies__________________________________ TotaBlonaurmd boef rHpeeaolpthle__li_v_i_n_g__i_n__C__it_i_e_s__w__h_i_c_h__h_a_v__e_M___on--t-_h_l_y_A__n_a_l_y_s_e__s_m__a_d_e__o_f__w__a_t_e_r_s_u__p_p_l_i_e_s_b__y_t_h__e_S__t_a_t_e

27,945 378,599 886,078

Tota number of people living in Cities that make their own Analyses and do not have Monthly Analyses

made by the State Board of Health------------------------------------------------------------------ 91,450 Total number people living in Cities having Municipal water works where no analyses are made_______ 59,360

TABLE NO. XII.

TABLE SHOWING CO-OPERATION GIVEN STATE BOARD OF HEALTH BY CITIES RELATIVE TO HAVING MONTHLY ANALYSES MADE OF WATER SUPPLIES. 1924.

----~---

-

--------

~--

Column 1

Column2

ColumnS

Column 4:

Cities giving excellent co-operation.

Cities giving fair co-operation.

Cities giving poor co-operation.

Cities giving no co-operation.

Acworth.

Abbeville.

Bronwood.

Adairsville.

Alma.

College Park.

Adel.

Cornelia.

Douglas.

Albany.

Dawson.

Hawkinsville.

Allenhurst.

East Lake.

Milstead.

Americus.

Folkston.

Sylvania.

Aragon.

b....

Ashburn . Atco (American

Vidalia. Vienna. Wrightsville.

Textile Mills.)

I

Athens.

Atlanta.

Atlanta (Exposition

Cotton Mills.)

Augusta.

Baconton.

Bainbridge. Barnesville. Barwick. Baxley.



Blackshear.

Blakely.

Blue Ridge.

Boston.

Brunswick.

-

-

--

-

-

--------

Alamo.

Arlington.

Bowdon.

Brinson.

Broxton.

Buena Vista.

Bullockville.

Butler.

Byromville.

Clayton.

Climax.

Crawford.

Darien.

Dexter.

Flowery Branch.

Grantville.

Guyton.

Hahira.

Hampton.

Hapeville.

Hazlehurst.

Homerville.

Iron City.

Jakin.

Jesup.

-

-

TABLE NO. XU-Continued. TABLE SHOWING CO-OPERATION GIVEN STATE BOARD OF HEALTH BY CITIES RELATIVE TO
HAVING MONTHLY ANALYSES MADE OF WATER SUPPLIES. 1924.

Column 1

Cities giving excellent co-operation.

Buford.

Cairo.

Calhoun.

Camilla.

Canton.

Canton (Cotton Mills.)

Carrollton.

8

Cartersville. Cave Spring.

Cave Spring (School

for Deaf.)

Cedartown.

Chamblee.

Chatsworth.

Chickamauga.

Chipley.

Claxton.

Cochran.

Colquitt.

Columbus.

Commerce.

Conyers.

Cordele.

Covington.

Cuthbert.

Column 2 Cities giving fair
co-opera.tion.

Column3 Cities giving poor
co-operation.

Column4 Cities giving no co-operation. Leary. Leesburg. Lithonia. Locust Grove. Marshallville. Millen. Milltown. Montezuma. Morven. Mount Vernon. New Holland. Norcross. Norman Park. Ocilla. Oglethorpe. Pavo. Pinehurst. Pooler. Preston. Ray City. Reidsville. Reynolds. Rochelle. Sale City. Scottdale.

'_. -..:~ '

TABLE NO. XII-Continued. TABLE SHOWING CO-OPERATION GIVEN STATE BOARD OF HEALTH BY CITIES RELATIVE TO
HAVING MONTHLY ANALYSES MADE OF WATER SUPPLIES. 1924.
-------

Column 1

Column 2

Column 3

Column4

Cities giving excellent co-operation.

Cities giving fair co-operation.

Cities giving poor co-operation.

Cities giving no co-operation.

Dalton.

Decatur.

Doerun.

Donalson.

Douglasville.

Dublin.

......
8

Eastman. East Point. Eatonton.

Edison.

Elberton.

Ellaville.

Fairburn.

Fitzgerald.

Forsyth.

Fort Gaines.

Fort Valley.

Gainesville.

Glennville.

Greensboro.

Greenville.~

Griffin.

Hartwell.

Hebardsville.

Helena.

----

Soperton. St. Marys. Stone Mountain. Talbotton. Thunderbolt. Toomsboro. Tybee . Ty-Ty. Unadilla. Wadley. Willacoochee. Woodbury. Zebulon.

/_)

TABLE NO. XU-Continued. TABLE SHOWING CO-OPERATION GIVEN STATE BOARD OF HEALTH BY CITIES RELATIVE TO
HAVING MONTHLY ANALYSES MADE OF WATER SUPPLIES. 1924.
----------

Columnl

Column 2

Column 3

Column 4

Cities giving excellent co-operation.

Cities giving fair co-operation.

Cities giving poor co-operation.

Cities giving no co-operation.

Hogansville.

Jackson.

Jefferson.

Jeffersonville.

Jonesboro.

LaFayette.

.....

LaGrange.

~

Lavonia.

Lawrenceville.

Lindale (Mass.

Cotton Mills.)

Louisville.

Lumpkin.

Lyons.

McDonough.

McRae.

Macon.

Madison.

'

Manchester.

Marietta.

Meigs.

Metter.

Midville.

Milledgeville.

TABLE NO. XU-Continued. TABLE SHOWING CO-OPERATION GIVEN STATE BOARD OF HEALTH BY CITIES RELATIVE TO
HAVING MONTHLY ANALYSES MADE OF WATER SUPPLIES. 1924.

Columnl

Column2

Cities giving excellent co-operation.

Cities giving fair co-operation.

:Milledgeville (State San.)

Monroe.

Monticello.

Moultrie.

Nashville.

Newnan.

...... ~

Pearson Pelham. Pembroke.

Perry.

Plains.

Porterdale.

Quitman.

Richland.

Rockmart.

Rome.

Rome (McLin

Textile :Mills.)

Rome (Shorter College.)

Royston.

Sandersville.

Savannah.

Shellman.

Smithville.

-

Column 3 Cities giving poor
co-operation.

Column4 Cities giving no co-operation.

TABLE NO. XU-Continued. TABLE SHOWING CO-OPERATION GIVEN STATE BOARD OF HEALTH BY CITIES RELATIVE TO

HAVING MONTHLY ANALYSES MADE OF WATER SUPPLIES. 1924.

-

-----~

-----------

--

-

-- --- --- -

Column 1

Column2

Column 3

Column4

Cities giving excellent co-operation.

Cities giving fair co-operation.

Cities giving poor co-operation.

Cities giving no co-operation.

Social Circle.

Sparks.

Sparta.

Statesboro.

Summerville.


c:o

Swainsboro. Sycamore. Sylvester.

.

Tennille.

Thomaston.

Thomasville.

Thomson.

Tifton.

Toccoa.

Trion.

Valdosta.

Washington.

Waycross.

Waynesboro.

Weston.

West Point.

Whigham.

Winder.

TABLE NO. XIII. CONDITION OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.

Column 1
Cities having excellent water supplies.

Column 2 Cities having a doubtful
water supply.

Column 3
Cities having a dangerous water supply.

Column4
Cities having either sent in no samples, or too few to judge the bacteriological condition of the water supply.

Abbeville.

Acworth.

Adairsville.

......

Adel. Albany. Allenhurst.

0

Alma.

Americus.

Ashburn.

Atco (American

Textile Mills).

Athens.

Atlanta.

Atlanta (Exposition

Cotton Mills).

Augusta.

Baconton.

Bainbridge.

Barnesville.

Barwick.

Baxley.

Blackshear.

Blakely.

Chatsworth. Edison. Hartwell. Lyons.
Manchester. Pearson. Vienna.

Aragon.
Chickamauga. Flowery Branch. Folkston. Norcross. Pembroke .

Alamo.

Arlington.

.

Bowdon. Brinson.

Broxton.

Buena Vista.

Bullockville.

Butler.

Byromville.

Clayton.

Climax.

College Park.

Crawford.

Darien.

Dexter.

Grantville.

Guyton.

Hahira.

Hampton.

Hapeville.

Hazlehurst.

Homerville.

Iron City.

TABLE NO. XIII. CONDITIONS OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.

-------

--

-

Column 1

Column2

Column 3

Column4

Cities having excellent water supplies.

Cities having a. doubtful water supply.

Cities having a dangerous water supply.

Cities having either sent in no samples, or too few to judge the bacteriological condition of the water supply.

Blue Ridge.

Boston.

Bronwood.

Brunswick.

Buford.

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

Cairo. Calhoun. Camilla.

Canton.

Canton (Cotton Mills).

Carrollton.

Cartersville.

cave Spring.

Cave Spring (School

for Deaf.)

Cedartown.

Chamblee.

Chipley.

Claxton.

Cochran.

Colqui-tt.

Columbus.

Commerce.

Conyers.

Jakin.

.

Jeffersonville. Jesup .

Leary. Leesburg. Lithonia. Locust Grove. Marshallville. Millen. Milltown. Montezuma. Morven. Mount Vernon. New Holland. Norman Park. Ocilla. Oglethorpe. Pavo. Pinehurst. Pooler. Preston. Ray City. Reidsville.
----

----

TABLE NO. XIII. CONDITION OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.
--

Columnl

Column 2

Columna

Column 4

Cities having excellent water supplies.

Cities having a doubtful water supply.

Cities having a dangerous water supply.

Cities having either sent in no samples, or too few to judge the bacteriological condition of the water supply.

Cordele.

Cornelia.

Covington.

Cuthbert.

Dalton.

........
N

Dawson. Decatur. Doerun.

Donalsonville.

Douglas.

Douglasville.

Dublin.

East Lake.

Eastman.

East Point.

Eatonton.

Elberton.

Ellaville.

Fairburn.

Fitzgerald.

Forsyth.

Fort Gaines.

Fort Valley.

Gainesville.

Reynolds. Rochelle. Sale City. Scottdale. Soperton. St. Marys. Stone Mountain. Talbotton. Thunderbolt.
Toomsboro. Tybee. Ty-Ty. Unadilla. Wadley. Willacoochee. Woodbury. Zebulon.
I -

TABLE NO. XIII. CONDITIONS OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.

--

-

--

-

--

--

Column 1

Column 2

Columna

Column4

Cities having excellent water supplies.

Cities having a doubtful water supply.

Cities having a dangerous water supply.

Cities having either sent in no samples, or too few to judge the bacteriological condition of the water supply.

Glennville.

Greensboro.

Greenville.

Glennville.

..........
0)

Greensboro . Greenville.

Griffin.

Hawkinsville.

Hebardsville.

Helena.

Hogansville.

.Tacks o n .

.Tefferson .

.Tonesboro.

La Fayette.

La Grange.

Lavonia.

Lawrenceville.

Lindale (Mass. Cotton

Mills.)

Louisville.

Lumpkin.

-

- ------

TABLE NO. XIII. CONDITION OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.

-------

-

-

-

-----

-

-~

-

--

---- -

Columnl

Column2

Column 3

Column4

Cities having excellent water supplies.

Cities having a. doubt ul water supply.

Cities having a dangerous water supply.

Cities having either sent in no samples, or too few to judge the bacteriological condition of the water supply.

McDonough.

McRae.

Macon.

Madison.

....
~

Marietta. Meigs. Metter.

Midville.

Milledgeville.

Milledgeville (State

San.)

Milstead.

Monroe.

Monticello.

Moultrie.

Nashville.

Newnan.

Pelham.

Perry.

Plains.

Porterdale.

Quitman.

-

TABLE NO. XIII.

CONDITIONS OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.

-

-

---~

--

~--

~--

-
~~

Column 1

Column 2

Column 3

Column4

Cities having excellent water supplies.

Cities having a doubtful water supply.

Cities having a dangerous water supply.

Cities having either sent 1n no samples, or too few to judge the bacteriologi< al condition of the wat r supply.

Richland.

Rockmart.

Rome.

Rome (McLin

........

Textile Mills.) Rome (Shorter College.)

Ut

Royston.

Sandersville.

Shellman.

Smithville.

Scoan Circle.

Sparks.

Sparta.

Statesboro.

Summerville.

Swainsboro.

Sycamore.

Sylvania.

Sylvester.

Tennille.

Thomaston.

-

-

TABLE NO. XIII. CONDITION OF WATER SUPPLIES IN GEORGIA FOR YEAR 1924.

Columnl Cities having excellent
water supplies.

Column 2 Cities having a doubtful
water supply.

Columna Cities having a dangerous
water supply.

Column4 Cities having either sent in
no samples, or too few to judge the bacteriological condition of the water supply.

Thomasville.

Thomson.

Tifton.

Toccoa.

..........

Trion. Valdosta.

0)

Vidalia.

Washington.

Waycrosss.

Waynesboro.

Weston.

West Point.

Whigham.

Winder.

Wrightsville.

SANITARY ENGINEERING

AND

MALARIA CONTROL

URBAN WORK

During the year 1924, this division gave attention to both rural and urban malaria, but due to limited personnel it was impossib'e to give rural malaria the attention it deserves. However, the impression must not exist that urban malaria is not still a serious probleqJ.. At least it is in certain sections of the State of Georgia and will continue to be so long as preferential Anopheles breeding places are allowed to exist in congested areas, especially when malaria infected rural residents visit the cities. If towns and cities pay no attention to malaria control through elimination of Anopheles breeding places our rural population will certainly continue to disseminate the infection throughout the urban populations.

The following is a list of towns and cities doing malaria work

through .the assistance of the State Board of Health in 1924,

showing 40 in number with an annual expenditure of $123,041.25

and a total population of 632,060:

A. B. & A. R. R. (Brunswick) Douglas

"

(Fitzgerald)

Edison

Albany

Fort Benning

Americus

Fort Valley

Atlanta

Leslie

Augusta

Louisville

Baconton

Macon

Bainbridge

Milledgeville

Bibb County

Moultrie

Blackshear

Pelham

Blakely

Quitman

Brunswick

Savannah

Cairo Camilla Cen. of Ga. R. R. Chatham County

Sumter County Sylvania Thomasville Tifton

Colquitt

Tybee

Columbus

Valdosta

Desoto

Vidalia

Donalsonville

Waynesboro
117





Our assistance to these 40 towns and cities during 1924 included 170 visits to make inspections, supervise the work and make surveys and maps. All of these towns and cities are located in malarious sections of the state. It has been the aim to give preference to towns and cities in which through geographic and topographic locations, malaria is a serious problem.
In dealing with the urban malaria problem the chief aim is to eradicate the malaria mosquito. However, for psychologic reasons, it often becomes necessary, in order to obtain cooperation, to treat the problem as a general mosquito problem. We have been gratified with the results obtained.
RURAL WORK
In addition to the work above mentioned, we have under way as much rural work as can be effectively carried on with our limited personnel. Details of this work follows:
A hydro-electric development was started in 1923 known as the White Power Company. This project necessitated impounding an area of about thirty acres. Within one mile from the boundary of this lake are approximately fifteen families making a population of nearly 100 people. A study has been conducted of the effect the impounding of this water will have upon the incidence of malaria. In 1923 and 1924, a malaria census was taken throughout this community. The results have shown, to date, that practically no malaria exists. An annual census will be taken each year to determine whether or not the impounding of this water is affecting the malaria rate. This project remains subject to our impounded water regulations, and should a malaria menace be created legal steps will be taken under these regulations.
On the South River in Fulton and DeKalb Counties there has been a high rate of malaria due to overflowing of the river, leaving standing water in large ponds. This malaria has been studied and a malaria census taken. Reports of this condition have been submitted at several meetings of the County Supervisors of these counties and recommendations have been made for a drainage district to be established. Surveys and estimates have

118

recently been made on this project and we believe that in due time this drainage district will be perfected and the malaria menace eliminated.
Near Columbus, Georgia, a large hydro-electric development is under way and when completed will inundate about 6,000 acres. There are several hundred people living along the shore of this impounded reservoir. We have required the promoters of this project to obtain a permit from the State Board of Health and to comply with our regulations covering impounded water. We have received excellent cooperation, with the result that the shore line is being properly cleared of all vegetation, meeting with our specifications. This project will remain under our observation and the health of the people will be protected.
A considerable number of smaller rural projects have been investigated and engineering assistance has been given County Health Commissioners in their problems. Several small rural drainage projects have been staked and grades given for construction work. Railroad companies have been induced to provide proper ditching, and farmers have been aided and advice given in problems of vertical drainage and ditching.
Conditions exist in Georgia peculiar to the Southeastern section of the United States. This section is commonly known as a lime-sink section. Lime-sinks have been found to be preferential breeding places for the A. quadrimaculatus. Our highest malaria rate is in sections of the state where these lime sinks are found. These lime-sinks are nothing more than various types of ponds, some of which can be drained by ditching, some perhaps by vertical drainage, some by filling, while a large number can probably never be eliminated. However, we feel that most of these can be treated as separate and individual problems. We are now promoting means of experimental work in vertical drainage of lime-sinks, such experiments awaiting proper weather and a lower ground water elevation. We hope eventually to arrive at some practical and comparatively inexpensive means to control the breeding of A. quadrimaculatus in these lime-sinks.
In certain sections of the state conditions have been studied, and it is considered that before minor drainage can become effective major drainage to some extent must be perfected. Not only this, but we believe that a large factor in reducing our rural
119

malaria is the improvement of industrial conditions. Improvement of economic conditions will establish an economic and social standard with the ultimate result of education and a general demand for better health and living conditions. With these facts in view, we are promoting a drainage district comprising approximately 60,000 acres, requiring approximately 40 miles of canals. This project will cost approximately $200,000. The area to be drained is in one of the sections of the state where the highest malaria rate exists. If this major drainage were perfected the flood waters which now remain after storms would be carried away more quickly. Furthermore, the ground water table would be lowered to a point below certain depressions and many such depressions could be drained into the canals. With this major drainage the minor drainage would be made a more simple problem and would be more popular with the farmers. This drainage project is in one of the most productive sections of the state and thousands of fertile acres could be made suitable for cultivation.
The main obstacle in the promotion of drainage districts in Georgia is certain defects in the state drainage laws. Work is in progress now to revise these laws and it is believed that though it may take several years this drainage district, as well as others, will be perfected.
In connection with this drainage district, in one of the counties within the district, we are placing in the hands of the County Superintendent of Schools cards to be distributed by the pupils to be filled out at home, showing the family history of malaria in each school district. This plan will be extended to certain other counties where the malaria rate is considerable.
120

MALARIA CONTROL SURVEYS AND EDUCATION
Dr. M.A. Fort
The following is an outline of my activities during 1924: A visit to Camden Co., taking histories of malaria and hookworm, talking these subjects in all schools.
A visit to Savannah and visits to various schools.
A visit to S. W. Ga. counties with Dr. Waller, attempting to get a health unit established in three Counties.
A visit to Dr. Darling at Leesburg, perfecting myself in examinations of spleens according to his method.
A visit to Terrill Co. examining all spleens of the lower grade children, taking specimens for hookworm examinations, teaching, instructing, getting treatments in severe cases, making maps, working percentages and making reports. Conclusions and results are in my monthly reports. Moving pictures of hookworm and malaria were exhibited to a good audience.
Surveys of Crisp, Dooly and Burke Counties, examining spleens, taking histories, making maps and reports. Also partial surveys in Screven and Pulaski Counties. Visit to Healthmobile in Hazelhurst, showing the examination of spleens.
July. Visited the 13 normal schools in the state, lecturing on the examination of school children.
August. Investigated typhoid outbreak at Toccoa, and malaria in Ben Hill and Irwin Counties. Wrote health play, experimented with larvacides and insecticides and investigated malaria in N. W. Ga.
Reviewed laboratory work at Leesburg, learned the identification of anophelenes with the microscope. Tabulating results of survey and compared with sick cards at Dawson.
Visited Unadilla, Vienna and Dawson, re-examining spleens found enlarged by measles 6 months before. Most spleens had returned o normal, though some were stEI palpable.
Surveyed Randolph Co., making malaria map and report Produced health Play in high School in Cuthbert.
121

Visited Fort Valley, investigating a false report of typhoid epdemic.
Visited Early Co., surveying all schools, lecturing and teaching in a.ll schools, examining all spleens in the lower grades, collecting blood specimens from all positive spleens and having blood examined for parasites. Produced health play in Blakely. Visited New Orleans, S. M. A. making charts and maps, working out percentages and tabulating results.
The details of all this work can be secured from my monthly reports.
122

FIELD STUDIES IN MALARIA
Dr. Darling's Report
The following is a summary of some of the salient features of the year' swork at the Station in Leesburg, for 1924. You will understand of course that the work is in progress and refers to observations made in this region only. Possibly the opinion expressed in some of the sections may have to be modified slightly as we widen the scope of our observations.
Experience elsewhere has shown that because of the differences in the species of mosquitoes and their habits, differences in climate and topography and because of economic reasons each region presents pecularly specific problems. In our studies therefore it was decided to take little or nothing for granted, but to investigate as carefully as possible in the immediate locality, and afterwards to extend the investigation outwards into other regions until the problem of malaria in the southern states has been more or less envisaged.
There was found to be considerable advantage in working continuously in the locality through two rounds of seasons, for in this way a most intimate knowledge of all phases of the problem as affected by climate is obtained. In as-much as the first year of residence was a year of heavy rainfall with high mosquito density, while in the second year there was a prolonged dry season during summer and fall with markedly diminished mosquito production, there were abundant opportunities for noting the effect of rainfall and drought on mosquito production and on malaria.
Two classes of work have been undertaken, one investigational, having for its aim a study of the specific nature of the malaria problem in Georgia and in the South, the other educational, or the training and instruction in malariology of various persons who wish to pursue this subject, either as Health Officers, Epidemiologists, Teachers, Sanitary Ip.spectors or Technicians.
Some of the more important subjects investigated during the year are as follows:
THE NATURAL HISTORY OF MALARIA
An extended series of observations has been made to ascertain the natural course of events in a family, all members of which were naturally infected with malaria, and to det!Jrmine the degree of infectiousness of such a family. They live in an environment
123

unprotected from A. quadrimaculatus which was breeding
close by, and they had little or no quinine medication except for a period during the study and they were probably suffering from some undernourishment. The study is one of chronic malaria as it is manifested by clinical symptoms, splenic enlargement, anemia and by the presence of plasmodia in the peripheral blood. A family of negroes, including the mother and four children, have been examined at weekly intervals for more than a year. At each examination individual histories were taken, spleens examined, hemoglobins estimated and blood smears obtained for the estimation of the relative numbers of game-tocytes and plasmodia. The mother is 32 years of age, the children are 9, 6, 4 and 2 years respectively. They live in an unscreened house
in which adult female A. quadrimaculatus were taken at times
during the year. There have been comparatively few acute clinical episodes during the year. The mother has had twelve chills during the five months while her blood contained parasites. The girl, age 9, had four chills during six months while her blood was positive and for two weeks her spleen was tender. The boy, age 6, has had no chills although his blood contained parasites for five months. The boy, age 4, has had only one chill during twelve months although his blood has been negative for a period of only two weeks. He has had as many as 300 parasites per 500 fields without enough malaise to impress his mother sufficiently for her to report it. The girl, age 2, has had ten chills in twelve months, her blood being negative for only four weeks of this period, but she has had periods of fever and headache occasionally. All of the children look normal and none appear to be suffering from ill health.
PARASITES: From the date of the first examination in November, 1923, until the beginning of an eight weeks standard quinine treatment in March, 1924, each of these negroes had shown parasites in the peripheral blood. The mother and girl, age 9, had all three species; the boy, age 6, only quartan parasites; the boy, age 4, only subtertian; while the girl, age 2, had both tertian and subtertian parasites.
GAMETOCYTES: Excepting for two weeks in March, two in April and three in May one or more members of this family at all times have been carriers of gametocytes in sufticient numbers to be infective.
124

HEMOGLOBIN: In general the hemoglobin curve has inversely followed the parasite curve, that is, a fall of hemoglobin corresponded with an increase in the numbers of parasites. In every case a rise in hemoglobin percentage occurred during quinine treatment, followed by a fall attributable to quinine.
SPLEENS: The children have had enlarged spleens at all times. Those of the girl, age 9, and of the boy, age 4, have ranged from palpable to the umbilicus. That of the youngest child from 2 finger's breadth to the pelvis.
This experiment has also shown that when the administration of quinine is left to the family itself it cannot be depended upon to control malaria. As it is customary in malarial communities for health authorities to dispense quinine at intervals, leaving it to be taken or not by ignorant or careless persons, it is evident that there must be an enormous waste of quinine without material reduction in the amount of malaria.
AN EXPERIMENT WITH THE STANDARD QUININE TREATMENT
An experiment was made to ascertain the effect of standard quinine treatment in reducing malaria and the size of the spleen in a group of negro children who were severely infected with malaria. The experiment was begun in early spring. All of the children had enlarged spleens. Fifty received standard treatment, while twenty-five were untreated controls. The controls were brothers and sisters of the treatment group and lived in the same houses and under the same economic and environmental conditions as the experimental cases. The children in both groups were carefully examined at intervals of about a month for about eight months. The results of this experiment show that when standard treatment is regularly given by a responsible person it will remove plasmodia from the peripheral blood for as long a period as the treatment is maintained. During this time there is a progressive reduction in the size of the spleen in ea~h type of enlargement, it being far more marked in the larger sized spleens than in those merely palpable on inspiration.
In the control cases untreated by quinine there was a slight increase in the size of the spleen while at the same time the spleen
125

of those under treatment was steadily reduced in volume. The quinine treatment was continued during a period of ten weeks following the discontinuance of which there was noted a gradual increase in the spleen mass of all groups of cases. The increase in the spleen mass after the conclusion of treatment in the treated and control groups was due it is believed to relapse and to new infections. It was observed that hard work in the fields, plowing in the hot sun or harvesting heavy crops, would provoke relapse in cases receiving treatment, even when plasmodia had been driven from the peripheral blood. Success with the standard treatment can only be obtained when the quinine is given in proper dosage regularly by a responsible person.
BLACKWATER FEVER
It is interesting to record that coincident with the drought, the disappearance of quadrimaculatus breeding places, and marked reduction in A. quadrimaculatus itself, there has been not only a marked reduction in the amount of clinical malaria in the county but a reduction in the cases of blackwater fever as well. In 1923 there were six deaths from this disease in Lee County. During 1924 there have been no deaths from this disease and only one mild case.
THE SPLEEN INDEX
Malarial infection is a condition in which on the whole the deeper viscera are involved to a greater extent than the peripheral blood, which latter sometime represents an overflow from the deeper organs where the great drama is being enacted. During infection mature and segmenting forms of the plasmodium often retire from the peripheral blood to the deeper viscera. After the administration of quinine the peripheral blood is more thoroughly cleared of parasites than are the internal organs, particularly the spleen and bone marrow. Even after apparent cure, relapses often occur from the multiplication of parasites which we believe were lying in the blood spaces of the spleen and marrow. The spleen enlarges during malaria infection and in relapse and it remains enlarged in cases in which parasites have to some extent either become sparse or have disappeared from the peripheral blood. In as-much as plasmodia are more apt to be found in the deeper viscera than in the peripheral blood the examination
126

of a viscus like the spleen should give us more information as to the presence of infection than the examination of the peripheral blood when for the purpose of measuring malaria in any locality numbers of cases are considered. The method of examining the spleen was described in last year's report.
An analysis of the results of examinations of spleens and of blood made during two years shows how perfect is the correspondence between splenic enlargement and the presence of plasmodia in the peripheral blood for in groups of cases those presenting the higher degree of splenic enlargement are more apt to reveal plasmodia in the peripheral blood than those with the smaller degrees of enlargement, in other words a definite relationship was found to subsist between the size of the spleen and the amount of malaria as rp.easured by the presence of plasmodia in the peripheral blood.
SPLEENS AND HISTORIES When histories were carefully taken and compared with the spleen and parasite rate, it was found that the spleen rate corresponded more closely with the history rate than did the blood rate. This correspondence will enable the health officer to ascertain the amount of malaria directly by the spleen examination instead of relying for the accuracy of malarial data on the testimony of children or of ignorant, careless, or otherwise unsatisfactory persons. The spleen examination may become the method of preference over that of the blood examination which latter is objectionable to children and sometimes difficult to carry out.
B7

CORRELATION BETWEEN MALARIAL PREVALENCE AND SEASONABLE DENSITY OF THESE
SPECIES OF AMOPHELES
Observations made in 1924 confirm those of 1923 that, when the incidence of malaria, as determined by spleen, blood or history rate is compared with the density of the three species of mosquitoes at several periods of the year, it is seen that malaria increases in the warmer season when quadrimaculatus is found in greater numbers. At the same time crucians and punctipennis are seen to diminish in number, for quadrimaculatus is a mosquito preferring warm weather while crucians and punctipennis are found in greatest numbers during the cooler months when the incidence in severity of malaria are at their lowest points, a circumstance which, taken into consideration with other data, .indicates that A. crucians and A. punctipennis may be disregarded for practical purposes as carriers of malaria.
RELATION BETWEEN TOPOGRAPHY, MALARIAL . INCIDENCE
AND PREVALENCE OF ANOPHELES SPECIES
Observations so far tend to show that Georgia may be divided with reference to certain topographical and geological formations into about seven regions. Each region has a characteristic surface formation and each yields a characteristic history in regard to the severity of malaria.
Regions 1 and 3, the Cumberland Plateau and Appalachian Mountains are mountainous with waterfalls and rapidly running streams in which type of water A. punctipennis breeds, but in which A. quadrimaaculatus is not usually encountered. No fatal cases of malaria are recorded from these regions.
Region No. 2 is the Appalachian Valley. In these valleys although A. punctipennis is the predominating species, A. quadrimaculatus finds a few breeding places accessible, and a few deaths from malaria are recorded from this region annually.
Region No.4 is the Piedmont Plateau, a rolling county throughout, with a characteristic red clay eroded by the streams, many of which have falls along their course. A. punctipennis is the predominant species excepting in places and at times when water
128

has been brought to rest and becomes favorable for the breeding of A. quadrimaculatus. There is a small amount of fatal malaria reported from this :region.
Region No.6, the Piney Flat Woods region. This is relatively free from severe or fatal malaria. As far as our investigations have gone A. punctipennis is absent. A. crucians is the predominating species but A. quadrimaculatus occurs in places.
Regions Nos. 5, A and B, and region No.7, represent a peculiar limestone formation in which limesinks, ponds, and swamps occur in large numbers. These sinks are formed by the corrosion or solution of the subterranean limestone strata. The falling in of the superincumbent layers of soil has formed basin and bowl like depressions often containing standing water in which A. quadrimaculatus will breed if habitations or animals are within reach. Most of the severe and fatal cases of malaria and of blackwater or hemorrhagic fever occur in this limestone formation. Although A. punctipennis and A. crucians may be found breeding in various waters in this region A. quadrimaculatus is found in very much larger numbers than in any other area of Georgia so far as our investigation has disclosed, and this is preeminently the malaria region of Georgia.
129

THE RELATIVE IMPORTANCE IN TRANSMITTING
MALARIA OF A. QUADRIMACULATUS, A. PUNCTIPENNIS, and A. CRUCIANS and THE ADVISA-
BILITY OF DIFFERENTIATING BETWEEN
THESE SPECIES IN APPLYING
CONTROL MEASURES
In determining the relative importance of the different species of anopheles as vectors of malaria it is essential that a large number of human malarial carriers be present at a time when the mosquitoes are breeding in order that an infectivety rate may be determined without the dissection of an inordinate number of specimens. In Lee County areas exist where the malaria is severe and where the three species of anopheles are to be found breeding during the height of the malarial season.
THE INFECTIVITY RATE OF THE THREE SPECIES OF ANOPHELES IN LEE COUNTY: The mosquitoes dissected in this series for the year 1923 number 2179 and were collected from a wide variety of situations. All were taken in the neighborhood of habitations where spleen rates ranged from 8 to 100%. Most of the mosquitoes were taken at a time when spleen rates were 40% or over. No matter what the season, whether summer or early fall gamete carriers ~1ere always available and plentiful among negro children for the infection of anopheles mosquitoes. In many instances the spleen and blood rates of the children in the neighborhood were obtained at the time the mosquitoes were collected. Definite information was in this way obtained for the correlation of mosquito infectivity rates with the spleen and parasites rates, and an attempt was made to avoid the source of uncertainty likely to occur when mosquito vectors are searched for in a region where the malaria rates of each mosquito collecting place is not known.
Following are the results of dissections for 1923: Percentage of 1531 A. quadrimaculatus dissected-
positive........................................ 3. 9%
Percentage of 571 A. crucians dissected-positive ..... 0. O% Percentage of 77 A. punctipennis dissected-positive .. 0. O%
130

The infection rates of A. qua.drima.cula.tus ranged from 2 to 5% During the warm months of the year and during the entire summer not a single specimen of A. crucia.ns was found to be infected although this species was often taken under houses where infected A. qua.drima.cula.tus was found at some time during the summer, and this makes the negative evidence against A. crucia.ns as a carrier all the stronger.
It is regrettable that the negative evidence against A. punctipennis is still incomplete. This is partly due to the circumstance that adult A. punctipennis is not very abundant during the malarial season. This species is found in large numbers in the strealll8 of the Piedmont Plateau but, curiously enough, malaria. is much less common or absent in those localities. The information which we elicited positively incriminates A. qua.drimacula.tus as being a carrier of malaria and for practical purposes the sole carrier of malaria in the region under consideration. The evidence with regard to A. crucians while of a negative character is conclusive enough for practical purposes. More dissections will have to be made with A. punctipennis during the next year.
PREFERENTIAL FEEDING HABITS OF A. CRUCIANS, A. PUNCTIPENNIS AND A. QUADRIMACULATUS: Noting that the two first mentioned species were rarely found feeding on man and never to the extent observed with A. quadrimacula.tus, the proved effective transmitter of malaria, it was desired to ascertain the origin of the blood meal by the precipitin test in specimens of these two species. The tests were carried out by Dr. Bull at his laboratcry in Baltimore and a very marked preference for animal blood of A. crucia.ns and A. punctipennis was disclosed. Out of 272 specimens of A. qua.drimacula.tus 88 had fed on man, the remainder on animals chiefly the cow. Out of 235 crucians only 3 had fed on man, the remainder on animals, chiefly the cow, and of 10 punctipennis none had fed on man.
The precipitin test revealing as it does the preference of crucians and punctipennis for animal blood to that of man shows why these two species although susceptible to infection experimentally do not become so naturally, and why in control operations they probably need not be regarded efficient carriers of malaria.
131

PREFERENTIAL BREEDING PLACES: Our observations tend to show that A. punctipennis is more apt to be found breeding in and near running water than in still water. On the other hand A. crucians and A. quadri:maculatus seem to require for breeding purposes still water without a current. This is not only true of the immediate locality but, taking the state as a whole and even the entire southeastern states, the hill stream mosquito of the Piedmont Plateau, the Appalachian Mountains and of the Cumberland Plateau is A. punctipennis, while A. quadri:maculatus the proved carrier of malaria is found in the flat land, or in the hill country whenever water had been impounded in reservoirs, mill ponds or fish ponds, or in late summer in the residual pools of streams or in swamps or limesinks. While it is true that the three species are sometimes to be found breeding in the same collection of water, very definite tendencies in the selection of breeding places has been noted and this matter is being thoroughly pursued.
SPECIES CONTROL: Species control or "species sanitation" is a practical measure and has been used in other counties. Whether it may be used in the South will depend in part on whether the species exercise any constant preference in the selection of breeding places. We have observed certain tendencies in this regard. For example A. quadrimaculatus is found exclusively in still water as we have shown, the same is true of A. crucians. A. puncitpennis on the other hand is found in or near running water or in still water near by. The point is that A. quadri:maculatus the effective malaria carrier will not breed while the current of water is :maintained. Before a stream is impounded this species is either absent, extremely sparse or not found until drought in late summer has caused pools to form in the bed of the river. After the current is reestablished in the stream A. quadri:maculatus begin to disappear. The physical state or condition of the water which renders it more suitable as a breeding place for quadrimaculatus may be related to abundance of food for there is an increase in the amount of plankton upon stagnation when quadrimaculatus becomes implanted.
132

The bio-chemistry of the different breeding places differs with changes in physical state and in the character of the plankton. This is reflected in the tendencies of divers bodies of water to have a different reaction when measured by the hydrogen-on concentration test. For example in swamps, ditches and borrow pits
from which A. crucia.ns has been taken the Ph. is usually minim-
acid. On the other hand in the stream margins, puddles, and
pools in which A. punctipennis is taken the water is sub-alkaline
or minim-alkaline. In India wells become the breeding places for malaria carrying anophelines but this is probably not true in the Southern States. Plankton is very scanty in well water and the anopheline species usually encountered under these conditions and in wells is punctipennis.
It is a mistake to assume that the habits of anopheles are the same in all regions or that because in India a malaria trans!Jlitting species has been found to breed in wells that we should assume the same is true in the southern states and that we should attempt to control anopheles breeding in wells on the assumtion that wells are a menace to health from malaria.
A good many of the text books on malaria are compilations from the world's literature dealing with observations and experiences of workers in India, Italy or Panama where the species of anopheles differ in their habits from those of the southern states.
One hears the statement made that borrow pits are breeding places for malarial mosquitoes. We now have records of observations made of borrow pits in a number of places in south Georgia, some of them in the heart of a region of severe malaria, but anopheles breeding in these borrow pits is either absent or very scanty and the few larvae collected have usually been non-malarial carriers. All borrow pits are not necessarily a menace. Whether
they will become so and breed A. qua.dri:ma.cula.tus will depend
on their age and proximity to habitations . A study of the limology of borrow pits shows that in the younger pits plankton is scanty. Under these circumstances the water in the pits will not support a rich anophelene fauna. When borrow pits grow old, then, in the neighborhood of habitations when other
breeding places customarily used by A. quadri:ma.cula.tus have
dried out, this species may become temporarily implanted. Therefore while all borrow pits possess potentialities inimical to
133

the public health, it has not been possible in our experience to incriminate them unreservedly as a malarial menace, Some discrimination therefore should be exercised in the destruction of borrow pits when there are other real malarial problems in the neighborhood.
Illustrative of the tendency to borrow observations and generalizations from abroad and erroneously apply them to our conditions in the south is the well known statement that the malarial mosquito here can be recognized at a glance by its attitude when resting on the wall. This mosquito being said to rest with its body projecting outward from the wall at an angle of 45 degrees. Culex on the other hand rests with its body more nearly parallel with the wall. Now the truth of the matter is that A. qua.dri;macula.tus, the malaria transmitter of the southern states, has a culex-like attitude and when resting does not project from the wall in the anopheline-like attitude observed in A. crucia.ns and A. punctipennis.
In attempting to define the nature of the malarial problem in this region the study involved the habits of the anophelene mosquito and its distribution, the relation of breeding places to topography and to soil and subsoil conditions. As the three species of anopheles were not found to carry malaria in equal degrees and as A. qua.dri;ma.cula.tus appeared to be the sole carrier, a careful study of the breeding places of each species has been carried out in order that we might learn whether it would be possible to carry out species control or the control of malaria by giving attention especially to the species which is the effective carrier. So far as our work has progressed it would seem that there is some justification for the statement that species control is possible and practicable.
A prudent and humane expenditure of funds in malarial control requires that the real source of infection, that is to my, the proved breeding places for A. quadr;ma.cula.tus, must be considered first, To do this the specific nature of a problem should first be determined instead of attempting to use general measures which may have been based on experiences derived from other regions having their ow:r: special kinds of anopheles.
Methods for the control of malaria in the southern states should be derived from studies and experiences in the south and not from the experiences of others in parts of the world where problems are different in nature from ours. We should aim at an intelli-
134

gent control based on positive knowledge derived wherever necessary from field studies made in our own communities. Such intelligent control will necessitate the special training of men who are to engage in malaria work and this can best be done in the field where experience can be obtained by a study of conditions as they actually exist.
LIMNOLOGICAL STUDIES
During the past summer the plankton of various breeding places was studied and some light was thrown on the tendency for the selection of breeding places by anopheles mosquitoes. A. punctipennis for example was often found in the waters of streams or wells relatively scanty in plankton when compared with waters in which A. quadrimaculatus was found. When_ the water of streams was brought to rest in residual pools through lack of rain and surface wash, the plankton increased in amount, and when this occurred A. quadrimaculatus often became implanted while A. punctipennis might show a tendency to disappear. On the whole A. quadrimaculatus was found in greater numbers during the summer at a period when Chlorophyceae or green algae were more abundant.
In locations where there was little or no anopheles breeding as in certain borrow pits, ponds, or swamps, there was a corresponding absence of the types of plankton found abundantly in places where anopheles breeding was present or prolific.
EFFECT OF COLD
Observations on the effect of cold and of freezing temperatures on all stages of the mosquito have been interesting and of some practical value. Perhaps the most important was the effect of cold on the anopheles larva. \Vhen the temperature of water is reduced to a point below 55 or thereabouts, larvae leave the surface for the bottom of the water, remaining there for long periods, but rising to the surface when the temperature becomes elevated. This has been studied in the laboratory under artificial conditions and in the field. During the winter months when temperatures of the water range from 390 to 500, larvae spend most of their time on the bottom in a quiescent state. If they are disturbed they may return to the surface or nearly to the surface momentarily, but usually drop to the bottom and remain there.
135

The practical importance of this observation is that, when searching for breeding places and evidences of breeding during the cooler months, the bottom of the water must be well disturbed so as to bring larvae when present to the surface which must then be scrutinized at once.
RESTING PLACES OF ADULT ANOPHELES
The location in which a blooded anopheles is found is only presumtive evidence that she acquired a blood meal in the habitation, stable or fowlhouse in question, and occasionally this evidence may be erroneous, for dissections of A. quadri;m.aculatus caught in a fowlhouse have revealed mammalian erythrocytes in the mosquito's stomach.
From observations on the relative numbers of males and females caught in various locations in relation to distance from breeding places, it appears that the relative numbers of males to females diminish directly with the distance from the breeding place. This has been helpful in the search for anopheles breeding places. In general male mosquitoes are found in greatest numbers close to the breeding places near which locations mating probably occurs.
FLIGHT EXPERIMENTS
Flight experiments were made to determine the source of A. quadri:macula.tus visiting a certain community. The flight was observed as noted simultaneously by several observers, to occur at a certain moment about dusk. This was proceded by a movement of bats flying toward the mosquito breeding place. Mosquitoes stained by a dusting powder were later collected at several locations inside and under houses and in outbuildings in the community in question, thus confirming the observations made during the flight and incriminating a particular breeding place.
DISPERSION OF MOSQUITOES
The dispersion of A. quadri:maculatus from a large breeding area in a sparsely populated and scattered community was studied for the purpose of ascertaining the approximate limits within which malarial control would be required. Most of the mosquitoes were found within %. of a mile of the breeding place. Very few traveled as far as llh to 1%. of a mile. None was found beyond this.
136

IDENTIFICATION OF THE SPECIES OF ANOPHELES

BY THE

ANATOMICAL CHARACTERS OF THE LARVA

The immediate diagnosis of the species of an anopheles mosquito from the larva will enable the inspector to incriminate a breeding place without the delay usually attendant upon the breeding out of adult mosquitoes from larvae. Such information was of value in the Orient as well as other places where all of the species of anopheles in the region are not efficient transmitters of malaria. If, as there appears to be for practical purposes, but one vector of malaria in the southern states, and that species, as she appears to do, exercises preferences in her breeding places, then an immediate diagnosis of the species from the larval characters will be a valuable aid to malarial workers in this region. Dr. Paul F. Russell, working at this Station, has determined a number of the specific anatomical characters of the three species of anopheles and has formulated a key which enables one positively to differentiate the species of anopheles of this region from the 4th stage larva.

Key to the larvae of the three common anophelines of the Southern United States.

!-Abdominal segments 4 and 5 having both a dorsal submarginal hair and an antepalmate hair............ .
Abdominal segments 4 and 5 having an antepalmate hair but no dorsal submarginal hair ................ .

A. crucians
2

2-Anterior internal clypeal hairs close
together at base . . . . . . . . . . . . . . . . . A. punctipennis
Anterior internal clypeal hairs well
separated at base ................ A. quadrimaculatus

In addition to those briefly outlinedother studies have been pursued as follows:

A preliminary study of the topographic and geologic features of the limesink region of the Dougherty Plain in relation to the engineering problem of the drainage of this region, by Mr. F. F. Longley.
137

The parasitic Neosporidia of anopheles mosquitoes, by Dr. R. Kudo.
Various other studies, not completed, of the habits of anopheles mosquitoes.
The surveys of Leesburg by Messers Clarkson and Johnson for the purpose of laying out a drainage scheme for the city. The plan and estimate of cost has been submitted to Mayor Lee.
MALARIAL SURVEYS
Malarial surveys have been made in some of the adjoining counties and in more distant places, in part, for the study of some phase of the malarial problem, or in order to add to our information on the distribution and severity of malaria; also for the purpose of obtaining information for the use of local health authorities.
Some re-surveys were made of plantations in Lee County to ascertain the effect of drought in reducing the amourt of malaria. A notable reduction in the spleen rates, in the sizes of the spleen, in the blood rates, and in the incidence of blackwater fever was noted, due entirely to reduced mosquito production.
A partial survey in Sumter County was made. A more complete survey of the city of Albany and of Dougherty County has been completed.
Surveys were also made in Covington County, Alabama; Hartford, Alabama; Gibson County, Tennessee; Terrell County, Georgia; and in the town of Warwick, Worth County.
Anopheline surveys were made in southeastern Georgia from Waycross to Savannah, also on Billy's Island in the Okefinokee Swamp, and rapid surveys were made in southwest Georgia in Bak~r, Early, Decatur, ,Seminole and Calhoun counties.
Valuable information has been derived from the monthly surveys made at the Gantt impounded area in Covington county, Alabama, now having been conducted for nearly two years. Here the rate of implantation of the malarial carrier, A. qua.drima.cula.tus, after the impounding of the water of a large stream and the rise of an epidemic of malaria, have been observed.
138

Monthly inspections of the area were begun in May 16,1923, but only A. crucians and A. punctipennis, the stream breeder, were found until September 4, 1923; when one female A. quadrimaculatus was found in a hollow tree between Dunn's & Gantt' bridges. No A. quadrimaculatus were found from that date until December 24, when quads were reported breeding in a swamp in the town of Gantt. Two cases of malaria in negroes working on the dam were reported at that time.
Regular monthly inspections were resumed on March 30, 1924, at which time the stream had been impounded. No A. quadrimaculatus were found in May. On June 2, one female quadrimaculatus was found in a road cut one mile East of the town of Gantt. The water level in the reservoir had risen four feet and there was much floatage and visible algae noted. Quadrimaculatus larvae were taken from the impounded area just northeast of the main Gantt bridge. Implantation of this malaria carrier therefore had taken place in May and a case of malaria with plasmodia had occurred in the town of Gantt. In July an increased number of quadrimaculati was found in the reservoir, for the Gambusia are unable to control breeding because of the large amount of floatage present. Adult A. quadrimaculati were taken under houses in the town of Gantt and far up the reservoir. On August 11 a notable increase in adult quadrimaculatus was noted, 103 being taken at the regular stations where 53 had been caught the month before. Twenty-three cases of malaria have been reported to date this year. On September 14 breeding of A. quadrimaculatus continued and, while there was no notable increase in numbers of adult quads taken, fifty cases of malaria had occurred within the impounded area up to that time.
Information derived from most of these surveys has been imparted to the health authorities or to the employers of labor as in the case of a lumber camp.
The Director gave addresses on the work being done at the Station or on malarial subjects before the Augusta Medical Society and before the Medical students of the Medical College, Augusta; to the medical students at Emory University, Atlanta; the Medical Society of Bibb County, Macon, the Randolph County Medical Society, Cuthbert, and also to lay audiences at Camilla, Pelham and Albany. Dr. Paul Russell addressed lay audiences at Pelham, Camilla and Sylvester.
139

The Malarial Film was shown to lay audiences and to those in training at the Station at the following places: Americus, Albany, Cuthbert, Camilla, Dawson, Pelham and Sylvester.
THE TRAINING STATION
At the Training Station information is imparted largely in an informal manner. Formal talks are given on certain subjects and some of these are illustrated by lantern slides, but a good deal of the instruction is given in the field, in the laboratory and on the verandah of the hotel where most of those in training take their meals. It is understood that the trainees are not to be mere observers but for the time being become actual members of the staff and that the work assigned for them to do must be carefully and conscientiously done. A number of stations have been established in a wide variety of situations where malaria abounds and in which mosquitoes and larvae are to be found. The men are required to visit these stations regularly, to make collections of adult mosquitoes and of larvae. They examine blood and Spleens of children and have assigned to them certain families, the members of which are visited and examined regularly. Laboratory work is required in staining technique of thick and thin blood films, in the identification of adult mosquitoes and larvae and the mounting of the same. Mosquitoes are dissected for the detection of malarial plasmodia. Larvicides are tested. Malarial data cards are analyzed. Collateral reading is required. The Director is always accessible at numerous informal conferences. Pains are taken to show the men how the work is to be done, and to see that each day is filled full of accomplishment.
After a period of instruction more directly under the immediate supervision of the Director each person is assigned a piece of work, usually a malarial survey which is undertaken at some point distant from the Station. Here the trainee is placed on his own resources, making a survey including maps and a study of the local problem with recommendations for control.
Following is a list of visitors and workers at the Station during the past year:
Dr. C. B. Blaisdell; Mr. M. M. Balfour; Dr. George Bevier; Dr. S. B. Bieker, of the Alabama State Board of Health; Dr. Chas. A. Bailey; Dr. M. E. Barnes; Miss Adah Corpening, Virginia State Board of Health; Dr. R. W. Bradshaw; Mr. R. B. Broughman, Florida State Board of Health; Dr. Emile Brumpt,
140

of the University of Paris; Dr. J. H. L. Cumpston, Australia; Dr. R. K. Collins; Mr. L. T. Coggeshall of he University of Indiana; Dr. K. Drensky, of Bulgaria; Mr. Peter de Jarnette, Georgia State Board of Health; Dr. E. C. Faust, Peking Medical College; Dr. John A. Ferrell; Dr. R. G. Hamilton, South Carolina State Board of Health; Dr. A. L. Hoops, Straits Settlements; Mr. Wm. Hoffman; Dr. Ross Hopkins, Missouri State Board of Health; Mr. H. A. Johnson; Dr. J. H. Janney; Dr. W. P. Jacocks; Dr. C. H. Kinnaman, Florida State Board of Health, Dr. Carl Puckett, Oklahoma State Board of Health; Dr. H. A. Taylor; Dr. C. A. Kane of the Virginia State Board of Health; Dr. John F. Kendrick; Dr. F. E. Kitchens, of the Tennessee State Board; Dr. W. H. Nicholls, Tennessee; Dr. Henry Meleney, of the Peking Medical College; Dr. R.N. Holland of the Florida State Board; Dr. Vernon L. Kellogg; Dr. R. Kudo of the University of Illinois; Dr. Chas. N. Leach; Dr. Gustavo de Lessa, of Brazil; Mr. F. F. Longley; Mr. Thos. LeBlanc, U.S. P. H. S., Miss Marion Maitland, University of Toronto; Dr. F. T. Milam; Dr. Leroy Meader; Dr. Martin, Alabama; Dr. W. N. Newcomb; Dr. Thorvald Madsen, Denmark; Dr. P. H. Muse, of the Tennessee State Board of Health; Dr. George Payne; Dr. Massimo Pantaleoni, of Italy; Dr. V. G. Presson; Dr. F. F. Russell, Dr. H. C. Ricks, Oklahoma State Board; Mr. Jack Sandground, Johns Hopkins University; Mr. T. F. Sellers, Georgia State Board of Health; Dr. J. R. Mahone, Texas State Board; Dr. W. G. Smillie; Dr. W. A. Sawyer; Dr. R. M. Taylor; Mr. E. S. Talbot, Florida State Board; Dr. Wu Lien Teh, of China; Dr. and Mrs. E. Walch, Holland and Java; Mr. J. S. Wise, South Carolina State Board; Dr. S. W. Welch, Alabama; Dr. David B. Wilson.
PERSONEL
Position Director_ ______________ 1 1 1 1 1 1 1 1 .1 1 1 1 I. H. B. Field Director
in Training_________ 1 1 1 1 1 1 1 1 1 1 1 1 Liinologist_________________________ 1 1 . 1 1 1 ---------------Secretary______________ 1 1 1 1 1 1 1 1 1 1 1 1 Field Asst._____________ 1 1 1 1 1 1 1 2 1 1 1 1 Microscopist____________ 1 1 1 1 1 1 1 1 1 1 1 1 Technician____________ 1 1 1 1 1 1 1 1 1 1 1 1 Laboratory boy________ 1 1 1 1 1 1 1 1 ---------------Janitress---------------------------------------------- 1 1 1 14
Samuel T. Da rling, Director Station for Field Studies in Malaria, Leesburg, Lee County, Georgia. 141

VENEREAL DISEASE CONTROL
Joe. P. Bowdoin, M.D. Director.
The work in venereal disease control during 1924 has consisted largely of educational measures. This educational work came nearer conforming to the ideal than we have heretofore been able to do.
The clinics established in 1918 are doing good work. The treatment of cases is being kept up. Physicians over the state are giving enthusiastic support, and many cases of syphilis that a few years ago would not have received arsphenamine are now getting this remedy. The introduction of Sulpharsphenamine has simplified the technique to where it can be given anywhere at any time without so much of the detail necessary in intravenous injections.
The law enforcement phase of venereal disease control has not been stressed by this Division, it being considered out of ou1 line of duty except for quarantine purposes. This also necessarily applies to interstate travel. The laws of the state seem to be adequate, and it is to be hoped that those whose duty it is to enforce them will interest themselves in the statutes governing pros-titution and venereal diseases, closing all questionable houses and -taking away the rights of drivers of automobiles used in the -traffic of women. Apparently, the bill known as the "'Jitney Bus Bill", passed in 1918, has not yet been invoked. Very few communities take advantage of the law of 1918, giving the right of examination of individuals suspected of being infected with venereal disease and detentionfollowingproperevidence. During 1924 only 593 were reported kept in detention, 244 males and 349 females. This law, with the rules and regulations adopted by the State Board of Health, gives ample protection to the community and the individual.
The Division has had valuable cooperation from physicians, the U. S. Public Health Service, the State Department of Education, superintendents of schools, state universities, Parent Teacher Associations, women'sclubs, W. C. T. U., League of Women Voters, missionary societies, civic organizations, clubs of different kinds, and a host of individuals. They are responsible for much that has been accomplished.
142

The outstanding educational work, the past year, was among teachers and high school pupils. The Public Health Service detailed to Georgia two of its best instructors, Miss Anne Jane . Simpson lecturer to women and girls, and Prof. Maurice Ricker, instructor in biology and venereal diseases, who exhibited the moving picture, "The Science of Life."
Miss Simpson was with us several months and visited (under the auspices of the P. T. A.) approximately two-thirds of the high schools. Her work was of the highest order and everywhere she was well and favorably received She spoke to approximately 16,163 women and girls, her subject being, "The Story of Life". Many requests for her return have been received.
Prof. Ricker was detailed originally for college and university work, but we were permitted to use him also in the twelve A. & M. Schools. He used well selected reels from the twelve-reel picture, "'The Science of Life." Prof. Ricker is a teacher and superintendent of education of long experience, and his addresses were enthusiastically received. Approximately 15,925 people heard him. The Surgeon General has been asked for the services of both Miss Simpson and Prof. Ricker again.
The Division was called upon for lectures in the 13 Summer Normal Schools for teachers which were held at the A. & M. schools and at Ellijay, during July. Ten periods were assigned the State Board, two of them being devoted to our subject. We were fortunate in securing the services of Prof. Ricker and Miss Simpson for this work, also. The lectures were repeated before the summer school at the University of Georgia.
Many card exhibits have been used during the year. The sets are "Youth and Life" for girls, and "Keeping Fit" for boys. One set of each is especially prepared for colored boys and girls. These have been furnished on an indefinite loan to many of the best negro schools in the state. The card exhibit is one of the best methods of presenting the problem.
The Attract-0-Scope has been in use most of the time. When at work at fairs or in store windows it always holds a crowd. It is a fascinating and inexpensive method of getting the question of health and venereal disease across. It is difficult to estimate the number viewing these pictures the past year, probably more than 50,000.
143

Owing to the limitation of the printing fund we have not been able to use as much newspaper space as we otherwise would. One thousand eight hundred columns of matter were prepared and sent out to the best weekly newspapers during the year. Many of the articles dealt directly with venereal disease and many others o indirectly. Copy has also been sent to all papers for their own composition. We have probably had more than a million readers the past year. The press of Georgia is a unit for better health and space is given freely.
The number of venereal disease pamphlets distributed during the year will compare favorably with the preceding year. The withdrawal of funds by the federal government will of necessity cut down this distribution. Beginning with July our appropriation for 1924-1925 was only $685.84. There is little prospect that we will be given any funds for 1925-1926. In 1918 wereceived $32,000 for this work. If this fund is entirely withdrawn we should have a state appropriation for this purpose.
The fourth year of the Institute-Clinic for physicians through and with Emory University was the most successful yet held. The work began June 4th and continued for five days. The venereal disease clinics and lectures began each day at 2:00P.M. and lasted until nightfall. The attendance was about 500. A great many from other states appeared on the registration list. lnteresting and instructiue programs filled the days from 8:00 ;A. M. until after dark. Great credit is due to Emory University ~ndl Grady Hospital for their cooperation, all physicians and surgeons of Atlanta who gave their time freely and the private hospitals who cordially invited all visiting doctors to attend operations and inspect their institutions. The Institute-Clinic has been the means of doing much good and is a fixture.
Six of the seven original clinics are still in service. The clinic at Rome was temporarily closed in November. It is possible that it may not reopen. Arrangements have been made with physicians and hospitals to take care of the charity cases that may be referred to them by the health officer. The other clinics are doing good work. The Atlanta clinic has been greatly improved. In the white department new quarters have been provided and entirely new equipment installed. ~ While the work of the clinics has been splendid there has been a serious hindrance in the lack of proper follow-up work. Through
144

the cooperation of .the Bureau of Maternity & Infancy, nurses for this work have been secu~ed in Atlanta, Macon, Columbus, Savannah and Augusta.
Several other cities have opened clinics where venereal disease can be given attention. These clinics are general in nature .and are a decided asset to the communities.
So far as the Division knows there is no restricted district in Georgia, and the public and law enforcement officers should give attention to the eradication of the clandestine prostitute. She is the source of all infection. Physicians should use their influence in getting inform~tion as to the source of infection of their patients, and this information should be imparted to the health officer or police force. This particular line of repression has never been given the prominence that its importance demands. All prostitutes are infected, therefore all prostitutes should be handled under the law of 1918. If there is an exception as to infection, it is due to the fact that the prostitute, either male or female, has not followed the life a sufficient length of time.
Your careful study of the consolidated repcrt for the past year, is urged. See page 47. It gives a complete statistical history of the work of the Division and is self-explanatory.
WASSERMANN REPORT
The work of the Wassermann Department has been conducted just as last year and with the same technicians.
As stated above the federal allotment for our work July 1 to July 1 was only $685. 84. So far nothing is provided for 1925-1926. The state has not given an increase, in fact, the app;:opriation was cut $5000,00 seve'ral years ago. We are receiving only $10,000. 00 for the entire work. This condition of our budget forced the withdrawal on June 1, 1924 of the free Arsphenamine that has been furnished for charity cases and also free vacuum tubes for collecting blood. Through the cooperation of the manufacturers of the tubes and arsphenamines we were able to make a very satisfactory price, offering the clinics and physicians these remedies and the tubes much below the wholesale market prices. Two circular letters have been issued to the profession outlining the method of distribution, which was strictly on a C. 0. D. basis, parcel post. Since Jan. 1st, 21,070 Keidel tubes and 26,476 ampules of arsphenamine !,in its various forms have been distributed or 6,880 more ampules than during
145

the preceding year. This appeared to be the best possible solu-

tion of our problem.



In cooperation with the Division of Maternity and Infancy

we have been securing blood specimens of the negro midwives

who have attended our classes of instructions. Quite a number

have been positive for syphilis. We, of ~ourse, refuse to issue

certificates to them and also do our best to see that they are

treated at least until they are non-communicative.

As a preventive of blindness from gonorrhea, 13,658 ampules

of 1% silver nitrate have been distributed during the year. These

ampules are manufactured in our laboratory. The law of Georgia

requires their use.

G-EORG-IA 7AN. 1., 18LI
q<EOR~II\ STATE BOARD OF HtALTH.

1S black o~t1~;!. -~speo:llllllla for Waaa81'111a11%1 aubmitted.
NumeYala repreaent tlle'1lUJee!" of iVaesftrmanna for tlote coul'\ty.. Total 7/uaermaana .. 1.9.832. sent In by 1,207 llhl'siciw 3.8U O't the. above wre J)Oa1t1Ye.
146

SUMMARY OJ' Vl!:NBB.BAL DISBASl!l CONTROL WORK J'OR THE YEAR ENDING DECEMBER 31, 1924,

Joe P. Bowdoin, Director, Venereal Disease Bureau,

Gl!:ORGIA STATl!l BOARD OJ' Bl!:ALTB.

-

--

--

--

1924 Month
J a n. ____ Feb._____ March. ..

Syphilis

Gonorrhea Chancroid

Detention

Audiences

Ara- Wasser- Smears

Pam-

Total Clip-

- - - - phena- manna

phleta

Atten- pings

- -I' - - -M - - -I' - - - - - -I' - -m-ine- - - - - - - - -M - - -I' - - - - -L-ect-. -l'i-lm-s -Ca-rd-a dance

339 227 300

54

42

2

814 2253

150 24

21 1789 -------- ---------- -------- -------- 16

265 141 220

70

30

3 1859 2198

227 40

29

299 353 6681 -------- 7034 --------

332 213 289

54

38

3 2117 2695

179 15

24

435 3087 3056 -------- 6143 --------

ApriL-- 353 203 265

88

30

2 2230 2885

117 10

11

456

700

4448 -------- 5148

5

MaY----- 318 149 260

93

46

1 2496 2832

214 11

21

845 4060

200 -------- 4260 --------

:;;;: June ____ 318 249 257

81

35

3 2199 2301

148 13

26

137 636

275

123 1034 --------

~ July_____ 274 205 243

54

31

3 3443 2502

140 20

47

522 1989 1740 -------- 3729

6

Aug._____ 232 151 301 120

40

0 2670 1850 113 22

61

400 -------- 200 -------- 200 20

Sei>t. ____ 352 198 325 121

Oct.. ____ 289 162 203

43

33 34

1 2471 2669 1 2074 2328

160 24 158 21

41 18

79 375 'A.ttraci= -------- 375 --------

450 275 5()()()(H) -------- 50275

6

Nov._____ 314 190 275

52

36

1 2368 2365

201 20

31

(SCOI>e)
320 130 ---------- -------- 130 --------

- - - - - -- - Dec._____
---

170 - -lll- - -293-

28

33 - -1 - -1-788- -2-255- -14-2 - -24 -- -19 - - -65- ----------- - -30- ----------- - -30- - -57 -

- - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL 3556 2199 3231 858 428 21 -26-529- 29133 -1-949- -2-44 - - -349- -5-797- -11-605- 66630 - -123- -78-358- -1-10 -

GRAND

TOTAL

5755

4089

449

26529 29133 1949

593

5797 11605 66630

123 78358 110

-

--

-

-

--

STATE TUBERCULOSIS SANITORIUM
Edson W. Glidden, M.D., Superintendent
At the beginning of the year, Jan. 1, 1924, there were under treatment in the Sanatorium 78 patients. At the close of the year 81 were under treatment. The average daily census for the year was 88.19 patients, this being larger than any previous year. The average length of stay for each of the patients was 127. 8 days. The total number of hospital days for the year was 32,277. This is also a larger figure than for any preceding year. The total number of patients treated during the year-326-however, was somewhat lower than the year 1923, but greater than other preceding years.
The per capita per diem cost for the year, as estimated by the State Auditing Department was $1. 88.
The appended tables report upon the classification of 245 patients who were discharged during the year. The number of counties represented by these patients was 79. The counties in larger centers of population and having full time health officers send the larger number of patients.
Routine examinations of the blood for Wassermann reaction has been done by the Laboratory of the State Board of Health with 8 positive tests. Although greatly overworked they have made these tests at no cost to the .Sanatorium. Their cooperation is greatly appreciated. The low incidence of positive Wassermanns among our patients was unexpected and surprising. The explanation, however, can probably be found in two or three factors-one especially being that a large proportion of our patients are from rural sections.
There has been a large percentage of complications among our patients, notably those of temperament and psychology. A smaller incidence of known organic complications is observable. A list of the more frequent complications is appended. (See Table No.2.)
While there seems to be a smaller proportion of advanced cases this year, the temperamental and neurotic conditions re-
148

ferred to above have made the conduct of these cases more difficult and results less striking. It is, however, a source of satisfaction to call attention to the low death incidence. Only nine deaths occured in the Sanatorium during 1924. This is fewer than any preceding year. During the latter part of the year there has been almost a pandemic of acute catarrhal conditions of upper respiratory tract which have been accompanied by unusual rise of temperature and marked incidence of facial neuralgia. The results of these catarrhal conditions upon the lower respiratory tract has been marked by chronic catarrhal conditions persisting in bases. These "colds" seem to be closely allied to former cases of "Influenzia."
The usual Sanatorium, rest-dietetic treatment has beem employed. We have again this year studied the use of tuberculin and stock vaccines. Our observations have not satisfied us of their usefulness in this work.
Routine examinations of feces have been instituted with particular reference to Hook Worm, Tapeworm and Ascarides. But owing to the limited staff, and, for the greater part of the year, lack of a medical assistant, the work has not been as thorough as it should have been. Special attention will be given to these examinations during 1925.
We have attempted to give the children, at the Sanatorium, some little schooling this year, but this has been unsatisfactory because of poor facilities. All teaching was done by adult patients, who, though they were school teachers formerly, were now only partially well themselves. These efforts while unsatisfactory were voluntary and appreciated by the administration.
The funds donated by the Hall County Medical Association have been used for the purpose of enlarging the dining-room and building a small stage where entertainments can be given for the patients. Above the enlargement of the dining-room, the porch was extended so as to ~ccommodate two additional patients. This opportunity is taken to again express our appreciation to the Medical Association for their generosity.
149

Mrs. W. B. Hunter of Cornelia again donated funds for our Christmas tree. These funds were raised with considerable effort by the sale of Christmas cards. Mr. and Mrs. Hunter also donated a young heifer to the Sanatorium dairy, and Mr. E. 0. Whealler generously contributed a veal calf.
Other donations, greatly appreciated, were the following: Christmas Fund-Holbrook Hardware Company, Cornelia, Ga. Christmas Fund-Miss Corinne Richardson, Alto, Ga. Christmus Fund-Holbrook Furniture Company, Cornelia, Ga. Christmus Fund-Mr. C. H. Dance, Toccoa, Ga.
Books-Council of Jewish Women, Columbus, Ga. Books-Mr. Nathaniel Fairbrother, 1732 E. 8th St., Charlotte,
N.C. Vegetables-Mrs. M. J. Bonds, Glouds, Fla. Vegetables-Mrs. J. H. Turner, Chauncey, Ga., R. F. D. No. 1. Plants-Mrs. C. D. Whelchel, Gainesville, Ga. Plants-Mr. Beach Cox, Gainesville, Ga. Plants-Mrs. Carter, Chipley, Ga. Fruits-Mrs. W. B. Hunter, Cornelia, Ga. Fruits-Mr. J. T. Thursby, Cornelia, Ga. Fruits-Mr. C. Cornwall, Alto, Ga. Fruits-Mr. C. M. Miller, Cornelia, Ga. Candy and Nuts-Talmadge Bros., Athens, Ga. Currency-Mrs. Mary M. Connell, Nashville, Ga. Melons-Dr. C. D. Whelchel, Gainesville, Ga. Melons-Col. Ham Kimsey, Cornelia, Ga. Free Bed Fund-Miss Margaret Little, Alto, Ga. Cloth-Anchor Duck Mills, Rome, Ga.
It is again our pleasant privilege to express our gratitude to Rev. Harry S. Cobey of Gainesville, for his faithful ministration to our patients, spiritual health.
The Sanatorium Sunday School and B. Y. P. U. have this year as for two or three years past been a distinct pleasure and comfort to our patients and have on more than one occasion assisted patients who were in need of funds for special purposes, such as for truss or railroad expenses when it was necessary to send patients to Eye specialist or surgeon for treatment.
150

MEDICAL REPORT. STATISTICAL.
Number of Patients reported on _____________ ----___________ 245 Number of Patients in Sanitorium December 31, 1924________ 81
Total number of Patients treated during year______ 326 lDl oasilpyi tpae1rDcaaypsi t_a__c_o__s_t___-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_- 3$21,2.8787 Average stay of Patients reported on, days _________________ 127.8
TABLE NO.1. CLASSIFICATION.

CLASSIFICATION ON ADMISSION

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

Incipient ______________
--------

_
-

2
-

-

-1

-

-

-

-

-

-1 -

-

-

-

-

Mod. Adv._______________
----------

126
--

-

-

1-1

-

47
--

-

48
--

-

-

-7 -

-

-

-

-

1-3

-

-AIn-davca-nticve-de__-______-____-______-_____-______-__

113
--1

-

2
-

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

-

-

12
-

-

-

54
-

-

-

21
-

-

-

-9

-

-

-15 -

- - - - - - - - - -1-

Not Classified_________ _
-----------

-

-3

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-3

-

Total_______________ 245 14 59 102 29

9 32

Patients classified under "Not considered" are those patients who remained in the Sanotorium less than thirty days.

TABLE NO.2.

COMPLICATIONS.

Larynx____________________ 31
Fistula in Ano____________ 3 Syphilis___________________ 2 Enteritis__________________ 5 Tape Worm_______________ 2 llook Worm_______________ 2 Ascaris___________________ 1 llysteria_ _________________ 1 Peritonitis________________ 1 llernia____________________ 2

Arithritis_________________ 1 Gonorrhea________________ 1 Chronic Gastritis_________ 1 APeulrliacgurlaa_r_F__ib__r_il_l_a_t_io__n_________ 11
Chronic Nephritis________ 1 Osteitis___________________ 1 Cervical Adenitis_________ 1 TOhtityisr_o_i_d__________--_-_-_-_-_-_-_-_-_-_-_-_- 12

Orchitis ___ --------------- 1 Diabetes__________________ 2

Wassermanns, positive____ 8

151

TABLE NO.3. AGE AND SEX OF PATIENTS.

- - Age-Years

1-10

11-20 --

21-30
--

31--40 41-60
- -- -

-51--60

61-70
--

71-80
--

Total

Males _______ Females _____
Totals __

1

13
--

37
--

29 19
- -- -

-

6-

-

1
-

----

----

-106-

4

33
--

-53-

-26--18-

-

3
-

-

1
-

-

1--139-

5 46 90 55 37

9

2

1 245

TABLE NO.4.

OCCUPATION.

Accountant ______________ 1 Barber____________________ 1 Boarding-House Keeper__ 1 Bookbinder_______________ 1 Bookkeeper_______________ 3 Brick Mason______________ 1 Butcher__________________ 1
Candy Maker------------- 2 Carpenter________________ 2
CCliatyy Fwiorerkmear _n___-_-_-_-_-_-_-_-_-_-_-_- 11
Clerk of Court____________ 1 Clerk (.Eiotel)_____________ 1 Clerk (Office) ____________ 2 Clerk (Merchandise)______ 9 Cook______________________ 1 Electrician________________ 1 Express Messenger________ 1 FFlaorrimst_e_r_______-_-_-_--_-_-_-_-_-_-_-_-_-_-_- 302 Harness Maker ___________ 1 House Wife _______________ 69 Insurance Agent _________ . 1
JIaronnitoCro_n_s_t_r_u_c__ti_o__n_W___o_r_k_e_r 11
Laborer___________________ 1

I,awyer___________________ 1 I,ineman__________________ 1 Machinist_________________ 5 Meter Reader_____________ 1 Mill Hand (Cotton) _______ 28 Milliner___________________ 3 Minister___________________ 1
Night Watchman_________ 2 Nurse (trained) __________ 2 Nurse (student)__________ 2 Operator (telephone)____ 4 Operator (telegraph)_____ 2 PhotographeJ:____________ 1
Plaining Mill Man_________ 1 Printer___________________ 1 Railroad Engineer________ 2 Railroad Flagman________ 1 SScahwoMolilBl oSyu_p_e_r_i_n_t_e_n__d_e_n__t__ 71
School GirL----~--------- 16 School Teacher___________ 6 Stenographer_____________ 7 Stone Cutter_____________ 1
Students ___ -------------- 3 Traveling Salesman_______ 7 Typest____________________ 2

152

TABLE NO.5.

COUNTIES FROM WHICH THE PATIENTS CAME.

Bacon ____________________ 1

BBaalrdtwoivn._____________________________________ 32 Ben Hill __________________ 2 BBeirbrbie_n________________________________________ 135

Burke_____________________ 1 Calhoun__________________ 1 Chatham_________________ 16
Cherokee_________________ 1 Clayton___________________ 1 Clarke____________________ 5 Cobb______________________ 3 Colquitt__________________ 1 Cook______________________ 1 Coweta ___________________ 3 Crisp_ ____________________ 2
I>ecatur__________________ 1 I>e Kalb __________________ 8 I>odge ____________________ 3

EEFlaabnerrlnty_i-_n-__-__-__-__-__-__-__-__-__-__-_-__-__-__-__-__-__-__-__-

11 1

Fayette___________________ 1 Floyd_____________________ 6 Fulton____________________ 20

GGllaysncno_c_k__________-_-_-_-_-_-_-_-_-_-_-_-_- 61

Gv.innett_________________ 5 Habersham_______________ 5 llall_______________________ 5 llancock__ ________________ 2 llaralson _________________ 2
llenrY--------~----------- 1 llouston________ ---------- 5 Irv.in_____________________ 2 Jackson _________ --------- 2 Jeff I>avis. ___ ------------ 1 Jefferson_________________ 1 Johnson_______ ------_____ 1

JLoanmes_a_r_______________________________________

1 3

Laurens __________________ 1

Lowndes__________________ 5

Lumpkin__________________ 1

Macon____________________ 1 Madison __________________ 2

Marion____________________ 1

MMiotcnhreoleL____________________________________

2 1

MMoursgcaong_e-e--_-_-_-_-________________________ 211

MOccoi>nuefefi_e____________-_-_-_-_-_-_-_-_-_-_-_- 21

Paulding__________________ 2

Pickens___________________ 2

Pike______________________ Polk ______________________

1 3

Putnam___________________ 3 Quitman__________________ 1 Rabun____________________ 1

TRiacthtnmaonn_d______-_-_-_-_-_-_-_-_-_-_-_-_-_- 112

Thomas____________ ------- 3 Tift_______________________ 2 Toombs___________________ 1

UUTnrpioosuno_pn___________-__-__-__-__-__-__-__-__-__-__-__-__-__-__-__-__- 811

VValker____________________ 1 VValton____________________ 2 VVare______________________ 8 VVVVaaysnhein_g_t_o_n_______________________________ 13

VVebster___________________ 1 VVhite_____________________ 3 VVhitfield _________________ 1

VVVViillkkeinss_o_n__-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_- 11

153

TABLE NO.6. COMPARATIVE STATISTICS FOR SIX YEARS-1919-1924

1919 1920 1921 1922 1923 1924
----------

No. of patients reported on ___ 118 204 216 237 278 245

Nos.iso_f__p__a_t_i_e_n_t_s___n_o_t___tu__b_e_r_c__u_-

2

2

2

7

4

0

No. of patients in Sanatorium December 3L ________________ 82 84 90 79 78 81

No. of patients treated during year ended __________________ 200 288 308 323 364 326
Hospital Days _________________ 19,829 29,518 32,177 31,454 31,799 32,277

Daily per capita cost __________ $1.89 $2.24 $1.95 $1.94 $2.01 $1.88

Average Stay, days ____________ 91.14 138.9 131.26 144.6 123.92 127.8

Incipient cases ________________ 12

6

5 11

5

2

Moderately advanced cases ____ 42 1{)7 90 100 125 126

Advanced cases________________ 62 86 117 124 142 113

No Classified __________________ Arrested_______________________

-----5

-----8

4 5

2 2

6 1

3 0

Apparently Arrested __________ 1() 12 13 16 21 14

Quiescent _____________________ I m p r o v e d ______________________ 1Jnimproved___________________ Dead_________________________ -_

15
43 17 10

41()
62 30 18

44 70
29 16

54 54 59

78 101 102

41 43 29

16 12

9

Not considered ________________ 16 32 41 38 50 32

Counties sending patients ____ 54 80 77 82 92 79

154

GEORGIA
l)eo.3J.-1924o
SJATE TUBERCULOSIS SANATORIUM. ALTO GEORGIA
Figures indicate numbe. of patients from each county since Sanatorium was established 1n 1910.
~
Counties not represented: Dade, Talbot, wl1nch, Lanier, Dawson, MC!n\oeb,Brantley and Taliaferro
155

GEORGIA TRAINING SCHOOL FOR MENTAL DEFECTIVES

George H. Preston, M. D., Superintendent

The year 1924 is the third full year of operation for the Georgia Training School for Mental Defectives. Despite the financial handicap that has continued from the first, some progress has been made.

There are more than a thousand children that should have the care that we are giving to a few. In January 1922 we had 129 applicants for admission on our waiting list; on January 1, 1923 the number had increased to 216; on January 1, 1924 there were more than 300; and on January 1, 1925 approximately 400 applications were in our files.

It is this increasing number of applicants for admission that

presents the most serious problem confronting the institution.

Almost daily, emergency requests for admission are made, ac-

companied by pathetic letters and frantic appeals. The only

possible reply is that there is no room. This means that feeble-

minded boys and girls are passing the trainable stage of their

lives in environment where they learn nothing constructive and

acquire bad habits.



In addition to making the admission of urgent cases impossi-

ble, the smallness of our appropriation also necessitates the crowd-

ing together of children of varoius mental ages and varying past

experiences in the same building. This is particularly unfortu-

nate in the cases of girls, because here girls with previous sex

experience live in the same building with girls untrained in these

matters, to the obvious detriment of the latter group. An in-

crease in the size of the institution would make adequate classi-

fication possible.



The tables which follow have been prepared in the standard form adopted by the American Association for the Study of the Feeble-minded and the National Committee for Mental Hygiene. Owing to the small population, certain tables have been omitted as of no consequence, others for the following reasons: (a) under the law all patients must be citizens of the State of Georgia; (b) at present the ;nstitution receives only children, all of whom
156

are unmarried; (c) having no field workers, accurate information as to the economic conditions of families is unobtainable; (d) no deaths occured during the year.
The total hospital days during 1924 were 20,120, the net operating cost $26,485.41, and the per capita cost $1.316 per day, as compared to 17,001 hospital days, $22,004.33 net operating cost, and $1.294 per capita cost during the previous year.

TABLE NO. 1.-GENERAL INFORMATION.

1. Date of opening as an institution for feebleminded: July 5, 1921,

2. Type of institution: State.

3. Institution plant:-

Value of institution property: Real Estate and buildings_________________________ $98,991.40 Personal property_________________________________ 13,831.54

Total acreage of main institution property:

C>wned_____________________________________________

325

Rented____________________________________________

o

Colonies___________________________________________

0

Total acreage under cultivation____________________

160

Actually in ser-

vice at end of

year.

Fe-

4. (}fficers and emyloyees:

Male male Total

Superintendents _____________________________ _ Teachers of grade subjects ___________________ _

1 0

0 1

1 1

Teachers of special subjects _________________ _ Stewards _____________________________________ _ }fatrons ______________________________________ _

0 1 0

3
0
2

3
1
2

All C>thers ____________________ ----- ____ -------- 2 6 8

4 12 16

TABLE NO.2. MOVEMENT OF TOTAL PATIENT POPULATION. 1. C>n books of institution at beginning of institutional year:

FeIn institution __ .______________________________ M3a1le m2a2le To53tal
Away from institution________________________ 0 0 0 '

2. ReceivTeodtadlu--r-in--g--y-e-ar-_-_-_-_-_-_-_-_-_-_-_-_-_~_-_-_-_-_-_-_-_-_-_-_-_-_-_-_- 3114

22 4

53 18

3. Total on books during year______________________ 45 26 71 4. Discharged:
a. Into community--------------------------- 7 3 10 b. To all other institutions__________________ 0 3 3 c. Died_______________________________________ 0 0 0

Total~---------------------------------- 38 20 58

157

TABLB 3. IIBNTAL STATUS OF FI:&ST ADMISSIONS AND :&!:ADMISSIONS FOB Yea.r ending Dec. 31. 19:M.

Total

1st Admissions

Be admissions

IIIBNTALSTATUS
Idiot_----------------Imbecile-------- ______ Moron______________ --(Exclude Eoileotics) Not feebleminded---Under observation___
TOTAL_---------

II

-F -

T --

-

II
-

-

-

-F

-

-

-T

-

-

-II

-

-

F
-

-

-

-T

-

5 -1- -6- - -5 - - -1 - - -6 - - -0- - -'0 - 0

8

-

1 -

-

9-

-

-8

-

-

-1

-

-

-9

-

-

-1

-

-

-0

-

-

-1

-

1 -2- -3- - -0 - - -1 - - -1 - - -0 - - -1 - - -1 -

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

0 -0- -0- - -0 - - -0 - - -0 - - -0 - - -0 - 0

0 -0- -0- - -0 - - -0 - - -0 - - -0 - - -0- 0

14 4 18 13

3

16

1

1

2

TABLB 4.

CENSUS OF PATIENT POPtJLATION AT END OF YEA:& IN INSTITUTION.

Males

Females

Total

Feebleminded (not eoileotic)_______________

35

19

54

Feebleminded eoileotics____________________ Eoileotics (not feebleminded)______________

o3

1 0

4 0

Other (Soecify)______________________________

0

0

0

TotaL____________________________________ 1 - - -38- - - - 1 - - -20- - - 1 - - - -58- - -

Enrolled but absent from institution. None. There are no colored oatients in the institution.

158

TABLB 5. AGE 01' I'IRST ADMISSIONS CLASSII'IED WITH BEI'EBENCE TO MENTAL STATUS

Total

Idiot

Imbecile

Moron

- - A-G-E G-R-OU-P - - 1M1I'-T-M -I-'T - - -II- -I' - -T - -II- -I'- -T-

Under 10 years____________ 3 0 3 2 o 2

0

0 00

10
-

to
-

14
-

years______________
-----1-

5
-1

-

-6 -

-

-

-

-4 -

-2 -

-

-0

-

-2

-

-

0-

-

-0

-

0
--

15 to 19 years______________ 5 2 7 0 0 0 4

5

2

20 to 24 years______________ 0 o 0 0 0 o 0

0

0

0

0

0

25 to 29 years__________________________________ ---- ______ ------ ______ ------ ______ ------

30 to 34 years_________________________________________________________________________ _

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

TotaL_______________ 13 3 161 5

67

8

2

TABLE 6. ENVIRONMENT 01' I'IRST ADMISSIONS CLASSII'IED WITH REFERENCE TO MENTAL STATUS

Total

Idiot

Imbecile

Moron

__E_N_V_I_R_o_N_M_E__NT__1_M_ _!_~ ~_!_~~_!__~~_!_I_:_

Urban_____________________ 11
---------1

2
-

13
-

4
--

0
-

4
-

-

-6

-

-

-

-7

-

-

-

-

-2-

RuraL-------------------- 2

3

2

0

000

TotaL _______________ 13 3 16 5

6

8

2

TABLE 7. DISCHARGES CLASSil"IED WITH REI'ERENCE TO MENTAL STATUS AND CHRONOLOGICAL AGE

Total

Idiot

Imbecile

I AGE GROUP

II

-F -

-T -

-

II
-

-

-

F
-

-

-

T
-

-

-

II
-

-

-

-F

-

-T-

Under 10 years________ 0 -0- -0- -0- - -0- - -0- - -0- - -0- - -0-

10 to 14 years__________ 15 to 19 years__________ 20 to 24 years__________
TotaL ___________

5 2 0 7

-

3-

-

8 -

-5-

-

-2 -

-

-7 -

-

-0 -

-

-I

-

-

-1

-

i+-

1-

30
-2 ~0 -

-0 0

-

-0 -
0

-

-2-
0

-

-1-
2

-

-3 2

-

13 5

2

7

2

4

6

159

As an example of the service the school for the Feeble-minded purposes to render the state when properly supported, the reports of the work done by the Superintendent in the Decatur and Elberton Schools is submitted. This is in reality the beginning of a Mental Hygiene program.
SPECIAL CLASS REPORT DECATUR PUBLIC SCHOOLS
At the request of Dr. W. A. Harrison of the DeKalb County Board of Health an examination of the children of the two special classes conducted by the City Schools of De~atur was made with a view to determine their intellectual status. As the time available for these examinations was limited no attempt was made to evaluate emotional trends, personal peculiarities, or psychopathic complexes, and these conditions were only noted as they became obvious during routine examinations. As all of the children examined were to some degree retarded in their school work, it is clear that some of these classed as intellectually normal or probably normal must have been handicapped in other ways. Certainly some of them were handicapped by personal peculiarities which were not revealed by the rapid routine examination; some of them were handicapped by their social condition; some of them by changes from one school to ano~her, particularly from country to city schools, and some by physical conditions, altho it was surprising to note that in this group there were very few . children handicapped by any serious physical abnormality. One childshowedaprobablyseriousheartlesion, one the results of serious brain damage in infancy, and one the results of a head injury of three or four years' duration. The other children showed no physical abnormality to which their retardation could be attributed.
In determining intelligence levels certain parts of the Pinter & Patterson Performance Scale were used in addition to the Standard Revision of the Benet Simon Scale. The thirty-four children in the two classes were examined by this method and were separated into the following four groups. First, those who seemed to be of slightly superior intellect. Second, those who seemed normal. Third, those who seemed probably normal or dullnormal, but who represented the border land between normal or defectives. Fourth, those clearly belonging to the group of men-
160

tal defectives. These four groups appeared in the following numbers: Superiors, 3; Normals, 10; Probable normals, 11; Defectives, 10. In other words, approximately one-third of the children in this special class were feeble-minded, one-third normal, one-tenth superior, and the remainder on the border line between normal or defective.
The fact that three superior individuals were found in a class for retards is interesting. A study of these three cases throws some light on the question. The first boy in this group was ten years and nine months old when examined and was not promoted from fourth grade last year. When tested he showed ability to sJ.o twelve year old work. When transferred to the special class he brought a record of being a disciplinary problem. His teacher said he was vicious. His teacher in the special class said he was clean, polite, and no trouble. The boy said he would not go back to the regular school. Here we were probably dealing with a boy for whom fourth grade work was easy enough to allow plenty of time for misbehavior and whose fertile mind was able to invent plenty of opportunity for even serious misbehavior. Placed in an environment which pleased him and given work suited to his ability he ceased to be a problem. The second boy was eight years and four months old and probably capable of doing ten year old work. He did not succeed because he would not make an effort to do work which was too easy to interest him. He will probably do better if given harder work. The third boy was ten years old and easily able to do work a year above his age. He suffered by having attended the first grade in one country school and the second and third in ariother.
These three cases constitute the most pleasing surprise of the special classes in the Decatur Schools. In most of the smaller school systems one of the chief objections to special classes is that parents object so strenuouslyto having their children placed in special classes because of the connotation of mental defect carried by such a transfer. Because there are normal and superior children in the classes in Decatur these classes catTy no suggestion of defect and are looked on simply as coaching classes. Although this method of mixing defectives and normals is absolutely opposed to the teaching of most experts in the field of education, it seems to possess advantages in some school systems which outweigh ali objections. If the teachers in these special classes can recognize
161

the fact that they have both normals and defectives to handle,

and if they can so arrange the classes that the normals and defectives are segregated in such a way that each class receives the type of training suited to it without making this segregation obvious to the public, great good can be done. In order to function

~

properly these classes should "filter out" the defectives, pass the

normals back into the general school as fast as possible, and give

the defectives such education as they are able to assimilate with-

out ever passing them back into the general school. Although the

primary duty of a school system is to the normals, the defective

individuals should be offered every possible opportunity and in

order to do this fully such classes should be separated from the

general schools, and so situated that noise, games, singing and

marching could be indulged in to the fullest extent without inter-

ference with the regular scholars. Furthermore outside work,

such as gardening is a great advantage in handling defective!' as

also are all forms of handwork. Just at present this type of work

is not being carried on as fully as it should be in the Decatur special

classes.

As mentioned above, there were in the classes at the time of examination ten normal children and eleven who should probably be classed as normal. The presence of these children in a claEs for repeaters should be sufficient justification for a careful investigation. Practically all of these children should be passed back into the school as quickly as possible.

Of the ten defectives found, one showed ability to do only four year old work, one the ability to do about five year old work, and one about six year old werk. The others varied in ability between seven and eight year work with the exception of one fourteen year old individual who could do ten year work. The actual ages of this group varied between nine and fourteen and a half years. These children are clearly unable to compete with normals on equal terms, and can never be expected to keep up with normal classes. If it is the duty of a school system to train it~' scholars to meet conditions of life in the best way possible these children should be taught the rudiments of education which they are likely to use, for examle; to tell time; to make change; to read simple directions; and in addition to this they should be taught to
keep clean, to obey, to work, and to love tQ work.

l62

SUMMARY. There were found in two special classes three children pos-
sessing superior ability, twenty-one children of normal and probably normal ability, and ten defective children.
The special classes possessed the advantage of not being definately associated with feeble-mindedness. The special classes as organized could with slight internal changes be made to act as a "filter" which would remove feeble-minded children from the regular school grades.
There was insufficient opportunity for manual work and for recreation offered defectives. The classes are handicapped because of the fear of disturbing normal classes.

RECOMMENDATIONS.
1. That the classes be operated with the idea of passing only normal children back into the general school system.

2. That all defective children should be given what education they are capable of acquiring without ever passing them back into the general school system.

3. That arrangements be made to give the defective children an opportunity for more hand-work and more recreation during school hours.

4. That regular mental and physical examinations begiven all children in special classes at least once a year.

5. That special classes be so located and controlled that they cannot disturb the rest of the school.

6. That arrangements be made by which normal children from the special classes can be easily passed back into the general school at least at mid-term.

7. That a definite system for admission to the special

classes be adopted and that in each case the superintendent of

special classes be supplied with as full information as to the

reasons for admission as possible.



(The repmt of the individual examinations were sent only to the Superintendent of City Schools and to the Health Officer.)

163

ELBERTON PUBLIC SCHOOLS.

In compliance with a request of the Health Department of the Elberton Public School, an examination of the mental health of certain children in the school system was made.

Although the only absolutely satisfactory method of obtaining insight into the mental health of the children in the school system would have been an individual examination of every pupil the amount of time required made it necessary to limit the investigation to a small group. Therefore, with a few exceptions, only pupils of the first grade were examined. In order to further facilitate matters each first grade teacher was asked to present a list of children believed to be mental hygiene problems, and only those children presented by the teachers were considered for examination. The nature of these problems had been previously presented to each teacher as concisely as possible.

The number of children reported for examination as present-

.

ing some special problem in the class room must be, to any one not

-

closely in touch with mental hygiene work in public schools, one

of the most striking results of the study. In one first grade of 36

pupils, 23 werereported for examination, and in the other first

grade 28 were reported from a total of 39. In other words, the

first grade teachers thought that 68% of their class might be

benefited by some special consideration of their mental hygiene

problems. This is not an unusually high percentage because of

course some of these children showed no abnormality while others

were victims of physical rather than mental variations.

Of the 75 children reported for examination 9 were classed as first grade repeaters, one for the third time, but in all of these cases some other notes, as a personal peculiarity, were recorded by the teacher, no case being presented solely as a repeater. Quite a large number of cases were presented as "timid," "easily embarassed", "baby like", "cries easily", "afraid'', etc.,and in view of the fact that the examination was conducted in November, only three mpnths after many of these children entered the first grade, some of them certainly must be thought of as children who had not "found themselves" yet. The question of course is "why they had not found themselves as quickly as the others?' and will they "find themselves" quickly enough to carry on their work". A partial answer to this question will be found in the results of the

164

examinations. Other cases were reported as "slow", "learns slowly", "blank", ''dull", "stupid", etc. A few were reported as nervous, a few as in poor health, and several for other miscellaneous causes.
Of the cases reported in the first grade, 23 were given individual examinations. This examination consisted of the study of the history of the child and its family as far as data were available, a personal sizing up of the child, and measurement of intelligence level by means of the Standard Revision of the Binet-Simon Scale and the Pinter-Patterson Performance Scale. Of these children five were found to be doing work more than two years below what should be expected of a normal child of their age, while three were found doing work of approximately one year over their actual age. One child of eight years was found unable to do four year old work, and one child of six was found able to do almost eight year old work. The chronological ages of these first grade children varied from six to twelve years, and the intelligence ratings from that of a child three years and eight months to that of a ten year old. It is interesting that many of the children reported as "timid", etc., although six years old according to the calendar, were able to do only five year old work. This difference is probably not enough to warrant serious consideration as far as their ultimate course through school is concerned, but it does help to explain the teachers' reports, and it also sheds light on their proper handling in class. Two definitely psychoneurotic children were found, both of whom are laying the foundation for nervous breakdowns in after life.
In concluding the report of examinations, special mention should be made of one family. Three members of this family are attending school. One boy of almost fourteen shows an intelligence level of nine years and a half and is in the sixth grade though he is probably not able to do good fourth grade work.
One of his sisters of the same age shows an intelligence level of eight years and ten months and is doing fourth grade work. She has been in school at least seven years. The third membe1 of the family is nine years old, shows an intelligence level of less than six years and is repeating the second grade. Granting that these children entered school at six years of age, they have together used up twenty school years and have together gained much less than twelve years education. These children are certainly an expensive addition to the Elberton Public School System.
165

,From this study the following conditions seem clear: (1) There are many children who need special study. (2) There are several children who can progress faster
than the average. (3) There are certain children who are unable to keep up
with the average and who profit little from the ordinary school course. RECOMMENDATIONS: (1) Provisions to enable the brighter children to advance just as rapidly as possible. (2) Study of all repeaters and ultimately coaching for those who can go ahead, and special classes for those unable to profit by methods of teaching.
166

'I..,