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) 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 < ,; ., ce .. ""pR I.>.<. I .... oil 0 .< 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 ... :! 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 .. ~ 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 ~ .:":. -'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 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 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..,