Report of the Georgia State Board of Health for 1925-1926 [1927]

REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
I
FOR 1925-1926
A TLA NTA, GA,

REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR 1925-1926
A TLA NTA, 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 Fort E. Land, 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., Cemmissioner of Health. Joe P. Bowdoin, M.D., Deputy Commissioner of Health, and
Director, Division of Venereal Disease Control, and Division of Child Hygiene. T. F. Sellers, Director, Division of Laboratories. L. M. Clarkson, Director, Division of Sanitary Engineering and Water Analysis. Butler Toombs, Director, Bureau of Vital Statistics. M. E. Winchester, M.D., birector, Division of County Health Work. Edson W. Glidden, M.D., Superintendent, State Tuberculosis Sanatorium. John W. Oden, M.D., Superintendent, Georgia Training School for Mental Defectives.
3

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

Atlanta, Georgia.

Dear Sir: The report of the State Department of Health for the two years,
1925 and 1926, is necessarily abbreviated since the demand of the volume of work indicated in the report has stretched our meager appropriation to such an extent that we are unable to publish the usual details.
During this period our Vital Statistics Law was destroyed by a decision of the Supreme Court, and re-established in 1926 by vote of the people.
In spite of the fact that Georgia's state appropriation for public health ( 3 cents per capita) is lower that that of any other southern state, the work of the various divisions during this biennium has been exceptional. I would call your special attention to the serious situation in our laboratories where the amount of work has doubled in six years, while the staff has remained practically the same. The work in every other division has increased immeasurably, until we are stretching ourselves beyond human possibilities, and without additional resources the efficiency that has been developed cannot be maintained.
The increasing appreciation of public health on the part of the general public and lay organizations, and their cooperation with us upon every occasion has made possible muct of the work set forth in this report.
The reports of the divisions are presented in the following order: 1. County Health Work. 2. Vital Statistics. 3. Laboratory. 4. Sanitary Engineering. 5. Child Hygiene. 6. Vener.eal Disease Control. 7. Tube.rculosis Sanatorium. 8. School for Mental Defectives. Respectfully submitted, T. F. ABERCROMBIE, Secretary, State Board of Health.

4

DIVISION OF COUNTY HEALTH WORK
M. E. Winchester, M.D., Director.
In addition to the supervision of the work of the organized counties of the state during the. year, an active educational campaign was carried out in a number of the .counties in middle and south Georgia in an effort to convince the public of the value of. organized health work. As evidence of the results two Grand Jury approvals were secured in the following counties: Brooks, Colquitt, Worth, Coffee, Macon and Pierce, and one Grand Jury approval in Charlton, Camden and Crisp, with the expectation of a second approval in 1927. Spalding County did not adopt the Ellis Health Law but decided to organize under a joint City-County program, under state supervision, however. .Health officers were secured for only two counties: Brooks and Spalding. The same difficulty is encountered in this state as in many other states, that of securing competent health officers, and to put an incompetent man at the head of a health organization would mean failure. It is hoped that competent men may be secured for the other counties early in 1927. Two men are now in training for positions in this state. Brooks, Colquitt and Worth Counties once had health organizations but abandoned the work on account of poor financial conditions. The resuming of the work by these three counties shows that they realize its great value.
Epidemiological investigation requires much more time than the Director of this Department has been able to give to it and it is suggested that an Epidemiologist be employed as soon as funds are available. Many investigations have been made during the year, and, in most instances, the cause of the epidemic has been found.
After a careful study of the tax valuation of the various counties of Georgia the writer finds that there are approximately 130 counties in the state unable to finance an adequate health organization without state aid and it is suggested that an effort be made to secure an appropriation from the state sufficient to organize several groups of counties each year, similar to the tri-county project now in operation in South Georgia. By having this appropriation increased each year it would be a matter of only a few years before it would be possible for every county to have organized health work.
5

The accompanying table shows the activities carried on and the results accomplished in the 24 counties which were operating at the close of the year, 1926.
One of the outstanding features of the work was the Toxin-Antitoxin Campaign which was very successfully carried out. Note the great increase in the number of sanitary privies installed. This is a , very important work and is striking at one of the main sources of Typhoid and Dysentery.
The mortality records of counties with health organizations show that there has been a marked decrease in the typhoid death rate, while there has been an increased death rate over the state as a whole.
Attention is also called to the increase in smallpox vaccinations and the correction of defects found in school children. One has only to compare the budget for health work in 1919, $70,000, with 15 counties operating, to that of 1926, $226,000 with 24 counties operating, to realize the growth of the work in the state.
6

SUMMARY OF, COUNTY HEALTH WORK FOR THE YEARS 1925 and 1926

ACTIVITIES

I. EDUCATIONAL:

1925

Public meetings addressed ___________________________ 2,856

Attendance -------------------------------------------------- 143,444

Bulletins distributed

65,422

Newspaper articles ------------------------------------ 833 lI

II. COMMUNICABLE DISEASE CONTROL: Number of cases visited ____________________________
Total number of visits ____________________________ _

2,711 5,041

III. CHILD HYGIENE:
Pre-natal Home visits __________________________________________ 5,367 Office consultations ____________________________ 1,226
No. new cases ---------------------------------------- 1,413 Midwives instructed _____________________________ 2,092
Silver nitrate treatments distributed 3,131
Infant and Pre-School
Visits to newborn- --------------------------------- 6,295 Group conferences with mothers ________ 539 Office consultations with mothers______ 2,616 Visits to pre-school cases ___________________ 7,865
New school cases -------------------------------- ___ 2,070 School
Children examined _______________________________ 64,937 Number defective children __________________ 31,001 Total number defects found _______________ 47,645
Follow-up visits -------------------------------------- 12,929 Maternal
No. new cases ---------------------- _________________ 856 No. visits maternity cases _________________ 6,555

IV. IMMUNIZATIONS:

Completed antityphoid vaccinations________ 51,238

, Completed toxin-antitoxin treatments ____ 13,773

Protective antitoxin, cases ____________________

500

Curative antitoxin, cases__________________________ 154

Antismallpox vaccinations ---------------------- 18,990

Antirabic treatments __________ ---------------------

224

V. VENEREAL DISEASES: Total number treatments __________________________ 20,977

1926 2,570
33,015 94,129
755
5,037 9,675
6,127 799
1,504 2,489 5,548
6,795 936
4,012 9,420 2,258
66,961 29,631 41,685 15,667
1,153 7,434
44,077 27,675
853 304 652 276
20,779

7

VI. HOOKWORM: Number completed treatments----~---------- 7,784

7,749

VII. SANITATION OF FOOD SUPPLIES: Inspections of dairies________________________________ 2,834 Cows tuberculin tested ______________________________ 11,239
Inspections of stores and eating places 9,903
Examinations of food handlers and dai-
ry employees ------------------------------------------ 1,948

3,232 11,859 15,125
1,726

VIII.

MALARIA:

Ponds and marshes drained._____________________

186

Yards of water surface oiled.___________________3,055,719

Quinine treatments induced._____________________ 2,123

Grains quinine distributed________________________ 273,572

Homes screened -----------------------------------------

742

154 24,786,740
1,035 250,278
326

IX. GENERAL SANITATION: Inspections of private premises______________ 168,958 Schools and other public buildings________ 1,988

130,357 2,239

X. LABORATORY:

Specimens examined ------------------------------ 14,616

Specimens sent to State Laboratory________ 4,421 Milk samples, total counts._______________________ 2,572

Water samples examined----------------------- 1,041

Water samples to State Laboratory______ 569

Others

-------------- ------------------------------- 4,664

RESULTS

17,740 3,763
2,180,106 908 902
5,778

I. SANITARY PRIVIES INSTALLED: Rural Urban _________________ ----------------------------------------

650 2,800

860 1,494

II. PRIVIES RESTORED TO SANITARY TYPE:

Rural

____ ---------

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

523

Urban

2,002

394 1,004

III. SEPTIC TANKS INSTALLED:

Rural --------------- -------------------

195

254

Urban ------------------------------------------------------------

186

101

IV. NEW WATER AND SEWER CONNECTIONS: Water __________________ _________________ _________________ 1,034
Sewer --------------- ------------------------------------------ 1,009

1,386 1,209

8

BUREAU OF VITAL STATISTICS
Butler Toombs, Director
In June, 1925, a supreme court decision declared the payment of local registrars' fees by the county unconstitutional, disorganizing the vital statistics system throughout the State. Fortunately this did not completely destroy the registration organization as 89 of the 161 counties continued the payment of th~ local registrars' fees, and over 200 of the local registrars in the counties that did not pay these fees continued to collect and return to the Bureau of Vital Statistics certificates of births and deaths.
The Legislature, in 1926, proposed a constitutional amendment to correct this defect in the Vital Statistics Law. This amendment was ratified in the election on November 2, 1926, by an 87 per cent affirmative vote, representing the largest majority any constitutional amendment has received in the last de~ade.
In 1926 the Bureau of Vital Statistics conducted an intensive publicity campaign, emphasizing the importance of birth and death registration. Due to this campaign and the strong sentiment for these records already existing, it is not unreasonable to expect registration to soon reach the necessary completeness to be admitted in the Federal Registration Area, and to that end every effort should be exerted.
In 1924 there were filed with the Bureau of Vital Statistics 59,846 birth certificates, whereas in 1926 there were only 44,191, a decrease of 15,655, or 26 per cent. In comparing the birth certificates filed in November an entirely different picture is presented. In November 1926 there was an increase of 2 per cent over the number. filed in November 1924.
The number of death certificates filed in 1924 was 34,890, and in 1926 they dropped to 28,871, a decrease of 6,019, or 17 per cent. The number filed in November 1926 shows an increase of 7 per cent over the number filed in November 1924.
No tabulations and compilations have been made from the birth and death certificates filed in 1925 and 1926 as such statistics would not only be useless but misleading.
9

The demand for ~ertified copies of the records of births and deaths has grown by leaps and bounds. There were 156 copies issued in 1921, an increase to 252 in 1922, a still further increase to 298 in 1923. The year 1924 showed a general demand for such records, not only by the veterans of the recent war, their widows and orphans in the settlement of claims against the Federal Government,. but also in the administration of the Child Labor Law, and the School Laws. In that year 515 copies were issued, and during 1925, as the peDple were beginning to understand the use of such records, the number jumped to 1,002 copies issued, not including the hundreds of requests for copies where the records had not been filed .. During 1926 there were 979 copies issued.
COMMUNICABLE DISEASE REPORTS Reports of communicable diseases from physicians have shown an increase of forty percent over any previous year since a new method of collecting these reports was inaugurated in 1924. There were 35,217 cases reported during 1926. The Journal of the Medical Association of Georgia is publishing both mobidity and mortality reports each month, thus rendering valuable assistance in presenting this information to the public in readable form.
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COMMUNICABLE DISEASES REPORTED 1922-1926

1922

Actinomycosis ---------------------------

2

Acute Inf. Conjunctivitis__________ 13

Anchylostomiasis ------------------------ 852

Anthrax ----------------------------------------

1

Cerebrospinal Meningitis____________ 29

Chicken Pox -------------------------------- 619

Dengue ------------------------------------------ 5,148

Diphtheria ------------------------------------ 1,812

Dysentery ------------------------------------ 183 German Measles __________________________ 9

Gonorrhea ------------------------------------ 1,340

Influenza -------------------------------------- 6,612

Leprosy ----------------------------------------

0

Lethargic Encephalitis________________ 0

Malaria ---------------------------------------- 1,888

Measles ---------------------------------------- 170

Mumps ------------------------------------------ 142

Paratyphoid Fever -------------------- 36

Pellagra ------------------------

30

Pneumonia -----------------------

743

Poliomyelitis ---------------- --------------- 16 Rabies (In man) __________________________ 1

Scarlet Fever ------------------------------ 644 Septic Sore Throat _____________________ 115

Smallpox -------------------------------------- 756

Syphilis ---------------------------------------- 1,570

Tetanus ------ ----------------- --------------- 24

Trachoma --------------- --------------------- 11

Trichinosis ---- -------------------

0

Tuberculosis (Pulmonary) ________ 569

Tuberculosis (Other) ___________ ___ 30

Typhoid Fever ---------------

990

Typhus Fever ----------------

15

Whooping Cough ----

629

1923 0
11 815
0 18 515 44 1,100 173 276 1,145 7,140
0 0 1,485 7,836 220 30 31 1,146 4 0 394 78 673 1,624 11 24 0 732 34 656 20 704

1924 0 20
507 1 4
818 8
1,012 197 115
1,163 1,223
2 0 763 3,622 861 21 46 1,151 10 1 407 50 2,107 1,453 13 6 0 652 14 601 4 946

1925 2
89 364
0 38 1,127 36 943 1,042 19 3,331 11,996
1 4 2,452 548 1,005 87 401 2,755 30 2 328 449 444 1,792 20 21 1 1,184 26 2,016 33 1,458

1926 0
33 '215
1 23 1,159 21 1,498 519
0 2,588 12,024
1 1 2,039 3,030 1,100 67 294 2,715 13 1 535 523 957 1,962 12 6 0 1,063 9 1,701 50 11066

Total

---------------- 24,999 26,942 17,798 34,944 35,217

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DIVISiON OF LABORATORIES'

T. F. Sellers, Director

The following table compares the growth of the laboratory work

during the past five years:

1922 Bacteriological Specimens ~--- _____12,635 Wassermann Tests -------------- __14,804 Water Analyses ------------------------ 3,240

1923 16,253 18,061
5,015

1924 17,994 19,832
5,794

1925 17,102 22,326
6,562

1926 15,370 26,307 ,6,608

Total __________________________________________30,679 39,329 43,620 45,990 48,285

THE FOLLOWING BIOLOGICALS WERE DISTRIBUTED:

1925

Complete treatments for Rabies, manu-

factured and distributed_________________________ 2,315

Typhoid Vaccine _____ __ _____________

312,188 c.c.

Diphtheria Antitoxin, Units ________, _____________ 35,301,000

Toxin-Antitoxin (permanent immuniza-

tion)

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

19,555 c.c.

Schick Tests for Diphtheria____________________ 11,250

Silver Nitrate for Babies' Eyes, Ampules 20,106

Carbon Tetrachloride for treatment of

Hookworm -------------------------------------------------- 19,280 Tetanus Antitoxin, Units____________________________ 174,500

Smallpox Vaccine ___________ ---------------------------- 22,020

1926
2,162 243,629 c.c. 57,296,000
151,555 c.c. 7,650
23,345
16,500 739,000
54,820

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BACTERIOLOGICAL LABORATORY

Sputum examinations for Tuberculosis: Positive ---------------------------------------------------------N egative _________________________________:_____________________

1925 518
1'746

Total _____ ---------------------------- ______________
Throat swabs for Diphtheria: Positive -------------------------------- _______________________ N egative ____________________________

2264
252 1168

Total Weil Felix reaction for Typhus:
Positive ---------------------------------------------------------Negative --------------------------------------------------------

1413
5 3

Total ---------------------------------------Widal Tests for Typhoid and Paratyphoid:
Positive ------------------------------------------------ _________ Negative --------------------------------------------------------

8
252 1329

Total ---------------------------------------------Blood Cultures for Typhoid and Paratyphoid:
Positive _____________ -------------------------------------------Negative --------------------------------------------------------

1581
40 230

Total ----------------------------------------------

270

Stool and Urine Cultures for Typhoid Dysentery

Group:

Positive ---------------------------- ----------------------------

21

Negative --------------------------------------------

217

Total ----------------------------------------------

238

Pus Smears for Gonococci:

Positive ----------------------------------------------------------

265

Negative --------------------------------------------------------

608

Total -------------------------------------Blood Smears for Malaria:
Positive ---------------------------------------------------------Negative --------------------------------------------------------

873
62 1667

Total __________ -------------------------------------Feces for Intestinal Parasites:
Positive

1729 2511

13

1926 436
1638
2074
579 2492
3071
5 9
14
252 1247
1499
92 339
431
21 204
225
261 629
890
13( 1763
1893
1610

Negative --------------------------------------------------------

4942

2513

Total -----------------------------------------------Animal Brains for Rabies:
Positive ---------------------------------------------------------Negative _________________________:______________________________

7453
424 486

4123
353 472

Total ------------------------------"---------------

910

825

Miscellaneous

363

325

Totals for Year ----------------------------------------------------------- 17,102

SEROLOGICAL LABORATORY
Specimens of Blood for Wassermann test: Positive __________ ----------------------------------Negative -------------------------------------------------------Doubtful -------------------------------------------------------Anticomplementary ------------------------------------

1925
3963 18187
74 102

15,370
1926
5758 20338
89 122

Total __ -------------------------------------------
SUMMARY Bacteriological Laboratory __ ------------------------------------Serological Laboratory ----------------------------------------------

22326
17102 22326

26307
15370 26307

Total Total Water Samples for Year____________________________

39428 6562

41677 6608

Grand Total ------------------------------------------

45990 48285

ANIMAL HEADS EXAMINED FOR RABIES

1922 Number heads examined _____________________1,224 Number positive for Negri bodies ___ 487
Percentage positive for Negri bodies 39.7

1923 838 423 50.4

1924 1,038
509 49.0

1925 910 424 46.5

1926 825 353 42.7

As evidenced by the heads examined for rabies and by the number of antirabic treatments, the incidence of the disease among animals seems to have declined since 1924. We are hardly justified in attributing this to prophylactic vaccination of dogs, although this may prove to be an important factor in course of time.

14

LABORATORY IDENTIFICATION OF MOSQUITO
LARVAE
Several consignments of anopheline mosquito larvae were submitted for identification. A total of 300 larvae were identified and reported to the Sanitary Engineer. Plans are under way for a much mort>. extensive application of this phase of malarial control. By the Russell method it is very easy to determine what species of ano phelines are present in any given location. Thus control measures can be concentrated only on those breeding places where Anopheles Quadrimaculatus is found.
WIDAL TESTS FOR TYPHOID AND PARATYPHOID
There is developing among public health laboratories generally the feeling that the ordinary Widal test performed on dried drops of blood submitted on glass slides and bits of paper is not sufficiently reliable. As supplementary procedure it will always be useful and by no means should it be abandoned. We feel that not only should the technique of the test be carried out along more scientific lines, but that it should be augmented by the blood culture.
We are, therefore, recommending to the physicians that all specimens from suspected typhoid or similar conditions be submitted in liquid form, preferably in the ordinary Keidel Tube such as is used for the Wassermann test. From such specimens we can make a more accurate agglutination test and also a blood culture.
TYPHUS FEVER-(BRILL'S DISEASE)
It is time public health authorities were beginning to take note of the increasing prevalence of Brill's disease, which, according to K. F. Maxcy of the U. S. Public Health Service (see December 4, 1926, U. S. Public Health Bulletin) is in endemic form in the Southeastern United States. From laboratory standpoint this disease can be easily diagnosed by means of the Weil Felix test, quite similar in technique to the Widal test for typhoid. Brill's disease may easily be mistaken for typhoid, especially by physicians not familiar with the finer details of differential diagnosis. It is probable that true Brill's disease is often overlooked, and we hope to
15

show that a routine Weil Felix test on all specimens submitted for typhoid will prove to be of considerable assistance to the medical profession.
Therefore, as a supplementary routine procedure, we are instituting the Weil Felix test along with the improved Widal and the blood culture for typhoid, making all three tests on all specimens of liquid blood submitted.
SCARLET FEVER PRODUCTS Scarlet fever toxin (Dick) for susceptibility testing and for immunizing purposes and also scarlet fever antitoxin both preventive and curative have been added to our stock of biologicals. The demand so far has been insignificant owing to the novelty of these products. In October a small outbreak of seven cases of scarlet fever occurred in the State Institution for the Deaf at Cave Spring. We supplied the medical officer there with forty preventive packages of antitoxin which was administered to those inmates who gave a positive Dick skin test. No further cases occurred, but we are hardly justified in attributing the cessation of the outbreak tq antitoxin, but the results were sufficiently encouraging to warrant further trial.
REMODELING OF LABORATORY QUARTERS BADLY NEEDED
While the activities of the laboratory as a whole continue to show a steady increase, we cannot expect to keep apace with the rapidly increasing demands being made upon it until better and larger quarters, additional apparatus and larger operating budget are provided. The need of a thorough remodeling and rearrangement of our present quarters is becoming very acute, and it is hoped that some provision will be made by the next Legislature to this end.
16

DIVISION OF SANITARY ENGINEERING
L. M. Clarkson, Director
It is gratifying to look over the activities of the past two years and note the volume of routine work, the increased demand for service; and the cooperation given the Division, resulting in improved sanitary conditions throughout the State.
The principal activities of the Division may be brieflly summarized as follows:
Examination, approval, and filing of plans, specifications and maps of public works.
Furnishing plans and specifications for private works and institutions serving the public.
Advice to those in charge of public and private works in connection with construction, maintenance and operation. Bacteriological examinations of public and private water supplies. Chemical analyses, inspections, recommendations and supervision.
Municipal surveys and supervision of mosquito eradication and malaria control.
Regulating impounding waters in connection with malaria control and many other engineering duties connected with sanitation.

SURVEYS

1925

Water Works

136

Sewerage Systems, sewage disposal, sanitary privies 22

Swimming Pools ~---------------------------------------------------------------

3

Malaria -------------------------------------------------------------------------------- 124

Shellfish __________________ ---------------------------------------------------------- 4 Conferences in Field _________________________________________________________ 12

General

1926
188 15 7 79 0 14 13

Total ------------------------------------------------------------------------------------ 301 316

Literature, Plans and Specifications, Bulletins, etc., were distributed during 1926 as follows:

Mosquito Bulletins ---------------------------------------------------------------Privy Bulletins ---------------------------------------------------------------------Plans, Specifications Septic Tanks____________________________________ Plans, Specifications Septic Privies__________________________________
Miscellaneous ------------------------------------------------------------------------

1929 1930
39 44
781

Total

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

4723

17

WATER SUPPLIES
During the period of this report most of the water supplies of the S~ate were inspected on two or more occasions. Water works inspection co-ordinates with bacteriological examination and chemical analysis, consequently the necessity for inspection increases with laboratory examinations. Furthermore, with the inauguration of
annual certification of water supplies, beginning with the year 1926,
the necessity for more frequent and thorough inspection will result. There are at the present time1 approximately 242 public water supplies in the State. This number is constantly growing. Of this number approximately 180, or 75 per cent, have bacteriological examinations made and are under the supervision of this Division. This list is being constantly increased by adding municipalities formerly not cooperating and those constructing new plants. The goal of the Division is to eventually place on this list every public water supply in the State.

TABLE No.1

Table Showing Distribution of Bacteriological Examinations

Made in 1926. Municipal Water Supplies _____________________ ----------------------------
Private Water Supplies -----------------------------------------------------Swimming Pools -------------------------------------------------------------------Sewage ________________ -------------------------------------------------------------------

5994 458 136
14

Total _____________________ ------------------------------------------------------------------ 6602
TABLE No.2
Showing Number of Public Water Supplies Certified; Not Certified; and Not Cooperating With State Board of Health.
Public Water Supplies Certified for 1926_____________________________________________ 89 Public Water Supplies not Certified, due to insanitary conditions
or defective plants; failure to meet bacteriological standards, or to having submitted too few samples for examination to be .entitled to certification -------------------------------------------------------------------------- 90 Public Water Supplies giving no cooperation to State Board of Health in submitting samples for bacteriological examination____ 63 Total Public Water Supplies in Georgia________________________________________________242

18

TABLE NO.3.

Comparison of Laboratory Work by Years June 1, 1910-December

31, 1926.

Bacteriological

Chemical

Total

Year

Analyses

Analyses

Analyses

1910 -------------------- IS2______________________ I 06_____________________ 258

1911 -------------------- 2 72 ---------------------- 25I______________________ 523
1912 -------------------- 276______________________ 23 6---------------------- 512

1913 -------------------- 278---------------------- 252 --------------------- 530
1914 -------------------- 116______________________ 76______________________ 192

1915 -------------------- 398______________________ 9 7---------------------- 495 19I6 -------------------- 37I ______________________ 4I______________________ 4I2

I917 -------------------- 250______________________ 13---------------------- 263

I9I8 -------------------- 322 --------------------- 36 --------------------- 358

19I9 -------------------- 48 7---------------------- 68---------------------- 55 5 1920 -------------------- 970---------------------- 47______________________ I,0 I7

I921 -------------------- 2' 780---------------------- 54---------------------- 2'834 1922 -------------------- 3, I 06______________________ 134---------------------- 3:240 I923 -------------------- 4'993---------------------- 22______________________ 5,0 IS

1924 -------------------- 5'776---------------------- 18 --------------------- 5'794

I925 -------------------- 6,559----------------------

3---------------------- 6, 562

1926 -------------------- 6, 602 ---------------------- ---------------------------- 6,602

PROGRESS OF MALARIA CONTROL

Previous to the year I923 when an additional engineer was added to the personnel there had been requests from many municipalities for engineering assistance in simple mosquito nuisance problems and consequently before more important malaria work was started it was necessary to clean up all such minor problems. The result of this first work is that sanitary inspectors for municipalities have been educated to handle pestiferous mosquito problems as well as minor malaria problems. During the period from July I, 1923, to January I, I926, the whole State was covered thoroughly by making surveys of the municipalities, getting mosquito control work unde_r way through the training of municipal sanitary inspectors and segregating pestiferous mosquito problems from malaria problems and then following a general course of giving preference to the sections of the State where malaria is prevalent. County health officers were rendered assistance wherever the Divis.ion of Sanitary Engineering could serve any particular purpose.
During the years 1925 and I926 hydro-electric development attained considerable progress throughout our malarious section of the

19

State, also sentiment in favor of drainage districts increased. The formation of several large drainage districts has been gotten under way through this Division and though the progress is slow we believe that in time several drainage districts of considerable magnitude will be formed in the southern part of the State.
It has been necessary to enact impounding water regulations to protect the people in certain localities against malaria infection. Considerable difficulty has been experienced in connection with enforcing such regulations, consequently, impounded water projects have been handled under considerable difficulty, but in the best way possible to get results through cooperation from promoters of such projects with little friction and without legal entanglement. There are at the present time either in operation or contemplated about six-hydroelectric developments in the malarious sections. Three of these pmjects are in operation and have complied with our regulations regarding impounding of waters; the other three have expressed a desire to cooperat(1 with us. During the past two years impounded water problems have required most of the attention from the Division and service to municipalities has been rendered only to those where malaria is a problem." It may be said in conclusion that from year to year the more important malaria problems are requiring practically all of the attention from the engineering personnel and the minor mosquito problems having no influence upon public health are being eliminated independent of the State Board of Health due chiefly to the training of municipal authorities and sanitary inspectors to handle their own problems.
20

LOCALITIES OF INSPECTIONS AND ASSISTANCE RENDERED IN MOSQUITO ERADICATION AND MALARIA CONTROL WORK, 1926.

Adams (Lee Co.)

Chipley

McRae

Albany

Claxton

Macon

Americus (Sumter Co.) Columbus

Moultrie

Aragon

Cordele

Newnan

Bainbridge (Decatur Co.) . Ellaville

Newton

Baker County (Power Co.) Fitzgerald

Oglethorpe

Bartlett's Ferry (Power Co. Fort Benning

Rockmart

Blackshear

Fort Gaines

Rome'

Blue Ridge

Gainesville

Smithville

Blue Springs

Georgetown

Statesboro

Boston

Greenville

Toccoa

Brookton

Hazlehurst

Valdosta

Butler

Helena

Vidalia

Calhoun County (Drainage Jesup

Vienna

Cartersville

District) Kingston

Waynesboro.

Cedartown

Liberty Co.

(Drainage Dist.)

21

DIVISION OF CHILD HYGIENE
Joe P. Bowdoin, M. D., Director.
The work of the Division of Child Hygiene for the past two years has been continued and has further developed the program adopted in1924. The work of training mothers to care for themselves during pregnancy and after birth and to protect the health of the infant has shown a marked increase. Health education has been brought to the people through the following methods:
1. Mothers' classes conducted by county and city public health nurses, by State Board of Health nurses, and through the cooperation of the State Extension Department of the State College of Agriculure, State Department of Education, Womens' Clubs, P. T. A., and individual members.
2. Child Hygiene Conferences and Health Centers. 3. Lectures, Radio Talks and wide distribution of child hygiene literature.
4. Little Mothers' Leagues.
In February 1926 the second edition of our Georgia Baby Book was issued-indexed and ilrustrated. Thirty thousand copies were printed and this supply will last--over a year. It has been received very favorably by physicians and the laity.
Monthly letters have kept the Division in touch with nurses and midwives.
Each physician m the State was sent a copy of "Prenatal Cart'' and "Child Care" early in .1926. This literature was accompanied by a letter in which attention was called to the necessity of a physician having charge of all expectant mothers from the beginning of pregnancy.
MAY DAY PROGRAM
Through the cooperation of the American Child Health Associ~ tion a very extensive May Day Program was put on last year. Mrs. C. A. VerNooy, of Athens, acted as Chairman of the May Day Committee. Plans for 1927 were carefully prepared, and included the following objectives:
22

"Each community to have an active May Day Committee, representing organizations interested in Health education and Welfare.
Each baby on reaching six months of age to be given Toxin-Antitoxin' to prevent diphtheria.
Each child to present birth, medical, dental and vaccination certificates on entering school.
Each county, either singly or in combination with other counties, to have a Commissioner of Health, Public Health Nurse as provided by the Ellis Health Law, and to have a Demonstration Agent.
Each citizen to know of reduced rates on railroads and hospitals for treatment of indigent children. Arrangements to be made through the State Board of Health, Atlanta, Georgia.
Each citizen to know that but 3c per capita is appropriated by the Legislature for health activities for all citizens of Georgia. A progressive program of health conservation calls for an adequate appropriation to our State Board of Health. We must appreciate that the absence from school, because of preventable illness or physical defect, is a large item of waste in school administration, and that health for our entire State is to be had through a reasonable expenditure of money. Full enjoyment of good roads, good schools and good churches depends upon good health."
TEACHERS' NORMAL COURSES
A thirty lesson course, prepared with the aid of the Georgia Tuberculosis Association, was given to the thirteen teacher's normal schools during the summer months. This Department furnished the lessons and material, and the Department of Education furnished the teachers to present this course to at least three thousand school teachers. This lesson course will be published in the State School Items by the Department of Education, and will reach practically every school teacher in Georgia.
MIDWIFE TRAINING
To safeguard the mother during confinement, work of raising the standards among mi4wives in the State has gone forward as rapidly as possible. When the rules and. regulations for midwives were adopted in January 1925, a plan for reaching the midwives was outlined. This plan called for contacting the physicians and le~ders,
23

white and colored, in each community, and laying before them the plans for giving better obstetrical care to women in rural districts. Direct contact was made with the midwives registered and their help solicited in locating the women practicing surreptitiously. Through the help of doctors, lay people and midwives, practically every midwife in the county visited was located.
The best results in getting the right sort of midwives in the rural districts, where doctors are hard to get, will be obtained when that part of the public which is dependent on the services of midwives, is educated to the importance of demanding only those who are trained for this work. This, with the education of the midwife will automatically eliminate the unfit and leave the field open .for the ones who recognize the importance of being prepared for his branch of service.
During the two years 48 counties were visited for midwife instruction. A total of 158 classes were conducted and 1,019 midwives received certificates. In the counties visited, 997 midwives were registered in the Bureau of Vital Statistics. When the work was completed 1,829 had been located-over fifty percent more than were registered.
SHEPPARD-TOWER NURSES
It has been the policy of this Division to, in some way, match the Federal Sheppard-Tower funds that have been allotted to Georgia. We have no fu.nds that can be spared from the general appropriation to the State Board of Health. The special appropriation of $5,000.00 annually is the only State money received toward matching the annual Federal allotment of $24,530.55. In 1926 we were able to obtain all the Federal funds allotted to us. by getting counties and individuals to match the funds. During 1926 we had three new counties added to our list: Thomas, Peach and Burke. These nurses were installed and instructed by our staff nurses, and they give promise of doing splendid service. Two of them are negroes, those in Thomas and Peach, the latter being a part-time nurse. In two of the counties, Burke ,and Peach, there is no other public health work being dune. It is hoped that the demonstration may be instrumental in securing the enactment of the Ellis Health Law. There are now maternity and infancy nurses in Richmond, Chatham, Muscogee, Bibb, Clarke,
24

DeKalb, Fulton, Burke, Whitfield, Dougherty, Thomas and Peach counties. Most of the Federal allotment for 1927 has been matched. Unfortunately Congress has repealed the Sheppard-Towner Act effective June 30, 1929.
DIPHTHERIA IMMUNIZATION
One of the most successful campaigns ever inaugurated by the State Board of Health was that for the immunization of children against diphtheria carried on during the fall months in cooperation with the Georgia Pediatric Society, and the Georgia Congress of Parents-Teachers. The Division furnished free of charge 76,555 c. c. of Toxin-Antitoxin. This of course stimulated the desire on the part of the people to have their children immunized from other sources, and we estimate that approximately 100,000 children were given permanent protection against diphtheria as a result of this campaign.
REDUCED HOSPITAL CHARGES
For the past ten or fifteen years health authorities of the country have stressed the medical examination of school children and pointed out to the parents and communities the enormous number of physical defects and handicaps school children really have, but until recently very little has been done to correct the defects on a systematic basis. Clinics have been held more or less spasmodically throughout the State for the past few years. In counties where they have no health authorities to make provisions for the correction of physical defects the people have been at a loss to know how to go about securing such serv1ce.
Fortunately arrangements have been made with twenty-seven hospitals throughout the State to take chiltlren that have physical defects and are unable to pay the regular prices to have all the correctio;1al work done for a maximum charge of $7.50. The railroads have cooperated by granting half-fare rates for such children to and from the hospitals. With this arrangement there is no excuse for any child in the State of Georgia having a physical defect of any kind to go uncorrected. It only remains for us to reach these children and get them into the hospitals. We have never seen a finer spirit than wa~ manifested by the ~ospitals and railroads in agreeing to co-operate with us. Some of the hospitals that were not included in our original list have written asking. to be put on the list of those willing to cooperate.
25

DIVISION OF MATERNITY AND INFANCY
Activities of 15 permanent city or county nurses and 4 staff nurses during 1926.
1. ALL VISITS:
Nursing Care Visits-Total ---------------------------------------------- 13,020 Babies (under 1 yr.) ------------------------------------ 3,805 Preschool children (1-7 yrs.) ------------------------ 2,217 School children ( 7-16 yrs.) ________________________ 808 Adults (16 yrs. and over) ---------------------------- 6,192
Instruction or Demonstrations-Total ------------------------------ 18,947 Babies (under 1 yr.) ------------------------------------- 6,279 Preschool children ( 1-7 yrs.) ------------------------ 3,581 School Children ( 7-16 yrs.) ____ _____________________ 641 Adults ( 16 yrs. and over) ---------------------------- 2,550
Prenatal ------------------------------------------------------------ 5,896 Investigation Visits-Total -------------------------------------------------- 3,751
Babies (under 1 yr.) ____________________ _________________ 1,047 Preschool children ( 1-7 yrs.) ------------------------ 549 School children ( 7-16 yrs.) __________________________ 275 Adults (16 yrs. and over) ------------------------------ 661 Maternal ------------------------------------------------------ 1,219 Miscellaneous Visits ---------------------------------------- _____________________ 3,204 Visits to Schools ---------------------------------------------------------------------- 857
TOTAL OF ALL VISITS ---------------------------------------- 3Q. 770

~. CONFERENCES NURSE CONDUCTED OR

ASSISTED WITH:
1. Tuberculosis 2. Dental 3. Surgery 4. Prenatal:
Complete Urinalysis 5. Preschool 6. Infant Care No. treatments given to above Corrective Work

No. Clinics
224 318 197

No. Patients Attending
35 459
91 5,026 3,327 5,836 3,931 5,989
646

26

3. DEMONST~ATIONS:
Home Nursing Infant care Maternity outfits Food preparation

897 1,115
838 349

TOTALDEMONSTRATIONS

3,199

No. New Classes

4. CLASSES

Organized

Home Hygiene and Care of Sick

95

Little Mothers' Leagues

239

Midwife Classes

241

Mothers' Classes

39

No. New Pupils
Enrolled
1,438 4,349 2,198
601

614
5. Talks Given (other than to school classes) News items in local newspapers Health exhibits arranged

8,586 316 140 64

27

HEALTHMOBILE ACTIVITIES

The healthmobile has visited 138 counties since it was put in operation in 1922, through the cooperation of the National Phi M u Fraternity, which purchased the equipment and paid for a new chassis and rebuilding in 1926.

May 4 to July 30, 1925-Counties visited: Peach, .Houston, Dooly, Crisp, Lee, Dougherty, Baker, Terrell, Sumter, Schley, and Macon.
August 9 to December 7, 1926-Counties visited: Taliaferro, Warren, McDuffie, Lincoln, Columbia, Richmond, Glascock, Washington, Wilkinson, Twiggs, Bleckley, Crawford, Butts, Upson, Meriwether, Fayette, and Clayton.

Number Health Talks Persons reached
Number Motion Pictures Persons reached
Number children examined Defects found
Doctors conferences with parents Nurses conferences on nutrition

1925 11 Counties (3 months)
80 6,360
33 3,232
862 530

1926 17 Counties ( 4 months)
124 9,540
242 8,455 2,561 4,936 1,405
325

Pre-natal Pre-school School Miscellaneous

LITERATORE DISTRIBUTED 1925
7,233 22,970 77,348
1,225

1926
3,961 19,400 62,053
703

Total

108,776

86,117

28

DIVISION OF VENEREAL DISEASE CONTROL
Joe P. Bowdoin, M. D. Director
During the past two years this Division has reached 24,682 people through the spoken word. These audiences have represented all classes, ages and sexes.
We have been invited by ministers, mothers, parent-teacher associations, physicians, nurses, schools, teachers, and almost every type of people to speak. In addition to the work done by our own office force we have had the benefit of expert lecturers, who have been well received. Miss Anne Jane Simpson, Regional Consultant of the U. S. Public Health Service, was loaned to Georgia for expert educational work. She devoted her time to women and girls, having spoken to 4,548 while in our state.
This year we have given the boys of our state special attention. The "Keeping Fit" campaign was in charge of Mr. H. E. Montague, who for many years has done splendid service in Y. M. C. A. work. Mr. Montag(le covered the boys' camps for us, giving the knowledge of keeping fit to 996 boys in all sections of the state. Many letters from scout masters and camp superintendents have asked for the work next season.
WORK AMONG NEGROES
Our colored people have not been neglected. We were fortunate in being able to secure from the U. S. Public Health Service Dr. Ralph B. Stewart as an educator for his race. Dr. Stewart covered Georgia in all sections, giving his address to 15,090 of our colored people. He met all the colored physicians in their medical societies and in their offices, giving them the benefit of his knowledge in the proper handling of their patients. I am sure that his contact with his people will be of great benefit to the work.
The Laboratory perhaps reflects the growth of the venereal disease work in our state more faithfully than any other index. In 1921 we did 12,931 Wassermanns; in 1922, 14,804; in 1923, 18,061; in 1924, 19,832; in 1925, 22,326; in 1926, 26,307. The day is not far distant when every physician will have a Wassermann on all of his patients, especially all expectant mothers and obscure diagnoses.
29

The use of the different arsphenamines has gradually increased also. This year we have furnished 37,788 ampules to our clinics and the physicians of our state; in 1921, five years ago, we furnished 24,603. The use of Keidel tubes also emphasizes the popularity of this department. In 1926 we distributed 28,696, an increase of 5,393 over the previous year.
Under the Rules and Regulations of the State Board of Health all midwives before they can secure a certificate must have a negative Wassermann and be free from all infectious and contagious diseases. We have been agreeably surprised at the number who are negative.
SOCIAL HYGIENE MEETINGS
Several social hygiene meetings and conventions have been held in the state this year, the American Social Hygiene Association having held a regional meeting in Atlanta in November, which was well attended.
The newspapers of the state have continued to be cooperative. We prepared and sent them 3,090 columns of plate matter besides several special articles.
In November it was decided to issue a quarterly bulletin. It has been seven years since our last publication, "Healthology" was discontinued. We changed the name to "Georgia's Health", retaining the age of our other publications, starting with ""X:ol. No. 1, November 15, 1926. It has been admitted to the mail as second class matter, "Georgia's Health" should be illustrated and be a monthly, with not less than eight pages.
We have been accorded the privilege of broadcasting our health program by the Atlanta Journal Radio Station, WSB. Through this source it is estimated that we had an audience of 400,000.
STATE PRISON SURVEY
We received a request from the State Prison Board to make a survey of the prison camps of the state as to venereal diseases and what was being done by the prison physicians for the unfortunates. The reports received were carefully studied, tabulated, and a report made to the Prison Board.
During the year we have addressed several communications to all of the Health Officers, and have sent them various forms and pamph-
30

lets. To both county and city offi<lials we sent a copy of the magazine, "The Survey", which contained a most interesting discussion of venereal disease.
The usual clinic for venereal diseases was held by Emory University. We cooperated with them, and the week was well spent by the 180 physicians who attended.
NEW CLINICS NEEDED
The seven venereal disease clinics are all doing good work. The reports to this office have been promptly made and in turn all our reports to Washington have gone in on time. This would not be possible were it not for the splendid work of our clinicians in the different cities. In this connection would suggest that we need a few more clinics in new territory, and in the present area covered we need night clinics for working people. These clinics would be self-sustaining; in fact, could be so conducted as to have a margin of profit.
The State Medical Association at its annual meeting passed resolutions favoring legislation to safeguard marriage relation, and appointed a committee to draft a bill. At the request of the committee this Division has corresponded with all of the Attorney Generals of the nation, who has gathered and compiled information on which Georgia can have a taw that will embrace the best of other laws.
Through the cooperation of the State Board of Health with the Department of Education the Teachers' Institutes were visited by
members of the State Board of Health. We distributed quite a number of copies of the pamphlet, "The Problem of Sex Education in Schools."
During the year we have had 736 prostitutes under quarantine in the State, but little has really been done for them or with them. Georgia needs some sort of institution for rehabilitation as well as treatment for this unfortunate class. It is one of our greatest problems.
The physicians of our state are not reporting their venereal diseases as they should; very few, comparatively speaking, do report; why, I do not know. There is no violation of professional ethics or secrecy m reporting these cases by number.
31

LlTE.RATURE DISTRIBUTED
We have distributed venereal disease literature to the number of 4,518 pamphlets in 1925 and 7,460 pamphlets in 1926. The card exhibits have been used, as in the years p_ast, and moving pi~tures have been shown. It is out of the question to estimate the actual number of people reached with this materiaL
The cooperation of the Division of Maternity and Infancy has assisted us in the manufacture and distribution of 23,098 ampules of silver nitrate for babies' eyes, a preventive of blindness from gonorrhea. Under our laws every baby born must have 1% solution of silver nitrate put in the eyes.
The Division has had valuable cooperation from physicians, the U. S. Public Health Service, The State Department of Education, superintendents of schools, state universities, Parent-Teacher Associations, Women's Clubs, W. C. T. U., League of Women Voters, missionary societies, civic organizations, clubs of different kinds, and a host of individuals. They are responsible for much that has been accomplished.

SUMMARY OF VENEREAL DISEASE CONTROL WORK

1925-1926.

1925
Syphilis -------------------------------------------- 6,443 Gonorrhea -------------------------------------- 6,214 Chancroid ------------------------------------------ 356 A rsph enamine ---------------------------------- 33,672 W assermanns ---------------------------------- 32,532 Smears ---------------------------------------------- 1,974 Detention _________________________________________ 468 Pamphlets ________________________________________ 4,518
Lectures -------------------------------------------- 16,891 Films ____________________ -----------------------
Clippings ____________ . ------------------------ 210

1926 5,256 4,108
334 37,788 38,588
1,376 736
7,460 7,791
819 194

32

STATE TU'BERCULOSIS SANATORIUM Edson W. Glidden, Superintendent
The waiting list has been heart rending. For the entire year-it has never been lower than 100 and most of the time above 125. The female waiting list has been larger than the male, which is the reverse of our experience heretofore. Every effort has been made to hold no beds vacant ,but to refill them as quickly as they are vacated-even this promptness does not seem to cause any reduction in the number on the waiting list.
It pains me to recall to you that there are women on the list at present who have been waiting since August-we are still five months behind. There is no need to remind you that five months is a terrific loss of time, and many die while waiting their turn for admission. You are already aware of this, and we at this end have with you made every effort to inform the legislature of these facts. The broadcasting of the news that a new Sanatorium is in process of construction has only served to increase the number and urgency of requests for immediate admission of patients.
The legislature has failed to appropriate adequate funds for the maintenance of the old institution, and failed distressingly in making adequate provision for the maintenance of the new Sanatorium. Only $100,000.00 has been allotted to us for the year 1927, whereas a minimum of $210,000.00 is necessary to enable the public to receive the full benefit of the enlarged institution. I believe that could our legislators see for themselves the suffering, death and heart-aches, they would hasten to give the Sanatorium sufficient support.
33

STATISTICAL REPORT
1925 Number of Patients Reported on ---------------------------- 247 Number of Patients Not Tubercular --------------------- 8 Number of Patients in Sanatorium December 3 L__ 89 Total number of Patients Treated During Year____ 336 Hospital Days ----------------------------------------------------------3 3,062 Average Stay of Patients Reported on, Days__________ 123.23 Average Daily Census --------------------------------------------- 90.03

1927_
272
9 85 357 33,931 I
126.74 92.96

TABLE NO.1

AGE AND SEX OF PATIENTS

1925-

1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 Total

Male ________________ 1 20 49 32 14 12 1 1 130

Female ____________ 1 23 53 26 10 4 0 0 117

Total ________________ 2 43 102 58 24 16 1 1 247

1926-

1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 Total

Male ______:_________ 12 22 49 31 23 8 1 1 147

Female ____________ 4 27 44 32 16 2 0 0 125

Total ________________ 16 49 93 63 39 10 1

1 272

34

TABLE No.2

Counties From Which Patients Came

Appling ------------------------------ 3 Atkinson ------------------------------ 1
Bacon ---------------------------------- 2
Baker ------------------------------------ 1 8 aldwin -------------------------------- 3 Banks ---------------------------------- 1
Bartow .-------------------------------- 5
Ben Hill ------------------------------ 4
Berrien -------------------------------- 1
Bibb --------------------------------------23 Brooks -------------------------------- 1 Bullock -------------------------------- 1 Calhoun ------------"----------------- 1 Campbell ---------------------------- 1 Carroll -------------------------------- 1 Chatham ------------------------------ 8 Clarke ---------------------------------- 3 Clayton -------------------------------- 1 Cobb ------------------------------------ 4 Colquitt ----------------------------- 3 Cook ------"---------------------------- 2 Dawson ------------------------------ 1 Decatur ------------------------------ 1 DeKalb -------------------------------- 9 Dougherty __________________________ 1 Effingham __________________________ 2
Emanuel ---------'--------------------- 4 Evans __________________ -~-------------- 2
Floyd ---------------------------------- 1 Franklin ------------------------------ 2 Fulton ---------------------------------- 30 Glynn --------------------------------- 2 Green ---------------------------------- 1 Habersham -------------------------- 3 Hall ------------------------------------ 9 Haralson _______________________________ 2
Harris ---------------------------------- 2 Henry ---------------------------------- 3 Houston ------------------------------ 1 Jackson ______________ __________________ 1 Liberty ______________ _________________ 1

Lowndes ------------------------------ 1 Lumpkin. ------------------------------ 1 M aeon -------------------------------- 1 Madison ------------------------------ 3 McDuffie ------------"--------------- 4 Meriwether ------------------------ 1 Mitchell ------------------------------ 2 Montgomery ---------------------- 1 Morgan ------------------------------ 2 M uscogee ---------------------------- 17
Newton ------------------------------ 5
Oconee -------------------------------- 3 Oglethorpe -------------------------- 1 Paulding ------------------------------ 1 Peach ---------------------------------- 4 Pickens -----------------------------~-- 1 Pierce ---------------------------------- 1 Polk ------------------------------------ 1 Richmond ---------------------------- 8 Rockdale ---------------------------- 2 Screven -------------------------------- 1
Spalding ------------------------------ 5
Stephens ------------------------------ 1
Sumter -------------------------------- 5
Tattnall ______________________________ 3
Taylor -------------------------------" 1 Telfair -------------------------------- 1 Thomas ___ ___________________ _ 2
Tift _______ --------------------------- 2 Towns -------------------------------- 1 Troup ---------------------------------- 12 Turner -------------------------------- 1 Union ---------------------------------- 1 Upson ___________________ _______________ 2
Walker -------------------------------- 4 Walton -------------------------------- 4
Ware __________________ ________________ 5 Washington ________________________ 5
Wilkes _______ __________ __________ 2 Wilkinson ____ ________________________ 1
White ---------------------------------- 2 Whitfield ____________________________ 3

35

GEORGIA TRAINING SCHOOL FOR MENTAL
DEFECTIVES
John W. Oden, M.D., Superintendent
In response to a resolution passed by the General Assembly of Georgia at its 1918 session, the Ron. Hugh M. Dorsey, who at that time was Governor, appointed a committee to investigate and report such facts and figures as they might secure, and make recommendations as might seem suitable to relieve the State of the uncared for feebleminded. At the request of this appointed committee, the National Committee for Mental Hygiene furnished Dr. V. V. Anderson, as scientific advisor, who conducted the survey for the State committee.
Quoting from the survey made by Dr. Anderson, forty per cent of the inmates of the almshouses were feebleminded, and feebleminded families were found in the state that had been supported by church and organized charities for four or five generations.
A study of one orphanage showed that 28.7 per cent of the children were feebleminded. If the same percentage exists in other orphanages, then there are at least eight hundred and ten feebleminded children in orphanages who need special care and training in a school for the feebleminded.
Seventeen and five-tenths per cent of the male inmates of the state-prison farm were feebleminded, forty-two and eight-tenths per cent of the women inmates of the prison farm were found to be feebleminded. In two typical county jails examined, 34 per cent of the inmates were feebleminded, with a mental level of ten years or under.
Of one hundred and twenty-two immoral women examined, 43.5 per cent were found to be feebleminded. The present policy of treating these feebleminded girls for venereal disease and then turning them out into the community to acquire it over again is a costly one. Probably the greatest single factor in the spread of venereal disease is the feebleminded prostitute.
Of one hundred cases of juvenile delinquents studied in the juvenile court, 17 per cent were found feebleminded. Fifteen per cent
36

of the Fulton County ~eforn1'!-tory for boys were feebleminded, 24.1 per cent of the inmates of the State. Reformatory for Boys, and 27 per cent of the inmates of the 'Georgia Training School for Girls. It is these feebleminded delinquent children that later on become the chronic recidivists m our jails, adult criminal courts, and state prisons.
Finally 3.5 per cent of the children examined in the public schools were found to be feebleminded. These are the children who are to become the "grist" of our future courts, jails, reformatories, and the state prisons, and to form the very backbone of the vast and grim procession of paupers, criminals and prostitutes of tomorrow.
The General Assembly has appropriated but $25,000.00 annually from the opening of the institution until 1926, when the yearly allotment was increased to $35,000.00. From the beginning applications have been pouring in, each year the waiting-list becomes longer, and still no relief for the hundreds who are eagerly seeking admission.
Other states m the union are spending millions of dollars in the care of their feebleminded children. What is Georgia going to do for the most unfortunate class of her population? . Children who are in no way responsible for their condition, have no adequate place in the state to be trained and fitted, even in a small way, to take their place in society.
The institutional care and training of feebleminded has long since passed the experimental stage, the only question is: will Georgia handle the situation in a humanitarian and scientific way or pay for her terrible error in crime, prostitution, venereal disease, and almshouses, which are costing much more in dollars and cents aside from the human misery and wretchedness that these unfortunates suffer at the hands of those who are not acquainted with their condition and who are not in sympathy with their short-comings? It is a fact that no well informed person will attempt to contradict that many of the vicious and idle types of mentally defective children can be trained to be useful and hard working citizens.
Our sister states have far outstripped us in the humane care of their feebleminded children; the states in the East and North have
37

been for years caring f<>r their mentally defective population m a scientific and humanitarian manner.
When we review the history of the Georgia Training School for Mental Defectives at Gracewood, and realize that for six years it has groped along with an appropriation scarcely enough to pay the necessary employees, and maintenance for the children, we can see at once why it has been necessary to have three superintendents within this short time. It is impossible for the State of Georgia or any other state to keep in its employ competent and conscientious workers when they are not given support in the work that they are undertaking. It has been impossible, up until this year, on account of the lack of proper financial circumstances to increase the usefulness of the institution. When your present superintendent came to the training school in April, two of the buildings were in such bad condition that he deemed it wise from a standpoint of sanitation to move the children out of them.
During the past six years close to a thousand applications have been made for admission, and several hundred continue on our waiting list. The parents, guardians, superintendents of orphanages, reformatories, and different charitable organizations over the state, are waiting eagerly for an opportunity to be relieved of their great burden, but the only opportunity they have for admission is when a child is discharged or a death occurs. You can see at once that little impression has been made on our waiting list when you realize that the period of training is necessarily very long and only three deaths have occurred since the opening of the school six years ago.
In a few instances we have been able to follow up some of the cases who made application at the beginning of the school and could not be received on account of the financial and crowded condition of the institution. Several of the girls are living the lives of prostitutes, two girls have borne illegitimate children, a number of these feebleminded girls have married (probably feebleminded men) of course to bear more feebleminded children, several boys are at present doing time on the chaingang, one boy has served two sentences at the state reform school at Milledgeville, and I understand
from the superintendent, Mr. W. E. Ireland, that he has several
feebleminded boys in his institution at present that should be transferred to us. The Georgia State Hospital for the Insane at Mil-
38

ledgeville is caring for a great number of this :mentally defective class, and should be relieved of this burden so their places could be taken by those that are mentally sick.
IMPROVEMENTS
We were handicapped this year on account of a deficit that was brought over from 1925, but regardless of this, numerous substantial improvements have been rnade. We have lived within our means, closing the year without a deficit and have met every obligation when due; two of the buildings have been repaired, new sewerage, increased bathing facilities, new plastering put on, the electric wiring has been gone over and is at present controlled by switches in the matrons' rooms instead of having it open into .the main dormitories. These buildings present a very attractive appearance, new hospitals beds, new mattresses, and bed-clothing have been purchased for them, and we are using these buildings for our higher-type boys and girls, making them more comfortable and getting them away from the lower grade cases. By doing this we have also been able to increase our population.
We have completed steam heat in building No. 5 used for lowergrade boys, formerly this two-story building was heated by one stove. It is much more comfortable and certainly less dangerous to the children that will occupy it. We have also increased bathing facilities, have put in some new sewerage from it and expect to complete repairs within the next thirty days.
A new reservoir, holding about four thousand gallons of water, has been installed, giving us at present a fairly adequate supply for the number of children that we can accommodate.
Some new fencing has been done around the barns, this was absolutely necessary to keep our stock off of the neighbors' premises.
On the east end of building No. 11, a garage has been built to take care of the state's automotive equipment.
A tar composition roofing was put on top of all the buildings shortly before April 1st, but this has proved unsatisfactory as practically all of the buildings continue to leak.
39

A dining room for the employees has been equipped, this I deem a very necessary expense when we-, realize the long hours that the employees are in constant touch with the children, some of whom are very destructive and untidy, feeling that for short periods at least they should be away from their charges.
A bath room, toilet, and sleeping quarters have also been added for the use of a senior medical student from the medical department of the University of Georgia, who at present IS relievi~g me of some of the medical work.
Two new sewing machines have been added to our equipment.
Until May 1st, two colored women with some of the girls were doing the laundry work, this expense has been cut in half by having the laundry done in Augusta in the form of a wet wash ironed by the girl inmates.
ENTERTAINMENT
While I believe that the institution has been run smce April 1st as economically as it is possible for it to be done by any one, I have not forgotten the fact that defective children need and deserve much recreation and pleasure. With this in view, we have given them picnics, wieher roasts, truck rides, and on a few occasions during the summer some of the higher-grade cases have had swimming parties.
This does not include the numerous entertainments given by the different social organizations of Augusta and Richmond County, all of which have been of the highest type and much appreciated. I would like to acknowledge with sincere thanks the cooperation that the people of Augusta and Richmond County have given me since I have been superintendent of the school; they are in touch with the situation at Gracewood, are highly interested in the work that we are trying to do and are working for a greater and better training school for the mentally defective children of the state.
FARM, GARDEN AND DAIRY
It is with a degree of satisfaction that I am able to report that our farm and dairy have shown a substantial profit for the year; we have had a bountiful supply of all kinds of vegetables and plenty
40

of milk to serve our children every day, and we are looking forward to a better year in 1927.
There are practically no fences on the place, it will be necessary to have these replaced before the farming situation can be handled more economically and scientifically.
We are at present preparing about ten acres of land near the school for over-head irrigation, but when or where we will get the money for this much needed improvement, I am unable at present to state.
During the year it has been necessary to employ two colored men to assist with the farm work. I hope eventually to get away from this and believe it can be done when the institution is larger and more high-grade boys are received that can be trained to do this class of work.
MEDICAL WORK The inmates of the institution continue to enjoy the best of health. We have had no epidemics and there has been no evidence of any nutritional diseases; all of the children have gained in weight with a very few exceptions. Two deaths have occurred during the past year, one from nephritis on February 3rd, and another from bronchopneumonia on October 2nd.
SCHOOL WORK The school has been in operation continuously except the month of September, when the teachers were given a vacation. Handicapped as we are, I believe that the work in this department compares favorably with any institution of its kind in the country.
41

GENERAL INFORMATION

1. On books of institution at beginning of institutional year: -
MalEl Females Total

In institution ----------------------------------

43

23

66

Away from institution___________________

0

0

0

Total

43

23

66

2. Received during year -----------------------------

13

6

19

3. Total on books during year _____________

56

29

85

4. Discharged:

A. Into community ________________________

9

3

12

B. To all other institutions ____________

0

0

0

C. Died---------------------------------------------

2

0

2

In institution at end of year_______________

45

26

71'

MENTAL STATUS OF FIRST ADMISSIONS AND

READMISSIONS

For year ending Dec. 31st, 1926.

1st

Total

Admissions

Mental Status

M. F. T. M. F. T.

Idiot

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

1

0

1

Imbecile -------------------------------- 31 13 44

101 30 13 43

Moron ------------------------------------ 13 13 26

13 13 26

(Exclude epileptics)

Total _______________________ 45 26 71 44 26 70

ReAdmissions M. F. T.
000 101 000
-- -
101

It is with pride that I refer you to the few discharges during the past year. Through social workers in different cities, and parents, we have been able to keep in touch with most of them; they are making good and in several instances are even assisting in caring for their families.

42

OUR NEEDS
If we are to function properly and do our best work for the most unfortunate class of individuals that the state has ever attempted to care for, we must begin at once to make preparations to take care of our waiting list and emergency cases. This will necessitate two new buildings for housing the increased population.
It is essential that we have a new school building, the one that is being used at present is beyond repair, uncomfortable and unsightly.
A shop for manual training is one of our greatest needs. I am sure that this addition would soon pay for itself if we were in a position to make our brooms, mops, chairs, repair shoes, and other things too numerous to mention.
A larger water supply and better sewage disposal will become essential as our population increases.
From an economic standpoint, we should have a central heating plant.
Arrangements should be made for a hospital building to care for our acutely sick. At present the University Hospital of Augusta, Georgia, is taking care of this feature of the work, but they cannot be expected to keep this up if the institution is enlarged as it should be.
A great saving could be made if a small ice plant was installed.
The farm should be fenced and cross-fenced, and silos should be connected with the dairy. We should have for immediate use, ten acres of over-head irrigation.
Trained field workers to investigate applications and follow up the discharged cases is another very important need.
Clinics in the larger cities and towns should be instituted for the study of the feebleminded, and advice given to parents as to the home care of their mentally defective children. Many cases in this way could be adjusted and returned to their homes thereby relieving the state of their institutional care.
43

INDEX
Members of State Board of Health ----------------------------------------------- 2 Directors of Division of State Health Department_______________________ 3 Division of County Health Work------------------------------------------------- 5 Bureau of Vital Statistics --------------------------------------------------------------- 9 Division of Laboratories ____________________ ------------------------------------------- 12 Division of Sanitary Engineering__________________________________________________ 17 Division of Child Hygiene ------------------------------------------------------------ 22 Division of Venereal Disease ControL____________ ----------------------------- 29 State Tuberculosis Sanatoriurn ------------------------------------------------------ 33 Georgia Training School for Mental Defectives------------------------- 36