Report of the Georgia State Board of Health for 1927 and 1928 [1929]

REPORT
OF THE
GEORGIA STATE BOARD OF HEALTH
FOR 1927 and 1928
ATLANTA, GEORGIA
(Table of Contents on Back Cover Page)

STATE BOARD OF HEALTH
Robert F. Maddox, President_ ___________________ Atlanta. James H. McDuffie, M.D., Vice-President ________ Columbus. C. L. Ridley, lYI. D. _____________________________ Macon. Arthur D. Little, M. D, _________________________ Thomasville. John W. Daniel, M. D. __________________________ Savannah. H. R. Carter, M. D, ____________________________ Madison. J. G. Dean, M. D. ______________________________ Dawson. 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. M. L. Duggan, State Superintendent of Schools, ex-
officio_____________________________________ Atlanta. J. M. Sutton, State Veterinarian, ex-officio_______ Atlanta. T. F. Abercrombie, M.D., Secretary, ex-officio _____ Atlanta.
STATE HEALTH DEPARTMENT
T. F. Abercrombie, M.D., Commissioner of Health. Joe P. Bowdoin, lYI. 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., Director, Division of County Health Work. Edson W. Glidden, M.D., Superintendent, State Tuberculosis Sanitorium,
Alto, Ga. John W. Oden, lVI. D., Superintendent, Georgia Training School for
Mental Defectives, Gracewood, Ga.
2

LETTER OF TRANSMITTAL
Atlanta, Georgia.
To His Excellency,
Ron. L. G. Hardman,
The Governor of Georgia.
Dear Sir:
The report of the State Department of Health for the' years, 1927 and 1928, is necessarily abbreviated since the demand of the volume of the work indicated in the report has stretched our meager appropriation to such an extent that we are unable to publish the usual details.
In spite of the fact that Georgia's state appropriation for public health (3 cents per capita) is lower than that of any other southern state, the work of the various divisions during this biennium has been exceptional. I desire to invite your especial attention to the serious condition in our laboratories where the amount of work has doubled in eight years, while the personnel of the staff has remained about the same. The work in the other divisions has greatly increased, 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 co-operation with us has made possible much of the work set forth in this report.
The reports of the divisions are set forth in the following order:
1. County Health Work. 2. Vital Statistics. 3. Laboratory. 4. Sanitary Engineering. 5. Child Hygiene. 6. Venereal Disease Control. 7. Malaria Control. 8. Tuberculosis Sanatorium. 9. School for Mental Defectives. 10. Financial Statement.
Respectfully submitted,
T. F. ABERCROMBIE, M. D.,
Secretary.
State Board of Health.

COUNTY HEALTH WORK
M. E. WINCHESTER, M. D., Director.
The one big aim of this division is to extend approval of the Ellis Health law to every county in the State. During the biennium ended December 31, 1928, seven new counties were added and arrangements made for the addition of two others in 1929. There now is a total of 31 counties in Georgia operating full time health units with a health officer and public health nurse.
We wish to impress upon the assembly the necessity for the establishment of a training school in Georgia for her health officers. This type of work, while demanding a physician of high calibre, is so vastly different from general practice that special trainjng is necessary for proper efficiency.
There are many counties desiring full time health units, but some of them feel that their income is insufficient to stand the expense. In these cases, we are endeavoring to establish a unit to cover several counties, usually two to four. Considerable interest is being evinced in this movement.
The value of full time health units in counties has been graphically demonstrated in the biennium through the reduction of the malaria death rate 42 percent in those counties where malaria does its worst work and where they have full time health units.
T,he matter of working for the betterment of community health is not a matter of "drives" and "health weeks" but a constant battling year in and year out with forces that sometime seem beyond control. Without expert advice, often the obvious is overlooked and many menaces to health are innocently allowed to exist, when the correction is easily made once attention is called to it.
We also wish to call attention to the reduction in the death rate from typhoid fever. The rate in 1928 was 13.9 per 100,000 of population in the state-the lowest in the history of vital statistics in Georgia. This result is traceable directly to the establishment of full-time county health units co-operating with the State Board of Health, and the never ending campaign for inoculation against typhoid fever. Only one county in the state with a full-time health unit had a typhoid epidemic in 1928.
The division in 1928 undertook one very interesting and worthwhile activity that will redound to the general good of the state. We conducted physical examinations of all student-teachers attending the summer schools in the health officer counties. Approximately 900 were examined in this campaign, resulting in the correction of a large number of defects.
The following statistical report will give a general idea of the work accomplished throughout the state in counties operating under the Ellis Health Law.
4

SUMMARY OF COUNTY HEALTH WORK FOR THE CALENDAR YEARS 1927 AND 1928

SERVICES

NUMBER

Increase (+) or Decrease (-)
II Over 1927

1927 11928 Number\ Per _ _ _ _ ,I_ _ _ _Cent

EdLueccattuiorensa_l_: ___________________________ Attendance __________________________
Literature Distributed _________________ Newspaper Articles ___________________

2982 147379 148619
909

CoCmamseusn_i_c_a_b_le__D__is_e_a_s_e_C__o_n_t_ro_l_:__________ 6197 Visits___________ - __ - ___________ -_--- 12171

Maternal, Infant and Preschool:

PrenatalNew Cases________________________ Home Visits ______________________

1934 7265

Midwives Instructed _______________ 3107

PostnatalNew Cases______________ - ________ Vi~ts ____________________________

1505 7625

Infant and Preschool:

Consultations With Mothers __________ 3323

Defective Cases Improved _____________ 755

School Children:

Examined_--_----_-------------- --- 75655 Defects Found _______________________ 56561 Follow-up Visits ________ - ____________ - 18630

Defective Cases Improved _____________ 11714

Immunizations:

Antityphoid Inoculations (complete) ____ 69559

Toxin-antitoxin Treatment (complete) ___ 21809

Protective Antitoxin __________________ 574 Curative Antitoxin ____________________ 281

Anti-smallpox Vaccinations _____________ 45127

Antirabic Treatments _________________ 318

Venereal Disease Control: New Cases Treated ___________________ 1434 Total Treatments_____________________ 26920

Hookworm Examinations________________ 9345

Sanitation:

Food-handlers and Dairy Employees Examined ___________ ------------- 3700
Insp~ctions- . Private prenuses _______________ - ____ 175225

Schools and Public Buildings_________ 1845

Dairies ____ -_---------------------- 4275 Market and Eating Places ___________ 14676 Complaints Investigated _____________ 3960

Nuisances Abated __________________ 8479

Sanitary Privies Installed____________ 2541

Privies Restored to Sanitary types ____ 1970

Laboratory: Specimens Examined__________________ 27619

Specimens Sent to State Laboratory ____ 3666

I

2921 i -61 -2.0

I 154456 +7077 +4.8

149772 1189

++1125830 I

+o.8 +30.8

16461 +10254 +165.5 21100 +8929 +73.4

3272 +1338 +69.2 12794 +5529 +76.1 2576 -531 -17.1

2926 +1421 +94.4 1R389 +10764 +141.2

4850 +1527 +46.0 1238 +483 +64.0

87265 +11610 61201 +4640 21058 +2428 14387 +2673

+15.3 +8.2 +13.0 +22.8

69760 20497
491 292 40276 223

+207
-1312 -83 +u
-4851 -95

+o.3 -6.0 -14.5 +3.9
-10.7 -29.9

3834 +2400 +167 .4 34828 +7908 +29.4 11868 +2523 +27.0

3300 -400 -10.8

214332 1644 3942 35895 29625 11871 1514 2261

+39107
-201 -333 +21219 +25665 +3392
-1027 +291

+22.3 -10.9 -7.8 +144.6 +648.1 +4Q.O -40.4 +14.8

59356 +31737 +n4.9 4939 +1273 +34.7

5

VITAL STATISTICS
BUTLER TOOMBS, Director.
The vital statistics presented in this report includes all births and deaths occurring in Georgia during 1927 and 1928 for which certificates have been filed with this bureau.
These statistics are valuable because they unerringly indicate the trend of the causes of death and make possible an immediate comparison of birth, death and infant mortality rates of Georgia with other states and foreign countries. They throw light on such matters as the extent to which the population of the state is increasing through excess of births over deaths, the relation between the birth rate and the rate of infant mortality, the ratio of stillbirths to live births, etc.
BIRTHS: The total number of live births registered in 1927 was 61,636, a rate of 19.4 per 1,000 population; for 1928 there were registered 59,228 births, a rate of 18.5 per 1,000, or a drop of 1.1 per 1,000.
DEATHS: The total number of deaths for 1927 was 31,869, a rate of 10.1 per 1,000 and for 1~28 a total of 36,085, a rate of 11.3 per 1,000, s!towing an excess in 1928 of 1.2 per 1,000.
INFANT MORTALITY: The total number of deaths under one year of age was 4,591 for 1927, a rate of 74.5 per 1,000 live births; for 1928 there were 4,977, a rate of 84 percent per 1,000 live births. This shows a.1 increase in infant mortality of nearly 10 percent between the two years.
Although provisional reports on birth rates for 1928 indicate a downward trend throughout the world, Georgia's rate, compared with 1926, shows such a big reduction that part of it is, no doubt, due to a falling off in registration. If such is the case, a vigorous campaign should be conducted during 1929 to prevent a continued laxity in registration, and to stimulate an interest and understanding in the value and importance of these records. It is essential that more field work be done if registration is to reach the state of completeness and correctness obtained in most of the other states.
6

TABLE 1.-POPULATION, BIRTHS AND DEATHS WITH RATES PER 1,000 POPULATION, INFANT MORTALITY AND STILLBlRTHS, BY COLOR: 1927 AND 1928.
-

Births and Deaths (exclusive of stillbirths)

! Infant Deatns
(under 1 year)

Stillbirths

Color

Population Estimated
as of July 1
I

Number
---1 Births Deaths

Rate Per 1,000 Population

I

Excess of

-

Births over

Births Deaths Deaths

YEAR 1927

-'1 TotaL ____ I3,171,0001 61,636 31,869

19.4

White_____ 1,935,800 39,294 16,231 20.3

Colored___ 1,235,200 22,342 15,638 18.2

10.1 29,767

8.4 23,063

12.7

6,704

Births Per 100
Deaths

Number
---1

Rate Per 1,000 Births

Number

Rate Per 100
Live
Births

i

-----

194

4591

74.5

3839

6.2

242

2335

59.4

1631

4.2

143

2256 101.0

2208

9.9

YEAR 1928

TotaL ____ 3,203,000 59,228 36,085

18.5

11.3 23,143

164

4977

84.0

3445

5.8

White_____ 1,965,200 37,081 18,642 18.9

9.5 18,437

199

2648

71.4

1322

3.6

Colored ___ 1,237,800 22,147 17,443 17.9

14.1

4,704

127

2327 105.2

2123

9.6

TABLE 2.-DEATHS AND DEATH RATE PER lOO,OOOPOPULATION, BY CAUSE OF DEATH AND COLOR: 1928

CAUSE OF DEATH

Number

Rate Per 100,000 Population

Total White Colored Total White I Colored

All Causes ________________ 36085 18642 17443 1126.60 948.60 1409.42

Tyfpehveorid___a__n_d___p_a_r_a_ty__p_h_o_i_d 444

182

262 13.86 9.26 21.16

Typhus fever ______________ Malta fever _______________

6 1

Malaria __________________ 582

2

4 0.18 0.10 0.32

1 -------- 0.03 0.05 ------- -

253

329 18.17 12.87 26.57

Small-pox ________________ Measles __________________

5 143

4 106

Scarlet Fever _____________ 36

29

1 0.15 0.20 0.08 37 4.46 5.39 2.98 7 1.12 1.47 0.56

Whooping COUf;h ___________ 163 Diphtheria________________ 240

99 177

64 5.08 5.03 5.17 63 7.49 9.00 5.08

Influenza (with pulmonary

complications) ________ c __ 1166 742

424 36.40 37.75 34.25

Infflieude)n_z_a_(_o_t_h_e_r_a_n_d__u_n_s_p_e_ci_- 875

462

Cholera nostras ___________

6

4

413 27.31 23.50 33.36 2 0.18 0.20 0.16

Dysentery ______________ -- 304 Erysipelas ________________ 31

189 28

115 9.49 9.61 9.29 3 0.96 1.42 0.24

Acute Poliomyelitis ________ 18

15

3 0.56 0.76 0.24

Lethargic encephalitis ______ 15

11

4 0.46 0.55 0.32

Meningococcus Meningitis__ 14

5

9 0.43 0.25 0.72

Other epidemic and endemic

diseases _________________ Anthrax __________________ Rabies ___________________ Tetanus __________________
Mycoses __________________

6 1
4 62
5

4

2

1 --------

3

1

23

39

3

2

0.18 0.03
0.12
1.93 0.15

0.20 0.16 0.05 ------0.15 0.08 1.17 3.15 0.15 0.16

Tuberculosis (total) ________ 2375 832 1543 74.14 42.33 124. 65

Of the respiratory system_ 2156 749 1407 67.31 38.11 113.66

Of the meninges, central

nervous system ________ 40

26

14 1.24 1.32 1.13

Ofnetuhme _i_n_te_s_t_i_n_e_s_,__p_e_r_it_o_-

65

15

50 2.02 0.76 4.03

Of the vertebral column __ 20

8

12 0.62 0.40 0.96

Of the joints____________ Of other organs__________
Disseminated (acute) _____ Disseminated (chronic) ___ S_yphilis __________________

12

6

36

12

43

16

3 -------

494 100

6 0.37 0.301 0.48

---~~~~I 24 1.12
27 1.34 3 0.09

1.93 2.1 8
0.24

394 15.42 5.08 31.83

Soft chancre ______________

2

1

1 0.06 0.05 0.08

Gonococcus infection _______ 25

7

18 0.78 0.35 1.45

Punrluiale_n_t__i_n_f_e_c_ti_o_n_,__s_e_p_t_ic_e_-

87

64

23 2.71 3.25 1.85

Cancer and other malignant

tumors (total) ___________ 1510 1013

Of the buccal cavity______ 55

43

'i:if 497

51.54 40.15

12

2.18 0.96

_OO_fftitthh=eensp=treoermi=ttoausncmhe~u,_,m_li_~v,_ee_r_i_=n___tc_e__e~__-~~~415~250~~==390-09-~--1-43=1 5~-14=:304~9=1450.1.~7527~~~1-21~..8329

8

Table 2.-Deaths and Death Rate Per 100,000 Population, By Cause of death and Color 1928 -Continued

CAUSE OF DEATH

Number

Rate Per 100.000 Population

Total White Colored Total White Colored
--

Ofgathnes _f_e_m__al_e__g_e_n_i_t_a_l _o_r_-
Of the breast____________ Of the skin ____________ -
Ofgoatnhse_r_o_r__u_n_s_p_e_c_if_i_e_d_o_r_-
Tufmieodr_s_,_b_e_n_i_g_n_a__n_d_u_n__q_u_a_li_-
Acute rheumatic fever ______ Chronic rheumatism, osteo-
arthritis, gout __________ -
scurvy ___________________
p ellagra __________________ R ickets ___________________ D iabetes mellitus__________ Anemia, Chlorosis _________ Digselaanseds___o_f__t_h_e___p_i_tu_i_t_a_r_y
Exophthalmic goiter_______ 0 tghlearnddi_s_e_a_s_es__o_f_t_h_e__t_h_y_r_o_id-
Digselaansedss_o_f__t_h_e__p_a_r_a_t_h_y_r_o_i_d
D iseases of the thymus gland D;seases of the adrenals ____
(Allison's disease) ___ - ___ Diseases of the spleen_ - ___ Leukemia _________________ H odgkin's disease __________ Alcoholism (acute or chronic) Chronic poisoning by organic
substances ______________
0E nt hceerphgaelnietirsa_l _d_i_se_a_s_e_s____________ Simple meningitis _________ Nonepidemic cerebrospinal
meningitis ______________
Taabteaxs iad) o_r_s_a_l_is___(_lo__c_o_m_o_t_o_r
Otchoerrd_d_is_e_a_s_e_s__o_f_t_h_e__s_p_i_n_a_l
Cerebral hemorrhage _______ Cerebral thrombosis and em-
holism________ --_------Pacraaulyssei_s__w__i_th_o__u_t__s_p_e_c_if_i_e_d
Gesnaenrea_l _p_a_r_a_l_y_s_is__o_f__t h_e__i_n_-

348 166 66
300
37 37
46 1 846 15 329 70
3 25
11
13 15
1 3 20 10 44
7 65 46 92
27
10
53 2369
25
522
54

188

160 10.86 9.56 12.92

116

50 5.18 5.90 4.03

56

10 2.06 2.84 0.80

211

89 9.36 10.73 7.19

12

25 1.15 0.61 2.01

21

16 1.15 1.06 1.29

17

29

1 --------

358

488

4

11

227

102

43

27

1.43 0.03 26.41 0.46 10.27 2.18

0.86 2.34 0.05 -------18.21 39.42
0.20 0.88 11.55 8.24
2.18 2.18

1

2 0.09 0.05 0.16

19

6 0.78 0.96 0.48

7

4 0.34 0.35 0.32

6

7

12

3

1 --------

3 --------

19

1

7

3

30

14

6

1

36

29

34

12

55

37

17

10

0.40 0.46
0.03 0.09 0.62 0.31 1.37
0.21 2.02 1.43 2.87
0.84

0.30 0.61

0.56 0.24

0.05 -------0.15 -------0.96 0.08 0.35 0.24
1.52 1.13

0.30
1.83 1. 73 2.79

0.08 2.34 0.96 2.98

0.86 0.80

7
32 1280

3
21 1089

0.31 0.35
1.65 1.62 73.96 65.13

0.24
1.69 87.97

17

8 0.78 0.86 0.64

250

272 16.29 12.72 21.97

28

26 1.68 1.42 2.10

9

Table 2.-Deaths and Death Rate Per 100,000 Population, By Cause of Death and Color: 1928.-Continued.

CAUSE OF DEATH

Number

Rate Per 100,000 Population

Total White Colored Total White Colored

Otthioernf_o_r_m_s__o_f_m__e_n_t_a_l _a_li_e_n_a_Epilepsy __________________
Convulsions (nonpue1"peral) (5 yrs. & over) __________
Infantile convulsions (under 5 years) ________________
Neuralgia and neuritis______ Softening of the brain ______ Other diseases of the nervous
system _________________
Dinseeaxsae_s__o_f _t_h_e__e_y_e__a_n_d__a_n_-
Diseases of the ear_________ Dicseesass_e_s_o_f_t_h_e__m__a_s_to_i_d__p_r_o_-
Pericarditis _______________
Endocarditis and myocarditis (acute) ____________ -_
Angina pectoris____________ Other diseases of the heart__ Aneurysm ________________
Other diseases of the arteries Embolism and thrombosis
(not cerebral) ___________ Diseases of the veins _______ Dissyeastseems _o_f___th_e___ly__m_p_h_a_t_i_c
Hemorrhage without specified cause _______________
Other diseases of the circulatory system _____________
Diseases of the nasal fossae annexa_ ----------------
Diseases of the larynx ______ Acute bronchitis ___________ Chronic bronchitis_________ Bronchitis (undefined) _____ Bronchopneumonia ________ Capillary bronchitis________ Lobar pneumonia__________ Pneumonia (undefined) _____ Pleurisy __________________
Congestion & hemorrhagic infarct of the lung _______
Gangrene of the lung_______ Asthma __________________
Pulmonary emphysema _____ Other diseases of the res-
piratory system__________

22

6

16

105

41

64

16

10

6

47

21

26

9

3

6

22

16

6

70

46

24

5

4

1

59

40

19

18

16

2

32

20

12

190

68

272 210

2813 1419

54

25

195 101

122 62 1394 29 94

46

36

10

11

5

6

4 -------

4

14

5

9

41

19

22

9

5

4

8

4

4

34

18

16

23

14

9

37

18

19

828 467

361

13

6

7

1086 564

522

849 404

445

47

21

26

61

40

21

2

2 --------

74

31

43

3

1

2

18

9

9

0.68 3.27
0.49
1.46 0.28 0.68
2.18
0.15 1.84
0.56 0.99
5.93 8.49 87.82 1.68 6.08
1.43 0.34
0.12
0.43
1. 28
0.28 0.24 0.06 0.71 1.15 25.85 0.40 33.90 26.50 1.46
1.90 0.06 2.31 0.09
0.56

0.30 2.08

1.29 5.17

0.50 0.48

1.06 0.15
0.81

2.10 0.48 0.48

2.34 1.93

0.20 2.03

0.08 1.53

0.81 0.16 1.01 0.96

3.46 10.68 72.20
1.27 5.13

9.85 5.00 112.61 2.34
7.59

1.83 0.80 0.25 0.48

-----

0.32

0.25 0.72

0.96 1.77

0.25 0.20 0.91 0.71 0.91 23.76 0.30 28.69 20.55
1.06

0.32 0.32 1.29 0.72 1.53 29.16 0.56 42.17 35.95 2.10

2.03 1.69
0.10 --------
1.57 3.47 0.05 0.16

0.45 0.72

10

Table 2.-Deaths and Death Rate Per 100,000 Population, By Cause of death and Color: 1928.-Continued.

CAUSE OF DEATH

Number

Rate Per 100,000 Population

Total White Colored Total White Colored

Diasenanseexsa _o_f __t h_e__m__o_u_t_h__a_n__d
Other diseases of the pharynx tonsils______________
Diseases of the esophagus ___ Ulcer of the stomach _______ Ulcer of the duodenum_____ Other diseases of the stomach Di2aryrehaeras)a_n_d_e_n_t_e_r_it_i_s_(_u_n_d_e_r
Diarrhea and enteritis (2 years and over) __________
Ankylostomiasis ___________ Diseases due to other intesti-
nal parasites____________ Appendicitis and typhlitis___ Hernia ___________________
Intestinal obstruction ______ Other diseases of the in-
testines_________________
AcruIvteery_e_l_lo_w___a_tr_o_p_h_y__o_f__t_h_e
Cirrhosis of the liver_______ Biliary calculi_ ____________ Other diseases of the liver___ Diseases of the pancreas____ Pecraituosnei_ti_s__w_i_t_h_o_u_t__s_p_e_c_if_i_e_d
Acute nephritis____________ Chronic nephritis__________ Otahnedr dainsneaesxeas_o_f__th_e__k_i_d_n_e_y_s
Caslacguelis_o_f__t_h_e__u_r_i_n_a_r_y__p_a_s_-
Diseases of the bladder_____ Diseases of the urethra, etc._ Diseases of the prostate ____ Nonvenereal diseases of male
genital organs___________ Cysts other benign tumors
of the ovary_____________
Saalpbisncgesitsi_s____a_n__d_____p_e_lv_i_c
Benign tumors of the uterus_ Noonrrphuaegrep_e_ra_l___u_te_r_i_n_e__h_e_m__-
Other diseases of the female genital organs ___________
Nobnrpeuasetr_p_e_r_al__d_is_e_a_s_e_s_o_f__t_h_e

----------

42 20

22 1.31 1.01 1.77

98 68

4

2

114 57

23 21

412 158

30 3.05 3.46 2.42 2 0.12 0.10 0.1 57 3.55 2.90 4.60 2 0.71 1.06 0.16 254 12.86 8.03 20.52

730 434 296 22.79 22.08 23.91

308 176

7

6

132 9.61 8.95 10.6& 1 0.21 0.30 0.08

5

2

364 236

59 33

184 102

3 0.15 0.10 0.24 128 11.36 12.00 10.34 26 1.84 1.67 2.10 82 5.74 5.19 6.62

67 32

35 2.09 1.62 2.82

15

9

102 61

16

9

117 75

8

6

6 0.46 0.45 0.48 41 3.18 3.10 3. 31 7 0.49 0.45 0.5& 42 3.6.5 3.81 3.39 2 0.24 0.30 0.16

68 34 451 193 3654 1969

34 2.12 1. 73 2.74 258 14.08 9.82 20.84 1685 114.08 100.19 136.1 2

106 58

48 3.30 2.95 3.87

8

7

52 27

15

5

68 41

1 0.24 0.35 0.08 25 1.62 1.37 2.01 10 0.46 0.25 0.80 27 2.12 2.08 2.18

6

1

5 0.18 0.05 0.40

25 11

14 0.78 0.55 1.13

43 18 57 13

25 1.34 0.91 2.01 44 1. 77 0.66 3.55

7

4

3 0.21 0.20 0.24

27

11

16 0.84 0.55 1.29

1

1 -- ----- 0.03 0.05 -------

11

Table 2.-Deaths and Death Rate Per 100,000 Population, By Cause of death and Color: 1928.-Continued.

CAUSE OF DEATH

Number

Rate Per 100,000 Population

- - - - - - - - - - - 1T-ot-al -W-h-ite- -Co-lo-red- -To-tal- -W-hit-e -C-ol-ore-d

The puerperal state (total)_ 622 312

310 19.41 15.87 25.04

Accidents of pregnancy __ _ 54

33

21 1.68 1.67 1.69

Puerperal hemorrhage___ _ 60

30

30 1.87 1.52 2.42

Other accidents of labor__ 89

43

46 2.77 2.18 3.71

Puerperal septicemia ____ _ 151

67

84 4.71 3.40 6.78

Puerperal phlegmasia alba

dolens, embolus, etc. ____ _ Puerperal albuminuria and
convulsions __________ _ Following childbirth
(undefined) ________ _
(}angrene~----------------
Furuncle ________________ _ Acute abscess ____________ _
Other diseases of the skin and annexa ________________ _
Diseases of the bones______ _ Diseases of the joints_____ _ Other diseases of the organs
of!ocomotion_ __________ Hydrocephalus____________ Congenital malformations of
the heart_ ______________
Other congenital malformations___________________
Congenital debility, icterus, sclerema_ _______________
Premature birth___________ Injury at birth____________

40

26

222 110

6

3

32

11

17

9

24

12

21

10

33

19

3 -------

5

2

41

18

59

49

59

45

223 104

1159 717

139

99

14 1.24 1.32 1.13
112 6.93 5.59 9.04
3 0.18 0.15 0.24 21 0.99 0.55 1.69 8 0.53 0.45 0.64 12 0.74 0.61 0.96
11 0.65 0.50 0.88 14 1. 03 0. 96 1. 13 3 0. 09 - -- - - -- 0. 24
3 0.15 0.10 0.24 23 1.28 0.91 1.85
10 1.84 2.49 0.80
14 1.84 2.28 1.13
119 6.96 5.29 9.61 442 36.18 36.48 35.70 40 4.33 5.03 3.23

Other diseases peculiar to

early infancy____________ 170

96

Lack of care_ _____________

9

4

Old age (senility)._________ 739 300

Suicide (total)_____________ 243 210

By poisons (gas or corro-

74 5.30 4.88 5.97 5 0.28 0.20 0.40 439 23.07 15.26 35.46 33 7.58 10.68 2.66

sives excepted)._______ 13

9

4 0.40 0.45 0.32

By corrosive substances___ 49

46

Bypoisonousgas ________ 19

13

3 1.52 2.34 0.24 6 0.59 0.66 0.48

By hanging or strangula-

tion_________________

6

6

By drowning_ ___________

5

5

Byfirearms_____________ 137 121

0.18 0.30-------0.15 0. 25 - -----16 4.27 6.15 1.29

By cutting or piercing in-

struments_____________ 11

10

1 0.34 0.50 0.08

By jumping from high places_ _______________

1 _______

1 0. 03 _____ 0. 08

By other means__________

2 _______

2 0.06 _______ 0.16

Homicide (total)__________ 511 159

352 15.95 8.09 28.43

By firearms_____________ 366 124

242 11.42 6.30 19.55

By cuttin,; or piercing

instruments_._________ 85

12

73 2.6511 0.61 5.89

_B~y_o~t~h~er~m==e=an=s~-~-~-~--~-~-~-~--~6~0_ _ _~2~3_ _ _~3~7_ _ _ _1~:~8~7_1_ _1~~1~7_ _ _ _2~~98

12

Table 2.-Deaths and Death Rate Per 10,000 Population, By Cause of death and Color 1928 -Continued

CAUSE OF DEATH

Number

Rate Per 100,000 Population

Total White Colored Total White Colored

Ac(ctiodteanl)ta_l__o_r__u_n_d_e_f_in_e_d_____
Poisoning by food ________ Poaisnoimnianlgs__b__y___v_e_n_o_m__o_u_s
Other acute poisonings (gas excepted) _______ --
Conflagration ___________
Bucrenpsted()c_o_n_fl_a_g_r_a_t_io_n___e_x_-
Mechanical suffocation ___ Absorption of irrespirable
or poisonous gas_______ Drowning _____ --------Traumatism by firearms
(except in war) ________ Traumatism by cutting or
piercing instruments ___ Traumatism by fall ______ Traumatism in mines_____ Traumatism by machinesRailroad accidents_______ Street-car accidents______ Automobile accidents_____ Injuries by other vehicles_ Aeroplane and balloon
accidents _____________
Landslide, other crushing_ Injuries by animals (not
poisoning) ____________ Wounds of war__________
Starvation (deprivation of food or water) _________
Excessive cold ___________ Excessive heat __________ Lightning _______________
Otshheorckasc_c_i_d_e_n_t_a_l__e_l_e_c_tr_i_c Infantkide ______________
Fracture (cause not speci-
fied)----------------Other external violence
(specified) ____________
Other external violence (not specified) _________
Sudden death _____________ Ill-defined ________________
Not specified or unknown__

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

1901 1090

30

17

811 59.35 55.46 65.51 13 0.93 0.86 1.05

5

3

2 0.15 0.15 0.16

57

26

35

16

31 1.77 1.32 2.50 19 1.09 0.81 1.53

262 111

58

28

151 8.17 5.64 12.19 30 1.81 1.42 2.42

2

1

115

50

1 0.06 0.05 0.08 65 3.59 2.54 5.25

115

58

57 3.59 2.95 4.60

7

5

2 0.21 0.25 0.16

229 183

46 7.14 9.31 3.71

1

1 -------- 0.03 0.05 --------

36

18

18 1.12 0.91 1.45

134 75

59 4.18 3.81 4.76

18

15

3 0.56 0.76 0.24

473 319

154 14.76 16.23 12.44

11

6

5 0.34 0.30 0.40

7

7 -------- 0.21 0.35 --------

66

35

31 2.06 1.78 2.50

19

12

2 -------

2 -------

11

2

7

1

38

15

7 0.59 0.61 0.56 2 0.06 ------- 0.16

2

0.06 -------

0.16

9 0.34 0.10 0.72

6 0.21 0.05 0.48

23 1.18 0.76 1.85

15

10

1 -------

5 0.46 0.50 0.40 1 0.03 ------- 0.08

3

2

1 0.09 0.10 0.08

103

55

48 3.21 2.79 3.87

40

19

141

74

798 326

1319 451

21 1.24 0.96 1.69 67 4.40 3.76 5.41 472 24.91 16.58 38.13 868 41.18 22.94 70.12

13

TABLE 3.-DEATHS AND DEATH RATE PER 100,000 POPULATION FROM SPECIFIED CAUSE, BY COLOR: 1920 TO 1928

YEAR
1920 1921 1922 1923 1924 1925 1926 1927 1928
1920 1921 1922 1923 1924 1925 1926 1927 1928
1920 1921 1922 1923 1924 1925 1926 1927 1928
1920 1921 1922 1923 1924 1925 1926 1927 1928

Number

Rate Per 100,000 Population.

Total
549 798 714 601 681 675 519 653 444
559 468 584 489 440 285 288 296 582
61 93 5 347 550 11 58 105 143
401 415 411 274 230 1'85 251 272 240

White Colored Total

White

I

I

I

I

I

TYPHOID FEVER

274

275

18.9

16.1

351

447

27.0

20.2

326

388

23.9

18.4

244

357

19.9

13.5

292

389

22.2

15.9

264

411

21.8

14.1

191

328

16.5

10.0

285

368

20.6

14.7

182

262

13.9

9.3

MALARIA

242

317

19.2

14.2

195

273

15.8

11.2

256

328

19.6

14.5

201

288

16.2

11.2

181

259

14.4

9.8

102

183

9.2

5.4

107

181

9.2

5.6

113

183

9.3

5.8

253

329

18.2

12.9

MEASLES

41

20

2.1

2.4

66

27

3.2

3.8

2

3

0.2

0.1

252

95

11.5

14.0

359

191

17.9

19.5

4

7

0.3

0.2

43

15

1.8

2.3

79

26

3.3

4.1

106

37

4.5

5.4

DIPHTHERIA

283

118

13.8

16.6

294

121

14.0

16.9

277

134

13.8

15.7

199

75

9.1

11.0

167

63

7.5

9.1

119

66

6.0

6.4

199

52

8.0

10.4

187

85

8.6

9.7

177

63

7.5

9.0

Colored
22.8 36.9 31.9 29.3 31.8 33.5 26.6 29.8 21.2
26.2 22.5 27.0 23.6 21.2 14.9 14.7 14.8 26.6
1.7 2.2 0.2 7.8 15.6 0.6 1.2 2.1 3.0
9.8 10.0 11.0 6.1 5.1 5.4 4,2 6.9 5.1

14

Table 3.-Deaths and Death Rate Per 100,000 Population From Specicified Cause, By Color, 1920 to 1928.-Continued.

YEAR

Number

Total

White I Colored

Rate Per 100,000 Population. Total White Colored

I

I

DYSENTERY

1920

170

116

54

5.8

6.8

4.5

1921

146

88

58

4".9

5.1

4.8

1922

112

69

43

3.8

3.9

3.5

1923

151

90

61

5.0

5.0

5.0

1924

187

104

83

6.1

5.6

6.8

1925

194

119

75

6.3

6.6

6.1

1926

207

129

78

6.6

6.8

6.3

1927

277

172

105

8.7

8.9

8.5

1928

304

189

115

9.5

9.6

9.3

TUBERCULOSIS (All forms)

1920

2362

1921

2531

1922

2683

1923

2642

1924

2620

1925

2448

1926

2278

1927

2307

1928

2375

882

1480

81.2

51.8 122.5

892

1639

85.7

51.2 135.2

991

1692

89.9

56.1 139.2

965

1677

87.4

53.6 137.5

917

1703

85.5

49.8 139.1

872

1576

78.9

46.5 128.3

807

1471

72.6

42.3 119.4

798

1509

72.8

41.2 122.2

832

1543

74.1

42.3 124.7

CANCER

1920

1124

766

1921

1210

803

1922

1212

782

1923

1263

870

1924

1393

913

1925

1311

891

1926

1257

860

1927

1470

995

1928

1510

1013

358

36.6

45.0

29.6

407

41.0

46.1

33.6

430

40.6

44.2

35.4

393

41.8

48.3

32.2

480

45.4

49.6

39.2

420

42.3

47.6

34.2

397

40.0

45.1

32.2

475

46.4

51.4

38.5

497

47.1

51.5

40.2

PELLAGRA

1920

432

210

222

14.8

12.3

18.4

1921

512

234

278

17.3

13.4

22.9

1922

527

249

278

17.7

14.1

22.9

1923

444

227

217

14.7

12.6

17.8

1924

337

181

156

11.0

9.8

12.7

1925

366

181

185

11.8

9.7

15.1

1926

425

225

200

13.5

11.8

16.2

1927

617

292

325

19.5

15.1

26.3

1928

846

358

488

26.4

18.2

39.4

15

Table 3.-Deaths and Death Rate Per 100,000 Population From Specified Cause, By Color, 1920 to 1928.-Continued.

YEAR
1920 1921 1922 1923 1924 1925 1926 1927 1928
1920 1921 1922 1923 1924 1925 1926 1927 1928
1920 1921 1922 1923 1924 1925 1926 1927 1928
1920 1921 1922 1923 1924 1925 1926 1927 1928

Number

Rate Per 100,000 Population.

Total White I Colored Total White \ Colored

I

I

I

I

HEART DISEASES

1892

1053

839

65.0

61.9

69.4

1768

923

845

59.9

53.0

69.7

1996

1053

943

66.9

59.6

77.6

2388

1186

1202

79.0

65.8

98.5

2424

1165

1259

79.0

63.2 102.8

2297

1077

1220

74.0

57.5

99.3

2429

1198

1231

77.4

62.8

99.9

2929

1497

1432

92.4

77.3 115.9

3307

1717

1590 103.2

87.4 128.4

PNEUMONIA (All forms)

2766

1470

1296

95.1

86.4 107.3

1925

1050

875

65.2

60.3

72.1

2664

1447

1217

89.3

81.9 100.1

3199

1596

1603 105.9

88.6 131.4

2922

1382

1540

95.3

75.0 125.8

2335

1135

1200

75.3

60.6

97.7

2442

1180

1262

77.8

61.8 102.4

2132

1015

1117

67.2

52.4

90.4

2776

1441

1335

86.7

73.3 107.8

PUERPERAL CAUSES (Total)

558

267

291

19.2

15.7

24.1

568

266

302

19.2

15.3

24.9

658

316

342

22.1

17.9

28.1

573

288

285

19.0

16.0

23.4

708

362

346

23.1

19.7

28.3

641

299

342

20.7

16.0

27.8

485

222

263

15.5

11.6

21.4

578

291

287

18.2

15.0

23.2

622

312 I 310

19.4

15.9

25.0

NEPHRITIS

2200

1258

942

75.6

73.9

78.0

2446

1347

1099

82.8

77.4

90.6

2903

1592

1311

97.3

90.0 107.8

3139

1684

1455 103.9

93.4 119.3

3449

1787

1662 112.5

97.0 135.8

3228

1715

1513 104.1

91.5 123.2

3385

1721

1664 107.8

90.2 135.1

3620

1970

1650 114.2 101.8 133.6

4105

2162

1943 128.2 110.0 157.0

16

TABLE 4.-DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, WITH PER CENT
INCREASE (+) OR DECREASE (-) IN THE RATE
OF 1928: 1927 AND 1928

CAUSE OF DEATH
All Causes _______________
Typhoid Fever _______________ Malaria _____________________ Smallpox ____________________ Measles _____________________ Scarlet Fever_________________ Whooping-cough ______________ D i p h t h e r i a ___________________ Influenza ____________________ Dysentery ___________________ Erysipelas ___________________ TCuabnecrecru_l_o_s_is__(_a_ll_f_o_r_m_s_)_______________ Rheumatism _________________ Pellagra _____________________ Diabetes mellitus_____________ Cerebral Hemorrhage, softening Heart Disease________________ Bronchitis ___________________ Pneumonia (all forms) ________ Diarrhea, Enteritis (-2 Yrs.) ___ Appendicitis, Typhilitis________ Hernia, Intestinal obstruction __ Cirrhosis of Liver_____________ Nephritis ____________________ Puerperal Septicemia__________ Other puerperal causes Early Infancy (Class X11) _____ Suicide ______________________ Homicide ____________________ Automobile accidents__________ Other external causes _________ Unknown, or ill-defined _______ All other causes ______________

Rate Per 100,000 Population

1927

1928

-------

Per Cent Increase (+)
or Decrease
H

1005.0

1126.6

+12

20.6 9.3 0.4 3.3 0.8 7.2 8.6 30.6 8.7 1.2 72.8 46.4 2.3 19.5 8.2 69.3 92.4 4.0 67.2 25.5 10.4 6.7 3.9 114.2 5.8 12.4 65.6 6.2 16.1 13.7 44.0 31.7 176.0

13.9

-33

18.2

+96

0.2

-5

4.5

+36

1.1

+37

5.1

-29

7.5

-13

63.7

+1Q8

9.5

+9

1.0

-17

74.1

+2

47.1

+2

1.4

-39

26.4

+as

10.3

+26

75.4

+g

103.2

+12

2.9

-28

86.7

+29

22.8

-11

11.4

+lQ

7.6

+13

3.2

-18

128.2

+12

4.7

-19

14.7

+19

53.1

-19

7.6

+23

16.0

-1

14.8

+8

44.6

+I

66.1

+1Q9

179.6

+2

17

TABLE 5.-DEATHS UNDER 1 YEAR OF AGE AND

RATE PER 1,000 BIRTHS, FROM SPECIFIED

CAUSES, BY COLOR: 1927 AND 1928

l I I CAUSE OF DEATH
I - - - - - - - - - - Total

1927 White

Colored Total

1928 White ,_Co_l_or_ed_

1

- - Number

A ll

Casues ________________

_457sJ2aa4

--~~2244 4977 __:648

2329

Measles __________________ 31

Scarlet Fever______________

2

Whooping-cough __________ 133

Diphtheria________________ Influenza _________________

41 104

Dysentery ________________ Erysipelas ________________

70 17

Tetanus__________________ 14

Tuberculosis (all forms) _____ Syphilis __________________

24 94

Convulsions_______________ 36 Bronchitis________________ 13

Pneumonia (all forms) ______ 148

Diseases of the stomach ____ 44

Diarrhea and Enteritis _____ 541

Congenital malformations___ 98

Congenital debility ________ 199

Premature birth ___________ 1193

Injury at birth ____________ 122

OtfhaenrcyD_i_s_e_a_se_s__o_f__E_a_r_l_y__I_n_- 558

External Causes___________ 117

Unknown, or ill-defined ____ 328

All other causes ___________ 312

18

13 30

2 -------- 3

68

65 90

19

22 43

57

47 232

38

32 84

16

1 12

3

11 17

11

13 33

20

74 92

13

23 37

6

7 18

208 279 640

16

28 51

266 275 482

80

18 132

94 105 215

738 455 1159

85

37 139

243 315 179

52

65 113

115 213 828

166 146 348

- - - All Causes________________ 74.3
M ea~es __________________ 0.5

Rate 59.4

Pe1r001.'0400

Btrths 84.0

0.5 0.6 0.5

scarlet Fever _____________ 0.0
Whooping-cough___________ 2.2

0.1 -------- 0.1 1.7 2.9 1.5

D iphtheria________________ 0.7 0.5

1.0 0.7

IDnyfslueenntezray_________________________________

1.7 1.1

1.5 1.0

2.1 3.9 1.4 1.4

TEerytasinpuesla_s_________________________________

0.3 0.2

0.4 0.1

0.0 0.2 0.5 0.3

sTyupbheirlcius l_o_s_i_s _(_a_ll__fo_r_m__s)_________

0.4 1.5

0.3 0.5

Convulsions_______________ 0.6 0.3

Bronchitis ________________ 0.2 0.2

0.6 0.6 3.3 1.6 1.0 0.6 0.3 0.3

Pneumonia (all forms) ______ 7.9 5.3 12.5 10.8

Diseases of the stomach ____ 0.7 0.4

1.3 0.9

Diarrhea and Enteritis _____ 8.8 6.8 12.3 8.1

Congenital malformations___ 1.6 2.0

0.8 2.2

Congenital debility_________ 3.2 2.4

4.7 3.6

Premature birth ___________ 19.4 18.8 20.4 19.6

Injury at birth ____________ 2.0 2.2

1.7 2.3

Otfhaenrcyd_is_e_a_s_e_s__o_f__e_a_rl_y__i_n_- 9.1

6.2

14.1

3.0

External causes ___________ 1.9 1.3

2.9 1.9

Unknown, or ill-defined _____ 5.3 2.9

9.5 14.0

All other causes ___________ 5.1 4.2

6.5 5.9

18

22

8

1

2

52

38

19

24

128 104

53

31

12 --------

4

13

18

15

24

68

15

22

11

7

312 328

26

25

277 205

97

35

100 115

717' 442

99

40

100

79

55

58

301 527

205 143

71.4 105.2 0.6 0.4 0.0 0.1 1.4 1.7 0.5 1.1 3.5 4.7 1.4 1.4 0.3 -------0.1 0.6 0.5 0.7 0.6 3.1 0.4 1.0 0.3 0.3 8.4 14.8 0.7 1.1 7.5 9.3 2.6 1.6 2.7 5.2 19.3 20.0 2.7 1.8 2.7 3.6 1.5 2.6 8.1 23.8 5.5 6.5

LABORATORY
T. F. SELLERS, Director.
Work in the laboratory has shown marked increase in 1927 and 1928 over previous years. There were examined in 1927 a grand total of 54,316 specimens, an increase of 6,031 over 1926. In 1928 we examined 60,107 specimens, an increase of 5,791.
Sharp decreases in diphtheriaforboth 1927 and 1928 have been noted by the laboratory as evidenced by the number of diphtheria specimens examined and by the lessening of the demand for antitoxin. In 1927 there were only 219 positive diagnostic findings as compared with 317 for 1926. In 1928 there were only 182 diagnostic cultures found positive. We are hardly justified in claiming toxinantitoxin is chiefly responsible for the decrease, but we believe it is an important factor.
Through institution of the Wei! Felix test, the laboratory has been able to recognize a comparatively large number of cases of Brill's disease, of typhus fever, some of which had been diagnosed by physicians as typhoid fever. Through development of this line of work, we have enabled physicians to recognize the clinical symptons of this disease and to avoid confusing it with typhoid. In 1927 over 50 cases of this disease were located. In 1928, this test was made in a routine manner on all liquid blood specimens, except those submitted for the Wassermann test only, with the result that 51 positive cases were determined.
Tularemia in Georgia is contracted by man in handling infected wild rabbits. It is, therefore, an accidental infection in man. There is very little likelihood of tularemia becoming epidemic except that increased infection in wild rabbits may result in increasing numbers of human cases. About 20 cases were diagnosed in our laboratory in 1928. We have issued warning through the press on several occasions regarding the danger of handling wild rabbits, especially those found sick or dead in the fields or woods.
Diagnosis of undulant fever is made exclusively by laboratory test, technique for which was introduced here in May 1928, since when several hundred have been made. Only 25 positive reactions were made, but the interest aroused among the medical profession has resulted in the policy of making routine tests on all liquid blood specimens, except Wassermans, in 1928. There is some evidence that milk of cows infected with contagious abortion is the source of undulant fever in man. However, four strains of the causative organism isolated from blood cultures from human cases in our laboratory have been found to be of the porcine (pork) type. This would suggest infected pork may be an important source of contagion. It is possible, also, that the porcine type can infect cows, and through them, humans.
Sharp decrease is noted in the incidence of rabies in 1928, the number of cases being lower than for any of the preceding 10 years. In 1927 we examined 729 heads, finding 262 positive cases. In 1928 we examined 621 heads, finding 210 positive cases. By way of comparison, in 1924 we handled 1,038 heads, finding 509 positive cases.
However, the decrease in the demand for antirabic treatment is more significant of the decline of rabies than brain examinations. In 1926 we distributed 1,852 complete treatments; in 1927, 1,723 and in 1928 only 1,260.
With the help of Governor Hardman, the laboratories have been completely rebuilt, and, to a large extent, re-equipped at a total cost of $20,000.00. We now have a system of laboratories that will compare favorably with the best in the United States. During the five months of rebuilding, from February to June 1928, routine laboratory work proceeded without interruption.
Although our space will care for our needs for several years to come, the growing demand for our services throughout the state Will soon require additional workers and equipment.
19

LABORATORY STATISTICS

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

1924 Bacteriological specimens 17,994 Wassermann tests_______ 19,832 Water analyses. ________ 5,794
TOTALS. __________ 43,620

1925
17' 102 22,326
6,562
45,990

1926
15,370 26,307
6,608
48,285

1927
15,570 31,376 7,190
54,316

1928
19,195 32,760 8,152
60,107

DISTRIBUTION OF BIOLOGICALS

Complete treatments for rabies, manufactured and distributed. __ _
Typhoid vaccine_________________ _ Diphtheria antitoxin, units _______ _ T~xIzianb:oAnnt)i_t_o_x_i_n_(_p_e_r_m__a_n_e_n_t_i_m_m__u_n_-
Schick tests for diphtheria ________ _ Silpvoeurlensi_tr_a_t_e__f_o_r__b_a_b_i_e_s'__e_y_e_s_, _a_m_ _-
Carbon tetrachloride for hookworm_ Tetanus antitoxin, units__________ _ Smallpox vaccine points __________ _

1927
1,956 348,135cc 49,334,000
72,392cc 7,300
26,890 16,485cc 1,411,000 73,198

1928
1,472 320, 705cc 35,999,000
39,310cc 7,840
34,749 11 ,675cc 713,000 32,400

ANIMAL HEADS EXAMINED FOR RABIES

1924

1925

1926

1927

1928

Number heads examined 1,038

910

825

729

621

Number positive for

N"egri bodies. ________ 509

424

353

262

210

Percentage positive _____ 49.0

46.5

42.7

35.9

33.8

20

BACTERIOLOGICAL LABORATORY

1927

Pos.

Neg.

Spluostuism__E__x_a_m_i_n_a_t_io_n_s__f_o_r__t_u_b_e_r_c_u_- 459

Otchuelrossipse_c_i_m_e_n_s__e_x_a_m__in_e_d__f_o_r_t_u_b_e_r_-

6

Animal inoculations for tuberculosis_

6

Examinations for diphtheria ________ 316

Wtypidhaolidt_e_s_ts___fo_r__t_y_p_h_o_i_d__a__n_d__p_a_r_a_- 407

Weil-Felix reactions for tyhpus _____ 57

Blood cultures for typhoid and para-

typhoid and other organisms _____ 134

Stool and Urine cultures for tyhpoid dysentery group ________________ 43

Smears to be examined for gonococci 296

Blood smears for malaria plasmodia_ 163

Examinations for intestinal parasites 1,515

Dark field examinations ___________

2

Brain examinations for rabies______ 262

Animal inoculations for rabies ________________

1,734
36 1
1,386
1,449 89
689
214 668 1,884 2,976
7 436
1

1928

Pos.

Neg.

463
4 3 290
468 35
139
45 220 281 1,825
8 210
2

1,778
27 12 1,499
1,684 180
1,102
334 790 2,230 4,145
3 387
----------

SEROLOGICAL LABORATORY

Specimens for Wassermann Test____

1927

Pos.

Neg.

6,596 24,604

1928

Pos.

Neg.

6,337 26,236

GENERAL SUMMARY

Bacteriological laboratory_________ _ Serological Laboratory ___________ Water laboratory ________________ _
GRAND TOTAL___________ _

1927
15,750 31,376 7,190
54,316

1928
19,195 32,760 8,152
60,107

21

SANITARY ENGINEERING
L. M. CLARKSON, Director.
Activities of the Division of Sanitary Engineering may be classified as fol lows:
Major: Public Water Supplies. Municipal Sanitary Sewage and Industrial Waste Disposal. Malaria Control.
Minor: Domestic Water Supplies. Swimming Pools. Privies and Home Sewage Disposal. Rural School Sanitation. General Sanitary Surveys.
These are made on the basis of comparative thoroughneEs arid effectivenes with which they are covered, rather than on their relative weight as public health problems. In consideration of relative importance, some carried in the minor list should be in the major classification. But in the utilization of limited resources, it is necessary to employ the time in reaching municipal authorities and industrial companies controlling the living conditions of groups of persons in order to serve the greatest number. Consequently, it is. to be regretted that paper contacts with individuals living adjacent to towns, in small villages or rural sections are ineffective and are not materially reducing the many health hazards involved.
Supervision of Water Supplies. The supervision of public and semi-public water supplies has been carried on by continuing to coordinate the results of the bacteriological examination of samples with field inspections and conferences with mayors and town councils. The number of bacteriological samples examined in 1928 was 8,139 against 970 in 1920, an increase of 739 percent.
In the case of supplies having deficiencies, the mayors and town council11 have been advised of needed improvements. The recommendations have varied from sterilization in the case of clear underground waters to complete rebuilding of filtration plants in the case of surface streams. In towns accepting the recommendations, it has been possible to obtain modern purification equipment.
A large part of the time has been devoted to encouraging the purchase of filter plant laboratory material and in perfecting a program for obtaining competent technical control of rapid sand fiter plants. This program is being undertaken to counteract the statewide belief by municipal authorities that untrained men can safely control water purification processes. The existing practice of placing low-paid, untrained men in charge of a public health protective proceM which requires a basic knowledge of chemistry, bacteriology and hydraulics is extremely dangerous. Standard report forms have been prepared for the use of water purification plant operators in compiling monthly operation reports to this divison. Increas'ed time of the personnel of this division will be given next year to instructing plant men in their duties and in record keeping.
Considerable danger exists in a number of public water supplies from cross connections between the municipal distribution system and an emergency fire protection supply. These emergency supplies are in nearly every case highly polluted. Often such polluted water under high pressure developed by fire pumps is separated from the drinking supply by a single leaky gate or check valve. Several cross-connection hazards have been eliminated in 1928 by municipal authorities requiring the severance of drinking and emergencyfire supplies which are polluted.
22

The co-operative work of the United States Public Health Service in connection with the certification of water used for drinking purposes on interstate carriers has been continued. This work included bacteriological examination of samples, field inspections of purification equipment, conferences and clerical work in compiling and forwarding pertinent data to the surgeon-general.
The installation of deep well pump and erection of elevated steel tank for the Georgia School for Mental Defectives at Gracewood was supervised.
Preliminary work in connection with selection of site for impounding basin and investigation of the chemical characteristics of stream water for design of filter plant at the State Tuberculosis Sanitorium at Alto has been completed.
Bottled Waters. In order to expand our service in protecting the public from the danger of drinking waters of unknown or of questionable quality, efforts have been made to determine the quality of all bottled water placed on the market and to assist in improving the quality when not meeting requirements for purity. Field investigations and bacteriological examinations have been made, with few exceptions, of all such supplies. The work was taken up with the idea in view of promotion of control by local laboratories and health boards wherever possible. This plan has been followed with the result that with only several exceptions, which will be eliminated, bottled waters sold on the market are either under the local or State Board of Health laboratory supervision.
Domestic Water Supplies. Bacteriological analyses are made of samples of water collected from private wells and springs. These analyses are made without charge. With each sample is obtained the owner's description of the well or spring. The owner is advised of the bacteriological results and report accompanied by letter suggesting improvements based on his description. A bulletin is supplied with each report illustrating in detail methods for improving each type of supply.
Supervision of Swimming Pools. Field inspections have been made of swimming pools. Bulletins prepared by the American Public Health Association containing the recommendations of the joint committee of the Association and the Conference of State Sanitary Engineers have been made available to owners, designers and operators of swimming pools. These recommendations embrace features of design, operation and standards of quality.
General and Miscellaneous Inspections. These are made to obtain information upon which to make recommendations to eliminate nuisances or for campaigns to promote new or better water ~upply, sewerage and safe privy programs.
Malaria Control. Full details of this division's activities in the malaria control campaign will be found in the section dealing with this subject.
Sewerage and Stream Pollution. This work has consisted of investigation of sewage disposal problems for towns and industrial plants. In the case of new sewerage systems and proposed outfalls, the towns in question have been visited to determine the extent of sewage treatment required. Approval has not been given to engineers' plans until the design of proposed treatment works conformed to accepted practice and were found to be applicable to the situation and stream under consideration. As far as possible,the co-operative agreement with the State Department of Game and Fish to make information on industrial waste discharges into streams mutually available to the two departments has been carried out. Data obtained from engineers' proposed plans and the results of field investigations have been made available to the Department of Game and Fish in all cases where fish life was affected.
Home and rnstitutional Sewage Disposal. A revised bulletin is being distributed to persons who desire a convenient and safe method of disposing of sewage from the home. The methods described therein are applicable to dwellings having a water supply under pressure. Bulletins also are furnished describing proper construction of privies as well as plans for institutional and rural school sewage disposal.
23

CLASSIFICATION OF WATER SUPPLIES BASED ON ESTIMATED 1928 POPULATIONS

Number

Percentage Percentage

of

Total

Population Population State

Using Pub- Population

lie Supplies

Public Water Supplies Receiving Filtration and Chlorination____
Public Water Supplies Receiving Chlorination Only ____________
Public Water Supplies Receiving No Treatment________________
Total Public Water Supplies_ Private Water Supplies__________
Total for State _______ _______

49 642,980 56.5

42

139,680 12.3

168

355,050 31.2

259 1,137,710 100.0 2,132,290

3,270,000

19.2
4.3 11.3 34.8 65.2
100.0

Public Supplies Accepting State Laboratory Service____________
Public Supplies Not Accepting State Laboratory Service______ TotaL __ _________________ --
Public Supplies Making Major Improvements to Plants-1928 ____

224 1,112,520 35 25,190 259 1,137,700

97.8 _____ ... ____
2.2 ---------100.0 ----------

18 67,980

5.9 ----------

24

CHILD HYGIENE
JOE P. BOWDOIN, M. D., Director.
The Healthmobile, by visiting every county in the state, taking with it the bright light of medical science, has opened up a new vista of health for Georgia. Little children, who never knew a doctor's care, have been placed on the road to sturdy manhood and womanhood, a heritage Georgia will prize for years to come.
Mothers, who otherwise would never have had the care of a doctor prior to the birth of their children, have been so instructed that they have borne strong infants with a chance for vigorous life that is the right of everyone.
Untold superstition and unbelievable practices among midwives have been eliminated through the law requiring their registration and through instruction of this class of practitioners by public health nurses. Every county will have been visited and instruction given before the end of the present federal fiscal year, June 30.
This work also has stimulated birth registration, as every midwife is required to memorize the birth certificate so she can have it filled out. This is required because many of them can neither read nor write. A total of 1,466 midwives has been refused certificates beca~ of old age and because of inability or refusal to meet the conditions required by law. Licenses have been granted to 2,406.
Care of children in homes, where, theretofore, they have been practically unattended until ill, has increased to a great extent through the instruction by public health nurses of older girls of the families. This has allowed the mother to go out to work, insuring ample care of the younger children.
This most valuable work, however, must cease after June 30, 1929 unless Georgia provides the funds. The Healthmobile is the gift of the Phi Mu fraternity, which also gives $1,500 per annum to its upkeep. Funds derived through the Sheppard-Towner law, which have been used to supplant Phi Mu and state and county funds, will not be available after that date because of repeal of the law by Congress.
A glance at the work done and the number of persons reached in 1928 alone will give an adequate idea of the value of the Healthmobile to Georgia. It was in the field seven months, visited 161 communities in 20 counties; 3,021 children under seven were examined and 7,688 defects found. Sixty-one were without defect, all except two of these being under two years old. Thirty-seven prenatal cases were examined and advised. Health talks to the number of 255 were made, reaching 17,915 persons; 495 health films were shown to 16,818 persons. The films dealt with malaria, hookworm, diphtheria, typhoid, smallpox, tuberculosis, care of teeth and annual examinations by physicians of the apparently well.
The fourth edition of Georgia's Baby Book, recognized as the foremost in America, is just off the press. There are 50,000 copies, given free for the asking. It treats of the latest approved methods of caring for the baby from birth until it is well along in years.
It's joyful acceptance among the more remote communities where reading is difficult has impressed this department with the importance of its mission. In fact, the reception of our nurses and doctors in communities where doctors are rare, has been pathetic, once our purpose is known.
Georgians are crying for the Gospel of Health. The Healthmobile and the public health nurse have proven it.
25

The following is preprinted from The Promotion of the Welfare and Hygiene of Maternity and Infancy, Fiscal Year 1928, Children's Bureau,
U. S. Department of Labor, Washington.
GEORGIA
Staff and Activities in 1928.
Administrative agency: State board of health, division of child hygiene, Atlanta.
Funds expended: Federal, $28,159.73; State, $23,991.37; total, $52,151.10. Staff:
Director (physician, part time), 1 physician (part year), 6 nurses (5 part year), 1 laboratory assistant (part-time), 1 stenographer, 1 clerk-typist (part year), 1 chauffeur (part year). Seventeen county nurses were paid from maternity and infancy funds (2 part time, 7 part year).
Activities: Child-health conferences conducted by physicians-1,234; infants and preschool children examined-8,033. Many of these conferences were conducted in the "healthmobile," which traveled through rural communities in 21 counties with a staff of a physician, a nurse, and a chauffeur. After the visit of the "healthmobile" in each county a permanent maternity and infancy committee was organized to do follow-up work. Defects found in children examined at conferences (January-July, 1928)11,982. Prenatal conferences conducted by physicians---378; expectant mothers examined---2.998. Conferences c~nducted by nurses, no physician present-107; children inspected-421; mothers instructed in prenatal care-70; visits to conferences by children-605. Dental conferences (January-July, 1928)-41; expectant mothers receiving dental examination-77; preschool children receiving dental examination-! 01. New permanent combined prenatal and child-health centers---2 established as a result of the maternity and infancy work. They are supported by maternity and infancy funds and by county funds. New permanent child-health center-1 established as a result of the maternity and infancy work. It is supported by maternity and infancy funds and by county funds. New permanent prenatal centers---4 established as a result of the maternity and infancy work. They are supported by maternity and infancy funds and by county funds. Classes for girls in care of infants and preschool children-191 organized; girls enrolled-4,968; lessons in course-12. Classes for mothers---66 organized; mothers enrolled-1,904; number completing course-288; number still on roll-1,716. Classes for midwives-209 organized (including 15 organized by a physician lent by the United States Children's Bureau); midwives enrolled1,764; number completing course-8Zl; lessons in course-10. Permanent midwives' clubs were organized in each county in which classes were conducted. Home visits by nurses---24,968 (prenatal cases seen 4,457; obstetrical cases, 96 (report incomplete); postnatal cases, 1,883; infants, 5,939; preschool children, 3,888). Maternity homes inspected-441 (report incomplete). Infant homes inspected-731 (report incomplete). Commun:ty deinonstrations-19, of a maternity and infancy public-health nursing program.
26

Goup demonstrations-633, to groups of mothers, expectant mothers, and midwives. In addition 3,20!) demonstrations were made for individuals.
Surveys-3; (1) Of midwives. (2) Of birth registration. (3) Cf 7 hrospitals.
Campaigns-8: (1) For observance of May Day as Child Health Day, state-wide. (2) For immunization of cuildren against diphthf'ria, statewide. (3) For examination of preschool children and correction of their defects before the children should enter school, in 1 county. (4, 5, 6) For interesting young girls in organizations for health work, in 1 county. (7) For dental care for children. (8) For promotion of negro health, in 1 city.
Talks and lectures-382. Literature distributed -105,875 pieces. A graduate course for nurses in maternity and infancy worK w..s conduct-
ed in Atlant11 in co-operation with Emory University. Nutrition work was done through individual instruction and througlt
classes conducted by a dietitian detailed by the State University to the "healthmobile" operated by the division in rural districts. Exhibits conducted-64. Article prepared-The Midwife Problem. Material for newspapers and for radio broadcasting was also prepared. Breast feeding was promoted by literature distributed on the subject. Infants born in the State during the calendar year 1927-61,636; infants under 1 year of age reached by the work of the division during the year under review-13,709; preschool children reached-12,956; expectant mothers reached-15,563. Counties in the State-161; counties in which maternity and infancy work was done during the year-77; counties in which maternity and infancy work has been done since the acceptance of the maternity and infancy act-160. Since the beginning of the State's co-operation undjer the maternity and infancy act three counties have assumed the responsibility for maternity and infancy work begun with maternity and infancy funds. The following state-wide organizations co-operated in the division's work: State department of education, State league of women voters, Women's Christian Temperance Union, State federation of women's clubs, fraternal and professional organizations, and the parent-teacher association. Home demonstration agents also co-operated. The assistance consisted mainly in arranging for conferences and other educational work on the maternity and infancy program. An outstanding achievement of the year was the contacts made with mothers in rural sections of the State.
Types of Work and Some Results.
The division of child hygiene was established in the State board of health in 1919. The State accepted the provisions of the maternity and infancy act on February 13, 1922. This was followed by legislative acceptance approved by the governor on August 16, 1922.
A physician has directed the work, another physician has acted as clinician on the "healthmobile," and State staff nurses have served in a supervisory capacity and assisted in special field work. The number of public-health nurses paid wholly or in part from maternity and infancy funds and detailed to counties is gradually increasing, 1 having been added in each of the last two years to the 15 that were reported for 1926.
Co-operation has been maintained with the State department of education, professional and fraternal organizations, women's organizations, and the parentteacher association.
Emphasis has been placed on child~health conferences made possible through the use of the "healthmobile" and on the establishment of permanent centers in
27

counties in whlch public-health nurses were stationed. Numerous prenatal conferences have been conducted, and many visits to the homes of mothers and children have been included in the work of the nurses.
Work with the negroes has been developed through activities of negro nurses in conducting prenatal conferences and instructing negro midwives. It is estimated that more than 5,000 mid"'~ives are in the State; by January 1, 1928, 4,661 had been located. Through the efforts of the division a large number of midwives have received instruction during the period of co-operation and have made application for certificates of fitness to practice. Many who were unfit have ceased to take cases. By January 1, 1928, 2,471 had obtained certificates, 1,529 had failed to qualify for certificates, and 661 were still uninstructed. To receive a certificate, each midwife must attend a school of instruction for 10 periods and must pass a satisfactory examination. She must have a negative reaction from the Wassermann test, must be vaccinated against smallpox, must agree to abide by the regulations promulgated by the State board of health, and must undertake to report all births promptly to the local registrar of vital statistics. Ampoules of nitrate of silver are distributed free, and midwives are required to use ttlis prophylactic in the eyes of the new born. The followup work with midwives has been dif;icult, and there are problems yet to be met. But that the midwives constitute an indispensable group is indicated by the fact that they delivered 31.4 per cent of the total births reported in the State in 1927.
The State has been both in and out of the depth-registration area during the period of co-operation. It was dropped in 1925 owing to the lack of satisfactory legislation. This was secured in 1926, and the State was readmitted to the death-registration area for 1928, being admitted to the birth-registration area the same year. The staff of the division of child hygiene assisted in the campaign to accomplish entry. The work with the midwives in securing better registration of births was an important feature of the campaign.
O"'ing to the recent admission of the State to the birth-registration area infant and maternal mortality rates are not available from the United States Bureau of the Census. That improvement has occurred in maternal welfare, at least, is indicated by the improvement in the type of midwives now practicing and in the character of their work.
ORAL HYGIENE
There has been only nine months of real work done in the schools. Twentyfour counties have been visited, twelve counties fully covered. By that is meant we have visited all schools in twelve of the counties making examinations and explaining the program advocating prophylactic or home made charts, inspection each morning, health songs and plays, holidays, honor rolls and clear teeth cards as inducements for corrections, competition between grades to keep interest alive in mouth cleanliness.
In the other twelve schools visited mostly the city schools and have met the dentists, county and city superintendents, and executives o;" various civic organizations.
The Supervisor has visited twenty-four counties, made examinations in 196 schools. examined 25,971 children in these schools, made 363 talks in schools and organizations, visited 12 Teachers' Institutes, visited 5 Summer Camps for girls and women.
Examinations show a general average of from 65% to 95% defective teeth in our schools. We already know thiR, but find the examinations necessary in creating more interest among the teachers and children. However, examinations take up a great deal of valuable time which should be given to establishing a real Mouth Hygiene Program in each school. Our program needs publicity. It can only be gained by covering a large amount of territory in a short time. We cannot cover a large territory if we must make examinations and sell our program to teachers and superintendents.
28

VENEREAL DISEASE CONTROL
JOE P. BOWDOIN, M. D., Director.
Unless the general assembly supplies the funds for this work, we must reconcile ourselves to an increased number or deaths of mothers and babies. Our present appropriation is $10.000.00. barely sufficient to maintain the laboratory and bare office expenses. Withdrawal of federal aid through repeal of the Sheppard-Towner law has forced elimination of field and educational work.
Another phase is the education of physicians who first contact the cases. A few treatments at the beginning mean so much to the individual, and consequently to the vicinity and the state. Few so-called family physicians care to treat these diseases and often dismiss them with a prescription. Expenditure of money for lectures, literature, movies and books in this connection would be extremely wise.
Every health officer should keep in constant touch with all venereal disease cases as they are highly communicable and should be regarded in the same light as diphtheria, scarlet fever, smallpox and cerebro-spinal meningitis.
Physicians on the whole are on the alert in the detection of syphilis, as, witness the growth of the Wassermann department in the laboratory and more recently, the Kahn test. Approximately 3,000 tests a month are made when 11 years ago not one was made. At the request of doctors we are running Kahn tests parallel with Wassermanns.
Venereal disease control work is being done along the same established lines, policies having undergone no change whatever. Sales of arsphenamine and Keidel tubes have greatly increased. We shall continue to supply these to physicians at special prices.
All seven of the original venereal disease clinics are open and running in fine shape.
So far as this division knows, there is no restricted district in Georgia, and the public and law enforcement officers should give attention to the eradication of the clandestine prostitute-she is the source of all infection. All confirmed prostitutes are infected and therefore should be handled under the law of 1918.
It is impossible to find out the conditions in regard to the prevalence of venereal diseases, but we do have one dependable source of information of one formbrain syphilis. It is the State Sanitarium at Milledgeville. In 1918, says this institution, 15.8 percent of the new admissions showed positive Wassermann reaction. In 1927, the percentage was only 9.7, a reduction of 40 percent. Of the new admissions in 1927, only 117 showed positive reaction, but had the ratio been equal to that of 1918 there would have been 194. The annual percapita cost in 1927 was $224.57. Since there was a reduction of 77, it represented a saving to the state of $17,291.89. This result has been brought about by education and early treatment
Syphilis is one of the most common diseases. In 1928, 7,335 cases were reported. Clinics and physicians gave 43,418 doses of arsphenamine. We made 47,661 Wassermann tests.
Two prenatal clinic8 in Atlanta and Savannah are doing good work and saving many lives through examination and treatment of prospective mothers.
The laboratory furnishes silver nitrate ampoules for the prevention of blindness of babies. The law requires that every baby born shall have one percent silver nitrate put in its eyes. Statistics show, however, that less than half receive this treatment.
We respectfully invite your attention to the following statistical report on venereal disease control work for 1927 and 1928.
29

SUMMARY OF VENEREAL DISEASE CONTROL WORK FOE THE YEAR ENDING DECEMBER

----

31, 1927

I

1927

Syphilis

Gonorrhea

Chancroid

Month

Arsphena- Wasser-

Audiences

Male

Female

I Male

Female

Male

Female

mine

manns Smears Pamphlets Lectures

Jan.

Feb.

Mch.

Apr.

May

June

July

~

Aug. Sept.

Oct.

Nov.

Dec.

TOTAL

GRAND TOTAL

322

204

261

116

312

179

242

89

297

174

296

80

298

223

212

85

289

270

221

83

238

226

181

67

328

242

207

70

304

345

192

62

374

327

179

70

489

358

274

122

340

241

161

49

306

224

234 I 97

3897

3013 -26601 990

22

1

2972

3074

118

85

21 27

------1----

4002 4198

3508 4036

123 128

445 350

19 16 16 16

------------------------1----

4938 4649 5020 3964

3935 4112 3989 3875

154 155 122 102

615 95 415 75

12 11 18

--------------1-----

3687 4148 3847

3733 4214 4024

70 134 146

35 525 130

20 6

-----2-----

3484 3099

3842 3061

142 108

75 230

204

6

48008

45401 1502

3075

6910

3650

210

48008 I 45401

-------

1502

3075

Manufactured and distributed on request for prevention of blindness 26,890 ampoules of Silver Nitrate.

50 906 318 597 1089 480 1351 283 600 1555 515
----------
7744
7744

SUMMARY OF VENEREAL DISEASE CONTROL WORK FOR THE YEAR ENDING DECEMBER

31, 1928

--

----- -

-----

1928 Month

Syphilis Male Female

Gonorrhea

Male

Female

Chancroid

I Male

Female

Arsphenamine

Wassermanns

Smears Pamphlets Audiences Lectures

Jan. Feb. Mch. Apr. May June .c.....:.>. July Aug. Sept. Oct. Nov. Dec.
TOTAL
GRAND TOTAL

271

199

335

248

388

333

341

316

297

265

440

345

304

223

334

331

574

305

374

312

275

259

242

224

3975

3360

7335

198

42

229

55

250

80

226

69

230

50

276

87

216

56

170

47

258

86

215

53

231

67

220

54

2719

746

3465

12 10 5 16 11 9

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

3552 3660 4177 4063 3399 3995

3507 3323 4328 4105 4501 4586

20 13 4 2 3 9

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

3315 3629 3901 3388 3990 2349

3907 4219 3998 4385 3890 2912

102

815

81

570

68

303

102

315

76

365

103

1275

120

265

128

340

100

430

146

2095

105

645

107

235

114

2

I

43418

47661 I 1238

7653

116

43418

47661 I 1238

7653

Manufactured and distributed on request for prevention of blindness 34,075 ampoules of Silver Nitrate.

394 50 350 533 588 300
----------------------7-7-5----
--------------------
2990
2990

MALARIA CONTROL
Though Malaria is confined only to certain sections of the state it is no doubt the most important health problem within the classification of preventable diseases. There is probably more sickness and a greater economic loss due to malaria than to any other disease generally distributed throughout the state. Malaria is geographically confined chiefly to a section of varying width immediately south of the dividing line between the Piedmont Plateau on the north and the coastal plain on the south. This section begins imll).ediately south of Augusta and extends in a southwestern direction, increasing in width as it approaches the southwestern extremity, comprising about 40 counties with an average annual death rate of 25 and more per 100,000 of population. However the problem in other scattered sections is sufficient to be considered of considerable importance.
Although at the present time there is a very considerable incidence of malaria, there is evidence from mortality statistics and from verbal statements that the malaria rate is declining considerably when considered over a period of years.
This reduction, however, is considered chiefly due to control measures provided by municipalities rather than by counties and rural communities. This fa.ct, of course, emphasizes the important rural health problem to be considered With rural control the objective. No doubt the county should be the unit for constructive malaria control under experienced malaria engineering personnel attached to the county health organization. Under such system the return' on the investment to the counties and to the state would be inestimable. Only through such personnel could the department properly serve the rural population as it has the urban through specifically delegated local personnel with mosquito eradication offered undivided attention.
In the past year, in counties where full-time health units have been maintained, malaria has been reduced 42 percent.
Due to an unusual amount of rainfall during the past year malaria infection was considerably increased. The problem became extremely acute chiefly with the rural population. The control measures conducted by the municipalities for the past years repaid liberally as was evident from the comparatively small amount of malaria infection in and surrounding municipalities. The acute conditions no doubt have impressed minicipal officials with the importance of continuing control measures and the county officials with the importance of making provision for active rural malaria control.
In most of the larger municipalities mosquito eradication and malaria control is now considered regular routine under a competent sanitary inspector. Such work has been promoted as much as possible by this department. During the year, inspections were made and instructions given for modern, effective control. Municipal officials were conferred with and sentiment promoted for continuance of the work. Of interest in this connection is the fact that the citizens generally are now demanding of municipal administrations annual appropriations for continuance of the work.
Since this department became actively engaged in malaria control, several major drainage projects have been carried to completion; other surveys, investigations and estimates have been furnished. One county has, by machine equipment purchased for the purpose, carried on a county-wide drainage. Several drainage districts are in prospect when economic conditions will permit.
One district comprising parts of two counties has advanced to the extent of surveys. plans and estimates and is now awaiting the signatures of several large property owners. County health officers have been furnished free advice and assistance for drainage, administration and other means of control. The department recently has promoted an experiment with drainage wells in the southwest sections with the possibility in view of vertically draining ponds and lime sinks. The well-drilling equipment is now operating, but it is too early yet to state results definitely.
Further studies have been made of geographical distribution of the anopheline species, applying the information obtained to the mortality geographical dis-
32

tribution. Spot maps have been kept to date, defining malaria as a state problem. Mortality statistics have been recorded and mapped. The clear definition of the problem is considered the foundation upon which will be built the provision for future constructive rural control, when the combination of public sentiment and finances will permit.
The department during the year was very active under the permit system for impounded water control. Permits for impounding waters are issued after plan and specifications for vegetation clearing and control equipment are examined and approved. This constitutes our major and most difficult problems in connections with malaria control. To date there are in the state about 36 impounded areas for the purpose of hydro-electric development, covering approximately 100,000 acres. The most extensive hydro-electric development is confined to the section where malaria is most prevalent. In this section in addition to clearing requirements application of oil several times monthly by mechanical means is also required during the mosquito breeding season. Experiments will be conducted during the current year with special equipment for applying Paris green in lieu of oil for a comparison of economy and efficiency. Stocking all waters so developed with gambusia (minnows) which destroy mosquito larvae also is being promoted. In addition to the larger impounded areas for hydro-electric development, other smaller areas for various purposes are being placed under the regulations. The cooperation now received from hydro-electric officials is gratifying. It is realized that a healthy and prosperous population is the foundation for industrial development.
TUBERCULOSIS SANATORIUM
EDSON W. GLIDDEN, M. D., Superintendent.
The most pressing need of this institution is a nurses' home, and appropriation for one should be made at the coming session of the general assembly. This will release rooms at present occupied by nurses to administrative staff, now housed in rooms needed for other purposes.
Our present heating plant soon will be inadequate, and if a nurses home is built, a much larger one will be necessary. It is recommended that appropriation be made for one, separate from the buildings, adequate to heat the present and projected buildings.
A complete dental equipment has been installed, so that in the future, proper dental att~ntion will be given those wno heretofore have been forced to go to Gainesville or Cornelia for treatment. If they were too sick to travel, they have had to do without treatment. Dr. Brice, of Gainesville, and Dr. Jarrell, of Cornelia, have volunteered to care for the dental work for us, but it is feared these busy dentists will not be abl to give as much time as will be required. It is felt eventually we will have to employ a part-time permanent dentist.
Grading the grounds have been continued. The planting of shrubs and shade trees has been completed and the lawns enlarged. The new sanitarium has been completely painted inside. The reroofing of tne helio-decks has been completed.
The sewer plant has been partly renovated. The water supply has been a serious problem, much damage already having been done to the plumbing and machinery by mineral contents of the water. It is hoped that shortly the new chemical treatment plant and sewage basin will be begun.
A new railroad station has been built for us and hedge plants placed by the Southern Railway. Grading about the station has been done by the saaitarium and grading done.
It is assured the Masonic cottage will be ready for occupancy about July 1929, and that the school building will also be ready during the year.
The medical staff has remained unchanged, except Dr. Foster, formerly a patient here. He was put on duty, but after three or four months resigned to take a more lucrative position.
33

STATISTICAL

1927

Number of patients reported on __ --- _________________ -_ 224

Number of patients not tubercular_____________________ _

10

Patients in Sanitarium at end of year __________________ _ 142

Total patients treated during year _____________________ _ 366

Hospital days _______________________________________ _ 38,385

Average daily census _________________________________ _ 105.2

Average stay of patients______________________________ _ 153.57

1928 430 32 196 626
64,416 175
134.8

CLASSIFICATION ON DISCHARGE

1927

Hilar and tracheo-br<fu.chiaL __________________________ _

MinimaL __________________________________________ --

12

Mod. Advanced _____________________________________ _ Far advanced _______________________________________ _
Non-tubercular______________________________________ _ Not classified _______________________________________ _

91 107 10
4

TOTALS__________________________________ ---- __ --

224

1928 10 64 131 180 32 13 430

AGE AND SEX OF PATIENTS, 1927

Age

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

Male____ 3

17

41

16

17

12

1

Female _ 5

25

45

26

9

4

3

Totals___ 8

42

86

42

26

16

4

Total 107 117 224

AGE AND SEX OF PATIENTS, 1928

Age

1-10 11-20 21-30 31-40 41-50 5l-60 61-70

Male____ 25

42

53

29

18

8

2

Female__ 21

64

87

49

23

6

3

Totals___ 46 106 140

78

41

14

5

Totrl 117 253 430

34

SCHOOL FOR MENTAL DEFECTIVES
J. W. ODEN, M. D., Superintendent.
One of the most serious situations confronting the government of Georgia is the care and training of mentally defective boys and girls. The following table of percenta5es of feeble-minded population in various types of institutions will give a good insight into the situation:
Orphanages ______________________ 28 percent Almshouses ______________________ 40 percent State Farm ______________________ 18 percent Public Schools___________________ 4 percent
Other than the above there are 200 feeble-minded children in the State Sanitarium at Milledgeville.
This means that state funds are being expended in these institutions for their care, when, as a matter of fact, they are not prepared to care for this class of unfortunates and should not be burdened with them.
Figure, if you will, what this costs the state in money, aside from the humanitarian standpoint. The normal individual is being handicapped and the defective child is being deprived of the proper care and training. Georgia appropriates far less than any other state that makes any effort to care for their mental defectives.
During 1928, our appropriation was $60,000. With these funds, we have more than doubled our population and spent for repairs, replacements, buildings and other equipment nearly $25,000. In addition, we have kept our carpenter busy with small repair jobs and general upkeep of the plant. I believe the institution is in better condition in every respect than it has ever been.
We should have, for immediate use, a silo connected with the dairy, a mill for grinding our own meal and grits and have the whole farm fenced with substantial wire fencing.
We have a waiting list of several hundred, necessitating two buildings costing $100,000 each with a corresponding increase in maintenance appropriation. Another urgent need is a well-equiped hospital building. A cottage is urgently needed for the superintendent and his family apart from the buildings in which the children are housed. The cottage the superintendent is now using would be well-adapted for the care of low-grade boys.
In view of the fact that the period of training is necessarily long, few deaths occur. We have had only five since the institution opened in 1921.
A law should be enacted as early as possible regarding the marriage of the mentally and physically unfit. Our records show that more than 50 percent of the population of this school is due to the intermarriage of mentally-defective parents.
Another law changing the name of the institution from the Georgia Training School for Mental Defectives to something more appropriate and less suggestive is recommended. Our high-grade children and their parents object seriously to the present name.
The superintendent would like to express his appreciation for the cooperation given by the Kiwanis Club, the Rotary Club, the different charitable organizations and church societies of Augusta and Richmond county and to the Georgia Elks Association for the many things they have done for us. It will be remembered the Elks gave to the children here in January 1928 a mostJup-to-dateland expensive playground.
35

MOVEMENT OF TOTAL PATIENT POPULATION

Males Females Total

Into Institution_________ ________________________ 48

43

91

Away from Institution ___________________________ _

TotaL ________________________________________ 48

43

91

Received during year______________________________ 63 Total on books during year_ _______________________ 111

16

79

59 170

Discharged: Into community________________________________ 8
To all other institutions_ ________________________ 2 Died__________________________________________ 1

3

11

1

3

1

TotaL______________________________________ 100

55 155

MENTAL STATUS OF ADMISSIONS AND READMISSIONS

Total

1st Admission

Readmission

MF T M F T MF T

Idiot ____________ 4 Imbecile___________ 77

26 42 119

4 77

Moron (Exclude

Epileptic) _______ 19 10 29 19

Not Feeble Minded. ______ 1 1

TotaL __________ 100 55 155 100

26 41 118
10 29 11
54 154

1 11

CENSUS OF PATIENT POPULATION AT END OF YEAR
Males Females Total

Feeble-minded (not epileptic)______________________ 97 Feeble minded epileptics._________________________ 3 Epileptics, not feeble minded. ____________________ _ Others not feeble minded_________________________ _
Total_________________________________________ 100

53 150

1

4

1

55 1.55

36

AGE OF FIRST ADMISSIONS CLASSIFIED WITH REFERENCE TO MENTAL STATUS

Total

Idiot

Imbecile

Moron Not Feeble minded

MFTMFTMFTMFTMFT

Under 10

years______ 13 4 17

2 3 10 2 12 2 ____ 2 ------------

11-14years___ 47 16 52 3 ____ 3 34 10 44 10 5 15 -------- ___ _

15-19 years___ 35 24 59 ------------ 28 20 48 7 3 10 ____ 1 1

20-24 years___ 4 8 12 ------------ 4 7 11 ____ 1 1 __________ _

3205--3249yyeeaarrss________1____4____5__-_-_-_-_-_-_-_-_-_-_-_-___1____3____4________________-_-_-_-_-_-_-_-_-_-_-_-_-_-_--_

Totals_____ 100 55 155 4 2 6 77 42 119 19 10 29 ____ 1 1

ENVIRONMENT OF FIRST ADMISSIONS WITH REFERENCE TO MENTAL STATUS

Total

Idiot

Imbecile Moron

MF T MF T MF T MF T

Urban___________________ 73 11ural ___________________ 27

44 117 10 37

1 3

1 1

2 54 34 88 18 9 27 4 23 9 32 1 ---- 1

Total ________________ .100 54 154 4 2 6 77 43 120 19 9 28

DISCHARGES WITH REFERENCE TO MENTAL STATUS AND AGE

Total

Idiot

Imbecile

Moron

MFTMFTMFTMFT

Under 10 years.__________ ll-14years ______________
15-19 years_______________ 2 0 - 2 4 y e a r s ______________

2 ____ 31
53 1 ____

2 2 ____ 2 _____________________ _ 4 1 ____ 1 2 ---- 2 ____ 1 1
8 ------------ 3 3 6 2 ---- 2 1------------ 1---- 1------------

Totals________________ 11 4 15 3 ____ 3 6 3 9 2

3

37

GENERAL BOOKS
RECEIPTS
Year Ending December 31, 1928
INCOME General Fund
State Appro: General Maintenance ______________ $ 110,000.00 Venereal Disease_________________ 10,000.00$ 120,000.00

Interest on Bank Balances: General Fund ___________________ _ Rural Sanitation Fund ___________ _

475.78 43.67

519.45

Total of General Fund Income_-------------------------- 120,519.45

Rural Sanitation Fund

Rockefeller Foundation______________ 11,220.83

Less Refunded___________________

477.29 10,743.54

CoCurnistyp _U_n_i_t_s:_________ _ Less refunded _____ _
EmanueL ___________ _ Washington_________ _
Less refunded _____ _
Wayne _____________ _ Worth ______________ _
Less refunded _____ _

3,400.00 14.18
3,375.00 659.52
1,500.00 23.70

3,385.82 750.00
2,715.48 2,750.00 1,476.30

11,077.60

Total of Rural Sanitation Fund__________________________ 21,821.14 Maternity and Infancy Fund
ScheduleR 1----------------------------------------------- 52,709.79

Total of Income Receipts________________________________ 195,050.38

NON-INCOME State Appropriation
State Tuberculosis Sanatorium___________________ _ 169,952.13 Training School for Mental Defectives ___________ _ 60,000.00 229,952.13

Fees Co=issioner of Health-Ellis Law _______________ _ Birth and Death Certificates____________________ _

80.00 538.26

618.26

Refunds

Maternity and Infancy Fund_________________________________

8.00

425,628.77 Balance, January 1, 1928 _______________ ------ ____ ------------- 8,417.61

$ 434,046.38

38

GENERAL BOOKS
DISBURSEMENTS Year Ending December 31, 1928

EXPENSE

Administration and General-Schedule P L _____________________ $

Bureau of Vital Statistics-Child Hygiene Sanitary Engineering Venereal Disease Biologic Products

" P 2 --------------------" P 3 _____________________ _
P 4 _____________________ _ P 5 _____________________ _ P 6 _____________________ _

Laboratory

" P 7 _____________________ _

20,175.88 21,466.95 2,736.59 13,291.92
10,625.69 6,869.33 31,820.63

Total of Expense Disbursements__________________________$ 106,986.99

NON-EXPENSE
Transfers to Fund Book: Rural Sanitation Division: County Health Work Fund (ExB) __ Malarial Control Fund (ExC) _____ _ Vital Statistics Fund (ExD) ______ _

15,116.70
14,327.19 2,400.00

Total to Division of Rural Sanitation ________ _ 31,843.89 Maternity and Infancy Division (ExE) ----------- 61,036.86

Transfers to Institutions: State Tuberculosis Sanitorium _________ ________ _ 169,952.13 Training School for Mental Defectives ___________ _ 60,000.00

92,880.75

Total to Institutions------------------------------------ 229,952.13

Transfers to State Treasury:

Fees--Commissioner of Health___________________

80.00

Birth and Death Certificates_____________________

538.26

Total to State Treasury_________________________________

618.26

BaBlaanncke,oDveercdermafbte_r__3_1_, _1_9_2_8_:______________________ _ Checks for deposit_____________________________ _

Advances for Travel: Dr. T. F. Abercrombie ___________ _ Dr. Clara B. Barrett_ ____________ _ Mrs. Lucy Kennedy______________ _

329.29 300.00
200.00

$ 430,438.13 1,424.104,203.06
829.29

Total ________________________________________________ _ 3,608.25

Totals _________________________________________________ $ 434,046.38

39

TABLE OF CONTENTS. -0-Page
Personnel---------- - - - -- -- - --- - - - --- -- --- - - ---- - - -- ------------------ 2 Letter of TransmittaL_ _____ __ _________ __ ______ __ ____ __ ___ ___ ___ ______ 3 County Health Work __ ___ __ _____ _- - ---- __ ____ ________ ________ ______ _._ 4 Vital Statistics ___ ____ ___ ___ _____ ___ _____ __ ___ __ _________ ____ _____ ____ 6
LabQratory --- - ------- - --- -- -- --- -- - - - ---- - -- ----- - ----- -- - - --- - ---- 19 Sanitary Engineering __ ____ ___ ___ ____ ____ _____ ________ ___________ ______ 22 Child Hygiene _____ _____ ____ ___ ______ __________ ._, . ___ _____ ____ _______ . 25
Oral Hygiene. _---- ___ ___ --- - - - ---------- - - -- ------- - -.- --.-- . 28 Venereal Disease ControL __ __ __ ___ __ ______ ______ ---- ___ _-- - - --- ___ .29 Malaria ControL __ __ __ :. ________ ______ ____ ____ ___ ___ - ____ _--------- _. 32 Tuberculosis Sanitorium. ___ _______ __ __ _________ ____-._ .- - .- - --- -_ - - .33 School for Mental Defectives____ - - --- - _____ ____ ____- __ - - -.-- - ----.- -- - . 35 Financial Statement. __ ________ __ -- - - . --. - - - -. ----- ---- - - .---.--- .38