Biennial report 1931-1932

STATE BOARD of HEALTH
OFFICIAL. BULLETIN
ON

' I~
BIENNIAL .REPORT
DEPARTMENT OF PUBLIC HEALTH
1931-1932
.,

(Table of Contenb on Back of Cover Page)
' ~~ ----------------~------~
..

'

T. F. ABERCROMBIE. M. D.

COMMISSIONER OP HEALTH

ATI.A.NTA

STATE BOARD
of HEALTH
. ~:
OFFICIAL BULLETIN
ON
BIENNIAL REPORT
DEPARTMENT OF PUBLIC HEALTH 1931-1932
T. F. ABERCROMBIE, M. D.
COMMISSIONER OF HEALTH ATLANTA 1

MEMBERS S'l'ATE BOARD OF HEALTH
-0Ex-Offid o: HON, EUGENE TALMADGE Governtr of Georgi a

NAME
Cleve land Tholfpson, M.D.,
C, K. Sharp, M, D,,
R, C. Ellis, Esq,, M, M, Head, M, D., fl.on, Rnbert F. Maddcx A. R, Rozar, M. D., M, M. tlcCord, M. D. 1 H, '1/, Clerr.ents, M. D., L. C. Allen, M, D,, W. A, Mulherin, M, D., M, H, Varn, D, D. S,, R, F, Sullivan, D, D, S,, T, C, Marshall, Ph. G,, Claude Rountree, Ph. G.,

-0RESIDENCE
Mi lien Ar I ingtcn Americus Zebulon Atlanta MarJJn Rome Adel Hosch t e n Augusta At Iant a
SaiJama~
Atlanta Thomasvi I Ie

TERM EXPIRES
Sept. I, 1339 Sept. I, 1939 Sept. I, 1936 Sept. I, 1937 Sept. I, 1936 Sept. I, 1938 Sept. I, 1938 Sept. I, 1938 Sept. I, 1939 Sept. I, 1937 Sept. I, 1934 Sept. I, 1934 Sept. I, 1935 Sept. I, 1935

REPRESENT! NG
First Distriot Second District Third Distri<'i Ftrth Distr id Fifth Diitrict Sixth Di:.triot Seventh District Eighth District Ninth District Tenth District State-at Large State-at-Large state-at-Lru-se State-at-Large

NOT~I The State IXIard of Health was appointed July 5, 1933 by Hio:
Excellency, Gnvernor Eugene Talmadge, in pu-suanc<1; of an
Act approv&d Mlrch 18, 1933

2

DEPARTMENT OF PUBLIC HEALTH
Personnel of Staff:
-0-
D., T, F, ABERC'RCM31 E~ M,
Director of PubI i c Hea Ith

-0Chiefs of Divisicns:
Joe P, Bowdoin, M, 0, 1 ...................... Assistant Director of Public 1-\::alth Child Hygiene, Vl;flereal Diseases,

Thomas Fcrt Sellers, M. D., .................. Laboratory

Millard E, Winchester, M.D.,

County Health Work

Daniel L. Seckinger, M. 0,, ................. Epidemiolegy

H, C, Schenck, M. 0,, ....................... Tuberculosis Control

Butler Toombs ................................ Vital Statistics

Lee Massey Clarkson ......................... Sanitary Engineering

C. L. Tinsley................................ Finance and AecoU1ting

hlgus A. Acree .............................. S11ppl ie:o

3

(
Atlanta, Georgia,
August 30, 1933.
To His Excellency, Hen. Eugone Ta Irradge, The Governor of G<;;orgi a.
Dear Sir:
I have the hcncr to present to you the biennia I repcrt of the
Department of Public P.ealth fer the yoars 1931 and 1932.
lnGreasing demands and requests fer servjce to the people of the State are being met without any curtai lrr:ent on account of decreased reviilllues. So far, tho persomel of the dopartrr.ent has loyally absQrbed the greater pert of o~r diminished resources by reductions in salary, in order that the standard of service we have set in the past may be m~intained.
New problems are constantly presenting themselves fc;r solution by this deparbrent, and these are being ~ret with dosp;tch by both our offi co ar.d
fie! d for cos,
The rapods of the divisions of the deparitrent arE) set fcrth in the "follcwins order:
Laborat~ry,
Scni tary Engineering, Child Hygiene, Vener-ea I Di seo~ses1 Epidemiology, Co~nty Hea!Ur 'ilork,
Tuberou los is Ccnio I, V[tal Statistics.
4

DIVISIO~ OF LABORATORIES T. F. Sellers, Chief

1931 and 1932:

I beg to submit the following ccnso\ idated report for the years

SP~C\Ij[JS EXA' \Ni:f) IN 8ACTERIOLOGICAL LABORATCR'I

Twbercu los is Total Positive

1931

19)2

3,121 714

OiFhtheria Total Positive

1,813
340

'1/idal tusts for Typhoid (Dried sr-ecim:ms)

Total

552

Positive

152

Agglutination Hcaction (liqJid speciw.cn>) Total

3,5)0

Pcsitive for Typhoid Paatyphoid Bri I i 1s Undulant Tularomia Mi sed Ianeous

I ,C84

918

79

22

189

309

58

56

34

3!

()

8

Blood Culbres Total Pes it ives - Tohl
Positive fer
Ty~hoid Pa~atyphoid
u.-.dul ant Other Crgani sms

3,345 431
410
6
~
6

3,6rn
410
)90 8 4 8

Gonococcus Total Positive
5

2,155 520

Spec irr.Gns examined in Bacter iol og ical Laboratory ( cont in~ed)

1931 Stool and L:r in'-' Cui tures

Total Positives - Total Positives for

1,829 83

Typhoid

76

Paratyphoid

I

Oys.:nte;ry

6

Oth~r Organisms

0

1932

I ,980

i

142

/'

134 5
2

Malaria Tobl Positive

10,88~
388

17,284 1,004

Intest ina I Parasites Total Pas itive
Rabios Total Pas it ive
Mi see II aneous
Tota I for year
'.':assermarn tests Total Positive

19,535 4,268
815 355 703 49,146
46,711 1'1,418

27,651 3,124
...
813 360
b09
63,657
49,296 11,757

\later Sanples Grand Total

9,419 105,276

9,175 122, 128

The following table canpares the growth of the laboratory work during th8 past

five yeors: ~

1928

192)

1930

1931

1932

Bactcr ioIog i ca I spec i trens 19,155

25.7~0 ?1,576 49,146 63,65?

l

\'lassermar:n tests

32, ~6G

36,768 49,328 46,711 49,256

I

Water analysis

_Jhl12 .....ij'i8 ...2z..04'i ~ ..h.!l5..

Total

6o, 107

?0,986 89,94.9 IC) ,276 122, I2R

6

The total number of specimens handled during 1932 was 122,128, an increase of lb1 852 1 cr J6y;, l'hi Ia nearly all types of spocin:ws increase:d in number, the
principal gain was due to blood smearrs for malaria and stools for intestinal parasites,
During 1932 thoro '1/a an increase of 16% '>VOr 1931. For the two year period of 1931-1932 the increase owr the preceding two ye:.ars was 41.3%.

There is considerable variaticn in the amount of work required
for each type of specimen. CGrtain specimens are subjected to a number of separate tests which are called procec!~res, For example- the a'Jc.rage specimen to be examinGd for diphtheria requires two procedures, while a specimen of I iquid blood requires about five procedures in examining the serum fraction and fo~r for eXamining the clot fr~ction which, incidemtally1 is regarded as a separate specimen, If the \.assenr.arn test is a Iso dos ired, a pert i en of the serum is referred to the Wassermann Laboratory and is also co~ted as a separate specirt:n. As shown by the following table, the total nUilb~r
of procedures for 1931 was 340,5121 or an average of 3.2 procGdur5s per specimen, ar.d for 1932 tho tota I nLmber of procedures NaS 381,327, Cf" an average of 3.1 precodurfls
par speciJT.cn.

Types of specimen

Nuff.bcr of procudures per sp.cc i rr.en

Tuberculosis

2

Diphtheria

2

Widals

2

Agglutinations

5

alood Cultures

4

Stool & t!rino Cui tures

3

Gcnococcis

rt~alaria

2

Intestinal Parasites

2

Rabi-::s

3

rM see II aneous

3

1\'asscrmann

4

iater

4

Tot a I number of prpcedure$

Average number of prvcedu-es per specirren

Nur.ber of procedures

for each typo of spec.

1931

1932

6,242

6,&82

5,818

3,626

I I 104 166,500

776
1~,180

13,380 5,487

J4 I 748 5,940

1,927

2,155

21,760 34,568

39,070 2,445

55.302 2,439

2,109
186,844 37,676
;!40,512

1,827
197,184
36,700 JSI,)27

32

3.1

7

S?UTUh' EXMW~AT IONS

The following table compares tho sputum examination results in tho

/

past f ivo years,

Nurrbor of spcci rwcns examined Nuwbcr of pos it ivo ;'ercenta.ge pos itivo

1928 2,261
,163 20,4

1929 2,325
~.84
20.8

1930
2,556 482 18,8

l9JI 3,050
709 22.8

1932 3.334
428 12.8

.~verago
2, 705 513 19.1

rositi1c findings fer tubercle baci IIi obtained in cnly 12,8;: of specimens as compared with 22.8), in 1931. This was largely due to routine examination of sputum fer barccrs who, as a rosul t of recently cn-fcrood regulations, arc reqc.ircd to submit to this test in order to obtain I icensc to ~ractico, ~ractically all such spociw~ns were negative.
EXf"''NATIO~l OF CULTUi~ES FCI~ Dh'HTHERIA

1931

1932

Tota I

:ositi,c

Total

f'osi tivc

Diagnosis

2,281

452

808

196

~:

Release from Quarant inc

251

77

291

91

Dotoetion of carrier

252

22

673

50

Virulence Test Total

26

17

2,909

568

7

3

I ,813

340

~ihilo morbidity ard mortality records are not yet available, tho incidence of diphtheria was ap~ar<mtly low during 1332, Only 1:;6 positive diagnostic cultt..res were obtained as cow.pared with 452 "for the preceding year,

Tho following table shews the n~.mber of positive diagnostic cultures for diphtheria for tho past five yoars,

1928 ~ O'ii tive d iasnost i0 cui tures

182

1929 II

II

rt

83

1930 II

11

rt

123

1931 II

rt

II

452

1932 11

II

rt

196

SEROLOGIC/1L AGGLLITIIIJATIO~I HEACT!Or-!S (Liquid Blood)

Th~ demand fer this work continuos to increase. 3,8)6 specimens of I iquid blood were submitted for agglutination fer typhoid, pantyphoid, Sri I Jls typhus, undulant fever and tularemia, as compared with 3,530 for 1931 and 2,569 for 1930,

.\n analysis of tho positive agglutination tests shows th.. following:

Typhoid and i aratyphoid Brill's (Typhus) Undu Iant Fever Tularemia Other Crganisms

1931

1932

1,163

940

1~9

309

58

56

34

31

0

8

These figures should, howt:lvor, not bo i:'terpreted as an indox to the incidence of these diseases. 1\gglutinations, per se, except strong reactions for undulant fover and tularemia are not specifically diagnostic,

TniUS (8r i II' s Disease)

309 positive \'lei 1-Fel ix tests for An:orican typhus were obtained as compared with 189 for 1931. The epidemiological report ~cws 290 cases on record fer
1932, 146, or 50.;$ of these wero repcrted through 0\J" Iaboratory. 96 cases 11ere
ropcded from Savannah and Chatham Comty. i''resumably diag10sis of all of those was confirmed by the Savamah laboratories, Several endomio foci were located nhere rats :.
were very prevalent.

the past four years.
January Feb-uary March Apri I May Jll'le July August September October November December

The fo II owing tab Ie shows tho reported incidence of typhus dt:ring

1)29

1930

1931

1932

7

14

15

7

7

12

3

II

H

8

b

10

II

4

22

4

13

5

15

b

II

5

21

5

28

15

25

2b

38

19

45

16

'f;

16

46

II

29

17

56

15

15

19

28

6

13

8

28

Ut{)UL\NT FEVER
lhe incidence of this diseas<J shows no increaso. 56 positivo reaotions for ~J~dulant were obtained as ccmpared with 58 fer 19~1, 33 cases were roported to the Epidemiological Department. Of this numbr 23, ot 7ar, were roported
throU\fl our Iabcra tcry.
9

TULAREMIA

Tho incidence of tularemia oS indicated by laboratory findings was
slightly less than fer 1931.

BLOCD CULTURES

Nurrher posi tivo fer 8, typhosiJI Nurrber positive for 8, paratyphcsus Number positive for er. abortus Nurcbcr positive for Other Crganisrrs

1931

1932

t, 10

330

6

8

9

4

6

8

Note that of 338 bIocd ou I tun;s posit ho for the typha id par a-
typhoid group only 8 cr 2% were paratyphoid in 1332, This is evidence of the relatively
minor importance of this disease in ou- State.

STOOL AND URINE GLULRES
Number positive fer B. typhosus Nurtber positive fer 8. paratyphosus Number positive for 8, dysentery Number positive for Other Organisms

1931

1932

76

134

I

5

6

0

2

Duo to tho activity of tho Epidemiological depart~rent, interest in this wcrk has greatly increased, ;'ositive findings occu1red in li,2 specirtens as com-
pared with 83 in 1931. f, new mediwn for the isolation of typhoid in stools and urine
ha~ been recently investig~ted in our laboratory and found to be far superior to the old endo rr.edi~m. This new medium was devised by 1'/i II iam & Blair of Belfast, Ireland, and so far has not been used in this country. The improved technique will undoubtedly greatly increase our positive findings fer the coming year,

MAL~RI A

The following table shews the positive malaria for the past five years:

1928

1930

1931

1932

281

486

388

I,C04

Of the totul "f 17,284 blood smears examined fer malaria, cnly 2,731 were routine speoi~rens submitted by physicims for diagnosis, The remaining 14,553
were largely thick smears submitted by health' w~rkers for tho p~rpose of determining

10

malaria indices, The most interesting of these indices was that of Calhoun County made
in 1932 which showed 1 g-oss positive blood index of 26,\S%, Many of the negro schools showed a positive index of more than 60%, the highest bGing 87.5%. A rr11re dotai lod
discussion of this wcrk wi 1\ be found in the reports of the Epidemiologist and the Chief Sanitary Engineer,

INTESTINAL PARASITES

Single \nfest~tion
,Jorms fer Indent if ication Hookworm Dwarf Tape Worm Rourd Wcrm Pin Ylcrm ihip Ylcrm Amoeba histolytica SpeciJrens not included in above

1931
I
3, 714 279 75 59 22 6

1932
1\
8,251
217
280
66 25 3
4

41 !60
DOUBLE INFESTATION (Two kir.ds of worms in same patient)

Kookworm and dwarf tape worm 1'1ookworm and romd worm Hookworm and p in worm Hookworm ar.d wh i p worm Hookworm and Hyrrenol ep is d iminuta Dwarf Tape Worm and Round Worm Dwarf Tape Ylorm ard Pin \'lcrm Round worm ard pin worm Rour.d wcrm ard whip worm Pin worm ard whip wcrm

50 26
II 10 I
2 2 l
_ _o
104

97
ll8
17
9 c
8 0 ~
8
_I 264

TRIPLE INFESTATION (Three kinds of wcrlf.s in same patient)

Hockwcrm1 dwarf ta~e wcrm am rourd wcrm Hockworm, dwarf tape worm ar.d pin wcrm Hookworm, rourd 11crm ar.d pin worm Hookw.;rm, ro~nd wcrm and whip worm

0 2 _ _!
4

2
6
_ l_
tn

11

MISCELLIINEOUS EX M4 I'~.'.T IONS

1931

Uorrrs for Ident if i cation

0

Dark Field

16

L'rines (Bacteriologi~al)

IJO

Diff~rential blood counts

69

Vir.cent 1s angina

141

Chancroid - B. Oucrey

16

1\1 i see I I ar.eous CuI lures

Type of Organism

1811

Spinal Fluids for ~l.eningitis

62

Unclassified

88

703

1932
7 9
129 84 1)6

ANIMAL HEADS EXN.'INED FCR RABIES

Nurrber heads examined Nurrber pos i ti ve fer Neg- i bodies i'ercentage i"osi ti ve

1928

1929

193f

1931

1932

621

652

I ,050

803

791

210

289

507

351

343

33.8 34.3

48.2 437 4J.J

CLASSIFICATION OF Al~ii/AL HEflDS EX.V!INED FCR Rfli31ES

Kind of Anirral
Dog Cat Ccw Mule Horse Hog Goat

?ositive

1931

1932

324

JC8

16

16

10

13

2

0

2

0

I

0

I

351

343

I.'ANUFACTlRE N;o DISTRIBUTION ~F f\NTIRABIC TREATMENTS

Year

Human

1928

I ,26Q

1929

I14i'4

1930

2,466

1\ni<rar
212 1(;8 196

Total
I ,472 1,642 2,662

H~man deaths from rabies during and after treatrwnt
2 I 2

1931

I, 789

178

1,967

0

1932

I ,748

98

I ,846

12

1931

Canine Vaccine distributed

791

Typhoid vaccine distributed 1928 Ty;Jhoid vaccine distributed 1929 Typhoid vaccine distributed 1930
Ty,,hoid vaccinG distributed 1931 Typhoid vaccine distributed 1932

320.705 c.c.
317,802 c.c.
390,645 ~.c.
421 ,bob c,c.
640,823 c,c.

kl investig..tion 'Of tne potency of ou- typhoid vaccine was begl.l1 dtring 1932 and is being ccntinued, Thoro is sufficient evider.co at hand to indicate that the Rawlings strain of B. tyrhosus which has boen used by tho U.S. Army 11'adical School ard by almost all stato, ll1\I,iciral and corr.rmrcial laboratories fer the manu-
m factLre of t~hoid vaccine has lest much of its criginal antig~;nic potency.
increasing nLII'her of cases of typhoid fever repcrtcd as occ<.rring in vaccinated persons during the jlast three cr foLr years may be attributable to this deterioration. After studying a large nt..mber of strains of B. typhcsus, most of -M1 ich wore of local origin, we have decided to us6 as vaccine antigen a strain isolated from the blood of a yoo.;ng white mar who had r.reveiously rec&ivcd our vaccim prcperly administered cne year prior to cnset and also three years rricr to that. This strain seems to fulfi II all requirements in evo1y way.

Plans fer a rather critical stt.o'dy of the entire subject of typhoid vaccinatico are ncw t..r.dcrway, nd only in ot..r State, but throughout the lhited States urder the auspices of the A.~.H.A. and the National Institute of Health.

As a result of the nurrber of cases of typhoid fe-.er in Athens
occurring among vaccir.ated ;.ers:,ns in 1931, tho Clarke County Health Oopartlr.ent t:nder
the directicn of Dr.\:,\';', 8rcwn, Health Officer, has suggested that a s;;ecial strain
of B. tyr..hosus ll!ay be locally prevaknt in that col.nty against which strain the Raw! ins vacci nc wi II not ;;rohct, After a vory interesting study of the st.bject, Dr. Brown requested that ou- labcratcrJ pr<..pare for them a special vaocir.e 11111de 'frCII tho
s~veral str~ins isolated from Athws cases of feVEt'. A lot 'Of 5,0CC e.c. was prerared and has beer. used exclusively in Clarke County d~ring 1932. No 1.1\toward reactions
r8sultcd, 't is yet too early, how~vif, to obte.in any sati;;factvry data as to its
s~.per ior i ty owr Raw I ins vaoo in<:J.

Due credit should be given to Or. &-own and his bacte-iologist, Miss Louise Stcry, for their part in !:ringing about the rrcduction of an imrroved typhoid vaccine. A mere detailed report en the vaccine study will be made later.

13

r-

TY'W:IO VACCINE DISTRI81JTED Tr COUNTY HEALTrl OFFICERS
DURING nRS 1331 ard 1932

County Baldwin 8artow Bibb Brooks Chatham Clarke Clinch Cobb Coffee Colquitt DecatwDeKalb Dougherty Floyd Gl )On Grady Hall Jefferscn Jerl< ins Lai.T&"\S Lowndes Mitchell Augusta & Richmond Spalding Sumter Thomas Troup II are Washington City of Col ur.bus City of Atlanta
Grand Total

Total Number c.c. distributed during

1931

1932

2,225

3,440

6,500

7,821

3,630

7,121

3,61;;

12,419

2,6oo

6,657

6,634

2,230

I, 788

0

IO,COO

12,122

3,008

0

),700

9,321

3,965

9.333

8,490

3.750

910

2,981

5,900

24,691

620

0

3,023

4,344

10,308

2,640

6,186

5,801

4,100

6,o69

5,700

10,680

6,086

4,826

3,106

30,298

6,600

8,495

4,9QO

6,392

3,406

6,545

3,610

12,711

6,350

8,938

5,616

8,398

4,726

20,098

2,250

4,574

1.Q12_

_2z.QR_

154,552

256,496

14

OIPHlHERIA ANTITOXIN

Number Lnits diphtheria antitoxin di.stributed 1928

11

"

"

1929

II

II

1330

II

It

11

1931

"

It

11

1932

TOXIN-ANT ITOXIN

Number c.c. Toxin-antitoxin distributed 1928

"

11

"

11

"

11

11

"

"

""

TOXOID

Number c.c. toxoid distributed 1931

"

"

1932

S(}l ICK MATERIAL

Nurrber c.c. Schick material drstr ibuted 1328

,, " 11

1929

"

II

" 1330

II

11

II

1931

"

II

1932

SMALLPOX VACCINE POINTS

Sma II pox vaccine points distr ibuted 1928

"
I!

11

" 1929

11

II 1330

" "

II
,,

II 1931
" 1932

SILVER NITRATE AM'ULES

Silver nitrate ampules distributed

II

"

"

"

11

"

"

;i

1928 1929 1930 1931 1932
15

35.999,000 30,6')6,oco 29,924,000 34,565,000
Jb, 141 ,ooo
39.710 104 1 ]b8 49,074 26,774 17,565
7,84f.
II ,400
13,490 16,155 10,125
32,400 27,160 27,710 26,817 27,830
34,749 41,883 39.767 41,423 46,050

TETANUS ANT ITOX IN

.. Number units tetanus antitoxin distributed
" " "" "" II

1328 1929 1930

II

II

"

II

1931

""

II

" 1932

713,000 2,562,000
2,881 ,ooo
2,599,600 8,398,8GO

CARBON T~TfiACHLCiliDE-OIL OF CHENOPODIUM ~11XTURE

Number c,c. Carbon tetrart,l.,ride mixture distributed 1928

"

II

1929

"

II

"

1930

"

II

"

1931

"

"

"

1932

11,685 21,280 23,231) 18,409 28,6?3

TU3ERCULIN

Number Tt.<bercul in tests distr ibut6d 1931

"

"

1932

YEAST

66,800 pol.llds of dried Brewers yeast were purchased and distributed during 1932 as ocmpared with 100,400 pounds distributed in 1931. Several thousand prunds were distributed free to indigent patients. Not more than two pounds per month was supplied to any cne applicant,

Yeast is sold primarily for the prevention and cure of pellagra but its distribution is not I imited to this field.

Respectful! y submitted,

T. F. Sellers, M.D., Chief of Laboratories,

16

DIVISION OF SAl~ITARY ENGINEERING L, M, Clarkson, Chief
I have the honor to slhmit herewith a biennial report of the Olvisicrt of
Sanitary Engineering for 1931 and 1932
S!Tvioo rendered by the Division of Sanitary f:ngineering may be listed as .follows:
S~.p0rvision of design and operation of public and semi-public water supplies,
CErtification of water supplies for interstate trar'ISportation in cooperation with the United States Public Health Service.
Supervision of design and operation of swimming p~ls,
Sanitation of private water st.ppl ies.
Laboratory service fer bacteriological cxaminacions of water st.ppl ies,
Supervision of design and operation of sewage and industrial waste disposal plants,
Promotion of privies and home sewage disposa I pI ants
Promotion and s~..pervision of malaria control by drainage and other methrds,
Cooperation with State Department of Edl'cati.n for school sanitation,
Cooperation with United States Pub! ic Health Service field investigations of malaria control,
Munieipal sanitary sarveys and emergency sanitary problems,
llrganizt.tion, enginoering surveys and supervision ef 111e111ploymcYit rol ief in oolrlties reeolving Reccnstruction Finance Corpcration loans,
It wi II be roted that the abcvo itoms of service may be classified undor urban ard ri.Tal, In rendering such service wo must ccnsider tl!.at a majcrity of the total imabitants of the State live on farms and in unincporated towns and villages. It is also true that populatiens without the faoi Iities ef m'-'licipal governments and sanitary regulations are in c:crtsideraele need of assistance to improve insanitary environments.
17

Tho State is physiographical ly divided into two sections almost equal in area and population: narrLiy, the Piedmont Plateau on the North and the Coastal Plain an the South. The sanitary engineering problems in those twa sections are extremely adverse, In tho industrial Piodrror,t Plahau water filtration pl:mts, sewage disposal and industrial waste are major problems. In the agricultural Coastal ?lain deep well water supp I ies, sma llcr municipal populat i ens with lesser sewage and industria I waste comprise the rn.micipal sanitary problems. However, in this section are two problems of esp~cial importance: narr.ely, hookwarm and malaria. Tho malaria prablom is so vast in extent ar.d so exceptionally endemic that it constitutes a problem in public health and eeonomics unequalod in few sections of the coiSltry. Drainage and general rural sanitation are urgent necessities.
It has for some time been the objective to divide sanitary engir.eering application nearer equal between these twt- sections, specializing l"n problems characteristic of each secticn, This wa~ in the past difficult en account of distance an;l inaccessibility of tho Coastal Plain section from administrative headquarters, Long distance travol involved mu:h time and expmsive transpcrtati,n. Recently it became possible to establish two district engineers, or.c in H.e soutl".west ar.d tho other in tho southeast, special izing en malaria control, deep wd I water suppl ics and other m~;nicipal and rtre.l sanitary engineering rrobl~ms, This plan has made it possible, fur other personnel at administrat ivo headquarters to more adequately serve tho P icdmcnt PI ateau soot ion on such problems as filtration of surface water s~;pplios, sewage and industrial waste into water s~;pply streams and other correlated ~roblems, This distribution f personnel is resulting in marked progress in each activity of the Divisi(')l1 and the public is receiving rrt~re equal distribution of service in a moro eccnomical manner.
SUi'ERVISION OF PUBLIC ::ATER SLfHlES
At the end of 1932, 286 p~;bl ic and semi-p~;bl ic water s~ppl ies made water avai Iable to I, l2310CO people, or 38,5 per cent nf the total population of the State. Of these s~;ppl ies, 128 maintain purification plants and equiprront. These 128 supplies, emb-acing the filtration and chl<"rination :)lants, f~rnish water to 959,000 people, or 85.4 per oont of the population served by pub I i c water supp Iies. The group of 158 supplies net maintaining treatrrent plants include the deep wells and SIJrings, Within this S'"Ol.P are many towns that have safe wells, and p~.rificaticn as a public health measure can be safely withheld fer the present. This gray:> also inclt.des towns that are not giving the maximum protection to their water C'ons~s through failure to install protective equi~rrent or to Froperly utilize natural conditions which would make for safety if wisely used, Many tor.ns in this latter groy:> are small ones that have made a start towards provi;Jing a p~.;bl ic water supply but lack somo feature that makes for maximum protection.
18

Nature of Problem:
Ev!ln with the ptopor mechanical &quipment ar.d struDtures, tho maintenance of tho safety of a pub! ic water supply is one of constant vigilance on the part of those in local IX>ntrol. Arr.or.g such a larg<> group of supplies there are many persons who are: not trained for the specific work involved. The rate of depreciation of certain types of purification equipment is high and diflgers duf.l to t'lbsoloscence are constantly mounting. It is, therefore, apparent that this Division's efforts must be directed not only to promoting initial irrprovOIIIll'ltS but in better operation of purification equipment already insblled and replacing wern-out and obsolete rr.aterial. The pr<lblem of instructing in water purification, especially filtration, is complicated oy the che~r.ical and bacteriological princi?les involved and the fact that many of those locally responsiblE> fer the safety of the plbl ic watf';r st.pply are not technically trained.
TRAINING OF 1'L!\NT o:'ERATCRS, LABCRATCRY AT-0 RH1lTS
To meet t~e requirements for lnstructins in the elements of water purifi~~tion, the Division has undertaken to teach local rersonnel by having a ~:eprosentative stay at the water plant as long as necessary to demonstrate the use of the plant control laboratory and to apply tho t(Jst results to the daily opcratien of the plant. i';hen this work was started <~.bout fot.r years agf' only two cities, the largest and the fifth largest in tho State, were using a plant laboratory for control of the pt.rificaticn process. Since the in5tructional service has been made avai Iable, fifteen additional filtered sup;:lios have ;>rovicld the chc;mical and bactfjriological laboratory equipment and taken advantage of the increased efficiency and safety resulting from an apr Iication of basic principles s~.perseding the uncertain rules of thwnb. A sinple yet detailed rej>ort form has been prepared up-.n which is kopt a complete recerd of each day's physical, chemical, and bacteriological tests madG by tho plant epClrator. These reports are submitted to this division each month and are equivalent to daily contact with each plant sc cClntrolleJ. It has been demonstrated that this reliabie type of fi Iter pi ant control can bo applied in the smallest as well as the largest toYns. The seventeen fi Iter plants nt'IW cot.trolled by local chemical and bacteriological laboratory represent eam major tr,e of organized oonmU1ity in the state served by a ~X~trmcn water s~..pply. In the list are mcnicipal, in~Justrial village and public institution WJater s~.p~l ies. TIH1 iJCFUiaticn served l>y these seventeen chemical and bacteriological laboratory ea'1'trolle<i filter rlants is ~a,ooo.
In eollabtoration with the Georgia School Qf Teohnology the divisim hold a three day sohool fer fi Iter ;;!ant opEI"ators. The course inoh.ded looh.rus and laboratory worl( direetly rel.tt:d to the pr&ctlcal ~9blems arisina in ;:!ant operati'ln. A laboratory 11\1:111ual was prepwed in mieog-apb form fer use in this eourse. Seventy plant operators and oth' 111111ieipal represontati~s attended this school.
19

~---
~~LANT IM"ROVEr-JENT
Major inrrovements were com;::lotc<l on fcrty-foLT existing water sup~! ies. The
j)cr,>ulation of this group of towns is 552,407. The im;,roveJOOnts inc! u:le fine new fi Iter
plants with control laboratories, ten chlorination or hy;:ochlorite arparatus on deer wells anti s;-rings not ~reviously steri I ized, three old chlorinator plants replaced with new units, six existing filter plants placed under local laberatory control, two steel surface reservoirs re;,facing leaky '.n:lergrot..nd reservoirs, changing construction of the first softening ;:lant in the state, major cr(lSs-ccnnectians with non-potables~ j)l ies el iminatd in two towrs 1 seven towns regularly reporting daily chlorine tests and five sanitary improvements to well rum;: heads, suction I ir.es and ground reservoirs. Tho only sup~ly frem unfiltered surface stream was reclaced by chlorinated springs
during 1332. All water now used from surface streams by the public water supplies
receives filtration and chlorination. Cr.e new filter plant re~lacing an inadequate ~!ant is new \I\Jcr constructicn.
Several cities have made formal ap; I ication to the Reconstruction Finance Carperat ion for f~nds with which to construct now water works systems or reconstruct existing plrification ~lads. Two such loans have boen grante:J in Georgia. Cr.u city is now rebuilding its filter i'lant with !aJar from money granted for relief rurroses. In th<o othc.r city, plans arc being prepared for a corrplete new water system and deep well to be financed with Reconstruction Finance Corporation funds already authorized.
coo: l:fl',TIVE , CRK 1'/ITH UNITI'D STATES 'LBLIC Hf!'.\llH
SERVICE ON DRINKING :IAT!:R ON INITRST\TE CARRIERS
All field inspections, IJborutory and cl~rical work for the L~ited States ?ubi ic Health Sa-vice codification of supplies furnishing drinking water on interstate vessels, trains and airplar.es is done by the Division. In 1~31, of fifty-five public water su;pl ies furnishing drinking water to inte-rstate carriers, eight made major inprovements, forty-one received favorable, eight provisional, and six ~ro
hibitory certifications. In 1932, nine made major improvements, thirty-six
received favorable, fifteen ~rovisional and five prohibitory certification.
SE'::ERI.GE AN0 SElVAGE DISiCS.\L
Routine supervision was given to tho operation of existing sewage treatment plants and to extension to sewerage faoil ities to urban areas not previo~sly sewered, One mll'licipal sewage disposal rlar.t com~ose:! of coarse bar screen, ln:hoff tank, dosing ard measuring tank, sprinkling fi Iter and sludge bod v1as ccnstructed. Cne municipality installe-! sewerage tCJ serve approimately cne half of the tcwn, This system includes ;)arti~l treatment by sedilrentation and Jigestion ef the. sewage sol ids. A textile vi II age was completely sowered followed by Imhoff tank treatment. A new sewerage system was canstr~cted at a health resort, ~nd an additional municipali-
20

l
ty bui It a treatment :I ant,
Improvement of char.ncl Mnditions to permit free flow of stream'> receiving rrimary treat.r.ent r:lant effluents has materially reduced 5ellf"&l local nuisance situations. By repidly leadir.g plant effluents away to largl1" strea.ms, suffici~t diluticn may often be, sec<.red with conseqJel'\t elimination of tldcrs ar.d nuisance mosquito production, TMis is equivalent in many instances to the providing of seconJary treatment on existing primary tarks, This is partieularly a;:.>pl icable when relief fl.nds are available fer hand labor only and when no bui I ding material can be pwd'lased,
SAN fTI.RY RIVY ?RWllT I ON N\0 CONSTRUCT ION
It is not possible to obtain acc~rate inf~rmation of t~e total sanitary privies ccnstrJcted, The number of installatims, esi_oecially r:..ral, must necessarily be considerably greater than those en<;rr.erated. To t;Oderstand the great number of ~.nrecorded installaticn~ it is necessary to consider the manner of sanitary privy rromoticn. Hmc!reds of ir.Jividuals have been interviewed and con fcrred with relative to various sanitary problems ar.d p~l ic health matters, These persons are influential in th.:1ir commmities in txlth public and private capacities or have ocC~.<pied public positions, During such ernferenc!JS oppcdmityhas not been lost tor-resent plans fer sanitary privy oor.struction and to stress the importance of such sanitation. There is no doubt tr.at a large volume of privy construetiCII"l has been a~rorn;-1 ished in this infcrmal marner. Public talks to civic organizations haYe been maje and city co~ci I meetings have been attended for promotion of such
sanitation. The result h1s been passage of the standard plt privy ~dinanoe in a nunber of tcwn$,
In Sl.'lllllarizing the wcrk definitely recorded, a total of 72~ sanit~y privies have been constructed in fourteen towns, 107 in n:ral homes, and 49 at
rtral schools.
The great irrportance of this type of sanitatim is fully realized and this work is being greatly accelerated dLring the CITrent year. The neKt re;:>crt will show this work exceeding! y active.
At the tillle of eom;leticn of this re;:>ort, prog-ess is being tnade in obtaining loans for other oomties from the Reoonstn.:eticn Finanee CO";.>OratiQil for the p<.rpose of both sanitation ar:J unemr-loyment rei ief.
Si'ECIAL TYt'HOID FEVER E.IOI;MICS INVESTIG~TEO
Below is a list of toMlS and corrmunities at which special trrhoid frNer investigations were made upon requests and general sanitation promoted on account
21

r--

1
of e~idemics, Brant ley Cami II a Carroll ton Fitzgerald

Lal!bert Leesbt.rg McRae Nc1ille

Statesboro St..rrenoy \':aver ly

RECA:'ITUL\TION CF P!.SLIC \'lATER SUPPLIES TQ DEC, 31, 1932

Supplies receiving both filtration and ch lor inat ion

Nurrber
6o

Population ,'ercU'ltag~ population ( 1930 cessus) using pub I ic supp Iies
662,000

i'ercentage tota I state population
22.6

Deep wells, shallow we II s and springs receiving chlorination

301 ,ceo

Deep wells, sha II ow

we II s and srr ings not

receiving chlorinatior' 158

16~,coo

14.6

Total pub Ii c water supplies

286 I, 127,0')0

\':ater from home wells and springs in rural sect ions end vi II ages without rublic water sup;-> Iies Total for State

I, 775,500 2,902,500

100,0

38.5
61.5 100.0

Pili Iic su; pI ies accepting

Department 1s Iabcratory

service in 1932

221

~l.blic supplies not accepting De;J<U"tn:cnt' s laboratory service in
1~32
Total

I,088 1 0CC
39 1 COO
1, 127 ,ceo

34
100,0

;'~bl ic supplies making

major improvements in

1932

24

l

RECAi' ITULIITl ON OF PLBL IC WATER SUP"LI ES TO DEC. 31, 1932 (continued) Population Percentage population
Number (1930 census)using public supplies

Percentage total statu population

Fi Iter pI ants under

local chemical am!

bacterial ogical

Iaboratory contr:o I

17 4bo,ooo

41,8

Filter plants under

local dlemical

laboratory control

8

44,500

4,0

FIELD 11\SPECTIONS, CONFERENCES mJ ENGINEERS Plf!NS APPROVED

Pub I ic water suppi i es Sewage dis;>osal Malaria control Swimming pools, privies and misootlanoous Engineers plans fer water Sl'ppl ius approved Engineers plans fer sewage disrosal approved

856
164 1,185
171 10
5

BULLETINS DISTfl ISUTID
Farrrstead wator st..pp Iy llama sewage d i s;:.osa I Pit privy leaflets Mosquitoes and ~alaria control Swimming pool Miscellaneous

3.265
2,829
25.595 6,723
59
2,860

VIATER LABCRATO"<Y I>NALYSES

Bacteriological a Public water supplies Private w1ter supplies S.imming pool Total

Chemical a

Pwl ic water supplies

4()

23

l
MALAR IA CONlROL
Tho year 1~32 was the socorrl full year of intensive prcmotion o-F urban and rural drainage, principally by the use of co~.r~ty and state ccnvicts fer nalaria drainage. The latter quurter of the year was marked by adding tv convict Iaber certain forces classified ur.der unc~loy~T~Jnt relief, city tax delinqumts,: city prisoners and regular city orrplcyoes, It wi Il be noted from the tabulation under "County Drainage for Malaria Control - 1~3211 the naroos of counties, together with thu nl.lllbor of ponds drained, acres drained, and I ineal feet of ;surveys and ccnstruction, In ccndensing this tabulation it can be sho\11'1 that ap;::roximately
141 miles of new drainage was ccnstructed and approximately 500 miles of maintenance, or old drainage invulving Iighter wcrk, There were 745 porrls comprising over 41000
acres rlraino,f,

Even though there was an eXO(;SS of rai nfa II fer the year trroughout the malarious counties the malaria .deaths, due to somo cause, remained practically stationery, Because of its shcrt Juration too much credit shouiJ not be given to drainage.

An atte!'Pt was llBdc during th() year in two coll1ties tc mere accurately obtain infcrmation relati11e to malaria incidence by means of blood examinations in all schools. lmnediately after this infcrmaticn was obtained sbowing a very high rate of malaria infection, cne of these ccll1ties readily agreed to cooperate by assigning ocnvicts fer use on drainage. Drainage surveys are now in ;:>regress and actual cc.nstructkn wi II immediately follow, It is pro~osed to use those two cOIS'Ities as demcnstration areas to measure results. This wcrk is in co~peration with the Division of Epidemiulogy.

Several colrlties have vbtained I.Jans frcm the Reconstruction Finance Ccrporaticn and are using L11e~lcyed forces fQr malaria drainage. It is anticipated that during this year work will be considerably augmented anJ many counties will take advantage of this means c,f unemployment relief and public health i~rovOIT'IJnt.

MALARIA DRAINAGE BY REGUUR CITY EM'LOYEES

The following cities used regular city employees fer the purpose of malaria drainage. The Iist shows the maximum nunber used at any time Jl.ring the year

Americus

. ..,~

4

Baxley

2

Eastman

4

McRae

2

Millen

Sa11amah.

18

Sylvania

4

Waycross

10

Wa)11esboro

8

TOTAL

53

24

l

MALAR!~ DRAINAGE BY FREE LABOR

The fo II owing cities emp Ioyed free Iabor and requi sitiorad com ty

convicts for tho purpose of ~!aria drainage.

Ashburn

3

Brmswick

10

Cami II a

IC

Cordele

4

Fitzgerald

8

Hawk insvi lie

2

Leesburg

2

Manchester

9

Oci II a

3

llaycross

10

Total

61

MALM IADHAINAGE BY DYN/I.MI TE

Aproject worthy of mention is a very serious malaria problem in a valley twenty-five miles ncrth of Atlanta. lhe problem involves several hLndred fami les in excellent agricultural territory. It is nc exaggeraticn to state that the malaria rrublem has been so serious that familes have moved from the CoLnty en account of this condition. The problem involv{!S a drainage project of exceptional magnitude. After three years of effort by the Divisicn, the project was recently started. Pcrticns of the drainage-way huve been improved by the use of dynamite. It is prop<lSed during the current y<Jar tu continue the work, gradually completing the entire pr;,ject.

O..ASSIFIGATION CF COlNTIES OOER MALMIA DRAIIIlAGE

By refer<:nce it will be notej that there are fcrty-fcour counties which have been rendered engineering service by ti"ainage s~rwys and <i"ainago supervision. Sume of these c::>l.l'\tills have practiceu' relaria t:ontrol by the use of col.llty or state convicts for bdh r~ral and U"ban drainage. others have made use of 111isoellaneous labur t'hiefly in blms but in SOIIIB instar!oas fer both l.f"ban and r~ral drainage. It will be ootet! by referring to the d&tail c.f "CJ:u\ty Drainage for 11\tlaria Control - 1~32" that the olassificatic:n of Iaber oth41" than
county or state ca'lvicts is as follows1 (a) ~loy!Wit relief (b) city tax
delinquents (c) olty prisoners (d) regular city empl~es.

Below there is Iisted accredited anJ non-accredited O'J~..nties. h\ accredited coU'lty is defirod as followst (a) cfficial ac!;,pticn of malaria c.:ntrol by col.l'\ty commissioners (b) use of col.l'lty or state convicts or other Iaber authorized by ccLnty officials (c) plan intermittent or continuous consistent
25

l~--

with agreement of county. A non-accredited county is one which has co~leted a project or projects without official asstrance of continuous work.

Accred i ted Counties Appling Ben Hi II
B~rke
Calhot..n Chatham Colquitt Decatur Dcdgo Doughedy Irwin Latrens 1\'criwethcr Mi llcr f/itchcll
f~ontgomery
Richm<;nd Screven Sunter Thomas Turror Worth

Non-Accredited Counties Bacon Bryan Bulloch Candler Coffee Crisp Dooly Enanuel Evans Fulton Glynn Jenkins Jdlnscn Loe Liberty Pulaski Tattnall Telfair
Tift
Treutlen Washington

o'iheeler

CONTROL OF ll.'fOUNOED ''.'ATERS

Under a permit system all water inpcunded in the state must meet requirements for r-rotection of tho pub! ic from malaria caused by impouoding of waters for hydro-electric, water power, recreational and fishing purrcses. The pr:JPOSed area must first be cl~ared d all vegetation, and if in the malarious section of the state an apr;roved larvaocide, together with approved equipment for applying same, must meet specification of the Department of i'ubl ic Health. My person, firm, cor:ocration, county .r municipality desiring to im;oo..nd water must first submit plans and description cf such project. Tho pro;oosed sita is then investigated by a representative of the OivisiJn. If ar,~roved, a prcl iminary permit is granted to proce.;;d with constructicn. This area then is under c~nstant observati::n until satisfactcry work justifies raising of the water .'hen clearin, larva~cide a;pl icati,,n and equipment is satisfactcry, a final maintenance permit is issuod. Below is dato showing tho extent of in-pol.l'ded wat~r malaria control.
26

l

HYORO-ELEC'TR IC \MPOIJllEO I';,IJtR MALAR IA CONTROL

NJilber of hydro-electric developments ~reet ing impoLnded water regulations

NUITber d acres in hydro-electric areas Num Nunber of hydro-electric developments using larveacides fer mosquito centro I
Nutrber of aorea under larvaGcide control

150,000
7
21,000

i'RIVATE IMi>OtJWEO WATEf< PROJECTS

County Bulloch
" "
Bl.l"ke Candler
"
Decatur Liberty M:::Ouff ie
"
"
Meriwether Ware Worth

No. Ponds
5
I lj

N.) Aerea
3
20
20 2 50 I 250 20 10
13
10 100

Owner J. B. Johnsen M. M. Rushing Scu. Ga, Teachers Cui lege Vesta I Lurrber Cclllli>any Mil len Lumber Company
Authority 0f City &County
M. B. Hcwe II Car I isle Veneer Company ?, C. Bowden
G. W, Arrington
G. F. Hobbs U.S. Bureau of Fisheries City of l~aycross Wa II Brothers

It is interesting to note that as progress is made in establishing urban and rural drainage authorized by public officials tho intGrest of individual property owners is als;; so stiruiated tha~ service fr.;m the Oivisim is requested for malaria and drainage investigations. The fact that a pond, either natl.l"al or artificial, usually cc:tstitutes a malaria problem is being more generally reco(11ized. This is a cvnsiderable aid to official establishment of coLnty drain-
ago.
In addition to county and fll.lnicipal project authcrized f\'r ~~~alaria
drainage, individual property owners requested service from the Oivisicn tn private projects as I i sted be I;:w.

27

PRIVATE IML.ARI A DRAIN~Gr PROJECTS

County Bryan Burke Chatham Colquitt
" "
Decatur Jeffersun Jenkins
"
"
fv'er iwether
"
Miller Montgorrory Rich mend Screven Sumter
n
Treutlen '.Jorth
"

Ponds

Acrea

5

90

3

6o

2

2

2

5

I

I

2

G

20

5

2

2

I

I

I

5

15

3

2

3

I

10

I

I

3

15

2

7

I

10

I

ICO

I

2

20

Prcperty OMlor Ford Farms F. F, Cates, Jr. A, C. l., il, 11. Drake Gecrge Thompson Tyson Newtcn Long V,j Ison H, A, Drake Virgi I Burke Alwood A, B. & C. R.R. Rev. Harvy Err.est Sl\effield M, H. Newsorro Gracewood lnstituticn J. A. Mi lis Bailey Geiger ,\, B. Jchnson Champicn Smicrely

fMLA:il A ORA IN.\GE BY MACH INERY

Below is given a list A cccnti~s making use of machir.ery fer malaria drainage. Because of the fact that no type of malaria drainage is contract work, no cubic yardage reccrd is kept ur rer.~rted. The nunber of I ineal feet of drainage by machinery is I isted elsewhere in the repcrt,

Col.l'lty Appling Chatham Decatur Jenkins Pulaski Richmord

Type of Machine
3/4 yd. Drag Linc 3/4 yd. Drag Lir.o 3i4 yci, Shovel 3/4 yd. Drag line 3/4 yd, Shovel 314 rc, Drag Liro

Employed By Courty City Comty County Comty County

28

l

MAL~RIA DRAINAGE BY CITY rRISONERS

The following eighteen cities have made use on malaria drainage of !layer's

cotrt prisoners ar.J tax workers, The maxirrum number assigned at any tirro in these

various cities is shewn boiCJw,

Adrain

30

Albany

10

Alrr.a

15

Cami II a

8

Claxtcn

30

Ccrdele

13

Doerun

12

Eastman

10

Hawkinsvi lie

6

Lee (CoLilty)

8

Leesburg

6

t.'etter

15

Ocilla

7

i'oulan

6

Sandersvi lie

20

Stah;sbcrc

25

Sylvester

7

Swainsboro

30

Tifton

10

268

MALAn IA o:;AINAGE BY LNE~HOYt/ENT RELIEF

Twenty-three cities anc eounties have caree for the Unei!ployed by provid-

ing labor f:r malaria drainage. Because of the fact that employees arc alternated
in order to provide employment for as many as possible, the following I ist shews

the maxirr.um nunber working at any one time ard nd tho total number given ei!ployment

which would be c,,nsiderably great~r.

Albany and Daug1erty Ccunty

141

Arer i cus

6

Ashb~..rn

17

Atlanta and Ful bn C0unty

6oo

Ball ley

12

Cami I ia

7

Claxton

15

Coil ins

4

Ccrdele

25

Doerun

8

Douglas

15

~1Alf,l!A DflAINAGE B'f LNBiu"LOYIIENT RELIEF

(Cent i nued)

Garfield

2

Hawi<$o"1Sv i II e

5

McRae

10

Midvi lie

10

Millen

40

M~ul trie

20

Pelham

8

i'crtal

I

Savannah

10

Statesbcro

15

S)lvania

4

Thomas vi II e and Thomas County

69

Total

1,044

Colilty I. Appling 2. Bacon 3 Ben Hi II 4. Erooks
5 Bulloch
6. B~ke 7 Candler 8. Chatham
9 Colquitt
10. Coffee II. Crisp 12. Detiatur 13. Dodge 14. Oooly 15. Dougherty 16. Evans 17. Fulton 18, Glynn 19. Houstcn 20. Irwin 21. Jefferson 22. Jenkins 23. Laurens 24. Lee

No, f'onds Drained
8 2
4
7 I
35
2 128 51
4
80 23
4
74 II
33 12 61
53 I
86 12 6

No,Acres Draimd Hand La' ="" and
Machinery 66 I
9
9 I
75
12
239 382 10 10
I, I58
30 303 1,073 21 6ta
75
730 289 100
998
151 16

30

Lineal Feet New Cwstruction and Maintenance
33,050 3.000 6,()00 4,100 50,300 60,200 4,250 2,270,500 71,800 6,000 6,300 56,950 12,)20 8,680
153.550 1?,800 62,800 25,000
94,700
43,2L'O 2,6oo 152,425 14,)25 4,6oo

l

County
2). Liberty 26. Meriwether 27. Miller 28. Mitchell
29. Mcntgomery 30 Pulaski
)I. ;iichmond
32. Screvf.ln 33 Sumter 34. Tattnall 35 Tel fair 36. Thomas
37 Tift
38 Turmr
39 ~are
4G. Washington
41. Worth

No.Acres Oraimd

N~. Pcnds Hand Laber and

Drained

Machinery

I

5

27

493

34

310

68

502

9

5

23

107

10

5,CIO

4

14

65

535

I

I

2

6

9

14

113

43

242

3

I

~

26

49

186

Tota1 number of pcnds drained, twu years

Total miles of drainage Total acres drained

"" ""

Lineal Feet New Construct ion am mainten<r~oe
I, 150 44,500 42,650 126,000
I ,9CO 35,700 )06,400 18,903 81,115
1,925
I,CCO
7,2co 24,000 67,500 34,000 4,300 50,3C0
]6o 1,060 13,737

L. M. Clarkson, Chief Oivisi ;;.n of Sanitary Engineering

31

1-~~
I

DIVISION OF CHILD HYGIENE Joe P. Bowdoin, Chief

Tho j:f"ogr~m of maternity and child health wcrk has cne of tho strcngost of
all human aRJeals. It po;lls upon the heart-strings. It is a call to all wh,, have
human interest at heart. i.e see year after year the death rate of mothers in childbed remaining abut tho saroo. llo see stillbirths and deaths, prier to one year, by far tao high. \",b witness broken and grief striken horros. ;;e see children orphaned all because tho rr.cther didn't know the necessity of prenatal care or kncwing did not have thu means ta procure proper examination and treatment. This being true, it should stir us to renewed activity and a re-dedication of our efforts to save I ives.

MIDWIFE WORK

In 1~31 the work of tho five itinerant mrses was about tho sane as

~revic-us yoars, that is, the sane I ine of contacts were made. The state was dis-

trictcd intc five zcnos and each nurse given a definite territcry to wcrk, the

idea being that a nurse wcrking the same territcry wo..Jij become mere efficient and

could do a given c~unty in luss time after becoming acquainted with the roads and

the midwives. In 1931 we ccntacted all tho counties in the state, except thirteen.

By this we mean that in only thirteen counties did we have to renew tho certifi-

i

I

cates by questicnnaire from the central office,

In the spring of 1932, t~.e state was divided into fol.l' districts ewing to
tho transfer of one of our nurses t0 the tuberculosis healthmobi lo unit. This, of course, necessitated cutting down the length of time in each cc.unty. The volume of wcrk done was only lri.lde possible by the wholehearted ccoperaticn of everyone, especially the health officers, physicians, ar.d registrars in the counties. Many of the doctcrs fU"nished their offices, and others gave their time for taking lassermams. Many of the doctors ha~ continue~ their assistance by giving instructions to tho midwives who failed to sec~re a certificate, inspecting their bags, and vaccinating them against smalljJOX after the nurse left the county. In
1932, certificates in 21; counties were issued by the health officer; in II) counties they were isst..ed by fell' nurses from the central officeJ and in 13 counties the
certificates were renewed by qll!sticnnaire from this office. Ccrtif lcates in the County of Burke were issU.d by tho county nurse. Twc counties, with certificates
expiring in Oeoenber 1;131, wero carried over to Jl\nuary 1332.

The eooncmio condition of the midwife as a class is deplorable. Many can not collect fer their servioos and in consequenoo have been unable to meet

32

l
tho instructor cr buy the necessary equipment fcr their bags. This has made it hard on tho nurses as in many cases they have t.:: drive thoir cars at their own expense b visit the midwives in their huoos.
Many of the midwives arc. getting advanced in years and the questicn of training new enos is cnc that shculd engage serious consideration. In preparing n:;w midwives the amount of educativn and training necessary sh)<.J!d be ccnsidcred, anc: the actual noe:l d th~ sections in which they live.
In 1932, twt1 of otr nurses wer<- withdrawn from the midwife work and
assigned tc a hcusc tc, house survey in the CoU>ty d Mi Iton, now Fultc-11 County. 1\b. ut six wooks were required fer this work, neccssitat ing the renewal of midwi fo certificates by questimnaire in nine counties.
SPECIAL COM1 1SSI<J; APPOINTED
Tho 8~ate Medical Association, at its amual session in Savamah,
May, 1932, discussod in the house of delegates the high maternal anll infant death
rate, c.nc passed a resoluticn creating a ccnmission of twenty doctors, two frun each cong-essional district, b study the cntin field. The chairman of the cc:m missicn is Or. Hines Roberts of Atlana; the co-chairman, Or. C. B. Upshaw,. is also of Ati,Vlta. t:c have cooperated with this commission by furnishing a cupy of
all maternal and infant deaths fer 1932. This means the writing d ever fccr
thcus.~tnd death c<.rtificates. The task is a big one and wi II require a great deal of wcrk.
MAY DAY A~ SUt/1/.ER ROLND-UP
The t~ay Day- Child Health Day program was given considerable time. Every cc~nty in the state put en scme kind d wcrk, and many counties had elaborate programs. Alcng with i.lay Da~ VIas carried tho Summer RoU'ld-Up of the preschool chi Idrcn vf the state. Tho respcnse to the appeal for this work was vory pleasing. The governor's proclamatkn for beth years were mailed tc; all newspapers and broadcast over tho radio.
The Medical Associaticn als._, participated in this wcrk by conducting a health education we<:k1 giving physic~! examinaticns and public addresses throughout the stato. The presi..:ent of the Association appointed cne ~ysician in each county to make physical examinations of all preschool chi I .ren.
INVITATIONS
We haw never ha~ as many invitaticns from clubs, civic bodies, churches and other crganizaticns to speak bofcro the people en sanitation, hygiene ard irnnunizati en.
33

UNtf!G.~NIZED BOMDS OF Hr\LTH VISITED
Many counties with L(lorganizcd boards of h~;<'.lth were visited, Many of the county boards of health have not organize~ or adopted any rules and regulations, ncr in any way ;rcmulgate<i regulati1.ns :}overning quarantinr, Contacting this offici at group has been of great advantage.
R:o1o
Tho radic broadcast vvf'T \'.SB has been ccntinued, ffftoon mll)ites being allotted for the broa,icast.
TUBERCULOSIS
The fight un childhJOd tuberculosis has been carried en mere intensely than ever before, not alvnc by the ldt~ Sanatcrium and the State Department of Public Health, but by individual rhysicians, with the result that the children's coHag<; at Altco has been full, with a v.aiting list. The department is happy over the canpletion of the Jchn A Rhcdes school builc!ing for the afflicted children at the State Institution.
MOTHERS' HEALPERS1 LEAGUES
Owing to oLT prog-am being so crawded, tho itinerant nurses did not have timo to remain in the c~urties !eng enuugh to put en but fow Mothers' Helpers Leagues. This form of cJucaticn is funJamentall~ sound and education for parenthood is rerhaps of more real value than many things that are 8iven precedence.
COOPER\TIVE AGENCIES
For thu ~ast few years the :livision has been n:.quosted tc. prepare for
the Congress of Parents and Teachers of Ge.crgia a Frcgram fer the health wcrk of this great Associati~n. Such out! ines were prepared the past two years and adopted by the boarc1 cf directcrs. This crganizati~n has given the department great opportunity to carry the h,.alth messages to the reoplo of our stahl, offering space in their bulldin as 11()11 as extending many invitations to the heads ~f the different divisi,ns and the nurses to address their mc'etings.
The Wcman 1s Aux i I iary of the "'od ical Associ at iJn has been of great service to oLr divisicn, Sever~! shcrt talks wore ;::repared and distributej fer use before different woi!\Q1s 1 grou~s. This oJucational material has potential lfJod an::l is far reaching in its efforts.
34

l
In 1931, the State Department of Education requested the chief of the division to addr(.SS the supcrintsndents of schools of the state at a neoting held in Macon, Abcut twc hurdred were "resent. It . as a feat opportunity to speak to the m<:JJrbers of the bQards of health of ~ach of the colilties.
SUMMER COURSES FOR DOCTORS
The sunrner cvurses for physicians \;javc ti100 for obstetrics as well as child hygiene. These were well attenJerl and splendid work was dcre.
The chief of the divisi:n was invited tc read a paper before the Amual Ccngress on !lhlic~.l Educatiw, Medical Licensure and Hospitals, held in Chicago, February 17, 1~31. Tho subject d the paper was "Extension Ccu-ses for Rural Phys ici ansi!,
GEORGIA BABY BOCK
In 1~31 the Georgia Pediatrics Society a;,pointed a committee of three to assist in the rewriting and &!iting of the Go;.crgia Baby Book. The book was carefully revised andrew !lll<terial introduced, It was delivered for distributicn January 13, 1932. lnmediately copies were so..pplicd to all libraries of the state, to state and tcrritcrial health officers, as 'Mlll as local health officers. Fifty thousand wore pr inteu,
SPECIAL SURVEY, HABERSHAII COUNTY
In 1931 a p ieee of work of ccns iderabl e inwrest was done by the extension .lepartment of the State College of Agriculture in Habersham Cot.nty, The ontire coU1ty was covered in an intEJ1sive campaign. Every child in school was given physical and dental examinations by local physicians and dentists, and in addition to this a hbcrculosis t:;xamination was given by a specialist in diseases of the chest in chil~ren. lnvtmizaticn work was also carried on, The climax was a meeting at the colt'lty seat, a parade and pageant.
DIPHTHERIA, LtliON CO!JHY
OWing to an outl:reak of diphtheria in Lnicn CW'ty in 1132 we gave
the services of one of our nurses for several days. Th:-. ccnditial was in an isolated section of the coU'\ty. (Soe statistical report)
CMPAI~, A.OYD COUNTY
Request was made of the chief of the division to assist in plaming a campaign for Floyd County in the ~revcntion of diphtheria. Several visits were
35

made tv Rolll6, This project was sponsored by the Chamber of Conmerce and was executed
by the Health Officer, Or. B. V. Elmore,
P(BTAGE
Tho advance in the cost cf postage made a ccnside:rabk difference in our operating expense, To overcome this, we decided to use P"stal cards to notify our midwives when to meet the instructor, This has proven satisfaotcry,
EDUCi\TIONi\l !,~CVEMENT - CANCER
The continued increase in deaths from c~ncer is alarming, Because so many homes are left in scrr~w by the moth~r dying of this disease, a movement for educating the rrothers was deerred wise, and in 1932 il conference was arranged by this division between thE: president of the Parent-Teacher Association, the chairman of the Cancer Commission, arid the president-elect of the Wcman1s Medical Auxiliary, It was agreed to~ave the Cancer Commission appear before the summer institute of the Parent-Teachtr Association at Athens to discuss the menace of this disease. This was done accordingly, and in addition a paper was prepared and distributed along this line. The paper was written by Or, J, L, Campbell, chairman of the Commission en Cancer for tho Medical Association, and has had wide distribution,
ORGA~IZATION OF ~rLL BABY HE~LTH CENTEBS
In the fall of 1932, a new program was Froposed and a volunteer physician, Dr, leila Denmark enabled us to try out a project for nearby ct:ntcrs to Atlanta in the crganization of well baby health centers. The proposal was made to the president of the Parent-Teacher Association of the state, Mrs. R. H, Hankinson, She a1,provod the plan ancl the local Parent-Teacher Associations at lk{)cnough, Douglasville, and Lawrenooville were contacted with the result that the Oe,'art~e~t uf Plbl ie Health received an invitation from each County Medical Society to put on such a oonter, Tho spcnsor'ir19 Partnt-T~acher Assooiat ion has charge of the local arrangements. Or. Oermark is giving hLr time three days in the month to the ~eople of these collliiU1ities, The idea is good and we believe will prove to be cntirol) satisfactcry and of vast benefit tr. the mothers and their chi ldron, Infants and children up to six years of a::Je aro ::Jivlll'l the examination without charge, This ?roject wi II give l!llJch r.eeded s~ervision to supposedly well babies,
This narrative and CQillpi lation does not cover the W<Jrk in child hy~iene and maternity th~t is ::!one in tho counties with full time corm~issioners of health. These will be found in detail in the re~ort of Col11ty Hoalth Work, This co.rse is thought best as their use here would giV(; a false idea of the total work done, To get a com;Jietc rope-d you aro invited L study in connection the statistics of Or. Winchester in his ropart of the activities of tho health officers,

ACT! VITI ES OF "l\.I,;SES
MIDIJIFE ~:ORK: Classes Organizd ~'eet ings He Id Midw ivcs Contacted Midwives Receiving Certificates V/assermams Taken: Positive Negative Mic!wives V~ccinated Against Srrallpox Homes Inspected No Visits to Midwives Oerronstrations Given Bags Insrectcd Bagt Approved Notices Sent tu Midwives by Nurse Midwives not LLcated Midwives who did
MOTHERS' HELPERS LEAGUE: Classes (A-ganized r.betings ~ld No, Girls Errolled Children Rocei ving Ccrt ificates
MOTH SiS I CLASSES I
Classes CT,1an ized treetin;Js Held No. Attending lfeetings Oew~nstrati ens Given No. Ccmpletin11 Cvurse
IMitUIIZ'-TI ON l'iffiK (Assist in3 Physician) 1 Smallpox (Nv, Doses) Tvxuid (No. D:ses) Taxin-antotoxin (NJ. Doses) Typh~id Inoculation (Nc. Doses) Hookworm Treatment

(5 Nurses) 1931 341 1,080 4,614 2,132 100 467 351 610
I ,(1)8
2c6
115 522 5,020 3,246
53 187
824
755
48
2,363

(4 Nurses) 1932
358 1,c6o 4,827 2,493
153 517 597
m
1,486 474
2,445 2,266 I,352
207 164
6o 317 2,940 1,044
26 73 265 25 247
58 159 309 341
7

37

VISITSa Adults Prenatal Obstetr ica I Postnatal Infant Preschool Sch(,QI Physicians& Satisfactcry Visits Unsatisfactory Visits Not at H'.rre Registrarsa Satisfactory Visits Unsatisfactory Visits Not at Heme

1931
3,014 216 23
14
279 183 269

MISCELLAI-.EOLSa Talks to Lay Gr~ups Attendance Perfected Birth Certificates fer Midwives literature Distributed

10,851

?HYSIGAL EXAMINATION, lr&IUNIZATION, UNION COLNTY Ch oestoe Corrmun i ty
Nove nber 1932

Preschool mi ldren examined

86

Sdlool children examined

110

klu Its examined

25

Vaccinated for typhoid

148

Vaccinated for diphtheria

a6

'h.ocinate:J for smallpox

29

1932
2,632 235
<J5
56 320 273 233 560 59 298
413
25
80
272 13,634
218 10,864

(

Joe :Bowdoin, M. D.,

01ief, Division of Child Hygiene.
38

DIVISION OF VENEREAL DISEASE OONTROL Joe P. ]owdoi~, Chief
The Division of Venereal Disease Control has gene forward with a fundamentally strong prog-am dtring 1931 and 1932. This is stated because of the increased demand en the part of the p&opl"' of all classes for information, and consequently has been of great importmce,
In 1931 the general assembly established a new i3arber Examining Board which passes a regulation requiring freedom frcm venereal disease of all barbers, a negative \'iasserman being req.,ired as well as a phys1cal examination, This began to boar fruit early in the year 19)2. In the physical examination of the individual
it was required that each oo examined by "regular physician, and that they must
be free of infectious diseases; that the appl ica-1t for I icense must be free of venereal diseases; and the fi I ing of a reputable laboratory r!lport was obi igatory.
The result was that during the first year's operation 726 barbers W&ro refused
I iocnse because of syphi I is, Thre<.; hcnclred shops were closed entirely because they were not sanitary. It also beca100 necessary to revoke I icenses of 72 for this reascn,
The or;~raLs ar.d proprietors of beauty parlors did not wish to be supervised and l:rought a bi II of injunction to prevcnt the Barber Board interfering with their business, This was c~rr ied throu(#l the courts and in the fa II the supreme col;rt of the stat,, hanJed d0wn a deeision in favor of thG Barber Board placing all beauty ~hops, hair dressers, etc., IIlder the SliJervision of the Board, This decisicn is be rc:ci!nt tu h::'Je any rercrts cr en;ouftl insp,,ctions to be of service in an evalu3tkn of the final results.
The examinati:n of barbtJrs, however, proves the value of examinaticn and certificati~n of all individuals who are feed handlers, mrsemaids and those coming in ccntact with J\I rocplo in such a way that diseases might be transmitted.
The stcri I ization bi II as proposed ay tho Human Betterment Fol.l'ldation
was indc,.sed by the State 1.\ldical Association and wi II be proposed for passage in our state in January.
A great deal of educational material was prepared and sent out from the Departtront of Public H~alth during the biemial,
ihe publ icaticn "Gecrgials He,llth" has steadily increased in popularity. Requests have come fer it from every walk of I ife. Many school teachers requested it for use as a basis for th>-ir hr:alth talks,
39

T-
1
Popular articles have.been prepared for the Educational Journal, P.T.A. magazine, Masonic Heme Messenger, tho stato newspapers, the Uoited States Daily,
Aglaia, Nati~nal Phi WIU rragazine, and others. During 19'32 special mcnthly articles,
writton by different members of oii staff, a;:pearc.d in each issu0 of the Journal of the State Medical Association. Th(j Journal has also reproduced a n'-'!lber d articles that have originated in 0\T departrent. This cooperation is greatly arpreciated.
In 1932 eight short talks hf.ro mimeographed, five of them prerar\ld in our
office, fa- the l.cmanls Auxi I iary. The subjects of these W') prepared wcrc, "The Most Dangercus Age 11, "Immunization against Typhoid", "Smallpox and Di;>hthoria", "Degenerative r.r the Silent Diseases", "NI.Tsemaids Should Have Health Certificates", "Ewry Co~.nty Has a Beard cf Health". One Thousand eaoh of the eight talks were mimeo9'"aphed and delivered to M-s. N. Peterson at Tifton. This material was for use in thdr health program~.
Along educational lines we should mention the wvnderful response to our appeal for help in ,..utting en a wcdh-while May Day-Naticnal Child Health Day both in 1;131 and in 1932. Every county and almost every community had a program. The SUI!Iller RclZld-up of th(, ?,T.A. was put on in ccnnectivn with Health Week sronsored and put over by the Ge~rgia Medical Association. A physician in eaoh county was appointed by the Prusident of the Association to examine thG children and immvnize thfll ~gai"st di;lhtheria. This cooperation was arcr-reci~ted by all. Each yc.;ar Governor Richard B. Russell issued the usual May Day Proclarration. This v.as furnished the State Chairman, was sent to all th6 news,.,apers and was also read over >ISB.
The physicians of the state set up a lectiie Bureau and fiinished many speakers to a Iarge number of counties. This was an important part cf the work and was well ruceived by the public.
The follcwing is copied from the report rrade to the American Child Health Association: liThe President of the State Medical Associati~n appointed a physician in each county to examine presch,1ol ohi ldren during tho Sumner Rcund-up. The Commiteo en Health and legislati~n crganizcd a bureau of pub! ic speakers en health. These speakers I iveJ in liJVery section cf the statu am could be secured by any organization for l!ny occasion. At the May meeting of the Asscciation .a committee of twenty physicians was apr-ointed to stu.:y the conditions anJ causes of maternal and infant. deaths in tho state, and tc re, -:rt at tho next annual meeting with suggestions for ln~~ering the rate. This study is new r..nc~Gr way."
We have prepared special I i teratiic en syphi I is and gonorrhea. Copies of this as well as the goverruoont partphlet, "Managell'llnt of Syphi I is in General Practice" have been mailed tc each physician in the state.
40

l
The insert to be enclosed with automobile tags in 1933 will carry a notice to all ?<TChasers on "Syphi I is", In anticipation of this, instructicns to the infected as to taking care of themselves and to prevent the spread of the disease have been prepared, also thousands of copies of the leaflet, "What the People Should Know about Syphi I is", have been printed, Other material is avai Iable en request in I imited quantities. Notice has been received that free materialthat has been given us previously by the Lhited States i'ublic Health Service has been withdrawn and no mere can be furnished by them.
The State Chairman en Social Hygiene of the Georgia Ccngress of Parents and Teachers has been active in her work, All local chairmen have been furnished informatiun an<.! letters have ::een written as to their program, Many talks have been given by women lecturers.
Dr. Valeria Parker, ~f the Aroor-ican Social Hygiene Association, was a visitor to otr state in t.1arch of 1931. Sho att,;nded the meeting of the State Coi.I'ICi I of Sooial Agencies in Athens, alsc visited other interested groups in sevsral sections of the state.
In 1932 th~ Georgia Sooial Hygiene Associaticn was organized nl has held two meetings. It is t~ be ho1,ec that a state-wide Frogram can be ~.ut on for the education of the people in this inpcrtant matter.
There has been agreat demard fer health talks by members of tfie staff d~r ing both 1)31 and 1~32 Invitations to address almost every type of plbl ic assembly have been recetved and accepted, Vie have spcken to n~rses 1 training schools, senicr meJical students, civic clubs, fraternity meetings, Associaticn of Workers for the 81 ind 1 State !k,dical AU)(i I iaries, Press Association, EdJcation Association, COU'lty comnissioners, many of the women's clubs ard other crganizaticns.
A nunber of bay 1s sch od s havo asked th is 0; vis i en to send a speaker to address their boys ~n social hygiene. Over three thousand boys have been reached each year in this way. lhese sox and veweal disease talks have been wei I received and
many of the sl.4'erintendents cf school.:~ and deans 0f men have been kind enOIJ!tl to tell
ua ~t the work was highly satisfactory.
In l.ll1JSIJII deparhre from the inv itat iens to address peop Ie came fr0111 the judicial circuits of Jt.dges Pittmlf' and h'addax, This invitatiM was to address the cotrt W\i le in session. This was done in several cunties and the talks were well received.
During the two years, lj31 and 1932, we have spcken to more than 20,000 people en varied subjects, alI of them by invitaticn,

We have ccntinucd our week.ly broadcasts uver :ISB. In 1932 we were accorded
tho privilege of brvadcasting over five additional stations! WJTL, Oglethcrpe University; ~.'ROW, Augusta; WOTC, Savarnah; 1\'RBL, Columbus; WFDV, Rome, About fifty talks have been given over these stations, They are very short- not over three minutes in deliveryand are read by the announcer. No doubt these talks are heard by thousands of people.
For the first time in the histcry cf our Department a request for a social hygiuoe talk over r~dio was received fr:>m the station at Rcme. This talk was given, sponsored by thu Radio Chairman of the Seventh District P.T.A,
A special r.rogram was preparec fer the Rcme Broadcasting Ccmpany at the request of the Rcme Chamber of CiJfQillerce, In cooperation with the local health officer several radio brQadcasts were prepared on Diphtheria and the use of Toxoid, also a nuriler of articles for tho Rome Dai Iy News.
Both in 1931 and in 1:-!32 a successful Venereal Disease Clinic was put on
in connection with and through the cooperation of Emery University. This is one of the oldest clinic weeks that I kno111 of in the cot..ntry. It wi II be recalled that it was originally a strictly venereal diseasu clinic, lfganized just after the close of the World War .ihe Alumni Association Week was added to it with great advantage to all. This service is appreciated by the Gecrgia physicians and by many from outside
the state1 in 1931 we had 199 rhysicians registered; in 1932, 205; and as usual an
t..nkncwn nt..mber who did not register. The clinic opened en l.'cnday and c.cntimed through Friday, closing 111ith a banquet and annual meeting of the Alurmi at the BiltffiQre Hotel.
In 1931 the annual Extonsi on Courses for the state, ccnduoted joint! y by
the faculties of the University of Georgia and Ern;.ry University were held in six
centers, In 1932 these courses were repeated and two additional twons added, making
a total of eight centers, t~wit: Val~osta, Statesboro, Albany, Hawkinsvi lie, Mil ledgevi lie, Griffin, Athens,. and Roroo, The physicians who attended requesteJ that the same centers be used again anrJ that th> cou-se be repeated,
A rew foature of the course in 1932 was that the Woman's Auxi Iiary
participated and held a meeting en each ~~cdrl(;sday a half hour before the regJiar lecture. The pediatrician conducted this pericd. The Auxiliary seemed to appr~iate this up,,ortt..nity. Many nurses attended, It was the wish of all that this feature be c'ntin~.ed, Complete reports were furnished beth th$ Universities aro the Board of Regents.
The good wcrk dcne almg these I ines has traveled beycnd tho borders of oil" state, as we have received a letter frcm Dr. Janes A. Hayne of South Caroline, asking how we organized and conJucted oil" sUT~~~~er sd1ool. This infcrmation was given him in detai I.

A five day course for negro r;hysiciiJls was held in cooperatim with Emory University ard the Rosenwald Fl.f'd. The coi.Tse covered many subjects but gave
special attention to the venereal diseases. It was attended by 53 physicians from
21 counties of the state.
The free venereal disease ol inlc that for rMny years has been ccnducted by Emery lhiversity was ti.Tner.l uvcr to the City of HliJlta in 1932, an<.l for some months new has been in ch1rge of the City Health Officer, It has l:oen moved from Emory to the contagi-ous .1isease and letenti~n building en College Street, The attendance continues largo,
The other clinics over the state have been continued and one new ol inio opened, the same being a part Qf the new ho5pit;,.l at i'.ayoross, We are U'lder obligation to all of the clinics and health officers for their help in tho work of eradication and control of venereal diseases.
Early in 1~31 the questicn of contacting co~r~ty boards of health was discussed by Dr, Abercrombie, Dr. 'ilinchcstor, and myself, with the decision that thv state shout~ be .1ividod b~tweon us, and when cceasion permitted we would visit the cOU"Ities, call the health boards together, 1d if they had not been .:rganized, to organize them. Lists of c01.nties were made up and assigned, I have don~ some of my assignment I found the work very ploasant and believe it is of sufficient inoport&nce to be ~ushod to a coflllletc crganization of the state, I hac the privilege
of attending the meetings ,,f th0 board of health in Whitfield, M\rray, Habersham,
Gorden, Fannin, Taliaferro, Colunbia, V.'arren, McDuffie, Tu-ner, and Berrien, In Clayton we trat with a majority of the board but definite action on adopting the regulations was postpond ~r~til the full board cvuld attend, In each co\.l'lty I was received with c~rdial ity,
For some time it has 1-een kncwn that cur I ist of physicians was net ccmplete or acou-~te. Lat,o in 1~32 it was decided that a list of physicians as nearly perfect as possible would be completed. The. work was therefore begul, IIJ'ld has been prosecuted \.l'ltil as the yeer OCfiii!S to a close this list is almost complete. It
will bo an on I j.ghtenmg sh.dy, as wo haV'J a nunber of o';t.ntias in GeorJia wi til only one, two, rr three physicians, The new law requiros that each ph)'Sieian register with the Secretary :Jf Shte, cJUt en ched<ing tllis list it was fo\J'ICI to bo inCOfllllete. Ou" field fcrc.os ar~; ondc.avoring tc get tho unregistered physicians to r!ll)ister.
Frvm tha Serol caical Department it will be fc\.l'ld that tho demand has grown for blood c-xamir>\ticns. The ropcrt oi the Oirector will reveal that the positives fe>r syphili3 average 23.at fer the year 1:)32, and that the requests for service h.ve been practically universal. In t~is repcrt arc not included thereports made by ths health officers excet where clinics arc established and then

only the clinic caaJS and not repcrts of in~ ividual physicians, The health officers only report to our Division of CoLnty Health Wcrk, To visualize the situati:nof tho state this report must be studied in ccnjuncticn with tho Divisicn of County Health,

Attenticn is directed to the st~tistical report of the clinics and the De;:>artment of Serology that is folrd below.

SEROLOGICAL DEPARTMENT 1~31 - 1~32

Below wi II be found report on blood specimens examined for convenience of reference, The corrplete report of the Serological Department will be found under Laboratory.

Number of SllCcimens examined in 1~)2 Nwmber of specimens examined in 1~31
Number of specimens increase for 1~)2 Percentage increase of 1~)2 over 1931

5,026
11.4%

Average number of specimens examined per month in 1~32 Av~rage nunber of specimens examined per month in 1931

Averag:; month specimen increase of 1932 over 1~31

41~

Percentage of specimens in 1932 shewing rosi tive reactions Percentage of specimens in 1~31 showing positive re,acticns

Percentage increase of positive reactions of 1932 over 1931

Number of s~ecimens rejected as unsatisfactory in 1932 Number of specimens rejected as unsatisfactory U1 1~31

Number of rejected specimens increase of 1~)2 over 1~31

6

Nunber of Keidel tubes ftrnished phrsicians in 1932
Number of Keidel tubes furnished physicians in 1~31

48,137
51,022

Numter of Keidel tubes furnished decrease of 19)2 under 1731

2,885

Nunber of Keidel tubes on hand .!anuary I, 1~33

3,111

2,623 (The above dces not inc ludc

specimens from the Rosenwald Clinic, Brunswick,

Gc::.rg1 .., fer 1931)

44

__ __,.,J

SUMMARY OF VENEREAL DIS"f:.:ASE CONTROL WORK FOR THE YEAR ElmiNG DECEMBER 31, 1931 Joe P. :Bowdoin, g.D., Director, Venereal Disease Control Bureau

1~1
MONTH

S)Phi lis
M. F.

Gcncrrhea

M.

F.

Chancroid

M.

F.

Arsphenamine

l~assermanns

Smears

Pamphlets

Lechres Aul.

Jan.

380 28~ 347 103

90

Feb.

368 268 225 81

84

Mch.

m 435 32j

83

20

0

Apr.

451 379 2"/6 81

22 2

+
\,]1

May

404 348 281 93

33 3

JU'\e

641 8~ 263 74

10 4

July
Aug.

343 266 318 259

244 58 lfo . 64

Sept. 352 314 283 ]4

70 29 I
24 4

Oct.

583 557 303 ICO

22 I

Nov.

470 334 300 76

17 0

Dee.

40C 288 232 6]

17 3

3,524
3,:m 3.955 5,036
5099 4,563 4,311
3.557 4,JCb
5.395 5,803 5,187

4,)52
5,316 4,949 5,880 5,918 6,223
5,941 .-.,631
5.~3
5.~1
4,422 4,444

235

I ,492

217

I ,345

169

1,'1.)0

231

936

2.)2

807

223

1,040

293

765

235

3cb

244

450

270

603

215

1,003

219

370

II
~
1,070 982
1,056 351
0
300 450 2,8]0 130 2,645

TOTAL 5,145 4,526 3,223 954 218 22

54,175

64,430

2,803

11,067

9.995

~Ali)
TOTAl

j,6]1

... m

240

54,175

64,430

2,803

II ,067

9.9J5

SUMMARY OF VENEREAL DISEASE CONTROL WORK FOR YEAR ENDING DECEMBER 31, 1932

l

Joe P. ~owdoin, ~~D., Chief, Venereal Disease Bureau

1)32
MONTH

Sy,>hi I is M. F.

Gmorrhea

M.

F.

Ch3tlcroid

M.

F.

Arsphenamine

Wasser manns

Smears

Pamrhlcts

Audiences
Lect~res

Jan.

814 546 321 108 19

2

6,497

6,264

250

610

40

Feb. 574 447 168 28 17 2

6,~2

6,485

222

812

0

tr..

Mar.

585 437 284 84 18

4

Apr. TJ2 546 256 106 7 I

5,430 7,2]1

5.569 6,583

189

1,023

2]0

865

1,120 1,814

Yay

768 583 307 87 II

3

5,818

6,613

283

482

1,110

Jll'le

666 479 'f57 123 17

2

5,673

6,268

270

211

1,420

July

382 652 348 125 16

I

5.733

6,449

289

285

280

Aug.

822 577 391 147 17

4

6,3'16

7,oc6

311

260

2)0

Sept. ]58 647 30 118

8

()

6,482

6,496

310

998

1,027

Oct.

554 321 258 'j6

4

0

5,G7&

6,3'fo

247

405

2,579

Nov.

227 162 156 16

4

0

4,765

5,224

261

529

I,Jbl

Doc.

743 411 522 214

80

4,915

5,182

239

647

313

TOTAL 8,469 5,8C8 3,708 1,252 146 19

70,950

74,879

3,141

],207

GRN-JO

TOTAL

14,077

4,560

165

]0,950

74,879

3.141

],207

II ,'Jj4
II ,Jj4

Jce P. Bowdoin, M.D., Chief, Divisim of Venereal Disease Control

DIVISION OF EPIDEMIOIDGY Daniel L. Seckinger, Chief
Inasmuch as the Division of Epidemiology was not established mti I February,
1932, it is irr.possible to summarize certain statistical data for 1931 and 1932 into a
mified report throughout, With the establishment of the Division and a full tiroo clerk for reoord keeping, it has been possible to institute a system of record keeping similar to other well established divisions of epidemiology throughout the cot.ntry,
which was not possible unti I the beginning of 1932.
EPIDEMI<lOGY
Tho statement has been repeatedly made by public health workers, to an extent now almost axiomatic, that "No health department, state or local, can effectively prevent or control disease without knowledge of when, where, and under what conditions cases are occurring." It is evident that in his state, comty or city, the epidemiologist must assume a large part of the responsibi I ity of ft.rnishing to hiS department, and through it to the people of the State, carefully collected and scientifically accuratv data as to when, where, and under what conditions cases of disease occur, f'e must go into the field when cases occur and employ every AlBans known to science and medicine before he can safely and justly arrive at ccnclu:.ions; and while fLrdionally ard perhaps not practically a clinician, bacteriologist, sanitarian, statistician, cr public health administrator, he must be able to apply these so iences whenever necessary as a part of his arrnmentar i um for guidance. Perhaps no better description of the epidemiologist as he wcrks tcday could be ft.rnished than that by Dr. Haven Emerson befcre the American Public Hellth Association in Washington, D.C.,
19321
"Y.tlether originating frc:m the scknces of laboratory medicine, or engineering, or mathematics, or out of the di:ociplos of observaticnal or clinical medicine, the epidemiolcgist is entitle<;! to the distinction cf R specialist in pt.blic health. In fact, he is a master of natu-al history of di;ease as it expresses itself in grcups of persoras, related by sc11e CQMIOn factcr such as age, sex, race, ccc~.paticn, or geographic distribution, as wet I as by development of disease.
IIWi thout nec;SS!!I" i Iy boing a ~act it iGnPr of ilflY of the basi o sciences of medicine or sanihti:n he must be able t.:> use th<Om in arriV-ing at his own objectives,
"By familiar tests epidemiology is not cnly a vocation, a career, an
intellectual discipline, an administrative functivn1 it is a scinence in so far as its theories and laws of disease perfcrmance &'e based upon accumulated facts, and objedtive reasoning, and to an increasing degree upcn planned experiment, both upon man ard upcn the lower animals,"

1/CRB 1D ITY REPCRT I1'.13
Fer the past three cr four years the Uhited States Public Health Service in cooperati~n with the physicians, state, county ard city health authorities has outlined r:;lans and procedure'- to improve morbidity repcrting thre1ughout the COlX\try. It is evi<i.nt that prcmpt corrplete and acc..rab ropcr-ting ,f diasese is one of the follldations upcn which pLbl ic health rests. Rep~ding by physicians is absolutely essential to knowledge and central of disease by health officers and the state authorities, ThEre are mary physicians who report promptly and regularly, while others report infrequently, and in some cases not at all. With the: health officers rests a great deal ai the n-.s;~cnsibi I ity in increasing mcrbidity reporting in their ooo.nties,
In oder to im;:rove repcrting general Iy throughout tho cocntry, the Uhited States Public Health Servire has established the r,.crbidity Rep~rting t,rea, lhder this plan states are rateJ with referencu to repcrting, Requirerr.ent for admission to the r.'crbidity R(:>crtinl) Area are a~ follows:
I. The Stato must be included in the registration area Jf births ard deaths,
2. There must be adequate leliislaticn to enfcrce repcrting,
3 Thre must be machinery for securin.J ropcrts and keeping records,
4, There must be clerical fcrc"l to do the w1rk required,
5 There must bs wiII ingncss tc cocperate in d forts to secure mere
nearly acctrate and com:;let~ repvrts of notifiable diseases.
6. The State must secur' at 1-::ast as '!?ny cases per death as the
average num':l..lr reported by states in tho registration area fer deaths fer th~; Jreceding three years for five diseases- diphtheria, reasles 1 scarlet fever, typhoid fever, and whooping cough.
4g

The following is a comparative percontafje rating of states 1)2& ~ lj301 and comprises the most recent ratin[J by the Public Health Service:

Comparative Percentage Rating of States - Five Diseases (Average I00 per cent)

1928

1930

State rated Standard - Above the

States rated Below Standard -Below the

average nll!'ber d oases fer each

average nunber of cases for each death

death

Per Cent

Per Cent

Cal ifcrnia

147

Alabare

bl

Connecticut

174

Arizona

51

District of Colu.bia

183

Arkansas

41

Illinois

11e

Col or ado

83

Kansas

141

Delaware

89

Miine

IIG

Fllr ida

b2

Maryland

150

Georgia

'j:,

Massachusetts

162

Idaho

83

Michigan

leG

Indiana

67

Minnesota

152

Iowa

63

Mississippi

133

Kentucky

30

fl'ontana

118

Louisiana

60

New Jersey

143

Missouri

70

New York

147

Netraska

91

North Carol ina

lib

New Hampsh i M

77

Ohio

12C

North Dakota

88

cregcn

134

Oklahoma

52

i'emsylvania

118

Tennessfle

57

Rhcde Island

102

\'lest Virginia

67

South Carol ina

107

utah Verm<-nt

19)

States for which comparable data for the

19~

three years were not avai table

Virginia llashington tliscons in Wyoming

125

201

Nevada

ti

New Mexico

102

South Dakota

Texas

From the above rerort it is evident that bofore Georgia can be admitted,

considerable improvotnent in morbidity reporting wi II be nec.;,ssary,

In order t<.: stimulat.;, re::din3 am01g tho physicians of the State, the Division of Epirlemi0logy instituted a plan early in 1932 of sending monthly morbidity reports to physicians, The respwnse in repcrting has beell gratitying as shewn by Tables I- XVII, which show a Jeorf.iaSe in FATALITY rates during 1932 for a number of

the more comnon dir.eases, Since the fatality rate is the ratio between the nul!ber of cases r<>ported and the number of deaths reoorded1 a decrease in the fatality rate indicates oril of two things, or both I (I) Improvement in treatment of cases, and (2) Improved morbidity reporting, It is evidonf that as morbidity reporting increases, fatality rates fall, and until morbidity reporting becomes more nearly uniform and complete, it will be difficult or impossible to accurately evaluate the effects of improved treatment. It is bel ioved wha1ever and wherever thiz point is forcibly enphasized to physicians, much improvement in reporting will result,
OUTBREAK OF DYSENTERY AT WARM SPRINGS
M epide.mic of dysentery of very unusual interest occurred at the Warm
Springs Foundation in May and June of 1932. Requests for assistance came fol,~wing
the death of a patia1t from dysentery the first of Jure,
Epidemiological investigation was begun on June 4th 1 at which tine 21 oases
were studied. Sixteen occurred from 1/a.y 30th to June 4th; 9, <Jr mere than half of
the cases occurred on June 1st. Five of the 21 oases belcnged to a previous outbreak about the middle of ~'By.
From tile explosive nature of the outbreaks and the wide distribution of cases amung the resident pcpulaticn, ccntaminatod water is boliewd to havo been responsible, although milk, ice, ve8atables and food-handlers were considered, but subsequent! y ruled out.
The Warm Springs FoU1dati~n is located on Pine MoU'ltain m Meriwether
CoU'lty and situated imnediately above the Warm Springs, from which residents obtain their water supply. At the tirro of the investigation the cnly method of sewage disposal was into :;apt ic tari;s and cesspools. Sewage from tho Infirmary of the Foundation
flcwed into a cesspool some 75 yards above tho springs, Solj8time about the middle of
May a patient with dysentery was treated at the Infirmary, from whose stools the Flelltler strain of i3. 'Jysenteriae was subsequently cultured. Flexner organisms were also cultured from stools of two others, including the patient that succul!bed.
Water coming frcm the springs was ohlcrinated before being pumped into a
tank on the mc>..ntaih, but on several occasions employees had experienced mechanical
difficulties with the chlcrinator and at the time of the outbreak chlorine concentration in the water was foU'ld insufficia1t for steri I ization,
In justice to the authorities at the Foundation, it should be stated that every possible assistance was given by them dl.l"ing tho investi:;Jation and every recommendation made by the Division was imrrodiatoly acted upon anri executed in minute detail.
50

Sewer mains, approved by thro Division of Sanitary Engineering of the Georgia Department of Public Health, have been lai~, an:J a pasteurization plant installed in the dairy at no small cost to the institution and the dairyman, ilhi le the illnesses and loss of a life is deeply rogretted, study of the outbreaks made pvssible therenewal of a condition which constituted a grave potential danger to tho ccnvalescent 1--ol iomyel it is patients anj resident population at the Foundaticn.
TR I CRESYLPHOSPHATE PAAAL YSI S
Upcn the request of the health officer and a local physician of Americus
for assistance in what was bel ievod tc oo an -outbreak of poliomyelitis, the Division
was called upcn to make an epidemiological study of the cases. Five cases of paralysis were reported; two yoU"\g adults and three negro children, two cases residing in cne home and three in another, A study of th-:J cases r~>vealed a paralytic condition of the extensor muscle of both logs of all the patients, with a characteristic "shuffle gait" when attempts b walk were made. In several cases thero was slight involvement of the muscles of ore arm, although this was by no means a characteristic feature. No history of acute iII ness could be obtained, Spinal fluid of all cases sh~wed a normal cell count and no increased globulin.
During the ~OII'se of the invostigaticn it was fc\.l'ld that all patients about a week prior t-o iII ness took what was supposed to have been castor oi I from a can labeled "lacquer". Corres;.ondence with the manufacturers of the particular
product revealed that the !Jiixturo contained I part trioresylphosphate tc 3 parts of
caster oi I.
It is of particular interest to note that during the past six months all of the patients have made notable progress towart recovery, which is generally o<.>ntrary to the experience of those: who have ~bserved "jake paralysis" cases. The physician in charge of the cases states that ho has employed electrical stimulation with the faradic current frequently sinc0 the onset of the paralysis,
TY''HO ID FEVER
The meth<Als fvr the proventi~n and erauioation of typhoid fever are too we II known among he.a Ith workers t. bo discussed here. No other disc ase offers greater hope for final obi itcrati0n, and nu brighter char;t9f' in the field of preventive medicine may be cit<~<' than that which rocJLnts the developroont of our present knowledge of thcetiol~gy, made of s;road, and roothcds of prevEntion and obi iteration.
The death r<.te from typhr.i:J fever in the Jcath registration area has fallen from 30 per 100,000 population at the beginning of the century to 4.6 in 1931. A number of cities and even states are able to show mortality rates of less than I per 100,000
populaticn.
51

l'lhi le GeorJia has shared scmewhat in the, deo-easeJ death rate frum
typhoid, the rate fr,r the past five ycrars sti II varies from 3 - 4 tiroos th~t of the
registratiun area, This fact fostered the desire, ard requests fer assisbnce from a rumber d stricken commt.nitics, made possible the study of endemic tyrh .. id cwditions
in the State during the past two summers, The study c.:-rrprises a ~ample of 213 cases
of typh,_,id fever, from whom detailed information was sec\JI'"ed in tho field, The study in detail ha$ beon submitted elsewhere for publ icaticn, but the essential findings are sumnar ized br iof Iy as fol kws 1
(I) In 80 per cent uf the cases, households were rated as insanitary; 74,6 per cont, both trban and rural, (CclTred where open strface privies were in use;
eKcreta from 40.8 per cent was dumpod en the grot.nd without previous treatment.
(2) Ninety-one (.r 42,1 per cent of cases occtrred in 32 households, The
high secondary case rate accentuates the lack of community and hcusehcld sanitation, improper treatment and disposal "f excreta, i rrproper nurs inu care, ard isol at ien of the sick.
(3) The decreased earning capacity cf 70 per cent (,f Ge<'r>jia's pc-~ulation,
classified as r~.ral, and inability ,f many of these to secu-e 1diquate rredical attention and instruction in the r;revcnticn of typh.id, are believed to be faotc.rs concerned in the continued high death rates, The fact is emphasized that the number of deaths due to disease <.nattended )y physicians in Gecrgia increased year by yeer
frcm 3,497 In 1929 h: 4,269 in 1932. (4) It is believed that before typhcid can be materially further reduced,
increased enrhasis should be placed upon sanitation, supervisicn of milk supplies and control of convalescent and chronic typhoid carriers, Typh0id vaccination cannot be substituted in the placb of thoso well recognized control methods; and while at present in Ge~rgia vaccination should be advised, it should not be allowed to assume the major role at the expense Jf other central methods, which unfortunately has been the case in many areas throughout the State, A ~II rounded program should include sanitation and centro! cf carriers primarily, with vaccination unti I such time that it will be found no lcn:;er necessary, except for contacts with recent cases, as already is the caso in a nllllber of cities and states.
TYP+!O ID CARR IERS
The search fer chronic and convalescent typhoid carriers constitutes an ltrpcrtant part of clT program in the study of outtreaks that occur from time to time. Rasults of this phase of a typhoid fever control program wi II def:'end up..:n the am;U'1t of emphasis and the interest exercised by the investigator when wcrking in a ccmmll'1ity. It has become a part of ctr routine to enlist the active support d some one in tho comnunity who has sh,wn particular interest du-ing the prcgress A the investigaticn, ~Jsually this is tho local physician in non-health officer c,ctnties, and through him and other so<rces obtain the names of all in the ccmm<.nity whoat any time ever had typhdd fever, Specimen outfits for stool and urine culhres art; left with these
52

individuals, and the physician cr othor interested citizen assUfres responsibility for sending sarre tc the State Labcratory1 ?rovided it is i~~pcssible to vbtain them du-ing the cou-se of the investigation, Obtaining specirrens is not an easy procedu-e crdinarily1 but with the assistance of scm; influential person in the C011'111U'lity and the exercise of tact, very satisfactory results may be had.
In Table A. it may be soen that 7 chronic carriers were detected in
connection with cutbreaks studied in 1~32 Fifty-five recent Frimary and secondary cases are reccrded as having been caused by these carriers in 1~32. Carrier years
for these i~ivijuals total 43.51 and if these carriers infected as many ind!ividuals
as were infected in 19321 it may be seen that they very readily might have caused
21J.)2 cases of typhoid fever in the 435 years.
After carriers are detected, their control becorres an obi igation uf the local and State health authorities, The qcestion is often asked what may be done to free carriers of tho carrier state. So far as known, science has developed no ch.g that wi II render carriers non-infectious, Otr only hopo at present consists in resort to su-gery. In order to obtain sorre idea of the value of removal of the gall-bladder of typhoid carriers with tho hope of riddin:; them of typh~id bacilli, letters were addressed to the Directors of Cc.mllU'licable Diseases d the States of Massachusetts ard New Ycrk. For a number of years these states have reconmenr:led and observe:! the results of operation fer typhcid carriers, and therefore have been able to collect considerable data, Dr. Rvy F, Feemster, Assistant Director of Communicable Diseases d the Massachuseets State Health Department, in reply states, that the State offers
to pay the cost of operation, not to ol'cced $2501 of all chronic typhoid carriers,
who have dischargt;J organisms for as lonj as one year after date of reccvery from the disease. Such indivi:luals are notified "that the only way thoy can ever get off our carrier I ist is to have the gall-bladder removed." Befcre oreraticn1 hcwever1 a duodenal tube is passed and a specirren of bile obtained, If typhuid bacilli are fo~.nd 1 the operation is recolfi11Cn(~od, Dr, Feemster states that "twelve individuals have been operated upon sinco this policy was begun, about half of them at State expense. Nol all of them have betJn rc leased frcm the c~r' i er I ist due to the fact that they (Jot tired ~,f submitting s;)ooimcns. Not cne cf the twleve1 hcwever, has continued to exorete typhuid crganisms after vperation"
Dr. George H. Ramsey, Dircctcr .~f CcjMlU'licable Diseases of the New York State Health Dep~rtment, writes that the State has "a small fund which we use to rneder financial assistance to typhoid cJrriors wh~ arc unable to pursue their crdinary occtpaticns because of the carrier state". With reference to typhoid
carrier situation in up-state New Ycrk he quotes from a reeent abstract ..f the
Department as fc II ows:
"An analytic study of 368 chronic typhoid carriers discovered in up-state
New York from 1~11 to June 301 1~32 (Exclusive of those discovered in New Ycrk State
53

lnstituticns; it was found th~t carriers who gave a history of' havins had typhuid
fever, cause,) .33 caso per person year prier to and .11 per person year subsequent
to discovery. Cholecystectc.my was perfcnood on 61 carriers, with a mortality of 14,7 per cent. Sixty-eight ,:er cent Jf those who survived the orer;,ticn and sub-
mitted the required spocin:ens were apparently ctred of the carrier conditicn,n

Fer ce-ntro! of ty;:.hoid carriers the G.;orgia prosram consists in a regulation which requires the ~wmission of at least two specimens of feces and urine of cunv1lescent patients. Written instructions arc given to carriers, which emphasize tho irrrcrtance of pcrsunal hygiene and household sanitati0n in the prevention of Sf!read to others, When carriers are found in sm~ll tcwns or rural areas, every possible attempt is made to :o~tain the installaticn of privies cr septic tanks of the tyros a~~roveJ the Stato Health D<Jpartment, Whc.n carriers have. been pi aced under supervision acccrding to al1ove sp<;cificaticns, it has been tho cxrerience of the Division that outbreaks of ty~hoid fever have been completely controlled in areas whore endemic typhoid is common.

Table A - Typhoid Carriers

CH~ONIC SEX CCLOR AGE OCCLPA- DATE OF TYPHC 10 TYPE OF PRI.&SEC. 'iRS,AS SE'lAGE

CARRIER M. F. W, C.

Tl ON

ILLNESS

CARRIER CASES CARRIER OIS~OSAL

M 2M

"

40 Farmer June 1, 1~31

c II School Dec. 1931

Lrinary Feces

3

F \',

48 House- Sun:rrer, I~28 Feces

wife

4

F

c 46 Cock

Sumrr.cr ,1~27 Feces

5 M ;,

46 Farrr.er r.1ay, 1920

Feces

6

F \'j

51 Practical Sunn:er, 1512 Feces

nur~'.l

7

F

c f2 Laur.dross J\116, ~32

Feces

TOTAL 3 4 4 3

5 '5 Open
Privy

5

1.0

II

5

4.0

II

5.0 Toilet
in yard
9 12.5 Open Privy
7 20.0 II

~ 0.5 "
55 43-5

lYPHCIO VACCINATION
It is evident that if all carriers could be detected and put U'lder c:ontrol, there would bo Iittle neod for vaccination, except these in close 00'\tact with the
carriers. lhiversal control of carr itr's is at the present ti11111 inpossible, and ewing
to sanitary conditions, particularly in the smaller to-.ns and in r~ral areas, vaccinati<ll'l on a large scale is sti II necessary. The point sho.lld be errphasized, however, that in such areas vaccine fai l\l"es have been rather conm<ll'l, due to the apport unity for "mass infection", Acconling to ol.t' present knc.wledge, imi1'IU'Iizati<ll'l is Cll'lly rei ative, depending LpCil two var iables1 the resistance of the host and the
virulence (or n\AI'ber) of the vina or bacteria. Therefore an efficient program in any
CCIIIIIIU'Iity, if vaccinati<ll'l is to be conclusiwly effective, miSt incllde every
reasCII'Iable atte~rpt to prevent the entrance of the erganisms into the body, which means
sanitatiCII'I. In our series of 213 casos1 21 individuals or ,,, per oent had been vaccinated within a period of one year. 1lhile there is room to believe, judging frot11 the independent wk of Arkright and Grinrell 1 and also from expor inents conducted
in our Laboratory, that the Ra~~~lins strain at present does not produce as potent a
vaccine as it is possible to prodt.ee1 tho vast majority of vaccination fail ~res in our series was du. in no small part to lack of sanitation. Foor chronic carriers wore found in the hones of 8 of the patients who l'lad been nccinated within ore ~ar, and in every instance the open sorface privy and gpport111ity for spread by flies was in evidence. lo'hether it wi II be possible to produce a vaccine that will protect U'lder all circumstances Is doubtful - it would seem that is asking too much, There will be cpportU'Iity fer observati<ll'l this N!lmel' of the effects of the new vaccine, and it Is hoped that useful data may be gathered which wi II make possible a conparison of the Raw I ins strain of vaocine with that prepared from virulent cultures of 8, typhosus, now being used through01.t th& State.
MALARIN.. STU>IES IN CALHO~ MD 1/CINTOSH COIJlTIES
kly atte~~pt to estimate the amo111t af illness due to malaria in any area o_. any length of ti is extrenely difficult. lhis is due in part to the fact that .n~people I ivlng In malarious areas know its s)'tl1)t0111tology end treatlllent, and therefore newr oell a physician 1111ess serious coaplioations arise. FlrtileniiOI"e1 there are aaae physioians in si.Ch areas who do not regularly rept the disease. HEnce any esti11111te that ray be obtained fr0111 casoe reported fal Is far short of the actual nudler that actually occur'. Again, death reports ~~~ay be used as a baaia for the oatiation of the prevalence of malaria, Actually this is the most CQIIII\Crlly employed method, for each death rcpted from two to four h\IIG'"ed cases are ordinarily estimated to have ccc~rred. This nethod has its objections, for .,.,-ors in diagtosis occiA" very frequently, particularly where laboratory w<ll"k is not done, Again the mortality frcm sub-tertian malaria is eonsiderably higher than fran tertian, and any estination based <11'1 mortality should take into consideration the type of
55

malaria prevalent, which is not always possible. Accurate malarial incidence may be obtained through blood indices, and the school population offers a most satisfactory sanplc.
In tho fall of 1932 it was decided to take blood indices in several
counties, whore malaria constitutes a mere or less serious prcblem, to establish a base line of malarial incidence ;;mel then institute corrective rr.eas~res. Reports of heavy malarial infection were received from f.'clntosh County, a coastal county in Southeast Georgia. l.lclntosh was selected bccaUio of its location on the coast. It was desired to include a coastal county as well as cne from the limestone area in the study, for while the sarro etiological factors that prcduce malaria arc operative in both areas, it was bel iewd that imr.edicate a:othcds of control might vary, ~~hen the topography of land and ability to institute worthwhile drainage projects are
ccnaidcrod. Mclnto~h C01.nty has a population of only 5,763 according to tho 1930 census, of which 1,830 arc white and 3,033 colored. CalheVl County in Southwest
Georgia was selected a representative of counties in tho I inestone aroa, where
malaria is particular~y prevalent. The County acccrding to tho 1930 census has a p~ulatia"l of 10,576, of ~hich Cl"lly 3,145 arc Illite and 71431 arc colorod. ~hi lc tho
soil is particularly adapted to agricultural purposes, in a considerable area of the
county malaria is so prevalent that it is impossible for white people to live in such areas.
Blood indices of school children in beth counties were made in October
and Novenbor of 1~32. Tho results are tabulated b~ schools and range frcm 0 to 87 5
per cent positio.e. Tho tests in tho l.'clntosh schools shewed ].6 per cent positive in white schools ard 18.5 per oent in tho col orad schools, tota I 14.2 per cent.
The Calhoun 111hite schools shcl'lod 4.66 positive and colored 3952 total 26.16. It
may be seen that a larger per cent of white children were infected in 1!cfntosh Coulty, while in Calhoun Colflty tho colored schools showed a much higher por cent infected.
In both counties all posiiivo cases have beon allocated to houses whoro the children lived. Thi;; has boen of ccnsidf.rablc value. Spot county maps shew a considerable gr01.ping of cases in certain areas, and it is in these areas whore concentration of effort is being directed in ccrroctlvo rreasuros. The Calholfl County CCIII!Iissicnr;rs are new using their convicts fer drainage in the most heavily infested areas, wherowr crainage is feasible.

MALARIAL SURVEY - :BU>OD INDEX MCINTOSH COUNTY, G.A.. October, 1932

COURED SCHOOLS

SCHOOL Carnagham

TOTAL SMEARS 37

Hldson

24

New Hnrr.e

2~

Johnson

34

Todd (Darien)

~I

Cannon Bl uff

29

Harris Neck

37

Credit Hi II

23

Warsaw

23

Ardoek

12

Ways

22

Triu

22

Brtro Neck

26

Eulonia

62

Borglum

15

Saint Siperine(Private) 25

Deans Grove

..5Q..

Sbl

POSITIVE
0
0 0 2 ~
3 4
3
3
2 4 4
5 18 6 12 _11. 104

PER CENT POSITIVE
0
0
0 5~ ~9 10.3 10.8 13.0 13.1 16.7 18.2 18.2
233 29.0 40.0 48.0 ~ 18.5

Darien TOII'lsend South Newport

WH tTE SCHOOLS

184

7

117

~

_ji

J.s

367

28

Tota I sr:ec imens

928

Total positive

132

Per cent positive

14.2

38
17
~

57

-r~-
I
MALARIAL OORVEY - :BIOOD INDEX CALHOUN COUNTY, GA.
November, 1932

SCHOOL Sandersvi lie Oak Grove Mt. Ebell St. Mark Mt. Nebo st. Jares Morgan Jacobs Chape I Edison Davis Olape I Cordray St, Peters HoI t-St. tlarys Leary Arlington Pleasant Grow Pleasant Hi II Parkersv i II e Sladesvi lie New Point
01 iver Grove
Hopewell Mt. Maria Th001as Grove Iii II iamsbu-g
fdison Ma-gan Art ington Jcnesvi lie leary

COLO~ED S~OOLS
TOTAL SI!EARS
31 25 40 38 56 28 33 31 177 25 67 60 38
%
72 26 24 55 20 27 35 50 43 69
_1Q_
1,206
\'~I TE SCHQQS
253 180
168 48 ~
751
Total specinans Total Positive Per cJn positive
58

POSITIVE
0
0
2 2
3 2
3 3 25 7 20 19
I~
41
37 15 16 36 14 21
28
40
35 59 ..3i. 477

PER CENT POSITIVE
0 0 5.0
53 54 71 90 97 14.2 28.0 29.8
3Q.I
395 43.4 51.4
577 66.0 65.4
]0.0
777 80.0 80.0 81.4
85.5
..2M_
3952

3 3 13 4 _12_
35
1,557 512
26.16

1.2
1.7
77 8.3
...!J.d._
4,66

In both eoll'\ties ther'eareseveral very heavily infected areas where drainage projoots at present would be prohibitive on aecoll'\t of tke cost of such projects in such areas. The Wi II iamsblrg area in the extrene southern part of C.alhoun Coll'\ty and the Deans Q-ove aroa in the extrene northwestern part of Mcintosh can hardly be reached with drainage projects, and it has been decided to map out these areas and institute control measi.Tes through systematic treatnent with Plasmochin and Atabrine throughout the coming season. If this can be effected, it will be of value and should be included in ol..l" anti-malarial program, for in many instances the Division of Sanitary Engineering finds, after making surveys, that the cost of drainage is too prohibitive ll'\der present eco~omic conditions.
P.ASMOCHIN AND ATABRINE IN THE PREVENTION AND TREATMENT OF WALARIA
lhe value of Plasmochin in the prophylaxis af malaria ha.s been recognized for a period of years, and a number of physicians,;in the State have reported its usc. with gocd results. It readily and effectively destroys the soXual forms of the Malarial parasite in the blood, and should be of vall.il in a malarial prevention program, fer it is the 11carry over" of seXual fcrm from season to season that infects ancphelene II'Osquitoes ~nd makes possible the oontinuatio" of the malarial cycle ootween man and the musquito.
Atabrine (originally called Ericn) is a new drug synthetically prepared by Bayer thlister - Lucius in Gernany. Fre I iminary exp(;f"iments with the drug proved its highly clTati-.e qualities in the treatnent of bird malaria. The repcrt of the Medical Departll'ent of the
lhitod Fruit Coopany fer 1931 indicates that the drug has proved eminently satisfactory in the
treatment of malaria in man in several of the Cofr;l40y 1s hospitals. TherE; appears to be a wide nargin of safety ootween the effective therapeutic dose and the toxic cne; its solution
and absorption takes place rapidly, but excretion is relatively slow according to repcrts, and
there is no demcnstrable d~leterio~ action, other than a possible temporary yellow ooloring of the skin, due to staining C!lllalitios of the drug when large quantities are taken. The drug
is put up in packages of 15 t~btets to each package and tho manufactlTers state that three
tablets daily administered fer five days will effectively and permanently rid the blood stream of the sexual parasites. If this is true, ani it seems to be substantiated by reports fr0111 severd physicians to whom we f~.mished trial packages flTnished to us for experimental pl..l"poses, then this drug wi II cone to occupy an important place in the treatment and prevention of malaria. It should be added that the drug also destroys sexual forns of all types exeept the sill-tertian. It hu been foll'\d that plasmochin tnly destroys the sexual form of sub-tertian ~alarla.
Through the courtesy of the Wintho-op Chemical Company, who are the Anerican Representatives of Atabrine and Plasrnochin, sufficient amoll'\ts of beth drugs have b<>..en obtained to carry on
studies throughout the coming malarial seascn in an area comprising a papulation of 500 people
in Calhoun CoV~ty and a similar area of approximatEily 200 population in Mcintosh. At regular intervals dlTing the season blood indices will be made, and in the late fall final blood indices should indicate the -.alue of these two uso ful drugs in the ccntnl en:: ~reventicn of mal;ria in population grol{lS where drainage is not feasible.
59

l
TL8ERCULOSIS
It nay be seen from the Morbidity, 1/ortality and Fatality tables that tho nl.lll'ber of cases of tt.OOrculosis reported dLring 1~32 was twice the nunber reported in 1'30, and the number reported in 1932 was more than twice the number reported in 1931. In fact 1932 was the only year in which the fatality rate was less then 100 per cent, all of which i llustre.tes tho fact that hberculosis has been poorly rlportcd. There is unquestionably bettr reporting of tuberculosis at present than has bean the case in the past, but tht; fact should be kept in mind that since the establ ishmcnt of the Division of Epidemiology, tho Laboratory rlccrds of known cases of communicable diseases and death repcrts from the Division of Vital Statistics are included in
final morbidity reports. Better reporting of the disease generally wi II mean increased opportunity for learning mere about the mc'de of spread of hberculosis.
The Division has cooperated with Or. M. F. Ha.yg<'od of the State Tuberculosis Sanitarium and Dr. C. St. C. Guild of the Naticnal Tlberculosis Association in attempting to make arrangements in several of the health officer cot.r1ties for the study of tuberculosis, with particular reference tc its mode of spread. Or. J. D. Applewhite, Commissioner of Health of Bibb County, is planning a study of the role played by domestic servants in the spread of tuberculosis, and intends to use a suitable samplu in the City of Macon fer his initial stlx.lies.
h'mBIDITY STlDIES AKlNG RURAL NEGROES IN OOLGLAS COtr-JTY
During the past yoar the Division has assisted in a health project in Douglas County among rural negroes. The area is composed of some 400 negroes, among whom Prof. V. A. Edwards, teacher cf Rural Sociology and Economics at M:lrehouse College in Atlanta, is attempting to make studios and eventually establish an ideal community to be made use )f by his students as a field labcratcry scheme of social, eccncmio and health betterl!llnt of nral negroes in Cecrgia,
Up to tho present the Divisicn has acted in an advisory capacity in the direction of a typhoid fever central program, including the sanitation cf the two schools and homes in the area, ifMU1izaticn of all school children with typhilid vacoi ne, and the search for typha id carriers among a II who gave histories of previous typhoid. A blank was prepared in the Oivisicn fer keeping morbidity data with reference to days lost, kinds and costs of medicines used, enplcyrrent of physicians, h01111 remedies, etc, It is hoped that arrangerrents can be made wheroby the incidence of syphilis and tuberculosis may be establ imed in this area. The project offers opportunity for the collection and assembling of useful data relative to health conditions among rural negroes.
6o

TRACHOMA IN DODGE COUNTY
Oppcrh.nity for study of tho epidemiology of trachoma was made possible through the discovery of cases !Jy Drs. C, B. Vlelch and C. E. Rice of the U, S, Pub"'c Health Service in Dodge Coi..C1ty, Thirty-two cases were rc;->crtod at the cotton mi II in Eastman and in the contiguous rural 'il"6a nvrthwest of that town, l'lhile trachcma fer years has been endemic in Decatur and Mitchell Col-TTties, where hundreds of cases were folrd and treated a:-,out twelvo years a.;;o and within the past twc years, it was believed that the cases in Dcdge Ccunty would offer better opportunity for epidemiological study, because 0f the fewer number found there anc: the possibel op~ortunity to observe these cases mere accurately with reference to close, particular!y fami I ial, coritact,
Tho cases diagnosed as trachoma were visited and an attnpt was made to establish previous inorect4ons of a similar nat~re among parents and near relatives. The Dodge County cases i !lustrated the we 11-establ ished t>el ief that trachoma is primarily a disease of the underprivi legcd, It selecterJ ib victims at the cot tal mill among those where lack of the crdinary comforts of I ifo is particularly noticeable and in the rural areas a!l'Ong tenant fanners where similar C)nclitions apply, although no kncwn association could be folrd between the mi II vi II ago cases and these
in the rural areas nearby.
The most interustin<J part of the irwestigat kn was ma.~o in the rural area in the study of cne diagnosed and two suspicious cases amcn3 children in the Hodge family, Hisbry of chr.mic eye infection and even subsequent ':Jiindness extends back f-:r fu;r g1.:neraticn amcng i mme<;iate forel;ears and r:oar relatives ~f tho Roland and Hedge fami les, This informat ion was given by merrbers of the Hodge family and was verified to th" third generation by th,; County School Superintendent of Education, v.ho hapr;erod to be raised in the community where the grandfather of the Hodge children suff;red with a chr:nic eye condition and gradually becaroo totally blind befzre his d(;;e>th. This man's father is said by members of the family to have migrated to Gecrgia fronr Virginia follc.wing one d the wars in whirh he served, prGsumaoly the Rovol utionary i'lar cr \~ar cf 1812, and was known to have had the oyo condition after his arrival in '4cr&ia, alth01.1;;h it is impossible to learn whether he came til this State with a pre-existing infeotic.n,
Judging from the cases shxlied in Gecrgia, it appears that trachoma is a disease associated with pCQr livin3 conditicns, and spreads through clas& familial aS!looiat ion, possibly through the roodium of the coiMICf'l face towel, han:lkerehiefs, and n~A~rerous other mans that would be possible through ccntinoous association with a patient amid )111\)'gienio surroundings. It appears to have a kw pathrgenaoity for those outside of family circles in which it occurs, fer thc;ugh the disease has apparently been in Dodge County f<.r years, it se.;ms to have sprQad little dll"l1lg

this time, ell<:ept in families or very dose associates of families in which it originally occu-red,
OUTBREAK OF DIPHTHERIA
A widespread outbreak of diphtheria occurred in the mountains of Northwest
Georgia during the sumner and early fall of 1931, The first cases occurred in August
at Chattoogaville in Chattcoga County, and at that time the cases were generally so mild that physicians treated tham as sore throat. Or, fred H, Simonton, District Commissioner of Health at LaFayette, learned of tho "sore throat" in the community, and made a .-...bar of cultures; most of them were found positive at oor laboratcry, Shortly afterwards cases began to appear throughout Chattooga County and a I itt lo later in the adjoining Counties of Walker, Gordon, Catoosa, and Whitfield, As tho season progressed and cases spread, the disease increased in severity, and it was feared that a quarantine of Chattooga CoLilty mi~t become necessary. However, with the establishment of rigid quarantine measlTes of cases and ccntacts, and taking of cultu-es fran suspicious oases ant! contacts, followed by irnmediate treatment of positives with antitOllin, the disease gradually subsided,
It is estimated that no loss than 250 cases occurred, including those not
originally recognized at the begiming of the outbreak. HistLries of 42 well recognized cases were obtained, but these represent only a fracti en of the nurr:ber believed to have had even mild clinical diphtheria.
The outbreak enphasizes the inportance of culture taking and early quarantine and treatment of cases and contacts, Had those mc:~sures been instituted at once and the oases reported to tho health officer, long before he casually learned of the outbreak through laymen, a great deal of ellpense to the cort\I1U'Iity and State would have been savo:l, as well as the prevention :>f serious illness and even deaths,
PAPPATACI FEVER
M outl:reak of disease of Jlusual interast occu-red at Waya"oss in July of 1~31, At the request of Dr. Geo. E, Atwocd, local health officer, the writer went to 1oaycross to study the cases. The health officer had had previous experience with similar outbreaks in the tropics, and frcm the na.tlre of the disease he expressed the belief that the Waycross outOreak was Pappataci fever, ilhich, judging from tho avai table I iterat~re and st.bsequent studies, is bel ievod to be ccrroct.
With reference tc the epidomiology or mode of spread, th!:i bits of the sand-fly of the crdt:r phlebotomus papatasi is the usually recognized insect vectcr from which the disease spreads, Eighty-seven and cne-half per cent of the cases
occurred in chi leren U'lder 15 years Jf age.

'l

O'lset of the disease is sudden usually with chill an.l fever, which may

suldenly riase to 104- IQ5, Too disease is of shcrt duraticn and the tenperature
usually falls to normal after 3 or 4 days, with no residual symptoms, except weak-

ness, and in a few cases nausea. Thirty-two cases were shdied, Fer the benefit

of physicians and health officers, who may encounter this disease in the future, the

more common symptoms as they were found in these cases in the order of their fre-

quency are recorded as follcwss

Per Cent

Per cont

Rigcr frontal Headache

82.6

Erythema face ard neck

435

7~.1

Vomiting ar.d diarrhea

435

lnjecticn Mueus Merrbrane

Lumbar cr body pains

435

(Nasc-Pharnyx)

73~

Oelirun

21.7

Acute Ccnjunct ivi tis

67.4

Epistaxis

1~.o

E1lball Pain

4].8

Abdominal pain

13.0

Excitation

47.8

The disease, while similar to dengue, differs in sewral important chronical aro epidemiological respects, which because of the iac.c ,,c space cannot be discussed.

REPORTING AND TABULATION OF CASES BY NAME, ~DRESS, SEX, COLOR AND AGE

The epidemiologist even with a limited amcU'lt of data is able to furnish useful informaticn with reference to the nature of diseases as they occur in his state. Vlo have been unable to mako use of all data sont to the Division until 1~, at which til!'e the tabulation of communicable diseases by narro, ad'!ress, sex1 color and age was begl.i1, This requires a general and cross-indax system, inasmuch as the Division tabulated reports ftom the physicians, health officers, certain hospitals, and from the State Labcratory and Bureau of Vital Statistics.

Sene Idea of the valuo of the present method of tabulation may be gained from the Tables 1nd Graphs hereto apr;endaged. The tables aro com;;leto for certain diseases and in addi{icn show the i~idencc of disuase and case rates for every county and alse for every tcwn above 215CO in the State. The Graphs are shewn to illustrate the &IIPU'lt of useful material th:d health )fficcrs, physicians and others 11111y obtain upon re,;uest from the Oepartrent. This information is both local and ctrrent, and hence should be of interest to Georgians &verywhere.

lnvestigaticns of Disease outbreaks in other than those ccnsidc.red above were investi3ated by the Divisicn. Space does not permit their enUTSraticn here, but scme idua of their nature and locations may be gained from the record of field trips for 1~32.

'1
I

FIELD ffiiPS
March I , 1932 to December 31 1 1932

CEREBROSPINAL MENINGITIS CHICKEf'+-POX

Sta tesbcro (2)

Carrollton (2)

DIPHTHERIA

LaFayette

DYSENTERY

Rhyre
Dahlmega

Springfield Rutledge

EftYTHEMA MULTIFOR~E

Viarm Springs (4) Manchester (2)

HEALTH SLRVEYS

Millon

LECTLRES AA'O TALKS

Brunswick Winston

Cami Ita

MALNliA MEETIOOS

Albany Arlington Winder Statesboro Darien Winstm
Darien (4)
t.bnrc:e
Edison (3)

Macon
Atlanta (4) Camilla (2)
Manchester Woodbury
k-1 ington (4)
Townsend (2)
Syl~~ester

NARCtt.EPSY

Brunswick
Statosboro (2)
Camilla Dah lcnega Winstcn Mcilae

Savannah
Atlanta (6)
Strrer.cy Winder Darien

Shad) Dale MILK

SCARLET FEVER

LaFayette

Camilla

TRICRESYLPHOSPHATE PARAlYSIS

LaFayette h:ericus

Bremen
Warrenton Perry
Blandtoiil'l
Irwinton
&me (2)
Frankl in llnrgan Me Rae
Mlrgan (2)
Ways
Jmes (2)
Rorr.e Albany Millen Mi lledgevi Ito Morgan
Warm Springs

64'

l I

SUSPECTED CONTAGIOUS DISEASES
TUBERCQOSIS TYPf-Kl ID FEVER
TYPHUS (BRILLS) IJIDULANT FEVER VISITS TO HEALTH
OFFICERS

FIELD TRIPS (ContinuEd)

Millen Edison Nahunta

Carrolltm Baxley

LUII'pkin Statesboro

Jakin
t.'cRao Statesboro Nahunta
S~dis
Milner Woodbury Leesburg (2) Cami !Ia Co II ege Park Roberta
Pinecra (3)
Dah Imega Barnesvi lie (2) Schlattervi llo

Ellavi lie
Baxley
Blandtown (3)
Vidalia Ways Blakely Cordele Palmetto Poulan Lovejoy Carroll ton Concord
l~aycross
Gray (2) Jakin

Su-rency (3)
'Ninston Girard Fitzgerald Frari<l in Lunpkin Cedar Springs (2) Sylvania Davisboro Winder Fry Manchester (2)
~lena
Waverly

Leslie

Blakely

laFayette

Millen (3)
Macon (4)
Athens (3)
Augusta (2) Savannah (4)
v;aycross (3)
Brunswick (4) Atlanta (8)
Valdosta (3) Cartersvi lie (3)

Baintr idge (2) Cairo (I) Thomasvi lie (2) Albany (4)
Cami II a (5)
Anerieus (4) 1/oultrie (I) Griffin (2) QtJitman (2) Gairesvi lie (2)

Douglas (1) Louisvi lie (2)
Sandersvi I le (3)
Mi lledgevi lie (2) Marietta (2)
LaFayette (3) Co ll.!lbus (3)
Dublin (1)
LaGrange (3) Rone (3)

PLRPOSE

SUt.'MARY OF FIELD 1R IPS

Cerebrospinal Meningitis Ch i cken-pox Diphtheria Dysentery Erythema Mu It ifcnoo Hea Ith S.rJe:rs Lectures and Talks !vial aria Mootir.3s Milk Narl",olepsy Scarlet Fever Suspected Gontag i ous 0 i seasos Tricr(sylphosphate Paralysis Tuber0~los is Typt-o:d fever Typhus (8r i lis) lh:lulant fever Visits to Health Officers

Total

March I, 1~)2 to
Decellbor 31 , 1932
5
I
6 6
4 22
17
22
3
I I
7
2
56
2 I rJ,
244

'l

M<f(BIDITY, M~TALITY AM:> FATALITY RATES
1928 - 1932

Table I -Diphtheria

Year Cases Case Rate per

100,000 Pop.

1~28

862

30.0

~~~

757

26.0

1~0

758

26.0

1~31

~78

233

1932 1,362

46.0

Deaths
240 183 135 158 168

Death Rate per
100,00 Pop, 8.3 6.3 4.6
54 57

Fatality Rate (Per cent)
2].8 24,2 1].8 16.2 12.3

Table II - Dysentery

1928

563

19.4

304

10.5

54.0

1929 624

21.5

204

J,O

327

1~30

614

21.1

305

10.5

4~.7

1931

355

12.1

177

6.o

4~.~

1~32

435

14.6

141

4.8

324

Table Ill- Malaria

1928 5,080

1]4.]

582

20.0

11.5

1929 6, 703

230.S

677

233

10.1

1930 3. ]20

12].6

442

15.2

1931 1,907

64.9

307

10.5

II.~
16.1

1932 3,411

115.2

314

10.6

92

Table IV - !teas les

1928 4,]81

164.5

143

4.9

3.0

1929 I, 188

40.)

31

1.1

2.6

1930 4, 751

163.0

128

4.4

1~1 3,180

108.2

1932 1,075

363

62

2.1

15

o.s

2.7 2.0 1.4

Table V- Meningitis

1928

29

1.0

14

o.s

48.3

1929

87

3-0

1930

134

4.6

1931

87

30

55

1.9

93

32

56

1.9

6}.2
69.4 64,4

1932

78

2.6

26

0.9

333

'"I !

MOBBiD!~'t'; MOD'l:...tl:TY AND F.~TALITY RATES

l$28 - 1932

Year Cases

1928

658

1929 730

1930

705

1931

627

1932

~6

1928 2,097 1929 2,001 19~ 1,791 1931 2,262 1932 4,252

1528

12

1329

24

1930

21

1931

32

1932

42

1928 1929 1930 1931 1932

1,000 l,o69 I, le6 2,129
802

1328
tm

~
165

1930

62

1931

1/6

1932

20

Table VI - Pellagra

Case Rate per Deaths Death Rater per

100,000 Pop.

100,00 Pop.

22,6

846

29.1

25.1

871

3Q.O

24,2

713

24.5

21.3

563

19.2

332

491

16.6

Fatality Rate (Per cent)
128.6 liM 101.1
898 497

Table VII- Pneumonia

r~.2

2,776

955

68.8

2,316

79.6

61.5

2,580

n.o

2,465

88.5 839

143,2

2,443

82.5

132.3 1157 144.5 10').0 56.3

Table VIII- Poliomyelitis

0.4

18

o.6

0,8

21

0,]

0.7

31

1.1

1,1

33

1.1

1.4

27

0.9

150.0 875 147.6 103.1 64.3

Table IX - Scar let Fever

34.4

36

1.2

'f, .a

40

1.4

36 31

40.7

38

1,3

32

725

46

1.6

2.2

2],1

19

0.6

2,4

Table X- Small-poX

8.1

5

0,2

2.1

57

2

0,1

1,2

2.1

0

0

0

6.o

0

0

0

0,7

I

0

5.0

MOB:BIDITY, MORTALITY .AND FATALITY RATES 1928 - 1932

Table XI- Tuberculosis

Year Cases Case Rate per

100,000 Pop.

1928

833

28.7

1929 927

319

1930

879

30.2

1931 1,691

57-5

1]32 3,321

I 12.2

Deaths
2,J/5 2,190 2,175 2,165 1,927

Death Rate per
100,000 Pop. 81.7
753 74.6
737 65.1

Fatality Rate
(Per cent)
285.1 236.2
258.8
128.0
ss.o

Table XII- Typhoid

1928 1,061

'1>5

444

153

41.7

1929

899

309

1930 I, 126

386

1931 1,226

41.7

1932 1,79)

Go.e

340

11.7

500

17-2

513

175

362

12,2

378 44.4 41.8 20.1

Table XIII- Endemic Typhus (!rills)

1928

48

1.7

1)29

57

2.C

1~30

134

4.6

1}31

127

4,3

1932

303

10.4

6

0.2

12.7

I

0.03

I.B

9

0.3

6.7

7

0.2

57

8

0.3

2.6

Table XIV - Lhdulant Fever

1920

10

0.)

1

o.o

10.0

1929

14

8.5

1930

10

J.3

1931

8

0.3

1932

35

1.2

o.o

o.o

0

c

3

o.1

7.1 10.1 0 e.6

Table XV - Whooping GoUQh

1926 778

2~.8

lb3

s.6

21.0

1929 I, 7C7

60.9

IJ30 1,293

44.4

280

96

257

c.s

2'j.!l
199

1931

774

26.3

113

38

14.6

1932 1,085

'5>5

Ill

37

10.2

MJRBimTY, MORTALITY .AND FATALITY RATES 1928 ..,. 1932

Year

Cases

1:;2<3 I, 756 19~ 2,175 1930 2,493 1931 2,03Q 1932 2,'f23

1320 2J,6VO 1929 29,033 1930 3,284 1931 12,354 1932 15.61J5

192S 1, 7e2 1~9 1,876
f330 2,33Q
1)31 2,531
I~ 6, 776

Table XV I - Gonorrhea

Case Rate per

Deaths

I Gv, L:}O Pop.

60,4

27

74.13

15

05.5

19

69.4

16

91.8

32

Death Rate per 190,00C Pop.
0.)
Do5 0,] 0.5 1.1

Fata Iity Rate
(Per cent)
1.5 0.]
o.o o.o
1.2

Table XVII - lnflwnza

821.9

2,041

70.2

8.5

99:1.5

2,543

8],6

8,8

112.7

964

)3.1

29.4

420,6

1,301

44.3

10.5

52::i.2

1,168

395

].4

Table XVIII- Syphilis

61.3
64.5

494

1],0

277

461

159

24.6

80.0

42)

14.7

f[l,4

BG.2

413

14.1

16.3

220.9

425

14.4

6.3

70

MORBIDITY REPORTS EY YEARS 1925 - 1932

Diseases

1)32 1931

Acute ln.Conjunct iviti s 71

34

Act inomycos is

Anchy lost an ias is

3,965 b'fj

Anthrax

2

Cer.h'eningi tis

78 f37

Chicken poX

)46 1,3C4

Deng<..e

6 II

Diphtheria

1,362 978

Dysentery Gonorrhea

435 355 2,]23 2,038

lnfl uenza

15,685 12,354

Let.Encephalitis Leprosy

22

3

I

Malaria

3,411 1,907

M:lasles

I,075 3, leO

M.mps

]86 996

Paratyphoid fever

19 26

P'lllagra Pneumonia

936 627 4,252 2,262

Pol iomyel it is Psittacosis

42

32

I 31

Rabies (In Man)

3

2

Scarlet fever

i302 2,129

Septic Sore Throat

325 491

Small-pox Syphi I is

20 176
6, 776 2,531

Tetanus

29 7

Trachow.a

592 54

Trichinosis

Tuberculosis

3,321 1,691

Tularemia Typhoid fever

2'j

5

I, 799 1,226

Typhus fever

3CU 127

l.hdulant fever Whooping Cough

35 8 1,ocs 774

1930
27
1375 I
134 1,210
9
750
614 2,493 3,284
3
3,720 4, 751 1,270
29 705 1,791 21
I
I, 186 403 62
2,33~ ')
9 4 iJ79 2C 1,126 134 10 IJ293

1929 20 2 167 I 87 710 62 757 624
2,175 29,033
4
6,703 1,18[
574 38 73C 2,001 24
l,o69 386 165
1,8]6 8 I 3
927 8
899
57 14 1,]70

192!3 17
139 2 2'j
I ,232 78 13t2 563
1,756 231CC8
5
5,0ll0 4, TJI
543
rp 658
2,097 12
1,080 437 236
I1 782 13
833 18
I ,c:1 48 10 778

1927 43
157 3
23
1,246 43
1,315 559
2,369 5,6o2
5
2,233 3,661
932 69 443 1,619 21
4 979 394 1,934 2,119
13 7
8fl7
1,723 57
1,464

1926 1925

33 !39 2

215 364

I

23 38

1,159 I, 127
21 36

1,498 943

519 1,042

2,588 3,331

12,024 11,996

I

4

I

I

~039 2,452

3,030 567

I,IGC 1,905

67 07

294 401

2,715 2,755

13

~

I 535 523 957 1,962
12 6
1,0']2

2
328 449 444
1,7~
20 21 I 1,210

1,701 2,016
so 33

l,c:6 1,450

Total

5C,'fj2 36,150 29,161 52,0134 40,015 29,~4 ,35,217 34,944

71

Oases of no~;i:::i:.1ble eli sea.~es re:t:~crted in the State of Georgie:. ........rinc;; ;; .-J.e year. ~932, by months

DiHases

Total January_. February MiJrch April

Nay

Jv)e

July August. September October Novel!bcr December

Acute ln. Cc.njlSlC.

71

2

Anchylostomiasis+ 3.%5

27

lnthrax

2

Ce. Me"lingitis

78

14

Chickenpox

946

lob

Dengue

6

Diphtheria

1,)62

91

Oysentery G<ncrrhea

435

15

2,]23

260

Influenza

15,685 486

Le. Encephalitis

22

2

Malaria Measles

3,411

99

1,075

17

ltUJps

786

54

Paratyphoid Fewr

19

Pella!Ta PneiAIIc.nia

986

52

4,252 3)2

Pol~elitis

42

4

Rabies (In Man)
Scarlet Fever
Septic s. Throat

3

I

802 109

325

21

Smallpox

20

I

Syphi Iis

6,]76 500

Tetanus

29

2

Trachoma

592

3

Tlberculosis

3,321 257

Tularemia

29

I

Typhoid Fever

1,799

72

Typhus fewr

3013

4

Lhdulant Fever 1'/hocping Cough

35

4

1,005

Ill

9

I

2

27

28

63 '645 410

187

164

89

I{)

10

10

4

3

8

6

100

95 219 86

64

25

3

48

44

63 41

28

49

72

15

17

32

45

122

77

48

121

I4B

164 177

264

305

236

628

869 907 502 iOI

118

84

3

2

4

2

2

2

68

48

102 132 240 3bo

348

24

159

174 301

t48

55

20

74

189

192 109

155

32

6

I

2

2

5

5

42

70

71

<f.

202

149

105

287

m 385

463 256 216

146

5

6

2

6

I

I

59

37

53 38

21

21

43

22

9

22 27

34

21

32

4

I

3

5

I

3

427

386

592 527

~

773

664

3

3

5

5

3

I

I

42

12

31

I

232

250

366 3313

~9

341

341

II

2

5

2

2

I

71

78

82 102

l51

410

328

13

6

24

16

23

26

47

4

4

2

I

.5

3

2

89

90

154 105

ill9

~

102

21

4

181

426

l

3

I

18

26

3

I

215

283

25

18

303

220

122

187

l

479

484

15

30

13

17

2

l

75

23

174

197

6

105

124

55

~

2

799

501

2

2

38

45

234

233

4

2132

131

48

38

5

2

37

5C

.4

505

240

9
27 m

I

2')6

132

13

8

213

312

371 11,210

l

2

432

619

3

21

16

49

I

55

46

321

676

6

6

104

eB

26

24

445

446

I

2

136

2133

222

2!e

a,

26

30

30

3

50

30

Psittacosis

I

Leprosy

I

Puerperal Fever

Total

50,993 2,]28

2,395 2,987 5,679 3,545 3,ae6 3,274 2,767

3,258 3,118

3,344 14,712

72

Casee of notifiable diseases reported in Georgia during 1932,by color and sex, with case rates

Diseases
Conjt110t ivi tis Diphtheria ilpentery Malaria Measles Meningitis Paratyphoid F. Pellagra Fneumcnia Pol iomyel it is Scarlet fever Septic S. Throat Snallpcoc Traohana Tuberculosis
T~aremia
Typhoid fever Typhus fever lhd111ant fever ftlooping eough

&tns+NC ++CR
26 0.9 9o6 31.2 297 10.2 1;543 530 311 10.7 65 2.2
18 0.6 622 21.4
1,905 655
33 1.1
409 14.1 118 4.1 14 0.5 568 19.5 2,639 907 30 1.0 1,501 51.6
189 6.5 30 1.0 427 14.7

TOTAL M!.le
NC CR
14 1.0 425 2].6
153 10.7
]62 53'
14~ IG.4 44 3.1
9 o.6
199 13.0 1,058 ]3.8
16 1.1
165 11.5
54 3.8
12 o.a ~I 25.1 1,214 84.6 18 '3 7'34 503 12G 8.3 20 1.4 201 14.0

female
NC CR 12 0.8
46l )2.6
144 98 781 530 162 IO.:J 21 1.4
9 o.6 423 28.7
847 57-5 17 1.2
244 16.6 64 4.3 2 o.I 'ZV] 14.0
1,425 96.
12 0.8
707 48.0
69 4.]
10 o.a
226 15-3

WHITE

cel~Rm

Both ~s

Male

female

Both Sexes

Male

Female

NC

CR NC rn NC CR

NC

rn

NC CR

NC CR

22 1.2 13 1.4 9 1.0
sa; 43.9 382 41.5 424 46.3 229 12.5 122 13.2 107 11.7 I,O'jl 57.2 520 58.6 511 55-8

4 0.4
100 ~3
68 6.3
492 46.o

I 0.2 ~3 8.4 3t 6.0 222 43.2

3 0.5 57 10.2 37 6.6 270 48.4

233 12.7 113 12.3 120 13.1 41 2.2 31 3-4 10 1.1

78 7-3 3b 7.0
24 2.2 13 2.5

42 7-5
II 2.0

15 o.8 7 o.8 8 0.9 335 18.2 123 13.4 212 231
I, 186 64.7 639 69.4 549 6o.o
23 1.3 10 1.1 13 1.4
400 21.8 163 17-7 237 259
'f5 52 46 50 49 53
12 0.7 10 1.1 2 0.2

3 0.3 2 0.4

I 0.2

2B7 26.8 ]6 14.8 211 378

717 6].0 419 81.6 298 534

10 0.9 c 1.2

4 0.7

9 o.e 2 0.4

7 1.3

23 2.1

8 1.6

15 2.]

rtt-"\

2 0.2 2 0.4

c0

568 31.0 )61 3').2 207 22.6
1,182 64.3 595 65.0 584 63.7
18 t.c II 1.2 7 0.8
783 42.6 409 44.4 374 40.8 174 95 Ill 12.1 63 39 28 1.5 18 2.0 10 1.1

1,457 136.o
12 1.1
]18 6].0 l5 1.4
2 0.2

6t6 120.0
7 1.4 385 ]5.0
9 1.8
2 o.4

841 150.8
5 0.9
333 597
6 1.1

347 18.9 163 17.7 184 20.1

80 7-5 38 ].4 .42 75

+ Nurber of cases ++ Rate per IOC,OOO population

Cas' es of notifiable diseases reported in Georgta during 1932, by ages

Diseases

.."0.'.
I-

~

...

:; .

U~ J

~

~~
"'

UJ
Ia
~
CY"\

. ..

~

UJ
'>..

"'>'..

.... ... ... O')U)(I)cn
L~ !~;; :~;; ~~

en
:~;;

""L~''

:'!
0

-n----.
0

"'(\J
0

..q

Lt"'\ "-.0 . ~ co

cr-.

0

!:0 ~

.
"'>'..
g;-
.s
~

.. .

~Ul -

~"'

... (~ ~
..0.. 0

..
...._"'>,'... ..,!,U.;...l.,.
... ..0.. 0

t ...c""r"--
0

~

~

0
""'

.c..,r. -

c0 r-

..

"t""
cr-
..0...

(f)
'>..
.,_~
...'-D
0

~ -~

~
.0
"''c0 R"'..

!
,5 ~

CrojWJCtivitis 71

43

4I

2

5I 4

42

0 iphther ia

I,362 43 7{ 85 115 120 87 81 64 49 37 78 18 16 6 8 4 4

4}5

Dysentery

435 45 5-3 14 8 2 4 5 3

8 7 15 6 15 14 19 II 12 9 . 10 38 157

Malaria

31 411 25 14 31 26 . 35 23 36 10 42 12 roo 119 16o 132 12& 127 102 79 ~ 47 87 68 1,910

Meastes

I,075 7 II 9 16 17 24 35 29 33 16 48 22 13 4 4 2

32

779

l&!nirigitis

78 12 -4

222 4

45654

I2 I

I

21

ParatyphOid f. 19.

'3 2 I

4 I4

I

I

Pel la9"a

586

I

'4 20 38 40 55 45 63 59 43 36 . 63 68 450

Prie~m<nia

4,252" 195 88 67 54 38 36 40 44 34 32 1'15 147 134 94 9-9 85 84 65 73 73 140 203 472

Po(ianyel itis

42 5 5 2 3 5

3

3I 2 1

.I

-9

r.:-t

sCarlet fever 1302 8 -18 20 32 48 33 54 38 21 24 55 15 5 3 -5 2 I 2 I

sep. S. Throat 325

I 3 3 5 l 2

6 3 7 9 l';J II -9 9 5 4 3

Slllilllpox

20

I 3I2

2.

I

417
3 220
I 7

Trachoma'

592

2

5 rp 43 47 52 2<Q 76 21 14 8 10 5 7 I 4 3 I - 32

Tlberculosis 3,321 14 12 II 8 12 9 19 14 II 22 85 223 417 337 302 258 218 181 135 ICB 91 73 ]66

Tul~ia

29

Typhoid fever 1,799