Annual report of the director 1936 [1937]

GEORGIA
~
.ANNUAL REPORI' OF TilE DIRli!CTOR
DEPARTlilENl' OF PUBLIC HEALTH
1 936

VITAL STATISTICS
Births There were 60,037 births registered in Georgia during 1936,
corresponding to a birth rate of 19.7 :per 1,000 :population. The number of births in 1936 shows a decrease of 3,2.53, or 6 :per cent over the number (63,290) registere.d in 193.5. Deaths
In 1936 there were registered 36,79.5 deaths, corresponding to a death rate of 12 .1. T:lir:: is an increttse of 7 per cent over 193.5. Infant Mortality
The infant nortality rate increased from 68.2 per 1,000 live births in 193.5 to 70.7 in 1936. While the deaths under one year of age actually show a decrease in number (4,246 in 1936 and 4,316 in 193.5) there is an increase in the rate of 4 per cent, which is due to the decrease in the live births for 1936. Maternal Uortality
There were 481 maternal deaths vvith a rate of 8,0 :per 1,000 live births. In 193.5 there were 4.58 deaths v.r:i.th a rate of 7.2, There is one maternal death for every 12.5 live births in 1936, while there were 14.5 live births to one maternal deatL in 193.5. Stillbirths
There were 3,.579 stillbirths registered in 1936 corresponding to urate of 63.0 :per 1,000 live births, \Jhile in 193.5 there were 3,987 with a rate of .59.6, which is a decrease of .5 per cent over 193.5. Deaths :per 100,000 Population
The greatest increase was in deaths from meningococcus neningitis, lethargic encephalitis, :poliomyelitis., malaria, typhus fever, pellagra, influenza, and pneumonia. Heart disease, nephritis and cerebral hemorrhage are still showing an upward trend. Accidental deaths are increasing from

2
year to year, the rate 90~0 per 100,000 population for 1936 is the highest
for l\ny year. Most of these accidental deaths were from auto1:1obiles which show an increase of 3 per cent over 1935, and the rate of 31.6 for 1936 is the highest ever recorded in Georgia.
There is a decrease in measles, whooping cough, diphtheria, scarlet
fever, and dysentery. Cancer is showing a slight decrease of 0.2 per cent.
The rates for typhoid and tuberculosis show the lowest points recorded in Georgia. County Death Rates
The lowest rnte in 1936 from :r:Jalaria was for Floyd County with a rate of 1..9 and Long County showed the highest rote with 137.6. There were no deaths from malaria in 47 counties.
The lowest rate from typhoid fever was for Dei~lb County, 2.7, and Taylor County showed the highest rate with 44.8. There were no deaths from typhoid fever in 66 counties,
The lowest rate from tuberculosis was for Coffee County, 4.6.
Baldwin County had the highest rate, 265.6, as a result of State institutions
in that county. There were no deaths fro~ tuberculosis in 12 counties. The lowest rate in 1936 from pellagra. was for Decatur County, 4.0.
Baldwin County had the highest rate, 71.1. There v1ere no dec.ths from pellngro. in 48 counties.
The lowest rote from heart disease was for limier CO'lmty, 18.4, and Richmond County shovmd the highest rote of 413.8. Ec..ch county in the State had at least one death from heart disease. Attendance nt Births nnd Deaths
There wns o. slight decrease in the nunber of births attended by midvTives. In 1936 there vmre 40.4 per cent attended by midwives with 40.7
in 193.5.

3
There was an increase in the deaths vvithout nedicn1 attendance
from 10.7 in 193.5 to 13.5 in 1936. There were .5,464 without nedica1 attend-
o.nce in 193.5 o.nd .5,808 in 1936, or 1.5 per cent of the totn1 deaths.

DEATHS AND DEATH: RATES PER 100,000 POPUlATION FROM SPECIFIED CAUSES VliTH'THE PER CENI' INCREASE OR
DECREASE IN THE RATES, IN GEORGIA: 193.5 and 1936

I T - - - - - - - - - - - - - - - - - - , - - - - - - - - - - - - - - - - - - --.o.----r

Nunbor

Rnto

I

Pier Cont ncrense

Cnuso of Death
-------------~.. :;:;:.19'-"'-"~3~. .... .. ~?3.~

-t 1 ~t ~9~ ?

De~;ease
in.._,Bg.t~.c. =""'--l

ALL CAUSES

~6 '7 <)I;

~~. ~1 ~ 1 ?n'> .1 illM. + =='=6;:E"===t

Typhoid Fever . 192

Typl1us Fovor

42

11D.lt.trif'.. .595
Sn'1llpox

1leC". sles , , ....

7

I Scarlet Fever .

14

VJhooping Cough . . 64

1 Diphtheria . 1 11!3
Inf luonzo. 1810

Dy'scnt ecy .. 152

Poli~litis ; :. :. : 1 28

Loth,_,rglc Encqu~.l1t1s 1 10

1 I.Ioningococ~us IIoningitis

67

Tuborculos1s (nll fon~s) 1697

Ca.ncer .. 1724
I

Dinbotes Mellitus . Polln.grr'. , Cerebral Hcnorrho.go

386 382 2,561

Ilonrt Disonsos .5.5.55
Pneunonin (rcll forus) 3746

D~nrrllc~ & Ent ?ritis - y Yrs. I
C1rrhos1s of L1vor ~
1 Nephritis
1'1:'l.lforr.1D.tion & Eo.rly Infancy Suicide ,
I
Hor1icide l
Accidents & Other Violoncc i
Unknovvn and Ill-Defined i
All other onuses !

.537 13.5 3405 1771 310
.57.5
2749 2130
.5.552

*Infnnt Hortn.lity I
*lhtcrnn.1 Hortnlity 1 *Stillbirths '!'

4246 . 481
3579

261 . 28 387
1 2.5
23 149 161 13.51 163
16 5 33 1731 171.5
388 36.5
2410
.5071
30}5
.507
. 142
31.5.5
1736
300
661 2428 212.5 .5477
4316 4.58 3987

6.3

8.6

1;4

0.9

19:.5 I

12.8
o.o

0.2

0.8

- 27.0

++--

48.9 ,52 .5

- 100.0

- 73.2

0 .5

o.8 - 40.0

'2.1

4~9

5?.4

l ,I: . 39
5;9.-o3

. .5.3 44.8

=

27.3 32.4

,5.4

7.4

0.9 I
I 0.3 I I

0.,5
0.2
1.1
.57.1
,56.6

1, t+- 75.0
100.0
+ 102.8 2.7 0.2

12.6 12.8

12 .5

12.0

83.9 I 79.5

181.9 122.7 ,,!

167.3 100.2

17.6 16.7
4.4 i 4.7

I 111 .5 ,58.0

104.1
.57.3

I 10.2

9.9

18.8 i 21.8

90.0 I 80.1

69.8 70.1

181.8 1 180.7

70.7 68.2 8.0 I 7.2 .59.6 . 63.0

1.3.

i:

3.9 .5 .5

i: 8.7 22 .5

I

Ii t i-

,5.1
).6

I + 71

I + 1.3

I + 2 .5

II - 13.? t 12.4 0.,5 0.6
I;

i + 3.?
1 + 1o.a
I - .5.4

*Rr.tos :por 1,000

NOTE: 1936 fie;ures aro provisionn1 nnd n.rc subject to correction in finn.l tc.bulntions.

4

5
COUNTY l$ALTH WORK
From two organized counties with five persons employed in 1915, the number of county health departments has increased to 33 counties with 263 employees in 1936. In 1915 only 17,546 people bad the advantage of health service, whereas the number has increased to 1,594,076 in 1936. The population having the benefit of public health service has increased 7845 per cent, and the total amount spent for the work has increased from $4,637 in 1915 to $458,500 in 1936, or an increase of 9788 per cent. In 1936, 47.9 per cent of the people were being served by full-time county health
departments, although the service in sorae counties was rather inadequate. Six counties had only a health officer, and tvm others had only a health officer and a nurse. Twenty-five counties had the services of a health officer, one or more sanitary engineers or sanitarians, and one or r1ore nurses. In addition to the usual personnel of a health department, eight of the larger departments have additional personnel, such as dentists and veterinarians connected with the department.
Two new health departments were established during the year, Terrell starting the work on January 1 and Brooks on July 1. The Hall and Sumter County departments were enlarged.
The State has been divided into seven proposed.health districts, each of which will be served by a health officer, sanitary engineer, three nurses and a clerk. For the reason that qualified personnel is not available, only tno of these districts are now in operation. These two districts are conducting splendid demonstration and educational programs.
During the past year the grand juries of Douglo.s, Huscogee, Toombs, Burke, Whitfield, Wilkes, Ben Hill, and Wheeler Counties made the necessary recommendations for adopting the Ellis Henlth Law.
HaviDJg adopted the standard of qualifications for health department personnel as recommended by the Conference of State and Territorial Health

6
Officers., it has been found necessary to train people for the vnrious positions before sending them into a county or district to work., An allotment was made from Social Socurity funds to defray the expense of this training and during the year eight medical trainees were appointed and given training at the University of North Carolina. Twenty-one white nurses were given short courses at the Peabody Teachers College and two others were given more complete courses at the Col~bia University. Two colored nurses were given courses at the Medical College of Virginia. Two sanitary engineers were given cot~ses at the University of North Carolina and three entered Harvard for a period of one year. These trainees, after completing the courses at the various colleges, were sent to the Glynn-Mcintosh-Camden Health Department for n period of field training and observation.
Budgets were upproved for Burke, Vlhitfield, Horth, fmd Tift Counties as single-county units. Two districts composed of Telfair and Wheeler Counties, and Montgomery and Toombs Counties were formed and budgets approved.
A consolido.tion of the activities of the organized counties ho.s been made. Because of a change in the report form to conform with the uniform record, as requested by the United States Public Health Service, it is not possible to compare these activities with previous years. Increased efficiency has been brought about in tho VQrious county health departments by the enlargement of personnel and the use of newly printed forms which are furnished by this Department.
Considering the f~ct that the Departn~nt is now in position to subsidize county health work with funds made available through the Social Security Act, and from the enthusiastic interest being mnnifest by the general public, as well as by county officials and county boQrds of health, the prospects for nn enlarged progrnm throughout the Stnte ere very gratifying.

7

EPIDEMIOLOGY

During the yenr f936 there were reported 71,763 cases of communi-

cable diseasea This exceeds the 1935 total by 17,103. This increase is

apparuntly due, in part, to better reporting. This fact .is borne out by

tho fntality rates for each disease. Typhoid shows the lowest fatality rate

in four years, while five other disenscs hc.ve the lowest fe.tality rate in

three years.

M.'llarin, influenza, and pneumonia a.re lr.rgcly responsible for the

increase in the number of cases over last year. A decrease in the number

of cases over 1935 is noted in measles, pellngrn, smnllpox, tuberculosis,

'

.

typhoid, undulant, whooping cough, c.nd gonorrhea.

This state of ~ffnirs is encouraging nnd it is hoped thnt c. still

greater coopcrction and understanding can be established with the private

pru.ctitioners and tho health officers throughout the State. Nearly every

county health officer has reported 100 per cent for the year.

Diphtheria

During 1936 there uero reported 1,083 cases of diphtheric. as com-

pared with 1,050 cases during 1935. While this is an increase of 33 reported

cases, it is gratifying to note that thoro was n reduction of 43 deaths from

this disease.

Dysent ery-.Aroo bic

This is n disease thc.t is apparently very poorly reported. Follow-

ing the work of Doctor Seckinger, it wns hoped tha.t nm.ebic dysentery would be

more generally recognized and reported. The nunber of cc.ses reported can in

no way be n measure of the prevelcnce of this disense. During 1935 only 91

cases were reported. During 1936, however, 148 ceses wore recorded.

Dysontery-BncilL~rz

During 1935 there were 335 ccses of bncillnry dysentery reported.

The figure for 1936 is 380, which is an increase of 45 over the preceding

yoc:.r, This is c. field in which is grc:[:tly noedod concentrc.tod study in

8
order that some knowledge may be gained of the types, their prevalence, and distribution in the State. Since this is one of the greatest causes of deaths in infancy, it warrants attention and study us soon as sufficient personnel is avcilnble to curry on the work. 1hlaria
During 1936 there was a very wide spread distribution of malaria in
this State. Cases were reported in almost every county except in a few in
the mountainous northeastern section. There were reported during 1936, 11,810 cases, which is the L~rgest number on record. The 897 deaths reported, however, is 80 less than the 67? deaths in 1929. While the number of deaths is the second largest on record, the fatality rate of 8.1 is the lowest. As
a result of the gradual extension of the disease into middle and north Georgia, considerable alnr.m has been felt over the possible affect of this disease upon industry, not to mention tho economic loss as a result of morbidity and mortality. This di sense, vying for honors with syphilis in its bid a.s the greatest health and oconondc problem, demands that every control measure be employed to combat it. Measles
Measles reached a low nnrk in 1936 when only 216 cases were reported. This is 411 cases less than the 62? reported in 1938. The fetclity rate of }.2 is only exceeded by the 1934 fatality rate of 4.0 during the pnst five
years. Meningococcus Meningitis.
The 182 cases of this disease reported during 1936 is the largest
number ever reported to the Department. In no locality did the disease reach epidemic proportions, the cases for the most part being widely scattered.
The fatality rate of 36.8, while not considered high, might be further
reduced by better recognition of the disease and more prompt treatment.

9
The occurrence of an atypicnl type of the disease which pri:mnrily attacked the circulatory system was very disturbing nnd ~.kes the diagnosis much more obscure. Pneumonia.
Pneumonia. followed in the wake of influonzn, which was prevalent during January, Februn.ry, M~rch, and April. The 6 ,.500 cases of pneumonia reported during 1936 was the largest number over recorded. The cases reported exceeded the number in 193.5 (4,8.52) by 1,648. Poliomyelitis
The year 1936 brought forth the largest number of cases of poliomyelitis ever to be recorded in Georgio.. Fortunately the 1.58 cases were scattered with the exception of a localized epidemic involving Mi tchel1, Colquitt, and
'
Thoma.s Counties, which constituted .57 cases, or approxi~.tely one-third of the number reported. The 28 deaths reported approxi~.te the number reported in 1934 and in 1932. The fatality rate, however, is greatly reduced over any previous yer::.r. Scarlet Fever
The 1,098 cases of scnrlet fever reported during 1936 were approached in 1928 when 1,000 were reported and in 1929 when 1,186 cases were r~corded. In 1930, 1,186 cases were reported and 1931 saw the high mnrk of 2,129 cases. Since it appears to be the history of this disease that there is n genernl build up of cases it is felt likely that 1937 or 1938 Vfill be a peak yea.r. It is interesting to note that while 1936 shows the largest number of cases in the past five years, the number of deaths as well as the fatality rate for this year is the lowest. Typhoid Fever
For the year 1936 there were 917 cases of typhoid fever reported. This is the s:ma.llest number of cases ever to be reported. While this is only a reduction of 96 cases over the 1,013 reported in 1935, there is n redu~tion

10
of 67 deaths over tho previous year. Even though the smallest number of cases of typhoid fever were
reported in 1936, there occurred in Lanur County a small epidemic associated with a large number of endemic cases. In c.ddition, tho City of Monroe ho.d a milk-borne outbreak affecting some 28 people. This disease appears to have been much more prevalent in tho northern half of the State. Typhus Fever
During 1936, 815 cnsos of typhus fever wore reported, which is an increase of 326 cases over the total for 1935 when 489 cases were recorded. This disease is rapidly becoming one of our most serious problems. The cost of repair and the cost of food for the rats alone is sufficient to wnrrant their extermination. It is expected Unt this disease sb.'lll continue on the increase until such time us the general public shell become sufficiently enlightened to the seriousness of the disease and institute rat-proofing and rat extermination. Influenza
During 1936, 15,113 cases of influenza were reported. This is the largest number to be reported since 1932 when 15,685 were recorded. There wore 1,810 deaths due to influon~~, the largest number during the past five years. While the death rate of 59.3 per 100,000 from influenza is likewise the highest, it is interesting to note that the fatality rate is the lowest since 1933. The Venereal Diseases
The diseases, gonorrhea and syphilis, constitute the lc.rgest problem in public health. Since these diseases are so poorly reported and since the mortality figures are unreliable, it is felt that an c.nalysis of the figures available is not of any IJ~;i.rticulnr vc.lue. There were .5,221 cases of gonorrhea and 8,569 cases of syphilis reported during 1936.

11

LABORATORY

The total number of specimens bcndled by the luborntory was 193,414,

an increc.se of three per cent over the previous year. There wns o.n avemge

of 3.2 procedures per specimen.

Examino.tions for tuberculosis ---------------Exnminntions for diphtherin -----------------Widnl tests for typhoid fever ---------------Smco.rs examined for gonococci ---------------Blood smeo.rs for mnlc.ria plasmodia ----------Specimens examined for mnlarin index --------Examinntions for intestinal parasites --------
Brain exo.minntions for rabies ---------------Animal inoculations for rabies --------------Miscellaneous specimens ---------------------Agglutination reaction (liquid specimens} ----
Blood cultures ------------------------------Stool and urine cultures --------------------Blood nnd spinal fluid for Wassernnnn tests --
Water analyses -------------------------------

... --
4;326 1,.522-
"216
4~231
.. 6;3"43
36;.531 31;.580
ljl3.5 1,143
'887
7;072
6;128
2;.58.5 81;9.53
8,891

Total laboratory specimens ------------------- 193,414

Per Cent Positive
2.5 ~-3 14.3 22.4 16.1 12.0
.5.2 8.6 1.5.2

So great has been the den~nd for cninr.l inoculations for tubereulosis

that the laboratory now limits nnirrnl inoculations to cases for which three

previous negative micros~opie tests have been obtn~ned. The procedure not only

requires much time c.nd attention, but is ruther expensive. However, it is

justified in nnny insto.nces and with new anin:nl qunrters nov; nvailo.ble more

work of this kind can be done. Investigations of the artificial culture

methods are being :mnde, and it is hoped that this my prove to be as effective

as the a.ni:mtll test.

The routine examination of thin blood smears from physicio.ns in-

creased from 3,869 in 193.5 to 6,343 in 1936. This increase is comparable with

the large increase in mulnrio. morbid!ty. Ivi'11Qria index work included the

examination of 36,.531 thick s:menrs showing 7.4 per cent positive. Operations

at the Albany branch laboratory were discontinued in December, partly due to

the temporary cessntion of :mnlo.ria work in this section nnd pertly to nllow

the technician in charge to avail herself of specinl training under the Social

Security program. It is planned to reopen this branch in June.

12

Follovnng is n list of tho biologicr,ls distributed during the past

year~

Typhoid vnccine ------------------------------ '190;63.5 c.c.

Diphtherin antitoxin ------------------------- 6,072,000 units

Toxin-antitoxin ------------------------------

'213 c.c~

Toxoid (plc.in) -------------------------------

1;2:40 c.c~

Alum precipitated toxoid --------------------- 16;93.5 c.c~

Schick mr.teri~l ------------------------~---- Smnllpox v~ccino points ----------------------

-8;530 c.c.
13 ..132

Silver nitrate nmpules ----------------------- 49~328

Tek.nus nntit oxin ---------------------------- 1,440;800 units

Cnrbon tetrachloride-oil of chenopodium ------ 19~268 c.c.

Tuberculin----------------------------------- 66 ~262 tests

Tuberculin, purified protein deriv~tive ------
Dick tests ----------------------------------UnduL~nt fever vnccino ----------------------Antimoningococcus bacterin ------------------Ant1moningococcus sorum----------------------

4 1 420 tests 100
10 c.c.
2.50 c.c. . 1.5 c.c.

Scnrlet fever nntitoxin, therapeutic --------- 18,010 units

Tho specimen lond is Tilpidly nppronching tho c~pc.city limit nt the

present quarters of tho laboratory. If the plans for expansion of local health

units materialize, the load on the laboratory vnll far exceed the capacity.

To relieve this situation the establishment of branch laboratories is

recommended at certain strategic locations. These branches should be organized,

equipped, and operated as integral parts of the State laboratory system.

They should eventually handle the same variety of routine public health

laboratory work as does the central laboratory, vlith the exception of the

Vlasserm.nn test for syphilis, special culture work, o.nd animal inoculations.

13
MATERNITY AND CHILD HYGIEilli The work in maternity and child hygiene has been greatly expanded
during the past year, by the addition of field, clerical, and technical personnel, including a pediatrician, assistant supervisor of dentul health education, and advisory nurses.
For public health nursing the past year was notable in two particulc.rs, n temporary loss of WPA nurses and consequently the amount of service rendered, and the creation of a per.nnnent public health nursing organization which serves as a foundation upon which to build for the future. Since January 1934 the Department b.ns been entirely dependent upon relief projects for public health nursing service. A project npproved in November 1935 provided the service of approximately 200 nurses and curried public health nursing into every county in Georgia. However, this extensive service wns availc.ble for only a short time. With the improvement of economic conditions nurses begnn leaving the project to ac ccpt pei'IIJI:I.nent employment. In Mo.y 1936 the State relief office found it necessary to reduce the nursesV salary and travel allowance to n point where successful operation of the project becrune difficult. It wns decided to suspend the project on r.r.y 30, leaving only such nursing service as the counties themselves could finc,nce and that which had been established through Social Security funds.
Socinl Security funds becune available for public health nursing service on April 1.5. The progrnm gnve Georgia n per.rrnnent str,ff consisting of u director, assistant director, and 18 field advisory nurses. Georgia has been fortunate in securing for these positions nurses with wide experience and good professional preparation for public health nursing. The duties of this group include a. supervisory n.nd advisory service to county nurses and the rendering of actual nursing service in counties where no other nursing service exists. In those counties they hr.,ve conducted midwife classes, taught classes in hame hygiene and cure of the sick, and have done a certain rumount of irmuunizf'.tion work.

14

In addition to the State staff, Social Security funds have WL~de

the appointment of 20 public hec.lth nurses possible in the counties. Ten

counties which were not prepared to adopt the Ellis Health ~.w end establish

a health department appropriated money for nursing service only. Nursing

se:rvice wa.s also estnblished at Pine Mountain settlement and the Irwinville

settlement.

The Department also established, through Social SecQrity funds,

six itinernnt district tuberculosis nt~ses in order that clinics might be

orgnnized in counties where there was no nursing service. At the close of the

year, the follmving permnent public her.lth nursing staff' 'liVCS at work in

Georgie.:

Director

1

Assistnnt Director

1

Field Advisory Nurses

lS

District Itinernnt Tuberculods nurses

.. 6

Nurses in orgnnized counties

36

Nurses in unorganized counties

10

72

Those figures do not include the public health nurses employed in

Richmond, Chathrun, Bibb, Fulton, and Huscogee Counties.

The State WPA nursing service wns re-ostc.blished in September and

a.t the close of tho yec.r 'VIas giving employment to 46 nurses.

Nursing service wns availc.ble in 68' of Goorgio.' s 1.59 counties at the

end of the your.

The nurses have continued to carry n generalized public health pro-

gram including midwife supervision, honlth supervision of prospective mothers,

babies and preschool children, school nursing, administration of vaccines,

tuberculosis nursing c~d assistance with the control of communicable diseases.

The statistical report shows intensive work in the field of rudwife

supervision, 1,691 classes having been held with the totc.l nttendance of

9,177 and 5,182 visits made to the homes of this group. At the close of the

15

year thoro were 3,297 certified w~dwivcs who had sufficient equipment and

instruction for tho prnctic:o of Llidvdfery. The midwivcs, ns a class, seem

to be obeying tho rules and ere prompt in reporting births to the local

registrars. It will bo recalled thc.t in 192.5 vm hnd c.round 9,000 midwives

practicing in Georgia.

Emphasis has been pl2.ccd on prcnntnl and infnnt ~nro c.nd the super-

vision of tuberculosis pntients. Nursing service was given to over 4,600

prospective mothers nnd to over 30,000 infants nnd preschool children. A

total of 63,271 visits were Inf'.de to this group.

A sto.tisticnl report of tho nursing service follows:

Child hygiene service

Cases

Visits

Antepartum Postpnrtum Infant Pro school School Crippled Children Midwives

.4,692
10;.590 19;878
2,170 83

12;859 10;2'.53 14;231 25;82'8 16,043
. 634
52182

Total

31,413

85,030

Group activities

MidWife classes taught Attendance
Health classes, attendance Classroom health tQlks
Attendance

1;691 9;177 1,4:98
'233 8,191

Conmunicnble disease control, homo visits
Immunizntions: ~.llpox Typhoid Diphtherin

'.
11~632
.59; 912 15,944

10,463 87,488

16
Dental Health Education Progress in dental health education depends primarily upon the
responsiveness of four organizations which cooperate in this program: The Georgia Dental Association, State Department of Education, Parent-Teacher Association, and the Agricultural Extension Service. The supervisor of dental health education acts as an intermediary and attempts to properly place dental health education in the individual programs so that each organization can vmrk to the best advantage with a :r:linimum loss of effort and a maximum service to children.
At its meeting in Hay, the Georgia Dental Association adopted definite dental policies to be follov.;ed in the public health program, The Association has organized an effective working council of 16 district and 1.59 county chairmen consisting of dentists whose particular duties.are to organize all ethical dentists to make dental inspections of all school children and to cooperate with local asencies in planning corrective programs.
Seven district dental societies featured the dental health education program, each having as guests the supervisor of dental health education, the chai:rtJan of health education of the Georgia Dental Association, a representative of the State Departr,lE)nt of Education, a.nd all the school superintendents of the district. In each instance the result was a better understanding of the importance of the establis)u:-1ent of the proper working relationship between the school, parent-teacher association, and dentists in the community.
In the promotion of dental health education, the cooperation of the State Department of Education has been of inestimable value.
Both state and local parent-teacher associations show an increased interest in dental health education. The associations in t1e col.1lillunities cooperate with the schools and dentists in planning for dental inspections and corrective work.
Dental inspections were mde of 128,211 school children in Georgia from 61 countiel'l:

17
80.9 per cent had defective mouths .50.4 per cent had never been to a dentist 22.3 per cent did not ovm a toothbrush 18.6 per cent had apparent malocclusion
53.5 :per cent VTere in need of prophylaxis

18
SANIT.ARY ENGI:r:-m.ERING The State is divided into three sanitation divisions which are subdivided into seven districts. Each of' these divisions and districts is provided with a sanitary engineer. In addition 25 sanitarians have been placed in counties under Social Security planning. There are also 12 district nnd assistant district supervisors operating under a budget provided by the United States Public Health Service and the Works Progress Adn.inistration. Water Works and Sewerage It is necessary to have available scientific and engineering knowledge of chemical and biological processes involved in the purification of water and the treatr.1ent of sewage. This involves weighing of relative costs and advantages of new developments in processes, and the adaptation of these products of research to practical conditions in Georgia. All engineering plans and specifications for water and sewage treatment plants are technically reviewed and approved. Plans for 22 wvater works and 20 sewerage })rejects were reviewed and approved. The results of bacteriological exaru.inations of wateF supplies in the laboratory are interpreted and LRde use of in forMulating reconnendations for necessary improvements to assure the safety of individual nunici:rnl water supplies. The personnel in this division gives detailed instructions in operating and controlling water purification and sewage treatncnt plo.nts. in the cities nnd tovms. Group instruction is given once each year in Atlanta to representutives of the tovms v;ho assemble for this purpose. The totc.l
attendance o.t this four-day course vvo.s 183. Two days were devoted to cle.ssroom vvork at Georgia Tech und two days to practical expc~rience and observation on the modern wo.ter and sevro.ge plo.nts and swimming pool at Griffir:a.
\later works projects were completed in 22 towns not previously having wn.ter works;

19

B..'lll Ground Buchnmn Cc.mnk Cc.rnesville Cumming fuvisboro Gordon Grey Hc.milton Hnrle:m. Lexington

Milnn Montrose OLlega Palmetto Ringgold Screven Stnthrun Temple Ham Springs Wor,dck Headland

NeVil' purification plants were completed in 12 towns:

Athens BoviTdon Bremen Cra.wford Dublin Elberton

Forsyth Gainesville Hogansville Stone Hounto.in Toccoa Uo.ynesboro

Four water treatment plc.nts were being improved or enlarged~

Carrollton College Pt::trk

Hewnnn Vle. shingt on

Additions c.nd improvements WOl'O completed on 17 existing vrater systems:

Americus Albc.ny Cnlhoun Clnyton Coolidge Dnrion Decatur Ellaville Fort V:1.lley

Jesup l.hrshnllville Reidsville Roswell Snvnnnc.h Sylvania Thon:nsville Thunderbolt

Six town~ installed new sterilizing equipment on wnter supplies:

Abbeville Americus Climnx

llcR1:'.e Uontezumn Soci[tl Circle

Tnelvo tovms constructed new sewer systems which wore previously

without sm.rere.ge:

Chatsworth Cumming Douglasville Fairburn Glennville Hurlom

Jasper Lumpkin Honticollo Reidsville Sr.JYrnn Vilh'l. Rica

Five sevm.ge t reo.tment plants were added to existing sower systems:

Fort Valley, Griffin, N.bdison, Mhrietto., Newnan.

20
Work has boon continuvd in co:rwtructinr; interceptor sewers to serve the City ~Atlanta, adjacent municipalities and unincorporated sections of Fulton and DeKalb Counties. These sewers are being built jointly by the City of Atlanta, Fulton County, and the Works Progress Administration. Four sewage treatnent plants are now under construction to treat the sewage to be collected by these interceptors.
All investigations, studies, recommendations, and inspections of improvenents to public and semi-public water supplies used for drinking and culinary purposes on interstate rail~Y trains, vesselst and airplanes are ~de by this clivision for the United States Public Health Service. Certification action v.ras taken on 50 supplies last year. Of this number 42 received favorable and 6 provisiOik'll certificates .. 'l'wo supplies were prohibited from supplying water to interstate carriers until recomJ.ended corrections are r:.ade.
There are 325 public vmter supplies in the state serving 40.5 per cent of the total population of the State. Malaria Control
Progress in I:Jalaria control has continued by tho r.1othod of drainage with the use of relief labor. A total of lt208,953 lineal feet of drainage was accomplished, comprising 673 ponds consisting of 8,608 acres.
The number of deaths from nalario. increased coi!lLlensuro.te with excess of ro.info.ll similo.r to the years 1922 and 1929. This substantiates, to some extent, the theory of the seven year cycle of rnlQria intensity. During the past year there seemed to be a groat increase in virulent type of rrnlo.ria throughout the entire State. During tho yet.>,rs 1926 and 1932 when there was a decided increase in rainfall the incidence in malaria deaths was negligible. It seems possible that cortr~in yearly cycles of r:JC.ss infection rac.y be followed by several years of partial immunity or less susceptibility. Inforrontion is meager previous to 1921 relo.tive to c.nnunl variations in mlr~rin deaths. It has been noted, hovvever, from certc.in historical data that references

21 are made to certain years of :roo.lnrin. intensity, which conform to this seven yec.r cycle. In the few succeeding yea.rs there my be a ra.thcr stea.dy decline
of m.'llc.ria Itlortality until 1943 VJhon the seventh ycc.r of this cycle will show
an increase. If these deductions a.ro reliable, tho conditions rJay be stated briefly that excessive rainfall nay not be such a. serious fa.ctor in incrcnsing m..-;.la.ria mortality unless such excess comes at the sovon yonr cycle period.
Whereas the increase in ma.la.rio. mortality during the past year v1as discoura.gine, there are certain facts which my be considered. There c.re no nenns of detorrnining how high ml8.rio. IJ.ortnlity night have been during the :pc.st your ha.d it not boon for control methods. There arc cortc.in localities in which nnlario. nosquito production o.nd o.lso m'llnrie wc.s prevented. A considoro.ble amount of tho drainage a.cco:mplishod in the last few yoc.rs wns more for the ::)Urposo of work relief than for a.ctu~,l mla.ric. control. Tho t ota.l r'..Llount of dra.ioogo a.ccomplishod we.s not equivalent to noro than co!lpL;ted malaria. drainage for two or throe counties if the work had boon concentrated.
It is believed that tho Llensuromcnt of ef:fectivo malaria control by dreinaco should not be considered over c period of only "' few yours. This State hns the greatest area of nnlnrio. infection of ~ny other state. N!:.lo.rio. intensity is also equivalent to one of the highest. Considering the problem of rnclnrin control by dro.illi'lgc over such an onoroous area. and of such intensity, progress must necessarily be slou in effecting considerable .nfllnric. reduction.
It is hoped that fl combifu'ltion field investigation nnd mclaria control unit can soon be put into opora.tion. T~is should comprise a medical epidoLliOlogist and an engineer-entomologist. Such oporr~tion should comprise chiefly concentration in certain organized counties making every possible usc of the co~~ty health officer and his ontiro personnel. Tho proc0dure should involve a complete set of m~.ps by tho ene;inoer on n suitnblc scnlc showing locc.t ions of every home numbered on tho nLp a.nd n correlated ca.rd index system filed with the county hoelth officer. Those ~ps should show nll streams c.nd ponded

22 waters, the m'l.pping to be n bnsis for nll futuro investigations nnd control. Tho enginoer-entonologist should then proceed to study biologicn.lly the field conditions, types of Anopheles production f'.nd engineering d~:.tn vv-hich should nll be clenrly indicated on such mnp nnd reports. The n'l.lc.ria epidemiologist with the nid of tho county hoc.lth officer end nurses should proceed to collect blood smeo.rs not only to determine every nnln.rin infected person in the county but to indicate nlso the foci of infection. There should be one or more engineers or sanitarians c.s personnel of tho county hunlth department to assist tho engineer-entomologist in preparation of mnps for general studios and for planning and execution of drainage.
Screening should certainly bo an item included in control methods. R:-.ris green dusting would be ap:plicc..blo to some particular problems. Drug control should be established as part of tho county health depc.rtnentVs routine. A general educational campaign in the cotmty should be established in order to arouse public sentiment.
Such routine suggested would survo tho purpose of presentation to county officials tho groat need for m'llarin control, a comprehensive outline of Il][~lnrin control procedure nnd an ostL'mtc of cost over n period of yet:'..rs. Finally, this whole scheme should be followed by a program of :r.Jnintenance which would include tho continuance of the drugs, drninnge, screening, und other methods. Community Sanitation
'rho prog!'f'.m of construction of sanitary privies nnd se:')tic tanks has
gone for;l[[>.rd "~>lith undiminished LJ.Otlontum. During 1936, 9, 969 sanitc.ry privies
were constructed. This record is especially satisfactory considering the reduction in WPA labor avn.ilnble. A total of 31,048 sanitary privies ho.ve boon constructed with relief labor during tho past few yonrs.
Thoro hc.s boon n concerted effort to fornnrd tho promotion of snnitary privy construction by tho uso of county convicts. An effort has been mnde to

23
osk,blish this routine so thnt c.s relief lc.bor diminishes the:::-o will be established nnothor :plnn for furnishing lnbor of this typo of snni.t::.~tion, Thoro nre nine counties thnt have sot up :privy building :phmts nt county convict cnm:ps, It is nnticiputed thQt convict labor mny be relied upon to c. groat c:>..."tent in the futuro for rmintonunco of snnitc.tion nnd drc.iru::ge,
It is not the :purpose of this division to promote construction of sanitary :privies in municipc.litios wherever there is possibility of promotion of initial sowers c.nd sower extension, Suburban nrons and ruro.l comr.1unities comprise the grcntost need for this type of sanitation,
Concerted effort is being mudo to provide sanitc.ry privies in the rural homos throughout those nrons of greatest hookworm infostntion, Home nnd School Sewngo Disposnl Plo.nt s
A totnl of 949 homo and school sowrcge disposnl plo.nts were instnlled under tho supervision of this division. Those figures do not include n lnrge number of pl:::.nts installed by homo owners who obtained copies of plnns nrn.d specificntions from tho office,
There is considerable increnso in de~~nd for this type of snnitc.tion.

24 TUBERCULOSIS CONTROL
Tho functioning of tho tuberculosis control divisj.on was hr:mpcred to some extent becc.uso of dcpcndonco for clinic orgnnizr:tion rend follow-up on in-
ndoquc.toly pc.id WPA nurses. District tuberculosis nurses w.ried fran 18 to 6,
the lutter being tho :present number. Although those nurses v10re valuubly assisted by county vJPA nurses, Social Socuri ty nurses, county henlth officers, and others, 901 fewer exnminr'.tions were :mc.do thnn in tho previous yonr.
As heretofore the coope~~tion of the nedicnl profession hns been freely rendered n.nd without their ['_id nnd thnt of various civic orgn.nizc.tions, tuberculosis associetions, county officir-tls and invididuals in furr.ishing the siDD.ll foe required from or.. ch porson x-rnyed, little could hn.vo boon r:ccomplishod. (Tho x-rny foe was discontinued Fcbrur:ry 16, 1937, and ns n result clinic orgnnizc.tion Hill bo much e[~sier c.nd more sntisfr:ctory.) As usun.l tho Phi Uu Frc.ternity hns r.nde their nnnu::'.l contribution of Cl ,500.00 to this progrc.m.
In 1936, 6,248 white persons wore oxnninod Hith 461 cnsos discovered, and 260 new crcses wore found in the oxm...ination of 2,329 colored people. Re-exam.inc.tions were l"!'JG.do of 3,181 v.rhite persons .J.nd 665 colored, rrnking a total of 12,602 tht~t were x-royed c.nd 721 nm.r C[csos thr-.t wore discovered.
The tuberculosis cc~se loc~d of tho nurses on Doconbcr 31, was 21,320 to which 32,743 visits wore LJndo. Those nurses also did .5,871 tuberculin tests. Contr~ct wns broken for 1,414 persons, o.drnission to tho SarmtoriUJ!l o.rrnnged for 187 cr.sos, nnd relief wns secured for 261 cE:sos.
A study of tho tuberculosis donth rc.to in Goorcin before and since October 1930, when this service VW<'.S begun, n.ppor:rs to provo thoro is norit in the progrnm. Tho 1920 rnte per 100 1 000 population wc.s 81.6 c.nd in 1928 it was 81.7, hr.ving fluctu~ted between 78.5 r-.nd 92.6. In 1929, 1930 r:nd 1931 the l'C'.tes vmre respectively 75.3, 74.6 o.nd 73.7. Then tho rc.te dropped ec.ch yof'.r quite ~.pidly until for 1935 tho ro.to wo.s 57.1. The provision~l rr:te for 1936
.1s .55.2. In the five yec.r period, 1926 through 1931, the porcontnge of

25

decrease in tho death rntc wns 6.1, nnd in tho four year period ending Docenber

31, 1935 it was 22.5~ Case finding by this Dopnr~nont through field nurses

assisting physicians, curly treatment under tho direction of tho farllly phy-

sicinn ns c. result of this ceso finding, nnd tho Wider usc of lung collapse

measures nrc no doubt responsible for this rc.pid decrease in the tuberculosis

donth rc.to. And to no less degree should tho inportnnt brenking of frunilir-.1

household contc.cts be credited to those ngencics in their conbincd effort.

Tho situntion, c.lthough improved, is still very serious. Therefore,

c. brander use of tho LIDthod found to bo nest ocononicnl nnd ufficient, thc.t is,

x-raying the reactors to tho tuberculin test in certain ago groups, of under-

privileged children, of contacts, of industrinl groups, nnd of c.ll persons

hc.ving syt:J.ptoms of tuberculosis is being :Planned on the c-,ssuruption tlk-:t u stc.to-

wide health progrc.m is to be osta.blishod. Such nn exp.'l.ndod service, consisting

of c. largo stable force of county public health nurses under the direction of

a trained hoc.lth officer, is c. requisite for tho organization nnd follow-up of

the greatly increased clinic service which is to bo offered.

With tho increased locP.l county hea.lth service expected in 1937, t:'Jl

ndditionnl full-tine x-ray unit should be provided. In 1938 c.nothor field

x-ray unit should be necessary so that in 1939 instond of the present number

of x-rny ex~r~nc.tions (less tllitn 13,000) it would be possible to llcko 6o,ooo.

Tho 12,602 persons wore x-rnyod us follows during the pest yonr:

In 136 counties in 178 clinics orgrmized by tho

district tuberculosis nurses ---------------In 17 hcnlth-officer and county public health nurse

co~~tios in 39 clinics ----------------------
Agnes Scott College, Spocinl 81inic --------------Georgia Stute College for ~Jonon, Spocinl Clinic

South Gcorgir'.. Toc.chersl' College

"

11

.A..11dro-v1 College

11

11

University of Gcorgio.

11

11

Spel:tJ.."'.n College (colored)

11

11

2,741
.58
299
145
"76 304 281

26
VENEP.EA.L DISEASE CONTROL The work in venereQl disease control hns boon gro~tly increased due
to tho ~wQkoning of public sentiment to tho seriousness of these diseases, especi~lly syphilis. The assistant chief of this division has been nctivc in field work, promoting public interest in tho problem of socic.l hygiene nnd educo.ting tho public as to tho necessity of e.dequr1.te treetnont of tho infected.
Quite n few of the neWSPf'.pers )-)_eve boon vory liberp_l in giving space for tho discussion of tho venero~l diseases. A number of lr.rgo blue prints have been issued showing tho provc.lonce of tho vonoroal discn.scs. The reprint of Surgeon Gonoi'('.l Pnrrnn's urticlo "stamp Out Syphilis" wns m::cilod to nll honlth officers, physicir~ns, pnront-tonchor a.ssocic.tions, ministers, child honlth r'.nd wolfc.ro councils, nowspf'.pors, logisk.tors, f'.nd others interested in this problon. "A lTc..nuc,l of Infoi"LJ[1.tion for Physicians on the Tront:oont of Syphilis r.tnd tho Control of Venereal DiSO['.SOSfl fron tho Anoricf'.n Hodicc.l Associntion wr.s distributed to tho hoc.lth officers, physiciL:ns, ~nd public ho!'.lth nurses of tho st~to.
Tho Atlc.ntr:. Chrmbor of Cor.1r1orco bccr.no very interested in the control of syphilis. Roconnonde.tions of this Do}l[~rtnont Trero r.doptod, end c. resolution was c.lso f.'.doptod requesting other ch:;.nbors of co:on.orco to tnko action in the control of those disoc.sos.
Coopo:rr.tion hc.s boon continued vli th tho CCC cc.nps in the.: vonorcc.l disoc.so situn_tion. Out of f'.. mmbor of cr'.nps reported to this Dopr-.rtnont, there
have been 124 cc:sos of syphilis, 3.58 gonorrhea., c:nd 81 chc.ncroid.
A spocic.l study of syphilis in tho insc.ne vrc.s rr,do so tb..:.'"'.t infornntion night be c.vailnblo c.s to tho cost of this typo of syphilis to tho tc.x p..'"'.yors.
The study covered ~ period of 22 yenrs rend shows tho nvorr'.go o.dnissions to tho hospitc~ls for this period of tino wns 12.8 por cent for BY"I)hilitics. On this ~sis it is ostir~~tod thnt of tho 6,337 inu1tos during 193.5, 811 hQd syphilis.

27
At tho beginning of the yco.r there were 12 venereul disoeso clinics throughout the Stc.tc for the trcntrlent of venorenl disoc:.ses, sevorc.l of which wore not running full-tine. An nttenpt has boen r:ndo to pronate intorest in the finding of now cc.sos nnd in norc adequc.to treo.tnent of the sy:plcilitic individu.a.l, to stinulatc tho follml-up of tl.J.e conto.cts of the ini'octed individuc.ls c.nd to pronate n kindlier feeling between tho private physicio.ns nnd the clinics for the treatnont or indigent individuals.
Since J"une_. 7 new venereal disease clinics ho.ve been established in
coopcrc.tion nith tho rmdica.l societies in the loco.l coununities. .An c.ttcnpt hc.s boon ~r.de to give lay c.nd civic orgnnizc.tions salle
knowledge or tho pre~.lonce or the venereal diseases, results that co.n be expected, the tine tho infection cnn be nest o.p:propridcly troc.tcd, the percentage of cures to be expected in dela.yed troutnent. Tho cost of t ront;..1ent end co.re for noe;lcctod cases !lc.s boon stressed, c.s well o.s tho o.dvn.ntc..ges of pronc.tnl oxnr.li nnt ions P
In lectures to tho youth of tho Stuto, the dnngor frau tho vc..rious nnglcs of tho disoc.so hc.s been pointed out, in c..n effort to educate boys and girls to n higher stc.ndnrd or uornls nnd to instill in then tho thought the.t they should take ovary procnution possible to })rovent contracting the d.isoo.ses. They hc.vo. been instructed with regnrd to trcatnont should tho disonsc be cant rr.ct od, and thu neccssity or protecting otlwrs fron tho r.r.lndy h..n.s been stressed.
With the nodicc~ croups t:ilis division has acted in o.n advisory co.pncity, trying to give tho Cfjnbers souo of tho statistics of studios r1e.de in tho lnrgor clinics in the United Stntes. An effort hc.s boon nndo to stinulnte nore interest in tho venorenl disonsos and to pronate coopo1ution in reporting these diseases to this Dopr~oont.
The ussistnnt chiot ot this division ho.s contacted 220 individu~ls in the interest of this prOSMP.t given .59 lectures to 4,08.5 people.