Annual report 1937 [1938]

STATE OF GEORGIA
I
DEPARTMENT 0}~
PUBLIC HEALTH
ANNUAL REPORT
1937

COB'l'ENTS

Letter of Transmittal

1

State Board of Health

2

Department of Public Health

3

Cancer Control

5

County Health Work

9

Dental Health Education

17

Epidemiology

21

Laboratories

45

Maternal and Child Hygiene

61

Public Health Nursing

65

Sanitary ~neering

67

Tuberculosis Control

83

Tuberculosis Sanatorium

": 87

Venereal Disease Control

91

Vital Statistics

93

To His Excellency, Hon. E. D. Rivers, Governor of Georgia. Dear Sir:
I have the honor to present to you the annual report of the work of the Department of Public Health for th" year 1937.
With the expansion of the health program and increase in activities, the yearly reports are too comprehensive to effectively appear in biennial form. Therefore, beginning with the report for 1937, the Department of Public Health will publish separate reports.
Since this fact was not determined until the close of 1938, statistical data were collected previously on the biennial basis. For reasons of econ~, these have not been re-made and are included with the 1938 report.
Respectfully submitted,
T-~~::.1. Direetor,
State Department of Publ:ic Health.
1

MEMBERS STA!I!Iil BOARD OF HKALTH December 31, 1937

h-Officio Hon. E. D. Rivers Governor of Georgia

NAMlil

.ADDRJlSS

Cleveland Thompson, M.D. Millen

C.K. Sharp, M.D.

Arlington

R.O. Ellis

.Americus

M.M. Head, M.D.

Zebulon

R.F. Maddox, Chairman Atlanta

A.R. Rozar, M.D.

Uacon

M.}l. McCord, M.D.

Rome

H.W. Clements, M.D.

Ade1

L.C. Allen, M.D.

Hoschton

W.A. Mulherin, M.D.

Augusta

T.C. Marshall, Ph.G.

Marietta

Y.T. Edmunds, Ph.G.

Augusta

J.G. Williams, D.D.s. Atlanta

Paul McGee, D.D.s.

Waycross

TJ:lDl EXPIRES REPRESENTIBG Sept. 1, 1939 First District Sept. 1, 1939 Second District Sept. 1, 1942 Third District Sept. 1, 1537 Fourth District Sept. 1, 1942 Fifth District Sept. 1, 1938 Sixth District Sept. 1, 1938 Seventh District Sept. 1, 1938 Eighth District Sept. 1, 1939 Ninth Dietrict Sept. 1, 1937 Tenth District Sept. 1, 1935 State-at-Large Sept. 1, 19~1 State-at-Large Sept. 1, l94o State-at-Large Sept. 1, 1940 State-at-Large

-~ .... _' '"'- ...

Note: Those members whose terms expired during 1937 served throughout the year and until their successors were appointed.
2

DEPARTMENT OF PtmLIC HB:ALTH
T. l. AllERCROJlBIE, M.D.
DIRECTOR C. L. Tinsley, Secretary - Treasurer

DIRECTORS OF DIVISIONS

J. W. Schereschewsky, M.D. Guy G. Lunsford, M.D. J. G. Williams, D.D.S.
c. Daniel Bowdoin, M.D.
T. F. Sellers, M.D. Joe P. Bowdoin, M.D. Mrs. Abbie R. Weaver, R.N. L. M. Clarkson, C.E. H. C. Schenck, M.D. D. T. Rankin, M.D. Joe P. Bowdoin, M.D. Butler Toombs
3

Cancer Control County Health Work Dental Health Education Epidemiology Laboratories Maternal and Child ~giene Public Health lfu.rBing Sanitary ~nearing Tuberaulosis Control Tuberculosis Sanatorium Venereal Disease Control Vital Statistics

DIVISION OF CL~CER CONTROL
The recently enacted cancer Law" charges the State Department of Health, among other things with: Establishing a standard for the organization, equipment and conduct of cancer units or departments in general hospitals in Georgia; with conducting an educational campaign for cancer control; with provid~ng a plan for the care and treatment of indigent persons suffering from cancer; and with acquiring such laboratories, hospitals or other property real, or personal, by gift, purchase or otherwise as is necessar,r to carry out the provisions of the Act.
Pursuant to the provisions of this law a division of cancer control was established in the State Department of Health. Operations
began September 30, 1937.
Survey of Treatment Centers
The first activity of the division was to appraise the cancer treatment facilities throughout the State. Fifteen Georgia cities were visited during the course of the survey. Hospital and other treatment facilities were inspected and contacts with leadine physicians were established in each community.
Findings: There were six regularly organized cancer treatment centers in the State: three. at Atlanta, and one each at Augusta, !-lacon, and Thomasville. Additional facilities, as yet unorganized - such as certain amounts of radium and deep therapy units --were available in other Georgia cities in addition to Atlanta, notably at Americus, Columbus, LaGrange, Rome and Savannah. A considerable section was found in the southeastern part of the State in which there were no organized facilities for the treatment of cancer. This applies as well to that portion of the State north of Atlanta, and particularly the northeastern part.
Indications: From the survey, it appeared that facilities for the treatment of cancer were not equally available over all the State and that additional cancer treatment centers should be organized at strategic points. The survey showed that these could be advantageously located, from the geographical standpoint, at Columbus, Savannah, Waycross, and at one or two points in the northern part of the State, such as Rome or Dalton for the northwestern, and at Athens or Gainesville for the northeastern section of the State.
Some of the physicians interviewed during the survey expressed the opinion that the State should build a hospital at some central point for the treatment of indigent sufferers from cancer, as has been done in Massachusetts and New York. Such a project has much to commend it, especially the opportunity for the planned treatment of all cases admitted, the uniformity and systematization of surgical, radiological and pathological services, the relatively greater efficiency of record keeping and follow-up service when operated from a common center. The
great disadvantage is the first cost (about $4oo,ooo.oo) and the annual
operating expense ($200,000.00). While the project for a central, state-operated cancer hospital must remain in the offing as a project deserving of careful ~ture consideration, for the present, it seemed that an attempt to organize additional cancer treatment centers in well chosen locations would be in better accord with existing State revenues,
5

6

CAl'lCER COftROL

aDd proTide readier means of realizing adequate facilities tor cancer treatment.

Current Program of Cancer Control

In Tiew of the results of the surve7, the diTision of cancer control t. nov engaged in c&r171ng out the following program:
1. Promote the establishment of additional cancer treatment centel"a a\ Columbus, SaTallii8h, Yqcross and at a .point in Northern Georgia.
2. ProTide state-aid in the treatment of indigent sufferers from
J~Uoer so far as existing twlda will allow.
J. ProTide a state aerrlce for the lld.oroacopic diagnosis, in in-
dicant cases, of neoplastic tiane. ~. Cooperate with the YoMD'a lield ~ of the American Socie\7
for the PreTention and Control of Cancer in a campaign of popular education with respect to cancer.
!he followiDg progress oan be reported 1UI4er each of these headir~gs.

!be Deed for ori8Dilac additioD&l cancer treatment centers is nov beiDg ur~ b7 interrlewa with leadiDg pbJwiciana and addresses before coun\7 dical aocietiee. !his need baa also been brought to the atten'Gion of ciTic organisations; the cooperation of local women' organizations baa been aough\1 atte~~~~ta are beiDg made locall7 to raise funds for the purcbaae and installation of deep therap7 x-rq units. Application baa been 11114e to the United States Public Health SerTioe for the lctan of radiwa. under the Bone Act, for use at additional cancer treataant canters and to alllllifl' in this respect the resources of existiDg oua. J.a aa indu of procreaa aloDg these linea. a cancer treatment center a\ Ool'llllbu vas opaned ahortl7 after Ja.nua17 1, 1938. .U W~oaa, a cancer trea11Mnt center is in process of organisation. J.t SaTallii8h, the Georcia Medical Socie\7 baa appointed a committee to consider waTS all4 ll8aD8 of giTing that ci\7 a treatment center and a co111111ttee of the Woaen'a J.uiliar7 to \be Medical Socle\7 baa been appointed to cooperate with the coamittee of the Medical Societ7. In Dalton a committee appointed b7 the Whitfield Co1m\7 Medical Sociev aDd the CiTitan Club,
throUCh their Hospital Board, is giTiDg consideration to establishing a
cancer treatllent center at that point. J.t the present Ume the outlook appears \o be enoouragtag for the organization of the additional cancer treatmant centers which are needed if the chain of facilities for the adequate treatment of caacer is to be complete.
State...U.d for Indigent Patients
Acccrd.iltc to proTiaiona illplicit in the lav state-aid can be turalahed onq at caaoer Ullita or departments of general hospitals approT8d b7 the State.
'letho4 of I'JbtainiDg J.id
Beoaue of the .lillited appropriation for this purpose, state-aid "t.e co:a.teaplated onq in thtlae cases where a reaaou.ble prospect exists of arrestlac the disease
.Application for State-J.idt 1'l'his- is made, in behalf of the patient, b7 the famiq pqsician on a form turniahed b7 the State Department of

7
Health. The lesion h daecribad aa to character, aUe, duration, preeence of glandular in'nlvltlllllllt or other llllltaatuis and an opinion 1a axpressed as to whether treatment offers a reasonable proapect of arrest.
Inability to Paza Thia ia certified to on the form by the director
of the county welfare department. If a caae ia deemed amenable to treatment, the patient ia directed to report to the nearest cancer treatment center. The director of thia clinic ia notified immediate!T of the paDding arrival of the patiaat and 1a given .all available data. DoubtfUl cases are directed to visit the clinic for examination and aubaequent report. Thia group of caaea includ thoae which are probab!T, though not certainl7, cancer - or those 1i1 which there h 'JDCertainty aa to whether the diaeaae baa prosreaaed teo far to hold out a reaaonable proapect of arreat.
Reimbursement of CliniCal Clinica are reimburaed for the coat of treatment on a definite scale arrived at through conaultation wi.th the conference committee appointed by the State Cancer Commiaaion. The coat of cancer treatment baa been segregated into elemanta, and the clinic ia paid the total of the coats of each of thaae elements on a definite scale. While the preseat scale of coata appeara to be aatlafactory, aa a first approximation, some minor adJustments or additions to the acalea IIIIQ" be required with the paaaege of tiu
.lctivitiea
In order to brillg the proviaioaa for atate-aid in the treatment of cancer to the attention of the medical profeaaion of the State, application blankll and an explanatory circular letter were sent in November to all physicians in Georgia.
The first patient to receive state-aid vaa admitted November 15, .1937 at the !'b.omaaville Cancer !reatment Center. Since that tiu 175 applications for state-aid han been received and acted on. .1a knowlecJce of th8 helpiDg heDd extaDded b7 the State beco~~aa disauinatad, and aa nav cancer treatment centera are established, the rate at which auch applicatioaa are received *-r be expected to show a stead7 increase.
!iasue Diyuoatic Servicea .1a a fUrther aid in the dia&noaia of -.llgnant diaeaae, a atate eernce for the microscopic examination and diapoaia of tUIIOr tiaaua haa baa organ11ed. The service 1a available to the phJ'Biciana of the State onl7 in iDdigant casea. !l.'he on1T tia~uea examined are neoplastic tiaauea or those auapected to be of neoplaatic origin. Mail1Dg caaea containiDc a apecimen bottle with fixiDg aolution and direoUona are aupplied to ph7aioiana upon requeat. fhia service vaa armounced to the madical profeeaion beginniDg in
January of 1938
Popular lducat1on1 In educatillg the general public vith reapect to cancer, the cancer control division will cooperate vi th the Yomena lie14 Arlq of the American Socie\7 for the Prevention and Control of
Caacer. !'hia organization haa been operatbe in the State since 1936
.All actin educational campaip. in which the State Department of Health
will cooperate, ia acheduled for the SpriDg of 1938.

DIVISION OF COUNTY HEALTH YORK
On December 31, 1937, Georgia finished its moat successful year as
regards county health york. Further in the report is a table ehOYing the status of county health work in Georgia for each year since the firat
county health department vas oranized in 1915.
Erpcnsion of Organized Territory
During 1937, elevGn new countie1 began operation of full-tim health departments, with individual unite baing organized in Burke, Tift, Whit-
field, Worth, Calhoun and Clinch Countie1. Jonea County vas combined with Bibb County to form a diatrict, and districts compoaed of Montgomery and Toombs Countin and Telfair and Wheeler .Counti6e vera organized. Reorganization of the departments in Spalding, Sumter and Thomas Counties was also effected during the year,
Plans have been perfected and qualified personnel selected so that health departments may begin operation in the following countiea on Jan-
uary 1, 1938: Blackley, Bulloch, Coffee, Dodge and Walton. The work
will begin in Crisp and Wonroe Counties as soon as qualified personnel can be secured.
Coverage and Costa: The forty-four counties having health departments, together with the health department of the City of Atlanta, with
a personnel of 375, on December 31, served 1,580,669, or 51 per cent of the State'a population, at a cost of 4l~ per capita, 35 of which vas borne by the counties. This is an increase of 186,593 persons, or 5 per
cent of tho population, receiving the benefits of full-time health service.
Future Prospects: The grand juries of several other counties made the necessary recommendations for the establishment of health departments in their countiea. Many others have made one recommendation and will probably make the second at the next meeting.
The demand for qualified personnel in counties and small di1tricts is greater than the supply; therefore, the plan for dividing the State into etx large districts has been temporarily abandoned.
Atlanta and Fulton County: At the request of the health authorities of Atlanta and Fulton County, the United States Public Health Service made a survey of the health conditione of Atlanta. and Fulton County.
This survey was made during the period June 28 to July 17 and copies of
the report were furnished to the officials of the c1 ty and county, and to other \nterested citizens. There t~s been a partial reorganisation of the city health department and a more complete reorganization is anticipated in the near future.
Trainees
The allotment from Social Security funds vas continued for the
training of personnel and during the ye."l.r 15 medical officer traineu
were given training; throe of these were sent to Johns Hopkins University and 12 to the University of North Carolina. Thirty-one nurses
9

10

COUNTY HEALTH WORK

vare given training at Peabody College, 4 at the University of Pennsylvania, 2 (colored) at the Medical College of Virginia, and 2 at Columbia Unlvarsi ty. Twelve sanitary engineers were sent to the University of North Carolina, 2 to the University of Michigan, and 4 to Harvard University. All of these trainees received a certain amount of field training
at the training station which is operated in connection with the GlynnMcintoah-Camden health department.
'rhe director has been pleased with the commendation of the Georgia trainees by the faculty of the division of public health at the University of North Carolina.

Spacial Educational Activities

The Institute of Public Affairs of the University of Georgia was held in Athens on June 22, 23 and 24, all sessions of which were attended by the director. The director also assisted in the arrangement of that part of the program conducted by the Georgia Public Health Association and took part in all discussions.
The annual meeting of the Georgia Public Health Association was held in Atlanta at the Biltmore Hotel on April 22, 23 and 24, A splendid program was presented and the attendance was far greater than ever in the past.
The director addressed the South Carolina Public Health Association at its annual meeting, on the progress of county health work in Georgia,
At the invitation of the Atlanta Public Forum, the director conducted a forum for five nights in different sections of Atlanta. In company with others from the department, he also attended the North Georgia Forum at Clayton,
The Conference of ~tate and Territorial Health Officers, which was
held in Washington, D. C. on April 7 and 8, was attended by the direc-
tor, as was the meeting of the Medical Association of Georgia in Macon on May 12,
Talks were made to the junior medical students of the University of Georgia ~edical School, and to the student body of the Georgia State College for Women, as well as to various civic organizations and service clubs throughout the State. The dlractor also talked to the sanitary engineers at their conference in Macon.

Routine Activities

During the year, the director traveled 29,200 miles, made 145 visit! to health departments for conferences and observations, met with cl ty and county officials and county boards of health on 110 occasions for the purpose of promoting the organization of health departments, ar:rangoment or budgets, and selection of personnel. Thirteen appearances ~era mads before grand juries for the purpose of explaining the benefits 'o ba derived from the adoptlon of the Ellla Health Law,
Following is a consolidation of the activities of the county health
4pa.rtlllents for tha year.

ll
SUTISTI<al. StOOWlT or ACTIVITIES or COOllTT HEALTH m:PARTMENTS

A. caotUJIIC!BLl: DISEASB CONTROL
1. Adaiaeione to medical service
(a) Admieeione to nursing service (b) !otal adminione to medical u4/or nuraing eervice
2. Conaultations with ~eiciane
Field Tieih: ~ Diphtheria
Typhoid fever and paratyphoid fever
5 Scarlet fever 6. Smallpox 7 :lleaales 8. Whooping oough 9. (a) Malaria
(ll) lloo!Q,ol'll
(a) Others
!otal field vieita for communicable dieeaee control Admiaeione to hoaEitalat
10. Diphtheria 11. !lphoid fever end paratyphoid fever 12. lcarlet fever 13. lllllallpox 14. Othere
Total admieaione to hoepitale Immunisation (E!rsons immunised~a
15. lllllallpox lb. Diphtheria - under 1 year 17. Diphtheria - 1 through 4 years 18. Diphtheria - 5 years and over
!otal diphtheria immunisation
19. Typhoid fever
20. Others
21. Public lecturee end talks 22. Attendance

1937 24,611! 12,057 27,308 2,625
12,,53a74 1,645
36
l!g'
9,543 3,062
~
29,185
94 75 72
~37
30,434 5,064 13,036 .J30,.2i1l9l 114,658 10,375
608 30,113

B. T.IIIJ:II:UL DI WSJ: COB'.rROL
1. Admi1sion1 to medical eervice
(a) Admieaicna to nursing eervice
(b) Total admiuione to medical and/or nursing ..rvice 2. Caaea transferred to private physicians
~ Clinic viaih lield vlaite
5 (a) lUmber of treatment given
(b) Diamiseed from arvice
6. Public lectures encl. talka 7. Attendance

19,691! 7.530 20,573
665 168,135 12,027 161,483
2,691 ' 621 22,296

C. !URIII.COLOSIS COJIDOL

1. Il:ldividual1 admitted to madlcal aarvice

6,670

(a) Pc1itive oa1ee

1,275

(b) Suepicioue oaaee

2,224

(o) Contacts

3,171

2. Individuals admitted. to nursing service

10,344

(a) Positive caeee

2,038

(b) Suspicious caaee

2,694

(o) Contaotl

5,612

(cl.) !otal ind1viduale admitted to medical and/or nureing service 12,668

(a) Poaitive caee1

2,449

(f) Suepioioua oases

3.392

(g) Contact

6,827

3. Phyaioial UUiinatione in eUnice

5,324

4. X..rq exudnaticne

7,199

12

COUliTY l!lW.TB WORK

C, TUBERCULOSIS CO~OL - continued
5 Clinic visi to (a) Visito to State clinice
6, Visits to private peysiciana (patient.)
(a) Visits to private peysioiane (health officer or nuroe) (b) V1s1 ts to other (health officer or nurea)
7. Field visit.
(a) Visits to cases of tuberculosh
(b) Vidh to tuberculoah auopecto (c) Visits to contact. (d) Violto to pereons unclau1:t1ed 8, Offioe Visits
(a) Office viaita of casea of tuberculosis (b) Offioe vhih of tuberculoah euopecta (c) Office Thih of contacts
(d) Office Tiaito of pereons unclaesified
9 .ldmiasione to sanatoria
(a) Dismissed from oupervhton 10. (a) !lumber tuberculin testa tven
(b) !lumber tuberculin testa completed (a) !lumber poaitiTa (d) Jlumber negative (completed hate) (e) Contacts bron (f) Contact partly broken
(g) Relief secured for pooitiTe case (h) Relief ascured for tuberculous fam111ea (1) Cottages, eleeping porchea, etc. (!lumber built) 11, Public lectures and talks 12, Attendance

D, IIATEI!lli Tr SERVIClli
l, Cases admitted to prenatal medical eervioe
2, Cases admitted to prenatal nursing aervioe
(a) Caseo adm1 tted to medical and/or nnrsing service
3, V1Bits by prenatal cases to medical conferences 40 Visits by prenatal cases to private peyaictana 5 J'ield visits to prenatal oases 6. Office nursing visits by prenatal caees 7. Caeeo attended by nurses for del1ve17 service
8. Cases g1 von postpartum medical examination
9. Cases given postpartum examination by private peyoiciane 10. Cases admitted to postpartum nursing service
11. Visits to poetpartum oasea 12. (a) Permanent health conference
(b) !lumber of eassiona
(c) Itinerant health aanterencea
(d) Sessions held 13. llidwives registered for formal instruction 14. llidwife meetings 15. Attendance at meetings 16, Vioita for midwife superviaio" 17. Other service 18, Public lacturee and talka 19. Attendance 20, llinrollment in maternity classea 21, At tendanoe

ll. INJ'AJIT .AND PRESCHOOL BYGIEilll: Infanta:
1. IndiVIduals admitted to medical aorvice 2. Individuals admitted to nursing aerTica
(a) Individuals admitted to medical and/or nursing service (b) Permanent health conferences (c) Jllllllber of aeeaions

1937
9,713 3,245 1, 74s 1,780 2,004 35,121 12,259 6,212 16,019
631 11,874 2,985 4,328 3.905
656
356 1,250 13,673 12,220 4,947 7,273
735 297 243 191 25 279 16,42)
7.950 7,410 11 171 21,441 1,051 20,364 6,556
37 1,019
175 3,846 21,!)62 . 88 1,357
118 316 1,298 757 7.452 2,918
5,lg5 7,626 10,247
121 2,282

COUNTY l1EALTH WORK

E. lllFANT AND PRJ:SCHOOL !ITGIENE - continued
(d) Itinerant health conferences
(e) Sessions held
3 Visits to medical conferences 4 Visits to private peysicians 5. Field visits 6. Office visite 7. Consultation with parents
.Preschool: 8, Individuals admitted to medical service
9. Individuals admitted to nursing service
(a) Individuals admitted to medical and/or nursing service
(b) .Permanent health conferences
(c) Number of sessions
(d) Itinerant health conferences (e) Sessions held
10. Visi to to medical conferences ll. Visits to private pcysicians 12. Field visits 13. Office visits 14. Inspections by dentists or dental eygienists 15. Prophylaxis by dentists or dental eygienists 16, Consultations with parents
17. Public lectures and talks 18. Attendance 19. Enrollment in infant and preschool classes 20, Attendance
Total number of infants !Uld preschool children admitted
to medical and/ or nursing service
Total n11111ber of field visits in regard to infant and preschool eygiene
Total number of consultations with parents regarding
infants and preschool children

F, SCHOOL IITGIENE
1, Inspections by physicians or nurses
2. Examinations by plcy"sicians
3. Examinations by plcy"sioians with parents present 4 Individuals admitted to nursing service 5. Field visits 6. Office visits 7. Inspections by dentists or dental hygienists
8. Prophylaxis by dentists or dental cygieniota
9. (a) Children with defects (b) Consultat ions w1 th parent.
10, Public lectures and talks
ll. Attendance 12. Claaaroom health talks
13. Attendance

G. AMT ErGIJI!II

lledical axeminations:

1, JliJ.k,;.handlars

2. Other food-handlers

Total number of examinations of food-handlers

34

Midwives Teachers

5 Others

H. llORBIDITY SEB.VICJ: 1. Admiuions to medical eervice 2. Admiaeions to nuraint; eervice (a) Total admi..ione to JBedical and/or nureinc Mrvice 3. Clinic visits

13
1937
151 591 7,603 1,636 30,987 4,975 27,369
6, 709 8,551 12,o44
89 1,937
284 4o9 7. 742 549 18,503 5,29? 1,801 350 18, 93'. 361 7,134 13,257 4,152
22,291
49,495
46,304
193,297 11~,301
.957 14,753 31,980 85,162 71,675 .2,312 61,023 15,252
702 34,~6 7. 3 203,595
Nr1,003 1 1180 620 6,875

14

CotJIITY HEALTH WORK

B, UORBIDI!Y SERVICI - continued 4. Field medical visi ta 5. Field nursing visits Total number of field visits
6. Office visits
1 Admissions to hoapi tala
8, Total patient-dqa of hospital service 9. Individuals admitted to dental service 10. Refractions
11, Tonsil and adenoid operations 12, Book.vorm treatments completed

I. CRIPPUD CBILIIID SERVICJI 1, Individuals reported 2. Individuals examined at diat;noatic clinics 3 Individuals treated 4. Individuals admitted to nursing service 5 Viaita to diat;noatio clinics 6. Nurai~~ot visits 7, Other service 8. Public lecturea and talks
9. Attendance

I-1. OTJD:R ACTIVITIES 1, Confarencea with peyoioians or dentists 2. Personal conferences with others Hewapaper articles a: Bulletins distributed 5 Circular let tara 6. Uilea travelled on duty

J, !!lW. SAlll'I!ATIOH 1. Approved individual water suppliee installed 2, Hew priviea installed (a) Wood privies installed at homes (b) Concrete privies installed at homes (c) Wood privies installed at schools (d) Concrete privies installed at schools (e) Priviea repaired 3 l:lew septic t!lllks installed (a) Septic tanka installed at homes (b) Sentic t!lllka installed at schools (c) s.W.itation mapa prepared Field visita: 4, Private premises (a) Privats premi sea improved
5 Camp sites
(a) Camp s1 te s improved
6. Swimming pools (a) Swimming pools improved
7. :Barber shops and beauty parlora (a) :Barber shops and baauty parlors improved
8, Schoola (a) Schools improved
9. Public water supplies (a) Public water supplies improved
10. Sewerage plants (a) Sewerage plants improved (b) Linear feet sewer laid
ll. Other viaits 12, :Bui ldinga mosquito-proofed 13. Minor draina.ge - linear feet completed
(a) Linear feet ditch cleared 14. Anopheles breeding places eliminated

1937

/

., 16,873

30,811

47,684

28,079

7,872

53,087

2,288

94o

1,490

7,260

l,lo4 880
2,317 385 683
2,021
6 120

31,823 81,126
2,937 lal,o46 . 6,253 1,494,061
I
495 6,632 3,196 3,075
142 219 3,115 1,388 1,359
29 163
288,901 19,149 774 86 290 72 218 36 1,795 428 1,272 2,357 lo4
85 103,681
68 741 658,715 2,237,128 2,678

COUNTY lllllALTH llO!iX

J, GENn.AL SANITATION - O()Jltinu.ed (a) Acree drained
15. Anophelae breeding places controlled
16, Other serv1 oe 17, Public leoturea and talks
lS, Attendance

I, PROTECTION OF FOOD AND IULI
1. Food-handling establishments registered for supervision 2, Field visits to food-handling establishments
3 Dairy farms registered for aupervision
4 Field visits to dairy farms 5 Milk plants registered for supervision 6, Field visits to milk plants 7 Cows tuberculin tested
8, Animals s~tered under inspection
9, Carcasses condemned in whole or in part 10. Other service
11, Public lecture& and talks
12. Attendance

L, LAllORATORY

Specimens examined-=:.....llil:

1. Water - bacteriological

2. Water - chemical

t Milk or milk products Other food

65.

Typhoid: Typhoid:

blood Widal

cultures

1s.

Typhoid: Typhoid:

stool urine

cultures cultures

9, Diphtheria oultures

10. Syphilis

11. Undulant fever (human)

12, Bangs disease (animal)

1a Typhus fever 1 Tularemia

15. Malaria

16. Gonorrhea

17. Tuberculosis

lS. Feces for parasites

19. Urina4>"aia 20, Rabies

21. Others

Total

Positive
783 3
4,091 119 78 85 129 19 792
19,301
46
80 261 18 2,380 1,578 6,9774a 15,687 224 ~ 57,007

REl'ORTAllLE DI SF.ASES
Anthrax Chickenpox Diphtheria llyaenteey Gonorrhea Hookworm Influenza Malaria Measles Meningococcus meningitis Ophthalmia neonatorum Pellagra Pneumonia Poliomyali tia Puerperal septicemia Rabies in man

15 1937 3,676 47,227
610 13,663
5,875 55,819
906 8,50G
103 . 3,g6g
2,586 177,157 17,55?
5,774 1,016 14,400
90 731 1,636 3,252 1,458 3,850 75.570 1,307 233 1,288 37 20,859 5,683 4,273 18,677 7,lo4 117
~0_9Q
If;li45
-Ca-se;s
1,088 567 148
3,122 5,183
5,460
3,669 96 36 20 515
1,660 37 26 6

16

COUNTY ID:ALTH WORX

liEPORl;\:: LE DISEASES
Rabies in animal Scarlet fever Smallpox Streptococcic sore throat Syphilis Trachoma Tuberculosis Tularemia Typhoid fever Typhus fever Undulant fever Whooping cough Ot'hers
Total

1937
246
629 4
632 11,762
30
1,394 35
307
513 59
923
_.hm. 39,393

DIVISION OF DENTAL HEALTH EDUCATION
The dental health education program is one of education and organization designed to cooperate ~lith all health and educational agencies, to coordinate activities and to promote dental health, The state organizations cooperating with the State Department of Health are the Georgia Department of Education, Georgia Dental Association, Georgia Congress of Parents and Teachers, and Agricultural Extension Service, All local groups interested in child health and welfare are asked ~o participate in the promotion of dental inspection, correction, and education. The auccess of a;r.y health endeavor should be measured by the service rendered to the people for whom it is planned. It is regretted that adequate reporting facilities are not available to evaluate the amount of dental health service rendered to the people of Georgia through this educational program.
Inspections
To make effective the dental inspection, which of necessity is the first step in the program, the State Department of Education, Georgia Congress of Parents and Teachers, and Agricultural Extension Service have prepared the way for the Georgia Dental Association and the State Department of Health. Since the school year begins in September and ends in May, and the inspection program often extends into March and April, it is difficult to give a report in January. Because the biennial report for the years 1935-1936 was not submitted until May 1937, the tabulation of the 1936-1937 school dental survey by counties ~~ included. The total figures of that report are repeated oalow:
Total number inspected --------~------------------- 167, 588 Per cent of average attendance inspected :-------- 56.5
Numoer with defents ------------------------------- 121,247 Per cent with defects ----------------------------- 72.3 Number who had been to dcmtiat -------------------- 73,275 Per cent been to dentist -------------------------- 51~.3 Number who had been to dentist ~ri thlu last year --- 42,859 Per cent been to dentist within last year--------- 31.8 Number with own toothbrush------------------------ 148,818 Per cent with own toothbrush---------------------- 88,8 Apparent Malocclusions ---------------------------- 28,210 Per cent ~ith apparent malocclusions -------------- 16.8 Prophylaxis needed -------------------------------- 79,672 Per cent prophylaxis needed ---------------------- 47.5 Number with cavities------------------------------ 101,743
Per cent with cavities---------------------------- 6o.7
Cavities in deciduous teeth (elementary schools) -- 2.1 per child Cavities in permanent teeth ------------------------ 3.0 per child Cavities in deciduous and permanent teeth --------- 3.7 per ~ild
Counties Visited: The work in 107 counties visited has consisted of conferences wHh commissionars of health, dentist3, school IIUperintendents, parent-teacher repr~sentatives, home demonstration agents, nurses, and others interested in health.
17

18

DENTAL HEALTH

Tn date 94 counties have ordered materiel indicating that they are
participating in the program. Thirty-eight counties have returned inepection blanks. This report will be completed in l,iay,

Georgia Dental Association! The dentists of Georgia are to be
commended for the excellent way in which they have continued to assist the State Department of Health in what is believed to be a splendid
dental health education program. Inasmuch as 26 counties in Georgia have no dentists and 122 have four or less dentists, the unselfish
service that the dentists in rural counties are rendering becomes more
evident. Many dentists travel 50 and 75 miles into adjoining counties
to make dental inspections when requested by schools.

Corrections

Since one of the fundamentals of the Georgia dental program is that local communities shall plan corrective programs to fit local problems and facilities, and since the activities of the State Department of Health are confined to education and organization, it is impossible to give an accurate report on the number of corrections made. The decline in the percentage of children with defective mouths in many counties indicates t~~t corrections are b~ing made. Reports from commissioners of health, school superintendents, and dentists reveal the large number of children going to the dentist. The tabulation previously referred to in this report shows that five per cent more children went to the den-
tist in the school year 1935-1936 than in the year before. A number of
schools in Georgia have reported one hundred per cent ~n dental corrections.
At the suggestion of the United States Public Health Service, the Lost Molar Index survey is being conducted in selected communities as an evaluation of the school dental program. Reports will be made at a later date.

Education

To assist the teachers in their program of classroom instruction, the State Department of Health has distributed Dentistry and Public Health, an excellent bulletin apnroved by the American Dental Association and the United States Publi~ Health Service.
At the Institute of Public Affairs, the subject of dental health was featured for the first time.
Staff members have served on the source materials committee of the Georgia Education Association. The division of dental health education has assisted in the preparation and presentation of exhibits displayed at the Georgia Congress of Parents and Teachers, Georgia Education Association, Southeastern Fair, and the rorest Festival.
The Journal of the Georgia Dental Association carries in each issue an article prepared by the division.
During this year the division director has served on the public health committee of the American Dental Association: as a member of the economics committee of the American Dental Association; and as director of the newly formed American Association of Public Health Dentists.
Approval and publicity of the Georgia program is indicated by an invitation from the Florida Dental Association to discuss the Georgia program; a request from the editor of Oral Hygiene for an article for the May issue; and a request from the economics committee of the American Dental Aasociation to send to all states an outline of the Georgia program.

DENTAL HEALTH

Statistical Report

Talks

Number

Public Meetings ---- ------------------------ 4
Public Schools ----------------------------- 6o Colleges ----------------------------------- 1 Teachers ----------------------------------- 5 Women's Clubs and P.T.A.'s ----------------- 13 Civic Organizations ------------------------- 3 Radio ---------- ------------------- ----- ------ 3
~ Dentists ---------------------------- -------
Public Health Workers ------------- ---------

Total

98

Conferences (Exclusive of Group MeetiOs)

Denti ats ------------------- -------- --------Physicians --------------------------------School Superintendents --------------------Home Demonstration Agents -----------------Agricultural Extension Workers ------------Nurses -------------------------------------Public Health Workers ---------------------P.T.A. Workers -----------------------------
Total

Articles, Letters

Newspaper Articles Form Letters

Miles Traveled on Duty

Counties Visited

Associations and Conventions Attended

19
Attendance
14,5()1 6o 332
366
15,259
415 67
200
21 10 29 32
_____n
801
14 5,421 28,814
107 19

DIVISION OF EPIDEMIOLO'W
During the last of December, 1936, the State Board of Health ad.op-
ted the report of a committee of the Amerl can Public Health Associatior on the control of communicable diseaeee. Thia bulletin was obtained from the Government Printing Office and, with permission, a blue cover was attached identifying the bulletin as being the Official Rules and Regulations of the Georgi& Department of Public Health. This bulletir, has been sent free of charge to every physician in the state and to all members of county boards of health.
In addition, all physicians in this state have recHived a copy of "Practical Sug1;estions on Poliomyelitis", &s publhhed by the American MedicRl Asocietion, free of charge. A poliomyelitis bulletin for ley consumption has b8 en reproduc-ed and one on typhus has been edited and print6d, The division has also made up a poliomyelitis and a typhus fever investig-dtion card. A list of available pamphlets on soclnl hy-giene has been compiled f!Ild two pamphlets, "Typhus Fever" and "Deadly Bugs that Spread Disease", have been published.
FiP-ld Investigations
_Conjunctivitis: During the month of Aoril there occurred ahout 100 cases of epidemic con.Junct i viti s among school children at Fort Ga 1nes, Georgia. Forty children were seen who were either coming down or gettl nr, well of the Infection. Smears were made on th1 s number 'lnd 50 per cel'lt showed only pneumococci present. One smear was suggestive of Morax Axenfeld bacilli. The otr.er smears were negative. On culture pneumococci were grown and ln sorr,e instances Hemolytic Staphyloccus albue was found. Attempt to type the organism met with spontaneous agglutination at both the National Institute of Health and at the Connecticut State Department of Health. The outbreak is of interest since very few have been found recorded in the literature.
Menlncitis: During the firt part of May an investigation at the
Civilian Conservation Corps Camp F 6, Clayton, was made at the request
of the officer in charge of the camps located in this section. Wittin. a period of several months prior to the investigation, 2 cases of!men-
ingococcic meningitis had occurred, the lBst case some 7 to 10 days prior
to the investigation, Ali persons who had been in contact 'iOtjlre irttsolation. Iu fact all,~ including the patl ent, were new. recruite and. :Were in isolation, as is the custom, when the case occurred, A portable incubator was used to transport the cujture tubes and after inoculation they were returned to the laboratory where they were incubated under reduced oxygen tension. No carriers were found, and after the customary' period of isolation all were released.
Diarrhea: On the basis of a report of 65 to 75 caMe of :vegetable
diarrhea at Jersey, Walton County, an investigation revealed that most of the people had recovered. However, 2 cases wers foU11d ,that were in the acute etages. Bacteriological exaE.ination,revealed that both.had Flexner'a type bacillary dysentery.
Poliosrel~tia: The director responded to a call to Columbua from the city health officer. About three to four weeks previous to this
21

22

EPIDJ:MIOLOGY

request 2 cases of pollo~elitia had been investigated in that city, On investigation it was found that 3 more positive cases and 2 suspicious ca.see had developed, A talk on poliom,yeli tis was given before the medical society, which was well attended, and recommendations and advise about nasal apr~ and quarantine were given.
The health officer of Glynn County reported an outbreak of polio-
~elltis in Brunswick, the first case occurring the first part of September. About a week later three more cases developed, one of which was in school at the time of onset. An investigation was made by the division. It is interesting to point out that 2 of these cases vera found in the same family, Alarm became acute when a fifth child became suddenly ill and died after an illness of some 48 to 72 hours. However, it was the opinion of the two physicians who saw this case that it was not polio-
~elitis. The diagnosia given was acute intestinal toxemia with marked dehydration. While the health officer and the director of this division did not adviae closing the schools, the board of education was forced to
close them due to the very poor attendance. In order to prevent the congregating of children below the age of 18 years, a rigid quarantine was
put into effect of all theaters, churches, Sunday schools, etc., applicable only to the above mentioned age group. Fortunately, no further
cases developed,

!7Phold Fever: As a result of a typhoid fever case, a staff m..ber

visited Barnesville and with the district nurse and local welfare worker,

contacted the chairman of the county commissioners, the mayor of Barnes-

ville and membera of the County Board of ~ucation. It was arranged for

the county to employ a public health nurse for thirty d~s for a county-

wide typhoid immunization program. fhe case of typhoid investigated at

Barnesville was the granddaughter of a carrier near Zebulon, who had

been found through examination of suspected carriers on a study made dur-

ing the laat few months.

Of particular interest was an outbreak of typhoid that occured at

Trenton, Dade County. The outbreak came to the attention of the divie-

ion on November 4, and immediately all forces of the State Health Depart-

ment came into action. The affair proved to be a water-borne one in-

volving the school supp}. In all 28 cases occurred. Through the cour-
tesy of the Bational Red Croaa, 4 nurses vera made available for bedside

care and other neceasities were supplied. It is to the credit of the

Red Croes nurses that no aecondar,y cases and no deaths occurred. ~

utililillf: Ule senices.~ a _trainee public health nurse, some 1,600 1-

INJlil:ations were t;tY.n.

The diviion.bas continued durinc 1937 to concentrate on typhoid.

Durtng the 7ee:r 429 GaiN were reported to the dhillion frqa non-health

officer cQ1lntiea'. 0!-_.W:e n\llloar. 55 ca"e cuae to light through death certificatee. 1)! ~ r8aininc 374 caaes: in non-health officer counties,

308, or 82.4 p.r cent, have been investipted by this divilion. During

1937, 18 t7Phqid carriers were found in the various counties of the

ataw. H lS-;hopM. tbat durinc the coainc 7ear every case of typhoid

fev~r can be, proapt] inUp.t~.



Diphtherial !Woamall outbreaks of diphtheria occurred during the last quarter, one at .Chatworth and the other at Daaring. With the 1nat11;ution of pro:Per control measures both quickly subsided.

AtlPical Influenza: Of interest during the first week in July was
an investigation of some 25 to 30 reported cases of a malady having the
~tome of a mild influensa without coryza and with only one acutely

EPIDEMIOLOGY

23

inflamed eye, which occurred at Commerce, Georgia. Only tl~ee cases in the acute stage were seen. Bacteriological examination and culture revealed a green streptococci in the three cases. It vas believed, however, to be a virus type disease.
The illness vas sudden ~n onset, with generalized malaise, headache, fever usually at night, some restlesness, one eye becoming acutely inflamed with vel'Y llttle pus shortly after onset, and as a rule no G. I. upset. All euses were mild and none acutely ill. The course vas four to five days and they became well as abruptly as they became ill.

Malaria: During the year the Department of Public Health was very fortunate in securing a protozoologist from the school of hygiene and public health of Johns Hopkins University to work in malaria control during the summer months. As a result, a comprehensive plRn for malaria control vas worked out. This plan set up a division of malaria inves-
tigations, to be headed by this individual (who will return permanently
on Way 1, 1938). An epidemiologist will be supplied from this division
and a sanitary engineer from the division of sanitary engineering. It is hoped that the malaria problem can be thoroughly investigated, understood and controlled.
During the fall, 18 counties conducted surveys among school children 12 years and younger. In 3 counties these surveys were carried ou\
by this division.

Special Activities

Dental Survey: The compilation an~ tabulation of the school dental examinations begun in February were completed the last of June.
This work was accomplished by five Works Progress Administration work-
ers under the aupervision of this division. A total of 134,869 blanks vera tabulated by the division and 32,719 blanks tabulated and compiled by Atlanta City Schools were added, making a grand total of 167,588
school children included in the survey.

Crippled Children: A considerable amount of the director's time was given to setting up and directing a division of crippled children
on an emergen~ program for the indigent cases of poliomyelitis occur-
ring during 1936. The money for this venture, which was supplied by the
Children's Bureau and the Red Cross did not become available until about February 1, 1937. Some 37 children were-given t_he opportunity of th1a service~ ODe was uns.ble tci report, due to illneas in the family~ One did not need the service and the reme.inder have been hospi t!l1i :~ed and the ne~ear,y care :given. -~0 nurs~ were used on thia program "liur:!~~~: February and lfarcb. A&.orif;inally. aet ul), the program. came. to All enci on April. 1. ,llo.wever, tbere 1fae' a considerable amount of mop"_ey left vhloh vas proportionately refunded to the Red Crose and the Child.ren'
llureau.

~bit~:. Tti:~ ~l'ei)\:df:_.of, tae d1vbio~ at~ended the conveJition or:

the GeOi'g{a Congress of.l"aftbta and Teachers an4 the Georgfe. Edqcational .bsocill.t1on held durlng the w&me veek in sannllilh~ -A haaltft exhibit. was

'.

diaplqed during b.oth eon:tentionti. The Corlgt'~ gave 11 rising vot& of - the.nka .to t~ Health ~partment for having br0'11ght ft to their conven->

tion.

During the last quarter of the year two health exhibits were dis-

played; one at the Southeastern Fair in Atlanta and one during the For-

estry Festival in Wa7croea. In each instance the exhibits were well

attended and it vas fel\ that they had been worth while.

24

EP I DElli OLOGY

Social Hygiene: The director has helped with the reorganization
of the Georgia Council of Social Hygiene and assisted in promoting a
very satisfactory meeting on February 2 &nd 3.

Meetings Attended: Representatives of the division attended: the American Public Health Association meeting; Medlcal Association of Geor~ia; Georgia Public He~lth Association; Institute of Public Affairs, Uni vers Hy of Georgia; Georgia Den tal Association; Southvest Georgia P'Jhl\c Health Association, and varioH local and district medical and D'lblic l1ealth meetings.
Pa.pers And Ad_~r_<-:_~o_cc~: Staff members made a total of 26 talks to
var:ous groups, both professional and lay. A paper was presented at tne Georg~a M1hlic Health Association en-
titled, 11 .i<:ndemic 1'yphus Fever as a lhjor Health Problam in Georgia". An abstr~Jct. of this prl;->er W'1S cJUblisheJ in tr.e bullc;tin of the Fulton County Medical Society.
;:he director discussed a paDer pre-:enteil by a membar of the staff of the Alabama Department of ruhlir: ~<:& lth Rt the American PCJhlic Health A~soci8tion m?et; ng. The subject was an outbreak of diarrhea in West
Point, Gorgi2. and Lanett, AlaiJama ,i-J:-ing the spring o~ 1937,
':'he direc:~or read a report on st~tistical analysis of the school dental cr_a.inathns before the Geor,;ia Dental Association.
Tr_e directcr, also, lectllred to the j1mior class of "he mc,dical scLo l o: the Un\.versl t;v of Georgl.a on epiiemiology.

Cormnomicable Dis.,nses Comment on Statistical RP.port

In looking over the statistical'tables, it is seen that the number

of reported cases o;" diphther~a and: typh6id is less than a~r year in

the history of the division andt-h<i't tt':e:d.,atr. rates are the lowest. The

number of reported ceses of tuberculosis Is the low~st in the five-year

period, 1933-1937. Re.iuction in the number of reported cases of the

follow:ng diseases: influenza, malaria, meningitis, poliomyelitis, and
scarlet fever is noted when'comparad to 1936,

=i The numiJer of reported cases of t;rphu s and s;,rphi 1 is Is the largest

in the history rjf the division. Gonorrhea

pellagra show the large-

est nuinbcr of reported cases for the five-year p!lriod 1933-1937. In-

crea~es in the r"''orted C>'i~8s over -1336 for dysenter.r, measles, ru1d

whooping coCJ,o-h are noted.

Difhtt~ria: The 917 cases of diphtheria recorded in 1937 is 183 l8ss than the 1,100 c~ses reported in 1936. The 108 deaths is 15 lese t",an th~ 123 re:'orted in 1936. The death rate is the lowest during the :ive year ner~od 1933-1937. The fatality rate re:nains anproxirnatdy t.ne sc,Jne. It is hoped that during 1338 a concentrated effort can be
Flt forward to Li!'ther reduce this unnecessary disease. It is planned
to atterrmt epidemiological investigations of all cases outside of the
health officer co"J.nties. Witr, the distribution of free Rntl.toxin and
frGe tox~id there is no reason why trlis disease cannot become as rare
as srnall-pox.

Dvsente2: .,.hile the 715 reported cases is the largest numter reported s!nce 1934, when 740 cases were reported, the 130 denths is the lowest ~:umber reco:"ded during the fi ve-J'ear period 1933-1937. The
dA,ch r'ite RS well as the ffltality rate is the lowest duril'F the period

EPIDEMIOLOGY
1933-1937 The lowered death rate points, it is believed, to better
and earlier treatment. No doubt the dissemination of literature on infant feeding and care has also had its influence, The lowered fatali\7 rate is indicative of better reporti~.
Influenza: During 1937 there were reported 14,799 cases of infl~ enza, which is 424 cases less than the 15,223 cases reported in 1936. The death rate of 46.7 is a marked reduction over the death rate of 60,3 for 1936. The fatality rate of 9.7 1a the smallest for the fiTyear period 1933-1937. The reduction of 4o6 deaths over 1936 attests
to better reporting, since the decrease in morbidity is not in proportion.
Malarial The year 1937 shows 6,813 casas of reported malaria. This is a reduction of 5,118 cases over 1936, when 11,931 cases were reported, The year 1936 being an epidemic year, the reduction for 1937 appears quite large. However, the reduction is actuall7 greater
than appears since the results of some of the survey work done during
the fall of 1937 is incl~d in the figures. The death rate of 7.6 ia approximateq 50 per cent lese than the death rate in any year -in the
previous five-year period. The fatality rate is also the lowest durint;
the five year period 1933-1937
Measles: The 926 cases recorded during 1937 is the largest since 1934 when 25,206 cases were reported, It appears that this disease is on the up-grade and that 1938 will in all probability be an epidemic year, The death rate of 0.3 is the same as the preTioua ;rear and the fstality rate of 1.1 is the lowest during the five-year period 19331937.
Meningitis: There was a reduction from 187 reported casas of mea-
ingitia during 1936 to 94 reported cases during 1937. There is are--
duction of approximatelY 50 per cent in the reported cases. The 35 deaths recorded, while considerab17 leas than the 67 recorded during 1936, is larger than any number recorded during any of the other years in the 1933-1937 period, The fact that the fatality rate is increased shows that reporting during 1937 vas not quite so good as during 1936.
Pellagra: The 847 cases of pellagra reported during 1937 1a the largest for the five-year period 1933-1937. The fatality rate is also
the lowest for the five-year period. The problem of pall&l;ra is one which is definite17 tied up with the many socioeconomic problema. The problem is considered one largely of education.
Pneumonia: The year 1937 shows 5,637 reported cases of pneumonia, which is 1,234 less than the 6,871 reported in 1936. The 1937 figure
is 'the next to the largest number recorded durin& the five-year period. The fatality rate ia the lowest for the entire five-year period, It ia hoped that through the establishment of typing station and the more extensive use of specific antisera that this terrible toll can be reduced.
Poliomrelitis: During the year 1937 there was a considerable re--
duction in the cases of poliomyelitis reported over the previous year,
165 being reported in 1936 and 94 being reported during 1937. This is
indeed encouraging since some anxiety vas felt over the possibility of
an increase for 1937. There was also a slight reduction in the death

EPIDEMIOLOGY

rate over the previous year. The fatality rate sho~s that cases vera
not quite as well reported during 1937 as in 1936.

Scarlet Fever: Scarlet fever apparently hit a peak during 1936 since the 1,100 cases reported this year vera the largest during the five-year period 1933-1937. Nineteen thir~ seven shows 935 cases, which is 165 cases l&M than the 1936 figure. The death rate and the fatality rate remained approximately the same as 1936.

Small-pos: 'l'hare _.. oaly 15 - of thh d1-ae reported duriDg 1937. There is considerable likelihood that at least some of these
cases were severe chick&n-pox. There ia in this atate a large unvaccinated population which is rapidly growing up. The consequences of this condition~ be very aerioua should small-pox appear.

Tuberculoaia: This diaease ia only mentioned to note that the
amallest number of cases is recorded for 1937 in the five-year period 1933-1937. There were 301 less cases than reported in 1936. There were lt4 less d&&ths and a reduction of 5.8 in the death rate for 1937. The fatality rate is slightly less than any year during the years 19331937.

!zphoid Je?er: ~oid fever, with its 719 reported cases, marks
the all time low for this disease. 'l'bere were 207 lees caaes reported
than in 1936 aDd 56 lees deaths. The fatality rate of 19.3 is the low-
eat in the hiator.r of tbe diaeaae in this diviaion. The division in-
vestigated 82.4 per cent of all reported cases outaide of health officer countiea. It is hoped that during 1938 every case outside of health of-
ficer COUllties can be investigated. 1fhc it is remBIIIbered that there
vere 1, 799 reported cas and 363 deatha in 1932, these results are in-
deed encouraging.

!lphua Pwer: '!'be 1,092 ca of typhua reported during 1937 h

the largest nuaber ot case. e?Br recorded qy the division. The in-

crease of this di..... tro. 52 cases reported in 1929 to the present

level has been pbeDoaiual. While there has been an incr- of 275

casea over 1936, there - s only an increase of 10 deaths. There baa

been a al18nt.i~-in.the death rate over the previous year, but a

slight decreaN in tile tatal.1 t,y rate.



During the year a typhus control prograai has been deneed whereby

M engineer, wbo has beea properly trained in rat proofing, can be

placed in charge of the prog!"aall. AD e-pidemiologist will be supplied

b7 the divisioa for the iDVeetigation of cases. It is hoped that ey

proper case findiDC aad investigation a. comprehenaive program can be

begun in an attempt to control tibia disease. It is plalmecl that duriq

1938 at leaet one peream from this division will de.ote his entire time

to this work.

Whooping Co~: Whooping coup tor the ;year 1937 shoW a decided increase over 19 and 1935. While the death rate is inereaeed over
the previoua ;year, the fatality is the lowest for the five-year period.
It is evident that this die-- is on tha increa.. and that the ;year
1938 or 1939 will in all probability bs the peak year.

Gonorrh.eal !he 5,549 ca- reported to the divisloa is the largeMt on record. The caae rate per 100.000 is 11kewiee higher than - r
recorded before. 'l'he death rate and fatallt.;y rate is approxilllately the

BPIIm!IOLOOY

27

same as in the preTious 7ear. It is possible that the wide publicity ctven venereal diseases is responsible for the increase in reporting.

Szph111s: During 1937, 15,341 oases of eyph111s were reported to the d1Tie1on. This is the larps\ nUIIber ever reported and 1a 6, 701
re e&8e8 tball recorded 1n 1936. While the number of deaths recorded baa increased only b,y 52 over 1936, the fatalit7 rate has considerably . .creaeed over the preTioua 7ear. Only when these diseases can be epi._1o1og1oal~ investigated and adequate treatlll8nt provided free, can JIUCh reductiOD in this disease be eXpected.

S\athtical tables are appended.

21

lll'IIlDllOLOGY

ll)li]IIDI'l'l', IIOll!'.u.I'l'l', .Ali1D J'A!ALI'l'l' !W!IS

1933 - 1937

D1naeea Diphtherial Dreter.ra Gono:rrheac 111tl-al llalarlal Xaaeleaa lln1Dg1 tll hUecral Pan.nlaa

Tear

Oe.ae Bate
Per 100,000
O...ea l'owl&tlon

Death Bate

Per 100,000 J'atallt:r Bate

~ l'opulatlon

(Per Cent)

119933,

1374 1233

116.2 41.0

187
188

6.3 6.,3

135 15.2

~~ 1u0o5o0

~7
36.o

161 123

~-.o3

15-3 11.2

1937 917 298

108

3!5

u.s

1199~

442 lito

11!..8 24.6

119933i

426
5114

14.1 17.8

1937 715 232

153

51

219 16~

7., 5

15 130

~-.21

J4.6 29.6
~!! .,
21.7 11!.2

1199~ 119933i 1937

3698 ~133
~

113213.., 178.6 171.1 180.4

~

1.2 1.6

36

1.2

~

o.6
o.s

1.0 1.2 0.7 0.4 0.4

119933, ~~

119933i 1937

10206 11~272939

385-6
20~7
~.1.!6 lt.Sl.o

1237

lt-1.g

1009
~ru

~=~
6o.J

1436

116.7

10.1! 16.5 1132.31 97

1199~

11612 4937

119933i

lto21! 11931

11~-.92 132.9 3907

'~ ~

12.2 13-9 12.8 19.8

19
s.~
9 51

1937 681.3 221.11-

235

7.6

3.1!.

~ 119933,

161.1! SJ8.2

72

2.4

5lto

18.0

1.5 2.1

1199u 1937

627
~

20.7 )01.31

25
I!

o.l! o.,

10

O.J

lt..o 13.16

119 ~

61
II()

119933i 1937

72
~

2.0 12.., 6.1 31

20

0.7

25
~

0.1! 1.1 2.2

35

1.1

~-I! lt-5.58 351! 372

1199~

R~

26.6 21.4

119933i 1937

719 78~57

~.11 215

421

11!..1

5~

11.7 12.0

391

12.1!

370

12.0

55,..16
5().1! ~3-2
31

1199~

lt.a86 4935

1~.6
1 .1

2314 3030

17070-.68

~14..40

1935 41152 16o.1

3035

100.2

62.6

1936 6871 225.0 1937 "37 11).2

31!03

124.6

~

100.0

~:i

:IIPIDIMIOLOGT

29

MOl!l!IDI'l't, MORT.ALI'l't, .AND FATALITY BATES

1933 - 1937

Dina _!!..
Pol1~l1 \181
193~
193 1199332 1937
lcar1et J'ner1 119933~ 1199332 1937
..U-pax1 119933~ 1199332 1937
e,phllhl 193~
193 1199332 1937
!u'berCIIl.oah 1 119 ~ 1199332 1937
!Jrpboid J'nerl
~m
1199332 1937
fnbu hnrl 119933~ 119933 2 1937
'Olldlllallt J'nera 119933~ 1199332 1937
'llboophc Cuuch 119933~ 119 ~ 1937

Caae Rate Per 100,000 Cane PoJ!!!!!tiOII

In

1.~

118

1.6

1~

1.2
5~

31

~I

21.7 19.1

781
1100

3~I.o!

935

JO.~

~7

1.6

a1~

0.5 1.0 0.5

15

Oo5

~7 ~
~~
153~1

162.~ 1~.1
2 .1! 21!3.0
~.6

33~37

110.7
121.~

3581! 118.

3303111

108.6 gs.o

Ul8
1252

~1I.!6

1~~
719

33~
JO,'II 23~

~

21.0 1J.S

1189

16.1

817

26.1!

1092

355

'm9

1o3 2.1 2.2

60

2.0

58

1.9

~
1206

n.,
87 398

702

2J,O

171~

557

Death Rate Per 100,000 ~ PoJ!!!at1011

12

o.~

26

0.9

16

0.5

29

o.g

20

0.7

19

0.6

17

o.6

~

o.s o.r:

u

o.,

1

0.03

1

0.03

m
~
1!96
1m 1172 1731 1713 1549
251 316 261 195 139
29 21!
28 Iii! 5~
2 1 1 1

1~.1
1 .8
1~3
1 5 16.1
59.6 51!9 5~.11 503
8.1l 1s0.. ~ 6.11 ll.5
1.0 o.9 1o.. ~ 1.8
0.1 0.03 0.03 0.03

m

171.51
~.9

67

2.2

1~

~.6

J'atalit)r Bate ~Per Ce11t)
29.2
~~.2
32 17.6 21.3 2.9 3.0 2.9 1.3 1.2
7o1 3-2
8.1 95 5o5 5o1 32 ~-I.6! 118.2 51.6 51.4 22.5 252 25.6 21.1 19o3 ll.6 6.1! 5~~79~ 15.16 1.5 1.7 10.2 12.7 12.4
9o5 8.3

JJSEASES .lctinOIIIYC08h

~-

Acnte Inf. OonjuncttTitta 82

.lllthrax

2

Ollrebrosp1na1 lleningi t i l

94

Chicken-POX

1550

Deugo. a

12

D.pbtherta

917

:~Faente17, Jlaebic

207

J:lraente17, Bact llary

508

ra'IUa Gonorrhea Hookwol'll

2
1~

In:tluen~a

~ Let. lllcephalith

3 Valaria

0
!;! I
H

lleaalea ll:unpa
ParaVpboicl

~ PQerperal Sepaia

1 799 7
6;~
1553 17 14

Pellagra

847

Puamollia PoliODelith

5637 94

Rabi.. (In man)

6

lll.amatic laTer

17

Scarlet rever

935

Septic Sore !hroat

532

llmal1-POZ

15

llrpbilia

15341

'l'etanua

li9

'l'r~

2

'rri chinoat

2

!11 berCJ11oah

3016

!lllaremia

50

'fn>hoid rever

719

'l',)rubna rrrer

1092

Unda.1ant rever

58

11hoo:etn11 Caal!!

1714

"'0

~tal

79074

IPIDDIIOJ.OGY

..m... OASIS OJ' NOTIJ'IABLJ: MSEASES BEPORTID IN

..1.NL.

.MWI1 ....a.. ~

G.IQRGU.,
ll!mL

:1.931 1 ;!!T
IZlUL

l!QJI'l'HS
..&!i..

- - - - - - 3

7

g

3

1

4

2

12

- - - - - - - 1

17

12

12

10

12

1

3

3

320 6 76

-107 50

-163
45

-246
33

-220
22

g6
1 12

-21

9 1

28

90

23

19

29

22

20

25

12

14

-7

7

5
1

23

56

224 1

-107

39

531

410

482

482

491

439

489

466

1237 1824 2300 1082 1294

361

320

323

1818

- 5026

4477 3

1414

-305

-63

-31

39
1

478

293

285

484

544

587

745

871

28
-223 2

1~
2-

55 285
1
2

15

33

321
-2

-223 3

13 81
1
2

10
34
3 2

11 13
5 1

48 710
,9
-/-
' 96
1!6
5

m34 6 1
3
~-

50
909
-3
3 87
57 1

55
657
-3
2 41
-41

82 434
-3
2 48 29
1

104 210
g
-1
24
-24

201
179
-17
4o
-16

58 146
--17
33
32

1190 1072 1147 1163 14o2 1237 1419 1264

--2
227 9

-2
276 4

--4
269 12

--2
282 11

-2
1 304
3

-5
1 261
3

--6
-247

-5 -
261 2

27

13

9

14

30

97

222

121

~g
5

25 3

45 4

48 7

6s5

1!9

153

156

11

9

4

14o

102

101

90

219

187

234

310

7'412 10321 10854 6554 5857 4163 4550 4308

.JIU ~

-15
2 .4
3 135 10
-16
387 485 42
1 665
2~ 2 1
55 137
10 2 1
81!
-45
1245
-4 -233
75
127 2
119
3944

17
,1 7
-
197 16
-13
514
2659
-179
567 56 15 1
-
64
278
-6
2 16o
53 2 1682 6
-1
241 2 48
115 2
75
7009

~
-7
9 128
1 141
7
-7
382 2359 426
1 809 170
--57
33
4os 5
-1
125 52 5
1336
--4
-210
48 86 1
66
68Si;

..]lQ..
3
6
-216 gg 10 -4 476 1650 979
1 485 489
-126 1 63 836
7
1 4 135
52
1 1184
7
1-
20,
15
95
2
71
7217

IPI DIIIIOIQQJ

QASJ8 OF J'OTU'I@LI piSilS!S UPQBTID I! GI?!GU IIJII!G 1937 UlfDD O!il YIAR OF AGI

.~
t.

.,&1
.8.s..
~"'
~

. a . .a ~ fl ~

~ .a

I
C\1
I
....

8e

g
e

"" 4

I

I

C\1

""

II

"" \D

I

I

4 ""

,I_ I 110

I

I

\D

r-

. . ,&1

, ,&1

!

0'\

0....

fl
....6s....

~
8s
C..\.1.

I
110

I 0'\

I
0....

......I..

Ala\1 Inf. OonJunc\1vitia 9

llth\hedt.

25

~tent err, Jllabic

3

DTaenterr, ~1llary

~1

Malaria

39

Meaa1ea

11

ileninclUa

5

Parat7Phold

1

Pneumonia

121

?oliOI!ITI11 til

6

6
-1 -1 ----6

--

- -1

1

1

3

2

1

----4

---
-10

1
-1
7 4
-
-1
s
1

-
-1
2
7
--
1
-12

---
4
3
3
1
11 1

-
1 1
'1
2
-13

-
-3
3 5
-3
10 2

-~
1 2
5
--
11 1

1
-7
5 1
1 1
-11

1
-3
~ ~
1
-13

-2
1
~
3
2
12 1

t.3..
M ~
~

Scarlet rner
Sep\io lore !hl'oat

- - 7
~

-
1

-- -- 1

-- -1

1

- - - - 1

2

1

-1 2

'l'eta~ma
'l'llberaa.1oah Whooplag Couch

10 8
64

1--0

-
1

-1
5 10

2
s

1
5

-1

6

~

-- 1
977

2 2

~ ....

.WIS OJ BOTinABt.ll: DIS.WU:s UPOB!ED llt G:mBGU. ID:Illr!J 1937, BY MHIS

mswu

e
.t...

Jllthras

2

Allllte Iat. ConJunct. 82

Deqv.e

12

It~therla

917

~..nte17, .-btc 207

!
g~II
9 25 3

:a :a :a I5I:.:.:.., :.&".:.:.::a.:.::.a :. i.
I . . . .



:a~:a







l a l a

..................

~ ~ t
0 h ~~~

~


:a

~

f i

~



f iii

&'~~~,j'~fbit-v

1!. "J
f

& I ' " " " ' . : f - U " ' \ \ . 0 , . . _ . , 0 \ r - 4

..1

I

N

I 1"\

~I

I

I

ll'\\.0

I

I

r-""

I
"'

OI
..

I

I

~!il

I

I

I

I

g l " \ It\
N

II'\

8

I

I

I

I



~

~&!,

111'\ll'\111'\

ll'\\.0

r-

- ~ 3 2 3 ~ 2 1 - 1 ~

11

--- - 2

11

- - - - - 60 106 1~ !!~ 56 79 31 31 19 67 11 1~ 11 1~

522

12

12

13 ~ 6

1--- 1

11

1 1 ~,

I

1 5

3

2

1

-

-7 1 151

6 I 5 5 I ~ - 1,0

!
i
~

~-h17, Bacil1a. 501

llalaria

611:5

81..

92ti

lleabptb

~

Para~ol4

17

~1
39
11
5
1

~~
6 6

30
79 20
6
1

1~
s6 20 2

8
!!~
19 5

J 13~ 1 1 1 11 6 10 11 10 10 10 15 6 13 9 129 122 136 631 397 383 ~ 266 197 201 170 157 202 116

36
4

52
1

59 1

31!
2

27 1

30
12

20 10

15 ~

~3
55

3 1

2 1

1 -

1

2 1

1

32 2

31 1

rr Q>

50 17,.

551

2'1

1

1

Pe1hcra

1~7

PD....t.a
Pol1~11tb

,s~

121
6

~ Scarlet J'ner

935

Septic lere ~roat 5.32

79 120
9g
23 45
37

68 12
59
7

1
Gl
65 12

1
59
7
!!5
8

Go 8 95 7

1
~
5'

~
52 I

3 11 21 ~1 ~7 ~3
29 137 1~3 1~ 136 105 102
- 12 3 ~ l 30 71 15 17 I 5 1
1 ~ 31 ~1 32 21 11

63 17
2
13

6~
Gg
1
5

55 105 79 113
11 10

n a.7 267 75 -,672 11
211
~ 1 26o

lllall-pu
'-kb1..
~ 'lllbera~~.loeb
'11l1ar1a fTphotd ~er fTplau r.nr V.dlllaat J'ner IMopiJic O.UCll
.N....

15
6
119 10
2
,.)016 I
719
1072
5I
171~ 6~

1
14
1
5
1
77

10 8 87

11

1

1

5 9 10

10 11 19
534 77 57 79

2 8
27 4
62

1

~

3

!! 11 I

1 27 22 20
- - 6 6 7
47 4!! 21

1111

111

-~

1

1- -

75 3- - 21

1

- - - - - 6o 1'50 2"' 255 235 ls6 1l!o 1)2 101 153 81

3657 6 ~62 1 1

JZ 9g 93
57

2~ 82 62 )0 38 20 1,3 21 19 86 110 6~ 6~ ~ 51 64

l 1
25

8 12 2 6 5 2 3 1

21 31

11

7 1
15

-

1

25 1095

7
I 110
9 210 -9
- 1055

P'Il"~O!.OG!

_ _ _ _ _ _ _ _ ___..::C,""CI"'lt""S~O~~.:;l'T~OTI!!~!_gl!~S~.~~-D IN GIDRGIA Jl~ al!Ol.l A<'ID_~~--!'"TS ~E2'!R_l;Q?,OOO f?F.l'UTION, 1SJ1

msli:4.S~

!t''rU,

'!T!Tl/! .~!' rorc~~

MAJ:,'!:

:!'m.!AL!:

II TOT,U.

~ CAS~S 0,\S".S 'P._'\T~ CASJS :UT!C CAS~S P~Tl:

P.Al'"l:

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

Jn"br""
Acut~ !~f. ~~une%,
Ile!lr.n
])!,phth.,ri" :Qreente:ey, Ame~c

1
":'';l
!!!'6 03

o.r:;

:t.;; ~4

o.~
zt;,.z

,ql.'\l

3.0 -~3

1
1.6 l'i 0 .. 2 2 26.0 412 3" 4('1

~() {l.l
1 .. 0 1
0 .. 2 'j -5 26.4 6!13 2 .. t' i 7JJ.

1.~
O.J 32.7
3 .. ~

DTaentery ,:Racilhry Jhc->}lhl\lt ti.. L<ot. IIB1arl" 'lle.,sles lle::l.ingttt s

2!!6
5 l':z?2 33:1
"'CI

93
0.2
1~;:1.5 12~S
2.')

1'56
3 222?, 19'1-
53

10.3 130 0.2 2 146.7 2069
12.~ 199 3-5 25

8o..c)
13<'.~
12.'!
:!..1'

i 2()4
I5 P-:;19
i13~3 ~q

10.4 0.3 12!!.3
18.2
;~.o

?ar..typho1.d Pelbgr" Pnerunnn1,. PoliOJI!l"'lHis R"bies

i 17 o.s 10 0.7 7 o.l n o.G

~(\
21!!<;
c4 6

1q.s 174

71.0 2.7

lW-42'i

0.2 6

11.5 llz6
86.!! S69 2.'! 42 0.4

27.3 55 7

'~;2!1~9)

I 2 .. 7 ~ 67 3

s1s5...

~
6

3.'~

o.2

l!h<!WII!\tto ,..,,,.r
Sc..rlolt '"""'" Septic Sore Th""at !hallpox

1!! 66[1

0.6 6
21.7 ~:?

o.s 10
19.3 376

I

I 0;6

"i

24.1 59S

0.3 30.4

300
!l

o9.:~;

141 1&

9.3 15~
0.3

10,2 253
0.3 1 4

13.0 0.2

i

Tet .... ti1S Tr,..,boma '1111><1rculomh '111larem1,.
'rypho1.<!. Te.,..,r Typbn.s '!'~.,.,.r
Unmlltl1t r..v..r
fhoopi~ ~

45
~-
2008 43
6)!! !!fl?
55

1.5 (!g

0.1

6<; ;
i);

930 Z1

ro.7 3113

2~,.9 57'

1 .. ~

3~

1.8 17z
61.4 1075 1.1! 21
22.6 ~5
37-9 315
2,& 1&

1.1 15

0.1

2

6g.1 1927 1.) 1 <:h
,1!!.9 327
20-2 ,.s;
l::..o 4J

o.s
0-l 47.2 1.3
lb. 7
4o.s
2.2

67)~ ~1.<;1 333 2)."1 321 20.6 1 "35 27'.4

'lf!l!~ MJJ,~
CASJ!S RATE

lq l,;;
3 o.3
315 32.1 41. 4 .. 2

112 ;I
13"'9
11!6
'~1

11.4
0.3 140.;:
1~.?
k. z

1

o.1

s 11:\ ll .. J
752 75.

33 3.t..

3 o.3

5

O.:'i

253 2'>.3

122 12).!.
1 o.1

9 0.9

-

-

461 46.9

l7

1. 7

184 1!'!.7
5n 52.o 30 ).l an zr..6

l"'!!MA.'Llll
CA~~ RATE

~TAL
CAS'!:S R~TJ!l

li

1.~ i

;1, ~

o.;;. 0.3

2 o.2 i

)2S 3J,h. 163 l4.b

~3

;~4 19

1,7

92 94 1!2 7.4

2

0.2

~

n4o ns.1 l.773 159.3

172 17-5 35 J.l

1r,

;..g 20

1.s

4 o.4 6 o.;

2;::
537

25 7 54. 7

121~~,67

21 .. 3
130.5

34 3.5 :r';' 1.5

~

- : O.J

l

O.l ;.~

1.1

3h0 34.6 iO 6. 3

1)3 13-5 1+(. 4.0

3 0.3

~ o.4

6 0.6 30 2.7

2 0.2 -

-

465 47.5 lOSl 97.2

9 0.3 :::2 2.0

143 a::~

'* 14.6 : 3~1
2~.91

2l!,O
"4

13 l.~ 12 1.1

'.'51 t$.i!. ':!.> 12.2

OOIORliiD !I.AtE CASES RATE

5 0.9

79 lk.ll 12 2.. 3

44 ll.J

e;l!4 l~:J.:;

1!1

1.5

12 2.3

7,

0.6

6~

11.~

"...".. 49

1C'5.1l
1.7

3 0.6

3 0.6 34 6.4
19 J.6
3 o.s

19 3.6

-

-

469 ll7.9

10 1.9

153 29.~
~>J u.s
9 1.7

72 1:'1.5

:rl!"IA.'LJ!l

CAS!IS Ur::i

,,:1.

t.:'~ :1
o.:

g4 i4.5

7

1.:;!

}~

G'~"

...92n9.,

l&i'l.:: l~~ i'

I!!

"' Ll\ H H

lT~
332
s

...~ r:~ ~'}
;c.0

....
0

5'<l 0

;,,A\ ~

9 1.6 3 6.2 25 4.)
:t o.?.

11 1.9

~l-2 l~,,-6

12 2.!\

J'j2 2&.~

3'-
3

o5.s''

64 n.o .~

34

JIPIDJI(IOLOGY

IIOOIIIl OP OASIS AND CASI li.A!IS PD 100,000 POPOLU'IOB OP SPICIJ'UD IOTIPUJILB DI SIASIS IIII:POR!Bll Ilf CJIOliGIA :8!' COilll'l'IJIS - 1937

C.rebroapillal

.&rea

Ca :Pbotpbullaatteio4n

MenillgiUa Bate

Diphtheria Oaeee Bate

Gonorrhea
Oaue llata

I~1uenza
ea. llata

State !otal
llara1
C1u.. 2500 - 5000 Cities 5000 6 AboTe
App11Dg Atkinson Bacon Baker
ealdvin Bank

3.076.568 2,141,920
116,474 818,174
14,177 7,808 7.693 8,552 23,851 10,93

94 3-1
52 2.4 2 1.7 4o 4.9
-
2 26.0 2 2).11-

917 29.8

512 54

~:~

351 42.9

3 21.2 1 12.1!
- 1 13.0
1 4.2

5549 iso.~ 1-'799 lt81..o

1~

75.11 1751

3730 1155-9

~~
6188

366.,
653
7563

8 56.4
-
42 178.1

s 56.11
1 12.8
-2 26.0
42 178.1 21 192.0

Barrow
Bartow Ben 11111 Berrien llibb ll1ecklq
llrantlq Brooks
lr7an
Bulloch
li\IZ'ke
:Butta

13.561 27.292 13,634 16,523 78,818 9,887 7.591 22,642 6,430 29,184 30.471 9.490

-
1 6.1 4 5-1
-
1 4.4 1 15.6 1 34

3 22.1 23 84.3 2 14.7
18 22.1! 3 303

9 ~1

3 10 14

~-.319

2 21.1

4 295
29 1o6.3

17 102.9

1~

166.2 4o4.6

1 13.:? 30 132-5

11 37-7 31 101.7 2 21.1

49 242

38661e3q

1436

95~
278.

14674

~-6 1 7

3 39o5

82 106

~2 1 -~

1'31 148612..7

23 242,1~

Calhoun
Camden Candler
Carroll
Catoosa Charlton

11,243 6,642 9.788 36,808 10,197 4,852

1 2.7 5 49,0

1 8.9
-
2 54 1 9.8 1 2.1

2 30-1 11 112.4 13 353 49 480.5 5 10.3

28 249.0

13

115.2 10.2

38 103.2

134 823-~

23 47.4

Ob&tham Chattahoochee Ob&ttooga Cherokee Clarke 01q

107.780 9.554 16,755 22,4~ 26,0 7.1150

5 4.6 1 10.5 1 38 1 1J.l~

-69 64.0
5 29.! 11 49.1 12 46.1

979 908.3 176 11!42.2
4 23.9 9 4o.1 23 88.4

1289 1196.0

44 46o.5

k8g

507.0 339-0

999

9 120.8

Clqton
Clineh
Cobb Coff... Colquitt Colwnbia

10,891 7.667 37.612 21,994 32.913 9.518

1 30

2 18.4 21 55.8 5 22.7 7 21.3

6 55-1 1 13.0 24 6J.!I 10 455 29 88.1 12 126.1

4 367 9 117.4 375 997.0 22 100,0 24o 729.2 !17 914.1

Cook Coweta Crawford Orhp Dade Dawson

12,369 26,396 7.629 18,358 4.733 3.734

1 8.1 1 38

2 10.9

g 24.3 22.7 1 13.1 4 21.8

35 283.0 146 5531 24 314.6 34 185.2
1 21.1 8 214.2

Decatur De:talb Dodge Dool;r Dougherty Douglas

25.333 73.910 23.716 19,141 22,864 10,266

2 2.7

2 19 19 257 3 12.6 5 48.7

10 395 14 18.9 17 71.7 26 1~.8 11 .1 8 119

141 5a6.6

257 210

3 11 13855

125 6530

47 205.6

36 3507

EPIDEHIOLOGY

35

NUMBER OF CASES AND CASE RATES PER 100,000 POPULATION OF SPECIFIED NOTIFI.A:BLS DISEASES REPORTED Ill GEO!l.GIA BY COtn!TIES - 1937

Area
Early Echols Effingham Elbert Emanuel Evans
Fannin
F~ette
Floyd Forsyth Franklin Fulton
G1J.Jter Glascock Glynn Gordon Grady
Greene
Gwinnett Habersham IW.l Hancock Haralson Harris
Hart Heard Heney Houston Irwin Jackson
Jasper Jeff Davis Jefferson Jenkins Johnson Jones
Lamar Lanier Laurena Lee Liberty Lincoln
Long Lowni'.es Lumpkin McDuffie Mcintosh Mncon
Madison Uarion Meriwether Miller Mitchell
Monroe

Estimated PopulB.tion
19,643 2,751 10,918 19.543 25.971 7.675

Cerebrospinal
Menin~itis
Casog Rate
2 11

IliEhtheria Qases Rate
3 275 10 51.3
5 193 1 13.0

Gonorrhea Influenza Cases Rate Cases Rate

1 5-l 3 109.1 12 109.9 15 76.9 19 732

5 25-5 18 6543 19 174.0 99 507.6 38 146.3 4 52.1

14,767 9.165 52,06o 12,081 17.279 341~. 753
8,359 4.758 20,466 18,579 20,846 12,971

27 78 1 4.8

1 6.8

10 671 17 115.1

23

41~.2

2 16.6

3 32-7 65 124.9 351 674.2
18 149.0

8 46.3

30 17a6 4s 277.8

132 383 1670 4s .4 2944 8539

4 479 1 21.0 4 195 11 592 4 19.2 7 54.0

.-1 12.0
24 129.2 3 14.2 3 23.1

1 12.0 3 63.1 22 1075 26 1399 149 714.8 16 123.4

29.694 14,031 33.431
11a.,945165 11,908

1 7-1 1 30

1 34 8 239 5 35.8 2 13-9 1 8.4

1 34 6 42.8 46 1376 23 164.8 3 20.8 12 100.8

~~

43.8 1853

36 107.7

132 945.9

5 347

52 4367

17,073 10,539 16,~75 11, 32 13,221
23,263

4 235 4 39.8 1 59
1 7.6 5 21.5

8 47.0

7 69.6 18 106.0

1~

437 121.0

7 30.1

30 176~1 35 347.9 28 164.9 9 78.7 57 4}1.1 31 1333

9,015 8,611 22,010
13.524 13,638 9. 724

1 11.1 1 4.s
1 10.3

1 11.1

2 9.1

~
4

22.2 293

14 1553 1 11.6 9 40.9 4 29.6 9 66.0

31 343-9 5 58.1 41 186.} 47 347-5 111 813." 10 102.8

10,289 5,~8 34.5 2 8,6o4 5,523 8,913

3 292 16 46.3 1 11.7

6 583 77 745.4 1 13.'i
14 40.5 167 48).;:, 13 15o.r
5 585 8 93-t 3 336 22 246.:-:

4.390 31,966
5.369 9.580 5.901 17.354

1 31

4 12.5 3 559 7 731 2 339 3 173

6 1367 100 312.8
9 167.6 2 20.9 1 16.9 15 86.4

11 250.6 85 2659 36 670-5 3 315 2 339 4s 276.6

16.a20 274.,13~ 10,106 26,063 12,418

1 6.1 1 38

2 11
1 8.1

2 12.3
3 4o.o
2 8.3 1 10.0 33 126.6 32 2577

3 3

lS .~>
4o.c

130 538-7

12 119-9

113 43}.6

215 1731.4

EPIDEMIOLOGY
!M!BER OF CASES A;/D CASE RATE PER 100,000 POPULATIOJ1 OF SPECIFIED lTO~IF'lAllD: DI s;:ASc:S 'L'CPOP.~':SD IN GEORGIA BY COU'TT!ES - 1937

Aree
Montgomery Morgan Murrey
Musco gee Newton Oconee

Estimnted

Cerebrospinnl

Population _;1;.:.;'-e:::n:.:i;:;n,_.g1"-t"-'l'-'s,_ __:;D:.:.i"'-ph"-t'-'h'-'e"-r"'-ia,.___--"'S-0"-'n'-'o"-r"-rh:o:O' :.,;r:.

_______c_~_se_s_ _~_t_e___c_n_s_e_s__fu_"_--t_c_____c_a_se_r_,__~_c_to

I nf 1uen...:.,:.El_ Cnses Rnte

10,818
12,995 10,230 58,406
17.935
8,568

1 9.2

l

9. 2 l>S l>lJ'. 7

4 30.8

16 12.1 75 577-1

51

13 127.1
9 15.4

4~ -'?.2 2615~ Lt4s"~:oQ

18 100.4

cG 167.' 1:~1, 691.11
3 s.o

Oglethorpe
Paulding Peach Pickens Pierce Pike

14,131
13.726
10.536 10,739
13,675
11,426

1 93 1 7-'

8 s6.6
2 19.0
3 27 .s 1 7)
l~ 55.0

6

5

67 Q

6~.

(il,], 202 18723

Ft

1JC.,7
s'),:::

19 ns.s
125 10~14.0

Polk Pulaski PutnAJll
~uitrua..n
Rabun Rnndolph

26,816
9.527 9,010
4,407
6, 933
18,167

2 7. 5

11 41. ~

3 4;;. 3 16.5

2?ll 8
11 7 4'. 7 4 90.;
11 158-7 215 113\.5

Richmond Rockdale Schley Screven Seminole Spnliint;

71!, 175 7. 261
5.622
22,953
7,86o 23,814

77 103.5 1 1~". g
3 5.'3 2 8.7
2 25.4
12 50.4

450 6os.o 213 2S6.1+

25 3411.:\ 70 g6i!,],

3 5'. 3

8 1112.2

1) 56.6 23 100.2

37 1+70. 7 253 7213.8

26 109.2 70 291.'?

Stephens Stewc.rt Sunter Talbot Talia.fer>o Tattnall

13.045
12,056
27.902
9.451
G.s64
16,709

1 7.7 1 36
1 6.0

1 7. 7
1 8.)
7 25.1 5 52-9 1 15.2
1 6.0

61.'
2 16.b 2 7-2
3 31.7
28 167.6

27 207.0 22 182-5 92 .129. 7 7 74.1
34 513.0
70 418.9

Taylor Telfair Terrell Thomas Tift
Toor::tbs

11,262
16,11+2
18,986
)1!,1124
i6.967
18,912

1 2.9
3 17-7

4 355
11 68.1
6 31.6 9 26.1
12 70.7
1 53

22 19~ 3 109 9t73 25 151+. 9 112 691.8
7 36.9 ss 46o.s 21 61.0 128 'l7l.ll
32 18P.,6 190 1i n.e
24 126.9 53 230.2

Tol'ms Treutlen Troup Turner T\;i t~~-~e Union
Upson
\'lr,l~er
~/c,l ton Ware Warren \'lashincton

4,91'3 8,075
38.511
12,487 9.373 7.195

20,705

28.490

22,916

27,870

1

12 ,16? 26,14~

9 1,v:;
10 35 .o 13 56.7 1 36
l 8.2
11 42.]

l

6

2, 21;,S

34

226 5f.,? 3

9

2 l7 .2

9

45 ~SO.l

3

58 ~06.1

101 :.s~.~ 411 212.9

7 24.6 26 91.3

10 1i3~5 91: 42"{.6

n6 11JG.2 813 29351

5 1+1.)

4 329

18 68.~ 130 497-2

Wayne Webster Wheeler White Whi tflold Wilcw.

13,662
5.358
10,193
6.955
23,081>
14, 31+5

2 1!+.6
1 13.7 10 95.1 15 215-7 12 52~0
7 48.3

2 1i1.G
1 18.7
5 119.1
6 sG.3 62 ?6r.C
10 6'J."i

5 ;,6.6 2 37 3 2 lg.6 6 8~.3
7G 329.2 46 320.7

Wilke

16.,466

G.J

97 5GIJ.6

\{ill:lnnc~

11, )E

23

32 20.1)

~------~---~~-~-~-"-~------------~-- ---~ -~'~ ~-----~L~ ---- ----~~____})____~~~-~~!

EPI!l!i:MIOLOGY

37

li1Jl.!BIJR OF CASl!lS .AND GASl!l RATE PER 100,000 POPULATIOJ! OF SPECIFIED NOTIFIABLE DL Si,A3ES REPOR'rED Ill OEORGIA BY COln!'1!l!lS - 1937

,\rca

Malaria CEtses Rate

-..::=--=-===--~-----

Scarlet

J.1enslas

Pnmm.onla.

Poliomyelitis Fever

Cases Rate Caoa~t Rata Cnaea Rate Cases Rate

State rota! Rural
Citlos 2500- 5000 Cities 5000 & Above
.\ppllng Atkinson Bncon Balter Baldwin llanko
Darrow Bartow Ben Hill Berrien Bibb Blackley
Drnnt1ey Brooks BryM Bu.Uoc:O. Burke
Batts
Cnlhmm Crundan Cl'lndlsr Carroll Catoosa Ctk"1rl ton
Chaths.'!l
Chn.ttahoo~Jhoa
Chat tonga !Jhorok.Je rnarke lJ1:1y
r.tvoon
fJltnch 'Jobb Coffeo Colquttt IJolr.u-aOia
Oook
CoH~b-
CI'~1'11' f;:,r-l Cri.3p Dn-h
Oat~.J,)ll

6,313 221.4 5.2T5 21+6.3
595 510.8
943 1153

926 30.1 5.637 183.2
Ia4 22.1 2,954 1379 12.0 310 3177 1f39 5:'..7 2,313 282.7

5 35-2 2 ;~5.6 19 222.2

2 3.5

9 63.a

~

)8. 73.0

7 31.4 85 36o.

12 109-7

6 41+.2 11 ~0.3
5 36.7 30 lg1.6 30 )3.1 60 6o6.9

2 12.1 17 21.6
2 20.2

21 154-9 53 194.2 23 168.7
32 193-7 106 13lf.5
4o 4o4.6

10 131.7 1035 47:)2.0
217 3371f.8 74 ~?5J.6
330 1033.0
6 63.2

1 4.4

lf 52.7 12 530 21 326.6
22 754 75 246.1
13 137-0

267 2371f.3 43 647.4 22 221+.3 19 51.6
5 49.0 3 16.5
'n9 3as.3
21 2t9.3 5 2).~
.,6.9 lj.l!

8 71.2
20 543 32 Jrl.3 1 2.1
11 lO.'?
s 3).f
2 11,9
2 !3.3
11.5

14 124.5 9 1355
12 122.6 2lf 65.2
13 127-5
5 10.3
259 ;!ItO.} 3~ 408.2 2o 155-1 3l! 151.7 26 99-9 10 241.6

!3 TJ,.5 20 26o.g

:)4 21!9.9

92 124

InHs3.-s3

22 2)1.1

3 '),l

5 115-9 10 1.}0,11 '11 109.0 30 .lj6.4 64 ?552 17 1{3.6

30 G~J.G.<>

6 5

G22s..7s

15 <31.7

4 15'"2

22 117-9 20 75.8
l2 1573 31 168.9

94 31 57 2.3 7 6.0 30 37

93~ 30.4 32+ 15.1
30 25.8 581 71.0
2 14.1

l 74 l 37 1 73
1 34
1 8.9
4 10.9
l 9~
2 1.9
l 10.5 1 lf,5
l S.l 2 7.6 2 l0.9

1 9.1 2 14.7 4 14.7 1 13 ::>8 355 2 20.2

2 8.8 1 15.6
1 33 2 21.1
1 8.9

3 8.2 g 735

33 30.6

'j 29.8

loJ

1}.4 61.5

2 18.4 24 6}.3 9 27-3

1 8.1
- 1 33
1 5.4

"COJn.t,tr
DoK~l'o
Do,,ga f")voly
Cou_;:l~rty
;)u1.t;;L:.a
.'!]nrty

.':'3 Hl!.5
15 21.6 55 ::-sG. t
165 ~62.0 206 )01.0
23 221),0
'10 ~)~.2

l

1. )~

2 l-), 'l

1 J.T

23 110.5 142 132.1
26 ll3.1
26 l)) .8 31 ~SL8
lJ )7 ,I.!
31 l'57 .s

l. 39
2 2.{ l 4.2 ~? W,l.f
,. 19.')

1n
l.,

sa:~
5.2

5 29.2

38

l!IPIDIIMIOLOGT

NUIOllllR OJ' OASIS AND CASI RATJI: PER 100,000 PO~ION 0!' SPliiCIFIIID NOTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1937

.Area
llchols Effingham Elbert i:manuel Evans Fannin
Fayette lloyd Forsyth Franklin Fulton Gilmer
Glascock
Gl:~<nn
Gordon Grady Graene
Gwinnett Habersham llall llan<ck Haralson Harris Rart
Beard Henry l!ouaton Irwin Jackson Jasper
Jeff Davis Jefferson Jenld.ns Johnson Jones :LNDar
:Lanier :Laurens :Lee :LibertT :Lincoln :Long
:Lowndes :Lumpkin
McDuffie
Mclntoah Macon Madison
Marion Meriwether Miller Mitchell Monroe Montgome17
Morgan

Malaria Cases Rate
14 128.2 1 51 84 32).4 2 26.1

Measles Cases Rate
2 10.3 22 149.0

Pneumonia
Cases Rate 4 145.4 15 1~.4 48 2 .1 17 65.5 16 208.a 29 196.

Po11omyel1 tis Cases Rate
2 727
1 6.8

Scarlet !'ever Cases Rate
3 15.4

9 98.2

4 43.6

11 21.1 28 538 131 251.6

10 19.2

4 331 14 1~.9

4 331

5 28.9

1 58 25 1 7

1 58

29 8.4 280 81.2 1118 324.3 11 32 412 1195

4 1179 12 143.6

7 837

6 126.1 43 210.1 8 43.1 81 388.6 15 115.6

1 21.0 5 24.4
1 4.1!

1 21.0 57 2785 38 204.5 24 115.1 23 177-3

4 195

1 21.0 7 34.2 3 16.1
2 15.4

1 7.1 5 15.0 29 207.8 2 139 3 252 1 59

1 71 1 30 17 1179

16 16

115~.o9

33 987 19 136.2

8 555 12 100.8

14 82.2

4 12.0

I! 570 4 12.0 2 14.3 2 139 1 8.4 1 59

~ 39.1!
a 295 35.0 38 287.4 10 43.0 7 776

I! 795

21 123.7

2 175

35 264.7

~~

64.5 155.3

1 9o9

1 11.1

~ 21.~ 66.

17 1,7.4 10 54 11!2 13~1! 1!0 51! .6 1 10.3 1 97

1 4.5 1 97

9 104.5

25 113.6

~~

110.9 1173

1~

309 136.1

1 11.6

1 13

191 5529 192 22~.2 92 lOt .4
6 7o2 46 1047.1!

1 2.9 1 11.2

3 550

71 2055

2~

266.1! 46.1!

9 101.0

1 22.1!

24 69.5

64 200.2 1 11!.6 2 20.9 48 813.4
49 282.4

2 6.J 1 18.6 1 16.9

41 128.3 42 71!2.3 17 1775
J 50.8 2305 12 735

3 559 1 16.9

2 6.3 2 373

2 26.7 19 71!7
5 5Q.O 161 617.1!
1 9.2

1 38

12 16o.l 46 190.6 5 !)0.0
~ 226.4 362.4
9 83.2

1 lJ.J 4 16.6

7 29

1 31!

15 115.4

10 770

I! 61.

liPim:MIOLOGY

39

Blllll!ER OJ' OASIS .&liD CASil BAT:I Pli:R 100,000 POPULA.TIO!I' OJ' BI'JICII'DD lfOTIFI.ABLE DISEASilS HlilPOR'rED I!l' GEORGIA :BY COIJ!I'TIES - 1937

Murrq lfuecogee !l'ewton Oconee Oglethorpe Paulding
Peach Pickens Pierce Pike Polk Pulaald.
Pntnaa q;u!tman :Rabun :Randolph Richmond Bockdale
Schley Screven Seminole Spalding Stephana Stewart
Sumter Talbot !aliaterro Tattnall 'fqlor !l'eltair
Terrell 'l!hoaae 'f1tt 'fooaba Town a !reutlen
!roup fluoner '!wigga Union Upson Walker
Walton Ware Warren Washing' ;m WBJU Webater
Wheeler 11h1te Vh1U'ield WUcox Wilke a Wilkinaon
Worth

Malaria Caees Rate
17 29.1 6 335

Measles Cases Rate
1 98 2 J.4
1 7.1

Pneumonia

Polio1J17elitis

Scarlet J'ever

Q.ses Rate Ca.aes Rate Cases Bate

s l8.2
~ 1 2.7 2509 3 ~.o 7
5 36:a

7 12.0 12 20.5

1 56

-

2 14.2

4 291

50 474.6
14 102.4 18 1575 32 1193
3 315

85 787.8 117 4363

24 ~.s

19 17 .1

1so7

124.3 700.2

6s 12

1~..6o

6 556

1 73

-

34 126.8

1 10.5

1 22.7 1 14.4
19 104.5 15~ 210!25.l

-2 28.8
6 8.1
4 551

6 66.5
~ 433 220.2
294 3~3
25 3 3

1 3

,..5o 19 255

2 J,.6 63 27 5 109 1386.8
3 12.6
1 11
5 41.5

1 17.8 1 4.4
2 254 2 1!.4

1 19.1! 2~ 100.2
~ 458.0 201.6
4 307 15 124.4

1

12.7

2 20

~.,o4

1 11

191 684.5 2 21.2
3 457 39 2334 10 81!.1! 118 731.0

3 10.8
-
16 958

46 164.9
11 116.4 7 1o6.6 28 167.6
~~ 16s.l 210,

3 10.1
1 15.2
1 8.9 3 18.6

26 136.9 82 231!.2
98 5776
34 17!1.8

1 53

1 4

2.l 23

43 227.4

54 284.4

~;

110.4 3949

17 89.9

8 162.6

4 49.5

5 26.3 1 2.9

2 10.5

1 2.9

3 2

1107,l

71 182.9 5 4~.0
-39 41 .1 5 24.2 5 17.6
. - 30 1309
15 538 118 18~.6
2 1 .6 1 18.7

5 12.9
--
117 1626.1 4 19.4 3 10.5
2 7.2

96 247.4

2 17.2

16 12

l1l2.7s

54 261.3

29 101.8

38 165.8

89
s

31695. ~

31 118.6

8 586

4 745

3

11 28 72.1

..7 -,

ao
,.12

1. 1f

2 1 .4

5 19.1

3 294
3 13.0 59 411,3 1 6.1 3 26.3

1 4.3
1 10
3 26.3

5 49.1

37 16o.J

25 11

l n .38

19 166.1!

-2 19.6
~ 1~.0 1 6.1

101 4357

22 94.9

4 173

4o

liPIIIDIIOLOGY

NUMllER OF CASES AND CASE RATE PlllR 100,000 POPtlL.lTIOl'l OF SPlllCIFIED NOTIFI.AliLE DISEASES REPORTED Il'l GEORGI.ll!Y cotm'!'IES, 1937

Area
!?'

Syphilis Cases Rate

'ru.berculosia Typhoid lever Typhus J'noer

'llhoopillg Cough

Cases Rat Case a Rat Cases Rate Case a Rate

State Total

1~,341 498.6 3,016 98.0

Rural Cities 2500- 5000

,526 742

211,, 637i

l,m

63.1 123.6

Cities 5000 &Above 10,073 1231.2 1,520 185.8

719 ~.4 1,092 559 .1 668

355 1,714 557 31.2 813 ~8.0

33 28.3 143 122.8 72 1.8

127 155 281 343 829 101.3

Appling Atkinson Bacon Baker Baldwin Banks
Barrow Bartow Ben Bill Berrien Bibb Bleckle;y
llrantle;y llrooka Br;van Bu.lloch Bu.rke Bu.Us

2 14.1
-
4o 169.6

1 7.4

50 183.2

1 10

676.3~

623 790

21 212.4

-
245 1082.1

27 925 134 4398

~

353 51.2

~

65.0 40.8

20 84.8

6 549

3 22.1

3~

120.9 44.0

6 36.a 143 181.

8 80.9

1 13.2 14 61.8
3 46.7 17 ~83 43 1 1.1
5 527

1 12.8 2 26.0 2 23.4 8 33~ 11 100
-
11 4o.3 4 29-3
10 12.7

7 309

1 15.6

l 8 12

12~6:.4~

22 1552 3 39o0
5 585

1 13

i~

78-7 17.8

2 20.2

1 1J.2 24 106.0

22 754 3 9oS

1 7.1 1 13.0
'
3 22.1 9 33o0
45 571 2 20.2
8 353
20 6s.s
6 19.1 3 31.

Qalhoun Camden Candler
carroll Catoosa
Charlton

30 268.8 211 3176.8
3 30.6 5 '13.6
36 3530 21 433

13 115.6 2 30.1
10 102.2 16 435 17 166.7
2 4.1

6 53-4
4 4o.9 9 24.5 1 98

13 115.6 2 J0,1 22 224.8

1 7

1~.48

10 150.6
46 451.1
14 28.9

Chatham Chattahoochee Chatto!)ga Qherokee Clarke Clocy-
Clocy-ton Clinch . Cobb Coffee Colo_uitt Columbia
Qcok
Coweta Crawford Crisp Dade Dawson
Decatur DeKalb
Dodge
Dool;y Doughert;y Douglas

3. 863 35842 91 9525 2 11.9
591 2270.8

4 ~6-7

34 35

22 585

5 22.7

l~~

464.9 252.2

4 323 9 }4.1

35 1907
-

16 63.2 246 332.3
15 63.2 9 47.0
172 7523 12 116.9

261 242.2 7 733
15 395 9 4o.1
50 192.1 3 4o.3

215 a 52.2 47 125.0 9 4o.9 21 6}.8 14 147.1

2 16.2

9 }4.1 2 26.2

23 3

162}5.6~

1 26.8

17 6~.1 71 9 .l
6 253 11 5~5 22 9 .2
6 58.4

- 43 499
~ 23., 16 71.
2 11
1 13.4

5 '!59 5 1)5,2

5' 1

la' 5

2 6.1

1 10.5

1 8.1

~

11.4 78.6

1 54

28 591.6

3 u.s
2 2.7 1 42 9 47.0 7 30.6 4 390

96 89.1 123 114.1

3 1J.9 1 4.5 2 77 5 67.1
-
9 117.4 1 2o7 13 591 42 127.6
15 121.3
36 196.1

33 196,8 1 4.5
1 26.9
3 4o;3
1 9.2
5 1).3
1 ).0 21 220.6 '
-
5 18.9
':'

20 78.9

fo 4.1 143.4

1
32

1~..6o

-
16 21.6 1 4.2 1' 83,6
39 )So;o

lilarl;y

5 255

26 132,l~

4 20.4

9 45.8

EPIDEMIOLOGY

41

NUI!llER O:r CASES AI!D CASE RATE PER 100,000 POPl'LATIOJ; OF SPECIFIED NOTIFIABLE DISEASES REPORTED Ill GEORGIA BY COUNTIES - 1937

Area
Echola Effingham J:lbert
lmBllu~l
:Evans Fannin
FSJ'ette Floyd. Forsyth Franklin Fulton Gilmer
Glascock Glynn Gcrd.on Graey Greene Gwinnett
Habersham Hall Hancock Raralaon Harris Hart
Heard Henry Houston Irwin Jackson Jasper
Jeff Devia Jefferson Jenkins Johnson Jones Lamar
Lanier Laurens Lee Liberty Lincoln Lon&
Lowndes Lumpkin McDuffie Mcintosh Macon Madison
Marion Meriwether Miller M1tchs11 Monroe Montgomery
MorgBll

Syphilis

'l'uberculosis Typhoid Fever Typhus Fever

Whooping Co h

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate

14 128.2
19 97.4 13 50.1

336 645.4
15 86.8 2161 626.8
1 12.0

8 168.1
629 3073.4 14 754 37 177.5
3 23.1 1 3~

6 42.8
170 508.5 126 902.9

17 142.9 2 11.7

2 19.9
35 206.2 2 .17.5
7 52.9 12.9
a 44. 11

1 11.6

34 154.5

17
6

1~..7o

3 29.2

7 64.1 10 51.;
2 7.7
3 39.1 11 745

2 21.1! 62 119.1
6 49.7
6 347 641 185'?
7 837

3 63.1 19 92.8
5 26.9 17 81.6
4 30.8
10 33 7

7 49.9

14 41.9

9 64.5
6 41.6

"6

41.'3 35.2

3 29.g

7 41.2

5 437

7 529

9 4

t47. ll

1 11.6 16 72. i
17 125-7 1~ 102.7
7 72.0
8 77.8

1 9.2 6 30.8
10 385 1 13.0
1 6.8

8 g

87.~ 15.

1 8.3

6 34.7

32 5

07
5"9"8'

5 105.1

5 26.9

3 10.1
1 7.1 5 15.0
~ "' , 21.5 '--Jr
2 11.7
3 29.8 5 29.5 1 8.7 7 52.9 3 12.9 1 11.1

5 22.7 2 14.~ 1 7-3 1 10.3 3 29.2

3 27-5
18 69.3 3 39.1

1 9.2 46 235.8 1 3'?
18 121.'?

1 1.9
4o 11.6
2 9.8 22 105-5 1 34
4 12.0 2 14.3

8 15.4
6 34.7 474 1375
2 23.9
--
56 273.6 3 16.1
1 1 7 1 34
12 86.c 111 770.0
20 168.0

5 37-g
6 69.7 2 9.1 19 14o.s

2 19.9
1 8. 7 7 52-'3 8 34.11 12 133-1
-
8 363 2 14.S 14 102.7 4 41.1

52 150.5

2a

29().0 46.8

6 67.2

374 1170.0 39 726,11
2 20.9 22~ 37790 1 !!0.7

2 26.7
6 24.9
4 4o.o
lo6 4o6.s
25 201.3

8 61.6

21 6o.3
~.3
a .t! 2 22.11 5 1139
3~ 115.7 lll.S
7 7~ .1 8 7
la 80.7 4 24.5
4 534 16 66.3
1 10.0 13 49.9 20 161.11
1 9.2
6 46.2

21 Go.~
6 69.6
g 25.0 14 26o.s
- g 835
6 34.6 3 18.1.! 3 4o.o 2 8.3 3 30.0 1 38 4 32.2 3 27.7
3 23.1

17 49.2 1 11.6 1 11.2
16 50.1
4 23.0
1 la-3 1 .1 10 100.0 67 257.1 4 370 2 15.1~

4 11.6
5 15.5
1 5.3 4 24.s 1 133 9 37-3 1 10,0 17 65.2 4 32.2 4 37.0

42

EPIDEMIOLOGY

1"JI!llER OF CAS-ss AND CASE RAT'S PER 100,000 POPULATION OF Sl'iCIFili:D ':OTIFIAELE DISEAS':S REPORTED IN G:OORGU BY COUNTIES - 1937

Area
Murr&T
Muaco~ee
Nevton Oconee Oglet'torpe Paulding
Peach Pickens Pierce Pike Polk Pulaski
Putll&.!L Qui t:nan Babun Randolph Bicbnond Rockdale
Schley Screven Seminole Spalding Stephans Stewart
Sumter Talbot Talis!erro Tattnall Taylor Telfair
Terrell Thomas Tift 'foomba Towne
~eutlen
Troup Turner Twigge Union Upson l'alker
Walton 'li&re Warren Washington l'a;yne Webster
Wheeler White
T'.o~tfield
Wilcox litlkes Wilkinson
forth

Syphilis

Ttlberculo sis Typhoid J'ever Typlma J'ever

'fboopiAg c~

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate

402 688.3 87 485.1
2 14.2

10 97,S 54 92.; 15 83.6 2 233 10 70.S 5 36.~

4 39.1 6 10.3 1 5.6 1 11.7 2 14.2

5 8,6

1 9.5 1!4 14J.!l 3 16.7 1 7o1 1 13

130 12339 3 27oS 7 51.2 3 26.3 31 115.6 1 10.5

9 8~.4 8 7 .1

5 16

1~..6o

19 70.9

8 84,o

2 19.0 10 92.7 4 293 14 122.5
3 11,2

- 2 19.0
18 1J1.6 1 3.7 4 42.0

2 19.0
1 13 1 11.8 16 59.7

1 11.1 1 22.7 3 43.3 21 115.6 816 1097.1 11 151.5

11 122.0 2 45.4 1 14.4 I! 44.0
188 252.8 I! 110.2

2 21!.8 9 49.5 24 32.3 5 68.9

20 110.1 8 10.8

J 16.5 35.0 1 13.1!

7 124.4 26 113.3 56 712.5 35 147.0 11 84.3 4 33.2

12 213.~ 15 65.
2 25.4 34 142.8 11 84.3
6 50.0

3 53.3 2 8.7 3 38.2 10 42,0 2 16.6

3 53.3 10 43.6 19 241.7 1 4.2 1 1!,3

16 203.6 9 37.8 1 7. 7

283 1014.3 5 52.9 37 563.7 5 29.9 11 97.7 10 495.4

27 96.8 7 74.1 4 6o.9 I 47.9 7 62.2 4 24.8

- 3 10.8

~

45.7 23.9

12 106.6

2 12,4

19 68.1
16 95.8 37 229.2

10 35.1 15 228.5
- 2 12.0
1 6.2

vo 92 484.6
1372710).2 9 47.6

9 47.4 11 32.0 28 165.0 14 74.0 1 20.3
6 74.3

2 10.5 4 11.6 19 ,112.0 6 31.7 1 20.3

13 68.5 12 34.9 45 265.2 15 79.3 .

2 5.8 6 35.4 24 126.9

242 4

6~~:~

-2 21.3

169 817.9

58 203.6

7 )0.5
537 1926.1 1 8,2
- 31 118.6
J 56.0

57 146.9 3 25.8 9 96.0 1 13.9 20 96.8 33 115.8
8 34.9 18 64,6
7 57.5 13 49.7 9 65.9 2 37.3

3 7.7 9 77.5
-
3 14.5 7 24.6

17 74.2

6 21.5

3 24. 7

~

11.5 29.3

1 2.6 8 68.9
13 46.6 1 3.8 10 7~.2 4 7 7

10 206.1

1 10.7

2~

111.3 14.0

2 8. 7 34 122.0

11 176.6
' '~.1
158
9 62.7 9 54.7
20 175.6

3 29.4
.~ 207.9
2 13.9 9 54.7 6 52.7

6 58.9 6 86.3 2 8.7 1 7.0 3 18.2

35 343.4 6 41.8

12 52.0 9 54.7 3 26.3

333 1436.5 26 112,2

7 30,2 30 129.4 12 51.1

Total
Albllll7 Jaertma &.then a AH!U1\& .aDuta Balnbridge
BNDO'IIici:
Carrollton Cartersville Cedartown College Park: Colwnbuo
Cordele Dalton De ca.tur
])].bUn T.aet Point F1ttgerald
GoinoSTillo Griffin LaGrange !lacon Marietta lll.llodgorlllo
lloultrio Ne1man Rome Savmnah 'l'homaston
'l'ho~I'Ville
Valdosta .lW=ll.aA

IIUJIB!:R 01 ClliS ~D CASI RJ.TI Pli:R 100,000 POPULA!IOII OF SPICIPUD lfO'l'InABLE MS:USU RJ:l'OR'I'!D IN G_,RGIA BY CI'!'IES OP 5,000 POPU~'l'IOII AIID ABOVI - 1937

Estimated Pop].lation
!U!,174
111,999 9,075 18,a~1 252, 9 6o,877 6,6o5
14,832 5,420 5,561 8,750 6,856 44,096
7,301 9,093 14,123 7,045 9,9n 6,692
9,457 10,522 21,462 61,437
8,129 5,732
8,6o2 6,773 23,482 86,877 8,614 12,501
14,129 16 145

Cerebroepinal
MWD&ISil Cae Rate

40

4.9

--- --

23

9.1

-2 -33

----- ----

3

6.8

--- ----

-

-- --

-- - 4

6.5

-

--- ---

- - 5

5.8

1

8.0

1

7.1

l_

6.2

Diphtheria
ea... Rate
351 42.9
--
3 ~.1 9 .II 92 36.4
- - 72 ll8.3
- - 2 135
11 llO.a 8 91. 2 29.2 8 18.1
1 13.7 2 22.0 3 21.2 4 56.~ 2 20.0 1 14.9
1 10.6 4 38.0 16 74.6 15 24.4 16 196.8 1 17.4
- - 1 11.6
9 38-3 58 66.~
3 34.~ 3 24.0
3 21.2 1 6 :1.

Gonorrhea 0&181 Bate

3,730 455.9

11 733 1 ll.O
1 5.4
1,649 653.2
- - 427 701.4
-
9 166.1 14 140.4 20 228.6 3 43.~ 35 79.4

3 6o

41.1
66o.o

2 14.2

6 85.2

- -5 50.1

35 370.1 ll 104.5
15 70.0 121! 208.3
7 86.1 16 279.1

29 5

3n37.s1

17 72.4

917 10555

99 1149.3

15 120.0

80 566.2 110 681.}

Influensa ca.aea Bate

6,U!8 756.3
42 280.0 70 771.3 8 ~~a.o 2,687 106 .4 209 3433 6 90.1

21 141.6 22 405.9 23 230.6 182 2080.0
30 437.6 76 17-2.4

20 273.9

62 681.8

6 42.5

57 809.1

1~

190.2 59.3

11 116.3
~a 408.7 298.2 41 66.7 4 49.2 3 52.3
169 1964.7 7 103.11
152 647.3 12117 1435.4
38 441.1 29 232.0
23 162.8
!l~_501'i.6

Malaria
ea ltate

943 115.3

166 1106.7

20 220.11

7 37.0

7 2.8

142 7

126Z.o3

18 121.11
111 258.3 2 20.1 10 1111.3
3 43.8 8 U!.1

14 191.8
3 330 3 21.2 21! 397.4 4 40.0 1 14.9

5 52.9 2 19.0
s 37.3
24 39.1 3 )6.9

- - M 1023.0 2 8.5 310 356.~
4 46.4 20 16o.o
4 21!.3 _14 86.7

Ca1Rate
1139 537

3 16.1 27~ 109 7
99

3 20.2 17 313.7

sll 96o.o

1 14.6 2 4.5

1\'l
H

---1 --11.0

"I"S'
0
8
~

1 10.0

1 10.6
.o 2 1~.o
31 15 211.4

a 34.9 59.1

1 4.a

9 10.

- 4 46.4
- - -

5

2 12.4

Total

Albal'Q" Amerlw. Uben1
Atl11.~ta
Augusta Balnbrl dge

B:..'Unswiclt

... "~ '

Carroll ton Carterevi lle Cedartown

~ College Park

-~ Columbo. a
r=l

;4 Cordele Dalton JNcatur IllbUn Eaet Point Fitzgerald

Ga!noiiVille Grlffln LaGrange Macjjn
Marietta ll!.lloagev! lle

M011ltrl e Newnan Rome Sl!lvannah ThOmaltOD Thomas~ lle

Valdosta Wa;rcross

m NWBER OF CASES AND CASI RA.TE PER 100,000 POFIJLATIO!l Of S?!ICIFIED llOTIF!Al!LE 3lllidl!!S
Rl:?ORrl!ID Ill G!ORGIA BY CITIES OF ~ ,000 POFIJLATIO~ AND A!lOVE - 1937.

Pneumonia

Cases

R&.te

2,313 282.7

30 200.0 24 264.5 24 129.1 938 371.6 270 443.'i 9 136.3

37 249.5 11 203.0 16 160.4 20 228.6 21 3Qb.3 77 174.6

lb 219.1 30 330.0 g 56.6
27 3833 15 150.2 17 254.0

15 158.6 J4 323.1 38 177.1 100 162.8
11 135 3 11 191.9

47 546,4

5 73.8

70 298.1

2~~

265.9 437.6

13 104,0

19 134.5 87 538.9

Polio<eyelitlo Caees '!'tate

30

3. 7

--- ---

8

32

- -2

33

4 27.0
---2 36---.9
7 15.9

----1

--13.7
--

1 14.9

-- ----3 14---.0

--- ---

- - 1

1. 2

1

8.0

-- --

Scarlet J'ever
Cases Rate
581 71.0
- - 1 11.0
14 753 311 123.2
- -19 '1. ~ - - 4 27 .o
1 10.0 34 388.6 3 43.8 10 22,7
1 13.7 19 209.0 26 184,1 5 71.0
-7 70-.1
2 21.1 17 161.6 26 121.1 27 43.9
- - 9 110.7
1 11.6 1 14.8 2 8.5
- - 26 299
1 8.0
2 14,2 12 74.3

Synh1111 Cases Rate

10,073 1231.2

171 n4o.l

220 2424.2

56 301.2

2,151 B52.1

808 3

134257.4

627 4227a
3 55 26 260.7
2-4 274-3
394 8935

25 342.4 148 1627.6 17 120.4
- - 16 227.1
1 14.9

153 1bl7 .8
29 275.6 179 834,0 bl6 1002.7 10 12"1,0
6 104.7

144 1674.0 3 44.3
70' 298.1
3 '366 3874.4 168 1950.3
21 lb8,0

94 665~ 524 3245.

Tabercu.loll. a Cawes Rate

1,520 185.8

16 106.7

18 198.3

s?.2

193.6 213.9

168 276.0

g 121,1

1~ 101.1

4

n.~

14 14o.4

7 80.0

16 233.3

52 117.9

15 205.5 33 362.9 17 120,4 7 99.4 15 150.2 4 59.8

9 95.2 21 199.6 31 144,4 128 :>01!.3 15 ~4.5
9 157 .o

7 81.4 4 59.1 34 144.3 225 259.0 14 162.5
5 4o.o

18 127.4 15 929

Typhoid !'over
Case a Rat&
127 15.5
5 333 2 22.0 1 5.4 18 7.1 13 21.4 1 15.1
--
3 55.4 2 20.1
- - 2 22.9
4 9.1
1 1).7
- - 1 11.0
1 14.2 3 30.0 2 299
1 10.6 3 28.5 1 4, 7
4 8 1 .o
2 2 .6 3 52.3
2 233 1 14.8 5 21.3 27 31.1 2 23.2 4 32.0
4 28.3 5 31,0

Typhuo J'ner
Ca Bate
281 34.3
29 193.3 12 132.2 1 5.4 34 135 7 11.5 7 106.0
2 13.5
-1 11.4
-
5 11.3
- - 33 452.0
1 7.1 7 98.4 2 20.0 1 14.9
3 31.7 1 9.5 1 4. 7 12 19.6 1 12.3
-15 174.4
1 4.3
- - 83 955 6 48.0
7 49.5 9 55.7

llhoopl ng Cough Cal81 Rate
829 101.3
1 11.0 7 37.7 464 183.8 26 42.7
45 303.4
5 57.1 2 29.2 18 4o.8
12 132.1)
- 1 7.1
4 4o.1
9 85.5 36 167.7 2'i 4o. 7
-1 11.6
6 25.6 110 126.6
23 267.0
J4 210.6

DIVISION OF LABORATORIES
The total number of specimens handled for the year was 254,153. an increase o!' 31.4 per cent over the prece.iing year, 1936.
Branch Laboratories
Two well equipped branch laboratories were established in South Georgia.
In selecting sites for the branch laboratories, it was necessary to consider railroad and mail facilities, highway radiation, and to some extent geographic locations. A number of towns were considered before W3Ycross and Albany were selected.
Both laboratories are entirely State owned and controlled. With no local obligations, impartial service can thus be render~d to all sections of South Georgia.
Both laboratories are well equipped with new apparatus and materials of the most modern design.
'lllth a few exceptions, the branches are prepared to carry out the s;,ne ;ariet;r and quality of work as is done at the central ls.boratory in Atl~~ta. In addition, they serve as distriauting stations for biolot:i cal products and all laboratory supplies.
FullCt ions:
1. To render laboratory service more readily available to the southern half of the State.
2. To relieve the overload on the central laborctory. Evi~ence that the objective is being attained is indicated by a 20 per cent decline in the output of the central laboratory during November and December.
3. To increase the aggregate capacity
of the division of laboratories to withstand the anticipated demands arising from the rapidly expanding field progr~ now getting underway throughout the State.
Waycross Laboratory: The examination of specimens began about September 1.
Seventy-eight specimens, from the anti-syphilis campaign being con<lucted in Glynn, Mcintosh an<i Camden Co1mties, were handled on the first day.
During the first three and one-r.alf months of operation, the

LABORATORIES
Waycross branch examined 10,271 specimens, classified as follows:

Microscopic Se ro 1ogi cal

Total

10,271

The coat of installation of the Waycross branch, inc}uding build-
ing lease for one 7ear, alterations, and equipment was $7,020,04,

Albany Laboratory: The examination of specimens began on Septem-
ber 23.
During the first three months of operation, the Albany branch ex-
amined 11,576 specimens, classified as follows:

Microscopic Serological

8,424 2,152

Total

11,576

The coat of installation of the AlbaDT branch, including lease
for one year, building alterations, and equipment vas $6,561,41.

stn.!MA.RY FOR ENTIRE STATE

All Laborator7 Examination

Wicroacopic

97,262

Culture and Agglutination

18,345

Serologic

128,297

Water

10,249

Total

254,153

The folloviLg table compares the growth of the laboratory work during the past five 7ears:

:Bacteriological Serological Water Analyses

1933 37.744 50,563 8,212

1934
68,169 67,o47
8,2~2

1935 102,567 76.564
8,~94

1936 102,570 81,953
s.s21

1937 115,607 128,297 10,242

Total

96,579 143,511 187,725 193,414 254,153

,~

--.:---

)o.

iuORA~CI!IIS

li1

~

i- --- ...
- ~
.. --- ~Ci
- cJa
-- ~ to~
- -- ~
--- -~ II)

:
l L.
~~
t
c :5 r
.t ~ ~ ~ <( ii S: ~ IS:: ~
I
I
I
I

~l~~+ --- iJ a

II

~I

J I sNol..NI.,.x3 t H3tnN ~.

II

t.-, .....,
..

....,.
.., . _ "'
""''
;;;
....
"'cr:
:::<(
.... >w-

"N '

~- ...

...

N

I

...

..N
~N

. ~ N ~

~!

- ct-1 ~
Cl
I

---'------~'---~- ___j

48

L.LBOR;:.TORIES

ltlcroscopic Examinations

Specimens for Tuberculosis
!nlmal Inoculations for Tuberculosis
Oultures for Diphtheria
Slllears for Gonococci
Dartc Field Examinations
lood smears for ) KB alaria (~-a..-u' smears
Blood smears for ) Malaria (Thick smears

Posit iv8 Ne[:'&tiv" Doubtful Total
Positive Herative Total
Positive llegativ,.. Doubtful. Total
Positive Negative Doubtful Total
POl!itive l!leative Doubtful Total
Positive legative Total
Positive llegative Total

693
4,854
25
l2
141
454
1,)20 59
1,081
4,128
)6
61.
144 1
509 7,0)1
1,155
2.3,606

5,572 15)
l,SJJ 5,245
2:>9 7,54o
24,761

L.\.90RATO.RIES

Microscopic (contld)

SpeciJnens for Intestinal Parasites (routine)
Speci;nens for Intestinal Parasites (Index)

PositivE' Negative D011bt:l'ul Total
Positive Negative Total

1,262 6,572
1
14,o47 27,464

Brain examinations

for Rabies

Positive

697

Negative

598

Doubtful

.38

Total

.Animal Inoculations

for Rabies

Positive

4J

Negative

257

Total

Miscellaneous

Total

Total Microscopic Examinations

Cultures and Aggluti.t ations

lldal tests for typhoid

(Dried specimens)

Positive

26

Negative

109

Total

Agglutination reaotions (Liquid spec.)

Total

Positive for

Typhoid

3.54

Brill's

9f.fi

Undulant

66

Tularemia

48

49
7,835 41,5ll
1,.333 300
970
97,262
135 7,614

50

LA.BORATORIES

Cultures and .lgglutiMt1ons
(cont' c. )

Blood Cultures

Positiv-., for
Typhoid Paratyphoid Undulant Other OrganisiiiS
Negative Total

2BJ 11
8
14
6,ll0

Stool and Urine Cultures

Positive for
Typhoid Paratyphoid Dysentery Other Organ1sma
legative Total

281
6
J4 .3 .3,869

Total CuJturea aD4
.Agglutinations

Serologic bam!nat ions.

Blood and Spinal J'hnd for Serological testa

Positive legative
DoubtfUl Anticomp. Tota1

23,8.37 lDJ,Ol4
l.,l-46
300

Water Exalllinations.

Tota:l

Orand total all examinations

4,19.3 JB,.)/6

LA:BORATORIJ:S

51

Microscopic Examinations

Sputum lxaminational The following table compares the sputum examination resulta in the past five years:

lo. apeciena examined Jo. pod t1 ve Percentage poaitive

1933
3,744 437
11.6

1934
4,~~
11.2

1935
4,445 521
11.7

1936
4,222 594
14.0

1937 J.vera,;e

5.572
J.~:a

4,~~
12.2

One hundred and fif\7-three specimens were subjected to guinea pig inoculation. Onl7 twelve positive findings were obtained. It will be neoeasarT in the future to restrict this service onl7 to special cases.
Lack of cace ~ce in the animal room is also a problem to be solved.

Diph,theria:

Positive

lfegative

Doubtful Total

Dia,;noatio Release from quarantine
Detection of Carrier Tirulence Tealo

24o 181 19 _!_I!

1,016 201
_ _ 976

1,256 382 116
__?_Q

Total

454

1,320

59

1,833

Pua Smears !or Gonococci:

1933 1934 1935 1936 1937 J.verace

Io. apecimena e2amined Bo. poaif.ive Percentage poaitive

3,098 3.765 4,218 4,237 5.245 4,112

804 l,o62 1,083

952 1,081

996

25.9 27.9 25.6 22.4 19.2 24.2

Dark J'ield ;lxaminationa for Spiro-.ta h.l.lidwa: Peydciana IU17vhere in tbe state ~nov collect exuAatee from suspected .rphilitic lesions in special capill&TT outfits and submit tb.se U,y mail to the laborator,.. These outfits are nov 'beiJ~g supplied free of aharce 'fhia ahould baYe tlw effect of enooura,;!Rg earlT dia,;noais of BTPh111a and
p-eatlT uha.nce the proapeota of COIIIJ>lat.e cures.
Two hundred and nine dark field teats were made this year, with 64,
or 30.6 per cent, poaitiva findings as compared with 70 for 1936, with 27, or 33.8 per cent, poaitivaa.

Malaria- Thin a.eara: While 1DOH thin ..-are of blood were . . . -
ined thh ,-..r, tbe poaithe find~ dropped tro. 16.1 per oent in
1936 to 6.6 per cent in 1937. !hh decreue 1a in li:eepinc vi th the proipitate decline of clinical malaria throuChout the State,

'!'hick ,_are1 About 14o,OOO thlok .-ara were au'baitted to the lab-
oratories duri.nc tlM 7tt.r. OYer 30,000 ,.re oo11ect.ed in Octoller and
Ioveber in connection with proJects oegun at that tllll8 ey the newly cr-
at414 divhion of .alaria investigations. J.bout 15,000 t1111ears were 7e\

52

LA.BORATOR IES

to be examined at the close of the year. All three laboratories are participating but the major part ie allotted to the branch in Albany and to the central laboratory. A more detailed prospectus of the new division of malaria investigations is given in the report of that division.
Of the 24,761 thick smears examined this year, only 1,155 gave positive findings, or 4.6 per cent, as compared with 6.3 per cent po.itives ln 1936.
Intestinal Parasites: There were 49,)46 apac1mena of feces examined for intestinal parasites in 1937. Of thia total, 7,835 vera routine specimens eubmittad by individual peysiciane. The re-.iniq 41,511
were collected by nurses and health officers from school children ia connection with hookworm surveys from counties listed in following table.
Unfortunately these results are very crude, in that no differentiation is made between light, moderate and heavy infeatationa. Plaas are now being made to institute egg countinc technique whereby the relative number of worms per case can be determined.
It ill probable that many areas having high lncidenoe by the cruder methode now employed may prove to have predominantly ligh\ infeatations by the worm count technique, perhaps too low to e&\we !LilY pcyaiolocical effect. Areas thus found to have high vora counts would be logical pointe of concentrated attack by state and count7 sanitary engineers.
It is to be regretted that these specimens cannot be examined also for Entamoeba histolytica. There is ample evidence o! widespraad incidence of amoebic dysentery throughout the State. Perhaps moat of this ie subclinical in the form of cyst carriers, but many active caaea could no doubt be found by investigation on a large scale.
As by-products of hookworm surveys, the incidence of other intestinal worms is revealed. Many double and triple infestations are found, as shown in the tabular analysis,

Mi s cellane ous :

Urines (bacteriological)-

60

Differential Blood Counts

74

Vincent's angina-- - ------- 2)0

Chancroid E. Ducrey - - - - - - - - - 76

Examinations for type of Organisms

265

Spinal Fluids for Meningitis

30

Cultures - - - - - - - -

13

Unclassified Total

~
951

53
Intestinal Parasites Single Infestation.

Worms for Identification

----------

Hookworm - Necator americana - - - - - - - - - -

Dwarf Tapeworm - Flyt:~enolepis nana - - - - - - - -

Ro'.mdworm- !<~cariB lumhriooideB - - - - - - - -

Pimvom - 0:lQ'lllris vormicularle - - - - - - - -

lhlpworm - Tricruris trichiura - - - - - - - - -

A.mocba hlstolytica - - - - - - - - - - - - - - -

Specimens not included in above classification -

4 l4,394
133 314
139 :?.3 9 8

15,o34

Double Infestation.
Hookworm anrl Dwarf Tapewol'll - - - - - - - - - Hookworm and Rt'1mdwoi'IIi - - - - - - - - - - - - Hookworm and Pi.nworm - - - - - - - - - - - - Hookworm and Whipwol"ll - - - - - - - - - - - - Hookworm ani H. diminuta- - - - - - - - - - - Roundworm and Pinworm - - - - - - - - - - - - Roundworm and Whipworm - - - - - - - - - - - -

50
104
103 lit
2
2 ----~2~--------2?7~

Triple Infestation.
Hookworm, Dwarf Tapeworm and Roundworm- - - - Hookworm, Roundworm and Pinworm - - - - - - - Hookworm, Roundworm and lhipworm - - - - - - Hookworm, Pinworm and Wl:lpworm - - - - - - - -

1 2
3
_ _ _ _2:;::,__ _ _ _ _ _, .
8

Total specimenB positive for ova of hookworm - - - Total specimens positive for ova of dwarf tapeworm-
Total specimenB positive for roundworm- - - - - - Total specimeM positive for pimrorm- - - -- - - Total Specimens positive for whipworm - - - - - - Total speeillens positive for amoeba histolytic& - -

14,675 184 428
348 44
'

County
Appllllg 8aoaD Bal.dw1n Brooks Beyan
Bulloch Burke Calhoun Camden Charlton Chatham Clay Clinch Coffee Colquitt Cook Dougherty Eftingh8111 Emanuel Evans Floyd lllllton Glascock Glynn Grady
Hancock llarris Jasper Jeff Davis Jenkins Jonas Lanier Laurens Lee
Linco]Jl
Lowndes Lumpld.n Kalntolh llitchall llonroe llontgomeey Pierce Rabun Randolph Schley Screven Sumter Tattnall Taylor Telfair Thomas T1rt Toombs Treutlen Walton Wqe
Wqne Wheeler 11'Ukinson Worth

UBORATORIFE

Hookworm Index Work by Counties

Total.

Hookworm Positive

13 116 726 .3,056 1,061 2t9.37
.348
.352 278 818 l2l .310 1,008 107 255
220
2,804 1,297 1,997
792 142 491 .367
2.3 .36 251 .38 .329 64 616
59 2 1,295 198 112 .32 2.38 47 1,501 958 1,308 1,555 18
122
.371 2,354
507 .32.3 919 44s 1,113 1,017 1,814 8.34 .30 2,004 1,825 410 362 .341

2 44 16 1,031
188
1,0.31 103 109 91
.346
79 9.3 181
7.3 115 126 235 427 925 3.39 14 25 106
8 19 40 2 1 42 276 11 0 601. 54 .32 25 l5 18 508 16 406 694 5 41
S9
796 125 161 292 19.3 4s7 324
798
289
0 645 586 236 150 1.36

Percentage
Positive
15-.3 .37.9 2.2 .3.3-7 70.5 .35.4 29.5 39.4 ,32.7 42.1 65.2 ,30.0 17.9 68.2 45.0 57.2 8.0 .30.5 46.,3 42.8 9.8 5.0 28.8 .34.7 52.7 15.9 5.2 0.3 65.6 44.8 18.6
0 46.6 27.2 28.5 78.1 6.,3 38.2 33.8 1.6 .31.0 44.6 27.7 .33.6 23.9 JJ.8 24.6 49.8 ]1.7 43.0 l,J.7
Jl.8
'3-9 .34.6
0 .34.1
J2.1
57.5 41.4 39.8

I.AllClP.ATORIES

55

Rabies: The fiuding of rabies in 697 animal heads in 1937 surpasses all previous records and indicates that the disease in animals is steadily increasing, This increase is not explained by the establishment of branch laboratories, in that only 13 positives came from this
sour\:e. Animal Roads Examined for Rabies During last Five Years

No. heads examined No. positive for Negri bodies Percentage positive

1933
951 332 40.1

1334
lllO 507
45.6

1335
1312 618
47.1

1936
1135 590
51.9

1937
1333 697
52.2

Classification of Animal Heads ll:xamined for Rabies 1937

Kind of Animal Dog Cat Cow Horse and Mule Hog Goat Opossum Squirrel Chicken Rabbit Rat Fox
Total

Positive
6~
18 2 3
-
b9f

Negative 429 122 21
7 7
1 1 4 2 1
1 2
598

Unsatisfactory 25 ll 1 1
38-

Total 1,033
173 40 9 11 1 1 4 2
1
1 2 1,}33

Cultures and Agglutinations

While principally devoted to typhoid studies,, tile work of this depa.rtment includes the following:
1. Serologic tests for tn:hoid, t;y-phus, undulant fever and tularemia. 2. Blood cultures of all kinds,
3. Stool and urine cultures for enttcr!c organisms,

Agglutinations: There were 7, 614 spec!mer.s of liquid blood submitted, showing the following positive findings:

Typhus (Brill 1 s) 909

Typhoid

354

Undulant Fever

66

Tulare~ia

48

hus Fever: While the mortality rnte of endemic t~hua (Brill 1 s

fever is relatively low, this disease has become a serious pC~blic health

problem in Georgia, As will be shown in nrrorts from the division of ep-

idemiology, there were more cases of tyr;hc;s rported this year than of

typhoid. fever,

Year

Cases Reported

Positive Well-Felix Teets

1933

625

1934

414

1935

489

1936

817

1937

lo46

514 399
524
1080
909

LABORATORIES

Typhoid Feve~: The consistent downward trend of typhoid fever in-

cidence was again reflected in 1937, not only by morbidity and mortali-

ty records but by the decreasing numbers of positive blood cultures in

the laboratory. This downward trend is shown in the following compara-

tive table covering a period of five years.

Positive

Year

Cases Reported

Deaths

Blood Cultures

1933

1118

251

284

1934

1252

316

361

1m93G5

1013 926

1937

720

261
19~
13

346 281 260

Serological Tests for Syphilis

During the first half of 1937. the laboratory was receiving about 10,000 specimens per month submitted for the serological test for syphilis, which was approximately a 50 per cent increase over the corres-
ponding period of the previous year. The division had been endeavoring to comply with the request of the physician for either the Wassermann
or Kahn test, the two procedures employed for some time. It was found, however, that requests for both tests were mounting
so rapidly that ere long duplicate tests would have been made on the great majority of specimens. The application of more than one test is desirable in queztionable cases of syphilis but the greater portion of
the specimens received was submitted in the routine examination of p&-
tients. Limited facilities necessitated a search for a highly sensitive
yet comparatively simple test to be used as an eliminating procedure,
since about 80 per cent of the specimens gave negative reactions by
both the Kolmer-Wassermann and Kahn tests. In this connection, through
the securing of a Rockefeller travel grant, the serologist vas given an
opportunity to visit several laboratories in t:1e Eastern and Mid-West
states, including those of Dr. Kolmer and Dr. Kahn, to study the aero-
logical teste employed, Partly as a result of this study, it was decided to adopt the Kahn
presumptive test as an eliminating procedure to be applied routinely to
all specimens. Those specimens showing negative reactions by this teat are reportei negative, since accumulated data showed that very seldom
would such specimens give positive reactions by the more conservative diagnostic tests. The application of this highly sensitive test serves
a twofold purpose:
1, Enables the laboratory to report about 70 per cent of the
specimens by a short and quick procedure,

2. Enhances the value of a negative reaction in the exclusion of syphilis.

Specimens show!ng positive or doubtful reactions by the Kahn presumptive test are not reported by this test, since it is considered too sensitive for diagnostic purposes, but have applied to them next the standard Kahn test. Definite positive reactions by the standard Kahn test are reported without further wait. Specimens showing a partially positive, donbtful, or negative reaction by the standard Kahn teat then

LAl!ORA TORIES

57

have applied to them the Kolmer-Wassermann teat with the result of both testa reported. The Wassermann teat is performed now only three times per week.
It is felt that by the adoption of the policy outlined the laboratory is enabled not only to meet more easily the continued increasing demands for serological testa, but also to render a better service to the physicians.

:Biologicals

Manufacture and Distribution of Antirabic Treatments:

Human Deaths from Rabies

Year

Human

Animal

Total

During or After Treatment

1933 2,335

178

2,424

1

1934

2,9~5

173

3,128

1935 3,2 6

36

3,282

2

1936 3,027

3,027

3

1937 3,445

3,445

3

Typhoid Vaccine Distributed:

1933 - - 1934 - - 193519361937-

438,583 cc. 700,000 oc. 594,762 cc. 426,342 cc. 458,452 co.

Diphtheria Antitoxin: Beginning by legislative enactment in 1909,
the Department of Public Health began distributing diphtheria antitoxin for use of indigent p~tients only. At that time, and for many years
thereafter, the incidence of diphtheria was so high that the cost of antitoxin consumed a large part of the very meager appropriation available
for all health work. Even in 1933 the coat of distribution amounted to over $5,000,00. In 1933 the operating budget was reduced to such an ex-
tent that it was no longer possible to furnish free antitoxin, However,
its distribution continued at Department of Health prices.
In 1937 the appropriations for health were greatly increased and
in September by request of the Governor the Ires distribution of anti-
toxin was resumed, not only.for indigents, but for all residents of the State who required it, regardless of economic status, Strange to say, this new free to allpolicy will probably cost the state only a few thousand dollars annually. Diphtheria during the last few years has declined so greatly in incidence that the demand for antitoxin will not be great.

Diphtheria Antitoxin Units Distributed:

1933 - - - 1934 - - 1935 1936 1937

36,257,000 12,661,000 8,478,000 6,072,000 15,928,000

Free Diphtheria Toxoid: Another important product of the increased appropriation is the'free distribution of diphtheria toxoid. However,

58

LABORATORIES

this is limited to children under six years of age. The purpose of this
limitation is to stimulate immunization of children before and durir~
their years of greatest suscept1Cil1ty. There we1e 47,320 iiiJIIIUnizationa wi tl: diphtheria toxoid supplied in 1937, as cor,,pared with 17,555 for the
preceding year.
Free Sctick test toxir, has also been aun.lied,

Toxin-Antitoxi~:

Amount Distri~uted

1933 -- - - -

10,212 cc.

1934 - - - - - - - - - 6,453 cc.

1935 - - - - - - - - - 660 cc.

- - 1936
1937

--

--

-

--

-

-

-

-

213 cc. 103 cc.

Toxoid (Plain) :

Amount Distributed

1933 - - - - - - - - - 43,866 cc. 1934 - - - - - - - - - 31,468 cc. 1935 - - -- - -- -- 5.995 cc. 1936 - - - - - - - - - 1,240 cc. 1937 - - - - - - - - - 2,036 cc.

Alum Precipitated Toxoid: Amount Distributed

1934 - - - - - - - - - 15,462 cc. 1935 - - - -- -- - - 22,505 cc. 1936 - - - - - - - - - 16,935 cc. 1937 - - - - - - - - - 46,302 cc.

Schick Material:

Amount Distributed

1933 - - - - - - - - - 12,930 cc.

1934 - - - - - - - - - 12,560 co.

1935--------- 7,520 cc.

1936 - - - - -

8,530 co.

1937 - - - - - - - - - 14,077 cc.

Smallpox Vaccine Pointe: Amount Distributed

1933 - - - - - - - - - 30,695

1934 - - - - - - - - - 28,844

1935 - - - - - - - - - 15,823

1936

- - - - - -13,132

1937 -- - - - - - - - 18,117

LABORATORIES

59

Sirver Nitrate Ampules! Amount Distributed

1933 - - - - - - - - - 45,847

1934 .. - - -- - - -- 53,807

1935 - - - - - - - - - 55,853

19~6 - - -

- - - 49,328

19)7 - - - - - - - - - 39,203

Tetanus Anti t.2.!1!l_U_J_!fu: Amount Distributed

1g~~ - - - - - - - - - 21,819,000

19~4 - - - - ..

5,237,000

19~5

- - - - - 1,616,520

193t

- - - - - 1,448,800

1937 - - - - - - - 460,600

Carbon T~-~_!!.chl_?_rj.j.~p_u._ of Chanopodi \liD IUxture: Amouut Distributed

1933 - - - - - - - - - 18,893 co. 1934 - - - - - - - - - 24,487 co. 1935 - - - - - - - - - 19,068 cc. 1936 - - - - - - - - - 19,268 co. 1937 - - - - - - - - - 29,430 co.
Tuberculin Testa: Amount Distributed

1933 - - - - - - - - - 14,097 1934 - - - - - - - - - 25,001 1935--- - - - - -- 27,139 1936 - - - - - - - - - 66,262 1937--------- 10,728

Tuberculin - Purified Protein Derivative: Amount Distributed
1934- - - - - - - - - 3,900 1935 - - - - - - - - - 2,573 1936 - - - - - - - - - 4,420 1937 - - - - - - - - - 1,115

Miscellaneous 1

Amount Distributed

Antimaningococcus Serum - -

30 cc.

Distilled Water - - - - - -174,000 cc,

~ismuth Subsalicylate - - - 5,492 cc.

Arsenicals - - - - - - - - 86,273 ampulea

Yeast - - - - - - - - - - - 20,373 pounda

LABODATORIES

6o

Rabies :Research

In the fall of 1936 the Rockefeller Foundation established a rabies research laboratory at Montgomery, Alabama, Early in 1937, the Fo,md.a-
tion solicited tho collaboration of the Georgia. Department of Public Health in furnishing materials and statistics,
The first worth vhtle product of this research was the development of a mouse inoculation teat for confirming microscopic di~oeis, It
wan found tha.t a certain strain of whl ta mo',lBB was extremely auscapti bla to rabies, having an incubation period of about eight <iaya,
ldice were inoculated with 1,032 specimens received from different
laboratories, including the Georgia State laboratories, Of these, 333 had bean reported microscopically positive by these laboratories, 690
negati vs, and 4 questionabls. Of the 338 reported posl ti va for Negri bodies, 3 proved to be 'lagattve on mouse inoculation. Of tha 690 negatives, 83 (12.1 par cant) proved to be poaitive by tha mouse teat. The
value of the tost as a Jheck on microscopically nag!itlva apoclmena thua
bac!Uila evident: ao in July, 1937 it was instlt~ted aa a routine proce-
dure in this diviaion' 9 laboatories. Since that time th3 mouse test
haa bean applied to 284 microscopically negative brains, of which 33, or 11.6 par cant, have proved poaithe,
This divhion breeds !lll of tha mice need in ita laboratory.
In addition to the confirmatory ~ork, many interestlD~ end inform1\tlve experiments with rablaa virus ha.va bean made, While the raaoarch phase of the .,ork has j1.1at begun. it is Daliavad that throJgh coopera-
tion vith the Rockefeller Foundation rabies research bborat017 much
naw and valuable informatlon will be gained, which lti 11 ult l.nntaly had to mo.-a afflclant prophy.l.a.dil in ma.n a.nd control of rablaa ln aniw,ala.

DIVISION 0]' MATERNAL AND CITILD ITYGIEh'E

The year 1937 has seen gratifying expa.neion of a.ll maternal and
child health activities. The organizing of new local health departments, and enlarging of the field staff by the addition of an obstetrician and a pediatrician, has likewise le.id. the foundation for lltill greater progress in educational and field services for the future, The
activities report for 1937 represents work in an expanding field.

Field Activities of Staff

Consultations and clinical services

Interviews and conferences, total

Papers and ad.dresses, total attendBIJ.ce
Physicians PD.bli c Health Pex so nne l
~-

373 666 1,800

77 1,075
2,839

Comment on Ratee

For the first tiroe both infant and maternal mortality !limultaneously show sharp declines,
Maternal Mortali ~: Puerperal d.ea.th rate of 7.4 shove a decrease of 7.5 per -cent fromtho 1936 rate of 8.0. The current death rat6 approaches the previous lowest point, 7,2, eetablished in 1935.

Stillbirtha: The 1937 rate of 58.2 represents a docrealls of 2,2 per cent .frOlll the 1936 Tt.t& Of 595

Infant Mortalitl: Infant death rs.te of 62.8 shove e d.ecreaee of )0,4 per cent from the 1936 rate, whlcr' ~me 70.1. 'llte 193i rate for infant deaths represents a new low for Georgia.

Maternal and Infant Henlth Centers

It r.ae been possible for the firet tlme to make definlte conoerte<l effort toward eetc.bJ ithing new health centere, ann extendin& t.he eenicce thereof to parts of tho eto.te previ ousl.> lackinc tbi s set'Vi ce. Centere hcve been started in rooro ne~r countie dcning the year tha11 were starte-d
in an previous yearecon:binc)d:-' Colintiev wltl1 materncl heaith cer.teu,
hn.'\"ebccn moro tbnn trij):iCd;and those \\i tb infei:lt eenten t.ave mon Uam doubled, as is indicat&d by the fuHowing compcro.tive fig\lre.s:

Ae of

Countl es ~:l th Mat.crn&l Ccl.ten:;

Countie!l lt'lth Jnfant CentE-rL

Jan. l, 1937

12

10

Jan. 1, 1938

37

2(,

All of the oountler witb infent heaJtl> ccntcrro have hcL}th depn.rt,-
rr,cnt. Of the cc.uJ,ucs witb matc.Inal Lcr,ltL cei.tcr, 5 ale ~;.nc.rg<:.nis;c0.,

61

li.ATERNAL AND CHILD HYGIENE
and the work is done gratis by private p~vsicians assisted by county nurse or the district itinerant nurse.
In addition to the 37 counties with prenatal clinics, there are 9
counties with health departments rendering services to expectant mothers by small itinerant health conferences or individual services in the office. Thus a modicum of continuing prenatal observation by phy-
sicians exists in 46 counties. The number of expectant mothers receiving prenatal service increased by gg per cent during 1937.
Free Distribution of Diphtheria Toxoid
During March it became possible to make alum precipitated toxoid available free of charge for immunization of children under the age of
six. By the close of the year 47,320 doses h&ve been distributed on
this basis.
Midvives
Midvife instruction and certification vas accomplished in each of
the state's 159 counties during the year. With a fev exceptions t.\ois
entailed a class each month in ever; county. The number of midwives
certified vas 3,171.
Special Activities
Publications: The mailing list of "Georgia's Health" (monthly)
has increased to over 12,000. A nev issue of 50,000 copies of the Georgia Eaby Book vas printed
and distributed. A new booklet of prenatal advice with illustrations was completed
and vill be printed immediately. A compend on ~~ternal care was purchased from the University o:
Chicago Press for free distribution to ~!orgia physicians ~~d seni0r medical students.
A study of maternal deaths in Georgia for 1935. as reported by the committee of the Medical Association of Georgia was reprinted and 3,000
copies distributed.
Educational Programs: Staff members have participated in the following meetings, assemblies, and educational procra:ns: several conferences at the Children's Bureau, including a paper on the projected maternal health demonstration in Tift County; Institute of Public Affairs, University of Georgia; Negro Health Week; Georgia Social Hygiene Council; Institute for Home Demonstration Agents, University of Georgia; Health Forum in Rabun Co~ty, and others. A successful May Day program w~s carried out, which has been reported upon separately.
Cooperation vith other Agencies: The division assisted in organization of a program vith the Georgia Child Health and Welfare Council
looking tovard developing special emphasis on their activities in 12
counties. Assistance was given the Women's AuxiliarY of the Medical Association of Georgia in preparing and distributing literature on better care for mothers. The staff has cooperated with the Medical Association of Georgia through its several committees, including the annual study of maternal mortality. A pediatrician was sup,plied to the 4-!I Clubs for examination, at several strategic points in the state, of their applicants for health awards.

MATERNAL AND CHILD HYGIKNE
Demonstrations
A child health program, with emphasis on nutrition, wns started
during 1936. Glascock and Hancock counties were selected because of
apparent nutritional problems, interest manifested by local people, and the fact tl:e t this strictly rural community was fairly t;rpi cal of other sections of Georgia with respect to agriculture and nutritional status of the people.
During the year careful consideration was given to the establishment of a demonstration in maternal health in a typical ~Jral Georgia community. Tift County was selected because it is fairly typical; there are good interconnecting roads, there is a high birth rate, a high maternal, infant and stillbirth mortality, and a high percentage of midwife deliveries.
Bi-count Demonstration in Child Health and Nutrition: Opera-
tions began in July, 193 , with a medical director, engineer, clerk, 4 white and one negro nurse, and a pediatrician for the school term.
Very important and an integral part of the program is cooperative service from the extension division, College of Agriculture, University of Georgia; the Georgia Experiment Station; and the Georgia Department of Education. Farm and Home Demonstration Agents, vocational education teachers, soil conservationists and various experts of the extension division are actively participating. Staff conferences are held monthly and representatives of the various cooperating agencies attend and contribute to nlanning the program.
Satisfactory progress is being made, and it is believed that final results vill be of definite value, not only to the community, but by contributing knowledge applicable elsewhere in the state.
Maternal Health Demonstration: Principal activities are clinics for pre-and-postnatal oases; supervision of midwives; assistance and collaboration to physicians by postpartum care and care of the newborn, by home nursing visits and nursing delivery service; well baby clinics; and a program of 1~ education.
The demonstration adds to the 4-piece health unit: an obstetrician; tvo obstetrical nurses; and a third nurse to be added as the case load increases. The staff is trained in public health work and
in obstetrics. Full operations began December 15, 1937. Nursing de-
livery service functioned during the last six weeks of the year, rendering home delivery service to physicians in 30 cases.

DIVISION OF PUBLIC HEALTH NURSING

The year 1937 marks a very substantial growth in the public health nursing service in Georgia. During the year new nursing services were established in 24 counties, 12 of which were organized counties and 12 unorganized. Three organized counties added an additional nurse, namely, Thomas, Sumter and Floyd. making a total gain of 27 nurses during the year.
Field Services

The 18 state advisory nurses and the 9 district tuberculosis nurses

have continued to render service to counties without nurses. These

nurses have concentratedon midwife supervision, tuberculosis control

and immunization against communicable disease. An account of the ser-

vice rendered by nurses in unorganized counties is given in a statisti-

cal report which is appended.

At the close of the year the permanent public health nursing staff

at work in Georgia was as follo~rs:

Statewide Service:

Central Office

2

District Advisory Nurses

18

District Tuberculosis Nurses 9
County Service:

Organized Counties

120

Unorganized Counties

_gQ

Total

Trainees

During the year training was given to 39 nurses, 37 of whom were white and two colored. Thirty-one of these students attended George Peabody College for Teachers; two Teachers' College, Columbia University; four University of Pennsylvania and two ~!edical College of Virginia. These trainees have all been able to meet the entrance requirements of the colleges they attended. Ten had done college work before entering a school of nursi~; three of the group had received their Bachelor's Degree; five had completed two years of college and two completed one year of college work. Georgia is fortunate in having at the present time a sufficient number of well qualified nurses to meet the demand in the public health field.
Without exception the public health nurses of the State have continued to carry their programs with a high degree of efficiency which will undoubtedly be reflected in better health for the people of Georgia.

Child Hygiene Service Maternity Service Antepartum Postpartum Health Supervision Infant Preschool School Crippled Children Midwives Total

Cases
827 447
.35 1,212
526 141
3,888

Visits
2,05~
87
2,286 2,972
830
1,~
10,796

65

66

NURSING

Group Activities Midwife classes taught Attendance Class Room health talka Attendance Health talks (adult) Attendance

1,062
6, 720
543
11,306 46
1,091

i'uherculoeil

Pos.

Number patient. 4,661

Field visits made 5.949

Office visi ta

317

Sus.
4,514 5.268
5411

Contacts Unclassified Total

23,471

6,481 39,127

12,981

829 25,027

769

239

1, 869

Admission to Sanatorium

72

Tuberculin teata completed 4,092

Health talka

175

Attendance

698

Co.municable Disease
c
Jield naitl
Venereal Die....
ea
Jield visits

2, 724 6,344
295 763

I-.unization
s-npox
Typhoid rever Diphtheria

7.324 6o,s44 14,955

Korbidi t7
a..
lield viei ts

Other Activities Conferences with Physicians or Dentists Personal conference with others Newspaper articlea Bulletins diatributed Niacellaneous talk .Utendance

4,567 11,607
1,163
17,445 98
l, 7!4

DIVISION OF SANI~ ENGIWIERISG
In order to render more adequate sanitary engineering service, the State is divided into three divisions, each under supervision of a division engineer. These divisions are fairly equal in population and area and are designated as follows% North Division, Southeast Division, and Southwest Division. Therefore, portions of this report show certain classified services rendered by the three divisions separately. This provision has been of rather gradual establishment giving due consideration to the individual counties involved, nature of problems and adaptabili~ of personnel as well as facilities for permanen\ headquarters. This division plan is nov operating with satisfaction.
Yater Yorks and Sewerage
The administrative responsibilities in connection with the service of water supplies and sewerage may be briefly outlined in the following manner. This service is of such nature as to bring into being the necessity of relations with other states. This applies particularly in the matter of interstate streams from which public water supplies are taken and into which is discharged sewage from municipalities and industrial plants. There is also the necessi~ of close cooperation with several Jederal departments, commissions and administrations as well as other state departments whose interest touch those of this division. There is also the closeat relationship between this d4.vision and the municipal and manufacturing corporations within the State which maintain and operate either or both drinking water suppliea and aewerage systems. The basic policiea and long range plana are mattera of constant review and stw!7 to check their effectiveneaa under changing demand& and technical progresa. It is also necessary that the division remain alwaTS in a position and be adequately equipped to take over responsible charge of local situations in periods of disaster or cataatrophe where the public water supply is involved.
This division technically reviews and approve& all engineering plans and specifications for water and sewage treatment plants. lrequent consultations are held with professional engineers and manufacturing representatives on propoaed new procesaes and new developments in water purification and sewage treatment equipment. The results of bacteriological examinations of water aamplea in the laboratory of this diviaion are interpreted and made use of in formulating recommendations for necessar,y improvement to assure the safety of individual municipal water suppliea.
Instruction is rendered by having a representative of the division remain at all new water purification plants until the operator in responsible charge is thoroughly familiar with his duties in producing safe water. The reports of plant operation submitted to this division are carefully reviewed and as frequently as possible follow-up visits are made for further instruction and advice to local operating personnel. Group instruction is given once each year in Atlanta to representatives of the towns who assemble for this period of instruction.
During 1937, plans and specifications for 16 water works and 9
sewerage projects were reviewed and approved. All projects in the following liata have been approved.
67

68

SANITARY ENGINEERIEG

New Water Works in Following TOwns

Completed:

Under Constructioq

Ball Ground Crawfordville Davieboro Gordon Grq Hulilton Pine Mountain Recreational Park Screven Warwick

Cumming Demorest Bahunta Oliver Portal
Rutled&e Senoia "'in CiQ"

Additions to Existing Vater Supplies

UDder Oonstruotiom

.Ub&r!l' Bremen Buena Vista CollSf:e Park Marshallville
MonteZU~~a
Newnan Savannah
TUbise Chatillon Oorportion, Rome

.Atlanta
J.ug\UIU. Meigs i'homson

Jrev Sterilizing Equipment on lxisting Water &applies in Jolloving !evne a

Barwick Camilla Colquitt Columbus Dalton Darlington School, Rome Jackson

McRae Monticello N- Holland Pavo Tifton Warm Springs

l!Tew Severe S)-steu in the lollowi:ng ToVDII

Complete6

Under Construotiom

Chatsworth Dou.glaavi lle Jasper Reid avilla

OummiDg Harlem Villa Rioa

Sewage Treatment Plants on l:xisting Sever Systems

Cedartovn Glennville Marietta

B.UII'URY ENGINEERING

69

Atlanta Metropolitan Sewerage System: During 1937 work haa been
continued 1n constructing interceptor sewers to serve the City of Atlanta, adJacent municipalities and unincorporated sections of lulton and DeKalb Countiea. Theae interceptor aewera are being built jointlT by the City of Atlanta, Julton County, and the Yorke Progresa Adminietration.
J'our 18lf8e treatment plantl have been constructed to treat the -age collected by theee interceptor

Stream Pollution Studie11 A preliminary etudy of a eeotion of the
Chattooga RiTer wa1 made during 1937 by the diTieion. A IDOre complete
etream atu.dy and induetrial wah surTey of Chattanoop Creek was made by this division in conjunction with the Tenneeeee State Board of Health and the Tanneesee Valley Authority. Both the Chattooga RiTer and
Chattanooga Creek are interstate etreame. The stream pollution etudiea will be extended to other creeks and rivera receiving excesliT8 sewage
and induetrial waete diaoharge. The basic sanitary engineering data secured from etudiea of thil uture proTide essential information for
planning programs of improvement affecting large groups of urban end rural population.

Certification of Yater Suppliea for Interstate Carrier Use: All inveetigations, studies, recommendations, and inspections regarding improvements to public, semi-public, and private water supplies uaed tor drinking and culinary purposes on interetate railV&T trains, vessels and
airplanes were made by the divieion for the United State Public Health
Service. Certification action was taken on 47 supplies in 1937 Ot this number, 39 received faTOrable and 6 provieional certification. TVo
supplies were prohibited from suppl71Dc water to 1nteretate carriere un-
til recommended correotiona are made.

Yater and S!!!8 Plant Operator' School: !he sixth annual water
and sewage plant operators school conducted by the division of sanitary engineering in cooperation with the Georgia Water Works and S~e Plant
Operators' Association and the Biology Department, Georgia School of
Technology, was held in Atlanta. The total attendance at this four-dq course of instruction was 205, over 85 per cent of the aan being operators ot water or sewage plants in Georgia municipalities or industrial villagee. ~aaed on written examinations, the Georgia Yater Yorks and Sewage Plant
Operator' Aaeociation issued 41 certificates in the following claaaifi-
cational 5 Cla.. A, 15 Claaa B, and 21 Claaa C.

70

SANITARY ENGINEERING

Recapitulation of Public Water Supplies to December 31, 1937

Number

Population
(1930 Census)

Percentage Population Using Public Suppliu

Percentage Total State Population

Supplies receivl~ both filtration and chlorination (including softening plants) 80

739. 500

25.5

Deep wells, shallow wells

and springs chlorinated 82

290,000

10.0

Deep wells, shallow wells and springs not
chlorinated lll
333
Water from home wells and springe in rural areas and villages without public water s1.1ppliea ........
Total for State

154,000 1,183.500
1, 719,000
2,902,500

100.0

_5_.1
4o.8

Water Laboratory

During the yea:r 1937, the water laboratory handled a total of
10,26o samples, which is the greateat number ever received by this lab-
oratory in one year. The following table shows the diatribution of
theee samplee:

Bacteriological aamplea froa public and eemi-public
wa.ter sllpplie ...................... 9.787

Bacteriological aamplee froa private water auppliea Bacteriological aamplea from .wimming poole . Chemical ..a~J)l" ............. Miacellaneoua .......................

302
106
54
__!!

10,26o

Prom the ahoft it is eeen that the greater portion of the work det.cl of the bacteriological examination of 111111ples from public and s..t-public water 11upplies. An effort baa been made to secure samplea at 110nthq intervale from all such supplies. However, due to the inability of the division personnel to cover all towns in the State at suCh frequent intervale it has been necessary for local representative to collect and t~it samples to the laboratory,
In some cases local representatives have submitted samples at
irr.gular intervale and 32 public supplies failed to submit any Pamplsa
for the yee:r. On the other haDd, dur!~ 1937 samples were received
from 23 public supplies for the first ti-. Included in this number are all the uew muaicipal or rural euppliea completed in 1937

SANITARY ENGINEERING

71

The follmdng table sho'.<S the number of public supplies submitting ..-ples to the laboratory for the past four years:

Number submitting samples for:

1937 1936 1935 1934

10 or more months

229

198

202

198

6 through 9 months

37

1 through 5 months ~

26
_.a

14 28

17 22

Total

311

277

244

237

Cumulative bacteriological records of 303 of these supplies were kept for the year and are grouped as follows:

Number of

Supplies

All samples fo~ the year negative

for B. Coli 88 0.1 to 10.0 per cent of all 10 c.~.

portions positive for B. Coli

~

Total supplies meeting U. s.
Treasury Dept. Standards 246

Per Cent of Supplies
81.1

Supplies with more than 10 per cent of all 10 c.c. portions positive
for!. Coli 57

Community Sanitation

In this portion of the report it is d.esired to emphasize the term COIIIIIIUDit7 B81litaUcm as this activity is more applicable to community
t~ to moD!cipeli~. It is not the purpose of this division to promote conatructiaa ot Mnitar7 priYiH in ll!l.l.llicipalities wherever there is a possibili~ ot promotion of initial sewers or extension of sewers. ProYision tor aewers and sewer connections wherever public water is supplied is allii!IIYa considered foremost in prc.otion work. Also, it is not ths purpose to promote provision for priYate residence septic tanks, financed 1J.r propert;y owners, as an adjunct to a public water service thereb,r jeo~zing possibilities of the simultaneous projection or extensioa of both water and sewer mains by public financing. There are, howeYer, ~ sections in municipalities and environs where, in order to meet an emerpney public health hazard, 1t is necessary to construct sanitar,y privies as a temporar,y measure. There are other sections of
lllllllicipali tiH where proper1;T values are low and where there are no prospects of providing public water service, plumbing and sewage di&-
posal. ~ comprise localities which represent the greatest problt!lll in public health. It is recognized that such localities, especially suburban areas and rural communities, comprise the gxeateet need for this type or sanitation.
The program or construction of sanitary privies and septic tanks
went fon.rd with undiminished moemnt1.1111 during 1937. The number of
s1111itU7 privies constructed for the year - s 10,177 compared with 9,969 the pre'rlou.s year. This record is especially eatisfactoey considar1Dg the great reduction or W.P.A. labor. The total number of

72

SANI~Y ENGINEEa!NG

unitary priviea conatructed during the past few years with the use of relief labor is 41,226. .An attempt has been made to increase the value and permanency of construction by an annual increase of the percentage of concrete priviea. Percentages of wood and concrete privies in the three divisiona of the atate since the beginning of the program will be noted in a sUIIIIIIEI.r,Y following the tabulation of sanitary privies.
There has been a concerted effort to forward the promotion of aanitary privy construction by the use of county convicts. An effort has been made to eatabliah this routine so that aa relief labor diminishes there will be eatabliahed another plan for furnishing labor for this type of aanitation. To date, there are approximately fourteen counties which have aet up privy building planta at county convict camps. The cooperation received from county commissioner is gratifying. Promotion of the use of convicts for sanitation and malaria drainage will be continued as rapidly as possible and it ia anticipated that in the future reliance lll8l' be placed to a great extent upon convict labor for maintenance of sanitation and drainage.
The rural problem in this state is one of the moat serious. The
rate of hookvorn infeatation in the rural population represents one of the moat serioua of public health problema. Concerted effort is being made to provide aanitary priviea in the rural homea throughout those areaa of greateat hookworm infeatation.
The death rate from typhoid in 1921 was 27 .5. At the end of 1937,
the d-th rate haa been reduced to 4.!J. the lowest typhoid death rate
ever indicated for the State. The decreasing ~rend is particularly noticeable over the last six year period.

Home and School Sewage Disposal Plantaa During the year there was a total of 701 hoJDes and sewage disposal plants installed under the auperviaion of the diviaion of sanitary engineering. These figurea do not include a large DWilber of plants installed by home owners who obtained copies of plans and specification& from the office.
In addition to these, plans and specifications were furnished governmental agenois such as Resettlement Administration, Federal Housing !dminiatration, eD4 othera.
fhere ia considerable increaae in demand by the public for this type of sanitation. It is impoasible, of course, for the personnel of this division to supervise construction of all home sewage disposal planta which are the result of securing plana and specifications through the mail and by office distribution.

Other School Sanitation& During the year, the division of sanitary

engineering ha.a worked in close coordination with the State Department

of Education by improving the sanitary conditions at achools. It is the

ultimate objective to provide every school in the State with safe drink-

ing water and aanitary facilities for the teachers and the pupils.

Su!Dmarza

Borth Southeast Southwest Totals for

Ga. Georgia Georda

State

Drinking fountains in-

atalled or improved

4

lJ

6

23

Vater supplies t.proved 26

26

27

79

Septic taDks installed Septic tanka repaired

~

4
3

2 5

11 12

JJew pit privies installed 70

349

120

539

Pit priviea repaired

6

19

52

77

Vater examined Urinals

51

0

0

46

~

SA5ITAJ3.Y ESGINEERING

73

Total new privy unl.ts for the State by divisions, and with range of per cent c.ncrete slabs annu:-lly over the five-year period, 1933-1937:
North Ga. S.E. Gn. s.w. Ga. Total for State

% 1933-Total Units Concrete
% 1934-Total Units Concrete 1935-Total Units
'f;, Core rete
% 1936-Total Units Concrete
% 1937-Total Units Concreto

o55.o0

159
o.o

661
o.o

4,946

2,577

7,020

8.4 3,186

12.4 3.50

2.4 3.471

1'3.0
2,ssa

25.2 4,646

17.3 2.337

67.

11.1

63.1

3,167

4,909

2,101

~1<_._2._______l._Q_~_ _ _153

1,370 o.o
14,543 6.<!
10,461
20.7 9.565
4o.o
10,177 6o.o

Total Unite 14,734

C,:, Concrete

38.3

16,095 23.7

15.590 27.2

46,419 29.6

Pri_~.A~~r-~: To tal

New Wood

North Ga.
s.E . Ga.
S.11i. Ga.

Di viGion a167

482

_ _2..909

3.495

1 0 1_ _ _ _ _ __9~.

New Concrete
2,ssa
1,41 _J,004

Repain1
24o
1,598 4o6

Total for State

10,177

4,074

6,103

2,244

Sani_t_Q:lJ'.~!.:l:.'C~s. Mans. __and ReYJorts:_ Realizing that nothing of e. constructive nature can satisfactorily procee1 without systematic planning, urban and rural mP.:ps arc being prepared together with complete sanitation reports. StmJ.rlard specifications for such lllc'"\!)S have been adopted ani\ maps a.ncl reports are now in the course of preoaration. Realizing an obligation to those counties adopting local count;~ health work, preference is bei.ng ,~iven to towna, cities and conrnunlties within orgv.nhed counties, The
urban nJ.Oc' s show each residence ~1i thin the town, and. whether such home is
,:Jrodd.ed \oli th sanitation facilities. Water mdns, sewer mains, septic
t::ml:s, private wells and privies are included. The rural ma;s show the prirn..<J.ry ru1d secondary rends ru1d. each home inJ lea ted by a nwnber on the map ~>h l.ch conesponds to a card inrlex in the. honl th office showing the n:unes of the occu11ants. Alsc the maps indicate places of m;,laria moscpi to prod,lction, 1\'hereaa these mFcps are pri!lk'1rily for the division of sanitary eiV~ineerinc; they may be used by the health officer or the nurse for any pt.trpose desired. These m::cps are particularly sui table for epidemiologiC3.l investication~ to be fol1o1;ed by corrective measures. The rural maps ~"'"'v0 proved most V!'-luable in connection with hook\rorm and malaria investi-
gation~.
'I'bo maps have a.lso proven valuable to cities by providiDE them with detai 1 information co:n~err..ing the act,J.al existing conditions, a..11d in al:ncst every town ~<here. there are needed. irrmrove.nents, the cities coonerated
with this depark:ent by improving the sanl to..ry cond itionn, such as ~xtend
ing water mains, makinc; illl;roveL1ents to water plants, constructing s=itary privies wlH~re topographical conditions were unfavorable to sewer lines. With ever'y city mc;? prepared there i.s also a detail report prusented with the map, iescribl.IJ6 the condition~ fully, also practical recommendations by thl.s division which will mal:e tr,e city a cleaner, hc1alth1cr place in which to live.

SANITARY ENGINEERING

Summa.ry:

City sanitary survey maps and narrative reporta 31

City sa.ni tary survey mapa

14

District sanitary survey 1118pa

25

Sanitary survey maps of entire county

2

Malaria control maps

14

Mapa of counties showing houses,roads and streams~

Total maps completed

93

Ma.la.ria Control

Principal functions in malaria control may be divided into two classes: those directed toward preventing the creation of new malaria mosquito breeding places by man's activities, and those directed toward the suppression or elimination of existing malaria mosquito breeding places, both natural and man-:~~ade.
Preventive activities are largely of an educational and consultative character. They include efforts toward educating and guiding city and county governments, state highway forces, corporations, private individuals, park departments and various sub-divisions of the Federal government in methods of highway construction, ponds and lake and artesian well development, etc., which will serve to prevent the creation of public health menaces causing illness and death to Georgia citizens. This service includes limited detail engineering consultation on individual construction projects and also takes expression in the administration of the 1D>ounded water regulations of the State Health Department by the engi~eering division.
As these activities serve to prevent more malaria than is alread7 cansed by existing malaria-mosquito breeding places, results achieved can be expressed neither in terms of malaria reduction nor by any other yardstick; for it is impossible to estimate the volume of additional malaria which would have been transmitted bad it not been for these efforts, The problem of man-maae malaria mosquito breeding places is one of magnitude in the Georgia malaria picture, and preventive activities in this field are equal in imoortance to that of the control of existing breeding areas.
Malaria control by drainage and filling is the most axtensiTB method used in the field of suppression and elimination of malaria mosquito breediJ:l places. The volume of this work shows sharp reduction by co.parison with the previous year, 1936, as a result of marked eurtaillllent in the nWJiler of 1f.P. J.. laborers assigned to .malaria drainage projects. Emplo;rment on 4nJ:oage in 1937 totals approxi-.tely .two million man-houra as co~~pared w1 th three million man-hours in 1936.
ln _co~t~oa tor this reduction in Tolume0 there has been great . illlpl'QWblent 411 ethel' factors. The quality and qliantity of malal'lological
and e*tiD&el'~ planning and supervision of op~tiou li,- state and county
hea.l th departlll8nt personnel has increased from a negligible a11101mt to a degree ai~&t ~~llate to furnish skeleton control over operatiO'.U, as a reslU.t.ef.p~.-.pansion. The Yolume of. dre.i.up III!UnteMII.~:e by local ~t ui.e of maehine17 for drainage construction and ths
number p.f." eDUnty govel'nlllents co!ldueting organizttd ~ia co!fl'ol prograiia
fina.xiaed, byJDil.lage tax have all shown marked increaae. For adlliintatra\1..-e purposea, malaria control and JDOst other oper..-
tions of tbe. san!~ engineering division are divided into three 8reaa
or field diTisio~a. comprising North, Southeast and Southwest Georgia. As in previous years, the great bulk of ma.laria draina.ge operations in 1937 has been concentrated in the Southeastern division, which accounted

SANI~Y ENGINEERING

75

for 70 per cent of the total drainage work in the State. On a basis of man hours of labor employed, work carried on in thf. Southwestern dl \"! ., 1rvn vas three and one-half times that in the North Georgia division. while Southeastern Georgia work activities vere ten times those in North Georgia. Consolidating the comparison, South Georgia drainage activitie~ vere thirteen and one-half times those in North Georgia. This proportion is in accord vith good planning, for malaria is not only still predominantly a South Georgia disease, but it is also more amenable to relatively inexpensive minor drainage methods in South Georgia.
A tabulation follows below, detailing drainage operations by divisions.

Number Man Hours Ditch Ponds Pond

Cost of the

Division Counties Employment Footage Drained Acreage Work

S.E. Ga.
s.w. Ga.

30 24

North Ga.

10

State Total 64

1,~9,137
7.192 141,007
2,023,694

2,495. 533 201,803 156,045
2, 853.381

747 171
96 1014

3.311 1,058
l, 738 6,107

$45~,273 11 '910
38.500
$596,683

The actual value of vork carried on is considerably greater than the
above estimate of $6oo,ooo. This is also true of other figures quoted,
both in the table above and in the subsequent list of work detailed by individual counties. Many counties and municipalities do not keep complate cost records of vork undertaken, Furthermore, these tables, covering only labor employed on drainage do not include expenditures of considerable aggregate amount made by local governments and corporations for the larviciul control of malaria mosquito breeding, and for malaria control engineering and other malariological field service, nor do they include partially supervised drainage activities by farlilers and other private land ovners. The a&gregate expenditure for all classes of supervised malaria control is estimated in the vicinity of one million dollars.
The detailed promotion, planning and supervision of a program of this magnitude is a tremendous undertaking, as it not only involves the equivalent of resident engineering service on construction operations but also lengthy and time consuming malaria studies, educational vork and negotiations preceding the conduct of almost every unit of work, totaling over 1,000 individual ponds drained or filled, and a still larger number under larvicidal control.

Machiaa Drailll!f;al Special mention of counties undertaking malaria drainage by machine methods is warranted, in viev of the effectiveness with which certain types of mechanical equipment can be utilized on this class of work. Draglinas, ranging from 3/8 cubic yards to 1-1/4 cubic yards were operated in the following counties: Fulton, Cobb, Spalding, Chatham (2 machines), Sumter and Bryan County-Ford Farms (2 machines), a total of S drnglines.

Larvicidal Prbg:raml Small scal.e larvicidal programs, involving the use of either Paris green or oil for malaria mosquito control, are c~ried on in a score of ll!llilicipal and suburban areas in the. State.. These are in
addition to similar local pregrams involving oil application, primarily
for the control of nuisance mosqu1 toes. In the field of large scale operations, outstanding programs are
in operation by the Georgia Pover Company in the control of a number of major hydro-electric impounded areas, and by Dougherty County on a

SAI:I'I:A.RY ENGINEERING
cou,1ty-1,lde scale. EY.t('nsive l.Rrvicidal progrnr.w have also been autLorized or carried on in Ric~.wcr,c~. Sumter, Brooks and Terrell Counties.
2!R':!'.o1 zed~~.!;[ :.:,,laria Con_!rol__!:.Q2:llTIBI The outstnn<iinc devclop:~rl:lt of tl:e yC'ar was the establishment of orclUlized !Il[l}aria control pror:rnms ln r, number of count:es by the paBBlC of a county millat,:e tax or otr.er
cc':al:lichecl mcUods of m:propriation, Prior to 1937, onl;, one county in
Ur, entire State 1<'1'-S can-yill{ on an orgllllized I!Ullaria control progrrun with its own resources and. in conforruar,co with professional s tanclarda of malaria con '.ro l, nl tl:oUf:r. several were carryiDt: on a limited type of pror:rrun.

The DoucLerty County proc;ram, supported by milla~;e tax appropriation,
wes started ir. 1929 and has oncrnted continuously since then under the
dlrc'ction of 2 county !M.larl" con',rol encincer. The plan of operation invclve~ cysteo.atie hnnd labor drai!lll{:e cons+r-c:ction leadirt toward the ultimate permanent elirr.ir.a tion of the di seaoe, supnlemer,ted by a countyv.'ld.: procrc..m of maleria mosquito SU>lpressi<.n by the use of Paris green. 8pplied to breedin,c: areas weekly as larvicide.

Chatham Coun tv

On l:arch l, 1937, thiR county converted its program from one of r,en-

ere.l drdnage to one ,e:ivi!ll~ focalized attention to l!l[llari8 control. Thi~

is the larr,cet rro,crnm cf its kiml in tr.e Str,te, employi11t~ nn nvcr!le force of 55 cunvicts on drr.inB{;e oc,nlnt<nrJ1ce, wi tL two drr"'1lnes and sev-

eral hunclr<'d. W.P.A. laborers on ma.~or drr,ir.Pe rPconstnlcticn. The

f,

principal IJUrpose of this 1Jrcr:ram ic tl:e maintenance an'' vrecual rebuild-

in{: of ChatLam County's several tr.ousancl miles of drcinll{:e catwls, for

lllt,]pria control purposes.

The ;,:a:Caria control prc)r;rar:, in Rl chmond County is nricnrily on an
areu~1:ide basis arcund Au,c:usta nnrl sul>urbiU1 areas. It involves a col:lbi-
nction o: dndnnt::e constn:ction, mainten1mcc and Paris green larvicidal
:neact:res, A force of 15 convicts has been assi1:ned for du.inuge mainte-
Ncnce arc: sever2~ hundred W.F .A. workers are eniployed on draii18e con-
~truction, mucl. of it ma,jor in cheracter. l!nrked progress has been made
lr. tLe profescionLl plrumir~G and systematic orgnnization of malaria con-
trol cpcratior,s.

In the E'JYu:.er of 1937, Broo}:s County instituted a ;c r:nruHmt county-
"t:lde mBlari8. control program 11hich has nl.r,edy lJeen effective in ,::reatly r('cluoill[: malnria inc~dence, particularly in the vicinity of ({ui tm[lll, the county seat. A fcrce of county convicts is re[;ularly employed on drainD~e [lllC S'lpplerrentnry assistet:ce or. drail18:e conntructiou lf< also provided [,y W.P.A. forcca, The prcgram involves the s:rstematic drn.in~;e of Jr.nown mnlr;ria raosqul to breedirJ places as inriicated by oarPful malarionetric s turiy, ~u1vclemented by larvicidal and carrier treatment rro,-u,rns for ter::porary suppression ;~enriinr, extem;ion of completed drr"illil;";e.

SANITARY ENGINEERING

17

In Aurust 1937, this county passed a two ~ill tax for county-wide malaria control. A large portion of the 1937 levy has been devoted to the part payment of a dragline machine purcha~ed for malaria drainage construction, and for salaries and equipment needed by malariological personnel for malarlometric operations as a necessary introduction to a properly plrumed control program.
Hechine drainage cons true tion has b!len carried on, aided by con\'ict gang used for clearing right-of-way and fine grading. An area"""'ide larvicidal program was also undertaken during the malaria season.
Terrell Count~
In the fall of 1937, this county passed a l-1/3 mill tax, yieldings to be used on a gradual county-wide malar-ia control program begin~ing in 1938. Extansive malariometry was carried on in 1937, to permit the proper plalUling of future control operations.
Malariometric Surve~st One phase of malariometr~c progress was a smear and spleen survey of elementary school children in 14 health officer and two non-health officer comparison counties in the fall of 1937. The proper application of these data on county-wide malaria maps will make it possible for county and state health department officials to gain accurate information of malaria distribution within localized control areas in the county.
Malaria in 1~1 The medical profession and the laity both recog~iza malaria as a disease of cycles, with its good years and its bad or "epidemic" years. The year 1936 was an epidemic year with 606 deaths, while 1937 was a post-epidemic year with only 235 deaths, the lo~rest in the history of the State Health Department records.
Determination of the trend of the disease can be made crudely by comparison of deaths during previous peak el"n depression trocJE:hS of the c;rcle. It is gratifying to note that the trPnd indicated by such a comparison is definitely downward, for which control operations must be gi'ven their proper credit. Deaths in 1937 were lower than in any other minimum malaria year1 also, deaths in 1936, a peak epidemic year, were materially lower than in previous peak years.
Conclusion: Special reference is made to the outstanding promotional achievement and effort involved in obtaining an appropriation of $4,000 to $15,000 in rural counties for the conduct of an organized malaria control program.
Difficulty is often experienced in obtaining action by count-ies in supplying $4,ooo to $5,000 for the establishment of a county health department, even though the State Health Department offers dollar for dollar in matching, promotes county health departments on the argument that all preventable diseases will be reduced, including malaria: and all divisions of the State Health Department lend concentrated promotional aid to this program.
Malaria control programs on the other hand, although a basic part of public health work, are promoted without benefit of matching, involve larger local appropriations, are larsely promoted only by malaria control workers, and are promoted after tae local government has already made a substantial appropriation for general health service. Und.er such circumstances, rOI'id progress in establishing auch programs is not possible.

78

IWIITARY ENGINEERlllG

STATIWIDI IW.AlW. DBUIIA.CD: 19I

C0011TY

l4AN HOURS DI'IDH

LABOR

FOOTAGll:

NUMBER
~
DRAINED

PaiD ~

COST OF WORK

.A.ppliq Bacon Baker Banke BenH111 Berrien
Bibb
Brooka Bryan
Bulloch Burke
Calhoun Cand.l.er Chetbem Cherlton Clerke
Cle.T Clinch
Cobb
Cottee Cook Decatur
Dodge
Dooly Dougherty Echols EttiDghem Eftns Fulton Glascock Glynn
Greens Gwinnett
Ball
Barri Bart Irwin
:rett Davis :retterson
:Tenldns
Laurens X.e Liberty Lowndes IU.ller lfontgOIIIBey
Qnitman Richmond Schley Screven Seminole SpaldiDg Sumter Taylor Telfair Terrell Thomas Troup Twiggs WeshiDgton Wayne Worth

17,6G 7,214 4,618
25,846 1,513 1,852 149,454 4,432 2,632 8,089 34,513 13,438 9,512 671,035
!,2D8 2,814 28,060 1,902 23,789 15,221 5,559
510 24,402
4,972 16,124 2,469 11,010 4,788 U 1834 14,313
0 0
7,2~
30,938 3,940
11,252 20,747 14,291 19,203
2,677 2,661 10,978 8,197 5,330 3.231 451,347 10,985 20,498
8,552 137,365
6,464 4,336 2,993 6,050 1,168 170.241 9,885
7,622

43,060 21,555 7,200
210 3,175
700
50,731 7,993 83,826 17,609 14,858 3,500 17,417 1,845,155 8,800 9,240 2,200 9,000 28,450 1,000 15,118 3,700 5,495
2,000 0
10,720 16,406
3,550 66,778
4,125 12,000 11,790
0 500 800 11,747 1,550 13,710 14,300 19,835 11,800 900
6,750 10,450
8,626
5,300
1.920 241,731 15,711 26,402
0 154,220
!'1,200 900
3,362 1,328
0
55,121 10,299 13,835
5,608 15,430

16

172

13

254

6

16

2

22

2

10

0

0

49

196

3

32

13

118

4

21

10

36

4

6

3

4

461 1364

35

75

0

15

2

50

5

12

63

575

1

10

7

223

2

102

6

13

0

0

0

0

7

38

13

170

3

8

11

667

0

2

15

16

1

10

1

2

1

0

3

81

2

157

3

40

21

214

8

106

6

7

8

53

2

9

3

7

11

153

4

6

4

16

2

13

57

369

8

10.5

12

47

0

0

96

1,738

2

2

0

0

2

9

0

5

0

0

49

196.5

4

11

2

1

4

7

23

61.5

2,932.64 1,209.34
986.52 4,330.22
302.60 318.80 42,9213.44 726.44 4,698.00 1,282.44 6,869.22 2,436.20 1,683.71 278,508.22
10 Gl.79 551.16
5,512.93 322.05
4,557.21 3,220.47
968.92 102.80 3,070.50 897.10 3,115.60 589.28 2,678.00 784.10 9,357.70 2,828.36
0 0 835.00 6,411.82 670.00 1,895.10 4,277.17 3,178.06 4,279.95 493.28 502.59 2,474.35 1,431.20 1,323.41 561.51
115,600.18 1,879.13 4,573,84 1,458.20 27,905.43 931.30 1,079.80 506.64 1,043.28 170.40 42,974.57 1,6, 6.78
1,320.80

TOTAL

2,020,052 2,851,556

1,014

6,107,5

596,089.12

SANITARY ENGINEERING

79

T,yphus Fever Control

With endemic typhus fever increasing from 51 cases and ore death reported in 1929 to 817 cases and 42 deaths in 1936 and 1,092 cases and 54 deaths reported in 1937, it is evident that this disease has become one of
the major public health problems. Endemic typhus fever is principally confined to the southern half of
the State. However, a few cases are reported occasionally in the northern half of the State which is an indication ttAt this disease is gradually spreadi~ northward. and may be attributed to the present-day transportation facilities. It is well to mention that while typhus fever is considered an urban disease, many cases have been found to originate in rural areas, thereby increasing tr.e problem of control. However, the disease is contracted more often by individuals at the place of occupation rather than at the place of residence. Although typhus fever occurs throughout the year, the seasonal incidence has been established in ~orgia as greatest duriDg the months of July, August, and September.
There was started on August 1 of this year a statewide typhus fever control program involving the coordination of the divisions of epidemiology and sanitary eDgineering. In establishing this program a sanitary engineer was assigned specifically to the work, assisting municipal administrations and county and city health departments where personnel and necessary materials are provided. The plan of control is primarily educational whereby contacts with health departments, property owners, municipalities, and civic organizations are made. Following the educational program rat extermination work, employiDg the use of red squill as the killing agent, has been carried on for teq>orary relief in to1o"'lS and counties in which the incidence of typhus fever has warranted such measures.

Rodent Exterminations As of December 31, 1937, municipal rat
extermination programs have been well planned and executed, principally as demonstrations to determine the effectiveness of such campaigns in reducing the incidence of typhus, in the following cities and towns: Tifton, Sylvester, Ashburn, Bainbridge, Millen, Glenwood, and Waycross. In addition to rat extermination campaigns, tr.e workers r~e stressed the importance of general clean-up campaigns to municipalities as a preliminary measure in extermination work which also aids in the reduction of the rat population.
A municipal garba,ge ordinance was passed by the town of Alma and recommendations made for the improvement of this type of work for other cities and towns. Revision of the building regulations of the City of Waycross to include rat proof construction methods were also made and recommended by this division.
Due to the popularity of the program and demancl for service under county health departments and various municipal administrations, an additional sanitary engineer was assigned on December 1 to the statewide typhus fever control.program.

Typhus Control School: During the month of December, the United States Public Health Service, in cooperation with the Georgia Department of PUblic Health, conducted a typhus control school in Vacon0 in which rat proofing of buildings was studied by engineering personnel of this
division and representatives from health departments of other Southern states.

80

S.A.liiT.A.RY EHGI!EERING

Hat-Proofing: Inasmuch as rat proofing of new and {>:JCisting buildings is the only permanent solution to the control of endemic typhus fever and other plague-like diseases, this division at the close of the year established rat proofing of buildings as the major control measure with rat extermination as a supplementary control measure to relieve the immediate 3mergency. With the adoption of rat proofing as the permanent control measure, surveys of buildings are being conducted by personnel of this division as well as county sanitarians in order to determine the existence, character, and location of rat harborage and extent of ~-at infestA.tion. Reports of surveys along \-lith reco:n:JCnc;c.tLn for rat proofi!l,t; constr'.l.ctions are rruccde directly to property owners and tenants.

Mattre~s Sanitation
l~ork under the mattress sanitation law was begun on June 8, 1937, the law having been passed by the Georgia General Assembly o,n March 30, 1937, designating the State Department of Public Health as the authority
to enforce the law,
Survey work locating mattress manufacturers and renovators not
listed in "Davison's 1937 Mattress Directory" was carried on until July 12, ~~ing this time re~~lations covering the type of revenue stamp,
method of sterilization, and the method of labeling were drawn up. In deciding ~'on these regulations, the experience of other states operating under similar laws was used.
A standard tag, similar to the one used iu 17 other states and two
large cities, was chosen in order to minimize any conflict that might
occur between manufacturers in the State shipping bedding articles into o~~er states having bedding laws, and vice verga,
In setting up re~~lations governing sterili~atlcn, the two me~~ods of dry heat and live steam were selected as they were moat practical and moat adaptable to the situation existing in Georgia,
From July 12 until December 31, 1937, general inspection of those
plants previously contacted was carried on as they completed installation of sterilizing equipment. In those localities where full compliance was
made, an insyJection of furnl ture stores was completed after this compliance had been made.
The followi~ is a complete resume of activities: Through Dece~cer
31, 1937, all factories operating in the followin,; cities had fully com-
plied with the beddin,:; law - Atlanta, Athens, Aur,-lsta, Columbus, Dublin, Gainesvtlle, Griffin, Hartwell, l:.C"tcon, Rome, ancl Savannah.
A total of 155 mattress manu~aCt'.ll'ers and reno,;ators were located fror.1 Jun" P! to Dece;nber 31, 193"7. Of this number, 4 were transients and 46 haYa since gone out of budn,,gs.
Thro1Jh December 31, 1937, there were applications for 69 llcenses, 46 P~ving complied in full with conditions as set forth in the law and
therefore havillG been issue1i licenses,

Coor:llnation wHh County Health Crc;aniz~tions

In order to more adeqllately reru1er the services of this division to the State generally it has been necessary to coordlnatz t!1e facilities of the division with the divislon of count~ health work. The :reans by -,;hich thi1 has been established i3 the coun~y sanl tarian. Every effort possible
has been exerted in order to establish the sc,_nltarian as a nermanent integral factor of an O!"i;anlzed cu:mty health departwent. Un:1 H~sti')aably, the Bfrollcation of sanitation t0 the cout~-r envlrorunent is of nri:ne import~,,~e. Correction of insanitary c'ln,:itlon~ ctusing sickn~ss ia

SAUITARY EN:>Y.lTEERil!G

81

f.m,l:J:nentally the basis of the preservation of the public health, and witho~t t:1is consilieration the objective cannot be attaimd.
Emphas 1s ma.y be in order in s ta tine that the full value of the service of this divtsion cannot be available to the general public to the ma..'dlllUIIl until county and district sanitation personnel in local health d~Jartments is rJrovld.ed to the maxircru.m. It is evident that only through this medium eveuJ;Jally adequate public health service by the application of sanitation can be rendered to all of the people all of the time. There will be no recession of efforts to accomplish this purpose.

DIVISION OF TUBERCULOSIS CONTROL

The appended tables indicate that a greater amount of work has been done by the x-ray field unit than in any previous year, a total of
14,847 x-ray pictures having been made, and, as a result of this field clinic work, 603 new cases of tuberculosis were found.

Deaths

In a comparison of the deaths and death rates for the years 1936 and 1937, the percentage of the total rate reduction over that of the previous year is 10.3 per cent. This comparison is shown as follows:

Year

Number

White Col 1d. Total

1936

64g 1,065 l, 713

1937

559 990 1,549

Rate
White Col 1d. Total
33-3 96.2 56.1 28.5 88.9 503

The reduction follows closely on an extraordinary stimulation of early treatment, the wider use of lung collapse measures, and a greater effort to provide assistance for the treatment of people in their homes.
However, as gratifying as this death rate reduction is, one must not be too sanguine regarding the continuance of this reduction, because there are many factors which will tend to hold the present death rate at a level, or at least at a smaller rate of decline. None of these factors, however, are of such a nature but that they could not be overcome were the necessary means to do it made available. The reasons for the continuance of tuberculosis as a menace in Georgia, and in every community, state, and country, are principally ignorance, willfUlness and poverty.
The majority of ignorant people can be taught, and this is being done in a very satisfactory manner through various means of education. Probably the most important factor in the educational field in tuberculosis control has been the National Tuberculosis Association.

Incidence

In spite of the decrease in the death rate in tuberculosis, tuberculin tests over a number of years in various colleges in the State have shown that there is not an accompanying decrease in the tuberculous infection rate. Some colleges have even shown an increase in the percentage of reactors. The lack of control of tuberculosis carriers and communicable cases among the ignorant, willful, and poverty stricken is responsible for this widespread infection, and here it may be said that every infected person is a potential case of tuberculosis some time in the future. This widespread infection shows the necessity of a better control of these special groups.

Activities

At the present time field clinics are conducted as usual and attempts
cnade to follow up every case of tuberculosis located through the district
tuberculosis nurses, of which there are nine; through the district ad-
visory nurses, numbering 17; and through the county public health nurses
and health co~issioners, These field workers secure whatever of assist-

83

84

TUBERCULOSIS CONTROL

anca they may through the COWlty welfare departments, tuberculosis seal sale Coillmittees, and many other agencies.

~f

Medical Carel Because of the paucity of beds, the people who have tuberculosis can be oifered very little sanatorium care and must therefore depend upon securing most of what is necessary for recovery in the communities in which the patients live. The medical care of these people must be directed by the family pr.ysician aided by whatever local facilities there may be for lung compression. More than one hundred fifty physicians in this State have qualified themselves to perform these services and practically all physicians in the State are aiding in the care of tuberculosis in some way.

Coooerating Agencies: A splendid piece of work is being done by the Georgia Tuberculosis Association, which has become interested in furnishing fees for pneumothorax refills and special x-ray pictures and other medical services, paying to the physician performing these services a comparatively small though fairly reasonable fee, arrange;nents being made with the physicians for indigent cases, the indigency of such cases having first been established through an investigation by the county welfare director.
The State Welfare Department, through the assistance planning division and the county welfare directors, has been very sympathetic to the needs of tuberculous families and is doing all that it can. it is believed, toward relief with the funds at its disposal. As a rule, how~ver, the amount of money available for relief in tuberculous families has been far below what has been actually necessary. A special carnpaign of assistance to the ueedy tuberculous in their homes was started on the assumption that relief to sucl1 families would be available on the basis of thirty dollars per month per family. However, the assistance that is available under the Social Security Act, apparently amounts to only about one-half of that. In some counties, Fulton for inRtance, the amount falls far below that, being about $9.50 at the present time. Until this can be corrected satisfactory care of patients in their homes or co.nmunities will be handicapped considerably.

Sanatorium: The State Tuberculosis Sanatorium has b~en integrated into the tuberculosis control work in that the policy for admissions to the Sanatorium is now on a basis of the need for lung c.ompression. In this way the Sanatorium a)1;1ltcation waiting list for suitable patients has been reduced to such a point that white fen1ale patients can now be admitted with practically no delay, and white men usually within two months after the application is accepted.
Certain of the services of the State Tuberculosis Sanatorium are limited at the present time because of the inadequate funds upon which it is required to operate. The appropriation of $240,000 annually, which amounts to $20,000 per month, has been reduced by law so that they are required to budget on a basis of $16,000 per month, and for the first quarter of 1938, the allowance is only $13,6oo per month.
lt is estimated that from 275 to 300 beds could be maintained at the State Sanatorium with a full appropriation. With the budget of $16,000 per month, the average attendance was about 220, so it must be apparent that further reduction will become necessary unless adequate funds are provided.

TUBERCULOSIS CONTROL

35

In 1937, 153 counties were served in 205 clinics x-raying 14,847 persons. These persons were x-rayed as follows;

In 120 counties in 138 clinics organized by the district

tuberculosis and advisory nurses --------------------In 33 health officer and county public health ~urse

counties in 67 clinics -------------------------------

University of Georgia, Athens ----------- Special Clinic

State Teachers College, Collegeboro -----



State Teachers &Agricultural College,
Forsyth, (col.) ----------------------- Georgia State College for Women, Milledgeville Agnes Scott College, Decatur,------------



Young Harris College, Young Harris ------ Sapelo Island, Mcintosh County ----------

"

6.555
l.au5.386
112 375
2j~
__SQl

Total

14,847

Following is shown the case load of the district tuberculosis and advisory nurses on December 31, 1937:

Positive cases Suspects Contacts Unclassified

4,661
4,514
23,471 6,481

Total

39.127

Some of the services performed by field public health workers are as follows:

Health Counties not
<5'ffi:'Cer having public Total
Counties health depart-
ments

Individuals admitted to nursing

or medical service or both

12,668

Physical examinations in clinics 5.324

Field visits

35.121

Office visits

11,874

Admissions to sanatoria

356

Number completed tuberculin testa 12,220

Percentage positive

4o.5

Contact& broken

735

Contacts partly broken Relief secured for positive cases

~~

Cottages and sleeping porches built 25

6,022
25,027 1,869 72 2,819 61.7 664 252 126 11

18,690 5,324
6o,l4s 13.743
428 15,039
1,~
369 36

86

TUBERCULOSIS OOXTROL

Total All Age Groups

Summar,r of Clinic Examinations for the Year 1937

~.,

Original ExamiDationa

l
--~

White

'l'otal

Percent-

Percent

Total

Percent-

Male age

J'emala age

Male-Jemale age

Childhood

17

Minilll&l

29

Moderately .A.dT. 50 Jar ..Ldvanced 105

Total Poaitivea 201

Suspicious

469

Negatin Total

~

.43 o72 1.25 2.62 5.02 11.70 83.28 100.00

14 37 52 71 174 44o
~

.34 1.2960 1.73 4.23 10.69 85.08 100.00

31

.38

66

.81

102

1.26

176

2.17

375

4.62

909

11.19

. 6838
8122

~

Colored

Childhood

13 1.02 19 1.23

Minimal

11

.87

23

1.50

Moderately .A.dv. lS

1.42

18

1.17

Jar .A.dTanced

6o 4.72

66

4.30

Total Positive 102 8.03 126

8.20

Suspicious Negative Total

142 11.17 1027 80.80 1271 100.00

ll3
i5!t

814.~
100.00

32

1.14

34

1.21

36

1.28

126

4.119

228

8.12

25,

909

~

~

2807 100.00

- Unclassified (White and Colored)

Re-exam1nations -White 3,092

Colored 749

Grand To tal of all Examina tiona

77 3841 14,847

Comparing Percentages of Pulmonary 'l'u.berculosis in Xale and Jelll&le

Colibined in Various Groups

up to 16

17 to 45

White

All .Ages

Years

Years

Number examined 8122

2714

4635

Minimal

.81

33

-97

Moderately .A.dT. 1.26

.07

1.10

Jar .A.dTanced Total

~.2

~ 7

2.24 4.31

Childhood

.38

1.11

.02

46 Years up 773
1.5~
6.3
~95

Colored

Number eX8JIIined 2807

1067

1374

366

Minimal

1.21

Moderately Adv. 1.28

.47

1.6o

19

1.82

21.~

Jar .A.dvanced Total Childhood

~.98
1.14

1i.0l3l

1l0i.9l9l

4.92 9-29

STATE TUBERCULOSIS SANA'roi:UUM
The year 1937 has been rather unsettled due to the sanatorium being under three different governing boards during the space of the first six months. However, the work has been carried along on the same lines with the constant endeavor to increase the per cent of collapse caaes, and to treat a greater number of patients.
jppropriation
At the beginni~g of the fiscal year July 1, 1937, the appropriation to the sanatorium vas cut to SO per cent, At that time, owing to the fact that a general raise had been made in salaries, and that the cost of sllpplies had. advanced, it val found necessary to reduce the bed li11it
of the sanatorium !roll 343 to 250, llaking the quotas 190 white and 6o
colored patients. It vas also found necessary to reduce the time of hospital residence fro11 6 to 3 months except in such cases as vera receiving special treatment, or the few who in the opinion of the staff
would greatly benefit fro11 a longer taT
Waiting Liat
At the beginning of 1937, there vera approximately 180 applicants on the accepted liat and the list was steadily growing. During the yu:r, notwithstanding the small number of bade in use, it has been possible to wipe out the white fe~~ale list and to practically catch up with the white male liat. Unfortunately material progress has not been possible with the colored vatting liat.
Present Statue
The general work of the hospital has increased as shown by the following statistical reports.
The buildings and general equipment are in fair shape. It has been possible to add a meat refrigerating roo11, to pipe steam to the p~ai clans1 cottages, to resurface the sun decks on the Children' Building and to buy a new tractor and plow.
There is still much to be done. Practically every building should be repainted, and some of the equipment should be replaced or repaired,

88

Adults
' c.
45171

Children
1'. c.
107 .46

Sui>-Total.
w. c.
.558 117

Total
'li.& o.
675

ht1ente 1n S&natoriur: Doeember .I!: 1 19,;n

Adulta
' c.
128.36

Ohlldren
' c.
;s 21

SulrTotal
' c.
157 ~

fotal
t ,&; c.
21.4

Total Number Patients Treat-ed, !ron: Jsrru.arr 1, 19)7 through Jn.~

eeaber .311 1937

889

J.verage DalJ.y Census, f'l'Om J &llUSI7 1 , 19'51 thr<mgh December .31,

19'51

267

Age and Se:r o~ Patients (Both Races)

.Ace Group

Male

J'emale

Total

1 - 10 Years 11-20 I
21- JO II
.31-.4o I
41- .50 I
51-60 I 61- 70 II
" 71- 90

'51

'51

52

8]

86

120

73

5'?

J9

37

17

.21

4

ll

1

.308

)67

74
1.35 206 1.30 76
J8
15 1
675

Cl.ast~1f1eat1on or Pat1ent8 from January 1 1 1937 thro:!!f;h December ~ 1 19!Z

On !dm.ssion

On Discharge

White
.lrre;t.
Oh.T.B. -'> 6
141n. 23 1 Kod .l.d.l58 1 Far. 244 1 NonT.B. 96 0 Total .558 9

J.p .lrrst. 26
7 7 0 0
.4o

Quie. 0
10
53
24
0
87

Imp.
l 4
74 161
0
240

Unimp.
2 0 1
1.3 0
16

Died
0 1 0 10 0 11

NotCons. 0 2
22 .35
0 59

lfon T.B. 0 0 0
0 96 96

Colored

Ch.T.B. J9 4

Min.

71

Mod .l.d. 23 2

F'ar." 45 2

NonT.B. 3 0 Total 117 9

6

0 ;s

0

0

0

0

0

06

0

0

0

0

1

0 17

1

1

1

0

0

0 25

6 12

0

0

0

0

0

0

0

0

J

7

0 77

7 1.3

1

3

SJ.NlTORI'OM

89

Complications

J.bscesa, LUll&

5

J.ppeDdic1tia

5

Arterioac:leroeta

1

Artbrtt1e DetormaDII

1

J.atlma, Bronchial.

7

Bronchiectaets, Pri.Mr7 1.3



SecondaJ'7 1

Daentta, Praecox Diabetes, llel.litue

l

Drug Addiction

1

ElapTema, Chronic

1

:&:ncepbalitie, Chronic

1

Eptlepq

1

Foreign Bod7 in Lurw

1

Hooltwoni

1

B;ypertension, J.asent1al.

4

Iritis

1

llalar1a

1

Mental Detic1ena,r

1

Mitral Regurgitation

2

Stenosis

9

lephritis, Chronic

2

Oleothorax

4

Otitis, Media Chronic

6

Pellagra

2

Pericarditie

2

Pneullothorax, J.rtit1c1al 2ff7



Spontaneous 3

Pneuao-Peritoneua

6

Pot's Diseaee

1

Pregnancy

3

Pu1J1onar7 Infarc

1

Scabies

2

Silicosis

1

8.Jphtlis

8

Teyrotold cosia

1

Tuberculous, Enteritis

11



Fistula in J.no 4



Hip

1



LarJngitia 21.



Meningitis

1



PneWIOnia

1

Special Examinations and Treatments Classified

Patients Receiving Pneumothorax Operations Ho. Pneumothorax Operations Patients Receiving Oleothorax No. Oleothorax Treatments
Patients Receiving Pneumo-Peritoneua lo. Pneu.o-Peritoneua Operations Phrenic Operations Apicol7sis Operations Tboracentisis Pneuaol7sis Operations llo. Consultation E:l:aainations lo. Patients Referred b7 State Field Clinic lo. Roentgenographic lilxalll1nationa lo. :::-...,roscopic l!lxam1 nations lo. Li.}. odol Injections lo. Specillens Examined in Clin1cal Laboratory

lbite
336 3,580
5 2.3 6 118
193
2
51
2 1,874
8,3

Colar:-ed
70
1,019 2
14
0
0
15
1
82
1
93 35

Total lt06
4,'.599
7 Yl
6 118
208
J 13.3
3 1,967
118
5,~
4,4ffl
J4
9,077

Patient Dqs b7 Month

Month

White Colored Total llonth

White Colored Total

Janu&r7 Februar;y
March AprU
llq
June

6,Sl8 5,895 6,727 6,494 6,.581.
6,308

2,574 2,199 2,,314
2,174 2,272 2,326

Total tor Iear 19'57

9,423 8,094 9,o41 8,668
7,854
8,7,34

Jul7 J.uguet Septeaber )ctober
.l'loveaber
Decelllber

6,456 .5,419
.5,061. .5,,322 5,,308
5,70.3

2,497 2,016
1,667 1,728
1,681
1,969

8,95.3 7,4J.5 6,728 7,050
6,989 7,672

72,12.3 25,417 97,54o

90

s.ulU'ORilll

Counties Represented

Count7

lbite Oo1. County

1h1te Oo1.

1ppllng 1tlc1naon Bacon Baldwin
Barrow
Bartow Ben Bill Berrien Bibb Bl.eckl.q Brooka Brantlq
Bulloch Burke
Calhoun
Callden
Carroll Catooaa
Charlton
Chathaa
Chattooga
Cherokee Clarke Cllnch Cobb eorree Colquitt
Cook Coweta Crawtord Crisp Dade
Doughert.;r
Dawson Decatur DeK&lb Dodge
Dool;r Douglas
Earl;r if'tinghala Elbert Ellanual

21. 1 10 1
52
20 20 13 0 20 20 18 3 20
11
10
10
12
10
30 60 J0
10 14 7
70 10 0
95 10 11 2 10
90 40
41 20 70 20 50 20
50
40
20 31 61
40 40
71 10

Evana
Fannin
no;rd
Frankll.D Fulton QUiaer Glascock
G~
Gordon
Graq
Green Owinnett
Haberahaa
Hall
Haralaon Barris
Barl
Beard
Hell17 Houaton
Jaokaon Jasper Jeteraon Jenld.na Johneon Lamar Laurens Lee Libert,;y Lowndea LUIIIpldn llcDutf'le Macon Madison Meriwether 111tchell Monroe llontgo11e1'7 Morgan
llurrq
lluacoge Newton Oconee

10 30 24 4 60 4o 11 02 20 24 10 0
20 51 16 0
70 14 3
J0 30 21 10 10
10
72 04
20 10
20 30 50 10 01 42 20
32 42 40 1J 10
J5
10
41 41 13 5 42
10

Count;r

1h1te Ool.

Oglethorpe

1

0

~

PaulcU.ng Pickens

30 20

Pierce

11

Pike

20

Polk

11 1

Pulaski

11

Putnall

10

Rabun
Randolph

10 3

RichlaoDd Roclcdale

93 20

Schle;r

20

Screven

40

Sellinole

10

SpalcU.ng

70

Stephana

32

Stewart

20

Swrter

42

Talbot

30

Tali.af'erro 0 1

Tattnall

60

Tq1or

21

Telfair

10

Terrell

1J

ThoMa

51

Ti.tt

60

Toollbs

60

Treutlen

01

Troup Twigg a

11 3 10

Union

20

Upaon

41

Walker

91

Ware Washington

"0
12

Wqne

50

Wheeler

20

Whitfield 16 1

I'llcox

01

11'Uld.nson

10

Worth

10

DIVISION OF VENEREAL DISEASE CONTROL
The activities of the division of venereal disease control have centered around the following main projects: clinic organization, educational programs; cooperation with lay, professional, and civic groups in their programs for venereal disease control; consultative, advisory, and laboratory services to physicians! and follow-up work.
Case Reporting
For the year 1937, a total of 18,723 new cases of syphilis wa.a reported in Georgia. by clinics and private physicians. Totals of 5,918 new cases of gonorrhea and 270 new cases of chancroid were also reported.
Clinic Organization
At the beginning of 1937, 17 countin in Georgia were being served by venereal disease clinics. During the year, 19 new clinics were
or~ized, making treatment for indigent patients available in 36 counties as the rear drew to a close.
Diagnostic Services
Attention is called to the division of laboratories report for a detailed account of venereal disease control activities. Special mention should be made, however, with reference to the fact that free diagnostic services for syphilis and gonorrhea are offered all physicians of Georgia. In addition, clinicians and health officers are sold hypodermic syringes, needles, and the anti-syphilitic drugs at coat price.
Early in 1937 a project vas undertaken in cooperation with the National Youth Administration of Fulton and DeKalb Counties, for the purpose of making serological routine blood examinations for syphilis. The Kahn teet was made on about 4oo Negro girls between 1$ and 24 years
of age, with 43 per cent having a po_si tive reaction. Also, about 300 white girls of the same strata and age group were examined with 5 per
cent having a positive reaction for syphilis.
Educational Activities
Educational work consists generally of public appearances before lay, professional, and student groups; preparation and distribution of informative literature! preparation of articles for medical and lay publications; and similar activities. For the year 1937, a total of 185 lectures was made to a total audience of 28,352 persons. A total of 46,137 pieces of literature vas distributed. Reprints of a number of the United States PUblic Health Service leaflets were made, and a revised edition of the leaflet venereal Disease Information, Instructions to Patients was prepared. A supply of this leaflet was sent to every doctor in Georgia. In April 1937, a project wac started to have posted in all public toilets throughout the State placards warning against the dangers of syphilis and gonorrhea. This project was axtensively carried out with gratifying results.
91

DIVISIOH OF VITAL StATISTICS
The following report ia baaed upon the birth and death certificates registered with this department for tb8 ;rear 1937, with dela7ecl certificates receied through lebruar,y 4, 1938 included.
For more detailed tabulations, the re..S.r 1e referred to tb8 1938 report, which eabracea the biennial period 1937-1938.
Death Bates liT Cau..a
The death rate for all causes shove a drop froa 1221.4 for 1936 to 1100.8 for 1937, or a decrease of 9.9 per cent.
!zpbua leer: The death rate for 1937 for this disease is 1.8, ae coapared with 1.4 for 1936. This ia an increase of 28.6 per cent and ia the highest rate for this disease on record.
~hoid Fever: A rate of 4.5 for 1937, as compared with 6.4 for 1936, shows a decrease of 29.7 per cent. This ia the lowest rate yet recorded for this disease.
lfalariaz There vas a marked reduction in the nuaber of -laria deaths durinc 1937, aa compared with 1936. The rates were 7.6 and 19.8 reepectiel7, or a decrease of 61.6 per cent for 1937 from the 1936 figure.
Influenu.z There vas a decline in tha rate fro 60.3 to 46.7 for 1937, or a decrease of 22.6 per cent.
Tuberculoaia: lor this d:I.Maae tblre vas 10.3 per cent decrease for 1937 aa ooapared with 1936, the rates beinc 50.3 and 56.1 reapect:I.Tel.T.
Cancer: !here vas an :l.noreaae in the 1937 rate of !)8.4, aa copared with 573 for 1936, or an increase of 1.9 per cent. This ia probabl.T due to tvo thinca, better 4iagnoatio faci11t1ea &Dd increa...
iDe number of persona reach:I.Dc the cancer ac-
Cerebral s-orrb&ge: !here vas a decrease of 0.8 per cent for 1937, with a rate of 85.7 aa compared with 86.4 for 1936.
Heart D:l.aeaaez There .aa a decrease of 6.5 per cent for 1937, v:l.th a rate of 171.7 aa compared with 183.6 for the year 1936.
Pneumonia: The rates for this disease ahov a decline for 1937 t4 19.7, aa compared with 1936 when the rates for the tvo yeara were 124.6 and 100,0 reapectiel7.
Bephritie: !he decrease in the rate for this diaeaae for the year 1937 vas 112.4 from 112.9 in 1936, or a per cent decrease of 0.4.
All other die.... show a decrease, with tbe exception of WhoopiDe Cough, Cirrhoaia of the lier and Homicide, which ehov increases a.er tbe rates for 1936.
93

VITAL STATISTICS :Birtha
Live :Birthar The birth rate ehowr a alight decrease for the 7ear
1937 aa compared with 1936, the ratea being 20,8 and 20.2 reapectively. Stillbirths! There vas a deoreaae ot 3.5 per cent. The rates
were 57.4 for 1937 and 59.5 for 1936. This is probably due to the in-
creaaed 1ervice to expectant mothera.
Maternal and Infant Death Rates
Maternal Mortality: There vas a decrease in the rate for 1937 of 7.4 from S,O for 1936, or a decreaae of 7.5 per cent, showing there-
aulta of increaaed aervice to expectant mothers.
Infant Mortality: There vas a decline in this rate from 70.1 to 62.0 tor 1937, or a decrease of 11.6 per cent.

VITAL ST~ISTICS

95

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIR!'HS A:m RATES PER 1,000 POPULATION, STILLB!Rl'HS, DEATHS UNDER ONE YEAR OF AGE APD MATERNAL DEATHS \'liTH RATES PER 1,000 LIVE BIRl'HS AND THE PER CENI Il\CREASE OR DECREASE IN TilE RATES&
19.)6 AND 19.)7

CAUSE OF DEATH
ALL CAUSES
Typhus Fever...................... Typhoid Fever..................... Malaria........................... Smallpox Measles ...........................
Scarlet Feve'!'.................. , Whoopillg-cough.................... Diphtheria..................... Influenza......................... Dysenterr.........................
Polioa,yelitia..................... Lethargic Encephalitis Meningococcus Meningitis Tlme:rculosis...................... Cancer............................
m..betes llellltus Pellagra.......................... Cerebral Hemorrl>..age Heart Diseases.................... Pneumonia.........................
:Dtarrhea and Enterltis -2 Irs 01rrhoa1e or Liver................ Nephritis.........................
Malformation &Early Infancy.
Suicide...........................
Hold.cida..........................
Acc1dents &Other Violence.
Unknown or 111-defined All. other causes................. ~
LiYe Births....................... Stillbirths............... .. Infant llortslity.................. llaternsl Mortality................

NUUBER

19.37

1936

J4,411
54 1J9
-235
10
11 142 108 1,436 lJO
20
5 35
1,549 1,797
J92
370
2,6)6 5,284
J,crn
480 151 ),458 1,66J 315
641 2,413 1,921 5,468
64,012
3,671
3,968 471

J7,29J
1,4 195
-606 8
14 67 123 1,842 156
':8 9 67 1,713 1,751
J9l J9l
2,638 5,606 J,80J
549 139 J,446 1,797 311
589
2,715 2,179
5,564
61,617 J,6f.6 4,)19
491

RATE

19J7

1936

1118.5
1.8 4.5
-7.6
0.3
0.4 4.6
35
46.7 4.2
0.7 0.2 1.1
50.3
58.4
12.7 12.0 85.7 171.7 100.0
15.6 4.9
112.1. 54.1 10.2
20.8 78.4 62.4 177.7
20.8 57.4 62.0 7.1.

1221.4
l.L. 6.L.
- 19.8 O.J
0.5 2.2 4.0 60.J 5.1
0.9 O,J 2.2 56.1 57.3
12.8 12.8 86.1. 18J.6 124.6
18.0 4.6
112.9 58.8 10.2
19.3 90.9 71.) 182.2
zo.z
59.5 70.1 8.0

Per Cent Increant:.
or Decrease
- 8.4
28.6
-- :e:..9e.7.
-- 20.0
101.1
- 12.5 22.6
-- 17.6 - 22.z - JJ.J
50.0
-- 10.3 1.9
0.8
-- 6.J 0.8
-- 6.5
- 19.7
- lJ.J 6.5 0.1.
-- -8.0
7.8 1).8
-- 12.5 - 2.5
J.O
- J.5 11.6
-- 7.5