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"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~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<1rculomh '111larem1,. 'rypho1..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' 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:~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 conw- "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 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'.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 ~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 outstnnlpressi<.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,nlnturbiU1 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 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