Annual report 1938 [1939]

STATE OF GEORGIA
DEPARTMENT OF
PUBLIC HEALTH
ANNUAL REPORT 1938

COliTENTS

Letter of Transmittal

1

State Board of Health

2

Department of Public Health

3

Cancer Control

5

County Health Work

7

Dental Health Education

17

Epidemiology

21

Laboratories

45

Malaria Investigations

77

Maternal and Child Hygiene

89

Public Health Education

95

Public Health Nursing

99

Sanitary Engineering

105

TUberculosis Control

139

TUberculosis Sanatorium

147

Venereal Disease Control

153

Vital Statistics

159

To His Excellenc~, Hon. E. D. Rivera, Governor of Georgia. Dear Sir:
I have the honor to present to ~ou. the annual report of the work of the Department of Pu.blie Health for the ~a~ 1938,
With the expansion of the health program and increase in activities, the ~ear~ reports are too comprehensive to effectivel~ appear in biennial form, Therefore, beginning with the report for 1937, the Department of Public Health reports will be printed
separate~.
Since this fact was not determined until the close of 1938, statistical data were collected previous~ on the biennial basis. For reasons of econo~, these have not been re-made and are published with the 1938 report.
Respectful~ submitted,
rK~torf-~ State Department of Public Health

MEMBDS
STATE BOABD OF HEALTli December 31, 1938

Ex-Qfficio Ron. E. D. Rivera Governor of Georgia

NlME

.ADDBlllSS

Cleveland Thompson, M.D. Millen

C.K. Sharp, M.D.

Arlington

R.C. Ellis

Americus

J.A. Corry, M.D.

Barnesville

R.F. Maddox, Chairman Atlanta

A.R. Rozar, M.D.

Macon

(Vacancy)

H.W. Clements, M.D.

Adel

L.C. Allen, M.D.

Hoschton

D.N. Thompson, M.D.

Elberton

M.D. Hodges, Ph.G.

Marietta

W.T. Edmunda, Ph.G.

Augusta

J.G. Williams, D.D.S. Atlanta

Paul McGee, D.D.S.

Waycroas

TEBM EXPIRES BEPRESENTING Sept. 1, 1939 First District Sept. 1, 1939 Second District Sept. 1, 1942 Third District Sept. 1, 1943 Fourth District Sept. 1, 1942 Fifth District Sept. 1, 1938 Sixth District
Seventh District Sept. 1, 1938 Eighth District Sept. 1, 1939 Ninth District Sept. 1, 1943 Tenth District Sept. 1, 1941 State-at-Large Sept. 1, 1941 State-at-Large Sept. 1, 194o State-at-Large Sept. 1, 194o State-at-Large

Notel Those members whose terms expired during 1938 served throughout the year and until their successors were appointed.
2

DllPARTIC&N! OF PUBLIC liE!LTH
T. J', ABERCROMBIE, M.D. DIRECTCil
C. L. Tinsle;y, Secretar,y - Treasurer

DIRECTORS OF DIVISIONS

Ralph Mosteller, M.D. G~ G. Lunsford, M.D. J. G. Williams, D.D.S.
c. Daniel lk>vdoin, M.D.
T, F. Sellers, M.D. Justin Andrews, D,Sc, Joe P, lk>vdoin, M.D.
Jannie ~. Shaw, M.s.
Mrs. Abbie R. Weaver, R.B.
L. )(, Clarkson, C.!. H. C. Schenck, U.D, C. U, Sharp, M.D. Joe P. ~ovdoin, M.D.
Butler Toombs

Cancer Control Count;y Health Work Dental Health Education :lpidemiolog;y Laboratories Malaria Investigations Maternal and Child argiene Public Health Education Public Health Bursing Sanitary Engineering Tuberculosis Control Tuberculosis Sanatorium Venereal Disease Control Vital Statistics

3

DIVISION Or CANCER CONTROL

l I

Cancer as an economic problem in Georgia is of prime importance because of its prevalence, its disabling effects and the economic loss it causes. Needless suffering and waste of human life results from this disease because many persons are financially unable to provide treatment for themselves.
Problem
Cancer is prevalent in middle and later life and affects the economic status not only of the sufferer but also of his or her dependents. Early diagnosis and prompt treatment are the essential factors on which the control of cancer depends.
Adequate treatment is dependent on special equipment as well as the services of medical men trained in this branch of diagnosis and therapy. The essential equipment is an x-ray machine capable of delivering deep therapy, a sufficient amount of radium, a pathological laboratory, and facilities for major surgery. raw of these are ordinarily available to the average medical practitioner. Maximum results can be secured only where proper facilities and trained personnel are at hand. Thus the private treatment of cancer is an expensive procedure beyond the means of many.
Prevalence: Based on 1,782 deaths from cancer reported 1n Georgia in 1937, it is estimated that there are annually more than 5,000 cases of cancer in Georgia. It is also estimated on the basis of the msdical and economic survey made in 16 Georgia counties that 50 per cent of the persons suffering from cancer are unable to finance treatment for their condition. On this basis, there are some 2,500 cases of cancer in Georgia that will not receive adequate treatment without aid.
Program
Since cancer is curable if diagnosed and adequately treated during the early stages and since cancer is 100 per cent fatal if allowed to go untreated, it is important from an economic as well as a humane standpoint that some provision be made to extend aid to citizens of Georgia afflicted with this disease.
A forward step along this line was taken in 1937 when the State cancer law was enacted to provide care and treatment for indigent cancer patients. The sum of $50,000.00 was appropriated annually for two years for the purpose of carrying on this work.
Treatment Centers: Ten state-aid cancer clinics were organized and operate as diagnostic and treatment centers for approved patients. These cancer clinics are located geographically with a view to convenience and needs of each section. These centers are organized on the basis of the minimum requirements as recommended by the American College of Surgeons Committee on Malignant Disease.
5

6

CANCER CONTROL

Activities: During the year 1938, a total of 1,523 applications for state-aid in the treatment of cancer were received, Of ~~is number, 1,4ol patients reported to the various clinics for examination. Of the number reporting for examination, 1,103 were found to be suffering from cancer in some form. Disposal of all applications is tabulated as follows:

Cancer cases treated ------------------------------------ 1,034
Cancer cases too far advanced for treatment -------------- 6o Cancer cases refusing treatment ------------------------- 9
Non-malignant cases -------------------------------------- 298 Cases failing to report to clinic ----------------------- 62 Applications held for lack of funds ---------------------- 6o
Cancer cases have been treated from 147 of the 159 counties in Georgia, Sixty applications for state-aid treatment during the month of December were withheld due to lack of funds.

Results: Follow-up reports on cases treated indicate that 45 per cent of them were cured or arrested, 19 per cent improved, 8 per cent dead. The remainder are still under treatment. Those cases classified
as cured or arrested will remain under observation for a period of five years.

Coat: The average cost per patient, including both treatment and diagnostic service, was $1!0.63. This includes actual cost of hospitalization and radiation therapy. No fees for professional service have been paid. The following is an analysis of the cost of treatment distributed by type of service:

Radiation (x-r& and radium) ---------------------------- 36% Operating room and anesthetic --------------------------- 10%
Laboratory service -------------------------------------- 5%
Hospital room and board ---------------------------------- 49%
Present Status
Appropriated funds for the treatment of indigent cancer patients were exhausted December 1, 1938. About 170 applications monthly are being received for state-aid treatment. These necessarily have to be held in abeyance until additional funds are provided.
Many of the patients that have received initial treatments will lose the benefit of such treatments as a result of temporary interruption. Others will be del&ed in receiving state-aid treatment until maximum results cannot be e:xpected.

DIVISION OF COUNTY HEALTH WORK

It is encouraging to note the progress of county health work during
the period December 31, 1935 to December 31, 1938, which is shown b.v the
increase in the number of counties having full-time health departments,
the total population receiving public health protection, and the number of persons engaged in public health work.

At End of Year

No.Counties Organized

lilo.Persons Employed

Population Served

1935

31

1936

33

1937

46

1938

54

233

1,327,018

263

1,394,076

375

1,380,669

462

1,777,129

The addition of a well-trained and experienced assistant health officer, and a sanitary engineer especiallY trained in milk control, to the staff of the City of Atlanta Health Department is an accomplishment of the year. Another assistant health officer, who vas already employed b,y that department, is availing himself of the training course at Harvard University School of Public Health. These, and other anticipated changes which are to be affected in this department will result in a very much improved service for the people of this city.

Personnel Training

In 1936 the State Department of Public Health adopted the standard
of qualifications for public health personnel, as recommended by the Conference of State and Territorial Health Officers, and the United States Public Health Service allotted funds under the Social Security Act to defr~ the expenses of training personnel to meet this standard.
Since that time, a number of physicians; public health nurses, sanitary engineers and other technical personnel have been given the advan-
tages of this training. During 1938, 19 physicians, 37 nurses, 14 sanitary engineers and 4 laboratory technicians have received training at
various schools. In this connection, it might vall be stated that the employment of
qualified public health workers is considered by many to be of more importance than the increased number of persons employed. The percentage of professional persona now engaged in public health work, who have had special training, is very much higher than ever before, and this percentage is constantly increasing. In addition to the personnel being added
to county health departments, who were given training before being as-
signed to positions, many of the workers that have been connected with departments in the state for a number of years have taken advantage of
this privilege.
Among the physicians being trained during 1938 vas the associate
director of this division. Although he has had considerable experience
in public health work in Georgia, it vas felt that he would be better
qualified to promote public health activities after having the advantage
of .further training. He enrolled at Johns Hopkins University School of Hygiene and Public Health in September and will complete his course in
June of next year. Other members of the staff of the State Department

7

g

COUNTY Hl!:ALTH WORX

are also taking advantage of this training.

Scarcitz of_~ined Personnel: Greater progress in county health work has been handicapped by the lack of properly qualified p~sicians
who are sufficiently interested to take up public health work as a ca-
reer. Even though the department's need for these p~sicians has been made known on every occasion, it has been impossible to meet the demand for qualified physicians to fill the positions of county commissioners
of health.
On January 1, 1937 there were 7 organized counties that were not
eligible for financial assistance from Federal and State funds for the reason that they did not meet the requirements regarding qualified per-
sonnel, or in some other respect. On January 1, 1939 only one of the
54 organized counties (Fulton) had failed to qualify and receive finan-
cial assistance from the State Department of Public Health.

Results: The increased personnel and increased efficiency, because
of proper training, has resulted in a phenomenal increase in the services rendered by the county health departments. This is partially re-
flected in the statistical summary of activities which accompanies this report. However, the true picture cannot be presented by mere figures. There are accomplishments which cannot be told in this manner, and cannot be shown in a report.
It is not the number of home visits made by a nurse, nor the number that attends a medical conference that really counts, but rather the quality of service given on these visits or at these conferences. The decrease in deaths, the smaller amount of sickness, and the general improvement in health conditions in these counties proves this contention.

Resume of Activities

The Georgia Public Health Association, which is composed of approx-
imately 300 public health workers, held its annual meeting at the Atlanta Biltmore Hotel on February 24,25 and 26. In preparation for this meeting, the division of county health work assisted the program committee in arranging the program and other details of the meeting. The attendance at these sessions was far greater than ever before and it is
felt that the next meeting, which is to be held early in 1939, will be
even better, in view of the increased interest in public health work in
Georgia. The county health work division vas extended an invitation by the
Medical Association of Georgia to enter an exhibit on county health work at the annual meeting held at the Forrest Hills Hotel in Augusta
on April 26, 27, 28 and 29. An toxhi bit vas arranged to show the workings of a model county health department. This vas praised highly by all visitors, and served to stimulate the interest of many persons who had not previously known of the benefits to be derived from this activ-
ity. The annual meeting of the Georgia Dental Association, which was
held in Macon on May 16, was addressed by the director of this division. The Institute of Public Affairs, under the auspices of the Univer-
sity of Georgia, vas held in Athens on June 13, 14 and 15. The director
of this division took part in the round table discussion which was de-
voted to public health. In an effort to further increase the efficiency of the personnel
of county health departments and to promote uniform reporting of activities, a training school for the clerks of these departments was held

COUNTY HEALTH WORX

in Atlanta on June 15 and 16. Each member of this division assisted in

arranging details of the meeting and took part on the program. Since

that time, a decided improvement has been noted in the manner of report-

ing and in other activities conducted by the clerks.

An invitation was extended to this division for the director to

discuss public health with the student body of the Georgia State College

for Women. This invitation is extended each year and is always eagerly

accepted, for through the younger generation, and especially the school

teachers, the future of public health work is established.

Talks were also made to the junior class of the University of Geor--

gia Medical School. It is hoped that with a better understanding of

public health work, which is made possible through these talks, more of

the young physicians of the state will become interested in this work as

a profession.

Another way in which public health work has been brought to the at-

tention of the people of Georgia has been through public forums. The

director of this division has been active in these discussions and in

several instances, he has been the leader. In this way the lay groups

have a chance to better understand public health work and take part in

its promotion.

An encouraging feature of the public health program is the increased

interest of the general public. One noticeable evidence of this is that,

although there was a decrease of 17t% in the number of public talks b,y
the personnel of county health departments, the attendance showed a 2~

increase, indicating that public health education is being carried on

better with less effort and time.

The usual work of promoting public health activities through con-

tacts with grand juries, civic clubs, county and city officials, and in

distributing public health material to these groups, has been carried

on during the year.



Increased Services: A review of the accompanying comparative summary of activities of the county health departments during the years
1937 and 1938 will reveal an increase in practically every item, the in-
crease ranging from 25% to 10~ in moat instances, and in some it is even higher. A few illustrations of the increases are given here:

Smallpox Vaccinations, 16~ Diphtheria Immunizations, 41~ Venereal Disease Treatments, 106~ Tuberculosis Admissions, 4~ Admissions to Maternal Service, ~.

10

COUl!TY HJW.TH WOmt

Comparative Statistical Summar.y of Activities of County Health Departments

1937 - 1938

1937 1938

A. COl.Jl.rulU CABLE DISEASE CONTBOL

1. Admissions to medical service

24,618 23.364

(a) Admissions to nursing service

12,057 19.322

(b) Total admissions to medical and/or nursing

service

27,~08 27,486

2. Consultations with ~sicians

2, 25 2,945

Field visits:

Diphtheria

;a.:

Typhoid Scarlet

fever fever

and

paratyphoid

fever

2,5~ 1,~ 1, 5

3.561 2,145 1,6;6

6. Smallpox

36

180

7 Measles 8. Whoopin& cough

8~~

4,617 1,700

9. (a) Malaria

9.5~3 11,343

(b) Bookworm

3,0 2 5.160

~ (c) Others

~

Total field visits for communicable disease control 29,1 5 53

Admissions to hos~itals:

10. Diphtheria

94

156

11. Typhoid fever and paratyphoid fever

75

95

12. Scarlet fever

72

125

1a Slnallpox 1 Others
Total admissions to hospitals Immunizations ~~ersons immunized):

13
~ ~ 37 2,03

15. Smallpox 16. Diphtheria - under 1 year

3;0,,o4~

78,9ll 7.568

17. Diphtheria - 1 through 4 years

13,036 17.538

18. Diphtheria - 5 years and over Total diphtheria immunizations

..&1U
30,219

~

19. Typhoid fever

ll4,6;s 150,290

20. Others

10,375 15,986

21. Public lectures and talks

6os

576

22. Attendance

20,ll3 36.993

B. V".i!llfEllEAL DISEASE COllTROL 1. Admissions to medical service (a) Admissions to nursing service (b) Total admissions to medical and/or nursing service
2. Cases transferred to private ~sicians Clinic visits
a: Field visits 5 (a) lfamber of treatments given
(b) Dismissed from service
6. Public lectures and talks
7. Attendance

19,698 29,ll5 7.530 14,775

20,m
168,135 12,027 161,4133
2,691 621
22,~6

29.894 870
363,168
19,919
330,15~
4,80
449
29,610

c. 'l'UBERCULO SIS COJlTllOL
1. Individuals admitted to medical service (a) Positive cases ~b) Suspicious cases c) Contacts
2. Individuals admitted to nursing service (a) Positive cases (b) Suspicious cases
(c) Contacts (d) Total individuals admitted to medical and/or
nursing service

6,670
1,21a 2,22 3.171 10,344 2,039 2,694 ;,612
12,668

12,334 2,289 ~,412 ,633
13.552 2,578 3.075 7.899
18,430

COUNTY lllilAL'l'H WOllE:

11

1937

c. 'l'Ul!II:RCULOSIS CONTROL - continued

2. (e) Positive cases

2,449

(f) Suspicious cases

3.392

(g) Contach

6,827

a ~sical examinations in clinics

5.324

x-r~ examinations

7.199

5 Clinic visits

9.713

(a) Visits tc State clinics

3.245

6. Visits to private pbTsicians (patients)

1,748

(a) Visits to private pbTsiciens (health officer

or nurse)

1,780

(b) Visits to others (health officer or nurse)

2,004

1 Field vial ta
(a) Visits to cases of tuberculosis

35.121 12,259

(b) Visits to tuberculosis suspects

6,212

(c) Visits to contacts

16,019

(d) Visits to persons unclassified
s. Office visits

631 11,874

(a) Office visits of cases of tuberculosis

2,985

(b) Office visits of tuber~~osia suspects

4,328

(c) Office visits of contacts (d) Office visits of persons unclassified

3.90g 65

9 Admissions to sanatoria (a) Dismissed from supervision

356 1,250

10. (a) NUmber tuberculin tests given

13.673

(b) NUmber tuber~lin tests completed

12,220

(c) NUmber positive

4,947

(d) NUmber negative (completed teats)

7.273

(e) Contacts broken

735

(f) Contacts partly broken

2~7

(g) Relief secured for positive cases

23

(h) Relief secured for t~berculous families

191

(1) Cottages, sleeping porches, etc. (number built)

25

11. Public lectures and talks

279

12. Attendance

16,423

1938
a,5627S4 10,228 10,862 10,~ 23.5
7.~3 l, 3
2,001 1,085 48,780 17.506 7.312 22,956 1,006 15.576 4,729 3.937 6,095
815 385 1,893 17.337
15,01~
6,72 8,295 1,196
~
203 21
19.4s~

1

D. MATER!U'l't S:DVICI

1. Cases admitted to prenatal medical service

7.950 11,036

2. Cases admitted to prenatal n~sin' service

7.410 14,227

(a) Cases admitted to medical and or nursing service 11,171 15.700

Visits b,r prenatal cases to medical conferences

21,441 4o,361

a: Visits b,r prenatal cases to private pbTsicians
g: Field visits to prenatal cases Office nursing visits b,r prenatal cases

l,Ogl 1,166 20,3 4 25,615 6,556 12,363

1 Cases attended b,r nurses for delivery service
8. Cases given postpartum medical examination

37

278

1,019 1,658

9 Cases given postpartum examination by private

PhTBicians

175

203

10. Cases admitted to postpartum nursing service

3.846 7.096

11. Visits to postpartum cases

21,562 24,384

12. (a) Permanent health conferences

88

145

(b) Number of sessions

1,357 2,550

(c) Itinerant health conferences

llS

123

(d) Sessions held

316

237

ll a

Midwives registered Midwife meetings

for

formal

instruction

1,298 1,439

757

924

15. Attendance at meetings

7.452 9.214

16. Visits for midwife supervision

2,918 3.547

17. Other service

18. Public lecturea and talks

258

253

19. Attendance 20. Enrollment in maternity classes 21. Attendance

4,098
4,347

6,143
d6~

Figures for items marked with an asterisk are unavailable for 1937

12

001Jftt IIIAimi 1IOiiJ:

E. :mFA'RT AND PRESCHOOL RYGIENI
Infanta:
1. Individuals admitted to medical serrice 2. Individuals admitted to nursing service
(a) Individuals admitted to medical and/or nurslDc service
(b) Permanent health conferences (c) HUmber of sessions (d) Itinerant health conference (e) Sasaions held
t Visits to medical conferences Visits to private pbTsieians
t Field vialte Office vialts
1 Consultations with parents
Preschool:
8. Individuals admitted to medical service 9 Individuals admitted to nursing service
(a) Individuals admitted to medical and/or nursing serrtce
(b) Permanent health conferences (e) lUmber of sessions (d) Itinerant health conferences (e) Sessions held
10. Visits to medical conference 11. Visits to private pbTsiciana 12. Field visits
1~. Office visits
1 Inspections bT denthts or dental bTglenista 1~. ProphTlarls bT dentists or dental bTgieniste 1 Consultations with parents 17. Public lectu.rea and talka 18, Attendance 19. Enrollment in infant and preschool classes
20. Attendance
r. SCHOOL HYGIENI
1. Inspections bT pbTsiciana or nurses 2. Examinations bT ~sicians ~ Examinations bT pbTsiciana with parents present
Individuals admitted to nursing service ~ Field visits
Office visits
7. Inspection. bT dentists or dental bTglenista 8, PropbTlaxis bT dentists or dental bTgieniata 9. (a) Children w1 th defects
(b) Consultations with parents
10. Public lectu.rea and talk
11. Attendance
12. Classroom health talka 13. Attendance

1937 1938

5,18~
7,62

155.,28651

10,247 17,491

121 179

2,282 3.519

151 173

17.,6~31~ 30.987

1318, ~.5~~

4,915 6.697

27.3 9 30,'589

6,709 7.364 8,551 12,277

12,<>44 15,435

89 lJO

1,937 2,577

284 291

4o9 7.742
549

416 9.~r

18,508 20,016

5.292 6,659 1,801 1,182

350 179

18,935 361

19,~~

7.134

J,863 1,260

4,152 lO,OJO

193.297 265.055 11~,301 137.873
.957 8,989 14,753 28,315 31.980 36,121 85.162 17,907 71,675 100,767 2,312 2,495 61,023 79.~ 15.252 15,
702 781 34.~6 4I,416 2073..5953 210,~61

G. AOOLT RYGIENI Medical examinations:
1. Mil.k-baiidlers 2. Other food-bandlera
~ Midwivea Teachers
5 Others
Total medical examinations of adulta

1,003 1,~59

6,448 10,~9

480

7

620 1,268

~ 5. ~ 2,557

B. MORBIDITY SERVICI
1. Admissions to medical service

4J,682 lo6,o63

CO'!JftY IDIALTB 1I'OliJ:

I
13

H. MOBBIDU'!' SB:RVI Cl - contim1ed 2. Admissions to nursing service (a) ~tal admissions to medical and/or nursing service
~: Clinic visits Field medical visita
2: Field nursing visits Office visits
1 Admissions to hoapitala 8. Total patisnt-da;ra of hoapi tal service 9. Individuals admitted to dental service 10. Refractions 11. Tonsil and adenoid operations 12. Hookworm treatments completed

1937 11,906 5426,,74a: 16,873 30,811 28,079 7.872 53.087
2,288
1,~
7.26o

1938
10,451
109,11()2 151,569 19,737 31.809 31,621 671.,9249~
3.7 73',
1,426 11,513

I. Cl!IPPLED CHILDREN SEmel
1. Individuals reported 2. Individuals examined at diagnostic clinics
~ Individuals treated
g Individuals admitted to nursing service Visits to diagnostic clinics
!Ursing visits
1 Other service 8. Public lectures and talk 9 Attendance

l,lo4
880 2,317
g:~
2,021 6
120

951 1,306 2,~~
823 2,311
13 663

I-i. OTHER ACTIVITIES
1. Conferences with p~sicians or dentists 2. Personal conferencea with othera
~ Newspaper articles
g Bulletins distributed Circular letters Miles travelled on dut,r

31,8~ J0,883

81,1 102,291

2,~ 1~,
1,494,-gg31

2,606
1~I:~~
1,918,072

J. GENERAL SANITATION 1. Ap}roved individual water supplies installed (a Individual water supplies improved 2, New privies installed (a) Wood privies installed at homes (b) Concrete privies installed at homes
(c) Wood privies installed at schools (d) Concrete privies installed at schools (e) Privies repaired
3 New septic tanks installed
(a) Septic tanks installed at homes
(b) Septic tanka installed at schools Field viai ts:
g4. Private premises C!llllp sites S.rimming pools
1 Barber shops and beaut)' parlors 8. Schools 9. Public water ~ppliea 10. Sewerage plants 11. Other
Total fiel~ visits in regard to general
sani te.tion Results:
12. 'iiiiiT'dliigs mosc.ui to-proofed 13. Minor dre~nage - linear feet completed
(a) Linear feet ditch cleared
14. Anopheles breeding places aliminated
(a) Acres drained

495
6,632 3.196 3,075
142 219 3.115 1,388 1,359 29

706 948 9.490 3.~ 5. 1318l
4,0~
1,9
1,8~

288,901 774 290 218
1,795
1,~
__.!

344,216 1,369 549 549 3.159 1,250 455 ~

293.425 356,136

741 1,323 658.715 1,432.743 2.237.128 4,583,120
2,678 2,448 3.676 11,747

14

OOumY m:ALTB WOBX

J, GENERAL SANITATION - continued 1~, Anopheles breeding places controlled l , Other service 17, Public lectures and talks 18, Attendance 19, Private premises improved 20, Camp sites improved 21. Swimcing pools improved 22, Barber shops and beauty parlors improved
~ Scrools improved 2 , Public water supplies improved
~ SS\<erage plants improved , Connections to public water supply
27. Connections to public sewer 28. Sanitation maps prepared

K. PBOTECTION OF FOOD A1'1l MILK 1, Food-handling establishments registered for supervision 2. Field visits to food-r~dling establishments
~ Dairy fame registered for supervision Field visi ta to dairy f!U'IIls
~ Milk plants registered for supervision Field visits to milk plants
7. Co>Ts tuberculin tested 8. Animals slaughtered under inspection 9. Carcasses condemned in >rhole or in part
10. Other service 11. Public lectures and talks
12. Attendance

L. LAllORATORY

ill1

E.2!:.

Neg,

Specimens examined:

1. Water-bacteriological

783

5.774

2. Water-chemical

3

1,016

~ ~!ilk or milk products

4,091 14,4oo

Other food

119

90

5 ~9hoid1 blood cultures 6. ~hoid: 'llidal
1 ~hoid: stool cultures

78 85

1, l336l

129

3.252

S, ~hoid: urine cultures

19

1,458

9 Diphthsria cultures

792

3.850

10. Syphilis

19,301 75.570

11. Undulant fever (human)

46

1,307

12. Bangs disease (animal)

so

233

1~. ~us fever

261

1,288

l Tularemia

18

37

15, Malaria.

2,380 20,859

16. Gonorrhea 17. Tuberculosis 18. Feces for parasites

1,578
74~
6,97

,.683 273
18,677

19. Urinalysia

15,687

7.lo4

20. Ilabies

224

117

21. Other service

~~

Total laboratory examination

2 ,452

1937
47,227
610 13,663 19,149
86 72 36 428 2,357
85
163

1938
5.969
285 10,273 31,4ol
226 88
3~
368 127 4,23~ 2,27 272

5.875 55.819
906 8,506
103 3,868 2,586
177,157
17,555

6, 7g9 89,8 9 1,321 12,524
79 6,589 8,~ 261,
45,888

7~j

41 1,085

ill! E.2!:. ...1!!i:.

957

7.350

19

1,033

11.081 11,293

109

35

l~

729

1,577

247

4,344

62

1,566

1,216

4,379

25.911 118,~01

33

l, 19

90

7,661

343

1,276

21

123

2,205 1,427
1,110

31.,73 ~,31262

13,802 30,800

20,5!~

10,665

225

121

~332,4o~

COUNTY KULTH WORK

RlllPORTA:BLI!l DISEASES Anthrax Chickenpox Diphtheria Dysenteey Gonorrhea Hookworm Influenza Malaria Measles Meningococcu.s moningi tis Ophthalmia neonatorum Pellagra Pneumonia Poliomyelitis Puerperal septicemia RAbies in man Rabies in animal Scarlet fever Smallpox Streptococcic sore throat Syphilis Trachoma Tubercu.losis Tularemia Typhoid fever Typhus fever Undulant fever Whooping cough Others

ill1. -O-as3es Deaths

1,088

1

567

47

148

61

3,122

2

5,183 5.460 3,669
96 36 20
lJ~

2483 72 2 17
108 1,284

~~
6

4 315

246

133

629

5

4

6~2 11,7 2

24 142

30

10

1,394

614

35

307

3a

513

19

59

1

923

50

1,223

19

15

122!

~

~

1,708 788 4o7
4,26o 12,297 2,158 3,167 7,077
39 21
1,02~
2,548
~a
2 _300
6ag
909 20,773
26
1,9a~
362 634 58 1,861 1,483

49 104
1
200 65 42
-25
134 1,520
12 27 2 300 4 1
2~~
879 2 42 21 1 60 36

!TOTE:
'Because of sickness and death, Bartow County was ~ri thout the services of
a commissioner of health for six mouths of 1938.
~e commissioners of health of Colquitt and Jefferson Counties were given a leave of absence from their positions to attend the University
of North Carolina School of Public Health during three months of 1938. Crisp, Emanuel and l1a;rne Counties began operation on July 1, 1938.

l!l!ICORD Ol!' COUNTY l!l!IALTH WORK IN CBORGIA

1915 - 1938

Number

Number

Organized Persons Poplllation

Tear Counties EmJ21ozed Served

Total
~et

Per Capita !!!l5I!enditures

Count7 Budget

191g

2

191

4

1917

5

1918

7

1919

13

1920

18

1921

17

1922

19

119922a

17 21

1199~

~a

1927

27

1928

31

1929

34

1930

34

1931

36

1932

36

119933a

31 31

193g

31

193 1937

aa

1938

54

5

17.545

4,6:n.oo

7

56.509

7, 96o.oo

11

132,105 17,290.00

17

170,0~

28,93~-00

a~

190,5
~,106

46,91 .oo 72,695.00

~

,817 108,6o2.00 454.541 103,272.00

41

g21,987 -126,037.oo

83

69.783 183,217.00

71

598,107 179,812.00

78

670,397 199,894.00

223

61!9,039 306,317.00

166

856.989 ~6,216.00

221

1,024,84~

9,004.00

205

1,011,97 451,217.00

221

995.728 426,141.00

212

998,037 433,848.00

220

1.osa,209 368,544.00

217

1,31 ,663

~8,181.00

233

1,327,018

9,292.00

263

1,394,076 458,500.00

~~

1,580,669 698,898.03 1, 777,129 859,887.00

.26

4,637-00

.14

7.960.00

.13

16,790-00

.17

22,33~-00

.25

31!,18 .oo

.21

70,895-00

.24

103,262.00

..22a

99,232.00 121,697.00

,27

171.37700

30

168,272.00

:a:!

187,154.00
297.47~-00

:~

a17.81 .oo
~,204.00

45

,go4.oo

.43

41a,966.oo

.43

41 .95a.oo

35 39

353.65 .oo 321,481.00

35

399.256.00

:aa

3~797-00
5 775-52

.48

621,736.oo

....
"'

Per Capita Expenditure !!z Countl

.26 .14 .13 .13 .20 .20 .23 .22

I :~
,28 .28

.43
:a:21
.42 .42

~
Ill
i

34

.24

30 .28

3a 3

DIVISION OF DEN~ HEALTH EDUCATION

During the year 1938, the division of dental health education has
pursued the same type program as in the previous year with no change as
to policy or in personnel. Chief amo~ the objectives have been: (1) dental inspection of pre-school, school children and 4-H Club members
by local dentists; (2) correction of defects: (3) education of adults
and children as to the value of mouth health and preventive measures. The accomplishments of this division have been made possible through the
cooperation of the Georgia Dental Association and other organizations interested in health and welfare. It- has been the purpose of this divi-
sion to assist county health departments, schools, and communities in the organization and promotion of effective local dental programs.
There are many indications of increased interest in this important phase of health that cannot be measured in figures. From reports sent to the State Health Department, there was an increase in the IIWilber of schools
participating in the state dental program from 872 schools in 106 co~ties in 1937 to 1,018 schools in 128 counties in 1938.

Divisional Staff

The educational director was granted a scholarship at Columbia Universit.r Summer School. Courses included Principles of Health Edu-
cation, Personal and General Hygiene Applied, and Educational Phychology.

Field Activities
Talks Public Meetings Public Schools Colleges Teachers Women 1 s Clubs, P.T.A. 1 s Civic Organizations 4-H Clubs Radio Dental Groups

Number
224
5 158
2
15
23
2 10
2
7

Conference a Dentists Physicians School Superintendents Rome Demonstration Agents Agricultural Extension Workers Nurses Public Health Workers P.T.A. Workers

1,052 478
102
2~~
10 96
~

Attendance
52,o49 48,839
395 1,305
1,050
46o

Newspaper and Magazine Articles Form Letters Schools Shown Moving Pictures Counties Visited
17

9
9,013
57
122

20,000

18

DENTAL HEALTH

Dental Inspection

State, district, and county chairmen furnished by the Georgia Dental Association organized the dentists for the purpose of making dental inspections. County health departments, schools, public health nurses, and parent-teacher associations are the organizations which prepare for and sponsor the school dental inspection. Printed material for the inspection was furnished by the State Health Department and the inspection blanks were returned to this Department for tabulation.
The report of a dental survey of school children in Georgia - 1937-38
was completed in May and presented to the Georgia Dental Association
at its annual meeting. Copies of this report ma:r be obtained from the
Georgia Department of Public Health upon request. Interesting features of this report are:

Total number of children inspected--~--------------- 215,56o

Number of schools represented ----------------------- 1,018

Number Number

of of

counties represented ---------------------inspection blanks tabulated---------------

128 171,463

Per cent of children with cavities------------------ 69.8

Per cent of children having been to dentist within the

Pelracset nyteoafr -c-h-i-ld--r-e-n--h-a-v-i-n-g--h-a-d--d-e-n-t-a-l--t-r-e-a-t-m-e-n--t -a-t--- 333

some time ----------------------------------------Per cent of children owning a toothbrush ------------

577 88.4

Per cent of children with apparent malocclusions ---- 16.9

Per cent of children needing prophylaxis ------------ 58-7
Average number of cavities in deciduous teeth per

Avcehraiglde n-u-m--b-e-r-o--f--c-a-v-i-t-ie-s--i-n--p-e-r-m--a-n-e-n-t --te-e--th--p-e--r ----

2.3

child --------------------------------------------- 2.2
Average number of cavities in decidious and permanent

teeth --------------------------------------------- 4.0

Since the dental program is primarily a school program, it is al-
ways difficult to make a report as of December 31. The organization and plans for the 1938-39 school dental program were begun in August
with enthusiasm on the part of the Georgia Dental Association, the
State Department of Education, and the Georgia Congress of Parents
and Teachers. To explain and promote the dental program, 5,207 let-
ters were sent from August 1 to November 1 to school officials, county
health departments, pUblic health nurses, dentists, parent-teacher
associations, and home demonstration agents.

Cba.nge in ~nsuection Material: At the suggestion of the dentists,
inspection blanks were changed to give a more simple and less time con-
suming inspection. The report for the school year 1938-39 will be completed by May 15, 1939. Up to December 31, 101 counties had ordered
dental inspection material indicating that inspections were being made,
and 46 counties had returned dental inspection sheets representing 219 schools.

Education

With the increased interest in a general health program for schools a more effective dental health education program is assured.

19
More and better health text books for all schools have stimulated interest in health. To supplement the texts the division of dental health education has distributed free to teachers the fourteen page booklet, Dentistey and Public Health: to parents and teachers, Preparing Teeth for School.
The four moving picture films which have been used extensively by this division are: Care of the Teeth, How Teeth Grow, Life of a Healt~ Child, and Nature the :Builder of Teeth. These pictures were shown to approximately 20,000 people in 57 schools. Other visual education aids include five models demonstrating progress of decay and effects of loss of six-year molar. School contacts made by the personnel of this division include 158 talks to public schools with a total attendance of 48,839. 15 talks to teachers with an attendance of 1,305, 23 talks to parent-teacher associations, and conferences with 285 school superintendents.
Exhibits: This division was asked to prepare an exhibit for the Georgia Dental Association to be displayed in the Hall of Health at the Southeastern Fair in October. Exhibits,were also displayed at Crisp, Dodge, Montgomer,y, Sumter, Toombs, Wayne, and Worth County Fairs.
Refresher Course in Children's Dentistry: A very successful and beneficial undertaking of this division was the Refresher Course in Children's Dentistey given to the dentists of Georgia. Programs were presented in five localities with an attendance of 220. All dentists who participated were enthusiastic in their praise of the lecturer and grateful to the Department for giving such a constructive course.
Dental Corrections
:Because dental corrections are made in dental offices and not in clinics, it is difficult to estimate the number of corrections. Those who travel over the State and talk with school officials, dentists, and parent-teacher association workers know that an increasing number of children are receiving dental corrections.
The following examples are cited to show the different types of corrective programs. In Thomson, McDuffie County, where about 700 school children have had the necessary dental corrections each year over a long period of time, only 17 per cent of the children had cavities upon examination this year. This program has been financed by the parent-teacher associations and schools. In Rome, Floyd County, $100.00 per month is spent for dental corrections for indigent children. The work is done in the office of a local dentist. He reports 10 children
per week are given adequate service. _Worth County reports 4oo indigent
children cared for in a dental clinic, local dentists doing the work. Jones County, with no resident dentist, reports a clinic financed by local clubs with 198 children cared for from September through December. :Bibb and Fulton Counties and the City of Atlanta have paid dentists to work for indigent children. In many places, parent-teacher associations are assisting with the problem of indigent children. In some communities there is no dentist and very little corrective work is being done.
The report of the dental survey showed that 33.3 per cent of the chil-
dreninspected had received dental service within the year.

20

DENTAL HEALTH

Cooperation With Other Agencies

Georgia Dental Association: Any report of dental health activities in Georgia must give credit to the dentists. Their continued contribution is recognized and greatly appreciated by the State Health Department. The dental health education program was given prominence at the annual meeting of the Georgia Dental Association in Macon. A representative of the bureau of public relations of the American Dental Association was invited to be the principal speaker at a luncheon attended by 225 dentists.

Georgia Congress of Parents and Teachers: State and local parent teacher associations have rendered great assistance in the promotion of the dental program. The director of this division was invited to serve as the dentist on the advisory committee. The educational director appeared on the state program in Albaey. Seven hundred sixty-one letters in the interest of the dental program were sent to officers of local parent-teacher associations from the President of the Georgia Congress of Parents and Teachers.

Assemblies

Nineteen organizations were attended or participated in by representatives of this division. Participation in these groups was of benefit to the welfare of the dental health education program.

DIVISION OF EPIDEMIOLOGY
Personnel
Several changes have been made in personnel during 1938. One physician was added to the staff and two returned from taking special training. One field biologist resigned on Yay 21. One physician and two biologists were transferred to the division of malaria investigations.
Field Investigations
Diphtheria: The year 1938 was characterized by an extensive outbreak of diphtheria which occurred in Forsyth County during the months of August and September. Before it was realized, some 25 or 30 cases had occurred, with two deaths. On investigation, it was soon evident that the district itinerant nurse could not handle the situation alone. Therefore, a nurse trainee was assigned to the county and the cooperation of the county board of health vas obtained and quarantine put into effect.
In spite of these measures, cases continued to increase and a public health nurse, assigned to this county during the Federal Emergency Relief Administration, vas given temporary employment. On September 16 the epidemiologist affiliated with the malaria investigations division vas borrowed and placed in charge of the situation.
The spread was very hard to control because the cases were largely rural, there were numerous protracted meetings of the people, and much visiting, particularly of the sick.
Typhoid Fever: One of the most interesting small outbreaks of typhoid fever occurred in DeKalb County the latter part of May and early part of June. Some seven cases occurred, all sweet milk customers of a dairy located in Owinnett County.
Positive stool cultures were obtained on two persona living on the place, the owner and his small daughter. Neither gave a historJ of typhoid previously to the current illness. The owner stated that he felt badly for one ~ and did not work that ~. No cases were reported among his buttermilk customers although these greatly outnumbered the sweet milk customers, the sweet milk sale being only a small sideline.
The Health Officer of DeKalb County took a prominent part in handling the outbreak. After elapse of the time usually required for convalescents' stool to become free from typhoid organisms, nine successive negative stool cultures were obtained on each case, thus apparently establishing the cases as ambulant cases of typhoid rather than as carriers.
In Jeff Davia County another small outbreak of typhoid occurred in December, involving twelve cases and three deaths. The Department placed a nurse in this county for one month to assist the district itinerant nurse in handling the situation. Epidemiological investigations point to the conclusion that all cases were secondary to a primary case which died undiagnosed.
The increased incidence of typhoid fever during the summer necessitated the temporary assignment of an epidemiologist to assist the
21

22

EPIDEMIOLOGY

one who had been directed to investigate all cases of typhoid reported
from non-health officer counties.
In all, there were 439 cases of typhoid investigated Qy staff members of this division, 415 of which were in non-health officer counties and 24 in health officer counties, made at the request of the health
officers. This thorough investigation of cases resulted in the finding
of 115 cases, or 27.7 per cent of the cases in non-health officer coun-
ties, which evidently would not have come to the Department's attention or been put under control measures. For this same reason, the number of
cases in health officer counties, 46.4 per cent of total cases reported
for the State, appears to give a higher case rate than in non-health officer counties. Credit is due health officers who were alert and found cases of typhoid that would not have come to light without this public
health procedure. Consequently, an apparent increase is found. in reported typhoid
cases for the calendar year 1938. Five cases were found during the year
that were due to a small variant form of the organisms. These cases are
of parti~~lar interest, bacteriologically speaking. Special effort has been made during the year for the first time to
obtain release cultures on every case of typhoid. Consequently, 95.2
per cent of the cases investigated sent in first release cultures. At
the end of the year 43 remained convalescent carriers and were under
supervision in order to determine what their final status would be.
During the course of investigation and study, 18 chronic typhoid carriers were found who had typhoid prior to 1938. While investiga-
tions were being made, other chronic carriers, formerly found, were vis-
ited and reminded as to their duties in preventing the spread of this
disease.
Two verJ interesting carriers were visited; one a white female,
aged 83, who apparently was the source of infection of 4 cases, one of
which died. In the process of investigation of 2 cases of typhoid in Cherokee County, an old carrier was discovered in the community. Her cooperation had never been obtained, due in part to her poor circumstances and to the fact that she had been ostracized from the community.
She could get no work, had difficulty in finding a place to live, and felt that she was being discriminated against. An attempt, thro~ cooperation of the sanitary engineering and nursing divisions, to sanitate premises and obtain for this carrier some material relief was made.

Bacillary pysentery: During March of this year an investigation of an outbreak of some 30 cases of diarrhea occurring among the students at the Georgia State College for Women at Milledgeville was made. The request for help came from the school physician. Most of the cases had recovered at the time the request was made but, regardless of this fact, stool cultures were collected at the school hospital.
As a result of the generous use of disinfectants in bedpans, all cultures were sterile; not even a colon bacillus could be found on the culture plates. By this time all of the cases had recovered and further stool studies were futile. However, a number of blood samples were obtained on the former cases and positive agglutinations were secured in a large per cent for Flexner dysentery.

Typhus Fever: In accordance with the plan which was adopted for the study and control of endemic typhus fever, a staff member was as-

EPIDEMIOLOGY

23

signed to this particular work. Promotion of the plan consisted of making a county-wide study of every available case of typhus fever occurring in the county before studies would be undertaken elsewhere. The respective counties covered, with the number of investigations made during the year, are as follows:

Crisp 31 Colquitt l02
Dougherty 92
Jenkins 31 Lowndes 49 Mitchell 95 Telfair 44
Wheeler J~ Total ~

The typhus problem was discussed with the county officials and the local health authorities as an ititiation of the work in each county. As a result of these surveys, a surprising amount of rat-proofing has been started in this State and numerous rat poisoning campaigns have been carried on. In addition, quite a few cities have enacted ordinances concerning the collection and disposal of garbage, to minimize rat infestation.
One of the most heartening results of the intensive studies being made on typhus cases in Georgia and the interest being manifested by public health authorities was the fact that the director of Infectious Diseases for the National Institute of Health, and an assistant bacteriologist, United States Public Health Service, T,yphus Research Laboratory, Mobile, Alabama, made a trip to Georgia to investigate the situation.
They were favorably impressed with the opportunities afforded for research work and plans were completed during the month of September for the establishment of a ~phus Research Laboratory at Albany by the United States Public Health Service. An agreement was reached between the State Department of Health and the Dougherty County Board of Health to lease the Hayes Veterinary Hospital to house the laboratory. During September a lease was signed and at the close of the year the laboratory was ready to begin operation.

Hookworm: Due to the large amount of sanitation completed in Bryan County, it was decided to use this county as a demonstration area to show what a combined program of sanitation and treatment could accomplish in controlling hookworm.
The director of this division obtained the cooperation of the local physicians concerning this proposed hookworm survey and control program and, as a result of his efforts, the hookworm demonstration began in Bryan County on September 1, as scheduled. The medical supoo arvision was under a staff member, in cooperation with the local physicians.
The county was divided into eight districts to be surveyed and treated individually. It is interesting to know that the school children who had been treated in previous years showed the lowest incidence. Although the program was not completed at the end of this calendar year,
315 people had been contacted and 255 treated. The program has been

24

EPIDEMIOLOGY

somewhat handicapped, due to the lack of a proper educational program, education depending upon pamphlets and talks.

Poliomwelitis: The only approach to an outbreak of poliomyelitis
occurred during the last quarter of the year when 4 cases were reported
from Cobbtown, Tattnall County, 2 of which were in the same family.

Smallpox: During the spring there was some apprehension that there might be an epidemic of smallpox, due to the fact that in March an un-
usual outbreak, which proved to be of minor proportions, occurred in DeKalb, Fulton and Catoosa Counties. The 3 cases in DeKalb and 3 in Catoosa Counties were investigated and confirmation made. Although several other suspected cases of smallpox were investigated over scattered areas
in the State, most of them proved to be severe cases of chicken-pox.

Malaria: During May and June the plan for malaria investigations was instituted in connection with this division but it was found to be expedient to make a separate division for this particular work. Therefore, a report on special activities in malaria investigations will be found in reports of that division.

Cooperation With Other Agencies

The director of this division has not onLv directed the communicable disease control program, but has been active in extra activities
correlated with public health. He has served as secretary to the Georgia Social Hygiene Council and arranged for Social Hygiene Day, February 2,
1938.
As a member of the Board of Managers of the Georgia Congress of Parents and Teachers, the director made possible the featuring of an
hour program at the Convention of the Georgia Congress of Parents and Teachers in Albany, Georgia.
Through the cooperation of this division, the inspection blanks for the division of dental health education were tabulated, numbering
215,560. It was necessary, however, to employ six clerks and to obtain
assistance from other divisions to carry out this tabulation so that it would be completed for the State Dental Convention.

Nutrition Project: Through the cooperation of the Works Progress Administration, a project was granted for the purpose of compiling and tabulating data obtained from questionnaires concerning a farm food sur-
vey and child health and nutrition study of 685 families and 2,434
school children in Glascock and Hancock Counties. Six people were employed on this project. At the close of the
year the work had practically been completed, but not until the first
of February, 1939 was a printed report submitted. This report repre-
sents a vast amount of work. This division takes this opportunity to commend the Works Progress Administration on the thoroughness of its
workers.

Special Educational Activities

Bu+letins on typhus fever and typhoid fever have been revised and one on hookworm has been edited. The director read a paper entitled,

EPIDEMIOLOGY

25

11 The Efficacy of TYphoid Vaccine in an Acute Water-Borne Outbreak of TYphoid Fever, 11 at the American Public Health Association convention.
All requests for investigations, consultations and many other activities have been satisfactorily dealt with.
During the year 1938 this division directed the displaying of a total of eight health exhibits at various points throughout the State.
A total of thirty-two addresses before different organizations in the State were made by the staff members of this division during 1938.

Communicable Diseases Analysis of Statistical Report

Diphtheria: The 1,232 cases of diphtheria reported in 1938 is the largest number of cases reported since 1934, when 1,233 were reported. However, the 106 deaths and the death rate of 3.4 per 100,000 is the lowest in the history of the division. The fatality rate per 100 is 8.6, which is also the lowest in the history cf the Department. This low fatality rate points to much better reporting on the part of physicians and to the wisdom of free distribution of antitoxin. It is hoped that a more concentrated effort can be made against this disease and that shortly it will become as rare as smallpox.

Pfsentery: During 1938 there were 679 cases of dysentery reported to the division. This is 36 less cases than were reported in 1937, when 715 cases were recorded. However, the 192 deaths is 62 more than reported in 19)7. With the exception of 1934, this is the highest number of deaths and the highest death rate recorded since 1931. The 10.1 increase in the fatality rate points to the fact that cases were not as well reported in 1938 as in 1937, but some better than in previous years.

Influenza: There were 3,782 cases of this disease reported during 1938.~18 the lowest number of cases to be recorded. The previous low year was 1934, when 6,124 cases were reported. The 802 deaths is the lowest on recora and represents a reduction of 44.2 per cent over the previous year, when 1,436 deaths were reported. The lowest number of deaths in any previous year was 1934, when 1,009 were recorded. The
death rate for 1938 vas 25.9, while in 1934 it was 33.6. The fatality rate of 21.2 points to poorer reporting than in any previous year. This vas in part due to the extreme mildness of the disease and consequently the doctor was not called to the case.

Measles: The year 1938 was an epidemic year for measles as was predicte~-rhe annual report of 1937. There were 10,514 cases reported, which is the largest number since 1934, when 25,206 cases were reported. There were 157 deaths in 1938, as contrasted against 540 deaths in 1934. The death rate of 5.1 is the highest since 1934, when it was 18.0. The fatality rate of 1.5 is the lowest on record except 1937, when it was 1.1. This points to excellent reporting of this disease.

~n~cocus Meningitis: During 1938 there were only 4o cases of
this disease reported. This is the lowest number reported since 1934, when 40 cases were recorded. The case rate of 1.3 and the death rate of 0.6 is as low as any previously recorded. The increased fatality rate points to the fact that cases were not very well reported.

Pellagra: There were 1,209 cases of this disease reported in 1938.

EPIDEMIOLOGY
While this is a larger number of cases than reported in any previous
year, the 365 deaths and the death rate of 11.8 compares favorably with
the deaths and death rates for previous years. The fatality rate of
30.2, while high, points to considerable improvement in the reporting
of this disease.
Pneumonia: The 5,165 cases of this disease reported in 1938 was 472 cases less than the 5,637 cases reported in 1937. The case rate of 166.6 is the lowest since 1935, when the case rate was 160.1. The 2,731 recorded deaths dropped to the lowest point since 1933, when 2,314 deaths were reported. The death rate of 88,1 is also the lowest since 1933, when the death rate was 77.6. The fatality rate of 52.9
is the lowest on record. With anti-sera now available for a majority of the types of pneumonia, there is no reason why the death rate from this disease cannot be greatly reduced over the present level.
Poliom[elitis: During 1938 there were 76 cases of poliomyelitis reported. This is the smallest number since 1935, when 37 cases were reported, The 18 deaths reported and the death rate of 0.6 compare
favorably with previous years. The fatality rate indicates that reporting was not quite as good as in the previous two years.
Scarlet Fever: The 782 cases of scarlet fever reported in 1938 is the loweslrllum:ber to be reported since 1935, when 781 cases were reported. The year 1936 appears to have been a peak year in this disease with 1,100 cases reported. The 13 deaths recorded for 1938 was the lowest number in the history of the division, except for 1937, when 11 were reported, The death rate for 1938 vas the same as that for 1937, and the fatality rate of 1.6 compares favorably with previous years,
Smallp~: During 1938 there oc~~rred 33 cases of smallpox, which is the largest number to be reported since 1933, when 47 cases were re-
corded, A large number of these cases were scattered, but two small outbreaks did occur, which were promptly put under control. Fortunately, no deaths occurred, which leaves the previous record intact;
1935 having been the last time that a death from smallpox was reportt~
in this State.
Tuberculosis: The 3,011 cases of tuberculosis reported in 1938 is
the smallest number ever to be recorded in the history of this division.
The case rate of 97.1 is 0,9 less than 19}7, when the case rate was 98.0, The 1,612 deaths reported in 1938 are 63 more than 1937, when the deaths were 1,549. The death rate of 52.0 is 1,7 higher in 1938 than in 1937.
It would appear that this disease has about reached its level until further financial assistance can be obtained to better control and care for these unfortunate people.
Typhoid Fever: During 1938 there were 829 cases of typhoid fever reported. This is 110 cases more than were reported during 1937, when 719 cases were recorded. However, only 121 deaths were reported, which is 18 less deaths than the 139 recorded for 1937. The death rate of 3.9 is the lowest in the history of the division, and the fatality rate of 14.6 is 4.7 less than the fatality rate of 19.3 for 1937. Consequent-
ly, it is readily seen that the apparent increase in the reported cases

EPIDEMIOLOGY

27

was due to the thorough investigation carried out in this State during
1938 for the first time. The death rate of 3.9 per 100,000 stands as a
beacon light for further attempts in the eradication of this disease.

Typhus Fever: During 1938 there were 1,017 cases of this disease reported. This is 75 less cases than the 1,092 reported cases during 1937. Forty-seven deaths were reported, with the death rate of 1.5 for the year. While the death rate is slightly less than the rate of 1.8 for 1937, it compares favorably with the death rate of 1.4 for 1936. The fatality rate of 4.6 is the lowest to be recorded since 1933, when the fatality rate was 4.6. Reporting of this disease compares favor-
ably with last year, and is considerably better than that found in the previous three years. It is felt that the activities of the typhus con-
trol program are responsible at least in part for the reduction in this
disease.

Undulant Fever: There were 83 cases of undulant fever reported in 1938. This is the largest number ever to be recorded in the history of
the division. Three deaths were reported, which is the largest number ever recorded. The disease is probably considerably more prevalent than has been previously thought. The increase in the Department's available laboratory facilities has probably brought to light this apparent increase in undulant fever. More emphasis should be put on diagnosis and thorough laboratory work in attempting to diagnose diseases. Better control measures should be instituted in order to rid this State of infected herds of cattle.

Whooping Cough: During 1938 there were 2,329 cases of this disease
reported. This is the largest number of cases of whooping cough to be
recorded since 1934, when 2,629 cases were reported. The case rate of 75.1 is less than the case rate of 87.4 recorded in 1934. In the pre-
vious annual report, it was suggested that an epidemic of this disease
was about due. This epidemic, in all probability, will continue on
through the Spring of 1939. There were 225 deaths recorded for 1938, which compares very favorably with the 334 deaths reported in 1934. The death rate of 7.3 is the largest since 1934, when the death rate was 11.1. The case fatality rate of 9.7 compares favorably with previous years, and is considerably less than the fatality rate of 12.7, which is recorded fo~ 1934. This points to the fact that the reporting of
this disease was considerably better during this epidemic period than
that experienced during 1934. It is hoped that some efficient means m&1
soon come to light in order to control this disease.

Appendaged hereto are tables showing the distribution of communi-
cable diseases b.1 months, b.1 counties, qy cities of 5,000 and above pop-
ulation, and by color, sex and age. A morbidity, mortality and fataL-
ity table is also attached, incorporating reports for the past five
years.

IPIDDIIOIDGT lllRBim'l'T, lllll'l'.LLI'l'T, .&I!D U'f.UI!T UD8- 1934- 1938

.!!.!!!!!!.
:d.phtherla:

Caae late Per

Death late Per l'atali t;y late

!!!!: .!!!!!! 1001000 Popa.1ation ~ 1001000 Popa.lation !Per Oaftt}

1934 1233

41.0

11111

6.J

15.2

1935 1050

34.7

161

5.3

15.3

1936 1100

36.0

123

4.0

11.~

1937 917

29.11

1011

19311 1232

39.7

106

3., 3

11.1! 11.6

~-\8171

1934 7llo

24.6

219

1935 426

14.1

16~

1936 544

17.11

15

,.17.~
5

29.6 383 211.7

1937 19311

11759

23.~
21.9

1)) 192

.2 6.2

111.2 211.3

Gonorrhea:

1934 1935

53~133

131.4 1711.6

411 36

1.6 1.2

1.2 0.7

1936 5223

1937 19311

~~

171.1 1110.4
151.~

~
21

0.6 0.11 0.7

0.4 o.4 o.4

Intluensa:

1934 6124 1935 102.06 1936 1,223

..2.0g7
~ 11.6

1009 1357 11142

~.I6I Co.J

16.5 13.3 12.1

1937 1 799

4111.0

1436

46.7

97

1938 37112

122.0

1!02

25.9

21.i!

Jlalarla:

1934 1935

~~

1936 11931

164.2 132.9
390 7

411!
~l

13.9 12.11 19.11

11.5 9.6 5.1

1937 6Si3 19311 31116

221.4 123.1

i~

7.6 4. 7

34 31!

lleaa1ee1

1934 252.06

11311.2

5llo

111.0

1932 627

2.0. 7

193 1937

~~

73 301

25
II
10

0.11 O.J O.J

2,1 4,(! 3.6 1.1

19311 10514

339.2

157

5.1

1.5

llellill&i tial

1934 l4o 193, 72

21.. ~

193 11!7

6.1

25
g~

o.s
1.1
2~2

~ 1937
1938

31 1.3

35 2.0

1.1
o,i'

62.5 45.11 35' 37.2 'j().O

Pellagra:

1934 643

21.4

1935 719

1936 1937

I7I~75

2~.11 27.5

~~
391 310

11.7 12.0 12.11 12.0

54.6 'j().ll ,3.2 3,7

19311 12.09

390

365

11.1!

)).2

Ph.amonia:

1934 4935

164.1

3030

100.11

61.4

1935 41152

1Co.1

3035

100.2

62.6

1936 61171

225.0

31!03

124.6

~~ 1937
1938

111g.2 16 ,6

3077 2731

100,0 1111.1

553 54.6 52.9

Bote: 19311 deatha include raeidenta of Georgia cl,y1ng in other atateo

md are excluaiTe of non-reoi denta of Georgia.

JPI DDIIOIOGY

29

MlRBIMTY, Mlll'U.LITY, .1ND l!'.u'ALITY RAT!S- 1934- 1938

Ileaaea

Caae Rate Per

Death Rate Per Fatality Rate

Year Oases 100,000 Popu.1ation Deaths 100,000 Po1'U1ation (Per Cent)

Poli01111eli tis:

1934 48

1,6

26

0,9

1935 37

1,:?

16

0.5

1936 1937

1;,

5.4 3.1

29 20

0.9 0.7

1938 76

2.5

18

0.6

Scarlet rever:

1934 574

19.1

17

0.6

1935 781

2~.8

1936 1100

3 .o

ia

o0..8,

1937 935

J0.4

11

o.

1938 782

25.2

13

0.4

lballpoz:

1934 14

o.s

1

0.03

1935 31

1,0

1

0,03

1936 16

0,!)

1937 15

0.5

1938 33

1,1

Qrphilio:

1934 4664

1,5.1

444

14.8

1932 193

m~

1937 15341

2 2.8 283.0 4g8.6

~
1196

la3 1 5 16,1

1938 ll\Q43

582.1

478

15.4

'lllberca.l.oaio:

1934 3647 1935 3588

11128l,.a

1TI2 1731

58.9 57.1

1936 1937

33031ll

108. 98.0

1713 1549

1938 3011

97-1

1612

56.1 50-3 52.0

'!7pboid J'eTOr:

1934 1252

41,6

193g 193

1~~

334
30.~

1937 719

2t.~

316 261
195 139

10.5 8.6 6.4
4.5

1938 829

2 7

121

39

'1)-pbna J'rler:

1934 414 1935 489

1~.8 1 ,]

1936 817

26.11

28 28 44

0.9 0.9 1,4

1937 1092

35~

1938 1017

32.11

'~

1.8 1.5

Uncmlant rever:

1934 63

2.1

1935 67

2.2

1936 6o

2.0

1937 58

1.9

1938 83

2. 7

1

0.03

1

0,03

1

0,03

3

0.1

..ocrping Oongh:

1934 2629

87.4

1935 1206

39.11

1936 702

23.0

1937 1714 19311 2329

557 75.1

i~
67 142 225

11.1 4.9 2,2 4.6
7.3

Rote: 1938 deatho include reaidento of Georgia dying 111 other otates and are ezc1uaive of non-reaidente of Georgia,

54.?
43.~
17.6
21.~
23.7
3.0 2.9 1.3
1.2
1.6
7,1 3.2
9.5 55 5ol 3.2 2.6
48.6 48.2 51.6 51.4 535
25.2 25.6 21.1 19.~ 14,
6.8 5. 7 ,.4 9 4.6
1.6 1.5
1.7 3.6
12.7 12.4 9.'5 8.3 9.7

.1!.!!.!!!.!. Total

~etinOJD7COa11

3

Aaa.te Inf. OonjUncti vi tie .lllthra:z

-33

Cerebroopinal lleningi tis 110

IJ>.icken-pox

161!2

Dongu.e

12

llphtheria ~eenteey, .lllebi c

li~

~eenteey, :Bac111&17

510

Gonorrhea

461!6

BooltWorm

17711

Influenza Leproq

371!2 2

Lethargi c :a.cephalit1o llalaria

7 31!16

~

lleael. . ltullpe

s0 Parat)']>hoid

... Pe111J8ra

a Pll-nia

!If

PoliOJD78li til Puerperal Sepa1o

10514
1506 26
1209 5165
76 26

lla'ti eo (In llan)

2

!lhewu.t1 c lever Bocii:T lit. Spotted rner

-31!

Scarlet rever

71!2

Screw Worm Infection (In Wan) 4

Septic Sore Throat 11Da11pox IIYPbili

505
11!0,~

Tetanue

51

!rac!loma

28

Trichinoa1e

1

!uberculo a1e !lllaremia

3011 62

!'Tphoid rever

829

!JPlm liver

1017

Undlllant liver

1!3

lhooping Oongh

2329

.0....

Total

79025

alllll111r C.AJ!LE mSEASES llEroR'rED Ilf GK>RGI.lliY I[)NTI!S, 1938

Janua,. lebl'11a!Z

-

-I!

6

7

6

306

361!

66 I! 7 355 1619
-101!7
62 12411
353 1
74 766
2 4 1 2
-
82
4'
1276
-2
247 5
10
50 3 162
7858

44 4
11 411! 311!1
-7lt9 1 127 3120
-212
51 776
3 1
-6 -58
52 2 141!1
--2
211! 10 14
21!
5
237
11191

llarch J.1l.!i.L .l!!!l..

- 1 -

-4

3

--

I! 279

~-

4 111
1

42 30

26

14 15

15

3
~~

~g
2219

177
395 735

- - 429 23-2

92

1

111 174 296

11!119 2147 lo67

251 211! 182

4

5

3

1!1 654

~~

149 367

~
-~

7 5

3
-2

1

4

3

- 36 34

110
-

34 72

31!

16

2

2

--1467
26o
11 )4

11!72
,--4
288
9
30

1629 7
-24
329 3 52

32

58

6

10

214 303 385

1!824 9092 6205

JUne
-
-2
1 62 4 20 14 133
g~
--63
217 41!6
-1!2
~~
12
-1 -2 -31
17 2
1590
-2
1 235
6 166
76 11 21!5
4874

~
1
-2
2 7
61 19 50 431! 616 65
1
414
209 23 5 155 219
-10
1
1-39
34
2 11!08
9
-2
288 2
11!9 142 10 322
5146

...A!!il!!!L Sept..ber october lfovanber Docember

1

2

2

-

2

4

2

2

-

7

1119 235

20

13

37

22

1104 473

1102 1!30

- 45 110
1

1

1

51!1! 712

65

26

JO

29

5

2

145

76

150 11!2

6

7

1

-5

-6

-3

-110

70 1

-52

46

1421! 1334

--6

4 1
-

210 2

29,

165

59

145 150

12

10

lJO

87

4252 4830

--3
3-5
323 15 11 390 1903
-191
6o3 25 37 1 101!
290
-7 -3
123
-36
1775 6
--
232 3
39 119
2 85
6365

--
2 75
169 16 17
290
1364
-164
44o
~
61 381
--6
3
126 3 42 1
1155 4
-
156 2 26
110
4l
4766

-1
1 11!9
67 16 9 3'[1 1569
-555 3 72 219
Q5
-
39
628 8 1
4
10-3
37 2
1221! 5
-1
225 5 35 79 7
---1!..
5622

Under 1 1- 2

IPI DDIIOIDGT

31

. .. ll:l'l'In.Al!LJ m WSIS REPOBUD l!T CDIDR, SU, An -'GI, 1938

tl

iH
0

i..

~

i
.i..a..:.
{J,t,

I C I CI cI CI cI

oI CI CI C

II 6

3

r 211

1

54 9
1 1 47 11

II

1

r

2

3 II 72

2 1

29 !! 22 7

2- 3 3-4 4-5 5-6 6- 7

1 2

2 11

II 22 4 4

r 20 3 1

1

2 1

7- s

rII

~w

4

4
2

s- 9

1 2

II 4 1 2 r 26 4 2

10- 14
15- 19

2s
5 17

II
r

6 11

7 2 14

3
2

1

II 2
r5

12 5 2 10 6

II
r

3
2

12 ~ 1 12 ~

II
r5

22

2

12 2 1

35- 39

II 1
r1

61 2 74

llo-44

II 1
r

61

7

1

II

1

r

2

II
r

5

1

551

55- 64

II
r

1 1

II

1

r

111

75 I Above IrI Unlmown Ac rII

3
1

1~~

2

4

Lf 1 14 2 1

!otel

rII

11~~111

~~ 116 VI 124

J1J7

15 8

51 24 62 32
12
64
21 11
42 21

3
11
443 61
652 1 79
10 4 5 291
1 16 s 1
76 2 I 6 10 1 1
s 41 68 1 1
62
II 4 22

7 7 2 5 33 27 32 1
10 29 1 2 ~ 23 21 2

1 1 4 5 1 1 38 27 , 3 2

1 31 95

27 19 20 3

32 91 1

28 2011! 11 ~

1 77 149

3 13 27 25 11

6o Ill 5
2 80123 2

23 21 35 8 8 18 16 27 5 1

4 61 61 3 1 20 12 47 8 3 57 73 1 3 9 9 20 7 2

113J

1~ ~

41 20

3
2

3
2

61 43 1 3
35 49 2

21 1
11.3 26 2 22 25 3 1

6 6 42 3 7 31 92 2

82 ~ 1 1 54 19

43 17 1 1 110 14 1

4 4 1~ 3 1 5

1 28 16 16 14

12 1
24 16 11 12

~ 10
39 !! 27
~
46 6 43 14
2
3 22 23 12 2 16 2 2 23 6 25 3
2 2 1 22 1 1 11
1
1 2 1
11 2
1

32

liPillBIMIOLOGY

NOTIJ!'Um.:&: DISEASBIS REPOR1'ED BY OOLOB., SIX, AND AGE 1 1938

.

Age Level b;v

....'Cil
"~.
p.~

Tears

f.O

i i,D "

't..:.
,!J
-a
~

.~
.+e;'0;
~il

.~~...~......
tl ~.::

.
'5
~

.......

.. .....
'..".... gI"I

::
::::
...~"...

'f c 'f c 'f c 'f c 'f c 'f c 'f c 'f c 1' c

Onder 1

M2
r

1t 6

2 2S 7 & 5 l l 7 2

4o 32 3

10 2 1

12 10 5 2 17 1 1 1 37 2& 1 1

1- 2

II
r

31 1 33

~2

1

2il g
2l 3

6 6

II 1

113
llll

5 3

27 19 5 1 23 8 2 1

2- 3

II J1

~ 2~ 2

l

6

15 2 6 11 87 12 1 13 5 7 II 88 10 l

117 211 7 3 30 17 II l

3 -II

II 1 J

62 15 &7 7

10 1 10 111 72 10 8 1 12 12 90 7 1

27 11 2 32 5 1

II- 5

II

66 12 2

J 2 1 53 9

2 16 12 101 11

5

9 6 106 6 2

37 lli 3 20 8 1 1

5-6

II

J

4o II 2 4o 9

II 1 10 11 109 111

2

9 7 105 12

211 8 1 18 5 3

6- 7

II J1

Ill 2 112 6 1

1 20 16 226 18 1 2 1 13 111 201 211 3

36 b 2 2 23 8

7- s

II J

1 ~~

8 8

2 19 12 201 27

1 2l 10

1

II 13 10 2111 33 1

23 6 1

s- 9
9- 10

II 1 1 25 2

J

26 7

12 1

II J

18 12

~1

2

111 12 16& 15 1

27 6

6 11 163 2l 1

2l 7 1 1

u 10 10

1~~

8 II

~ 1

11

51

10- 111

~ II 2 1
J1 1

7

l

15 1

5 3

s6 63 176 23 3 l 115 26 7 58 ~ 176 23 7 2 115 111 l 1

15- 19

II

J

1 8 31 1 17 II 1 1

5 2

2

71
56

51 66

69 18 6
61 17 12

2 5

53 4o 5
20 16

1

20- 211

II 2 J2

1 22 1 1 2l 5 3

II 5

1 3

77
77

g~

27 51

s7

2 10

1 11

2S 113 22 26

25 - 29

II J

II 1 2

II 2 77 39 211 11 3

32 25

II 1 1 1 II 1 62 39 30 5 23 22 16 19

30 - 34

II
r

2 16
11 3 s

II 72 25 23 1 2 1 35 23 6 ~ llll 27 1 25 27 17 15 2

35 - 39

~ II
J1 1

11

1 56 26 9

9 2 26 33

3 1 II 1 30 32 10 II 113 311 15 16

4o-llll

II

J

II

3~ 2 2 6 1 liS 18 II
2 2 6 liS 211 9 2

1 111 23 26 13 7

115 - 119
~-511
55 - 611

II J II 1 J1
II J

1

31

II 1 1

1 12 1 13 1

II 5

3 5

~~

2l 18

&2 11

211 211

~a

12 2

II II 52 28 11 2 31 23

2

6 II

6

37 10

&

0s

1 1 211 13

1

211 7

2 115 29

~

23 9

'17
15
311 17 2l 12

65- 711

II 1 J

b1 1

7 111 20 3 7 3 23 7 5

29 15 27 8 36 16 25 &

75 & Above
Unknown Age Total

II J
II
: 1~

2

2 1 11 2 1

211 3 15 7

1

II 3 10 6 2

[}2 17 23 II

fa rn lm 2 ;~ ~ ~ 1 !~

I~ I~!

1119 112

~ 118 II 1?1 112

f~ li

1

11~ 1~

1~

~ ~~l:ri~ lm~

~~ I~ I~ ~~~

~~

IS 8

EPIIlliliiiOLOGT

33

NUMBliR OF CASES AND CASE RATlli PIR 100,000 POl'ULATION OF SPICU'IJIII' BOTIFIAllLE DISEASES RlllPORTlliD IB GEORGIA BY COUNTIES, 1938

Area

let!.mated Population

Cerebrospinal Meningitis

Diphtheria

Gonorrhea

Influenza

Cases Rate Oaaea Rats Cues Rate Cases Rate

State Total lillral

3.099, 74~ 2,160,~

Ci tiea 2500 - 5000 117,

Cities 5000 & Above 821,575

Appling Atkinson !aeon
:Baker :Baldwin Banke

14,296
7.934 7,~1 8, 3 23,992 11,106

Barrow :Bartow Ben Hill :Berrien lllbb llleckley
:Brantley Brooke Br,yan l!ullooh Burke llutto

13,721 27.558 1~, 715 1 .782 79.o63 9.991
7,687 22,~ 6, 29.~3 30, 3 9.510

Calhoun Camden Candler Carroll Catooaa Charlton

11,33~ 6,68
9,898 37.1~ 10,3
4,917

Chatham Chattahoochee Chattooga Cherokee Clarke Clq

108,1o4
g645
1 .941 22,750 26,083
7.520

Clqton Clinoh Cobb Coffee Colquitt
Collllllbla

10,978
7.757 37.916 22,305
33.229 9.618

Cook Cowsta Crawford Criap
Dade Dawson

12,515 26,571
7. 713 18,498
4,814
3. 766

Decatur DeXal.b Doc!t;e
DoolT Douchlrt;r Douglas

~:~~
24,008 19,~ 22, 1
10,377

4o 1.3

~

1.2 34

11 lo3

- - 1 7,0
- - 1 12.9

- - 1 4.2

---- ----
- - 1 1.3

--

- --1 --

4-.4
--

---2
--

17-----.6

-6 5-.6

1
--1

-~-.49

---- ----

-2 6-.o

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

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

1232 813
42
377

39I 37 ~57
59

3 21.0 2 25.2
-- --7 90.2
3 210

7 50.11

15 54.4

1 1

~.o3

38 48.1
4 IW.o

4 52.0
-2 s-.s
17 57-~
- - 10 32.

2 17.6
- - 3 44.9 1--0 --26.9

- - 37 34.2
18 106.3 8 g52 17 52 1 133

~ 82.0 773 19 ~0,1 11 93
- -10 30.1

2 16.0 1 37 3 ~8.9
- - 8 32
9 239.0

--
16 21.5 4 16.7 2 10.4

7 10

3960.1o17-

4686 151.2 3782 122.0 1672 77.4 2258 1o4.5
201 171.0 180 1531 2813 342,4 1344 163.6

- - 15 104.9 - - 10 128.5 - - 13 54.2

6 42.0 1 12.6
- - 1 12.9
4 16.7 22 198.1

3 21.6
- - 9 32.7
9 536 12 15.2 16 160.1
- - 14 61.~ 1 15.. 20 67.7 15 45.0
1 10.5

7 50,4 21 76.2
- -3 21.9
20 253 37 3703

2 26.0

6 26.3

82 1262.3

37 125.2

i~

1730 147.2

5 44.1

1 15.0

1~

~05 ~1

52 50 1

17 3457

11 97.0 2 299 3 303
10 26.9 12 116.5
6 122.0

887 820,!)

201 2064.5

8 47.2

-~~

65.9
92-.0

-
13 167.6 18 47-5 37 165.9 27 81.~
1 10.

456 421.1! 2 20.5 1~ 100.~ 26.1+ 16 61.3 1 133

3 213

1 12.9

32 84,1.1

8
~~

~9
1 5 249.5

- - 2 16.0
1 13.0
- - - - 4 21.6

8 639 16 6o.2
4 51.9 21 1135
- - 1 20,1!

29 113.4 22 30.0 13 54.1 22 114.0 34 148.9 2 19,3

5 19.6

1~

168.0 100.0

136 7o4.s

21 ~0 36 3 9

l1Pll8110LOGT BUMDl\ OJ' CASII:S .AND CASI BAD PIR 100,000 POl'tlLA'rlO!I OF SPIClFUD
IIO'rtrlAl!LII MSIAS3S BEPORTID 111 GEORGIA BY COllN'rl:&S, 1931!

.Area
lar17
lchole lt':Clngbaa llbert :ra.am.el :Ivane
J'annln Fqatte no,u rorQ"th J'ranklin ll!.lton
GU.111er Glascock Gl7m Gordon
GradT
Greene
ilwllllllltt
Baber sham Ball llancock Baraleon Barrla
Bart
Be&rcl. Bell17
Bouaton Irvin Jackeon
Jaaper Jet:t: Davia Jet:t:ereon Jlllldna Johneon Jonea
:r-ar zL.a..nui.e..r..
t... Libert, Lincoln
Lone Lcwdea r.oup!dn Mcn.!:fle llcintoah Macon
Madl~JCn
Marlon Merivether Mlller Mltchell
Monroe

letl.aated Population
19,1!32 2, 752
11,022 ~.61!9
7:~
15,0~
9,2 52.521! 12,21!2 17.469 J46,o68
8,499 4,809 20,613 18 ,SlS 21,073 13,020
1~,924088
3,.861 1 ,077 1124,,0517'
17.335 10,191 17,120 11,~ 13,~ 23. 1
9.073 1!,679 22,187 13,fio9 lJ, 710 9.825
10,~
38a, :m 8,m 9.
4,419 32. 2JI!
5.~
9. 157,.~2
16,5~ 7.5 24,J6s 10,248 26.400 12,530

Cerebro~~
Men!.Dgitia Diphtheria Gonorrhaa

Casea !ate Caaea !ate ea.... !ate

------ ------
--- ---
- - 1 S.l
8 2.J
---- ----
-1 4-.7 -- --
---2 5---9 ------ ------
--
- - 1 11.5
--1 1--3 ------ ----------- ----------- ------

- - 7 353

~

210 20.3

- - 20 76.J

--4 --20,2
9 457 53 202.1 2 251!

20 1332 4 26.6

3 ,2.5 1 10.8

- - 23 3!1 49 933
155 1262.0

15 161

~9 70 400.7 5 1378 398.2

- - 2 235
6 29.1
- - 13 69.1
5 JS.4

7 82.i 2 41. 2 97
31! 201.9
-3 14-.2

4 13.6 3 21.1 19 56.1 1 7.1 2 137 5 41.7
1 51! 9 I!S.J 14 1!1,1! 1 1!.7 2 15.0 6 255

1 34 9 63.3 31 91.6
234.4 3' 214 3 250
--
5 49.1 10 58.4 3 26.2 1 7-4 14 59.6

1 11.0 1 11.5
i ~.51
3 21.8 9 91.6

10 110.2

2 23.0

- - 3
5 9

135
~.14

-4 31!.6
22 63.2 1 11.6
-1 11-.7

1 9.6 1 18.2
- -31 1!9.1
5 51!3 1 11.0

1 22.6 12 372 1 18.2
5 51.8 3 507 2 11.5

2 45-3 85 2637 11 200.3 6 62.1 5 84.5 8 45.8

3 18.2 2 61.0
- - 5 20.5 - - 4 15.2

3 18.2 3 91.6
- - 7 21!.7
46 174.2 6 47.9

lllflu.ensa

Caoea !ate

-s - 14 70.6 7l.l 20 101. 46 175.4
3 Jl!.7
6 40.0 2 21.7 151! 300,8 7 57.0 4s 274.! 481 139.0

3 353 1 20.8 20 97.0
s24 l2is7.;o5
9 9.1

12 40.7

19 133 7

34 100,4

25 177.6

11 .2

7~5 1 7

11 51

50603..,

6 3

~.02

13 8S

91g 374.

12 132.3 1 11.5 5 22.5 2 14.7 9 65.4 3 30.5

-3 21!.9
56 16o.~ 6 69. 3 350 1 77.3

11,.1 2' 7 .4

17 309.6 4 41,4

3 7

~.11

2 12.1 4 122.1
- - 32 1313
'~ 113.6 327.2

IPil:ID!IOT...Otr!

35

IIW!BlltR OF CASES AND CASI!l RATll Pill 100,000 POPOL.I.TIO! OF SPICIFIJID NOTIFUJ!Lll DISIA&l:S llm'OIITllD I! GIORGIA J!Y COUNTIES, 1938

Area
Montgomery Morgan Murl'aT Muecogee Iewton Oconee
Oglethorpe Paulding Peach Piclceno Pierce Pike
Polk Pulaski PtltDall
~itmen
Rabun Randolph
Ricbmond Rockdale Schle;r Screven Seminole Spalding
Stephena Stewart Sumter 'hlbot Taliaferro Tattnell
!l!qlor Telfair Terrell Thoma !ritt !'combo
Towne Treutlen !'roup !urner !viggo Union
Up eon Walker Walton Ware Warren Waohington
Wqne Webster 'llhaeler 1lh1 te llhl.t:l'ield Wilcox
Wilke a Wilkinson Worth

llloUmated Cerebroopinal Population Men1ng1Uo Dipht..'>er1a Gonorrhea

Influenza

10,928 13.065 10,370 58,5~ 18,0 8,635
14,297 13,919 10,573 10,941 13,834 11,505
27.047
9.599
~,109
,481! 7,016 18,)04
74.566 7.26~ 5.6 23.291 7.925 23,1!58
13,2~
12,18 28,054 9.588 6,618 16,888
11.351 16,300
1~,082
3 .674 17,091 19,153
4.998 8,156 39.~5 12, 5 9.511 7.313
20,870 28,~ 23,1 28,051 12,303 26,300
13,802 5.4o3 10,337 7.o79 12~~9708
16,~8
11, 3
23.470

Cae Casea Rate Caeeo Rate

Rate Caaea Rate

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

2 111.3
g 23.0 57.9 10 17.1
- - 9 49.9
4 28,0 1 7.2 5 47.3 12 109.7 1 7.2 2 17.4

--
19 145.4 2 u.31
i 4 - - 244.1
--
1 7.2 70 662.1
5 4g. 7
g 532~:~

-

- -23 176.0

i~
li

~.16 23.2

25 174.9
i~ 21.6 132.4 201.1
l 14.5
25 217.3

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

12 44.4
l 10.3
- - 3 32.9
5 71.3 2 10.9

- --- - 36 1331
l 14:; 3 16.

:: 1!8.7 20.7
\ 1537 8~.1

l 31

1169. ~

----1 1----.3
1 4.2
-- --
---1 3---6 ---- ----
- - 1 59
------ ------
--- ----2 7--.1
-----2 14-----.5
-- --
1 4.3

- - 53 71.1
1 17.7

3 12.l 1 12. JO 125.7

-- --
5 17,8
- - 2 20.9
1 59

--

3 18.4

~

15.7 11.5

2 11.7

3 15.7

--
1 12.3

38 97.2
-1 1-9
1 31

9 43.1 11 ~.2 14 4 1 36
4 32-5 4 15.2

-5 36.2
10 96.7 3 42.4
17 72.7 1 6.9
-- --
3 12.8

352 472.1 4 551 4 70.7 11! 773 28 3533 20 1!3.8

-6
3

~-.~6

11 114.7

1 15.1

4 237

J 44.0 147.~
25 131.0 28 80.8 29 1~.7 5 .1
-- --
26 66.5 2 15.8 1 10.5 2 27.3

~
8

11' 3904:~

31 110::

1g 624o:.1

-1l. -1 1~
9 4 5 5
- - 83 354.7

2 12. 46 4o1.; 45 191.

5~ 751
1239

~

177 25.8

81 1022.1

13 545

~ 45.4 49.2

- 17 60.6
~ 6o.4

7 41.4

-

g~

362.0 3~1

50 1 .2

~ 52.7 10.4

1 20,0
- - ~ 107.4
7 736 47 6112.7

3C 1437

~~5 17.4

4i

l u.72
48.8

2~ 83.7

-

li
~
29

222.1 1~.11 85-~ 200.

~~
le

~.9o
256

IPIIlllliiiOloOGT
NUMl!IR OF CASilS AND CASII ~ Pill 100,000 POPULATION OF SPlll CIFIID NOTIFIAJ!LE DlSIASIIS l!ilPORTID IN GlllORGIA BY COUNTIES, 1938

Area

Malaria

Measle a

Pneumonia Pol1o11QJ'el1tis Scarlet l!'ever

Ca.e Rate C&aea Rate Cases Rate Cases Rate Cases Rate

State Total

3816 12J.l 10514

Rural Cities 2500 - 5000

2793 475

~.31

5397 288

Ci tie a 5000 & Above 548 66.7 4829

3a9.2 5165 166.6 2 9.8 2931 1357 245.0 281 239.1 587.8 1953 2377

.lppli~~g
J.tldneon !aeon Baker Baldwin
Banks

- - 11 769

4 4

~4
.2

2 8.4

2 18.0

- - 25 174.9
- -- - 1 12.9
35 315.1

16 111.9
5 ~0
5 3 7 80.9 17 70.9 17 1531

Barrow Bartow Ben 11111 :Berrien Bibb B1eckle;y
Brantle;y Brooks Br;,.an l!u.lloch
Rurke
l!u.tta

6 43.2 1 36 1 13 17 101.~ 10 12. 17 170.2
--
300 1314.5 77 11853 39 132.0
- - 251 8191

39 281.0
- - 72 261.3
~~2 11.~ 843. 160.1
--- ---
120 406.1
- - 54 176.2

15 108.1 60 2177 19 1385 19 113.2 90 113.8 54 5110.5
g 104.1 25 109.5
J 138.5 88.0 64 208.9 21 220.8

Calhoun Camden Candler
Carroll Catooaa
Charlton

~ 1141.1 89.8 7 707 14 311
- -4 38.8

2 17.6 42 628.4 1 10.1
93 2503 71 689.1 16 3254

22 194.1

5 74.8

13 131.3

3~

94.2 58.2

3 61.0

Chatham Chattahoochee Chattooga Cherokee Clarke Clq

210 194-3 12 1233 10 59.0
5 22.0 2 11 1 133

lo6o 980.,

1~8 1417.

1 6 979-9

114 ~-0

- - 116

1

~ 254.4 4~1.l!. 28 1~3 56 2 .2
32 122.7 11 146.3

Clqton Clinch Cobb
Coffee Colquitt Columbia

1 9-l

6 113

8
~f

22614..g1
201.

4 41.6

11 100.2

2 25-8

328 8~.1

10

.8

- - 79 2377

9 82.0

7 90.2

87 229.,

a~

170. 123.4

1 72.S

Cook Coweta Craw:ford Crisp
Dade Dawson

63 503.4
3 11.3 1 13.0
- -- - 30 162.2

17 13~8

- - 15 5 5

3 16.2

5 1

l~:g

l!.2 3356 35 131.7
~' 194.5 129.7 2 41.~ 1 26.

Decatur Dei&lb Dodge
Dool;,. Dougherty Douglas

35 1369 7 9-4 31 1~.1 78 40 .2 91 3985 22 212.0

7 27.l!.
295 3~4

10 1.7

l

5.2

16 1053

1014770:.~1

24 93-9 93 125.0 29 120.8 31 16o.7 34 148.a 32 308.

76 2.5
50 2.3 5 4.~
21 2.

---- ----
1 4.2 1 9.0
---- ----
-1 1-.3
--- ---
--l 3--4
------ ------

5 4.6 1 10.3

l 1
-1

':~ -38

---- ----
- -l 30

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

--

l 1.3

---2 -8--.3

782 310

ia2 1 3

27 2a.o

445 5 .2

-- --

- - 1
-

-12.9

2 18.0

2 14.4
- - 5 18.1
3 17.9 18 22.8 1 10.0
--
6 26.a 1 15. 5 16.9 1 33 l 10.5
--- --
6 16.1
- - 5 48.5

41 379

3 3o.s

l 4

157. ~

- - 14 537

-- --

35 923 1 4.5
- -3 9.0

8 63.9
----l -3---7
--
37 49-7
- -2 8.3
2 8.8
27 26o.2

lD'IlliiiiOLOGT

37

lfl1MBIR OF CASBS .&liD CASB RATll PllR 100,000 J'OPULATIOII OF SPICIFIID NOTIFIABLE DISIASBS IIIPORTID Ill GIORGIA BT COll!l'riliS, 1938

Area
larq
lchob ltf1J18baa llbert ....,uel lvaAa
ranntn lqette llo7d ror17th lrankl1n J'uJ. ton
IUJ.mer Glaaooolt Gl.Tnn Gordon
Gr~
Greene
Gwinnett Baberahaa Ball llanooolt Baraleon Barrla
Bart Beard Benr,y Bouaton Irw1D Jaolteon
Juper Jeff Davia Jertenon Jenld.na Johnaon .Tone a
Ioamar Lanter Laurena :Lee Libert;r Lincoln
Long LoVIldee Lumpkin llcDurt1a Mcintoah Macon
Ma41aon Marion Meriwether Miller Mitchell
Monroe

llalaria

llaaslaa

Jl'n..,_DI.a

PollOIIIT8li tie

Scarlet Fever

Caaea Bate ea... Rata Casea Bate Oaaea Bate Caaea Bate

- - 22 110.9 I
- - 5 44.9
181 69<>.1 1 12.9

-- --
6 539 452.0
2 - - 915

- 31 1563 6 539 37 187.9 21 80.1 4 51.6

--- ----
- - 6 22.9

--2 --10.1

1

~.1

-1

3-8

--
2 21.7

- - 7 46.6 12 799 10 108.3

-- --

~

20.0 43.3

- - 6 11.4 242 46CJ.7 124 ~6.1 33 268.7 20 2.8

21~~ 10 572
48 139

108.8 34 194.6
622.4 996 287.8

1 1.9

2

-1 8.1

2

5 1.4 31g

l.~g.8
28. 91.3

1 11.8 3 62.4 1 4.9 6 3lo9 75 3559 1 11
1 34
- - 4 28.2 - - 15 1o6.6
3 25.0
-- --
5 29o2 10 873 12 89.8 35 149.0

11 129.4 7 145.6
201 9751 73 3879 1 4.7 19 145.9

4 13.6

~ 173g,87

~

35~
21

10 83.4

1 511

117 1148.1

12 70.1

..g

78.6 ~.4

245 1 3.0

- - 11 129.4
42 203.8 44 2338 23 109o1 17 1J0.6

18 61.1 20 ll4o.8
52 153.6 11 78.1
8 ~9
17 1 1.7

16 923

1~

88,3 93g

9 78.

25 187.1

37 157,5

---- ----
- - 1 4.7 -- --
1 30
- - - 1 7.1
-
------ ------

-- --

- - 6 29.1

2 9o5

1

11

3 10.2

1---~

a15.32
---

3 173

- ---1

-9.8
-

8 34.1

2 22.0
5 576 2 9.0 189 1388.8
- - 15 108.9

-9 99-.2

2 90

26 19lol

ljo
9

29910.g

17 187.4

12 1383 22 99.2

28 13

~.14

5 509

-- -1 11.0
-
1 13
- - 1 73

----
1-

----
-13

- - 8 77.2
~ 824.8 ~2.1 - - 23 8.3

-- --- -- 103 296.0
1 11.0

5 48.2

1~63

54.6 198.3

1gg.l

4

1

3 331

-- --

-1 -
-

2---.9

-7 1---2

-67-5
-345
--

30 678.9
-- 3---1 96.2
29 166.2

-ig 102.4
291.4 1 10.4
2 338 1 57

1 22.6
24 74.4 12 218.~ 21 217.
7 118.2 29 162.2

--- ---
2 20.7
- - 2 33.8

--

1

3o1

---1 ---18.2

--
2 61,0 10 41.0
3~ 13296. ~ 2 16.0

3 18.2

- 3
88

Jl.6 1.1

64 242.4

2 16.0

15 9Q,S
~15 4579 201.1
39.0 19 72.0
15 119.7

-- -- -1 4.1 - - 3 11.4

------

------

38

IPlDJIMlOLOGT

llt1HliiR or CASES .AND CASI RATI PIR 100,000 PO:I'ULA1'10N or BnClPD!D
NOTlrlAl!LJl DlSIDASZS l!ZPORTID IN GliORGlA :BY OOU!I'rU:S, 1938

Are&
Jlontgou17 Morgan
Jlurrq
lluooope levton Ooonee
Ocletborpe Pau.l41Dc Pe&Ch Picana Pierce Pia
Polk hl&ald. Pu.tQaa Q.u.ltmen
la.bQn
llaa4olph
Biohmond
llllckd&le Schlq So raven Seminole 8p&l41DC
Stephen a Stev&rt Suater 'falbot
~aliatorro
'f&t\nall
!qlor 'fel!&ir 'farrell '!home.a !itt !J!ooaba
'fovna 'freutlen !roup 'fluoner 'l'vicga 11n1on
11paon 11&1Dr lfaltoD 11&re 11&rren
, _ll&llhiDCton
Webater 'llheeler White 1lhl.ttield 111loox
Vilaa 11illt1neon Worth

11&1&1'1&

ea... la.te

2 lS.g

4 30.

2 19.g

- - 15 3

~:6

- - 1 7.0 - - 57 539.1
2 14.5 6 52.2

32 118.3
- -1- -10.3
1 14.3 14 76.5

142 1~.4

3 1.3 1 17.7

~

128.11 807.6

9 377

1 7.6 5 41.0 231 82J.4
- - 5 52.1
4 2).7

14 123~

~~

337 324.9

~

72.1 93.6

6 313
--
1 12.3

48 122.8

7 553
- - 1 10.5

6 28.7 3 10.4 32 138.1 1 3.6 1 8.1 59 224.3

2 14.5 19 3517
- - 3 29.0
2 8.5 22 152.0
-
8 69.8 33 lllo,6

lle&aleo

Caoe la.te
--
88 673.6 4 ~.6 201 335 7 J8.8 1 u.6

43 J00.8 3 21.6 10 94.6 301 2151.1 1 72 14 121.7

145 536.1
-- -- 1 u.o
17 242.3 88 48o.s

174 2334

2 215

1 177

~

~II 7 7

1111 7511 7

- - 19 1437
33 117.6
- - 1 10.4
--

-

10 61.3

~

26.2 11.5

5 2

1209. ~

- - 1 20.0
- - -98 2507
13 1778

14 67.1 119 4~.1 15 .8 98 ~.4
~ 5 9 1293

51 16

~.51

llo JS7.0

15 211.9

37 158.1 1 6.9

--

3 26.2 33 lllo.6

Pnewaoni& PoU~llth

Scarlet fever

eaeea la.te

g 732

16 10

19226.. ~

72 12).0

~

1~7 3

9 ~0

~

1 416.2

34 310.8

13 94.0

50 434.6

ea... la.te
--- --- --2 -3.4 ---- ----
- - 1 7.2

0&181 la.te

-

- - 8 61.2

20 34.2

- -1

55

-- -

- - 1 66.2

- -1

7o2

47 173.8

22 227.5

3 2

~:l

2
38

m28..~

-2
- - - - -

-7.4
--- !

6
--1 -

22.2
10----.3

247 3313 17 2)4.1

7 1237

~

115.9 201.9

38 1593

4 5.4 1 13.!1
- -- - 1 17.7
--

- - -14
1

18.8
-4.~

1 12.

5 21.0

14 20

~.91

36 7

1n28.o.3

3 453

17 100.7

16 141.0
50 ~7
83 350 65 187.5 39 228.2 11 574

1 20.0 5 61.3 82 21)9.7 6 47.4 4 42.1 15 21)5.1

16 76.7

~

798 103.6

47 167.6

11 89.4

37 lllo. 7

10 72~5

3 11

1~:~

J 70.6 111.1

14 96.8

13 78,6 12 104.7 45 1917

1 7.6

- -1 -
-

8.2
-

5 29.6

-- --
- - 1 5.2
1 59 1 5.2

-- --
- - 2 5.1 - - 1 10.5

-- -
- - 2 8,6
1 8,1 1 3.8
---- ---- - 2 8.5 -- --
1 4.3

- - 4 }0.2
- -- -3 10.7
- -

--

t2 2 12.3
1 5 14

- - 1

59

-- --

25 639

1

7-9

- - 1 10.5

-

2

6.9

~

1~.0 1 3

1

8.1

u

41,8

-- --
5 48.4 1 14.1

9 385

1

6.9

--- ---

liPilliMIOLOGY

39

NliMBJIIR OF OASES A11D OASIII RATE Pill 100,000 POPUL.'TIOII OF SPJIIOIFIED NOTIFI.ABLlll DI9ASES RiliPOR!ml IN lliORGIA BY OOIDITIJIIS, 1938

Ana

S;yphillo

'llhooplDC !l'l!.berculooil Typhoid J'eve Typhus J'ever Cough

Caoeo Rate Caoaal Rate

State Total llnral
Oltiea 2500 - 5000 01 ties 5000 & Above

18043 582.1 3011

687~
158

318.2 1387 13~6 171

9584 11 5 1453

~.12 1~5 17 9

AWliDC Atkinson Bacon Baker
Baldwin l!anko

5 350
-- -- g 102.8

7 1
~

49.0 12.6
~.6
.2

~ 14 58.4
1 9o0

13~..oo

Barrow Bartow Ben Bill :Berrien Bibb Blecltlq
Brantlq Broo:U Beyan Bl111och Burke Butta

5 ~.0

19

9

5 365 1 6.0

134 169.5

275 27525

1 13.0
-207 9070
226 764.7
- -108 352.4

4 21!.8
23 83.5 10 72-~
53 92 121.4
6 6o.l
--
4 17.a 6 92
~ 91.4 ll7o5 4 112.1

Calhoun
Calllden Candler Carroll Catoooa Charlton

456 1Kl22.9 10 88.2 2 29.9 1 15.0 1 10.1 6 6o.6
1~ 1Kl.4 20 ~.s
\ 330.0 20 1 .1 81.4 1 20.,

Chatham Chattahoochee Chattooga Charo:Ue 01arlal Ol.q
Clqton Cllnoh Cobb Coffee Colquitt Oolubla

3871 lKl6

~58D.I! 170.1

277
8

- - 3 17.7 15 23 51!5 2242.8 18

2 26.6 3

1 9.1 8

77 992.7 14

~r ~ 50
417 18 .,

201

13

16 16d 10

256.2 82.2
ss.~
101.0 69.0 39-9
729 180.5 118.7
62.8
103~-.o1

Cook Coweta
Oravtord Criop Dade Daveon

39 311.6 8 63-9

-5 18.8
-- -- 120 648.7

24
J
13 2

903
1~:~
270.0 531

Decatur Deltalb
Do~~&~
Dool.T
lloucber~7
Douclu

23 90.0 ll 43.0

302 1Kl59 39 ~2.4

33 1375 15 2.5

- - 6~ 259 19 ~5

2159

i~

1 5 154.2

Caaeo Rate

829 26.7
655 303
37 315 137 16.7

- - 5 35.0
4 51.4
--5 --578

- - 1
21

7l '.22

2 11.9

17 21.5

1 10.0

-- --
1 15.4

8 211
- - 11 359

5 44.1 1 15.0 1 10.1
- -16 43.1
1 20.3

3--6 --333
15 65-9
- -2 11
1 9.1 1 12.9 18 47-5 2 9.0
- - 13 391
1 s.o 14 527 1 1~.0
- - 3 1 .2
1 26.6

2 12

1l.g1

10 41.7

13 67.4

2 8.8

22 212.0

Caoeo Rate Caoeo Rate

lOll 32.S 2329 751

63 29.4 ll50 ~2

~~

89~ 33

11~

2.1 134.6

- -14 98.0

- 4
-- - 4

I

~.4
.2

--

1 36

4 29.2

6 358

20 253

7 70.1

1 13.0 18 71!.~ 1 15. 43 1~.5
- - 2 5

-1 r-.o
- -4 51.4
2 s.4 4 36.o

10 72.0

9 327

1 13

3 321

~.9o

1 10.0

--
2 8.8
8 ~2
5 1 9
- - 17 555

-11 197.0
-- 19 192.0
:I
1 I 20.3

3 26.~
- - 10 149.
9 24.2 33 3203 3 61.0

8----7
2

-80.5
--
26.6

194 1795

2 4

20.i 23

2 8.8

- -36 138.0

1 9ol 2 258 1 2.6 14 62.1!
- - 52 1565

1 9

112.o1

145.1 5' 17.9

6 18.1

5 52.0

-- -- 18 143.1!
-- 2--2 118.9

8 63-9

- ----2

--15
-

2S 109.5 8 10.8
18 750 10 51.8
- - 44 192.7

2 7o8 43 57o8
- - 3 125 301
6r 5878

liPllliiMIOLOGT
lltlMl!J:R OF CAS:B:S Allll CASll RATE PIR 100,000 POPULATION OF SPI:CirUD l!OTIFUl!LE DIS:B:AS:B:S R!CPOB.TED IN GIORGIA BY COUNTllliS, 1938

.Area

117Philia

'tlhoopiug !l'ubercu.loah Tn>hoid rever !7Phua Faver Oough

llar1y lcholl lffingham llbert lmanual lllvano
Fannin J'ayotte Floyd J'oroyth Franklin J'ul.ton
Gilmer Glaacoclt Glynn Gordon Groey Greene
Owinnett Habersham Hall Hancoclt Haralaon Harris
Hart Beard !Ieney Bouoton Irwin Jackson
Jasper Jeff Davis Jefferson JBDld.ns Johnson Jonea
Lamar Lanier
Lanrens
Lee
Liberty Lincoln
Long
Lowndes
Immpldn McDuffie Mcintosh Macon
Madison Marion Meriwether Miller Mitchell Monroe

Ca.sea Bate
- - 7 353
1 9.0 23 116.8 llW 5338
2 25.8
- - 3 20.0 - -1~9 321.7
68 3893 1W16 u6o.5

Case a
-11
111 6 12 II
9 II 811 3 8 639

Bate
55' 125.!
~:i
5l:i
a9' 3
:e15~
12~:e

Ca Bate
-- --
1 9.0 3 1a.2 9 3 3 8 103.2
--
8 86.6 6 11.4 5 IW.7 8 45.8 36 10.11

- -2 235
8 38.8 311 180.7 110 522.0 3 23.0

2 2 14

4231:. ~ 67:~

13 69.

15 71.~

15 115.~

7 82., 3 62.
- - 3 111.6
3 111.2 8 61.4

5 17.0 18 61.]

1 70 153 451.8

8
26

7566:.~

2 14.2 7 49.7

2 13.7 7 48.(

7 58.4 8 66.]

--
1 9.8 13 759
5 43.7

6 3
~

3~:~
29:: 5292::i-

7 52.4 2 15.0

12 51.1 12 51.1

II 13.6 6 112.2 6 17.7 4 28.4
- - 23 157.8
7 IW.~10 98.1 1 58
- -7 61.1
10 42.6

- - 2 22.0
6 27.0 52 382.1
7 so.s
23 234.1

g

g92 9.1

22 99.2

11 80.8

4 29.0

16 162.8

5 1'

1a.sl
18.0

4 29~

14 101.7

4 IW.7

- -2 193
231 663.9 2 23.1
-1 11-.7

-6 57-9

20 6

6579. ~

5 583

5 552

2 19.3 9 163.11 7 20.1
- - -2 23-.1

2 453 521 1616.1
7 1275 3 31.1 1 16.9
35 200.!

4 905

16
s

49.6 145.7

9 932

4 67.6
14 so.?.

6 1358
3 93 1 18.2 3 31.0 1 16.9 5 28.7

- - 2 12.1
1 305

9 545

-7 28.7 15 61.6 1 91!

279 1056.~ 16 6o.6

17 135 11 87.8

- - 6 363
7 28.7 2 19.5
- - ll 41.7

Caaea Bate Oases Bate

- -111 70.6

- - 1 9.0

i~

87.7 206.3

----- -----
30 8.7

-- -- - II 19.4
7 332 1 11

-- --
-1 3-0 - - 1 6.9
-- --1 -9.8
3 22.5 1 4.3

1 11.0

s 92.2

1 4.5

22
- - -

161-.7

-- --
14 1W.2

5 579
- - 3 350

4 905

3---9

121.0
---

3 17.2

--
3 91.6 1 4.1

2 195
- -47 178.0

- - 6 303
2 18.0 8 IW.6
1-6 61-.0

1 6.7 1 10.1!
9 17.1 IW.7
a 22.9 417 120.5

4 58.8 83.2

13 63.1

- - 3
1

la9 1

7 237 3 21.1 7 20.7
-1 7-.1
6 50.0

5 28.8

- - 1~

186.4 23.4

1 74

67 285.2

--
1 11.5

4 18.0

3 22.0

33 2397

5 509

-1 9-.6

39 112.1

1 11.6

- - 1 11.7

--

3 93 1 18.2

1 10.4

3 7

~.11

- - 1 6.1
- - 32 1313
8 )0.3 25 1~9-5

liiPIImiiOLOGY

41

lm!BEI! or CASES AND CASE RATJl PER 100,000 POPIJLATIOJ! OF SPECIFIED
NOTIFI.AllLE DISEASES REPORTJlD IN GEORGIA :BY COUl!TIES, 1938

Whooping

Area

Syphilis

Tubercula sis Typhoid Fever Typhus Fever Cough

Montgomer;y Morgan Murra;y
Muacogee
lllewton Oconee
Oglethorpe Paulding Peach Pickens Pierce Pike
Polk Pulaski Putnam
~tman
Rabun Randolph
111chmond Rockdale Schley Screven Seminole Spalding
Stephens Stewart Sumter Talbot !l!aliaferro Tattnall
Ta;ylor Telfair Terrell Thomas Tift Toombs
Towns Treutlen Troup Turner Mggs 11nion
Upson Walker Walton Ware
Warren
Washington
Wa;yne Webster Wheeler White Whitfield Wilcox
Wilkes Wilkinson Worth

Cases Rate

1 9.2

6 45.9

1 9.6

1~ -

58ol
- 776o7

- - 2 14.0
I 217 2052.4
6 54.1! 5 ~6.1 17 1 7oS

- -54 1997 - -1 11.0
1 14.3 38 207.6

593 7953 29 3993 10 176.7 21 90.2 56 706.6
325 1362.2
--
1 8.2 352 1254.7
- - 8 83.4
3 17.8
--
117 717.1! 229 1200.1 21 6o.6 438 2562.! 15 783

1 20.0

1 12.3

338 864.6

--2

-l5o8
-

2 9o6 24 83o~ 248 1070og
- - I 374 13333 4o 152.1

153 1108.5

1 48

18.~
464.~

4 565

159 6795

1 6.9

12 72.6 37 322.1! 122 519.8

Cases Rate Casea Rate

2 18.3
s 61.2

67.5

5l ~-7

17

3

5 57-9

~ 27.!) 30o6 7 bJ-5 3 Sol 3 16.6 2 23o2

5 35.0 12 86.2 11 104,0 4 36.6
4 28.9 12 104o3

4 28.0
4 28.7 1 9.5
5 45.7 1 7.2 11 95.6

26 96.1 3 31.0
- - 5 54.9
9 128.3 18 983

- - 15 555
- - 4 43-9
2 28.5 16 87.1:

138 185.1 9 12~.9
11 19 3 27 115-~ 1 12. 43 180o2

8 Go.s

4 32.8

1~ ~31-.5~

5 11

I

75 65.1

I

2 17.6

7 42.9

~a

68.1 4o.4

14 81.9

8 41.1!

6 120oC
4 49oO
32 81.9 10 79o0
l 10.5
2 273

15 20.1 6 82.6 6 106.0
2 8.6
2 25.2
15 62.9

2 1~.1

~

2 o6 14.3

- -- -

1 59

-4 -35.2
5 26.2 2 ~-! 11 .4 2 10o4
-- --
13 333 7 553 1 10.~ 8 109...

26 124o6
56 194o4 22 95.0
25 89ol 2 16.3 22 837

8 38o3

4 14

1630o.Q4

4 14.3

2 16.~

7 26o6

16 115.9

2 14.5

1 18o5

1 18.5

3 29.0

2 19.~

2 28.3 11 155.4

39 4

166.7 27.6

I

2 8.5 2 13.1!

7 42.3 8 69.1! 16 6so2

- - 4 24.2
g 34.1

Cases Rate Cases Rate

--4 36--.6
-- - 4 6.1! -
-- --
- - 5 47-3 - - 9 65.1 -- - 1 10.3 - - 1 22.3
16 87.4

1 9-2 53 4o5.7 3 28o9 S2 14o.l
4 22.2
1 11.6

4 28.0
1 7o2
19 179.7 50 457.0
s 57.8
11 95.6

- 4
- - --

-14.!

- -25 356.3

- -3 4.0
~ 88.3 17.2
- - 15 189.3

--
3 24.6
-- - 25 89.1
18 106.6

--

19 116.6

18 943

13 42

2~57

18 9 .o

-- --
2 5.1

- - 7 553
--

-- --
2 8.6

- - 15 53-5 3 11.4.

138 18~.1 33 45 .4
- - 9 1599
3 379 5 21.0

11 8a,2

1~

2 .6 57.0

2 20.9

2 g

~0.2 7-4

--
g 49.1 1 52 7 20.2
9 52.7 l 5.2

--
1 12.3
-- -- 6o 153o5
3 41.0

15 71.~ 5 17o 9 389
15 53-5 1 8.1 3 11.4

4 29.0 6 111.0
-- - 11 106o4 9 62.2
--
2 17.4 14 597

-4 -29.0
- - 4 38o7
2 8.5 2 13.1!
--
2 17.4 7 29.1!

IPIDI!IIIOIOOY CASl!:S .lc~D CASE RATE Plm 100.000 II)PULATIOll !OR SPECIFIED MSJ:ASES !!l!:II)RTED Ill GIDRGIJ. BY CITIES OJ' 5,000 FOPULA.TIOII .&liD .dOTJ:, 1931

latimated lcerebroapinal

Area

Popo.1at1on lleningi tio 11!i1 theri a Gonorrhea Influenza lla1aria

Meaelee

Pn.....,nia

Caoeo Rate Cases Rate Caoea !late Caaeo !late Oaeea !late

Ca !late Ca !late

Total

A1b!lllT j)DeriCill
Athena Atlanta Jllgllota :Bainbridge

:Bmnawick

Carrollton

Cart oraville

~

Cadortown Collep Park:

I

Colwnbu.e
Cordele

Ill

Dalton Decatur

])lblin

J:aot Point

J'ltqerald

Ga1neod11e Griff!.n
LaDrense !lacon llarietta JlllleclgeTille

llollltrie llewnan
llomo
Savannah !bomuton !boiii&ITl.lle

Taldoota

!J

W~~rcrooa

821,575
15,059 9,120 18,6~ 253,2 6o,938 6,666
14,931 5,472 5,6os 8,827 6,1186 44,185
7.356 ,,214 1 ,218 7.097 10,035 6,732
9,570 10,542 21,644 61,635 8,190 5,765
8,681 6,819 23,683 117,145
5,342
12,594
14,211 16,239

11 1,3

--- ---
5 2.0
-1 1,6 -
------ ------
------ ------

- -- -1 10.4

- 1 --

1.6
-

- --1 -11.5
--2 2--.3
-- --

377 45.9

6 39.8 1 11.0 12 64.4
111 43.8
- - 47 77.1

2 13.4 1 lii.J 5 119.2 5 56.6 5 72.6 10 22.6

1~

4o.s 151.9

3 21.1

7 98.6

4 1

~9 1 9

6 62.7 18 170.7
25 115.5
3--6 --58.4

- - 6 69.1
9 38.0 31 J5.6
5 93.6 2 15.9

-2 14.1
-

2813 342.4 1344 163.6 548 66.7

-10 66.4
-
1 5.4 1351 5~5.
- - 332 5 .II
2 13.4 14 255.11 2 357 31 351.2 4 58.1 17 385

18 1195 10 109.6 12 b4,4 441 174.1
51 113.7 1 15.0

I 17

11a.s 5 .II

i

g 107.0

13 147.3

130.7

1' 31.7

31 205.9

29 3111.0

2 10.7

~

12.2 75.5

1 1';.0

1 6.7
- - II 146,2 -18 203.9
9 20.4

2 27.2
77 835 7 5 35.2 12 169.1
- -5 49.8

16 217., 11 11,. 2 1 .1 38 53?.~ 3 299
2 29.7

16 217.5 1 10.9 4 28,1
-65 915.9
1 14.9

29 303.0 7 66.4 16 739 7 11.4 9 109.9 11 190.8

12 125.4 6 56.9 14 64.7
16 26.0
7 115.5 1 17.3

4 37.9
5 23.1 10 16.2
- - 1 12.2

- 21 j241.9
6 253 794 11,1
7 31.0 7 55.6
6 42.2 28 172.4

39 449.3 7 102.7
~ 139~ 576. 21 3931 25 198.5
8 56.3 31 234.0

- - 63 725.7 tJ 12.7
211.1 & 112.3 5 39.7
3 21.1 1 6.2

4829 5117.11 1953 237.7

13 86.3 32 ~50-9 79 24.0 2013 794.9
173 2113.9 1 15.0

24 159.4 16 175.4 23 123.~
777 306.s 221 ;,62.7
6 90.0

14o 937.2

13 237.6

2 35.7

12 18

~t~

38 86.0

32 214.2 15 274.1
15 267.5 14 ~.6 24 5 56 126.7

2 27.2
32 347.3 1 7.0 57 803.2
- - 28 279.0

6 81.6 18 195.4 13 91.~ 41 577.7 25 249.1 13 193.1

13 ~511 133 1.6 13 3373 611 991g
- -55 671.

19 198.5 23 218.2 32 147.11 74 120.1 22 26!1.6 9 156.1

- - 79 910,0
125 527.11 978 1122.3 13 243.4
4 J1.8
3 21.1 tiS 541.9

23 264.9 11 161.3

511 2114.9

253 II

=.~!

21 2111.4

13 915 42 2511.6

Area
Total
Alb~
AmeriCll Athena Atlanta Allgllata Bainbri lice
:Brunowick Carrollton Oarterovi 11e Oodarto"lll College Parle Oo1umbil
Cordele Dalton Decatur lllblin lllaot Point
J'lt~orald
Gainem llo Griffin LaGrange !lacon llarietta lll.llodgevi llo
li>Ultrie Jlewnan !lome Savannah Thomaaton Thomaovi lle
Va1doata 'llavcroaa

IPIDJ:IIIOIOOT
CASES AND CASE !W!E PlliR 100,000 POPULATION JOR SPECIFUD mSliiA.SES
l!IPOI!TED Ill GJOBGIA :BT CITIES OJ 6,000 PO!ULATION AND mv:z, 1938

Polioii\Yeli tia Scarlet :revel !lr!>hilio illberClloai a 'J7t>hoi d :rover 'l'.n>lna :rover Whooping Oca8h Case a Rate Cases Rate Casea !late Oases Rate Casea Rate Oa.aes Rate C&OOI Rate

21 2.6

-- -
l 5.4 4 1.6
- - 3 4.9 --- ---
-1 11.3
2 4.5

--
1 10.9
---1 7---.0
-- --
2 9.2
- - 1 1.6
--

-- -

1 4.2

-4
---

4----.6

445 54.2
2 133 2 22.0 12 64.4 24! 979
- - 12 19.7

95!4 1166.5
4! 31!.7
~ lo4l.7 182.5 11()()2 15!03 571 937.0 l 15.0

1453 176.9
28 1!5.9 7 76.! 18 96.6 563 222.3 128 210.0
4 6o.o

137 16.7
--
l 11.0 l 5.4 lS 7.1 9 14.8 l 15.0

276 33.6
35 232.4
- - ll 120.6
27 10.7 2 33 16 24o.o

1106 134.6
6 398 15 164.5 17 91.2 387 152.8
- - 130 213.3

4 26.8
- - 2 36.5
l ll.~ 5 72. 18 4o.7
-
8 86.8 20 14o.7 5 70.5
- - 6 59.8
10 1o4.5 2 1~.0 14 6 7 16 26.0
-9 - 109.9

7 46.9 l1 201.0 7 124.8 51 577.! 2 29.0 19 43.0
93 1264.3 150 16:!8.0
6 42.2 19 267.7 1 10.0 4 59.4
139 1452.5
~ 2447.4 127.3 ;1 82.7 16 195.4 10 173-5

10 66.9 5 91.4 6 107.0 14 158.6 9 130.7
49 110.9
17 231.1 25 271.3 10 70-3 5 70.5 8 797 9 133 7
12 125.4 30 284.6 22 101.1 87 141.2 14 170.9 14 2112.1!

3 ~20.1 10 2. 7

2 6

635s.-o7

4 58.1

2 4.;

1 13.6 2 21.7 2 14.1
--3 --42.3 -
7 66.4 9 41.6 13 21.1
- - 3 36.6

- -- - 4 26.8

1~ 87.0
73-1
-1 17.8

l 14.5

1 14.5

1'3

4 9.1
- - 7 95.2
2 14.1

6 13.6
- - 2 21.7
4 :!8.1

~ ~

- -7 98.6
4 59.4

5 70.5
- - 1 10.0

- - 1 10.4
2 9-2 18 29.2
- 1 12.2
-

1 10.4 4 37.9 47 217.2
240 389.4
9 1099 1 17.3

3 34.6
-1 14.7
- - 39 44.8 2 15.9 4 24.6

200 230~.9

1 1 1

- - 13
3159

~62554..09

18 142.9

3 21.1
~1;1 2161.~

9 10~. 7

14 46

l~-.32

245 :!81.1

ll 205.9

4 31.8

ll 77-4 1G 117.0

4 46.1
- 6 88.0
26 29.8
1 18.7
1 7.9
1 r.o
1 6.2

- - - - 16 184.3
80 91.8
--
3 23.8

- 6 69.1
6 253 175 200.8
10 187.2 2 15.9

25 1~5q 10 1.&

1J 80.1

&

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

DIVISICE OF LABORATORIES

Table 1.

Classif1cation of Examinations

Tuberculosis Positive Negative Doubt.ftil
Total

Central
680 5,547
41 6,268

Microscopic

llbaey

Waycross

109

41

866

357

1

3

976

.4ol

Total
830
6,7!0
45

Grand Total 7,645

Diphtheria
Positive Negative Doubtful Total

866 1,875
86
2,827

95

43

l,Oo4

329

174

2,378

7

4

97

431

221

3,479

Gonorrhea Positive Negative Doubtful
Total

1,006 4,016
43 5,065

73

5.3

1,132

2.39

ll9

4,374

5

15

63

317

187

5,569

Malaria Positive Negative
Total

1,241 29,6.4o .30,881

549 20,501 21,050

154 6,637 6,791

1,944 56,778

58,722

Intestinal Parasites
Positive Negative
Total

6,791 16,360
2.3,151

5,513
13,~35
18,748

6,609 12,092 18,701

18,913 41,687

60,600

Rabies Positive Negative
Doubtful Total

508 867 19 1,.394

52

24

584

51

16

934

3

22

103

4.3

1,5-4o

Miscellaneous 1,430

250

.354

2,034

Total

71,016

41,875

26,698

139,589

Agglutinations

Total

7,339.

CUltures

1,8.4o

500

9,679 I

Pesitive for

Typhoid

369

Brill's

5o4

Undulant

55

Tularemia

36

16

ll

396

277

60

841

24

4

83

21

2

59

45

46

Cultures (Cont'd) Table 1

Blood Cultures Positive for
Typhoid Paratyphoid Undulant Other Org. Negative Total

Central
.34.:3 10 5 13
5,821 6,192

Stool and Urine Cultures Positive for
Typhoid Paratyphoid Dysentery
Other Org. Negative
Total

587
.:3 58 l
.:3,811 4,46o

Total

17,991

LABOR.A.TORIFS

Albany
45 2
1,.4os 1,455

Waycross
15
2 1.47
464

-2.3
14
525 562
.:3,857

2
1.:3 6 1,202 1,22.:3
2,187

Total
.4o.:3 12 5 15
7,676
612 .:3 85 7
5,538

Grand Total
S,lll
6,245 24,0.:35

Blood & Spinal

Fluid for Kahn

Test.

Positive 24,0.:36

Negative 99,.:310

Doubti'ul

1,0.:34

.A.nticomp.

48

Total

124,428

Dark Field tests

tor Syphilis.

Positive

82

Negative

107

Doubti'ul

4

Total

19.:3

Total

11,922

Total

5o4

Grand Total 226,054

Serological

5,659 17,.4ol
24.:3
2.3,303

6,550 24,185
-747
.:31,482

.:36,245
1.40,896
2,024 48

179,213

9

6

.:32

8

1

2

42

16

Water

Cancer Control

69,071

60,.:38.:3

97 147
7 251
11,922
5o4 .:355,514

LABORATORiliS

General Discussion of Laboratory Work During 1938

Summary of Table 1

Central

Albany

Waycross

Total

Microscopic Cultures Serological Water Tissue

71,209 17,991 124,428 11,922
2o4

41,917 3,857 23,303

26,714 2,187 31,482

139,84o 24,035 179,213 11,922
2o4

Total

226,054

69,077

60,383

355.514

Total for 1937

2~.12.2

Increase (39.~) 101,361

A sUIIIIII!U'Y of Table 1, given above, shows that during the past year
the division of laboratories handled 355,514 specimens, an increase of 101,361, or 39.9 per cent, over 1937 Thia is the greatest increase the
division of laboratories haa enjoyed in its history.
As can be seen in Table 2 and Diagram 1, the specimen load during
the past five years has increased from 143,511 specimens to 355,514, an increase of 212,003, or 147 per cent. The growth b,y divisions over the
same period is shown in Diagram 2.

Table 2

Growth of Laboratory 1934 - 1938

1934

1935

1936

1937

1938

Microscopic Culture Serological Water Tissue

56,143 12,026 67,o47 8,295

89,728 12,839 76,564 8,594

86,569 16,001 81,953 8,891

97,262 18,345 128,297 10,249

139,840 24,035 179,213 11,922
504

Totals

143,511 187,725 193,414 254,153 355.514

The specimen load of each laboratory vas as follows:

Central laboratory A1bany branch
W81'cross branch

226,054 69,077 60,383

Total

355.514

The percentage of the total specimen load handled b,y each laboratory
is shown in Diagram 3.

It was anticipated and hoped that the establishment of the branch laboratories would serve a twofold purpose:

48
375,000

LABORATORIES I ~IAGRAM
GRO:VTH OF lABrRATORY 7!0RK: 1934 - 1938

.. 300,000
.."!,l
~ 225,000
UJ
....
0
~ 150,000
1
75,000

0

19~4

1935

1936

1937

1938

Years

180,000
150,000
.
."..~ 120,000
~"
.... 90,000
0
".,
~ 60,000 z
30,000

DLill.:.ti\M 2

GROWTH OF lABORATORY WORK BY DIVISIONS: 1934 - 1938

Ill IJ Microscopic

Serological

Typhoid

D Water

-- 504 Tissue Specimens

0 1934

1935

1936 Years

1937

1938

LABORATORIES

49

DIAGRAM 3 SPECIMEN LOAD BY LABORATORIES: 1938

Gentral Leborc.tory 226,054
DIAGRAM 4 SPECIMEN LOAD BY DIVISIONS: 1938
Serological ::!.79,213
*Tissue Specimens-504 less than 1%
Water Specimens-11,922 3.3%

50

LABORATORIES

1. Relieve the central laboratory of a specimen load which had become increasingly difficult to handle because of inadequate quarters and personnel.

2, Increase the total specimen capacity of the division of laboratories by making the services of the division more accessible to a larger number of pqysicians and health officers.

A resume of the first full year in which the branch laboratories have been functioning shows that this is being accomplished,
During 1938, the central laboratory handled 226,054, a decrease of 6,252. The Albany laboratory, which began functioning in September, 1937, handled during the first four months of its existence 11,576, whereas in 1938, it handled 69,077, an increase of 57,529. Likewise, the Waycross laboratory, which began to function in September, 1937, handled 10,271 during the first four months of its existence, whereas it handled 6o,383 during 1938, an increase of 50,112.
Map 1 shows the counties from which specimens were received by the Albany laboratory, while Yap 2 shows the counties serviced by the Way-
cross laboratory. lach laboratory received specimens from 42 counties during 1938.
It can be noted that the geographical area serviced by each branch laboratory is rather sharply demarcated. Since no effort has been made to define these areas, those shown on the maps were largely established
by convenience of mail service. Apparent overlapping of the two areas was due to readjustment of
specimen loads through the transfer of specimens from onelaboratory to another. (Malaria Survey slides sent from the Albany branch to the Way-
cross branch: Seminole, 736: Crisp, 1,416: Decatur, 1,415). There were 14 check specimens also sent from the central laboratory (Fulton
County) to Waycross. This ability to distribute the specimen load, when necessary, has proved a distinct advantage.

Specimen Examinations by Divisions

An analysis of the specimen examinations made by the several diviaions is ginn in fable 2 and Diagram 4. lllo discuuion of the water analyses or tissue examinations will be made since these laboratories
are directly under the divisions of sanitary engineering and cancer con-
trol, respectively. It will be noted, however, that these examinations are made only in the central laboratory. With these exceptions and a few others, such as animal inoculations and the manufacture of certain biologics and media, the branch laboratories offer the same service as
does the central laboratory.
It can be seen from Diagram 4 that 139,840, or 39.3 per cent of the specimen load was handled by the microscopic laboratories; 24,035, or 6.7 per cent, by the culture laboratories; 179,213, or 50.4 per cent, by the serological laboratories; 11,922, or 3.3 per cent, by the water laboratory, and 5o4, or less than 1 per cent, by the cancer control labor-
atory. It should be kept in mind that the specimen load does not fully
represent the amount of work done by any one division, since the effort
expended varies with the individual specimen and test. Diagram 5 shows the percentage of work dona by each division of
each laboratory.

LAJ!ORATORIES IIAl' I

51
69 ,077 apecim8118 42 Counties

LAl!ORATORIES

IIAP 2

WAYCROSS BRANCH LABORATORr
Source of specimens rece1Ted during the year 1938
60,383 Specimens 42 Counties

LABQRATOR!ES

53

Dl.AG&IM 5
SPECIMEN LOAD BY DIVISIONS IN EACH LABORATORY: 1938

CENTRAL LABORATORY

*Tissue-504 Specimens less than 1%

ALBiJ\Y LABORicTORY
tcu~tore-38~7 Jpecimens, b.~

WhYCROSS LABORATORY *Cu1ture-218? Specimens, 3.6%

LABORATORIES

Although the work of each division is well defined in the central
laboratory, this does not hold true for the branch laboratories where, in general, the work of the several divisions is performed by the personnel as a whole.
It will be noted that the division of work in the central laboratory and Waycross branch are rather comparable, whereas in the Albany
branch, the microscopic laboratory accounted for over 60 per cent of the
specimen load, with the serological examinations accounting for slightly
more than 33 per cent. The greater percentage of microscopic work done
in the Albany branch, as compared with the Waycross branch, is accounted
for chiefly by the larger number of malaria examinations made in this laboratory.
For example, 21,050 malaria examinations were made in Alba:ey and 6,791 in Waycross. In contrast, the Waycross laboratory, which is mak-
ing all the serological tests for syphilis for the venereal disease control program being conducted by the United States Public Health Service
in Glynn, Camden and Mcintosh Counties, had 31,4g2 serological examinations, as compared with 23,303 in the Albany laboratory_.

Discussion of York b,r Divisions

Microscopic

Tuberculosis:
During 193g, a total of 7,359 specimens of sputa and other exudates were examined for tuberculosis, an increase of 32 per cent over the pre-
ceding year. See Table 1.
Table 3 shows the increase in this work during the past five years.
Table 3

Sputum Examinations 1934 - 193g

1934 1935 1936 1937

lllumber examined lllumber pod t1ve Per cent positive

4,314 4g6 11.2

4,445 521 11.7

4,222 1,9.4o

5.572 693 12.4

193g
7.3g5o9g 10.9

It can be seen that the increase during the past year has been greater than for any single year during the period covered. Increased activity in the field by the division of tuberculosis control no doubt accounts for much of this increase, although the availability of services from the branch laboratories is doubtless an important factor.
There were 286 specimens subjected to animal inoculation (guinea pigs). Positive results were obtained in 22 of these.
This was an increase of 133 inoculations, or g6.9 per cent, over 1937. Three cultures on Petragnani media were made with every specimen
subjected to animal inoculation. Negative results were obtained in cultures of eight specimens for which the animal inoculation teet was positive. One culture was positive where the animal inoculation test was
negative.

Diphtherial
Table 4 gives a classification of the cultures examined for diphtheria during 1938.

LABORATORIES

55

Table 4

Cultures for Diphtheria

Positive

Negative

Total

Dilll;llOStiC

464

Release Carrier

5~a

Virulence

ll

Unclassified

l,ll-39 682 234
23

1,903 1,187
258 34 _..!E.

Total

l,oo4

2,378

3,479

During 1938, a total of 34 guinea pig virulence tests were made. This small number is accounted for by the fact that it has been the laboratory poll~ to confine virulence tests to positive cultures from true diphtheria carriers, or from convalescent carriers having positive cultures aix weeks or longer after onset of illness.

Gonorrhea: Table 5 shows the examinations for gonococci during the past five
years.
Table 5

Pus Smears for Gonococci

1934 1935 1936 1937 1938

Number Specimens examined Number positive Per cent positive

3,765 1,062 27.9

4,237 952 22.4

5,245 1,081
19.2

5,569 1,132
20.3

Malaria:
Table 6 shows the malaria examinations made by each laboratory during 1938.
Table 6

Routine and Index Malaria Examinations

Central Albany Wqcross Total Grand Total

Routine Positive Negative
Total
Index Positive Negative

343 ~
6,134
898 23,849

99 ~
3,000
450 17,600

26 __J]l
403
128 6,260

468 ~
1,476 4],709

9.537

Total

24,747

18,050

6,288

49118~

58,722

LABORATORIES

Table 7 gives comparative summary of the malaria examinations made in 1937 and 1938, and of the positive findings for these years.

Table 7

Summary

1937

Total

Per cent

Number Positive Positive

1938

Total

Per cent

Number Positive Positive

Routine 7,540

509

Index

_?_~ _h!22

6.8
_hl

9,537 491182

468 1,476

4.9 ..l.!.Q

Total 32,301 1,664

5-l

58,722 1,944

33

It can be seen that 26,421 more malaria slides were examined in 1938 than were examined in 1937, an increase of 81.8 per cent. The summary shows a slight decrease in the percentage of positive findings both in the routine and index specimens.
Many of the index, or survey, slides were collected in the fall of 1937 and were not examined until early in 1938. A smaller number of specimens were collected in the 1938 fall survey so that fewer slides will be carried over into 1939. No discussion of the index specimen examinations will be attempted since a detailed report on them will be made by the division of malaria investigations.
It has been observed that the number of thick blood films being submitted for malaria examination by the individual physicians is increasing each year. The superiority of the thick blood film over the thin film for malaria examination is rapidly recognized.
During the year, the practice of making differential counts when requested was discontinued, and these counts are made only when the blood picture suggests some pathology or dyscrasia. A number of cases of anemia, leukemia and glandular fever were found in the examination of the thin blood films and this service remains available to thephysician, even though the practice of making differential counts routinely upon request, has been discontinued.

Intestinal Parasites:

Table 8

Routine and Index Intestinal Parasite Examinations

Routine Positive Negative
Total

Central
1,388
...LEl
8,615

Albany 873
...hg
2,560

Waycross 270
~ 784

Total 2,531 ~

Grand Total 11,959

Index Positive Negative
Total

5,403 ~
14,536

4,640 11,248
16,188

6,339
.!.b.2I!
17,917

16,380 32,261

48,641
60,600

Table 9.

Hookworm Index by Counties

Central

Albany

Waycross

Grand Totals

Countz

Total Hookworm Total Hookworm Total Hookworm

Hookworm Percent

S:2ec. Positive Spec. Positive Spec. Positive S:2ecimens Positive Positive

Appling Bacon Baldwin Berrien
Blackley Brooks Bryan Bulloch Camden Charlton Clay Clinch Colquitt
Coffee
Cook
Crisp Dodge
Dougherty Early
Effingham Emanuel Floyd Fulton

-378
- 1,93.5 -600
370
.3-----.5 -3
1,344
-- 1,121
2,026
118
144

28.5
4-6
-.319
114
-----7
--3

---720
2,0.57
---206
-989
152 561

667
--507
768 21 46

592 4,785
-.533
---

---44.5 71----6

-
1.38
-1.54
--386
1,226
732 .502

-.51 -521
81
271
.315 .3.57
16----0

- 1,410
-- 2,189
---
4.36
-792
-

-
41
-4
--76
464 186
219
--.398 8%9-----9 14--9

378
138 2,089
726 986 2,0.57 370 1,261
732 .502 206 1,410
989 2,192
152 .561 1,936 4,785 533 1,5.57 2,818 118 144

28.5 41
.50 44.5
39.5 716 114 471 186
219 .51 398 521
902 81
217 982
357 160 603 917
21 46

00.7 JQ.O
2.3 61.0
Lto.o
34.0 ,30.8
36.5 2.5.0 4.3.0 24.0 28.0 5.3.0 41.1 53.0 38.0 50.7 7.0 ,30.0
38.7 32 .5 17.8 lto.J

E
~
..;
!..i.J.
le1n'il
\J1

-.j

Table 9 (Cont'd)

Hookworm Index by Counties

Central

Albany

Waycross

Grand Totals

Countz

Glascock

Glynn

Grady

Houston

rn

Jefferson

11'1
H

Jenkins

gj

Lanier

E-t
~

Laurens Lee

~

Lumpkin llitchell

Pierce

Quitman

Screven

Tattnall

Taylor

Telfair

Thomas

Ti.t't

Toombs

Wayne

Wheeler

Total Bookworm Total Hookworm Total Hookworm

S2ec. Positive Spec. Positive ~ec. Positive

618
-20.3
121
450
296
--5
--168
9.3 1,.3.3.3
llJ 60
884 6 18
52-2
512

2A8
-62
59
1o4
97
-5

--
797
--
---

1,.324 L.o
-- -- 1,507

1!()
414 49

--2J.

- 17 105
485 .3 1,1'77

10

.378

-.Jo4
191

--4

----278 ---16.3
--608 1--2 -23
.389 166

-
5.3
--
-510
252
-- 1,~
-
-6~
--
-- .3,986 -

.3

.307

785

-- 1,098

----1
~
llS
-555
--
--228
1m7----8
.304 4o9

Hookworm Percent Specimens Positive Positive

618

248

.30.2

256

6.3

24.6

797

278

.35.0

121

59

48.8

45o

104

~.1

806

220

Z/.2

257

120

46.6

1,.4o4

555

L.o.o

1,.324 168

16.>3

12.0 25.6

1,507

608

L.o.o

623

228

.37.0

114

52

45.6

1,.3.3.3

414

3().0

llJ

49

4.3.3

165

4o

24.2

4,870 1,262

25.9

1,18.3

.392

.3.3.1

.396

176

44.4

8.3.3

485

58.2

785

.304

.)9.0

1,600

600

.37-5

I)() Ll"\

LABORATORIES

Table 10. Classification of Intestinal Parasite Findings

Single Infestations&

Worms for identification - - - - - - - - - - -
Hookworm - Necator americana - - - - - - - - - - -
Dwarf Tapeworm - Hymenolepis nana - - - - - - - Roundworm - Ascaris lumbricoides - - - - - - - -
Pinworm- Oxyuris vermicularis -- ----- - Whipworm-;,.. Trichuris trichiura - - - - - - - - Rat Tapeworm - Hymenolepis diminuta - - - - - - Specimens not included in above classification - -

24
17,9.39 155 .329 lZl .38 1
.3

18,616

Double Infestation&

Hookworm and Dwarf Tapeworm - - - - - - - - - -
Hookworm and Roundworm - - - - - - - - - - - - Hookworm and Pinworm - - - - - - - - - - - - Hookworm and Whipworm - - - - - - - - - - - - Hookworm and Rat Tapeworm - - - - - - - - - - - Roundworm and Dwarf Tapeworm - - - - - - - - - Roundworm and Whipworm - - - - - - - - - - - -

87
l2S 57
19
4
1 _ _;:;2_ _--::':::::'
295

Triple Infestation

Hookworm, Dwa1't Tapeworm and Whipworm - - - - - -

1

Hookworm, Roundworm and Whipworm - - - - - - - - ---=1=------,..

2

Summary

Total specimens positive for ova of hookworm - - 18,2.3.3
Total specimens positive for ova of Dwarf Tapeworm- 244

Total specimens positive for ova of Roundworm - -

458

Total specimens positive for ova of Pinworm

184

Total specimens positive for ova of Whipworm - - -

61

Total specimens positive for ova of Rat Tapeworm -

5

60

LABORATORIES

There were 60,600 fecal specimens examined for intestinal parasites in 1938, an increase of 11,07~ over 1937. The hookworm findings of the
different laboratories for the counties making surveys, are listed in
Table 9.
The findings of intestinal parasites, other than hookworms, are
shown in Table 10.

Rabies - Microscopic Examination: An apparent decline in the incidence of rabies throughout the State
is indicated b,y the laboratory findings for 1938. A total of 1,16~ heads was examined microscopically, end in 538, or ~6.2 per cent, positive evidence of rabies was found. There was a decrease of 169 (11.9 per cent)
in the total number of heads examined from 1937. There was also a decrease of 159 (22.8 per cent) in the number showing positive evidence of rabies. Table 11 gives a comparison of the results obtained during the past five years.

Table 11

Animal Heads Examined for Rabies - 193~1938

193~ 1935 1936 1937 1938

Number heads examined Number positive for Negri bodies Percentage positive

1110 507
~5.1

1312 618
~7.1

1135 590 51.9

1333 697 52.2

11~
538 46.2

The source of animal heads positive for rabies is shown in Map 3.
It can be seen that the disease is prevalent throughout the State. The actual incidence, however, cannot be shown since the heads of m~ rabid
animals are not submitted to the laboratory for examination, either because of the expense in shipping them or because a clinical diagnosis of rabies has been made b,y a competent veterinarian. Also, the findings from the several city laboratories making examinations for evidbnce of rabies, including those at Augusta, Savannah, Macon and Columbus, are not included.
Table 12

Classification of Animal Heads Examined for Rabies 1938

Animal

Positive

Negative

Doubtful

Total

Dog
Cat Cow Rat Fox Kula Goat Pig Mole Rabbit Squirrel
Guinea Pigs
Human
Total

5~3 ~1
13 1
3
1 2
2
""bb5

363 117 20
5
3
1
6
1 1
18
-1
53b

18
~
-~

92~
162
33 5
1
6
2 8 1
1 18
1
2
17fbli'

LAllORATORIES

61

MAP 3

ANIMAL HEADS POSITIVE !"'R RABIES: 1938

Total Number - 538

,.-:,One Positive Examination
L:..J Central Laboratory

r::::-1
~

One Positive Examination Albany Laboratory

* -Examinations ma.de by L'Jcal Laboratory

62

LABORATORIES

Rabies - Animal Inoculation Tests:
The introduction of the mouse inoculation test in 1937 afforded
the opportunity of obtaining information both as to the specificity of the positive microscopic findings and as to the percentage of specimens failing to show positive evidence of rabies microscopically, which would produce the disease when inoculated into mice.
The poliqy vas to subject to the mouse inoculation teat all brain specimens Negri negative microscopically. This poliqy vas continued
through Mq 31, 1938. From January 1, 1938 throll&h Uq 31, 1938, 36o Negri negative brain specimens were injected into mice. There were 40 (11.1 per cent) of these positive, as compared with 11.6 per cent positive obtained on 284 Negri negative brains tested during 1937. Since it
vas felt that adequate information bad been obtained as a result of the above work, it vas decided to limit mouse inoculation teats to cases
coming within the following classifications:

(1) In all instances where the microscopic Negri bodies test fails to confirm the veterinarian's clinical diagnosis.

(2) In cases where inclusion bodies are found by the microscope, but are .too scarce to identify as Negri bodies, or are not typical.

(3) In cases where the clinical history disagrees with the negative
microscopic findings.

(4) In cases of str~ animals whose history is not obtainable but
which have bitten persons or othtr animals. This especially applies to such instances where the animal is killed at once after biting and the brain fails to reveal Negri bodies.

(5) In cases of animals injured on the highvq biting persona attempting to handle them, and dying soon thereafter. Exceptions are to be made in such cases where the history of the animal is known and is clearly negative.

(6) In cases of animals killed or dying after shoving suggestive
symptoms of rabies, such animals having been previously vaccinated or having received antirabic treatment.

The new policy vas placed in effect on June 1, 1938. From this time through December 31, 1938, a total of 120 microscopic negative brain specimens were subjected to mouse inoculation. Of this number 30 (25 per cent) were found to be positive. During the year, therefore, a total of 480 specimens were injected into mice, with 70 (14.5 per cent) giving positive results. A summary of this work is given in Table 13.

!able 13

1937
Unselected July-Dec.

1938
Unselected Jan.-June Selected June-Dec.

Micro. Mouse Per cent Neg. Pos. Poa.

Micro. Mouse Per cent Micro. Mouse Per cent Neg. Poe. Poe. Beg. Poe. Poe.

284 33 11.6

360

11.1 120 30 25

LABCIU.TORI:a:S

Miscellaneous:

Central Albaey

Urines (bacteriological) Differential Blood Counts Vincent's Angina Chancroid - B. ducrey Examinations for Type of Organism Spinal Fluids for Meningitis Cultures Amebic D,ysentery Trichomanae Vaginalie Pneumococcic Typing Unclassified
Total

195 47 272 31 39 195
206
75 _lJ.2
1,430

16 8
3 71 10 32 2
11
39
--.2!
250

63

Waycross Total

1 54 9
45 7 32 108 4o 32
__..?!

1
70 212
50 388 48
103
305 257 146 ~

354 2,034

Culture

The work of this laboratory increased tremend011sly during the past year. A total of 24,035 agglutination teste and cultures was made, in
contrast to 18,345 during 1937. In addition, this division of the central laboratoey included in
its work virulence tests for diphtheria, examination of spinal fluids for meningococci, influenza bacilli and other organisms, all cultural studies of transudates and exudates other than for tuberculosis, and typoo ing of pneumococci. The division also prepared antigens and sera used in the several tests and maintained the stock culture collection. Time was also found to carry on several important investigations.

!gglutination Tests:

During 1938, 9,679 specimens of blood were tested, an increase of

2,065 over 1937. The positive results obtained as compared with 1937

are as follows:

1938

1937

Typhoid
Brill's Typhus Undulant Tularemia

396

354

841

909

83

66

59

48

During the past year, the microscopic agglutination test of dried

blood specimens for typhoid was discontinued. The unreliability of the

results obtained by this test should have resulted in its discontinuance

much sooner,



Typhoid Fever: There was a rather marked increase in positive blood cultures for
typhoid during the past year. During 1938, there were 403 positive cul-
tures as compared with 260 in 1937 This increase does not necessarily indicate an upward trend in the
incidence of typhoid fever, since the work of the division of epidemiology, no doubt, was responsible for laboratoey confirmation of most of the cases of typhoid fever reported in the State. There were 612 stool and urine cultures positive for typhoid in 1938, in contrast to

64

LABOBATORIIS

281 positive cultures obtained in 1937. The work of the epidemiology division undoubtedly pl~cy"ed an important part in the increase of the number of such specimens submitted and in the positive findings.
Another probable factor responsible for the increase in positive findings on stool and urine cultures, is the refinements instituted in the technical procedure. At present, all such cultures upon receipt are inoculated directly on bismuth sulphite media and into selenite enrichment broth. After 24 hours' incubation, transfers are made from selenite enrichment broth to deso~cholate citrate media. Both plates are examined 48 hours after receipt of specimen.
The use of these two procedures has, no doubt, resulted in the finding of a greater number of positive cultures than would have been possible otherwise. (For further discussion, see Research and Investigation,)
The incidence of paratyphoid fever continues to remain negligible, only 12 blood cultures and 3 stool cultures having been found positive during the past year. There was an increase in stool cultures positive for B. D,yaentery from 34 in 1937 to 85 in 1938. A discussion of the various types isolated will be found under Research and Investigation.

Other Fevers: A total of 841 positive Yeil-Felix reactions for Brill's typhus
fever was obtained during 1938. This was a reduction of 68 from 1937.
Undulant fever and tularemia continue to be diseases of comparatively insignificant public health importance in this State. During
1938, 83 positive serological testa for undulant fever and 59 for tularemia were obtained. Five blood cultures were positive for undulant. All were of the porcine type. Slide agglutinations are made for Brill's typhus and undulant fever on all blood serums submitted to the culture laboratory. Several cases have been discovered b,y this procedure.

Pneumococcus ~ping: During the past few years, rapid progress has been made both in
the development of a rapid and accurate method of typing pneumococci and in the preparation and practical manufacture of type specific anti-
pneumococcic sera. Since there are 30 types of pneumococci, each of which has ita
own specific sera, it is necessar.y to determine the type causing each infection before the proper serum can be selected.
Of the several methods of typing available, the recently developed Neufeld reaction is probably the moat practical aDd accurate. In January, 1938, the division of laboratories instituted this method as a routine procedure and began the distribution of the type specific sera
available. In the beginning of this work, testa were made only for those types
for which specific therapeutic sera were available. Later, as specific sera became available for an increasingly larger number of types, testa were made for all 30 types. Ty-ping service it maintained at any hour of the daf or night.
During 1938, a total of 99 specimens were successfully typed. Of 105 positive typinga, several specimens showed more than one type. The
results are shown in Diagram 6. It is interesting to note that 21.7
per cent were of type 1, the moat predominant in this series, and that 76.4 per cent were of the first eight types, with only 23.6 per cent falling in types above type 8.

DIAGRA!l 6
DISTRIBUTION OF PNEUMOGOOGUS TYPES
25
IN 99 POSITIVE SPECIMENS : 1938

20

.,
."8Q..)
0
"n.15
..U..........,.l,

E
!...
lil

.a0...
olO
.,1-<

g.0 z

5

0

""'' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 27 28 29 31 32

66

LA1!0RATORIES

It is interesting to note from the report of the Albany branch that 16 of the negative specimens were obtained from patients who had been treated "almost to saturation" with prontosil. It is thought by some that such therap,y produces at first loss of type specificity and later
complete decapsulation of the pneumococcus which, of course, would cause the typing to be of no value. Apparently, however, passage through mice
restores the capsules and type specificity. Further study will have to be made to determine this.

Serological

Syphilis: During 1938, a total of 179,213 specimens were subjected to the
serological test for syphilis. Of these,l78,373 were specimens of blood and 840 were specimens of spinal fluid. The results obtained on blood specimens and spinal fluids are given in Table 14.

Table 14

Blood

Central

Al~

Waycron

Total

Positive Negative
Doubtful Anticomplementary

23,975 98,626
983 48

5,658
17,385 243

6,547 24,163
745

36,180 140,174
1,971 48

Total

123,632

23,286

31,455 178,373

Spinal l!'luids

Positive Negative Doubtful

61

1

684

16

___.2!

3

65

22

722

2

_.52.

Total

796

17

27

840

The central laboratory performed 124,428 (69.5 per cent) of these tests, the Waycross branch 31,482 (17.5 per cent), and the Albany branch
23,303 (13.0 per cent). There was an increase of 58,687 specimens (48.6 per cent) over the preceding year. The central laboratory received about 4,000 more specimens in 1938 than in 1937, despite the fact that the two branch laboratories examined approximately 55,000 such specimens.
The Kolmer complement fixation test for syphilis was abandoned on August 1, 1938, after a review of several thousand specimens revealed that the comparatively small amount of additional information obtained through ampla,ying this test in conjunction with the Xahn test would not justify its continuation.
At present, the presumptive Kahn test is empla,yed to eliminate all frankly negative reactions and the standard Kahn test is used for confirmation of positive reactions obtained by the presumptive test. Approximately 75 per cent of the specimens examined require only the presumptive test.
The central and Waycross branch laboratories participated i~ the 1938 sero-diagnostic evaluation series conducted qy the United States

LABORATORIES

Public Health Service. Both laboratories received a very high rating with both the presumptive and standard Kahn tests. Authorization for the Albany branch laboratory to participate in the 1939 sero-diagnoatic atudy has been granted by the United States Public Health Service.

Darkfield Examinations: A total of 251 darkfield examinations of sera for Treponema pal-
lidum were made during 1938. There were 97 (38.6 per cent) positive. This was an increase of 42 specimens over 1937.
While many of the specimens were collected directly from the male patients who had been sent to the laborator.y, the majority were submitted in special capillary outfits distributed by the laborator.y. ~ of the specimens received in the capillar.y outfits were not entirely satisfactory for examination due to the presence of pus, and also because insufficient specimen was submitted. Apparently, a much higher percentage of positives was obtained on the specimens collected in the laboratory. Records will be kept hereafter to determine this point.

Table 15

Biological Products Distributed

Central

Albany

Wqcross

Diphtheria antitoxin, units

55,298,000

Tetanus antitoxin, units

l,o46,800

Toxin-antitoxin, cc.

180

Plain toxoid, cc.

1,390

Alum precipitated toxoid, co.

67,382

Schick material, tests

22,831

Typhoid vaccine, co.

688,000

Carbon tetrachloride mixture, cc.

2,170

Tetrachloret~lene, 0.5 co, caps

35.715

Smallpox vaccine, points

82,846

Tuberculin, diluted, co.

15,200

Tuberculin, P.P.D., tests

1,910

Silver nitrate, ampules

70,000

Antimeningococcus aerum, cc. Bismuth subsalicylate, cc.

135 66,34;

Distilled water, cc,

546,000

Antipneumococcic serum, units

2,o4o,ooo

fArsenicale, ampules

77,987

Yeaat, pounda

23,263

+Antirabic treatments

2,938

2,260,000 288,000 0 0
2,050 840
17,860 150
1,700 4,170
0
0
1,307 0
1,800 ;6,215 1,420,000 1,180
0

1,469,000 56,000
0
0 1,020
550 17,250
0 4,000
1,590 0 0
1,106
0
1,74o 45,800 160,000
850 0

Bote: The biologics distributed by the branch laboratories are furniahed them by the central laborator.y and are included in the central labor-
atory report. Diatributed in 100 cc. bottles.
In addition, 55 gallons were distributed in demijohns to clinics by the Wqcrosa branch.
I Equivalent to 142,833 individual doses of 0.6 grams or lese.
+ Four vials of vaccine are supplied by the branch laboratoriea for each patient for whom treatment is requested, The remainder of the treatment is sent from the central laboratory.

68

LABORATORIES

Table 15 shows the distribution of various biological products dur-
ing the year. With the exception of typhoid vaccine, antirabic treat-
ment, silver nitrate and distilled water, which are manufactured by the laboratory, these products are purchased from various commercial houses and distributed gratis or at cost price.
All biologics distributed by the branch laboratories are invoiced
to them from the central laboratory, so that the distribution recorded from the central laboratory represents the total distribution for the year.
While there was an increased demand for most of the biologics, the distribution of diphtheria antitoxin and alum precipitated toxoid show-
ed an unusually marked increase. The distribution of these products
during the past five years is shown in Diagram 7. The increased demand
for certain other biologics is shown below.

1937

1938

Increase

T7phoid Vaccine, cc. Silver Nitrate, ampules Smallpox Vaccine, points Distilled Water, cc. Bismuth Subsalicylate, cc.

458,452 39,203 18,117 174,000 5,492

688,000 70,000 82,846 546,000 66,345

229,548 30,797 64,729 372,000 6o,853

Human Antirabic Treatments:
A total of 2,938 complete human antirabic treatments was distributed in 1938. This was a decrease of 507 treatments (14.7 per cent) from the preceding year. As can be seen from Table 16, this is the smallest num-
ber distributed during the past five years.

Table 16

Year

Human Treatments

Human Deaths During or After
Treatment

Human Deaths Without Treatment

Total Deaths

1934

2,955

2

1935

3,246

2

1936

3,027

3

1937

3,445

3

1938

2,938

l

3

2

4

3

l

4

2

2

While there was a decrease in the total number of treatments distributed, the geographic distribution throughout the State was compar-
able to that in 1937. During 1938 treatments were sent to 146 counties as compared with 149 counties in 1937. Map 4 shows the distribution for 1938.
This map probably indicates more accurately the true distribution of rabies throughout the State than does the map showing positive animal
head examinations. It can be noted that Fulton and Richmond Counties,
in the order named, received the largest number of treatments. In 1937 theae two counties received slightly more than 20 per cent of the total number of treatments distributed, and in 1938 slightly more than 19
per cent.

LABORATORIES

60
.'0

;.+;a:>>:

50

..+A".>.' 40

....<0......1.... 30

:00

..<.1.
.+.>.. 20

...p<1 10

1

0

70,000
60,000
.'0
:g 50,000
;::
+>
~40,000
0
..o30,ooo
.~"a20,000
10,000
0

DIAGRAM 7 DISTRIBUTION OJ!' DIPH'lHERIA ANTITOXIN
1934 - 1938
Years *Free distribution begun November 1, 1937
DISTRIBUTION OJ!' ALUM PRECIPITATED TOXOID 1934 - 1938
Years *Free distribution begun March 1, 1937

70

LABORATORIES

MAP 4

r--..,.-:r-:--:T"~-,-::--"T""..,..,.-T'"--:--r"'7""'""";'"7DIS'I'RII!UTION OP lltllfAN ANTIRABIC TIIBA'l'KI!IiTS: 1938

Total NUII1ber - 2, 938

Note

1'111ton 432 Cobb

59

Richmond 132 Deltalb

52

Bibb

108 Ball

~

:Muacogee 82 Co1qu1 tt 43

Troup

78 Glynn

43

Cheth8111 78 Sumter

41

Floyd

70 Waah1Dgton 41

Tattnall 67 Scrnen 40

LA.BORATORH~S

71

Four types of anitrabic treatments are manufactured and distributed:

(1) The Precautionary Treatment - consisting of twelve daily injections, This is recommended for exposures other than actual bites. Exception is made !n the case of very young children who cannot give accurate or acceptable information as to tr~ possibility of having been bitten. The mild treatment is routinely advised for such patients.

(2) The Mild Treatment

consisting of twenty-one daily injec-

tions, This is advised for all superficial or mild bites made on por-

tions of the body other than the face and head.

(3) The Intensive Treatment

consisting of two injections daily

for ten days, followed by one injection daily for eleven days. This is

advised for superficial or mild bites on the face or head, and for those

cases where institution of antirabic treatment has been delayed for

longer than one week.

(4) The Drastic Treatment

consisting of three daily injections

over a fifteen day period. Special dilutions of vaccine are given after

the sixth day of treatment. Drastic treatment is advised for severe or

multiple bites on the face and head and is supplied only by special ar-

rangement. A written schedule is furnished the attending physicl.an

with each drastic treatment.

The total number of treatments according to type distributed dur-
ing 1937 and 1938 is given,in Table 17. Table 17

Type Treatment

1937
Number Per cent

1938
Number Per cent

Precautionary Mild Intensive Drastic

979 2,229
216 21

28.41 64.70 6.27 o.61

946 1,762
207
_..?l

32.19 59.97 7.o4 0.7

Total

3.445

2,938

Human Deaths from Rabies: There were two deaths from rabies during 1938. Neither of these
patients received antirabic treatment.

(1) The first case was that of a twenty-four year old negro male,
resident of Atlanta, Georgia. He gave a history of having been bitten
November 3. 1937 on the thumb by his dog, which had been given to him
the day before. The dog was sick at the time and the patient was bitten trying to give the dog a dose of medicine. The following day the dog
was picked up dead by the sanitary department. No examination for rabies
was made,
On January 3, 1938, patient was nauseated and complained of numbness in the upper extremities. Nausea and vomiting continued January 4
and patient experienced difficulty in swallowing, Symptoms were more

72

LABORATORIES

pronounced the following day, Patient was admitted to hospital January
1. Temperature was slightly elevated, eyes dilated and throat sore.
Shortly after admission he becsme extremely irrational and all symptoms increased, Dea.th occurred two days later, January 9. Autopsy was per-
formed and Negri bodies demonstrated microscopically. Animal inoculations were also positive.

(2) The second case was that of a five year old white male, giving a history of having been bitten twice within a period of ten days by two different dogs, The first dog bit the child about May 15 on the arm just above the wrist. The child was scratched on the face and slightly bitten on the leg ten days later by the second dog. The information available as to the dogs is meager but one is known to have been subsequently found dead. No brain examination was made. The parents are known to have consulted their physician once but antirabic treatment was not advised,
On June 15 the child complained of a tingling sensation in right arm. The following day nausea, vomiting and an occipital headache were present, accompanied by restlessness that night. Difficulty in swallowing and photophobia developed June 17. Patient was hospitalized late J1me 17. Temperature was elevated at trAt time. Paro~sms began at 7:00A.M., June 8. The child died at 10:00 A.M. Autopsy was performed. Microscopic examination of brain smears was negative, Mice inoculated developed rabies on the ninth day and Negri bodies were demonstrated in smears made from these brains.

Distribution of Specimen Outfits

Table 18

Central Albany Waycross

Keidel Tubes Keidel Butts Dark Field Outfits Diphtheria Outfits Feces Outfits-tins, Survey Feces Outfits, Routine Slide Outfits Sputum Outfits Stool Culture Outfits
Syringes 1 cc. Tuberculin Syringe 2 cc, Syringes 5 cc, Syringes 10 cc, Syringes
Needles 19 Gauge 22 Gauge 24 Gauge 26 Gauge

150,001 17,847
578 4,432 80,214
766 9,686 9,272 7,479

11,082 1,694 88
350 3,672
12
144 773
616

22 167
83 251

14 dz. 61 H
36 " 162 II

1,299 6,919
42 200
14,976 0
522 366 387

Specimen Outfits: Table 18 shows the distribution of specimen outfits by each lab-
oratory during 1938. It is the policy to send to the branch laboratories various portions of the specimen outfits with supplies of labels,

LABORATORIES

73

direction sheets, etc. These are then assembled by the branches and distributed as completed outfits. Likewise, returned outfits are reclaimed and re-distributed by each laboratory. The table, therefore, shows the number of outfits assembled and distributed by each laboratory.
The only exception is the Keidel tubes. These are sent to the branch laboratories from the central laboratory, together with the empty mailing boxes and direction sheets. The 150,001 Keidel tubes distributed from the central laboratory thus represents both the completed outfits distributed by the central laboratory and the Keidel tubes only sent to the branch laboratories.
In addition to the outfits listed in the table, the following supplies used in malaria surveys were distributed by the central laboratory:

Glass Slides Slide Boxes (25s) Blood Stickers

83,3o4 1,182
40

Since the slide outfits each contain two glass elides, a total of 20,704 slides were distributed in the outfits. These, with the slides distributed for malaria surveys, make a total of 104,008 slides distributed during the year.

Manufacture of Media

Beef Extract Broth- - - - - - - - - - - - - - 48,000 cc.

Beef Infusion Agar- - - - - - - - - - - - - -129,300 cc.

Beef Infusion Broth- - - - - - - - - - - - - 28,000 cc.

Beef Infusion (Double)- - - - - - - - - - - -111,000 cc.

Conradi's Bile Broth------ ----- - 118,000 cc.

Dextrose Infusion Broth- - - - - - - - - - - 34,000 cc.

Desoxycholate Citrate Agar- - - - - - - - - - 36,300 cc.

Endo Agar (Stock)- - - - - - - - - - - - - - 39,000 cc.

Glycerine and Salt Solution- - - - - - - - - 88,000 co.

Loeffler's Blood Serum- - - - - - - - - - - - 13,300 co.

Pork Infusion Agar- - - - - - - - - - - - - - 42,000 co.

Pork Infusion Broth- - - - - - - - - - -

56,000 oc.

Russell's Double Sugar Agar- - - - - - -

9,500 co.

Selenite "F11 llnriohment Broth- - - - - -

30,000 co.

P~siologioal Salt Solution- - - - - - -

529,000 co.

Sugar Fermentation Broth--- -- ---- - 7,6oo co.

Wilson Blair Agar (Stock)------ - - - - 112,000 co.

Wilson Blair Mixture- - - - - - -- - - - - 6,800 co.

Miscellaneous- - - - - - - - - - - - - - - - 93,700 co.

With the exception of those given below, all media used in the branch laboratories is manufactured at the branches:

Beef Infusion, Beef Infusion Agar, Endo 1 s Agar, Wilson Blair Agar, Russell's Double Sugar Agar, Sabaroud's Media, Petragnani's media, Loeffler's blood serum and Wilson Blair mixture.

74

LABORATORIES

Research and Investigation

During the past year, a research unit consisting of a part-time senior bacteriologist and a full-time assistant, was established. The duties of this unit were in part routine and in part research. The routine work consisted of the performance of the mouse inoculation tests for rabies, the breeding of mice and of animal inoculations for tuberculosis. The investigative work included the studies of problems associated with the routine laboratory work, and research problems dealing chiefly with rabies, but including tuberculosis, blood chemistry, fungus cultures, and detergents. A detailed account of these activities has been prepared in a separate report. Only a brief summary of the research studies will be given here.

-----r. Rabies: Studies to determine the length of time the virus contained in the antirabic vaccine prepared by the laboratory remained viable under varying temperatures. As an adjunct to this work, a stu~ was made of the antigenic value of vaccine containing viable virus and vaccine in which no living virus could be demonstrated.

2. Attempts to standardize antirabic vaccine by titration, using Swiss mice.

3. With the aid of the director of laboratories, through his
position as referee on rabies diagnoses for the American Public Health Association, the research unit had the opportunity
of comparing the various diagnostic laboratory procedures utilized by most of the laboratories throughout the country.

4. The various methods of staining Negri bodies were studied
and preparations made by the research unit were compared with samples submitted by other laboratories.
5 Comparative tests of various procedures used in the lab-
oratory examination for rabies, such as smears, impressions, tissue sections and mouse inoculations.

6. A study of possible virus reservoirs which included an in-
vestigation of saliva from rabid dogs, fleas recovered from rabid dogs, spinal fluid from human cases, and brain tissue from apparently normal rats and squirrels.

7. A at~ of thermal changes in Swiss mice and the effect
aQY such changes might have on the develo~ment of rabies in
inoculated mice.

8. A method of removing brain tissue from inoculated mice by biopsy without permanent injury to the animal. This procedure proved successful in a number of attempts.

9. Study of certain experimentally infected mice which re-
covered after apparently developing symptoms of rabies.

-,

LABORATORIES

Tuberculosis: Studies were

made

of

the

feasibility

of

making

animal

inocu,l_aLti.o::n_s

I

intracranially.

Blood Chemist;r Determinations: As an adjunct to an investigation being conducted by the Glascock-
Hancock County Demonstration Unit on soil enrichment and nutritional status of persons consuming food grown on this soil, the research unit performed blood serum calcium and phosphorus determinations on fifty persons. This work is to be repeated at a later date.

~s Cultures.: The increasing demand for cultural studies of specimens submitted
for ~cological examination made necessary the development of technical procedures for the growth and identification of pathogenic fungi. Apparently, adequate procedures have been developed by the research unit, which has also made sn evaluation of the various media used in the cultivation of fungi.

Study of Detergents: A study of several proprietary cleaning preparations used by the
laboratory in cleaning glassware was undertaken to determine the optimum conditions under which these preparations were most effective and, if possible, to determine the principles underlying their detergent activity.

Other Investigations: In addition to the above mentioned research and investigations,
several departments of the laboratory carried on investigations of problems arising in connection with the routine laboratory examina-
tions. 1. The culture department of the central laboratory made a study of various enrichment media used in the isolation of typhoid bacilli from feces and urine specimens.

2. With the cooperation of the United St~tes Public Health Service, a complete classification was made of forty strains of B. dysenteriae isolated in the laboratory.

3. An intensive study has been made of five strains of
B. typhosus isolated in the laboratory which var,v markedly from the strains usually recovered. These are known as small colony variants and have rarely been isolated directly from patients.

It is expected that with the establishment in the near future U,V the United States Public Health Service of typhus fever and dysentery and diarrhea research laboratories at Albany, Georgia, the laborator,v will be afforded an opportunity to cooperate in the development of the knowledge of these diseases. This should prove of mutual benefit.

The microscopic division continued the investigation of a grading method of fecal specimens positive for hookworm. Comparison of the results obtained b,y this method with a more refined egg counting method was made by two of our personnel at Johns Hopkins University, The

LABORATORIES
microscopic department also has under investigation concentration and cultural methods for protozoan cysts. Both this department and the Waycross branch laboratory have been engaged in an investigation of several concentration and cultural methods for the detection of B. tuberculosis.
Personnel
Although there was a marked increase in all phases of the laboratory activities during 1938, the work was accomplished without an increase of technical personnel.
There were fifty-seven employees in the three laboratories (excluding personnel in the water laboratory and cancer control laboratory, who are employed by other divisions). Forty-five are employed in the central laboratory and six in each of the branch laboratories. Fortytwo are white and fifteen colored. The only increase in personnel was the addition of one colored diener.
In February, three technicians were sent to Johns Hopkins School of aygiene and Public Health, Baltimore, on training status as provided by the Social Security Budget. They completed their training there in June. One junior bacteriologist and one technician were sent to the same school under the same conditions in September. They will complete their training in February, 1939. Replacements for these were made from laboratory student trainees.
During the year, four applicants were accepted for training in the laboratory. One completed training during the year. Through the cooperation of the division of cancer control, training in tissue technic has been added to the work studied by these students. Because of the present lack of demand for laboratory technicians, the advisability of discontinuing this training has been under consideration. However, the majority of technicians in the personnel were selected from trainees, and there is considerable advantage in having a source of adequately trained replacements. The requests for such training are increasing, while the qualifications of the applicants are, in general, superior.
The director attended the annual meeting of the American Public Health Association held in Kansas City, Missouri, from October 25 to 28. The laboratory was honored when the director was chosen as chairman of the laboratory section of.the Association. He is also referee on rabies for the Association. The director and chief serologist attended the Assembly of Laboratory Directors and Serologiste held at Hot Springs, Arkansas, from October 21 to October 22.
Under a travel grant from the Rockefeller Foundation, the associate director spent the month of October visiting a number of state laboratories, in which he studied their organization and various activities.

DIVISION OF MALARIA INVES~IGATIONS
This division was planned and partly organized in 1937, but did not exist as an independent budgetary reality until July 1, 193S. As of that date, professional personnel consisted of a director (protozoologist), a medical epidemiologist, two field biologists and an engineer, the last operating in a liaison capacity with the division of sanitary engineering in which he is known as the malaria control engineer.
The main objectives of this division are (1) to promote, plm, and budget county-wide malaria control according to the principles of the Standard Plan for County-wide Malaria Control in Georgia, (2) to study malaria and ita control, especially those phases of these problema as
they occur in Georgia, and (3) to devote such time as is thereafter
available to the study and control of other par~sitic diseases in Georgia.
To briefly recapitulate 1937 accomplishments, Brooks, Sumter, and Terrell Counties adopted the Standard Plan, and active malaria control activities were commenced in each county. Progress reports on current malaria investigations, and recommendations and proposed budgets were submitted to Sumter and Brooks Counties. County-wide malariometry was promoted, supervised, or actually carried out by division personnel in 15 counties - Brooks, Burke, Calhoun, Decatur, Dougherty, Jenkins, Laurens, Lee, Liberty, Richmond, Sumter, Terrell, Thomas, Tift, and Worth, Malaria control mapping was advanced to varying degrees of completion in all malariometry counties. An attempt was made at winter anopheline survey in Thomas County, and observations on winter anopheline ecology were commenced in Brooks, Sumter, Terrell, and Thomas Counties.
Standard Plan Accomplishments in 1938
In 1938, Thomas, Calhoun, Dougherty, Burke, and Crisp Counties definitely agreed to adopt the Standard Plan. Provisional adoption was made in Laurens County.
Investigations were carried to a point where progress reports could be made and budgets planned for county-wide control in Thomas and Terrell Counties. These reports are based upon joint contributions from the fields of malaria epidemiology, biology, and engineeriDg. They include historical and current data bearing upon the importance of malaria to the county, its distribution and relative intensity in various parts of the county, mapping accomplishments, entomological investigations showing the number and types of ponds visited, dipped and found positive for the malaria-carryiDg mosquito, and an account of previous and present malaria control activities. On the basis of this information, a definite plan of procedure is recommended and a budget devised to show the direction and general magnitude of spending to support the plan. Similar reports are in preparation for Calhoun and Lee Counties. Studies are being made in Dougherty, Crisp, and Burke Counties on which future reports and budgets will be based.
A second report summarizing malaria control accomplishments for one year, suggesting lines of :future activities, and revising the malaria control budget was submitted to the Sumter County Board of Health.
77

78

MALARIA INVESTIGATIONS

Educational and Promotional

Unnumbered informal discussions and conferences have been held with county health and WPA personnel throughout the year. In addition to these, 17 lectures have been given before university, scientific, or civic interest groups, and 13 appearances have been made before county commissioners and boards of health. Literature has been sent to all health organized counties.
A local malaria trade journal, the Georgia Malaria Bulletin, has been edited by members of the division. It is mimeographed on Si''x 1111 paper, has a circulation of nearly 425, and contains items primarily of interest and importance to persons concerned with the investigation and control of malaria in Georgia.

Malariometry

Malariometrical analyses and summaries were made by the malaria control engineer and by the medical epidemiologist on the blood and spleen
data collected from elementary public school children in 1937 Two of the counties, Lee and Liberty, were investigated to provide bases for measuring natural fluctuations in malaria prevalence in the absence of organized malaria control operations. Such information, if systematically ac~lated each year, will assist in the objective evaluation of anti-malaria activities in comparable situations.
In continuance of this policy, enlarged spleen or thick blood film surveys, or both, on elementary school children during the late fall of 1938 were supervised or actually carried out by the division personnel in 12 counties either on a complete or partial county-wide basis, In addition to the two comparison counties, Lee and Liberty, the following counties participated: Bibb, Brooks, Butts, Calhoun, Crisp, Dougherty, Jenkins, Laurens, Sumter, and Terrell, This has involved the collection of some 20,000 blood smears and the examination of approximately 25,000 children.

Entomoloo

Routine malaria field entomology has been carried on in Burke, Calhoun, Crisp, Dougherty, Lee, Sumter, and Thomas Counties. Special entomological investigations have been made in Bibb, Brooks, Crisp, Decatur,
and Laurens Counties. During the winter months of 1938, field observations were made in Brooks, Sumter, Terrell, and Thomas Counties on the hibernal incidence, distribution, and habits of anophelines, especially
! quadrimaculatus. These projects have involved visiting nearly 1900
different ponds, many of them on several occasions, not only to collect and identify anopheline larvae but to record the physical and biological characteristics of the breeding areas.
About 50 sets of mounted adult specimoms of the common species of
anopheline mosquitoes have been prepared by the entomologists and have been distributed to interested county health departments.

Special Investigations

At the request of county health personnel or of the mlaria control engineer, the following special entomological field studies were made:

MALARIA INVESTIGATIONS

79

1. Crisp County Power Impoundment - to evaluate present malaria control activities.
2. Decatur County - to determine malariogenic importance of certain
ponds and sloughs the WPA drainage of which vas disapproved by the Bio-
logical Survey.
3. Laurens County- to discover quad. breeding, if any, in old CWA
drainage projects.
4. Bibb County - to determine the malaria justification, if any,
of the proposed machine drainage of an area south and southeast of Macon,

Reports on these subjects analysing and commenting upon the field obser-
vations have been delivered to the interested parties. Special investigations and reports have been made by the medical
epidemiologist on the following subjects: (l) A malaria history survey in Carroll County, (2) A thick film house-to-house survey on persons of
all ages in Warwick, Worth County. (3) Antimalarial sales investigation
in counties included in the Northeast Georgia Health and Conservation Association. A special investigation was made and report rendered on the malariousness of the nine counties included in the Northeast Georgia Health and Conservation Association.

Research

A. walkeri, a mosquito potentially capable of transmitting malaria, though it has not yet been found infected in nature, was first recognized in Georgia by one of the field biologists. A note to this effect has been published in the Southern Medical Journal.
A type of A. crucians resembling the one usually found in brackishwater situations was found distances of over 100 miles from the coast. Its ecology was described by the field biologist before the National Malaria Committee. A research note on these observations is now in press in the Journal of Parasitology.
In collaboration with a staff member of the division of sanitary engineering, the malaria control engineer investigated the relative effectiveness per unit cost of pyrethrum extracts and Paris green as anti-anopheline larvicides. It was found that either, if sufficiently concentrated, was capable of destroying nearly all larvae but that the cost of the minimal lethal application rate, per unit area, of pyrethrum extract was 15 times that of Paris green under the experimental conditions of dense vegetation, The results were reported before the National Malaria Committee and will be published in the Southern Medical Journal.
Certain of the ecological data routinely collected by the field biologists have served as the basis for public discussions of papers presented before the National Malaria Committee and the American Society of Parasitologists during the year. These will be published later.
A study of the historical prevalence of malaria as revealed by reported deaths in relation to meterological circumstances has been commenced. It is hoped that this will be completed and published in the future.

PUblications

Staff members contributed to the current literature during 1938 as
follows: (1) The Occurence of Anopheles walkeri Theobald in Georgia.
Southern Medical Journal, 31:797. (2) An Anopheline from Inland Georgia
Resembling the Brackish-water Race of Anopheles Crucians. Journal of

----------

30

MALARIA INVESTIGATIONS

Parasitology. In press. (3) A Comparative Evaluation of Paris Green
and Pyrethrum Emulsion Larvicides for Malaria Control in Georgia; A
Progress Report. Southern Medical Journal. In press.

Malaria in Georgia in 1938

Malaria prevalence in this State during the past year as judged by reported deaths, cases, and the personal testimony of health officers and inhabitants of endemic areas was at an all time low level. It is interesting and may or may not be significant that this conforms to the pattern of "seven year cyclicity" heretofore observed in this State. The total number of reported deaths from malaria was 146, a rate per
100,000 of 4.7. This is 32.1 per cent of the average annual death rate (14.6) for the last ten years.
Similarly the case load for t.he State was light, totalling 3,816 for the year, a rate per 100,000 population of 123.1. This is 69.2 per cent of the average annual case rate (177.8) for the previous ten years. While this figure is the lowest since 1932, it is actually higher than
would have been reported if survey blood positives had not been included. The health officers and nurses in Standard Plan counties are also especially interested in apprehending malaria cases themselves and encourage their local physicia.Ils ~o send blood smears to the State Health Department Laboratory for diagnosis. These factors have undoubtedly increased
and added to the malaria case reporting in 1938.
Some of the reasons for the phenomenal decline in malaria prevalence during the last year follow: 14alaria incidence for the previous year,
1937, was depressed, reported deaths and death rates being the lowest on record up to 1938. This naturally resulted in a reduced disease
potential for the following year as there were proportionately fewer relapses and chronic cases to carry over through the winter and thus few-
er gametocyte carriers to start mosquito infection in 1938. The second reason was the deficiency in rainfall. During 1938, the
accumulated state-wide precipitation amounted to 42.04 inches, which is only 84.2 per cent of the annual average (49.96 in.) since 1892. South of the fall line, the deficiency (78.0 per cent of the average rainfall)
was even more marked especially during August and September. Reduced
rainfall influences malaria prevalence adversely in two different ways. First, it diminishes the number and area of possible breeding places for Anopheles quadrimaculatus. Ponds were dry in South Georgia last year which had never been dry before according to nearby residents. In the second place, the lack of rainfall results in lower atmospheric humidity. The longevity of life of adult mosquitoes varies directly with the amount
of moisture in the air, other conditions being constant. Inasmuch as (1)
the development of parasites in mosquitoes requires eight days or longer according to environmental temperature, and (2) the chances of mosquitoes feeding on gametocyte carriers increase with the length of their lives, it follows that the liklihood of anophelines living long enough to become infective depends to a large extent upon the local rainfall.
The third reason which may be properly offered is the extensive malaria control efforts which are under way in different parts of the State. Major and minor drainage, filling, impoundment basin improvement, larviciding, water-level fluctuation, fish-stocking, screening and antimalarial drug distribution are being actively prosecuted in various places. The collective effect of these activities is perceptible on more than local scale and played some part in the observed statewide reduction.

IIALARll INVJ!iSj!IGAUONS

81

10

1

I!BlPQRj!~D I!ALARIA MORTALI'fY IN GEO!iGIA -1938-
D Aver!lll8 llonthl,y Death Rate (1928-37) [ZJ llonthl,y Death .Rate--1938

1.0

0.1

0.01

!':

~
.~..,

e~ ..".0.

11
,~.

....
'I!
~

,t.l

~"

..
i !:I
~

1""l !el-
rn

.!.""0.l.
0

'""ll I";
:.;

1..!""".1l. 0.01

82

li.ALARIA IlMilS'tlGA~IONS

110

100

llEPOR'l'ED li.ALA."<IA IIO!iBIDITY IN GEORGIA -1938-

Average llonthl,y Case Rate (1928-37)
llonthl.,y Case Rate--1938

D
[ZJ

10 ~414

~~
~

~ 18.36 ~s
v- ,J.!!..3l
lt. "~ 48

11b.60
~

10

hi .9
b 61 .96

~,,

g

~
a..~..

I
1.84

i.

~~ n
..8."....
..",
."."1'

3.. 3.2

~ 1. 9C .0

0.1

.. . ~


I'.'
e~
~

-3
::

...
'J:
~

)

~

k
.!!

.. a.

.
.1"1
eo
"'

..0."...
0"

.
1"1
!"

1...1
."!1 0.1

II

&n!IW!T BY OOUNTU:S 01 1937 1ALL Tlli at BIOOD l!'ILM SJRV:EYS 01 !L!IdEtlTARY SCHoOL Cl!ILDREII

(Arranged in deacending order of total paraai to indi cea)

\lHIT!i

OOIORID

TOTAL

eo.mv

- llalaria
DeatJl No. Rates

f.
Po a.

~ g' ~! l!!IIIU1u Tor- Sl>.b- Qlar- Ill. xed Uan Tertn tan & Undo-
termd

No. ham.

f.
Poe.

~ gt .Ul ;egu t~ u
Ter- Sl>.b- Qlar- Mi:rad tian Tertn tan & Unde-
term'd

-No,

f.
Po a.

S gt ~1 E211 ti ve1
Ter- 911>- QUar- lll.xed Uan Tertn tan & Unde-
tenn d

Calhoom 76

slls 1.4 42.9 42.9 14.3

859 26.8 9.1 81.8 0.9 8.2 1343 17.7 10.1 80.6 1.3 8.0

~

Lee

90

Jeldna 90

Liberty 77

170 4. 7 644 36 3b8 0.8

25.0 75.0
43.5 5b.5 333 bb.7

67~
42

18.3 19.1

35z 1

64.5 91.4 1.2

495 14.1 12.9 87.1 1.0

849 15.5 34.! 65.2 lObS 9.7 15.4 83.6 863 8.5 13.7 8b.3

~


Blrlce

72

91mter

24

Brooks

37

Laurena 118

llollgherty 31!

940 1,6
1231 1.8 1631 4.1 2597 1.3 1391 0.4

5.9
909 91.0 32.3 6o.o

70.7 ll. 7
9.1 3.0 67.7 4o.o

11.7 1081
1708 6.0 651
1278 1799

7.4 2.5
52 4o.5 1.4 3~3 b,l 1 .1 11.6 25.~

94.9 1.3
59.5 66.7 85.9 61!.6 6.1

1.3 2021 4.8 3.1 901 3.1 3.1

2939 3.8 50.5 49.5

2282 3.3 84,2 10.5

5.3

3875 2.9 19.6 1!0.4

3190 2.8 27.3 67.0 5.7

."~.'.
~
0
!il

Terrell 36

975 1.0 3Q.O 70.0

1253 34 21. 71!.6

2228 2.3 23.1 7b.9

Decatur Worth

~

Thomaa

31

Tift

31

Rlchmond 11

1280 0.7 555 44.5

158, 0., 20.0 4o.o 189 o. 25.0 12.5

181!2 0.3 100.0

591! 0.2

100.0

384 2.1 22.2 66.7 4o.o 852 2.5 19.1 76.1 62.5 469 0.9 75.0 25.0
No colored children exemined
391! o.o

11,1 1664 1.1 39.0 555 4.8 2435 1.1 19.2 69.2

2363 0.5 41.7 16.7

11!1!2 0.3 100.0

996 0.1

100.0

55 ll,b 41,7

-ror.u.

17661! 1.4 57.2 35 7 1.3

5.8 123:,0 75 18.b 71!.0 1.0

2.4 29998 J.S 26.2 69.1! 1.0 31

~verage annual reported malaria death rates per 100,000 poJ>Illation computed on

a

a 10-;rear bali

_ _j

84

IIAURIA INVESTIGATIONS

III

SJl.IMARY :BY OOUNTIES OF 1937 J'ALL SPLEJN SJBVETS OF ELDIJNTARf SC!lJOL CHILDREN

(Arranged in descending order of total spleen enlargement indices)

County

Malaria Death Rates

W!IITE No. Exam. '1> Poe.

Cl)UlllED No. Exam. '1> Poe.

'l'OTAL
No. Exam. 'f. Pos.

Lee

90

Worth

44

Jenkins

90

Calhoun 76

Brooke

37

Richmond 11

Terrell

36

Decatur

32

Thoma

31

Liberty 77

Tift

31

Sllllter

24

Jlou&herv 31!

'l'O'l'AL

147 1583
638 484 1631 628 466
1111! ~
12~~
1231 1294
12417

43.5 lb.4 14.8 15.3 13.2 11.5
5.11 7.2
6.a 11.
3.4 5.6 0.3
9.0

517

21.7

1152

19.3

436

11.7

845

12.0

651

4.6

428

1.4

705

7.0

334

0.9

485

33

3112

3-9

No colored exams.

1701!

1.7

1537

1.4

1!1!1!0

6.7

664 2435 1074 1329 22112 1056 1171 1473 2~79
17 1247 2939 21!31
21297

26.5 17.4 13.5 13.3 10.7 7.4
6.5 5.11 5.1! 4.6 3.4 3.3 0.9
8.1

Average annual reported malaria death rates per 100,000 poPJ.lation, comPJ.ted on a 10-year basis.

IV
l!htomo1ogi ca.l n eld Sertl ca
Numbers of !llffarent Ponds Visited by J'ield Jlhtomologiets in 1938

County

Ponds Visited

Ponds Dr7

Ponds !llpped

Ponds Anopheline-
poaHiTe

Pond a
A. qnadrimaculatus posi tiYe

Bibb

10

0

10

6

1

Brooke

11

0

11

10

6

Burke

376

149

227

1~

141!

Calhoun

468

413

55

31

Criap

93

41!

45

26

g

Decatur

27

0

27

23

20

Iklughert;r

63

0

63

34

21

l&lrene

39

14

25

23.

15

Lee

193

114

79

49

15

Sllllter

55

0

55

43

15

Terrell

12

1

11

9

2

~omu

490

167

323

261

93

Worth

1

0

1

1

1

'l'O'l'ALS

11193

906

932

726

376

~~anT ponds ware viei ted more than once, but aa far aa poesibla the table above ahowe the !llllllber of ponds visited ra.ther than the llWIIber of villi ta made to ponds.

M4LARI.l UIVISTI GATIOJIS

85

:II.B. The following table, corrected to date, is subject to slight future revi aion due to adjustment of places and times of death, correction of cases, etc.
VI
Kal.il.l.l ll!lllr.tiAio llliYI.-ti$11 PER IQO ,QQ.Q !!,2PULA.TIQJI
111lll. llAI!II 111lil. C.li::l:i$!11 ED J,QQ ,QQQ ~PULA.IJ;QN ill !li!!Ul.i [!It 19311

Oounto;r
.AppliJIC .ltkinaon Baoon Baker Balclwln Banke Barrow Bartow
Ben m.u
Ben1.a Bibb Bleckl.., Brantlq Brooke Bl')"llll Bu.lloch Bu.rke Bu.tta Calhoun Can dell Clllldler Carroll Catoou Charlton Cbathaa Cbattahoochee Cbattooga Cherokee Clarke Clq Clqton Clinch Cobb Coffee Colquitt Ool'ambia Cook Coweta Crawford Crisp Dade llaWIOil Decatur llahlb
Dod& Doo] Dougherto;r Douglal larq

Mortali!iz

Death a

Rates

1

7.0

1

12.9

1

11.6

1

5.9

1

7.3

4

5.1

2

8.8

1

15.4

3

10.2

5

-16.3

3

26.5

1

15.0

1

2.7

1

0.9

1

13.3

1

12.9

1

2.6

2

9.0

1

8.0

1

5.4

1

39

4

16.7

2

10.4

2

8.7

2

10.1

Morlotdi tz

Cases

Rates

10

69.9

3

38.6

3

34.7

2

8.3

2

18.0

6

43.7

1
17

-3.6
101.~

6

7.

17

170.2

299

1310.1

76

1170.0

~~

121.8 809.3

45

391.0

5

74.8

7

70.7

1~

35.0 38.8

210

194.2

12

124.4

9

53.1

5

22.0

2

7.7

1

9.1

5

64.4

8

21.1

58

26o.o

67

::m.6

4

41.6

62

495.4

3

11.3

1

13.0

29

156.8

-

34

133.0

7

9.4

27

112.5

76

393.9

72

315.3

22

212.0

20

100.8

86
OOwlt;r
Jlchola lftinglwl
nber~
mnazm.e1 Ivana Jumin
Pqe~te
llo;rd lore;rth lranklin Jb.ltOD Gilmer Glaaoock G:cynn Gordon
Gra~
ar..na
Gwl.lllle\t Habereham Ball Hancock Haralaon Harrie Han Heard Hen17 H011eton Irwin Jaakaon Jaeper Jeff Davia Jefferaon Jellld.u John eon Jone1
:r.mar
Lanier Lll1rene Lee I4bert;r I4ncoln Lone Lo1111odea IDmpld.n McDlftie llcintoah Macon Vadieon llarion lleriwether !Iiller llhchell Monroe Montgomer;r Morgan

IIALWA INVESTIGATIONS

!IQrta1itY

Death a

Bate a

3

11,4

1

12.9

1

5 T

2

o.6

1

:20.8

4

19.0

-
4

-34.9

1

4.:3

1

11.5

1

4.5

4

29.0

3

28.9

1

18.2

T

20.1

1

ll.T

3

9.:3

3

1To2

1

4.1

1

9.8

:3

11.4

2

18.3

Morbiditr

Ca

Bate a

5

45--.4

lTS

6T8.6

-

2

21.6

6

11,4

9

51.5

48
1

1u3.s9

2

41.6

1

4.8

6

31.9

10

332.2

1

T.T

1

3:3

4

-28.1

15

6.6

:3

2!).0

5

29.2

T

61.1

11

82.:3

35

149.0

2

22.0

4

46.1

1

4.5

188

1381.4

13

-94.4

5 21!n

-48.2
m4. T

20

231.4

-T

81.6

29

656.2

28

86.8

-

26

-149.0

2

26.4

~

36.9 58.5

29

109.8

-2

16.0

4

30.6

IULARU INVESTIGATIONS

87

County

lfotlali t:r

Deaths

Rates

lllrray

lmecogee

1

Newton

Oconee

Oglethorpe

P1111lding

Peach

1

Pickens

Pierce

Pllte

Polk

Plllaald

1

Plltnan

~itman

Rabun

Randolph

Rlchmond

3

Rockdale

Schley Scre'Yen

1a.

Semlnole

1

Spalding

2

Stephens

Stewart

1

So.mter Talbot

13

Taliaferro

Tattnall

1

Taylor

Telfair

2

Terrell

5

Thomas

Tift

2

Toombs

2

Towns

Treo. tlen

1

Troup

1

To.rner

3

Twiggs

1

Union

Upson

Walker

Walton

Ware

Warren

Washington

4

Wayne

2

Webster

1

Wheeler

1

White

Wld. tfield

Wilcox

Wilkes

lllkinson

1

Worth

3

!!XITA.L for State 141

1.7
95
10.4
4-.0
17.7 17.2 12.6 8.4 8.2 10.7 10.4 59 12.3 26.2 11.7 10.4 122.. ~':1 23.7 10.5
11a..r2; 18.5 9. 7
8.7 12.8 4.5

Morbidity

ea....

Rata a

2

19.3

14

23.9

3

16.6

1

7.0

57 2

-539.1
14.4

6

52.2

32

llS.J

1-4

76.r;

139

186.4

3

41.3

25

107.3

62

782.3

7 1

279. ~

4
208

7a21..84

4

41.7

17.8

la

123.3

50

J06.7

46

241.1

1254

72.1 81.9

3

15.7

-

48

122.8

4

31.6

6

28.7

3

10.4

32

1J8.1

1

3.6

1

8.1

55

209.1

18

:m.1

3

29.0

2

8.5

2-62

152.0 52.J

29

123.6

3572

115.2

DIVISION OF MATERNAL AND CHILD HYGIENE

Divisional Staff
Field Activities:
Consultations and Clinical Services Interviews and Conferences Radio Talks

483 1,521
3

Papers, addresses, etc., total attendance:

P~sicians

568

Public Health Personnel

621

Lay Groups

12,41;0

13,639

Motion pictures shown, total attendance:

P~sicians

446

Lay Groups

3, 978

4,424

Additions to Staff: Associate Director, Pediatrician, on leave
for additional training in the fall of 1937, returned to duty Januar,r 1, 1938. In the last quarter a pediatrician vas loaned by the Child-
ren's Bureau for special work among negro ~sicians and leT groups. :By the end of December nearly every negro peyaician in the State has been visited b,y this staff member, whose services are available as
private consultant and in an educational capacity.

Comment on Rates

Maternal Mortality: There has been a marked decrease both in
number and rate of maternal deaths during 1938. Fifty fewer mothers
died than in any year in the past ten. The maternal mortality rate of
6.5 represents a new low rate for Georgia.

Stillbirths: There has been marked reduction in the number and
rate of stillbirths during 1938, which is the first time than any con-
siderable reduction has occurred. There occurred 220 fever still-
births than at any time in recent years, and the rate of 52.7 repre-
sents a new low for Georgia.

Infant Deaths: The 1938 rate of 67.7 is an increase over last year's all-time low of 62.0. There were 450 more infant deaths than in 1937, which is due in part to the increased prevalence of diarrheal diseases in all age groups during the spring and 8UIIIIIIer of 1938.

Rate of deaths under one month Rate of deaths under one week Rate of deaths under one dq

These 1938 rates are practically the same as 1937, the rates for each
of these years representing distinct decreases from those of previous
years.

89

90

l4ATERNAL AND CHILD HYGIENE

Maternal and Infant Health Centers

The year 1938 has seen great expansion in this field of the activ-
ities, as is indicated b,y the following table of the number of counties
served b,y maternal and by infant health centers:

Aa of Date:

No.Counties With Maternal Centers

No.Counties With Infant Centers

January 1, 1937

12

10

Januar,y 1, 1938

37

26

January 1, 1939

66

52

It is estimated that there were functioning at the close of the
year some 169 maternal centers and 144 infant centers, as compared to 21 maternal and 50 infant centers in operation two years ago. There were 51 counties receiving~ types of service at the end of the year.

State Subsidized Centers: The major phase of expansion was the development of a subsidy plan, in cooperation with the Children's Bureau,
enabling the division to supply equipment and to pay honoraria to private p~sicians serving these centers. The plan was agreed upon in the
third quarter of the year, although the actual participation did not be-
gin until the last quarter. ~ the end of the year, the division was
participating in centers of this type in 32 counties (in addition to
Chatham, Glascock, Hancock, and Tift, who participate on another basis.) Most of the remaining counties with centers have taken steps to qualify at the present writing.
For the month of December, the 32 counties reporting in the subsidy
plan showed:

59 centers 123 sessions s4o prenatal visits 520 visits b,y infants and young children.

During the last quarter 66 practicing p~sicians have shared in this
activity over the State.

Midwives

Midwives attenden 36.5 per cent of all live births in the State, or about the same percentage as in 1937. This is distinctly lower than in former years, which have varied from 4o to 43 per cent.

Total Number of Midwives Certified

3,049

Total Number of Midwives Denied

Certificates

518

Total Number of Live Births Attended

by Midwives

23,34o

Midwife Meetings

1,931

Attendance at Meetings

14,596

Visits for Midwife Supervision

4,752

Midwives receiving Medical Examination 489

Increase or De-
crease over 1937 - 4~
-~
+ 5~
+11~
+ 6% +16%

MA'I'ERNAL AND CHILD HYGIENE

91

Control activities have increased slightly over the preceding year; quality of the work has markedly improved, and there is room for still further improvement. Midwife certificates were renewed in all counties save two, in which certificates have been temporarily withheld pending
more satisfactory qualification. A new midwife syllabu~, begun during the year, has not been completed.

Local Maternal and Child Health Activities

The following is abstracted from the combined reports of the division of county health work and the division of public health nursing, and represents the work reported by cooperating local health departments, maternal and child health demonstrations, state itinerant nurses and county nurses in unorganized areas.

~ternal Health Service: Item
Cases admitted to prenatal medical service Cases admitted to prenatal nursing service Visits by prenatal cases to medical conferences Field and office visits to prenatal cases Cases given postpartum medical examination Cases admitted to postpartum nursing service Visits to postpartum cases

Total
11,429 14,974 40,581 39,718 1,644 7,142 25,076

Increase
over 1937 + 48~
+~
+ 91~ + 41~
+121~
+ 93~
+3~

It is apparent from the above that gratifying increase in maternal
health activities has occurred during the year. It seems that an average
of 3.55 visits to conference vas made by each case admitted, which should
be considered a rather satisfactory ratio in view of the fact that many of these centers are rural. Particularly gratifying is the fact that
cases given postpartum medical examination have considerably more than
doubled. The need for further increase is indicated by the fact that
postpartum medical examinations were given 14.4 per cent of the number
admitted to prenatal medical service.

Infant and Child Hrgiene:

Item

Infant Hygiene

Individuals admitted to medical service

Individuals admitted to nursing service

Visits to medical conferences

Field and office visits

Total
5,110 16,089 11,668 45,974

Increase
over 1937
+1~
+ 91~
+~ +1~

Item

Preschool Hygiene

Individuals admitted to medical service

Individuals admitted to nursing service

Visits to medical conferences

Field and office visits

7.534 12,101 9,885 28,115

+3~
+ 41~
+3~
+ 13~

Item

School Hygiene

Examinations by p~sicians

Inspections by dentists

128,256 105,561

+4~
+ 33~

In general these activities show decided increase over those of the pre-
vious year. It is gratifying to point out that the number of infants admitted to public health nursing service during the year amounts to ap-
proximately 26 per cent of all children born in ths State, or more than one out of 4.

92

MATERNAL AND CHILD HYGIENE

Inspections by dentists of school children is an incomplete figure, inasmuch as many more examinations are conducted by the Dental Association of Georgia in cooperation with the division of dental education and appear in reports of that division.

IDDDunizations:
Item Smallpox
Diphtheria - under 1 year
Diphtheria - 1 through 4 years Diphtheria - 5 years and over
Total Diphtheria

Total
91,745 9,195 23,910
22,~85
55. 90

Increase
over 1937 +153~ +19%
+1~ +3~
+~

The increase in immunization against smallpox is particularly grat-
ifying. There is still room for improvement. The increase in iDDDuni-
zations against diphtheria, particularly in those under 5, is disappoint-
ing. During the coming spring and summer every effort will be made to
increase this activity at a more rapid rate.

Special Educational Activities

Publications: 1 Georgia's Health has more than doubled its circulation in the past eighteen months. It now goes to about 22,000 people in this State monthly. It should be enlarged and illustrated, which, however, would entail a larger budget.
"Maternal Care 11 , an illustrated book for expectant mothers, was released in January. Over 31,000 copies have been distributed. The Georgia Baby Book continues to have a heavy demand.
A bulletin for p~sicians on the treatment of congenital syphilis has been well received. A set of diet cards has been prepared and distributed to all infant health centers and health departments.
A compand on normal obstetrics was purchased for distribution to p~sicians on request. Over 700 copies were supplied to Georgia doctors and medical students. The value of numerous publications of the Children's Bureau, which are distributed through this division, is acknowledged. A number of these were reprinted by permission.

ParticiJeation in Health Curricula in Colleges: Staff members of the division participated in the course in Public Health given the medical students of the University of Georgia and in the course for teachers at Oglethorpe University Summer School. Staff members lectured to 10 classes in the Summer School at Georgia State College for Women, and 8 classes during the fall quarter at this institution. With respect to Georgia State College for Women and the Medical School of the University, our participation is a regular activity each year.

Fifth Sundq Meetings for Negroes: Negro Health Week this year
was well observed throughout the State, the division participating to
considerable extent in a number of these programs. Fifth Sunday Meet-
ings, which occur approximately quarterly, and are particularly suitable to assemblage of rural negroes, were also inaugurated. Meetings were
held in from 9 to 11 points on each of the Fifth Sundays (May, July and
October.) Members of this division and others of the Department showed
motion picturet and made talks at these meetings. They have been well attended, the assemblies varying from 100 to 4oo at each point. It is

MATERNAL AND CHILD HYGIENE

93

estimated that the members of this division alone addressed over 2000 people at such meetings during the year.

Cooperation with 4-H Clubs: The staff pediatrician made physical examinations for the health awards of this group during the third quarter. The division cooperated with the state organization of 4-H Clubs to inaugurate a program bringing sanitation, hygiene and health information to a more prominent place in the work of their 80,000 members.

Visual Education: During the year motion picture equipment and films were secured. Two pictures on prenatal and infant health have been shown extensively. Several excellent films for physicians on obstetrical subjects have been secured and shown to groups of physicians
numbering 446. Two of these films were shown at the annual meeting of
the Medical Association of Georgia.
Y!f Day Activities: An extensive program was conducted in cooper-
ation with Parent-Teacher Associations, school authorities and others, directed by the division of health education, whose report will embody the details.

Postgraduate Medical Education: An extensive use of obstetrical motion pictures at county, district and state assemblies has been well received. During the last quarter the director has completed plans for a series of meeting of physicians at ten strategic points, to begin in January. There will be two meetings at each point, a week apart. Similar plans are under way for the negro physicians of the State.

Demonstrations

Demonstration in Child Health and NUtrition, Glascock- Hancock Counties: The unit has completed its 30th month of operations. Copies of the director 1s report for the year are available. It requires no comment other than to note that, in addition to the balanced public health program, definite and tangible results are manifest in the field of child health and nutrition. The Extension Division of the Agricultural College of the University of Georgia has contributed no small share to this project. It is quite evident that public support and cooperation have become outstanding during the past twelve months, and that the ultimate objectives are being attained.

Maternal Health Demonstration, Tift County: It is evident that the demonstration, which has Just completed its first year, has been productive of much good in reducing morbidity and mortality for mothers and babies. This is likewise apparent to the people in the colllllllltlity. A brief statistical summary is included. Some points worthy of note are:

Maternal mortality rate of 8.4, as compared with the previous 5-year average of 13.9.

Stillbirth rate of 39.8, as compared with previous 5-year average of 82.

Rate of deaths under 1 month, 44, as compared with the previous 5-year average of 58.

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

MATERNAL AND CHILD HYGIENE
Infant death rate of 88.1, as compared with a previous 5-year average of 104.
The 15 qualified midwives attended 32.7~ of births, as compared with the previous 5-year average of 4~, indicating that more confinements are being placed in the hands of physicians.
~idwives attended 33~ of stillbirths as compared with the previous percentage of 49.

Annual Statistical Summary of Activities Tift County Demonstration

Bates:
Live Births Stillborn Maternal Deaths Deaths under one month Infant Death Bate

Total
477
19 4
21

Rate
27.9 39.8
8.~
44.0 88.1

Activities:
Births attended by physician Births attended by midwives Prenatal admissions to medical service Number of admissions with positive Wassermanns
Visits to prenatal medical conferences Average visits per admission Prenatal admissions to nursing service Nursing delivery service to physicians
Delivery supervision of midwife cases (last half year onlf)
Admissions to postpartum nursing aervice Postpartum nursing visits Average visits per admission Postpartum examination
Cases receiving clinician 1 s service in consultation

Total
275
46
1107 4
4oo 24o 44
360 1030
2.9 89
14

Per Cent 75 32

DIVISION OF PUBLIC HEALTH EDUCATION

The division of public health education, initiated January 1, has attempted to develop three types of service: (1) The development, accumulation and distribution of educational materials; (2) A cooperative service
with the other divisions and with other interested organizations; (3)
Field service of speaking and motion picture engagements for school and adult health education groups and consultant service for the initiation of new work. The entire schedule was based on invitations.
The activities of division of public health education are largely experimental, since organized public health education is in its infancy not only in Georgia but in the United States as well,

Distribution of Materials

The health education division distributes all materials of general
and school nature. During 1938, 155,762 pieces of health education
materials have been distributed. This does not include large quantities
sent to county health units.

Preparation of Materials

A director,rof the personnel and activities of the State Department of Health was prepared, mimeographed, and distributed to the Rural-Urban Woman's meeting in cooperation with the State Department of Agriculture.
Suggestions for the Child Health Day program were prepared, mimeographed, and distributed to all superintendents of schools and nurses.
The report of the Fact Finding CoDDDit tee on Georgia 1 s health was revised and mimeographed to be used in the summer schools,
Much time has been spent in preparing a manuscript, Georgia's Health Problems, for the State Department of Education to be used as a textbook in the eighth grade,
An article on Safe~ Education ~s written for the State Department of Education to be published in their monthly ma.gazine,
A guide to the use of State adopted health education textbooks for use by elementary teachers has been prepared.

Accumulation of Materials

An Eastman Xodascope and beaded daylight screen with tripods were purchased for use by the public health and dental health education divisions.
The following motion picture films have been purchased for use by
members of the staff of the State Department of Health:

Division

Number of Films

Dental Health Education

4

Public Health Education

9

Malaria Investigation

2

Maternal and Child Hygiene

4

Sanitary Engineering

4

Tuberculosis

4

Venereal Disease

3

95

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

HEALTH EIKJCATION

Child Health Day

A broad program based on infant and pre-school health, school health, physical education, and adult or communi~ health education was developed. The health education division distributed 12,926 pieces of material to the county and independent superintendents and others cooperating with them in planning Child Health Day. In addition, 4,245 letters were sent to cooperative workers in the State. The following is a condensed report of the activities in the Child Health Day program:

School Report on Child Health Pay Activities

Counties known to participate --------------------------- 42 Number of schools participating ------------------------- 272 Approximate number of children participating --------- 43,195
Children given physical examination --------------------- 31,494 Children immunized by nurses and doctors -------------- 34, 857
Health assemblies held in schools ----------------------- 26o Home-room health education programs held ---------------- 11,636 Playground programs held -------------------------------- 265 Community child health education programs held ---------- 99 Parent-teacher programs devoted to child health education 143

Nurses 1 Report of Child Health Day Activities

Advisory nurses heard from ------------------------------ 15 Counties in districts of these nurses ------------------- 128 Counties participating in Child Health Day activities --- 61

Child health clinics held ------------------------------- 136

Infant and preschool children examined ------------------ 817 Health education bulletins distributed------------------ 15,785

Newspaper articles received -----------------------------

8

Health Plays --------------------------------------------

3

Field Trials --------------------------------------------

2

Poster Contests -----------------------------------------

2

Hookworm Tests ------------------------------------------ 358

Picture Shows --- 10 ---Attendance --------------------- 1,025

Dental Examinations ------------------------------------- 30

Displays ------------------------------------------------

1

Schick Tests --------------------------------------------

8

Children receiving smallpox vaccinations ---------------- 4,843

Children under six given toxoid------------------------ 1,785

Children receiving typhoid vaccine ---------------------- 8,819

Adult health education programs held -------------------- 183

Talks

The director of the division of health education made 72 talks during 1938. These talks were largely centered around three topics. For adult public health programs "Georgia's Health Problems", a summary of the Fact Finding Report, has been used. In speaking to public school
faculty groups 11The Essentials of School Health Education" has been used. For forum discussions "Developing Health Consciousness in Georgia" has been used. These have stimulated local interest in health education.

HEALTH EDUCATION

97

Moving Pictures

During the year, the health education director conducted 116 pUblic health education programs with the use of moving pictures. Introductions to the films were made by physicians from the staff, local health officers, or private physicians. Discussions based on questions from the audience followed films. At these meetings, 20,473 people were in attendance.
It is apparent that more people attend a public health meeting where moving pictures are used.

University Summer School

The director of the division of public health eucation taught two courses at the first summer school at the University of Georgia, Julie 15 through July 22. Education 512-712, which is Health Education for School Administrators, enrolled 18 students. Education 511-711, which is Health Education for Classroom Teachers, enrolled 12 students.
The health education director made the following recommendations to the University for Health Education in the summer school of 1939: (1) One graduate course in "Personal Hygiene Applied" to be given by the physical education department; (2) One graduate course in 11Public Health Education" to be given by the biology department; (3) One graduate course
in "School Health Education" to be given by the school of education. These three graduate courses would provide a minor in health education for school administrators and classroom teachers who wish to take more than one course in health education.

Public Schools Visited

The health education director made a special effort to visit & sampling of schools in the various sections of the State in order to secure a true picture of the school health problema. Intensive work was done in each of the following counties, including a visit to each school room with the county school superintendent or school supervisor.

Schools

Number of Meetings

Attendance

Blue Ridge School

3

Clinch County Schools

5

Taylor County Schools

9

Harris County Schools

8

Dalton Schools Treutlen County Schools

1~

Cook County Schools

~

800 2,025 1,342 1,100 1,100
1,500
~

Conferences

School Personnel (Individuals) Health Personnel (Individuals) Health and Education (Group) PUblic Schools Visited Colleges Visited

98

HEALTH XDUCATION

lzperimental Public Health Education Programs with Motion Pictures

Places

Number of Meetings

Douglas County Meetings Glascock-Hancock County Meetings Atlanta Woman's Federation of Clubs - Outdoor Park PrQgrams Bibb County P.T.A. Council Meetings Richmond County Meetings Attended
Fifth Sun~ Midwife Meetings P. T. A. Programs Woman 1 a Clubs Programs Y.P.A. Training School Meetings Agricultural Bxtenaion Division of the University of Georgia Programs Georgi& State Public Forums Summer School Meetings School Programs Adult Health Education Programs Butta County

32 12
6 5 5 5 3
1 11
5
1 1
22 6
_1_

Totals

116

Attendance
2,727 1,379
1,668 1,200 1,737 1,059
2~f
1,892
915 37 350 6,085 942 200
20,473

Health Literature Distributed

~ of Literature
Cancer County Health Work Dental Health Communicable Disease Miscellaneous Materials Mothers and Babies Sanitation Tuberculosis -venereal Disease Vital Statistics

Totals

!Jumber Distributed
1,54o 12,222 12,695 23,056 26,481 17,327 7,327 20,075 34,115
924
155.762

Venereal Disease pamphlets distributed from April through December

DIVISIOB OF PUBLIC HEAL'l'H NURSING
Throughout t.he year 1938, there has been a steady though slow advance in the extension of public health nursing service over the State. On January l, there vere 164 public health nurses as compared vith 178 December 31. This increaae in staff ia accounted for by the establishment of nev services in organized counties.
Distribution of Nuraing Personnel
At the beginning of the year, 51 counties vere covered b,y health department and ll countiea employed a nurse only. The remaining 97 counties vere grouped into 18 districts; in each district the State Department of Health placed an itinerant nurse vho vas responsible for the supervision of nurses in her district and also for direct service to the people in every field except that of tuberculosis control which
vas covered b,y a special staff of 9 nurses each of vhom covered tvo
nursing districts and devoted her entire time to the tuberculosis vork.
Re-distribution of State Staff: On July 1, a reorganization of the state staff vent into effect. In the nev set up the staff consists
of 27 nurses - a director, assistant director, 5 area consultant nurses,
and 20 district itinerant nurses. The nursing service is nov completely generalized and each itiner-
ant nurse within her district ia responsible tor every type of nursing service including child bTgiene, communicable disease control, tuberculosis control, venereal disease control, a morbidity service and health education. Each nurse covers from 4 to 6 counties vith a population unit of 50,000 people.
The 5 consultant nurses devote their entire time to administrative and aupervisory duties within their respective areas.
This reorganisation has brought about an increased amount of service rendered during the past six months of the year. Each nurse in a smaller area has been able to become more intimately acquainted vith the public officials, civic and social groups and has had an opportunity to interpret her program to them. She baa been able to keep in cloaer touch vi th individual patients requiring her care.
Activities of nurees in the organised counties of the State are covered in the report on county health vork. The statistical report which is attached represents vork done b,y the consultant and itinerant nursing staff and the vork done by ten nurses working in unorganized counties.
Analysis of service in unorganized counties is covered in the following comments.
Maternal and Child aygiene
One of the greatest unmet needs in the field of health at the beginning of the year 1938 vas that of medical supervision for expectant mothers, babiee and young children. In the course of the year this need baa in some measure been met. Maternal and child health conferences have been organised in ~ centers in both organised and unorganized counties through which examination by a p~sician is now made available
99

100

NURSIJIG

to prospective mothers who are to be delivered by midwives and to young babies and preschool children.
The attendance at these conferences has been good. The midwives throughout the State have taken keen interest in these conferences, frequently being present, and have brought their patients to the p~si cians for care. This contact with the doctors and nurses has been of
educational value to the midwife. The conferences have, therefore, served a double purpose: that of providing medical supervision to mothers and young children, and improving the service rendered by the midwife.
There has been a marked increase in the maternal and child health
services rendered in unorganized counties during 1938 as compared with 1937. The number of prospective mothers admitted to nursing service increased from 827 to l, 26o. The number of mothers receiving medical examination increased from 75 to l, 784. The number of infants and preschool children receiving medical examinations increased from 147 to 2,510.

Communicable Disease Control

The nurses covering unorganized counties cared for 3, 300 caaes of communicable disease as compared with 2,724 in 1937. Immunization for smallpox increased from 7,324 to 19,347. These nurses c~leted duri~ the year 13,882 immunizations against diphtheria and 65,365 immunizations against tn>hoid fever. There was a marked increase in the number of patients admitted to venereal disease control service, 1,123 patients having been cared for as compared with 295 the preceding year.

TUberculosis Service

The change in the policy of caring for patients at Alto for a short

period of time instead of for many months has placed an increased respo~

sibility upon public health nurses for home supervision of tuberculosis

patients. The nurses have continued to organize tuberculosis clinics

preceding a visit by the healthmobile and in so doing have completed
2,545 tuberculin testa. The following f~es contrasting individuals

cared for through this service indicate the marked growth in service

during the past yearz

Admitted to Nursing Service

Cases

856

Suspects

598

.3!2.7.3816

19~
8,lil5
Cases 1,333 Suspects 1, 428

Contacts

~JJ~

3:780

Nursing Visits

8,64o

Contacts 15.6154
Pff5 22,6oo

Demonstrations

Child gygiene Demonstration in Nutrition& Very definite progress has been made in the development of public health nursing service in
Hancock and Glascock Counties where the nutrition demonstration is
being conducted. There has been no change in staff in the 5 nurses who
cover this service. A detailed report on this demonstration is given elsewhere and further comment will not be made in this report.

NURSING

101

Maternal HYgiene Demonstration: The maternal hygiene demonstration in Tift County though officially started in October 1937 did not get under wa:y until early in Janua.ry. It was difficult to secure a nursing staff with both pUblic health training and experience and special knowledge of obstetrics. This demonstration has presented certain problems in the administration of nursing service which have not yet been altogether solved. It is hard to effect a satisfactory plan which will make the service of the nurse available over 24 hours of every day of the
month with a staff of but 4 nurses. However, definite progress has been
made. The service has been well received by the coliiDIUJli ty and even in so short a time has shown results in a decrease in maternal, stillbirth, and infant death rates.

Conclusions

Although it is possible to report progress in the year 1938 in both quantity and quality of nursing service rendered, the year ended with a keen realization of the inadequacy of the service that is now being provided. The people throughout the State have become increasingly conscious of the value of health protection with the result that the demands for nursing service are greater than can be met by the present staff.
It is estimated that one nurse for every J,OOO people is required to carry a completely generalized program. In rural Georgia today, there is one nurse to every 21,000 people. Realizing the need for increased pUblic health nursing service, the State Department of Health is oontemplating the adoption of a program for the extension of the service which will provide at least one nurse for every county and one for every 10,000 people in the larger counties.

102

NURsmG

S'UTIS'riCAL suMMARY OF N!]RSING ERVICE FOR TEE lEAR 1938 (Service in unorganized counties)

COMMUNICABLE DISEASE CON'rROL: .Admissions to nursing service Field Visits Diphtheria Typhoid fever-paratyphoid fever Scarlet fever Measles Whooping cough Malaria Hookworm Others
liiUIIIlilization a

572 676 22 uG 78
81
8581
1o,~acl

3,301 10,746

Smallpox
Diphtheria-under 1 ~ear Diphtheria-l through 4 ~ears
Diphtheria-5 ~ears and over
!rypl:loid fever Others (spec if'~)

VENJ:~REAL DISI!l~ CONTROL:

Admissions to nursing 1ervice

1,123

TUBERCUICSIS CONTBOL:

Individuals admitted to nursing service

Positive cases

1333

Suspicious cases

1428

Contacts

_5Q5lL_

""""ffi5

Visits

NUmber of tuberculin testa completed

Contacts broken

Relief secured for positive cases

Cottagea,aleeping porcbea,etc.(no.built)

8,415
22,6oo 2,545
523 194 15

MATERNITY S[RVICE: Cases admitted to prenatal nursing 1ervice Visits by prenatal cases to medical conferences Visits to prenatal cases Visits to postpartum cases Permanent health conferences Number of' sessions Midwives registered for formal instruction Midwife meetings .Attendance at meetings Visits for midwife supervision

1,260 l, 784
l, 771
609 26
193 2,096 1,047 5,899 1,314

NURSING
INFANT ~TD PRESCHOOL HYGIENE: Infants Individuals admitted to nursing service Permanent health conferences NUmber of sessions Visits to medical conferences Visits Consultations with parents Preschool Individuals admitted to nursing service Permanent health conferences Nuniber of sessions Visits to medical conferences Visits Consultations with parents
SCBJOL HYGDID: Inspections by nurses lxaminations by p~aicians Individuals admitted to nursing service Visits
ADULT HYGil!lNE: Medical examinations Milk-handlers Other food-handlers Midwives Teachers Others
MORBIDITY SERVICI: Admissions to nursing service Visits BoOkworm treatments completed
CRIPPLED CHILJJRD SERVICE: Individuals reported Individuals examined at diagnostic clinics Individuals treated Individuals admitted to nursing service Visits to diagnostic clinics Nursing visits Other service
OTBI!IR J.CTIVITIIlS: Conferences with p~sicians or dentists Newspaper articles Bulletins distributed Public lectures and talka Attendance

103
332 9 27 31
894
470
471 5
15
~5
725 486
10,621 1, 774
474 1,474
14 17 39 36 65
655 2,157 3,017
142
54 15
45
21 142 59
4,oss
379 37,474
509 18,177

DIVISION OF SANI~Y ENGINE~~ING
Introduction
The division of sanitary engineering has accomplished. more COllRtr~c tive work benefiting both rural and urban population during the past year than any previous period.
An impressive expansion of every service normally rendered is noted. Expansion has been applicable to a number of new activities ~rhich for many years have been most prominently necessary, yet until recently impossible of attainment.
There are several factors relative to this more extensive service now being rendered. It is the result of long range planning and of steady progress toward the objective. For years it was evident that a gradual addition of per~onnel would not only stimulate administration of the division but would also eventually permit a much desired plan of decentralization by establishment of tr~ee geographical sanitary engineering divisions supervised by competent engineering personnel.
This plan resulted in dividing the state, both by area and population, into three portions as nearly equal as practicable. It has enabled the division to make available localized sanitary engineering service for the public in every community, municipality, and county in the state. With a more recent expansion of county health work, this geographical division plan has readily made possible close coordination of state division and county health work. A more recent improvement in financial resources has greatly augmented the usefulness of this plan. It is believed that the maximum usefulness of the division of sanitary engineering will not be attained until the maximum achievement of establishment of organized county health work is accomplished. This would afford a more direct contact by the division with every county in need of increased service.
In planning a program of service, both urban and rural populations are given equivalent consideration. In application the chief concerns are certain diseases prevented or controlled by improvement of the sanitary environment. Certain diseases in Georgia are prevalent and prevention or control of these depends upon improvement of the sanitary environment. These diseases, na~ely, typhoid, paratyphoid, dysentery, undulant fever, malaria, dengue, typhus, and hookworm, 'may be generally classified into t~ro groups: filth-borne or intestinal diseases and insect-borne diseases. There are a number of other diseases closely related to the sanitary environment, not yet common in Georgia but which may become so; consequently, application of sanitary engineering mu~t always be available for existing problems as well as for those which are potential.
In the southern or coastal plain section of the state, malaria, hoob:orm, and typhus constitu.te problems of exceptional public health and economic importance. Economic loss from these diseases amounts to millions of dollars annually. Characteristic of this section also is the predominance of deep well water supplies for municipalities. The water from deep wells requires treat~ent to improve its chemical and sanitary quality. Industrial wastes from manufacturing plants processing agricultural products discharged into streams without treatment create stream pollution problems of local importance. Cooperative sewage treatment by the to,ms and these industries are necessary. This section also represents the greatest need for typhus control by extermination of rats, by poisoning, trapping, and rat proofing, for malaria control by drainage of malaria mosquito producing areas, control of
105

106

SANITARY ENGINEERING

impounded \1aters and screening, for hooklrorm control by construction of sanitary privies at rural homes and improvement of general environmental conditions.
The northern, or Piedmont plateau section, embraces the area of predominating public water supplies derived from surface streams neces-
sitating water filtration plants. This, of course, involves the correlated problem of returning to the streams, necessary as sources of water supply, the used water in the form of sewage. In this section of the state a satisfactory beginning has been made in properly treating sewage before discharging into the creeks and rivers.
In whatever progress more recently accomplished, evaluation must be placed upon unrelenting and continuous efforts to coordinate division objectives with those of all federal agencies operating in the state. Also acknowledgement with appreciation is made for the cooperation received from all such federal agencies. These agencies have solicited guidance and assistance in applying the principles of public health benefit to the many projects throughout the state. In reviewing these projects, it is notewor~ the very high percentage that has been projected for the purpose of public health protection. These efforts have reflected in improvement of the public health.
In effectuating the objectives of the division, it is necessary to have connecting channels of interchange of technical thought and development with national professional and scientific organizations existing for the establishing of sanitary engineering principles. These national organizations are composed of persons who give freely of their time and ability in contributing to this common fund of recorded information. In receiving the benefits of such connections, there exists the obligation to participate in the constant enlargement of this common store of available technical information. Staff members consider it a privilege of duty to serve on boards and technical committees of organizations whose influence on accepted practices is universally recognized. Members of
the division staff are currently serving on governing boards and technical or advisory committees of the following organizations.
1. Chairmanship, Governmental Relations and Engineering Sub-Committees, National Malaria Committee.
2. Water Works Practice Committee, American Water Works Association. 3. Governing Board, Federation of Sewage Works Associations.
4 River Basin Sub-Committees, National Water Resources Committee. 5 Mosquito Control Committee, Conference of State Sanitary Engin-
eers.
6. Membership Committee, American Public Health Association.

A general outline of the services rendered by the division of sani-
tary engineering followsa
l. Public health supervision of municipal, institutional, public
and semi-public recreational, and industrial village water works and sewerage. This includes the review and approval of engineering plans and
specifications and the control of methods of water purification and sewage
treatment plant operation.
2. Field work and recommendations to the United States Public Health
Service for certification of drinking and culinary water used on inter-
state carriers.
3 Bacteriological examination of water samples from public and semi-
public water supplies.
4. Collection and utilization of stream pollution data.
5 Sanitary improvement to swimming pools through approval of design
and assistance in operation.

SANITARY ENGINEERING

107

6. Improved sanitary protection to private water supplies in rural
areas.
7. Annual school. for instruction of water and self8e plant, and swim-
ming pool operators. 8. Construction of rural and urban sanitary privies and home self8e
disposal plants.
9. Assistance to local health departments for improvement of milk
production and distribution. 10. Malaria surveys resulting in plans, specifications and supervi-
sion of drainage projects and other methods of malaria control. 11. Control of impounded water areas for malaria prevention, includ-
ing hydroelectric development and other impoundments. 12. ~hoid and hookworm investigations preceding promotion and
supervision of rural and community sanitation. 13. Selection and nomination of engineers and sanitarians for assign-
ments to organized county and district health departments rendering local service in planning and advice to such personnel in matters of sanitary engineering and general sanitation.
14. Cooperation with divisions of epidemiology and county health work for investigations of disease prevalence and control measures.
15. Sanitation investigations, surveys, maps and reports for the purpose of future planning for sanitary engineering and general public
health. 16. Improvement of water supplies and sewage disposal for schools.
This includes a general school sanitation program recently expanded. 17. Investigation of typhus fever problems involving rat extermina-
tion, promotion of rat proofing, and educational programs. 18. Operation of state sanitary bedding law passed in 1937 provid-
ing for inspec~ion and licensing of manufacturers and renovators of mattresses and other articles.
19. Cooperation with state and federal administration agencies in
public works, homesteads, national resources developments, national parks,
etc. 20. Participation in operation of state training center for engineers,
sanitarians, and other personnel for state and county assignments. 21. Other miscellaneous sanitation problems involving action necess-
ary for health protection.

Water S~lies, Sewerage and Swimming Pools

The exercise of the general powers of supervision of the Department
of Public Health in all matters pertaining to public water supplies and sewerage systems is one of the major duties of the division of sanitary engineering. Administrative, technical and instructive duties are required in this branch of public health supervision. This supervision covers municipal, institutional, recreational, and industrial village water supplies and sewerage systems. Swimming pool sanitation also receives the same kind of supervision rendered in an advisory and recommend-
atory manner. Administrative responsibilities are briefly illustrated by the
following activities. The service of water supply and sewerage is of such nature as to bring about relations with other states, particularly where interstate streams are concerned. Several federal departments, commissions and administrations as well as other state departments have interests touching closely those of this divisien. There is close relationship and cooperation with all of these and with the municipal and

lOS

SANITARY ENGINEERING

manufacturing corporations within the state which maintain and operate either or both drinking water supplies, sewerage systems, and swimmiDg pools, A long range plan is followed for all of these activities to cover present and future anticipated changes. These basic plans are subject to constant review and study to enlarge their effectiveness with changing demands brought about by sociological and technical progress, Division personnel and emergency equipment constitute a prepared reserve for immediate service to communities in periods of disaster or catastrophe where the public water supply is involved.
The safety of public water supplies, sewage treatment and swimming pools depends on the providing of special structures, mechanical equipment and treatment chemicals. The application of chemical and biological processes to water purification and sewage treatment is subject to change due to technical discoveries and developments. The adaptability of these products of research to local conditions is the subject of constant investigation and study by this division. Technical review and approval is given to all engineering plans and specifications for water and sewage treatment plants and swimmiDg pools before construction begins. Frequent consultations are held with professional engineers and manufacturing representatives who propose methods or equipment for water and sewage treatment. The results of bacteriological examinations of water samples in the sanitary engineering laboratory of this division are interpreted and made use of in making recommendations for needed improvements to secure and maintain safety of municipal water supplies. These recommendations form the basis for construction programs and extensions in municipalities and industrial villages.
The element of instruction in the maintenance of sanitary engineer-
iii facilities is a part of all the pUblic relations of this division. Trained and experienced personnel gives instruction in the operation and control of water purification, sewage treatment and swimmiDg pool processes in the cities and towns of the state. Local personnel is trained in the operation of the particular equipment or process for which they
are responsible. Reports of plant operation are submitted to this division and are carefully and regularly reviewed to determine the efficiency of purification processes. Representatives of towns operating water and sewage treatment plants and swimming pools assemble once each year in Atlanta for group instruction. An account of the Seventh Annual Georgia Water and Sewage School occurs in a later part of this report.

Publication of Educational Material& To meet the growing need for an elementary description of pUblic water supplies a non-technical illustrated 16 page booklet was prepared and made available. This publication under the title "The Story of Modern Public Water Supplies in
Georgia" is useful to students and teachers in the high schools and colleges, mayors and city councilmen, and citizens who wish to know what makes their public water supply possible. .Approximately five thousand copies have been distributed in Georgia, other states and foreign countries.

~ciP.~tion in Securing Basic Water Dataa In order for a state or local program of public water supply and sewage treatment to proceed alon& rational lines and to best serve under all probable future demands at lowest cost it is necessary to have long term records of qualities of certain materials and reliable information on conditions sUbject to irregular change. The precision of engineering calculations and the useful endurance of water works and sewerage structures largely depend on

SANITARY ENGINEERING

109

accurate observation and recording of chemical analyses of nat~al waters, surface stream flow measurements, and underground water observations. The resumption of this long interrupted program was made possible by an
appropriation of the 1937 General Assembly to the Georgia Department of
Natural Resources for cooperative 1~or:c ~lith the United States Geological Survey, The direct sanitary engineering usefulness of these data brought opportunity to cooperate in making available supplementary infor~tion and in effectuating the program to serve public health needs, Full nonfinancial cooperation and participation in the program has been given in representing the public health viewpoint.

Water Works_,_ Se"!erage and Swimming_Jool School: The Seventh Annual \'later and Sewage School conducted by the division of sanitary engineering in cooperation with the Georgia Water and Sewage Association and the Biology Department, Georgia School of Technology, was held in Atlanta,
The total attendance at this four-day course of instruction lias 233, over
85 per cent of the men being either connected with water and se11age plants in Georgia municipalities and industrial villages or in public service, Based on written examinations, the Georgia Water and Sewage Association
issued 18 certificates in the following classifications: 1 Class A, 3 Class B, and 14 Class C, The number standing examination were as follows: 9 for Class A, 14 for Class B, and 22 for Class C.

Certification of Water Sunplies for Inte~~ate C~~~: All in-

vestigations, studies, recommendations and inspections regarding improve-

ments to public, semi-public, and private water supplies used for drink-

ing and culinary purposes on interstate railway trains, vessels and air-

planes were made by the division for the United States Public Health

Service, Certification action was taken on 45 supplies for 1938. Of

this number, 4o received favorable and 4 provisional certification. One

supply was prohibited from supplying water to interstate carriers until

recommended corrections are made,

Classification of public and semi-public water supplies receiving

certification is shown in the following lists:

Favorable

Adel

Cornelia

~itman

Albany

Dublin

Rocky Ford

Americus

Fitzgerald-City

Savannah-City

Ashburn

II A.B.&C. Rwy. Shops

" ~l;exican Petroleum

Athens

Fort Valley

Corporation

Atlanta

Glennville

11 Airport Well

Blue Ridge

Griffin

Smithville

Brunswick

Hawkinsville

Tennille

Camak

Macon

Thomasville

Cartersville

Manchester

Valdosta

Cedartown

Midville

Vidalia

Columbus

1-lonroe

Wadley

College Park

Moultrie

Waycross

Cordele

Pelham

Provisional

Augusta

Jesup

Cuthbert

Rome

Prohibited

Gainesville

110

SA!."HT.ARY ENGINEERING

Progress in Water Works, Sewergge and Swimming Pool Constr~ction: The effectuation of efforts to provide safe pUblic water supplies and sewerage necessitates modern water purification and sewage treatment plants. It is also equally necessary to make these services available to all the citizens throughout the entire town by providing adequate water distribution and sewage collection systems. Inventories of past years have revealed entirely inadequate water distribution and sewage collection systems in many municipalities although in some of these modern water and sewage treatment plants had been constructed. Sanitary engineering activities in 1938 have therefore been directed to the construction of basic treatment plants and also to the extension of systems for distribution of water and collection of sewage. Greater progress in this field has been made in 1938 than in any other year. Construction at such an accelerated pace does not occur without some considerable change in underlyiD desires and methods of municipal procedures. It would be impossible to narrate here the entire history of this progressive change but a few factors of major effect may be stated briefly. 1. A general awakening of public consciousness to the possibilities
of health protection and the active daneers of an insanitary community. 2. A cooperative division policy which separately analyzes each
community problem and suggests practical methods to meet present and future problems in the order of their public health and economic import-
ance.
3 Cumulative results of years of aggressive educational activities
by the division to demonstrate to municipal officials the practicability of s~ested methods.
4. A steady growth in public demand for wise expenditure for profitable capital investments for properly planned permanent community sanitary
improvements.
5 The placing of attainment of desired results within financial
reach of local communities through federal subsidy. The tabulation of engineering plans and specifications approved
during 1938 for water works, sewerage and swimming pools and the descriptive list of projects which follows shows what is being provided in Georgia cities, towns and industrial villages to provide permanent sanitary protection to urban citizens.
Water Supply ----------------- 71
Sewerage --------------------- 103 Swimming Pools --------------- 11

Water Works for Towns Not Previously Having Water Works: Alpharetta. Deep well, sterilization equipment, elevated tank, and
distribution system under construction. (P.W.A.) Population 477
Concord. Spring, sterilizing equipment, elevated tank, and distri-
bution system under construction. (P.W.A.) Population 447.
Cumming. Deep well, iron removal plant and sterilization equipment, elevated tank and distribution system under construction. (P.W.A.) Population 648.
Demorest. Distribution system taking water from Corneli~ replacing inadequate supply, completed in 1938. (P.W.A.) Population 730.
Forest Park. Deep well, carbon dioxide removal and sterilization equipment, elevated tank, and distribution system under construction.
(P.W.A.) Population 388. Fort Mountain State Park. New spring water supply with pump, steri-
lizing equipment and pipe lines. (c.c.c.)

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SUPPLIES
DEPARTMENT OF PUBLIC HEALTH DIVISION OF SANITARY ENGINEERING
APRIL 19.)1
FILTER PLANT-SURFACE STREAM WATER

L~S:.bi. rc~c.LHOU. ~,.SPERo -<:..~~ L__,___/.,-A.~-:-\ + ATT '-- ..5_...,____

OBTAINS WATER FROM ADJACENT CITY

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FILTER PLANT-LOCAL CHEMICAL CONTROL LABORATORY
[8] FILTER PLANT-LOCAL CHEMICAL AND
BACTERIOLOGICAL CONTROL LABORA10RY

DEEP WELL

SHALLOW WELL

SPRING

WELL t,~). SPRING-IRON REMOVAL

A WELL

SPRING-CARBON DIOXIDE REMOVAL

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DEPARTMENT Of PUBLIC HEALTH DIVISION Of SANITARY ENGINEERING
APRL 1131

LEGEND

8/:::,.SEWER SYSTEM ONLY-NO TREATMENT

ONE PLANT

QTHREE PLANTS

TWO PLANTS

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I SEPTIC TANK

2 SEPTIC TANK & SECONDARY TREATMENT 3 IMHOff TANK 4 IMHOff TANK & TRICKLING fiLTER

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CLARifiER 6 SEPARATE. SLUDGE. DIGESTION 7 SEPARATE. SLUDGE. DIGESTION & TRICKUNG fiLTCR

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_.,..~1

)

....._)

SANITARY ENGINEERING

111

Kingsland. Deep well, elevated tank, aeration for hydrogen sulfide
removal, and distribution system under construction. (P.W.A.) Population
615.
Lincolnton. Deep well, elevated tank, and distribution system under
construction. (P.W.A.) Population 916.
Loganville. Spring, sterilization and carbon dioxide removal equip-
ment, elevated tank, and distribution system completed in 1938. (P.W.A.) Population 631.
Ludowici. Deep well, pneumatic pressure tank and distribution sys-
tem under construction. (P.~1.A.) Population 615.
Lumber City. Deep well, elevated tank, and distribution system under
construction. (P.W.A.) Population 1,043.
Mansfield. Deep well, elevated tank and distribution system under
construction. (P.W.A.) Population 469.
Mcintyre. Deep well, plans and specifications approved. Construc-
tion not started. Population 171.
Nahunta. Deep well, pneumatic pressure tank and distribution system
completed in 1938. (W.P.A.) Population 352.
Newton. Deep well, sterilizing equipment, elevated tank, and dis-
tribution system under construction. (P.W.A.) Population 517.
Nicholls. Deep well, elevated tank, and distribution system under
construction. (P.W.A.) Population 651.
Oliver. Pu!lq>ing equipment in previously drilled well, pneumatic
pressure tank and distribution system completed in 1938. (W.P.A.) Population 242.
Portal. Deep well, elevated tank, and distribution system completed
in 1938. (P.W.A.) Population 374.
Roberta. Deep well, elevated tank and distribution system under con-
struction. (P.W.A.) Population 449.
Rutledge. Deep well, elevated tank and distribution system completed
in 1938. (P.W.A.) Population 523.
Senoia. Deep well, elevated tank and distributing system completed
in 1938. (P.W.A.) Population 736.
Twin City. Deep well, elevated tank and distributing system completec
in 1938. (P.W.A.) Population 901.
Union City. Deep well, carbon dioxide removal equipment, elevated
tank, and distribution system under construction. (P.W.A.) Population
776. Watkinsville. Water purification plant consisting of coagulation,
sedimentation, filtration, sterilization, and chemical laboratory to-
gether with elevated tank and distribution system under construction.
(P.W.A.) Population 425.

Additions and Improvements to Existing Public Water Supplies:
Albany. Deep well to replace defective wells under construction.
(P.W.A.) Installation of equipment for chlorination on entire supply.
Population 14,507.
Aragon. Obsolete Chlorinator replaced with new equipment.
Arlington. Water main extensions under construction. (P.W.A.) Population 1,232.
Ashburn. ~Tater main extension. (W.P.A.) Population 2,073.
Atlanta. Completion of sedimentation basin as the first unit in a
five year program of water purification plant expansion. Population
270,366.
Athens. ~Tater main extensions and new elevated tank under construc-
tion. (P.W.A.) Population 18,192.

112

SANITARY ENGINEEB.ING

Augusta. Completion of' new 15 million gallons per day purification plant replacing c;ij>solete one. Plant processes to treat Savannah River water including pre-chlorimination, coagulation, sedimentation, filtration, and post chlorination with chemical and bacteriological laboratory control. (P.W.A.) Population 60,342.
Baconton. Sterilization equipment and extensions to distribution system under construction. (P.W.A.) Population 498.
Barnesville. Water main extensions. (W.P,A.) Population 3,236. Buena Vista. Carbon dioxide removal, sterilization, and water main extension project under construction, (P.W.A.) Population 1,097. Butler. Deep well, plans and specifications approved, work not started. Proposed system is to replace inadequate privately owned sys-
tem. (P.W.A.) Population 857 Cadwell. New drilled well and elevated tank, water main extensions,
plans and specifications for well approved. (P.W.A.) Population 208. Carrollton. New sterilization equipment replaced old equipment.
Population 5,052. Cedartown. Water main extensions under construction. (W.P.A.)
Old chlorinating equipment on spring replaced with modern sterilization unit. Population 8,124.
Clarkesville. New water filtration plant using stream water. Coagulation, sedimentation, filtration, sterilization and chemical laboratory under construction to replace inadequate and unsafe spring and shallow well supply. (P.W.A.) Population 617.
Cochran. Replacement of old chlorinator with new semi-automatic chlorination equipment.
Columbus. Water main extensions under construction. (P .W .A.) Population 43,131.
Conyers. Water main extensions under construction. (W.P.A.) Pop-
ulation 1,495 Dalton. Construction begun in converting water treatment plant
into softening plant. (P.W.A,) Population 8,16o. Dallas. Deficient wells being replaced by purification plant taking
surface stream water and providing coagulation, sedimentation, filtration, sterilization, and chemical laboratory. (P.W.A.) Population 1,410,
Decatur. Water main extension. (W.P.A.) Populatio~ 13,276, Doerun. Water main extensions under construction (W.P .A.) Popu-
lation 719. Douglasville. Obsolete chlorinator replaced with new equipment
and new chemical feeders installed at water purification plant. Popu-
lation 2,316. Dudley. Sterilizing equipment on existing deep well, elevated tank,
water main extensions under construction. (P,W.A,) Population 252. East Point. Water main extensions and elevated tank under con-
struction. (P.W.A.) Population 9,512. Eatonton. Obsolete filtration plant being replaced by new purifi-
cation plant providing coagulation, sedimentation, filtration, sterilization, and chemical laboratory. (P.W.A.) Population 1,876.
Fairburn. Plans and specifications approved for new water purification plant to replace obsolete plant. Purification to consist of coagulation, sedimentation, filtration and sterilization. (W .P .A.)
Population 1,372. Fitzgerald. Water main extensions under construction. (W.P.A,)
Population 6,412. Fort Gaines. BY.pochlorinator equipment installed on previously un-
eterilized water supply. Population 1,272.

SANI~Y ENGINEERING

113

Greensboro. Obsolete filter plant, deficient well and spring being replaced by purification plant providing coagulation, sedimentation, filtration, sterilization, and chemical laboratory. (P.W.A.} Population
2,125. Griffin, Water main extensions under construction. (W.P.A.} Popu-
lation 10,321. Hapeville, Extension of water mains. (W.P.A.} Population 4,224. Hawkinsville, Reservoir and sterilization project under construc-
tio:a.. (P.W.A.} Population 2,484. LaGrange, Water main extensions under construction. (W .P .A.} Pop-
ulation 20,131. Lindale, Two modern chlorinators to replace former sterilization
equipment. Lithonia, Improved raw water storage basin under construction.
(W.P.A.} Population 1,457 Louisville. Water main extensions. (W.P.A,) Population 1,650. Marietta. Water main extensions. (W.P.A.} Population 7,638. Marshallville. New reservoir to replace defective unit and new dis-
tribution system to replace inadequate system, under construction. (P .W.A.} Population 931.
Meigs, Deep well completed, Population 1,000.
Milan, Water main extensions. (W.P.A.} Population 630. Milledgeville, Plans and specifications for modernization and enlargement of water purification plant approved but construction not started. (W .P .A.} Population 5, 534. Moultrie. Water main extensions under construction. (W.P.A.) Population 8, 027 Newnan. Water main extension. (P.W.A.} Population 6,386. Norcross. Iron removal and sterilization plant under construction. (P.W.A.} Population 892. Preston. Water main extensions under construction, (W.P.A.} Population 321. ~itman. Water main extensions under construction. (W.P.A.}
Population 4,149. Rome. Outgrown filter plant being replaced by new purification
plant providing pre-chlorimination, coagulation, sedimentation, filtration, sterilization and new laboratory for chemical and bacteriological control. (P.W.A.} Population 21,843.
Shannon. Solution feed chlorinator to replace direct feeder.
Statesboro. Water main extensions under construction. (P.W.A.}
Population 3,996. Thomson. Completion of coagulation and sedimentation basin to re-
place ineffective structure, modern sterilization equipment to replace obsolete machine. Population 1,914.
Thomaston. Obsolete filter plant being replaced by new purification plant providing pre-chlorimination, coagulation, sedimentation, filtration, and sterilization. (P.WJL.) Also obsolete chlorinator at present plant replaced by modern equipment. Population 4,992.
Thomaston Cotton Mills. Obsolete chlorinator replaced by new
sterilizing equipment. Thomasville. New sterilization equipment installed at softening
plant, Population 11,733. Tifton. Water main extensions completed. (W.P.A.) Population
3.390. Trenton. Chlorinator installed on previously unsterilized private-
ly owned public water supply. Population 370,

ll4

SANITARY ENGINEERING

Trion. New sterilization equipment to replace old machine. Popula-
tion 3,289. Ty Ty. Hypochlorinator equipment installed on previously unsteri-
lized water supply. Population 452. Vienna. Semi-automatic sterilization equipment installed on well
supply replacing obsolete equipment. Population 1,832. Vinings. (Boy Scout Camp) New sterilization equipment replaced old
machine. West Point. Water purification plant modernization, (P.W.A.) water
main extension, booster station and elevated ~. (W.P.A.) under construction. Population 2,146.
Wrightsville. Water main extension. (W.P.A.) Population 1,741.

City-Industry Waste Treatment Cooperation: Meat packing plants, both municipally and privately owned, are being constructed quite generally over the state. Since meat packing waste is one of the mOst intensely polluting industrial wastes when emptied into streams, the rapid gro~rth of these plants in many cases presents a serious problem in treating the waste.
In the past many attempts have been made to treat the meat packing waste at the plant site with only a small degree of success, and at great expense. It has been considered economical procedure for some time to mix indus trial was tee with municipal sanitary sewage and treat the dilute mixture at the municipal sewage treatment plant. The difficulty has been in getting industries to recognize the problem to the extent of contributing financially to the construction and operating cost of the municipal sewage treatment plant.
Through the efforts of the Tift County Commissioners and Health Department, City of Tifton and its consulting engineers, Armour and Company, and the sanitary engineering division, State Department of Public Health, an agreement between the City of Tifton and Armour and Company was reached this year whereby these two parties will share the financing of a municipal sewage plant to treat the combined meat packing waste and municipal sanitary sewage. Armour and Company 1 s share of the construction cost was based on the additional money required to construct the municipal sewage plant large enough to treat approximately one-half million gallons per dq of meat packing waste. The percentage of the operating cost which Armour and Company will pay is a fixed monthly amount based on the strength and quantity of meat packing waste as compared with the municipal sanitary sewage.

Sewer Systems in Towns Not Previous].z Having Sewerage: Bremen. Sewer system and primary treatment plant under construction.
(W.P.A.) Population 1,030. Cadwell. Sewer system and primary treatment plant under construc-
tion. (W.P.A.) Population 208. Colquitt. Sewer system with primary treatment plant under construc-
tion. (P.W.A.) Population 832. Cumming. Sewer system and primary treatment plant completed.
(W.P.A.) Population 648.
Douglasville. Sewer system and two primary treatment plants completed. (W.P.A.) Population 2,316.
Fort Gaines. Sewer system plans and specifioa.tions approved, construction not started. Population 1,272.
Harlem. Sewer system and primary treatment plant completed. (W.P.A.) Population 784.

SANITARY ENGINEERING

115

Jackson Lake. (Future Farmers of America Camp) Sewer system and primary treatment plant with secondary treatment in the form of sand filters. Completed.
Linwood, Sewer system plans and specifications approved, construction not started. Sewage to be treated by neighboring city, LaFayette. Population 828.
Ringgold, Sewer system and primary treatment plant under construc-
tion. (P.W.A.) Population 684, Villa Rica. Sewer system with two treatment plants, each consist-
ing of primary and secondary units, completed, (W .P .A.) Population
1,304.

New Sewage Treatment Plants on Existi;g Systems: Alto Samtorium, Plans and specifications approved. Plans include new plant to consist of Imhoff tank, sludge drying bed, trickling filter,
and secondary settling tank. Construction not begun. Arlington. Extending an outfall sewer and constructing a sewage
treatment plant providing primary treatment. Under construction.
(P.W.A.) Population 1,232. Ashburn. Combining several outfalls and constructing t~ro Imhoff
tanks with sludge drying beds. Under construction. 0T.P .A.) Popula-
tion 2,073. Atlanta - Egan Park Plant. Plans and specifications approved,
Plant to consist of primary settling, separate sludge digestion with open sludge drying beds, trickling filter, and final clarifier. Chlo-
rination will be provided for odor control. Construction under (W.P.A.)
to start soon. Cairo. Pumping station, and sewage treatment plant consisting of
primary sedimentation, separate sludge digestion, trickling filter, and final clarification. Under construction, (P.W.A.) Population
3,169. Cedartown. Constructed sanitary sewage and industrial waste treat-
ment plant consisting of pumping station, primary sedimentation, separate sludge digestion, sludge drying bed, trickling filter, and final clarifier. Provision is made for the addition of chemical treating equipment when necessary, Construction completed. (P.W.A,) Population 8, 124.
Dalton. Extending south side outfalls and constructing sewage pumping station. (W.P.A.) Constructing south side sewage treatment plant consisting of coarse bar screens, primary clarifier, trickling filter, final clarifier, chlorination, separate sludge digestion, and sludge drying bed,. under construction. (P.W.A.) Population 8,160,
Eastman. Remodeling old Imhoff tank and trickling filter, and constructing a sludge drying bed, Completed. Population 3,022.
LaFayette. Pumping station, outfall sewers, and sewage treatment consisting of primary sedimentation, separate sludge digestion, trickling filter and final clarification. Under construction. (P.W.A.) Population 2,811,
LaGrange. Extending east side sewer outfall and constructing
treatment plant consisting of primary settling, separate sludge digestion, sludge drying bed, trickling filter, and final clarification. Under construction. (W.P.A.) Population 20,131.
Moultrie. Pumping station, outfall sewer, and sewage treatment consisting of primary sedimentation, separate sludge digestion, trickling filter, final clarification, and chlorination for odor control. Under construction. (P.W~.) Population 8,027,

ll6

SAN!~ ENGINEERING

Rossville. Remodeling old Imhoff tank and sludge drying bed. Under construction. (P.W.A.) Population 3,230.
Statesboro. Pumping station, outfall sewers, and sewage treatment plant consisting of primary sedimentation and separate sludge digestionwith chlorination for odor control. Under construction. (P.W.A.) Population 3,996.
Sylvania. Combining several outfall sewers into two trunk outlets and constructing two Imhoff tanks with sludge drying beds. Under construction. (P.W.A.) Population 1,781.
Tifton. Combination meat packing waste and sanitary se~rage treatment plant consisting of primary settling of the separate wastes, aeration and trickling filter for the meat packing waste, followed by a trickling filter and final clarifier for the combined wastes. The sludge will be handled by separate sludge digestion and open sludge
drying beds. Under construction, (P.W.A.) Population 3,390.

or Sewer Extensions in the Followi

Acworth

Dahlonega

Arlington

Dallas

Ashburn

Dalton

Athens

DeKalb County

Atlanta

Douglasville

Blakely

Dublin

Brunswick

Fitzgerald

Carrollton

Gainesville

Cedartown

Hapeville

Cochran

Hogansville

Columbus

LaGrange

Conyers

Lyons

Cities:
t~B.rietta
McDonough McCaysville Millen Rome Rossville Savannah Summerville Tifton Villa Rica
W~cross

New Public Swimming Pools and Improvements to Existing Pools: Adel. Plans and specifications approved for concrete pool with recirculating system including chemical treatment, pressure filters, and
sterilization. Population 1, 796. Berry School - Rome. Manually operated solution feed gas type
chlorinator installed on existing pool. Brunswick, Concrete pool supplied by large flowing well, steri-
lization with chloramines. (P.W.A.) Population 14,022, Columbus. Concrete pool with recirculating system including
chemical treatment, pressure filters, and sterilization with chlora-
mines. (P.W.A.) Population 43,131. Clayton. Plans and specifications approved for concrete pool "ti th
recirculating system including chemical treatment, pressure filters,
and sterilization. Population 798. Forsyth, Concrete pool with recirculating system including
chemical treatment, pressure filters, and sterilization. (W.P.A.)
Population 2,277. Fritz Orr Club. Private swimming pool concrete structure with re-
circulating system including chemical treatment, pressure filters, and
sterilization, completed. Marietta. Concrete pool with recirculating system including
chemical treatment, pressure filters, and sterilization with chloramines,
under construction. (W.P.A.) Population 7,638. Monroe. Plans and specifications approved for concrete pool with
recirculating system including chemical treatment, pressure filters, and sterilization equipment. Construction not started, Population 3706.

SANITARY ENGINEERING

117

North Fulton Park Swimming Pool. Plans approved for concrete pool
with recirculating system to include chemical treatment pressure filters, and sterilization.
Pine Mountain Valley. Concrete pool with recirculating system including chemical treatment, pressure filters, and sterilization.
(W.P.A.) Toccoa. Plans approved for concrete pool with recirculating system
including chemical treatment, pressure filters, and sterilization. Population 4,6o2.
Georgia State Woman' College, Valdosta. Concrete pool with recirculating system including chemical treatment, pressure fi~ters, and sterilization.
Vinings. Improved solution feed chlorinator replaced obsolete machine. (Boy Scout Camp)
Winder. Plans approved for concrete pool with recirculating system including chemical treatment, pressure filters, and sterilization.
Population 3,283.
Y.W.C.A. Atlanta. l4anually operated solution feed chlorinator installed on pool.

Sanitary Engineering Labor~~: The major activity of this labo-

rator,y~-as been bacteriological examination of water samples from the

public and semi-public water supplies throughout the State. Samples

from private water supplies have been examined, upon request, wherever

such supplies have been reasonably constructed so as to eliminate ob-

vious contamination. Other laboratory examinations of a chemical or

biological nature have been conducted when needed in connection with

the state-wide program of the division of sanitary engineering.

During the year, this laboratory handled 11,94o samples as shown

in the fo11o\1ing table:

Public and semi-public water samples ----------- 11,073
Private water samples -------------------------- 683

Swimming pool samples -------------------------Samples for chemical analyses ------------------
Miscellaneous ----------------------------------

117
~~

Total

11,94o

An effort has been made to obtain samples from all public water supplies at monthly or more frequent intervals and these supplies submitted samples as shown in the table below:
No. supplies submitting samples for 10 or more months
No. supplies submitting samples from 6 through 9 a No. supplies submitting samples from 1 through 5 n
Total supplies submitting samples during year

There were approximately 33 supplies which failed to submit any
samples during the year.
The United States Treasury Department (United States Public Health Service) Standards commonly used in this country for appraising the bacteriological quality of water state (in part) that in any given series of samples examined not more than 10 per cent of all 10 ml.
portions examined shall be positive for members of the Colonaerogenes group of bacteria.
A record of the percentage of positive 10 ml. portions has been kept for 311 of the supplies submitting samples. Of this number 258,

118

SANITARY ENGINEERING

or 82.9 per cent, met the above standards of purity. The percenta,ge of Georgia water supplies meeting the Treasury
Department (United States Public Health Service) Bacterioligical Standards from 1926 through 1938 is shown in the following chartl
Attention is called to the fact that a higher percentage of surface water supplies (filtered and chlorinated) has met these standards
each year than has been the case where water is obtained from deep wells and springs.
In other words, contrary to popular opinion, a better quality of water is furnished, on the whole, from the surface supplies than from deep well and epring supplies.
There were no reported water-borne epidemics in the state during the year.

PER CENT GEORGIA WATER SUPPLIES MEETING U. S. TRF..ASURY DEPARTIIENT (U. S. PUBLIC HEALTH SERVICE ) BACTERIOLOGICAL STANDARDS,

100

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90 A/ !'\. J

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v -- B/~ .............!' r-.....

v J ............

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I 1/I I 70
v v I " c

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v 1 "f\\ 1/I 60 L

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-
- !""-.....

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j!uppli
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erili

ed

- - Or und1 ter S pplie terU zed

b- Al Publ c Wet r Sup lies

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ntree ~ed

/,()
1926 ;a 28 29 .)0 .31 32 .3.3 )

.35 .36 'J7 )8

SANITARY ENGil\'EERIN'G

119

Community Sanitation

In this portion of the report it is desired to emphasize the term community sanitation because this activity is more applicable to community than to municipality. It is not the purpose of the division to promote construction of sanitary privies in municipalities \'lherever there is possibility of installation of or extension of sewers. Provision for sewers and sewer connections wherever public water is supplied is always considered foremost. Also, it is not the purpose to promote the private residence septic tank when the need for public se~r ers is indicated. The prime purpose is, ho~rever, to promote public water supplies with maximum extensions of both water and. se\terDE;e facilities. There are, however, some sections in municipal suburbs where in order to meet a public health emergency it is necessary to construct sanitary privias at least as a temporary measure. There are also certain slum sections of municipalities with lo~r property values and ~i thout possibilities of public water service, plumbing and se~1age disposal. Such localities, especially suburban areas and rural co~unities, comprise the greatest need for this type of sanitation. It is apparent tr~t most of the typhoid and other intestinal infections occur in the typical low class suburban and rural homes. Consequently, promotion of privies
for rural homes has been stressed. The program of construction of sanitary privies and septic tanks
went forward with undiminished momentum during 1938. The number of sanitary privies constructed for the year ~ms 13,471 compared with 10,177 the previous year. This record is especially satisfactory con-
sidering the great reduction of W.P.A. labor. The total number of sanitary privies constructed during the past six years with the use of
relief labor is 59,B90. An attempt has been made to increase the value
and permanency of construction by an annual increase of the percentage of concrete privies. A privy at a rural home should be permanent. Percentages of wood and concrete privies in the three divisions of the state since the beginning of the program will be noted in a summary follo~ring the tabulation of sanitary privies.
There has been a concerted effort to forward the promotion of sanitary privy construction by the use of county convicts. An effort has been made to establish this routine so that as relief labor diminishes there will be established another plan for furnishing labor on this type of sanitation. To date, there are approximately fourteen counties which have set up privy building plants at county convict camps. The cooperation received from county commissioners is gratifying. Promotion of the use of convicts for sanitation and malaria drainage will be continued as rapidly as possible and it is anticipated that in the future reliance may be placed to a great extent upon convict labor for maintenance of sanitation and drainage.
The rate of hookworm infestation in the rural population represents one of the most serious of public health problems. Concerted effort is being made to provide sanitary privies in the rural homes throughout those areas of greatest hookworm infestation. It is difficult, however, to make considerable progress along this line of sanitation without organized county health work providing for sanitation personnel. It is believed that the greatest value to organized county health work in these areas is provision for a sanitarian to devote a great amount of his time to promoting construction of rural sanitary privies. Efforts along this line certainly serve the purpose of progress in control of

120

SANITARY ENGINEERING

at least three diseases: namely, hool~torm, typhoid, and dysentery. The

rural population of the state certainly deserves this service.

Included in this report is a chart showing the annual death rates

of typhoid from the year 1921 to 1938, inclusive. A glance at this chart

will show the very gratifying reducing death rate trend from typhoid,

It will be noted that the death rate from typhoid in 1921 was 27 .5.

At the end of 1938, the death rate has been reduced to 3.9, the lowest

typhoid death rate ever indicated for the state. The decreasing trend

is particularly noticeable over the last six year period. This result

is reviewed with considerable encouragement. It is believed that san-

itatior. in all its phases, such as purification of public water supplies,

proper disposal of public sewage, together with accomplishments of san-

itation for the suburban and rural homes, have been factors largely

responsible for this very satisfactory typhoid reduction,

There is listed herewith for comparison the total sanitary priVY

units in the state for each of the calendar years 1933, 1934, 1935,

1936, 1937, 1938, and percentage of concrete slab units constructed.

State of Georgia

Year

Total Privies

tf, Concrete tf, Wood

1933

1,370

o.o

100.

1934

14,534

6.2

97.8

1935 1936

10,461 9,868

20.7
4o.o

769o.3o

1937

10,177

6o.o

4o.o

1938

~

70.5

29.5

To tal - 6 years

59,890

Home and Other Small Sewage Disposal Plants: During the year there
~1as a total of 1, 784 home and small sewage disposal plants installed
under the supervision of the division of sanitary engineering. These figures do not include a large number of plants installed by home owners who obtained copies of plans and specifications from the office. In addition, plans and specifications were furnished governmental agencies, such as Federal Housing Administration, Farm Security Administration, National and State Park Service, Forestry Service, and others.
The Federal Housing Administration requires that all sewage disposal and water supplies at the homes of clients meet the approval of the State Health Department. Consequently, the division of sanitary
engineering has furnished plans and specifications for 777 septic
tanks and SO water supplies. In most cases the above installations and locations have been located and construction supervised by division personnel, and all completed units have had final inspection and approval by this division. This service assures the property owner of a properly sanitated home,
The Farm Security Administration has been most cooperative in their relationship with the Department. This agency is responsible
for increased activities and accomplishments in the field of sanitation. During the year, the Farm Security Administration selected a
number of farms for their clients, and realizing the value of public health and sanitation they included in their rehabilitation program priVY construction and improved water supplies; also a screening program was carried on. In order that the maximum benefits from the limited amount of funds available could be derived, the division
furnished plans and supervision for this work. l<lors than a

SANI~Y ENGINEERING

121

thousand sanitary privies were constructed under this program and some 200 new wells were constructed and many existing water supplies improved.

Sanitary Surveys, Maps and Reports.: Realizing that nothing of a constructive nature can satisfactorily proceed without systematic planning, urban and rural maps are being prepared together with complete sanitation reports. Standard specifications for such maps have been adopted and maps and reports are now in the course of preparation. Realizing an obligation to those counties adopting local county health work, preference is being given to towns, citi.cs end communities within organized counties. In making selections of sanitarians for assignment to organized counties, it is necessary that sanitation personnel be qualified for this work. The urban maps show each residence within the town, and if such home is provided with sanitation facilities. ~Tater mains, sewer mains, septic tanks, private wells and privies are included. The rural maps show the primary and secondary roads and each ~orne indicated by a number on the map which corresponds to a card index in the health office showing the names of the occupants. Also the maps indicate places of malaria mosquito production. Whereas these maps are primarily for the division of sanitary engineering they may be used by the health officer or the nurse for any purpose desired. These maps are pa.rticularly suitable for epidemiological investigations to be follo,V"ed by corrective measures. The rural maps have proved most valuable in connection with hookworm and malaria investigations.
The maps have also proved valuable to cities by providing them with detail information concerning the actual existing conditions, and in almost every town where there are needed improvements, the cities cooperated with this department by improving the sanitary conditions, such as extending water mains, making improvements to wat~r plants, constructing sanitary privies where topographical conditions were unfavorable to sewer lines. With each city map prepared there is also a detail report presented with the map, describing the conditions fully, also practical recommendations by this division which will make the city a cleaner, healthier place in which to live.
Summary for Year 1938: City sanitary survey maps and narrative reports -------- 39
District sanitary survey maps -------------------------- 5 Basic district maps ------------------------------------ 5
County malaria control maps ---------------------------- 2
~~:!~-~~~-~=-~~~~=~~-~~~~=~-~~~~~~~-~~~~~~-~~~~~~-=-~
Total maps of all types to date ----------------------- 135
Camp Sanitation: Concerted effort is made to properly sanitate all camps in the state. Such efforts serve the purpose of minimizing the chances of infection by such diseases as typhoid, dysentery, hookworm and malaria during camping season,
Particular attention is given to disposal of sewage, water supplies, milk supplies, swimming pools, screening, and garbage disposal. Water supplies are collected and a bacteriological examination made.
During the year, 11 camps were found with sanitary defects. These were all improved following recommendations. Services rendered consisted of plans, specifications and supervision of construction of sewage
disposal systems, improvements to 7 drinking water supplies, and 5 in-
cinerators for garbage disposal.

122

SANITARY ENGINEERING

School Sanitation: During the year, considerable progress has been made in school sanitation. Realizing the great need for sanitary sewage disposal systems for schools and safe drinking water supplies, the division assigned a sanitary engineer to coordinate school sanitation l'Ti th state and county boards of education.
Sanitary surveys were made at 54o rural schools during the year, and from the information obtained a state-l'ride project for improving water supplies at schools was prepared and submitted to W.P.A. This project has been approved and is no\'r eligible for operation. It is the ultimate objective to provide every school child and teacher in the state with safe drinking water and sanitary facilities. Th~ improvements already made to school water supplies and other sanitary facilities provided at schoolshave protected approximately 41,455 pupils and teachers from communicable diseases.
When school sanitation is evaluated one must consider that the child is educated at the school. His education should include hygiene and sanitation. The practical need for these should be demonstrated by practical application. It is very probable that the child will expect nothing better at his home than he has at his school. Therefore, sanitary facilities at the school is not only a public health safeguard but should be the practical application of the teachings of hygiene and sanitation.
There are more than 6,000 schools in the state. The total school population is nearly three quarters of a million, including pupils and teachers. Here is the health worker's exceptional opportunity, through various means, in urban and rural schools to reach nearly 25 per cent of the total population of the state. In this school sanitation program this advantage has not been overlooked. Consequently, sanitary facilities at schools will primarily safeguard a large per cent of the population of the state, while secondarily it will be a means of public health education and an influence to provide better sanitary facilities at the pupil's home. This is a long range program and its value should be fully estimated.
In the routine of this work, a school sanitary survey record sheet is prepared showing the conditions at each school. This record sheet sho\'rs the name and location of the school and various items relative to sanitary conditions. This record sheet is currently used in order to record the improvements as they are made.
The cooperation received from the state and local boards has been
most encouraging and the efforts have been well rewarded.

Malaria Control

The malaria control program promoted and supervised by the division of sanitary engineering t~~oughout the state involves many separate functions and several methods of control. Principal functions may be divided into two classes, those directed toward preventing the creation of new malaria mosquito breeding places by man's activities, and those directed toward the suppression or elimination of existing malaria
mosquito-breeding places, both natural and man-made. Prevention activities are largely of an educational and consultative
character. They include the education and guidance of city and county governments, state highl'ray forces, corporations, private individuals, park departments and various subdivisions of the federal government in methods of highway construction, pond and lake and artesian well developments, etc., to prevent the creation of public health menaces causing

SANITARY ENGINEERING

123

illness and deat~ to Georgia citizens from malaria, This service includes limited detail engineering consultation on individual construction projects and also takes expression in the administration of the impounded water regulations of the State Health Department by the sanitary engineering division.
As these preventive activities serve to prevent malaria increase rather than decrease existing malaria, results achieved can be expressed
neither in terms of malaria reduction nor by any other ":,.-a.rdstick'' for it is impossible to estimate the additional malaria which would have resulted had it not been for these efforts. From kno~1ledge of conditions in the field ho1t1ever, the problem of man-made malaria mosquito breeding places is considered one of magnitude in the Georgia malaria picture, and preventive needs in this field are classed as equal in importance to
the cont=ol of existing breeding areas. In the reduction or elimination of existing malaria problems by con-
trolling malaria mosquito breeding, various methods are practiced, but of these drainage and filling are the most extensively used. The volume
of drainage and filling accomplished in 1938 shows marked increase by
comparison with the previous year. This in part is a result of expansion of relief workers on the W.P.A. rolls, and in part of the expanded development of local governmental support to county-wide malaria control in general and W.P.A. operations in particular. justifying a higher priority ranking of malaria drainage in relation to other W.P.A. projects aV"clilable for relief labor assignment. More professional labor on the planning and supervision of malaria control has been expended by counties than ever before, and more county funds have b~en spent for machinery, materials and common labor on malaria control than ever before. Records of the engineering division show expenditure of
$1,161,869.67 in 1938 in 59 counties for malaria drainage and filling alone, as compared 1t1ith $596,000.00 net in 1937. This tabulation is
admittedly incomplete and almost exclusively covers only W.P.A. expenditures. It is estimated that the grand total of all physical
malaria control expenditures in the state is $1,500,000.00 including
impounded area preventive operations and malaria drainage maintenance. The sanitary engineering division pays particular attention to the
"Standard Plan County" operating under a planned program of areawide malaria control projected by the division of malaria investigations, and in cooperation with tr~t division emphasizes and promotes the extension of this plan to other counties. Favorable progress has been made during the year by state and county engineering personnel in fulfilling a numbef of the basic engineering planning steps indicated under the Standard Plan. The primary basic step in the execution of this plan is the preparation of an accurate county map showing all houses, roads and watered areas, and establishment of a system of serial numbering for watered areas and houses. The preparation of this map is a basic necessity for all well organized public health activity as well, and has significance in the prevention and control of other diseases. These mapping operations were in progress
in 20 counties in 1938.
The volume of drainage maintenance by local governments, use of machinery for drainage construction, and the number of county governments conducting organized malaria control programs financed by millage tax have all shown marked increase,

124

SANITARY ENGINEERING

Control of malaria mosquito breeding areas by county health departments through the application of Paris green larvicide has also expanded and commitments were made in 1938 for the further expansion of this work in 1939. Extensive reservoir shoreline clearance work on an existing major impoundment was also performed during the year, while a number of private individuals were encouraged to perform similar work on existing minor artificial impoundments, this being in addition to preventive work
on proposed impoundments, previously mentioned. For administrative purposes, malaria control and most other opera-
tions of the sanitary engineering division are divided into three areas or field divisions, comprising North, Southeast ~ Southwest Georgia, The volume of drainage work conducted in the North Georgia division has been considerably less than in the two South Georgia divisions, this being justified by good malaria control planning as the bulk of Georgia's
malaria incidence is still located in South Georgia. The correction by drainage of South Georgia malaria problems customarily involves relatively inexpensive hand labor minor drainage, while major machine drainage or non-drainage methods is generally indicated in North Georgia, South Georgia drainage maintenance problems are simpler, and more in-
expensive to perform. Machine Drainage: Special mention of counties undertaking drain-
age by machine methods is warranted, in view of the effectiveness with which certain types of mechanical equipment can be utilized on this class of ~rork. Draglines, ranging from 3/8 cubic yards to 1-1/4 cubic yards were operated in the following counties: Cobb, Spalding, Chatham (2 machines), Sumter, Bryan County-Ford Farms (2 machines), Coweta, and Troup Counties, a total of 9 draglines. Machine drainage excavation in Bibb and Muscogee Counties is also planned for execution early in 1939, as a result of 1938 surveys and investigations,
Larvicidal Programz Small scale larvicidal programs, involving the use of either Paris green or oil for malaria mosquito control, are carried on in a number of municipal and suburban areas in the state. These are in addition to other local programs involving oil application, primarily for the control of nuisance mosquitoes.
In the field of large scale operations, outstanding programs are in operation by the Georgia Power Company in the control of a n~ber of major hydroelectirc impounded areas. Extensive area~ride Paris green larvicidal programs have also been authorized or carried on in Richmond,
Sumter, Brooks, Terrell, Jenkins, Calhoun, Crisp and Thomas Counties, Malaria in 1938z Malaria deaths for the state, occuring in 1938,
as reported to the division of vital statistics totaled 146, the lowest number on record in the history of the State Department of Health. This extreme reduction is due primarily to the cyclicity of the disease and to other variable factors, and fluctuations may be expected in future years. There is much evidenc~however, to confirm the hypothesis
that malaria control operations have palyed a substantial part in this reduction.
Summary and Conclusionsz Personnel available for malaria control on the budget of the sanitary engineering division showed consistent
decrease for 1938 as compared with 1937, and for the latter half of 1938 by comparison with the first half. This decrease has oc~~red in spite of acute need for compensatory personnel assignments to replace field engineering assignments dropped from federal technical supervisory budgets on the W.P.A. program, and the steadily increasing load of technical detail needed to comply with Federal Works Progress Administration requirements.

SANITARY ENGINEERING

125

Engineering service available in the field included three assistant division engineers (malaria control), assigned full time to this work during the first half of 1938 and available part time during the second half of the year. The development of necessary new programs by the sanitary engineering division, as well as curtaiLnent of field personnel assignments, has played a joint part in the reduction of field engineering personnel available for malaria work.
Special local appropriations by counties for malaria control operations over 1938 have ranged from a minimum of approximately $2,000 to an estimated maximum of $4o, 000 to $60,000. The p~ssage of millage taxes for the specific purpose of malaria control by counties, over and above the local matching appropriation required for the establishment of a county health department is an outstanding achievement, as these appropriations are not only unsupported by matching, but face
the competition of other public health specialties offering preferential financial inducement.
There is a basic need in the public health program for the recognition of malaria control work as a legitimate public health activity possessing opportunity in obtaining outside matching funds on supplementary personnel proportionate to the inducements offered on other disease control operations.
Until some measure of progress has been accomplished in this direction, malaria control will suffer under a distinct handicap.

Typhus Fever Control

During the year 1938, the first complete year of operation since

establishment of the state-wide program of murine t~~hus fever control,

approximately 50,000 people were directly benefited, as a result of

the work carried on by the t~to engineers assigned to this new activity.

The work of the division consisted principally of serving in an ad-

visory capacity county health departments and training of county sani-

tarians and inspectors for municipalities to conduct tj~hus control.

The program has been strictly on a voluntary plan of cooperation

between the state and local county and city health departments. The

costs, other than the supervision furnished by the State Health Depart-

ment, have been defrayed by the municipalities, counties, and indivi-

dual citizens.

In 1938, a decrease of approximately 150 cases of typhus fever as

compared with 1937 was noted. For the first time a decrease has

occurred since the year 1934. Although many factors are involved in

this decrease, control work has no doubt played a major part in re-

ducing the disease. The following control methods have been valuable:

(e.) Educational. (b) Refuse disposal and rat harborage elimina-

tion. (c) Rat extermination by means of poison bait. (d) Rat proof-

ing of new and existing buildings.

The following listed counties have taken part in this program.

Appling Colquitt

Fulton (Atlanta) Lowndes

Tift

Bacon

Crisp

Green

Miller

Turner

Bibb

Decatur

G\~innett

Mitchell Ware

Brooks Dougherty Jenkins

Telfair

Wheeler

Coffee Early

Laurens

Terrell

Worth

Detailed accomplishments are tabulated below:

1. Educational. It is essential that facts relative to a new disease ~e convey~o the public as to the methods of transmission and

126

SANITARY ENGINEERING

methods of control. This is in order that the program sponsored by the health departments may obtain the full cooperation of the public. This phase of the program which has been stressed is most essential in control procedure. Educational contacts have been with civic organizations, county, and city officials, and at general pUblic gatherings. Lectures at 51 of such public gatherings have been recorded.
Lectures consisted of outlining and discussing factors involved in the transmission of the disease, the plan of control, and methods of attainment, illustrated by motion pictures and lantern slides. In towns and cities where inspectors were employed by the local community, extensive educational programs were carried on through the medium of circQlar letters, newspaper articles, and hand bills. For every premise inspected for conditions conducive to rat life, a written report was made and a copy presented to the owner. At all buildings surveyed for rat proofine, the owners or tenants of the buildings were requested to accompany the inspector, thereby obtaining direct information as to potentialities of rat infestation and methods of correction.
2. Refuse Disposal and Rat Harborage Elimination on Premises: Although refuse disposal is not directly a public health problem, it is, however, indirectly associated with the control of diseases through the animal which utilizes garbage for food and breeding purposes. Garbage and rat harborage are conducive to rat infestation, therefore refuse disposal is a part of the typhus control program.
a. Cities and towns employing sanitary inspectors for the purpose of typhus fever control.
W~cross -------------- Ware County Camilla ---------------Mitchell County l~cRae ----------------- Telfair County
Alma ------------------ Bacon County Doerun ---------------- Colquitt County Greensboro ------------ Greene County Lawrenceville --------- ~~innett County Colquitt -------------- Miller County
Sylvester ------------- Worth County Bainbridge ------------ Decatur County b. Premises inspected by county sanitarians or city inspectors,
y,ooo.
c. Municipalities enacting garbage ordinances: Camilla, McRae, Baconton, Ashburn, Lawrenceville.
}. Rat_E.xtermination Programs: Rat extermination by poison consists of powdered red squill mixed with ground meat, fish, or cereal.
During the year, 13 municipalities in 11 counties conducted extermination programs. Tift County carried on a county-wide extermination campaign which included all municipal as well as rural areas. It is estimated that 12,631 pounds of bait were used on 10,000 premises at
an estimated cost of $2,430 in these counties. The City of Albany has carried on an extensive city-wide rat ex-
termination program by the city health department. The amount of poison bait distributed was approximately 3,919 pounds. Atlanta under the direction of the health department, initiated a typhus control program by encouraging merchants in t~ro large business blocks to carry on rat extermination programs. In this case, commercial exterminators were employed by the merchants to treat approximately 80 business establishments on a contract basis.
4. Rat Proofing: a. Surveys of existing buildings (written reports

SANITARY ENGINEERING

127

on file) 179 surveys in 24 counties. The purpose of the written surveys is to give detailed information
to property owners or tenants as to rat harborage in the structures and information as to how these harborages may be eliminated. These reports are in written form and the owner may turn same over to local carpenters.
b. Buildings rat proofed 50 buildings in 20 counties. For a building to be 100 per cent rat proofed, every possible rat harborage must eliminated. Recommendations are based upon removal of all rat harborage. Through the educational program many buildings have been rat proofed of which there are no records available. Three chain grocery concerns have shown an unusual amount of interest in rat proofing. They have requested the assistance of the division and are applying rat proof construction to all new stores under construction as well as to existing stores being remodeled. Information on rat proof construction is also being conveyed to architects and builders throughout the state.
It is interesting to note that typhus, which has been annually increasing, has shown a decline in death rate for the past year. At the end of 1937, the death rate was 1.8 per 100,000 population, whereas for
the year 1938 it was 1.5 per 100,000.

Milk Sanitation

Milk sanitation has been, without exception, one of the greatest needs in the sanitation program. It has also been the most difficult to include in the general routine. With extension of county health organization, there has been an increasing demand upon this division to render service on sanitary production of milk.
Recognizing the need for this service, the division initiated a plan to assist county health departments in this phase of sanitary engineering. This plan has been coordinated with the training of ranitary engineering personnel. Three engineers properly selected by
experience and technical equlifications have specialized in milk sanitation in postgraduate work at one of the universities best qualified for such instruction.
Two of these trainees have returned and the third will return this year so that provision will be made for a milk sanitation specialist to be assigned to each of the three sanitary engineering divisions referred to in the introduction of this report. It is understood that this is not to be state-wide function by the State Department of Health and does not encroach upon authority otherwise delegated but conforms strictly to provision of state establishment of county health depart ments and designated county functions by health laws. To date, this plan has been made effective in only one of the three divisions, namely, the southwest. It is planned to supply this specialized personnel during 1939 to the southeast division and as soon as possible thereafter to the northern division.
However, during 1938 the division of sanitary engineering received
an increasing number of requests for milk sanitation service. In view of the fact that two engineers had completed post-graduate work specializing in milk sanitation, a milk sanitation program was definitely established in the southwest division. Therefore, in order to establish this program and in order to insure immediate and efficient service,
the State Department of Health requested the United States Public Health Service to assign temporarily a milk sanitation specialist to the division of sanitary engineering to assist in establishing a permanent

12S

SANITARY EUGINEERING

service by tr.e division to the local county and district health depart-

ments.

This assistance from the United States Public Health Service was

based upon milk production under the United States Public Health Service

Milk Ord.inance and Code. The request ~/S.s granted by the United States

Public Health Service, and in October of 193S a public health engineer

from the Service \o/S.S detailed to the state and a milk sanitation survey

was inaugurated through the organized county health departments in the

southwest division, with plans to gradually expand this activity to the

southeast and north divisions. The engineer with the State Department

of Health, trained for milk sanitation, has also received the benefit

of the assignment of the milk sanitarian of the United States Public

Health Service and is now in every respect qualified to conduct a per-

manent milk sanitation service.

In order to obtain a comprehensive index of the sanitation status

of the milk supplies and to provide a measure for the amount of improve-

ment over a period of years, sanitation ratings were made during this

initial survey of the retail raw and pasteurized milk supplies in 13

counties of the southwest division:

Bibb

Decatur

Spalding

Thomas

Brooks

Dougher~

Sumter

Tift

Colquitt

Grady

Terrell

Worth

Crisp

So that comparable results could be obtained, all ratings were made on

a co~on standard, namely, the latest edition of the Public Health Ser-

vice l.Ulk Ordinance and Code which is recognized by public health

autr.orities as the standard of safety for good milk production and which

has been adopted by nearly a thousand cities in the United States and

by a number of states. It is noted that all except two of the 26 items

on inspection and grading sheets have definite public health engineering

significance. Based on these requirements, a rating of 90 per cent or

more is considered satisfactory. The ratings of retail raw and

pasteurized milk are shown in Table I and Table II respectively. Cities

are not listed by name but are given alphabetical designations.

Table I. Batings Retail Raw lUlk

U.S.P.H.s.

Honor Roll

90 Per Cent

Cities A- Gs per cent

G- 57 per cent

] - 67 per cent

Jl. - 57 per cent

C - 60 per cent
D - Go per cent

I - 56 per cent J - 55 per cent

E - Go per cent

X - 51 per cent

ll' - 57 per cent

L - 26 per cent

Table II. Ratings Pasteurized Milk

U.S.P.R.S.

Honor Roll

90 Per Cent

Cities A - Go per cent

C - 53 per cent

B - 58 per cent

D - 45 per cent

It is noted from these' tables that there is a wide variance in the re-
tail raw milk which ranges from 26 per cent to Gg per cent. In the

pasteurized milk the variance is considerably less, ranging from 45

per cent to 61 per cent. However, there is no particular significance

in a comparison between the raw and pasteurized milk rating because

they are not made on the same basis.

The survey also revealed that the average daily per capita con-
sumption of milk in the cities surveyed varied from .2 pints to .78

SANITARY ENGINEERING_

129

pints, which is considerably less than that for the United States at
large (.81 pints) and for the South Atlantic States (.63 pints). The

per capita, per day consumption in pints is shown in Table III below:

Table III. Market Milk Consumption -Pints Per Capita Daily- 1938

Survey:

Recommended consumption - 2.0 pints per capita daily. Average con-

sumption United States - .81 pints per capita daily. Average consump-

tion South Atlantic States - .63 pints per capita daily. Cities survey-

ed: A- .78 pints per capita daily G- .35 pints per capita daily

c _ 1! - .68 a

.~2

11

II 11

II H

II
n

D - .44



11

n

H - .32 H D

II

II

I _ .29 n

n

11

J _ .27 n

11

11

N

E - .39 II

"

II

"

F - .38 II

"

"

II

X - .20 II

II

II

"

L - .18 II

II

II

II

It has been repeatedly demonstrated in to~rns which have adopted and en-

forced the PUblic Health Service Milk Ordinance and Code, that the

consumption of fluid milk has materially increased. This increase may

be attributed partly to favorable publicity sponsored by local health

departments and to increase confidence in the milk supply by the con-

suming public.

Milk is a fluid secreted by the mammary glands and because of its

high nutritive content is, when coming from healthy cows, a valuable

part of the daily diet of every child and adult.

In addition to being the most nearly perfect food found in nature,

milk in its production and distribution has a definite public health

significance. When not properly safeguarded it may be the medium for

the transmission of tuberculosis, undulant fever, t,r.phoid, diphtheria,

scarlet fever, septic sore throat and enteric diseases common to chil-

dren.

The production of an abundant, safe, wholesome, milk supply is of

vi tal public health concern and of economic importance to every commu-

nity and should receive the coordinated attention of state and local

agencies responsible for public health and agricultural interests.

Recognizing the public health supervision of milk supplies as a

function of governmental departments with technically trained public

health personnel, a number of municipalities in the state adopted local

ordinances for regulating the safe production, processing and distribu-

tion of milk with responsibility for enforcement in the local health

departments.

Although only a small number of the milksheds were included in

this survey, it is felt that they represent a fair cross section of

conditions prevailing througtout the state and indicates the potential

danger existing in the present milk supplies. It also shows the need

for an effectively planned milk sanitation program through the public

health trained personnel in county or city health departments and who

already are engaged in controlling disease through improvement of en-

vironmental sanitation.

In view of the fact that milk is the most favorable medium for

the growth of bacteria, the milk supply of any city or county is con-

sidered by public health authorities a most important feature of

public health activities.

Mattress Sanitation

On March 30, 1937, the General Assembly passed legislation as

130

SANITARY ENGINEERING

follows: "An Act to improve the sanitary condition of the manufacture of mattresses and. beddill, upholstered furniture"; and 11 to provide that the authority to enforce the provisions of the Act shall be in the Department of Public Health", and 11to provide an inspection or license fee for persons engaged in making, remaking, or renovatill mattresses".
During the first six months of 1938 all mattress manufacturill and renovating concerns in the State of Georgia had complied with the sterilizing requirements and other regulations as set up under the Mattress Sanitary Regulations, Act No. 472 of the Georgia General Assembly. At the close of the year, there were 105 concerns authorized to operate in accordance with the bedding law, all of whom were issued 1938 licenses,
Routine-inspections of all mattress plants and a small percentage
of the furniture stores were made on an average of once every five weeks. Atlanta and its immediate vicinity require about one week's time. Approximately 2,600 routine inspections were made during the year. 260 being made on one round. Of these inspections, 150 were mattress manufacturing and renovating plants and the remainder were furniture stores,
Furniture store inspections require that the entire mattress stock
be gone over to determine whether correct labels and stamps are attached to each article, In some cases it necessitates the cutting of the mattresses to determine whether or not the filling material corresponds to the description on the label. At present, furniture stores are not inspected repeatedly, a complete round being accomplished twice during the year.
As a result of these inspections it was necessary to take legal action in 13 instances. However, in only two of these was it necessary to carry the cases into court. The parties concerned in these two instances were the only renovators in the entire state who have failed to cooperate with the intent of the bedding law. One case included in the above mentioned was against a wholesale concern for the resale of second-~~d mattresses which had supposedly been sterilized in Alabama. The action in this case was dropped after the party in question had all of the mattresses re-sterilized and properly tagged and stamped according to the Georgia regulations.
Prior to the passage of the Mattress Sanitary Regulations in Georgia, a large number of out-of-state concerns selling merchandise in this state had various and sundry labels attached to said articles. However, durill the year all of these firms have changed their labels to comply with the Georgia law. As set forth in previous reports, the label which is required under this law is patterned after a standard tag which is used in 17 other states and two large cities having similar bedding laws.

Training

With the inception of provisions of Social Security and in cooperation with the United States Public Health Service in an expanded program for state public health work, there was experienced a dearth of engineers having trainill or experience in public health work,
Because of the fact that public health ellineering is comparatively a new, though rapidly expanding field, and that in the regular college curricula public health engineering has not been of routine inst~~ction, there was placed upon state health departments an emergency personnel problem, Also this realization prompted a committee

SANITARY ENGINEERING

131

of Provincial and State Health Officers to establish a recommendedstandard )f qualifications for public health workers. This Depart:nent has attempted to meet this standard.
In attempting to meet the sudden and urgent demand for engineers in the field of public health, it became encumbent upon the division to make proper selections of well qualified engineers and to provide for special public health engineering training at certain designated colleges.
It is interesting to note that of the total money spent under Social Security provisions for training of health workers, the amount spent by the United States Public Health Service and the states for training of public health engineers is most prominent. In view of this manifestation of confidence in ~1e eneineering profession, it is proper that the utmost care in selection of engineering personnel for public health work be exerted. It is evident that preventive medicine and sanitation are in effect synonomous, and that control of the major
diseases necessitates improvement of the sanitary environment. This certainly involves the application of engineering principles in purification of drinking water, sanitary treatment and disposal of sewage, sanitary production and distribution of milk, industrial hygiene and sanitation, control of rodents, control of insect-borne diseases, housing, slum clearance, and many other engineering problems.
In view of these considerations, the division of sanitary engineering has exerted every possible means to select the best basically qualified engineers for state health work, and to also make provision for postgraduate training. It is evident that the word 11 inspector11 in public health work is rapidly becoming obsolete.
Since provision has been made for the training of engineers for state health work, there have been sent to the several universities 30 qualified men for specialization in public health engineering. Most of these men have been nominated to county health departments in order that an organization may be built that is well prepared to extend public health engineering service into all portions of the state population. The value of any public service is measured by the type of personnel rendering such service.

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SANITARY ENGINEERING

Recapitulation or Public Water Supplies to December 31, 1938.

Number

Population (19.30 Census)

Percentage Population Using Public &pplies

Percentage Total State Population

Supplies receiving both filtration and chlorination (including sortening and iron removal plants) 85
Deep wells, shallow wells and springs chlorinated 83
Deep wells,shallow wells and springs not chlorinated
:];!]__

753,500 303,000 158,000

Total public water supplies}45

1,214,500

62.0 25.0 .1:.hQ_ 100.0

26.3 10.5
.2.d...
42.2

Water from home

wells and springs

in rural areas

and villages

without public

water supplies 1,688,000

57.8

Total tor State 2,902,500

North Georgia Divisiona
County
Banks Butts Carroll Cherokee Clarke Clayton Cobb DeKalb Elbert Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Greene Gwi."'llett Hall Hancock Hart
Heard
Henry t.lcDuf'fie Newton Oconee Oglethorpe Paulding Pickens Polk Rabun Rockdale Spalding Stephens Taliaferro Walke!'-Catoosa Walton 'llhite Whitfield Wilkes

SANITARY ENGINEERING
Sanitary Privies by Counties
Total Constructed
10 10 178 153 y4s 126 375 260
28
38 551
2 177 709 89 126
62 82 204 216 215 10
2 13 161 14 16
l 3 48 163 74 542 18 25 11 124 21
50
62

Total
Southeast Georgia Divisiona
Appling Atkinson Bacon Brantley Bryan Bulloch Burke Camden Candler Cllarlt:>n Clinch Coffl'e Emanuel Glynn Grady Jef'f Davis

5,317
.34 24 203 33 383 290 373 6J. 42 17 194 352
62 200
4 21

133 Total ReEaired
0 4o 39 30 7

134

SANITARY EiiGlliEEBirl

8ani.tal7 Privies b)' Counties

Southeaat Geora:1a D1naion (Oontd),

County

Total Oonatructed

Jerdd.na

254

Lanier

l)O

Laurene

.324

Liberty

,)69

Lolli

169

Lowndes

2-48

Mitchell

4

Pie roe

176

R1chllond

4)0

Screven

7

Telta1r

3>4

Tho

3

Treutlen

74

Tlr1&g

2

Ware

449

Washington

28,)

Wa;yne

51

Wheeler

2.)4

Total

5,704

Sollth1111at Geora:b Dinaiona

Be)l:er Ben Hill Berrien Bibb BroQka Calhoun Colquitt Oook Crisp
~oatur
Dooly Dougherty Early Grady Houston
Inrl.n
Jones Laaar Lee llacon 14eriwether lliller Mitchell Yuacogee Pike Quitman Randol Pi Sellinole Stewart
~barter
Terrell
Tho rut Troup
Turner IUoox
!forth '!'otala

29 :10 25 ,)6 184 53 9 l 60
280
24 259 22 55 16 4.)
97 ,)4
.39 llO
35
2.3 27 19
3 26 36 19 2 15
28
lJ.o
79 .)60
9 56 177 2,450

Total ReJ:!ired 23]. 2-48 l ll 18 4
14 125 215
1,0.)1
l2 7 2
709
1
2 :10 185
8 976

135

Sewage Disposal
Total new septic tanks installed.................... 27 Total ~~eptic tanka repaired. 31 Total privies installed. 606 Total privies repaired.. 17
Water &lppllea
New water supplies.................................. 4
Water supply improvement. ?0 Water salllpl.es examined. l T7 Water supplies temporaril;y sterilized............... 35

North Ga. - School Sanitation

County
Catoosa Clayton Cobb Columbia
Dade
DeKalb Floyd Glaacock Hancock Hall Hart Heney Newton Rabun Rockdale Spalding Walker Walton Whitf'ield
Total

!:!1!!!.!.
4 4 :8
5 6 13 9
30
28
2 4 36 35
1 12
'223

Septic Tanka
1 l 1 2
1 1
7

Southeast Ga.

Appling

13

1

Bulloch

4

3

2

Burke

8

4

Bryant

1

1

Brantley

4

l

Charlton

1

Clinch

4

Cofee

4

l

Jenkina

13

l

Laurens

22

l

l2

Lanier

4

Liberty

8

Long

9

Richllond

4

Telfair

9

Treutlen

6

Twiggs

2

Ware

7

Washington

3

1

.,_eeler

7

Total

132

ll

18

136

SANITARY m:liNEERIHl

Southwest Ga. - School Sanitation

County

~

SeEtic Tank

Baker

8

Brooks

2

7

Calhoun

3

Colquitt

2

2

Decatur

15

1

6

Dougherty

5

2

Early

2

Grady

3

1

Jones

14

<Lamar

2

Macon

2

Muscogee

1

Terrell

3

Thomas

46

1

ll

Troup

94

2

Worth

'}.9

Totals

251

9

24

School Sewage Dispossl Plants Approved and Unuer Construction at the End of the Year.

Muscogee County School (Twin Churches)

Montrose School, Laurens Co.

Grantville Negro School, Coweta Co.

Camak School, McDuffie Co.

Shady Dale School, Jasper Co.

Pinehurst Dooly County School

Catoosa Consolidated School, Catoosa Co.

ForPst Park School, Clayton Co.

Crisp County School (East Crisp County School)

Arabi School, Crisp Co.

Juliet School, Jones Co.

Oakman School, Gordon Co.

Morgan School, Calhoun Co.

Red Bud School, Gordon Co.

Doerun School, Colquitt Co.

Ringgold Consolidated School, Catoosa Co.

Lyerly Consolidated School, Chattooga Co.

Kennesaw Consolidated School, Cobb Co.

Ashton Consolidated School, Ben Hill Co.

Heard County Centrslhatchee High School, Franklin, Ga.

Roanoke Consolidated School, Ben Hill Co.

East Clayton Consolidated School

Pineview Consolidated, Wilcox Co.

Pitts Consolidated, Wilcox Co.

Antioch School

Crisp County West High School

Haralson County School, Buchanan, Ga.

Pine Grove Consolidated, Lowndes Co.

Gracewood School, Richmond Co.

Roanoke Consolidated School, Ben Hill, Ga.

Deep well

Pineview Consolidated School, Wilcox Co.

Water supply

Crisp County West High School

Deep well

SANiTARY ENGINEERING

137

STA'!'E-WJ.DE MALARIA DRAHUOE TABULATION

YEAR 19,38.

County
Baker Banks Ben Hill l:!errien Bibb Brooks Bulloch !:!urke Calhoun Chatham Clay Cl1nch Cobb Cook Coweta Crawford Crisp Decatur Dougherty Early Echols Effingham
~ranklln
Fulton Glascock Grady
Green Gw:l.nnett Hart Houston ,Jackson Jefferson Jenkins Johnson Laurens Lee Lowndes Mac)n
McDuffie Miller l.!itohell Pulaski Randolph Richmond Schley Screven Seminole Spalding Sumter Tattnall Terrell Thomas Trenton Treutlen Troup
Turner Twiggs Walton WUcox Worth Totals

D:l.toh Footage
7,'Z7J 4,747 7,4oo 27,098
~2,197
50,085 1,3,100 53,099 !8,45'1 262,5.38 3,500
J8,9J8 22,900 2.1,547 ll,SOO 6,4oo 10,7,37 l4,4oo .!.,3,900
350 JOO 6,,352 6,750 98J 1,600
4,000 28,855 6,700 ll,JlO lll,67J 15,500 19,265 7,971
225 JO,JOO 30,500
900 ll,950
),200
50 7,053 18,3,720 17,995 4,125 8,700 7.3,232 53,455 7,250 1,3,78.3 54,87,3 2,000 5,4oo 241,496 6,800 .3,164 5,4oo 24,800 1,68212,1096706

!'lumber Ponds Drained
6
7 8 Jl .32 19 28 12 42J J
22
12 17 6 8 14 20
J
6
J
6
J
69 12 lJ 10
27 9
14 2
6 ll J 15 2 53 12 8 6 65 4 8 229 J 5
8 20 l,JOJ

Man Hours Labor
),652
62,245 12,0,36 17,,328
4,35,9~
60,954 38,998 lOJ,7ll 4.3,541 968,551 6,226
429 ,35,187
JJ,lJO 54,0,38 41,5,32 64,889 ?l,HiO 67,lll 18,268
272 11,.384
4,644 8,012 ll,524
1,560 2,047 7,186 48,90,3 10,216 71,894 104,4,34 81,961 50,,314 41,904 7,788 J2,oo4 51,457

Coat of Work
6)l.07 ll,7,36.66
2,789.00 .3,251.45 12.3,55,3.01 ll,692.68 B,074.02 20,179.8.3 8,4,39.27 281,621.68 1,228.55
74.4o 9,00,3.81
5,948.75 12,251.4o 8,,3,36.61
15,,389. 79 15,5,38.80 J.4,84o.95 3,455.66
55.4o 2,455.58
947.)0 J,4o8.24 1,961.18
261.48 488.80 1,525.00 8,18J.4o 2,025.,32 14,9,3,3.25 19,896.27 15,904.64 9,4,36.92 9,9,37.01 1,577.ll 6,594.22 10,,362.41

27,545 8,295 7,109 8,788
694,.325 19,769
7,721 17,165
,32,427 109,698
1.3,825 4o,05J 38,528 1,288
7,677
94,3,729
9,51.3 7,288
22,494 46,502
4 , 7 72221, ~

4,769.JJ 1,710.84 1,496.52 1,781.65 192,785.41
J,518.JJ 1, 722.05 ,3,229.)4
7,444.71 25,)86.55 2,782.,35 7,,364.59 8,855.60
217.96 1,298.07
208,625.90 1,951.67
1,285.28 4,652.85
8,,371.85
4 1627.90 tl,l6i,869.67

138

SANITARI ENGINEERING

LIST OF IMPOUNDED WATER AREAS ON WHICH PEHv!ITS WERE GRANTED IN 19J8.

Seria1 No.
11-ll 1$-1 57-ll 6$-ll 70-ll 72-ll 82-1 87-ll 87-12 14$-1 15.3-ll 15,3-12

County
Bibb Bryan Floyd Grady Hancock Harris Jenldns Laurens Laurens Upson Wheeler Wheeler

Size of Area (Acres)
25 30 1/6 1/2
20
28
.35 5
J.i
2 2
.3

Type of Permit
Pre11m1naey
II II
"II
Maintenance
Preliminaey II ""II

Tota1

152-1/6

DIVISION OF i'lmERCULOSIS CONTROL

There has not been a continued reduction in the number of deaths from tuberculosis, but the increase is comparatively slight. The comparison follows:

YEAR NUMBER OF DEATHS White Colored Total No. ~ No. ~
1937 559 36 990 1,549 1938 602 37 1010 63 1,612

RATE PER 100,000 POP.
White Colored Total
28.5 89.0 50.3 30.3 90-3 52.0

PERCENTAGE NEGROES IN
GEORGIA
j~

The fact that there was no further decrease of deaths in 1938 ~ be due to the death of some patients in 1938 who would have died in 1937 had not their lives been prolonged by treatment received during
that year under the expanded program. It is believed that there will
likely be a decrease of deaths in 1939, although not much further de-
crease IIIIey" be expected until many more beds be provided.

Clinic Examinations

During the year 1938, 14,074 x-ray examinations in 219 clinics were made by the field unit and as a result 820 new cases were found. This was 217 more than were found in 1937. This is probably a result
of better selection of subjects for clinics, for approximately the same
number of examinations were made in 1937 and 1938. (See Tables 1 to 7
for analyses of these examinations.) Table 5 shows the comparatively small number (less than 2a{o in the
white and la{o in the colored race) of cases found in the minimal stage
and makes evident the need for the greatest possible effort to find and
treat more cases in early stages.
Table 6 is extremely important and startlill as 1t shows what a.
small percentage of cases were found in examinations of persons (con
tacts, suspects and t'Uberculin positive individuals principally) 16 years
of age and under as compared with the much lar,er percentage of cases
found in those over 16, and that it required 14 times the effort and
cost to find a case of pulmonary tuberculosis in white persons up to the
age of 16 as it did in those over 16 years of age. This is the experi-
ence of contemporary workers and clearly points to the necessity of di-
rectill case findill efforts chiefly to those over 15 in the white race and to those over 13 in the colored. This is true for contacts as well and if there is to be a choice of examining adult contacts over 15 and those up to 15 years of age. the choice should be in favor of the adults.
Re-examinationa, 1t can be shown (See Table 7) , yield a much smaller
percentage of positive cases -.. an average of only 1.63 per cent, or 59 out of 3,618 re-examinations of white and 3.44 per cent, or 28 out of 813 re-examinations of colored patients.
Table 8 points out that in counties with health units 72 per cent more cases were known of on December 31, 1938 than in counties served only by a county health nurse and 161 per cent more than in counties
served only by district nurses doli! general public health work. Table
9 lists a number of field activities by local health workers and it is noted that from 58.3 per cent to 95.4 per cent of all of them are in the

139

14o

TUBERCULOSIS CONTROL

counties having full time health units. An interesting fact brought out is that during the year an average of 6.3 visits per case of tuberculosis was made in fUll time health unit counties as against
2.8 visits per patient in county nurse counties and 4.1 visits in
district nurse counties. Thus it is indicated that tuberculosis control services are much more extensive in those counties having units
operating under the Ellis Health Law.

Survey of Destitute Patients

A survey made by this division at the end of the year with returns from 154 counties resulted in obtaining the names and addresses of destitute tuberculous patients, many of them homeless, as listed below:

White

Colored

Total

Homeless Destitute

r1u68

186
.ill.

Total

1035

701

Adequate provision for their care, even food and shelter, has not been made, although every possible effort to do so is being exerted by local agencies, and it is impossible with existing facilities to isolate them properly for the protection of members of their famil\es, associates and the general public.

Personnel

The personnel of this division is excellently trained and is now in a position to make and report 35,000 x-r:q examinations instead of the present 14,000 to 15,000, provided the necessary funds be made available. It is estimated that about $63,44o would be required. This is less than $2.00 per examination against $5.00 as is the estimated cost in some other states.

Study of Sanatorium Report

A study of the sanatorium report for 1938 shows that services there were greatly increased in the last six months of the year 1938 over those of the preceding like period. This gratifying increase came about
following administrative chanees at the institution. The results obtained justify the changes which have been made and prove the soundness of the policies adopted by the State Department of Health in its fight against tuberculosis as they apply to the sanatorium. The present sanatorium administration insures continuance of its sympathetic and intelligent cooperation in tuberculosis control. This increased sanatorium
service has made the case finding and consultation service much more effective than it ever was before because it has permitted lung collapse therapy to be used much earlier in lll8.ey cases than was formerly possible. It should result in some decrease in the annual death rate next year.

Georgia Tuberculosis Association

During the period September 1, 1937 to December 8, 1938, the Georgia Tuberculosis Association in addition to its other valuable contributions
toward tuberculosis control paid 77 p~siciana throughout the State fees

TUBERCULOSIS COBTBOL

for pneumothorax refills in 486 indigent cases. This has done much in 1937 to lower the death rate and to keep it down in 1938. It is hoped this assistance can be kept up until it can be properly taken over by the State through its health or welfare department. The cost this would be to the State for 500 patients is estimated at about $24,000 annually.

Phi Mu Contribution

The Phi Mu Fraternity, which has for many years been contributing

to the maintenance in the field of the x-ra:y heal thmobile, again aided

with a gift of $1,500.00 in 1938. This is a generous and greatly

appreciated assistance which has been of much value to the people of

the State.



Cooperating Agencies

Occasion must be taken to express appreciation to the medical profession, local public health workers, local seal sale committees, and tuberculosis associations, count,y welfare directors, and other persona and agencies interested in vlping out tuberculosis for their wonderful cooperation. It is recognized that nothing could be done without their assistance.

Need for Additional Beds

To an extent greater than ever before the need for from two to three institutional beds per annual death from tuberculosis is being emphasiud nationally. This means that from 3,000 to 4,500 beds are needed in this State. After the contemplated and contracted projects at Alto are completed, 692 State beds will have been provided. Only 114 of these are for Negroes. It is shown above that there are at least 1,800 indigent tuberculosis patients in the State for whom there are no beds and about 3, 000 new cases are being reported annually. At least 200 hospital beds, preferably in an institution or sanatorium built for the purpose, should be provided for Negroes and an adcUtional
2,000 domiciliary beds in inexpensively constructed buildings divided as needed among white and Negro patients are required. The latter should not be considered as new or additional expense, but rather as transferring the present burden from local charitable and welfare
agencies to the State. Laws requiring adequate and proper isolation of communicable cases could then be enforced.

A total of 14,074 x-ray examinations were made by the field x-ra:y unit and 820 new cases were discovered which was 217 more than were
found in 1937. In addition, 3,011 new cases were reported in 1938 and 3,016 in
1937 In a case finding program the need is shown for concentrating
efforts on low income groups of adults over 15 years of age and that the finding and early treatment of early tuberculosis. (chiefly to be found in the 15 to 25 year ~e group) should be greatly stimulated.
It is pointed out that 63 per cent of the deaths are in 36 per cent of the population - the Negroes - and that tuberculosis in Georgia

142

TUBERCULOSIS CONTROL

cannot be controlled so long as this reservoir of infection is allowed to remain.
A 200 bed Negro unit and 2,000 domiciliary beds for white and colored are shown to be vital needs.
The value of integrating the State TUberculosis Sanatorium in the control program is made apparent.
The value of full time county health units is demonstrated in the control of tuberculosis.

NOTE:
*The 1937 and 1938 figures as given in this report are not exactly comparable, inasmuch as the f~es for 1938 include residents of Georgia who have died of tuberculosis outside of the State and exclude nonresidents who have died within the State.

Month

Nuuber Clinics

January 19

February 20

March

20

April

18

MSl'

19

June

18

TUBERCU!.O SIS COllTROL

TAl!Llll I

7ruMlllm OF CLINICS AN!l CLIJUC DAYS IN 1938

Number
of Dar

!'lumber X-rqed

Month

Number Clinics

Number of l)qs

21

1128

July

10

11

20 23

1~~

August

22

September 20

23 21

21

1277

October 17

20

22 22

1112a1

November 19 December 17

22 17

Total

for Tear 219

243

llumber X- rayed
559 1182 1084 1701 1714 967
14,:>74

TAl!LE II

DISTRillUTION OF CLilTICS

In 59 counties in 103 elinics organized by health officers and public health nurses

In 83 counties in 108 clinics organized b~ district nurses

University of Georgia

172 Berry Schools, Rome

Douglas County High School 111 Young Harris College

Beaver l\111s, Douglasville

81 Agnes Scott College, Decatur

Rock Chapel Hountain

Women's Camp, State Prison,

:);uarries, Lithonia

Mi11edev111e

Total for Year

6,794
4,990
1,134 172 193
353 14,074

TAl!Lil: III S!Jl.fi:ART OF OASIS FOUND

First and Re-examinations

Wlite

and Type

Number Cases

lx-ra.ved Found

AAult Type-Orig. E%ams

5015 412

Adult Type-Re-examinations
Total
1st Infection-Infiltrative Type-Qri.dnal l:~ta~~~s let Infection-Infiltrative Type-Re-examinations

2538 59 7553 471 2067 '56 1080 20

Total

3147 76

Colored

mute & olored Comb

Number Caeee

Uumber Cases

~ X-raYed Found '!l X-r~Lved Found

"

8,2 1642 205 12.5 6657 617 93

2.3 499

28 56 3037 87 2.9

6.2 2141 233 10.8 9694 704 73

2.7 818

~7 4.r:; ~go;

Q~

~.:>

1.9 314 2.4 1132

3 1.0 1394 23 1.6 40 35 4279 116 2.7

Grand Total

10,700 547 5.1 3273

273 8.3 13.973 820

59

144

TtlllERCULOSI S COl!TROL

TABLE IV

RESULTS OF ORIGIUAL EXAMIUTIONS, ALL AGES BY SEX A:l!D COLOR SIIOWING NUlruRS AND PERCE?!TAGES

White
Childhood !Unimal l-iod. Adv. Fa.r Mv. Total Pos.
Suspicious l!egative TOTAL

Male
Number %
32 .sg 35 97 58 1.61 108 300 233 6.47 552 15.33 2816 ]!!.20
3b5I 100.00~

Female

!!umber

%

24

.Gg

46 1.}2

58 1.67

107 307

235 6.75

507 14.57

~Ui ~ 100. .

Male and Female

Combined

Number

%

56

79

81

1.14

116

1.64

215

}.o4

468

6.61

1059

14.~

.750i282.l

~ .

Colored

Childhood

20 2.06

17 1.14

37

Minimal

3 31

17 1.14

20

Mod. Adv.

22 2.26

30 2.00

52

Far Adv. Total Pos.

59 6.08 104 10.]1

74 4.97 138 921

12~32

Suspicious

131 13.49

152 10.21

283

I:egative TOTAL

.ill.
971

~ 100. .

tm1 9 ~ 100. '

~

1.50 .82 2.11 5.41 g.84 11.50 78.66 1oo.oo%

TABLE V

CLASSIFICATION OF THE CASES FOUND BY ORIGINAL EXAMINATIONS ACCORDING TO STAGE IN AGE GROUPS, !-!ALE AND PID!ALE COI!BillE!l, SHOWING llUl!BERS AND PERC:illiTAGES

White

Age Groups
l-linimal Mod. Adv. Far Adv, TOTAL
Colored

Up to 16

Number

f.

7 1.7

3 2 12

1 5 2.9

17-45 Number %
59 14.3 71 1].2 148 359 278 6].4

46 Up
Number f.
15 36 42 10.3 65 15.8 122 297

All Agee Number
"' 81 19.6
116 28.2 215 52.2 412 100.0

~!inimal
Mod. Adv. Far Adv. TOTAL

4 3 8

1.9 1.5 39

15
16~

118.30 51.7

15 13 158 77.0

1 12

5 59

19 93

32 157

20

97

52 2a.4

133 6 9

205 100.0

TUBERCULOSIS CONTROL

TA:BU VI

lM!llER AND P:llRCEt:TAGE OF CASES FOUllD llY ::'IRST EXAMil'ATIONS IN P.ELATION TO 1ltJl.ffi:ER X-RAYED, HALE AHD FEMALE COMBINED, CLASSIFIED ACCORDING TO STAGE AllD AGE GROUP

CASES FOUND

White
Ac,e Groups
Up to 16 1~-45 4 Up TOTAL

Number X-rayed
2079 4232 771 7082

Minimal

No.

"' 7
59

1. ~

15 1.94

81 1.14

Mod. Adv.

No.

;<:

3

.14

71

1.67

42 116

15.6~

Far Adv.

No.

~

2

.10

148 65

3s.aoa

215 3.0

All Cases

no.

%

12 58 278 6.57 122 15.82 412 5.82

Colored

Up to 16 1~-45 4 Up TOTAL

833

4 .48 3

36 8

.96 15 l.t<:O

1311

15 1.14 37

2.82 106 8.08 158 12.05

2~

1 32 12 20 .81 52

379 19 2.11 133

6.01 32 10.12 54o 205 8.32

TAJlLE VII

!'IU}tBER AllD PERCEJ;TAGE OF CASES FOUND J3Y RE-EXAMINATIOUS IN RJ':LATION TO THE NUJ.:JlER X-P.AYED, MJLE AllD FEl!ALE COJ.:ll!EED, CLASSIFIED ACCORDING TO STAGE .L'ID AGE GROUP

CASES FOUND

White
NI,e Groups
Up to 16 17-115 46 Up TOTAL
Colored

Number X-reyed
1080 1894 644 3618

Minimal
No. %
1 .og
21 1.11
5 77
27 75

Mod. Adv.

NQ.

%

2

.19

1~

19
.62

21

58

,, Far Adv.

No.

"

0 .oo

10

53

1

.16

11

30

All Cases

no.

%

4~

.28 2.42

10 1.55

59 1.63

Up to 16
17-1!5 46 Up TOTAL

314

6 1.91

1

.;2 1

32 g 2.25

369 130

7 1.89 2 1.53

5 0

1..o3o6

5 1

1.36 17
11 3

4.61 2.~

813

15 l.t<:5

6

74 7

.t<:6 28 3

TA:BLE VIII
llmlllER OF CASES OF PULMONARY TUllERCULOSIS unDER OBSERVATION OF PUllLIC F.EALTH 110!1Y.ERS ON DECEllllER 31, 1938, 3HO'.I'IlfG AVERAGE PER COU11TY

!lumber of Counties

Type of Service

Case Load White Colored

Total

Averlle Per Count;

*51 . .10
94 155

Health Unit

1433

519

County Nurse

157

65

District Nurse

1013

289

Total

2691

913

1952 222
1302 36o4

383 22.2 139*"* 22.4

*Figures from Bartow, Tift and DeKalb Counties end City of Atlanta are not included. **Ho figures from Muscogee County. ***The 20 District Nurses had in their districts an averlle case loeA of 65.1 patients per district on December 31, 1938 with an average of 4.7 counties per district.

146

'l'Ul!ERCULOSIS CONTROL

TABLB: IX

PUBLIC HEALTH TUBERCULOSIS CONTROL ACTIVITIES IN 1938

By Full Time lly J'ull Time By 20 District

Percentage

Health Uni ta Count;r lfurses lfurses

Total Health Unit

51 Counties 10 Counties 94 Counties Services Counties

Cases ot tuberculosis admitted to service
Visits to tuberculosis cases, contacts and suspects
Visits to cases of tuberculosis
Average number of visits to cases of tuberculosis
Office visits b;r cases of tuberculosis
Admissio111 to Sanatoria
Number of completed tuberculin tests
Number of positive tuberculin tests
Contacts broken
Conte.cts partly broken
Relief securednumber of cases
Tuberculosis cottages built
Public lectures and talks

2578
47,774 17,506
6.1! 4729 385 15,019 6724 1196 294 445
21 329

295
1829 819
2.8 120 25 479 212 149 44 59
4 12

1038

3911

6586 56,1!!9 4232 22,557

4.1

110

4959

129

539

2066 17.564

1434

8370

374

1719

30

368

135

639

11

36

28

369

65-95 85.02 77.61
9536 71.43 S5.49 80.33 69.'58 79.S9 69.64 5833 89.16

STATE TUBERCULOSIS SANATORIUM
Some of the statistical tables herein presented are purposely comparative by six-month periods. This comparison is made to demonstrate the value of a sanatorium personnel familiar with the problems of tuberculosis control, both from the institutional and the public health
perspective. It was during the last six months of 1938 that the work
of the sanatorium and the division of tuberculosis control of the State Department of Health were more closely coordinated than at any previous time. This was brought about by the temporary appointment of the associate clinician of the division of tuberculosis control, as acting
superintendent at the sanatorium from June 8, 1938 to December 15, 1938,
following the resignation of the former superintendent of the sanatorium. Eecause of this, the sanatorium administration was enabled to function on a broader basis from the standpoint of efficiency in tuberculosis treatment and control and stricter economy could be practiced in business administration.
Institutional Care
(1) There were 81 more patients admitted during the last six months of 1938.
(2) There were 66 more patients discharged during the last six
months.
(3) There were 109 more patients treated during the last six months. (4) There were 78 more beds placed in use, the majority being for
adults.
(5) The average length of residence per patient was 74 ~s which was 9 days less per patient during the last six months, and which enabled
more patients to be admitted and benefited from the services of the sanatorium.
(6) The average daily census for the last six months \'/S.S 247 which \1"'" an increase of 17 patients daily.
(7) There were 72 more patients given artificial pneumothorax treat-
ment the last six months.
(8) There were 2,570 more pneumothorax refills administered. (9) There were 26 more patients receiving pneumolysis operations. (10) There were 4 more patients receiving thoracoplasty operations
and two more receiving phrenic nerve operations.
Business Administration
( 1) The patient ~s increased from 41, 657 durizlg the first period to 45,536 during the second. This was an increase of 3.879 patient days.
(2) Due to improved management the daily per capita cost was re-
duced from $2.18 during the first period to $1.97 for the last period.
(3) There was a gain in services for the State of an additional
value of $9,562.56 for the last period. (4) The sanatorium gave increased service at less cost.
Every effort will be made to maintain the administration improvements in service and in business administration wherever possible.

Beds Available Admissions Disclu>rges
Patients Treated Deaths Patient Dlcy's Daily Per Capita Cost Average Stay Per Patient
Average Daily Census

Ttll!ERCULO SIS SAllATORIUM
TAllLE I
GENE!l.AL STATISTICAL INFORI-!ATION
First 6 Honths Last 6 Months
250 282 26o 497
6 41,657
2.18 83 230

Increase or Decrease in Last 6 Months
+78 +81 +66 +109 +4 +3,879 -.21
-9
+17

TAllLBI II

PAUtmTS AlllHTTEU, 1liSCHARGlilD AND TREATED

Total-1938

Adults
wc

Children

w

c

Su.b-Total

w

c

Admitted Discharged Treated
TOTAL-FIRST SIX MONTHS Admitted Discharged Treated

484 104 416 96

41 33

16 41

~

120 137

612 14o

70

37

682

177

213 33

25

11

238

44

193 32 341 69

~a

22

206

33

395

54 102

TOTAL-LAST SIX J.!OIITHS
Admitted
Discharged Treated

271 71

16

5

287

76

4212a

64 108

20 62

19

24~

22

47

83 130

InCR3ASE OR DECEASE LAST SIX MONTHS

Admitted Discharged
Treated

+58 +38

-9

-6

+119

+19

+30 +32

+7

-3

+37

+29

+73 +39

+8

-11

+81

+28

Total
64s 586 859
282 26o 497
363 326 6o6
+81 +56 +109

TAllLE III

AGE AND SEX OF PATililNTS (BOTH RACES) ON DISCHARGE

1938

Age Groups First 6 Months

M

F

Last 6 !(onths

M

r

Su.b-Tota1

M

F

1-10

7

11-20

18

2ljg

24

31

36

41-50

20

51-Go

8

61-70

-l

Total

116

11

11

~
32

18
~

15

18

6

23

-l _g

144

163

22

18

33

22

36

50

69

~

37

82

69

20

38

35

9

31

15

-l

_j,

_!

163

279

307

Total
51 91 163
u151
....!!
586

ON AD-IISSIOll'
White
Childhood T.B. Minimal Mod. Adv. Far Adv. Non-clinical T.B. TOTAL
ON DISCHARGE
White
Childhood T.B. !.finimal Mod. Adv. Far Adv. Non-clinical T.B. TOTAL
Colored
Childhood T.B. Minimal t4od. Adv. Far Adv. Non-clinical T.B. TOTAL

TABLE IV CLASSIFICATION OF PATIENTS FROM JANUAE! 1, 1938 THROUGH DECEl.f.BER 31, 19:8

Colored

35

Childhood T.B.

25

32

Minimal

5

121

Mod. Adv.

25

212

Far Adv.

41

67

Non-clinical T.B.

23

467

TOTAL

119

Arrested
16 0 0 0 1
17

.App. Arrest.
12 6 5 2 1
26

Quiescent
0 9 35 13 0 57

Improved Unimp.

4

1

7

4

56

12

121

53

1

32

190

102

White and Colored

Childhood T.B.
Minimal Mod. Adv. Far Adv. Non-clinical T.B. TOTAL

Go
la~

253 90



586 l3



Cll

H

Died lrot Considered Non T.B.

Ul

rn

;>;:

0

0

2

!>'!

0

5

1

12

9

14

0

t3

0

~

0

~

0

2

30

10

33

32

0

8

0 0

4

0

0

0

0

0

15

0

17

0

0

1

1

0

0

2

17

1

1

0

25

8

7

0

1

2

0

3

61

11

g

0

0

0

0

0

0

1

0

0

20

1

20

t-'
$

TABLE V

COLLAPSE AND OPERATIVE TBEA'n.llCN'r 1938

Number Initial Pneumothorax Operations Number Patients Receiving Pneunothor~%

Firat 6 Mos.
84
196

Last 6 Months 72
268

ll'umber Pneumothor~x Refills
s... ll'umber Initial PnEIUI!Io-Peri toneum
~

216o

4730

5

1

~
~

Number Patients Receiving Pneumo-Peritoneum

5

3

Number Pne~o-Peritoneum Refills

68

115

Ul

H

Ul
i

Number Patients Receiving Pneumolysis Number Pneumolysis Operations

7

33

14

35

~ Number Patients Receiving Thoracoplasties

6

10

Number Thoracoplasty Stages Performed

12

15

NUmber Phrenic Nerve Operations

96

98

Spinal Fusion

1

0

AppendectoacyDilatation and CUrettage 1?-. Blood Transfusions
r-l

1

1

0

1

0

2

Total 156 464 6890
6 8 183 l!o
49
16 27 194 1
2 1 2

Increase or Decrease -12 +72
+2570 -4 -2 +47 +26 +21 +4 +3 +2 -1
0 +1 +2

TUBERCULOSIS SA:tfATORIUl~

151

T.ABLBI Vl

COMPLICATIOUS Fl!OM JANUARY 1, 19:8 THROUGH m:cEliBER 31, 1938

Abscess, L1lll& Atelectasis Apieol.ysi s Appendicitis Adenitis Bronchiectasis Bronchitis Cardiae Disease Chronic Empyema Non Tbe. Diabetes l!elli tus Hernia Inguinal Hypertension, Essential Intestinal Obstruction Mitral Stenosis 1-fyoearditis Heasles Nephritis, acute Oleothorax Otitis Media, Chronic Purulent Pleurisy with ~ffusion Pneumothorax, Artificial Pneumothorax, Spontaneous Pneumo-peritoneum Pellagra
Pleural Fistula Pyelitis Phimosis
Silicosis Syphilis T.3, :iilmpyema T.B. Enteritis T.!l. l'!eningitis T.B. Hephritis T.B. Peritonitis T,B, Laryngitis

'1-Thi te 4
0 0 1 0 8 0 0 1 1 2
4
1 8
5
0 1
0
1
5 128
s3
2
4
0 0
3 3 5 5
1 1 1 22

Colored
1 0 1 0 2 0 1 2 0 0 0 1 0
0 1 1 0 1 0 0
26
0 0 0 0 1 1 0
3
0 0 0 0 1 2

TABLE VII

JAliDARY 1, 1938 THROUGH DECEMBER 31, 1938

X-r~ Examinations 1. House Patients 2. Consultations
3 Bronchograms (Lipiodol)

Number
2950 n6o
29

Laboratory ExaminRtions

10,366

Fluoroscopic Examinations

5456

152

Tl.i'BZRCULOSIS SA..UIDRIUM

TABLE VIII

cotmTIES REPRESEHTED (BOTH RACES) JANUARY 1, 1938 THROUGH DECEMBER 31, 1938

Appling

3

Atkinson 2

Bald,~in

4

Benke

3

:Barrow

1

Bartow

9

Ben Hill 3

Berrien

2

Bibb

14

Blecldey 4

Brantley 1

Brooks

3

Bryan

2

Bullo-ch

3

Burke

1

Calhoun

2

Camden

1

Candler

2

Carroll

3

Catoosa

5

Chatham 17

Cha.t tooga 11

Chero:~ee

4

Clarke

9

Cla;y

1

Cla;yton

3

Cobb

8

Coffee

2

Colquitt 1

Columbia 3

Coweta

5

Crisp

7

Dade

2

Dawson

1

Decatur

5

DeKalb

7

Dodge

11

Doo1y

2

Dougherty 5

Douglas

2

Early

1

Effingham 1

Elbert

8

Emanuel

1

Evans

1

Fllllllin 2

Fa;yette 2

Floyd Franklin

2~

Forsyth 1

Fulton 33 Gilmer 3

Glascock 1

Glynn

4

Gordon 1

Gra~

1

Greene 1

Gwinnett 1

Habersham 11

Hall

17

Hancock 3

Haralson 3 Harris 2

Hart

3

Henry

2

Irwin

1

Jackson 5

Jasper 2

Jeff Davis 1

Jefferson 2

Jenkins 1

a Johnson
Lamar

LMier 1

Laurens 5 Lincoln 1

Lowndes 1

Lumpkin 2

Macon

2

Madison 3

McDu.ffie 2

Mcintosh 2

Meriwether 7

Miller 2

Mitchell 2

Monroe 7 Morgan 3

Murra;y 2

l~uscogee

5

Newton

2

Oconee

2

Paulding

3

Peach

1

Pickens

5

Pierce

l

Pike

2

Polk

8

Pulaski

1

Rabun

2

Randolph

6

Richmond 18

Rockdale

3

Schley

3

Spalding 15

Stephens

2

Sumter

2

Taliaferro 1

Talbot

2

Tattnall

1

Ta;ylor

2

Telfair

1

Terrell

2

Thomas

'I

Tift

~

Toombs

4

Towns

2

Treutlen

1

Troup

2

Turner

1

Upson

4

Walker

10

Walton

4

Ware

5

Warren

1

Washington 3

Wa;yne

3

Webster

2

Wheeler

2

Whitfield 26

Wilkes

1

Worth

4

TOTAL

541

DIVISION OF VENEREAL DISEASE CO:tl!IROL

During the year 1938 the activities in 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; case follow-up; consultative, advisory, and laboratory services to physicians. During the last quarter of this year, the Federal appropriations for the control of venereal diseases made it poesible to add to the usual program the distribtuion of free anti-syphilitic drugs to the physicians of the State.
A physician on loan from the United States Public Health Service joined the staff in an advisory capacity.

Case Reporting

Totals of 28,902 new cases of syphilis, 4,603 new cases of gonorrhea, and 788 new cases of chancroid were reported to the Georgia Department of Public Health. Case reports from private physicians were received in the division of epidemiology on the regular weekly morbidity report cards, and from clinics in the division of venereal disease control on the monthly clinic report cards.

New Reporting aystem: Beginning in September, a new system of reporting was inaU&UI"ated as a part of the free anti-syphilitic drug distribution. From September through December, therefore, 430 new cases of eyphilis, and 43 new cases of gonorrhea, were reported by private physicians to the division of venereal disease control on individ-
ual case report cards.

Distribution of Free Anti-Leutic Drugs

The distribution of free Neoarsphenamine, Sulpharsphenamine, and

Bismuth for the treatment of syphilis was made possible in the State

Department of Public Health by Federal appropriations for venereal dis-

ease control. The program in Georgia did not actually get under W87

until October 1, 1938, although considerable work and planning was done

during the preceding months.



New report forms for private physicians, health officers, and clinics

were prepared and distributed throughout the State, along with letters

announcing the new program and a copy of the regulations.

These regulations provided for the distribution of free anti-syph-

ilitic drugs to be used in the treatment of all indigent and semi-

indigent patients.

Participation of Doctors: Since October 1, 1938, a total of 225 doctors, in 79 counties of the State, participated in the progr~. Of these, 148 doctors, in 31 counties, were served by health officers. The remaining 77 doctors, in 48 counties, were served directly through the State Department of Public Health.
As the year closes, the program is steadily increasing in extent. This is encouraging in view of the very slow progress made in the past in the fight against this disease.

153

154

VENEREAL DISEASE CONTROL

Clinic Organization

Efforts to organize clinics throughout the State have been steadily maintained.

Services to Clinics: Under the present set-up, clinics are suppli-
ed, free of charge, with drugs, distilled water, record cards, and sterile corked vials for use when taking blood for examination with a syringe. They are furnished, at cost, supplies such as syringes, needles, Keidel tubes, etc.

Increase in Clinics: At the end of the year, 52 counties are being served by clinics, there being more than one clinic in many counties. Of the counties having clinics, 41 are served by organized health departments. At the end of the year 1937, 35 counties were operating clinics, showing an increase for the year of 17 counties now making treatment available for venereal disease patients who are unable to pay a physician for this treatment.

Convict Clinicsf A campaign is being carried on, in cooperation with the State Board of Penal Administration, to provide treatment in all convict camps and prisons in the State. These convict clinics make monthly reports, similarly to the regular clinics for indigent patients, and receive the same services. In this way, provision is being made for every syphilitic convict in Georgia to receive treatment for his infection.

Laboratory

Attention is called to the report of the division of laboratories for detailed account of the work done in venereal disease control. A total of 179,213 serologic examinations for syphilis were performed during 1938 in the central laboratory and two branch laboratories. Of this number, 20.2 per cent gave positive reactiona. The number of serologic examinations for 1937 was 120,526, showing an increase of 58,687 examinations, or 48.6 per cent. For 1937 there was a percentage of 18.4
positive.

Educational

Educational work is centered around the joint activities of the division of health education and the division of venereal disease control, in bringing lectures, films, literature, etc., to lay, professional, and student groups throughout Georgia.
During the year, 190 public appearances for showing of movies or
making lectures were made, with a total audience of 27,749, of which number 10,081 persons were lay, 819 professional and 17,749 student.
There were 34,709 pieces of literature distributed during the course of the year.
An important phase of the educational work was the college program, which was brought before the student bodies of nearly every college in Georgia.

Films Available: At the end of the year 1938, the Georgia Department of Public Health has available for showing upon request three

VENEREAL DISEASE CONTROL

155

venereal disease films, namelY:

"Let's Open Our. Eyes11 11Darkfield Diagnosis
"Science and Modern Medicine".

Arrangements have been made to secure 11 Three Counties Against Syphilis," the new United States Public Health Service film depicting the work of the mobile clinic operating in GlYnn, Mcintosh and Camden Counties.

Follow-Up Activities

Follow-up of delinquent patients and of contacts is done by the health officers in the counties having organized health departments, and b,r the State Department of Public Health for those counties not having organized health departments.
Delinquent patients are reported b,y private p~sicians on special cards for this purpose. At the present time, the State's activities consist chiefly in writing letters to the delinquent patients, urging the resumption of treatment.

1 9 38

Januar;r

february

I

March

8

April

~

Mq

H

1=1

June

I

Ju1;y Allgo.at

September

October

November

December

TOTALS
~
.l.!..'. \

!fEll OASES :REPORTED l!;r Month, January - December, 1938

SYPHILIS Male I female Total

916 1,130

777 1,693

97~

2,1~

1,~13

1,101 2,31~

1,37~

1,233 2,6o7

1,401

1,~79 2,7130

1, ,26

1,~63 2,589

1,509

1,37~

2,g~3

1,209 1,069 2,278

1,0130

906 1,9!!6

1,429

1,195 2,62~

1,402 1,41!! 2,820

..1..l1L ..LQ!fi_ 2.~2~ 15,167 13,735 2g,902

GONORRHI.A. !Ia e female Total

193

100

293

2~2

105

3~7

26~

103

367

309

136

445

258

123

381

237

112

3~

299

1~1

4J.lo

287

139

426

3~1

1'i3

~~

296

1?.2

~1!!

208

9~

302

~ ___i5_ _ill_

3,180 1,~23 4,603

CHAN ORO I D Male J'emale TotAl

~1

0

~1

73

0

73

66

0

66

102

1

103

78

2

80

55

0

55

~1

~

45

79

2

81

!!2

3

!!5

63

2

65

' 24
~

_ 2_

27 _]__

769

I I

19

7!!!!

STATIS!ICAL SJIIMARY OF VENEREAL DISEASE CLINIC ACTIVITIES liT lfonth, Janua17 - December, 1938

1938

"II~ W -0 L N

SYPHILIS

lfale

Female

c CAS E S REP R T E D

OONORBIIEA

CHANcroiD

Male Female Male Female

IX>SES .ARSEtUCALS GIV!N

IX>SES

SEroiDGI CAL DARKFIELD EXAMIN.A..

HEAVY ME'r- 'l:XA.IJIN.A.. ElWIIN.A.. TIONS !OR

ALS GIV'Im TIONS

TIONS

GONOOOCCI

Jan.

398

519

67

39

41

0

9,651

8,1?3

4,411

29

157

J'eb,

490

656

82

28

67

0

11,097

9,070

5,653

32

192

liar.

474

735

96

23

63

0

13,146

11,492

5,065

30

216

.Apr. lfq

470

784

85

622

991

89

30

100

44

77

1

13,755

13,017

2

18,877

13,595

5,0!!6 7,014

28 25

277 250

I

J'ane
Juq

t:;l

6oJ

901

78

37

53

0

15,437

13,552

6,6o8

678

954

73

28

4o

4

18,291

13,185

6,867

JO
6o

229 268

~

.IDeo Sept,

510

722

84

41

78

2

14,826

13,193

7.339

394

567

122

48

81

3

13,204

11,659

3.~1

32 47

219 280

I

Oct,

449

681

93

25

63

2

17,158

15,200

5.699

17

290

Nov,

730 1,024

70

27

24

3

23,144

16,821

9,719

39

231

Dec,

----58.2_ ~ __..29_

....!!L _.25... _z._ ..J.9....5QL ...!!UQL _J_.m_

--..!!a...

---15!L

TOTALS

6,l!oo 9,232 1,008

384

752

19 188,0!'l7 153,014

73.399

--------

411

2,759

.I.'J"..1.'

DIVISION OF VI~ STATISTICS
The division of vital statistics registered 33,617 death, 64,307 birth and 3,390 stillbirth certificates in 1938 as compared with 34,411 death, 64,012 birth and 3,677 stillbirth certificates in 1937.
During the period 1937-1938 registration improved both in quality and quantity. This is due in all probability to the supervision and personal contacts with local registrars by the field agent. The number of incomplete certificates received dropped from approximately 2,000 to about 250 monthlY.
Certified Copies
In 1938there were 2,357 certified copies issued, 1,476 birth and 881 death certificates respectively. In 1937 there were 1,969 certified copies issued, 1,034 birth and 935 death certificates. During 1937-1938 innumerable requests for verification of birth and death registration from welfare organizations were answered. Countless registration certificates were issued to enable children to enter school. There were approximately 55,000 registration certificates mailed to parents of babies born during this period. At the close of 1938 there were 12 counties issuing these certificates from their offices.
MonthlY Mortality Report
The division of vital statistics began issuing a monthly mortality report during 1938. This bulletin furnishes the health officer and other interested parties with recent information for the State and the individual counties.
Reallocation
During 1938 the iivision of vital statistics began reallocating births and deaths to the county of residence (with the exception of accidental deaths which are given to place of occurrence). It is felt this will prove of value in cutting down existing high rates in counties having large hospitals as well as counties having out of state cases in their hospitals.
Statistics
Birth Rate: There was a slight drop in the birth rate from 20.8 in 1937 to 20.7 for 1938, a decrease of 0.5 per cent. Georgia's birth rate remains above the average for the United States.
Maternal Mortaliti: There was a marked decreade in the maternal
mortality rate from 1 per 1,000 live births in 1937 to 6.5 in 1938,
a decrease of 12.2 per cent. The increased amount of prenatal service rendered not only resulted in this but also caused a drop in the stillbirth rate.
Stillbirths: There was a considerable reduction in the number of stillbirths recorded in 1938, a drop from 3,677 to 3,390 or a decrease in the rate of 8.2 per cent.
Infant Mortality: There was an increase in the infant mortality
159

160

VITAL STATISTICS

rate of 9.2 per cent. One would expect an increase in this rate with
such a marked decrease in the stillbirth rate. This would mean that although many mothers placed under care in prenatal clinics do not receive sufficient treatment to give birth to a normal child although they do receive enough treatment to have a living child. Another reason for this increase is the increase in deaths from diarrhea and enteritis in the rural areas, where sanitary conditions are very poor and enteric diseases were on the incline.

~hoid Fever: During 1938 Georgia had the lowest typhoid fever death rate ever recorded. The rate dropped from 4.5 to 3.9 or a decrease of 13.3 per cent.
~hus Fever: Although this disease is becoming a major health
problem in the South, the death rate dropped from 1.8 to 1.5 or a decrease of 16.7 per cent during 1938.
Malaria Fever: During 1937 malaria had the lowest death rate in the history of the State. The 1938 malaria death rate established a new low record of 4.7 or a decrease of 38.2 per cent below the 1937
figure.
Diphtheria: There was a decrease in the diphtheria rate from 35 to 3.4 or a decrease of 2.9 per cent, establishing a new all time record.

Measles: The diseases of childhood were epidemic in the State in
1938. The measles death rate increased from 0.3 to 5.1.
Scarlet Fever: The death rate for this disease remained the same
as for 1937.
Whooping-COugh: This disease was epidemic in the State during the
year 1938, the rate increasing from 4.6 to 7.3, an increase of 58.7 per
cent.
Poliomwelitis: There was a decrease in the number of deaths from
this disease from 20 in 1937 to 18 in 1938. The rate decreased from 0.7 to 0.6 or a decrease of 14.3 per cent.

Meningococcus Meningitis: There was a drop in the death rate from

this disease of 455 per cent.

Tuberculosis: There was a slight increase in the death rate from

tuberculosis from 50.3 to 52.0 or an increase of 3.4 per cent. This is

due chiefly to the fact that Georgians dying in institutions in other

States are added into the State total for 1938. This reallocation has

not been done in previous years.

lis

frSoymph4i9l6is:to

There was a decrease
478 or a decrease of

in the number
4.3 per cent.

of

deaths

from

syphi-

Cancer: There was an increase in the number of cancer deaths from

1,797 in 1937 to 1,927 in 1938, an increase in the rate 58.4 to 62.2 or

an increase of 6.5 per cent. This is to be expected with the number of

persons living to reach the older a&e groups.

Diabetes Mellitus: The death rate from this condition increased
from 12.7 to 13.5 or an increase of 6.3 per cent.
Pellagra: There was a decrease in the number of deaths from this
condition from 370 to 365 or a decrease in the rate of 1.7 per cent.
Cerebral Hemorrhage: There was a decrease in the death rate from
this condition from 85.7 to 88.0 or an increase of 2.7 per cent. Heart Disease: There was a drop of 1.5 per cent in the death rate
from heart disease in 1938.

VI~ STATISTICS

161

Pneumonia: There was a marked drop in the death rate from pneumonia. The rate was 100.0 in 1937 and 88.1 in 1938 or a drop of 11.9 per cent.
Diarrhea and Enteritis under 2 Years: There was a sharp increase in the death rate from these conditions. The greatest increase was during the gummer and in the rural areas. The rate increased from 15.6 to 22.3 or 42.9 per cent.
N!Phritis: There was a slight increase of 1.3 per cent in the death rate from this condition.
Malformation, Early Infancy Diseases: There was an increase in the
rate from this condition due chiefly to the manner in which these certificates were coded during 1938.

Automobile Accidents: There was a decrease in number from 952 to 781 deaths from this cause or a decrease in rates from 30.9 to 25.2 or 18.4 per cent.
All other Accidents: There was a decrease of 8.6 per cent in the death rate from all other accidents.
All Oausesz There was a decrease in the actual number of deaths occurring in the State during 1938 from 34,411 to 33,617, the rate decreased from 1118.5 to 1084.5 or 3.0 per cent. The most outstanding drops were in the diseases and conditions which-are preventable. This is very encouraging and every effort possible should be exerted to bring about further decreases in these death rates.

162

VITAL SfATISfiCS....TABLE1 1

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIR!'HS AND RATES PER 1,000 POPULATION, SfiLLBIRTHS, DEATHS UNDER ONE YEAR OF AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIRTHS mH THE PER CENl' INCREASE OR DECREASE IN THE RATES, IN GJOORGIA1 1937 AND 19.38

CAUSE OF DEATH
ALL CAUSES
Typhoid rever ... Typhus rever..................... Malaria rever.................... Smallpox Measles Scarlet fever 'llhooping-cough, , , , D i p h t h e r i a. . . . . . . . . . . . . . . . . . . . . . . Infiuenza........................ Dysenteey........................ Polio~elitis Lethargic encephalitis Meningococcus meningitis Tuberculosis..................... Syphilis ......................... Cancer. Diabetes lle11itus , , Pellagra......................... Cerebral hemorrhage, e~gom Heart diseases................... Pneumonia..................... Diarrhea & enteritis (-2 Irs.) Cirrhosis of liver............... Nephritis........................ llalformation & Early Inf~f{eases Suicide.......................... Homicide . . . . . . . . . . . . . . . . . . . . . . . . . Automobile accidents , All other accidents Unknown or ill-defined causes All other causes.................

NUMBER

19.38 1937

.33,617 _34,411

121
47
-146
157 13 225
106
802
192 18 10
20
1,612
478 1,929
420
365 2,727
5,246 2,731
691 141
3,531 2,431
295
582 781 1,.344 911 5,124

139 54
23-5
10 11 142 108 1,4,36
130 20
5 35
1,549
496 1,797
392 370 2,6,36
5,284 3,077
4ao
151 3,458 1,663
315
641
952 1,461 1,921 4,972

RATE 19.38 19.37

PER CENl' INCREASE
OR DECREASE

- 1~.5 lll8.5

3.0

39 1.5
-4.7
5.1 0.4
7.3 3.4 25.9 6.2 0.6
0.3
0.6
52.0 15.4 62.2
13.5 11.8 88.0
169.2 88.1
22.3 4.5
113.9 78.4
9.5
18.8
25.2 43.4 29.4
165.3

4.5 - 133

1.8 - 16.7

- -7.6 - .)8.2

o.; o.4

- +1600.0

4.6 + 58.7

35

2.9

46.7 - 44.5

4.2 + 47.6

0.7 -14.3

0.2 + 50.0

1.1 - 45.5

- so.; + 3.4

16.1

4.;

58.4 + 6.5

- 12.7 + 6.;

12.0

1.7

- 85.7 + 2.7

171.7

1.5

100.0 - 11.9

- 15.6 + 42.9

4.9

8.2

112.4 + 1.,3

54.1 + 44.9

10.2

6.9

-- 20.8

9.6

- 30.9 - 18.4

47.5

8.6

62.4 - 52.9

161.6 + 2.3

Live Births......................
Stillbirths...................... Intant llortalit;r................. llaternsl llortalit;y...............

64,;07 3,390
4,352 421

64,012
3,677 3,968
471

20.7 52.7 67.7
6.5

-- 20.8

0.5

57.4

8.2

62.0 + 9.2

7.4 - 12.2

Notet 19.38 figures exclude non-residents of Georgia and include births and deaths of Georgia residents occurring 1n other states.

VITAL STATIBriCS..TABLEa 1-A
DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIRI'HS AND RATES PER 1,000 POPULATION, STILLBIRI'HS, DEATHS UNDER ONE YEAR OF AGE. AND MATE:RNAL DEATHS WITH RATES PER 1,000 LIVE BIRI'HS, BY COLOR, IN GEORGIA1 1938

CAUSE OF DWH

NUMBER
WIIITE COLORED

RATE WHITE COLORED

ALL CAUSES

Typhoid fever........................

Typhus fever.........................

Malaria fever........................

Smallpox

Measles. .......... Scarlet fever........................ Whooping-cough, ......................

Diphtheria , , ,

Influenza............................

Dysentery ,, .................. ,

PolioJIIYelitis........................

Lethargic encephalitis

Meningococcus meningitis

Tuberculosis.........................

Syphilis

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetes Mellitus

Pellagra.............................

Cerebral Heart dis

hemorrhage, eases



emboli&~&~~.~~.i ~

Pneumonia Diarrhea & enteritis (-2 Yrs.)

Cirrhosis of liver

Nephritis............................ Malformation & Early Infana,y diseases

Suicide..............................

Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Automobile accidents

All other accidents

Unknown or ill-defined causes

All other causes.....................

18,1~
51 33
6-3
ll8 ll 112 74
u39:n3
13 6 15 602 77 1,343 3ll 170 1,465 3,059 1,321 385 100 1,996 1,289 266 131 537 772 274 2,817

15,508
70 14
8-3
39 2 ll3 32
~
85 5 4 5 1,010 4ol. 586
1~
195 1,262 2,187 1,410
306 41 1,535 1,142 29 451 .244 572 637 2,307

914.0 1,,386.7

2.6 1.7
32-
6.0 0.6
5.7
3-7 19.8
5.4 0.7 0.3 0.8 30.4
39 67.8
15.7 8.6
73.9 154.4
66.7 19.4
5.0 100.7 65.1 13.4
6.6 27.1 39.0 13.8 142.2

6.2 1.3
-7.4
35 0.2 :..o.1 2.9 J6.6 7.6 o.4 o.4 0.4 90.3 35.9 52.4 9.7 17.4 112.8 195.6 126.1 27.4
37 1373 102.1
2.6
4o.3 21.8
51.2 57.0 206.3

Live Births..........................
Stillbirths......................... Infant Mortality..................... Maternal Mortality...................

38,613 1,,386
2,267 198

25,694 2,oo4 2,085
223

19.5

23.0

35.9

78.0

58.7

81.1

5.1

8.7

Notea 1938 figures exclude non-residents of Georgia and include bi~ha and deatha of Georgia residents occurring in other states.

164

VITAL STATISTICS..TABLE1 1-B

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIRTHS AND RATES PER 1,000 POPULATION, STILLBIRTHS, DEATHS UNDER ONE YEAR OF AOE, A.'lD MATERNAL DEATHS WITH RATES PEa 1,000 LIVE BIRTHS, BY COLCR, IN OEOROIAa 1937

CAUSE OF DEATH

NUMBER \'IlliTE COLOREU

RATE WHITE COLORED

ALL CAUSES
Typhoid fever Typhus rever Malaria fever Smallpox Measles Scarlet rever Whooping-cough Diphtheria Innuenza Dysenteey Poliomyelitis Lethargic encephalitis Meningococcus meningitis Tuberculosis Syphilis Cancer Diabetes Mellitus Pellagra . Cerebral hemorrhage, emboli!ftro~ i Heart diseases ~~.~ Pneumonia
Diarrhea & enteritis (-2 Yrs. )
Cirrhosis of liver Nephritis
Malformation & Early Intana,y diseases
Suicide Homicide Automobile accidents All other accidents Unknown or ill-defined causes All other causes

18,49.3
54 4.3
-11.3 8 10
75 66
7.39 67 1.3
.3 27
559 96
1,)20 281 175
1,444 .3,1)2 1,49o
247
95
1,919 1,028
288
1.36 670 825 6:31 2,699

15,918
85
11
-122 2 1 67 42 697
6.3 7 2 8 990 4oo 477 lll 195 1,192 2,152 1,587
2:3:3
56
1,5.39
635
27
505
282 6:36 1,290 2,27:3

941.7
2.7 2.2
5.8
o.4-
0.5
).8 ).4
37.6
34 0.7 0.2 1.4 28.5 4.9 67.2 14.J 8.9
7.3.5 159.5
75.9
12.6
4.8 97.7 52.:3 14.7
6.9 )4.1 42.0 )2.1 1)7.4

14)0.6
7.6 1.0
- 11.0 0.2 0.1 6.0 3.8 62.6
5.7 0.6 0.2 0.7 89.0
35.9
42.9 10.0 17.5 107.1 19;3.4 142.6 20.9
5.0
1)8.) 57.1 2.4 45.4
25:3 57.2 115.9 204.J

Live Births Stillbirths
Infant Mortality . Maternal Mortality

J8,181
1,499
2,014
24o

25,8.31 2,178 1,954
2:31

19.4
J9.J 52.7 6.J

2).2
a4.J 75.6 8.9

mAL STATISTICS-TABLEt 2 BIRTHS AND DEATHS (exclusive of stillbirths) WITH RATES PER 1,000 POPULATION AND BIRrHS PER 100 DEATHS, IN GEORGIAt 1920-1938

NUMBER

RATE

BIRTHS

YEAR

PER 100

BIRTHS

DEATHS

BIRl'HS

DEATHS

DEATHS

1920

60,061

32,243

20.7

U.l

186

1921

66,378

29,552

22.9

10.2

225

1922 1923

65,082 63,681

31,714 34,082

22.5 22.0

1u0..s9

205 187

1924

63,386

34,797

21.8

12.0

182

1925

59,610

31,278

20.5

10.8

191

1926 1927

50,493 62,246

29,906 31,869

17.4 21.4

1u0..o3

169 195

1928

60,259

36,085

20.7

12.4

167

1929

58,521 35,34o

20.1

12.2

166

1930

60,318

35,188

20.7

12.1

171

1931

6l,n4

32,989

21.0

U.2

187

1932

63,690

32,122

21.5

10.8

198

1933 1934

60,744

31,184

20.4

10.5

64,615 35,590

21.5

u.s

195 182

1935

63,290

34,313

20.9

Uo3

184

1936

61,617

37,293

20.2

12.2

165

1937

64,012

34,4U

20.8

U.2

186

1938

64,307

33,617

20.7

10.8

191

Note& 1938 figures exclude non-residents of Georgie and include births and deaths of Georgia residents occurring 1n other states.

mAL STATISTICS-TABLEt 3
DEATHS UNDER ONE YEAR OF AGE, MATERNAL DEATHS AND STILLBIRl'HS WITH RATES PER 1,000 LIVE BIRl'HS, Ill GEORGIA& 1920-1938

NUMB Ell

RATE

YEAR INFANI' MATERNAL STILI.- INFANI' IIATmNAL STILI.MORrALITY MORTALITY BIRTHS MORTALITY 140RTALITI BIRl'HB

1920

5,305

558

3.389

88.,)

9.,)

56.4

1921

4,905

568

3,820

73.9

8.6

57.5

1922

4,937

658

.),862

75.9

10.1

59.3

1923 1924

5,384 5,674

573 '708

.),958
.),864

84.5 89.5

9.0

62.2

U.2

61.0

1925

4,7o4

641

.),455

78.9

10.8

58.0

1926

4,405

485

2,972

87.2

9.6

58.9

1927

4,578

578

3,836

73.5

9.3

61.6

1928

4.875

622

3,478

80.9

10.,)

57.7

1929

4,464

549

3,541

76.3

9.4 60.5

1930

4,713

658

3,.796

78.1

10.9

62.9

1931

4,234

616

3,678

68.5

10.0

59.5

1932

4,097

620

,),847

64.,)

9.7

60.4

1933

4,r:t79

46,)

.),700

67.2

7.6

60.9

1934

5,086

505

4,120

78.7

7.8

63.8

1935

4,316

458

3,987

68.2

7.2 63.0

1936

4,.)19

491

.),666

70.1

8.0

59.5

1937

3,968

471

3,6n

62.0

7.4

57.4

1938

4,352

421

3.390

67.7

6.5

52.7

NOTEt 1938 figures exclude non-residents ot Georgia and include births and deaths ot Georgia residents occurrir~ in other states.

166

VIUL STATISTICS-TABLEs 4

LIVE BIR!'BS !liD RATES PER 1,000 POPULATION, STILLBIRrBS AND RATES PEJ! 1,000 LIVE BIR!'HS IN EACH CCUNTI IN OEOROUo l9J7 AND 19J8

LIVE BIRrBS

STILLBIRrHS

NUMBEJ!

RATE PER l,OOC POPULATION

NUMBER

RATE PER 1,000 LIVE BIRrBS

19J8 1937 19J8 1937

19J8 1937 19J8

1937

STATE TOTAL 64,J07 64,012

Appling

320

310

Atk11111on

220

172

Bacon

196

213

Baker

208

182

Baldwin

244

272

Ballke

189

181

Barrow

260

221

Bartow

52J

48o

Ben H1.ll.......

256

261

Berrien...

J89

417

Bibb Bleckl.q
Brantlq
Brooke . Beyan

l,JSQ 197 182
531 141

1,449 221 214
5J5 1J8

Bul.loch

641

714

Burke

625

571

Butte

157

168

Calhoun

258

263

C&llldan

146

161

Candler Carroll Catoosa .. Charlton Chatham

178
748 160
ll7 2,174

200
770 229 143 2,128

Chattahoochee

177

202

Cbattooga

508

473

Cherokee

478

474

Clarke

468

514

Clq...........

136

164

Clqton

189

163

Clinch

170

lfn

Cobb

688

606

Coffee

f174

528

Colquitt

767

714

Columbia

21J

2ll

Cook. . . . . . . . . . .

266

258

Coweta

496

474

Crawford

169

192

Crisp ..........

426

J82

Dade
Dawson. . . . . . . . . Decatur........ DeXalb , Dodge . . . . . . . . . .

115 ll9 508 1,377
544

llO
87 542 1,159
514

Dool:y . . . . . . . . . .

408

419

Dougherty

477

4J4

Douglas

219

208

Ear:cy

471

450

Echola

78

65

Effinghalll

217

2J4

Elbert .........

4f:IJ

458

Emanuel . . . . . . . .

503

549

Eva~~~~ . . . . . . . . . .

1J4

151

Fannin

353

J71

20.7
22.4 27.7 25.2 24.0 10.2
17.0 18.9 19.0 18.7 2J.2
17.5 19.7 23o7 233 21.7
21.7 20.4 16.5 22.8 21.8
18.0 20.1 15-5 2J.8 20.1
18.4 JO,O 21.0 17.9 18.1
17.2 21.9 18.1 25.7 2J.l
22.1 21o3 18.7 21.9 2Jo0
2J.9 31.6 19.9 18.5 22.7
21.2 20.8 21.1 23.7 28.J
19.7 20.8 19.2 17.3 23o5

20.8
21.9 22.0 27.7 21.3 u.4
16.6 16.J 17.6 19.1 25.2
18.4 22.4 28.2 23.6 21.5
24.5 18.7 17.7 2J.4 24.2
20.4 20.9 22.5 29.5 19.7
21.1 28.2 21.1 19.7 22.0
15.0 22.0 16.1 24.0 21.7
22.2 20.9 18,0 25.2 20.8
23.2 23.3 21.4 15.7 21.7
21.9 19.0 20.3 22.9 2J.6
21.4 2J.4 21.1 19.7 25.1

J,J90
l2 10 17
8 2J
6 10 14 19 22
77 l2 ll 41 7
J5 f11 6 9 8
13
-J4
ll 105
9 19 18 31 15
ll 13 2J 28 J4
ll 22 14 l2 26
5 5 J6 52 22
28 10 10 21
2
21 21 30 13 17

J,677
22 7 9 10 19
8 7 26 19 22
95 10 10 JJ 9
48 41 18 15 4
14 50 7 4 l23
J 20 21 J2 6
6 10 Jl 20 57
15 21 25 ll 21
2 2 50 52 28
18 25 7 27 5
16 25 4J 4 13

52.7
J7.5 45.5 86.7 J8.5 94.3
31.7 J8.5 26.8 74.2 56.6
55.8 60.9 60.4 77.2 49.6
54.6 91.2 J8.2 J4.9 54.8
73.0
-45.5
94.0 48.3
50.8 J7.4 37.7 66.2 llO,J
58.2 76.5 JJ.4 48.8 44.3
51.6 82.7 28.2 71.0 61.0
43.5 42.0 70.9 37.8 4o.4
68,6 21.0 45.7 44.6 25.6
96.8 51.3 59.6 97.0 48.2

57.4
71.0 4o.7 42.3 54.9 fl/.9
44.2 3lo7 54.2 72.8 52.8
65.6 45.2 46.7 61.7 65.2
67.2 71.8 107.1 57.0 24.8
70.0 64.9 30.6 28.0 57.8
14.9 42.3 44.J 62.3 J6.6
36.8 59.2 51.2 J7,9 79.8
71.1 81.4 52.7 57.3 55.0
18.2 23.0 92o3 44.9 54.5
43.0 57.6 33o7 60.0 76.9
68.4 54.6 78.3 26.5 J5.0

nTAL STATISTIC~TABLE1 4

LIVE BIRTHS AND RATES PER 1,000 POPULATION, STILLBIRTHS AND RATES PER 1,000 LIVE BIRTHS IN EACH COUNTY IN GEOR0ll1 1937 AND 1938

LIVE BIRTHS

NU!.IBER

{lATE PER 1,000 POPULATION

1938 1937 1938 1937

SriLLBIRTHS

NUilBER

RATE PER 1,000 LIVE BI!!l'HS

1938 1937 1938 1937

Fayette

190

187 20.6 20.4

6

8 316 42.8

Floyd 1,033 l,lll 19.7 21o3

4o

62 387 55.8

Forayth

246

.)00 20.0 24.8

9

3 .)6.6 10.0

Franklin

305

.)14 17.5 18.2

16

ll 52.5 JS.O

Fulton oS,824 6,815 19.7 19.8

.)CD.

361 44.1 5.).0

Gllaer

225

214 26.5 25.6

13

4 57.8 18.7

Glascock

lll

108 23.1 22.7

6

9 54.1 83o:J

G l y n n. . . . . . . . . .

IK1J

416 19.8 20.3

22

24 5;J.8 57.7

Gordon

438

451 233 24.3

14

15 .)2.0 .333

Gred7..........

424

44.3 20.1 21.)

21

22 liM /8.7

Greene

285

314 21.9 24.2

12

12 42.1 382

Orlnnett

6.31

605 21.1 20.4

29

26 46.0 4.3.0

Haberehelll

.322

.347 22.7 24.7

ll

9 .)4.2 25.9

Hall

558

589 16.5 17.6

26

29 46.6 18.2

Hancock

.319

.324 22.7 2.32

14

15 4.3.9 46 .3

Hareleon Harris

.300
246

2m73

20.6 20.5

18.9 2.).3

8 22

10 26.7 .)6.6 19 89.4 68.6

Hart...........

.318

.)14 18.) 18.4

8

l2 25.2 382

Haard

159

182 15.6 18.1

5

3 314 16.5

Halll7 .........

355

325 20.7 19.1

19

19 535 58.5

Houston..

233

243 20.) 21.)

16

22 68.7 90.5

Irwin

.3.34

286 25.0 21.6

18

17 5;J.9 59.4

Jackson.

487

44.) 20.7 19.0

9

28 18.5 6.).2

Jasper..

191

192 21.1 21.)

9

10 47.1 52.1

Jeff Davie

2CD.

192 23.2 22.)

1.3

21

64.7 1~.4

Jeffereon

512

482 2.3.1 21.9

25

39 48.8 80.9

Jenkine

207

315 15.2 233

4

22 19.) 69.8

Johneon

295

2J5 21.4 17.2

24

22 81.4 9.).6

Jones ..

197

190 20.1 19.5

17

19 86.) 100.0

Lemar. . . . . . . . . .

187

215 18.0 20.9

16

9 85.6 41.9

Lanier Laurene

76 848

m39

1.).8 24.4

7.1 22.5

5 4.)

7 46

6so5..18

179.5 59.1

Lee

180

186 20.8 21.6

24

26 1333 139.8

Libart;r

195

182 22.7 21.4

17

13 87.2 71.4

Lincoln

165

159 18.2 17.8

5

4 .)0.) 25.2

Long . . . . . . . . . . .

62

61 14.0 1.).9

6

2 96.8 .32.8

LcRrnd.ea

7.1,5

723 22.2 22.6

4o

52 55.9 71.9

Lumpkin

125

157 23.0 29.2

4

2 J2.0 12.7

llcDuffie

231

197 2.3.9 20.6

12

ll !)1.9 55.8

Mcintosh

115

131 19.4 22.2

9

10 78.) 76.)

Macon

4o6

378 2J.) 21.8

29

28 71.4 74.1

lladieon

306

320 18.5 19.6

14

15 45.8 46.9

! ! a r i o n. . . . . . . . .

228

192 .)0.1 25.6

18

l2 78.9 62.5

Meriwether

461

487 18.9 20.2

38

25 82.4 51.)

!Iiller

197

186 19.2 18.4

17

19 86.J 102.2

Mitchell

626

607 2.).7 233

44

44 70.) 72.5

Monroe

264

254 21.1 20.5

21

13 79.5 51.2

llcntgoaeey

262

2.31 24.0 21.4

17

17 64.9 7J.6

Morgan

319

216 24.4 16.6

22

12 69.0 55.6

Murray

294

261 28.4 25.5

12

ll 4o.8 42.1

lluocogee 1,226 1,210

20.9

20.7

68

79 55.5 65.J

Newton

4o4

4o4 22.4 22.5

24

16 59.4 39.6

Oconee .

156

136 18.1 15.9

7

6 44.9 44.1

Oglethorpe

266

287 18.6 20.)

20

19 75.2 66.2

Paulding.......

261

235 18.8 17.1

12

7 46.0 29.8

168

VITAL S!.lTISTI~TABLEa 4

LIVE BIRTHS .lND RATES PER 1,000 POPUUTIOII, STILLBIRrHB .lND RATES PER 1,000 LIVE BIR'l'BS Ill E.lCB COUNTI IN GEXl!DI.la 19.37 .liiD 19.38

LIVE BIR'l'BS

NliiiBER

RATE PER 1,000 POPUL.lTIOII

19.38 19.)7 19.38 19.)7

STILLBIR'l'HB

IIDIIBER

RATE PER 1,000 LIVE BIR'l'HS

19.38 19.37 19.38 19.)7

Peach

2.)7

2.)7 22.4 22.5

19

20 80.2 84.4

Pickens ........

206

2.38 18.8 22.1

8

ll ,38.8 -'6.2

Pierce

.)02

.324 21.8 2.).7

ll

18 .)6.4 55.6

Pike ........... Polk...........

2m74

276 2.).8 24.2 599 21.2 22.)

18 2B

20 65.7 72.5 10 48.9 16.7

Pulaold.........

162

168 l6.9 17.6

6

9 .)7.0 5.).6

Put~~a~~. . . . . . . . .

217

197 2.).8 21.8

17

17 78.) 86.)

Quitman........

10.)

60 2.).0 1.).6

2

1 19.4 l6.7

Rabun. . . . . . . . . .

150

125 21.4 18.0

4

.) 26.7 24.0

Randolph

.)4o

4o.) 18,6 22.2

.)1

.)2 91.2 79.4

Richmond Rockdale Schl.e,y. . . . . . . . . Screven. ....... Sem1110l.e

1,522
154 n4
468 2o4

1,6.)0 1.)4
1.)7
-'67 2.)0

20.4
21.2 20.1 20.1 25.7

21.9 18.5 24.4 20 .)
29 .)

86

1o4 56.5 6.).8

7

7 45.5 52.2

5

1.) 4.).9 94.9

25

.).)

5.).4

70.7

ll

ll 5.).9 47.8

Spalding

456

5l2 19.1 21.5

47

41 10.).1 80.1

Stephens

2.)9

262 18.1 20.1

16

l2 66.9 45.8

Stewart........

269

2.)1 22.1 19.2

15

2.) 55.8 99.6

Swoter

551

580 19.6 20.8

19

.)1 .)4.5 5.).4

Talbot.........

2o4

171 21.) 18.1

8

19 .)9.2 lll.l

Taliaferro

165

1.)6 24.9 20.7

7

6 42.4 44.1

Tattnall .......

.322

.3-'6 19.1 20.7

19

16 59.0 -'6.2

Taylor.........

282

271 24.8 24.1

l2

17 42.6 62.7

Telre1r........

.)18

.)55 19.5 22.0

22

.)2 69.2 90.1

Terrell

414

424 21.7 22.3

.37

25 89.4 59.0

Thous

60.)

664 17.4 19.3

47

54 77.9 81.)

T1tt,

~2

-'65 2B.8 27.4

19

18 ,38.6 ,38.7

Toollbs......... Toarna ..........

.n32o7

.3.37 17.1 17.8 125 22.0 25.4

19 5

17 58.1 50.4 4 45.5 .)2.0

Treutlen

145

16.) 17.8 20.2

9

7 62.1 42.9

Troup..........

8.)4

852 21.) 22.0

-'6

46 55.2 54.0

Turner.........

242

22B 19.1 18.)

15

16 62.0 70.2

'l'w1ggs .

226

218 2.),8 2.),.:J

15

18 66.4 82.6

U n i o n. . . . . . . . . .

221

201. .)0.2 27.9

8

9 .)6.2 44,8

Upson. . . . . . . . . .

552

564 26.4 27.2

.32

.35 ss.o 62.1

Walker . . . . .

54o

52.:l 18.7 18.4

14

17 25.9 .)2.5

W a l t o n. . . . . . . . .

484

466 20.9 20,.:J

Ware . . . . . . . . . . .

~

565 19.6 20.:J

.:l2
46

.38 66.1 81.5

~

8.:Jo8

86.7

Warren.........

219

24o 17.8 19.7

7

14 .:J2.0 58 .)

Waehington ,

5-'6

5.)7 20.8 20.5

.39

.)6 71.4 67.0

Wayne ..........

.3-'6

.)67 25o1 26.9

14

14 4o.5 ,38.1

Webster........

1.)2

122 24.4 22.8

3

8 22.7 65.6

1heeler ...

202

202 19.5 19.8

9

16 44.6 79.2

11h1ta. . . . . . . . . .

160

178 22.6 25.6

3

2 18.8 ll.2

1lh1t t 1 e l d . . . . . .

551

552 2.).5 2.).9

23

19 41.7 .)4.4

W i l c o x. . . . . . . . .

277

278 19.1 19.4

14

24 50o5 86.)

Wilkes.........

.3.35

.)26 20.) 19.8

18

17 531 52.1

Wilkinson

2l6

217 18.8 19.1

10

13 46.) 59.9

Worth..........

578

502 24.6 21.7

.)6

.)1 62.:J 61.8

NOTEa 19.)8 rigurea are allocated to place or residence and exclude non-residents or
Georgia. <lnJ.T the state totals include residents or Georgia births occurring in other
states.

VITAL STATISTICS-TABLE 5

DEATHS ONDER ONE YEAR OF AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIR!'HS IN EACH COONTI IN GEORGIAI 1937 AND 1938

INFANT 140Rl'ALITI

MATERNAL 140Rl'ALIT!

NUMBER

RATE PER 1,000 LIVE BIR!'HS

NOI!BER

RATE PER 1,000 LIVE BIRTHS

1938 1937 1938 1937 1938 1937 1938 1937

STATE TOTAL

4,352 3,968 67.7 62.0

421

471

6.5

7.1.

Appling

13

11 J.o.6 35.5

Atkinson

11

3 50.0 17.1.

-1

-2

3-1

-6.5

Bacon

22

12 112.2 56.3

Baker

7

10 33.7 51..9

Baldw:l.n

18

lS 73.8 55.1

1 1 2

--2

s.1 1..8 8.2

9.1--.

Banke..........

10

11 52.9 60.8

Barrow.........

29

18 111.5 81.4

-
2

-2

11.0
- - 7.7

B a r t O i f. . . . . . . . .

1.2

39 80.3 81.3

3

1

5.7

2.1

Ben Hill....... Berrien....

20 18

17 21

78.1 1.6.3

6so5..J1.

1 3

3

3.9 u.s

1

7.7

2.1.

Bibb...........

110

122 79.7 81..2

Bleckley, ......

18

14 91.4 633

Brantlq.......

18

14 98.9 65.4

B r o o k s. . . . . . . . .

32

J.o 60.3 74.8

B e y a n. . . . . . . . . .

15

7 106.4 50.7

-8

12 1

-s.8

8.3 4.5

1

2

s.5

9.3

5 2

- - 7

9.4 13.1

14.2

Bulloch........

27

39 42.1 51..6

6

8

9.1. 11.2

Burke

37

26 59.2 45.5

4

6

6.4 10.5

Butta..........

8

12 51.0 71.4

1

1

6.4

6.0

Calhoun

14

22 51..3 83.7

Camden. . . . . . . . .

9

4 61.6 21..8

2 1

-1

7.8 6.8

-38

Candler

15

14 81..3 70.0

1

Carroll........ Catoosa........ Charlton

56

52 74.9 67.5

12 8

- - 10 75.0 43.7 68.4

--3

l
4 2

5.6 15.0

-4.0
-

5.2
17.5 14.0

Chatham........

179

157 82.3 7).8

17

21

7.8

9.9

Chattahoochee

10

11 56.5 51..5

1

Chattooga

32

29 63.0 61.3

7

Cherokee .......

27

30 56.5 633

2

Clarke .........

28

41 59.8 79.8

1

Clq...........

8

11 58.8 67.1

3

Clayton........

17

9 89.9 55.2

3

Clinch.........

12

9 70.6 533

1

Cobb . . . . . . . . . . .

41

36 59.6 59.4

Coffee .........

29

20 50.5 379

i

Colquitt .......

39

31 so.8 43.4

11

1

5.6

5.0

2 13.8

4.2

4

4.2

8.4

5

2.1

9.7

1 22.1

6.1

15.9
-- s.9

--

1

4.4

1.7

3

7.0

5.7

3 14.3

4.2

Columbia

7

8 32.9 37.9

Cook...........

21

9 78.9 )4.9

Coweta.........

18

21 363 44.3

Crawford

10

15 59.2 78.1

Crisp ..........

33

30 77.5 78.5

Dade........... Dawson......... Decatur........ DeKalb......... Dodge..........

5

6 43.5 s;..s

3

2 25.2 2).0

39

39 76.8 72.0

79

60 57.4 51.8

29

30 533 58.4

2

- 9.5

4

4 15.0 15.5

2

6

4.0 12.7

2

1 11.8

5.2

1

3

2.3

7.9

-
1

-- 8.4

--

4

3

7.9

5.5

5

11

3o6

9.5

6

s 11.0

9.7

Doo:Q' . . . . . . . . . .

19

26 1.6.6 62.1

3

1

7.4

2.4

Dougherty ,

28

28 58.7 6J..s

1

9

2.1 20.7

Douglas........

16

8 73.1 )8.5

4

1 18.3

4.8

Ear:Q'..........

28

25 59.4 55.6

5

5 10.6 11.1

Echola.........

7

4 89.7 61.5

1

2 12.8 30.8

Effingham

26

19 119.8 81.2

3

- 13.8

-

Elbert

26

28 6,).6 61.1

4

3

9.8

6.6

Emanuel

33

29 65.6 52.8

6

5 11.9

9.1

E\rans

10

9 74.6 59.6

3

3 22.4 19.9

Fannin

32

31 90.7 8,).6

1

2

2.8

5.4

170

VITAL STATISTICS..TABLEa 5

DEATHS UNDER ONE YEAR OF AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIRTHS IN EACH COUNTY IN OEORGIAa 19.37 AND 19.38

INFANT L!ORTALITY

MATERNAL MORTALITY

NUMBER

RATE PER 1,000 LIVE BIRTIIS

NUMBER

RATE PER 1,000 UVE BIRTIIS

19.38 19.37 19.38 19.37

19.38 19.37 19.38 19.37

Fayette . Floyd Forsyth Franklin FUlton
Gilmer Glascock Glynn Gordon Grady

1.3

9

66

78

13

16

ll

22

420 428

15

ll

1

6

33

28

19

20

40 36

68.4 6,3.9 52.8 36.1 61.5
66.7 9.0 80.7 43.4 94.:_!

48.1 70.2 533 70.1 62.8
51.4 55.6 67.3 44.3 81.3

-1

5.,3

5 2

-8

4.8 8.1

7.2
-

2

1

6.6

3.2

20

44

2.9

6.5

1 1

--

4.4 9.0

--

5

2 12.2

4.8

1

4

2.3

8.9

4

4

9.4

9.0

Greene .. Gwinnett Habersham Hall Hanccck
Harelson. Harris Hart Heard Heney

l!l

21

52.6 66.9

41

.35

65.0 57.9

15

19

46.6 54.8

46

40

82.4 .67.9

12

15

37.6 46.,3

10

17

3.33 62.,3

25

14 101.6 50.5

28

7

88.1 22.,3

21

12 1,32.1 65.9

21

18

59.2 55.4

2 1

-1

7.0 1.6

-,3.2

.3

1

9.3

2.9

.3

10

5.4 17.0

1

1

3.1

,3.1

-

4

- 14.7

.3

1 12.2

,3.6

.3 2

-2

9.4

12.6

-6.4

1

1

2.8

31

Houston Irwin Jackson Jasper Jeff Davie

14

9

60.1 37.0

19

12

56.9 42.0

.32

24

65.7 54.2

14

13

7.3.3 67.7

16

9

79.6 46.9

--4

.3 1 2

--17.2

12.3 3.5 4.5

.3

.3 15.7 15.6

2

1 10.0

5.2

Jefferson Jenkins
Johnson
Jones.......... Lamar . . . . . . . . . .
Lenier Laurena Lee. . . . . . . . . . . . Liberty........ Lincoln........
Long Lowndes . . . . . . . . Llllllpkl.n. . . . . . . . McDuffie Mcintosh

4,3

14

84.0 29.0

ll

14

5.31 44.4

19

11

64.4 46.8

15

1.3

76.1 68.4

14

14

74.9 65.1

6

4

78.9 102.6

a

58

71.9 74.6

16

28

88.9 150.5

17

20

87.2 109.9

8

5

48.5 ,31.4

4

.3

64.5 '8.2

47

51

65.7 70.5

10

7

80.0 44.6

19

10

82.,3 50.8

9

14

78.,3 106.9

7

.3 13.7

6.2

2

5

9.7 15.9

1

2

,3.4

8.5

1

5.3

4

1 21.4

4.7

1

- 1,3.2

-

5

7

5.9

9.0

-5
1

2
-1

- 27.8
6.1

10.8
-5.5

1

- 16.1

-

6 1

-6

8.4 8.0

-8.,3

2

1

8.7

5.1

1

1

8.7

7.6

Mecon. . . . . . . . . . Madison. . . . . . . . l l a r i o n. . . . . . . . . Meriwether Miller
Mitchell
Monroe
Montgomeey Morgan. . . . . . . . .
Murray.........

36

.32

88.7 84.7

21

13

68.6 40.6

12

1.3

52.6 67.7

.35

19

75.9 39.0

7

8

.355 4,3.0

50

50

79.9 82.4

24

17

90.9 66.9

12

21

45.8 90.9

20

15

62.7 69.4

17

17

57.8 65.1

.3

1

7.4

2.6

2

1

6.!5

,3.1

1

2

4.4 10.4

2 1

-4

4.,3 5.1

-8.2

4

5

6.4

8.2

.3

1 11.4

3.9

1

1

:_!,8

4.:_!

-4

1 2

-12.5

4.6 7.7

lluacogee Newton
Oconee Oglethorpe Paulding

71

91

57.9 75.2

36

22

89.1 54.5

14

8

89.7 58.8

19

15

71.4 52.:_!

ll

1.3

42.1 55.,3

6

15

4.9 12.4

3 1

-1

7.4 6.4

-2.5

1

3

,3.8 10.5

2

1

7.7

4.3

VITAL SUTISTICS..TABLEa 5

171

DEATHS UNDER ONE YEAR OF AGE AND IIATER!W. DEATHS mH RATES PER 1,000 LIVE BIRl'HS IN EACH COUNTY IN GEORGIA& 1937 AND 1938

INFANT UORl'ALITI

NUMBER

RATE PER 1,000 LIVE BIRl'HS

14ATERNAL MORl'ALM

NUMBD!

RATE PER 1,000 LIVE BIRl'HS

1938 1937 1938 1937 1938 1937 1938 1937

Peach Pickens Pierce P1lce
Polk

17

21 71.7 88.6

10

16 48.5 67.2

24

19 79.5 58.6

22

21 80.3 76.1

37

34 64.6 56.8

--2

3 2 2

-8.4
-

12.7 8.4
6.2

2

1

7.3

36

5

1

8.7

1.7

Pulaski Putnam Quitman Rabun

19

9 117.3 53.6

17

11 78.3 55.8

3

3 29.1 50.0

9

4 60.0 32.0

---2

- ---3

-12.3
--

--17.9

Randolph

23

19 67.6 47.1

3

2

8.8

5.0

Richmond Rockdale Schle;y Screven.. Selllinole

94

lll 61.8 68.1

15

9 97.4 67.2

6

10 52.6 7).0

31

38 66.2 81,4

8

6 )9.2 26.1

11

20

7.2 12.3

1-

2 2

-6.5 14.9 14.6

2 2

-2

4.3 9.8

4.3-

Spalding Stephens

61

43 13).8 84.0

11

14 46.0 53.4

-6

1 2

-13.2

2.0 7.6

Stewart........

21

16 78.1 69.3

1

5

3-7 21.6

Sumter Talbot

29

37 52.6 63.8

10

16 49.0 93.6

3 2

-4

5.4 9.8

-6.9

Taliaferro

13

11 78.8 80.9

1

1

6.1

7.4

Tattnall

21

12 65.2 )4.7

1

1

3.1

2.9

Taylor......... Telfair........

17

18 60.3 66.4

18

8 56.6 22.5

1 3

1s

3.5

37

9.4 14.1

Terrell

35

28 84.5 66.0

2

2

4.8

4.7

Thomas

47

49 77.9 73.8

11

13 18.2 19.6

Tirt...........

47

38 95.5 81.7

4

4

8.1

8.6

Toolllba

28

28 85.6 83.1

TOWilll ..........

3

4 27o3 32.0

-2

- - - 4

6.1 11.9

Treutlen

8

8 55,2 49.1

1

2

6.9 12.3

Troup.......... Turner... Twiggs U n i o n. . . . . . . . . . Upson..........
Walker......... Walton lare .... Warren Washington.
Wayne .......... Webster... Wheeler........ White Whitfield

75

64 89.9 75.1

22

8 90.9 35.1

20

12 88.5 55.0

20

12 90.5 59.7

41

29 74.3 51.4

28

20 51.9 38.2

31

33 64.0 70.8

31

35 56.5 61.9

20

11 91.3 45.8

37

38 67.8 70.8

29

19 83.8 51.8

10

4 75.8 32.8

9

9 44.6 44.6

15

11 93.8 61.8

s4

38 98.0 68.8

8
1-

--7
3

9.6
4.-1-

-8.2
14.9

4

1

7.2

1.8

3

- !).6

-

5

6 10.3 12.9

6 1

10 3

10.9 4.6

1u7..s7

2

1

37

1.9

-
2

4

10.9

- - - 15.2

2

2

9.9

9.9

2

3 12.5 16.9

3

6

5.4 10.9

W i l c o x. . . . . . . . .

13

13 46.9 46.8

2

1

7.2

36

Wilkes .........

10

21 29.9 64.4

4

2 11.9

6.1

Wilk1nson

12

12 55.6 553

1

1

4.6

4.6

Worth..........

49

35 84,8 69.7

6

4 10.4

8,0

NOTEa 1938 figures are allocated to place or residence and exclude no~>orea1dento or
Georgia. Onl;y the state totals include rea1dento or Georgia d;y1ng in other states.

172

VITAL STATISTICI>TABLE1 6

DEATHS AND DEATH RATES PER 1,000 POPULATION IN EACH COUNTY IN GIDROIA1 19J7 AND 19J8

STATE TOTAL
Appling ........ Atkinson... Bacon . . . . . . . . . Baker.......... Baldwin........
Banks.......... Barrow . . . . . . . . . . Bartow......... Ben Hill....... Berrien........
Bibb........... Bleckley....... Brantley . Brooks ...... Bryan..........
Bulloch........ Burke .......... Butts .......... Calhoun........ Camden. . . . . . . . .
Candler........ Carroll ........ Catoosa . Charlton Chatham . . . . . . . .
Chattahoochee Chattooga Cherokee . Clarke ......... Clay ...........
Clayton Clinch......... Cobb . . . . . . . . . . . Coffee ......... Colquitt
Columbia Cook . . . . . . . . . . . Coweta . . . . . . . . . Crawford Crisp ..........
Dade . . . . . . . . . . . Dawson Decatur........ DeKalb . . . . . . . . . Dodge ..........
Deely.......... Dougherty Douglas ........ Early .......... Echols.........
Effingham Elbert ......... Emanuel. .......
Evans .
Fannin.........

DEATHS

NU!I.BER

RATE PER
1,000 POPULATION

1938 19J7 19J8 l9J7

JJ,617 J4,4U 10.8 11.2

100

95 7.0 6.7 Fayette........

49

J5 6.2 4.5 Floyd..........

1()!

86 1J.9 11.2 Forsyth........

55

58 6.4 6.8 Franklin

197 7J7 8.2 J0.9 Fulton.........

85

8J 7.7 7.6 Gilmer.........

159 114 11.6 8.4 Glascock

265 181

251 150

9.6 1J.2

u9..o2

Glynn . . . . . . . . . . Gordon. . . . . . . . .

1J7 126 8.2 7.6 Grady..........

1,114 106 75 2J4 86

1,238 92 67
222
64

14.1 10.6 9.8 lO.J 1J.2

15.7 9.J 8.8 9.8
10.0

Greene .... Owinnett Habersham Hall ........... Hancock

225

241 7.6 8,J Haralson..

Jl7 26J lO.J 8,6 Harris.........

97 1()! 10.2 11.4 Hart ...........

99 114 8.7 10.1 Heard..........

101

79 15.1 11.9 Henry ..........

97
J29 7J 50
1,m

90
295 85
J5 1,9J7

9.8 8.'}
7.1 10.2 16.4

9.2 8,0
8.J 7.2 18.0

Houston........ Irwin.......... Jackson... Jasper......... Jeff Davis

5J

72 5.5 7.5 Jefferson

166 156 9.8 9.J Jenkins........

172 172 7.6 7.7 Johnson........

J5J 4oJ lJ.5 15.5 Jones...........

72

75 9.6 10.1 Lamar..........

119

9J 10.8 8.5 Lanier.........

66

46 8.5 6.0 Laurens...

J61 Jl6 9.5 8.4 Lee............

201

207 9.0 9.4 Liberty........

292 J21 8.8 9.8 Lincoln........

97

70 10.1 7.4 Long ...........

117

95 9.J 7.7 Lowndes

215 190 8.1 7.2 Lumpkin........

85

75 11.0 9.8 McDuffie.

2J5

227 12.7 12.4 Mcintosh

4J

42 8.9 8.9 Macon

Jl 282

18 8.2 4.8 Madison........
Jl2 n.o 12.J Marion.........

725 85J 9.7 n.s Meriwether

214 205 8.9 8.6 Miller.........

185 169 9.6 8.8 Mitchell

Jo4 :374 lJ.J 16.4 Monroe.........

95

79 9.2 7.7 Montgomery

172 19J 8.7 9.8 Morgan.........

28

17 10.2 6.2 Murrey.........

lJO 111 11.8 10.2 1!uscogee......

234 1% 11.9 10.0 Newton.........

2JJ

224 8.9 8.6 Oconee

82

75 10.6 9.8 Oglethorpe

117 141 7.8 9.5 Paulding

DE:ATHS

Nil.'IllER

RATE PER
1,000 POPULATION

1938 19J7 l9J8 19J7

91
544
5J 144
4,679

87
572 47 14o 5,118

9.9 9.5
10.4 u.o
4.J J.9 8.2 8.1
1J.5 14.8

72

68 8.5 8.1

Jl

J7 6.4 7.8

29J

279 14.2 :!.3.6

14o

lJl ";.4 7.1

200

2JO 9.5 11.0

165 125 12.7 9.6

251

2JJ 8.4 7.8

1()! 129 7.6 9.2

,:llO J50 9.2 10.5

128 109 9.1 7.8

112

94 7.7 6.5

l4J 115 11.9 9.7

l4J 109 8.2 6.4

88

67 8.6 6.7

159 149 9.J 8.8

107 109 9.J 9.5

95 134 7.1 10.1

212 197 9.0 8.5

lOJ 121 11.4 lJ.4

95

7J 10.9 8.5

2J6 162 10.6 7.4

99 lJl 7.J 9.7

%

79 7.0 5.8

98

75 10.0 7.7

127 128 12.J 12.4

38

24 6.9 4.4

4J5 46J 12.5 1J.4

112 106 lJ.O 12.J

llJ lOJ 1J.2 12.1

41

J6 4.5 4.0

JO

24 6.8 5.5

J45 414 10.7 lJ,O

47

54 8.7 10.1

120

99 12.4 lO.J

89

80 15.0 lJ.6

191 205 10.9 u.s

140 lJ2 8.5 8.1

78

79 lO.J 10.5

248 229 10.2 9.5

45

53 4,1, 5.2

241

258 9.1 9.9

14o

lJO 11.2 10.~

94

89 8.6 8.2

155 127 11.9 9.!!

86

97 8.J 9.5

8JO 865 14.2 14.8

22J 172 12.4 9.6

8J

58 9.6 6.8

128

lJJ 9.0 9.4

105

B4 7.5 6.1

VITAL SrATISTICS-TABLEa 6

173

DEATHS AND DEATH RATES PER 1,000 POPULATION IN EACH COUNTY IN GEORliAa 1937 A!m 19.)8

DEATHS

NUWlER

RATE PER 1,000
POPU TION

19.)8 1937 19.)8 1937

DEATHS

NUIIBER

RATE PER
PoPbu~oH

19.)8 1937 19.)8 1937

Peach

151 1:32 14.3 12.5 Thomas

361

473 10.4 13.7

Pickens

105

9) 9.6 8.6 Ti.ft

2)7

220 13.9 13.0

Pierce ..........

120 107 8.7 7.8 Toombs ..........

166

181 8.7 9.6

Pike ............

132 145 11.5 12.7 Towne ...........

4o

.)8 8.0 7.7

Polk............

249

226 9.2 8.4 Treutlen

62

60 7.6 7.4

Pulaski .........

116 128 12.1 13.4 Troup...........

447

527 11.4 1).6

PutJllllll . . . . . . . . . .

135 115 14,8 12.8 Turner..........

97

66 7.7 5.3

Quitman

31

35 6.9 7.9 Twiggs ..........

84

69 8.8 7.4

Rabun. . . . . . . . . . .

45

25 6.4 36 Union...........

61

61 8.3 8.5

Randolph

156 157 8.5 8.6 Upson...........

245

220 11.7 10.6

Richmond 1,076 1,)14 14.4 17.7 Welker..........

216

195 7.5 6.8

Rockdale

77

81 10.6 11.2 Walton..........

219

23) 9.5 10.2

Schley..........

65

46 11.5 8.2 Ware.

295

.)87 10.5 1).9

Screven...

217

202 9.3 8.8 Warren

113

lo4 9.2 8.5

Seminole

6)

61 7.9 7.8 Washington

272

265 10,3 10.1

Spalding........

358 )4o 15.0 14.) w81llll...........

116

98 8.4 7.2

Stephens

109

lo4 8.2 8.0 Webster.........

46

50 8.5 9.)

Stewart.........

120 132 9.8 10.9 Whee1er.. ..

67

70 6.5 6.9

Sumter..........

291

366 10.4 13.1 White...........

6)

65 8.9 9.3

Talbot

95 113 9.9 12.0 Whitfield

244

256 10.4 11.1

Taliaferrc Tattnall Taylor Telfair Terrell

71

6) 10.7 9.6 Wilcox..........

115

81 6.8 4.8 Wilkes

96

102 8.5 9.1 Wilkinson,

160 118 9.8 7.3 Worth...........

215 205 11.3 10.8

86

87 5.9 6.1

161

188 9.7 11.4

114

101 9.9 8.9

237

202 10.1 8.7

NOTEa 19.)8 figures are allocated to place of residence and exclude non-residents of Georgia. On1 the state totals include residents of Georgia dying in other states.

BIRl'H AND DEATH RATES PER 1,000 POPULATION IN GECRGIAa 1920-19.)8 24r-------------------------------------------------------~

__ /-------- DEATHS

,.,..,

........ .......... ___ ..._,...,....,

_,......_,.-, ..._

NOTEa The decline in the birth and death rates for 1926 is due to incomplete registration.

174

VITAL STATISTICS-TABLEt 7

DEATHS AND DEATH RATES PER 100,000 POPULATION FllOM TYPHOID AND MALARU IN EACH COUNTY IN OEXlROIAa 19J7 AND 19.')8

TYPHOID

NUIIBER

RATE PD! 100,000 POPULATION

IIALARU

!MIBD!

RATE PD! 100,000 POPULATION

19.')8

19J7

19.')8

19J7

19.')8

19J7

19.')8

19J7

STATE Tar.AL

121

1J9

J.9

4.5

146

2J5

4.7

7.6

Appling Atkinson

1

1

7.0

7.1

Bacon

2

1

25.7

lJ,O

1

12.9

Baker

1

2

U.6

2J.4

1

J

U.6

J5.1

Baldwin

2

8.4

1

4.2

Banks
Barrow Bartow Ben Hill Berrien

1

9.1

1

1

J.6

J.7

4

29.J

l

l

6.0

2

7.J 14.7

l

6.1

Bibb

4

J

5.1

J.S

4

4

5.1

5.1

Bleckley

l

l

10.0 10.1

Brantley

l

1J.2

Brooks

2

5

8.8 22.1

Br:yan

1

15.6

l

l

15.4 15.6

Bulloch

2

6.8

J

10.2

Burke

J

l

9.8

J.J

5

9 16.J 29.5

Butta

Calhoun

1

8.8

Calllden

J

1 26.5

8.9

l

5 15.0 75.)

Candler .

l

10.2

Carroll

4

2 10.8

5.4

l

2

2.7

5.4

Catoosa

Charlton

Chatham

2

5

1.9

4.6

l

lJ

0.9 12.1

Chattahoochee

Chattooga

l

6.0

Cherokee Clarke

J l

5 J

1).2 ).8

u22..sJ

Clay

l

lJ.J

Clayton

l

9.2

Clinch

1

12.9

l

2 12.9 26.1

Cobb

l

2.6

l

2

2.6

5.J

Coffee

l

4.5

2

2

9.0

9.1

Colquitt

2

2

6.0

6.1

5

15.2

Columbia

l

10.5

2

21.0

Cook .

l

8.1

l

l

8.0

8.1

Coweta

2

l

7.5

).8

Crawford

l

l

1).0 lJ.l

2

26.2

Crisp

l

l

5.4

5.4

2

2 10.8 10.9

Dade

Dawson

Decatur DeKalb

l

).9

l

J

).9 u.s

l

1.4

Dodge

2

S.J

4

2 16.7

8.4

Dooly

2

4 10.4 20.9

2

2 10.4 10.4

Dougherty

l

4.4

2

6

8.7 26.2

Douglas

J

28.9

Early

2

10.2

2

J

10.1 15.)

Echola

Effingham .

l

9.1

2

18.)

Elbert

l

l

5.1

5.1

Emanuel

l

l

).8

J.9

J

6

u.4

2).1

Evans .

J

1 .')8.7 lJ,O

l

12.9

Fannin

1

1

6.7

6.8

VITAL STATISTICS-TABLE 7

175

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM TYPHOID AND MALARIA IN EACH COUNTY IN GEOROIA1 1937 AND 1938

TYPHOID

MALARIA

NUMBER

RATE PER 100,000 POPULATION

lll1loiBER

RATE PER 100,000 POPULATION

1938 1937 1938 19.37 1938 19.37 1938

1937

Fayette Floyd . Forsyth Franklin Fulton.........
Qllmer.. Glascock Glynn.......... Gordon......... Grady..........
Greene .. Clwinnett Hsberahalll Hsll. .......... Hsncock........
Haralson Harris Hart ........... Heard Henr:y ..........
Houston........ Irwin.......... Jackson........ Jasper......... Jeff Davia.....
J e f f e r s o n. . . . . . Jenkins ........ Johnson........ Jones ........ Lamar..........
Lanier......... Laurens Lee............ Liberty........ Lincoln........
Long ........... Lowndes . . . . . . . . Lumpkin........ !!cDuff1e....... Mcintosh
Macon M a d i s o n. . . . . . . . ! . ! a r i o n. . . . . . . . . Meriwether.. Miller
Mitchell....... Monroe !lontgomeey Morgan......... Murray.........
Muecogee Newton. . . . . . . . . Oconee .. Oglethorpe Paulding.......

1

10.8

.3

5.8

1

1

5.7

5.8

1

5.7

.3

5

0.9

1.5

2

0.6

1

20.8

1

5.4

4

2

19.0

9.6

5

38.4

1

_3.4

2

14.1

2

6.0

.3

21.5

1

34

2

14 .3

1

6.9

2

11.5

1

9.9

2

11.8

5

1 4

-4_3.7

8.7 JO.J

4

1

_34.9

8.7

1

7.6

1

1

4 .3

4 .3

1

2

4._3

8.6

2

23.0

1

11.5

1

1

4.5

4.5

1

7.4

1

5

7.3 .37.0

1

7 .3

4

2

:8.0 14.7

1

10.3

1

2

9.6 19.4

3

28.9

1

18.2

1

4

2.9 11.6

7

6

20.1 17.4

1

4 11.6 46.5

4

46.5

1

3

11.7 .352

1

4

J,l

12.5

.3

6

9.3 18.8

1

10.4

2

20.9

2

.3.3.9

2

2 11.5 11.5

.3

.3

17.2 17.3

1

4.1

1

1

4.1

4.1

1

1

9.8

9.9

1

_3.8

3

5

11.4 19.2

1

8.1

1

4

9.2 _37.0

2

1

18._3

9.2

2

1 15.3

7.7

2

19.6

2

1

_3.4

1.7

1

4

1.7

6.8

1

1

5.5

5.6

2

14.0

176

VITAL STWSTICS-TABLEa 7

DEATHS AIID DEATH RI.TES PER 100,000 POPIJLATION FRal TYPHOID .&liD IW.ARU IN EACH COONI'I IN OEOROUa 1937 AIID 19,38

TIPHOID

NUJIBER

RI.TE PEH 100,000 POPULATION

19.38 1937 19.38 1937

IW.ARU

NUIIBEH

RATE PER 100,000 POPULATION

19.38

1937 19.38 1937

Peach.

1

9.5

1

2

9.5 19.0

Pickens........

1

J

9.1 27.8

Pierce ......... Pike...........

1

7.3

1

8.8

1

7.J

Pollc. . . . . . . . . . .

1

J,7

Pulaak1........

Putnam. . . . . . . . .

2

Quitlllall. . . . . . . .

Rabun. . . . . . . . . .

Randolph

1

22.0 5.5

1

2 10.4 21.0

2

11.0

Richmond

4

4

5.4

5.4

.3

.3

4.0

4.0

Rockdale.......

1

1 1,3.8 1,3.8

Schley.........

1

1 17.7 17.8

1

17.7

Screven..

1

4.J

4

8 17.2 ,34.9

Seminole

1

2 12.6 25.4

Spalding

1

.3

4.2 12.6

2

8.4

Stepheno

Stewart........

2

16.4

1

5

8.2 41.5

Sumter.........

1

,3.6

.3

4 10.7 14.,3

Talbot .........

1

10.6

1

10.4

Taliaferro

Tattnall T a y l o r. . . . . . . . .

1

4

5.9 2,3.9

Telfair........

1

6.2

2

4 12.,3 24.8

Terrell........

1

5.2

5

4 26.2 21.1

Th.omaa

1

2.9

15

4,3.6

Tift ...........

.3

1 17.6

5.9

2

5 11.7 29.5

Toombs . . . . . . . . .

1

4

5.2 21.2

2

6 10.4 31.7

Towne

Treutlen

1

12.3

Troup

1

1

2.6

2.6

Turner.........

1

1

7.9

8.0

3

2 23.7 16.0

Twiggo . . . . . . . . .

1

10.5

1

10.5

Union..........

Upaon. . . . . . . . . .

1

4.8

Wallrer . . . . . . . . .

1

35

Walton

1

4.3

lare .........

1

1

,3.6

,3.6

2

8.7

Warren. . . . . . . . .

Waehington

4

.3 15.2 11.5

5

.3 19.0 11.5

Wayne . . . . . . . . . .

1

7.,3

2

1 14.5

7.,3

Webster

1

1 18.5 18.7

11hee1er. . . . . . . . White..........

2

19.6

1

1

9.7

9.8

Whitfield ......

1

1

4.,3

4.3

1

4.3

WUcox. . . . . . . . .

1

7.0

W1lkeo . . . . . . . . .

1

6.0

W11k1noon

1

8.7

Worth . . . . . . . . . .

2

4

8.5 17.3

4

2 17.0

8.6

NOTEa 19.38 fl.gures are allocated to place of residence and exclude non-reoidento of Georgia. Onl.7 the otate totalo include resider'>s of Georgia dying 1n other states.

VITAL STATISTICB-TABLEo 8

177

DEATHS AND DEATH RATES PER 100,000 POPULATION FROI4 TUBERCULOSIS AND CANCER IN EACH CCUNTI IN OEOROIA& 1937 AND 1938

TUBERCULOSIS

CANCER

NUMBER

RATE PER 100,000 POPULATION

NUMBER

RATE PER 100,000 POPULATION

1938 1937 1938 1937 1938 1937 1938

1937

STATE TOTAL
Appling Atkinson, Bacon Baker..... Baldwin ,
Banks Barrow . . . . . . B a r t o w. . . . . . . . . Ben Hill....... B e r r i e n. . . . . . . .

1,.612
1 l 1 2 19
3 4 14 7 5

1,549
3 2 2 2 84
15 2
15 3 2

52.0
7.0 12.6 12.9 2Jol 79.2
27.0 29.2 50.8 !)l,O 29.8

50o3
21.2 25.6 26.0 23.4 352.1
137.2 14.7 55.0 22.0 12.1

1,929 1,797

-2
7

--4

6

3

17

14

2

3

10

5

16

ll

10

12

10

8

62.2
-14.0
90.0 69.3 70.9
18.0 72.9 58.1 72.9 59.6

58.4
--28.2
35.1 58-7
27.4 J6.9 4o.3 88.0 48.4

Bibb........... B l e c k l e ; r. . . . . . . Brantlq....... Brooks......... B r y a n. . . . . . . . . .
B u l l o c h. . . . . . . . Burke Butta.......... C a l h m m. . . . . . . . Camden. . . . . . . . .
Candler........ Carroll........ Catoosa Charlton Chatham
Chattahoochee Chattooga Cherokee ....... Clarke Clq...........
C l q t o n. . . . . . . . C l i n c h. . . . . . . . . Cobb Coffee Colquitt
Columbia Cook. . . . . . . . . . . Coweta......... Crawford, Crisp
Dade . . . . . . . . . . . Dawson. . . . . . . . . Decatur........ DeKalb......... Dodge
Doozy.......... Doughertf Douglas........ Earzy.......... Echola.........
Effingham Elbert banual ........ Evans . . . . . . . . . . Fannin

58

59 7J.4 74.9

-2

- - - 5 20.0 50.6

2

6

8.8 26.5

2

2 .30.8 Jl.l

10

10 33.8 34.3

15

19 49.0 62.4

2

1 21.0 10.5

-.3

- - 8

26.5

- 71.2

6

.3 60.6 J0,6

1.3

6 .35.0 16.3

no-6

- - - 6 58.2 58.8
120 101.8 lll.J

-2

20.9

ll

ll 64.9 65.7

7

6 .30.8 26.8

17

2.3 65.2 88.4

1

1 lJoJ 1.3.4

7 4

- - 2 6.3.8 18.4 51.6

27

18 71.2 47.9

5

2 22.4

9.1

6

ll 18.1 .3.3.4

5

5 52.0 52.5

8

.3 6.3.9 24.3

1.3

.3 48.9 u.4

1

.3 13.0 39.3

10

13 54.1 70.8

5 1

-2 103.9 26.6

-42.3

8

8 31.3 J1.6

36 4

- - .34 48.4 46.0 16.7

4

8 20.7 41.8

19

ll 82.8 48.1

6

6 57.8 ss.4

-10

- - - 9 50.4 45.8

10

2 90.7 18.3

6

4 30,5 20.5

4

1 15.3

39

2

1 25.8 13.0

5

5 33.3 339

66

72

7

5

3

4

7 5

-9

1.3

10

16

6

4

12

i6 1

2

1

2.3

14

-4

.3 2

99

ll2

-6

12

7

ll

1.3

25

25

4

4

8

4

1

1

22

18

15

8

ll

17

4-

8

3

ll
3

-8

8

10

3

5

2

2

9

14

59

78

ll

9

9

6

20

19

7

4

5 2

-5

2

2

16

9

12

ll

4

3

6

4

83.5 70.1 J9.0 30.7 77.0
44.0 52.2 42.1 26.5 59.8
20.2 61.9
-38.8
91.6
-
70.8 48.4 95.8 5.32
72.9 12.9 58.0 67.2 .3.3.1
41.6 6.3.9 41.4 389 4.3.2
62 .3 53.1 35.2 79 .3 45.8
46.6 87.2 67.5 25.2 72.7
18.1 81.3 45.8 51.6 4o.o

91.3 50.6 52.7
-J9.7
.34.3 19.7 126.4 5.3.4 15.1
10.2 38.0 29.4 41.2 10.3.9
62.8 41.8 58.0 96.1 5.3.7
J6.7 1.3.0 47.9 )6.4 51.7
24 .3
-.30-3
54.5
105.6 53.6 55.3
105.5 .37-9
313 8.3.1 J9.0
-25.5
18.3 46.1 42.4 J9.l 27.1

17S

mAL 8TJ.TISTICS-TABLEa 8

<DEATHS .AND DEJ.TH RATES PER 100,000 PCPULATIOII FROM TUBERCULOSIS .AND C.ANCE2! Ill EACH COUN'l'I IN GEX>IlOIJ.a 1937 .AND 1938

TUBERCULOSIS

C.ANCER

NUidBER

RATE PER 100,000 POPULATION

IIUIIBm

RATE PER 100,000 POPULATION

1938 1937 1938 1937 1938 1937 1938

1937

Fayette Floyd . . . . . . . . . . Forsyth........ Franklin. Fulton.........
Gilmer......... Glascock,,,,,,, Glynn. . . . . . . . . . Gordon. . . . . . . . . Grady..........
Oreene Gwinnett , Habersharl Hall ........... Hancock........
Haralson,,,,,,, Barrie ......... Hart........... Heard .......... Henry..........
Houston Irwin.......... Jackson... Jasper......... Jeff Davie.....
Jefferson. Jenkins........ Johnson. Jones .. Lamer
Lanier,,, Laurens Lee . . . . . . . . . . . . Liberty,,,,,,,, Lincoln...... :.
Long ........... Lowndes ........ Lllllpkin. . . . . . . . llcllui'f1e., , llclntoah
Macon Madison. . . . . . . . llar1on......... ller1wether lliller.........
111tche11 Monroe llontgome17 llorgan......... llurray.........
Muscogee Newton . . . . . . . . . Oconee Oglethorpe , Paulding ,,

3

2 32.5 21.8

9

6

97.5 65.5

-1,6

.34
l

-87.6

65.3 8.,3

38

33

72o3 63.4

l

2

8.1 16.6

4

3 22.9 17.4

4

7

22.9 4o.5

.349

316 100.8 91.7

337 367

97.4 106.5

2

2 23.5 2.).9

4

2

47.1 23.9

l

l

20.8 21.0

l

l

20.8 21.0

8

5 38.8 24.4

19

14

92.2 68.4

8

3 42.5 16.1

7

6

37.2 32.3

7

8 33.2 38.4

3

13

14.2 62.4

8

2 61.4 15.4

14

6 107.5 J.6.)

lS

7 SQ.l 2.).6

ll

12

36.7 4o.4

2 8

12 14.1 8S.s 14 2.).6 41.9

4 22

'19

28.2 65.0

.)5.6 56.8

'

5 .)5.5 .)5.8

4

5

28.4 .)5.8

5

l

_34 .)

6.9

9

.:l

61.7 20.8

7

3 58.3 25.2

ll

6

91.6 so.4

2

3 u.s 17.6

8

8

J.6.l J.6.9

.:l

2 29.4 19.9

4

5

393 49.7

2

7 11.7 41.2

10

6

58.4 353

l

4

8.7 35.0

3

6

26.2 52.5

l

5

7.5 37.8

4

4

29.9 303

.s:l

7 12.8 30.1 4 55.1 44.4

lS

13

6.).9 55.9

6

6

66.1 66.6

.:l

l

_34.6 11.6

4

l

J.6.l 11.6

ll 6

6 49.6 Zf,.)

7

44.1

51.8

-l l

8 5

-49.6

363 37.0

2 10

6 14.5 6 101.8

44.0 61.7

l

7

21.8 51.3

2

4o.7 20.6

8

.:l 77.2 29.2

7

10

67.5 97.2

-
14 2 3

--

12 4o.2 _34.7

l

2.).1 35.0

_34.9 J.6.9

2 16
5

2 14
4

36.4 J.6.o 57.9

346o..s6 J.6.s

.:l

l

35.0 11.7

l

2 u.o 22.4

.:l

2

3.).1 22.4

2

3 4S.:l 68.3

--

ll

21 _34.1 65.7

16

19

49.6 59.4

l 8

2
s

18.4 82.8

373 52.2

3

6

55.2 lll.8

3

5

31.1 52.2

5

3 84.5 50.8

6

l

101.4 16.9

ll

9 63.0 51.9

ll

6

63.0 34.6

2

3 12.1 18.4

7

ll

42.4 67.4

l

3 13.2 4o.o

6

4

79.3 5J.4

10 l

-10

41.0 9.8

-41.4

17

17

69.8 70.4

3

3

29.J 29.7

ss
2

4 18.9 15.3

17

12

64.4 46.0

-8

)9.9 18.3

-64.4

8 4

7

63.8 56.4

6

36.6 55.5

.3

3 2.3.0 2J.l

7

7

5J,6 5J.9

4

7 38.6 68.4

9

6

86.8 58.7

57 10

1,6 7

9ss7..s4

78.8 ,39.0

44

JS

75.2 59.9

ll

5

61.0 Zf,9

2 2

ls

2J.2 14.0

11.7 35.4

J

2

_34.7 2J.J

5

10

35.0 70.8

5

l 35.9

7.3

12

7

86.2 51.0

VITAL STATIBTIC8-TABLEa 8

179

DEATHS AND DElTH RATES PEJ! 100,000 POPULATION FROU TUBEJ!CULOSIS AND CANCEJ! IN EACH COUNTY IN GEX>ROIAa 19J7 AND 19J8

TUBEJ!CULOSIS

CANCER

NUJIBEJ!

RATE PEJ! 100,000 POPULATION

NUIIBER

RATE PEJ! 100,000 POPULATION

19.38 19.37 19.38 19J7 19J8 19J7 19.38 19J7

Peach

7

Pickens

2

Pierce

J

Pike

7

Polk...........

lS

2 66.2 19.0

10

9 94.6 85.4

4 18.J J7o1

10

5 91.4 ~-J

J 21.7 21.9

2

2 l4.s 14.6

5 60.8 4J.8

ll

12 95.6 105.0

9 55.5 J3.6

15

ll 55.S 41.0

Pulasld Putllalll. . . . . . . . . Quitman. . . . . . . .
Rabun. . . . . . . . . . Randolph

4

4 41.7 42.0

7

-J
J

9
-2

-J2.9
42.8

99.8
-45.4

10
2 2

8

4 4J.7 22.0

9

s2 72.9 109.8

2ss1..40

J

44.6

68.1

3 28.5 4J.J

8 49.2 44.0

Richmond Rockdale
Schlll7 0 0 0 0 0 0 0. Screven.... Seminole

66

75 88.5 100.8

sa

4 7

-5 55.1 12_3.7

-68.9

6 5

-ll

- - - 7 47.2 30.5

ll 3

7J 77.8 98.2

J

82.6

4l.J

l

88.3 17.8

9 47.2 J9.2

2 J7.9 25.4

Spald1ng

l8

l6 75.4 67.2

26

12 109.0 so.4

Stephens

J

7 22.7 53.7

7

4 52.9 J0.7

Stewart Sumter.........

2

6 16.4 49.8

4

5 J2.8 41.5

4

13

14.3

~.6

15

l6 53.5 57.3

Talbot .........

l

5 10.4 52.9

8

5 8J.4 52.9

Taliaferro Tattnall Taylor Telfair Terrell

4 2

2 2

60.4
u.s

JO.S 12.0

5 7

l
5 7

-4 s

8.8 J0.7 _36,7

-35.5
26.J

6 9 7

l

75.6 15.2

4 41.4 23.9

l

52.9

8.9

4 55.2 24.8

8 J6.7 42.1

Thomas

9

5 26.0 14.5

lS

25 43.J 72.6

Tift

7

9 41.0 5J.O

8

7

~.8

4l.J

Toombs . . . . . . . . .

2

7 10.4 J7.0

8

8 41.8 42.3

Towns. . . . . . . . . .

2

l 4o.o 20.3

2

l 4o.o 20.3

Treutlen

.3

l

)6.8 12.4

2

l

24.s 12.4

Troup.......... Turner

21 2

-27

53.7 15.8

-69.6

25 5

27 5

63.9 )9.5

69.6
4o.o

Twiggs

l

l

10.5 10.7

4

2 42.1 21.J

Union. . . . . . . . . .

l

2 lJ.7 27.8

l

2 1.3.7 27.8

Upson

ll

9 52.7 4J.5

5

10 24.0 4s.J

Walker . . . . . . . . .

21

12 72.9 42.1

16

20 55.S 70.2

Walton

ll

8 47.5 J4.9

ll

9 47.5 J9,J

Wars . . . . . . . . . . .

14

10 49.9 JS.9

ll

22 )9.2 78.9

Warren

2

4 l6.J J2.9

8

7 65.0 57.5

Waehington

7

J

26.6

11.5

18

17 68.4 65.0

Wayne . . . . . . . . . . Webster ..

-J

4 J

-21.7

29.J 56.0

4 J

-2

29.0 55.S

-14.6

Wheeler........

l

3

9.7 29.4

2

5 l9.J 49.1

White . . . . . . . . . .

l

l

14.1 14.4

4

l

56.5 14.4

Whitfield

19

21 81.2 91.0

16

10 68.4 43.J

Wilcox......... Wilkes . . . . . . . . .

-l

- 7.0

.3

5

6 .30.2 J6.4

17

5 20.7 6 102.8

J4,9 J6.4

Wilkinson

6

l

52.J

8.8

6

J

52.3 26.J

Worth. . . . . . . . . .

9

10 JB.J 43.1

6

2 25.6

8.6

NOTEa l9J8 figures are allocated to place of residence end exolude non-residents of Georgia. Only the state totals include residents of Georgia dying 1n other states.

180

VITAL STATISTICS-TABLE 9

DEATHS AND DEATH RATES PER 100,000 POPULATION niOU PELLAGRA AND PNEUMONIA IN EACH COUNTI IN GEOROUa 19.37 AND 19.38

PELLACHA

PNEUIIONU

NUMBER

RATE PER 100,000 POPULATION

NUMBER

RATE PER 100,000 POPULATION

19.38 19.37 1?.38 19.37

19.38 19.37 19.38 19.37

STATE TOTAL
Appling . Atkinson
Bacon
Baker Baldwin
Banke . . . . . . . . . . Barrow Bartaar Ben Hill Berrien
Bibb........... Blackley Brentley Brooks .. Bryen
Bulloch Burke Butta Calhoun........ Camden
Candler Carroll Catoosa... Charlton....... Chatham
Chattahoochee Chattooga Cherokee Clarke Clq
Clqton........ Clinch Cobb . . . . . . . . . . . Coffee Colquitt
Columbia Cook Coweta Crawford Cr1ap . . . . . . . . . .
Dade Dawson Decatur Delralb. . . . . . . . . Dodge . . . . . . . . . .
Dooly Dougherty Douglaa Early.......... Echola.........
Effingham Elbert Emanuel Evans Fannin.

.365

.370 u.s 12.0 2,7.31 .),077 88.1 100.0

--4

---1

--
- 51.4

---7.1

17
5 6
7

8 118.9 3 63.0 6 77.1 7 80.9

56.4 .)8.4
78.0 81.9

3

6 12.5 25.1

17

85 70.9 356-3

---

5

5 45.0 45.7

1

2

1.3 14.7

9

9 65.6 66.4

-1
1

3
1-

-3.6
6.0

ll.O
-1.3

29 18 10

30 105.2 109.9 19 131.2 1)9.4 15 59.6 90.8

16

14 20.2 17.8

84

107 106.2 135.8

3

1 30.0 10.1

13

7 130.1 70.8

2

1 26.0 13.2

8

4 lo4.1 52.7

-3

-1

- 1.).1

-4.4

19 6

9 83.2 )9.7 9 92.4 140.0

.3

2 10.2

6.9

17

15 57.5 51.4

.3

3

9.8

9.8

31

35 101.2 114.9

-2
3

1
1-

-21.0
44.9

10.5
-8.9

12 9 5

6 126.2 63.2 11 79.4 97.8
9 74.8 135-5

- - -- 9

6 90.9 61.3

7
-1

1 18.8
-- -9.7

--2.7

19 4
2

16 51.1 43.5 6 .)8.8 58.8
1 4o.7 20.6

23

21 21.3 19.5

119

145 110.1 1.)4.5

---
3 1

1 2 1
-6

u.s---
13.3

10.5 ll.9 4.5
-23.1

J 17 17 30 9

16 31.1 167.5 12 100.3 71.6 18 74.7 80.3
27 115.0 103.7 15 119.7 201.3

-3

1 1

-21.3

9.2 13.0

8 5

5 72.9 45.9 3 64.5 )9.1

1 4

-7

2.6 17.9

-18.6

31 16

J4 81.8 90.4
24 71.7 109.1

2

1

6.0

3.0

28

31 84.3 94.2

2

1 20.8 10.5

4

7 41.6 1).5

2

1 16.0

8.1

14

7 111.9 56.6

1

2

3.8

7.6

26

16 97.9 60.6

-1

1 1

-13.0

13.1 5.4

7 18

5 90.8 65.5 26 97.3 141.6

1 1

--

20.8 26.6

--

3 1

- 62.3 - 26.6

--

4

1 15.6

3.9

27

19 105.6 75.0

6

6

8.1

8.1

49

85 65.9 115.0

2

1

8.3

4.2

25

14 lo4.1 59.0

-

5

- 26.1

23

27 119.2 141.1

3

9 13.1 )9.4

23

29 100.3 126.8

1

1

9.6

9.7

9

4 86.7 )9.0

1 2

-4

5.0 72.7

-20.4

-26

- 27 131.1 1375

1

.)6.4

3 2

27.2
-- 10.2

-8

7 72.6 64.1

24

22 121.9 112.6

1

4

3.8 15.4

16

12 61.0 46.2

-1

- - - 1 12.9 13.0

3 12

10 .)8.7 130.3 19 79.9 128.7

VITAL BrATISTICS..TABLE1 9

181

DEATHS AND DEATH RATES PER 100,000 POPULATION FRal PELLAGRA AND P6EOIIONIA IN EACH COU!rl'I Ill GEORQUa 19.37 AND 19.38

PELLAGRA

PIIQJIIONU

liUJIBDi.

RATE PER 100,000 POPUL!TICN

liUJIBEJI

RATE PEJI 100,000 POPULATION

1938 1937 19.38 19J7

1938

19.37 19J8

1937

Fayette Floyd . Foreyth :. Fl-anklin Fulton
Gilmer Glascock Glynn Gordon Grady

.3

1 .32.5 10.9

6

5 65.0 54.6

6 1 2

--8

11.4 8.1
11.4

-15.4

49 2
15

69 9.3.3 1.32.5 10 16.3 82.8
5 85.9 28.9

.34

51

9.8 14.8

~

502 117.9 145.6

-1

-1 u.s- 12.0

-5

7 2

-58.8

8.3.7 42.0

7

5 .)4.0 24.4

15

28 72.8 1.)6.8

.3

2 15.9 10.8

12

16 6.).8 86.1

2

4

9.5 19.2

19

24 90.2 115.1

Greene Gwinnett Habersham Hell Hancock
Haralson llerria. Hart . Heard . Heney
Houston Indn Jackson Jai!IJ'er Jeff Dsvia

.3

2 2.3.0 15.4

11

12 84.5 92.5

-2

1 1

-6.7

.).4 7.1

17 14

l6 56.8 5.).9 8 98.5 57.0

1

.3

J.O

9.0

24

27 70.9 80.8

.3

2 2lo.3 14.3

5

4 .)5.5 28.7

- - --

7

7 48.0 48.6

2

5 16.6 42.0

8

12 66.6 100.8

.3 1

-1

17.3 9.8

-5.9

l6 2

8 92oJ 46.9 8 19.6 79.5

2

1 11.7

5.9

9

10 52.6 58.9

----

7

.3

61.1

26.2

2

.3 15.0 22.7

15

19 1l2.J 14.).7

2

2

8.5

8.6

19

9 80.9 J8.7

-.3

- - - 4 .3.31 44.4

7 1.3

5 77.2 55.5 11 149.8 127.7

Jefferson
Jenkins Johnson Jones Lamar

-

1

- 4.5

12

1.3 54.1 59.1

-5
2

--2

.367 20.4

--14.8

10 12
6

7

7.35

51.8

6 87.1 44.0

4 61.1 41.1

1

1

9.6

9.7

5

9 48.2 87.5

Lanier

----

.3

4

54.6

7.3.3

Laurena Lee

-12

- - - 4 .)4.5 11.6

4o 12

.39 115.0 1l2.9 22 1J8.9 255.7

Liberty Lincoln

2 1

-2

2.3.3

11.0

-2.3.5

5 1

4

58.3

46.9

.3 11.0 .3.37

Long

1

1 22.6 22.8

2

1 45.3 22.8

Lowndes Lumpkin. . . . . . . . McDuffie llcintoah

---2

5 1
2 1

-6.2
--

15.6 18.6 20.9 16.9

19
5 10
7

27 58.9 84.5

8

92.1 149.0

4 10.3.5 41.8

.3 118.2 50.8

llacon.......... l l a d i a o n. . . . . . . . llarlon......... Meriwether IIUler

--4

-4
.3

-- 22.9

-2_3,0
4o.o

17
1.3 11

2l 97.4 121.0 ll 78.7 67.4 11 145.3 146.8

-2

- - - 2

8.2

8 .3

2.3 2

2l 94.4 87.0 6 19.5 59.4

111tche11 Monroe

2 4

-1

7.6 .31.9

-.).8

18 10

24 68.2 92.1
7 79.8 56.4

MontgomeJ:7

1

1

9.2

9.2

8

5

7.32

46.2

Morgan. . . . . . . . .

.3

4

2.).0

.30.8

10

10 '76.5 77.0

llurray.........

1

2

9.6 19.6

11

9 106.1 88.0

llusccgee

18

!Iewton. . . . . . . . . Oconee
Oglethorpe

--.3

Paulding

1

4 .30.8

6.8

58

76 99.1 1.30.1

-6
2

--16.6

-.3.3.5
14.2

15 4
10

l6 8.).2 89.2

5

46 .3

58.4

9 eJ.9 6).7

2

7.2 14.6

9

8

64.7

58.3

182

VITAL STATISTICS-TABLEa 9

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM PELLAGRA AND PNEUIIONIA IN EACH COUNTY IN GIDROI.A.a l9J7 .I.ND l9J8

PELLAGRA

PNEUMONIA

NUMBER

RATE PER 100,000 POPULATION

NUI.!BER

RATE PER 100,000 POPULATION

l9J8

l9J7

l9J8

l9J7

l9J8

l9J7

l9J8

l9J7

Peach . Pickens Pierce Pike Polk
Pulaski Putnam Quitman Rabun Randolph

5

J 47.J 28.5

10

8 94.6 75.9

l l

l

9.1 7.2

-9.J

9 11

4 82.J J7.l 7 79.5 51.2

l

4

8.7 JS.O

14

14 121.7 122.5

2

2

7.4

7.5

27

25 99.8 9J.2

l

J

10.4

Jl.5

22

14 229.2 147.0

-J
l

l
-l

-J2.9
l4.J

11.1
-22.7

J 2
2

-6

J2.9 44.6

66.5

l

28.5 14.4

2

l

10.9

5.5

12

15 65.6 82.6

R1ohlllond Rockdale Schley Screven . Seminole

--9

14 l 2

--12.1

18.8 lJ.8 J5.6

75

lJ9 100.6 186.9

8 J

- - 8 110.1 110.2 5J.O

-J

- -2

12.9

-8.7

17 10

17 7J.O 74.1 lJ 126.2 165.4

Spalding Stephens Stewart Sumter Talbot

-J

8 12.6 JJ.6

Jl

41 129.9 172.2

2

l5.J

10

J

75.6 2J.O

2

l

16.4

8.J

lJ

lJ 106.7 107.8

-4

6 l

-l4.J

21.5 10.6

16 6

27 57.0 96.8 11 62.6 116.4

Taliaferro Tattnall Tqlor Talfa1r Terrell ....

2

2 J0.2 J0.5

5

2 75.6 J0.5

-l
l

2
-2

-5.9
6.1

12.0
-17.8

18 8
12

7 106.6

9

70.5

8 7J.6

41.9
79.9 49.6

6

2 Jl.4 10.5

2J

27 120.5 142.2

Thomas Tift Toombs Towns Treutlen.. ..

2

2

5.8

5.8

J2

27 92.J 78.4

l

l

5.9

5.9

20

l8 117.0 106.1

--2

-l
l

--10.4

5 .3 12.4

10 J 5

-16

52.2 60.0

-84.6

4 61.) 49.5

Troup Turner~
Twiggs
Union Upson

5 l
l

--5

12.8
7.9 10.5

-- 12.9

J4
5 2

57 87.0 146.9

l

J9.5

8.0

8

21.0

85.4

2

l

27.J lJ.9

8

l 109.4 1.).9

.3

4 14.4 19.)

15

24 71.9 115.9

Walker Walton Ware Warren Washington
Wayne . Webster Wheeler White Whitfield
Wilcox Wilkes Wilkinson Worth

2

.3

6.9 10.5

15

27 52.1 94.8

6

5

25.9

21.8

11

20 47.5 87.J

2

5

7.1 17.9

2J

J2 82.0 114.8

2

2 l6.J 16.4

10

7 81.) 51.5

.3

2 11.4

7.6

21

16 79.8 61.2

-l

-- -7.2

--

5 J

8 .)6.2 58.6 4 55.5 74.7

-l

- - - l

9.7

9.8

9 5

-4

87.1 70.6

-J9.2

J

6 12.8 26.0

24

18 102.6 78.0

-l

- 7.0

11

19 76.0 1.)2.5

J

.3 18.1 18.2

8

9

48.4

54.7

l J

-l

8.7 12.8

-8.8

8 24

12 69.8 105.4 11 l02.J 47.5

NOTEa l9J8 f1guree are allocated to plAce of residence and exclude non-residents or Georgia. Only the state totals include residents or Georgia dying in other states.