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\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.".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.) GEORGIA p-ssvl~i__lJI--rZJ-;c-c~/---TB~u ~--~:2:::--\~;;;;~b.;y------l WATER I <~CHICK.AMA.IJGA /f"ORTMT'1 P.-.RKI:.l}iRt IDGE k:J /tlPOWER,PI."NT --... / &CLAYTON ,/ '-t r.... / \ ~ A TRIENTON : \.6 r '\ R:SINC. FAWN [ r=I &,cR. . . /0':-''rv: i 00f2l ! /:."D'cwil ( E) ~-,R~~ .~Y.\"..,iRsi: T.cEc.-6R/, ~-_c~b,LAIN1f~.D:8~c;AJ:Hi~RL'~IAEOTT~Ut-.itBE-MI-ItZL[--L _@&,sAITDZ-]eAtIojR.tS.-VRIlTL-I_ELRE.SLV'l~ 1J'P7L-il~c'HA-I-NEATNOTn-OON~( "a-MIA9Lb~~ 1'CAUMOMIO~fNG,"I~ CoO-P~E~-\IE(;'~.A;f'B~V,FRIolOARtsNW~)cC,CEAH~rRN/EcSHG~HfJJC~oELiEYAL.Sl.ELM"VNNaCr'IPF.A:L:O.-ELJR:",CEDN-ROE~M~sS})I'V_L~lENLIRLC-LEAE~-oLA~VMoOr'/YLN~-LSI-v.oAT\NOINA \ HARTWELL > 0 \--~ l[!l ~ ~6. 1 Q & r-..-- '-....._ cawhoWN A \' - - - - -IS-:lA~ ~--RR--Ao-G\cO'_-KN/-MA/ -R-~ T-SP-PoR,I;wNIQ';G~:SA'ccEwYoO-R-MT-AH-R-1/IE, ThRoT~s;c;A.;tZ"~Jc~~t.LtlN~~(RNCRO~ ~Lr:::L-.1JABOWNRA/'""'EALNL CIN!JE~ ~wV.r.N~Io~~E\RT~/ ~......A..-I::VT'H! ENS ~ 0 ELBERTON -----"'\'" / \ 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 \ !.: !'Vl"'ree ~ 1 ""\" POo CLARK THO. 'i.LOISMI MIuJIL,;~;rr:Jbik'~l.:;;P~I . scSToONrETM~T' ,, / ' - - 'L_ --.,_0:--, ) ~!)WMAToKN.INRSoV~H.LE )' 1, IZJcRAWrofRof AI .c::J.LEXIN ToN J Ml SOFTENING PLANT-WELL OR SPRING - \ c STERILIZED WITH LIQUID CHLORINE r""'" 1t?JT~~~i:? "~ST ~uR\ ~~gANVICLE ~-A, ~e '' \ \ l~ -ZVJIaLoLr~I- wA;J:oC:RtIoIANCAR'""1R''c?:O':1J LP1~vLA~i~TL~LOM- LNP~lJE:-t:~.~o~JM-L~'~f~AEirABtTR.oK:UtJ~~i~ FL~~Li~~o-~~;.~w:.o:JVII ONTEAESfV+BLOTONJ~RO~LO'ASIC~T'~",Hlfrc&7,n.I'l.!1,NE..]YJ,cEOoXR,vrS"l'O~R~O&re,os~.~o~~c,ri1Ai/iL/O~CR~UI~RTIClrC;..:LiJE'lOGr\\ -...... EJwASHINOTO~ N\ ~ IZJcREENS~~~:~I,tlz_'l-/",.. - 7~ElLA OMARY 8cRAWrORDVILLt MILL_! \ t..__ H STERILIZED WITH '\- //,0::: 7 0 \ l ' 0' 0 0 I 6; ( A(- ~ENTO - - ---("';. \ Nou/,~ ARNCO MIU..S FAYETTEVILLE __, 17\\.w~:.oo ..., ' Lf7:1:.JPO,.R,T-;, ~ 0~ 0 ~~ ) EWJ-TB:NLIBP-BA..R-CKI:-ATt!Y,.L.-r~~ BUTR':Y~s,Q"!\~eFDRTfALL)EY ) ( ' / a~RIAN o)"FERsoy\'iLC; OMONTROsEr!joueLIN 71NSBO"O TWIN CITYO ONEWING~N OPORTAC ..,__QoLIVt,;""'\. Ae 'y-/ , I'Q 'JQ!coww7u r I . 0 c/c. 0 L , 1 0 -- )- ~I r 0 r, -( , 0 >''0 f 0,.... _ i vu c --- II -~,--~ ,~ -~ PERRY MARSHlA-LLcVdILNLECHfltL.Do/~ ), 0ouoLEY /' \ DEXTER RAN , 0MO....EZUMA / " OCHESTER RENTZ , eBUENA VOSTA I OCLEThP[ ELLAVILL[:o ~~AOILLA 0C HAW' ~NSVILLE 1 , \ QcADWE~ LL ) SOPEtT - - "\.._, - < I VIOAU... O I ETTEII ,~ ~ COLLIN$ STATSBDR"d\ I '-\ \ r'\om OROOKLET vroTON .. ~ \ SPRINGI';LO / {, 0 I1 a jl-0_ 1 o1 0 / 0 0 0 -1 0 '-0---- _ /0......\ , o".'. ~ ~1~'7N'1w-;6;..o..o. \o~rlltt/T" 'l1 ~s~ oL U M P L :t-----j' -,J1 R!FHLAND--1 oPREtTON ~MERIC:US \ \ KINe I PLAINS o QsY OPINE ROMVILU: V,ENNA _ __. H " W S T c EASTM\N\~ .o.-"':"/~ENA ~EVILLE 1""\ ALAMO ~oLIT,, :LE , OfMULGEE LYO~SI \ \ CLAX.JIIH' ,/ooLtR I PORT WENTWORTM RE\IO$YILL\E__-_;!~ Cl~~d~bo=::.~ PEMBROKE<. / SAV:SUG REF: :LUM.CO ,__/_ ~' l ~_D!RBOLT a~ WESTO\ LESUE 0c CORDELE1, '-" :(/ ( 0 ----:z---, I I ""\..l,. r....--.-- 0 T~ ~TO' J Bt..AKE:LV j NtWTON0_.,-o,bcHoeo,P/tt , /'......../..:..:..:.,....c'o'IA.....f.e__~,>et.... y\...._ / \ -7--l------; \ 1 j - ~Acvc_sINo1s :=..J l.o--1 /:::,.cARTtRSVILLt }"I ;;;.. / r' ' L:j,6i.iroR '"1... ( 'o @Jcrrcosol. ( < (I]RoVSTON LL J "' _ 1 ...._ ~ ' /:::,.tLBtRTON GEORGIA SEWERAGE SYSTEMS DEPARTMENT Of PUBLIC HEALTH DIVISION Of SANITARY ENGINEERING APRL 1131 LEGEND 8/:::,.SEWER SYSTEM ONLY-NO TREATMENT ONE PLANT QTHREE PLANTS TWO PLANTS 0fOUR PLANTS I SEPTIC TANK 2 SEPTIC TANK & SECONDARY TREATMENT 3 IMHOff TANK 4 IMHOff TANK & TRICKLING fiLTER 5 IMHOff TANK & TRICKLING fiLTER & fiNAL CLARifiER 6 SEPARATE. SLUDGE. DIGESTION 7 SEPARATE. SLUDGE. DIGESTION & TRICKUNG fiLTCR \--------f cJARTowN@ 1 8 ~ARoyuIARCrDDALuL~~\R!Si./tAncw' NolIBUS' !.\ J -I / \ -~( ' /'-1, (' \ _./ \ I - ' _j ~Pf!RRY) : ' /:::,.DuBLIN I ('--. / -~ l~l'r,. t , ) r' t'\.._.1\--- L ~--u-N riSTA~ A ,./ """ L- ---{ /::,. J ~ L, ,__ ~ @cocHRAN I A. -, / \ L...).t1AW11.1NSVII..I..t I UNAo;i,. , mov1 @ltASTVM:::X' IN Q)soPtRTON ____ __ _(__ Yj\viDAC,IA \: / f'V ) CDLYO'(S CD I ' \--.J---' "'1...._ I 'I ~----A \ \ CDcLAXTON \ \ /"-(. \ , / '\. H .\. \ / :~, ) I CD RICHI..AN'L...j \ /:::,.utRicus \ /:::,.vltNNA 1 1 \ "( / CD-- """ ,..{/ {(L-...---1, 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 v ..;' f"-. ./ I'.... ~ 90 A/ !'\. J v i \ /~ ..,.,.... ~""-- v -- B/~ .............!' r-..... v J ............ v/ I 1/I I 70 v v I " c .......... v v 1 "f\\ 1/I 60 L l I - - !""-..... """ 1/ v """vD -~ face ~tez j!uppli d&s 8- erili ed - - Or und1 ter S pplie terU zed b- Al Publ c Wet r Sup lies r 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. ln 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 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. 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 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.