STATE OF GEORGIA DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT 1942 STATE OF GEORGIA DEPARTMENT OF PUBLIC HEALTH T. F. ABERCROMBIE, M.D., Director ANNUAL REPORT FOR THE YEAR 1942 State Office Building Atlanta, Georgia October I, 1943 Contents Page Division of Local Health Organizations____________ lO Division of Public Health Nursing_________________ 71 Division of Public Health Engineering____________ 76 Division of Dental Health Education______________ 95 Division of Maternal and Child Health ____________ 107 Division of Public Health Education ______________ 142 Division of Preventable Diseases: Cancer Control Service ______________________ 145 Epidemiological Service ____________________ 154 Industrial Hygiene Service ___________________ 191 Typhus Fever Control Service ________________ 202 Venereal Disease Control Service _____________ 209 Division of Malaria and Hookworm Service________ 220 Division of Tuberculosis ControL _________________ 242 State Tuberculosis Sanatorium ___________________ 255 Division of Laboratories _________________________ 270 Division of Information and Statistics _____________ 311 STATE OF GEORGIA DEPARTMENT OF PUBLIC HEALTH T.F.ABERCROMBlE,M D .OIRE.CTOR ATLANTA !o Hie Excellenc7 Bon. Ellie Arnall Cove!'llor of Georgia Dear Sir: I haTe the honor to preeent to JOU the annual report of the work of the Department of Public Health for the 78ar 1942. !he death rate from all cauaee was 9.2 per 1,000 population, the lowest on record. !he birth rate shows an incn-eaee from 21.6 to 23.1 per 1,000 population .Aaong the important C811aea of death, eleTen show minilllum rates for 1942. !vo of these are the communicable diseaeea of childhooddiphtheria with a reduction of 12 per cent, and scarlet feTer with a reduction of 78.6 per cent. Another two are the important reapiratoey conditione- tuberculosis, declining 8 per cent: and pneumonia. 5.3 per cent. ~id feTer with a reduction of 56.3 per cent; appendicitis, 23.8 per cent; pellagra. 10.6 per cent: and diarrhea and enteritis (under tvo 7eara) with a 34.3 per cent reduction complete the list of specific disease a with new low rates. In addition, minilllum rates with significant reductions of 9.9 par cent for atillbirtha, 15.5 per cent for infant mortalit7, and 10.8 par cent for aate!'ll&l mortalit7 are recorded. Another factor which baa contributed to the excellent health record of 1942 1a the decline, eTen though alight, in the" rate for the cerdio-Taacular renal diseases, where inoreaaea haTe been accustomed. a Of the four dheasea which make 1lP this grQ1JP, three- cerebral hemorrha&e with 4.6 per cent reduction: nephrith, 5.1 per cent: and heart disease, 8.5 per cent haTe recorded lower rates in 1942 than the preTious 7ear. Cirrhosh of linr indicates a 2.7 per cent higher rate than formerl7. !vo other important diseaaee of middle 1111d later life- cancer with a 0.2 per cent reduction and diabetes with a reduction of 0.9 per cent alec registered low for 1942. 71~ T. J. Abercrombie, M.D., Director State Department of Public B'eal th MEMBERS OF THE GEORGIA STATE BOARD OF HEALTH RoBERT F. MADDOX, Chairman_______________________________ Atlanta C. L. RIDLEY, M.D., Vice.Chairman _______~ ____________________ Macon J. C. METTS, M.D._______________________________________ Savannah C. K. SHARP, M.D. _______________________________________ Arlington R. C. ELLIS_____________________________________________Americus J. A. CoRRY, M.D._____________________________________ Barnesville W. P. HARBIN, JR., M.D. ____________________________________Rome H. W. CLEMENTS, M.D. _______________________________________ Adel R. L. RoGERS, M.D. ______________________________________Gainesville D. N. THOMPSON, M.D.___________________________________ Elberton M. D. HoDGES, Ph.G-----------------------------~~--------Marietta JoHN W. WHITE, Ph.G---------------~-----------------Thomasville J. G. WILLIAMs, D.D.S. ____________________________________Atlanta W. K. WHITE, D.D.S. ____________________________________Savannah Brief History of Public Health in Georgia England set a fine example of early public health effort by appropriating, in 1732, 13 guineas ($62.40) for the relief of sick mothers during passage to the province. Colonial records for 1739 reveal that 40 pounds, 17 shillings, anJ 6 pence were paid for "physicks" to be given soldiers in General Oglethorpe's Regiment in Savannah. As early as 1760, there was an ad to oblige ships and other vessels coming from places infected with the plague, smallpox, or other contagious diseases to be quarantined. Larter, in 1817, a Georgia law was passed prohibiting the sale of unwholesome meat, bread, and liquors. Offenders could be fined for the first offense and imprisoned for the second. In 1823, a law was passed establishing an office in each county for the purpose of recording births. In fact, Georgia was the second of the States to require registration by law. In 1843, there was an enactment by the General Assembly requiring that a supply of smallpox vaccine matter be purchased and supplied to the people of the State free. Later, in 1866, the Legislature passed an acrt for the control of smallpox in Georgia. In February of 1875, the Legislature passed an act creating a State Board of Health. Agitation in favor of this had been begun by the Medical Association of Georgia at the close of the Civil War. Records showed that more soldiers died of preventable diseases during ,the war than were killed with bullets. From typhoid fever alone there was one death for every 28 soidiers enlisted. The law creating the Board of Health authorized the Governor to appoint a physician of experience from each of the nine Congressional Districts. These together with the Comptroller General, Attorney General, and the State Geologist constituted the Board. Dr. V. H. Taliaferro was elected Secretary at a salary of $1,000 a year. The program consisted of prevention of disease, promotion of public health, and the collection of vital statistics. Records show that Doctor Taliaferro was too busy even to attend all the meetings of the State Board of Health. A report indicates that a meeting was held in Atlanta on October 10, 1876, all members being present except the Secretary, who was delayed in Savannah on account of an epidemic of yellow fever. Doctor Tali.aferro made a complete investigation of the origin of the yellow fever epidemic and reported that sailors on the "Maria Carlina", who had moved .their bedding to a boarding house, brought the fever to Savannah. At that time, sanitary conditions in Savannah, as well as in other par,ts of the State, were very poor and played an important part in the spread of the disease. Cases occurred in Augusta, Brunswick, and Macon. 8 Georgia Department of Public Health On October 30, 1876, the Savannah Morning News stated that 8,000 refugees had left Savannah, and that the loss to the city was over onehalf million dollars. The same article stated that Savannah had spent $120,833.00 for charity during the epidemic. That year, only $1,000 was spent for public health in the entire State! The next outlook for public health work in Georgia was even darker, as no appropriation was made for the continuation of the work in 1877. Records for that period, furnished every ten years by the Census Bureau, show a constant increase in deaths from the more serious public health problems. Typhoid fever, malaria (then called bilious fever), and smallpox raged. Pellagra and hookworm disease were making their appearance. Georgia was without a public health program twenty-six years. The second State Board of Health was organized September 10, 1903, under an act of the Legislature. An appropriation of $3,000 was made and Dr. H. F. Harris was elected secretary at a salary of $2,000 yearly. The remainder of the appropriation was used in the general work of the Board. Doctor Harris, using a microscope and other apparatus of his own, began O'peration in one small room in the basement of the Capitol in 1904. His first work was devoted to bacteriology and the control of smallpox and yellow fever. He also did a vast amount of research in an effort to determine the cause of peUagra. A laboratory was opened in 1905. With assistance, Doctor Harris expanded his activities to include the manufacture of Pasteur treatment in 1908; diphtheria antitoxin in 1909; and typhoid vaccine in 1912. The first full-time county health project was established in Glynn County in 1914. Later in the year, the Ellis Health Law was passed, thereby creating a board of health in every county in the State. This law further provides for the employment of a full-time county health officer upon two successive recommendations of the grand jury. Following the passage of this law, Glynn and Floyd Counties adopted its provisions. At a meeting of the State Board of Health, in January of 1914, Doctor Harris expressed a desire to retire from public health work as soon as he could be relieved of his duties without prejudice to the work, in order that he might devote his entire time to research. At a meeting of the State Board of Health, in July of 1917, Dr. T. F. Abercrombie, formerly Commissioner of Health of Glynn County, was elected Secretary. Following is a list of the services of the State Department of Public Health, with the date of their establishment: Laboratory________________________________________ 1905 Field Sanitation (now Local Health Organizations) _______ 1910 Venereal Disease ControL___________________________ 1918 Vital Statistics_____________________________________ 1919 Maternal and Child Health__________________________ 1920 History of Public Health in Georgia 9 Sanitary Engineering----------------------------- ___ 1920 Dental Health Education ____________________________ 1928 Tuberculosis ControL ________________________________ 1930 Preventable Disease_________________________________ 1931 Public Health Nursing______________________________ 1936 Cancer Control ____________________________________ 1937 Typhus ControL ___________________________________ 1937 Malaria Investigations_______________________________ 1937 Public Health Education____________________________ 1938 Nutrition__________________________________________ 1940 Industrial Hygiene __________________________________ 1941 Division of Local Health Organizations Guy G. Lunsford, M.D., Director R. B. Griffin, M.D., Medical Director______________ Northwestern Region W. B. Harrison, M.D., Medical Director____________Northeastern Region W. D. Cagle, M.D., Medical Director_______________West Central Region A. J. Davis, M.D., Medical Director________________ East Central Region 0. F. Whitman, M.D., Medical Director____________ Southwestern Region J. D. Stillwell, M.D., Medical Director_____________ Southeastern Region Only a few years ago the principal objective of the Division of Local Health Organizations was the promotion of county health departments. Much of the time and effort of the director was spent trying to convince the people of the need for and value of public health service. Often it was harder to get local authorities to appropriate the necessary funds than it was to convince the people of the need for such service. PROGRESS IN TWENTY-EIGHT YEARS On December 31, 1934, twenty years after the passage of the Ellis Health Law which created a board of health in each county and enabled each county to organize and operate a health department, only thirty-one counties, with a population of 1,314,663, had departments of health. Eight years later, on December 31, 1942, fifty-nine counties, with a population of 1,960,851, had such departments, and four others were ready to make appropriations for public health. During these last eight years little effort was put forth in promoting local health departments for the reason that qualified commissioners of health and other personnel were not available. Truly the health education program in the earlier years has horne fruit, and the harvest has been bountiful. EFFECT OF THE WAR Added services and responsibilities consequent to 'the large number of Army, Navy, and other war projects located in Georgia since 1940 have been taken over hy the affected departments with cheerfulness and zeal. The fact that no epidemic has occurred as a result of the concentrations of population bears witness to the effectiveness of the labors of the public health workers in spite of the long-existing shortage of personnel, made more acute by the call of many of the staff to military duty or other work in connection with the war effort--and this handicap is increasing more and more as the nation goes forward in the war effort. During 1942, twenty-nine local public health workers resigned to enter military service or an activity directly connected with the war effort, bringing the number of such resignations from local and regional departments to fifty-four. During the year there was a number of changes in the commissioners of health due to resignations and transfers. To partly off-set this, eight Local Health Organizations 11 physicians entered public health work for the first time. These were employed after a course of in-service orientation with the State Health Department and one or more of the local health departments, with the understanding that formal training in public health would be offered when the war emergency had passed. In other instances, districts composed of two or three counties were formed, where the commissioner of health of one county assumed the direction of the public health activities in a second or even a third county where a vacancy existed. However, at the close of the year there were vacancies in the position of commissioner of health in the following health departments: Appling-Wayne District Bleckley-Dodge-Pulaski District Brooks County Health Department Bulloch County Health Department Calhoun County Health Department Coffee County Health Department Hall County Health Department Telfair-Wheeler District Terrell County Health Department Tift County Health Department Full-time health services were instituted in Dodge, Gwinnett, Harris, Meriwether, and Pulaski Counties, but discontinued in Bartow and Clinch Counties. The commissioners of health resigned in these two counties during 1941, and due to the dearth of public health doctors, their places were not filled. However, these counties continued the public health nursing program. Other counties employing a public health nurse during the year were: Heard Jeff Davis Monroe Randolph Stewart Turner Dodge, Gwinnett, Harris, and Meriwether Counties had public health nursing service before the complete health department was organized. Schley County had had a public health nurse for part of 1941 and in 1942 until the V. D. itinerant nursing service program was started. ITINERANT V. D. NURSING SERVICE This program, beginning in April of 1942, provided a nurse to conduct V. D. clinics in two to four counties not being served otherwise, and if time permitted, also to carry on an immunization program. The chief purpose of this service was, and is, to provide treatment for men who have been rejected by the loeal Selective Service Boards because of venereal disease infection. The physicians conducting these clinics are paid on an honorarium basis. As of December 31, 1942, there were nine such nurses employed, serving twenty-nine counties. 12 Georgia Department of Public Health REGIONAL WORK In addition to supervising the work of the nurses in the unorganized counties and that of the V. D. itinerant nurses, where there are vacancies in the position of the commissioner of health in organized counties, supervision of this work is done by the regional medical directors. Likewise, where there is a vacancy in the sanitation staff, the regional engineer renders such assistance as is possible. At all times the entire staff of the regional offices is available for advisory service. PERSONNEL PROBLEMS As mentioned previously in this report, there is a shortage of qualified personnel, but at the same time there has been an increase in the total number of persons at work. This is accounted for by the fact that in the emergency created by the war less qualified personnel has been employed in many instances. The nurses and clerks employed to carry on the V. D. clinic service providing for treatment of draftees rejected because of venereal disease infecti,on, and the addition of registered nurses to assist in the V. D. clinics, thereby relieving public health nurses for more important duties, account for this increase. As of December 31, 1942, there were five hundred and fifty full-time and forty-six 'part-time public health workers employed in county health departments, sixty-four public health nurses in unorganized counties, nine nurses in the V. D. itinerant program, nine clerks to assist these nurses, and twenty-nine workers in the regional health offices, making a total of seven hundred and seven persons as compared with six hundred and fifty last year. There were 1,960,851 persons served by full-time health departments (in fifty-nine counties), 698,819 by public health nurses (in sixtytwo counties), or 85.14% of the population of Georgia, as compared with 83.08% in 1941. In addition, 368,148 persons, or 11.78% of the population of Georgia, lived in counties served by the V. D. itinerant nurses. STATISTICAL COMPARISON Following is a complete statistical report of activities in local health departments for 1941 and 1942, and a condensed report by counties for 1942. In addition, there is a table showing a summary of activities for 1942 and the per cent of increase or decrease in these activities over 1937 and 1941. It is encouraging to note the very large per cent increase in services rendered in a five-year period. The decreases are also worthy of notice, especially the number of admissions to service for communicable disease control, 56%, which shows the effect of public health work. The decreases in 1942 as compared with 1941 are in preventable disease control, tuberculosis control, infant, 'preschool and school hygiene, morbidity service, and sanitation. The reduced number of sanitation personnel, and the fact that malaria control in war areas was assumed by another division, account for the reduction in sanitation activities in this report. The largest per cent increase over 1941 is shown in venereal disease control, followed by immunizations and maternal hygiene. Year 1915 1920 192'1 1930 193:; 1MO 1941 1942 Number Organized Counties 2 18 23 34 31 .):i :16 59 REcORD OF CouNTY HEALTH WoRK IN GEORGIA 1915-1942 Number Persons Employed ;. 4~ 71 205 233 498 544 550 Population Served li,54;) 4:l6,106 [;98,107 1,011,974 1,327,018 1,893,441 1,920,119 1,960,851 Total Budget $ 4,637.00 72,695.00 119,812.00 451,217.00 4:i9,292.00 1,066,126.20 1,124,729.00 1,370,304.90 Per Capita .26 .11 .30 .4:-i ,;{;) .56 .;)9 .70 County Budget $ 4,637.00 70,895.00 168,272.00 440,904.00 399,256.00 785,049.20 813,065.59 956,863.05 Per -tc"-< (") !;l ::X:: Capita ~ ;~;. .26 .16 0.... .28 .44 .30 .41 .~.;:.:.. &a .42 i;; .49 ~ ~ 14 Georgia Department of Public Health CoMPARATIVE STATISTICAL SuMMARY OF ToTAL LocAL PuBLIC HEALTH WORK IN GEORGIA, 1941-1942 Organized Counties 1941 1942 COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ _ Admissions to nursing service___________ _ Admissions to medical and/or nursing service _____________________________ _ Consultations with physicians ___________ Field Visits: Diphtheria Typhoid fever and paratyphoid fever_ __ _ Scarlet fever --------------------------Smallpox -----------------------------Meru;les Whooping cough ----------------------Malaria _______ -----------------------Hookworm ----------------------------Typhus __ -----------------------------Other communicable diseases_____________ 9,942 10,828 15,503 2,380 1,852 827 2,544 49 3,807 2,221 694 3,811 442 7,796 8,589 8,700 12,151 1,49:i 2,38;) 2,822 2,548 30 2,703 1,604 503 2,633 472 4,055 All Counties 1941 1942 12,210 15,818 19,731 2,742 10,654 12,062 1a,674 2,072 2,195 1,189 2,692 82 3,986 2,265 21,997 6,506 596 8,971 2,633 3,255 2,728 42 2,803 1,6a6 11,12G 5,281 490 4,377 Total field visits for communicable disease control ------------------------- ____ _ Persons treated for hookworms__________ _ Admissions to hospitals: Diphtheria ----------------------------Typhoid fever and paratyphoid fever ____ _ Scarlet fever -------------------------Smallpox -----------------------------Other communicable disease patients ad- mitted to hospitals ___________________ _ 24,043 4,884 48 32 81 802 19,7:>5 2,951 47 28 90 2 442 50,479 6,851 53 43 81 806 34,390 4,979 50 30 90 443 Total admissions to hospitals for communicable disease controL____________ Immunizations (persons immunized): Smallpox __ ---------------------------Diphtheria-under 1 year ______________ _ Diphtheria-l through 4 years _________ _ Diphtheria-5 years and over____________ 964 49,742 9,273 11,952 9,126 Total diphtheria immunizations__________ Schick tests given _____________________ _ Typhoid fever ________________________ _ Other immunizations_____________________ Public lectures and talld _____ _ XumlJer positive ------------------------- 12,545 1,897 4,:122 6,326 19,513 3,258 :>,343 10,912 22,034 3,522 6,663 11,869 10,958 15,866 24,7 48 9,680 1,169 1,273 1,401 56,027 17,229 10,472 28,326 23,479 :-i,156 S,!l:;O 9,373 547 22,191 7,86:\ 52,298 36,1i4 56,467 1,657 6:i8,405 30,766 507,946 14,370 101 9,470 12,386 2,07:> 3,478 6,833 16,180 2,942 5,071 8,167 19,049 3,234 5,801 10,014 8,682 18,259 25,441 9,048 942 1,095 1,799 52,337 15,945 9,338 27,074 21,292 5,290 n,-tH~ 9,510 G88 21,602 H,664 All Counties 1941 1942 48,884 30,730 50,620 1,283 621,702 43,106 561,778 10,467 192 14,684 64,585 48,710 69,315 1,758 830,700 60,072 667,250 15,518 125 11,645 16,909 2,323 3,598 8,988 27,094 4,131 7,348 15,615 30,4:i0 4,499 8,918 17,033 11,474 21,003 30,140 14,838 1,457 1,571 1,744 67,358 19,415 13,020 34,923 26,743 5,591 1 o,J:Jo 11,022 673 24,960 8,688 16,013 2,477 4,378 9,158 22,147 3,720 6,728 11,699 26,327 4,203 7,712 14,412 13,352 22,187 29,515 13,032 1,040 1,313 2,141 63,575 18,707 11,639 33,229 24,320 5,773 7 ,:i67 10,980 746 2:i,278 7,655 16 Georgia Department of Public Health CoMPARATIVE STATISTICAL SuMMARY OF ToTAL LocAL PuBLIC HEALTH WoRK IN GEORGIA, 1941-1942-Continued Organized Counties 1941 1942 TUBERCULOSIS CONTROL-Continued Number negative (completed tests) ____ _ Contacts broken ------------------------ _ Contacts partly broken _________________ _ Helief secured for tuberculosis cases ____ _ Cottages, sleeping porches, etc. (number built) ______________________________ _ Public lectures and talks_______________ _ Attendance ____________________________ _ 14,326 1,36~ 357 :;91 11 608 56,278 MATERNITY SERVICE Cases admitted to prenatal medical service Cases admitted. to prenatal nursing service Cases admitted to medical andjor nursing service Yisits b.r prenatal cases to medical confer- ence's ________________________________ _ Visit..~ by prenatal cases to private physicians _______________________________ _ Field visits to vrenatal cases __________ _ Office nursing visits by prenatal eases __ _ Cases attended by nurses for delivery service _____________________________ _ Cases given vostpartum medical examination Cases given postpartum examination by 'private physicians ____________________ _ .eases admitted to vostpartum nursing service _______________________________ ' 1.tisits. to postpartum cases _______________ _ Permanent health centers ______________ _ ?\umber of sessions __________________ _ Itinerant health centers ___________ _ Sessiuns held _________________ _ Midwives registered for formal instruetion l\Iidwife meetings ---------------------Attendance at meetings _______ ---------Yisits for midwife supervision __________ _ Public leetures and talks ________________ _ Attendance }~nrollment in maternity classes Attendan<'e 13,001 19,852 21,003 35,090 B08 32,20ii 46,299 331 2,477 262 15,631 39,310 179 3,653 21 46 1,371 9:52 8,354 3,207 261 4,728 594 1,990 14,938 1,208 378 :i86 10 348 23,431 li,126 20,870 22,014 57,781 936 :l4,128 51,220 155 2,940 427 17,632 39,994 189 6,143 12 40 1,3H 1,028 8,347 4,08.) 362 4,849 217 2,333 All Counties 1941 1942 16,272 1,437 368 667 13 670 77,201 11,623 1,406 396 6;)1 11 376 2:;,:;01 19,250 24,588 2:J,82J 62,616 1,038 37,387 54,794 389 3,081 17,921 43,319 241 6,760 21 46 2,289 1,600 12,317 5,037 308 5,428 597 1,993 21,497 26,659 27,B60 67,o78 1,021 40,3:;8 61,877 218 3,487 4'i6 20,369 40,309 242 7,469 12 40 2,481 1,617 11,794 :1,793 :l90 5,099 217 2,333 Local Health Organizations 17 CoMPARATIVE STATISTICAL SuMMARY OF ToTAL LocAL Pusuc HEALTH WoRK IN GEORGIA, 1941-1942-Continued Organized Counties 1941 1942 INFANT AND PRESCHOOL HYGIENE Infants: Individuals admitted to medical service __ Individuals admitted to nursing service __ Individuals admitted to medical and/or nursing service _____________________ _ Permanent he.alth centers _____________ _ ~umber of sessions ______________ _ Itinerant health centers _______________ _ Sessions held _ Yisits to medical conferences (by patients) Visits to prhate physicians (by patients) Field visits ---------------------------Offiee nursing visits ___________________ _ Consultations with parents _____________ _ 9,944 23)39-l 25,268 229 7,070 :iS 123 22,963 466 48,066 22,202 41,557 Preschool: Individuals admitted to medical service__ Individuals admitted to nursing service__ Individuals admitted to medical and/or nursing service ______________________ Permanent health centers ______________ _ Kumber of se.ssions _____________________ _ Itinerant health centers________________ _ Sessions held -------------------------Yisits to medical conferences (by patients) Yisits to private physicians (by patients) }""ield visits ---------------------------Office nursing visits (by patients) ______ _ Inspections by dentists or dental hygienists Prophylaxis by dentists or dental hygienists Consultations with parents ____________ _ Public lectures and talks _______________ _ Attendance Enrollment in infant and })reschool classes Attendance ___________________________ _ 12,313 20,798 22,940 201 5,503 230 371 22,444 360 32,353 23,684 20,016 533 35,683 196 4,829 639 833 SCHOOL HYGIENE Insve.ctions by physicians or nurses______ Examinations by physicians______________ Bxaminations Uy physicians with parents present --------------------------- __ _ Iudi\iduals admitted to nursing service__ l""ield visits ---------------------------- 313,706 95,377 3,646 19,87 4 33,888 9,825 27,113 27,976 236 6,596 36 80 23,504 291 5!,308 24,703 46,133 11,861 22,379 23,987 205 5,861 192 235 21,897 406 32,249 23,678 12,644 460 39,732 223 3,051 330 :>86 311,590 78,372 2,342 19,887 32,121 All Counties 1941 1942 11,340 27,303 28,854 283 7,833 58 123 25,281 508 54,831 2'3,812 46,672 11,290 31.64 7 32,593 282 7,503 36 80 26,420 343 59,602 28,187 49,004 13,622 23,658 25,860 240 6,019 236 378 24,714 382 35,634 26,206 20,093 562 40,300 221 7,090 660 1,298 13,073 25,268 26,931 243 6,470 202 265 24,049 430 35,891 25,922 12,674 564 41,502 218 4,067 330 586 330,410 96,775 3,744 21,397 34,800 325,532 79,650 2,663 20,94'i 33,022 18 Georgia Department of Public Health CoMPARATIVE STATISTICAL SuMMARY OF ToTAL LocAL PuBLIC HEALTH WoRK IN GEORGIA, 1941-1942-Continued Organized Counties 1941 1942 SCHOOL HYGIENE-Continued Office Yisits --------------------------Inspections by dentists or dental hygienists Prophylaxis by dentists or dental hygienists Public lectures and talks________________ Attendance Classroom health talks __________________ _ Attendance ___________________________ _ 18,880 77,653 3,147 494 ~9,754 4,338 I49,874 ADULT HYGIENE Medical Examinations: :llilk-handlers -------------------------Other food-handlers -------------------liidwives ______________ ---- ______ -----Teachers _______________ - __ --- ____ ---- __ Other adult medical examinations________ 2,066 37,864 474 1,261 I4,043 Total adult medical examinations _________ 55,708 MORBIDITY SERVICE Admissions to medical service ___________ Admissions to nursing service ___________ _ Admissions to medical and/or nursing service _________ ----------------------Clinic visits (by patients) ______________ _ Field medical visits _____________________ _ Field nursing visits_____________________ Office nursing visits___________________ _ Total admissions to hospitals __________ _ Total patient-days of hospital service___ _ Individuals admitted to dental service___ _ Refractions ____________ - --- _____ ------Tonsil and adenoid operations___________ Other defects corrected__________________ 21,969 7,96I 27,322 64,414 5,642 26,974 5,217 12,606 84,517 5,071 726 909 2,714 CANCER CONTROL Admissions to medical service Admissions to nursing se.rvice___________ _ Admissions to medical and/or nursing service ------------------------------ Office visits ---------------------------Field visits ---------------------------Applications for State aid ------------Cases receiving diagnostic service at State- aid clinics _________________________ _ Cases receiving treatment service at Stateaid clinics --------------------------- 638 445 775 I,G60 I,166 719 524 551 19,216 52,970 3,88:1 613 37 ,23I 3,528 131,964 1,940 37,I34 374 850 13,282 53,580 19,I48 5,914 22,865 46,555 2,829 19,709 6,356 10,617 84,561 I0,491 699 745 3,714 639 385 826 I ,562 937 632 833 616 All Counties 1941 1942 20,138 91,262 3,451 664 46,381 4,847 165,271 38,7!)5 62,789 4,372 739 42,911 4,027 146,023 2,066 38,004 476 1,262 14,298 36,106 1,940 37,I34 374 850 14,757 ;:i5,0G5 22,695 10,424 29,806 66,218 5,731 30,428 8,394 12,767 84,950 5,105 744 997 2,824 19,545 7,835 24,789 47,083 2,916 22,985 9,153 10,690 84,83:1 10,493 721 78I 3,786 714 645 976 1,739 1,389 834 608 999 1,713 I,130 747 892 660 Local Health Organizations 19 CoMPARATIVE STATISTICAL SuMMARY oF ToTAL LocAL Pusuc HEALTH WoRK IN GEORGIA, 1941-1942-Continued Organized Counties All Counties 1941 1942 1941 1942 CRIPPLED CHILDREN SERVICE Individuals reported Individuals examined at diagnostic clinics Individuals treated --------------------Individuals admitted to nursing service __ Visits to diagnostic clinics (by patients) Xursing visits ------------------------Public lectures and talks________________ Attendance 523 653 475 379 718 2,087 149 OTHER ACTIVITIES Conferences with physicians or dentists __ 21,346 Personal conferences with others ________ 120,209 :Xewspaper articles --------------------- 3,540 Bulletins distributed -------------------- 126,511 Circular letters ------------------------ 41,211 1\Iiles travelled on duty________________ _ 2,193,471 Days off duty-------------------------Conferences with official groups________ 1,080 1,628 Attendance __________ ------------------Public lectures and talks ______________ _ 19,890 759 Attendance 38,729 Red Cross classes (sessions) _____________ Attendance ___________ ------------------ GENERAL SANITATION Water: Approved individual water supplies installed Individual water supplies improved_______ Public water supplioo improved__________ Corrnections to public water supplies____ _ 1,388 850 150 6,242 Sewage: New privies installed------------------Wood privies installed at homes _________ _ Concrete privies installed at homes ______ _ Wood privies installed at schools_________ Concrete privies installed at schools ____ _ Wood privies installed at other public places Concrete privies installed at other public places ------------------------------Privies rei)aired (or improved) __________ New septic tanks installed_______________ Septic tanks installed at homes ________ _ Septic tanks installed at schools Septic tanks installed at other public places Septic tanks improved __________________ _ Connections to public sewer~-~~---~-----Sewerage systems or plants improved______ 5,692 639 4,412 53 263 129 196 1,529 3,372 3,093 40 239 225 3,363 80 927 1,026 549 438 1,111 2,008 10 821 19,828 131,062 1,373 101,441 86,874 1,527,506 1,069 1,294 17,724 944 49,182 1,129 24,210 1,489 603 64 4,059 2,073 375 1,447 38 72 100 41 1,800 2,261 2,177 21 63 211 4,213 58 565 781 501 527 885 2,259 4 149 29,447 152,947 3,894 149,960 48,319 4,115,952 2,071 2,329 27,754 1,949 71,464 1,567 1,213 219 6,512 7,695 857 5,906 73 486 149 224 2,016 3,671 3,321 52 298 299 3,478 85 981 1,069 589 650 1,205 2,431 10 821 28,127 162,111 1,673 136,221 93,756 2,941,201 2,236 1,957 22,785 1,603 75,0f\3 1,637 29,677 1,605 939 102 5,346 3,077 540 2,183 59 114 122 59 1,8:.4 2,523 2,415 34 74 252 4,280 71 20 Georgia Department of Public Health CoMPARATIVE STATISTICAL SuMMARY OF ToTAL LocAL Pusuc HEALTH WoRK IN GEORGIA, 1941-1942-Continued Organized Counties 1941 1942 All Counties -------- 1941 1942 GENERAL SANITATION-Continued Field visits: Private premises --------------------- Camp sites -------------------------- Swimming pools ---------------------- Barber shops and beauty parlors------ Schools ------------------------------ Public water supplies (plants and systems) -----~-------------------- Sewerage plants ---------------------- Other field visits for general sanitation __ 294,007 1,827 860 161 3,480 798 741 60,378 284,4 72 1,170 429 203 2,633 965 588 49,680 297,366 1,978 880 164 4,351 1,066 925 60,802 287,399 1,200 433 204 2,972 1,196 680 49,682 Total field visits for general sanitation __ 362,252 In sect contNll: Buildings mosquito-proofed ------------ 1,158 Minor drainage-linear feet completed__ 298,980 Linear feet ditch cleared_______________ 3,553,040 Anopheles breeding places eliminated___ 4,205 Acres drained ----------------------- 1,586 Anopheles breeding places controlled ____ 18,029 Miscellaneous: Public lectures and talks ______________ Attendance --------------------------Posters, charts, exhibit models completed Sanitation or malaria maps completed __ 235 12,945 522 96 Rodent control: Premises surveyed for rodent controL_ Buildings rat-proofed ----------------Buildings improved ------------------Premises improved -------------------Pounds of pi)!son bait distributed------ 2,679 658 128 270 946 PROTECTION OF FOOD ANO MILK Food-handling establishments registered for supervision --------------------Field visits to food-handling establish- ments ----------------------------Dairy farms registered for supervision__ Field visits to dairy farms ___________ Milk plants registered for supervision __ Field visits to milk plants_____________ Cows tuberculin tested________________ Animals slaughtered under Inspection __ Carcasses condemned In whole or In part Public lecturoo and talks ______________ Attendance --------------------------- 7,495 78,342 1,280 12,828 85 3.376 11,19:l 544,185 57,503 58 2,371 340,140 367,472 2,655 158,726 2,069,788 86 27011, 12,380 1,510 369,730 3,594,930 4,215 1,624 18,065 196 5,828 242 143 272 16,022 577 113 2,481 521 374 1,162 2,621 2,470 718 141 274 951 7,359 73,478 1,195 10,507 94 3,144 12,795 2:\8,799 51,953 82 3,:l4:l 7,495 78,847 1,280 12,883 85 3,382 11,193 544,185 57,o03 58 2,371 343,766 3,030 185,126 2,093,788 86 2,28911, 12,381 209 6,446 269 1~6 2,544 521 374 1,162 2,621 7,364 73,531 1,205 10,522 94 3,144 12,795 2:i8,799 51,95:-i 82 3,:143 CoMPARATIVE STATISTICAL SuMMARY oF ToTAL LocAL PuBLIC HEALTH WoRK IN GEORGIA, 1941-1942-Continued Organized Counties 1941 1942 LABORATORY Specimens examined: Water-bacteriological ------------------------Water-chemical -----------------------------1\I!lk or milk products __________________________ Other food -----------------------------------Typhoid: blood cultures ________________________ Typhoid: Widal ------------------------------Typhoid: stool culture__________________________ Typhoid: urine cultures _________________________ Diphtheria cultures ---------------------------Syphilis-serologicaL __________________________ Syphilis-darkfield ---------- -----------------Undulant fever (human)------------------------ (animal)------------------------- Tularemia -----------------------------------~I alaria _______________________________________ Gonorrhea ------------ -----------------------Tuberculosis ------------------------- --------~eces for parasites _____________________________ lrrinalysis ---------------------------- --------Rabies ________________________________________ Other laboratory specimens examined ___________ Pos. 1,114 936 48 54 152 47 598 30,258 120 44 18 256 23 503 2,843 1,485 5,894 5,160 202 31 141 372 Total laboratory specimens examined-~---_ ---~~~ 50,299 Neg. 6,205 398 13,004 147 1,048 1,676 7,343 2,594 4,863 167,600 426 1,805 1,444 1,648 170 15,348 11,785 9,604 15,841 42,225 470 32 1,370 6,795 313.841 Pos. Neg. 1,014 10 977 2 60 45 396 32 773 39,386 95 40 3 2:i7 23 375 4,549 1,608 3,946 3,674 124 13 135 416 57,953 5,628 445 10,740 61 757 1,395 9,891 2,637 8,195 188,674 310 1,388 656 1,218 198 8,276 16,518 10,334 9,510 41.742 137 28 1,124 5,49ti --~~~ 325,357 All Counties 1941 1942 Pos. Neg. Pos. Neg. 1,339 936 54 54 175 50 653 34,236 123 44 18 261 39 536 2,914 1,640 9,026 5,791 208 31 141 381 58,650 8,050 399 13,004 148 1,075 1,685 1,615 2,644 5,046 182,060 434 1,818 1,453 1,666 203 18,802 12,136 11,754 20,898 45,374 481 34 1,377 6,850 345,006 1,269 7,406 10 445 979 2 70 47 443 40 825 45,141 97 42 3 276 129 393 4,675 10,742 ~ 61 799 1,409 10,218 2,666 8,437 0 ;":", -::r:: ;":', -;;.. 207,262 c 315 ~ 1,413 656 1,263 256 a.c;.;.;.. 13,527 t: 17,341 1,921 5,850 5,455 125 14,059 12,288 4 7,292 139 13 28 135 1,143 563 5,584 -- 68,503 364,749 1:..:1 I-"' 22 Georgia Department of Public Health TABULATION OF SPECIFIED AcTIVITIES IN 1942, SHOWING PER CENT oF INCREASE OR DECREASE OVER 1937 AND 1941 Total for Year 1942 Per Cent Increase Decrease 1937 Per Cent Increase Decrease 1941 COMMUNICABLE DISEASE CONTROL Admissions to service_____ -------- __________ _ 10,654 Consultations with physicians___________________ 2,072 Field visits ------------------------------------ 34,390 Smallpox immunizations ------------------------ 92,368 Dh)htheria immunizaHons ---------------------- 50,587 Typhoid fever immunizations ____________________ 297,818 Venereal Disease Control: Individuals admitted to medieal service___________ 64,585 Clinic visits ----------------------------------- 830,700 Field visits _____________________ ______________ 60,072 Tuberculosis Control: Individuals admitted to medical service___________ 16,013 Individuals admitted to nursing service.___________ 22,147 Clinic visits ----------------------------------- 29,515 Nursing visits --------------------------------- 87,895 Maternity Service: Individuals admitted to medical service 24,984 Individuals admitted tn nursing service__________ 47,246 Visits by ante-partum cases to medical conferences 67,578 Nursing visits -------------------------------- 147,744 Infant Hygiene: Individuals admitted to medical service___________ Individuals admitted to nursing service__________ Visits to medical conferences____________________ Nursing visits --------------------------------- 11,290 31,64 7 26,420 87,789 Preschool Hygiene: Individuals admitted to medical service __________ Individuals admitted to nursing ser1ice ___________ Visits to medical conferences-------------------Nursing visits ---------------------------------Inspections by dentists or dental hygienists______ 13,073 25,268 24,049 61,813 12,674 School Hygiene: Inspections by physicians or nurses ______________ 325,532 ~~xaminations by physicians--------------------- 79,650 Individuals admitted to nursing service__________ 20,945 Nursing visits --------------------------------- 71,817 Inspections by dentists or dental hygienists_______ 62,78U Adult Hygiene: :Medical examinations -------------------------- C.:i,O:-i:i -56% -13% + 22% +227% + 81% +208% +235% +400% +419% +161% +123% +249% +109% +183% +336% +216% +219% +135% +319% +252% +146% +109% +198% +221% +164% + 604% + 72% - 16o/o + 42% 37% 10% +282lj~ -13% -24% -32% + 24% + 16% + 15% + 32% + 34% + 39% - 5o/o -18% 2% - 7% + 12% + 10% + 8% + 9% + 16% + 5% + 9% 4% + 7% 3% -37% 1% 18% 2% + 31% --- :~1 o/o - 2o/o Local Health Organizations 23 TABULATION OF SPECIFIED AcTIVITIES IN 1942, SHOWING PER CENT oF INCREASE OR DECREASE OvER 1937 AND 1941-Continued Total for Year 1942 Per Cent Increase Decrease 1937 Per Cent Increase Decrease 1941 Morbidity Service: ~Iedical visits --------------------------------i\ursing visits ---------------------------------Admissions to hospitals_________________________ 49,999 32,138 10,690 General Sanitation: Approved individual water supplies installed______ 1,605 Approved excreta disposal systems installed_______ a,600 Field visits ------------------------------------ 343,766 Protection of Food and Milk: Food-handling establishments registered for supervision ________________________________ _ Field visits to food-handling establishments______ Dairy f.arms registered for supervision__________ ~'ield visits to dairy farms _____________________ _ Milk plants registered for supervision____________ Field visits to milk plants_______________________ _ 7,364 73,531 1,205 10,522 94 3,144 Laboratory: Specimens examined --------------------------- 433,252 -26% 41% + 36% +240% 19% +54% + 26% + 38% + 36% + 37% 1% - 8% + 78% -31% -17% - 16% + 2% 51% - 6% 2% 7% 6% -18% + 11% - 7% + 7% 24 Georgia Department of Public Health LOCAL HEALTH SERVICE STATE OF GEORGIA DECEMBER 31, 1942 -~ ~:;:;:;:;:;d COUNTY HEALTH DISTRICTS NURSING COUNTIES ,.,...- HEALTH REGIONS CoNDENSED REPORT OF AcTiviTIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942 i""i' c. oc( COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ ConsuHatlons with physicians __________ Field visits -------------------------Smallpox immunizations ______________ Diphtheria immunizations ------------Typhoid immunizations _______________ 186 3 272 1,719 481 3,038 VENEREAL DISEASE CONTROL Admissions to medical service __________ Clinic visits -----------------------Field visits ----------------------- Number of clinic treatments 148 1,934 2 1,836 TUBERCULOSIS CONTROL .Admissions to medical service __________ 84 Admissions to nursing service__________ 242 Clinic visits -------------------------- 100 Field and office visits________________ 524 MATERNITY SERVICE .Admissions to medical service_________ 76 Admissions to nursing service __________ 79 Visits by ante-partum cases to medical conferences _________________________ 166 Field and office visits ___ ----- ________ 200 "0w :";; ::c ~.. 0,., ;o::c::c!::o:: ."0 " Ill . I"""l"l .'",i o; Ill 18 3 26 224 303 1,983 394 15 :>86 7,292 :J,687 3,&28 73 1 90 ;)06 li5 2,413 31 10,663 101 67 1,727 17 6 :)8 1,052 253 4,901 118 1,631 273 1,604 9,848 104,119 7,373 95,998 94 1,194 226 1,067 97 1,029 4:i 1,007 318 4,432 500 4,080 ;j5 1,818 63 24 102 111 2,287 120 711 196 59 f>,340 69 3:1 280 201 li>,962 231 131 ;;14 60 187 86 740 ;)4 13ri 133 '\7 174 149 126 735 1113 292 478 326 :1,618 1711 4:-i2 582 .w """ Ill :t t "Ill .::c " Ill 1 16 8 188 333 176 189 463 1,432 "7 211 5,592 174 5 3,035 12:1 1,333 !Iii 1,149 114 220 11 114 4:i3 11 64 88 118 149 .."".. ...... Ill iii 250 649 t""< 0 2,402 1,242 ("'> .!;.:.>... 1,634 ::z:: ~ ~ 3,336 34,042 0 ..... 3,99;) .... i>4,410 ;a; ... 497 ;0:s 4 497 1,829 4 1,062 1,563 2,242 6,314 3,2rHi !>.:) <:11 t-:1 CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued 0'- "c ' c. c. <( c ~ :;c;; ::;: ..... 1: 0 <~o~ .c0., "'Ill ..~ .. I"ll' c ,"ij; ;;; Ill .0.. c 3: t I"ll' "'Ill c .:c c Ill E ........ "Ill iii INFANT HYGIENE Admissions to 1nedical service 92 27 740 23 18 103 56 Admissions to nursing service____ _ 92 91 6,369 78 70 162 118 Visits to medical conferences _________ _ 173 39 2,273 48 18 310 173 Field and office 194 186 10,553 19~ 176 539 261 PRESCHOOL HYGIENE Admissions to medical service _________ _ 130 37 1,585 144 89 Admissions to nursing service _________ _ 130 71 'i,537 36 163 128 Visits to medical conferences_________ _ 197 65 3,897 241 229 Field and office visits _______________ _ 209 90 9,946 49 321 159 Dental inspections 40 SCHOOL HYGIENE Inspections by Ilhysicians or nurses ___ _ 99 309 90,994 40 Examinations by physicians __________ _ 73 662 31.677 366 Admissions to nursing service_________ _ 33 309 3,471 _Field and office visits _______________ _ 5:i 314 8,765 15 67 Dental inspections 268 29,832 ADULT HYGIENE Medical examinations 13 24,524 5:\3 ~ 1,007 ~ c 1,820 ~ 2,601 ~ 3,120 1::::1 ~ 772 ~ ..., 1,898 ' 1,895 3,405 ~ -.;,:.:,l . c ~ g:o- 47,321 12,676 1,386 2,928 -i:l::: ~ ~ s.. 1,179 CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CoUNTIEs-1942-Continued "c ' ;.;.,. <( c :;: :;c;: < ._ ..-::; .=<(=(=.")' ."c.. Ill .... ~ Ill c 'i ...'CI Ill ...~ .. c ....3....: .:c c .~ ....,, Ill Ill Ill Ill iii MORBIDITY SERVICE Medical visits ------------------------ 23 ~\using visits --------------------- ___ 33 Admissions to hospitals _______________ SANITATION \Vater supplies approved_______________ -- Privies and septic tanks installed ______ -- Food-handling establishments registered -- Dairy farms registered ________________ Milk plants registered _________________ Field visits -------------------------- 5 LABORATORY SPECIMENS Specimens examined __________________ 1,340 1 24,665 79 822 3 723 1 58 28 2 3,403 646 37 143 47,710 403 39,09:i 3 49 10 28 224 15 1 5 1 26 8 10 25 1 18 86 il16 2,641 1,812 30 -- 2 -- 2 12 7 2;) 1,117 136 ct"-< (") .>..:l... 25 ::X:: 402 376 119 ~ >..:.l... So -- 6 0..., 25,278 42,672 ~ ;::! ......>:l c ;::! "' t-.:) ....:J CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued .,.., ~ Ill COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ Consultations with physicians________ Field visits -------------------------Smallpox immunizations_______________ Diphtheria immunizations______________ Typhoid immunizations________________ 32 12 31 115 130 1,268 VENEREAL DISEASE CONTROL Admissions to medical service__________ Clinie visits ________________ Field visits ------------------------ __ ~umber of clinic treatments ____________ 109 l,:l06 294 1,213 TUBERCULOSIS CONTROL Admissions to medical service_________ 60 Admissions to nursing service__________ 91 95 329 MATERNITY SERVICE Admissions to medical service __________ 61 Admissions to nursing service~--------- 104 Visits by ante-11artum cases to medieal conferences ________ ----~ ____________ 238 Field and office visitL _______________ 308 ,., " c E Ill ""cc"' IIi ..,c .. , Ill .c "c "Ill t": "Ill 11 1 139 217 192 1,387 40 344 874 300 4,117 12 19 267 104 1,152 34 26 44 696 289 2,911 ;;4 15 93 2,653 922 4,242 30 243 127 362 913 :162 3,227 2,124 4,089 13,10:) 36 397 251 136 614 353 2,920 2,000 4,078 13,049 17 4 46 152 144 20 63 77 173 218 17 61 59 146 190 :J4 464 161 813 1,01G ;,o 244 66 360 47 1;)7 689 62 163 689 90 936 134 382 1,967 104 1,6f>4 82 415 2,036 c ~ "' "Ill -."cc; (,) .."c.. E . .:";; c (,) (,) 5 3 6 96 182 1,787 9 63 572 330 1,378 205 21 61 433 454 1,708 32 1 34 491 170 1,222 197 3,13!) 139 2,8f>3 305 3,918 94 3,918 106 2,494 167 1,718 213 3,048 94 2,785 48 43 23 117 ri7 86 70 135 49 43 43 120 193 87 184 338 99 206 158 84 124 216 217 118 281 381 167 207 445 403 325 276 t>:l 00 ~. (,) ~ 2 ~ 2 2 0 ~s !;:::) ~ ~ ...1..'.:.1, s 65 140 78 -.";:.:'., 0 ;~::: s:: 8 (''") 2 -::t:: "'1':1 ;;. CoNDENSED REPORT oF AcTIVITIES oF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued .,., .:;; i"ii INFANT HYGIENE Admissions to medical service__________ 22 Admissions to nursing service__________ 51 Visits to medical conferences _____ 81) l'ield and office visitL_______________ 150 -.,., ." . = ...,. 0 =0 ,..c..:, m .c "0 '; m ~" m" 13 91 27 93 36G 100 353 60 111 354 18 156 38 251 724 319 799 115 299 871 c: =m""' ".0c "; 0 .."c..: E .. .:";; " 0 0 14 23 165 45 105 27 165 78 14 28 138 76 146 34 286 140 PRESCHOOL HYGIENE Admissions to medical service __________ 11 46 58 2 55 120 12 Admissions to nursing service__________ Visits to medical conferences _____ ___ 1.2, 148 351 46 137 6 ;;;_; 93 51 2 68 138 12 Field and office visits_________________ 21 188 1.17'> 13 78 74 64 Dental Inspections_____________________ 7 43 26 249 39 43 58 460 68 SCHOOL HYGIENE Inspections by physicians or nurses ____ 578 4,377 148 :;s3 1,119 470 }~xamina tions by phys,icians __ ________ 66 1 54 2 5 197 Admissions to nursing service__________ (;4 492 2 22 11 12 Field and office visits_________________ 112 1,302 3 77 26 16 Dental inspections_____________________ 135 34 3 109 6 200 643 ADULT HYGIENE )ledical examinations ----------------- 38 196 306 MORBIDITY SERVICE Medical visits ------------------------ -- ~ 2 8 81 81 20 Nursing visits _______________________ 25 146 122 44 86 4 45 Admissions to hospitals _______________ 3 4 3 3 3 25 77 6 1 ~.. 0 ct--< ~ .!;.:.>... ::z:: "';;.;.:;.,.... 0.... ~ ;:: .;a.:.;. c ;:: "' ~ 1.0 CoNDENSED REPORT oF AcTIVITIEs oF LocAL HEALTH DEPARTMENTS, BY CoUNTIEs-1942-Continued .:~;; " iii -. " c e"li' ..."..' eli c "~ ' Cll ...c " ::1 Cll t" ::1 Cll -..::1 Cll .c ::1 .c "; (,) ."c., E "'(,) .... .:;; c (,) SANITATION Water supplies approved _______________ Privies and septic tanks installed _____ Food-handling establishments registered -- Dairy farms registered_________________ Milk plants registered_________________ Field visits -------------------------- 4 LABORATORY SPECIMENS Specimens examined _________________ 656 1 46 12 3 3 775 581 3,990 18 15 2 67 67 24 5 44 4 3 17 32 724 1,037 2,135 552 1,675 4,074 l,GOO 9 53 213 35 938 2,408 2,561 "0"" - ~. (,) - ~ <.c1.>. C1'l ~- t::::l <1> ... 51 ~ >:l " .<;.:1:.:>,. -c . ~ !:::: ;?:: ~ ::X:: <1> .>...:..l.... ;;::- CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS, BY CoUNTiES-1942-Continued =C> -C:>. .ce "i: ."c' e .-":c.' .c (,) (,) (,) ~ .c "C> .Cc> -~:. .c (,) .".'. C> ::C:>: ."c' (,) ..:""C.<>. ."c (,) t": 0"' COMMUNICABLE DISEASE CONTROL Admissions to medical service_________ Consultations with phrsicians________ Field visits __________________________ Smallpox immunizations_______________ Diphtheria immunizations ______________ Typhoid immunizations ________________ 17 3 69 346 813 3,910 294 1,237 71 H6 :!26 4,226 42 32 3,419 239 73 963 136 698 2,082 34 1 15:1 1 101 1 1,0Il 434 947 3,lii4 VENEREAL DISEASE CONTROL Admissions to medical service__________ 10 129 6,218 33 29 5;) 350 Clinic visits ------------------------ 107 1,379 76,149 482 319 697 8,044 Field visits __________________________ 21 352 8,831 44 26 20 692 Xumber of clinic treatments___________ 106 1,379 62,625 473 376 68o 6,713 TUBERCULOSIS CONTROL Admissions to medical service __________ 98 42 616 5 3 7 40 Admissions to nursing service__________ 74 96 571 14 160 Clinic visits ------------------------- 79 42 1,621 3 7 148 Field and office visits _________________ 265 223 6,325 61 716 MATERNITY SERVICE Admissions to medical service__________ 10 70 2,080 6 Admissions to nursing service__________ 21 78 1,738 37 Visits by ante-partum cases to medical 1:! 206 6,466 6 46 383 16,109 70 207 -- 258 52!-f 1,6fJ2 . ...ce 0"' 0"' 1 6 5 1 47 5;:)5 155 2,005 120 1,359 3 20 1,125 1 91 128 1 110 276 41 90 .c "c 0 ""C''> (,) 169 t-< 44 0 8 "' 678 ,~_ 1 143 805 1,071 956 5,422 ::t:: ~",_' ;:;:. a 431 ..., C1'l 6,125 ~ ;:: 4 1,269 5,985 a~:s ;:: 139 "' 4 469 161 7 1,984 23 5 99 22 6 235 .w...... CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CoUNTIEs-1942-Continued "'"t-.:1 ~.. -:. . c.. E -.~ .-:c. .c .c 0 0 0 ...."c " .c ~. .:.:..:.: .c .c 0 0 INFANT HYGIENE Admissions to medical service__________ 19 Admissions to nursing service________ 52 Visits to medical conferences ___________ 54 Field and office visits _________________ 119 PRESCHOOL HYGIENE Admissions to medical service________ 58 Admissions to nursing service__________ 53 Visits to medical conferences_________ 81 Field and office visits ________________ 60 Dental inspections____________________ SCHOOL HYGIENE Inspections by physicians or nurses ____ 9o6 Examinations by physicians ____________ 291 Admissions to nursing service__________ Field and office visits ________________ 98 Dental inspections_____________ _______ 75 68 535 1 96 3,27:l 58 151 578 1 296 12,864 149 566 8 243 969 11 570 275 2,888 4 668 850 36,:\30 2;")7 15 2,031 1 9 5,692 8 13 12,912 20 110 2,892 .."... f ."c 0 ...~ .. 0 c .,., ..!,3., 0 0 .c "c 0 .""0 ' ' ~ ~ .c., 251 460 17 5 23 221 O;<;l 1,095 17 t::::l 2,381 37 " 621 ~ ..."1~.:.::,! 120 26 222 ;:l 174 27 3 ...~ 494 :::1 115 458 26 27 3 221 608 ..c..... -- 94 ~ jJ)62 1,044 -- 150 252 : N, C'l 385 2,32:> 37 ::X:: ~ 2 2 125 284 .I;.;.;.>..:..:.-. ADULT HYGIENE Medical examinations __________________ 36 ti,707 1,174 -- 264 MOBIDITY SERVICE Medical visits ----------------------- 2 Xursing visits ______ ------------------ 29 Admissions to hospitals________________ -- 8 16,283 4 13 9,846 62 6,184 1 190 -- 31 -- 16 94 313 Arlml~:,~.~:,~.lnnC! tn Tna..rHnnl CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs~l942~Continued ~ ..0 2 (,.) SANITATION Water supplies approved _ ~----------- 1 Privies and septic tanks installed ---- 9 Food-handling establishments registered -- Dairy farms registered_________________ Milk plants registe-red_________________ Field visits _________________________ 79 LABORATORY SPECIMENS Specimens examined -- ----- ---------- 22 c ~. e. .-:c;; .c .c (.) (.) 791 1 395 950 34 12 95,113 559 61,768 :l ~ .."0c' ~ . ."0 ' ::0:: .c .c (.) (.) """.0.".' ."c (.) .t": -0 0.".' c 2."' 0 4 2 2 111 90 95 36 -- 8 -- 21 11 15,6;)3 389 173 158 7,131 1 896 ...c " 0 ""0"" (.) 90 t-- 227 0 ~ .!;.:>... ,::.t:: 18 1,454 ;~:;. 24 a... 3,nt6 rJo. !;:> ;:::! t:; s~ ;:::! "' ~ ~ ~ CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued >f:. . :u: u0 ~.".. u0 .. :a E u0" ... 0 u0 ..:! "u0 ~ ..0 '; u ,; ..., /3 Q c .;0 Q z."... Q "-"; :.:: Q" COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ Cansultations with physicians -------Field visits -------------------------Smallpox immunizations_______________ Diphtheria immunizations______________ Typhoid immunizations ________________ 158 28 366 1,405 618 2,557 VENEREAL DISEASE CONTROL Admissions to medical service__________ Clinic visits -------------------------Field visits ------------------------Number of clinic treatments__________ 256 4,983 274 4,434 TUBERCULOSIS CONTROL Admissions to medical service__________ 116 Admissions to nursing service__________ 172 Clinic visits -------------------------- 132 Field ,and office visits_________________ 954 MATERNITY SERVICE Admissions to medical service_________ 129 Admissions to nursing service__________ 231 Visits by ante-partum cases to medical conferences ------------------------ 791 Field and Qffice visits----------------- 926 143 1 50 1 71 1 561 427 1,924 476 7,446 152 7,321 108 1,313 4 1,172 106 156 1 135 220 1 256 260 1,003 1,020 5 1 25 300 319 1,320 1 11 219 201 1,200 3 529 143 7,339 2,274 3 276 83 6,539 2,100 93 62 134 85 111 89 729 263 -- 4 61 60 91 3 139 170 ~21 18 3 46 543 224 1,()79 409 6,843 246 6,087 155 212 142 477 304 337 1,046 1,274 12 65 12!"J 1,369 4 84 91 93 163 5 333 292 1,074 -- 6 6 310 22 86 671 326 2,6G2 1,232 4,729 337 3,566 116 116 59 681 ~ ,. 156 c s 66 ~ 319 2,998 901 2,317 ~ ~ 1....:..1,.. ;3 "' 78ft 12,794 .;.:.:.,. 124 ~ 12,794 206 -~ I=: C"' ~ 287 ::t:: "' 323 .... 940 1....:..1...... 14 274 312 54 128 274 ~11 21 1,171 820 117 284 1,303 1,312 CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued :...:. u ~"... 0u . :.; E 0u" .... u0 .-l=l u .."f 'i u .... ..., u Q c .;0 Q . .1"0 " Q ;.a; .:.;:: iNFANT HYGIENE Admissions to medical service__________ 92 127 Admissions to nursing service__________ 200 164 Visits to medical conferences__________ 465 274 Fi.,ld and office visits _________________ 591 344 PRESCHOOL HYGIENE Admissions to medical service__________ 48 171 Admissions to nursing service ________ 91 169 Visits to medical conferences __________ 239 229 Field and office visits _________________ 274 227 -- Dental inspections_____________________ SCHOOL HYGIENE lnspect1ons by physicians or nurses __ 2,868 1,414 Examinations by physicians ____________ 1,187 290 -- Admissions to nursing service__________ 9 4 Field and office visits _________________ 22 96 Dental inspections_____________________ 2,011 ADULT HYGIENE 1\'Iedical examinations ________________ 222 644 MORBIDITY SERVICE Medical visits ------------------------ 187 3 Nursing visits ------------------------ 164 2 Admissions to hospitals________________ -- 3 12 127 4 58 230 35 47 233 87 113 65 424 3 17 72 151 231 518 166 5 355 132 189 362 735 tc'-< .~ ~... ::t:: 51 10 84 66 38 51 47 98 4 13 4 51 54 117 .... 515 488 514 ";~.;..':.- 31 129 4 -- 67 130 3 2 1,282 52 52 103 2 61 29 20 63 224 31 ... 125 1,823 0 Ol:l ~ 4,828 .a...;;::::;! 5,493 -- 4,200 c 185 808 605 728 ;:::! "' 145 33 1,259 -- 185 -- 253 534 11 1 55 43 -- 6 1 4 13 274 2 -- 1 1,013 650 105 ~ Coil w CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNT.Es-1942-Continued 0\ .. ~ c3 E :::1 0"' 0 ..!.!. ..E:. 0 SANITATION \\'ater supplies approved_______________ 13 Privies and septic tanks installed _____ 65 Food-handling establishments registered 11 18 Dairy farms registered _______________ 8 :\lilk plants registered---------------- 2 Field visits ____ ---------------------- 58 565 14 LABORATORY SPECIMENS Specimens examined _________ 1,242 2,783 309 "..",, .~ .il,: 0 0 ~., 'i E 0 c. 0"' ."'C Q ..", ~ Q ...~ ; <.> Q ...... c~ ~ 2 -- 89 9 1 20 1 40 149 "' 5 420 .c... 16 s(J'q 2 194 -- 7 -- 46 119 13 4 \:::1 20 1,115 1,157 "'"!:..:;..::.:..,l. ;:::! :J 1,027 231 3,259 133 320 4,237 4,126 -"'.;,::.:!. c ~ !;:: ...:.:. <') ::t: s:"-;:.',.. J CoNDENSED REPORT oF AcTIVITIEs oF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued ------ .."... c" :; ..,, 0 c" ..c c=""' =c=" ., ... 0 ..c ~"' ~ " .E "'..c c ~ L;j t: :":! ~ ;; =c "E ' ~ ., c "> ' ~ COMMUNICABLE DISEASE CONTROL Admissions to medical service __________ 39 Smallpox immunizations_______________ Diphtheria immunizations______________ Typhoid immunizations________________ 39 307 341 1,867 VENEREAL DISEASE CONTROL Admissions to medical service __________ Clinic visits _________________________ Field visits -------------------------Number of clinic treatments ____________ 234 2,886 87 2,663 TUBERCULOSIS CONTROL Admissions to medical service__________ 63 Admissions to nursing service __________ 116 Clinic visits __________________________ 78 Field and office visits ________________ 263 MATERNITY SERVICE Admissions to medical service________ 143 Admissions to nursing service __________ 139 Visits by ante-partum cases to medical conferences ________________________ 419 Field and office visits _______________ 287 5 392 2 21 2 9 2,617 6 -- 858 170 36 392 94 256 4,701 1,186 l:ll 1, 776 96 1,5ri7 72 1,013 97 981 67 1,193 179 1,195 88 33 2 212 80 1 113 57 5 747 228 425 30 -- 498 54 -- 1,939 67 -- 2,582 168 2 87 2 5 94 1 5 1 2 181 2 2 6 148 178 2:l7 258 208 125 116 199 256 656 1,481 133 2,701 871 99 814 1 119 810 84 58 271 120 917 917 3,179 1,464 194 2 91 275 808 917 2,904 1,387 30 18 63 30 47 127 91 73 87 l!H 12:{ 86 176 463 38 51 92 :13 63 1:!7 239 180 52 94 62 117 160 131 18;) 407 c .cc..,. 114 t"-< l:i3 162 1,169 -0 "'>=> ::t:: ~ ";;':. 11 183 23 a (1""q !;:> 172 ;:l ;:; 134 c~; ;:l 303 "' 134 607 61 119 157 329 CJ.j -l CoNDENSED REPORT oF AcTIVITIEs oF LocAL HEALTH DEPARTMENTS, BY CoUNTIEs-1942-Continued ..""..' c 0.,.., c .,., .t.:, c""..' ... .;;, c" .,., ~ .... .. .0.., .... ..E., c": ' t.:. ;; c.". ..c.: ~ i;j :..!.!. ..E.. ..>.. INFANT HYGIENE Admissions to medical service____ ------ 79 Admissions to nursing service__________ 104 Visits to medical conferences ___________ 225 Field and office vis!ts _______________ 212 PRESCHOOL HYGIENE Admissions to medical service__________ 30 Admissions to nursing service__________ 9 Visits to medical conferences_________ 31 Field and office visits _________________ 11 Dental Inspections_____________________ -- SCHOOL HYGIENE Inspections by physicians or nurses ____ 120 Ex,aminations by physicians___________ Admissions to nursing service __________ 4 Field and office visits_________________ 4 Dental Inspection--------------------- -- ADULT HYGIENE Medical examinations _________________ 38 MORBIDITY SERVICE Medical visits ------------------------ 6 Nursing visits ------------------------ 23 Admissions to hospitals_______________ -- 120 14 457 53 169 20 1,017 132 -- 21 21 76 45 34 25 213 106 7 62 11 149 26 99 32 332 370 8 819 16 837 10 3,659 21 5,963 58 139 233 1,271 205 430 42 42 10 14 29 21 61 -- -- 199 -- -- -- 83 -- 13 4 15 30 13 4 24 40 -- -- -- 1 163 255 5 1 2 24 3 2 42 -- -- 1,229 4 -- 10 1 422 1 CcJo.J c: .;: .c..: <;") 18 88 (.c1..>. 25 ~ E; 165 t:l ~ 36 l... 1~2 ;l ... 43 ~ ;::! 200 -- ~ ~ -- 6 St ~ 6 6 -- -:::r:: (1> .1,:1.. 14 220 CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued ..... 0 Q ~ Q"" ...,., .t.:, Q=" . =;;, Q" ..,.., "' .. ..0., "' ...E., E" "' SANITATION Water supplies approved_______________ 21 21 Privies and septic tanks Installed_______ -- 209 21 17 Food-handling establishments registered -- -- 20 -- Dairy farms registered________________ -- -- 11 Milk plants registered_________________ -- 1 -- -- -- Field visits ------------------------- -- 1 930 23 5 1 4 LABORATORY SPECIMENS Specimens examined __________________ 1,497 700 5.H7 184 9 1,025 439 .1...: ;:;; .'"=G E >.." "' "' 27 1 -- -- -- -- -- -- 5 53 23 2 951 775 .";: .".. 120 ...tc-- -- (") 1:) -- 202 ...::t:: <1) 1;.:.::.)... 607 0... Oi ;::s .o...' .=.=. ~ j ;I:. 0 CoNDENSED REPORT OF AcTiviTIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued ~ I""I.'' COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ Consultations with physicians __________ Field visit' ____ ------------------Smallpox immunizations _______________ Diphtheria immunizations_____________ Typhoid immunizations ________________ I 1 3 70 28 1,493 VENEREAL DISEASE CONTROL Admissions to medical service__________ Clinic visits __________________________ Field visits -- ----- -----------------Number of clinic treatments __________ 77 1,740 36 1,348 TUBERCULOSIS CONTROL Admissions to medical service -------- 22 \.dmissions to nursing service__________ 22 Clinic visits ______________________ 23 Field and office visits ________________ 24 MATERNITY SERVICE Admissions to medical service __________ -- Admissions to nursing service__________ -- Visits by ante-partum cases to medical conferences __ ----------------Field and office visits _______________ c ..'CI ;";:' .c .>. ~ II. :;:; c :! II. c fa "II. 5 126 1,743 619 6,j74 164 63() 415 2,461 10 216 197 2,914 44 23 448 2,264 1,338 7,500 529 7,620 575 7,247 93 3,850 1,850 3:1,331 -- 134 2,266 1,728 32,781 272 82 88 2,::105 579 99 1,o61 293 98 3,5:13 1,800 250 191 5,414 14 138 116 33 577 54 868 21 ;.4 1.782 332 3:)4 102 3,875 .... "E ... ~.""..,.. c c ~ c ....'C...I. "''CI f "c "".... "' "' "' "' "' "' ~ ~ 1 1,810 2 91 7 .0.. 1 141 2 5 1 ~ 2 28 719 140 36 23 ~ 127 128 1,721 2,43;) 483 331 1::::1 36 70 1,100 195 264 296 ~ ~ 406 1,3i3 2,624 3,652 2,719 2,28:i ..~..... ;3 20 29 1,637 85 421 374 ~ ;::, 177 11 174 619 20,G84 :;o 2,447 444 L\,898 900 79 886 6,118 257 5,154 8,811 75 8,436 --"" 0 ~ 0::: 5;) 96 1:)2 fi2 28:) 278 : ~ '"' 30 126 69 26:1 :::z:: ~ 54 1,684 168 1,370 159 599 23 210 134 807 ..~..,............ 2,)9 61 29S 617 17G 760 151 240 14 173 2:i8 451 50 2:) 596 6Ki _j CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued -..."..,..' ., "'C> ii: c =.C".~.>' .:;;; c .~ .. c ...~ ::1 .~ E ... "u ~"~' c c .,c C> ~ ~ C> ..", ' ~ ..c ~ "' "' "' "' "' "' INFANT HYGIENE Admissions to medical service__________ -- Admissions to nursing service__________ Visits to medical eonferences Field and office visits _____ PRESCHOOL HYGIENE Admissions to medical service __________ Admissions to nursing service__________ Yisi.s to medical conferences }~ield and office visits _______ Dental inspections_______ --.------- -- SCHOOL HYGIENE Ins!Jections by physicians or nurses ___ J<:xaminations by physicians ___________ Admissions to nursing service__________ Field and office visits_ ___ Dental inspections________ ------------- -- 30 2:11 Ei:J 38 Gil 677 116 ~II 398 !!6 229 36 914 211 :i,669 4,6:1! 34 166 ~.278 1 2.) 36 42 725 88 1,476 67 1,579 2:J7 ri,671) 28 1,948 47 2,949 8:; 2,693 129 7 ,lOG 3 ;,,426 2,:)88 1,129 11 2,511 25 82 60 83 84 :J311 28 184 307 137 141 141 I:"-< Ci 2f:7 1,324 120 487 649 ."Q."... 374 31 :i17 430 39 946 ::t: 45 17 8!) 176 604 ;;".:.:;'.,... 20 89 42 170 435 1,618 a..., '{ ::l t;; 2 1,860 3 1,09:J 121 1,2:18 1,334 419 ;.,:.:,,. "0" ;:I 24 44:J 0 "' 36 3,894 1,33G ADULT HYGIENE Mediral examinations ---------------- 924 1,293 2111 1,781 -- 869 66 MORBIOITY SERVICE Medical visits _______________________ Xursing vh:its _______ --------- ----Admissions to hospitals _____________ 3 2 91 IO:J 7 13 5 7;)8 87 -- 2,262 423 188 140 142 18 13 1 13 .o.f..>... I J CoNDENSED REPORT OF ACTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued .~....... ...... 0 ii: :.S.. ~ 0 II. ...c: c: II. c: ...=0 ::1 .. E ~ ...,. .0 ~ ..c: ~ Cll .c.0...: 0 ........ Cll Cll SANITATION Water supplies approved______________ -- 2 3 -- 206 -- Privies and septic tanks Installed ______ 38 22 20 3 397 -- Food-handling establishments registered -- 176 157 -- Dairy farms registered_________________ -- Milk plants registered_________________ -- 42 18 -- -- 1 -- ---- Field visits __________________________ 126 1,268 22 11 7,100 3 LABORATORY SPECIMENS Spcimens examined __________________ 1 2,007 430 408 13,584 209 -- 2 114 125 15 1 18 156,230 2 2 41 104 -- -- 22 9,402 414 18,024 1,148 2,649 t .... ~ ~ 61 ~ <:> 72 -- ~s --- 458 t:::! ~ .~.. ~ 2,206 ~ -.:.:.:.l <:> ~ g:0"' t:t: ~ ;~;. CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY COUNTIES-1942-Continued =. 1: '"i' Ill .....E... .a :z: .. :z: ....10....: ..1: 0 ~. :z: :z: ....... :z: .1: :z: .~ :z": ..~ 1: :z: -"0:;' :"0z: COMMUNICABLE DISEASE CONTROL .Admissions to medical service__________ Consutatlons with physicians __________ Field visits -------------------------Smallpox Immunizations_______________ Diphtheria immunizations______________ Typhoid Immunizations________________ 50 94 785 418 3,811 22 18 132 390 263 2,243 13 1 226 486 660 3,703 11 25 60 645 497 2,565 1 3 18 1,115 222 1,661 9 5 30 1,251 123 2,169 1 3 4 11 2 1 3 11 2 13 11 21 4 601 1 2 442 634 VENEREAL DISEASE CONTROL .Admissions to medical service__________ 190 49 603 68 21 211 51 148 -- Clinic visits ------------------------- 3,901 515 5,312 1,135 128 3,100 969 2,296 -- Field visits -------------------------- 82 116 306 58 40 10 -- 3 Number of clinic treatments____________ 3,502 512 5,071 1,135 92 3,056 836 -- 2,081 -- TUBERCULOSIS CONTROL .Admissions to medical service__________ 118 136 112 2 71 90 10 6 46 6 .Admissions to nursing service__________ 214 82 184 55 161 96 6 91 6 Clinic visits ------------------------- 79 137 110 54 16 92 10 3 57 6 Field and office visits ________ 685 454 663 110 295 210 8 159 6 MATERNITY SERVICE Admissions to medical service__________ 42 Admissions to nursing service__________ 73 Visits by ante-partum cases to medical conferences ~----------------------- 86 Field and office visits ________________ 145 37 13 340 55 219 435 71 186 911 203 123 992 -- 140 31 146 391 60 413 -- -- 5 4 -- -- -- -- -- 6 5 . ~ 3 25 118 ct--o 165 1,312 .2.... ::X:: 38 ~ "s'. 419 1 c... 391 -~ 35 c 128 ;:: 36 "' 218 95 119 300 510 ~ CONDEN~~D REPORT oF AcTIVITIES OF LOCAL HEALTH DEPARTMENTS, BY CouNTIEs-l942~Con~inued "cc 'i ."' .~.".., ... ~ ."0 "c c 0 ~ f. .. .~ ~ "' X :c :c X X INFANT HYGIENE Admissions to medical service~-------- 48 Admissions to nursing service__________ 104 30 103 215 -- 10 77 430 459 47 25 Visits to medical conferences 112 81 214 336 27 Field and office visits _________________ 268 228 1,875 1,065 112 46 -.~ X ....., ~ X" c ~ ~ c :::0 X" 0 X 1 25 -- 1 126 PRESCHOOL HYGIENE Admissions to medical service 112 Admissions to nursing service__________ 143 Visits to 1nedical conferences __________ 161 Field and office visits ________________ 254 Dental inspections _____________ ------- -- SCHOOL HYGIENE lnspertions by vhysicians and nurses _ Examinations by physici-ans ____________ Admissions to nursing service __________ Field and office visits ________ Dental inspections ______ ------- 5r:i7 1,033 814 870 36 141 246 63 48 403 fi89 68 29 98 331 432 68 193 1,189 951 167 44 123 3,217 648 9 322 290 686 5 66 35 s 42 90 103 17 147 1 103 1 1 1 -- 1 1 4 8 22 ADULT HYGIENE )fediral examinations ________________ 30 1 416 1 17 MORBIDITY SERVICE l\fedical visits ------------- 48 Xursing visits ------- ________________ 187 Admissions to hospitals _______________ 14 3 26 32 2!'! '\7 sn 28 4 7 7" 3 23 4:16 3 ........ c ~ ~ 54 92 ".c..'. 101 r:Je. ~- 104 i:::l 1 "."~,"...",,'. 5 ;::! 1 12 -"',:.:,l. c "'i:; ;:: 138 8 : :"":t'':: 14 \":.'.. ;;. 230 3:i0 5 CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-l942----ontcinued -""""i .E .~ ."c -; ~ 8". "' X X X SANITATION 'Vater supplies aPilroved ____________ __ 2 Privies and septic tanks installed _____ _ 19 Food-handling establishments registered Dairy farms registered________________ Milk plants registered_________________ 14 20 65 13 26 Field visits 733 203 2.385 .~"""' ."~ ' ~ X X 10 13 4 75 ."t: ":E X X ;:_. t": X"" :::J X" -- 7 22 73 35 19 62 161 183 LABORATORY SPECIMENS Specimens examined 761 458 2.163 1.022 151 868 12 33 197 43 "~ 19 t"-< 0 ."!;.:>'.. 5 ::t:: ....~ !;:> 387 ;:;:. a.... ...0\:\ "g~' ;::; "' ~ j CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY COUNTIES-l942-----ontinued ...."0...., ........,. . ;;; 1: -. = Q" .., 0 I! ..., . .~" ."., "~ ..t"0.=, ... .0"., ....E.... ..."... .. ."~ :::0 .... COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ Consultations with physicians____ . _____ Field visits --------------------- ---Smallpox immunizations_______________ Diphtheria immunizations ______________ Typhoid immunizations________________ 2 4 33 43fi 826 4,345 VENEREAL DISEASE CONTROL Admissions to medical service__________ Clinic visits ------------------------Field visits -------------------------Number of clinic treatments __________ 144 1,838 230 1,820 TUBERCULOSIS CONTROL Admissions to medical service _________ f5 Admissions to nursing service__________ 121 Clinic visits -------------------------- 75 Field and office visits ________________ 314 MATERNITY SERVICE Admissions to medical service __________ 31 Admissions to nursing service_________ 50 Visits by ante-partum cases to medical conferences ------------------------ 95 Field and office visits _________________ 156 1 2 19 568 569 1,781 146 1,976 193 1,826 17 29 17 137 76 100 209 383 1 14 61 8 1 1 6 18 1 2 49 121 1 61 1 288 242 262 7'3 168 248 632 318 318 62 300 117 964 2,627 2,541 1,715 3,049 1,734 92 244 347 132 826 3,084 4,405 1,253 142 929 54 31 803 3,052 4,397 1,089 163 3,029 109 3,022 220 3,593 223 3,206 72 34 117 37 59 104 130 98 118 38 103 132 72 28 151 39 62 128 168 264 42:i 114 381 461 14 493 271 37 86 142 26 493 271 55 138 183 24 1,471 1,150 135 90 1,826 1,225 252 192 350 332 691 48 254 2 117 64 106 165 2.913 188 750 778 5,155 133 466 987 4.389 445 54 784 4,372 38 105 66 105 38 205 144 333 91 12 116 20 242 8 373 40 ~ . .... ~ 1 1 ."c.,' 10 ~ ;; 472 203 1,056 t:l "'"!.l.:..::.1,.l. ;3 "'.... 295 ~ 2,864 119 ~ 2,293 ~ !o;: - 33 f- 48 ::t: 36 128 ;a";'... 202 218 500 620 J CoNDENSED REPORT oF AcTIVITIES oF LocAL HEALTH DEPARTMENTS, BY CoUNTIEs-1942-Cont>inued .."... ~" .......... ....;.: Cl ~ .:%...".:..! ., .~."".. ..s""0.... ."....... .....E.... .. ...".. .. ."f ::J .... INFANT HYGIENE Admissions to medical service__________ 22 27 7 163 125 4 44 62 40 Admissions to nursing service__________ 47 62 25 163 163 ll7 172 198 87 11 Visits to medical conferences__________ 67 65 13 334 280 4 77 110 40 Field and office visits________________ 185 149 70 426 222 63 405 599 210 14 PRESCHOOL HYGIENE Admissions to medical service__________ 21 Admissions to nursing service__________ 16 Visits to medical conferences___________ 46 Field and office visits_______________ 69 Dental Inspections_____________________ -- SCHOOL HYGIENE Inspections by physicians or nurses ____ -- Examinations by physicians____________ -- Admissions to nursing service__________ -- Field and office visits .--------------- -- Dental Inspections_____________________ 41 3 44 32 22 14 32 28 65 27 7 58 35 15 14 163 148 71 1 6 61 84 25 14 48 45 88 19 24 91 104 15 14 333 313 136 13 -- -- -- 5 29 -- -- to -- 1,753 31 233 1,274 20 1,454 789 -- 42 -- -- 946 109 8 49 -- 54 -- 55 16 14 81 4 -- 310 -- 84 150 -- -- 582 -- 621 ADULT HYGIENE Medical examinations ________________ -- MORBIDITY SERVICE Medical visits _______________________ -- Nursing visits ------------------------ 13 Admissions to hospitals---------------- -- 426 9 -- 388 1,107 -- -- 44 50 -- 33 -- 214 2 7 6 78 4 -- 89 85 493 2 -- 1 -- 31 .. .... 78 151 154 tc-- 372 .'!".:>.'.. ::t:: 106 138 156 285 s"~'. a.... -- I{ ;::s 405 9 ~.!o:.>. ;::s 6 49 "' 2 121 ~ to CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIES-1942-Continued c .,~ .>1. ~ SANITATION Water supplies approved_______________ 1 Privies and septic tanks installed _____ 22 Food-handling establishments registered Dairy fanns registered ________________ -- Milk plants registered _________________ Field visits __________________________ 11 LABORATORY SPECIMENS Specimens examined ------------------ 782 ... ~"""'' :";:' -Q " ~ =."0.'. ~ :;"c;;' c ..".. c .c~., ~ 2 -- 12 -- 1 4 43 3 8 -- 18 -- -- 3 1 112 39 825 36 640 65~, uh. 1,321 320 ... ... "c ' "c"' ~ "E ' "...J .!! c "...J ~ :::s "'...J ""...J ~ 14.. 14 2 30 .~ a... CJq ~ 4 6 52 36 1:i 322 1::::::1 ~ 7 "T;, .i...;....l. ;3 s:;s 961 609 3,043 1,487 ~ -.~.... a ~ g:!o::- ::X:: ~ i;l s""."' CoNDENSED REPORT oF AcTIVITIES oF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued ~ .::c:; COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ Consultations with 11hysicians ------ ]'!eld visits -------------------------Smallpox immunzations _______________ Diphtheria immunizations ______________ Typhoid immunizations ________________ 157 :; 603 750 339 1,453 VENEREAL DISEASE CONTROL Admissions to medical service _________ Clinic visits _______________________ Field visits __________________________ Numbc.r of rlinic treatments __________ 442 7,289 556 6,545 TUBERCULOSIS CONTROL Admissions to medical service 20 Admissions to nursing service _________ 61 Clinie visits ________________________ 14 Field and office. visits _______________ 210 MATERNITY SERVICE Admissions to n1edical service__________ 148 Admissions to nursing service __________ 175 Yi.sits by ante- parturn cases to medical conferences ____ ------------------- 452 Field and offiee visits ________________ 607 ~ c 0 ~ :::; "c ' 0 ..J ""c" "0 ..J i73 338 3 70 1,131 679 279 1,343 9 92 621 1,023 388 104 1,178 13 1,162 113 3,126 373 3,o42 1,048 16,78;) 322 11,513 41 160 G3 166 44 167 ISO 1,4 iO 40 478 60 566 l!'il I ,851 209 2,835 .c "' E "..J "~ ~ .c .~ e c" c u u :;; :;; .c 0 u :;:: 1 130 12 1 14 5 38 66 52 160 131 .96 9," 458 13 728 1,2:15 1,600 25 328 505 5,178 10 12 499 4,710 109 2,164 774 1,6.>:! 392 6,054 1,028 5,471 82 10 71 113 22 87 93 102 107 141 :!43 352 33 79 151 59 86 206 71 78 367 1:39 n:l 1,387 c .~ :;; ::;; c ~ ":;; 2 2 2 106 49 20 8 137 52 72 849 1,288 2 564 994 =;~s :;; 10 6 61 1,234 312 -ta"- (') 1:) 3,769 ::X:: "(:'.. ;:;. 269 3,621 a..., 72 C/0. 1:) 3,144 N;:: . 90 c~; ;:: 199 "' 90 491 119 163 256 333 .j:. 10 CoNDENSED REPORT OF AcTIVITIES oF LOCAL HEALTH DEPARTMENTS, BY CouNTIEs-1942--Continued .... .'1.:.: :::; ..c: 0 c: :::; ..... .."0.'. c: it ..0.. ..c.:. E g .."Cl -; .s c: c; ."0 ' ."... :E :E :E c: ..:i;i;i .c: ~ :E :E INFANT HYGIENE Admissions to medical service_________ 147 Admissions to nursing service_________ 214 Visits to medical conferences__________ 371 Field and ~ c 0 :;: st: 0 -".;' .c ~ 0 0 :;; :;; ... t :";; ."" 0 "~ :";; c 0 'i z" 4 -- 3 3 14 34 4G:l 9R2 1,038 1,476 241 239 338 223 333 1,862 1,290 2,188 ;)4 5 771 910 7;)5 5,695 181 2,840 68 2,514 97 1,226 61 1,143 216 3,081 19 2,548 3, 748 31,653 3,68:; :li,827 427 9,223 217 7,836 78 68 122 414 50 11 43 1o6 ;:i25 96 80 122 737 270 31 207 264 1,894 31 34 106 :II ss 148 ::i6 47 2:>0 100 224 194 4 9:l7 34 8:i9 8 3,621 88 2,0113 "~ ""c 8 =0 ;";. 0 0 8 39 20 19 262 41 125 898 4,147 12 2 :>17 2,37;) 2 7 2 7 (J1 t-,:; ... c ='=. 11. G':l 1 1 (.c1..). ~ 1 ~ 139 53 t::::l (1) 146 ~ .~... 34 308 13 290 (1) -.,,:::1. c '"tl g: ~. 1 "' ::X:: ;\'?";..... CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTs, BY CouNTIEs-1942-Continued CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTs, BY CouNTIES-l942~Continued . :E .. "~" :E ..0 c ..i:.' E 0 !! c .c ~ .. ~ 0 :E 0 :E 0 :E :"E' .0..... :"E' c .0 i z .. ..c0. 1: =.0 iii 0 0 SANITATION Water supplies approved 8 28 18 Privies and se>Ptlc tanks Installed ____ _ 19 111 44 10 17 211 34 Food-handling establishments registered 189 Dairy farms registered ________________ 65 ~Iilk plants 3 Field visits 18 94 53 19 13 17 8,342 31 6 21 -- 5 56 LABORATORY SPECIMENS Specimens examined 1,919 604 355 202 10,728 1 5 1 ~ .. ..:c; :; A. ~ 45 (c-'.b, ()q 5- t:l ('b 100 "!::! -.!;..:.>,.. ::3 ('b 59 .:.=.1.. c -;~: o- -~ ::X:: ('b s.!.;.:.>.... CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942--Continued ...., II. COMMUNICABLE DISEASE CONTROL Admissions to medical service__________ Consultations with physicians__________ Field visits -------------------------Smallpox immunizations _______________ Diphtheria immunizations_____________ Typhoid Immunizations________________ 15 5 52 564 438 1,754 VENEREAL DISEASE CONTROL Admissions to medical service__________ Clinic visits -------------------------Field visits --------------------------- 306 5,693 281 5,080 TUBERCULOSIS CONTROL Admissions to medical service _________ 110 Admissions to nursing service__________ 165 Clinic visits ------------------------- 137 Field and office visits_________________ 386 .~ ..".. a: . f a": .a..:. 1 23 5 1 3 5 1 32 41 189 487 519 72 108 280 663 1,719 1,355 19 164 224 205 1,862 3,773 6 102 215 202 1, 778 3,404 1 28 118 48 132 1 47 125 157 240 ... 0 ~. :; II. II. !E "II. 3 15 -- 4 8 -- 3 13 904 10 800 3 506 204 63 400 118 5,099 2 30 84 5,099 94 1,511 1,403 11 57 -- -- 61 -- 6 71 -- 164 ..E" "c:l .."".. "' ...,. .0.. ""' ... ...E"0., ii: -- 10 1 36 -- 1 2 29 50 10 1,036 tc"-< 125 161 2,206 361 1,611 1,683 .2...... 961 31 528 2,868 270 1,912 7,528 3,838 55,338 -~ 1..:..>... c.... 1 so 44 6,441 ~ 512 1,544 46,766 ...r;; .1.:.>. 76 41 1,372 c ;:s 15 80 94 168 42 "" 1,395 3,580 15 283 247 8,905 MATERNITY SERVICE Admissions to medical service__________ 236 Admissions to nursing service________ 307 Visits by ante-partum cases to medical conferences ------------------------ 543 Field and office visits ______________.___ 609 113 61 72 66 130 131 -- 150 66 290 159 320 256 377 357 -- 151 292 53 !14 1,199 63 107 1,437 194 354 4,111 410 304 9,003 <:Jl <:Jl <:J1 CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued 0'\ ...c -" 0.. ,;".' a": a"""~: ,a".: ,. c; 0.. .:;; "' =0.. E. .::s: 0.. .c E :s t:1 c .:a:1 a": ..c,. .c.,; c a: ., c 0 E .c 0" : INFANT HYGIENE Admissions to medical service __________ 99 Admissions to nursing service__________ 150 VL;Its to medical conferences ________ 1;)3 Field and office visits _______ 214 PRESCHOOL HYGIENE Admissions to medical service __________ 20 Admissions to nursing service __________ 14 Visits to medical conferences _________ 9:J Field and office visits _______________ 109 Dental inspections____________________ -- SCHOOL HYGIENE Inspections by physicians or nurses Examinations by physicians __________ Admissions to nursing service __________ Field and office visits _________________ Dental inspections ___ ~'i-"--"c-~--------- 24 5 5 1,250 ADULT HYGIENE :Medical erimens examined _________ _ 601 22 18 9 39 55 29 1,015 737 70 2 28 2,048 30 12 11 4:17 1,010 t:'-; a 124 (') .I=.>... 160 2 19,790 ::X:: ;"::'.. ;;. GG:> 901 69,400 a ""(Jo, I;=::>: aNc";' ;::: "' (Jl o.-J j CoNDENSED REPORT OF AcTIVITIEs OF LocAL HEALTH DEPARTMENTS, BY CouNTIES-1942-Continued ., ..o.,;. c"0c .,., :;: "" ' .c , > ~ "" ' . 0 .ce. "' . c o'=..;. "' ., c .:"c:' Cij ..t: .3.: Cij e.. :::1 ..0.... o; ....0 ..... o; "' 1- 1- COMMUNICABLE DISEASE CONTROL Admissions to medical service _________ 1 11 9 51 18 10 3 38 1 Consultations with physicians __________ 1 2 3 28 8 13 Field visits --------------------------- 1 73 16 43 63 67 21 85 2 1 Smallpox immunizations_______________ 74 159 229 81 591 1,212 1,187 116 112 -- Diphtheria immunizations______________ 102 95 194 189 474 311 606 302 11 -- Typhoid immunizations________________ 967 l'i3 2,388 558 5,125 2,738 1,912 4,365 198 VENEREAL DISEASE CONTROL .Admissions to medical service__________ 87 164 554 121 915 66 Clinic visits -------------------------- 2,259 2,928 8,485 809 19,427 773 Field visits -------------------------- 40 499 6 235 452 150 ~umber of clinic treatments_ _________ 1,412 2,308 7,919 747 16,928 765 58 611 611 12,867 :13 107 586 11,544 102 1,808 28 1,380 162 2,725 5 2,496 TUBERCULOSIS CONTROL Admissions to medical service__________ -Admissions to nursing service__________ -Clinic visits -------------------------- -Field and office visits _________________ -- 84 52 91 213 26 81 128 667 138 124 48 392 212 34 149 447 1,fl96 174 43 106 49 127 46 99 113 ;}26 3 14 3 2 14 3 MATERNITY SERVICE Admissions to medical service__________ -- 25 105 120 274 43 65 452 -- Admissions to nursing service__________ -- 53 107 133 348 78 111 577 -- Visits by ante-partum cases to medical 42 296 350 1,029 83 127 1,583 118 302 438 1,326 ~32 217 2,134 ..c.... -:< 1- 290 6 291 1,327 158 2,748 81 1,368 167 1,361 3 83 3 150 4 48 7 113 <:rt 00 ~ ., aq ~ 1::::1 ~ ..~....,. ;3 <1> -.~.... c "'i:: !::: 0" ~ -::X:: <1> ~ ;;. CoNDENSED REPORT OF AcTIVITIEs OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued . ..O....i ="0 .,., :;: r"n .c > ~ r"n .. .. 0 .ec rn :c ; Or.n.i. .. c ....c.. ;; .t: ;ll .,_ 'E r"n - .. .0.. .:~. .O..i ... INFANT HYGIENE Admissions to medical service__________ -- 9 6 39 153 22 15 217 -- -- Admissions to nursing service_________ -- 42 25 91 369 68 60 347 Visits to medical conferences__________ 11 7 62 301 50 23 531 Field and office visits ________________ 109 34 194 1,084 197 100 1,163 PRESCHOOL HYGIENE Admissions to medical service__________ 4 6 159 107 Admissions to nursing service__________ -- 28 Visits to medical conference.. _________ 4 10 394 130 6 292 117 Field and office visits ________________ 46 17 818 184 Dental inspections____________________ -- -- -- SCHOOL HYGIENE Inspections by physicians or nurses ____ Examinations by physicians ____________ -- Admissions to nursing service__________ Field and office visits~--------------- Dental Inspections ____________________ -- 393 1 4 2,754 1,199 253 172 2 1 28 12 4 18 165 114 57 5,438 ADULT HYGIENE ].!edical examinations ---------------- 1,292 207 98 1 169 297 3 560 -- 7 J32 552 -- 13 8 31 161 -- -- -- ---- MORBIDITY SERVICE Medical visits ________________________ Nursing visits --------------- ------- 2 Admissions to hospitals ________________ 15 9 35 3 13 8 :; c .~.. 4 39 6 72 -ct-< ~ l:l 3 33 -:::t:: ~ !;l ;:;. 6 35 0.... ~ ;::s ...;:; 188 l:l 23 15" ;::s 34 "' 49 "1"0' CoNDENSED REPORT oF AcTIVITIES oF LocAL HEALTH DEPARTMENTS, BY CouNTIES-1942-Continued -.".;, ~ "0:: SANITATION Water supplies approved ______________ _ Privies and septic tanks installed __ __ Food-handling establishments registered Dairy farms legistered _____ _ :V!ilk plants registered __________ _ Field visits 11 LABORATORY SPECIMENS Specimens examined c ~"' .c ">~ "Ci) e"n 20 767 1,381 ~ c" E e"n ... :cc -; e"n ' "c ' ."c e""n' 11 32 16 37 69 !)3 3S 2;; 2 1,1lfl6 366 647 3,936 1,004 .t: ~ en . ='E" rJl 4 1~ 12 32 4 2,18:! 466 4.472 -.-."..;.. -t ".~ .-.;. 2 9 ;-!4 2 6;) 4fi:i 0\ 0 ..c -.O..i C0 "' 3 a-.0o.... ~ t:::l "' 13 "I.":.>.". ' G84 -"'::l "" 0 ~ ~ ...:. (') ::t:: "'I,;>_ s. CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued ~ >" . 1"-' COMMUNICABLE DISEASE CONTROL Admissions to medical service __________ Consultal.ions with physidans ------ ___ Field visits ___ -- -----------------Smallpox immunizations ______________ Diphtheria immunizations ______________ Typhoid immunizations ________________ T4 3 63 I 39 1,023 VENEREAL DISEASE CONTROL Admissions to medical service__________ Clinic visits ------------------------ __ Fie!d visits __ ----------------------:Number of clinic treatments _________ 215 4,738 102 3,311 TUBERCULOSIS CONTROL Admissions to medical service _________ 50 Admissions to nursing senice________ __ 53 Clinic visits ---- ------- GO Field and office visits ________________ 120 MATERNITY SERVICE Admissions to medical service________ 53 Admissions to nursing service__________ 79 Visits by ante-partum cases to medical conferences ------------------------ 166 Field and office visits _________________ 260 ~ -~.; 1- ~ 1" - 89 1 188 2:i2 1,387 I 7 1,5];) :ll2 :J,ll:l 223 ~.::i8R 280 2,4o6 659 9,14G 1 8,790 ::r; s 89 20 35 308 38 118 482 123 482 475 2,072 549 2,072 .~ E =0 1- 60 64 794 340 4,:1111 479 4,724 217 4,724 69 82 68 187 55;) 606 1,906 2,322 .~ .. -j:: E 1""- 93 33 8 138 38 702 171 224 189 3,695 9'>1 612 4,688 317 4,423 2:l7 2,80G 98 2,784 170 5~ 238 96 119 63 433 147 306 102 .~23 128 1,105 246 1,279 399 ~ c 1""-' c ~ ;"":. c. ;"":. ~ c" ..,. ~ 1"- 'i 1- I 37 8 6:ll 21:1 238 1,929 183 206 1,3')1 7::;6 867 7,821 79 1,339 186 1,246 810 12,930 26.1 ll,548 :;8 88 GO 399 41 :!91 304 2,594 45 274 78 340 103 1,004 314 1,834 11 48 136 89 18 4J:i 109 t'-; -c '~"' G84 2,238 -:::t:: "~ ' ;;. :14 182 .., 476 2,817 0 38 1111 C1'< 421 61 2,578 32 ~ ar;:::l c:; ;::l 143 61 63 47 "' 270 ll6 14 202 109 214 19 6ll 191 68~ 0...'.1.. CoNDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued >.... . ~ -.; 1- 1- INFANT HYGIENE Admissions to medical service---------- 2 86 Admissions to nursing service---------- 15 105 Visits to medical conferences---- _____ 3 :J77 }~ield and office visits ___________ 36 496 PRESCHOOL HYGIENE Admissions to medical service__________ -- 1 Admissions to nursing service__________ 1 1 Visits to medical conferences ________ 3 1 Field and office visits -------------- 4 7 Dental inspections____________________ -- SCHOOL HYGIENE Inspections by physicians or nurses 156 10 Examinations by physicians Admissions to nursing service __________ 4 !8 Field and office visits ---------- 30 53 Dental inspections____________________ 579 306 ADULT HYGIENE Medical e.xaminations ---------------- -- MORBIDITY SERVICE ~Iedical visits ------------------------ Nursing visits ------------------------ 2 1 Adn1issions to hospitals ________________ ~. ..E..... 1- 1- =i= ...E.... 0 1- 146 316 142 43 146 571 360 98 427 891 374 90 435 1,877 753 209 9;) 175 29 103 215 56 2ll 155 49 237 327 131 -- -- -- 182 104 1,064 82 18 ll7 -- 6 2 127 1 9 4 187 1 -- 205 439 -- 1 1 ll -- 6 -- 5 4 .. ..c il: 1- c .~ " {::. ..". ' 1- :.:. 1" - -- 17 161 53 310 73 22 220 139 824 116 8 45 22 188 9 9 49 32 326 15 -- 41 9,029 135 4 390 13 5 9ll 14 -- -- 445 181 5 429 13 89 -- ~ .... 'i 1- n ll8 203 ~ . ~ ~ 257 .gt:::1 4 1...,.:..)., 3 ;:; 14 13 <.;.':I>.s. -- ~ "tt I;: o- 457 ~ 281 s-.::z:: <'I> 1:) 28 -- _j CONDENSED REPORT OF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CoUNTIES-1942-Continued >.... 1- .;; -a; 1- ~ 1" - ., ..E .c 1- ::: j:: ....E..,, 1- SANITATION 'Vater supplies approved _______________ 1 Privies and septic tanks installed ______ 9 Food-handling establishments registered -- Dairy farms registered _________________ -- :\filk plants registered_________________ Field visits -------------------------- 35 1 1 2 1 18 12 19 3 -- -- -- 8 129 15 259 73 LABORATORY SPECIMENS Sveeimens examined ------- 218 678 1,855 2,477 2,168 698 ...c . . 1- ;c i""= ..".. i= . :" : 1"- ." . 'i 1- 5 58 13 56 ct-< 5 -- 1 2,159 -3 <':> -- 11 ~ ::t: s.:.:.:.:0.... 4 486 2,295 344 1,156 .a., ....~:: ::::0 c :;::! "' ~ 0'\ CoNDENSED REPORT oF AcTIVITIEs OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued >!'- c ,;.Q.;,; COMMUNICABLE DISEASE CONTROL Admissions to medical service-------- 1 Consultatio:-ts with physicians - -- -- Field visits ---- ---- ---------- -- 2 Smallpox immunizations ____________ 2:i1 ll"iphtheria immunizations ____________ 223 Typhoid immunizations _______ 926 VENEREAL DISEASE CONTROL Admissions to medical service_________ -- Clinic visits -- ---- ---- ---- ------ Field visits ------------------------ TUBERCULOSIS CONTROL Admissions to medical service __________ Admissions to nursing service __________ Clinic visits ____________________ Field and office visits -- ---- -- MATERNITY SERVICE Admissions to medieal service _________ Admissions to nursing service __________ -- ViRits hy ante-partum casrs to medieal :.c;.:. -."...;.. ::> ;:,:: c -.:1; ;:,:: ;:"".,.:':. c"...... 3":' 7 43 30 132 1 16 21 81 13 251 1:30 19 219 1,535 404 842 107 592 476 462 -- 1,035 r.,201 4,188 4,006 324 8,456 ri6 7,795 106 2,096 226 2,039 207 3,41:1 145 3,409 :168 5,983 5,342 16o 1,935 1,681 136 226 66 94 268 316 221 94 162 222 144 102 760 846 627 40:i 88 3 79 202 113 18 130 202 271 3 HiO 284 2!14 33 273 354 .cQ.. c ..::: ;:",::' ."c >": ' 69 90 77 270 381 0,,829 446 372 382 260 2,206 2:14 3,262 133 :1,262 :J04 3,99:1 235 3,499 140 123 140 196 149 170 92;) 699 377 ~0 :nr 67 1,42:1 130 1,618 289 -... ;."".;.' ... Q" ; ".::: ;:,:: " .::: ;:,:: <:;"') 8 :; .~ a..., 8 44 1 CJo. ~- 43 230 235 t:; 73 14:> 174 ~ 400, 1,:517 1,0o9 '"<:l >:l ;:::;. ;:; ;,o 694 :J 684 43 466 224 408 27 485 482 -;~:;. a ;~: ;~::; 21 21 23 11 ::X:: 23 21 48 107 ~ s..>..:.l... 23 68 99 fi3 273 3ri:l CoNDENSED REPORT oF AcTIVITIEs OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued .. t ~" ...s .=.<: "' ~ ,.."., ~ .... .""..' ~ .... ;"; ".<: ~ .<: ~ ~ 62 58 16 224 66 54 48 62 155 19 1.218 238 160 47 -to-- 2 ::t:: 166 6 143 13 166 8 ~"' ;;. 150 28 a.., ~ ;::! 507 221 1,965 39:) 20 220 34 .c..' :{8 20 196 109 39 28 221 ;::! "' 1.921 339 19 755 272 356 487 23 51 3 0\ CJ1 CoNDENSED REPORT OF AcTIVITIES oF LocAL HEALTH DEPARTMENTS, BY CouNTIES-1942-Continued c ..c:.!, :"ll c. ....".....'. c Q .~ ... :::l ~ ~ ~ ~" c t ~" ~" c .-;; ~ .c" ~"' .~.. ... ~ ~ .c ~ SANITATION \Vater supnlies approved______________ Ptivie~ and septi<"' tanks ins~alled ______ 8 20 1:{ 69 !j;) :H 1;) Food-handling establishments registered 220 47 Hairy farms registered________________ -- 3 13 2 :.\lill\ }llants registered ________________ 3 }~ield visits __________________________ 1.) 74 363 808 1:i.008 49 2,008 1.>7 9!i LABORATORY SPECIMENS Specimens examined ------------------ 64 1 ,6';'!} 738 l,:?:JG 111.1S6 48:J :?.oqo !,21S 147 ;)(j~ C\ 0\ :"c ~ ~ ~ a.0...s.. !;:l tl ~ ~ !;:l ;::;. ;3 !2:J ~ -,:.:,:l. 0 '"'::1 ~ ;;:;: ::t: ~ ;!.;.;.::.l.,.. CoNDENSED REPORT OF ACTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued COMMUNICABLE DISEASE CONTROL Admissions to Commttations Field visits __ Smallpox Diphtheria Typhoid VENEREAL DISEASE CONTROL Clinic visits Field visits Xumbcr of clinic treatments ____________ _ TUBERCULOSIS CONTROL Admissions to medical MATERNITY SERVICE Admissions to medical sernce________ Admissions to nursing Visits by ante-nartum Fie~ct and office vL<;its ~ .c ~ c ..)( ~" ~""' ~ ~ c ~ ~ ..c t: ~ 106 128 ~;,6 7:JH 776 3,849 40:1 :i,:l64 211 4,198 11;() 274 3:-;n I ,04:> -4 -- J:l:J l,:J:J;j 89 1,371 ;_; ;; :l4:i 3,87:i 228 2,866 4 77 446 129 2,699 188 :l,1flf) :n 2,87:J 96 1fl0 H6 211 38 1 139 ct-< 1,069 (") ,:;:_:, 598 3,183 -::t:: "':;::, ;.;. ()72 7,94!) .0... 1,331 (Jq :;::, 6,646 ~ a!:; 112 c"' ~ 216 "' 113 1,250 33 48 -- 44 109 83 164 121 351 279 658 369 1,570 0\ -l 0\ CoNDENSED REPORT oF AcTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued 00 -...., ;; ... ~ ~" ~ 0 :"!!. ~ c ~ c ~ j ... t: 0 ~ INFANT HYGIENE Admissions to medical Admissions to nursing PRESCHOOL HYGIENE Admissions to medical Dental inspections___________________________________________________________________ _ SCHOOL HYGIENE Inspections by physicians Admissions to nursing Field and office '\'isiLs Dental inspections ADULT HYGIENE :Medical examinations - MORBIDITY SERVICE Medical visits Nursing visits Admissions to 98 117 1:;9 20\J 265 264 333 363 3,367 799 6 26 739 30 25 3 ~ -- 45 92 107 337 Cc b ~ 63 s 144 C1'l. -- 147 6ri3 t:1 Cb '1:;j -- 30 37 >=l .~... 30 143 ;3 -- 30 30 55 233 Cb -.::.:.!. c ;'":t:l -- 3 -- 2,30'> 303 ;:?::; f:i --- 2 3 263 562 369 -::X:: Cb .>.=.l . ~ -- 19 -- 21 28 105 CONDENSED REPORT OF ACTIVITIES OF LocAL HEALTH DEPARTMENTS, BY CouNTIEs-1942-Continued -., ;; .c ~ .>.< ~" :""!!' ~ c ~ c :;; ~ ..c 1: ~ SANITATION 110 Hi Dairy t'arms regis~erell _____________________ ------------------------------------------ _____________ 27 Milk plants registered------------------------------------------------------------ ________________ 1 Field visits _____________ ________ ______ __ ____________________ --------------------------- _______ :>86 16 LABORATORY SPECIMENS Specimens examined _____________________________________ . -------------------------- ___________ 2,461 329 10 --- 20 I -ct'-< (") I:> 4 4:1 2 -::t:: ~ ..!,;,:.>,... -- 939 4,oo:; a..., CJe. I:> r:::l; .:I,:s.>.. ::l "' ~ 70 Georgia Department of Public Health NOTES: The following counties have full time health unit: Atlanta, City of Avvling-\Ya:vne * Baldwin Bibb-Jones * Blecldey-Dodge-Pulaski Brooks Bulloch Burl{e-.Tenkins * Calhoun Chatham Clarke Cobb Coffee Colquitt Crisp-Worth* Decatur DeKalb Houghert:r Floyd Fulton Glynn-Camden-)Iclntosh * Grady Greene G\vinnett Habersham-Rabun-Stephens * Hall Hanrork Harris-.:\Ieriwether * Jefferson Laurens Liberty Lowndes )!ltchell .:\Iusrogee Richmond Spalding Sumter Telfair- Wheeler* Terrell Thomas Tift Troup "'alh:er-C'atoosa * Walton Ware Washington Whitfield *Health district composed of two or more counties. The following counties have nursing serv1ce only: Atkinson Baron Baker Barrow Brantley Bryan Butts Candler Charlton Chattahoochee Clayton Clinch f'oweta Crawford Dade Da\vson Douglas Echols Effingham Emanuel Evans Fannin Forsyth Franklin Glascoek Gordon Haralson Heard Henry Irwin Jackson .Tasver .Jeff naris Johnson Lamar Lanier Lee Long Lum}lkin ::\I a e o n ~Ion roe ::\lontgomery )I organ llurray Peach Pierce Pike Putnam Randolph Serer en Seminole Stewart Tattnall Taylor Toombs Treutlen Turner Twiggs rnson Webster \Yikinson Work in the remarmng counties was done by regional personnel and special venereal disease control itinerant nurse1i. Division of Public Health Nursing January 1, 1942, found the country at wa.r. It was impossible to forecast what changes would be necessary in the nursing program to meet this overwhelming national catastrophe. Certain changes could be anticipated, among them~the shifting of population, with the concentration of people around war industries and army camps, causing an increased hazard in relation to communicable disease; the withdrawal of women from their homes to industries and other types of war work creating the problem of child care; the scarcity of foods with the problem of maintaining good nutrition; the withdrawal of private physicians to military service resulting in the lack of adequate medical care, especially in rural areas; but, the problem which gave greatest concern was the anticipated withdrawal of public health personnel-physicians, nurses and engineers-to service with the armed forces. All of these changes have occurred, creating the need for greater health protection than has existed in recent years, a need which has had to be met with a depleted staff. GROWTH IN NURSING SERVICE The annual census of public health nurses which is taken on January 1st of each year, shows a total of 507 nurses employed on January 1, 1943. This figure represents an increase of 84 nurses as of January 1, 1942, a growth during the year of 19 per cent in the total number of nurses employed. Of this group 358 nurses were employed by official health agencies, 32 by non-official health agencies, and 117 by industries. Though definite gains have been made in the extension of public health nursing in Georgia during the past year there still remained at the end of ~he year 37 counties without full-time nursing service. During the year nursing services were es.tablished in seven new counties, namely: Dawson, Heard, Monroe, Jeff Davis, Randolph, Stewart, and Turner. One county, Schley, discontinued service. Walker and Spalding counties employed a fourth nurse, one of the group being given status as senior nurse. Two assistant supervisors were appointed in Fulton County and one in Muscogee County. Four counties added a second nurse, Stephens, Decatur, Meriwether, and Colquitt. The nursing unit connected with the venereal disease service in the City of Atlanta was reorganized. A supervising nurse was appointed and three colored nurses were added to the staff. In order to bring at least part time service to those counties which had no nursing service whatever the State Department of Public Health established an itinerant nursing service through which treatment for venereal diseases and immunizations against communicable diseases are being provided. This service now covers 32 counties. At the close of the year 35 public health nursing positions were waiting to be filled. On December 31, 1942, State and local official health organizations employed the following nursing staff: 72 Georgia Department of Public Health Director ------------------------------------------- 1 Associate Directors_________________________ ________ 2 Industrial Hygiene Consultant_________________________ 1 Instructor, Public Health Nursing______________________ 1 Regional Consultant Nurses___________________________ 6 Regional Reserve Nurses______________________________ 4 Local Health Organizations-Supervisors_______________ 19 Local Health Organizations-Staff Nurses_______________ 324 Total_______________________________________ 358 Additional nurses employed byNon-official agencies_______________________________ 32 Industries --------------------------------------- 117 Total _______________________________________ 507 During the year 42 nurses resigned, 12 to enter military service; 10 to marry; 5 for maternity leave; 4 because of illness; 4 to accept other positions; and 7 for other reasons. The number of resignations in 1942 was nearly twice the number that occurred during the entire two prect>ding years. The service of the public health nurse has been augmented by the use of clinic nurses who have been recruited for the most part from among inactive marrried nurses. In cities these nurses have usually served in a full time capacity .and in rural areas on a part time basis. At the close of the year there were 15 full time and 77 part time clinic nurses being used. Their service has included the setting up and dismantling of clinics; administration of vaccines, the sterilization of equipment, syringes and needles for the venereal disease clinics; the mixing of drugs and assisting physicians in these clinics; assistance in record keeping and clinic management. V:olunteer lay help is also being increasingly used especially in connection with maternal child health conferences. TRAINING PROGRAM One of the most serious effects of the war on the development and extension of public health nursing in Georgia has been the decrease in the number of new nurses being trained for service. That number has decreased from 65 in 1941 to 46 in 1942, a loss of 29 per cent, and this reduction in trainees occurs at a time when additional service of hi '!h quality is increasingly and urgently needed. It is doubtful if the number of trainees can he increased in the coming year. It is the young graduate nurse who is most needed for military service and a very high per cent of all the younger nurses will continue to join the Army or Navy Nurse Corps. The 46 nurses selected for training during the past year attended the institutions listed below: Public Health Nursing 73 Peabody College __________________________ Frontier Nursing Service____________________ Columbia University ----------------------Medical College of Virginia__________________ 34 2 1 9 (colored) HEALTH CENTERS AND NURSING EQUIPMENT Thl'oughout the year steady gains have been made in securing better housing for health services. This has been especially true in nursing counties where in many instances the provision of offices was very inade quate. Several new health buildings have been completed and plans for the erection of others are being made with the hope that they can be carried out as soon as the war is over. Additions have also been made to nursing and clinic equipment. These materials include standard nursing bags, scales, examining tables, sterilizers, a more adequate supply of syringes and needles. Many of the health centers have been made more attractive by the provision of paint and new floor covering, and suitable furniture to replace improvised articles. MATERNAL AND CHILD HEALTH SERVICE Early last spring five nurse mdwives were assigned to carefully selected counties to carry on a program of intensive supervision of the lay midwives. These nurses had all had special training in midwifery. A detailed account of this program and an evaluation of results obtained is given in the report of the Division of Maternal and Child Health. Throughout the year emphasis has been placed on more adequate nursing care for pre mature babies. Miss Theodora A. Floyd, Assodate Director, spent three weeks at the Michael Reese Hospital observing the care of premature infants. Miss Floyd has shared this knowledge with the public health nurses throughout the State through demonstrations at staff conferences in each region and in several of the large cities. INDUSTRIAL NURSING At the close of 1941, the industrial nurses in Georgia numbered appmximately 58. At the end of 1942 they numbered well over 100 and this number is steadily increasing. During the year these nurses have been visited by the Nursing Consultant, Miss Mary G. Devine, and their programs reviewed. An effort has been made to assist them in the development of well-rounded public health nursing pmgrams properly integrated with the indus.trial hygiene service in the plant and public health aotivities in the community. New industries, machines and materials have created new problems for management, worker, and medical, nursing and engineerin2; personnel, not the least of which are health hazards. One special function has been to acouaint the nurse in industrv of the hazards in her respective indu-,try and controls needed. The new industries in Georgia are shipbuilding, airplane assembly, shell plants. 74 Georgia Department of Public Health An outstanding problem is procurement of qualified nursing service in small industries; lack of personnel has particularly handicapped this development of the service. IN-SERVICE EDUCATION Because of the war emergency no in-service nurses have been released for formal education. As the year closes some modification of that policy is under consideration. Quarterly staff conferences have been held in each of the six regions of the State with a good attendance. The programs have included demonstrations on the nursing care of the premature baby and on the Kenny method of nursing care during the acute stage of poliomyelitis. In the summer the Warm Springs Foundation offered an institute covering a period of one week in the nursing care of infantile paraly;:rards and housing projects. Completed in 1942. Population 95,996. Summerville._ Xew deep well COIUilleted and plans for water treatment plant avprO\ed 1942. Population 1,358. Thomaston Cotton Mills. Plans for additions and alterations at water vurification plant approved 1942. Valdosta. Plans and specifications for new deep well approved 1942. Population 13,39:>. Washington. Reconstruction of raw water reservoir, coagulation and sedimentation basins, filters and clear water resenoir. Under construction 1942 (\Y.P.A.). Population 3,537. Waycross. Xew 750,000 gallon storage reservoir completed 1\l42 (WPA). Population 16,673. Zebulon. Xew hypo ehlorinator on water supply not previously chlorinated. Installed 1942. Population 543. Sewers and Sewage Treatment for Municipalities and Districts Blue Ridge. Imhoff tank and sludge drying beds completed 1\142 (W.P.A.). Population 1,362. Brunswick. Sewer extensions to housing projects completed 1942. Population 15,0~Ei. Cornelia. Sewage treatment vlant consisting of coan;;e sereens, 11rimary clarifier, trickling filter, secondary clarifier, sludge digester, sludge drying beds and control house eomvleted in 1942 (W.P.A.). Population 1,808. Dalton. Sewer extensions completed 1942. P,opulation 10,44S. Decatur. Sewer extensions completed 1942. Population 16/)61. Delleted in 1942. Waycross Air B.ase. Water supply from deep well and distribution system with storage and chlorination. Sewerage system and treatment plant consisting of Imhoff tank and sludge drying beds. Under construction 1942. St. Simons Island Naval Air Base. Water supply from deep well with storage, chlorination, and distribution system. Sewerage sys.tem and treatment plant consisting of pump station, Imhoff tank, sludge drying beds and tile drain field. Completed in 1942. Camp Toccoa, near Toccoa. Water suiJply system containing water from surface stream. Purification plant includes coagulation, sedimentation, filtration, sterilization and laboratory control. Distribution and elevated storage is provided. Sewerage system and treatment plant consisting of coarse screens, primary settling, separate sludge digestion, open sludge drying beds, trickling filter and secondary clarifier. Completed in 1942. Public Health Engineering 81 Recapitulation of Public Water Supplies to December 31, 1942 Number Supplies receiving both fillration and chlorination (including softening and iron removal plants)_ 96 Deei> wells, shallow wells and springs chlorinated------------- 92 Deep wells, shallow we.Jls and springs not chlorinated __________ 183 Total public water supplies ______ :171 \Vater from home wells and springs in rural areas and villages without public water supplies _____ _ Total for State _____________ _ Population ( 1940 Census) Percentage Population Using Public Supplies 862,900 330,100 165,900 1,378,900 1,744,800 3.1~3. iOO 62.6 25.4 12.0 100.00 Percentage Total State Population 27.6 11.1 G.4 44.1 55.9 PUBLIC HEALTH ENGINEERING LABORATORY This laboratory serves to supplement the work of the Public Health Engineering Division by performing such tests, analyses, or examinations of a physical, chemioal or bacteriological nature as may be required in the general state-wide sanitation program. For the most part, the work has consisted primarily of the bacteriological examinations of samples of water from public and semi-public supplies, public school supplies, improved private supplies, and approved swimming pools. However, a certain amount of chemical work for the purpose of removal of iron and carbon dioxide and the prevention of corrosion at various public and private supplies, as well as steam pollution work, in an effort to assist municipalities in efficient operation of sewage treatment plants has been clone. Du11ing the year, the laboratory handled a total of 13,918 samples, :m increase -of 708 samples or 5.3 per cent over the number examined in any previous year. The following table shows the distribution of these samples, Bacteriologiral samples : Public and semi-public _____________________________ 12.525 Private __ ____________ ____________ __________ _______ 1,027 Swimming I>ool _________ ____ _____ _____ _____________ 244 Chemical samples _ ------------------------------------------- _____ _____ __ 46 Stream pollution samples ________________________________________ --------____ 76 An attempt has been made to secure monthly samples for bacteriological examination from all the .public and semi-public water supplies in the State, but due to the scarcity of county engineers and the limited amount of travel from the central office on account of the rationing of tires and gas we have had to depend more and more on local representatives to see 82 Georgia Department of Public Health that samples are submitted. This has resulted in samples being received at irregular intervals from quite a few supplies and 34 supplies failed to submit any samples during the year. On the other hand, samples were received from eight supplies for the first time. The public and semi-public water supplies in the State may be divided into three major classifications as to source and treatment: namely, ground waters, untreated; ground waters, sterilized; and surface waters, filtered and sterilized. The number of months each of these submitted samples is shown in the table below. Supplies submitting samples: 10-12 Ground waters-untreated ______________ 107 Ground waters-sterilized ____________ __ R:) Rurfacc supplies-filtered and sterilized__ 77 Total _ __ ___ ___ __ __ 267 Number Months 6-9 1-5 :1.) 2!J :~o 13 0 4R 3;) :1-t Total 201 104 7V 3R4 Cumulative bacteriological records were kept on all samples received in the laLoratory, as shown in the table below. No. Showing 0.1 to I O.O<(c, No. Neg. of 10 MI. Portions for Prsitive Co:iform for Coliform No. Showing More Than 10'/f. of 10 MI. Portions Positive for Coliform Supplies Meeting USPHS Standards No. '!c Ground \Vaters-untreated __ 35 84 52 ll9 69.6 Ground water-sterilized ___ 33 j(l 17 83 83.0 Surface Sllllr>lies- filtered and sterilized____ 42 33 'j::J !l6.2 Total __________________ ll(l 167 'i2 277 79.4 A study of the above table reveals the fact that 277 or 79.4 per cent of the 350 sup-plies from which we received bacteriological samples met the United States Public Health Service Standards. Brieflv, these standards state, in part, that in .a given series -of samples not more. than 10 per cent of all lO ml. portions examined shall show the presence of the coliform group of bacteria. A further study would indicate that the quality of the water, as a whole, produced by supplies employing filtration and sterilization is superior to water from either the untreated or the sterilized ground water supplies. *Bacteriological a\erages not compiled on samples received from one supply. Public Health Engineering 83 THE WATER BORNE TYPHOID FEVER OUTBREAK AT FLINT RIVER COTTON MILL, DOUGHERTY, COUNTY, GEORGIA The Flint River Cotton Mill and village are located just north of the city of Albany in Dougherty County, Georgia. On January 22, 1942, rthe attention of public health officials was called to the fact that an outbreak of diarrhea had occurred among the employees of the mill and residents of the village. An investigation of this outbreak was started on January 23 and the first ease of typhoid was repo11ted the following day. More cases followed in rapid succession until late in February a total of eighty-one cases had been discovered, and two deaths occurred. In addition to the typhoid cases, a total of seventy-nine cases of bacillary dysenrtery were confirmed by stool cul,tures in the State Health Department laboratory. The epidemiological investigation indicated that this outbreak was water borne. There was no common milk supply, food supply, nor had there been any ,public gathering; flies were not prevalent at this season. On the other hand, both the mill and village were served by the independent water supply owned and operated by the mill. Prior to the latter part of 1941, water for this supply had been obtained from a drilled well located immediately behind the mill. This well, designated as well No. 1, was reported to be approximately 700 feet deep and for the major portion of its depth :penertrated the limestone formations which underlie all of this part of Geo.rgia. It is reported that for many years this was a flowing well, but gradually the static pressure of the underground water in this area was reduced as other wells were drilled in the cicinity. When the well ceased to flow it was equipped with a pump and continued to serve as the sole source of water until the summer of 1941 when it became apparent that additional water would be required. A new well, designated as well No. 2, was then drilled in dose proximity to well No. l. According to the drillers' log, well No. 2 is 215 feet deep, and, like well No. 1, penertrates limestone for most of its depth. A steel casing extends from the ground surface to a depth of 95 feet, the remainder of the well being an open hole. The drillers' records show that water bearing strata were encountered almost continuously below a depth of 150 feet. The static level of 1the water was 42 feet below the ground surface. The well was equipped with a turbine type deep well pump discharging directly into the distribution system. Sewage from the village was collected by a gravity system and conveyed to a small septic tank, :the effluent from which discharged into a vertical drainage well in the bottom of a nearby limesink. Sewage from the mill proper discharged into the sewer system of the city of Albany. A sewer line from one portion of the village passed approximately 200 feet from the site of the two water wells and the sewage drainage well was approximately 675 feet from the site of the water wells. The bottom of the limesink is approximately 40 feet lower than the ground surface at the water wells and the casing of the sewage drainage well is reported to end 36 84 Georgia Department of Public Health feet below the lowest point in the limesink. Thus the elevation of the lower end of the drainage well casing seated in a limestone fissure !is a few feet higher rthan the lower end of the casing in well No. 2. Very little definite information could be obtained as to the exact time well No. 2 was put into service. This well was released for use by the driller in July, 1941, but representatives of the mill and the County Health Department asserted that the well was not put into service until some time in October and not Ullltil samples of water collected by the County Health Department had shown no ev,idence of contamination. The state water laboratory, however, had no record of such samples nor could laboratory reports be produced by local authorities. Water samples collected during the epidemiological investigation showed that water from well No. 2 was grossly contaminated in January and February, 1942. The following recommendations were made by the Public Health Engineering Division. l. Warter from the mill and village be obtained fr.om the ciil:y of Albany water supply and the two wells at the mill be abandoned and sealed. 2. The practice of discharging sewage into the limesink be discontinued and a pump station installed .to pump sewage from the village inio the Albany sewerage system. A temporary water line from the city of Albany was installed immediately following these recommendations and permanent improvements will be carried out as soon ~as the necessary ma~terials can be secured. MILK SANITAT/ON On July 1 our milk sanitarian entered military service. This seriously interrupted milk sanitation service which had been rendered to local hoolth depa11tments and cities which have adopted the standard milk ordinance. However, at the time of writing this report it can be stated that the United States Public Health Service has assigned to us a milk sanitarian and an effort is being made to resume the service to the extent that it was formerly rendered. A demand for more and better milk is rapidly increasing in Georgia. Looal heal,th department milk sanitation aci:Jivities like other sanitation programs of county and city health departments are being handicapped by loss of personnel for miJ.itary service. In spite of this difficulty, together with priority requirements for materials and supplies, improvements are being made by dairy farms and pasteurization plants in the twenty-six cities and three counties that have adopted the Public Health Service Milk Ordinance. Many of the improvements are influenced by increased demands fm milk and milk products, particularly in defense areas. As rapidly as possible under war-time conditions, existing facilities are being expanded to keep abreast with the increased demand. These improvements are resulting in providing milk supplies of higher quality and degree of safey, 'thus instilling greater confidence in public milk supplies. Public Health Engineering 85 List of cities ,and counties having adopted the United States Public Health Service Milk Ordinance (Standard Milk Ordinance) : Cities Americus Athens Atlanta Augusta Brunswick Cartersville Cordele Cities Dalton Douglas Gainesville Griffin Hinesville Hogansville LaGrange Cities ~fa ron :II i l l e n :l!oultrie Quitman Rome Savannah Cities Statesboro Thomasv!lle Tifton Waycross Waynesboro West Point Counties Crisp Fulton Spalding SURVEYS, MAPS, AND PLANS In connection with the war effort it has been necessary to prepare maps of each of the extra-cantonment zones around army and navy establishments, war industrial plants, and emergency housing areas. These maps are generally developed from aerial photographs, by field surveys, stereoscopic examination, and projection on a light table, with final field checking. A very highly satisfactory map has been produced by this method, especially suitable for malaria control and sanitation studies. Surveys and maps for portions of the following counties have been made: Baker Bibb Burke Coffee Colquitt DeKalb Dougherty Early Echols Fannin Laurens Liberty Lowndes Richmond Stephens Towns rnion Standard municipal sanitary survey maps have been prepared of Hiawassee, Blairsville, Toccoa, and McCaysVIille. A standard sectional sanitary survey map was also prepared by McCaysville vicinity. Six suggested plans for health centers were drawn, and plans made for milk house alterations at the State Tuberculosis Sanatorium at Alto. Letterhead size ma:ps of Echols and Coffee Counties were prepared for the Regional Health Office at Waycross. Seventeen speoial ,drawings were completed for an automatic siphon, precast ditch lining inverts, screening details for special bulletin, miscellaneous profiles, e>tc. Twenty-four special maps were prepared for the Malaria Control in War Areas program, as well as a chart showing the organization of that program. Maps and drawings in process of completion include (1) standard basic county maps of Laurens, Burke, Brantley, Charlton, Bulloch, and Decatur (2) standard county malaria maps of Laurens, Burke, and Bulloch (3) standard county sanitary survey maps of Brantley and Charlton, and (4) special malaria control maps of portions of Mcintosh, Tift, Thomas, Bulloch, and Glynn Counties. 86 Georgia Department of Public Health COORDINATED COMMUNITY SANITAT/ON During the year 3,255privies and 2,493 septic tanks, with 496,124 feet of 4" drain tile for secondary treatment, were installed at homes not having public sewers aV'ailable. Because of the reduced quota of relief labor on WPA rolls, and a reluctance to give pviority to this type of project even when cerbified to by army and navy officials, the cooperative program, in which relief labor was furnished by the WPA, materials by property owners, and supervision by personnel of the various health departments, has dropped to the point where it is now being carried on 'in only two counties. Wherever possible the program is being carried on either by private contracting or with convict labor furnished by 'the counties. The shortage of certain critical materials, rising costs and necessity for priorities on lumber have also curtailed the program. The following tabulation shows the number of privies built during the year, listed by counties. It also shows the comparison in those built with concrete floor and riser and the more tempor,ary wooden fl.oor and riser type. The increase in wooden floors is accounted for by the reduction of central plant operations and the difficulty of concrete construction for in dividuals who do their own work. TABLE SHOWING PRIVIES BUILT IN 1942 Home County Wood Concrete Appling ~----- Atkinson ----- 40 Bacon ------- 3 40 Baldwin ----- 8 Banks -- ---- Bibb -------- 30 Brantley ----- Brooks --- -- 26 Bryan --- ---- 3 Bulloch ------ -- 36 Burke ------- 32 Butts -------- 4 9 Calhoun ------ 10 Camden ------ 2 Carroll ------- Catoosa ----- Chatham ---- 103 28 Chattahoochee_ 2 1 Chattooga ---- Clarke ------- 76 8 Clay -------- 8 Clayton --- --- 14 Cohb ----- -- 1! 61 Colquitt ------ 11 (l School Wood Concrete 11 7 2 41 2 26 10 20 20 1 Total :J;) 50 15 2 9:-i 32 ~ fi:2 ;)j 13 10 1'i1 3 86 8 20 107 23 Repair l!l 14 36 14 123 ~18 10 Public Health Engineering TABLE SHOWING PRIVIES BUILT IN 1942-Continued Home School County Wood Coweta ------Crawford ---Cris}J - Dt>eatur 21 DeKalb Dodge -------- Dougherty ---- Douglas ------ Early --------Elbert ------- Fannin 104 Fayette -----Floyd -------Forsyth ------ Fulton ------- Glascock ----(;ordon ------ Grady -------- Ureene 17 Gwinnett Habersham Hall --------Harris ------Hart --------Heard -------- Henry -------Houston ------ 41 Jackson -----Jasper ________ .Jeff DaYis ---.lenldns Johnson .Jone.;; -------- Lamar ------- Lanier ------- Laurens 1:1 Liberty -----J.ong -------Lowndes ~lrDuffie ----::\Ia eon ------:\Iadison -----::\Ieriwether ~Iiller - - - - - - }litl'hell ------ ()2 Monroe -----::\lontgomeT.Y -)!organ -----)luseogee ---- Xewton ------ Concrete 74 :J 102 289 1:-.i 31 20 :1s 27 33 18 144 1 28 ;)2 10 38 12 17 :.!0 21 1 15 Wood Concrete IC 16 4 15 4 66 28 19 40 38 10 16 1 ?') 34 Total ,,, 144 289 1:1 37 20 :18 27 120 ;-:;;, 20 148 33 71 16 17 42 17 23 2:-i J2 21 1 38 11 17 6 4 66 41 19 102 44 HI 16 12() a4 87 Repair 107 311 50 27 30 2 10 Hi 88 Georgia Department of Public Health TABLE SHOWING PRIVIES BUILT IN 1942-Continued Home County Wood Oconee _______ Oglethorpe __ _ Paulding ____ _ Peach _______ _ Pierce ______ _ Pike _________ Polk _________ Quitman ____ _ Rabun ______ _ Randolph ___ _ Schley Seminole Spalding ____ _ Stephens ____ _ Stewart _____ _ Talbot _____ _ Taliaferro ___ _ Tattnall _____ 3 Taylor _______ __ Telfair ______ Terrell ______ _ Thomas ____ _ Tift ________ _ Toombs ______ Troup _______ Turner ______ _ rnion ------- --rpson -------Walker _____ _ Walton _____ _ Ware _______ _ Washington __ 11 Wayne Webster ______ Wheeler _____ _ Whitfield __ _ Wilcox Worth _____ _ Concrete 20 :J6 14 21 16 12 24 20 12 18 9 14 54 21 19 39 10 67 Schcol Wood Concrete Total 22 36 14 21 16 3 3 1~ 6 8 24 23 12 8 18 14 54 21 8 21 59 16 20 1:> 2 8 67 Repair 24 14:> 286 1 649 2,263 181 162 3,255 1.816 The total construction of private sewage disposal systems at homes where public sewers are not available has continued at almost the same level as for the preceding year notwithstanding restrictions on general building, The majority of these improvements have been made m war areas where housing conditions continue to be acute. The following table Public Health Engineering 89 shows the number of septic tanks built during the past year at homes, schools, or other public places, by counties, which have been approved by the health department. SEPTIC TANKS FOR 1942 BY CouNTIES County Home Appling Atkinson Baldwin -------- 15 Bibb ----------- 275 Brool.::s ---------- 6 Bulloch --------- Burke ----------- 9 Butts ----------- 8 Camden --------- Catoosa --------- C'hwrlton -------- Chatham -------- 211 Clarke ---------- 25 Clayton --------- 68 Cobb ------------ 104 Colquitt --------- 42 Coweta ---------- 11 Crawford -------- 3 Crisp ----------- Dawson Decatur 10 DeKalb 127 Dodge ----------Dougherty ------- 168 Douglas --------- Evans ----------- Fayette --------- Floyd 13 Franklin -------- Fulton ---------- 209 Glascock -------- Glynn ----------- 114 Grady ----------- 6 Greene ---------- Gwinnett -------- Habersham -----Hall ------------ 12 Hancock --------Harris ---------Henry ---------- 46 Houston -------- 31 Jackson 1 Jenkins Johnson Public Place 6 8 16 4 3 5 2 3 Total Vi 281 14 215 2:i 69 120 42 11 5 12 131 172 1 1 13 3 214 114 7 1 3 3 15 1 7 47 33 1 7 1 County Home Jones -- --- Lan1ar ---------Laurens ~~ - - - - - - Liberty --------Long -----------Lowndes McDuffie -------- 1:i )lacon ---------- 1 )leriwether ------ Mitchell -------- Morgan --------- ::\Iuscogee -------- 84 Newton --------- Oglethorpe ------ Paulding -------- Peach ----------- 9 Pierce ---------- Pike ------------ 1 Polk ----------- 2 Rabun ---------Richmond ------- 437 Schley ---------- 1 Screven --------- Spalding -------- 12 Stephens -------- 44 Sumter ---------- 42 Talbot ---------- 6 Taylor ---------- 7 Thomas --------- Tift ------------- Toombs --------- Troup ----------- 13 l:pson ---------- 3 Walker ---------- 11 Walton 8 ----~----- Ware ----------- 39 Washington ----- 10 Wayne --- ------- 2 Wheeler --------- 2 Whitfield -------- 15 \Vilcox ---------- 1 Public Place Total 10 10 15 1 9 85 9 2 2 7 437 13 46 42 7 ;) 13 3 12 10 41 11 2 2 15 1 TOTAL ---------- 2,394 99 2,493 90 Georgia Department of Public Health MALARIA CONROL The malaria control drainage program using WPA relief labor on the statewide malaria drainage project continued on a l'imited scale during the first half of the year. The major portion of this work wes done in the war areas in Chatham and Liberty Counties. Smaller projects were carried on in Troup and Washington Counties, principally for completion of drainage already under way when curtailment of labor was found necessary. All WPA drainage projects were closed out during the early fall. Maintenance of existing or newly constructed drainage systems has been conducted exclusively with local convict or free labor crews working under local superv.ision. Accomplishments of record under the drainage program consist of 406,672 linear feet of ditching, 85 ponds drained, 3,014 acres drained, 1,788,551 linear feet of right-of-way clearing, 11,000 linear feet of ditch paved, 32,100 square yards of ditch banks sodded, 455 linear feet of culvert placed, 1,038,727 linear feet of ditch and stre&ms cleared or maintained. Major drainage operations in the Camp Stewart-Hinesville area were largely completed under the WPA drainage program with a limited amount of lateral construction. Eight or ten miles of ditches on the Camp Stewart army reservation have been 1ined with precast concrete slabs, the banks being sodded with grass, and this work will be continued until all lateral drainage in this flat area is carried in lined ditches. Most of the ditch 1ining installed is of the new type of precast slab developed by personnel of this Division. The Division personnel is also cooperating in a similar program being carried on in the Fort Benning Reservation. Progress has been recorded in the development of a precast concrete automatic siphon for use in fluctuating reservoir water levels and for flushing ditches for the prevention of Anopheles mosquito breeding. Considerable success has been achieved in the use of the siphon for ditch flushing. In the Georgia malaria control program, concentrated attention is being given to the preparation of accurate maps showing roads, houses, watered areas and completed drainage construction. These maps are essential to malaria 'investigations and are used for the detailed planning and administration of control operations. Five counties have made current or pending appropriations for a county-wide Paris green larvicide program; 14 dragl.ines have been used in eight counties. Area-wide Paris green larvicidal programs, less than county-wide in scope are under way in three counties. MALARIA CONTROL IN WAR AREAS Early in the year the Division, upon request from the United States Public Health Service to the Director of the State Department of Public Public Health Engineering 91 Health, undertook the organization of a malaria control program through control of th evector, the A. quadrimaculatus mosquito, in all war areas in the State where malaria might possibly be of sanitary significance. Field headquarters were stationed at Macon and during the season operations were carried on in 12 areas protecting 57 war establishments. The United States Public Health Service provides personnel consisting of engineers, entomologists, engineering a-ides, inspectors, foremen and laborers, and the major portion of material and equipment costs, the work being planned and conducted under direct supervision of state personnel. As much as possible the work is coordinated with that of the local health department operating in each individual area, operating head quarters usually being set up in the local health department offices. Mosquito control measures are conducted only in the areas where regular inspection indicates a definite need for control, thus in some areas routine inspections of all possible mosquito breeding places is the only activity undertaken. Control measures for the 1942 season are enumerated as follows: 237 gallons of oil and 3,813 pounds of Paris green used in larviciding 2,491,150 linear feet of ditch, and 204,138,994 square feet of pond surfaces; 436,554 linear feet of ditching and cleaning was done, and 80,005 linear feet of ditch and 7,045,887 square feet of pond surface was cleared; 64.,341 man hours of work were required .in these operations. During the coming year, these operations will be extended to a num- ber cf new areas where war establishments have been set up during the loatter months of the year 1942. Very close cooperation is maintained with army and navy personnel carrying on similar measures within the reservations in order that the most effective control can be maintained. REGULATIONS OF IMPOUNDED WATERS FOR MALARIA CONTROL These regulations apply to large and small areas where water is impounded for hydroelectric power, recreational and other purposes. The lis,ting of smaller areas is omitted to save space. Larger areas, used particularly for hydroelectric power, flood control and related purposes include impoundments owned by the Georgia Power Company, Crisp County Power Commission, Georgia Power & Light Company, Tennessee Valley Authority, and the United States War Department. A number of these are licensed by the Federal Power Commission, one of the stipula tions of the license being that malaria control operations are maintained to the satisfaction of the Georgia Department of Public Health. In general the regulations include, first, clearing of all areas to be im pounded, followed by effective larvici.ding during the malaria mosquito breeding seasons. It is quite evident that this program has been influen tial in prevention of serious malaria epidemics around such areas. The War Program has initiated a new era of hydroelectric develop ment and flood control which has added at least four such areas in Georgia comprising 51,300 acres and divided among the following projects: 92 Georgia Department of Public Health Nottley, 11,000; Chatuge, 15,000; Hiawassee, 5,000; and Allatoona, 20,300. These 1proj ects .are practically all cleared, conforming to the regulations of the State Board of Health. Added to the above, new preliminary permits for 16 impoundments to cover some 213 acres, and one maintenance permit for an impoundment of 2% acres, have been issued during the past year. The majority of these impoundments are for fishing and stock watering purposes. SCHOOL SANITAT/ON The Division has worked in close cooperation with state and county boards of education by furnishing plans and supervising construction of sewage disposal devices and for improvement of drinking water supplies at schools. While still in opemtion the Work Projects Administration and the National Youth Administration require approval by the Division of all plans and specifications for sanitary facilities for all buildings, for schools and other public places, as a prerequisite for their acceptance as a construction project. Review of complete plans and specifications for each project was required and often field investigations were necessary to determine adequacy of sanitary facilities. Privies constructed at schools and other public places ____ 343 Water samples collected at schools____________________ 307 FEDERAL HOUSING ADMINISTRATION SANITAT/ON In order to secure 'a loan insured by the Federal Housing Administration in Georgia, those homes not conneoted to approved public water supplies and public sewer systems must have a private water supply and sewage disposal system constructed according to recommendations of the State Health Department. Inspection and approval of proposed subdivisions in rural areas not having city water and city sewers, or either, by this Division 'is also required by the F.H.A. befme 31pproval will be given to such subdivisions. This procedure has resulted in improving the standard of construction of all sanitary facilities in other .than F.H.A. construction and has been instrumental in obtaining many more connections to approved public water supplies and sewer systems. Approval certificates have been executed and forwarded to the F.H.A. under this program covering 626 private sewage disposal systems and 13 private water supplies in 30 counties of the State. FARM SECURITY ADMINISTRATION SANITATION The Farm Security Administration has received aid from the Division in the form of standard plans, specifications, and methods of sanitation of rural homes. Many clients of the F.S.A. have received grants for sanitation needs and cooperation has been given by assistance .in preparing plans and estimates and final approval by a health department representative to Public Health Engineering 93 insure satisfactory completion of the work. This program is reaching those rural residents most in need of sanitary facilities, ~and includes sanitary G.isposal of sewage, improvement of water supplies, screening and general environmenta.I sanitation corrections. This program operated in the following counties during the past year: ApJlling Burke Calhoun Catoosa Colquitt f'risiJ Douglas Emanuel Fayette Greene Gwinnett Habersham Heard Jackson Jones :llcDuffle Montgomery Oglethorpe Randolph Talbot Terrell Thomas Washington White Whitfield Wilkinson RURAL ELECTRIFICATION ADMINISTRATION SANITAT/ON The Rural Electrification Administration in cooperation with the Division is promoting sanitary features at such homes as receive rural electricity. This is generally because immediately following the installation of electricity in .a rural home development of a water pressure system is in order. This involves (l) an improved well (2) plumbing f>acilities (3) proper disposal of sewage. The amount of such sanitation is measured by the number of approxima.tely 1,500 homes in one year receiving approved water supplies, plumbing and satisfactory sewage disposal. NATIONAL YOUTH ADMINISTRATION In raddition to the review of all plans and specifications proposed for construction by the N.Y.A. for approval by this Division, as mentioned in the section on school sanitation, active assistance is rendered in the in. spection of sanitary facilities at N.Y.A. resident projects. This inspection which is followed by detailed recommendations, covers water supply, sew. emge, milk supply, housing, bathing, ventil,ation, lighting, food handling and storage, garbage collection and disposal, etc. CAMP SANITAT/ON A concerted effort has been made to protect the health of summer campers. With this in view a bulletin has been prepared, "Essential Features of Camp Sanitation", together with inspection blranks. This program has inV'olved finding and listing all summer camps, such as Boy Scouts, Girl Scouts, Y.M.C.A., Y.W.C.A., Camp Fire Girls, 4H Club, and general recreational summer camps. Attempt is made by inspections of all camps, preferably during oamping season, to record all necessary sanitary improvements. Conferences and correspondence are conducted with organization officials and camp directors in order to effect such improve ments as may assure protection of the health of campers. The Division maintains a file showing records of all camp inspections, listing improve ments necessary and improvements effected. MATTRESS SANITAT/ON This service conforms with an act of the State Legislature which re 94 Georgia Department of Public Health quires the inspection and licensing of aU mattress manufacturers, renovators and establishments where mattresses, as defined in the law, are sold. Provision is also made for the labeling and purchase of revenue stamps to be 'attached to each label, said labels being required on all articles coming within jurisdiction of this law. During the year, 753 inspections and 460 rechecks on machinery not in use were made. The rechecks were m::tde in order that all machinery not in use could be located in event of complaint or possible violation. The inspections made included manufacturing and renovating establishments, furniture stores, and other establishments where mattresses were stored with intent to sell or trade. The following assistance was given to the State Tuberculosis Sanatorium: All mattresses bought new or renovated were inspected; located and purchased supplies for maintenance of building, equipment and grounds; also assisted in the installation of equipment where necessary. During the year, 66 licenses were renewed, three new licenses issued, eight plants consolidated to form four plants consisting of two each of the original eight. Seven other plants ceased operations. The new licenses were for renovating plants, all of which installed and operated sterilizing equipment that complied with the requirements as specified under the Mattress Sanitary Regulations. All complaints of bedding law violations were investigated; however, in no ins.tance was it necessary to resort to legal action. An 'analysis of the revenue received by the Department during the five and one-half years of enforcing the mattress sanitary rel!ulations shows that a large percenbage was derived from out of state manufacturers selling within the state. During 1942, there were 68 out-of-state concerns who purchased bedding revenue stamps to be placed on articles to be sold within the state. The following figures show the percentage of total revenue furnished by out-of-state manufacturers: 1937 1938 1939 1940 1941 1942 New Licenses Issued 1937 54 1938 44 1939 25 1940 10 1941 6 1942 3 11.17. 22.5'/r 32.0'/r 34.1 'I< 40.07< 45.17r Licenses Renewed 1937 1938 1939 1940 1941 1942 Firo't year of operation 52 82 100 102 66 Division of Dental Health Education J. G. Williams, D.D.S., Part-time Director Annie Taylor __________________________________Educational Director During the year 1942, the Division of Dental Health Education has continued a program which has as its objectives: l. Dental health education. 2. Correction of dental defects. 3. A plan to provide dental care for indigent children and pre- natal cases. 4. Community participation in dental health programs through County Dental Health Councils. The following narrative and statistical reports summarize activities. The enlistment of and cooperation with State agencies-official and voluntary-are important functions of this division. Appreciation is expressed to the Georgia Dental Association and to its Public He,alth Committee who have so willingly and c;.bly advised and assisted whenever called on by the Georgia Department of Public Health. During the year the Public Health Committee, wi,th Dr. Homer Davis, chairman; Dr. W. A. Garrett and Dr. Frank Lamons, have met with the Director and Educ01tiona.l Director for approximately twenty conferences. Appreciation is also expressed to the Sta.te Department of Education, Agricultural Extension Service, Farm Security Administration, Georgia Congress of Parents and Teachers and to each organization, club and agency that has contributed to dental health either by educational efforts or by financial a-ssis.tance. The plan of work during this year has of necessity been altered to meet the unusual conditions brought about by war. While there have been many obstacles as: Limited travel, disorga:nized schools, decreased number of dentists, it is encouraging to note an increased 'awareness on the part of the public as to dental needs and a large increase in 249 203 126 ;") 48 156 199 45 10 939 389 77 10 332 25.7 5. 7 25.3 21.3 11.8 5.8 6.3 7.7 32.6 7.9 43.6 3.9 9.2 23.8 6.3 11.9 3.3 5.9 15.8 20.7 9.7 24.0 Need \0 00 Treatment Treatment Treatment, Received in Received in None Ever Past, None Past, More Received Needed Needed .."..,. E z" 317 80 187 69 2,841 216 87 556 341 1,146 30 62 313 423 839 126 96 -c Q"... IE 74.1 28.7 33.0 20.4 29.7 33.7 20.2 34.4 44.6 44.0 10.4 48.4 ii9.8 64.6 26.5 33.2 31.8 .:.;.; E z" -.c . .Q... a. 77 12;i .118 1,462 83 115 232 86 2'16 102 15 30 30 616 50 27 27.6 22.1 :H.9 1ii.3 12.9 26.7 14.3 11.2 9.8 35.3 11.7 !i. 7 4.6 19.5 13.2 8.9 ..".... E z" 106 111 79 4,033 305 201 705 88 1,001 67 46 132 46 1,509 158 169 Q"" ... a" . ~ "'C) .2 ~ 38.0 (S 19.6 tl "' 23.4 42.1 ~ 47.6 46.7 ~ 43.6 11.5 38.4 23.2 -.~,.., C) ~ 3fi.9 !2:: 25.2 ~- 7.0 19.5 41.1 56.0 ::t: ~ 4,334 27.3 2,769 17.4 7,835 49.3 340 13.8 867 35.3 860 3ii.O 250 67.4 58 56.3 4 1.1 15 14.6 40 10.8 20 19.4 1,053 76.0 Counties Irwin Jenkins Macon McDuffie ______ _ **Meriwether --Mitchell Morgan Peach Rabun Schley Stephens Taylor Toombs Twiggs Upson Washington ----\Yayne ______ _ Wheeler Wilkes -..E=....="...... ::lc ZLIJ 2,078 710 807 719 111 837 1,242 890 1,331 294 2,248 1,114 634 648 3,085 2,109 475 286 430 .-.. -Inspected " " c ~. o ... -"... Q"..LIcJ . .... ... !l .Eel-: Z""t-' 70.1 99.8 92.1 99.3 92.8 87.6 82.2 96.1 87.9 78.9 86.1 88.1 93.7 94.1 92.7 90.0 100.0 98.2 78.4 1,456 709 743 714 103 733 1,021 855 1,170 232 1,935 982 594 610 2,861 1,898 475 281 337 Need Treatment - ... c ."c E .0 " z" "0.. 1,377 364 676 155 98 578 717 604 1,081 226 1,571 701 480 565 2,102 1,638 392 260 111 H.6 51.3 91.0 21.7 9~1 ~.8 70.2 rn.6 9L4 9~4 81.2 71.4 M.8 9L6 73.5 8~3 8L5 9L5 3L9 Treatment Received In Past ... ."c E z" -0...c... 0.. 319 21.9 125 17.6 527 70.9 420 58.8 369 50.3 190 18.6 163 19.1 156 921 307 378 137 1,769 1,044 73 57 2oH 67.2 47.6 36.4 63.6 22.5 61.8 :l5.0 15.4 20.3 75.1 Incomplete Report. Need No Treatment, None Ever Received - .. ."c E c ~.. z" ;, 41 2.8 284 40.0 l:l 1.7 338 47.3 81 11.0 225 22.0 200 23.4 89 7.6 3 1.3 172 8.9 146 14.9 28 4.7 27 4.4 308 10.8 108 5. 7 50 10.5 15 5.3 28 8.3 Need Treatment, None Ever Received - .. c ."c E 0"... z" "0.. 1,176 8.1 300 42.3 202 27.2 19 2.7 282 605 438 1,081 73 857 481 191 446 855 753 353 201 60 38.5 59.2 51.2 92.4 31.1) 44.3 49.0 32.1 73.1 29.8 39.7 74.3 71.5 17.8 Treatment Received in Past, None Needed -.. c . ."c E 0.".. z" a. Treatment Received in Past, More Needed - .. c .. ."c ~ E z" "0.. 38 2.6 61 8.6 50 6.7 220 30.8 74 10.1 79 7. 7 50 5.8 1.3 193 10.0 141 14.3 86 14.5 18 3.0 456 16.0 152 8.0 32 6.7 6 2.1 198 58.7 201 64 478 137 296 112 167 153 713 214 289 119 1,245 885 40 59 51 13.8 9.0 64.3 19.2 1:::::1 ~ ~ 40.4 ::t:: 11.0 ct. 19.0, ~ 66.0 ~ 37.0 R.::.. 21.8 48.6 19.5 .fc.l.;. ;:l 43.5 46.6 8.4 20.9 15.1 ~ Need No ...... 0 Need Treatment Treatment 0 Treatment Treatment, Treatment, Received in Received in Need Received None Ever None Ever Past, None Past, More Counties -..=...~.-. =E=f ZlU TOTAL WHITE __ 70,31:; Atlanta _________ 36,1ii9 TOTAL STATE WHITE 106,474 Inspected -...0 -,c _.Ec, .. ..oc; .. c ...,.._.,, -=- E=~" Q.lU Zl- 93.6 67,218 78.3 28,304 89.7 95,522 Negro Schools: Fulton --------~Peach ____ ~----Schley __________ Chatham _______ 25 161 223 6,108 100.00 65.8 72.2 76.2 25 106 161 4,654 TOTAL STATE Treatment - .. -E= ..c , 0 z" D. 49,473 73.6 12,410 43.8 61,883 64.8 19 76.0 33 31.1 138 85.7 2,941 63.2 in Past - . .c -E= z" 0..,. D. 39,753 59.1 39,753 41.6 1 4.0 -- 2 1.2 528 11.3 Received . - . .c, . -E= 0 z" "D. 8,468 12.6 -- 8,468 8.9 5 20.0 73 68.9 23 14.3 1,621 34.8 Received - .., .c. -E= z" 0..,. D. 25,663 38.2 -- 25,663 26.9 19 33 136 2,614 76.0 31.'1' 84.5 56.2 Needed Needed .., -E= z" -.c , 0 .., D. .., -E= z" 9,276 14.0 -- 23,702 -- -.c , 0 .. c;":) D. c(1> 35.3 ~ -- ~- 9,276 9. 7 23,702 t:::::l ~ ... 24.8 ~..., ;:; 1 4.0 -- -- 166 :;.6 -2 353 -- -- 1.2 7.6 -...(1> ;::! c ~ g~:; o NEGRO 6,517 75.9 4,946 3,131 63.3 531 10.7 1,722 34.8 2,802 56.6 167 3.4 355 GRA~D TOTAL __ 112,991 88.9 100,468 6ii,014 64.7 40,284 40.1 10,190 10.1 28,465 28.3 9,443 9.4 24,057 7.2 23.9 -::X:: (1> ~ ;;.. ***Exclusive of Atlanta. J Dental Health Education 101 5TATE OF GEORGIA, BOARD OF HEALTH DEPAJUM ENT OF PUBLIC HEAl1H LEGEIID 1Ifi 80 - 100% Showing percentage school children needing dental I I tiJ - 79% treatment as reported in dental inspections, ~ 40 - 59% September 1941 - !lay 1942. fJ 0 - 39% o Uo inspection " Atlanta - 43.8% 102 Georgia Department of Public Health CORRECTION OF DEFECTS The primary objective of the dental health education program is to stimulate dental corrections; to encourage people of self-supporting families to secure dental corrections regularly and to prevent the accumulation of dental defects by beginning a regular program of dental care for the young child. We have many evidences that an increasing number of children and ~adults are receiving dental care. It is also encouraging to note the increased interest on the part of the dental profession to provide a high standard of dentistry for children. Dental Clinics The dental clinic 1plan, which was first begun in February, 1940, and adopted in August, 1941, as a permanent plan, has continued to meet with approval of all participating. Regulations for Paying Honoraria to Clinicians Conducting Dental Clinics was amended June, 1942, allowing: (1) All counties with full-time public health personnel and who meet qualifications to conduct dinics. (2) Lowering the admission 1age of children from 6 to 5 years. (3) Allowing limited dental service for indigent prenatal cases. Lack of available equipment, lack of dentists and transportation difficulties have prevented many counties from organizing dental clinics. During the year 27 counties have conducted dental clinics as follows: County AJlpling Brooks Camden Chatham Clarke Colquitl CrisP DeKalb Decatur Floyd Glynn Jenkins :Vlitchell 1\!organ Rabun Spalding Stephens Telfair Thomas Toombs Months Qperatinf in 1942 6 12 3 12 8 8 12 11 12 8 1 9 9 3 Type of Clinic WJlite Children White Children White Children White Children Negro Children White Children White Children White Children White Children White Children Negro Children White Children WJ!He Children Negro Children White Children White Children White Children White Children White Prenatal Cases White Children White Children White Children White Children Negro Prenatal Two Clinics fot White Children Upson Walker Ware \Vayne Wheeler Whitfield Worth Dental Health Education 12 4 7 12 6 4 12 103 White Children White Children White Children White Children White Children White Children White Children DENTAL CLINIC REPORT FOR THE YEAR 1942 White NUMBER COUXTIES OPERATIXG CLIXICS_____________________ NUMBER CLINICS -------------------- ----------------------XUMBER CLIXIC SESSIONS ________________________________ _ 1'-Tl\!BER CI,INIC HOURS (TOTAl,) ___________________________ _ 1\U)!BER DEXTISTS WORKIXG __________________________ _ 27 28 2,079 4,158 77 HOXORARIA PAID DENTISTS __ _ $10,395.00 TOTAL AD~USSIONS ----------------------------------------TOTAL ADMISSIONS BY AGES 6-8 years ------------------------------------------------9-11 years -----------------------------------------------12-14 years ----------------------------------------------Percentage 6-8 years----------------------- _______________ _ Percentage 9-11 years-------------------------------------Percentage 12-14 years _____________________________________ TOTAL VISITS --------------------------------------- ________ TOTAL PATIENTS DISMISSED _______________________________ _ Completed ------------------------------------------------Others Percentage Completed______________________________________ 5,737 2,533 2,152 1,052 44% 38% 18% 7,916 5,236 4,867 369 84% PROPHYLAXIS Percentage of Admissions ___________________________________ NUMBER OF TEETH EXTRACTED _____________________________ Decid. ---------------------------------------------------1st Perm. Molars__________________________________________ _ Other Perm. Teeth_________________________________________ NUMBER TEETH FILLED_____________________________________ Decid. ---------------------------------------------------1st Perm. Molars------------------------------------------Other Perm. Teeth----------------------------------------- NUMBER FILLINGS -----------------------------------------Cement --------------------------------------------------Al!oy ----------------------------------------------------Silicate 2,258 39% 6,626 5,601 484 141 12.474 3,765 6,895 1,814 13,685 1,306 11,772 607 Negro 4 122 244 4 $610.00 177 120 44 13 68% 25% 7% 418 154 151 3 85% 135 76% 129 115 13 322 180 184 8 365 111 243 11 Toombs County operates clinics at Lyons and Vidalia. 104 Georgia Depurtment of Public Heulth Clinic Supervision During the year the director has visited twenty-four of the twenty-eight clinics. Conferences were planned in advance with public health personnel-den~is,ts, County Dental Heahh Councils and sponsoring groups to evaluate and discuss the following: (1) Equipment and quarters. (2) Service reported. (3) Records. (4) Cooperation of School. (5) County Denta~ Health Council. (6) Plan of selecting children. (7) Recommendations bv: a. Local dentists. b. County Health Department. c. State Health Department. FARM SECURITY ADMINISTRATION DENTAL PROGRAM A cooperative dental program of the Farm Security Administration should he cited as a means by which dental corrections are being obtained among farm families in Georgia. The following report was made to this division by Mr. E. C. Young, State Director, on August 3, 1942: "According to repor,ts recently received from various counties in Georgia, we have 68 dental programs covering 78 counties in the State, including 8,350 families, 45,495 individuals, with an average of $3,530.01 available monthly to pay for necessary dental services consisting of extradions, simple fillings, cleanings, and soft tissue treatment." Dental Health Education materials are made 'available to the workers of Farm Security Administration and this division cooperates whenever possible with this agency. ASSOCIATIONS AND CONVENTIONS ATTENDED Listed below are the State and National meetings attended by one or more of the personnel of this division: ADA Committee Meetings, Chicago-Williams. Dent,al Meeting, Adanta-Williams, ~aylor. State Parent-Teacher, Gainesville-Williams, Taylor, lvey. Georgia Educational Association, Savannah-Ivey. Georgia Dental Association, Savannah-Williams, Taylor. Parent-Teacher Institute, Athens-Taylor, lvey. American Dental Association, St. Louis-Williams. Parent-Teacher Association Board Meeting, Atlanta-Taylor. American Public Health Association, St. Louis-Taylor. State School Administrators, Atlanta-Taylor, Whitehead. Dental Health Education 105 High School Victory Corps Institute, Atlanta-~aylor, Whitehead. PAPERS AND ARTICLES PUBLISHED Dr. Williams presented a. pHper Is Dental Health Education the Answer? before the First District Dental Society of New York. It was published in the Journal of that society. Dr. Williams also presented a paper before the Fulton County MedicHl Society. Articles written by Miss Taylor were published in January issue of The Bulletin of the American Association of Public Health Dentists, and the May issue of Dental Health. STATISTICAL REPORT OF ACTIVITIES COUXTIES VISITED ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~ ~ ~~~~~~~~~~~- ~~~~~~ 78 Counties with full time Health Departments~~~~~~~~_~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 44 Counties with Xursing Service_________________________________ ------------------ 26 Unorganized Counties ---------------------------------------------------------- 8 MILES TRAYELED Educational Director _ ~~~~~~~~~~~~~~~~~~- ~~~~ -~~ _~ ~~~~~~~~~~~~~~~-~~~~~~~~~~~~ 7,317 Associate Educational Director_~~~~~~-~-~-~~~~~~~~~~--~~~~~~~~~~~~~~~~~-~-~~~~~~ 11,654 PUBLIC SCHOOLS YISITED~~~~~~~~~~-~~- ~~~~~~~-~~~~~~- ~~~~~~~-~~~~~~~~~ ~~~~~~~~ 200 Talks ~~~~~~~~~~~~~~~~~~~~~-~~~~~~- ~~~~~~~~~- ~- ~~~~~- ~~~~~~~~~~~~-~~~~~~- ~~~~~~ 200 Attendance-White ~~~~~~~~~~~~~~~ ~~-- ~~~- ~~-~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~ 55,835 X egro ___________________ -------------------------------- _______ 5,875 Films and Talks ~~ ~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 200 Attendance-White ~~~~~~~~--~~ ~~~~ _~~~~ _~~~~~~~~~~~~ ~ ~~ ~~~~~~~~~~~~~ -~~~ ~~~ 55,835 Negro ________ --------------------- _----------------------- ___ 5,87 5 COLLEGES VISITED ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Talks ~~~~~~~~~~ ~~~~ -~~~~ -~~~~ -~~~~-~~~~~~~~~~~~~~~~~~~~~~~- ~~~~~~~~~~~~~~~~~~ Attendance-White ~~~~~ _~~~~~ ~~~~~~~~~~- ~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~ Films and Talks-~~~~~~~_~~~~~~~~~~~~~~~~~~~~~_~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~_~~ Attendance-White ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~~ ~ ~~ ~ ~~~~ ~ ~ ~ ~~~ ~ ~~ ~ ~~ ~ ~ ~ ~~ ~~~ --~ ~ ~ ~ ~ ~ Total Attendance ~~~~~~~~~~~ -~~~~~~~~~~~~~~~~~~~~~~~- ~~~~~~~~~~~~~~~~~~~~~-~~~~ 12 12 1,03 7 8 970 2,007 TEACHERS' MEETINGS ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~ Talks ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ ~~~~- ~~~~~~ Attendance-White ~~~~~~- ~~ -~~~~~~~~~~~- ~~~~~~~~- _~~~~~~~~~~~~~~~~~~~~~~~~ X egro __________________ ____________ ____________ _________ _____ Films ~ ~~~~~~~~ -~~~~~~~~~-~~~~~~~ ~- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Attendance-White ~~~~~~~~~~~~~~~ ~~~~~-~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Negro -- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~-~~~~~~~~~~ 18 18 798 7j 6 193 75 PAREXT-TEACHER ASSOC. ATTEXDED Talks ~ ~ ~~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~~ ~~ ~ ~~ ~~~~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~~ ~ ~~ ~ ~~ ~ ~ ~~ ~ ~ ~ A tte.nda nee _ _ __ ___ __ ___ ___ __ __ __ ___ _ __ _ __ __ __ _ _ __ ___ _ __ __ __ ___ _ __ __ ___ _ ___ _ Films ~ ~ ~ - ~ ~~ ~ ~ ~ ~ ~~ ~~ ~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ ~~ ~ ~~ ~ ~ ~ ~ ~ ~ ~~~~~ ~~ ~ ~ ~ ~ ~~~ ~~ ~ ~ ~ ~~ ~ ~ ~~ ~~ ~ ~ ~ Attenda nee ~ ~ ~ ~~ ~~ ~ ~ ~ ~ ~ ~~~ ~ ~ ~ ~ ~~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~~ ~~ ~ ~ __ ~ ~~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ 23 1, 55 5 21 1,3 6 5 WOMEN'S CLUBS Talks ~~ ~~~ ~~~~ ~~ ~ ~ ~ ~~ ~ ~ ~ ~ ~~~ ~~ ~ ~ ~ ~~ ~~ ~ ~ ~~~~ ~ ~ ~ ~~ ~~ ~~ ~ ~ ~ ~ ~ ~ ~~ ~ ~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ Attendance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 69 Films ~~~~~~~~~~~~~~- ~-~~~~~~~~~~~~~~~~~~~--~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 Attendance ~~~~~~~~~~~--~~~~~~--~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 69 106 Georgia Department of Public Health CIVIC ORGANIZATIONS Talks ------------------------------------------------------------------------- 22 Attendance _____ -------- ________ -- ______ __ ____ ___ __ ____ ___ __ __ ___ __ __ __ ____ 757 Films ------------------------------------------------------------------------- 22 Attendance 757 4-H CLUBS Talks Attendance ---------------------------------------------------------------- 550 Films 1 Attendance 550 DEXTISTS Talks 5 Attendance ___ ___ _______ ____ __ __ __ ___ _____ __ ____ ______ ____ ________ ____ ____ _ 90 Films 3 Attendance ---------------------------------------------------------------- 90 PUBLIC HEALTH PERSONNEL Talks 4 Attendance ----------------------------------------------------------------- 79 Films --------------------------------------------------------------------- 3 Attendance ---------------------------------------------------------------- 61 PUBLIC :\IEETIXGS Talks ________________________________________________________________________ _ 10 Attendance ---------------------------------------------------------------- 757 Films 11 Attendance ________________ -- ___ --- _---- _____________ ---------------------- 757 PUBLIC OR DEXTAL HEALTH COUNCILS Talks Attendance ---------------------------------------------------------------- 69 Films 2 Attendance ___ - ------- ___ -- ---- _ --- __ --- ___ -------------------------------- 23 OTHER MEETINGS Talks ____ ___ __ __ ______ __ __ _____ ____ __ ___ ___ ___ __ _____ ____ ____ __ ____ __ _____ ____ 3 Attendance ---------------------------------------------------------------- 155 Films ------------------------------------------------------------------------- .Mtendance 155 DENTAL CLIXICS VISITED_______________________________________________________ 27 REGIO"'AL OFFICES VISITED_____________________________________________________ 6 CONFEREXCES 1. Regional Medical Direct.ars___________________________________________________ 8 2. County Health Commissioners_______________ ---------------------------------- 71 3. Dentists -------------------------------------------------------------------- 177 4. School Superintendents ------------------------------------------------------ 101 5. Physicians ----------------------------------------------------------------- 12 6. Home Demonstration Agents__________________________________________________ 3 7. Nurses --------------------------------------------------------------------- 158 8. Parent-Teacher Workers ----------------------------------------------------- 27 9. Others --------------------------------------------------------------------- 178 RADIO TALKS -------------------------------------------------------------------ARTICLES ----------------- ------------------------------------------------------- ASSOCIATIONS. CONVENTIONS ATTENDED In the State_____________________ -------------------------______________________ 3 Out of the S.ate________________________________________________________________ 3 Division of Maternal and Child Health Joe P. Bowdoin, M.D., Director Edwin R. Watson, M.D. ___________________________Associate Director Mary Emma Barnes____________________________Nutrition Consultant The Division suffered the loss of its Director, Dr. Joe P. Bowdoin, on August 7, 1942. Doctor Bowdoin had been at the helm since 1923, and continued to devote his time and effort to this phase of public health until and including the day of his death. It was his nurture that paved the way for the development of the clinical iphase of the program. The Division will continue to benefit from his guidance, counsel and insight as a result of his tutorship. His humanitarian qualities were unsurpassed. His interest in mothers and babies never declined. His outlook was a.Iways optimistic. Public health is in dire need of more workers with the qualities which he so beautifully exemplified. Many personnel changes occurred in the Division during the year. In May the Associate Director was called to active duty by the United States Public Health Service and assigned to the Director of the Georgia Department of Public Health as Deputy State Chief of Emergency Medical Service fur civilian defense. The activities thus imposed left scant time for his former duties in the Division. The Divison had just previously lost its obstetric consultant, who was called to active duty hy the Army. Thus, the Director and Nutrition Consultant were the only full-time staff members remaining. The Associate Professor of Public Healrth Administration of the Johns Hopkins School of Public Heal~h was a Division staff member during some of the spring and summer months on a discontinuous basis. A pediatrician was employed temporarily during the summer months when she was not required to serve as college physician. Upon the death of the Director, the Associate Director wa,s instructed to assume directorship of the Division and in addition continue his previous assignment as Deputy State Chief, Emergency Medical Service. Due to continuing personnel changes in State and local staffs, and numerous impediments resulting from t:he sate of war and conditions of population shifts, the Division has advisedly operated in an aHempt to hold the quantitative status of service as nearly as possible and to improve i:ts quality whenever possible. A part of the considered policy has been to refrain from wholesale promotion of new activities, except where the staff was convinced of considerable likelihood that such extensions can be maintained despite probable readjustments. With this in mind, it is somewhat surprising to find rthat quantitative increases of service have occurred in sl' r-ht to moderate degrees. GENERAL EDUCATIONAL ACTIVITIES The divisional staff has continued to lecture to nursing trainees while engaged in securing field experience. This opportunity is utilized to convey to prospective public health nurses the more important phase of maternal 108 Georgia Department of Public Health and child health services with which they should be concerned. It also provides an opportunity to emphasize those particular aspects whioh are not included in their general experience. Regional conferences have continued to be held each quarter and members of the staff have participated in those meetings upon request. Although regional conferences permit an excellent opportunity for discus sion of current problems with local staffs, it has not been possible to devote sufficient time and effort to prog.ram planning to utilize the conferences as frequently. Members of the divisional staff have continued ~o cooperate with the two schools of medicine, in that lectures were given to junior students of medicine. This activity permits the divisional staff to become acquainted with future practitioners of medicine, and provides for a very brief presentation of objectives, plans and policies of the Division. Participation in public forums has been sharply curtailed. Although this provides an excellent opportunity to discuss health problems with representative citizens, other duties have not permitted our participation to the extent desired. It has been deemed wise to curtail travel for this purpose. The staff confers frequent! y with members of the State Department of Public Welfare regJarding health standards and health problems pertaining to Day Care Nurseries. In this connection it might be said that some time has been devoted to problems concerned with evacuation, .though plans for evacuation and registration are as yet incomplete. In May, the Division received from the Medical 'and Surgical Relief Committee, a national organization wirth headquarters in New York City, an inquiry as to whether there were areas in the State where donations of foods and drugs might be put to good use. It was arranged that vitamin concentrates, pr.incipally cod liver oil and iron preparations, would be contributed by that agency in small to moderate amounts from time to time, with no assured regularity. Three shipments were received. Unfortunately the products, received as yet, do noil: nearly meet the probable need. Nevertheless, this is a desirable supplement to locally procured products. Georgia's Health, the departmental monthly publication, has continued to be edi1ted in this Division. This publication is continuing to reach a great number of subscribers. As au added feature, an effort is being made to include at least one cut along with a feature article in each issue. The customary distribution of promotional literature for the observance of May Day was carried out. In addition, two special bulletins on smallpox and diphtheria were prepared, which were included in thP May Day material. Althou~h the maternal demonstration in Tift County was discontinued on December 31, 1941, a complete statement of the results has not been prepared in final form due to other pressing commitments. It is hoped that this report can be made ready for publication in the very ncar future. Maternal and Child Health 109 Out-of-state meetings attended by staff members of the Division included: the regional meeting of the Children's Bureau and the National Conference of Social Workers held in New Orleans; the American Congress on Maternal Welfare and the American Public Health Association held at St. Louis. The Associate Director, while attending the American Public Health Association meeting, was an official representative of the Director of 1;he Department at a meeting of the Association of State Health Officers. MEDICAL AcTIVITIES Statistical Summary of Activities: Number Attendance Total Papers, talks, addresses, total attendance__ 734 Public health personneL____________ 14 162 Professional __________________ ____ 2 7 Lay groups ______________________ 4 565 Consultations and clinical services________ 23 Interviews and conferences, total attendance 865 Physicians and health officers________ 171 280 Nurses and other public health workers 136 368 Officials and civic leaders___________ 29 172 Civilian defense activities___________ 11 43 MCH centers conducted or inspected_____ 56 340 Visits to nurseries, schools, lunchro-oms, hospitals, etc. ______________________ 13 Selected Activities: Case consultation service has been discontinued except insdar as it can be rendered in connection with other services. Assistance has been provided local health departments in securing hospitalization of needy cases. The premature infant care program has progressed very satisfactorily. The premature infant death rate for 1942 was 15.2 per 1,000 live births, which is rthe lowest mte ever recorded. Incubators for premature infants furnished by the Department have been used extensively in homes and hospitals. lnformation pertaining -to medical and nursing care provided through institutes has been utilized by public health personnel throughout the State to a gratifying extent. One county has had from four to six incubators in constant use. Hospitals and health departments have become interested in constructing additional incubators, and the Division is lending guidance in this movement. All incubators have now been completed and have been placed in the counties for their use. In view of the fact that many new hospitals have ignored sound planning for maternity and newborn services, the Associate Director has devoted considerable time to the study of recommended hospital standards for maternity and newborn services. Several requests have been received for professional advice on this subject, and in each instance construction no Georgia Department of Public Health plans were altered to permit the recommendation of the Division to be put into effect. Additional time should be devoted to this activity in the future, both in regard to new structures and rearrangement of old structures. This type of activity will coincide with the proposed licensing and standardization of services rendered maternal and child health cases by hospitals and m&ternity homes. In anticipation of financial participation with hospitals, and in view of the establishment of maternity homes, proposed legislation was drawn up which would empower the State Board of Health to adopt such rules a.nd regulations as it deemed necessary to protect mothers and newborn infants, cared for during the antepartum, intrapartum, postpartum and newborn period, in institutions offering such service or care within the State of Georgia. Ali institutions rendering such service would be licensed. In addition, a part of the bill would empower the State Board of Health to make rules and regulations necessary to protect individuals served by midwives. At present, midwife certification is regulated by the State Board of Health, but is not supported by a specific law, which makes it difficult to prosecute midwives successfully. In anticipation of increased federal grants-in-aid for maternal and child hea.lth ipurposes, it was deemed wise to submit to the Advisory Committee of the Medical Association of Georgia a projected medical care plan. This plan was approved by the committee authorizing the Georgia Department of Public Health to participate in intrapartum care programs in any one or more of the following ways: (1) By subsidizing hospitals rendering acceptable standards of service for delivery of cases now served by midwives. (2) By aiding financially in the construction, maintenance and opE>>ation of maternity homes in rural areas without hospital facilities (deliveries to be done by local physicians or nurse-midwife; the latter must be acceptable to the Department and must he agents of local physicians). (3) By the employment of nurse-midwives (acceptable to the Department) for home deliveries in areas where hospitals or maternity homes are not feasible. (4) By compensating private physicians for home deliveries or deliveries in quarters related to their office for cases now cared for by midwives. It is thought that one or more of the above combinations would prove to he a satisfactory appr'Oach to the problem. Survey of hospitals in the State, with respect to facilities for the care of premature infants was made during the year. The survey form used was supplied by the Children's Bureau of the United States Department of Labor. Approximately one-third of the hospitals completed and returned the form. The results have been tabulated, and an article has been prepared for .publication in the Journal of the Medical Association of Georgia. The survey provided sufficient evidence to warrant the statement that premature infant care in Georgia hospitals is far from desirable. There waG no indication that ho&pitals in Georgia provide a good premature infant care program. The maternity mortality study was discontinued during the spring be- Maternal and Child Health Ill cause many physicians were leaving for the armed services, thus is was difficult to get the questionnaires completed. Results of this study over a period of years have provided us with information as to causes of death, and it now remains for us in cooperation with the medical profession to formulate programs which will help to solve the causes previously determined. It s doubtful that the continuation of this study would do more than provide us with essentially the same data as that collected for some years. The Associate Director has continued to serve as a member of the Scientific Advisory Committee to the State Nutrition Committee. During the year considerable time and effort was devoted to the study of enriched flour and bread. The State Committee adopted proposed legislation to prohibit the sale of other than enriched Hour and bread. In addition, he has served as Child Hygiene Chairman of the Georgia Congress of Parents and Teachers for a number of years. Although time has permitted him to devote adequate attention to this phase of Parent-Teacher activities, he has attempted to promote those child health services in which this organization is interested. As a result of their interest, more local associations are contributing toward the securing of quarters and equipment for health centers, and an increasing number of members are serving as volunteers in centers. The Associate Director has continued to serve as a member of the Policy Committee, Publications Committee and the Record Committee of the Department. All printed publications and reports are submitted to these committees for approval prior to adoption or distribution. Articles, per'taining to maternal and child health subjects, have continued to be submitted to the editor of the Journal of the Medical Association of Georgia for publication. Every effort is made to write on a timely subject and to choose subjects that are of interest to private practitioners of medicine. At the request of the Director of the Division of Local Health Organization, a maternal and child health section of a proposed health officer's manual was prepared. It is hoped that this manual will aid in familiarizing health officer trainees and others in the interpretation of divisional objectives, policies and plans. At the request of physicians serving in maternal and child health centers, a brochure on the professional aspects of infant feeding has been prepared and is to be published at an early date. Plans offering postgraduate instruction and experience to hospital supervisors of maternity and newborn services were formulated during the latter part of the year. There is every reason to believe that this project will materialize. Interest in this phase of infant care must be stimulated. Accptable experience should do much to encourage elevation of standards of care. Though supervision from this office will aid materially, it can best be utilized in hospitals that have staffs trained in this phase of infant :;are. Early in the spring physicians participat financially able to secure medical or nursing supervision. School hygiene activities show a distinct decline in the number of school children examined by physicians with and without parents present. This was antic~pated in view of the additional duties incurred by public health medical personnel and private physicians as a result of the war emergency. The remarkable increase in field nursing visits, as well as office nursing visi,ts, is not readily explainable. Nursing personnel has not been increased to this extent during the year. This increased activity is probably a result of focusing attention on additional nursing service in an effort to overcome the diminution of medical service to school children and also probably as a result of better reporting. Inspections hy dentists show a significant decline. This probably has resulted from the increase in private practice due to a decrease in the number of dentists available as a result of the war emergency, and perhaips because many inspections are now being done in the dental clinics, rather than in schools. It is thought that transportation has been a factor in reducing this activity. %+or- 1942 over 1941 Immunizations Smallpox --------------------------------------------- Diphth<>ria, under 1 year-------------------------------1 through 4 years _____________________________ 5 years and over_____________________________ _ 92,368 14,028 21,022 15,53 7 Maternity Service Admissions to prenatal medical serv,lce_________________ 24,984 Admissions to prenatal nursing service__________________ 47,246 Visits to medical conferences____________________________ 67,578 Field and office visits _________________________________ 14 7, 744 Cases given postpartum medical exam._______________ 3,487 Visits to postparum cases______________________________ 45,309 Cases attended by nurses for delivery service____________ 218 Casoo admitted to postpartum nursing service____________ 20,369 Visits for midwife supervision_________________________ 5,795 Attendance __ ____ _____ __ _____ __ ____ __ _________ __ ____ __ 2,3 40 + 24 + 10 + 12 + 29 + 30 + 92 ++ 60 + 13 +5 -45 + + 14 15 + 17 Maternal and Child Health 123 Infant and Preschool Hygiene Infants: Admissions to medical service______________________ Admissions to nursing service______________________ Visits to medical conferences_______________________ Field and office nursing visits______________________ Preschool: Admissions to medical service_______________________ Admissions to nursing service~---~----------------Visits to medical conferences_______________________ Field and office visits-----------------------------Attendance 11,290 31,647 26,420 87,789 13,073 25,268 24,049 61,813 586 - 45 + 16 +5 +9 4 +7 -55 School Hygiene Examinations by physicians-----------------------Examinations by Ilhysicians~parents present_ _____ _ Field nursing visits________________________________ Inspections by dentists or dental hygiene __________ _ 79,650 2,663 71,817 62,789 - 18 - 29 + 31 -- 31 MATERNITY HOMES During 'the latter part of the year two maternity homes were opened. One of these maternity homes had been incorporated and was operating when ~he details became known to this Division. This maternity home closed before the end of the year and probably will not reopen soon. The other matern~ty home was established in Rabun County in November. This Division has been stimulating interest in this project in this particular county for several years. Although a.U obstacles have not been overcome, the Rabun County home is functioning satisfaotorily. This county is a part of a tri-counrty unit 'and had one public heahh nurse on the staff until recently when a nurse-midwife was placed there by the Georgia Department ,of Public Health to instruct and supervise midwives and work toward improvement and integration of maternal and child health services. The nurse-midwife continued her more specialized public health activities, devoting particular attention to private physicians' cases in that she included these in her routine antepartum, postpartum, and newborn services. At the time that the maternity home was opened she began rto devote her full time to organizing this service. She is being assisted by a midwife with many years of training, though the latter's activi,ties are limited to practical nursing duties. The expenses ,of the home are borne by the county-wide Community Chest, general funds of the county, contributions, and by funds collected from cases that are able to pay. The ma,ternity home is a modern frame structure, containing eight rooms, four rooms of which are used for living quarters of the staff and the other four rooms are used for cases. Although full-time nursing service on a twenty-four-hour basis is not now ,available, plans are under way to employ a qualified nurse for this purpose. Deliveries are attended by physicians, except in a few instances when the nurse-midwife assumes this responsibility as an agent of a local physician. Cases are admitted regardless of ability to pay, but are charged on the basis of their ability l I 124 Georgia Department of Public Health to pay. The maternity home serves all cases in the county, regardless of economic or social status, and physicians are limiting their services to those cases confined in ~the maternity home, except in a few instances in which they previously had committed themselves to home delivery. The private physicians requested that they be permitted to deliver all cases and were willing to attend charity cases without charge. Private cases make their own financial arrangements with priv,ate physicians, hut pay the maternity home for services rendered. The home has not operated a sufficient length of time to make any definite statement concerning cost of patients per day. Deliveries are 'avemging about ten per month at present. The maternity home is affiliated with a hospital so that all complicated cases can be transferred to the latter. This probably is the best solution to the midwife problem in counties where hospital facilities are not feasible. The maternity home is closely coordinated with the Health Department and one local physician is thoroughly familiar with health center cases that are admitted for delivery service since he is the dinieian at the maternal health center. T!he facility has provided us with the means of caring for premature infants in rural areas without hospi,tals. Though it will require much effort and time to standardize the maternity home service and adapt it to the best advantage, it is fe1t that a good start has been made in this direction. Forms have been prepared which the maternity homes will use to report their activi,ties to the Department. In this way we hope to gain 'an insig'ht into the cost of operation, and the types and extent of services rendered. MIDWIFE PROGRAM Certified Lay-Midwives As a resul't of the war emergency, it has been impossible to purchase, for resale 1to certified midwives, the type of midwife bag previously used. As a result it has been necessary to purchase bags that are not as suitable hut more expensive. Since the cost of these bags ex;ceeds the midwife's ability to pay, a paPt of the cost has been absorbed by the Department. Plans are under way to make midwife bags of a waterproof canvas material patterned along approved lines which will be cheaper and more durable. Policies were ado,pted by the Division which do not permit the certification of midwives not previously certified, unless there is a demonstrated need for their services individually. This policy was adopted in an attempt to discourage wholesale recru~tment. All public healbh personnel has been encouraged to retire all midwives in excess of the number needed. To encourage retirement, badges have been purchased and are awarded to the midwives who make a promise under oath not to engage in practice. It is thought that this badge will be helpful in securing such .a pledge from those with religious zeal who do not qualify. The following table presents all available statistical information pertaining to certification of midwives in Georgia for the eleven-year period elapsing between 1932 and 1942 inclusive: Year Total 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 3,358 3,562 3,434 3,510 3,297 3,171 3,049 2,951 2,861 2,594 2,412 Not available. MIDWIFE APPLICATIONS, DEATHS, AND CERTIFICATIONS BY AGE Certifications w. . 316 326 298 267 253 233 c. . 3,194 2,971 2,751 * 2,594 2,341 2,179 Initial Certification by Age Groups Age Under 50 5065 Over 65 Unknown Total . .. .. * 135 * * * * 134 59 75 37 22 4 5 68 25 13 3 2 43 Applications Midwife Refused Deaths 2,949 3,463 3,402 3,510 3,509 * 518 749 653 638 447 125 ...~ l:l <..b, 99 :::s 223 .l.:.l.. 165 l:l [ * 134 85 C.;.:..":.....:-.i. l:l... 86 ::t:: 71 taL __________ _ White _________ _ 2,770 /Colored 2,525 iTotal 12,727 3,900 Number school gardens cultivated for lunch purposes_________________________________ 48 Number quarts food canned in school for lunch purposes_____________________________ 5,000 FARM SECURITY ADMINISTRATION Number privies installed for F. S. A. families _______________________________________ _ Number gardens cultivated by F. S. A. families______________________________________ 146 Number quarts of food canned_______________________________________________________ 46,500 Number demonstrations in food preparation or food preservation_______________________ 59 Number cows 260 HOME DEMONSTRATION AGENT Quarts of food canned_______________________________________________________________ 10,900 Number demonstrations held__________________ 115 Total attendance_ 932 Number of clubs_____________________________ 9 Total attendance_ 609 Total numher of meetings_____________________ 108 Total attendance_ 321 Number individuals starting garden projects__________________________________________ 937 Number families who have milk cows_______________________________________________ 650 FARM AGENT Number meetings with farmers ______________ _ 8 Total attendance_ Number demonstrations in gardening__________ 16 Total attendance_ Number c,onferences with farmers_____________ 5,028 Total attendance_ Number farmers cooperating in fertilizing practices___________________________________ 1,615 320 5,028 675 VOCATIONAL TEACHERS Number classes held_________________________ 1 daily Total enrollment_ 31'> Maternal and Child Health 133 SUMMARY OF ACTIVITIES OF NUTRITIONIST IN HANCOCK COUNTY (AUGUST-DECEMBER 31, 1942) I. Total D-17A-Diet Questionnaire and Mothers' Diet History Taken__ 33 D-17B-Nutritionist Field Visits__________________________ 11 D-17C-Nutritionist Office Visits_________________________ 15 D-17D-Attendance at Maternal Conferences on Special Food Problems ------------------------------------- 36 D-20 -Enrollment in Maternity Food Classes_______________ 65 D-21 -Attendance at Maternity Food Classes_______________ 479 E-7A -Nutritionist Field Visits (Infant)__________________ 9 E-7B -Nutritionist Office Visits (lnf'ant) _________________ 21 E-19 -Enrollment in Infant and Pre-School Food Classes____ 3 E-20 -A,ttendance at Infant and Pre-School Food Classes____ 30 E-21A-Nutritionist Field Visits (Pre-School)______________ 2 E-21B-Nutritionist Office Visits (Pre-School)_____________ 2 F-9A -Visits to Lunchroom by Nutritionist_ _______________ 100 F-9B -Office Conferences on Lunchroom Program by Nu- tritionist -------------------------------------- 18 F-lO -Public Lectures and Talks------------------------ 2 F-11 -Attendance ____________________________________ 60 II. Demonstrations: Total Number Held_____________________________________ 47 Attendance ________________________________________ 623 Average Attendance_________________________________ 12+ Number Who Refused Food Served_____________________ 24 Number Who Ate Only Part of Food___________________ 10 Number Who Ate All of Food Served___________________ 495 Number Who Said They Liked the Food Served__________ 247 Visits Made to the 16 Families Taking Part in Garden Project__ 20 ,.... Cl.:l of>. MATERNAL MORTALITY PER 1000 LIVE BIRTHS IN GEORGIA AND U.S. REGISTRATION AREA ( 1920 -1941) 12 II 10 1"',/-\_/V"--... 10 ~ c ~ i:i 9 1/) t::::; :I: I- !!: 8 m >UJ 7 :::i g6 0 ~5 D.. ~4 ca: \_ ...---... -- \ _...-,---/--',, " ' --- -..o.---o-- o___._ __of/111'., ...,..,o- .... ...... 0 ---o._....., " o ...... ', ....'......... --..._. "'GA. ....... u.s. 3 ~ ~.... ' .;~:.::.,. ~ ~ 0.,."_' r; ;:z::: ~ 2 DEATH RATE UNDER ONE MONTH OF AGE IN GEORGIA AND U.S. REGISTRATION AREA (1920-1941) 100 90 80 ~ Ill ~ ..., X:i: 70 ;:::! .I.:..)... m I:) w 60 > ;:::! R.. :::i ("') 0 50 0 .~...... 0 R.. a: 40 w Q. .,o---o---o---o--o---o-....o.,../-o-o_--o-o_-O-o_-oo..-..._oo-_--oo/-o--o...-...-...-..oo_-o-.-..o....-._~-o-....o..o---o-o---ooU~.GS.A. ::X:: ~ I:) ~ 30 : <[ a: 20 10 1-' 1:1..:> CJ1 136 Georgia Department of Public Health 0 2 0en 0 CXI 0 ,.._ 000 10 10 :::i 50 1&. 0 _,o ~ 40 w (.) a: 30 wa.. .,,o-'"' ,,o' .,.,o" , .0 , , . - o - ------ 10 ---o---o---o--o---o---o'' ______....--- --~---------------~--------- -=HOME --=HOSP. o=WHITE =COL. Maternal and Child Health 141 PER CENT OF BIRTHS IN GEORGIA(STILLBIRTHS EXCLUDED) OCCURRING IN HOSPITALS AND HOMES ( 1929-1941) 100 90 80 (I) ~70 a: iii 60 1.1.1 > .J 50 II.. 0 .z.. 40 1.1.1 () a: 30 1.1.1 CL 20 10 , ,_,oHOSPITAL ,o ..o'' -o---o--. . . ,.-o---o---o--- ... ,o'" _. 0""'- o---o' Division of Public Health Education During the first five months .of the year the Division functioned about as usual, except meetings attended by staff personnel were curtailed due to restricted travel. On May 15th the Director entered 'the armed forces and the Division was placed under the supervison of the Director of the Division of Preventable Diseases. Up to this time the staff had consisted of the Director, an illustrator, a photographer and two stenographers. Then on August 31st the illustrator resigned and one of the stenographers was transferred to another division, and on October 2nd the photographer resigned. Replacements for these technically trained persons could not be found and it was necessary to greatly curtail the work in the field of public health education. During the fint six months of the year this Division distributed 207,379 pieces of health education material. There were 94 films which were shown 1,093 times to a total audience of 204,014 people. During this same period this Division had exhibits at the following meetings: Medical Association of Georgia meeting-Augusta, Georgia. Georgia Conference of Social Welfare-Savannah, Georgia. Six hundred seven photographic prints, 601 negatives and 188 slides were made by the staff photographer. Our staff artist made a total of 61 illustrations and posters. This Division has cooperated whole-heartedly with the Woman's Auxiliary and the Medical Association of Georgia and has continued in the capacity of being advisory and acting as secretary to this organization in the capacity of keeping a strict acoount of the films shown and attendance at meetings promoted hy them. We are indeed appreciative of the cooperation which this organization has given us and we take this opportunity to eongratulate them upon the fine and extensive health educa.tion program which they have promoted. Arrangements have been made whereby this program will be continued during the next twelve months. We are also grateful for the fine eooperation of the Georgia Congress of Parents and Teachers who have for years been foremost in the field of health educati.on. Emphasis on Nutrition has been greatly increased due to the efforts of both of the above organizations and to the splendid work of our Nutritionist. During the last six months of the year the work of this Division consisted chiefly of the mailing out of pamphlets on public health subjects, answering by letter requests for information we do not have published for distribution. For the entire year the Division distributed 335,145 pieces of literature and sent out 456 films, which were shown a total of 1,339 times to an audience of 248,662. The Division will have to carry on its work through Public Health Education 143 the mailing of literature and the booking of films for groups who have their own projectors until more personnel is available and traveling conditions are better_ BULLETINS, PAMPHLETS AND OTHER LITERATURE DISTRIBUTED January ------~--------------------------------- 22,711 February --------------------------------------- 29,670 March ------------------------------------------ 53,258 April ------------------------------------------- 46,825 May -------------------------------------------- 27,277 June ------------------------------------------- 27,638 July -------------------------------------------- 21,441 August _____ __ ________ __________ ________________ 12,447 September -------------------------------------- 23,456 October ----------------------------------------- 24,754 November --------------------------------------- 18,247 December --------------------------------------- 27,391 VISUAL EDUCATION Number Different Total Number Month Films Shown January __________________ _ 48 February ______________________ _ 49 March ------------------------- 50 April -------------------------- 57 May __________________________ _ 47 June --------------------------- 32 July __________________________ _ 22 Augu~ ________________________ _ 14 September _____________________ _ 26 October _______________________ _ 40 November _____________________ _ 43 December _____________________ _ 28 Times Shown Attendance 190 39,923 317 62,823 217 45,122 213 39,913 111 12,565 45 3,668 31 1,761 15 525 31 5,734 60 20,374 72 12,631 37 3,623 Total _________________ 456 1,339 248,662 LIBRARY The Library of the Georgia Department of Public Health, set up in the State Office Building in 1940, functioned with a fair degree of success during 1942. The Staff Library Committee, reduced to two members by losses to the war effort, made several important rulings with regard to the requisitioning of books and journals, and to the administering of the divisional and regional collections. The Work Projects Administration of 144 Georgia Department of Public Health Georgia continued to furnish help-one assistant all the year, and one for 'about six months. The general collection was increased by about 147 new hooks and 878 pamphlets, the accession number rising from 5,200 to 6,225. In addition to these, the library has had the use of 53 books loaned for the duration of the war or longer by Dr. A. W. Hill when he left to enter the service. At his request, these are being used just as if they were regular library books. A new branch collection was catalogued and prepared for the Training Center of the Division of Public Health Nursing, beginning with 33 h1 ooks. Also, a number of books and pamphlets were added to the previously organized branch collections, many of !!hem going to the industrial Hygiene Service. To 'the 73 journals on the 1941 list have been added 25 new tides, among them the bi-weekly Proceedings of the Staff Meetings of the Mayo Clinic and the weekly Current List of Medical Literature from the Library of the Surgeon General of the United States Army. The latter carries with it the privilege of procuring microfilm reprints from the Medicofilm Service connected with this library. Books and journals for the year, including binding, have cost about $1,143.00, and library supplies, furnishings, et cetera, have cost about $272.00. The cataloging is considerably behind, but the duplicate cards for the regional offices have 1heen typed up to the point decided upon. As soon as the references and eross references, and the checking are completed, these duplicate catalogs can he set up. Loans for the year add up to 2,648 or more, and reference calls numbering 1,988 have been recorded-an average of about 220 per month for the former, and 165 for the latter. This does not include all the use of material in branch collections, and some of the most frequent users of the library went into the service during the year. In addition to official public health workers, 'there have been a number of other users of the collectionpublic welfare workers, doctors, students, teachers, officials in the United States armed forces, and others. The Fernhank Forest Association, upon request, was loaned a considerable number of books and pamphlets, and was furnished with several bibliographies, for use in an exhibit put on by the Association during National Book Week in November. Division of Preventable Diseases C. D. Bowdoin, M.D., Director and Epidemiologist John M. Walton, M.D. ____ ~ _________________ Venereal Disease Control William J. Mu11phy, M.D. ____________________________ Cancer Control Lester M. Petrie, M.D. ________________________ ____ Industrial Hygiene David M. Wolfe, M.D. ______________________ Assistant Epidemiologist Roy J. Boston, Engineer_ _______________________ Typhus Fever Control CANCER CONTROL SERVICE The Georgia Cancer Control Program functioned without interruption throughout the year. Problems were encountered as the result of war activities, but the Program was not seriously affected and it was possible to provide diagnostic and treatment service for all eligible patients who applied for state-aid. No major changes in policy were made during the year. PERSONNEL~CANCER CONTROL SERVICE At the beginning of the year the personnel of the Cancer Control Service consisted of a director and two clerks. These three individuals served continuously throughout the year. On October 1, 1942, a new clerk was added to the staff for the purpose of assisting with the tabulation of data provided by the clinic records. TREATMENT CENTERS The twelve treatment centers which are cooperating in the Program gave uninterrupted service throughout the year. No additional clinics met the requirements for recognition. A considerahle number of the physicians on the staffs of the clinics entered the armed services during the year. For the most part, however, it has been possible for the Clinic Directors to secure adequate replacements. One clinic director, Dr. R. C. Pendergrass, of Americus, entered the armed services. He was succeeded by Dr. A. C. Primrose, who has been associated with the Americus Clinic since it was organized. ACTIVITIES Applications. Alpplications for state-aid totaled 2,249 in 194.2 as compared with 2,229 in 1941. Though the number of applicants in 1942 increased slightly over the preceding year~ the net increase was the smallest noted in any year since the Program was begun. Moreover, during the last six months of 1942 the number of applications received showed a decrease over the corresponding period for 1941. This was most pronounced during the last three months of the year when only 474 applications were received as compared with 544 for the final quarter of 1941. The causes associated with the reduction in the number of applicants for state-aid during the la,st half of the year are not wholly clear, but two 146 Georgia Department of Public Health factors are undoubtedly responsible in part: (1) Increase m the annual income of many families; (2) Transportation difficulties. Comparison of the number of applications received in 1942 from each of the twelve clinic areas with the number received from the same area in 1941, shows considerable variation in the findings in different parts of the State. In some areas the number of applicants in 1942 increased markedly over the previous year while in other areas decreases occurred. This is shown in Table I. In the same table is shown the number of applications received per 10,000 population from each clinic area. These rates vary greatly in different parts of the State. Of the 2,249 applica.tions received during the year all but four were approved. The number of applications disa'pproved has been negligible since July, 1941, when the regulation dealing with patients over 75 years of age was rescinded. Clinic Activities. During 1942 a total of 2,002 patients reported to the clinics for the first time. Of this number, 1,199 were diagnosed as having malignant disease, 789 were diagnosed as having non-malignant disease and in 14 cases the diagnosis was deferred. The number of patients reporting to the clinics for the first time in 1942 was slightly less than the number (2,010) reporting in 1941. The total number of cases receiving diagnostic and treatment service in 1942, however, showed a substantial increase over the number receiving such service during the previous year. Each year since the Control Program was inaugurated there has occurred a gradual but steady increase in the number of cases classed as non-malignant. The increase is noted not only with respect to the number of patients reporting but also in the proportion of non-malignant to malignant cases. The significance of this trend is not wholly clear, but it is consistent with the assumption that physicians are trying to refer cases earlier in the course of the disease. In Table II is shown a summary of the activities in 1942 as compared with those .. 1-0 Jefferson -- 22 8 30 Jenkins ---- 18 24 Johnson --- 7 2 9 Jones ------ 3 8 Lamar -- -- 10 6 16 Lanier ----- 6 6 Laurens --- 41 11 52 Lee -------- 3 5 8 Liberty ---- 4 Lincoln ---- 16 10 26 Long ------ 1 Lowndes 28 35 Lumpkin --- 1 McDuffie -- 17 4 21 lllclnt-osh -- l\lacon ----- 6 l\Iadison --- 10 2 8 2 12 :Marion -- ~- 6 7 Meriwether - 23 16 39 Miller ----- 14 3 17 Mitchell 13 18 Monroe ---- 10 15 Montgomery_ 19 6 25 Morgan ---- 3 6 9 1\lurray ---- Muscogee ___ 32 33 Newton ---- 6 8 Oconee -- --- 3 4 Oglethorpe - 2 Paulding -- 6 1 Peach ----- 8 10 18 Pickens ---- 3 Pierce ----- 10 3 13 Pike ------- 7 5 12 Polk ------- 16 6 22 Pulaski ---- 6 3 9 Putnam ---- 6 11 Quitman --- Rabun 5 2 Randolph Richmond - -:;; C> 0 1,122.25 1,262.50 359.29 37 4.20 586.33 165.;)5 1,190.75 354.13 330.50 1,025.25 10.00 1,678.75 45.50 548.38 391.15 480.70 221.50 1,881.81 506.00 1,059.09 575.80 662.64 247.7o 106.50 1,431.52 432.00 221.50 268.07 132.62 423.18 73.50 280.00 325.77 1,253.25 286.62 476.68 6.50 295.00 516.32 c. Counties .~ c: . .c: -"-"'""'' :lEO c: .':!! . .Oi :z".;,;'o:"..,', -.."..' ~C>"'. . 1-0 -:;; C> 0 Rockdale -- 2 Schley 6 Screven ---- 13 14 Seminole 5 1 Spalding --- 11 Stephens 10 Stewart ---- 1 Sumter __ -- 17 17 Talbot 4 Taliaferro -- 6 Tattnall ---- 9 2 Taylor 5 Telfair 11 Terrell 6 4 Thomas 19 8 Tift -- ----- 14 Toombs ---- 26 Towns ----- 1 1 Treutlen --- 12 2 Tvoup 33 12 Turner 11 2 Twiggs Union 2 Upson 15 Walker _____ 15 4 Walton ---- 3 Ware ------ 12 6 'Varren ---- 7 Washington _ \Vayne --. -- 11 Webster ---- Wheeler --- White ------ 3 Whitfield -- 16 3 Wilcox -- 8 2 Wilkes -- -- 8 Wilkinson -- 12 Worth 19 11 2 36.50 186.11 27 1,236.40 6 167.08 16 689.70 12 4:17.75 1 10.00 34 1,707.94 4 200.27 6 278.18 11 586.64 6 405.91 16 694.87 10 44 7.65 27 744.26 21 660.78 31 1,097.32 2 111.25 14 364.27 45 1,906.20 13 721.60 10 167.00 2 128.00 18 420.52 19 270.15 208.00 18 668.71 12 453.90 14 1,105.45 11 402.00 411.02 7 243.55 3 80.00 19 835.80 10 404.65 8 466.00 15 584.96 30 1,598.56 ----- Total --- 1,641 585 2,226 $91,181.37 154 Georgia Department of Public Health PERSONNEL EPIDEMIOLOGIC SERVICE The personnel of this Service consists of the Director of the Division of Preventable Diseases, who is also State Epidemiologist, and one stenographer. Valuable assistance has been rendered by staff members of the Division of Preventable Diseases in making special investigations connected with unusual outbreaks of disease. Regional medical directors and nurses as well as county public health nurses in non-health officer counties have also assisted in making epidemiologic field visits and investigations. OFFICE PROCEDURES Regular routine office procedures have been carried out in which this Service collaborated with the Regional Medical Directors and Health Officers by accumulating and disseminating morbidity reports to these officials weekly and monthly as well as daily whenever necessary to expedite investigation and control of communicable diseases. Information pertaining to the names of physicians and their locations in the State has been given to public health workers regularly in order to effect a more accurate accounting of reports, correspondence, and finances. Inasmuch as the State Epidemiologist is a:lso Director of the Division of Preventable Diseases, much of his time has been spent in directing not only the activities for this Service but for the following Services: Industrial Hygiene, Venereal Disease Control, Typhus Contml and Cancer Control. In addition to this he was appointed acting director for the Divisions of Health Education and Malaria and Hookworm during the absence of their directors who are in armed forces. SPECIAL INVESTIGATIONS Typhoid and Dysentery-On January 22 this Service was notified of an outbreak of typhoid fever and bacillary dysentery at the Flint River Cotton Mill Village, Albany, Georgia. The following day a preliminary investigation was conducted in this mill village and vicinity by a member of our medical staff and one engineer, in cooperation with the Dougherty County Health Department as well as officials of the mill. At this time the seriousness of the outbreak was not fully demomtrated, but on February 4 a call meeting of the Dougherty County Board of Health with State Health Department representatives was held, at which time it was agreed that the most probable route of the infection wa.s polluted water from the Flint River Cotton Mill wells. Arrangements were made for closing this water supply and substituting safe water from the City of Albany and for a more complete investigation by the State Health Department. By February 9 the outbreak had reached such proportions that it seemed advisable that the State Heaith Department take complete charge of the work connected with clearing up the epidemic as well as the nursing program connected with it. This proposal submitted to the Dougherty County Boar.d of Health on February 10 received their unanimous approval. The assistance rendered in personnel by the State Health Department Preventable Diseases I 55 consisted of 4 physicians, 7 nurses, 2 engineers, I bacteriologist, and I technician. The mill furnished 2 graduate nurses and 5 practical nurses. Expenses of hospitalization, medical and nursing care, field headquarters, telephone, supplies, and equipment were horne by the mill. The services of the local WPA Housekeeping Project were secured. They supplied 7 housekeepers and a supervisor. Epidemiological investigations were made and specimens for culture were obtained from every known case of typhoid fever or dysentery and from every known suspect. The final report of the investigations and studies revealed that a total of 8I cases of tyrphoid fever occurred, 2 having died. Twelve of these cases were without symptoms of typhoid. In addition to the typhoid fever, there were 79 cases of bacillary dysentery, 4 of these cases having a double infection with both typhoid and bacillary dysentery. Two individuals died from diarrhea of undetermined etiology. All epi demiological evidence indicated that this was a water-borne outbreak. Drinking water from the Flint River Cotton Mill wells was common to all but one of the victims whose source of water was a nearby private well, drawing water from the same underground source. A more detailed report of this investigation is being prepared for publication. Typhus Fever-A request was made to the Division of Preventable Diseases for an investigation of the I7 cases of typhus fever which had been reported for the City of Brunswick and Glynn County for the period of January I through November I4. Two of these cases were reported in February, I in May, II in August, 3 in September, and none in October and November. Of the I7 cases reported, I3 were investigated and complete epidemiological cards made. Of the 4 not contacted, 2 had moved from Brunswick, l could not be located in the county and the fourth case was appa-rently out of town, as repeated visits to his home failed to get any response. All of the I7 cases reported were white and 10 were male and 7 female. The I3 cases investigated were widely scattered over the town, only 2 of them living in the same neighborhood, l of which occurred in February and the other in October. Therefore, it was concluded that the place of infection was at the place of employment, since all cases pointed back to the business district of the town, especially the food stores and restaurants which gave a definite history of rat infestation, and the employees stated they had had insect bites but could not state definitely whether they were from fleas or mosquitoes. The staff member making the investigation reported that he found a serious situation with all of the eating establishments over-taxed by the unusually large influx of population brought on as a result of a ship-building project and other governmental construction going- on in and around Brunswick and that it was possible for a serious outbreak of typhus to develop in this locality. He recommended that the business district of Brunswick be rat-proofed and that after this was done a campaign for destruction of existing rats be carried out. 156 Georgia Department of Public Health Gastro-Intestinal Episodes- !) A food poisoning outbreak occurred in the FFA Camp near Covington during the latter part of January and early part of February, involving 20 cases, 10 or 12 of which were hospitalized. The principal symptoms were nausea and vomiting which lasted about 24 hours. An investigation was made by a member of our staff and one of our sanitary engineers, who reported that circumstantial evidence suggested that this was a milk-borne outbreak connected with the same dairy which was reported to be the source of a simila-r outbreak in Covington during 1941. 2) An epidemiologic report of a milk-borne outbreak, diagnosed as gastroenteritis, was received from the medical director of the Northwestern Health Region, which occurred in March at the Haralson County jail where each of 15 prisoners became sick. The same day the wife of the sheriff and the negro cook suffered similar attacks. The following day two visitors who had lunch at the jail were also subject to similar vomiting and diarrhea. All illnesses terminated within a few hours. E'pidemiological investigation showed that the only common article of food ingested by the prisoners and others was milk, produced in the home. The Assistant Engineer on Milk Sanitation made a study of the two cows owned by the sheriff and reported that labomtory results indicated that 1the food 1poisoning cases were probably caused by toxin resulting in the milk caused by the presence of staphylococcus aureus organisms in one of the cow's udders. 3) On June 2 a citizen of Blue Ridge, Georgia, reported to the publi::: health nurse of Fannin County that her family, consisting of 6 members, two other families, consisting of 8 members, and one other from the hotel had all taken sick about ll :00 P. M., June l, with vomiting, diarrhea and cramps. When the nurse made an investigation the following evening she found them all up, feeling better, vomiting had ceased about 4:00 A. M., but all were still nauseated. Diarrhea had been checked but they were not entirely comfor.table. None had temperature above normal, but all showed signs of shock. 'Ilhe only common article of food used by all in their respective homes was buttermilk and cornbread, which was taken about 6:00 or 7:00 o'clock P. M. on June l. All had obtained milk from the same source that day, but the cornbread had been prep;ued in each individual home. On June 15, the Regional Medical Director noted the report of this outbreak and in company with the public health engineer made further investigation. The producer of the buttermilk reported that he and his family of 4 as well as another family of 4 drank some of the same milk with no bad results. It was reported that each of the families who became sick and another family who drank milk from the same source but did not become ill used water from the same unprotected spring. The producer of the milk also used water from his spring also unprotected. After approximately 15 days after the outbreak it was impossible to point out the definite source of the outbreak, but the character of the sickness was of the type produced by toxins such as are commonly formed in Preventable Diseases 157 milk infected wi.th staphylococcus aureus, under favorable conditions for culture. 4) On July 7 an investigation was made by one of the staff members of the Division .of Preventable Diseases of a G. I. upset among the students at North Georgia College, Dahlonega, Georgia. Most of the cases who had been sick during the so-called epidemic were contacted as well as the college physician, and the history obtained from him was that of a typical case of food poisoning. The physician was called during the early morning hours about 2:00 A. M. and found some 20 boys acutely ill-nausea, vomiting and diarrhea. Some few of the boys had violent cramp-like pains in abdomen. They were all 'considerably better the next day and the following day all were back in class except one boy. None of the girls reported ill at "sick call" but one gave a history of having been slightly upset during the night. The dietician reported that they had cold supper Sunday night, consisting of cold sliced ham, pineapple and potato salad. The boys and girls both ate the same food, but the boys ate considerably more than the girls. No new help had been recently employed in the kitchen and n.o history could be gotten of any of the kitchen help having suffered with this trouble. The boys who had been ill had eaten ice cream both from canteen and local Soda Company, but nearly everyone had had different kinds from different places and some had not eaten any. The public health physician who made the investigation reported that his impression of the outbreak was one of food poisoning. 5) An outbreak of an intes,tinal trouble developed in the Darlington School, Rome, from December 8-12 with a case rate of 85 of the 144 (41.3% of total) boarding students and 13 of the 62 (6.3% of total) day students. From detailed history records of cases, previously obtained by the president of the school and information obtained from the dietician and nurse, it was concluded that it was difficult to determine just what was the cause of this trouble. The fact that an investigation was not made until the trouble cleared up afld that stool cultures on all food handlers from ki,tchen and dairy were not obtained made it more difficult to give a definite opinion as to the source of outbreak. However, from the laboratory and engineer reports and from the 1past experience of this .office with staphylococci in milk, it was the opinion of the epidemiologis,t that milk was the etiological factor in this outbreak. 6) Two gastro-intestinal outbreaks occurred following dinners served on November 20 and December 20, 1942, at the same hotel in Dalton, Georgia. The last outbreak was investigated by a staff member of this Division, accompanied by the county health officer and public health engineer. Ninety-eight of the personnel of the American Thread Mill attended the last dinner and practically everyone had some upset, varying from slight pains in the abdomen to severe griping pains with profuse diarrhea at the end of 3 days. Menus for both dinners were obtained. However, from checking the menu with each patient, it was impossible to point out any one food as a causative agent, as nearly everyone ate the foods you 158 Georgia Department of Public Health would most likely suspect. The milk and cream served came from a dairy that has constantly run a very high bacteria count. On both occasions an extra cook and 4 extra waiters were employed, none of which had been examined for fnod handler's cer.tificates, but regular employees had. Arrangements were made to have stool specimens sent in on all kitchen help as well as extra help employed, but one extra cook was not located at the time of investigation. It was concluded that this was a food poisoning outbreak with no definite known origin. Paratyphoid Fever-On December 20th a trip was made to Elberton, Georgia, by a member of our staff to investigate 2 proven cases of paratyphoid fever and 2 suspected cases that had occurred during the last two months. After getting a history of these cases, it was decided that the one common factor seemed to be milk. It was, therefore, concluded that this was milk-borne paratyphoid. Septic Sore Throat-In response to a telephone call on May 4 from the Superintendent of the State Tuberculosis Sanatorium at Alto, an investigation was made of a very decided increase in the prevalence of sore throat noted among patients and employees of the institution. Studies of the outbreak were begun on May 5. Participating in the investigation were one medical s'taff member, director of laboratories, and assistant engineer, milk sanitation, Sta.te Department of Public Health, and the veterinarian from the City of Atlanta. For several weeks prior to the date of investigation, sporadic cases of sore throat had been noted among nurses and employees of the institution. During the period of March 27 to April 26, a total of 14 cases of sore throat were known to have occurred. During the four-day period of April 27-30, there occurred a small outbreak of respiratory diseases among the white patients on the third floor annex. Seventeen cases occurred on this floor among a total of 101 patients. During this same four-day period five sporadic cases, apparently unrelated to the outbreak on the third floor, occurred in various parts of the institution among patients and employees. From Sunday evening, May 3, to Monday evening, May 4, a total of 101 cases of sore throat developed. During the entire period covered by the survey, a total of 157 cases of sore throat developed in persons associated with the institution. After May 4, the outbreak rapidly subsided and there were no new cases after May 7. Epidemiologic investigation revealed that the distribution of oases was associated with the source of the food supply rather than type of employment. Considering the evidence at hand, it was found that the most likely food responsible for the outbreak appeared to be milk. The main arguments in favor of this conclusion are: 1) Large-scale outbreaks of septic sore throat are practically always associated with milk supplies; 2) In connection with this outbreak, opportunities for contamination of the milk supply were 'present; 3) Evidence tending to incriminate the milk supply lacked some of the details needed for a clear explanation of how contamination and subsequent distribution were brought about, the findings in general are consistent with respect to this assumption. Preventable Diseases 159 FIELD VISITS The following table gives a summary -of consultations with physicians, admissions to medical service and field visits by public health nurses, regional medical directors and staff members of the Division of Preventable Diseases in non-health officer counties for !!he years 1941 and 1942. This table is self-explanatory and will show the comparison of these activities for the two years. However, the number of admissions ~to medical service for each year is not comparable with the number of field visits, in that these numbers include persons admitted for medical service in connection with malaria and hookworm, which is res1ponsible in all probability for the large number for each year. Inasmuch as the number of admissions on reports from regional medical directors and nurses were not broken down according to diseases, but included all cc:-ses admitted in connection with preventable diseases, it is impossible to state the actual number of persons admitted for medical service for the diseases tabulated below. TABLE I SuMMARY OF AcTIVITIEs IN THE CoNTROL oF PREVENTABLE DisEASEs IN NoN-HEALTH OFFICER CouNTIES, 1941 and 1942 Type of Activity Regional Medical Directors and Staff 1941 Consultations with physicians __ 468 Admissions to mediral service -- 2,268 Admissions to nursing service ___ Admisssions to medical and/or nursing service ------- Field Visits: Diphtheria ---------------- Me.asles ------------------ Poliomyelitis ------------- 214 Searlet fever ------------- 12 Smallpox ----------------- 9 Typhoid and paratyphoid __ 95 Typhus fever ------------- 63 "'hooping cough ---------Others _____________________ 119 1942 304 2,246 12 4 23 6 125 10 2 103 Total field visits ____ 327 292 Public Health Nurses 1941 1942 4,990 3,375 327 178 669 106 28 289 56 41 2:\3 1,947 240 95 31 174 5 338 10 49 228 1,170 Total 1941 468 2,268 4,990 1942 304 2,246 3,375 4,228 3,o3a 335 183 883 118 37 384 119 43 372 2,474 252 99 54 180 12 463 20 51 331 1,462 Other Field Visits: In addition to the above field VISits, numerous other trips were made in health officer counties and for other purposes. The foregoing narrative of special outbreaks incorporates some of the o.ther field visits by staff members of this Division made in connection with same. The State Epidemiologist responded to 4 requests for assist- 160 Georgia Department of Public Health ance from health officers in addition to those reported above: an outbreak of diarrhea and nausea in Savannah during February; a typhoid case in the State Hospital, Milledgeville, in April; an outbreak of several cases of typhoid in Columbus in June; and an outbreak of food poisoning at the Ship Building Yards in Savannah also during June. He also made 19 field trips for the purpose of investigating locations for detention homes for prostitutes in the following towns: Macon, 3; Milledgeville, 1; Chatsworth, 1; Eton, 1; Chipley, 1; Marietta, 1; Rutledge, 1; Waynesboro, 1; Augusta, 2; Rydal, 1; Greensboro, 1; and Atlanta, 5. Field Visits by Counties-The following table will show the number of field visits made in the control of specified and other preventable diseases in non-health officer counties for 1942 as reported by regional medica-l directors, public health nurses, and staff members of this Division: Diphtheria: Barrow -------- 13 Brantley ------- 5 Butts ---------- 3 Candler -------- 2 Clayton -------- 4 Clinch --------- 4 Coweta 6 - - - - - - - - - - Dade ---------- 4 Dawson -------- 2 Douglas -------- 1 Measles: Atkinson -------- 1 Bryan --------- 4 Charlton ------- 15 Dade ---------- 1 Evans -- ---- --- 10 Poliomyelitis: Bryan ---------- 1 Carroll --------- 1 Cherokee --------- 1 Fannin ----------- 31 Forsyth --------- 4 Scarlet Fever: Atkinson --- 2 Baker ----------- 1 Bryan --------- 2 Clayton -------- 1 Coweta -------- 4 Dade ----------- 5 Emanuel ------- l Evans ----------- 6 Forsyth -------- 44 Gordon ------- 48 Haralson ------ 15 Jackson -------- 12 Jasper ---------- 16 Jeff Davis ----- 2 Lanier -------- 4 Macon --------- 1 Monroe ------- 13 Murray ------- 16 Peach -------- 2 Pike ----------- 15 Rockdale ------- 2 Screven ------- 2 Stewart ------- 3 Taylor -------- 3 Turner 2 - - - - - - - Union -------- 2 Fannin ------- 8 Macon -------- 17 Forsyth -------- 1 Pike ----------- 11 Glascock ------ 8 Upson -------- ] Irwin --------- 16 Toombs ------- 1 Long --------- 5"' Gilmer -------- 2 Jackson ------- 1 Lumpkin ------ 3 Macon -------- 1 Pickens -------- 1 Pierce -------- 4 Polk --------- 1 Towns ------- -- 1 Turner 1 --------Webster ------ 1 Fannin -------- ll Forsyth ------- 42 Glascock ------ l l Gordon ------- 73 Jackson ------- 5 Jasper -------- 4 Lumpkin ------ 6 Murray ------- 1 Rockdale ------ 1 Toombs ------- 2 Turner -------- 2 Twiggs ------- 1 Upson -------- 5 Preventable Diseases 161 Smallpox: Atkinson _______ 2 Carroll ________ 1 Columbia _ 1 Haralson ~----- 3 Lee ----------- 2 Monroe ------- 1 Screven 1 ~-----Webster -------- l Typhus Fever: Evans __________ 2 Henry _________ 1 Irwin __________ 4 Marion ------- 2 Peach -------- 3 Schley --------- 2 Taylor -------- 4 Twiggs ------- 2 Typhoid Fever: Ben Hill ________ 8 Brantley ________ 4 Butts __________ 4 Carroll ____ ____ 2 Clay ___________ 1 Clayton ________ 37 Coweta ________ ll Crawford _______ 4 Dooly _________ 9 Douglas ________ 5 Early __________ 1 Effingham ______ 2 Elbert _________ 6 Emanuel _______ 1 Evans _________ 6 Fannin --------- 41 Fayette ------- 3 Forsyth - ------ 9 Franklin ------ 8 Gordon ---- -- 15 Haralson -------- a" Hart ---------- 2 Heard -------- 7 Henry -- ----- ll Houston ------- 23 Irwin ----------- l Jackson ------- 15 Jasper --------- l Lamar -------- 1 Macon ------ 20 Munay ------- 15 Paulding ------- 1 Peach ------- -- 24 Pierce -------- 1 Pike --- ------- ll Randolph ----- 9 Stewart ------- 20 Talbot -------- 2 Taliaferro ----- 1 Toombs ------- 2 Turner ------- 31 Twiggs ------- 7 White -------- 1 Wilcox ------- 4 Wilkinson ----- 73 Whooping Cough: Brantley _______ 1 Evans _________ 18 Fannin _________ 2 Forsyth _______ 2 Lumpkin ______ 16 Glascock ______ 1 Macon ________ 9 Gordon _______ 2 Other Preventable Diseases: Atkinson _______ 7 Brantley _______ 62 Butts __________ 6 Candler ________ 1 Dade __________ 2 Clinch _________ 4 Cook ___ _______ 2 Cowet:a ________ 4 Dawson ________ 3 Early __________ 1 Emanuel _______ 5 Evans __________ 17 Fannin ________ 25 Forsyth _______ 58 Glascock _____ __ 8 Gordon _______ 6 Habersham ____ 50 Henry ________ 1 Houston ___ ___ 4 Johnson ______ 1 Irwin _________ 3 Lumpkin ______ 17 Macon ________ 2 Murray _______ 3 Newton _______ 2 Peach ________ 4 Pierce ________ 5 Pike __:________ 4 Polk __ ___ ___ 2 Randolph _____ 1 Screven _______ 7 Stewart _______ 3 Tattnall _______ 2 Tiaylor ________ 3 Turner _______ 4 Upson ________ 2 162 Georgia Department of Public Health REGULATION: On April 16, 1942, the Director of this Division submitted to the State Board of Health a regulation prohibiting the importation, purchase, breeding, giving away, sale or offer of sale of birds of the psittacine family, which was adopted effec:tive not less than three months after the date of its adoption. EDUCATIONAL ACTIVITIES Meetings Attended and Addressed: During the year 1942 the Director of this Division attended 14 public meetings, 6 of which were addressed, with an approximate attendance of 768. At the Southern Medical Association, Richmond, Virginia, he discussed a paper on "Pretibial Fever-An Obscure Disease," read by Worth B. Daniels, Lt. Col., Medical Corps, Fort Bragg, North Carolina. Articles Contributed: The Director of this Division contributed an article entitled "A New Disease Entity?" to the Journal of the Medical Association of Georgia, which was published in the December issue, 1942. Literature Distributed: During the year 46,327 bulletins on the control of preventable diseases were distributed to schools, organizations, and individuals. This number exceeded the number of bulletins distributed in 1941 by 13,443, when 32, 884 pamphlets were sent out. ANALYSIS OF STATISTICAL REPORT Tabulated information concerning morbidity and mortality reports in connection with preventable diseases are attached, and the comments on certain of these diseases which follow are based on these tables. Diphthera: During 1942 there were 660 cases and 55 deaths from diphtheria reported to the Department 1as compared with 758 cases and 63 deaths in 1941. The case rate 'per 100,000 population dropped from 24.1 to 21.1 and the death rate dropped from 2.0 to 1.8 to set a new all-time low rate for the State. The case fatality rate was 8.3, the same as for the previous year. Dysentery: There was an increase in the number of cases of dysentery reported in 1942, when the number increased from 516 in 1941 to 584. The case rate per 100,000 population increased from 16.4 to 18.7, although there was a decline in the death rate from 3.5 in 1941 to 2.8 in 1942, when the number of deaths decreased from 109 to 86. Gonorrhea: There was a considerable increase in the number of cases of gonorrhea reported in 1942, when the number jumped to 16,786 from 7,229 in 1941. The case rate per 100,000 population jumped from 229.8 in 1941 to 537.4 in 1942. This was due chiefly to Selective Service as a case-finding 'agency and to the distribution of free drugs to physicians for treatment of this disease. Hookworm: In 1942 there were 4,617 cases of hookworm reported as compared wi~th 7,143 cases in 1942, and the c<::se rate decreased from 227.1 Preventable Diseases 163 to 147.8 in 1942. This does not mean an actual drop in the rate hut rather is the result of curtailing the hookworm program. See report of Division of Malaria and Hookworm. Influenza: There were 2,900 cases of influenza reported in 1942 as compared with 36,021 cases in 1941. The case rate dropped from 1,145.3 to 92.8 in 1942. The probable reason for the great drop is that influenza was epidemic in 1941 and to the fact that many of the milder cases were not seen by a, physician in 1942, due to the shortage of doctors. There were 994 deaths in 1941as compared with 482 in 1942, and the death rate dropped from 31.6 to 15.4. Malaria: The number of reported cases of malaria drorpped from 1,122 in 1941 to 981 in 1942. The case rate dropped from 35.7 to 31.4, but the number of deaths remained practically the same, when there were 75 deaths in 1941 and 76 deaths in 1942. The death rate remained the same, 2.4 for the two years. Measles: There was a drop in the number of cases of measles from ll,009 in 1941 to 5,921 in 1942. The case rate dropped from 350.0 to 189.5 in 1942, the death rate from 5.0 to 1.9, and the number of deaths from 157 in 1941, when measles was epidemic, to 60 in 1942, which was a post epidemic year. Meningitis: There was an increase in the number of cases of meningitis from 35 in 1941 to 53 in 1942. The rate increased from 1.1 to 1.7, the death rate increased from 0.5 to 0.6 in 1942, but the case fatality rate dropped from 48.6 in 194,1 to 34.0 in 1942. Pellagra: There was a continued decline in pellagra repmted in 1942, .the number of cases dropping from 334 in 1941 to 257 in 1942. The case rate dropped from 10.6 to 8.2 and the death from 6.5 to 5.8 in 1942. The case fatality rate increased from 61.1 to 70.4 in 1942. Pneumonia: The number of cases reported in 1942 increased from 3,623 to 4,172, and the rate increased from ll5.2 to 133.6. However, the deaths from this disease decreased from 1,7 A to 1,612, .the death rate from 54.5 to 51.6, and the case fatality rate dropped from 47.3 to 38.6. Some of the increase in the number of cases is probably accounted for by including the "virus" or atypical pneumonia in this classification, which were probably called influenza in former years. The reduotion in the number of deaths is in all probability due to the greater use of the "sulfa drugs." Poliomyelitis: There were 49 cases of poliomyelitis reported in 1942, as compared with 790 cases in 1941, Georgia's great epidemic year. The case rate was 1.6 as compared with 25.1 per 100,000 population in 1941, and there were lO deaths as compared with 33 in 1941, when the death rate decreased from 1.1 to 0.3 in 1942. Scarlet Fever: There was an increase in the number of cases of scarlet fever from 1,079 in 1941 .to 1,148 in 1942, and the erase rate increased from 34.3 to 36.8. However, the deaths decreased from 9 in 1941 to 2 in 1942, and the case fatality rate dropped from 0.8 to 0.2 in 1942. 164 Georgia Department of Public Health Smallpox: There were 7 cases of smallpox reported in 1942 as compared with ll cases in 1941. The case rate decreased from 0.3 to 0.2 and there were no deaths recorded. Syphilis: There were 19,540 cases of syphilis repor,ted in 1941 and 21,544 cases in 1942, a case rate increase from 621.3 to 689.7. The number of deaths, however, decreased from 503 to 462, when the death rate dropped from 16.0 to 14.8 and the case fatality rate declined from 2.6 to 2.1 in 1942. Tuberculosis: The number of cases of tuberculosis increased from 2,635 to 3,067 in 1942, and the case rate from 83.8 to 98.2, but the deaths decreased from 1,385 to 1,265 and the death rate dropped from 44.0 to 40.5 in 1942. The ca-se fatality rate dropped from 52.6 to 41.2 in 1942. Typhoid Fever: There were 384 cases of typhoid fever reported in 1942 as compared with 397 cases for 1941, and the case rate declined from 12.6 to 12.3. The deaths from typhoid fever dropped from 55 in 1941 to 24 in 1942, and the death rate from 1.7 to 0.8, a new all-time low death rate for the State from this disease. The case fatality rate dropped from 13.9 to 6.3 in 1942. Typhus Fever: There was ,an increase in the number of cases of typhus fever in 1942, from 946 in 1941 'to 1,153, and a case rate increase from 30.1 to 36.9. The number of deaths from ,this disease increased from 36 in 1941 to 52 in 1942, and the death rate increased from 1.1 to 1.7, when 'the case fatality rate increased from 3.8 to 4.6. Undulant Fever: There was a slight increase in the number of cases of undulant fever in 1942 from 117 ,to 129, and the case rate increased slightly from 3.5 to 4.1. However, there were no deaths in 1942 as com pared with 2 from this disease in 1941. Whooping Cough: There was a slight decrease in the case rate from whooping cough from 44.7 to 43.8 in 194.2, and the number of cases dropped from 1,406 to 1,369. The deaths dropped from 140 in 1941 to 101 in 1942, the death rate declined from 4.5 to 3.2, and the case fatality rate dropped from 10.0 to 7.1 in 1942. It is encouraging to note that the numbers of cases o influenza, malaria, pellagra, smallpox, and t)'lphoid fever are the lowest to ever be reported to the Department. The numbers of deaths caused from diphtheria, dysentery, gonorrhea, influenza, pellagra, pneumonia, scarlet fever, tuberculosis, and typhoid fever are also less than ever previously reported. Deaths from undulant fever again reached the zero mark as it did in 1936, and no deaths froiiL smallpox have occurred for the past seven years. Preventable Diseases 165 NuMBER OF CAsEs AND DEATHS FRoM SPECIFIED NoTIFIABLE DISEAsEs REPORTED IN GEORGIA, 1938. 1942 WITH RATES PER 100,000 PoPULATION AND PER CENT FATALITY Diseases Diphtheria : Dysentery: Gonorrhea: Hookworm: Influenza Malaria: Measles: Year 1938 1939 1940 1941 1942 1938 1939 1940 1941 1942 1938 1939 1940 1941 1942 1938 1939 1940 1941 1942 1938 1939 1940 1941 1942 1938 1939 1940 1941 1942 1938 1939 1940 1941 1942 Cases Case Rate Per 100,000 Population Deaths Death Rate Per 100,000 Population Fatility Rate (Per Cent) 1232 1112 543 7;)8 660 39.7 106 3;).3 95 17.4 59 24.1 63 21.1 55 679 21.9 192 58;) 18.6 127 582 18.6 126 516 16.4 109 584 18.7 86 4686 lfil.2 21 1;)83 14;).7 24 5282 169.1 22 7229 229.8 24 16786 537.4 6 17711 20384 17306 7143 4617 571.4 647.9 554.0 227.1 147.8 3782 122.0 802 11592 368.5 950 13420 429.6 924 36021 1145.3 994 2900 92.8 482 3816 123.1 146 2996 95.2 101 2502 80.1 89 1122 35.7 75 981 31.4 76 10514 339.2 Vi7 3423 108.8 51 3282 105.1 23 11009 350.0 157 5921 189.5 60 3.4 3.0 1.9 2.0 1.8 6.2 4.1 4.0 3.5 2.8 0.7 0.8 0.7 0.8 0.0 0.1 0.3 0.03 0.1 25.9 30.4 29.6 31.6 15.4 4.7 3.2 2.8 2.4 2.4 5.1 1.6 0.7 5.0 1.9 8.6 8.;; 10.9 8.3 8.3 28.3 21.7 21.6 21.1 14.7 0.4 O.:i 0.4 0.3 0.03 0.01 0.04 0.01 0.04 21.2 8.2 6.9 2.8 16.6 3.8 3.4 3.6 6.7 7.7 1.~ l.:i 0.7 1.4 1.0 166 Georgia Department of Public Health NuMBER oF CAsEs AND DEATHs FRoM SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA, 1938. 1942 WITH RATES PER 100,000 PoPULATION AND PER CENT FATALITY-Continued Diseases Year ~Ieningitis: Pellagra: Pneumonia: Poliomy- PREVENTABLE DisEASES REPORTED IN GEORGIA BY MoNTHs, 1942 0\ 00 Disease Total Actinomycosis Acute In f. Conjunctivitis----------------- 65 Anthrax __________________________________ 3 1426 Dengue ------------------------- --------- Diphtheria ------------------------------- 660 Dysentery. Amebic ------ ---------------- 67 Dysentery, Bacillary -------------------- 373 Dysentery, Unspecified -------------------- 144 16786 4617 Influenza ---------- ---------------------- 2900 Leprosy ---------------------------------- Lethargic Encephalitis -------------------- 7 981 5921 53 1659 32 257 Pneumonia ----------------------------- 4172 P-oliomyelitis _______ --------------------- 49 3 4 88 6 1148 357 Smallpox _________________________________ 7 Syphilis __________________________________ 21544 Tetanus __________________________________ 39 Jan. 2 173 50 5 17 3 87i 570 607 1 13 1036 1 136 2 21 462 4 10 1 132 47 2 1520 1 Feb. 2 1 234 34 1 45 5 893 698 627 28 1530 3 212 23 459 2 1 7 100 54 1313 2 Mar. 1 211 23 8 51 10 839 538 517 1 9 1370 8 163 1 26 468 1 1 5 74 27 1612 1 Apr. 6 309 19 2 10 8 848 511 245 1 36 857 6 345 4 20 302 3 1 4 55 20 1 1484 3 May 237 14 4 21 8 1702 484 126 70 804 4 262 1 22 279 5 1 1 11 45 44 3 2093 10 June 1 67 -- 10 9 100 19 1369 356 43 -- 93 176 4 115 5 22 159 1 -- 6 22 25 1745 4 July Aug. Sept. Oct. Nov. Dec. 24 26 3 1 1 6 17 5 4 24 57 -- 45 125 180 103 99 ~ 40 .c<.b. 6 6 8 6 6 35 34 14 20 17 6 9 Cl'l ~- 49 5 5 17 6 9 t:::l 1031 1584 2079 1701 1938 1925 <..::.!.".".' ".~.'.. """""!;:>''''' ...... ~ 170 Georgia Department of Public Health NoTIFIABLE DisEAsEs REPORTED BY CoLoR, SEx, AND AcE-1942 Age Level by Years Diphtheria wc Amebic Dysentery wc Bacillary Dysentery wc Malaria wc Menincococcus Measles Meningitis w cwc Under 1 Year M 10 F 8 14 2 14 3 13 12 15 1-2 Years 111 25 18 F 12 13 4 13 3 3 19 13 1 30 8 2-3 Years M 38 F 31 10 2 31 19 9 29 11 2 3-4 Years 111 29 F 39 8 2 44 10 11 3 30 14 4-5 Years M 29 4 6 44 12 F 31 6 1 44 5-6 Years M 23 6 3 33 3 F 21 6 47 9 6-7 Years M 20 F 26 94 14 89 21 7-8 Years M 18 2 1 3 80 12 F 17 3 4 2 82 16 8-9 Years M 17 F 14 6 2 62 16 2 2 5 57 15 9-10 Years Ill 13 3 3 2 34 9 F 10 2 4 39 13 1()--14 Years M 28 3 1 F 33 6 1 13 34 16 75 41 24 15 98 36 15-19 Years M 7 F 11 3 21 20 43 1 13 9 16 12 2 20-24 Years M 4 F 6 18 11 14 12 6 11 25 16 13 4 2,5-29 Years M F 2 6 20 12 14 2 3 22 16 6 6 30-34 Years M F 2 6 29 8 3 2 7 26 12 35-39 Years )\[ F 17 5 3 2 6 20 11 40-44 Years M F 16 6 2 5 16 12 45-49 Years M F 12 6 3 22 50-54 Years M F 3 6 2 13 55-64 Years M F 21 16 18 9 65-74 Yem'S M F 2 2 3 2 75 and Above ~~ ~' 10 3 3 2 Unknown 111 F 10 1 22 13 3 27 39 38 11 Total M 265 52 18 10 131 31 262 133 622 229 21 F 276 47 24 146 3:J 2;j6 141 659 201 10 This also includes unspecified dysentery, Preventable Diseases 171 NOTIFIABLE DisEAsEs REPORTED BY CoLoR, SEx, AND AcE-1942 (Continued) Age Level by Years Under 1 Year M F 1-2 Years l\1 F 2-3 Years M F 3-4 Years M F 4-5 Years M F 5-6 Years M F 6-7 Years l\1 F 7-8 Years l\1 F 8-9 Years M F 9-10 Years l\1 F 10-14 Years M ]' 13-19 Years M F 20-24 Years l\1 F 25-29 Years M F 30-34 Years M F 35-39 Years M F 40--44 Years M F 45-49 Years M F 50-54 Years M F 55-64 Years M F 6:\-74 Years M F 75 and Above M F Unknown M F Total M F Pellagra wc Pneumonia Poliomyelitis w cwc Scarlet Fever wc Septic Sere Throat wc 129 133 93 164 28 35 25 23 22 19 12 18 17 7 15 ;; 19 6 17 14 2 9 8 16 6 7 4 13 8 17 1 2 14 2 40 21 26 10 23 35 10 20 18 29 4 I 16 28 2 16 41 20 30 17 44 23 15 2 18 45 7 13 32 1 32 26 10 8 24 34 23 50 19 34 4 6 36 40 10 31 23 6 45 46 18 12 37 38 14 75 35 39 10 84 22 11 2 78 32 15 8 88 24 16 13 19 13 43 26 726 674 23 108 71 612 560 1:> 6 1 7 2 11 22 4 26 3 37 4 45 56 50 51 6 39 74 5 55 3 76 3 3 46 63 3 40 54 5 29 2 40 4 1 73 8 9 85 9 10 16 14 10 15 1 17 3 18 8 3 9 6 7 6 4 439 28 102 30 611 31 136 23 Smallpox wc 172 Georgia Department of Public Health NoTIFIABLE DisEASEs REPORTED BY CoLoR, SEx, AND AcE-1942 (Continued) Age Lev11l by Years Under 1 Year M F 1-2 Years M F 2-3 Years M F 3-4 Years M F 4-5 Years M F 5-6 Years M F 6-7 Years M F 7-8 Years M F 8-9 Years M F 9-10 Years M F 10-14 Years M F 15-19 Years M F 20-24 Years M F 25-29 Years M F 30-34 Years M F 35-39 Years M F 40-44 Years M F 45-49 Years M F 50-54 Years ;\I F 55-64 Years M F 65-74 Years M F 75 and Above M F Unknown M F Total M F Tuberculosis Tularemia wcw c 2 8 3 2 6 3 3 3 1 2 3 2 3 3 2 2 3 1 2 3 2 3 2 3 3 4 3 1 2 2 12 20 7 18 15 53 4 24 83 46 101 1 66 136 3 I 57 108 2 66 128 73 94 I 2 53 85 2 4 61 60 I 45 53 4 56 50 3 38 51 5 47 38 40 35 2 54 39 33 17 3 89 37 3 45 16 2 36 14 2 27 11 12 24 21 3 3 I' 6 4 604 672 21 17 494 658 17 21 Typhoid Undulant Fever Typhus Fever Fever w c wcw c 1 2 2 2 3 2 2 4 8 4 2 5 3 3 7 3 2 2 7 6 3 4 5 5 4 5 4 9 2 4 3 3 4 6 10 45 1 2 14 10 22 5 19 9 55 12 2 2 6 41 5 41 14 3 10 9 58 8 11 8 49 10 10 5 8 35 6 1 9 56 10 6 31 4 9 2 48 7 12 2 7 4 26 2 2 1 3 8 48 5 12 4 3:> 4 2 2 6 :l9 6 10 3 24 3 3 3 46 3 6 3 3 25 1 2 :\6 10 6 39 6 2 14 13 2 Whooping Cough wc 36 41 42 43 20 20 21 9 28 16 27 22 20 22 13 32 13 22 7 15 30 16 22 11 34 8 11 6 24 16 8 9 3 11 16 11 8 46 1 3 38 4 112 82 577 88 79 14 218 l:l4 113 62 415 46 20 7 264 147 Preventable Diseases 173 NuMBER oF CAsEs AND CAsE RATE PER 100,000 PoPULATION oF SPECIF'IED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1942 Area Census* Diphtheria Population Cases Rate Gonorrhea Cases Rate Influenza Malaria Cases Rate Cases Rate State Total ----- 3,123,723 Rural --- ----- 2,049,915 Cities 2,5{}0-5,000. 118,844 Cities 5,000 And Above 954,964 Military Res. Appling -------- 14,497 Atkinson ------- 7,(}93 Baoon --------~ Baker --------- BaldwLn ------- Banks --------- Barrow -------- Bartow -------- Ben Hill ------- Berrien -------- Bibb ---------- Cochran Field. Camp Wheeler_ Bleckley ------- Brantley ------- Brooks --------Bryant --------- Bulloch -------Burke Butts --------- 8,096 7.344 16,411 8,733 13,064 25,283 14,523 15,370 83,783 9,655 6,871 20,497 6,288 26,010 26,520 9,182 Calhoun Camden Candler Carroll Catoosa Ft. Oglethorpe Charlton ------Chatham ------- Navy Sec. Base Fort Screven__ Savannah Air Base ------Chattahoochee -- Fort Benning__ Chattooga -----Cherokee ------Clarke --------- 10,438 5,910 9,103 34,156 10,899 5,256 117,970 5,138 18,532 20,126 28,398 660 21.1 16,786 537.4 416 20.3 1,924 93.9 47 39.5 329 276.8 198 20.7 2 6.9 1 13.6 1 6.1 11 126.0 1 7.7 6.9 6 7.2 3,364 11,176 7 2 54 2 3 2 97 352.3 48.3 28.2 61.8 40.8 329.0 15.3 11.9 13.0 115.8 10.4 14.6 4.9 26.9 4 15.1 3 28.7 16.9 1 11.0 3 8.8 6 55.1 9 1.6 403 29 300.4 3 14.6 111.3 43 165.3 106 399.7 10.9 25 239.5 14 153.8 6 17.6 12 110.1 543 8 152.2 265 224.6 1 6 32.4 8 39.7 47 165.5 9,390 10 6 29 54.0 29.8 102.1 2,900 1,403 197 92.8 68.4 165.8 1,125 175 14 3 117.8 96.6 42.3 4 24.4 2 22.9 7 53.6 3 11.9 1 6.9 1 6.5 12 14.3 30 17 176.1 14.6 4.9 42 667.9 6 23.1 8 30.2 15 163.4 12 115.0 1 16.9 1 11.0 3 8.8 1 64.2 11 5 95.1 434 367.9 19.5 50 4 21.6 2 n.9 7 24.6 981 31.4 641 31.3 80 67.3 139 14.6 123 17 117.3 14.1 11 149.8 3 18.3 7.7 2 7.9 13.8 10.7 21 2 20.7 64 312.2 13 206.7 16 61.5 47 177.2 10.9 1 67.1 54.9 2.9 10 8 152.2 14 11.9 83 174 Georgia Department of Public Health NUMBER OF CASES AND CASE RATE PEi 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIES, 1942-Continued Area Census* Diphtheria Population Cases Rate u.s. Nav. Pref. School ----Clay ----------Clayton -------- Conley Supply Depot -----Clinch --------Cobb ---------Coffee --------- A.A.F.F.T. D. __ Colquitt ------- Spence Field __ Columbia ------ Look ---------Coweta -------Crawford --~---- Crisp ---------- 7,064 ll,65:i 6,437 38,272 21,541 33,012 9,433 ll,919 26,972 7,128 17,540 Dade ---------Dawson -------Decatur -------- A.A. F. B. Fly. School ----- DeKalb -------Lawson General Hasp. -----U.S.N. Air Base Dodge ---------Dooly ---------Dougherty ------ Turner Field __ Darr Aero Tech Douglas -------- 5,894 4,479 22,234 86,942 21,022 16,886 28,565 10,053 Early ---------- Echols --------Effingham ----Elbert --------- Emanuel ------- Evans --------- 18,679 2,964 9,646 19,618 23,517 7,401 Fannin Fayette Floyd ---------Forsyth -------Franklin ------Fulton --------- Ft. McPherson 14,752 8,170 56,141 11,322 15,612 392,886 15.5 lj 39.2 23.2 10.6 :i8.7 18.:; 11.4 2 44.7 7 3l.:J 10 11.5 9 42.8 11.8 3.5 19.9 4 21.4 2 20.7 9 45.9 3 12.8 13.5 2 13.6 23 41.0 4 35.3 6.4 51 13.0 Gonorrhea Cases Rate Influenza Malaria Cases Rate Cases Rate 6 84.9 11.2 8.6 8.6 31.1 33 86.2 82 380.7 50 151.5 27 226.5 4 14.8 14.0 53 302.2 22.3 22.5 11 28.7 10 46.4 10 30.3 28 296.8 34 285.3 3 11.1 12 68.4 13 34.0 9 41.8 10 30.3 3 31.8 13 109.1 3. 7 1 14.0 6 34.2 5 22.5 13 58.5 36 41.4 125 1 18 85.6 u.s 104 364.1 4 2 59.7 3 16.1 67.5 10 103.7 2 10.2 3 12.8 4 54.0 12 81.3 10 122.4 42 74.8 10 1,013 64.1 257.8 130 149.5 15 28 133.2 14 82.9 6 21.0 14 139.3 4 21.0 6 62.2 7 35.7 3 12.8 3 40.5 6.8 12.2 137 244.0 9 79.5 23 147.3 469 119.4 8.5 16 9 42.S ll.S 30 10;).0 1 6 32.1 33.7 51.8 6 25.5 2 27.0 6.8 12.2 2 3.6 2 17.7 46 11.7 Preventable Diseases 175 NuMBER OF CAsEs AND CASE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIES, 1942-Continued Area Census Diphtheria Population Cases Rate Gonorrhea Cases Rate Influenza Malaria Cases Rate Cases Rate Gilmer Glascock ------Glynn Gordon Grady Greene --------- Gwinnett ------- Habersham ----- Hall -----~----- Hancock ------- Haralson ------ Harris --------- Hart ----------- Heard --------- Henry --------- Houston -------- Robins Field - Irwin ---------- Jackson -------Jasper --------Jeff Davis ------ Jefferson ------- Jenkins -------Johnson -------J.ones ---------- Lamar Lanier --------Laurens -------Lee -----------Liberty Camp Stewart. Llnwln -------Long ---------Lowndes -- Moody Field Lumpkin Macon --------Madison ------Marion -------McDuffie ------Mcintosh ------Meriwether ----!\Iiller --------Mitchell .Monroe -------- 9,001 4,547 21,920 18,445 19,654 13,709 29,087 14,771 34,822 12,764 14,377 11.428 15,512 8,610 15,119 11,303 12,936 20,089 8,772 8,841 20,040 11,843 12,953 8,331 10,091 5,632 33,606 7,837 8,595 7,042 4,086 31,860 6,223 15,947 13,431 6,954 10,878 5,292 22,055 9,998 23,261 10,749 11.1 2 9.1 16 86.7 2 14.6 3.4 18 121.9 12 34.5 :; 2il.5 4 27.8 2 17.5 1 6.6 6 53.1 15.5 18 89.6 24 273.6 1 11.3 20.0 25.3 12.0 18 53.6 3.1 6.3 7.4 9.2 1 4.3 4 37.2 4 44.4 22.0 31 168.1 59 300.2 42 306.4 7 24.1 75 215.4 ~ 10 2 13.9 2 17 ,::, 32.2 2 23.2 2 13.2 3 23.2 9 44.8 19 216.6 9 101.8 58 289.4 10 84.4 1 7.7 12.0 1 9.9 2 35.5 ]~ 36.5 114.8 134 1559.0 2 48.9 82 257.4 48 301.0 1 7.4 43.1 56.7 23 104.3 114 490.1 14 130.2 2 44.0 13.7 13 70.5 4 20.4 3 21.9 2 6.9 4 27.1 11 31.6 13 101.8 27.8 8.8 6 38.7 6 69.7 46.3 2 17.7 22.0 4 21.7 5.1 2 14.6 3 10.3 2 15.7 4 46.5 3.'i.4 3 23.2 62 308.6 11 125.4 1 11.3 21 104.8 2 16.9 3 23.2 12.0 39.6 1 17.8 36 107.1 25.5 11.6 12 59.7 14 69.9 28 236.4 15.4 18 53.6 21 268.0 2 23.3 24.5 13 40.8 2 32.1 5 31.4 14.4 75.6 36 163.2 10.0 4 17.2 6 55.8 2 48.9 54 169.5 4 25.1 9.2 22.7 4.3 9.3 I 176 Georgia Department of Public Health NuMBER OF CAsEs AND CASE RATE PER 100,000 PoPULATION oF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1942-Continued Area Census* Diphtheria Population Cases Rate Gonorrhea Cases Rate Influenza Malaria Cases Rate Cases Rate Montgomery Morgan -------Murray -------Muscogee ------ Newton 9,668 12,713 11,137 75,494 18,576 Oconee Oglethorpe ----- Paulding ------Peach --------Pickens -------Pierce __________ Pike ----------Polk ----------Pulaski Putnam 7,576 12,430 12,832 10,378 9,136 11,800 10,375 28,467 9,829 8,514 Quitman 3,435 Rabun --------- Ran!folph -----Richmond ------ Oliver General Hospital --- Camp H<>rdon _ Ga. Aero Tech_ Camp Hanc<>ck Augusta Air Base Rockdale ------- 7,821 16,609 81,863 1,124 Schley --------Screven -------Seminole Spalding ------- st.,J>hens ------Camp Toccoa _ Stewart -------Sumter ------- - Souther Field_ 5,033 20.3:i3 8,492 28,427 12,912 10,603 24,502 Talb<>t --------- Taliaferro ------ Tattnall -------Taylor Telfair --------- Terrell --------Thomas -------- Finney General HOBPital ---- 8,141 6,278 16 !43 10,768 15,145 16,675 31,289 4 31.5 4 35.9 21 35.8 3 16.1 2 26.4 16.1 98.5 8.5 5 48.2 20 70.3 1 10.2 11.7 6.0 20 24.4 1 90.6 4.9 7.0 1 54.0 3 28.3 8.2 12.3 9.3 6 39.6 1 6.0 3 9.6 2 15.7 22 29.1 24 129.2 8.0 60 578.1 3 32.8 11 93.2 19.3 24 84.3 10 101.7 3 2 1,243 38.4 12.0 1518.4 661 35 1 90.6 3 59.6 11 54.0 6 70.7 41 165.3 8 6U 9.4 66 269.4 2 24.6 9 55.4 62 409.4 60 359.8 41 131.0 10.3 10 18.1 4 35.9 23 30.5 31.1 5 66.0 10 80.5 5 39.0 14 134.9 42.4 29 279.5 90 316.2 30 305.2 4 47.0 3 87.3 3 4.0 4 38.5 8.5 1 9.6 1 24.6 9 91.6 59 355.2 65 19.4 4 24.1 10 12.2 3 116.5 6 29.5 53 624.1 5 17.6 1 1.1 9.4 16.3 22 108.1 84 989.2 2 15.4 66.ij 11 44.9 12.3 3 47.8 3 1s.a 55 510.8 6.6 52 311.8 18 57.5 12.:; 3 19.8 3 18.0 9 28.8 Preventable Diseases 177 NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1942 (Continued) Area Census* Diphtheria Population Cases Rate Gonorrhea Cases Rate Influenza Malaria Cases Rate Cases Rate Tift ------------ Toombs -------Camp Toombs _ Towns --------- Treutlen ________ Troup ---------Turner Twiggs --------- Union Upson Walker Walton --------Ware ---------- Waycross Air Base ------ \Varren -------Washington ---Wayne --------Webster -------- Wheeler -------- White ---------- Whitfield -----Wilcox --------- Wilkes Wilkinson -----Worth --------- 18,599 16,952 4,925 7,632 43,879 10,846 9,117 7,680 25,064 31,024 20,111 27,929 10,236 24,230 13,122 4,126 8,535 6,417 26,105 12,755 15,084 11,025 21,374 5.4 20.3 1 13.1 16 36.5 9.2 11.0 11 143.2 12.0 8 25.8 10 48.1 2 1.2 1 9.8 4 16.5 1 1.6 2 42.3 62.3 17 65.1 6.6 9.1 4.1 69 371.0 9 53.1 55 125.3 1 9.2 11.0 3 39.1 4.0 46 148.3 11 52.9 158 565.7 68.4 4.1 51 3~~.7 1 21.2 8 93.7 7i.9 253 969.2 22 172.5 46.4 89 416.4 2 10.8 34 200.6 4 81.2 13.1 11 25.1 3 32.9 21 3:il.6 12.0 6 19.3 6 28.9 31 111.0 3 16.1 41.3 11.4 3 32.9 4.0 6.4 1.2 5 48.8 34 140.3 1.6 5 105.8 11.7 15.6 3.8 19 149.0 59 391.1 1~.1 2 9.4 4 39.1 11 43.4 1.6 11 232.8 23.4 22 1i2.5 .;,ii 4.7 Rates are based on enumerated census population of 1940. NOTE: All U. S. Army and Navy Air Fields, Forts, and Camps are exclusivE> of county totals and follow the county In whiDh located. 178 Georgia Department of Public Health NuMBER oF CAsEs AND CAsE RATE PER 100,000 PoPULATION oF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIES, 1942-Continued Area Meningococcus Measles Meningitis Cases Rate Cases Rate Pneumonia Poliomyelitis Cases Rate Cases Rate Scarlet Fever Cases Rate State Total ----- 5,921 Rural ---------- 3,040 Cities 2,500-5,000 517 Cities 5,00(} and Above 1,835 ~-----Military Res. ____ 529 Appling -------- 77 Atkinson ------- Bacon ---------- Baker ---------- Baldwin -------- Banks ---------- Barrow -------- 17 Bartow -------- Ben Hill ------- 6 Berrien -------- Bibb ----------- 205 Cochran Field Camp Wheeler_ 276 Bleckle.y ------- 33 Brantley ------- Brooks --------- 19 Bryan 70 Bulloch -------- 34 Burke 30 Butts ---------- Calhoun Camden 9 Candler 2 Carroll --------- Catoosa ---- . -- 33 Ft. Oglethorpe_ 36 Charlton ------- 30 Chatham ------- 854 Xavy Sec. Base Fort Screven Savannah Air Base ------- Chattahoochee -Fort Benning - 206 Chattooga ------ 51 Cherokee ------- Clarke --------- 70 189.5 148.3 435.0 192.2 531.1 13.6 12.2 11.5 130.1 41.3 6.5 244.7 341.8 92.7 1113.2 130.7 113.1 98.0 9.6 152.3 22.0 302.8 570.8 723.9 275.2 246.5 53 1.7 20 1.0 6 5.0 16 1.7 11 14.1 7.7 4.0 1.2 5 1 9.6 1 16.9 11.0 9.2 3 2.5 4 5.0 4,172 1,615 190 1,070 1,297 20 3 3 31 1 16 13 48 99 6 15 34 22 8 17 78 6 297 1,080 8 26 23 133.6 78.8 159.9 112.0 138.0 56.4 37.1 40.8 J >8.9 11.5 30.6 63.3 89.3 32.5 57.3 72.5 87.3 34.2 238.5 130.7 83.0 87.1 86.2 50.8 33.0 50.0 82.6 114.2 251.8 38.9 43.2 129.2 81.0 49 1.6 1,148 36.8 32 1.6 517 25.2 3 2.5 42 35.3 13 1.4 555 58.1 34 4 24.4 3 34.4 3 23.0 4.0 3 11.9 6.9 6.5 37 44.2 13 31.1 4.9 7. 7 3 2.5 2 19.2 2.9 10 91.8 27 22.9 16 9.9 24.8 14 49.3 Preventable Diseases 179 NUMBER OF CASES AND CASE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIES, 1942-Continued Area Meningococcus Measles Meningitis Cases Rate Cases Rate u. s. Naval Pref. Sch. -- Clay ----------- Clayton -------Conley Supply Depot ------ Clinch --------- 1 Cobb ----------- 4 Coffee --------- 114 A.A.F.F.T.D. -- Colquitt -------- 6 Spence Field __ Columbia ------ 71 Cook ----------- 11 Coweta --------- 26 Crawford ------- 1 Crisp ---------- 9 Dade ----------Dawson -------- Decatur -------- 193 A.A.F.B. F.S._ DeKalb -------- 15 Lawson General Hospital --- 4 U.S.N. Air Base Dodge ---------- 8 Dooly ---------- 3 Dougherty ------ 120 Turner Field - Darr Aero Tech 4 Douglas -------- Early ---------- 3 Echols --------- Effingham ----- 20 Elbert ---------- 12 Emanuel ------- Evans ---------- 6 Fannin --------- Fayette -------- Floyd ---------- 40 Forsyth -------- Franklin ------- 4 Fulton --------- 9() Ft. MePherson_ 14.2 8.6 15.5 10.5 529.2 18.2 752.7 92.3 96.4 14.0 51.3 868.0 17.3 38.1 17.8 420.1 16.1 207.3 61.2 81.1 71.2 25.6 22.9 6.1 3.7 4.8 3 16.1 3.6 1.3 Pneumonia Poliomyelitis Scarlet Fever Cases Rate Cases Rate Cases Rate 14.2 77.0 8.6 3 46.6 22 57.5 30 139.3 21 63.6 ;":_j 12 127.2 13 109.1 9 3"3.4 14 196.4 6 34.2 33.9 30 134.9 79 90.9 40 6 28.5 20 118.4 30 105.0 2.6 55 143.7 4.6 13 39.4 8.4 8.4 11.4 5.7 17.0 22.3 3 13.5 2.3 101 116.2 9.5 5 29.6 24.5 49.7 17 91.0 14 145.1 40.8 11 46.8 19 256.7 12 81.3 6 73.4 54 96.2 6 53.0 11 70.;) 395 100.3 5.4 4.3 6 40.7 8.8 4 1.0 4 39.8 5.4 3 15.3 6.8 64 114.0 5 44.2 1 6.4 283 72.0 180 Georgia Department of Public Health ~UMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1942---Continued Area Meningococcus Measles Meningitis Cues Rate Cases Rate Pneumonia Poliomyelitis Cases Rate Cases Rate Scarlet Fever Cases Rate Gilmer Glascock ------- 2 44.0 Glynn ---------- 375 Gordon --------- 58 Grady ---------- Greene --------- 42 1710.8 314.4 306.4 Gwinnett ------- 1 3.4 Habersham ----- Hall ----------- Hancock -------- 25 195.9 Haralson ------- Harris --------- 1 8.8 Hart ----------- Heard ---------- Henry ---------- Houston ------- 2 17.7 Robins Field __ Irwin ---------- 2 15.5 Jackson -------- 11 Jasper --------- Jeff Davis ----- 3 Jefferson ------ 56 Jenkins -------- 4 Johnson -------Jones ---------- 25 54.8 33.9 279.4 33.8 300.1 Lamar --------Lanier --------- Laurens -------- 15 Lee ------------ Liberty Camp Stewart_ Lincoln -------Long ----------- 5 Lowndes 61 MoodY Field_ Lumpkin 44.6 122.4 210.3 Macon --------- 14 Madison -------- Marion -------- McDuffie 38 \l:clntosh ------- 87.8 349.3 4 44.4 1 22.0 17 11.6 33 178.9 5.1 21 106.8 9 65.7 15 51.6 9 60.9 21 60.3 5 39.2 12 83.5 3 26.3 12 77.4 81.3 6.6 15 99.2 13 115.0 11.1 4 18.2 25 135.5 7.3 20 68.8 3 20.3 45 129.2 54.8 2 17.5 4 25.8 6 46.4 14 69.7 7 79.8 6 67.9 1 11.3 19 94.8 30 253.3 7.7 2 15.4 8 96.0 13 128.8 2 35.5 17 50.6 9 114.8 1 81.4 14.2 1 14.2 1 24.5 18 56.5 3.1 3 48.2 24 150.5 6.3 7.4 9 129.4 25 229.8 2 37.8 6 29.9 2 22.8 3 36.0 4 11.9 2 25.5 5 71.0 3.1 7.4 Preventable Diseases 181 NuMBER oF CAsEs AND CASE RATE PER 100,000 PoPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIES, 1942-Continued Area Meningococcus Measles Meningitis Cases Rate Cases Rate Meriwether 38 Miller ---------- Mitchell -------- 476 MQnroe -------Montgomery ---Morgan -------- 112.3 2046.3 Murray --------- Muscoge ------- 43 57.0 4.0 Newton -------- 2 10.8 Oconee --------- Oglethorpe ------ Paulding ------- Peach ---------- 10 96.4 Pickens -------- Pierce ---------- 59.3 Pike ----------- 4 38.6 Polk ----------- 4 14.1 3.5 Pulaski 54 549.4 Putnam Quitman Rabun -------- Rand<>lph ------- 451 2715.4 6.0 Richmond ------ 212 259.0 6.1 Oliver General Hospital ---- Camp Gordon - Ga. Aero Tech Camp Hancock Augusta Air Base ------- Rockdale ------- 12.9 Schley --------- 18 357.6 Screven -------- Seminole 14 164.9 Spalding ------- 4 14.1 Stephens ------- Camp Toccoa - Stewart -------- 10 94.3 Sumter --------- 33 134.7 Souther Field __ Talbot ------ -- 12.3 Taliaferro ------ 11 175.2 Tattnall ----- -- 6.2 Pneumonia Poliomyelitis Scarlet Fever Cases Rate Cases Rate Cases Rate 33 149.6 2 20.0 12 51.6 24 223.3 2 20.7 8 62.9 1 10.0 1 4.3 6. 27.2 17.2 7.9 7 62.9 88 116.6 12 64.6 6 79.2 7 56.3 7 54.6 65 86.1 2 10.8 16.1 34 327.6 23 251.8 15 127.1 55 530.1 16 56.2 8 81.4 10.9 8.5 9.6 3 28.9 3.5 24.6 23.5 29.1 4 51.1 24 144.5 70 85.5 3 38.4 1.2 10 12.2 16 207.1 12.9 20.0 25 122.8 13 153.1 30 105.5 3.5 7.7 23.1 28.3 17 69.4 28.6 10 122.8 3 47.8 30.8 182 Georgia Department of Public Health NuMBER OF CAsEs AND CAsE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIES, 1942-Continued Area Meningococcus Measles Meningitis Cases Rate Cases Rate Taylor 9.3 Tel.falr 13.2 Terrell 293 1757.1 1homas 81 258.9 Finney General Hospital ---- Tift ------------ 5.4 Toombs -------- 44 259.6 5.9 Camp Toombs _ Towns --------- Treutlen -------- Troup ---------- 4 9.1 Turner --------- 3 27.7 Twiggs --------- Union ---------- Upson ---------- 9 35.9 Walker --------- 72 232.1 3.2 Walton --------- 8 38.5 Ware ---------- 160 572.9 Pneumonia Poliomyelitis Cases Rate Cases Rate 65.0 22 145.3 42 251.9 8 25.6 6 32.3 5.4 11 64.9 12 243.7 2 26.2 35 79.8 18.4 9.2 4 43.9 6 78.1 12 47.9 10 32.2 11 52.9 4.8 32 114.6 Scarlet Fever Cases Rate 6.0 16.0 14 31.9 11.0 16 208.3 69 222.4 6 28.9 \V.aycross Air Base --------- \Varren -------- 5 Washington ----- 15 Wayne --------- 27 Webster 33 Wheeler -------- 16 White ---------- Whitfield ------- 14 Wilcox --------- 8 Wilkes --------- 107 Wilkinson ------ Worth ---------- 35 48.8 61.9 205.8 698.3 187.5 53.6 62.1 709.4 163.8 4 39.1 16 66.0 2 15.2 4 84.6 2 23.4 62.3 10 38.3 35 274.4 21 139.2 14 127.0 21 98.3 4.1 2 13.3 37.1 70.3 67 256.7 7.8 6.6 1 9.1 2 9.4 NOTE: Ail U. S. Anny and Xavy Air Fields, Forts and Camps are exclusive of county totals and follow the county in which located. Rates are based on enumerated census population at 1940. Preventable Diseases 183 NuMBER OF CAsEs AND CASE RATE PER 100,000 PoPULATION oF SPECIF'IED NOTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1942 (Continued) Area Syphilis Cases Rate State Total. 21,544 Rural ----- 6,528 Cities 2,500- 5,000 ---- 967 Cities 5,000 and Above 12,295 1\lilitary Res- ervations_ 1,754 Appling --- 59 Atkinson -- 11 Bacon ----- Baker ----- 2 Baldwin --- 165 Banks ----- 1 Barrow --Bartow ---Ben Hill -Berrien ____ Bibb Cochran Field - 4 3 1 1 1,094 Camp Wheeler 130 Bleckley -- 40 Brantley -- Brooks ---- 118 Bryan 25 Bulloch --- 174 Burke ---- 487 Butts ----- Calhoun 97 Camden --- 6 Candler --- Carroll ---- 4 Catoosa --- 3 Ft. Ogle- thorpe - 73 Charlton -- Chatham -- 3,119 ~avy Section Base -- Fort Screven Savannah Air Base -Chatta- hoochee Fort Ben- ning -Chattooga Cherokee Clarke ---- 1,318 1 1 379 689.7 318.5 813.7 1287.5 407.0 155.1 27.2 1005.4 11.5 30.6 11.9 6.9 6.5 1305.8 414.3 14.6 575.7 397.6 669.0 1836.3 929.3 101.5 11.0 11.7 27.5 57.1 2643.9 5.4 5.0 1334.6 Tuberculosis Cases Rate 3,067 98.2 1,312 64.0 Typhoid Fever Cases Rate 384 12.3 236 11.5 Typhus Fever Cases Rate 1,153 36.9 565 27.6 158 132.9 24 20.2 188 158.2 1,466 153.5 123 12.9 393 41.2 131 48.3 14.1 61.8 81.7 32 195.0 6 68.7 8 61.2 12 47.5 34.4 2 13.1 130 155.2 1 2 13.8 1 13.6 4 24.4 2 13.8 6.5 10 11.9 16 110.4 11 155.1 9 111.2 6 81.7 10 68.9 32.5 73 87.1 15 31.1 29.1 5 24.4 3 47.7 19 73.0 33 124.4 6 65.3 47.9 67.7 9 98.9 12 35.1 3 27.5 15 3 57.1 221 187.3 14.6 3 14.6 1 15.9 7.5 10.9 9.6 33.8 11.7 2.5 10 103.6 3 43.7 23 112.2 47.7 28 107.7 11 41.5 16 153.3 4 43.9 6 114.2 82 69.5 64 37.8 4 21.6 34.8 1 5.0 5.0 19 66.9 3 10.6 Whooping Cough Cases Rate 1,369 43.8 793 38.7 88 74.0 479 50.2 14 96.6 12 73.1 3 34.4 1 4.0 18 123.9 73 87.1 31.1 39.0 12 46.1 11 41.5 118.4 73.4 14 266.4 215 182.2 61 303.1 19 66.9 184 Georgia Department of Public Health NuMBER oF CAsEs AND CAsE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASEs REPORTED IN GEoRGIA BY CouNTIEs, 1942 (Continued) Area Syphilis Cases Rate Tuberculosi~ Cases Rate Typhoid Fever Cases Rate Typhus Fever Cases Rate Whooping Cough Cases Rate C.S.N.P.S. Clay -----Clayton ____ Conley Sup. Depot __ Clinch ---Cobb ------ 214 Coffee ---- 156 A.A. F. F.T.D. - Colquitt --- 199 Spence Field -- Columbia Cook ------ Coweta Crawford -- Crisp 167 Dade Dawson Decatur 14.2 17.2 15.5 559.2 724.2 602.8 10.6 75.5 18.5 952.1 22.3 18.0 1 14.2 6 51.5 2 28.3 3 25.7 3 46.6 30 78.4 17 78.9 5 13.1 22 66.6 2 6.1 5 53.0 4 33.6 14 51.9 70.1 19 108.3 84.8 22.3 14 63.0 18.5 39.9 3 13.5 5 70.8 8.6 5 77.7 2.6 32 148.6 45 136.3 16 134.2 13 74.1 29 130.4 8.6 3 46.6 7 18.3 30 139.3 4 12.1 26 218.1 4 56.1 17 76.5 A.A. F. B.F.S. - DeKalb 484 Lawson General Hosp. 39 U.S.N. Air Base -- Dodge 119 Dooly ----- 3 Dougherty - 28 Turner Field -- 3 Darr Aero Tech ___ Douglas --- Early ----- 16 l!:chols ----- 1 Effingham - 14 Elbert ----- 6 Emanuel -- Eva>ns ----- Fannin Fayette ---- 2 Floyd ----- 363 Forsyth ---Franklin -Fulton ---- 5,634 Ft. 1\lcPher- son --- 556.7 566.1 17.8 98.0 85.7 33.7 145.1 30.6 12.8 40.5 27.1 24.5 646.6 1434.0 59 67.9 4 4.6 37 10 47.6 5 29.6 56 196.0 2 9.5 47.4 87 304.6 9 89.5 6 32.1 2 19.9 5.4 3 31.1 10 51.0 9 38.3 6 81.1 15 101.7 4 49.0 76 135.4 3 26.5 6 38.4 711 181.0 3 15.3 5 33.9 4 7.1 8.8 6.4 20 5.1 14 16.1 6 6.9 21 99.9 41.5 26 91.0 2 2 9.5 14 49.0 9.9 25 133.8 20.7 34.1 3 40.5 2 3.6 55 14.0 33.7 6 62.2 2 10.2 4.3 3 40.5 5 33.9 24 42.7 16 141.3 1 6.4 113 28.8 Preventable Diseases 185 NuMBER OF CAsEs AND CASE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIEs, 1942-Continued Area Syphilis Cases Rate Gilmer 11.1 Glascock ___ Glynn ~---- 22.8 Gordon 10 54.2 Grady 135 686.9 Greene 89 649.2 Gwinnett -- Habersham _ 14 Hall ------ 148 Hancock -- 16 Haralson -- Harris ---- 58 Hart ------ Heard ----- Henry 5 Houston --- Robins Field -- Irwin ------ 24.1 94.8 425.0 125.4 507.5 33.1 15.5 Jackson --Jasper ---Jeff Davis _ Jefferson -Jenkins Johnson --- 24.9 5 57.0 11.3 152 758.5 200 1688.8 7.7 Jones ----- 79 Lamar ---- 4 Lanier ---- Laurens --- 228 Lee ------- 2 Liberty ---- 31 Camp Stew- art ---- Lincoln --- Long ------ 4 Lowndes 295 Moody Field Lumpkin 948.3 39.6 17.8 678.5 25.5 360.7 97.9 925.9 Macon ---- 37 232.0 Madison --- Marlon ---- McDuffie 18.4 Mcintosh -- 37.8 Tuberculosis Cases Rate 22.2 22.0 16 73.0 31 168.1 9 45.8 6 43.8 29 99.7 18 121.9 29 83.3 54.8 12 83.5 3 26.3 2 12.9 23.2 16 105.8 3 26.5 Typhoid Fever Cases Rate 11.1 9.1 4 21.7 1 5.1 3.4 5 33.9 8 23.0 7.8 7.0 23.2 3 19.8 5 44.2 Typhus Fever Cases Rate 22.0 17 77.6 23 117.0 1 6.8 2 5.7 1 7.8 13.2 54.1 8 39.8 57.0 34.9 16 135.1 3 23.2 6 72.0 49.5 18 53.6 6 76.6 58.2 7.7 10.0 11.4 20.0 16.9 9.9 3 8.9 11.6 38.7 6 68.4 6 67.9 16 135.1 17.8 14 41.7 2 25 5 2 23.3 14.2 73.4 22 69.1 3.1 48.2 13 81.5 3 22.3 2 28.8 3 27.6 3 56.7 9 56.4 9.2 24.5 11 34.5 4 25.1 3 43.1 W~ooping Cough Cases Rate 22.2 1 22.0 6 27 4 1 5.4 5 25.4 20 145.9 2 6.9 6.8 23 160.0 92.9 33.1 8.8 26 129.q 15 74.9 8.4 96.0 6 47.6 12.8 58.2 3 18.8 7.4 186 Georgia Department of Public Health NuMBER OF CAsEs AND CASE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY CouNTIEs, 1942 (Continued) Area Syphilis Cases Rate Tuberculosis Cases Rate Typhoid Fever Cases Rate Typhus Fever Cases Rate Whooping Cough Cases Rate Meriwether _ 40 Miller ----- Mitchell --- 360 Monroe ---- 1 Montgomery_ :\Iorgan --- Murray --1\Iuscogee -Kewton ---Oronee ---- Oglethorpe Paulding -- 1,222 14 3 3 1 Peach 160 Pickens --- 6 Pierce ---- 10 Pike ------ 3 Polk ------ 17 Pulaski ---- Putnam --- Quitman -- Rabun ---- Randolph 37 Richmond 882 Oliver Gen. Hosp Camp Gor- don --- 186 Ga. Aero Tech -- Camp Han- cock -- Augusta Air Base -- 3 Rockdale -- 4 Schley ---- Screven --- Seminole -- Spalding --- 342 Stephens ___ 29 Camp Toccoa_ Stewart --- Sumter ---- 258 Souther Field -- Talbot ---- Taliaferro - 1 Tattnall --- 22 181.4 1547.7 9.3 31.5 18.0 1618.7 75.4 39.6 24.1 7.8 1541.7 65.7 84.7 28.7 59.7 20.3 222.8 1077.4 51.8 34.4 23.6 1203.1 223.6 37.7 1053.0 15.9 135.4 18 81.6 20.0 16 6R.X 12 111.6 5 51.7 17 133.7 12 107.7 85 112.6 8 43.1 39.6 64.4 4 31.2 17 163.8 4 43.8 50.8 86.7 33 115.9 3 30.5 3 35.2 58.2 51.1 10 60.2 120 146.6 9.1 8.6 15.7 9.0 23 33.1 1 5.4 8.0 48.2 21.9 1 8.5 2 19.3 3 10.5 25.6 18.1 103.6 79.5 17 83.5 94.2 33 116.1 61.7 2 25 9 9.8 7.0 16 150.9 28.3 24 98.0 12.2 49.1 47.8 16 98.5 2 9.1 3 30.0 38 163.4 10.3 3 4.0 4 32.2 3 28.9 18 152.5 1 9.6 1 3.5 22 223.8 36.1 17 20.8 4 79.5 16 78.6 12 141.3 10.6 18.9 15 61.2 21 129.3 46 208.6 20.7 31.5 11 14.6 1 5.4 4 38.5 32 350.3 76.3 1 9.6 6 21.1 12.8 2 12.0 9 11.0 25.9 14.7 11.8 21.1 20 154.2 5 20.4 Preventable Diseases 187 NuMBER oF CAsEs AND CAsE RATE PER 100,000 PoPULATION OF SPECIFIED NoTIFIABLE DisEASEs REPORTED IN GEoRGIA BY CouNTIEs, 1942 (Continued) Area Syphilis Cases Rate Tuberculosis Cases Rate Typhoid Fever Cases Rate Typhus Fever Cases Rate Whooping Cough Cases Rate Taylor Telfair 53 350.0 Terrell 142 851.6 Thomas --- 4 12.8 Finney Gen. Hosp. Tift ~------ 217 1166.7 27.9 46.2 54.0 18.0 26 83.1 3.2 18 96.8 10 53.8 8 743 26 171.7 14 84.0 28 89.5 20 107.5 2 18.6 4 26.4 54.0 26 83.1 5.4 Toombs --Camp 27 159.3 Toombs_ Towns ---- Treutlen --- Troup ----- 207 471.8 Turner 6 55.3 13 76.7 2 11.8 2 40.6 3 39.3 57 129.9 8 73.8 23 4 36.9 16 94.4 56 330.3 4 52.4 2.3 64.5 20.3 136 309.9 9.2 Twiggs Union ----- Upson 8.0 Walker ---- 50 161.2 Walton ---- 84 404.3 Ware ------ 123 440.4 65.8 4 52.1 26 103.7 34 109.6 10 48.1 19 68.0 3 32.9 3.2 24.1 2 6.4 1 4.8 19 68.0 4 52.1 1 4.0 4 12.9 19.3 7.2 Waycross Air Base -- Warren ____ Washington_ Wayne _____ Webster Wheeler --- 3 29.3 88 363.2 155 1181.2 21.2 18 210.9 68.4 24 99.1 15.2 3 63.5 2 23.4 4.1 7.6 2 42.3 11.7 9.8 10 41.3 5 38.1 3 63.5 8 93.7 6 58.6 30.5 84.6 58.6 White ----Whitfield -- Wilcox ---- Wilkes ---- Wilkinson - W-orth ---- 69 264.3 22 172.5 3 19.9 3 27.2 298 1394.2 2 31.2 33 126.4 4 31.4 12 79.6 81.6 17 79.5 62.3 2 7.7 15.7 45.4 12 94 1 2 13.3 1 9.1 20 93.6 3.8 39.2 9 59.7 3 27.2 4.7 NOTE: All U. S. Army and Navy Air Fields, Forts and Camps are exclusive of county totals and follow the county In which located. Rates are based on enumerated census population of 1940. 188 Georgia Department of Public Health NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NoTIFIABLE DISEAsEs REPORTED IN GEoRGIA BY CouNTIES, 1942 (Continued) Diphtheria Population Cases Rate Gonorrhea Cases Rate Influenza Malaria Cases Rate Cases Rate Total ------------- 954,964 Albany Americus Athens Atlanta (DeKalb) 19,055 9,281 20,650 28,994 Atlanta (Fulton) Augusta Bainbridge Brunswick CarroJH.on Cartersrille 273,294 65,919 6,352 15,035 6,214 6,141 Cedartown College Park Columbus Cordele Dalton Decatur 9,025 8,213 53,280 7,929 10,448 16,.>G1 Douglas Dublin East Point Elberton Fitzgerald Gainesville 5,175 7,814 12,403 6,188 7,388 10,243 Griffin Hapeville LaGrange Macon Marietta Milledgeville 13,222 5,059 21,983 57,865 8,667 6,778 Moultrie Newnan Rome Savannah Statesboro Thomaston 10,147 7,182 26,282 95,996 5,028 6,396 Thomasville Tifton Toccoa Valdosta Waycross 12,683 5,228 5,494 15,595 16,763 198 20.7 10.8 36 174.3 36 13.2 17 25.8 15.7 2 13.3 2 32.2 11 121.9 1 12.2 21 39.4 1 12.6 9 86.1 b.u 19..'! 64.0 8 129.3 3,364 16 6 10 993 1,202 1 16 2 22 22 248 46 4 5 352.3 84.0 64.6 14.5 34.5 363.3 1823.4 15.7 80.5 16.3 177.3 24.4 41.3 277.5 2373.7 6.0 888.9 51.2 40.3 16.2 48.8 15.1 19.8 8 36.4 4 6.9 57.7 14.8 13.9 6 22.8 3 3.1 3 46.9 15.8 54.6 6.0 57 556.5 40 302.5 2 39.5 33 150.1 56 96.8 9 103.8 46 678.7 44 433.6 3 11.4 236 245.8 16 318.2 15.6 16 226.2 28 535.6 127.4 13 83.4 153 912.7 1,125 4 3 413 61 2 3 2 18 2 17 4 24 3 32 11 3 4 6 1 22 423 8 6 30 117.8 21.0 9.1 10.3 151.1 92.5 31.5 20.0 32.2 16.3 199.4 24.4 31.9 75.7 6.0 77.3 307.1 8.1 16.2 9.8 22.7 632.5 22.7 19.0 34.6 59.0 59.1 13.9 83.7 440.6 19.9 46.9 63.1 18.2 38.5 179.0 139 14.6 9 47.2 3 32.3 2 6.9 12 4.4 10 15.2 4 63.0 6 66.5 3.8 50.4 2 12.1 3 58.0 89.6 8.1 27.1 1 4.5 5 8.6 3 29.6 13 13.5 2 39.8 15.6 19.1 2 36.4 42 269.3 2 11.9 Preventable Diseases 189 NuMBER OF CAsEs AND CASE RATE PER 100,000 PoPULATION oF SPECIFIED NoTIFIABLE DISEASEs REPORTED IN GEORGIA BY CouNTIEs, 1942 (Continued) Area Meningococcus Measles Meningitis Cases Rate Cases Rate Scarlet Pneumonia Poliomyelitis Fever Cases Rate Cases Rate Cases Rate Total ------------- Albany Americus Athens Atianta (DeKalbJ Atlanta (Fulton) Augusta Bainbridge Brunswick Carrollton Cartersville Cedartown College Park Columbus Cordele Dalton Decatur Douglas Dublin East Point Elberton Fitzgerald Gainesville Griffin Hapeville LaGrange Macon Marietta Milledgeville Moultrie Newnan Rome Savannah Statesboro Thomaston Thomasville Tifton Toccoa Valdosta Waycross 1,835 84 28 38 80 210 195 41 9 2 43 2 4 146 5 13 648 21 8 40 42 160 192.2 440.8 301.7 184.1 29.3 318.6 1297.0 11.1 12.2 77.0 113.5 19.1 830.9 25.6 8.1 16.2 61.1 30.3 4.5 252.3 34.6 29.5 49.3 49.5 675.0 417.7 125.1 315.4 19.1 269.3 954.5 16 1.7 1,070 21 18 21 4 1.5 305 4 6.1 61 9 15 7 11.1 3.8 76 12 5 8.1 9 3 9 11 3 16 1.7 37 10 13 11 2 3.8 22 2.1 262 12 3 1 12 25 112.0 141.7 97.0 87.2 72.4 111.6 92.5 141.7 99.8 112.6 130.3 33.2 60.9 142.6 12.6 19.1 30.2 231.9 64.0 72.6 48.5 121.8 68.3 128.6 59.3 72.8 63.9 115.4 191.8 108.4 27.8 83.7 272.9 238.7 109.4 23.7 19.1 76.9 149.1 13 1.4 2 6.9 3 1.1 1.5 11.1 12.6 11.5 3.1 6.4 55G 58.1 6 31.5 53.9 14 67.2 26 89.7 216 79.0 8 12.1 15.7 13.3 2 22.2 4 48.7 51 95.7 1 12.6 35 335.0 24 144.9 25.6 16.1 48.5 19 185.G 9 177.9 9 40.9 33 57.0 8 92.3 29.5 12 118.3 30 114.1 23 24.0 19.9 5 39.4 18.2 6.4 190 Georgia Department of Public Health NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NoTIFIABLE DISEASEs REPORTED IN GEORGIA BY CouNTIEs, 1942 (Continued) Syphilis Cases Rate Tuberculosis Cases Rate Typhoid Fever Cases Rate Typhus Whooping Fever Cough Cases Rate Cases Rate Total Albany Americus Athens Atlanta (DeKalb) Atlanta (Fulton) Augusta Bainbridge Brunswick Carrollton Cartersrille Cedartown Colleke Park Columbus Cordele Dalton Oeratur Douglas Dublin East Point Elberton Fitzgerald Gainesville Griffin Hapeville LaGrange Macon Marietta Milledgeville Moultrie Newnan Rome Savannah Statesboro Thomaston Thomasville Tifton Toccoa Valdosta \Vaycross 12,295 1287.5 1,466 153.5 20 105.0 61 657.3 48 232.4 4 13.8 44 230.9 15 161.6 16 77.5 16 55.2 5,609 2052.4 871 1321.3 20.0 32.2 526 192.5 99 150.2 2 31.5 9 59.9 3 48.3 81.4 99.7 1,168 107 68 2192.2 1349.5 650.8 12.1 12 133.0 7 85.2 60 112.6 12 151.3 19 181.9 11 66.4 98 1893.7 6 76.8 8.1 64.6 13.5 133 1298.4 9 173.9 7 89.6 20 161.3 64.6 27.1 26 253.8 221 1671.5 134 609.6 483 834.7 154 1776.9 149 2198.3 29 219.3 11 217.4 38 172.9 113 19"5.3 11 126.9 18 265.6 180 2,331 63 1773.9 27.8 11.4 2428.2 1253.0 31.3 15 147.8 8 111.8 47 178.8 173 180.2 8 159.0 13 203.3 15.8 184 3519.5 21 382.2 28 179.5 123 733.8 11 86.7 12 229.5 7 127.4 11 70.5 17 101.4 123 12.9 393 41.2 479 32 167.9 18 94.5 8 86.2 2 9.7 16 3.4 10.3 16 ::i.9 47 17.2 100 17 25.8 16 251.9 2 2 13.3 15 99.8 6 4 64.4 50.2 36.7 10.8 77.5 36.6 12.1 :H.5 39.9 12.2 21 39.4 3 37.8 9.6 2 25.6 2 27.1 19.5 7.6 4.5 8 13.8 2 23.1 14.8 19.7 41.8 15.2 3.1 1 7.9 7 133.9 6.4 11.1 3 5.6 12 151.3 2 12.1 16 309.2 4 51.2 8.1 8 108.3 9.8 22.7 67 115.8 1 11.5 23 226.7 11.1 24.4 11 20.6 9.6 12.1 173.9 12.8 16.2 37.8 19.8 71 323.0 43 74.3 11.5 14.8 19.7 7.6 19.0 73 76.0 144 150.0 10 198.9 1 19.9 15.6" 55.2 17 325.2 32.1 13 77.6 14 110.4 1 19.1 20 364.0 6.0 Preventable Diseases 191 INDUSTRIAL HYGIENE SERVICE During the year 1942, the demands upon the Industrial Hvgiene Service were tremendously increased due to the all-out production by the industries of the State in the National war effort. The Industrial Hygiene Service for the year 1942 has been working directly with the various plants in an effort to assist them in matters of industrial health, with the objective in view ,of keeping the industrial worker on the job. PERSONNEL In approaching the comprehensive program of industrial health, the professions of medicine, engineering, chemistry, and nursing become intimately involved. In order to render the required service of these professions, the following personnel are attached to this Service: 1 Medical Director. 1 Assistant Physician who was assigned to the Service from the National Institute of Health in July of 1942. 1 Chemical Engineer. 1 Chemist, employed September 1, 1942. 1 Consultant Nurse who has been assigned to the Service from the Nati,onal Institute of Health and who was transferred to the Service in July. 3 Secretaries--2 of the secretaries were assigned to Industrial Hygiene in September and October, 1942. The consultant nurse spent one month taking a post-graduate course at St. Louis University. PROBLEMS AND SCOPE OF WORK During a portion of the year 1941, in which the activities of the Industrial Hygiene Service were inaugurated, obviously little definite information was at hand as to the exact extent of the problem in the State, and the approaches which should be taken through the various field activities. During the :period covered in this report, it has been possible to evaluate the nature and extent of the work to be accomplished, and also to develop policies and methods of handling the work. Due to the limited personnel, it appears necessary to devote all efforts to those plants which are producing war materials. This policy will be followed for the duration. The importance of maintaining the health of workers in industry has long ,been recognized. The Army has established an Industrial Hygiene Service, the purpose of which is to work with ordnance plants owned and operated by the Government. The Navy has developed an Industrial Hygiene Division which functions in the various shipyards and other shore establishments owned and operated by the Navy. Since a greater portion of the war materi,al is produced by private industry, under war contract, it became necessary to establish some official agency 192 Georgia Department of Public Health to render Industrial Hygiene Service to plants in this group. The responsibility for this service to privately owned 1plants under war contracts was delegated to the Georgia Department of Public Health. The most important problems presented during this period are associated with war plants. From a medical standpoint, these include developing first aid and medical facilities, physical examinations including chest x-ray services, study and control of dermatitis, observing and treating individuals ex:posed to poisonous or toxic materials. Engineering activities include complete studies of industrial plants, engineering recommendations and consultations on control of observed hazards, collection and examination of atmospheric 'and other samples, presentation of industrial hygiene material through talks and group meetings. There are certain industries in the State which have potential and actual problems for which Industrial Hygiene Services are greatly in need. This applies especially to the granite industries, most of which are located in the area of Elberton. Although the importance of silicosis is definitely realized and particularly its potentialities in the granite industries, it has been deemed advisable to postpone work with the granite industries for the duration. This decision has been based on the fact that these pl-ants are not engaged in the production of war material and also because of priorities they are unable to secure protective equipment. LABORATORY A complete chemical laboratory provides facilities for the quantitative and qualitative investigations of air contaminants such as dusts, fumes, gases, vapors, mists, smokes, etc., and for other toxic materials in the industrial environment. This laboratory is also used for study of blood, urine, and other biological samples which are taken in connection with plant studies. From January l, through December 31, 428 samples have been analyzed in .this laboratory. The findings obtained in laboratory studies are correlated with the general engineering investigation of the plant, and the results incorporated in the report presented to the industry concerned. Certain pieces of field equipment have been obtained which permit .the analysis of samples in the plant at the time the study is being made. PUBLIC RELATIONS During the period covered by this report, a total of 47l conferences were recorded with 1,006 individuals. These conferences were concerned with the various Industrial Hygiene problems. The members of the staff of this Service attended 34 meetings; addressed 30 meetings attended bv 700 persons. These included ll lectures to the students at Emory University, Georgia School of Technology, University of Georgia, Georgia Baptist Nurses' Training School, and .a paper read before the Medical Association of Georgia ail its annual meeting. There were four showings of the industrial hygiene film "Save a Day." Approximately 7,300 pieces of literature were distributed, including copies of papers and talks 'prepared by Preventable Diseases 193 the members of the Industrial Hygiene Service Staff. The U.S. Department of Labor Bulletin No. 41, "Occupational Hazards and D~agnostic Signs-A Guide to Impairments to be Looked for in Hazardous Occupations", together with a copy of rthe regulations for reporting occupational diseases was distributed to each physician in the State. Two mdio talks were made and two newspaper articles were submitted for 'publicwtion. The policy of inserting an industri,al hygiene article in each monthly issue of "Georgi,a's Health" was initiated. At the meeting of the Medical Association of Georgia, an Industrial Hygiene exhibit was on display. Organizations already existent, whose active cooperation has been secured, include twenty chambers of commerce, seven industrial insurance carrie11s, two manufacturers' associations, the Army engineers, Army laboratory, and the Army Industrial Hygiene Service. Valuable assistance has been secured from many related agencies, including the U. S. Public Health Service, State Health Department, the U. S. Navy, U. S. Maritime Commission, American Medical Assodation, National Nutrition Committee, educational insti,tutes, and many others-the U. S. ,and State Labor Departments, State Department of Education, and the Medical Association of Georgia. Formal instruction in industrial hygiene courses have been developed at the Georgia School of Technology, and at the University of Georgia Medical School in Augusta. A course which is to include industrial hygiene material is being considered for the School of Medicine at Emory University. This 'proposed course is to go into effect at Emory next year. In connection with these courses at Georgia Tech and the University of Georgia, :personnel of the Industrial Hygiene Service have been assisting in presenting lectures. These lectures cover the medical, engineering, and chemical approach to the investi@ation and control of hazards involving toxic smokes, dusts, fumes, mists, vapors, and the like. In addition to the lectures which have been presented at Georgia Tech, students taking this course have visited the Industrial Hygiene Laboratory and observed equipment and methods used in plant studies. NUTRITION PROGRAM The Industrial Hygiene Director participated in the Region VII meeting of National Nutrition Committee of Office of Defense Health and Welfare in Birmingham, Alabama, July ll, 1942. He has also been appointed co-chairman of the State Nutrition in Industry Sub-Committee. Better facilities for nutrition in industry are being promoted in all plants, the work being correlated with the State and local Nutrition Committee programs in the homes of individual workers. NATIONAL COMMITTEE FOR CONSERVATION OF MANPOWER IN WAR INDUSTRIES The Industrial Hygiene Director has been appointed as Medical Consultant to the State Committee of this organization. With the engineering members of his staff he has arranged and conducted lectures on industrial 194 Georgia Department of Public Health hygiene at the special schools for training safety directors and foremen under this program. FIELD ACTIVITIES Direct assistance is being rendered to the critical war plants of the Sta,te which include shipyards, plants manufacturing artillery shells, plants manufactuTing bombers, and airplane assembly parts, naval ordnance materials, chemical munitions, and other various plants which are producing essential war materials. There are ap,proximately 2,400 industrial plants in the State of Georgia which are concerned with manufacturing and transpO'ltation. Of these a portion are producing materials which are concerned with the National War effort. In addition, these plants which are engaged in the manuhcture of war materials are required to meet the health and safety regulations in the State in which work is being performed as set forth in the Walsh-Healey Public Contracts Act. During the period covered by this report, 148 promotional visits were made. Sixty-four plant investigations and 30 completed plant surveys. A statistical analysis of these field visits indicates a well-rounded program covering the various engineering activities. MEDICAL AND NURSING ACTIVITIES The medical and nursing personnel of the Industrial Hygiene Service investigated 237 cases of diseases in industrial areas. In connection with these investigations 132 conferences were held with physicians. Conferences were held with 177 nurses. Certain of these conferences were concerned with the procurement of industrial nurses for the various industries of the S~ate which are in need of qualified nurses for their industrial health programs. Of outstanding importance was the investigation and prompt control of the explosive water-borne outbreak of typhoid fever and bacillary dysentery in a cotton mill village in southwe~t Georgia. This outbreak involved 81 cases of typhoid and 79 cases of dysentery, with four deaths. There were no secondary cases discovered, although several hundred might have been anticipated if no trained personnel had been available. The medical director and 'the consultant nurse devoted pTactically the entire month of February and all !the month of March to this outbreak. The consultant nurse also spent the month of April doing follow-up work in connection with this outbreak. In April, the medical director, chemical engineer, and consultant nurse lll1:tended the Conference of Governmental Industrial Hygienists which was held in Washington, D. C. This meeting afforded an opportunity to discuss with industrial hygiene personnel of other states their programs and approach to various problems. In May a visit was made to the construction project of the Tennessee Valley Authority located near Farner, Tennessee. This visit was made by the medical director and the chemical engineer. The purpose of the visit Preventable Diseases 195 was to observe in detail general methods used in controlling occupational hazards incident to tunnelling operations. Considerable time was spent in the preparation of the proposed industrial health program for the Southeastern Shipbuilding Corporation in Savannah. Additional time was also spent in assisting the other shipyards of the State in developing adequate medical services. It was found necessary to promote the proposed program with the Maritime Commission on a national scale to secure approval for its adoption in the Georgia Maritime Commission Yards. In this connection, a trip was made by the medical ciirector to the Hartford Accident & Indemnity Company, New York City, where a .conference was held with Mr. George T. Merrick, Associate Manager. This meeting was at the request of Mr. C. L. Daughtry, Hartford Accident & Indemnity Claims Manager, Atlanta. Mr. Daughtry had expressed his conviction that this type plan is important to the national war effort in increasing the productive capacity of the shipyards, and that it should be promoted on a national scale and not confined essentially to the Southeastern Shipbuilding Corporation. A conference was also held with Mr. Robert T. Hooker, Jr., of the Maritime Commission, Washington, D. C. Mr. Hooker expressed interest in the proposed program as a general plan to be applied to all shipyards owned and operated by the Maritime Commission. Indorsement of this program was secured from the National Institute .of Health, General Motors Medical Department, and Harvard University School of Public Health. This proposed pwgram was later broadened so as to include any large war industry. As a direct result of this promotional effort, a health program for all maritime commission yards in the country has been developed to be administered by the U. S. Navy with the 'assistance of Professor Philip Drinker as special consultant. A considerable amount of time has been spent with the various industries in promoting x-ray services. To date, thirty plants are being surveyed and 12,861 chest x-rays have been taken. This 'activity appears to be of definite value in an industrial health program. In addition to surveying individuals previously employed, chest x-rays are being promoted as a :part of the routine pre-placement physical examination. Its application should result in reducing the possible exposure to individuals infected with tuberculosis, and in terms of a long range program should show definite results. A report was prepared by the medical director and submitted to the Physicians' Procurement and Assignment Service. Facts were given about the principle industries and industrial areas of the State and certain health services available to workers and their families, such as the number of physicians and hospital beds per unit population. ENGINEERING ACTIVITIES A total of 101 engineering visits to plants were made during this period. A total of thirty plants have been surveyed and studies completed. Four hundred and twenty-nine samples were collected and 'analyzed, 192 determinations were made in the field and 237 in the laboratory. Considerable time was spent with the shipyards of the State in developing an en- 196 Ceorgia Department of Public Health gineering approach to the control of metal fume fever. This occupational disease has caused considerable Ioss of time on the part of skilled welders in the shipbuilding industry, and obviously has resulted in considerable loss of productive ability. Studies for the control of this situation involved detailed measurement of exhaust systems used by the various shipyards, including a great number of individual measurements covering velocities, air flows, and other pertinent data on ventilation. These observed data have been carefully analyzed and a detailed report prepared rand presented to the shipyards. These studies also involved chemical analysis of the air which contained varous contaminants produced by welding operations. These findings, along with recommendations for control procedures were submitted to the yards. Some time has been spent with the industrial plants in assisting with the design of ventilating equipment for the control of toxic dusts such as asbestos. This has involved the correlation of existing dust concentrations with current engineering practice employed for the control of these dusts. These studies have been further augmented by design of new ventilating equipment which has proved considerably more efficient than that formerly used. Much time has been spent with plants manufacturing artillery shells. This requires oomplete study of various plant operations and atmospheric samples when indicated. The exposures to dusts, organic solvents, gases and cutting oils appear to be the principal problems observed in these plants. Important examples of these are the control of dust in foundry operations, and control of acrolein in heat treating operations. A great number of samples have been taken in these plants and the results correlated with the engineering findings and used in the basic design of exhaust systems. In wmking with these plants, detailed studies 'are made which include indicated atmospheric samples, air flow measurements, study of operations, machinery .and the like. When all of the data have been obtained, samples and information are analyzed and studied and a complete en gineering report is prepared. These reports which include recommendations for control of observed hazards are presented and discussed with the plant management. In .addition, enl!ineering services are rendered in assisting with the design and installation or construction of recommended control equipment. Some time has heen spent with the welding schools of this State in an effort to demonstrate safe welding practices. This included actual investigations of these schools and recommendations for the control of toxic materials 1and rays which are produced by welding. SUMMARY The various activities of the Industrial Hygiene Service are carried out with the active cooperation of the related divisions of the Georgia Department of Public Health. By such a cooperation, all the facilities of the State Department of Health are made available to industry. In these instances where follow-up of individual patients or their contacts is indicated, ar- Preventable Diseases 197 rangements are made with the local health departments and members of the medical profession. The medical director has been appointed also as secretary of the lndustri,al Health Committee of the Medical Association of Georgia and 1as co-chairman of the State Nutrition in Industry Committee. By these and other similar relationships an effective program for discovery, prevention, and control of all known preventable health hazards to our industrial workers is !'apidly expanding. I Cancer Control I Epidemology DIVISION OF PREVENTABLE DISEASES DIRECTOR 1""0"' 00 I Typhus Control I Industrial Hygiene I V.D. Control I Public Health Education I Malaria and Hookworm MEDICAL !DIRECTOR I MEDICINE MEDICAL DIRECTOR ASSISTANT PHYSICIAN I I NURSING CONSULTANT NURSE <;") ~ I ENGINEERING I CHEMIST ~ 15' INDUSTRIAL HYGIENE CHEMIST ~ INDUSTRIA!, HYGIENE ENGINEER s..,"<::; ;::, ~ .;.:.l. I ~ 1. Administration 2. Professional Consultations 3. Promote and assist plant Medical Departments 4. Promote routine Physical Examinations 5. Diagnostic assistance 1. Consultations with Industrial Nurses 2. Promote Medical, Nursing and Industrial Hygiene Services 3. Standing orders for Industrial Nurses I. Conducting plant studies I. Collection of Samples "t:: 2. Consultation on Control Procedures 2. Chemical Analyses 3. Special Investigations ~ c,":_;" 3. Industrial Ventilation 4. Assist in Plant studies 4. Preparation of Reports 5. Instruction in Instruments :::.:: 5. Sanitation and illumination and I,aboratory Methods ;~::, 6. Supervision of Chemical 6. Assistance in Reports : 6. Industrial Epidemiology 4. Interpret Industrial hazards Laboratory 7. Examination of Biological 7. Sickness Absenteeism to Industrial Nurses 7. Promotion in Plants Samples 8. Industrial Nutrition 5. Industrial Nutrition 8. Group Talks 9. Promote Industrial 6. Education Industrial 9. Analysis of hazardous Dentistry Nurses and Public Operations and Exposuses 10. Education Health Nurses 10. Checking Plans and 7. Coordinate Program Public Specifications on Exhaust Health Nursing ana Systems Industrial Nursing COOPERATION WITH OTHER ESTABLISHED AGENCIES FEDERAL AGENCIES U. S. Public Health Service U. S. Department of Labor U.S. War Department U.S. Navy U. S. Maritime Commission U. S. Bureau of Mines Office of Defense Health and Welfare Services N.Y. A. STATE AXD LOCAL GOVERNMENTS Labor Department Industrial Board Department Education Local Health Departments Other Divisions Georgia Department Public Health Welfare Department PRIVATE AGENCIES Schools and Universities American Medical Association American Public Health Association American Dental Association Insurance Companies Chambe.rs of Commerce Tuberculosis Association Civic Organizations ::\ianufacturers Associations Labor Organizations Foundations .'.".,tl ~ ~ -s-;~::, o- ~ ~ ~:: ~ ~ ..... 10 \0 200 Georgia DeJXIrtment of Public Health INDUSTRIAL HYGIENE SERVICE I. Public, Relations: Activities Reported for Year 1942 I. Conferences: a. Number ------------------------b. Attendance ______________________ _ 2. Meetings: a. Attended ________________________ _ b. Addressed ______________________ _ c. Number of persons addressed ______ _ d. Films shown_____________________ _ 3. Literature distributed ________________ _ 4. Radio talks_________________________ _ 5. Newspaper articles submitted__________ _ 491 1,005 34 31 751 4 7,474 2 2 II. Field Visits: I. Promotional VISits ___________________ _ 148 2. Plant investi~ations__________________ _ M 3. Follow-up _________________________ _ 1 4. Plant survey _______________________ _ 20 5. X-ray survey-individuals____________ _ 12,861 III. Medical Nursing Activities: I. Cases investigated ___________________ 241 2. Consultations with physicians__________ 132 3. Conferences with nurses_______________ 177 4. Special investigations _________________ 1 5. Nursing consuLtations_________________ 13 IV. Engineering Activities: I. Sanitation -------------------------- 22 2. Ventilation ------------------------- 66 3. Dust studies_________________________ 34 4. Organic solvents_____________________ 4 5. Illumination ________________________ 13 6. Temperature humidity_________________ 0 7. Special investigations_________________ 13 V. Chemical Studies: l. Samples collected____________________ 422 2. Samples analyzed____________________ 428 3. Field determinations__________________ 209 4. Laboratory determinations_____________ 226 5. Special studies_______________________ 0 Preventable Diseases 201 STATISTICAL SUMMARY INDUSTRIES IN GEORGIA SERVED BY INDUSTRIAL HYGIENE PERSONNEL OF THE GEoRGIA DEPARTMENT oF PuBLic HEALTH 1941 Number of Plants Visited______ ------------------- 20 Number of New Piants Visited______________________ 20 Reason for Visit to New Plants: Occupational Disease Report___________________ 0 Self-initiated -------------------------------- 9 Employer Request --------------------------- 7 Local Health Department______________________ 0 Physician Request --------------------------- 0 Army Reque~ ------------------------------- 0 Other Request ------------------------------- 4 Type of Studies Done: Medical ------------------------------------ 17 Engineering -------------------------------- 17 Nursing ------------------------------------ 9 Laburatory --------------------------------- 5 1942 96 88 1 65 17 3 0 0 2 60 31 42 13 202 Georgia Department of Public Health TYPHUS .FEVER CONTROL SERVICE The Typhus Control Service of the Division of Preventable Diseases is directed by the Engineer of the Division, who duties are also divided with other services of the Division. The Director and Engineer of the Division are located in Atlanta. A field office is located in Macon, Georgia, which is within the proximity of the most important typhus area of the State. An assistant engineer, en gineering aide, and stenographer are located in this office. For the most part of 194.2, the pwfessional staff of the Typhus Control Service consisted of one engineer in charge and one assistant engineer, as compared with one engineer in charge and two assistant engineers for previous years. However, the professional staff was increased in Octoher, 1942, by the addition of an engineering aide. Medical activities of the Typhus Control Service are provided by the medical staff of the Division of Preventable Diseases, Regional Medical Directors, and County Health Officers. At the close of 1942, the first full year of the present World War II, the Typhus Control Service, like all other public health activities throughout the State and Nation, was placed on a war.time basis of pro viding the most efficient service possible for the protection of the health of soldiers and civilian war industrial workers. Activities of the Typhus Control Service for the year were therefore concentrated primarily in war .areas of Georgia in which typhus tever was prevalent. In addition to services rendered cities, towns, and rural communities in war areas, ad. visory services were rendered the U. S. Army in construction and main tenance of military cantonments, and Federal Agencies in the construction of war housing projects, for the prevention of typhus fever. Due to the critical shortage of materials for civilian use, as caused by the war effort, essential materials used in the control o.f typhus fever became difficult to obtain during 1942 without preference ratings from the War Production Board. This shortage of materials has practically eliminated the individual citizen from purchasing materials, mainly metals, for vent stopping (rat proofing) his own building or residence. However, typhus control programs that are given financial sponsorship by local govern mental agencies in war areas, preference ratings may be ohtained as indicated by the fact that several of the cities in Georgia have received high preference ratings to procure all the materials necessary for conducting typhus control programs. During the year, the City of Savannah established a permanent typhus control division within the City Health Department. This is the second large city of Georgia to establish a permanent typhus oontrol division; the other city being Atlanta, which established their typhus control division in 1940. Undoubtedly other Georgia cities will soon follow the action of Atlanta and Savannah. Preventable Diseases 203 TYPHUS CONTROL ACTIVITIES The activities of the professional staff of the Typhus Control Service consisted in general of educational and promotional activities, epidemiologic and engineering investig.ations, special investigative studies, and advisory assistance to cities, towns, and rural communities in establishing control measures; such as, vent-stoppage .of buildings (a modified f.orm of rat-proofing), rat extermination, and municipal refuse collection and disposal. During the year, 298 field visits were made rendering these services to 40 cities, towns, and rural communities in thirty-five counties of Georgia. EDUCATIONAL AND PROMOTIONAL ACTIVITIES The educational and :promotional activities continued in 1942, as in previous years, through the principal media of radio talks, pamphlets and booklets, public meetings, and personal conferences. During the year, two meetings were attended in the interest of typhus fever control in which no participation in the program was made and seventeen additional meetings were 'attended and addresses made. About 379 persons were in attendance at the meetings addressed. There were 1,201 personal conferences conducted 'and one radio talk made. Approximately 6,598 pieces of typhus literature were distributed. The literature distributed was principally the booklet entitled, "Murine Typhus Fever." In addition to the many requests received for this booklet by citizens of Georgia, an inestimable number of requests have been received from governmental agencies throughout the nation. From the records of requests received, this booklet has undoubtedly reached every state in the nation 'and many foreign countries. An inestimable number of reprints of published scientific papers of the typhus fever eontrol program in Georgia, and other available scientifie information on this subject as kept on file by the Typhus Control Service, have been requested by public health agencies and individuals in many states. Two lectures were given to students in the public health engineering class at the Georgia School of Technology, and one lecture to students in the public health class of the University of Georgia Medical School. INVESTIGATIONS Epidemio[o,gic Two special epidemiologic investigations of rep.orted typhus fever cases were made during the year. One investigation was made in Brunswick, Glynn County, and the other one in Savannah, Chatham County. The Brunswick investig.ation was made by a member of the medical staff, Division of Preventable Diseases; whereas, the Savannah investigation was made by the medical staff of the Ty.phus Control Division, U. S. Public Health Service, and the Assistant County Health Officer of Chatham County. These investigations precede the engineering investigations and indicate the possible foci of the disease on spot maps. 204 Georgia Department of Public Health Engineering Six city-wide and seven special engineering investigations were made during the year. These investigations were directed towards the determination of the prevalence by species of rats encountered, types of buildings and amount of harborage, and refuse conditions and harborage on premises. The investigations also included the type of business establishments, and the amount of material required for applying control measures. SPECIAL INVESTIGATIVE STUDIES The Savannah typhus fever investigative study as started in February, 1941, continued throughout 1942. However, with the withdrawal of the Work Projects Administration participation in this study on December 31, this investigative study was 'officially terminated on this date. The agencies involved in this study were the Georgia Department of Public Health, U. S. Public Health Service, Savannah City Health Department, and the Work Projects Administration. The purpose of the Savannah investigative study was to evaluate the effeotiveness of typhus fever control measures originated and currently employed by the Trphus Control Service in controlling typhus fever in cities, towns, and rural ,communities throughout the State. Epidemioiogic, entomologic, and engineering control studies were made. Data obtained from this study is now being assembled and correlated for publication. During the year many visitors engaged in public health activities in other states inspected the work of this project, and numerous requests for information were received. CONTROL MEASURES Vent-Stoppage Vent-stoppage is the primary typhus fever control measure which is applied to business establishments to prevent the entry of rats, thereby preventing the close 'association .between man and rat that is necessary for .the transmission of the disease. At the close of the year, 727 business establishments were surveyed for vent-stopp,age and 437 were vent-stopped. Since May, 1939, when vent-stoppage was first applied, a ,total of 2,279 business establishments have been vent-stopped. Of this number of business establishments vent-stopped, 481 received maintenance during 1942. Inspections were made of 4,720 business establishments. Rat Extermination Organized rat extermination progmms employing the use of poisons were conducted in three cities and towns. Organized trapping campaigns were carried on in twelve cities and towns during the year. These rat extermination programs were under the direction of the Typhus Control Service, and were conducted principally during the instaUation and after completion of vent-stoppage to business establishments. This has been found to be the most effective method of obtaining the best results from rat eJCtermination. Preventable Diseases 205 Refuse Collection and Disposal Advisory assistance in matters of refuse collection and disposal was rendered many municipalities requesting assistance ~n controlling .typhus fever during the year. A special investigation was made of the refuse collection and disposal practices in the City of West Point. In view of the shortage of materials and equipment for civilian use, expansion or improvement of refuse collection and disposal facilities, involving new construction or equipment, has been greatly curtailed. Impairment of sanitary refuse disposal on public and private premises has been specifically experienced by municipalities, due to the shortage of metal garbage receptacles. These receptacles are made of galvanized metal, consequently, come within the classification of critical materials by the War Production Board. It is therefore anticipated, that for the duration of the war, municipalities can 'Only hope to maintain minimum facilities :or refuse collection and disposal. VISITORS INSPECTING FIELD ACTIVITIES During .the year, many visitors were received to inspect the field activities of the Typhus Control Service. Among the list of visitors received were representatives from Public Health Agencies in China; British West Indies; Columbia, South America; and the States of Tennessee, North Carolina, Louisiana, and Florida. TYPHUS FEVER IN GEORGIA DURING 1942 The geographical distribution of typhus fever continues to he prevalent, as in previous years, throughout the coastal plain counties of the State, with the greatest incidence in the Southwest portion. The disease also con tinues to be a problem in the cities, towns, and rural communities, more so than in the sparsely settled areas of the counties. During the year 1942, there were 1,154 cases of typhus fever reported as compared with 944 oases for :the year 1941. This is an increase of 210 cases or 22.2 per cent in 1942 over 1941. The number of deaths occurred during 1942 were 53 as compared with 36 deaths in 1941, an increase of about 47 per cent in the number of deaths reported for 1942 over 1941. It is interesting to note, from the graph, the apparent cycle of the disease over the tenyear period 1933 through 1942. This :apparent cycle is indicated more effectively by the number of deaths repmted, as these re :ports are more reliable than the reports of the numbers of cases. However, inasmuch as .typhus fever in Georgia is comparatively a new disease, in so far as recognition is concerned, it is too early to attempt to dr.aw any definite conclusions on the basis of existing data, as to .the cycle occurrence of the disease; or any factor or condition that may be responsible for the increase in the disease during 1942 over previous years. 1'-:1 TYPHUS FE;VER CONTROL SERVICE 0 01 STATISTICAL SuMMARY oF AcTIVITIEs 1942 Educational lnvestigations Control Measures County Non Health Officer Health Officer Cities Towns and Rural Communities ________________ Baker ________ Rural Bibb -------------------------Macon Vent Stoppage of Rat Exler- Ordin's ~ >... Q; ;;:: " "- c"""' ,=.c._."c. a".=.o ::""c ''".".'. - c :IE< _.... ..""c,,-'.'".","",.'' :IE< ....a==""'.".'":"":":''' =-= Z<( ~ . ._.. ~ 1- _"=.="., ":=c ,~_~ :: -~ Cl: .JC .".. i >, C:3 ~ ".o.;. rJ) Bus. Establishments mination Enacted ...,. ..., > =rJ) -......,,.. 0=E ... ~ ."".. "c ' . . . ------- 1l c "c c c ., ... "c;; ::E ... :c;: ;; a.. "ii .,o".r"n"o' "f= >=~=-~~cc5. ~ 0 ~ ~- l:::;j ~ 2 9 21 54 5 16 g~.... Brooks ------------------------Quitman 5 Bulloch ----------------------Statesboro ------- 2 2 ;<:l;>. Burke ------------------------Waynesboro _____ _ 13 46 -- -- 22 32 !29 ~ Chatham ---------------------Savannah Cobb _______________ -- .. --------- :VIarietta Coffee ------------------------Douglas Colquitt ---------------------.Moultrie 52 434 2 2 57 33 2 29 6 2 21 50 -1 219 1!00 199 227 10 -;'":tl 0"' f:; Dodge ------------------------Eastman 1! 37 2 5a -- 90 14 ::X:: Dougherty --------------------Albany Fulton ______________________ .Atlanta 4 12 6 !50 747 95 1030 188 s~ : Glynn ------------------------Brunswick ______ _ 41 -- -- 1 -- 37 1 Sea Island _____ _ 9 1 Grady -----------------------Cairo 300 Greene -----------------------Union Point ____ _ -- Gwinnett _____________________ Lawrenceville 2 8 1 10 ________________ Houston ______ Cochran Field Laurens ______________________Dublin Lowndes ----------------------Valdosta :.\Iusrogee ------------------- __ Columbus TYPHus FEVER CoNTROL SERVICE STATISTICAL SuMMARY OF ACTIVITIES 1942 Educational lnvestigations Control Measures Vent Stoppage of Rat Exter- Ordin's Bus. Establishments mination Enacted County Non Health Officer Health Officer Cities Towns and Rural Communities ., ., -;;; -c"" .,..., > c"'"~ C'""C'"C ... .. - .. ;"C;C o" .~,= o 0..(.) ~.-,c- :;;;::( "CC :-""c""l<-""''"~"c""""'(' "c ' o"CC a""~.""'"~ "'' ""O"CC zct -.".""..' 1- 0 "CC "CC _,~""~_.i.- "".,:. ""'' ~c ""CC ~ b C3 ...... c; " rJl "CC " "> ~ "rJl -"CC c"". E 0 (.) -"CC ""c". "c ' ""c "c ' !l ;c;; :;;; . c ;c : ;; a. .. cc . c. I"=' ." .... "'... c. cc. "=, "c0'. >~ ~a ________________ Peach ________ Fort Valley ----- 2 4 1 18 22 -- .~ ... Pull1ski _______________________ Hawkinsville ---- 7 24 1 19 1 <::! Riehmond _____________________Augusta -------- 2 4 ________________ Screven _______ Sylvania -------- 4 28 1 50 2 20 113 1 42 1 35 .;.:.:.l . I;) ---------------Seminole ______ Donaldsonville --- 1 6 -- o....-. Spalding _____________________Griffin ----------- 31 93 80 73 75;1 94 1 Stephens _____________________ Toccoa ---------- 1 4 -- t::::l Sumter _______________________ Americus 1 4 Telfair _______________________McRae ---------- 18 i':18 -- -- -- 1 9 1 73 17 250 ""'' l:l Rural ----------- 1 2 "' Tift -------------------------Tifton ---------- 4 ll -- -- -- 208 "' Troup ------------------------LaGrange ------- 10 24 Point ______ 12 44 -- 1 72 434 \Yalker_________________________ LaFayette ------- 1 5 _______________________________ Rossville -------- Washington _____________________ Sandersville ----- 1 2 1 37 37 Davisboro Whitfield _______________________ Dalton Worth __________________________ Sylvester 2 1 65 Unclassified ----------------- ----------------- 66 147 3 75 1 :>924 Total ------ 30 5 Total ------ 31 21 40 298 1,201 2 17 379 1 6.)98 6 r 1369 437 4078 481 3 12 ~ Statistical Summary of 1941 0 -.1 58 356 1,332 8 25 345 3 5000 13 3 1227 589 3414 284 208 Georgia Department of Public Health U) 60 :~c 0 50 ~~ 40 ~~ 30 Q.. ~~ 20 ~ 10 ::I z 0 MURINE TYPHUS fEVER CASES AND DEATHS REPORTED IN GEORGIA Preventable Diseases 209 VENEREAL DISEASE CONTROL SERVICE PERSONNEL The Venereal Disease Control Service consists of a State Venereal Disease Control Officer, Associate Venereal Disease Control Officer, four stenographers, and members of the laboratory staff who are engaged in performing examinations for venereal diseases and with the distribution of drugs and supplies. CASE REPORTING During the period under discussion, 3,525 new cases of syphilis were reported to this Service by private physicians; 21,517 new oases of syphilis were admitted to the clinics, making a total of 25,042 new cases of syphilis being reported to the Georgia Department of Puhlic Health. There was a total of 21,657 new cases of syphilis reported in 1941. Private physicians reported 2,125 new cases of gonorrhea, and the clinics reported 7,453 new cases, making a total of 9,578 new cases of gonorrhea. There were 3,36L cases of gonorrhea reported in 1941. There were 640 cases of chancroid, 104 cases of granuloma inguinale and 51 cases of lymphogranuloma inguinale reported in 1942. Case reports are received by the Venereal Disease Control Service from: l) private physicians on individual case report cards (which are also used for ordering free drugs), and 2) venereal disease clinics. Each patient admitted to a syphilis clinic is reported individually to the CTU on a new ,admission card approved for this purpose. Each service rendered each patient is reported to the CTU on treatment progress cards. At the end of the month, the CTU furnishes the Venereal Disease Control Service with administrative reports, showing the number of patients treated and the amount of treatment given. Venereal diseases other than syphilis are reported by private 'physicians on individual case report cards and by clinics on the Clinic Monthly Report. DISTRIBUTION OF FREE DRUGS An estimated total of 2,450,868 doses of neoarsphenamine, sul- pharsphenamine, mapharsen, stovarsol, bismuth, and sulfathiazole were issued to private physicians and clinics for the treatment of syphilis and gonorrhea, as compared with 1,340,826 doses for 1941. For ,a detailed report of drugs distributed see Tables E and F. CLINICS At the end of the year, there was a total of 251 clinics operating in 144 counties; 376 physicians were receiving honoraria at the rate of $5.00 .per clinic session for conducting free venereal disease clinics, and 201 nurses were receiving honoraria at the rate of $2.50 per clinic session for assisting in these clinics. 210 Georgia Department of Public Health LABORATORY During the year, 515,566 serologic examina'tions for syphilis were performed by the central laboratory and the two branch l'aboratories. Of this number, there were 77,459 (15.0%) positive reactions. The number of serologic examinations for 1941 was 347,270, with 50,695 positive reactions. During the period under discussion, a total ,of 226 clarkfield examinations were made, with 84 (37.2%) giving ,a positive reaction. The number of clarkfield ex'aminations for 1941 was 309, with 77 giving a positive reaction. During 1942, there were 9,813 examinations made for g-onococci, with 1,593 (16.2%) giving a positive reaction. During 1941, there were 9,882 examinations made for gonococci, with 1,929 giving a positive reaction. EDUCATIONAL A total of eight lectures was made during the year to a total audience uf 189, as compared with eight lectures with an audience of 310 for 194.1. Films were shown to 87 groups, comprising an audience of 13,217, as com pared with 155 films shown to an audience of 19,792 for 1941. Approximately 85,266 pieces ,of li,terature on venereal diseases were distributed, as compared with 46,168 pieces of literature distributed during 1941. There were 138 clinic visits made, 54 conferences, and 3 meetings attended (not addressed) . FOLLOW-UP Letters were written to health 'authorities concerning all patients reported as being a delinquent or contact of venereal disease. ITINERANT NURSING SERVICE As a result cf additional federal funds, an itinerant nursing service has been provided for some 38 counties in Georgi,a, which were without public health organizations, with each public health nurse covering ,three or four counties and holding clinics weekly or oftener in each county. Clinics are open to all indigent patients as well as draftees. Treatment is given by local practicing physicians and no charges are made. The itinerant nursing service has been available only since May, 1942. Nine nurses have been assigned to cover 31 counties. COOPERATION WITH SELECTIVE SERVICE All positive reports on selectees clear through this Service and are referred to the health officer, or where there is no health officer, to the regional medical director. The result of the investigations for eleven months, not including December, which is not avaiiable at this time, is as follows: Total investigated-5,652. Put under treatment-4,837. Already under treatment-191. Investigated but not put under treatment-299. Preventable Diseases 211 Unable to locate-196. Moved out of State-87. Moved into State-42. It should be noted that this report consists only of the investigations, and does not include the total number referred. RECORD FORMS RCA 103-20-Syphilis Patient Transfer Form. This form has been adopted :to facilitate transfer of patients from one treatment source to another. The form is used in duplicate, one copy being given the patient and one copy being sent to the CTU. The patient can receive immediate treatment upon appearing at the new clinic upon presenting his copy. OTHER ACTIVITIES Doctor R. A. Vonderlehr of the U. S. Public Health Service visited this Service February 20. The State Venereal Disease Control Officer attended the meeting of the Georgia Medical Association in Augusta April 29. Mr. Earl Lippincott of the Division of Social Protection, Federal Security Agency, visited this Service frequently relative to the controlling of prostitution in Georgia. During the month of November, the State Venereal Disease Control Officer accompanied Dr. P. S. Pelouze, Assistant Professor of Urology at the University of Pennsylvania and an eminent author and authority on gonorrhea, on a lecture tour throughout the State. Dr. Pelouze made 17 lectures to an audience of approximately 1,077. TABLE "A" SYPHILIS CASES REPORTED TO VENEREAL DISEASE CONTROL SERVICE BY PRIVATE PHYSICIANS UNDER PROGRAM FOR DISTRIBUTION OF fREE ANTISYPHILITIC DRUGS January-December, 1942 New Cases (Never Previously Treated) White January -----------February ____________ March ______________ April --------------May ________________ June ---------------July ________________ M F ---- 58 34 55 34 48 41 18 10 41 40 57 49 47 28 42 41 60 39 46 36 21 28 43 33 Colored M F 101 76 144 113 93 94 72 90 132 117 135 143 107 118 107 116 128 125 106 118 107 83 79 72 Total 269 346 276 190 330 384 300 306 352 306 239 227 TGtal --------------- 536 413 1311 1265 3525 Old Cases (Previously Treated) White M F Colored M F 24 19 68 34 23 15 46 33 39 31 30 28 17 15 30 31 17 22 33 32 44 28 70 62 27 :n 38 48 16 18 31 16 31 21 37 32 25 24 41 38 27 23 44 48 29 19 18 23 319 266 486 425 Total 145 117 128 93 104 204 144 81 121 128 142 89 1496 Total Reported White M F Colored M F 82 53 169 110 78 49 190 146 87 72 123 122 35 25 102 121 58 62 165 149 101 77 205 205 74 59 145 166 58 59 138 132 91 60 165 157 71 60 147 !56 48 51 151 131 72 52 97 95 855 679 1797 1690 1..-.:.1.. 1-:1 ~ ...<1> <;) ~ 15" t:l Total 414 <1> ~.;....:... 463 404 283 434 588 444 387 .;<.:1.:.>,. 0 -~ -.Io.:.: -. <"l 473 434 ::t:: <1> 381 l;::;l:- 316 ;::.- 5021 TABLE "B" SUMMARY REPORT OF CLINIC ACTIVITIES SYPHILIS January-December, 1942 New Cases of Syphilis Admitted to Clinic White M F 48 45 29 41 March ____________________________________ 59 54 April ------------------------------------- 68 67 May ______ -------------------------------- 72 54 June ------------------------------------- 48 62 July ------------------------------------- 76 47 83 50 87 51 October ---------------------------------- 90 61 67 40 December _________________________________ 80 40 Total ______________ - - -- --- ----- 807 612 Colored M F 518 436 639 769 743 769 1087 1112 1136 1193 1066 1001 489 474 697 824 757 934 1018 1019 1021 1067 768 561 10469 9629 Old Cases of Syphilis Admitted to Clinic Total Admissions Doses Administered White M F 91 68 117 100 106 89 140 113 126 91 106 89 144 110 166 140 209 168 206 238 170 137 134 99 Colored M F 634 810 948 1038 981 889 979 1442 1498 1472 1345 1085 809 1235 1084 1284 1111 1029 1124 1408 1541 1562 1320 856 Heavy Arsenicals Metal '...t. j 2702 3242 3676 23487 25534 30210 21037 21222 22736 <:! ""'';::: gIS': 4303 3935 3926 32413 34681 33594 26230 26075 "t:'::l 26698 ~ 4585 5420 5ill 36452 39322 43331 30007 29746 32268 """"l=''''l 5889 48418 37445 4913 42690 35873 3856 37792 31854 17Vi 1442 13121 14363 52158 427924 341191 !>:) ....... '"'" TABLE "C" !,>..:.). of:. GONNORRHEA CASES REPORTED TO VENEREAL DISEASE CONTROL SERVICE BY CLINICS January-December, 1942 New Cases of Gonorrhea Admitted to Clinic Genitourinary White Colored M F M F Opthalmia Neonatorum Wh. Col. M F MF Other Wh. Col. Unknown M FM FM F Old Cases of Gonorrhea Admitted to Clinic Genitourinary Wh. Col. MF M F Opthalmia Neonatorum Wh. Col. M F MF Wh. MF Other Col. MF Unknown MF Jan. ____ 70 57 242 54 1 Feb. ____ 42 38 172 68 1 March __ 57 53 154 46 1 April ___ 70 48 217 67 1 M,ay 56 51 232 59 22 5 7 -- -- -- -- June --- 60 68 257 103 July ____ 62 323 524 329 11 1 -- 10 10 52 24 August - 65 148 469 244 1 6 6 27 60 61 Sept. --- 4:l 97 429 224 1 8 9 19 47 33 October _ 54 158 582 322 6 2:i 47 102 Nov. 59 85 311 278 1 7 5 24 3 Dec. ____ 11 14 138 37 9 6 52 15 57 4 1 -- --- 1 -- -- 5 1 17 7 Total 649 1140 3727 1831 2 1 1 1 10 7 67 17 45 95 239 233 5 1 17 8 Total Admissions No. of Treat- men! Visits 424 321 327 403 398 586 1239 1087 913 1296 772 329 1234 756 873 1303 1344 1414 2591 2381 1861 3319 1908 886 8095 19870 ~ ~ Si r:.r.o.... I;> t::; ~ ~ .......... ;::; ~ .;:.:.,.. c -~ ~ -.o...-. ('> ::r:: ;~ ";'. TABLE "D" ToTAL NEW VENEREAL DISEASE CASES REPORTED TO THE VENEREAL DISEASE CoNTROL SERVICE January-December, 1942 By Private Physicians White MF Colored M F Unknown M F Syphilis Primary and secondary__ 393 :ng 893 82.1 Early and latent ______ 1 2 2 4 J..ate and late latent ____ 12:1 91 397 :198 Congenital _____________ 17 19 16 Prenatal _______________ 1 22 Total ------- - -------- 536 413 1311 1265 Gonococcus Infection 'denHo-urinary --------- 'Opihalmia neo __________ -- Other __________________ 340 144 1218 423 Total ------------------ 340 144 1218 423 Other Venereal Disease Chancroid ------------- 9 2 59 13 Granuloma inguinale __ 20 6 Lymphogranuloma 1 10 6 Other Total __________________ 9 3 89 25 By Clinics, Hospitals or Other Institutions White MF Colored M F Unknown M F 96 10') 824 620 312 309 ril47 5947 363 162 4250 2800 36 36 248 262 -- 807 612 10469 9629 649 1140 2 1 10 7 661 1148 3727 1 67 3795 1831 1 17 1849 Total By All Sources White M F Colored M F Unknown M F 491 424 1717 1445 31:~ 311 o149 'l951 486 2:-i3 4647 3198 53 36 267 278 1 22 1343 1025 11780 10894 649 1140 2 1 330 151 1001 1292 3727 1 1285 5013 1831 1 440 2272 ."..'t, ;j ~ ~ ...~ -- ;::! I':> 0..."..' ~ t:::; &; ~ ~ ~ "' 32 8 438 79 6 6 43 23 3 14 17 41 14 495 119 41 10 497 92 6 6 63 29 3 1 24 23 50 17 584 144 .t.-...:1.. VI TABLE "E" .15 ranu&ry ----- -- -- February ------- -March ____________ April ___________ 10 May ----------- 10 June ----------- -July ____________ 10 A.ugust --------- -September ------ -October ___________ November _________ December _________ rota! ___________ 30 Total Number of Doses________ 30 .3 2~0 750 260 280 1000 560 380 1140 360 1240 300 400 6890 6890 .45 1290 2040 1760 920 1230 1150 1520 2570 800 2220 1840 875 18215 18215 FREE ANTISYPHILITIC DRUGS DISTRIBUTED VENEREAL DISEASE CONTROL SERVICE 1anuary-December, 1943 NEOARSPHENAMINE .6 .75 .9 1.5 3.0 4.5 6010 200 160 9450 40 220 7800 450 780 6370 200 82fi0 130 240 7570 60 210 9060 440 10530 10 170 8490 100 220 1700 120 610 8010 400 190 7230 180 730 620 350 310 630 280 620 20 920 310 930 90 970 460 960 300 1140 220 920 540 1300 290 715 460 96470 1510 3620 10185 3900 96470 1510 3620 50925 29250 5.4 6.0 1710 1317 1820 1640 2530 1930 2740 2490 1970 2640 3270 1790 25907 259070 Total number of doses of neoarsJ>henamine. 563,708 (for larger ampoules, 0.6 gms. considered average dose.) .t.-...:..l 0\ 10.8 240 380 370 150 206 90 110 120 110 550 270 500 3096 45.0 ~ 60 ~ c -- 60 ~ ~- t::::l ~ 60 100 'g.....,. ;3 ~ 100 ISO -.;.::.l. c ~ !c.'.:.!.-.. 560 ~. (") :::t: ~ 55728 42000 :l;:::l:.-- TABLE "F" fREE ANTISYPHILITIC DRUGS DISTRIBUTED (Continued) VENEREAL DISEASE CONTROL SERVICE January-December, 1942 Sulpharspehenamine 0.2 0.3 0.4 0.6 60 -- 10 10 50 290 10 March --------------- 60 April ----------------- 200 170 -- 60 20 May ----------------- 180 50 40 June ----------------- 70 280 10 July ------------------ 110 50 50 210 -- 120 90 40 50 200 460 10 130 December ____________ 10.5 90 50 315 75 Total _________________ 1495 1915 315 Total Doses __________ 1490. 1915 315 Mapharsen 0.04 1100 920 870 880 1060 1220 1110 1310 1090 1840 1600 1030 14030 14030 0.06 1660 1430 1960 1600 1640 1970 1600 3280 1880 3070 3030 1420 24540 24540 0.6 100 130 480 120 540 620 730 570 340 760 380 950 5720 57200 Stovarsol Bismuth Su lgath iazole T-abl-ets2250 3430 75 1120 1500 5635 3285 1300 4400 5425 2600 1125 30-cc 408 531 397 366 564 735 561 438 452 676 506 336 :l2145 5970 Bottles of 60-cc 566 Tablets --- 36000 40 Tablets 344 41000 .~.. 530 61500 300 46000 474 53000 2499 704 55000 307 "~ ' "';::: IS g: 697 91000 344 9;)5 99500 610 467 105000 732 805 101000 901 968 78000 521 1~63 76000 312 ."i.:.':..l ;""""":''','' 8073 843000 6226 32145 179100 484380 1092040 T.otal number of doses of neoarsphenamine -------- ------------ 11otal number of doses of sulpharsphenamine ---------------------------- --Total number of doses of manharsen _____________________________________ ;i63,708 3,725 9ri,770 Total number of doses of stovarsol _________________ ---------------------- 32,145 Total number of doses of sulfathiazole __________ ------------------------- 1,092,040 Total number of doses of bismuth ----------------------- __________________ 663,480 -- Total -------------------------------------------------------------- 2'4 50,8 68 (For large.r ampoules, 0.6 gmR. considered dose) (l-ee considered dose) t-.J 1-' -.) ~ TABLE "G'' ~ 00 LABORATORY ExAMINATIONS FOR VENEREAL DISEASES PERFORMED IN CENTRAL LABORATORY AND Two BRANCH LABORATORIES GEORGIA DEPARTMENT oF PuBLIC HEALTH January-December, 1942 Serologic Examinations Number Number Percent Darkfield Examinations Number Number Percent Examinations for Gonococci ~ Number Number Percent .c~.., Total Positive Negative Positive Total Positive Negative Positive Total Positive Negative Positive (Jo. ~ January -------------- 31,202 4,073 27,129 13.1 17 5 12 29.4 813 150 663 18.5 t:::; February ------------- 28,477 4,689 23,788 16.5 30 8 22 26.6 660 102 558 15.5 ~ March --------------- 35,588 5,712 29,876 16.1 18 5 13 27.7 747 April ----------------- 31,841 4,889 26,952 15.4 16 10 6 62.5 821 102 124 645 13.7 697 15.1 "<:; ;..:....,,. May ----------------- 32,969 4,778 28,191 14.5 22 19 3 86.4 786 120 666 15.2 ;3 June ------------------ 43,741 6,636 37,105 15.2 23 11 12 47.8 862 136 726 15.8 .:~ :.=. July ----------------- 51,109 7,917 43,192 15.5 22 4 18 18.2 871 August --------------- 47,314 7,509 39,805 15.9 13 3 10 23.1 1,010 162 174 709 18.6 836 17.2 ...c..... September ------------ 52,544 7,962 44,582 15.2 21 3 18 14.3 862 171 691 19.8 October --------------- 59,857 9,025 50,832 15.1 9 2 7 22.2 909 140 769 15.4 ;"t:1 0,_" November ------------ 50,876 8,160 42,716 16.0 23 10 13 43.0> 806 111 695 13.8 ~. December _____________ 50,048 6,109 43,939 12.2 12 4 8 33.3 666 101 565 15.2 "::'t: Total ----------------- 515,566 77,459 438,107 15.0 226 84 142 37.2 9,813 1,593 8,220 16.2 ~ ;:, ~ ~ J TABLE "H" Lectures No. January __ February _ 2 March April ____ 1 May _____ 1 June ---- 1 July _____ August -- Sept. ---October __ November. 1 December. 2 'rota! ____ 8 Au d. 80 45 8 6 -- -- 10 40 189 SuMMARY REPORT OF EDuCATIONAL AcTiviTIES VENEREAL DISEASE CONTROL SERVICE January-December, 1942 Films (V. D.) No. Aud. -- -- 2 240 -- 1 45 -- -- -- -- -- -- -- -- -- -- 3 285 Films No. Au d. 7 996 16 985 8 972 18 4,538 8 508 4 817 9 453 4 1,504 5 1,840 1 20 4 299 84 12,932 No. of Clinic Visits No. of No. of Follow-Up Conferences Visits No. of Meetings Attended (Not Ad- Litera- dressed) ture 12 4 -- 2 -- -- 2 1 6 4 9 2 21 11 15 8 24 13 -- 24 4 10 2 1 15 3 138 54 1 2,664 .'"..i.:l 1 4,012 5,942 12,328 .,"'~ "';:::: "" 8,775 0....".. 6,700 "' 2 8,551 6,077 536 5,987 3,410 .,.....1::::::1 """"'"'''' 20,284 3 85,266 1..'-.:.1. \0 Division of Malaria and Hookworm Service Justin Andrews, Sc. D., Director* D. M. Wolfe, M.D. _________________________________Acting Director J. Allen Scott, Sc.D. ______________________________Associate Director Arthur W. Hill, M.D. _______________________ Medical Epidemiologist* I During 1942 there was a considerable turnover in the personnel of this Division brought about by various staff members entering the armed forces or other types of work. For rthe first four months the staff consisted of the Director, Medical Epidemiologist, Engineer, two Field Biologists, Field Nurse, Sanitarian, two secretaries and a part-time steno-clerk. During May, the entire staff, with the exception of the Field Biologist, Field Nurse and the secretaries, departed to enter the armed forces or for other work related to the war. The Biologist was shifted .to the central office and made Associate Director, and the Division was placed under the supervision of the Director of the Division of Preventable Diseases. The Associate Director was placed in charge of the office work and new field personnel were employed as qualified persons could be found. One Field Biologist was assigned to the Division of Public Health Engineering 'to assist with a program in cooperation with the U. S. Pubrlic Health Service, Office of Malaria Control in War Areas. On July 15th, the Assistant Epidemiologist, Division of Preventable Diseases, was made Acting Director of the Division Qf Malaria and Hookworm Service. Then On October lst, further changes were made in the field personnel so that the staff from then until the end of the year consisted .of the Acting Director, Associate Director, three Biologists, Field Nurse and One secretary. Two Assistant Biologists were also employed for the summer season. With certain modifications due to the unusual conditions, the antimalaria activities of the Division have been of the same type as those of previous years, including standard plan activities, malariometry, entomological service, special investigations, research, and publication of the Georgia Mal,aria Bulletin. Early in the year, the U. S. Public Health Service created an office of Malaria Control in War Areas, and the supervision of this program in Georgia was assigned to the Division of Public Health Engineering. The Division of Malafi.a and Hookworm Service assisted in the organization of this program by selecting, training and supervising the inspectors who were to collect mosquitoes in the areas to be brought under control. These duties in addition to certain special investigations in new war areas occur-ied most of the time of the staff during the first four months of the year. At the end of that time, the Director of the Division and several staff Left for military duty during May, Malaria and Hookworm Service 221 members left to enter the armed forces. One biologist was assigned to work exclusively with the malaria control program in war areas, and a report of his activities will be included in the report of the Division of Public Health Engineering. Standard Plan Activities Early in the year it was decided that with the loss of engineering personnel from the county health department staffs it would be impossible for most counties to fulfill their commitments under the standard plan. It was, therefore, announced that the standard plan would be discontinued for the duration. Several counties did, however, continue their control activities and whenever assistance was requested from the Division of Malaria and Hookworm Service, the usual type of aid wa-s given. During the summer period, biologists were assigned to Bulloch, Crisp and Jenkins Counties to assist in the supervision and evaluation of their control programs. They, and the Associate Director, also .spent part of their time assisting other counties in their control programs. Only a minimum of educational and promotional work under the standard plan was continued, because of the abnormal conditions. A tabulation of the educational and promotional anti.malaria and antihookworm activities in the various counties is shown in Table I. Malariometry The 1941 Fall Malaria Survey in white and colored elementary schools was conducted in thirteen counties by county health department personnel, assisted in some cases by the Medical Epidemiologist of the Division (See Table VII). As noted in the previous annual repor.t, hlood film diagnosis is not as satisfactory as spleen palpation for the purpose of making surveys of malaria prevalence in white children. Spleen palpations were made of a total of 4,715 children, the results of which are shown in Table II. In all, approximately ll% showed some degree of splenic enlargement, which is a~most exactly the same proportion encountered in the survey of the previous year. In Table III, the results of examination of thick blood films are shown. In the case of white children, these films were taken only from those showing splenic enlargement, except in cases noted. The films from colored children, however, represent a random sampling. A total of 9,223 films were examined. The prevalence of malaria in white children as indicated by the spleen palpation and blood film diagnosis was approximately the same in 1941 as in the previous year. That is to say, approximately 11% showed some degree of splenic enlargement, while less ,than 1% showed parasites in their blood. Perhaps if .all the films had been taken at random as they were previously, the proportion of positives would have dropped stiU lJwer. The prevalence of malaria in colored children as indicated by blood film diagnosis dropped from approximately 4% in 1940 to less than 1% in 1941. This difference is borne out by a comparison of the figures for those counties in which a reasonably large number were exemined both years. In brief, these figures added to those of previous 222 Georgia Department of Public Health reports, indicate that malaria prevalence in white children may have reached a minimum in 1939, while that in colored chirldren did not drop to the same minimum until 1941. The Fall Survey of 1942 was made on a limited basis, on account of the shortage of personnel in this Division and in the laboratory, and since in county health departments there had been an increase in other activities due to the warr. In some counties surveys were omitted, while in others blood-films were :taken only in regions known to be malarious in the past. In addition to counties usually surveyed, plans were made to take approximately 300 thick blood-films from counties having control programs supervised by the Division of Public Health Engineering in cooperation with the U. S. Public Health Service, Office of Malaria Control in War Areas. The films were collected from rural regions in which the control program was operating, namely, regions surrounding cantonments and other war activities, and also from persons residing in a zone of five miles outside of the controlled areas. Negro children were eJQamined principally as they seemed to provide the best index, but where possible some white children were included. The data from .the survey are shown in Table IV. Spleen surveys were omitted eX:cept in one county, Burke, where officers from the U. S. Public Health Service were taken to obtain eJCperience with spleen palpation. All spleens of 141 children were negative, however, as TABLE IV PROVISIONAL SUMMARY BY COUNTIES OF 1942 FALL THICK BLOOD-FILM EXAMINATIONS OF ELEMENTARY SCHOOL CHILDREN County Blood-films Number Examined Made To Date Baker x ____________________ 1669 Bibb * ____________________ _ 345 Brooks ____________________ _ 316 CBuhraktheam---*--_-_-_-_-_-__-_-_-_-_-_-_-_-_-_-_--_ 59 300 59 300 Coffee * ___________________ _ 306 306 Colquitt * _________________ _ 331 Dougherty * _______________ _ 169 169 Glvnn * ___________________ _ 300 300 LLeibeer-t-y-*---_-_-_-_-_-_-__-_-_-_-_-_-_-_-_-_-_--_ 343 296 343 296 Lowndes * _________________ _ 289 289 Peach ______________________ 296 296 Richmond * ________________ _ 245 Sumter * ------------------- 85 Ware * ____________________ _ 250 Total ______________________ 5599 2358 x Emory University Project. Counties included In control prog.ram for War Areas. Number Positives 1 2 8 11 Malaria and Hookworm Service 223 were blood-films taken from every fourth child in the group. Entomological Service In spite of the changes In the biological staff which occurred during the year, and the necessity for training new persons, some of whom did not remain with the Division even during the balance of the year, the entomological services rendered during the year, 'as summarized in Table V, were three-quarters of the number rendered during l94L In fact, the reduction in the amount of service rendered was due more to the lack of requests for this service on the part of the counties, than to our inability to meet the demands. Special Investigation In response to requests from the proper officials, investigations were made by the division biologists of mosquito breeding in the defense areas in the vicinity of Columbus, and at the Lynn Station area in Decatur County. The engineer made a special investigation of mosquito control and filter fly breeding at Cochran Field. In response to requests from officials in county health departments, investigations and reports were made of pest mosquito breeding in Washington, Georgia; of anopheline breeding and the efficiency of larviciding measures 1at the Crisp County Impounded Reservoir; of anopheline breeding in the fish ponds of Bulloch County; of anopheline breeding in the ponds of Worth County; of malaria mosquito breeding and the efficiency of hrviciding measures in Crisp and Sumter Counties; as well as observations on malaria control in Jenkins County, and a report on .a screening project in Liberty County. Research During the first part of the year, the Director continued in his capacity as advisor to the Emory University Field Station in Baker County, but when he left the Division, this work was turned over to other agencies. During the summer, in connection with mosquito investigations associated with control operations in various counties, data were collected to supplement those collected in previous years on several long-time studies of mosquito breeding in certain key areas of the State. A new device for collecting mosquito larvre from certain types of vegetation was originated by one of the division biologists and will be described in a forthcoming publication. Studies of epidemiological, entomological and climatological data were undertaken and tentative conclusions reached. The results will not be reported until additional data have been collected. 224 Georgia Department of Public Health v TABLE ENTOMOLOGICAL FIELD SERVICE County Ponds Investigated 1 Baker ------------------------------- 6 2 Bibb ------------------------------- 36 3 Brooks ----------------------------- 1 4 Bulloch ---------------------------- 117 5 Calhoun ____________________________ 2 6 Chatham --------------------------- 21 7 Coffee ----------------------------8 Colqu~t ---------------------------- 10 9 Crisp ------------------------------ 420 10 Decatur ____________________________ 16 11 Dooly ----------------------------12 Dougherty __________________________ 15 13 Glynn ----------------------------- 6 14 Grady ------------------------------ 1 15 Houston ---------------------------- 3 16 Jenkins ----------------------------- 242 17 Lee -------------------------------- 5 18 Liberty _________ ___________________ 48 19 Muscogee --------------------------- 10 20 Pulaski ---------------------------- 5 21 Richmond __________________________ 6 22 Sumter ----------------------------- 51 23 Terrell ----------------------------- 3 24 Thomas ---------------------------- 8 25 VVorth ______________________________ 43 Total ------------------------------ 1075 Searches for Adult Anophelines 2 24 27 l 2 16 250 28 12 3 178 5 317 4 16 885 Georgia Malarial Bulletin Three issues of the Georgia Malarial Bulletin have been prepared and distributed during the year. These contained the fourth annual report of the Division; an article on malaria control in Jenkins County during 1941; a brief key ~to the identification of anopheles mosquitoes of Georgia; excerpts from an article on the macroscopic species-identification of larval 'anopheles, and the usual ~tables on malariometry. The contents of the hookworm supplements are discussed below. Malaria and Hookworm Service 225 Malaria in Georgia. in 1942 There were 76 deaths and 981 cases reported in 1942 as being due to malaria. The deaths were slightly more and the cases slightly less than those reported in 1941, but the differences are probably not significant in either case. The deaths and cases and their respective rates are listed by counties in Taible VI and their distribution shown in Figure l. The 1942 monthly rates for the State as a whole are projected against the mean monthly rates for ,the previous decennium in Figures 2 and 3. The current rates are not far .different from those of the previous year. In the previous annual report, mention was made of the significance of the downward ,trend of malaria mortality and morbidity since 1936. The data of Figure 4 indicates .that this trend has not yet been reversed. It was noted in the previous report that rainfall had been deficient for several years and, therefore, surface water acreage was probably markedly reduced and atmospheric humidity low during ,the mosquito season. During the present year, rainfall has been slightly above average for every month in the year with the exception of February, the total for the year being approximately 50 inches or 107% of the average rainfall since 1892. It is especially significant that rainfall was a.bove normal during the winter season when the ground water reservoirs are replenished, and that it remained above normal throughout the mosquito breeding season. It can not yet be said whether this excessive rainfall will have a delayed effect upon mosquito breeding in the coming year. The mean monthly tempem ture during t:he year was approximately equal to the average observations since 1892. In summary then, the results of mortality and morbidity reports and the data from the Fall Survey indicate that malaria was not significantly higher during 1942 than during the previous year, in spite of the fact that rainfall during the year was above normal. It seems very doubtful if malaria control activities in the State have been sufficiently widespread to account for this low level, and there should be no relaxation of the effort to maintain a control of ,this disease. The potential effect of large numbers of military personnel either non-immune or carrying strains of parasites new to the State has not yet ~been determined. Since malaria epidemics have occurred in Georgia three times at intervals of seven years, a cyclic hypothesis has often been suggested, on the basis of which there would have been postulated a rise in the rates for 1942 and a peak in 1943. The data so far availa!ble show no rise in the rates during 1942. ANTI-HOOKWORM ACTIVITIES Two circumstances have tended ,to reduce the amount of anti-hookworm activities that could be carried on during this year. Early in May the Medical Epidemiologist was called to active duty in the Army, and under the present conditions his place could not be filled. Soon thereafter, we were informed that it was impossible to purchase tetrachlorethylene for the treatment of hookworm and the distribution of this drug was therefore stopped during the summer months. By the time the drug again became 226 Georgia Department of Public Health 'available in the fall and plans had been made for its distribution on a limited scale, many county health departments had dropped hookworm work from their county programs. In spite of these difficulties, however, the figures reported here show that those anti-hookworm activities which can ~be reduced to a numerical form were about three-quarters of the number achieved in 1941. Moreover, hookworm treatments and certain other items far outnumbered those of the previous year. These 'accomplishments were made possible by the Field Nurse continuing her work throughout the year, and by an increase in the number of biologists to three, all of whom were engaged primarily in anti-hookworm aotivi,ties after the opening of the elementary schools in ,the fall. After an intensive educational and promotional campaign, most of the counties formerly doing hookworm work have reinstated it in their programs, and several new counties have started anti-hookworm programs. Hookworm Control Programs Under War-Time Conditions Previous reports of .this Division have mentioned a change in emphasis from a broad hookworm survey and trea,tment program to a program consisting of the selection of probable clinical cases with subsequent treatment of these cases and their families. Because of the need for conserving tires and travel time under war conditions, ,the medical epidemiologist devised a system of hookworm clinics. Entire families who have been found to be heavily infected with hookworms are brought to the county seat in school buses, and there given a physical examination and treatment for hookworm disease. Thus the need for a return ~trip on the part of the doctor to ~distribute this treatment was obviated. Later in the year, regulations regarding the use of ~tires again changed, and this program had to be abandoned. At the end of .the year, an attempt was being made in cooperation with the staffs of the regional headquarters to more thoroughly integrate hookworm control work into the bal,ance of the health program of the county departments. Members of the divisional staff assisted in the organization of selected school surveys in a number of counties, especially where inexperienced nurses have been stationed in newly organized health departments. The school children were examined for the signs of anemia in order to pick suspected hookworm cases, specimens were collected from these children, and if .the resulting egg count proved high, the county nurse was advised to visit the family for the purpose of examining other members. The divisional staff assisted in making some of these visits and frequently made visits with the nurse for purposes of consultation. Subsequent treatment of the families needing such attention was arranged through the cooperation of local physicians. Partially as a result of an eXJperimental approach to the problem of anemia on the part of the divisional staff, a number of counties began the distribution of iron compounds for the improvement of the health of the school children. A number of the families having a high degree of hookworm infection Malaria and Hookworm Service 227 were supplied with sanitation as a part of a research program to be described below. The anti-hookworm aotivi.ties of the staff .of the Division are recorded according to counties in Tables VII and VIII. On account of the loss of clerical staff, it has not been possible to bring the figures on hookworm egg count up to date, hut they will be published in an early number of the Georg~a Malaria Bulletin. The laboratory reports show that 2,469 egg counts were made, i.e., 72% of the number done in 1941, which is considered a very satisfactory accomplishment in view of the difficulties already mentioned. Calculations based on the usual rate of infection indicate that of the 11,142 index S'pecimens submitted, about 7,000 were submi,tted .for egg count. It is clear that the promotional work of the last two years is beginning to show fruit in a reduction in the number of specimens submitted solely for flotation examination, with a corresponding increase in the proportion of examinations submi,tted for egg count. Research Throughout the work of the year, there has been a constant attempt to evaluate scientifically the program described above, namely, the location of suspected hookworm cases and treatment on a family basis. Data are also being collected for eventual analysis to determine more exactly the correlation between symptoms and hookworm egg counts. In a number of .::ounties programs to determine the effects of treatment with preparations containing iron have been started. Egg counts and hemoglobin determinations were made before the treatment began, and will be repea.ted at intervals of three or four months during the 'period of treatment. In most oases an initial anthelmintic treatment was given as well, but in one county the scarcity of physicians has made the use o anthelmintic drugs impossible, and :an attempt is therefore being made to determine how effective treatment wi,th iron compounds alone will ibe. The experiments which have been carried out during previous years to determine the effect of cold weather on the hookworm infestation of the soil were continued in the winter of 1941 and 1942, and are being continued in the present year. The results indicate the soundness of the previous conclusions, namely that little or no hookworm infection occurs during three or four months of the winter season, even in the most southern part of Georgia. Based on these studies, we are continuing to recommend to health departments that they do all of the treatment possible during this season, so that entire families can be brought to a low level of infection at a time when they will not be liable to immediate reinfection. The attempt to devise a means of sanitation for hookworm infected families, who usually live at the lowest economic level and cannot afford a standard privy, has been continued. Early in the summer, the sanitarian was transferred to another 'public health agency where his work would be n:ore closely connected to the .defense program, but at ~the end of the mosquito breeding season it was possiJble to assign a biologist to this 228 Georgia Department of Public Health program for ,the winter season. Observations will have to continue over a period of years before conclusions can be drawn, but the preliminary results are very encouraging from all points of view. Observations have been continued during the year on various phases of the epidemiology of hookworm diseases. As a result, we feel very confident in saying that our information at the present time indicates that most hookworm infection is acquired in the close proximity of the houses. It is possible that some infection arises in the neighborhood of schools where sanitation is often poor. But since hookworm infection generally occurs in its severest form in specific families where sanitary conditions are poor, the home environment seems to be 'the primary factor at fault. It is still impossible to determine exactly when and where the person acquires his infection, facts which it is desimble to know if a rational program of control is to be instituted. Our information on these points is increasing. One of the biologists recently attached ,to our staff has already originated a new device for isolating hookworm larvre from the soil. Although this will not replace the well known Baermann isolation apparatus for routine work, it has made possible a solution of certain specific problems of epidemiology. A cooperative program for a study of immunity in hookworm diseases has been carried out during the year. The program was supported by the International Health Division of the Rockefeller Foundation, and sponsored by the Division of Malaria and Hookworm Service of the Georgia Department of Public Health. The work was under ,the direction of Dr. Gilbert F. Otto, of the School of Hygiene and Public Health, John Hopkins University. He was assisted by Dr. Sterling Brackett, of the School of Public Health, University of North Carolina, and a technician. A laboratory was established in the offices of the Regional Director at Waycross. Assisted by staff members of ,the Division of Malaria and Hookworm Service and by the director and staff of the Branch Laboratory at Waycross, extensive studies were made in the southeastern part of the State. Dr. Otto also made a preliminary visit in January, and will need to make additional return visit of short duration before conclusions can be drawn from the data which he collected. Hookworm Supplements to the Georgta Malara Bulletin Each issue of the Georgia Malaria Bulletin during the year carried a hookworm supplement. The script of two radio broadcas,ts on hookworm disease were published in these supplements, while the third issue carried notices with regard to the changes in the recommended hookworm control program and an article on a war-time anti-hookworm program. EDUCATIONAL ACTIVITIES The educational activities of the Division have been reduced during the year covered by this report. Several causes contri!buted to this reduction. The loss of engineering personnel on the part of the county health depart- Malaria and Hookworm Service 229 ments, the reducton of WPA assistance, and the scarcity of materials and labor have made it impossible to organize effective progvams to follow the educational effor,ts. Moreover, the interest of the public has been centered on projects related to civilian defense. There has also been an effort to reduce ~the use of transportation facilities which has contributed to this reduction of educational activities. In addition to 'addresses given to various district medical and public health groups in ,the State, a number of formal lectures were delivered. The Director twice gave a lecture on malaria investigation and control to the U. S. Public Health Service trainees. He lectured to a conference of the 'public health workers of Alabama on hookworm disease control in Georgia. As Acting Director of the Division of Public Health Education, he addressed the Medical Association of Georgia on Public Health Education for laymen. The Acting Director of this Division addressed the public health classes of nurses at Grady Hospi~al on malaria and hookworm control. The Associate Director also addressed these classes, as well as several classes of trainee nurses in rthe Georgia Department of Public Health on our malaria and hookworm control progvams. He also addressed various groups under the agencies of the American Association of University Women, the P. T. A., District Medical Associations and their various auxiliaries, and the Georgia Teachers College, and lectured to the Alabama Association of Medical Technicians on hookworm egg counting. The following ten articles were published in scientific journals during the year by members of the divisional staff: l. Studies on the Concentration and Distribution of Paris-Green-Lime Mixtures Applied as Anopheline Larvicides.-R. S. Howard and Justin Andrews. Amer. Jour. Trop. Med. 22:283-293. 2. Observations on the Macroscopic Species-Identification of Larval Anopheles in Georgia.-R. E. Bellamy. Jour. Parasit., 28:299-310. 3. New Methods of Hookworm Disease Investigation and Control.Justin Andrews. Amer. Jour. Pub. Health, 32:282-288. 4. The Design and Application of a New Type Automatic Siphon.W. A. Legwen, and R. S. Howard, Jr. Jour. Nat. Malaria Soc. 1:83-92. 5. Relation of Hookworm Burden to Physical Status in Georgia.Ar,thur W. Hill and Justin Andrews. Amer. Jour. Trop. Med., 22 :499-506. 6. The Transmission of Endamoeba Histolytica and Amebic Disease.Justin Andrews. Sou. Med. Jour. 35:693-699. 7. The Natural Pattern of Dilution Counts of Helminth Eggs.-J. Allen Scott. Amer. Jour. Trop. Med. 22:647-654. 8. Malaria Control, Ditch-Lining Experience in a South Georgia County.-Justin Andrews, R. S. Howard, Jr., and E. Archer Turner. Jour. Nat. Malaria Soc. 1:57-67. 9. Hookworm Disease Control Methods in Georgia.-Justin Andrews. Jour. Med. Assoc. Ala., April, 1942. 10. Modern Views on the Treatment and Prevention of Hookworm Disease.-Justin Andrews. Annals Int. Med., 17:891-901. 230 Georgia Department of Public Health TABLE VI REPORTED MALARIA DEATHS AND CASES AND APPARENT RATES PER 100,000 PoPULATION IN GEORGIA FOR 1942 County Mortality Deaths Rates 1 Appling ____________________________ 2 .Atkinson --------------------------- 14.1 Baker ------------------------------ 3 40.8 4 Baldwin ---------------------------- 5 Barrow Bartow ----------------------------Ben Hill ___________________________ Bibb ------------------------------(Camp Wheeler) -------------------Bleckley ___________ ----------------10 Brooks ----------------------------- 2 11 Bryan -----------------------------12 Bulloch ----------------------------- 1 13 Burke ------------------------------ 4 14 Butts -----------------------------15 Calhoun ---------------------------- 16 Candler 17 Carroll ----------------------------- (Fort Oglethorpe) __________________ _ 18 Charlton --------------------------19 Chatham --------------------------- (Hunter Field) --------------------20 Chattahoochee _____________________ _ (Fort Benning) --------------------- 21 Clay ------------------------------22 Cobb ------------------------------23 Coffee -----------------------------24 Colquitt ---------------------------- 3 25 Columbia --------------------------- 6.9 9.8 15.9 3.8 15.1 10.9 14.2 9.1 26 Cook ------------------------------27 Coweta ----------------------------28 Crawford --------------------------29 Crisp -------------------------------- 4 30 Decatur ---------------------------- 3 31 DeKalb ----------------------------(Lawson General Hospital) __________ _ 32 Dodge -----------------------------33 Dooly -----------------------------34 Dougherty -------------------------- (Turner Field) ---------------------35 Early ------------------------------ 2 36 Echols ----------------------------37 Effingham -------------------------38 Emanuel --------------------------39 Evans -----------------------------40 Fannin ----------------------------- 14.0 22.8 13.5 3.5 10.7 33.7 4.3 Morbidity Cases Rates 17 117.3 1 14.1 11 149.8 3 18.3 7.7 7.9 2 13.8 9 10.7 21 2 20.7 64 312.2 13 206.7 16 61.5 47 177.2 1 10.9 7 67.1 54.9 2.9 10 8 152.2 14 11.9 83 14.2 13 34.0 9 41.8 10 30.3 3 31.8 13 109.1 3.7 14.0 6 34.2 13 58.5 8.1 42.8 11.8 30 105.0 1 6 32.1 33.7 51.8 25.5 2 27.0 6.8 Malaria and Hookworm Service 231 TABLE VI (Continued) REPORTED MALARIA DEATHS AND CASES AND APPARENT RATES PER 100,000 POPULATION IN GEORGIA FOR 1942 County Mortality Deaths Rates 41 Fayette ----------------------------- 42 Floyd ------------------------------ 1.8 43 Forsyth ---------------------------- 44 Fulton ------------------------------ 3 0.8 45 Glascock ---------------------------- 46 Gordon ----------------------------- 47 Grady ------------------------------ 5.1 18 Greene ----------------------------- 49 Gwinnett --------------------------- 50 Hancock ---------------------------- 15.7 51 Heard ------------------------------ 52 H'Juston ---------------------------- 53 Jackson ----------------------------- 54 Jefferson --------------------------- 5.0 55 Jenkins ----------------------------- 8.4 56 Johnson ---------------------------- 7. 7 51 Laurens ---------------------------- 6 17.9 58 Lee -------------------------------- 59 Liberty ----------------------------- 60 Long ------------------------------- 61 Lowndes ---------------------------- 3.1 62 Macon ----------------------------- 6.3 63 McDuffie --------------------------- 64 Meriwether ------------------------65 Mitchell ___________________________ _ 66 Monroe ----------------------------- 9.3 67 Muscoge.e -------------------------- 6S Peach ----------------------------- 9.6 59 Pierce ----------------------------- 1 8.5 70 Pike ------------------------------- 71 Polk 72 Pulaski ----------------------------- 10.2 73 Randolph --------------------------- 74 Richmond -------------------------- 1 1.2 (Camp Gordon) --------------------- 75 Screven ----------------------------- 3 14.7 76 Seminole --------------------------- 2 23.6 77 Stephens --------------------------- 78 Stewart ---------------------------- 9.4 79 Sumter ----------------------------- SO Tattnall ---------------------------- Morbidity Cases Rates 12.2 2 3.6 2 17.7 46 11.7 22.0 4 21.7 5.1 2 14.6 3 10.3 2 15.7 4 46.5 4 35.4 12 59.7 14 69.9 28 236.4 2 15.4 18 53.6 21 268.0 2 23.3 2 48.9 54 169.5 4 23.1 1 9.2 5 22.7 1 4.3 1 9.3 3 4.0 4 38.5 8.5 9.6 24.6 9 91.6 4 24.1 10 12.2 1 22 108.1 84 989.2 2 15.4 66.0 11 44.9 2 12.3 232 Georgia Department of Public Health TABLE VI (Continued) REPORTED MALARIA DEATHS AND CASES AND APPARENT RATES PER 100,000 POPULATION IN GEORGIA FOR 1942 County Mortality Deaths Rates Morbidity Cases Rates 81 Telfair 6.6 19.8 82 Terrell 12.0 18.0 83 Thomas ---------------------------- 3.2 9 28.8 84 Tift -------------------------------- 1 5.4 3 16.1 85 Toombs __,___________________________ 3 17.7 41.3 i16 Troup -----------------------------81' Twiggs ----------------------------88 Upson -----------------------------89 Walker ----------------------------90 Ware ------------------------------ 11.4 11.0 3 32.9 1 4.0 2 6.4 7.2 91 Warren ----------------------------92 Washington ------------------------- 4 93 Wayne ----------------------------94 Webster ---------------------------95 Wheeler ---------------------------- 4 39.1 16.5 11 45.4 1 7.6 21.2 11 232.8 23.4 96 Wilcox ----------------------------97 Wilkes _---------------------------98 Worth ------------------------------ 7.8 22 172.5 1 6.6 4.1 NOTE: Army camps and Army Forts are exclusive of county totals and follow the counties in which located. Malaria and Hookworm Service 233 .-------- JIMI 2 1 REPO!irl!:D V.ALA.'IUA MORTALITY IN G!Dl!GU lOR 1942 :BY 140NTI!S AVl!:RAGE MO~lTHLY DEATH :UTE PER 100,000 PoPULATION, 1932-1941 ( CalCillated on basis of 194o census) il i 2. 0 ,... -------------------------------............................................................. ................................... 2. 0 1.56 . 1.14~'1 1.0 ......................_ .............- .......................- ................T~:..~~ ..t--------~---------.................. ~ ............... 1.0 0.5 ...................- ~I o.61 ................................................... ~-------~~-------- .-1?41 1 - ,0.21 i I I .-2.&!-~ 11 I I I I 0.15 1! '"O.i3" ...................-J-6;~-- o.5 0.1 0.05. ;t' ~ o.o1!_, ...:~:_~ ___] ~"-'-~=-\-fiP-\.~~ t ... k 1 i -i ~ ~ : r i _ _:~.:_ _ _~G) _ _.';~1,_ _ ~" _<_ _._, _ _o~~ _ _: _~_ ~" _R _ 0.01 234 Georgia Department of Public Health FIGURE 3 -19- UPORTJlli MALARIA MORBIDITY Ill GEORGIA FOR 1942 l!Y MONTHS 50.0 i~~~~~~~~r:~~-~~:::i;1.......................H................ _.......... 50.0 (Calculated on basis of 194o census) MONT!iLY CASE RATE- 1942 2~.6 24.8 ~--l I ~16 0 to.o --------------- -------;---1-1-.F5 ----------------------------- ------- 10.0 8,2 . . . . . . . ~.:=~ :.:.~~ 6..!l_j ----f.......... __.......... 5 0 ......................................... 5. 47 6, ws- 4 2 4.1 1.0 ......... ~ 0.29 I O.lllI t" ~ ~ "" -.5.. :.1 .... ".".. ~ ::~.:- ~" ... ..... ~ ...,. j .~..".p,,,. "' ... Q) ~..., 0" ... ... .gQ) Q) .g .".. uQ) ~ Q) 101 0,1 Malaria and Hookworm Service 235 ~EATH-A.'tlD IJj AliNUAL MALARIA CASE-BATES REPORTED IN GEORGIA! 1926 - 194;:!, inc. 4oo Deat!,l Rates per 100,000 - - : ~ ; ' pop1~ation. 11 ' ' 1 Case Rates per 100,000 'I 30 ~ation. !, I ,_ ; : ... 300 ' I! I . I i \' I 20 --+ ......~.. ! ... 200 j . ---+I . j +- t-- ...l............ -J. ~-M0-~000-00o! ! I I .{............ti......... .........~. ~ 5 I ~ ,.i . I ~+ ...L.... .J. .. p., S 100 ,JL::::il . . . . ..L 1 i-~-- 80 8... ~ ;\j---+ 60 ~ 30 Jl'igure '4 236 Georgia Department of Public Health -17- STATE OF' GEORGIA, BOARD OF HEALTH DEPARTMENT OF PJBLIC HEAIJH Reported MALARIA DEATH l!ATES l!Y COUNTI:CS GEORGIA 1942 10.25 25-50 FIGURE I County Physical Exams. 1 Brantley ------------------ 72 2 Burke ------- ------------------ 3 Charlton ----------------------- 484 6 Coffee ----- ------------------- 11 7 Colquitt -----------------------8 Echols _________________________ 9 Jeff Davis ---------------------10 Liberty ---- ---------- -------11 Long ___________________________ 41 12 Lowndes ------------------ ---13 Pierce -- ----------------------14 Tattnall ------------------------ 73 15 Telfair ----------- ------------- 6 16 Turner ------------------------17 \Vare ----- -------------------18 Wayne ------------------------- 23 Total ---------- ------ -- - ---- 720 TABLE VII EPIDEMIOLOGICAL AND NuRsiNG SERVICE Hemoglobin 155 Hookworm Treatment 389 Home Vi sots 399 Epid. Misc. 878 303 511 39 72 !".150 350 20 20 20 16 -- 70 104 6 37 152 32 54 43 52 151 5 724 101 6o 6 19 41 270 2') 1035 3 1 1 6 27 10 103 1:ll 428 665 2204 8:i1 :1709 Malaria Smears 30 59 353 231 289 -- 1 232 1195 Spleen Palp. -- 141 3 -- 144 Blood Count ;. ---- ---- -- -- -- 1 --- 6 Soil Samp. 39 -- ~ !.;.:>... !.;.:.>, ~ !;:> ;:: !;:>,. ::t:: 0 0 ;"::": ' .0.., ;:; \J) .(.I.>, ~ ~ 120 (I> l:i9 1:-,j <:.J.') ""-I 238 Georgia Department of Public Health TABLE VIII County SANITATION SERVICE Sanitary Surveys Atkinson -------------------------------------- 12 Brantley -------------------------------------- 44 8 Bryan ---------------------------------------- 30 4 Camden --------------------------------------5 Charlton -------------------------------------6 Coffee ----------------------------------------7 Echols ---------------------------------------- 3 8 Glynn ----------------------------------------- 5 9 Laurens --------------------------------------- 78 10 Liberty --------------------------------------- 35 11 Pierce ---------------------------------------- 31 12 Tift ------------------------------------------- 32 13 Turner ---------------------------------------- 6 14 Ware ----------------------------------------- 63 15 Wayne ---------------------------------------- Total ----------------------------------------- 346 Sanitary Units 9 2 1 9 22 Mapping Activities 19 5 2 3 36 Malaria arul Hookworm Service TABLE EDUCATIONAL AND PROMOTIONAL ACTIVITIES DuRING THE YEAR 1942 County Meetings Attended 1 Appling_____________________________ 2 A tklnson___________________________ _ Bacon~----------------------------- 4 Baker-----------------------------Baldwin ___________________________ _ Bibb _______________________________, Bleckley___________________________ _ Brantley---------------------------Rrooks _______ ~---------- ----------- 10 Bryan _____________________________ _ 11 Bulloch _____________________________ 12 Burke ___ --------------------------13 Calhoun ___________________________ _ 14 Camden ____________________________ _ 15 Candler---------------------- ______ _ 16 Charlton___________________________ _ 17 Chatham ___________________________ _ 18 Chattahoochee ______________________ _ 19 Clarks _____________________________ _ 20 Clay--~----------------------------- 21 Clinch _____________________________ _ 22 Coffee_____________________________ _ 23 Colqu!tt_ ___________________________ _ 24 Crisp ------------------------------25 Decatur_ __________________________ - 26 DeKalb ____________________________ _ 27 Dooly------------------------------28 Dougherty--------------------------29 Echols _____________________________ _ 30 EmanueL ___ ------------------------ 31 Evans-----------------------------32 Fulton _____________________________ _ 3:3 Glynn ___ --------------------------- 34 Grady-----------------------------35 Houston____________________________ _ 36 Irwin ______________________________ _ 37 Jeff Davis_ ________________________ _ 38 Jefferson_____________________________ 39 Jenkins ____________________________ _ 40 Lanier----------------------------- Addresses Made 1 3 2 2 2 20 Exhibits Shown 3 2 239 Consultations, Conferences, Contacts, Etc. 10 12 l7 142 152 4 38 66 41 7 4 40 10 57 8 42 30 3 104 21 1 3 3 3 1 28 1 240 Georgia Department of Pubiic Health TABLE I (Continued) EDUCATIONAL AND PROMOTIONAL AcTIVITIEs DURING THE YEAR 1942 County Meetings Attended Addreoses Made 41 Laurens---------------------------- 42 Lee ________________________________ _ 43 Liberty __ ---------------------------- 44 Long_______________________________ 3 45 Lowndes____________________________ 46 MitchelL ______ ------~-------------- 47 Montgomery------------------------48 Muscogee --------------------------49 Peach ___________ ------------------50 Pierce_____________________________ _ 51 PulaskL ___________ ----------------- 52 Richmond____ ---------------------- 4 53 Schley__________ ------------------- 54 Seminole____________________________ 55 Sp aiding ____________________________ _ 56 Stewart_ ___________________________ _ 57 Sumter_----------------------------- f>8 TattnalL___________________________ _ 11 59 Taylor________ -------------------- 60 Telfair------------------------------ 61 TerrelL _________ -------------------62 Thomas ____________________________ _ 63 Tift_ _____ -------------------------- 64 Toombs ____________________________ _ 65 TurnHr _______ ----------------------- 66 Twiggg _____________________________ _ 67 Walker_---------------------------- 68 Ware ______ ------------------------- 69 Wayne _____ ------------------------ 3 70 Wheeler_ _________ ------------------ 71 Wilkes ______________________________ 72 Wilkinson ___________________________ 13 Worth______________________________ Out of State____________________________ 8 TotaL__________________________________ 31 Exhibits Shown 2 5 4 25 Consultations, Conferences, Contacts, Etc. 21 1 136 43 21 3 18 1,.., 29 41 4 4 8 302 104 1 Malaria and Hookworm Service 241 TABLE II SuMMARY BY CouNTIEs oF THE 1941 FALL SPLEEN SuRvEY OF WHITE ELEMENTARY ScHOOL CHILDREN No. Ex'd Baker-------- _____________________ 404 Bulloch -------------------------- 168 Burke____________ -------- _________ 703 Camden__________________________ - 370 Calhoun___________________________ 401 Crisp ---------------------------- 154 Jenkins ___ --------- ________________ 559 Laurens ------ -------------------- 942 Lee______________ ------ ___________ 233 Liberty---------------------------_ 221 Mcln tosh __________________________ 264 Terrell --------------------------- 296 TotaL_____________________________ 47Ei No. % Enlarged Enlarged % of All Enlarged P.O. I. I. 2. 97 24 93 0 18 11 89 11 56 8 80 18 2 20 100 0 0 62 15 79 21 30 20 60 33 7 45 8 87 13 0 93 10 77 22 21 9 100 0 21 10 57 43 0 3 75 12 12 35 12 83 14 3 506 11 83 16 Division of Tuberculosis Control Nineteen-forty-two has proved to be another banner year in reduction of tuberculosis mortality for the State. There were 1,265 deaths against 1,385 in the year 1941, and the new death rate per 100,000 population is down to 40.5, which is a decrease of nearly 8% for the year and of 45.1% since 1930, and of 16.1% in the past two years. Increased interest by the many public health offices, practicing physicians, and the public in case finding and treatment is no doubt a contributing factor. The doubled bed capacity of the State Tuberculosis Sanatorium and the increased load carried by the participating physicians in the State Health Department's artificial pneumothorax refill program surely have much to do with it. Three thousand sixty-seven new cases were reported in the year 1942. This is an increase of 432 over the previous year. It may be due to an increase in incidence of tuberculosis, but is rather believed to be due to increased case finding efforts such as that in Fulton and other counties. The discovery of more cases and prompt treatment and effort to prevent spread of infection should result in lowered death rate and infection incidence. The following tables show death and case incidence: DEATHS AND DEATH RATES White Colored Total Rate per I00,000 Population No. 1930 ----------------- 774 1931 ----------------- 700 1932 ----------------- 665 1933 1934 1935 1936 ----------------- 675 ----------------- 605 ----------------- 649 ----------------- 648 1937 ----------------- 559 1938 ----------------- 602 1939 ----------------- 543 1940 ----------------- 544 1941 ----------------- 501 1942 ----------------- 465 % No. 36 1401 32 1465 35 1268 38 1102 34 1167 37 1082 38 1065 36 990 37 1010 35 990 35 989 35 884 35 800 % W&C White Colored W &C 64 2175 42.0 130.6 74.6 68 2165 37.7 135.8 73.7 65 1933 35.4 116.9 65.3 62 1777 35.6 101.1 59.6 66 1772 31.7 106.5 58.9 63 1731 33.6 98.2 57.1 62 1713 33.3 96.2 56.1 64 1549 28.5 89.0 50.3 63 1612 30.3 90.3 52.0 65 1533 27.2 88.1 49.1 65 1a33 26.7 91.2 49.1 65 1385 24.3 81.3 44.0 65 1265 22.8 73.7 40.5 CASES OF TUBERCULOSIS REPORTED IN THE STATE Number of Cases Year Reported 1934 ------------------------ 3647 1935 ------------------------ 3588 1936 ------------------------ 3317 1937 ------------------------ 3016 1938 3011 1939 ------------------------ 2996 1940 ------------------ ----- 2800 1941 ------------------------ 2635 1942 ------------------------ 3067 Rate Per 100,000 Population 121.3 118.4 108.6 98.0 97.1 95.9 89.6 83.8 98.2 Tuberculosis Control 243 An unprecedented amount of x-ray clinic work was done in 1942, as is shown by the following table: TABLE I NuMBER OF REGULAR CLINICS AND CLINIC DAYS IN 1942 Month Number Clinics Number of Days Number X-rayed January -------------------------------------- 23 20 1,211 February ------------------------------------- 26 20 1,521 March ---------------------------------------- 22 22 999 April ----------------------------------------- 19 22 1,447 May ------------------------------------------ 21 21 1,008 June ----------------------------------------- 23 22 1,178 July ------------------------------------------ 18 18 681 August --------------------------------------- 15 16 1,092 September ------------------------------------ 21 22 1,254 October --------------------------------------- 12 12 548 December ------------------------------------- 16 16 678 216 211 11,617 NOTE: No regular clinics were held in November. Special surve,ys were made with the 35 mm. x-ray machine. TABLE II DISTRIBUTION OF CLINICS In 56 counties in 109 clinics organized by health officers___________________ In 59 counties in 99 clinics organized by county health nurses______________ Jackson Lake School-Newton County________________________________________ Emory University-DeKalb County ------------------------------------------Toccoa Falls Institute-Stephens County------------------------------------Georgia State College-Chatham County_______________________________________ Habersham and Piedmont College-Habersham County-------------------------- 6848 4111 65 393 72 68 60 Total regular x-rays made in regular clinics__________________________________ Regular x-rays in office of patients referred by physicians_____________________ Regular x-rays in incomplete follow-up study of 35 mm. fluoro-photographlc surveys ----------------------------------------------------------------- 11617 520 263 35 mm. fluoro-photographic surveys in 28 industrial plants promoted by the Division of Industrial Hygiene, representing 48 additional clinic days______ 12400 12861 Grand T,otal of X-ray Pictures Made in 1942--------------------------- 25261 This work resulted in the finding ,of 553 new cases. Or, including the 54 cases located through the consultation films, in the finding of a total of 607 cases, shown as follows: Number of x-rays in regular clinics___________ ll617~Cases found 443 Number of x-rays in 35 mm. survey follow-up (not completed) _____________________ _ 263-Cases found 17 Number of x-rays made in office_____________ _ 520--Cases found 93 Total _______________________________ 12400 553 Number of consultation x-rays interpreted for physicians requesting it_________________ 652-Cases found 54 244 Gem gia Department of Public Health Miniature Fluoro-photographic X-ray In September, 1942, survey work in industrial plants was begun as a part of the program promoted by the Division of Industrial Hygiene and, as shown in Table II, above, 12,861 35mm. chest x-ray films were made. Unfortunately, we have been delayed for many reasons in completing the follow-up by conventional x-ray of 1,873 persons with suspicious and unsatisfactory pictures. It is being completed, however, and the figures will be available at any early date. The purpose of this phase of case finding is to carry a comparatively cheap x-ray service to large groups such as industrial plants, colleges, and high schools. The film cost is only about 1/20 of that of regular x-ray films. It is also very rapid and an average of 400 to 500 pictures per day is possible. Shortage and disturbance of personnel, professional and clerical, a natural and unavoidable result of our participation in the present World War, is responsible for our difficulties. It is hoped that the work can be kept up, as it should prove very valuable, espec~ally in the indus.trial field. Artificial Pneumothorax Program Five hundred fifty-nine patients, an increase of 170 over the previous year, were under treatment at the end of the year, a total of 646 having been treated in 1942. Of these, 14 or a little over 2% have died, which is considered remarkable because a large number were not conceded to have much chance of being benefited when the pneumothorax was commenced. Only 59 physicians were participating in this program at the end of the year. Thirteen entered military service and five retired from service for various reasons. The average cost per month per patient was only $2.89, which was much helow the anticipated figures of $5.00 per month. Details o.f this service are shown in Tables XI and XII. Placement of Fluoroscopic-Radiographic. Machines in County Health Offices During the latter part of the year, 30 fluoroscopic x-ray machines with which chest and other x-ray pictures may be made were purchased by the State Health Department and placed in as many county health offices. These are being used to further tuberculosis case finding and are eXJpected to be used for many other purposes, such as in prenatal and venereal disease clinics, and bone work in nutritional deficiency investigations. Lack of medical personnel in the Division occasioned by the need at the State Tuberculosis Sanatorium for practically full-time service of one of our physicians and part time of another one has unfortunate!y prevented the development of this x-ray service as was planned. However, it is believed possible to make better headway with this program in the coming year. Tuberculosis Control 245 Follow-up of Rejected Selectees Reports of selectees rejected because of tuberculosis are received by this Division and the opportunity is offered each rejectee (indeed it is urged) for x-ray and other necessary follow-up diagnostic study and treatment. County Public Health Services A study of Table IX reveals some falling off of many services. This is to he expected because of restricted automobile travel. Office visits by patients, admission to sanatoria, relief secured, contacts broken and tuberculin testing have increased or closely approached the 1941 level. The service performed by local public heal,th workers in close cooperation with the medical profession has certainly played an exceedingly important part in case-finding, treatment and disease prevention, and in securing the relief so necessary in most cases. Much, if not most, of the credit for the lowered death rate is due to their intelligent and untiring effort. Appended are other tables showing det,ail and results of tuberculosis services of this Division and by local public health physicians and nurses. Georgia Tuberculosis Association As usual, the Georgia Tuberculosis Association has been most cooperative in securing x-ray examination of persons who cannot secure this service without finandal assistance. This service is especially useful in counties not having local public health services and are not visited by State x-ray clinics, and in other counties between state clinics when the need for x-ray is pressing. Another of its services is in arranging for assistances to needy cases and their families and for the rehabilitation and vocational training and job placement of patients needing such services. Mr. J. P. Faulkner, the Executive Secretary of the Association, has always responded to our many requests for such service and his cheerful response is deeply appreciated, not only by the State Health Department, but by the many recipients of his favors. He may be assured there will be an ever increasing need for these services and it is hoped he may always be able to meet the demand. In spite of the decreased mortality rate, attention must be called to the still very great need for many more ins,titutional beds; actually more than a thousand additional beds should be provided, either in branch state sanatoria, or by ,the larger cities. It is absolutely impossible with the present facilities to isolate the many, many hundreds of communicable cases who should be domiciled. 246 Geor.gia Department of Public Health This report would not be complete without a word of thanks to our very efficient Division co-workers: Dr. John F. Busch, Associate Clinician Dr. Clara B. Barrett, Associate Clinician Mr. T. S. Tinsley, X-ray Technician Mr. D. B. Lewellen, Xray Technician Mr. Wm. Bailey Harrison, X.ray Technician Miss Marie Price, Secretary Mrs. Eleanor A. Almand, Secretary Mrs. Inez Riley, Darkroom Technician arul Typist Miss D. C. Livsey, X-ray Technician arul Clerk Mrs. Cebe Smith, Typist and File Clerk These have made possible the immense and varied service of this Division. TABLE Ill Sul\tMARY OF CAsEs FouND 1942 White Colored White and Colored Combined Number Cases Number Cases Number Cases Xrayed Found % Xrayed Found o/o Xrayed Found o/o Adult Type Original Exams ___________________________ 3185 175 5.5 1915 138 7.2 5100 313 6.1 Adult Type Re-exams ----------------------- ------- 2383 41 1.7 799 28 3.5 3182 69 2.2 ""'3 >::: 0""' Total ----------------------------------------------- 5568 216 3.9 2714 166 6.1 8282 382 4.6 ".0..'. First Infection-Infiltrative Type-Original Exams______ 1202 18 1.5 765 22 2.9 1967 40 2.0 >..:.:.:... 0 First Infection-Infiltrative Type--Re-examinations--- 867 15 1.7 420 6 1.4 1287 21 1.6 ~"'- C') Total ____ ------------------------------------------- 2069 33 Grand TotaL_________________________________________ 7637 249 1.6 3.3 1185 3899 28 2.4 194 5.0 3254 11536 61 443 1.9 3.8 -.0.;..:..:.!. 0 81 examinations were unclassified because of poor films and lack of proper information. ~ 248 Georgia Department of Public Health TABLE IV RESULTS OF ORIGINAL ExAMINATIONs, ALL AGES BY SEx AND COLOR SHOWING NUMBERS AND PERCENTAGES Male White Number o/o Childhood Minimal 15 :lfod. Adv. ----- 33 Far. Adv. ______ 32 Total Pos. ---- 88 Suspicious ----- 345 Negative ------- 1774 .36 .68 1.50 1.45 3.99 5.63 80.38 Total ---------- 2207 100.00 Colored Childhood 14 1\linlmal ------- 4 1\lod. Adv. 21 Far Adv. 54 Total Pos. 93 Suspicious 157 Negative ------- 861 1.26 .36 1.98 4.87 8.37 14.13 77.50 Total --------- 1111 100.00 Female Number o/o 10 18 49 28 105 326 1749 .46 .83 2.25 1.28 4.82 14.95 80.23 2180 100.00 Male and Female Combined Number o/o 18 33 82 60 193 671 3523 .41 .75 1.87 1.37 4.40 15.30 80.30 4387 100.00 9 12 38 67 210 1292 1569 .51 .57 .77 2.42 4.27 13.38 82.35 100.00 22 13 33 92 160 367 2153 2680 .82 .49 1.23 3.43 5.97 13.70 80.33 100.00 TABLE V CLASSIFICATION oF THE CAsEs FoUND BY ORIGINAL ExAMINATIONS AccoRDING To STAGE IN AGE GROUPS, MALE AND FEMALE COMBINED, SHOWING NUMBERS AND PERCENTAGES White Age Groups Up to 17 No. % 17-45 No. % 46 Up No. '.it- Minimal ------------------------------------ 2 Mod. Adv. ----------------------------------- 1 l'ar Adv. ----------------------------------- 1 Total ______________ -- _______________ ------ -- 4 1.14 25 .57 56 .57 46 2.28 127 14.29 6 32.00 25 26.28 13 72.57 44 3.43 14.29 7.43 2G.l5 Colored Minimal ------------------------ _____ ------- 1 Mod. Adv. __________________________________ 1 Far Adv. ____________ ----------------------- 7 Total -------- ------------------------------- 9 .72 10 .72 23 5.08 67 6.52 100 7.25 2 16.67 9 48.5;) 18 72.47 29 1.45 6.52 13.04 21.01 All Cases No. (Yo 33 18.8~ '""'l ~ 82 60 46.86 0" 34.28 ~ .... ~ 175 100.00 .c~..... ;";'; ("') 13 33 9.42 23.91 c ..~....... ;2... 92 66.67 138 100.00 1:-.J ~ ~ 0 TABLE VI NuMBER AND PERCENTAGE oF CAsEs FoUND BY FIRsT ExAMINATIONs IN RELATION To NuMBER X-RAYED, MALE AND FEMALE CoMBINED, CLAssiFIED AccoRDING To STAGE AND AGE GROUP White Age Groups Number X-rayed Up to 17-------------------------------- 1205 17-45 ------------------------------------ 2515 46 Up ----------------------------------- 667 Total ------------------------------------ 4387 Colored Up to 17--------------------------------- 774 17-45 ------------------------------------ 1565 46 Up ------------------------------------ 341 Total ------------------------------------ 2680 Minimal No. % 2 .17 25 .99 6 .90 33 .75 1 .13 10 .64 2 .59 13 .49 Cases Found Mod. Adv. No. % 1 .08 56 2.23 25 3.75 82 1.86 1 .13 23 1.47 9 2.64 33 1.23 Far Adv. No. % 1 .08 46 1.83 13 1.95 60 1.38 7 .90 67 4.28 18 5.27 92 3.43 ~ All Cases <11 0 No. % ~..... 4 .33 ~ 127 5.05 1::::1 <11 44 175 ... 6.60 ~.... 3.99 ~ ...;<::1s1 9 1.16 ~ 100 29 6.39 8.50 ~ o!.;..:-.. 138 5.15 ~ ::X:: <11 s~ : TABLE VII 1942 NuMBER AND PERCENTAGE oF CAsEs FouND BY RE-EXAMINATIONS IN RELATION TO THE NuMBER X-RAYED, MALE AND FEMALE CoMBINED, CLASSIFIED AccoRDING TO STAGE AND AGE GROUP --- Cases Found White Age Group Number X-rayed Up to 17------------------------------------- 867 17-45 --------------------------------------- 1809 46 Up --------------------------------------- 574 Total --------------------------------------- 3250 Colored Up to 17------------------------------------- 420 17-45 --------------------------------------- 624 46 Up -------------------------------------- 175 Total --------------------------------------- 1219 Minimal No. % 4 .46 16 .88 3 .52 23 .71 2 .48 4 .64 2 1.14 8 .66 Mod. Adv. No. % 1 .12 9 .50 3 .52 13 .40 2 .48 5 .80 1 .57 8 .66 Far Adv. No. % 0 .00 4 .22 1 .17 5 .15 3 .71 9 1.44 0 .00 12 .98 All Cases No. % 5 .58 ;'":"::"'3 o- 29 1.60 .<..b. 7 41 1.21 1.26 ~.c..... ~"'- ~ 7 1.67 ...c;...:...s..... 18 2.88 3 1.71 28 2.30 1>;1 I..J...l. - -----------, 252 Georgia Department of Public Health TABLE VIII RESULTS OF INTERPRETATION OF FILMS REFERRED BY PHYSICIANS January 1 Through December 31, 1942 New Cases: Childhood 2 Minimal 3 Moderately Advanced ------------------------------------------------------ 22 Far Advanced -------------------------------------------------------------- 27 Total Positive ------------------------------------------------------------- 54 Suspicious ----------------------------------------------------------------- 97 Negative ------------------------------------------------------------------- 226 323 Cases on Which Previous Diagnosis Had Been Made: Films sent in for review on cases that had been previously diagnosed and no change shown ------------------------------------------------------- 275 TOTAL OF ALL FILMS SEXT I~ FOR INTERPRETATIOX IN 1942_____________ 652 TABLE IX PuBLic HEALTH TuBERCULOSIS CoNTROL AcTIVITIES 1941 and 1942 Year 1941 Cases of tuberculosis admitted to service________ ----------------- 4,499 Visits to tuberculosis cases, contacts and suspects----------------- 67,358 Visits to cases of tuberculosis ____________________________________ 19,415 Average number of visits to cases of tuberculosis __ _________ __ __ 4.32 Office visits by cases of tuberculosis____________________________ 5,591 Admission to sanatoria___________________________________________ 673 Number completed tuberculin tests________________________________ 24,960 Number positive --------------------------------------------- Contacts broken ------------------------------------------------Contacts partly broken __________________ -----------------------__ Relief secured-number of cases___________________________________ 8,688 1,437 368 667 Tuberculosis cottages built______ -------------------------------- 13 Public lectures and talks on tuberculosis____________________________ 670 Year 1942 ~ 63,!)75 16,707 3.98 5,773 746 25,278 7,655 1,406 396 651 11 376 TABLE X RESULTS OF INTERPRETATION OF X-RAY FILMS MADE IN GENERAL OFFICE January 1 Through December 31, 1942 Original Examinations Childhood cases Minimal cases ----------------------------------------------------------------------- 4 Moderate advanced cases-------------------------------------------------------------- 16 Far advanced caseS------------------------------------------------------------------- 16 Total positive ------------------------------------------------------------------------ 43 Suspicious --------------------------------------------------------------------------- 57 ~egative _____________________________________________________ ------------------------ 233 Total ------------------------------------------------------------------------------- 353 Tuberculosis Sanatorium 253 Re-examinations Childhood cases --------------------------------------------------------------------- 4 Minimal cases ----------------------------------------------------------------------- 11 Moderately advanced cases ____________________________________________________________ 1j Far advanced cases___________________________________________________________________ _ 18 Total positive ----------------------------------------------------------------------- 50 Suspicious 15 Negative 102 Total __ 167 Total of All X-rays Made in Office_____________________________________________________ 520 TABLE XI STATE PNEUMOTHORAX REFILL PROGRAM Year 1942 Number of patients unde.r treatment January 1, 1942__________________________ 389 New cases admitted to service during 1942 ___________________________________ 237 Total cases under treatment during 1942 ________________ ----------------------- 646 Patients dropped from Service during 1942: Admitted to sanatorium____________________________________________________ 44 Pneumothorax discontinued ____ ------------------------------------------- 17 Pneumothorax unsuccessful ------------------------------------- 14 Disease arrested ----------------------------------------------- 3 Discharged to private physician-------------------------------------------- Moved -------------------------------------------------------------------Deaths _________ __ __ __ ____ _____ ____________ __ ____ ____ _____ ____ __ _______ ___ 14 Total patients dropped from Service during 1942----------------------------Total Number of Patients Under Treatment Jlecember 31, 1942 __ __________ ____ -8 7 559 TABLE XII STATE PNEUMOTHORAX REFILL PROGRAM CosTs Year 1942 Number Patients 1942 On List at End of Month Month January __________ -------------------------------------- 402 February ____ ------------------------------------------- 408 March -------------------- ----------------------------- 404 April -------------------------------------------------- 415 May __________________ --------------------------------- 431 June 448 July 482 August _ ------------------------------------------- 494 September ___ ___ ______ ____ ____ __ __ ____ ____ ___________ ___ 50 4 October _____ ------------------------------------------- 528 November 546 December 559 Total _______ ----------------- _------------------------Total average per month ________________________________ 468 Average cost per patient________________________________ 2.89 Total Cost Per Month $ 1,164.00 1,119.'JO 1,190.00 1,264.00 1,169.00 1,529.00 1,378.50 1,416.00 1,444.50 1,666.00 1,484.00 1,442.00 $16,266.50 $ 1,355.54 ExAMINATIONs MADE AT TuBERCULOSIS CLINICS Original Examinations _________________ 7148 - - Re-examinations ----------------------- 4469 Total ------------- _______________ 11617 Counties, 205 Year 1942 White * 20 To 16 Age Male * 10 17-45 46 up Childhood T.B. ------------------------------ 7 1 0 Minimal ------------------------------------- 1 11 3 Mod. Adv. ---------------------------------- 1 22 10 26 5 10 60 18 Suspicious ------------------------------- 109 145 91 515 1032 227 Total --------------------------------- 634 1237 336 Colored 3 * 10 *I Childhood T.B. ------------------------------ 14 0 0 Minimal ------------------------------------ 0 4 0 Mod. Adv. ----------------------------------- 1 13 7 Far Adv. ----------------------------------- 5 36 13 Total Positive ------------------------------- 20 53 20 52 90 15 282 457 122 Total ----------------------------------- 354 600 157 Date, 1942 Total Male 8 15 33 32 88 345 1774 2207 14 4 21 54 93 157 861 1111 *9 To 16 10 1 0 0 11 74 486 571 9 8 1 0 2 11 66 343 420 Number Clinics, 216 Age Female *6 17-45 46 Up Total Female 0 14 34 20 68 164 1046 0 10 3 18 15 49 8 28 26 105 88 326 217 1749 1278 331 2180 * 10 0 6 10 31 47 120 798 *I 0 8 2 9 2 12 5 38 9 67 24 210 151 1292 965 184 1569 Unclassified~81 Re-examinations: White~3250 Black~1219 Total~4469 t-.:l <:.11 ~ ((;) Cb Total ~ <1'l 18 iS" 33 82 60 193 ~ ~ ...!.;.:>., 671 ;3 Cb 3523 1::. 4387 --c.... ."::t::: <..:.:.!.". 22 0~- 13 ::r:: 33 92 Cb ~ 160 ;::- 367 2153 2680 STATE TUBERCULOSIS SANATORIUM John W. Oden, M.D. _________________ -c _______________Superintendent MEDICAL STAFF F. C. Whelchel, M.D. Fred Crenshaw, M.D. H. E. Crow, M.D. Robert H. Cox, M.D. Norman L. Anderson, M.D. Glenn P. Dewberry, M.D. C. D. Whelchel, M.D. __________________ Thoracic:; Surgeon, Non.resident John G. Scott, D.D.S. ____________________________ Dentist, Non-resident Patient days in 1942 increased from 168,171 in the previous year to 216,323, and the average daily census from 461 in 1941 to 593. The daily per capita net cost was 1.897 against 1.888 in 1941. Number of patients admitted, treated and discharged during the year is shown as follows: Patients remaining December 31, 194L_______________________ 573 Patients admitted in 1942___________________________________ 759 Total number of patients treated in 1942______________________ 1,332 Number of patients discharged in 1942________________________ 770 Patients remaining December 31, 1942________________________ 562 Greater detail concerning patients by color, sex, age and disease classification is given in the appended tables, numbers 1 to 12. Some of these tables compare figures for 1941 and 1942. A study of the .table.;; of x-ray, 1uboratory and operating procedures, which are comparative for the years 1941 and 1942, will afford some idea of ,~he enormous amount of work done at the Sanatorium as well as of its nature. Especial attention is called to the increase of x-roy service, 20,608 examinations in 1942 against 12,352 in 1941, and in operative procedures which amounted to 25,919 in 1942 and 17,103 in 1941. This work has been done and has been kept up to a high level in spite of war conditions and the resultant effect of reducing personnel and making personnel replacements difficult. Inadequate employee housing is a fu;ther contributing factor toward the latter difficulty. Function of the Sanatorium For several years (since 1937) the Sanatorium has bet>a an integral part of the tuberculosis control program of the State Health Department and this integration has been of distinct value in the control of tuberculosis and the reduced death rate. (See 1942 report of the Division of Tuberculosis Control.) The policy of admitting patients chiefly for lung collapse measures when indicated and depending on community resources for the 256 Georgia Department of Public Health bed care of those requiring only such measures has worked out as affording the greatest good to the greatest number. The State has more than 5,000 known cases of tuberculosis. One thousand three hundred thirty-two received treatment in the Sanatorium in 1942. More than 600 received artificial pneumothorax and pneumoperitoneum refills after discharge from the Sanatorium through the State Health Department and the 70 or more practicing physicians who par ticipate in this program. The rest of the 5,000 tuberculosis patients are being supervised by the county and city public health physicians and nurses, and the latter secure additional aid through local physicians, the local welfare departments, state and local tuberculosis associations, civic clubs, the relatives of patients and of interested individuals. Although the Sanatorium beds are being used primarily for lung collapse cases, some few patients constituting particularly difficult public health menace problems are admitted when, after investigation and effort by the proper authorities, no other solution of the problem can be found. In order to prevent the Sanatorium from becoming filled with what may be termed "boarder" patients there should be no let up in effort to provide a way for them to be cared for in their own communities so that they may be discharged as early as possible. It is obvious that the State Tuberculosis Sanatorium with its approximate bed capacity of 600 can house a.t one time only 12% of known patients. The above policy of admission is fair and efficient under the circumstances and every effort should be made to keep it in force. A word should be added in reference to the colored patient situation. An attempt is being made to put the same policy of admission in effect for Negroes, but because the proportion of beds is much smaller than that of the whites, the need being greater, less institutional care can be given and more by local communities is necessary. Recommendations CHILDREN'S BUILDING. It is recommended that the Children's Building should be closed to P'atients. Usually only three or four of the seventeen or eighteen patients cared for in this building require treatment, and those who do can be cared for properly in the Main Building or in the Annex. It would have the effect of releasing four nurses badly needed for other service and to close the kitchen and dietary service now in operation in this building. J,t would temporarily, at least, relieve some of the acute employee housing situation if some of the moms and other space could be utilized for ,the purpose. It would be a measure of real economy, so sorely needed in these times, and would serve a much better purpose than it does now. Future Planning The need for adequate housing of all personnel for whom it may be required should be gone into thoroughly so that needs, plans and costs can be presented at the first suitable time. Tuberculosis Sanatorium 257 Repairs A great amount of repairing has become necessary and it is expected that a list of these will soon be availaible showing in what order they are necessary and estimated costs. Need for Additional Funds It is believed to be absolutely impossible to operate the Sanatorium to its full capacity in the future within the limits imposed by the present appropriation. The per capita cost for the fiscal year July I, 1941, to June 30, 1942, was 1.888. Since then supplies of all kinds have increased in cost and are still increasing. So have wages and salaries. The funds previously made av,ailable have not been enough to operate on and to properly keep up the buildings and plant. In addition to the increasing demands for repairs, stocks of supplies purchased when their cost was lower are rapidly diminishing. Help of all kinds is being lost. We are always short-handed, and inexperienced help, even difficult to secure, must fill,the vacancies. The only remedy for the latter is increased pay, which would no doubt be cheaper in the end. It is firmly believed, no matter how we economize, that we will very soon be faced with the alternative of greatly reducing our patient load and our personnel if sufficient money is not provided to meet the increasing costs of supplies and service. An additional report setting forth in more detail what will be needed is being made up and will be presented at a later date. Conclusion The year 1942 was marked by many administration changes: Dr. Sharp resigned the superintendency September 8, 1942, and was succeeded by Dr. John F. Busch, who carried on as Acting Superintendent until the appointment of Dr. John W. Oden, September 20, 1942. Dr. Oden was forced to resign by sudden illness from which he did not recover sufficiently to resume his duties, and again Dr. Busch functioned as Acting Superintendent. The resignation of Dr. Busch made it necessary for the Director, Division of Tuberculosis Control, to act as superintendent beginning January ll, 1943. Dr. Sharp resigned to enter the United States Public Health Service, and Dr. Busch to enter the service of the American Red Cross. This is an illustration of one of the many personnel difficulties encountered and explains the unavoidably delayed report which had to be prepared. 258 Georgia Department of Public Health Patients Remaining 12-31-41 White Men ---------------- 202 White Women ------------- 230 White Boys --------------- 12 White Girls --------------- 10 Colored Men --------------- 37 Colored \Vomen ----------- 66 Colored Boys --------------Colored Girls -------------- Total -------------- ------- 573 TABLE Patients Admitted In 1942 296 262 25 19 75 69 5 759 Total Treated In 1942 498 492 37 29 112 135 17 12 1,332 Patients Discharged In 1942 286 285 25 22 61 70 11 10 770 Patients Remaining 12-31-42 212 207 12 51 65 6 562 TABLE II AGE AND SEX OF PATIENTS DISCHARGED From January 1, 1942, Through December 31, 1942 Age Grc ups Male 1-10 -------------------------------------------------------- 27 11-20 ------------------------------------------------------- 38 21-30 110 31-40 99 41-50 ------------------------------------------------------- 49 51-60 ------------------------------------------------------- 45 61-70 11 71-80 Total 384 Female 27 61 132 84 48 25 9 0 386 TABLE Ill CoMPARISON oF NuMBER oF PATIENTS ADMITTED IN YEARS oF 1941 AND 1942 1941 1942 White Men -------------------------------------------- ______ 332 296 White Women ------------------------------------------------ 312 262 White Boys --------------------------------------------------- 20 25 White Girls -------------------------------------------------- 21 19 Colored Men ----------------------------------------- _________ 49 75 Colored Women ----------------------------------------------- 79 69 Colored Boys ------------------------------------------------- 5 8 Colored Girls ------------------------------------------------- Total -------------------------------------------------------- 829 759 Tuberculosis Sanatorium 259 TABLE IV COMPARISON OF NUMBER OF PATIENTS DISCHARGED IN YEARS 1941 AND 1942 1941 White Men --------------------------------~~----------------- 251 White Women ------------------------------------------------ 218 White Boys --------------------------------------------------- 19 White Girls --------------------------------------------------- 23 Colored Men ------------------------------------------------- 45 Colored Women --------------------------------~ ________ ______ 65 Colored Boys --------------------------------------------- ____ 1 Colored Girls ------------------------~ ------------------------ Total --------------------------------------------------------- 623 1942 286 285 2~ 22 61 iO 11 10 770 TABLE V ADMISSION CLASSIFICATION OF WHITE PATIENTS January 1, 1942-December 31, 1942 Far advanced ------------------------------------------------------------------------ 232 Moderately advanced __ ___ _______ __ _______ ___ _____ ___ ____ ___ __ __ ______ __ __ ______ ____ __ 191 Minimal ----------------------------------------------------------------------------- 27 Primary Type ------------------------------------------------------------------------ 37 Miliary __________________ ------------- ______________________________________________ _ Suspicious _________________________________________________________________________ _ Non-tuberculous --------------------------------------------------------------------- 20 Tuberculous Pleurisy ----------------------------------------------------------------Undiagnosed ------------------------------------------------------------------------- 84 Total ------------------------------------------------------------------------------- 603 TABLE VI ADMISSION CLASSIFICATION OF COLORED PATIENTS January 1, 1942-December 31, 1942 Far advanced _______________________________ --------------------------~------------- 85 :lloderately advanced --------------------- -------------------------------------------- 30 :Minimal _____ ____ _______________________________ ~-- _____ __ __ __ __ _______ ___ __ _______ __ 13 Primary Type _______ ----------------- ____ ------------------------------------------- 9 )liliary ________________________ ----- ____________________________________ --------- __ _ Suspicious 1 Non-tuberculous ________ -- __________________________________ ------------------------- 0 Tuberculous Pleurisy ----------------------------------------------------------------- Undiagnosed ------------------------------------------------------------------------- 17 Total ____________ ---------------------- _____________ __________________ ___ __________ __ 17 260 Georgia Department of Public Health TABLE VII DISCHARGE CLASSIFICATION OF WHITE PATIENTS January 1, 1942-December 31, 1942 Heal. App.Heal. Arrest.App. Arr. Qules. Imp. Unimp. Died Far advanced 0 0 1 Moderately advanced _ 6 Minimal _____________ 0 0 Primary Type ------- 2 0 M!Jiary ______________ 0 0 0 Suspicious ---------- 0 Non-tuberculous ----- 0 0 Tbc. Adenitis ________ Tbc. Pleurisy ------- 0 Undiagnosed _________ 0 0 0 Total --------------- 1 8 80 70 63 9 36 131 36 4 3 9 14 4 36 0 0 0 0 0 0 19 0 0 42 1 2 0 1 0 0 0 7 0 29 13 53 359 112 69 Total 223 225 30 39 19 45 1 29 619 TABLE VIII DISCHARGE CLASSIFICATION OF CoLORED PATIENTS January 1, 1942-December 31, 1942 Heal. App.Heal. Arrest.App. Arr. Quies. Imp. Unimp. Died Far advanced ________ 0 0 0 1 16 20 35 Moderately advanced~- 0 0 6 17 5 3 Minimal ------------ 0 2 6 2 0 Primary Type ------- 6 Mil!ary ______________ 0 0 0 0 11 0 0 0 0 Suspicious ___________ 0 0 0 Non-tuberculous ----- 0 0 0 Tbc. Pleurisy ________ 0 0 0 0 6 0 0 Undiagnosed -------- 0 0 Total ---------------- 0 15 10 59 27 39 Total 73 33 15 20 1 6 151 Tuberculosis Sanatorium 261 TABLE IX COMPARATIVE X-RAY REPORT OF THE YEARS 1941 AND 1942 1941 1942 F!uoroscopics (Colored and White) --------------------------------- 12,352 X- rays ------------------------------------------------------------ 5,732 Flats __ -------------------------- __________________ ------------- __ 4,976 Buckys __________________________ --------------------------------- 30 Stereos 58 Colon X-rays ________________ ------------------- __________________ _ G. I. -- ----------------------------------------------------------- 48 Bone Plates ____________ ------------------------------------------- 113 Portables ----------------------------- .. ---------------------------- 99 Fluid X- rays -------------------------------------------.. -- ------- 16 Kidney X-rays 25 Mastoid X-rays Sinus X-rays ------------------------------------------------------ 12 Lateral Chest X-rays______________________________________________ _ 0 Skull X-rays ------------------------------------------------------- Obliques ---------------------------- ------------------ ___________ _ Fetus X-rays ------------------------------------------------------ Photo Roentgenoscope --------------------------------------------- 343 B. M. R. ----------------------------------------------------------- 13 E. K. G----------------------------------------------------------- 21 White Adults: House Patil'nts Consultation Patients 3,009 1,502 White Children : House Patients --~---------------------- --------------------------- 200 Consultation Patients 183 Colored Adults: House Patients 650 Consultation Patients 144 Colored Children : House Patients ---------------------------------------------------- 44 Consultation Patients 0 Lipiodol Injections : House Patients ---------------------------------------------------- 11 Consultation Patients ---------------------------------------------- 20,608 6,525 5,468 1 57 2 57 115 31 0 27 1 19 0 0 747 36 3,679 1,474 167 163 755 256 30 26 4 In the clinic at the Sanatorium 75 new cases of pulmonary tuberculosis were found from January 1, 1942, through December 31, 1942. Four hundred and eighty-two of the consultation x-rays sent in by outside physicians, during the year 1942, were positive. How many were previously diagnosed is not shown. 262 Georgia Department of Public Health TABLE X CoMPARATIVE LABORATORY REPORT oF YEARS 1941 AND 1942 1941 Sputum: Direct Smear -------------------------------------------------Concentration ___ ___ ___ ______ ____ ____ _____ _______ ________ __ __ ___ Culture ____ __ ____ ______ ________ ___ __ ___ __ ___ _____ _____ __ _______ 4,784 5 65 4 23 Animal Inoculation (S.B.H.) ------------------------------------ 12 Fontana ------------------------------------------------------- 59 Fungus -------------------------------------------------------- 11 Fungus Culture ----------------------------------------------- 0 Blood: Culture Count --------------------------------------------------------CoagulaJ!lon --------------------------------------------------Typing -------------------------------------------------------Crossmatchlng _______________ ---------------------------------- Kahn (S.B.H.) ------------------------------------------------Malaria ------------------------------------------------------- 1,345 208 220 116 885 29 Blood Chemistry : Sedimentation Blood Sugar Urea- Nitrogen ________________________________________________ _ Sulfanilamide -------------------------------------------------N. P. N ------------------------------------------------------- 1,012 37 5 6 Urine: p. s. p ----------- -------------------------------------------- Routine ______ ---------------------- ---------------------------- Culture 4,101 Feees: Routine 104 Culture 6 Pleural Fluid: Smear ~ ______________________________________________________ _ 107 Cuiture ______________________________________________________ _ 37 Secondary Organisms __________________________________________ Spinal Fluid : Routine 13 Culture 2 Smears: Mixed Organisms ______________________________________________ 47 Gonococci _______ ----- _______________________________ ------- __ _ 23 Pneumococci ________________________________ ------------ _____ _ 2 Staphylococci _________________________________________________ _ Streptococci ------------------------------------------------------- 6 Vincents _________________________________ --------------------- Colon Bac!Ill -------------------------------------------------- Bacteria Count : Milk ___________ ~--- ___________________________________________ _ 11 1942 3,430 396 302 49 23 15 2 1,239 188 77 65 917 15 1,230 73 3 15 5,038 5 34 183 140 0 13 2 11 1~ 2 6 2 0 Tuberculosis Sanatorium 263 TABLE X (Continued) CoMPARATIVE LABORATORY REPORT oF YEARS 1941 AND 1942 1941 Gastric: Direct Smear ___________ ------------ ______ --------------------- 2 Routine ______________________________________________________ _ 6 Cuiture _______________________________________________________ Animal Inoculation (S.B.H.) ------------------------------------ 21 Analysis ______________________________________________________ Miscellaneous : Abdominal Fluid ---------------------------------------------- 0 Agglutination Test ________________ ----------------------------- 0 Bleeding Time __ -------------------------------- ______________ _ Cholestoral ___________________________________________________ _ Creatinine __________________________ ----------'---------------- 0 Diphtheria Culture _____ ---------------------------------------- 0 Diphtheria Smear __ -------------------- _----------------------- Direct Smear-Buttocks Abscess_________________________________ 0 Drainage from Abscess ----------------------------------------- 0 Ear Smear for Tuberculosis ------------------------------------- 0 Febrile Antigens ----------------------------------------------- G. C. Culture -------------------------------------------------- 3 Glucose Tolerance _____________________________________________ _ 0 Gram Stain-Drainage from Abscess ---------------------------- 0 Gram Smear _____ ------------------------------ ______________ _ 2 Knee Fluid Culture -------------------------------------------- 1 Mastic Test ____________________________________________________ 4 Sickle Test ___________________________________________________ _ Silicosis (Saranac Lake) --------------------------------------- Sulfathiazole Test ___________ ---------------------------------- 0 T.B. Smear _______ --------------------------------------------- 6 Total _____________ ----------------------------- __ ____________ _____ ___ 14.263 1942 28 21 2 4 1 2 1 0 8 0 13.595 264 Georgia Department of Public Health TABLE XI CoMPARATIVE OPERATING RooM REPORT OF YEARS 1941 AND 1942 1941 Thoracic Surgical Procedures: ApioolYses Bronchoscopic Examinations --------------------------------------Inci&ion and Drainage of Abscesses ------------------------------ __ Incision and Drainage of Lung Abscesses _____ ----------------------Incision and Drainage of Pleural Cavity ---------------------------Injection of Intercostal Nerve --------------------------- _________ _ Instillation of Continuous Irrigation ----------------------------- __ _ Irrigation of Pleural Space ----------------------------------------Lobectomies ______________________________________________________ _ Monaldi Tube Inserted ------------------------------------------- __ Oleothorax, Avg. No. P.atients Receiving ____________________________ _ 28 1 0 1,227 1 3 Oleothorax, Refills -------------------------------- _______________ _ 79 Oleothorax, Out-Patients Receiving ______________________________ _ 3 Oleothorax, Out-Pat10nts Refills ______________________________ _ 8 Oleothorax, Removal of --------------------------------------------- Phrenicotomies --------------------------- __ ___ ____ ______________ _ 116 Phrenicotomies, Out-Patients ---------------------- _________ _ 0 Pneumolyses: Patients ______________________ --------------- _____ _ 23 Pneumolyses : First Stage ________ ------ ____________ -- ------------------------ 23 Second Stage _________________________________________________ _ Third Stage ___________ ---------------------------------------- 1 Pneumoperitoneum, Inlttal ------------------------------------------ 22 Pneumoperitoneum, Avg. No. Patients Receiving _____________________ _ 41 Pneumoperitoneum, Refills ----------------------------------------- 1,927 Pneumoperitoneum Patients Discharged ---------------------------- 12 Pneumoperitoneum Patients Discontinued ---------------------------- 17 Pneumoperitoneum, Avg. No. Out-Patients Receiving-----------------Pneumoperitoneum, Out-Patient Refills______________________________ _ 16 Pneumothovaces, Initial __ ----------------------------------------- 382 Pneumothoraces, Successful ---------------------------------------- 194 Pneumothoraces, Unsuccessful -------------------------------------- 271 Pneumothorax, Avg. No. Patients Receiving_________________________ _ 110 P-neumothorax, Refills -------------------------------------------- 9,195 Pneumothorax, Patients Admitted with______________________________ _ 0 Pneumothorax Patients Discharged -------------------------------- 100 Pneumothorax Patients Discontinued ------------------------------- 59 Pneumothorax, Avg. No. Out-Patients Receiving__ ------------------- 18 Pneumothorax, Out-Patient Refills ________________ ------------------ 381 Removal of Air ---------------------------------------------------- 145 Removal of Part of Scapula ---------------------------------------- 1 Rib Resections ---------------------------------------------------- 0 Rib Resection and Tube Insertion ---------------------------------- Secondary Closure of Thoracoplasty Wound ------------------------- 2 Thoracenteses ____________________________________________________ _ 2,093 Thoracenteses, Out-Patients ---------------------------------------- 2 Thoracoplasties: Patients ----------------------------- _------------ 48 Thoracoplasties : First Stage 48 1942 45 2 3 2 2,568 1 0 41 0 0 257 1 27 27 4 129 62 5,475 30 7 24 218 155 54 132 11,732 8 130 81 29 174 111 0 1 0 2,851 1 38 38 Tuberculosis Sanatorium 265 TABLE XI (Continued) CoMPARATIVE OPERATING RooM REPORT oF YEARs 1941 AND 1942 Second Stage ------------------------------------------------Third Stage --------------------------------------------------Third Stage~Anter!.or -----------------------------------------Fourth Stage -------------------------------------------------Fourth Stage~Anterior ---------------------------------------Fifth Stage --------------------------------------------------Sixth Stage --------------------------------------------------Sixth S!age--Anter!or _________________________________________ _ Seventh Stage ------------------------------------------------Thoracotomies _____________________________________________________ Transpleural Decompression ---------------------------------------Tube Inserted In Pleural Cavity ------------------------------------ Deaths During Surgical Procedures: 1941 48 46 30 0 13 Other Surgical Procedures: Appendectomies ___________________________________________________ _ Blood Tran.sfusions ____________________ ---------------------------- 30 Coccygotoml es ____________________________________________________ _ 0 Curette ,of Sinuses ------------------------------------------------- DHation and Curettage --------------------------------------------- Enucleation of Eye ------------------------------------------------ Lumbar Punctures ___ ---------------------------------------------l\Iastoidectomies __________________________ ------------ ____________ _ Removal of Cysts ___ ----------------------------------------------Removal of Growth from Breast -----------------------------------Removal of Growth from Forehead -------------------------------Removal ,o.f Growth from Mouth _____________ ----------------------- Removal ,of Lymph Xode -------------------- __ -------------------- Removal of Wart from Hand --------------------------------------- Therapeutic Abortions ---------------------------------------------- Tubes Inserted ---------------------------------------------------- 10 Other Operating Room Procedures: Antiluetic Treatments, Avg. No. Patients Receiving______________ 12 Antiluetic Treatments, No. Given ----------------------------------- 709 App!ica.tion of Radium --------------------------------------------- Application of Plaster Spllnt to Wrist_______ .------------------ ____ _ 2 Autopsie.s ________________________________________________________ _ Biopsy of Gland on C\1eck ------------------------------------------ Biopsy of Knee _______ --------------------------------------------Bladder Instillations ________________ _ Debridement of Wounds Gastric Lavages ____ --------------------------------------------- 15 Gland Biopsy, Axilla ----------------------------------------------- Gluteal Aspira!ions ------------------------------------------------ Incision and Drainage of Abscesses________________________________ 23 Injections, I. V. -------------------------------------------------- 224 Oxygen Lavages --------------------------------------------------0. T., Avg. No. Patients Receiving________________________________ _ 0. T., No. Treatments Given --------------------------------------- 127 Paracenteses _____________________________________________________ _ 0 1942 36 48 14 4 3 0 33 1 19 19 1,165 1 0 0 35 0 6 33 431 27 0 0 5 266 Georgia Department of Public Health TABLE XI (Continued) CoMPARATIVE OPERATING RooM REPORT OF YEARS 1941 AND 1942 1941 Pelvic Examinations ----------------------------------------------- 38 Rectal Examinations ----------------------------------------------- 1 Removal of F<>reign Body from Finger---------------------------- 0 Removal of Foreign Body from Hand________________________________ 0 Removal of Lipoma from Forearm__________________________________ 0 Skin Tests _________________ -------------- ------------------------- 40 Surgical Drainage -------------------------------------------------- 1 Suturing <>f Lacerated Finger --------------------------------------Suturing of Lacerated Wound on For.,head ___________________________ Suturing of Lacerated Upper Lip___________________________________ 1 Vagina! Dilations __________________________________________________ 0 Other Treatments -------------------------------------------------- 5 Total Operating Room Procedures: --------------------------------- 17,103 1942 23 0 279 0 0 0 0 1 0 25,919 TABLE Ill SuMMARY BY CouNTIES OF 1941 FALL THICK BLoOD-FILM ExAMINATIONS OF ELEMENTARY ScHOOL CHILDREN No. Ex'd Ral\er * ---- ----------- [)46 Bulloeh ------------ -- 18 Burke ---------- ------ 60 Camden _______________ 370 Calhoun 0"' 877 (II ..... ll93 ;'":' 30 0 "' 460 ~:: 768 115 690 889 640 CJJ ;!;::>: ...!c;...:.>....... 994 ;: ;3 922a 1941 Survey represents--random blood films on colored school children and blood films of white school children with enlarged spleens, except counties marked as follows: * Random survey on both white and colored. x Random survey on white children. t--.:1 0\ --J I. 268 Georgia Department of Public Health TABLE XII COUNTIES REPRESENTED (BOTH RACES) JANUARY I, I942-DECEMBER 3I, I942 Atkinson _______________ _ I Bacon __________________ _ I Baker __________________ _ I Baldwin ________________ _ 7 Banks __________________ _ 3 Barrow __________________ 5 Bartow __________________ 9 Berrien __________________ 2 Bihb ____________________ I8 Brantley _________________ 2 Brooks __________________ 3 Bulloch __________________ 6 Burke ___________________ 3 Butts ____________________ 4 Calhoun ____________ 3 Camden _________________ 2 Candler _________________ I Carroll __________________ 2 Catoosa _________________ 4 Charlton _________________ I Chatham _________________ 21 Chattooga _______________ 19 Cherokee ________________ 5 Clarke ___________________ 4 Clayton ____ _____________ 5 Clinch __________________ I Cobb ___________________ I3 Coffee ___________________ IO Colquitt _________________ 9 Columbia ________________ I Cook ____________________ 3 Coweta __________________ 5 Crisp ___________________ 4 Dade ____________________ 4 Dawson ________________ _ 3 Decatur ________________ _ 7 DeKalb _________________ _ 20 Dodge _________________ _ 2 Dougherty ______________ _ 9 Doug~s ________________ _ 5 Early __________________ _ 3 Echols _________________ _ 1 Effingham ______________ _ I Elbert ___________________ 6 Emanuel _________________ 6 Fannin __________________ 8 Fayette __________________ 5 Floyd ___________________ 47 Franklin _________________ 3 Fulton __________________ 94 Gilmer __________________ 2 Glascock _________________ 1 Glynn ___________________ 8 Gordon __________________ I8 Grady ___________________ 2 Greene __________________ 4 Gwinnett ________________ I2 Habersham ______________ 12 Hall ____________________ 11 Hancock ----------------- l Haralson _______________ _ 4 Hart ___________________ _ 6 Heard __________________ _ l Henry __________________ _ 3 Irwin __________________ _ 2 Jackson ________________ _ 2 Jasper _________________ _ I Jefferson _______________ _ 2 Jenkins _________________ _ 7 Johnson ________________ _ I Jones ------------------- 2 Lamar __________________ _ 3 Laurens ----------------- 8 Liberty _________________ _ I Lincoln ----------------- l Long ___________________ _ 2 Lowndes ----------------- 3 Lumpkin _______________ _ 3 Mcintosh --------------- I Macon _________________ _ 4 Madison ----------------- 4 Marion _________________ _ 1 Meriwether ______________ _ 2 Mitchell ---------------- _ 4 Monroe ----------------- 4 Montgomery ____________ _ 2 Laboratories 269 TABLE XII (Continued) COUNTIES REPRESENTED (BOTH RACES) JANUARY 1, 1942-DECEMBER 31, 1942 Morgan _______ ________ 1 Murray __________________ 8 Muscogee ________________ 10 Newton ------------------ 1 Oconee __________________ 1 Oglethorpe _______________ 3 Paulding ________________ 4 Peach ___________________ 4 Pickens __________________ 3 Pierce __________________ _ 2 Pike ____________________ 1 Polk -------------------- 8 Pulaski _________________ _ 1 Putnam __________________ 1 Rabun ___________________ 4 Randolph _______________ _ 3 Richmond ______________ _ 12 Rockdale _______________ _ 1 Screven ________________ _ 1 Schley _________________ _ 1 Seminole _______________ _ 2 Spalding _______________ _ 17 Stephens ________________ _ 2 Stewart _________________ _ 1 Sumter __________________ 1 Talbot __________________ 1 Tattnall _________________ 4 Telfair __________________ 4 Terrell __________________ 10 Thomas _________________ 5 Tift _____________________ 7 Toombs _________________ 3 Towns ___________________ 1 Troup ___________________ 8 Turner __________________ 1 Twiggs __________________ 2 Union ------------------- 6 Upson ------------------- 11 Walker __________________ 6 Walton __________________ 1 Ware ___________________ 13 Warren _________________ _ 1 Washington _____________ _ 4 Wayne ------------------ 7 Wheeler ________________ _ 1 Whitfield _______________ _ 23 Wilkes ------------------- 1 Wilkinson ______________ _ 8 Worth __________________ _ 3 ----, Division of Laboratories T. F. Sellers, M.D., Director E. J. Sunkes, Dr.P.H., Chief Bacteriologist Janie Morris, M.S. ________________________________________Cultures Madge Reynolds, A.B.__________________________________Microscopy E. L. ~'ebb, A.B. ________________________________________Serology M. M. Harris, Ph.D. _______________________________ Waycross Branch Elizabeth Butt, A.B.* ________________________________Albany Branch * Acting Director. The work of the Division of Laboratories reached a new high level during 1942. There was a marked increase not only in the number of specimens examined, but in all other >activities, including the manufacture and distribution of biologics and auxiliary services such as the preparation of media, glassware and specimen outfits. During the year 642,916 specimens were examined. This was an increase of 135,593, or 26.7 per cent, over the number examined in 1941. It was the Iargest increase for a comparable period in the history of the Division of Laboratories. INCREASE IN LABORATORY WORK Diagram 1 shows (l) the marked growth in the specimen loads over the 20-year period from 1920 to 1940, and (2) the gain annually from 1940 to 1942. Diagram 2 gives a comparison of the specimen load in the several departments during the 20-year period from 1920 to 1940, and annually from 1940 to 1942. Laboratories DIAGRAM I GROWTH OF LABORATORY WORK 1920-1942 271 642,916 507,323 395,004 272 Georgia Department of Public Health 40 000 ' DIAGIIAM 2 GROWTH OF LABORATORY WORK BY DEPARTMENTS 1920-1942 0 MICROSCOPY m CULTURE SEROLOGY 120,000 Cbll 1925 19:JO 1"5 1940 1941 1942 Laboratories 273 A comparison of the number of specimens of different types examined during 1941 and 1942 is given in Table l. TABLE I COMPARATIVE CLASSIFICATION OF SPECIMENS 1941-1942 1941 Tuberculosis ------------------------------------ 13,969 Diphtheria ------------------------------------- 2,694 Gonorrhea -------------------------------------- 9,882 Malaria __ --------------------------------------- 33,157 Intestinal Parasites ------------------------------ 53,205 Rabies ------------------------------------------ 1,264 Agglutinations ------------------- _______________ 10,943 Blood Cultures --------------------------------- 9,322 Stool and Urine Cultures ------------------------ 8,983 Darkfield --------------------------------------- 309 Water ------------------------------------------ 13,205 Miscellanoous ----------------------------------- 3,120 Syphilis Serology ------------------------------- 347,270 Grand Total ------------------------------------ 507,323 1942 15,969 2,939 9,813 19,189 30,884 1,216 10,829 9,244 10,586 226 13,918 2,537 515,566 642,916 Gain or Loss + 2,000 + 245 69 - 13,968 - 22,321 48 114 78 + 1,603 83 + 713 583 + 168,296 +135,593 Examination of Table 1 reveals the fact that the greatest increase occurred in specimens submitted for syphilis serology, which showed a gain of 168,296. Much of this gain resulted from the increase in specimens submitted by Selective Service boards. There were 199,544 such specimens submiUed in 1942, compared to 71,957 submitted in 1941, a gain of 127,587. Lesser increases were noted in those submitted for examination for enteric organisms, tuberculosis, diphtheria, and water analyses. Losses occurred in the number of specimens submitted for all other examinations, the greatest decrease occurring in those submitted for malaria and intestinal parasite examination. There were 36,289 fewer of these. Malaria specimens decreased 13,968; intestinal parasite specimens 22,321, and hookworm egg counts 1,385. The marked decline in malaria work was due in part to diversion of field personnel to War activities, and in part to the low incidence of this disease. The interruption of the field hookworm program likewise explains the decline in examinations for intestinal parasites. Table 2 shows the division of the specimen load among the three laboratories with the increase or decrease in each. 274 Georgia Department of Public Health TABLE 2 SPECIMEN LOAD BY LABORATORIES 1941 Central Laboratory, Atlanta __________________ 353,658 Southwestern Branch, Albany________________ 81,203 Southeastern Branch, Waycross______________ 72,462 Grand Total ------------------------------- 507,323 1942 501,229 71,856 69,831 642,916 Increase or Decrease In 1942 +147,511 - 9,347 - 2,631 + 135,593 Diagrams 3, 4, 5 and 6 show in graphic form the number and the percentage of the total specimen load carried by each laboratory during 1942, the specimen loads handled hy the several divisions, the specimen load by divisions in each laboratory, and the percentage of the specimen load classified according to the type handled in each laboratory. Laboratories 275 DIAGIIAII :S SPECIMEN LOAD BY LABORATORIES 1942 CENTRAL !101,229 78.0'1. SEROLOGY 5e1!o1,n56.6 DIAGRAM 4 SPECIMEN LOAD BY DIVISIONS 1942 276 Georgia Department of Public Health DIAIRAM 5 SPECIMEN LOAD BY DIVISIONS IN EACH LABORATORY 1942 CENTRAL LABORATORY ALBANY LABORATORY WAYCROSS LABORATORY Laboratories 277 DIA8RAII I SPECIMEN LOAD BY DIVISIONS 1942 PERCENTAGE TOTAL LOAO HANDLED IN EACH LABORATORY SEROLOGY MICROSCOPY CULTURE 278 C'Jorgia Department of Public Health The consolidated repor,ts of the three State Laboratories, composing the Division of Laboratories, is given in Table 3. TABLE 3 REPORT OF COMBINED LABORATORIES FOR 1942 Total Tuberculosis-Microscopic ________________________________________ _ Tuberculosis-Cuiture _____________________________________________ Tuberculosis-Animal Inoculations --------------------------------Diphtheria ____ ------------------------------- -------------------Genorrhea __ ------- _______ ----- __ --------------------------------Darkfield Test for Syphilis ---------------------------------------Malaria ------- _-------------------------------------------------Intestinal Parasites ----------------------------------------------Egg Counts _____________________ --------- ___________ - _- ______ - --- Rabies-Microscopic Rabies-Animal Inoculations -------------------------------------Miscellaneous __ __ ___ ___ __ ___ _____ __ _____ ___________ ___ ___ ___ __ __ __ 14,667 946 356 2,939 9,813 226 19,189 28,41;) 2,469 1,050 166 2,531 Total for Microscopy --------------------------------------------- 82,113 Agglutinations ____ -------------------- ---------------------------- Typhoid Fever -----------------------------------------------Typhus (Brill's) Fever --------------------------------------Brucellosis ______ ------------------------------ ______________ _ Tularemia __ ____ ____ ____ _________ __ ____ ______ _____ __ ____ ____ __ 10,829 Pcsitive 1,256 89 58 515 1,593 64 290 1,771 488 56 111 196 153 18 Blood Cultures ---------------------------------- __________________ 9,244 E. typhosa ------------------------------ ______________________ 184 Salmonella ___________ -------------------------- --------------- 15 Brucella ____ ------------------------------------------------- 38 Others __ ___ __ ___ ______ ______ ___ _______ __ _____ ____ __ ___ ____ ___ 21 Stool and Urine Cultures__________________________________________ 10,586 E. typhosa _-------------------------------------------------- 500 Salmonella ______________________ ----------- ------------------ 28 Shigella _________________________________________________ - ---- 240 Others ____ - ---------------- ----------------- ------------------ T,otal for Culture 30,659 Syphilis Serology 515,566 Water 13,918 Grand Total __ ----------------------------------- _________________ 642,916 76,996 Laboratories 279 DISCUSSION OF WORK BY LABORATORIES CENTRAL LABORATORY The statistical report for the Central Laboratory is shown in Table 4, while Table 5 gives a comparative classification of the examinations made in this laboratory. Examination of Table 5 reveals that the gain of 147,571 specimens handled in the Central Laboratory was due chiefly to the increase in the syphilis serology load, and to a lesser extent to the gains in examinations for tuberculosis, diphtheria and water analyses. The greatest decrease occurred in those specimens submitted for malaria and intestinal parasite examination, which showed a loss of 19,133. Lesser losses, totaling 2,988 specimens, occurred in all other types of examinations. TABLE 4 REPORT OF CENTRAL LABORATORY FOR 1942 Total Tuberculosis-Microscopic ----------------- -----------------------Tuberculosis-Culture --------------------------------------------Tube-rculosis-Animal Inoculation --------------------------------Diphtheria ______ ------------------------------------------------Gononhea ------------------------------------------------------Darkfield Test for Syphilis --------------------------------------~Ialaria _______ -------------------------------------------------Intestinal Parasites ___ ------------------------------------------Egg Counts __ ---------------------------------------------------Rabies-Microscopic --------------------- _____________ ____________ Rabies-Animal Inoculation --------------------------------------~Iiscellaneous _________ ------------------ _____________ ____________ Total for Microscopy ---------------------------------------------- 11,064 842 356 2,552 6,139 168 7,330 13,450 532 882 166 1,291 44,772 Agglutinations __ ____ ____ ____ ________ _____ _____ __ __ __ __ ____ ___ _____ Typhoid Fever _ ---------------------------------------------Typhus (Brill's) Fever ---------------------------------------Brucellosis __________________________________________________ _ Tularemia ___________________________ ------ ____________ -------- 5,817 Blood Cultures --------------------------------------------------E. typhosa ________________ ----------------------------------Salmonella ___________________________________________________ Brucella ____________________________________________________ _ Others ____________ --- ------ _------------------------ ---------- 5,129 Stool and lJrine Cultures -----------------------------------------E. typhosa __________________________ ------- _________________ _ Salmonella ___________________________________________________ Shigella ________________________________ - __ - ----------- __ ------- Others ______ --------------------------------------- _________ _ 5,047 Total for Culture 15,993 Syphilis Serology __________________ ------------------------------ 426,546 \Vater ---------------------- __ ____ __ __ __ ________ ____ ____ _________ 13,918 (>rand Total ________ __ __ __ _____ ____ _ ___ __ ________________ 501,229 Pcsitive 932 80 58 484 80 2 48 186 2,253 408 56 58 315 85 30 103 11 27 9 174 24 107 63,997 280 Georgia Department of Public Health TABLE 5 CoMPARATIVE CLASSIFICATION oF SPECIMENs 1941-1942 CENTRAL LABORATORY 1941 Tuberculosis --------------------------- ____________ 10,599 Diphtheria ----------------------------------------- 2,119 Gonorrhea ____ ------------------------------------ 6,826 Darkfield Test tor Syphilis ------------------------- 264 Malaria ------------------------------------------- 14,312 Intestinal Parasites -------------------------------- 26,133 Rabies -------------------------------------------- 1,134 Miscellaneous ------------------------------------- 1,776 Agglutinations ------------------------------------ 6,639 Blood Cultures ------------------------------------ 5,869 Stool and TJrine Cultures -------------------------- 5,119 Syphilis Serology ---------------------------------- 259,663 Water -------------------------------------------- 13,205 1942 12,262 2,552 6,139 168 7,330 13,982 1,048 1,291 5,817 5,129 5,047 426,546 13,918 Gain or Loss + 1,663 + 433 687 96 6,982 - 12,151 86 485 822 740 72 + 166,883 + 713 Grand Totals -------------------------------------- 353,658 501,229 +147,571 Microscopy ------------------------------------ 63,163 Culture --------------------------------------- 17,627 Syphilis Serology ------------------------------ 259,663 Water _________ -------------------------------- 13,205 44,772 15,993 426,546 13,918 - 18,391 - 1,634 +166,883 + 713 BRANCH LABORATORIES The branch laboratories at Albany and Waycross handled a total of 141,687 specimens during 1942, as compared with 153,665 during 1941, a decrease of 11,978 specimens. This constituted 22.0 per cent of the total specimen load as compared to 30.2 per cent in 1941. The Albany Labora,tory handled 71,856 specimens in 1942, a decrease of 9,347, or 11.5 per cent, compared with 1941. Decreases occurred in those specimens submitted for microscopic examination and for syphilis serology. A material increase was noted in the number of specimens submitted for agglutination tests and cultures. This was the result of a typhoid-dysentery outbreak in Dougherty County, which is discussed on page 26. Table 6 gives the statistical report for the Albany Laboratory, while Table 7 gives a comparative classification of the specimens examined in 1941 and 1942. Map 1 shows the counties from which specimens were received by the Albany Laboratory. Laboratories TABLE 6 REPORT OF ALBANY LABORATORY FOR 1942 Total Tuberculosis-Microocopic ______________________________________ _ Diphtheria ------- ____________________ --------- -- ----------------G<>norrhea ______ ---------------------- --------------------------Darkfleld Test for Syphllls ----------------------------------------Malaria _______________________ ----------------------------------Intestinal Parasites Rables-Microscopic _________________________________________ ------ Miscellaneous -------------------------------------- ___ ___________ Total for Microscopy _______________________ ----------------------- 1,692 159 1,938 42 9,504 4,834 127 432 18,728 Agglutinations ____________________________ -----------------------Typhoid Fever _____________________ ---------------------------Typhus (Brlll's) Fever ____________ ---------------------------Brucellosis ____________ _______________________ ________________ Tularemia ______ ______________ _______ _________________________ 3,636 Blood Cultures E. typh - 10,093 + 1,597 849 Laboratories 283 MAP I ALBANY BRANCH LABORATORY Specim1111 284 Georgia Department of Public Health A total of 69,832 specimens were examined by the Waycross Laboratory during the year, a decrease of 2,632, or 3.6 per cent, compared with 1941. The loss occurred solely in the microscopic load and was due to a loss of 6,055 in the number -of specimens examined for intestinal parasites. Nearly every other type of examination showed increases. The considerable gain in the number of specimens submitted to the Waycross Laboratory for syphilis serology was due to the faot that a considerable number of specimens was received from war industry 'plants located in the area serviced by this laboratory. Table 8 gives a statistical report for the Waycross Laboratory, while Table 9 gives a comparative classification of the specimens examined in 1941 and 1942. Map 2 shows the counties from which specimens were received by the Waycross Laboratory. TABLE 8 REPORT OF WAYCROSS LABORATORY FOR 1942 Total Tuberculosis-llficroscopic ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~ Tuberculosis-Culture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Diphtheria ~~~~~~- ~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ -~~~~~~~ Gonorrhea ~~~-- -~~ ~~~~~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~ Darkfield Test for Syphilis ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Malaria ~- ~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Intestinal Parasites ~~~~~~~~~~~~~~ -~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Egg Counts ~~ ~~~~~~~~~~~~~~~~~~~~-~~~~--~~~~~--~~~~~~~~~~~~~~~~~~~~ Rabies-Microscopic ~- ~~~~~~~~~~~~-~~~~~~~~~~~--~~~~~~~~~ -~~~~~~~~~~ Miscellaneous ~~ ~~ ~ ~~ ~~~ ~~~ ~~ ~~~ ~ ~~~ ~ ~~~ ~~~~~~~~~~~~ ~ ~ ~~ ~~~ ~ ~ ~~~~~ Total for Microscopy ~~- ~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1,911 104 228 1,736 16 2,355 10,131 1,937 41 814 19,273 Agglutinations ~ _~~ ~~ ~ ~~~ ~~~ ~ ~ ~~ ~~ ~ ~~~~ ~~ ~~~~ ~~~ ~~~~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~~ ~~ Typhoid Fever ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~-~~~~-~~~-~~~ Typhus (Brill's) Fever ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Brucellosis ________________ -- _____________________ - -- __ ------- Tularemia ~ ~ ~ ~ ~~ ~ ~~~~ ~~~~ ~~ ~ ~ ~ ~~~~~ ~ ~ ~~ ~ ~~~~ ~~~~~ ~~ ~~~~ ~~~~~~ _ 1,3 76 Blood Cultures E. typhosa ~~~~~ ~ ~~ ~~ ~ ~ ~~ ~ ~~~~~~~ ~~ ~~~~~~~ ~~~ ~~~~~~ ~~~~~ ~~~~ ~ ~ Salmon ell a ~~ ~~ ~ ~~~ ~~ ~~ ~~ ~~ ~ ~~ ~~ ~~~ ~~~~~~~~~- ~~~ ~~~ ~~ ~ ~~~ ~ ~~~ ~ B rue ella ~~ ~ ~ ~ ~ ~~ ~~~~~~~~ ~ ~ ~ ~~ ~~ ~ ~~ ~~~~ ~~~ ~~ ~~~ ~~~~~ ~~~~ ~ ~~~ ~ ~ Others ~~~~ ~ ~~ ~ ~~~~ ~~~ ~~~~ ~~~ ~ ~~~~~ ~~~ ~~ ~~ ~ ~ ~ ~ ~~ ~~ _~ ~ ~ ~ ~~ ~ ~~~~ 1,329 Stool and Urine Culture ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~~~~~~ E. typhosa ~~~~~~~~~~~~~~~~~~~~~~~-~~~~~~-~----~~-----~~~~---Salmonella ~~ ~~ ~~~ ~~~ ~~ ~~ ~ ~~ ~~ ~~ ~ ~~ ~ ~~~~ ~-~~~~~~ ~~ ~~~ ~~ ~~ ~ ~~~~ Shigella ~~~ ~~~~~~~~ ~~~~~~ ~ ~~~~ ~~~ ~~ ~~~-- ~~----~ ~~~~ ~~~~~~ ~~~~~ Others ~~ _~ ~ ~~ ~ ~~ ~~ ~ ~~~ ~~ ~~~ ~ ~~~ ~ ~~ ~~~~~~ ~~ ~ ~ ~~~~ ~~~~ ~ ~~ ~~ ~~ ~~ 2,313 Total for Culture 5,018 Syphilis Serology 45,540 Grand T-otal ~~~~~~~~~~~~~~-~~~-~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~ 69,831 Positive 115 9 25 507 16 3,944 16 172 28 10 11 2 0 6 9 7 6,349 Laboratories 285 TABLE 9 CoMPARATIVE CLASSIFICATION OF SPECIMENs 1941-1942 WAYCROSS LABORATORY 1941 Tuberculosis --------------------------------------Diphtheria ---------------------------------------Gonorrhea --------------------- ______ ------------Darkfield Test for Syphilis ________________________ 1,691 327 850 12 Malaria -----------------------------------------Intestinal Parasites -------------------------------Rabies -------------------------------------------Miscel!anoous ------------------------------------Agglutin.,tions -----------------------------------Blood Cultures -----------------------------------Stool and Urine Cultures -------------------------Syphilis Serology ---------------------------------- 3,262 18,563 38 870 893 803 1,875 43,278 1942 2,015 228 1,736 16 2,355 12,068 41 814 1,376 1,329 2,313 45,540 Gain or Loss + 324 99 + 886 + 907 -6,495 +3 56 + 483 + 526 + 438 +2.262 Grand Total --------------------------------------- 72,462 69,831 -2,631 Microscopy ------------------------------------ 25,613 Culture --------------------------------------- 3,511 Serology -------------------------------------- 43,278 19,273 5,018 45,540 -7,557 +1.447 +2,262 286 Georgia Department of Public Health MAP 2 WAYOROSS BRANCH LABORATORY Source of specimens received durinQ the year 1942 69,832 Specimens - Laboratories 287 DISCUSSION OF WORK BY UNITS MICROSCOPY UNIT TUBERCULOSIS Included in the studies made for M. tuberculosis were microscopic examinations, cultures and animal inoculations. Compared with 1941 the following gains were noted during the past year in the several types of examinations: Microscopic, 1,659; cultures, 199; animal inocul,ations, 140; total increase, 1,998. Most of the specimens for culture and/or animal inoculations were received from the State Sanatorium at Alto and from county health nurses. TABLE 10 MicRoscoPIC ExAMINATIONS FOR TuBERCLE BAciLLI Five Year Period 1938-1942 1938 Number examined ----------- 7,359 Xumber positive ------------ 808 Per cent positive ------------ 10.9 1939 8,985 896 9.9 1940 10,385 975 8.4 1941 13,008 1,063 8.2 1942 14,667 1,256 8.6 A total of 1,042 cultures for M. tuberculosis was made during the year. The Central laboratory made 938 of these, and the Waycross branch 104. Of these 741 specimens were cultured only, while 301 were made in conjunction with animal inoculations. The results of the culture studies only are given in Table ll, while results on cultures and animal inoculations are given in Table 12. Type StJeclm&n Stool Total TABLE II TuBERCULOSIS CuLTUREs Central Pos. Neg. Total 52 576 628 1 1 2 Waycross Pos. Neg. 8 87 6 Total 95 6 53 584 637 95 104 Type Specimen Total Stomach Washings ------------------- 101 Pleural Fluid ------------------------ 61 Sputum ----------------------------- 53 Urine ------------------------------- 42 Cultures ---------------------------- 16 Pus --------------------------------- 13 Synovial Fluid _______________________ 1 Abdominal Fluid _____________________ 6 Miscellaneous and Unclassified Fluids__ 15 rota! -------------------------------- 314 TABLE 12 TuBERCULosis ANIMAL INocuLATIONs Micro. Findings Neg. Pos. 101 -- 61 52 1 42 -- 16 13 -- 7 6 14 1 296 18 Culture Neg. Pos. 92 8 55 9 45 42 7 1 6 J. 16 4 210 31 1-.:l 85 Totals Pos. Neg. Total 60 663 723 7 8 ~ 6 7 .~ c.. 0<:! ~- 62 679 741 t:; ~ ...'"1::l l;:l ..... ~ -...~ ;::! c ~ Animal Inoculations (::: o....-.. Neg. Pos. ~. <"l 81 20 ::X:: ~ 47 14 ;l;;::l - 44 9 ~ 42 7 9 11 2 1 4 13 - 256 58 Laboratories 289 Diphtheria Diphtheria cultures increased from 2,693 in 1941, to 2,939 in 1942. The greatest gain was made in diagnostic cultures, which increased from 1,832 to 2,203. However, there was an increase of only 13 positive diagnostic culture findings during this period. Twenty-eight virulence tests were made in 1942, compared to 13 in 1941. See Table 13. TABLE 13 CLASSIFICATION OF DIPHTHERIA EXAMINATIONS 1942 Total Diagnostic ~~~~~~- _~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2,203 Release and Carrier ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 708 Virulence ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 28 Total ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2,939 Positive 291 205 19 515 Negative 1,902 496 9 Doubtful 10 2,407 17 TABLE 14 ExAMINATIONS FOR GoNococci Five Year Period 1938-1942 1938 :'\umber specimens examined~~~~~~ 5,569 Number positive ~~~~~~~~~~~~~~~~ 1,132 Per cent positive ~~~~~~~~~~~~~~- 20.3 1939 7,599 1,662 21.8 1940 8,248 1,818 22.0 1941 9,882 1,929 19.5 1942 9,813 1,593 16.2 Malaria During :the past year 19,189 malaria examinations were made compared to 33,157 in 1941, a decrease of 13,968. There were 1,413 fewer routine specimens, and 9,613 fewer index specimens. See Table 17. Positive findings decreased from 551 in 1941, to 290 in 1942. During the fall 2,703 blood films were received from extra-cantonment areas in five counties. Examination of 1,158 of these was completed. with only two positive findings. Examination of 698 index films hom three other counties not having cantonment .areas gave eight positive findings. Table 15 shows the malaria examinations made and the results obtained in the seve11al laboratories during 1942. Table 16 gives classification of the positive findings. 290 Georgia Department of Public Health TABLE 15 RouTINE AND INDEX MALARIA ExAMINATIONs 1942 (Routine specimens are those submitted from individual patients. Index specimens are those collected in organized surveys t<> determine malaria indices.) Central Albany Waycross Total Routine Positive Negative 147 2,835 Total ----------------------------------- 2,982 018 5,241 5,299 10 1,285 1,295 Grand Total ----------------------------------------------------------- Index Positive Negative 39 4,309 30 4,175 6 1,054 Total ----------------------------------- 4,348 4,205 1,060 Grand Total -----------------------------------------------------------T,otal Routine and Index Malaria Examinations______________________________ _ 215 9,361 9,5 76 75 9,538 9,613 19,189 TABLE 16 CLASSIFICATION oF MALARIA PosiTivEs Tertian E-A Quartan Unclass. Routine ------------------------------------ 54 158 3 Index -------------------------------------- 16 58 Total --------------------------------------- 70 216 Total 215 75 290 TABLE 17 EXAMINATIONS FOR MALARIA Five Year Period 1938-1942 Routine 1938 Totals --------------- 9,537 Gain 'Or Loss over pre- + ceding year ------- 1,997 Index Totals ---------------- 49,185 Gain or Loss over pre- + ceding year _______ 24,424 1939 9,780 + 243 1940 10,452 + 672 26,914 -22,271 25,629 - 1,285 1941 10,989 + 537 22,168 - 3,461 1942 9,576 - 1,413 9,613 -12,555 Laboratories 291 Intestinal Parasites The past year showed a material decrease in the number of specimens submitted for intestinal parasite examination. For the first time in many years there was a decline in the routine specimens as well as in the index. This is shown in Table 18. This decrease, noted during the past three years, has been due not only to the discouragement of surveys other than those related to definitely planned programs of control, but also, especially during the past year, to a loss of personnel engaged in hookworm control. A considerable por.tion of the index work as well as hookworm egg counts was made in the Waycross Laboratory. See Table 19. TABLE 18 EXAMINATIONS F'OR INTESTINAL pARASITES Five Year Period 1938-1942 Rcutine 1938 Total -------- -------- 11,9:;!1 Gain or Loss over pre- ceding year + 4,124 Index Total ------------------ 48,641 Gain or Loss over pre- ceding year --------+ 7,130 1939 14,563 + 2,604 1940 17,921 + 3,358 1941 22,352 + 4,431 56,720 + 8,079 39,591 -17,129 27,000 -12,591 1942 17,273 - 5,079 11,142 -15,858 TABLE 19 RouTINE AND INDEX INTESTINAL PARASITE ExAMINATIONs (Routine specimens are those submitted by private physicians. Index specimens are those collected in organized surveys by Public Health agencies to determine intestinal parasite (chiefly hookworm) indices.) Central Routine Positive ____________________ 1,115 Negative -------------------- 8,184 Total ---------------------- 9,299 Albany Waycross Total Grand Total 1,310 3,000 4,310 1,213 2,451 3,664 3,638 13,635 17,273 Index Positive ____________________ 1,138 Negative ___________________ 3,013 T"tal ______________________ 4,151 Egg Counts 532 264 2,731 4,133 260 3,736 7,009 524 6,467 11,142 1,937 2,469 Grand Total 30,884 292 Georgia Department of Public Health TABLE 20 CLASSIFICATION OF INTESTINAL PARASITE FINDINGs-1942 Single Infestation Wmms for Identification ------------------------------------------------- 14 Hookworm ____ ____ __ __ _____ ___ ______ ___ __ ______ ______ __ __ _____ ______ ____ 1,430 Dwarf Tapeworm -------------------------------------------------------- 10 Round Worm ------------------------------------------------------------ 191 Whip Worm ------------------------------------------------------------ 43 Pin Worm --------------------------------------------------------------- 111 Others ------------------------------------------------------------------ 6-7,865 Double Infestation Hookworm and Pin Worm________________________________________________ _ Round Worm and Whip Worm ___________________________________________ _ Hookwonn and Dwarf Tapeworm _________________________________________ _ Hookworm and Round Worm_______________________________________________ Hookworm and Whip Worm _______________________________________________ _ Round Worm and Pin Worm______________________________________________ Whip Worm and Pin Worm ________________________________________________ _ 43 1 20 68 11 2 1- 152 Triple Infestation Hookworm, Round Worm, Pin Worm--------------------------------------- Total Specimens Positive for Ova of Hookworm ________________________________ 1,519 Dwarf Tapeworm -------------------------------------------------------- 90 Round Worm _______________ --------------------------------------------- 263 Whip Worm _________________________ _______________________ _____________ 62 Pin Wonn _________________ ---------------------------------------- __ ____ 158 Others __________ ----------------------------------------------------- --- Rabies-Micros~o pic Examinations Compared with 1941 there was very Httle change during the past year either in the total of examinations made for rabies, or in the number of positive findings. A comparison of the results obtained during the past five years is given in Table 21. A classification of the animal heads examined during 1942 is shown in Table 22. During the year an extensive outbreak of rabies among foxes occurred in Dade, ChaUooga and Walker Counties. First reports of the presence of suspected rabid foxes were received from Dade County early in September. Beyond the definite identification of the -disease as rabies through the examination of a few specimens, no attempt was made to secure all fox heads for laboratory examination. However, during the remainder of the year Ill positive fox histories were reported by wild life rangers. Fortunately very few persons were attacked and only one human antirabic treatment was administered. The findings in various city and county boards of health laboratories throughout the State is given in Table 23. TABLE 21 ANIMAL HEADS EXAMINED FOR RABIES 1938-1942 1938 Number heads examined __________ 1,164 Positive for Negri bodies _________ 538 Percentage positive _______________ 46.2 1939 981 443 44.6 1940 1,252 496 39.6 1941 1,090 492 45.1 1942 1,050 488 46.5 t-:1 1w 0 Columbus Pos. Total Dog -------------------------------------- 3 11 Cat -------------------------------------- -- 5 Pig Raccoon Total ------------------------------------- 3 16 TABLE 23 Macon Pos. Total 5 31 2 7 39 Savannah Pos. Total 4 16 5 4 21 t-.:1 :12 Augusta Pos. Total 11 19 ~ 1 5 ~ .<.:.;>, ~ :s 12 24 I;, ~ .!.:..>..,. ~ ~ .;:.:.!. -c . '"'t:1 I;: o\..:.).". :::r:: ~ !:> : Laboratories 295 Map 3 shows the source of ,aU heads found positive for rabies by the several State and municipal laboratories. This map does not necessarily show the actual incidence of rabies since the number of heads submitted to the laboratory for examination will vary roughly with the avaihtbility of the laboratory service. MAP! MAP SHOWING ANIMAL HEADS POSITIVE FOR RABIES 1942 Richmond County-- Augusta Lab 12 Muac:og" County - - Columbus Lab 3 Bibb County - - Macon Lab 1 Chatham County - - Savannah 4 Tolol - City Laboratories 26 Total- State Laboratories 488 Grand Totol 51 4 296 Georgia Department of Public Health Rabies-Animal Inoculation There were 166 mouse inoculation tests for rabies completed during 1942, compared to 173 in 1941. Thirteen tests were unsatisfactory. An analysis of these studies is given in Table 24. TABLE 24 ANIMAL INOCULATIONS FOR RABIES Type Specimen Micro.Mouse- + Micro.- Micro. ? Micro. Uns. Micro. + + Mouse Mouse- Mouse Checks Dog ---------------------- 62 25 Cat ----------------------- 27 4 Cow ---------------------- 2 Mule ---------------------- Hog ----------------------Goat ______________________ Squirrel ------------------- 10 Rat ----------------------Fox _______ ---------------Glands-dog ______________ _ Miscellaneous _____________ _ Total --------------------- 106 36 4 2 18 Total 100 36 10 1 166 Table 24 shows .that 38 specimens reported after microscopic examination only as either negative or unsatisfactory were positive by animal inoculation. Since 488 were reported as positive after microscopic examination only, a total of 526 examined by the Division of Laboratories was positive for rabies during 1942. Miscellaneous Table 25 shows .the miscellaneous examinations made during 1942. There was a decrease of 578 such examinations compared with 1941. Ameba examinations increased from 581 to 679. Pneumococcus typing, which decreased from 170 in 1941 to 76 in 1942, was discontinued in November because of the difficulty of securing both typing and therapeutic serum. During the year 27 specimens were examined for Donovan's bodies, pathonogmonic of granuloma inguinale. Of these 14 were found positive. Of the 17 specimens examined for meningitis positive findings were obtained in nine specimens as follows: N. intracellularis 3; H. inftuenzre 4; D. pneumonire 2. During the year 75 heterophile antibody tests for glandular fever were made compared with 63 in 1941. Twenty-five were positive. These tests were made in the Waycross Branch Laboratory. Laboratories 297 TABLE 25 CLASSIFICATIONS OF MISCELLANEOUS EXAMINATIONS Ameba __ 679 Pneumococcus typing __ ------------------------------------------------------------- 76 Vincent's -organisms _______ ----------------------------- ___ __ ________________________ 355 Trichomonas vaginalis ______________________________________ ------------------------ 219 Chancroid (B. ducrey) ------------------------------------------------------------- 56 Spinal fluids for meningitis --------------------------- ------------------------------ 17 Exam.inations for type of organism__________________________________________________ 250 Cultures --------------------------------------------------------------------------- 368 Glandular fever (heterophile antibody test)------------------------------------------- 75 Unclassified ----------------------------------------------------------------------- 442 Total _______________________ ----------------------------------- ________________ _____ 2,537 CULTURE UNIT Under this heading are included blood and stool cultures, agglutination tests for typhoid, typhus, undulant fever, and tularemia, as well as a miscellany of special bacteriology. The work in the culture unit remained fairly stable during 1942, as compared to the previous year. Agglutination tests decreased from 10,943 to 10,829; blood cultures from 9,322 to 9,244, while stool and urine cultures increased from 8,984 to 10,586. The total number of specimens handled by this unit in 1942 was 30,659 compared to 29,248 in 1941, an increase of 1,411. The positive results obtained in 1942, as compared with previous years are shown in the tables that follow. TABLE 26 PosiTIVE AGGLUTINATION TEsTs 1938 Typhoid --------------------------------- 396 Endemic Typhus (Brill's) ----------------- 841 Undulant ------------------------------- 83 Tularemia ------------------------------- 59 1939 237 832 144 130 1940 369 429 153 97 1941 116 651 115 63 1942 111 796 153 78 TABLE 27 PosiTIVE BLOOD CuLTURES 1938 E. tyvhosa ------------------------------ 403 Salmonella ____ -------------------------- 12 Bruce-lla -------------------------------- 5 Other Organisms ------------------------- 15 1939 255 11 14 32 1940 265 9 22 25 1941 182 9 43 25 1942 184 15 38 21 298 Georgia Department of Public Health TABLE 28 PosiTIVE STooL AND URINE CuLTURES 1938 E. typhosa ------------------------------ 612 Salmonella -----------------------------Shigella --------------------------------- 85 Other Organisms ------------------------ 7 1939 453 9 114 1 1940 360 3 136 5 1941 266 206 1942 500 28 240 During the year an outbreak of typhoid fever combined with bacillary dysentery occurred in Dougherty County. From 78 individuals E. typhosa was isola.ted 33 times from the blood, and 270 times from feces and urine. S. dysenterire was isolated 116 times from 80 individuals. Typing studies by application of bacteriophage showed all the cases of typhoid to be Type A. There were 7l cases of Flexner type dysentery, eight of New Castle, and one from which both Flexner and New Castle was isolated. During the outbreak a study was made of the relative efficiency of various media for the isolation of enteric pathogens. During the year Brucella was isolated by blood culture in 38 of 153 blood specimens showing some degree of positive agglutination. Twentyseven of these were made at the Central laboratory and ll at the Albany branch. They were classified as follows: Br. abortus 8, Br. Suis 30. The typing of E. typhosa strains by the application of bacteriophage, instituted in 1941, was continued during the past year. Six hundred thi1.1tysix cultures from 309 individuals were typed. The results are shown in Table 29. TABLE 29 BACTERIOPHAGE TYPES E. TYPHOSA-1942 A c E F H -:;"umber persons _______ 147 39 47 2 6 Xumber cultures ________ 381 78 65 10 5 Beta Gamma W 59 89 Total 309 636 The preponderance of Type A strains is due to 291 isolations typed during the outbreak in Dougherty County, all of which were Type A. There were 44 isoiations of members of the Salmonella group during 1942. Fifteen were from blood and 29 from stool cultures. The types isolated by each of the several laboratories is given in Table 30. Typing of all Salmonella cultures were made or confirmed by the New York Salmonella Typing Center at Beth Israel Hospital. Laboratories TABLE 30 SALMONELLA CLASSIFICATION-1942 Central S. para A S. para B S. bredeney -----------------------------8. anatum -------------------------------8. cholerae suis -------------------------- 3 S. derby ---------------------------------- 2 S give ----------------------------------8. montevideo ____________________________ S. lichtfield __________________ -----------S. newport __ ----------------------------8. oranienburg --------------------------S. typhi murium ------------------------- 14 S. meleagridis --------------------------- _ Total ------------------------------------ 36 Albany Waycross 299 Total 2 6 2 1 3 14 44 Isolations of Shigella from stool and urine cultures increased from 206 in 1941, to 240 in 1942. The types isolated by the several laboratories during 1942 is given in Table 31. TABLE 31 SHIGELLA CLASSIFICATION-1942 Central Flexner ---------------------------------- 76 Newcastle _------------------------------Sonne ------------------------------------ 24 Total 107 Albany 109 13 4 126 Waycross Total 191 20 29 240 TABLE 32 MiscELLANEous BLOOD CuLTURE IsoLATIONs Central Strevtococcus gamma type _______________ _ Stre-ptococcus hemolyticus ----------------Streptococcus Yiridans ---------------------Streptococcus (anaerobic) ________________ _ Staphylococcus albus _____________________ Staphylococcus aureus _ __ ______________ 4 Staphylococcus (hemolytic) ________________ Albany 4 Waycross Total 4 6 20 300 Georgia Department of Public Health SEROLOGY UNIT All specimens submitted for the serologic test for syphilis are first subjected to the Presumptive Kahn test, and if found negative are so reported. Those showing any degree of reaction with the presumptive test are then subjected to the Standard Kahn test, and the reactions obtained with this test are reported. Serologic tests for syphilis increased from 347,270 specimens in 1941, to 515,566, a gain of 168,296, or 48.7%. Syphilis serology in 1942 represented 80.2 per cent of the specimen load as compared to 68.5 per cent in 1941, and 57.3 per cent in 1940. Fifteen per cent of the specimens examined in 1942 gave positive reactions as compared to 14.6 per cent in 1941. During the year 199,544 specimens submitted by Selective Service boards were examined in the Central Laboratory, an increase of 127,587 specimens, or 177.3 per cent as compared with 1941. These specimens represented 46.8. per cent of the syphilis serology load in the Central Laboratory as compared to 27.7 per cent in 1941; 15.9 per cent were positive. This percentage cannot be taken as incidence of infection since registrants giving :posi,tive reactions are required to have a repeated test. During 1942, routine specimens (those submitted from sources other than Seleotive Service) increased by 40,609. A comparison of the tests made in the several laboratories is shown in Table 33. TABLE 33 Blood Central 1942 ------------------1941 ------------------- 425,919 258,985 + 166,934 Spinal Fluids 1942 ------------------- 627 1941 ------------------- 678 - 51 Blood and Spinal Fluids 1942 ------------------1941 ------------------ 426,546. 259,663 + 166,883 Albany 43,337 44,201 864 143 128 + 15 43,480 44,329 849 Waycross 45,474 43,199 + 2,275 66 79 -13 45,540 43,278 + 2,262 Total 514,730 346,385 + 168,345 836 885 - 49 51G,;J66 347,270 + 168,296 Includes 199,541 Selective Service specimens. Includes 71,957 Selective Service specimens. The examination of Selective Service specimens began in November, 1940. Labomtories 301 The Central Laboratory again achieved a very satisfactory rating in the 1942 syphilis serology study conducted by the U. S. Public Health Service. The results obtained by our laboratory as compared with the control laboratory is given in Table 34. TABLE 34 NATIONAL SEROLOGY EvALUATION STUDY-1942 Laboratory Presumptive Kahn Test Sensitivity Specificity Contvol 87.9 Georgia ----------------------------- 87.8 100.0 99.6 Standard Kahil Test Sensitivity Specificity 80.7 100.0 80.0 99.6 The Central Laboratory serving as the control conducted an intrastate evaluation study participated in by the two branch laboratories and eight other public health laboratories. Specimens from 100 syphilitics and 50 normal individuals were submitted. The ratings of sensitivity and specificity in all except four of these laboratories came within the limits for acceptable performance of diagnostic procedures. The following laboratories participated: Central-Control, Albany Branch, Waycross Branch, Muscogee County, Richmond County, Savannah-City, AtlantaCity, Clarke County, Grady Hospital-Atlanta, Lowndes County, Macon Hospital. A new type form with interleaved carbon, which serves both for the identification of the specimen and for the report of the examination, was constructed and placed in use during the year for both the routine and Selective Service syphilis serology specimens. BIOLOGICS AND DRUGS Several changes occurred during the past year in the list of biologies and drugs distributed. Sulfathiazole tablets were substituted for Sulfanilamide. These were distributed free of charge, along with the arsenicals, bismuth and Stovarsol .through the Division of Venereal Disease Control. The distribution of Oil of Chenopodium was discontinued and Hexylresorcinol Crystoids distributed instead. Difficulty was encountered during the year in securing sufficient Tetrachlorethylene capsules to supply our usual demands. The policy was therefore instituted of supplying these capsules only to those cases showing clinical evidence of hookworm disease confirmed by laboratory findings. Tetrachlorethylene C'apsules, Hexylresorcinol Crystoids and Blaud's pills are distributed through the Division of Malaria and Hookworm Service. Because of increasing difficulty in securing antipneumococcic serum this item is no longer carried in stock. Table 35 shows the distribution of biologics and drugs by the various laboratories during 1942. 302 Georgia Department of Public Health TABLE 35 BIOLOGIC PRODUCTS AND DRUGS DISTRIBUTED Product Central Albany Sera and Vaccines Diphtheria Antitoxin, units 40,569,000 Diphtheria Toxoid, cc. -----------------------Diphtheria Toxin-antitoxin, cc. ________________ _ 80,155 240 Diphtheria Schick Tests, tests ------------------ 43,530 Tetanus Antitoxin, units ------------------------ 3,373,000 Scarlet Fever Antitoxin, units -----------------Gas Gangrene Antitoxin, package _______________ 18,000 1 Antitularemic Serum, cc. ---------------------- 45 Antipneumococcic Serum, units ________________ 260,000 A.ntivenin, cc. --------------------------------- 60 Smallpox Vaccine, points ----------------------- 115,490 Typhoid Vaccine, cc. --------------------------- 555,240 Tuberculin, P.P.D., tests ----------------------- 830 Tuberculin, Diluted, cc. ----------------------- 18,395 (1) Antirabic Treatments (persons treated) ___ _ 2,130 Drugs Silver Nitrate, ampules ----------------------Tetrachlorethylene, 8 minim capsules _________ Oil of Chenopodium, ti minim capsules ________ _ Hexylresorcinol Crystoids, treatments __________ _ B!aud's Pills, 5 gr. --------------------------Brewer's Yeast, pound ------------------------(2) Distilled Water, cc. ----------------------Sulfathiazole, tablets, 0.5 gm. _________________ Stovarsol, tablets, 0.25 gm. --------------------(3) Bismuth Subsalicylate in Oil, cc. ___________ (4) Arsenicals, ampules ---------------------- 76,063 20,444 9 115 39,720 21,721 3,646,330 1,101,120 32,145 671,250 236,079 2,630,000 5,040 860 373,000 7,260 60,440 599 3,532 1,900 554,650 300 835 Waycross 1,252,000 4,740 1.610 60,000 6,340 38,900 162 4,700 8,100 269,090 1 259 (1) The figures given for the Branch Laboratories do not represent complete treatments. Four vials of vaccine are supplied by the Branch Laboratories for each patient for whom treatment is requested. The re mainder of the treatment is sent from ,the Central Laboratory. (2) Distributed in 10 cc. and 100 cc. bottles. (3) Distributed in 30 cc. and 60 cc. bottles. (4) Equivalent to 685,613 doses of 0.6 gms. or less. Laboratories 303 TABLE 36 BIOLOGICS SHOWING MARKED INCREASE OR DECREASE OVER 1941 DISTRIBUTION Product 1941 1942 Increase or Decrease Sera and Vaccines Diphtheria Autotoxin, units ___________ 48,768,000 Diphtheria Toxoid, cc. _______________ 71,765 Tetanus Antitoxin, units ______________ 2,753,500 Antipneumococcic Serum, units _____ __ 4,480,000 Drugs Tetrachlorethylene, :s minim capsules __ Distilled Water, cc. -----------------Stovarsol, tablets, 0. 2:; gm. ___________ _ Biemuth Subsa!icylate in Oil, cc. ____ _ Arsenicals, ampules 53,180 2,539,110 25,375 421,980 195,415 40,569,000 80,155 3,373,000 260,000 20,444 3,646,330 32,145 671,250 236,079 -8,199,000 + 8,390 + 619,500 -4,220,000 32,736 + 1,107,220 + 6,770 + 249,270 + 40,664 Human Antirabic Treatments There was a slight decrease in the number of antirabic treatments distributed during the past year. In 1941 there were 2,262 treatments sent to 148 counties, whereas last year 2,130 were distributed to 139 counties. A comparison for the past five years is given in Table 37, while Table 38 gives a classification according to type for 1941 and 1942. Map 4 shows the geographical distribution of treatments. 304 Georgia Department of Public Health MAP 4 MAP SHOWING DISTRIBUTION OF HUMAN ANTIRABIC TREATMENTS 1942 Totol Number - 2130 Note: Bibb County 221 FuHon County 321 Lowndes County I Of Laboratories TABLE 37 ANTIRABIC TREATMENT AND RABIES MORTALITY 1938 Human Treatments ____________ 2,938 Human Deaths During or After Treatment ---------------Human Deaths Without Treat- Treatment ---------------- 2 Total Deaths ------------------ Diagnosis doubtful In one case. See case history number 3. 1939 2,394 2 1940 1,903 1941 2,262 2 305 1942 2,130 2 2 4 TABLE 38 CLASSIFICATION ANTIRABIC TREATMENT BY TYPE Type Treatment 1941 Number Per Cent Precautionary ______________ __________ 901 39.8 Mild ------------------ _____________ 1,255 55.5 Intensive _____________ ________________ 95 4.2 Drastic ------------------------------ 11 0.5 Total -------------------------------- 2,262 1942 Number Per Cent 780 36.7 1,243 58.3 91 4.3 16 0. 7 2,130 Human Cases of Rabies During 1942 four human cases of rabies were reported. Two were diagnosed clinically and two brought to autopsy. Two received antirabic treatment, but onset of symptoms occurred prior to completion of treat- ment. Two received no antirabic treatment. One of the two receiving treatment was bitten in Georgia, treated in South Carolina, and died in Georgia. (See Case 3.) . CASE I-A.T.N., Route 2, Decatur, DeKalb County, Georgia. White, male, age 9. Bitten on let thumb by stray rabid cat March 20, 1942. Diagnosis of animal confirmed by laboratory examination. Mild antirabic treatment begun three days later. On April 7 (19 days after date of bite) the child began to show characteristic symptoms of rabies, was admiUed to Grady Hospital, Atlanta, and died April 10. The clinical diagnosis of rabies was confirmed by the mouse inoculation test of brain tissue obtained at autopsy. CASE II-V.S., Route l, Clayton, Rabun County, Georgia. White, female, age 5. Bitten on upper lip, left wrist and ankle April 9, 1942, by a neighbor's dog. This dog was considered normally vicious and rabies was not suspected, but it was killed the following day. No laboratory examination was made of its brain. Antirabic treatment was not administered. On May 1 (22 days after she was bitten) the child began 306 Georgia Department of Public Health to show symptoms which rapidly became typical of rabies. Death occurred May 6. No autopsy was performed. The clinical diagnosis was rabies. CASE 111-C.E.P., Greenville, South Carolina. White, male, age 5. While visiting relatives in Oglethorpe County, Georgia, this child was bitten on the nose October 18, 1942, by a dog which was killed at once. No laboratory examination was made of the dog's brain. The child was returned to his home in Greenville, where intensive antirabic treatment furnished by the South Carolina Health Department was administered beginning October 23. No November 6 (19 days after he was bitten) the child began to show symptoms which rapidly became typical of mbies. The child died November 8. No autopsy was performed. The clinical diagnosis was rabies. CAsE IV-D.B., Route 7, Gainesville, Hall County, Georgia. White, male, age 22. No history of this man's exposure to rabies could be elicited from the family or any other source except that about 21 months previously he played with a pet dog, which after biting two children in this family, suddenly disappeared. The two children received antirabic treatment. If this man was bitten he failed to reveal the fact, and he received no treatment. An incubation period as long as 21 months has never been recorded, the longest in our experience being seven months, hence this possible exposure was discounted. lt is assumed that a much more recent but unrevealed exposure must have occurred. On November 10, 1942, this man began to show symptoms, which three days later, became typical of rabies. Death occurred November 14 (four days after onset). Autopsy was performed and the diagnosis of rabies was confirmed by the finding of Negri bodies in the brain, and also by the mouse inoculation test. More or less detailed clinical notes of all four cases are on file in the Laboratory office. Laboratories 307 TABLE 39 DISTRIBUTION OF SPECIMEN OUTFITS BY LABORATORIES Central Albany Waycross Keidel Tubes For Selective Service-------------- 227,103 Other ------------------------------ 190,959 Sterile Corked Vials ------------------Darkfield Outfits ---------------------Throat Culture Outfits__________________ Intestinal Parasite Outfits, Routine ___ _ Intestinal Parasite Tins, Survey ________ Slide Outfits ------------------------Slides --------------------------------Sputum Outfits -----------------------Stool Culture Outfits ------------------ 418,062 121,808 749 3,659 5,860 23,983 9.153 16,704 16,576 8,138 14,505 28,348 73 341 2,935 2,208 1,404 4,752 2,297 3,692 2,974 13,665 101 561 1,404 5,579 965 1,769 1,62f> 1,599 Needles 19 Gauge, 2 inch ------------------- 22 Gauge 1'h inch ----------------24 Gauge % inch _________________ _ 26 Gauge % inch and 'h inch _____ _ 97 2-3 dozen 173 1-3 dozen 188 dozen 138 dozen Syringes 1 cc. Tuberculin ___________________ _ 2 cc. Hypodermic __________________ _ 5 cc.Hypodermic___________________ _ 10 cc. Hypodermic ___________________ _ 59 only 833 only 201 only 1,182 only Includes Keidel tubes sent to the Albany ~nd Waycross Branch Laboratories and distributed by them. TABLE 40 DISTRIBUTION OF SPECIMEN OuTFITS Two Year Period 1941-1942 1941 Keidel Tubes --------------------------------- 253,276 Sterile Corked Vials __________________ _________ 98,864 Darkfield Outfits _____________________________ _ 665 Diphtheria Outfits ___________________________ _ 3,790 Slide Outfits ---------------------------------- 9,974 Slides _______________ ------------------------- 21,672 Intestinal Parasite Outfits, Routine______________ 8,90i Intestinal Parasite Tins, Survey _______________ _ 86,155 Sputum Outfits ------------------------------- 17,701 Stool Culture Outfits -------------------------- 10,841 1942 Increase or Decrease 418,062 121,808 + 164,786 + 22,944 749 + 84 3,659 131 5,860 23,983 9,155 4,114 + 2,311 + 248 16,704 69,451 16,576 1,125 8,138 2,703 308 Georgia Department of Public Health Media and Vaccine TABLE 41 MEDIA AND VACCINE UNIT Media Beef Infusion Donble____________________ ---------------------------- _ Pork Infusion ------------------------------------------------------Beef Infusion Broth____________ ------------------------------------Beef Extract Broth ________________ ----------------------------------- Selenite ''F'' ------------------------------------------------------Conrad's Bile ------------------------------------------------------Miscellaneous Broths _______________________________________________ Beef Infusion Agar -------------------------------------------------Beef Extract Agar --------------------------------------------------Pork Infusion Agar________ -----------------------------------------Endo's Stock Agar__________________________________________________ Wilson Blair Agar______________ ------------------------------------Desoxycholate Citrate Agar ---------------------------------------Krumwiede's Triple Sugar Agar_____________________________________ MacConkey's Agar --------------------------------------------------S. S. Agar -------------------------------------------------------1\l:iscellaneous Agars ------------------------------------------------Loeffler's Blood Serum --------------------------------------------Petragnani's -------------------------------------------------------Frye's Mediurn _____________________________________________________ - Sugar Fermentation Tubes ----------------------------------------- _ Miscellaneous Media ------------------------------------------------- 100,000 cc. 14,000 cc. 64,500 cc. 49,000 cc. 4,000 cc. 95,000 cc. 36,000 cc. 110,000 cc. 1,000 cc. 14,000 cc. 16,000 cc. 255,070 cc. 18,000 cc. 9,800 cc. 9,500 cc. 11,500 cc. 17,890 cc. 11,322 cc. 17,000 cc. 3,000 cc. 5,750 cc. 3,405 cc. (The following media were prepared in the Engineering Laboratory.) Lactose Broth ------------------------------------------------------Endo Agar --------------------------------------------------------Nutrient Agar ______________________________________________________ _ Brilliant Green Lactose Bile Broth___________________________________ Miscellaneous ------------------------------------------------------- 1,440 Liters 48 Liters 24 Liters 90 Liters 1 Liter Solutions and Indicators Dyes for Media -----------------------------------------------------Reagents for Media ------------------------------------------------Bismuth Sulfite Mixture __________ ---------------------------------Glycerine Salt Solution ---------------------------------------------Salt Solution ------------------------------------------------------Silver Nitrate Solution ---------- __ -------------------------------Miscellaneous Solutions 700 cc. 14,659 cc. 24,500 cc. 59,000 cc. 845,700 cc. 40,300 cc. 47,650 cc. 1% Silver Nitrate Number Ampules made 1942-----------------------------------------Number Ampules filled 1942-----------------------------------------Number Ampules distributed 1942------------------------------------ 100,000 Ampules 68,000 Ampules 78,750 Ampules Water filled 1942 Water distributed 1942 Sterile Distilled Water 3,873,900 cc. 3,855,900 cc. Diluted Tuberculin (Old) Tuberculin diluted 1942 ---------------------------------------------Tuberculin distributed 1942 ------------------------------------------ 20,500 cc. 21,085 cc. - Laboratories 309 PERSONNEL There were ninety-two employees in the three laboratories. Seventyseven were employed in the Central Laboratory, seven in the Waycross Branch, and eight in the Albany Branch. Seventy were white and twentytwo colored. CENTRAL LABORATORY Medical Director, Bacteriologist VI_________________________ 1 Assistant Director, Bacteriologist V______________________ 1 Bacteriologist IV --------------------------------------- l Serologist IV _____________________ _____________________ 1 Bacteriologist III ----------------------------------------- 1 Bacteriologist II ----------------------------------------- 1 Bacteriologist I ---------------------------------------- _ 6 Technicians A ------------------------------------------ 9 Technicians B ------------------------------------------ 7 Technicians C ------------------------------------------ 3 Office Secretaries --------------------------------------- _ 2 Stenographers ------------------------------------------ 2 Typists _---------------------------------------------- _ 1 Statistioal Clerk ---------------------------------------- 1 Report Clerks ________________________ __________________ 7 Shipping Clerks ---------------------------------------- 4 Mail Clerk --------------------------------------------- 1 Laboratory Clerks --------------------------------------- 5 Stockroom Foreman _______________ ________________________ 1 Stockroom Clerk ----------------------------------------- 1 Porters __________________________ ______ _______________ 3 Maids ------------------------------------------------- 15 74 Students ----------------------------------------------- 3--77 ALBANY LABORATORY Acting Director, Bacteriologist II _______________ 1 Technician A _____________ 1 Technician B _____________ 2 Stenographer _____________ 1 Clerk ___________________ 1 Porter ___________________ 1 Maid ____________________ 1 WAYCROSS LABORATORY Director, Bacteriologist IV__ 1 Technicians A ____________ 2 Technician B _____________ 1 Stenographer _____________ 1 Maids ___________________ 2 7 310 Georgia Department of Public Health PERSONNEL PROBLEMS One of the outstanding problems confronting the laboratory management during the past year had to do with personnel turnover_ Six of the personnel entered the military service. A number of well trained women technicians left the service either because of marriage or to obtain positions in military hospital laboratories. A partial solution of the technical personnel problem was obtained through the training of students. During 1942, nine persons were admitted as trainees and eight completed training. The chief turnover, however, has been in the clerical help who have been able to obtain higher salaries in other positions. In spite of personnel problems and increasing difficulty in obtaining supplies, we are maintaining a laboratory service of rapidly increasing size and we believe of excellent quality. MERIT SYSTEM Under the Merit System established July lst, and approved by Federal agencies, the entire laboratory personnel was classified and qualified either by assembled or unassembled examination. In addition a formal program of didactic and technical instruction was given to both students and staff workers. MALARIA SCHOOL During the year a malaria school was conducted by Miss Aimee Wilcox, Assistant Technologist, Malaria Investigations, National Institute of Health. The school was attended by eleven members of our personnel and by four from other laborat:ories. Division of Information and Statistics Richard C. Brewer, Acting Director The year 1942 saw the Division of Information and Statistics almost deluged under a tremendous number of requests for certified copies of birth certificates. This increase, first noted in 1940, climbed upward month by month until it had passed all previous records many times. From time to time it has been necessary to expand both the personnel and quarters to take care of the increase. The department issued 74,996 certified copies in 1942. These were composed of 74,379 births and 617 deaths, respectively. This was an in crease of 55,353 certified copies or 282 per cent over 1941. It is interesting to note that the demand for ce11tified copies in 1942 was almost 32 .times greater than in the typical year 1938. At the same time, the department was placing on file 59,416 delayed certificates of birth. This was an increase of 40,416 or 212 per cent over the 19,000 delayed birth certificates filed in 1941. Incoming mail to this department, which had reached the total of 86,396 pieces of letter mail in 1941, reached a total of near 200,000 pieces in 1942. A special certificate was used in the latter part of 1942 to give infor mation required by the Servicemen's Dependent's Allowance Act of 1942 (Public Law 625) . Several thousand of these certificates have been issued. Special requests for verifications of births were received in great numbers from the Army, Navy, and other official agencies. The usual de mand for notifications of Birth Registrations was felt upon the opening of schools in the fall of the year. During 1942 there were 103,782 current eertificates piaced on record consisting of 72,189 births, 28,807 deaths and 2,786 stillbirths. The current birth and death certificates were handled in the !'outine manner. They are received, arranged in alphabetical order by county, checked for com pleteness, queried for necessary additional information, credited to the local registrars, financial Statements prepared for county financial. agents, coded for place of residence (for reallocation tabulations) and all death certificates coded for cause of death by the International List of Causes of Death and the Joint Cause Manual. They are numbered and bound into volumes of 500 certificates, and punch cards are made for each certificate. These punch cards are vertified and are used for making routine and special tabulations. The certificates are indexed and filed in alphabetical order. STATISTICS BIRTH RATE: The birth rate for Georgia increased from 21.6 per 1,000 population in 1941 to 23.1 in 1942, or an increase of 7.2 per cent. The rate for Georgia is considerably above the birth rate for the United States as a whole. This is the highest birth rate ever recorded for Georgia. 312 Georgia Department of Public Health STILLBIRTHS: There was a further drop in the stillbirth rate from 42.8 per 1,000 live births in 1941 to 38.6 in 1942, or a decrease of 9.9 per cent. This is the lowest rate ever recorded for stillbirths in Georgia. MATERNAL MoRTALITY: The maternal mortality rate decreased from 4.6 per 1,000 live births in 1941 to 4.1 in 1942, or a drop of 10.8 per cent in the maternal mortality rate. This is also the lowest rate ever recorded for Georgia. DEATH RATE: During 1942 the death rate decreased from 1,004 per 100,000 population in 1941 to 922.2 per 100,000 population in 1942 or a decrease of 8.1 per cent. This is the lowest death rate ever recorded in Georgia. TYPHOID FEVER: The 1942 typhoid death rate of 0.8 per 100,000 population is the lowest ever recorded for the State of Georgia. The rate dropped 56.3 per cent from the 1.7 in 1941 which was the previous all-time low. The number of deaths dropped from 55 in 1941 to 24 in 1942. TYPHUS FEVER: The typhus fever death rate increased 45.6 per cent from 1941 to 1942 when the rate increased from 1.1 to 1.7 and the deaths from 36 in 1941 to 52 in 1942. MALARIA: The malaria death rate for 1942 shows a very slight increase, the death rate being 2.4 per 100,000 population or an increase of 1.3 per cent. The number of deaths increased from 75 in 1941 to 76 in 1942. SMALLPOX: There were no smallpox deaths recorded in 1942. DISEASES OF CHILDHOOD: There was a decline in the death rate from MEASLES from 5.0 to 1.9 in 1942 or a decrease of 61.5 per cent. The number of deaths decreased from 157 in 1941 to 60 in 1942. ScARLET FEVER: There was a decrease in the number of deaths from this disease from 9 in 1941 to 2 in 1942 when the death rate dropped from 0.3 to 0.1 or 78.6 per cent. WHOOPING CouGH: There was a 27.4 per cent decrease in the death rate from this condition. The number of deaths declined from 140 in 1941 to 101 in 1942. DIPHTHERIA: There was also a drop in the diphtheria death rate from 2.0 to 1.8, or 12.0 per cent. The number of deaths dropped from 63 in ] 941 to 55 in 1942. INFLUENZA: There was a marked drop in the influenza death mte when 482 persons died from this disease in 1942 as compared with 994 in 1941. The rate dropped from 31.6 to 15.4 in 1942 or a rate decrease of 51.2 per cent. DYSENTERY: The deaths and death rates from this condition also show a decrease as 109 persons died in 1941 as compared with 86 in 1942. The rate dropped from 3.5 in 1941 to 2.8 in 1942 or 20.3 per cent. PoLIOMYELITIS: There was a marked decrease in .the number of deaths from 33 in 1941 to 10 in 1942. The rate dropped from 1.1 in 1941 to 0.3 in 1942 or 69.2 per cent. LETHARGIC ENCEPHALITIS: The deaths and death rates from this disease remained the same as five persons died in 1941 and also five in 1942. The Information and Statistics 313 death rate was ,the same for both years, 0.2, consequently no percent of increase or decrease. MENINGococcus MENINGITIS: The deaths and death rates remained practically the same, 'as 17 persons died in 1941 as compared with 18 in 1842, thus showing a slight increase of 5.6 per cent, the rate being 0.5 in 1941 against 0.6 in 1942. TuBERCULOSIS: The tuberculosis death xate shows a decrease with 1,385 deaths in 1941 against 1,265 in 1942. The death rate for 1941 was 44.0, decreasing to 40.5 in 1942, the mte being 8.0 per cent. SYPHILIS: There was a decrease in the death rate from syphilis from 503 in 1941 to 462 in 1942. The rate being 16.0 in 1941 against 14.8 in 1942 or 7.5 per cent. CANCER: The death rate for this disease remained practically the same with 2,139 deaths in 1941 compared with 2,120 in 1942. The rate 68.0 in 1941 and 67.9 in 1942 the rate of decrease being 0.2 per cent. DIABETES MELLITUS: There was a very slight decline in this disease from 376 deaths in 1941 to 370 in 1942 at the rate of 12.0 in 1941 to 11.8 in 1942 or 0.9 per cent. PELLAGRA: Shows a decrease of 10.6 per cent. The deaths in 1941 were 204 compared with 181 in 1942, the rate being 6.5 in 1941 to 5.8 in 1942. CEREBRAL HEMORRHAGE: There was a decline in the rate of deaths from cerebral hemorrhags. The rate for 1942 was 92.0 ,as compared to 96.4 in 1941. The number of deatns was 2,~73 as compared with 3,033 in 1941 or 4.6 per cent. HEART DISEASE: This is the lea :ling cause of death in Georgia as well as the nation. However, the death rate from this condition shows a decrease of 8.5 per cent, 'the mte for 1941 being 183.8 as compared with 168.1 in 1942. The number of deaths in 1941 was 5,780 and in 1942 it was 5,251. PNEUMONIA: Deaths due to pneumonia show a very slight decrease, the rate 'being 54.5 in 1941 against 51.6 in 1942. The number of deaths was 1,714 in 1941 and 1,612 in 1942. DIARRHEA AND ENTERIS UNDER 2 YEARS: The number of deaths from this condition decreased from 435 in 1941 to 284 in 1942. The rate de- in clined from 13.8 to 9.1 or 34.3 per cent. CIRRHOSIS OF LIVER: There was ,a very slight increase deaths due to this cause. The rate increased from 4.9 to 5.0 o.r 2.7 per cent. The number of deaths from 154 in 1941 to 157 in 1942. APPENDICITIS: There was a decrease in deaths due to appendicitis, the number being 230 in 1941 as compared with 174 in 1942. The rate was 7.3 in 1941 and 5.6 in 1942 or 23.8 per cent. NEPHRITIS: The deaths from this condition show a slight decrease, but it still stands second in the list of oouses of death in our State. The rate decreased from 107.5 in 1941 to 102.0 in 1942 or a decrease of 5.1 per 314 Georgia Department of Public Health cent. The number of deaths in 1941 was 3,381 in 1941 compared with 3,187 in 1942. MALFORMATION AND EARLY INFANCY DISEASES: The number of deaths from these causes decreased from 2,163 in 1941 to 2,020 in 1942. The rate declined from 68.8 to 64.7 or 6.0 per cent. SuiCIDE: The number of deaths from suicide decreased from 236 in 1941 to 219 in 1942 or a decrease in the rate of 6.5 per cent. HoMICIDE: There was a decrease in the number of deaths from homicide from 649 in 1941 to 519 in 1942. The rate decreased from 20.6 to 16.6 or 19.5 per cent. MoTOR VEHICLE AcciDENTS: There was a decrease in the number of motor vehicle deaths from 946 in 1941 to 673 in 1942. The rate decreased from 30.1 to 21.5 or a decline of 28.4 per cent. AcciDENTAL DEATHs (ExcLUSIVE OF AuTo AcciDENTS) : There was an increase in the number of accidental deaths from 1,262 in 1941 to 1,383 in 1942. The rate increased from 40.1 to 44.3 or 10.3 per cent. Information and Statistics 315 TABLE 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 AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIRTHS AND THE PERCENT INCREASE OR DECREASE IN THE RATES, IN GEORGIA: 1941 AND 1942 Cause of Death Number 1942 1941 ALL CAUSES 28,807 Typhoid fever --------------------- 24 Typhus fever --------------------- 52 Malaria --------------------------- 76 Smallpox -------------------------- Measles -------------------------- 60 Scarlet fever ---------------------- Whooping cough ------------------- 101 Diphtheria ------------------------ 55 Influenza ------------------------- 482 Dysentery ------------------------- 86 Poliomyelitis 10 Lethargic encephalitis _____________ 5 Meningococcus meningitis ___________ 18 Tuberculosis (aH fonns) ___________ 1,265 Syphilis 462 Canc0r ---------------------------- 2,120 Diabetes mellitus ----------------- 370 Pellagra -------------------------- 181 Cerebral hemorrhage, embolism and thrombosis --------------------- 2,873 Heart diseases --------------------- 5,251 Pneumonia ------------------------ 1,612 Diarrhea and enteritis (under 2 years) 284 Cirrhosis of liver ------------------- 157 Appendicitis ----------------------- 174 Nephritis -------------------------- 3,187 Malformation and early infancy diseases ----------------------- 2,020 Suicide --------------------------- 219 Homicide 519 Motor vehicle accidents __________ _ 673 All other accidents ________________ 1,383 Unknown and !!!-defined causes ____ _ 1,071 All other means ___________________ 4,015 31,579 55 36 75 157 140 63 994 109 33 17 1,385 503 2,139 376 204 3,033 5,780 1,714 435 154 230 3,381 2,163 236 649 946 1,262 1,026 4,270 Live births ------------------------ 72,189 St!llbirths ------------------------- 2,786 Infant mortality ------------------- 3,559 Maternal mortality ________________ _ 299 67' 785 2,903 3,955 315 Rate 1942 1941 922.2 0.8 1.7 2.4 1004.0 1.7 1.1 2.4 Per Cent Increase or Decrease - 8.1 - 56.3 + 45.6 + 1.3 1.9 5.0 61.5 0.1 0.3 - 78.6 3.2 4.5 - 27.4 1.8 2.0 - 12.0 15.4 31.6 - 51.2 2.8 3.5 - 20.3 0.3 1.1 - 69.2 0.2 0.2 0.6 0.5 + 5.6 40.5 44.0 8.0 14.8 16.0 7.5 67.9 68.0 0.2 11.8 12.0 0.9 5.8 6.5 10.6 92.0 168.1 51.6 9.1 5.0 5.6 102.0 96.4 183.8 54.5 13.8 4.9 7.3 107.5 4.6 8.5 5.3 - 34.3 + 2.7 - 23.8 5.1 64.7 7.0 16.6 21.5 44.3 34.3 128.5 23.1 38.6 49.3 4.1 68.8 7.5 20.6 30.1 40.1 32.6 135.8 21.6 42.8 58.3 4.6 6.0 6.5 - 19.5 28.4 + 10.3 + 5.1 5.4 + 7.2 9.9 - 15.5 - 10.8 NOTE: Figures exclude non-residents of Georgia and include births and deaths of Georgia residents occurring in other states. 316 Georgia Department of Public Health TABLE 2 DEATHS UNDER ONE YEAR OF AGE, MATERNAL DEATHS AND STILLBIRTHS WITH RATES PER 1,000 LIVE BIRTHS, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 192:> 1926 19:::7 ~- 1928 19~9 1930 19:H 1932 1933 1934 198:! 1936 1937 1938 1939 1940 1941 1942 Infant Mortality 5,305 4,905 4,937 5,384 5,674 4,704 4,405 4,578 4,875 4,464 4,113 4,234 4,097 4,079 5,086 4,316 4,319 3,968 4,352 3,817 3,737 3,955 3,559 Number Maternal Mortality 558 568 658 573 708 641 485 578 622 549 658 616 620 463 505 458 491 411 421 356 342 315 299 Stillbirths 3,389 3,820 3,862 3,958 3,864 3,455 2,972 3,836 3,478 3,541 3,796 3,678 3,847 3,700 4,120 3,987 3,666 3,671 3,390 3,228 3,078 2,903 2,785 Infant Mortality 88.3 73.9 75.9 84.5 89.5 78.9 87.2 73.5 80.9 76.3 78.1 68.5 64.3 67.2 18.1 68.2 70.1 62.0 61.1 58.8 57.8 58.3 49.3 Rate Maternal Mortality 9.3 8.6 10.1 9.0 11.2 10.8 9.6 9.3 10.3 9.4 10.9 10.0 9.1 1.6 7.8 7.2 8.0 1.4 6.5 5.5 5.3 4.6 4.1 Stillbirths 56.4 57.5 59.3 62.2 61.0 58.0 58.9 61.6 57.7 60.5 62.9 59.5 60.4 60.9 63.8 63.0 59.5 57.4 52.7 49.7 47.6 42.8 38.6 TABLE 3 BIRTHS AND DEATHS (EXCLUSIVE OF STILLBIRTHS) WITH RATES PER 1,000 POPULATION AND BIRTHS PER 100 DEATHS, IN GEORGIA: 1920--1942 Year Number Births Deaths Rate Births Deaths Births Per 100 Deaths 1920 1921 1922 1923 1924 1925 19:36 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1v:;s 1939 1940 1941 1942 ~ -------- -------------------------------------------------------------- ----------------~ ----------------- ---------- ----------------------------- ----------------- ---------- -------------------------- -- 60,061 66,378 65,082 63,681 63,386 59,610 50,493 62,246 60,259 58,521 60,318 61,774 63,690 60,744 64,615 63,290 61,617 64,012 64,307 64,910 64,695 67,785 72,189 32,243 29,552 31,114 34,082 34,797 31,278 29,906 31,869 36,085 35,340 35,188 32,989 32,122 31,184 35,590 34,313 31,293 34,411 33,617 31,856 32,285 31,579 28,807 20.7 11.1 186 22.9 10.2 225 22.5 10.9 20:i 22.0 11.8 187 21.8 12.0 182 20.5 10.8 191 17.4 10.3 169 21.4 11.0 195 20.7 12.4 167 20.1 12.2 166 20.7 12.1 111 21.0 11.2 137 21.5 10.8 198 20.4 10.5 195 21.5 11.8 182 20.9 11.3 184 20.2 12.2 165 20.8 11.2 186 20.7 10.8 191 20.8 10.2 204 20.7 10.3 200 21.6 10.0 215 23.1 9.2 251 Information and Statistics 317 TABLE 4 DEATHS UNDER ONE YEAR OF AGE, MATERNAL DEATHS, ILLEGITIMATE BIRTHS (EXCLUSIVE OF STILLBIRTHS) AND STILLBIRTHS WITH RATES PER 1,000 LIVE BIRTHS, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 192;, 1926 1927 1028 1929 1930 1931 1932 1933 1034 1935 1936 1937 1938 1939 1940 1941 1942 INFANT MORTALITY NUMBER RATE Total White Col. Total While Col. 5305 2961 2344 88.3 71.1 127.1 4905 2606 2299 73.9 58.5 105.3 4937 2509 2428 75.9 59.1 107.4 5384 2938 2446 84.5 58.4 108.3 5674 2989 2685 89.5 72.2 122.0 4704 2486 2218 78.9 65.0 103.9 4405 2299 2106 87.2 71.3 115.3 4:178 2334 2244 73.5 59.4 97.7 4875 2574 2301 80.9 67.5 104.0 4464 2343 2121 76.3 65.5 93.1 4713 2468 2245 78.1 66.6 96.5 4234 2137 2097 68.5 56.9 86.5 4097 2122 1975 64.3 55.5 17.5 4079 2119 1960 67.2 59.4 78 ..2 5086 2628 2458 78.7 68.6 93.5 4316 2227 2089 68.2 59.6 80.5 4319 2114 2205 70.1 58.2 87.2 3968 2014 1954 62.0 52.7 75.6 4352 2267 2085 67.7 58.7 81.1 3817 1960 1857 58.8 50.4 71.5 3737 1851 1886 57.8 47.6 73.1 3955 1988 1967 58.3 48.2 74.2 3559 1756 1803 49.3 38.9 66.8 MATERNAL MORTALITY NUMBER RATE Total White Col. Total White Col. 558 267 291 9.3 6.4 15.8 568 266 302 8.6 6.0 13.8 658 316 342 10.1 7.4 15.1 573 288 285 9.0 7.0 12.6 708 362 346 11.2 8.7 15.7 641 299 342 10.8 7.8 16.0 485 222 263 9.6 6.9 14.4 578 291 287 9.3 7.4 12.5 622 312 310 10.3 8.2 14.0 549 284 265 9.4 7.9 11.6 658 361 297 10.9 9.7 12.8 616 322 294 10.0 8.6 12.1 620 310 310 9.7 8.1 12.2 463 227 236 7.6 6.4 9.4 505 262 243 7.8 6.8 9.2 458 230 228 7.2 6.2 8.8 491 251 240 8.0 6.9 9.5 471 240 231 7.4 6.3 8.9 421 198 223 6.5 5.1 8.7 356 175 181 5.5 4.5 7.0 342 146 196 5.3 3.8 7.6 315 133 182 4.6 3.2 6.9 299 146 153 4.1 3.2 5.7 Year 1920 1921 1922 1923 u924 1925 "1926 l927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 ILLEGITIMATE BIRTHS NUMBER RATE Total White Col. Total White Col. 2695 474 2221 44.9 11.4 120.4 3077 516 2561 46.4 11.6 117.4 3606 500 3106 55.4 11.8 137.4 4045 543 3502 63.5 13.2 155.0 4089 574 3515 64.5 13.9 159.7 4014 534 3480 67.3 14.0 163.0 3155 461 2694 62.5 14.3 147.5 4089 637 3452 65.7 16.2 150.3 3868 482 3386 64.2 12.6 153.0 4061 515 3546 69.4 14.4 155.7 4141 512 3629 68.7 13.8 156.1 4429 547 3882 71.7 14.6 160.1 5125 600 4525 80.5 15.7 177.6 5101 582 4519 84.0 16.3 180.4 5089 651 4438 78.8 17.0 168.9 5031 643 4388 79.:\ 17.2 169.1 4878 598 4280 79.2 16.5 169.2 4739 526 4213 74.0 13.8 163.1 4724 580 4144 73.5 15.0 161.3 4960 596 4364 76.4 15.3 167.9 5046 565 4481 78.0 14.5 173.8 5134 607 4527 75.7 14.7 170.8 5038 578 4460 69.8 12.8 165.2 STILLBIRTHS NUMBER RATE Total White Col. Total White Col. 3389 3820 3862 3958 3864 3455 2972 3836 3478 3541 3796 3678 3847 3700 4120 3987 3666 3677 3390 3228 3078 2903 2786 1608 1720 1716 1802 1675 1435 1246 1604 1335 1374 1454 1424 1492 1382 1673 1532 1457 1499 1386 1337 1326 1276 1268 1781 2100 2146 2156 2189 2020 1726 2232 2143 2167 2342 2254 2355 2318 2447 2455 2209 2178 2004 1891 1752 1627 1518 56.4 57.5 59.3 62.2 61.0 58.0 58.9 61.6 57.7 60.5 62.9 59.5 60.4 60.9 63.8 63.0 59.5 57.4 52.7 49.7 4 7.6 42.8 38.6 38.6 38.6 40.4 43.9 40.5 37.5 38.7 40.8 35.0 38.4 39.2 37.9 39.0 38.7 43.6 41.0 40.1 39.3 35.9 34.3 34.1 30.9 28.1 96.6 96.2 94.9 95.4 99.5 94.6 94.5 97.2 96.6 95.2 100.7 93.0 92.4 92.5 93.1 94.6 87.3 84.3 78.0 72.8 67.9 61.4 56.2 318 Georgia Department of Public Health DEATHS AND BIRTHS (EXCLUSIVE OF STILLBIRTHS) AND RATES PER 1,000 PoPULATION, IN GEORGIA: 1920-1942 BIRTHS NUMBER RATE Year Total White Col. Total White Col. 1920 60061 41618 18443 20.7 24.5 1921 66378 44555 21823 22.9 26.0 1922 65082 42475 22607 22.5 24.6 1923 63681 41088 22593 22.0 23.6 1924 63386 41379 22007 21.8 23.6 1925 59610 38254 21356 20.5 21.6 1926 50493 32226 18267 17.4 18.1 1927 62246 39281 22965 21.4 21.9 1928 60259 38135 22124 20.7 21.0 1929 58521 35751 22770 20.1 19.6 1930 60318 37064 23254 20.7 20.1 1931 61774 37531 24243 21.0 20.4 1932 63690 38209 25481 21.5 20.4 1933 60744 35692 25052 20.4 18.8 1934 64615 38333 26282 21.5 20.1 1935 63290 37345 25945 20.9 19.4 1936 61617 36320 25297 20.2 18.7 1937 64012 38181 25831 20.8 19.4 1938 64307 38613 25694 20.7 19.5 1939 64910 38923 25987 20.8 19.5 1940 64695 38911 25784 20.7 19.1 1941 67785 41277 26508 21.6 20.1 1942 72189 45192 26997 23.1 22.2 15.4 18.4 19.3 19.5 19.2 18.8 16.3 20.7 20.2 21.1 21.7 22.5 23.5 23.0 24.0 23.6 22.9 23.2 23.0 23.1 23.8 24.4 24.9 DEATHS NUMBER RATE Total White Col. Total White Col. 32243 29552 31714 34082 34797 31278 29906 31869 36085 35340 35188 32989 32122 31184 35590 34313 37293 34411 33617 31856 32285 31579 28807 17212 15439 16540 17763 17750 15860 15141 16230 18642 18245 18036 17012 16813 16847 19157 18677 20156 18493 18109 17486 17313 16717 15820 15031 14113 15174 16319 17047 15418 14765 15639 17 443 17095 17152 15977 15309 14337 16433 15636 17137 15918 15508 14370 14972 14862 12987 11.1 10.2 10.9 11.8 12.0 10.8 10.3 11.0 12.4 12.2 12.1 11.2 10.8 10.5 11.8 11.3 12.2 11.2 10.8 10.2 10.3 10.0 9.2 10.1 9.0 9.6 10.2 10.1 9.0 8.5 9.0 10.3 10.0 9.8 9.2 9.0 8.9 10.0 9. 7 10.4 9.4 9.1 8.7 8.5 8.1 7.8 12.5 11.9 12.9 14.1 14.9 13.6 13.2 14.1 15.9 15.8 16.0 14.8 14.1 13.2 15.0 14.2 15.5 14.3 13.9 12.8 13.8 13.7 12.0 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 TYPHOID NUMBER RATE Total White Col. Total White Col. 549 274 275 19.0 16.2 22.9 798 351 447 27.5 20.5 37.7 714 326 388 24.6 18.9 33.1 601 244 357 20.7 14.0 30.8 681 292 389 23.5 16.7 33.9 675 264 411 23.3 14.9 36.2 519 191 328 17.9 10.7 29.3 653 285 368 22.5 15.9 33.2 444 182 262 15.3 10.0 23.9 340 140 200 11.7 7. 7 18.5 500 207 293 17.2 11.2 27.3 513 201 312 17.5 10.8 28.9 363 133 230 12.3 7.1 21.2 251 105 146 8.4 5.5 13.4 316 110 206 10.5 5.8 18.8 261 100 161 8.6 5.2 14.6 195 68 127 6.4 3.5 11.5 139 54 85 4.5 2.7 7.6 121 51 70 3.9 2.6 6.2 83 38 45 2. 7 1.9 4.0 68 27 41 2.2 1.3 3.8 55 22 33 1.7 1.1 3.0 24 6 18 0.8 0.3 1.7 TYPHUS FEVER NUMBER RATE Tctal White Col. Total White Col. 2 2 2 2 2 3 1 0.1 0.1 0.1 0.1 0.1 0.1 0.1. 0.1 0.2 0.03 0.1 10 8 2 o.3 o.5 q_2 6 2 4 0.2 0.1 0.4 1 1 0.03 0.1 9 0.3 0.4 0.1 7 0.2 0.3 0.2 4 4 0.3 0.2 0.4 29 26 3 1.0 1.4 0.3 28 21 0.9 1.1 0.6 28 23 5 0.9 1.2 0.5 44 35 1.4 1.8 0.8 54 43 11 1.8 2.2 1.0 47 33 14 1.5 1. 7 1.3 44 39 5 1.4 2.0 0.4 26 18 0.8 0.9 0. 7 36 27 9 1.1 1.3 0.8 52 40 12 1.7 2.0 1.1 Information and Statistics 319 DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, BY COLOR, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 MALARIA NUMBER RATE Total White Col. Total White Col. 559 242 317 19.3 14.3 26.4 468 195 273 16.2 11.4 23.0 584 256 328 20.2 14.8 27.9 489 201 288 16.9 11.6 24.8 440 181 259 15.2 10.3 22.6 28G 102 183 9.8 5.8 16.1 288 107 181 9.9 6.0 16.2 296 113 183 10.2 6.3 16.5 582 253 329 20.0 14.0 30.1 677 322 355 23.3 17.6 32.8 442 186 256 15.2 10.1 23.9 307 119 188 10.5 6.5 17.4 316 136 180 10.7 7.2 16.6 364 193 171 12.2 10.2 15.7 418 212 206 13.9 11.1 18.8 387 186 211 12.8 9.1 19.2 606 321 285 19.8 16.5 25.7 235 113 122 7.6 5.8 11.0 146 63 83 4.7 3.2 7.4 101 40 61 3.2 2.0 5.4 89 35 54 2.8 1.1 5.0 75 29 46 2.4 1.4 4.2 16 24 52 2.4 1.2 4.8 MEASLES NUMBER RATE Total White Col. Total White Col. 61 41 20 2.1 2.4 1.7 93 66 27 3.2 3.9 2.3 2 3 0.2 0.1 0.3 347 252 95 12.0 14.5 8.2 550 359 191 19.0 20.5 16.7 11 4 1 0.4 0.2 0.6 58 43 15 2.0 2.4 1.3 105 79 26 3.6 4.4 2.4 143 106 37 4.9 5.9 3.4 31 26 1.1 1.4 0.5 128 94 34 4.4 5.1 3.2 62 37 25 2.1 2.0 2.3 15 6 9 0.5 0.3 0.8 72 50 22 2.4 2.6 2.0 540 401 139 18.0 21.0 12.7 25 15 10 0.8 0.8 0.9 8 5 3 0.3 0.3 0.3 10 8 2 0.3 0.4 0.2 157 118 39 5.1 6.0 3.5 51 24 27 1.6 1.2 2.4 23 14 9 0.7 0.7 0.8 157 94 63 5.0 4.6 5.8 60 23 37 1.9 1.1 3.4 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 SCARLET FEVER NUMBER RATE Total White Col. Total White Col. 32 31 28 25 24 20 20 17 20 16 11 8 13 12 25 20 36 29 40 33 38 33 46 38 19 17 19 19 17 16 23 21 14 11 11 10 13 11 19 16 16 15 9 8 2 1.1 1.8 0.1 3 1.0 1.5 0.3 4 0.8 1.2 0.3 3 0.7 1.0 0.3 0.1 0.9 0.4 0.4 0.5 0.3 0.5 0.1 0.1 0.9 1.1 0.5 1.2 1.6 0.6 1.4 1.8 0.6 5 1.3 1.8 0.5 8 1.6 2.0 0.7 0.6 0.9 0.2 0.6 1.0 1 0.6 0.8 0.1 2 0.8 1.1 0.2 0.5 0.6 0.3 0.4 0.5 0.1 2 0.4 0.6 0.2 3 0.6 0.8 0.3 0.5 0.1 0.1 0.3 0.4 0.1 0.1 0.1 WHOOPING COUGH NUMBER RATE Total White Col. Total White Col. 373 240 133 12.9 14.2 11.1 183 93 90 6.3 5.4 7.6 130 51 79 4.5 3.0 6.7 254 116 138 8.8 6.7 11.9 435 203 232 15.0 11.6 20.2 313 167 146 10.8 9.4 12.9 141 74 67 4.9 4.2 6.0 229 118 111 7.9 6.6 10.0 163 99 64 5.6 5.5 5.9 280 171 109 9.6 9.4 10.1 257 121 136 8.8 6.6 12.7 113 59 54 3.8 3.2 5.0 112 52 60 3.8 2.8 5.5 223 116 107 7.5 6.1 9.8 334 169 165 11.1 8.8 15.1 149 77 72 4.9 4.0 6.5 61 30 37 2.2 1.5 3.3 142 75 61 4.6 3.8 6.0 225 112 113 7.3 5.7 10.1 134 61 73 4.3 3.1 6.5 108 52 56 3.5 2.6 5.2 140 69 71 4.5 3.4 6.5 101 35 66 3.2 1.7 6.1 320 Georgia Department of Public Health DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAusEs, BY CoLOR, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 DIPHTHERIA NUMBER RATE Total White Col. Total White Col. 401 283 118 13.8 16.7 9.8 415 294 121 14.3 17.2 10.2 411 277 134 14.2 16.1 11.4 274 199 75 9.5 11.4 6.5 230 167 63 7.9 9.5 5.5 185 119 66 6.4 6. 7 5.8 251 199 52 8.6 11.2 4.6 272 187 85 9.4 10.4 7.7 240 117 63 8.3 9.8 5.8 183 139 44 6.3 7.6 4.1 135 102 33 4.6 5.5 3.1 158 122 36 5.4 6.6 3.3 169 139 30 5.7 7.4 2.8 187 152 35 6.3 8.0 3.2 188 152 36 6.3 8.0 3.3 161 116 45 5.3 6.0 4.1 123 83 40 4.0 4.3 3.6 108 66 42 3.5 3.4 3.8 106 74 32 3.4 3.7 2.9 95 65 30 3.0 3.3 2.7 59 44 15 1.9 2. 2 1.4 63 36 27 2.0 1.7 2.5 55 42 13 1.8 2.1 1.2 INFLUENZA NUMBER RATE Total White Col. Total White Col. 2581 278 1014 1500 886 1384 1493 971 2041 2543 964 1301 1170 1237 1009 1357 1842 1436 802 950 924 994 482 1516 159 615 880 512 773 800 480 1204 1450 532 703 694 694 563 781 1058 739 393 495 503 483 200 1065 119 399 620 374 611 693 491 837 1093 432 598 476 543 446 576 784 697 409 455 421 511 282 89.1 9.6 35.0 51.7 30.5 47.7 51.4 33.4 70.2 87.5 33.1 44.3 39,::; 41.5 33.6 44.8 60.3 46.7 25.9 30.4 29.6 31.6 15.4 89.4 9.3 35.7 50.6 29.2 43.7 44.9 26.7 66.5 79.4 28.9 37.8 37.0 36.6 29.5 40.5 54.4 37.6 19.8 24.8 24.7 23.5 9.8 88.7 10.0 34.0 53.4 32.6 53.9 61.8 44.3 76.5 101.1 40.3 55.4 43.9 49.8 40.7 52.3 70.8 62.6 36.6 40.5 38.8 47.0 26.0 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 DYSENTERY NUMBER RATE Total White Col. Total White Col. 110 116 54 5.9 6.8 4.5 146 88 58 5.0 5.1 4.9 112 69 43 3.9 4.0 3.7 151 90 61 5.2 5.2 5.3 187 104 83 6.5 5.9 7.2 194 119 75 6.7 6.7 6.6 207 129 78 7.1 7.2 7.0 277 172 105 9.5 9.6 9.5 304 189 115 10.5 10.4 10.5 204 99 105 7.0 5.4 9.7 305 158 147 10.5 8.6 13.7 177 86 91 6.0 4.6 8.4 141 85 56 4.8 4.5 5.2 153 86 67 5.1 4.5 6.1 219 123 96 7.3 6.4 8.8 163 86 77 5.4 4.5 7.0 156 78 78 5.1 4.0 7.0 130 61 63 4.2 3.4 5.7 192 107 85 6.2 5.4 7.6 127 65 62 4.1 3.3 5.5 126 67 59 4.0 3.3 5.4 109 52 57 3.5 2.5 5.2 86 43 43 2.8 2.1 4.0 TUBERCULOSIS (ALL FORMS) NUMBER RATE Total White Col. Total White Col. 2362 2531 2683 2642 2620 2448 2278 2307 2375 2190 2115 2165 1933 1111 1172 ,1131 1713 1549 1612 1533 1533 1385 1265 882 1480 81.6 52.0 123.3 892 1639 87.4 52.1 138.1 991 1692 92.6 57.4 144.2 965 1677 91.1 55.5 144.5 911 1703 90.3 52.3 148.4 872 1576 84.4 49.3 1:39.0 807 1471 rs.::; 4o.3 131.2 798 1509 79.4 44.4 136.2 832 1543 81.7 45.9 141.0 742 1448 75.3 40.6 133.9 774 1401 74.6 42.0 130.6 700 1465 73.7 37.7 135.8 665 1268 63.3 35.4 116.9 675 1102 59.6 33.6 101.1 605 1167 58.9 31.7 106.5 649 1082 57.1 33.6 98.2 648 1065 56.1 33.3 96.2 559 990 50.3 28.5 89.0 602 1010 52.0 30.4 90.3 543 990 49.1 27.2 88.1 544 989 49.1 26.7 91.2 501 884 44.0 24.3 81.3 465 8()0 40.5 22.8 73.7 Information and Statistics 321 .CEATHS AND DEATH RATES PER 100,000 PoPULATION FRoM SPECIFIED CAUSES, BY COLOR, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 SYPHILIS NUMBER RATE Total White Col. Total White Col. 2114 34 170 7.0 2.0 14.2 296 56 240 10.2 3.3 20.2 421 70 351 14.5 4.1 29.9 371 73 298 12.8 4.2 25.7 425 81 344 14.7 4.7 30.0 454 72 382 15.6 4.1 33.7 409 59 350 14.1 3.3 31.2 4:i7 65 392 15.7 3.6 35.4 494 100 394 17.0 5.5 36.0 461 82 379 15.9 4.5 35.0 429 77 352 14.7 4.2 32.8 413 54 359 14.1 2.9 33.2 425 73 352 14.4 3.9 32.5 391 57 334 13.1 3.0 30.6 444 87 357 14.8 4.6 32.6 403 85 318 13.3 4.4 28.9 444 77 367 14.5 4.0 33.2 496 96 400 16.1 4.9 35.9 478 77 401 15.4 3.9 35.9 473 61 412 15.1 3.1 36.7 587 127 460 18.8 6.2 42.4 503 110 393 16.0 5.3 36.2 462 97 365 14.8 4.8 33.6 Year 1920 1921 1922 1923 1924 1923 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 DIABETES MELLITUS NUMBER RATE Total White Col. Total White 182 139 43 6.3 8.2 202 144 58 7.0 8.4 255 182 73 8.8 10.6 249 182 67 8.6 10.5 247 161 86 8.5 9.2 234 174 60 8.1 9.8 223 138 8:; 1.1 1.1 259 177 82 8.9 9.9 329 227 102 11.3 12.5 302 201 101 10.4 11.0 352 240 112 12.1 13.0 322 224 98 11.0 12.1 343 260 83 11.6 13.9 349 241 108 11.7 12.7 389 275 114 12.9 14.4 388 297 91 12.8 15.4 391 299 92 12.8 1:).4 392 281 111 12.7 14.3 420 311 109 13.'i 1:>. 7 368 247 121 11.8 12.4 349 2'>8 91 11.2 12.7 376 278 98 12.0 13.5 370 27;) 93 11.8 13.:> Col. 3.6 4.9 6.2 5.8 7.5 5.3 7.6 7.4 9.3 9.3 10.4 9.1 7. 7 9.9 10.4 8.:; 8.3 10.0 9. 7 10.8 8.4 9.0 8.8 CANCER NUMBER RATE Total White Col. Total White Col. 1124 1210 1212 1263 1393 1311 1257 1470 1510 14:)6 1332 1580 l'i31 1647 1762 1715 1751 1797 1929 2003 19'\9 2139 2120 766 803 782 870 913 891 860 995 1013 988 1105 1106 1052 1213 1272 12:l9 1239 1320 1343 1426 1380 1473 1509 358 38.8 4:>.2 407 41.8 46.9 430 41.8 45.3 393 43.6 50.0 480 48.0 52.1 420 45.2 50.4 397 43.3 48.2 475 50.6 35.4 497 52.0 55.9 468 50.1 :i4.1 447 53.3 60.0 474 53.8 59.5 479 51.7 56.1 434 55.2 64.0 490 58.6 66.5 476 56.6 64.2 512 :)7.3 63.7 477 58.4 67.2 586 62.2 67.8 577 64.1 71.3 579 62.7 67.7 666 68.0 71.6 611 67.9 74.0 29.8 34.3 36.6 33.9 41.8 37.0 35.4 42.9 45.4 43.3 41.7 43.9 44.2 39.8 44.7 43.2 46.3 42.9 52.4 51.3 53.4 61.3 56.3 PELLAGRA NUMBER RATE Total White Col. Total White Col. 432 210 222 14.9 12.4 18.5 512 234 278 17.7 13.7 23.4 527 249 278 18.2 14.4 23.7 444 227 217 15.3 13.1 18.7 337 181 1:i6 11.6 10.3 13.6 366 181 185 12.6 10.2 16.3 42:; 22J 200 14.6 12.6 17.8 617 292 325 21.2 16.3 29.3 846 358 488 29.1 19.8 44.6 871 334 537 30.0 18.3 49.7 71:l 23::i 458 24.5 13.8 42.7 563 192 371 19.2 10.3 34.4 492 20j 287 16.6 10.9 26.'i 421 179 242 14.1 9.5 22.2 3;;1 163 188 11.7 8.5 17.2 365 190 175 12.0 9.9 15.9 391 184 207 12.8 9.5 18.7 370 17'\ 19') 12.0 8.9 17.3 36;; 170 195 11.8 8.6 17.4 271 134 137 8.7 6.7 12.2 23:1 118 117 7.'J 5.8 10.8 204 106 98 6.5 :u 9.11 181 10! 77 ;1,8 :i.l 7.1 322 Georgia Department of Public Health DEATHS AND DEATH RATES PER 100,000 PoPULATION FRoM SPECIFIED CAusEs, BY CoLoR, IN GEoRGIA: 1920-1942 Year 1B20 1!!21 1922 1923 1924 1&25 1926 1927 1928 1929 1930 19:11 1932 1933 1934 19a5 1936 1937 1938 1939 1940 1941 1942 CEREBRAL HEMORRHAGE NUMBER RATE Total White Col. Total White Col. 1336 1449 1563 1724 1766 1995 2006 21il 2394 2299 2:\23 2340 2382 2159 2310 2410 2638 2636 2727 3048 3035 3033 2873 807 839 887 1002 963 1044 1078 1195 1297 1257 1317 1256 1269 1195 1222 1337 1425 1444 1465 1598 1574 1513 1538 529 610 676 722 803 951 928 976 1097 1042 1206 1084 1113 964 1088 1073 1213 1192 1262 1450 1461 1520 1335 46.1 50.0 53.9 59.5 60.9 68.7 69.1 74.7 82.4 79.1 86.6 79.7 80.5 72.4 76.8 79.5 86.4 85.7 88.0 97.6 97.2 96.4 92.0 47.6 49.0 51.4 57.6 54.9 59.0 60.5 66.5 71.6 68.8 71.5 67.6 67.6 63.1 63.9 69.3 73.2 73.5 73.9 79.9 77.2 73.5 75.5 44.1 51.4 37.6 62.2 70.0 83.9 82.8 88.1 100.2 96.3 112.4 100.5 102.6 88.4 99.3 97.4 109.6 107.1 112.8 129.0 134.6 139.9 123.0 HEART DISEASE NUMBER RATE Total White Col. Total White Col. 1892 1768 1996 2388 2424 2297 2429 2929 :1307 3691 4099 3948 4102 3993 5019 5071 5606 5284 5246 5417 6176 5780 5251 1053 923 1953 1186 1165 1077 1198 1497 1717 1923 21119 2101 2308 2360 2!!111 2961 3270 3132 3059 3240 3662 3316 3165 839 65.3 62.1 845 61.0 54.0 943 68.9 61.0 1202 82.3 68.2 1259 83.5 !Hi A 1220 79.1 (i().!J 1231 83.7 (i7 .2 1432 100.!! s:1.:1 1590 113.8 !14.8 1768 126.9 10:1.:1 1990 140.6 114.:J 1847 134.4 u:;.o 1794 138.6 12:!.11 1633 133.8 12Ui 2118 166.9 1;-)J .X 2110 167.3 J:i:l.:J 2336 183.6 168.0 2152 111.7 lti!),j 2187 169.2 134.4 2177 173.5 162.1 2514 197.7 17!1.6 2464 183.8 161.1 2086 168.1 1:-i:J.:; 6!1.!1 '1.2 811.3 1113.6 I 11!1.7 1117.1i 111!1. 8 1~:1.:1 l4:J.:I Hi:l.:i 18:1.1 J7U J!i;i ..i li!I.S 1 u:L:; l!ll.li 211.0 JU3.4 I!IG.Ii I !1:1.7 2:ll.7 2~(i.7 JH2.2 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 PNEUMONIA NUMBER RATE Total White Col. Total White Col. 2766 1925 2664 3199 2922 2335 2442 2132 2776 2316 2580 2465 2444 2314 3030 3035 3803 3077 2731 22(!9 2055 1714 1612 1470 1050 1447 1596 1382 1135 1180 1015 1441 1165 1240 1255 1204 1172 1580 1572 2012 1490 1321 1209 1019 800 737 1296 875 1217 1603 1540 1200 1262 1117 1335 1151 1340 1210 1240 1142 1450 1463 1791 1587 1410 1090 1036 914 87f) 95.5 66.4 91.9 110.3 100.7 80.5 84.1 73.4 95.5 79.6 88.5 83.9 82.5 77.6 100.8 100.2 124.6 100.0 88.1 73.6 65.8 54.5 :il.6 86.7 61.4 83.9 91.8 78.8 64.2 66.2 56.5 79.5 63.8 67.4 67.5 64.1 61.9 82.7 81.5 103.4 75.9 66.< 60.5 50.0 38.9 36.2 108.0 73.7 103.7 138.1 134.2 105.8 112.6 100.8 122.0 106.4 124.9 112.2 114.3 104.8 132.3 132.9 161.8 142.6 126.1 97.0 9:>.:i 84.1 80.6 DIARRHEA AND ENTERITIS (UNDER 2 YEARS) NUMBER RATE Total White Col. Total White Col. 1252 759 493 43.2 44.7 41.1 1230 722 508 42.5 42.2 42.H 1175 686 489 40.5 39.8 41.7 1183 698 485 40.8 40.1 41.8 1:122 736 586 4o.6 12.11 :; 1.1 !149 510 439 32.7 28.8 3H.7 873 462 411 30.1 25.!1 ::li.7 810 440 370 27.!1 2cl.:) :::1.1 730 434 296 2:\.1 24.11 2<'.11 :i26 292 234 18.1 16.0 2Ui 721 453 268 24.7 24.6 2:i.O 54:i 291 2;,4 18.6 1:i.7 2:1.:; 3!10 254 136 13.2 1:J.:J 12.5 493 324 169 16.:i 17.1 l:J.:> 651 378 273 21.7 1!1.8 24.9 ;)07 :lOS 199 16.7 16.0 18.1 :149 3G:J 246 18.0 1:i.(i 22.2 480 247 233 1:1.6 12.6 20.9 fiHl 38:) :J06 22.3 19.4 27.1 416 217 1!19 13.3 10.9 17.7 395 21J 180 12.6 10.6 16.6 43:> 218 217 1:3.8 10.6 20.0 284 138 146 9.1 6.8 13.:i 1nformation and Statistics 323 DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAusEs, BY CoLOR, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 1920> 1926 1927 1928 1929 1930 1931 1932 1!133 1934 1935 1936 19:l7 1938 1939 1940 1941 1942 APPENDICITIS NUMBER RATE Total White Col. Total White 236 152 84 8.2 9.0 276 190 86 9.5 11.1 300 208 92 10.4 12.1 281 183 98 9.7 10.5 318 210 108 11.0 12.0 357 212 145 12.3 12.0 289 178 Ill 10.0 10.0 330 211 119 11.4 11.7 364 236 128 12.5 13.0 3:;o 228 102 11.3 12.5 333 211 122 11.4 11.5 H7 234 113 11.8 12.6 358 2tiil 103 12.1 13.6 :J23 218 105 10.8 1 Ui 339 226 113 11.3 11.8 300 202 98 9.9 10.5 312 201 111 10.2 10.3 319 2:l0 89 10.4 11.7 287 194 93 9.3 9.8 280 186 94 9.0 9.3 276 159 117 8.8 7.8 230 135 95 7.3 6.6 174 102 72 5.6 'i.O Col. 7.0 ';',3 7.8 8.4 9.4 12.8 9.9 10.7 11.7 9.4 11.4 I O.:i 9.5 9.6 10.3 8.9 10.0 8.0 8.3 8.4 10.8 8.7 6.6 NEPHRITIS (ACUTE AND CHRONIC) NUMBER RATE Year Tctal White Col. Total White Col. 1920 1921 1922 1923 1924 1923 1926 1927 1928 1929 1930 19:11 1932 1933 19:14 1935 1936 1937 1938 1939 1940 1941 1942 2200 2446 2903 3139 3449 3228 3385 3620 4105 4003 3787 :1226 3216 3118 3:J01 315;; 3446 3458 :J:i31 3041 3:l48 :1381 3187 1258 1:147 1592 1684 1787 1715 1721 1970 2162 2187 2060 1794 1753 1769 1903 1803 1910 1919 1996 1771 1848 1816 1766 942 1099 1311 1455 1662 1513 1664 1650 1943 1816 1727 1432 1463 1349 1398 1352 1536 1539 153'\ 1270 1o00 1'i6:i 1421 76.0 84.4 100.1 108.2 118.9 111.2 116.6 124.6 14U 137.7 129.9 109.8 108.6 104.'\ 109.8 104.1 112.9 112.4 113.9 97.4 107.2 107.'\ 102.0 74.2 78.7 92.3 96.8 101.9 97.0 96.5 109.6 119.3 119.8 111.9 96.5 93.4 93.4 99.6 93.5 98.1 97.7 100.7 88.6 !10.7 88.2 86.6 78.5 92.6 111.7 12:i.4 144.9 133.4 148.4 148.9 17Ui 167.9 160.9 132.8 134.9 !23.8 127.6 122.8 138.8 138.3 1:l7.3 113.0 138.2 144.0 130.9 CIRRHOSIS OF LIVER NUMBER RATE Tctal White Col. Total White Col. 93 61 83 52 78 43 90 54 98 69 117 77 99 62 12!) 75 102 61 128 74 134 80 124 87 91 61 116 73 110 73 142 97 139 87 151 95 141 100 Ia2 111 14:i 102 154 110 157 123 32 3.2 3.6 2.7 31 2.9 3.0 2.6 35 2.7 2.5 3.0 36 3.1 3.1 3.1 29 3.4 3.9 2.:;. 40 4.0 4.4 3Ji 37 :l.4 3.3 3.3 50 4.3 4.2 4.a 41 3.5 3.4 3.8 :i4 4.4 4.1 ;;.o 54 4.6 4.3 :>.0 37 4.2 4.7 3.4 30 3.1 3.3 2.8 43 3.9 3.9 :1.9 :n 3. 7 3.8 3.4 45 4. 7 5.0 4.1 52 4.6 4.;) 4. 7 56 4.9 4.8 5.0 41 4.'\ 5.0 3. 7 41 4.9 5.6 3.6 43 4.6 ;;.o 4.0 44 4.9 a.3 4.0 34 5.0 6.0 3.1 MALFORMATION, EARLY INFANCY NUMBER RATE Total White Col. Total White Col. 1878 2480 2842 2878 2995 20>26 2239 2192 180>9 17 42 1890 1827 1662 1639 1904 1736 1797 1663 2431 2150> 2034 216:l 2020 1245 1446 1505 1636 1674 1434 1251 1244 1132 1050 118a 1111 1024 994 1126 1076 1064 1028 1289 1199 1098 1206 n:;; 633 64.8 1034 85.6 1337 98.4 1242 99.2 1321 103.2 1092 87.0 988 77.1 948 7'\.r; 727 64.0 692 :\9.9 70:i 64.8 716 62.2 638 56.1 645 :i4.9 778 63.3 660 !l'i".:J 73:J ii8.8 6:1:J :>4.1 1142 78.4 956 69.0 936 65.1 957 68.8 883 64.7 73.4 84.5 87.2 94.0 95.4 81.1 70.2 69.:i 62.'\ Oi7.5 64.3 59.7 54.6 52.:i 58.9 5:J.S 54.7 52.3 65.1 60.0 53.9 58.6 5ii.S :i2. 7 87.1 113.!1 107.0 .I,I!i.1 96.:1 88.1 8'\.6 66.4 64.0 65.7 66.4 ;;s.x :i!l.2 71.0 ri9.H 66.2 57.1 102.1 8'\.1 86.~ 88.1 81.3 324 Georgia Department of Public Health DEATHs AND DEATH RATES PER 100,000 PoPuLATION FROM SPECIFIED CAusEs, BY CoLOR, IN GEORGIA: 1920-1942 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 19~1 1932 1933 1934 1!13:0 19H6 1!1:H u1:1s 1939 1940 1941 1942 Year 1921) 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 193:) 1936 1937 1938 1939 19411 1941 1942 SUICIDE NUMBER RATE Total White Co!. Total White Col. 128 110 18 4.4 6.a 1.;) 167 142 25 5.8 8.3 2.1 181 152 29 6.2 8.8 2.5 166 150 16 5.7 8.6 1.4 19;j 173 22 6.7 9.9 1.9 189 169 20 6.:0 9.6 1.8 1:04 134 20 5.3 7.5 1.8 198 179 19 6.8 10.0 1.7 24:1 210 33 8.4 11.6 :l.O 287 268 19 9.9 14.7 1.8 296 27:! 2:1 10.2 14.8 2.1 31:; 282 31 10.7 15.2 2.9 304 279 25 10.3 14.9 2.3 :n2 276 36 10.5 14.6 3.3 2H7 26:1 32 9.9 13.9 2.9 300 270 30 9.9 14.0 2.7 311 284 27 10.2 14.6 2.4 315 288 27 10.2 14.7 2.4 29;; 266 29 9.5 13.4 2.6 316 290 26 10.1 14.5 2.:l 282 246 36 9.0 12.1 3.3 2:16 212 24 7.'i 10.3 2.2 219 20:1 16 7.0 10.0 1.;) MOTOR VEHICLE ACCIDENTS NUMBER RATE Total White Col. Total White Col. 140 100 40 4.8 5.9 3.3 132 108 24 4.6 6.3 2.0 203 142 61 7.0 8.2 5.2 267 189 78 9.2 10.9 6.7 31:1 239 74 10.8 13.6 6.5 348 238 110 12.0 13.5 9.7 370 266 104 12.7 14.9 9.3 483 288 14'i 14.9 16.0 13.1 473 319 Li4 16.3 17.6 14.1 G:H 33;, 196 18.3 18.3 18.1 612 425 187 21.0 23.1 17.4 655 428 227 22.3 23.0 21.0 :-18:-i 426 159 19.7 22.7 14.7 6Fi 47:1 202 22.6 25.0 18.'i 809 574 23'i 26.9 30.0 21.4 942 646 296 31.1 33.:i 26.9 991 692 299 32.4 35.'i 27.0 964 680 284 31.3 34.6 2:-i ..) 789 !)45 244 2fi.4 27.S 21.8 669 483 186 21.4 24.2 16.5 802 ;);)6 246 25.7 27.3 22.7 946 6:)i 289 311.1 31.!1 2.6 67:1 47-1 1!19 21.5 23.3 18.3 HOMICIDE NUMBER RATE Total White Col. Total White Col. 479 100 379 16.5 5.9 31.6 a49 143 406 19.0 8.4 34.2 564 146 418 19.G 8.:i 3G.6 505 12:1 380 17.4 7.2 32.7 :>62 15;:) 407 19.4 8.8 3a.5 464 141 323 16.0 8.0 28.3 395 97 298 13.6 5.4 26.1i ;)10 141 369 17.6 7.9 '!13.3 :)12 159 3:i3 17.6 8.8 32.3 :J2:l 14H 374 18.0 8.2 34.6 569 us 411 19,:, 8.6 31!.3 597 179 418 20.3 9.6 38.8 :354 175 379 18.7 9.:; 35.0 670 208 462 22.5 11.0 42.4 720 205 :il5 23.9 10.7 4/.0 661 1:i6 504 21.8 8.1 4:0.8 :J89 1;)5 434 19.3 8.0 39.2 liH 136 50:i 20.8 6.9 45.4 582 131 451 18.8 6.6 40.:l i)6(l 109 451 17.9 5.5 40.1 616 111 50;:) 19.7 5.4 46.5 649 120 529 20.6 5.8 48.7 :-i19 102 417 16.6 5.0 38.4 ACCIDENTS AND OTHER VIOLENCE NUMBER RATE Total White Col. Total White Col. 1603 853 750 55.3 50.:~ 62.5 1436 788 668 50.3 46.1 56.:l 1508 846 662 52.0 49.0 fi(i.4 1575 8:10 725 54.3 48.9 62.:i 1772 945 827 61.1 53.9 72.1 1682 947 735 58.0 fi3.6 64.8 Li85 928 657 54.6 ;)2,1 58.0 1831 1035 796 63.0 a7.6 7U1 1901 1090 811 6a.4 60.2 74.1 1978 1113 865 68.0 60.9 80.0 1992 1164 828 68.4 6:1.2 77.2 2010 1243 767 68.4 66.9 71.1 1914 1182 732 64.6 63.0 Gl.:i 1992 1213 779 66.8 64.0 71.:i 22:;1 1389 2428 1453 862 74.9 72.7 78.7 97:; 80.1 7G.3 ss.:; 277.i 1682 1093 90.9 86.4 98.7 2413 149:i 918 78.4 76.1 82.:i 212;) 1309 816 68.6 66.1 7:!.11 1850 1186 664 59.2 59.4 59.0 20:i7 1217 840 6o.9 59.7 77.4 2208 1412 7!!6 70.2 68.6 7:!.2 2056 1328 728 6o.s 65.2 67.1 Information and Statistics 325 TABLE 5 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 AGE AND MATERNAL DEATHS WITH RATE-S PER 1,000 LIVE BIRTHS, BY CoLoR, IN GEORGIA: 1942 Cause of Death Total Number White Colored Total Rate White Colored ALL CAUSES 28,807 Typhoid fever ____________ _ Typhus fever ____________ _ :llalaria Smallpox _________________ Measles ___________________ Scarlet fever _____________ Whooping cough __________ _ Diphtheria ________________ Influenza Dysenlery ________________ _ Poliomyelitis ______________ Lethargic encephalitis ____ _ l\Ieningoeoccus meningitis _ Tuberculosis ______________ Syphilis _________________ _ Gonorrhea ________________ Cancer ------------------Diabetes mellitus _________ _ Pellagra -----------------Cerebral hemorrhage, em- bolism and thrombosis __ Heart diseases ___________ _ Pneumonia _______________ _ [}iarrhea and enteritis (-2 rears) _______________ _ Appendicitis Cirrhosis o.f liver _________ _ Xephritis ________________ _ :\lalfonnation and early infancy diseases _________ Suicide ___________________ Homicide __ ________________ 24 52 76 60 2 101 55 482 86 10 18 1,265 462 6 2,120 370 181 2,873 5,251 1,612 284 174 157 3,187 2,020 219 519 Motor vehicle accidents ___ All other accidents ________ l:nlmown and ill-defined causes ________________ All other causes ____ _______ 673 1,383 1,071 4,009 15,820 40 24 23 35 42 200 43 12 465 97 1,509 275 104 1,538 3,165 737 138 102 123 1,766 1,137 203 102 474 854 403 2,193 12,987 18 12 52 37 66 13 282 43 800 365 611 95 77 1,335 2,086 875 146 72 34 1,421 883 16 417 199 529 668 1,816 922.2 0.8 1.7 2.4 1.9 0.1 3.2 1.8 15.4 2.8 0.3 0.2 0.6 40.5 14.8 0.2 67.9 11.8 5.8 92.0 168.1 51.6 9.1 5.6 5.0 102.0 64.7 7.0 16.6 21.5 44.3 34.3 128.3 776.1 0.3 2.0 1.2 1.1 0.1 1.7 2.1 9.8 2.1 0.2 0.1 0.6 22.8 4.8 74.0 13.5 5.1 75.5 155.3 36.2 6.8 5.0 6.0 86.6 5J.8 10.0 5.0 23.3 41.9 19.8 107.6 1196.5 1.7 1.1 4.8 3.4 6.1 1.2 26.0 4.0 0.5 0.2 0.6 73.7 33.6 0.6 56.3 8.8 7.1 123.0 192.2 80.6 13.5 6.6 3.1 130.9 81.3 1.5 :J8.4 18.3 48.7 61.5 167.3 Live births _______________ 72,189 45,192 26,997 23.1 22.2 24.9 Stillbirths _________________ 2,786 1,268 1,518 38.6 28.1 56.2 Infant mortality 3,559 1,756 1,803 49.3 38.9 66.8 :\laternal mortality 299 146 10,3 4.1 3.2 5.7 NOTE: These figures exclude nonresidents of Georgia and include births and deaths of Georgia residents occurring In other states. 326 Georgia Department of Public Health TABLE 6 DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIRTHS AND RATES PER 1,000 POPULATION, STILLBIRTHS, INFANT AND MATERNAL MORTALITY WITH RATES PER 1,000 LIVE BIRTHS, BY CoLoR, IN GEORGIA: 1941 Cause of o.,atn Total Number White Colored Total Rate White Colored ALL CAUSES --------- 31,579 1'yphold fever ------------ 5;. Typhus fever -------------- 36 Malaria ------------------ 75 Smallpox _________________ Measles -------------------Scarlet fever -------------Whooping cough ____ ------Diphtheria __________________ Influenza ---------------Dysentery ___________________ Poliomyelitis ___ -----------Lethargic encephalitis -----Meningococcus meningitis -Tuberculosis --------------Syphilis ------------Gonorrhea ---------------Cancer ------------------Diabetes mellitus ---------Pellagra -----------------Cerebral hemorrhage, em- bolism and thrombosis Heart diseases -----------Pneumonia ---------------Diarrhea and enteritis (-2 years) ---------------Appendicitis -------------Cirrhosis of liver --------Nephritis ----------------Malformation and early In- fancy diseases -------Suicide ------------------Homicile -----------------Motor vehicle accidents ---AU other accidents ------Unknown and Ill-defined causes ---------------- 157 9 140 63 994 109 33 5 17 1,385 503 24 2,139 376 204 3,033 5,780 1,714 435 230 154 3,381 2,163 236 649 946 1,262 1,026 16,717 22 27 29 94 8 69 36 483 52 25 14 501 110 1,473 278 106 1,513 3,316 800 218 135 110 1,816 1,206 212 120 657 755 356 14,862 33 9 46 63 71 27 511 57 2 3 884 393 23 666 98 98 1,520 2,464 914 217 95 44 1,565 957 24 529 289 507 670 1004.0 1.7 1.1 2.4 5.0 0.3 4.5 2.0 31.6 3.5 1.0 0.2 0.5 44.0 16.0 0.8 68.0 12.0 6.5 96.4 183.8 54.5 13.8 7.3 4.9 107.5 68.8 7.5 20.6 30.1 40.1 32.6 812.1 1.1 1.3 1.4 4.6 0.4 3.4 1.7 23.5 2.5 1.2 0.1 0.7 24.3 5.3 0.04 71.6 13.5 5.1 73.5 161.1 38.9 10.6 6.6 5.3 88.2 58.6 10.3 5.8 31.9 36.7 17.3 1367 .a 3.0 0.8 4.2 5.8 0.1 6.!) 2.5 47.0 5.2 0.7 0.2 0.3 81.3 36.2 2.1 61.3 9.0 9.0 139.9 226.7 84.1 20.0 8.7 4.0 144.0 88.1 2.2 48.7 26.6 46.6 61.6 All other causes ----------- 4,246 Live births --------------- 67,785 Stillbirths ---------------- 2,903 Infant mortality ----------- 3,955 Maternal mortality -------- 315 2,172 41,277 1,276 1,988 133 2,074 26,508 1,627 1,967 182 135.0 21.6 42.8 58.3 4.6 105.5 20.1 30.9 48.2 3.2 190.8 24.4 61.4 74.2 6.9 NOTE: These figures exclude nonresidents of Georgia and include births and deaths of Georgia residents occurring in other states. Information and Statistics 327 TABLE 7 CENSUS ENUMERATED PoPuLATION As OF APRIL 1, 1940, BY COLOR AND CouNTY, IN GEORGIA County Total White Colored County Total White Colored TOTAL 3,123,723 2,038,278 1,085,445 Appling ---- 11,497 11,856 2,641 Atkinson -- 7,093 5,422 1,671 Bacon ----- 8,096 7,042 1,054 Baker ----- 7,344 3,049 4,295 Baldwin -- Banks ----- 16,411 8,733 7,713 8,072 8,698 661 Barrow ---- 13,064 10,605 2,459 Bartow ---Ben Hill ___ 25,283 14,523 21,073 9,674 4,210 4,849 Berrien ---- 15,370 13,033 2,337 Bibb ------ 83,783 48,239 35,544 B!eckley 9,655 6,331 3,324 Brantley --- 6,871 5,727 1,144 krooks 20,497 9,9no 10,507 Bryan 6,288 3,735 2,553 Bulloch 26,010 16,168 9,842 Burke ----- 26,520 6,654 19,866 Buas ------ 9,182 4,891 4,291 Calhoun --- 10,438 3,309 7,129 Camden 5,910 2,486 3,424 Candler 9,103 5,996 3,107 Carroll 34,156 26,903 7,253 Catoosa 10,899 10,576 323 Charlton 5,256 3,760 1,496 Chatham 117,970 65,027 52,943 Chatt'chee - 5,138 3,110 2,028 Chattooga -Cherokee ___ 18,532 20,126 16,720 19,229 1,812 897 Clarke 28,398 18,335 10,063 Clay ------ 7,064 2,077 4,987 ('layton --- 11,655 8,671 2,984 Clinch ----- 6,437 3,938 2,499 Cobb ------ 38,272 31,990 6,282 Coffee ----- 21,541 16,165 5,376 Colquitt --- 33,012 24,955 8,057 Columbia -- 9,433 3,769 5,664 Cook ------ 11,919 8,728 3,191 Coweta ---- 26,972 16,149 10,823 Crawford -- 7,128 3,105 4,023 f'risp ------ 17,540 9,426 8,114 Dade ------ 5,894 5,597 297 nawson 4,479 4,415 64 Decatur ____ 22,234 11,473 10,761 DeKalb 86,942 72,973 13,969 Dodge ----- 21,022 14,045 6,977 Dooly ----- 16,886 7,555 9,331 Dougherty Douglas ____ 28,565 10,053 13,028 7,880 15,537 2,173 Early ----- 18,679 9,065 9,614 Echols ~---- Effingham Elbert Emanuel --Evans Fannin ---Fayette Floyd ----Forsyth Franklin Fulton ----Gilmer _____ Glascock Glynn ----Gordon ---Grady ----Greene _____ Gwinnett -Habersham _ Hall Hancock --Haralson ___ Harris ----Hart -----Heard ----Henry ----Houston --Irwin -----Jackson --Jasper ----Jeff Davis - Jefferson -- Jenkins Johnson --Jones -----Lamar ---Lanier ----Laurens --Lee ________ Liberty Lincoln ---Long -----Lowndes --Lumpkin McDu~fie -Mcintosh -- Macon ----Madison --Marion Meriwether _ 2,964 9,646 19,618 23,517 7,401 14,752 8,170 56,141 11,322 15,612 392,886 9,001 4,547 21,920 18,445 19,654 13,709 29,087 14,771 34,822 12,764 14,377 11,428 15,512 8,610 15,119 11,303 12,936 20,089 8,772 8,841 20,040 11,843 12,953 8,331 10,091 5,632 33,606 7,837 8,595 7,042 4,086 31,860 6,223 10,878 5,292 15,947 13,431 6,954 22,055 "'Baldwin County population excludes the State Milledgeville Hospital. 1,899 5,644 11,887 15,206 4,908 14,675 5,503 47,500 11,281 13,342 269,743 8,952 3,326 13,356 17,242 12,930 6,554 25,751 14,104 31,483 3,581 12,853 4,626 11,551 6,023 7,955 3,984 8,178 16,548 3,777 7,231 8,583 5,306 8,029 3,250 5,668 4,017 19,861 1,895 3,077 3,423 2,625 17,186 6,003 5,565 2,135 5,053 10,826 3,129 10,334 1,065 4,002 7,731 8,311 2,493 77 2,667 8,641 41 2,270 123,143 49 1,221 8,564 1,203 6,724 7,155 3,336 667 3,339 9,183 1,524 6,802 3,961 2,587 7,164 7,319 4,758 3,541 4,995 1,610 11,457 6,537 4,924 5,081 4,423 1,615 13,745 5,942 5,518 3,619 1,461 14,674 220 5,313 3,157 10,894 2,605 3,825 11,721 328 Georgia Department of Public Health TABLE 7 (Continued) CENSUS ENUMERATED PoPuLATION As OF' APRIL l, 1940, BY COLOR AND CouNTY, IN GEORGIA County Total White Colored County Total White Co:ored Miller ----lllitchell --1\Ioiiroe ---Montgomery_ Morgan ---Murray ---l\luscogee -- :"'ewton ---Oconee ---Oglethorpe Paulding -Peach ----Pickens ---Pierce Pike ------Polk _______ Pulaski --Putnam ---Quitman Rabun Randolph -Richmond -Rockdale ___ Schley ----Screven Seminole -- Spalding Stephens --Stewart Sumter ---- 9,998 23,261 10,749 9,668 12,713 11,137 75,494 18,576 7,576 12,430 12,832 10,378 9,136 11,800 10,373 28,467 9,829 8,514 3,43;) 7,821 16,609 81,863 7,724 5,033 20,353 8,492 28,427 12,972 10,603 24,502 6,753 10,996 4,596 5,788 5,936 10,756 49,478 12,154 5,317 6,934 11,534 4,012 8,656 9,346 5,310 23,698 4,470 3,417 1,057 7,686 5,205 48,494 5,274 1,999 8,746 5,035 19,485 11,116 2,882 9,504 3,245 12,265 6,153 3,880 6,777 381 26,016 6,422 2,259 5,496 1,298 6,366 480 2,454 5,065 4,769 5,359 5,097 2,378 135 11,404 33,369 2,448 3,034 11,607 3,457 8,942 1,856 7,721 14,998 Talbot Taliaferro Tattnall Taylor ----Telfair Terrell Thomas Tift -- Toombs Towns Treutlen --Troup ----Turner ---Twiggs ---Union ----Upson ----Walker Walton ---Ware -----\Varren ---Washington_ Wayne ---Webster --Wheeler --White Whitfield -Wilcox ---Wilkes ----Wilkinson -Worth ----- 8,141 6,278 16,243 10,768 15,143 16,673 31,289 18,599 16,932 4,925 7,632 43,879 10,846 9,117 7,680 25,064 31,024 20,777 27,929 10,236 24,230 13,122 4,726 8,535 6,417 26,105 12,7;);) 15,084 11,025 21,374 2,460 1,997 12,076 5,586 10,358 4,714 17,309 13,106 12,434 4,925 5,333 27,527 7,036 3,253 7,669 17,377 28,789 14,168 20,389 3,G71 10,357 10,328 1,834 5,855 6,o;,o 24,640 7,879 6,041 5,618 11,397 5,681 4,281 4,167 5,182 4,787 11,961 13,980 5,493 4,518 2,299 16,352 3,810 5,864 11 7,687 2,235 6,609 7,540 6,665 13,873 2,794 2,892 2,680 367 1,465 4,876 9,043 5,407 9,977 Information and Statistics TABLE 8 LIVE BIRTHs AND RATES PER 1,000 PoPULATioN, STILLBIRTHS AND RATES PER 1,000 LIVE BIRTHs IN EAcH CouNTY IN GEoRGIA: 1941 AND 1942 County LIVE BIRTHS Rate Per 1,000 Number Population 1942 1941 1942 1941 TOTAL 72,189 67,78:> 2:l.l 21.6 Appling 364 329 25.1 22.7 Atkinson _________________ _ 187 179 26.4 25.2 Bacon 228 207 28.2 25.6 Baker 199 1:i6 27 .I 21.2 Baldwin 324 Banks __ 161 Barrow ___________________ _ 262 Bartow __________________ _ 599 Ben Hill ____ ----~ _______ _ 278 336 19.7 20.5 180 18.4 20.6 277 20.1 21.2 ;)2;) 23.7 20.8 279 19.1 19.2 Berrien Bibb Bleckley Brantley Brool.7 15 25 46.7 76.2 12 15 48.0 63.8 23 28 44.7 ;)8,6 NOTE: These figures are allocated to county of residence and exclude non-residents of Georgia. Only the state totals include residents of Georgia with births occurring in other states. Live birth rates based on the 1940 Cen."ts Enumerated Population. Information and Statistics 333 TABLE 9 DEATHS UNDER ONE YEAR OF AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIRTHS IN EAcH CouNTY IN GEORGIA: 1941 AND 1942 County INFANT MORTALITY Rate Per I ,000 Number Live Births 1942 1941 1942 1941 TOTAL AJlllling Atkinson __________________ _ Baeon Raker _ 3,559 11 2 13 10 3,955 11 9 13 6 49.3 30.2 10.7 57.0 50.3 58.3 33.4 50.3 62.8 38.5 Baldwin 10 Banks -------------------- 3 Barrow ------------------- 17 Bartow ------------------- 39 Ben Hill ------------------ 21 24 30.9 71.4 7 18.6 38.9 22 64.9 79.4 41 65.1 78.1 20 75.5 71.7 Berrien ------------------- Bibb 100 Bleckle'Y ------------------ 17 Brantley ------------------ 9 Brooks 23 15 30.2 45.5 139 42.8 74.7 8 68.3 34.3 53.3 28.7 38 41.8 75.5 Bryan -------------------- Bulloch ------------------- 25 Burke -------------------- 24 Butts __ ------------------- 11 Calhoun 20 13 49.0 89.7 14 48.2 25.1 31 33.7 42.5 15 51.2 71.1 21 69.7 91.3 MATERNAL MORTALITY Rate Per I ,000 Number Live Births 1942 1941 1942 1941 299 313 2 1 4.1 4.6 5.5 3.0 5.3 11.2 4.4 4.8 5.0 4 6.2 11.9 12.4 1 3.6 6 1.7 11.4 14.4 3.6 3.S 11 9 4.7 4.8 1 4.0 2 11.8 1 2 1.8 4.0 2 13.8 2 3.9 3.6 2.8 4.1 1 4.7 1 3.5 Camden Candler Carroll 28 Catoosa 11 Charlton 1 Chatham 206 Chattahoochee ------------- 3 Chattooga ----------------- 11 Cherokee ------------------ 30 Clarke -------------------- 28 Clay ___ ------------------- Clayton ___________________ 15 Clinch __ ------------------ Cobb ____________________ _ 32 Coffee 35 Colquitt ___________________ 37 Columbia _________________ _ 9 Cook ____________________ _ 14 Coweta -------------------- 21 Crawford ________________ _ 11 Cristl ____________________ _ 29 Dade _____________________ 3 Dawson D'el'atur 47 DeKalb 7:i 8 43.0 51.6 52.2 45.8 50 42.9 69:3 11 57.9 63.6 8 10.3 65.0 155 65.7 61.7 4 45.5 56.3 12 26.6 26.8 32 73.3 73.2 29 51.7 58.1 11 44.6 66.7 21 72.5 109.9 65.2 65.4 39 36.4 51.4 35 53.7 58.6 49 40.7 68.2 17 43.5 79.8 6 56.5 24.2 25 40.1 51.9 19 65.9 119.5 25 68.6 61.3 4 24.6 33.9 2 41.7 21.3 39 77.3 77.1 68 38.9 40.0 1 6.5 2 14.9 Hi.3 3.1 4.2 3 5.3 17.3 12 15 3.8 6.0 2.2 2 7.3 4.6 2 5.5 4.0 5.2 1 9.3 3 2.3 4.0 6 2 9.2 3.4 9 5.5 12.5 4.8 4.7 3 4.0 12.1 3 7.6 6.2 12.6 2.4 3 8.2 il.9 4 2.1 0.6 334 Georgia Department of Public Health TABLE 9 (Continued) DEATHS UNDER ONE YEAR OF AcE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIRTHS IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County INFANT MORTALITY Rate Per I ,000 Number Live Births 1942 1941 1942 1941 Dodge --------------------- 14 Dooly --------------------- 18 Dougherty 42 Douglas 6 Early 24 26 31.5 5S.7 27 47.6 63.8 37 60.7 63.2 15 30.6 73.5 28 49.1 62.6 Echols Effingham ________________ 20 Elbert -------------------- 16 Emanuel _________________ _ 33 Evans --------------------- 11 Fannin __________________ _ 32 Fayette ___________________ 10 Floyd _____________________ 61 Forsyth __________________ _ 11 Franklin ------------------ 15 39.2 12 106.4 32 37.3 42 68.9 17 58.8 31 100.0 12 62.5 86 46.0 42.8 15 51.0 29.4 49.2 86.5 83.7 91.9 94 2 59.4 67.5 21.1 47.6 Fulton -------------------- 407 Gilmer -------------------- 10 Glascock __________________ 2 Glynn _____________________ 30 Gordon 23 414 47.7 51.6 17 41.0 73.3 6 18.9 54.5 38 51.3 76.5 19 59.3 42.2 Grady 30 Greene 19 Gwinnett ________________ _ 21 Habersham ________________ 15 Hall ______________________ 28 Hancock __________________ 10 Haralson _________________ _ 14 Harris -------------------- Hart ---------------------- 11 Heard 11 Henry ____________________ 13 Houston ------------------ 12 Irwin --~------------------ Jarks.on __________________ _ 21 Jasper ___________________ _ 15 ,Jeff Davis ________________ _ 13 Jefferson _________________ _ 19 Jenkins ______ ------------- 13 Johnson __________________ _ 10 Jones --------------------- 10 Lamar ____________________ Lanier -------------------Laurens __________________ _ 34 Lee ----------------------- 7 Liberty _________________ -- 14 21 63.4 47.4 20 59.7 62.5 39 36.8 76.6 19 47.9 59.7 44 37.3 62.3 10 28.1 31.8 10 54.1 44.8 10 20.9 39.5 22 36.3 67.5 93.2 50.4 18 39.8 G6.8 13 39.6 48.1 20 14.8 70.4 29 45.9 67.0 11 86.2 60.1 13 73.4 61.6 17 39.1 35.4 14 41.9 41.7 44.2 2ri.O 48.1 37.4 24 45.5 1!:1.9 6 48.2 70.6 37 45.6 51.2 14 49.:1 93.3 13 71.8 71.4 MATERNAL MORTALITY Rate Per I ,000 Number Live Births 1942 1941 1942 1941 2 6.8 4.5 5.3 4 5.8 3.4 4.1 2.2 4.1 7.0 2.7 4.2 4.0 2 10.7 3.1 1 2 6.3 9.9 2 3 1.5 2.4 4.2 3.4 3.2 15 !9 1.8 2.4 4.1 4.3 2 9.4 18.2 1 6.8 2.0 3 5.2 6. 7 10.6 6.8 1 3.1 2 3.5 3.9 4.0 2.8 1 2.8 3.2 4 17.9 4.2 2 3.3 6.1 3.1 3.2 4 14.8 5.9 3.:l 4.4 2.3 5.7 ~-:; 2 3 4.1 6.3 2 3.2 6.0 4.4 :).0 4.8 2:~.5 9.4 4.1 1:1.3 5.1 5.::J information and Statistics 335 TABLE 9 (Continued) DEATHS UNDER ONE YEAR OF AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LivE BIRTHS IN EACH CoUNTY IN GEORGIA: 1941 AND 1942 County Lincoln ______________ Long ---------------Lowndes Lumpkin ~!cDuffie INFANT MORTALITY Number 1942 1941 Rate Per 1,000 Live Births 1942 1941 11.7 50.3 58.8 42.3 29 24 35.8 37.9 4 3 27.8 25.6 13 12 45.0 48.6 :lie Intosh 12 !\lacon -------------------- 39 Madison ------------------ 1\Iarion ------------------- 10 Meriwether ________________ 18 l\liller ____________________ 10 Mitchell 26 Monroe ___________________ 19 Montgomery ______________ _ 11 ).!organ 15 78.4 44.4 38 98.2 80.2 19 25.5 66.0 16 48.5 88.4 24 33.2 49.8 4 55.6 19.3 39 42.3 67.2 22 73.9 94.4 13 54.7 74.3 14 46.2 48.4 MATERNAL MORTALITY Number 1942 1941 Rate Per 1,000 Live Births 1942 1941 4 2 4.9 3.2 1 8.5 3.5 13.1 7.4 10.1 6.3 7.3 5.5 1.8 10.4 5.6 2 6.5 3.4 3.9 5.0 3 10.4 .:\lurray 11 ~J uscogee- ________________ _ 109 "X ewton ------------------- 15 Oconee ------------------- 12 Oglethorpe ____________ _ 22 Paulding 19 Peach --------------------- 14 Pickens 10 Pierce -------------------- 10 Pike ---------------------- 16 Polk 27 Pulasl 4 2 18.9 9.4 3.2 3.3 5.1 5.5 5.0 4 2.6 11.4 11 6 5.:l :~.3 3 22.1 3 2.4 6.6 9.:l 8.7 12.2 13.7 5.0 6.8 4.4 9.9 1.8 9.0 3.8 8.1 5.3 16.9 6.6 5. 7 336 Georgia Department of Public Health TABLE 9 (Continued) DEATHS UNDER ONE YEAR OF AGE AND MATERNAL DEATHS WITH RATES PER 1,000 LIVE BIRTHS IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County INFANT MORTALITY Number 1942 1941 Rate Per I ,000 Live Births 1942 1941 Terrell 29 Thomas ______ ------------ 40 Tift ---------------------- 22 Toombs ------------------- 15 Towns -------------------- 3 Treutlen _________________ _ Troup _____ ------- -------- 62 Turner ___________________ _ 10 Twiggs -------------------- 16 Union 7 23 66.2 51.2 :H li0.:1 . -! ~ 31 46.4 71.6 18 41.1 48.6 3 29.4 26.3 9 37.6 52.3 64 64.7 69.6 12 46.9 51.1 18 59.7 66.4 10 36.6 48.1 Upson 20 Walker 27 Walton 32 Ware --------------------- 31 Warren 16 Washington ______________ _ 25 Wayne -------------------- 10 Webster ------------------- 3 Wheeler _______ ----- _____ _ 11 White __________________ -- 10 Whitfield _________________ 31 Wilcox -------------------- Wilkes -------------------- 18 Wilkinson ________________ 16 Worth -------------------- 41 Residents of Georgia, births or deaths occurring in other states ----------- 18 32 33.7 57.2 27 42.8 41.3 28 70.5 61.9 31 45.1 46.0 13 63.7 62.5 25 44.6 46.8 14 29.2 39.5 7 25.6 64.2 53.9 38.5 59.9 59.3 44 47.0 7G.2 12 21.9 53.6 14 56.1 42.7 18 64.0 76.6 26 79.8 54.4 23 MATERNAL MORTALITY Number 1942 1941 Rate Per I ,000 Live Births 1942 1941 4.:. 8 I U.l l.:J 3 4 6.3 9.:! 2. 7 2. 7 ll.G 6 13 6.3 14.1 4.7 8 ..) 'j .4 10.5 3 5.1 :u 1.6 3.1 4 8.8 6.6 4 5.8 'j.4 1 4.0 !l.6 4 7.1 3. i 8.5 9.2 2 12.0 3 1.4 :u 4.4 8.9 2 6.2 3.0 1 4.0 4.3 3 5.8 2.1 6 6 NOTE: These figures are allocated to county of residence and exclude non-residents of Georgia. Only the state totals include residents of Georgia dying in other states. Information and Statistics 337 TABLE 10 DEATHS AND DEATH RATES PER 1,000 POPULATION IN EACH COUNTY IN GEORGIA: 1941 AND 1942 DEATHS Number 1942 1941 Rate Per 1,000 Population 1942 1941 TOTAL __ 28,807 31,579 Appling ______ 91 78 Atkinson _____ 40 48 Bacon 59 78 Baker _______ 68 40 Baldwin _____ 141 211 Banks 44 66 Barrow ______ 109 138 Bartow ______ 226 280 Ben Hill _____ 169 145 Berrien 79 98 Bibb ________ 1,066 1,204 Bleckley 91 87 Brantley 60 39 Brooks 162 181 Bryan 53 81 Bulloch 149 159 Burke ______ _ 253 315 Butts 120 125 Calhoun ____ _ 95 115 Camden 76 89 Candler 61 76 Carroll 209 292 Catoosa 61 65 Charlton ____ _ 28 36 Chatham ____ _ 1,789 1,770 Chattahoochee_ 21 26 Chattooga 84 75 Cherokee ____ _ 161 190 Clarke 307 344 Clay ________ _ 46 76 Clayton 88 124 Clinch ______ _ 46 42 Cobb ________ 349 385 Coffee 183 196 Colquitt ____ _ 252 287 Columbia ___ _ 75 92 Cook _______ _ 98 95 Cowe~a 169 238 Crawford ___ _ 62 104 Crisp 175 191 Dade _______ _ 33 28 Dawson 13 23 Decatur 256 252 DeKalb 725 769 Dodge ______ _ 137 182 9.2 6.3 5.6 7.3 9.3 8.6 5.0 8.3 8.9 11.6 5.1 12.7 9.4 8. 7 7.9 8.4 5.7 9.5 13.1 9.1 12.9 6.7 6.1 5.6 5.3 15.2 4.1 4.3 8.0 10.8 6.'i 7.6 7.1 9.1 8.5 7.6 8.0 8.2 6.3 8.7 10.0 5.6 2.9 11.5 8.3 6.5 10.(1 5.4 6.8 9.6 5.4 12.9 7.6 10.6 11.1 10.0 6.4 14.4 9.0 8.6 8.8 12.9 6.1 11.9 13.6 11.0 15.1 8.3 8.5 6.0 6.8 15.0 fi.l 4.0 9.4 12.1 10.8 10.6 6.5 10.1 9.1 8. 7 9.8 8.0 8.8 14.6 10.9 4.8 5.1 11.3 8.8 8.7 DEATHS Number 1942 1941 Rate Per I ,000 Population 1942 1941 Dooly ------- 158 Dougherty __ _ 319 Douglas ____ _ 79 Early 161 Echols ______ _ 16 Effingham 107 Elbert 171 Emanuel ____ _ 200 Evans ______ _ 78 Fannin ______ 112 Fayette 67 Floyd _______ _ 465 Forsyth _____ _ 48 Franklin ____ _ 114 Fulton _______ 4,216 Gilmer ______ _ 64 Glascock ____ _ 34 .1 11.3 1 10.!1 28.i ' Candler Carroll Catoosa Charlton Chatham ------------------ Chattahoochee _____________ Chattooga ________________ _ Cherokee --------------- __ Clarke -------------------Clay ---------------------- Clayton __________________ _ Clinch -------------------Cobb --------------------Coffee ___________________ _ Colquitt ___________________ Columbia _________________ Cook ______________________ _ Coweta ------------------Crawford _________________ Crisp Dade 2.9 19.0 2 0.8 1.7 4 19.!) 4.6 3.7 ri.7 :1.7 2.9 0.8 14.2 3 9.1 14.0 2 22.8 11.4 340 Georgia Department of Public Health TABLE II (Continued) DEATHS AND DEATH RATES PER 100,000 PoPULATION FROM TYPHOID AND MALARIA IN EAcH CouNTY IN GEoRGIA: 1941 AND 1942 County Dawson Decatur DeKalb Dodge -------------------Dooly Doughe.rty ---------------Douglas ------------------Early -------------------Echols -------------------Effingham _________________ TYPHOID Rate Per I00,000 Number Population 1942 1941 1942 1941 1.2 1 4.8 4.8 1 5.9 5.9 3.5 Elbert Emanuel -----------------Evans _____________________ Fannin ------------------Fayette ------------------- Floyd _____________________ Forsyth Franklin ------------------ Fulton -------------------- 2 Gilmer -------------------- Glascock -----------------Glynn -------------------Gordon ------------------Grady -------------------Greene -------------------- Gwinnett ________________ Habersham _______________ _ Hall ---------------------Hancock Haralson ------------------ Harris ------------------Hart ---------------------Heard --------------------Henry --------------------Houston ------------------ Irwin --------------------Jackson ------------------Jasper -------------------Jeff Davis ---------------Jefferson ------------------ .Tenldns ------------------Johnson _________________ _ Jones _______________ _ Lamar 2 10.2 4.3 13.5 1.8 8.8 17.7 6.4 3 0.5 0.8 11.6 1.1 11.3 1.1 9.9 MALARIA Rate Per I00,000 Number Population 1942 1941 1942 1941 5.1 15.7 6.6 11.3 5.0 15.0 8.4 1. 7 1. 7 Information and Statistics 341 TABLE II (Continued) DEATHS AND DEATH RATES PER 100,000 PoPULATION FROM TYPHOID AND MALARIA IN EAcH CouNTY IN GEoRGIA: 1941 AND 1942 County Lanier -------------------Laurens __________________ _ Lee ----------------------Liberty ------------------Lincoln ------------------- Long ---------------------Lowndes -----------------Lumpkin -----------------1\IcDuffie ----------------Mcintosh Macon Madison Marion -------------------Meriwether ---------------1\Iiller -------------------- Mitchell Monroe Montgomery ~lor~ an Murray ------------------- 1\Iuscogee ----------------Newton ------------------Oconee ------------------Oglethorpe ________________ Paulding ------------------ Peach -------------------Pickens ------------------Pierce -------------------Pike ______________________ Polk ---------------------- Pulaski ------------------Putnam ------------------Quitman -----------------Rabun -------------------Randolph Richmond ----------------- Rockdale __________________ Schley Srreven ___________________ Seminole Spalding Stephens Stewart ___________________ TYPHOID Rate Per I00,000 Number Population 1942 1941 1942 1941 25.5 11.6 36.8 6.3 6.3 7.4 4.3 4.3 1 9.3 1 10.3 7.9 9.0 1.3 1.3 10.8 8.0 3.5 MALARIA Rate Per I00,000 Number Population 1942 1941 1942 1941 6 17.9 11.9 11.6 3.1 3.1 1 9.2 1 18.9 6.3 6.3 4.5 10.0 4.3 9.3 2.6 9.6 8.5 9.6 10.2 12.0 1.2 2.4 14.7 14.7 2 23.6 23.6 9.4 342 Georgia Department oj Public Health TABLE II (Continued) DEATHS AND DEATH RATES PER 100,000 PoPULATION FRoM TYPHOID AND MALARIA IN EAcH CouNTY IN GEORGIA: 1941 AND 1942 County Sumter ___________________ Talbot ___________________ _ Taliaferro _________________ Tattnall ------------------Taylor Telfair Terrell Thomas ------------------Tift ---------------------Toombs ------------------- Towns ____________________ Treutlen Troup Turner Twiggs ------------------ Union Upson Walker Walton ---------------- __ _ \Vare --------------------- Warren __________________ _ Washington ______________ _ "rayne -------------------Webster -----------------Whee.Jer ------------------- White -------------------Whitfield ________________ _ Wilcox -------------------Wilkes -------------------Wilkinson ----------------- Worth -------------------Residents of Georgia, death occurring in other states TYPHOID Rate Per I 00,000 Number Population 1942 1941 1942 1941 6.2 6.6 3.2 10.8 2.3 4.8 11.7 13.6 3.8 i.8 MALARIA Rate Per I 00,000 Number Population 1942 1941 1942 1941 2 6.6 13.2 12.0 6.0 3.2 3.2 5.4 5.4 17.7 23.6 9.2 11.0 4 16.5 4.1 2 15.2 21.2 11.7 3 7.8 23.5 NOTE: These figures are allocated to county of residence and exclude non-residents of Georgia. Only the state totals include residents of Georgia dying in other states. Information and Statistics 343 TABLE 12 DEATHS AND DEATH RATES PER 100,000 PoPULATION FROM TuBERCULOSis AND CANCER IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County TUBERCULOSIS Rate Per 100,000 Number Population 1942 1941 1942 1941 CANCER Rate Per I 00,000 Number Population 1942 1941 1942 1941 TOTAL 1,265 1,385 40.5 44.0 Appling Atkinson _________________ _ 14.1 Bacon ___________________ _ 1 12.4 12.4 Baker -------------------- 4 Baldwin __________________ 11 54.5 67.0 54.8 2,120 2,139 4 4 1 2 18 67.9 68.0 27.6 27.6 14.1 28.2 12.4 54.5 40.8 42.7 109.7 Banks ___________________ _ Barrow ------------------- Bartow __________________ _ 10 Ben Hill __________________ Berrien ------------------- 11.5 7.7 15.3 12 39.6 47.5 4 27.5 27.5 3 34.4 34.4 14 6 107.2 45.9 17 17 67.2 67 .:! 15 103.3 34.4 7 11 45.5 71.6 Bibb ---------------------- 65 Bleckley __________________ _ 1 Brantley __________________ Brooks Bryan 58 77.6 69.2 1 10.4 10.4 29.1 1 9.8 4.9 3 31.8 47.7 55 82 65.6 97.9 6 72.5 62.1 4 58.2 58.2 6 11 29.3 53.7 63.6 15.9 Bulloch Burke -------------------- 14 Butts ____________________ _ Calhoun 3 Camden 34.6 15.4 20 52.8 75.4 4 32.7 43.6 28.7 28.7 50.8 50.8 11 26.9 42.3 15 20 56.6 75.4 4 43.6 76.2 6 6 57.5 57.~ 101.5 84.6 Candler Carroll Catoosa __________ _ Charlton ___________ _ Chatham _________________ _ 105 Chattahoochee ____________ _ 1 22.0 11.0 8 14.6 23.4 27.5 43.9 19.0 83 89.0 70.4 3 Ci8.4 22.0 19 17 5:J.6 3 45.9 3 57.1 122 112 103.4 11.0 49.H 27.5 38.1 94.9 38.9 f'hattooga ________________ _ Cherol{ee _________________ _ Clarke _____________ _ Clay ______________________ Clayton 27.0 16.2 19.9 34.8 11 24.6 38.7 2 28.3 42.9 34.3 16.2 21.6 18 18 89.4 89.4 23 26 81.0 91.6 2 3 28.3 42.!'.1 9 60.1 77.2 Clinch _____________ _ Cobb ____________________ _ 15 Coffee ___________________ _ 6 Colquitt _________________ _ Columbia 15.5 12 39.2 31.4, 4 27.9 18.6 21.2 3.0 21.2 10.6 77.7 :n 26 81.0 H7 .H 1 17 78.9 41.8 Fi 17 4!i.4 5l.;i 10 4 106.0 42.4 Cook ____________________ _ 2 16.8 33.6 r-18. 7 7G.fi rm\'eta ------------------- 8 10 29.7 37.1 Cra\\ford _________ _ 1 3 14.0 42.1 13 18 48.2 66.7 6 84.2 28.1 Crisp 7 39.9 22.8 6 11 34.2 62.7 Dade 50.9 33.9 GO.!l 'ill.9 --------------------------------------------- 344 Georgia Department of Public Health TABLE 12 (Continued) DEATHS AND DEATH RATES PER 100,000 POPULATION FROM TUBERCULOSIS AND CANCER IN EAcH CouNTY IN GEORGIA: 1941 AND 1942 County Dawson Decatur DeKalb Dodge -------------------Dooly --------------------- Dougherty _________________ Douglas ------------------Early -------------------Echols Effingham _______________ _ Elbert ___________________ _ Emanuel __ __ _ ____ _ Evans ____________________ _ Fannin ------------------Fayette __________________ _ Floyd Forsyth ------------------Franklin _________________ _ Fulton Gilmer -------------------- Glascock _________________ _ Glynn ___________________ _ Gordon ___________________ Grady -------------------Greene -------------------- Gwinnett __________________ Habersham ________________ Hall ---------------------Hancock Haralson ------------------ Harris -------------------Hart ______________________ Heard --------------------Henry ____________________ Houston __________________ lr'\vin ____________________ _ Jackson _________________ _ Jasper ___________________ _ .Jeff Davis _________________ Jefferson _________________ _ TUBERCULOSIS Rate Per I 00,000 Number Population 1942 1941 1942 1941 1 22.3 22.3 9 40.5 36.0 26 40 29.9 46.0 1 4 4.8 19.0 3 6 17.8 35.5 16 15 56.0 52.5 3 3 29.8 29.8 2 26.8 10.7 3 101.2 4 10.4 41.5 6 25.5 30.6 12.8 8.fi 3 40.5 40.5 54.2 33.9 12.2 49.0 30 33 53.4 58.8 17.7 12.8 12.8 292 305 74.3 77.6 1 11.1 11.1 22.0 22.0 4 15 18.2 68.4 8 3 43.4 16.3 3 3 15.3 15.3 6 14.6 43.8 4 27.5 13.8 33.9 33.9 6 12 17.2 34.5 2 4 15.7 31.3 3 20.9 4 35.0 35.0 4 12.9 25.8 1 23.2 ll.6 11 3 72.8 19.8 3 26.5 26.5 23.2 2 14.9 10.0 3 45.6 34.2 2 22.6 7 34.9 34.9 CANCER Rate Per I 00,000 Number Population 1942 1941 1942 1941 22.3 10 13 43.0 58.5 81 71 9:l.2 81.7 11 33.3 :J2.3 41.5 53.3 27 30 94.G 105.0 8 5 79.6 49.7 48.2 48.2 4 4 41.5 41.3 15 16 76.5 81.6 14 l7 59.5 72.3 4 3 54.0 40.5 9 61.0 61.0 4 6 49.0 73.'! 43 56 76.6 99.7 2 17.7 61.8 10 64.1 57.G 355 390 90.4 99.:1 2 6 22.2 66.7 44.0 14 13 63.9 'i9.3 8 43.4 38.0 12 11 61.1 56.0 8 58.4 43.8 21 21 72.2 72.2 4 8 27.1 54.2 20 18 57.4 51.7 5 8 39.2 62.7 48.7 34.8 10 10 87.5 87.5 4 25.8 19.3 58.1 12 16 79.4 1oo.s 8 4 70.8 35.4 54.1 1::1.::1 8 11 39.8 54.8 I 45.6 11.4 43.2 43.2 11 c4.9 34.9 Information and Statistics 34.S TABLE 12 (Continued) DEATHS AND DEATH RATEs PER 100,000 PoPULATION FROM TuBERCULOSIS AND CANCER IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County Jenkins Johnson Jones --------------------Lamar -------------------Lanier -------------------Laurens ------------------ Lee ----------------------Liberty ____________________ Lincoln ------------------Long --------------------Lowndes Lumpkin McDuffie Mcintosh -----------------:\lacon -------------------Madison Marion ------------------Meriwether ________________ Mille-r ------- ------------l\Iitchell :\Ionroe ------------------- Montgomery _______________ Morgan ------------------Murray ------------------1\Iuscogee ----------------Newton ------------------- Oconee -------------------Oglethorpe ________________ Paulding -----------------Peach ___________________ _ Pickens ___________________ Pierce -------------------Pike --------------------Polk ______________________ Pulaski Putnam ------------------- Quitman -----------------Rabun -------------------Randolph ________________ _ Richmond ----------------Rockdale __________________ TUBERCULOSIS Rate Per I 00,000 Number Population 1942 1941 1942 1941 8 67.6 67.6 2 15.4 36.0 60.0 2 9.9 19.8 20.8 23.8 1 12.8 12.8 2 23.3 81.4 14.2 6 18.8 28.2 32.1 80.3 1 9.2 18.4 2 37.8 37.8 37.6 31.4 14.9 37.2 28.8 28.8 10 ll 45.3 49.9 3 1 30.0 10.0 2 25.8 8.6 55.8 3 31.0 55.1 47.2 6 9.0 53.9 35 44 46.4 58.3 5.4 37.7 2 13.2 26.4 4 40.2 32.2 6 46.8 15.6 8 77.1 57.8 2 21.9 54.7 3 25.4 59.3 19.3 67.5 ll l7 38.6 59.7 10.2 10.2 4 47.0 58.2 29.1 1 12.8 4 4 24.1 24.1 70 83 85.5 101.4 4 51.8 12.9 CANCER Rate Per I 00,000 Number Population 1942 1941 1942 1941 7 59.1 67.(i 54.0 7.7 84.0 84.0 14 138.7 49.:> 35.5 71.0 18 24 53.6 71.4 89.3 89.3 34.9 46.5 4 G6.8 il.O 48.9 2<:1.5 19 19 59.6 59.6 4 64.3 32.1 10 10 ()1.9 91.9 7 1 132.3 18.9 15 9 94.1 56.4 ll 81.9 37.2 14.4 43.1 ll 18 49.9 81.6 6 6 60.0 60.0 12 1:i ;:)1.6 64.::; 10 6 93.0 53.8 41.4 41.! 9 70.8 70.8 2 44.[) 18.0 52 65 68.9 8fi.l 18 43.1 96.9 4 1:1.2 ri2.8 6 72.4 48.3 3 23.4 54.6 4 57.8 38.5 6 65.7 6J.7 4 6 33.9 50.8 12 3 ll:\.7 28.9 l7 20 59.7 70.:l 8 81.4 50.9 4 4 47.0 47.0 3 29.1 87.3 12.8 17 14 102.4 84.3 88 70 107.:> 83.5 4 2:1.9 ;)1.8 346 Georgia Department of Public Health TABLE 12 (Continued) DEATHs AND DEATH RATES PER 100,000 PoPULATION FROM TuBERCULOSIS AND CANCER IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County TUBERCULOSIS Rate Per I 00,000 Number Population 1942 1941 1942 1941 CANCER Rate Per I 00,000 Number Population 1942 1941 1942 1941 Schley Screven ------------------- Seminole _----------------- 1 Spalding __________________ 8 Stephens Stewart ___________________ Sumter ____________________ 10 Talbot -------------------- 3 Taliaferro _________________ 2 Tattnall ------------------- 3 39.7 59.6 24.6 34.4 11.8 13 28.1 45.7 7.7 7.7 47.2 11 40.8 44.9 36.9 49.1 4 31.9 63.7 9 49.3 55.4 39.7 39.7 9 44.2 29.5 4 47.1 23.6 25 20 87.9 70.4 7 54.0 54.0 37.7 28.3 22 18 89.8 73.5 11 133.1 24.6 4 63.7 19.6 24.6 30.8 Taylor Telfair Terrell Thomas ___________________ 12 Tift ---------------------- 6 3 18.6 21.9 3 19.8 42.0 30.0 17 38.4 54.3 32.3 26.9 4 31.1 27.9 11 72.6 26.4 16 96.0 48.0 21 22 67.1 711.:) 17 14 91.4 75.3 Toombs ------------------- 3 Towns -------------------- 1 Treutlen ------------------ Troup 17 Turner 2 17.7 17.7 20.3 20.8 26 38.7 59.3 18.4 18.4 9 53.1 41.3 40.6 111l.o 26.2 3!!.3 38 57.0 86.6 8 46.1 7:l.8 Twiggs 4 Union Upson Walker 14 Walton ------------------ 3 Ware ____________________ _ \Varren ------------------\Yashington ______________ _ Wayne -------------------Webster 43.9 2!.9 52.1 13.0 27.9 19.9 12 45.1 38.7 14.4 14.4 28.6 28.6 19.5 39.1 11 37.1 45.4 4 30.5 21.2 4 43.9 7G.H 4 G2.1 52.1 16 10 63.8 39.9 18 17 58.0 :i4.8 18 19 86.6 43.3 10 21 33.8 7;).2 2\J.:l 68.4 13 J3.7 i13.7 38.1 30.;) 21.2 21.2 Wheeler White ___________________ _ Whitfield ----------------- 1H Wilcox ----------- _________ 1 Wilkes ------------------- "rilkinson ________________ _ Worth ___________________ Residents of Georgia, death occurring in other states 37 Military Reservations _____ _ 11.7 15.6 17.9 16 69.0 61.:3 3 7.8 :!:).J 33.1 26,;) 27.2 36.3 32.8 37.4 57 :J:-;,1 46.9 3 46.8 46.S 22 16 84.3 61.8 1 15.7 7.8 13 l:J 86.2 8fi.2 6 8 :>4.4 72.6 9 42.1 42.1 34 37 10 NOTE: These figures are allocated to county of residence and exclude non-residents of Georgia. Only the state totals include residents of Georgia dying in other states. Rates based on the 1940 Census Enumerated Population. Information and Statistics 347 TABLE 13 DEATHS AND DEATH RATES PER 100,000 PoPULATION FRoM PELLAGRA AND PNEUMONIA IN EAcH CouNTY IN GEoRGIA: 1941 AND 1942 County PELLAGRA Rate Per 100,000 Number Population 1942 1941 1942 1941 TOTAL --------------- Appling ------------------Atkinson -----------------Bacon -------------------Baker --------------------Baldwin ---- ------------- Banks -------------------Barrow ------------------Bartow -------------------Ben Hill ----------------Berrien ------------------- Bibb --------------------B!eckley -----------------Brantley ----------------Brooks -------------------Bryan -------------------- Bulloch ------------------- Burke -------------------- Butts --------------------- Calhoun ------------------- Camden - - - - - ----~------~- (and1er -------------------- Carroll ---------~---~---~- Catoosa ----------~---~--- Charlton - - - - - - - --------~-- Chatham -----~------------ Chattahoochee --------~--- Chattooga ---------------- Cherokee -----------------~ Clarke -------------------- Clay --------------- ----~-- Clayton -- ----------------- Clinch -------------------- Cobb --- ------------------ Coffee - - - - - --------------~ Colquitt ------------------- Columbia -------------- --- Cook -------- -----~- ------ Coweta - - - - ------~---~---- Crawford ------------------ Crisp -------------- ~-~---- 181 2 2 1 1 4 2 204 1 2 16 4 2 2 16 5.8 12.4 11.5 7.9 4.8 9.8 7.5 10.9 11.0 2.9 9.2 19.0 7.6 3.5 14.2 15.5 10.5 3.0 21.2 25.2 3.7 6.5 7.7 4.0 13.H 6.5 19.1 19.5 31.8 11.3 21.8 13.6 5.0 7.0 14.2 2.6 ~.3 9.1 3.7 PNEUMONIA Rate Per 100,000 Number Population 1942 1941 1942 1941 1,612 1,714 51.6 54.5 55.2 34.5 3 5 42.3 70.5 3 9 37.1 111.2 2 27.2 68.1 21 13 128.0 79.2 1 11.5 4:i.8 4 10 30.6 76.5 11 17 43.5 67.2 13 15 89.5 103.3 5 5 32.5 32.5 43 52 51.3 62.1 20.7 51.8 6 5 87.3 72.8 6 11 29.3 53.7 2 31.8 10 38.4 30.8 10 16 37.7 60.3 8 9 87.1 98.0 38.3 47.9 50.8 50.8 3 3 33.0 33.0 13 16 38.1 46.8 7 5 64.2 45.9 3 57.1 105 99 89.0 83.9 2 38.9 38.9 37.8 21.6 12 19 59.6 94.4 23 12 81.0 42.:1 1 14.2 127.4 9 6 77.2 51.;) 46.6 31.1 11 18 28.7 47.0 IX 19 83.6 88.2 18 19 54.5 57.6 53.0 53.0 6 41.9 50.3 6 15 22.2 55.6 98.2 98.2 3 17.1 45.6 348 Georgia Department of Public Health TABLE 13 (Continued) DEATHs AND DEATH RATES PER 100,000 PoPULATION FROM PELLAGRA AND PNEUMONIA IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County PELLAGRA Rate Per I 00,000 Number Population 1942 1941 1942 1941 Dade --------------------Dawson Decatur ------------------- 1 DeKalb ------------------ 2 Dodge 2 4.5 2.3 8.1 4 9.5 19.0 Dooly 3 Dougherty ---------- ______ _ 4 Douglas ------------------- Early --------------------- Echols -------------------- Effingham ----------------Elbert -------------------Emanuel -----------------Evans -------------------Fannin ------------------- Fayette ------------------ Floyd --------------------- 3 Forsyth Franklin ------------------ Fulton -------------------- 24 Gilmer Glascock ------------------ Glynn -------------------- Gordon -------------------- Grady ----------------- --- 2 Greene -------------------- Gwinnett ------------------ 3 Habersham ---------------- 2 Hall ---------------------- 2 Hancock 2 11.8 14.0 11.5 9.9 10.4 5.1 10.2 13.5 6.8 1 12.2 4 5.3 7.1 6.4 26 6.1 6.6 11.1 1 22.0 4.6 1 5.4 1 10.2 5.1 7.3 7.3 5 10.3 11.2 3 13.5 20.3 2 5.1 5.7 2 15.7 15.7 Haralson Harris -------------------- Hart --------------------- 1 Heard --------------------Henry ___________________ _ 7.0 11.5 6.4 6.6 Houston ------------------ 1 Irwin --------------------- Jackson __________________ _ 2 Jasper -------------------- 3 Jeff Davis _______________ _ 8.8 10.0 5.0 34.2 11.4 PNEUMONIA Rate Per I00,000 Number Population 1942 1941 1942 1941 33.9 17.0 16 72.0 31.5 36 35 41.4 40.3 6 11 28.5 52.3 4 53.3 23.7 13 25 45.5 87.5 3 49.7 29.8 12 8 64.2 42.8 33.7 2 51.8 20.7 4 11 20.4 56.1 9 17 38.3 72.3 3 94.6 40.5 8 1 54.2 47.5 6 2 73.4 24.5 38 33 61.1 58.8 4 3 35.3 26.5 8 9 51.2 57.6 204 191 51.9 48.6 4 44.4 88.9 1 22.0 11 20 50.2 91.2 6 9 32.5 48.8 6 40.7 30.5 3 21.9 51.1 15 11 51.6 58.4 6 40.6 40.6 11 19 48.8 54.6 2 4 15.7 31.3 10 34.8 69.6 3 3 26.3 26.3 10 58.0 64.5 4 3 46.5 34.8 13 10 86.0 66.1 11 4 97.3 35.4 3 3 23.2 23.2 10 8 49.8 39.8 4 57.0 45.6 4 67.9 45.2 Information and Statistics 349 TABLE 13 (Continued) DEATHS AND DEATH RATES PER 100,000 PoPULATION FROM PELLAGRA AND PNEUMONIA IN EAcH CouNTY IN GEORGIA: 1941 AND 1942 County PELLAGRA Rate Per I 00,000 Number Population 1942 1941 1942 1941 Jefferson Jenkins ------------------- Johnson ------------------ Jones --------------------- 3 10.0 5.0 8.4 16.9 36.0 12.0 Lamar -------------------- Lanier ------------------- Laurens ------------------ 5 14.9 Lee ----------------------- Liberty ------------------- Lincoln Long --------------------- 1 Lowndes 2 Lumpkin McDuffie 24.5 6.3 3.1 9.2 9.2 Mcintosh ------------------ 1 Macon 3 Madison -----------------:\larion ______ _________ _ Meriwether ---------------- 18.9 4 18.8 25.1 1 14.4 1 4.5 4.5 Miller --------------------Mitchell -----------------:llonroe ------------------Montgomery --------------Morgan ------------------- Murray Muscogee ----------------- Newton 2 Oconee -------------------Oglethorpe _______________ _ 4.3 10.3 15.7 9.0 6 1.3 7.9 10.8 5.4 Paulding Peach --------------------Pickens __________________ _ Pierce -------------------- 2 Pike ---------------------- 2 Polk Pulaski ------------------Putnam ------------------Quitman -----------------Rabun -------------------- Randolph ----------------Richmond ----------------Rockdale -----------------Schley -------------------F;creven __________________ _ 15.6 7.8 9.6 9.6 10.9 10.9 16.9 19.3 9.6 2 3.5 7.0 10.2 29.1 2 6.0 12.0 3 6.1 3.7 12.9 12.9 3 59.6 14.7 9.8 PNEUMONIA Rate Per I 00,000 Number Population 1942 1941 1942 1941 6 29.9 39.9 5 42.2 76.0 2 15.4 15.4 8 96.0 36.0 12 15 118.9 148.6 2 3 35.5 53.3 11 2:1 32.7 6S.4 6 3 76.6 38.3 7 81.4 11.6 28.4 24.5 24.5 17 12 53.4 37.7 3 1 48.2 16.1 6 6 55.2 55.2 2 37.8 37.8 9 6 56.4 37.6 3 7.4 22.3 9 129.4 57.5 11 6 49.9 27.2 20.0 50.0 6 25.8 30.1 24 10 223.3 93.0 10.3 93.1 3 47.2 23.6 7 62.9 26.9 48 74 63.6 98.0 9 11 48.4 ri9.2 6 79.2 79.2 7 3 56.3 24.1 10 54.6 77.9 6 4 57.8 38.5 3 21.9 54.7 6 6 50.8 50.8 16 154.2 77.1 9 31.6 24.6 8 81.4 91.6 2 8 23.5 94.0 1 2 29.1 58.2 2 23.6 7 6 42.1 36.1 65 68 79.4 83.1 6 77.7 64.7 19.9 19.9 14 12 68.8 59.0 350 Georgia Department of Public Health TABLE 13 (Continued) DEATHs AND DEATH RATES PER 100,000 PoPULATION FRoM PELLAGRA AND PNEUMONIA IN EACH COUNTY IN GEORGIA: 1941 AND 1942 County PELLAGRA Rate Per I00,000 Number Population 1942 1941 1942 1941 Seminole ------------------ Spalding ------------------ Stephens ------------------ Stewart ------------------- 2 Sumter -------------------- 23.6 3.5 18.9 Talbot -------------------Taliaferro ----------------Tattnall ------------------- Taylor -------------------Telfair ------------------- 1 12.3 2 15.9 31.9 6.2 9.3 Terrell -------------------- Thomas ------------------ 2 Tift ---------------------- 2 Toombs ------------------- 4 Towns ------------------- 12.0 6.4 6.4 10.8 21.5 23.6 11.8 20.3 Treutlen ------------------ Troup -------------------- 3 Turner -------------------- Twiggs ------------------- Union -------------------- 6.8 4.6 9.2 13.0 Upson -------------------- 1 Walker ------------------- 2 Walton ------------------- 2 Ware --------------------- 2 Warren ------------------- 4.0 1 6.4 3.2 2 9.6 9.6 7.2 9.8 Washington --------------- 2 Wayne -------------------- Webster ------------------- Wheeler ------------------ White --------------------- 8.3 4.1 11.7 31.2 15.6 Whitfield ----------------Wilcox -------------------Wilkes ------------------Wilkinson ----------------Worth -------------------- 7.7 6.6 4.7 4. 7 Residents of Georgia, death occurring In other states 4 Military Reservations ------ PNEUMONIA Rate Per 100,000 Number Population 1942 1941 1942 1941 10 117.8 82.4 27 29 95.0 102.0 1 3 7. i 23.1 6 56.6 17 20 69.4 81.6 10 6 122.8 73.7 3 47.8 31.9 3 18.5 18.5 3 4 27.9 37.1 7 6 46.2 39.6 10 9 60.0 54.0 7 13 22.4 41.5 4 26.9 21.5 9 10 53.1 59.0 20.3 20.3 26.2 13.1 24 22 54.7 50.1 3 9.2 27.7 43.9 54.8 13.0 13.0 15 27.9 59.8 10 12 32.2 38.7 9 11 43.3 52.9 14 13 50.1 46.5 3 4 29.3 39.1 13 37.1 53.7 5 15.2 38.1 21.2 11.7 11.7 3 46.8 i7.9 10 18 38.3 69.0 3 7 23.5 54.9 4 19.9 26.5 13 13 117.9 117.9 13 5 60.8 23.4 15 28 8 5 NOTE: These figures are allocated to county of residence and exclude non-residents of Georgia. Only the state totals Include residents of Georgia dying In other states. Rates based on the 1940 Census Enumerated Population. ----- Information and Statistics 351 TABLE 14 NuMBER AND PERCENT OF BIRTHs (ExcLUSIVE OF STILLBIRTHS) BY PERSON IN ATTENDANCE AND COLOR, IN GEORGIA: 1929-1942 Total Total 1929 ----- 58,521 1930 ----- 60,318 19:Jl ---- 61,774 1932 ----- 63,690 1933 ----- 60,744 1934 ----- 64,615 19R5 ____ 6R,290 1936 1937 1938 1939 1940 1941 1942 ----- 61,617 ----- 64,012 ----- 64,307 ----- 64,910 ----- 64,695 ----- 67,785 ----- 72,189 White 1929 ----- 35,751 1930 ----- 37,064 1931 ----- 37,531 1932 ----- 38,209 1933 ----- 35,692 1934 ----- 38,333 1935 ----- 37,345 1936 ----- 36,320 1937 ----- 38,181 1938 ----- 38,613 1939 ----- 38,923 1940 ----- 38,911 1941 ----- 41,277 1942 ----- 45,192 Colored 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 ----- 22,770 ----- 23,254 ----- 24,243 ----- 25,481 ----- 25,052 ----- 26,282 ----- 25,945 ----- 2!i,297 ---- 2:>,831 ----. 25,694 ----- 25,987 ----- 25,784 26,508 ----- 26,997 Number Physician 38,448 39,416 38,322 37,981 35,112 39,498 37,312 36,659 39,510 40,111 40,856 41,637 44,872 50,099 32,229 33,240 32,663 32,169 29,597 33,052 31,798 31,111 33,412 34,014 34,448 34,907 37,612 42,077 6,219 6,176 5,659 5,812 5,515 6,446 5,514 5,548 6,098 6,097 6,408 6,730 7,260 8,022 Midwife 19,956 20,728 23,315 25,578 25,396 25,043 25,737 24,661 24,262 23,970 23,769 22,807 22,715 21,968 3,429 3,695 4,761 5,944 5,919 5,226 5,373 4,998 4,615 4,473 4,275 3,830 3,544 3,035 16,527 17,033 18,554 19,634 19,477 19,817 20,364 19,663 19,647 19,497 19,494 18,977 19,171 18,933 Other Total Percent Physician Midwife Other 117 100.0 65.7 34.1 0.2 174 100.0 65.3 34.4 0.3 137 100.0 62.0 37.7 0.3 131 100.0 59.6 40.2 0.2 236 100.0 57.8 41.8 0.4 74 100.0 61.1 38.8 0.1 241 100.0 59.0 40.7 0.3 297 100.0 59.5 40.0 0.5 240 100.0 61.7 37.9 0.4 226 100.0 62.4 37.3 0.3 28;) 100.0 62.9 36.6 0.5 251 100.0 64.4 3'i.3 0.3 198 100.0 66.2 33.5 0.3 122 100.0 69.4 30.4 0.2 93 100.0 90.1 9.6 0.3 129 100.0 89.7 10.0 0.3 107 100.0 87.0 12.7 0.3 96 100.0 84.2 15.6 0.~ 176 100.0 82.9 16.6 0.5 55 100.0 86.2 13.6 0.2 174 100.0 85.1 14.4 0.5 211 100.0 85.7 13.8 0.5 l!l4 100.0 87.5 12.1 0.4 126 100.0 88.1 11.6 0.3 200 100.0 88.5. 11.0 0.5 174 100.0 89.7 9.8 0.5 121 100.0 91.1 8.6 0.3 80 100.0 93.1 6.7 0.2 24 100.0 27.3 72.6 0.1 45 100.0 26.5 73.2 0.3 30 100.0 23.3 76.5 0 ) 35 100.0 22.8 77.1 0.1 60 100.0 22.1 77.7 0.2 19 100.0 24.5 75.4 0.1 67 100.0 21.3 78.5 0.2 86 100.0 21.9 77.7 0.4 86 100.0 23.6 76.1 0.3 100 100.0 23.7 75.9 0.4 85 100.0 24.7 75.0 0.3 77 100.0 26.1 73.6 0.3 77 100.0 27.4 72.3 0.3 42 100.0 29.7 70.1 0.2 352 Georgia Department of Public Health TABLE 15 DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES IN GEORGIA FOR THE YEARS 1850-1940 Cause of Death 1850 Number of Deaths 1860 1870 1880 1890 1900 1920 1930 1940 ALL CAUSES ---- 9,925 12,813 13,606 21,549 21,174 26,941 32,243 35,188 32,285 Typhoid fever --------- 557 Malaria --------------- 185 Smallpox ------------- Measles --------------- 74 Scarlet fever ---------- 202 Whooping cough ------- 385 Diphtheria ------------ 344 Dysentery, diarrhea and enteritis ---------- 654 Tuberculosis ----------- 379 Cancer --------------- 60 Pneumonia ----------- 651 Heart diseases --------- 603 A!I other causes 5,831 887 568 8 47 217 334 440 1,061 550 81 1,268 723 6,629 772 705 18 270 12 92 417 1,414 996 131 1,363 274 7 ,14~ 987 1,000 1,766 549 500 68 1,060 937 1,226 559 442 89 2 46 496 440 201 61 128 23 31 8 44 32 38 16 650 89 222 373 257 108 1,309 553 819 401 135 59 2,011 1,882 240 1,685 1,451 9,745 2,353 2,324 293 1,738 1,405 10,034 2,235 2,830 382 2,598 2,127 12,44:i 1,725 2,362 1,124 2,766 1,892 20,396 1,347 2,175 1,552 2,580 4,099 21,93;) 693 1,533 1,959 2,0ti5 6,176 19)06 Rates Per 100,000 Population [850 1860 1870 1880 1890 1900 1920 1930 1940 ALL CAUSES ---- 1095.3 Typhoid fever ------- 61.5 Malaria -------------- 20.4 Smallpox ------------- Measles -------------- 8.2 Scarlet fever --------- 22.3 Whooping Cough _______ 42.5 Diphtheria ----------- 38.0 Dysentery, diarrhea and enteritis 72.2 Tuberculosis ---------- 41.8 Cancer --------------- 6.6 Pneumonia ----------- 71.8 Heart diseases -------- 66.5 AI! other causes ----- 643.5 1211.9 83.9 53.7 0.8 4.5 20.5 31.6 41.6 100.4 52.0 7.7 119.9 68.4 627.0 1149.0 65.2 59.5 1.5 22.8 1.0 7.8 35.2 119.4 84.1 11.1 115.1 23.1 603.2 1397.3 64.0 68.7 0.1 32.2 2.0 42.1 84.9 130.4 122.0 15.6 109.3 94.1 631.9 1152.4 1219.11 54.4 79.9 51.0 55.5 2.1 24.0 9.1 0.4 2.0 4.8 10.0 30.1 37.1 128.1 126.5 16.0 94.6 76.5 546.1 101.1 128.1 17.3 117.6 96.2 563.1 1113.2 19.0 19.3 0.1 2.1 1.1 12.9 13.8 59.6 81.6 38.8 95.5 65.3 704.2 1207.4 17.2 15.2 4.4 1.3 8.8 4.6 46.2 74.6 53.3 88.5 140.6 752.7 1033.5 2.2 2.S 0.7 0.5 3.5 1.9 22.2 49.1 62.7 65.8 197.7 624.4 NOTE: Figures for the year 1910 not available. Information and Statistics 353 TABLE 16 DEATHS UNDER ONE YEAR OF AGE, MATERNAL DEATHS AND STILLBIRTHS WITH RATES PER 1,000 LIVE BIRTHS, IN GEORGIA: 1920-1942 Year Infant Mortality 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1W~& 1937 1938 1939 1940 1941 1942 ------------------- 5305 ---------------------- 4905 --------------------- 4U37 --------------------- 5384 --------------------- 5674 ---------------------- 4704 - -------------------- 4405 --------------------- 4578 --------------------- 4875 --------------------- 4464 --------------------- 4713 ---------------------- 4234 --------------------- 4097 --------------------- 4079 - ------------------- 5086 --------------------- 4316 --------------------- 4319 --------------------- 3968 --------------------- 4352 --------------------- 3817 --- ------------------ 3737 --------------------- 3955 --------------------- 3559 Number Mortality 558 568 658 573 708 641 485 578 622 549 658 616 620 463 505 458 491 471 421 356 342 315 299 Stillbirths 3389 3820 3862 3958 3864 3455 2972 3836 3478 3541 3796 3678 3847 3700 4120 3987 3666 3677 3390 3228 3078 2903 2786 Infant Mortality Rate Maternal Mortality 88.3 73.9 75.9 84.5 89.5 78.9 87.2 73.5 80.9 76.3 78.1 68.5 64.3 67.2 78.7 68.2 70.1 62.0 67.7 58.8 57.8 58.3 49.3 9.3 8.6 10.1 9.0 11.2 10.8 9.6 9.3 10.3 9.4 10.9 10.0 9.7 7.6 7.8 7.2 8.0 7.4 6.5 5.5 5.3 4.6 4.1 Stillbirths 56.4 57.:1 59.3 62.2 61.0 58.0 58.9 61.6 57.7 60.5 62.9 59.5 60.4 60.9 63.8 63.0 59.5 57.4 52.7 49.7 47.6 42.8 38.6 TABLE i7 BIRTHS AND DEATHS (ExcLusivE oF STILLBIRTHS) WITH RATES PER 1,000 PoPULATION AND BIRTHs PER 100 DEATHs, IN GEORGIA: 1920-1942 Year Number Births Deaths Rate Births Deaths Births Per 100 Deaths 1920 -------------------- 60,061 32,243 20.7 11.1 186 1921 -------------------- 66,378 29,552 22.9 10.2 225 1922 -------------------- 65,082 31,714 22.5 10.9 205 1923 -------------------- 63,681 34,082 22.0 ll.8 187 1924 -------------------- 63,386 34,797 21.8 12.0 182 1925 -------------------- 59,610 31,278 20.5 10.8 191 1926 -------------------- 50,493 29,906 17.4 10.3 169 1927 -------------------- 62,246 31,869 21.4 11.0 195 1928 -------------------- 60,259 36,085 20.7 12.4 167 1929 -------------------- 58,521 35,340 20.1 12.2 166 1930 -------------------- 60,318 35,188 20.7 12.1 171 1931 -------------------- 61,774 32,989 21.0 11.2 187 1932 -------------------- 63,690 32,122 21.5 10.8 198 1933 -------------------- 60,744 31.184 20.4 10.5 195 1934 -------------------- 64,615 35,590 21.5 ll.8 182 1935 -------------------- 63,290 34,313 20.9 11.3 184 1936 -------------------- 61,617 37,293 20.2 12.2 165 1937 -------------------- 64,012 34,411 20.8 ll.2 186 193S -------------------- 64,307 33,617 20.7 10.8 191 1939 -------------------- 64,910 31,856 20.8 10.2 204 1940 ---- ---------------- 64,695 32,285 20.7 10.3 200 JR41 -------------------- 67,785 31,579 21.6 10.0 215 1R42 -------------------- 72,189 28,807 23.1 9.2 251