STATE OF GEORGIA EPARTMEN DD ANNUAL REPORT 1946 STA1.,E OF GEORGIA DEPARTMENT OF PUBLIC HEALTH T. F. ABERCROMBIE, M.D., Director ANNUAL REPORT FOR THE YEAR 1946 State Office Building Atlanta, Georgia STATE OF GEORGIA DEPARTMENT OF PUBLIC HEALTB T.F.ABERCROMBIE,M. D., DIRECTOR AT~ANTA To His Excellency Hon. Ellis Arnall Governor of Georgia Dear Sir: I have the honor to present to you the annual report of the work of the Department of Public Health for the year 1946. Fewer Georgians died in 1946 than in any other year in the history of State health records, There were 27,405 deaths and 85,699 births recorded. The births occurred at the ratio of 313 for each 100 deaths, The death rate from all causes declined to 877.3 per 100,000 population, a decrease of 3.7 per cent over 1945, Tabulation of deaths from 31 leading causes shows only eight with an increase last year - measles, diabetes, .heart disease and cirrhosis of liver, malformation and early infancy diseases, suicide, homicide and accidents. The other 23 diseases show reductions from 0.9 to 100 per cent. All communicable diseases, except measles, show appreciable declines. Cancer, nephritis, cerebral hemorrhage, embolism-and thrombosis- causes of'death in the older-age group, all show declines, Typhus fever which has been increasing steadily since 1933, shows an encouraging reduction of 44.1 per cent - the first decided improvement in the rate in the past 13 years, The ten leading causes of death were, in the order named: heart disease; cerebral hemorrhage; embolism and thromposis; nephritis; cancer; accidents; malformation and early infancy diseases; pneumonia; tuberculosis; homicide and influenza. Since 1920, births in Georgia have increased from 20;7 per 1,000 population to 27.4. Births per 100 deaths in 1920 were 186 anr. in 1946 were 313. The infant mortality has declined from 88.3 per 1,000 live births in 1920 to 35.8 last year. Maternal mortality improved from 9,3 deaths per 1,000 live births in 1920 to 2,7 in 1946. Table of Contents Page Division of local Health Organizations____________________________________________________ 13 Division of Public Heahh Nursing____________________________________________________________ 55 Division of Public Heahh Engineering______________________________________________________ 65 Division of Dental Health Education________________________________________________________ 91 Division of Maternal and Child Health______________________________________________________ 103 Division of Public Health Education________________________________________________________ 125 Division of Preventable Diseases________________________________________________________________ 133 Cancer Control Service________________________________________________________________________ 13 5 Epidemiologic Service__________________________________________________________________________ 140 Industrial Hygiene Service__________________________________________________________________ 186 Social Hygiene________________________________________ -------------------------------------------- 192 Typhus Control Service______________________________________________________________________ 196 Venereal Disease Control Service________________________________________________________ 21 0 Division of Tuberculosis ComroL______________________________________________________________ 221 Battey State HospitaL_______________________________________________________________________________ 231 Division of laboratories______________________________________________________________________________ 249 Division of Information and Statiscics________________________________________________________ 297 0 ~ < MEMBERS OF THE GEORGIA STATE BOARD OF HEALTH C. L. RIDLEY, M. D., Chrtirman______________________________________________________________Macon .R. L. ROGERS, M. D., Vice-Chrtirman______________________________________________Gainesville ROBERT F. MADDOX--------------------------------------------------------------------------------Atlanta B. H. MINCHEW, M. D.______________________________________________________________________Waycross C. K. SHARP, M. D.____________________________________________________________________________Arlingmn J. A. CORRY, M. D.----------------------------------------------------------------------------Barnesville \Y/. P. HARBIN, JR., M. D.---------------------------~--------------------------------------------Rome J. M. BYNE, JR., M. D.____________________________________________________________________Waynesboro D. N. THOMPSON, M. D.______________________________________________________________________Elbenon GEORGE WRIGHT, PH. G----------------------------~------------------------------------------Tifton J. W. WHITE, PH. G--------------------------------------------------------------------Thomasville J. G. WILLIAMS, D. D. s_______________________________________________________________________Atlama w. K. WHITE, D. D. s_____________________________________________________________________Savannah J. C. PATTERSON---------------------------------------------------.-------------------------------Cuthbert Brief History of Public I-lealth 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, and 6 pence were paid for "physicks" to be given soldiers in General Oglethorpe's Regiment in Savannah. As early as 1760, there was an act to oblige ships and other vessels coming from places infected with the plague, smallpox, or other contagious diseases to be quarantined. Later, 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 Stares to require registracion 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 act 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 soldiers 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 indicated 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 Taliaferro 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 parts of the State, were very poor and played an important part in the spread of the disease. Cases occurred in Augusta, Brunswick, and Macon. 10 Georgia Depa1tment of Pttblic Health On Ocwber 30, 1876, the S' COMMUNICABLE DISEASE CONTROL Admission to medical service . 101 155 201 54 2 G .... 2 Consultations with physicians... . Field visits. . . . . . . . . . . . . . . . . . . ....... .... 2~5 1 135 654 I !GO riss 7 6.1 I 1 29 Smallpox immunizations..... . . . . . . . . . . . . . 284 315 4461 735 ti3 4G4 . ... 214 .139 Diphtheria immunizations.... 218 386 4758 144 299 277 100 G3 Typhoid immunizations. . . . . . . . . . . .... 3513 1952 6794 3119 1827 3489 1560 3590 Whooping cough. . . . . . . . . . . . . . . ........... 124 145 1440 109 32 170 70 16 .... VENERAL DISEASE CONTROL Admission to medical service ................. 70 99 10245 93 28 84 .... 38 Clinic visits.... . . . . . . . . . . . . ............... 502 517 88428 424 629 359 .... 90 51G Field visits ................. .............. 23 54 14598 85 22 82 30 55 Number of clinic treatments .. 304 345 52604 3G5 220 280 .... 504 TUBERCULOSIS CONTROL Admission to meiical service 44 50 1067 47 Admission to nursing service ...... G4 G2 2328 148 Clinic visits.... . . . . . . . . . . . . . Field and office visits . . . . . . . . . .......... . 44 144 50 4638 221 14103 47 185 26 55 .... 64 55 .... 33 8G 87 147 20 17G GG 55 !JO 149 187 202 MATERNITY SERVICE Admission to medical service ..... 85 82 91 47 96 112 Admission to nursing service ......... .: . : ....... 88 82 720 50 162 225 Visits by ante-partum cases to medical conferences. 2G5 238 390 105 402 237 Field and office visits ..... ...... 283 271 2885 158 744 483 31 Gil 20 98 182 41 INFANT HYGIENE Admission to medical service ... Admission to nursing service .... Visits to medical conferences.. Field and office visits . . . . . . 24 G9 910 23 91 25 G9 7982 50 82 3~2 38 94 2233 56 4 255 48 212 11455 121 420 807 20 105 20 49 255 47 -""~' "' 15 1:-< " 21 <::> 289 ~ !58 1533 ::r; "' G9 l:, 54 ;~ :s-. 636 54 C... ) 4S1 o-c, ;l;:s, N 15 23 16 ~. <::> 32 :;; '-, 23 28 ~s 62 12 56 105 1-' \Q CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) en E<"c'. c ~ ~ < ~'Q =.=:"'>- <~ 0"' :;l "' ~" "' c ~ '0 "'"' ~ """''' ;. :l.: "' ;. ~ ""'' J: """'' PRESCHOOL HYGIENE Admission to medical service ...... 5 58 2623 7 34 . ... 17 .... Admission to nursing service. . .... : : : . 5 Visits to medical conferences ............. 7 Field and office visits ..... Dental inspections........... ::::::::::::::::: .. ....8 58 80 ...83. 5239 4510 9.6.2..0 16 9 . 16 ... .... . ... . ... 101 .... 85 . ... .3.0..5 . ... 142 66 262 15 2o . ... ........ .. ... ... SCHOOL HYGIENE Inspections by physicians or nurses ........ ...... 200 138 113875 306 .... Examinations by physicians. . . . . . . . . . . . . .... 16 Admission to nursing service....... . ........... 16 198 23472 45 4152 5 ........ Field and Office visits.. . . . . . . . . . . ............. Dental inspections.. ............................ ...2.0 .6..5.8 9282 30249 ..1.3. . ... 405 80 14 2 .................... 67 5 2 4 502 21 ....2 ................ ADULT HYGIENE Medical examinations...... . . . . . ............ 70 .... 43214 . ... .... 368 3 1 . ... MORBIDITY SERVICE Medical visits.............. Nursing visits . ............. ...................... .... Admissions to hospitals ..... ............... 1 19 238 627 3 694 2406 1 .... .4.5..8 12 . ... 52 8 . ... . ... 29 2 2 . ... ........ SANITATION Water supplies approved. . . . . . ... Privies and septic tanks instalied. . . . . . . . ... 8 Food-haudlh1g establishments registered ........... Dairy farms registered. . . ....... Milk plants registered ... Field visits .. .. .. .. . .. .. .. . .... . i4 ..4.2. 19 3191 682 33 99 61216 1 .... 39 .... .... '":i 1 13 5 9 54 9 31 22 73 15 LABORATORY SPECIMENS Specimens examined . ..... .................... 1293 1145 52848 997 978 1862 21 893 314 .... 1--.l 0 ""::'' ""' c:;] "c ' . .7 ~ ~ . \::. .. iil . ... tJ ~ 260 2 ~ ~ 16 . .3.1. "';;:) -."c...'.. 15 '\:j "'~ 2 "~. - "' 31 ::r: 1 "~ &' ~ 66 265 CONDENSED REPORT OP AcTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) i""i""i it; ~ a; it; ~ I! "' ~ :0 : "' ""~ ' ' 73 :~ ; "' "' "'i"=!' .!!l '5 "' g"' "7"ii 0 ,""'' E 0"' COMMUNICABLE DISEASE CONTROL Admission to medical service.... . . ..... ....... 159 22 30 197 30 300 47 2 5 254 Consultations with physicians... Field visits .................... 3 499 Smallpox immunizations ............. : : : : : : : : 1421 44 242 ...44 1G 170 374 13 1 127 87 363 81 36 18 7 309 1534 823 588 516 16 Diphtheria immunizations........ . .... 779 Typhoid immunizations. . . . . . . . . . ........... 1585 Whooping cough .......... ............ . ... 267 1070 140 ........ . ... 377 2755 228 170 2786 148 550 512 354 170 6 4565 354 4357 129 2.7.5..4. 1949 147 ..9.4.7 VENERAL DISEASE CONTROL Admission to medical service .... Clinic visits ............... Field visits ................. Number of clinic treatments ......... ..... ..... .... ...... 2708 26077 2061 18862 82 . ... 664 . ... 107 . ... 333 62 136 1G2 188 87 158 203 688 1588 1554 2972 789 2270 314 146 2 75 136 37 76 30 540 1588 856 2885 403 2270 181 TUBERCULOSIS CONTROL Admission to medical service .. ............ 208 43 Admission to nursing service. .......... 205 70 Clinic visits ............. 796 43 Field and office visits ............ :. :::::::::. 1452 181 13 1 59 GO 47 60 53 29 21 97 72 137 56 128 61 1 11 190 59 GO 25 59 52 19 43 339 125 208 291 190 197 30 MATERNITY SERVICE Admission to medical service. . .................. 1345 Admission to nursing service..................... 1529 Visits by ante-partum cases to medical conferences .. 4274 Field and office visits ...... ....... . ....... 2190 140 224 150 l 324 424 ... i 55{ 434 1000 80 80 265 268 304 573 340 435 693 1646 723 1141 109 143 231 428 193 193 417 486 ........ . ... INFANT HYGIENE Admission to medical service ... .............. 668 37 . ... 7 46 287 253 51 151 Admission to nursing service ... ........ 1044 47 221 70 478 182 138 171 . ... Visits to medical conferences.. Field and office visits ........ 1458 ...... 1758 107 .... 133 . ... 10 826 292 76 463 757 483 346 73 234 151 250 . ... :"0' 0""'' 26 "' 3 32 Ic-< 24 53 ~ "' 1533 25 ::r:; ~ 8~ 22 .0.., (}q ~"'"" '" 43 98 '"c""""' '-; 83 146 97 151 - .N..... CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 ( Conrinued) ..acc; ~""' OJ ~;: E Ill ~ ~ <: Ill <= a~; 13 ~ :; Ill ~" "Ill .!!l 'E Ill <= i5 .s= "0 i5 '0 E 0 !>RESCHOOL HYGIENE Admission to medical service. 315 Admission to nursing service ... 645 Visits to medical conferences .. 820 Field and office visits .... Ill! Dental inspections ...... I 136 51 RO 2:J :n 141 261 4 256 60 31 I 226 57 JOJ 25 31 415 480 2 414 69 ...3.1 SCHOOL HYGIENE Inspections by physicians or nurses. Examinations by physicians ...... ...... Admission to nursing service. Field and office visits. ...... Dental inspections......... 13244 3721 808 1709 413 5 28 1157 1715 87 1767 1006 246 406 28 351 9 29 2 51 9 lO 11 17 277 31 17 29 16 11 519 .... ADULT HYGIENE Mcdioal examinations. ............ 2362 179 88 29 232 441 302 12 MORBIDITY SERVICE Medi.r.al vi.s!t .... Nursmg; VIsits............... Admissions to ho;;pitals ..... (j 3 47 8 J:l2 OS G 3 14 SANITATION Wat.er supplies approved. . . . . . . . . . ......... 33 5 16 Privies and septic tanks installed. . . . .. 368 2 2 Food~handling establishments registered .......... 381 Dair.v farms registered. . . . . . . . . . . . . . . . .... 135 .... .... 11 8 1 74 58 27 41 I G 53 1 Milk plants registered........ . . . . . ... 11 1 3 Field visits .................................... 28150 17 40 18 751 958 122 24 LABORATORY SPECIMENS Specimens examined .. - 20593 961 GO 2978 761 3893 2264 2630 1115 313 1'0 1'0 'C" "<= 0 (') "' 96 ~"a-' 133 ti ~ "' .:.;.:.. 202 "~- --26 49 ."",''. a "tJ ~"' <"> 54 4 ::c ~ "' :":"s- 6Q.l CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) COMMUNICABLE DISEASE CONTROL Admission to medical service .......... Consultations with physicians..... Field visits. . . . . ... Rmallpox immunizations .... Diphtheria immunizations. Typhoid immunizations . Whooping cough .... VENERAL DISEASE CONTROL Admission to medical service...... Clinic visits ........ Field visits ................. Number of clinic treatments. ............ ....... ..... TUBERCULOSIS CONTROL Admission to medical servire .. ....... Admission to nursing service. ............ Clinic visits............... ............. Field and office visits ..... MATERNITY SERVICE Admission to medical service ... Admission to nursing service..................... Visits by ante-partum cases to medical conferences. Field :ind office visits. . . . . . . . . . ....... INFANT HYGIENE Admission. to medical service ..................... Admission to nursing service ................ Visits to medical conferences ..................... li'ield and office visits ........................... 0:: <'."l 5 3 g 304 83 3007 191 46 364 16 281 30 iii i 3 ~ ~ <.l 11 778 574 GG18 258 7 ....5 . "3:i 82 299 i7 48 3 130 14 275 E" ~ g ~ ~""'' ":"g' "<.'l <".'l "<.'l 115 305 181 140 138G 123 3358 25 233 1818 13 873 7479 293 SG 783 4 59 7138 279 GG127 24 1014 200 8182 4GG G 437 1777 15 6775 81 12>5 95 1338 195 31!3 317 10026 iii 25 178 86 2836 15 42 631 164 1491! 30 g. .8 ";< ~""' ~"' ,., >"0 . <".'l .c <.l 0'" 0'" 0"' 118 .... 2 259 591 995 3212 ........... 10 399 159 21(12 42 40 240 . ... 56 689 .... 523 347 691 . ... 17 382 28 .... 53 173 336 1170 ........ . ... 90 59 146 216 .... 84 248 95 512 180 761 188 345 . ... 17 """:i 271 1124 1464 ........ 23 23 38 ;".":!:0'; 32 t-< C) " 203 ~ ::c 163 70 "' 999 20 ~ ":::";... GG a 549 "' 83 O"q "' 343 "" N ""ii '""C""')' "' ..78 <-, 43 73 113 176 13 41 20 80 h.l \JO CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) - Q) Q) ~ <".>' tl .0s <".>' .cs: 'i: "'.::; <.> E ~"' .::; <.> ~ .::; ~ g">' .-s; Q) ""~" Q) ~ >, .::; <.> .::; <.> .::; <.> 1"3' 1"3' PRESCHOOL HYGIENE Admission to medical service .... Admission to nursing service ... Visits to medical conferences .. Field and o!fice visits ........ Dental inspections... ....... 19 1 254 31 I 410 . ... SCHOOL HYGIENE Inspections by physicians or nurses .. Examination by physicians .... Admission to nursing service ........ Field and o!fice visits ............... Dental inspections.................... 31 9 .4..1.6 6 6 8 .... ADULT HYGIENE Medical examinations ................... 49 MORBIDITY SERVICE Medical visits..... . . . ........ Nursing visits.. . . . . . . . . .... Admissions to hospitals ..... ....... .... . 64 ... SANITATION Water supplies approved ........ Privies and septic tanks installed .......... .... ........ Foodhandliug establishments registered ... .... Dairy farms registered .......................... .... Milk plants registered ....................... Field visits ................ 86 ............ LABORATORY SPECIMENS Specimens examined .......... ........ 140 329 10 !50 132 989 18 331 1G6 5789 417 27 144 .... . ... 45 . ... .2.2.1. !0 42569 5 2128 4 ........ ........ 1265 644 55 70 684 5706 8558 2166 3 . ..1.7 .... . ... 140 44 . ... . ... . ... 1766 .... .... 1277 .... 620 66 5440 2610 .... .... .... 10 . ... . ... .... 23 6 27 192 292 950 30 .... .36 ........ ................ i4i . ... 115 36 42 7 59900 .... 78 "i:i 6 13137 10 863 73127 .... . ... . ... 6638 .... c: ~ 13 3 3 3 7 235 . ... 83 . 492 . ... 4 70 164 603 N "" -E c: 13 c;) "'<::l ~ 7 ~- 12 8 tJ . ..1.5 ~ ~ 1217 30 5 !10 "~'" ";;;', "" <::l 620 -"\:! ~ 35 -.. 48 ":"":"'c'" "' I !< ~ ;:,... 60 676 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ""c0"" =c"0"'' ~ ccC" :C" E - c g c ~ c~ 1: .E 3: c~ c. c":;' c'C""' 15 ~ c COMMUNICABLE DISEASE CONTROL Admission to medical service... . . . . ............. 309 201 66 1 Consultations witl1 physicians .................... 24 11 1 Field visits .................................... 780 373 230 3 Smallpox immunizations. . . . . . . . . . . . . . .......... 906 901 573 403 Diphtheria immunizations ........... 552 974 541 160 Typlwid immunizations ......................... 7629 Whooping cough ........................ ..... 119 2.7.4.5. 3516 139 3259 19 3 1 .... 13 .... 2 3 2 7 282 114 966 35 7 422 204 1333 105 5 56 77 641 85 288 974 2409 24 66 12 27 113 50 1 ....2 ............ VENERAL DISEASE CONTROL Admission to medical service..................... 230 382 238 51 Clinic visits ............... ............... 1191 2121 774 434 Field visits. . .. .. .. .. . . .. . .. ... 447 260 370 120 Number of clinic treatments ......... : : : : : : ... 1053 1295 724 274 23 36 9 27 313 3510 202 1833 25 174 . ii:i 342 2923 99 1101 .... ...1.1 .... ........ . ... TUBERCULOSIS CONTROL Admission to medical service..................... 194 136 77 ~ft~~s~~it!~. ~~-r~~~~ ~~~~i.e~."."."::: ..'..'.".' .. ..... 279 182 136 120 143 167 Field and office visits ...................... 1029 796 407 14 7 26 14 58 "74 42 10 173 66 32 169 48 40 10 206 175 52 595 75 .... MATERNITY SERVICE Admission to medical service .................... 7 263 210 Admission to nursing service..................... 43 289 295 Visits by ante-partum cases to medical conferences. 3 611 342 Field and office visits . . . . .. . .......... 110 858 634 4 13 4 53 3 12 4 22 . i84 399 50 109 284 257 794 798 ":io 57 .... ............ INFANT HYGIENE Admission to medical service..................... 4 307 106 Admission to nursing service............... 49 333 189 Visits to medical conferences.. . ................ Field and office visits ....................... li7 530 707 173 385 13 21 1 "'i ................ .. ii "iii 106 104 158 170 ":i2 io2 ................ c~ .... t-< ":ii <::> <') 254 ~ ::c 213 1703 181 ~ ~ ;:s... a 1594 4568 "" 137 3372 O'Q ~ 88 79 170 ~~ "<::"> "' 252 "" 304 304 884 945 276 276 507 631 l'-' VI j 1'0 0\ CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) PRESCHOOL HYGIENE Admission to medical service. Admission to nursing service .. Visits to medical conferences .. Field and office visits. Denial inspections.. SCHOOL HYGIENE Inspections by physicians or nurses. Examinations by physicians ... Admission to nursing service. Field and office visits .... Dental inspections.. :"E' ."g' 'E""'' '5 E C" :> 0 0 g '-' '-' '-' '-' '-' 375 158 20 336 187 46 40 373 323 44 429 459 115 122 168 318 3054 1354 556 207 624 301 33 351 2 59 .... 91 4G5 I 1 I 1Gi 1 so 1: ~ ~ 0 '-' ~ ~ '-' e. 0 Q""""' 12 41 14 16 41 33 i4 8 17 47 52 G8 175 12 247 4R 1 23 8 1 133 10 <= ..0 3' Q c~ c;) ...(1) <::> 107 107 O;"':Q:,.. 114 114 t:J (1) ~ ;::,. ~ S34 3049 (1) ;;:l -..."" 192 3049 <::> ADULT HYGIENE Medical examination... 679 240 539 9 357 1G4 :'";1::::1 <:::;-- MORBIDITY SERVICE ~ Medical visits ........ 81 10 1 Nursing visits........... 83 24 95 13 1 Admissions to hospitals .. ............... 3 62 7 ".~ .... (1) !>. SANITATION i:;:" \~rater supplies approved. . . . . . . 2 IS 3 <:J.. Privies and septic tanks installed ......... !53 18 25 2 I 55 6 85 !55 Food-handling establishments registered .. 30 50 70 Dairy farms registered ...................... 18 3 Milk plall(S registered ...... 2 2 Field visits ............... 1133 46 1653 52 39 111 3S 2968 14 1 2356 l' LABORATORY SPECIMENS Specimens examined. ..... 4260 1739 4224 342 lui 999 250 2920 90 4140 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY 1 COUNTIEs-1946 (Continued) ~""' 0 C..), -g 0 >. c0 .~.c., i5 0 00 g" . c 00 >. 0::: .0c "U1 .1! E '", ;c;:: ,'Q" U1 iii -., "c:' "E U1 COMMUNICABLE DISEASE CONTROL Admission to med.ical service ............ 97 Consultations with physicians..... . . . . . . . ... 58 Field visits. . . . . . . . . . . . . . . . . . . . . . . . ......... 317 Smallpox immunizations ..................... 1294 Diphtheria immunizations ...... ............. 582 Typhoid immunizations ... 8400 Whooping cough ....... 87 265 10 144 2255 796 39115 382 1 98 1 37 1 274 786 .... 187 3536 .... 204 "578 207 2 3 8 964 337 3554 70 ............ ........ ........ 8 12 269 127 2185 44 1 1 1 ........ .... 23 8 50 166 335 3029 54 VENERAL DISEASE CONTROL Admission to medical service .... 405 81 699 1 52 81 Clinic visits ................. ............... 2582 253 7803 3 669 425 Field visits ... Number of clinic treait~l(mts ...... : 460 2528 257 .... 530 213 .... 6882 11 3G 40 522 133 304 TUBERCULOSIS CONTROL Admission to medical service. Admission to nursing service. Clinic visits .... ......... Field and office visits." ." : ... ...... 344 128 345 154 344 125 445 364 181 54 456 14 120 .... 75 40 293 91 54 1252 35 153 197 93 MATERNITY SERVICE Admission to medical service..... . . . ........... 288 125 348 2 .... 84 Admission to nursing service................... 461 128 375 18 6G 31 108 Visits by ante-partum cases to medical conferences. R35 Field and office visits .......................... 1050 324 1502 445 .... 1766 4:i 144 .. 78 166 256 INFANT HYGIENE Admission to medical sen~ice. 108 88 81 Admission to nursing service. . . :::::: 411 176 397 Visiis to medical conferences ..... 292 258 224 Fiold and office visits .................... 671 362 1145 21 . 28 11 31 .... . ... 19 28 .... 72 60 c00 "> U1 101 t-< " 126 <::> 276 .~....... 197 2445 ~ "' 152 ~ ~ 71 <:5-- a 269 273 ..,_ 156 O"Q ~ "~'- ~ 47 1 ""<:':'>" "' 130 <.-, 65 73 138 230 43 1QO 38 203 l'-.l --.J CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) "..". ~ ~ '""C'" (5 ,.. 0 (5 ~ "cQ"""" ."~ .'. "Q CJ .1..i 0"' ."::"! E ~""""'" i":""i'i 05 ."""E..' PRESCHOOL HYGIENE Admission to medical service.. . . . . . . . ...... 411 Admission to nursing service ..................... 450 Visits to medical conferences. . . ................. 403 Field and office visits ........................... 156 Dental inspections............................... .... 264 56 1157 .... 618 63 .... 3828 . ... . ... . ... 13 .... 9 15 ........ ........ 19 ........ . ... . ... SCHOOL HYGIENE lnspect.ions by physicians or nurses. ..... 4077 668 5684 121 . ... 301 508 Examinations by physicians. . . . . . ..... 860 372 .... 38 36 40 Admission to nursing service. Field and office visits ...... Dental inspections........... ...... 306 ..... 345 ....... .... 60 92 . ... 118 129 .... ..3..8 24 26 2 3 ADULT HYGIENE Medical examinations........ 1443 .... 68 . ... .... .... .... . ... . ... MORBIDITY SERVICE Medical visil s . . . . . . . . . . . . . . . . . . . . 5 .... Nursing visits .............. 256 126 . ... Admissions to hospitals ....... : : : : ...... : : : : : ... 81 .... 5 6 . ... ....2 .... 221 .... . ... 21 . ... SANITATION Water supplies approved .............. Privies and septic tanks installed .......... Food-handling establishments registered... Dairy farms registered. Milk plants registered ...... : 8 705 ....5 .... . ... 2 . ... 23 163 16 2 Field visits .................... :::: ... :::::: ... 1999 24 143 .7 23 38 6 .... 25 18 LABORATORY SPECIMENS Specimens examined .................... 3561 2556 5159 44' 371 2 1021 13 1025 h.l 00 ..~""..' (') "'Cl 4 13 ~ :";,' 22 tJ ~ .149 1 30 37 .~..... ~ "':..;.s... .... -.C..l... . ... 'i:l ~ .<.:.:.!.- . ii3i 7 :"":"r:: ~"' ~ 13 607 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ";:' ~"' !!l "$ ~"' ., c>. ii: .=c~.. .:;;:; ."::' ."s' ;f :;; . 0 g a~ a>""''. "c ' 1: G COMMUNICABLE DISEASE CONTROL Admission to medical service......... 1 Consultations with physicians........... : : : : . 1 .... Field visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 9 .... Smallpox immunizations................ 123 Diphtheria immunizations. . . . . . . . . . . . . . . .... 246 .... Typhoid immunizations ................. 1343 Whooping cough ........................... 40 19 4 46 1384 373 8679 205 1 1 ... 1 ........ 3 3 4 18 97 1028 72 65 436 2391 1566 15217 934 ............ . ... ........ . ... ........ .. ...... . ... 2856 174 509 923 907 5171 244 . ... . ... . ... 2 4 VENERAL DISEASE CONTROL Admission to medical service ....... ........... .... .... 398 .... Clinic visits................................. Field visits. . . . . . . . . . . . . . . . . . . . . . . ......... Number of clinic treatments. . . . . . . . ... ..... 21 2 .... ........ 1551 369 1929 ............ 32 198 6062 15024 ........ .. ...... 2671 24708 10 115 2450 6939 ........ ........ 821 7420 2 2 3 2 TUBERCULOSIS CONTROL Admission to medical service........ ........... 66 Admission to nursing service........ 224 Clinic visits .................................... 66 Field and office visits .................... 762 7 7 7 7 646 914 598 2908 ................ 1920 1 1230 3868 6 3000 5 5 ........ ........ 507 507 510 688 2 3 MATERNITY SERVICE Admission to medical service ..................... 82 .... Admission to nursing service..................... 136 .... Visits by ante-partum cases to medical conferences. 187 Field and office visits. . . . . . . . . . . . . ............ 292 1 32 ............ 85 .... ioi 518 1017 ........ . ... . ... 217 239 ........ 154 1404 3420 ........ . ... 544 427 .... INFANT HYGIENE Admission to medical service . . . . . . . . . . . . . . ..... 61 Admission to nursing service ..................... 222 Visits to medical conferences . . . . . . . . . . . . . . . .... 135 Field and office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 ... ........ 1 66 .... . ... 238 . ... 80 756 1568 ........ .... .... 60 500 1500 .... 156 134 5569 . ... 1780 1 2 .>, . ::'! (!) 710 1 t--< <::> "' 76S 836 ~ ::c 560 5332 "' 161 :::, ~ <::;- 145 1021 C) 192 762 ~ :::, 81 88 "~' ~ "<::'>- 206 ~ 125 151 379 440 103 211 156 622 ~~ \D CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) PRESCHOOL HYGIENE Admission to medical service.. Admission to nursing senrice .. Visits to medical conferences .. Field and office visits .... Dental inspections...... SCHOOL HYGIENE Inspections by physir.ians or nurses. ]!;xaminations by physicians. Admission to nursing service. Field and office visits. Dental inspections.. . .... . . . . . . . . ADULT HYGIENE Medical examinations... MORBIDITY SERVICE Medical visits .... Nursing visits......... ............. Admissions io hospitals ..... SANITATION Water supplies approved ........ Privies and septic tanks installed. . .... Food-handling establishments registered. Dairy farms registered .. Milk plants registered.. Field visits .... . . . . . . . . . LABORATORY SPECIMENS Specimens examined ...... c ' ""- ~ '">. ~ ">C . 0 ii: .<:: ~ & .:: :.:=c=. c 0 1: c3 81 342 150 367 150 333 275 753 954 6774 3 132 5 27 5 180 1328 100 11 3 1 2 5 1 14 17 100 76 6 41 47 6053 318 15 2901 1967 2 3969 2942 2 9.5.3..6 247 6301 4266 1481 2956 11052 2692 34 313 256 99 14 1023 456 38 4 11 8141 13 307 12130 354 528 364 825 4734 15J 120 15(i5 7125 1 2619 142 298 22 20 135 10 l 15783 2.1 38818 8 IJO 0 >. e"C Cl <:;) "a " "" 27 0'<:> 52 "~" 48 88 \:) 1521 .157 """."~~,""."..' 34 ;.",;.;".;. a '--1-. 500 'l:i "" 5 "."<,".'").".. 57 1 J:: "~ ~" <::l-o 25Q 4047 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) E ""c ~ ' ' > "- 13 "" . ... !:> ;~ :s.. G3 1095 a 5 833 "' .... ~ ;!;:s> 4 6 G 29 .... .... . ... ~- .!.:.>.,. ";a;s' <-, 37 20 95 --- '.)> I-' CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) E "<=' "::': Cl ~ .< 301 ~ 771 ~ 4211 ...._ 284 ~ ::: 187 3818 C) 109 ..,. 3818 ~ ~- 187 :;:, 187 it. 453 o 5<17 ~ 199 199 vo <:.)0 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) w c '! ~8c ~ 1c~ ~~ ~ -~~ w . w ~ g ~ - ..., - - ....... '-\ ..., - ...J ....I PRESCHOOL HYGIENE Admission to medical service...... . . . . . . . .... 4 3 .... 33 20 40 19 Admission to nursing service.......... ..... .... 4 18 .... 33 6 13 1!2 11 19 Visits to medical conferences......... ..... .... 4 6 .... 98 24 .... 76 .... 19 Field and office visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 27 .... 135 6 37 183 12 21 Dental inspections............. . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... .... 16 .... .... SCHOOL HYGIENE lnspegtio~s by physici~~s or nurses . . . . . . . . . . .... !38 !054 .... 1184 560 .... 1066 785 281 Exa"?-u~atwns by J?hystma!'s . . ..... .... .... .... .... .... .... .. . 489 785 8 Admtsston to nursmg service............ . . . . . . . . . . . . . .... .... !6 0 46 .... 39 Field and office visits . . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... 35 25 2 303 .... 54 Dental inspections... . . . . . . . . . . . . . . . . . . . .... .... .... .... .... .... .... 523 .... 300 ADULT HYGIE:NE. MediCal exammatwns.... . . . . . . . . . . . . 9 3 23 .... 99 40 .... 198 16 53 MORB.IDITY. SERVICE MediCal VlSlts.... . . . . . . . . . . . . . . . . . . . . . . . . . .... .... Nursing visits............................... .... 21 55 Admissions to hospitals... ........... .... .... .... 10 6 1 54 .... 2 78 18 126 1 .... .... 31 4 4 ~~~ IVatersupplies approved. . . . . . . . .... .... 1 .... .... Privies and septic tanks installed........ . . . . . . . . . 13 3 25 .... 40 . .. . .... 19 5 Food-handling establishments registered. . . . . . . . . . . .... .... .... .... .... .... .... .... Dairy farmsregistered. . . . . . . . . . . . . . . . . . . . . . . . . . .... .... .... .... .... .... Milk plantsregistered. . . . . . . . . . . . . . . . . . . . .... .... Field visits........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 53 8 30 .... 1098 1 .... 186 26 LABORATORY SPECIMENS Rpecimens examined. . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 243 691 .... 1870 3370 398 861 2234 783 IJJ ~ ~ ~ ...J c;) ~ ~ 114 IJI:, 114 ~ 1 239 tJ .... ~ ~ 965 ~ 302 ~ 30 ,. 262 ~ . . . . ..c...... 'i:i 1754 <::: ~ . ... . .... "::C' : .... ~ ~ 20 ;:s... 92 4 3 2 528 2066 CONDENSED REPORT OF ACTIVI'I"lES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ..""..'.' COMMUNICABLE DISEASE CONTROL Admission to medical service ............ ... Consultations witlt physicians .............. ........ Field visits ................................. Smallpox immunizations . ..................... .. 83 Diphtheria immunizations. . ................ 130 Typhoid immunizations . . . ......... Whooping cough .................. .. .................... 874. 18 VENEREAL DISEASE CONTROL Admission to medical service............. 129 Clinic visits............................ ...... 618 Field visits ................... 98 Number of clinic treatments ...... :: ::: ... :::: ... 527 TUBERCULOSIS CONTROL Admission to medical service. . . . . . .............. Admission to nursing service.. . ....... 6 Clinic visits.... . . . . . . . . . . . . . ... ..... Field and office visits ............ ..... 53 MATERNITY SERVICE Admission to medical service . .. 238 Admission to nursing service.. . 241 Visits by antepartum cases to medical conferences. 647 Field and office visits ........ 749 INFANT HYGIENE Aamission Admission to to medical nursing service service . ... .. .. . . . . . . . . . ..... 149 163 Visits to medical conferences ... 279 Field and office visits ....... 401 .i., c 0 8 ::i ::i 42 5 1 1 139 237 142 1605 88 ....5 ............ 247 1230 451 605 ................ 77 109 92 34.2 ................ 147 168 382 468 ............ .... 128 174 281 ........ .... 395 .""s'' ",:".'' ..0... 46 220 4{ 147 313 77 2544 24 479 891 3967 2 184 35 845 476 1288 110 70 374 1215 4.4 260 66 298 43 7 164 728 2 471 56 511 2 1440 309 592 231 52 251 364 64 398 e:c;;; .."..'. cI"=E' ::"E ~ "' :E .s"' ::E ."0 ~ :;; ::E . ... 1 310 . ... . ... 15 161 50 1303 11 1 ........4 ........ 126 38 215 153 1059 75 1 199 93 1181 6 .................... . ... .. i9 . ... ................ 325 505 108 262 62 975 122 768 ................ .. :ii 1 56 . . . . ............ 56 74 50 115 34 55 35 230 ................ .. 45 91 ........ .. ...... 46 ..59 162 164 255 271 79 170 ............ 52 ..66 7 .:5"a:' ::E . ... . .. t-< -0 "l'>. . ... ::t "' . ... l'>. ~ . ... <:s-o ............ c-.a..:., ~ . ... ........ . ... ,.l~'..>,..... ;0;:; "' V' VI i 'i CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ."".J" .~:.;,; :::; c 1i ::c:; ' ..J ""'~"' 0 ..J :;c;: E" .."J' iE"" c"' ~ ~c ~ g ~ :;;; :;":' :";:' PRESCHOOL HYGIENE Admission to medical service.. . . . . . . . .......... 75 Admission to nursing service....... ....... 79 Visits to medical conferences ...... 104 Field and office visits ........... ......... 233 Dental Inspections .................. SCHOOL HYGIENE Inspections by physicians or nurses. . ....... 61 Examinations by physicians.. 45 Admission to nursing service. . ......... .... Field and office visits . . . . . . . . . . . . . . . . . . . . . 51 Dental inspections.......... .... ADULT HYGIENE Medical examinations. .... MORBIDITY SERVICE Medical visits................... .... Nursing visit.s ............... Admissions to hospitals ...... ..... ..... ..... ..... 397 SANITATION \Vater supplies approved. . . ......... Privies and septic tanks installed .......... Food-handling establislunents registered ... Dairy farms registered . . . . . . . . . . . . . . . . . : : Milk plants registered........ . . . . . . ......... Field visits. . . . . . . . . . . . . . . . ..... LABORATORY SPECIMENS Specimens examined ............. .... .... 4 1131 108 123 259 337 1 592 66 70 188 757 163 4 69 5 1 34 2151 .... 67 82 .... 81 150 517 177 403 686 .... 1126 145 4523 1 4 1 i5 10 22 675 568S . ... 80 5 136 . . ...... 8 .... 417 594 i 69 2 348 3 . ... 1 . ... 17 3 30 6 59 268 9 80 . ... 51 416 . ... 1 13 9 34 5 27 59 25 701 328 3 '.JJ 0\ .c0., :";:' c.;) "<:"> "" ............ (}(:, ":;:'. tJ . ... ~ :;:. ;""!"!' """" . ... "<:>' "-;... "' .... '\:j <::;-< . ... ........ ~ <"> :::c "~" 12 20 36 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) -- <: "<"";'; -~ ~ "" :E ' " :E "0 " c: ::0;: E 0 .cE: ' :E c: "i:'' ~ >. f ::5;: ::"t""=;"l":' c: ~ z"' ""c:'' 8 0 COMMUNICABLE DISEASE CONTROL Admission to medical service.................. 1 .... 11 Consultations with physicians... . . . . . . . . . . . . . ... 8 Field visits. . . . . . . . . . . . . . . . . . . . . . . . . . . ..... 49 ........ . i7i Smallpox immunizations .................... 675 .... 1592 Diphtheria immunizations. . . . . ... 245 .... 530 Typhoid immunizations. . . . . . . . . . . . . . . . . ... 2108 Whooping cough ............................. 18 .... 3670 287 47 4 io 245 . ... . 736 ........ .... . ... 4 120 1194 . ... .. "4 248 61 62 182 892 283 775 16 2433 29 1999 76 . .. 2549 1164 396 161 VENEREAL DISEASE CONTROL Admission to medical service.......... 214 Clinic visits ........... ; ....... Ji'ield visits ...................... .' ." ." . ......... 2523 138 Number of clinic treatments ...... 1850 ............ .... 129 1916 583 1355 62 759 48 398 38 532 95 540 81 902 ........ 2180 26153 146 1734 . ... 30 784 . . ...... 1185 19910 101 1573 TUBERCULOSIS CONTROL Admission to medical service ..... Admission to nursing service ... ...... 35 ... i 17 28 27 108 Clinic visits.................. 2 ... i 33 28 Field and office visits ............ ::::::::: 83 251 172 10 ..25 . ... .... 256 996 81 78 13 37 43 .... 1329 71 .... 1323 127 23G . i4 MATERNITY SERVICE Admission to medical service. . . . . . ....... 202 Admission to nursing service..................... 250 Visits by ante-partum cases to medical confer-ences. 431 Field and office visits ........................... 701 .... ............ 295 228 415 70<[ 1 40 132 . ... SSG 55 48 78 158 . ... 1019 144 1 58 289 . ... 1931 131 91 113 345 . ... 3685 319 INFANT HYGIENE Admission to medical service.... 125 Admission to nursing service.. . . . . .. :::. :::::: 191 Visits to medical conferences.............. 202 Field and office visits ........................ 280 ........ ........ 173 158 is 89 406 29 12 80 14 97 145 150 ............ 705 1722 2151 47 127 400 . ... <[869 52 "c" . 0 .c: <;; '0 " " 1 I 1-< <:> 5 \':... ::c: "';:;;:;,:- <:::;-. a . ... "O:;';;Qs:, ~.... ~ . ... ";a;s' <.., <...)J -....! CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ..., .i~.",' ., :E Q; ~ :E ., e. c: ~ et- g0 c: 0 ~ c: l":' ' ::E ~="~' .. ~"~=' a ~ z .a. 0 PRESCHOOL HYGIENE Admission to medical service. Admission to nursing service. Visits to medical conferences .. Field and office visits . . . . . . Dental inspections......... 110 209 10 13 .... 4 136 10 .2.6.9. .... ....3 .... .... 6 . ... SCHOOL HYGIENE Inspection by physicians or nurses. .. .......... 484 Examinations by physicians . ....... . .,. Admission to nursing service ........ ..... 28 Field and office visits . . . . . . . . . . . . 43 Dental inspections.... ........... ............ ........ 1695 194 ........ 1 77 .... ........ 144 17 20 23 514 48 . ... 3019 23 .... 2152 95 .. ...... 6. 8.9..1 138 . ... 5482 3 .... .... 1 595 3 . ... 1128 1265 25 .... 30 .... 327 .... 2 3 .... ADULT HYGIENE Medical examinations .. .... 53 .... .... . ... MORBIDITY SERVICE Medical visits......... 1 Nursing visits . .............. 224 Admissions to hospitals . . . . . . . . . : : : : : ..... 1 .... .... 5 . ... 1 1 83 .... ...7.4 713 1 427 21 SANITATION Water supplie' approved. . . . . . . . . . ..... Privies and septic tanks installed ......... Food-handling establishments registered ... Dairy farms registered ..... Milk plants registered .... Field visits ............ .... 4 .2.9.0. .... .... 14 1292 2 11 ........ .... 63 2 9 ........ .... 287 427 2 19 8 16 65 2 25 15 31602 23 28 LABORATORY SPECIMENS Specimens examined . .................. 761 .... 1347 317 410 298 .... 30014 442 11 \j.l 00 .~.. c~ . 0 () O~"""Q"'' t; ~ ;";'t ~ .";:.:.':. "' -~ ~ -"<""> ::t: . ... ~"' <:s- 13 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ::"";:;;' ""-' ~ ""-' ~"""'' ii: e"' i"i:' i""i":' "0 " "- ~ :";' "- .E '"S "- "E :; 0' ."a""": COMMUNICABLE DISEASE CONTROL Admission to medical service..................... .... Consultations with physicians................. .... Field visits .................................... .... Smallpox immunizations. . . . . . . . . . . . ........... .... Diphtheria immunizations. . . . . . . . . . . ........... .... Typhoid immunizations ....................... Whooping Cough ...... ......................... .... .... 6 46 . .. 8 152 21 1190 5 ....6 ........ . ... 184 1170 950 4972 371 4 1 13 419 117 1455 44 1 5 . ... 1 6 4 718 66 781 ....4 115 353 . ... .3.8..5 1605 100 . ... ........ ................ . ... i ''':i 205 46 1569 32 VENEREAL DISEASE CONTROL Admission to medical service. . . . . . . . . . . ......... Clinic visits.......................... ........ Field visits ................................. NUli!ber of clinic treatments .......... .... 169 728 149 540 ................ 18 260 178 226 64 280 60 143 . ... ..3..1 114 163 150 123 ................ .... ............ 5 8 ...1.1 TUBERCULOSIS CONTROL ...9 Admission to medic.al service..................... Admission to nursing service..................... Clinic visits........................ . g Field and office visits ........................... 24 .... 51 20 94 .... .... .... 35 60 36 161 33 58 69 147 84 67 84 164 57 63 56 215 ................ 7 .. . 7 . 8 lO MATERNITY SERVICE Admission to medical service.................... .... Admission to nursing service.................... Visits by ante-partum cases to medical conferences. .... Field and office visits ........................... 103 117 291 . ... ........ 305 .... 36 43 90 221 111 134 262 320 .... .... 2 "'2 235 1016 .... ........ . ... . ... 19 289 88 124 INFANT HYGIENE Admission to medical service .................... .... 22 Admission to nursing service.... Visits to medical conferences..... ...... .... 40 30 Field and office visits ........................... .... 60 13 2 1 29 79 1 14 3 1 129 158 1 241 ........ .. ...... 16 197 1 609 .. ...... 23 1287 ...."l. 0 a" : -........ t-< 0 .24i 163 """' ., 3966. ::r:: 306 "";~ :s... 189 4057 127 .a... 3535 O \0 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ~<"=" ;a c.. ' c""..' 00 <= ".>: ":";;; 0:: ".>: 0:: .>: ~ :;;: 00 :";' c.. E "<=' ;r <= .":5;' 0' <= "a""":'' PRESCHOOL HYGIENE Admission to medical service ... Admission to nmsing service.. . Visits i.o medical conferences ... Field and office visits .......... .... Dental inspections............ 17 .... 51 21 .... 3 G 14G 5 33 .... 50 47 .... 17 G 50G 5 .... . ... SCHOOL HYGIENE Inspections by physicians or nurses. Examinations by physicians . . . Admission to nursing service. Field and office visits ... Dental inspections ...... ..... .... 380 223 . ... 49G . ... 241 .... ........ 231 1 G 1 12 218 1 29 1 374 .... . ... . ... ADULT HYGIENE Medical examinations.... ..... . ... . ... 47 57 .... MORBIDITY SERVICE Medical visits ............ Nursing visits............. Admissions to hospitals ... ... 2 78 G 4 105 .... 5 SANITATION Water supplies approved ........ .... 1 Privies and septic tanks installed ......... Food.handling establishments registered .. Dairy farms registered ............ ..... 1G .... ........ 1 .... 22 Milk plants registered ..................... Fit>ld visits ................... . i7 55 18 55 227 2 .... 10 3 34 . . ...... 38 ........ 5 G 1G 9 3 3 3G3 LABORATORY SPECIMENS Specimens examined .. .......... . ... G55 11G7 1429 227 242G . ... 485 0""" ""Q. 0 'C <= a":' c;] o.-"a.c."., 1 ~. ~ 1 t:1 . ... ~ .~..,.. 442 ~ "" 1 . ...G :..;.l,. ...a..,._ . ... ':1::::1 "~'""' 1 <""> ::c 309 . ... ""~ ~ ;:s... 12 1427 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) -"ec': a'f:j <"a "g ' a: >. ~" (/) c: "~ (/) g" .E "(/) :"cc:" "~ . ... ::t; (\) "'~ :::s-- a . ... ~ "';;l "' .... .~,. "C">" ;;l <.., ~ i-' CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ~ 0 ~E a: ~ i~i ag : t =5 cn .::::: It cn sc~~ en a w &~1:: ~c:. ! !-~ ~ ~o en en en en t- PRESCHOOL HYGIENE Admission to medical service.......... .. . .. .. .. 418 .. . . .. .. 17 .. .. 127 10 .. .. 231 .. .. Admission to nursing service...... . . . . . . . . . . . . 730 . .. . 37 .... 265 72 .... 122 . .. . Visits to medical conferences.. . . . . . . . . . . . . . . . . . 824 .... 18 .... 260 10 .... 397 .... Field and office visits.. . .. .. . .. .. .. .. .. .. .. . .. . 1866 37 . 2329 53 .. .. 346 .. .. Dental inspections..... . . . . . . . . . . . . . . . . . . .... .... .... .... .... .... .... .... .... SCHOOL HYGIENE Inspections by physicians or nurses.. .. .. .. .. .. 7945 .. .. 44 .. .. 6066 3965 .. .. 42 12 Examinations by physicians.. .. .. .. .. . .. .. .. .. .. 712 .. .. 2 .. .. 655 3 .. .. ll28 .. .. Admission to nursing service................. 317 .... . .. . 3 .. .. 10 129 . .. . . .. . Field and office visits.. .. .. .. . .. .. . .. .. .. .. 406 .. .. .. .. 12 .. .. 106 90 .. .. 11 .. .. Dental inspections............ . . . . . .. .. . . .. . . .. . .... .. .. .... . .. . . .. . 64 .. .. .... . .. . ADULT HYGI~NE_ MediCal exammatwns. .. .. .. .. .. .. .. .. .. .. .. .. .. 12979 . 1.. . .. . . MORBIDITY SERVICE Medical visits........................... .. .. . .. .. .. .. .. .. Nursing visits.......... . .. .. .. . .. .. .. .. 255 .. .. .. .. 80 .. .. 2 .. .. 2 .. .. 551 .. .. .. .. 19 .. .. 48 341 .. .. 577 .. .. 2 11 1 Admissions to hospitals.. . .. .. ... .. . .. .. .. .. .. .. . .. .. .. .. .. .. 3 .. .. 3 6 .. .. .. .. .. ~~~ Water supplies approved................. . .. .. .. 99 6 .. .. 6 1 . .. . .. .. Privies and septictanks installed. . . . . . . . . . . . . .. .. 235 3 20 15 .. . . 57 88 .. .. 85 28 Food-handling establishments registered........... 758 .... .... 35 .... 43 21 .... 25 Dairy farms registered. . . . . . . . . . . . . . . . . . . . . . 99 . .. . . .. . . .. . .. . . 18 1 . . .. 5 Milk plants registered.......... . . . . . . . . . . . . . . . . . 1 . .. . . .. . 4 .. . . 5 Field visits................... .. .. .. . .. .. .. . 19950 1 53 1022 37 1151 810 6 1977 68 LABORATORY SPECIMENS Specimens examined.................... . .. .. . 103119 .. .. 21 2371 .. .. 7105 1055 .. .. 3622 232 ~ N e ~a.. =a t- c;) "~ ' .. .. OQ . . . . ~. . . . t-< .. .. v .... ~ ~ . .. . ~ .. .. "' . .. . .. .. .... -~ ..,.,_ c 'i:i .. .. ;;; ~ ~ .. .. .. .. :<:':>C .. .. "' ~ .. .. ;::;-.. 5 4 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTlES-1946 (Continued) ... {! 0 >. 1"-' ~ ~ Gi 1- 'i; !ii t- !(l E 0 .<: t- i= .~ c E 0 0 1- "<:': ;t 0 t- s~ fl; .=0=c. COMMUNICABLE DISEASE CONTROL Admission to medical service............... .... 6 .... 9 7 3 56 22 Consultations with. physicians........... .... Field visits ............................ Smallpox immunizations ...... .................. ........ Diphtheria immunizations . ................... Typhoid immunizations ......................... Whooping cough ............................... ........ .... 11 . 229 2.4.1..2 . . 28 140 112 1047 16 10 198 981 823 273 552 2359 5777 37 165 ...8 32 .... 65 . ... 8 195 762 565 883 68 76 796 3715 51 2193 47 . ... 9007 230 VENEREAL DISEASE CONTROL Admission to medical service... .. Clinic visits .................. Field visits .................. , .. :::::::: ............ No. of clinic treatments ................... .... 48 1913 26 1772 15 206 324 273 2890 2140 40 47 178 168 2769 1573 189 135 . ... 583 542 72 542 320 2 117 ........ 4747 . ... 787 3510 TUBERCULOS.IS CONTROL Admission to medical service .................... Admission to nursing service. . . . . . . . . . . . . . . . . . . . Clinic visits .................................... .... ........ Field and office visits ........................... .... 19 25 20 56 64 1 18 4 93 101 4 66 177 71 87 69 . ... . ... 48 152. 507 62 135 101 191 295 228 .... 822 MATERNITY SERVICE Admission to medical service..................... Admission to nursing service . .................... .... .... 12 Visits by ante-partum cases to medical conferences .. Field and office visits ........................... .... .... . . 39 321 431 40 386 435 62 1!82 1331 230 1449 1367 231 231 63 73 . ... . ... . ... . ... 279 326 807 172 .... 895 848 192 1225 INFANT HYGIENE Admission to medical service .... ................. Admission to nursing service .. ................... Visits to medical conferences.. . . . ............... Field and office visits ........................... .... ............ ...8 . .28 35 101 81 134 274 134 383 534 991 600 !397 96 113 103 187 41 41 83 98 . ... . ... ........ ........ 167 333 262 761 :. <:: li t- !c:"-< ... "~ ::r: "";:. ~ <:s-- . ... C) "' ... ~ ;:. ;;s ~~ . ... "c' . ... ~ ..:>.. <.)0 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) ~ :c:::: 1"-' PRESCHOOL HYGIENE Admission to medical service... . .......... Admission to nursing service...... ..... Visits to medical conferences...... ..... Field and office visits ....... Dental inspections.......... .... SCHOOL HYGIENE Inspections by physicians or nurses. Examinations by physicians ...... Admission to nursing service ......... Field and office visits ....... Dental inspections................ .............. ....... .... ADULT HYGIENE 1v1edical examinations..... ........ MORBIDITY SERVICE Medical visits.......... Nursing visits......... Admissions to hospitals. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . SANITATION v-.rater supplies approved ........ Privies and septic tanks installed ....... Food-handling establishments regiRtered ...... Dairy farms registered ............. Milk plants registered ........ .... Field visits ............ LABORATORY SPECIMENS Specimens examined ......... ~ 0 >. 1" - ~ o; 1- t:;; 1- 9 . .. 35 34 .... 12 . 3 ... ....6 657 .... . ... 2 . ... 21 3 7 2 1 .... .... 27 .... . ... 87 .... .... 147 439 1464 ~ =1oE- 113 108 122 115 g 121 7 1740 1 5 38 314 4453 .:: i= ..wc 15 ~ cw : 3: ~ c: :"g ~" Q. ~" 9 75 .... .... 52 12 22 75 119 ........ ........ 91 69 33 .1.5.2. ........ . . ...... .1.6.1. 387 19 16 36 36 36 36 .... ........ ............ 6600 692 91 399 48 . ... .... . ... .... 447 9 7 33 . ... .... 2 214 .... 5 .... 53 g 3 270 11 123 8 994 5 44 ........ 45 2 14G9 2283 1085 6 3543 .!0>.. ~ "E 1"- Cl ""a "()-q ""tJ'' ";":";"t,' ;_: ;",s". -a . ~ ~ <::;-.. ~ :"'t ~ "" "<::->-- 23 CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) g '6, w ~""'' c"c:' ::::> ~ ::::> .:".': ~ ~"' ~ :;"::' ~""'' :"E' ~ "c ' ~ 'l"n' :;;.10. COMMUNICABLE DISEASE CONTROL Admission to medical service... . Consultations with physicians .. . Field visits ............ . Smallpox immunizations .. . Diphtheria immunizations. Typhoid immunizations ........... . Whooping cough ........... . VENEREAL DISEASE CONTROL Admission to medical service ..... . Clinic visits ................ . Fielrl visits .................. . Number of clinic treatments .. . TUBERCULOSIS CONTROL Admission to medical service.. Admission to nursing service .. . Clinic visits................. . Field and office visits ........ . MATERNITY SERVICE Admission to medical service ............ . Admission to nursing service ................... . Visits by antepartum cases to medical conferences. Field and office visits . . . . . . . . . . . INFANT HYGIENE Admission to medical service .. . Admission to nursing service.. . Visits to medical conferences .. . Field and office visits .......... . 37 8 70 .... 5 97 89 97 1 5 32 29 46 395 160 12 .... 595 .... 5 12 . 22i 330 292 11 2791 16 24 199 1 589 4455 243 506 37G1 306 ............ 252 3763 214 337 3092 90 126 159 342 .... 151 88 .... 2007 402 4275 .... 99.5 753 52 1086 2 68 334 :i755 .... .... 339 263 154 260 .... 62 232 73 107 22 190 114 92 92 75 ............ 103 106 93 109 37 2 2 381 27 547 375 .... 481 514 33 39 210 278 191 .... 365 191 .... 469 43 53 52 62 434 600 389 430 .... 1024 1481 77 153 7 7 7 4 117 289 255 163 163 ........ 315 453 402 .... 1168 17 23 27 14 705 479 1833 70 :.';""":::' .... .. ... ... at-< <'> ~ .... .~:":,"; a..., . ... ~;;s .,~ ........ . ... "";a;""s <-, ~ Vl CONDENSED REPORT OF ACTIVITIES OF LOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) PRESCHOOL HYGIENE Admission to medical service. Admission to nursing service . .. Visits to medical conferences ... .... Field and office visits .... Dental iiL'ipections.. .............. SCHOOL HYGIENE Inspections by physicians or nurses. Examinations by physicians . .... Admission to nursing service. ... Field and office visits .. ....... Dental inspections. ... ADULT HYGIENE Medical examinations. MORBIDITY SERVICE Medical visits ... Nursing visitf! . .............. Admissions tO: hospitals ..... SANITATION Water supplies approved Privies and septic tanks installed........ Food-handling establishments registered. Dairy farms registered ... Milk plants registered ... Field \~sits .. : . ....... LABORATORY SPECIMENS Specimens ex~mined .. c ..~""'' c ";:' ::::> c ~ ::::> :; .>< ~ c E "3: . ~ .c ~ E :"cE' ~ .. c ~"' ~ D ~ 6 122 243 ... 264 12 6 179 243 135 21 7 142 368 109 34 .... 9 . 2..1.4 416 .1.1..0 63 567 3S8 1344 3042 50 320 22 54 68 82 4 97 128 39 343 194 2399 181 4 30 12 20 1373 829 85 5 43 3 58 1 2 2 4845 .... ...2.4 . . ili 38 2 6 . ... 67 280 35 6 2 18 118 616 12o 16454 7 26 1529 83 1690 11937 3 2773 898 "0"\". ., ~ .c 3: Cl "c ' O"Q' ~- b ~ ,~ . .... ~ -;.".:.:'.. c '"1;:1 :;; ,~ _ "<'"> ::r:: ~"' <:so- Local Hectlth 01gctnizations 47 CONDENSED REPORT OF ACTIVITIES OF lOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) :~c ~ COMMUNICABLE DISEASE CONTROL Admissions to medical service.................... Consultations with physicians.................... Field visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Smallpox Immunizations ........................ Diphtheria Immunizations....................... Typhoid Immunizations......................... Whooping cough; .............................. VENEREAL DISEASE CONTROL Admissions to medical service................... Clinic visits................................... Field visits Number of ...................... c!inic treatments ....... .............. ,......' ...... TUBERCULOSIS CONTROL Admissions to medical service.................... Admission to nursing service..................... Clinic visits................................... Field and office visits ... , . . . . . . . . . . . . . . . . . . MATERNITY SERVICE Admission to medical service..................... Admission to nursing service..................... Visits by ante-partum cases to medical conferences .. Field and office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . INFANT HYGIENE Adm:ssion to medical service~ .......... Admission to nursing service.... . . . . .. Visits to medical conferences............ Field and dfice visits ..... ... ;; :':c5 ~ ~ ~ :""i!''i 3: c g .. ;cg ' 3: ~ 7 6 16 6 1 12 16 1 22 20 340 280 772 20 60 192 545 50 1930 1772 3149 16 101 124 279 89 79 181 262 161 834 1866 1488 9 !50 92 73 93 1426 618 187 59 53 188 87 59 210 1348 63 51 183 122 185 399 41 97 206 60 104 294 115 225 497 176 358 880 32 48 188 69 81 316 49 113 426 145 161 730 48 Georgia Depctrtment of Pttblic Health CONDENSED REPORT OF ACTIVITIES OF lOCAL HEALTH DEPARTMENTS BY COUNTIES-1946 (Continued) g" = ;"g t:: ~ ~ PRESCHOOL HYGIENE Admission to medical service.... . 9 22 77 Admissions to nursing service ................. . 10 26 103 Visits to medical conferences.................... . 2 17 54 115 Field and office visits. . . . . ........... . 21 47 224 Dental Inspections ..... SCHOOL HYGIENE Inspections by physicians or nurses ............. . 255 76 41 342 Examinations by physicians .... 3 15 1 Admissions to nursing service. 53 10 Field and office visits . . . . . . . . . . . . . . . . . . . . . . . 61 38 Dental Inspections..... . .......... . 2 ADULT HYGIENE Medical examinations.. 75 70 MORBIDITY SERVICE Ivledical visits..... . ........... . Nursing visits........ . Admissions to hospitals. I 379 2,1 4 1 SANITATION Water supplies approved ....... . Privies and septic tanks installed ........ . Food-hand1ing establishments registered .. Dairy farms registered ............ . Milk plants registered .... . Field visits ....... . 20 21 2 23 53 29 LABORATORY SPECIMENS Specimens examined ..... 14 720 546 785 2183 Local Health Orgcmizations 49 COMPARATIVE STATISTICAL SUMMARY OF TOTAL loCAL PUBLIC HEALTH WORK IN GEORGIA, 1945-1946 COMMUNICABLE DISEASE CONTROL Admissions fo 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 .. Measles ......... Whooping cough. Malaria ..... Hookworm .. Typhus .................... Other communicahle diseases. Total field visits for communicable disease con trol. ... Persons treated for hookworms ... Admissions to hospitals: Diphtheria........................ Typhoid fever and paratyphoid fever. Scarlet fever. Smallpox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other communicable disease patients admitted to hospitals.... ............ 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. Total diphtheria immunizations .. Rchick tests given .... Typhoid fever .................... Whooping cougb-under 1 year ... " 7hooping cough-over 1 year. Total whooping cough immunizations. Public lectures and talks .. Attendance . . . Persons tested .. in .s.u.r.veY~:: . VENEREAL DISEASE CONTROL Admission to medical service.... . . . . . . . . . . . . Admissions to nursing service. . . . . . . .. . . . . . . Tota] admissions to medical and/or nursinA: serv- ice............................. . Cases transferred to private physieians. Clinir visits Iby patients). Field visits (to patients) ... Number of clinir treatments: .' .. DOfifsimceisvseisditfsro-Rmaspeirdvitcree.a. t~~~t ~~~t~; Public lectures Attendance. and talks. ...... . . . . . . Organized Counties 1945 1946 6,154 R,411 9,526 1,227 2,219 509 3,175 25 287 1,035 74 1,827 600 3.283 13,034 2,117 156 5 36 144 341 54,571 13,300 16,574 11,831 41,705 12,790 222,701 8,112 4,918 13,060 115 2.745 10,974 41,194 30,737 43,476 1,679 411,986 42,096 320,284 16,487 2,798 59 4,755 7,863 8,413 9,698 1,119 1,015 285 1,464 32 1,355 602 86 2,692 200 2,345 10,074 3,389 53 27 16 304 400 53,150 11,274 6,566 9, 709 27' 549 8,362 238,047 8, 790 4,418 13,208 216 3,252 63,517 40,728 31,359 51,950 3,374 327,592 32,411 185,355 15,996 5,657 119 6,245 All Counties 1945 1946 7,318 10,050 11 '227 l ,313 2,477 720 3,460 33 311 1,048 74 3,695 636 3,441 18,57a 3,478 8,621 9,693 11,018 1,196 1,144 352 1,542 35 1,401 617 1,105 3,982 207 2,660 12,945 4,393 158 57 6 28 38 16 2 1 152 412 356 514 70,826 17,307 21,902 13,800 53,009 14,558 311,669 11,067 5,909 16,976 143 4,108 13,809 68,133 13,554 1u5,,5m54 40,579 9,247 322,273 10,743 5,220 15,963 372 5.123 65,154 47,447 37,414 50,174 1,899 494,856 49,400 391,282 18,917 3,q52 66 7,347 52,573 34,601 55,194 3,563 358,581 35,143 208,109 16,639 6,759 121 6,274 50 Georgia Dep(trtment of Pttblic Hectlth COMPARATIVE STATISTICAL SUMMARY OF TOTAL LOCAL PUBLIC HEALTH WORK IN GEORGIA, 1945-1946-Continued TUBERCULOSIS CONTROL Individuals admitted to medical service........ . Positive cases . .............................. . Suspicious cases . ............................ . Contacts ................................... . Individuals admitted to nursing service . ....... . Positive cases .............................. . . Suspicious cases ............................. . Contacts................................... . Total individuals admitted to medical and/or nursing service . ........................... . Positive cases ............................... . Suspicious cases ............................. . Contacts .................................. .. Physical examinations in clinics . .............. . X-ray examinations......................... . . Clinic visits (by patients) ................... .. Visits to Etate clinics (by patients) ............ Visits to private physicians (by patients) ....... . Visits to private physicians (health officer or nurse) ................................... . Visits to others (health officer or nurse) ........ . Field visits . ................................ . Visits to cases of tuberculosis ................. . Visits to tuberculosis suspects.. ............... . Visits to contacts........................... .. Office visits................................. . Office visits of eases of tuberculosis . . . . . . . . . . . . . Office visits of tuberculosis suspects ........... . Office visits of contacts ........... ....... . Admissions to sanatoria ....... ......... . Number tuberculin tests completed ..... . Number positive . ................ . Number negative (completed tests) ............ . Contacts broken . ........................... . Contacts partly broken ................ . Relief secured for tuberculosis cases...... ...... . Cottages, sleeping porches, ete. (Number built) Public lectures and talks .................... .. Attendance ................................. . MATERNITY SERVICE Cases admitted to prenatal medical service ..... Cases admitted to prenatal nursing service ...... . Cases admitted to medical and/or nursing service. Vis its by prenatal cases to medical conferences . . . Visits by prenatal cases to private physicians .... . Field visits to prenatal eases .................. . Office nursing visits by prenatal cases . ......... . Cases attended by nurses for delivery service .... . Cases given postpartum medical examination . .. . Cases given postpartum examination by private physicians . ............................... . Cases admitted to postpartum nursing service . . Visits to postpartum cases .......... . Permanent Health Centers ......... . Number of sessions . ................. . Itinerant health centers .............. . Sessions held ..... ........................... . Midwives registered for formal instruction ...... . Midwife meetings ........................... . Attendance at meetings......... . . Visits for midwife supervision. . . . . ... Public lectures and talks. . . . . . . .. Attendance................... . Enro11ment in maternity classes .. Attendance................ . ............ . Organized Countios 1945 1946 12,267 2,419 3,229 6,619 17,861 3,312 4,216 10,R06 19,557 3,510 4,944 11,103 5,450 27,624 27,161 4,557 560 689 802 39,072 10,870 7,234 20,968 20,584 6,472 5,629 8,483 498 14,242 !,370 9,872 1,051 177 228 5 279 23,423 14,459 17,811 18,298 45,121 467 19,3!9 39,827 26 2,885 161 16,118 35.922 157 !,978 5 15 1,121 582 5,513 2,758 192 2,412 74! 2,100 11,269 2,201 3,175 5,890 14,368 2,892 3,406 8,070 16,993 3,570 4,286 9,137 3,745 25,352 25,572 2,575 627 1,197 1,035 34,25>1 9,919 6,274 18,061 19,523 7,0!>1 5,035 7,444 603 17,481 4,547 12,934 1,165 99 316 17 45 3,652 15,486 19,015 19,920 48,148 828 17,898 40,125 9 2,748 136 16 '787 32,8!5 132 3,358 1 4 973 608 4,994 2,266 122 1,313 525 1,230 All Countios 1945 1946 1>!,383 2,675 3,516 8,162 21,884 3,921 5,176 12,787 2!,241 4,186 5,978 14,077 5,450 30,611 30,071 7,427 677 837 1,015 44,896 12,526 8,229 24,1>!1 23,612 7.045 6,528 10,039 580 17,220 5,18! 12,036 1,151 191 251 6 286 24,148 17,130 21,753 22,325 52,133 611 21.,!10 !8, 783 39 3,272 180 17, 74! 38,532 20,! 6,06! 5 15 1,617 1,031 7,549 3, 789 203 2, 700 744 2,100 12,718 2,409 3,,!66 6,843 17,452 3,459 4,122 9,871 20,158 4,160 5.007 10,991 3,7>18 27,176 27,274 4,181 735 1,361 1,212 38,290 11,147 6,997 20,1>!6 21,775 7,515 5,703 8,557 707 19,741 4,972 1>!,769 1,324 105 335 22 50 4,381 17,687 22,627 23,546 53,324 925 20,060 48,292 ,!9 3,115 166 18,138 35,147 154 5,056 1 4 1,312 900 6,572 2,976 138 1,444 525 1,230 Local Health Organizations 51 COMPARATIVE STATISTICAL SUMMARY OF TOTAL LOCAL PUBLIC HEALTH WORK IN GEORGIA, 1945-1946-Continued INFANT AND PRESCHOOL HYGIENE Infants: Individuals admitted to medical service ......... Individuals admitted to nursing service ......... Individuals admit.ted to medical and/or nursing service .... ................................ Permanent health centers..... ................. INt iunmebr aenr tohf esaelstshiocnesn.t.e.rs. ................ .................... .. .. .. .. .. Sessions held ................................. Visits to medical conferences (by patients) ....... Visits to private phys,icions (by patients) ........ Field visits .......................... Office nursing visits. ................ Consultations with parents .......... Preschool: Individuals admitted to medico! service ......... Individuals admitted to nursing service ......... Individuals admitted to medical and/or nursing service .... ................................ IPNteiunrmmebraaennratonhfteshaeelstashlitohcnescn.et.en.rtse.r..s................................................................. Sessions held . ................................ Visits to medical conferences (by patients) ....... Visits to private physicians (by patioots) ........ Field 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 preschool classes. Attendance . . . . . . . . . . . . . . . . . . . . . . . . . SCHOOL HYGIENE InspPctions by physicians or nurses . ...... Examinations by physicians ........ ............ Examinations by physicians with parents present. Tndivicluals admitted to nursing service . ........ Field visits . ............................. Office visits.................................. Inspections by dentists or dental hygienists...... Prophylaxis by dentists or dental hygienists ..... Public lectures and talks .......... : ....... Attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . Classroom health talks ......... Attendance ................. ADULT HYGIENE Medical Examinations: Milk-handlers............. 0 ther food-handlers ....... Midwives ..... Teachers . . . . . . . . . . . . . . . . . . . . . . . . . . . Other adult medica! examinations . ... Total adult medical examinations. 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 Total nursing visits admissions to .h..os.p.i.t.a.ls... ................... Total patient-days of hospital service ........... Organited Counties 1945 1946 10,081 26,971 27,315 201 6,327 51 113 25,341 241 49,800 31,955 37,859 10,920 23,,133 24,301 179 5,364 150 219 21,2,15 260 34,537 2'1,539 810 47 27.087 406 5, 760 261,H7 43,263 3,540 17,839 24,002 19,315 30,217 3,947 '13,1 13,759 2,191 77,361 860 ,16,205 387 7,17 21.190 69,389 13,,170 '1,704 16,989 14,,148 930 9,188 4, 769 9,,189 59,H4,J 9,944 27,248 27,793 258 5,663 37 98 23,313 262 44,396 27,525 33,582 10,490 21,882 23,082 216 '1,593 124 214 17.641 10<1 29,237 21,543 602 588 26,100 ,125 4,542 ,12 42 255,183 50,1,16 3,227 15,871 21,659 16,296 50,322 2,570 512 2'1.478 2,692 101,276 1,0,17 5<1,823 331 1,879 20,986 79,066 15,883 6,372 20,497 26,266 1,354 9,178 5,370 10,425 65,056 All Counties ,945 1946 11,044 29,896 30,271 2,!1 7,259 51 113 27,443 284 53,848 34,605 40,733 11,528 25,063 25,940 214 6,099 152 221 22,350 287 36,015 26,355 810 56 28,729 ,109 5,850 275,285 43,941 3,593 18,390 2'1, 719 20,525 32,297 4,250 466 15,098 2,786 84,377 10,914 29,748 30,341 268 6,307 37 98 25,234 298 47,388 29,846 35,590 10,963 23,223 24,426 220 5,068 125 221 18,352 138 30,595 22,688 602 588 26,959 426 4,573 60 125 268,611 50,815 3,358 17,276 22,023 16,841 52,107 2, 747 575 28,123 2,856 109,197 860 46,284 396 747 21,213 69,500 13,572 5,771 18,056 14,596 957 11,261 8,252 9,528 59,890 1,093 55,15,1 351 1,879 21,124 79,601 15,971 7,3,15 21,573 26,415 1,367 11,196 8,808 10,474 65,,198 52 Georgict Department of Pttblic Health COMPARATIVE STATISTICAL SUMMARY OF ToTAL LOCAL PUBLIC HEALTH WORK IN GEORGIA, 1945-1946-Cominued MORBIDITY SERVICE-Continued Individuals admitted to dental service ...... . Refractions................ . Tonsil and adenoid operations. Other defects corrected..... CANCER CONTROL Admissions to medical service..... . Admissions to nursing service ................. . Admissions to medical and/or nursing service ... . Office visits................................. . Field visits ................... . ACapsp~lsi.carteicoenivshf1ogr State aid ..... . diagnostic service at S"t.;t~~id Ca~1~~1crse.c~i~il;g. t~~at~~~-t. s~~~i~e at .st;t~-~id clinics......... . CRIPPLE CHILDREN SERVICE Individuals reported ......................... . Individuals examined at diagnostic clinics ...... . Individuals treated .................. . Individuals admit-ted to nursing service. Visits to diagnostic clinics (by patients) . Nursing visits.......... . ......... . Public lectures and talks. Attendance ... OTHER ACTIVITIES Conferences with physicians or dentists ..... . Personal conferences with others. Newspaper articles ......... . Bulletins distributed....... . Circular letters........ . Miles traveled on duty .. Days off duty................ . Conferences with official groups ........... . Attendance... . . . . . . . . . . . ........... . Public lectures and talks. Attendance................................. . Home Hygiene and Red Cross Classes (Sessions). Attendance ...... . GENERAL SANITATION Water: Approved individual water supplies installed.. Individual water supplies improved... . Public water supplies improved ...... . Conuect.ion to p!tblic water :mpplies .. Sewage: New privies installed ............. . Wood privies installed at homes... . Concrete pdvies installed at homes ............ . Wood privies installer! at schools .............. . Concrete privies installed at schools ........... . Wood privies installed at other public places .... . Concrete privies installed at other public places .. Privies repaired (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 ..... . 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 ......... . Total field visits for general sanitation ......... . Organized Counties 1945 1946 2,325 715 537 1,494 4,780 633 764 3,456 421 430 239 234 539 508 986 928 820 509 329 275 740 725 602 571 598 598 555 (2.8m32 4 112 767 931 675 981 1,019 2,284 14,080 126,110 1,803 140,209 82,312 2,211,799 2,804)1! 1,315 14,812 395 15,546 193 3,425 14,972 147,865 5,995 111,208 67,107 1'987' 666 3,514 1, 754 19,472 776 32,486 1, 734 5,613 704 895 87 4,473 1,055 391 524 26 41 16 57 1,891 1,605 1,500 14 91 597 1,838 745 125,513 493 390 272 1,681 353 1,613 87' 902 218,217 644 1,179 160 7,484 1,475 760 472 29 54 15 145 2,068 3,605 3,442 12 151 619 3,691 220 146,493 713 471 174 2,191 489 986 52,741 204,258 All Counties 1945 1946 2,599 717 566 1,501 4,901 662 773 3,475 435 311 612 1,070 914 386 750 615 449 321 595 1,043 656 343 735 578 702 676 604 l,OfJO 1,027 2,949 5 122 865 961 685 1,186 1,055 2,651 18,830 18,820 146,445 158,526 1,951 6,223 153,033 125,192 94,297 73,601 2,861,797 2,545,291 3,624H 4,203H 1,677 2,090 16,313 22,074 644 1,072 23,826 42,710 230 1,736 3,877 6,453 722 1,192 120 4,756 1,281 449 656 30 52 34 60 2,038 1,849 1, 713 18 118 629 2,048 745 126,460 510 403 272 1,873 674 1,685 87,957 220,014 697 1,489 236 7,729 1,721 872 575 35 56 38 145 2,206 4,114 3,861 20 233 642 3,794 221 148,092 947 485 175 2,527 839 1,072 52,848 206,985 Local Health Org ~. - - 0 to to 10.0 5.0 10.0 No. Per- - - - - - - - - - - - - - - - - - -c-enta-ge - H - - - -45 - - -31 - - 64 - - - - 186 -- - - - - -120- - 65.9 --- 0 - 4 - - - -0 - 1 5 4 80.0 ---- "t' i ~ ~ - - -1 - - -1 - - 0 - - - -1 - - - - -3 - - - -2- - -6-6.7- ~ - -0 - - - 0- - - I - - - -0 - - - - I - - - - -1- - -1-00-.0 - C> 15 - 39 - - - 16 -- - 31 -- - 102 70 69.3 ---- ~ Ground Waters-Chlorination and Carbon Dioxide RemoYal. .... ..... 7 --- 'l --- - -1 - 0 11 1 7 1 2 --- --- 11 Ground Waters-Chlorination and I ron Removal. .......... 1 - -0 - - -0 - 0 1 - 0 -- 0 -- - - 1 -- 0 1 Ground \Vaters-Chlorination and Roftening...... 3 - -0 - - -0 - 0 ------ - -3- - 0 --- - -1 - 1 --- 1 3 ~ 9 81.8 ~ - - - - "' I 100.0 :J:: "~' - - - - 2 66.7 Surface Waters-Filtration and Chlorination....... 79 - 2 -- - -2 - 1 84 27 39 10 7 --- --- ----- 83 - -7-6 - - -91-.5- Surfaoe Waters-Filtration, Chlorination and Soft- euing ....................... - 1 - - - -0 - 0 0 1 - 0- - 1 - - - - 0- - - 0 1 1 100.0 --- ----- TOTAL . . . . . . . .................. 271 60 65 19 415 88 137 61 107 396 286 73.3 Pttblic Hectlth Engineeting 77 MILK SANITATION Service on milk sanitation is designed to assist all local health departments, cities, counties, and the milk industry. Service is rendered those who have established or plan to establish facilities for public milk supplies. Consultation and advice is furnished relative w dairy barns, milk houses, and pasteurization plants. Promotion of adoption of the standard milk ordinance by cities and counties comprises a considerable portion of the service. After adoption of the ordinance, assistance is rendered in technical and legal interpretation. Commissioners of health, engineers, and sanitarians seek advice from the division in all matters pertaining to sanitary and safe milk supplies. School lunch rooms, of which there are over 1,500 providing school lunches for over 300,000, are also furnished this service. Milk supplies are f.lso certified for the U S. Public Health Service on interstate carriers. Of particular value in this service is a mobile milk laboratory which has now been in service nearly two years. The objective of this laboratory service is to carry into the field all phases of bacteriological and sanitary production of milk and simultaneously to render service of dairy and milk plant inspection and grading of all milk supplies. Correlated with this laboratory service is an educational program for the dairy farmers and milk producers. It is so planned that it is itinerant and moved to the various milksheds. The purpose is to completely sanitate and grade each individual milkshed before moving to another. The maxim"Lun l"ime spent on one milkshed has been approximately four and one-half months. The following milksheds have been serviced to date: Dalton, Eatonton, Griffin, LaGrange, Marietta, Moultrie, Rome, Thomasville. The demand has become so great for this mobile service that it has been necessary to purchase and begin equipping the second mobile laboratory. In addition to the normal program of milk sanitation, the following was accomplished by the mobile milk laboratory: Health departments rendered assisrance____________________________ 10 Raw dairies inspected ________________________________________________________ 311 Pasteurization plants inspected____________________________________________ 26 Bacteriological examinations._____________________________________________ 483 Phosphatase tests.----------------------------------------------------------------- 48 Sediment tests--------------------------------------------------------------------- 176 Temperature tests--------------------------------------------------------------- 325 FOOD SANITATION The service of food sanitation comprises mainly an educational program, inspections and grading of restaurants, cafes, school lunchrooms and other eating and drinking places. Food handling schools for duration of practically one week each have been held in most of the larger cities throughout 78 Ge01gict Depctrtme-nt of Pttblic Health the srate and at some of the state educational institutions and industrial esrablishmems. The general routine of these schools comprises initial meetings with organized local restaurant associations, chambers of commerce, civic clubs nnd other imerested groups to discuss the purposes and objectives of the school, followed by three or more days of classes for food handlers. The course of instruction comprises lectures and demonstrations in sanitation, hygiene, elementary bacteriology, types and uses of mechanical equipment and chemical sterilization. It is coordinated with activities of the local health departments and, in general, initiated and sponsored by such departmem. The same service is rendered for school lunchrooms and in cooperation v:;ith the school lunchroom program of the State Department of Education. In addition to the food handlers schools, normal service comprises chiefly consultative and advisory service to local health departments and assistance to such local health deparrment personnel for inspections and grading of restaurants and other eating and drinking places. The demand for this service by local health departments, county and municipal officials is far greater than this Division can meet with very limited personnel. A standard ordinance is promoted and adopted by counties and municipalities accepting this service. In addition to the normal routine of assistance to local health departmems artd others, food handlers schools held to date were in the following places. Albany Atlanta Augusta Brunswick Columbus Hinesville Jesup LaGrange Macon Milledgeville Savannah St. Simons Thomasville University of Georgia MALARIA CONTROL Malaria has continued to follow its trend downward although the 1945 mortality record of 28 deaths from this disease, giving a rate of .8 per 100,000, was an all-time low. Reponed deaths from malaria in 1946 were 12, striking an almost unbelievable new minimum of approximately .34 per 100,000, which lends hope to the Utopian goal of ultimate extinction. j\tfct!arict Co-nt1ol i-n War Areas With the cessation of acmal warfare and the rapid demobilization of the armed services, all of the major military and naval establishments in the endemic malaria zone of the state have been closed, making unnecessary further malaria control activities in the extra-cantonment zones surrounding such areas. Exceptions to this were the army's Oliver General Hospital at Augusta, the naval hospital at Dublin, and the former naval fuse loading plant at Macon. The control operations at Augusta were reduced over previous war years, the Augusra-Richmond County Health Department furnishing two laborers to do minor ditching and larviciding as needed under supervision of this Public Health Engineering 79 -c.... 80 Georgi?t Department of Pttblic Health Division. Bulldozer .filling operadons were carried out in eliminating some of the continuously watered breeding areas for malaria mosquitoes. At the Dublin Naval Hospital minor drainage and larviciding was carried on through the entire season. At all times full entomological inspections were maintained in order to detect any unusual mosquito breeding in the area. No comrol operations were indicated m Macon beyond the regular entomological surveillance which was effective throughout the season. All of the above were operated in cooperation with the U. S. Public Health Service, Malaria Control in War Areas activity. M?tlctrict Control in lmpottnded Waters During 1946, 71 impounded water permits were issued, covering a watered surface of 437.85 acres. This activity is founded on the impounded water regulations of the State Board of Health, promulgated in 1925 with subsequent revisions. The several agencies and corporations continue cooperation with the Department on malaria mosquito control on hydroelectric development lakes in the state. Regular reports of malaria control operations including clearing, cleaning, and larviciding are received from the hydroelectric companies. Bartlett's Ferry (Georgia Power Co.) in Muscogee and Harris Coumies. Seasonal larvicidal operations are conducted by the power company under the joint surveillance and approval of this Department and the Alabama State Health Department. Regular larvicicling is accomplished by applying fuel oil, using the oil-water method, to the edges of the pond where mosquiw breeding occurs. Good control is obtained. Lloyd Shoals (Georgia Power Co.) in Newton, Jasper, Butts, and Henry Counties. Larvicide, consisting of 10% Paris green in 90% hydrated lime, is applied weekly to breeding areas through a power cluster mounted in a boat, the latter propelled by an outboard motor. Fair control is obtained. Flint River (Georgia Power Co.) in Lee and Dougherty Counties. Larviciding with Paris green is practiced on this reservoir also. The continued encroachment of surface vegetat~on on this pond indicates that additional measures will need to be taken soon w obtain effective control. Spring Creek (Georgia Light & Power Co.) in Seminole and Decatur Counties. Larvicicling with Paris green is practiced on this reservoir with fair results. The proposed Flint-Chattahoochee Development now in the planning stage, which will back water as far as Bainbridge on the Flint River, will inundate the clamsite of the subject reservoir. Blue Ridge (Tennessee Valley Authority) in Fannin County, Notley (TVA) in Union County, and Chatuge in Towns County. The .first named has required no control measures, but the TVA exercises vigilant patrol and such control as is indicated on the latter two reservoirs. Lake Blackshear (Crisp County Power Commission) in Worth, Lee, Crisp, Sumter, and Dooly Counties. Mosquito control on this reservoir has Pttblic Health Engineering 81 been very difficult since its impoundment without primary conditioning of the basin to be flooded, and subsequent raising of the water level w flood new uncleared areas. Some measure of control has been accomplished with Paris green larviciding from boats but the inaccessibility of the breeding areas has prevented effective results. Contracts were made in 1946 with two differem airplane operators for Paris green applications but the results were disappointing. Adulticides were resorted w for the latter part of the season. All adult mosquiw resting places within one and one-fourth miles of the pond's edge were sprayed with a DDT emulsion. This was very effective in reducing the adult mosquito population for the remainder of the season. To accomplish adequate control on this reservoir it is essential that the inaccessible breeding areas be cleared and made accessible. Allatoona (U. S. Army Engineers) and Clark's Hill (USED) . The former, which will impound waters of the Allatoona River for a considerable distance above Carrollton, has been started and is well under way. The latter, which calls for a dam across the Savannah River a short distance above Augusta, will soon be under construction. Assurance of the engineer corps has been obtained for safeguarding health on both of these projeCts. The Production and Marketing Administration Agency (formerly AAA) of the U. S. Department of Agriculture has incorporated in the remainder of the calendar year 1946 (starting October 1) a conservation practice which provides up to $300 payments on construction of dams and spillways for farm stock water and irrigation ponds. The practice will also be continued through 1947. This has stimulated the construction of small impoundments, taxing the facilities of field personnel in furnishing advisory assistance and inspection for compliance with regulations of the Board. Letters of authorization for beginning construction have been issued for several hundreds of new ponds, many of which will not be ready for maintenance permits until 1947. The excellent cooperation of the Federal Soil Conservation Service in rendering advisory assistance to farm owners has been of inestimable aid to public health authorities in obtaining proper pond conditioning prior to impoundment. ''Extended iHalaria Control" Extended malaria control is the name given to a program stemming from the cooperative Malaria Control in War Areas program in which the U. S. Public Health Service furnished personnel, equipment and materials for comrol of malaria mosquito breeding in the vicinity of military camps and war industrial areas. In an extension of this program an entirely new concept of malaria control was evolved. The new insecticide DDT ( dichlorodiphenyl-trichloroethane) was applied in an emulsion to the walls and ceilings of homes and privies in certain of the counties having the highest !ldemic malaria rates in recent years, the object being to destroy the insect carrier of malaria either before biting a malaria carrier and becoming infected or before it had an opportunity to transmit the infection to a well person. In 1945 the cost of this new program in all or parts of fourteen 82 Georgict Department of Pttblic He,tlth counties was defrayed largely by Federal funds, through the U. S. Public Health Service, and 25,000 units were treated once, twice, or three times during the season. The popularity of the program for general household insect control and the limitation of Federal funds required the adoption of a new policy in order to meet expanded needs. A new proposal was submitted to the fifty-four counties having the highest malaria mortality rate for the five-year period .!938-42. In this proposal the counties were offered the program if they would furnish office and warehouse space and the necessary labor (with transportation) for applying the spray; the state and USPHS to furnish supervision, chemicals, equipment for spraying, contact personnel, mapping and record form requirements and such incidentals as were required. The response was very gratifying and thirty-seven counties participated during the season. Cities under 4,000 population were included, but for larger cities to join the program it was necessary to ask them to furnish the extra chemicals required. The operating procedure was very similar to the pattern developed for the 1945 season and reported on in the annual report. It was necessary to decentralize supervision to some extent and use was made of three district supervisors to direct operations in the eleven areas comprising the thirtyseven counties. For the first three months DDT was applied at the rate of 200 milligrams per square foot of surface sprayed. The unprecedented demand for the insecticide made deliveries from the manufacturer uncertain and it became necessary to reduce applications to the 1945 rate of 100 mg. per square fom. The latter dosage apparently had sufficient residual potency over the three month planned control period, and resulted in a very material saving in total costs of the program. The sharp reduction in Federal allocations to the states made it necessary to continue this saving during the remainder of the season, though DDT deliveries were sharply increased during August and September. A total of 158,369 units (houses) was sprayed during the season, involving a gross man-hour expenditure of 133,853. Emulsion totaling 411,200.6 gallons was used in spraying the 717,557 rooms, 221,427 porches, 117,877 privies, and thousands of mattresses comprising the units mentioned above. The following table shows the location, number and local costs borne by counties and cities. Pttblic Health Engineering 83 1946 EXTENDED MALARIA CONTROL PROGRAM LOCAL PARTICIPATION CosTs County Local Costs Lora! Local Units (wjo DDT) Cost/Unit DDT Cost Bacon ..... .. . . . . .... .. ...... .. . s 3,047 1,913 . 63 Baker........................... 2,519 1,916 . 75 *Ben Hill..... Brantley .... ... .. . . . . .. .' .. . . . .. . . . . . . . . 1,238 667 .5o! 2,331 1,652 . 71 ***MCFBBBCCCCtrauuaaloo.aynlmlrlulhyGqakdoldo.nuelctaeeu.ri.hi.nitr.nn.et.....e.........s............................................................... 2,319 7,707 10,131 3, 736 2,180 1,055 2, 794 93 6,816 I ,571 2,019 7,285 7,373 2,342 1,629 1,057 1,758 46 6,033 060 .87 .95 .73 .63 . 75 1.00 .63 .49 .89 .61 s 765 5H 40 1,218 Crisp .......... 4,564 3,758 .82 1,073 Decatur ........ 6,310 4,008 .61 *Bainbridge ...... 3<14 238 .69 311 Dooly.......... 5,831 1,800 .82 Dougherty ..... 3,030 1,801 .60 Early ......... 7,264 4,H3 .57 Echols ...... ............ 1,234 827 .67 Jefferson . ......... 6,662 I, 700 . 71 Jenkins ........... 4,135 3,809 .86 Johnson ......... 3,528 3,598 1.02 Lee............ LSSMMMceibiromalecenliveortnregtnoy.nol..e.m........e.....r....y............................................ 2,996 3,600 5,937 3,850 2,853 7,130 2,965 2,199 1,883 5,052 2,MO 2,175 6,137 1,671 .73 .52 .85 . 66 . 76 .86 .56 Sumter........ 6,476 '1,284 .66 1,292 Terrell ........ Toombs . . . . . . . *Treutlen ...... .. .. . 5,979 4,153 . 74 4, 798 3,644 . 76 1,032 716 .69 Turner . . . . . . . . . . 3,378 1,980 .59 Wayne ........... 4,330 3,202 .74 Webster ........ 1,691 I ,150 .68 Wilcox ....... ........... 3,915 2,608 .66 Worth ....... 6,904 1,449 .65 Totals ... Maxima . . Minima .... .. .............. Average ...... ............... 158,369 S116,531 S5,2J3 10,131 7,373 1.02 1,032 667 .52 1,280 3,150 . 73 *Received less than two applications. Total Total Cost Cost; Unit 1,913 .63 1,916 .75 667 .54 1,652 . 71 2,619 .87 8,050 1.01 7,373 .73 2,312 .63 1,629 .75 1,571 1.'19 1,758 .63 86 .92 6,033 .89 2,208 1.41 1,831 1.06 4,008 .61 5<19 1.60 4,800 .82 1,804 .60 1,143 .57 827 . 67 I, 700 . 71 3,809 .86 3,598 1.02 2,199 .73 1,883 .52 5,052 .85 2,540 .66 2,175 .76 6,137 .86 1,674 .56 5,576 .86 1,153 .74 3,644 .76 716 .69 1,980 .59 3,202 . 74 1,150 .68 2,608 .66 4,499 .65 $121,774 In a program of this nature where malaria has diminished w an unmeasurable minimum, and its technical justification beyond an absence of household insects is difficult w establish, it was deemed desirable to obtain a public opinion poll in the form of a written statement containing the writer's opinion and any specific constructive criticism of the program. A frank statement was requested of health commissioners, physicians, county commissioners, county agents, rural mail carriers, and other leading citizens who are in frequent contact with the public and whose integrity is unquestionable. Statements were received from 5 health commissioners (all but <)oe); 38 members of local boards of health, 3 members of the State Board cf Health; 9 local health department employees; 33 private physicians; 3 elected state officials; 25 county commissioners; 31 other county officials; and 8 city officials. In no case has the success of the program in homes been questioned, the principal criticism being directed at its limitation to houses 84 Georgict Depctrtment of Pttblic Health of human occupancy. In the public's opinion the benefits of general household insect control overshadow the primary object of malaria comrol. Several physicians credited the program with rhe reduction of enteric diseases in children as high as 90%. The extended program operations have in no insmnce curtailed any current health activity, but have awakened the public w the benefits of intelligently and economically conducted public health operations. Local funds used in this program sometimes far exceeded any other annual appropriations made for public health purposes and the phenomenal success of rhis program .,..,-ill no doubt facilitare the secural of local financial participation in fmure public health programs. Other residual benefits received from the extended program operations are discussed further under mapping and housing sanitarian secrions of rhis report. Mapping is very closely coordinated with extended malaria program acrivities as personnel on the latter activity use and check rhe maps, and all necessary changes required are promptly furnished the mapping section for (ntering on the original maps. As each habitable hose is given a number on the county and communiry maps this number is stenciled on a painted board which is nailed to the house or other conveniem location in the immediate vicinity. In this manner every house in the county has a number posred which corresponds to the number shown on the map. For each house in the coumy the contact individual obtains information on the name of the householder, number of occupants, whether owner or tenant, and whether house is screened, furnished with elecrriciry, type and condition of water supply and sewage disposal. Thus the data on fundamentals of housing sanitation are tabulated for use on future public health activities. SCHOOL SANITATION The return of sanitation personnel from the armed services and the augmentarion of county services with new men have accelerared the program of school sanitation. The objective is to see that all schools are provided wirh (a) safe drinking water, (b) approved plumbing, (c) satisfactory sewage disposal, (d) safe milk supply, and (e) sanitary serving of school lunches. Many schools, having deferred consrruction during the war years, are making plans for new buildings and additions to existing structures. Though the shortage of building materials and excessive uncertain labor costs are a deterrent it is still necessary to review and approve plans and specifications covering sanitation features of construction. The Division cooperates very closely in this work with the Department of Education and with private architects. Improved excreta disposal facilities have been provided by rhe consrruction of 110 approved privies and 31 septic ranks with auxiliary absorption Pttblic Hectlth Engineering 85 1ields. Many samples of water from school supplies have been collected and sent to the Division laboratory for bacteriological examination, principally for confirmation of findings of physical inspections of the supplies. HOUSING SANITATION During the war the housing sanitation program was directed principally to war housing projects constructed by governmental agencies and those without available public water and sewerage. There has been an increasing activity in private home building since the end of hostilities, limited only by the shortage of certain building materials and uncertainty of labor costs. This activity has renewed the custom of this Division reviewing plans for subdivisions, where approved public water supplies and sewerage are not available, to determine whether they would be suitable for development 'With individual private water supplies and/or sewerage disposal systems. All homes built under loans insured by the Federal Housing Administration, for which private water and/or sewerage systems are required, receive inspection and approval by local or regional sanitation personnel and are reviewed and approved in the Division office before approval of the F.H.A. can be secured. Other Federal agencies operating in the housing programs with which the Division is cooperating are the National Housing Agency and the Veterans Administration. The following tabular summary shows the distribution by counties of the 1,678 privies and 4,033 septic ranks built, and 2,183 privies repaired, under supervision of sanitation personnel. PRIVIES AND SEPTIC TANKS CONSTRUCTED BY COUNTIES County Home Appling .... Atkinson. . . . . . . . . .............. 17 Bacon ........ ................... 1 Banks ..... 1 Barrow .. 2 Bartow ..... "Berrien . .... Bibb ......... 39 Brantley .... Brooks...... Bryan ..... Bulloch ... 3 Burke .... 36 Butts ....... 2 Candler .... Charlton .. 22 Chatham .. 98 Chattooga .. Clarke .... 54 Clayton .. 9 Clinch .... 1 Cobb ..... 19 Coffee . . . . Colquitt .. 5 Columbia. 2 Cook ... Coweta .... 38 Crawford .. PRIVIES Public Places Total 8 8 9 26 4 5 1 2 93 132 5 8 7 43 2 22 98 54 9 1 19 16 16 5 2 ,!3 Repair 126 5 39 5 169 740 9 2 15 SEPTIC TANKS Homo Public Total Places ll 4 15 10 2,! 34 2 2 3 3 8 9 3 'l 219 226 2 2 1 1 1 65 1 66 17 17 19 25 2 2 5 5 180 14 19,! 36 36 86 1 87 'H 17 61 2 2 127 134 2 14 5 2 19 1 i 10 2 12 3 3 86 Georgir;t Department of Pttblic Health PRIVIES AND SEPTIC TANKS CONSTRUCTED BY COUNTIES (Continued) County Home Crisp ..................... . 21 Decatur .. . 103 DeKalb. 9 Dooly .... Dougherty 12 Douglas .. Earl.v ... . Elbert .... . Emanuel .. . Fannin .... . Fayette ... . Floyd ....... . Franklin ............. . 14 Fulton ............... . 15 Glynn ....... . Greene. . ........... . Habersham.. . ......... . Hall ........................... . Haralson ................. .......... . Heard ................. . Henry ................. . Houston ..... . Jackson . ......... . Jasper . ......... . Jeff Davis .. . 6 Jenkins . ... . 31 Lamar. 6 Lanier ... . 2 Laurens ........ .......... . 30 Liberty ....... . Lincoln ....... . Long ........ . Macon ............ . Madison ........ . 4 Marion ........... . 6 McDuffie............ . 10 Mitchell. ............................ . 266 Monroe .................. . Morgan .................. . 4 Muscogee ......................... . 57 Newton ....................... . 2 Oconee .. ............ . 3 Peach .......... . 3 Pierce . ......... . Pike ............... . Polk .................. . Putnam .......... . . 34 Rabun .......... . 8 Randolph .......................... . Richmond............ . ......... . 65 Rockdale...................... . 3 Schley ........................ . 2 Screven. . . . . . ............. . 20 Spalding... . ......... . 18 Stephens .................. . 62 Sumter............ . 18 Talhot. .......... . Taliaferro . ..................... . 3 Taylor.. . ........ , ......... . 5 Thomas............ . .......... . 4 Tift.................... . I Towns .. 2 Troup ........ . 149 Upson ... . 4 Walker...................... . 18 Walton ....... . Ware ....... . 'i4 Warren . ..... . Washington ... . Wayne........ . ............ . White.................. . 2 Wilcox ............................... . 1,411 PRIVIES Public Places Total 5 26 22 125 2 11 14 26 14 19 7 2 6 33 6 2 12 42 4 2 8 5 15 4 270 4 61 4 3 3 12 34 8 . 65 3 2 27 18 63 18 5 7 1 2 18 167 4 18 2 14 2 267 1,678 Repair 8 43 10 35 10 14 2 .. 4.5 10 22 2 5 1 197 14 2 28 29 64 160 59 45 6 34 23 1 1 180 2,183 SEPTIC TANKS Home Public To tat Places 57 59 3 4 636 1 636z 115 123 7 I 2 2 1 I 1 12 12 1i 17 087 35 1:o:i:i 20 20 I 1i 19 5 7 1 1 5 7 10 10 10 2 12 5 5 1 1 10 19 7 7 13 13 2 1 3 22 10 32 1 I 3 3 i3 13 3 5 4 4 17 17 17 20 9 9 5 5 226 226 13 15 13 13 13 13 I I 8 8 3 3 3 8 I I 166 170 17 18 16 16 36 39 25 25 66 1 67 18 10 28 2 2 17 5 22 23 8 31 5 3 8 '64 I I 18 82 20 20 47 16 63 4 4 53 53 3 3 3 3 4 4 1 I 1 1 3, 781 252 4,033 Pttblic Health Engineering 87 SHELLFISH SANITATION legislation by the General Assembly of Georgia placed shellfish sanitation under two state departments, namely, the Department of Health and Department of Game and Fish. legislation concerning the Health Departmem provides for inspection of oyster beds, prohibits taking oysters from contaminated waters and places management and control of sanitation of oysters exclusively under the Health Departmem. legislation concerning the Game and Fish Department provides for planting and replanting, growing, and gathering, leasing of oyster beds, taxation of the industry and responsibility of recognizing sanitary standards. Authority given the Health Depanment provides for rules and regulations to be adopted by the Swte Board of Health for the purpose of shellfish sanitation. Pursuant w these Acts of the General Assembly, the State Board of Health has adopted rules and regulations regarding shellfish sanitation and has placed authority for enforcemem under this Division. The sanimry conditions of oyster growing areas, shucking houses, and marketing conditions of oysters have improved w the extent that oysters marketed from the various sources meet the requirements under the rules and regulations. During the past year it was necessary to collect samples only on the boundaries of formerly condemned areas in order w again define these areas. There were numbers of shucking houses improved and issued permits for state and interstate shipment and sale. Approximately 200 acres of previously condemned oyster growing areas were released for production and sale because of a new sewage treatment plant in the Brunswick area. Following are some of the accomplishments in shellfish sanitation during the year. Shucking house inspections____________________________________________ 485 Samples of water bacteriologically examined__________________ 146 Acres of waters investigated, approximate______________________ 1,500 Shucking houses certified to USPHS________________________________ 10 Shucking houses improved______________________________________________ 20 Additional acres condemned, approximate____________________ 250 CAMP SANITATION Cooperation with camp owners has been continued on inspection and recommendations for sanitary improvements at recreation:;t! camps. The arrangements for similar service at all state prison camps, effected at rhe request of the State Department of Corrections, has also been continued. On April 18, 1946 the State Board of Health adopted regulations concerning sanitary requirements for operation of tourist camps with the stipula- 88 Georgia Depctrtment of Pttblic Hectlth tion that all shall comply with the regulations and have a permit from the Department by April 1, 1947. An inventory was begun immediately, but it was found that more personnel would be required to make appreciable progress in a venture of this magnitude. Upon completion of the spraying season on the extended malaria comrol program certain key personnel being retained for the 1947 season were assigned ro regional offices to assist in making a facrual survey of sanitary conditions at all tourist camps. This survey, which will be the basis for further improvements and final permits from the local and regional health authorities, was completed in December. More than 488 tourist camps, trailer camps, and courts, were inspected. Many excellent camps were found, but many will probably not be able to comply with sanitary requirements and should be closed when the time limit expires on April 1. MATTRESS SANITATION The mattress sanitation program conforms to an Act of the General Assembly No. 472, Georgia Laws 1937. This is an act to improve the sanitary condition in the manufacture, remaking or renovation of mattresses, to provide for fees from persons applying to the Board of Health for license, to provide for placing of tags showing date of receipt of the mattress and for a stamp to be attached to the mattress, made, renovated or sold, etc. To a considerable extent those engaged in the industry have conformed to the laws and regulations. It is now necessary to inform those newly established in the industry of the laws and regulations. Seven new firms began business during 1946. During the year, 103 complaints were investigated and approximately 85 inspections were made. Shortage of personnel to some extent limited operations. However, it will be continued with all possible attention in order to effect the full purpose of the law. MAPPING The Division has continued to make surveys and maps for sanitation services for state, coumy, and municipal public health uses. Whenever available, aerial photographs are used in the preparation of complete planimetric maps suitable for use in public health activities. The demand for municipal and county-wide maps for use on the extended malaria control program has taxed all available facilities to the utmost. Complete county maps have been prepared for the following counties: Bacon Baker Ben Hill Bramley Bulloch Candler Colquitt Decatur Echols Johnson Macon Montgomery Pulaski Toombs Treutlen Turner Wayne Webster Pttblic Health Engimering 89 Original city and community maps were prepared for the following: Adrian Ailey Alexis Alma Alston Amboy Amsterdam Ashburn Attapulgus Avera Baconton Bartow Bellville Benevolence Berlin Blitch Camilla Canoochee Carnegie Clarkesville Claxton Climax Coffee Coleman Cotton Covena Coverdale Crossland Cuthbert Daisy Dakota Doerun Doles Donovan Ellenton Faceville Finleyson FunstOn Garfield Hagan Hartford Hawkinsville Higgs ton Hoboken Hortense Ideal Kite Louisville Marshallville Matthews Meeks Meigs Metter Modoc Montezuma Needmore Newton Norman Park Normamon Nunez Oakfield Oak Park Odum Oglethorpe Oxford Pelham Pineville Poulan Preston Pulaski Queensland Rebecca Register Richland Riverside Rockingham Sale City Scott Screven Shellman Shingler Sibley Soperton Sou. Sylvania Springvale Stapleton Stellaville Stillmore Summertown Sycamore Tarrytown Tarver Uvalda Wadley Wesley W. Bainbridge Weston Worth Wrens Wrightsville RECRUITING PERSONNEL The Engineering Division is a source from which regions, districts, and counties secure engineers and sanitarians for organized health service. It seems logical that this Division should have a dearer perspective of the engineering and sanitation needs of the state and serve conjunctively with the Division of Local Health Organizations in securing training and assigning engineers and sanitarians. During the year, the U. S. Public Health Service established two schools in Georgia for training engineers and sanitarians, namely, at Columbus and Savannah. These were established and recognized in addition to University of North Carolina and Vanderbilt University. Previous to acceptance of an applicant for training, his education, experience and general adaptability is .firsr analyzed and second he is evaluated by the Merit System and rated according to classification. During the year a total of 18 engineers and sanitarians wNe recruited for such training. Division of Dental Health Education J. G. WILLIAMS, D. D. s.____________________________________________________Part-time Director ANNIE TAYLOR________________________________________________________________ Edttcrttionctl Director VIRGINIA LI'TTLE________________________________________________Associate Edttctttionctl Director Division of Dental Health Education The following narrative and statistical repons summanze the activities of the Division of Dental Heahh for the year 1946. Personnel and Policy Chctnges The appointment of Miss Virginia little as Associa[e Educational Director is the only change in the staff of the Division of Dental Heahh. A change in the Plctn for Finctncictl Assistctnce to Locctl Hectlth Depctrtments affects the dental program in that dentists are included as basic personnel and grants-in-aid are made w heahh departments for their salaries, which now gives three plans for financial participation to local health departments for dental service programs: ( 1) Employment of a full-time dentis[, (2) Employment of a part-time dentist, ( 3) Honoraria paid to dentists for service in clinics. Job classifications for Denktl Clinicictn II, Denktl Health Officer III, and Dented Hectlth Director IV-A have been adopted by the Depanment with Merit System approval. As dentists become available, the larger heahh departments in the State have indicated that they will employ dentists on fulltime and part-time basis. To promote better dental health for the people of Georgia, the Division of Dental Health has continued w emphasize Plctnning, Edttcation and Sr7rvice at Sta[e and local levels with and through all agencies that are interested in and working for health and welfare. Stttdies to determine needs of children and adults and Resectrch to investigate the epidemiology of demal caries have been the new phases of the dental program during the past year. Both have proved interesting and profitable. Plcmning at State, county and community levels is encouraged as a means whereby the dental health problem can be studied and programs devised to meet the needs and available facilities. Experience has taught thac when groups or individuals can be brought together for study and cooperative planning and action, [he results are better and more lasting. The staff has taken advantage of every oppormni[y to assis[ local heahh departments in bringing together for study and planning the dentists, school administrators and teachers, county and home demonstration agents, representatives from Parent-Teacher Associations, civic clubs and all agencies capable of assisting in the solution of the dental problem. A permanent committee or council 1n every county is an objective of the Division of Dental Health and one 94 Georgia Department of Pttblic Health Dental Health Education 95 which is fundamental if successful programs of dental health education and dental service are to be realized. Education of all the people as to the need for and the ways by which dental health can be attained and maintained is the first objective of the dental health program since every study indicates lack of understanding and knowledge to be the greatest handicapping factor. Listed below are some of the groups toward which our activities have been directed: Teachers- (both in-service and pre-service) School Administrators Supervisors of Education Visiting Teachers Parents Community Leaders Dentists College Students School Children Parent-Teacher and other Civic Clubs County and Home Demonstration Agents 4-H Club Members During the year, members of the staff have visited and worked in fortyeight counties. With our limited staff, activities have been directed chiefly toward those who can influence other groups. For example, supervisors of education, in turn, can interpret the dental health program to county teachers, parents and children. The Pttblic Health course for senior dental students initiated in 1945 proved successful and has been conducted again in 1946 by Dr. Williams with the assistance of the Department of Health staff members. Georgia Department of Public Health Educational Aids The Division has used and distributed widely, free of cost, the following aids: Bulletins Facts About Teeth and Their Care Your Child's Teeth About Faces The Truth About Teeth Hold On To Your Teeth Dental Care for the School Child How to Save Teeth and Money Films The Student Flyer About Faces Our Teeth Told By A Tooth Winky the Watchman Dental Service The reports of dentists, local public health personnel and school ad- ministratOrs indicate that an increasing number of children and adults are going tO dental offices for needed corrections. Every dentist in Georgia is working from early morning until late at night. Dental Clinics Activities in dental clinics operating during 1946 according tO Regula- tions for Paying Honoraria to Clinicians Conducting Dental Clinics may be summarized as follows: There were twenty-one clinics in twenty counties with thirty-seven white dentists and four Negro dentists, working 2,606 hours, admitting 2,123 white children and 421 Negro children. There were 10,500 operations or approximately four operations per child, including fillings, extractions and Dental Health Edttcation ';)7 Young Cbildreu Are Enconraged to Visit tbe Dmtist prophylaxis. Local dentists were paid $6,5 15.00 in honoraria for these services. The clinics have been visited and supervised by the Dental Director. Counries operating clinics during the year 1946 are as follows: Cou1zty Months Operating in 1946 Type of Clinic 1. Bibb 2. Chadron 3. Chatham. 8 Negro Children 8 White Children 5 Negro Children 98 Georgitt Depttrtment of Pttblic Health Comzty 1\!Ionths Operttting in 1946 Type of Clinic 4. Clarke 8 5. Clinch 3 6. Decatur 6 7. DeKalb 12 8. Fulton-Adanta City 7 Bass 2 9. Jenkins 9 10. Jones 4 11. Liberty 11 12. Morgan 2 13. Muscogee 5 14. Rabun 11 15. Spalding 12 16. Screven 9 17. Stephens 5 18. Toombs 4 19. Upson 10 20. Ware 6 White Children White Children Negro Children White Children White Children White Prenatal Cases White Children White Children Negro Children White Children Stttdies With the assistance of Dr. Thomas L. Hagan, Senior Dental Surgeon of the U. S. Public Health Service, a study of 24,092 Georgia children in twelve communities was made to determine demal caries prevalence and rooth mortality. Places included were: Cities 1. Atlanta 2. Albany 3. Columbus 4. Griffin 5.. Savannah Coumies 6. Camden 7. Glynn 8. Fulton 9. Floyd 10. Muscogee 11. North Georgia Group 12. Spalding Dental Health Edttcation 99 Appreciation is expressed to Dr. Hagan and to local health departments, school administrators and dentists for their valuable assistance. Dr. Hagan has submitted the full report for publication. A few pertinem findings are listed below: 1. The prevalence of dental caries 1n permanent teeth vanes in the differem places studied. 2. The annual increment of dental caries in permanent reeth also varies from place to place. 3. Evidence has been presented which indicates chat no significant variation in caries experience can be attributed to economic status. 4. There is some evidence that the prevalence of dental canes in permanem reerh may be increasing. 5. The tomb mortality rate of a community adheres quite closely to the relative pattern established by the caries anack rate, except in those places where dental healch promotion is carried out extensively. 6. Individuals in the high economic strata experience significantly lower rooth mortality rates than those persons in the lower economic levels, except where concerted efforts are made to save teeth by dental care. Also with the assistance of Dr. Hagan, studies of the dental health and dental needs of adulcs were conducced in connection with the TB-VD Surveys in Columbus, Macon and Augusta. When this report is tabulated, ir will represent the largest and most complete cross-section study of the dental needs of adults that has been recorded. Epidemiological studies of dental caries have been begun in various secdons of Georgia through the cooperation of the Dental Section of the National Institute of Healrh and the Division of Public Health Engineering of the Stare Health Department. Dr. F. A. Arnold, Dental Surgeon, National Institute of Health, has made examinations of childrens' teeth in McDuffie Coumy and in Richmond County. Dr. H. T. Dean, also of the National Institute of Health, examined a sampling of childrens' teeth in Colquitt, Pierce, Wayne, Glynn, Camden and Mcintosh Coumies. With the assistance of Mr. Weir, Public Health Engineer, Georgia Department of Public Health, investigations of fluorine coment of water supplies are being studied with relation to dental caries prevalence. Appreciation is expressed to the Georgia Dental Association, its Public Health Committee and individual members for their cooperating and active support in making possible the dental program described in this report. Appreciation is also expressed to the Department of Education and to its allied agencies, rhe Agricultural Extension Service, the Georgia Congress of Parents and Teachers, and all ocher groups with whom and through whom progress has been made. 100 Georgia Department of Public Health STATE, LOCAL AND FEDERAL AGENCIES COOPERATE IN THE THOMAS COUNTY SURVEY TO DETERMINE DENTAL NEEDS CONFERENCES, MEETINGS, AND ASSOCIATIONS ATTENDED Meetings Attended By: Instructional Supervisors' Conference, Atlanta _____________________ ___________Taylor Little Seventh District Parent-Teacher Association, Rome ____ ______ ____ ____ Little American Public Health Association, Cleveland _____ _____________ _________Taylor Superintendents' Conference, Atlanta __________ ___ _________________Taylor Fifth District Parent-Teacher Association, Ellenwood ________________________Taylor Little Instructional Supervisors' Conference, Atlanta __ ____ Taylor Little Board of Managers, Georgia Congress of Parents & Teachers, Atlanta __ _Taylor Northeastern Regional Nurses' Conference, Athens ________________________ _______Little Parent-Teacher Institute, Athens __________________ _________ ______________ _______ Taylor Georgia Dental Association, Atlanta ---------- ----------------- -- ------------ --- _Williams Taylor American Association of Public Health Dentists, Chicago _____________ Williams American Dental Association, Chicago ___ ______ ___Williams _Georgia Public Health Association, Atlanta __ _Taylor Dentrtl Hertlth Edttccttio1~ 101 Conference on Rural Life and Education of the South Atlantic Scates, Atlanta__________________________________________________________________________________ Taylor Parent-Teacher Association Convention, Savannah___________________________ Williams Taylor Home Economics Council Meeting, Athens____________________________________________Taylor District Parent-Teacher Association, Carrollton______________________________________Taylor District Dental Society (Northwestern), Rome ____________________________________Taylor Hinman Midwinter Dental Clinic, Atlanta ___________________________________________Taylor Williams Georgia Supervisors' Conference, Atlanta ________________________________________________Taylor Atlanta Social Hygiene Council, Atlanta ________________________________________________Taylor District Dental Society, Columbus _________________________________________________________Taylor Instructional Supervisors' Conferences in Carrollton, Milledgeville_______ Little T e?tchers' W arkshops Attended Troup County-LaGrange Cherokee County-Camon Gwinnett County-Lawrenceville _Health Education Workshop, Athens Visiting Teachers, Athens Instructional Supervisors, Athens Mercer University, Macon G.S.C.W., Milledgeville Thomas County 102 Georgia Department of Pttblic He(tlth DENTAL CLINIC STATISTICS-JANUARY THROUGH DECEMBER, 1946 NUMBER COUNTIES OPERATING CLINICS ... . NUMBER CLINICS ........................... . NUMBER CLINIC SESSIONS............. . NUMBER CLINIC HOURS (TOTAL) . NUMBER DENTISTS WORKING HONORARIA PAID DENTISTS .................. . TOTAJ, ADMISSIONS .......... .. TOTAL ADMISSIONS BY AGES 6-8 Yrs............. . ........................ . 9-11 Yrs........ . ...................................... . 12-14 Yrs....... . ................................... . % 6-8 Yrs................ . . . . . . . . . . . . . . . . . . . . . . . . . ........... . %9-11 Yrs........................................... .. .......... . %12-14 Yrs.............. .. ............................... .. TOTAL VISITS............ . ...................................... . TOTAL PATIENTS DISMISSED ....................................... . Completed .............. . Others. % Completed... PROPHYLAXIS........ . % of Admissions . ...... . NUMBER TEETH EXTRACTED .... Decid.................... .. 1st. Perm. Molars .......... . Other Perm. Teeth ....... . NUMBER TEETH FILLED.. Decid................... . 1st Perm. Molars....... . Other Perm. Teeth ...... . NUMBER FILLINGS ... Cement... . ....... . Alloy ........................................................... .. Silicate .................... . Two Clinics in Fulton County.* White 18 19* 1,158Yz 2,317 37 $5,792.50 2,123 948 754 421 45% 36% 19% 1,928 1,995 1, 759 236 83% 822 39% 2,052 1, 770 247 35 5,150 1,521 2,665 964 6,423 429 5,660 334 Negro 4 4 144Yz 289 4 $722.50 421 178 161 82 42% 38% 20% 669 253 244 9 58% 122 29% 722 565 147 10 359 185 !58 16 359 103 242 14 Division of Maternal and Child Health GuY V. RICE, M. D.__________________________________________________________________________ Director MYRA REAGAN_ _________ ---------------------- ---------------------- _____ Nttfrition Consttltant Division of Maternal and Child Health The maternal and child health program has made definite gains during the latter half of 1946. In the organized counties, maternal and child health conferences reporting to the Division (this includes centers in which the Georgia Department of Public Health participates financially) have increased from 147 in the first half of the year to 164 at the end of the year. However, there was not the same proportionate increase in the nursing counties, there being one less conference at the end of the year than at the beginning. Although some effort has been made to carry on the type of educational and in-service training program that would increase the enthusiasm of local personnel in maternal and child health work, it has not been possible to produce the desired effect because of limited personnel. Relief of this :ituation next year is anticipated. At least one maternal and child health consultant will be assigned to work in two of the regions, and four prospective nutritionists have been definitely engaged to supplement the regional staff. It is hoped that additional medical personnel may be obtained making possible one maternal and child health consultant for each two regions as a ll11illmUm. Personnel The organization of the Division has remained the same. There has been little change in personnel. Three nutritionists have been granted scholarships in nutrition education and will return to work in Georgia afi:er their training is completed. Miss Hannah Mitchell has joined the Division as nursing consultant. Plan for lvlCH Di,vision The annual description of the State Plan for maternal and child health services was submitted the latter part of June in accordance with instructions set forth in MCH Information Circular 18, issued March 1946, by the Children's Bureau of the U. S. Department of Labor. This plan was developed following recommendations of the State and Territorial Health Officers, and consists of the following four parts: Part I includes an outline of material which will constitute a permctnent MCH State Plan file. Part II includes an outline of basic plan material for the development of a program for a 5-year MCH State Plan. Part III includes material needed annually as a basis for determining that conditions are met for allotment of funds under the provision of Title V, Part 1 of the Social Security Act, as amended. (The annual material requested for subsequent years, when a complete plan is not submitted, will be somewhat modified.) Part IV includes instructions for preparation of MCH budgets and apportionments of funds for fiscal year 1947. ~06 Georgict Depctrtme-nt of Pttblic Health lHeclical Activities lectures: 1. Universiry of Georgia Medical School 2. Health Education Work Shop, University of Georgia 3. Regional nurses conferences 4. Public Health Service internship training program 5. State Nutrition Committee 6. Georgia Dietetic Commictee 7. Science Club, University of Georgia 8. Missionary Group, Presbyterian Church (Negro) Conferences: 1. Children's Bureau 2. U. S. Public Health Service 3. University o Georgia Medical School 4. Maternal Morbidity and Mortality Committee 5. Pediatric Committee 6. Medical Association o Georgia 7. Pediatric Society 8. Crippled Children's Service 9. Vocation Rehabilitation Service 10. Grady Contraceptive Clinic 11. Dr. W. w. Daniel, re: standing orders for nurse-midwives 12. Nutrition Committee 13. Veterans Administracion 14. Red Cross 15. Superintendent and Medical Administrators, Crawford long Hospital Membership in Committees: 1. Scientific Advisors Committee, State Nutrition Commitree 2. Policy and Record Committee, State Health Depanmem 3. Joint Health-Education Committee 4. Advisory Committee, Crawford long Premature Training Program Meetings Arrended: 1. Georgia Pediatric Sociery 2. Medical Associacion of Georgia 3. Georgia Public Health Association 4. American Public Heahh Association 5. Saluda Pediatric Seminar 6. Maternal and Child Health Directors Association 7. Meeting of State and Territorial Heahh Officers Report of Consttltant Nmse Emphasis continues w be focused on the care of rhe premature infant. Demonstrations on care and early reporting of infants have been srressed in tonferences and calks w nurses. In every instance, where possible, the use of rhe incubator has been demonstrated to hospital nurses. Programs of coordination of hospital and Health Depanmem have been emphasized. Re- Mctternal and Child Health 107 ferrals of infants to Health Departments have increased as a result of the emphasis being pm on this program. Maternal and child health conferences have been visited throughom the year. Conferences with regional personnel have been held. Contans with hospitals under the Emergency Maternity and Infant Care program were made to interpret the program and give assistance where needed. Plans have been started in connection with the esrablishment of a premature nursery here in Atlanta. Plans are being made for an in-service educational program to be worked out with the regional personnel. Plans for a nurse-midwife service were started late in the year. The nurses will render a direct service ro the patients delivered by midwives. NUTRITION The Nutrition Consultant's position was filled by Miss Myra Reagan October 15, 1945, after a lapse of >\pproximarely a year and a half. This lapse necessitated developing an almosr entirely new nutrition program, and the early months of 1946 were devoted to planning and reorganizing the program. The long period without staff education, the employment of many new nurses, and the newer findings in nutrition made this necessary. Stctff Edttccttion One region, the Southwestern, planned for the nurses to meer in two groups, each group meeting every other month and devoting half of their meeting-time to nutrition education. This program continued during the entire year. The East Cenrral Region planned quarterly all-clay conferences for the nurses. The January and April conferences were planned emirely around nurrition. The Northeastem Region has a plan similar to that of the East Cenrral Region. Their March and September conferences were on nurrition. The Northwestern Regional conference, held in February, gave about half the day to nutrition. The nutrition consultant has met with the nurses in twelve regional meetings to help with the nutrition work. In Fulton County the nutritionist mer with the nurses at their regular Monday staff conference for a series of lectures and discussions. A week was spent working with the nurses in Richmond and in Muscogee Counties. An hour each morning was given to lectures and discussions and the rest of the day was spent in clinic, school and home visits helping the nurses with nutrition problems. It is hoped that similar work may be developed in other counties where the staff is large enough to justify such a program. During the year the nutritionist visited in forty-two counties and worked with the nurses in all but two of these. These two counties did not have nursing service; however, rhere was special nutrition work ro be done in these counties. Work wirh the nurses varied, but consisted chiefly of clinic work, school work and home visits. The object was ro help the nurses underst:md the nutrition problems and the ways whereby they could be met. 108 Georgict Depctrtrnent of Pttb!ic Hectlth U. S. Pttblic Health Service Ntttrition Stwvey In 1945 Albany, Georgia was selected as a national training center fat nutrition survey teams with the U. S. Public Health Service. This work was planned so that more accurate information on the nutritive conditions of population groups might be available. It was also hoped that simple methods of evaluating the nutritive status of individuals might be developed. These ~imple methods are needed for general public health work. The findings in particular areas can be used as the basis for a nutrition education program in that area. Schools in Dougherty, Mitchell and Baker Counties were surveyed. These surveys included hemoglobin readings and nutritional inspections. A survey was also made at the Clarke O.N.T. Mills in Pelham and the Flint River Cotton Mill and village in Albany. These surveys included hemoglobin and hematocrit studie~, dietary analyses and suggestions and nutritional inspections. The survey in Pelham resulted in an immediate introduction and quire generous sales of milk in the mill. The nutrition survey team spent a few days at the Health EducationNutrition Workshop at the University of Georgia. All workshop participants and demonstration school students were given physical inspection and hemoglobin readings were made on them. Illustrated lectures were given the group, explaining th.i.s work and the signs of malnutrition. The teachers considered this one of the most valuable features of the workshop program and many asked for similar work in their own schools. The nutrition con~ultant spent a week during September working with the survey team in Albany at the Flint River Cotton Mill and village. Help was given in taking dietary surveys and in consultations on diets. One school child gave such unsatisfactory answers to questions it was believed she was mentally deficient. When the nutritionist checked at the clinic she found this child had a hemoglobin reading of 4.5 grams. It was concluded the deficiency was not mental but physical. Further studies are planned in the State and the nutritionist hopes to be able to follow these with an educational program and assistance in the mills and schools in their nutrition problems. Georgict State Callege fM Women The institutional management director at Georgia State College for Women suggested the possibility of her senior girls giving food demonstrations at the Baldwin County clinics, as a benefit to the clinics, and future help in other sections of the State as these girls graduate and take jobs over the State. Two trips to Milledgeville were made to work on this. Conferences to plan the work were held with the teachers involved, the county nurses and the Regional Nurse. The nutritionist also met and talked with the two classes concerned. Similar demonstrations were planned, procedures outlined, and inexpensive menus and buying guides were furnished the classes. Con- iVIatemal and Child Health 109 Proper Prrpara l iou Aids iu Prescrl'iug N ul rilirr Valu e of Foods rinuarion of this work is planned and it is hoped that similar programs may be developed in other schools. During the summer session, talks on nutrition in public health were made ro classes in Health Education and in Child Guidance. Sttrvey on Food Conmmption, Prodttction and Bttying Quire a large number of questionnaires on the above subject were distributed ro nurses in the Stare bur, except for Richmond County, few have been returned. Forty-nine completed records were made in this county in May, 1946. Following are a few high-lights from these records : Amount Spent for Food per Adult Unit per Week White urban families ._____ ------------------------ $5.68 Colored urban families .......----------------------- 4.38 White rural families ........------------------------------- 2.60 Colored rural families ._______________________________________ 1.27 All families spent roo much for protein foods-most of them approximately 30 per cent of rhe food money. None spent enough for milk and cheese. The colored families spent about 7 per cent and the white rural families 9.5 per cent and rhe white urban families 15 per cent. llO Georgia Department of Pttblic Hetttth Crippled Children's Clinic Representatives of the Crippled Children's Division of the Department of Welfare asked for assistance with their nutrition problems for clinic patients. In June a conference was arranged, in the nutrition consultam's office, with these representatives and the Extension Nutritionist. It was realized that more help was needed than could be given by the Health Department Nutrition Consultant and rhe Extension Nutritionist. Ir was dedeled to call on the Red Cross nutrition workers for help. The nutrition consultant has taken the lead in securing help for these clinics and planning the type work to be done. The nurrition consultant works in rwo clinics a month. The State Red Cross Nutririonist takes two clinics a month and the Atlanta Red Cross Nutritionist usually works in four a momh. The pediarridan refers patients who need special advice on diet to the nutririonist serving the clinic. The nutririon consultant has prepared for distribution at these clinics materials on reducing diets for children of different ages, good normal diets, and rraining in food habits. A supply of feeding cards and meal planning guides is also kept for distribution. Similar clinics are held in Augusta, Columbus and Savannah but lack of personnel has made it impossible to give any assistance in these ciries. Tttberctt!osis Association The nutritionist has worked with the Atlanta Tuberculosis Association on diets for the tuberculous patient and the convalescent. Recognizing that many of the "returnees" to the institutions could be prevented by proper diet, tentative plans have been made for a nutrition education program with these p.tients while they are in institutions and after their return home. Marerial on diet in tuberculosis has been prepared for distribution to the medical officers and nurses. This has been discussed in rhe staff education meetings. School Lttnch Program It is difficult to enumerate the different ways the nutrition consultant has worked on this phase of child health. She has had numerous consultarions with rhe supervisors of the program in the Deparrment of Education. At some of the regional conferences the nurririonisr suggested having talks from a representative of the School Lunch Division. These ralks explained the program and the ways public health workers could help. The nurritionist visited lunch rooms in Augusta in May and wrote a report on conditions. This report resulted in a meering of school people to consider the school lunch situation. Only two schools in the city were serving lunches. The other schools had counters where soft drinks, candy, cakes, potato chips and similar products were sold. In the fall of 1946 twelve more schools in the city started serving a complete lunch. The nurrition consultant met with lunch room managers in a summer workshop and ralked on the imporrance for good health of nutrition and the school lunch. lHaternctl ctnd Child Health 111 In a school in Thomas County, there was much concern over the unavailability of milk for the school lunch. The nutritionist was asked to prerare dry skim milk and observe the reaction of the children to it. Eight gallons of this milk were prepared for 130 children. No sugar or flavoring was used. Two high school girls and two elementary children who did nor c.lrink milk anyway left full glasses. Most of the children lined up with their glasses for a second serving. Many wanted a third glass but the quantity prepared was not sufficient. All concerned were convinced this could be a practical way of getting milk in school lunches where fresh milk is not available. All schools in this county not serving milk have requested dry milk for their lunch rooms and are to receive it starting in January 1947. Hectlth Edttccttion-Ntttrition Workshop The nutrition consultant worked with representatives of the University of Georgia, Department of Education and Health Department in planning for the workshop held at the University of Georgia the summer of 1946 and acted as a staff member during the time of the workshop. Two features of the workshop which seemed of particular interest to the participants were results of efforts of the nutrition consultant. The other special feature in nutrition was work conducted by one of the U. S. Public Health Service Nutrition Survey Teams, which has been explained under a previous headi!1g. In July, the nutritionist spent two days at Atlanta University working with a group of Negro teachers in a Health Education-Nutrition workshop. Unfortunately this group had little staff help on nutrition in their course. The nutritionist discussed with the entire class nutrition problems and teaching methods, then worked with small groups on particular problems. It is hoped that more time may be given to this class another year. Other Agencies ctnd Organizations Congress of Parents and Teachers: Talks have been given to these groups on child health and nutrition. The nutritionist has worked with the State chairman and the local group on the training of volunteers to give food demonstrations in the health clinics. Red Cross Nutrition Program: Vocational Home Economics Education, Extension Service. There are many ways in which these programs coincide with that of the Health Department nutrition work. Close working relations and cooperation with these groups have been maintained. Georgia Nutrition Committee: The nutrition consultant is an active member of the State Nutrition Committee. She has served on the sub-committee, on Diet Planning and Food Habits, the Scientific Advisors Committee and on a Program Planning Committee. The nutrition consultant is a member of the Georgia Dietetic Association, the Georgia Home Economics Association, Georgia Home Economics Council, Arlanta Home Economics Club and Atlanta Dietetic Association. 112 Georgia Department of Public H ealth i\tlaternctl ctnd Child Hectlth 113 Through these organizations she is able to help promote better nutrmon in the State and to help coordinate the entire nutrition program in the State. Work with Student Nurses: Work has been done with only one group, Negro girls at Grady Hospital. This, however, is a definite part of the nutrition program and will be continued. lndttstrial W ark The nutritionist has visited three industrial establishments to encourage 8ncl assist in the development of better feeding facilities for the employees. Plans are to continue and expand this type work. lnstittttional W ark Help was requested by the minister in charge of a church orphanage. The nutritionist spent a clay there evaluating the situation. She watched the preparation of the food, ate dinner with the group, inspected the storage and food supplies, observed clishwashing and other sanitary facilities. No menus ~were made bur she secured from the housekeeping-cook the foods served for two clays before. During the stay at the orphanage, written suggestions on food production, food preparation, menu planning and sanitation were given. This was followed up by writing them more detailed suggestions .on menus, recipes and cooking. The nutritionist also requested the help of the sanitary engineer from the Regional Office for this institution. The nutritionist does not consic!er the work done a finished job, but rather a beginning, and expects ta follow up with all possible help. It is hoped that this type work can be extended into all private and public institutions in the State. Thomas Cotmty Ntttrition Edttcation Program In the early summer, the Commissioner of Health of Thomas Coumy 1equested the nutrition consultant's help in the schools in the county, in the fall after schools opened. In September, the nutritionist visited the county 2.nd made work-plans with the health officer and the instructional supervisor of the County Department of Education. In early October a nutrition education program was launched in all white schools in the county. The ins.tructlonal supervisor had been doing preliminary work with the teachers, so they were willing and anxious to carry on the work. The first step was to secure dietary records on the school children. These records were on a three-day period, Si.mclay, Monday and Tuesday. Such records were secured from over 2,000 school children. The information obtained was used as the basis of the nutrition teaching. The health officer devised a growth record which was given to the teachers for each child. All children were weighed and measured and those found more than 12 per cent below the expected weight have been given special examinations, including hookworm tests and hemoglobin readings. 114 Georgia Department of Pttblic Health Of the seven white schools in the coumy, only two were serving milk in the school lunch, because an approved supply of fresh milk was not available. All schools have become so interested in nutrition that they have requested dry skim milk and are to receive it. The present plan is to start rhe use of Wetzel Grids with the first, second and third grades in two schools. The nmrition consultant plans to spend one week out of each two months in the county working with the County Health Department and the County Department of Education in carrying out the nutrition program with community groups, teachers and pupils. The result of the work is already nmiceable in improved condition of the children and the interest of parents, teachers and children. Food Demonstrations Simple demonstrations on food preparation are one of the most effective ways to teach nutrition. This is particularly true for individuals who have little education. It is well known also that the poor preparation of food is one of the biggest factors in malnutrition. For these reasons plans were made to have food demonstrations given at clinics in as many counties as possible. A questionnaire revealed that six counties already had food demonstrations and that twenty-five others wanted to start them. Arrangements were made to supply simple cooking equipment to these counties and, where necessary, to employ a trained home economist, part-time worker, to give the demonstration. When the counties learned this help could be obtained, more .ielt it would be possible to have the demonstration. Demonstrations have been planned on dry skim milk, potatoes, leafy vegetables, other vegetables, fruits and fruit juices, cereals, eggs, lean meat (pork liver) and fish. It has not been possible to visit all coumies wanting to start these demonstrations but it is the plan to do so in the near future. Work With lHidwi,ves Unfortunately, it was not possible for the nutrition consultant to do much work with midwives during the past year and she met with only one group c.omposed entirely of midwives. The nurse in Randolph County requested the help of the nutritionist at one monthly meeting with midwives. The nutritionist talked about the food the mother should have before delivery as well as after. The midwives appeared interested and receptive to the talk. In other meetings with mothers, some midwives were present and received the instruction on diets. Midwives are influential with the women they serve. They reach many women with the least education, and they could be an important factor in improving the diets of these women. Materials Prepared One new leaflet for children, called "My House of Health", was prepared Matern(tl (tnd Child 1-le(tlth 115 for publication. The leaflet "What to Eat Before the Baby Comes" and the nutrition part of the bulletin, "Maternal Care", were completely rewritten. A series of lessons for use in staff education were prepared. They are: A General Introduction to Nutrition The Normal Diet Diet in Pregnancy and Lactation Diet in Tuberculosis Proteins Questions and Answers on Nutrition (This was prepared from questions submirted by the nurses and covered many of the problems most frequendy encountered) A series of six food demonstrations with recipes has been wrirten. There are robe three more in the series. The six which were completed in 1946 are: Cereals Eggs Lean Meat (demonstrating pork liver) Fish Dry skim milk Potatoes Mimeographed material was prepared for distribution at the Crippled Children's Clinic. This is: Suggestions for Good Food for Children Training in Food Habits Reducing Diets for Children of Different Ages A questionnaire was prepared on food consumption and food buying. The nutrition consultam hoped that each nurse would use these questionnaires to give her more accurate information on actual eating habits. Each month the nutrition consultant prepared a shaH nurrition article for Georgia's Health. One on "Mineral Oil" was copied in Consumer's Guide and an excerpt from it was used in at least one other state health department publication. The last few mond1S me series has been on vitamins from Georgia foods. These anicles have been on different vitamins and the everyday foods from which they may be obtained. EDUCATIONAL ACTIVITIES Literature Distributed: Mothers and babies___________ -------------------------------------------- 74,457 N u trition publications____________________________________________________ 5,036 N utrition reprints .____________________------------------------------______ _ 14,396 93,889 116 Georgia Dep,vrtment of Pttblic Health Professional Personnel Trained: Public Health Administration (physician) ______ _ 1 Premature Care- Public Health Nurses --------------------- 4 Institutional Nurses_____ 1 5 Maternity Nursing Care- Public Health Nurses ______ ---------------------------- 0 Institutional Nurses ------------------------------------- 1 1 Midwifery (refresher training)------------------------ 1 In-trained in Nmrition Education__________ 1 In training, Industrial Feeding ___________________________ 1 Southern Pediatric Seminar-Physicians (refresher)_ 24 Slossfield Health Center-Negro Physicians (refresher)____ 8 (Training was offered Negro physicians the second time during the year but plans never materialized because of illness of President of Georgia State Medical Association) The Director of the Division of Maternal and Child Health has had conferences with the Director of Local Health Organizations, the Director of Nursing, and rhe Regional Medical Directors in regard to developing a coordinated in-training service program which would be developed on a regional basis. MIDWIVES The number of midwives continues to decline, as it has for the past ten years. Although no special study has been made to determine the reason for the decline, there are several theories in regard to this. Most of our midwives are colored and better opportunities for the colored individual, with increase in educational facilities, have been extended, and for this and other reasons midwifery does not have the appeal to the individual that it formerly had. 1-'atients are becoming more aware of the fact that the services of a physician are desirable. During the past two or three years, the Emergency Maternity and Infant Care program has probably caused more infants to be delivered by physicians than in the past. Another factor in the decrease is the fact that rhe Georgia Department of Public Health has discouraged the appointment of midwives improperly trained with the hope that a program of some kind would be developed to properly train qualified personnel to rake the place of the existing midwife as she drops out of the program. Closer supervision has resulted in the refusal to certify midwives who are non-cooperative and inefficient. 1\!Ictternctl ctnd Child Hectlth 117 MIDWIFE APPLICATIONS, DEATI-IS, AND CERTIFICATIONS BY AGE GROUP Initial Certifications by Age Group Year TotalCertifwic.ations c. Under Over Age Total Applica- Midwife Midwives 50 50-65 65 Unknown tions He.. Deaths Retired fused 1932 3358 2919 1933 3562 3463 1934 3434 3402 99 1935 3510 316 3191 3510 223 1936 3297 326 2971 135 3509 165 1937 3171 1938 3049 298 2751 134 518 134 1939 2951 59 749 85 1940 281H 267 2594 75 653 86 1941 2594 253 2341 37 22 4 5 68 638 71 1942 2412 233 2179 25 13 3 2 43 447 61 37 1943 2203 200 2003 21 16 6 6 52 394 46 45 1944 2074 180 1891 21 10 2 1 31 290 43 38 1945 1944 151 1790 10 7 1 20 235 35 30 1916 1759 146 1613 12 3 1 17 233 38 34 NURSE-MIDWIFE PROGRAM Preparations were made for a nurse-midwife program to begin in Walton County January 1, 1947. Although this program was tried in Walton Coumy a few years ago, and discominued because it was not working satisfactorily, it is thought that most of the difficulties which were encountered before have been amicipated and their possibility of occurring again has been eliminated. Standing orders and policies have been approved by the local medical profession, the local board of health, local hospital board and the State Department of Health. The program will be operated under the county health department in cooperation with the local physicians and hospital, with consultation and direction from the Division of Maternal and Child Health, State Department of Public Health. Nurse-midwife patients are to be delivered in the local hospital with medical consultation from the local clinicians. Patients are to be admitted to the hospital for three days, at a total cost of $15.00, which is equivalent to the fee charged by the local untrained midwife. The program is set up so that there will be a minimum of two nursemidwives. In addition to the delivery of midwife cases, the nurse-midwives will assist the physicians with their private cases. They also will assist with prenatal conferences, and make a minimum of one prenatal visit and three postpartum visits to patients attending the prenatal conferences. It is anticipated that this service will be established in two additional centers during 1947. This division expects to develop a service in connection with a maternity shelter, and a service in a county in which home deliveries will be done. 118 Georgiw " "Q1W ~8 =."~ *s"" ""ilw :E~" " w :E z 0 1- 0 "" 27 15 ll 1 32 15 7 32 28 16 3 3 2 13 12 JJ 15 5 23 '1 5 12 2 27 2 51 42 2,118.26 12 659.12 47 3458.'15 7 783,32 . 5 290.50 H 1985.2,1 3 353.50 'j 208.50 5 115.95 16 5M.02 19 7,15.20 17 725.53 21 714.70 11 255.95 2S 820.36 g 710.75 H 474.00 29 1616.37 6 474.70 Counties ="" = "' "w cnw ""ilw :E~ "" '" ~~ <0 :E z 2 ~ 0s ~ ~ "" Twiggs .. 7 Union ....... 10 Upson ..... 23 Walker ..... 8 Walton .... 10 Ware ... 15 \Yarren ... .... 6 Washiogton .. 8 Wayne .... 3 Wehster .... 4 Wheeler .. 14 White ...... 1 Whitfield .. 11 \Vilcox .. 19 'Yillws ... j Vlilkinson. 6 Worth ... 13 Total. ...... .... 1'7'19 11 31R.05 H 353.05 30 799.'13 6 8 16 119.75 1389.05 1 16 1151. 9S 3 9 65R.OO .j 12 802. RO 3 187.50 .3 '1 17 124.03 .521. 20 l 2 295.50 11 1207.75 22 1056.00 8 487.00 7 161.61 21 - -11-81.-JJ 611 2,31j0 Sll6,32!.32 EPIDENIIOLOGIC SERVICE Personnel The personnel of the central office consisted of the State Epidemiologist and one stenographer. The field personnel assigned to the biological section of (he Service was made up of a Senior Biologist, who acts as executive as sistant to the Epidemiologist in supervising biological activities, a permanent field biologist, a field nurse and a secretary. A second permanent field biologist 1esigned during the year. During the summer months, the former Assistant Director of the Malaria and Hookworm Service returned to continue a special research program and two additional temporary biologists were employed on special projects. F:tnctiom The office of the State Epidemiologist is the center of all activities related to reporting and control of preventable diseases. To this end, weekly and monthly morbidity reports, which are compiled from data assembled by the Central Tabulating Unit, are forwarded to all staff personnel and health officers. Regional Medical Directors are notified of all cases of preventable diseases reported to the office and are delegated to make such investigations as seem pertinent. Special assistance in investigating and combatting epidemic conditions is rendered by the Epidemiologist or h'is medical and scientific t.ides whenever such assistance is requested. As an aid to communication Pre,ventable Disectses 141 with private physicians in the state and for the convenience of public health workers, a classified medical directory of physicians in the state by county is mimeographed and circulated to health officials and others interested. This directory is kept up-to-date by forwarding supplements and cor- rections as changes occur. The general biological activities carried on by the Service fall into two groups: helminthological investigations and control programs, aimed primarily at hookworm control; and entomological studies which provide data for the insect control activities of other scate and county :tgencies, or which are designed to work out simpler, more economical meth- ods of controlling medically important insects. This general plan of activities envisions the temporary employment of consultant biologists and biological aides during the summer months when entomological activities are at their peak, and cooperation with colleges and universities in providing materials and facilities for parasitological research which bears on the work of the <;: ~ervKe. During 1946, several investigations on worm diseases were made as described briefly under the general heading on hookworm control and three major entomological investigations were carried out. These programs are described under appropriate headings. Field Visits The total number of field visits made in unorganized counties by regional medical directors and public health nurses amounted to 2,671 in 1946 and 5.617 in 1945. This was a 52.5 per cent reduction in field visits, which was brought about largely by a reduction in field visits in the control of malaria. The following table shows the summary broken clown by diseases and personnel: SUMMARY OF ACTIVITIES IN THE CONTROL OF PREVENTABLE DISEASES, 1945 AND 1946 Type of Activity Regional Medical Directors and Epidemiologist 1945 1946 Consultations Admissions to wmiethdicpahlysseircviaicnes . .... .... .. .. .. .. .. .. .. .. 101 70 1196 704 Admissions to nursing service . ............... Admissions to medical and/or nursing service . ... Field Visits Diphtheria ..... ............ :Malaria ...... Measles ...... Scarlet fever . .. Smallpox ............... Typhoid and paratyphoid .... Typhus.... . ... Whooping cough ........... Hookworm ............... Others ................... 57 1 8 2 'j 1 33 26 21 2 71 35 Total field visits.......... 195 75 Public Health Nurses 1945 1946 1636 1179 200 2835 20 278 6 189 14 16 1771 93 5422 119 888 4,1 73 2 38 3 15 1209 205 2596 Total 1945 1946 101 70 1196 704 1636 1179 1726 1217 257 127 2335 21 88,g9 286 75 10 3 222 64 35 5 16 15 1771 1209 164 240 5617 2671 142 Georgia Depctrtment of Pttblic Health The following tabulations will show the number of field visits made by public health workers in the state by counties: Diphtherict: Appling ------------------------------ 7 Baldwin ------------------------------ 28 Barrow -------------------------------- 1 Barrow -------------------------------- 21 Bibb ------------------------------------ 132 Brantley ------------------------------ 1 Brooks -------------------------------- 8 Bulloch -------------------------------- 20 Burke ---------------------------------- 5 Butts ------------------------------ ______ 22 Camden ------------------------------ 2 Carroll -------------------------------- 4 Chacham ------------------------------ 40 Clarke ---------------------------------- 44 Clayton -------------------------------- 2 Cobb ------------------------------------ 179 Coffee ---------------------------------- 26 Colquitt ------------------------------ 70 Cook ------------------------------------ 2 Coweta -------------------------------- 1 Crisp ------------------------------------ 12 Dade ---------------------------------- 2 DeKalb ____________ -------------------- 16 Dodge ---------------------------------- 8 Emanuel ------------------------------ 8 Floyd ---------------------------------- 3 Fulton ---------------------------------- 56 Grady ---------------------------------- 3 Gwinnett ---------------------------- 2 Habersham _______ _____________ _____ 7 Hall ------------------------------------ 46 Hart _----------------------------------- 6 Jeff Davis ---------------------------- 1 ]enkins -------------------------------- 1 Johnson ------------------------------ 23 Laurens -------------------------------- 3 Long ------------------------------------ 5 Lowndes ------------------------------ 5 Macon -------------------------------- 1 Meriwether ------------------------ 5 Mitchell ------------------------------ 5 Montgomery ------------------------ 2 Muscogee ---------------------------- 31 Pierce ---------------------------------- 13 Rabun ---------------------------------- 2 Richmond -------------------------- 28 Spalding ------------------------------ 112 Sumter -------------------------------- 1 Telfair -------------------------------- 3 Terrell -------------------------------- 3 Thomas ------------------------------ 39 Tift ------------------------------------ 1 Toombs __________ ______________ ______ 4 Troup ---------------------------------- 14 Upson ---------------------------------- 8 Walker ___ ----------------------------- 2 Walton -------------------------------- 11 Ware ---------------------------------- 4 W ashingwn ------------------------ 3 Wayne -------------------------------- 20 Whitfield ---------------------------- 4 Wilcox -------------------------------- 1 Wilkes -------------------------------- 1 Worth ------------------'------ ______ 4 Total ---------------------------- 1144 l-1 ookworm: Appling ----------------------------- 198 Atkinson ---------------------------- 122 Bacon ---------------------------------- 139 Baker ---------------------------------- 113 Baldwin ------------------------------ 23 Berrien -------------------------------- 19 Bleckley ------------------------------ 30 Brantley ------------------------------ 41 Brooks __ ----------------------------- 59 Bryan ---------------------------------- 87 Bulloch -------------------------------- 324 Burke _____ ----------------------------- 22 Calhoun ------------------------------ 8 Candler -------------------------------- 32 Charlwn ------------------------------ 133 Chatham ---------------------------- 176 Pre-ventable Diseases 143 Clinch ---------------------------------- 74 Cobb ---------- ------------------- ______ 1 Coffee ---------------------------------- 199 Colquitt ------------------------------ 1 Cook ------------------------------------ 2 Decatur ------------------------------ 30 Dodge -------------------------------- 121 Dougherty ------------------------- 39 Effingham ----------------------_------ 10 Emanuel ------------------------------ 28 Evans ---------------------------------- 105 Fulton -------------------------------- 3 Glynn -------------------------------- 50 Grady ---------------------------------- 75 5 Jasper ---------------------------------- 1 Jefferson -----------"----------- ._____ 6 Jenkins -------------------------------- 20 Johnson ------------------------------ 23 Jones ---------------------------------- 2 Lanier --------------------------------- 46 laurens -------------------------------- 100 libeny -------------------------------- 29 long -------------- ______ ------------- 136 lowndes ------------------------------ 56 Mcintosh ---------------------------- 19 Mitchell ------------------------------ 112 Montgomery ---------------------- 5 Muscogee ---------------------------- 31 Pierce ---------------------------------- 101 Pulaski -------------------------------- 12 Screven -------------------------------- 6 Stephens ------------------- ___________ 3 Sumter -------------------------------- 5 Taylor ______ ___________________________ 8 0 Terrell ----------------------- _________ 1 Thomas ------------------------------ 23 Toombs ------------------------------ 58 Upson ---------------------------------- 24 Wayne -------------------------------- 101 Wilcox -------------------------------- 7 Wonh. -------------------------------- 3 Total ---------------------------- 3882 Mala-ria: Bacon -------- ------------------------- 1 Baker ---------------------------------- 87 5 Bibb ------------------------------------ 3 Calhoun ------------------------------ 1 Charlton ------------------------------ 1 Chatham ------------------------------ 19 Effingham ---------------------------- 2 Evans ---------------------------------- 1 Glynn ---------------------------------- 3 Jenkins -------------------------------- 1 lowndes ------------------------------ 20 Measles: Bacon ---------------------------------- 2 Baldwin ------------------------------ 1 Bibb ----------------------------------- 47 . Brooks ------------------------------- 2 Bulloch ------------------------------ 7 Burke ----------~----------------------- 9 Butts ------------------------------------ 4 Calhoun ------------------------------ 2 Catoosa -------------------------------- 6 Chatham ------------------------------ 286 Mclmosh ---------------------------- 6 Muscogee ---------------------------- 2 Sumter -------------------------------- 2 Thomas ------------------------------ 1 Tift ------------------------------------ 1 Troup ---------------------------------- 2 Upson -------------------------------- 4 Wilcox --------------------------- ____ 6 Total ---------------------------- 951 Clarke ---------------------------------- 49 Cobb ---------------------------------- 17 Coffee --------------- ___________________ 98 Colquitt ------------------------------ 3 DeKalb ______ ------------------------ 10 Dodge -------------------------------- 3 Dougherty -------------------------- 102 Evans ---------------------------------- 17 Fannin ________ ------------------------ 1 Floyd ---------------------------------- 28 144 Georgia Department of Pttblic Hectlth Fulton -------------------------------- 186 Glynn --------------------------------- 77 Gwinnett ____________________________ 1 Habersham ____________________ ------ 5 Hall ____________________ _____________ 2 Henry ______________ ___ ______________ 1 Jasper ---------------------------------- 1 Jenkins -------------------------- _____ 1 Johnson ------------------------------ 1 Jones ________________ _ __ _________ 36 Liberty __ --------------------------- 31 Long __ ____________ ___ __ __ ___ _ ___ 5 Lowndes _____ ______________________ _ 100 Lumpkin __ __________________ 5 Meriwether _______________________ 1 Scarlet Fever: Bibb _____ __ _____________________ _____ 101 Bartow -------------------------------- 1 Bleckley _____ ___________________ 4 Brooks -------------------------------- 3 Bulloch _____ ________ _______________ 2 Burke ______________ ___________________ 6 Chatham ------------------------------ 171 Clarke _____________ _________________ 28 Claywn -------------------------------- 7 Cobb ---------- ---------- -------------- 335 Colquitt ___ __________________________ 10 Columbia _______ _____________ ____ 1 Coweta _________________________ 1 Crawford ---------------------------- 5 Crisp _____________ ____ _______________ 28 Dade ____________________ __ _ _____ 10 Decatur ____________________ 1 DeKalb ____________ _________________ 113 Dodge ________ ____ ____________ 7 Dougherty -------------------------- 3 Emanuel ___________________ _________ 1 Fannin -------------------------------- 3 Floyd _________ ______ ____________ 15 Franklin ______ ___ ___________________ 1 Fulton ---------------------------------- 385 Glynn __________________ ____________ 17 Habersham -------------------------- 3 Small-pox: Dooly ______________________________ Jasper ___ _____ __________ ______ ____ 2 Meriwether __________________________ 29 Muscogee ________________ 11 Peach ------------------- ______________ 1 Pulaski ______________ ___________ ____ 4 Richmond _________________ 187 Screven -------------------------------- 1 Stephens ____ _____ ___________________ 17 Sumter ----------------------- _ 8 Terrell _______________ _________________ 1 Troup ----------- --------------------- 29 Upson _____ _ 10 Walton ------------------------------ _ 5 Ware --------------------------------- 2 Total _______________ 1423 Hall ----------------------------------- 29 Jasper __________ ---------------------- _ 9 Johnson --------------------------- 15 Jones _______________________ __________ 10 Lamar ---------------------------------- 5 Laurens ____________ ___________________ 1 Liberty _____ _ __ ______ _______ 5 Lowndes __________ 4 Lumpkin ________ --------------------- 9 Mitchell ___ __ ___________________ 2 Muscogee ___ _______________________ 27 Peach _____________________ ____ _____ 7 Pike ---------------------------- ______ 6 Richmond _ _ ___________ _____ 39 Spalding ________________ 22 Stephens ------------------------------ 2 Terrell ------------------------------- 1 Troup _____________ ________________ ___ 60 Upson ---------------------------------- 1 Walker _______ __________________ _____ 1 Walton __________________________ ______ 7 Ware _____ _________________ __________ 2 W ashingcon ------------------------ 2 Wayne ------------------------------ 8 Whitfield _________________ ________ 5 Total __ ____________________ 1541 Terrell -------------------------------- 3 Total _____ ____________________ 35 Preventctble Diseases 145 Typhoid Feve-r: Atkinson ---------------------------- 4 Bibb ------------------------------------ 6 Bulloch ------------------------------ 4 Burke ---------------------------------- 2 Butts ------------------------------------ 3 Chatham ----------------------------- 64 Clarke ---------------------------------- 2 Clayton -------------------------------- 1 Cobb ------------------------------------ . 7 Colquitt ------------------------------ 8 Coweta -------------------------------- 4 Crisp _____________ -------------------- 10 DeKalb -------------------- __________ . 13 Dougherty -------------------------- 4 Emanuel ------------------------------ 12 Fannin -------------------------------- 1 Forsyth -------------------------------- 1 Franklin ------------------------------ 3 Fulcon ---------------------------------- 50 Glynn ---------------------------------- 2 Greene -------------------------------- 1 Hall ------------------------------------ 11 Hancock ------------------------------ 13 Haralson ------------------------------ 1 Henry ---------------------------------- 6 ]ackson -------------------------------- 1 Jefferson ------------------------------ 22 Johnson ______ ________ _________ _______ 1 Laurens ------------------------------ () Lincoln -------------------------------- 5 Lowndes ------------------------------ 13 McDuffie ---------------------------- 4 Meriwether -------------------------- 11 Montgomery ---------------------- 3 Muscogee ---------------------------- 6 Newton ------------------------------ 1 ,Oglethorpe -------------------------- 5 Pickens -------------------------------- 6 Pierce ---------------------------------- 4 Pike ------------------------------------ 3 Putnam -------------------------------- 4 Richmond ---------------------------- 8 Spalding -----------------------------. 5 Thomas ------------------------------ 2 Toombs ------------------------------ 3 Troup ---------------------------------- 5 Wayne -------------------------------- 3 Wilcox -------------------------------- 1 Total ---------------------------- 355 Typhtts Fever: Bulloch -------------------------------- 4 Burke ---------------------------------- 3 Calhoun ------------------------------ 1 Carroll -------------------------------- 1 Chatham ------------------------------ 85 Coffee ---------------------------------- 21 DeKalb ------------------------------ 2 Dodge ________ ------------------------ 1 Dougherty -------------------------- 2 Evans ---------------------------------- 2 Glynn ---------------------------------- 10 Haralson __________ -------------------- 2 Jenkins -------------------------------- 1 Johnson ------------------------------ 1 Liberty ------------------------------- 2 Lowndes ------------------------------ 4 Mcintosh ---------------------------- 2 Meriwether -------------------------- 3 Pulaski _____________ ------------------ 2 Richmond ---------------------------- 8 Screven -------------------------------- 3 Tift ------------------- _____________ ______ 6 Walker -------------------------------- 2 Walton -------------------------------- 2 Washington ------------------------ 1 W orrh ________________ ________________ 4 Tom!--------------------------- 175 Whooping Cottgh: Bibb ------------------------------------ 102 Catoosa -------------------------------- 1 Charlton ------------------------------ 5 Chatham ------------------------------ 36 146 Georgict Department of Pttb!ic Health Clarke ---------------------------------- 55 -Cobb ----------------------------------- 3 Coffee ---------------------------------- 14 Colquirr ------------------------------ 1 Columbia ---------------------------- 1 Cook ------------------------------------ 1 Dougherty -------------------------- 51 :Evans ---------------------------------- 1 Fannin -------------------------------- 4 Fulton -------------------------------- 56 Glynn ---------------------------------- 25 Greene -------------------------------- 1 Gwinnett ---------------------------- 9 Liberty -------------------------------- 7 Lowndes ------------------------ _____ 111 Muscogee ---------------------------- 4 Newton ------------------------------ 3 Pierce --------------------------------- 1 Pulaski -------------------------------- 23 Richmond -------------------------- 52 Spalding ------------------------------ 14 Stephens _----------------------------- 1 Troup ---------------------------------- 36 Walton -------------------------------- 1 Total _________ ------------------ 619 Others: Atkinson ------------------------------ 9 Bacon ---------------------------------- 18 Baldwin ------------------------------ 13 Barrow -------------------------------- 7 Berrien -------------------------------- 2 Bibb ----------------------------------- 108 Bleckley ------------------------------ 10 Brantley ------------------------------ 2 Brooks -------------------------------- 98 Bulloch -------------------------------- 2 Burke --------------------------------- 36 Butrs ------------------------------------ 7 Calhoun ------------------------------ 6 Camden ------------------------------ 5 Carroll -------------------------------- 4 Catoosa ------------------------------- 4 Charlton ------------------------------ 1 Chatham ---------------------------- 509 Clarke ---------------------------------- 81 Clinch ---------------------------------- 129 Cobb ------------------------------------ 238 Coffee ---------------------------------- 15 Columbia ---------------------------- 1 Colquitt ------------------------------ 49 Cook ----------------------------------- 2 Coweta -------------------------------- 1 Crisp ---------------------------------- G Dawson ------------------------------ 2 DeKalb -------------------------------- 154 Dodge -------------------------------- 4 Dougherty -------------------------- 73 Early ------------------------------------ 8 Elbert ---------------------------------- 1 Emanuel ------------------------------ 1 Fulton ---------------------- ___________ 354 Glynn ---------------------------------- 32 5 Grady ---------------------------------- 10 Hall ------------------------------------ 12 Henry ---------------------------------- 5 Jefferson ------------------------------ 17 Jenkins -------------------------------- 3 Johnson ------------------------------ 3 Lamar ---------------------------------- 1 Lanier ---------------------------------- 12 Laurens ------ -------- ... -------------- 1 Libeny -------------------------------- 65 Long ___________..________________________ 1 Lumpkin ---------------------------- 1 Mdmosh ------- -------------------- 11 Mitchell ------------------------------ 4 Muscogee ---------------------------- 7 Pierce -------------- ------------------- 65 Pike ------------------------------------ 4 Polk _________________________..__________ 4 Pulaski -------------------------------- 25 Rabun -------------------------------- 1 Richmond -------------------------- 153 Screven -------------------------------- 1 Stephens _______________ ______________ 6 Sumter -------------------------------- 4 Taylor ---------------------------------- 3 Telfair -------------------------------- 14 Terrell -------------------------------- 1 Thomas ------------------------------ 133 'Troup ---------------------------------- 49 Upson ---------------------------------- 42 Preventable Diseases 147 Walton -------------------------------- 10 Ware ---------------------------------- 4 Washington ------------------------ 6 Whitfield ---------------------------- 3 Wilcox __ ----------------------------- 1 Worth ---------------------------------- 11 Toml -------------------------- 2978 Otttbrectks ln-vestigctted The staff members of the Epidemiologic Service investigated only three outbreaks of any consequence, which are as follows: Gastroenteritis- ( 1) An investigation was made by both the Clayton County Nurse and a staff member of the Department of an October outbreak of food poisoning in Jonesboro. Twenty-five persons developed sympwms typical of toxin food poisoning. It was found that all patients had eaten chicken salad at a certain Jonesboro restaurant. Specimens of the salad were examined by the Public Health laboramry, and a hemolytic staphylococcus was recovered in practically a pure culture. Upon investigation, it was obvious that the staphylococcus enterotoxin was present in the salad at the time of preparation. How the chicken had become contaminated originally was not definitely determined. ( 2) In February there was a sudden outbreak of a gastro-intestinal disorder among the students in the Conyers High School. Staff members of the Department investigated and found that approximately 66 per cent of the entire dairy herd which supplied milk for the school cafeteria were found to give positive reactions for mastitis. It was concluded that the most probable cause of the outbreak was the presence in the milk of staphylococcus enterotoxin. iHeningococctts iHeningitis-A small outbreak of meningococcus meningitis occurred in Hall County from January 2 to February 1, involving five cases. Control measures which were applied were effective and further spread was prevented. Qttctrctntine R egttlcttion On June 17 a quarantine regulation was released by the Director calling attention to an epidemic of infantile paralysis in Florida and notifying the public that people coming from Florida into Georgia would be expected m place themselves under voluntary quarantine and report to their health officer at their point of destination. Quarantine for a period of two weeks applied to all people with the exception of the bret'ldwinner in the family who must be isolated and remain away from the person in quarantine in rhe home. A person whose occupation had to do with the handling of food for public consumption was not allowed to return to his job until the period of two weeks was up. No barriers were placed at the smte line nor was there any interference with interstate commerce. People traveling by automobile to other states were permitted m continue on their way without being molested. On July S it was deemed necessary to amend the quarantine regulation to rhe effect that all persons entering Florida and returning to Georgia for other than necessary business would be subject to quarantine for a period of two weeks upon remrn, which included all members of the family. 148 Georgict Department of Pttblic Hectlth Other Acti-vities Typhoid Cctrriers-Through the efforts of all public health workers during the year 1946 a total of 6 typhoid carriers was found, which was a considerable reduction from the 21 found in 1945, the largesc number of chronic carriers found in any one year. Since there was a 51.8 per cent reduction in the number of cases of typhoid fever during the year, the demand for investigation of carriers was less. Edttccttionctl-During the year the Director attended 19 meetings, 11 of which were addressed by him, with a total attendance of approximacely 1015. The number of pieces of literature distributed on the control of communicable diseases totaled 34,077. Conferences-The Director held a total of 76 field conferences connected with the promotional activities related to the Epidemiologic Service as well as other Services coming under his jurisdiction. .!lnrtlysis of Stcttisticctl Reports A table of data on che morbidity and fatality rates of reportable diseases v,rhich follows these comments gives the morbidity rates per 100,000 population and the fatality rates as percentages of cases which were reported as deaths for the year 1946 and for the preceding 9 years. Since these data are so readily available, it seemed desirable to avoid repetition and instead to utilize the individual discussion of diseases to point out the degree to which the number of cases and deaths in 1946 varied from the number of cases and deaths in 1945, and, as a broader index of trend of the disease, to indicate the median number of cases and deaths in the five years 1942-1946, inclusive. Accordingly each paragraph of discussion is prefaced by: ( 1) a statement of the median number of cases, the number of cases in 1946 and che percentage increase or decrease of cases in 1946 compared with 1945; and by ( 2) a statement of the median number of deaths, the number of df'aths in 1946, and the percentage increase or decrease in deaths in 1946 compared wich 1945. Diphtherirt Crtses Median (1942-1946) __________ 520 Reported in 1946 ____________ __ 371 Percentage decrease since 1945 ---------------------------- 46.6 Dectths Median (1942-1946)_________ 47 Reported in 1946._______________ 45 Percentage decrease since 1945 ---------------------------- 36.G Diphtheria cases and deaths decreased rather sharply in 1946 from the totals recorded in 1945. Previous to 1945, a tendency toward reduction in incidence of the disease had been apparent, and the increased 1945 rates had therefore been viewed with some concern. It was suggested in the 1945 Annual Report that, "During 1945, it is possible that the introduction of a number of veterans returning from epidemic areas in the European theatre of war might have raised the carrier rate in the general population and thus :;.ccounted for the upswing." The resumption of a downward trend in 1946, when the number of returning European veterans was much less, lends added Pre,ventable Diseases 149 credibility to this suggestion. The fatality rate, 12.1 %, remained above the general level however. The median fatality rate for 1942-1946 was 9.0% and for the preceding five-year period the rate was 8.6%. Dysentery Cases Median ( 1942-1946) __________ 313 Reported in 1946________________ 214 Percentage decrease since 1945 ---------------------------- 31.6 Deaths Median ( 1942-1946) ______ 63 Reported in 1946________________ 36 Percentage decrease since 1945 ---------------------------- 40.0 Cases and deaths from dysentery were the lowest of record in 1946. There had been little change in cases and deaths in 1945 as compared with 1944, Dlthough a steady decrease in cases and deaths had occurred during the period 1937-1944. The resumption of a downward trend is therefore encouraging. lt is considered quite possible that the widespread use of residual insecticides might have been an appreciable factor in producing the marked drop in dysenteric disorders during 1946. Considerable effort has also been expended on improvement in restaurant sanitation by all public health agencies, and major significance should be attributed to this factor. The fatality rate was slightly below the median rate for 1942-1945. Gonorrhect Cctses Median (1942-1946) __________12 340 Reported in 1946 _______________ 15282 Percentage increase since 1945 --------------------- ------ 23.8 Dectths Median (1942-1946) __________ 6 Reported in 1946 _______________ 2 Percentage decrease since 1945 ---------------------------- 60.0 The number of reported cases of gonorrhea continued in 1946 co show the effect of an active case-finding program and of public confidence in the rapid treatment methods in use. The number of cases found was only slightly below the all-time high reported in 1942 when the wartime control program was at its peak. The 1946 record, however, reflects only the activities of state and local organizations in control of gonorrhea. Success in case finding and treatment is reflected in a decrease in reported deaths. The fatality rate is the lowest of record. Hooku;orm Cctses Median (1942-1946) __________ 3799 Reported in 1946 _______________ 4928 Percentage increase since 1945 ---------------------------- 29.7 Dectths Median ( 1942-1946) __________ 1 Reported in 1946 _______________ 0 Percentage change since 1945 ---------------------------- 0 The apparent increase in number of cases of hookworm shown in 1946 1s attributable partly to a change in reporting methods made in mid year. During the period 1936-1940, the median number of cases reported was 17,307, a figure which derives from the inclusion of all cases positive by salt flotation. The median shown above for 1942-1946 is influenced very largely 150 Georgict Department of Pttblic Health by che limitation of reporting to infecrions showing an egg count of 2,000 or more eggs per cc as determined by che Stoll dilution method, and also by wartime limitations on case finding and treatmem. In 1946, active hookworm control work was resumed, and late in che year reporting of all positives was again begun. It is cherefore likely chat routine and special sanitation activities will reflect themselves in higher yearly case totals, although it is not expected that the limited survey methods now in use will permit che attainment of totals comparable to the figures based on general surveys. Infittenza Cases Median (1942-1946) __________ 3780 Reponed in 1946________________ 2279 Percentage decrease since 1945 ---------------------------- 39.7 Dectths Median (1942-1946) __________ 482 Reported in 1946________________ Li23 Percentage decrease since 1945 ---------------------------- 10.6 Influenza in 1946 fell to a new low in number of cases and deaths. The death rate also fell to a new low, bm, as has been the experience in other years of low endemicity ( 1938, 1942, 1945), the case facality rate ( 18.6%) was high, being exceeded during the period 1937-1946 only by the rate for 1938. Ic has been customary co assume that the high fatality rates of nonepidemic years were conditioned pardy by variations in attention paid to reporting between epidemic and non-epidemic periods, as well as by variations in severity of the disease. Inasmuch as neither 1945 nor 1946 can be considered an epidemic year, and inasmuch as reporting should have varied little between these two years, it is perhaps worthwhile to report that analysis shows a statistically significant difference between deaths and survivals from influenza in these two years. Either the age factor in persons attacked or virulence of the non-epidemic organism would, of course, suffice to explain chis difference. Malctrict Cases Median (1942-1946) __________ 460 Reported in 1946________________ 115 Percentage decrease since 1945 ---------------------------- 75.0 Deaths Median (1942-1946) __________ 34 Reported in 1946 _______________ 12 Percentage decrease since 1945 ---------------------------- 53.8 A sharp decrease in malaria cases and deaths from malaria occurred in 1946 in contnist to the increase in number of cases which was reported in 1945. This rise and fall in case totals is apparently a refleccion of the return of veterans with active cases from the Pacific, African, and Caribbean theatres of war in 1945 and che subsequent subsidence of many of these active cases. Failure co report recurrent cases in 1946 is also a probable factor. Continued efforts co find endemic foci in Georgia by thick smear surveys have yielded no positive cases. Investigation of reported malaria cases has as yec revealed no confirmed case of locally transmitted malaria. The total number of deachs from malaria decreased nearly as sharply as the number of cases, but the fatality race, which was strongly affected by the high proportion of chronic infections in the total cases reported, rose to a ten-year peak. Pre,ventable Diseases 151 i'vlectsles Cases Median (1942-1946) __________ 4413 Reported in 1946________________ 4184 Dectths Median (1942-1946) ________ 44 Reported in 1946________________ 44 Percentage increase since 1945 ---------------------------- 540,7 Percentage increase since 1945 ---------------------------- 442.8 Measles increased markedly in cases and deaths over 1945, but the 1946 totals fell short of. the five-year case median and provide the median number of deaths for the same base period. Recem experience with measles can best be summarized by pointing out that the median number of cases for the period 1937-1946 is 5167, and the median number of deaths for the same period is 48. Therefore, the 1946 history is very nearly an average of the record for the past ten years. No significant change in fatality rate has occurred in ten years and no change at all in the past three years. i\lleningitis (Met~ingococctts) Cases Median ( 1942-1946) __________ 117 Reported in 1946________________ 70 Deaths Median ( 1942-1946) __________ 31 Reported in 1946________________ 31 Percentage decrease since 1945 ---------------------------- 40.2 Percentage decrease since 1945 ---------------------------- 18.4 A decrease again occurred in Meningococcus Meningitis cases and deaths 1n 1946, cominuing a downward trend which started in 1945. Comparison of the two medians for 1937-1941 (35) with the case median shown above indicates that~the disease tripled in incidence in the 1942-1946 period. The combined ten-year median ( 61) reflects a falling incidence of the disease in the early part of the period, a steadily rising incidence which began in 1941 and culminated in 1944, and the recession reported in the last two years. The present downward swing has, then, not yet reached the level of reasonable expectancy. It will be noted that the number of deaths recorded is quite large in comparison with the total number of cases and the facality rate is relatively high. The calculated line of trend for the period 1939-1946 indicates a pronounced falling off of the fatality rate first dearly manifested in 1943, continuing downward in 1944, moving upward slightly in 1945, and very markedly swinging upward in 1946. The level reached in 1946 by this smoothed curve is, however, still considerably below the levels calculated for the four-year period 1939-1942. Since the years with lower fatality rates are aiso years of increased incidence, the effect manifested is not entirely at- tribmable to the use of improved therapy. It also follows that it would be llilwarranted at this time to attribute rising fatality rates entirely to the developmem of drug-resistant strains of the Meningococcus. Pellctgrct Cases Median (1942-1946) __________ 159 Reported in 1946________________ 107 Percentage decrease since 1945 ---------------------------- 2.7 Deaths Median ( 1942-1946) __________ 131 Reported in 1946________________ 93 Percentage decrease since 1945 ---------------------------- 12.3 152 Georgia Depa'!'tment of Pttblic 1-Je,tfth Pellagra cases and deachs continued the decline first manifested in 1939. There was, however, only a minor reduction in cases from the number recorded in 1945. The number of deaths decreased slightly but not enough tO interrupt the upward trend of the fatality rate which has risen as the number of cases reported has fallen. This would s~Cem to indicate that a t<"ndency exists to report only frank cases of pellagra, a large proportion of which terminate fatally. Pnettmonia C?tSes Median (1942-1946) .......... 2524 Reported in 1946................ 1947 Percentage increase since 1945 - 1.9 De?tths Median (1942-1946) ....------ 1581 Reported in 1946................ 1341 Percentage decrease since 1945 - 10.6 The number of cases of pneumonia rose slightly in 1946 but not suf!iriently to indicate a change in the general tendency toward reduction in the number of cases. The number of deaths reported continued the downward movement in 1946, and the widened spread between cases and deaths caused a slight and non-significant reduction in fatality rate. Improved therapy is apparently indirectly responsible for the higher fatality rates of the last few years. A great many cases are being averted and pneumonias develop chiefly under circumstances which make for a poor prognosis. A portion of. the cases reported are undoubtedly due to virus pneumonias. Poliomyelitis Cases Median (1942-1946).......... 104 Reported in 1946................ 165 Percentage increase since 1945 ............................ 28.9 De?tths Median (1942-1946) .......... 9 Reported in 1946................ 8 Percentage decrease since 1945 ........................... 20.0 Poliomyelitis cases in Georgia continued the upswing begun in 1944 and rr::flected in a measure the sharply increased incidence experienced in an adjoining state. Maps of case distribution indicated a tendency for the disease to develop in conjunction with well traveled tourist routes and limitation of non-essential travel to and from the most seriously affected area was resorted to in an effort to block, or at least delay, the northward progression of the disease. Since the season of greatest incidence is usually summer and early fall, it appeared reasonable to believe that a delayed onset would shorten the course of an epidemic and reduce considerably the danger therefrom. Under these circumstances, interdiction of idle and unnecessary travel was considered to be indicated and was accordingly placed in effect. The increase in cases in 1946 was not accompanied by an increase in deaths, and the fatality rate was the lowest recorded since the epidemic year of 1949 (790 cases). Preventctble Disemes 153 Scarlet Fever Cctses Median (1942-1946) __________ 997 Reported in 1946________________ 503 Percentage decrease since 1945 ---------------------------- 57.6 Deaths Median (1942-1946) __________ 2 Reported in 1946________________ 1 Percentage decrease since 1945 ---------------------------- 80.0 There were less than half as many cases of scarlet fever in 1946 as in 1945, and the .figure for 1946 is the lowest shown in the period 1937-1946. Deaths were correspondingly reduced and the fatality rate is down again to the low level which has been characteristic of the 1942-1946 period. Improvement in therapy is of course the explanation of the lowered fatality rate. However, no ready explanation of the fall in rotal number of cases after a ten-year period in which scarlet fever has remained virtually static at ap proximately 1,000 cases per year can be offered, unless it be assumed that a larger than usual percentage of streptococci infections were unattended by the characteristic sign of scarlet fever. This rash suggestion should probably be tempered with the notation chat the increased use of penicillin alone and in combination with the sulfonamides might account for a number of aborted cases, and so be responsible for the lowered totals. ,Smallpox Cctses Median (1942-1946) ---------- 7 Reported in 1946________________ 3 Percentage decrease since 1945 ---------------------------- 70.0 Dectths Median ( 1942-1946) __________ 0 Reported in 1946________________ 0 Percemage decrease since 1945 --------------------- ------ 100.0 Smallpox cases decreased in a new low level in 1946. There were no fatal cases in 1946. Inasmuch as only one fatality occurred in 1945, the reduction in deaths appears as a percentage decrease of 100%. The fatality reported in 1945 is the only one recorded for the 1937-1946 period. Comparison of the case median for 1937-1941 (15) with the .figure for 19421946 shown above is the best indication of the present trend. Syphilis Cases Median (1942-1946) ----------13954 Reported in 1946________________11477 Percentage decrease since 1945 ---------------------------- 6.1 Dectths Median (1942-1946) __________ 372 Reported in 1946________________ 309 Percentage decrease since 1945 - -------------------------- 13.7 Comparison of the case median shown above with the case median for 1937-1941 (19,540) gives a true indication of an improving position with regard to syphilis. A rise in total cases accompanied the increased casefinding activities of the late pre-war and war periods, but a steady decline has been noted for the last three years, despite the fact that case finding activities have constantly been augmented. The .figures indicate not a relaxation of effort but a reduction of the disease and the lowered totals are the result of treatment of large numbers of individuals in rapid treatment 154 Georgia Dep(trtment of Pttblic Health centers. The smaller number of dea(hs reported is likewise the resuh of modern case finding and treatment campaigns. The fatali(y ra(e, however, shows no material change and reflects the residuum of cases which was not reached by early diagnosis and treatmem. T ttbercttlosis Cases Median (1942-1946) --------- 2608 Reported in 1946________________ 2534 Percentage increase since 1945 -------------------------- 20.0 Deaths Median (1942-1946) --------- 1108 Reported in 1946________________ 1048 Percemage decrease since 1945 ---------------------------- 5.4 Tuberculosis cases rose slightly in 1946 largely as the result of the x-ray examina(ion of greater numbers of individuals in combined YD.-Tuberculosis surveys which reached thousands of individuals who would not otherwise have been prompted to seek medical attention. The slow recession of tuberculosis is best indicated by comparing the median number of deaths in 1937-1941 (1533) with the median deaths for 1942-1946 shown above. Typhoid Fe,ver C(tses Median (1942-1946) __________ 177 Reported in 1946________________ 81 Percentage decrease since 1945 ---------------------------- 51.8 Deaths Median ( 1942-1946)__________ 23 Reported in 1946________________ 11 Percentage decrease since 1945 ---------------------------- 52.2 Typhoid fever, which has declined year by year since 1934 with the exception of 1938, fell to the lowest recorded levels in 1946. The decrease in cases over this period is clearly indicated by the relationship between the .five-year medians; the 1942-1946 median is equal to less than one-third of the 1937-1941 median. Deaths from typhoid fell sharply in 1946 after remaining nearly static for the previous four years. The fatality rate has changed linle in trend since 1938. Typhtts Fever Cases Median (1942-1946) __________ 1153 Reported in 1946________________ 606 Percemage decrease since 1945 ---------------------------- 45.5 Deaths Median ( 1942-1946) __________ 57 Reported in 1946________________ 33 Percentage decrease since 1945 ---------------------------- 44.1 The case total for typhus fever fell sharply in 1946. A slight reduction in cases had been noted in the four previous years during which control activities have been carried on, and the present drop in cases is therefore especially encouraging. Before (he control program began operation, typhus was slowly increasing in Georgia. The 1937-1941 median was 1017 cases, 136 cases less than the median shown above. Therefore, the apparent reverse in trend is in itself a hopeful sign. Cases and deaths fell at about the same rate in 1946 and the fatality rate shows litde change. Preventable Disectses 155 Undttlcmt Fe,ver Cctses Median (1942-1946)__________ 151 Reported in 1946________________ 169 Percentage increase since 1945 ---------------------------- 1L9 Dectths Median (1942-1946) ---------- 3 Reported in 1946________________ 3 Percentage change since 1945 --------------------------- 0 Undulant fever reswned its upward course in 1946, Despite minor fluctuations in case totals for the past ten years, it is obvious from the calculated trend line that a steady increase in this disease is transpiring, The death coral has remained abouc the same so that it is possible that greater attention to this disease may be responsible for a part of the apparent increase. Whichever interpretation is correct, there is no justification for confidence with regard to undulant fever. Tl7 hooping Cottgh Cases Median (1942-1946)__________ 921 Reported in 1946_______________ 615 Percentage decrease since 1945 ---------------------------- 33.2 Dectths Median (1942-19Li6)__________ 65 Reported in 1946________________ 60 Percentage decrease since 1945 ---------------------------- 7.7 The disappointing rise in whooping cough in 1945 did not repeat itself in 1946 and the case total is well below that of 1944, the previous all-time low. The downward reach of the calculated trend line is interrupted only by the statistical effect of the upsurge in 1943. Deaths remained at about the level reached in 1944 and 1945. The fatality rate continued to be approximately twice that of poliomyelitis and in excess of rhat produced by such frightening entities as typhus and scarlet fever. Gonorrhea, hookworm, measles, pneumonia, poliomyelitis, tuberculosis and undulant fever increased in number of cases in 1946. Diphtheria, dysentery, influenza, malaria, meningitis, pellagra, scarlet fever, small-pox, syphilis, typhoid fever, typhus fever and whooping cough decreased in number of cases in 1946. The number of deaths from measles, only, increased in 1946, and the deaths from diphtheria, dysenrery, gonorrhea, influenza, malaria, meningitis, pellagra, pneumonia, poliomyelitis, scarlet fever, smallpox, syphilis, tuberculosis, typhoid fever, typhus fever and whooping cough decreased in 1946. Deaths from hookworm and undulant fever remained L111changed. Other Tctbtt!cttions Following rhe morbidity, mortality and fatality tables will be found the reported incidence of notifiable diseases by months, the number of known cases by color, sex, and age, and rhe reported number of cases and case rates per 100,000 population of the major notifiable diseases by counties and cities of 5,000 populations and above. 156 Georgict Department of Pttblic Health TABLE I NUMBER OF CASES AND DEATHS FROM SPECIFIED NOTIFIABLE DISEASES REPORTED IN GEORGIA, 1937-1946 WITH RATES PER 100,000 POPULATION AND PER CENT FATALITY Diseases Diphtheria: Dysentery: Gonorrhea: Hookworm: Influenza: Case Rate Death Rate Per 100,000 Per 100,000 Fatality Rate Year Cases Population Deaths Population (Per Cent) 1937 917 29.8 108 1938 1232 39.7 106 1939 1112 35.3 95 1940 543 17.4 59 1941 758 24.1 63 1942 660 21.1 55 1943 520 16.6 47 1944 162 14.8 40 1945 695 22.2 71 1946 371 11.9 45 1937 715 23.2 130 1938 679 21.9 192 1939 585 18.6 127 1940 582 18.6 126 1941 516 16.4 109 1942 584 18.7 86 1943 459 14.7 79 194<1 304 9. 7 63 1945 313 10.0 60 1946 214 6. 9 36 1937 5549 180.4 24 1938 4686 151.2 21 1939 4583 145.7 24 1940 5282 169.1 22 19Jl 7229 229.8 21 1912 16786 537.4 6 1943 10028 321.0 12 1944 8557 273.9 8 1945 12340 395.0 5 1946 15282 489.2 2 1937 15891 516.6 2 1938 17711 571.4 2 1939 20384 647.9 1940 17306 554.0 1941 7H3 227.1 1942 4617 147.8 2 1943 3409 109.1 1 1944 3372 107.9 1915 3799 121.6 1946 4928 157.8 1937 14799 481.0 1436 1938 3782 122.0 802 1939 11592 368.5 950 1940 13420 429.6 924 1941 36021 1145.3 994 1942 2900 92.8 182 1943 13238 423.8 624 1944 8118 259.9 742 1945 3780 121.0 473 1946 2279 73.0 123 3.5 3.'! 3.0 1.9 2.0 1.8 1.5 1.3 2.3 1.4 4.2 6.2 !.1 1.0 3.5 2.8 2.5 2.0 2.0 1.2 0.8 0. 7 0.8 0. 7 0.8 0.2 0.4 0.3 0.2 0.1 0.1 0.1 0.3 0.03 0.1 0.03 11.8 8.6 8.5 10.9 8.3 8.3 9.0 8. 7 10.2 12.1 18.2 28.3 21.7 21.6 21.1 H.7 17.2 20.7 19.2 16.8 0.4 0.4 0.5 0.4 0.3 0.03 0.1 0.1 0.04 0.01 0.01 0.01 0.04 0.01 0.01 0.02 46.7 9. 7 25.9 21.2 30.4 8.2 29.6 6.9 31.6 2.8 15.'! 16.6 20.0 !. 7 23.8 9.1 15.1 12.5 13.5 B.6 Pre,ventctble Diseases 157 TABLE !-Continued NUMBER OF CASES AND DEATHS FROM SPECIFIED NOTIFIABLE DISEASES REPORTED IN GEORGIA, 1937-1946 WITH RATES PER 100,000 POPULATION AND PER CENT FATALITY Diseases Malaria: Measles: Meningitis: (Meningococcus) Pellagra: Pnr.:umonia: Year 1937 1038 1939 1040 19, 1 ILl 22,0 2 44.0 ... i 22 100.4 4.6 2 10.8 11 59,6 6 30,5 2 10.2 39 284.5 1 7.3 2 6,9 11 37.8 1 3.4 8 54.2 17.2 13 37.3 2.9 19 3 23.5 4 27.8 3 20.9 8.8 5 43.8 5 32.2 5 58.1 1 11.6 9 59.5 10 88.5 4 30.9 1 7. 7 12 59.7 11.4 2 22.8 11.3 7 79.2 11.3 6 29.9 5.0 20 168.9 3 23.2 3 36.0 8 79.3 2 19.8 .. i9 56.5 3 38.3 11.6 1 11.6 11 156.2 ii 1 24.5 12 37.7 2 32.1 i 16.1 11 69.0 2 12.5 16 119.1 2 28.8 9.2 5 '16.0 4 75.6 1 4.5 7 31.7 2 20.0 10 43.0 12.9 7 65.1 '1 '11.4 7.9 16 125.9 4 5.3 5 <14.9 68 90.1 5 6. 6 .. 28 8 '13.1 1 13.2 4 52.8 1 8.0 8 62.3 16 154.2 5 48.2 8 87.6 5 42.4 8.5 8 77.1 2 3.5 27 94.8 3 10.5 6 61.0 2 23.3 7 82.2 1 29.1 6 36.1 3.7 98 119.7 21 6 77.7 6 29.5 3 35.3 7.0 13 45.7 8 61.7 18.2 27.1 5,1 7.3 54.6 11.6 46.3 23.2 71.0 122.4 4.3 9.3 37.1 5.4 :i2:8 i9:3 25.7 7. 7 166 Geatgia Depctrtment of Pttblic Health TABLE III-Continued NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NoTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1946 Measles Meningococcus Meningitis Pneumonia Poliomyelitis Scarlet fever Area Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate SSutemwtaerrt......... ..... 4 37.7 27 110.2 Talbot .......... Taliaferro ..... Tattnall......... Taylor .......... 74.3 Telfair .......... rrerrell ......... rrhomas ....... Tift........... Toombs ...... 5.9 Towns ......... Treutlen ....... Troup......... 55 125.3 Turner . . . . . . . . . . . . . . . . . . Twiggs . . . . . . . . . . . . . . . . . . 21.9 Union .......... Upson ....... 10 39.9 Walker.................. Walton .............. 6 28.9 Ware ........... 3 10.7 Warren ....... Washington. Wayne......... Webster ......... 8 169.3 Wheeler . . . . . . . . . White.............. Whitfield . . . . . . . . . . . 10 38.3 Wilcox ......... Wilkes ............ 60 397.8 Wilkinson . . . . . . . . . Worth .................. ... Military Reservations..... 23 12.3 6.4 'l. 6 21.9 15.6 2 tRates based on enumerated cemus population of 1940. 7 66.0 13 53.1 5 61.4 12.3 3 47.8 5 30.8 2 12.3 5 46.4 1 9.3 4 26.4 1 6. 6 16 96.0 1 6.0 16 51.1 1 3.2 5 26.9 3 16.1 8 47.2 1 5.9 3 60.9 4 52.4 31 70.6 3 6.8 19 4 4:i:9 2 18.4 6 78.1 8 31.9 5 19.9 1 8 25.8 1 3.2 4 13 62.6 1 4.8 1 9 32.2 3 10.7 4 39.1 9 37.1 3 4 30.5 7.6 3 3 63.5 3 35.1 1 15.6 2 23.4 ...i 11 42.1 ... i 4 4 31.4 7.8 3 19.9 1 6.6 5 45.4 18 84.2 ... i '4:7 91 1 7 43.3 4.0 12.9 4.8 12.4 22.9 15.6 15.3 Pre-ventable Diseases 167 TABLE III-Continued NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1946 Area Syphilis Gases Rate Tuberculosis Cases Rate Typhoid Fever Cases Rate Typhus Fever Cases Rate Whooping Gough Cases Rate State TotaL , , , ......... RuraL ................. Cities 2500-5000 ......... Cities 5000 and Above .... Military Reservations 11,477 2,651 580 7,937 309 367.4 128.6 427.5 857,2 2534 81.1 927 45.0 103 75.9 1486 160.5 18 81 2.6 606 19.4 615 19.7 50 2.'1 421 20.4 306 14.8 5 3, 7 33 24.3 22 16.2 26 2.8 152 16.4 287 31.0 Appling ....... Atkinson ...... Bacon ......... Baker........... Baldwin . . . . . . . . . Banks.. "' ..... Barrow ....... Bartow........ Ben Hill ...... Berrien ..... .. Bibb........... Bleckley........ Brantley ...... Brooks........ Bryan .......... Bulloch ........ Burke . . . . . . . . . But.ts ......... Calhoun ......... Camden . . . . . . . . . Candler .......... Carroll........... Catoosa ............. Charlton ........... Chatham . . . . . . . . . . Chattahoochee .... Chattooga . . . . . . . . Cherokee . . . . . . . . . . rtarke ............ Clay............. Clayton ............ Clinch .. '" ......... Cobb .............. Coffee .............. Colquitt............. Columbia ........... Cook . . . . . . . . . . . . . . . . Coweta ............. Crawford......... Crisp ............ Dade ............... Dawson .......... Decatur . . . . . . DeKalb ............ Dodge ............. Dooly........... Dougherty ....... Douglas........... Early ............ Echols .......... Effingham ....... Elbert .. , .. , .... Emanuel. ...... Evans ...... Fannin ...... Fayette ..... Floyd........ Forsyth ...... Franklin...... ........... 12 82.8 1 13.6 75 457.0 1 11.5 15 114.8 3 11.9 3 20.7 380 453.6 10 103.6 76 370.g 9 143.1 76 292,2 270 1018.1 1 10,9 47 501.0 3 33,0 16 46.8 1 9.2 1 19.0 2,788 2363.3 7 136.2 4 19.9 218 767.7 1 14.2 3 25,7 130 339.7 101 468,9 77 233.2 1 10.6 6 50.3 3 11.1 1 H.O 160 912,2 1 17.0 2 4!.7 5 22.5 236 271.4 38 180.8 7 Jl.5 129 451.6 15.2 13 134:8 5 25.5 10 42.5 1 13.5 8 M.2 . i84 327.7 3 20,7 1 H.1 ! 49.4 3 40.8 18 109,7 1 11.5 1 7.7 18 71.2 6 41.3 5 32.5 101 120.5 2 20.7 2 29.1 8 39.0 6 95.4 12 !6.1 15 56.6 ! !3.6 6 64.0 4 67.7 5 54.9 16 46,8 8 73.4 i89 160.2 28 1i>i:i 9 44.7 21 73.9 6 5i:5 4 62.1 37 96,7 12 55.7 18 54,5 1 10,6 9 75.5 7 26.0 1 14.0 7 39.9 13 220.6 1 22,3 8 36.0 54 62.1 4 19.0 5 29.6 32 112.0 6 59.7 18 91.2 1 33.7 7 72,6 8 40.8 6 25.5 2 27.0 14 94.9 1 12.2 85 151.4 5 <14.2 6 38.'! 1.2 """i 3.8 5.9 3.4 5.4 5.0 3.5 2.6 2 6,1 2 7.4 1. 5.7 3.5 7.0 . 5:i 12.8 ... i 6.8 1 12.2 2 3.6 2 17.7 1 6.4 12 82.8 4 56.4 5 61.8 1 13.6 1 ii:5 1 7, 7 2 7. 9 7 48.2 8 52,0 9 10.7 6 62.1 2 29.1 5 24.4 2 31.8 10 38.4 4 15.1 3 32.0 1 16.9 3 33.0 7 20.5 21 17-8 ! 27.6 2 15,3 H 55.4 41 48.9 .. "8 30,8 32,0 5 14.6 7 64.2 1 19.0 1J 9.3 :ii:i 28.3 3 7.8 2! 111.4 20 60.6 1 10.6 8 67.1 I 3.7 51.3 1 5.0 28 98.6 .i3 34.0 3 13.9 1 10.6 2 16.8 1 3.7 2 ii:4 15 67.5 4 4.6 8 38.1 12 71.1 5 17.5 15.2 2 20.7 H 59.5 11 HS.6 1.8 i3:5 9.2 i 5.9 31 108.5 23 117.2 .. i7 1i5:2 9 16.0 1 8.8 168 Georgict Depctrtment of Pt~blic Hectlth TABLE III-Continued NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN GEORGIA BY CoUNTIEs, 1946 Syphilis Tuberculosis Typhoid Fever Typhus Fever Whooping Cough Area Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Fulton ....... Gilmer .................. Glascock ................ Glynn ........... Gordon .......... ::::::: Grady .................. Greene . . . . . . . . . . . . . . . . . . Gwinneoo .... : . .......... Habersham .............. Hall .................... Hancock ................ Haralson ................ Harris ............. Haro . . . . . . . . . . . . . . . . Heard ............. Henry ............. Houston ............ Irwin ................... Jackson ................. Jasper .................. Jeff Davis ............... Jefferson . ........ Jenkins .......... ,Johnson ............. ::. Jones ........ ........... Lamar .................. Lanier . . . . . . . . . . . . . . . . . . LLeaeu.re.n. s. .. .. . . . ........ . . . . Libert.y . . . . . . . . . . . . . . . . . Lincoln ............ Long . . . . . . . . . . . . . . . . . . . . Lowndes . . . . . . . . . . . . . . . . Lumpkin ................ Macon .................. Madison ................ Marion ................. McDuffie ................ Mcinoosh ............... Meriwether. ............. Miller . . . . . . . . . . . . . . . . . . . Mitchell ................. Monroe ................ lVIontgomery . . . . . . Morgan ........... Murray .......... Muscogee ......... Newton . . . . . . . . . . . Oconee . . . . . . . . . . . . . . . . . . Oglethorpe .............. Paulding ................ Peach ................... Pickens ................. Pierce ................... Pike .................... Polk .................... Pulaski. ................ Puonam ................. Quitman . . . . . . . . . . . . . . . . . Rabun .................. Randolph ............... Richmond ............... Rockdale ................ Schley .................. Screven . ................ Seminole ................ 2605 6R5.0 1 11.1 2 44.0 15 68.4 103 524.1 36 262.6 19 65.3 3 20.3 71 203.9 2 15.7 36. 3i5:o 4 25.8 1 11.6 16 t4i:li 29.9 ! 45.2 103 514.0 84 709.3 12 144:o 1 9.9 1 17.8 97 288.6 3 38.3 2! 279.2 3 42.6 2 48.9 8 25.1 .. 19 119.1 7 52.1 2 28.8 1 9.2 5 94.5 89 403.5 4 40.0 93 399.8 1 9.3 3 31.0 8 62.9 3 26.9 854 1131.2 3 16.1 8 105.6 10 80.5 66 636.0 2 21.9 3 25.4 1 9.6 25 87.8 26 264.5 1 11.7 24:1 212 259.0 1 12.9 2 39.7 154 756.6 8 94.2 123 107.7 5 55.5 1 22.0 20 91.2 3 16.3 7 35.6 3 21.9 8 27.5 3 20.3 18 51.7 8 62.7 9 62.6 5 43.8 1 11.6 8 52.9 5 <14.2 6 46.4 2 10.0 6 68A 2 22.6 11 54.9 7 59.1 1 7.7 2 24.0 8 79.3 1 17.8 19 56.5 2 25.5 5 58.2 3 73.4 17 53 A 2 32.1 5 31.4 2 H.9 4 57.5 5 46.0 2 37.8 10 45.3 2 20.0 9 38.7 9 83.7 1 10.3 4 31.5 4 35.9 480 635.8 8 43.1 1 13.2 2 16.1 5 39.0 11 106.0 4 43.8 2 16.9 ! 38.6 13 45.7 1 10.2 2 23.5 1 29.1 3 i8:i 115 140.5 3 38.8 1 19.9 8 39.3 3 35.3 1.5 4.6 3A 2 5.7 1 7.8 R.8 11.6 5.0 ... i 11.3 4 20.0 7i:O 9.2 2 9.1 .. 1 5.<1 8.0 .j 9.6 1 10.9 1i:7 11.8 33 SA 41.1 40.7 8.6 i3:9 6.4 3 26:5 8 61.8 1oi :S 5.0 8.! 7.7 3 29:7 5 88.8 9 26.8 3 38.3 2 23.3 2 48:9 13 40.8 3 48.2 3 18.8 57.5 18.9 2 20.0 7 30.1 1 9.3 1 10.3 1 7.9 """1 1.3 1 5.4 ! 38.5 8 87.6 10 84.7 2 7.0 4 40.7 10 60.2 10 12.2 1 12.9 11 218.6 10 49.1 7 82.4 39 9.0 17 77.6 6 43.8 5 17.2 1 6.8 ! 11.5 7.0 8.8 "j ii:il 44.2 26 129:7 2 16.9 11.6 6.3 7.4 9.2 1.3 7.9 .. i3 17:2 1 5.4 8.0 7.8 12 131.3 15 1<14.6 10 35.1 25 25<1.3 69 84.3 6 77.7 35.3 Preventctble Disectses 169 TABLE III-Continued NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN GEORGIA BY COUNTIES, 1946 Syphilis Tuberculosis Typhoid Fever Typhus Fever Whooping Cough Area Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Spalding ................ ~i:~~~~~::::::::::::: ... Sumter.......... Talbot .............. Taliaferro ............... Tattnall ................. Taylor .......... Telfair ............. Terrell ............. Thomas . . . . . . . Tift........... Toombs ....... Towns ........ Treutlen ....... Troup................... :ru~ner . . . . . . . . . . . . . . . . . . Tw1ggs . . . . . . . . . . Union ........... Upson .......... Walker . . . . . . . . . . Walton .......... Ware .............. Warren ............ Washington . . . . . . . . . Wayne ......... Webster ....... Wheeler . . . . . . . . . White ........... Whitfield ........ Wilcox .......... Wilkes . . . . . . . . . . . Wilkinson . . . . . . . . . . . . . Worth .................. Military Reservations..... 46 161.8 3 23.1 5 47.2 213 869.3 1 12.3 7 43.1 2 18.6 28 184.9 85 509.7 35 111.9 120 645.2 2 11.8 1 20.3 133 303.1 7 64.5 8 87.7 2 8.0 2 6.4 43 207.0 44 157.5 2 19.5 110 454.0 33 251.5 1 21.2 3 35.1 28 107:3 2 15.7 6 39.8 17 154.2 70 327.5 309 11 33.7 3.5 9 69.4 6 56.6 17 69.4 .. il 44.9 2 24.6 1 12.3 3 !7.8 5 30.8 4:i:i 1 9.3 6 39.6 3 19.8 6 36.0 2 12.0 20 63.9 2 6.4 18 57.5 13 69.9 3 16.1 19 102.2 10 59.0 1 5.9 ! 23.6 3 60.9 2 26.2 25 57.0 1 2.3 6 55.3 10 92.2 3 32.9 1 11.0 1 12 13.0 47.9 ... i 4:o 4.0 25 80.6 11 52.9 1 1.8 21 75.2 10 35.8 1 9.8 7 28.9 .. '2 .. '4 16.5 8 61.0 15.2 7 53.3 1 21.2 2 42.3 4 46.9 2 23.4 5 58.6 6 93.5 32 122.6 2 7.7 '"i 3.8 3 23.5 1 7.8 6 47.0 4 26.5 ! 36.3 1 .9:1 9 42.1 10 46.8 18 tRates are based on enumerated census population of 1940. 3.5 2 8.2 H 130.0 1 6.6 4 12.8 3 16.1 !8 109.4 io 247.4 6 23.9 1 3.2 7.6 3.8 7.8 ko 170 Georgia Dep?trtment of Pttblic Health TABLE IV NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN CITIES OF 5,000 1946 POPULATION AND ABOVE IN GEORGIA, Diphtheria Gonorrhea Influenza Malaria Area Population Cases Rate Cases Rate Cases Rate Cases Rate TOTAL .... Albany . . . . . Americus . . . . . Athens . . . . . . . . . . . . . . Atlanta (DeKalb) .... Atlanta (Fulton). Augusta . . . . . . . . Bainbridge ..... Brunswick . . . . Carrollton ...... Cartersville .... . Cedartown ..... College Park.... Columbus ..... Cordele ........ Dalton . . . . . . . . Decatur ...... Douglas . . . . . . . Dublin ........ East Point.... Elberton ..... Fitzgerald ..... Gainesville ... Griffin . . . . . . . Hapeville . . . . . I~aGrange ...... Macon ........ Marietta .... 'Milledgeville. Moultrie ....... Newnan ........ Rome ........ Savannah .... Statesboro.... Thomaston ... Thomasville .... Tifton ..... Toccoa... Valdosta . . . . . Waycross . . . . . 925,970 19,055 9,281 20,650 28,994 273,294 65,919 6,352 15,035 6,214 6,141 9,025 8,213 53,280 7,929 10,448 16,561 5,175 7,814 12,403 6,188 7,388 10,243 13,222 5,059 21,983 57,865 8,667 6,778 10,147 7,182 26,282 95,996 5,028 6,396 12,683 5,228 5,494 15,595 16,763 105 11.3 10872 1174.1 375 1968.0 198 2133.4 4 19.4 47 227.6 2 6.9 15 51.7 25 9.1 6477 2370.0 6 9.1 1261 1913.0 1 15.7 1 15.7 11 177.0 16.3 8 130.3 8 88.6 1 12.2 10 18.8 ... i 9.6 1 6.0 28 310.2 38 462.7 350 656.9 78 983.7 136 1301.7 -20 120.8 4 77.3 1 12.8 183 3536.2 88 1126.2 48 387.0 5 48.8 2 21.1 118 1152.0 2 15.1 1 4.5 8 13.8 4 !6.2 41 310.1 9 177.9 149 677.8 117 202.2 60 692.3 27 398.3 69.0 """i 3.8 2 2.1 15.6 115 1133.3 3 41.8 161 612.6 413 430.2 19 377.9 2 31.3 71.0 164 1293.1 40 765.1 24 436.8 12 76.9 34 202.8 978 105.6 17 89.2 44 474.1 3 14.5 2 6.9 363 132.8 81 122.9 5 78.7 8 53.2 76 842.1 25 46:9 5 63.1 4 38.3 160 966.1 2 38.6 5 64.0 2 16.1 1 16.2 29.3 30.3 21 95.5 2 3.5 8 92.3 1 14.8 29.6 2 7.6 105 109.4 4 79.6 1 15.6 39.4 109.2 2 12.8 8 47.7 19 2.1 1.8 2 ii:i 32.2 3.8 i2: 1 19.3 12.8 8.1 9:8 1.7 1.0 Pre-tentable Diseases 171 TABLE IV-Continued NUMBER OF CASES AND CASE RATE PER 100,000 POPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN CITIES OF 5,000 POPULATION AND ABOVE IN GEORGIA, 1946 Measles Meningococcus Meningitis Pneumonia Poliomyelitis Scarlet Fever Area Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate TOTAL ......... Albany . . . . . . . . . . Americus . . . . . . . . . . . . . . . . Athens . . . . . . . . . . . . . . . . . . Atlanta (DeKalb) ........ 2204 48. 25 32 2 238.0 251.9 269.4 155.0 6.9 Atlanta (Fulton) ... Augusta............. Bainbridge .......... Brunswick . . . . . . Carrollton ....... Cartersville . . . . . . 474 173.4 717 1087.7 10 157.4 25 166.3 3 48.3 30 488.5 Cedartown ...... College Park ........... Columbus ............... Cordele .............. Dalton . . . . . . . . . . . . . . . . . . Decatur . . . . . . . . . . . . . . . . . 111 1229.9 53 645.3 65 122.0 .. '3 28:7 72 434.8 Douglas . . . . . . . . . . . . . . . . . Dublin . . . . . . . . . . . . . East Point .......... Elberton ........ Fitzgerald .... Gainesville ...... 29 560.4 2 25.6 2 16.1 96 1551.4 29.3 Griffin . . . . . . . Hapeville . . . . . . . . . . LaGrange ........ Macon .......... Marietta ........ Milledgeville 7.6 9 40.9 57 98.5 68 784.6 Moultrie .......... 9.9 Newnan . . . . . . . . . . . . Rome ................... 12 45.7 Savannah . .............. 207 215.6 Statesboro . . . Thomaston. . ...... .. ...... . . .. . 16 318.2 8 125.1 '"rhomasville . ............ Tifton .................. Toccoa.................. Valdosta ................ Waycross . . . . . . . . . . . . . . . . 9 163.8 11 70.5 3 17.9 27 2.9 1 5.2 3.4 4 1.5 3 4.6 16.3 1.9 48:8 2 15.1 1 19.8 1 4.5 1 1.7 1 11.5 . i 13.9 1 3.8 2 2.1 7.9 723 78.1 12 63.0 5 53.9 7 33.9 9 31.0 60 6.5 318 1 .4:8 11 10.3 10 207 75.7 19 7.0 98 82 124.4 21 10 157.4 2 31.5 18 119.7 1 6.7 2 32.2 1 16.1 2 32.6 11 121.9 6 73.1 52 97.6 8 100.9 7 67.0 18 108.7 11.1 12.2 5.6 23 1 1 27 7 135.3 7 89.6 12 96.8 2 32.3 1 13.5 1 9.8 58.0 3 11 1 1 8 8 60.5 1 19.8 16 72.8 37 63.9 11 126.9 14 206.6 1 19.8 3 2 9.1 18 6 10.4 18 21 5 49.3 3 41.8 14 53.3 92 95.8 3 59.7 3 46.9 2 7:6 7 6 6.3 26 5 78.2 10 78.8 2 38.3 . "1 19.1 4 72.8 9 57.7 5 29.8 2 11.9 31.3 5.2 53.3 34.5 35.9 31.9 26.6 43.2 12.6 9.6 163.0 38.4 88.7 16.2 13.5 78.1 59.3 81.9 31.1 242.3 19.7 26.6 27.1 i5:6 6.4 172 Georgict Depctrtment of Pttblic Hectlth TABLE IV-Continued NUMBER OF CASES AND CASE RATE PER 100,000 PoPULATION OF SPECIFIED NOTIFIABLE DISEASES REPORTED IN CITIES .OF 5,000 POPULATION AND ABOVE IN GEORGIA, 1946 Syphilis Tuberculosis Typhoid Fever Typhus Fever Whooping Cough Area Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate TOTAL ................. 7937 857.2 1486 160.5 26 2.8 152 16.4 287 31.0 Albany .................. 118 619.3 30 157.<1 2 10.5 4 21.0 11 57.7 Americus. ............... 156 1680.9 Athens.................. 186 900.7 12 129.3 18 87.2 '"i ',1:8 6 64.6 6 29.1 1 10.8 28 135.6 Atlanta (DeKalb) ........ 4 13.8 13 44.8 1 3. 0.. t< 63 62.4 248 53.2 167 52.0 37 49.3 148 45.8 170 M.5 67 JlA 73 41.2 179 39.6 227 38.6 10 35.7 117 35.6 59 35.1 33 35.1 28 35.0 60 31.4 27 27.8 29 26.9 11 14.7 160 28.7 Totall945 ....... ... 4,859 1,943 10.0 Total1943 .......... 6,155 3, 950 6!.2 Total! 941 ......... 1,195 2,121 50.6 Colored, aU Co's Total1945 ......... 359 304 10.6 Total1943 287 19 17.0 Total1944 .......... 283 48 17.0 Total Submitted Le3s QNS-Percentages "z ' 0' 0 q0 ",(;.'; <> 1;;'2. 0 ":;!'; := 0 0 7"' 0 8'l 0 0 .".'; 6 q0 "' 0 0 "~ ' 0 .0 0 0 ,a. ""' <> ~ <>I! 0 0 0 0 0 0 ~ gj 49 71.2 5.8 9.6 11.5 19.2 38.5 1.9 87 36.0 10.6 17.0 13.7 9.5 8. 7 5.0 28 28.3 8.5 20.1 10.6 8.2 6.5 3.1 12 31.7 0.5 17.5 7.9 1.8 12.7 6.3 46 31.0 9.0 13.4 14.1 8.3 6.9 1.8 26 20.2 11.5 16.0 12.1 4.8 2.8 0.6 g 15.7 12.4 15.7 9.8 5.2 0.7 0 27 29.3 4.0 15.3 6.0 7.3 9.3 6. 7 64 23.7 7.5 13.4 10.1 5.4 5.4 2.8 68 19.6 8.5 15.6 10.6 1.8 3.1 1.2 10 18.6 9.8 10.8 10.8 2.9 4.9 0 54 18.9 7.3 6.4 8.0 2.9 4. 7 3.3 42 19.0 9.5 18.3 8.7 J.O 5.6 0. 8 10 15.5 7.1 16.7 8.3 2A 3.6 1.2 3 H.3 7.8 19.5 5.2 1.3 6.5 1.3 21 17.1 6.5 11.8 5.3 5.3 4.1 2.4 14 13.3 1 4.7 6.0 13.3 6.5 15. g 1.8 3.7 4.8 0 2.4 0 o1..o2 3 6.9 4.2 4.2 1.4 !A !A 2.8 96 13.2 8.4 12.8 7.1 1.7 2.8 1.5 670 22.2 8.5 15.2 9.5 5.2 5.2 2.2 36.0 26.3 2.5 3.4 1.5 2.0 0.6 0 5.0 3.0 Preventable Diseases 177 In 1945, the hookworm activities of the Service were largely carried on by one .field nurse and even the limited success obtained is rherefore remarkable. Also, a shortage of tetrachlorethylene made ir impossible to treat all positives found, and selective, limited treatment had ro be resorted to. During 1946, the personnel of the division was augmented and work on a wider scale was again begun. This fact is reflected in the number of specimens examined. However, activity again increased most in areas where previous work had been done and no great percentage increase in positives found is to be noted. More positives were located and many more treared since tetrachlorethylene is now readily available. The basic plan of hookworm activities underwent some modification in 1946. No great effort to encourage selective school surveys was made except in health officer counties or counties with experienced nurses. In counties with new nurses, ir was found more satisfactory to permit limited general surveys and to encourage the examination of all clinic patients and the for\Varding of specimens on a routine basis by the nurse and by practicing physicians. It was urged that nurses not attempt to .find more cases than they could treat and follow up. At the year's end, several good community surveys were being organized under the aegis of the local Farm Bureau organizations. These surveys were planned to emphasize the sanitation aspects of the hookworm program and communities accepting such a program, which entails considerable work on the part of biological, engineering, sanitation, nursing and laboratory persunnel involved, were required ro undertake an organized program of privy building and sanitation improvemem. It has been pointed our that these preventive activities are essential if a real reduction in hookworm over a period of time is to be gained. A new mailing container for hookworm specimens has been developed and is being given a trial. If successful in practice, this new container will further reduce the collection of specimens at schools and will obviate some of the serious defects in the school program. The emphasis of the present program is therefore being laid not on rhe finding of clinically damaging infestation in the individual, but on reduction of hookworm incidence by intensive sanitation and treatment programs. Provision has been made, however, for easy handling of selective survey in schools where these surveys can be successfully followed through. The .field nurses' activities continue largely unchanged with the exception that a wider l::ase for selection of examinees has been established and egg counting is not used as a basis for the initial decision to treat. The Stoll count method is no longer routinely applied to all positive specimens but is reserved for special programs in which knowledge of the ltvel of infection is essential, or for cases in which an egg count is of use to the physician in deciding on the treatment, or further treatment, of an individual. This reduces the burden on the laboratories and makes possible the examination and treatment of a greater number of individuals. A new and simpler egg counting method is under study, however, and rhe complete abandonment of quantitative methods is not contemplated. 178 Georgict Depctrtment of Pttblic Hectlth Further studies are being made on the success of treatment and the effect of low grade infesrations. Mctlctrict Control Recem developmems in mosquiro and malaria comrol, including the Malaria Control in War Areas DDT house spraying program, led the biological section of the Epidemiologic Service to consider the possibility that control of anopheline mosquitoes could best be achieved by an inclusive program of DDT spraying of all good rescing places for anophelines in an area either with or without concomitam house spraying. Since the house spraying technique is designed to reduce the possibility that an anopheline mosquito which bites a human malaria carrier will survive through the requisite incubation period and transmit malaria to another person, and the outside resting place spraying plan is designed to reduce the over-all mosquito population, the two methods are not mutually exclusive, but in areas .in which anophelines are abundant and human carriers exist might properly be considered complememary to each other. The outside resting place spraying program is then more nearly a substitute for a general larviciding program. Complete success, i.e., total destruction of the anopheline population, would of course obviate the necessity for ather control devices. Since this is a very remote possibility at the moment, the question at hand can best be stated as follows: Is a program of spraying of natural anopheline resting places, i.e., bridges, culverts, privies, animal shelters, house porches, eaves, doors, windows, the undersides of houses, hollow trees, etc., as effective in reducing adult and larval populations as a fully developed pond larviciding program, and what is the comparative cost of the two programs. Doztgherty ctnd Worth Cottnties Project Accordingly, an experimental area was chosen in Dougherty and W orrh Coumies in which the cost in labor and materials of a Paris Green larviciding program was well known. All such larviciding was dispensed with, and entire dependence placed on 5% DDT emulsion spraying of resting places and house exteriors in a sixteen ( 16) square mile area in Worth and Dougherty Counties near Acree, Ga. This area was formerly very malarious ~.nd good data on year-to-year variations in anopheline populations exists. To the surprise of the cooperating county health departments and the biologist in charge of the experimental work, only two hundred forty-seven ( 247) gallons of DDT concentrate were needed to cover the area. Fifty (50) man hours of labor sufficed for the entire operation despite equipment difficulties which .could easily be avoided in a larger scale program and the total costs of the operation, including labor, materials and operation of equipment, entailed an e:x;penditure of approximately two hundred and four dollars ( $204.00). The cost of larviciding these ponds during an average breeding season would approach one thousand dollars ($1,000.00) if the larvicide were Paris Green, and three hundred and fifty dollars ( $350.00) if the larvicide were DDT. The expenditure required for spraying the occupied dwellings within the community would amount to approximately three hundred and seventy-five dollars ( $375.00). These estimates were supplied Pre-ventable Diseases 179 by the Sanitary Engineer of Dougheny Coumy who cooperated in the program, The biological results of the program are shown in the cable which folhws: Summary of Mosquito Collecrion Dam Dougherty-Worth County Project Adults Auophelims per Search Meau No, .Anopheline Larvae per Sweep Before Spraying Experimemal Area__________________ 12-89 Check Area______________________________ Areas Combined______________________ 0.476 0.721 0.514 After Spraying Experimental Area__________________ *2-37 Check Area______________________________ Areas Combined___ ------------------ ________ 0.912 8.343 2.584 Mediau No. A11opheline La>'Vae Per S11!eep 0.512 0.967 0.513 1.020 6.829 1.254 *Several artificial, unsprayed shelters were purposely added after the area was sprayed. Only one Anopheles adult was found in a sprayed shelter. From these data, there would appear to have been a considerable reduction in adulr anophelines in the experimental area after spraying. Oi:her areas under study during the period of the experiment did not show any tendency wward a concomitant natural reducdon in population. Also, it will be noted thar the mean number of larval anophelines found in the sprayed experimental area increased 91.6% after spraying, while the increase in the unsprayed check area was ten times as great. Further staristical analysis shows that the difference between the mean values obtained from the experimental and check areas before spraying is nor significant, i.e., that the apparent slight difference which existed in the beginning between the two areas is probably due to chance variation in samples. On the mher hand, the difference between the check and experimental means afrer spraying is statisdcally signilicam and the probability that chance alone is responsible for the large difference which developed after the use of DDT is less than one in one hundred. While this does not emirely exclude the possibility that chance selection . of samples produced the great apparent difference, and while it must be gramed that other unknown factors could have influenced the result, it is certainly permissible to conclude that the most probable cause was the DDT treatment. This interpretation is rendered even more plausible by the fact that the statistical methods used were conservadve and make considerable allowance for the relative smallness of the sample. Catldon in the imerpretarion of the results is considered necessary and proper, and the experiment 180 Georgia Department of Pttblic Health will be repeated on a larger scale, but publication of the results to date is considered both advisable and justifiable. Fly and iVlosqttito Control lnvestigcttion A third entomological project was carried on by the Muscogee County Health Department and biologists of the Epidemiologic Service. In the city of Columbus, an attempt was made to determine the value of the spraying of houses and outbuildings as a control measure for all domestic mosquitoes and other domestic insects. Particular attention was devoted to anopheline control, control of Aedes egypme, the vector of yellow and dengue fevers, and to house fly control. The city of Phenix City, Alabama, across the river from Columbus was used for check purposes. Adult collections of house mosquitoes were made routinely, and fly traps, lighting frams, and fly paper strips were used to study the variarions in fly populations between the two cities. No complete report of the project has been written since the biologist in charge is now teaching at the University of Delaware and the project was Oiganized late in the summer of 1946 and is to be continued during the summer of 1947. However, work reports filed routinely provide an indication of the general results to date. A material effect on both fly and mosquito populations was noted and incomplete data indicate a possible reduction in dysentery rates, especially among children, in Columbus. Phenix City, on the other hand, experienced no diminution of noxious insect populations and no noticeable change in dysenteric complaints. The project is therefore to be continued until enough data can be assembled to make the results significant. The Magnolia Springs area of Jenkins County continues to be used as ar- index of Anopheles quaclrimaculatus populations in the southeastern section of the state. For the fifth successive year, the population of A. quadrimaculatus showed an appreciable decrease and is now approximately one tenth of what it was in 1940. Tick Cantral The occurrence of seven cases of Rocky Mountain spotted fever during 1945 within one small area in DeKalb County caused considerable interest to develop in the possibility of controlling ticks with DDT dust. The area in question included approximately one hundred seventy acres and was, during 1945 and early 1946, about one-half built up. Interspersed between fully developed streets and additional scattered homes, there were numerous stretches of second-growth woodland, old fields and pastures. These unimproved areas were traversed by numerous paths and unmaintainecl roads 'which were used as short cuts from street to street by the human population in some measure and by the clog population, which was large, as a matter of routine. Since the clogs provide an excellent host for the so-called wood tick or dog tick, Dermacentor variabilis, conditions were ideal for the development Pre-ventctble Diseases 181 o a large tick population, and, after the ticks became infected, for the propagation of Rocky Mountain spotted fever, The DeKalb County Health Department had already carried on a program of immunization against Rocky Mountain spotted fever and the people of the region were well acquainted with the dangers of the disease and its mode of transmission, Therefore, it was relatively easy to secure permission to dust a portion of the area with 10% DDT in Pyrophyllite during the period of nck acrivity and to secure cooperation in searching domestic animals for ticks, The portion of the area which remained unclustecl was used as a check for comparison with the treated area and the same collection and evaluation techniques were followed carefully in the two sections, These methods consisted principally of dragging paths and roadways wirh a flannel drag which was inspected every 200 ft,, and weekly examination of all clogs and cats resident in the area, The data derived from these investigations are summarized in the table which follows: Sttmmctry of Tick Collection Dttttt Before Dusting Mean No, of Ticks per Infected Dog or Car Check Area Experimental Area --------------------~--- Aclulr Ticks by Dragging Check Area 21 Experimental Area 98 -----------------------~"-- Mean No, of Ticks Tick Numphs and larvae per Infested Rat Check Area 0,00 Experimental Area 2DO .11tter Dusting L92 L35 5 5 5,35 2-32 Ticks Collected from H1.unans Check Area 1 7 Experimental Area 1 0 It will be noted from the figures above that the experimental area was considerably more productive of ticks than the check area in the period before dusting, and that after dusting, the situation was apparently reversed, Perhaps the most important and significant effect is indicated by the figures on collections from infested rats, These imply that the trend in numphal and larval activities, i,e., the developing tick population of the next year was materially affected by DDT dusting, The largest body of data is derived from clog and cat examinations. Since these animals roamed both areas, although they naturally spem more time near home, it is surprising that a marked difference between the areas is 182 Ge01gict Department of Pttblic Health found before dusting in this caregory of collections. It is equally surprising that after dusting, this marked difference disappeared completely and rhe .check area became slightly more productive of ticks. It can only be supposed rhar considerable destruction of ticks had occurred in the experimental area. It is also reasonable to assume that all dogs entering the dusted area at any time picked up a small amount of DDT dust and :So in some measure extended the effect of the treatment to the check area. The original difference has statistical significance while the difference after .dusting is not significant, the implication being that some factor, presumably .the DDT dust, intervened to produce a leveling of the rwo populations before .the cessation of seasonal activity would normally have produced such an effect. However, the sample is coo small to justify the assumption that the apparent statistical significance of the difference is adequate evidence of the value of the program. The most credible indication that some success was :attained lies in rhe fact thar all categories of data point in the same direction, i.e., they indicate an unequal rate of reduction in the two areas as the season _progressed and the tick populations subsided into normal winter inactiviry. The techniques of collection and evaluation employed were themselves -control methods. All ticks and rats caught were removed from the area instead of being again released as has been the practice in other tick projects. This destruction of ticks and rars was decided upon because rhe area is a focus for Rocky Mountain spotted fever and public health considerations forbade any .experimental procedure, however scientifically sound it might be, which would in any way jeopardize rhe health of the people resident in the area. The results lose in conclusiveness by such a procedure, but it is believed that the data are adequate enough to show thar the method has promise and to justify continued study of the DeKalb area and treatment on an experimental basis of larger, semi-urban areas where Rocky Mc,untain spotted fever 'has become established. Finally, it is believed from the above evidence and on the basis of results Obtained by Smith, Cole and Gouck in Massachusetts that marerial reduction ln year-co-year popularions of Dermacentor variabilis can be effected in semiurban areas by assiduous collection and destruction of adult ticks engorging on dogs. Dusting dogs with DDT powder and/or dipping twice weekly in :standard derris dip (2 onces of derris and 1 ounce of neutral soap to 1 gallon -of water) as practiced by Smirh and associates in Massachusetts will destroy ticks before the females can engorge and lay eggs. When such a program is combined with DDT dusting or spraying of all vegetation along paths .and roadsides and around residences, there is reason to suppose rhar both rhe current danger from an existing adult population and the area potemial for Rocky Mountain spotted fever can be reduced. The following table will show a summary of activities by counties in con_necdon with epidemiological and entomological services. SUMMARY OF ACTIVITIES BY COUNTIES Educational and Promotional EPIDEMIOLOGICAL SERVICES Hookworm Treat. Containers COUNTY Phy. Mtgs. Addrs. Exhibits Confs' Exams. Hgb. Home Malaria Spleen Soil Altd. Made or Ins. Anthel- Persons Visits Smears Palp. Dis!. Coli. Samp. _ _ _ _ _ ,_ _ _ ,_ _ _ ,_ _ _ ,_ _ _ , _ _ _ ,_ _ _ _ _ _ mintic , _ _ _ Treated , Iron ,_ _ _,_ _ _,_ _ _,_ _ _ ,_ _ _ ,_ __ Appling ........ . Atkinson ......... . Bacon ........... . Baker........... . Berrien ........... . Bleckley......... .. Bibb............. . Brantley ........ .. Brooks.......... .. Bryan............ . Bulloch .......... . Burke............ . Candler .......... . Charlton ......... . Chatham...... . Clarke ........... . Coffee . . . . . . . . . . . . 1 Clinch ........... . Cobb ............ . Colquitt.......... . Cook ........... .. Crisp ............ . Dawson .......... . Decatur.......... . DeKalb ........ .. Dougherty ....... . Echoill ........... . Effingham ........ . 22 45 28 1 1 3 3 2 38 2 2 11 8 1 7 21 13 11 6 '3 .. 2 74 1 1 23 93 86 llm1 I ....s.. I ..u.1 u 1 -~ I 15 .J ..... 6 .. u .......... u7 1 6 1 3 ..... ..... ..... ....... ........ ..... . . . 400 344 61 ~ ~ ~ ;;;:- ~ 50 50 ~ 250 ~ 140 78 "~ ' ~ ...... 00 \,.)J SUMMARY OF ACTIVITIES BY COUNTIES-Continued Educational and Promotional EPIDEMIOLOGICAL SERVICES COUNTY Mtgs. Attd. Addrs. Exhibits Conts. Made -----1------------ Emanuel ..... . 13 Evans ...... . 2 Floyd...... . I Fulton ..... . 148 Grady ...... . 10 Jefferson. . . . 3 Jenkins ..... . 17 Johnson ... . 1 Lanier ... . 5 Laurens.... . 5 Liberty ..... . 11 Long.......... . 7 Lowndes ..... . 6 Mitchell ....... . 1 Montgomery...... . 2 Muscogee ........ . 37 Newton ........ . 1 Pulaski .......... . 1 Phenix City, Ala... . 3 Randolph .. . 4 Richmond.. . 1 Rockdale... . 6 Screven ... . 1 Telfair .. . 6 Terrell ..... . 1 Thomas..... . 13 Toombs .... . 3 \Vare ......... . 90 Washington .... . 2 Wayne... . 17 Wilcox ........ . 6 \Vorth .......... . 5 TOTAL .. 12 810 Hookworm Treat. Phy. Exams. Hgb. Home Malaria Spleen or Ins. Anthel- Persons Visits Smears Palp. mintic Treated Iron 312 I. . . . . . . I. .I I. I. .. .. .. I. .. .. . 0 I. ~I u .I.. .. 2 I : ::: 11 . ~ . . . . . . . .. . . . ......... . . 21 I. 1 11 ~0 ........ 125 265 36 . 1 . I ..1.. 32 -~i .. :........ : : ... 1 I 14 I. 295 1 359 416 790 282 17 168 1,494 Containers Dist. Coli. ~ 12 916 ~ 1~ 400 25 2,532 423 ,...., 00 ""' Soil Sam11. c;] "~" ()<) ~- tJ ""~""" ~ ;";;": -"c ' . "': ":":''r; ~ ~ SUMMARY OF ACTIVITIES BY COUNTIES-Continued ENTOMOLOGICAL SERVICES II SANITARIAN SERVICES SiJeCies Found Species Found COUNTY I Ponds Ponds Anon h. Adult Anoph. Sanitary Light Map lnves. Dimwd Neg. Searches Neg. AQ. Ac. AIJ. Others Q. c. Surveys P. Others Premises Traps Run Hours --- --- --- - - --- --- ---- ---- --- --- --- - - --- ---- --- Baker ... 2 1 ... Ben Hill ... :::: Brooks .. .... ,. 3 .3. 1 1 3 3 1 1 2 16 10 5 5 5 Bulloch .. 6 4 1 3 3 . .... 69 64 1 5 Burke .... ::::::::. 3 2 1 2 5 3 1 1 Calhoun .. ....... 1 1 Crisp 157 115 33 52 1 56 i7 2 2 355 173 138 93 20 DeKalb.:::: ... :: ::: Dooly ...... 25 12 3 9 7 3 88 25 69 32 28 Dougherty... ..... 490 314 102 110 202 13 503 233 208 1% 36 . . . . . . . . . ... 6 108 1 48 168 4 5 :p
  • w ""..''. 40 rn ::> ,.:1: 30 0.. 1- a:: "'Ill ;:!: :z:> 10 0 eo 70 >"' 60 E rn ~ UNDUSTED BUILDINGS 0z rt::> 40 rn ~ .a.:.: 30 0 ""<'t' 20 1z - "0a:': 10 "'0.. 0 \...., ........... JAN. FEB. ldAR. APR. MAY. JUNE JULY AUG. SEPT. OCT. NOV. DEC. CHART 2. PERCENTAGE OF RATS FOUND POSITIVE TO MURINE TYPHUS FEVER IN DDT DUSTED AND UNDUSTED BUILDINGS IN 24 COUNTIES. GRAPH No. 2 206 Georgia Department of Pttblic Health MURINE TYPHUS FEVER CONTROL STATE OF GEORGIA TYPHUS FC:VER ~ATES REPORTED BY MONTHS IN THE FOLLOWING 2/COUNTIES PARTICIPATING IN DOT OUST.. lNG ANORATERRAOIOATION DURING 194G CASE RATES BASED ON 100,000 POPULATION II APPLING fULTON BIBB GLYNN BULLOCH JENKINS BURKE LAURENS CHATHAM RICH MONO 10 COFFEE COLO\JITT SCREVEN TELFAIR CRISP TE~RELL OEKALB TIFT DOUGHERTY TOOMBS WORTH 9 8 ,to_uo_oz 7 twuooo 5 o"-o0o ::>- J:o: [":-aw. 3 2 PERIOD OF ORGANIZING COUNTY OOT OUSTING PROGRAMS 1945 SEPTEMBER THROUGHOECEMBER I' I RATES REPORTED-> 1945 I I ./ // // / / ', \ \ \ \ I I \ I I I \ \ -... .................. 0 JAN. FEB. MAR. APR. MAY JUNE JULY AUG. SEPT. OCT. NOV. DEC. GRAPH No. 3 100 eo u ~ 60 ow r 0 !:: 40 w (!) 20 <1: 1z - w o0 r w 0.. -20 Pre-ventable Diseases 207 MURINE TYPHUS FEVER CONTROL. STATE OF GEORGIA COMPARISON OF PERCENTAGE VARIATION,9'f MONTHS,IN REPORTED MURINE TYPHUS FEVER CASE RATES PER IOO,OOOPOPULATION FOr\ 1946 AS COMPARED WITH 19"-5 B'f THE FOLLOWING CUUNTV GROUP CURVES. - STATE-WIDE TOTAL-INCLUDES 159 COUNTIES - 75 COUNTIES WITH NO COMTROL PROGRAM - - - 21 COUNTIE:S WITH FULL-TIME CONTROL PROGRAMS DURING 1946 NOTE-63 COUNTIE.:S OF TOTAL 159 NOT INCLUDED DUE TO PARTIALLV CONDUCTED CONTROL PROGRAMS DURING 1945- 194 6 w -40 --' l'-..l SYPHILIS CASES REPORTED TO VENEREAL DISEASE CONTROL SERVICE By Privare Physician UNDER PROGRAM FOR DISTRIBUTION OF FREE ANTISYPHILITIC DRUGS January- December, 1946 -- January . . . February . . . Mareh ................ April. ........ .... May........ June ....... ... July ....... ... .. August ........ .. Sel)tember ... .. October .... ........... NEW CASES (Never nre\ icusly treated) White Colored --- TOTAL OLD CASES !Previously !reate~) White Colored I TOTAL M F. --- - -M - - - F - - - - - - M - - - -F - - -M - F 3 6 31 32 72 2 1 16 12 31 6 2 12 33 53 6 6 7 18 37 4 11 21 17 53 2 2 12 22 38 12 11 110 74 207 14 g 59 69 151 12 11 72 86 181 4 4 13 22 43 16 23 84 141 2M 2 9 33 57 101 14 16 63 146 239 2 8 22 29 61 5 4 24 52 85 2 2 11 13 28 10 11 69 98 188 5 8 19 18 50 6 6 58 114 184 4 4 11 39 58 TOTAL REPORTED c:;) White "' -- ----- C> Colored TOTAL ~"' - M - - - F-. - M - - - -F - tJ ~ 5 7 47 44 103 ~ 12 8 19 51 90 "~ ' 6 13 33 39 91 "' 26 20 169 143 16 15 85 108 358 224 ~ ;p <:s-- 18 32 117 198 365 ~ I 16 24 85 175 7 6 35 65 15 19 88 116 303 ::c 113 238 "~' 10 10 69 153 242 November.. 8 4 15 30 57 5 3 12 9 29 13 7 27 39 86 December ..... ...... 9 - -10- - -14- - -12- - - -45 - - -1- - -4- - -3- - -10- - -1-8 - - -10- - -14- - -17- 22 63 TOTAL .. 105 115 573 835 1628 49 GO 218 318 645 154 175 791 1153 2273 -- - - - -- - - TABLE II SUMMARY REPORT OF CLINIC ACTIVITIES Syphilis January- December, 1946 January ... .... February . . . . . . . . . . . . . . . . . . . . . MarciL ....... April. ............ May.............. June ......................... July ...... .. . . . . . . . . . . . . August. .................... September . . . . . . . . . . . . . . . . . . . . October ......... November . . December ..................... TOTAL ......... NEW CASES OF SYPHILIS ADMITTED TO CLINIC White Colored M F M --- 32 33 319 108 72 914 68 65 638 46 60 42.5 32 39 320 56 so 445 57 51 417 62 54 357 55 68 429 56 54 489 32 48 252 60 54 363 664 678 5,368 F 456 1,078 920 600 651 701 596 537 6M 748 382 488 7, 764 OLD CASES OF SYPHILIS DOSES ADMITTED TO CLINIC ADMINISTERED Total Ad- Total Under missions Rx During White Colored Month Arsenicals Heavy ------ ------ Metals :p -M- - - F - - - -M - F 70 49 615 690 93 69 717 808 2,264 3,859 5,685 5,342 "" - - -
  • """CiQ :";,'. Unk Total Unk Total Unk Total tJ """ January . . . . . . . . . . . . . . . . . . . . . . -M- -F- -M- F -- - - - - - - 233 155 551 331 ........ 1,270 -M- 49 -F- 22 M -67 -F23 -. .-.. - - -161 M -- F -- -M- -F- - - - - - - 282 177 618 354 1,431 "1::):;,. ~ February . . . . . . . . . . . . . . . . . . 146 103 388 244 ........ 881 """' March ..... .... ............... 155 108 517 267 ........ 1,047 ..._ April. .... ......... 163 113 576 301 ........ 1,153 13 10 40 14 . ... 23 11 28 15 . ... 14 9 22 12 ..... 77 159 113 428 258 958 ~ 77 178 119 545 282 . ....... 1,124 <:> 57 177 122 598 313 1,210 May . . . . . . . . . . . . . . ...... 189 119 735 365 ........ 1,408 20 3 16 4 . ..... 'l::i 43 209 122 751 369 1,451 ~ <::;-.< June . . . . .... ...... 216 123 730 459 ........ 1,528 24 5 36 10 75 240 128 766 469 1,603 ~ <-. July ..... .................. 226 99 794 394 99 1,612 1 2 9 1 13 227 101 803 395 ::c 99 1,625 August..... ............ 171 September........................ 142 66 738 342 72 590 233 477 1,794 ...... ...... ...... . .... 612 1,649 ...... ...... ....... .. 171 66 738 342 . ....... 142 72 590 233 "" 477 1,794 :;,. ~ 612 1,649 ~ October ..... ........ 132 52 474 316 555 1,529 9 4 11 5 3 32 141 56 485 321 558 1,561 November ... 133 71 442 298 828 1.772 7 5 8 1 21 140 76 450 299 828 1,793 December .... - - - - - 84 - - 4-8 248 -14-0 - -35-8 - -87-8 - 4 - - -2 - -3 - -1 - - - - -1-0 88 -- 50 -25-1 -14-1 - -35-8 - -88-8 TOTAL ............. . . . . . . . . . . . . 1,990 1,129 6, 783 3,690 2,929 16,521 164 73 240 86 3 566 2,154 1,202 7,023 3, 776 2,932 17' 087 TABLE IV TOTAL VENEREAL DISEASE CASES REPORTED TO THE VENEREAL DISEASE CONTROL SERVICE January- December, 1946 BY PRIVATE PHYSICIANS BY CLINICS, HOSPITALS OR OTHER INSTITUTIONS TOTAL BY ALL SOURCES White Colorerl White Colored ----1------,--- - - - - Unk M F MI F MIF MIF White M F Colored M IF ~ Unk Total <\> "~" ------------ ------------ --- -------------------- ~ SYPHILIS Pri. & See.................. 81 97 319 Early Latent. ............... 1 22 45 Late & Late Latent........... 23 1R 222 Con~enital. ................. Prenatal.. ................... .... 3 2 ..... i39 .. 6 TOTAL ....................... 108 592 552 246 10 164 220 242 6 12 7R8 . ... 664. 166 1,007 916 ....... 220 1,322 2,592 262 30 2, 755 284 3,955 301 .................. ....... 678 5,368 7. 764 .......... ~ 327 165 265 15 772. 263 242 1,326 1.367 1,468 2,602 3,384 2,376 280 2,977 4,175 .......... 7,697 32 .8i7 290 5,960 307 8;552" .......... 644 16,101 ~ t;i ~<\> ~ '-; ~ GONOCOCCUS INFECTION Genito~urinary............... 0 pthalmia Neo. . . . . . . . . . . . . . . Not Stated .................. TOTAL . . . . . . . . . . . . . . . . . . . . . . ...... . ... 81 81 ...... 46 46 l. i29 1 6;7831. 1 112:on I ....... .. .... . ....... 452 .i28 .. L99o i; 452 128 1,990 1,129 6,783 3;69o 3,690 2;929 2,929 1 1,175 I 7,235 3.818 I 2,g2g 2,071 1,175 7,235 13,818 2,929 17,228 17,228 OTHER VENEREAL DISEASE Chancroid................... 1 ....... 1 ........ 161 21 Granuloma Ing.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... Lvmphogranuloma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ........ TOTAL..................... 1 ........ 1 ........ 18 2 253941 36 329 87521 8 165 234 1 2 II . 31 30 295 19:1 . . .. "2"1 I ~~ I 235 59 36 330 165 234 31 30 295 570 165 76 811 l'-.l I-' V1 J'anuary ... February .. Marr.h .... April.. May ... June . July ... Au~ust .. September... . October .. . November .... December. TOTAL ... TOTAL NO. OF DOSES .. [,..) t-' 0\ TABLE V FREE ANTISYPHILITIC DRUGS DISTRIBUTED Venereal Disease Conrrol Service January- December, 1946 Cl NEOARSPHENAMINE II ARSENOXIDE - -.3 - - -.45- - -.6- - - -. 75- - .9 - - - 3.0 -- - -4-.5 - - 6.0 -- - 10.8 -- - - .-045- - .067 -- - .45 -- - .67 -- - 195 255 3,115 ..... 50 -90 430 115 55 635 3,205 25 1,570 ""<:::> "'ere, "~" .."t.",J. 270 340 2,485 60 120 ..... 275 .......... 1,515 3,950 60 1,410 ;~;;. 80 650 2,840 100 90 ....... 380 420 . ....... 1,210 2,805 360 1, 650 ;:l 30 195 4,040 ...... 145 ....... 85 .580 . ......... 280 3,035 30 "",. 665 ;:l 240 720 2,530 ...... 85 ...... 70 20 ...... 770 3,815 30 1,690 <:::> '--;.. 120 -5 180 GO 320 1,030 185 420 165 920 2,185 900 3, 785 2,590 3,550 . ....... ..... ....... ...... 40 150 -60 -90 ..... . ...... 150 ....... 160 85 . ...... . .. .. ... ....... . ......... ......... ...... .. .... .... ... 1,025 730 900 400 740 4,650 6,690 4,190 5,030 4,700 50 60 . ...... 610 1,570 1,040 890 '";:j "'-<:.:,.-. ""::""c 1,190 510 ""~ ;~ ::;.. 200 650 1,895 ...... .......... 660 3,860 10 1,315 - -300- - -3-60- - 1-, 775- ...... -- - ..... -- . .. - - -- ----. ....... -- - - . ..... -- - -220- 3,350 --- - - 20 -- 385 ---- I I I-uoI I .I5.163[14.1o0I 1 1,990 ,990 5 5,890 ,890 ~ 31,690 140 975 -30 -975 ---=150 875 I 1,410 55 -990 9,0~5 9,085 49,280 49' 280 1,255 12,550 13,885 138,850 ~------~------- TABLE VI FREE ANTISYPHILITIC DRUGS DISTRIBUTED Venereal Disease Control Service January- December, 1946 January .. February. March .. April. May. June. July. August ..... . September .. October .. November. December .... TOTAL .. TOTAL NO. OF DORES .. TRYPARSAMIDE SULPHARSPHENAMI NE STOVARSOL 3.0 0.2 0.4 0.6 Tablets I I -10 -160 II 25 1,650 -15 10 -160 -30 10 III .. ...5.0. . 10 40 20 10 so ......... ......... 40 . ......... 100 1,750 50 70 50 30 ____ ____ ____ _, _ _ __ , 155 , 90 , -125 3,500 155 90 -125 3,500 FUADIN IISULFATH-1\ IAZOLE BISMUTH VACCINES PENICILLIN - Bottles of 5-cc 40 Tablets 30-oo 270 636 117 430 835 139 670 890 149 1,060 471 237 1,140 1,219 287 890 526 200 1,400 742 197 920 450 443 1,240 3,015 478 Frei I Duorey 60-cc pkg. (10l I pkg. (50l 187 10 14 257 II 17 140 231 10 126 I 16 13 136 14 338 13 132 13 6 15 100.000 units -- 4,806 9,005 ~ "'"' 10,240 "';:: "" 7,210 :;:. 11,040 13,359 .~ ..._ "tJ' !l ,097 ~ "~ ' 14,970 ~ 12,936 650 926 293 465 3,868 580 1,234 192 184 6,820 -64-0 - 533 ---- - - -87- - - -49- - - -12- - - -2- -3-,33-7 9,890 --- -1-1,4-77- - 2,819 --- - -2,2-51- - - 145 -- - - -5-7 - -10-8' 68-8 9,890 459,080 84,570 135,060 1,450 2,850 dosage varies Total number does of tryparsamide ........ . Total number doses of neoarsphenamine... . Total number doses of arsenoxides..... . . . Total number doses of sulpharsphenamine. Total number doses of stovarsol. . 0 60,788 209,765 120 3,500 Total number doses of fuadin ...... Total number doses of sulfathiazole. Total number doses of bismuth ...... Total number tests of frei antigen ................. rrotal number tests of ducrey antigen ............... 9.89J 459,080 4,300 I ,450 2,850 ,N_. -...! 1...'-....l 00 TABLE VII LABORATORY EXAMINATIONS FOR VENEREAL DISEASES Performed in Central Laboratory and Two Branch Laboratories Georgia Department of Public Health January ........ ......... February ....... March ................................ April. ................ ...... ....... May ........ .... ........ June .................. ..... . July ................. . .. .. . . . . ... .. August . . . . . . . . . . September............. .... Total 31,818 29,355 31,462 31,527 31,607 30,721 33.711 32,265 31,450 January- December, 1946 SEROLOGIC EXAMINATIONS DARKFIELD EXAMINATIONS c;] EXAMINATIONS FOR GONOCOCCI <::> ""''~. :;, Number Number Percent Number Number Percent Number Number Percent Positive --- -N-ega-tiv-e Positive ---- - -Tot-al - -Po-sitiv-e Negative --- -P-osi-tive- -T-otal- -Po-sitiv-e Negative --- Positive --- 3, 740 28,078 11.8 11 5 6 45.5 2 447 443 2,004 18.1 tJ ~g 3,550 25,805 12.1 17 12 5 70.6 2,315 365 1,950 15.8 .~.... 3,562 27.900 11.3 26 8 18 30.8 2,468 464 2,004. 18.8 - .<::> 3,537 27,990 11.2 29 6 23 20.7 2,490 474 2,016 19.0 'i:i 3, 783 27,824 12.0 18 3,593 27,128 11.7 28 5 10 13 18 27.8 2, 720 35.7 2,540 525 431 2,195 2,109 19.3 17.0 <~ ";":s"-< <'> 4,239 29,472 12.6 46 20 26 43.5 2,914 477 2,437 16.4 ~ 4,172 28,265 12.9 39 17 22 43.6 2,556 453 2,103 17.7 ~ 3,994 27,456 12.6 28 14 14 50.0 2,408 398 2,010 16.5 October ..... ......... ............ 32,471 4,180 28,291 12.9 27 19 8 70.4 2,872 500 2,372 17.4 November . . . . . . . . . . . . ... . . 27,090 3,319 23,771 12.3 33 13 20 39.4 2,334 398 1,936 17.1 December .............. 25,663 3,169 22,494 12.3 25 7 18 28.0 2,184 360 1,824 16.5 TOTAL . . . . . . . . . . . . . . . . . . . 44.838 369,340 324,474 ~[--;27_1_3_6_ _1_9_1-~ 30,248 5,288 24,960 ~- January . . . . February ....... . March ..... . April. ..... May ... June .. July ....... . august.... . Sep~ember ....... . October ......... . November............ . December........... . TOTAL......... . TABLE VIII SUMMARY REPORT OF EDUCATIONAL ACTIVITIES Venereal Disease Comrol Service January- December, 1946 Meetings Addressed No. Au d. Meetings Attended (Not addressed) Films No. Aud. 2 233 200 20 2,040 1,100 382 18 1,635 57 No. of Clinic Visits No. of Conferences Exhibits Displayed 15 750 450 12 2 73 6,847 20 17 Literature Distributed f 9,737 2,646 3,688 -"'"',. 29 8 18 18 0 14 4 15* 2 TOTALS ----------------------- 1,672 P_"J 22 9 90 3 1,784 135 615 615 0 474* 130 542* 69 Cultures for Pathogenicity -------------------------------------------------- 4 0 4 TOTAL EXAMINATIONS -------------------------- ------------------- 619 615 0 474* 134 *'l'he difference in numbers is due to an unsatisfactory report-either death of animal ot contamination of culture. 542* - - 69 l'-.l 0\ VI 266 Georgia Department of Pttblic Health Diphtheria- During the year 3,140 cultures were examined for diphtheria. There was a decided decline in the number of positive diagnostic cultures as only 197 were obtained, compared with 472 in 1945. TABLE 12 CLASSIFICATION OF DIPHTHERIA EXAMINATIONS-1946 Positive Negative Dottbtfttl Total Diagnostic ---------------------------------- 197 Release and Carrier -------------------- 37 Virulence ------------------------------------ 3 ToTALS __________________________ 237 2,474 415 6 2,895 7 2,678 1 453 9 8 3,140 Gonorrhea- A marked increase in the number of specimens examined for N. gonorrhoeae was noted during 1946. See Table 13. Microscopic examinations showed a gain of 1,775 or 9.3 per cent. Cultures increased from 7,886 in 1945 to 9,751 in 1946, a gain of 1,865 or 23.6 per cent. Practically all of the cultures made in the Central laboratory originated in the venereal disease clinics of FultOn County and the City of Atlanta. One hundred sixty-two ( 162) cultures submitted from the Ware County Clinic were examined in the Waycross branch laboratory. Since at the present time cultural examinations for gonococci are satisfactOry only when local laboratory facilities are available, there is a definite need tO develop procedures which make this valuable diagnostic service available tO those county health departments which, of necessity, must' send their specimens to distant laboratories. The possibility of inoculating and incubating cultures locally and then mailing them to the State laboratories for examination is being investigated. A classification of the examinations made in the several laboratOries is given in Table 14. TABLE 13 MICROSCOPIC EXAMINATIONS FOR N. GONORRHOEAE FIVE YEAR PERIOD-1942-1946 1942 1943 1944 1945 1946 Number Specimens---------------------- 9,813 11,784 14,133 18,822 20,597 Number Positive ------------------------ 1,593 1,642 2,249 2,650 3,204 Per Cent Positive ------------------------ 16.2% 13.9% 15.9% 14.1% 15.6o/o Division of Lctborcttories 267 TABLE 14 CLASSIFICATION OF EXAMINATIONS FOR N. GONORRHOEAE-1946 Central J'vlicroscopic Number Specimens ____________________ 11,515 Number Positive ------------------------ 1,682 Per Cent Posidve ------------------------ 14.6% Cttltttre ~~:~:~ ~~:f:~;n_~--~~~~~~~~~~~~~~~~~~~~ 9,589 2,064 Per cent Positive ------------------------ 21.5% Albany 1'aycross l"otal 5,352 1,063 19.9% 3,730 459 12.3% 20,597 3,204 15.6% 162 20 12.3% 9,751 2,084 21.4% Malaria- Malaria examinations decreased 66.2 per cent in 1946. This is a continuation of the rrend noted in recent years, and is attributable to the low endemicity of the disease. Very few surveys have been conducted, and rhe demand by private physicians for rhis examination has decreased considerably. During the year 270 positive malaria findipgs were reported of which 268 were Plasmodium vivax (tertian malaria) type. Two could not be ryped because of the pauciry of parasites. Information as to the source of infection was obtained on 221 positive findings and of these 217 were from ex-servicemen who had acquired the infection outside the cominental United States. See T abies 15 and 16. TABLE 15 EXAMINATIONS FOR MALARIA FIVE YEAR PERIOD-1942-1946 1942 1943 1944 1945 1946 Number Specimens -------------------- 19,189 11,951 9,379 12,691 7,633 Number Positive ------------------------ 290 77 41 80 270 Increase o1 Decrease Over Preceding Year Number Specimens -------------------13,968 -7,238 -2,572 +3,312 -5,058 Number Positive---------------------- -265 -213 -36 +39 +190 TABLE 16 EXAMINATIONS FOR MALARIA-1946 Cent1'ctl Number Specimens -------------------- 3,436 Number Positive ------------------------ 199 Albany 3,226 44 1'aycross 971 27 Total 7,633 270 268 Georgict Department of Pttblic Health Intestinal Parasites- The post war reactivation of the Division of Hookworm and Malaria Services resulted in a marked increase in intestinal parasite examinations. See Table 17. While there was an increase in the number of ova counts, practically all of which were made on specimens from surveys, the tendency is to place less emphasis on this phase of the hookworm studies. There was a marked increase in the number of specimens examined for E. histolytica but the percentage of positives remained low. The intestinal parasite work was fairly distributed among the three laboratories as shown in Table 18. TABLE 17 INTESTINAL PARASITE EXAMINATIONS FIVE YEAR PERIOD-1942-1946 1942 Total-Ova -------------- 28,415 Increase or Decrease__-20,937 Ova Counts ______________ 2,469 Increase or Decrease__ -1,385 Amebic Dysentery ____ 679 Increase or Decrease __ -f---98 1943 20,772 -7,643 3,007 -f---538 429 -250 1944 20,022 -750 2,032 -975 441 -f---12 1945 1946 24,057 -f---4,035 2,029 -3 555 -f---114 35,713 -f---11,656 2,251 -f---222 758 -f---203 TABLE 18 INTESTINAL PARASITE EXAMINATIONS-1946 Central Albctny lVctycross Total Ovct Positive -------------------Negative -----------------Total -------------------------Ovct Cottnts -------------- 2,931 12,235 15,166 747 2,733 5,992 8,725 4,757 7,065 11,822 1,504 10,421 25,292 Amebic Dysentery Positive ____________________ 8 7 4 19 Negative __________________ 537 99 103 739 Total ------------------------ 545 106 107 GRAND TOTAL --------------------------------------------------------------------- GRAND TOTAL 35,713 2,251 758 38,722 A classification of the intesdnal parasite findings is given in Table 19. Di,vision of Labo,ratories 269 TABLE 19 CLASSIFICATION OF INTESTINAL PARASITE FINDINGS-1946 SINGLE INFECTION Worms for Identification -----------------------------------------------------------Hookworm ---------------------------------------------------------------------------------Round Worm -----------------------------------------------------------------------------pin Worm ---------------------------------------------------------------------------------Whip Worm -----------------------------------------------------------------------------Dwarf Tapeworm -----------------------------------------------------------------------Others ------------------------------------------------------------------------------------------ 22 9,925 263 248 63 83 7 DOUBLE INFECTION Hookworm and Pin Worm -------------------------------------------------------- 84 Hookworm and Dwarf Tapeworm -------------------------------------------- 22 Hookworm and Round Worm ---------------------------------------------------- 68 Hookworm and Whip Worm ---------------------------------------------------- 13 Round Worm and Pin Worm ---------------------------------------------------- 2 Whip Worm and Dwarf Tapeworm------------------------------------------ 1 Pin Worm and Whip Worm ---------------------------------------------------- 1 TRIPLE INFECTION Hookworm and Pin Worm and Whip Worm-------------------------- 1 Hookworm and Round Worm and Pin Worm------------------------ 2 Hookworm and Pin Worm and Dwarf Tapeworm-------------------- 1 Total Specimens Positive for Ova of Hookworm ---------------------------- Round Worm -----------------------------------------------------------------------------pin Worm ---------------------------------------------------------------------------------Whip Worm -----------------------------------------------------------------------------Dwarf Tapeworm ---------------------------------------------------------------------Others ------------------------------------------------------------------------------------------ 10,116 335 339 79 107 7 Rabies- The rabies situation during the past year has been alarming due primarily to a widespread increase of the disease among foxes. Of the 740 animal heads found positive during the year by the State laboratories 241 were foxes. See Table 20. This was an increase of 128 or 113.3 per cent compared with 1945. During the year various municipal laboratories throughout the state found 25 fox heads positive. See Table 21. Rabid foxes were reported in 66 counties which are listed in Table 22. In contrast during 1945 only 29 counties were involved. Antirabic treatment was given to 106 persons bitten by rabid foxes. Of the 864 dog heads examined by the State laboratories only 367 were positive. This was 34 fewer than were found in the previous year. Positive findings in cattle increased from 37 in 1945 to 54 during the past year. Laboratory results, however, do not present the true picture where the 270 Georgia Department of Pttblic Health disease has become highly endemic in foxes. Only a small percentage of rabid foxes reach the laboratory for examination. Because of rhe expense and difficulry of getting the heads of suspected rabid catde to rhe laboratory, the laboratory examines only a small percentage of the catde acrually rabid. However, we know that the loss of domesric animals, as a resulr of the epizootic in foxes, has been quite high. Based on reports received from rabies inspectors and veterinarians in 77 counties alone, this loss wa> $138,678.75. The acmalloss was undoubredly much higher. Rabies control measures have included rhe vaccination of dogs throughout the State, the destruction of unvaccinated dogs and a reduction of the fox population. Under the law passed in 1945, rabies control was placed under the Georgia Department of Public Healrh. However, appoimmem of a rabies control inspector in each county is a function of the County Board of Health. Mosr of rhese boards appoimed inspectors. They reponed 187,611 dogs vaccinated. Two hundred fifty-eight thousand (258,000) rags and certificates were disrributed by our department. Since a number of inspectors failed to make reports, it is probable that over 200,000 clogs were vaccinated during the year. However, the vaccination was exceedingly spotty. In some counties, a high percentage of the dogs were vaccinated while 'in others no attempt has been made to enforce the law. There is need for revision of rhe rabies control law and this will be attemprecl ar the next session of the legislature. Control of rabies in foxes has been effected in a number of counties through reduction of the fox population. This work was supervised by a representative of the Federal Fish and Wild Life Service. He has trained many people to destroy foxes by trapping, using poison bait and gas bombs in their dens, and huming them wirh packs of fox . hunters. The destruction of foxes has been increased through the payment by the effected counties of bounties running from $2.00 to $5.00 per head. Under this program, $9,655.75 in bounties was paid for 4,377 heads. It is hoped that a more effective enforcemem of the rabies control law throughout the State, and a continuation of the fox control program during 1947, will result in a better comrol of the disease. In addition to the microscopic examinations for rabies 56 specimens were subjecrecl w the mouse inoculation tests. An analysis of this work is given in Table 23. Division of Lotborottories 271 272 Georgia Department of Pttblic Health TABLE 20 CLASSIFICATION OF ANIMAL HEADS-1946 EXAMINED MICROSC::OPICALLY FOR RABIES-STATE LABORATORIES Animal CENTRAL Specimens Pos. Dog ---------------------------------------- 666 297 Cat ------------------------------------------ 166 41 Hog ---------------------------------------- 6 ------ Cow and Calf -------------------------- 49 26 Fox ------------------------------------------ 124 86 Mule and Hor.se ---------------------- 9 4 Squirrel ---------------------------------- 11 ------ Rabbit ------------------------------------ 3 ------ Rae ------------------------------------------ 2 Goat ---------------------------------------- 4 2 Deer ---------------------------------------- 1 ------ Wildcat ---------------------------------- ------ ------ Chipmunk ------------------------------ 1 Pole Cat ---------------------------------- ------ Hawk -------------------------------------- 1 ------ Opossum -------------------------------- ------ Unclassiiied ---------------------------- 4 1 GRAND TOTALS ------------- 1,047 457 ALBANY Specimens Pos. 137 49 ------ 38 183 6 s ------ ------ ------ 1 ------ 1 ------ 1 ------ 36 16 ------ 27 121 1 ------ ------ ------ ------ ----------- 1 ------ ----------- 421 202 WAYCROSS Specimens Pos. 61 34 34 ll 2 ------ 3 1 34 34 3 1 ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ 1 ------ ------ 138 81 TOTALS Specimens 864 249 8 90 341 18 16 3 2 4 1 1 1 1 1 2 4 1,606 Pos. 367 68 0 "' ------ 54 241 6 .."""~""."'''_'' 1-< "' ------ <:so< ------ ------ 2 "~"""ll'''.-'. "'<., 1 1 740 l-0 -....j \.)0 274 Geo1gia Department of Pttblic Health TABLE 21 CLASSIFICATION OF ANIMAL HEADS-1946 EXAMINED MICROSCOPICALLY FOR RABIES-MUNICIPAL LABORATORIES Animal COLUMBUS SAVANNAH AUGUSTA MACON TOTALS Spec. Pos. Spec. Pos. Spec. Pos. Spec. Pos. Spec. Pos. Dog ---------------- 20 2 35 8 17 8 72 18 Cat ------------------ 7 3 10 3 10 2 27 8 Fox ------------------ 104 25 104 25 Racoon ---------- 1 1 Horse -------------- 1 1 Monkey ---------- 1 1 Squirrel ---------- 3 3 Rat -----------------Unclassified ---- 1 1 74 12 74 12 GRAND ToTALs 133 30 49 11 28 10 74 12 284 63 TABLE 22 EXAMINATION OF Fox HEADS FOR RABIES-BY COUNTIES-1946 (State and Municipal Laborarories) Cottnty Totals Appling 4 Bacon ---------------------------------------------------------------------- 11 Baldwin ------------------------------------------------------------------ 2 Bleckley ------------------------------------------------------------------ 3 Brooks ----------------------------------------------------- _______________ 4 Clinch -------------------------------------------------------------------- 1 Coffee ---------------------------------------------------------------------- 5 Colqui tt ------------------------------------------------------------------ 4 Crawford ---------------------------------------------------------------- 1 Crisp ---------------------------------------------------------------------- 1 Decatur ------------------------------------------------------------------ 2 DeKalb ------------------------------------------------------------------ 2 Dodge ------------"------------------------------------------------------- 11 Dougherty -------------------------------------------------------------- 11 Fulton -------------------------------------------------------------------- 2 Grady ---------------------------------------------------------------------- 2 Habersham -------------------------------------------------------------- 1 Harris ---------------------------------------------------------------------- 4 ]asper ---------------------------------------------------------------------- 20 Positi-ves 3 2 1 3 4 1 5 4 1 2 9 7 2 2 9 Di-vision of Laboratories TABLE 22-Continued Cottnty Totals Jones ---------------------------------------------------------------------- 1 Lamar ---------------------------------------------------------------------- 2 Lnurens ------------------------------------------------------------------ 1 Lee -------------------------------------------------------------------------- 43 Marion -------------------------------------------------------------------- 21 1!eriwether ------------------------------------------------------------ 5 Mitchell ------------------------------------------------------------------ 4 Monroe ------------------------------------------------------------------ 45 11ontgomery ---------------------------------------------------------- 3 Muscogee ---------------------------------------------------------------- 105 Newton ------------------------------------------------------------------ 2 Peach ---------------------------------------------------------------------- 4 Pierce ---------------------------------------------------------------------- 7 Pike ------------------------------------------------------------------------ 1 Putnam ------------------------------------------------------------------ 5 Quitman ------------------------------------------------------------------ 2 Randolph ---------------------------------------------------------------- 33 Schley ---------------------------------------------------------------------- 2 Seminole ---------------------------------------------------------------- 1 Spalding ---------------------------------------------------------------- 1 Stewart -------------------------------------------------------------------- 3 StJmter -------------------------------------------------------------------- 5 Taylor ---------------------------------------------------------------------- 2 Telfair -------------------------------------------------------------------- 9 Terrell -------------------------------------------------------------------- 9 Thomas ------------------------------------------------------------------ 9 1'oombs ------------------------------------------------------------------ 6 Treutlen ------------------------------------------------------------------ 2 Upson ---------------------------------------------------------------------- 23 Walton ------------------------------------------------------------------ 1 Ware ---------------------------------------------------------------------- 4 Warren ------------------------------------------------------------------ 2 Washington ------------------------------------------------------------ 1 Wayne -------------------------------------------------------------------- 5 Webster ------------------------------------------------------------------ 23 Wilkinson -------------------------------------------------------------- 2 Worth -------------------------------------------------------------------- 2 GRAND ToTALs ------------------------------------------------- 487 275 Positives 1 2 1 35 14 5 4 17 1 26 1 3 7 5 1 21 2 1 3 3 2 9 9 9 6 1 8 4 5 4 2 2 269 l-.j --..J 0\ TABLE 23 ANIMAL INOCULATIONS FOR RABIES Type Specimen Micro.Mouse- Dog ------------------------------------------ l l Car -------------------------------------------- 5 Fox -------------------------------------------- ---Cow ------------------------------------------ 2 Goar ------------------------------------------ 1 Human -------------------------------------- ---pig -------------------------------------------- 2 Mule ------------------------------------------ GRAND TOTALS-------------------- 21 Micro.Mouse+ 8 5 1 6 ---1 1 1 _? ") Micro. ? Mouse- ---- ---- ---- ---- ------- ---- Micro. ? Mouse+ 2 1 ---- ---- ---------- ---- 3 Micro. Uns. Micro. Uns. Mouse- Mouse+ 3 2 ---- ---- 2 1 ---- ---- ---- ---- ---- ---- ---- ---- Micro. + Checks ------------- ---- 1 ---- ---- 5 3 1 c;) ""Cl ~ :";:". Total \::1 26 ""~"""' ll "~ ' 4 8 ;"::"; -"C'.l 1 :'i;::,:i ~ 2 3 1 ~ :":c "~" <::;-. -- 56 Division of Labor?ttories 277 Miscellaneous- Table 24 shows the miscellaneous examinations made during the year. The statistics given for Vincent's organisms are on specimens submitted for this examination only and do not include the positive findings on specimens submitted primarily for gonorrhoeae examination. Neither do the figures for Trichomonads represent the actual totals since the finding of these organisms in pus smears submitted primarily for gonorrhoeae examinations are not tabulated. An unusual finding in spinal fluids was the fungus Torula histolytica recovered in the Waycross laborarory. Other isolations were as nmed below: Central Alb?tny Waycross Total N. intracellularis ------------------------ 7 7 D. pneumoniae -------------------------- 5 2 1 8 H. influenzae ------------------------------ 12 3 15 T. histolytica ------------------------------ 1 1 TOTAL ------------------------------------ 24 5 2 31 In the Central laboratory, 30 examinations for Donovan's bodies (Lymphogranuloma inguinale) were made with 3 positive and 1 doubtful findings. These specimens were all received from the Atlanta Health Center V. D. Clinic. During the year 1,258 heterophile antibody tests for glandular fever (Infectious mononucleosis) were made. The Waycross laboratory performed 504 of these and the Central laboratory 754. Since most of the requests for this test have originated in the northern part of the State, rhe test has, since May, been performed only in the Serology unit of the Central laboratory. TABLE 24 CLASSIFICATION OF MISCELLANEOUS EXAMINATIONS Toktl Vincent's ------------------------------------------------------------------ 457 Trichomonads ---------------------------------------------------------- 460 Chancroid (B. ducrey) ----------------------------------- ________ 109 Darkfield (T r. pallid um) ---------------------------------------- 327 Spinal Fluids for Meningitis ------------------------------------ 143 Glandular Fever (Heterophile Antibody Test) ______ 1,258 Examinations for Type of Organisms -------------------- 212 Cultures -------------------------------------------------------------------- 359 Unclassified -------------------------------------------------------------- 444 GRAND TOTAL ------------------------------------------------------ 3,769 Positive 226 105 24 136 31 311 CULTURE UNIT Cultural studies which included blood, stool and urine cultures, agglutination tests, and a miscellany of special bacteriology, increased from 29,312 specimens in 1945 to 34,272 in 1946, a gain of 4,960 or 16.9%. See Table 25. 278 Georgict Department of Pttblic Health TABLE 25 CULTURAL STUDIES-1946-1945 Agglutination Series ____________ Blood Culture ______________________ Stool and Urine Culmres ____ 1946 12,669 9,880 11,723 1945 11,377 9,414 8,521 Increase or Decrease +1,292 + 466 +3,202 +11.4% + 5.0% +37.6% GRAND TOTALS -------------- 34,272 29,312 +4,960 +16.9% The marked gain in stool and urine cultures was due to extensive laborawry studies made in several outbreaks of food poisoning, which occurred during the year. A smdy of Tables 26, 27, and 28 will show the remarkable and continued decrease in positive findings for typhoid in recent years culminating in an all-time low during 1946. In contrast there was a fairly marked increase in salmonella isolations from srool cultures due to the occurrence of several rather extensive ourbreaks of food poisoning. Positive findings for Endemic typhus have also decreased sharply in recent years due to the effective comrol measures that have been applied in infected areas. For example in 1936 we obtained 1,080 positive reactions whereas in 1946 we had only 446. TABLE 26 POSITIVE AGGLUTINATION TESTS 1942 Typhoid ------------------------------------ 111 Typhus (Endemic) Fever ________ 796 Brucellosis -------------------------------- 153 Tularemia -------------------------------- 78 1943 106 839 96 84 1944 92 705 163 46 GRAND ToTALs ____________________ 1,138 1,125 1,006 1945 1946 55 32 632 446 186 181 55 64 928 723 TABLE 27 POSITIVE BLOOD (ULTURES 1942 E. cyphosa -------------------------------- 184 Salmonella -------------------------------- 15 Brucella ------------------------------------ 38 Other Organisms ---------------------- 21 GRAND ToTALs ------------------ 258 1943 115 19 30 16 180 1944 93 14 53 10 170 1945 1946 73 49 12 4 60 51 12 24 157 128 Di-vision of Lotborcttories 279 TABLE 28 POSITIVE STOOL AND URINE CULTURES 1942 E. typhosa ---------------------------------- 500 Salmonella -------------------------------- 28 Shigella -------------------------------------- 240 Other Organisms ---------------------- GRAND ToTALs ------------------ 768 1943 162 52 203 2 419 1944 143 200 135 478 1945 1946 191 86 79 103 108 50 1 378 240 A highly imponant but time-consuming activity of the Central laboratory culture unit is the critical typing of Typhoid, Salmonella, Brucella and Shigella isolations. An extensive variety of diagnostic sera and reagents is required for this work and, consequently, it can best be undertaken in the Central laboratory. During the year, 143 cultures of E. typhosa, 117 cultures of Salmonella, 58 Brucella isolations, and 117 Shigella cultures were typed. These were all isolated in State laboratories. In addition, typing was done on 131 cultures received from other laboratories within the State and from State laboratories in Indiana, Texas, Idaho, Missouri, Tennessee, and the District of Columbia. An analysis of the typing studies is given in Tables 29 through 34. Included in the isolations from miscellaneous cultures in the Central laborarory were the following fungi: Candida albicans-1 isolation; Trich- ophyton-1 isolation; Microsporum audouini-4 isolations; as reported ttnder miscellaneous examinations the Waycross laboratory isolated Torula histolytica from a spinal fluid. During 1945 several of the personnel from the Central laboratory culture unit received special training in mycologic technic at the Fourth Service Command Laboratory. Shortly thereafter several isolations of fungi were made. Of especial interest was the finding of Sporo- trichum schenkii in cultures from a chain of ruptured nodules on the arm of a patient living in Clarkesville, whose condition had remained undiagnosed over a period of six weeks. The laboratory findings resulted in a satisfactory clearing up of the infection. Since then the demand for mycologic studies has increased rapidly. In 1945 we instituted Lactobacillus counts on saliva specimens and during the year 102 counts were made. The demand for this service dropped considerably during the current year, only 10 having been made. 1'-.l 00 0 TABLE 29 ISOLATIONS OF E. TYPHOSA-1946 Type CENTRAL Blood- Feces-1 nd.* A 7 8 13 c 4 14 9 E 11 19 18 F 244 J 233 Bera, Gamma, W Forms ---------------- 8 14 14 TOTALS ------------------ 34 62 61 *Duplications are not excluded. **Peritoneal exudate. ALBANY Blood- Feces- Ind.* 375 1 ---- 1 224 ---1 ---- 1 352 10 14 13 WAYCROSS Blood- Feces-1 nd.* ---- 3 2 22 1 ---1 ---- 1 ---- ---- ---- 24 3 597 OTHER LABS. Blood- Feces- Ind. 112 1 1 ** 2 213 ---- ---- ---- 2 2 639 c;] ...<1) <::> Ot> TOTALS ~ Blood-Feces- Ind. t:::J ~ 11 19 22 :;:, ~ 8 17 13 ~ <1) 15 22 34 25 5 ;t ."<.::_>' 3 3 4 '"1::1 1.::: <::s- ~ 15 23 21 :":'c <1) 55 88 90 :;:, ~ ~ Division of Laboratories TABLE 30 TYPHOID CASES AND CARRIERS-1946 E. typhosa __Iype Cases''' A 18 c 10 E 21 F 5 J 4 Beta, Gamma, W forms 18 ToTALs________________________ 76 *Duplications excluclecl. New Carrier 2 2 4 Old Carrier 1 3 1 5 281 Total 21 12 24 5 4 19 85 TABLE 31 '0'"0 l'>.l SALMONELLA lSOLATIONS-1946 Group A B c D E Type S. paratyphi A S. paratyphi B S. typhi murium S. derby S. california S. !Jrcdency S. cholerae suis S. oranienburg S. barcilly S. montevideo S. newport**** S. mucnchcn S. litchfield S. enteritidis S. scndai S. panama S. pensacola S. give S. anatum S. meleagridis S. illinois CENTRAL Blood Feces ALBANY Blood Feces WAYCROSS Blood Feces OTHER LABS. Blood Feces TOTALS I sol. Ind. 2 -- -- - - - 1 -- - - 12* -- 10 --- -- 1** 2 l 1 1 Cl 25 18 ~""' ;~;:.. 11 - 1*** 4 1 l 11 2 -- ... -- -- 4 - 2 1 4 1 - 1 - 1 1***** 1 - 14 3 \:I ~ "' 13 11 .~..;. ~ 12 7 ,"".'' 2 2 .."...... 12 4 '1::1 10 6 "".<,:s_o< ":"::'c 2 2 ";;:'. ~ <:s- 5 5 1 1 TOTALS 40 3 57 117 75 *1 Double infection with S. oranienburg. **Isolated from autopsy material (large intestine and liver). ***Same as Albany. ****1 Double infection with E. typhosa. *****Fron1 spinal fluid. Group A B c D E Misc. TOTALS Salmonella paratyphi paratyphi A paratyphi paratyphi B typhi murium derby bredeney san diego california cholerac suis oranienburg bareilly montevideo tennessee georgia newport muenchen litchfield manhattan enteritidis sendai panama pensacola give ana tum meleagridis newington illinois rubislaw poona worthington minnesota TABLE 32 SALMONELLA TYPES ISOLATED IN GEORGIA-1942-1946 1942 1 --8 14 2 1 .... ---6 3 --- 3 ------1 ---1 --- --- ---- 1 2 1 --- 1943 4 20 10 1 ---5 6 ---2 2 1 - 3 --9 5 1 - 1944 2 -- 9 --- 162 9 1 1 1 8 8 --- 3 -- 3 2 1 ---- 1 - 3 -- 2 1945 --- --- 15 ll 3 5 1 1 13 41 6 1 21 1 ---2 1 3 5 1 Total No. 1946 Isolations Blood From Stool Total No. Urine Individuals 7 7 - 4 2 2 -- 2 1 52 20 32 26 1 1 1 25 222 4- 218 162 2 17 --- 17 14 14 21 2 19 - 6 2 --- 2 ---- 2 tJ 1 3 -- 3 3 "<:':": 3 35 27 8 --- 33 13 34 7 27 -- 26 <::; "c' 2 3 ---- 3 ---- 3 1 15 4 10 1 12 -"c " . 3 1 2 2 1-< --- 1 - 12 37 37 1 --- 1 -- 23 "'~ .c... 2 8 - 8 6 !;; 12 14- -- 14- ---- 6 c.... ---- 2 - 2 1 "~" 10 10 2 8 1 6 17 2 15 5 20 - 20 - 18 1 3 -- 3 --- 3 - 3 -- 3 --- 3 3 - - 3 3 -- 6 --- 6 --- - 2 ---- --- 2 1 1 3 l'-l 2 00 \.)J 44 72 221 100 ll7 554 ll4 439 1 384 284 Georgia Department of Public Health TABLE 33 SHIGELLA IsoLATIONS-1946 Type Central FJexner V ---------------------- 1 W ---------------------- 8 X ---------------------- 1 y ---------------------- 2 z ---------------------- 88 ---------------------- 1 103 -------------------- 1 V, Z ------------------ Sh. sonnei ---------------------- 5 Sh. Boyd P 274 1 Sh. ambigua -------------------- 1 Sh. dispar ------------------------ 1 Sh. alkalescens ______________ 37 Albany 10 2 1 2 7 1 12 Waycross 2 2 1 Others''' 4 4 1 9 ToTALs __________________ 59 35 5 18 *Isolations made in other laboratories, typed in Central laboratory. Total 11 16 1 2 1 ? 1 2 16 2 1 3 58 117 TABLE 34 BRUCELLA lSOLATIONS-1946 Type Central Albany Wavcross Other Labs. Totals lsol. Ind. lsol. Ind. lsol. Ind. lsol. Ind. lsol. Ind. B1. aborms __________ 9 8 33 4 4 16 15 Br. suis ---------------- 23 19 16 11 3* 2 42 32 ToTALs ________ 32 27 *1 same as Central laboratory. 19 14 7 6 58 47 SYPHILIS SEROLOGY The syphilis serology load for rhe division of laboratories amounted to 369,140 specimens during 1946. This was an increase of 40,448 or 12.3% over 1945. See Table 35. Included in these specimens were 577 submitred from small children on which the Micro Kahn test was performed. Beginning January 1, 1946, the Quantitative Kahn resr was applied routinely to all specimens giving four plus, atypical, or zone type reactions by the Standard Kahn test. Although ir has added considerably w the amount of work in the serology unit, it is felt thar the application of the quantitative Di-visio11 of Laborato-ries 285 test, as indicated above, is a well advanced step in the present-day serologic methods. A total of 25,084 quantitative tests was performed in the rhree laboratories. A special syphilis serology service rendered by the Central laborawry is rhe performance of multiple serologic tests on selected specimens submitred by physicians from cases suspected to be showing non-specific reacrions in repeated routine resrs. This battery of tesrs was applied as follows: Kahn Presumptive__________________________________________ 254 Kahn Standard------------------------------------------------ 442 Kahn Quantirarive__________________________________________ 217 Kolmer Complement-Fixation________________________ 354 ~~~;in~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~ Eagle Flocculation ------------------------------------------ 327 Hinton Flocculation --------------------------------------- 312 Cardiolipin V.D.R.L. (experimental)____________ 402 GRAND ToTAL________________________________________ 3,31 5 During the year the Central laboratory again panicipated in the annual national evaluation study of serologic tests for syphilis conducted by the United States Public Health Service. A credirable raring of performance in both sensitivity and specificity was obtained in all of the several tests evaluared. Table 36 shows the comparative ratings of our laborawry wirh the laboratories of the author serologists. TABLE 35 SYPHILIS SEROLOGY-1946 BLOOD 1946 -----------------------------1945 ------------------------------ Central 268,504 240,281 Increase or Decrease ______ SPINAL FLUID 1946 -----------------------------1945 ------------------------------ +28,223 780 1,162 Increase or Decrease ______ -382 BLOOD AND SPINAL FLUID 1946 -----------------------------1945 ------------------------------ 269,284 241,443 Increase or Decrease ______ +27,841 Albany 58,602 43,231 +15,371 381 372 +9 58,983 43,603 +15,380 Waycross 40,725 43,502 -2,777 148 144 +4 40,873 43,646 -2,773 Total 367,831 327,014 +40,817 1,309 1,678 -369 369,140 328,692 +40,448 286 Georgia Department of Public Health TABLE 36 NATIONAL SEROLOGY EVALUATION STUDY-1946 Test Georgia Laboratory Author Serologist Laboratory Sensitivity Specificity Sensitivity Specificity Kahn Presumptive -------------- 91.8% Kahn Srandard -------------------- 83.2% Kline Diagnostic ________________ 83.3% Kol~er. Complement- F1xatwn -------------------------- 81.2% Eagle Microflocculation ______ 87.3% Hinton Flocculation ------------ 84.6% Mazzini Flocculation ____________ 87.7% 97.4% 100.0% 99.6% 100.0% 98.0% 100.0% 98.9% 88.9% 83.1% 81.8% 88.4% 85.9% 84.6% 84.0% 100.0o/a 100.0% 100.0% 100.0% 98.5 o/o 99.3% 100.0o/a During the year, the Intra-State Serology Evaluation Study was continued with nineteen laboratories, exclusive of ~he Srate system, participating. Twenty test specimens were submitted w these laboratories by the Central laborawry each momh over a ten-month period. As a result of this study, approval was given to sixteen of these laboratories in accordance with the provisions of the State prenatal law. The serology unit of the Central laboratory trained and furnished the technical staff of the serology laboramry in the syphilis-tuberculosis surveys conducted in Macon, Columbus, and Augusta. This laboratory examined 142,679 specimens. In July, 1946, the laboratory of the Alto Medical Center was opened. During the year 12,167 specimens were handled. The bulk of the work consisted of blood and spinal fluid testing for evidence of syphilis, and cultures for N. gonorrhoeae. See Table 37. TABLE 37 EXAMINATIONS PERFORMED BY ALTO MEDICAL CENTER LABORATORY Blood -----------------------------------------------------------Spinal Fluid -------------------------------------------------Gonococcus Culmres -----------------------------------Urinalyses ---------------------------------------------------Miscellaneous ---------------------------------------------- 5,908 3,841 2,165 194 59 GRAND ToTAL ------------------------------------ 12,167 Preparations are being made to begin, in the early part of 1947, blood grouping and Rh testing. An attempt will be made w limit requests for this service to specimens from prenatal patients and related cases. BIOLOGICS AND DRUGS Table 38 shows the biologics and drugs distributed during the year. A number, especially some of those used in the diagnosis and treatment of various venereal diseases, were available only to state clinics and were not distributed m private physicians. Di-vision of Lttborat01ies 287 TABLE 38 BIOLOGIC PRODUCTS AND DRUGS DISTRIBUTED PRODUCT CENTRAL ALBANY WAYCROSS SERA AND VACCINES Diphtheria Antitoxin, units-----------Diphtheria Toxoid, cc. _______________ _ Diphtheria Schick Tests, tests________ _ Ducrey Vaccine, cc-----------------Pertussis Vaccine, cc. vials___________ _ Smallpox Vaccine, points____________ _ Tetanus Antitoxin, Wlits_______________ Tetanus Toxoid, cc.------------------Tuberculin, Diluted, cc.______________ _ Tuberculin, PPD, tests_______________ _ Typhoid Vaccine, cc----------------- (l) Anthabic T1eatments (pe1sons treated)--------------------------Immune Serum Globulin, cc---------- Diphthe1ia-Penussis-Tetanus, cc. ______ _ Diphtheria-Pertussis Toxoid __________ _ '1.8,711,000 73,050 '13,540 290 4-,503 114,160 8,885,500 360 12,320 10,300 521,550 1,735 10,450 500 200 '1,979,000 5,960 970 -------- 307' 7,820 858,000 -------- --------------- 46,'1-30 880 ---------------------- 5,283,000 7,160 3,800 -------- 201 6,330 510,000 -------- --------------- 39,600 491 -------- -------- DRUGS (3) Arsenicals, ampules _______________ (2) Bismuth Subsalicylate in Oil, cc._ Brewers Yeast, pounds_______________ _ Clinitest, tablets _____________________ _ (4) Distilled Wat(tr, cc.______________ _ Fuadin, ampules_____________________ Hexylrescorcinol Crystoids, vials______ _ Lygranum, tests_____________________ _ Pan~~-'s_ Solut.ion, oz. ________________ _ Pemcdlm, umts_____________________ _ Silver Nitrate, ampules________________ Stovarsol, tablets_____________________ _ Sulfathiazole, tablets, 4.0s____________ _ Tetrachlorethylene, capsules, (8 minim) 135,250 232,530 15,552 22,800 1,837,600 10,000 104 1,460 28 2,167,700,000 82,3,].2 3,500 459,080 25,751 975 1,,110 --------------- 58,350 -------- ----------------------------- 3,527 --------------- 2,800 ----------------------------- 38,650 ----------------------------- -------3,955 --------------- 5,200 Delacillin, cc------------------------ 39,850 -------- -------- Plasma, cc-------------------------- '].,'119,000 -------- -------- Streptomycin, 1 gm.------------------ 50 -------- -------- Gentian Violet, tablets-----;:----------- Procaine Solution, cc._______________-_- - - - - - - - 2,008 --1-0-0 - - - - -------- ---------------- - - - - -_-__-_-_-_-_--..,. ------- (1) The figures given for the Branch laboratories do not represent complete treat ments. Four vials of vaccine are supplied by the Branch laboratories for each patient for whom treatment is requested. The remainder of the treatment is sent from the Central laboratory. (2) Distributed in 30 cc. and 60 cc. bottles. (3) Equivalent to 292,351 doses of 0.6 gm. or Jess. ( . .... Pneumonia ....... Diarrhea, Enteritis (-2 yrs.). Appendicitis .... . . . . . . . . . . . . . . .. C:irrhosis of liver . .................... Nephritis ........... Malformation and early infancy diseases . . Suicide ... Homicide .. Motor-vehicle accidents. All other accidents.. Unknown and ill-defined causes. All other causes. 28,456 27 59 26 1 65 71 473 60 10 38 1,108 358 5 2,441 380 106 3,137 5, 779 1,500 312 171 157 2,863 1, 761 212 485 688 1,300 952 3,892 LIVE BIRTHS... STILLBIRTHS ... INFANT MORTALITY.. MATERNAL MORTALITY .. 74,994 2,208 3,181 250 16,310 11 46 12 12,146 16 13 14 4 44 51 206 28 10 27 434' 76 1,735 289 77 1,655 3,805 713 159 89 113 1,558 1,108 188 103 481 792 342 2,148 47,422 1,036 1,728 102 4 21 20 267 32 4 11 674 282 5 706 91 29 1,.482 1,974 787 153 82 44 1,305 653 24 382 207 508 610 1,744 27,572 1,172 1,453 148 911.0 0.9 1.9 0.8 0.03 0.2 0.2 2.1 2.3 15.1 1.9 0.3 0.2 1.2 35.5 11.5 0.2 78.1 12.2 3.4 100.4 185.0 48.0 10.0 5.5 5.0 91.7 56.4 6.8 15.5 22.0 41.6 30.5 124.6 24.0 29.4 42.4 3.3 800.2 0.5 2.3 0.6 0.1 0.2 2.2 2.5 10.1 1.4 0.5 0.1 1.3 21.3 3. 7 85.1 14.2 3.8 81.2 186.7 35.0 7.8 4.4 5.5 76.4 54.4 9.2 5.1 23.6 38.9 16.8 105.4 1119.0 1.5 1.2 1.3 0.1 0.4 0.1 1.9 . 1.8 24.6 2.9 0.4 1. 62.1 26.0 0.5 65.0 8.4 2. 7 136.5 181.9 72.5 14.1 7.6 4.1 120.2 60.2 2.2 35.2 19.1 46.8 56.2 160.7 23.3 25.4 21.8 42.5 36.4 52.7 2.2 5.4 NOTE: These figures exclude nonresidents of Georgia and include births and deaths of Georgia residents occurring in other states. 314 Georgia Department of Pttblic Hectlth 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 BIR'THS, BY COLOR, IN GEORGIA: 1946 Cause of Death Total Number Whit a Colored Total Rate White Colored ALL CAUSES........... .............. 27,405 Typhoid fever ... Typhus fever .... .... .......... 11 33 Malaria ..... 12 Smallpox . . . . . ................ Measles.... .............. 41! Scarlet fever. . . . . . . . . . . . . . . . Whooping Cough ................ 60 Diphtheria. ........... 45 Influenza ... 423 Dysentery. ... . .. .. .. . .. ............. 36 Poliomyelitis .... .. .. ... ..... ... 8 Lethargic Encephaliti" .. ............ 3 Meningococcus Meningitis ........... 31 Tuberculosis. ....... 1,048 Syphilis ... 309 Gonorrhea Cancer. 2 ............ 2,420 Diahet.es Mellitus ..... Pellagra .. 395 93 Cerebral hemorrhage, embolism and thrombosis . . 2,S19 Heart diseases . ...... 5,961 Pneumonia ......... 1,341 Diarrhea and enteritis (-2 yrs.). Appendicitis. .................... Cirrhosis of Liver . ..... . . . . . . . . . . . ...... Nephritis ............ ................... H8 117 183 2,576 Malformation and ear1y infancy diseases . ....... 1,859 Suicide.... ............. 234 Homicide......... 564 Motor~vehicle accidents ...... 807 All other aecidents ............. 1,341 Unknown and ill-defined causes . . . . . . . . . 845 All other causes .... 3,636 LIVE BIRTHS... STILLBIRTHS.... INFANT MORTALITY...... MATERNAL MORTALITY ................. 85,699 2,421 3,068 229 16,160 6 25 6 20 1 28 32 191 19 21 467 59 1,731 281 67 1,523 3,927 6S4 58 62 137 1,417 1,229 218 127 595 857 301 2,060 56,354 1,161 1, 694 85 11,245 5 8 24 32 13 232 17 10 581 250 2 689 114 26 1,296 2,034 657 90 55 46 1,159 630 16 437 212 484 544 1,576 29,345 1,260 1,374 H'J 877.3 0.4 1.1 OA 792.8 0.3 1.2 .03 1036.0 0.5 0. 7 0.6 1.4 0.03 1.9 1.4 13.5 1.2 0.3 0.1 1.0 33.5 9.9 0.1 77.5 12.6 3.0 90.2 190.8 42.9 4.7 3. 7 5.9 82.5 59.5 7.5 18.1 25.8 '12.9 27.1 116.4 21A 28.2 35.8 2.7 1.0 0.04 1.4 1.6 9.4 0.9 0.4 0.1 1.0 22.9 2.9 84.9 13.8 3.3 74.7 192.7 33.6 2.8 3.0 6.7 69.5 60.3 10.7 6.2 29.2 42.0 14.8 101.1 27.6 20.6 30.1 1.5 2.2 2.9 1.2 21.4 1.6 0.9 53.5 23.0 0.2 63.5 10.5 2.4 119.4 187.4 60.5 8.3 5.1 4.2 106.8 58.0 1.5 'J0.3 19.5 '14.6 50.1 145.2 27 .o 42.9 46.8 4.9 NOTE: These figures exclude nonresidents of Georgia and include births and deaths of Georgia residents occurrh)g in other states. Rates based on the 1940 Census Enumerated Population. Informcttion and Statistics 315 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 .. 14,497 11,851) 2,641 Atkinson. 7,093 5,422 1,1)71 Bacon ...... 8,096 7,042 1,054 Baker.... 7,344 3,049 1,295 tBaldwin . . . . . . 11l,411 7,713 8,698 Banks........ 8, 733 8,072 Bill Barrow ....... 13,064 10,605 2,459 Bartow ...... 25,283 21,073 4,210 Ben Hill...... 14,523 9,1l74 4,849 Berrien ......... 15,370 13,033 2,337 Bibb........... 83,783 48,239 35,544 Bleckley. 9,655 1),331 3,324 Brantley ..... 6,871 5,727 1,118 3,034 11,607 3,457 8,912 1,856 7,721 14,998 County Total White Colored Talbot.. Taliaferro. Tatt.nall .. Taylor. Talfair .. Terrell .. Thomas. Tift.. Toombs. Towns ... Treutlen. Troup .. Turner . . Twiggs Union. Upson .. Walker Walton Ware .... Warren ... washington ...... Wayne. Webster. Wheeler. White. Whitfield .. Wilcox. Wilkes. Wilkinson. Worth .. 8,141 6,278 16,243 10,768 15,145 16,675 31,289 18,599 16,952 4,925 7,632 43,879 10,846 9,117 7,680 25,064 31,024 20,777 27,929 10,236 21,230 13,122 4, 726 8,535 6,417 21),105 12,755 15,084 11,025 21,374 2,460 1,997 12,076 5,586 10,358 4,714 17,309 13,101) 12,434 4,925 5,333 27,527 7,036 3,253 7,669 17,377 28,789 14,168 20,389 3,571 10,357 10,328 1,83! 5,855 6,050 24,640 7,879 6,041 5,1)18 11,397 5,681 !,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 9,0,13 5,407 9,977 Informtttion and Statistics 317 TABLE 8 LIVE BIRTHS AND RATES PER 1,000 PoPULATION, STILLBIRTHS AND RATES PER 1,000 LIVE BIRTHS IN EACH COUNTY IN GEORGIA: 1945 AND 1946 County LIVE BIRTHS Number Rate Per 1,000 Population STILLBIRTHS Number Rate Per 1,000 Live Births 1946 1945 1946 1945 TOTAL......... Appling . . . . . . . . . . . . . . Atkinson .............. Bacon ................. Baker......................... Baldwin . . . . . . . . . . . . . . . . . . . . . . . BBBBaeaarnnrrtkools:wwli.!...!........................................................................................... Berrien . . . . ............ Bibb ........ B!cck!ey ..... Brantley .... ................................. Brooks . . . . . . . . . . . . . . . . . . . . . . . . Bryan......................... BuHoch ....................... Burke............... Butts ......................... Calhoun ....................... Camden .................. Candler ............... Carro!! ........................ Catoosa ....................... Charlton ...................... Chatham . . . . . . . . . . . . . . . . . . . . . . Chattahoochee ................. Chattooga..................... Cherokee . . . . . . . . . . . . . . . . . . . . . . Clarke ...... ........... Clay . . . . . . . . Clayton . . . . . ............ Clinch ..... Cobb ...... Co~ee ...... . . . . . . . . ........... Colquitt....................... Columbia . . . . . . . . . . . . . . . . . . . . . . Cook ......................... Coweta . . . . . . . . . . . . . . . . . . . . . . . . Crawford ..................... Crisp ......................... Dade ......................... Dawson ....................... Decatur................ DeKalb ....................... Dodge ..................... Dooly . . . . . . . . . . . . . . . . . . . . . . . . . Dougherty.................... Douglas . . . . . . . . . . . . . . . . . . . Early ......................... Echols ........................ Efllgham .................... Elbert . . . . . . . . . . . . . . . . . . . . . . Emanuel ...... Evans .......... :::::::::::::. Fannin ..................... Fayette ............. Floyd ......................... Forsyth ................. Franklin . . . . . . . . . . . . Fulton Gilmer ................................. Glascock .................. 85,699 433 215 262 183 449 193 325 702 ,103 459 2,779 252 200 577 160 657 712 207 255 195 218 826 270 141 3,626 51 572 531 807 191 354 172 1,491 725 1,028 212 332 696 179