Annual report for the year 1949 [1949]

STATE OF GEORGIA
EPARTMEN
DD D
ANNUAL REPORT
1949

STATE OF GEORGIA
DEPARTMENT OF PUBLIC HEALTH
T. F. SELLERS, M.D., Director
ANNUAL REPORT FOR THE YEAR 1949
State Office Building Atlanta, Georgia

STATE OF GEORGIA DEPARTMENT OF PUBLIC HEALTH
T. F. SE!.!.ERS, M. D., DIRECTOR
ATLANTA
To His Excellency Honorable Herman E. Talmadge Governor of Georgia
Dear Sir: I herewith present to you, the Annual Report
of the Activities of the Georgia Department of Public Health covering the calendar year 1949.
Respectfully submitted,
T. F. Sellers, M.D. Director

MEMBERS OF THE GEORGIA STATE BOARD OF HEALTH

R. L. Rogers, M.D., Chairman . . . B. H. Minchew, M.D., Vice-Chairman ]. B. Butts, Ph.G. . . ]. M. Byne, ] r., M.D. ]. A. Corry, M.D. . . W. P. Harbin, Jr., M.D. S. A. Kirk~and, M.D. . . R. C. Montgomery, M.D. C. L. Ridley, M.D. C. K. Sharp, M.D. D. N. Thompson, M.D. ]. M. Hawley, D.D.S. ]. G. Williams, D.D.S. G. A. Wright, Ph.G. .
C. L. Tinsley, Secretary-Treasurer

Gainesville Waycross Milledgeville Waynesboro Barnesville Rome Atlanta Butler l\!Iacon Arlington Elberton Columbus Atlanta Tifton

GEORGIA DEPARTMENT OF PUBLIC HEALTH

T. F. SELLERS, M.D., Director

Director Emeritus .

Dr. T. F. Abercrombie

Budgets and Accounts

Mr. C. L. Tinsley, Director

Cancer Control and Epidemiology Dr. Wm. ]. Murphy, Director

Dental Health

Dr. ]. G. Williams, Director

Public Health Engineering

Mr. L. M. Clarkson, Director

Water Pollution Control

Mr. W. H. Weir, Director

Hospital Services

Mr.]. E. Ransom, Director

Industrial Hygiene

Dr. L. M. Petrie, Director

Laboratories ;

Dr. E. ]. Sunkes, Director

Local Health Organizations
Maternal, and Child Health, and Mental Health

Dr. Guy G. Lunsford, Director Dr. Guy V. Rice, Director

Public Health Nursing.

Miss Theodora A. Floyd, Director

Personnel .

Mr. H. M. Chester, Administrator

Tuberculosis Control

Dr. H. C. Schenck, Director

Battey State Tuberculosis Hospital Dr. Rufus F. Payne, Superintendent

Typhus Control .

Mr. Roy ]. Boston, Director

Venereal Disease Control and Public Health Education .

Dr. C. D. B~wdoin, Director

Alto Rapid Treatment Center

Dr. Eldis M. Christensen, Director

Vital Statistics

Mr. L. M. Lacy, Director

I
.'

- - - - - - ~---vf<\JAT~1LATION 1-'LAN' OF THE

GEORGIA DEPARTMENT OF PUBLIC HEALTH

NtOlCAL A:i:$0CIATION Of GEORGIA

GEORGIA DENTAL ASSOCIAnOft

(j[ORGIA PHARIIIACE(,ITICAL. A$$0CIATIOK

NAK HOWIHATIONS TO THE
GOVERNOR

STATE BOARDS OF HEALTH

WHO ELEGT Tt!E



DIRECTOR

!l1J

PROPRH

IrN s A D M
., CENTAAL

1-
d<JOG ETS "

TR AT I0
CENTRAL TRAINING

NIPERSONNEL

-

ACQUISITION.. TABULATING

RECOROS.

UNIT.

ACCOUNTS. PRINTING.

AOMINIS TRt.TION.

AND RES!;RVE

OFFICER. MERIT SYSTEM

'

PERSONNEL LIAISON.

/


TWELVE DIVISIONS RENDER I N.G STATEWIDE FIELD SERVICES

HOSPITAL SERVICES
CONSTRUCTION. REGULATION CONSUlTATION

a DENTAL HEALTH MATERNAL
CHILD HEALTH

VITAL

I LABORATORIES PUBLIC HEALTH PUBLIC HEALTH' TUBERCULOSIS

STATISTICS

NURSING

ENGINEERING

INDUSTRIAL HYGIENE

EPIDEMIOLOGY VENEREAL PUBLIC HEALTH

DISEASE

EDUCATION

EDUCATION.
S~RYICE.
,_

MATERNAl.. HEALTH. BIRTH 6 DEATH

CEUTRAL L.ABORA.. SUPERVISION.

WATER, SEWAGE,

CONTROL t.cEAS ENVIRONMENTAL SERVICCS

CHILO HEALTH.

REGISTRATIOH.

TORY.

iRAINtNC.

SWU~MING POOL

URES PROMOTION.

ENG<NEERING

NUTRITION, EMERGENCY MATER-

BRANCH LADORATORIES:

i !.NO STREAr.t .

BATTEY STATE

POI..L'tfTIOtl CON1RC(.. HOSPITAL INTf ..

VEHTlLATION CHEhHCAL

NAL ANQ INFANT CARE.

'

ALDAN'(

Nh.CON

MILK,fOOO, a SHEU... GRATtON.

P.ERSONAI. SERVICES

FISH SANITATION.

CASE REGlSTEnS.

MEDICAL.

WAYCROSS
tHsmunON LAe-

COMh!UNITY, SCHOOL TRAINING. 6CAMPSAH!Th.TION. BATTEY STATE

NURSING INOUSTRIAL H'I'GIENE

ORATORIES: ALTO

MALARIA CONTROL; HOSPITAL. PHOTOGRAPHING a

LABORATORY

OATTEY

MAPPING.

BEOOIHG SANITATION.

~
:::-

"'-..'/
DIVISION OF

::::::::-:::==::::::~

LOCAL HEALTH

COMMUNICA5LE

VENEREAL

DISEASE CONTROL, DISEASE CONTROl..,

TYPHUS ClONTROI., ALTO NEOICAL

CANCER CONTROL._ CENTER.

WALARIA AND

HOOKWORM. '

ORGANIZATIONS

(INCLUDING MENTAL HYGIENE)

LOCAL REGISTRARS

dlL

df9"

~

IrRIIl' I a a CLINICS SURVEYS PNEUMOTHORAX
FNEUMOPERITONEUM TREATMENT CENTERS

DENTAL CORRECTION CLINICS

(co, ~ a UNTLYOCDAILSTRICT

H I (I

HEALTH DEPARTMENTS ~)--l VENEREAL DISEASE TREATMENT CENTERS

-

SIX REGIONAL STAFFS
~TY ~URSES a MATERNAL CHILD
HEALTH CENTERS

CANCER TREATMENT CENTERS

ADULT AND SCHOOL
HEALTH EDUCATION. HEALTH PU8LICATIONS, fllh!S, EXHIBITS, POSTERS.

I

I

I

TABLE OF CONTENTS

Page Local Health Organization .................................. .

Cancer Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1-

Health Education

27

Dental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Public Health Engineering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Water Pollution Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Hospital Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5+

Industrial Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Maternal and Child Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9+

Mental Hygiene ........................................... 10+

Personnel Administration .................................... 107

Public Health Nursing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Tuberculosis Control ....................................... 118

Battey State Hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Typhus Control Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

Venereal Disease Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Vital Statistics ............................................. 147

BRIEF HISTORY OF PUBLIC HEALTH IN GEORGIA
England set a fine example of early public health effort by appropriating, in 1732, 13 guineas ($62.40) for the relief of sick mothers during passage to the province.
Colonial records for 1739 reveal that 40 pounds, 17 shillings, 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 States to require registration by law.
In 1843, there was an enactment by the General Assembly requiring that a supply of smallpox vaccine matter be purchased and supplied to the people of the State free. Later, in 1866, the Legislature passed an 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 $1,000.00 a year. The program consisted of prevention of disease, promotion of public health, and the collection of vital statistics.

Records show that Dr. 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 lYiacon.
On October 30, 1876, the Savannah JVlorning News stated that 8,000 refugees had left Savannah, and that the loss to the city was over one-half million dollars. The same article stated that Savannah had spent $120,833.00 for charity during the epidemic. That year, only $1,000 was spent for public health in the entire State!
The next outlook for public health work in Georgia was even darker, as no appropriation was made for the continuation of the work in 1877. Records for that period, furnished every ten years by the Census Bureau, show a constant increase in deaths from the more serious public. health problems. Typhoid fever, malaria (then called bilious fever), and smallpox raged. Pellagra and hookworm disease were making their appearance.
Georgia was without a public health program twenty-six years. The second State Board of Health was organized September 10, 1903, under an act of the Legislature. An appropriation of $3,000 was made and Dr. H. F. Harris was elected Secretary at a s~lary of $2,000 yearly. The remainder of the appropriation was used in the general work of the Board.
Doctor Harris, using a microscope and other apparatus of his own, began operation in one small room in the basement of the Capitol in 1904. His first work wes devoted. to bacteriology and the control of smallpox and yellow fever. He also did a vast amount of research in an effort to determine the cause of pellagra.
A laboratory was opened in 1905. With assistance, Doctor Harris expanded his activities to include the manufacture of Pasteur treatment in 1908; diphtheria antitoxin in 1909; and typhoid vaccine in 1912.
The first full-time county health project was established in Glynn County in 1914. Later in the year, the Ellis Health Law was passed, thereby

creating a board of health in every county in the State. This law further provides for the employment of a full-time county health officer upon two successive recommendations of the grand jury. Following the passage of this law, Glynn and Floyd Counties adopted its provisions.
At a meeting of the State Board of Health, in January of 1914, Doctor Harris expressed a desire to retire from public health work as soon as he could be relieved of his duties without prejudice to the work, in order that he might devote his entire time to research.
At a meeting of the State Board of Health in July of 1917, Dr. T. F. Abercrombie, formerly Commissioner of Health of Glynn County, was elected Secretary. After 30 years of service, Dr. Abercrombie was made Director Emeritus and Dr. T. F. Sellers, formerly Director of Laboratories, was elected Director of the State Department of Public Health.

STATE OF
GEORGIA
COUNTIES WITH BUDGETS
FOR
HEALTH SERVICE
AS OF DECEMBER 31, 1949

LEGEND :

l!llllll SINGLE-COUNTY UNITS

s

MULTI-COUNTY UNITS

~ NURSING SERVICE

CJ NO BUDGET

LOCAL HEALTH ORGANIZATIONS
GUY G. LUNSFORD, M.D., Director

W. D. Cagle, M.D. W. B. Harrison, M.D.
S. C. Rutland, M.D. .
~'W. D. Lundquist, M.D. 0. F. Whitman, M.D.
H. T. Adkins, M.D.

. Northwestern Region . Northeastern Region . West Central Region . East Central Region . Southwestern Region . Southeastern Region

"Adequate protection of the Nation's health is essential to the security and well-being of our country and cannot be achieved unless basic public-health services are available in every locality through adequately staffed and properly equipped local public-health units."
June 30, 1949, marked the first decade of the operation of the regional offices, which were instituted to decentralize the public health program con" ducted by the Georgia Department of Public Health and to bring the workers offering consultant and supervisory services closer to the communities and the persons with whom they work. The regional staffs also render limited direct services where there is no local public health personnel. The administration of these offices is through the director of the Division of Local Health Organizations.
The original plan of operation called for medical, nursing, and sanitation personnel, with the necessary clerical help; to this have been add9d nutritionists and communicable disease investigators. There were 33 persons in the regional offices in 1939. On December 31, 1949, there were 75 persons assigned to the regional staffs.

During 1949 there were 11,458 visits into the counties by the staffs of the regions, ra' nging from 11 visits to one county (a health-officer county)
to 296 visits to another county (also a health-officer county), the median
being 63 visits and the average 72 visits per county for the State as a whole.

*Doctor Lundquist 'elected to report for duty January 1, 1950.

2 ANNUAL REPORT, 1949
The purposes of the visits varied greatly, depending on the local situation and the problems.
The program of the regional offices has been developed in such a way as to make it possible to increase the supervisory and consultant services available to local personnel, as well as the direct services to the communities. There has, been improvement in coordination of the programs of the other divisions of the State Health Department and the local health departments through the Division of Local Health Organizations, including the regional offices.
A method of coordinating and strengthening the services rendered to the local health departments has been by regular meetings of the public health personnel within. the several regions. The medical directors also meet together regularly with the director of the Division of Local Health Organizations to discuss common problems and to plan for the general public health program as it affects the local health departments in all sections o{ Georgia.
In-service training, an essential program in progress for a number of years, was expanded during 1949 to include the clerical personnel of the regional and local health departments. Smoother and speedier operation . of work in those offices where this has been done has proved the value of the program.
Every activity must have some one whose duty it is to guide and coordinate the program. This is the role of the Division of Local Health Organizations; the public health work is done by the workers in the local communities. Although more professional assistance is needed in the central office, the division director thinks it more important to first provide personnel for the local health departments and t]fe six regional offices of the Georgia Department of Public Health. The need for additional professional
personnel continues a major problem, and the program of recruiting has
been intensified. The activation of the Retirement System, established by the 1949 Legislature, will aid in this endeavor. An adequate salary scale would help materially.
HEALTH CENTER FACILITIES
Another deterrent to public health in Georgia is the poor physical facilities in many counties: 2 or 3 rooms in the basement or attic of the courthouse or over a store building 'located on an all~y or in a slum area. The health departments in 4 counties are housed in buildings formerly used

LOCAL HEALTH ORGANIZATIONS 3
as jails. The furniture often has been discarded by some otlier department of the county government.
Progress is being made in this respect. 'When funds under the Hil1Burton Act were available (October 1947), 24 health centers and auxiliaries were reported as adequate; 4 of these have already been found to be inadequate for the growing program. Since 1947, 3 auxiliary centers have been built and paid for entirely from local funds, and 15 health centers and auxiliaries have been built or are under construction, and -14 centers have been approved for grants-in-aid from Federal funds provided by the HillBurton Act and more recently by the Georgia Legislature (1949). Other applications are being filed for processing, pending availability of funds in the new fiscal year.
One of the forward steps in the program of decentralization of State health services during its first decade was the erection of modern buildings to house the offices for the Southeastern, Southwestern, and vVest Central Health Regions. A building is urgently needed for the East Central Region, and the need is only slightly less for the Northeastern Region. The Northwestern Region is housed in the administration building of the Battey State Hospital and it will probably be some years before this is changed. The branch laboratories are also housed in the regional buildings at Albany,
. Macon, and vVaycross. '
LOCAL HEALTH SERVICES
Progress in the organization of local health departments is shown by the fact that in 1939 there were 52 counties with budgets for health departments, covering 57.9% of 'the population. On December 31, 1940, there
were budgets for health departments in 55 counties, covering 60.7%
of the population. The program of grants-in-aid to counties for nursing service was started on July 1, 1939; at the end of 1949, 53 counties had budgets for such service. In addition, 92 counties had adopted budgets for full-time health departments, leaving only 14 counties without budgets for local public health services. However, vacancies existed in 17 counties. On December 31, 1949, 128 counties had local public health personnel,' serving 90% of the citizens of Georgia; a total of 848 persons were employed fulltime in these counties. An additional 6% (17 counties) had budgets for services with existing vacancies, leaving only 4% ( 14 counties) without budgets for local public health work.
Although progress in providing public health services has been made, only 12 health departments were staffed with what is considered the minimum for adequate service: one full-time medical officer for each 50,000

COMPARISON OF DISTRIBUTION OF ACTIVITIES FOR SPECIFIED PHASES OF PUBLIC HEALTH PROGRAM

""'

IN GEORGIA FOR YEARS 1939 AND 1949

1939

1949

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HYGIENE 21 '"4

LOCAL HEALTH ORGANIZATIONS 5

DEATH RATES FROM DIPHTHERIA 1923-1949
and
NUMBER OF IMMUNIZATIONS GIVEN BY HEALTH DEPARTMENTS

RATE
Per 100.000

NUMBERS
(Tho!Jsonds)

IIIII

70

I

-Death rote per 100,000 population 1- - - - Number of immunizations in thousands

_j I 65

I

:I 60

-

,",

-LI

55

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~ " YEAR 1923

1926

1929

1932

1935

1938

1941

30
- 25

20

- t5

A

10

5

1944

1947 1949

Graph No.2

6 ANNUAL REPORT, 1949,
persons, one nurse for each 5,000 persons, one sanitarian or public health engineer for each 20,000 persons, and one clerk for each 15,000 persons (according to the American Public Health Association).
GENERAL PUBLIC HEALTH PROGRAM: An efficient public health department conducts a well-rounded program. By this is meant that each problem or menace to the health of the citizen, regardless of age, sex, race, and economic status, is given the attention its importance demands. A public health department should be alert that a public health menace, actual or potential, is not neglected in favor of problems of lesser importance because these happen to be spectacular. Graph No. 1 shows the percent of attention, as indicated by visits, given to the several phases of public health during the years 1939 and 1949. During 1949, the personnel of the regions and the local health departments made more than one and one-third million office, clinic, and field visits at which time individual and direct services were rendered to the citizens and to the community. The distribution of public health services shown in 1949 is not the ideal, but it more nearly reaches the ideal than in former years. A larger percentage of services is shown for the control of tuberculosis, and for maternal, infant, preschool, and school hygiene. Fewer cases of the common communicable diseases were admitted to health department service in 1949 (13,767) as compared with 1939 (16,424). Decreasing morbidity and mortality rates indicate that these diseases are being controlled; this is also evidenced by the fact that only 2% of the visits by public health personnel were directed toward this particular phase of the program. Venereal disease cases are treated at the rapid treatment centers, thus requiring less service from the local health departments.
Diphtheria 17{lmttnization. Another evidence of the progress in the control of communicable diseases is shown by the comparison of deaths per 100,000 population from diphtheria with the number of children immunized in health department fa:cilities each year from 1923 through 1949, as shown by Graph No. 2. In 1923, 4,600 children were immunized, and the death rate was 9.5; as the number increased to reach nearly 70,000 immunized in 1949, the death rate dropped to 0.6 per 100,000. While improved methods of diagnosis and treatment account for some reduction in number of deaths from diphtheria, there can be no doubt that the immunization program is the principal cause for this. The number of immunizations reported here are those administered by the local health departments. Although there i$ no record, observation has shown that immunizations by private physicians increase or decrease in direct ratio to those done by the health departments. ,
One disturbing fact is that only about one baby in four born in Georgia is immunized before he is one year of age. Counties. with health depart-

.
LOCAL HEALTH ORGANIZATIONS 7
ments show a much higher percentage of babies immunized during the first year of life.,
A study of the number of visits made in 1949 by or to patients receiving one of the 13 principal services rendered by the public health departments
shows the average number of visits per case was 2.90, ranging from 1.55 visits per case for communicable disease control to 5.26 visits per maternity
case. There are no recognized criteria for the ratio of visits per admission, as the problems vary with the different communities as well as from year to year. However, in order that the local health departments in Georgia may measure their activities, the average for the State of Georgia for the year 1949 is shown. See Table No. 1.
Over the years one of the major problems of the local health departments has been the inability to secure personnel. The director of the Division of Local Health Organizations feels that with personnel, he could immediately get complete coverage of the State on the local level. Better salaries, more adequate and suitable housing for local health departments, and additional financial aid from the Georgia Legislature and by passage of the Local Health Services Act by the United States Congress will do much toward bringing about the greatly needed coverage of the State with at least the minimum adequate local health services which are being demanded by a public-health conscious citizenry.
Six public health physicians in Georgia have already been accepted as founders or charter members of the newly-created American Board of Preventive Medicine and Public Health; others will be accepted before the deadline of July 1, 1950. It is anticipated that this recognition of preventive medicine and public health as a medical specialty will influence more physicians to enter this field.

CXI

TABLE NO. 1

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NUMBER OF ADMISSIONS TO SPECIFIED SERVICES AND NUMBER OF VISITS BY LOCAL PUBLIC

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HEALTH PERSONNEL FOR YEARS 1939, 1944, AND 19491 WITH RATIO OF VISITS PER ADMISSION FOR YEAR 1949

r-
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"'1:1

Service

1939 Admissions Visits

1944 Admissions Visits

1949 Admissions Visits

Ratio of Visits per Admission

0
~...

Communicable Disease Control ........ . 32,058 52,539* 10,880 20,413"' 13,767 21,388 Venereal Disease Control. ............ . 38,858 559,063 52,799 815,407 48,583 193,835

1.55

.".(.).

3.99

"()

Tuberculosis Control ................ . 23,458 108,702 23,653 111,793 73,226 147,419

2.01

Antepartum Service ................. . 19,381 106,749 25,134 142,175 26,604 140,060

5.26

Postpartum Service# ................ . 10,059 29,252 18,662 40,470 23,328 46,198

1.98

Infant Hygiene ..................... . 21,168 80,207 32,855 121,434 42,971 156,526

3.64

Preschool Hygiene .................. . 19,265 61,973 27,862 91,036 37,981 124,025

3.27

School Hygiene# ................... . 20,492 60,225 18,649 48,100 12,926 44,813

3.47

Morbidity Service ................... . 11,044 110,572 17,108 43,223 24,516 56,042

2.29

Cancer Control Service ............... . 471

1,318

653

2,044

1,087

2,838

2.61

Crippled Children Service# ........... . 363

2,062

654

2,190

1,263

3,791

3.00

Dental Correction Service ............. . Mental Hygiene .................... .

-

-

-

-

16,187 38,093

2.35

985

3,360

3.41

Sanitation Ii1spections ................ .

398,637

492,649

326,042

~Includes Field Visits Only. #Admissions to Nursing Service Only. -Dental Correction Service First Reported in 1949. -Mental Hygiene Service First Reported in 194-8.

RECORD OF BUDGETS ADOPTED FOR COUNTY HEALTH DEPARTMENTS IN GEORGIA 1915- 1949

Year
1915 1920 1925 1930, 1935 1940 1945 1946 1947 1948 1949

Number Organized Counties
2 18 23 34 31 55 61 66 75 87 92

''U. S. Census.

Number Persons Employed
5 42 71 205 233 498 620 690 741 805 798

Population Served*
17,545 436,106 598,107 1,011,974 1,327,018 1,893,441 1,996,288 2,048,650 2,188,316 2,341,561 2,404,413

Total Budget
$ 4,637.00
72,695.00 179,812.00 451,217.00 459,292.00 1,066,126.20 1,627,968.30 2,001,143.16 2,333,981.01 2,752,916.20 2,828,654.61

Per Capita

County Budget

Per Capita

.26 $ 4,637.00

.26

.17

70,895.00

.16

.30

168,272.00

.28

.45

440,904.00

.44

r-

.35

399,256.00

.30

0

.56 .82 .98

785,049.20

.41

I ,223, 465.39

.61

1,421,189.05

.69

0 )> r:I: m

1.07

1,756,428.68

.80

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1.18

1,947,934.45

.83

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1.18

2,142,248.25

.89

0

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CANCER CONTROL

WILLIAM J. MURPHY, M.D., Director

The Cancer Control program continued to expand during 1949. The number of applicants for state aid totaled 3,748 as compared with 3,464 in 1948, an increase of 284 (8.2%).

The continued increase in the patient load has caused a sharp rise in the cost of the program. During the 3-year period, 1947-9, the increase in cost averaged more than $45,000.00 per year. Expenditures for diagnostic and treatment services during 1949 amounted to $255,030.08 as compared with $214,472.82.in 1948 and $161,442.03 in 1947. In Table I is shown the expenditures for 1949 according to the services rendered. Table II shows the expenditures for malignant and nonmalignant cases by clinics.

In view of the rapid and continued rise in the cost of the program, the

0

Cancer Commission met in l\!Iacon during the summer and considered ways

and means by which expenditures might be reduced or, at least, kept from

increasing still more. Subsequently, instructions were prepared for local

welfare workers for the purpose of having applicants screened more rigidly.

The instructions were distributed in September through the State Welfare

office. Some weeks later a similar but condensed set of instructions was

mailed to the physicians of the State. At the close of the year it appeared

that the upward surge in the cost of the program had been checked or, at

least, slowed down.

The tumor clinic at Crawford W. Long Memorial Hospital was approved in January. With this addition, there are now 17 state-aid clinics cooperating in the program.

Miss Delores Howley, a consultant nurse of the U.S.P.H.S., has been assigned to Georgia for the purpose of organizing and coordinating public health activities in cancer control at the local level. She reported for duty in September and will remain with this department at least one year.

Three thousand subscriptions to the Cancer Bulletin (formerly the Texas Cancer Bulletin) were purchased for distribution to the physicians of the State. This bulletin was substituted for the Illinois Cancer Bulletin which had previously been distributed by the Georgia Division, American Cancer Society.

TABLE I

EXPENDITURES ACCORDING TO TYPE OF SERVICE RENDERED BY CLINICS

--

1949

-

--- --

------

~~--

Chg. 1 Hosp.

Hospital Board Out- Day-Out- Biopsies Diagnostic Radium X-Ray Others

Cost Side Hosp. Patients

X-Rays

Therapy

Total

Americus. ______ Athens _________ Augusta ________ Canton_________
Columbus. _____ Crawford Long__ D a l t o n _________ LaGrange _______ Macon _________
SRaovmanen.a-h-_-_-_-_-_-_-_Sheffield ________
St. Joseph ______ Thomasville _____ Valdosta________ Waycross _______ Winship ________

6,565.50 10,892.00 34,496.00 4,270.00 7,007.00 6,342.50
700.00 10,290.00 19,368.00 3,682.00 11,851.00 12,300.00 6,356.00 15,927.00 3,129.00 1,806.00 7' 784.00

850.00
921.00
645.00
70.00 52_90 1,531.50 3"so~oo 680.50
------
107.15
8.00

Totals---------- $162,766.00 $5,246.05

----------14.00

10.00

7.00 ------

234.50

-----------

------

-----------

------

-
$265

- 0 so

612.00 1,224.00

640.00

613.00

919.31 441.68

2,962.39 3,705.23

-------
99.00

13,133.20 16,390.91

1,692.00 2,918.00 104.00 265.00

2,345.19 218.62

4,279.07 2,144.87

-------
9.00

46,651.26 7,025.49

361.00

823.10

448.27 3,414.45 12.85 12,711.67

276.00 485.00

45.00 596.96 ------- 7,755.46

68.00

132.00

332.25 1,914.25 ------- 3,216.50

464.00

591.00 1,182.23 3,876.25 ------- 16,463.38

1,464.00 2,411.00 4,302.87 4,692.08 ------- 33,769.45

198.50 168.00

284.89 1,293.73 ------- 5,627.12

988.00 1,144.00

416.90 2,980.95 ------- 17,995.35

676.00 400.00 376.00 344.00 192.00

1,964.00 737.00
1,130.00 571.00 152.00

332.25 120.75 582.19 147.75 795.75

5,057.34 ------546.50 -------
4,469.50 ------1,410.75 ------2,654.75 -------

21,010.09 8,160.25 22,580.69 5,709.65 5,600.50

nz~
m
;;tl

244.00 429.00

78.37 2, 781.74 ------- 11,325.11 n

$9,099.50 $15,757.10 $12,994.27 $48,780.81 $120.85 $255,030.08

0z
-1

;;tl

r0 -

......

...
N

TABLE II

/ z)>

SUMMARY OF PEOPLE ON WHOM BILLS WERE PAID WITH COST FOR CALENDAR YEAR

z
c

1949

)>
r-

-

--------

:m:0

"1:1

Clinics

Malignant

Non-Malignant

Malignant and Non-Malignant

0
~...

No.

Average No.

Average No.

Average loO

Cases Amount

Cost Cases Amount

Cost Cases Amount

Cost

""loO

Americus ____________ Athens ______________
A u g u s t a _____________ Canton______________

165 160 351 136

Colmbus ____________

94

Crawford Loi}g_______ Dalton ______________

39 62

LaGrange ___________ Macon ______________

170 400

SRaovmaen_n_a_h-_-_-_-____-_-_-_-_-_-_-

68 176

Sheffield_________ -_-_ 188

St. Joseph ___________

56

Thomasville_______ --_ 243

Valdosta_____ ________ ' 76

Waycross ____________ Winship _____________
To tal ___________ :_ ___

128 132
--
2,644

9,686.62 11 '264. 64 34,452.38 4,977.99 9,393.63 6,124.46 2,816.50 13,155.63 24,969.95 3,902.60 12,950.80 15,878.72 5,961.50 18,492.59 3,792.15 5,056.00 8,6'74.49
$191,550.65

58.71 70.40 98.15 36.60 99.93 157.04 45.42 77.39 62.42 57.39 73.58 84.46 106.45 76.10 49.90 39.50 65.72
--
$72.45

107 100 190 60 51 24
8
75 233 32 159 109 56 69
55 29 53
--
1,410

3,446.58 5,126.27 12,198.88 2,047.50 3,318.04 1,631.00
400.00 3,307.75 8,799.50 1 '724.52 5,044.55 5,131.37 2,198.75 3,992.10 1,917.50
544.50 2,650.62
$63,479.43

32.21 51.26 64.21 34.12 65.06
67.96 50.00 44.10 37.76 53.89
31.73 47.08 39.26 57.85 34.86 18.77 50.01
--
$45.02

272 260 541 196 145 63 70 245 633 100 335 297 112 312 131 157 185
--
4,054

13,133.20 16,390.91 46 '651. 26 7,025.49 12,711.67 7,755.46 3,216.50 16,463.38 33,769.45 5,627.12 17,995.35 21,010.09 8,160.25 22,484.69 5,709.65 5,600.50 11,325.11
$255,030.08

48.28 63.04 86.23 35.84 87.67 123.10 45.95 67.20 53.35 56.27 53.71 70.74 72.86 72.06 43.58 35.67 61.22
--
$62.91

I
CANCER CONTROL 13
Two new cancer films, "What Is Cancer" and "Breast Cancer: The Problem of Early Diagnosis," were purchased. The first of these is intended primarily for nurses while the second was prepared for showing to physiCians.
A summary of activities for 1949 is shown in Table III.

TABLE Ill
SUMMARY Of ACTIVITIES 1948-1949

11 pplications:
Total received ...................... . Number approved ................... . Number disapproved ................. . Counties represented ................. .

1948
3,464 3,457
7
156

Cases Given Financial 11id:
Total number ...................... . Malignant ......................... . Non-malignant ..................... .

3,618 2,197 1,421

Amount of Financial/lid:

Total amount given ................... $214,472.82

Average amount per malignant case......

75.51

Average amount per 'non-malignant case. .

34.21

Other 11 ctivities:
Addresses made ..................... . Other meetings attended .............. .
Clinic visits and consultations .......... . Articles written ..................... . Literature distributed ................ .

16 14
65
6
7,908

1949 3,748 3,740
8 158
4,054 2,644 1,410
$255,030.08 72.45 45.02
17 15 43
6 4,621

EPIDEMIOLOGY
WILLIAM J. MURPHY, M.D., Director
PERSONNEL AND FACILITIES
Personnel assigned primarily to general epidemiologic actiVIties (apart from the specialized work of the Cancer Control Service and the Rabies Control Service) which is reported separately, consisted in 1949 of the director of the Division, an assistant director ( USPHS), a research epidemiologist assigned to directiol:!- of field biological studies, two field biologists, a field nurse and a secretary. Three part-time biologists were employed for research studies during the school year and four temporary workers were used in field studies during the summer. An office was maintained in Waycross until the end of 1949 at which time all administrative activities were combined in Atlanta. In mid-year, the assistant director was recalled by the U. S. Public Health Service and his duties were assumed by the research epidemiologist.
DIVISION ACTIVITIES
WORK OF THE STATE EPIDEMIOLOGIST: The office of the State Epidemiologist continues to act as a clearing agency for epidemiologic information. Reports received from practicing physicians are examined and forwarded to the Central Statistical Unit for tabulation. Reports from this source are forwarded each week to staff personnel, health officers and regional directors. Regional Medical Directors aid the Epidemiologist by direct investigation of cases of preventable diseases and by guiding non-medical epidemiology personnel in epidemic investigations.
MORBIDITY REPORTING: A study of morbidity reporting in one health region was made during 1949 for the purpose of planning a more effective reporting program. This study will be continued in a modified form during 1950 since results, while encouraging, do not as yet provide an adequate basis for modification of existing procedures.
EPIDEMIOLOGIC INVESTIGATION: Two investigations of gastroenteritis outbreaks were made by the director and will be reported in detail by publication. Convincing evidence of the implication in the outbreaks of organisms of the paracolon group was found.

EPIDEMIOLOGY 15
An epidemic of unexplained illness occurring in Emanuel County largely involved young men who had been swimming in, fishing in, or working near the Ohoopee River. The disease has, therefore, been tentatively called Ohoopee fever and some evidence has accumulated that it is produced by infection with one of the strains of the so-called CO..xsackie virus which had previously been isolated only in association with polio-like epidemics. Coxsackie virus was found in 7 patients, but there was no paralysis and all patients recovered. Headache, high fever, nausea, and severe and persistent vomiting were the most common symptoms reported. Four patients out of a total of 16 were hospitalized. Three of these required intravenous fluids because of serious dehydration and a fourth was provisionally diagnosed as a polio case in Indiana, to which state he had gone while in the incubation period of the disease. The study is being continued and virus isolation from several other of the original patients is possible, since these cultures are still being run. All patients with suspicious illnesses in the area are being given special attention in an effort to make additional virus isolations and immunologic studies.
POLIOMYELITIS ACTIVITIES: The number of cases of poliomyelitis in Georgia in 1949 (227) was approximately equal to the number occurring in 1948. Despite this absence of epidemic conditions in Georgia, the Epidemiology Division was compelled by national conditions to devote considerable time to answering telephone and other inquiries concerning the incidence of the disease in other sections. This information was desired chiefly by those planning to have visitors from affected states or to travel in those states. Maps of the most important areas were therefore prepared and corrected at approximately weekly intervals as a basis for advising those interested.
HOOKWORM CONTROL: The Division of Epidemiology inherited the personnel of the old Division of Malaria and Hookworm Investigations and with it responsibility for hookworm control. Despite the strides m~de in recent years, the epidemiology of this parasitic infection is not entirely clear and problems exist with regard to every phase of-the control program. The public health importance of the disease is indicated by the fact that in South Georgia 62% of all nursing home visits for communicable diseases were made to hookworm families. This figure represents the practices and opinions of local health personnel and is not a reflection of promotional activities or pressures by hookworm control personnel. State workers assigned to hookworm control in 1949 have confined 'themselves largely to aiding the county departments most in need of assistance because of heavy case loads. Approximately 15,000 cases were reported in 1949. A new intestinal para-

16 ANNUAL REPORT, 1949
site laboratory information blank scheduled for use some time in 1950 will greatly facilitate reporting of all parasitic disorders.
RESEARCH ON HELMINTH DISEASES: A study of the relationship between nutritional status and hookworm "immunity" was carried on in collaboration with the microscopy section of the Waycross Branch Laboratory and with Maternal and Child Health personnel. This study seems to indicate that one practical approach to hookworm control lies in the use of relatively inexpensive dietary supplements. Work on this project is being continued and will be pushed vigorously in 1950 if circumstances permit.
A new pinworm outfit was devised and tested in 1949 in collaboration with the microscopy section of the Central Laboratory and a special study of the applicability of egg counting methods to helminth infections other than hookworm was made.
MALARIA: Eighty-eight cases of malaria were reported by physicians in Georgia in 1949. Each of these cases was queried, if necessary, to complete epidemiologic and laboratory data and replies were carefully studied and classified. Twenty-nine cases classified as "positive" were in persons who had been outside the United States in recent years. No instance of local transmission of malaria could be substantiated through analysis of reports, nor were any cases found by examination of more than 2,000 thick films from areas in which malaria had been suspected. On the other hand, studies on anopheline mosquito population indicate that an increase in the number of)arm ponds has actually created conditions more favorable for the production of Anopheles quadrimaculatus than those prevailing a few years ago. In the face of this uncertain situation, control and surveillance activities cannot be reduced below a level which would permit rapid restoration of an effective control organization.
ROCKY MOUNTAIN SPOTTED FEVER: A continuing study of the incidence, identification and control of rickettsial diseases has characterized the work of the Health Department in recent years. In 1949 renewed effort was made to find all cases of spotted fever and to differentiate between this condition and endemic typhus. While the two diseases present almost identical treatment problems, they are very unlike epidemiologically and require dissimilar control programs. Control measures directed against typhus are discussed in the report of the Typhus Control Service.
Twenty-eight cases of Rocky 1\!Iountain spotted fever were reported in 1949. Seventeen cases have been completely or partially confirmed by complement fixation tests. The majority of these cases were treated with

EPIDEMIOLOGY 17
aureomycin at an estimated cost for drugs ranging from $10.00 to $30.00 per case or chloromycetin at a slightly lower average cost. By comparison, the cost of 25 lbs. of 10% DDT dust for use in treating one acre for the control of ticks is $1.37. Despite the effectiveness of the newer antibiotics, studies on tick control have been continued in order 1:,9 provide the means of recognizing and eradicating endemic foci of Rocky Mountain spotted fever before the disease can become well established and to develop methods suitable for use by individuals in protecting home sites against dangerous tick infestations. A complete report of 1949 tick studies has been prepared for publication and a mimeographed abstract will shortly be available for distribution.
EASTE.RN EQUINE ENCEPHALITIS: Three fatal human cases of this disease occurred in Georgia in 1949 and the infection was widespread in horses and mules. Early in the year, field studies in which the Division participated revealed that Mansonia perturbans, a common pest mosquito, is infected naturally with the virus of E.E.E. in Burke County, Georgia. A study of mosquito vector and host relationships was, therefore, undertaken
' in an effort to clarify the epidemiology of this extremely serious infection
in Georgia. It now appears that migratory aquatic birds may be the reservoir hosts of Eastern equine encephalomyelitis. Identification of all the bird and mosquito species involved remain~ to be made and this phase of the study will be resumed as soon as personnel becomes available. The veterinary medical aspects of this problem are further discussed in the report of the Veterinary section.
ENTOMOLOGICAL FIELD STUDIES: Work on methods of mosquito and fly control has been continued in association with the Dougherty and lVIuscogee County Health Departments, respectively. In both cases the purpose of the study is to aid local health departments in discharging satisfactorily and economically responsibilities which have grown out of malaria control and environmental sanitation programs. The services rendered are advisory only.
ANALYSIS OF STATISTICAL REPORTS
A table of data on the morbidity and mortality rates of reportable diseases for the years 1940-1949 follows these comments. To avoid repetition and a fictitious appearance of accuracy in summarizing data on diseases not well reported, only selected diseases requiring especial comment or explanation will be considered in detail.
In order to show as simply as possible the trend of each disease discussed
.. ,

18 ANNUAL REPORT, 1949

below, the five year median numbers of cases and deaths, the number o cases and deaths in 1949, and the percentage changes from 1948 are shown.

DIPHTHERIA: Cases
Median (1945-1949) . . . . . . . 437 Reported in 1949 .......... 393 Percentage decrease since 1948 15.8

Deaths
Median (1945-1949) ....... 42 Reported in 1949. . . . . . . . . . 21 Percentage decrease since 1948 25.0

Diphtheria cases decreased in 1949, falling below the median number of

cases for the period. The number of deaths decreased also to maintain a

trend which has continued for some years. The fatality rate is the lowest

of record.

DYSENTERY: Cases

Deaths

Median (1945-1949) ....... 301 Median (1945-1949) ....... 44 Reported in 1949 .......... 466 Reported in 1949 . . . . . . . . . . 44 Percentage increase since 1948 54.8 Percentage decrease since 1948 17.0

Dysentery cases increased in 1949 and exceeded the 1945-1949 median

but not the 1940-1944 median ( 543). Deaths fell slightly in 1949 to
establish a new median for the five year period.

HOOKWORM: Cases
Median (1945-1949) ..... 4928 Reported in 194.9 . . . . . . . . 17547 Percentage increase since 194S. 10.3

Deaths
Median (1945-1949)....... 0 Reported in 1949. . . . . . . . . . 1 Percentage increase since 1948

Hookworm continues to show an apparent increase in cases because of an improving reporting system. In 1941 it became the policy of the Department to report only cases having egg counts of 2,000 or more eggs per cc (fsb) by the Stoll dilution method. With the reduction of egg counting in 1946, a partial return to reporting of all positives found on salt flotation

was made. In 1948 all positives listed by the various laboratories were

reported for the first time since 1940. The present case total should there-

fore be considered only in terms of records previous to 1940, the 1936-

1940 median (17,307) providing the best base line for comparative pur-

poses. Hookworm case totals reflect not the prevalence of the infection

but the amount of laboratory work done and reported by the State labo-

ratories. In recent years tittle emphasis. has been placed by the Health

Department on case finding and the children and clinic patients examined

have been. tested because there were obvious reasons for suspecting hook-

work infection. A more inclusive examination policy would find many

more cases. The one death reported in 1949 is the first attributed to hook-

worm since 1943. Since the 1948 report was 0 deaths, the percentage

increase over 1948 is incalculable.

EPIDEMIOLOGY 19

MALARIA: Cases

Deaths

Median (1945-1949) ....... 67 Reported in 1949 . . . . . . . . . . 53 Percentage increase or decrease
since 1948 . . . . . . . . . . . . . . 0

Median (1945-1949) ....... 12 Reported in 1949. . . . . . . . . . 5 Percentage increase
since 1948 .............. 150.0

Reported malaria cases remained the same in 1949 to arrest a steady

downward trend of 10 years' duration. Only one case was confirmed by

laboratory examination. This patient was found on investigation to be a

student recently arrived in the United States from Puerto Rico. An exten-

sive thick film malaria survey around the Jim vVoodruff impoundment area

in Decatur and Seminole. counties included 2,025 slides and was entirely

negative. A 643-slide survey in Lincoln and Columbia counties was under-

taken because malaria positives had been found in a survey on the South

Carolina side of the Savannah River in this area which will be affected by

the Clarks Hill impoundment. Again all slides were negative on exami-

nation. The percentage increase in deaths is probably without significance

since the numbers involved are very small and the number of deaths is well

below the median for the five year period.

MENINGOCOCCUS MENINGITIS:

Cases
Median (1945-1949) ....... 59 Reported in 1949 . . . . . . . . . . 59 Percentage increase since 1948 28.3

Deaths
Median (1945-1949) ....... 20 Reported in 1949 . . . . . . . . . . 15 Percentage decrease since 1948 21.1

The number of cases of Meningococcus meningitis increased slightly in

1949 to establish a median level for the period which closely approaches

th_e median for the 1940-1944 period (53). These case totals are above

the pre-war median (35) but the number of deaths is below the current

median and the medians for the two preceding five-year periods. The

fatality rate continues to fall.

POLIOMYELITIS:

Cases

Deaths

Median (1945-1949) ....... 165 Median (1945-1949)....... 8 Reported in 1949 .......... 227 Reported in 1949. . . . . . . . . . 10 Percentage decrease since 1948 1.3 Percentage increase since 1948 42.8

Poliomyelitis cases in Georgia decreased slightly in 1949 despite the high

national incidence experienced. The influence of epidemic conditions else-

where is apparently discernible however in the upward trend of the past

several years. The number of deaths increased by 3 in 1949 to produce a

sharp percentage rise and the fatality rate increased slightly.

20 ANNUAL REPORT, 1949

TUBERCULOSIS:

Cases
Median ( 1945-1949) ...... 2894 Reported in 1949 ......... 2894 Percentage decrease since 1948 7.0

Deaths
Median ( 1945-1949) ...... 1048 Reported in 1949 . . . . . . . . . 946 Percentage decrease since 1948 5.2

Tuberculosis cases again decreased slightly in 1949 as survey campaigns

continued in smaller cities and rural areas where the incidence of tuberculosis is somewhat lower. The number of deaths continued the slow decrease which has been characteristic of tuberculosis in recent years. Progress is best measured by comparing the 1940-1944 median (1,304) with that shown above.

TYPHOID FEVER:

Cases

.

Median (1945-1949) ....... 90

Reported in 1949. . . . . . . . . . 90

Percentage decrease since 1948 10.9

Deaths
Median (1945-1949)....... 8 Reported in 1949 . . . . . . . . . . 11 Percentage increase since 1948 57.1

. J'yphoid fever which has declined year by year since 1934 with the exception 1938 (829 cases) and 1948 (101 cases) decreased slightly in 1949 to establish a new five-year median. Deaths showed a large percentage increase which represents an actual increase of 4 cases. The median number of cases for the five-year period 1940-1944 was three times that of the current five-year period.

TYPHUS FEVER:

Cases
Median ( 1945-1949) ....... 441 Reported in 1949 .......... 214 Percentage decr}ase since 1948 1.8

Deaths
Median (1945-1949) ....... 31 Reported in 1949. . . . . . . . . . 14 Percentage decrease since 1948 22.2

Endemic typhus cases decreased slightly in 1949 to continue the trend begun when control activities were undertaken. Prior to that time the trend was upward. Comparison of the 1940-1944 median with that shown

above indicates. the reduction experienced. As cases and deaths declined,

the fatality rate rose steadily but in 1949, probably as a result of the avail-

ability of new antibiotics, a break in this tendency is to be noted.

UNDULANT FEVER:

Cases
Median. (1945-1949) ....... 136 Reported in 1949 .......... 122 Percentage decrease since 1948 8.3

Deaths
Median (1945-1949) ....... 3 Reported in 1949. . . . . . . . . . 3 Percentage increase since 1948 50.0

Undulant fever declined slightly in 1949 as it did in 1947 and 1948.

"

-

"'....- f ' ~

EPIDEMIOLOGY 21
NUMBER OF CASES AND DEATHS FROM SPECIFIC NOTIFIABLE. DISEASES REPORTED IN GEORGIA
With Rates Per 100,000 Population and Per Cent Fatality Rate: 1945-1949

DISEASES 3
Diphtheria: (10)
Dysentery: (27a, b, c)
Gpnorrhea: (25)
Hookworm: (40)
Influenza: (33)
Malaria: (28)
Measles: . (35 & 38d)
Meningococcus Meningitis: (6)

CASES

DEATHS

Fatality

1

Rate

Year Nutnber Rate 2 Number Rate 2

1945 1946 1947 1948 1949
1945 1946 1947 1948 1949
1945 1946 1947 1948 1949
1945 1946 1947 1948 1949
1945 1946 1947 1948 1949
1945 1946 1947 1948 1949
1945 1946 1947 1948 .1949

695 371 437 467 393
313 214 154 301 466
12340 15282 12338 11000 10901
3799 4928 4321 15906 17547
3780 2279 6073 1351 1110
460 115 67 53 53
653 4184 3406 1481 9410

22.2 11.9 13.5 14.6 12.2
9.1 6.7 4.7 9.3 14.4
314.1 444.7 354.5 321.8 323.8
121.5 157.8 133.7 497.1 544.1
120.4 72.6 187.8 41.5 34.3
14.1 3.6 2.1 1.6 1.6
19.9 133.2 105.0 45.3 289.4

71

2.3 10.2

45

1.4 12.1

42

1.3

9.6

28

0.9

6.0

21

0.6

5.3

60

2.0 19.2

36

1.2 16.8

19 0.6 12.3

53

1.7 17.6

44

1.4

9.4

5

0.2

0.04

2

0.1

0.01

5

0.2

0.04

11

0.3

0.1

8

0.2

0.1

0 ---- ---0 ---- ---0 ---- ---0 ---- ---1 0.03 0.05

473 15.1 12.5

423 13.5 18.6

367 11.4

6.0

225

7.0 16.6

181

5.6 16.3

26

0.8

6.0

12

0.4 10.4

13

0.4 19.4

2

0.1

3.8

5

0.2

9.4

7

0.2

1.1

44

1.4

1.1

17

0.5

0.5

7 0.2 0.5

33

1.0

0.4

1945

117

3.6

1946

70 2.2

1947

53

1.6

1948

46

1.3

1949

59

1.6

38

1.2 32.5

31

1.0 44.3

20

0.6 37.7

19 0.6 41.3

15

0.5 25.4

22 ANNUAL REPORT, 1949
NUMBER OF CASES AND DEATHS FROM SPECIFIC NOTIFIABLE DISEASES REPORTED IN GEORGIA
With Rates Per 100,000 Population and Per Cent Fatality Rate: 1945-1249 (Continued)

DISEASES 3
Pellagra: (69)
Pneumonia: (107-109)
Poliomyelitis: (36)
Scarlet Fever: (8)
Smallpox: (34)
Syphilis: (30)
Tuberculosis: (13-22)
Typhoid Fever: (I)
-

Year

CASES Number

I
Rate 2

DEATHS Number Rate 2

Fatality Rate
---

1945

110

3.5

106

3.4 96.4

1946

107

3.4

93

3.0 86.9

1947

112

3.5

102

3.2 91.1

1948

95

3.0

79

2.5 83.2

1949

81

2.5

73

2.3 90.1

1945 1911 57.2 1500 48.0 78.5 1946 1947 59.4 1341 42.9 68.9 1947 1897 56.0 1294 40.0 68.2 1948 2318 66.7 1242 38.8 53.6 1949 2216 61.7 1204 37.3 54.3

1945

128

4.0

1946

165

5.3

1947

89

2.8

1948

230

7.1

1949

227

7.0

10

0.3

8.0

8

0.3

4.8

4

0.1

4.5

7

0.2

3.0

10

0.3

4.4

1945 1187 37.9

1946

503 15.9

1947

621 19.0

1948

853 26.6

1949

668 20.7

5

0.2

0.4

1 0.03 0.2

1 0.03 0.2

1 0.03 0.1

1 0.03 0.2

1945

10

0.3

1 0.03 10.0

1946 1947 1948 1949

3 0.1 3 0.1 1 0.03 0 ----

0 ---- ---0 ---- ---0 ---- ---0 ---- ----

1945 12224 380.2

358 11.5

2.9

1946 11477 357.5

309

9.9

2.7

1947 11103 335.8

322 10.0

2.9

1948 7963 243.5

267

8.3

3.4

1949 6317 191.3

281

8.7

4.4

1945 2112 66.6 1108 35.5 52.5

1946 2534 80.5 1048 33.5 41.4

1947 3324 102.1 1074 33.2 32.3

1948 3110 96.6

998 31.2 32.1

1949 2894 89.4

946 29.3 32.7

1945

168

5.4

1946

81

2.6

1947

74

2.3

1948

101

3.2

1949

90

2.8

23

0.7 13.7

8 0.3

9.9

8 0.2 10.8

7

0.2

6.9

11

0.3 12.2

EPIDEMIOLOGY 23 \
NUMBER OF CASES AND DEATHS FROM SPECIFIC NOTIFIABLE DISEASES REPORTED IN GEORGIA
With Rates Per 100,000 Population and Per Cent Fatality Rate: 1945-1949 {Continued)

DISEASES 3
Typhus Fever: (39a, b, d)
Undulant Fever: (5)
Whooping Cough: (9)

Year

CASES

DEATHS

1
Number Rate 2 Number Rate 2

Fatality Rate

1945 1946 1947 1948 1949
1945 1946 1947 1948 1949
1945 1946 1947 1948 1949

1111 606 441 218 214
151 169 136 133 122
921 615 1384 542 248

35.5 19.4 13.6 6.8 6.6
4.8 5.4 4.2 4.2 3.8
29.5 19.7 42.8 16.9 7.7

59

1.9

5.3

33

1.1

5.4

31

1.0

7.0

18

0.6

8.2

14

0.4

6.5

3

0.1

2.0

3

0.1

1.8

1

0.03 0.7

2

0.1

1.5

3

0.1

2.5

65

2.1

7.1

60

1.9

9.8

95

2.9

6.9

39

1.2

7.2

23

0.7

9.3

Rates for the years 1942 through 1949 are computed on state totals exclusive of cases reported for military reservations since populations include civilians -only.

2 Rates for the years 1940 through 1946 are computed on the enumerated census

population as of April 1, 1940. Rates for 1947, 1948 and 1949 are computed

on the estimated population as of July 1, 1947, 1948 and 1949.



I

3 International Disease Codes are shown in parentheses.

An upward trend had b'een noted prior to 1947. The number of cases
reported in 1949 approaches closely the median for the 1940-1945 period .( 123 cases). The small number of deaths reported makes percentage changes misleading.

WHOOPING COUGH:

Cases
Median (1945-1949) ....... 615 Reported in 1949 .......... 248

Deaths
Median (1945-1949) ....... 60 Reported in 1949. . . . . . . . . . 23

Percentage decrease since 1948 54.2 Percentage decrease since 1948 41.0

. Whooping cough declined markedly in 1949 for the second consecutive

year after a sharp upsurge in 1947. In the main there has been a reduction

in whooping cough in recent years as immunization practices have Jmproved,

24 ANNUAL REPORT, 1949
as comparison of the 1940-1944 median (1,369) with that shown above will indicate. The 1947 upsurge apparently refle<;ts the introduction of a highly infectious organism which produced a temporary increase without, however, revising the trend. Deaths also decreased in 1949.
VETERINARY PUBLIC HEALTH ACTIVITIES
EQUINE ENCEPHALOMYELITIS: Eleven proven cases of this disease in horses were found in the following counties: Jeff Davis, Thomas, Screven, Burke, Lowndes, Pierce, 'vVayne and Appling. A survey of Appling County was made by Dr. A. L. Stafford who tested at random 50 apparently normal horses in the county. Of these animals five had neutralizing bodies in sufficient titer to indicate prior exposure and probable immunity. One animal was in the acute stage of the illness but neutralizing bodies were demonstrated. This would indicate that the virus and vectors were prevalent throughout the county.
POULTRY: Two groups of poultry were investigated and blood samples drawn in communities in which there had occurred a mild outbreak of illness of unknown etiology in the human population. No connection could be established between the human illness and the chickens. Chicken blood is difficult to obtain in a satisfactory condition and quantity for testing and laboratory tests were inconclusive.
R'ABIES: The disease occurred sporadically in dogs in over 50 counties in the State, but reached epidemic proportions only in metropolitan Atlanta. Except for this area the disease showed a marked decline. According to laboratory records, 41% of the positive dogs found and 40% of the human treatments given were in this area. It is estimated that approximately 40% of the dogs in rural areas are vaccinated annually whereas in metropolitan Atlanta not over 20% of a numerous population are vaccinated. Destruction of stray clogs and vaccination of not less than 80% of the remainder appears to be the solution to this control problem.
AVIANIZED VACCINE: A new, living, chick embryo, fixed virus, antirabic vaccine (avianized) has been on field trial in the State during 1949. Because of the hesitancy by many of the v~terinarians of the State to adopt for use a new proprietary product, it was necessary for us to devote considerable time to professional work on this avianized vaccine project.
A total of 2,397 dogs have been immunized since May 14, 1949 by 12 veterinarians. These dogs have been checked closely and there have been only three incident; which may be attributed to the vaccine. One dog developed paralysis, but recovered, and two developed edema three days

EPIDEMIOLOGY 25
following immunization. One of these died and one recovered. The dogs wtih edema are suspected of having been previously sensitized to egg albu~ men and of reacting following injection of chick embryo proteins.
Nine dogs were immunized 14 days prior to being severely bitten by a presumably rabid fox November 1949. All remain normal to date. One
practicing veterinarian has immunized approximately 30 dogs up to 5 days
after exposure to rabid dogs or foxes. All are normal to date.
A total of 1,781 dogs, or all but 12 known dogs in Jasper County, were immunized without cost to the owner between October 12 and No~ vember 1, 1949. Rabies in foxes was quite common in portions of the county, but only one rabid fox has been reported since November 1949. This test is therefore inconclusive as yet.
A total of 121 cattle in 4 herds were immunized June 12 and 14, 1949. Cattle in 3 of the herds had died of rabies a few days prior to this time.
Fourteen to 28 days following immunization, 15 head in one herd died
after developing symptoms not typical of rabies in cattle. Negri bodies could not be demonstrated in the brains of these animals but mice inoculated intracerebrally with brain material died in from 6-9 days, although Negri bodies were still not demonstrable. On second passage Negri bodies were found in the brain of one mouse. In the final outcome rabies virus was recovered from 7 of 10 cattle brains. This virus had characteristics typical of street virus rather than of the fixed virus with which the cattle had been immunized. It is reasonable to assume that these animals were already infected prior to immunization and the introduction of a fixed virus vaccine resulted in what is known as an interference factor. Partial immunization appears to have resulted in an alteration of the street virus and the develop~ ment of atypical symptoms. The remainder of the cattle remain normal.
Part of one goat herd was immunized with no untoward incidents as the result of exposure.
RABIES CONTROL: Rabies control is still not in a satisfactory condition. Revision of the State Rabies Act and adoption of the avianized antirabic vaccine as the principal medium of immunizing dogs will greatly facilitate rabies eradication. Dog rabies has been very bad in Fulton and adjoining counties thruoghout the entire year but foxes do not appear to be involved. Fox rabies has been severe in the East Central and West Central areas of the State. Control programs with fox bounties have been in effect in 9 counties.
It should be noted that indifference toward dog vaccination has been on the increase in most counties. Free vaccination with avianized vaccine in infected areas appears to be the best solution.

N 0\

)>
zz
c

A STATISTICAL SUMMARY OF RABIES CONTROL IN GEORGIA BY REGIONS: 1949

)>
r-

:m::a

"tt

REGIONS

Dogs Vaccinated

POSITIVE HEADS 1

CLINICAL CASES

TREATED AFTER

d d~i-J

EXPOSURE

Sc:ld

Dog

'Fox --

Cat --

Cow --

Other --

- =::~"- '="'

Dog --

Fox --

Horse --

Cattle --

Hog
--

C -

at -

Dog --

Hog --

-Cat-tle

Horse
--

0
~
'0
"'"0"

State TotaL ____ 159,376 291 104 35 31 3 994 127 50 17 52 10 30 271 35 355 55

Northwestern ___ 44,153 164 0 9 2 0 438 54 0 0

1

0 0 66 0 34

2

Northeastern ___ 26,031 43 14 1 10 2 161 12 3 0

6

0 1 22 8 1

2

West CentraL __ 20,389 25 20 4 2 0 110

261

9

1 0 11 0 11

3

East CentraL ___ 25,402 24 35 6 8 .0 137 24 30 9 13

0 2 lOS 3 249 35

Southwestern ___ 26,739 17 35 8 9 1 79

7 11 7 21

6 1 40 1 60 13

Southeastern____ 16,662 17 0 7 0 0 69 28 0 0

2

3 26 24 23 0

0

LOne positive dog from Franklin, N. C. examined in Central Laboratory, included in state total only.

"'

HEALTH EDUCATION

C. D. BOWDOIN, M.D., Director

The Division of Public Health Education has operated on the premise that an informed and educated public will lead to a healthier public, and an improved human life. To make this theory a reality, a program of adequate information and cooperation with school and community groups has been adopted in an effort to stimulate a consciousness of better health on the part of the individual and the community.

With an organized plan of attack, the Division has resorted to the use

of all communication media, the training of health education per~onnel,

and the democratic principle of active participation on the- par.t of the individual and the group. Through visual aids the interest ~f individuals

has been stimulated. Through personal contact and assistance, group or-

ganization and progressive action has been effected.



The success of the program adopted is eviden<;ed by the ever increasing interest on the part of groups i~ all sections of the State. The Division has given all assistance possible, but the increased interest has surpassed the assistance facilities and a more thorough operation can be completed only with additional personnel.

INFORMATIONAL SERVICES
ART AND PHOTOGRAPHIC SERVICES: To me.et the demand for informatio.nal li~erature, two artists and a photographer are maintained by the Division. The serv_ices of this skilled staff are utilized in the preparation of illustrations for pamphlets, the lay-out for bulletins, and the working out of suggested ideas for exhibits and displays, cartoons, and related media.
PUBLIC INFORMATION SERVICE: The public information representative prepares weekly news releases to all newspapers in the State, acts as a consultant with each division on matters relating to preparation of pamphlets, speeches, books, exhibits, radio talks, posters, and interviews representatives of the press and radio. During 1949, newspapers in approximately 140 of Georgia's 159 counties published material from this office._
FILM SERVICES: To satisfy the increasing demand foreducation films, the
film library was augmented by the pur~ha~e of. 18 new films. Th'e motion

28 ANNUAL REPORT, 1949
picture library now has a total of 109 different films including sound pictures and color photography. The reported monthly use of films reveals that films from this Division were shown to an estimated total audience of 368,093 persons.
MATERIAL EVALUATION: To determine the type of informational material needed, and to evaluate material distributed, a representative of the Health Education Division has worked with faculty groups in teacher education institutions, parent groups, teacher groups, nurse groups, wor.kshop groups, and medical students.
As a result of this research, the Division of Health Education, together with the Division of ly.faternal and Child Health, has begun the preparation of a film strip and a film. The film strip deals with the problem of conflict in child development, andis entitled "It Is Time' To Grow Up." The film strip will be available to college groups, and personnel of the State Department. of Public Health, and the State Department of Education.
FREE MATERIAL BUREAU: During the past year, 491,765 health education circulars were distributed free of charge by the Division in answer to requests for information from individuals, professional, ~nd lay groups. During the previous year, the distribution totaled 468,950. This circulation surpassed th~t of 1947 by more than 200,000 when a total of 247,730 were distributed. This circulation record is significant of the increased interest developed by health education activities.
PRODUCTION OF MATERIALS: With the ever increasing demand for publications distributed by the Division, new material must be composed and old material must be revised. To comply with the demand, nine new publications have been added and one booklet was revised.
SOME PUBLICATIONS ADDED AND REVISED IN 1949 Publications produced by the State Department of Public Health:
1. Good Blood-A brightly colored, nine page booklet giving in simple words the pertinent facts about syphilis. Simple drawings on each page of the booklet add to its appearance and attract the attention of the reader.
2. Dark Ages-A small, four page leaflet that tells in simple language and drawings that syphilis can be Jcured in a short period of time. This material is directed to the employer in an effort to obtain his cooperation in treating syphilis in the worker.

HEALTH EDUCATION 29
3. Here It Comes-A colorful pamphlet, with drawings and few words, that is used to promote participation in syphilis and tuberculosis surveys.
4. Everybody Smile-A brightly colored picture book that teaches the young child the proper care of teeth. The 32-page book bears a close resemblance to the popular and modern version of the nursery rhyme books.
5. Health Is Everybody's Business-A four-page leaflet used to stimulate community organization.
6. So You Think It's Love-(Reprint of a talk made by Dr. Ralph G. Eckert to students at West Georgia College, Carrollton. Published by permission of the author.) A 11-page booklet that stresses proper courtship for a happy marriage.
PUBLIC HEALTH LIBRARY
During this year the Central Library has made available to the regional offices author and title cards for all books assigned to them. This plan was inaugurated for the purpose of setting up a title and author index for the different regions, which enables the regional personnel to keep an accurate account of their materials.
A number 'of new editions of books which are essential to the public health worker have been added during the year, and an effort has been made to supply the literature which will keep Department of Health personnel infonrr('!d of current scientific and medical developments. Eighteen journals have been added by subscription and 22 by gift or exchange.
In June the library cooperated with the University of Georgia, College of Education Workshop on health education and nutrition by the loan of
52 books. In addition to this service, the library has received and handled
numerous requests for data on recent medical developments from various colleges and hospitals, and many requests are also received from school children for material on subjects for debates and essays.
SCHOOL AND COMMUNITY SERVICE
With a limited staff the Public Health Education Division has worked. in many ways with groups and individuals and developed a successful organizational plan in various parts of the State. Although the staff limitations have made the development of a state-wide plan of work impossible, the staff members have endeavored to answer requests for assistance throughout the State.

30 ANNUAL REPORT, 1949
Work throughout the State has revealed that people are concerned about many health problems, particularly those pertaining to schools and communities. School administrators and faculty members in many places have endeavored to improve the health instruction of schools and to work to~ard a functional health prog_ram' from primary grades through high school. To this end, the problem-solving technique has been used effectively.
Parents, teachers and other community leaders have in many areas worked together on finding the problems and working on possible solutions, which, by working together, they may solve. With the increased interest in school health programs, teachers have been aware of, and called to the attention of consultants the need for improved health education.
There is need for a state-wide program to include health education for the layman; to encourage and work toward developing better health edu- cation for pre-service and in-service teachers; to find ways to work more W:ith school administrators; and to continue to work with faculty groups in planning functional health programs.' These things and many others may be accomplished only with an increase in personnel.
During 1949 the Assistant Director of the Health Education Division served as a lecturer, consultant, and organizer with 19 different groups throughout the State.
HEALTH EDUCATION FOR NEGROES
The Office of Health Education for Negroes was set up in 1948. It is located in the heart of the Negro business district, and has a staff of four persons-three health education consultants, and a receptionist-stenographer. A Health Education Consultant has also been assigned to this office by the Office of Health Education, U. S. Public Health Service, for a special prdject in Health Education for teachers in training at Clark College.
PUBLIC HEALTH EDUCATION: Talks and discussion groups have been utilized in keeping with the many requests made for them. However, this office is committed to the problem solving method, in which groups are guided to discover community problems and work toward solution of them. The process is much slower than the "lecture" method, but results are more lasting, and planning more realistic.
The problem solving method has been used with parent-teacher groups, ministers, student groups, and others. It has been particularly applicable to student marriage and family seminars, both on the high school and college level. Such seminars were held at Morehouse College, Fort Valley

HEALTH EDUCATION 31
State College, Carver Vocational School, David T. Howard High School, Atlanta; and the Colored High School in LaGrange. This method finds its highest expression in the local health council and assistance was given in the organization of such councils in Talbotton, Athens, Rome, Griffin, and Atlanta. The Rome Council studied the dental needs of school children, and through cooperative community planning has succeeded in getting such services through the local health department. Similar temporary groups have been organized in local communities around the problem of tuberculosis and venereal diseases, leading up to mass V.D. and chest X-ray surveys.
INFORMATIONAL PROGRAM: Representatives of this office work-ed with the Hall County Department of Health in the production of the film "Palmour Street." This production, filmed for the Georgia Department of Public Health, is directed particularly to adult Negro audiences, and reveals how even small things in mother-father-child relations affect the emotional life of the child.
Radio programs, including problems of the child from one to five years, syphilis, superstitions, etc., have been presented over radio stations in Atlanta, Fort Valley, and Savannah. In addition to this work, two articles have been released for publication-"The Role of the lVIonotheistic Con. cept in the Evolution of JVIedical Thought," Atlanta Unhersity Phylon,' and "Using Community Resources for Health Education," Journal of Parents and Teachers.
TEACHER HEALTH EDUCATION: For the teachers in service, conferences were held in LaGrange, Talbotton, Cedartown, Buford, Gainesville, Bain- _ bridge, and Savannah. This office also cooperated with the State Department of Education in introducing the film, "The School That Learned to Eat," and in interpreting the "Guide in Health Education for Teachers." Visits were made to ten regional teachers' meetings in this effort.
For teachers in training, cooperative planning was extended to 12 colleges in the State. Services included active participation as consultant to deans of colleges, the Committee on Cooperation in Teacher. Education, and the Committee on Curriculum Planning in developing a philosophy in health education in our colleges, and planning a program of teaching experiences. Such planning culminated the addition of courses in some colleges, and revision of courses in others. It aJso involved the setting up of summer workshops, work conferences, and health courses for in-service teachers, and recommendation of efficient personnel.

DENTAL HEALTH
J. G. WILLIAMS, D.D.S., Part~Time Director
PURPOSE OF THE DIVISION OF DENTAL HEALTH
To promote better dental health and to contribute to the development of a sound and progressive dental health program for the State, the Division of Dental Health has worked toward the following objectives:
1. To give assistance to health departments and to State and local agencies and organizations in dental health program planning, including dental health education, dental disease prevention, correction of dental defects and evaluation of activities.
2. To keep informed on developments in dental research and to give authentic dental information to the public through the various media as press, radio, exhibits, publications, films, discussion groups, lectures and personal contacts.
3. To encourage communities to study their dental needs and to develop local facilities to meet these needs.
4. To develop, select, distribute and encourage wise use of educational aids appropriate for all ages and interests.
5. To assist with experiments and demonstrations to teach new dental facts and to demonstrate new methods.
6. To give supervision and appraisal to public health dental clinics. 7. To work with teacher education and curriculum study gro'IPS and
all education forces to properly correlate dental health education with the general education program of the State.
COOPERATION OF AGENCIES
Appreciation is expressed to the Georgia Dental Association for active support of and participation in the dental health program. Mention should be made of the valuable cooperation of the State Department of Education and to the Surplus Property Division for allowing the Division of Dental Health to place dental equipment given by law to the Department of Education in areas where this equipment can be used. Recognition is given to the many organizations, official and voluntary, that have contributed time and money to dental clinic services and to all phases of the dental program.
DENTAL CLINIC SERVICES
Effective July 1, the policy of financial participation 111 dental clinics

DENTAL HEALTH 33
in local health departments was changed from payment by the Georgia Department of Public Health of. honoraria to dentists at the rate of $15 per half-day session and fees to dental clinic assistants at the rate of $3 per ses~ion to grant-in-aid to local health departments with dental clinic services allowed the same participating percentage as other health services.
The principles and policies to be followed in dental clinics were adopted by the Georgia Department of Public Health and approved by the Public Health and vVelfare Committee of the Georgia Dental Association.
During 1949 a total of 43 clinics receiving fina'ncial aid from the Georgia Department of Public Health operated in 34 counties with 112 dentists working. A total of 9,136 children were admitted for 18,985 visits and received 39,160 operations. The cost to the Georgia Department of Public Health for these services was $48,676.00.
During 1949 the following counties operated dental clinics to which the Georgia Department of Public Health gave financial aid: Bibb; Charlton; Chatham; Clarke; Clinch; Cobb; Colquitt; Coweta; Crawford; Decatur; DeKalb; Dougherty; Evans; Floyd; Fulton-Atlanta City and Bass High School; Glynn; Harris; Jones; Liberty; Meriwether; M uscogee; Pike; Rabun; Richmond; Screven; Spalding; Stevens; Sumter; Terrell; Thomas; Troup; Upson; Ware; and Whitfield. (See map.)
The following five-year comparison shows the increase in dental clinic services.

Year
1949 1948 1947 1946 1945

White

No. Dentists No. Clinics vVorking No. Admissions

37

105

30

83

20

46

.19

37

14

32

7,252 5,414 3,087 2,123 1,910

No. Visits
16,333 12,355 7,000 3,828 3,021

Total Operations
33,815 27;768 14,918 9,297
9,730

Year
1949 1948 1947 1946 1945

Negro

No. Dentists No. Clinics Working No. Admissions

6

7

1,884

3

3

495

1

1

394

4

4

421

3

3

272

No. Visits
2,652 831 572 669 487

Total Operations
5,349 1,367
875 1,203 1,000

34 ANNUAL REPORT, 1949
It is regrettable that dental services rendered by private practitiOners can not be measured. It is our sincere opinion that an ever increasing number of children and adults are receiving regular dental treatment.
DENTAL CARIES PREVENTION SERVICES
Topical application of sodium fluoride as a dental caries preventive is accepted and used by the majority of Georgia dentists in their practice for children. Following the recommendation of the American Dental Association and the U. S. Public Health Service, the Division of Dental Health has promoted the use of sodium fluoride in every possible way.
The demand for topical application of sodium fluoride for all children is increasing. Health officers, dentists, schools, Parent-Teacher Associations are urgently requesting financial and personnel assistance to implement this muchly needed public health service which will reduce the incidence of dental caries by 40% in children.
SPECIAL PROJECTS
The Columbus-Muscogee County Dental Health Demonstration Project, which was begun September, 1948, and discussed in previous reports, has been continued with satisfactory success.
The Spalding-Lamar-Pike School Health Demonstration was successful in providing a dental clinic in Pike County and a topical fluoride program for the Spalding County Schools and other phases of the dental program have been strengthened.
Chatham and Liberty Counties continued their Negro Dental Demonstration Program until July 1 when the U. S. Public Health Service personnel was withdrawn. . The 4-H Club Dental Health Project has continued to be a most effective way of reaching this organization of 117,000 Georgia boys and girls.
The Dental Division has assisted the Atlanta Health Department and the Hoke Smith Community Council to plan and initiate a dental demonstration program to reach all the children living in the Hoke Smith area of Atlanta which falls in the low income bracket.
DENTAL HEALTH EDUCATION
Dental health education has been promoted in cooperation with the appropriate State and community agencies. Educational publications, films, and aids which are furnished free to the people of Georgia are superior in quality and therefore are most acceptable and useful to educators.

DENTAL HEALTH 35
The new dental health reader, Everybody Smile, was published by the Division of Dental Health in August, 1949. The American Dental Association requested permission to distribute this reader along with the previous Georgia publication, Frank Visits the Dentist. The national recognition and enthusiastic praise of these publications has been most gratifying to the Division of Dental Health.
The following activities indicate some of the ways in which the Dental Division staff has promoted dental health education:
1. At Emory University School of Dentistry, a sixteen-weeks course for seniors in public health dentistry.
2. Participation in State and district dental society meetings. 3. Conferences with dentists and dental hygienists. 4. Lecture to junior medical students in Augusta. 5. Teacher education through:
a. 'Participation in college training schools, workshops, summer schools.
b. Planning conferences at State, county and local levels. c. Teacher education and curriculum studies. d. School evaluations. 6. The Director has served .on the Board of Managers of the Georgia Congress of Parents and Teachers and the Educational Director has served as a member of this board. Requests by civic clubs and lay organizations for lectures and discussions are filled as staff time will permit.
ADDITIONAL ACTIVITIES OF THE STAFF
Consultation has been provided to the Hospital Division in an effort to insure adequate and appropriate fa~ilities in construction of health centers and hospitals;
The Educational Director served as 'Secretary of the Georgia Public Health Association from June, 1948 to June, 1949; attended the American Public Health Association in New York; made a trip to the Central Office . of the American Dental Association to discuss the proposed dental health education program of the American Dental Association.
The three staff members of the Division attended the Conference of State Dental Directors called by the U. S. Public Health Service and Childrens Bureau in \iVashington in June.
The Dental Health Officer w'as on military leave for clinic service from November 28 t~rough December 12.

36 ANNUAL REPORT, 1949

STATE OF
GEORGIA
DENTAL CLINICS 1949

SERVICES FOR WHITE CHILDREN AND NEGRO CHILDREN.
SERVICES FOR WHITE CHILDREN ONLY. SERVICES FOR WHITE CHILDREN, NEGRO CHILDREN, l'lf.GRO PRENATALS
SERVICES F0fl WHITE CHILDReN, WHITE PRENATALS.

.SCALE JN MILE$

~

"'

J<>

" 15'

DENTAL HEALTH 37
URGENT NEEDS
Progress in the Division of Dental Health has been limited because of the need for additional personnel. A minimum of two dentists and two health educators should be added to the State staff at the earliest possible time. Other needs are:
1. Financial assistance to local health departments to employ dental hygienists for topical application of sodium fluoride should be provided.
2. Seminars to provide additional training for dentists in the fields of public health clinics and children's dentistry should be conducted during the coming year.
3. More consideration should be given to the provision for adequate and appropriate dental facilities in the hospital and health center building program.
4. An expanded program for training dental students in the field of public health should be initiated during the coming year.
I

PUBLIC HEALTH ENGINEERING
L. M. CLARKSON, Director
ADMINISTRATION AND COORDINATION
This division of the Georgia Department of Public Health has the responsibility of planning and administering the program of public health engineering, including the assignment of duties, reviewing all activities of the personnel and coordinating the program with other divisions of the Department. It has the responsibility of maintaining cooperative relationship with the engineering profession and consulting engineers, all agencies, other departments of the State and Federal government whose activities relate to sanitation through engineering for protection of the public health.
Public health engineering is a normal function of federal, state, district, county, and municipality. Public health engineering service is available to the public from the following organizations, (a) central administration, Georgia Department of Public Health, Atlanta, and other field offices, (b) regional engineers in each of the six regional offices located at Marietta, Gainesville, Swainsboro, Griffin, Waycross, and Albany, (c) county public health engineers and sanitarians in organized county health departments, (d) municipal sanitary engineers functioning in the larger city health departments. In counties without health departments, regional engineers render regular service.
MALARIA CONTROL
lVIalaria, as officially reported by practicing physicians, rose slightly as compared to the previous year. Forty-eight cases were reported for 1949 with not a single death from this disease. Only one positive blood smear has been confirmed by the State Laboratory, and this patient gave a history of overseas service, where the disease was very probably contracted.
IMPOUNDED WATERS: Under Division surveillance and direction, control of A. quadrimaculatus breeding on the hydro-electric reservoirs throughout the State continues as a responsibility of the operating agency.
Companies and agencies cooperating during 1949 were: Georgia Power Co. (3 reservoirs) Georgia Power & Light Co. ( 1 reservoir) Tennessee Valley Authority (3 reservoirs)

PUBLIC HEALTH ENGINEERING 39

i.

Crisp County Power Commission ( 1 reservoir)

U .. S. Army Engineers (3 reservoirs under construction)

The Georgia Power Company, through contract operations, sprays the Flint River Impoundment near Albany with DDT. The Lloyd Shoals Reservoir near Jackson in- Butt~ County was controlled with Paris green larvicide. Larviciding on the Bartlett's Ferry Impoundment near Columbus is accomplished with an oil-water mixture. The cont1:ol operations on the Flint River are observed jointly by the Dougherty County Health Department and this Division. The Bartlett's Ferry operations are supervised jointly by the Division and concurrence of the Alabama State Health Department.

Pending completion of the Jim Woodruff Dam near Chattahoochee, Florida, at the confluence of the Flint and Chattahoochee Rivers, the Georgia Power and Light Company continued control measures, using Paris green larvicide, on the Spring Creek Impoundment on 'the western boundary of Decatur County.
The Tennessee Valley Authority has continued control measures on the Blue Ridge Reservoir, near Blue Ridge; the Chatuge Reservoir near Hiawassee; and N ottley Reservoir near Blairsville, all in North Georgia. Control of mosquito breeding in these reservoirs is accomplished princi-
. . pally through naturalistic methods, supplemented by larviciding when
necessary.
On Lake Blackshear, the Crisp County Power Commission has continued clearing opera.tions on a small scale during 1949. New equipment has been secured (Lawrence Aero-Mist) for better distribution of larvicidal dust and/or mist using DDT, and roads are being constructed around the perimeter of the lake to permit larvicidal operations from the land side of the many breeding areas. l\!Iosquito adulticidal operations, spraying with
DDT formulations all mosquito resting places within 174 miles of the lake
perimeter in Crisp, Dooly, Lee, Sumter and Worth Counties, have been continued.
The Allatoona Dam near Cartersville has been completed and the reservoir is in the process of filling. Adult and l~rval mosquito collections in the area have so far revealed very few A. quadrimaculatus. The main body of this lake will probably fluctuate so much that mosquito breeding will be of no moment, but there is a standing level pool projected for recreational purposes in the Acworth area which requires careful surveillance. . The Clark Hill development on .the Savannah River near Augusta IS

40 ANNUAL REPORT, 1949
still under construction and no clearing operations have been started. The U.S. Army Engineers will accept the responsibility for A. quadrimaculatus control. A recent survey of the area by staff members of the Epidemiology Division revealed no positive bloods from those examined, although several cases were confirmed on the South Carolina side of the river.
Progress is being made on the Jim Woodruff Dam in Florida at the confluence of the Flint and Chattahoochee Rivers and studies are being made on preimpoundment conditions by the Epidemiology Division, as well as the U. S. Army Engineers. Recent reports on findings reveal many adult A. 9uadrimaculatus in resting places in proximity to the future impoundment. This reservoir will warrant continued surveillance .so as not to get out of hand before larvicidal operations are inaugurated.
The Production and Marketing Administration (AAA) of the U. S. Department of Agriculture continued financial assistance to fanners in the construction of farm stock watering ponds. To qualify for payment from the AAA, it is necessary for the owner to have an Impounded Water Permit from the State Department of Public Health. Four hundred and twenty-one impounded water permits were issued in 1949. Authorizations to begin construction were issued to many more, but ponds have not been completed according to the regulations, or have not been started. The U. S. Soil Conservation Service continues to give technical service to those building ponds and advises them regarding the regulations of the State Board of Health. This simplifies the duties of engineers and sanitarians somewhat in securing compliance. The program is being continued in 1950.
MALARIA ERADICATION PROGRAM: For the past five years, the Division has directed a program of extended malaria control, now known as the Malaria Eradication Program. The U. S. Public Health Service and local governments are cooperating in this program, furnishing substantially all of the funds spent. Operations are directed against the insect vector in houses, and consists of two seasonal sprayings of walls and ceilings of homes and privies with DDT ( dichloro-diphenyl-trichloroetharie) emulsion. The application rate was sufficient to leave a residual of 100 milligrams of DDT per square foot of sprayed surface, as this proved toxic to mosquitoes alighting thereon for a period of 10 to 14 week.s.
Operations were conducted in 35 counties, with 30 counties completing two rounds of spraying, two counties completing one round, and three counties terminating operations before the initial round was completed.
Spraying was performed with the regulated pressure sprayers developed

PUBLIC HEALTH ENGINEERING 41
on the program in Georgia, which is still superior to any commercial type sprayer now available. Improvement in emulsion barrel agitator has also insured an even concentration of residual being placed on sprayed surfaces.
The residual benefits from DDT spraying in the elimination of other household insects than malaria carrying mosquitoes has always made the program very popular especially with rural populations where farm animals are kept and fly infestations are heavy. Prompt investigations and demonstrations of continued toxicity were very effective in reducing complaints. Ineffective fly control was primarily due to excessive breeding and poor sanitation practices.
To give a still better control of fly breeding, a new program of premise spraying was inaugurated prior to the regular house spraying program. This consisted of complete premise spraying embracing all barns, chicken houses, outhouses, fences, low bushes, etc., where flies rested. A special DDT formulation, using a rosin sticker, was applied in this program and the property owner or tenant paid most of the cost. The charge was determined by the amount of material used to spray the premises. This program eliminated most of the dissidence regarding the effectiveness of the spray program, and further demonstrated the necessity for good sanitation practices. On 6,463 premises, 19,281 outbuildings were sprayed. The local cost was $22,839, or $3.58 per premise.
In the 35 counties operating, an average of 2.8 gallons of 3.56% DDT emulsion was applied in 131,054 unit sprayings, each unit being one house (including privy, mattresses and porches where such were indicated). Total expenditures on the program amounted to $368,331.00 of' which $125,662.00 was by State and counties and $242,669.00 was by the U. S. Public Health Service. Unit costs averaged $2.81; $0.96 for State and county and $1.85 for the U.S.P.H.S. The U.S.P.H.S. costs include the off-season activities of key personnel which have been utilized in general sanitation activities.
During the early part of the year, 14 key men on the Malaria Eradication Program were called to Atlanta for a short intensive course on insect and vector control given at the U.S.P.H.S. Training Center. The course was very effective in improving operations for the year's activities.
SCHOOL SANITATION
The School Sanitation Program has the following principal objectives: (a) safe drinking water, (b) approved plumbing, (c) satisfactory sanitary

42 ANNUAL REPORT, 1949
disposal of sewage, (d) a safe milk supply, and (e) sanitary serving of school lunches.
The review and approval of plans and specifications covering sanitation construction features continues as a major activity of the Division. Close cooperation is maintained with the State Department of Education and private architects. The preliminary review of plans and field inspection of physical characteristics of the school plants is a function of regional and local sanitation personnel.
Specific standards on school sanitation have been prepared by joint action of staff members of the State Departments of Public Health and Education, for joint promulgation of the respective State Boards. Some minor changes remain before Board action will be taken. These standards will provide a base for the Accrediting Boards of the elementary and of the high schools of the State, and will result in an improvement of sanitary conditions at all public schools.
Improved excreta disposal facilities at public places, including schools, have been provided by the construction of 190 approved privies and 392 septic tanks with appropriate auxiliary tile absorption fields. Samples of water for bacteriological examination have been collected and sent to the Division Water Laboratory, principally for confirmation of findings of physical inspections of the supplies.
In addition to the school sanitation surveys in 75 counties during 1948,
key personnel of the Malaria Eradication Program were used in completing
surveys of schools in 15 additional counties during 1949.
School locations were plotted on county maps prepared by the Division Mapping Service, and copies are now available to county school superintendents and others needing this information.
Staff personnel participated in the annual meeting of school administration officials and presented a partial summary of findings on the sanitation survey including the following data: There were 2,20.9 schools surveyed. The assembled data included 774 schools in 32 counties with nearly 100,000 pupils enrolled. The ratio of white to colored was approximately 3 to 2.
30% of the children at these schools had unprotected or no water supply. 12% had no drinking water facilities. 7% had no toilets of any kind. 12% had surface toilets.

PUBLIC HEALTH ENGINEERING 43
4-2% had poor or fair toilets. 20% had bad or no toilets. Only 1 of each 3 children had clean toilets available. 43% of the 774 school plants summarized had bad toilets or none at all.
Recognizing the need for more accurate information on the design characteristics of distribution boxes used in school sewage disposal systems, considerable research was done at the Macon Field Office of the Division. This work resulted in setting up new design features of distribution boxes which will be recommended following future review of plans and specifications for school or other semi-public sewage disposal systems requiring this unit.
HOUSING SANITATION
The building of new homes in urban and rural areas has continued unabated throughout the year. The Division continues the custom of reviewing plans for new and existing subdivisions where approved public water supply and sewerage systems are not available. In general, for subdivisions where individual sewage disposal systems are required, private water supplies are not approved because of eveptual contamination of the ground water strata. Every effort is made to encourage public sanitary sewerage for all new and existing subdivisions. Community sewerage systems, except those which are tax supported and maintenance of which is the responsibility of a public agency, are seldom satisfactory and have not been approved by the Division.
All homes built under loans insured with the Federal Housing Administration, having or proposing to have private water andjor sewerage systems, are required to have approval of the State Department of Public Health. In addition to the investigation and approval of subdivisions, the individual systems are inspected and approved by local or state sanitation personnel, followed by review and approval by the Division before F.H.A. acceptance is obtained.
A commercial metal roofing concern in the State, with assistance of Division personnel, has designed and constructed an "all-aluminum" privy which has been placed on the market. The price of the unit, shipped in three packages and weighing 97 lbs., has been set at actual cost, which is considerably cheaper than a corresponding all-wood unit can be constructed. Distribution of the unit as a whole, floor only, seat and riser, or. superstructure has been arranged through the Macon Division Field Office. The unit promises to be very useful and popular.

44 ANNUAL REPORT, 1949
Through cooperation of the Veterans On-the-Farm Training Program of the State Department of Education, the Portland Cement Association and the Division, thirteen demonstrations of septic tank construction were conducted in all sections of the, State including almost 1,100 instructors of the VOTFT Program, using re-usable wooden forms constructed from plans prepared in the Division. These demonstrations are being followed with further demonstrations under the direction of the instructors so that a total of 20,000 trainees will be reached. Construction of septic tanks is not limited to trainees on this program, and consequently a great improvement in sanitation at rural homes should result. Some of t'ne recent installation demonstrations have had as many as 250 persons in attendance.
CAMP SANITATION
Assistance is rendered to recreational and public works or labor camps on all phases of sanitation, including water supply, sewage disposal, screening, garbage disposal, milk and food sanitation, insect control and swimming areas.
During the year, 493 tourist camp permits were issued. Sanitary items which must meet certain minimum requirements for a permit include water supply, sewerage, plumbing, garbage disposal, screening, drainage, insect control, general cleanliness, etc. Slightly over 100 tourist camps were unable to meet the minimum requirements for a permit.
A number of deaths due to carbon monoxide poisoning in to'urist cabins impelled the inauguration of a research project by the Division of Industrial Hygiene which would furnish information regarding proper heating installations for tourist cabins. When this has been determined, the Hoard of Health will be requested to include a proper definition of a safe heating system in the regulations on tourist camp sanitation.
GARBAGE DISPOSAL
In connection with the Malaria Control Program and its residual fly control potentialities, a check was made in 29 of the operating counties on garbage disposal methods. Forty-five open city dumps were located, only one city in the area using an incinerator. On 16 of the dumps hogs are kept. None of these dumps are being operated as sanitary land fills. Poor garbage collection service and open dumps are responsible for much of the fly breeding in many of the cities and towns of Georgia.
PUBLIC HEALTH MAPPING & PHOTOGRAPHIC LABORATORY
The Division is now prepared to render all mapping and photographic

PUBLIC HEALTH ENGINEERING 45
service to local health departments and other divisions of the State Health Department in addition to regular operations of the Division, limited only by the capacities of personnel employed. Further improvements have been made to reproductive processes extending the service rendered manifold.
CITY AND COUNTY MAPS: Basic f!nd sanitary survey maps are prepared from basic data obtained from the field or from aerial photographs. Basic maps show all roads, streets, houses, public buildings, railroads, principal drainage channels, with house numbers and names of roads, streets, churches, schools or other identifying characteristics which would make the maps more usable. Sanitary survey maps include all basic data mentioned, but have the following additional data shown thereon; water mains, valves, fire hydrants, storage tanks, sewer mains, manholes, sewage treatment works and symbols showing the type and condition of water and sewage disposal facilities at each inhabited place. Special maps are also prepared for specialized operations of the Health Department, such as malaria survey maps, typhus control maps, DDT residual spray program maps, etc.
Three new county maps were prepared and four city maps. County
maps and all of the town maps of 51 counties which had participated in the
Extended Malaria Control Program were revised in accordance with changes reported by field supervisors.
Plans were prepared for the construction of reusable forms for septic tanks and other construction details, which.were needed for the cooperative On-the-Farm Training Program for Veterans as previously mentioned.
Negative prints of 174 maps _of towns, averaging 40" x 40" in size, were prepared for the Bureau of the Census, Department of Commerce, to be used in connection with the census of 1950.
Intermediate prints were made of 58 maps, 40" x 50", for use in making
Ozalid prints. Intermediates are made to avoid excessive wear on original tracings.
During the year 4,443 Ozalid prints, averaging 36" x 42" were made. The photographic laboratory made 730 photoprints of aerial pictures used
in mapping; 92 enlargements 20" x 24''; 38 enlargements 30" x 40"; 8 enlargements 40'' x 60", and 11 enlargements 40" x 90".
In cooperation with the Division of Public Health Education, 87 charts, graphs, diagrams and illustrations were prepared, 168 lantern slides were prepared and 248 color photos were taken. 2,275 postcards of the Alto

46 ANNUAL REPORT, 1949
Medical Center were made for resale at that institution. Photo prints to
the number of 4,258 ranging in size from 4" x 5" to 30'~ x 40" were also p:t:epared. Of these, 3,253 were 8" x 10" and 8,0" x 11".
MILK SANITATION
Service on milk sanitation comprises assistance to all local health departments, cities, counties and the milk industry. Service is rendered to those who have established or plan to establish sanitary standards for milk supplies. Consultation and advice are furnished relative to all phases of high
standards for quality and safety. Promotion of adoption of the 'standard
milk ordinance and code comprises a considerable portion of the service. After adoption of the ordinance and code, assistance is rendered in tech-
nical and legal interpretations. Commissioners of health, engineers, and sanitarians cooperate with this Division in this objective.
Two mobile milk laboratories are in constant use in the service completing work on one milk shed before leaving for another. In addition to the mobile laboratory service, during the year two State Health Department' branch laboratories, namely at Macon and Albany, initiated regular service affording constant submission of milk samples from local health departments. Statistical data on this work will be shown in the annual report of the Division of Laboratories.
During the year the two mobile. milk laboratories were stationed at the following cities: Americus, Carrollton, Cordele, Dalton, Gainesville, lVlarietta, Savannah, Thomaston, and Toccoa.
The following statistics show in more detail the services rendered: Dairy inspections ................................ . 1026
Toilets constructed or repaired ..... - .............. . 80
Barns and milk houses painted ..................... . 123
Milk houses screened ............................ . 94 Handwashing facilities installed .................... . 147 Phosphatase tests for pasteurization efficiency ......... . 751 Bacteria determinations .......................... . (4249) Bacteria determination (coliform) .................. . (738)
Total bacteria determinations . . . . . . . . . . . . . . . . . . . . . . . 4987 Water supplies protected .......................... . 99 Sediment tests .................................. . 2373
FOOD SANITATION
Food sanitation comprises mainly inspections and grading of food han-
,

PUBLIC HEALTH ENGINEERING 47
dling establishments, inclusive of school lunchrooms. Also, food handling schools are conducted throughout the State with the objective of training food handlers so that food may be handled and served in a safe and sanitary manner. This service is conducted quite similar to the milk sanitation program in that a standard food handling ordinance is adopted by cities and counties and eating and drinking establishments are graded similar to milk supplies. During the year the following was accomplished in inspections of such establishments:
School lunchrooms inspected . . . . . . . . . . . . . . . . . . . . . . . . 1694 Public eating and drinking establishments inspected. . . . . 458
Total..................................... 2152

SHELLFISH

Comparative rating on shellfish program in the 20 states producing shellfish was made by the U. S. Public Health Service for 1948-1949 oyster season. The Georgia rating is fourth. In 1943 when the Department was given authority by the Legislature to carry on a shellfish program the State was blacklisted for interstate shipment and had no rating.

Assistance was given during the year to seven shucking houses for rebuilding, and for planning and construction of two new shucking houses. Assistance was also given to rebuilding two crabmeat plants.

Certificates issued for interstate shipment .. , ......... .

10

Samples collected in general pollution resurvey ....... . 1,569

Chemical samples collected ....................... .

19

Shellfish samples collected ...................... , ..

2

Shucking house inspections ........................ . 900

Crabmeat plant inspections ........................ . 220

Acres of growing areas covered in sampling .......... . 16,000

MATTRESS SANITATION

A total of 80 new licenses were issued, 175 complaints investigated, and

600 routine inspections made.

\

INSPECTION OF HOMES FOR WELFARE DEPARTMENT
The State Welfare Department receives applications from families desiring to adopt an orphan child or board one. Before such requests are granted the Welfare Department requests this Division to make a sanitary survey

48 ANNUAL REPORT, 1949
of the home together with a report of the conditions. During the year a total of fifty-five such inspections were made with reports to the Welfare Department.
RECRUITING AND TRAINING PERSONNEL
The Division maintains an application file of persons interested 111 a career of public health engineering and sanitation. Interviews and investigations are conducted and in cooperation with the Merit System and personnel director these persons are selected, cleared through the lVIerit System, and given training when necessary. Fifteen trainees were sent to training school during the year, others were selected for assignments.

WATER POLLUTION CONTROL
W. H. WEIR, B.S., Director
The public health supervision of water supply, sewage works, industrial waste treatment, stream quality control and allied activities throughout the State is performed by the \Vater Pollution Control Service of the Georgia Department of Public Health. The service is performed within a plan of cooperative procedures between the Department and local governmental units, industrial communities and institutions both publicly and privately owned. The cooperative plan has operated over a long period of years with modifications and adjustments required by growth and increased services. Consistent adherence to the plan has assured the citizens of the State of safety against waterborne disease and satisfactory sources of water
for all industrial and domestic consumption demands.
OBJECTIVE OF THE WATER POLLUTION CONTROL PROGRAM
The objective of the Water Pollution Control Service is to provide for and maintain a satisfactory quality balance between all of the uses of water in its many forms. This necessitates the fulfillment of the requirement that drinking water of the public systems be of the highest quality, that sewage and industrial wastes be returned to the receiving streams after adequate treatment or with sufficient dilution to maintain the satisfactory sanitary balance, and that the quality of the intrastate and interstate streams of Georgia be maintained for present usage and preserved for future development. The measures to accomplish the all inclusive objectives involve the persistent application of the science of sanitary engineering and the technical and administrative procedures allied thereto in providing complete control throughout the State.
The water pollution control plan of Georgia is generally understood, accepted and increasingly being followed by the municipalities and industrial communities. The problems of the many urban communities vary widely both in kind and degree due to their size, location, accessibility to natural water supplies of adequate quantity, proximity to other communities and a multitude of other factors of increasingly complex nature. The comprehensive state-wide plan contemplates a local plan for each community. The state-wide plan is established and administered by the Water Pollution Control Service of the Georgia Department of Public Health. Conformance to and benefits of the comprehensive plan by local communities are accomplished by them in providing the physical facilities for the procure-

50 ANNUAL REPORT, 1949
ment, purification and distribution of public water supplies and the collection and treatment of sewage and industrial wastes, all under the public health supervision of and with the technical assistance df the Department's Water Pollution Control Service. There were no known or reported cases of waterborne disease from public water supplies in Georgia in 1949.
REVIEW AND APPROVAL OF ENGINEERING REPORTS, PLANS AND SPECIFICATIONS
The Engineering Practice Law of Georgia requires that all public works of an engineering nature, financed by public funds, be designed by and constructed under the supervision of a registered engineer whenever the estimated cost of such works exceeds $2,000. The Rules and Regulations of the Georgia State Board of Health require that engineering reports, plans and specifications for water and sewage works projects be submitted to the Georgia Department of Public Health for review and approval before construction is begun.
Each water and sewage works. project is a separate undertaking which must be studied on its own merits. A thorough knowledge of local conditions is essential in each instance. This necessitates extensive field investigations, laboratory studies and numerous conferences with the engineers, owners and all interested parties to assure a sound decision and to adequately safeguard the public health of the community served. This is the paramount activity and objective of the Water Pollution Control Service to the effectuation of which many of the other procedures are eventually directed.
Through such reviews and related investigations, conferences and studies, pertinent fundamental public health engineering principles are applied to each project almost from its very conception. In this manner the collective knowledge and experience of State Health Department personnel, the designing engineer and the local owners and operators are pooled to insure the design and construction of water and sewage works adequate for local needs.
STREAM POLLUTION CONTROL
Prevention of stream pollution by adequate liquid waste treatment before discharge into the watercourses of the State is the basis of safe public water supply. It is also the basic guarantee of continued usefulness in the streams for metropolitan, urban, rural and industrial expansion. Continuous pres~ sure is exerted in all directions to bring about that consciousness of resp~n-

-. -.

~1

WATER POLLUTION CONTROL 51
sibility which produces revenue to finance construction of sewage and industrial waste treatment facilities. Federal legislation has been enacted with the avowed purpose of promulgating a policy of stream pollution control. However, such legislation is of little value without the aroused public opinion whereby local citizens are willing to tax themselves to provide funds for the construction of sewage works. The Georgia Department of Public Health continues to wage its successful campaign of education to the necessity for sewage works and industrial waste treatment installations. Numerous physical structures dedicated to stream pollution abatement are materializing over the State and many others already stand as a monument to the effectiveness of this educational policy.
STREAM SURVEYS AND INVESTIGATIONS
Considerable progress has been made in recent years toward the accumulation of valuable basic stream analytical data. Permanent sampling stations have been set up on the major water sheds of the State. Stream sampling and laboratory analyses have been carried on by the Water Pollution Control Service through the years. The essential data thus obtained forms the base line for determining and administering stream usage. The picture is far from complete, however, and continued energetic pressure is required to add to the data annually..
CONTINUOUS TRAINING OF LOCAL PERSONNEL
The continuous training program for personnel responsible for the operation of water purification and sewage treatment process plants throughout the State occupies a place of high importance. A large share of the total time of the small staff available for the water and sewage protection program is budgeted for training municipal and industrial water, sewage and industrial wastes treatment process operating personnel. The training activities are carried on by staff engineers of the Water Pollution Control Service with local personnel within their own plants where the daily operations are performed. This on-the-job instruction enables a very practical type of training to be given. Where necessary, arrangements are made for personnel of municipalities to visit other installations to observe good practice and gain wider experience than local facilities permit. The principle of adjusting skills and aptitudes of highly varying degrees is applied in proper position placement for effective results and stability. The progress being made by individuals and the application of their knowledge is checked upon through monthly plant and control laboratory reports submitted to the Water Pollution Control Service.

52 ANNUAL REPORT, 1949
THE GEORGIA WATER AND SEWAGE SCHOOL
The Georgia Water and Sewage School is a part of the continuous local personnel training program. The School is an intensive group instruction course, conducted without charge f~r attendance, held in Atlanta each year. The School is sponsored and conducted jointly by the Georgia Water and Sewage Association, the Engineering Extension Division of the Georgia Institute of Technology and the Georgia Department of Public Health. The 18th annual session of the School in September 1949 was attended by approximately 300 men from municipalities and industries over the entire State. In addition to presenting opportunity for acquiring practical knowledge directly derived from the theoretical, the annual School sessions maintain an esprit de corps essential to the raising of standards of performance in any collective enterprise. A direct result of the S'Chool is a voluntary system of graded certification of water and sewage operators maintained by the Georgia Water and Sewage Association. Certification is now recognized as a measure of ability in placing responsibility on local personnel for water purification and sewage treatment safety. The Georgia \Vater and Sewage School annually attracts observers from outside the State. It has been the model for similar schools in several other states.
A special school for swimming pool operators was held in 1949. This school was sponsored jointly by the Fulton County Health Department and the Georgia Department of Public Health. It was attended by operators of swimming pool facilities and recreational directors from communities throughout the State. Timed with the opening of the outdoor swimming season, it provided essential practical instruction in a field where the annual turnover of local personnel is extremely high.
THE ENGINEERING LABORATORY
The Engineering Laboratory, serving as a vital tool in the state-wide program of water purification, sewage treatment, stream pollution and shellfish sanitation analyzed in 1949 a total of 17,934 samples which is the largest number of samples. examined in any year since the laboratory was established.
The following table shows the number and classification of the samples examined in the Engineering Laboratory in 1949:
Drinking l/Vater Samples Bacteriological Public and semi-public .......................... . 13,999 Camp ...................................... . 103 Dairy ...................................... . 48

WATER POLLUTION CONTROL 53

Lunchroom and market ........................ . School ...................................... . Private ..................................... . Shellfish Samples Bacteriological ................................. . Chemical ...................................... .
Swimming Pool Samples Bacteriological ................................. .
Stream Pollution Biochemical Oxygen Demand ...................... . Chemical ...................................... .
iVIiscellaneous Bacteriological ................................. . Che1nical ...................................... .

19
244 1,184
1,569 19
461
79
12
68
129

Total. ......................... 17,934 The above tabulation shovvs an increase in the number of shellfish samples examined in 1949. However, the greatest increase in work was in the number of swimming pool samples examined. This was attributable to the general demand of the public for safe swimming waters and to the information acquired by those attending the Second Annual Short School for Swimming Pool Operators conducted in 1949 jointly by the Engineering Divisions of the Fulton County and State Health Departments. There was also an increase in the number of bacteriological samples from camps and suburban and country homes. A still larger number of requests was received and complied with for assistance on taste and odor problems, corrosion problems, problems of suspected contamination from gasoline, propane or butane, and other problems of a biochemical or chemical nature.
WATER AND SEWAGE WORKS CONSTRUCTION
The stage was set for a major water and sewage expansion program although such opposing factors as high construction costs, slightly more difficult municipal financing and in some circles a forlorn hope for Federal aid have no doubt had some deterring effect. Nevertheless, the year has seen much progress in this field with basic public health protection, through the media of more extensive public water and sewage systems, being extended to more and more of the citizens of the State. These improvements include completely new water and sewage systems with treatment facilities in communities previously without such utilities, replacement of obsolete units, enlargement and extension of existing units and extension of sewage collecting and water distribution systems.

HOSPITAL SERVICES
JOHN E. RANSOM1 Director
INTRODUCTION
The Georgia Hospital Construction Program was initiated in December, 1945, by the establishment of the Hospital Survey and Planning Section within the Division of Administration. In December, 1947, the program obtained full divisional status by the activation of the Division of Hospital Services. The Division was organized for the purpose of: administration of the grants-in-aid construction program under the provision of Public Law 725, 79th Congress (Hill-Burton Act); administration of the Georgia Hospital Regulation Act No. 623, 1946; conducting periodic surveys and studies to determine relative need for medical facilities in the various sections of the State; and rendering various type~ of consultative services to existing hospital and potential project sponsors.
In 1949 the activities of the Division were greatly increased by: the passage of the State Act 62 (Georgia Laws 1949) which provides for State grants-in-aid for hospital and health center construction; the passage by Congress of an amendment to the Hill-Burton Act; an urgent request from the Governor to make a nation-wide study of the operation of State owned hospitals; the activation of a community planning section through which the Division assists communities in making detailed studies of their needs for hospital services and their resources available to build and mait~ tain the facilities requisite to meet those needs; and the definition of certain ,basic elements of the hospital licensure program.
During the year there was a steady influx of special requests for counsel and advice from physicians, hospital boards and administrators, individuals, civic and professional organizations and other groups. Although many of these requests were beyond the normal scope of the program, the Division undertook such tasks because of their relationship to the broader aspects of the program. The basic philosophy of the Division has consistently been to assist to the fullest possible extent any individual, group, or organization which is legitimately and conscientiously concerned with improving medical facilities and hospital services for the people of the State.
GEORGIA: HOSPITAL CONSTRUCTION ACT
The State Act 62 (Georgia Laws, 1949) which became effective February 7, 1949, au.thorizes the State to make grants. to assist in the construction of public hospital and public health centers. The sum of $3,000,000.00

HOSPITAL SERVICES 55
is appropriated annually for this purpose. Projects receiving Federal funds under the Hill-Burton Act are eligible for State grants. The State grant authorized under this act is "an amount equal to one-third of the allowable cost of construction," however, provisions were included so that: "In the event the ratio of Federal grants authorized under Public Law 725 is increased by the act of the Congress, the ratio of State grants authorized under this Act may bear a reduced per centum of the cost of such construction, provided that the aggregate of Federal and State grants shall not be less than 66 2/3 per centum of the total allowable cost of such construction."
AMENDMENTS TO HILL-BURTON ACT
Public Law 380 ( 81 st Congress) signed by the President in October, 1949, made several amendments to the Hospital Survey and Construction Act. The principal amendments included in the Act are summarized as follows:
1. The duration of the program vvas extended four years to the end of the fiscal year 1954-55.
2. The allotment base was increased from $75,000,000 to $150,000,000 per annum beginning with the 1950 fiscal year.
3. The proportion of Federal participation was changed from a flat onethird for all projects i~ all states to a percentage ratio determined by the various State agencies through an option selection method.
4. The Surgeon General was authorized to conduct research, experiments, and demonstrations relating to the effective development and utilization of hospital services, facilities and resources and to make grants to public and private nonprofit agencies for the conduct of this category of activity.
5. In addition to the foregoing, a number of technical amendments were added to facilitate the administration of the Act.
STATE HOSPITAL PLAN
The S,tate Hospital Plan is based on a state-wide survey of the needs for hospital facilities of various types and an inventory of existing facilities. It follows a general pattern outlined in the Hill-Burton Act and the Federal Regulations prescribed thereunder by the Surgeon General of the U. S. Public Health Service. The primary objective is the development of such additional hospital facilities as may be needed to provide adequately for the people of Georgia.
One of the requirements of the Surgeon General of the U. S. Public Health Service is that each State Agency make an annual review of the

56 ANNUAL REPORT, 1949

State Hospital Plan and make necessary revisions taking into consideration changes in population estimates, hospitals constructed during the past year and socio-economic conditions relative to hospital planning.
The annual revision to the Georgia Hospital Plan was prepared by the Division of Hospital Services during February and March of 1949. This revision required the review by the Division of such major items as the geographic division of the State into hospital areas, determination of relative need for facilities, recalculation of area priorities and further development of basic principles of the administration of the program.
It was also necessary fpr the Division to obtain, by correspondence or personal visit by field representatives, current statistical information from all hospitals in the State. The data used for this revised Plan again revealed the acute need for all types of hospital facilities within our State. Following are some of the more pertinent facts revealed in this study:

Category

Total Beds Needed

General Hospital Beds ......... 14,075

Nervous and Mental Beds ...... 15,640

Tuberculosis Beds . . . . . . . . . . . . . 2,820

Chronic Beds . . . . . . . . . . . . . . . . . 6,256

Total Existing Beds
6,995 9,327 1,460 1,321

Percentage of Need Met
50 60 52 21

The State Board of Health at the regular meeting on April 28, 1949, officially adopted the revised plan which was subsequently approved by the U. S. Public Health Service on August 29, 1949.

COMMUNITY PLANNING
During 1949 the citizens of Georgia became more aware of the pressing need of adequate hospital facilities, and consequently an increasing number of communities requested Federal and State aid to meet their need. To assist the communities in evaluating their needs and resources, a Community Planning Section was established within the Division of Hospital Services in the latter part of the year.
It was realized that many communities desired improved hospital facilities but that a more detailed study should be made to ascertain their needs before applications for aid were filed. The Community Planning Section was charged with the responsibility of making surveys of the social, economic and medical situation in the communities to determine if improved hospital facilities were actually needed and if so, what size facility was necessary and could be supported.
After the section was created, it laid the groundwork for procedures in

HOSPITAL SERVICES 57
community surveys and completed a few reports before the end of the year. The communities, by their requests, were furnished technical personnel who worked with them in evaluating their respective areas.
There has grown out of this procedure more than a mere measurement of a community for a hospital. It has resulted also in an education of the sponsors of the project to the extensive responsibility inv~lved in such an intricate community endeavor.
SPECIAL SURVEY OF STATE OWNED HOSPITALS
On request of the Governor in October, 1949, the Division of Hospital Services completed and submitted to his office on December 15, 1949, a "Special Survey of State Owned Hospitals in Georgia and Other States."
The study was made for the purpose of ascertaining as thoroughly as possible the most successful plan of control and operation of such State owned institutions. The report was divided into four distinct sections: (1) State Hospitals Other than General Hospitals, (2) State University General Hospitals, (3) Medical Care Through Coordination, (4) Conclusions and Recommendatiops.
In the course of the survey, nine states were visited by members of the staff. Considerable information was also obtained by correspondence and by research. Specific recommendations, attempting to apply the experience of other states to the situation in Georgia, were made. The data should be of invaluable assistance in the future planning of medical care in State owned and operated hospitals.
HOSPITAL INSTITUTE
The Division of Hospital Services, in cooperation with the U. S. Public Health Service and other State agencies in Region VI, held an institute for the discussion of problems connected with the opening of a new hospital. Georgia served as host State at this meeting which was held in the Senate Chamber of the State Capitol in Atlanta on November 15, 16 and 17. Administrators, members of hospital authorities and State agency personnel attended.
This institute, the :first held in the United States for the discussion of problems connected with the opening of new hospitals, will probably set a pattern for future similar conferences to be sponsored by the several State agencies in cooperation with the American Hospital Association and the U. S. Public Health Service. Lectures on such subjects as the hospital budget, accounting and bookkeeping, personnel problems, organization of

58 ANNUAL REPORT, 1949
nursing service, legal aspects of hospital operation, food service, hospital insurance and plant operation, maintenance and repair were presented by nationally known hospital administrators and consultants.
GEORGIA HOSPITAL AND HEALTH COUNCIL
In October, 1949, the Eighty-first Congress enacted Public Law No. 380, which amended the Hill-Burton Act, and included a new section specifically authorizing the Surgeon General to conduct research experiments and demonstrations relating to the effective development and utilization of hospital services, facilities and resources. It also authorized the Surgeon General, after consulting with the Federal Hospital Council, to make grants-inaid to political subdivisions of State universities, hospitals, and other public and private nonprofit institutions or organizations, for projects for the conduct of research, experiments, and demonstrations relating to development, utilization, and coordination of hospital services, facilities and resources.
The Division of Hospital Services participated in several informal conferences during November and December of 1949 with representatives of our two medical schools, the U. S. Public Health Service and others relative to the procedure or action prerequisite to executing an application for a research grant.
In December, 1949, the members of the Georgia Hospital and Health Council was organized. The Council will be responsible for the inauguration of the project through which a study will be made and assistance given in the development, utilization and coo~dination of hospital services, facilities and resources.
The establishment of this Council is the initial step in a program to supply better medical care, particularly to the sparsely settled areas in Georgia. The Division of Hospital Services is proud to have had a minor role in the early planning of such a potentially outstanding and important program for the State.
ADMINISTRATION OF CONSTRUCTION PROGRAM
The administration of the Hospital Construction Program consists of .the preparation for approval by the U. S. Public Health Service of an annual project construction schedule; the review and approval of applications and amendments; the review and approval of contracts, bonds and insurance certificates; the preparation of project progress reports for installment payments and audits of project records by the Division and the Federal Security Agency.
A project construction schedule for each fiscal year is prepared and sub-

HOSPITAL SERVICES 59
mitted to the U. S. Public Health Service as soon as possible after approval of the annual revision of the State Hospital Plan. Projects which can submit and have approved the completed application, including plans and specifications, prior to the end of the following fiscal year are included on the schedule in the order of the priority of the area as shown in the State Plan.
Section 601 (b) of the Federal Regulation states that the purpose of the Hospital Construction Act is to assist the several States: "to construct public and other nonprofit hospitals in accordance with such programs."
Specific Facilities Eligible are:
(1) Health Center-"A publicly owned facility utilized by a local health unit for provision of public health services, including related facilities such as laboratories, clinics, and administrative offices operated in connection with public health centers."
(2) General H ospitals-"Any hospital for in-patient medical or surgical care of acute illness or injury and for obstetrics of which not more than 50% of the total patient days during the year are customarily assignable to the following categories of cases: Chronic, convalescent and rest, drug and alcoholic, epileptic, mentally deficient, mental, nervous, and mental and tuberculosis."
(3) Tuberculosis H ospital-"A hospital for the diagnosis and treatment of tuberculosis, excluding preventoria."
(4) Mental H ospital-"A hospital for the diagnosis and treatment of nervous and mental illness but excluding institutions for feebleminded and epileptics."
(5) Clzronic Disease H ospital-"A hospital, the primary purpose of which is medical treatment of chronic illness, including the degenerative diseases, and which furnishes hospital treatment and care, administered by or under the direction of persons licensed to practice medicine in the State. The term includes such convalescent homes as meet the foregoing qualifications. It excludes tuberculosis and mental hospitals, nursing homes, and also institutions, the primary purpose of which is domiciliary care."
Projects for the expansion, remodeling and alteration of existing facilities in the above categories may be included in construction schedule.
ALLOTMENT OF FUNDS: The allotment of Federal funds to the several states is calculated by the Surgeon General of the U. S. Public Health

60 ANNUAL REPORT, 1949
Service in accordance with a formula prescribed in the Hill-Burton Act. Each year, on the basis of current data, this allotment of Federal funds is re-determined which accounts for the annual variations of Hill-Burton funds available to the several states. Act 62, Georgia Laws 1949, provides for an appropriation of $3,000,000.00 annually, beginning with the 1948-49 fiscal year, for projects owned by political subdivisions of the State.
Following is a table showing Federal and State funds made available for grants to projects in Georgia since the beginning of the program:

Fiscal Year
1947-48 1948-49 1949-50 *1949-50 (Supplement)

Federal Funds
2, 97 6,228.00 2,791,307.00 2,624,178.00 , ..... 2,624,178.00

State Funds
3,000,000.00 3,000,000.00

Total. ............. 11,015,891.00

6,000,000.00

All funds available to the State through June 30, 1950, have been allotted to specific projects.
After approval of the project construction schedule for a fiscal year, sponsors of projects listed thereon are notified to proceed with the preparation and submission of application forms, and plans and specifications.

REVIEW AND APPROVAL OF APPLICATIONS: During 1949 it was necessary for personnel of the Division of Hospital Services to meet with sponsors of all projects for the purpose of explaining the procedure and requirements of the Federal and State regulations and assist them in completing the required documents.
All applications, forms and other documents are reviewed and approved by the Division of Hospital Services and the Public Health Service.
Obtaining all documents and assurances for final approval of applications during 1949 required a large amount of correspondence and many meetings with sponsors and architects in our office and in the communities.
Some of the more important requirements for final approval that had to be reviewed and passed on by the Division are:
(1) Adequacy of construction and equipment cost estimates on the application.

*(Public Law 380, signed into law in October, 1949, doubles the Federal allotment to the States beginning with the 1949-50 fiscal year.)

HOSPITAL SERVICES 61
(2) Adequacy of operating cost and income estimates for the first two years of operation.
(3) Proof of non-profit status.
(4) Proof of ownership or lease of property to provide for undisturbed use for not less than fifty years.
(5) Assurance by the sponsors that sufficient local funds are available locally to liquidate the sponsors' share of the cost of construction and to cover operating deficits during the first two years of operation.
(6) Correct procedures for obtaining bids and awarding contracts.
(7) Review of all contracts including performance and payment bonds. ( 8) Check on adequ\(cy of insurance coverage for the co~tractors and
sponsor.
The Division of Local Health Organizations cooperated with the Division in approving health center projects.
The passage of the Georgia Grant-in-Aid Act and the amendment to the Federal Act required reviews and refiling of applications to include the new requirements and changes in percentage of Federal and State aid in individual projects.
Public Law 380, amending the Hospital Survey and Construction Act, gave the State Board of Health the authority to annually establish the percentage of Federal participation in individual projects. InN ovember, 1949, the Board decided that 60% of the cost of projects to begin construction after October 25, 1949, would be paid from Federal funds and 20% from State funds. This left only 20% of the cost to be provided from local sources.
After construction is begun the sponsor is entitled to installment payments of Federal and State funds as the work progresses, the first payment becoming due when not less than 15% of the construction is completed. Application for payments require an inspection of the project by technical personnel of the Division and the preparation of project progress reports, inspection reports and vouchers. Before final payments are made to projects a preliminary audit of the sponsor's records must be made by the Division and a final audit made by auditors of the Federal Security Agency.
As of December 31, 1949, payments totaling over $2,084,000.00 Federal funds and $1,443,000.00 State funds had been made to sponsors of projects - completed or under construction.

'''1

62 ANNUAL REPORTT 1949

The following tables show the .status of projects approved and/or under

construction as of December 31, 1949:

..

PROJECTS APPROVED

No. of Total Projects App. Beds

New General Hospitals.,.. . Addition to Existing Hos-

34

1 1,596

pitals . . . . . . . . . . . . . . . . .

7

162

Public Health Centers and

Auxiliary Public Health

Centers .............. .

29

Total all Projects....

70

1,758

Total Estimated Cost
$20,198,904.00 1,984,382.00
2,093,557.00 24,276,843.00

Projects Completed Number Beds

New General Hospitals. . . . 4

139

Additions to Existing Hos-

pitals . . . . . . . . . . . . . . . . . 3

102

Health Centers and Aux-

iliary . . . . . . . . . . . . . . . . . 13

Projects Under Construction

11

831

1

15

2

Total. .......... 20

241 14

846

ARCHITECTURAL AND ENGINEERING REVIEW
The functions of the technical section of the Division of Hospital Services, consisting of the State Agency architect and engineer, are numerous, varied and highly technical. The proper planning of hospital buildings involves the solution of many difficult and complicated problems. Therefore, the skill of these professions are essential to assure proper architectural development of the proposed hospitals and health centers.
The technical section is responsible for the following general functions and services during the progressive steps of planning and construction: '
A. The State Agency archite~t works with the project sponsor and his architect in the development of a general program which must be tailored to fit the needs. and budgetary limitations of the community.

HOSPITAL SERVICES 63
He or the engineer inspects the site proposed for the desired facility to assure that it is suitable for the purpose for which it will be used.
B. As a first step the project architect prepares a schematic or single line drawing of the hospital or health center 15uilding. This is checked by the State Agency architect in order that planning errors may be corrected before working drawings are begun.
C. As preliminary and working drawings and specifications are developed, the architect and engineer review thoroughly the architectural, structural, mechanical and electrical elements and characteristics of the proposed construction. They ascertain that there is compliance with all Federal and State regulations and requirements. They also recommend desirable revisions in order to increase efficiency and promote economy of construction and operation. They certify approval of plans to the State Agency Director and to the U. S. Public Health Service.
D. A representative of the technical section attends all openings of contractors' bids. During construction, all contract modifications are reviewed and processed by the engineer or architect.
E. Periodic inspections are made by the technical staff whenever installment payments are requested by the project sponsor. It is the responsibility of the State Agency architect to assure that all specifications are met and that the construction work is properly completed. The architect must certify to the value and quality of the work in place and to the eligibility of the project for grant-in-aid payment.
The technical section of the Division of Hospital Services also reviews plans of hospitals which are to be built without Federal and State assistance in order to determine compliance with State licensure regulations. Consultation service to owners, architects and contractors regarding various technical problems of hospital construction is furnished.
EQUIPMENT PLANNING
It is essential that hospitals and health centers be adequately equipped for the services to be rendered. It is the responsibility of the State Agency to assist in planning the equipment as well as the construction of each hospital and health center. To this end, the Division of Hospital Services works with the sponsor's representative, usually the hospital administrator, in planning the equipment desired for the project and reviews the list of equipment and cost estimate compiled by this local representative. \Vhen

64 ANNUAL REPORT, 1949
the proposed equipment program appears to be satisfactory for the project in question, the, equipment list is submitted to the U. S. Public Health Service for approval, after which actual purchasing by the project sponsor is begun.
The equipment so purchased is inspected and the equipment invoices, submitted as evidence of funds expended, are collected and reviewed by the Division of Hospital Services. It is on the basis of these inspections and data that the sponsor is reimbursed for equipment purchases.
An investigation is now being conducted to determine the need for and desirability of regulation by the State Agency of the purchasing procedure used by project sponsors in the procurement of equipment so that maximum value may be secured for the equipment funds expended. The Division of Hospital Services strives to render consultative service to hospital administrators in order that equipment which is selected may be the best available within the budget limitation of each project.
LICENSURE SERVICE
In 1946 the General Assembly of the State of Georgia enacted a law relative to hospitals and other institutions providing facilities for the care of the sick. The Act provides that following the adoption of Rules and Regulations by the State Board of Health, all persons operating or in charge of any hospital or other institution foi: the care of the sick is to make application to that Board for a permit to operate the same. Permits to operate are renewed annually. In accorda~ce with the above described procedure and with the counsel and the advice of an Advisory Committee, the State Board of Health at a meeting held in October, 1948, adopted Rules and Regulations, reasonable compliance with which is required, as a basis on which a permit to operate will be issued.
The purpose of these Rules and Regulations is twofold. The first purpose is to establish general standards covering construction, equipment, fire prevention, sanitation, and such procedures as are essential, to insure adequate protection to the health and life of patients. The other purpose is to set forth in sufficient detail certain principles of hospital operations which are generally accepted as requisite to good modern hospital service and to recommend the adoption of and compliance with these principles in so far as possible by all hospitals in the State.
During 1948-49 representatives of the Division of Hospital Services visited each hospital in the State for the purpose of acquainting the admin-

HOSPITAL SERVICES 65
istrator or owner with the requirements of the law and the purposes of the :i:{ules and Regulations. They have assured the hospitals that the Department of Public Health desires to assist them in every way possible to meet the requirements. With hardly an exception, our representatives have been well received and have found that hospital people generally are in agreement that institutions which provide facilities for the care of the sick should be required to meet reasonable minimum standards related to
their plant, eqyipment, and their service to patie,nts.
As of December 31, 1949, applications for permits have been received from all known hospitals and related institutions. Personnel of the Division made detailed inspections of 149 hospitals and related institutions during 1949. The information obtained through these inspectional visits will serve as a basis for a complete file on each institution in the State.

INDUSTRIAL HYGIENE
LESTER M. PETRIE, M.D., Director
INTRODUCTION
The industrial hygiene program has as its objective the maintenance and improvement of the health of employed people. This includes safeguarding them from both occupational and non-occupational diseases. Occupational disease control is the specialty of the Division. Non-occupational disease control is an obligation which must be met by integrating for iiidustry all the services of the State and local health departments and related agencies which are useful to them.
There are two approaches which apply to either occupational or nonoccupational diseases. One has to do with the individual exposed to risk and is primarily medical. The other is control of the environment, principally chemical and engineering. Personnel and facilities for the highly technical chemical and engineering services required for the investigation and control of occupational disease hazards in the working environment have continued at the expanded level attained last year, as have also the corresponding requests for rendering this type of service to industry. The inability to find medical personnel has prevented a similar expansion in the . medical and nursing service of the Division.
Divisional personnel conduct surveys and studies of industrial health problems. Where indicated formal reports are prepared for submission to industrial management, including such items as the scope and purpose of the study, details of the specific findings, and recommendations for control of occupational and non-occupational disease exposures. The commitment, which we have wi.th plant management in every plant in which we work, to the agreement that confidential information will not be released to unauthorized persons by the Health Department is evidenced by officially stamping every report with the following quotation from the State regulation: "CONFIDENTIAL REPORT-Information obtained and opinions based upon these investigations shall be confidential records of the Board of Health and shall not be open for public inspection." This regulation was adopted by the State Board of Health on October 16, 1941. Divisional copies of reports are kept under lock and key at all times.
PERSONNEL
A good program as outlined above requires a team made up of doctors,

' '1'
INDUSTRIAL HYGIENE 67
nurses, engineers and chemists, and on occasion other specialists in such fields as radioactivity, noise and lighting. Personnel are being trained in radioactivity monitoring and experts in these special fields from the Division of Industrial Hygiene of the U. S. Public Health Service are freely available to us upon request.
The Division personnel who participated in the actiVIties described in this report included: The medical director, two consultant nurses, two chemical engineers, four chemists and three stenographers..
Employees of other divisions of the State Health Department and of regional and local h'ealth departments have also contributed services to industry within their respective sp<;cialties. Particularly important are: ( 1) personnel of the Divisions of V enereal.Disease Control, Tuberculosis Control, and Laboratories in the mass blood test and chest x-ray surveys; (2) the Division of Maternal and Child Health in industrial nutrition.
MEDICAL AND NURSING PROGRAM.
l\lledical and nursing activities include the investigation and recording of occupational diseases, assistance in the control of non-occupational diseases and accidents, the promotion and establishment of medical and nursing services in industry including cooperative health centers for small industries and the establishment of proper and adequate records. Also included are the promotion of g~neral health procedures in industry, and the coordination of the industrial health program with the community health program. Programs dealing with tuberculosis, venereal disease, immunizations, eyesight conservation, nutrition, sanitation, dental hygiene, and health education are emphasized, wherever possible, the same as the program for occupational disease control.
NUTRITION PROGRAM
The nutrition program was reactivated during the year with the employment of a dietary consultant. The nutritional activities include the surveying of feeding facilities in plants. in order to evaluate the adequacy of the feeding program for employees. Suggestions are made for improving existing facilities in the plant.
ENGINEERING AND CHEMICAL PROGRAM
Engineering personnel promote and carry out plant studies of processing methods and materials and their relationship to the working environment. This is done by means of impartial studies including chemical and physical determinations where indicated. Observed data are assembled and carefully

68 ANNUAL REPORT, 1949
analyzed, including correlation of the findings with any known medical facts concerning the effects of the hazards upon the workers exposed to the risks. Following this, engineering reports are prepared which cover observation and presentation of recommendations for the alleviation of occt.pational exposures. All findings and reports are handled confidentially. Professional engineering service is rendered to the industry in the form of consultation on methods and procedures for the correction of hazards noted in the course of plant studies. In addition, assistance is rendered in the development of proper sanitation facilities in the plant and in training individuals concerned with industrial hygiene and safety programs.
INDUSTRIAL HYGIENE LABORATORY: A laboratory is provided for the quantitation of air contaminants such as dusts, fumes, gases, vapors, mists, smokes, and the like. In addition to the study of processing materials and their by-products which may be toxic, a certain amount of biochemical work is done on blood, urine, and other biological samples. These data are correlated with the engineering and medical data so that actual hazards may be properly evaluated and that a more intelligent and comprehensive report may be submitted to the industry concerned.
PUBLIC RELATIONS
TEACHING IN PROFESSIONAL SCHOOLS: Medical, engineering and nursing personnel have participated in lectures to professional students at the University of Georgia Schools of Medicine, Extension Course at Athens, Evening College in Atlanta; Emory University Medical and Dental Schools; Georgia State College for Women, and Georgia Institute of Technology.
TRAINING OF PROFESSIONAL WORKERS FOR OTHER ORGANIZATIONS: The Industrial Hygiene Division has cooperated with the Training Division of the Communicable Disease Control Center of the U. S. Public Health Service in its field training of engineers and chemists. Many other professional workers, doctors, nurses, engineers, etc., from Georgia, other states, and foreign countries have been given instruction and field visits at the request of such agencies as.Harvard University, Johns Hopkins University, Rockefeller Foundation, or the U. S. Public Health Service. The Division arranged training for an M.S. degree in industrial hygiene at Harvard University for an engineer of the Fulton County Health Department. This engineer completed his training in June.
GEORGIA SECTION OF AMERICAN INDUSTRIAL HYGIENE ASSOCIATION: The Industrial Hygiene Division continues to cooperate with the Georgia

INDUSTRIAL HYGIENE 69
Section of the American Industrial Hygiene Association on matters pertaining to the promotion of industrial hygiene in Georgia. The medical director served as the Secretary-Treasurer of the Georgia Section of the American Industrial Hygiene Association.
MEDICAL ASSOCIATION OF GEORGIA: The medical director continues to serve as Secretary of the Committee on Industrial Health for the Medical Association of Georgia.
ATLANTA TUBERCULOSIS ASSOCIATION: The medical director has been elected to the Board of Directors of this organization and continues to serve as Chairman of the Industrial Health Steering Committee.
VISITORS TO THE DIVISION: Twenty-six visitors have been recorded in the guest book. States represented have been New York, Ohio, Illinois, Indiana, Wisconsin, Alabama, and Georgia. One visitor from New Delhi, India, visited the Division.
EXHIBITS: An exhibit entitled "Occupational Diseases and Differential Diagnosis" was presented under the joint auspices of the Division of Industrial Hygiene, the Medical Association of Georgia, and the U. S. Public Health.
OUT OF STATE MEETINGS: ( 1) Amer.ican Medical Association-Council on Industrial Health at Chicago, Illinois, was attended by the medical director as a representative of Georgia; (2) American Conference of Governmental Ind~1strial Hygienists, Detroit, Michigan. This joint industrial health meeting of the American Conference of Governmental Industrial Hygienists, American Association of Industrial Physicians and Surgeons, American Association of Industrial Nurses, American Association of Industrial Dentists, and American Industrial Hygiene Association was attended by the medical director, chemist, and nurse. The medical director served on the Committee on Codes, and was appointed to the Constitutional Revision Committee of the American Conference of Governmental Industrial Hygienists. He was also appointed Chairman of the Personnel Placement Committee of the American Industrial Hygiene Association. The medical director continues to serve on the Board of Directors of the American Iudustrial Hygiene Association.
SPECIAL PROJECTS AND PLANT SURVEYS
GRANITE SHEDS: The Division has been promoting a survey of the health hazards in the GeoPgia granite industries since 1942. Previous reports have told of the excellent progress which has been made in controlling the dust

.-.,
-
70 ANNUAL REPORT, 1949
hazards in the environment. In February, a TB-VD survey was conducted in two major granite industries in DeKalb County. In J\1ay a county-wide survey was made in the Elbert County area. Occupational histories of all dust exposures were obtained from granite workers. A statistical summary showing the high incidence of pneumoconiosis is attached.
BLOOD AND URINARY LEAD: The Industrial Hygiene Division has been advocating for several years that routine periodic urinary and blood analyses be done on all workers exposed to lead hazards. Consequently, it is glad that at least one plant has adopted this procedure as a routine. A number of other plants with lead hazards cooperate with this Division in surveys.
ECONOMIC POISONS: More and more of the newer insecticides are being introduced into the State of Georgia and being used more widely by the farmers of the State. Some of them are quite toxic and require more precaution in their use. The Division at present is attempting to compile in chart form the precautions to be used, the symptomatology of over exposure and the necessary antidote. It is. hoped that this information will be available soon.
CLARK HILL DAM: The Clark Hill Dam Project opera~es a quarry in Georgia. The process is extremely dusty, the dust is of high silica content, and control of the dust is difficult. A study was done and recommendations made. The recommendations are being instituted and should result in a vast reduction of the amount of dust to which the workers are exposed.
ATMOSPHERIC POLLUTION COMPLAINTS: In February and March, the -Division was called in on an air pollution problem in Atlanta. It was dem-
onstrated that the atmospheric pollution emanated hom a considerable number of different sources in this highly industrialized area. No toxic concentrations of fumes were demonstrated in the atmosphere at any time. Urine and blood analyses made on specimens obtained from residents of the area were negative. Other atmospheric pollution complaints are received from scattered areas throughout the State. All such complaints are investigated.
CARBON MONOXIDE RESEARCH PROJECT: This Division has been presented the problem of writing a regulation covering the requirements for approval of space heaters in tourist courts burning carbonaceous fuels such as liquefied petroleum gas, oil and the like. This program has been stimulated by the number of deaths which are being reported due to the use of such heaters in tightly sealed cabins or rooms. Three c1ses and three deaths in Georgia were reported during 1949.

INDUSTRIAL HYGIENE 71
A research project is being conducted in cooperation with Georgia Tech to investigate the combustion products formed by the burning of gas heaters in an enclosed space. The crux of our problem is to determine : ( 1) the minimum ventilation requirements to make an unvented heater safe in a sealed room, and (2) the minimum quantity of air needed to be introduced into the sealed room with a vented heater to maintain the normal concentration of oxygen and allow for complete removal of the products of combustion. The Division of Research Grants and Fellowships of the U. S. Public Health Service has granted funds to defray certain expenses of this project.
CHEST X-RAY AND BLOOD TEST SURVEYS: The Division has continued to promote these surveys in industry. The surveys are in cooperation with the Division of Tuberculosis Control and Venereal Disease Control and local health departments. The Division has given considerable time to receiving and coordinating requests from individual industrial plants with the schedule of the survey teams, and in preparing and submitting statistical summaries of the survey findings to the industrial plants. Individual findings are kept confidential with the individual and the physician of his choice and are not identified in reports to management.
DIABETES CASE FINDING: The Advisory Committee to the State' Board of Health of the Medical Association of Georgia approved the inclusion of a program for diabetes case finding in our mass TB-VD surveys. The industrial hygiene laboratory adapted the Anthrone blood carbohydrate test to mass survey techniques. Experimental surveys have been done in some industries in Twiggs and Lowndes Counties.
COOPERATIVE INDUSTRIAL HEALTH CENTERS: Atlanta: The establishment of cooperative industrial health centers in Atlanta has been under consideration since 194-2, when the Health Committee of the Atlanta Senior Chamber of Commerce requested the Fulton County Medical Society and the State Health Department to work up a plan to make better industrial health services available to small industry. Atlanta Health Week, initiated in September, 1946, was a direct outgrowth of this.
On November 1, 194-9, nearly every profession or business in the Atlanta area concerned with groups of employed people was invited to a dinner meeting at Georgia Tech in order to present to this group the facts, figures and philosophy concerning what can be done with cooperative industrial health centers in Atlanta. Seventy-three persons attended, and this meeting appeared to be an outstanding success. Prospects seem to be very bright for the establishment of not only one but several industrial health cooperative

72 ANNUAL REPORT, 1949
groups in this area as. a direct result. Representatives. of 15 different establishments, in addition to the laundry and dry cleaners' association, signed cards which stated: "I am interested in exploring the possibility of a cooperative industrial health center in my area." Plans have been set up to contact these 15 interested industries individually in order to facilitate the formation of an actual center in Atlanta at the earliest possible date.
Unanimous approval of the proposed Cooperative Industrial Health Center was obtained in 1946 from the House of Delegates of the Medical Associations of Georgia and also from the Board of Trustees of the Fulton County Medical Society. The latter reaffirmed its approval in 1949.
Griffin: The Griffin Cooperative Health Service participated in by industrial plants and administered by the County Health Commissioner appears to be continuing successfully. A report on this Service entitled "The !Jriffin Plan" appeared in the December 1949 issue of Public I-1ealth Nursing.
Gainesville and J-1artwell: In both of these areas there has been considerable interest shown in establishing cooperative industrial health centers.
GEORGIA ASSOCIATION OF INDUSTRIAL NURSES: Both industrial hygiene nurses were active in the Association, one serving on the Board of Directors. A quarterly newsletter is sent to industrial nurses, supervising public health nurses and regional consultant nurses.
INDUSTRIAL HYGIENE CODE: The Committee on Industrial Hygiene Codes of the American Conference of Governmental Industrial Hygienists has completed their model general code. The director of the Georgia Division of Industrial Hygiene was a medical member of this Committee. The model code was adopted as the official recommendation of the American Conference at their annual meeting in Detroit. As the document carries no legal status, it should be considered as a guide only for use of governmental agencies in preparing their own codes. The document has been submitted to the American Standards Association for approval by that body. 1It is also being distributed in Georgia by the Division of Industrial Hygiene as a guide to industrial plants.
PRESENT AND CONTEMPLATED PLANS
I
In addition to continuation of routine services, it is planned to emphasize the following: ( 1) intensive promotion of plans for cooperative industrial health centers in Atlanta and the State; (2) continuation of the carbon

INDUSTRIAL HYGIENE 73
monoxide research project at Georgia Tech; (3) special studies of lead hazard industries; (4) putting into practice on mass survey basis the diabetes case finding program, and ( 5) providing graduate training for ,additional members of professional staff.

TABLE I

GEORGIA SUMMARY Of INDUSTRIAL HYGIENE ACTIVITIES

January-December, 1949

No. Establishments , . , .. , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412

No. of Workers ........................................................ 108,119 No. of Plant Visits Made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518

Reason for Service:

Self-initiated ............................. , . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Request:

Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

99

Labor ..................................

Local Health Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16

Private Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

Insurance Carrier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20

152

Occupational Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

Follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41

Type of Service Given:

No. Plants

Promotional . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 247

Environmental Surveys .. .. .. .. .. .. .. .. .. .. .. . .. .. .. 111

Technical Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32

Nuisance Complaint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

No. Services 289 152 57 17

Appraisal of Medical Department . . . . . . . . . . . . . . . . . . .

7

9

Investigate Occupational Disease . . . . . . . . . . . . . . . . . . . .

19

30

Examination of Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

11

Tuberculosis Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

112

VD Surveys ....................................... ~ 107

118

Consultations Regarding:

Working Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

189

Medical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

177

Nmsing Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

64

82

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23

34

Improvements Recommended:

No. No. Recom- No. Workers Plants mendations Affected

Working Environment ................ .

46

Health and Welfare ................. .. 105

137

5,234

194

54,810

ImprovemC1ltS Canied Out:

Working Environment ................. .

13

Health and Welfare .................. .

66

25

2,592

129

22,873

Specific Services:

Chest X-rays .............................................. .

11,089

Blood Tests ...............................................

11,408

samples for Lab Analysis ................................... . Field Determinations . : . ......... , ...... , .................. . 0. D. Cases Investigated ................................... .

1,289 154 564

......

TABLE II

""'

NUMBER OF PLANTS SERVED BY THE DIVISION OF INDUSTRIAL HYGIENE, AND TYPES OF

zz:r>-

SERVICE RENDERED

c:: :rr>--

1941 I 1942 I 1943

Total No. Plants _________________ I 20 I 96

113

1944 85

1945 153

1946 183

1947 192

1948 223

:;1:1

m

Cumulative "1:1

1949 I Total
1941-49

0
~

....

412

905

loO

No. New Plants (initial service during current period) ______________

!

20

I

87

47

34

96

128

83

126

268

l"o"O'

-------------1--1---1----1

I

I

I

I

I

1-----

No. Old Plants (service initiated in previous years) _________________ I_____ _! 9

66

51

57

55

99

107

144

No. Plants Receiving:

Medical Service_---____________ 17 61

75

64

86

146

36

30

69

413

Nursing Service________________ 11 44

64

17

87

120

77

43

93

364

Engineering Service_____________ 17 31

33

44

64

49

87

179

306

542

Laboratory Service_____________ 4 12

18

23

13

5

47

85

34

192

Feeding Service________________ ------ ------

5

21

13

4

1

5

37

No. Plant Days that Plants were Visited ________________________

I

48

I 310

396

255

404

237

295

423

-------------1--1--1

I

I

I

I

I

I

1-----

Total Employee Population of P l a n t s _________________________

J _____ _J _____ _I163,798

1186,800

1124,389

1120,213

I 98,556

I

80,466

I

108,1191

281,934

NoL. oCcaotuendt_ie_s__in__w__h_i_ch__P__la_n_t_s__w_e_r_e_ I 14

28

31

21

31

25 " 45

68

78

106

TABLE Ill REPORTED OCCUPATIONAL DISEASES, 1947-1949

CUMULATIVE

CASES

II

DEATHS

IJ

TOTAL

DISEASE

1947-1949

I 1947

1948

I 1949

II

I 1947

1948

I 1949

II Cases 1 Deaths

Allergy _______________________ _ BBruornncsh_i_t_is_______-____--_-_-_-_-_-_-_-_-_-_-_-_-_-_--_ Bysinnosis __________ ---- ______ _

------------
-2

7

1 7

'

**Carbon Monoxide______________ _

6

5

--
--
1
--
3

--

--

--

--
--

----

----

--

--

3

5

3

7

--

1

--

8

--

2

14

11

Cellulitise____ --- _--- __________ _ Cement Poisoning______________ _

---

1

--

2

1

Chemical Burns (NOC)* ________ _ Chemical Poison_______________ _ Conjun~t~vitis _________________ _ Dermatttls______ -- __________ - --

---2

13 2 6 136

1
1 60

Epicondylitis ___ ---- ___________ _ Erysipelas ____________________ _
***Illuminating Gas_______________ _ Jnfection (NOC)*______________ _ Injury (both feet) ______________ _ Lead Poisoning________________ _

--

-

--
6

--

--

4

1 1
8
5 16
--

--
11 4
1 9

Metal Fume Fever (Zinc) _______ _ ***Poisonous Gas (NO C)* _________ _

--
4

2
4

1 2

--

--

--

1

--

--

--

--

3

--

--

--

--

14

--

--
--
----

--
----

------

2
7
198

--

1

--
----

--

1

6

8

11

25

2~

----

1

--

9 17

-i

--

--

1

13

1

--
3

' -~3

--
2

3
10

8

.I

Poisonous Gas-Bromine _______ _ --

--

1

Poisonous Gas-Paint Fumes____ _

--

--

2

Poisonous Gas-Ammonia ______ _

--

1

P_n.eu~oconiosis (NOC)*________ _

--

172

1

Stltcosts____ ------ ____ -- __ -- _---

63

19

6

Tuberculosis-OccupationaL ____ _ ***Tularemia ____________________ _
Undulant Fever_ ______________ _
TOTAL________________.___ _

1
----
88

8 77 142
-
634

5 97 123
-
332

-----
1 1

------
5
8

----

1 2

1

1

6

173

6

88

5

14

--

z

1 6 12 14

ct:l
"-1'
::0
r~ -

---
-

1 2
-

4

174

3

265

-

5 5
-

:-<c !!!

14

39

36

1,054

89

zrn

(NOC)*-Not otherwise classified.

'

rn

**-Informatioi1 obtained from newspaper reports and the like has given us unconfirmed evidence of many more cases.

***-Includes cases not necessarily of occupational origin.



~
en

I
~

.j

J

TABLE IV

""0\

NUMBER OF PNEUMOCONIOSIS CASES BY AGE GROUPS, AND YEARS OF EXPOSURE IN

GRANITE QUARRY INDUSTRIES IN ELBERTON, GEORGIA: 1949
YEARS OF EXPOSURE

cz:zt>-

AGE Under20

"0
I~
.5... ;a
0 I>< E-<[.:l;'l

Under

s10 "'

Cl

~

I>< [.:l;'l

o<.'l

s "' 10-14

Cl

~

I>< [.:l;'l

oCl

15-19

d
;

"~ '

I>< [.:l;'l

o<.'l

s20-24

!.'l

r~n

I>< [.:l;'l

o<.'l

25-29

d
;

r~n

I>< [.:l;'l

oCl

s30-34

Cl

r~n

I>< [.:l;'l

o<.'l

s35-39

!.'l

r~n

I>< [.:l;'l

o<.'l

40-44

d
;

r~n

I>< [.:l;'l

oCl

45-49

d
;

r~n

I>< [.:l;'l

oCl

Unk.

d
;

r~n

I>< [.:l;'l

oCl

8"~'

a~ ~o

5.....
0

~;::
~<.'l. ~.

E-< o~

-m~--1--1================~ --1-----r:T

:rt>--
m:::0
"tl
0 :::0 ,-1
....

20-24 25-29

204 204 ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ---- 0. 0

>0

196 172---- 20---- 4---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ---- 0.0 >""0"

30-34

186 130---- 42 1 12---- 2---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- 1 0.5

35-39

244 117 1 62 5 41 7 22 6 2 ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- 19 7. 8

40-44

167 73 2 23 4 24 7 32 8 12 4 1 ---- 1 ---- ---- ---- ---- ---- 1 1 26 15.6

45-49

89

50-54

52

55-59

52

65 6a0n-d64over 3162

Unknown

6

TotaL___ 1, 314

37---- 6---- 5 1 18 8 17 9 6 5------------ -------- ---- --------- 23 25.8
23 1 3 1 3---- 8 4 9 4 3---- 2 2-------- 1---- ---- ----- 12 23.1 24---- 3---- 4 1 5 ---- 2 2 5 3 3 1 5 1 1 ---- ---- ----- 8 15.4 149 -__-_-_- -__-_-_- -_-__-_- ____3 -__-_-_- 34 ____1 11 ----1 ____3 ____1 11 11 41 31 21 11 -__-_-_- -__-_-_-_- 65 3175..56
----n 3 ____ 1____ ____ ____ 1 1 1 1 ____ ____ ____ ____ ____ ____ ____ ____ ____ _____ 2 33.3
875 -5161 U "9"6 ------r6 ----gs 28 ~ ----r8 -9 -8 -5 ---yo -5 -5 -2 --1 --1 103 - -

Case Rate --------:5'7--TI--16.7--29.5--46.7--50.0-- 62.5--50.0--40.0--100.0 --~

(Per 100)

STAGES

CASES OF PNEUMOCONIOSIS BY STAGES NUMBER

PERCENT

Beginning first stage First stage Second stage Third stage Unknown

6

5.9

41

39.8

26

25.2

26

25.2

4

3.9

TOTAL CASES

103

100.0

LABORATORIES
E. J. SUNKES1 DR.P.H.I Director
The primary function of the Division of Laboratories is to assist the physicians in the diagnosis of communicable diseases. This is accomplished by the application of a wide range of scientifically approved techniques to various kinds of specimens submitted from patients. By this means, infectious diseases are located and protective measures instituted for those exposed. It serves also, in this way, a very useful purpose in checking on the efficacy of treatment. Information relating to the occurrence of highly infectious diseases is immediately transmitted to the Division of Epidemiology.
A properly collected specimen is essential in this work, and, therefore, it is necessary for the laboratory to prepare and supply to the physicians suitable containers. A written report on the results o~f the examination is promptly forwarded to the physician and a carbon copy is kept on permanent file. The laboratory also manufactures some immunologic products and distributes other biologics, antibiotics, and drugs used in the treatment and prevention of disease.
LABORATORY SYSTEM
The Division of Laboratories consists of the Central laboratory in Atlanta and branch laboratories in Albany, :Macon and Waycross. It also directs and is responsible for the laboratory service rendered in the Battey State Hospital and the Alto Medical Center. The same type of se1~vice, with very .few minor exceptions, is rendered in the branch laboratories as is given in the Central laboratory. The service in the institutional laboratories is determined by consultation with the medical directors.
These combined laboratories made a total of 1,016,989 examinations in 1949 as compared to 916,599 in 1948. This is a gain of 100,390 or 11% over the preceding year. Other related services in this Division show a corresponding increase in activities.
To illustrate the growth of the laboratories over the last quarter of a century in Diagram I, five-year periods are selected from 1925 through 1940, and then two-year intervals are shown for the last decade. It is pointed out that the heavy demand for serologic tests on selective service registrants occasioned an abnormal growth of the laboratory during the mid-war years. Immediately following the war a recession is observed due to the discontinuance of this phase of work for the army. Since the war,

-,

78 ANNUAL REPORT, 1949
however, the laboratory has had to expand to keep pace with the increased demand for its services.
Diagram II shows the distribution of the specimen load by laboratories in terms of volume and percent. The distribution by laboratory units is shown in Diagram III in like manner.
A comparison is made in Table 1 with the volume clone in 1948 in the different laboratories. It will be observed that all laborator!es, with the single exception of the Central laboratory, show an increase of work over the preceding year.

TABLE I SPECIMEN LOAD BY LABORATORIES 1949-1948

1949

Central Labo;atory . . . . . . . . 519,260

AWlabyacnryosBs rBanracnhcLh aLbaobraotroartyory. ..

149,807 83,325

Macon Branch Laboratory... 143,224

Battey State Hospital Lab.... 67,222

Alto Medical Center Lab.... 54,151

Grand Total .......... 1,016,989

1948
564,410 122,593 75,912
60,739 42,407 50,538 916,599

Increase or I>ecrease
- 45,150 - 8.0% + 27,214 +22.2% + 7,413 + 9.8% + 82,485 +135.8% + 24,815 +58.5% + 3,613 + 7.1% +100,390 +11.0%

The decrease shown for the Central laboratory is attributed primarily to the development of services in the Macon branch laboratory. This decrease occurred chiefly in the microscopy and serology units. The Central laboratory, however; made 51% of the examinations in the laboratory system as compared to 61% in 1948. This is the first time since the establishment of branch laboratories that the specimen load has been reduced in the Central laboratory. Heretofore, branch laboratories were only able to absorb the greater portion of the annual increase. As branch laboratories relieve the routine load, more time can be devoted in the Central laboratory to the investigation of methods and eva~uation of test performance.

BRANCH LABORATORIES
ALBANY BRANCH LABORATORY: This laboratory established a new record in the total number of examinations made. All units showed a substantial increase in the number of specimens examined. An increase of 45% in feces and urine cultures was clue to, r<2quests for those-tests on food handlers. The greatest ipcrease, however, was observed in 'the serology section. This is attributed chiefly to the activities of the venereal disease investigators in the southwest region. They were responsible for 12% of the total volume of examinations. Private physicians submitted 50% of

' 1,100,000 1,000,00 900,000

Diagram I
GROWTH OF LABORATORY WORK
1925- 1949

-
~

800,000
azw
~ 700,000
wX
til
~ 600,000
::0
0aw..
til
500,000 "-
0
0w:: <D400,000
::0
:z:>

r---'
r-
~
-

300,000

~

ta

0

:;1:1

200,000

-

~
0

::':

111

100,000

"'

D 0 rt

....
"()

1925

1930

1935

1940

1942

1944

1946

1948

1949

80 ANNUAL REPORT, 1949

Diogrom II
SPECIMEN LOAD BY
LABORATORIES
1949

CENTRAL 519,260
51.1%

ALTO '54,151
5.3%

67,222 6.6%

SEROLOGY 722,774
71:1%

Diagram m
SPECIMEN LOAD BY UNITS
1949

CLINICA~
48,873 4.8%

CULTURE 63,724 6. 3%

LABORATORIES 81
the entire specimen load and the remainder came from county health departments. This laboratory isolated a pathogenic fungus ( C: immitis) which had not before been identified by any of our laboratories, and also isolated another rare fungus (S. schenkii) which had been identified by us only once previously. These findings have stimulated an interest in fungus detection among many physicians in that region.
WAYCROSS BRANCH LABORATORY: This laboratory examined more specimens than it had in any year since 1943 when a large number of serology specimens were examined for the shipyards on the coast of that area. There was an increase in all types of examinations except those for the agglutination series and intestinal parasites. The latter, however, ran an all time high of 38.8% in positive results due to selective collection. More examinations for tuberculosis were made than in any year since the establishment of the laboratory in 1937. The increase in serology specimens accounts for most of the gain in this laboratory. This phase of work would have shown an even greater increase except for the reason that the venereal disease investigators in that region conducted several county-wide surveys and these specimens were sent to the special serology section established in the Central laboratory for survey work.
MACON LABORATORY: Due to its strategic location as relates to mail service, the Macon laboratory showed a phenomenal increase in its specimen load. Within 2 years' time this laboratory has almost reached the volume of the Albany laboratory which was established 13 years ago. It serves an area in the middle of the State which, for the most part, was previously served by the Central laboratory. This laboratory was patronized by 305 physicians and 56 county health departments. This represents a considerable increase in both sources. Two-thirds of the specimens, however, were received from health departments. Milk examinations were made for' health departments in 6 <:ounties and covered 210 producers. The increase in the patronage of. the private physicians over the previous year is an indication for continued growth.
BATTEY LABORATORY: This laboratory showed a remarkable growth in all phases of its work. The sputum examinations increased 100% over the previous 12-month period. This increase is due to checking at frequent intervals by cultural methods the effect of drug and antibiotic therapy and to the community-wide survey specimens referred through the Central laboratory, as well as to an expansion of the patient load. Improved methodology has resulted in a better correlation between direct and concentrate

82 ANNUAL REPORT, 1949
microscopic examinations and cultures ,and animal inoculations. This laboratory also carried on experimental work to determine thf. efficacy of ;arious types of treatment: During the latter part of the year a therapy evaluation study was made in cooperation with the Communicable Disease Center of the U. S. Public Health Service. Plans are being made for new and enlarged laboratory facilities to meet the demands resulting from an increased bed capacity of the institution.
ALTO' LABORATORY: This laboratory showed a normal growth without any outstanding features in its activities. All phases of its work showed some increase except the culture section. The decrease shown in this unit is due to a change in the policy of the medical staff in regard to discontinuing requests for cultures on specimens submitted for gonorrhea examinations. The percentage of positive serologic reactions are somewhat lower than would be anticipated but this is due to repeated test in cases which proved to be nonsyphilitic infection. One of the more experienced technicians was given special training in clinical laboratory work in order to render a more expanded service requested by the medical director. This laboratory is called upon more and more to conduct experimental and investigative studies on the effect of different drugs in the treatment of venereal diseases.

TABLE II

MICROSCOPY UNIT-EXAMINATION

1949

TUBERCULOSIS

Total Positive

Microscopic ............ 56,700 8,671

Culture Animal

I.n. oculatio n ....

12,897 2,676

4,096 676

Total .. 72,273 13,443

DIPHTHERIA



Diagnostic Release and

Carrier.:..

3,881 904

563 145

Virulence 43 30 Total 4,828 738

GONORRHEA ........... 19,529 2,183

INTESTINAL PARASITES

Ova Ova

. ' .... Count

'..'................'....

70,165 383

E. histolytica ........... 1,554

Worm for Identification. 13

Total ................. 72,115

19,793 16
19,809

MALARIA 6,946

3

RAMABnicIiEmroSaslcoIpnioccu.l.a.ti.o.n............

1,291 181

458 51

MISCELLANEOUS ...... 4,455 601

TOTAL FOR UNIT .. ' .. 181,618

1948

Increase or Decrease

Total Positive Total Positive

39,320 5,231 +17,380 +3,440.

6,632 1,357 + 6,265 +2,739

1,739 603 + 937 + 73

47,691 7,191 +24,582 +6,252

4,123 333 37
4,493
18,333

820

242

257

38 + 571 + 107

28 +

6+ 2

886 + 335

148

2,323 + 1,196

140

63,347 18,472 + 6,818 +1,321

192

+ 191

1,583

18

29

2

.22

9

65,144 18,490 + 6,971 +1,319

7,352

13

406

10

1,022 90
2,485
146,610

318 + 269 + 140 20 + 91 + 31 490 + 1,970 + 111
+35,008

r
LABORATORifS 83
THE MICROSCOPY UNIT
This unit is so named because the microscope is used chiefly in these examinations. Table II presents the classification of the examinations made in this unit of the several laboratories. A comparison is. made with the previous year in the number of specimens examined and in those found to be positive.
TUBERCULOSIS: The increase shown in the number of examinations does not represent new cases revealed in this proportion. In this disease many tests may be made on the diagnosed case under treatment and on the suspicious case until tuberculosis is ruled out. A total of 3,837 specimens were examined as a result of the follow-up work in connection with the community-wide surveys and accounts for a large part of this increase. The Battey laboratory made the majority of the microscopic examinations for tuberculosis and all of the culture and animal inoculation work, except a small number done as a special study in the Central laboratory.
DIPHTHERIA: An increase is noted in the number of diphtheria examinations but the number of positives is decidedly lower than for 1948. This reflects a decrease in the incidence of the disease. The increase in cases during the previous year evidently made physicians and health workers more alert to the existence of this controllable disease. The large increase in release and carrier examinations indicates a more careful follow-up of individual cases.
GONORRHEA: The direct examination for gonorrhea remained at about the same level as for the past several years. Some decrease is noted, however, in the positive results. The general use of effective antibiotics is probably responsible for the lack of a trend of increase as is shown in most other types of examinations.
INTESTI'NAL PARASITES: There was a continued increase in total ova examinations, as has been apparent for the past 5 years. This increase is less, however, than in any year since 1945. There were 507 specimens showing double infections and 6 specimens which showed triple infections. There was but little change in either the total number of examinations for amebic dysentery or the positive results. The increase shown in ova counts will probably continue since this service now rendered only in the Central and Waycross laboratories will be made available soon in the other 2 branch laboratories. Only a few worms are submitted for identification. The Central laboratory is participating in an evaluation study in the diagnosis of amGebiasis conducted by the Communicable Disease Center of the U. S. Public Health Service.

84 ANNUAL REPORT, 1949
MALARIA: This disease has become almost non-existent in the State. There was a slight decrease in the number of examinations and an all time low of 3 positive findings, all of which were of the tertian type. One of these cases was acquired in Puerto Rico and another was a veteran who had seen service in the South Pacific area. The investigation as to the source of infection in the third case is not yet completed. All of the 1,826 specimens collected in a survey of the area around the Allatoona Dam were negative.
RABIES: There was a decided increase both in the number of microscopic examinations and in the positive findings. Dogs lead the list of animals, accounting for 803 examinations, 286 of which were positive. Cats came next with 34 positives out of 224 examined. Contrary to popular rumor
only 35% of the animals examined were reported as rabid. However, 83% of the 125 foxes examined showed positive evidence of rabies. The
heads of a few other animals both domestic and wild were submitted for examination. The 458 positive heads were received from 70 counties as compared to 388 positive heads received from 75 counties in the previous year. The Municipal laboratories in Savannah, Augusta, and Columbus examined 80 animals, 6 of which showed positive results. :Mouse inoculations were made in those cases in which the history was suggestive and the laboratory examination was negative.
MISCELLANEOUS: All other types of examinations in the microscopy unit which are comparatively small in number are grouped under this classification. They are made chiefly on specimens from lesions of venereal disease or infections relating to or resembling these diseases in some way. The test for sugar determination in urine was added during the latter part of the year 'in cooperation with an experimental study introduced in the Community-wide Venereal Disease and Tuberculosis Survey Program. It is thought that by this means an effective screening procedure can be established for the detection of diabetes. These urine sugar tests accounted for about one-third of the miscellaneous examinations.
THE CULTURE UNIT
This unit, sometimes referred to as the Enteric Bacteriology unit, examines specimens of blood for various types of febrile diseases and makes cultural studies on stool specimens for typhoid fever or carriers and for dysentery. Cultural studies are also made for pathogenic fungi, N. gonorrhoea, and a miscellany of pathogenic bacteria. Table III gives the combined statistical tabulation for this type of work done in the various labo-

LABORATORIES 85

ratories. A comparison is also given for the number of examinations, and positive ndings for the previous year. An increase of approximately 33% is noted in the work of this unit.

TABLE Ill CULTURE.UNIT-EXAMINATIONS

1949

Tota:l Positive

AGGLUTINATIO~ ..... 14,987

Typhoid . . . . . . . . . . . . . . .

128

Endemic Typhus . . . . . . .

159

Undulant . . . . .. . . . . . . . . .

228

Tularemia . . . . . . . . . . . . .

122

Tota:l . . . . . . . . . . . . . . . . . .

637

BLOOD CULTURE ...... 7,444

S. Typhosa . . .. . . . . . . . . .

40

Other Salmonella ...... .

Brucella . . . . . . .. . . . . . . . .

72

Other Organisms . . . . . . . .

13

Total . . . . . . . . . . . . . . . . . .

125

STOOL AND URINE .... 16,8%

S. Typhosa . . . . . . . . . . . .

171

Other Salmonella . . . . . . .

139

Shigella .. .. .. .. . .. .. .. .

133

Total . . . . . . . . . . . . . . . . . .

443

GONORRHEA ........... 10,533 2,070

MILK . . . . . . . .. . .. . .. . .. . 11,089

MISCELLANEOUS . . . . . . 2,833

TOTAL FOR UNIT ..... 63,724

1948

Increase or Decrease

Total Positive Total Positive

13,905

+ + 1,082

87

41

181 158
66

++

22 70 56

492

+ 145

7,701

36 12
82 24 154

+ 257 4 12 10 11 29

13,093

+ 3,745

156 89

++ 15 50

165

32

410

+ 33

9,807 2,110 + 726

40

813

+10,276

1,723

+ 1,110

47,042

+16,682

AGGLUTINATION TESTS: These tests performed on blood specimens for the presence of antibodies offer suggestive evidence of infection or t4e indication of a residual of these antibodies following convalescence or immuni-
/
zation. They show a moderate increase over the preceding year except in the case of typhus fever. The trend of this disease is still downward due to an effective rodent control program.

BLOOD CULTURES: There was a slight drop in blood culture tests due probably to th~ policy adopted on July 1, 1948 of culturing only on the specic request of the physician. The Brucella organism was' isolated one
or more times in 54 cases of undulant fever as compared to 57 cases in 1948.

STOOL AND URINE CULTURES: Eighty-one cases of typhoid were detected as compared to 69 in the previous year. Seven new carriers were found but
at least 3 of these are thought to be contact carriers who acquired the organ~
ism but did not develop the disease. The type of the organism in all but 3 of the typhoid cases was determined. Organisms isolated in the branch laboratories are referred to the Central laboratory for these highly specialized typing studies.

,,

86 ANNUAL REPORT, 1949

Other Salmonella organisms were isolated from 109 patients,, S. typhi murium was the predominant type. In an outbreak of gastro-enteritis at the Battey State Hospital this organism was recovered from 45 persons. In a second but smaller outbreak in that hospital a member of the Arizona group of paracolon orgal}isms was isolated in 6 cases. This organism was also found in the same number of cases in a small outbreak in Atlanta. A report on these outbreaks has been submitted for publication.

There were 151 cases of bacillary dysentery diagnosed by the isolation

of Shigella, exclusive of S. alkalescens, which is of doubtful pathogenic

importance. The Flexner type was isolated in the Waycross laboratory in

a small outbreak of dysentery in that vicinity. There were 3 isolations

of a type (8. tiete) which had not been previously recognized in Georgia.

Two of these were from patients having fever and diarrhea and the third

was from a food handler.

'

GONORRHEA CULTURES: These cultures are made only in those laboratories serving local clinics, where the specimens can be transmitted within a few hours after collection. This type of work is limited in its application for the reason that a suitable culture medium has not yet been developed which will keep the organisms alive through mail transportation. The increase in the number of these tests over the previous year is only moderate. A slight drop is observed in the positive results.

MILK: Examination on milk and ice cream was begun in the Albany and Waycross laboratories in the latter part of 1948. This accounts for the large increase shown in the comparison for the 2 years. Bacteria counts, butterfat determinations, and tests for added water and for p;oper pasteurization are made on these samples. This type of service is rendered only at the request of local health departments which have standard milk ordinances.

MISCELLANEOUS: Examinations on the miscellaneous type of specimen show about 65% increase over the preceding year. Of special interest is the increase shown in the examination for pathogenic fungi. It appears that physicians are becoming aware of the value of this service.

SEROLOGY UNIT
This unit examined 71.1% of the specimens received in the entire labo-ratory system. Fortunately these tests are not as complex and time con-
suming as some of the laboratory procedures. Table IV gives a compilation of the tests applied, positive results, and a comparison for the previous year. An overall increase of approximately 6% is shown in the work of this unit.
..

LABO~ATORIES 87

TABLE IV

SEROLOGY UNIT-EXAMINATIONS

1949

1948

Increase or Decrease

% PosiTotal tive SYPHILIS Blood ............... 583,783 9.5 Spinal Fluid ........ 11,841 10.4-
Total ............... 595,624 9.5

% PosiTotal tive
572,391 11.6 11,592 10.2 583,983 11.6

% PosiTotal tive
+11,392 -2.1 + 249 + .2 +11,641 -2.1

RH FACTOR ......... 62,211 13.5 (Neg.) 47,788 14.5 (Neg.) +14,423 -1.0

BLOOD GROUP ...... 62,215

47,793

+14,422

HETEROPHILE ANTIBODY .............. 2,724 12.6

2,203 11.2

+ 521 +1.4

TOTAL FOR UNIT ... 722,774

681,767

+41,007

'SYPHILIS: The serologic test for syphilis accounts for the large volume of specimens examine~ in this unit. Six out of every 10 specimens received in the laboratory system is for the blood test for syphilis. This test has become popularized through the cooperative efforts of the Venereal Disease Division and the U. S. Public Health Service. Positive findings continue a downward trend and indicate gradual progress in the control program.

Community-wide surveys were conducted by field teams in 16 counties. Smaller surveys were carried out by Communicable Disease Investigators in 22 counties. These surveys have a rather popular appeal and reach more than 90% of the testable population. They were responsible for 134,000 of the blood specimens submitted for the sero-diagnosis of syphilis. Specimens from this source showed a decrease of approximately 17% from the previous year when similar surveys were conducted in more populous counties.

The requirements of the premarital law added to the work of this unit.
The State laboratories examined 17,215 premarital specimens during ap-
proximately the last four months of the year. Of these 793 or 4.6% were found to ~e positive, and are classified by race and sex as follows:

W-M43

vV-F 58

C-M 331

C-F 362

In addition, reports from all of the other approved laboratories show 7,366 examinations with 231 positive results, but these were not classified by ' race and sex.

A special section of the serology unit of the Central laboratory has. for

several years conducted evaluation studies with other laboratories in the

State for the purpose of approval under the provisions of the prenatal law.

I

The premarital law has caused several additional laboratories to request

88 ANNUAL REPORT, 1949

approval and has thereby considerably increased the work of this section. Technical assistance was rendered to laboratories failing to meet the rather rigid criterion for acceptable test performance. Thirty-nine laboratqries in addition to those in the State system were given approval under the provisions of these 2 laws. An evaluation of test performance of the Rh and Blood Group tests was conducted with all State laboratories with complete agreement in results. This section participated in the annual national serology evaluation study and achieved a creditable rating in the application of 6 different serologic tests for syphilis.
RH AND BLOOD GROUP TESTS: These tests are performed on the same specimen but involve different test procedures. This work is limited to prenatal and closely related cases. A steady increase has resulted in the demand for this service since its establishment as a routine function 3 years ago. Facilities do not permit the application of these tests for the purpose of personal information or in connection with blood donor service.
HETEROPHILE ANTIBODY TEST: This test for glandular fever or infectious mononucleosis is performed only in the Central laboratory where a supply of sheep blood cells used in the test are available. Branch laboratories refer specimens for this test to the Central laboratory. Positive reactions are regarded as only presumptive evidence and should be correlated with the bloo~ picture. Requests for this test are gradually increasing from year to year.

CLINICAL TESTS
These tests are done only in the Alto and Battey laboratories. They are not usually employed in public health work but are valuable guides to the clinicians in the treatment of patients. in these institutions. Table V gives a classification of these tests and shows a comparison with the work of the preceding year. A slight decrease is observed in blood chemistry, a small gain in spinal fluids and miscellaneous examinations, and a pronounced increase in hematolo&Y and urinalyses.

TABLE V

CLINICAL TESTS (INSTITUTIONAL LABORATORIES)

Hematology ............. . Blood Chemistry ......... . Urine .................. . Spinal fluids ............. . Miscellaneous ............ . TOTAL FOR UNIT ..., .

1949
18,979 587
5,874 21,740
1,693 48,873

1948
14,223
605 3,820 20,915 1,617 41,180

Increase or lJecrease
+4,756 +33.4% 18 - 3.0%
+2,054 +53.8% + 825 + 3.9% + . 76 + 4.7% +7,693 +18.7%

LABORATORIES 89
ANTIRABIC TREATMENT
Antirabic treatment for humans is manufactured and distributed from the Central laboratory. The Branch laboratories keep on hand a small amount sufficient to 'supply the initial 4 doses in order to avoid delays in beginning treatment. The order then is referred to the Central 'laboratory for completion. An accurate record is kept on file of every case for which treatment is furnished. Table VI gives a comparison by types of the treatments supplied for the past 2 years. A slight rise is observed both in thet total number of treatments and in the precautionary type.

TABLE VI

CLASSIFICATION OF ANTIRABIC TREATMENT

1949

Type

Number Percent

PMrielcdau.ti.o.n.a.r.y..........

486 427

48.9 43.0

Intensive Drastic TOTAL

........................

74 7 994

7.4 .7

1948

Increase or Decrease

Number Percent Number Percent

423

45.3

436 46.7

69

7.4

6

.6

934

+63 -9
+5 +1 +60

+3.6 -3.7
+ .1

The laboratory advises with physicians in regard to the necessity of

treatment or as to the type indicated in each individual case. The precau-

tionary treatment is suggested in cases in which there has been no actual

bite but where there has been an exposure to the saliva through a fresh

pre-existent abrasion. The mild type of treatment is usually recommended

for bites on the extremities. Intensive treatment is given in cases of mild

bites on the face or head, or severe bites on the hands. These treatments

vary only in the number of doses or frequency of administration. Drastic

treatment of greater potency is indicated in severe bites around the face.

Map I shows the distribution of antirabic treatment by counties. The

greater number of treatments were distributed in the northern part of the

State. It will be observed that the 4 counties of Cobb,. Fulton, DeKalb

and Gwinnett required 40% of the entire number of treatments distributed

to the whole State.

HUMAN CASES OF RABIES AND TREATMENT PARALYSIS
For the first time since 1931 there has been no human case of rabies r~ported in the State. No cases of treatment paralysis have occurred within the last 4 years. It is thought that these post-vaccinal accidents have been reduced by adopting the policy of terminating treatment at 6 doses in cases which have received treatment at any time in the past. Twenty-nine persons were treated in this manner during the past year.

90 ANNUAL REPORT, 1949

TENNESSEE

NORTH CAROLINA

MAP I
DISTRIBUTION 0 F ANTIRABIC TREATMENT
1949
TOTAL 994



LABORATORIES 91

A hyperimmune rabies serum for clinical trial, furnished from a commercial source was administered to 16 patients during the year. All had been severely bitten by rabid or suspected rabid animals. No unfavorable reactions were reported except in one patient who had previously been treated with antirabic vaccine. It would appear that the use of hyperimmune serum might be contra-indicated in such cases. The serum is more effective if administered within 24 hours but may be given within 48 hours. It is hoped that use of the serum will necessitate administration of a much smaller number of doses of vaccine.

MEDIA AND VACCINE
Media is made chiefly in the Central laboratory and is distributed to the branch and institutional laboratories. The branch laboratories, however, make certain kinds for their own immediate use. A total of 2,607_ liters were prepared in all the laboratories which is ~lightly more than that pro~uced in the previous year.
The Central laboratory prepared 621 liters of typhoid vaccine for distribution. This approached the all time high production record of 1936. A total of 116,300 silver nitrate ampules were made for use in the prevention of infection in the eyes of the new-born infants. Almost 20 liters of diluted tuberculin were prepared as a skin test material in tuberculosis diagnosis. During the year this product was made available to private physicians as well as to State clinics. The distribution of P.P.D., a commercial product, was discontinued. The advent of penicillin therapy has reduced the demand for distilled water in clinics and only 980 liters were prepared during the year.

SPECIMEN CONTAINERS

There was no pronounced change in the distribution of specimen outfits

as a whole. Some drop is shown for intestinal parasite containers due to

lessened activities in survey work. Some increase was observed in requests

for sputum, stool culture, and pinworm outfits.

.

BIOLOGIC SALES
This service is J;endered in connection with the work of other divisions of the Department, primarily, Maternal and Child Health, Tuberculosis Control, Local Health Organizations, and Venereal Disease Control. There was a decrease in the distribution of diphtheria antitoxin and an increased demand was observed for penicillin and for the drugs furnished in the treatment of intestinal parasites. Other products were distributed in about the same amounts as for the previous year. The Red Cross recalled allsurplus

I

92 ANNUAL REPORT, 1949
war-time dried blood plasJUa because of the expiration date. This ~ill be fractionated into immune serum globulin which has been available from this source.
THE PREMARITAL LAW
This law was enacted by the 1949 session of the legislature and became
effective on August 25. It requires that the applicant for a marriage license
have a medical examination for syphilis, including a blood test, but does not require a waiting period. This law is administered jointly by the ordinaries and the State Department of Health. It has been necessary to augment the technical and clerical staffs to carry out the provisions of this law.
Inspection of facilities and check studies in performance were carried out with laboratories requesting approval. Premarital certificates have been prepared and supplied to approved laboratories. The ordinaries are advised as changes occur in this list of laboratories.
Physicians were circularized in regard to the manner of submitting specimens for the purpose of securing premarital certificates. lVIuch correspondence has ensued in regard to inquiries regarding this new law. A pamphlet outlining the step by step procedure for applicants for marriage licenses is being prepared for public distribution.
INVESTIGATIONS AND PAPERS
An investigation was carried out at the Battey laboratory on the effectiveness of irradiation from ultra-violet lights on organisms in sputum. It was found that 70% of the airborne bacteria and 96% of the tuberculosis organisms in sputum were destroyed through exposure at 6 to 8 feet for 22 hours. As a result of this study, ultra-violet lights have been installed in some of the rooms of the Battey laboratory to further insure the safety of the laboratory workers. A report on this work was presented to the laboratory section of the American Public Health Association in October.
Studies were also begun on different methods of collection and mailing of gastric lavage specimens. The results are promising but the work is incomplete. A parallel study was made between the Exton and the Ames method of albumin determination in urine with inconclusive results.
A study was instituted in the Culture Unit to determine the incidence of Salmonella alkalescens in the general population. In the lVIicroscopy Unit studies. were begun on the development of a new cellulose tape pinworm outfit and on a polyvinal alcohol outfit for use in the diagnosis of E. histolytica infection ..

.. , I
LABORATORIES' 93
One of the personnel in the Serology Unit was appointed on a subcommittee from the joint committee of the Laboratory Directors Conference and the American Public Health Association for the study of standardizing the serologic tests for syphilis. This has resulted in considerable parallel testing of methods and reagents which will continue for some time.
A paper entitled "The Conversion of a Standard Incubator to a C02 Incubator" was presented by one of the staff to the 1947 meeting of the Southern Branch of the American Public Health Association and was published in the Journal of Laboratory and Clinical Jilledicine. Another paper entitled "Methods of Isolation and Incidence of Brucella Types in Georgia" by another staff member w~s read before the April meeting of the same scientific body. This paper has also been accepted for publication by the same journal.
EXPANSION OF FACILITIES
The quarters formerly occupied by the print shop were allocated to the laboratory for expansion of its services. Three laboratory rooms and 2 offices have been constructed in this space. Laboratory furniture has been purchased and is awaiting installation. This will give more space to the special serology section in which the work has enlarged as a result of the premarital law. It will also provide for the milk work v~hich will be begun within a few months. If plans mature to expand the communitywide survey work to inch;de diabetes detection, some of this space may be used for blood sugar determination tests. It will also allow for the expansion of evaluation studies of test performance with other laboratories, which is planned for the near future.
RESIGNATIONS AND APPOINTMENTS
There were 22 resignations and 27 appointments in the technical and clerical staffs and 7 resignations and an equal number of appointments in the unskilled group of employees. One-third of those resigning did so in order to accept better positions elsewhere. A formal course of training was given in the Central laboratory to 18 of the 21 technical replacements. The classification for trainees was elevated to the next higher bracket as an inducement to those having the better educational" backgr_ound and qualifications.
VISITORS Thirty-two visitors from 20 foreign countries and 64 from other states
were shown the work and facilities in the Central laboratory. There were 638 visitors from schools and lay groups within the State interested m public health work.

MATERNAL AND CHILD HEALTH
GUY V. RICE, M.D., Director
The objectives of the State Health Department toward which we aim in the field of maternal and child health and nutrition are a state of physical and emotion~l well being, a low incidence of disease, and reduced death rates for mothers and children. In order to reach these objectives, it is necessary that we have intermediate objectives. Some of these are: an improved health environment; improved medical and nursing care; improved hospital facilities; better public health facilities and aroused socioeconomic consciousness; opportunity for, and understanding of, better nu1 trition; and a complete staff in the Maternal and Child Health Division adequately trained in their respective fields.
PERSONNEL
The year began with a pediatric consultant physician, a school health consultant physician, a pediatric nursing consultant, a maternity nursing consultant, a nutrition consultant, and a health educator in the Division office.
During seven months of the year, it was possible to obtain the services of an obstetric consultant physician. A maternity nursing consultant returned from educational leave and another pediatric nursing consultant was employed, the latter to work with Grady Hospital in their pediatric and premature programs. The position of nutritionist with the Nutrition Survey Team was vacant after July 1. A dietary consultant was added to the State Office to work with the Hospital and Industrial Hlygiene Divisions as well as the Maternal and Child Health Division, July 1.
There were nutrition consultants in each of the six regional offices, one with the Special School Health Project and a nutritionist on the local level. Two nutritionists were on educational leave during the year preparing for positions as consultants.
MATERNAL AND INFANT CARE
The Maternal and Child Health Clinics have increased fr~m 230 to 285, which does not include counties having only nursing conferences. There were 94 counties which sponsored medical MCH Centers in 1948 against 99 in 1949. We consider that this may show an increase in the quality of serv.ices, as some or our clinics which were not rendering adequate services were discontinued when the honorarium became the joint responsibility of

MATERNAL AND CHILD HEALTH 95
County and State. Prenatal admissions increased in all periods of gestation for both white and colored in 1949. Although the number of colored prenatal patients exami~ed for syphilis was slightly less than for last year, the number of positive cases was lower for both white and colored. Infant and preschool admissions increased during the year for both white and colored and .in all age groups. (See lVIaternal and Child Health Centers r~porting to this office on page 101, and Maternal and Infant Center Activities, page 102.)
SPALDING-PIKE-LAMAR SCHOOL HEALTH PROJECT
The Tri-County Demonstration Project of Spalding-Pike-Lamar Counties, whose purpose was outlined in detail in last year's annual report, was still in the early planning stage at the,end of last year (December 1948). It was possible to start operational activities March 15, 1949, it being felt that the short time (2;1 months) remaining in the school year would serve mainly as a pilot study for the new school year. As is true of all pioneer projects, many difficulties have been encountered. In spite of difficulties, some of which still exist, the program is now serving a large segment of the. communities' school children in a sound defect :finding, defect correction program. It has demonstrated; in that area, the practicability of an improved school health examination by physicians, based on teacher-nurse conferences and teacher screening, and is furnishing a unique study of the use of a mental hygiene team and nutrition team in a school health program.
Until Jun~ 1, the School Health Consultant Physician was loaned to this area to assist the local health commissioner in developing the Special School Health Program. Her activities were limited primarily to research in development of the project to :fit the needs of the area and assistance to the health commissioner in policy making, record developing, program planning and community orientation to the program.
On March 15 actual work was begun in the schools. Through Decem-
ber 31, 1949, local physicians had examined 2,112 children-all the :first grade children and pupils in grades two to seven who were referred by their teachers for medical and behavior problems. On this original screen-' ing 1,945 defects were found and were referred by these physicians to the Pediatric Clinic at the Health Department. After examining these children the pediatrician referred those with defects either to the child's private physician for correction of the defects or for correction under the program. Among the 1,179 children who kept their appointments to the Pediatric Clinic, 1,519 defects were found on examination. by the pe~iatrician. At

96 ANNUAL REPORT, 1949
the close of the year 536 defects had been corrected under program funds, while 20 had been corrected ~y the private physicians at family expense.
As in the past, scholarships were offered health officers and clinicians who served in the maternal and child health centers in 1949. There were 20 physicians who attended the Southern Pediatric Seminar at Saluda, North Carolina, and 18 physicians attended the Obstetric Seminar at the University of Georgia School of Medicine, Augusta, Georgia. The Obstetric Seminar was sponsored by the University School of Medicine in cooperation with the Georgia Department of Public Health, South Carolina Department of Public Health and Florida Department of Public Health.
LOCAL MIDWIVES
The number_ of midwives continues to decline, as it has for the past several years. There were only 1,496 certified in 1949 as against 2,951 in 1939.
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 with better opportunities extended the colored individual, and with increased educational facilities, midwifery does not have the appeal to the individual that it formerly did. Patients are becoming 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 formerly. Another factor in the decrease is the fact that the Georgia Department of Public Health has discouraged the appointment of midwives improperly trained, and the hope that a program of some kind would be developed to properly train qualified personnel to take 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.
NURSE-MIDWIFE PROGRAM The Nurse-midwife Program in vValton County completed its third
year of activity. This is a hospital delivery service connected with a county hospital. The Nurse-midwife Program 'in Thomas County has now been in operation 2,0 years. (See table at end of section for service rendered by the nurse-midwives in each county for the years in operation.)
The Nurse-midwife Program has not expanded to any other area this year but the services have increased in the two already existing demonstrations. Plans are under way for a third demonstration to be started in

MATERNAL AND CHILD HEALTH 97
Barnesville, Lamar County, and a nurse-midwife school in cooperation with Emory University and Grady Hospital. (See statistical chart on page 102.)
CONSULTANT SERVICES AND ACTIVITIES
The postgraduate nursing course at Crawford vV. Long Hospital in the
care of the premature was officially started on January 1. Classes are scheduled every month and during the year 21 nurses took the premature care course including 8 county nurses and 13 hospital nurses. Three fulltime graduate instructors are employed and supervised by the Division of Maternal and Child Health. Future plans include a transportation service for white infants born within a radius of 90 miles of Atlanta.
Plans were started at Grady Hospital towards the building of a new premature unit that would house both colored and white infants. The plans will eventually develop into a training course in the care of the premature infants for colored nurses. Affiliating student nurses will be given 2 weeks' experience in the new nursery. Incubators for the unit will be furnished by this Division and a well qualified pediatric nurse will be responsible for the course.
A hospital survey was made of the obstetrical and nursery and formula facilities of the Columbus City Hospital. The entire physical set-up was revised and terminal sterilization of formulas was iristituted.
The obstetrical and nursery quarters at Floyd County Hospital, the nursery at Brunswick City Hospital, Macon City Hospital formula room and Aidmore Crippled Children's Hospital formula room, were evaluated and recommendations made.
The use of the :Micro Kahn was demonstrated in the regional offices to county nurses and follow-up demonstrations were done in some counties.
Surveys of infant mortality with emphasis on causes of prematurity were done in Chatham, Dougherty and Glynn Counties.
A study was made of the incubators distributed for the care of the premature throughout the State and an incubator filing index was set up in each region.
There were 6,759 children tested during viswn testing demonstrations in collaboration with the Georgia Lighthouse for the Blind. Also, 1,615 children were tested in vision testing demonstrations independent of the above organization.

98 ANNUAL REPORT, 1949

NUTRITION
STAFF EDUCATION: Routine staff education was carried on through work at clinics, in home visits with nurses, through conferences and at county and regi'onal staff meetings. Besides these methods 3 two-day nutrition institutes were held for all health department personnel. One region and one county had one-day nutrition institutes.

WORK WITH PATIENTS: A limited amount of work was done directly with patients. Most of this was done as a method of staff education. This work includes conference~ at prenatal, child health, chest x-ray and crippled children's clinics. Home visits were made with nurses for the same purpose as the work in clinics.

WORK WITH OTHER AGENCIES AND ORGANIZATIONS: All nutrition work-

ers participated in and cooperated with the work of other agencies and

organizations. Among these are the Department of Education, the State.

Welfare Department, the Extension Service, Red Cross, Congress of

Parents and Teachers, the State Nutrition Council, Home Economics Asso-

ciation, Dietetic Association, Georgia Educational Association, Girl and

Boy Scouts and Civic Clubs.

1

WORK IN COLLEGES AND SCHOOLS: In 2 or 3 schools of each region, hemoglobin readings and dietary surveys were made. This was preliminary to a nutrition education program. Each regional consultant and the two nutritioni~ts in counties have helped teachers plan a nutrition education program for thei~ schools.
One regional consultant was full-time staff ~ember for seven weeks, in charge of the nutrition phase of the Health Education Workshop at the University of Georgia. The other consultants participated for shorter periods of time in workshops for teachers and school lunchroom workers.
Senior students in Child Development at the University of Georgia visited pr~natal clinics and child health conferences with the Regional Nutritionist. Senior Home Economics students at Georgia State College for Women and at Georgia Teachers' College observed at clinics. The latter group participated in the food demonstrations at the clinic. Talks have been given to various college groups, especially home economics groups. These talks have been to explain the Health Department nutrition service and to interest girls in preparing for this type work.

Plans were developed for an improvement in the type nutrition teaching given student nurses in one hospital. Conferences have been held with

MATERNAL AND CHILD HEALTH 99
other directors of nursing education on this subject. Conferences have also been held with those training dietitians to emphasize the need for more training in normal nutrition for dietitians who are to teach student nurses.
One lecture was given to medical students on health department nutrition services.
CRIPPLED CHILDREN'S CLINICS: Four half-days were given monthly at the clinics in Augusta and Atlanta and 2 full-days monthly in Savannah. Children in especial need of dietary help were visited in their homes in all of the regions.
FOOD DEMONSTRATIONS: Demonstrations on food preparation were given in some counties in every region. These are simple demonstrations of low cost foods. The preparation for all age groups is shown. Some of the demonstrations were given by Home Demonstration Agents and some by parttime workers paid by the Health Department. The number of part-time workers was greatly reduced when the counties had to assume a portion of the payments.
WORK WITH MIDWIVES: A limited amount of work has been done with midwife groups. This instruction is on the importance and components of good prenatal diets. The instruction is simple and practical.
NUTRITION SURVEY TEAM: The work of this team was disrupted during the year due to a lack of personnel. The medical officer resigned in June and was not replaced until November. A biochemist was available for only brief periods. The nutritionist resigned in June and no qualified person was found to take this place. No technician was available and no clerk was employed after July. The only position filled for the entire year was that of the nurse. In the early part of the year a study was made at Bessie Tift College on the appraisal of dietary techniques. Periodically the team worked in the Special School Health Project with children referred for nutritional defects.
INDUSTRIAL AND INSTITUTIONAL WORK: July 1st a dietary consultant was employed to work with the Hospital, Industrial Hygiene, and Mater nal and Child Health Divisions. The work in the Hospital Division is of two types. Plans for new hospitals are reviewed and suggestions are made on the location and equipment of dietary facilities. Ten plans were reviewed. Help, on request, was given to seven operating hospitals on the improvement of dietary services. In the Industrial Hygiene Division suggestions were given to five industries on the improvement or installation of

100 ANNUAL REPORT, 1949
feeding facilities. The work carried on so far, which has been directly concerned with Maternal and Child Health, has been in four child-caring institutions. Suggestions were given on better planned meals for the children.
One of the regional consultants plans menus monthly for the Florence Crittenton Home in Atlanta.
Help on meal preparation and menus wa~ given one small college.
The county nutritionist conducted nutrition classes for the employees in one industry.
EDUCATIONAL MATERIALS: In most of the regions a regular newsletter was sent to the counties. The regional consultants pr~pared articles for these publications. A monthly newsletter on food and nutrition was sent from the State Office to all counties.
Material on nutrition was prepared and revised for a manual for health department nurses.
A radio script was prepared on better food habits for high school students. This script was transcribed with the help of three high school students and broadcast in all Atlanta high schools. It has been offered to other parts of the State.
All nutrition workers prepared news articles on their field of work.
The State Nutrition Consultant attended a two-weeks' workshop on the preparation of nutrition education materials.
Posters and exhibits have been prepared for use in many different situations and nutrition movies have been shown to a large number of professional, school and community groups.
HEALTH EDUCATION
Approximately 43,000 Georgia Mother and Baby BooksJ 3,000 This is the Figbush Family (a lay-person booklet stressing the importance of early immunization of infants and preschool children) ; and 4,000 Summertime Health Hints for ChildrenJ were requested.
Exhibits have been prepared for varied groups, i.e., Area Meetings; American Academy Pediatrics; Annual Meeting Georgia Public Health Association; Carroll, Dade, Polk, Brooks, Baldwin, and Middle Georgia County Fairs; Northwest Region, Better Health Conference; Home Park

MATERNAL AND CHILD HEALTH 101
School PTA Health Meeting; West End Woman's Club Health Program Meeting; Sixth Georgia Citizens' Conference; Obstetrical Seminar, U ni- _ versity of Georgia School of Medicine; and the Annual State Leadership Meeting of the Woman's Auxiliary to the Fulton County Medical Association, and Grady County.
EDUCATIONAL MATERIALS: Besides editorial help given staff members, specific work has been done on articles for Georgia's Health; reprinting :Midwife Rules and Regulations; sections of the Public H ealtlz Nursing 111an-. ual; JVlental Health Bulletin for the Mental Health Committee of the 1949 Better Health Conference; and other materials to teach the principles of good health habits to mothers and children.

MATERNAL AND CHILD HEALTH CENTERS REPORTING TO THIS OFFICE, 1949

Mater-

Com- Mater-

nal Infant bined nal Infant

Cen- Cen- Cen- Ses- Ses- Combined

ters ---

ters ---

-t-ers-

sions sions Sessions ---------

Counties Sponsoring

Medic9a4l _M__C__H__C__e_n_te_r_s_

69

112

104

2073 2872

2466

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

Counties Sponsoring

Nutrition Services at

MCH25C_e_n_te_r_s_________

7

13

33

182 191

433

Services Rendered by Nurse-Midwives in 1947, 1948,1949 Monroe, Walton County

1947 Assisted with doctors' cases .......... : . . . . . . 303 Nurse-widwife deliveries . . . . . . . . . . . . . . . . . . 62 Nurse-midwife patients delivered by doctors. . . 2 Hospital postpartum visits. . . . . . . . . . . . . . . . . . 938 Prenatal home visits. . . . . . . . . . . . . . . . . . . . . . . 166
Postpartum home visits. . . . . . . . . . . . . . . . . . . . 275 Prenatal clinic attendance .................. 595

1948 1949

271

300

80

123

0

'2

786

901

137

91

351

568

806 1116

102 ANNUAL REPORT, 1949

Service Rendered by Nurse-Midwives in 19481 1949

Thomasville/ Thomas Ccunty

1948 1949

Home deliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

128

Prenatal clinic attendance ........................... 2372 2001

Prenatal home visits ................................ 157

213

Postpartum home visits ............................. 1099

948

MATERNAL HEALTH CENTER ACTIVITY State-subsidized Centers

1948 Prenatal Admissions
Admissions, total ................. 18048 White ....................... 1648 Negro ........................ 16400
Period gestation, total. .._.......... 18048 Under 16 weeks. . . . . . . . . . . . . . . . 4720 16-27 weeks ............ ; . . . . . . 8977 28-36 weeks . . . . . . . . . . . . . . . . . . . 3829 over 36 weeks. . . . . . . . . . . . . . . . . . 522
Prenatal Syphilis Reports, total ................ , ... 11655 White ........................ 1055 Negro ....................... 10600 Number positive, total. ............ 1042 White . . . . . . . . . . . . . . . . . . . . . . . 34 Negro ........................ 1008
Prenatal Activities Visits, total ..................... 60410 White ........................ 6005 Negro . , ...................... 54405 Transferred total . . . . . . . . . . . . . . . . 243
Postnatal Activities Admissions, total ................. 4473 White . . . . . . . . . . . . . . . . . . . . . . . . 661 Negro ..................... .'.. 3812 Visits, total . . . . . . . . . . . . . . . . . . . . . 5286 White . . . . . . . . . . . . . . . . . . . . . . . . 843 Negro ....................... 4443

1949
19520 1840 17680 19520 4754 9780 4310
676
12542 1265 10477
866 26 840
62129 6676
55453 318
4944 562 4382 6119 742 5377

%plus or minus
+8 +12 +8 +8 +.7 +9 +13 +30
+8 +20 -1 -17 -24 -17
+3 +11 +2 +31
+11 -15 +15 +16 -12 +21

MATERNAL AND CHILD HEALTH 103

INFANT HEALTH CENTER ACTIVITY State-subsidized Centers

1948 A dmissions-lnfant and Preschool
Admissions, total . . . . . . . . . . . . . . . . . 23985 White ........................ 8812 Negro ....................... 15173
Age groups, total. ................ 23985 1Jnder 4 months ................ 8427 4-12 months ................... 6433 1-5 years ...................... 9125
Visits and Activities Visits, tota.t ..................... 67173 White ....................... 23099 Negro .......... , ............ .44074 Referred cases . . . . . . . . . . . . . . . . . . . 1981

1949
27686 9445 18241 27686 9870 7211 10605
79353 27025 52328
2681

%plus or mmus
+15 +7 +20 +15 +17 +12 +16
+18 +22 +19 +35

MENTAL HYGIENE
GUY V. RICE, M.D., Director
OBJECTIVES OF PROGRAM
The Mental Hygiene Program still may be considered the baby of the Health Department. The objectives of this Division are:
(A) To develop an awareness of the people of Georgia of the need and desirability of a long range preventive mental hygiene program.
(B) To expand the services of the guidance centers in Georgia so that they become an integral part of the community and State mental health program.
(C) To develop a closer working relationship between all agencies and groups now interested and to be interested in mental hygiene.
(D) To conduct in-service training programs for all public health personnel and other groups in so far as is practical and possible.
These goals are to be accomplished by:
(A) An education program which will feature the use of such techniques as verbal skill clinics, socio-dramas, and panel discussions. These techniques are primarily to be used to stimulate individual participation. It is hoped that this will lead to an actual experience in the use and knowledge of mental hygiene concepts that will have some carry-over value to the individual personally and professionally.
(B) A mass information program will also be used, combining the distribution of pamphlets, radio programs, and discussion groups, and the training of lay leaders to carry the program into all areas of the State.
PERSONNEL
Dr. Michael Pescor left during July. A psychiatric social worker was employed but it has been difficult to obtain a professional staff because of the low salaries paid public health workers which do not compare with. these workers in the mental hygiene field in other areas.
The mental hygiene clinic staff in the Spalding-Pike-Lamar health district has been completed but only a few cases were completed during the latter part of the year since most of the activities were along the lines of community education in the field of school health.

EDUCATION

MENTAL HYGIENE 105

Pierre the Pelican, a publication for parents with their first baby, has been enthusiastically received and since July 1, 1948, approximately 295,000 copies of Pierre the Pelican have been mailed to parents of 38,000 fitstcborn babies.
lVIental hygiene kits containing 25 pamphlets were distributed to teachers,
health departments, workshops, child guidance clinics and universities. to the number of 934.
In~titutes have been held in the local health departments to incorporate mental hygiene into the public health program. It is our feeling that the first priority for attack in developing a Mental Health Program would .be the training au'd orientati~n of public health personnel in mental hygiene practices and concepts. This should be approached through the teamwork concept a~d the unit should be local, regional, and Stat~ Health Department staffs in which every member, fr~m clerk to health officer, participates. This would provide a recognition by each person of his part in the Mental Health Program. It will also provide them with a basis of supporting the indiv{dual or members of the unit who w~uld have the responsibilitY' of carrying out the functional program. We have begun this pro~ram.

Along with this we have also endeavored to build a receptivity, awareness and a desire for an overall program in the minds of the lay public.

Scholarships we!e granted three visiting teachers for training in psychia-

tric social work, and a grant was made to the University of Georgia to

furnish a consultant to work with the visiting teachers and counsellors in

Georgia.

.

LOCAL CLINICS
The clinics at Savannah and Augusta are beginning to serve as community centers for the development of an overall mental hygiene program which is their true function, in addition to treatment of selected cases.
We have worked with the local health department in Bibb County, giving consultant service in the community education program, preliminary to the setting up of a menta!' hygiene clinic there. This is one of the best examples of community planni~g which we have seen. We feel that when the clinic is established there, it. will be much more successful because of the well-laid groundwork.

106 ANNUAL REPORT, 1949
RICHMOND COUNTY ENTAL HYGIENE CLINIC1 1949
Total 1. Individuals admitted to service ............................ 1065
a. No. of above admitted to psychiatric service. . . . . . . . . . . . . . . . 356 b. No. of above admitted to psychological service. . . . . . . . . . . . . . 543 c. No. of above admitted to psychiatric nursing or social service. . 530 2. Interviews with patients by psychiatrist ...................... 1304 3. Interviews about patients by psychiatrist. . . . . . . . . . . . . . . . . . . . . 67 4. Interviews with patients by psychologist. . . . . . . . . . . . . . . . . . . . . 894 5. Interviews about patients by psychologist. . . . . . . . . . . . . . . . . . . . 52 6. Interviews with patients by psychiatric nurse or social worker .... 822 7. Interviews about patients by psychiatric nurse or social worker ... 183 8. Special examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 9. Individuals referred for correction of physical defects....... . . . 2 10. Individuals recommended for hospitalization ... : . . . . . . . . . . . . . . 35 11. Lectures to professional groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 12. Attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ... 2857 13. Lectures to lay groups.................................... 21 14. Attendance . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2096
SAVANNAH CHILD GUIDANCE CENTER, 1949
Total I. Report of Case Load
1. Total. cases open .................................... 669 2. Cases closed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 3. Cases carried forward ............................... 504
II. Staff Personnel Report
1. Service plan for new and reopened cases (Number of hours) a. Service as planned on new and reopened cases. . . . . . . . . 254 b. Service given on cases closed. . . . . . . . . . . . . . . . . . . . . . . 258
III. Activities Report on all Cases Open 1. .Interviews with patients ............................. 750
2. Interviews about patients ................ : . . . . . . . . . . . 714 3. Special examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 4. Ipdividuals. referred for physical defects. . . . . . . . . . . . . . . . 7 5. Individuals recommended for hospitalization. . . . . . . . . . . . . 8
IV. Educational Activities 1. Public lectures and talks. . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
2. Attendance ....................................... 2242

PERSONNEL ADMINISTRATION
H. M. CHESTER, M.A., Administrator
The Ellis Health Law in 1914 set the pattern for the selection and appointment of Health Department employees on the basis of skill and ability. In 1941 a more comprehensive personnel program for employees of the local and State offices of the Health Department was developed through the establishment of a Personnel Office. In 1943 the State Legislature established a State Merit System Administration to develop overall personnel policies and to recruit and examine applicants for employment in several of the departments of the State Government.
At the present time, all departmental personnel policies and procedures are developed and carried out by the departmental Personnel Administrator within the broad framework established by the State Merit System Administration.
GROWTH OF PUBLIC HEALTH WORK
The continued demand for additional public health service has resulted in a continued increase in the number of full-time employees in public health work in Georgia. There was an increase of 102 employees during 1949. Most of these were added at Battey State Hospital where additional appropriations made money available for opening new wards. On the State staff, the increases were primarily in communicable disease investigators and nurses who render services throughout the State.
In spite of the overall increase in the number of employees, there was a loss of 8 physicians-3 in the local departments, 2 on the State staff, one at Alto and 2 at Battey.
In the local health departments there was a net loss of 2 nurses and 13 sanitarians during the year. The loss of services in these fields is of utmost seriousness to the public health program. The local health departments did, however, gain in the amount of time available to nurses for nursing service since the State adopted a policy of participating in the salaries of clerical workers in the nursing counties, thereby relieving these nurses from office work details.

108 ANNUAL REPORT, 1949

FULL-TIME EMPLOYEES IN PUBLIC HEALTH WORK

Dec. 31, 1947
Local . . . . . . . . . . . . . . . . . . . . . . . . 574 State . . . . . . . . . . . . . . . . . . . . . . . . . 409 Alto . . . . . . . . . . . . . . . . . . . . . . . . . 153 Battey . . . . . . . . . . . . . . . . . . . . . . . 502

Dec. 31, 1948
. 642
496 177 595

Dec. 31. 1949
650 521 183 658

1,638

1,910

2,012

FULL-TIME EMPLOYEES-LOCAL HEALTH DEPARTMENTS

Employees in whose salaries the State participates.

Dec. 31, 1948
Physicians . . . . . . . . . . . . . . . . . . . . . . . 31 Nurses .......................... 373 Engineers . . . . . . . . . . . . . . . . . . . . . . . . 20 Sanitarians . . . . . . . . . . . . . . . . . . . . . . . 77 Clerks . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Others . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Dec. 31,19+9
28 371
22 64 151 14

:'\et Gain
-3 -2
2 -13
18 6

642

650

8

FULL-TIME EMPLOYEES-STATE AND REGIONAL OFFICES

Dec. 31, 1948

Physicians . . . . . . . . . . . . . . . . . . . . . . . . 20

Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Engineers ....................... . 18

Sanitarians ...................... . 16

Laboratorians .................... . 73

Clerical, Administrative, Fiscal ...... . 234

Nutritionists .................... . 9

Biologists ....................... . 3

Industrial Hygienists ............. . 5

Health Educators ................ . 7

Communicable Disease Investigators. . 19

Unskilled Laborers . . . . . . . . . . . . . . . . 40

'*Others

29

Dec. 31,1949
18 32 20 20 76 228
8 3 6 7 23 41 39

~et Gain
-2 9 2 4 3
-6 -1
0 1 0 4 1 10

496

521

25

*X-ray Technicians, Field Representatives, Illustrators, Photographers, Architects.

PERSONNEL ADMINISTRATION 109
FULL-TI' ME EMPLOYEES-ALTO MEDICAL CENTER

Medical
Dec. 31, 1948
Physicians . . . . . . . . . . . . . . . . . . . . . 2 Nurses . . . . . . . . . . . . . . . . . . . . . . . . 25 Medical Administrative . . . . . . . . . . 6 Administration . . . . . . . . . . . . . . . . . . . 7 Clerical . . . . . . . . . . . . . . . . . . . . . . . . . 24 Maintenance . . . . . . . . . . . . . . . . . . . . . 34 Culinary . . . . . . . . . . . . . . . . . . . . . . . . 8 Housekeeping . . . . . . . . . . . . . . . . . . . . 13 Laundry . . . . . . . . . . . . . . . . . . . . . . . . . 1 Farm and Dairy. . . . . . . . . . . . . . . . . . . 6 Institutional Workers . . . . . . . . . . . . . . 51

Dec. 31,1949
1 . 29
7 7 24 36 9 13 1 6 50

Net Gain
-1 4 1 0 0 2 1 0 0 0
-1

177

183

6

FULL-TIME EMPLOYEES-BATTEY STATE HOSPITAL

Dec. 31, 1948

Physicians

0. 0

Trainee Physicians 0 0 0 0

Nurses

0 . 0

Laboratory Technicians 0

X-ray Technicians 0. 0. 0

Clerical, Administrative, Fiscal .......

Department Heads 0 0 0

Skilled Laborers 0 0 0

Unskilled Laborers 0 0

16 5 173 5 2 50 9 85 250

Dec. 31,1949
14 6 202 8 3 52 9 85 279

Net Gain
-2 1
29 3 1 2 0 0
29

595

658

63

EMPLOYEE. TURNOVER
The employee turnover rate, though slightly lower than for 1948, continued at extravagantly high figures. In order to secure the net gain. of 102 employees, 857 appointments were made and 755 separations occurred. This means that for every working day throughout the year, public health

110 ANNUAL REPORT, 1949
in Georgia lost an average of three employees in all of whom more or less time, effort and money in training had been invested. The task of orienting 857 new employees in a single year is a crushing burden which must be carried on in addition to the regular duties. Excessive turnover is the most wasteful activity that the Department can engage in.
l\!Iuch of the turnover is due to the large proportion of women employed in health work since in our society it is the woman who may cease work after marriage, the wife who moves to another city with her husband's change of work and the mother who stays at home to take care of the children. Our institutions employ a large number of manual laborers whose continuity on the job is spasmodic. The low salary scales of the Health Department play an important part in the loss of qualified employees.

EMPLOYEE TURNOVER IN 1949

Appointments

Local

163

State .......................... . 185

Alto .................... ... 80

Battey ......................... 429

Separations
155
160 74 366

Net Gain
8
25
6
63

857

755

102

...
EMPLOYEE'S RETIREMENT SYSTEM

A major achievement in 1949 was the e~tablishment of a Retirement System for employees of the Health and several other departments. The State Legislature passed the necessary laws in its 1949 session. The Board of Trustees authorized by this Act began functioning in the fall and prepared the necessary forms for State employees to accept membership and to claim credit for prior service in health work. The Personnel Office sponsored meetings of all Health Department employees in the rooms of the House of Representatives to which the Executive Secretary of the Retirement System explained the new law. Copies of the law were made available to each employee.
The law provides that the State pays for the credits that would have been accrued by employees who were in service before the passage of the law. Securing and certifying the employee's statement of prior service constituted a tremendous task which was competently handled by the office . forces of the Personnel and Accduriting offices.

PERSONNEL ADMINISTRATION 111
PERSONNEL POINTERS
Recognizing that the interests of the various program directors is tied up in their programs, the Personnel Office, during 1949, prepared a series of bulletins under the title "Personnel Pointers." These bulletins undertook to translate in usable language those phases of the departmental personnel policies and the Merit System Rules and Regulations needed by Division directors for good administration.
LOYALTY OATHS
In the spring of 1949, the State Legislature passed a law requiring all employees of the government to sign an Oath of Loyalty to the United States with particular reference to non-participation in communism. The task of securing these oaths was successfully completed by the Personnel Office in addition to its regular duties.

PUBLIC HEALTH NURSING
THEODORA A. FLOYD, R.N., M.A., Director
PURPOSE
The members of the Nursing Division consider as one of their major responsibilities that of being active members of a team of health workers to plan and carry out a program which will result in maximum health for every individual in the State. High in priority to help achieve this goal is securing an adequate number of well qualified nurses who can give nursing care on a demonstration basis; assist with immunizations against preventable diseases; give health education instruction to individuals and groups in schools, clinics, and homes; and help secure the necessary medical, hospital, and social services to insure the maintenance of an optimum state of health as defined by the World Health Organization.
A continuous intensive educational program both in-service and extramural is carried on for the purpose of preparing nurses for positions of increased responsibilities; to fill newly created positions, on local and State levels, and to fill positions vacated by nurses who leave the State for more remunerative positions.
Consultation to schools of nursing and talks to classes in Professional Adjustment, are some of the methods of aiding the steady flow of new graduate nurses into the challenging field of Public Health Nursing. Our Division provided the director for a large school of nursing in the loan of one of our most capable associates.
ACCOMPLISHMENTS OF THE YEAR
PERSONNEL: One of the outstanding accomplishments of the year was to secure a wider geographic coverage of Public Health Nursing in counties throughout the State. There were only 31 counties without Public Health Nursing service at the end of 1949 as compared to 40 counties without such service in 1948.
Approximately 52% of the 433 nurses employed on local and State level positions have had some education in Public Health while only 28% have had one or more years of education for this special field of nursing. (See table, page 117.) It is a discouraging outlook when one notes that

PUBLIC HEALTH NURSING 113

during the period between 1945 and 1950, 128 nurses had public health 1 education from 3 to 12 months in duration. During this same period of
time, 130 nurses with public health education had resigned for various reasons. This picture would be very different had we not had 89 nurses who availed themselves of the opportunity to study under the scholarships provided by the State Health Department. (See tables for types of courses taken, page 117.)

NURSING MANUAL: The completion of the nursing manual was an im-

portant event. Its culmination was the result of efforts of nurses on staff,

supervisory, and consultant levels. All divisions made rich contributions

to its content. It has been enthusiastically received by nurses and doctors

,.

throughout the State.

FULTON COUNTY NURSING COST STUDY: A cost study of nursing service in Fulton County was carried out. The objectives of the study were to determine :
a. The distribution of time in various nursing activities. b. The total cost of the Nursing Division. c. The cost of nursing in each diagnostic classification.
An analysis of the introduction of new nurses to the field was initiated. It included nurses appointed to counties which did not provide a local supervisory nurse. Because of the necessity .for satisfaction and a feeling of personal reward in any job, it is essential that the new nurse have an opportunity to understand the significance of the work to be done. The right kind and m~ount of guidance at this time of being introduced to a new field of nursing is a powerful factor in relation to job satisfaction. An outcome of this analysis has been the appointment of an Orientation Committee which is composed of State and regional consultant nurses, local supervisory and staff nurses. This committee is working on a plan to be used as a guide for the introduction of new nurses to the field of Public Health Nursing and criteria for evaluating this experience.
ATLANTA VISITING NURSES ASSOCIATION: This Division has had representation on the Health Committee of the Social Planning Council for a number of years. The Committee has worked toward the establishment of a Visiting Nurse Service for Metropolitan Atlanta. In April, 1949 the Atlanta Visiting Nurse Service emerged as a full-blown organization with a director of nurses and three staff nurses. Tile Fulton County JVIedical Society provided headquarters for the visiting nurses in the Academy of Medicine. The service is available to anyone who needs it, but fees have been collected for more than one-half of the visits made this year.

~-1

114 ANNUAL REPORT, 1949

PUBLIC
TENNESSEE

HEALTH NURSING SERVICE

NORTH CAROLINA

1949

STATE OF

GEORGIA

398 PUBLIC HEALTH NURSES MADE 205,910 FAMILY HEALTH VISITS IN 1949
VISITS INCLUDE:
MATERNITY- CHILD HEALTHCRIPPLED CHILDREN- GANGERCOMMUNICABLE DISE.'ASESTUBERCULOSIS SICK CARE

:<:; <
<D
< <-'

FLORIDA

LEGEND: FIGURES INDICATE NUMBER OF VISITS MADE IN EACH COUNTY

Mdfj~E~gA~AgisE:~!T cg~~~~GN~~E~ENb~E~c~~~O

FOR DIFFERENTIATION BETWEEN FIELD VISITS

OF NURSES ANO COMMUNICABLE DISEASE INVEST!~

GATOR$.

t

PUBLIC HEALTH NURSING 115
SUMMER WORKSHOP AT UNIVERSITY OF GEORGIA: A member of the Nursing Division participated in the Summer Health Education Workshop for teachers in the School of Education, University of Georgia, for a 7 weeks' period. The value of teacher observation of children was emphasized. The members of this Workshop made very practical applications of new techniques gained in measurement of physical setup of a school in a nearby county in relation to sanitation, lighting, ventilation, and the school lunch room; and worked with community groups in bringing about the necessary .changes.
SCHOOL HEALTH PROJECT: vVe co-operated with the Maternal and Child Health Division by providing a supervisory nurse for the special school health project in Spalding, Pike, and Lamar Counties during the illness of the regular supervising nurse. Her activities included assembling of the necessary equipment for giving care on nursing visits to school and homes, survey of areas covered by various nurses, rearranging boundary lines of districts, planning an orientation for new nurses, and initiating an in-service education program for the nurses.
CO-OPERATION WITH OTHER AGENCIES TO FURTHER NURSING EDUCATION
CRAWFORD W. LONG PREMATURE TRAINING PROGRAM:. The realizati9n of a premature training program in Georgia is the result of long-time planning of the Hospital and Health Department, and the concerted efforts of the Pediatric .Consultant Nurse who worked in the nursery during the first six weeks of the program. Concurrent with the provision of training in premature care locally, there has been an improvement in the care of the premature infant. Twenty-two nurses from hospitals and local health departments have had the benefit of training in premature care at Crawford Long Hospital since the inception of the program.
VENEREAL DISEASE EDUCATION: The State Board of Nurse Examiners requested an affiliation in venereal disease control at Alto Medical Center. The Nursing and Venereal Disease Divisions subsequently requested the loan of a specially qualified nurse to serve as Educational Director in this program; As a result, an Educational Director was assigned to Alto Medical Center for that purpose by the U. S. Public Health Service. She worked closely with the Venereal Disease and Nursing Divisions of the State Health Department, the State Board of Nurse Examiners, and' Schools of N'ursing through individual and group conferences. During the

)
116 ANNUAL REPORT, 1949
first month, 16 student nurses had this experience. They expressed much enthusiasm in relation to their experience at Alto Medical Center.
TUBERCULOSIS NURSING EDUCATION: The need for education in relation to tuberculosis nursing is equally as great as venereal disease. The interest of the Board of Nurse Examiners in the development of an affiliation has been expressed. Clinical facilities in Georgia are ample, and the need for additional nurses to care for and instruct tuberculosis cases is well known. Every effort 1vill be put forth to help meet this need during the coming year.
CANCER CONTROL NURSING: Since the assignment of Miss Howley as Cancer Consultant Nurse to the State Health Department, considerable emphasis has been put on cancer nursing. The greatest effort has been directed toward utilization of available resources in cancer control. The film "What Is Cancer" was procured and will be used in Nursing Education for public health and student nurses. Additional tools are to be purchased and others developed. A well-planned program of in-service education, including observation visits to cancer clinics, will be carried out during the coming year.
IN-SERVICE EDUCATION: In-service education programs for county nurses have been carried on in each region at intervals varying from once monthly to once each quarter. Members of this division, as well as specialized consultant nurses in other divisiogs, have participated in these programs on request.
Quarterly meetings of two days each have been held in which regional consultant nurses and nurses in the State Office have participated. The educational content has centered around the newer techniques in supervision, new programs in nursing, and trends in nursing.

PUBLIC HEALTH NURSING 117

STATISTICAL

EDUCATIONAL QUALIFICATIONS OF NURSES EMPLOYED IN 1948-1949

1948
Number of nurses having no public health education .. 205

1949 223

Number of nurses having less than a year of public

health education ........................... . 121

112

Number of nurses having one or more years of public

health education ........................... . 111

135

Number of nurses who have one or more collegiate

degrees in public health ..................... .

69

74

TYPEs oF EDucATIONAL PRoGRAMs FOR PuBLic HEALTH NuRsEs

FOR WHICH ScHOLARSHIPS WERE PROVIDED IN 1948-1949

1948

1949

Public Health Nursing ....................... .

42

35

Supervision in Public Health Nursing ........... .

1

Care of the Premature Infant .................. .

9

28

Midwifery .................................. .

3

Orientation-Month prior to assignment ........ .

18

10

Extension Courses ............................. .

12

Senior Cadet ................................ .

10

Pediatric Nursing ............................ .

1

Mental Hygiene Workshop ............ ........ .

3

Total ............................ ..

83

89

MAJOR AcTIVITIEs OF CouNTY NuRsEs FOR 1948 AND 1949

Field Visits

1948

Communicable Disease Control . . . . . . . . . . . . . . . . 17,235

1949 19,339

Venereal Disease Control . . . . . . . . . . . . . . . . . . . . . 36,578 Tuberculosis Control . . . . . . . . . . . . . . . . . . . . . . . . 48,138

45,905 50,411

Maternity Service . . . . . . . . . . . . . . . . . . . . . . . . . . . 63,698 Infant and Preschool Hygiene ................. 123,377 School Hygiene ............................ .

60,166 93,293 42,726

Morbidity Service .......................... . 13,329 Cancer Control ............................ 704 Crippled Children's Services ................. . 7,769

15,814 1,143 2,787

'I;otal ............................... 334,644

Immunizations

1948

Smallpox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80,501

Diphtheria ................ , . . . . . . . . . . . . . . . 51,919

Triple Vaccine DPT . . . . . . . . . . . . . . . . . . . . . . . .

0'*

Whooping Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,825

Typhoid Fever ............................. 369,985

Total ................... , .... . ; ..... 552,230

*The use of triple vaccine was started in 1949.

331,584
1949 88,434 27,607 41,315
0*' 419,633
590,398

''

TUBERCULOSIS CONTROL
H. C. SCHENCK, M.D., Director

X-RAY SERVICE
The following table shows the results of X-ray pictures interpreted by the physicians of the Division:

TABLE 1

BRIEF SUMMARY OF X-RAY SERVICES AND RESULTS, 1949

Number

Kind of Clinics

Services

Regular County Clinics (14 x 17) .... 370

Original. Ex:'minations .......

Re-exammatwns ............... .

Number X-Rays
12,082 9,400

Number New Per Cases Found Cent
218 342

,Elberton Special Clinic (14 x 17).... 1 Industrial Surveys (14 x 17)........ 3 Industrial Survey Follow-Ups
(14 X 17) , . , , . , , , , , , , ,,,,,,, .... , 33 Ma~s TB-VD Survey Follow-Ups
(14 X 17) ............. ,. , . , .... , . 12 College and High School Follow-Ups
(14 X 17) , , . , , , , , ... , , . , . , , . , , , . , 10
-Miscellaneous X-rays (14 x 17) ..... X-rays made in Central Office
(14 x 17) (continuous) ..........

21,482 98
303
1,177
5,443
297 11
537

560

2.65

61

0.231

398

0.462

7

0.05 3

9

1.67

Total 14 x 17 X-Rays Made and Interpreted by Us ..................... .
Consultation Film Interpretations: From Physicians 1st X-ray .................. . Re-exam. X-ray ............ .

29,348
461 1+5

1,035
25
2

From Local Health Departments 1st X-ray ... , .............. . Re-exam. X-ray ............ .

606
2,948 '1,583

27

4.44

100 21

From State Prison 1st X-ray .................. . Re-exam. X-ray ............ .

4,531
1,044 71

121

2.67

26 1

Douglasville School Children 14 x 17 Special Clinic.........
Miscellaneous X-rays . . . . . . . . . . . .

1,115
47 77

27

2.42

7

9.09

Total 14 x 17 X-rays Interpreted and Cases

Found . . . . . .. . . . . . . . . .. .. . . .. .. . 6,376

182

Americus Trade School X-rays Interpreted

(14 x 17) (continuous)..................

150

Alto Medical Center X-rays Interpreted

(70 MM) (co.ntinuous).................. 7,568

27

0.36

Total Cases Found Through Division Inter-

pretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,244

1. Percent calculated from 26,624 persons X-rayed in the Surveys.

2. Percent calculated from 86,256 persons X-rayed in the Surveys.

3. Percent ca-lculated from 14,581 persons X-myed in the Surveys.

TUBERCULOSIS CONTROL 119
The Division of Tuberculosis Control interpreted 171,665 chest X-ray films. Of these, 135,801 were Survey films. The total in the previous year was 194,732. There was a greater number of X-ray Clinic services rendered during the year than in the previous year, but evidently the attendance in these clinics was less or the groups X-rayed were smaller than those served in the previous year. The number of cases discovered through those services was 1,244 as against 1,561 in 1948. This figure (1 ,561), unfortunately, included an unknown number of previously known cases. During the year, 2,894 new cases were reported; therefore, nearly half of these were located through the various X-ray clinic and survey services of this Division, and nearly half of those found through the Division services were located by Mass Surveys.
Of the 2,894 new cases reported, 1,610 were white, 1,284 colored, and the source of these reports is shown in the following table.
Health Office Reports. . . . . . . . . . . . . . . . . . . . . . 703 Private Physician Reports . . . . . . . . . . . . . . . . . . . 20
Laboratory Reports . . . . . . . . . . . . . . . . . . . . . . . . 535
Deaths never reported as cases. . . . . . . . . . . . . . . . 360 Positive X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . 737 Veterans Hospitals . . . . . . . . . . . . . . . . . . . . . . . . 179 Military Reservations . . . . . . . . . . . . . . . . . . . . . . 44 Battey State Hospital . . . . . . . . . . . . . . . . . . . . . . 270 All other reports . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Total .............................. 2,894
It should be noted that cases not reported until death numbered 360, which is 13% less than the 413 similarly reported last year.
The number of deaths reported is 946, which is compared with the figure of 998, number of deaths reported for the same period last year, as being gratifying, but not unusually marked when compared with the deaths in previous years, which is illustrated in the following table:

TUBERCULOSIS DEATHS AND DEATH RATES PER 100,000 POPULATION IN GEORGIA

Year
1921 ............ 1922 ............ 1923 ............

NUMBER

Total
2,531 2,683 2,642

White
892 991 965

Colored
1,639 1,692 1,677

Total
87.4 92.6 91.1

RATE
White
52.1 57.4
55.5

Colored
138.1 144.2 144.5

120 ANNUAL REPORT, 1949

TUBERCULOSIS DEATHS AND DEATH RATES PER 100,000 POPULATION IN GEORGIA {Continued)

Year
1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949

NUMBER
Total White Colored
2,620 917 1,703 2,448 872 1,576 2,278 807 1,471 2,307 798 1,509 2,375 832 1,543 2,190 742 1,448 2,175 774 1,401 2,165 700 1,465 1,933 665 1,268 1,777 675 1,102 1,772 605 1,167 1,731 649 1,082 1,713 648 1,065 1,549 559 990 1,612 602 1,010 1,533 543 990 1,533 544 989 1,385 501 884 1,265 465 800 1,304 499 805 1,107 419 688 1,108 434 674 1,048 407 639 1,074 415 659
998 400 598 946 372 574

Total
90.3 84.4 78.5 79.4 81.7 75.3 74.6 73.7 65.3 59.6 58.9 57.1 56.1 50.3 52.0 49.1 49.1 44.0 40.5 41.7 35.4 35.5 33.5 33.2 31.2 29.3

RATE White Colored

52.3 49.3 45.3 44.4 45.9 40.6 42.0 37.7 35.4 35.6 31.7 33.6 33.3 28.5 30.4 27.2 26.7 24.3 22.8 24.5 20.6 21.3 22.9 19.4 18.9 17.4

148.4 139.0 131.2 136.2 141.0 133.9 130.6 135.8 116.9 101.1 106.5
98.2 96.2 89.0 90.3 88.1 91.2 81.3 73.7 74.2 63.4 62.1 53.5 60.3 55.2 53.0

Field activities in tuberculosis work by local organizations, as shown by the following table, have increased considerably. Attention is called to the fact that nearly 2,000 more cases, making a total of more than 7,000 cases, were admitted to service in local health organizations in 1949.

Cases of tuberculosis admitted to service ......... . Visits to tuberculosis cases, contacts and suspects .. . Visits to cases of tuberculosis ................. . Admissions to sanatoria ..................... . Number of completed tuberculin tests . . . . . . . . . . . Contacts broken ........................... . Contacts partly broken ...................... .

1948 5,183 48,138 12,488
941 29,537
1,678 208

1949 7,248 50,411 12,768 1,011 31,705 2,966
275

TUBERCULOSIS CONTROL 121
In addition to the X-ray service performed by this division in the interest of tuberculosis control work, more than 100,000 additional films were made by local health organizations, which with the reexaminations, together with the reexaminations by them, amount to more than a total of 300,000 X-ray pictures made by state and local health departments for the year.

PNEUMOTHORAX AND PNEUMOPERITONEUM REFILL PROGRAM
The pneumothorax and pneumoperitoneum refill program has been continued as usual, but with a very marked increase. 21,443 refills were given, at a cost of $43,814.00. This, as against 15,522 refills, at a cost of $31,594.00 in 1948. The following table presents further details. It will be noted that the number of patients under treatment at the end of 1949 was 730 as against 666 at the end of 1948.

STATE PNEUMOTHORAX AND PNEUMOPERITONEUM REFILL PROGRAM
JANUARY- DECEMBER, 1949

Number patients under treatment January 1, 1949 ....... . 666 New cases admitted to service during year 1949 ........ . 260

Total cases under treatment during 1949 ............. . Patients dropped from service during 1949:
Admitted to Battey State Hospital ................. . Admitted to other Sanatoria ...................... . Pneumothorax or pneumoperitoneum discontinued ..... . Assumed own payment ........................... . Moved away ................................... . Refused treatment .............................. . Deaths ........................................ . Imprisoned ..................................... .

926
47 8
88 13 11 3 24
2 -196

Total Number Patients Under Treatment December 31, 1949.... 730

TUBERCULOSIS CASE REGISTER
Our State tuberculosis case register contains records of 9,795 cases. It is not yet complete and does not contain a record of all the cases in the larger cities of the State. It shows in the cases recorded, 7,887 active and

122 ANNUAL REPORT, 1949
questionably active cases in their homes, 1,947 listed as having positive sputum.
The Division has had as one of its objects, the establishment of tuber~ culosis case registers in local health departments. During the past year, 28 have been established, making a total of 45 at the present time. It is hoped that through the assistance of regional health personnel, and the consultant tuberculosis nurse of this division, adequate registers may be set up during the year in all of the remaining local public health departments. It is not believed that a full knowledge of the tuberculosis problem as it exists in the State, can be fully determined until case registers are set up in every local health department, and made to perform adequately.
REHABILITATION OF TUBERCULOSIS PATIENTS
Stimulation of rehabilitation of tuberculosis patients is one of the objects of this division, as being necessary in tuberculosis control. The Rehabilitation Consultant' of the Division has made over 100 referrals of patients outside of institutions to the official vocational and rehabilitation agencies.
It is believed that much of the increase in the activities of the local health departments is due to the efforts of the Tuberculosis Nurse Consultant and the Rehabilitation Consultant, as a result of the many contacts they have made with the local health department personnel during the year.
UNSOLVED PROBLEMS PREVENTING BETTER CONTROL AND MORE RAPID ELIMINATION OF TUBERCULOSIS
No means to adequately control the infection source cases of tuberculosis, that are unhospitalized (They far outnumber the cases it is possible to hospitalize.) has been provided. Actually, not more than one-fourth of the clinically active and convalescent tuberculous patients in the State can be in hospital beds or sanatorium beds at any one time; in other words, since patients can be admitted to sanatoria only after others have been discharged, it is very obvious that the patient who cannot be hospitalized must be more seriously considered, in respect to all of his needs for care and treatment, and in respect to the needs of the general public in respect to its protection from tuberculous infection.
Additional relief of needy families must be brought about. Additional medical services through the better utilization of practicing physicians outside of institutions, is to be encouraged and it is believed that some method should be devised through the use of public funds, to make such services more largely possible.

TUBERCULOSIS CONTROL 123
vVherever it is impossible to obtain proper control and care and treatment of tuberculosis patients, facilities should be provided at the local level, through funds which should be provided for the purpose, whether raised locally or through State support. The important thing is to get it done by some means. Unless the problem is attacked in its entirety, the money spent for partial service is, and will continue to be, largely wasted. Because enough attention has not been given to the importance of care and treatment and control of the unhospitalized patient, the very considerable increase of State hospital beds has not made a proportionate dent in the overall problem of tuberculosis control, and number of cases developing and number of people dying apparently are not greatly changed in rate of decline.

BATTEY STATE HOSPITAL
RUFUS S. PAYNE, M.D., Superintendent
PATIENT LOAD
The year of 1949 has shown a continued expansion of Battey Hospital. The number of patients in the hospital on the first day of each of the past six calendar years as compared with January 1, 1950 were:
1944 1945 1946 1947 1948 1949 1950
Total . . . . . . . . . 453 518 544 986 1,199 1,305 1,444
Battey continued its expansion in 1949 from a patient load of 1,305 ori January 1, to 1,444 in December 1949. This is an increase of 1,044 patients over the patient load in December of 1944. Applications during 1949 slightly exceeded 1,500 as against 1,677 applications during the year 1948. This is the first time since Battey has been opened that the number of applications has decreased and it is hoped that this reflects a favorable trend in the tuberculosis rate. 1,029 patients were admitted during the year which is about 100 less than were admitted during the year 1948.
MAINTENANCE
During 1949 the colored cafeteria was completed as was the special diet kitchen, all of which were started during the last year, the colored wards were remodeled, and new diet kitchens were placed on each ward, which made it possible to have food service on the colored side comparable with that on the white side. When Battey was first opened for tuberculosis patients, temporary reservations were made, pending the time when labor and materials were available for bringing these wards up to the same standards which the other wards have. At the farm an additional duplex was constructed for the use of the tenants and a new milk barn which will give space for milking 120 cows at a time. This will aid considerably m the milk production program.
PERSONNEL
During the year we were more fortunate in securing personnel, particularly professional personnel, such as physicians and nurses, and at the end of the year it was felt that there was an adequate medical staff for the patient load. The University of Georgia continues to rotate its residents in medicine for a three month period at Battey. On the first of January, 1950, the Department of Surgery will begin the rotation of surgical residents, with each spending three to six months at Battey. This will add one

BATTEY STATE HOSPITAL 125
additional person to our surgical staff and in addition will furnish valuable training facilities for the University Medical School. During the year a nursing representative from the U.S.P.H.S. made a survey of nursing needs and the amount of personnel at Battey. This report showed that on a theoretical basis, at least, we only had about one-half the amount of nursing personnel needed. While this is somewhat disturbing, there are many hos-
pitals which are operating with only 25-% of their nursing personnel
needs met.

PERSONNEL-PATIENT RATIO*, BY DEPARTMENT AND YEAR

10/1/45
Administrative ........... 1 :42

Medical

0

1:54

Nursing ................. 1 :9

Culinary 0 0

1 :16

Housekeeping ............ 1 :13

Laundry ................ 1:30

Maintenance ............. 1:22

Farm and Dairy .......... 1:45

7/1/46 1:26 1:20 1:8 1 :7 1:12 1:19 1:12 1:37

1/1/48 1 /1/49

1:35 1 :33

1:25 1:24

1 :8

1 :8

1 :13 1 :11

1 :18 1 :14

1:30 1:33

1:23 1:22

1:55 1:84

1/1/50 1:34 1:26 1 :7 1 :10 1:14 1 !35 1:25 1:80

Total Ratio ............. 1:2.6 1 :1.6 1:2.4 1:2.2 1:2.2

Total Employees ......... 205 Total Patients ........... 540

386

507

610

669

625 1,199 1,305 1,444

'*The average sanatorium in the United States has approximately one employee for each two patients. Some of the sanatoria, particularly in the Veterans Administration, run an exact opposite ratio. Some run as many as two employees for every patient.
There were more employees per patient on July 1, 1946 than at any other time. Since that time the ratio of employees per patient has been raised to the point where it is approaching normal standards by adding to this ratio approximately 100 prisoners distributed between the Nursing, Culinary, Housekeeping and Laundry Departments. If these were included, the ratio would be about one employee for each two patients which would be just about the normal average. It is regrettable that more nursing personnel was not available so that the ratio of nurses to patients would approximate one nurse for every 6 patients. However, it has been our constant desire to get as many patients as possible into the institution, so long as they were not allowed to actually suffer from lack of nursing care.

126 ANNUAL REPORT, 1949

COST PER PATIENT
In 1945, $540,000.00 was budgeted to care for an average of 525 to 550 patients. At Alto at that time the average patient cost was about $1,000 a year or approximately $2.75 per day. Beginning in the third quarter of 1945, prices began to increase rapidly and have continued to increase. The table below shows a comparison of costs at Alto and Battey during 1945, 1946, 1947, 1948, and 1949.

Period

Salaries

First half 1945 1.29 0 0.
Last half 1945 ............. 1.27 First half 1946 ............. 1.62 Last half 1946 ............. 1.92 First half 1947 ............. 1.61 Last half 1947 ............. 1.66

First half 1948 1.85 0 0

Last half 1948 1.89 0
First. half 1949 ............. 1.88 Last half 1949 ............. 1.94

Supplies
1.21 1.05 1.47 2.49 1.73 1.75 2.69 2.28 2.31 2.11

Net Cost
2.50 2.32 3.09 4.41 3.34 3.41 4.54 4.17 4.19 4.05

Outlay
.08 .17 1.45 1.71 .85 .30*' .28* .17* .29'* .38

Total
2.58 2.49 4.54 6.12 4.19 3.71 4.82 4.34 4.48 4.43

*This includes outlay for new equipment only and does not include improvements made in building, etc.
With the rise in wages and prices and the taking over of B-attey, costs reached a peak in the first half of 1948, with an average per capita cost of $4.54 a day, with salaries amounting to $1.85 and supplies $2.69. Costs appear to be leveling off now and in a few instances are dropping slightly, but there has been no marked reduction since January 1. Outlay cost refers to purchase of the farm and the construction of new buildings on the farm and at the hospital, also the purchase of livestock.

ADDED CAPACITY
Due to the foresight and interest of the Administration and Legislature, additional funds were voted for Battey Hospital at a special session in the third quarter of 1949 which increased our appropriation to $3,055,000.00 per year. With this increase in appropriation, plans were started immediately looking toward the. eventual occupancy of every bed at Battey by a patient with tuberculosis. Contracts were let for a new milking barn, and a new nurses' home. Plans have been drawn and specifications have been written for a colored nurses' home and a new laboratory building. All wards have been opened which can possibly be opened until some additional housing facilities can be erected for nursing personnel and physicians.

BATTEY STATE HOSPITAL 127
Seventeen houses have been completed on the grounds and 8 apartments, but additional housing facilities for personnel will have to be completed for further expansion of the hospital.

STREPTOMYCIN TREATMENT

The investigative program in the treatment of tuberculosis with streptomycin which was started in 1947 has resulted in the treatment of more cases than any other single hospital of which we have any record. The limitations and exceptions of the drug are fairly well clarified at the present time. It will relieve the harassing cough of the terminal stages and make the patient much more comfortable than anything that we have ever used in the past. Streptomycin is the only treatment for miliary tuberculosis and meningitis, and is a valuable aid in the treatment of .renal and bone tuberculosis. We have found it to be very efficacious in the treatment of tuberculous pneumonia and also of marked value in acute exudative forms of the disease when used in conjunction with collapse therapy. The following table shows the influence of streptomycin on the death rate and on producing stable disease of different type cases in comparison with other forms of treatment.

FAD FAC FAB MAC MAB

WHITE PATIENTS

Deaths

Streptomycin No Streptomycin

435

810

128

416

410

185

0

176

26

24

Disease Stable

Streptomycin No Streptomycin

205

19

320

177

455

321

815

176

790

470

999

1,612

2,585

1,163

RESEARCH ACTIVITIES
During the past year, observations were made of the use of streptomycin in conjunction with para-aminosalicylic acid. This was part of a large study conducted by the Special Studies Section, U.S.P.H.S. in cooperation with the American Trudeau Society. This study has been very worthwhile as it shows the very definite superiority of this combination over that of either drug alone.
During the latter part of 1949, at the request of the Schenley Corporation a study was made of the use of Tibione, the new chemical which has gained such widespread favor in Germany in the treatment of tuberculosis.

128 ANNUAL REPORT, 1949

This study at Battey will be limited primarily to the study of the development of resistance. Other investigators are studying other phases of the drug such as toxicity, the optimum dosage, and types of disease for which the drug is best suited.

HOSPITAL STATISTICS

TABLE I

The following table shows the number of persons making application for admission to Battey and Alto during the past 6 years:

Year White Colored

1943 575 314

1944 524 251

1945
477
298

1946 964 586

1947 1,033
616

1948 998 679

1949 914 615

Total

889

775

775 1,550 1,649 1,677 1,529

It will be noted that in 1949 there was a considerable drop in the number of applications, and it is our sincere hope that this is a reflection of decrease in the amount of tuberculosis. If this be true, then the opening of 500 to 700 additional beds at Battey will probably take care of the tuberculosis hospital problem in Georgia even earlier than has been anticipated. On the other hand if this does not reflect a decrease in the amount of tuberculosis, additional beds may be needed.

TABLE II The following table shows applications, by age group, for admission to Battey and Alto during the past 7 years.

Under 20 White Col.
1942 78 50 1943 47 47 1944 24 53 1945 40 58 1946 62 85
1947 61 72
1948 59 88 1949 49 90

20-39 White Col.
369 254 302 213 267 136 216 171 414 309 455 361 430 366 404 314

40-59 White Col.
238 75 179 47 152 48 164 62 357 171 367 157 375 196 334 166

60 Plus White Col.
83 9 47 7 81 14 57 7 131 21 150 26 134 29 127 45

Total White Col.
768 388 575 314 524 251 477 298 964 58S 1,033 616 998 679 91+ 615

It should be noted that in 1949 there was a continued decrease in the number of applicants in the age group under 20 and less of a decrease in the group over 40, and actually an increase in the group over age 60. We believe that this continued trend shows that tuberculosis is being transmitted less among the younger age group than it was previously. This

BATTEY STATE HOSPITAL 129

continued increase in the ratio of older persons probably reflects the development of tuberculosis from endogenous sources rather than from infected individuals.

TABLE Ill

The following table shows the percentage of persons rejected for admission in the different age groups in the past 7 years:

Under 20 White Col.
1942 18 58 1943 28 50 1944 33 15 1945 2 33 1946 19 41
1947 8 43 1948 10 43 1949 10 25

20-39 White Col.
14 54 19 49 15 42 16 35 12 26 13 46
9 33 9 25

40-59 White Col.
20 37
25 53
26 40
20 27
15 27
21 39
15 35
16 32

60 Plus White Col.
43 66
53 85
37 28
55 55
41 33
47 58
33 55
30 56

Total White Col.
19 52
24 51
25 35
21 33
17 29 18 44
15 36
15 29

It will be noted that the greatest difference in rejection rates are in the group under 20 years of age and the group from 20 to 39. In 1947 there

was an overall increase among the colored in their percentage who were rejected for admission, due to the fact that once the beds were filled there was no alternative other than to reject the patients. It is obvious that when a physician finds that all of his far advanced hopeless cases are rejected

for admission that he will automatically stop making application for this

type of case. In 1948, we were having approximately 600 to 700 or more admissions and most of these were the more advanced, or less favorable cases. This explains our failure to decrease the per capita cost with the

addition of more patients. Instead of adding patients who needed average or less than the average amount of medical care, we are adding practically altogether those patients who are acutely ill and whose cost of hospital care is quite high. It will be noted here that there were far less rejections in

1949 than in previous years. This is particularly noticeable among the colored group. With the rejection rate falling from 36% to 29% and that

in the white group remaining the same.

TABLE IV

The following table shows the number of admissions, by color, for the

past 6 years at Battey and Alto, as compared with 1949:

Year

1943 1944 1945 1946 1947 1948 1949

White

425

425

470

765

738

803

728

Colored 134

121

210

377

362

322

284

Total

559

546

680 1,142 1,100 1,125 1,012

130 ANNUAL REPORT, 1949
This table shows the number of admissions by color for the past 7 years and it will be noted that our admission rate is not quite so high in 1949 as compared with previous years.

TABLE V

The following table shows the number of patients in the hospital on the first day of each of the past 7 calendar years:

Total

1944 453

1945 518

1946 544

1947 986

1948 1,199

1949 1,305

1950 1,444

The table shows the rather phenomenal growth in tuberculosis hospital days since 1943. On January 1, 1950, we had 1,444 patients which was more than 450 greater than on January 1, 1947 and was 900 greater than on January 1, 1946. It represents a gain of nearly 1,000 patients over January 1, 1944.

TABLE VI
The following table shows the number of admissions, by diagnosis, during the past 5 years at Alto and Battey:

Year
1944 1945 1946 1947 1948 1949

Far Moderately Advanced Advanced Minimal Wht. Col. Wht. Col. Wht. Col.

147 48 183 122 405 232 385 183 317 152 347 121

173 45 196 49 231 83 132 103 283 92 252 102

31 8 19 7 26 12 27 5 41 15 40 20

Other Forms Wht. Col.
20 6 14 8 28 15 82 50 75 47 21 27

Non Tuberculous Wht. Col.
54 14 58 24 75 35 61 21 87 16 68 14

Total Wht. Col.
425 121 470 210 765 377 738 362 803 322 728 284

It will be seen that there is a direct ratio between the number of admissions and the percentage of far advanced cases admitted. In 1944 only 35% of white and 40% of colored admissions were far advanced while in 1946 54% of white and 62% of colored admissions were far advanced cases of tuberculosis. It is suspected that a higher proportion of moderately advanced cases of the disease are being found due to a large number of case finding programs that are being conducted in the State at the present time. It will also be noted that there were more extra pulmonary forms of tuberculosis admitted in 1947 than admitted previously. Most of these were admitted for tr~atment with streptomycin and included glandular tuberculosis, tuberculosis meningitis, and a few cases of bone tuberculosis, peritonitis, miliary, and renal tuberculosis. It should be noted that in 1949, in spite of the fact that considerably less patients were admitted, far advanced

BATTEY STATE HOSPITAL 131
white cases averaged 54% of the total of white tuberculous cases admitted. The increase in the number of minimal cases admitted is very gratifying and it is hoped that this can be continued.

TABLE VII
The following table shows the number of admissions, by age groups,
during the past 5 years at Alto and Battey:

Age Group Under 20
White Col.
1944 16 13
1945 24 21 1946 39 38 1947 47 33 1948 45 33 1949 44 40

20-39 White Col.

251

80

351 134

368 217

379 181

344 196

336 150

40-59 White Col.

137

27

164

51

287 113

316

99

319

80

267

76

60 Plus White Col.

21

1

31 +

71

7

41

2

95 13

81 15

The above table conforms fairly closely to the findings of the other tables which shows the continued admission of a larger proportion of older age patients. It shows that we are continually increasing the number of patients admitted who are over 40 years of age. In our opinion this is due to the fact that there is a continued decrease in the amount of new cases of tuberculosis in the younger age groups, due to the fact that there is less opportunity now for the spread of tuberculosis.

TABLE VIII

The following table shows the experience, percentage basis, of different age groups approximately two years after admission to the Sanatorium:

Status
Dies at Hospital

Under 20 White Col.
4 15

20-39'

40-59

60 Plus

White Col. White Col. White Col.

7 20 10 12 17 6

Still in Hospital

22 30 25 32 27 42 26 19

Home-Sputa Pos.'~ 14 7 19 19 22 19 16 38

Home-Sputa Neg.* 61 48 47 30 41 27 41 37

'*This refers to the patients' condition on leaving the hospital. Many have died at home, some are well, and many are still living.

The table shows the difference in the expected mortality of patients in the older age groups among whites. The table would indicate a lower mortality in older negroes but the number of cases is too small to give significant percentage. The chances for converting sputum to negative is much greater in the younger aged groups than it is in the older aged groups. This empha-

132 ANNUAL REPORT, 1949
sizes the importance of finding the cases among the younger aged groups. It must be remembered; however, that the colored have a much poorer prognosis than do the whites.

TABLE IX

Table showing the number of discharges from the hospital at Alto and Battey during the past 7 years:

White Colored

1943 546 129

1944 431 149

1945 376 168

1946 459 159

1947 629 267

1948 754 275

1949 613 212

Total 675

580

544

618

896 1029

825

By referring to Table IV it will be noted that the discharges exceeded admissions in 1943 and 1944 when hospital cases were constantly falling. During the past 3 years, however, the number of admissions have so far exceeded the discharges that there has been a constant rise in the number of cases in the Sanatorium.

TABLE X

This table shows the status of patients at discharge, during the past 6 years at Alto and Battey:

Quiescent

or

Total

Arrested Improved Unimproved Deaths

TBC NonTBC

White Col. White Col. White Col. White Col. White Col. White Col.

1944 110 52 151 45 80 31 40 13 381 141 50 8

1945 105 28 95 53 93 26 32 34 324 141 52 25

1946

92 15 97 30 152 46 58 54 399 145 60 14

1947 113 30 187 65 160 53 75 101 535 249 74 18

1948 144 49 274 84 149 31 75 89 642 253 112 22

1949 207 49 173 69 87 9 73 64 540 191 73 21

The status of patients at discharge from 1944 to 1948 is shown and it will be noted that we are constantly having a larger increase in the number of deaths, which in itself reflects the fact that we are admitting far more hopeless cases than we did formerly. It should also be noted that there has been a larger number of patients discharged in the improved and quiescent state than ever before. Fewer patients have been discharged in unimproved status than previous years. It should be noted that in spite of the fact that in 1949 we were discharging twice as many patients as we were in 1944 and 1945 that we still have about the same number of unimproved patients, so this reflects a considerably better treatment record than previously. Also

BATTEY STATE HOSPITAL 133
the number of quiescent and arrested cases is more than twice as great as in those years.

TABLE XI
Table showing number of discharges who had positive sputum at time of discharge, by status, by year and color:

1944 1945 1946 1947 1948 1949

Quiescent or

Arrested

Improved

White Colored White Colored

3

0

37

10

1

0

30

14

4

0

25

12

2

0

64

23

8

1 101

28

5

0

68

27

Unimproved

Total

White Colored White Colored

45

23

85

33

60

16

91

30

87

26 116

38

106

31 170

54

98

20 207

48

73

6 146

33

This table shows the number of patients discharged with a positive sputum during these 6 years. It will be noted that there was only a relatively slight increase in the number of positive sputums in recent years in spite of the much larger number of discharges. It must also be remembered that laboratory work is far more accurate now than it was in previous years. There are many patients who are now being discharged as positive sputum who in former years would have been discharged as negative due to the fact that we are depending almost altogether on gastric washings rather than on direct sputum smears.

TABLE XII
Table showing the discharge status of patients, percent of total tubercu-
losis discharges, during the past 5 years at Alto and Battey:

Quies. or Arrested Improved Unimp.
Deaths

1944

1945

1946

1947

1948

19,19

White Col. White Col. White Col. White Col. White Col. White Col.

29 37 32 20 23 10 21 12 22 19 38 25

40 32 29 37 24 21 35 26 43 33 32 36

21 21 29 18 38 32 30 21 23 12 16

5

10 10 10 25 15 37 14 41 12 36 14 33

This table shows the number of patients with an improved and quiescent status increased considerably over former years. It will also be noted that the percentage of deaths are constantly increasing. During 1947 14% of the white patients and 41% of all the colored discharged were by reason of death. This within itself reflects again the fact that we are taking much sicker patients than formerly. The decrease in death rate in 1948 and 1949 is believed to be due to the influence of streptomycin.

134 ANNUAL REPORT, 1949
TABLE XIII
Table showing length of stay in the hospital on a percentage of total cases discharged in different diagnostic categories at Alto and Battey during the past five years:

Year Under 3 mos.
4-13 mos. 14-23 mos. More than 2,1

WHITE PATIENTS

Far Advanced '44 '45 '46 't!7 '48 '49 29 39 49 37 28 22 40 44 35 46 40 32 10 11 10 10 21 18 21 6 5 9 11 28

Mod. Advanced '44 '45 ''16 '47 ',18 '49 29 42 29 37 39 26 50 45 46 38 31 34 11 9 18 15 17 16 10 4 7 10 13 24

Minhnal

'4tt '45 '46 '47 '48 '49

45 50 31 57 37 35

31 40 53 33 42 33

20 10 11 5 11 15

4

5 10 17

This table shows what is necessary to bring an ordinary case of tuberculosis under control. The great majority of all cases leaving under three months either leave against advice or die, and it will be noted that in 1946 that almost half of the far advanced cases fell in this category whereas it has decreased significantly during 1947, 1948, and 1949. As compared with former years, it appeared that patients were staying for considerably longer time than they did previously.

TABLE XIV
The following table shows the average survival time, after entering Alto and Battey Hospitals, for patients who died and whose disease was either moderately or far advanced on admission:

'WHITE

(a)

Far Advanced

Year

'44 '45 '46 '47 '48 '49

Under 3 mos. 6 13 29 22 24 16

3-12 mos.

13 12 20 30 20 21

13-24 mos. 11 3 4 14 16 15

Over 24 mos. 5 0 1 3 6 19

Moderately Advanced

'44 '45 '46 '47 '48 '49

2000

040311

20

40

1

0

1 .)

1 .)

1

CoLORED

(b)

Far Advanced

Year

'44 '45 '46 '47 '48 '49

Under 3 mos. 5 20 25 31 23 14

3-12 mos.

3 12 23 46 35 20

13-24 mos.

2 1 0 14 10

Over 24 mos. 1 0 3 0 6 13

Moderately Advanced

'44 '45 '46 '47 '48 '49

0

0

4

1 .)

1

20 1341

001

21

000

2

BATTEY STATE HOSPITAL 135
TABLE XV Converting Table XIII into percentage basis we find the following picture as regards the far advanced cases:.

White

Far Advanced

Year

'44 '45 '46 '47 '48 '49

Under 3 mos. 17 46 54 32 36 22

3-12 mos.

37 43 37 44 30 29

13-24 mos. 31 11 7 20 24 14

Over 24 mos. 15 0 2 4 6 35

Colored
Far Advanced
'44 '45 '46 '47 '-1-8 '49 50 59 50 34 30 25 30 35 46 50 45 35 10 6 2 10 18 18
10 0 2 6 7 22

The two tables above show the influence of public health measures for isolation of far advanced hopeless cases. It will be noted that during 1946 that half or more of the patients who died with far advanced disease did so within three months after entering the sanatorium. The same thing is not so obvious for previous years in the white cases, but it is among the colored. The same thing is as marked in 1949, but here we think is due to the influence of streptomycin. Streptomycin was given to all of our patients who were considered hopeless early in 1947 and a great many of them are undoubtedly surviving now who would not have done so a year ago. The very fact that they have lived longer with streptomycin is some indication within itself of the fact that the drug is well worthwhile using. For those patients who die within three months after admission to the sanatorium it is obvious that hospitalization has been no influence so far as the spread of tuberculosis is concerned, since these patients have already infected their contacts at home. Table XIII should also be studied very closely to see the influence of treatment when tuberculosis is found early. It will be noted
that no cases of minimal tuberculosis have died during the past 5 years, and
very few cases of moderately advanced tuberculosis have progressed and died, whereas most of the deaths have been among those persons who had far advanced disease when discovered and sent to the sanatorium. This, within itself, is sufficient reason to urge the further extension of case finding programs all over the State. With a case finding program which will uncover asymptomatic, moderately advanced disease, the death rate can be lowered markedly over what it is at 'the present time if the patients can stay in the sanatorium until they are well along in their convalescence. In the past we have sent patients home as soon as sputum was converted and many times before conversion so that new cases might be admitted for treatment. At the present time we are maki1~g an effort to keep patients in the hospital until they can have three to four hours' exercise daily. During this

136 ANNUAL REPORT, 1949

time they can be given vocational trmmng if necessary to help them when they return home, but most important of all they can be observed closely through their convalescent period to see if they can tolerate exercise sufficiently well to be discharged.

TABLE XVI

The following table shows trends in treatment procedures in use at the Sanatorium in 1942 and at Battey in 1949. The type treatment used is indicated as percentage of total patients discharged alive whose diagnosis on admission falls within the group under which the percentage is listed:

Year Bed rest only Phrenic Crush Pneumothorax* Thoracoplasty** Pneumoperitoneum Diagnostic Only*** Streptomycin**** Pneumonectomy

White Patients

Far Adv. Mod. Adv. Min.

'42 ''19 '42 '49 '42 ',19

21 65 18 41 23 33

3 27

8 57 17 3

29 7 45 19 50

16 21

43

21 127 16 117

27

10 29

9 ,12

7 31

0 137

26

3

0

Colored Patients

Far Adv. Mod. Adv. Min.

'42 '49 '42 '49 ''12 '49

20 31 16 16 42 31

0

13 10 33

46

,18 3 25

12 0

0

0

20 50 17 16

44

2

18

0 25

0 42

6

0

0

*This includes all cases in which pneumothorax was the primary procedure used. It includes all auxiliary procedures such as pneumolysis.
**This includes all cases regardless of other preceding treatment, such as pneumothorax or pneumoperi toneun1.
***This includes the cases which left against advice before treatn1ent was initiated.
****This was used as adjunct to other types of Rx given above.

It will be seen from the table above that pneumoperitoneum has almost replaced the other collapse measures in popularity at this hospital. These include many cases which were started on pneumothorax and failed to respond and also includes many cases which would have gone on to thoracoplasty under ordinary treatment procedures. It will be noted that a large proportion of our patients receive some type of collapse therapy and that relatively few are placed on bed rest alone. There are many references in literature recently on pneumoperitoneum as a method of treatment and we like to think that our work here is partly responsible in that we probably have a larger series of patients than any other hospital. It will also be noted that in 1949, 40% of the patients discharged in the far advanced category had been given streptomycin. A lesser number had been given it in moderately advanced disease and none had been given to minimal tuberculosis. l\!Iany of these patients were patients who entered the sanatorium and left against advice as soon as it was discontinued. This was the patient's privilege, of course, but it has hampered our efforts greatly to find out what happened in all of these cases, since we were unable to follow them as well on the outside as we could have if the patients had been in the sanatorium.

TYPHUS CONTROL SERVICE
ROY J. BOSTON, M.S.Eng., Director
INTRODUCTION
The control of murine typhus fever is directed at the rat flea, vector X. cheopis, and the rodent reservoir of the disease. To accomplish this purpose, the activities of the Typhus Control Service for the calendar year 1949 consisted of the following: ( 1) D:DT dusting of rat runs and harbours, (2) rat eradication, ( 3) epidemiology, (4) ratproofing of buildings, (5) sanitary refuse collection and disposal, (6) biological, and ( 7) anti-rat sanitation.
All typhus activities were under the supervision of the Director of Typhus Control Service of the Georgia Department of Public Health, Atlanta.
Field operations were directed from the Macon Field Office to the regional supervisors located in the Southwest, Southeast, and East Central Regions. The regional supervisors were responsible for typhus control in their respective areas. In the Northeast, Northwest, and \Vest Central regwns typhus control activities were directed by the Atlanta and Macon offices.
The State and local typhus control programs were made possible through the financial participation of the U. S. Public Health Service, Georgia Department of Public Health and the various local governments. Federal participation amounted to about 50% of the total funds expended and was used principally for salaries, automotive equipment including operating costs, DDT dust, DDT dusting equipment, and certain rodenticides such as 1080 (Sodium Fluoroacetate) and arsenic preparations; also the purchase of necessary biological equipment, supplies, and miscellaneous equipment. The U. S. Public Health Service also furnished laboratory services.
The State's participation included travel expense for supervisory personnel, salaries for the State Director, a sanitarian in l\!Iacon, a clerk in Statesboro, together with needed office supplies in the various regions..
Local participation was more extensive than in previous years. This included rodenticides (such as Red Squill) not furnished by the U. S. Public Health Service or State; and office space for local employees; and labor personnel for the distribution of rodenticides, trapping rats, and applying DDT dust.

138 ANNUAL REPORT, 1949
PERSONNEL
There were 83 persons employed in typhus control operations in 1949. Of this number, State personnel consisted of a State Director, one sanitarian, and one cleric. Included in the total number employees were 32 Civil Service employees as compared with 53 in 1948, a reduction of 39.7%. Also included in the total of typhus employees were 49 locally paid personnel which showed an increase of 28.6% over 1948 when there were only 35 employed.
The number of man hours expended on typhus operations throughout the State totaled 170,739 in 1949.
EDUCATIONAL
The purpose of the educational program was to first present the problem to the county or city and second to assist in correcting this problem. This program included meetings with civic organizations, city and county officials, farm bureaus, schools and other groups. Pertinent material and information relative to the control and prevention of typhus fever was disseminated through the use of posters, booklets, newspaper articles, film strips, radios, and direct contacts by the field personnel with the lay public when applying control measures. Literature and pamphlets distributed by the U. S. Public Health Service and the State Health Department together with film strips and motion pictures aided greatly in presenting the local typhus problem and, consequently, a better understanding was had of the nature and extent of control that was needed.
During the calendar year 1949, there were 102 meetings addressed and 52 newspaper articles published, averaging one newspaper article per week, relative to typhus operations. The field personnel during the year made 54,606 personal conferences and/or contacts in the interest of typhus fever control. In previous years, consolidated reports of typhus operations were presented periodically to participating counties. However, this past year, with the increase in biological studies, the educational need was to not only present the statistical data, but to also include a complete biological survey together with maps which showed the problem and made possible an opportunity to make pertinent recommendations.
MURINE TYPHUS FEVER
The total number of cases of murine typhus fever reported in 1945, the first year that DDT dust was used, was 1,111, and each successive year there has been a reduction in cases reported. In 1949 there were only 2'16 cases reported, a reduction of 80.6% from the 1945 figure. DDT dust has

TYPHUS CONTROL SERVICE 139
been the most influential factor in accomplishing this reduction and this, through the control of the vector (X. cheopis flea) chief transmitter of typhus fever. Practical applications of results obtained through research and field operations were influential factors in carrying out control measures of murine typhus fever operations.
The majority of typhus cases reported during the past five years have been located in the Southeast, Southwest, and East Central Regions of the State. During this 5 year period the case rate has become gradually higher in rural areas while the metropolitan areas have shown a marked decrease. This has presented a more difficult control problem because of time, equipment, and personnel needed to reach throughout the rural areas. Participating counties during this interim were preapproved on the basis of the number of murine typhus fever cases previously reported. It is, therefore, impractical to evaluate control measures by counties throughout this period because in many instances the same counties did not participate each successive year.
In 1945 there were 33 counties reporting 10 or more cases of murine
typhus fever and 24 reporting 5 or more cases but less than 10 as compared
with 1949 showing 3 counties reporting 10 or more and 9 counties report-
ing 5 or more but less than 10. This was a reduction of 91.0% in the
number of counties reporting 10 or more, and 62.5% in the number of
counties reporting more than 5 but less than 10. With the exception of 4
counties-Houston, Fulton, Bartow, and Polk-all counties that reported . at least one case during the year were located in the Southwestern, Southeastern, and East Central Regions.
EPIDEMIOLOGY
Epidemiological investigations of murine typhus fever were conducted by the regional typhus personnel who acted under the general supervision of the Regional Medical Directors and County Health Officers.
The information obtained was non-medical in nature and the basic principles of these investigations were to apply control measures at the apparent foci of infection. This information was obtained through interviews with patients who had had murine typhus fever, and from pertinent facts secured from the physician on the case. Through inspections made of the patients' home environment together with existing conditions and places frequented prior to the onset of the disease, additional information was obtained. This data was recorded and transcribed on maps. Upon completion of the investigation, DDT dusting control measures were applied at the home of the

140 ANNUAL REPORT, 1949
patient and other places that the patient frequented prior to the onset of the disease. This operation aided greatly in effecting immediate control not only at the center of infection, but also where the potential danger of spreading the disease was the greatest.
There were 121 reported typhus fever cases investigated and the control measures exercised included dusting 2,193 premises with DDT dust.
DDT DUSTING OPERATIONS
Since the first use of DDT qust as a control factor of the vector many changes have been inaugurated. Experience gained through actual DDT dusting operations and certain biological data that was furnished showed that one cycle of DDT dusting of rat burrows, harborages, shelters, and runs would give adequate control if properly applied and no adverse weather conditions were experienced. Unseasonably warm weather early in the year appeared to have caused marked increase in the flea and ectoparasite population in certain sections of the State.
Experience in the field with the 5% dust showed that it apparently did not have as an immediate kill as 10% dust, and that the holding time of its effectiveness was not as long as the 10% dust. On this basis orders for 5% dust were discontinued.
Requests received from various towns, clttes and counties for assistance in dusting and eradication control measures were handled for the first 7 months by a sanitarian (in charge of Mobile Unit) located in the Macon Field office. The last 5 months of the year these requests were handled by various field personnel assigned to the typhus program. These operations in non-participating areas applied 1,758 pounds of DDT dust in treating 2,197 premises averaging .80 pounds of dust per premise.
There were 34 counties that participated in DDT dusting operations on a county-wide basis during 1949. There were also 25 counties that participated on a part-time basis which was based principally upon request.
The DDT dusting operations for 1949 were modified and underwent frequent changes as dictated by the extent of the control needs shown. During the past year there were 314,556 pounds of DDT dust used as compared with 435,817 pounds used in 1948.
RAT ERADICATION
Rat eradication activities during 1949 were carried on at about the same level as in 1948. During the past year the principal rodenticide used was Red Squill. Other rodenticides, although more toxic to' rodents, are not as

TYPHUS CONTROL SERVICE 141
safe for wide-scale eradication because of the danger involved to pets, farm animals and small children. Other rodenticides that were used are as follows: 1080 (Sodium Fluoroacetate), Antu (Alphanaptholthiourea), Cyanogas-A-Dust (cyanide-gas) and Arsenic Trioxide. The principal bait material varied according to the section of the State and the species of rat being poisoned. It was found that in some sections peanut meal bait was the most acceptable while in others fish meal, meat scraps, etc., were found to be the most effective. The use of Cyanogas-A-Dust met with great favor especially in rural areas since it was not only very successful as a rodenticide, but it also aided greatly in the control of ectoparasites that inhabited rat burrows. The more toxic rodenticides such as 1080 and Cyanogas-A-Dust were highly effective but were used under certain restrictions because of the toxic nature.
At the dose of the year the eradication services had poisoned 98,194 premises using 64,267 pounds of Red Squill bait; 6,308 pounds of A-Dust; 97.5 gallons of 1080; 536 gallons of liquid arsenic; 90 pounds of Antu and 627 ounces of Phosphorus. The best results obtained on this wide scale eradication was during the late fall and winter months.
The Mobile Unit assisted by organizing and giving technical supervision in several localities throughout the State that requested assistance in carrying on rat eradication programs. The Mobile Unit treated 4,818 premises using 3,821 pounds of Red Squill bait.
RATPROOFING
Ratproofing operations in 1949 were carried on in 3 Cities in the State, Atlanta, Waycross, and Tifton. The ratproofing operations in the cities of Tifton and Waycross were under the immediate supervision of the Regional Supervisors located in these respective regions who directed ratproofing supervisors on these projects. The City of Atlanta's ratproofing program was directed by the Atlanta City Health Department.
Ratproofing is considered a permanent type of rodent and typhus control and includes complete eradication following the actual ratproofing of the buildings. Ratproofing ordinances were in effect in these 3 cities and the cost of operating was handled through local revolving funds.
There were 582 establishments that were ratproofed in 1948. The average cost of ratproofing for the past year was $44.88 per business establishment. Several other towns have shown an imuest in ratproofing activities and preliminary survey work has been clone in Americus, Ashburn and Fitzgerald.

142 ANNUAL REPORT, 1949
REFUSE COLLECTION AND DISPOSAL
The Refuse Collection and Disposal Service which was activated in April 1948 has met with continued success during 1949 as a section of the Georgia Typhus and Rodent Control Services. The requests for assistance in this field by various municipalities and health officials throughout the State increased in number.
The technician in charge of these operations, under the supervision of the State Director, worked directly with the State field supervisor and regional supervisors. This technician and his services were available upon request: ( 1) to advise and help plan proper refuse collection and disposal, (2) to help inaugurate sanitary landfill operations by actual participation, ( 3) to demonstrate the use of various types of equipment used in these operations such as bulldozers, draglines, tractors, etc., and (4) to maintain liaison with all landfill operations making inspections and helping to correct any faults observed.
The results of this program have helped to: ( 1) eliminate open-dump disposals, ( 2) assist in land reclamations, ( 3) eliminate odor nuisances, (4) correct insect problems and, (5) reduce the rat population by eliminating rat harborages and shelters.
The following cities and counties spent $68,600 in purchasing sanitary landfill equipment during the past year: Savannah, Dalton, Milledgeville, Albany, Calhoun, and Fulton.
The cities of Athens, Albany, Dalton, l\!Iilledgeville, and Savannah, together with Fulton County, inaugurated new sanitary landfill operations during 1949; and the cities of Cordele, Valdosta, vVaycross, and Bibb County corrected and improved their waste disposal methods. In addition to the above there are 9 other cities and towns that are contemplating starting sanitary landfill operations in the immediate future.
In accomplishing the results listed above the field technician made 431 field visits, 13 meetings, 640 contacts. The increased number of requests for this service has not only proven the popularity of this operation but shows the need throughout the State for proper waste collection and elimination of open refuse dumps.
ANTI-RAT SANITATION
Anti-Rat Sanitation may be defined as any sanitary activity which aids in the reduction of a rodent population. Considerable effort has been made in bringing before civic groups, health departments and individuals the im-

TYPHUS CONTROL SERVICE 143
portance of the control of rodent population through ( 1) proper storage and shelter of foodstuffs, (2) cleaning up debris and other material about premises that would offer rodents shelter and harborages, (3) proper handling of all food wastes and blocking same from rodent population, (4) maintaining close liaison on food sanitation programs with health departments, ( 5) cooperating in fire prevention week in eliminating rat harborages, ( 6) working in conjunction with civic clean-up campaigns using rodent control as one means of creating interest, (7) public safety programs, (8) working with slum clearance and housing projects.
BIOLOGICAL ACTIVITIES
Biological studies made in the field included trapping, combing, and bleeding of an adequate sample of the rodent population in order to obtain data relative to the rate of infection of murine typhus fever in rats, the geographic distribution of the rodents, and the rat ectoparasite infestation.
With the reduction in the human typhus fever incidence, it was necessary to inaugurate county-wide biological surveys to determine the location of the foci of infection in the rodent population. This information was then used to apply control measures where they were needed; thereby reducing the extent and cost of operations with control being concentrated in the sections where the greatest benefit through control measures could be obtained.
A flexible formula was devised to establish a statistically sound standard method of sampling the rodent population. Geographical coverage in the counties by militia districts and sufficiency of sampling within these areas for evaluation was obtained through the application of this formula. This assured sampling of 10% or more of the total number of premises in any county or militia district. During 1949, biological surveys were conducted in the East Central, Southeast, and Southwest Regions by 3 biological aids and 3 trappers. Detailed spot maps showing location of human typhus cases, the premises having infected rodents, and other pertinent biological data accompanied reports to the counties with recommendations for control.
There were 8,089 rats obtained in these investigations and 105,006 rat ectoparasite specimens identified by the entomological aiel in lVIacon. Of the total number of rats examined, there were 6,678 which were shown to be infested with fleas and there were 20,229 fleas identified. The reduction of the flea index showed 36.2% less for the treated (DDT dusted areas) as compared with the unclustecl areas.
In those counties trapped the percent of infection of typhus fever 111

144 ANNUAL REPORT, 1949
rodents varied from 0.6% to 55.0% and an average infection of 10.91 ;Po is shown for all counties that were surveyed. This is a reduction of 3.16% over the previous year. There were 46 counties that participated in the biological surveys and the value of this information was exemplified in many instances by more local participation. The majority of the typhus fever cases reported came from counties that had over 80% of Norvvay rats as shown by the specimens trapped.
SUMMARY
In 1945, murine typhus fever was of mounting public health significance. Since this date each successive year, including 1949, there has been fewer typhus fever cases reported in the State. Many types of prevention and control have been utilized in typhus operations during the past 5 years, but the use of DDT dust as an insecticide appeared the most beneficial in reduction of the disease in rodents and man.
With the ultimate goal of "overall" control of typhus fever, other measures were incorporated, such as rat eradication, extensive biologic studies, ratproofing, epidemiologic studies of human cases and control DDT dusting of premises at apparent foci of infection, sanitary refuse collection and disposal and anti-rat sanitation. Laboratory research and field operations have been used as a guide in gradually concentrating control efforts where the need was shown to be the greatest.
Typhus fever is still a major public health problem in Georgia as shown by the number of cases reported (216) in 1949 and 'the recording of 10.91% of rodent population (sampled) being infected. The extent and type of future typhus control is indeterminate because this is contingent upon the incidence and future financial participation.

VENEREAL DISEASE CONTROL
C. D. BOWDOIN, M.D., Director
DIVISION FUNCTION
To control venereal diseases in the State of Georgia, through the various case-finding procedures including public information, mass serology, and contact investigation; and through the treatment of all infectious cases discovered.
GENERAL
The efforts of this division for the year 1949 have largely been devoted to case-finding. This continues to be our major problem in syphillis control.
Our records for 1949 continue to show a declining incidence and prevalence of syphilis. During 1949 with materially increased case-finding effort both the percentage and number of positive findings for syphilis have decreased. In our Communicable Disease Investigator Program the volume of suspects investigated in 1949 was more than double the number investigated in 1948, but the percentage of early infectious syphilis cases derived from these investigations as well as through our mass and miniature serologic surveys continues to decline. This, as we see it, is conclusive evidence of a declining syphilis attack rate.
Georgia still leads the nation in the number of infectious syphilis cases brought to treatment, although some of our neighboring states have treated a much larger number of syphilis patients. This is evidence of the fact that our program is well directed from the standpoint of controlling the spread of syphilis, and also reflects the fact that during the past few years we have removed a large percentage of our backlog of syphilis prevalence through effective case-finding and treatment procedures.
Our program of suspect investigation is the outstanding program of its type in the nation. Since the addition of our Communicable Disease Investigator Program which began in July of 1947, we have approximately doubled our indices for contact investigation in the State of Georgia. Since this program is now our leading method for the discovery of early infectious cases of syphilis this is one of our most profitable activities. As a result of our Communicable Disease Investigator Program in Georgia, the U. S. Public Health Service has now aided all other states having a major syphilis problem in initiating and executing similar programs. Sixteen of our Communicable Disease Investigators have now been promoted to higher paying positions with the U. S. Public Health Service and assigned

146 ANNUAL REPORT, 1949
to other states to assist in the initiation and operation of such programs. Also, as a direct result of our outstanding Communicable Disease Investigator Program in Georgia, the U. S. Public Health Service has now assisted us in establishing Alto Medical Center Training School where contact investigation personnel for all the states, the army, and the air forces are being trained.
V. D. SURVEYS-COMMUNICABLE DISEASE INVESTIGATOR PROGRAM
During 1949 a total of 8,906 suspects were investigated and from these investigations 3,525 previously known cases of venereal disease were referred to treatment, of which 598 were primary or secondary and 627 congenital syphilis.
ALTO MEDICAL CENTER-IN-PATIENT CARE
During 1949 a total of 10,748 patients were treated at Alto Medical Center, of which number 1,935 were treated for primary or secondary syphilis. This compares with 12,138 patients treated during 1948, of which 2,385 were treated for primary or secondary syphilis.
NEW VENEREAL DISEASE CASES REPORTED
During 1949, 9,990 cases of syphilis were reported, of which 2,529 were primary or secondary infections. During 1949, 15,004 cases of gonorrhea, 903 cases of chancroid, 248 cases of granuloma inguinale, 131 cases of lymphogranuloma venereum, and 17 "no diagnosis" cases of "other venereal diseases" were reported.
This compares with 10,846 cases of syphilis reported in 1948, of which 3,237 were primary or secondary infections, and 15,548 cases of gonorrhea, 1,015 cases of chancroid, 204 cases of granuloma inguinale, 128 cases of lymphogranuloma venereum, and 15 "no diagnosis" cases of "other venereal disease." Although these figures reflect a slight decrease in the total number of cases of syphilis reported for 1949 over 1948, our serologic laboratory report shows that an appreciably larger number of serologic tests were run in 1948 than in 1949, reflecting again our increased volume of case-finding work with diminishing returns in terms of incidence and prevalence.
SYPHILIS CASES REPORTED TO VENEREAL DISEASE CONTROL DIVISION BY PRIVATE PHYSICIANS
During 1949, 666 cases of syphilis were reported to the Division of Venereal Disease Control by private physicians. This compares with 1,058 cases reported by private physicians for 1948.

VITAL STATISTICS
LEALON M. LACY, Ph.M., Director
DIVISION OF VITAL STATISTICS
The activities of the Division of Vital Statistics are divided into two units of operation: (a) The registration and filing of vital events as required by law; and (b) Statistical service required for public health activities.
THE ACTIVITIES OF THE REGISTRATION UNIT: The Registration Unit is charged with the legal responsibility for the collection, filing, and preserving of a certificate for each birth, death, stillbirth, adoption, legitimation, and name-change that occurs in the State of Georgia. These records are collected, indexed, filed, and preserved for searching, certification, and statistical purposes.
IMPROVEMENT IN RECORD COLLECTION: Both the quantity and quality of reporting of vital events in Georgia were improved during 1949. The central office was aided greatly by the field staff who contacted registrars, ordinaries, doctors, funeral directors, hospitals, midwives, health officers, county nurses, and medical colleges. Birth and death certificates that had any necessary information missing were queried for completeness before acceptance and filing. The number of registration areas and local registrars decreased from 962 in 1948 to 800 in 1949.
BIRTH AND DEATH CERTIFICATES REPORTED: According to State lavv six months are allowed to file birth and death certificates. The number of resident and nonresident live birth and death certificates filed to date for 1949 show a slight decrease from that of the same ,period of 1948. A total of 93,688 birth and 29,709 death certificates have been placed on record for 1949 as compared to 92,526 birth and 29,620 deaths for the similar period of last year.
CERTIFIED COPIES OF BIRTH AND DEATH RECORDS: The issuance of certified copies to the public of individual birth and death records decreased from 21,650 in 1948 to 19,251 in 1949, while certified copies of deaths increased from 2,245 in 1948 to 2,314 in 1949. This includes 4,404 certifications furnished free to veterans. Free verification and searching services for governmental agencies increased in 1949.

148 ANNUAL REPORT, 1949
DELAYED BIRTH REGISTRATION: A total of 13,264 delayed birth certificates were filed during 1949, as compared to 12,468 for 1948. These certificates are issued for those born in Georgia prior to 1919, the first year of registrati0n, or whose birth was not reported at the time of birth.
LEGAL ACTIVITIES: During 1949, 632 adoptions were completed as compared to 901 for the preceding year. There were 339 legitimations and four name-changes for the year while 441 legitimations and 14 name-changes were recorded in 1948.
CENTRAL STATISTICAL UNIT
The Central Statistical Unit operates in cooperation with the Division of Vital Statistics and renders specialized statistical services to the general health program. The unit is responsible for the processing, tabulation, and the distribution of official public health statistics required by law. Mechanical and other specialized statistical services required for the public health activities of the Central Statistical Unit are described below.
ACCOUNTING: Activities included the issuance of payroll, checks, individual income tax statements, payroll certifications to the merit system, quarterly budget listings, and preparation of special reports as required by the Division of Administration, Budget and Accounts.
COMMUNICABLE DISEASES: Under the supervision of the Division of Epidemiology morbidity statistics on communicable diseases were collected, queried, and compiled for weekly, monthly, and annual State and U. S. Public Health Service reports. Special requests were prepared for the various divisions, physicians, public health workers, and the public.
VENEREAL DISEASES: A Central Register of contacts and/or suspects as well as all known cases of venereal diseases is maintained. lVIonthly and semi-annual epidemiological activity and venereal diseases control reports are prepared for evaluation of results of investigation.
OFFICIAL STATISTICS: State, county, and city statistics on births, deaths, stillbirths, infant and maternal mortality were compiled and rates computed as to race, age, sex, and color in order to provide official public health statistics on the health status of the people in Georgia. Three special publications of public health statistics were compiled and published during the year.
SPECIAL SERVICES: Special machine and/or hand tabulations were prepared to fill requests from the various divisiops, the public, and voluntary

VITAL STATISTICS 149
health agencies. During 1949 the volume of special requests increased rapidly which is evidence of more general interest in public health activities. Special effort was made during the year to give consultative service to division directors and local health officers on records and statistical problems. Local health units that are custodian of vital records were encouraged to utilize these records for public health planning, evaluation, and publication.
During the year the following statistical publications were prepared and distributed:
"A Study of Child Health Services in Georgia" "Georgia 1948 Natality and Mortality Statistics" "Georgia 1948 Morbidity Statistics" "Results of the Crippled Children Survey in Georgia" "July 1, 1948, Population Estimates of Georgia Counties and Cities."
SUMMARY OF 1949 STATISTICAL DATA
1949 STATISTICAL RATES: The Vital Statistics rates presented for 1949 in this report are decreased, except for the live birth rate, partially because of the larger population used to calculate all rates based on population. The 1949 rates are based on an estimated population of 3,225,000 for Georgia as compared to an estimated population of 3,200,000 for 1948. This increase in the estimated population of Georgia was based on the excess of births over deaths and migration information.
. 1949 LIVE BIRTH RATE: Resident births recorded in Georgia during the
year totaled 93,557, an increase of 1,953 over the 91,604 for 1948. The
birth rate for 1949 is 29.01 per 1,000 population which has increased 1.33% over the 28.63 rate for 1948.
1949 DEATH RATE: The death rate of residents of Georgia was 915.88 per 100,000 population and represents only a slight decrease of 0.003% under the rate, 915.91 for 1948.
Death from heart diseases, cancer and cerebral hemorrhage accounted for the greatest net increase in the number of deaths. The death rate change was greatest for measles, which increased 350.00%, followed by malaria 166.67;7o, lethargic encephalitis 81.825"'o, and poliomyelitis 40.91%, but these accounted for only 32, 5, 13 and 10 deaths respectively. The greatest rate decreases during the year were reported for whooping cough, gonorrhea, diphtheria, meningococcus, influenza, and homicide. Five of these causes of death showing great decreases in rates are preventable diseases that reflect public health activities.

150 ANNUAL REPORT, 1949
STILLBIRTHS: There have been 2,179 stillbirths reported for 1949, as compared to 2,408 in 1948. The 1949 rate of 23.29 per 1,000 live births shows a decrease of 11.41% as compared to the 1948 rate of 26.29 for the same period of time.
INFANT MORTALITY: A total of 3,093 infant deaths were reported for 1949, a decrease of 57 deaths from 1948. The decrease in rate was 3.87% with the 1949 rate 33 .06, and the 1948 rate 34.39.
MATERNAL MORTALITY: A 12.78% decrease wasrecorded in 1949, when the Maternal Mortality rate dropped from 2.27 per 1,000 live births in 1948 to 1.98 in 1949. In terms of lives saved, this decrease represents a saving of 23 mothers with 185 reported in 1949 and 208 in 1948.
OTHER CAUSES OF DEATH: See statistical tables following this report.

VITAL STATISTICS 151
TABLE 1
DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIRTH RATES PER 1,000 POPULATION, STILLBIRTH, INFANT AND MATERNAL MORTALITY RATES PER 1,000 LIVE BIRTHS IN UNITED STATES AND GEORGIA: 1948

CAUSE OF DEATH

International Code No.

ALL CAUSES ___________ --------------

Typhoid and Paratyphoid fever_

(1 ,2)

Meningococcus meningitis ______ Scarlet fever __________________

(6) (8)

Whooping cough ______________ Diptheria_____________________

(9) (10)

Tuberculosis; all forms _________ D y s e n t e r y ____________________ Malaria ______________________ Syphilis ______________________
Measles ______________________
Poliomyelitis__________________

(13-22) (27) (28) (30)
(35) (36)

Catnucmerorsa_n_d___o_t_h_e_r___m_a_l_i_g_n_a_n_t_

(45-55)

Acute rheumatic fever__________ Diabetes mellitus______________ Exophthalmic goiter_ __________ Pellagra_____________ ---- _____ Alcoholism (ethylism) __________

(58) (61) (63b)
(69) (77)

Intorraicgrinan__ia_l__le_s_i_o_n_s__o_f_v__a_sc_u_l_a_r_

(83)

Diseases of the heart_ __________ (90-95)

Pnfeluuemnozna_ia__(_a_ll__f_o_rm__s_)__a_n_d__I_n_-_ (33' 107-109)

Ulcer of stomach or duodenum__

(117)

Diarrhea and enteritis__________ Appendicitis._--- _____________

(119' 120) (121)

Hernia and Intestinal obstruction_________ ----- __ ----- ___

(122)

Cirrhosis of liver_______ ---- ___

(124)

Nephritis.. ____________ ---- ___ (130-132)

Diseases of the Prostrate _______

(137)

Congenital Malformations ______ Premature Birth_______________

(157) (159)

Suicide_____ ------------- _____ (163' 164)

Homicide____ ---------- __ ----- 165-168)

Accidental deaths (Total)_______ (169-195)

LMivoetorB-ivrethhisc_l_e_a_c_c_i_d_e_n_t_s________________

(170)

Stillbirths ____________________
Infant MortalitY-------------Maternal MortalitY------------

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

u.s.
Rate
988.5
0.2 0.6 0.0 0.8 0.4 30.0 0.7 0.1 8.0 0.6 1.3
134.9 0.6
26.4 1.4 0.4 1.7
89.7 322.7
38.7 6.0 6.0 2.9
6.9 11.3 53.0 4.6 13.2 26.7 11.2
5.8 67.1 22.1 24.2 20.6 32.0
1.2

Georgia Georgia Rate Rank

932.3

17

0.3

35

0.6

26

0.0

17

1.3

33

0.9

41

31.6

31

1.6

44

0.1

30

8.9

34

0.2

7

0.2

5

92.7

10

1.0

39

14.5

6

0.8

8

2.6

48

2.7

36

111.5

43

230.5

9

46.9

37

4.9

16

7.9

42

2.7

17

6.8

20

6.4

13

78.7

47

4.6

23

11.3

5

32.7

36

8.6

14

16.9

48

67.4

17

24.6

27

29.3

43

26.1

43

34.2

31

2.1

44

SOURCE: National Office of Vital Statistics, Special Reports-Val. 34, Nos. 1 through 48; Vol. 35, Nos. 1 and 6.

TABLE 2

....
c.n

I>)

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, LIVE BIRTHS

AND RATES PER 1,000 POPULATION, STILLBIRTHS, INFANT AND MATERNAL MORTALITY WITH RATES PER 1,000 LIVE BIRTHS, BY COLOR, IN GEORGIA FOR THE YEAR 1949 AND THE PERCENT

zz)>

CHANGE IN THE RATES, 1939-1949

.c).>.

CAUSE OF DEATH

::0

NUMBER

RATE

PERCENT CHANGE IN THE RATES: 1939-1949

In "tt
0

~

Total White Colored Total White Colored Total White Colored

10
ALL CAUSES ______________ 29,537 17,351 12,186 915.88 810.04 1,125.21 -10.21 -7.41 -11.97 1""0"

Typhoid & Paratyphoid Fever (1, 2) Typhus Fever (39a,b,d) __________
SMmaalallrpioax(2(384)) -_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-
SMceaarsleletsF(e3v5er)-(8-)--_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_Whooping Cough (9) ______________ Diphtheria (10) __________________ Influenza (33) ____________________ Dysentery (27) ___________________ Poliomyelitis (36) _________________
Lethargic Encephalitis (3 7) ________ Meningococcus Meningitis (6) ______ Tuberculosis, all forms (13-22) _____ Syphilis (30) _____________________ Gonorrhea (25) ___________________ Cancer (15-55) ___________________ Diabetes Mellitus (61) ____________
Pellagra (69)--------------------Cerebral hemorrhage, embolism and
thrombosis (83a, b) _____________

11 14
5 0 32 1 23 21 181 44 10 13 15 946 281 8 3,060 536 73
3,480

7 . 06
0 22 0
9 17 52 20 8 6 12 372
72 1'
2,154
371 46

4

0.34

0.32

0.37 -87.17 -83.16 -90.73

8

0.43

0.28

0. 74 -69.28 -85.64 +68.18

5

0.16 --------- 0.46 -95.05 -100.00 -91.51

0 10

-----0-.9-9--

-----1-.0--3-

---------
0.92

----3-9-.-2-6--

----1-4-.-1-7--

----6-1-.-6-7--

1 14

0.03 0.71

----0--.4--2-

0.09 -95.00 -100.00 -65.38 1.29 -83.45 -86.23 -80.12

4

0.65

0.79

0.37 -78.62 -75.69 -86.09

129

5.61

2.43 11.91 -81.56 -90.18 -70.57

24

1.36

0.93

2.22 -66.50 -71.38 -59.71

2

0.31

0.37

0.18 -18.42 +5.71 -59.09

.37

0.40 0.46

0.28 0.56

0.65 +233 .33 +180.00 +282.35 0.28 -4.17 +24.44 -47.17

574 29.33 17.37 53.00 -40.24 -36.04 -39.82

209

8. 71

3.36 19.30 -42.47 +10.16 -47.34

7

0.25

Q.OS

0.65 -67.10 -75.00 -63.28

906 94.88 100.56 83.66 +47.95 +40.98 +62.98

165 16.62 17.32 15.42 +41.09 +40.24 +41.64

27

2.26

2.15

2.49 -73.93 -67.91 -79.56

1,791 1,689 107.91 83.61 155.96 +10.56 +4.59 +20.90

--
CAUSE OF DEATH

-~

--

NUMBER

--

--~
RATE

PERCENT CHANGE IN THE RATES: 1939-1949

Total White Colored Total White Colored Total White Colored

Heart Diseases (90-95) ____________ Pneumonia (107-109) _____________

7,667 1 '204

4,972 585

2,695 237.74 232.12 248.84 -j-37 .06 -j-43.21 +28 .49 619 37.33 27.31 57.16 -49.29 -54.84 -41.05

Diarrhea and Enteritis, under 2 years of age (119) _______________
Appendicitis (121) ________________
Cirrhosis of Liver (124) ____________ Nephritis (130-132) _______________

236 96
222 2,452

114 49 155
1 '316

122 47 67 1,136

7.32 2.98 6.88 76.03

5.32 2.29 7.24 61.44

11.26 4.34 6.19 104.89

-45.04 -66.74 -j-41.56 -21.92

-50.97 -75.38 -j-30.45 -30.65

-36.38 -48.09
+70.05 -7.16

Malformations and Early Infancy Diseases (157-161) ______________
Suicide (163-164) _________________ Homicide (165-168) _______________
Motor- vehicle Accidents (170)______

1,999 295 426 739

1,244 266 101 554

755 61.98 58.08 69.71 -10.17 -3.17 -18.04

29

9.15 12.42

2.68 -9.50 -14.34 +16.02

325 13.21

4.72 30.01 -26.32 -13.39 -25.20

185 22.91 25.86 17.08 -j-7.06 +7.04 -j-3.33

All Other Accidents (169, 171-195) __ 1,243

766

477 38.55 35.76 44.05 -j-1.90 -j-1.68 -j-3.55

Un2k0n0o) w__n__&__Il_l_-D__e_f_in_e_d__C_a_u_s_e_s_(_1_9_9_, All Other Causes _________________

749 3,455

264 1 '999

485 23.22 1,456 107.13

12.33 44.78 -21.26 -18.34 -18.67 93.32 134.44 -34.38 -33.28 -34.35

LIVE BIRTHS_-- _______________ S T I L L B I R T H S __________________
INFANT MORTALIT_ _________

93,557 2,179
3,093

58,659 973
1,668

34,898 1,206 1,425

29.01 23.29 33.06

27.38 16.59 28.44

32.22 -j-39.60 +40.63 -j-39.36 34.56 -53.17 -51.70 -52.51 40.83 -43.78 -43.53 -42.86

<
~
r-

MATERNAL MORTALITy_ _____

185

71

114

1. 98

1. 21

3.27 -63.87 -73.11 -53.02

~

)>
:!

NOTE: These figures exclude nonresidents of Georgia and include births and deaths of Georgia residents occurring in other states. Figures in parentheses are the 1938 (Fifth Revision) International List of Causes of Death code numbers.

":!'
0

"'

....

Uw l

TABLE 3

DEATHS UNDER ONE YEAR OF AGE, MATERNAL DEATHS, ILLEGITIMATE BIRTHS (EXCLUSIVE OF '.-.,".
STILLBIRTHS) AND STILLBIRTHS WITH RATES PER 1,000 LIVE BIRTHS, IN GEORGIA: 1920-1949

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

-

----------

~

-

INFANT MORTALITY

-- --

MATERNAL MORTALITY

>z

z

NUMBER

RATE

NUMBER

RATE

c>r-

Total
5305 4704 4713 4316 3737 3181

White
2961 2486 2468 2227 1851 1728

Col.

Total White Col.

Total White Col. Total White Col. ---

::c
rn "C

2344

88.3 71.1 127.1

2218

78.9 65.0 103.9

2245

78.1 66.6 96.5

558 641 658

267
299 361

291

9.3

342 10.8

297 10.9

6.4 15.8 7.8 16.0 9.7 12.8

0::c
..:.-.1.

2089

68.2 59.6 80.5

458

230

228

7.2

6.2

8.8

.-.o,.

1886

57.8 47.6 73.1

342

146

196

5.3

3.8

7.6

-o

1453

42.4 36.4 52.7

250

102

148

3.3

2.2

5.4

3068

1694

1374

35.8 30.1 46.8

229

85

144

2.7

1.5

4.9

3239

1771

1468

34.3 28.4 46.0

247

107

140

2.6

1.7

4.4

3150

1661

1489

34.4 28.3 45.1

208

78

130

2.3

1.3

3.9

3093

1668

1425

33.1 28.4 40.8

185

71

114

2.0

1.2

3.3

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

ILLEGITIMATE BIRTHS

NUMBER

RATE

Total
2695 4014 4141' 5031 5046 5385 5289 6056 6240 6847

White
474 534 512 643 565 721 681 744 730 712

Col.
2221 3480 3629 4388 4481 4664 4608 5312 5510 6135

Total
44.9 67.3 68.7 79.5 78.0 71.8 61.7 64.2 68.1 73.2

White
11.4 14.0 13.8 17.2 14.515.2 12.1 11.9 12.5 12.1

Col.
120.4 163.0 156.1 169.1 173.8 169.2 157.0 166.4 166.0 175.8

STILLBIRTHS

NUMBER

RATE

Total White Col. Total White Col.

3389 1608 1781 56.4 38.6 96.6

3455 1435 2020 58.0 37.5 94.6

3796 1454 2342 62.9 39.2 100.7

3987 1532 2455 63.0 41.0 94.6

3078 1326 1752 47.6 34.1 67.9

2208 1036 1172 29.4 21.8 42.5

2421 1161 1260 28.3 20.6 42.9

2457 1174 1283 26.1 18.8 40.2

2408 1109 1299 26.3 18.9 39.4

2179

973 1206 23.3 16.6 34.6

TABLE 3 (Continued)
DEATHS AND BIRTHS (EXCLUSIVE OF STILLBIRTHS) AND RATES PER 1,000 POPULATION, IN GEORGIA: 1920-1949

NUMBER

BIRTHS

RATE

NUMBER

DEATHS

RATE

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

Total
60061 59610 60318 63290 64695 74994 85699 94311 91604 93557

White
41618 38254 37064 37345 38911 47422 56354 62394 58601 58659

Col. Total White Col. 18443 20.7 24.5 15.4 21356 20.5 21.6 18.8 23254 20.7 20.1 21.7 25945 20.9 19.4 23.6 25784 20.7 19.1 23.8 27572 24.0 23.3 25.4 29345 27.4 27.6 27.0 31917 29.2 29.2 29.2 33003 28.6 27.7 30.5 34898 29.0 27.4 32.2

Total White Col. Total White Col.

32243 17212 15031 11.1 10.1 12.5

31278 15860 15418 10.8

9.0 13.6

35188 18036 17152 12.1

9.8 16.0

34313 18677 15636 11.3

9.7 14.2

32285 17313 14972 10.3

8.5 13.8

28456 16310 12146 9.1

8.0 11.2

27405 16160 11245 8.8

7.9 10.4

28780 17022 11758 8.9

8.0 10.8

29309 17083 12226 9.2

8.1 11.3

29537 17351 12186 9.2

8.1 11.2

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, BY COLOR, IN GEORGIA: 1920-1949

-----~-

-

-

~-

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

TYPHOID AND PARATYPHOID

NUMBER

RATE

TYPHUS FEVER

<

NUMBER

RATE

.~..

Total
549 675 500 261 68 27 11
9 10 11

White
274 264 207 100 27
11 6 4 6 7

Col. 275

Total White 19.0 16.2

Col. Total White Col. Total White Col. 22.9 -------- -------- -------- -------- -------- --------

g(It

411

23.3 14.9 36.2

293

17.2 11.2 27.3

1 9

1 -------- 0.03

8

1 0.3

0.1 --------

0.4

0.1

(It
:!

161

8.6

5.2 14.6

41

2.2

1.3

3.8

28

23

26

18

5 8

0.9 0.8

1.2 0.9

0.5 0.7

n
(It

16

0.9

0.5

1.5

59

46

13

1.9

2.3

1.2

5

0.4

0.3

0.5

33

25

8

1.1

1.2

0.7

IJt

5

0.3

0.2

0.5

31

17

14

1.0

0.8

1.3

IJt

4

0.3

0.3

0.4

18

15

3

0.6

0.7

0.3

4

0.3

0.3

0.4

14

6

8

0.4

0.3

0.7

---

TABLE 3 (Continued)

DEATHS AND DEATH RATES PER 1001000 POPULATION FROM SPECIFIED CAUSESr BY COLORr IN GEORGIA: 1920-1949

"'(!\

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

--

SYPHILIS NUMBER

RATE

CANCER

)>
zz

NUMBER

RATE

c

)>

r-

Total White

Col. Total White Col. Total White Col. Total White Col.

::tl

IT!

"tl

204

34

170

7.0

2.0 14.2 1124

766

358 38.8 45.2 29.8

0

454 429

72 77

382 352

16.6 14.7

4.1 33.7 4.2 32.8

1311

891

1552 1105

420 45.2 50.4 37.0 447 53.3 60.0 41.7

::tl
.:-t

403

85

318

13.3

4.4 28.9 1715 1239

476 56.6 64.2 43.2

'I)

587

127

460

18.8

6.2 42.4 1959 1380

579 62.7 67.7 53.4

.1:>

358

76

282

11.5

3.7 26.0 2441 1735

706 78.1 85.1 65.0

'I)

309

59

250

9.9

2.9 23.0 2420 1731

689 77.5 84.9 63.5

322

61

261

10.0

2.9 23.9 2680 1938

742 82.9 90.6 67.8

267

55

212

8.3

2.6 19.6 2892 2049

843 90.4 96.8 77.8

281

72

209

8.7

3.4 19.3 3060 2154

906 94.9 100.6 83.7

DIABETES MELLITUS

NUMBER

RATE

PELLAGRA NUMBER

RATE

Year -----
1920
1925 1930 1935
1940 1945 1946 1947
1948 1949

Total
182 234 352 388 349 380 395 448 454 536

White
139 174 240 297 258 289 281 311 321 371

Col. Total White Col. Total White Col. Total White Col.

---

43

6.3

8.2

3.6

432

210

222 14.9 12.4 18.5

60

8.1

9.8

5.3

366

181

185 12.6 10.2 16.3

112

12.1 13.0 10.4

713

255

458 24.5 13.8 42.7

91

12.8 15.4

8.3

365

190

175 12.0

9.9 15.9

91

11.2 12.7

8.4

235

118

117

7.5

5.8 10.8

91

12.2 14.2

8.4

106

77

29

3.4

3.8

2.7

114

12.6 13.8 10.5

93

67

26

3.0

3.3

2.4

137

13.9 14.5 12.5

102

65

37

3.2

3.0

3.4

133

14.2 15.2 12.3

79

57

22

2.5

2.7

2.0

165

16.6 17.3 15.2

73

46

27

2.3

2.2

2.5

Year 1920 1925 1930 1935 1940 1945 1946 1947 1948 1949
Year 1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

DIPHTHERIA NUMBER

RATE

Total
401 185 135 161 59 71 45 42 28 21

White
283 119 102 116 44 51 32 32 17 17

Col. Total White Col.

118

13.8 16.7

9.8

66

6.4

6.7

5.8

33

4.6

5.5

3.1

45

5.3

6.0

4.1

15

1.9

2.2

1.4

20

2.3

2.5

1.8

13

1.4

1.6

1.2

10

1.3

1.5

0.9

11

0.9

0.8

1.0

4

0.6

0.8

0.4

INFLUENZA NUMBER

RATE

Total White Col. Total White Col.

---

2581 1516 1065 89.1 89.4 88.7

1384

773

611 47.7 43.7 53.9

964

532

432 33.1 28.9 40.3

1357

781

576 44.8 40.5 52.3

924

503

421 29.6 24.7 38.8

473

206

267 15.1 10.1 24.6

423

191

232 13.5

9.4 21.4

367

163

204 11.4

7.6 18.7

225

95

130

7.0

4.5 12.0

181

52

129

5.6

2.4 11.9

DYSENTERY NUMBER

RATE

TUBERCULOSIS (ALL FORMS)

NUMBER

RATE

Total White

Col. Total White Col. Total White Col. Total White Col.

170

116

194

119

54 75

5.9 6.7

6.8 6.7

4.5 2362 6.6 2448

882 1480 81.6 52.0 123.3 872 1576 84.4 49.3 139.0

s<

305

158

147

10.5

8.6 13.7 2175

774 1401 74.6 42.0 130.6

r-

163 126 60

86 67 28

77 59 32

5.4 4.0 1.9

4.5 3.3 1.4

7.0 1731 5.4 1533 2.9 1108

649 1082 67.1 33.6 98.2

544

989 49.1 26.7 91.2

434

674 35.5 21.3 62.1

"~ '

36 19

19 8

17 11

1.2 0.6

0.9 0.4

1.6 1048 1.0 1074

467 415

581 33.5 22.9 53.5 659 33.2 19.4 60.3

":!'

53 44

23 20

30 24

1.7

1.1

1.4

0.9

2.8 2.2

998

400

598 31.2 18.9 55.2

946

372

574 29.3 17.4 53.0

0
"'

.....

U1
""

TABLE 3 (Continued)

DEATHS AND DEATH RATES PER 1001000 POPULATION FROM SPECIFIED CAUSESr BY COLORr IN

GEORGIA: 1920-1949

1.11

00

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

CEREBRAL HEMORRHAGE

NUMBER

RATE

HEART DISEASE

NUMBER

RATE

zz)>

c:

)>

Total White

Col. Total White Col. Total White Col. Total White Col.

r-

;;a

1336

807

529

46.1 47.6 44.1

1892 1053

839 65.3 62.1 69.9

rn '"C

1995 2523

1044 1317

951 1206

68.7 59.0 83.9 2297 1077 1220 79.1 60.9 107.6 86.6 71.5 112.4 4099 2109 1990 140.6 114.5 185.4

0
~

2410

1337

1073

79.5 69.3 97.4 5071 2961 2110 167.3 153.5 191.6

3035

1574

1461

97.2 77.2 134.6 6176 3662 2514 197.7 179.6 231.7

'0

3137 2819

1655 1523

1482 100.4 81.2 136.5 5779 3805 1974 185.0 186.7 118.9

1296

90.2 74.7 119.4 5961 3927 2034 190.8 192.7 187.4

-1:. '0

3197

1691

1506

98.9 79.0 137.7 6779 4495 2284 209.7 210.1 208.8

3383

1792

1591 105.7 84.7 146.9 7264 4647 2617 227.0 219.5 241.6

3480

1791

1689 107.9 83.6 156.0 7667 4972 2695 237.7 232.1 248.8

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

PNEUMONIA

NUMBER

RATE

Total
2766 2335 2580 3035 2055 1500 1341 1294 1242 1204

White
1470 1135 1240 1572 1019 713 684 615 617 585

Col. Total White Col.

1296

95.5 86.7 108.0

1200

80.5 64.2 105.8

1340

88.5 67.4 124.9

1463 100.2 81.5 132.9

1036

65.8 50.0 95.5

787

48.0 35.0 72.5

657

42.9 33.6 60.5

679

40.0 28.7 62.1

625

38.8 29.1 57.7

619

37.3 27.3 57.2

DIARRHEA AND ENTERITIS (Under 2 Years)

NUMBER

RATE

Total White Col. Total White Col.

1252

759

493 43.2 44.7 41.1

949

510

439 32.7 28.8 38.7

721

453

268 24.7 24.6 25.0

507

308

199 16.7 16.0 18.1

395

215

180 12.6 10.6 16.6

312

159

153 10.0

7.8 14.1

148

58

90

4.7

2.8

8.3

119

55

64

3.7

2.6

5.9

180

91

89

5.6

4.3

8.2

236

114

122

7.3

5.3 11.3

-

-

APPENDICITIS NUMBER

RATE

Year -----
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

Total
236 357 333 300 276 171 117 126 85 96

White
152 212 211 202 159 89 62 68 61 49

Col. Total White Col.

84

8.2

9.0

7.0

145

12.3 12.0 12.8

122

11.4 11.5 11.4

98

9.9 10.5

8.9

117

8.8

7.8 10.8

82

5.5

4.4

7.6

55

3.7

3.0

5.1

58

3.9

3.2

5.3

24

2.7

2.9

2.2

47

3.0

2.3

4.3

-

-

. CIRRHOSIS OF LIVER

NUMBER

RATE

Total White Col. Total White Col.

93

61

117

77

134

so

142

97

145

102

157

113

183

137

210

157

204

159

222

155

32

3.2

3.6

2.7

40

4.0

4.4

3.5

54

4.6

4.3

5.0

45

4.7

5.0

4.1

43

4.6

5.0 4.0

44

5.0

5.5

4.1

46

5.9

6.7

4.2

53

6.5

7.3

4.8

45

6.4

7.5

4.2

67

6.9

7.2

6.2

NEPHRITIS (ACUTE AND CHRONIC)

NUMBER

RATE

MALFORMATION, EARLY INFANCY

NUMBER

RATE

Year

Total White

Col. Total White Col. Total White Col. Total White Col.

----

1920

2200

1925

3228

1258 1715

942

76.0 74.2 78.5 1878 1245

633 64.8 73.4 52.7

1513 111.2 97.0 133.4 2526 1434 1092 87.0 81.1 96.3

<
~

1930

3787

2060

1727 129.9 111.9 160.9 1890 1185

705 64.8 64.3 65.7

r-

1935 1940 1945

3155 3348 2863

1803 1848 1558

1352 104.1 93.5 122.8 1736 1076

1500 107.2 90.7 138.2 2034 1098

1305

91.7 76.4 120.2 1761 1108

660 57.3 55.8 59.9 936 65.1 53.9 86.3 653 56.4 54.4 60.2

~

1946 1947

2576 2563

1417 1484

1159 1079

82.5 69.5 106.8 79.3 69.4 98.7

1859 1229 1990 1298

630 59.5 60.3 58.0 602 61.6 60.7 63.3

:!

1948 1949

2484 2452

1362

1122

1316 . 1136

77.6 64.3 103.6 76.0 61.4 104.9

1957 1208 1999 1244

749 61.2 57.1 69.2 755 62.0 58.1 69.7

0
"'

....

<-.aIt

TABLE 3 (Continued)

DEATHS AND DEATH RATES PER 1001000 POPULATION FROM SPECIFIED CAUSES/ BY COLOR/ IN 0\

GEORGIA: 1920-1949

0

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

MALARIA

MEASLES

z>z

NUMBER

RATE

NUMBER

RATE

c:
,r>-

Total White

Col. Total White Col. Total White Col. Total White Col.

rn

559

242

317

19.3 14.3 26.4

61

41

20

2.1

2.4

1.7

,"C
0

285

102

183

9.8

5.8 16.1

11

4

7

0.4

0.2

0.6

.:-'

442

186

256

15.2 10.1 23.9

128

94

34

4.4

5.1

3.2

387 89 26

176 35 12

211

12.8

9.1 19.2

54

2.8

1.7

5.0

14

0.8

0.6

1.3

25
23 7

15 14
3

10
9 4

0.8 0.7 0.2

0.8 0.7 0.1

0.9
0.8 0.4

""""''

12

6

6

0.4

0.3

0.6

44

20

24

1.4

1.0

2.2

13

9

4

0.4

0.4

0.4

17

11

6

0.5

0.5

0.5

2

1

1

0.1

0.05 0.1

7

3

4

0.2

0.1

0.4

5 ----------

5

0.2 -------- 0.5

32

22

10

1.0

1.0

0.9

Year
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

SCARLET FEVER

WHOOPING COUGH

NUMBER

Total White

Col.

RATE Total White Col.

NUMBER

. RATE

Total White Col. Total White Col.

32

31

1

1.1

1.8

0.1

373

240

133 12.~ 14.2 11.1

11

8

3

0.4

0.5

0.3

313

167

146 10.8

9.4 12.9

38

33

5

1.3

1.8

0.5

257

121

136

8.8

6.6 12.7

23

21

2

0.8

1.1

0.2

149

77

72

4.9

4.0

6.5

16

15

1

0.5

0.7

0.1

108

52

56

3.5

2.6

5.2

5

4

1

0.2

0.2

0.1

65

44

. 21

2.1

2.2

1.9

1 1

1 1

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

0.03 0.03

0.04 -------0.04 --------

60 95

28 -37

1 1

1
----------

-------1---

0.03 0.05 -------0.03 -------- 0.1

_'3)90_,

10 9

32

1.9

1.4

2.9

58

2.9

1.7

5.3

29

1.2

0.5

2.7

14

0.7

0.4

1.3

Year
-
1920 1925 1930 1935 1940 1945 1946 1947 1948 1949
Year 1920 1925 1930 1935 1940 1945 1946 1947 1948 1949

NUMBER

SUICIDE

RATE

Total
128 189 296 300 282 212 234 233 272 295

White
110 169 273 270 246 188 218 212 251 266

Col. Total White Col.

18

4.4

6.5

1.5

20

6.5

9.6

1.8

23

10.2 14.8

2.1

30

9.9 14.0

2.7

36

9.0 12.1

3.3

24

6.8

9.2

2.2

16

7.5 10.7

1.5

21

7.2

9.9

1.9

21

8.5 11.9

1.9

29

9.2 12.4

2.7

HOMICIDE NUMBER

RATE

Total White Col. Total White Col.

---

479

100

379 16.5

5.9 31.6

464

141

323 16.0

8.0 28.5

569

158

411 19.5

8.6 38.3

661

156

504 21.8

8.1 45.8

616

111

505 19.7

5.4 46.5

485

103

382 15.5

5.1 35.2

564

127

437 18.1

6.2 40.3

500

126

374 15.5

5.9 34.2

529

113

416 16.5

5.3 38.4

426

101

325 13.2

4.7 30.0

MOTOR-VEHICLE ACCIDENTS

NUMBER

RATE

ACCIDENTS (TOTAL)

NUMBER

RATE

Total White

Col. Total White Col. Total White Col. Total White Col.

140 348 612

100 238 425

40 110 187

4.8

5.9

3.3 1603

853

12.0 13.5

9.7

1682

947

21.0 23.1 17.4 1992 1164

750 55.3 50.3 62.5 735 58.0 53.6 64.8 828 68.4 63.2 77.2

<
~
r-

942

646

296

31.1 33.5 26.9 2428 1453

975 80.1 75.3 88.5

Vl

802 688 807 804

556 481 595 605

246 207 212 199

25.7 27.3 22.7 22.0 23.6 19.1 25.8 29.2 19.5 24.9 28.3 18.2

2057 1217 1990 1275 2148 1452 2110 1399

840 65.9 59.7 77.4 715 63.7 62.5 65.9 696 68.7 71.2 64.1 711 65.3 65.4 65.0

~
:!

765

545

220

23.9 25.7 20.3 2107 1341

766 65.8 63.3 70.7

0

739

554

185

22.9 25.9 17.1 1982 1320

662 61.5 61.6 61.1

VI
...

0\

Year
1930 1935 1940 1945 1946 1947 1948 1949
Percent: 1930 1935 1940 1945 1946 1947 1948 1949

....

TABLE 4

"~ "

NUMBER AND PERCENT OF BIRTHS (EXCLUSIVE OF STILLBIRTHS) BY PERSON IN ATTENDANCE AND COLOR, IN GEORGIA: 1930-1949

zz> c>r-

TOTAL

NUMBER OF BIRTHS

PHYSICIAN

MIDWIFE

;:a

rn

"1:1

0

OTHER AND NOT

~

STATED

....

Total

'() ~ '()
White Colored Total White Colored Total White Colored Total White Colored

60318

37064

23254 39416 33240 6176 20728 3695 17033

174

129

45

63290

37345

25945 37312 31798 5514 25737 5373 20364

241

174

67

64695

38911

25784 41637 34907 6730 22807 3830 18977

251

174

77

74994

47422

27572 55896 45708 10188 19023 1664 17359

75

50

25

85699

56354

29345 66508 54683 11825 19143 1643 17500

48

28

20

94311

62394

31917 74352 60918 13434 19813 1421 18392

146

55

91

91604

58601

33003 71725 57211 14514 19634 1317 18317

245

73

172

93557

58659

34898 73006 57218 15788 20216 1345 18871

335

96

239

100.0

100.0

100.0

65.3 89.7 26.5 34.4 10.0 73.2

0.3

0.3

0.3

100.0

100.0

100.0

59.0 85.1 21.3 40.7 14.4 78.5

0.3

0.5

0.2

100.0

100.0

100.0

64.4 89.7 26.1 35.3

9.8 73.6

0.3

0.5

0.3

100.0

100.0

100.0

74.5 96.4 37.0 25.4

3.5 63.0

0.1

0.1

0.0

100.0

10o:o

100.0

77.6 97.0 40.3 22.3

2.9 59.6

0.1

0.1

0.1

100.0

100.0

100.0

78.8 97.6 42.1 21.0

2.3 57.6

0.2

0.1

0.3

100.0

100.0

100.0

78.3 97.6 44.0 21.4

2.3 55.5

0.3

0.1

0.5

100.0

100.0

100.0

78.0 97.5 45.2 21.6

2.3 54.1

0.4

0.2

0.7

Year
1930 1935 1940 1945 1946 1947 1948 1949
Percent: 1930 1935 1940 1945 1946 1947 1948 1949

TABLE 5

NUMBER AND PERCENT OF BIRTHS (EXCLUSIVE OF STILLBIRTHS) BY PLACE OF OCCURRENCE AND COLOR, GEORGIA: 1930-1949

----

----

-

-

-

---

-----

NUMBER OF BIRTHS

TOTAL

HOME

HOSPITAL

OTHER

Total
60318 63290 64695 74994 85699 94311 91604 93557
100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

White Colored Total White Colored Total White Colored Total White Colored

37064

23254 53199 31956 21243 7119 5108 2011

0

0

0

37345

25945 53953 30352 23601 9300 6957 2343

37

36

1

38911

25784 46361 23989 22372 18248 14853 3395

86

69

17

47422

27572 35345 12850 22495 39596 34524 5072

53

48

5

56354

29345 34469 11883 22586 51157 44405 6752

73

66

7

62394

31917 33234 9971 23263 60997 52348 8649

80

75

5

58601

33003 31065 7970 23095 60459 50569 9890

80

62

18

58659

34898 30553 6817 23736 62926 51772 11154

78

70

8

100.0
100.0 100.0
100.0 100.0
100.0 100.0 100.0

100.0 100.0
100.0 100.0
100.0 100.0 100.0
100.0

<

88.2
85.2 71.7

86.2 81.3 61.7

91.4 91.0
86.8

11.8 14.7
28.2

13.8 18.6
38.2

8.6 -------- -------- --------

9.0

0.1

0.1

0.0

13.2

0.1

0.2

0.1

~
r-

47.1 27.1 81.6 52.8 72.8 18.4 40.2 21.1 77.0 59.7 78.8 23.0

0.1 0.1

0.1 0.1

0.0 0.0

VI
~

35.2 16.0 72.9 64.7 83.9 27.1

0.1

0.1

0.0

:!

33.9 13.6 70.0 66.0 86.3 30.0 32.6 11.6 68.0 67.3 88.3 32.0

0.1 0.1

0.1 0.1

0.0 0.0

:!
0

VI

...

w"'

0\
""

TABLE 6 DEATHS AND DEATH RATES PER 100,000 POPULATION FROM SPECIFIED CAUSES, IN GEORGIA

z:z1>
c

FOR THE YEARS: 1850, 1860, 1870, 1880, 1890, 1900, 1920, 1930, 1940, 1945 AND 1949

:r1->

CAUSE OF DEATH

---

----

--

--

NUMBER OF DEATHS

--

---

-

'"rn
"tJ

0

~

1850 1860 1870 1880 1890 1900 1920 1930 1940 1945 1949 10

"" - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ALL CAUSES _________________ 9,896 12,755 13,051 20,777 20,424 26,941 32,243 35,188 32,285 28,456 29,537

10

Typhoid & Paratyphoid Fever_ ________ Mal'aria ______________________ ---- __ Smallpox ___________________________
Measles _____________________ ------Scarlet Fever________________________ VVhooping Cough ____________________ Diphtheria__________ - _________ --- ___ Dysentery, Diarrhea & Enteritis _______ Diabetes Mellitus ____________________ Tuberculosis, all forms _______________ C a n c e r _____________________________
Pneumonia ___________________ --- ___ Heart Diseases______________________
Accidents _______ ---_---------------Suicide____ ------------------------AHlol mOitchi deer _C__a-u_se-s__-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-

557 185
74 202 385 344 654
6 379 60 651 603 569
14 23 5' 190

887 568
8 47 217 334 440
1,061 14
550 81
1 '268 723 943 20 20
5,574

772 705
18 270
12 92 417 1,414 10 996 131 1,363 274 786 14 116 5,661

987 1,060
2 496 31 650 1,309 2,011 24 1,882 240
1 '685 1,451 1,088
28 63 7,770

1,000 1,766 549 500

68

27

11

937 1 ,226 559 442

89

26

5

46

3 ------- -------

1 -------

440 201

61 128

23

7

32

8 44

32

38

16

5

1

89 222 373 257 108

65

23

553 819 401 135

59

71

21

2,353 '2,235 1'725 1,347 693 466 339

34 49 182 352 349 380 536

2,324 2,830 2,362 2,175 1,533 1,108 946

293 382 1,124 1,552 1,959 2,441 3,060

1,738 2,598 2,766 2,580 2,055 1,500 1,204

1,405 2,127 1'892 4,099 6,179 5,779 7,667

1' 143 1,382 1'603 1,992 2,057 1,988 1,982

29

48 128 296 282 212 295

94 178 479 569 616 485 426

7,984 10,788 18,004 18 '726 16,202 13,895 12,989

RATES PER 100,000 POPULATION

------

-------

1850 1860 1870 1880 1890 1900 1920 1930 1940 1945 1949

ALL

CAUSES _________________

--------------------------------1092.1 1206.4 1102.2 1347.2 1111.6 1219 .I 1113.2 1207.4 1033.5 911.0 915.9

T11yaplhaoriiad__&__P_a_r_a_ty__p_h_o_i_d__F_e_v_e_r________________ Smallpox ___________________________ 11easles_______________________ -----

61.5 20.4 -------
8.2

83.9 53.7 0.8 4.5

65.2 59.5 1.5 22.8

64.0 54.4 79.9 68.7 51.0 55.5 0.1 ------- 2.1 32.2 24.0 9.1

19.0 17.2 2.2 19.3 15.2 2.8
0.1 ------- -------
2.1 4.4 0.7

0.9 0.3 0.8 0.2 0.03 ------0.2 1.0

SWchaorloept iFnegvCe~o-u-g-h-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-__-_-

22.3 42.5

20.5 31.6

1.0 2.0 7.8 42.1

0.4 2.0 1.1 4.8 10.0 12.9

Diphtheria__________________________ 38.0 41.6 35.2 84.9 30.1 37.1 13.8

1.3 8.8 4.6

0.5 3.5 1.9

0.2 2.1 2.3

0.3 0.7 0.6

Dysentery, Diarrhea & Enteritis_______ 72.2 100.4 119.4 130.4 128.1 101.1 59.6 46.2 22.2 14.9 10.5

Diabetes 11ellitus____________________ 0.7 1.3 0.8 1.6 1.9 2.2 6.3 12.1 11.2 12.2 16.6

Tuberculosis, all forms _______________ Cancer _____________________________
Pneumonia _________________________ Heart Diseases______________________ Accidents ___________________________ Suicide _____________________________ Homicide.. - _________________________ All Other Causes ____________________

41.8 6.6 71.8 66.5 62.8 1.5 2.5
572.7

52.0 7.7 119.9 68.4 89.2
1.9 1.9 527.2

84.1 11.1 115.1 23.1 66.4 1.2 9.8 478.1

122.0 15.6 109.3 94.1 70.5 1.8 4.1 503.8

126.5 16.0 94.6 76.5 62.2 1.6
5.1 434.5

128.1 17.3 117.6 96.2 62.5 2.2 8.1 488.2

81.6 38.8 95.5 65.3 55.3 4.4 16.5 621.6

74.6 53.3 88.5 140.6 68.4 10.2 19.5 642.6

49.1 62.7 65.8 197.7 65.9 9.0 19.7 518.7

35.5 . 78.1
48.0 185.0 63.6
6.8 15.5 444.9

29.3 94.9 37.3 237.7 61.5 9.2 13.2 402.8

<
~
r

(II

NOTE: Figures for the year 1910 not available.

~

SOURCE: 7, 8, 9, 10,11 and 12th Census of the United States-Vital Statistics 1850-1900.

:!

0

(II

...

"'Ul

TABLE 7

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM THE TEN LEADING CAUSES

OF DEATH BY AGE GROUPS AND COLOR, IN GEORGIA: 1949

0\ 0\

-

--

------

--

AGE GROUP AND CAUSE OF DEATH

NUMBER

RATE PER 100,000 POPULATION

zz)>
c

)>

r-

Total White Colored Total White Colored ::a
rn

"1:1

ALL AGES (Int. Code)

0

ALL CAUSES_________________________________________ 1. Heart diseases (90-95)___ _____ _____ ____ _____________ 2. Intracraniallesionsofvascularorigin(83) _____________
3. Cancer and other malignant tumors (45-55) ----------

29,537 7, 667 3,554
3,060

17,351 4, 972 1,826
2,154

12,186 2, 695
1,728
906

915.88 237.74 110.20
94.88

810.04 232.12
85.25
100.56

1125.21 248.84 159.56
83.66

~...
.0.,.0.

4. Nephritis (130-132)-------------------------------- 2,452

1,316

1,136

76.03

61.44 104.89

0,0

5. Pneumonia, all forms, and Influenza (33, 107-109)_____ 1,385

637

748

42.94

29.74

69.07

6. Accidents, excluding motor-vehicle accidents (169,

171-195)---------------------------------------- 1,243

766

477

38.55

35.76

44.05

7. Premature birth (159)______________________________ 1,032

616

416

32.00

28.76

38.41

8. Senility, ill-defined and unknown causes (162, 199-200)_

987

367

620

30.60

17.14

57.24

9. Tuberculosis, all forms (13-22)______________________

946

372

574

29.33

17.37

53.00

10. Motor-vehicle accidents (170)_______________________

739

554

185

22.91

25.86

17.08

All Other Causes___________________________________ 6,472

3, 771

2,701

200.68

176.05 249;40

UNDER ONE YEAR ALL CAUSES ______________________ ----_______________ 1. Premature birth (159)______________________________ 2. Pneumonia, all forms, and Influenza (33, 107-109)____ __ 3. Injury at birth (160)------------------------------4. Congenital malformations (157)______________________ 5. Ill-defined and unknown causes (199-200)_____________ 6. Diarrhea, enteritis, and ulceration of the intestines (119) 7. Accidents, excluding motor-vehicle accidents (169, 171195)-------------------------------------------8. Asphyxia, cause not specified, atelectasis (16la)________ 9. Other specified diseases peculiar to the first year of life (l61b,c) ________________________________________
10. Congenital debility (158)---------------------------All Other Causes___________________________________

3,093 1,031
388 332 300 225 215
106 96
87 60 253

1, 668 615 148 203 225 65 104
54 60
51 22 121

1,425 416 240 129 75 160 111
52 36
36 38 132

3475.28 1158.43 435.96 373.03 337.08 252.81 241.57
119.10 107.86
97.75 67.42 284.27

2926.32 1078.95 259.65 356.14 394.74 114.04 182.46
94.74 105.26
89.47 38.60 212.28

4453.12 1300.00 750.00 403.12 234.38 500.00 346.88
162.50 112.50
112.50 118.75 412.50

-

--

--

--

---

-~

--

---

-----

OANLEL-FCOAUURSEYSE_A__R_S__(_I_n_t.__C_o_d_e_)__________________________

514

1. Pneumonia, all forms and Influenza (33, 107-109) ______

88

2. Ac1c9id5)e_n_ts_,__e_x_c_lu_d_i_n_g__m_o_t_o_r_-_v_e_h_ic_l_e__a_c_ci_d_e_n_t_s__(1_6_9_,__1_7_1_-

77

3. Congenital malformations (157) ______________________

49

4. Motor-vehicle accidents (170) ________________________

40

5. Diarrhea, enteritis, and ulceration of the intestines (119,

6. Le1uk2e0m)i-a-s-a--n-d--a-le-u-k-e-m--i-a-s-(-7-4-)-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-

28 17

7. 8.

Ill-defined and unknown causes (199-200) _____________ Measles (35) _______________________________________

14 14

9. 10.

Simple meningitis (81) ______________________________ Diphtheria (10) ____________________________________
All Other Causes ___________________________________

14 11 162

FAIVLEL-CFOAUUSRETSE_E__N__Y_E__A_R__S______________________________

407

1. Accidents, excluding motor-vehicle accidents (169, 171-

195)--------------------------------------------

94

2. Motor-vehicle accidents (170) ________ ---- ____________

52

3. Pneumonia, all forms, and Influenza (33, 107-109) _____

31

4. Cancer and other malignant tumors (45-55) ___________

19

5. Leukemias and aleukemias (74) ______________________

18

6. Congenital malformations (157) ______________________

18

7. Heart diseases (90-95) ___ ------ _____________ ~~ _______

17

8. Nephritis (130-132) ________________________________

12

9. Acute rheumatic fever (58)--------------------------

12

10. AAlplpOenthdeicritCisau(s1e2s_1_)_-_-_-_-_-_-_-_-_-_-_--_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_--_____

10 124

---~---

-~

-----

283

231

159.13 132.86 210.00

30

58

27.24

14.08

52.73

37

40

23.84

17.37

36.36

36

13

15.17

16.90

11.82

29

11 /

12.38

13.62

10.00

13

15

8.67

6.10

13.64

13

4

5.26

6.10

3.64

6

8

4.33

2.82

7.27

10

4

4.33

4.69

3.64

4

10

4.33

1.88

9.09

10

1

3.40

4.69

0.91

95

67

50.15

44.60

60.91

213

194

65.75

55.18

83.26

46

48

15.18

11.92

20.60

34

18

8.40

8.81

7.73

11 15

20 4

5.01 3.07

2.85 3.89

8.58 1.72

~

16

2

2.91

4.14

0.86

~

14

4

2.91

3.63

1.72

I""

7

10

2

10

5

7

2.75 1.94 1.94

1. 81 0.52 1.30

4.29 4.29 3.00

~

2 61

8 63

1.62 20.03

0.52 15.80

3.43 27.04

:l

0
"'

....

0\ '-4

TABLE 7 (Continued)

DEATHS AND DEATH RATES PER 100,000 POPULATION FROM THE TEN LEADING CAUSES

OF DEATH BY AGE GROUPS AND COLOR, IN GEORGIA: 1949

.....
o-

(0

-
~~

AGE GROUP AND CAUSE OF DEATH

NUMBER

RATE PER 100,000 POPULATION

)>
zz

c

)>

Total

White Colored Total

White Colored

r-

:;tl

m

FAIFLTLECEANU-TSEWSE__N_T__Y_-_F_O__U_R___Y_E_A__R_S__(_I_n_t_._C__o_d_e_) __________

914

1. Motor-vehicle accidents (170) _______________________

153

403 121

"tl

511

165.58 114.49 255.50

32

27.72

34.38

16.00

0
~

2. Accidents, excluding motor-vehicle accidents (169, 171-

.....

3. 4.

Tu1be9r5cu)l-o-s-i-s,--a-ll--fo-r-m--s-(-1-3---2-2-)-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_Homicide (165-168) ________________________________

138 117 90

5. Heart diseases (90-95) ______________________________

58

67

71

25.00

19.03

35.50

10

15 11

102

21.20

79

16.30

4.26 3.12

51.00 39.50

1""0"

29

29

10.51

8.24

14.50

6. Di(s1e4as0e-s15o0f) _p_r_e_g_n_a_n_c_y_,__c_h_il_d_b_i_r_th___a_n_d__t_h_e__p_u_e_r_p_e_ri_u_m_

53

16

37

9.60

4.54

18.50

7. Cancer and other malignant tumors (45-55) ___________

38

22

16

6.88

6.25

8.00

8. Pneumonia, all forms, and Influenza (33, 107-109) _____

31

9. 10.

Nephritis (130-132) ________________________________ Suicide (163-164) __________________________________
All Other Causes ___________________________________

31 26 179

6

25

5.62

1. 70

12.50

18

13

5.62

5.11

6.50

25

1

4.71

7.10

0.50

73

106

32.43

20.74

53.00

TAWLELNCTAYU-FSEIVSE__T__O__F_O__R__T_Y__-F__O_U__R__Y__E_A__R_S______________
1. Heart diseases (90-95) ______________________________ 2. Cancer and other malignant tumors (45-55) ___________ 3. Tuberculosis, all forms (13-22) _______________________ 4. Intracranial lesions of vascular origin (83) _____________ 5. Accidents, excluding motor-vehicle accidents (169, 171-
6. Mo1t9or5-v)e-h--ic-l-e--a-c-ci-d-e-n-t-s--(1-7-0-)-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_7. Homicide (165-168) ________________________________ 8. Nephritis (130-132) ________________________________ 9. Dis(1ea4s0e-s15o0f) _p_r_e_g_n_a_n_c_y_,__c_h_il_d_b_i_r_th__a_n__d__th__e__p_u_e_r_p_e_ri_u_m_

10.

Pneumonia, all forms, and Influenza (33, 107-109) _____ All Other Causes ___________________________________

4,020 668 390 377 302
295 265 241 239
128 114 1,001

1,738 290 215 107 69
178 199 58 71
54 27 470

2,282 378 175 270 233
117 66 183 168
74 87 531

436.01 72.45 42.30 40.89 32.75
32.00 28.74 26.14 25.92
13.88 12.36 108.57

276.31 46.10 34.18 17.01 10.97
28.30 31.64 9.22 11.29
8.59 4.29 74.72

778.84 129.01 59.73 92.15 79.52
39.93 22.52 62.46 57.34
25.26 29.69 181.23

- - - ---

FAOLRLTCYA-FUISVEES T__O__S_I_X__T_Y__-_F_O__U_R___Y_E_A__R_S_________________

1. Heart diseases (90-95) __________ ------- _____________

2. Intracranial lesions of vascular origin (83) _____________

3. 4.

Cancer and other malignant tumors (45-55) ___________ Nephritis (130-132) ________________________________

5. Tuberculosis, all forms (13-22)----------------------6. Pneumonia, all forms, and Influenza (33, 107-109) _____

7. 8.

Senility, ill-defined and unknown causes (162, 199-200)_ Diabetes mellitus (61) ______________________________

9. Accidents, excluding motor-vehicle accidents (169, 171-

10.

Mo1t9or5-v)-e-h-ic-l-e--a-c-ci-d-e-n-t-s--(1-7-0-)-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_All Other Causes___________________________________

SAIXLTLYC-AFUIVSEESY_E__A_R__S__A_N__D__O_V__E_R________________________

1. Heart diseases (90-95) ______________________________

2. 3.

Intracranial lesions of vascular origin (83) _____________ Nephritis (130-132) ________________________________

4. Cancer and other malignant tumors (45-55) ___________

5. Pneumonia, all forms, and Influenza (33, 107-109) _____

6. Senility, ill-defined and unknown causes (162, 199-200)_

7. Accidents, excluding motor-vehicle accidents (169, 171-

8. 9.

Ar1te9ri5os)c-l-e-ro-s-i-s--(9-7-)-_-_-_-_--_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_Diabetes mellitus (61) ______________________________

10.

Tubekulosis, all forms (13-22) _______________________ All Other Causes___________________________________

Unknown Age____________________________________

--
9,024 2,914 1,346 1,306
757 301 272 220 218
212 155 1,323
11,514 3,986 1,878 1,400 1,285
456 411
,319 314 263 131 1,071
51

4,565 1,591
493 835 274 142
91 73 123
118 111 714
8,462 3,041 1 '252
945 1,054
323 189
265 232 220 101 840
19

4,459 1,323
853 471 483 159 181 147
95
94 44 609

1683.58 543.66 251.12 243.66 141.23 56.16 50.75 41.04 40.67
39.55 28.92 246.83

1204.48 419.79 130.08 220.32 72.30 37.47 24.01
19.26 32.45
31.13 29.29 188.39

2840.13 842.68 543.31 300.00 307.64 101.27 115.29 93.63 60.51
59.87 28.02 387.90

3,052 6257.61 6715.87 5262.07

945 2166.30 2413.49 1629.31

626 1020.65 993.65 1079.31

455 760.87 750.00 784.48

231 698.37 836.51 398.28

133 247.83 256.35 229.31

222 223.37 150.00 382.76

<

54 173.37 210.32

93.10

82 170.65 184.13 141.38

~
r-

43 142.93 174.60

74.14

30

71.20

80.16

51.72

231

582.07 666.67 398.28

~

~

32 ---------- --- ------ ---------- 0

:

-"'
.a...,

... TABLE 8
NUMBER AND PERCENT OF DEATHS (EXCLUSIVE OF STILLBIRTHS} BY PLACE OF OCCURRENCE .... Q (HOME, HOSPITAL, ETC.} AND MEDICAL ATTENDANCE, BY COLOR, IN GEORGIA: 1944-1_949

Year and Color
Total: 1944 1945 1946 1947 1948 1949

----------

--

-----

------

z)>

TOTAL

HOME

HOSPITAL

INSTITUTION

STATED-

cz :

)>

With Without

-

r-

:::tl

Total Medical Medical Number Percent Number Percent Number Percent Number Percent

1'11 "1:1

Attend- Attend-

0

ance

ance

~...

28,803 25,261

3,542 18,968

65.9 8,047

27.9

28,456 24,941

3,515 17,926

63.0 8,569

30.1

952 3.3

836 2.9

933

3.3

1,028

3.6

'I)
""'I)

27,405 23,959 3,446 16,982 62.0 8,476 30.9

859

3.1

1,088

4.0 '

28,780 25,321

3,459 17,693

61.5 9,094

31.6 1,033

3.6

960 3.3

29,309 25,681

3,628 17,908

61.1 9,440

32.2 1,024

3.5

937 3.2

29,537 25,929

3,612 17,827

60.4 9,773

33.1

989

3.3

948

3.2

White:

-

1944

16,118 14,906

1,212 9,437

58.6 5,673

35.2

1945

16,310 14,952

1,358 9,163

56.2 6,006

36.8

1946

16,160 14,726

1,434 9,067

56.1 5,941

36.8

1947

17,022 15,710. 1,312 9,448

55.5 6,393

37.6

1948

17,083 15,689

1,394 9,265

54.2 6,654

39.0

1949

17,351 15,885

1,466 9,291

53.5 6,916

39.9

538 3.3

470 2.7

508 3.1

' 633

3.9

486

3.0

666

4.1

580 3.4

601 .3.5

579 3.4

585

3.4

540 3.1

604 3.5

Colored:

1944

12,685 10,355

2,330 9,531

75.1 2,374 18.7

1945

12,146

9,989

2,157 8,763

72.1 2,563' 21.1

1946

11,245

9,233

2,012 7,915

70.4 2,535

22.5

1947

11,758

9,611

2,147 8,245

70.1 2,701

23.0

1948

12,226

9,992

2,234 8,643

70.7 2,786

22.8

1949

12,186 10,040 2,146 8,536 70.0 2,857 23.4

414 3.3

425 3.5

373 3.3

453

3.9

445 3.6

449 3.7

366

2.9

395 3.3

422 3.8

359 3.0

352 2.9

344 2.8

NOTE: Figures prior to 1944 not available. These figures exclude nonresidents of Georgia and include residents of Georgia with death occurring in other states.