Annual report 1951 [1951]

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TABLE OF CONTENTS
ANNUAL REPORT GEORGIA DEPARTMENT OF PUBLIC HEALTH
1. Battey Hospital 2. Cancer Control 3. Cardiac Control
4. Crippled Children 5. Dental Health 6. Engineering ?. Epidemiology
8. Health Education 9. Hospital Services 10. Industrial Hygiene 11. Laboratories 12. L.H.O. (Loc'll Health Organizations) 13. M.C.H. (l1aternal and Child Health) ~4. M8ntal Hygiene ~-5o P. H. Nursing 16~ Personnel
17. Rabies Control
18, Tuberculosis Control 19. Typhus Control , 20. v,mereal Dise1.se Control 21. Vital Statistics 22. Water Pollution Control

1951 ANNUAL REPORT The year 1951 has shown a continued expansion of Battey Hospital, and you are referred for a more complete description of the hospital departments and activities to the 1946 annual report. As in the past we will continue to give a narrative report of the activities at Battey along with tabular material which will be comparable with what was done in previous years. The first thing of interest is the table below which shows the number of patients in the hospital on the first day of each of the past nine calendar years as compared with January 1, 1952.
- - 1944 1945 1946 1947 1948 1949 1950 1951 1.952
TOTAL 453 518 544 986 1199 1305 1444 1597 1762 Battey continued its expansion in 1951 from a patient load
of 1597 on January 1 to 1762 on December 31, 1951. This is an increase of 1309 patients over the patient load in December of 1944. This is more than the number of deaths that occurred in 1944 throughout the State and therefore represents more than an average of one bed per annual death for that time. While the figures for 1951 are incomplete, it is known that during the year we actually had in operation more than two beds per annu~l death, which until recently has been considered a very satisfactory standard. If we include the number of beds at Milledgeville, Savannah, Columbus and in the veterans Administration Hospitals where Georgia patients are hospitalized, it is reasonable to assume that there is in the neighborhood of four beds per annual death.
Applications during 1951 showed an overall total increase. Reflected in this increase, however, are applications for both

Page 2 the Columbus and Savannah Sanatoria which were included with applications to Battey during the last half of the year. The 1951 Session of the General Assembly passed an act providing that Battey state Hospital pay out of specially appropriated funds the per diem cost of patients in local county sanatoria where ever such sanatoria met the standards of care prescribed by the hospital and where the patients in those sanatoria would be eligible for admission to Battey State Hospital. Since there were forty patients in the sanatorium at Columbus on July 1 and fifty patients in the sanatorium at savannah on July 1, it is readily seen that the counting of these patients would account for the increase in applications, particularly when coupled with the additional applications received from these sanatoria during the last half of the year. No attempt was made to divide these applications by reason of the fact that when the application is made to the sanatorium a decision is made as to which of the three hospitals the patient would be better suited for and this would make it most difficult to keep them separate. A more detailed report on the operation of the two hospitals will be made in a separate section, however.
Another factor influencing this increase in applications was the change of policy which took place gradually during the year in regard to readmission of patients who had previously left against medical advice. While it is true that we had been admitting these patients in ever increasing numbers for the past few years we had not, prior to July 1, 1951, routinely accepted all patients for a second trial at sanatorium treatment if they had previously left against medical advice. Since this time we have not rejected patients who had previously left against

Page 3 medical advice unless they were disciplinary problems who had to be removed from the sanatorium due to alcoholism, drug addiction or some other obnoxious o~ dangerous traits which had made it impossible to associate them with cooperative type patients.
Applications have been reviewed in detail for the years since 1946 and,while the information is not presented in tabular form in this report,it was noted that the total application has not changed very markedly during these years. The number of previously unreported and previously unhospitalized patients at Battey have shown a rather considerable reduction in number in the white race, particularly white females, and has remained approximately stationary for the colored. While there has been an increase irt the nuMber of applications for colored patients, the increase is represented in its entirety almost by previously hospitalized patients, most of whom have left against medical advice, making reapplication for entry into the sanatorium.
Another fact worth calling to your attention is the decrease in applications for the younger age group and an increase in the number of applicants in the older age groups. As an example, in 1942 eleven per cent of the applicants were under twenty and only seven per cent were over sixty. In 1951 seven per cent were under twenty and fourteen per eent were over sixty. The proportion of patients making application in 1942 under the age of forty were sixty-five per cent as against forty-eight per cent in 1951. We also note that in 1942 sixty-seven per cent of the applicants were white and thirty-three per cent colored and the ration has gradually changed until 1951 when only fifty-~even per cent of the applicants were white and forty-three per cent colored. A study of applications show a definite continued trend downward

Page 4
in the younger age groups in both colors and also a downward trend in all the white groups, with the exception of the age group sixty and above,who have shown a continued increase in proportion.
During the last half of the year there was a decided decrease in the total number of applications and it is hoped that this trend will continue during the coming year. Unless there should be a marked upswing in applications, which we doubt seriously, the number of beds which are now open should be able to take care of all patients making application to the sanatorium except for those who have demonstrated beyond any reasonable doubt that they cannot, or will not, eonform to reasonable hospital rules and regulations which are designed to promote the cure of tuberculosis. l,Ti th the exception of colored males all patients are being admitted within ten to twenty days from the time application is received and after the colored nurses' home is completed and the colored nurses have been moved out of the ward which can be occupied by colored males, this waiting list will be rapidly decreased and we believe that these patients can be cared for also.
Our building program continued at a quite active pace in 1951. All farm buildings were completed during 1951 and the colored nurses' home will be ready for occupancy soon after the first of the year. The building was completed in 1951 and we were awaiting shipment of furniture before moving into the building. The laboratories for the departments of Surgical and Clinical Pathology is expected to be completed during the first quarter of 1952. This will give adequate space for surgical and clinical laboratory studies and for the first time will

Page 5 make it possible for us to adequately house what we consider to be the best tuberculosis bacteriology laboratory in the country. The bacteriological and clinical laboratory is being operated by the Division of Laboratories in the State Department of Public Health and Battey is reimbursing this division on the basis of nine cents per patient per day.
Homes for the staff were completed during 1951, bringing the total number of residencies to twenty-four, all of which are modern, two and three bed room houses which are quite an asset in inducing medical personnel to join the hospital staff.
We are converting one of the nurses' homes into efficiency apartments for married couples who work at the hospital. At the present time the only living quarters that we have for these individuals are private rooms and we hope to be able to provide space for all married couples in these efficiency apartments and this can be done without sacrificing any space so far as total occupants are concerned. The building supplies have already been purchased and this work should be completed during the early part of 1952.
It was necessary to buy completely new equipment for all of the wards as the Army equipment has been exhausted long ago. It is also necessary that we replace considerable amount of the Army equipment in the wards as it has worn out in the meantime, due to the fact that it was not of too good a construction.
Maintenance work on our hospital continues and the buildings are in a fairly good state of repair now. From an overall point of view they are probably in better condition than when the Army
left here with the exception of the floors. Due to the type or
soil which exists here there is constantly a high degree of

Page 6 moisture underneath these floors and in spite of increased ventilation there is considerable deterioration of the floor joists and these have to be replaced occasionally. Going along with this, of course, is the bucking and disfigurement which occurs, but the floors can at least be kept clean if not beautiful.
During the past year we also have completed the resetting of the boilers and installation of automatic control equipment which will not only make them considerably safer for operation, but will, in the opinion of the consultant who has been responsible for the work, make them much more economical to operate. These boilers were found to be in very bad condition when they were reworked and they are now in excellent state of repair and we believe they can be kept so with a minimum amount of maintenance.
The building and equipping of the hospital has been completed for the most part. There are still some renovations to be made in the interest of operating efficiency, however, which will still take considerable time and some expenditure of funds. As an example of this we hope to be able to move the admission ward into the group of buildings near the laboratory and X-ray department so that it will not .be necessary to haul the patients such long distances for routine laboratory and X-ray procedures. Then too we expect to convert one of these buildings into a recovery ward for the surgical department so that the surgical staff will be near the patients who are immediately postoperative. At the present time patients have to be kept in the operating room until they have reacted and then have to be transported a very considerable distance

Page 7
before they are returned to the regular surgical wards. This last renovation has been brought about by the marked
changes which have taken place in the treatment of tuberculosis since the advent of chemotherapy. We, as well as others, have found that the best treatment fbr the residual pulmonary focus in patients who have had chemotherapy is its extirpation by resection of wedges, segments, lobes or the whole lung in case it has been destroyed. During the past year there has been a marked increase in this type of surgery and at the present time we are approximately six months behind schedule even though we were up to date six months ago. This has occurred in spite of the fact that we have increased the surgical staff and are now operating on many more patients each week than we have operated on before. Another limiting factor has been anaesthesia as we are only able to obtain an anesthetist for three full days out of each week. The other three days are devoted to procedures which can be done either under spinal or under local anaesthesia.
At the present time this is the most serious deciciency in the operation of the hospital. We are in as fortunate a position as we are only be reason of the faet that we have a surgeon loaned to us by the United States Public Health Service, but we have already been notified that he will be moved sometime during the coming ~ix months. We have one additional full time surgeon who is helping us out until such time as he establishes a private practice, which he hopes to do by July 1, 1952. The present pay scales allow only a six hundred dollar per year differential between thoracic surgeon who must have at least five years beyond internship,as compared with other members of the staff who are

Page 8 required to have only three years' medical training in tuberculosis. It may become necessary that we either employ a surgeon without having him covered by the Merit System or we must induce the Merit System to make allowance for the additional training and experience in this most important position. The same thing applies to anaesthesiology and competition must be met if we are to continue our program.
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 we felt that we had an adequate medical staff for our patient load. The University of Georgia continues to rotate its residents in medicine for a three month period at Battey, and beginning on the first of January, 1950 the Department of Surgery began its rotation of surgical residents, each of which will spend three to six months at Battey. This added one additional person to our surgieal staff and in addition furnishes valuable training facilities for the University Medical School, thereby enabling them to train more physicians for Georgia. Unfortunately, this plan has been interrupted by the shortage of residents at the University Hospital, but is to be resumed just as soon as the Medical School can secure enough residents. During 1951 we
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added a part time resident in roentgenology from the Medical School at Augusta. The plan is to rotate the senior resident in roentgenology who will spend approximately one week out of each.month at the hospital, thereby increasing our professional personnel in this department. The table below shows the personnel patient ratio by department and the year.

Page 9

PERSONNEL PATIENT RATIO* BY DEPARTMENT AND YEAR

Department 10-1-45 7-1-46 1-1-48 1-1-49 1-1-50 1-1-51 1-1-52

Administrative Medical Nursing Housekeeping Culinary Laundry Maintenance Farm & Dairy

1:42 1:54
1:9 1:13 1:16 1:30 1:22 1:45

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

1:35 1:25 1:8 1:18 1:13 1.:30 1:23 1:55

1:33 1:24 1!8 1:14 1:11
1:33 1:22 1:84

1:34 1:26 1:7 1:14 1:10
1:35 1:25 1:80

1:36 1:27 1:6 1:13 1:10 1:37 1:26 1:84

1:43 1:36 1:6 1:13 1:9 1:36 1:26 1:76

Total Ratio

1:2.6 1:1.6 1:2.4 1:2.2 1:2.2 1:2.1 1:2.1

Total Employees 205 386 507 610 669 758 832

Total Patients 540 625 1199 1305 1444 1597 1762

*The average sanatorium in the United states has approximate-

ly one empioyee for each two patients. Some or the sanatoria,par-

ticularly in the Veterans Administration, run an exact opposite

ratio. Some run as many as two employees for every patient.

The table above shows the status of personnel-patient ratio

in October of 1945, July of 1946 and on the first of each calen-

dar year since that time. You will note that in Oetober, 1945

we had less employees per patient than at any other time (we had

fewer employees per patient than the sanatorium had at any time

as far as we have records). You will note also that we had more

employees per patient on July 1, 1946 than we ever had at any

other time. Since that time we have been able to bring up the

ratio of patients to employees to the point where it is approach-

ing the more nearly normal average. My reason for saying that

is the fact that the employee ratio does not show approximately

one hundred prisoners which are divided between the Nursing, Culi-

nary, Housekeeping and Laundry Departments. If these were includ-

ed, our ratio would be about one employee for each two patients

which would be just about the normal average. It will be noted

Page 10 from the table above that we have finally brought our ratio or patients per nurse more nearly to a normal figure. On January 1, 1951 we had reached the point where we had one nurse for each six patients and we have been able to maintain that ratio since that time. While it is generally conceded that one nurse for each five patients is a more desirable standard, this standard was adopted in the years prior to the time when streptomycin and the other chemotherapeutic agents were in use There can be no question about the fact that the addition of these drugs to our treatment schedule has markedly cut down the number of hours nursing time needed, particularly since the patients can have their complicating conditions more adequately handled. I refer particularly to empyema. laryngitis, enteritis and the other debilitating complications of pulmonary tuberculosis. You will also note that, with the ex.ception of the Medical, Nursing and CUlinary Departments, the average employee at Battey is taking care of more patients than they were when we were at Alto. It is true that the three departments mentioned above are the backbone of the hospital, but it is also quite true that these were the most inadequately staff ed of all the departments at Alto. One other factor must not be lost sight of and that is the fact that we are now taking all the patients who make application and consequently we have many sicker patients than we had formerly. The chemotherapeutic agents mentioned above, however, have been the redeeming factor in this situation and were it not for them we would have to have many more nurses than we now have on our staff.

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The table below show~ the average per diem cost for a

patient during each half of the calendar years 1945 through

1951, inclusive:

PERIOD

SALARIES SUPPLIES NET COST OUTLAY TOTAL

First half 1945 $1.29

$1.21

$2.50

$ .08 $2.58

Last half 1945 1.27

1.05

2.32

.17 2.49

First half 1946 1.62

1.47

3.09

1.45 4.54

Last half 1946 1.92

2.49

4.41

1. 71 6.12

First half 1947 1.61

1. 73

3.34

.85 4.19

Last half 1947 1.66

1.75

3.41

.30* 3.71

First half 1948 1.85

2.69

4.54

.28* 4.82

Last half 1948 1.89

2.28

4.17

.17* 4.34

First half 1949 1.88

2.31

4.19

.29* 4.48

Last half 1949 1.94

2.11

4.05

.38 4.43

First half 1950 2.07

2.50

4.57

.71 5.28

:~;

Last half 1950 2.10

2.34

4.44

.74 5.28

First half 1951 2.23

2.90

5.13

.78 5.91

Last half 1951 2.35

2.28

4.63

.42 5.05

*This includes outlay for new equipment only and does not

include improvements made in building, etc.

Most everyone can remember that the cost of wages and sup

plies at hospitals was unreasonably low during 1945. This was

especially true at Alto where we were markedly understaffed

and as a consequence the salary items were particularly low.

No one remembers with any great pleasure the fact that food

supplies were certainly not of the same quality as are now

being bought and we also know at that time that drugs such as
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streptomycin and P.A.S. were also not available. The cost of

drugs alone in 1951, on a per diem basis, amounts almost to

the total cost of physicians' salaries for patient care in

the year 1945. Streptomycin costs forty cents per gram and

para-aminosalicylic acid costs an average of ten to fifteen

cents per day. Approximately seventy-five per cent of all

patients now receive these drugs for a period of six to

nine months.

Page 12 Another factor which makes interpretation of the above
table somewhat difficult is the fact that the total cost includes all the lands and buildings, repairs and renovations, replacement and new equipment which has been bought since we have been at Battey.
There has also been an increase in salaries during this period which was necessary to hold employees and insofar as we have a record there is no position now filled at Battey which does not pay at least twice as much as the same position paid at Alto. In spite of that fact the per diem cost of salary has not quite doubled, showing that some increase in efficieney ha~ occurred. There is no need to comment on the cost of supplies because these have been quite variable and the cost of supplies is also intermingled in the cost of repairs and renovations at the hospital and we will not have this figure stablized until all renovations have been completed. we can say, however, that the last half of 1951 more near ly approaches the stable figure of hospital costs than at any other time. We believe that the net per diem cost of the hospital will probably not exceed the figure of $4.63 in the table above. As~uming that this is true the appropriation which we now have will care for 1800 patients. This will require an additional appropriation next year as past experience indicates that we will add approximately one hundred ~ixty-f1w patients during this coming year. It is impossible to say wifu accuracy what future hospital needs will be, but it is recommended that an additional $300,000.00 be requested at the ne~ session of the General Assembly which will allow us to increase our patient load to approximately 2000. This will be

Page 13 near the maximum number of beds that can be maintained and unless there should be need for additional stay, or unless patients should change their attitude very considerably, we will more than likely be able to take care of the patients needing hospitalization.
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 fai~ly well clarified at the present time and we think that we know the best manner in whieh the drug can be used. For instance, the extreme and distressing forms of tuberculosis which we usually see in the terminal stages have almost disappeared at Battey since streptomycin will now relieve enteritis and laryngitis. It will also relieve the harassing cough of the terminal stages and make the patient much more comfortable than anything that we have ever had in the past. At the present time this is one of the most important uses of the drug, although it does not cure the patient. Streptomycin, of course, 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 of different type cases in comparison with other forms of treatment. It also shows the effect on producing stable disease as compared with other forms of

Page 14

treatment. While these results are based on approximately 500

streptomycin cases as compared with 5,000 non-streptomycin

cases, it is felt that they are significant.

'~TE PATIENTS

DEATHS

DISEASE STABLE

STREPTOMYCIN NO STREPTOMYCIN STREPTOMYCIN NO STREPTOMYCIN

FAD

435

810

205

19

FAC

128

416

320

177

FA:S

410

185

455

321

MAC

0

176

815

176

MAB

. 26

999

- 24
1612

790 2585

470 1163

During 1949 and 1950 we engaged in the trial of strepto-

mycin in conjunction with para-aminosalicylic acid, as a part

of a large study conducted by the Special Studies Section of

the United states Public Health Service in cooperation with

the American Trudeau Society. \\'e believe that the contribu-

tion which we have made to this study has been very worth

while and we feel that the study itself will show the very

definite superiority of this combination over that of either

drug alone.

During the latter part of 1949 we were asked by the

Schenley Coropration to study the new chemical which has

gained such widespread favor in Germany in the treatment of

tuberculosis, Tibione. Our study at Battey was limited pri-

marily to the study of the development of resistance. Other

investigators have studied other phases of the drug such as

toxicity, the optimum dosage, and types of disease for which

the drug is best suited. Unfortunately, the drug has not

Pae;e 15 been as efficacious as was hoped for at first and at the present time its use is confined primarily to local application of the drug into empyema spaces. We have found that this is one of the best treatments for tuberculous empyema that has been used in this institution. Fortunately, with the discontinuance of pneumothorax as the temporary collapse method of cho~e there are not as many cases of this type as there have been previously.
Another drug which we have used to a limited degree in the treatment of tuberculosis has been cortisone. In view of all the literature and the experiences of other people which have shown that this drug is definitely hazardous when administered in the ordinary dosages, we have been reluctant to use it parenterally. On the other hand, we have been able to show that the drug when nebulized directly into the tracheobronchial tree is of very marked benefit in cases of acute laryngitis or tracheobronchitis. We have apparently been able to achieve some degree of local desensitization of the tissues which promotes drainage and with the concomitant use of streptomycin, many of these patients have shown marked and unusual benefits. 'tl!e ex.pect to report this observation in the literature sometime during the coming year.
There is now another drug under study, not at this institution, which holds a promise of being of marked benefit to patients with tuberculosis. The only thing we can say about the drug at the present time is that it is a fact that it has been reported unofficially that it appears to be more bactericidal than streptomycin and in addition is a relatively simple compound which can be easily manufactured and which can be

Page 16 taken orally. As soon as the drug is released for clinical investigation we expect to use it at Battey on as large a scale as results indicate.
In view or the increasing waiting list for surgery at the
hospital we are recommending to the Budget Bureau that we be allowed to contract with other hospitals, which have adequate starr in thoracic surgery, to take patients from Battey for operation and then for these patients to be returned here for their period of bed rest. In addition we hope to double the surgical staff here, but even this will not take care of the patients at Battey needing surgery unless we can secure assistance from the other hospitals. l~ contemplate asking both the University Hospital at Augusta and the Grady Hospital in Atlanta to admit patients on a flat per diem charge for surgical procedures. It is felt that this is the most urgent need that the hospital has at the present time and that we should make every effort to get these patients under surgical treatment as rapidly as possible since every patient on the waiting list for even one day represents an additional cost to the hospital and additional loss of time to the patient in his cure.
No other request is being made for a change in general operational policies as we believe that the policy under which the institution has operated in the past has demonstrated conclusively that the institution can play a big factor in tuberculosis control, and that this policy should be continued. There are many changes and quite a little bit of repair work, along with alterations and renovations~ that need to be made ~ Battey, but we believe that it is best to do these on the ~ of full time general maintenance schedule than it is to hire a

Page 17
large group of individuals to work for a short time. In other words, we believe that our present staff is gradually catching up with our repair problems at the institution and that the buildings are in better shape, all things considered, than they were when we came five years ago. Shrubbery and flowers are being added to the hospital grounds to try to improve the appearance, and every provision possible is being made for the patients' treatment, recreation, and other needs while they are in the hospital. It is true that we could probably give more luxuries if we had more personnel, but to do this would mean that it was necessary to keep some patients out of the hospital that could be admitted. We have therefore followed the consistent policy of admitting every patient that we felt we could possibly handle and give adequate medical and nursing care.
We refer you to the tabular material which accompanies this report as the tables give a concise and significant story of the hospital and we believe reflect the general trend better than a narrative report.
TABLE I The following table shows the number or persons making application for admission to Battey and Alto during the past nine years:
- - - Year 1943 1944 1945 1946 1947 1948 1949 1950 1951
White 575 524 477 964 1033 998 914 939 981
- - - Colored 314 251 298 586 616 679 615 639 717
Total 889 775 115 1550 1649 1677 1529 1578 1698
It will be noted that there was a conaiderable increase in
the number of applications during 1951, but this was brought
about primarily because of two factors. The first factor is that of a change in operational policies which allows the readmission of patients who previously left against medical advice. The other is the fact that the Savannah and Columbus

Page 18

Sanatoria make applications directly to Battey which are counted in the total number of applications. Detailed study of the applications shows that there has been no increase in the number of new cases making application to the sanatorium, but that the increase in the number is reflected primarily in old patients making re-application. During the year approximately fifteen per cent of applications were from old patients.

TABLE II

The following table shows applications, by age group, for admission to Battey and Alto during the past ten years:

Under 20 20 - 39 40 - 59 60 plus

Total

Year White Col. "'hite Col. White Col. White Col. White Col.

1942 78 50 369 254 238 75 83 9 768 388

1943 47 47 302 213 179 47 47 7 575 314

1944 24 53 267 136 152 48 81 14 524 251

1945 40 58 216 171 164 62 57 7 477 298

1946 62 85 414 309 357 171 131 21 964 586

1947 61 72 455 361 367 157 150 26 1033 616

1948 59 88 430 366 375 196 134 29 998 679

1949 49 90 404 314 33G 16~ 127 45 914 615

1950 56 81 381 318 361 194 141 46 939 639

1951 50 72 358 348 415 240 158 57 981 717

Here again it should be noted that in 1951 there was a continued decrease in the number of applicants in the age group under 20. It will be noted also that there was an increase in the group over 40 and over 60. We believe that this continued trend shows that tuberculosis is being transmitted far less among the younger age group than it was previously and that this continued increase in the ratio of older persons probably reflects the development or tuberculosis from endogenous sources rather than from infected individuals in recent months.

Page 19

TABLE III

The following table shows the percentage of persons rejected for admission in the difrerent age groups in the past ten years'

Under 20 20 - 39 40 - 59 60 ~lus

Total

Year Wfiite Col. White co!. WK!te Col. White Col. Wfi!te C'o1.

1942 18 58 14 54 20 37 43 66 19 52

1943 ~8 50 19 49 25 53 53 85 24 51 1944 33 15 15 42 26 40 37 28 25 35 1945 2 33 16 35 20 27 55 55 21 33 1946 19 41 12 26 15 27 41 33 17 29 1947 8 43 13 46 21 39 47 58 18 44

1948 10 43 9 33 15 35 33 55 15 36 1949 10 25 9 25 16 32 30 56 15 29 1950 18 32 12 23 15 24 20 35 15 25 1951 16 12 6 14 8 14 15 32 9 15

This table shows the influence ot Battey on the number of applicants who have been rfjected for admission in the different age groups. It will be noted that the greatest difference in r~ jection rates is in the gr~up under twenty years of age and the group from twenty to thirty-nine. In 1947 there was an overall increase among the colored in their percentage who were rejected for admission, due to the fact that onee the beds were filled there was no alternative othe~ than to reJect the patients. The real significance of this table can probably not be appreciated unless one goes back and notes the number of persons making application in previous years as compared with the past year. It is obvious that when a physician finds that all of his far advanced hopeless eases are rejected for admission that he will automatically stop making application for this type of case, but will make his application only for the earlier cases. we reel ~ we take the years 1943, 1944, and 1945, that the number or persons applying during these years were the individuals who had the most favorable chances for reeovery. This means, if this assum~ tion is true,that in 1948 we were having approximately six or seven hundred or more than in recent years and that most or th~ were the more advanced, less favorable cases. We know from general observation that we are taking many cases now that in former years would not have been considered favorable at all. This explains our failure to decrease the per capita cost. 1~re are adding practically altogether those patients who are acutely ill and whose cost of hospital care is quite high. It can be stated that the great majority of all rejections were in pe~sons who were not considered to have active disease.

Page 20

TABLE IV

The following table shows the number of admissions by color, for the past nine years at Battey and Altoj as compared
With 1951:

Color White Colored Total

1943 425 134 559

1944 425 121 546

1945 470 210 680

1946 765 377
1142

1947 738 362
1100

1948 803 322
1125

1949 728 284
1012

1950 731 456
1187

1951 842 561
1403'

This table shows the number of admissions by color for
the past nine years and it will be noted that our admission rate was much higher in 1951 as compared with previous years. A
large part of the increase in admissions was due to the fact that we accepted many more of the sicker patients than we had in previous years and also because of the fact that we readmitted
many patients for the second and some even for the third time during the year.

TABLE V

The following table s~ows the number of patients in the hospital on the first day of each of the past nine calendar years:
1944 1945 1946 1947 1948 1949 1950 1951 1952
Total 453 518 544 986 1199 1305 1444 1597 1762

The table shows the rather phenomenal growth in tuberculosis hospital days since 1943. On January 1, 1952 we had 1762 patients which was nearly 800 greater than on January 1, 1947 and was 1200 greater than on January 1, 1946. It rep~esents
a gain of 1300 patients over January 1, 1944.

Page 21

TABLE VI

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

FAR ADV.

MOD. ADV. MINIMAL

OTHER FORMS

NON TBC.

TOTAt

Year l-Jh. Col. \lfh < Col Wh. Col. Wh. Col. 1A1h. Col. Wh. Col.

1944 147 48 173 45 31 8 20 6 54 14 425 121

1945 183 122 196 49 19 7 14 8 58 24 470 210

1946 405 232 231 83 26 12 28 15 75 35 765 377

1947 385 183 132 103 27 5 82 50 61 21 738 362

1948 317 152 283 92 41 15 75 47 87 16 803 322

1949 347 121 252 102 40 20 21 27 68 14 728 284

1950 377 179 265 206 27 25 18 25 44 21 731 456

1951 436 342 292 125 27 18 27 39 60 37 842 561

It will be seen that there is a direct ratio between the number of admissions and the percentage of far advanced cases ad-
mitted. 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~r advanced cases of tuberculosis. It is suspected that we are finding a higher proportlon of moderately ad-
vanced disease than ever before due to the large number of case finding programs that are in effect at the present time and it iP also suspected that the number of minimal and moderately advanc--
ed cases will continue to decrease in the next few years if tu-
berculosis falls as we think and hope that it will. It Will aloo be noted that there were more extra-pulmonary forms of tubercula
sis admitted in 1947 than have ever been admitted previously or since. Most of these were admitted for treatment with streptomycin and include glandular tuberculosis, tuberculous meningitis,
some few cases of bone tuberculosis, peritonitis, miliary, and renal tuberculosis. It will be noted that in 1949, in spite of the fact that we admitted considerably less patients than we had
in previous years, that the number of far advanced white cases
averaged 54% of the total of tuberculous cases admitted. This percentage continued to climb in 1950, going to approx.imately
57%. There was a relative drop in the percentage of far advanced colored patients admitted during that year, which was prob-
ably due to the Atlanta survey in which a large number of moderately advanced cases in the negroes was found. The year 1951 showed a continued increase in the number of far advanced cases admitted. The greater part of this increase was account-
ed for by the colored which showed more than 60% of far advanced cases. A large number of these patients represent the seca~

Page 22
or third admission during the year, a~ stated previously, and consequently do not reflect the ratio of far advanced and moderately advanced cases as noted in those patients making application to the sanatorium for the first time. This group of patients continues to show less far advanced cases each year.

TABLE VII

The following table shows the number of admissions by age groups during the past eight years at Alto and Battey:

Age Group Under 20

20 - 39

40 - 59

60 plus

'\IJhi te CoL White Col. vJhi te Col. Vhi te Col.

1944

16 13 251 80 137 27

21

1

1945

24 21 351 134 164 51

31

4

1946

39 38 368 217 287 113

71

7

1947

47 33 379 181 316 99

41

2

1948

45 33 344 196 319 80

95 13

1949

44 40 336 150 267 76

81 15

1950

47 57 309 240 284 136

91 23

1951

27 55 328 278 352 199 135 29

The above table conforms fairly close to the findings of the other tables which shows the continued admission of a large: proportion of older age patients. It shows that we are continually increasing the number of patients admitted who are over forty years of age. The exact significance is debatable, but in our opinion it is due 'to the fact that there is a continued decrease in the amount of new cases of tuberculosis in the younger age groups, and this is a reflection of the fact that there is less opportunity for the spread of tuberculosis now than there has been previously.

Page 23

TABLE VII

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

status

Under 20

20 - 39

40 - 59

60 plus

White Col. Fhi te col. White Col. 1.fhi te Col

Died at Hosp .

4 15

Still in Hosp.

22 30

Home - Sputa Pos.* 14 7

61 48

7 20 25 32 19 19 47 30

10 12 27 42 22 19 41 27

17 6 26 19 16 38 41 37

*This refers to the patient's 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
emphasizes 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 white.

TABLE IX

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

lt!hite

- - 1943 1944 1945 1946 1947 1948 1949 1950 1951 546 431 376 459 629 754 613 652 789

- Colored 129 149 168 159 267 275 212 331 473

Total

675 580 544 618 896 1029 825 983 1262

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 seven 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.

Page 24

TABLE X

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

QUIESCENT OR
ARRESTED IMPROVED UNIMP.

DEATHS

TOTAL TBC. NON-TBC.

V.Th. Col. v!h. Col. l~Th. Col \,Jh. Col. Hh. Col. V.Th. 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

1950 232 84 225 157 88 16 61 57 606 314 46 17

1951 213 108 270 194 164 52 73 66 720 420 69 53

The status of patients at discharge from 1944 to 1951 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 quies-
cent status than ever before. The unimproved group of patients makes up a much larger number than \1-.re have had in previous years as well as a large!' proportion. Fere it not for the fact that we were readmitting these patients back to the hospital we would
be more concerned than we are. In view of the fact, however, that we are readmitting the greater proportion of these patients
it is felt that if this group wel'e removed from the table that we would continue to show much greater improvement in our discharge cases than we have in previous years.

:~:!
?~

Page 25

:;~~

':(

TABLE XI

Table shm'ling number of discharges who had positive sputum at time of discharge by status, by year and by color:

QUIESCENT
OR ARRESTED

IMPROVED UNIMPROVED

TOTAL

White Col. Vlhite Col. \~!hi te Col. Hhite Col.

1944

30

37 10

45 23

85 33

1945

10

30 14

60 16

91 30

..:,;.::

!?

1946

40

25 12

87 26

116 38

1947

20

64 23

106 31

170 54

1948

81

101 28

98 20

207 48

1949

50

68 27

73 6

146 33

1950

62

104 60

80 11

190 73

1951

81

118 74

130 44

256 119

This table shows the number or patients discharged with a positive sputum during these eight 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 laboPa-
tory work is far more accurate now than it was in previous years and 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 which will probably double the number of positives obta].ned. Due to the fact that the greater number of these patients who left as unimproved with a positive sputum
have been r~admitted during the year we are not too concerned about the number of unimproved leaving with positive sputums. It will be noted that in the other categories the number of discharges with positive sputum \'ras less in proportion to the
total number of discharges than in previous years.

Page 26

TABLE XII

Table showing the discharge status of patients, per cent of total tuberculous discharged, during the past eight years at Alto and Battey:

~UIESCENT
OR ARRESTED

IMPROVED

UNIMPROVED

DEATHS

White Col. White Col. 1~Thi te Col. White col.

1944

29 37

40 32

21 22

10

9

,,

1945

32 20

29 37

29 18

10 25

1946

23 10

24 21

38 32

15 37

1947

21 12

35 26

30 21

14 41

1948

22 19 43 33 23 12 12 36

1949

38 25

32 36

16

5

14 33

1950

38 27

37 50

15

5

10 18

1951

30 26 38 46 23 12 10 16

In this table it will be noted that we are increasing the
number of patients with an improved and quiescent status considerably over former years. It will also be noted that the
percentage of deaths is constantly increasing to where during
1947 that 14% of the white patients discharged were discharged by reason of death, whereas 41% of all the colored discharges
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 since 1947 is believed to be due to
the influence of streptomycin.

Page 27

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 seven years:

WHITE PATIENTS

UNDER 3 MOS.

1945

39

1946

49

1947

37

1948

28

1949

22

1950

21

1951

21

FAR ADVANCED

4 - 13 MOS. 14 - 22 MOS.

44

11

35

10

46

10

40

21

32

18

31

16

35

16

MORE THAN 23 MOS.
6 5 9 11 28 32 28

MODERATELY ADVANCED

1945

42

45

9

4

1946

29

46

18

7

1947

37

38

15

10

1948

39

31

17

13

1949

26

34

16

24

1950

21

38

18

23

1951

36

33

16

15

MINIMAL

1945

50

40

10

0

1946

31

53

11

5

1947

57

33

5

5

1948

37

42

11

10

1949

35

33

15

17

1950

32

31

20

17

1951

27

45

14

14

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 ad-
vice 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 since that time. As compared with former years> it appeared that patients were staying for
considerably longer time than they did previously.

Page 28

TABLE XIV

The following tables show 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:

(a)

WHITE

FAR ADVANCED

UNDER 3 MOS. 3 - 13 MOS. 14 - 22 MOS. OVER 23 MOS.

1944

6

13

11

5

1945

13

12

3

0

1946

29

20

4

1

1947

22

30

14

3

1948

24

20

16

6

1949

16

21

15

19

1950

13

16

11

19

1951

9

20

18

20

MODERATELY ADVANCED

1944

2

0

2

1

1945

0

4

0

0

1946

0

0

1

3

1947

0

3

1

1

1948

1

1

4

3

1949

1

1

0

1

1950

1

2

1

1

1951

1

1

0

2

(b)

COLORED

FAR ADVANCED

1944

5

3

1

1

1945

20

12

2

0

1946

25

23

1

3

1947

31

46

0

0

1948

23

35

14

6

1949

14

20

10

13

1950

17

5

11

17

1951

23

16

4

15

MODERATELY ADVANCED

1944

1

2

0

0

1945

0

0

0

0

1946

0

1

1

0

1947

4

3

1

1

1948

3

4

2

2

1949

1

1

1

1

1950

1

1

1

1

1951

1

2

1

2

Page 29

TABLE XV

Converting Table XIII into percentage basis we find the following picture as regards the far advanced cases:

V.lHITE

FAR ADVANCED

UNDER 3 MOS. 3 - 13 MOS. 14 - 22 MOS. OVER 23 MOS.

1944

17

37

31

15

1945

46

43

11

0

1946

54

37

7

2

1947

32

44

20

4

1948

36

30

24

6

1949

22

29

14

35

1950

24

30

20

26

1951

13

30

27

30

COLORED

FAR ADVANCED

1944

50

30

10

10

1945

59

35

6

0

1946

50

46

2

2

1947

34

50

10

6

1948

30

45

18

7

1949

25

35

18

22

1950

34

10

36

20

1951

40

28

3

26

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 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 not as marked in 1950J but here we think it
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 worth while using.
For those patients ~.,rho 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 ~s concerned~ since these patients have already infected their contacts at home. Table XIV should also be studied very closely to see
the influence of treatment when tuberct1los is is found early.
It will be noted that no cases of minimal tuberculosis have died during the past five years, and very few cases of moderat~
ly advanced tuberculosis have progressed and died whereas most of the deaths have been among those persons who had far advanc-
ed disease when discovered and sent to the sanatorium.

Page 30

TABLE XVI

The following table shows trends in treatment procedures in use at the sanatorium in 1942 and at Battey in 1951. The type treatment used is indicated as percentage of total patients discharged alive 'It-Those diagnosis on admission falls within the group under which the percentage is listed:

~TRITE PATIENTS

COLORED PATIENTS

Year

FAR ADV. MOD.ADV. MIN. FAR ADV. MOD.ADV. MIN.
42 '51 142 '51'42 '51 '42 '51 142 '51 142 '51

Bed rest only

21 36

Phrenic crush

31

Pneumothorax*

29 1

Thoracoplasty ** 16 9

Pneumoperitoneum 21 48

D:iagncstic only*** 10 5

streptomycin**** 0 15

Resection

0l

18 4 23 20 20 30 8 1 17 0 0 '1 45 2 50 8 46 2 4 3 0 8 12 5 16 59 3 49 20 52 9 30 7 11 2 9 0 31 0 42 0 68 0 10 4 0 1

16 20 42 32 13 0 33 0 48 5 25 18
6 20 0 17 60 0 36
0 12 0 14 0 24 0 18 0 10 0

*This includes all cases in l'Thich pneumothorax. was the primary procedure used. It includes all auxiliary procedures such as pneumonolysis.

**This includes all cases regardless of other preceding treatment such as pneumothorax or pneumoperitoneum.

***This includes the cases which left against advice before treatment was initiated.

****This was used as adjunct to other types of Rx given above.

It will be seen fro~ 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 't'muld 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 rel-
atively 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 1951, 75% 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 minimal tuberculosis. Many 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.

Page 31

This is a report ~or the Columbus and savannah local sanatoria showing the status of patients at discharge:

Q.UIESCENT OR
ARRESTED IMPROVED

UNIMP.

DEATHS

TOTAL TBC.

1!lh. Col. l.lfh' Col. lr.Th _ Col. 'lATh. Col. Wh. Col.

savannah 0

2

1

51

30

3 2 13

Columbus 4

2 11

23

1

1

4 19

9

It will be noted that the number of quiescent and arrested cases is smaller in proportion than is the case at Battey. This would be expected, however, in view of the fact that most of
these sanatoria primarily admit cases with a poor prognosis3
cases who have not been willing to stay in Battey and cases who present special problems in isolation.

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

QUIESCENT OR
ARRESTED

IMPROVED

UNIMPROVED

TOTAL

White Col. 1~Thi te Col. White Col. Fhite Col.

savannah

0

0

03

13

16

Columbus

10

31

31

72

Here again it is noted that patients being discharged
with positive sputum are greater in proportion than they are at Battey as would be expected. Most, if not all,of these
patients. left the local sanatorium against medical advice,
of course.

Page 32

Table showing length of stay in the hospital:

Savannah: All discharged less than 3 months.

Columbus: Under 3 mos. 4 - 13 mosc 14 - 22 mos.

9

12

4

More than 23 3

The length of stay in patients in these small hospitals does not compare favorably with Battey as would be expected. There is a considerable number who are admitted for a short term stay only and who are transferred to Battey. As an example, it was noted that all of the patients discharged from Savannah had been in residence for less than three months and of the group at Columbus twenty-one out of twenty-eight patients stayed in the hos?ital for less than a year.
These tables really are not subject to interpretation because they only cover the last half of the year and a more significant report will have to wait a full year's operation.

Annuo.l Report
The activities of the cancer control program vmrc similar in most respects to those carried on during the previous your. This vias also true of tho cooperation between this division and the Cancer Commission, Medical Associo.tion of Georgia and tho Georgia Division, American Cancer Society.
State-aid program The number of persons rocelVlng diagnostic o.nd treatment service
during tho year increased slightly in spite of efforts to roduco the case load. By tho end of tho your it 11ns apparent that tho metl1ods employed in tho past for screening applicants wert) inadequate and plans wore being made to employ a more offoctivo moans for determining eligibility.
Effective July 1, a change 1-ms mndo in tho r;,othod by uhich rates for hospito.l cure aro ostablishod. Prior to that time tho sumo per diem rnto wns paid to oc..c~1 of tho hospitals. Tho no1-T rnto for oach hospito.l is fixed nt 75 per cent of tho roimburso.blo cost. This chungo resulted in o. substnntbl incroo.so in tho per diem ro.to pnid to many of tho hospitnls c.nd, nlso, materially :i.ncronsod tho cost of tho program
during tho lust 6 months of tho yonr.
No novr clinicc wore .:;pprovod during tho ;:,cc,r but o. number of medical groupo expressed o.n intoroot in tho progrum. This wr.w pnrticulcrly truo of tho hospitnl stuffs in Albnny, Gainesville nnd Nnriotta.
Cancer Education Distribution of tho Cancer Bulletin to all physicians in tho stnto
was continued during tho your. Finnncio.l asoistnnco i.JUS also provided to pay tho expenses of phyrJicinns Hho participated ln a number of cancer seminars for general practitioners.
Assistance was given Dr. H. E. Nicburgs of tho Hodical College of Georgia in organizing a cervical smear survey of tho adult female population of Floyd County. Tho survey will be ropoo.tod after nn interval of about two yours vd.th a vioH to determining tho incidence of tho disonso nt various ago levels as well as provalenco rates. All of tho physicians in Floyd County o.re participating in tho survey.
Some financial assistance VJns provided for n semino.r on exfoliative cytology which Hac sponsorod by tho lfedical College of Georgia under tho direction of Dr. H. E. Nieburgs. Tuitions vlore paid for tumor clinic staff physicians vrho attended.
In cooperation with tho Hedicnl College of Georgia and tho Richmond County Chapter, ACS, a cc.:ncor seminar for nurses was hold on Murch 5-7 at tho University Hospital. Nurses in attendance included state and regional public hoalth nurses, representatives from tho schools of nursing, suporvi.sing nurses fron tho larger public health departments and roprosonto.tivos from corta.in private orgo.nizations.

Hiss Ko.tho.rino Akin joined tho staff on September l in tho co.po.city of co.ncor consultant. Sho ho.s spent much of her time in tho field working with rogiono.l o.nd loco.l nurses.
Tho problem of co.ncor of tho uterus wo.s discussed o.t o. number of rogiono.l nursos conforoncos.
Vo.rious cc.ncor films ,mro shown to both profcsd.ono.l o.nd lay groups.
Other o.ctivitics Fino.ncio.l o.ssistnnco for clorico.l sorvicos in tho clinics 1..ro.s
continued, tho sum of ~5.00 per co.so boing paid for clinical reports. Prior to July l, tho Cancer Control So:cvico po.id ~?3.00 of tho.t amount etnd tho Goorgin Division, ACS pnicl :~2.00. After July l tho Cnncor Control Service petid tho full amount.
Atto.chod nro to.blc:s \Jhich su.m:::::arizc tho activities etnd oxpondituros of tho stetto-o.id ~rogro.m. Tetblo I sho1.w tho expenditures by clinics etccording to tho typo of sorvlco rondorod and tG..blo II shows tho o.voro.go costs for mo.ligno.nt o.nd nonmaligno.nt cetsos. In to.blo III is shown et su:r.:llllD.ry of o.ctivitio s for tho year.

Hospital .Cost

Americus

7;96o~72

Athens

15,031.30

Augusta 51,456.76

Canton

3,439.67

Columbus 6,383.44

Craw. Long 6,875.96

Dalton

691.04

LaGrange 9,959.28

Macon

20,449.60

Rome

3,799.70

Savannah 11,699.03

Sheffield 21,100.82

Steiner

252.00

St. Joseph 9,052.26

Thomasville 27,261.88

Valdosta 2,335.00

Waycross 2,598.85

Vlinship 14,826.00 TOTALS $215,173.31

TABLE I

Expenditures According to Type of Service Rendered By Clinics 1951

Board Out- Chg. l Hasp.

Side HosJ2. Daz-Out-Patients Bio12sies

1,o~~~oo

69~26

720.~00

Diagnostic
X-Ra~s
1,321.,50

Radi~
749c,86

55.08

,552.00 582.00

306.75

1,131.00

542.12

1,908.00 5,021.50 1,678.51

19,06

204.00 257.00

151.50

397.50

312.00 745.00

474.79

300.00 613.00

189.00

150.00

100.00

69.00

202.50

36.00

68.46

452.00 561.00

584.70

2,097.60

131.60

1,388.00 2,407.00 3,902.89

7.00

400.00 251.00

269.25

531.50

432.85

1,308.00 1,55'7.00

982.20

205.00

191.21

1,016.00 2,194.00

579.75

4.00

40.00

357.42

588.00 905.00

158.03

20.04

476.00 1,086.00

378.53

41.45

308.00 280.00

140.63

25.18

300.00 253.00

462.12

~2.00
$5,606.05

---
$1,969.28

322.0-0

246.00

$l0,658.oo Cl8,389.oo $ll,2ll.Ol

X-Ra;z: Ther~ Others ~

3,920'145

100.00 15,845~79

3,582.52

20,109.65

5,578.46 1,780.00 69,096.35

1,371,75 4,332.69

20.00 5,462.98 12,645.42

849.13

8,827.09

1,473.00

20.00 2,705.54

3,500.75 321.46 15,483.65

3,738.92

85.82 34,201.43

1,088.96

5,815.91

6,892.15

5.00 23,457.73

2,313.66 212.50 27,812.94

6.50 798.88

302.50 250.00 12,109.59

5,166.50 155.54 34,544.49

1,762.51

4,867.59

1,924.15

5,563.30

- - 2,959.26

20.00 18,385.26

$51,260.24 $2 '970.32 $317,237.21

Clini~G
Americus Athens Augusta Canton Columbus Crawford Long Dalton LaGrange Hac on Rome Savanna.h Sheffield Steiner St. Joseph Thomasville Valdosta Waycross Winship
TOTALS

Nalignant No. Cases Amount

178 12,517.57

133 12,719.79

365 56,478.87

97 3,619.70

99 10,737.68 49 6,947.94

56 2,613.54

139 12,313.31

442 26,548.74

85 4,671.54

244 18,763.17

195 16,722.92

1

241.50

76 8,154.13

260 28,465.81

72 3,885.87

131 4,674.70
..112 16~0~7.6,2 2761 :;246,134.41

TABlE II

Summary of People on Hhom Bills Here Paid 1951

A-ve-ra-ge
Cost 70.32 95.64 154.74 37.32 108.46 141.79 46.67 88.58 60.07 54.96 76.90 85.76 241.50 107.29 109.48 53.97 35.68 115.22 $89.15

----- Non-Malignant
No. Cases Amount Average Cost

97

3,328.22 34.31

128

7,389.86 57.73

152

12,617.48 83.01

78

1,843.28 23.63

38

1,907.74 50.20

28

1,879.15 67.11

6

92.00 15.33

77

3,170.34 41.17

202

7,652.69 37.88

43

1,11.4.37 26.61

162

4,694. 56 28.93

118

11,090.02 93,98

1

61.00 61.00

62

3,955.46 63.80

72

6,078.68 84.43

44

981-.72 22.31

44

888.60 20.20

/tO

21 ,227!6,2 28!12

1392 $71,102.80 $51.08

Nali nant agd Non-Malignant

No. Cases A:mOUc'1t
--

Average C.Q.[L__ _

275

15,845.79 57.62

261

20,109.65 77.05

517

69,096.35 133.65

175

5,462.98 31.22

137

12,645.42 92.30

77

8,827.09 114.63

62

2,705.54 43.64

216

15,483.65 71.68

61.4

34,20..1.. .43 53.ll

128

5,815.91 45.44

/+06

23,457.73 57.78

313

27,812.94 88.86

~

302.50 151.25

lt8

12,109.59 87.75

332

34,544.49 104.05

116

4,867.59 41.96

175

5,563.30 31.79

179 4153

181385.26 102.71
~317,237.21 ~~76.39

TABlE III
Sumrnary of Activities 1950-1951

1950 APPLICATIONS

Tot:1l reco:i.vod

3561

Number approved

3535

Number disapproved

26

Countios roprosonted

157

CASES GIVEN FINANCIAL AID

Total number

4043

:tv'JD.lignant

2719

Non-malignant

1324

ANOUNI' OF FINANCIAL AID

Total amount given

$243,511.07

Avoro.go amount per mo.~ignant case

70.35

Avorago amount per non-mo.ligno.nt case 39.45

OTHER AGTIVTIIES

Addresses made Other meetings attended Clinic visits o.nd consultations Articles \.J'rittJn
Literature distributed

23 6
59 6
6119

1951
3545 3527
18 158
4153 2761 1392
$317,237.2lit 89.15 51.08
13 10 33 10 5299

~~his figure docs not include ~346.50 refunded by insurance benefits.

ANNUAL REPORT c;.RDIAC CON'rROL PROGRAM
1951

Services Rendered

Richmond County

1. Cases admitted

220

2. Visits b,y patients

1,744

3. Field visits to patients

1,288

4. Instructions in nutrition

1,380

5. Cases hospitalized

22

6. Transferrals or dismissals

136

7. Dismissed from Social Service

0

8, Not-horne visits

75

9. Visits in behalf of cardiac patients 56

10. Other services

993

11. Letters and telephone calls

226

Fulton & Total

DeKalb Counties

*

1,097

1,317

9,524 11,268

6,020

7 ,.308

164

1,544

47

69

291

427

749

749

626

701

.309

.365

.3,129

4,122

1,544

1,770

With certain vital equipment furnished by the Georgia Department of Public Health, cardiac clinics have been established in Savannah, Brunswick, Columbus, Macon, and LaGrange. Without equipment furnished by the State, cardiac clinics have also been established in Athens and Albany. Plans for the operation of clinics in Gainesville, Griffin, and Thomasville have also been discussed.
A chronic disease consultant nurse has been added to the Georgia Department of Public H?.alth staff, who is giving part-time service to the various cardiac clinics.

~~Graey Hospital Cardiac Clinic

CRIPPLED CHILDREN'S DIVISION
The calendar year of 1951 brought a great change to the Crippled Children's Division. In that year Legislation was passed by the General Assem~y transferring the functions of this Division from the State Department of Public Welfare to the State Department of Public Health. This took place on July 1, 1951. Needless to state the entire staff is happy to be in the Health Department. As our aim is to bring better health to the children of Georgia we feel that we are in the most appropriate spot to accomplish our purpose. At the same time it gives us a much closer tie-up with the local public health units which are so very vital to the functioning of our program.
Regular clinics have been held at Albany, Atlanta, Augusta, Columbus and Savannah. During the year an itinerant clinic was planned for Cordele and has been held there on a monthly basis for several months. A weekly cast clinic where infants with clubfeet and children who have had surgery and need change or removal of cast was established in Thomasville.
An interesting development has come through a cooperative relationship vdth the State Department of Education. We have been asked to supervise the therapy aspects of the several schools for handicapped children which have developed within local public school systems. This is a new venture for us and we are moving into it slowly and thoughtfully so that we may offer as much consultation as we can from the State level and yet not L~tcrfere vnth the administration and responsibilities of local officials. One of our staff doctors, a doctor of physical medicine, has been appointed to make regular visits to these schools. Our orthopedic nursing consultant and medical social consultant vnll also visit at intervals to discuss any problems that may arise wherein they may be of some help.
As has been true for the past several years there has been tremendous pressure to increase our service to the cerebral palsy group. A plan to accomplish this was made and has been started with the calendar year of 1952. Heretofore we have had weekly cerebral palsy clinics in Atlanta where children from all of the State were

called in for examination and advice as to treatment. The plan now is to hold quarterly clinics in each of our nine districts. In attond~ce will be an orthopedist, a pediatrician, a doctor of physical medicine and such therapists as this staff of doctors feels is necessary. Local Public Health Commissioners and nurses are always invited and urged to attend. We feel that this plan will not only Inc.'l.ke it possible to serve a larger group but by calling in doctors from various fields and urging the attendance of local public health personnel we believe that an educational program can be dono that v..-ill o.cquaint a larger group of doctors with the present methods used in treating cerebral palsied children.
A study of our statistics shows that tho saturation point has almost been reached with our present staff and methods of handling our case load. An un-
duplicated account of patients treated shows that we had 3,642 under care in 1950 and 3,706 in 1951. This is a gain of only 64 cas0s. The unduplicatcd count of patients attending clinic rose from 3,444 to 3,573 an increase of 129 patients. Our clinic visits rose from 81 230 to 9,165 an increase of 935 visits. The greatest increase was shown in tho number of patients hospitalized. In 1950 we hospitalized 739 individual patients and in 1951, 913 which is a go.in of 174 patients. 27,165 hospital days wore utilized in 1950 with 31,276 having boon used in 1951. We be-
lieve that increase in the number of patients hospitalized was due to tho fact that
our appropriations for the fiscal year 1952 was increased. We expect to soc an
even greater increase during the present calendar year dth the increased funds our doctors are trying desperately to catch up before July 1 on our back log of patients awaiting hospitalization.
We have had certain difficulties kno~n to all agencies in filling our staff. We have only one medical social consultant and no medical social workers. We have no physical therapists. Such personnel is badly needed but we cannot compete with the Veteran's Administration and Axmy as to salary at the prosont time. Y!e are also in need of public health nurses withEPecial training in tho area of Crippled Children.

DIVISION OF DENTAL HZi~LTH J. G. ':'Jillic-ans, D.D.S., Director Annie T~ylor, Educatio~l Director
The following m.rrative e:.nd stcc.tistical reports summe:.rize the activities of the Division of Dental He:1lth for the year 1951.
This division he:.s worked for the prevention rmd control of dentc.l diseases emphasizing three genere:.l objectives: Prevention, Educe:.tion and Tre!ltment.
There he:.ve been no che:.nges or additions in personnel. The only change in operating policy has been the addition of dente:.l hygienists in the Pl...-.n for FinanciC:.l Assistnnce to Loc.:-~1 Health Depo.rtments, as follows:
Dento.l Hygienists: One position for each 50,000 population served provided the loc::.l hee:.lth depo.rtment is adequately sto.ffed with public hec>.lth nurses, public hec.lth engineers or public health se:.nitarians, o.nd clericcl >vorkers nnd under the supervision D.nd directien of a full-time local conunissioner of heGlth. Provisions must ho.ve been mo.de for adequo.te dentccl supervision either by employment of o. full-time dentist or by so.tisf.o.ctory nrr::;.ngements m..cde vr.ith a p.:1rt-time dento.l clinician employed by the local health depo.rtment.
PREVE!'JTI OIJ 1. Fluorido.tion of -;:ater Supplies
Tre Georgia De p::.rtrrent of Public Ho::'..lth hns supported the principle of fluoridL'.tion o.s o. me:c.ns of reducing dental c.:-.ries and hc.s recommended th::-t communities which have wder supplies free from or low in fluorides consider the feo.sibility of adjusting the fluoride concentro.tion to the optimum level not to exceed one p::rt per million. This policy was adopted on the

- 2basis of adequde proof thc.'.t (1) the tooth decay experience is significantly lower in fluoride are:1.s than in non-fluoride l:'.reas, .:md (2) controlled fluoridc..tion hC:.s been in opere:.tion long enough to prove its simplicity in operction c.nd to show the benefits that cnn be obt:J.ined, nnd (3) no objection to fluoridntion ho.s proved to be valid.
A mnjor portion of the time l:'.nd :J.ctivities of this division h2.s been spent in clarifying ~:nd giving informn.tion on <.:11 o.spects of fluoridc.ction to dentists, physicians, public henlth workers .:end interested citizens. This has been done through conferences, letters, publicc~tions, rc:.dio talks, nev;s relec:.ses, talks c.t State and District Dento.l Societies ;:.nd Civic Clubs.
DeKnlb County begnn fluorid-<:tion of its wder supply on April 26 nnd the cit~r of Athens n few weeks l::tter. By the end of the year, "..bout ten cities ;:.nd tovms in the Stde indic.::.ted their intentions to fluoridc-cte water supplies as necess.":.ry o..rr:::cngements l:'.nd adjustments could be m:tde 2. IP.ical Application of Sodium Fluoride
Dougherty ;:cnd ; '~e County Henlth De_p<"lrtments C".dded full-time dental hygienists to their staffs to give sodium fluoride treatments to ::tll children in the second, fifth and eighth grades in the public schools.
Topic~l fluoride treatments have been continued in j\iuscogee County l:'.nd in the Hoke Smith Community Council Schools in Atlanta. This division :::.ssisted Rockdale Cow1ty to obt:1.in the loan of equipment from the U. S. Public Health Service to be used by a volunteer dentCtl hygienist in Conyers o.nd Rockdale County Schools.

- 3-
Several otrer health departments provided budgets to include sodium fluoride treatr.1ents but no qualified dente1l hygienists could be employed.
DENTAL H ALTH RD:JCATION -----~-Dental health education has been cnrried on in cooperation with Stc:.te c-.nd locn:L official and voluntary agencies G:LS Georgia Dental Association, .Stnte Department of i~ducation, Ae.;riculturnl Extension Service, U~nversit,y System, Parent Tee.cher Association, Civic Clubs. All available ;;,edia have been utilized. Public:ttions a..YJ.d films have been provided upon request. The educational aids furnished free by this division to loce. l he2lth departments, schools and general public have been widely used and from OlJI' observation to a good advantage. The excellent r1or:cing relationship between the division of Dental Health and such professional groups as Georgia Educ<ltion Association, Instructional Supervisors, Visiting Te~;.chers, 0t 2te De~)artment of Education Staff, makes all phases of the dental health education progrlm more effective. The following indicate some of the vvays in which the Dental Division staff members h.?.ve promoted dental he<:~lth educntion: Participation in State and District Dental Societies; Te~~ccher education through workshops, college classes, Stette and District Georgia Educe1tion Association meetings, County Teachers 1 meetings' and local school f:::cult~r conferences; State, District and Lo c2.l Parent-Teacher meetings; Talks at Civic Clubs and 1 omen 1s Clubs; Consult.s.tion with Com.mmity, He::clth and Dental Councils; A sixteen-weeks lecture course in Public Health Dentistry for ~1nory University s,::mior dental students.

- 4-

DZNTAI CI I:ITC .SEEVIC ,_;:s

In accordance vlith "Orgnnization and Operation of Dental Clinics

in Local Health Departhlents", thirty-six coW1ties have operated

forty-eight dent2l clinics, JanuarJr througtl December, 1951. A total of

110 white dentists and 8 Negro dentists h:::..ve worked 9,1,00~ hours with 10,448 children c::dmitted; 20,163 visits recorded; o.nd 5,526 children

completed; requiring a total of 41,050 operations.

The following: comparison with 1950 shows ~Jractically the same dental

treat:nent services rendered for both years:

Ye2r Ho. ClinJ~~ No. Dentists Adrnissions Visits Total Operu.tions

\\lhite

1951

40

110

1950

39

112

7,638 15,354 7' 736 14,843

33,241 26,847

1951

8

9

1950

8

7

2,810 4,809 3,311 4,552

7,809 8,293

New clinics operdcd in Polk, :.,:itchell, Appling, Tift Counties and

/'Jest End Community Cou11cil Schools, Atlanta. Counties which operated

during 1950 but which were inactive during 1951 ~are Cravvford, Coffee

and Jones.

The building of new her,lth centers vvi th well-equipped dental

clinics v1ill W1doubtedly increase dental clinic services in the State,

SPECIAL PROJ ~CTS Dentell Se1:lin2,r
A total of 172 dentists from all over the State attended the Fifth Annual iJental Seminar, June 17-22, sponsored jointly by the
Georgia Dental ;~.ssociation and the Georgia Depnrtment of Public Her..lth. T1e topics of discussion '!'I ere: "Protecting the Dentist 1 s Health11 ;"Fluoridation of Public "'ater 2upplies 11 ; and "Problems of

- 5-
Dentistry for Children''. The Directors of ~!ater Pollution Control and Public ~ielc:.tions cooperated vJith the Dental Division to make the conferences :J.t Savc:.nnah, "'.aeon c::.nd icome successful.

Dc.F .Studv of De:'>alb Countv School Children Delblb County school children were exarnined on November 8 and 9 to
obt2i:1 bc:~seline d.::tta for evc.luation purposes prior to fluoride.tion of DeKalb C01mty .Jat.;;r Supply. This exar,tindion was a cooperative project of the DeKalb County He:J.lth Lle_:-:o.rtment; Dental Division of St&te He~~lth
Departrrent; Dentd ConsulL.nt, U.S. l)ublic He<'-lth Service; 77 Zmory
Universit,;' clent::cl se:1iort1; Del(alb County dentists and Pc.rent Ter1cher

Associc:tion. A detailed report is being t:~bul:J.tecl. The following sununa:r;r is

of interest:
r.Iwnber of Children ;:v,:n__r;:ined, 6-17 Ye2.rs of ;~ge Percent 6-17 Yrs. with Caries free Permanent Teeth
Percent 5-ll Yrs. with Co.rie s Free Deciduous Teeth
Caries Attc:,ck H;..:.te ( 6-17 Years)
DLF lcate Per Child

12,668 11.3% 14.7% 1.03/b
5.35

~.oultrie-'.Ta,rcross-:::rurlswick Study The Division of .Jentc:l Hecclth cooperated v:ith Jr. F. A. Arnold,
AssociG.te Director, National Institute of Dental Hesearch, to obtain inforiTIDtion on c:.ries 2nd tooth mortality rates in three tovms known to hc:we some fluorides in the drinl-::ing 1NC:cter. The study contributes to d2.tc. being collected in an effort to determine the amount of fluorides that should be added in hot clim&tes. Dr. Arnold submitted the follo':ing findings:

Parts Per lJri.llion Fluoride
-"h:..ycro s s 0.35
Brunswick 0.5
:Moultrie 0.7

- 6-
Percent CclriesFree
14.6 26.7 14.6

Dl.:F Ro.te Lt-.25
2.66 2.70

Mortality Rnte
0.36 0.24 0.12

To meet the dem::..nds for m.:..inte'.ining the present dentnl health progrwm nnd to provide for desire'.ble expansion, the Division of Derrtnl Hec~lth needs the following personnel:
Two full-time public he~lth dentists; Two dentc.l he:::.lth educ<:.tors; One stenographer.
The Division of Dent~l He~lth recommends thnt fluorid~tion of public wc.ter supplies be encouraged o.nd th,::.t necesso.ry nssistzmce nnd guidc.nce be given by public heJ.lth personnel to loco.l con:J.:nunitie s to understcmd ond effectuate fluoridation whenever the procedure is indicated nnd desirable standards can be rnnint~ined,

- 7-
D!~TTAL CUNIC STATISTICS

,_Tanuc:.ry through December, 1951

I\j1E1r:R COUNTL::~ OP&;:NrHJG CIVTICS l\;D1.=B~ c.-. I~JICS

1-Jhi-t e
35 40

FUl s:H:H CliniC lK:1RS (TOTAl)

2,584 1/6 7,752 1/2
11:

8 8
549 1/3 1_,648
9

;-:oro~1.aiA LUD DEIITISTS

~.-38, 762.50

$8,240.00

TOTAL im.lEi.S IOIJS
Total ;.c:l.mission~py__Age~:
6-8 Yrs.
9-11 Yrs. 12-14 Yrs.
>~ 6-8 Yrs.
~6 9-11 Yrs. ~~ 12-14 Yrs.
TOTAL VISITS

3, 849 2,295 1,494
50% 30% 20%
15,354

2,810
1,058
955
797
38%
34%
28%
4,809

TOT/,1 PATIEETS DIS?.::ISS'~D
Completed
Others
%Com:Jlet ed

2..t_234 4,921
313 65%

PRO ~)nilA~<IS
% of Admissions

800 29%

HUI'Cf:. c:;;R TE}:;TB -:::; :TJUl,. CT c;D Decid. lst I'erm. Lolars Other Perm. Teeth

6,632 4,891 1,183
558

4,07~
2,787 1,099
186

Decid. lst Perm. l:oln.rs Other Perm. Teeth

18,241
5,605
8,707 3,929

2,646 1,125 1,121
400

i~U::B B FIJ.LIIJGS Cement hlloy Silicate

24,193
3,385
19,607
1,201

2,937
523 2,363
51

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

4NW4L REPORT DIVISIO~ OF PUBLIC HEALTH !U~GINEERING GEORGIA DEPARTY~~T OF Pu~LIC ~~LTH
1951

PUBLIC HEALTH ENGINEERING

~his Division of the Department has the responsibility of adminis,tering the program of public health engineering including the asslg~ent of duties, supervising and. reviewing all a.ctivi ties of the engineering and sanitation personnel and coordinating the program with other Divisions of the Department: maintaining cooperative relations with other agencies, state and federal in all relations of engineering and sanitation in the field of public health.

The services rendered are quite variable because of the many factors involved in environmental sanitation, both in rural and urban populations. The operation of the Division is a normal function of federal, state, district, county and municipality in efforts to irrprove the community and maintain high standards of health. The service is available to the public through the fol101,1Ting organizationsa (a) central administration of the State Health Department, (b) regional engineers and sanitarians in the six regional offices, (c) municipal sanitary engineers, sanitarians and inspectors in counties, to\otns and cities.

It is the purpose of this report to outline the various activities and to record. accomplishments in the various fields affecting both urban and rural populations. These general headings are as follm.rs:

1. Malaria Prevention and Insect
I Control
2. Housing Sanitation
3 School Sanitation 4. Camp Sanitation 5. Tourist Courts 6. Hospital Sanitation
7, Surveying and Mappin.!;

So Plans, Charts, and Photography
9 Food Sanitation
10. Milk Sanitation 11. Shellfish Sanitation 12. Recruiti~ and Training
13. Home Sanitation for Welfare
Placements
14. Nuisance Abatement

#

1. MdLARI~ PREV~~TION AND INSECT CONTROL

One primary indigenous case of malaria occurred in Geor~a during 1951.
A limited number of blood smears "'ere found positive by the State Laboratory from service men returned from countries 1r1here malaria is still a major public health problem.

Impounded Waters

Control of Anopheles quadrimaculatus breeding on hydro-electric developments throughout the State continues as a responsibility of the operating agency under surveillance and direction of this Di~rision. Reference is made to the follo~"ing reservoirs so classified:

Georgia Power Company

Flint liver, Albany

Lloyd Shoals, Jackson

Bartlett's Ferry, Columbus

Furman Shoals, Milledgeville

High Falls, Forsyth County

Georgia Po,.rer & Light Co.

5pring Creek, Bainbridge

Tennessee Valley AUthority Blue Ridge, Blue Ridge

Ohatuge, Hiawassee

Nottely, Blairsville

Crisp County Power Commission Blackshear, Cordele

u. s. 4rmy Engineers

4llatoona, Cartersville

Clark Hill, augusta

Jim Woodruff, Chattahoochee

Buford, :Buford

Hartwell, Hartwell

The accomplishments of the various agencies in mosquito control have been good, The Flint River, Lloyd Shoals and High Falls reservoirs of the Georgia Power Compa~v are larvicided with DDT from an airplane. On the Bartlett's Ferry reservoir an oil-water mixture is sprayed from a boat. This reservoir is under the joint surveillance of this division and the ~labama Health Department. The operations on the Flint River are observed jointly by this division and the Dougherty County Health Department.

Larviciding on the Spring Creek Impoundment is primarily a malaria control precaution using paris green for the control of Anopheles guadrimaculatus only.

On County-owned. Lake Blackshear some clearing operations have been continued. Larviciding and adul ticiding '"i th DDT has been continued using an .Aero-mist sprayer from land and water. The residual spraying of mosquito resting places within one and one-fourth miles of the reservoir perimeter
has been continued.

Control of mosquito breeding on the Allatoona and Clark Hill Reservoirs
now impounded are a responsibility of the U. s. Army Engineers, who are
cooperating closely with the division in this work, Clearing of the Clark Hill project is not quite completed but should be accomplished soon.
. The Jim ~'loodruff Dam is progressing and negotiations are under way to arrange for satisfactory clearing of the area to be impounded which lies in the States of 4labama, Georgia, and Florida,
The Buford and Hartwell dams on the upper Chattahoochee and Savannah Rivers respectively are authorized but still in plannin~ stages. These should not present problems of mosquito control as extensive as those mentioned above,
Four hundred fifty-four impounded water permits "'ere granted in 1951 to
persons who had complied "'1 th the rules and regulations of the State Board
of Health concerning impounded waters. .n. majori t~r of these were farm ponds for stoCk watering, constructed under a farm practice of the Production and
Marketing Administration of the U, s. Department of .n.griculture '"hich requires
that the client must possess a permit from the State Department of Public Health.
Residual Spra~r Program
Since the spring of 1945 the division has directed a cooperative program financed jointly by the federal, state, and local governments, most recently called the Georgia Malaria Program, directed against the insect vectors of malaria. Two seasonal sprayings of "ralls and ceilin,!SS of homes and privies with DDT emulsions at a concentration sufficient to provide a residual of 100 milligrams of DDT per square foot of sprayed surface has proven sufficient to remain toxic to mosquitoes alighting thereon for a period of ten to fourteen weeks.
Operations '\'rere conducted on a county-\ride basis in 19 counties, and
special fly-control projects were conducted in two cities. More than 6o.ooo
individual premises sprayings were done.
The residual benefits of DDT spraying of homes in eliminating other household insects than malaria carrying mosquitoes have maintained support and demand for the program, particularly for fly control. ~on-residential promise spraying '\'ras performed in many areas to eupplcmont tho house spraying the individual concerned paying tho entire cost.
Much continued interest is being demonstrated in general insect control ,.rork embracing not only disease carrying mosquitoes. but pest mosquitoes, flies, roaches, ants, bedbugs, etc., tho presence of any or all of ,_,,hich have come to be a measure of the degree of sanitation existing in the lives of all .. Insect control operations must of necessity include systematic garbage collection. storage 'Uld disposal. Careless disposal of many industrial wastes contribute cnorously to the fly problem, and no progrD.lll of control can succeed ,1ri thout fundamental genor<:tl sanitation as a pri1ncar~r requisite for its opcr'J.tion.
The contribution of federal funds has been lessened to such a degree that local communities and individu'J.ls have financed the bulk of the program except
for general supervision fUrnished through the u. 8. Public H2alth Service
-3-

The continuing trend of develOpment of housing in the "fringe" area around all maJor cities has presented a serious problem of satisfactory sewage disposal. Entire subdivisions ranging from a half dozen to hundreds of lots are proposed for development with individual sewage disposal systems in entirely unsuitable areas. Mueh time has been spent in developing sewerage programs to cope with this and other problems.
For many years the division has cooperated with the Federal Housing Administration in approving individual sewage disposal systems at homes built under FHn. insured loans where such arc warranted. Improvements in sewer extensions are obtained in r.1any areas proposed for individual systems duo to the FHA requirement that approval of the health department must be obtained before development of new subdivisions.
The same review of individual sewage disposal systems by local health department personnel has been arrange for with the Veteran's Administration so that sewerage for the major portion of all new homes construction is now receiving competent revie\r by local and state health departments.,
i. total of 7635 septic tanks have been built under health department supervision. At homes, 7288, at schools, 74; and at other public places, 273;
Septic tanks with complementary tile disposal fields have been built.
In the same period 1024 privies were built, at homes, 914; schools, 33; and other public places, 77; while more than 1411 privies were repaired and
made sanitary.
The program of water and sewage disposal installations conducted by the Veterans-on-the-farm Training Program of the State Department of Education, in cooperation with the health department and the Portland Cement .~ssociation,
has so far resulted in the construction of 2651 septic tanks, 2093 bathrooms, and the installation of 4653 purnps.
new progran of rural non....farm housing devel opmen'b under the Public Housing ..~dministration of the Housing and Home Finance --~gency requires approval of plans and specifications for water supply and sewage disposal by tho divtsion. This development is carried on through local housing authority in or in the vicinity of smaller com~itios throughout the State. Being low-rent projects they present many problems often difficult to work out because of unsuitable topography, soil and space requirements.
-4-

3. SCHOOL SANIT.AT!ON
Since the adoption of tho minimum foundation program for tho State Department of Education there has boon an ever increasing call on tho division for review and approval of plans and specifications for major sanitary facilities at schools. a working relationship "dth private architects has been established which ,,111 help considera'bl~r in having plans presented in suitable form and detail. This reauires consultation 1.orith architects and school officials as "'ell as close -liaison "rith health departnent sanitation personnel.
County maps have boon furnished to tho school superintendents of most
of the 159 counties for use of tho oonmittoes in revie'" of school facilities
and their recoooendations for consolidations, additions, deletions, etc., of present facilities.
The numbers of septic tanks and privies constructed at schools has been nontioned in a preceding paragraph.
Assistance is rendered to recreational and public works or labor camps on all phases of oonitation, including "'atcr supply, se,.,a~e disposal, screening, garbage disposal, milk and food sanitation, insect control and sanitation of swimming areas.
5. TotJRIST COURTS .~D TR&l.ILER PARKS
On May 24, 1951 the State Eoard of Health revised tho rules and regulations
fnr the sanitary control of tourist courts and trailer parks. Tho principal changes were tho requirements for satisfactory heating appli!lllcos as protection against accidental carbon monoxide poisoning, and fire extinguishers for protection of life and property.
Permits were issued to 577 tourist courts and trailer parks during 1951.
This included many ,rhich were issued permits before the ch:1nge in regulations. but more than 150 were operatints ,_,n thout porl'!lits, not having met other mininmm requirements of the State Board of Health.
The change re~arding heating necessit~ted major overhauling of heating practices and ,,,i:.l :relf..tire sone tine to be fully effectuatedo .1. research project "'as se ~ up tv sii:viy the effect of certain henting applhnces to govern the interpretation of the re~lations. This was done in the Industrial Hygiene Division. The final interpretations of the a~y phases of heating has required many conferences and directives due to their conplexity.
- 5-

6. HOSPITAL &l~ITATION
~t the request of the Hospital Services Division, this division has been requested to report on sanitary aspects of water supply, sewa~e dispos~l, food h.1.ndling and milk supply nt all hospi tala in the Stn.te. About 300 hospitals and clinics are involved in this program "rhich is a continuing process, particularly in the food handlin~ and milk supply ph..'l.ses.
Continuin~ conferences are necessary to uaintain uniform accurate interpreto.tions of the regul'l.tions and conformunce by the hospitals. Inspections are made by county :md re~ional sanitation personnel, the reports are received and coordinated in the division office and rcwlts reported to the Hospital Services Divis ion.
The improvement in hospit~l sanit~tion has been extraordinary. There is some ln~ in approval of milk supplies due to the tremendous follow-Up required on dairies and distributors. It is not uncommon for approval of the milk supply to a sin~le hospital to require inspection and improvement in as rna~ as 20 to 30 dairies and a distribution (pasteurization) plant.
7. SURVEYilifG AND MAPPING
The Division is prepared to render almost any mapping or photographic service to local health departments and other divisions of the State Department of Public Health.
Basic and sanitary survey maps are prepared from basic data obbined in the field or from aerial photographs The latter are usually obtained through the Production and Marketing 4d.r.linistration, USD.n., but sooe have been obtained
from the U. s. ~ir Corps. some from the State Highway Department, and some have
been photographed directly by Division personnel.
Basic maps show roads, streets, residences, public building~. business houses, railroads, principal drainage channels, schools or other identifying characteristics ,.,hich would make the maps more useful for public health operations.
Snnitar~r survey maps include all basic datn mentioned above together with water mains, valves, fire hydr<:tnts, stor::>.ge tanks, se,,rer lines, manholes, sewage treatment "'orks, and symbols sho,rin~ t~'Pe and conditions of water and se,o.rage di~osal facilities at each inhabited place.
Special maps are prepared for specialized operations of the health department such as malaria survey maps, typhus control maps, DDT residual spray program maps, etco From time to time revisions nre made of existing maps to reflect changed conditions r.nd needs. Eighteen county and 103 town mps ,.,ere revised for residual spray operations.
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:Basic map of the City of Washin~ton ~Tas made and a ne,., map of Dougherty County was prepared. 4 similar map of Coweta County is in preparation.
Eleven thousand five hundred fifteen ozalid reproductions \orere turned out.
8. PI..tt.l~s, CR..RTS .n.l~D PHGTOG:Rn.PHY
Orie;inal plnns are drawn and reproduced for all ty_pes of health department activities. Graphs, charts, lantern slides and posters are prepared. Exhibit r.t"'.terials are desie;ned, gathered or produced for display at public health school and civic meetings. Illustrations are prepared for public health publications. Public health activities throughout the State are photographed for distribution to schools and civic groups.
Ne"' plans for septic tanks were propnred and 900 tracings ,,.,ere printed. Y~terials for Spnldi~ County Annual Report were prepared and 500 copies \Tere printed.
Cilc1.rts, schedules, and laboratory report ferns ,,,ere drafted and printed for the Laboratory Division.
Artwork for Geore;ia' s Health, booklets, posters and exhibits ,.,ere prepared.
Re.gula.r and jumbo photoe;ra.phs were ma.de for mppin'2,', public1. tion and exhibit purposes.
Food sanitation comprises n~inly of promotion of adoption of local ordinances under organized local health services, including advisoJ7 service from the central office training and assistance to no''' local personnel in public eatine; and drinki~ establishnonts nnd school lunchrooms inspections. The chief objective is to bring nll eatino; and drinkin~ establishments as well as nll school lunchrooms to Grade A compliance.
There are over 1600 school lunchroons in the State providin~ d.ail~r lunches to thousands of students and teachers. Considerin~ the lnre;e number of persons served daily lunches it is one of the ~ost important functions of this division. Under the ~ini~um foundation progr~~ which is providin~ new buildings and equipnent for schools, this division serves in an advisory mn.nner to architects in plnnnine; for lunchroo~ desi~n and equipnento The total number of all inspections for the year was 1,869c
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10. MILK SAh IT.n.TIOl-J
The milk sanitation pro~ram as conducted from the Central office level continues to be a pro~ram of encouragin~ and assistin~ local henlth departments to conduct their milk sanitation pro~rams on a very hi~h level. This service is tendered by direct contacts ,.rith both local and regional health dep'lrtnen t personnel. :Basicnlly there are t~To phases of this program, namely: (1) advisory service and (2) material assistence.
Included in the advisory ph'1ses of the pro~~an are the follcwing services:
1. Trl'l.ining of personnel ..
2. Promoting the adoption of a uniforn and nationally recognized milk ordinance.
3 Providin~ uniforn interpretations of local t:1ilk ordinances.
4. Encouragin~ frequent submission of nilk sanples to Georgia Department
of Public Health Laboratories for laboratory analyses.
5 Interpretation of laboratory results.
6. Providin~ adequate record koepin::; forms.
7 Providing of modern and pr~ctical dairy barn and milk house plans.
This is acconplished through close cooperation with the Agriculture Extension Service of the University of Geor~ia.
8. Reviewin~ ne"' construction nnd renodeling plans for pasteurization plants.
9. Testing efficiency of pasteurization equipnont.
10. Makin~ of milk sanitation surveys to deternine efficiency of local milk sanitation program.
11. .--\.dvice and encouragenent rel1.tive to good enforcement of local milk ordinance.
12. Provision of loc'l.l departnents ,!Ti th all survey r'ltin~s in order to promote the movement of good milk fron one comounity to another.
V~terial assistnnce to local he~lth dep~rtments is mainly rendered through the use of t'~>ro mobile nilk lfl.boratories. The interior of t1110 modern house trailers have been remodeled to ncconnodate only labor~tory equipment. Each unit is staffed with one ,.,ell qualified milk sanitarian who devotes full time "rith pasteurization plant and d1.iry farn inspections. .~lso a well qualified laboratory technician devotes full tine to the collection and analyses of milk sanples. These mobile units 'J..nd the operating personnel are st~tioned fl.t, 'J..nd lo~ned to, 1oc1.l he1.lth dep~rtnent s for 1. period of t,.,o to four months. Durin~
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this time a very intensive milk snnit'1tion progr"tm is conducted in cooperation "~>lith the local health dep~trtmen t. This h"l.s been one of the most popul~r and gratifyin~ services of the milk snnitation pro~ram. This is evidenced by the
fact that both the milk industry :tnd local departments have continu'llly mD.de requests for this service thn t we ho.ve been unr1.ble to f'alfil1. The Goortda Depn.rtmen t of Public Health is n n1. tionnl leader in this phase of milk sr1.ni tation. Inquiries from other states indicate th1.t other milk control a~encies h.".ve reco~nized the fe1.sibili ty of this nnnner of appro11ch to milk sani tntion,
and will adopt a sinilar plan.

In cooperation with the director of lr1.bor ... tories nnd local he'll th depart-
ments, the milk sanitation personnel of this division has continued to approach the matter of excess wnter in milk in a very positive n~ner. Duri~ 1951 nine thousand !1-nd sevent~r-four sn~les were examined for excess water. Three thousand ei~ht hundred and t,~,enty-throe, or forty-two per cent, contained
excess water as compared with thirty per cent in 1950. It Nould "l.ppoar that no proP.:ress reP.:'l.rdi~ the m"ltter of excess \oTnter w1s "l.CComplished in 1951. This is not the case because in 1951 the number of samples examined was approxinately four times ~renter th':l.n in 1950. In other words, n~y sanplcs "'ere received from areas which had not prcviously been provided such service. Also in 1950 there ,.,as much evidence of .c;ross adulteration. This h:ts not been the
cnse in 1951. The fact is that ,,,,hilo nnny samples contain some excess "'ator, in many instances the amount was so sa1.ll that ~eneral C"l.relessness rather th'tn adulteration was indic'lted. Ho,/Tever, therc renains a problen ro~llrding this matter and local health departments are bei~ ur~ed to approach this matter in a positive mtl.nner.

The first appro~ch to any sound milk snnit~tion pro~ram must be that so
~o.rdin.e; the milk so as to prevent its contamination ''ri th dise1.se producin~ orgnnisms. This c1n only be accor~plishod by routine dairy inspections and requ1ri~ the producers and distributors of milk to provide such protective facilities as sanitary utensils, protected water supplies, safe se,.rerrv;o disposal, sufficient refri~eration, adequate handwashin.e; f~cilities, hot water, screened milk houses, cle~ barns ~d ~ilk houses, etc.

The fi~res listed bolo"' seen to offer ample evidence th"l.t tho nilk sanitation personnel from the En.e:ineerin?, Division in cooperation "rith ReP,ional and local personnel is vigorously pushiru; this phase of the proe;r'J.m and that tho accomplishments are noteworthy.

Inspections accomplished by Central Office Personnel Barns and milk houses painted Nilk houses screened or screens r~aired Wntor heaters provided Toilets constructed or repaired Water supplies protected Handwa.shing f'lcili ties provided

1421 172 172
12 86 148 54

The provision of protective facilities at dairies is of no public health si~ific~ce, unless efficient use is oado of them$ Frequent l'lboratory an".lyses of milk samples is necess:1ry in order to ooasure the efficiency "'i th ,,,hich protective facilities are used. Th1.t this protion of the Bilk sanitation received much enphasis is evidenced by the follo"ri~ fi~res:

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Milk saoples exanined for total bacteria Pasteurized nilk sar:~les exaoined for colifora or~anisms Phosphatase (efficiency of pasteuriz~tion)
}IIUk sai!lples examined for excessive sediment Temperature determinations

4585
1161
854 2492 2453

Only within the last few ~'ears has there be on avail!'.ble a sir:tplc and rapid test for coliform organ:sms in pnstourized mllkQ how that this test is available, .it can readily "ue deterninod if and 1;<rhcn pasteurized nilk is unduly exposed to contaminationo Routine tostin~ of al1 pasteurized nilk samples for coliform organisns "'as incorporated in the milk sanitation program in 1950o During 1951 much time was devoted to the operators of pasteurization plants in order to assist then to elimin:tte these organisms fron pasteurized I!lllk. This has done f.lUCh to ind'lCe Le1jter cleaning practices and to promote r.10re C'1.reful mndling of nilk :'l.fter pasteurization. Coliforn standards are ne,,,, and pastrurizntion pl1.nt G;Jerators are having to sone,rh.~t revolutionize their nethods of clenninp equipment and milk
handlin~ practices in order to meet said requirenents.

Tho Georgia tepartmcnt of Public Health is a national le9.der in incorporatin.go coliform st'Uldards in the 1:1ilk ordinance which it rocor.u:Jends for adoption by local boards of hcaltho Even thou~h at this date only a fo'" cities in tho Ilc'ltion have adoptod coliforn requirements, the lar~e mo.j ority of local boards of health in Goor~ia h'l.vo so done.
It seems that the one ~reatest criticism of all health dep~rtnents by the milk industry is the failure to adopt a standard nilk ordinance. Such criticisn of locql bo~rds of health in Gcor~ia is not justified. Our nilk ordinances are uniform and almost entirely free of trade barriers. '~en local personnel is inefficiently trained, inspections and interpretations are nado which are not uniform. This Dakes it appear that milk ordinances are not uniform. This at tines tends to prevent tho move1:1ent of milk from one conmunity to another. Much tine and effort hns boon d.evoted to traini~ local personnel relative to uniform interpretation nnd inspection. Certainl~r fron our efforts ~avo come nore uniformity of inspections and ordinance interpretation. This has been of si.gonificant value to the milk industry.
In conclusion. I feel that no one can c'~oubt that the nilk sanitation pro-
gran as conducted from the En~inoori~ Division of the Geor.goia Departncnt of
Public Health will conpare f'l.vorably ,.ri th any other state pro.<;r<J.n, That the consuni~ public has 1:1atorially benefited is evidenced as follows:
1. There was no known incidence of diseases caused by milk in Gcor~ia duri~ 1951,
2. The applyi~ of coliform stnnda.rds to pasteurized nilk h<J.s done much to accor~lish oven bettor sanitizin~ nethods and safer handling of nilk on the part of pnstouriz'l.tion plant operators.
3 In 1950 the ~ross adulteration of nilk was~ real problemo Because
of routine testin~ of milk for excess ,,rater and positive t\Ction on the part of local health department personnel this problem of ~ross adulteration is no longer of nnjor si~nificance,
4. Fifteen co!!li!lunities no,., ha.ve nilk supplies th~.t are officially
reco~nized by the Uv 3. Public Health Service as bein~ excellent.

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It is conternpb.ted that the sane effort '\trill be devoted to the milk
sani tnt ion pro~ru:1 durin~ 1952 and as a result the consumin~ public ' d l l
have even more confidence in its nilk supplies and because of this the milk industry in Geor~ia will continue to ~row.

11, SHELLFISH SANITATION

l~ew so.ni tary re~lations were adopted by the Stgte Bo3.rd of Health, Those ne'" re~l<>.tions are in more detail than the old ones and are narc
closely patterned after the reconnendations of tho U, 3, Public Ho~lth
Service,

.n.l thout?;h a complete resurvey of the oyster ~ro'.fi~ areas was not
r:1ade durin~ 1951, surveys were made of the critical areas in order to keep
the pollution data and charts up to date, These surveys included bn..cteriolo,c;icn.l exaoin'ltion of water saoples collected over oyster ~ro,!Tin,c; areas as well as sanitary surveys of surroundin~ territory. Fron data compiled durin;:; surveys, charts were brou~ht up to Mte showin~ the entire coastal
o.roa of the State \d. th closed areas indicated thereono

E:1ch cor.mercbl fishermn en.<;:J.~cd in tho tr.kin~ of shellfish was issued an Oyster Gatherer 1s Pormi t toP,othor "'i th 'l current ch:1rt shmori~ polluted or closed areas in the vicinity of his ~thorinA: oper'\tions. Those pernits were issued in cooperation with tho Coastal Fisheries Division of tho Gooreia State Gnne and Fish Cornnission,
The U. s. Public Health Service m~.de a review of our Shellfish s.,_nita-
tion Proeran in March and Novenber of 1951. Certain recommendations have
been made for the improvement of the Pro,r;r"m and every effort is beine nade to so that these recommendations nrc c~rried out.

Follo,.Tin~ 3.re statistics of shellfish snni tation activities for 1951:

Oyster shuckin~ ~nd/or p~ckin~ plant inspections

187

Crab ment packin~ pl~t inspections

8

Retail seafood markets checked

25

1'1holesale seafood mn.rkets checked

25

Conferences Ni th plant O'l-rnors ':JXJ.d/ or operators

118

Conferences with other officials

74

Shellfish plnnts certified to USPHS for interstate shipment 8

Oyster P-atherer 1 s permits iaauad, with charts

53

W~ter samples collected for bacteriolo~ical examination

912

Hours shellfish bo'J. t oper9.ted takin;; "rater s9.mples

9%

Hours shellfish boat operated patrolling closed areas

39

Miles trnveled on officiD.l business, State truck

12,311

Miles traveled on official business, pcrso~~l ~uto

5.338

12, RECRUITIHG .-~.hD TR11.I1Hl~G

Durin~ a six months 1 period, 18 sanitarians were recruited for traini~ nt the School for Sqnitarians at Colunbus, Geor~ia. Such trainin~ is for the purpose of proparin~ men for qualification under the State Merit System and
l'ltcr assia:nment to local health departments.

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13. liOME SANIT.i.TION :E'OR V-'ELFARE PLACEMEl~S
The State Department of Public i'lelfn.re depends upon the Shto Departmont of Public Health to inspect, ~~prove or disapprove such homes for the placement of orphans nnd other charP,es of the Department. This plan alone has cnal:lod the St'lte Health Dep'lrttnont to establish modal home sanitation in many counties and communities, thereby influencin~ a ~eneral desire for bettor livinP- throt1P~ sanitation,
This Division is a clearin~ house for a ~reat number of complaints \olhich arc re.t.';istered throUP-hou t the St'lte. In adclition to abatement of nuisances for bettor livi~ and health protection, it has n duel result of preventin~ unpleasant and unnocess~ry loP,al actions,
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ANNUAL REPORT DIVISION OF EPIDEMIOLOGY
1951
A. PERSONNEL AND ACTIVITIES
Cancer Control, Rabies Control, and Epidemiologic Investigations are grouped administratively under the Division of Epidemiolor..y. Cancer Control is budgeted separately from the other sectione since its flmctions are basically dissimilar to those of the rr:edical, biologic, veterinary, and nursing team set up to provide essential epidemiologic services.
During 1951 the profeseional personnel attached to the Division con-
sisted of a medical director, an assistant director who is a biologist, two field biologists, a research laboratory biologist, and a field nurse. Two additional field biologists were employed tempo:-arily durJ.ng the summer monthe. The associated veterinary personnel consisted of a chief veterinarian who is in charge of rabies control and acts as coneultant for all health department activities, including those at Battey and Alto Hospitale, and a field veterinarian who is actively engaged in the promotton of antirabies measures. Late
in 1951, a U. S. Public Health Service Medical Officer and a U. S. Public
Health Service Nurse were assigned to the Division for Epidemic Intelligence duties. In practice no rigorous distinction is made between the general investigative duties and responsibilities of medical, veterinarian, biologic, and nursing personnel other than the neceseary separation of functions on the basis of the professional techniques involved.
One field biologist is stationed at Albany, the field nurse and the research biologist are at Waycross, and the field veterinarian is located temporarily in Atlanta because of the press of rabies activitiee in the counties surrounding the metropolitan area. The remaining personnel are assigned to the Atlanta office and all workere, lncluding the field personnel stationed in Albany and Waycrose, have state-wide responsibilities for work in their respective specialties.
B. DIVISION ACTIVITIES
1. Activities of the State Epidemiologist.
The office of the State Epidemiologist acts as a clearing house for epidemiologic informntion. With the assistance and collaboration of the Central Statistical Unit, morbidity reports and death certificates forwarded by private physicians and Health Depcrtments are summarized and collated. Summaries based on this information are provided at weekly and monthly intervals to the county henlth departments and the U. S. Public HeRlth Service. Aleo, current reports of um1sual dieease incidence from other stetes are picked up from the statistical releasee of those states ~nd from Federal weekly reports and communicated to the county and regional offices in the form of bulletins and memoranda.
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The State Epidemiologist receives a large number of mail requests for information bearing on the occurrence, control, and treatment of communicable diseases. Much of this information is supplied by the Central Statistical Unit, but a considerable number of queries requir~ a specific answer and an interpretation of data. In such cases, the Statistical Unit and the Division of Epidemiology collaborate in providing the needed information.
Also, the normal volume of telephone inquiries is large and any newspaper story on epidemic conditions, particularly with reference to widely publicized and feared diseases, SllCh ae poliomyelitls, ie likely to result in a deluge of telephone calls from the Atlanta metropolitan area. During 1951 the number of duplicating and unnecessary queries was noticeably reduced, probably as the result of the prompt notification given Health Departments and newspapers of any change in the epidemic E'ituation. This reduction in the face of an increased incidence in polio givee substance to the hope that progress is being made in public relations.
2. Morbidity Reporting.
Morbidity reporting in Georgia, as in other states, underwent a complete re-exQmination and evaluation in 1951. While plans were being made to conform to the etandard reporting procedure designed to be put into effect January l, 1952, efforte were directed toward improvement of the mailing liet of physicians to whom reports are eent directly from the State Health Department and to modernization and simplification of the reporting machinery for the state at large. The addition of a number of physicians to the mailing list resulted in a very marked improvement in disease reporting for the year.
Emphaeis continued to be placed on procuring confirmatory laboratory data on reported caees of cotlmunicable diseaee. Case reports of certain diseases were selected and the physician and County Health Department requested to complete a case history and to obtain convalescent specimens. Typhus, Rocl\,Y Mountain Spotted Fever, and Malaria cases were found in this manner. As wus expected, numerous cases of malaria in Korean veterans were found during the year and checks made of all reported cases in order to separate possible indigenous cases from those occurring in veterans.
Reports of unusual disease incidence continued to be given particular attention during the year because of the poesibility of biological warfare. All State Health Departments are aseisting in this project on a national scale by reporting disease outbreaks. The Division of Epidemiology has asked the assistance of local health pereonnel and practicing physicians in the reporting of emall outbreake of cor:ununicable disease because such reports would be of value in establiehing the presence of an unusual diseaee pattern.
3. Epidemiologic Investigation&.
a, Malaria
Early in 1951 the Division assumed primary reeponsibility for
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maintaining surveillance of malaria cases in Korean veterans. As this is being written, approximately 1000 positive or formerly positive cases in military installation8 in Georgia and ab01.1t one tenth that number of cases in discharged veteran8 scattered over the state are under ob8ervation. One
indigenous case, the first since 1944, was discovered by a private physician.
This case is apparently unconnected with currently reported foreign malaria but may derive from household contact with World War II veterans. However, the patient is not a veteran, he had malaria as a child, has a history of yearly recurrences for ten years, and has been more or less chronically ill for three years. His malaria ie therefore coneidered to be a recurrence of a long standing infection of local origin.
Invcetj_gation of the surrounding area revealed no other suspicious illnesses and th:i.ck films taken of other person:: Uving 1vithin a mile and a half of the case, including all members of the patient's family and his two vetere_n brothers, gave negative reeults. The area has been kept under surveillance for more than six months without the discovery of additional cases.
The long prepatent period manifested by the Korean strain of P. vivax malaria, the behavior of which is essentially similar to the St. Elizabeth strain of P . vivax which was isolated from American sources a nur.~ber of years ago and-has been used in the treatment of paresis since that time, has been viewed as a possible source of added danger in re-establishing foci of malaria in the United States. Why this should be so is not clear since it is precisely the type of malaria which appears to hc.ve died out for natural reasons under A.~erican conditions. Since Anopheles quadrimaculatus did not become infected in sufficient numbcre with World War II strains of tropical vivax malc.ria, with their frequent relapses and consequent high rates of parasitcmio., it appcc.rs likely that the Korean strain would be somewhat less dangerous, for presumably more bites wm1ld be required to produce a heavy Korean strain infection in a mosquito than would be needed with tropical straine.
b. Typhus and Rocky Mountain Spotted Fever.
Recent advances in therapy have adversely affected tho reporting of rickettsial diseases. Special efforts have therefore been made to procure epidemiologic information on e11der.1ic typhus and Rocky Mountain Spotted fever. \ihenever possible, convalescent blood specimens have been obtained in order to get serological differentiation and confirmation of these diseases. Although many case investigations ere incomplete, it appears that a large proportion of reported cases can be serologically confirmed. Three deaths from Rocky Mmmtain Spotted fever and five deaths from typhus have been reported.
c. Typhoid and Gastro~enteritis Investigations.
Four field investigations were made in areas where multiple cases of typhoid occurred. In each instance the disease was apparently carrierborne, neither water nor food having acted as a common source of infection.
Several gastro-enteritis outbreaks were inveetigated, at least one
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1951 ANNUAL REPORT DIVISION OF PUBLIC HEALTH EDUCATION
During 1951, the Division of Public Health Education continued its program of making available to the health department staff varied educational techniques and materials. Working through staff, the division served to present health information to the average Georgia citizen in such a way to motivate him to improve his personal, his family, and his community health.
HEAL'rH INFORNA TION This section utilized the media of newsp.q,pers, radio, pamphlets, exhibits, lectures, fibns in telling the health story to thousands of Georgia citizens during the year. Weekly news Nleases to some 200 newspapers in the st::te, stories in Atlanta pap3rs, and daily contact with wire services provided a steady flow of health information from the Department.
SCHOOL HEALTH EDUCii.TION School health education activities of this division have included: working with faculty groups in planning functional health programs for schools; working with teacher education colleges in area of school health program for pre-service teachers; serving on school evaluation committees at request of State Education Department; guiding in preparation of a Guide for Teachers in cooperation with the Georgia Teachers and Educational Association; sponsoring of a two-day, state-wide audio-visual conference attended by over two hundred teachers, held at Atlanta University.
C0~1UNITY HEALTH EDUCATION Community organization functions of this division have consisted of leading study and discussion groups for health progr~s; helping communities to organize health councils; serving as consultants to Better Health Council and other state-wide voluntary and official agencies interested in health.

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EDUCATIONAL MATERIALS With the acquisition of Multilith equipment for the print shop, plans went forward for the production of low-cost pamphlets within the department itself. Titles of new pamphlets included: "Planned Refuse Collection"; "COLD Don't Let It Get You Down"; "Protection" (Rabies); "Ill At Ease" (Mental Health); and "Just vJhat Is It?" (Gonorrhea). A new, popularized annual report, "Report of Progress," was produced and distributed widely throughout the state. A total of 358,653 pieces of literature was distributed during the year. Better coordination of exhibit production rmd distribution has increased efficiency in this activity. Greatest remaining problem in this area is the lack of workshop space. The Film Library distributed 816 films for a total number of showings of 2,671, to an audience of 211,771. Three new films were added to the film library: "Birthright" (Congenital Syphilis); "Nursing"; and "Your Children's Eyes." The public health library reported a total of 12,283 books and pamphlets in 1951, available as reference or for circulation to public health workers. This represented an increase of 608 pieces of literature over 1950. A total of 5, 513 pieces of literature circulated from the library last year. A total of 2,566 reference calls was answered.

1951 ANNUAL REPORT DIVISIOH OF HOSPITAL SERVICES R. C. 1Villi<:.rns, I1.D., Director
GENERJI..L
The Division of Hospital Services llas organized for the purpose of: (1) the administration of tho hospital ~.nd public health center construction pro,ram uith Federal gro.nts ur1dor tho provision of Public L~Jl 725, 79th Congress (Hill-Burton Act); (2) the administration of the Georgia Hospital Regulation Act. No. 623, 1946; (3) the conducting of periodic surveys o.nd studios to determine relative need for medical facilities in the v2.rious sections of the Stnte; and (4) tho provision of v~~rious t;ypos of cor:sultc.tive Sl)rvlces to existing hospitals and potential project sponsors.
Tho objectives of tho Goor~ia Hospitnl Progr2.r.1 arc oxp~dod and improved hospital facilities in tho State, as uell <'.S tho mc:..intonance <:end improvement of good patient care. The Division is also responsible for the construction phase of tho public h\)dth centers in nccord~11co Hith tho proGrm'!l for loc<::'.l ho<::'.lth services and fetcilitios 2.s pl.:'.nnod by tho Division of Locol Honlth Org<:niz<::'.tions.
P~OGTI.AII PL"JmDJG
A. Tho St<'.to Hospital Plm1 Tho Survey and Planninr, Section is responsible for ossombling information
necessary for providin[, c.nd <::c1rl.nistorine the St0.tc Hospit::l Plnn. This master plan is tho b<::'.sic document lvhich presents tho nnnunl st::'.tmvide inventory of existing fncilitios, cl2.ssifiod as "accopk.blo11 or "roplaconblo", toccthor '1Jith the relative priority of the forty-seven hospik.l service etroets. Tho prim<'.ry objective of the State Hospit<.Cl PlM is tho s;rston<.Ctic o..nd intor-rolnted dovolcpmont of such ~.dditional facili tics as r.K:y bo required to provide more ~doqudo hospital service for the people of Georgia.

B. Connnunity Surveys
Program in tho follmrl.nc uays:
(1) Tho olimin~tion of specific questionable Jrojects in hospital nroas
of hich priority by succostinc other ways by vrhich the cor.nnunity c~'1 meet indic<'..ted nocds. Thoro arc I'Tk'UlY rurr.l cm'ffi!unitics in Gcorci"- desirous of ::end in need of clinic2.l nedico.l services; ;rot, tho co cor.1r.mnitios, duo to tho nbs once of trained medical personnel, smc:Ul )Opt:.lationB, : nd limited fin;-ncit.l resources, <>.re unable
.
to support a hospitd of t-vmnty-five (25) bods or nero . (2) Project S~)on;;:;ors ho.vc boon shmm thd thoro r-.ro m::my problems other
th.::n tho erection of ::-. buildinc thd nust be solved in order to provide efficient and o.doquato hospit<'..l :::erYico. For ox~:)lc, fincmci2.l support for indicant c~.ro, opor<:.tinc deficits, <'..dcquc.tc sto.ffinc, oru.nizod community support, r'lld other rolt'.tod mo.ttors nocosst:ry for tho successful opor:-.tion of ;::, hospital r.ro discussed.
(3) Cormm.1..'1ity surveys h-::-.vo boon .:m effective mo::u:s of :1rovic1inc 2ccurato in.formo.tion to conr.littcos roc<:.rc~inc tho St::'.tc Hcs~itt:l Procr2m <'.nc.l tho loc;<'.l 2nd non-local requirements for ;_)c.rtici:x~tion in tho hospit::'.l construction ~'rocr;::-:.m. This hr..s nndo l)Ossiblo bettor 1.mclcrst.:>ndinc and ir:1:1rovcd public rcl2tions for tho Division.
(4) Surveys h::-vc boon em ::..r:\JCJrtr'.nt source of :;ortL.'lont informo.tion for tho annu2.l revision of tho St2te i.:.lo.n c.ad for more officiant o.dministrc.tion of tho Hospit~l Procr2n.
Durinc tho year, comr.mnity surveys ucro m<:.clc in Duluth, Ncuton, Bruns1Jick, IJc.shvillc, Doucl<:.s, Alb.:-ny, Bl::-.cksho.:--,r, Ocillo., Ashburn, <:.nd South Fulton County. Spoci::tl studios -vmro m~do of hoSl)it<:.l schoc.lulc o.f r:-.tos ond tho <:.p]r~is:-:.1 of current nnd :;rejected needs for hos:;itQl ftecilities in defense c.ror.s. C. Hospit2.l Pb.nnin;; in tho I!otro:;olitt'.l'l Arot:s
Considorr'blc tiuc utes spent clurinc, tho :roQr in ~Jl2nninc for futur.::J oxp.:-.nsian ~nd improvement of hos)itnl f.:--.cilities in tho :.1etro:')olit:-n <'-ro.:'.s of tho Stntc.
.. 2 -

As the more urc0nt needs for smnll hcspitnls in rural nrens ~re boinc met, soniD of tho motropolitc-.n nro:-cs uill rcC'.ch n hichcr priority for nssist.:-ncc under tho procrrun. Instcnd of conductinc local community surveys in thoao nrons, the Division is sponsorinc the orr_pnizntion of reprcsontc-.tive locr;l metropolitm hospitrl plD.nninc councils for mnkinc pl;;ns for tho efficient exp~nsion of hospitnl fncilities .:mel services. The metropolitan areas, ospocinlly those 11ith schools of medicine, not only serve their immodinte o.rens, but the entire Stnte. The develcp:-,lcnt of those <'.!'ens into modern medicnl nncl. hos~)it<'.l centers, coordinnted ~~i th the needs of the recionL~.l .:md rural hospitnls, is essenti~l for tho success cf tho ovcr-:11 St~te Pl:-.n.fbr nn intocrnted hospit:-.1 system in Georcic.. D. Critic~ Defense Arons
The ICorc."'.n situ._".tion, the re.:- ctlv:'.tion of nilit-:ry inst.:-.11::-.tions .".nd industries connected Hith the defense effort h:-cve led to unusu.:'.l dom:mds for modicnl .:mel hospitnl services in spcd.fic ."rons in the St".to. In cooper~tion >rith tho United St.:-.tos .~.)lblic He~.lth Service, periodic surveys .:-nd speci.:'l nttcntion hrcvc boon civcn to the more critic.:-.1 ::-.rons. This .".ctivity is intim.:-.toly nssocircted with thc.t of tho St.:-.to Civil Defense ?1.:-cnnint.; Orc."llizntion. E. Referrrcl of Physicic-.ns to Rur.-.1 !.ro~s
Tho Survey nnd Plnn:1inc Section m.:-intrcins .-.n nctive file of communities in need of n physici.-:n. Pertinent cl<".t~ ;:cbout these communitics ,.,ro nv:--.il.:'.blo to mcclic.".l school cr~:cduo.tcs .:-.nd others uho request rcssistancc in finclinc desir.".blo loc.:-.tions for modicnl :Jr.:-.cticc in Gcorci"'- Throuch this nctivity, scvor.:-.1 communitics ucro successful durinc tho yc['.r in n.ttr.cctinc .:'. physici:cn.
COIJSTRUCTIV2 ~'ROGR.'.H
....,, Adrninistrntion c:f Construction :2ro;:r::-m
Durinc the 1950 c.-:lonc:.:--.r ye r tho hospitc.l construction procr['m unclor the
provisions of Fedor.:'.l Public Ln.w 725, rosultocl in tho completion of 20 projects nnd
the C'.:)prov~l of 20 .:;.dc~tion:-:.1 :)rojccts tc bccin construction. Fcdornl Public 1."-W
-3 -

725 conunonly knmm as tho Hill-Burton .Act, approved Aucust 13, 1946, nuthorizos

Federal crants-in-aid to sponsors of publicly ovmcd and other non-profit hospital

construction projects. The dcfL~ition of hospit~ls for tho purpose of this act

includes all catecorics of hospit~.ls, public health centers ~nd adjunct facilities.

In October 1949, Public Lau 3 80, 'tms enacted ['mcndinc tho Hill-Burton
Act by incroasinc tho nuthorized Federal appropriation from 075,ooo,ooo to

$150,000,000 for the fiscal yor.r ondinc Juno 30, 1950, .:mel for each of tho fi vo succoodinr:; fisc2l ye!'.rs. Act 62, Goorci2 k,us 19L~9, l'1.c.kos .::vdl['blo 03 ,ooo,oco

Sk.to funds annu['.lly for cr.::nts to publicly mmcd :Jrcjccts npproved for Fodornl

assistance.

Bocnuso of tho intornc-.tioncl situation nnd tho n['tionnl defense procrnm,

tho $150,000,000 <'.ut!1orizod Federal appropridion 1-ms reduced except for tho

fi3cal year ondinc Juno 30, 19.50. Tho follouinc t2blo civos tho Federal C'Jld State

funds nvailablo to Georgia :::inca tho bocin.'1inc of tho procrnm.

Fiscal Yonr

Foderi"'.l Funds

Stnte Fundn

1947-48 1948-49 1949-50 1950-51 1951-52

Tot~

02,976,228.00 2, 791,307 .oo 5,248,356.00 2,609,914.00 3,o6e;BC.9.oo
Cl6,694,694.oo

(> none 3,ooo,ooo.oo 3,ooo,ooo.oo 3,ooo,ooo.oo 3 2000,000.00 $12,000,000.00

In accordance 't-rith "' diroctivc of the St2.to Bonrd of Health, first con-

sidoration 't'las civcn in approvinc; projocts for tho 1951-52 fisco.1 year to projects

that wore tontativel;';- scheduled for tho previous yonr but curtailed duo to tho

reduction in expected Fodornl funds.

Processing Applicntions:

A project construction schedule listinc proposed projects in the order

of tho area prioritics in tho State Hospitc.l Plan wns .::pprovod in September 1951

for tho 1951-52 fisc~l ye<'.r. Project sponsors tmre notified to proceed with tho

filinc of ::t)plict".tion fcrms ::mel tho ;.Jrop.::.r;-.tion <Of a construction procram, plans

and spocific.:-.tions. Proccssinc of tho ;:'lpplicdions required a review nnd approval

of tho many documents and m~tonsivc information submitted by tho applic~1ts in

- 4-

accordffilcc lti.th tho Stntc ~nd Fcclcrcl roculo.tions. Applicc.nts :rrru.st furnish evidence
st<>.tus of tho cxistin[ or :,rc:,csoci. hoSl)itc.l. Assurr.ncos uorc obtc.inod rclc.tivo to tho )revision in the :>iJ~lic~nts' :Jrccr~Pl for tho c,:.ro of indicant :x,ticnts, c:nd sorvic.:;s for nll persons in the aron roc~.rdlcss of r:.co, creed or color. Construction Period:
IJ'toJr n)~ rov~l of :--.11 ~!i'.rts of the ~~):)licr'.tion, pl.:cns .:-.nd spocificdions, bids ~ro t::.kon for construction ::.nd r.);,rov"l ::..s r_ivcn for ::.u::-.rdinc of contrr-cts. Durinc 1951, C4,ll0,58).31 Fodor~l ~nd 01,658,704.43 Stdc funds ucro disbursed to ni_)l)lic:-::nts ::.s construction )roe::rossr.:d. Inspections uoro nc.cle of records .:-,nd 0.ccounts of inclividual projects under ccnstructic. n. Inforrn~tion u,-.s collected for the ~;re p<>.rc:>.tion of rc:1orts .:-nd for :)l.:-1ninc nou projects. 1\. c:Jk:ilcd ~uclit UI"'.S mc.dc of the records .:mel c:>.ccotmts of nll )rejects completed. Percentq;e of Pc:>.rtici1)::.tion:
Tho c:>.mcnc'Jncnt to Fo(Jcrnl Public k.u 725 ~uthcri::;os the Stc:>.tc Boc:>.rd of
Hoc.lth to establish .:-Jmu::.lly the )Orcc~lt:".[O of )reject cost to be :xcicl from Feder<'-1 funds. 1~t its nrumr<.l !'leetine i::.1 l'I<"'.y 1951, the Bo::.rcl clirectcc: tho.t the Fcdcr::.l shi're for j_)rojocts np:;rovcd c:urinc tho 1951-52 fisc:-:1 y.;.-:-.r IIOulc~ be 45% of tho "i))roved project cost c.nd thc.t the St::cto sh::'.rc 1Joulc1 be 33 1/3%. Controlled M2.tcric.ls Plc.n:
Pursu:-.nt to tho N:::tion::-.1 Defense 2roduction Let the u. s. Dcpc.rtmont of
Commerce throuch tho III"'.ticn::-.1 Proc~ucticn .".uthcrit~. put into effect on July 1, 1951, tho Controlled H:::toric.ls Plc.n (CIlP) for ccnstruction. This ~;rocr['J/1 involves the issu2.11co of construction :;crr,Iits ::-.ml 0.lJ.occ.ticm c,f contrc:1loc1 liK~torio.ls c.nd l)roducts required in nevi construction. Tho ;->.uthcrit:' tc npprovo, mcdify, or disnl'l)rove n~J:"J1ic:-ttions under tho ~Jl~n for hcs:)i kls .:cncl ether hc."'.lth fc.cili tics 't'i<'-S dclccc.tcd
to the Surccon Gcncr:-1, U. s. Public Hcc.lth Service.
Tc :;ormi t bettor coordin:::tion :-.nc' )rol;cr ov:~lu:".tic:n of c.pplicc..tions, tho St:::te Hosl)itc.l Pl::.m1inc .\c...:ncics wore r~qucstccl to :"J:::rticipdc in the j_)rocrc.m to
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/

tho extent of disscmin~ting informt.tion concerning tho progrnm and tho processing

Services 1-1as assigned this r0s;;Jonsibility uith rcg~.rd to nll proposed hospital

2nd relntod constrt'..ction roc;:crc:lcss of :rhothor or not it cnmo under tho Hill-Burton

Progrmn.

Throuch Doccmbor 31, 19.51, the} Division hr-.s :Jrocessod forty-tvro (42)

ccpplice>.ticns for hcspit:-~1 C.l1d ho2.lth cor:t,;r projects under the Hill-Burton Progrmn

nnd cloven (11) applicdicns for construction porr.ti. ts D.nd equipment for ether

hcD-1th fc.cili tics .'1nd D.ctivitics. All !:'.pplic<'.tions precessed t-rore npprovod by tho

U. S. Public Henlth Sorvice; hcuovcr, s;_Jonsors D.nd .".rchi tocts uoro urged to usc

substituto mc::tori."cls i"i'hcrcvor possible. Informnt1on oxpl;:--.ining the oporntion of

tho Controlled lvr.tcri."cls Pl:'.n uns for\Jr.rclod to <.11 county hot.lth depnrtmonts, <.11

hospitc::ls nnd rebted cr:,nniz!:'.tic:ls in tho Stnte

St.:'..tus cf tho Progr<'m:

The folloving k.blo civos the st.:-.tus of thJ construction progrmn ns of

December 31, 1951:

Tok.l Projects Lpprovod

Tot::cl Pro,jccts

No. of

Totnl Estimo.tod

Bods Added

Cost

New Genernl Hospitnls

44

Additions to Existing Hosp.

11

Public Hcnlth Centers

47

(includes ~.ux. centers)

Other Projects

6

108

2,192 228 11
37 2,468

$28,013,135.10 3,877,079.23
3,699 ,116.]J
10lzl20.22 C35,69o,45o.68

Construction Prcr;ross

Pro}Jcts

Nevi Hospitnls

22

Additions

5

Public Ifunlth Centers 26

Other

3

~

Com)lctod

Bods

-Cost

1,047 C12,761,518.o8

123 1,340, 703.03
11 1,889,357 ~3 7

___11

101,120.22

1,218 $16,092,698.70

ProJ<;'Cts
13 1
13 2
29

Under Construction

Bods

~

785 CilO, 287,627.02

16

405,275.20

1,072,432. 76

. 317,575.00

$12,o82,909.9S

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B. Technical Services
The Tochnict:'.l Socticn of the Division of Hcs)itd Services, consisting of tho hospitt:'.l architect nnd ['n engineer, is responsible for review c.nd npprovc.l of u.ll pl.::ns [1.nd specificnticns r:.ncl construction of projects :->.pprovod W1dor the provisicns of Public L<'.W 725, 79th Congress, Hill-Burton Act ['S ~10ll 2.s inspection :mel C.PlJrovnl of sites for the ~Jrcposed ;_Jrojocts.
Archi tocts omplcyod bj? the spcnscrs of projects h.::-ve fcW1d it ndv::...l'ltngeous tc sub1~ri.t plo.ns t:'.nd S)ocifico.tions to tho Division for review c.nd rccommen_ dnticns j_)rior to submission of fim:.l plt:'.nts; first stcge: procr~1 ::md schomntic pl:ms; soccncl stc.t;o: prulim:!_n::-.ry plc.ns, elcvo.ticns c.nd outline specific<'.tions; third stC.0: l-Jorkinc clrc.id.ncs c.nd spocific.::.tions. In follouing tho nbove procedure, plc.ns o.nd spccifico.ticns for ;_Jrojocts .::.ru checked in dotdl .".t lcr-.st throe times by
this Division ;;nc:.l by tho u. s. Pu0lic Hc.:'.lth Service.
Complotinc plc.ns for finc.l submission to contr<.ctors for bids requires ronny meotincs c.nd much corrosj_)onC.onco botuocn tho t0chnicc.l section c.nd tho sponsors nnd their <'-rchitocts. Durin[ 1951, c. totc.l of seventy-six (76) sets of pl~s <'.lld spocific.:'.tivns vlCro processed tl:rour:h this Division. Seventeen (17) projects -vmrc put out for bids c.i:l<l c.ro nou unclor cu1structicn.
Follouing c.ucTll cf tho construction ccntrc.cts, tho technicnl personnel of tho Divisicn r.kcke ~Joricdic2l inspections to soc th.::t tho construction is done in nccordance viith tho pl2ns t.nd s)ccifico.tions. One hW1drod and forty-one (J..41) such inspections \/Oro l.lC.t.le clurint:; 1951. InsJ_;oction reports ;_Jroporly certified by the Divisicn nrchituct or oncineor c.ro nccess2.ry tc SUlJJort a request for installmont p~~ymonts of Fcdcr~l rnc.l St<Cto Funds to tho Sj_;onsor. All ch;:-.ncos in pl.:ms and specificnticns o.ftor vwrk cor.li!lOnccs must be rovio1-rod ~nd po.ssed on by this Division.
In nddition to tho tochnicnl services in connection uith the construction j_Jrocr21a, tho Division :)rovidos ccnsulktive sorvice to oxistinc hospit<'-ls uhich wish to expr'.nd cr remodel fncilitios. Tho Stcto Hospitc.l Licensure Let requires tho
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Div-ision to rcvicu .:md r;~)provc :;l['.ns for r.ll hospitr.ls to be constructed in Gcorcir..
c. Equipment Plr:J1nine

Hospit~l equipment ~;lnnninc ccncrc.lly fc.lls into four cenerc.l cntccorics:

(1) Visit to n co:mmunitJr nfter the project hc.s boon <:!.))roved :-end prior

to t:1c :'.ctur.l mc.kinc U) of :::Il equij;)mcnt list, to fQT.'l.ili:-rizc )reject sponsors '\lith

tho stops thnt r.rust be t.::.kcn in the oqui))inc of D. hospit~l under this procrrun. This

miL_ht be considered M initi:'.l oduc.::.tionnl visit. Eleven hospit:-ls uore visited for

this purpose.

(2) Conk.ct Hith .::. cor.mmnit:;,r for tho ~mr_..,oso of 1-:l:'.kinc up ['.n equipment

list or instructinc tho project S)Oilsor in tho ~)roper ~1rococluro noccssnry. This

field tri:) conorr.lly roqciros listinc onci1 i tm~1 of cqui;_;nont ~c;ith ostim.:~tod costs.

Also durinc n visit cf this sort, instructions c.rc civon on tho cc.tccorios of equip-

mont, Hhcthcr Group I, II, III, or SU)~~ly items. All s:)ccificc.tions <:-.ro mittcn

b;r tho project S~)onsor. Seven hospit .. ls 1mro visited for this purpose.

(3) Routine visits to hos:,it['.ls to c.ssist s:)onscrs in submittinG invoices

to this office for ~)['.yY!lcnt. Thirteen hcspit.~.ls uore -..i.sited for this purpose. (4) Fin"",1 equipment ins~;cctions nrc conducted in hos:_-;ik.ls 1-:-hero equipment

hns been received c.nd is in plncc. This includes .::. physicr.l f'Uc.'it of cc.ch item of
equipment. At this time, su~;:1lcmont:-l cquip1-:1cnt lists c.ro subr:ti.ttod to tho u. s.

Public Hcc.lth Service for c.pprovr'l of items of cqui:-:m1cnt thc.t1ore :)urchc.scd nnd do

not np:x~r'cr on w np:)roved list. Thirte..;n such visits ucro mdo.

Thoro hns boon sr.tisf:-:ctory cocrc1in.~tion between tho Division of Hospitc.l

Services, tho Division of Loc<:-.1 Ho:-.lth Oruniz.:ctions r.ncl tho Division of Dcntcl

Hcr..lth nnd Division of II.:ctornc.l r.nd Child Ho:-.lth in b:--.lr'ncinc.: tho equipment needs

of c~ch rosj_;octivc cloj_).:crtncnt J.n tho ho:clth c0ntcrs -nc1. one n.::.tornity shelter.

Duo to tho lir:ti.tcd oqui:1mont <:-.llotiilcnt for scr.1o centers, it h.:cs bc""'n ncccss:--ry to

~1urchc.sc used dcnt.::tl oqui~Jmcnt. ! ..11 of tho )Ublic he:2lth contors h.::vo h:-.d their

cquipr.1cnt dclivcrccl in t:i.mc for oponinc oxco)t for some su:1plcmcntnl equipment. Thoro hc..s been scmo dcl.:cy in ccttinc delivery on mct.:cl oqui:11~1ont - desks, files,

nnd tho like.

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CONSULT.:.TION

A. Hospitd ::..dministr:;.tion Consultcnt Service

There is a short~ge of tr~incd or experienced hospit2l administrators

in the State, o:x-p..;cially for the smaller hospitals. Because of this situr.tion,

hospital r.uthoritics hr..vc been forced to employ administrr..tors uithout previous

hospit.?.l training or experience. Tho incxporioncod administrator is forced to

rely almost entirely upon tho trial tnd error method uhich is usually vor<-J costly

tnd frequently uns~.tisfactory.

Consultt.tion services 2re gro.::tly needed in this field, ::end cspocir.lly

in tho orc~nizinf: ~.nd the prolimim~.ry plr-.nninc for tho opor~.tion of a ncH facility.

During tho ye::-.r, limited assist::cnco t-r::-.s provided hospit.:--.1 trustees and administrn.-

tors uith such problems :-.s:

(1) Prcp:-.rdion of the budget

(2) Est::-.blishing hospit::cl r.:--.tcs (3) Sal.:--.ry ~.nd personnel policies
(4) Uniform accountinL systems

(5) Inventory controls

(6) Hedic,--::.. records system

During 1951, r:. m['.jori ty of tho nmv hospitds opening rccoived this

assist['nco. Requests for consultr'.tivo services h:'ve boon so numerous th.::t the

time ['.llotted to c.::ch non project noccss.::rily h:-.s boon limited.

B. Hospitcl lJursinr; Concultt'.tion Progr;'Jl1

Durinr; 1951, the second ye::-.r of tho hospit.::l nursing consult.::tion service,

continued cmpht'.sis vlr.s civen to progr.-:m pl~nning, consulk.tion to hospitt'.lS and

oduc~tion~l progr~.

Pror;r<".m planning vf.:-.s carried on uith tochnicd cuid<".nce from the Division

of Public He~lth Nursing ~nd the Division of Hospik.l Services. .\dv~ces have

been slou but stet'.dy ~nd a pattern of nursing consultation from a State .Agency is

gradu::clly evolving.

- 9-

The Hospitnl Nurse Consultt'.nt )nrticipded uith committees 11ho wore
in tho St.:ttc of Gcorcin, !'.S follmm: (1) A survc~r o:L nursinc in tho hospik.ls of Gcorcin -vrns mr'.de and com-
j_1loted; (2) \"Jorlc was dono uith <:1. corr.mitteo or rurd affiliation for student nurses uith Emory U~nvcrsit;y-; (3) ~lssistod a spoci.:-.1 conmittco for tho dovolo~Jraont of a [.;uido to nursil1C, a j_Jrocedure m.:::.nu::l for hos:_:1it<::ls in the St~:to lL:lS bepm; (4) Coo}Jerc::tod uith the Advisory Comrnittoc of tho Deytrtmunt of Vocation2.l Education in tho development of n school for lJr:-ctic!'.l nursinc in Ge:)rci<'.; (5) Discussion c;rou:_Js nero est2.blishod in tl.1roo ::-.ro<'.s in the Stc::.tc for the )UI'".i.1osc of dcvelopinc a tcnchinc cuidc for nurses <::iclo trrininL :Jrocr<'-Y'lSe
Direct consult?.tion ur-.s extondc:d to nll hospit~:ls upon request. Over fifty visits were mC>.do durinc 1951, l'lkcny visits Hero mccdc jointly with tho Regional Public Health Nurse to those hospit['.ls. Emph.::>.sis F.:ts pl2ccc1 on tho improvement of nursinc service <:'.nd cduco.tion uithin tho nursinc service. In a number of instdncos, visits -vrcrc mc.dc to the sc.mc hospi-t:::lo v:hcro intoro.st, vins m:::nifostod cmd assistance soucht.
One in-service cclucaticn ;_::rc;c;r;r,l on ~ roculc.r sust2incd basis uns ost<lblishcd at Harictta, Georci:::, ~mel ccntinucus -vmokly classes for mothers uorc established in tho s.:-cmc hospit<,l.
Various kinds of instructive nctcrlccls have boon compiled such as Guides to personnel policies, hospital st.[.ndcords lists, nursi.1'1C crc~niz[ction chQrts, ;:nd trc~tmont tr.:-cys includinc equipment.
Prolimin.:-cr~r crcu.Kl 1rork uas lc:i.cl for futL:ro ::Jrocr<'-m :1l<::nninc and ~ssisto.ncc to ndr.d.nistrntors by <>.ttondinc roci.om1 ['~clministr.:'.tivo croup mectincs o.t uhich time intorpret~.tion of nursinc service <md nursinc nc.:;ds ucre discussed. Approxim:::tcly fifteen of those council meotinc:s vroro 2.ttendcc~ clurinc the yoc:r.
- 10 -

c. Food Service and Dietetic Consultation Program
The services of the Dietetic Section, Division of Hospital Services, fall into three general categories:
1. Reviei'l of blueprints and nrchiteet 1s workinc drawings 2. Consultative service on dietetic matters to smaller hospitals
3. Development of institutes end c~scussion meetints for dietitians
and food service supervisors The tJOrk in connection Hith blueprints consisted of a revieu of blueprints of hospitcls being plan11ed and those under construction. After evaluation of these blueprints, reports are developed uith recornrnendations for any chances that seemed to be indicated for improvement of the operatinG efficienc:~ of the dietetic departments. Equipment lists for food service are reviewed and checked. The consultative service consisted of an inspection and appraisal of the dietary facilities and service of several hospitals. These inspections vrere followed by conferences uith dietitians, and/or food seryice supervisors and administrators. These conferenc~s include revieus of findinc.s of the inspections, Recommendations are r;iven for chances in or development of the dietary service, These recommendations usually are concerned vlith various problems relatinG to personnel administration, use and cc..re of equipment; dietetic procedures, food procurement and diet therapy. Durinc the year, a dietary institute for food service personnel of the Hest Central Hospital Council /.rea vms held at the Upson County Hospital, Thomaston, Geort;ia. A four day meeting on Institutional k:nagement uns conducted for Georgia Recional Nutritionists in Atlanta, A scheduled program for monthly meetinss of dietitians and food service supervisors in hospitals hc..s been developed and is being carried out in certain hospital councils of the State. The procrams for these rneetincs are pl~ed on a six months basis covering the follouing subjects: menu planning, food cost accountint; <md control; employee
- ll -

training, sanitation and food handl ng, diet therapy, and food preparation, preservation, and storage.

HOSPITAL LICElTSURE PROGRAM

The Hospital Regulation Act, No. 623, Georgia Lmws 1946, authorized the

State Board of Health to make and promulgate reasonable rules and regulations for

the protection of the health and lives of inmates and patients of hospitals. In

October, 1948, tho State Board of Health adopted rules and regulations and required

a permit of all persons operating a hospital.

In carrying out tho provisions of the above mentioned regulations, per

sonnel of the Licensure Section inspected 83 hospitals during tho year and made

200 additional visits. Return visits 'vera made to approximately 75% of all hos-

pitals inspected and non-comlJlianccs w-ore discussed liith the administrator. These

re~urn visits have resulted in quite a number of improvements in different hospitals

over the State. Permits wore issued to 232 hospitals in the State.

Considerable "t-;rork was done on tho re-survey of all existing hospitals.

Visits v1ore made to determine vlhether or not a hospital could be rcconunendcd as

acceptable or replaceable according to the revised State Hospital Plan. Tho

Licensure Section has worked in conjunction with the State Fire }mrshal in deter-

mining the acceptability of existing hospital facilities in regards to fire safety.

The Licensure Section had members in attendance at the American Hospital

Association meJting in St. Louis in September 1951, and all members attended a

two day institute for governing boards and administrators both in Savannah and

Rome. Many useful contacts v10re made and much usable infori,mtion v1as obtained at

these various meetings.

Hospitals uero informed of the St2.te Ac;oncy (State Department of Education)

responsible for the disposal of surplus property and through contacts made by tho

Licensure Section, many hospitals arc noll participating in the Surplus Property

Program.

- 12 -

A number of nursing homes have been visited to secure information that is needed to determine if such institutions come under the requirements of the licensure law. College and university infirmaries have also been visited for the same purpose.
The Licensure Section has participated actively in Civil Defense Planning related to providing emergency hospital care. One member of the Section has attended all the regular Civil Defense Planning Heetings during the year and has assisted various comnutteos in this field.
OTHER ACTIVITIES OF Tr~ DIVISION
A. Hospital Trustee Conference
Uith the assistEmcc of tho u. s. Public Health Service, two conferences
for hospital trustees and administrators vTCro hold during the year. The first at Savannah on October 29 and 30, the second at Rome on November 1 and 2. The attendance at each of these conferences uas approximately forty with from tvTOlvc to fifteen hospital trustees and fifteen to eighteen hospital administrators at each meeting. The object of those conferences was to assist hospital trustees, particularly those who have been recently appointed, in becoming familiar with their duties and responsibilities. B. Hospital Councils
Seven regional hospital councils have boon established as constituent parts of the Georgia Hospital Association. These councils arc designated as follovrs:
Northeastern Hospital Council East Central Hospital Council Southeastern Hospital Council Northwestern Hospital Council West Central Hospital Council Southwestern Hospital Council Atlanta-Dckalb Hospital Council Any hospital vli thin the area covered by tho council is eligible to attmd meetings and participate in its activities. Each of the hospital councils held
- 13 -

meetincs during the year and conducted programs of interest to persons concerned with hospital administration. Roproscnt:?.tivcs of the Division of Hospital Services have attended meetincs of the various hospital councils. The nursing consultant and the dietetic consultant have boon especially active in participatinG in programs of the hospital councils. A special effort is made to have e rcprosontative from this Division attend each meetinc of the hospital councils hold outside of i'..tlcnta. C. Need for Trained Hospital Administrators
llith the completion and l)Utting into operation of tuonty-throo hospitals since tho beginning of tho Hospital Construction Procram, tho need for trained hospital administrators -v;ho can be secured at a salary that tho smaller hospitals of this State can afford to p~y, has been repeatedly stressed. Slichtly more than seventy-nine per cent of the hospitals no-vr in Georgia have fifty bods or loss. During this year, thoro h2.vo boon eight chances in administrators of neuly opened hospitals in tho State. Some of tho persons appointed as administrators for the now hospitals had little or no background in hospital administr&tion. Some have no background lvhatsoevor in any type of hospital iJOrk. Efforts are being made to secure tho cooperation of one of tho units of the State University System in tho development oi a course of traininc in hospit2.l administrc.tion that vJOuld be of especial v2.lue to persons ilho rTould undertake administration of hospitals of fifty bods or under. D. Eugene Talmadg~ Homorial Hospital, .\ucusta, Georgia
l~ considerable amount of time has boon spent bJ staff members of the Division of Hospital Services during tho year imrldng'Wi.th tho architects and a special hospital consultant in various pl1ascs of the preparation of plans for the ncu Stc:tc general hospital that is to be erected at Aucusta as tho teaching hospital for the Hedical College of Georgia. This hospit2.l vrill provide medical care for indigent citi7.cns from all sections of tho State. Tho hospital vlill have approximately eight hundred bods. ~ training school for nurses is planned as well as instruction for medical technologists and x-ray technicians. The
- 14 -

hospital will also include n psychiatric scroeninc unit ~d speci['_l facilities for the study ~d tro~tncnt of chronic clccholic ~clc1iction. Unusuc~l efforts h.:-ve been ronde to insure in the plnnninc of this institution th~t the most modern nrrnncoment of fncilitios ~nd oquipnent uill be ['.Vc..ilnblo for providinc modicc..l cc..rc for the indicant sick c..nd for tho instruction of medic.:'.l students. Construction is expected to bocin durinc 1952.
E, Civil Defense
Activities c.s rolc.te to hos)ikls hc.vo included :x~rtidpction by severnl members of the Division st.:cff in the St.:-tovride Civil Defense Pl.:cn. Representatives from tho Division h.:cve .:-.ttended tho monthly civil defense mootincs hold in Atlanta nnd hnvo rendered <:>.ssist:.nce to the St.:cto civil dofonse orc.:cnizo.tion in collectinc informtttion ::-.s to the :)rofossionc.l stc.ffinc of dl hospitc..ls in Georcin :.mel the nccmnulntion of other ir,1l1ort~~nt infcr:r.1.:ction nccessn~r in formul.:ctinc current civil defense pl:ms c.s cunccrn hospikls for !'.11 sections of the Sto.to. F Hiscell~ncous
A medic~l record libr.:-.ri:o.n consulknt :rorldnc on [\ pr.'.l't-timo b~sis h~s ~ssisted ncvrly opened hcs:):i.t~ls in tho ot~t~blishr~1ont cf clinicr-.1 records uhich Qre so import<='.nt for the pormt'.nont files of etech hospik.l.
The cledic.:-~tion coremon~r for now hospitcls is nn import.:-nt event in eo.ch cormnunity. Reprcsent~~tivos from the Divisicn h~vo r-.ttondocl dodicction ceremonies for thirteen hos~it~ls durinc tho yoter,
The folloninc ch:mcos hnvo tckon pl~co in tho stnff of the Division durinc tho yor-.r:
Appointed c'.S Chief of tho Survey Section, Hr. UillL'm E. Uzzell Appointed tc tho sk~ff of tho Survey Section, Nr, 1Jnlter E. Cooke Resic;ncd .:-.s Dietetic Corwulk.nt, Hrs. IL:ry P. ~Jerrell, uho -vr~s succoodod sovcr.:cl months 1:-.tcr by Hiss n~_rjoric J, Uood. Tv1o hospit_.l r-.c!ministr!'.ticn technicinns nero o.clc~ocl to tho Licensure
Section clurinc: the ye;>r - Hr. Dr-.vid c. Clc.rk ;>_nd Irr, lli.llr>.rd L. Uonr.
- 15 -

'Ilm auditors uerc added to the staff during 19.51 - Hr. Marion K. DeLoach r.lld Iil'. C::r1 .A.. Ridloy.
Dr. Ralph C. Hilliams became Director of the Division on January 22, 1951.
- 16 -

LIST OF CONSTRUCTION PROJECTS
Hospital ~md Hcc.lth Centor Cohstruction Program Doccmbor 31, 1951

Hospital Status

Hospitals Completed
-Name
1. Tanner Hemorial Hospital 2. Minnie G. Boswell Mom. Hospital 3. upson County Hospital 4. Hall County Hospital
5. Hitchell County Hospital
6. Elbert County Hospital 7. Cobb 11cmorial Hospik.l 8. \lorth County Hospital
9. St. Frances Hospital
lOo Stewart-llcbster Hospital 11. Spalding County Hospital 12. Kennestonc Memorial Hospital 13. The Memorial Hospital
14. Jasper County Hospital
15. Burke County Hospital 16. Arlington City Hospital 17. Rabun County Hospital 18. Towns County Hospital 19. Terrell County Hospital 20. Baxley~ppling County Hospital 21. Screven County Hospital 22. Barrow County Hospital
Hospitals Under Construction
-Name
1. McRae-Telfair County Hospital 2. Chattooga County Hospital .3~ Coffee County Hospital
4. Habersham County Hospital
5. ..\mericus-sumtcr County Hospital 6. Emanuel County Hospital 7. Atlanta Negro Hospital 8. St. Joseph Hospital
9. McDuffie County Hospital
10. Tri-County Hospital 11. Bacon County Hospitil 12. Laurens County Hospital 13. Trcutlen County Hospital

Location
Carrollton Greensboro Thomaston Gains ville Camilla Elberton Royston Sylvester Columbus Richland Griffin Harietta Adel Honticello Waynesboro Arlington Clayton Hiauassee Dawson Baxley Sylvania ilindcr
Totals

No~ of
!!fie

Total Cost

37 28
92 112
32 4"7 2.3 28
154
2h 96
105 27 "25
J8
16 20
14
28 "27
34
-40
1,047

0 528,000~00
401;250.00
1,122;000~00
1'608 ;306 ~00
268,168~72 780:,2'16~00
213 ,460.3 2 . 29.3,113. 72 1,910,566.68 . 255:,536.38 1,321,491.00
1,226,321~9>
19.3,800.00 26o,ooo.oo 416,069;91
158,900~00
2.37 ,ooo~oo 17.3 ,o65 .oo 254,167 .so 258,024.90 .332,000.00 550,000.00
~ * --- .
$12,761,518.08

Location

No. of Beds

Total Cost

Ncnae Summerville Douglas Demorest Americus Svrainsboro Atlanta Aucusta Thomson Fort Oglethorpe Alma Dublin Soperton
Totals

.30 31 60
hh
100
5-o 116 110
29 100
3"0 60
..12_

0 .36o;ooo.oo
345,000~00
937:,264.00
499,545.00
1,320;000~00
591;790~00
1,717,984.02 1,566;ooo.oo
325,500.00
1,109;066~00
329,;000~00
886:,068.00
300 24lo.oo

785 ;,'p\ 10,287,627.02

- 17-

HOspitals Approved
-Name
1. Lmmdes County Hospital 2. Gordon County Hospital 3. Rockmart-Aragon Hospital 4. Crisp County Hospital
5. Turner County Hospital
6. Irwin County Hospital 7. Peach County Hospital
8. Pierce County Hospital

Location
Valdosta Calhoun Rockmart Cordele Brunswick Ashburn Fort Valley Blackshear
Totals

No. of Beds
80 40 25 40
75 25 25
-25
l3S

Total Cost
$ 1,1)2,000.00 531,900.00 300,000.00 542,500.00
l,o5o,ooo.oo
330,000.00
366,500.00 3$0,000.00
41622,900.00

eomplated .' Nrune

Additions and Alterations to HosEitals

Location

No. of Beds

Total Cost

1. City-County Hospital
2. Athens General Hospital 3. Hacon City Hospital 4. Hacon City Hospital
5. Polk General Hospital

LaGr<::.nge Athens Hac on Iracon Cedartmm

74 $ '>o4,ooo.oo

71

552,900.00

156,445.37

28

57,858.66

10

69,500.00

Under Construction

Totals

l8J

{\
\II 1,340, 704.03

1. ~ County Hospital

Toccoa

16

.(.'; 4o5 ,275. 20

Approved

1. Americus-Sumter County HosiJital A.'11ericus

~ 199,200.00

2. Universit;r Hospital

Aur;usta

10

900,000.00

3. Vereen Henorial Hospital

!Ioultrie

24

478,500.00

4. Jolm D. Archbold Hem. Hospital Thomasville

25

5. Tift County Hospital

Tifton

-30

300,000.00 253,400.00

Total

89

.(.'; 2,131,100.00

Other Projects

Completed

1. l1itchcll County Hospit2.l (Nurses Home)
2. Heard Count:; Nemori al Hospital (Equipment)
3. Nurray County Hospital (Equi-Jment)

Camilla FrCJ.'1klin Chatsvmrth Total

18
.....
37

.co {\
'til

42,903

17,217.22

41 2000.'00 $ 101,120.22

Under Construction 1. Battey State Hospital (Nurses Home) Ronc 2. Battey State Ho.spital (Laboratory) Ror.1e
- 18 -

...

oc;;'>' 161,r2o.co 156zo55.00

w"' 317,575 .co

Approved 1. Columbus City Hospital (Nurses Homo) Columbus

Health Center Status

Health Centers Completed

count;E
1. DeKalb 2. Fulton 3. Fulton 4. Fulton .5. Fulton 6. Fulton 7. Fulton 8. Fulton 9. Fulton 10. Fulton 11. Fulton 12. Fulton 13. Fulton 14. Fulton
15~ Fulton
16. Harris 17. llilkinson 18. ;~,tldnson 19. Taylor 20. Bulloch 21. Spalding
22. Lamar
23. Elbert 24. Oconee 25. Davrson 26. Camden

Cit;r
Decatur Lakewood South Fulton ..Upharetta Sandy Springs Center Hill Adamsville Atlanta Howell Hill Fairburn Collins Buckhead Red Oak Rockdale Porkerson Hamilton Irwinton Pearson Butler Statesboro Griffin Barnesville Elberton if2.tki.nsville Dausonville Woodbine

Total

Health Centers Under Construction

Countz
1. lvaync 2. Thomas 3. Clarke
'4. Gwinnctt Effingham
6. Meriwether 7. !1cintosh
8~ Rabun
9. Burke 10. Hitchell 11. Brooks 12. Evans 1.3. Floyd

citx
Jesup Thomasville Athens Lawrenceville Springfield Greenville Dairen Clayton Uayncsboro Camilla Quitman Claxton Rome Total
- 19-

~ 300 ,ooo.oo
Total Cost
$ 19.5;216.00 37,93.5 .18 33,111.1.5 3-7:,6.53 .5o 36,270.70 42;120.28 43 ,001.4.5 476,881.00 31,678.62
40,696~08
39,379.81 38; 726~14
42,085~78
32,900.89 38:,189 ~ 79 33,800.00
37:,230~00
20,440.00 23 ;230~00 61;470.00 167 ,.5oo.oo 16.5 ;3 72.00
79;530~00
43,.500.,00 45,436.00 46,ooo.oo $1J 889 .3.54 ,J?.,
Total Cost
$ 87,.508.00 163 ,2.50~00 164,871.82 119,21.5.00 37,616.84
82,.500~00 49:,980~00 65,200~00
61:,322.00 -81,.530.92 .. 66,41.5 .oo :32,098.18 60,925.00 $1,072,432.76

_ Health Centers ~pproved County __.~~,
1. Dado 2. Douglas
3. Polk
4. Charlton
5. Hichmond
6~ llalton 7. Jenkins 8. Berrien

City
Trenton Douglasville Cedartown Folkston ,.\ugusta Honroe Hillen Nashville
Total

Total Cost

.I.\; 41; 705 ~00
35,000~00 75;450~00
.. 39;450~00
38o;aoo~oo
88;,400,00
40;,000~00
37 zl70.oo

t'
<J

73 7,9S'5 .oo

- 20-

ANNUAL NAHRATIVE REPORT DIVISION OF INDUSTRIAL HYGIENE GEORGIA DEPARTMENT OF PUBLIC HEALTH
January through December, 1951

INTRODUCTION

There are 5,000 factories and 15,000 mercantile establish-

ments in Georgia. More than 725,000 non-agricultural work-

ers are employed. All of the present or prospective defense

or war production labor forces of the State are included among these. Probably less

than 10% of these workers enjoy the benefits of an in-plant health maintGnance ser-

vice. The Health Department is the official agency specifically charged with the

responsibility of assisting these establishments and their employees in all health

matters. This assignment of responsibility has been acknowledged by the military

services &~d the United States Public Health Service.

Occupational disease control is the specialty of the Division of Industrial Hygiene. Non-occupational dis~ase control is an obligation which must be and is met by integrating for industry all the useful services of the state and local health departments and related agencies.

These services are directly related to the potential and actual productive capacity of the State in any war effort (especially in such plants as shipyards, munitions plants, chemical industries, assembly plants, and the like). The employees' health, sickness-absenteeism, and productive ability are all functions of industrial c~pacity.

There are two approaches which apply to either occupational or non-occupational 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. The problem is to match the two.

This means that the industrial medical department is a necessity. It is needed to match the physical capacities of the worker with the physical demands of the job. The responsibility is also placed upon management to match the physical demands of the job ~nth the physical capacities of the worker. Our national surTival may be dependent upon the last ounce of production. Production jobs will have to be adapted to the physical capacities of the available labor pool, including l'lomen, and the physically handicapped.

PERSONNEL

A good program as outlined above requires a team made up of

doctors, nurses, engineers, and chemists, an on occasion other

specialists in such fields as radio-activity, noise, and

lighting. 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, and with

their assistance our personnel have been and are being trained in radiation monitoring!

The division personnel who participated in the activities described in this report included: the medical director, a chief industrial hygienist, two consultant nurses, two chemical engineers, four chemists, and three stenographers; in addition were the part-time services of a nutritionist. Insufficient funds prevented the employment of an additional medical doctor, although demands from the field for medical assistance are increasing in excess of our limited resources.

Employees of other divisions of the State Health Department and of regional and local health departments have also contributed services to industry within their respective specialties. Particularly important in special fields are: 1) the Divisions of (a) Venereal Disease Control, (b) Tuberculosis Control, and (c) Laboratories in the mass blood test and chest x-ray surveys; 2) the Division of Maternal and Child Health in nursery schools for children of working parents and in industrial nutrition; 3) the Division of Sanitary Engineering in
industrial water supplies, sewage disposal, and industrial wastes, and 4) the
Division of Vital Statistics in records and reports.

MEDICAL AND NURSING

Medical and nursing activities include the investig~tion

ACTIVITIES

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 a..."ld adequate records. Also included are the promotion of

general health maintenance procedures in industry and the coordination of industrial

health programs with the community health programs and all other resources. Programs

dealing with tuberculosis, venereal disease, immunizations, eye sight conservation,

nutrition, sanitation, dental hygiene, and health education are emphasized whenever

possible the same as the program for occupational disease control.

.

INDUSTRIAL HEALTH

There are a few full-time industrial medical departments

MAINTENANCE FOF.

in Georgia. These are usually found only in larger

SMALL PLANTS

industries even though it is estimated that the smaller

plants employ 90% of the workers. One of the most signi-

ficant developments in the industrial hygiene program in

Georgia is the promotion of full-time industrial health clinics for small plants

on a cooperative basis--each full-time clinic giving specialized health maintenance

service to a number of small plants. There are no better facilities to serve as

nucleii round which to develop civilian medical defense than are afforded by modern

industrial clinics sta~fed by full-time specialists in industrial health maintenance.

Such clinics should be established throughout the state by the industries themselves

in every industrialized area. They provide an effective answer to the demand on the

part of employed people for better distribution and application of medical knowledge;

and they are within the framework of private enterprize and divorced from government-

al bureauracy. Industries which have a medical department are better equipped to

carry out and profit from the findings and recommendations of industrial hygiene

surveys.

The director, consultant nurse, and others have continued to be active in the stimulation of small industries to form cooperative health centers. The Atlanta Industrial Health Center No. I started operation August 7, 1951. It has been named 11The Petrie Clinicn in honor of the Director of the Division of Industrial Hygiene. All costs are borne by the participating industries. They have provided clinic facilities, f~ll-time nursing service and have employed a physician on a retainer fee basis. This is the fruition of over eight years of preparation toward this objective. The medical director of the Division of Industrial Hygiene has devoted many hours to consultation Hith officials of the Fulton County Medical Association headquarters staff in Chicago, and legal counsel to assure their complete support and ~"lderstanding of the clinic. Written opinions are in the record that the clinic is in harmony with the laws of Georgia and the ethics of t~e medical profession. The establishment of the clinic is considsred to be a positiv-e approach to the fulfillment of the 'Sleventh plank in the platfoTm approved by the House of Delegates of the

American Medical Association a year ago in covering objectives to combat the develop- ment of socialized medicine in the United States. Instead of maintaining a serene satisfaction with the status quo, p~oper 6~idance is being given to the inevitable pressures for social change in our 20th century economy.
The Medical Director is on the Board of Directors of the Petrie Clinic. At present there are three industries participating which represent an employee population of 750. It is anticipated that other companies will join. There is now one full-time nurse and a part-time doctor employed, but as the nurr:ber of employees increase, another nurse will be added and the services of the doctor
will be required on a full-time basis. Additional centers in the Atlanta Pxea are
envisioned for the future.

NURSING ACTIVITIES staff to two.

In January of 1951 a new consultant was added to the staff to replace the nurse who entered Military Service in July, 1950. This brought the number of consultant nurses on the

The two nursing consultants have as""isted in the promotion of nursing services in industry including cooperative health centers for small industries and establishment of proper and adequate records. Also included are the promotion of general health maintenance procedures in industry and the coordination of industrial health progrqms with the community health resources and all other resources
Programs deal ng with Tuberculosis and Venereal Disease case finding and control, immunization, eye sight conservation, sanitation, dental hygiene and health education are ewphasized whenever possible, the same as the program for the control of Occupatiot al Diseases and other hazards of work.

Since the coming of the nutritionist to the staff more impetus has been given to the questions regarding fGeding programs in industry and the nutrition of workers.

CIVIL DEFENSE

In January, 1951, both consultant nurses attended a five-day

NURSING

course on "Nursing Aspects of Atomic Warfare" at Emory Uni-

versity. The course was sponsored by the National Security

Rssources Board and the Atomic Energy Commission with instruct

ors from the United States Public Health Service. Subsequently the nursing consultant

have taught ten classes throughout the state. In the classes they taught were nurses

from industry, Public Health, hospitals, private duty and a few others classified as

"inactive". In addition to the above participation in Civil Defense activities, each

consultant has been given an assignment with the State Civil Defense Health Services.

Other nursing activities carried on during 1951 included keeping the nursing roster up to d~te; publication of the Industrial Flashlight; promotion of and assistance in multiphasic health testing in industrial plants. Some assistance has been given to management in planning and equipping medical departments and the procurement of nurses. Promotion of broader in-plant programs through visiting individual nurses and helping them with problems and encouraging the use of community resources and health education materials; talks to professional adjustment classes in hospital training schools. The consultant nurses have been active in the meetings of the nursing organizations including the Georgia Association of Industrial Nurses, Georgia State :lurses Association and the Atlanta Industrial Nurses Club. One of the consultant nurses arranged the Education ProgrQms for the Atlanta Industrial Nurses

Club for the year. This consult'3.!lt is a member of the Educs.tion Committee of the Georgia Association of Industrial Nurses. In connection with her duties as a member of this Education Co:;:mittec-:l, the consultant participaf~ed in an education program held in May for industri'll nurses throughout the state. The Educo.tion Committee also assisted in the revision of the Health Calendar which is an aid designed to encourage Industrial nurses to car~; on an effective continuous health education program in industry.
Both consultant nurses are interested in having an industrial nursing course for the industrial nurses in Georgia for the summer of 1952. Letters have been written and conferences held relating to the matter and at the close of 1951 the prospects look very brigbt for having such a course at the Atlanta Division of the University of Georgia. The Consultant Nurse on the Education Committee of the Georgia Associl::,tion of Industrial Nurses has kept her committee informed of progress made in this direction.

EXHIBITS

The nursing exhibit "Georgia Nurses in Industry - Pictorinl

Highlights" was shown at the meeting of the American Associa-

tion of Industrial Nurses in Atlantic City in April and at the

Boston College "Open House" for the National League of Nursing Education in Boston

in May. It continues to be useful when :naking talks to student nurses; public health

nurses and others to show the scope of industrial nursing.

The Health Calendar and the exhibit just mentioned were shown at the Georgia Stg,te Nurses Association meeting in November. There was also a spot map showing the location of all industrial nurses in the state.

CONGRESS ON DWUSTRH...L In February, largely through the efforts of the medical directHEALTH OF THE Al~EEICAN or, the 11th Congress on Industrial Health of the American MEDICAL ASSOCIATION AT Medical Association nas brought to Atlanta. This was recogTHE NURSES LUNCHEON nized by the foremost medical authorities of the growing im-
portance of industry and the industrial health movement of the
southeast in our nation.s.l economy.

One of the luncheons held during thls meeting was sponsored by the Georgia Association of Industrial Nurses and the Atlanta Iadustrial Nurses Club. One of the Consultants was chairman of the arrangements ana an attempt was made to give as many indust!'ial nurs::;s as possible sor:1e responsibility for the luncheon. They were very active in contacting industrial mru1agement and getting them to participate by their attendance, providing table favors, sending their nurses and in many other ways which brought not onl:l the industrial nurses closer together but gave management a better understending of nurses and their important place in industry. Mrs. Gladys Dundore, Exe~utive Secretary of American Association Industrial Nurses, New York City did much to strenf!then this understanding and relationship by her talk addressed to over 150 people including industrial nurses, management, d-:Jctors, safety engineers and others.

ATLANTIC CITY

In April the director, an industrial hygienist and a consul-

INDUSTRIAL HEALTH

tant nurse attended the N'3.tional Industrial Health Conference

CONVENTION

in Atlantic City, New Jersey. Organizations participating in

the annual convention included: the American Conference of

Governmental Industrial Hygienists, the American Industrial

Hygiene Association, the Industrial Medical Associa.tion, the American As3ociation of

Industrial Nurses, and the American As~ociation of Industrial Dentists. The medical
director was elected president of the American Conference of Governmental Industrial Hygienists.

PUBLICATIONS

One article has appeared in Nursing World, the magazine

incorporating industrial nursing. It was on the "Highlight

of the Industr:l.al Health Congress" and told of the industrial

nursing participation when the Congress was held in Atlanta, Georgia, in February 1951,

CIVIL DEF'ENSE WORK
BY
INDUSTRIAL HYGIENISTS

During 1951, much of the time of the medical director and two Industd.al Hygienists was spent in either the medical or enginEering phase of Civil Defense activities. The medical director was appointed by the Commissioner of Health to be deputy director of health services in the state Civil Defense organization.

The activity of two Industrial Hygienists centered around the development of radiation monitoring training progrrlms for hec;lth department personnel throughout the state. In order to be able to learn the latest methods for such work, three of the Industrial Hygienists attended a radiation monitor school at the U. S. Public Health Service Field Office in Cincinnati, Ohio. Upon completion of this in-service training and purchase of the necessary radiation monitoring equipment, schools similar to the Cincinnati courses were begun in each of the regional offices.

ECONOMIC POISONS

The use of pesticides has been expanded from year to year until

today it is i~possible for a farmer to market a crop unless

he used these materials. Each of thes"l agents is a poison and

as such muat be used with Y3.rying degree of caution. The I:1dustrial Hygiene Division

has attempted to stay abn:ast of the development of newer insecticides and methods for

their evaluation in cir contamination work and in human exposure.

CJnsiderable work was done with the plant in Georgia processing parathion and through the efforts of this division, control measures were instituted which have materially reduced exposures of pers')r.nel in this plant to parathion vapors.

l<,LUOHOSCOPIC SHOE

During the year an effort was made to inspect all fluoroscopic

FITTING MACHINES

shoe fitting devices in the state. Studies of each macblne

were made to determine the amounts of radiation produced, the

quantity and direction of stray radiation, the proper timing

of each instrument, and certain other electric features of these devices.

STUDIES IN THE GRANITE In November of 1951, all grGnite workers in the three-county

INDUSTRY

area co~posed of Elbert, Oglethorpe, and Madison counties,

were given the opportunity to take part in a multiphasic

health test examination. Some 1400 stone workers took advantage of this opportunity.

It was pos,3ible as a result of these tests to compare the chest x-ray data obtained

on this examination with that previously obtained in May, 1949.

STUDIES IN THE

This division continued its efforts to evaluate the environ-

KAOLIN INDUSTRY

mental health conditions in the many kaolin mines and plants

th~oughout the state. Supplimenting this work, an e~~ort

was made to obtain chest x-rays o~ all individuals who had

a kaolin exposure in either the mine or the mi 11.

TABLE I

GEORGIA

S:Ji'i1i:ARY OF INDUSTRIAL Hl"C-IENE i\CTIVITIES

January-December, 1951

No. Establishments.



No. of Workers



No. of Plant Visits 1f..ade

Reason For Service:

Self-initiated

Request:

Yanagement

78

Labor.

0

Local Health Organizations.

48

Private Physicians

10

Insurance Carrier.

10

Other.

19

Occupational Disease

Follow-up

Type of Service Given:
Promotional Environmental Surveys Technical Studies Nuisance Complaint Appraisal of Medical Department Investigate Occupationol Disease Examination of Plans Tuberculosis Surveys VD Surveys Consultations Regarding:
Working Environment Medical Services Nursing Services

No. Plants

207



93

85

12

6

39

12

42

38

111

44

99

Imnrovements Recommended:

No. Plants

working Environment

70

Health and Welfare

55

Improvements Carried Out:

'}orking Environment.

10

Health and Welfare.

25

pecific Services:

Chest X-rays

Blood Tests



Samples for Lab Analysis



Field Determinations



O.D. Cases Investigated

No. Recommendations
3h8 85 41 35


408 129550
813
230 165



6

7

No. Services
291 163 147 15
9 30 18 56 51
162 69
191

No. ilorkers
Affected
2DLf33 38475

501 21290

14926 13061
884 829
36

'f"
TABLE II
! UNBER OF PLANTS SERVED BY THE DIVISION OF INDUSTRIAL HYGIENE, AND TYPES OF SERVICE
RENDERED

1941
Total No. Plants 20
No. New Plants (initial service during cur1e_.t o~riod) ._ . ~ 20 No. Old Plants (service initiated in f'J:'e_yi()U~ ]l_eay0 _ --

1942
96
87
9

1943 113
47 66

1944 1945
83--m~ 15)

34 _ 96

51

57

1946 183
128
5~ )
146 120
49
5

1947 192

1948 223

1949 412

1950 5J2

83___~1~6-~___2_6_8~ __ _356

99

107

144

146

36

30

69

32

77

43

93

2~3

87

179

306

233

-47

85 1

34 5

24 12

1951 TOCTUAHLUL1A9T4IV1E-51
408 r,t>09
137

Located . 14

28

31

21

31

25

h5

68

78

60

60

172

________ _
--------------~-~-~-----------.;__

DIVISION OF LABORftTORIES
The chief function of this division is to assist physicians and local health departments in the diagnosis of infectious diseases through the application of a wide range of scientifically approved technics to various kinds of specimens collected from patients and suspected carriers. In this way it serves a most useful purpose in epidemiologic investigations and control of communicable diseases. To insure the receipt of specimens satisfactor,y for examination, it prepares and distributes various types of outfits. A complete record of all laboratory examinations is maintained, from which information in regard to the occurrence of communicable diseases within the state, is compiled and made available to other divisions of the department.
Another function includes the preparation and distribution of antirabic treatroent, typhoid vaccine and silver nitrate ampules. It also advises with pnysicians in regard to the necessity of antirabic treatment and as to the type indicated. A variety of biologics, antibiotics, and drugs used in the treatment and prevention of communicable diseases are purchased and distributed. Evaluation studies are conducted with various laboratories in the state in connection with approval as required by the state premarital and prenatal laws.
LABORATORY SYSTEM The Division of Laboratories consists of the Central laboratory in Atlanta end branch laboratories at Albany, Macon and Waycross. The same type of service with very few minor exceptions is rendered in the branch laboratories as in the Centr~l laboratory. It also directs and is responsible for the laboratory services rendered in the Alto Medical Center and the Battey State Hospital. The types of examinati:)ns in these institutional laboratories are determined by the requirements of the medical staffs. The demand for laboratory services continues to climb upward. Another

-2-

all time record of 1,372,216 examinations was established in 1951 as

compared to 1,176,962 in 1950. This is an increase of 195,254 or 16.6 percept

over the previous ye~r. The greater portion of this increase was due to the

expansion of the blood sugar work to include specimens collected by the

communicable disease investigators. Other v.ork related to laboratory

examinations shows correspondinglY increased activity.

The growth of the division of laboratories over the last 20 years is

illustratsd in diagram I. Five year periods were selected from 1931 through

1941 and then two ye~r periods are shown for the last 10 years. The previous

yeEJ.r is also shown for the purpose of immediate comparison. It ~"ill be noted

that there hc,s been en uninterrupted expansion of laboratory services since

1945. The elevation shown for 1941 and 1943 was occasioned by the hea~

demand for serologic tests on registrants during the last war.

Diagram II shows the distribution of the specimen load by laboratories

in terms of volume and percent. The distribution of examinations by

laboratory units is shown in diagram III in like manner.

A comparison is made in table 1 of the volume of work done in 1951 in

the several la.boratories with the examinations made in the previous year.

TABLE 1

SPECI1v1EN LOAD BY LABORATORIES 1951 - 1950

Central

1221
8i6,783

l-.2.2Q
559,450

Increase or Decrease
+257,333 +46 .O%

Albany

144,726

156,857 - 12,131 - 7.7%

V.acon Waycross

155,391 110,325

153,088 103,221

+ 2,303 + 7,104

+ 1.5% + 6.9%

Alto Medical Center

_56, 722

104,327 - 47,605 -45.6%

Battey State Hospital

88,269

100,019 - 11,750 -11.7%

GRAND TOTAL

1,372,216 1,176,2 +195,254 +16.6%

1,400,000
1,200,000
1,000,000
0
IzLl 2c
)(
ILl
zCl) 800,000
ILl
2
(.)
ILl A.
Cl)
II.. 600,000
0
a:
ILl CD
2
:z:l 400,000

Diagram I
GROWTH OF LABORATORY WORK
1931 - 1951 ~
-
r--

,....._ ,....._

-

,....._

200,000 0

n~

1931

1936

1941

1943

1945

194~

1949

1950

1951

Dioorom li
SPECIMEN LOAD BY
LABORATORIES
1951

CENTRAL 816,783 59.5%

218,820 15.9%
SEROLOGY 1,012,041 73.4%

Dioorom m
SPECIMEN LOAD BY UNITS
1951

-3-
CENTRAL LABORATORY
In the Central laboratory a total of 816,783 examinations were made, an increase of 257,33.3 ar 46.0 percent over 1950. Marked increases are observed
in the milk and serology units with a moderate increase in the microscopy unit. The decrease shmm in the culture unit is more apparent than real due to the discontinue.tion of gonococcus culturing and the transfer of the streptomycin sensitivity tests to the microscopy unit. The increase in the milk unit reflects anticipated growth.
BRANCH LABORATORIES
THE ALBANY BHANCH LABOR~,TORY me.de 144,726 examinations which is a decrease of 12,131 under the previous year. This decrease occurred prin-
cipally in serology and reflected the change in policy in diverting specimens collected by the communic~.ble dise8.Se investigators to the Central laboratory for the blood sugar determination as well as the Serologic tests for syphilis. The microscopy and culture units showed e. moderate decrease while the milk examinations more then doubled those of the preceding year. The number of
examinations made for private physicians increased by 3,722 while those
made for health departwents decreased nearly twice that amount. Of special interest was the isolation of typhi murium in a salmonella
outbreak in the maternity ward of a small hospital in southwest Georgia in May. This organism was recovered in a total of 9 cases which include two
maternity patients, 6 newborn infants, 1 of whom was premature, and a nurse
in the maternity ward.
THE MACON BRANCH LABORATOHY lead the branch laboratories with 155,391 examinations which is a 1.5 percent increase over the previous year.
Increases were shown in the microscopy and milk units ~~th some decrease in the culture and serology units. The patronage from health departments and
private physicians show no change from 6o and 40 percent, respectively,

-4reported in 1950. The loss in the serology unit is attributed to the diver-
sion of specimens collected by the communicable disease investigators to the Central laboratory.
The isolation of S. typhosa from a specimen of blood was of special interest because it was made three months after a previous isolation from the blood of the same patient. Both cultures were of the same type.
THE WAYCROSS BRANCH LABOR'TORY continued to show an uninterrupted grovrtp for the past three years. ftll units reflected substantial gains over the
preceding year. A total of 110,325 examinations were made, which is an increase of 7,104 or 6.9 percent over 1950. The establishment of the milk unit in this laboratory in October accounted for onlY 446 of the increase in total
examinations. Patronage from private physicians represented approximately
40 percent of the examination load with 60 percent coming from health
departments An interesting finding in intestinal parasite examinations was that of
E. histo~tica trophozoites and Strongyloides stercoralis larvae in the same stool specimen. There was only one positive examination for rabies during the entire year.
INSTITUTIONAL LABGrtATOHlliS
THE ALTO LABORATORY made a total of 50,722 examinations. This was a decrease of 47,605 or 45.6 percent compared with the peak year of 1950. The
unusual load of that year resulted from the Greater Atlanta Survey from which a large number of patients were sent to the .Alto Medical Center. Excluding
1950 the laboratory made more examinations than in any previous year.
While the work consists chiefly in the exa~ination of specimens of blood end spinal fluid for syphilis, laboratory service is rendered for the detection of other venereal diseases. Clinical tests are made es requested by the medical staff as an aid in the diagnosis and management of illness developing

-5-
among the p&tients. Cooperation by the application of various tests is ren~
dered in studies conducted by the V. D. Research Laboratory of the U. s.
Public Health Service. THE BATTEY LABORATORY made 100,019 examin&tions which is a decrease of
11,750 under 1950. This decrease is observed in all the units with the exception of serology which showed a moderate increase. The examinations for tuberculosis, as would be expected, represent more than one half of the
specimen load. The clinical unit, however, accounted for about 35 percent of
the total examinations made. Six hundred more units of blood was cross matched for the surgical service than was done in the previous year.
On October 1, all personnel and complete operation of the laboratory were placed in the Division of Laboratories with the hospital purchasing the laboratory serices. Previously the operation of the laborator,y had been jointly administered with the hospital. A new laboratory building is under construction and will be ready for occurancy at an early date.
THE MICROSCOPY UNIT The microscopy unit showed very little difference as compared to the specimen load in the previous year. The slight increase is not an actual gain but results from the transfer of streptomycin sensitivity tests to this unit, which were previously reported under the culture unit. All types of examinations with the exception of those for tuberculosis and intestinal parasites showed a decrease. The section of the state in which communitywide surveys ere held contributes to the fluctuation of sputum examinations in the various laboratories. Table 2 presents the classification of the total examinations end positive results made in the microscopy unit of the several laboratories compared to the previous year.

-h-

TABLE 2

MICROSCOPY UNIT

1951

Pos.

Total

1950

Pos.

Total

Increase or Decrease
Pos. Total

TUBERCULOSIS Microscopic Culture Animal Inoc, Tibione Sen. Strepto. Sen.
TOTAL

5,744 5,868
734
12,346

70,665 27,518 3,371
331 1,832 103,717

7,656 6, 733
813
15,202

72,057 -1,912 -1,392

22,259 - 865 +5,259

3,189

79 + 182

91,505 -2,856 -+6,212

DIPHTHERIA
Diagnosis
Rel & Carr
Virulence TOTAL

101 1,115

218

1,908

3

4

322

3,021

269 255

- 2,701
1,138

168 -1,590 40 + 770

12 536

- - 15
3,854

9

11

214

827

GONORRHEA Microscopic
MALARIA

2,583 23

18,975 2,607

- - 2,690 19,920

107

945

5,926 + 23 -3,319

INTESTINAL PARASITES

Egg

21,225

Egg Count

Worm Ident.

Amoebic Dys.

28

TOTAL

21,253

81,901 508
23 2,899 85,3.31

22,552 37
22,589

79,479 1,004
32 3,o65 83,580

-1,227 9
-1,336

+2,422
- 4
-9 166 +1,751

RABIES Microscopic Animal Inoc.
'IDTAL

309

1,080

31

162

340

1,242

394

1,165

85

84

30

139 + 1 + 23

424

1,304

84

61

MISCELLANEOUS

3,921

5,342

-1,421

'IDTAL FOR UNIT

218,820

217,431

+1,390

TUBERCULOSIS

The Central La.boratory showed a gain of 71 950 and the Waycross Laboratory of 723 examinations but these increases were overbalanced by losses in the

Albany, Macon and Battey Laboratories. The continued decline in positive

microscopic findings indicated that mass surveys are effective in educating

the public to have examinations made, if any symptom of the disease is

-7-
suspected. The survey program was conducted in 11 counties from which 35,039 specimens were examined, of which 81 were positive. Plans are underway whereby cultures will be made more easily available in earlY suspicious cases.
DIPHTHERIA
The incidence of diphtheria through the state was low and lead to a drop in laboratory examinations. Only 101 diagnostic specimens were positive
and these were from cases in 40 counties well distributed through the state.
There were 29 positive findings from a school survey in Chattooga County but onlY three were from diphtheria patients, the remainder being from asymptomatic or contact cases. Hall County, where the incidence of diphtheria has been high for several years, continued to have the largest number of cases, although there were fewer then in recent years GONORRHOEA
Although examinations for gonorrhoea were slightly lower than in 1950, there is no marked variation from the level of the past several years in tota+ examinations or positive results. The increase observed in the Central laboratory was due entirelY to specimens from a local clinic. This increase together with that shown by the Battey Laboratory was offset by a decrease in the other laboratories.
MALARIA
There were no malaria surveys conducted in the state ~nd as a result the total exRminations showed a sh~rp decline. Only 2,607 blood smears were examined as compared to the peak ye~r of 1938 when 581 722 examinations were made. Plasmodium vivax was found in 23 blood smeers from 19 Cflses. All of these with the exception of one were from militar,y personnel recently returned from Korea. This cRse occurred in a non-veteran living in Laurens County for six years, whose illness had extended over a ten year period.

-a-
Epidemiologic investigation indiceted that this infection was loce1lly acquired. A complete file of all positive blood films is maintained at the Central Lnborntory for reference and review. INTESTINAL PARASITES
The total examinations for intestinal parasites showed a small increase
with a slight drop in positive findings compared to 1950. Approximately 90
percent of these examinations were for helminth ova. The incidence of E.
histolytica continues low with only 28 positive findings in 28,099 examinations. Among the parasites comparatively r9re in the st~te, 7 H. diminuta, 7 Strongyloides and 1 Trichostrongylus were found. The PVA mailing outfit
for demonstration of motile amoebae has given satisfactory results. The cellophane tape slide outfit for pinworms appears to be an effective diagnostic aid, yielding about twice the number of positive findings as compared to the NIH swab outfit formerly used. RABIES
A total of 1,080 animal heads were examined microscopically for rabies. Of these 309 or 28.6 percent were found to be rabid which is the lowest number since 1929. Heads from 14 different kinds of animals were submitted. Dogs, as usually, lead the list with 694 examinations, of which 211 were rabid. Included in the 309 positives are five dogs from western North Carolina. Cats,
cattle and foxes follow in order. Other predatory animals account for comparatively few of these examinations. The only positive finding among these was in a hog. In addition to those examined in the state laboratories, the municipal laboratories in Savannah, Augusta and Columbus examined a total
of 56 animal heads of which eight were positiveo Twenty-one of the 126 mous~
inoculations made on negative or unsatisfactory microocopi: exs.mi.J.ati.ons
revealed the presence of the disease. In 10 cases, suspicious microccopic

-9-
examinations reported positive were confirmed by mouse inoculation. Rabies occurred chiefly in the north portion of the state. In the latter
part of the year, an outbreak of rabies in foxes presented quite a problem in Coweta, Fayette, Meriwether and Troup counties. Several hundred cows were lost in this section and several people received treatment as a result of bites by rabid foxes. MISCELLANEOUS
Miscellaneous examinations showed a decrease of 1,421 or 26.6 percent. Most of these examinations were made for Vincent's infection at the Battey State Hospital and in studies on minor venereal diseases at the Alto Medical Center. A total of 68 smears from the eye were found positive for loch..Week's bacillus and 9 were found positive for Morax-Axenfeld organisms. REFRESHER COURSES
In April a refresher course in the laboratory diagnosis of diphtheria was held in the Central Laborator,y for a limited group of branch laboratory personnel. The trainees in the microscop,y unit also attended this course.
THE CULTURE UNIT The number of examinations made in the culture unit again showed a decrease. The discontinuation of gonococcus culturing in the Central Laboratory and the transfer of the streptomycin sensitivity test previously counted in the work of this unit are responsible for the larger portion of this drop. There was an increase in feces cultures but this was offset by a decrease in the number of blood cultures and agglutination tests. Table 3 gives the combined statistical analysis of the work done by this unit in the several laboratories as compared to the previous year. Positive agglutinations for endemic typhus, undulant fever and tularemia continue a downward trend.

-10-

TABLE 3

AGGLUTINATION
Typhoid "O" Endemic typhus Undulant Tularemia Total
BLOOD CULTURE

CULTURE UNIT

1951

1950

Total Positive Total Positive

11,279

13,501

94

88

42

142

114

157

68

78

318

465

5,127

6,688

Increase or Decrease
Total Positive
-2,222
+6 -100 - 43 - 10 -147
-1,561

S. typhosa

34

Other Salmonella

3

Brucella

28

Other organism

4

Total

69

STOOL & URINE

22,631

S. typhosa

105

Other Salmonella

108

Shigella

176

Total

389

CULTURE IDENTIFICATION -574

OONORRHOEA

2,249 127

34 3 37 16 90
19,486
81 81 157 319
425
7,247 1243

0

..

0 9

- 12

-21

+3,145

+ 24 + 27 + 19 + 70

+ 149

-4,998 -1,116

MISCELLANEOUS

3,225

5,739

-2,514

TOTAL FOR UNIT

45,085

53,086

-8,001

ENTERIC DISEASES

There were 46 cases of typhoid diagnosed in the laboratories as compared

to 50 in the previous year. In addition, 11 new carriers were found.
Exclusive of s. typhosa there were 124 isolations of 25 types of Salmonella

organisms from 85 persons, which is a slight increase over the preceding year.

Shigella organisms were isolated from 196 persons which was 39 more than in
1950. A small outbreak of diarrhea due to s. flexneri 6 occurred in a

community near Elberton.

-11BRUCELLOSIS
Both the culture and agglutination tests for Brucellosis continued a downward course. Only 28 cultures and 110 agglutination tests were positive
as compared to 37 and 157, respectively, for the preceding year.
FUN GUS CULTURES The amount of fungus work appears to be steadily increasing. Sputum
cultures were responsible for most of this increase. Specimens of sputum sent through the mails usually are unsatisfactory. More cases of ringworm of the scalp were diagnosed in the laboratory than in 1950. GONORRHOEA
Gonococcus cultures are now done only in the M0con laboratory at the request of the local health department and in the Alto laboratory in maternity
cases. Due to its discontinuation in other laboratories, the total of 3,225
examinations is approximately a 70 percent decrease from the previous year. MISCELLANEOUS
Miscellaneous examinations also showed a considerable decrease from those made in 1950. A portion of this decrease is due to the transfer of the
streptomycin sensitivity test to the microscopy unit. A total of 313
specimens of spinal fluid were examined microscopically and by culture. Of the 21 positives, 12 were H. influenzae and 6 N. meningitidis. Other miscellaneous examinations were made on food, pus, sputum, urine, throat swabs, ~nd pleural fluids. IMPROVEMENT PROGRAM
This program initiated during the year has proved to be e. valuable addition to the activities of this unit. This study consisted of the submission to the branch laboratories of four series of culture specimens for isolation and identific'ltion, and one series of serum for the agglutination tests. A special study of various antigens found in enteric organisms was

-12-
also included in this program. INVESTIGATIONS
Requests from laboratories outside the state system for culture identification and typing ere increasing. All Brucella, Salmonella, Shigella and typhoid cultures isolated in the branch laboratories are typed in the Central. laborntory. This work consumes much of the time of this unit. Approximately
200 blood specimens and 350 Shigella cultures were referred to the Communi-
cable Disease Center for check typing. It was gratifying to observe that the two laboretories were in exceptionally close agreement. Assistance was rendered to the Division of Industrial Hygiene in investigating an outbreak of respiratory infection among the employees of a wood plant.
THE MILK UNIT The milk units previously established in the Central, Albany and Macon laboratories all showed pronounced increases over the previous year. This work was established in the Waycross laborator,y in October. The institutional
laboratories made examinations only on their own supplies. A total of 42,695 examinations were made as compared to 18,471 in 1950 which is an increase of 24,224 or 131.1 percent. The greatest increase occurred in the Central
laboratory followed by the laboratories in Albany and Macon. The Waycross leboratory examined comparatively few samples during its three months
operation. Table 4 presents the classification of exeminations made on
13,363 samples.
Throughout the year the refractometric method for screening samples for excess water was employed as a routine procedure. The refractometer was also adopted by the Engineering Division for use in the mobile laboratories. A comparative study for the evaluation of performance was carried on with the Alto Medical Center laboratory. It was found that discrepancies in plate and coliform counts previously observed was due to different temperatures of

-13-
incubation. It wes decided that rather than purchase a special incubator

for the Alto laboratory i.t would be better to discontinue the work there

and refer samples to the Central laboratory. An evaluation program of

determining excess water by the cryoscope was conducted with the Albany and

Macon laboratories.

TABLE 4

MILK UNIT

Plate Count Colifo:nn :Phospho. tase Butterfat Cryoscope Refractometer Solids not Fat Miscellaneous

~
8,447 2,383 2,433 8,241 4,654 9,074 7,290
173

1950
5,682 1,429 1,479 5,363 2,623
1,895

Increase or Decrease
+ 2, 765 + 954 + 954 + 2,878 + 2,031 + 9,074 + 7,290 - 1,722

TOTAL FOR UNIT

42,695

18,471

+24,224

This unit, in addition to routine examinations, offers to local health

departments special services designed to improve situ~tions, conducive to the

production of wholesome milk and other dairy products in plants and on the

farm.

THE S~ROLOGY UNIT

The work of the serology unit, in addition to serologic tests for syphilis

consists of the Rh e.nd Blood Group tests, the Heterophile Antibody tests and

Blood Sugar dete:nninatio~s. The combined report of the serology units showed

an increase in all types of examinations. This unit established another all

time high record of 1,2081108 examinations or 25.9 percent increase, and
represents 73.7 percent of the entire laboratory specimen load. Table 5

gives the classification of work in this unit with comp~rison for the

previous yeDr.

-14TABLE 5

SEROLOGY UNIT

SYPHILIS Blood Spinal Fluid Total

1951

1950

Incr or Deer

Total %Positive Total %Positive Total %Positive

655,992 6.1 12,773 8.9 668,765 6.1

590,823 10.0 22,992 9.4 61),815 9.9

+ 65,169 -3.9 - 10,219 - .5 + 54,950 -3.8

RH FACTOR

75,657 13.h (Neg) 71,426 13.1 (Neg) + 4,231 + .3

BWOD GROUP

75,694

71,483

+ 4,211

HETEROPHILE ANTIBODY 3,449 6.9

3,346 11.1

+ 103 -4.2

BWOD SUGAR

188,476

43,863

+144,613

TOTAL FOR UNIT 1,012,041

803,933

+208,108

SEROLOGIC TEST FOR SYPHILIS

A total of 668,765 specimens were examined as compared to 613,815 in 1950

and is an increase of 54,950 or 9 percent. The greatest increase was observed

in the Central laboratory. Smaller increases occurred in the Waycross and

Battey laboratories. The largest decrease was shown in the Alto laboratory

with the Albany and Macon laboratories following in order.

The Kahn quantitative test was performed on 28,116 positive specimens as

compared to 40,796 in the previous year. The Micro Kahn was applied to 1,135

specimens as compared to 2,o67 in 1950. Most of the 12 1 733 spinal fluids
were examined in the Alto laboratory. The trend of positive serologic re-

actions in the Central and branch laboratories continues downward as evidenced

in the reduction in the number of quantitative tests. Only 5.0 percent of the

specimens examined in these le.boratories gave positive results as compared to

7.5 percent in 1950 and 12.2 percent five years ago.

The V.D.R.L. test was adopted on January 1 as a screening test instead

of the Kahn Presumptive and Mazzini tests which had been used for many years.

This change was made only after several thousand specimens had been examined

-15-

in parallel by these three tests during the previous year.

Specimens were examined in 11 county-wide surveys and in 60 minor surveys

conducted by the communicable disease investigators in approximate~ 50

counties. These surveys accounted for 183,673 examinations which is almost

double those made in 1950 from these sources.

PREMARITAL SPECTI~NS

A total of 57,604 specimens were examined as required by the state

premarital law as compared to 59,536 in the preceding year. In the Alto and

Battey laboratories this service is limited to patients and personnel of those

institutions. Other approved laboratories outside the state system examined

36,908 specimens, making a total of 94,512, which is an increase of 17,048

over those reported in 1950. Positive reactions in this group of specimens

dropped from 4.5 to 3.5 percent. Specimens giving positive reactions in the

state laboratories are classified by race and color as followst

W-M 1o6

W-F 124

RH AND BLOOD GROUP TESTS

These tests although performed on the same specimen are counted as

separate examinations for the reason that different reagents and different

portions of the specimens are utilized. Specimens submitted for these two
tests increased from about 71,000 in 1950 to more than 75,000. Negative

results in Rh tests compared to those reported in the previous year varied

by onlY 0.3 percent. Maqy requests were received from civic organizations

for a blood typing service for the purpose of establishing registries of

available donors in communities. Inadequacies in personnel and space made it

necessary to continue to limit this service to prenatal and immediately

related cases.

HETEROPHILE ANTIBODY
This test performed on~ in the Central laboretory was applied to 31 449
specimens, which is an increase of 103 over the preceding year. Branch laboratories refer to the Central laborator,y the sera of specimens submitted to them for this test. Positive findings are considered only as presumptive evidence of infectious mononucleosis. BLOOD SUGAR TEST
Blood sugar determinations, using the Anthrone method, were made on
188,476 specimens. An annual comparison can not be made since this work was begun in September, 1950. During the remainder of that year this test was performed on 43,863 specimens. The monthlY rate of examinations, however, was approximatelY a 50 percent increase resulting from the expansion of the
original program for county-wide surveys to smaller surveys conducted b,y the communicable disease investig~tors. Specimens were examined from ll county-
wide surveys and from minor surveys in approximatelY 45 counties. A followup program was established which resulted in the performance of 9,387 suger
tolerance tests included in the total specimens examined. Sugar determinations in approximately 7 percent of the primary specimens indicated follow-up work. EVALUATION AND INVESTIGATIONS
For the first time since its beginning in 1937, a national serology evaluation stuqy was not conducted by the Public Health Service. It has been decided to conduct these studies at two year intervals in the future. INTRA.STATE EVALUATION STUDY - Sixty-five laboratories inclusive of those in the state system, participated in the annual serology evaluation study, which consisted in the preparation and distribution of 100 specimens of sera containing syphilitic reagin and an equal number containing no reagin. These specimens were distributed at the rate of 20 per month during the first ten

-17-
months of the year. The criterion for approval was the achievement of not less than 99 percent in specificity and a sensitivity rating of not more than
10 percentage points lower than the Special Serology unit which served as the control. At the conclusion of this study in October, 53 of the 65 latore
tories were approved and 9 were required to participate in a continued stuqy thru November and December. All 9 of these laboratories were then approved. Two other laboratories were not approved and another withdrew from the stuqy. During the year a short stuqy was conducted with 19 laboratories who applied for temporary approval.
Refresher courses of instructions were given at stated intervals to technicians in approved laboratories who felt that such instructions would be beneficial to them in achieving better performance. These courses were adapted to the preparation, experience and need of the individual technician and, therefore, varied in length. Twenty-four technicians availed themselves of this service. A program for furnishing to branch and institutional laboratories control serum at two week intervals was inaugerated. These sera were prepared so that they gave a pattern of reactions comparable
to those given qy the dehydrated control sera secured from the v. D.
Research Laboratory of the U.S. Public Health Service. An evaluation program for the Rh and blood group tests was conducted with the branch and institutional laboratories.
THE CLINICAL UNIT Clinical tests cover a large variety of laboratory procedures. They are performed only in the institutional laboratories in connection ~~th the
tre~tment of patients. These tests dropped from 84,051 to 53,575, which is ~ decrease of 36.3 percent. This decrease occurred in all of the general
classifications with the exception of the miscellaneous examinations. Table

-18-

6 presents the work done in this unit as compared to the previous year.

TABLE 6

CLINICAL TESTS (INSTITUTIONAL LABORATORIES)

Hematology Blood Chemistry Urine
Spina1 Fluids
Body Fluids
Miscellaneous

~
20,972 1,144 6,038 23,975
39 1,407

122Q
27,591 1,439 10,113 43,663
37 1,198

Increase or Decrease

- 6,619 295
- 4,075 -19,688 +2 + 209

-24.0% -20.5% -40o3% -45.1% + 5.4% +17.4%

TOTAL FOR UNIT

53,575

84,041

-30,466

-36.3%

Hematology in the Battey laboratory and cell count and total protein

determinations on spinal fluids in the Alto laboratory accounted for

approximately 80 percent of the clinical tests.

ANTIRABIC TREATI-I~ENT

Antirabic treatment for humans is manufactured in the Central laboratory,

The branch laboratories are furnished an adequate supply for distribution of

the first four doses. The order is then referred to the Central laboratory

for completion.

The distribution of antirabic treatment continues a downward trend, A

total of 688 of all types of treatment was distributed during the year. This

is the smallest number furnished within the last 30 years. Table 7 gives a

comparison by types of treatment as compared to those distributed in 1950.

TABLE 7

CLASSIFICATION OF ANTIRABIC TREATMENT

1951

1950

Increase or Decrease

Number Percent Number iercent Number Percent

Precautionary 310

45.1

453

5o.6

-143

-5.5

Mild Intensive Drastic

311 67 0

45.2 9.7 0

370 68
4

41.3 7,6
.5

---

59 1

4

-4.0 +2.1
0

GRAND TOTAL

688

895

.-207

-19The 12 dose (precautionary) and the 21 dose (mild) types were about equal in number and represent 90 percent of the treatments. Intensive treatment was furnished in 67 cases of exposure, and for the first time since it was introduced, no drastic type of treatment was supplied. Map I shows the distribution of treatment in 104 counties. Exposures to dogs accounted for 465 or 73.8 percent of the patients treated; to cats, 73; to foxes, 33; and to other animals, 59. Seventeen of 41 previously treated cases were given a booster series of six doses. The nature of exposure in the other 24 cases was not considered sufficient to indicate retreatment. ayperimmune serum was administered to 18 patients,,6 of whom received rabbit serum and 12 sheep serum. Due to frequency of reactions following administration the use of the sheep serum was discontinued and horse serum used instead. Two of the patients were out of state. To date the hyperimmune serum furnished by Lederle has been supplied for trial use in 54 cases.
HUMAN CASES OF RABIES AND TREATMEN:l' PARALYSIS
There was one human death from rabies during the year, the first since 1948. No treatment was given in this case. The history is presented in abbreviated form below:
H.C., white male, age 23, of Barney, Brooks County, Georgia,e On March 17 1 this patient was bitten by a pet puppy, severelY on the finger, the nai+ being torn away. The puppy died the following day but the head was not submitted for examination until two days later. The brain, when received at the laboratory, was partielly decomposed but was examined. No evidence of rabies was found. The animal history blank furnished with the written report was not complete or returned to the laboratory.
On April 21, the patient complained of pain which progressed from the

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-20fingers to the arm, shoulder and chest. This was accompanied by headache, nausea, loss of appetite and, on April 23 1 by inability to wwallow. Hewes hospitalized and was observed to be in great pain, restless, unable to swallow, and irrational. During hospitalization, he suffered numerous convulsions, A diagnosis of dementia praecox was made and the patient died on April 28 during preparations for his commitment to the State Hospital in Milledgeville. No autopsy was performed but the clinical history, with exposure to the puppy which later was proved rabid by mouse inoculation, supports the presumptive diagnosis of rabies.
Four other members of the family, who had been bitten by the same puppy, subsequently received entirabic treatment as did the mother, who was indirectly exposed, None developed the disease.
A comp~ete report on this case is available in the laboratory files, There was no report of the occurrence of post vaccinal paralysis during
the year, which extends the length of time to 6 years since such cases have
occurred, MEDIA AND VACCINE
This unit prepared culture media, typhoid vaccine, diluted "Koch's Old11 tuberculin, silver nitrate ampules, sterile distilled wa. ter and various reagents and solutions. Most of the media is prepared in the Central laboratory but the branch laboratories do prepare for ~heir own use some of the less complex media. While the Central laboratory showed a slight decrease in the preparation of media, the combined production in all laboratories showed a marked increase over the previous year. More than 1,000 liters of Lowenstein's medium were prepared as compared to approximately 600 liters in 1950 and accounts for about 75 percent of the increase in media production,
The preparation and distribution of typhoid vaccine and "Koch's Old11

-21tuberculin showed a moderate gain. The distribution of silver nitrate mnpules
increased to approximate~ the same peak level established in 1949.
BIOLOGIC SALES The distribution of biologics, drugs, and specimen outfits did not materially change from the previous year. Some decrease was observed in the distribution of diphtheria antitoxin and some increase in tetanus antitoxin.
The Atlanta V. D. Hospital substituted c.s.s. Penicillin for Penicillin in
Oil which accounts for the large decrease shown in the use of the former ite~. The use of bismuth and arsenical preparations continues a downward trend. Difference in the distribution of other items are not considered to be significant but reflect a normal fluctuation in their uses.
SEMINARS During the year two ver,r interesting and well attended seminars were held at the Central laboratory. One was a serobgy seminar held primari~ for the benefit of technicians in laboratories approved under the provisions of the state premarital law. Doctor Reuben L. Kahn, author of the Kahn test, and Mr. Hilfred N. Bossak, Co-author of the Rein-Bossak test, were guest speakers. The otherwaa held for the instruction of senior veterinary students from the University of Georgia in the clinical and laboratory diagnosis of rabies, and was participated in by personnel from both the Division of Laboratories and the Division of Epidemiology.
INVESTIGATIONS AND PAPERS
A study on two locallY acquired infections with Isospora hominis was .
made jointlY qy the Division of Laboratories and the Division of Epidemiology. A paper on this study is in the process of preparation and will be presented at an early meeting of the Southeastern Branch of the Society of American Bacteriologists

-22The microscopy unit participated in a tuberculosis program for the public health nurses in the East Central and Southwest regions. An exhibit and material for demonstration was furnished and a paper on "The Use and Interpretation of Laborator.y Methods in the Diagnosis of Tuberculosis" was presented. A similar program was presented for the public health nurses of the city of Atlanta. Exhibits were prepared for display at the formal openings of several new health centers completed during the year. In September a new policy for the conduct of the hookworm control program was adopted. Under the new plan only limited surveys will be made and the responsibility for coordination of the surveys and scheduling of specimens to the various laboratories will rest with the regional medical directors instead of the Division of Epidemiology, In the Battey laboratory two related investigative problems were undertaken. Fourteen atypical tuberculosis cultures, isolated repeatedly from the sputum or gastric contents of as many patients, were injected into rabbits, chickens, and guinea pigs. It was found that none were virulent for rabbits or chickens. In the customary 0.1 mg dose, only one culture was capable of inducing disease in a guinea pig. However, when the injection was increased
to 5.0 mg all of the cultures were slightly virulent except one, which
apparently was a saprophyte. The twelve cultures of reduced virulence were used to infect a group of guinea pigs, which were then given cortisone over a two month period, to see if the virulence might be increased. There was no evidence of the disease in the animals at autopsy.
A paper entitled, "Coccidioidomycosis: Report of a Case in Georgia", was published in the November issue of the Journal of the Medical Association of Georgia. A paper entitled "Delayed Examination of Gastric Washings", was presented at the annual meeting of the National Tuberculosis Association.

-23At the annual meeting of the Georgia Public Health Association the following papers relating to isolations made in the several laboratories were presented to the Laboratory Section by members of the staff:
Coccidoides immitis, Report of a Case in Georgia Sporotrichum schenckii Actinomyces bovis Blastomyces dermatitidis Salmonella albany r a New Type An Unusual Finding of Paracolon of the Arizona Group An investigation was begun in regard to the discrepancies found in the application of the V.D.R.L. and Kahn tests. Although the V.D.R.L. test has its sensitivity level set for diagnostic purposes, it was observed that this tests, adopted as a screening agency, gave many positive reactions which could not be confirmed by the Kahn test. The study was confined to specimens from the Burke County survey in which it was thought that a follow-up for diagnosis could more easily be made. The remaining portion of specimens of sera giving discrepant reactions were forwarded immediately to the Venereal
Disease Research Laborator,y of the u. s. Public Health Service for examination.
The agreement between the two laboratories proved to be excellent. Five hundred of these cases was then referred to the Division of Venereal Disease Control with the suggestion that the staff of the Alto Medical Center make any follow-up examinations that might be helpful in establishing a diagnosis of syphilis or ruling out this infection in these patients. A report on this follow-up study is awaited with interest, as its conclusions may influence the application of serologic tests in the Division of Laboratories.
A study is underway f~r modernizing our system of issuing and filing reports on laborator,y examinations. The present system of keeping an accurate record of the numbers and kinds of examinations has become more

-24-

~.

complicated as the work has expanded and grown through the past several years.

It has become increasinglY necessary for the unit directors in the Central

laboratory to give more and more of their time to the statistical data

involved in this work. A stuq, is to be made in an effort to reach a solution

to this growing problem.

A stuqy of the technical organization and classifications had been in

progress and it is hoped to bring it to a satisfactory conclusion within the

next few months.

Seven of the lsboratory staff attended refresher courses given at the

Communicable Disease Center.

EXPANSION OF FACILITIES

The expansion of blood sugar work, resulting i~ the overcrowding of the

facilities in the serology unit necessitated the construction of a new lab-

oratory for this work on the first floor of the No. 7 Hunter Street Building.

RESIGNATIONS AND APPOINTMENTS

There were 55 separations from the division during the year. Twenty-nine

were technical, 12 clerical, and 9 unskilled personnel of the regular staff.

Five others were technical personnel employed on temporary assignment. Of

those resigning 13 excepted other positions, 4 entered military service, 4

returned to school, 9 moved from Georgia, 1 retired, and the remainder seP-

arated for various reasons. We are still having difficulty in recruiting and

maintaining an adequately experienced technical staff.

VISITORS

Fourteen visitors from 10 foreign countries and 38 visitors from 16

other states were shovm the work and facilities in the Central laboratory.

Many of these visitors had come to Atlanta for special courses of study at
the Communicable Disease Center of the u. S. Public Health Service. There

-25-
were 270 visitors from school and lay groups within the state manifesting an interest in public health work.
ADDENDUM The Division of Laboratories keeps on file in its office a more detailed report of its activities for the year. Anyone desiring fuller information is invited to communicate with the director.

PERSONNEL
OF DIVISION OF LOCAL HEALTH ORGANIZATIONS
December 31, 1951

s. c. Rutland, M. D.
Emily C. Wade Phyllis E. Lee
Edith c. Thomas
Phyllis Ann Clary Lucile B., Marm Elizabeth P. Richardson

Director Administrative Aide Sr. Stenographer Sr. Stenographer Int. Typist Int. Typist Int. Typist

HEGIONAL MEDICAL DIRECTORS
w. D. Cagle, M. D. w. B. Harrison, M. D. s. c. Rutland, M. D. (Acting) o. F. Whitman, M. D.
J. F. Hooker, M. D.

N. w. Region
N. E. Region Central Region
s. w. Region s. E. Region

ANNUAL REPORT OF TdE DIVISION OF LOCAL HEALTH ORGANIZATIONS
1951
GENERAL FUNCTIONS In general the functions of the Division of Local Health
Organizations are: Expal'l.dillg local health services by the establishment of new full-time local health departments and by the strengthening of existing local health departments. Providing. for grants-in-aid to local health departments. Conducting in-service training programs. Making supervisor,v and consultant services available to local health departments. Assisting in recruitment of personnel for local health departments. Reviewing and evaluating local health department programs. EXPANSION OF LOCAL HEALTH SERVICES
On December 311 1951, 44 counties with a population of
1,999,205, or 58% of the state's total population was .. being
served by local. health departments with full-time cormnissioners of health. This reflects an expansion of public health services by full-time local health units as compared with the previous year
when full-time local com11d.ssioners of health were serving 34
counties representing 54% of the State's total populationc On January 1, 1951, Doctor w. D. Lundquist accepted appoint-
ment as Commissioner of Health for the Bulloch-Brycm..EffinghamEvans Health District.
On June 5, 1951, Doctor Donald L. Butterfield accepted
appointment as Comndssioner of Health for the Burke-JenkinsScreven Healt.h District.
On July 2, 1951, Doctor J. c. McGuire accepted appointment
as Commissioner of Health for the Barrow-Gwinnett Health District.

-2-

On May 1, 1951, the Bibb-Jones Health District was re-

organized. Doctor Frank R. Ca~ accepted appointment as

Commissioner of Health for the Bibb-Jones District.
As of December 31, 1951, in addition to the 44 counties

whose health departments were being administered by full-time

local commissioners of hedlth there were 95 counties employing

other full-time public health personnelo In 16 of these

public health nurses, public health engineers and/or sanitarians,

and clerical personnel were employed. In 52 of the counties

public heo.lth nurses and clerical personnel were employed.

In 2L. counties only public health nurses were employed, and in 3

counties either a sanitarian or clerk was being employed. Reports

of public health personnel and facilities covering the 139 re-

porting counties showed as of December 31, 19511 1,044 full-time
local public health personnel.

Public Health Physicians

36

Dentists

3

Dental Hygienists

5

Public Health Nurses

397

Clinic Nurses

52

Public Health Enr~ineers

23

Public Health Sanitarians

98

Other Sanitation Personnel

40

Health Educators

3

Nutritionists

1

Medical Social Workers

5

Health Investigators

7

Clerical Personnel

246

Maintenance and Custodial

1,-161454-

-3-

Negotiations with 44 counties to create 16 health

districts have been completed. These 16 health districts now

have vacancies in the local commissioner of health positions.

Of these 16 health districts 1~ are now staffed with public

health nurses, public health engineers or sanitarians, and

clerical personnel. 8 single county health units have vacancies in

the position local corr~issioner of health.

Percentage of Georgia's Population Served by Public Health Personne~

Commissioner of Health

58%

Public Health Nurse

92%

Public Health Eng'r. or Sanitarian 69%

Stenographer1Typist,or Clerk

90%

Total Population - 3,444,578

100%

LOCAL AND GRANT-IN-AID EXPENDITURES

To assist county health departments in expanding public

health services and continue existing services the State Depart-

ment of Health continued its program of financial assistance to

counties. The plan for financial assistance to local health

departments was amended July 1, 1951, to permit State Health

Department participation in the salaries of local health depart-

ment laborator.y personnel. During the year $1,232,086.16 was

granted to the several counties. The total expenditure by

counties and including grants-in-aid was $3,941,861.56. The

per capita expenditure for local public health services by county

health departments for the year was $1.14 of which 36 was

provided by our grant-in-aid program. Compared to 1950 these

are increases of 7 per capita for the total local expenditures

-4-
and 9 per capita in grant-in-aid fnnds. Both grant-in-aid funds and funds from local sources must increase as programs develop and as health services expand. A number of years ago public health experts set $1.50 per person per annum as the ver,r minimum annual expenditure for operating a full-time local health department. Because of the decreasing purchasing power of the dollar these same experts advise $2.50 per capita per annum, and even more in areas conducting additional necessary programs peculiar to the community needs. PUBLIC HEALTH CENTER .t~ND AUXILIARY HEALTH CENTER CONSTRUC'riON P.H.OGRAM. The p'ublic health center and auxiliary health center construction program continuos satisfactorily. The Division of Local Health Organizations is responsible for developing an over-all program for public health center construction and for processing
applications for assistance under Federal Public Law 725, and
State Act 62, in accordance wj_th the general policies. The Division of Local Health Organizations works closely with county officials in planning centers, developing programs, and for final approval of floor plans. The construction phase is administered by the Division of Hospital Services. This joint responsibility is economically sound and is functioning quite successfully. Communities can receive ~num health services and public health protection afforded by their health department only when adequate centers are equipped and available. Likevdso, the usage of an equipped health center is dependent upon the staffing of the local health department. Both factors must be considered in the development and extension of basically sound over-all long range public health programs designed to

-5-

meet the needs of the several counties and districts.

Status of Public Health Centers and Auxiliary Health
Centers as of December 31, 1951.

Projects Completed

County

Location

Atkinson

Pearson

Bulloch

Statesboro

Camden

Woodbine

Dawson

Dawsonville

DeKalb

Decatur

Elbert

Elberton

Fulton

Atlanta

Fulton

Alpharetta

Fulton

Adamsville

Fulton

Buckhead

Fulton

Center Hill

Fulton

Collins

Fulton

Fairburn

Fulton

Howell Mill

Fulton

Lakewood

Fulton

Parkerson

Fulton

Red Oak

Fulton

Rockdale

Fulton

Sandy Springs

Fulton

South Fulton

Harris

Hamilton

Lamar

Barnesville

Oconee

Watkinsville

Spalding

Griffin

-6-
County

Location

Taylor Wilkinson

Butler Irwinton

Projec!~Under Construction

Brooks

Quitman

Burke

Waynesboro

Clarke

Athens

Dade Douglas Effingham Evans Floyd GvJi.nnett Mcintosh Meriwether

Trenton Douglasville Springfield Claxton Rome Lawrenceville Darien Greenville

JIJiitchell

Camilla

Rabun

Clayton

Thomas

Thomasville

Wayne

Jesup

Berrien

Nashville

Charlton

Folkston

Jenkins

Wd.llen

Polk

Cedartown

Richmond

Augusta

Vvalton

Monroe

County health department requests for assistance under Federal

Public. Law 725 and State Act 62 for the construction of public

hoalth centers greatly exceeded the amount of available funds.

-7The Division of Local Health Orgcnizations has on file, as of December 31, 1951, applications for assistance in the construction of 19 health centers and one addition to an existing health center. The expenditure necessary to complete these 20 projects will exceed ~2,000 1 000o Operating on the present formula of 12!% Federal funds allocated to health center projects it will require at least two years funds to permit construction of these projects and then only by limiting each project to the bare minimum needs. Every health departnr.Jnt mould be adequately housed in a public health center completely equipped to insure full utilization of the skills and talents of our trained public health personnel.
Advirory and Consultative Services. ; Advisory- and .consultative services~for _pl.a;md:.ng,- developing and administering of public health programs arc available to the local departments by the divisions of the State Health Department in cooperation with the Division of Local Health Orgcnizations. As a rule it is not sound operating economy for local he&th departments to depend upon local funds for the highly specialized consultant services in public health. During the year rnm1y of the local health departments made use of these services. Particularly significant examples in ti1is area are responses to requests for assistance in epidemiological investigations, consultant and direct services in sanitation of milk production and processing, sanitation of food handling ostabliS1ments, specialized technical services in industrial hygiene, services in developing health exhibits, conrultcn t service in mental health programs, planning and developing vmtor flouridation programs, x-ray interpretations, and planning and conducting mass screening programs.

-8-
IN-SERVICE TRAINING In-service training was emphasized during the year.
Scholarships in advanced training in public health wore provided
for 4 commissioners of health, 1 public health engin<3er, and 1
administrative aide. In cooperation with the Division of Public Health Engineering and the Division of Industrial Hygiene a si~weeks course in Basic Information in Radiological Health Instrumentation conducted at the Envirorunontal Health Center,
Cincinnati, Ohio, was given 6 regional public health engineers. A short course in radiological health was given to 23 public
health engineers and sanitarians at the Georgia School of Technology. In cooperation with the Division of Mental gygiene a short course in mental health was conducted for the regional medical directors and the commissioners of health. Other inservice training consisted of regular monthly staff meetings of the regional medical directors, and regular staff meetings of the regional personnel including county personnel. The Division of Local Health Organizations has v.orked closely with the Nursing Division in developing plans for orientation of nurses and for securing academic training for nursing personnel. LOCAL HEALTH PnOGRAMS
Local health department progr~~s include communicable disease control; tuberculosis control; venereal disease control; environmental health services, including public health supervision of milk, food, ~!d water supplies; maternal and child health services; health education; laboratory services; and the recording and analysis of vital statistics, including maintenance

-9-
of registers of carriers and individuals known to have certain diseases. Public health programs are expanding to include mental hygiene, accident prevention, the hygiene of housing, and case finding in chronic diseases.
The Report of Specified Activities for the year
January 1 - December 31, 19.51, by counties shows county health
department activity in each basic program in every county employing health department personnel. Programs of local health departments cannot be evaluated by the content of our present monthly activity report. Health department activities alone cannot measure the effectiveness of the program. Many other factors should be considered. The characteristics of the community, the nature of its specific health problems, the scope of the services provided, and the coordination of the activities of other official agencies and voluntar,y health agencies are some of the factorso
The report for 19.51 shows 72,93.5 diphtheria immunizations of which 18,001 were under one year of age, and 78,7.5.5 pertussis innnunizations of which 23,00.5 were U...'1der one year of age. Venereal disease control programs admitted 46,820 individuals for services, vvith 9, 723 treated in local clinics or referred
to the Rapid Treatment Center at Alto.
This report shows 62,191 individuals admitted to tuberculosis services, as follows: positive cases 8,188, suspicious cases 13,387, contacts and others 40,616. X-ray examinations totaled 287,.562. Cases admitted to antepartum services totaled 28,464. There were 266,312 inspections in performing local environmental health services, and 83.5,4.52 laboratory specimens exwnined.
Many other activities in significantly high numbers were

-10... rendered by local health departments.
The number of imrnunizations shown on an activity report does not necessarily reflect the im.-nunity level of the community. The number of inspections in environmental health services does not show the degree of compliance with recommended health practices.
REGIG:l~AL PROGRANJS
The personnel of the regional offices continued important functions in the over-all program. Advisory and consultant services were made available to many local health departments by the regional medical directors, consultant nurses, public health engineers, public health sanitarians, public health nutritionists, and clerical personnel. The regional personnel rendered valuable services in working with county officials in adopting budgets, effectuating salary advance programs, recruiting and placing personnel, interpreting rules and regulations, planning for the formation of health districts, and planning local health programs. Many field visits were required to perform these services and to render certain minimal direct services now being required of the regional offices.
Dr. J. F. Hooker accepted appointment as regional medical director for the Southeastern Region as of September 1, 1951. The vacancy in the position medical director continued in the Central Region.
SUM!vUUiY
Approximately 92% of the state population was served by local health departments. However, the majority of these units were understaffed. The recruitment and placement problem is most acute in the local commissioner of health position.

-11-
Facilities to provide orientation and pre-employment and in-service training in the four basic disciplines of public health, namely, medical, public health nursing, public health engineering and sanitation, and clerical, are essential. The development of field training centers will meet the need to a considerable extent
....;

ci ty of Atlanta
A. p p l i n g Atkinson Baeon Baker Ba1dwin Banks Barrow Ba r t ow
Ben Hill Berrien Bibb B1eck1ey Brant1ey Brooks Bryan Bll11och B .1rke B.1tts
c :~.1houn c :~.mden c mdler c:l.rroll c ltoosa c1arlton
..::~~}~~~-

REPORT OF SPECIFIED ACTIVITIES FOR THE YEAR JANUARY 1 - DECEMBER 31,. 1951

Communicable Disease Control

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611287 411135
2,680
2,868 2,943
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Venereal
- Disease Control

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186 43

257 196

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155 306 45

95 157 25

77 237 30

1584 2098 1204

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123 130 647 160 189 478 240 328 2956 339 136 397 182 512
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Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Doug,herty Douglas Early

RE:t-'ORT OF SI-ECIFIED ACTIVITIES FOR THE YEAR JANUARY 1 - DECEi11BER 31, 1951

Communicable Disease Control

Venereal Disease Control

Tuberculosis Control

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382 962

160 236

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60 108

388 394

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278 320

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5,776 6, 575 4,645 2,931 7,128 2,003 4,307

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252 2527
66 155 424 87 174 140
1 294 1798 220 284 2714 2574 210

B ehols E ffingham E lbert
E:ma.nuel E vans F am1in F a.yette F loyd F orsyth Frank: lin F ulton
Gilmer G1a.scock
Glynn Go r d o n Gra.dy Greene
Gwi nnett H abersha.m
Hall
Han cook Hara1son H9.rri s H lrt H sard

REPORT OF ~.P.!!;C1FH.:1J ,AC'l'lVl'l'l.l!;:S 1''U.H. 'l'ti.l:!; :tl:!;llli .JANUlllii J.- 1J,I:!;C,I:!;J\Ill:it!;rt u.L, .L:1<JJ.

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-------- -------
Henry HO'J.ston Irwin J-ckson JLsper Jeff Davis Jefferson Jenkins Johuson Jones Lamar Larlier Laurens
Lee
Liberty Lincoln Long Lowndes Lumpkin aeon Madison },iarion McDuffie Mclutosh !Jleriwether
,

"-

llEi10'"?T OF S~ T;CIFT~D r~.CTIVITIH:S FOR THE YEA~- J ,, :u,,RY 1 - DECS'~IBt;:R 31, _!.._9_5]:.___

l

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I h _ Ve 1~erea~

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Di__se~se~Coiltrol

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Communicable Disease Control

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f REPORT OF SPECIFIED ACTIVITIES FOR THE YEAR JANUARY 1 - DECEMBER 31, 1951
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- - - - REPORT '~F 8FECIFI3D ACTIVITIES FCR THE J.'E.AR J.,~1LRY 1- DECE~:!BE"R 31. 1951 '

1

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HEr-vRT OF SPECIFIED .nCTlVITIES FuR THE YEAR JAi>IU.ttRY 1 - DECE.-~3ER 31, 1951

Co.ncer Control

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Seminole Spalding
Stephens Stewart Sumter Talbot Taliaferro Tattnall

REPORT OF SfECIFIED ACTIVITIES FOR THE YEAR JANUr\RY 1 - DECS~'BER 31, 19 51
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PORT OF SPECIFIED ACTIVITIES FOR THE YEAR JAT-TUARY 1 - DECEMBER 31,. 19 51

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~gotod Col.l'lty Health Districts EWgctcd ilrs ing CoLrit ics Hoalth flogions
.. ,
Dooomber 31 , 1951

County Health Districts

,pi ing-Baeon-Jeff Davit

01attooga-lllde-VIalker

Atkinson-Berrien-Coffee

Clayton-Coweta-Fayette

Bilnks-Ha I l

Cl inch-\'lare

Barrow-G.'~ i met t &rtow..f".ordon

Co Iumb ia-RIchmond
cr i sp-r!orth

Bibb-Jonos

Elbert-Hart

8 lcckloy-OtldJC:-PUinl<l

Grady-Mitt:hc II

ETant Ioy-L itorty-tong-VIaync Groono-Hancock-\'li lkos

11-ooks-Co Iquitt-Thol!lls

Habcrsh~m-Rabun-Stcphcns

P.rya~l ooh-Eff ingh am-Evans Harr is-i.br iwo thor

J.Jrko-Jonk i ns-scro von

Lnmar-PF: o-:Spa ld i ng

. Mte-Hcnry-r.bnroo

Murr<:y-Voh itf ioId

Cafrdon-GI ynn-1,~ Intosh

Paulding-Polk

:.rrcl 1-0ouglas-Haralson

To Ifa i r-\'heo lor

TOTAL PER CA?ITA EXI-EPDITU'BS FOR LOCAL PUPLIC HEALTH SERVICES
CALST1DAR Y:ZAR 1951
0 - 24 per capita - 74 per capita
.(\I.<!iI~l'IiVII :,n. 50 and over p,~r capita
December 31, 1951

GP..AHT-IN-AID BY GEORGIA DEPARTMENT OF PUBLIC HEALTH PER :~APITA EXPE}lDITUR.ES FOR LOCAL HEALTH SERVICES CALArmER YEAR 1951
0 - 9 per carita 10-24 per capita 25-49 per capita
50 and over per capita
December 31, 1951

PUBLIC HEALTH CENTEHS IN GERGGIA
DEC:SIE~Err 31, 19.51

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E.'CistinG Public Health Centers Existing Auxiliary Health Centers Centers Under Construction Centers Approved for Construction Proposed Public IIealth Centers Proposed Auxili.ary Health Centers

ANNUAL REPORT 1951 Division of Maternal and Child Health
Guy V. Rice, M.D., Director
Introduction: Maternal and Infant mortality rates is still a public health problem
of the first magnitude. The provisional figures for 1951 show the number of maternal deaths per 10,000 live births was 14.9. The rate for white women was 7.9, while the risk for Negro women was 26.6.
When we analyze the maternal deaths of the year 1951, in the light of economic status, extensiveness and utilization of medical, nursing and hospital facilities, striking parallels are noted in the distribution of maternal mortality rates.
Only 74% of the deliveries for the year were in the hospital and 19.3% of the women were delivered by midwives.
Of the 133 maternal deaths for 1951, 60 or 45.1% died of toxemia, 41 or 30.3% of hemorrhage, trauma or shock, 23 or 17.3% from infection, 9 or 6.8% from other causes, including embolism, ectopic pregnancy, etc.
In spite of the reactivation of the Maternal Care Committee of the Medical Association of Georgia, nothing has been done to study all deaths of mothers from causes associated with pregnancy.
In the past five years Georgia has reduced its infant death rate more than any other state. While there is just cause for pride in the reduction, much remains to be accomplished. Georgia still suffered a loss in 1951 of about 3,035 infants. The causes of death were as follows:
1. Immaturity 661 or 21.8% 2. Influenza and Pneumonia 422 or 13.9% 3. Postnatal asphyxia and atelectasis 308 or 10.1%

-2-

4. Congenital malformations 307 or 10.1~

_-,.,

5 Birth injuries 255 or 8.4~

6. Ill defined and unknown causes 370 or 12.~

7. Gastro-enterit1e, colitis, diarrhea of newborn 171 or 5.6~

8. Accidents (exclusive of motor vehicle) 126 or 4.~

9 Nutritional maladjustment 71 or 2.3%

10. Haemalytic disease of newborn 52 or 1.7%

11. Whooping cough 68 or 2 .~

Personnel The year began with a pediatric consultant physician, two pediatric
nursing consultants, a maternity nursing consultant, a nutrition consultant, a health educator, a vision and hearing technician, and an assistant to the director in the Division office.
In September three members of the staff, two pediatric consultant nurses and a pediatric consultant physician left the Division for poet
graduate study. In spite of the small staff throughout the year 1951, consultation has been given to 4,309 persons including 349 physicians, 1,950 nurses, 186 nutritionists, 85 dietitians, midwives, clerks and many
lay persons. This consultation service was on matters relating to maternal
and ohild health, nutrition or school health. Visits were made to 317 counties, 66 visits made to the regional offices and 54 hospital visits.
Sixty speeches were given, with a total attendance of 2,440 persons 1 and
75 classes were taught with an attendance of 883.

Maternal ana. Infant Care Clinics
Prenatal admissions to clinics have decreased slightly from 20,318 in

-31950 to 20,250 in 1951, (.33~). The total number of visits to clinics increased li showing more visits per patient, averaging 3.6 per patient. Late registrations is still a serious problem with only 25~ or 4,808 of the 20,250 persons admitted registering dur.tng the first trimester; 3.4% registering during the last month. Postnatal admissions have increased by 14%. Each postnatal patient, however, showed an average of only 1.1 vialts.
The number of infants admitted to well child clinics has increased 21% over 1950 or from 27;037 to 32,672. The age group of under 4 months had
the greatest attendance or 40% of the total. There has been, however, a
21% increase in the preschool age o~er last year,which shows a trend
toward care for what has heretofore been the "forgotten child".(See Maternal and ChUd Health center page, and Maternal and Infant Center Activities page).
The "Clinician's Manual", a mimeographed booklet in outline form giving the duties of the cl:lnician, nurse, clerk and other pertinent information for the physician has been issued this year in the endeavor to improve the quality of the clinics.
A six month clinic evaluation study of attendance has been issued to the regional offices for the purpose of stimulating better attendance in some of the small clinics.
Mother and Baby Car'?....2J-ass.es Instructors' courses in Mother and Baby Care were held in cooperation
with the American Red Cross in three regions. Comparing statistics for teaching "Home Care of the Sick" and "Mother and Baby Care" classes, in the Southeastern Area of the American Red Cross, Georgia led eight states
in the number of certificates issued, by a gain of 158% over 1950.

-4-
~nital Syph:l.lis A study of 63 congenital syphili t:i.c cases under 2 years was made
from June 1950 to June 1951. These cases had been found in the counties and treated by Alto Rapid Treatment Center. The purpose of the study was to ascertain whose responsibility was at fault. ~ospital Failure {13)
No referral to Health Department for follow-up: 6 No postpartum cases: 1
Treatment failure or inadequate Rx: 4
No blood test: 2 Patient Failure (25)
Late registration: 10 No registration: 12 Refusal to take Rx: 3 Health De~tment Failure (28)
Failure to get 8 months blood test on prenatal: 14
Failure to refer to physician: 1 Failure to do monthly blood test following Rx: 2 Fa:Uure to do Rx during pregnancy: 4 No postpartum follow-up: 7 Midwife Failure {11) Delivery without blood test: 5
No referral to Health Department or physician as prenatal: 6 Physician's Failure (9)
Failure to report to Health Department: 2 Failure to use Rapid Treatment Center facUlties: 3
Failure to take blood test: 4

-5 Vision and Hearing:
The vision and hearing technician has trained 127 lay persons, 58 nurses, 1 physician and 1,217 teachers to do hearing testing for screening purposes. In vision testing 107 lay persons and 29 nurses, 45 physicians and 1,180 teachers have been trained. As a part of the teaching demonstration 19,390 children have been tested in hearing and 17,368 in vision. Ch:l.ldren with vision or hearing defects are referred to physicians.
Premature Program: The post graduate nursing courses at Crawford W. Long and Grady
Hospitals in the care of the premature continue. During the year 17 nurses
took the premature courses, including 8 county nurses and 9 hospital nurses,
and returned to their communities better prepared to assist the Department in its campaign to save the infant, no matter how small.
The transportation of white premature infants born within a radius of 90 miles of Atlanta to Crawford Long Hospital has been discontinued.
Health Education: The Mother and Baby Book has been re-edited. Over 41,000 copies of
this book were requested this year by physicians and health departments. Other educational materials prepared of particular significance are: "Head 'Em Off", a leaflet on Hce control, and "Helpful Hints for Midwives", a booklet for use in instruction of midwives.
M.C.H. and Mental Hygiene exhibits were prepared for A.P.H.A.Southern Regional Meetlng in Biloxi, Georgia Medical Association, Health Officers' Meeting, State meeting of Home Economics teachers, Hogansville Fair, the Midwife Institute, and others.

-6-
Obesity exhibits for each of the regions (six in 195l),have been prepared for use at fairs, other community meetings, and for the nutritionists to use tn talks on the dangers of overweight.
Local Midwives: Midwives certified in 1951 by public health nurses numbered 1,322.
This number is in sharp contrast to the 2594 of ten years ago. The number of deliveries by midwives for 1951 was 17,174 or 19.3~ of the total number in Georgla. Their supervision has been varied in q_uality. Twenty-
-~
four counties have had special help, which included an institute at Cordele, as well as individual, and group, county meetings. Plans are made for "Midwife Supervision" institutes of two or three days in each region of the state. These institutes will enable the public health nurses to give more specialized midwlfe supervi.sion. A film is being made in Albany, Dougherty County during 1952 for use by the public health nurse in giving midwife instruction. This movie is under the direction of Mr. George Stoney who directed the Mental Hygiene film, "Palmour Street", which has been so well received. The movie has four purposes for its production:
1. Instruction of the midwife. 2. Bolster the public health nurse in her supervision.
-~-'
3. Give everyone connected with the birth of the baby a feeling of importance and responsibility with the midwife as part of the team.
4. Improvement of local services.

-7-
Nurse-Midwife Program: The Nurse~idwife Program has expanded to include a third demon-
stration at Barnesville, Lamar County. This demonstration opened in a new $65,000 combination Health Department and Maternity Shelter building in December. Three nurse-midwives assist local physicians with deliveries, and themselves deliver patients who cannot afford a physician. Walton and Thomas County demonstrations have rendered approximately the same amount of service as in 1950.
Spalding-Pike-Lamar District School Health Project The Spalding-Pike-Lamar District School Health Project completed its
third year of operation in 1951. During this annual period the tempo of health services to schools was increased sufficiently to eliminate practically all backlog of referrals and, in addition, the defect detection and correction phase of the project was extended to include the junior high schools. A growing acceptance of the project has recently been emerging, as evidenced by the number of teachers and school administrators who refer to the "health services program", rather than "that special project".
/
An eye clinic for appraisal and refraction of referrals from the school screening program was established at the Griffin Health Center as a pilot study. This clinic is conducted by approved optometrists who refer pathological cases to the local eye specialist. This study was developed jointly by the Health Department with the Medical Society, the Ophthalmological Association and the Georgia Optometrical Association.
During the summer months four medical students were employed to tabulate the data from the case records of the entire project. The coding of this information, when placed on IBM cards, will make possible for the first time a statistical treatment and analysis of the defect finding and correction part of the project.


-8-
The nursisg, mental health and health education services of the Health Departmeat, in conjunction with the Parent-Teacher Association, initiated an experimental pre-school roundup program in interested schools. Parente and pre-school children were invited to these conferences by letter, followed by a home visit by a PTA member. At the pre-eehool conference the child with a parent received his health examination and necessary immunizations, and visited the first grade room where he met his teacher. In the meantime, the parents were led in a discussion et ways of helping children adjust to school life by the social worker or a lay person she had trained. In moat instances, the conference ended with refreshments for everyone concerned.
The nutrition and mental health staff members continued their consultant services to parent and teacher groups.
Nutrition: In the Northeastern Region Mrs. Lois Prater was on leave from
September until December, when she resigned. The position in the region was vacant during this period. In the Central Region Mrs. Ruth Morrison resigned in September, and was replaced by Miss Jane Northington who had returned from a year's training in Community Nutrition at the
a University of Tennessee. Mise Re~ecca Broach left in September for
year's training at the University of North Carolina, working toward a Master's degree in Public Health. Miss Martha McKay replaced Miss Broach. Mrs. Mary Worrell, Dietary Consultant, resigned in April and was replaced in August by Miss Rebecca Roseberry. The positions in the other regional offices, the Special School Health Project and the state office were unchanged.

-9Staff Education
This still is considered the most important part of the work. There have been few changes in the methods of conducting this work. It is carried on by demonstration through consultation work at clinics and through home visits with other public health personnel. Much help to local workers is given in individual and group conferences. Working on the development of criteria for determining priorities in nutrition services has proven of benefit to the nutrition staff and it is believed will be of value to others.
Nutrition Education work with colleges and with other groups. The work here is the same as described in 1950, except more
workshop groups are being reached and possibly fewer individual schools. It is felt that this is a more effective way. of using the time of limited personnel.
Work with Patients This is being continued as a method of staff education.
Work with Other Agencies and Organizations The nutrition consultant in the state office is chairman of the
Georgia Nutrition Council. This has meant increased participation in the work of this organization, but it is felt that the council is helping to further the nutrition work of the Health Department. The Agricultural Extension Service has requested the help of the Health Department in promoting the enrichment of corn meal. This has been done by participating in conferences, wide ~ewspaper coverage on the value of enrichment, a radio broadcast, showing of films and individual conferences. Work with other groups is continuing as before.
Special School Health Project This work is continuing as previously described except there is no

10-
medical nutritionist for consultation. Most of the work is giving consultation at clinics to children and their parents on referral for nutritional help. Assistance to schools on nutrition education work and to community groups.
Obesity Recognizing the immensity of this public health problem, more
emphasis was given to its control. A pamphlet, "The Right Weight for You", was completed and printed. The Health Educator in the MCH Division completed arresting and info~ative exhibits for each region and the state office. These have been used at many professional and lay meetings, fairs, etc. A group was organized for a~y state employee who wished to attend. This group has been called the "Reducing Roundtable", as it meets once a week at the lunch hour and the members bring their lunch and eat during the discussion. The discussions are led by a psychologist in the Mental Hygiene Division, and the state nutrition consultant. The results seem fairly satisfactory, but are still not certain. A similar group is planned by the Regional Nutrition Consult-
ants in Macon during 1952. Several showings have been given to closed
groups of the film, "Losing to Win". One session of the fall meeting of the Georgia Nutrition Council was devoted to control of obesity. There was a panel consisting of a physician, a psychologist, a research worker and a life insurance company representative. The talks by the panel members and the discussion which followed were excellent.
Nutrition and Hookworm The special study on the relation of nutrition to hookworm
infestation was continued. The families 1.n this study were supplied with dried skim milk and dried eggs. Regular checks were made on hemoglobin levels and number of hookworm eggs. No spectacular results have been found and no conclusions have been reached.

-11-
0ne reglonal nutrition consultant obtained a "Worm Circus", which she has used and loaned widely. This has been used with all kinds of groups emphasizing the need for proper sanitation and good nutrition.
When it was found in one county that 62% of the white prenatals
and 26% of the Negro prenatals had hookworms it was felt that these parasites undoubtedly contributed to the anemia found in these women. A directive was sent to each county requesting hookworm tests on all prenatals in the "hookworm belt" and egg counts on all with hemoglobins under 11 gm. Treatment of those infested is left to the discretion of the local physician. In addition to helping the women concerned, we hope to get information on the severity of the infestation in women of both races.
Special Study on Prenatals Believing that malnutrition is a factor in maternal and infant
deaths, stillbirths, premature births and deaths from prematurity, a study was started on this line. Numbers and rates for a ten-year period were checked on all counties in the state. Five counties were selected on the basis of these figures, plus other considerations such as good supervision of clinics, good prospects for following through on the work, etc. These counties are being supplied with a high potency vitamin and mineral mixture and calcium. Regular checks are being made of the hemoglobinometers used and of the prenatal records to determine the outcome of the pregnancy and change in hemoglobin levels. It is too early to state any results.
Reports on Nutritf.o~ Services in Co~.ties These reports which include the work done by Regional Nutrition
Consultants as well as county wo,:-kers show an inC'rease in most services, except in food demonstrations. This reported increase may be due to

-12more work in this line or an increased awareness of the importance of nutrition, or both. Either is a step forward in the program

..
Instruction in nutrition to T.B. patients, convalescents, contacts .. , 13,097

Instruction in nutrition to prenatals 72,085

Food demonstration to prenatala 308

Attendance . .................... ~ . . . . . 4,199

Instruction in infant nutrition 80,139

" on nutrition for preschool children 51,423

Food demonstration on infant and preschool

nutrition. ................................ .

44

Attendance . ........................... . 8o4

Instruction in nutrition for school children 8,419

Conference on

II

II

"

"

Instruction on nutrition for patients admitted to morbidity service ........ 9,101

Instruction on nutrition to crippled children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 890

11,299 65,691
354 5,277 67,559 40,376
73 1,284 6,307 1,750
23,015
1,216

HIM:w 5-29-52

MATERNAL HEALTH CENTER ACTIVITY State-subsidized Centers

% Plus or Minus

Prenatal Admissions

Admissions, total

20318 _ _ _ _ 20250

- .33 - - - - - -

White ___ ___

1769 - - - - - 1707 -------- 4 - - - - -

Negro __________ 18549

18543--------- .03 ---- ----

%white _ %Negro_

-"------------------

Period gestation, totaL___ 20318

20250

- .33

Under 16 weeks ______ 5129

4808

- 6 --

16-27 weeks

10187 ____ 10256

-f 1 - - - - - - - -

28-36 weeks

4446

4494 .

f 1 -------

Over 36 weeks----- 556-

. 692----- f 24 -------- - -

%under 16 weeks -

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

ojo 16-27 weeks

%%2o8v-e3r6

weeks
36 weeks

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

____ -------------------------------------

__

__ _

~renata~ Syphilis

Reports, t o t a L . - - - - - 13322

13396 - - - - - -f 1 ___________

White

1278 _______ 1224 _ _ _ _ - 4 - - - - -

Negro

------ 12044

12072

%of Wadhmitiess_io_n_s_, _t_o_t_a_l_-_-_-_-__-_-_-_-_-_-_- - - - -

f .22

Negro _______________

Number positive, total _ _ _ 916 - - - - - 727 - - - - - 21 - - - - - - -

White

20

23

-f 15 - - -

%po

Negro sWithivitee ,_

896
_to_ta_l _ _____________ _ _

_

_

_

_

704
__

- 21-------
--------

Negro ---------------- ------------------
Treatments: total-----------------------------------------Treatment/positive ratio

Prenatal Activities
Visits, total._ - - - - - - 71836 _ _ _ _ 72522 _ _ __

White.

7135.

7272 _ __

N e g r o - - - - - - - - 64701

65258

Visit/admission ratio --~----- - - - - - - - - -

+l _____
---;. 1l _-_2_-_-_-_-_-

White------------------------------------------------

Negro - - - - - Transferred, total_

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

604

441_

- 27 ---------

Toxemias developed, total-------------- WNehgirtoe _____ _______________________________

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

%of admissions, total _ _ _ _ _ _ _ _ _ _ _ _ _.

White----------------------------------------------------

Ne ro

Postnatal Activities

Admissions, total ___

4776 -

5427 --

---- f 14 - -

White Negro

535-_ _ 4341

730 --__ 4697 _

_ f1:

36 8 -----

Visits, totaL _____ 6097------ 6127--------- f .49

White - - - - - - - - 728

798 - - - - - - .f 10 __

Negro -

5369 - - - - - 5329------ - l

%of prenatala, total - - - - - - -

White

Negro

INFANT HEALTH CENTER ACTIVITY State-subsidized Centers

% Plus or Minus

Ad.mJssions -- Infant and Preschool

--Admissions, total .._________

27037

White --

8781_

Negro. Age groups, total____

18256_ ___ 27037

t 32672___ 21

_ 9425 ____ f 7 _

_

23247 ____

32672 _

___

ff

27

__ : -~=--

21 _ _ _ __

Ur..d.er 4 months-----------4 -12 Llonths __,______

9886 _ _ _ 6566____ __

12849 7019

____

ff

30 ------7 ---------

1-5 yee_rs --

10585 - - - - - 12804

f 21 -- - - -

%und.er 4 months - - - - - -

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

% 4-12 months____

------------------- ..- ..-------------------- ___________

%1-5 years ___________

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

Nutrition, total

Abnon1

%Noarbmnaolrmal ________________________________

Visits and Act!.vi ties Visits, total _____________
White - - - - - - - Negro ---------Visit/admission ratio _ __

78946 25252 _ _ __ 53594 _ __

91768 27070

___ -f1

16 - - - 7

64698

t 21 - - -

White

Negro___________

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

Defe%cttso: tavl iecai tsees-_-_ - -_-_-_- -_-_-_- -_-_-_- -_-_-_- -_-_ - - - - - - - - - - - - - -

Referred cases

2989

_ 5130 ____ -f 72 _ _ __

Immunizations Diphtheria, total UOnvderer11yyeeaar r___________________________________

i% ooff aaddmmiissssiioonn 4to-1t2alm-on-th-s _ - -_-_-_-_- -_-_-_-_-_ - -_-_-_-_- -_-_-_-_-_
%of admission over 1 _ __
Smallpox, total ------- ----% of admission total
%of admission under l __
Thphoid, total _____________
%of admission total _______________________
%of admission over 1 - - - - - - - - - - - - - - - - - - - - -

MATEBNAT. AND CHTI.D HEAT.TH CENTERS REPORTING TO THIS_....QFEIC'J4__l95.l...

,____

Maternal

..

I - - r

-

Infant Combined Maternal Infant Combined

Centers - Centers Centers 1 Sessions !Sessions S AfH'I1 rm 1=1

I

Counties Sponsoring Medical MCH Centers

104

62

'

108

95

2021 full 2986 full 2274 full

sessions sessions sessions

287 one- 215 one- 274 one-

half

half

half

sessions sessions sessions

Counties Sponsoring Nutrition Services at MCH Centers

15

3

3

9

37

14

118

MIDWIFE DATA

MIDWIVES CERTIFIED

IMIDWIVES REFUSED

CERTIFICATES
Total w c

I

T

I'

1395 82 1313

71

-"
DEAD 24

T

-

I

NEW MIDWIVES

I
BADGES

UNDER

AGE NOT SENT RETIRED

'50 YRS. '50-6'5 GIVEN MIDWIVES

!
!

I

17

4

3

60

1----t i

I

I1

1322
I

!177

il245

1 i

104

I

I
I

4-

I
i

i

I i_._..

I
I
I I

I
j

.

I

1951

\
I
I
I
I
25 I 15

i-

~

8

0

1 I
l
"""
49

___1L____

---1



PROVISIONAL FIGURES

Maternal deaths, number and percent of total, from specified causes, and maternal death rate per 10,000 live births,

by race, Georgia: 1951

Cause and 6th Revision

i
I

Code Number

I

TOTAL

!Number _.....;:_ r;.-. 133

I korcont
100

+- 1

Toxemia. 642,652, 685, 686

60

45.1

Hemorrhage, Trauma or Shoe~ 643,644 645.0, 64?' 65 p,
1----
6?0, 67 ' 6?4, b?5, 67E,

6??, 67B

41

30.8

-----

-- 1---

'
Infection -

640,

641,

645.1 '

651,

6 oo-684,

689

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

- - - - 23

17.3

------ - - - - ---- '----- ~-----

--------~

----- f--------f------ ---
Other nnd unspecified causa s - 646, 648, 64 ~, 6t:IJ,

I--

-

6'13?, 6sa

-

9-

6.8 -

----

1-

~tarnal _9.ee.th rate per 10_.~ [ooo live births

-

Non-

Total White White

-------
------~.
--1----- -------
----

14.9 7.9 26.6
t--

NOTE: 1951 figures arc provisi >nel and subject to chan[go in fi tlal tabU: at ion.

-

g

t. of Public 01

'

,-

- -. I .. ..

......... I

4/1'7/52

cause <th !rev1s1on Code Number

PROVISIONAL FIGURES
Number and percent of total deaths from important causes of' infant death_ Ge~.r1rla7 , o~:,

TOTAL Immaturity unqualified (774t776}
Influenza &Pheumonin (480-f83,490-f93, 763
Postnatal asphyxia & atelectasis 1{762} Congenital malformations (7~0-759) Birth injuries (760-761)

3035 661 422

21.8 13 .. 9

308 307

10.1
I10.1

--

I255
205

8.4
I 6.8

Go.stro-enteritis, colitis at.d dicrrllea of n+vborn ( 571,764 Othor and ill-defined diseabes peculiar to 4arly infancy(76l6-769, j771, 77~) Accidents exclusive of motot vehicl~ (E800-IE802, EI840-~6e} Nutritional maladjustment 1(772) Haemolytic diseo.sos of nGwb~rn (7701) Whooping cough (056) All other causes
Unknown cause

171
I 165 -
126
71
52 I -
68
I 223 1

5.6
I 5.4
I 4.2
1 2.3
I 1.7
2.2
I 7.3

NOTE: All figures are SOURCE: Georgia Dept.

porf oP~~sbiloincalHeaanldths,

ubject to Division

change in final tabulation. of Vital Statistics,Contral

Statistical

Unit.

4/17/52

PROVISIONAL FIGURES Number and percent of total births in hospital, number nnd percent of total births daliverod by midwives,
.Georgia: 1951
------

NUMBER PERCENT

Live births in hospital Live births delivered by trddwivos

165,947 74.0
I.
117,174 19.3

'---
NOTE:

I

I

I

II

I

I

-

I

1951 figures are prevision 1 and s 1bjcct t p chango in fina

tabula~I ion.
!

j l __
I
I

. --~-
-----

-

I

I-

!

I SOURCE: Georgia Dept. of Public Iealth, )ivision of Vita Statis !llics, Co b.tral St tistica Unit.

I

I

I

I

I

I

I

I

II

l
I

I

4/17/5f

I

,\~''o

.:.r

ANNUAL REPORT 1 9 51
Division of Mental Hygiene
Guy v. Rice, M. D., Director
During 1951 the Mental Hygiene Division has been evaluating what has been learned in the past two years about developing a mental health program. The Division has been changing its approach to the problem in terms of what has been discovered and what seemed to be the needs of the state.
Program focusing and moving in new directions has been greatly facilitated by the adding of new staff members, a psychiatric social worker, clinical psychologist, and a mental health nurse. Also, a plan was set up to dev~lop regional mental health consultants who would work out of the five health regions in the state, such as in Nutrition and Nursing programs. Early in 1951 a mental hygiene consultant was placed in the Central Region and has been functioning in that capacity. This has proved to be a workable plan, although the knowledge of what still needs to be done is still evolving. The Mental Hygiene Division plans to place two more people in these positions during 1952.
At the same time the Division felt that a mental health program could be most effective if it were carried by local people. The Division feels that in order to make this possible, leadership and mental health understanding must be developed within these areas. In order to accomplish this it was thought necessary to work tm1ards better integration and understanding between the State Mental Hygiene Division and the local health departments. As a beginning, a Health Officers' conference on mental health was held in June, 1951. A committee on mental health was set up in the State Health Officers' Association who

-a..-
meet with the Mental Hygiene Division to work out ways and means of developing the program and meeting needs of local areas. Throughout the year a number of working conferences and workshops were held with public health people, in order to help them understand the field of mental health and find ways of applying its principles to their everyday working experiences in the community.
The chief clinical psychologist has been contributing his skills in testing and personality development, by working with both fields of health and education. The mental health consultant nurse has worked closely with the consultant nurses of the State Health Department and local projects throughout the state as a means of integrating mental health concepts into everyday practice. In addition, in the field she has been involved in training and consultation on state and local levels.
As a result of these experiences the Division now believes that it must integrate its efforts with the local health departments and will work towards helping them have responsibility for local mental health programs, if a state mental health program is to develop.
In focusing throughout 1951, the Division has moved more and more into working with key or index groups within the population. It has worked primarily with such groups as Public Health, Welfare, and Education. It is felt that, by virtue of the position in which these key groups find themselves, they can do much t~~ards developing a greater degree of social and emotional maturity by the way in which they integrate mental health understanding into their everyday practices and relationships with people. Whenever practical, the staff has continued to meet requests from parent groups, PTA, ministerial, and other interested groups. It is believed that ultimately these needs

- 3-
must be met by local personnel and the staff has been directing its efforts towards this end.
The mental health clinics have been moving more and more towards the building of community strengths. The clinic at Savannah has spent a major portion of time in working with key groups within the conununity. These groups have been able to meet many problems which otherwise would have been referred to the clinic or largely J~ft unmet. This typo of approach is showing great promise and is relatively new in the field of mental health. The clinic at Macon has developed a program well integrated with the local health department. The staff there has developed a social study of their community and their relationship to its needs, which has led to a consultation service to other agencies and an education program for the g~neral public. This is in addition to their treatment activities. The Atlanta clinic has been developing slowly in order that their services may meet the needs of the community on a sound basis. As yet they do not have a full staff.
A special project in mental hygiene at Griffin is showing promise. This project currently utilizes the services of a psychiatric social worker whose efforts arc largely directed towards helping the education system to find ways and means of utilizing mental health knowledge in the schools. It is hoped that this project will lead to some constructive ideas on ways and means of creating better relationships between students and teachers and some hints on ways in which the education system can assist in the social and emotional development of the child. In the broad sense this is preventive mental hygiene and personality building rather than a treatment program.
An experimental project was set up in 1951 in which a psychiatric social worker was placed, by a grant from the Mental Hygiene Division,

- 4-
with the court system of Atlanta to work with women offenders. This is a demonstration project to explore with the courts what the use of mental health personnel might mean in rehabilitation of public offenders.
During 1951 the Mental Hygiene Division has made liaison relation-
ships to other groups interested in mental health. In past years, meetings have boon held with the Inter-agency Council on Mental Health, which is composed of representatives from official state agencies. This has continued. This year a liaison committee has been set up between the Georgia Association for Mental Health and tho Division of Mental Hygiene, in order that state and public programs might coordinate their activities.
The Division has continued its program of distribution of materials, such as books, pamphlets, films, filmstrips, and recordings on mental health to interested groups throughout the state. Also, a magazine, "The Psychiatric Bulletin," was secured and has been sent to numerous physicians throughout the state as a means of bringing to their awareness some of the social and emotional factors apparent in medical practice.
In general, during 19)1 the Mental Hygiene Division has boon active
in making mental health an intog1al part of tho public health program, and in helping local areas to build up their own understanding and capacity in order that communities can ultimately examine their own problems, develop the capacity and facility to meet their own needs.
GVR/jm/bn
6-25-52

CONTENTS PAGE
I. PHILOSOPHY, OBJECTIVES 1\ND FUNCTIONS . . . 1
II. PERSONNEL: EDUC '\.TION, EMP~OY:::IENT, RESIGNATIONS, DEATHS . . 2

III. TR/I.TIHNG AND ORIENTATION . 12

IV. IN-SERVICE EDUCATION: INSTITUTES i'JJD WORKSHOPS :' 15

v.

COI:'riTTEES: ~:ffiETINGS: CONVENTIONS . 22

VI. FIELD ~iORK: STUDIES ,\ND SURVEYS: SPECL'!.L EVENTS 24

VII. INTEJDIVISIOW,L J.EL~\TIONSHIPS . . . . 27

VIII. Sill1~!ARY OF VISITS MJD ?fEETIPGS . 29

IX. ST:1FF NURSES 1 FIELD VISITS AND EI!>itUNIZA '!'IONS . . . 30
X. ~VHAT 'S ,\HE.\D FOR 1952? 32

NOTE: Drawings, rnps and statistics by Hargaret Hill, Secretary.

- 1-
Our philosophy is people centered -- patient, family, community --rather than "program", "division" or "service". It embodies the idea of having nursing activities interwoven with multi-public health and community disciplines, to the end that health needs are met. An objective is to increase our adeptness in working with each division and local health department in meeting patient, family and community needs. When all professional and allied individuals and groups reaffinn and execute this philosophy in daily living, then, on that d~ and that day alone, through the team approach, will public health workers, individuals, families and communities achieve a state of health as defined by World Health Organization: "Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity."
Emboqying the philosophy of the division, our aims are to have high standards of nursing, and to render efficient service to an ever increasing number of people throughout the state. These aims will be reached through recruiting and training; in-service education; the preparation and use of manuals and guides; studying nursing needs; correlating nursing throughout all programs; working with federal, state, regional and local health departments in evaluating nursing services and planning programs; providing leadership in the development of field training centers for public health and basic nursing students.

II PERSONNEL-EDUCATION, EMPIDTI-'IENT ,RESIGNATIONS, DEATHS

- 2-

At the end of the year there was a total of 487 nurses employed on the local and state level. ApproximatelY 50% of these nurses have had no public health education. This percent is a little smaller than in 1950. 21% of the nurses have had a year or more of public health education, and 29% have had less than one year. 15% have degrees in public health nursing. The percent of nurses with degrees is a little less than
in the United States as a whole. U. s. percentages are as follows:
48.6% of public health nurses in United States have some college work in public health but no degree; 17.1% have one or more collegiate degrees.

At the end of the year 22 of the total 159 counties were without public health nursing service. This is the lowest number on record. Only three years ago, 40 counties were without nursing service.

The distribution of nurses in relation to the 1950 population shows great

disparity in the different counties.

19 counties. have one public health nurse to 15,000 population or more

40

II

II " "

"

II

" 10,0001~,999 population

63

II

" "

II

"

" II 5,000- 9,999 II

15

II

II

II

II

II

" II

less than 5,000 II

The 15 counties with one nurse to less than 5,000 population are

Charlton, Chatham, Columbia, Echols, Effingham, Fulton, Lamar, Long,

Pike, Quitman, Spalding, Taliaferro, Thomas, Towns and Liberty. In

order to provide an adequate number of nurses on the basis of one nurse

per 5,000 population, a total of 688 nurses is needed, which means an

additional 200 nurses.

- 3-

Educational Qualifications of All Nurses Doing Public Health~
1247 - 1251

12!7.. 12M 1949 1950 1951

Number of nurses having no
public health education 181

205

223

206

243

Number of nurses having less

than a year of public health
education .................. 137

121

112

158

142

Number of nurses having one or

more years of public health education ...

90

111

135

130

102

Total

408 437 470 494 487

Number of nurses who have one or

more collegiate degrees in
public haalth 63

69

74

71

71

Two specialized consultant nurses were added to the state staff during the year: dss Florence Beasle,y, Mental Hygiene Consultant, and Miss Katharine Akin, Chronic Disease Consultant.

)
'

....r-
I.:.

t\r..

..,..

\2

2

79

L A.l

'"2"1.71\

1 r J7J\.ED
d .-

\f!1:..\.)

CD

STATE GFFICE

5

2

NJI..SE lf{S1itUCTO_,

1

r.L .:-"T 'VE PE;.scNNEL

1

Cl1Y CF Al'LANTA

7

1.3

APPOINT"i-:ENTS_ 1:-JURSE
Associate DirGctor of Public Health Nursinr; 26
Bischoff, Fiss Lillian ~I.

EMPLOYED IH State Office

- 5-

Public Health Nurse Consultant 24
Beasley, Eiss Florence

State Office

~urse ?Iidwife 19
Buchanan, ')iss Gwendolyn Geyer, :Tis s liinnie K.

Lamar County Lamar County

Public Health Nurse 19
Arrington, Hrs. Margaret S, Bridges, Hrs. Harie J. Chapm:m, liiss Eunice Evelyn Clarke, lirs. IIartha W. Crowe, Mrs. Lucille F. Ellington, Nurse Lula Eae Goodman, l~rs. Peggy 0 'NE-al Hogan, }~iss }lary Veronica Kleinsteuber, Mrs. Betty Le;mmond, Hrs. Frances Ligon, Miss Esther R. HcNair, Mrs. Eargaret F Meyer, I'tlrs. Annie B. Nelson, Hiss Edna Patrick, Hrs. Lois D. Robertson, i:lrs. Evelyn Jones Seymour, }.frs. Carnit:, Jane Smith, Hrs. Hary B. Spears, Jitrs. Thelma iL Swanson, 1Irs. Uartha B. Terhune, Mrs. Katharine P. wade, 11:rs. i.Iary Kathryn

Richmond County City of Atlanta Richmond County Richmond County Fulton County City of Atlanta Lumpkin County Fulton County Chatham County City of Atlanta Colquitt County Bibb County Houston County Fulton County Barrow County V!hitfield County Fulton County Tift County Lovmdes County Spalding County Polk County Oconee County

Graduate Nurse in Public HeB.lth 16
Adair, Mrs. Doris Adams, Hrs .\nne C. Baldwin, Hrs. Loita I.IcGee Bennett, Hrs. l.hry B. Browning, },\rs :.laggie Burton, 2.Iiss Doris L<..:e Bell Bush, l'Irs. L8na E. Cox, l:lrs. nary .\lice J. Davis, }Irs. Ilary D. Denny, Ers. !:~ary Copel3.nd

Brooks County City of ;\tlanta DeKalb County :oiitche:ll County Cobb County Mitcholl County Brooks County City of Atlanta Wa~1hington County Cobb County

(Graduate Nurse in Public Health 16, Continued)
Doherty, Hrs. Anna F". Driggers, Miss krtha Nann Dukes, Hiss Gladys Flury, Mrs. F ranees Franks, ~lrs. r1Iargaret B. Garland, }~iss i.Iyrtle E. Griner, Hrs. Faytie Hae Griner, I:rs. Rebecca D. Hartis, ::iss Evdyn H. Hicks, Mrs. Elsie J. Horne, ~;Irs. Bessie B. Ingram, :Irs. Harriet H. Jackson, Hrs. Merle B. Jenkins, Hrs. Hortense T. Johnson, Mrs. Nell K. Jones, Hiss Billie J. Kitchens, lirs. Elsie Lester Hc!uec, I"rs. Louise R. 0 1Rear, Ers. Lois C. Prochaska, l.~rs. Agnes E. Roach, iirs. Catherine T. Robbins, ?Irs. !Iargaret Russell, Hrs. Ora Belle L. Sanders, Brs. Franceska A. Sanders, Hiss Hary V. Scogin, riiss Jimmie Nelle Smith, IIrs. Louise C. Spell, Hrs. Ruby C. Stone, :Hiss Eula Lee Tarrcr, Hiss Charlotte A. Trulove, Hrs. Sarah June Watson, Frs. Virginia B. Wiggins, l'frs. Lillian ...1. Wright, }.Irs. Kathleen G.

Chattooga County City of Atlanta Bulloch County City of Atlanta Franklin County City of Atlanta Upson County Brantley County Chatham County Troup County Hilcox County Dougherty County Muscogee County DE::Kalb County Tift County Harris County Warren County Cherokee County Taliaferro County Camden County Rockdale County DeKalb County Jasper County Bulloch County Dougherty County Forsyth County Gwinnett County Toombs County Burke County
Hiller County Towns County Bulloch County Lowndes County Troup County

- 6-

Graduate Nurse in Public Health 16 (Colored)
Burnette, Nurse Frankie Nell Comer, Nurse Frieda Holness, Nurse ;.farie Jones Harshall, Nurse Hary L. Panter, Nurse Daisey E. Williams, Nurse Sadie Underwood T',Jilson, Nurse Eamie Lou

City of Atlanta City of Atlanta City of Atlanta City of Atlanta City of Atlanta Glynn County Chatham County

Public Health Clin.i.c Nurse 14
Callov,ray, Nurse Precious Burt Edmondson, f:rs. Lorene K.

Huscogce County Cobb County

RESIGNATIONS

NURSE

EMPLOYED IN

Public Health Nurse Con;mltant 24

Howley, :Iiss Dolores Reeve, Hiss }~argaret Reiter, r:iss Mary Sanchez, Hiss Frances

State Office State Office State Office State Office

- 7-
STATED RE.\SON FOR RESIGNATION
Further Study (P.H.S.) Health Further Study Further Study

Nurse Instructor (Crav~ord.Lon; Hospital)

Elder, !'Iiss Effie Grace

Crawford Long

Public Health Nurse Sunervisor 21

Cawley, ~~1iss :uny Smcllow, ~{iss Hc..nrietta Snyder, Ers. Edna P.

Lowndes County Dei\alb County Bulloch-Eff ingham-.
Bry:m District

Left Nursing (P-.H .S.) Transferred (P.E.S.)

Public }kalth Nurse 19

Bates, ~.Iiss Bennie llae
Bridges, :rrs. ;Iarie J.
Brockington, Hiss L<lura E. Brown, llrs. Evelyn F. Clary, ::Ii.ss Pauline Combest, Hrs. F ranees Goon, J::rs. Ruth C. Hackney, i1rs. :Iargaret B. Hamil, :Irs Sarah '. Handy, :l :iss i:Iircll Harris, Hiss Louise Hartlt:y, ?irs. ~~ary ~~. Hunter, ~:rs. Ruby D. Irwin, ~~iss Frances
e. Kitchens, ~.:rs. H..::lE.:n 0 1
Heyer, lirs. Annie B. Perkins, ~Irs. Lynn ~!. Rice, :Irs. Dorothy
Tucker, ~ass Berta :1..
~"Tilson, lirs. .Uberta 21.

L .H .0. (Reserve Personnel)
City of Atlanta :i~uscoge6 Cou.."'l.ty Warren County Ladison County Elbert County Spalding Co. Fulton County Spalding County Fulton County Tift County \!Iashington Co. Jenkins County Dought:-rty Co. Ricrunond County Turner County Cobb County Chatham Cou.."'l.ty Brooks County Richmond County

Personal Reasons V;ft Public Health Illness in family :::arried Health :iccept position elsewhere Home duties Eilitary Leave "\cccpt position elsewhere Harried liarried Pregnancy Accept position elsewhere
l~arried
Health Husband Transferred Husband Transferred To be with Husband r:nitary .\ssigru"lwt Home duties

Graduate Nurse L"'l. Public Health 16

Adair, 'Irs. Doris D. AndGrson, !Iiss Frances K.

Brooks County Ca.mdcn County

Bdflowur, :'liss Eva Kate Brown, Mrs. I.!ary H. Burton, I:rs. Doris Bell

Tift County 1!arren County Uitchell County

Maternity Did not return from
Lco>v8 of Absence !,ccept position elsewhere Accept position elsev,rhere "Tarried

Graduate Nurse in Public Health 16 (Continued)

Chancey, ~Irs. Vivian P. Daniel, 1::rs. :Iary Dukes, Hiss Gladys Flury, ~Irs. Frances Glover, lirs. Annie L. Haas, Hrs. Carolyn Harrington, l'tiss Sarah B.

Cobb County City of Atlanta Bulloch County City of Atlanta Bibb County City of Atlanta Camden County

Harris, Ers. Janett C. Hill, ~.:Irs. ~Iary Ann Kilpatrick, Urs. Virginia Lingo, ..iiss Helen B. Uaroncy, Hrs. Gertrude UcCullough, Hrs. Doris Hiller, ~iiss Lenore Mulligan, :1rs. Elizab0th D. l1urphy, ~:Iiss :.furtha V. Oliver, Hiss Lucy F ranees Oxford, Hrs. liary R. Pa.dgett, r;Irs Daisy L. Palmer, :.Irs. Frances Robbins, Mrs. :.fargaret Sapp, Hrs. Lula M. Smith, Mrs. Betty B. Smith, ~~rs. Louise G. Spikes, Hrs Bernie e Stephens, ~Iiss Agnes Stone, liiss Eula Lee Swords, Hrs. ::ary R. Taylor, ~Irs. ?1ajorie C. ~'villia.:ns, !Irs. Dora S. Wilson, Hrs. Neta B.

Spalding County Spalding County Rockdale County Eonroe County Walker County City of Atlanta City of Atlanta Chatham County Whitfield County Taylor County Jasper County Cobb County Chatham County Oconee County Bulloch County Lovmdes Co:...nty Gwinett County Fannin County Fulton County Burke County Chatham County }fitchell County Troup County DeKalb County

- B-
Husband transferred Homo duties
Home duties Temporary position Home duties Did not return from
Leave of Absence Home duties Continue Education Home duties Army position (Financial) Home duties Haternity
Home Duties Join Armed Forces Accept position c:lsewhcre Moved from county Home Duties Accept position elsewhere Hoved from county ;T.aternal Reasons Eatcrn<ll Reasons Health Family responsibilities
Enter Armed Forces Home duties Haternity
Further Education

Graduate Nurse in Public Health 16 (Colored)

Dixon, Nurse N0llie K. Drake, Nurse Gracye P.

Ware County City of Atlanta

Better position--more pay Accept position elsewhere

Public Health Nurse 19

DEATHS

Smith, Hiss Ruth Wiley, Mrs. Eleanor

Bibb County Fulton County

Publj_c Health Clinic Nurse 14

Ford, ~.irs. ~Jae A.
Stephens, Nurse Hassie H.

Glynn County _ Huscogee County

RETIRE~iETIJT

Public Health Nurse 19

Hair, lfiss Ethel I.

Richmond County

K-."\ ~-ft}.~L~IT4- MURiy-FA-N._NI.N {)_,UNIO\O.~~ ~N

NUMBER OF EMPLOYED PUBLIC HEALTH NURSES AS OF JANUARY l, 1952

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POPULATION PER NUa.3E
UNDER 5,000

5,000---9,999

til

10,000---14,999 15,000---UP
COUNTY WI TH NO PUBLIC HEALTH NURSE

~~'- BASED ON NliHBER. OF 'f~ NURSES :El1,1PLOYED DEC . 31,
1951 AND 1950 CENSUS
POPULATION .

TYPES OF HEALTH PHOGRAHS
LEGEND .~~~.. REGIONS
HEALTH OFFICER DISTRICT HEALTH OFFICER COUNTIES
Hi!i!i!i!!Wi~ NUll.S ING COUNTIES
I I COUNTIES WITH NO HEALTH PERSONNEL

- 12 III
TRAINING AND ORIENTATION
The Orientation Corrmittee completed a guide of policies and standards after meeting periodically for a two year period. Three plans for the orientation of graduate nurses in public health were assembled and approved for use. Plan I provides for a two months' period, of which one month is spent in an organized health commissioner county, two weeks with a county nurse working alone and two weeks of observation in various related agencies. This appears to be the most acceptable plan and is the one that is recommended. There m~ be a few instances when it is impossible for the Qaw. nurse to leave her home county. Plan II provides for a one month period in the home county during which time a supervising nurse will introduce the new nurse to the job. In this month the supervisor will follow the outline in Plan I with modifications in relation
to the established public h8alth program in the county. lli!Llli
provides for the introduction of the nurse in her home county by the regional consultant nurse and covers a period of six months of less concentrated supervision. It is believed that after a trial operation for a period of one year, orientation plans will be revised on the basis of suggestions from those who have participated in the orientation of nurses.
Through close working relationships with regional, state, ~nd local health s;;rvices personnel the orientJ.tion guides have been used in a number of areas. Regional and local personnel who participated in the orientation of nurses have expressed the need for concentrated help in orientation of graduate nurses and the introduction of other new nurses to staff work. This help was given in a number of instances by three nurses of this division who worked closely with the new nurse, her

- 13 -
consultant and supervisor for varying periods of time, ranging from one to four weeks.
In counseling nurses for training in public health nursing on st-tte scholarships, the concept of studying in a school of public health has been emphasized in order that public health nurses may learn to work efficiently with the multi-discipline team. Scholarships are usually granted to ourses after they have had a year of practical experience. For this reason, it is believed that many of them are prepared to benefit from courses taken with all types of public health workers.

TYPe~ of Educational Programs for Public Health Nurses for Which Scholarships Were Provided
1947 - 1951

- 14-

Public Heuth Nursing - - - - - - --

52 42 35 8 9*

U.S.P.H.S. Scholarships - - - - -- - -

2

Orientation - Month Prior to Assigr~ent . 13 18 10 15 13

Care of Premature Infant ____ ..,._ ...

6 9 28 13 17

Extension Courses

12 26

Supervision in Public Health Nursing -

1

Midwifery - - - - - - - - - - - - - Mental Hy~iene Workshop - - - - - - - Senior Cadet Nurses

3 3 6 10

Obstetrics - - - - - - - - - - - - - -

3

Industrial Hygiene - - - - - - - - - -

1

Pediatric Nursing - - - - - - - - - -

_.1

Total

82

1
- - - ____.
89 63 41

Institutes, Workshops and Short-Term Courses For Which Expenses Were Provided In 1950 and 1951 122Q

Cancer Institute - - - - - - - - - - - - - - -

6

Mental Hygiene and Tuberculosis - - - - - - - -

1

Operating Room Technic - - - - - - - - - - - - -

1

Tuberculosis - - - - - - - - - - - - - - - - -

3

Maternity Nursing - - - - - - - - - - - - - - -

1

Cancer Control - - - - - - - - - - - - - - - - -

1

Child Growth and Development - - - - - - - - - -

1

Georgia Heart Association Convention - - - - - -

Cardiac Nursing - - - - - - - - - - - - - - - -

6

Health Education Workshop - - - - - - - - - - -

2

Venereal Disease Control - public health nurses

74

Venereal Disease Control - students from schools 195

of nursing

Total - - 291

1951 31
7 1 2 72
lQL
214

-lllncluded was a specialized consultant nurse in Chronic Diseases.

- 15-
IV
IN-SERVICE EDUCATION, INSTITUTES, WORKSHOPS
Regional Consultants
Quarterly regional consultant meetings were planned with committees on a rotation basis, a nurse from this division serving on a committee throughout the year. The meetings were a departure from the former pattern in that local public health personnel of the various disciplines participated in the planning and in the meetings. The programs present.ed methods of evaluation of nursing services, supervision and orientation of new nurses. All meetings included state office nurses. Local supervisory nurses throughout the state participated in one of the meetings.
State Office Nurses
The specialized and generalized state office nurses have held weekly conferences for the pu~pose of keeping informed of one another's activities and for the purpose of making it easier to correlate special services with the generalized public health program.
Local Nurses
In-service education programs for county nurses have been carried on in each region at intervals var,ying from once monthly to once quarterly. Members of this division, as well as specialized consultant nurses, have participated in these progrmns upon request. In several of the regions committees composed of regional consultant nurses, local supervisors and staff nurses have planned programs to meet the felt needs of staff nurses.
NOTE- The book, Public Health Nursing Practice by Ruth Freeman, was distributed to each nurse as part of her in-service education.

Health Education--University of Georgia

- 16 -

The six and one-halt week workshop on Health, Physical Education and Recreation was participated in by a member of this division in the capacity of a staff member and group leader. This waa the seventh consecutive year that a public health nurse from the state office participated in the Universicy Health vvorkshop for teachers and public health nurses. One nurse participated for four years and the other nurse for the past three years. The workshop's participants numbered thirty-seven and included school principals; administrators; nursery, elementary and high school teachers; public health nurses and five staff members. The staff and participants did considerable work through committees and Interest Groups. Practical aspects of the workshop included a seminar in mental health, a nutrition survey and chest x-r~ of participants. Heilth materials and community resources were investigated with refer ence to their usefulness with the various levels of learning. Follow-up on a limited scale has been done by staff members. There has been considerable evidence of good school-public health relationships, an increased number of school health projects, and a greater awareness of school health needs of the child, his family and community.

Civil Defense
This new phase of public health nursing has received considerable attention throughout the year. Meetings of the state Advisory Committee for Civil Defense and of the Health Services Branch were participated in. Interpretation of the part which local nurses ars expected to play was given through various meetings with these nurses.
A member of this division and two consultants from the Industrial Hygiene Division took a five day course on "Nursing Aspects of Atomic

- 17-
Warfare" at Emory University. This course was sponsored by the National
Securit,r Board, the Atomic Energy Commission and the U. s. Public Health
Service. A total of seventGen nurses from Georgia took this course and a number has subsequentlY held classes for other nurses. The three state office nurses and one from the American Red Cross, Southeastern Area, who took the five day course worked out lesson plans. These nurses together with a local hospital nurse formed a team for the teaching of a two day course for nurses representing all fields of nursing. The Georgia State Nurses' Association and District Nurses Associations have done much to stimulate interest in classes throughout the state. During the year same 1,200 nurses in the state have had instruction in Civil Defense. It is estim,3.ted that well over one-hundred public health nurses have attended the classes.
Cancer Control
A three-day Cancer Institute for Nurses was held in March at the University Hospital in Augusta with the able assistance of the faculty of the Medical School. Fourteen Nursing Arts Instructors representing eleven schools of nursing, twenty-three consultant and supervisor,y nurses attended. The major emphasis was on "Scientific and Clinical Aspects of Cancer Control." It was suggested by some nurses that in future institutes more time be given to nursing and public health problems.
The AtL~ta metropolitan area health departments devoted three half-day sessions to a program on cancer nursing for staff nurses. In one region the nurses held a program on cancer nursing at which time the consultant in Cancer Control participated. The specialized consultant held conferences on Cancer Control with gr:1duate and undergraduate nurses at the Fulton County Field Training Center.

- 18 -
Observation at a cancer clinic has been included in the orientation program for graduate nurses employed by health departments. Assistance has been given lay and professional groups on working out cancer control programs. The film, "Breast Self-Examination", has been widely used by lay and professional groups.
Tuberculosis Control
Work conferences in tuberculosis, sponsored by the specialized consultant in Tuberculosis Control, were held in three regions. Plans have been worked out with the State Tuberculosis Hospital personnel, Local Health Organization, and Nursing Division for a short course of nursing in tuberculosis which will begin early next year. This project will consist of a planned orientation in tuberculosis for our newly assigned public health nurses. Through this plan, one week in length and at quarterly intervals, nurses will be given the broad perspective of the problem, public health responsibilities, techniques of public health nursing, four days of actual instruction in the disease, and hospital observation of the care and treatment at Battey State Hospital.
The specialized Tuberculosis and Mental Hygiene consultant nurses gave assistance to staff public health nurses in improving nursing services to tuberculosis patients and their families. This was done through family studies, demonstrations of interviews on home visits and post visit conferences with the nurses, at which time analyses of the visits and plans for continued supervision of the family were made. Coordination of the services of public health nurses and Battey Hospital personnel is also an objective of this project.

Maternal and Child Health--Mother and Baby CareJUL~

- 19 -

During 1950 the American Red Cross, Southeastern Area and the Georgia Health Department joined forces for the purpose of teaching Unit II Mother and Baby Care Classes to public health nurses in the state. The Nursing Division has participated in the training of twenty-four instructors. Supervision of classes which these instructors have held has been divided between the Maternal and Child He1lth and Nursing Divisions. This year the Nursing Division has supervised seventeen uni~s of Mother and Baby Care Classes.

Premature Infant pare
Quarterly courses of four weeks duration for the graduate nurse continued at Crawfora Long throughout the year. Of the nine who took the course, four were hospital nurses and five were public health nurses. Two four-week courses were given at Graey Hospital for colored nurses. Eight were in attendance; of this number, five were hospital nurses and three were public health nursas. As a result of these specialized short courses, premature babies have received better nursing care and the work of the hospital, home and health department has been correlated.

A member of the division taught a course in Principles of Public Health Nursing through the Atlanta Division, University of Georgia School of Nursing. Twentyseven nurses completed this course which was conducted twice a week for a period of eleven weeks.

- 20 -
Alto M~dical Center--Venereal Diseases
A total of 101 basic student and g:i.~e.duate nurses from four schools of nursing in Georgia attAnded the fiYe-da.y course given about three times a month in ver:.eroal diseaces at A}~,o i1edi(~al C-:mter. Due to our drastic reduct~_on in the budget, this cou:se we.s discontinued July 1.
A total of 11;2 pu'.:llic health nurses from 70 departmentB of hecl th attended the five-day course given once each month since Februar;v-,.1950. This year 72 public health nurses attended the course. As a result, services in venereal dise~ses have improved in quantity and quality as well as in satisfaction to the nurse perfonning the services.
The following map shows the location and number of student, graduate and public health nurses in attendance at the courses in venereal diseases at Alto Medical Center.

Hllen,l;n_c; {1/lo c?/u.JjeJ
195U - !()51
Liber t y Lif e In3 . I u r scs
I - Sta t e Offi ce ru r~ C;...) I - TB-VD Surv~..- y f ur se
i 0 -Peabody Student s 2 - F or i r, n Nu r s e-s

U) 'l'TT\!.,']

... - ~ ~ -

-..

56

.c.. J

36

: '] 1"

- - ."1

58

C' _ . . 1 G~l-Y

79

3

(..'J " '

21

4

To l

7

ILl~ Public Healt h Nurses ~'":1 :-.- 7I Student & Gra d uat e Nurs e s

v
CO~h~ITTEES, ~ETINGS, CONVENTIONS

- 22 -

Executive Committee, Atlanta Community Planning Council Personnel Committee of Atlanta Visiting Nurse Association Atlanta Visiting Nurse Association Board of Directors Advisor,y Committee for Training Program, Fulton County Health Department Minimum Criteria for Establishment of a Local Health Service Committee Practical Nurse Advisory Committee, State Department of Education
Health Education Joint Committee, State Dept. of Eiucation & St~te
Department of Health Nursing Advisory Committee, American Red Cross Nominating Committee for members of Governing Council of A.P.H.A. Public Health, Nursing Committee on Guide for Evaluation Orientntion Committee for Public Health Nurses Georgia Public Health Association Executive Committee Meetings Southern Branch American Public Health Association Executive Committee Fulton County Nursing Advisory Committee, Sub-committee on Records Georgia League of Nursing Education Curriculum Committee Better Health Council, Sub-committee on Constitution and B,y-laws State Practical Nurse Curriculum Committee Georgia Hospital Procedure Manual Committee Recruitment Committee of Unit V, G.S.O.P.H.N., and Meetings Field Training ~eetings for Public Health Nurses, University of
North Carolina and Peaboqy College Georgia Public Health Association Annual Convention American Public Health Association Convention in San Francisco Southern Branch American Public Health Association Meeting, Biloxi, Miss. Human Relations Institute, jointly with Local Health Organization Atomic Warfare Course Interviewing Course in Venereal Diseases Pediatric Institute

- 23-
Chronic Disease Seminar Cancer Institute Georgia Heart Association Meeting Venereal Disease Institute, Charleston, South Carolina Nominating Committee of Georgia Health Department Credit Union Georgia League of Nursing Education Meeting; Board Meetings Georgia State Nurses' Association Meeting Georgia State Organization for Public Health Nursing Meeting Regional Nursing Education Institute Executive Board of G.S.O.P.H.N. Family Life Conference School Health Meetings Industrial Hygiene Conference Meeting State Directors of Public Health Nursing Meeting, "i'Tashington, D. C. White House Conference Workshop, Macon Regional Conference of N.O.P.H.N. Georgia State Board of Health Meeting Federal Security Agency Meeting National Foundation for Infantile Paralysis Meeting
A member of this division served as president of the Georgia Public Health Association, and another member served as president of the State League of Nursing Education.

VI

- 24 -

FIELD WORK, STUDIES, SURVEYS, SPECIAL EVENTS

Visits to the field included consultation in relation to recruiting, training and orienting public health nurses; surveys and reviews of nursing service; adjustments of personality difficulties; planning with individuals and groups for in-service education.

All the regior.s were visited a number o times throughout the year. As a result of requasts from regional and staff nurses, three nurses fran this division gave concentrated assistance to a number of new nurses and to others who requested special help. Areas in which assistance was given included the preparation of exhibits and articles for the press. These publicity materials were made possible through cooperative efforts of the Health Education Division. School Health programs were strengthened through working and planning with school personnel and Parent Teacher Associations. Other areas in which help was given included analysis of the activities of nurses, their case loads, and evaluation of the nursing services. Results of working intensively with local nurses are shown in greater enthusiasm and interest for public health nursing. There is also more feeling of belonging to the t'otal state public health program.

Visits were made by tho Chronic Disease Consultant Nurse to nurses in health departments at the request of regional consultant nurses for the purpose of assisting with nursing care problems, clarifying questions regarding coding and reports, stimulating case finding, suggesting the use of public health education materials and interpreting the functions of related agencies. Conferences with the regional consultants and supervisors concerning in-service education and supervisory methods were included. Nursing service to the chronically ill is seen as a part of the family generalized health services. That this area is receiving

- 25 -
increased emphasis is shown by the expansion of nursing services given in cancer and other chronic diseases. Diabetes and heart diseases are the conditions which will be given greater attention in the coming months. The specialized consultant in Chronic Diseases worked intensively with the cardiac progr~ in Fulton and DeKalb Counties, making field visits with the nurses and assisting with plans for a cardiac institute to be held in the coming year.
A survV of Spalding-Pike-Lamar Health District was made by a member of the division, who worked with local, regional, state representatives and with the regional consultant nurse of Children's Bureau. This survey was made at the request of the local health conunissioner and supervisory nurse. A complete report of the survey is on file in the Nursing Division.
Monthly Calendars of Activities have continued to be studied. There has been a large increase in the number of activity plans received in the Nursing office since the beginning of this study. The activites which nurses contemplated carr,ying out showed greater efforts to give due emphasis to all areas in the generalized nursing progr~. A review of these calendars of activities shows more clearly than previously definite plans which nurses made, An ana1ysis of the guantity of supervision to newly employed graduate nurses who work without a local supervisory nurse was continued throughout the year.
A member of this division served as chairman of a committee which worked on a Hospital Procedure Manual 1 Nursing procedures were developed. This activity was carried on cooperatively with the specialized hospital consultant nurse and with other members of the committee. Although the! manual is incomplete, much ground work was covered and a large part of material was compiled.

Schools of Nursing

- 26 -

A number of schools of nursing in Ath~ta and throughout the state were visited for the purpose of assisting the teaching staff with the correlation of public health aspects in the basic curriculum. In one school assistance was given in arranging for a period of orientation in a health department for a member of the faculcy. A few haalth departments were given assistqnce in arranging for periods of observation for student nurses. Other activities in behalf of schools of nursing included talks to professional adjustments classes; arranging for tours and conferences with groups of students visiting the State Health Department; and holding individual conferences with students regarding souraes of materials for their s~cial projects. As a result of cooperative efforts with Miss Annie Lou Overton, Educational Supervisor of the State Board of Nurse Examiners and Schools of Nursing, increased emphasis is being given to the correlation of social and health aspects in the basie nursing curriculum.

Observation For Out-or-state Personnel

Miss Lydia Hall--Instructor, Teachers College, Columbia University Week's observation of cardiac program.
Dr. Bautista--Philippine Islands
Mrs. Marciona Mijaro--Philippine Islands, six weeks
Miss Helen Sotiropoulou--Greece, three weeks

VII INTERDIVISIONAL RELATIONSHIPS

- 2'1-

This division has worked with all other divisions in promoting generalized public health nursing throughout the state. All specialized consultants have assisted in planning and carrying out programs in relation to their specialties. Efforts have been made at all times to use these specialties in relation to the felt needs in the field, thereby correlating rather than imposing Jrograms. For example, the Division of Maternal and Child Health has been responsible for planning midwife institutes as a result of a felt need on the part of local public health nurses who supervise granny midwives.

The Mental Health Consultant Nurse has worked through this Division in reaching other specialized consultants, generalized consultants and local health departments, in stimulating an interest in understanding the plan of Mental Health in a generalized public health program.

The consultant in Chronic Diseases, assigned to the Nursing Division, has received administrative and medical guidance from the Directors of Cancer ru1d Heart prograills. Planning for chronic disease control has included cooperation with several other divisions. For example; Health Education in preparing exhibits; IV!aternal and Child Health for dietary consultation, especially in relation to diabetes and heart diseases; Hospital Division in relation to the care of the chronically ill in nursing homes.

The Directors of Local Health Org:mization and Nursing Divisions conferred frequently with one another regarding field situations, orientation, and appointments of nurses to positions on the local and state level.

On July 1, Crippled Children's Service was transferred from the St~te Welfare Department to the St::l.te Health Department. Local health

28 departments hava alweys given nursing care to handicapped children. The transfer of this service to the Health Department increases our responsibilities for consultation in relation to the nursing service. Considerable progress has been made in strengthening working relationships and in correlating the orthopedic services with the generalized public health nursing program.
_':.::, ..

VIII
SUMMARY OF VISITS AND ~lliETINGS
Visits to health departments 186 Visits to Regional Health Offices 55
Visits to Hospitals 17
Visits to Universities 5
Visits to Clinics ................... 20 Visits to Schools ................... 9 Talks at Meetings ................... 53
Average number of meetings attended during the year by each member of this division 46

- 29-

Statistical Data of
Field Visits and Immunizations by Sta.ff Nurses

- 30-

Field Visits:

1947 1948

Communicable Disease Control-- 17,759 17,235

Venereal Disease Control------ 24,749 36,578

Tuberculosis Control ---------- 44,627 48,138

Maternity Service ------------- 19,786 63,698

Infant and Preschool Hygiene--- 75,900 123,377
------ School Hygiene ---------------- 22,728

Morbidity Service ------------- 10,137 13,329

Cancer Control ---------------- 494

704

Crippled Children's Services--- 3,393 7,769

1949 1950 1951 19,339 18,037 19,907 45,905 41,155 37,061 50,411 52,332 59,064 60,166 55,172 58,138 93,293 90,092 103,384 42,726 20,755 25,409 15,814 23,015 22,041
1,143 1,366 1,722 2,787 3,393 5,096

TOTAL

219,573 334,644 331,584 305,137 331,822

Irmnunizations:

1947 1948 .1949 1950 1951

Small pox -------------------- 84,500 00,501 88,434 83,399 85,776

Diphtheria ------------------- 45,509 51,919 27,607 19,049 15,100

Triple Vaccine DPT -----------

()lr

~~ 41,315 53,886 66,002

Whooping Cough ----------..---- 20,915 29,825

0 14,246 11,953

/

Typhoid Fever------------~--- 349,761 369,985 419,633 438,178 442,167

TOTAL

500,685 552,230 590,398 608,758 621,878

* The use of triple vaccine was started in 1949.

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- .32 -
X
WHAT'S AHEAD ~OR 1952
A number of special events for which the Nursing Division has assisted with planning are scheduled to take place eJ.rly in the year. Among them are the following short courses and institutes:
Two-week course at Alto Medical Center for Professors and Instructors from Universities of Public HeJ.lth and Collegiate courses in nursing. Fathers classes at Alto Medical Center Institutes on the supervision of midwives Tuberculosis course for public health nurses at Battey State Hospital \vork Conference on Curriculum Building for schools of nursing, sponsored by the Education Committee of the State League of Nursing Education Southern Regional Educational Meeting for Collegiate Schools of Nursing
Much discussion has taken place throughout the year regarding reorgan-
ization of the State Health Department. At the close of 1951, it is
not known what changes will be made. The members of this division take the attitude that because public health nursing is basic and an integral part of all public health programs and because large numbers of well qualified public health nurses are employed, nursing should remain on an organizational level commensurate with the duties and responsibilities involved, It will then be possible, and then only, to work with the multi disciplines in public health, and to carry out the philosophy, aims and objectives of this division in the best interest of patients, families and communities.

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Illi?ORT OF THB P:RSON:JI~L ;l.DMINISTR.,i_'l"Qfi. lOR. 19 51 Georgia Department of Health

REPORT OF THE PERSONNEL Am1DJISTnl~TOR. FOR 1951

GROi:'!'IH OF PUBLIC H: H,TH rroRK:
There were 2,328 people engaged in full-time health vnrk in Georgia at the close of 1951--an increase of 167 over the total of the preceding year. The successful work in venereal disease control permitted a net reduction of 28 employees. A part of the increase on the State staff was due to the transfer of the Crippled Children's Services from the Department of Public Yvelfare to the Health Department. Laboratory workers formerly on the staff of Battey State Hospital were made a part of the S-tate Laboratory System.

FULL-TII''iE E!lPLOYEES IN PUBLIC HEALTH T!ORK

Local State

1950

1951

- - Net Gain

687

724

37

524

609

85

~~Alto

191

163

-28

Battey

759

-832

73

2,161

2,328

167

~} Of the em;?loye8s at Alto, 27 WOJ.'8 loaned in 19 50 arrl 22 in 1951. FULL-TTIIE EMPLOYEES---LOC.:u, HEALTH DEPARTTmms

1950

1951

-Ne-t G-a-in

._

Physicians

30

32

2

Dentists Nurses

2

4

2

388

396

8

Enr,ineers

23

17

-6

Sanitarians

74

81

7

Clerks

168

183

15

Labor a torians

8

8

Others

-2

-3

-1

687

724

37

Page 3

FULL-TIHE Ei\IPLOYEES---LLTO HEDICAL CEN'rER 1950 1951

Hcdical

Physicians

4

3

:\iurses

32

30

McO.ical Aclninistrative

9

7

Administration Clerical

7

7

25

23

Maintencmcc

36

31

Culinary Housel;:eeping

9

7

12

12

Laundry

1

1

Farm and Dairy Institutional '7orkers

6

2

- so hO
191 163

Net Gain
-1 -2
-2
0 -2 -5 -2 0 0
-4
-10 -28

FUU.-TI~1E EMPLOYE:CS---Bii.TTEY STLTE HOSPIT!~L

Phys:icians Dentists Trainee Physician Nurses LaboratorJ Technicians X-Ray Technicians Clerical, Administrative, Fiscal Department Heads Skilled Laborers Unskilled Laborers Dental Technicians

- - - 1950 1951 Net Gain

17

19

2

2

2

0

5

3

-2

247 272

25

8

0

-8

3

5

2

57

57

0

9

10

1

85

81

-3

327 382

55

0

1

1

759 832 7 3

................................................................................................................................................................................................(...................................................
900

800 ...........

J - - .........

:~1- 700 -

-

Battey Local

..S.t.a.te..............................

............................................................................................................................. ............................................................... ..................................................
300.................................................................................................................................. ...............................................................................................................
............................................................................................................. ............................................................. .............................................. .
200
-------1 ----------t-Alto 100 ,_...............................................................................................................................

1948

1949

19 50

Year

1951

HJClli-:AS:G IN NUTIB=:R OP Ii~ALTH . omCHS

Page ~

EMPLOYEr:: TURNOVER:
The Health Department continued to lose e~ployee s at an expensive rate. Employee turnover cannot be completely avoided so long as causes normal to our civilization exist, such as marriage, childbirth, removal from the state, retirement, and illness. The expense of training replacements for these former employees as well as for those employees who leave for other--and remedial--causes constitutes a drain on funds that would otherwise be available for public health servic(~s. Increased emphasis on proper orientation into the job, adequate compensation, suitable working conditions, competent supArVl.s~on, aggressive leadership, and mutual esteRm for the value of the service-s of all will result in an imp:rovAd public health pro:~ram.

Local State Alto Battey

EMPLOYE.: TUR.ttqOVER IN 19 ~1

Ap?ointments Se?aration_~

217

180

323

238

62
6~1 12~3

90
578 1.036

-Net-Ga-in
37
8~
-28
73 167

COMPENSATION:
After a study of comparative salaries throughout the United States, the Merit System Achninistration proposed a revised compensation plan that brought Health Department salaries more nearly in line with payments for similar services. The Department took advantage of this opportunity to restudy the pay levels of the several kinds of work required to conduct a health program. A substantial increase was made in the salaries of nurses and of office workers 'Who had previously been more inadequately paid than other health employeGs. Continuing its policy of increased benefits to local health departments, the State increased its participation to the third step of the a~propriate pay levels for qualified employees as well as extending participation in the new pay plan --.vhenever the county was able to adjust its budget.

Page 6

Salary Advances

Promotions

Local

h52

L6

State Alto Bat,tey

377
58
_m_
1220

80
8
- -81215

The new pay plan by no means placed health work<>rs in an enviable financial position. At the end of the year, the median salary in the
StatfJ and Tl.cgional Offic8s was :$207 a month. Despite the fact that health nork rPI:wirec: much specialized professional and technical education, as many employees WFlre mceiving less than $207 as were receiving mor0 t11an this figure. The U:,i ted States Civil Service Co!llii1ission report0d that the avnraso annual salary of Federal workPrS und!'\r the Salary
Classification 1\.ct was '~3,954 at the end of 1951. At the same time, the avoragP salary of State and Regional workGrs was $3,248 a year. Shown
on the next page is a table indicatj_ng the distribution of Etate Health
Departnent employcec on the various pay levels of the compensation plan as of Decf'Jmbor 31, 1951.

TRATIHNG:

There was a marked decrease in the amount of formal training applied
for by employens and prospective employees of the Department. Fifty-four
pPrsons completed 631 weeks of training as contrasted to 1696 WE!eks completPd by 139 persons in 1950.

Title

116

2

10 3

6

12

Yilk Mo Wks Mos W'l<:S Mos Mos Mos

Nurses

1 20 h

51

1

3

Physicians

1

1

Psychiatric Social VJorkers Sani tartans

1
-,.,
J.\,_ ..

Visiting TPachers 2
for 75 weeks

Educational Psychologist

1

Publi.c Health Hutrition

Education ~x~cutive

1

Alcohol Studies

2

Page 7

DISTRIBUTION OF STATE HEALTH DI;PARTMENT EMPLOY:i:I;S ON LZV:LS OF ?AY PLAN

Pay Level

Number Emp1oy~os

6

26

7

0

8

0

9

0

10

24

11

2

12 13
14



15
16

17

27 11
1
137
2
85 --------- Median salary ~207

18

28

(Includes all 609 employees,

19

45

from expnnsive1y trained

20

28

physicians to manual laborers)

21

22

22

21

23

32

24

hl

25

7

26

32

27

3

28

11

29

5

30

6

31

2

32

11

609

Page 8

CHANGES IN ~ SYST~! ~:

The following changes were made in Merit Syr:tem rules:

FebruarJ

"Change the number of the present paragraph 9.100 to 9.101 and add a new paragraph 9.102 to read as followr:

11A person who has resign0d while in good standing
or has been separated without prejudice from an agr:mcy not under the l\!Ieri t System shall, if that a~ency is subsequently placed under the provisions of the Rules and Regulations of the State Personnel Board, be eligible for reappointment at any time within a period of thrne y"ars from the date of separation subject to all other limitations and provisions 0pecified in Paragraph 9.101 above. 11

11 Any person who has filed an application for retirement under the Georgia Employees Retirement Law which ap~)lication has been approved by the Retiroment Board can be employed, reemployed, or reinstated under the Merit System only upon the request of an ap;)ointing authority."

May

G'11.an:.;es were made in Sections 6.204 I, 7. SOl, 9 .101,

9.102, and 12.102 to substitute the phrase "without

rGcommendation for reemployment" for the word

"prejudice".

Docember

Paragraphs A.302 and A.303 were deleted and the following two paragraphs were substituted~
A.302 An employee successfully completing a working test period following ap~)ointment in accordance with Sections 9 .200, 9. 700, or 10.100 of these Rules and Regulations may be given a one step salary advancement. In addition a permanent Amployen may be given a one step salary adva~cement at the beginning of any quarter provided he has served twelve months in a com~arable capacity since his last salary advancement.
A.303 A permanent employee who has not received th~ maximum number of salary advancements permitted by the time limits set forth in paragraph A.J02 may be given additional salary advancements at the beginning of any quarter provided his salary is not advanced to a step of the salary range higher than he would have reached had he received all salary advancements permitted by paragraph A.J02.

Page 9

AP )BALS TO THE P:CRSOWCL BOA?.D:
There were no appeals to the Personnel Board b;r employees of the Health Departmr:mt in 19 )1.

THE CLASSIFICATimJ PLAN:

A number of changer were made in the Classification Plan to keep it adapted to the grm'!bg nee dE of the health program. The following classes were establishPd:

February Child :JPvelopment Cons1;ltant 26 Hqional lilental Hygiene Consultant 23

Assistant to Sanatorium Superintendent (Administration) 29
Bus Dri v0r 15
Institutional Health Education 20

June

Probation Officer 24 Junior Biologic Aide 15

July

Refuse Collection and Disposal Co:::1sultant 26

Typhus and Rod:::nt Control Resional S'1pc rvi s or 25

Typhus and Rodent Conkol S~ecialist 22

Typhus and Rodrmt Control Aide

]_O /

Tuberculosis Case Worker 19

September Housing Hygiene Consultant 21

October Drmtal Health Rojiresrmtative 22

NovGmb"!r

Public Health Vekrinarian I 24
Assistant Past0uriz0 r 12
Assistant to Director of Local Health Office 29

The following ti tlo changes were mad0 effective April 1, 19 51:

Old Title

New Title

Graduate Nurse E Graduate Nurse D Public Health Nurse D Public H,"alth IJurso C Public Health Nurse B Public Health Nurse Consultant A
Public Health Nurse Consultant I

Public Health Clinic Nurse Graduate Nurse in Public Health Ac:sistant Public Health Nurse Public Health Nurse Public Hnal th Nur~e Supervisor Supervisor of Local Public Health Nursing
Public Health Nurse Consultant

PagA 10

?ublic Health Nurse Executivo II
Public Hr,alth Nurse Executive III
Nurse :~Iidwife C Public Health Nurse Midwife B Nurse Midwife Instructor and Consultant Hospital Nurse Consultant I Hospital Field Representative X-Ray Technician E X-Ray Technician D X-Ray Technician C
X-Ray Technician B
X-Ray Technician A

Associate Director of Public Health Nursing
State Director of Public Health Nursing Nurse Midwife
Public Health Nurse Midwife Nurse Midwife Consultant Hospital Nurse Consultant
Hospital Administration Technician X-Ray Trainee X-Ray Technician
Senior X-Ray Technician
Survey X-Ray Supervisor Chief of X-Ray Services

The following classes were abolished:

March

Biologic Research Director Supervisor of Statistical Information Bedding Inspector
Senior Hospital Analyst Scientific Research Assistant Nutrition Biochomist
Public Health Physician II
Administration R2cord Analyst Print Shop Assistant S Print Shop Assistant D Tuberculosis Records &~alyst Public Health Mapping Assistant Rodent Control Assistant Cartographer II Sanitary Inspector E
Vital Statistics Field Supervisor

May

X-Ray Analyst

The following classes were Teas signed to ~ different pay level:

March

Regional lviental Hyp.:iene Consultant from 23 to 24 Child Development Consultant from 26 to. 27

April

Staff Physician (Tuberculosis) from 30 to 30 and 31 Automotive L1echanic from 14 to 17

July

Tabulating Equipment Supervisor from 20 to 21

S0ptombor Dfilg Clork from 17 to 19

October

Dental Hygienist from 18 to 19

Page 11

The following classes were revised:

April

Public Health Nurse Consultant--option in Cancer and Cardiac Control added

June

Regional Mental Hygiene Consultant--training in psychiatric social work substitutr:>d for training in medical social work

Octobr:r

Rr:ofus8 Collection and Disposal Consultant--statements clarified
Ta1Julating Equipment Operator--to differentiate between IB~J1 and Remington-Rand

Dncember Assistant ?hotostat Operator--year of expr:>rience deleted

LAY-OFF PTIOCEDURSS:
The curtailment of staff at Alto Mec!ical Center gave the Health Department its first real expr1rience in utilizin:~ the lay-off formula promulgated by the Uerit System Administration. This procedur0 was compot<'!ntly handled by Hr. Jack Stiller, Administrator of Alto Medical Center. Due to his car~ ful n/S)lana~,ion of this difficult situation, the procedures wore well accepted by all concerned. It is 1x')lioved, however, that the lay-off procedure could be improved.

THE PZRSONlJ::::L OFFICE:
:Mrs. Renee Goodrum n'"signed as secrstary on May 31, 1951. This
position was reallocated to Senior Clerk and ihss Charlyn Bressler was promoted to the position. The position vacatr:>d by Miss Bressler was reallocated to Intermediate Stenographer, and Miss Gvvendolyn White was
appointed on June 5, 19 51. Mrs. Be~ tty Richardson resigned on January 2,
19 51, and Mrs. Dorothy Bryan was appointed.

VETERINARY ACTIVITIES ANNUAL REPORT FOR 1951
RABIES CONTROL
Rabies incidence for the year 1951 continued to show a gradual decline in all species of animals as compared with previous years with the exception of dog rabies in the Metropolitan area of Atlanta and fox rabies in a group of counties southeast of the Atlanta area. Rabies in the general Metropolitan area of Atlanta has remained fairly constant throughout a number of years. In 1951 twenty percent of the positive heads in the state as a whole occurred in Fulton and DeKalb Cotmties and twenty-one percent of the human treatments were administered in this area. This area has a greater concentration of dogs than a:ny other area in the state and it is estimated that about twenty percent of the dogs in the area are immunized annually. This is not adequate to control the infection. Rabies cases have occurred sporadically in other sections of the state but have not assumed serious epidemic proportions. Wherever such reports have been received, we have encouraged county health authorities to take appropriate action to correct the situation. Such outbreaks have occurred in Whitfield County and a few other counties in the northern part of the state. These occurred early in the spring and there have been no recurrences. A considerable outbreak occurred in Elbert and Hart co1. mties and coordinated ccntrol programs are in process of organization to take effect in 1952 in these counties. ~at ~d dog tabies huve been reported from Telfair, Dodge, La1Jrens, and Wheeler Counties. All of these have occurred late in the fall and we are hoping that concerted action can be taken early in 1952 to correct this situation.
- 1-

During 1950 we had considerable fox rabies in Upson and Pike Counties. It spread in the latter part of 1951 to Fayette, Coweta, Troup,
Meriwether, Harris, Muscogee, Stewart, Quitman, and Randolph Counties. In cooperation with the Federal and State Fish and Wildlife Services, organized trapping programs were put in effect in Fayette, Coweta, Meriwether, and Harris Counties in order to reduce the fox population. We are planning to closely coordinate this with thorough dog vaccination
programs early in 1952.
Through the courtesy of Governor Talmadge, funds were provided for the purchase of traps to be used in counties in which fox thinning
programs were put on and the counties had purchased traps. 100 dozen
traps have been purchased and are in use in Fayette, Coweta, Meriwether, and Harris Counties, twenty-five dozen to each county. These traps will be picked up as soon as the trapping programs are over and used in other counties.
A total of 136,428 dogs have been reported immunized with killed virus "brain tissue vaccine during the year. A total of 2,615 dogs
have been reported immunized with chick embryo live virus vaccine during
1951. Ap-fircximately 150 dogs have been given post exposure treatment with
chick emb-::-y0 vaccine with no cases of rabies occurring in the group.
There we;:-,;:; tv.o breaks in dogs immunized with chick embryo vaccine in 1951.
This makes a total of four since use of this vaccine ras started.
Late in 1951, $24,000 was allocated to the State Department of
Health for the purchase of chick embryo vaccine for froe distribution to counties which would agree to put on an organized control program which offered reasonable assurance of adequate dog vaccination. Most of the fall quarter was spent in explaining and organizing vaccination programs
to be put in effect early in the year 1952.
-2-

We have continued to act in a consultative capacity with respect to the health of the animals maintained at Battey State Hospital and the Alto Rapid Treatment Center at Alto. We also acted in a consultative and advisory capacity in other Divisions of the State Department of Health on the problems relating to animal diseases which are communicable to man, upon request.
Sample testing hogs throughout the southern part of the State to determine the relative incidence of Brucellosis in swine in the area is in progress.
- 3-

M!NU\1 REPORT, 1951

1.

DIVISION OF TUBETICULOSIS CONTROL

GEORGI/\ DEP ,R'ThlE~'T OF PUBIJC HE:,LTH

Item 1.

The tuberCLllORis morbidity and mortality figures given herein are

provi.sionnl and must be expected to be materially incree.ced with delayed ropo:rts.

The provisional number of dGaths reported in 1951 was 6JO as comp&rE:d with ri80 for the same period in 1950. The provisional rate is 18,2 as agr.~ino'L 22.6 .for

the same period in 1950. The percentage of decrease var1es from 13% in white

patients to 23% among Negroes.

There has been all through the years of onr r0ccrds a decline in death

rate, even long before the advent of modern surgery, lung C8lle.pse measures and

drug therapy" No doubt but that these improveti r,13t.hods he.ve been and are helping

in reducing the death rato. l\i;any whose lives have b'3en saved will relapse and

some will die later of t uLer-:.-ulosis. i, very consj_derable number still have

chronic tuberculosis in contagious form.

It is the co m>idered cunclusion of the great majorlty of informed tuber-

culosis workers that a dGclining death rate C\NNO'P Il'J IT.S3IF BE T'KEN AS AN U.JDEX

of the extent of the tuberculosis problem, nor of its elimination.

Item 2.

2501 new cases were reported during the year, 1477 white and 1024

colored. This is 406 fewer cases than were provisionally reported for 1950.

The reduction in cases r0ported may mean that fewer previously unknown cases

are being brought to light, or that cases are developing at a slower rate, or

both. It is estjm::tted by national observers that 100,000 new cases develop

annually, which menns our ANNU/.L "',TTACK Ri~TE is approximately 2, 000. However

this may be, our KNOViN C;-.s'~-Lo,:,D INCREi<SES ~~VERY YEAR. All cases that develop

during any year are not diagnosed within a year.

Item 3.

Our Central Case Register as of December 31, 1951, contains records

of thousands of cases. 9, 939 active and convalescent patients are living un....

hospitalized in the communities, except about 90 which are in local sanatoria in

Muscogee and Chatham Counties. 1756 are in Battey State Hospital, 431 in

Veterans l.d1ninistration Hospitals, 238 in the State Prison and at Milledgeville

State Hospital, and 1955 supposedly inactive are at home- a total of 14,314

persons.

Many of these patients have positive sputum. Our records show that 41%

of the patients being discharged from Battey State Hospital have positive sputum.

Nearly 46% of the discharges from Battey State Hospital are against medical

advice or disciplinary. Many for various reasons do not want to live in sanatoria.

Item 4.

195,594 chest x-ray pictures were made by the Division and 101,871

by local health departments. J, total of 209 ,Oh8 x-ray pictures were interpreted

by the Division, throu.1 which 1,108 NDv CASES were discovered.

Item 5.

Treatment. 30,000 services, such as artificial pneumothorax and

pneumoperitoneum refills and aspirations, were given at State Health Department

expense during the year, to a monthly average of 685 patients who live at home,

at an average cost per patient of $88.21 per year.

2.

Item 6.

Rehabilitation. 9h cases were referred to the Division of Vocational

Rehabilitation for rehabilitation services by the Rehabilitation Consultant; 76

cases were reviewed with vocational rehabilitation counselors throughout the

State; many services and consultations and investigations have been carried out

for the purpose of correcting and improving difficult problems of tuberculosis

control. There is an increase of requests for consultation on rehabilitation

cases by rehabilitation counselors in the Division of Vocational Rehabilitation.

Item 7.

Nurse Consultant Service. 18 new tuberculosis case registers were

established by the Tuberculosis Nurse Consultant. 54 case registers were re-

viewed. 123 counties now have tuberculosis case registers, 36 romnin to be

established. Several work conferences for public health nurses have been held in

the various regions of the Stnte. Home visits with public health nurses to

tuberculosis cases and other similar consultant activities, were carried out.

Orientation in tuberculosis for new st:-1ff public health nurses is being arranged

for 1952.

Item 8.

Tuberculosis C'.l.se ldork. This service, put .in operation in 1951,

has gotten away to a slow start bec:mse of difficulty in getting the type of

persormel we had planned on. Arrangement is being made to employ personnel with

certain minimum qualifications for in-service training and supervision by the

highly experienced two workers we now have in the Central Office. It is expected

that it will be easier to secnre thi3ffi and that this .important service can be

developed fully within the limits of a.ny budget requested and granted for the

purpose. VJe should have at least six employed at an early date and at least

six more added during the year. v:ide development of this important service in

the 3tate is a must if real control of tuberculosis is ever to be brought about.

Its purpose is to thoroughly appraise the overall needs of tuberculosis

patients to the end that something be done in bringing the needs to the attention

of the community and proper agencies in order that the patient and community

tuberculosis problems might be better met.

Item 9.

Developments: Through efforts of this Division and other divisions

of the State Health Department, the Georgi("). Association of Public Health

Physicians, the Georgia Tuberculosis Association and representatives of the

Medical Association of Georgia - and others ... an awareness of the very serious

nature of the tuberculosis problems that are ever present everywhere within the

State, is being developed. It is hoped that out of the recognition by the

Public that the problems ~re factual, means to solve them will be provided in

adequate degree. They pr~.arily consist of the development of methods that

would bring about REAL CONTROL of tuberculous contagion and treatment and care

of the thousands of patients who are at present unhospitalized and living in

every community in the Stnte. Through these efforts the Public is beginning

to realize that something vastly different, in adc:li tion to what is being done,

must be developed to meet the problems it, the Public, is having brought to its

attention through the agenci8s mentioned above. As the complacency of the Public

is disturbed, to that extent may we expect the action needed.

DIVISION OF TUBERCUlOSIS CONTROL

TABLE I

SL1vl1L\RY OF X-RhY SERVICES ,:,ND RESULTS, J,,NUARY 1 TO DECE!~BER 31, 1951

NT.r;E~n
S.C.!tVICES

}1Ul'33R
14 x 17 X-RI;,YS

Nt.r iBER NJci;i CASES FOUHD

R3GUL>R COUNTY CLHHC3 (14 x 17)

404

Original Ex~nations

8,550

135

Re-exarninati ons

12,667

224

total

21,217

359

Industrial Survey Follow-ups

12

on 13,921 x-rayed by 70 M1I Film

452

18

lv'Ias s TB-VD Survey Follow-ups

ll

3,400

453

on 101,344 x-rayed by 70 1:Jvl Film

College and School Survey Fol1m'1-ups

10

on 29,429 x-rayed by 70 ~1Jvl Film

231

11

Public Survey Follow-ups

21

on 32,052 x-rayed by 70 l\!!f Film

892

80

Other Survey Follovf-ups

2

19

3

on 3, 764 x-rayed by 70 f.2,i Film

Vdscellaneous x-rays

25

X-rays made in Central Office (cant inuous)
Total x-rays made and interpreted by the Division except as noted Less films made by local health depts. Total x-rays made and interpreted Survey Follow-up fiL~ a~de by local
health departments

99

26,335

924

123

26' ,21._?

123

Consultation Film Interpretations: From Physicians 1st x-ray Re-eY.am. x-ray From Local Health Department lst x-ray Re-exar.1. x-ray From State Prison lst x-ray Re-e.xam. x-ray
TOT.;L FILMS INTERPRETED

307

19

140

4

2,683

118

3,513

18

1,183

20

;316

5

8,265

TOT~~L NZ~ C'iSES FROI\!1 HI'I'SRPR.ET.~TIONS

FILMS ~;t'J)E BY OTHER

184

34,477

TOTAL NE.. C/SES FOUND

1,108

1.58 1.77 1.69
.13 .45 .04 .25 .50
6.19 2,.86 4.40
.51 1.69 1.58

4.

ANALYSIS OF TUBERCULOSIS GASES RECORDED IN CENTRl\L CASE REGISTER
GEORGIA DEPARTIIJENT OF PUBLIC HEALTH DECEI.~BER 31, 1951

STAGE OF DISEASE

TOTAL
C~\SES

ACTIVE AND
COtJVALESCENT C\SES IN THE
HOhS ii--

c.szs IN
B:',TT:C:Y

1RTZiliiNS HOSPITALS

PR!JBABLY
HL~CTIVE
C,',SES ,;T
Hm:E

IlJ ST:.,TE PRISON ;J-JD !.'IT LLEDGEVIT J P. ST,;TE HOSPIT.~L

Far advanced

2921

1621

1074

226

koderately 3682

3070

.Advanced

494

118

~.:inimal

2115

2040

39

36

Unclassified 5262

2879

197

41

1907

238

Primary

276

276

Other

58

10

48

Total

14,314

9886

1804

431

1955

238 -~:_~-

?~ Includes about 90 patients in Chatha'!! and Luscogee County Sanatoriums.

i~- This figure represents only the cases reported to us.

1. Last examination positive within the year 689 2. Negative within past 6 months - previously positive -
not included in 1 603
3. Undetermined- last exanQnation over 12 months ago l647 4. Undetermined or last report over a year ago was negative 6048 5. Last examination negative and none found positive in past year 755 6. No sputUin. .. . 144
Total 9886

T YP HUS C 0 NT R 0 L S ER V I C E GEORGIA .DEP.hRTIViENT OF PUBLIC HEALTH

**'***
Roy J. Boston, M.S., Director Henry Greene, M.S.P.H., Field Supervisor
Clifford J. Jessup, Rofuso Collection & Disposal Consultant

Typhus & Rodent Control Regional Supervisors



Jesse F. Piland, B.S.

- Central Region

Everette A. Stanaland - - - - - -
Harold s. Taylor- - - -

- Southwestern Region - Southeastern Region

James o. Harrison, A.B. - - - - - - - - Northeastern Region

Northv'EJstern Region

TYPHUS CONTROL SERVICE ANNUAL REPORT
Calendar Year 1951
During 1951, the administrative phases of the Typhus Control Program were consolidated into one office located in Atlanta. Formerly these activities were conducted from offices in Atlanta and ~lacon. These activities were under the supervision of the Director of Typhus Control Service, and the field operations were under the immediate supervision of the State Field Supervisor, who was responsible to the director. For efficiency of operations, Typhus & Rodent Control Regional Supervisors were located in the Southeastern, Southwester~ Central, and the combined Northeastern and Northwestern regions.
The Typhus Control Program was supported through the financial participation of the federal, state, and local health departments. This
participation ~o~nted to 63.4% from local and state funds, and the balance of )6.6% from federal funds. Materials and equipment such as; DDT dust, motor
vehicles, and DDT dusting equipment, and maintenance of equipment were provided by federal funds. Certain salaries and travel expenses of personnel were defrayed out of federal, state, and local funds. State funds also included expenditures for gas and oil, for the operation of motor vehicles on the State level, and for a portion of the small field equipment used, together with office equipment and space for state supervisory personnel. Local funds provided for salaries of local employed personnel, the purchase of practically all of the rodenticides used, and gas and oil for federal vehicles operating in the respective counties. Storage and certain needed office space were also provided by local agencies,
The program during 1951 consisted of the following activities: (1) Education, (2) Investigations involving typhus fever cases and rodents,

Annual Report - 1951
(3) Application of control measures consisting of (a) DDT dusting of rat runs and harborages, (b) Rat eradication (c) Anti-rat sanitation, and (d) Ratproofing of buildings.
TYPHUS FEVER IN GbORGIA
During 1951, there were 58 reported cases of hurine Typhus Fever as compared with 162 for the year 1950, showing a decrease of 64.2% for 1951 as comp1red with the hurine Typhus Fever cases reported during 1950. This percent decrease is the grec.test for any one year since the
inauguration of w.i.de-scde tn>hus fever control operations in Georgia.
The greatest number of C<l.ses reported in GnY one month during 1951 was 11, which were reported for the month of June . Grrl.ph Number 1, Page 3,
shows the seasonal variJ.tion of reported cases to be gradually diminish-
ing. This is shown in the graph curve for the year 1945 as compared with the years 1950 and 1951.
As has been the cuse in the pu.st few years, typhus fever distribution has been m.:.inly locatt;d in the Centr<ll, Southeastern, and
Southwestern health r6gions. In 1951, 99,08% of thE; reported cases were
located in these three regions, only one case being reported out side of these regions. For the first time since D:UT dust has been used on the
progr<:!.m, there W<:!.S one month (NovE:mber) in 1951 wherein no typhus fever cases were reported. Attention is invited to gre..ph Number 21 Page 9,
showing the comparison of the number of typhus fever cases for the years
1945 through 1951. This decrease of 1053 cnsE::s for 1951 is a reduction of 94.78% as compured to 1945, the first year DDT dust wns used as a
vector control, The use of JDT dust, as ..lpplied to rat-runs and harborages, has apparently obtainc."<i satisf<~ctory control of rodent ectopa.rasites; and consequently, had a me..rked effect on rbducing typhus infection, both in rats and hum:.;ns
(2)

GRAPE NO. 1

Seasonal Variation of Reported Typhus Fever Cases in Georgia

180--.-.---....----- -.----

T

I

I

I

I

I

I

160_1- - - - ~ - - - - -1- - - - - ~ - - - - .!. - - - - ~ - - - -~ - - - - ..!. - - - --'- --'"".- J. _!f)~5_ - _,_ - - -

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~ ~ ~ ~ -~~ ~>.. - -'- -~ i - - - 140_f_ - - -

----

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~- ~~.--

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+- - - - +- - - +- - -\ 100_1_ - - - ~ - - - -:- - - -- -: _.. - - - -:- - - - ~ - /~ ~-- ~ - - - -:- - - -

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/)I I

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1950 . I

I

I ', 20 - .__-__--- _-_ J L...---"---- _---L i- -- -_ -

-~I' -. . - - -

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T-

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-_-_-__.r..-----

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---..-..

I
-.J-_-___/

I- --!- .._ .IL-..~_,_ 4____,- UI-.9-51-

I _I. . . . - - -

-

0 ~I

Jan.

Feb;

. . I

- --+
_ -----1

-- - ~ -::t:-... ----+...._. _ I

------- I

I

- . ,..

--1----- I

I_

--------j----..

~-- - - -!-- -- - - --

I-...-..._._ I

_

-M1ar.

Apr.

May

June

July

Aug.

Sept.

Oct. 1'!~~-~---ve

Typhus Control Service Georgia Department of fublic Health

l.i,ONTHS

'~:~.::-~-:-

.~:

Annual Report - 1951 In addition, the increased use of anti-boitics has apparently had an influence on the reported incidence of typhus fever. During 1951, 36 counties reported one or more cases as compared with 62 counties for 1950. Of those counties reporting typhus fever during 1951, there wa~ only one county that reported more than three cases. During 1945, there were 59 deaths reported from typhus fever as compared with 6 in 1950, and 4 deaths in 1951, showing a 93,3% reduction in mortality for the period 1945 through 1951. The reductions in morbidity (94.78%) and the reduction in the mortality rate (93.30%) for the period 1945 through 1951 shows only 1.48% differential.

PERSONNEL

Personnel engaged in typhus control activities during 1951

totaled 52 as compared with 67 in l95ffi, showing a decrease of 23%. A

decrease in federal funds necessitated further reduction in federal paid

personnel from 16 in 1950 to 11 in 1951. At the end of 1951, personnel on

the program consisted of 1 State Field Supervisor, 2 Regional Supervisors,

2 Typhus Control Aides, 2 Biological Aides, 2 Clerk Stenographers, and 2

Clerk Typists. State employees included a State Director, 1 Refuse Collection

and Disposal Consultant, 2 Regional Supervisors, 2 Typhus Control Aides, and

2 Stenographers, The number of local personnel varied throughout the year;

however, at the close of the year 1951, there were 33 full time local paid,_:

employees.

EDUCATION

The main purpose of the Typhus Fever Educational Program was

to acquaint the people with the current disease problem and also the type

of control that was needed. During 1951, special effort was made toward

the above mentioned goal in working with school groups, farm socities,

(4)

Annual Report - 1951
agricultural agents, and civic groups. This was accomplished through and with Regional and County Health Department personnel. The most outstanding phase of this program was the preparation and showing of exhibit material which depicted the various phases of typhus fever control operations, and was made available for showing to schools, fairs, and civic and other interested groups. Pictures, placards, pamphlets, films, film strips, and mounted rat specimens were also used in telling the story of Murine Typhus Fever in Georgia. There were lOS locally released newspaper articles which presented to the public the history of this disease and its public health significance together with the type of control
measures which had been applied. During the caiendar year 1951, there were 11,762 personal conferences and contacts made by Typhus Control personnel, of which 9,263 were for control measures (general), 1,352 biological, 795 refuse collection and disposal, and 352 Epidemiology (human typhus fever investigations). In addition, 77 meetings were addressed with a total of 2,863 persons attending said meetings.
INVESTIGATIONS Typhus Fever Cases
Field investigations were made of all reported human typhus fever cases. The local potential 11danger spots", or foci of infection, were located where possible; thereby enabling more specific control to be applied. Information obtained from these surveys included data which had the name and address of ~tient, color, sex, and age, working and horne environmental sanitary conditions conductive to rat and flea infestation. The finding in these investigations aided greatly in showing the need
and type of specific control to be applied. A total of 57 dases were in-
vestigated, and 1107 premises associated with these cases were treated with
( S)

Annual Report - 1951

3,445 pounds of 10% DDT Dust. Tables one and two, page 7, were compiled

from these studies and show a break-down by color, sex, age, and occupation.

Table Number 1 shows that of the 58 casos reported, 47 were

white, showing 81.0% of the total cases reported. -iihite males accounted for

63.8% of the 47 cases, and white female 36.2%. The colored population

showed that of the ll cases reported, the male percent was 63.6%, and the

female 36.4%, which was practically the same ratio as shown for the white

cases investigated. All age groups were reported, with the highest per-

centage (25.9%), falling in the 30 to 39 age group.

From table Number 2, it may be observed that in 1951 as in 1950,
the greatest percent (60.3%) of the 58 cases were principally in the rural

areas and were in the home and agricultural groups. In addition, it is

interesting to note thnt there were no oases reported in the professional,

food handlers, and clerical occupational groups. Rodent and Ectoparasite

7/ith the exception of some "follow up11 rat tr<.:pping, the "finite

universe" statistical sampling formula was used as a guide to insure

adequacy of sampling for county-wide rodent surveys. Information obtained

from these surveys pointed out the apparent foci of infection in the rat

population by premise. Local public officials realized the importance of

this information and assisted in defraying the cost of these investigations.

Reports were prepared showing the geographical location of infected rats,

rat ectoparasite infestation, control measures which had been previously

applied and results accomplished, together with recommendations for Typhus

Control.

There were a~proximately 4,600 premises inspected, of which3,0SO

traps had been placed on individual premises. Rat blood specimens were

successfully tested from rats trapped on 1,050 premises. Of those, 66 premises wore shown to have had typhus infected rats, as were indicated by the presence

of Murine Typhus Fever Antibodies, showing a premise infection rate of 6.28%. { 6)

TABLE I
Reported Murine Typhus Fever Cases Investigated in Georgia by Color, bex and Age During the Calendar Year 1951 (Provisional Figures)

Age Groups ALL AGES

State Total
-N-o-. ~
58 100

-White-

-Colored-

- - a t - - , I. Total
~0~~

1':ale
~ !:?.

Female No. _

Total
No. !

Male Female
- No. 1f No. !

47 81.0 30 63.8 117 36..2 11 19o0

7 63o6

4

36.,4
_;:;_;_

0-9

5 8.6 3

2

1

2

1

1

10-19

9 15.5 8

6

2

1

1

0

20-29 30-39 40-49

5 8.6 3

3

0

~ 15 25.9 12

7 -5

10 17.2 8

4

4

2

2

0

3

1

2-

2

1

1

C:0-59

5 8.6 5

4

1

I0

0

0

60-69

7 12.1 6

3

3

1

1

0

~0 & Over 2 3.5

2

1

1

0

0

0

TABLE II
Reported 1i1urine Typlms Fever Cases Investigated In Georgia By Occupational Grm.lps During the Calendar Year 1951
(Provisional Figures)

Occupational
Group
All
Occupations

-'\'hi te-
State TotaJTotol Male femal_e
! N o . - r - No. ~ No. ~ No. ~
58 100 47 61.0 30 63.8 17 36.2

-Colorsd.Lotal I Male
! No~-! No.

.t"emale
-No. !

11 19(:0 7 63.,6 b. 36.4

Home

15 25o9 11

1

10.

Agriculture 20 34.4 18

17

1

4

1

3

2

2

0

Industry

5 8.6 2

2

0

3

3

0

Business

4

Professional 0

Food Handlers 0

Clerical

0

Miscellaneous 14

6.9 4

0

0

0

0

0

0

24.2 12

4

0

0

0

I 0- 0

0

0

6

6

(7)

0- 0

0

0

0

0

0

0

0

0 0-

0

2

1

1

Annual Report - 1951

Table Number 3, below, shows the decreasE: in the number and percent of rat bloo&positive to typhus fever, from th~ year 1946 through 1951. This table was compilsd on the basis of rat blood specimens examined from rats

trapped throughout the state. However, the major portion of the rat blood

specimens were obtained from the Southeast, Southwest and Central Health

Regions wherein th human typhus incidence was the greo.test. Graphs
Number 2 and 3, page 9, compare favorably in showing the downward trend in

both human and typhus infection.
TABLE # 3
Typhus Antibodies in ltat Blood Specirncns
1946-1951

Year

Number Examined

1946 3,267 --------------~-----------------

1947 ------------------------------- 3,145 1948 ------------------------------- 3,496

1949 ------------------------------- 5,087 1950 ------------------------------- 3,220 1951 ------------------------------- 1,256

l\!un1ber
Snowing Antibodies
1,038 846
492
555 303 79

Per cent Positive
31.6 26.9 14.1 10.9 9.3 6.,3

Rat ectoparasit0s from rats examim.:dJ totalinz 12,637; w0re identified. Of these, 3,281 were fleas, 6,533 v:cro mites, and 2,773 were lice. Only 44 rats examint.d during the year showed the presence of
Xenopsylla Cheopis fleas, principal vector of kurine Typhus Fever. These
rats were obtained from 43 separate premises. The predominant species of rats trapped were Rattus Norwegieus (Non1ay rat) 78.77%, and 21.23%
of Rattus Rattus Alcxandrinus (roof rats).

(8)

QRI..PH NO. 2

QR;.pH NO. 3

I

Number of Tynhus Fever Cases Reported in Georgia

I
I

!s.lU. - '

-
I

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

J! l-2.5 -

Percent of Rats Examined Having Murine Typhus .t.ntibodies
- ----- -----------

_ --~QQ

i

_

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!__

!!__---_-'T

______________

-

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: ! i : I l 64%

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.(.)_--..,

I I I ----0----I!,----!;. ---:!----j ----------IIi----lI-------I---.-j ---i!---r----'-' ---!1I:.--c--~-1!. ----I.! ---I'----i -----;i----t--------!..--,:.t----'-----Ii. ---II.-------

1945 1946 1947 1948 1949 1950 1951

1946 1947 1948 1949 1950 1951

YEhRS

Typhus Control Service Georgia Department of Public Health

Annual Report - 1951
CONTROL JV.EASURES DDT Dusting
Since 1945, DDT Dust has been used with apparent success as a
vector control by application to rat runs, rat harborages, and rat shelters. The usage o DDT dust as a vector control has changed progressively, as
dictated by the need, from (1) Urban areas, to (2) County wide, to (3) Restricted premise dusting. During 1951, there were 115,816 pounds of 10% DDT dust used in treating 33 1003 premises, This figure includes 3,445 pounds of DDT dust used in treating 1,107 prr:)rnises in connection with human
case investigatio~s. The apparent need for DDT dusting of pre~ises was
not as ereat in 1951 as in 1950, as indicated by field data obtained from human and rodent investigative studies. A total of 57 counties during 1951
received some form of DDT dusting for rat ectoparasite control, as compared
with 48 counties in 1950.
Rat Eradication Red Squill, which has for the past several years been used
as the principal rodenticide in Georgia because of its relative safety to humans and animals, was practically replaced by warfarin-prepared baits.
During 1951, there were 62,397 lbs. of prepared warfarin bait used in treating 30,764 premises as compared with 32,445 lbs~ of Red Squill bait used in treating 34,630 premises.
The majority of Red Squill baits were used in the Atlanta area,
totaling 25,976 premises treated, as compared with 34,594 for the state. There were approximately 60,000 more premises poisoned with warfarinprepared baits in 1951 than during the year 1950. This new rodent-
icide, which is relatively safe to humans as well as animals, was used more
(10)

Annual Report - 1951 successfully with a yellow corn meal base. It develops a hemorrhagic condition in the rats. The results reported from all areas where warfarin baits have been used are most promising, and in some instances, complete eradication has been noted. This bait is best disp~msed by the use of a permanent metal type bait station. Approximately 7,500 of these bait stations were constructed in 1951 through the efforts of regional and local typhus personnel in cooperation with County Health Departments and other local governmental agencies. The expense incurred in the making of these boxes, in most cases, was financed by local governmental agencies who in turn were reimbursed by tho individual promise ownar. The warfarin preparations were purchased by these agencies, bait prepared, and distributed to the premise owner at cost basis. Other rodentic:i.des used during the past year were Calcium
Cyanide Gas (A-Dust) in treating rat burrows on 3,431 premises, using
2,607 pounds of material, and lOBO Compound (Sodium Flouroacetate) used in treating 3 premises with 12 pints of this poison solution.
~Proofing
There was only one project in operation during the past year, and this project was locat()d in tho city of Atlanta. The Atlanta project was under the immediate supervision of the btJ.anta Health Department, and during the past year, rat-proofed 274 premises at an average cost of $58,09 per premise. The expense involvc;d in this type of program involving special equipment and'~technical personnel was such that federal typhus allocations were not sufficient in 1951 to support a wide-scale rat-proofing program; however, there was some maintenance rat-proofing accomplished in several cities under the immediate direction of the regional Typhus Control Supervisor.
(11)

Annual Report - 1951
Anti-rat Sanitation Environmental sanitation as interpreted in Typhus and Rodent
Control Services, pertains to any sanitary factor having an influence on rat populations such as improper food storage and elimination of rat harborage and/or shelters. All basic sanitation has a marked influence on rat populations and can be controlled to a great extent through the activities of the local health dGpartments and other local gov6rnmental agencies in cooperation with food, restaurant and other sanitation programs. In addition, city improvement projects, clean-up woek campaigns, and housing and safety programs aid greatly in the elimination of (a) rat shelters, (b) harborages and (c) trash or refuse removal, which in turn reduces rat infestation in the respective community.
The Typhus and Rodent Control program inciudes consultant services for the elimination of open garbage and refuse dumping and improving collection systems. This program has helped communities to eliminate many insanitary conditions.
In the establishing of sanitary landfills and improvement of garbage and refuse collection, rodent and insect problems have been greatly diminished. These services were under the immediate supervision of a consultant and consisted of tho following:
1. Advisory service to co!ll!I!unities concerning refuse collection and disposal services.
2. Demonstration of community sanitary landfill methods of refuse disposal.
(12}

Annual Report - 1951 3. Training local personnel in the operation of sanitary
landfills through lectures, movies, and active field demonstrations.
4. Inspection of open-dump areas. 5. Meeting with civic groups, local governmental agencies
and other interostud groups. 6. Distribution of 1iterature and pictures selectivE' to refuse
collection and sanitary landfill refuse disposal operations.
There vverc, during the past year, 8 cormnunities which inaugurated
new sanitary landfill methods of refuse disposal, making a total of 24 in operation during 19$1.
Many additional communities wishing to eliminate 11open dumping11 menaces havr::.: requested and been gven technical advice as to proper refuse
collection and sanitary landfill operations. There were 795 conferences and contacts made in behalf of this service in 31 communities located in 24 counties during 1951.
SUlvJviARY
During 1951, there werE; 58 human cases and 4 deaths attributed to Murine Typhus Fever in this State, as compared with 162 cas<::s and 6 deaths for the year 1950. This is a reduction of 64.2% in morbidity and a reduction of about 33% in mortality. One or more of these cases were reported from 36 counties during 1951, as comparr~d vvi th 62 counties for the year 19$0.
From the all-time peak year for typhus in 1943, in which 1,256 cases were report<:::d, tho incidence of this disease has decreased 96% to the level of 1951.
Financial assistance received of the U. s. Public Health Service,
Communicable Disease Center, during 1951, amounted to approximately 36.6%
(13)

Annual Report - 1951 of the total cost of the Stc..te-wide typhus control program, with the balance of the cost being provided by state and local funds.
Typhus control services were r;;"ndcred to 77 counties during 1951, as compared with 71 counties in 1950.
The most outstanding phase of the typhus educational program in
1951 was the preparation and showing of exhibit material at county fairs,
public health mestings, schools, and civic groups. Educational activities also included the attendance of personnel at 13) meetings of local groups; the distribution of pamphlots and posters; showix:g of movies and film strips; and the publishing of 105 n~wspaper arti clt.; s.
Investigations were made of 57 reported typhus fever cases.
The pE:rtinent environmantal data obtain.:.d through these iGvestigations was used by field personnel to locate the foci of infection of the disease so that typhus control measures could be moro effectivdy applied.
During 1951, rodent surveys were conducted in 14 southern
counties. The survey data obtained showed the location of the premises and areas having infected rodents. From these data, control measures were con-
centrated at these locations. There were 1,256 rat blood specimens successfully examined for typhus fever antibodies, 79 of which were found to be positive. This is an infection rate of 6.3% for the state in 1951, as compared wHh 9.3% for the state during 1950. All rat ectoparasites recovered, which included fleas, mitEs and lice; totaling 12,637, wsre idontifisd during 1951.
With tho succussful rGsul ts thus far obtairi,:;d with DDT Dust for the control of rat cctoparasit(;S, o:nd consequer::tly the transmission of typhus fever from rat to mo.n, the use of this ins~jctidde was continued
throughout 1951 as the principle typhus fever control m,?o.sure. During the
year, the DDT dusting of rat runs and harborages with this insecticide was
(14)

Annual Report - 1951 applied to 33y000 premises, using 115,816 pounds.
The most significant change in the rat eradication phase of the control program took place this year with the increased use of the comparatively new rodenticide known as "WARFARIN". This rodenticide is very effective and relatively safe to human and pet animals for wide-scale usage. It was used more extensively than other rodenticides corr~only used in the program,
A total of 97,461 pounds of all types o.f poison rat bait was
used by typhus control personnel throughout the state. The effectiveness of DDT dust and the new rodenticides in typhus
CQntrol has brought about the de-emphasis of r<.tt proof1ng of buildings during
1951 as compared with previous years. However a total of 274 business establishments were rat-proofed at a cost of $)8.09 per establishment,
Refuse collection and disposal consultant services were rendered
to 31 communities in 24 counties during 1951. The purpose of these services
was to aid communities in the improvement of their garbage and refuse collection and disposal facilities for the control of rodents, insects, and nuisancGs. Eight new sanitary landfills for the disposal of refuse were
started during 1951, making a total of 24 sanitary landfills in operation dur-
ing the year, Although the incidonce of typhus fever in humans is at am all-
time low level, the disease still remains a public health problem that requires a continued survt~illance program to prevent any increase that might otherwise take place, thereby nullifying work already pt;rformed, Therefore, the continued financial support of the governmt::ntal ag,:mcies concerned are needed to maintain the present control level by searching out the foci of infection in the human and rat populations and treating those areas to prsvent the spread of the disease.
(15)

ST~TISTICAL REPORT

Comparative T~tals

1. lzphus Fever Morbidity
No. Typhus Fever cases report.;;:d for State
2. Personnel
A. No. of employees 1. Local
2. State 3. Federal 4. Total
B. No. of man hours 1. Local 2. St:1te 3. Federal 4. Total
3. Edycat.iQn
A. Personal conferences and contacts B. Meetings attended C. Meetings addressed D. Persons attending meutings E. Films sho1"1fl F. Radio talks G. N:;mspnpor articles H. Literature distri.butod
4. Inv0stigatiop~
A. Epidemiology
l. Reportxl typhus fevnr cases invDstigatcd
2. Premises troatsd with DDT dust 3. DDT dust usod (pounds)
B. Rodent Investifations 1. Premises tr~pped 2. Rats examined 3. Premises with infect.od rats
4. Blood specimens examined 5. No. of blood specimens positive
6. %of blood specimens positive Typhus
Fever 7. Rat ectoparnsites examined

162
49 2 16 67
96,997 3,640 45,659 146,296
16,175 174 151
1,871 16 5 17 648
120 1,420 4,182
4,510 3,704
235 3,220
303
9.3 49,042

(16)

58
33 8
11
52
67,309 6,182 22,616 96,107
11,762 135 77
2,863 3
0
105 898
57 1,107 3,445
3,050 1,474
66 1,256
79
6.29 12,637

Statistical Report - 1951 (Cont.)

Qomparatiyo Totals

5. Control M13asures
A. Ratproofing 1. Est'3.blishments ratproofed a. Business establishmt-.mts b. Residential est1.blishments c. Total number estrtblishments
B. Rat Eradication 1. Premises tr)atcd with poisoned bait a. Farms b. Residences c. Businesses d. Total number tr0atod
2. Poisons used a. Pints poisoned liquid (1080)
b. Pounds poisoned bait (rod squill) c. Pounds poisoned gas (A dust)
d. Pounds poisoned bait (Compound 42)
c. Rat Flea Eracuc~tion - DDT Dusting
1. Premises troatod 1'Jith DDT Dust a. F11rms b. Rosidences c. BusinessGs d. Epidemiologic Investig11tions e. Total numbor treated
2. DDT Dust used a. DDT Dust used (pounds) b. DDT Dust per premise (pounds)

196

274

0

0

196

274

($58.09 per premise)

95,351
227 62,372
5,839 2,027
29,242 19,246
5,181 1,420 55,089
167' 504 3.04

68,828
12 32,445 2,607 62,397
19,919 9,337 2,640 1,107 33,003
115,816 ' 3.51

(17)

Counties
Appling Bacon Baker Barrow Ben Hill Berrien Bibb Bleckley Brooks Bryan Bulloch Calhoun Candler Carroll Charlton Chnttooga Clay Clayton Clinch Cobb Coffee Colquitt Cook Crisp Decatur Dodge Dooly Dougherty Early Emanuel Evans Fulton Grady Irwin
Jeff Davis Jefferson Johnson Lanier Laurens Lee Lowndes McDuffie Hacon Harion I.vliller I.vlitchell Nontgomery Pierce Polk

COUNTIES REPORTING CAS1S GF HURINE TYPHUS FEVER
1950
2 9 2 1 3 1
5
1 1 13 6 6 2 1 1 1 1 1
7
1 5
1 2 1 2 1 2 4 1 15 2 2 1
3 4 1 1 1
2 2 2
4 1

1951
7
1
1 2 1 1 2
1 1 3 1 1 2 2 1 1
2
3 2
1 1 1
1

(18)

Count"l
Pulaski Richmond Screven Seminole Spalding Stephens Stewart Sumter Tattnall Taylor Telfair Thomas Tift Turner Walton vfare Washington Wayne Wheeler Wilcox Worth

-2-
COUNTIES REFCRTTIJG CASES OF EURINE TYPHUS FEVER (continued)
1950
2
l 4
l l l 8 l
2 2
1 2
2
2 2 2 1 2

TOTALS

162

1951
l
2 l
l
3 l
1 1 2 1 2 2 1
58

1951 Figures Provisional

(19)

R 0 D E NT A ND E CT 0 P ARA S I T E I NVE S T I GAT I VE D A T A Calendar Year 19)1

COUNTIES PARTICIPATING IN HODEl:T AND
ECTOPARASITE INVESTIGATIVE OPERATIQI\IS

s::

s::

(1)
rl

0

H

C)

H

(:"~

(1)
iil

~
~ C)
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+"
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CD CD

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0 H

iS rf 8

~ ~
0 8

1. Number of Premises trap~md

264 336 21 68,1420 275 l2P _L5_ ill 12 18 217 2~ ?1 1.0C:O

2. No. of rats (avg.) per premise

.32 .h3 ..90 .,1G .r.::2 ~h .. 8~ ..09 .3 .06 .78 61 Lr clc:J

Jill_

4.3. No. of traps per County

U84l 2':l22 212 659 6060 1612 11h/ 2~1

No. o.f Nor-nay rats examined for

69( 10? lltO 11PG7

qc 1~0

17 , ?nC:

ectoparasites s:--No. of Roof rats examined for

6 20 22 Nme 726 67 _lll lillne 1~ None lL 70 1n __Q _l clt~

ectoparasites

76 125 None 13 6 26 None L N"cr..e None none 63NoLe None

111

6. 'Ictal no. of rats examined for

...-,.
c

ectoparasites

82 145 22 13 732 91 178 t, 3~ None lt 111 10 9 1 L1h

(\J "--'

7. Nc. of rats examined having X.

Cheopis fleas

1 1 1 N:lne 25 7 I) 1one 1 None 1 1 1 None

~44

8. No. of fleas submitted
9. No. of mites submitted

- 94 290
124 12067

43 l'bne 1662 749 323 1.1 22 l'Jone
3 7 2892 614 54~ 37 55 None

2 h~ 22 1?6

18 None 28 lS

3 281 6 .S83

10. No. of lice submitted 11. No. o blood samples
successfully tested

148 870 None 7 999 135 29C: None 13 None 26 268 10 2 2.._7_13_
52 159 20 10 542 92 nsl 3 18 2 10 125 10 5 1 256

12. No. of blood sarn;eles positive

15 16

13. No. of premises from which blood

specimens were success.filly testec 68 145

14. No. of prernises from which blood

specimens were .found positive

16 11 .-'

3 Ibne 3 8 5 500 3 1\Tme 3

3 31 None Nons None
71 102 3 17 2
2 21 None NOI'!_ None

2 6 None None 7 110 8 _h 2 6 None None

.12 l_._Q5_o
66

15. Infection rate in examined rats 18.1 10. l5. Nme .55 [3_.26 17.4 None None None 20 4.8 None None
16. Per cent of successfully tested premises having positive rat bloo~ 1_2_.1 11. 38. :tlne .6 2.8 20.6 None None None 28.~ '5.5 None None

6.22 6.28

_QmmiL..

SUMMARY OF TYPHUS CONTROL OPERATIONS BY COUNTIES (DDT Dusting and Rat Eradication)

DDT Dust & Poisoqs

-
No. Premises Treated

No. Pounds

No.

Pound s

No.

LPrE._m.1!!!l Man Hrs.

No~I Man Hrs
'I P!emise

Appling

DDT

1473

6554

4.45

681

Cyanogas

84

35

.42

43

Warfarin

365

1095

3.

218

Atlanta

DDT

266

2408

9.05

368

(City)

Red Squill 25976

27157

1.05

8532

V.!arfarin 6934

5540

.8 0

1014

Bacon

DDT

1200

6561

5.47

669

Cyanogas

2

2

1.

2

Baker

DDT

6

14

2.3 3

8

Warfarin

1

10

10.

1

Bartow

Red Squill 175

100

.5 7

68

Ben Hill

DDT

358

445

1.24

139

Warfarin

102 I 173

1.70

74

Berrien

DDT

1274

5624

4.41

721

Cyanogas

381

119

.31

294

Warfarin

635

752

1.18

358

Bibb

DDT

10

200

20.

8

Bleckley

DDT

14

37

2.64

6

Bulloch

I DDT
Cyanogas

\

2654 3

Warfarin 1434

8630

3.2 5

1459

10

3.3 3

3

3134

2.19

920

Burke
Calhoun Candler Carroll Chatham

DDT Cyanogas l?Tarfarin
DDT
DDT DDT
DDT
Cyanogas

I 421 4 1730 37 2 13 414 2

1946

4.62

19

4.7 5

I

5070 159

5

I 29

923

I4

I

2.93
4 .3 0 2.50 2.2 3 2.2 3 2.

304 5
1458 16 2 10
193 2

Warfarin

14

47

3 .36

13

Clarke

Red Squill

3 f 100

3 .3 3

48

Coffee

I DDT

1701

6407

Red Squill 1143

605

3.77

1343

.5 3

865

Cyanogas

603

476

.7 9

298

Colquitt
ICook
Crisp

Warfarin DDT Red Squill
~arfal'in
DDT DDT Red Squill

1649 1188 472
595 14 1115 1499

1562 4363 412
I 3241 I 52

I

.95 3.67
.87 5.45 3.71

6384

5.7 3

1019

.68

1059 623 204 1308
8
1019 1023

~narfarin

2138

7564

3.5 4

1841

L-----I------,----I------~-L~~ Decatur
\Dooly

DDT

461

Red Squill 554

Warfarin

1206

DDT

36

1036
I 283 1467 90

2..255~
1.2 2.5

146 294

(21)

.46
.51 .60 lo38
.33 .15 .56 1.
1.34 1.
.39
.39 .73 .57 .77
..s5o6
.43 .55 3.33 .64 72 1.25
.84 .43 1. .77
.47 1.
.93 16.
79 .76
.49 .64 .52 .43 2.20 .57
.91 .68 .86
:~_j..352~ 1
L

SUMMARY QF TYPHUS CONTROL OPERaTIONS BY COUNTIES (DDT Dusting and Rat Eradication} Page II-

Countv

DDT Dust & Poisons

No. Premises No. Treated PoundR

No.

No.

Pounds

No.

Man Hrs.

/PrP.mis e JJI.sw.J......,Irslo&of--..L.Er~~

Dougherty DDT

2144

Warfarin

6

I 93..6577

743 64

.35 10.67

Early

DDT

3350

1.76

671

.20

Warfarin

495

3.07

.385

.78

Evans

DDT

1

2.

1

1.

Glynn

DDT

610

1.38

252

.41

Red Squill 163

1.53

100

.61

Habersham Red Squill

16

3.13

26

1.63

Irwin

DDT

291

4.25

192

.66

Jefferson DDT

21

1.43

5

.24

Jenkins

DDT

1018

2.84

393

.39

Johnson

DDT

29

Lanier

DDT

15

1.90

16

4.33

12

..5so5

Laurens

DDT Cyanogas
Warfarin

1624 711
10~9

I 2.11

453

13..2024

542
970

.28 .76
.94

Lee

DDT

21

2.29

8

.38

Lowndes

DDT

1574

4.75

721

.46

Cyanogas

638

.29

368

.58

'l'Tarfarin

1730

1.76

745

.43

Macon

DDT

19

2.53

16

.84

Marion

DDT

8

2.25

8

1.

Miller

DDT

16

3.81

4

.25

Mitchell

DDT

13

3.70

8

.62

Montgomery DDT

15

2.60

10

.67

Peach

Red Squill 101

1.06

64

.63

Pulaski

DDT

156

1.43

56'

.36

Red Squill 150

.64

48

.32

Putnam

DDT

31-

2.58

16

.52

Rabun Richmond

rrarf'arin

42

Red Squill

40

DDT

456

1080

3

I Cyanogas

252

'~"'arfarin

693

3.57 I
I 2.50
I 41..70 I .71

24 46 647 10 425

.57 1.15 1.42 3.33 1.69

1.99 I 1196

1.73

Screven

I g~;nogas t

1466 13

f,l 1'\rfarin

685

3.18

785

.54

3.77 1 15

1.15

3.96

833

1.22

Seminole

DDT

892

2.97

397

.45

Red Squillj 594

.36

147

.25

Parf'arin 1 1109

2.81

1504

1.36

Spalding

DDT

29

2.93

8

.28

Sumter

DDT

1632

4.

660

.40

Red Squill 2294

.40

568

.25

I --------~---v-r-a-rf-a-r-in--.___1_0_2_9__~_______.1____5_._2_6_~1----8-8--0----~-------.-8-6---+

(22)

SUMMARY OF TYPHUS CONTROL OPERATIONS BY COUNTIES
(DDT Dusting and Rat Eradication) Page III

.Qountv

DDT Dust & Poisons

No.

Premises

No.

Treated __founds

No.

Pounds

No.

~e Ma.D..]rs

No.
Man Hrs. /Premise

Ta.ttnall Ta.ylor Telfair Terrell
Tift
T combs Troup Turner V1alton v;.are
m;. ashington
wheeler
wdlcox worth

DDT

41

DDT

10

DDT

6

' DDT

817

Red Squill 272

VTarfa.rin

856

DDT

59

Red Squill 124

DDT

3

Y1a.rfarin 1010

DDT

47

DDT

19

DDT

2649

Red Squill 212

Cyanogas

154

Warfarin 1711

DDT

46

DDT

814

Cyanogas

566

Warfarin

45

DDT

13

DDT

391

Warfarin

854

Red Squill 842

130

56

I

23 3178

252

2437

197

35

8

1000

102

43

10181

202

282

3890

111

2822 I 498

139

49

2121

2263

566

3.17

17

5o60

8

..4so1

3.83

8

1.33

3.89

758

.93

.93

228

.84

2.89

1273

1.49

3.34

19

.32

.28

48

.39

2.67

3

1.

.99

96

.10

2.17

8

.17

2.26

8

.42

3.84

1047

.40

.95

61

.29

1.83

54

.35

2.27

750

.44

2.41

19

.41

3.47

475

.58

.88

686

1.21

3.09

49

1.09

3.77

8

.62

5.42
2.65

408

1.04

1142 I 1.34

.67

465

.55

--

----f---

--

GRAND-

DDT

33003

115816

3.51 16607

.50

TOTAlS

Cyanogas 3431

2607

.76

2749

.80

Red Squill 34630

3!445

.94 12835

.37

---

l - - - - Wqrfarin 30178

61394

1080

I --------3--=+:- l2

2.03 20246 10
4.. -

.67 3.33

( 23)

ANNUAL RBPORT DIVISION OF VEN~R;c;AL Dio..::,-to.b CONTROL G..!";ORGIA DEF ARTHENT OF iUEiLIC H..:,;-~.LTH
January 1, 1951 - December 31, 1951
Division Function: To control venereal diseases in the State of Georgia, through the
various case-finding procedures including public information, mass serology, and contact Lwe::;tigation; and through the treatment of all infectious cases discovered; and to train venereal dise3.se personnel in the various aspects of venereal dise,we control.
The efforts of this Division in the year 1951 have been directed toward the control of the venereal diseases through intensive programs of case finding and treat~Jnt. In both our case finding and treatment programs our efforts have been dirt'lcted toward the control of spread of the venereal diseases and tmani the reduction of the problems arising from the end resu1ts of untreaterl cases. The discovery and treatment of latent and late cases of syphilis have been emphasized during 1951 with a view of minimizin& the traglc waste both in terms of our human and economic resources.
incidep,ce and prevalence of ~J;hilis. vJe have continued to increase our case findir~ efforts through public information, mass testing, and contact investigation. Although our records for 1951 show materially increased activities in all three phases of case finding, our percentages of positive findings and of nEM untrea:ted cases continue to show a decline. This is a definite indication c,f d:Jninishing returns for increased effort and is conclusive evidence of progress in bringing sy1)hilis to the point of control.
J.r~~.r_~~~~d....~ffort rather than retr,enchment is indicated if we are to hold
our ga:i,ns C9_,q __,c_ontinu~,~r d?._wnward trends in incidence and prevalence.
This is especially true in viev; of current military and defense mobilization.

Continued fin::mcial :-.,upport, both Federal and .)tate, is essential if we are to continue our present progress in bringing the venereal diseas~to a point of control. \Je believe it possible to bring venereal diseases to a point of control in Georgia in two more years, if we can continue our operations as at present. Drastic reduction in funds at this time will make it impossible for us to achieve this aim.
Statistics of the Division of Venereal Disease Control, U.S. Public H::;alth Service, continue to show that Geort,ia leads the Nation in the number of infectious syphilis cases brought to treatment. Although several of our neighbor states show a volum3 of eases treated as great or greater than ours, their number of infectious cases falls considerably below ours. This we believe to be attributable to our well balanced program of case finding which emphasizes all three major methods - public information, mass screening, and contact investigation.
Our Communicable Disease Investigator Program continues to stand at the top of similar programs in other states patterned after our successful pro~ gram in Georgia. Our trainin<S school at Alto hedical Center established in 1949 for the training of investigation personnel for the entire Nation has enjoyed phenomenal success during the past two years. The results of this school are now being reflected in the indices for contact investigation over the entire Nation.
TABLE I (Appended) -Multiphasic Healtht.asting Surveys: During 1951 Jv.i.ultipha.sic Healthtesting Surveys were conducted in Glynn,
Burke, Jackson, Newton, Putnam, Butts, lvionroe, Screven, Laurens, Telfair and Cook Counties. In these surveys we did a chest x-ray for tuberculosis and other chest pathology, serologic test for syphilis, hemoglobin determination for anemia, and a blood sugar determination for diabetes. In these 11 surveys conducted during 1951, we tested a total of 118,564 persons for syphilis. Of these, 8,991 were positiv.:; or weakly positive. From this number of

positive findll1gs, 1,614 new cases of syphilis were brought to tr~atment, This compares with 288,877 persons testad for syphilis in 1950, with 26,4~ positive or doubtful findings, and 12,705 new cases of syphilis brought to treatment. (The greater figures for 1950 are due to the Greater Atlanta Healthtesting ?rogram in which approximately 236,000 persons were
tested.)

TABLE II (Appended) - Communicable Disease Investigator Progra1!!,:
This table shows that 10,346 suspects were investigated by our Communi.. cable Disease Investigators during 1951 and that ~ previously unknown
cases were brought to treatment, of which ill were primary and secondary
syphilis, This compQres with 10,312 suspects investigated during 1950 with .2_, 549 previously unkown cases brought to treatment, of which 504 cases were primary and secondary syphilis. During 1951 our Communicable Disease Inves-
tigators brought to treatment ill cases of congenital syphilis. This com-
pares with 649 such cases brought to treatment during 1950.
In addition to the above activities of our Comn1unicable Disease Investi-
gators in the field of suspect investigation, they also conducted 56 Miniature Hultiphasic Healthtesting Programs in 58 counties. In these 2. miniature surveys they tested a total of 63,436 persons with 3,486 positive or
weakly positive findings,

TABLE

III

(Appended)

-

-Alto

1'ledical

Center .

-

In-Patient

Care:

This table shows that 6,688 cases of syphilis were treated during 1951

and that our total admissions for 1951 were 12,764, Tbis cornp<1res with
16,249 cases of syphilis treated during 1950 and 2:2 1 72.2. total admissions
during 1950. During 1951, 504 caset> of primary and secondary syphilis were

treated as compared with .L_l?l ca.ses of primary and secondary syphilis treat-

ed during 1950. During 1951, 980 cases of congenital syphilis "rere treated

as camp red wj_ th h7?1 cases of congenital syphilis trGated during 1950.

(Again the greater figures for 1950 are attributable to the Greater Atlanta Hea1thtesting Program.)
TABLE IV (Appended) - New Venereal Disease Cases Reported: During 1951, 5,173 cases of syphilis were reported, of which ~ were
primary and secondary infections. This compares with 9,156 cases of syphilis reported during 1950, of which 1,756 were primary and secondary infections. During 1951, 13,308 cases of ronorrhe a were reported. This compares with 14,501 cases of gonorrhea reported during 1950. During 1951, 1,022 cases of other venereal diseases were reported. This compares with 1,292 cases of other venereal diseases reported during 1950.
TABLE V (Appended) - Distribution of Free Antisyphilitic Drugs: This table shows comparative figures for the distribution of free
antisyphilitic drugs for the years 1950 and 1951.
TABLE VI (Appended) - Alto j:iedical Center Training School This table shows that 3.70 trainees attended Alto Hedical Center Training
School during 1951. Thc3Se trainees came from 2.2 states, Puerto Rico, Hiawiit
District of Columbia, Alaska, and from the Army and Air Corps.

VEi:IZHEAL Dio.i:ASE SUl'iVEYS IN GEORGIA

Table I

i

I

1951

v .D.R.L

City

County

Period I Pop. Number of New Syphilis Cases
I Tested Brought to Treatment i I . 'fo .rrim. Early jJther 1 Total i

Total

Kahn Tests Negative : Positive

PoSitive or
Doubtful W/Pos.

!

f Ages i and 1 Latent 1

j.

l

15-64 :Sec. !

I

i

Brunswick

Glynn 1 l-10 to

!

I

j

I

1

I l-30-51 111.0

7

1;[aynesboro Burke 3- 7 to

3-27-51 97.5

6

61 173 ! 241 ...;j..--24-,-075

63 439

508 l 15,748

22,856 i '
14.332

929 1_,_139

290

2,250

277

1~939

Jefferson 1 Jackson 4-18 to 1

!

5- 1-s1 85.5

o

Covington I Newton : 5-16 to

14

Ir 38
j

lI1

52

!
i

10~5so

10,438

110

32

275

I

. 5-29-51 88._2 I 2

49 ! 138 j 18') 10~510

10_.052 !

379 I

7'1

743

~atonton 1 Putnam 6-13 to ; 6-19-51 90.2

1I

j'
10 40

51

4. 592

4,411 :

137 It

44

331

Jackson

Lutts 1 7- 5 to 1 1-n-51

66~5

o

Forsyth

Monroe 1 7-25 to

7-31-51 l 97~8

0

oylvania

Screven 8-15 to

~
2 I 20

22 J. 769

i

3. 661 !

88

'

j

j

16

87

103

6.184 '

5.954 I

190

20

244

40

470

8-28-51 67.5

1

18 i 64

83

8, 551

8,255 '

225 I

71

807

Dublin Echae

Laurens 1 9-26 to , 110-16-51 ,

96~ 7

1

Telfair 11- 7 to (

!
I 31 l 217

249 20,027
1

lSi707

1,162

158 1~312

Ade1

11-20-51 j 99.6

0

Cook 12-17 to j

112-25-51 I 73.3

0

6 55

61 ! 2J28l

8J939

312

1

54 I'

55 I;

.
5,247 .

5,029

192

30

336

26

287

Total

:

I

! ~,325 ~ I 18

271

1,614 118,564

I

I

112,634

4,863

1,067

8,994

CQivJhUNICABLE DIS.:Adr:.: INVEdTIGATION PROGRAM

Table II
Disposition 1 (Invastigation incomplete) ........................ 0

"

2 (~xamined - Not infected) ......................... ~,909

II

2X (Previous treatment adequate) ..................... 980

" 3 (Old casE:B returned to Rx) ......................... 193

II

.................. 3X (New cases brought to treatment

2,907

II

4 (Located - Already under Rx) ..................... 198

II 5 (Infected - Not under Rx) ........................ 0

II 6 (Cannot locate) ............ ' .................... . 327

II

7 (Moved from jurisdiction) ........................ 545

II

8 (Insufficient information to investigate) 197

II 9 (Other) ........... ................. ' .......... 90

Total Suspects Investigated 10,346 Breakdown of Dispositions 3 (Found Infected - No Previous Treatment}

Pri.Ina cy syphilis ............ , , .. , , .

80

Secondary syphilis ........................ , ... , ..... , .... 251
Early latent ..................................................... 695 Late latent ...................................................... 824

Cardiovascular syphilis 17

Neurosyphilis........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75

Congenital syphilis ...................................... , .. , 543
Gonorrhea ........................................................ 355
Chancroid ........................................' ................ 34

Granuloma Inguinale . . . . , . . . . . . . . . . . . . . . . . . . . . .

15

Lymphogranuloma Venereum.......................................... 18

Total cases untreated V.D. found

?<Number of individuals found infected

CLASSIFICATION OF P1-1.TI&J1' LOAD ALTO l'1IZDICAL CZNTER 1950 and 1951

Table III

I. Syphilis (Treated)

1950

1. Primary and Secondary 2. Early Latent
3. Late Latent 4. Neuro-Syphilis 5. Other Late 6. Congenital

1,171 2,391 8,379 2,290
297 1,721

Total syphilis cases treated

16,249

II. Not in CQ!!!2ination with Syphilis (Treated)

1. Gonorrhea

108

2. Other V.D.

318

III. Observation and No v.D.

l. Observation only 2. Treatment given

6,012 20

IV. Patients Treated

l. Total number
v. Patients Treated and Observed

16,695

l. Total number

22,707

VI. Admissions

l. White 2. Colored

1,245 22,478

Total admissions

23; 723

VII. Total number of patient days

167, 1.024

1251 504
1,297 2,821
818 268 980 6,688
99 244
5,623 25
7,056
12,679
'666 12 2098 12,764
84,77~

~~~lv~1~~i-~

. ~ - -.;~ _. ~ ~-

DISEASE
SYPHILIS:
Primary and Secondary Barly Latent Late and Late Latent Congenital Unknown (Not s~ated)
Total syphilis cases
GONOCOCCUS DIFECTION
Genito-urinary Opthal.'Ilia Neo. Not Stated
OTHER VENEREAL DISiASES
Chancroid Granuloma Inguinale Lymphogranuloma Others (Not stated)
Total Other Venereal Diseases

NEW" VENEREAL DISEASE CAS!~S REPORTED TO VENEREAL DISEASE COl:TROL DIVISION
1951

Table IV

PRIVATE PHYSICIANS

~~hite

Colored

i I CLINICS

1

IJhite

Colored

ALL
Vih,ite

lSJl~B~CtE:S~d

f
I

u~~~;~!

TOTAL

H !F

Mt F

24

I I.

I
!

I8 64 19

7 5
0

7 j 20 I 9

I l I 15 7

!~

0I 0

I 7 l t 8! l

H

F_t M

F

iI

I!

I'

47 27 ! 395 '. 380

27 55
~0
0'

38 l 493 ! 842
I6o 731 i 1018
I I ~0 I 3il7 449 . 0 I 0. 0

M. F 1M: F

1!

I.

71 35 459 : 399 II

34 45 513 I 851

6o 61 : 746 11025 I

~0
7

I ll 1 3?r/ : 449 I
lI 8 1 I

964
1,443
j 1,892 857 17

! l i I ! 43 18 107 36 ,I 139 1135!2006 2689

i 182 153 !2113 12725

I 5,173

-
4

i i I : ' I , ' !

I

I I - -I - !.

!

-

lI

I

I

-1 - I'

'

-:

:
i

',

,

I

!

. ; ,' ~

I

-. -I

-!

-

I.',

; U 1 8 67; i 4U 873413463 674! 414 l81t.6 1347;: 1 3 ID,3o8

'I

;
i

I
.

l,

i'

1:

-
--
-

- II -

- I - - 1

-

-

-

-
- I -
-I

28 I

-
l

:'

1!_ j

!i
i

iI

-5 ~
-.
-!

472 )

95 122

III

9I

146 91 49
-

I'

28 1 4

;i

l
1

5 i 472 146 'ii

- I 95 . 91

-

l
i

122

I
I

49

-l 9 -

l

652 186 172 13

i I I I - .- 33 5 6981 286 33 . 5 1698 286

I I I

lI

L'

I'

i

i'

4

1,022

DISTRIBUTION OF FREE ANTISYPHILITIC DRUGS

1951

Table V

1950

1951

1. Arsenicals (Estimated number of doses

7,525

130

2. Bismuth

II

II

II

II

24,600 2,820

3. Sulfathiazol II

II

II

II

189,000

0

4. Fuadin

II

II

II

II

30

0

\~~)

Total doses

221,155 2,950

5. Penicillin (No. of 100,000 units)

283,648 241,369

6. Vaccines:

a) Ducrey (No. of tests)

b) F'rei

11

II

11

3,850 1,720

3,450 1,610

Total number of tests

5,570 5,060

7. Strepto:rr.ycin (Grams)

2,033 3,416

8. Sulfadiaz5.ne (Tablets)

65,000 141,900

;.;

.. :'

t.,..

,I';

(" !:~,7. ~.

Classification of Trainees:

ALTO MEDICAL CENTER TRAINING SCHOOL

1951

Table VI

One Heek Course for Interviewers

Three V.feek Course for VD Investigators

Consultants and PHN (Female) Sto.te .P:IN Directors PHN (Male) Nale Investigators Female Investigators l'ledical Doctors ;:);:mitarians Interviewers Health ~ducatm-s Clerks, Tech., Sec., etc. Social ~iorkers lviilitary .Personnel Public Health hepresentatives Professors, Sehoul of Public Health Health Officers, Lay
Total Trainees

74
1
1
128
9 5
0
4
2
5
2
0
2
1
2
236

14
0
2
105
1
1 1 0
0 2
1
5
1 0
-0
134 370

Distribution of Trainees b~ Area:

1. Alabama

6 ll..

2. Arizona

3 12.

3. Arkansas

23 13.

4. California

19 14.

5. Colorado

1 15.

6. Connecticut

7 16.

7. Florida

21 17.

8. Georgia

17 18.

9. Indiana

4 19.

10. Idaho

2 20.

Imm Kansas Kc:mtucky Loujsiana ha:r:rla.nJ
11assac~1US8tts J:i~ichigan
!l:':..n:.:-:Jsot a
l'~ississippi
11issouri

3 2L Nebraska 1 22, Ne:r ,Jersey

16

- '?;
'"~.-~

lJ e:v l~2Y...ico

23 24. Ne>-.r York

9

25. Lorti~ Carolina

3 26. Jkl::.horr.a.

16 27. ui:1io

2 ~8. Uregon

38 29. iennsJlvania

2 30. 3outh Carolina

l 31. Tennessee

8

11 32. Texas

10

2 33. Virginia

2

8 34. \1-Jasbin,c;ton

2

19 35. \Jest Virginia

13

26 36. ~,~ilitary

5

3 37. Puerto Rico

8

2 38. HaHaii

1

15 39. Dist. of Columbia 2

15 40. Alaska

1

DIVISION OF VI'IAL STATISTICS AUNllAL RE?OllT
1951
During 1951 the volume of work increased in practically every phase of the
vital statistics setup. This increase was more marked in some activities than others.
The number of birth certificates filed during the year increased from 91,808 in 1950 to 95,108 in 1951,
There was an increase in the number of death certificates filed; 31,508 in 1951 as compared to 30,602 in 1950.
The number of stillbirths increased from 2,047 in 1950 to 2,101 in 1951.
This increase appears to be reasonable in vie~tr of the large increase in live births recorded.
Final figures for events occurring to Georgia residents during 1951 will be shovm in the mimeographed report Georgia 1.2.21. Natality l.nd Mortality Statistics, which will be prepared after July 1, 1952. Provisional figures for 1951 (not
comparable with those shown above) on a residence basis are shown in the accompanying table, (Changes based on small figures should be interpreted carefully. )
The number of official certifications and verifications bsued, increased from
24,805 in 1950 to 29,064 in 1951. These figures include free verifications for veterans - 3,038 in 1950 and 3,270 in 1951. In addition, it is estimated that about 51,000 searches were made, for which no fee was collected,
There was an increase in delayed birth registration from about 14,000 in 1950 to 17,000 in 1951,
Legal activities also showed increases from 1950 figures. During 1951, 974 adoption decrees were received and 745 ne1rr birth certificates ~trere prepared and filed for these children. New certificates were recorded for 556 legitimated children. Fifty-six (56) orders for change of name wore received and processed,
In 1950, 870 adoption decrees were received and 640 new certificates filed; 4~9 new certificates 1t1ere recorded for legitimated children, and 58 orders for
change of name were received.
Much work 1r1as done on the Completeness of Birth Registration Test made by the Census Bureau and the National Office of Vital Statistics. Although Georgia ranked
second in the nation in percentage improvement over 1940 results, it was disappointing that the preliminary results for the 1950 test showed only .i.94.4~b
completeness of registration for births in the State, Considerable effort will be made to improve birth registration, utilizing the information available from the Birth Registration Test.
At the time this report is made, the Harriage and Divorce Registration Law
has been passed by the 1952 session of the r.renere.l Assembly and every effort is being made by the division to put the law into .effect by July 1, 1952.

PROVISION4k.J'IGURS~_..::_..l2.21.
(See the accompanying table)
Vi tal Events Occurring to Residents of Georgia during 1951 Recorded With the Division of Vital St8.tistics January l, 1951 - January 20, 1952, Compared 1tlith the Sane Period for 1950.
Liv:c; BIRTHS: (Provisional)
The number of recorded resident live births as of January 20, 1952, was about 5;~ hi~her than for the same date in 1950, If this trend continues through June 30, 1952 (the cut-off date for 1951 registration), more than 96,000 births (a record number) will be recorded for 1951.
STILLBIRTHS: (Provisionc'll)
The stillbirth rate (per 1,000 live births) decreased slightly compared with the rate for the same period in 1950,
INFANT DEATHS: (Provisional)
The infant mortality rate (per 1,000 live births) increased slightly compared with the rate for the same period in 1950,
lv!AT "lRNAL DEATHS: (Provisional)
The maternal mortality rate (per 1,000 live births) decreased almost 11% from the same period for 1950.
DEATHS: (Provisional)
The number of dee.ths from all causes is slightly more than for the same period in 1950.
Deaths from tuberculosis and. syphilis continued to decline.
The number of deaths from cancer 1:1ere E1.bout 4% lovrer than for the corres-
ponding period of 1950,
Deaths attributed to vascular lesions affecting tha centrE1.l nervous system increa.sed almost 6);.
There \ras no appreciable change in the m.l.ITlbllr of deaths from heart disease, but hypertension vri thout mention of heart appo.rently increased about 23%. The latter could be due to a number of factors such as changes in classification, and a relatively small number of deaths, etc.
Deaths from nephritis and ne-phrosis increased 67o.
The number of deaths from motor vehicle accirents increased about 7% and
the number from all other accidents increased 16% for the period,

FINAL FIGURES

NUMBER .n.ND RATE* - D&.THS FROH SPECIFIED Ci1.USES1 LIVEBIRTHS, STILLBIRTHS, INFANT ii.ND Mii.TERl'IAL MORTaLITY AND PERCEN'I'nGE CHANGE IN RISES, GEORGI.:., 1950-1951.

(Figures in parentheses are code numbers from the Sixth Revision of the International List of Diseases and Causes of Death)

CAUSE OF DEATH

NUHBER 1951 1950

RATE

PERCENTAGE

1951

1950

CilAL~GE

ALL CAUSES

30,802 30,1~16 865~05 880.60 -1.77

Tuberculosis, all forms (001-019) Syphilis and its sequel~e (020-029) Typhoid Fever ( OL1.0)
Dysenter,y, all fo1ms (045-043) Scarlet Fever (050) Streptococcal Sore Throat (051)
Diphtheria (055) \'/hooping Cough ( 056) Meningococcal Infections (057) Acute Poliomyelitis (080)

686

824 19.27 23.86 -19 .. 24

159

201 4.Lt6 5e82 -23o37

2

3 0,06 0.09 -33:33

42

h?

lol8

1.36 -13~24

2

0.06

11

13 0.31 0.38 -18,42

11

17

0.31

o.Lt9 -36~73

86

44 2?42 1.,27 +90.:55

37

34 1.04 0.98 + 6,.12

23

16 o.65 0.46 +41.30

Acute Infectious Encephalitis (082) Smallpox (084) Measles (085) Typhus and other Richettsial Di-
seases (100-103, 105-108) Rocky Mountain Spotted Fever (104) Malaria (llG-117) All other diseases classified as in-
fective and parasitic (030-039, 041-042, 043, 049, 052-054, 059-
074, 081, 083, 086-096, 120-138)

6

7 0.17 0.20 -15.00

0

22

10 0.62 0.29 +113.79

5

4 0.14 0.12 +16.67

3

1 0.08 0.03 +166o67

3

6 0.08 O.lT -52.9{+

116

100 3.26 2.90 +12.41

Malignant Neoplasms, including Neoplasms of L;ymphatic and Haemotopoietic '!'issues (140-205)
Benign and Unspecified Beoplasms
(210-239) Diabetes Mellitus (260) Pellagra (281) Anaemias (290-293) Vascular Lesions affecting Central
Nervous System (330-334) Nonmeningococca1 Meningitis (340)

3,209
95 449
56 55
4,364 47

3,339
105 440
38 69
4,09o 56

90,12
2...67 12-.61 1,.57 1,54
12..2,.56 L32

96.67
3.04 12.74 1.10
2.00
118.64 1.62

- 6.78
-12.17 - 1.02 +42. 72 -23.00
+ 3.30
-18.52

Rheumatic Fever (400-402)
Heart DiseD.ses (hl0-443) Hypertension without mention of
heart (444-447) Influenza (480-483) Pneumonia (490-493) Bronchitis (500-502)

54 9,011
475 350 1,091
61

38 L52 9,241 253-07

383
346 1,112
69 i

13 ,J/+ . 9.,g3
30.64 1.71

1.10 2.67.54
11..09
10~02
32ol9 2.00

+38.18 - 5.41
+20.29 - 1.90 - 4.82 -14.50

(cont'd on nGxt page)

NUMBEh ....ND RATE* - DEATHS i;1i.OM SPECIFIED C...USES, LIVEBIItTHS, STILLBlfi.THS, mF.,l!T r~ND 1-'b'Lc. li.NnL MOitT.t~.LITY :.;.ND PERCEJ:ll'i.G3 Cilid~GE :LN ,;J;.TES, GEO.r~GIJ., 1950-1951. (cant 'd)

CAUSE OF D&TH
Ulcer of Stomach and Duodenum (540-541)
Appendicitis (550-553) Intestinal obstruction and Her-
nia (560, 561, 570) Gqstritis, Duodenitis, Enteritis and
Colitis (except Diarrhea of the Newborn (543, 571, 572) Cirrhosis of Liver (581) Nephritis and Hephrosis ( 590-594)
Hyperplasia of Prostate (610) Congenital }k:.lformations (750-759) Birth Injuries, Postnutal kxphJ~a
and Atelectasis (760-762) Infection of the Newborn (763-768) Other Diseases peculiar to early in-
fancy, and immaturity unqualified (769-776) Senility, without mention of Psychosis (794)
Ill-defined and unknown causes (780793, 795)
Motor Vehicle accidents (E810, E835) ~11 other &ccidents (E800-E802, E840-
E962) Suicide (E963, E970-E979) Homicide (E964, E980-E985) All other diseases (h~sidual)

NUMBER 1951 1950

RATE

PERCENTAGE

1951 1950 CHaNGE

150

130 4.21 3.76 +11.97

66

73 1.85 2.11 -12.32

180

218 5.06 6.31 -19.81

267

230 7.50 6.66 +12.61

218

197 6.12 5.70 + 7.37

877

851 24.63 24.64 - 0.04

130

134 3.65 3.88 - 5.93

447

393 12.55 11.38 +10.28

597

608 16.77 17.60 - 4.72

172

151 4.83 4.37 +10.53

994

978 27.92 2.8.31 - 1.38

211

217 5.93 6.28 - 5.57

642 1,009
1,404 288 468
2,010

615 902
1,221 285
50$
1,89.2

18.03 2.8 .34
39.43 8.09 13.14 56.45

17.80 26.11
35.35 8.25
14.71 54.78

+ 1.29 + 8.54
+11.54 - 1.94 -10.67 + 3.05

LIVEBIRTHS INFr~.NT MOB.Tr~.LITY STlLLBIB.THS l~TEl~~AL MOrtTALITY

95,161 3,255 '2,097
143

92,099 3,081 2,026
150

26.73 34.21 22.04
1.50

26.66 33.45 22..00 1.63

+ 0.26 + 2.27 + 0.18
- 7.97

-4:-Deaths from specified causes per 100,000 estimated population present in the state, July 1, 1951)
Livebirths p<;r 1,000 populo.tion Maternal and Infant mortality and Stillbirths per 1, 000 Livebirths
Source: Division of Vital Statistics, Georgia D0partmcnt of Public Hu::.lth, Central Statistical Unitt

~tatr of <l3rorgia
Btpartmtnt of ~nblic !\talth
T. F. SELLERS, M.D., DIRECTOR ATLANTA
January 2, 1952

This is your report on the progress of V'ater pollution control throughout Georgia during 1951 as carried out through the cooperation of officials and citizens of municipalities and counties, industrial management, and the Georgia Department of Public Health. The report covers the fields of public water supply, sewage works, industrial waste treatment, stream pollution prevention and related activities.
The report has been kept short in consideration of your available reading time. In its brevity it touches only the high points If you wish more information on any subject touched upon in the report or any phase of water pollution control not mentioned in it, you are invited to write or call for anything that you want and we lilill do our best to supply it.

. .....

M '-- '\

I

~

.... / I

7

4,~) I

~-

W. H. ~leir, Director

Water Pollution Control

GEORGIA DEPARTlVlENT OF PUBLIC HEALTH ATLANTA
WATER POLLUTION CONTROL REFORT FOR 1951
Public health supervision of all phases of the state-wide water pollution control program is exercised by the Water Pollution Control Service of the Georgia Department of Public Health. The program has two major objectives which are accomplished by closely related administrative and operational procedures. One major objective is to prevent water-borne diseases in the drinking water supplies throughout the state. The other major objective is to control the water quality of the streams of Georgia to maintain and preserve the satisfactory condition for the most profitable uses for a rapidly increasing population and expanding industrial economy.
The methods and control procedures used to most advantageously attain the two broad objectives are very similar and are applied as completely integrated services to accomplish the desired results with a minimum financial budget and personnel staff. A continuous educational program has been carried on for many years to assist in creating a public desire to protect the quality of the waters of Georgia. This educational endeavor together with the services performed by this state agency supports the effective cooperation existing among the citizens of Georgia, municipal and industri~l managements and the Georgia Department of Public Health, The citizens of Georgia >:ill not tolerate the pollution of their ;vater resources. This intolerance of stream pollution is the motivating influence by vohich municipal officials and industrial managements secure financial support to provide modern sewage and industrial treatment facilities.
No disease was caused in 1951 by any of the more than four hundred public water supplies locally owned and operated and furnishing ~ater for about one half of the total population of Georgia or approximately 1,796,000 of a total of 3,444,578 people. Many effective measures in water pollution control were carried out in 1951 by municipalities, counties and industries for the protection of the state's natural water resources,
Review and Approval of Engineering Reports, Plans and Specifications
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 pollution control project, whether it be a municipal water purification or sewage treatment facility, an industrial waste recovery or waste refining plant, or any related undertaking affecting water quality either for consumption or discharge, presents a distinctive set of conditions to be considered and problems to be solved, A thorough knowledge of local conditions is essential in each instance. This necessitates extensive field investigations, laboratory studies dnd numerous conferences with the consulting engineers, owners, and a~ interested parties to assure a sound decision and to adequately safeguard the public health of the community served, This is a paramount activity of the Water Pollution Control Service to the effectuation of v;hich many of the other procedures 3.1'0 eventually directed.

Through such reviews and related field and laboratory investigations, conferences and studies, pertinent fundamental i:<J.tor pollution control principles are applied to each project from its very conception. Through those procedures the collective kno'.'.ledge and experience of the staff of the Hater Pollution Control Service, the designing engineer and the local owners and operators arc pooled to insure the design and construction of water and sewage works adequate for <.ill expo cted public health requirements.
Several major factors occurring or developing into lurgor proportions
in 1951 have a significant eff0ct upon tho state-dde pollution control program.
More mention of such matters as a rapid civilia.n industrial oxpunsion, a continuing movement of people from rural areas to urban centers, mobilization of the armed services for natiom.l defense 'ith military industrial plant and camp construction, unanticipated l~rge defense housing projects, restrictions placed upon civilian use of critica.l construction material, tho siphoning off of trained technological personnel into diroct defense activities, and the still increasing cost of building water 1 orks dnd sev:erago f-.1cilities, illustrate tho situd.tions to be met and overcome in supplying essential 'i:ater supply and se'.JOrago services. These situations d.re being mot and coped , ith through the greatly accelerated local undertaking of m<.lny 1.ator 11orks ...J.nd soHerJ.go projects constituting a multi-million dollar construction program over the state. Those public health protective facilities are financed by local taxation or sorvico ch;JXgos 1.-ith no federal fina.ncial grants.
M~icip~ Officials aro_Qgigg_A_Splendi~
A review of the municipal popuL1tion dat:J. in the 1950 census shows how
well tho governing bodies of urb.1n communities ho.ve incroJ.sed the availability of safe public v;ator service. Tho last doconnb.l census reveals th_,t fully one half of tho tot:J.l population of Georgia nm, hils access to public v:ator supplies. These data shmm in Table I a.ro quito contrary to tho gomro.l belief that Georgia's popuLltion is prodomim.ntly rural. Tho bala.nco betYJOen agricultural ~d industrial or urban employment has been attained much more rapidly the:.m genorc:~.lly reo.lized. Tho pressures of this urban trond ha.vo required roo.ppr:J.isa.ls of local plJ.ns <.lDd programs of 1i;J.tor supply and sower:J.go. M::J.ny existing plans and progrJ.mS hwo had to be discarded ..J.nd replaced with more expansive ones to keep abreast of tho over incro..J.sing demands. In all of this, to assist in tho prevention of confusion, conflicts, dol:J.ys, technical difficulties ::J.nd othor rot::l.rdntions Y>hich would load to lov;orod public heJ.lth protect'ion, tho rlator Pollution Control Service st.J.ff has operated to the; limit of its .J.bility to extend its usefulness to ovcry spct in tho st.J.to VJhoro it could help ;.md support locJ.l efforts. Tho prospect is thJ.t tho accelerated progrJ.ID vdll be continued. in the future.
2

Table 1

.,

Type of Su~ Ground Hater, Untreated
Ground r.ater, Chlorinated

12kQ.
112,000
355 ,ooo

l2.2.Q
1)6,000
471,000

Surf3.ce L1ter, Coagul.J.ted, Filtered and Chlorinated

906,000

Ground .:ator, Softened

_22,QQQ_

1,395 ,ooo

Total Popul~tion (1950 Census)

3,444,578

1,162,000
-~Q.QQ_
1,795,000

IngJJ.strY Goes To -~i9.It._On StrOJJI! Pollution Problo~
Tho industrial expansion in Georgia is coordin.J.ted with .J.nd actively participating in tho stre~ pollution control progr~. The attention of industrial man3.gement is focused upon the problems of industrial waste treatment
and proper usc of the receiving strE:.ams. a number of the existing lilrgo indus-
tries rdth inherent mJ.nufactur ing Wilsto problems J.rC now conducting stream surveys, oporJ.ting experimental or pilot Y'aste treJ.tmcnt installations and providing WJ.ste product recovery or ro-use systems within tho plants. Those future Georgia. industries norl socking loccJ.tions on th.:: rivers 1nd other -.;u.terways are including streara surveys :1nd comprehensive studios in their site investigations together vdth waste treatment budgets to preVGnt :J,buse of Georgia.' s water rosourc0s. The ' J.ter Pollution Control Service is closely related to those essential industrial activities and coordinates much of the privJ.tely fimr.cod studies so thJ.t the best interests of the public 'idll be SGrvcd from both an immedL.to J.nd long-ru.ngo viewpoint. In brief, :J.n or.:J. h.J.s been entered into in which industry hJ.S 11takor.. off its coat 11 :.tnd is ro!llly Ll.t ,-;ork in solving its 1iHSto problems. ~-;ith this pattern .:..nd v-uy of industrial lifo established, thoro is ovary re:.1son to expect J.n oven groator stcJ.to-wide industrial exp<J.nsicn to continuo through use of Goorgi.J.'s water resources v:ith <.1 mini11um of d-:unago to those irroplaccablo J.Ssots.

Progressive Trends Ip rater Supply_And Sower,1go ~lopmem
Distinctive patterns h:J.ve developed in methods of dealing dth tho involved problems of supplying enough s.:;.fe water ::tnd satisfJ.ctory tro3.tment of municipc1l and industrial Viastcs. Those p<ltterns include consolidation of smg,ll systems into metropolitan systor.1s 'J!ith the elimination of questionable sourcos of v-:.J.tor .J.nd unsatisf3.ctory set;uge phnts; co11bination of municipcll ;Iasto troJ.tmont v:ith thcJ.t of industries \.'here technic<J.lly conpJ.tiblo; ropl.J.cenent of recently outgrown sov.'ago tro.J.tmont pl<J.nts because of incroC"~sed service .J.rOJ.S and unanticipated contributing popul.J.tion; greJ.tly improved methods of financing public water supplies, se',;orJ.go ::md sewage tre:3.tnent through use of direct sorvico chJ.rges to nuko those public he:1lth f.:1cilitios fin.J.nci<llly self-supporting; o.nd extension of municipal .. J.ter syst8!1S into suburb~m J.nd cvon rur.;~.l JrGJ.S in .111 extensive rural VJJ.torfica.tion progra.m.
3

Special Investig-ttions o.nd Services
In addition to participation in the varied activities outlined in preceding pJ.ra.gr.lphs, ths Hater Pollution Control Service provided numerous services in sreci'J.l technical investigJ.tions, consultations .:J.nd procedures involved in developments in the water pollution control field. A. few illus-
trations fcllow. :1 great :1mount of inforr.ution has been furnished to dentists
and other citizt:ms on the natur~:1l fluoride occurrence in Georgia ..ind the tochnicJ.l meeins of .:.tpplying fluoridation to public water supr-lies. The discovery of nitrates in significJ.nt ccncontr3.tions in sevGral individu-11 '.7a.tGr sup:plias required considerable laboratory investigJ.tio~ J.nJ frequent interpretation of results. Tho increase of m:J.ngJ.neso due to nm; 1i.'3.tor stor::1go projects cro..1tod rurifica.tion process involvements requiring solution by . 3.ter Pollution Control Service st:.J.ff members. Othur special investig'ltions are macl.e in thG fields of chemic.J.l .:1nd bio-chemic:~.l engineering as needed to support a complete ':;ator supply protective program.
n severe drought occurred during the lJ.te summer und autumn of 1951 11hich necessitated emergency measures on sever .tl r;ater systems .ind required others to pL.n for additicn:~.l supplies of water to 1-:rovidc grsatur fJ.ctors of safety ag.J.inst recurrence of depleted VJJ.ter sources. Consultation service to industrial offici:J.ls is rrovided in the invostigJ.tion of proposed sites for now manufJ.cturing plunts having ~;a.ter pollution >u.stos. BJ.sod on those consultations and related-field studies, plant processes ..~.nd V:J.ste tre.J.tment methnds are developed by the industries J.fter tho ch.J.r.J.ct3ristics :md us;.;.ges of the intended receiving streJ.ms hJ.ve boon given considcr..~.tion. Continuing reL.l.tionships are rnJ.intained 1:.ith a numbor of foderc.l govorm1ent :J.gencies cng1god in some form of vu.ter :lCtivity <J.ffecting the quJ.lity cf stro:.1ms. Among these federal J.gencies JXo the Tennessee V:J.lloy huthority, U. S. Corps of Engineers,
U. s. Soil ConscrvJ.ticn Sorvico, U. S. Fublic HoJ.lth SGrvice, U.S. Bureau of
Community F J.Cilitios, and militJl'y posts J.nd stJ.tions. ,.J.ter pollution control on Georgia's interstJ.te strc:.J.ms is coorclin:ltod 'iiith ull of the ::1djacont stJ.tes with specific problo1:1s being solved J.S tboy occur .J.nd in addition particip.J.ting in establishing and offoctu:J.ting gonoral interstJ.to stream qu:tlity policies of the region. Articles J.rO prepclrel for prosent.J.tion to civic groups J.n::l for publication in technic.ll jourmls ::1nd tho st..itO press.
Trilling Local ~;c:1tor J.ncl Sov:ago ~orks~Q.!lnel !~itlh AnnuJ.l Goor.gi.J. ~r......illd Sovnge School
Much of the effecti venoss of tho vJ.tor pollution contrc;l progrJ.m rests in tho hJ.nds of tho Y.ator c.~.nd se7;:J.gc v.orks operJ.tionu.l ..md mJ.n3.guri..1.l persvnr1el in tho st.rea. Ofton their knowlodge, J.bility J.nd dotormin:J.tbn to see a job well dono is tho deciding f ..1.ctor in the S).lccess or fJ.ilurc of J. control project.
In order th:J.t tho Go,:,rgi.J. ;utor a.nl SG'Iii:.lgo v\'orks or.;er.J.tors and athcrs interGstod in the;so m<J.ttors m_ly hJ.VO :1.n opportunity to loll'n fundJ.mental principles of their p..;.rticul..~.r jrbs .md koop abro .1st of current ::1ovulopments in their fields a ~IJ.tor ..ind sewage v10rks schcol h.J.s been hold J.nnu:~.lly ff'r tho ]_:-J.St ,tvJenty yeJXs. This school is conducted J.t the Gec,rgL Institute of Technology under the joint sponsorship of the GocrgiJ. Dop.l!'tment c-f Public HeJ.lth, th::J Georgia. Institute of Technology .1n::I tho Gocrgi..1 .:.J.tor ..J.nd SovnJ.go AssociJ.tion.
4

The Twentieth Annual Georgia Water and Sewage School held in 1951 was attended by more than three hundred operators, superintendents and engineers. Instruction was given on various phases of water and sewage works subjects at both the elementary and advanced levels and included topics dealing v;ith public health; construction and maintenance; conservation; financing; civil defense and related matters.
The Water Laboratory
The Water Laboratory, functioning as an integral part of the Hater Pollution Control Division, performed during 1951 a multiplicity of bacteriological, bio-chemical and chemical tests necessary in a state-wide pollution control program. Table 2 shows the number of bacteriological examinations and chemical analyses in the various categories performed during the year. All of this was done vdth a minimum of experienced personnel.
The greatest volume of work consisted of bacteriological analyses of drinking water samples from some four hundred fifty municipal, industrial and institutional water supplies in the state but equally as time consuming was the chemical and miscellaneous tests made on samples from public and private supplies. These included tests relative to tastes and odors; insect identification; corrosion of y;ater supply systems; and contamination vJith gasoline and other petroleum products.
The Water Laboratory cooperated with the Division of Public Health Engineering in the shellfish control program; with the Division of Epidemiology subsequent to outbreaks of non-water-borne dysentery and infectious hepatitis; and with the Federal Public Health Service in making a study of the sanitary condition of drinking water served on airplanes arriving and departing from the atlanta Municipal Airport.
Continuing the nitrate study inaugurated early in 1950, the Water Laboratory made determinations for nitrates on all vvater samples submitted from privately owned supplies. Amounts of nitrates approaching the danger. zone were reported to county and regional personnel for careful follow-up. A paper on the occurrence and significance of nitrates in drinking water in Georgia was presented by the Director of the Water Laboratory at tho 1951 meeting of the Georgia Public Health Association.
Prior to and following the initial installations for tho application of fluorides (sodium fluoride and sodium fluorosilicate) to public water supplies in Georgia in 1951, extensive work \;as done on laboratory techniques for the accurate quantitative determination of tho concentration of fluoride ions in water. The present available colorimetric fluor ide tost procedures are subject to considor.J.ble interference v;ith variations in results. Because of these conditions and to secure the precise results desired in the ~ater Laboratory, considerable chemical knov,ledgo and skill is required to obtain accurate and reliable results.
5

Drinking Y'aterc samplcsl Fublic and semi-public c~mp and tourist court Dairy Lunchroom and market School FrivJ.to Total

13,704
73
91
42 243
_1.z2..Q1
15,354

Shellfish surv0y samples
Svlimmi ng poo 1 s amp los Totu.l

879
_-112.L

.io-::chemic:ll..2-~itn-y~!1s!
l!ll..lh~.Qg_ill,!]li c .:11 Sllia:la..

Grand total

16,697
_ _g~ 19,296

The definito popuLtion shift from rur J.l to urban c~.nd industrial centers has continued throughout tho y:.;,.;.r, consequently many municipalities faced tho mcossity of enlarging ':.u.ter and so-v.age L.lcilitios. In many instunces the so se;rvices h ..we boon oxtondod to unincorporJ.tod suburbs ,'J.nd in seve;r::tl thickly populu.kd counties 'I atcr systems now servo rurJ.l J.I'Oas J.S well. Lat0r .J.nd se'.:<J.ge works c;mstruction h:.s continued throughout tho yoJ.r as mc.ln.lgorial officials attempted to koep up v ith increc~.sing dumJ.nds.
Cognizance is tukon of tho sm:ors and so'; '-l.go tr0atmont v.orks constructed during tho ycn:r by beth la.rge and sm.1ll communities J.S citizens from J.ll parts of the st.1to unitu to protect public hO<llth cJ.nd prosorvo stro<J.ms for the VJ.ried us0s nocessJ.ry to J. gro,_,ing popuLJ.tion and accole;ratod industrial development.
Thoro follows J. pJ.rti;J.l list of tho m:J.jcr . J.tor ::1nd sow.:J.go ;;;orks projects under construction during the ye.'J:. Thoro may bo un~iVOidablo and unintentional omissions duo to LJ.ck of information on exact st-.~.tus at tho end of tho yo<J.I'. No effort has boon mado t:) list minor uxtonsions, rop-.~.irs or norm:..\1 naintonanco projects.

6

P1ans ~~g SPcifications Approved 1251 - Water Suppli~

..,._
Albany-Turner CityAmericusAtlanta-
Bainbridge-
BlytheCobb County-
College ParkCommerce-
Dacula-
Eatonton-Imperial MillsFayettevilleGarden City-
Griffin-
Hiawassee-
HinesvilleHogansvilleJesupKennesaw-
~iacon-
Newington-
OcillaSt. MarysTifton-
ValdostaWhitesburgWoodstockZebulon-

New water works system Distribution system extensions Distribution system additions and improve-
ments Water works improvements, elevated tank
and distribution system extensions New water works system New water purification plant, elevated storage,
and distribution system extensions Distribution system extensions Distribution system extensions and 200,000
gallon elevated tank Distribution system extensions and elevated
tank relocation Connections to city water supply New water purification plant iiiater .,,orks improvements, including distribu-
tion system extensions, and new 60,000 gallon elevated storage tank Additions and improvements to water purification plant, distribution system extensions, and l,ooo,ooo gallon elevated tank Hater works improvements, elevated storage reservoir and distribution system extensions. Distribution system extensions Distribution system extensions Distribution system extensions New water v10rks system Additions and improvements to water purification plant, new raw water pump station Water "orks improvements and distribution system extensions New deep vmll, pump and piping connections New water v:orks system
Ne7J deep well, pump house, and piping connections
Distribution system extensions New water works system Nev1 water works system Nm v;ater purification plant

Albany-Marine Depot-
AmericusBainbridgeBremen-
CamillaChipley-

Off-site sanitary sewer outfall for sewage treatment plant effluent
Sewor extensions Sov~or extensions a.nd pump station Sewer extensions, outfall, pump stations,
and new complete treatment plant Complete treatment phmt Nev~ sevmr system and primary treatment plant
7

GL.rkesville-
ClevolandCommerce-
Dalton-
GJ.inGsvilleHine s villeHog ..ms villeJesupLudo>JiciRockm.:rrtS:J.V:.lnnnh-
SopertonV,.J.ldustnVida.li<:i-

Sewer extensions, ~mtfa.ll, pump station u.n:i prin.J.ry tre.J.tmont plant
New sewer system a.nd prim.J.ry treatment plant Sower extensions, pump stC~.tions, .J.nd prinury
tre ,1tment pLmt Sewor extensions, 0utf~l, <J.nd new complete
tr~tmont pL::.nt Sewer extensions .J.nd pump st..;.tion Sewor extensions Sewer extensions Sewer extensions New sev:er system .J.nd 1-rimary treo.tment pbnt Ser~ers, =utf.J.ll .J.nd complete tre.J.tment plant Sewer extensions, outfall, pump st.J.tions an:i
complete treo.tment pl.J.nt Sower extensions Sewer extensions Sewer ~xtensions, pump st<.1tions, outf:.1.lls
und treatment plant NEJ;.: sewer systom .3-nd prim.J.ry trea.tment plJ.nt

~inter And Sewuge .iorks Constructiou_Projects 1951

Abbeville-

\:Cl.tcr distribution system extensions completed

A:l.el-

Mujcr sower extensions, .J. sewage pump station

:.md ne11 trunk sevJers cr:mpleted

.c\.l;J.I:lo-

~.ator '.iistributicn system extensions J.nd 60,000

gCJ.llon e levated k\nk completGd

.ci.lbany-

New 'iJell J.nd 500,000 gallon elevi.l.tcd t:...:.nk com-

pleted; mJ.jor i"I:J.tcr :J.nd SC\J8r oxtensions

under construction

Alb.J.ny-Ma.rine Depot-

Off-site sanit.:liY sewer outfall for sow.J.go

tre .J.tment r..Lmt effluent under construction

Alb J.ny-Turne r City-

NevJ Y':ltGr works system including deep v:ells,

pump hcuse, chlorim. tor .J.nd distribution

system co::1pleted

Alph::.lretta-

New .-:ell drilled .J.nd major distribution system

extensicns under construction

Athens-

Applic~1tion of fluorHus to r.,ublic Vi3.ter supply

std.rtod during 1951; YJ::J.tor ...1.nd sower extensions

a.nd ne;; 750,000 g.1llcn olovJ.ted tank completed

.....tLmta-

Two million gullon elov_tod t.J.nk .J.nd new shop

building conplote::i; extensions cmd improvements

to v.ro.tor distribution .J.nd se;Jor syster.1s under

construction

A.ustell-

-~,:J.tor distribution systen extensions .J.n:i filter

pl.J.nt udditions to ;roviJe tot.J.l ca.pa.city of

720,000 g.J.llons per do.y completed

Austell-Austell Boxbo:J.rd Cc. - Treatment f:J.cilitios fcr rar:er mill 'i.asto complete'

.~~V')nd.J.le-

Sew::.1ge treCJ.trwnt plant ubandrmcd J.nd connections

mo.c'l.e to DoKiJ.lb County seyJerJ.ge system

8

Bainbridge-
BlackshearBowman-
Bremen-
Co.millc1ChipleyClarkesvilleCle vo lCl.IldCobb County-:::1tor System-
ColbertCollege ParkColumbusCommerce-
DaculaDallas-
Dc1lton-
DeKulb County-

\.-.1ter works ioprovoments including new deep well, pump house, 500 1000 gr.1llon elevated tank :1nd distribution system cxtensior~ completed; sewo.ge works improvements including sewer extensions and pump station completed
Improvements to w.J.ter works and sewer system completed
New deep well drilled Sewer extensions, pu1-:1p sto.tions, outfall -.1nd
250,000 g:.1llons per day cor:Jplete sewage trea.tment pl.:mt under construction Sower extensions and 500,000 gallon per da.y complete sewage pla.nt under construction Nma sewer system <J.nd 50 ,000 g:1llon per d..lJ primary sewage treatment plant under construction Sewer extensions, SG\iage pump station, outfall and 20011000 g. 1llon per day primary treJ.tment plant under c.:;nstruction '1'1vo ne'.. deep ';ells drilled; sower system under construction Contr:.1.ct lot for distribution system extensions, four million gallon elevated storage :1nd eight million gallon por d<J.y water purification pl::.l.nt Nc::w v;atur 'JJorks system including deep v:e ll, hypochlorinator, 15 ,000 gallon elevated tank, :.J.nd distribution system coruploted l:atGr ~.crks ioprovononts including boosbr pump st-1tion -1nd m-1in extensions completed Extensions :1nd inprnvements to vmter purific:J.tion pl<:mt completed; major extensions to 7J.J.tor o.nd sewer system under construction rJb.jor oxtonsicms to VJ:.J.tor ...md sower system, 200,000 gallon elev-1ted t ..mk, sewage pump stations and 500,000 go.llon per d~y primary sew~ge treatnent plant under construction [,J.tor distribution system extensions and improvements under construction iiiL.J.jor sewer extensions, outfJ.lls, J.nd two (225,000 gJ.llons per dJ.y -1nd 135,000 g~llons per day) prirrury sewage tre.J.tLl-:mt phnts undor construction fvhjor VIator distribution system extensions including ruins to serve V..J.lley Point, E:1st Side and Pleas-1nt Grove areas under construction; major sevmr extensions, trunk
sewers, outfJ.ll and 1.5 million g:lllon
par d-1y complete sewage tro-1toent plant undor constructi1n Sew.J.ge purap sto.tion, c.utf.:.J.ll and 3.0 million g'J.llon per day complete se:age trEJ ..1.tment pl<J.nt CGElplGtod; v. J.ter -.1nd sewer extensions under construction; a:r:plicatio~ cf fluorides to public '.'<J.tor supply st-1rted in 1951

9

Douglas CountyDougbsville-
KJ.st PointE:1tonto n-
Flowery BrJ.nch-
Forrest P.1rkFult'"'n CountyForsyth-
Fort OglethorpeFranklinG-ainesville-
G~rdo n City-
Gracowood-Schoo 1 for Monto.l Defectives-
GreenvilleHJ.r.l.ptonHiavJ:J.ssoe-
HinesvilleHogansvilleHomervilleJefforscmJcnosboro-

L .J.ter works system tc serve arc.J. from Douglasville to and including Lithia Springs complotod
M:1jor sev:or extensions, ser1ago pump st-J.tion and a 150,000 g~llon per day addition to an existing primJ.ry sowdge treatment plant completed
~:::.tor mJ.in extensions to serve Ben Hill :md other surrounding areas completed
200,000 g<J.llon per dJ.y priwary sewage tre:.1tment plant completed
Now WCJ.ter >Jorks system including deep well, hypochlorinator, 100,000 gJ.llon elev'J.tod storage reservoir and distribution syster.J. completed
IIJLJ.jor water works improvements including ncu deep well pump ,J.Dd contrnls, hypochlorim.tor, 60,000 gJ.llon olevcJ.ted tJ.nk :J.nd distribution syster:1 extensions COI:lFleted
IVLJ.jor ~:.1ter distribution system oxtensicns J.nd booster pur.1p staticn cor.J.plcted
MJ.jor sm-:er projects on west ..md sruth sides of Atlant:J. including interceptors and pump stations completed
K:J.tor u.nd. sewer oxtensicns and W'.lter filter plant .J.dditic.ns to provide total capacity of 750,000 gallons por day completed
r..1tor distributic:n system extensions and re-
p drs under construction Nov: deep \Oll drilled Se\:or extensions, interceptors, and a SeVJage
pwnp sto.tion cumplotod; improvements J.nd additicns to w~ter purification plJ.nt c ::;r.1p lo to d MJ.jcr -,,a.tor 11-vorks i:nprovomonts, 60,000 gJ.llon GlovatGd tJ.nk, ne111 pU!llp hcuse, puap controls, chlorinator u.nd distribution systom extensions undGr construction
New 130,000 gallon per dJ.y conplete sewage tre:J.tment pl:lnt completed
New 144,000 gallon per day ~ater filter p~nt conploted
New deep well drilled !Vhjor WJ.tor Yorks improvements including spring
dovol0pmonts, new 60,000 gd.llon elovJ.tod stor:J.go reservoir .J.nd distribution system extensions under construction IvL.jor 11\J.ter J.ni sovmr extonsi" ns under construction Contr.J.ct lot on m.J.jor vutor .J.nd sower extensions !Vi:J.jor water systor.1 oxtensi0ns comFloted. iVi.J.jcr r.J.ter system extonsi:ms and 1,000,000 gallon standpiJ:'O completed Nm-:, deep ';ell drilled

10

Kennesaw-
LaFayetteLaGrange-
LudowiciMacon-
Ivladison-
ManchesterMcRae-
Menlo-
Ne1Jington-
OcillaPerryReynoldsRichmond County-
Fleming Heights CommunityRockmart-
RoswellSavannah-
SnellvilleSt.Simons Island-
StathamThomson-Kingsley Mills-

Ne1i; water works including deep well, hypochlorinator, 100,000 gallon elevated tank and distribution system under construction
Water system extensions to serve I~aomi and Rock Springs areas completed
Major sevier extensions, interceptors, sewage pump stations and neTI 3 million gallon per day complete sewage treatment plant under construction
New sewer system under construction Major water works improvements including dis-
tribution system extensions, new raw water pump station and additional coagulation structures to filter plant under construction Water works improvements including 150,000 gallon elevcited tank completed; sewer extensions under construction Major water and sewer extensions completed Major sewer extensions and new 175,000 gallon per day primary treatment plant under construction Nmv nater works system including spring develoPment, hypochlorinator, 60,000 gallon elevated storage reservoir and distribution system completed Contract let on major water works improve::~ents including nev: pump house and pumping equipment, hypochlorinator, 35,000 gallon standpipe and distribution system extensions Contract lot on new deep ~~ell, pump, and piping connections lia ter system extensions and new 200,000 gallon elevated tank completed New sewer system partially completed
110,000 gallon per day sewage treatment plant completed
Sev{er extensions, interceptors, outfall, se~7age pump station and 600,000 gallon per day complete sewage treatment plant under construction
Major :;ater, distribution systom extension completed
lvlajor v;atur and se1iJer extensions, sewage pump stations, outfall, and 2.5 million gallon per day sewage treatment p1J.nt undor construction
Deep well drilled preparatory to constructing public ,,ater '.vorks
New water >wrks system including deep v;ell, 100,000 gallon elevated tank and distribution system completed; sev,or extensions completed
NGi'' sew0r system 3.nd 50,000 gallon por day primary trGatment pl3.nt completed
New sewer system and 22,500 gallon per day complete treatment plant completed
11

TiftonToomsboro-
ValdostaVidalia-
WhitesburgWinder-
Wrens-

New deep r'ell drilled New water works system including deep well,
hypochlorinator, 64,000 gallon elevated storage reservoir, and distribution system
completed Major repairs to old 11ater treatment plant
completed; water and sewer extensions under
constructio'n Major sewage v;orks improvements including sewer
extensions and pump stations under construction; contract lot for 280,000 gallon per day primary sewage treatment plant Contract let on nevr water system including deep well, hypochlorinator, 50,000 gallon elevated storage reservoir and distribution system New 1,000,000 gallon per day 'Plater purification plant, sewer extensions, and 100,000 gdllon per day primary sewage treatment plant
completed New sevJ.Jr system and 225,000 gallon per day
primary treatment pl~nt under construction

12