Annual report 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

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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 p