Annual report 1952 [1952]

ADMINISTRATIVE SERVICES
Division of Central Administration Division of Hospital Services Division of Personnel Division of Public Health Education Division of Training Division of Vital Statistics

Division of Hospital Services

1952 ANNUAL REPORT DIVISION OF HOSPITAL SERVICES GEORGIA DEPARTMENT OF PUBLIC HEflLTH
R. C. Williams, M.D., Director

Table of Contents
General
Summary of 195 2 Activities A. Survey and Planning B. Construction Program C. Consultation Services D. Licensure Program
I. Pro~ram Planning A. The State Hospital Plan B. Community Surveys C. Special Studies
II. Construction Program A. Administration l. General 2. Processing Applications 3. Construction Period
4. Percentage of Participation 5. Controlled Materials Plan
6. Status of the Program B. Technical Services
c. Equipment Planning
III. Consultation A. Administrative Consultation Service B. Nursing Consultation Service C. Dietetic Consultation Service
IV. Licensure Program
V. Related A ctiviti es
VI. Hospital and Health Center Construction Program

Page
l
l-2
3-4 5-9
9-12 12-13 13-15 16-21

GENERAL
The Division of Hospital Services was organized for the purpose of: (l) Administering the hospital and public health center construction
program with Federal grants under the provision of Public Law 725, 79th
Congress (Hill-Burton Act); (2) Administering the Georgia Hospital Regula-
tion Act, No. 623, 1946; (3) Conducting periodic surveys and studies to
determine relative need for medical facilities in the various sections of
the State; and (4) Providing various types of consultative services to
existing hospitals and potential project sponsors.
The objectives of the Georgia Hospital Program are expanded and improved hospital facilities in the State, as well as the maintenance and extension of good patient care. The Division is also responsible for the construction phase of public health centers in accordance with the program for local health services and facilities as planned by the Division of Local Health Organizations.
Sl~RY OF 19)2 ACTIVITIES
The activities of the Division of Hospital Services during 19)2
may be divided into the broad categories of community survey and planning, construction, hospital consultation services, and hospital licensure. In addition to these activities, members of the Division were active in various hospital and related association meetings, conferences, institutes, and civil defense planning.
Survey and Planning
Survey personnel completed studies of the need for and ability to finance hospital facilities in thirteen communities in Georgia during the past year. Other activities under this section included a study of salaries paid in hospitals, hospital charges, hospitalization insurance in Georgia, and a review and revision of the State Hospital Plan.
Construction Program
vJith the completion of twenty-six projects, beginning of construction on twenty-one projects and the approval of twenty-five new projects, hospital and health center construction in Georgia reached an
all-time high in 19)2. The following table summarizes the cumulative
status of the program which began with the passage of the Hill-Burton
Act in 1946:

Category

Completed Pro.iects Cost

Under Construction

Pro~ects

Cost

Hospitals Ldditions Health Centers Other Projects

33 $ 21,1.58,907

6 1,762,826

38 2 '921, 807

6

630,699

ll $ 7,82.5 ,3.52

4

2,483 ,043

10

97.5,003

Grand Total

83 $ 26,474,239

2.5 $11,283,3 98

Approved Pro,iects Cost

5 $ 7,264,23 8

7

7,927,982

13

1,330,148

2.5 $16,.522,368

In addition to the approval of project applications, plans and specifications, the Division assisted project sponsors in selecting project
sites, obtaining construction permits and controlled materials, and in planning financial and construction programs. Technical personnel provided
architectural, engineering, and equipment consultation services in approving projects and during the con~truction period. These activities in 19.52 included processing eighty-three sets of plans and specifications, 129 physical
inspections of projects under construction, and more than one hundred visits to local communities regarding equipment planning, selection, purchasing and inspection. The Division processed 170 payments to local communities totaling $3,144,749 Federal and $1,.516,4.58 State funds.

Consultation Services for Hospitals
The Division provides consultative services to existing hospitals as well as those constructed under the Fill-Burton Program. A staff of qualified consultants in nursing, dietetics, engineering, medical technology, accounting, and hospital administration made more than seventy-five visits to hospitals during 19.52, assisting them in their operational problems. Additional services were made available by the consultants in sponsoring vJOrkshops and institutes for specific educational purposes and in disseminating material concerning hospital administration. A committee of certified public accountants, of the Georgia Society of Public Accountants, hospital administrators from the Georgia Hospital Division, and representatives of the Atlanta Division, University of Georgia, worked with the Division during the past year in preparing a simplified uniform system of accounting and reporting to be recommended for use by hospitals in the State, particularly the smaller institutions.

Licensure Program
Inspections were rr.ade and operating permits were issued to hospitals for 19.52 in accordance with the licensure rules and regulations. During the year, the State Board of Health directed that greater emphasis be placed on inspection and licensure of nursing homes. This part of the program is being developed.
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I
PROGRAM PLANNING

The Survey and Planning activities during 1952 may be divided
into the following broad categories: (l) The State Plan, (2) Community Surveys, and (3) Special Studies.
A. The State Hospital Plan
The Division is responsible for assembling current information necessary for rev1s1ng and administering the State Hospital Plan. This master plan is the basic document which presents the annual statewide inventory of existing facilities, classified as "acceptable" or 11 replaceable11, together with the relative priority of the forty-seven hospital service areas. The primary objective of the State Hospital Plan is the systematic and inter-related development of such additional facilities as may be required to provide more adequate hospital service for the people of Georgia.
B. Community Surveys
Another of the primary functions of the Division is to conduct socio-economic surveys in communities throughout the state. Surveys must be requested by responsible citizens of an area, and are made in order to assist the community in assessing its need for, its interest in, and its ability to finance improved hospital facilities. Surveys are scheduled in order of their receipt, and are completed on an average of one per month.
During 1952, surveys were completed for the following communities:

l. Marietta 2. Statesboro 3. Adel
4. Duluth 5. Greensboro
6. Brem3n 7. Tallapoosa

8. Hartwell 9. Camilla
10. Waycross
ll. Dalton 12. Rome
13. Villa Rica

Community surveys are essential in the administration of the State Program in the following ways:
(l) Specific questionable projects in hospital areas of high priority are often eliminated by suggesting other ways by which the community can meet indicated needs. There are many rural communities in Georgia desirous of and in need of clinical medical services; yet
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these communities, due to the absence of trained medical personnel, small populations, and lirnited financial resources, are unable to support a hospital of twenty-five beds or more.
(2) Project sponsors are shown that there are many problems other than the erection of a building that must be planned for in order to provide efficient and adequate hospital service. For example, financial support for indigent care, operating deficits, adequate staffing, organized community support, and other related matters necessary for the successful operation of a hospital are discussed.
(3) Community surveys are an effective means of providing accurate information to committees regarding the State Hospital Program and the legal and non-legal requirements for participation in the hospital construction program. This makes possible better understanding and improved public relations for the Division.
(4) Surveys provide an important source of pertinent information
for the annual revision of the State Plan and for more efficient administration of the hospital program.
C. Special Studies
The Division also completed a number of special studies during the past year. Only an enumeration can be attempted here, but an idea of the range of the reports can be gathered from the titles.
l. Post-audits of Hill-Burton hospitals after one year of operation
2. Compilation of Directory of Nursing Homes
3. Annual Report for Division of Hospital Services
4. Survey of Hospital Salaries and Personnel Policies in Georgia
5. Study of Hospital Charges
6. Report on the First Year of Operation of 17 Hill-Burton Hospitals
7. A Study of the First Two Years Operating Experience of Ten New
Hospitals in Georgia
B. Blue Cross Insurance Study
Numerous other unscheduled and less involved studies were completed by the Division during tne past year. At least three graduate students were assisted in the preparation of theses. Materials were assembled and consultation was given to the Metropolitan Planning Commission's study of hospital needs of the area. The Division also assisted the Medical Services Branch in Civil Defense Planning for Georgia Hospitals, the State Committee on Uniform Accounting Procedures, and provided information for several publications and articles on hospital programs in Georgia.
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II CONSTRUCTION PROGRJ~:rvr

A. J,dministration of Construction Program

l, General

The hospi~.l construction program saw a new record set in hospital and public hvalth center construction in Georgia during 1952. Twenty-one projects be~an construction, twenty-six completed construction, and twenty-five new projects were approved, giving
a total cost, since the program was initiated, of more than $54,ooo,ooo.

Although the Federal act authorizes an appropriation of ~l5o,ooo,ooo, the Federal appropriation for the 1952-53 fiscal year included only $75,000,000 of which Georgia was allotted $2,774,251. Funds available under the State act amount to $3,000,000 annuallye

To be eli~ible for grants, project sponsors must furnish assurances that the local share of the project cost will be available when needed and that construction will be started durin6 the year in which approved. Publicly owned projects are eligible for both Federal and State grants while other non-profit organizations can apply for Federal funds only.

The following table gives the amount of Federal and State Funds available for the program since 1947:

Fiscal Year

Federal Funds

State Funds

1947-48 1948-49 1949-50 1950-51 1951-52
1952-53

$ 2,976,228.00 2, 791,307.00 5,248,356.00 2,609,914.00 3,068,889.00 2, 774,251.00

None
t' 3,ooo,ooo.oo
3,ooo,ooo.oo 3,000,000.00 3,000,000.00 3,ooo,ooo.oo

Totals

$19,468,945 .oo

$15 '000,ooo .oo

2. Processing Lpplications

At the beginning of each fiscal year, a project construction schedule is prepared listin6 projects for approval in the order of area priority as shown in the Georgia Hospital Plan. v~hen a project is entered on the schedule, the sponsor is notified to proceed with the filin~ of formal application forms, supporting documents and the preparation of a program, plans, and specifications. The application contains assurances regardin~ hospital care for the indigent, and services for all races. The processin~ of applications and supporting material must include review for accuracy and acceptability of legal
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oplnlons regarding property ownership and non-profit status, copies of contracts, insurance certificates, bonds and financial statements.
3. Construction Period
Plans and specifications are prepared in accordance with minimum standards of construction, approved by the Division and the U. S. Public Health Service, then bids are obtained. All construction contracts are approved and periodic inspections made as work progresses.
Federal and State payments are made to project sponsors periodically
during the construction period. During 1952, one hundred and seventy
payments were processed totpling ~3,194,749 Federal and ~1,516,458 State funds. Numerous financial records and reports are prepared in detailed audits of the sponsor's financial records and expenditures.
In addition to consultative services in connectionv-rith construction records, the Division assisted several new hospitals in the installe>.tion of their accounting systems.
4. Percentage of Participation
Public Law 725, as amended, provides for the annual establishment
by the State Agency of the percentage of project cost to be paid from
Federal funds. At its regular meeting in June 1952, the State Board of Health set the Federal percente>.ge at 33 l/3 % of the cost for projects approved during the 1952-53 fiscal year.
5. Controlled Materials Plan
Another function of the Division is the operation of the controlled materials plan under the National Defense Act in so far as it affects the construction of health facilities in Georgia. This involves the dissemination of facts and materials concerning the program and the processing, including recommendation for approval, of applications from all health facilities projects. Sixteen applications were approved for projects other than those included in the Hill-Burton Program. No applications were disapproved or material requirements reduced to such an extent as to prevent completion of any planned projects.
6. Status of the Program
The following table presents in summary the status of the hospital
construction program as of December 31, 1952.
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Report of Construction
- - - - HOSPITI~LS:
New Facilities: Completed Under Construction Lpproved

Total Projects
33 11
5

Additions and J,lterations:

Completed

6

Under Construction

4

ilpproved

7

Equipment Only Projects:

Completed

2

PUBLIC HELLTH CENTERS:

Total Beds
1,672
541
484
139 99 287
37

Tote1l Est. Cost
$21,158,907.18 7,825,352.13 7,264,238 ..50
1, 762,826.34 2,483 ,043. 23 7,927,982.00
5F3,217.22

Health Centers:

Completed

13

Under Construction

3

Approved

6

Auxiliary Centers:

Completed

24

Under Construction

7

Approved

7

Combination w/Maternity

Shelter

Completed

1

NLJRSES HOHES:

1,816, 794.73 602,540.82 913,3 70.00
936,641.07 372,462.05 416,778.00

10

165,3 72.00

New Projects:

Completed

2

Under Construction

1

LLBORL.TORIES:

207,064.82
212,003 .oo

New Projects: Completed
Total-1~.11 Projects

1
--
133

B. Technical Services

3,268

153,413.18 $54,278,006.27

The Division is responsible for the review and approv2l of pl2ns and
specifications as well as inspection and approval of sites for all projects approved for construction.

Since hospitals of all types and related facilities as well as health center buildings are complicated, highly specialized functional
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structures which should be designed for the various facilities, instead of having the facilities forced into certain areas because of a desire to produce some particular architectural appearance, it has been found advantageous for the architects to submit plans and specifications to this Division for review and approval in three stages.
The specific items for each stage are: First Stage; schema tic plans, outline specifications and cost estimates: Second Stage; prelimin2.ry plans showing equipment for each room together with elevations, outline specifications and revised cost estimates: Third Stage; working drawings, specifications and revised cost estimate.
In following the above procedure, the plans and specifications for each project are checked in detail at least three times by the Division
and the regional office of the U. s. Public Health Service in Atlanta, Georgia
prior to placing the project on the I112.rket for biddj_ng purposes. This policy has, as the program advanced, corrected errors which formerly resulted in several instances of the censure of planners and builders, with dissatisfied patients, staff and employees as well as excessive operating or remodeling costs.
Prior to releasing plans to contractors for bids, there are many meetinE,s and much correspondence between the Division 2nd the sponsors and their architects and engineers relative to functional planning which includes heating, plumbing, electrical work, air conditioning and ventilating systems and equipment, selection of materials and finishes, fire safety, and cost
trends. During 1952, a total of eighty-three (83) sets of plans and specifications were processed through this Division. Twenty-nine (29) sites were
inspected durinE:, the year ..
When const1~ction contracts are awarded, the technical personnel of the Division nake periodical inspections to see that the construction is done in accordance with the plans and specifications. One hundred and
tHenty-nine such inspections were made during 1952. Inspection reports
properly certified by the Division architect or engineers are necessary to support a request for installment payments of Federal and State funds to the sponsor. Any change in plans and specifications after construction has begun must be reviewed and approved.
In addition to the technical services offered in connection with the construction program, the Division provides consultative service for problems arisinE, when any hospitel authority or board of trustees wishes to expand or remodel existing, or prep2.re plans for new facilities. The State Hospital Licensure Act requires that the plans for all hospi~~ls to be constructed in Georgia be reviewed and approved by this Divisi0n as a prerequisite for obtaining a license.
c. Equipment Planning
Hospit2.l equipment plannin~.s and consulte>.tion falls into four general cc".tegories:
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(1) Visit to the community soon after construction has begun
on the buildin~ to familiarize the project sponsors vJith the steps that must be t2.ken in the equippin, of a hospital under the proe,ram. This mi:;ht be considered <m initial informational visit. The equipment consultants will, if necessary, assist local committees in writing specifiC2.tions and in the evaluation of quotations, but all finol decisions and orders placed will be the responsibility of the local sponsors.

The following communities received this service:

Blackshear Fort Valley Ocilla Ashburn

Brunswick
Cordele Fort Oglethorpe Rockmart

Calhoun Soperton Alma

(2) Contact with either the hospital administrator or equipment committees for the purpose of assisting in making up their equipment list. Several visits are ~enerally necessary for this ~hase of equipment planning if a hospital administrator has not been hired. Communities ,enerally require assistance in listing each item of equipment with estimated cost.

(3) Routine visits to the hospitals to assist sponsors or administrators in submitting invoices to this office for payment. During this visit it is conm1on to inspect quotations and also assist in varied equipment probolms that frequently arise. The majority of projects under construction were visited for this purpose.

(4) Final equipment inspections are conducted in hospitals whore
equipment has been received and is in place. At this time, final supplemental
equipment lists are prep2red for approval.

Durin~ 1952, the delivery on metal equipment, such as bedroom
furniture, desks and files which had previously been delayed in delivery,
improved. There have been, enerally speaking, sufficient funds sot up for the equip~)ing of hospitDls constructed under the :lrogram.

Equipment consultation is available to all public health centers constructed under the program.

III CONSULTATION

A. Hos1jital Administr: tion Consultant Service
There is a shorta~e of trained or experienced hospital administrators in the sto.to, expecially for the smaller hospitals. Because of this situation, several hospital authorities have employed administrators without previous hospital training or experience.
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Consultation services are greatly needed in this field, especially in th0 organizing and preliminary planning for the operation of a new facility. During the year, limited assistance was provided hospital trustees and administrCltors Hith such ;_)roblems as:

(1) Prepar~tion of the budget
(2) Establishing hos;_Jital rates (J) Salary and personnel policies
(4) Uniform accounting systems (5) Inventory controls
(6) Medical records system

Durinf:, 1952, a majority of the new hospitals opening received such
assistance. Requests for consultative services have been so numerous that the time allotted to each new project necessarily has been limited.
B. ConsultBtion in HosjJital Nursing Services
Consult:1tion in hospital nursing available through this Division he1s com)l0ted its third ye:?.r. Nursing consult2 ti on has continued to promote all activities which have to do with imiJlemcntin[ nursint, services to the ~Jatic:mts in hos~Jitals. Nursing needs h::>.ve been defined throu~h studies and throu[h interpretation on national, st2te 2nd local levels.
Nursing consult~tion continued >-Jith direct services to both hospital administrators and directors of nursing service. Thirty-five hospit;:cls were visited for consultc:tion purj_)OSes. These visits covered a period from one to seven days. Services were rendered in the following areas:

(1) Nursing service administration

(2) Staffing

(J) Inter-iJersonal relationships

(4) In-service instruction for graduate nurses

(5) Training for auxiliary workers

(6) Nursing care as related to the medical,

surgical and obstetrical services offered

,,

by the hospitals to patients

Tho operating room section of the Nursing Procedure Manual vras finished and the Manual is com1Jlote o.nd ready to go to press. Three studies pertaininf:, to nurses residen~es were completed; two within the State and one, at the request of the State Board of Health, outside the State.
Talks relating to nursing services were given throughout the State at nurse m~etint,s and at six of tho fifteen regional hospital councils attended. Pa1:;ers on hospital nursing consultation in Geor;,ia were E;iven at the m.tional biennial nurses convention in Atlantic City; at the Georgia Hos~)ital Association; and at the Obstetrics and Gynecological Congress in Cincinnati.
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The staff worked with the vocational education corrmittee on Curriculum for Practical Nurses, with the Better Health Council, served on the Advisory Committee to the rural affiliation program for student nurses at Emory University, and worked on a sub-committee at the University of Georgia to further the establishment of a nursing training school at the Eugene Talmadge JVIC:Jmorial Hospite>l, now under construction, at Au,usta, Georgia.
During the year, ma.terial relatin, to nursin1:, service vms presented at seven pre-opening conferences for nev.r hospitals in the State. Appointments to visit and observe good nursin~ service techniques were arranged for ten nursing service directors throu,hout the year.
c. Dietetic Consultation Service
Projects started in 1951 were continued (and enlarged upon) in 1952. Schematic plans and blue prints of all new projects were reviGwed and discussed with the technical personnel. Conferences were held with the consultant on the plans for the Eugene Talmadge JVIemorial Hospital, Augusta, Georgia and the new county hospital in Savar~ah.
Other activities are classified into five main categories
1. Hospital Consultation
Upon requests of administrators and food service supervisors, twenty-three hospitals in Georgia were visited with an average of two days spent in each. These visits were for the purpose of inspection, evaluation and assistance in the administration of the dietetic departments. A continuing program of assistance was started in three hospitals and return visits made in accordance with the needs of each.
2. Workshops
a. Those participe>ted in:
A five day workshop for food service supervisors planned jointly by the Division and the University of Georgia 1.Jas held durin, the month of July in Athens. Additional workshops and conferences were held in nursin, administration in Macon, Georgia for nursing supervisors at Emory University and for teaching nurses how to teach dietetics, under the auspices of the Regional Health Office in Carroll County.
b. Those attended:
In-service training program for teaching dietetics to personnel at Lawson General Hospital, Atlanta
vJorkshop in dietetic administration, Cincinnati, Ohio, conducted by the American Hospital Association
- ll -

WorkshojJ on Present Conce:Jt of Nutritional Education at the Atlanta Chapter of the American Red Cross, sponsored by the Atlanta Nutrition Council
Conference for Chronic Disease, by the U. S. Public Health Service, Atlanta
Symposium on use of Instructor's Guide in Sanitation Food Service, Jacksonville, Florida, by the U. S. Public Health Service
3. Visits to Hos)ii:2ls Outside the State
In addition to a survey visit to Reading General Hospital in Reading, Pennsylvania, the St. Jose:Jh 1 s Hos;Jital in Tampa, Florida was visited to observe the installation and operation of the Meal Pack Food Service System, These visits were made at the suggestion of technical personnel in order to evaluate the use of this equipment.
4. Develo)ment of Sourc'e Materials
The following ~Jrojects were develOj_Jed during the year:
a. Prej_Jared sug~ested market order of groceries and food su~J~Jlies for opening day for twenty-five bed hospital
b. Prepared food service section of Civil Defense Manual for use in the State of Georgia
c. Continuation of the work in preparing the Georgia Diet Manual
d. Continuation of work on the develo:)ment of food service information kits for hospitals
e. Prepared sample forms for recording food costs
IV
LICENSURE PROGW.M
The Hospiul Regulation Act, No. 623, Georgia La>vs 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 ~atients of hospitc>.ls. In October 1948, the State Board of Health adopted rules and regulations and required a pormit of all persons operating a hos:)ital or related institution.
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In carrying out the provlslons of the above mentioned regulations, licensure personnel of the Division inspected 274 hospitals during 1952. Eighty-six addition2l visits were made by licensure ;_;ersonnel for various reasons such as obtainin~ information for the State Hospit2.1 Plan, attending conferences for planning the opening of new hos;;itals, and assisting in revievl of plens for ;_JrOj_)osed alterations to existin) building,s for the jJUrj_Jose of ccnvertin) them into hospital facilities.
An amendment to Social Security Regulations, effective July 1, 1953, provides that recipients of welfare funds in nursing homes would have to be in nursing homes that had been licensed by a State Licensure Agency. In preparation for placin5 )reater emphasis of the licensure of nursing homes, as directed by the State Board of Health, all known nursing homes (approximately 160 in number) 'tvere surveyed and visits made to each in order to determine which facilities would be eligible for permits under the licensure rules and regulations. A j_Jrogram was established for insj_Jections and issuance of J_Jermits to nursing homes.
Licensure personnel attended courses in food sanitation conducted
by the u. S. Public Health Service in Columbus, Georgia and a meeting of
nursing homes licensing agencies in conjunction with the convention of the American Association of Nursing Homes at Chicago in October 1952a
The Division assisted a number of eligible hospitals in securing
u. s. Government surplus J_Jroperty made available through the HosJJital Services
Division.
Licensure activities were coordinated closely with programs of the Georgia Safety Fire Commission and the Division of Public Health Engineering in their inspections for compliance with fire codes and sanitation requirements respectively.
It is the policy of this office to assist the hospitals in any way 1Jossible to develo;) a ;_Jrogram that will fulfill existing requlations and thereby 1Jrotect the lives and ins'ure the safety of j_Jatients in Georgia.
v
RELATED ACTIVITIES
A. ~pital Trustee Conference
With the assistance of the u. s. Public Health Service, a conference
for hos;_Jital trustees and administrators was held at Macon, Georgia, on April 10, 1952. This conference was the third of a similar t~Je of meetings which have been conducted in the state. Fifty persons were in attendance at the conferenceThe object of these conferences was to assist hospital trustees, particularly those >-rho have been recently appointed, in becoming familiar with their duties and responsibilities.
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B. Hospital Councils
Seven regional hospital councils have been established as constituent parts of the Georgia Hospital Association. These councils are designated as follows:
Northeastern Hospital Council East Central Hospital Council Southeastern Hospital Council Northwestern Hospital Council West Central Hospital Council Southwestern Hospital Council Atlanta-DeKalb Hospital Council
Any hospital within the area covered ~ the council is eligible to attend meetings and participate in its activities. Each of the hospital councils held meetings during the year and conducted programs of interest to persons concerned with hospital administration. Representatives of the Division of Hospital Services have attended meetings of the various hospital councils. The nursing consultant and the dietetic consult?.nt have been especially active in participating in programs of the hospital councils. A special effort is made to have a representative from this Division attend each meeting of the hospital councils held outside of Atlanta.
c. Training Program in Hospital Administration
Through the joint planning of the officials of the University of Georgia, the officers and members of the Georgia Hospital Association, and the Division of Hospital Services, a course of instruction in hospital administration was established at the Atlanta Division of the University of
Georgia in September 1952. The following subjects relating to hospital
administration are offered by the Atlanta Division of the University:
Hospital Organization and Management I, II, and III Medical Sciences Background for hospital Administrators Hospital Equipment and Supplies Hospital Accounting and Business Office Procedures Special Studies of Hospital Problems Hospital Plant Maintenance Hospital and Community Relationship Field Experience in Hospitals (27 weeks)
The program, which consists of nine months of academic study and approximately six months of field experience, is directed toward the need for trained hospital administrators in the smaller hospitals. Members of the staff of the Division were employed as part-time instructors for training in several of the courses.
D. Eugene Talmadge Memorial Hospital, Augusta, Georgia
A considerable amount of time has been spent by st2ff members of the Division of Hospital Services during the year working with the architects and a special hospital consultant in various phases of the preparation of
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plans for the new State General Hospital of 798 beds that is to be erected
at Au5usta as the teaching hospital for the Medical College of Georgia. Unusual efforts have been mc:de to insure in the plarming of this institution that the most modern arran~ement of facilities and equipment will be available for providin~ medical care for the indigent sick and for the instruction of medical students. E. Civil Defense
Activities as relate to hospitals have included participation by several members of the Division staff in the statewide Civil Defense Plan. Representatives from the Division have attended the monthly Civil Defense meetings held in Atlanta. The Division has rendered assistance to the State Civil Defense organizHtion in collecting info rmc: tion as to the Jrofessional staffing of all hospitals in Georgia and the accumulation of other imj_Jortant information necessary in formulating current Civil Defense plans as concern hos~'itals of the State.
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VI HOSPITAL AND HEALTH CENTER CONSTRUCTION PROGRAJYI

HOSPITAL STATUS

HOSPITA.LS C01'1PLETED: Name

Location

No. of Date Put Into

Beds Cperation

Total Cost

1. Tanner JYiemorial Hospital

Carrollton

37

2. JYiinnie G. Boswell Hem. Hosp. Greensboro

28

3 Upson County Hospital

Thomaston

92

4. Hall County Hospital
5. Mitchell County Hospital

Gainesville 112

Camilla

32

6. Elberton-Elbert County Hosp. Elberton

47

~:: 7. Cobb Iliemorial Hospital

Royston

23

B. \Iorth County Hospital

Sylvester

28

9~ Sto Francis Hospital

Columbus

154

10. Stewart-Webster Hospital

Richland

24

11, Griffin-Spalding County Hosp. Griffin

96

12. Kennestone JYiemorial Hospital Marietta

105

13. The JYiemorial Hospital
14. Jasper County Hospital

Adel

27

Nonticello

25

15. JYicRae-Telfair County Hospital HcRae

30

16. Burke County Hospital

Waynesboro

38

17. Arline:,ton City Hospital

Arlington

16

18. Rabun County Hospital

Clayton

20

19. Lee N. Happ, Jr. Hem. Hosp.

Hiawassee

14

20. Terrell County Hospital

Dawson

28

21, Baxley-Appling County Hosp.

Baxley

27

22. Chattooga County Hospital

Summerville 31

23. Screven County Hospital

Sylvania

34

24. McDuffie County Hospital

Thomson

29

25. Winder-Barrow Hospital

Winder

40

26. Hughes Spalding Pavilion

Atlanta

116

27, Emanuel County Hospital

Swainsboro

50

28. Habersham County Hospital

Demorest

44

29, Laurens County Hospital

Dublin

60

30. Americus-Sumter County Hosp, Americus

100

31, St, Joseph Hospital

f'mgusta

110

32. Bacon County Hospital

Alma

30

33. Rockmart-Aragon Hospital

Rockmart

25

11-1949 8-1949 4-1951 8-1951 9-1949 9-1950
1-1950 2-1950 10-1950 1-1950
1-1951 6-1950
8-1951 1-1952 3-1952 5-1951 4-1951 11-1951
2-1952
4-1951 6-1951 1-1952
9-1952 1-1952 12-1951 7-1952 6-1952 7-1952 9-1952
l-1953 12-1952 12-1952

$ 528,000.00 401,250.00
1,122,000,00 1,608,306,00
268,13 9.19 780,276.00
213,460.3 2 293,113.72 1,909,806.88 255,536.38 1,321,491.00 1,208,563.96
193 ,8oo.oo 260,000.00 360,000.00 416,069.91 158,900.00 23 7,ooo.oo
179,604.10 255,867.50 257,196.20 345 ,ooo.oo
332,000.00 3 25,500.00 55o,ooo.oo 1, 725,984.02 591,790.00 550,228.00 886,o6s .. oo
1,339,000.00 1,626,ooo.oo
329,000,00 329,956.00

Totals

1,672

$ 21,158,907.18

- 16 -

HOSPITLlS UND.!ER CONSTRUCTIOll:
Name
l. Coffee County Hospital 2. Tri-County Hospital 3. Treutlen County Hospital 4. Irwin Colmty Hospital
5. Pierce County Hospital
6. Peach County Hospital 7. Lo,mdes County Hospital 8. Gordon County Hospital 9. Crisp County Hospital 10. Brunswick City Hospital ll. Turner Colmty Hospital
Totals

-Lo-ca-tio-n
Douglas Fort Oglethorpe Soperton Ocilla Blackshear Fort Valley Valdosta Calhoun Cordele Brunswick Ashburn

No. of Beds
60 100 25
25 25 25 100 40 4o
75
25

540

APPROVED:

Name

Location

l. Newton County Hospital

Covington

2. Gilmer County Hospital

Ellijay

3. Savannah Chatham Coun~y Hosp. Savannah

4. Bremen General Hospital

Bremen

5. General Hospital

Waycross

Totals

No. of Beds
34 25 300 25 100
484

Total Cost
~ 937 ,264.oo l,lo9,o66.oo 310,410.00 328,775.46 340,563.76 4D8,ooo.oo 1,469,696.84 639,302.07 767,000.00 l,o98,6oo.oo 416,674.00
$ 7,825,352.13
Total
-Cos-t
$ 546,736.50 359,902.00
4,571,600.00 360,000.00
1,426,000. '!0
$ 7,264,238.50

ADDITIONS LND J,LTERATIONS TO HOSPITJ lS

COHPLETED: Name

Location

No. of Date Put Into

Beds

Operation

Total Cost

l. City-County Hospital 2 J, thens General Hospital 3 Hacon County Hospital 4. Hac on City Hospital
5. Polk General Hospital
6. Stephens County Hospital

LaGrange Athens Hac on Hacon Cedartown Toccoa

74

9-1949

ll

4-1951

8-1948

28

9-1948

10

7-1951

16

7-1952

$ 5o4,000aOO 552,900.00 154,592.55
57,833.79 69,500.00 424,000.00

Totals

139

$ l, 762,826.34

- 17 -

UNDB:R CONSTRUCTION :
Name
l. University Hospital
2. Americus-Sumter County Hosp. 3. Tift County Hospital 4. Vereen Memorial Hospital
Totals

Location
Augusta Americus Tifton Moultrie

Number of Beds
10 35 30 24
99

Total Cost
$ 1,067,000.00 286,082.24 3 71,120.00 758.840.99
$ 2,483,043. 23

APPROVED:
Name
1. John D. Archbold Mem. Hospital
2. Kennestone Hemorial Hospital 3. Bulloch County Hospital 4. Mitchell County Hospital 5. Macon City Hospital 6. Villa Rica Community Hospital 7. Douglas County Memorial Hosp.
Totals

Location

Number of Beds

Thomasville 25

Marietta

5o

Statesboro 30

Camilla

18

Macon

146

Villa Rica 12

Douglasville 6

287

Total Ccst
$ 300,000.00 75o,ooo.oo 6oo,ooo.oo 129,480.00
5,878,502.00 200,000.00 70,000.00
$ 7,927,982 .oo

COMPLETED:
Name
1. ~litchell County Hospital
2. Battey State Hospital
Totals

NURSES HOMES
Location
Camilla Rome

Date Put Into Operation
12-1949 3-1952

Total Cost
$ 42,903 .oo 164,161.82
$ 207,064.82

UNDER CONSTRUCTION: Name
l. Columbus City Hospital Totals

Location Columbus
- 18 -

Total Cost
212,003 oOO
212,003 .oo

LABORATORY

COMPLETED:
Name l. Battey State Hospital

Location Rome

Date Put Into Total Operation Cost
.5-19.52 $ 1.53 ,413 .18

Total

~ 1.53 ,413 .18

EQUIFlVIENT ONLY

COHPLETED:

Name

Location

l. Heard County Ivremorial Hospital Franklin

2. Murray Cmmty Hospital

Chatsworth

Number
-of-B-ed-s
18 19

Date Put Into Total
Operation -Cos-t

.5-1948 $ 17,217.22

8-19.50

41,000.00

Total

37

$ .58,217.22

PUBLIC HEALTH CENTERS

COMPL.d:TED:
County
l. DeKalb 2. Fulton 3. Bulloch 4. Spalding
5. Thomas
6. Elbert 7. Meriwether B. Wayne
9. Clarke
10. Gwinnett ll. Burke 12. Mitchell 13. Floyd

City
Decatur Atlanta Statesboro Griffin Thomasville Elberton Greenville Jesup Athens Lawrenceville Waynesboro Camilla Rome

Date Put Into Operation
l-19.50 .5-1949 9-19.51 6-19.51 2-19.52 8-19.51 2-19.52 .5-19.52 4-19.52 7-19.52 5-19.52 4-19.52 8-19.52

Total Cost
$ 19.5,216.00 476,881.00 61,470.44 173,944.96 163,2.50.00 79,491.28 82,.500.00 87,.508.00 164,871.81 ll9,2l.5.oo 61,822.00 8.5,397. 76 6.5,226.48

Total

- 19 -

$1,816,794.73

UNDER COHSTRUCTION:

l. Polk 2. \1alton
3. Richmond
Total

APPROVED:

County

l. Glynn

') ~

Coffee

3. CovJeta

4. Appling

5. Nuscogee

6. Carroll

Total

COl'1PLt:TED :
County
l. Fulton 2. Fulton 3. Fulton 4. Fulton 5. Fulton 6. Fulton 7. Fulton 8. Fulton 9. Fulton 10. Fulton ll. Fultcn 12. Fulton 13. Fulton

Cedartown I1onroe Augusta

Qity
Brunswick Douglas Newnan Pax ley Columbus Carrollton

AUXILIARY HEA-LTH CENTERS

City

Date_Put Into Operation

Lakewood South Fulton Alpharetta Sandy Springs
Center Hill Adamsville Howell Hill Fairburn Collins Buckhead Red Oak Rockdale Perkerson

5-1949 5-1949 6-1949
6-1949
5-1949 5-1949 12-1949 12-1949 12-1949 l-1950 12-1949 12-1949 12-1949

- 20 -

Total Cost
$ 82,650.00 93,270.82
426,620.00
~602,540.82
Total Cost
~~147 ,5oo.oo 84,070.00 95,ooo.oo 8o,ooo.oo
425,350 .oo ___1:~50 .oo $913 ,3 70 .oo
Total Cost
$ 3 7,935.18 33,111.15 3 7,653 .50 36,270.70 42,120.28 43,001.45 31,678.62 40,696.08 39,3 79.81 38,726.14 42,085.78 32,900.89 38,189.79

County

Date Put Into Operation

14. Harris

Hamilton

15. Wilkinson

Irwinton

16~ Atkinson

Pearson

17. Taylor

Butler

18. Lamar

Barnesville

(PHC and J1aternity Shelter - Ten Beds)

19. Oconee

Watkinsville

20. Dawson

Dawsonville

21. Camden

Woodbine

22. Effingham

Springfield

23. Brooks

Quitman

24. Evans

Claxton

25. Dade

Trenton

1-1951 11-15'51 ll-1951
8-1952 12-1951
10-1951
9-1951 6-1952 10-1952 6-1952

Total

UNDER CONSTRUCTION:
County
1. Mcintosh 2. Rabun 3 0 Douglas 4. Jenkins
5. Butts
6. Charlton 7. Berrien
Total
APPROVED:
County
l. Jones 2. Hart 3. Peach 4. Pike
5. Putnam
6. Barrow 7. Nacon
Total

City
Darien Clayton Douglasville Millen Jackson Folkston Nashville
City
Gray Hartwell Fort Valley Zebulon Eatonton Winder Oglethorpe

- 21 -

Total Cost
~ 33 ,8oo.oo 36,878.69 20,392.04 23 '730.00 165,3 72 .oo
43 ,5oo.oo 44,082.38 45,713.78 38,366.84 66,415.00 39,762.97 53,250.00

Total Cost

~ 49,980.00 65,200.00 52,000.00 51,749.10 57,988.95 46,ooo.oo
49.!544.00

t
<til

3 72,462.05

Total Cost
$ 55 ,o5o.co
6o,ooo.oo 55,ooo.oo 42,000.00 71,010.00 64,230.00 69,488.00
$ 416,778.00

Division of Personnel

REPORT OF THE PERSONNEL ADMINISTRATOR FOR 1952

GROWTH OF PUBLIC HEALTH WORK:
Although Alto Medical Center closed during 1953 upon the successful completion of its campaign against venereal disease, there was, nevertheless, a net increase of three in the total of persons engaged in full-time public health work in Georgia. The relatively large increase in the staffs of the county health departments, totaling 104, together with the smaller increase in the State and regional health offices and at Battey State Hospital more than offset the loss of 148 employees at Alto.

FULL-TIME EMPLOYEES IN PUBLIC HEALTH WORK

1951

1952

Local

724

828

State

609

629

Alto

163

15~~

Battey

832

859

2,328

2,331

-)~ Maintenance crew only

Net Gain 104 20 -148 27 3

FULL-TIME EMPLOYEES---LOCAL HEALTH DEPARTMENTS

1951

1952

Net Gain

Physicians

32

34

2

Dentists

4

3

-1

Nurses

396

438

42

Engineers

17

15

-2

Sanitarians

81

101

20

Clerks

183

212

29

Laboratorians

8

8

0

Others

3

17

14

724

828

104

FULL-TIME EMPLOYEES---STATE AND REGIONAL OFFICES

Biologists Clerical, Administrative, Fiscal Communicable Disease Investigators Engineers Health Educators Hospital Specialists Industrial Hygienists Laboratorians Maintenance, Service, Custodial Nurses Nutritionists Physicians Sanitarians Social Workers Statisticians Veterinarians X-Ray Technicians Others

1951 3
253 24 18 11 9 8 86 63 38 9 15 27 9 4 2 15 15 609

1952 3
264 23 18 9
7 7 87 72 38 10 19 22 12 5 1 18 14 629

Net Gain 0
11 -1
0 -2 -2 -1
1 9 0 1 4 -5 3 1 -1 3 -1 20

-2-

FULL-TTI~ EMPLOYEES--BATTEY STATE HOSPITAL

Administrative and Fiscal

Clerical

54

Custodial and Protective

14

Dentists

2

Dietary Executive

14

Educators

2

Graduate Nurses

31

Nurses, Sub-professional

181

Nurses Aides

67

Physicians

31

Skilled Labor

38

Skilled Trades and Crafts

20

Supervising and Managerial

7

Technical

11

Unskilled Labor

385

859

(A change in the organization of data in 1952 makes
a comparison with the preceding year inappropriate)

-3-

900 800 700 600 500 400 300 200

0

1947

1948

1949

1950

1951

FULL-TIME EMPLOYEES BY ORGANIZATION
+

ALTO
1952

240 0

230 0 220 0

~
/

210 0 200 0

/
~~

"""

~

190 0

/

/ 1800

~ 1700

1600

. --

150 0

140 0

130 0

120 0

110 0

I

100 0

l.

-~'

>

.c:::;

i
I''--~
,__J

0

1947

1948

1949

1950

1951

TOTAL FULL-TIME EMPLOYEES IN PUBLIC HEALTH

-5-

I
'
!95'2,

DISTRIBUTION OF STATE HEALTH DEPARTMENT EMPLOYEES ON LEVELS OF PAY PLAN

Pay Grade
6
10
11 12 13
14 15 16
17 18 19
20 21 22
23 24 25
26 27 28
29 30 31
32 33 34

Number of Employees

28

26

0 2
41

3 142
2

90
25 44 Average Salary $286.53

28
25 19

33
34 8

32
3 9

/

8

5

4

12 0 3

626 (3 unclassified positions omitted)

-6-

EMPLOYEE TURNOVER:
If the 148 separations arlslng from the closing of Alto Medical Center are ignored, it is obvious that there has been a decided decrease in the turnover rate. The 978 separations, after deleting the 148 directly attributable to the closing of Alto Medical Center, is a ten per cent decrease over the total of 1,086 for the preceding year. A fuller realization of the value of the Employees' Retirement System coupled with a change in the compensation plan were in part responsible for this decrease.

Local State Alto Battey

EMPLOYEE TURNOVER IN 1952

Appointments

Separations

291

187

215

195

75

223

548

521

1,129

1,126

Net Gain 104 20 -148 27 3

COMPENSATION:
During 1952 the State Merit System made a comprehensive study of the pay plan. The result was the complete abolition of the old pay plan and the substitution therefor of an internally integrated compensation plan. In the new plan a salary advance represents approximately a four per cent increase over the preceding pay step, no matter where such steps may fall in the overall plan. This plan, which became effective July l, 1952, made a small increase in the income of Employees.
In addition to the adoption of the new pay plan, a substantial number of salary advances were given, as well as 122 promotions to more responsible positions.

Salary Advances

Local

667

State

543

Alto

Battey

715

1,925

-lr Omitted because of closing of Institution
-?-

Promotions 21 46
55 122

ACTIVITIES OF THE PERSONNEL OFFICE:
During the year the Personnel Office prepared and issued a Handbook for New Employees for the purpose of giving a brief statement of the activities of the Health Department as well as personnel policies. These were distributed to all employees in the State and county health offices and a copy given to each new employee during the year.
At the request of the Director, and with the assistance of the Division Directors, the Personnel Office prepared a standardized sheet of organization charts showing the functional organization of each work unit within the Department.
In order to expedite work and decrease errors, the Personnel Office and the Accounting Office worked out a joint plan for maintaining leave records by use of tabulating machines.

CHANGES IN THE MERIT SYSTEM RULES:

The following changes were made in the Merit System Rules:

January

A.205

An employee who is reappointed or is appointed

on an intermittent basis may have his salary placed at

any step of the range applicable to the position to which

he is appointed provided that it is not a higher step

than that at which he was paid at the time of his release.

March

9.101 A reappointment to a position of a higher class than that in which the former employee held permanent status is a promotion. Former employees eligible for reappointment in accordance with Paragraph 9.101 may be promoted in the same manner as permanent employees.

APPEALS T0 THE PERSONNEL BOARD:

The following appeals were made to the Personnel Board:

February

Mrs. Maude M. Hill, Institutional Nurses Alde--Battey. Prejudice removed.

December

Ed Jones, Macon Laboratory Porter. Prejudice removed.
Harvey D. Hendrix, formerly X-Ray Technician. Prejudice removed.

-8-

THE CLASSIFICATION PLAN:

A number of changes were made in the Classification Plan to keep it adapted to the growing needs of the health program. The following classes were established:

February

Public Health Administrator 26 Director of Public Health Education 29

March

Supervising Tuberculosis Case Worker 21

June

Director of Environmental Health Services 32 Director of Public Health Laboratory Services 32 Medical Director, Public Health Services 34 Director of Division of Industrial Hygiene 30 Executive Director, Child Guidance Center 26

July

Junior Psychiatric Social Worker 21

August

Superintendent, General Hospital 34 Director of Nursing (General) 26 Physical Therapist 19

September

Medical Laboratory and X-Ray Technician 19

October

Medical Laboratory Consultant 24

November

Tuberculosis Survey Nurse 19 Junior Clinical Psychologist 21

December

Medical Laboratory Technician 16

The following classes were abolished:

September

Mental Hygiene Program Coordinator

The following classes were reassigned to a different pay level:

April

Thoracic Surgeon 32 to 34

June

Supervisor, Crippled Children Services 26 to 28 Editorialist 20 to 21 Clerk 12 to 13 Typist 12 to 13 Stenographer 12 to 13 Sanitorium Superintendent 33 to 34 (4th step)

-9-

July September December

Architect 28 to 29 Public Health Administrator 26 to 25 X-Ray Technician 15 to 16

The following classes were revised:

February

Architect Assistant Baker---Experience requirements deleted Assistant Baker B

June

Supervisor of Non-technical Services

(Public Health Laboratory) 25

July

Construction Engineer (Public Structures)-formerly Hospital Construction Engineer
Supervisor of Local Public Health Nursing changed to double title: Consultant to Local Public Health Nurses and Director of Local Public Health Nursing

October

Public Health Administrator (experience requirement reduced from 3 to 2 years) (initiated by Merit System) Director of Dental Health Services (32-4th step) (formerly Dental Health Director V)

November

Public Health Engineer IV (responsible to Director of Environmental Health Services rather than Department Director)

PERSONNEL CHANGES IN THE PERSONNEL OFFICE:
During the year Mrs. Anne Hitchcock replaced Mrs. Dorothy Bryan in the Personnel Office in Atlanta. In the Personnel Office of Battey State Hospital, Miss Barbara Bell replaced Mrs. Virginia Davis and Mrs. Mildred Formby replaced Miss Martha Davise

-10-

Division of Public Health Education

ANNUAL REPORT - 1952 PUBLIC HEALTH EDUCATION DIVISION

The year 1952 saw a reorganization of the Division of Public Health Education" The Division, directed for a number of years by Dr 0 C, D. Bowdoin, also Director of Venereal Disease Control, was made a separate activity and placed 1n Administrative Services., George Mo Stenhouse, who had been in the Division as information specialist for six years, was appointed Division Director 0

Services in the area of public information, community organtzation, school health education, Negro health education, and in-service health education, were continued by the newly-organized Division.

PUBLIC INFORMATION

"FAX" was born in February 1952" FAX is a "house organ," containing information about public health programs and people in state, regional,, and local health departments, Published monthly in the Department! s own print shop, FAX attempts to promote "teamwork among all public health workers in the state" 11 Items for FAX are contributed by personnel throughout the state, In addition, items on meetings, seminars, policies, and other subjects are prepared by the Division of Public Health Education.
GEORGIA s HEALTH, 11 The Department1 s monthly health bulletin for
Georgia citizens became, in 1952, the responsibi11ty of this Division, wJ.th Miss Erna Lee Mason, editor, transferred to the Division as editorialist, GEORGIA'S HEALTH has undergone a steady revamping of format, with the Division's 1nformation specialists giving consultation to the editor along thl s line.

HEALTH FILMS of the Department have been consolidated into a Central Film Library, under the supervision of the Division of Public Health Education. A loose-lea film catalogue has been designed, w1th supplements mailed to all holders of the catalogue when new ftlms are added or old films are retired from the library.

NEW FILMS - 19 52

Wonder Engine of the Body Guard Your Heart Your Eyes A Tale of Two Towns Cancer Division F1lms Mental Hygiene & MCH Films Dental Division Films You Can Be Safe From X-Rays

March March January April April Apnl Apnl May

. ".And Then Ice Cream Rice and Health Weight Reduction Through Diet

June June June

Whenever You Eat Health and the Cycle of Water

June June

Stanley Takes a Trip Husky and Skinny How to Catch a Cold Safe Service

July July August August

Rabies Can Be Controlled

September

He Acts His Age The Terrible Two's and The Trusting Three 1 s Losing to Win Food as Children See It One e Upon A Time Proof of the Pudding

October October December December December December

PAMPHLETS, leaflets, and other publications for general distribution have been consolidated into a Publications Libraryo This Diviston maintams a running inventory on distribution of such materials, and notifles division and program heads when stocks are lowo The Division is then available to consult in matters of revising or reprinting,

During 1952, the purchase of offset duplicating equipment by our print shop afforded the Public Health Education Division a low-cost, yet effective medium for producing pamphlets on various health subjects" A s1x-page pamphlet by the conventional letter press method would cost more than four times as much as one printed by the duplicating equipmento Pamphlets produced by this method in 1952 include:

GOOD PRENATAL NUTRITION GRADUATE INSTRUCTION- IMMATURE INFANTS NOW IS THE TIME (Cancer) INSTRUCTIONS - MASSO VISION TESTING SELF HELP AND NEIGHBOR HELP (Civil Defense) MEASURING UP THROUGH A COMMUNITY HEALTH
COUNCJL WE LOVE GARBAGE THE SILENT KILLER (Tularemia)

In addition, many flyers, notices, programmes, and similar materials were produced for division and program directors,

RADIO TRANSCRIPTIONSO The Division, m 1952, began the collection and distnbution of dramatic radio programs, on records, which local health departments may sponsor on their community radio stations,

-2-

USE OF MASS MEDIA. The Division continued to make available to newspapers, radio stations, and television stations health information and information as to Department activities, News releases were prepared approximately weekly and sent to daily and weekly newspapers, press associations, and radio stations throughout the state. A television series on nutrition was developed by this division, using resources of Maternal and Child Health Division {Nutrition Program}, and ran weekly on WAGA-TV. The Division provided a number of programs and films on varied subjects throughout the year for Atlanta television stations.
EXHIBITS, Plans were formulated, to be carried out in 1953, to develop a workable exhibit plan that would benefit state, regional, and local health departments. The plan involves the preparation of standardized exhibit frame, with the mass production of posters to be inserted in the frames. It is planned that several exhibit frames be placed in each region for loan to counties, It is hoped that many counties can buy their own standardized frames,
HEALTH EDUCATION CONSULTATION
WORK WITH STAFF. Worked with staff members upon request at the state and regional levels on plans for developing community and school health programs; personnel conferences, etc, Worked with training division m area of in-service education,
LOCAL HEALTH DEPARTMENTS, Worked with public health officers, nurses, and other public health personnel as consultant in planning for special programs involving health education such as multiphase testing programs; adult groups in community; school health education, etc.
LOCAL CONFERENCES -HEALTH, Served in various ways in local conference groups as leader of group discussion; as a panel member, etc,
REGIONAL HEALTH CONFERENCES- NURSES' CONFERENCES. Attended upon request Regional Health Conferences and Nurses' Conferencesparticipated in program as assigned.
COMMUNITY COUNCILS OR HEALTH COUNCILS, Worked with local health department representatives and other community leaders in planning for and organizing local community councils or health councils.
Served as consultant to counclls already organized to plan for conference meetings and special activities; served as panel leader at meetings or participated in program in other ways,
INFORMATION AND MATERIALS, Informed others in public health, state, reg1onal and local, of meetings, educational information, etc, -general and specific, Have sent to members of state staff printed materials from other states and from other sources in their respective areas of interest in health,
- 3-

TEACHER EDUCATION COLLEGES. Worked with Deans of Education and other faculty members in teacher education colleges as consultant, as they planned for student health programs and activities in the colleges. Served also as consultant as faculty members planned teacher education courses which included health instruction and activities for student teachers.
WORKSHOPS AND SUMMER SCHOOL SESSIONS. Upon invitation visited workshops and summer school sessions for teachers (in-service) at colleges in the University System of Georgia, Emory University, Reinhardt College, Mercer University and others. Participated in ways designated by Deans of Education or other faculty members,
LOCAL SCHOOLS, Upon request worked with classes in senior high schools on social hygiene education,
SCHOOL ADMINISTRATORS CONFERENCES, Attended upon request meetings of Teacher Education Council, State School Administrators, Instructional Supervisors of Education, Visiting Teachers,, School Lunch Food Supervisors,
SCHOOL SYSTEM WORKSHOPS. Participated in many local school system workshops where all school personnel within the system spent a day or several days working on im.provement of schools, Worked in all instances with groups concerned with health,
COMMUNITY GROUPS. Have worked in various ways (as speaker, group discussion leader, panel participant, consultant in program planningserved as judge in contests, etc. , ) with such groups as Home Demonstration Clubs, 4-H Clubs, Mens' service clubs, Hospital Auxilaries, Auxilaries to Medical Association, P. T. A. 's, etc,
BETTER HEALTH COUNCIL OF GEORGIA. Have cooperated with the Executive Secretary of the Better Health Council of Georgia in various ways: in preparing lists of state-wide organizations, sharing materials, etc"
PARENT-EDUCATION CONFERENCES, Served as a member of team to work in five of sixteen state-wide conferences on parent-education sponsored by Homemaking Division, State Department of Education; Georgia Congress of Parents and Teachers; and Home Demonstration CounciL
ATLANTA UNIVERSITY. Attended Jeanes Teachers Conference at Atlanta University; also worked with group of teachers in summer school on health problems.
OTHER GROUPS AND ORGANIZATIO-NS. Public Health Education consultants have served on the following groups, committees, or state-wide organizations:
L Assembly of the Metropolitan Atlanta Community, Inc.
-4-

2. Joint Committee on Health Education: Georgia Department of Public Health State Department of Education University System of Georgia
3. Governor's Committee on Children and Youth (designated by Governor}
4. Resource Use Education Committee-University of Georgia (mvited by president of University of Georgia)
5. Better Health Council of Georgia (designated by GPHA president to represent Georgia Public Health Association)
6.. Board of Managers, Georg1a Congress of Parents and Teachers; Chairman of Committee on Budget, Georgia Congress of Parents and Teachers; Member, Legislation Program Committee, Georgia Congress of Parents and Teachers.
7. Gerogia Study of Services of Handicapped Persons Committee.
8. Georgia Committee, Educational Television
9. Georgia Social Hygiene Council
10. Georgia Public Health Association --As secretary of G. P. H. A., assisted with plans for annual convention of G. P. H. A. in Savannah, 1952.
lL Natwnal Social Welfare Assembly
12. Advisory Council, National Institute of Dental Research, U.S.P.H.S.
NEGRO HEALTH EDUCATION SECTION
The following statement is a report of highlights of activities of this office for the year 1952.
The office worked closely with the Division of Maternal and Child Health in the production of the film "All My Babies." Cooperating with the Division of Venereal Disease, Federal Security Agency, U. S. Pub he Health Service, we worked actively in Charleston, S, C. , Detroit. Michtgan, and Pittsburgh, Pa., with Health Departments in these respective cities in the community organization for mass case finding programs in Venereal Diseases and Tuberculosis. Similarly community organizahon
- 5-

for case finding in Syphilis and Tuberculosis was completed in cooperation with the Hall County and Upson County Health Departments. More than sixty-five meetings were held with health departments, community groups, colleges, schools and teachers related to:

(1) Teacher -education college programs in Health Education. (2) Marriage and Family Life Education. ( 3) Evaluation of Georgia School Health Education Programs. (4) Midwives Education Program. {5) General health topics. (6) Civil Defense.

Many of these included the use of films, flannel board and other audio-visual materials. Agencies involved in these meetings included: Planned Parenthood Federation of America, Georgia Teachers and Education Association, Association of Georgia Jeanes Teachers, Georgia Congress of Colored Parents and Teachers, Young Mens' Christian Association, Young Womens' Christian Association, National Negro Insurance Association, Veterans Hospital, Tuskegee, Boy Scouts of America, Georgia Tuberculosis Association, American Cancer Society, Atlanta University, Clark College, Albany State College, Fort Valley State College, Savannah State College, Atlanta Mental Health Association, and State Department of Education.

Publications submitted include:

(1) "What are Our Teacher Needs in Health Education," A research project directed to health knowledge and health knowledge application from a random sample of Jeanes Teachers, classroom teachers, and pupils from certain accredited Negro High schools in Georgia.

(2) "Public Health Problems of the Negro In The South. " This is in process of publication by Harvard University, as a part of a collection of papers related to Negroes, and edited by a Nieman fellow.

LIBRARY SERVICE STATISTICAL REPORT, 1952

A. BOOKS AND PAMPHLETS

L Number of books and pamphlets reported in 1951

2. Number of books and pamphlets added in 1952

In Main Library

77

In Divisional Offices

190

In Regional Offices

97

In Branch Laboratories

0

3. Number of books and pamphlets lost or

discarded in 1952

In Main Library

38

In Regional Offices

10

12, 283

-6-

40 Number of books found in 1952

1

50 Total number of books and pamphlets

December 31, 1952

B. PAMPHLETS AND EPHEMERAL MATERIAL ADDED IN 1952

C. PERIODICALS CURRENTLY RECEIVED

L By subscription 1951

310

20 New titles added in 1952

54

30 Periodicals discontmued in 1952

17

40 Total number by subscription

D. PERIODICALS BY GIFT OR EXCHANGE

L Total number in 1951

114

2. Total number discontinued in 1952

4

3. New titles added in 1952

6

4. Total number of periodicals by gift

or exchange

E. TOTAL NUMBER OF PERIODICALS BY SUBSCRIPTION, GIFT AND EXCHANGE

F. JOURNALS, BOUND VOLUMES

L Number of Journals reported in 1951

2. Number of Journals added in 1952

In Main Library

124

In Divisional Offices

43

In Regional Offices

108

30 Number of Journals bound in 1952

40 Total number of bound volumes December 31,

1952

G. TOTAL NUMBER OF BOOKS AND BOUND VOLUMES

H. CIRCULATION FROM MAIN LIBRARY

I. REFERENCE CALLS ANSWERED L Inside Department 2 0 Outside Department 30 Total 4. Telephone Calls 50 Total

628 90
2, 301

Jo ATTENDANCE L Inside Department 2 0 Outside Department 3. Total

7,282 1,043

-7-

12, 600 851
347
116 463 1, 356
275 1, 631 14' 2 31 4,143
718 3, 019
8,325

Division of Training

REPORT OF THE; JJli!ISIOI\l OF TRAINING
July l - December 31, 1952
The Division of Training of the Georgia Department of Public Health
was established July 1, 1952 under policies approved by the Director of the Department on February 15, 1952.
The Director of Training, having commitments to his former local department and his successor having requested his continued presence therein,
did not report to the Division until August 15, at which time the Division
was activated.
Immediate objectives of finding office space, a secretary and orientation to the State Department were successfully reached during the first month. The Director also attended a two weeks' course at CDC in training methods during this period.
The next step in organization of the Division was the activation of the Advisory Committee of the Division of Training, consisting of the Division and Service Directors most concerned "ith training. To this group has been added a number of other individuals from divisions, such as Local Health Organizations, Nursing and local health departments. After its organization, the Advisory Committee established subcommittees to work on specific problems. All committees have worked hard and effectively and continue to develop plans and policies.
The Director of Training has been in contact 1~th the Training Branch of CDC, Emory University's Schools of Medicine, Dentistry and Nursing, the Department of Nursi11g Education of the Atlanta Division of the University of Georgia, in all of which there is real interest in public health and varving degrees of readiness for introduction of instruction into the curriculum.
Other activities of the Director include a visit to the University of North Carolina School of Public Health, attendance at the annual meeting of the American Public Health Association and a conference of State Training Officers, observation of the iVliddle Atlantic States Conference on Local Health Services at Roanoke, Va., attendance at a two weeks' course in Leadership Training in Human Relations and Group Dynamics at CDC, many visits to local health departments, as well as many meetings both for participation and attendance.
As was to be expected, the reception of the Division of Training was a mixture of expectation and concern that it might interfere vith current divisional responsibilities and activities.
The organization has been approached vvi th the philosoDhy that the Division of Training is a staff or service Jivision and justifies itself only in the degree to which it can provide service to line and program divisions. It mu.st be charged cith responsibility for quality of training, adequacy of trainin[': and the availability of training and its only authority should be th~t necessi'-yY to cover this responsibility.
~Jorking on thj_s basis, effective and pleasant working relationships have been established with all divisions so far, at least, as this division is concerned. And it is hoped that this feeling is reciprocated by other divisions.
-l -

Specific Developments in Training
Many things have come to pass in these first six months, some as normal developmental processes, others because of the influence of the Division of Training. The more important ones are listed here without any attempt to give credit except to all the individuals who have given of their time and effort.
Content of Training Programs. The Advisory Committee has reviewed the content of established training programs, as well as the spectrum of programs available to each of the basic categories of personnel, health officers, nurses, engineers and sanitarians, and clerical workers. This has served to acquaint the committee 11ith other programs than those they were familiar with and will serve as a basis for future planning. An interesting corollary of this activity has been that changes in content have resulted simply from the presentation to the group as if a critical review by the presenting person brought out heretofore unrecognized weaknesses,
Policy for the Selection of Trainees. The financial support of training has been administered by a committee which has followed reasonably fixed policy in their decisions. This policy had never been written or publicized and there were a number of instances where exceptions seem to have been made. The Advisory Committee has almost completed the documentation of proposed policy for the selection and support of trainees which will soon be presented to the Director for final approval.
Criteria for the Establishment of Field Experience Centers. The real backbone of a coordinated training program should be field experience, The selection and development of sound training centers is the most important factor in this phase of the program. Criteria which should be met by local health departments to permit them to offer good field experience to trainees are almost completed and rill be submitted to the Jirector at an early date.
Institutes for Members of Local Boards of Health. A better understanding of public health and of their responsibility therefor is one of the greatest needs of members of local boards of health and of the depart-
ments for Hhich they are responsible. A one-day institute has been
developed to both increase the understanding of public health, as such, and to outline administrative and fiscal responsibility. As soon as audiovisual aids have been completed, this is to be offered two or three areas and then evaluated. If effective, it will be offered statewide wherever requested. Health officers have been consulted and are enthusiastic.
Record Study. An effective record system is required for both good performance and good training. A study of local health records has been generally designed, and apnroval by CDC of the loan of a records person to undertake the study has been secured. This will begin shortly after April 1,
1953. The records committee is to be reorganized by the Director of the
Department to include real local re~resentation. This should be done before the project begins.
Training Records. McBee cards have been completed in the Division for all personnel except custodial. Codes have been established and punched for basic educational information and codes are being completed for training experiences 'vhich should be recorded. ':'Jhen these are ready questionnaires will be sent to all persons so that complete records of training may be currently maintained at all times.
- 2-

Undergraduate Programs. One of the important objectives of the Division of Training is the stimulation of public health instruction for undergraduates in the professions ~Ihich are encompassed in public health. Contacts have been made 1,rith the administrations of the Emory University Schools of I11edicine, Dentistry and Nursing 1~here there has been found a real interest in undertaking such instruction. Hany aspects of these programs are tentative. But the Director of the ,Jivision has been invited to attend the classes in preventive medicine for juniors in medical school
beginning January 9. There has been appointed a committee of faculty to
investigate the possibilities for a course in public health for freshmen beginning in February, in the teaching of 1ihich the Division viill participate. The Department of Nursing Education of the Atlanta Division of the University of Georgia has requested us to staff a course in public health for nurses to be offered in the Spring Quarter 1,rhich will be done if possible. Other plans are less well defined but continue to indicate that reasonable success can be anticipated. Other institutions are to be contacted as rapidly as possible.

Metropolitan Training Center, A study of personnel has been made by the Division indicating that some 40% of personnel qualified for sponsorship of nurse and sanitarian trainees are located in the Fulton and DeKalb Health Departments. This, together 1,rith the educational institutions, CDC and its subdivisions, and state offices of voluntary health associations, is leading us to the conclusion that a field experience center should be located here. This has led to a tentative plan of two primary training centers, one in the metropolitan area and one probably in Columbus. A group of secondary or smaller centers ,,rould be coordinated with these so that the advantasses of both can be attained. Such seems the only plan by 1rhich the need for field experience can be met. This need has been assessed as well as it can be and these figures appear in the stu]y mentioned above,

Other Plans in Development. JVIany other plans are in process of

maturation, all designed to meet some recognized need. Foreign visitors

have been the responsibility of Health Education but whether this continues

or not, the problem of knowing when they are coming and for vJhat purpose

they come is be in,:; discussed 1ith Federal agencies. To adequately meet

this need, a lan~e part of someone 1 s time '~rill always be required. Plans

for periodic presentation of the State Health Department in orientation to

new employees are in process in the attempt to do a better job ''vith less of

the time of the busy division directors. Assistance to other divisions in

the planning and arrangements for training experiences are almost constant

activities.

'

Appreciation

JVIuch of our progress would have been impossible lhrithout the contributions of others. Among those things for 'Ihich we are most r:crateful are: the provision of office space and services by the:; Accounting Division; the time, interest and effort of Nr. Chester, l'ir. Davis and others in the orientation of the Director; the time and thought of all of those who have helped in the planning; and the efficiency and kno1dedge of l1irs. Ruby Bynum.

- 3-

Division of ~ital Statistics

J

Division of Vital Statistics



Annual Report

1952

During the 1952 session of the General Assembly a bill was passed requiring the registration of all marriages and divorces with the Division of Vital Statistics. Our Field Representatives visited and discussed this law with each county ordinary, clerk of the superior court, and various attorneys seeking their cooperation. Forms were drawn, adopted, and tJistributed and the law effectuated early in June. Marriage certificates have been received from every county in the State and divorce certificates from all the counties which had superior court sessions after July first. We feel the successful inaguration of the program was due largely to the excellent work of jur Field Representatives.
There were 186,494 vital events recorded with us during the year 1952 or a total of 312,101 records (Georgia has dual birth registration, also requires an application and license for each marriage). This was the largest number of vital events recorded in one year in the history of the State. These events consists of 98,059 live births (the largest number in the history of the State); 2,026 stillbirths; 30,874 deaths; 27,548 marriages; 2,231 divorces; 24,682 delayed birth certificates, 13,537 of which were filed by court order; and 1,074 adoption decrees.
During 1952 the division issued 32,608 certified copies of birth and death records of which 4,219 were issued free to Veterans. Each year more school systems require a birth record for school admission. Thousands of certificates were issued for this purpose as well as for allotments for dependents of service men. Welfare agencies and other organizations require verification of irth and/or death and thousands of such verifications were made.
New birth certificates for 877 of the 1,074 children adopted during the year were placed on file. New certificates were also filed for 591 children who were legitimated during the year.
Our Field Representatives continue to conduct an educational program in the registration of vital events. This program is with the private physicians, commissioners of health, county commissioners, public health nurses, funeral directors, local registrars, record librarians in hospita+s and institutions, ordinaries, clerks of the superior courts, and midwives. This has been an effective program through which registration is constantly improved.
All certificates received are processed and bound. Each month :;;ta tement s are prerared for county fiscal officers of amounts due local registrars for filing birth, death, and stillbirth certificates. Photostats of births, deaths, and stillbirths are sent each month to the county custodians of vital records. The Crippled Childrens Division is notified of every child born with a congenital


~ivision of Vital Statistics -- Page 2
deformity and the Division of Maternal and Child Health is notified of each birth attended by an unlicensed midwife or when silver nitrate is not used in the baby's eyes. The Bureau of Immigration and Naturalization is notified when the death of a person born on foreign soil is reported. The American Medical Association and the American Dental lSsociation are notified of the death of doctors and dentists. Microfilm copies of all birth, death and stillbirth certificates are sent each month to the National Office of Vital Statistics as well as photostats of all death certificates for nonresidents of Georgia and deaths of infants under one year who were born in other states.
Two new programs were instituted du~ing 1952. The Division of Maternal and Child Health is furnished a photostat copy of each maternal death with a photostat of a birth or stillbirth certificate of this child if the birth or stillbirth was registered. These records are to be studied for the purpose of diminishing the number of Maternal deaths which occur yearly in Georgia.
A card is made for each birth certificate on which the attendant indicates that the child was dead when the medical report was filled in. Cards are also made from death certificates for each infant under one year of age and the birth and death card are matched. In nany instances either the birth or death certificate was not registered and in such cases a letter is written to secure the unregistered certificate. This procedure is a means of bettering registration as well as to increase the value of infant mortality statistics.
In cooperation with the National Office of Vital Statistics a survey of home accident fatalities is being made. Forms furnished by the National Office of Vital Statistics are partially completed from the original death certificate then sent to the area of death for further details pertaining to the accident. National statistics are compiled and are used by many organizations interested in accident prevention.
(2)

HEALTH CONSERVATION SERVICES
Division of Crippled Children Division of Maternal and Child Health Division of Mental Hygiene Division of School Health

J

Division of Crippled Children

ANNUAL REPORT - 1952
CRIPPLED CHILDREN 1 S DJiiiSION

Crippled Children's Division is glad to report a phenomenal growth
during 1952. Increase in requests for service grew from an average of 60 per month to 200 cases per month. Host of these came from
local health organizations, but an appreciable number were from private doctors and agencies handling problems relating to children.
Not all of these were valid, but all had to be processed and if not acceptable to erippled Children's Division, we felt a responsibility
to advise the referring agency where service may be obtained. An
increase in referrals always leads to an increase of activity in all
areas. Therefore, we find that more clinics were held in 1952 than
in any preceeding year, a larger number of individual patients were treated as well as more visits made to our many regular clinics. Statistically this shows up as follows:

Number of clinics

Clinic visits

1951 - 397 1952 - 442

1951 - 9,443 1952- 9,794

Services such as hospitalization, furnishing of appliances, and re-
ferring patients to consultants in various medical fields has also
sho~m an increase. In 1951, 3,706 individual children received one or more of the above services, whereas the number increased to 4,601 in 1952. This does not include the many services given in clinics
such as medical advice, physical therapy, occupational therapy,
speech correction and nutritional guidance which are not counted
statistically, but nevertheless are a tangible and important part
of patient care.

Not only did we reach more chilruen last year, but our service to
the individual child definitely improved. This was largely due to the fact that we had a reasonably adequate budget and were able to add some personnel in vital positions.

A physical therapy consultant and a physical therapist were added to the staff. The consultant has been of great value in assuring us that physical therapy obtained from various points over the State is of good quality. The physical therapist is the first we have had for many years who offered direct service to children. A physical therapy center was opened at Harris l':Iemorial Hospital (Negro), in Atlanta, where the therapist is stationed to give treatment to inpatients as well as to out-patients. The center is meeting a distinct and long felt need.

A regular clinic center was opened in the new clinic building of the Archbold Hemorial Hospital, in Thomasville. Regular weekly clinics vrere held there. This gives us a total of five permanent clinic centers, the others being in Atlanta, Augusta, Columbus and Savannah. Tvm regular field clinics were held at Cordele and Albany each month. Better organization was noted in all of our clinics

Page 2
>vi th progress in the multiple discipline approach which is used insofar as is practical for our patients.
A great joy to us was the development of a cardiac program. A regular clinic was held in Atlanta, specializing in cases needing diagnostic study that cannot be obtained in the several cardiac clinics that are presently being held throughout the State of Georgia. Crippled Children's Division has closely intergrated their program with the local clinics which have been developed through the efforts of the Georgia Heart Association and the State Department of Health's heart program so that there will be no overlapping. Our plan is to supplement the local clinics by offering special studies, surgery and care for acute and convalescent patients -vvith cardiac conditions vrhen no local sources are available.
Due to our rapid growth, plans have been made to add three orthopedic
surgeons early in 1953 to take care of the new cases. An itinerant
clinic will be added at some point in the southeastern part of the State. Field clinics will be organized for the northwest and northeast regions of the State.
A cooperative program was worked out with the State Department of Education whereby consultation by all professional staff is offered local school systems that set up special programs for handicapped children. A staff doctor visits the schools regularly and the physical therapy consultant gives supervision where there is a therapist in the school.
Plans are also being made to Yviden our scope during the coming year and we hope that vre will be able to include patients with many conditions that are not being treated at the present time. Iviuch of this, of course, rests on adequate finances as well as trained staff to handle the cases economically and to the best interest of the patient.

Division of Maternal and Child Health

ANNUAL REPORT - 1952
DIVISION OF ~ffiTERNAL AND CHILD HEALTH
Helen w. Bellhouse, M. D., Director
Introduction
An examination of the existing situation in maternal and child health in Georgia reveals both achievements that have been made and problems still to be solved. The greatest achievement has been the saving of the lives of infants and mothers; however, fetal, neonatal, and maternal deaths still constitute the third or fourth largest group of deaths among the total population. Stillbirths and neonatal deaths alone account for approximately 12% of all deaths at all ages from all causes. It is thought that there has been success in reducing the number of ill days for mothers and children; still, morbidity in these population groups continues to be high. Both morbidity and mortality have their highest rates from preventable causes.
Taking these facts as a basis for future action, tre aim must be to learn more, and to put into practice what is already known, about the medical, nutritional, social, emotional, and economic factors affecting this area. There is a need for more widely available adequate hospitalization for complicated obstetrics, both prenatal and natal. Particular emphasis should be placed on programs for the prevention of maternal disability and deaths from such causes as toxemia, hemorrhage, and infection; securing additional information on how to prevent or defer premature labor and reduce infant deaths from immaturity; learning and doing more about other leading causes of infant and preschool mortality, including accidents, diarrhea, upper respirato~ infections, and whooping cough; and spreading information about the normal pattern of physical, mental and emotional growth and development of children.
Organization and Staff
Organizational changes in 1952 within the Department as a whole directly affected both the program and staff of this Division. Of particular importance was the assignment of certain responsibilities to the newly-created Division of School Health. Major changes in administrative routine and personnel took place. The Director of NIGH was appointed to head Health Conservation Services and was succeeded as Director of MCH by the former pediatric consultant physician. Staff members added during the year were a public health administrator and an obstetric consultant physician. The latter served only a short time before his accidental death.
Other staff members included a maternity nursing consultant, who left in September for post-graduate study, a nutrition consultant, a health educator, the part-time services of the assistant to the Director of Health Conservation Services, and certain medical and nursing personnel working on special projects. Several positions were vacant because of inability to fill them with qualified personnel--namely, pediatric consultant physician, obstetric consultant physician, and pediatric consultant nurse.

- 2-
In spite of the shortage of professional staff, consultant services for local health departments, individuals, and public and private agencies or groups were continued at about the same rate as in previous years.

Maternal Health

As shown in Table I, there were 97,130 livebirths (per 1,000
estimated population) in Georgia in 1952, and a higher birth rate in the nonwhite race. This was an increase of 1,969 livebirths in 1952 over 1951. The total increase in numbers was greater in the white group, with
an actual decrease occurring in the nonwhite group.

LIVEBillTHS, NUMBER AND RATE

(Per 1,000 Estimated Population)

BY RACE, GEORGIA, 1952

-r-
Live births

(Resident Data)

1951

Number

Rate

19

Number

Rate

Total

95,161

26.7

97,130

27.3

V'fuite

59,285

24.1

Non-White

35,876

32.6

~
Source: Georgia Department of Publlc Health

Central Statistical Unit

61,439

24.9

35,691 --- 33.0

Table I

Table II, dealing with the attendant and place of occurrence of live-
births in Georgia, indicates that only 74,211, or 76.'C/o of the deliveries were done in the hospital. 79,325, or 81.7%, were performed by physicians and 17,417, or 17.9%, by midwives.

Of course, social and economic factors affect the maternal health picture in relation to the availability and early utilization of medical personnel and hospital facilities.

LIVEBI11.THS, NUHB=:R AND PERCEJI.iTAGE DISTRIBUTION, BY .KACE,
BY PLACE OF OCC~rlR;Nc~ AND ATTENDANT, GEORGIA, 19)2
(Resident Data)

Number Total White . Nonwhite

%Distribution
Total Vfuite I Nonwhite

Place of occurrence

Total

97,130 61,439

Hospital

74,211 58,518

Other

22,919 2,921

35,691 15,693 19,998

lCO.O 100.0 100.0 76.4 9).2 44.0 23.6 4.8 56.0

Attendant

Total

97,130 61,439 35,691

Physician

79,325 60,490 18,835

Hidwife '

17,417 899 16,518

Other

388

50

338

Source: Georgla Department o-f='P-=ub--l.l-c--:1~qealth

Central Statistical Unit

100.0 81.7 17.9
0.4

100.0 98.5 1.5 0.1

100.0 52.8
46.3
- -0.9- -

Table II

- 3-
Maternal mortality figures for 19.52 show the seriousness of the public
health problem still existing in maternal health in Georgia, although there
was a marked reduction in maternal deaths in 19.52 over 19.51. Table III shows a total of 128 maternal deaths with a death rate of 13.2 per 10,000 livebirths, as compared with 143 maternal deaths and a death rate of 1.5.0 per 10,000 livebirths in 19.51.

MATERNAL DEATHS, NillilBER AND rl.ATE
(Per 10,000 Livebirths) BY RACE, GEOrtGIA, 19.52

(Resident Data)

Deaths

Number , Rate

Number

~---~------+-~~.

19~1
I

Total

128

13.2

143 I I

I,

White
Non-White ____J

36

.5 .9

46 I 7.8

92

=2_.5_,...,.8.,.--_ _.____97___Ij 27_.o_ _

Source: Georgia Department of Public HeaLth

Central Statistical Unit

Table III

It should be noted that the increasingly lowered mortality rates do not necessarily indicate reduction of morbidity, although they do imply increased efficacy in meeting emergencies.

MATERNAL DEATHS, NilllffiER AND PERCENTAGE DISTRIBUTION,
BY SPECIFIE1 CAUSE AND RACE, GEORGIA, 19.52
(Resident Data)

---Cause of Death (International Code Number, Sixth Revision)
Total all causes

Number Total V'Jhi te Non-
INhite
128 36 92

%o Distr1bution

Total White Non-

--r-1oo.o

Too.o

V\fhi t e
1oo.o

Toxemias of Pregnancy (642)

36 11

Hemorrhage of childbirth and puer

n~ perium (670-672)

' 24

Ectopic pregnancy (645)

12

Other accidents and specified co

10 1

ditions of childbirth (673-678,

687)

I
I

12

4

Abortion, all causes (650-652)

11

1

Puerperal toxemias (68.5-686)
other complications arising dur-
ir.~ pregnancy (640,641,646-649)

\
I
!

8 7

4 2

Infection during childbirth and l

puerperium (680-684)

I7

2

other and unspecified conditions

of child birth and the puerperium:

(660,688)

i6

1

Hemorrhage of pregnancy (643,644) i 5 ; 0

~Source: Georgia Department of Public Health

Central Statistical Unit

2.5

28.1 30.6 27.2

14

18.8 27.8 1.5.2

11

9.4 2.8 12.0

8

9.4 11.1 8.7

10

8.6 2.8 10.9

4

6.2 ll.l 4.3

.5

.5 .5 .5.6 .5.4

5

5.5 .5.6 5.4

~~~I 5
.5

_ j _ _43..79,1'

.5.4 .5.4

Table IV

- 4-

Both Table III and Table IV, which lists maternal deaths by number
and rate and by cause and race, reflect a racial difference. For example,
the death rate for white wo;nen was 5.9 per 10,000 livebirths w:dle it was 25.8 for non-white women.

The Committee on Maternal vielfare ef the Medical Association of Georgia, of which the HCH Director is permanent secretary, met several times during the year to continue review and analysis of cnuses of maternal death and investigation of conditions affecting maternal and infant care
in Georgia, and to make recommendations concerning improvements thereof.
The Chairman and Secretary prepared and presented a paper on the subject for the Annual l'/Ieeting of the Medical Association of Georgia. Reflecting the broad approach of this committee was their study of maternal deaths
and neonatal deaths and stillbirths for Georgia in 1951. A definite program to further carry out the aims of this committee is planned for 1953.

Infant Health

The reported number of infant deaths (deaths under l year), as shown
in Table V, declined from 3,256 in 1951 to 3,158 in 1952. Neonatal deaths (deaths under 28 days) accounted for about two-thirds of the total numter.
The death rate continues much higher in the nonwhite than in the white
race.

INFANT DEATHS, I~mffiER AND RATE
(Per 1,00 Livebirths)

BY RACE, GEORGIA, 1951 ANTI 1952

(Resident Data)

~-------1--Number

1951
Rate

Total

3,256

34~2

White

1,548

26.1

1952
Number J Rate
I,
3,158 ! 32.5

1,567

I
I

25.5

Non-White

1,708

47.6 1,591

44.6

---------

Source: Georgia Department of Public Health Central Statistical Unit

Table V

- :J -

The rate of immature births remained high and, as seen in Table VI, deaths from immaturity totaled over 20% of all infant deaths in the state. Other leading causes of infant death are ','influenza and pneumonia of the newborn, 11 postnatal asphyxia and atelectasis, congenital malformations, and birth injuries. Again there is a different racial pattern, which should serve as a guide in program planning.

INFANT DEATHS, NmmER AND PERCENTAGE DIST3IBUTION BY 3ACE,

BY SPECIFIED CAUSE, GEORGIA, 19)2

(Resident Data)

Cause of Death Tlnternationa]

Number

--%0fTOtal

!

List Number--Sixth Revision) Tete~: rJhite I Nonwhite Total I White :Jonvrhite

TOTAL, ALL CAUSES

3158 1,567

l. Immaturity unqualified

1 64s

323

(774-776)

2. Influenza and pneumonia

including pneumonia of

newborn (480-493,490-493,

763)

458

132

Pneumonia of newborn (763) 108

44

3. Postnatal asphyxia and

atelectasis (762)

372

258

4. Congenital malformations

(750-759)

314

245

). Birth injuries (760-761)

255

173

6. Other and ill-defined

diseases peculiar to early

infancy (766-769,771,773) 211

116

7. Gastro-enteritis, colitis

and diarrhea of newborn

(571,76L)

2o6

49

Diarrhea of newborn (764)

33

10

8. Ill-defined and unknown

causes (780-793,795)

160

45

9. Accidents exclusive of

motor vehicle accidents

(E800-E802,E840,E962)

138

44

Accidental mechanical suf-

focation in bed (E924)

69

18

Inhalation and ingestion of

food causinG obstruction an

suffocation (E92l)

27

11

Accidental drovming and sub

mersion (E929)

3

l

Accidental burns (E916-E917) 8

3

10. All other parasitic and

infective diseases (030-044,

049-0)),057-138)

66

34

ll. Nutritional maladjustment

(772)

58

17

Haemolytic disease of new-

born (770)

)0

35

All other causes

225

96

Source: Georgia Department of Public Health

Central Statistical Unit

Table VI

1,591 322
326 64
114 69 82
95
1)7 23 ll)
94
)l
16
s2
32 41 15 129

100.0 100.0 100.0 20.4 20.6 20.2

11.8
9.9 8.1

8.4 2.8
16.5
1).6 ll.O

20.) 4.0
7.2
4.3 ).2

6.0

6.5 3.1 9.9 1.0 0.6 1.4
).1 2.9 7.2

4.4 2.8 ).9
2.2 l.l 3.2

0.9 0.7 1.0

0.1

0.1

0.3 0.2 0.3

2.1 2.2 2.0
1.8 l.l 2.6
1.6 2.2 0.9 7.1 6.1 8.1

-6-

It is clear that much remains to be done to prevent needless loss of infant lives.

Causes of death in the preschool age group (1 through 5 years), listed in Table VII, show that there is need for the increased specific progran: efforts now ceing exerted. It is anticipated that even more program
activities, particularly in the area of the prevention of home accidents, will ce conducted in the future.

DEATHS IN 1-5 YEAR AGE GROUP, BY SPECIFIED CAUSE AND RACE, GEORGIA, 1952 (Resident Data)

Cause of Death (International Code Number, Sixth Revision)
Total, all causes

Number
-- Ra.ruc __ Total White 662 325

NonWhite
337

%Distribution ~
'NonTotal White White
100.0. 100.0 100.0

Accidents excluding motor

vehicle (E800-E802,E840-E962) 1

(a) Accidental burns (E916-

E917)

(b) Accidental drowning &

submersion (E929)

(c) Accidental suffocation '

in bed (E924)

(d) Inhalation and ingestion

of food causing obstruction

and suffocation (E921)

Pneumonia and influenza (480-

483,490-493)

2.

Motor vehicle accidents (E810-

E835)

3

Gastritis, duodenitis, enter-

itis, and colitis (543,571,

572)

4

Congenital malformations (750-

759)

4

Malignant neoplasms including

neoplasms of lymphatic and

haemotopoietic tissues (140-

205)

5

Ill-defined and unknown (780-

793,795)

6

Meningococcal infections (057) 7

Nephritis and nephrosis (590-

594)

8

Nonrreningococcal meningitis

(340)

9

Diphtheria (055)

9

Heart Diseases (410-443)

10

~J.:easles (085)

11

Poliomyelitis (080)

12

Anaemias (290-293)

112

All other causes

107

I I

45

43

14

8

5

4

2

3

1

101 29

56 41

41 17 41 22

33

26

31 11 19 13

i 18

7

I

i 14

8

14 11

10

8

9

5

8

4

8

5

152 73

Source: Georg1a Department of Publ1c Health Central Statistical Unit
Table VII

62 16.2 13.8 18.4 29 6.5 4.3 8.6
3 1.2 1.5 0.9 2 0.6 0.6 0.6

2

0.5 0.3 o.6

72 15.3 8.9 21.4

15

8.5 12.6 4.5

24

6.2 5.2 7.1

19

6.2 6,8 5.6

7 5.0 8.0 2.1

20 4.7 3.4 5.9 6 2.9 4.0 1.8

11

2.7 2.2 3.3

6 2.1 2.5 1.8

3

2.1 3 ..4 0.9

2

1.5 2.5 o.6

4 1.4 1.5 1.2

4 1.2 1.2 1.2 3 I 1.2 1.5 0.9

79 23.0 22.5 23.4

-7-

Clinic Evaluation and Participation
Again in 19)2, a clinic evaluation study of attendance for each six
month period was made. These are for use by state, regional, and local personnel in appraising the activity of the clinics. This study covered all three types of clinics--maternal, well child, and combined.
State participation in the local maternal and child health clinic pro-
gram was continued in 19)2. Activities included participation in tre salaries of local personnel and in payment of honoraria for 229 part-time clinicians and 40 clinic nurses in the lOS counties where clinics were
held (Table VIII), provision of specialized consultant services, and location of certain standard equipment and supplies in local areas.
MATERNAL AND CHILD HEALTH CENTEHS
REPOnTING TO MCH DIVISION, 19)2

I Maternal!I Infant I Combined Maternal Infant

-
Combined

Centers Centers Centers Sessions Sessions Sessions

Counties Sponsoring Medical MCH Centers

105

59

96

96 1952 full 2985 full 2120 ful

sessions sessions sessions

340 one- 163 one- 340 one-

half

half

half

sessions sessions sessions

Counties Sponsoring Nutrition Services at MCH Centers
2

j_

i
Source: Georgia Department of Public Health Division of Maternal and Child Health


i
49
I
-'----~

Table VIII

1\fiaternal Clinics and Well Child Conferences

Maternal Clinics--Activities in maternal clinics (Table IX) showed a
slight decrease in prenatal admissions from 20,250 in 1951 to 19,378 in 1952 (4.3%), with a corresponding decrease in the number of centers from 62 in 1951 to 59 in 19)2 (4.8%). Although the quantity of prenatal care
given has lessened, it is hoped that emphasis on earlier care and quality
of care is producing results. Late registration is still a problem but
there is a continuing trend, however slow, toward securing earlier prenatal
care. Admissions with a gestation period of under 27 weeks increased from 74.4% in 1951 to 76.8% in 1952.

-8-
Only 23.3% of admissions in 1952 occurred after. the seventh month of
pregnancy as compared with 25.6% in 1951. Clinic visits for each prenatal admission and visits per postnatal admission remained about the same, with an average of 3.6 in 1952 as compared with 3.5 in 1951. The number of postpartal admissions decreased slightly. An indication that here is an area of activity requiring increased emphasis is the fact that only ~6.L% of the prenatals were admitted for postpartal care.
MATERNAL HEALTH ACTIVITY (State-Supported Centers in Georgia)

Type

1951

Prenatal Admissions -Admiss1 ons, Total
White Non-11\lhite % White % Non-White

20,250
1,707 18,543
8.4 91.6

Period Gestation, Total Under 16 weeks
16-27 weeks 28-36 weeks
Over 36 weeks
% mder 16 weeks
% 16-27 weeks
%28-36 weeks
% over 36 weeks

20,250 4,808
10,256
4,494 692 23.7
50.7 22.2
3.4

Prenatal Syphilis Reports, Total White Non-White

13,396 1,224 12,072

% of Admission, Total
Vfuite Non-l!Vhite

66.2
71.7 65.1

Number Positive, Total

727

1Vhite

23

Non-V~hite

704

%Positive, Total

5.4

1~hite

1.9

Non-White

5.8

Prenatal Activities Visits, Total Vfuite Non-VJhite

72,522
7,272 65,258 i

Table IX

(Continued)

i 1952
I
19,378
I
I 1,484 17,894 7-7 92.3
I 19,378 4,718
10,145 4,040
475 24.4 52.4 20.9 2.5
12,772 976
: 11,796
65.9 65.1 65.9
573 9
564
4.5 .9
4.8
69,584 6,215 63,369

Per Cent Increase or Decrease

- 4.0

-13.0

-- 3.0

;.

.7
7

- 4.0 - 2.0 - 1.0 -10.0
;-.3l..O7
;. 1. 7
-- 1.3 .9

- 5.0 -20.0
- 2.0

- .3

;-.

6.6 .8

-21.0 -61.0 -20.0
- .9
- leO - 1.0

- 4.0 -15.0
- 3.0

- 9I\f.IATERNAL HEJ LTH ACTIVITY

(State-Supported Centers in Georgia)

Type

1951

1952

Visit/Admission Ratio white Non-VJhite
Transferred, Total
Postnatal Activities
Admissions, Total White Non-White
Visits, Total Vvhite Non-White
%of Prenatals, Total
VJhite Non-White

3.5 4.3 3.5
441
5,427
730 4,697
6,127 798
5,329
26.8 42.8 25.3

3.6 4.2 3.6
504
c,~ 108 504
4,604
5,801 529
5,272
26.4 34.0 25.7

I
Per Cent Increase ., or Decrease
f. .1 1- .1 1- .1
/-14.0
- 6.0 -31.0 - 2.0
- 5.0 -34.0 - 1.0
.4 - 8.8
1- .4

Source: Georgia Department of Public Health Division of Maternal and Child Health

Table IX

li{ell Child Conferences

childPcroognrfaemrenemcepsharsaitsheinr

1952
than

was on improving the quality of the increasing the number of centers in

well Oferation.

There were fewer centers in oper2tion this year, but the number of
admissions remained about the same (Table X). Specifically, the number of
centers declined from 108 in 1951 to 96 in 1952, or 11.1%, but admissions showed a decrease of only .2% from 37,672 in 1951 to 32,591 in 1952. A continued increase was shown in the preschool group attendance, with 11; more admissions in 1952 than in 1951. This is real progress toward the
objective of continuous supervision of the child between infancy and the
time of entry into school.

Combined Centers

Combined centers providing both maternal and well child care increased
slightly in number from 95 in 1951 to 96 in 1952.

- 10-

CHilD HEALTH ACTIVITY

(State-Supported Centers in Georgia)

Type

1951

1952

and Preschool

--Admissions, Total

36,672

White

9,425

Non-Vfui te

23,247

Age Groups, Total

32,672

Under 4 months

12,849

4-12 months

7,019

1-5 years

12,804

%under 4 months

39.3

%4-12 months

21.5

%1-5 years

39.2

32,591 11,124 21,467 32,591 12,002
6,315 14,274
36.8 19.4 43.8

Visits and Activities

- Visits, Total

91,768

95,103.

Vfui t e

27,070

30,427

Non-White

64,698

64,676

Visit/Admission Ratio

2.8

2.9

Vfuite

2.9

2.7

Non-White

2.8

3.0

Referred Cases

5,130

3,158

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

Source: Georgia Department of Public Health

Division of Maternal and Child Health

Per Cent Increase or Decrease
- .2
,Ll8.o
-- 8.o .2 - 7.o -10.0 ,Ln ,o - 2.5 - 2.1
,L 4.6
,L 4.0
,Ll2 .o 0
,L .1
- .2
,L .2
-38.0

Table X

Immunizations

MCH is working closely with other interested and responsible divisions-among them, Nursing, Local Health Organizations, and Epidemiology--to improve the immunization program, particularly in the infant and preschool group. Special emphasis is being placed on completion of combined diphtheria, whooping cough and tetanus (DPT) immunizations under one year, with routine 11 booster11 injections at 2 and 5 years of age. The decreasing incidence of typhoid cases and, more important, of typhoid carriers, is allowing mass immunization against this disease to assume much lower priority in the total health program activity. Vfith this in mind, it is hoped that future local health department emphasis will be on making this type of immunization available to the individual only upon request. In communities where typhoid
immunizations seems mandatory, because of either determined high incidence of cases and carriers, or by public demand, public health personnel will be urged to include it as a part of the routine care for the preschool age group. It is anticipated that this will give added impetus to the desirable goal of continuous supervision of the preschool child, and will minimize time spent in mass immunization in the older age group.

- ll -

Table XI shows that there was an increase of 29.4% in DPT immunizations given in 1952 (86,457) over 1951 (66,802). Similarly, there was an encourag-
ing decrease in the number of single immunizations given against these
diseases. However, the number of DPT immunizations in each age group shows
a delay past the goal of complete immunization under one year. Only 19,411, or 22.4%, were completed under one year. 67,046, or 77.6%, were completed in tte age periods of over one year. Also, only 7.6% of the single immunizations for diphtheria and 48.2% of those for whooping cough under one year
of age. De-emphasis on typhoid immunizations had not begun to produce
results before the end of 1952.

IMMUNIZATIONS (Persons Immunized)

(Completed By Health Department Personnel on Georgia)

Typs

' 1951

1952

-'
Per Cent Increase

or Decrease

l. Triple Vaccine - D.P.T.

a. under l year b. over l year c. Total
2. Diphtheria

17,286 49,516 66,802

19,411 67,046
86,457

fl2.3 ,L35.4 .f.29.4

a. under 1 year
b. over l year c. Total

1,186 13,994 1.5,180

978 12,143 13,121

-17.5 -13.2 -13.6

3. Whooping Cough (Pertuss s)

~-. under l year b. over l year c. Total

5,719 6,234 11,953

5,572 5,998 11,570

- 2.6 - 5.4 - 3.2

4. Smallpox

a. Total

85,776

93,669

,L 9.2

5. Typhoid
a. Total

442,167 ~,631

I
I

.;. 6.9

Source: Georgia Department of Public Health LHO 7 - Monthly Activity Report of County Health Departrr:ents

Table XI

Training Programs

Two staff members, the director and public health administrator, returned from one year's postgraduate study at the University of North Carolina School of Public Health during tte year. The maternity consultant

- 12 -
nurse left in September for postgraduate wcrk, leading to an MPH, at the University of Pittsburgh.
As in the past, scholarships were offered to commissioners of health and maternal and child health clinicians at the Southern Pediatric and
Obstetric Seminar at Saluda, N. c., and the Tri-state Obstetric Seminar at
Daytona Beach, Florida. This year eight (8) physicians attended the Seminar at Saluda and thirty-nine (39) attended the Tri-State Seminar. Additionally, the division cooperated with other sponsoring groups in publicizing these Seminars to all interested physicians.
Health Education
Preparation and distribution of health educational materials by the Division were continued. New materials developed or revisions during 1952 included: "A Good Start At Home Helps Johnnie At Schoolll, a pamphlet describing helpful home relationships for children; 11 Prenatal Nutriti onfll, a graphic booklet for nurses 1 , nutritionists' and physicians' use, with expectant mothers; and materials and exhibits for the Obstetric Seminars which were held during the summer.
In addition to rendering consultation service, the health eaucator prepared maternal and child health and mental hygiene exhibits and educational materials for use during Mental Health Week, for the State Health Officers 1 Meeting on Mental Hygiene, for the Georgia Parent Teachers' Association Council Meeting, for use by the Governor's Committee, on Children and Youth and at the American Public Health Association and Southern Branch Ileetings.
An exhibit depiciting maternal and child health program elements in Georgia was prepared for orientation purposes. Also, a flyer was developed for the showing of the film "All My Babies" at the State and Territorial
Health Officer Is lifieeting in vvashington, D. c.
Editorial assistance was given to (l) the director in the final preparation of the monograph '''Maternal and Fetal Health11 , a review of Georgia's progress over a 30 year period, (2) the nutrition consultant in preparation of a paper on nutrition program in school for the State P.T.A. magazine, (3) the MCH director in preparation of a paper on Accidents Prevention for the State P.T.A. magazine. There were other additional editorial activities.
Areas of Special Activity
Nurse-Midwife Programs--Three types of nurse-midwife programs in Lamar, Walton, and Thomas Counties continue in operation. These programs are financed and administered by local areas, and receive support and technical supervision from this Division. Nurse-midwives carry on programs of prenatal supervision and hospital delivery service with added assistance to private physicians in Walton County; prenatal supervision ana home delivery service in Thomas County; and prenatal supervision and maternity shelter delivery service in Lamar County. A total of 375 babies were delivered by the nurse-midwives in the three counties in 1952; also, assistance was given to physicians in the delivery of 347 babies in Walton County.

13 -
Grady Hospital Project For Abnormal Obstetrics
The objectives of this project are to demonstrate reducticD of maternal and infant disasters by intensive medical care and supervision tv this specially selected group; to promote a better joint hospital-health department maternity program; and to provide a teaching facility for obstetrical students and staff. Participation by the State is now in its second year, A review of the annual report of the project for 1951-52 reveals, among other items, a marked reduction in both premature and full-term stillbirths, and in the incidence of premature births.
Training For Care of Immature Infants
Again in 1952 there was participation in the postgraduate course for
the care of immature infants, conducted at Crawford w. Long Hospital. A
total of seven (7) public health nurses took this training, which is designed to promote reduction of unnecessgry premature births and a higher standard of service in the care of these infants, also to permit those taking the course to share their knowledge with local hospital and health department staffs and in community programs. It is anticipated that during 1953 follow-up questionnaires will be sent to all nurses who graduates within the past five years to partially determine some of the outcomes. Supervised experience in premature care for student nurses, the medical house staff, and visiting physicians was again supported at Grady Hospital.
During the year, weekly and monthly meetings developed at several hospitals where obstetric and pediatric house staffs and pediatric and obstetric staffs met together with state and local health department representatives to review maternal and infant mortality and morbidity problems and their relations to hospital and health department activities. These have proved most interesting and profitable to all public heElth personnel concerned.
Incubators
Reflecting concern over the high rate of premature labor and deaths from immaturity is the program of loan of incubators to local hospitals and clinics, and to health departments for use by physicians and in homes. Over a 15-year period, about 700 incubators have been located throughout the state, with at least one in each county to expedite its use in case of emergency. A certain number of both wooden and metal incubators and Isolettes are located in two hospitals with university programs. Program activity by the Division how is largely that of assistance to the regions in maintenance and repair of the incubators already located in local areas.
Mother and Baby Care Classes
A joint program with the American Red Cross and l1ICH sponsorship was participated in by departmental nursing personnel again in 1952. This was
the teaching of a one week 1s instruct om course in Unit II Mother and
Baby Care in Atlanta, with 17 staff nurses of the Fulton and DeKalb County
Health Departments taking the course. This year 399 certificates were
issued in the 28 classes taught by public health nurses who had previously taken the instructors' course. In all, 1,415 certificates have

- 14 -

been issued to parents in the 38 counties where a total of 117 classes
were held in the past four years. There are a number of nurses yst to teach their first supervised class. This program provides the challenge
of a new type activity on the part of local nurses.

Local Hidwives

There were 1249 midwife certificates issued by local health departments in 1952, compared to 1322 in 1951 (Table XII). These midwives delivered 17,417 of the 97,130 deliveries in Georgia in 1952, or 17.9% of the total.
Deliveries per midwife varied from none (0) by some who were certified to
forty-five (45) for others. Five 1tidwife Supervision Institutes of three
day's duration were held for regional consultants and for county public
health nurses during the year.

MIDWIFE CERTIFICATION

IN GEORDIA

I
Year

Midwives Certified
Total w. N. W.

Midwives Refused Certificates

Ages of l{sw Midwives
Dead Ur.der .50- Over Age Badges 50 yrs. 65 65 not sent
given to retired
midwives

J5'51 1322 77 1245

104

25 15 8 0 0

49

1952 1249 79 i 1170

68

28 26 3 4 2

48

Source: Georgia Department of Public Health Division of Maternal and Child Health
Table XII
A total of 219 local nurses, representing 130 counties, attended these
institutes. Such tools as the midwife instruction training film, 11All My Babies," together with the decreasing number of midwives to be supervised by local medical and nursing personnel, should continue to raise the quality of midwife practice.

l "'-
NUTRITION PROGRAM
Personnel
In March Miss Jane Northington transferred from the Central to the Northeastern Region. From that time until August Miss Martha McKay covered the entire Central Region. When Miss Rebecca Broach returned from school in August, she resumed her work in the western part of the Central Region, and Miss McKay spent full time in the eastern section. July 1 Mrs. Ruth Morrison was employed as a nutritionist by Fulton County. Other positions remained filled and unchanged.
Staff Education
This phase of the work is continued in very much the same ways as before, i.e., group meetings, individual consultation, work at clinics and home visits with local workers. Expressed interest, requests for service and increased activity in nutrition work make it evident that the teaching is being effective.
Nutrition Education Work in Colleges and Schools
Help has been given in nutrition education at the University of Georgia) Athens; the Atlanta Branch of the University of Georgia; State College for Women; Mercer University; West Georgia College; Emory; Norman Junior College; Albany State College, and others. A full-time staff member was supplied for the Nutrition Education workshop at the University for four weeks. A large number of elementary and secondary schools all over the state have been helped with their nutrition education work.
Work With Patients
This is continued as before, as a method of staff education.
Work with Other Agencies and Organizations
There has been no major change in this except in the work of the Dietary Consultant. She has done more work than before with the Welfare Department, Civilian Defense, industrial groups and the Georgia and American Dietetic Associations.
Crippled Children's Services
There was a greater percent increase in instruction to crippled children than to any other group. The number of consultations rose from 1,216 in 1950 to 3,789 in 1952. An increase of 211%. Part of the increase undoubtedly reflects the change made by the transfer of this service to the Health Department and consultations given by public health nurses. Part of it is due to the larger number of clinics served by nutritionists and by greater understanding of the importance of good nutrition for the crippled child on the part of all concerned.

-16-

S~ecial Study on Prenatals

Giving vitamins, calcium and other minerals to the five counties concerned in this study has been continued. So far, it has not been possible to show any betterment in the hemoglobin level of the patients receiving the supplement. However, doctors and nurses working with these patients say they know they feel better and are in better condition. They say also that fewer small, weak babies are being born. If we can continue our study long enough it may be that our vital statistics will show us something.

Spencer Hemoglobinometers

It was found that many counties were not doing routine hemoglobin determinations on prenatals or on children where this was indicated. There were two main reasons for this: (l) there was a feeling that the instruments were inaccurate and (2) many of the nurses had not received adequate instruction in their use. During the year most of the instruments were checked and over a third were returned to the factory for correction. Instructions were given on their proper use at regional meetings and were mimeographed and mailed to the counties. This evidently increased the number of hemoglobin determinations made. In 1951 there were 21,375 hemolysis applicators ordered, in 1952 there were 27,250, an increase of over 27%.

Arrangements were finally completed to have the hemolysis applicators made in our laboratory. This reduces the cost from $2.00 per 100 to less than 10 cents per 100. Based on the number used in 1952, the saving is over $500.00 per year.

Hookworm, Anemia, and Diet

At the request of one county commissioner of health,help was given in getting dietary records on school children and an effort was made to correlate these scores with the hemoglobin levels and hookworm burden. There seems to be very little, if any, correlation. This could be due possibly to the inaccuracy of the dietary records. There was a slight increase in the hemoglobin averages as the diets scored higher except in the highest group. The number in this group was too small for the figures to be significant, and the others may not be statistically significant. The figures are:

Group

Diet score

Number children

Hb (mean)

I

Lowest

104

1I

Second lowest

213

III

Second highest

157

IV

Highest (best)

18

12.1 gm.
12.3 " 12.5 " 11.9 "

The records obtained are valuable for their information on food habits of school children, and could be very valuable as the basis of an educational program.

- l 7-

Some of the findings are:

Number completed records

I! with poor diets

I!

" fair "

I!

" good I!

I! having no green or yellow

vegetable

I! having adequate amount of green

or yellow vegetable

I! having no vitamin C rich food

I! having adequate vitamin C rich food

I! having no milk

I! having some milk, but less than

3 servings a day

I! having 3 or more servings of

milk a day

I! having no lean meat

" having adequate lean meat
I! having no eggs

" having a de qua te amount of eggs

" recording no table fat

I! recording adequate table fat

604

457

76%

93

15%

54

9%

266

44%

89

15%

169

28%

172

28%

47

8%

497

82%

60

10%

17

3%

500

86%

85

14%

265

44%

143

24%

3

0.5%

Special Diets

Much more attention is now being given to the problem of special diets. In At~anta the class in weight control was continued. Three television programs were devoted to this subject. In one region an exhibit was prepared which was used at two fairs, one college and in one store window. One radio talk on obesity was given, and talks on this problem were arranged for the joint meeting of the Georgia Nutrition Council, the Georgia Dietetic Association, and the Georgia Home Economics Association.

The Dietary Consultant worked at the Grady Hospital diabetic clinic two days a week for about four months. There was an instructional program for medical student groups. She gave talks on diabetic diets to the nurses in two regions, and the staff nurses in two of the larger counties. She and the Regional Nutrition Consultant presented a program on cardiac diets to the nurses in Fulton County, and assisted with a community diabetic program in Carrollton. The nutrition consultant in the state office was in charge of the nutrition part of the program at a Chronic Disease Seminar conducted by the U.S.Public Health Service for six states.

Television

In May regular bi-weekly telecasts were started. For several weeks the State Nutrition Consultant did all of the shows, but later it was decided to rotate the programs, with the Regional Consultants, the Dietary Consultant and the Fulton County nutritionist taking turns. Our time has usually been for five to ten minutes on a regular commercial program. We know from the

response we have received that a good many people are reached, but possibly the most valuable thing has been the experience we are getting, which will help when we do more educational TV work.
Statistics From Coded Reports
Each year shows a gratifying increase in the number of people recelvlng nutrition instruction. Much of this instruction is done by local personnel, which is also good. The reports indicate an increased awareness of the need for better nutrition and an increased effort in meeting this need. There has been a decrease in instruction to patients admitted to morbidity service, but there has also been a decrease in the number of patients admitted to this service.
The decrease in food demonstrations has been due in part to the change in payment procedure and to the difficulty in securing qualified personnel to give the demonstrations. This change is regrettable, particularly when it is recognized that the group which would be reached is the group more susceptible to teaching by seeing and tasting than by verbal instruction.

Instruction in nutrition to TB patients, contacts and convalescents
Instruction in nutrition to prenatals
Instruction in nutrition for infants
Instruction in nutrition for preschool children
Instruction in nutrition for school children
Instruction in nutrition to patients admitted for morbidity service
Instruction in nutrition for crippled children

Statistics Percent
1950 - 1951 - Change
11,299 - 13,097 f-16% 65,691 - 72,085 f'lO% 67' 559 - 80' 139 l--19% 40,376 - 51,423 f-27%
6,307 - 8,419 ~33%
23' 015 - 9' 101 --60% 1, 216 1, 890 -1-55%

Percent 1952 - Change from 1950
72' 954 -f 11%
+ 66' 074 64%
8,884 -f 41% 11,471 -50%
+ 3, 789 211%

Food demonstrations for prenatals
Attendance
Food demonstrations on infant and preschool nutrition
Attendance

q_

Statistics (Continued)

Percent
1950 - 1951 - Change

Percent
1952 - Change from 1950

354- 308 -13% 5,277- 4,199 --20%

178 2,518

-50% .. -52%

73 1,284

44 --40% 804 --37%

28 - 62% 313 ..75%

Division of Mental Hygiene

ANNUAL RE P 0 R T
Division of ~"ental Hygiene
GuyV. Rice, l':. D., Director
1 952
During 1952 the Mental Hygiene Division continued to
focus its efforts towards the integration of good mental health practices and concepts into the generalized Public Health program. The Division continues to feel that the best mental health program is one carried on by local corr~unities. To help facilitate this integration, the second annual Health Officers'
conference was held in June, 1952. It is believed that these
conferences are laying the foundation for the eventual meeting of the minds that is so necessary between clinically oriented mental hygiene personnel and the Health Officers who deal primarily in preventive practices.
Perhaps the greatest single accomplishment of the year was the development of the ]1~ental Hygiene plan for the fiscal
years 1953-54. This plan not only sets up the general policies
of the Division for this period, but it also indicates the results of the continual evaluation that the Division has been carrying on since its origin three years ago.
The Mental Hygiene Consultant Nurse has worked with the Tuberculosis Consultant Nurse to help solve, at the request of local Public Health nurses, some of the involved problems that are created when a patient leaves Battey against medical advice. Attempts have been made to improve services to patients through education in regard to the disease and by better understanding of factors involved in individual situations.
The Mental Hygiene Consultant Nurse, in cooperation with the Milledgeville State Hospital, has initiated a pilot project to extend Public Health nursing services to families of patients at the hospital. Six counties have been selected for the project and details of referral have been worked out with the hospital. This is an area of Public Health nursing that has been neglected in the past but seems to offer many opportunities for service. The program is developing slowly, but it is hoped that a worthwhile response to a felt need can be demonstrated.
The Chief Clinical Psychologist has continued to serve as a consultant to both the Depa~tments of Health and Education in t0sting and personality development. During the latter part of the year a new program was instituted, in cooperation with the Division of I;aternal and Child Health, in which the Chief Clinical Psychologist works with local Public Health nurses, commissioners of health, and clinicians in both well-baby and prenatal clinics and nursery schools. Special attention is given to demonstration of the

- 2-

methods and techniques of anticipating, preventing, and dealing with emotional situations. Pertinent information is gathered from the mothers who attend the clinics and a discussion is held by the nurse, physician, and psychologist to determine what course of action, if any, is indicated.

The project begun in 1951 in which a psychiatric social
worker was placed, by a grant from the Mental Hygiene Division, with the court in Atlanta to work with women offenders has been continued and enlarged, This worker now works with both male and female offenders at the request of the court of the Police Department.

.A. special grant for a psychologist has been provided to

the School of Education at the Uhiversi ty of Georgia who is helping

':'

to integrate mental health principles into classes required for

prospective teachers on the Athens campus, and through in-service

education over the state. Special emphasis is placed on the

in-service education of visiting teachers to help them better under-

stand the behavior problems in the schools.

The staff of the Division decreased by one member during the year--the psychiatric social worker. It now includes a chief clinical psychologist, mental health consultant nurse, consultant psychiatrist (part-time), regional mental health consultant, and an acting director.

The shortage of adequately trained psychiatric social workers, psychologists, and other specialists needed to carry out the mental hygiene program continues to be a problem. The Division sponsored the training of four psychiatric social workers (two of whom vrere visiting teachers, who will return to their previous positions) and three clinical psychologists. The Division also sent six people to a special three-weeks course offered at Yale University for studying the problem of alcoholism. These people represented the Emory University School of Nursing, Hilledgeville State Hospital, the Georgia Commission on Alcoholism, Georgia Highway Department, State Board of Pardons and Paroles, and the Department of Public Safety.

The entire staff of the li.'ental Hygiene Division has spent a great deal of time in in-service education programs for staff nurses, generalized and specialized consultants, and other Public Health workers, For example, a two-day mental hygiene ins ti tute was held in the State Health Department for all specialized consultant nurses, and a three-day institute for staff nurses in the old East Central Region was held at Swainsboro.

- 3-
Local clinics continued to serve in Macon, Savannah, and Atlanta. A new clinic was organized at Columbus, and a psychiatric social worker was added to the staff of the DeKalb County Health Department. The Psychiatric social worker assigned to the Spalding-Pike-Lamar Health Department has continued her work with the school systems to find ways and means of utilizing mental health knowledge in the schools and community. It is hoped that new clinics in Rome and Albany can be implemented within the near future.
The Division has continued to make available for use by any interested person(s) a number of mental health pamphlets and films. over 22,000 parents of first-born children received the "Pierre the Pelican" series of twelve monthly messages. These bulletins deal with many of the problems that every young parent faces. "The Psychiatric Bulletin" is distributed to the general practitioners in Georgia to emphasize the mental health implications of physical illness.
GVR:FHJII!: jm
4/8/53

Division of School Health

j

ANNUAL REPORT
Division of School Health Guy V. Rice, M. D., Director
l 952
The School Health Division was officially recognized in the
spring of 1952 when the reorganization of the Health Department
became effective. School health work has long constituted a major part of local public health activity but never before has had division status.
The staff of the School Health Division is extremely small. It consists of an acting director, an audio-visual testing instructor, and a stenographer. The coordinator for the Departments of Health and Education acts as a consultant to the Division and is housed in the same quarters. One of the associate directors of the Nursing Division has also devoted much of her time to school health activities.
The shortage of supervisory and coordinating personnel at the state level is probably the biggest problem that the Division faces. It is hoped that a full-time director, a consultant nurse, and an additional audio-visual testing instructor will be added in the near future so that the team can be completed.
The hearing and vision testing programs were continued and enlarged. The audio-visual testing instructor, through demonstration of the techniques of using the discrete frequency audiometer and the Massachusetts vision testing method, has trained many local workers to perform these tests. These local workers included nurses, doctors, teachers and lay persons.
Some 47,402 school children in twenty-nine counties were given audiometric tests. There were 3,060 children who failed the
tests, or about six and one-half per cent.
Vision tests were given to approximately 46,942 children in
thirty-four counties. Eight thousand six hundred and ninety
(8,690) children (about 18!%) failed this test.
Through cooperation with various civic organizations, corrections for many indigent children with either hearing or vision defects were financed. Most of the children who needed corrections were referred to private practitioners.
Although at least fourteen counties have their own audiometers and several have their own visual testing equipment, the vast
majorit,v of Georgia's approximately 806,243 school children are
not receiving the benefits of either audiometric or visual screening.

- 2-
The Special School Health Project in the Spalding-Lamar-Pike Health District completed the fourth of its scheduled five years
in June 1952. The operation of the project continued throughout
the year in essentially the same wqy that it has in previous years. There has been an increase in the number of children examined, particularly in preschool examinations.
A new health officer for this tri-county district was appointed on July 1. A medical records librarian was employed in the fall to abstract pertinent facts from the records to facilitate the machine tabulation of the data.
Plans for next year include simplifying the record system and the transfer of certain types of defects to the Crippled Children 1 s Division. If this new method proves practical and financially possible, it is hoped to extend the benefits of this modified school health program to every school child in Georgia.
During the school year 1951-52, in the tri-county district 3,567 school children were examined in health centers by part-time clinicians and optometrists; 2,567 were examined by physicians in the schools. Public health nurses made 938 home visits to school children. There were 396 defects corrected, exclusive of glasses
given.
Close cooperation with and joint planning by the Health and Education Departments at both the state and local level is essential to the implementation of an effective school health program. Many conferences were held during the year to accomplish the goal. For example, plans for clinic rooms in new school buildings were worked out jointly by the Coordinator, ihe Associate Director of Public Health Nursing Division and the State School Architect.
GVR:FHH: jm
8-:21-53

LABORATORY SERVICES

DIVISION OF LABORATORY SERVICES
All health department programs call for some amount of laboratory services. Consequently there are many functions of this division but the primary one relates to assistance rendered to physicians and local health departments in the diagnosis of infectious diseases. This service is accomplished through the application of a variety of scientifically approved techniques to multiple types of specimens submitted from patients or suspected carriers. A copy of all reports of laboratory examinations are kept on file for reference and for compilation of the data made available to other divisions of the department and to other health agencies. This information serves a very useful purpose in the program of epidemiologic investigations and the control of communicable diseases.
Suitable containers are prepared and distributed to physicians and nurses as the proper collection and transmission of specimens is essential to reliable examinations. Another function is the preparation and disbution of antirabic treatment, typhoid vaccine, and silver nitrate ampules. Biologics, antibiotics, and drugs used in the prevention and treatment of infectious diseases are purchased and supplied to physicians and local health departments.
Consultation service relating to the necessity of antirabic treatment, and to the type of treatment if indicated, is rendered to physicians and patients. Evaluation studies are conducted with all laboratories within the state requesting approval under the provisions of the state premarital law.
The Central laboratory in Atlanta, the branches in Albany, Macon, and Waycross, and the laboratories of the Alto Medical Center and the Battey State Hospital make up the Division of Laboratory Services. With very few exceptions, the same complete service~is rendered in the branch laboratories as by the Central laboratory. The services of the institutional laboratories are limited to the patients of those hospitals. In addition to tests usually used in public health work, these two laboratories perform clinical types of examinations required by their medical staffs.
For the first year since 1945 the number of examinations showed a decline. The total of 1,367,413 represents a decrease of 0.4 percent from
the previous year. The decline in syphilis incidence with the loss in serology specimens submitted by physicians and local health departments as well as the closing ef the Rapid Treatment Center at Alto and its labora-
tory on September 30 was chiefly responsible for the decrease shown. The
overall increases in the Central and Battey laboratories were not sufficient to overcome the decrease in the other laboratories. In general, services relating to other functions of this division showed proportionate activity to the number of specimens examined.
In diagram I the growth of laboratory services over the last 20 years is illustrated. Five year periods are shown through 1942 and two year
comparisons are given for the last ten year period. For immediate com-
parison the previous year is inserted. The recession shown for 1944 and 1946 is more apparent than real due to the unusual upsurge in 1942 which
included a large number of serologic tests for syphilis made on registrants during the war. It will be observed that the work of the division has
increased more than ten fold during this last 20 year period.

In diagram II, showing the distribution of specimen load among the several laboratories, it will be seen that the Central laboratory made more than 6o percent of the examinations. The specimens received from mass survey w~rk account for a large portion c-f its volume. Diagram III, in like manner, shows the distribution of specimens by laboratory units. The blood sugar tests which this year were separated from the serology work account for approximately 15 percent of the total specimen load.

In table l the volume of work done in 1952 in the several laboratories is coupared with the examinations made in 1951.
Tatle l

SPECil\'!EN LOAD BY LABORATORIES 1952 - 1951

l91J2

l91Jl

Incr. or Deer.

Central Albany Macon Waycross Alto Medical Center Battey State Hospital

845,242 143,336 145,573 104,531
38,718 90,013

816 '783 144,726 155,391 110,325
56' 722 88' 269

+28,459 - 1,390 - 9,818
- 5,794 -18,004 + 1,744

+ 3.5%
- 1.0%
- 6.3%
- 5.3%
-31.7% + 2.0%

GRAND TOTAL

1,367,413

1,372, 216

4,803 - 0.4%

CENTRAL LABORATORY

A total of 845,242 examinations were made in the Central laboratory as
compared to 816,783 in the previous year, an increase of 28,459 or 3.5
percent. All units showed increases except the culture unit which examined only 6 less specimens than in 1951. The largest increases occurred in the microscopy and blood sugar units. The increase in the microscopy unit is attributable chiefly to examinations for tuberculosis. The milk unit reflects a normal expected growth. The heavier demand for Rh and Blood Group tests are responsible for the increase in the serology unit, as the serologic tests for syphilis showed some decrease. The Blood Sugar unit, established this year as a separate unit due to an enlarged mass survey program accounted for more than half of the increase occurring in the Central laboratory.

BRANCH LABORATORIES

THE ALBANY BRANCH LABORATORY made a total of 143,336 examinations, a decrease of 1,390 or 1.0 percent from the 144,726 performed in 1951. All units showed an increase with the exception of the serology unit which showed a decrease of 7,683 examinations. This was due chiefly to the loss of specirr,ens collected hy the CorrJnunicable Disease Investigators, which are now sent to the Central laboratory.

The increase in the culture unit is identical with the 2,022 hog blood specimens examined for agglutinins using the Huddleston rapid agglutination method for brucellosis detection. This study was made in conjunction with the Division of Epidemiology. Specimens were collected three times a week and represented random sampling on about 6oo hogs slaughtered weekly at the local abattoir. Significant titers of l-50 were obtained on 190 or 9 percent of the specimens and suggests the extension of this work to other Stbattoirs.
- 2-

1,400,000
1,200,000
1,000,000
Q IIJ
:! :c:E
)( IIJ
II) 800,000 z
IIJ
2
C,)
IIJ 0..
II)
... 600,000
0
a:
IIJ Gl
2
:z:I 400,000

Diagram I

GROWTH OF LABORATORY WORK

1932- 1952

- ~

~

~

~

200,000 0

n L__

1932

1937

1942

1944

1946

1948

1950

1951

1952

Diagram n
SPECIMEN LOAD BY
LABORATORIES
1952

CENTRAL 845,242 61.9%

SEROLOGY 794,805 58.1%

m Diagram SPECIMEN LOAD
BY UNITS
1952
CULTURE 47,936 3.5% MILK 43,754 3.2% CLINICAL 46,230 3.4%

Only 3 of 1,784 specimens showed positive agglutination tests for endemic typhus as contrasted to 17 in the previous year. Of 1,300 sputum
specimens reported as negative microscopically in the Albany laboratory
and cultured in the Central laboratory only 36 or 3.0 percent were found to
be positive. This reflects careful work in smear examinations.
THE MACON BRANCH LABORATORY again led the branch laboratories in ~aking
145,573 examinations although its total loss exceeded that in either of the other laboratories. This compared to 155,391 examinations, a decrease of 9,818 or 6.3 percent. Some increases are shown in the microscopy and culture
units but greater decreases are observed in the milk and serology units.
The decrease in the milk unit is attributed to a change of policy in Bibb County Health Department in reducing the number of samples submitted, and to the diversion of samples from Troup County to the Central laboratory for convenience in transportation. The decrease in the serology unit was due to a change in policy resulting in the sending to the Central laboratory most of the specimens collected by the Communicable Disease Investigators. The increase in the culture unit is due largely to the increase in feces and gonorrhoea cultures. Of special interest was the increase in the number of positive spinal fluid cultures. Miscellaneous examinations accounted for the increase shown in the microscopy unit.
THE WAYCROSS BRANCH LABORATORY showed a decrease in volume of examina-
tions for the first time since 1947. The total of 104,531 examinations was a decrease of 5,794 or 5.3 percent from the preceding year. The loss
in the microscopy unit resulted chiefly from a reduction in intestinal parasite survey specimens and to a decrease in examinations for gonorrhoea. The culture unit showed an increase in all types of examinations except those of a miscellaneous nature. As in the other branch laboratories a change of policy was primarily responsible for the decrease in the serology unit. A comparison cannot be made for the milk unit since samples were examined onl;y during the last two months of the previous year.
A marked increase was observed in diphtheria examinations due to an
outbreak occurring in Brooks County in late September. A total of 110 isolations were made from 46 individuals. Koch-weeks bacilli were found in 36 smears of pus from eyes and Morax-Axenfeld in 9. One case showed a
double infection.
An outbreak of typhoid fever occurred in Bryan County during which S.
typhosa was isolated from 48 fecal and 4 blood specimens from the 15 cases.
There was an increase in positive spinal fluid examinations. Of interest was the isolation of N. meningitidis from both the spinal fluid and blood of the same patient. Four specimens of blood sent to the Communicable Disease Center were reported positive for Leptospirosis.
INSTITUTIONAL LABORATORIES
THE ALTO LABOR.">.TORY closed operations on September 30. During the nine months 38,445 examinations were made, 7,519 less than those made in same period of 1951. Decreases were shown in all the units as a result of the
gradual decline in the census of the institution. Most of the work in this laboratory is done in the serology and clinical units. Comparatively few tests were made in the microscopy unit. The milk examinations for the
- 3-

institution were discontinued in the early part of the year and the samples sent to the Central laboratory for more complete examination.
The laboratory cooperated with the medical staff in performing tests made in conjunction with special studies. Much time was given in lecturing and demonstrating technics to groups of personnel coming from other states and countries for courses of instruction in venereal disease control.
THE BATTEY LABORATORY made 90,013 examinations, an increase of 1,774 or 2.0 percent over the 88,269 performed in 1951. The increases in the
microscopy and clinical units overbalanced the decreases in the culture and serology units. Due to shortage of personnel all milk work was discontinued. For the same reason all enteric and miscellaneous bacteriologic specimens were referred to the Central laboratory until late in the year when, upon implementation of the staff, this work was again resumed.
An increase of 3,824 tuberculosis cultures was due chiefly to an
evaluation study on the new drug, Isoniazid, and to a change in policy necessitating cultures as well as microscopic examinations on each admission patient. This change was instituted originally to give information concerning the relative sensitivity of new patients to streptomycin but it has proved valuable in the apprehension of patients whose sputum cultures consistently show atypical growth.
A new laboratory was constructed and completely furnished with modern equipment. Transfer was made to the new quarters and open house was held
on March 30, with about five hundred guests present. The work was explained
and technics demonstrated by the personnel in each unit.
THE MICROSCOPY UNITS
The combined work of the microscopy units shows a 5.6 percent gain in
examinations over the preceding year. Increases occurred in each of the laboratories with the exception of Alto and Waycross. Examinations for tuberculosis were chiefly responsible for the increase shown. Smaller increases occurred in diphtheria, intestinal parasites, and rabies while decreases are observed in gonorrhoea, malaria and miscellaneous examinations.
Table 2 gives the classification of total examinations with positive results made in the microscopy units ccmpared to the previous year.
TUBERCULOSIS
A substantial gain in tuberculosis examinations occurred in each of the
laboratories, except Alto, and represents an increase of 12 percent. The
increase in the number of examinations does not proportionately reflect the work involved since the special technics require more time and effort. The change in policy in referring specimens for culture by the branch laboratories to the Central laboratory instead of to the Battey laboratory resulted in almost doubling the culture work in the Central laboratory. This arrangement made possible the expansion of the culture work at the Battey laboratory necessitated by the evaluation studies of Isonazid, which were instituted. Survey specimens were received in the Central laboratory frcm eleven counties but fewer specimens were examined from this source than in the previous year.
- 4-

Table 2

MICROSCOPY UNIT

TUBERCULOSIS Microscopic Culture Animal Inoc. Sensitivity Test TOTAL
DIPHTHERIA Diagnosis Rel & Carr. Virulence TOTAL

1952

Pos.

Total

6,822 s,6o5
535
15' 962

75' 227
37,031 2,588 2,951
117 '797

1951

Pos.

Total

5,744 5,868
734
12,346

70,665 27,518 3,371 2,163
103 '717

Incr. or Deer.

Pos.

Total

+ 1,078 + 4,562 + 2' 737 + 9' 513
199 - 783 + 788
+ 3,616 +14,080

180 1,322

266 2,071

32

45

478 3,438

101 1,115 + 79 + 207

218 1,908 + 48 + 163

3

4 + 29 + 41

322 3,027 + 156 + 411

GONORRHOEA Microscopic
MALARIA

1,952 28

16' 957 2,250

2,583 23

18,975

631 - 2,018

2,607 + 5 - 357

INTESTINAL PARASITES Egg
Egg Count Worm for Ident. Amoebic Dys. TOTAL

19,629
21 19,650

so, 771 1,438
24 3,805 86,038

21,225
28 21,253

81,901
508
23 2,899 85,331

- 1,596 - 1,130 + 930 +l
7 + 906 - 1,603 + 707

RABIES Microscopic Anirr:a l Inoc TOTAL
MISCELLANEOUS

385 1,151

27

174

412 1,325

3,315

309 1,080 + 76 + 71

31

162

4 + 12

340 1,242 + 72 + 83

3,921

6o6

TOTAL FOR UNIT

231,120

218,8::?0

+12,300

DIPHTHERIA

There was a slight increase in both the number of diphtheria specimens examined and positive findings as compared with the previous year. Each laboratory, except the Central, showed an increase in these examinations.
Thirty-seven laboratory diagnosed cases ~ccurred in Brooks County and 27 in
Morgan County. Hall County, as for the past 5 years, continues to show a
relative high incidence. Most of the cases in that county over this period
have shown the gravis type of infection.

GONORRHOEA

There was a 12 percent decrease in the number of smears examined for
gonorrhoea with a corresponding decline in positive results. Only in the Albany laboratory was an increase observed. This decrease however is probably of little significance since the greater part of the total occurred

- 5-

in the Central laboratory and was chiefly due to a change in policy by the Fulton County Health Department whereby its laboratory took over the examination of gonorrhoea specimens collected at the local clinics.
1'i:ALARIA
The malaria picture remains essentially the same as for the past few years. In the state laboratories, Plasmodium vivax was found in 28
specimens from 25 veterans returned from Korea. No cases of locally
acquired malaria occurred in the state during the year. The Central laboratory served as a reference laboratory in a Malaria Surveillance program
made by the U. S. P. H. S. and reviewed 35 specimens diagnosed in other
laboratories.
INTESTINAL PARASITES
The number of examinations for intestinal helminths has remained rather constant for the past three years due to the hookworm control program which curtails random surveys. Hookworm continues to be by far the most prevalent of the helminth infections. Pinworm replaced ascaris as the second most prevalent in all regions in the state except that served by the Waycross laboratory. The increase in pinworm findings may be attributed primarily to the superiority of the cellophane tape outfit over the NIH swab in collecting satisfactory specimens. Unusual helminths found
during the year include 3 Taenia, 5 Trichostrongylus and 22 Strongyloides.
The diagnosis of five additional cases of Trichostrongylus to the three
previously found is of special interest, since only 8 others have been
reported in this country. The number of examinations for amebiasis continues to increase but the incidence of Endamoeba histolytica remains less
than one percent.
RABIES
There was &n increase in the number of brains e~'~amined for rabies and
also an increase of approximately 5 percent in the positive findings. In
19 cases reported negative by the microscopic test, rabies was diagnosed
by mouse inoculation. In addition to those examined in the state lab-
oratories, 33 rabid animals were diagnosed in latoratories outside the state
system. The total incidence of laboratory diagnosed rabies in the state
was 437 cases. They occurred chiefly in dogs, foxes, cattle and cats and
were distributed in 75 counties. The concentration of rabies in dogs con-
tinues to be in Fulton and DeKalb Counties and surrounding areas. The greatest incidence in cattle occurred in counties to the southwest of this region. Fox rabies was fairly well scattered in counties in the western part of the state.
j1JSCELLANEOUS
A decrease occurred in the miscellaneous examinations. A decided drop vm.s observed in the unclassified group of specimens in the Battey laboratory. The ~~con laboratory shows a considerable increase in the examinations for Trichomoniasis. A large number of eye infections caused ty the Koch-Weeks and Morax-Axenfeld bacillis were diagnosed by the Albany and Waycross laboratories.
- 6-

INVESTIGATIONS

Due to the pressure of routine work and limited personnel investigative studies or organized researchs could not be undertaken. An informal study of the Hemophilus and Moraxella groups of organisms related to conjunctivitis was made in the Central laboratory for the instruction of the personnel of the unit. This study proved very informative but was limited by lack of material. It is hoped that this study may be resumed on specimens supplied by the Albany and Waycross laboratories.

THE CULTURE UNITS

Examinations made in the culture units showed a decided increase over
1951, chiefly in the number of feces cultures for enteric organisms and in
the miscellaneous specimens. There was a small decrease in the agglutination tests and blood cultures. Positive agglutinations for endemic typhus,
undulant fever and tularemia continue to decrease.

Table 3 shows the combined statistical tabulation of the work in these
units sf the several laboratories compared with the previous year.

Table 3

CULTURE UNIT

AGGLUTINATION
Typhoid "0"
Endemic typhus
Undulant Tularemia
TOTAL

1952

Pos.

Total

9,981

62

21

99

43

225

1951
Pos. Total
11,279
94 42 114 68
318

Incr. or Deer.
Pos. Total
- 1,298
- 32 - 21 - 15 - 25 - 93

BLOOD CULTURE

4,757

5,127

370

S. typhosa

25

34

9

Other Salmonella

4

Brucella

34

3

d:- l

28

+6

Other organisms

18

4

+ 14

TOTAL

81

69

+ 12

STOOL & URINE

S. typhosa

138

Other Salmonella

150

Shigella

176

TOTAL

464

CULTURE IDENTIFICATION

GONORRHOEA

152

25' 723 105 108 176 389
586
2,330 127

22,631

+ 3,092

+ 33

+ 42

+ 75

574

+ 12

2,249 + 25 + 81

MIS C:2LLANEOUS

4,559

3' 225

+ 1,334

TOTAL FOR UNIT

47,936

45,085

+ 2,851

- 7-

ENTERIC DISEASES
Sixty-eight cases of typhoid fever were diagnosed in the laboratories
as compared with 46 in 1951. An outbreak in Bryan County was responsible for most of the additional 22 cases. Only 3 new carriers were found, 2 of which will apparently continue as such. There were 177 isolations of Salmonella organisms from 117 persons. S. typhi-murium was most frequently
isolated. 3. montevideo and S. oranienburg were isolated from canned dried egg yolks sold as food for babies. S. montevideo was isolated from the stools of two of the babies who had gastroenteritis following the ingestion of the egg powder. The number of isolations of Shigella organisms was the
same as in 1951, although there vl'as an increase in the S. flexneri 6 type.
BRUCELLOSIS
Positive cultures for Brucella increased by 4, although isolations were
made from only 21 persons as compared with 24 in 1951. There were 15 fewer
positive agglutination tests.
FUNGUS INFECTIONS
Cultures for fungus infections decreased by 184 with a more decided
drop in positive results. Although Candida albicans is iucluded in the positive findings it is doubtful if these organisms are significant. Of the positive isolations, the following are of especial interest: Actinomyces bovis from a jaw abscess; Trichophyton schoenleini from scalp hair; Aspergillus fumigatus from an ear.
IMPROVEMENT PROGRAM
Specimens for seven studies were sent to the branch laboratories during the year. These studies are aimed at broadening the knowledge and experience of the technician rather than as a measure of knowledge. The specimens consisted of material from which the organisms pertaining to the work of this unit may be isolated and identified as well as serums for the agglutination series.
INVESTIGATIONS
As a result of a six months study of various media used in the isolation of Shigella organisms it was decided to continue the employment of the media in current use.
In addition to those isolated in the Central laboratory 586 cultures
were identified or typed either serologically or by bacteriophage, of which
136 were submitted by Jaboratories outside the state system. This work is done only in the Central laboratory. Approximately 850 blood serums were
processed and sent to reference laboratories of the U.S. Public Health Service for detection of virus infections since the. state laboratories are not equipped for this type of work. As a Tieans of evaluating our methods
for identification of organisms, 325 cultures were referred to the Communi-
cable Disease Center for serologic typing.
THE SEROLOGY UNITS
The combined report of the se~eral laboratories shows that the examinations made in the serology units declined for the first time in several
- 8-

years. This decrease was common to all the laboratories. The loss in specmens together with the separation of the blood sugar work into a separate unit reduces its representation of the entire laboratory specimen load to 58.1 percent. Table 4 gives the classification of the work in this unit with comparisons for the previous year.

Table 4

SEROLOGY UNIT

SYPHILIS Blood Spinal Fluid TOTAL
RH FACTOR

1952

1951

Incr. or Deer.

Total %Positive Total %Positive Total %Positive

4.4

655,992 6.1

-30,125 -1.7

7.0

12,773 8.9

- 3,324 - 1.9

4.4

668,765 6.1

-33,4)_4-9 1.7

77,696 13 .9(Neg) 75,657 13 .4(Neg) + 2,039 + .5

BL00:8 GROUP

77' 723

HETEROPHILE ANTIBODY 4,070 7.3

75,694 3,449 6.9

+ 2,029 + 621 + .4

TOTAL FOR UNIT

794,805

823,565

-28,760

SEROLOGIC TESTS FOR SYPHILIS

The decline in specimens for the serologic tests for syphilis was wholly responsible for the decrease shown for these units. This loss may indicate the beginning of a downward trend following an uninterrupted climb for many years. These tests show a more pronounced drop in the branch laboratories due to a change in policy which diverts most of the specimens collected by the Communicable Disease Investigators to the Central laboratory. Positive reactions continues a steady downward trend.

The Survey section examined 196,732 specimens frcm ll county-wide surveys and from minor surveys conducted in 45 counties. This volume was the greatest examined in any year since this work was begun in 1947. Of interest also is that while these tests decreased by 15,523 in the routine section of the Central laboratory, the survey section shows an increase of
13,059 specimens. This would indicate that practioners and health departments submitted less specimens.

Due to the continued decrease in the prevalence of syphilis, Kahn quantitative tests dropped to 18,807 frcm 28,116 performed in 1951. Only 714 Nlicro Kahn tests applied to small specimens from young children or aged people were performed as compared with 1,135 in the previous year. Most of the spinal fluid specimens were collected from patients at the Alto Medical Center and were examined in that laboratory.

PRE])}JARITAL SFECIJ\JJENS

A total of 54,255 specimens were examined in the state laboratories for premarital purposes as compared with 57,604 in the previous year. The decrease of 3,349 specimens was due in part to the approval of additional

.._, ~9 .....

laboratories. Approved laboratories outside the state system, examined
45,398 specimens, making a total of 99,653 for the entire state, an increase of 5,138 over those reported in 1951. Again, as in all previous years, the
number of positive reactions in premarital specimens were found in white males and the highest number in colored females.
RH AND BLOOD GROUP TESTS
These tests although performed on the same specimen are counted as separate examinations for the reason that different reagents and different portions of the specimens are used. Their application is limited to prenatal and immediately related ceses. Facilities were not adequate to extend them to the many requests in connection with the civil defense program or the establishment of regristries of available donors in communities. The demand for these tests continues upward.
HETEROPHILE ANTIBODY TEST
This test is performed only in the Central Laboratory. Positive findings are regarded as only presumptive evidence of infectious mononucleosis. Branch laboratories refer the sera of specimens submitted to them to the
Central laboratory. There was an 18 percent increase in the number of
examinations over the previous year.
EVALUATION STUDIES
The National Serology Evaluation study, omitted in 1951, was resumed
on a biennial schedule. It differs from former studies in that specimens were submitted in various size groups throughout the year instead of being confined to shipments during the first two or three months. A complete report on this study has not been released but the results compare favorably with those reported by the V. D. Research Laboratory. Participation in these studies are very helpful in connection with the performance of the multiple serologic tests as a special service and the approval of laboratories using different test procedures.
An evaluation study of the performance of the Rh and Blood Group tests was conducted with the Central, branch and institutional laboratories. This study consisted in the collection and distribution of 10 specimens of whole blood each month throughout the year. The comparative reports showed uniformity of results among the several laboratories.
During the year, 75 laboratories, including those in the state system,
participated in the intra-state serology evaluation study. This study consisted in the preparation and distribution of 100 specimens of sera containing syphilitic reagin and an equal number containing no reagin. These specimens were sutmitted at the rate of 20 per month during the first ten months of the year. This study is used as a basis in approving laboratories under the requirements of the state premarital and prenatal laws.
APPROVAL OF LABORATORILS
The criterion of approval for laboratories is the achievement cf not
less than 99 percent in specificity and a sensitivity rating of not more than
10 percentage points lower than the special serology unit which served as
the control. As a result, 57 laboratories were given annual approval for
- 10 -

the next year. Temporary approval until June 1, 1953 was granted to 8
laboratories which either applied late in the year or had required some technical assistance at the end of the evaluation study. One laboratory
did not request approval, 3 voluntarily closed, 2 withdrew from study and 4 could not be approved. In conjunction with this study 45 inspection
visits were made to 36 laboratories.
Refresher courses of instructions were offered at stated intervals for the benefit of technicians in improving performance. These courses were
adapted to the individual need of the technician and varied from l to 5 days.
Thirteen technicians availed themselves of this service.
INVESTIGATIONS
The Kolmer and VDRL tests were applied to a large group of spinal fluid specimens collected in a special survey in Burke County. The results were compared to those obtained on the same specimens by the Kahn test at the Alto laboratory. In this study the VDRL test was found to give as good results, requires smaller quantity of specimen, and is less complex in technique. Therefore, it was decided to substitute it for the Kahn test in the routine examination of spinal fluids.
Samples of serologic antigens were tested for sensitivity level and behavior under different working conditions before supplies were purchased. A limited study was made relating to specificity in cases of disagreement between the VDRL and Kahn tests. Specially prepared control sera was furnished at two week intervals to all state laboratories for these two tests. Statistical analyses were made on the relative sensitivity of the screen and confirmatory procedures employed in routine examinations.
THE MILK UNITS
The tests usually employed in dairy bacteriology were applied to
14,328 samples of milk and related products. These samples are accepted
only from local health departments. The combined report of the milk units
show an increase of 2.5 percent over the examinations made in the previous
year. This increase is due chiefly to the examinations made in the Waycross
laboratory where this service was not instituted until October, 1951. The Central laboratory showed an increase of 7.5 percent and the Albany laboratory a gain of 13 percent, but a decrease of 37.8 percent was observed in
the Macon laboratory. The reason for this decrease is given in the section
of this report relating to the work of that laboratory. Table 5 shows the
classification of the combined work of the several laboratories.
Milk examinations in both the Alto and Battey laboratories were discontinued during the year and the samples from those institutions were sent to the Central laboratory. The refractometric and cryoscopic procedures were inaugerated in the routine work of both the Albany and Waycross laboratories, so that now, all laboratories are performing complete examinations, Determinations of solids-not-fat are based on calculations frcm nther tests and are no longer counted as separate examinations.
Continuation and refinement of the evaluation program in cryoscopic examinations for excess water, has resulted in a satisfactory improvement ~f this work in the branch laboratories.
- ll -

Table 5

MILK UNIT

l9tJ2

l9tJl

Incr. or Deer.

Plate Count Coliform Phosphatase Butterfat Cryoscope Refractometer Solids not Fat Miscellaneous

10,920
3,850
3,482 10,751
4,310 10,140
301

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

+ 2,473 + 1,467 + 1,049 + 2,510
344 + 1,o66
- 7,290 + 128

+ 29.3% + 61.6% + 43.1%
+ 30.5%
7.4% + 11.7%
+ 74.0%

TOTAL FOR UNIT

43,754

42,695

+ 1,059 + 2.5%

THE BLOOD SUGAR UNIT

All blood sugar determinations are made in the Central laboratory and only those specimens collected by the multiphase survey teams are examined. The dosages of blood for this test are measured into the trichloroacetic acid preservative by the survey personnel at the time of collection. Consequently the laboratory cannot accept full responsibility for the results obtained. Greater average differences than would normally be expected among people in various sections have been observed in results on specimens collected by different teams.

The specimen load showed an increase of 8.0 percent over the previous year. Included in the examinations shown in table 6, giving the classification of results by groups, are 14,685 glucose tolerance tests. For this test two specimens are collected, at intervals following the ingestion of glucose, on those persons referred for further study as a result of the primary test. Of the 7,392 persons thus tested 4,286 were found to have suspicious abnormal blood sugar metabolism. This number represents 2.27 percent of the people examined in the primary or screen testing. These suspected patients are referred to physicians for further examination and diagnosis.
In the scheme of reporting groups 5 and 6 were added in June 1951, to
give additional information on those persons, previously classified in group 4, who show more than 300 mg% blood sugar. This change accounts for the wide differences shown in these groups for the two years.

This unit also prepares and furnishes to the survey teams fresh solutions of copper sulfate used in the screen test for anemia. A complete classification of the blood sugar and hemoglobin results by race, sex, and 10 year age groups is prepared for each survey. A copy of these reports are sent to the Division of Preventable Disease Services.

Investigations were carried out which proved helpful in solving some of the problems connected with this work but there are yet ffiany more to be solved. Time from routine duties is not sufficient for the present staff to undertake studies which might lead to a solution of some of the more complex problems.

- 12 -

Table 6

BLOOD SUGAR UNIT

PRIMARY SPECIMENS

Groups

1952

Percent

1951

Percent

I
II
III
IV
v
VI TOTAL

168,877

9.8

16,436

8.7

2,418

1.3

771

.4

255

.1

126

.07

188,883

166,469 10,140 1,378 910 126 66
179,089

9.3
5.7 .8
.5 .07 .04 Increase + 9,794

SECONDARY SPECIMENS

I
II
III
IV
v
VI TOTAL

4,081 4,271 3,417 2,130
.541 245 14,685

27.8 29.1 23.3 14 .5 3. 7 1.7

2,6o6
2,322 1, 732 2,171
460 96
9,387

27.8 24.7 18.)
23.1
4e9 1.0 Increase + .5,298

GRAND TOTAL

203 ,)68

188,476 Increase +15,092

THE CLINICAL UNITS

The clinical tests covering a variety of procedures are performed only in the Alto and Battey laboratories in connection with the treatment of patients in those institutions. The decrease observed in the total ntoober of examinations occurred in the Alto laboratory and is partly due to its closing on September 30. The Battey laboratory showed a slight increase over 1951. There were decreases in hematology, blood chemistry, and spinal fluids, and increases in urine, body fluid and miscellaneous examinations. Table 7 gives the classification of the work done in these units compared with the previous year. Again as in 1951, hematology in the Battey laboratory, and cell counts and total protein determinations on spinal fluid in the Alto laboratory accounted for 80 percent of the clinical tests.

Table 7

CLINICAL T"GSTS (INSTITUTIONAL LABORATORIES)

19c;2

19c;l

Incr. or Deer.

Hematology Blood Chemistry Urine Spinal Fluids Body Fluids IVliscellaneous

19,979 1,009 6,517
17,170 121
1,434

20,972 1,144 6,038
23' 97.5 39
1,407

993
13.5 + 479 -6,80.5 + 82 + 27

- 4.7%
- 10.9% + 7.9%
- 28.4%
+210 .3% + 1.9%

TOTAL FOR UNIT

46' 230

.53,.57.5

-7,345 - 13.7%

- 13 -

ANTIRABIC TREATMENT

Antirabic treatment for hpmans is manufactured in the Central laboratory. The branch laboratories are furnished with an adequate stock for supplying the first four doses. The order is then referred to the Central laboratory for completion.

Except for a slight rise in 1949, the distribution of antirabic treatment had shown a steady decline since 1944. The number of treatments furnished during the current year however show a 17.3 percent increase over 1951. Table 8 gives a comparison by types of treatment supplied, with those
furnished in the previous year.

Table 8

CLASSIFICATION OF ANTIRABIC TREATMENT

Precautionary Mild Intensive Drastic

1952
Number Percent

406

50.3

328

40.6

73

9.1

0

1951
Number PerceEt

310

45.1

311

45.2

67

9.7

0

Incr. or Deer. Number Percent

+ 96 + 5.2

+ 17

4.6

+6

.6

0

GRAND TOTAL

807

688

+119

The relationship between the C.istribution of the p. 3cautionary (12 dose) and the mild (21 dose) types of treatment remains about the same as for the
past few years. There was little difference in the number of the intensive
(31 dose) type usually recommended for bites about the face or head. For
the second consecutive year no drastic type of treatment has been supplied
since hyperirrJDune serum was available for the more severe exposures. Map I
shows the distribution of treatments in 104 counties.

Treatment blanks were not returned by physicians for all patients, but
the 756 forms returned show that 553 patients were exposed to dogs; 77 to cats; 34 to foxes; and 92 to other animals.

Nineteen of 36 previously treated patients were given a booster series of six doses. In the other 17 cases, the nature of the exposure did not
warrant retreatment. Hyperimmune serum furnished our laboratory for clinical trial was supplied for ll patients, one of who resided in another
state. There were no reports of reactions following the administration of
this horse serum product. In previous years serum reactions had been reported in several cases in which a hyperimmune serum prepared from rabbits
and sheep was used, To date hyperimmune serum has been supplied for 6)
patients.

Much time is required for consultation service rendered to patients and physicians in connection with decisions regarding the advisability of
antirabic treatment in cases of exposure to animals. More than 300 of these
consultations were held in person with residents of Fulton County. In
addition, the majority of approximately 700 consultations given over the
phone were with local people. The returned treatment forms were reviewed in
all cases to determine if any additional information might indicate an
altertion in the type of treatment recorrmended.

- 14 -

MAP I
DISTRIBUTION OF
ANTIRABIC TREATMENT
1952
TOTAL 807



I

I

HU:l\f.lAN RABIES AND TREATivlENT PARALYSIS
No human cases of rabies were reported in the state. For the seventh consecutive year no cases of post vaccinal paralysis were reported.
MEDIA AND VACCINE
A total cf 4,537 liters of various kinds of culture media was prepared. This is an increase of 222 liters or 5.0 percent over the 4,315 liters pro-
duced in the previous year. The greater part of this increase occurred in the Lowenstein and Wilson Blair media. Most of the media is prepared and supplied by the Central laboratory. The other laboratories, however, prepare some of the less complex media for their own use. The Battey laboratory produced all of its Lowenstein media as well as that used in connection with sensitivity tests.
The production of typhoid vaccine amounted to 534 liters which is 93 liters less than that prepared in 1951. There was an increase of approximate 5,000 in silver nitrate ampules. The preparation of Koch's Old
tuberculin has shown an increase for the past five years.
BIOLOGIC SALES
An increase occurred in the distribution of all biologic products with the exception of ducrey vaccine, Frei antigen and Schick test material. This increase was greatest in diphtheria and tetanus antitoxins. Most of the drugs, and especially penicillin, also showed an increase in distribution. There was some decrease in the distilled water supplied.
Bicillin on clinical trial in the treatment of syphilis is being used in the Fulton and Dougherty County treatment centers. The other centers use aqueous penicillin and penicillin in oil. Terramycin has been substituted for streptomycin for the treatment of lymphogranuloma venereum. The distribution of bismuth subsalicylate in oil has been discontinued.
SEMINARS
Two very interesting and well attended seminars were held at the Central laboratory. One was a syphilis serology seminar arranged for the benefit of technicians in laboratories approved under the provisions of the of the state premarital law. Dr. Charles R. Rein, consultant to the World Health Organization and Miss Genevieve Stout of the V. D. Research laboratory were the guest speakers. A seminar on rabies held for the instruction of the senior veterinary students from the University of Georgia was conducted by personnel from both the Division of 19boratory Services and the Division of Epidemiology.
INVESTIGATIONS AND PAPERS
An investigation was made of problems involved in the reporting system. It was found that quite frequently the copies on the interleaved carbon forms were not very legible. A study was begun with a view of gradually revising the present method of reporting. This will involve a change to translucent paper for the specimen identification forms on which space is to be proviied for entering the results of examination. Legible copies can then be made rapidly on sensitized paper on the Ozalid machine. One of these
- 15-

rr..achines was purchased for trial of this method in the Central laboratory before it is extended to the branch laboratories. The report forms for tuberculosis, diphtheria and intestinal parasite specimens have been revised for the machine process of making copies for the physicians or for filing purposes.
With the combined efforts of all units of the Central laboratory a booklet was prepared outlining the services available in the laboratories. This booklet is very complete in the outline of types of examinations made, directions for collecting and submitting specimens, outfits to be used, and biologics and drugs supplied. A copy of this booklet has been sent to all physicians and local health departments. It should prove to be of much mutual benefit to them and the laboratories.
Changes occur in laboratory procedures and new methods are adopted from
time to time. The Manual of Methods first prepared in 1946 for the guidance
of the technical staff is undergoing its first revision.
Complaints were received from various sources in regard to improper practice in issuing premarital certificates by some approved laboratories. An attempt was made to remedy this situation by securing the passage of a three day waiting period but these efforts failed in the Legislature. This led to the adoption of policy eutlining minimum requirements in regard to equipment, personnel, and quality of work, and providing for withdrawal of approval if these regulations or provisions of the law are found to be violated in the issuance of premarital certificates.
The Battey laboratory began participation in the Inah studies conducted by the Trudeau Foundation Laboratories, Saranac Lake, New York. These studies relate to the bacteriologic sensitivity and resistance in cases of tuberculosis treated with the newer antibiotics and drugs.
Most of the recommendations made in the 1951 program review by the U.S.
Public Health Service have been put into effect. An investigation devised for bringing about better correlation in the technical work done by the branch laboratories is in progress. Plans are being studied in regard to rendering consultative service to city and county laboratories in whose operation the Department now finanically participates.
A paper entitled 11Arizona Paracolon Recovered from Middle Ear Discharge" was presented before the laboratory section of the Southern Branch of the American Public Health Association in Biloxi, Mississippi. This paper was published in the November-December issue of The Journal of Infectious Diseases. Another paper entitled 11An Outbreak of Salmonella Typhi-murium in a Hospital Nursery" was presented at the meeting of the Society of American Bacteriologists in Athens and before the laboratory section of the Georgia Public Health Association at its annual meeting in Savannah. At the latter meeting another paper entitled 11The Significance of An Evaluation Program" was presented before the laboratory section.
Nine of the laboratory staff attended refresher courses given at the Communicable Disease Center.
CHANG.bS IN FACILITIES
One of the buildings at the Battey State Hospital was completely renovated and enlarged to accommodate the growing demand of services rendered by the laboratory at th&t institution. New laboratory furniture and equip-

ment were installed. The laboratory was moved into the new quarters in March and is now operating under much improved conditions with modern facilities.
Due to the steady decline in the patient census at the Alto Medical Center, the Division of Venereal Disease Control found it expedient to close that institution on September 30. This occasioned the closing of the Alto Laboratory on that date and the transfer of the technical staff to the Central laboratory.
Plans have been drawn and contract awarded for the complete renovation of the glassware cleaning room in the Central laboratory and furnishing it with more modern equipment.
RESIGNATIONS AND APPOINTMENTS
There were 50 resignations from the division during the year. ~venty
six were technical, ll were clerical, and 13 were unskilled personnel. Three of the technicians were employe on temporary work. There were 6 dismissals.
Of those voluntarily resigning, 15 accepted better positions, 2 entered military service, 5 returned to school, 3 moved from Atlanta, 6 resigned for
reason of maternity, and the remainder separated for various other reasons. Forty-eight appointments were made to 19 technical, 10 clerical and 19 unskilled positions. Much time for instruction has to be given to new employees who are appointed to vacated positions especially those requiring technical skill.
VISITORS
Twenty-seven visitors from 17 foreign countries and 49 visitors from
other states were shown the facilities and work in the Central laboratory. Many of these visitors had come to Atlanta for special courses of study given at the Communicable Disease Center of the U. S. Public Health Service.
There were 74 visitors in addition to many school groups within the state
manifesting an interest in public health work.
RECOMMENDATIONS
It is recorrended that provision be made for extending the evaluation study on Rh performance to hospital and private laboratories which might desire to participate. Several of these laboratories have expressed an interest in such study. It is felt that the extension of this studyJ now carried on in the state laboratories, would be instrumental in bringing about more uniform results in these tests among the laboratories throughout the state.
It is further recommended that efforts be made to secure federal grantin-aid funds for the employment of a qualified person who could give full time to the problems surrounding blood sugar determinations. The laboratory could accept full responsibility for its work if a satisfactory preservative could be found for preventing glycolosis. The Anthrone method used in blood sugar tests should be paralleled and more fully evaluated with other recognized procedures.
- 17 -

ADDENDUM The Division of Laboratory Services keeps on file in its office a more detailed report of its activities for the year. Anyone desiring fuller information is invited to communicate with the director.
- 18 -

LOCAL HEALTH SERVICES
Division of Local Health Organizations Division of Public Health Nursing

Division of Local Health Organizations
/

PERSONNEL
OF DIVISION OF LOCAL HEALTH ORG/\NIZATIONS
December 31, 1952

s. c. Rutland, M. D.
L. R. Tabor
Emily c. 1hde
Phyllis E. Lee
Edith C. Thomas
Phyllis c. Smith
Elizabeth P. Richardson
Vida L. Allen

Director Assistant to the Director Administrative Aide Senior Stenographer Senior Stenographer Intermediate Typist Intermediate Typist Intermediate Stenographer

REGIONJ.L MEDICAL DIRECTORS

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

N. 1rJ. Region N. E. Region Central Region
s. w. Region s. E. Region

STATE DEPARTMENT OF PUBLIC HEALTH
COUNTIES WITH BUDGETS FOR
PUBLIC HEALTH SERVICE

[!illlitlt~ Bulgotcd ec..nty Health lhits EWgctod <hll'lty Hoal th Districts Bulgotcd llrsing Count ios Hoa I th Rcgi oroS
lbvombor I, 1952

<hll'lty Hoa Ith ,lppl ing-Bacci,.Jcff Davis \tk inson-"1::: r lon-Ccffco & Idr~ In-Jaspor-Pvtnam
furl<s~ll
8arrow-G1!i ITIJtt Bartow-Gordon tllbb-Joncs Bl cck lcy-Oodgc-Pulasl<l ~ant Icy-Liberty -lon<J-r!nyno Brooks-lhnmas Br)"ln-Oulloch-Eff ingham-Evans
Blrkc-Jcnk Ins-Sere von 1\rtts-Honry-ll:onroo Camd~GI ym.-1/c lntoS! Carro [..Q,ugl as..Hara lscro

cts
O,arltcn-CI inich-Piorco-"aro
lhattooga-Oicf~IMc
Cl aytm-COJ.ota,..~;!yot te Co IUl!bla-fli dlmarld <looik-E'chola-lan icr-lowndcs Ct- i ap.olb-tll etbrlrt-ttar't. l;ad,_Mitdlolll;ocne..tfar.ack-lt lit~. lfalleli~bw..Stophons
..,,..i~
l&l!lli':-Pfkc-sp.ld lng bfo.Y,.IIftltf:lold
Pauldl~ol~ Tel fa ir-l'ohooler

LHO- l
THE DIVISION OF LOCAL HEfi.LTH ORGANIZATIONS
s. C. Rutland, M. D., Director
The Division of Local Health Organizations has the administrative responsibility of developing local health departments, coordinating and strengthening services rendered to local health departments, and coordinating the programs of the State Department of Public Health and the programs of local health departments. It has the responsibility of maintaining cooperative relationship of the divisions of the State Department of Public Health and the local health departments.
The division, including the regional offices, accepts the philosophy expressed in the official statement of the American Public Health Association: 11 The local health department is the basic service unit in the administration of public health. Through daily contact with the public the local health department obtains first hand information concerning local health needs and is responsible for providing its community with direct services.--"
Personnel
At the close of the calendar year 1951 the personnel of the
Central and Regional Offices included the Director of the Division, 4
Regional Medical Directors, ll Consultant Public Health Nurses, 12 Public
Health Engineers, 10 Public Health Sanitarians, 6 Nutritionists, 27 clerical persons, 3 building custodians and 3 janitors. On January l, 1952,
Mr. L. R. Tabor joined the Central Office Staff in the position,Assistant
to the Director. During the year we lost 4 Public Health Engineers, 3 by
transfer to other positions in the State and/or county health departments.
vJe gained 6 Public Health Sanitarians, giving a net gain of 4 employees.
The vacancy in the position Medical Director continues in the Central Region. The filling of this vacancy is an urgent need and efforts are being made tb recruit a qualified person.
The addition of medical tuberculosis consultants, dental health consultants and mental health consultants to the Regional Staffs would strengthen services to local health departments and improve the programs in the specific areas. The Director of the Division of Local Health Organjzations believes, however, that before developing such positions we should first adequately staff local health departments.
Regional Programs
The regional offices are branch offices of the State Department of Public Health. These offices are located in Albany, Athens, Macon, Rome and IJ,Taycross. They are established and staffed for the purpose of decentralizing, as far as possible, the public health programs conducted by the State Department of Public Health, to make consultant and supervisory services readily available to the community and to coordinate programs of the State and local health departments. To local health departments not having commissioners of health the regional personnel render valuable administrative services which are quite helpful to local boards of health. M;:my direct services are rendered in unorganized counties and a limited amount in organized counties.

LHO - 2 In addition to the personnel previously referred to in this report
other staff members are assigned to the regional offices, These include Communicable Disease Investigators, Mental Health Consultants, and X-Ray Technicians.
During 1952 the regional staffs made 11,166 field visits in
conducting epidemiological and communicable disease investigations, midwife supervision, educational activities, environmental health services, tuberculosis control and consultant supervisory and administrative services.
Northeastern Health Region Annual Narrative 1rJ, B. Harrison, M. D., Medical Director
There have been a number of changes in personnel in the Northeast
Region during the year 1952. In this immediate office, Mr. F. E. Johnston
was tranferred to the Engineering Division in the central office, and was replaced by Mr. B. E.Ivy, who has been serving for about ten years as sanitarian in the Tri-County District of Habersham-Rabun-Stephens. Mrs. Prater who was on leave without pay at the time, tendred her resignation as Nutrition Consultant, and was replaced by Miss Jane Northington, who transferred from the Central Region on April l. On June l, Mrs. Sara T. Otto also transferred from the Central Region in the role of Mental Health Consultant. Mr. Bartley Wilbanks, CDI, resigned to enter private business.
Baldwin County was added to the Northeast Region and the Tri-County Unit composed of Baldwin, Jasper and Putnam was formed. Miss Laverne Johnson was appointed supervisor of the nurses for the district. Mr. Robert Gunby was employed as sanitarian in Baldwin County, and Mr. Fred Hemphill became sanitarian for the counties of Jasper and Putnam. In addition the following sanitarians were employed: Mr. Judson JVIalcolm, replaced Mr. W. N. Yates who transferred from Wilkes County to Berrien County. Mr. Otis Hill was appointed milk sanitarian in Hall County. Hr. E. F. Cooper replaced Mr. Murray Simmons in Hart and Elbert Counties. Stephens County employed a sanitarian full-time for that county, and Mr. George Rice was appointed to this position. Mr. Curtis Mewborn was appointed sanitarian for Habersham and Rabun Counties.
In the nursing field, Mrs. Melba 1,\Jells resigned in McDuffie County and was replaced by Mrs. Elsie Cofer, Mrs. Elizabeth Wheelis resigned in Morgan and was replaced by Mrs. Beulah Tipton. Miss Elizabeth Quinby, nurse in Wilkes County, is suffering from a serious illness, and Mrs. Helen Kish was added to the staff in that county. Taliaferro has employed a full-time typist. Mrs. Lee Ette Duke was employed as Public Health Nurse in Madison County 1;.1here there had been a vacancy for a number of months. Miss Peggy Ann Epps was employed as typist to assist Mrs. Duke in her work. In Oconee County l1rs. Mary Wade resigned as Public Health Nurse and was employed in Walton County, leaving only the typist in the office in Oconee. Mrs. Kathleen Bozardt was employed as Public Health Nurse in Habersham County, Miss Betty Jean Jolly was employed as Public Health Nurse in Hart County, and Miss Elizabeth Britt was employed as Public Health Nurse in Gwinnett County,
We lost, by resignation, Dr. John C. McGuire, Health Commissioner in Barrow C'lnd Gwinnett Counties.
Three new health centers were completed in Rabun, Clarke and Gwinnett Counties.
There is much demand for higher standards in sanitation as evidenced by the adoption of milk and food handling regulations, as well as those applying to general sanitation, which have been adopted by several

LHO - 3
County Boards of Health in th~ region, This office is cooperating closely with the Department of Education on both state and local levels in initiating the multi-million dollar building program.
lrJe feel that the addition of a Mental Health Consultant to our staff will produce much good as there is a steadily increasing demand for her services throughout the region.
The Nutrition Consultant not only serves the counties in the region, but has participated as Co-Director for the Nutrition Workshop held at the University of Georgia during a six 1iJeeks period in the summer.
Multi-phase surveys were held in McDuffie, Gwinnett and Jasper Counties. Blood survey was held in Oglethorpe County. All of this was done by the Regional C.D.I. personnel. Mass surveys were conducted in Hall,
Stephens, IAfarren and Wilkes Counties. Of the 1814 persons who were reported as contacts to syphilis, some more than 93 per cent were located and
examined.
Northwestern Health Region Annual Narrative
W. D. Cagle, -M. D. , Medical Director
During the year 1952, there were no serious epidemics in the
Northwest Region. Infectious Hepatitis continued to be a problem but not
so extensive as in 1951. A few scattered cases of diphtheria, scarlet
fever and typhoid fever were reported. Epidemiological studies were made where indicated. The Civil Defense Program continued to occupy much of our time and considerable progress was made in organizing the program.
Exclusive of DeKalb and Fulton Counties, there were four counties with commissioners of health and a staff which in most cases was not entirely adequate. Twelve counties, exclusive of health officer counties, have public health nurses; five counties have sanitarians.
Nursing service by the regional consultant nurses consisted of consultant services in the counties vdth nurses; midwife supervision and limited follow up services where indicated in counties with no public health personnel.
Conferences of the nurses of the region were held monthly with the exception of the three summer months. The attendance was good and much good has come out of the meetings. At these meetings, problems concerning the nursing program in counties were discussed and ideas exchanged, 1-rith an occasional speaker from outside the region.
Bi-monthly meetings of sanitation field personel were held. Problems were discussed and exchange of information resulted in keeping abreast of new policies. A short course in Radiation Monitering was held. Assistance in the design of school sewerage systems was given. Review of new school sites for the expanded school building program was made. Assistance was given regarding the recreation areas.
In addition to general routine inspections of school lunchrooms, tourist courts were inspected. Technical assistance was given in rodent and insect control.
Number of milk plants under superv1s1on was twenty and producer daries numbered two hundred ninety-three. Sixteen counties in the region

LHO - 4
have no milk ordinance.
Some type of work in nutrition was done in all of the counties in the Northwest Region except two. Many activities were carried out in one of the school programs. Fruit juices were served to everyone in the morning. Skim milk was given to those who could not afford to buy whole milk. Classes were taught in gardening, caring for chickens, hogs and calves. A week's course in canning was held during the summer. Gardens were grown by many who had never had gardens before. A nutrition course was arranged. Five lessons were taught. Sixty-two different people attended with an average attendance of twenty-seven. Most of the agencies . :i.nterested in nutrition were represented,
Communicable Disease Investigators continued routine investigations and follow-up referrals. Twelve mass surveys among industries, schools and one county fair were made and followed up. The results of the venereal disease program has appeared good. The number of positives has been greatly reduced, The number of cases of syphilis in the State at large has become insufficient to justify continuing the Rapid Treatment Center at Alto.
The duties of the three stenographers were carried out as outlined in the job descriptions. Among these duties are attending to correspondence, keeping records and reports, filing, answering phone and acting as Librarian. The Senior Stenographer visited the various counties and instructed local clerks in their duties. Some of the county clerks visited the regional office and were instructed in their duties.
Changes in personnel in the counties, without commissioners of health, were as follows: Three new nurses were added to the local personnel and five resigned; two sanitarians were added and one resigned; four new clerks were added and two resigned.
There is still a demand for health workers in the counties but owing to the shortage they cannot be supplied. Every county in the Northwest Region would accept health work in a more or less complete form, were personnel available.
Central Health Region Annual Narrative
s. C. Rutland, M. D., Acting Medical Director
Bi-monthly, monthly and quarterly Field Staff Conferences were held in addition to monthly Regional Staff Conferences. Eight new health
centers were completed or under construction, with 6 additional authorized.
Clerical
There was no change in personnel during the year. Three senior and two intermediate stenographers and one intermediate typist were em played in the regional office. Two senior stenographers assisted with training new clerks in local health departments in filing, reporting and
/
records. Files in all but 10 counties have been set up according to standard outline. Two local departments authorized employment of clerical personnel, leaving only 3 organized counties without clerks.
Engineering and Sanitation
Three members of the Regional Staff were on educational leave.
Sanitarians were added t~ 7 counties and one to the Regional Staff, Three

LHO - )
municipalities installed new water systems and two installed new se-vJer
systems. Major improvements were made to ll water supplies and 14 sewer
systems. Nineteen ordinances on food and/or milk passed. Under regional
supervision or directly handled by regional staff, there were 533 dairies, 403 school lunchrooms, 269 tourist courts, 68 hospital kitchens inspected.
Nine fairs and exhibits were handled by the staff and S Short Schools on
milk and/or foud. Assistance was given in the development of Callaway Recreation Area, and to the City of Macon in negotiations of exchange of property between City and State for the new hospital. A representative of Regional Staff was Chairman of Engineering Section, and member of Governing Council of APHA was also a representative on Council of Consultf,nLs,r~ational Sanitation Foundation.
Nursing
There were 17 resignations and 23 new appointments. All new staff nurses had orientation in approved centers or local health departments. The total program has expanded in all services. Emphasis was placed on the School Health Program through preplanning and postplanning discussions which resulted in 22 counties having hearing and vision tests, with follow through for corrections, by local civic groups. Small groups have met monthly for staff conferences besides the quarterly regional conferences. Institutes in Midwifery and Mental Health were held at strategic points. A Pilot Study for M. S. H. patients was begun with 6 counties participating. Three Public Health Nurses were on education leave. All counties in the region have tuberculosis registries with files set up to correspond. Much time and effort was given to the preparation of Open House, Fairs and Exhibits.
Nutrition
One Consultant returned to duty in August after educational leave. Besides usual consultation to local health departments expanded services rendered during this year were: shared in the orientation of 2 public health physicians, 1 rrcental health consultant, 1 district supervising nurse and 1 county staff nurse; gave assistance in planning exhibits for 2 new health centers; prepared and presented first of a series of television programs; participated in an institute on midwife supervision and a 3 day school lunch managers workshop. Greater emphasis was given to: cooperation with other agencies to bring nutrition information to the public; shared home visitations; nutrition as it relates to crippled children and chronic diseases.
Communicable Disease
Venereal disease is still a problem but the tendency seems to be a decrease in new infectious cases. Case finding is the principal mode of operation in locating contacts, Numerous surveys have been conducted within the Region during the year, both on a county-wide basis and as "spot" checks. Two counties have expanded their clinic services to include treatment of patients from surrounding counties, due to the closing of Alto Hedical Center.
Southeastern Health Region Annual Narrative J. F. Hooker, H. D., Hedical Director
One of the outstanding accomplishments has been in organizing the Southeastern Health Region into health districts, resulting in six additionol counties being under the administration of commissioners of health and their nurse supervisors.

LHO - 6
,'>.pplications were made for the construction of nine health centers, One Hill-Burton hospital was completed in Bacon County and one approved for Pierce County,
The regional office lost one engineer and a sanitarisn on temporary assignment by transfer and an additional sanitarian was assigned to the staff who now is on educational leave, lpJith assignment of sanitation personnel to seven (7) adrlitional counties, twenty (20) of the twenty-two(22)
in the region either now employ sanitation personnel or have established a
budget for them.
Considerable work has been done on the Valdosta, Savannah, and Brunswick milk supplies and these supplies have been surveyed and placed on the U, S, P. H, S, list of 90% or better milk sheds which is circulated throughout the United States by U,S.P,H,S.
Consultative assistance was given to county sanitation personnel regarding their food programs and emphasis on the school lunchroom program was continued as in the past,
"' disastrous tornado struck Alapaha - Hay, 1952, demolishing the elevated water tank and approximately one-half of its buildings. The staff of the Regional Office supervised the establishment of improvised central -vratering points, the installation of a pneumatic water tank and repair of water lines, spraying of the area for insect control and numerous other activities in an effort to safeguard the health of the disaster victims.
Upon our recommendation to the local health commissioner a drainac;e project was completed by local forces at Homerville and another such project has been under consideration at Pearson.
Great progress has been made in the sanitation condition, particularly in the improvement of the heating system of tourist courts, JVIuch time has been spent with the local sanitarians in consultation with them regarrling the technical details of approval of these systems.
Nursing person0el in the region shows gain of 1 supervisor and 3 public he2.lth nurses. Ten nurses attended VD course at Alto; one nurse attended Premature Course at Crawford W, Long; two nurses took orientation in tuberculosis at Battey Hospital; one nurse attended course in Mental Hygiene at Columbia University; two nurses completed courses offered by the University of Georgia, and three nurses have been granted educational leave.
The Midwife Institute this year was outstanding and aDproved by all those vrho attended, including doctors, nurses and three midwives, Favorable comments about the Institute have been received from all persons attending,
Lowndes County Health Department and U, S, P, H. S, started Biological Survey of the rodent population in Lmvndes County. This survey differs from all other surveys due to its extensive nature which includes a premise by premise inspection, dusting, trapping and poisoning vJhere rodent infeetation is detected on every premise in Lowndes County. The cost of the above program is she1red jointly by the above mentioned parties.
Five cases of typhus fever were reported during the year 19)2, The C, D. I. 1 s held seven county-wide surveys in 1952; 14,962 persons were tested in these; 2,542 S, T, S. 1s were taken routinely as contact investigation; 122 new cases of G. C, were uncovered; 59 new cases

LHO - 7
of syphilis and 49 cases of syphilis were returned to treatment due to in-
adequate treatment.
There were four C. D. I.'s in the Regional Office at the first of the year; at the present time there are only two.
Oriented ten nurses nevJ to public health in nutrition in public health.
Overt-Jeight, a major problem, was selected as a special project. Conducted nutrition classes for two groups of midwives. The special hookworm project should be completed soon, we believe, with interesting results.
"'ssisted at tuberculosis, diabetic and M. C. H. clinics throughout the region.
Southwestern Health Region i\.nnual Narrative 0. F. Whitman, M.D., Medical Director
The Southwestern Health Region, "'rith headquRrters at iLlbany, is composed of twenty-eight counties in Southwest G8orgia. The total population
of 446,119 (1950 census) is about equally divided among the white and
colored. Thirty percent of the population is urban and seventy percent rural. Diversified farming vath increased livestock production is raising the economic level in the rural areas. The growth of industry is causing a migration of farm workers to the urban centers.
;~p-proximately forty-four percent of the region's population, located in seven counties, is served by basic public health personnel. Fifty-six percent is without public health medical service except what can be rendered by regional 2nd central offices. Five percent of the population located in three; counties have no local public health personnel. Ninety-five percent of the populatLn have local public health nursing service. i\pproximately forty-two percent of the population located in seventeen counties do not have the services of a local sanitarian or public health engineer.
To give this segment of the State's population basic public health protection, additional personnel must be secured. Seven district medical officers, twelve sanitarians and thirty-eight pu'olic health nurses are needed. ''lhile existing services have been improved, little or no progress has been made to secure the needed personnel for complete basic coverage.
New health centers have been erected in Thomas, Hitchell and Brooks counties. New and more adequate centers have been secured in Tift and Lee Counties. Dooly and ir<Jorth counties have renovated existing centers.
Irwin and Hiller counties have harl county-wide health test surveys. L diagnostic and treatment center for venereal disease to serve twenty-five counties in this region and one county in the Southeastern Region was opened in ;"lbc=my at the Dougherty County Health Department in December.
The sandy soils, moisture and mild -winters of this section are well adapted to the production of hookworms. Hookworm infestation continues to be a problem in the rural areas, reaching as high as sixty percent in many of the schools. Rural electrification has resulted in estimable improvement in rural sanitation, however, those areas not having this service show little or no improvement.
,n increased interest in nutrition and a desire for more help and

LHO - 8
information has been noticed among some of the local nurses. some schools are doing definite health and nutrition 1tJOrk, but the need for more educ2tion of teachers and school officials along these lines is still urgent.
In-service training has been stressed for dl public health personnel. Huch interest has been stimulated in the mental health aspects of Public Health through regular meetings of the personnel. The short courses of venereal disease, tuberculosis and the care of premature infants hJ.ve been well attended by the nurses. The short courses offered to S2.nitarians and engineers have also been well attended. Four nurses and one sanitarian aro taking postgraduate ltJOrk in public hea.l th and one sanitarian is completing undergraduate study. The moving picture, 11 ,' ll Hy Babies", 1><las filmed in Dougherty County 2nd promises to be an outstanding film for teaching mid~rii ves.
Three crippled children's clinics are operating in this region on a monthly or quarterly basis, giving rise to increased interest in this phase of public health.
Mrs. Mary Christopher, of the Grarly County Health Department, received the ;,bbie Roberts ~veaver ,\ward for outstanding achievement.
During 1952, the Southwestern Health Region has shown estimable progress in many areas because of the faithful devotion of its vwrkers. We are confident that progress will continue in these areas and that practical solutions will be evolved to cope with deficiencies. It is hoped that local coverage with basic public health personnel will be stressed at all levels, which in our opinion, should have priority over everything else. Too much money, time and effort is being expended on specialized programs.
In-Service Training
During 1952, 2 physicians and 1 administrative aide completed the requirements for a Haster of Public Health degree under the sponsorship of this division. it the close of the year 3 public health sanitarians were on educational leave at recognized schools of public health. Upon the satisfactory completion of their courses of study they will h2ve met the reqp:irements for a Haster of Public Hea.lth degree. Twenty sanitarians completed the twelve weeks course of study conducted by the Public Health Service at Columbus and returned to local health departments.
Continuing a program started several years ago for the purpose of familiarizing medical students with public health and the place of
public health in the local community, 6 medical students worked in local
health departments during the summer months under the sponsorship of this Division.
In cooperation with the Division of l'1ental Hygiene a three day short course in mental health was conducted for the lccal commissioners of health and regional medical directors. This course while serving its primary purpose also afforded excellent opportunity for the mental hygienu staff and consultants to obtain a fuller undc;rstanding of public he2.lth as practiced in local health departments.
This Division and the Division of Public Health Engineering, in cooperation with the Georgia School of Technology conducted a short school for the county and regional sanitarians and engineer~. During the intensive three day course nm11cr concepts and practices in environment2.l health services 1..rere emphasized,

LHO - 9

To provide continuous in-service training for the personnel of the division a plan for quarterly 3 day conferences was developed and inaugurated. Program analyses and administration problems are agenda items, The conferences are arranged by a different committee each quarter and thus offers opportunity for development of leadership and staff participation, Uniform interpretation of procedures and policies is one of the objectives of the plan. J~nother is making this information available to county health department staffs during regularly scheduled regional and county health department staff conferences. In-service training of this type is essential and will result in more efficient public health programs and administration,

Public Health Center Construction Program

~men Hill-Burton Funds became available(October 1947) 24 health
centers and auxiliary health centers were classified as adequate to meet
the community needs. Since then counties have taken forward steps in providing functional health centers to meet the needs for expanding public
health programs. On December 31, 1952, the status of the health center
construction is:

I, Health centers completed during 1952

Wayne County Thomas County Effingham County Mcintosh County Burke County Brooks County Dade County

Clarke County Gwinnett County Heriwether County Rabun County Mitchell County Floyd County Evans County

II, Health centers under construction

Douglas County Charlton County Walton County Berrien County

Polk County Richmond County Jenkins County Butts County

TII. Health center projects approved for construction

Jones County Appling County Pike County Muscogee County Carroll County Coffee County Baldwin County

Hart County Peach County Putnam County Coweta County Glynn County Macon County

Since assistance under Federal Public Law 725 and State Act 62, 40 public health centers and auxiliary centers have been C' 'ns tructed in 27 counties, On December 3~ the Division had on file 23 applications for
assistance in public health center construction, The total estimated cost
of the 23 projects is $1,692,725,00.

Local Health Departments

Bee:inning in 1915 with two organized local health departments ad-
ministered by a full-time public health physician, such departments numbered
22 in 1924; 33 in 1934; 42 in 1944 and 49 in January 1952. During the year

LHO - 10

the commissioner of health of Barrow and Gwinnett Counties resigned. On
December 31, 1952, 47 county health departments were operating under the
direction of a full-time commissioner of health,

A summary of reports of personnel and facilities shows as of
December 1952 local health departments were employing 25 commissicners of health; 10 assistant commissioners of health; 471 public health, graduate and clinic nurses; 20 public health engineers; 151 public health sanitarians; 244 clerical persons and 238 others including dentists, dental hygienists,
veterinarians, case workers, nutritionists, educators, x-ray and laboratory
technicians- a total of 1157. The summary shows 47 counties (57% of Georgia population) employing commissi ner of health; 136 counties ( 94.8% of Georgia population) employing nurses; 76 counties ( 58.3% of Georgia population) employing engineers or sanitarians; 126 counties ( 89.3% of Georgia population) employing clerical persons; 48 counties were operating dental clinics with part-time dental clinicians and assistants, and 104
counties operating maternal, infant and well-child clinics with part-time
medical clinicians and part-time nurses.

The number of full-time public health workers employed by local

health departments as of December 31, 1952, as compared with the previous

year is as follows:

1951

1952

Physicians Dentists Dental Hygienists Public Health Nurs~s Clinic Nurses Public Health Engineers Sanitarians Other Sanitation Personnel Health Educators Nutritionists X-Ray and Laboratory Technicians Hedical Social Workers Public Health Investigators Clerical and Statistical Personnel Custodial,Maintenance and Other

36
3
5 397 52 23 98 40
3
1
13
5
7 246 115
l,o44

39
3 6 428
43 20 114
47
2
2
28
4
9
244 172 1,161

Local health department expenditures during 1952 totaled $4,547,999.56 or $1.36 per capita. Of this amount $1,434,503.15, 43 cents
per capita, was grant-in-aid from the State Health Department. Per capita
figures are calculated for the population of the 139 reporting counties.

Compared with 1951 there was in 1952 an increase of $606,138.00 in total expenditures by local health departments and an increase of $202,418.99
in State grant-in-aid funds. These increases are accounted for by the
adoption of the new pay plan effective July 1 and by the change in the basis
of calculating the number of public health workers from the 1940 census to the 1950 census.

Gains have been made in developing local health departments. These
gains have brought marked improvements in Georgia's health. But many Georgia
counties have not developed and staffed local health departments to meet
their responsibilities nor provide the desirable minimum services and programs
Sixty counties have never employed a commissioner of health; 43 counties have never budgeted for such position; 6 counties have never employed

LHO - 11
personnel in any one of the disciplines and as of December 31,1952, 20 counties had no local health staffs and 10 of these had no budgetary provisions for full-time personnel in any of the disciplines, The greatest number of counties with health departments administered by full-time commissioner of health during any year was 56 in 1940, four years after the inauguration of the plan for state grant-in-aid to assist in financing local units. Of the 139 counties operating local departments on December 31,1952, 13 had no full-time clerical persons;63 had no sanitation personnel and 92 had no full-time medical directors, Only 3 counties had full-time dentists. In addition, with few exceptions, the local departments were under-staffed in other disciplines, particularly public health nursing and nurse supervision,
This Division's objective has been the development of well-organized, adequately staffed local health departments to conduct programs based on the needs of the respective communities. This goal,though not met,becomes increasingly necessary if the State and local governments accept additional public health responsibilities in programs of hygiene of housing,accident prevention,mental health,nutrition, and chronic diseases,which necessarily includes research,case finding,follow-up,health education,and rehabilitation.
To develop such local health organizations to administer such programs consideration must be given to the solution of several problems, Georgia has 116 counties with a population of less than 20,000;53 being under 10,000 and 10 under 5,000. 35 counties have a population of 20,001 to 50,000, and only 8 have a population of over 50,000, all of these 8 larger counties are operating health departments with full-time commissioners of health. Only 39, 25%, of the counties of less than 50,000 population h<we commissioners of health. The present state plan divides Georgia into 54 health districts,of these 4 are single county districts and the others comprise 2 to 5 counties. The policy written into the plan for financial assistance to counties in grant-in-aid and allocations for public health center construction incorporate this plan, Thirty-one of the proposed health districts have a population of less than 50,000.The plan, in the opinion of the Director, should be revised to divide the State into 36 multi-county health
districts;30 with population of approximately 75,000 each and 6 with popu-
lation of 100,000 The State Department of Public Health grant-in-aid plan should provide for a well qualified medical director,nurse supervisor,senior public health engineer or sanitarian, and chief clerk for each district and constitute the basis of calculating additional grant-in-aid to the counties composing the district.
Public Health Services
The summary report of services and activities attached to this report shows basic services were rendered in varying degrees in every.couot.y. The report reflects some imbalance in the program. This is due largely to lack of adequate staffing in many county health departments, Generalized services are improving and are expanding to include more services in the field of mental health, maternal and child heaJ.th clinic services,health education and school health.
Recruitment and placement of qualified personnel continues as our major problem in providing and balancing public health service programs designed to meet the needs of the respective communities.

Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson
Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel

SPECIFIED ACTIVITIES BY COlli~TIES:

I

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Venereal
I Disease Control

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Jill~UARY l - DECENillER 31. 1952

Tuberculosis Control

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Jack ::m Jaspe r
Jeff )avis

SPECIFIED ACTIVITIES BY COUNTIES: JANUARY 1 - DECEMBER 31.- 1952

II

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Di sea sa Contro 1

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Tuberculosis Control

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SPECIFTED ACTIVITIES 8Y COUN'l'IES,

Communicable Disease Control

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JMTUARY l - DECElilBER 31, 1952 Tuberculosis Control

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S2ECIFIED ACTIVITIES BY CClillJTIES:

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JANUARY l - DECEMBER 31, 1952 Tubercula sis Contra l
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Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson VYalker Walton Ware V'iarren Washingto.a Wayne Webster 'Nheeler VVhi t e 'dhi tfield -vYilcox Wilkes Wilkinson Vforth
TOTAL

SPEGIFIED ACTIVITIES BY COUNTIES: JANUARY l - DECEMBER 31 1952

l Communicable Disease Control

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Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow
Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee

SPECIFIED ACTIVITIES BY COUl'JTIES: JANUARY l - DECEHBER 31, 1952

l Maternal & Child Hoalth

Infant & Preschool Hygiene I School Hygiene

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Chattooga Cherokee Clarke
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L I I ~ SPECIFIED ACTIVITIES BY COllliJTIES: JANUARY l - DECEMBER 31, 1952 Maternal & Child Health Infant & Preschoolilygiene [ School- Hygiene

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Evans Fannin Fayette Floyd Forsyth Franklin Ful-ton Gilmer Glascock Glynn Gordon Grady Greene
Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irvvin Jackson Jasper Jeff Davis

SPECIFIED ACTIVITIES BY COUNTIES: JANUARY l - DECEMBER 31-. 1952

I
I Maternal & Child Health
I

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-

School Hygiene

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Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin McDuffie Mcintosh Macon Mac3.i son Marion Meriwether l\fJi ller Mitchell li.IJonroe Montgomery Morgan Murray Musco gee Newton

--~---

l - -- - - - ---------------,---------------------: SPECIFIED ACTIVITIES li_-:(_COUNTI_ES: ___j"Al~UARY 1 -:- DECEJ:lBER ~ 1953

.

-~--~-

~- -~~ ~- --~-----

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Infant & Preschool Hygiene I1 School Hygiene

j~

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Oconee Oglethorpe Ps.u1ding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Scrove.n Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor

S2ECIFIED ACTIVITIES BY COTJNTIES: JANUARY l

1~ternal & Child Health i Infant & Preschool Hygiene I

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L,r1_-

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Telfair Terrell Thor,-,as
Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson 'fvalker Walton 'Nare
~ivarron
VJashington V1fayne 1Jebster Wheeler Vifhi to 'Nhi tfiold Vlilcox WilkE::JS Yfilkinson Horth
TOTAL

SPECIFIED ACTIVITIES BY COill~TIES:

JANUARY l - DECELJBEH 31, 1952
----,----------~---~-----:--------------

1

Maternal & Child Health

, Infant & Preschool Hygiene 1 School Hygiene

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309 1574 392 1350 314 1681 277

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Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb
Bleakley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee

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SPECIFIED ACTIVITIES BY COUNTIES: JANUARY 1 - DECEl!lBEE 31, 1952

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Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett
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Telf'air Terrell Thomas Tif't Toombs Towns Treutlen Troup Turner Twiggs Union Upson 1Na1ker Walton Ware

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6 236 3351 36 997

2756!

I'OTAL

i 758 2472 3474 12183 20598 46762 92820 250978 1201 15662 458282 3044 77988 813694 ',

i I

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STATE DEPARTMENT OF PUBLIC HEALTH
DECEMBER 31, 195Z
I

HEALTH REGIONS

REGIONAL OFFICES

N. W,
N.E.
CENTRAL
s.w.
S. E.

ROME ATHENS MACON ALBANY WAYCROSS

STATE DEPARTMENT OF PUBLIC HEALTH
PROPOSED HEALTH DISTRICTS DECEMBER 31, 1952

G a.ADY

THOMA a

TENNESSEE

NORTH CAROLINA

i 0.36

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LEGEND:
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DECEMBER 31, 1952


STATE DEPARTMENT
OF PUBLIC HEALTH



Division of Public Health Nursinq

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ASSOCI,I\TE DIRECTOR

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................ ASSOCIATE DIRECTOR

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ASSOCIATE DIRECTOR



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

DJVJSJOj\J OF
PUBL JC J-J tJ-\L-rJ-J j\J lJ f~S JJ'JG
'J 9 52

C0 NTE NTS

I.

PHILOSOPHY & OBJECTIVES

1

II. PERSONNEL--EDUCATION, SALARIES, ENPLOTI1ENT, RESIGNATIONS 2

III. TRAINING AND ORIENTATION 16

IV. IN-SERVICE EDUCATION: INSTITUTES AND WORKSHOPS 18

V.

FIELD \rJORK: STUDIES AND SURVEYS 2'3

VI. INTERDIVISIONAL RELATIONSHIPS 26

VII. COMMITTEES: MEETINGS: CONVENTIONS 28

. . . . . . . VIII. SUMMARY OF VISITS AND MEETINGS

29

IX. STAFF NURSES' FIELD VISITS AND IMMUNIZATIONS 30

X.

WHAT 1S AHEAD FOR 19)3? 32

I
PHILOSOPHY AND OBJECTIVES
11 Public Health is pooplo11 --honco any public health program m ich
achieves its purpose must be centered on people. Cicero said, 11 In nothing do men more noar ly approach the gods than in giving health to people 11
Public Health nurses comprise the largest group of professional workers who are dedicated to providing care focused upon people and their needs, W1erever they find them in home, school, clinic, or industry.
Their opportunity is great in helping to bring to fruition the dream of Preventive Medicine and public health as expressed by Dr. Rosenau vJhen he said: 11 It dreams of a time when there shall be no unnecessary suffering and no premature death, when the welfare of people shall be our highest concern, and it dreams that all this shall be accomplished through the wisdom of man . 11
The major objective of the Nursing Division is to help each public health nurse achieve the necessary vJisdom to help people solve their own problems and meet their own needs. This can be accomplished only when all nurses have understanding of and appreciation for people as individuals--a vision of what they may become physically, mentally and emotionally. In addition to the competencies to help people achieve these goals, nurses must have a broad understanding of the significance of their work, and its relation to medicine, social work, engineering, sanitation, nutrition and education.
Scientific, social and educational advances have broadened and deepened the concept of public health nursing. Public health nurses recognize tho need for a unified and integrated approach to health care and are working VJith professional groups within and outside the health department, such as schools of nursing, educators and citizens groups in analyzing, planning and implementing a community health program.
- 1-

II PERSONNEL--EDUCATION, SALARIES, EMPLOYMENT, RESIGNATIONS

At the end of the year vle had a total of' 466 public health nurses or one nurse to 7,390 population. We need 222 more nurses to provide the accepted ratio of one nurse to 5,000 population.

There were 135 counties with public health nursing services at the end of 1952. The distribution of nurses according to the 1950 population shovJS great disparity in the different counties.

Table I

POPULATION PER PUBLIC HEALTH NURSE IN COUNTIES No. of

Population Counties 10

~c.o

30

40

50

60

70

per nurse

15,000 +

10,000--14,999 5,000--9,999
Less than 5000

NOTE: There were 24 counties with no public health nurse. (See Table IV)
There were 90 appointments to nursing positions and 19 transfers to state participation giving a total of 109 appointments; 52 resignations and 3 retirements. There was a total of 492 public health nurses including
regional and specialized consultant nurses (5 district orthopedic nurses
on the state level) employed in Georgia on December 31, 1952. (See Table V)
On July 1, 1952, the State Heri t System reclassified all public health nursing positions which inaugurated a new pay plan bringing the salaries in Georgia more in conformity with other southeastern states.
The study of nursing salaries for a ten year period showed an increase at six different periods. It is also interesting to note that graduate. nurses in public health were on the same pay level as clinic nurses prior to 1947. (See Table III)
Twenty-seven of the 109 nurses who were employed during 1952 had had at least six months of training in public health. The remaining 82 had not had preparation with the exception of 21 who had orientation in public health prior to their appointment. We were fortunate in gaining 2 consultant nurses, one as a regional consultant nurse and the other one in the field of Epidemiology. In addition to these tvm, one of our local supervisory nurses was promoted to the regional consultant nurse position. (See Table II)
- ~-

1947 1948
1949
\..J
1950
1951 1952

408

. .. . . . . 437

- ~
e13,

470

494

492
LEGEND
-.No. of nurses having no public health education
~No. of nurses having less than a year of public health education ~ 1 1 .!No. of nurses having one or more years of public health education

cz::
!:C
til
tz:l
til

z.0t..J..

cttz:J::l

0

()

"cU::
Ill

>
1..-..3.

... z .__, I:"'

0

C)
:I:
>tz:l
I:"'

0
lzj
>
I:"' I:"'

>
I:"'

~iii'

0 CD

>C:: H H

:1X-3:

I.l.:z.".j.'

~ .....

0 !~:C

(>)
j

II I ,.....

0Z
til

...0
""-..1

I
,.....

...0
U1 N

Salary 300

Table III SALARY STUDY - 1942--1952
of
Clinic, Graduate, Public Health Nurse and Supervising Nurses

275

250

225

,..Cll
Ul
z::s z

oz
~

..ua.. ..:.x.:

0 l) Ill

175

~~~

150

125

100

75 50

25

0

~I N '<t' .0....'

('I")
'<t'
.0....'

'<t' '<t'
.0....'

ll'l

-.!:1

r-

00

0'

'<t'

'<t'

'<t'

'<t'

'<t'

.0....'

.0....'

.0....'

.0....'

0...'..-

0

.....

ll'l

ll'l

.0....' .0....'

N ll'l
.0....'

- 4-

Table IV
STUDY OF COUNTIES WITHOUT PUBLIC HEALTH NURSES
1948 --- 1952

1948

1949

1950

1951

- 5-

Table V

APPOINTMENTS & RESIGNATIONS - 1952

Legend

Appointments - - -

- - 90

Reg. Consultants- 1

State Office Cons. 1

a Resignations -

sz

Reg. Cons. - 1

0 Retired

3

-6-

APPOINTMENTS AND RESIGNATIOl\TS AND
TRANSFER FROM LOCAL TO STATE PARTICIPATING BUDGET

January through December 1952

APPOINTMENTS

NURSE
Public~th Nurse Consultant - 24

EMPLOYED IN

Dick, Miss Lillian

Epidemiology Division

Consultant to Local Public Health Nurses - 23

Maloy, Hiss Hary Louise

Northwestern Region

Public Health Nurse Supervisor - 21

*Bradley, Mrs. Elizabeth Brockinton, Miss Laura E. Ellison, Miss Adrienne J. Johnson, Miss Laverne

Fulton County Cook-Echols-Lanier-Lowndes Muscogee County Baldwin-Jasper-Putnam

Public Health Nurse - 19

Acree, Mrs. Louise H. Barnwell, Mrs. Ruby B. -~marrett, Hrs. Nan H. Beavers, Hrs. Hazel C. Bevan, Hrs. Nettie A. Duke, Mrs. Lee Ette H. Fairey, liliss Vernon Garner, Miss Ann D. ~~Hendon, Miss Helen C. Hilgerson, Mrs. Ardith A. Jenkins, Hrs. Victoria fl..
Johnston, Hiss Julia 1. Joiner, Hrs. Hary B. ~<-Jones, Hrs. Nar j orie C. Lackay, Mrs. Helen R. -~~Langley, Hrs. Hary 1. Mansell, Hrs. Frances P. McCarty, Mrs. Cynthia J. Hetzger, Miss Doris Joan -~~Nelson, Miss Edna L. Olive, Mrs. Frances I. Robinson, Nurse Lillie Ruth Shay, Mrs. Barbara 1. Steinbrenner, Miss Jeanne H. Thornhill, Miss Grace Wall, Mrs. Sue Agnes \oJilliams, Miss Carmel

Spalding (Special School

Cobb County

Proj.)

Fulton County

Treutlen County

Fulton County

Madison County

Fulton County

Fulton County

Fulton County

Fulton County

Fulton County

DeKalb County

Dougherty County

Fulton County

Bibb County

Fulton County

Fulton County

DeKalb County

Fulton County

Fulton County

Huscogee County

Fulton County

Muscogee County

DeKalb County

Spalding County

Fulton County

Dougherty C.ounty

Nurse Midwife - 19

Blackburn, Mrs. Margaret Thelma Scott, Mrs. Betty R.

- 7-

Lamar County Lamar County

.APPOINTMENTS (Continued)

Graduate Nurse in Public Health - 16
Bray, lvirs. Eunico C.
-:~Beasley, Mrs. Geraldine D. Blankenship, Mrs. Verna Mae Boyd, Mrs. Hargaret E, Bozardt, Mrs, Kathleen B. Brady, Mrs. Augusta H.
~~Bragg, Mrs. Sadie Long Brinson, Mrs. Sara P. Britt, Miss Laura E, Brogdon, Mrs. Ruby Davis Brown, Mrs. Kate Sutton
~~-Brown, Nurse Lillian Carithers, Mrs, Doris P.
~~-Cliett, Mrs. Ann R. Cofer, Mrs. Elsie C.
i~Cole, Nurse Martha P. Cooper, Mrs. Kittye M. Craft, Mrs. Dorothy R. Cummings, Miss Sallie L. Drake, Nurse Gracye P. Dukes, Miss Gladys Dunham, Mrs. Eloise M. Eason, Mrs. Addie L. Easterlin, Mrs. Thelma D. Griffis, Mrs. LaTrelle M. Haley, Mrs. Synthia Ann Hall, Mrs. Winnie D. Heriot, Mrs. Delle A. Hinely, Miss Betty Jean Hughes, Mrs. Evelyn K. Jackson, Mrs. Lucille Johnson, Mrs. Mary Frank Shy Jolly, Miss Betty Jean Jones, Nljlrse Artie Mae Jones, Mrs. Irma Joanne Jones, Nurse Lannie Mae
-:~Kelly, Hrs Julia J. Many, l1rs. Juanita B. Haroney, Mrs, Gertrude S. May, Mrs. Eloise F. Miller, Hiss Faith Miller, Hrs. Natalie J. Mills, Mrs. Alberta J. Hitchell, Mrs. Amber J. Hitchell, Mrs. Nell E. Monk, Mrs. Delenith M. Nease, Mrs. Ann C. Polk, Nurse Evelyn Elizabeth Raines, Mrs. Alma A.
if-Robinson, Hrs. Nadeline E. Rankin, Hrs. Hilda L. i~Rebb, Hrs . .Ansley M. Simmons, Hrs. Hartha tf. Slappey, Hrs. Nora V>T. Strickland, Mrs. Rebecca C. Taylor, Nurse Cora Lee

- 8-

Clarke County
Chatham County Wilkinson County Bartow County Habersham Cm nty Chatham Chatham County Jenkins County Gwinnett County Berrien County Elbert County Chatham Ccu nty Elbert County Chatham County McDuffie County Chatham County Ware County DeKalb County Camden County l)eKalb County Bulloch County Wayne County Fulto1D. County Crisp County Pierce County Muscogee County Jenkins County Fannin County Lowndes County Richmond County Decatur County Sumter County Franklin County DeKalb County Muscogee County Chatham County Chatham County Liberty County Walker County Lee County Wayne County Bibb County Muscogee County Mitchell County Honroe County Huscogee County Chatham County
Muscogee County Worth County Chatham County Fulton County Fulton County Meriwether County Dougherty County Coweta County Bibb County

APPOINTMEl'ifTS (Continued)

Graduate Nurse in Public Health - 16 (Continued)

Warren, Nurse Corine B. -lr'V!atson, Nurse Eloise G. lrJheeler, Mrs. Geraldine 0. lrJhitmanl Mrs. Irene H. Williams, Mrs. Delle 1. ;Millis, Mrs. Irene \foodall, Mrs. Jeanette H.
Public Health Clinic Nurse - 14

Richmond County Fulton County DeKalb County Dougherty County DeKalb County Fulton County Upson County

Chastain, Mrs. Frances R. -lrCrawford, Nurse Aretha N.
Dugger, Miss Evelyn Groover, Mrs. Ida G. -lrMarshall, Nurse lvlary Louise
Sires, Hrs. Claudia L. Sloan, Hiss Faye Snyder, Hiss Helen -lrStone, Nurse Nellie H. vJall, Hrs. Virginia J. Woodruff, Hrs. Bessie B.

Clarke County Fulton County Fulton County Fulton County Fulton County Bibb County Thomas County Fulton County Fulton County Fulton County Fulton County

-lr Transfer from local to state participating budget

RESIGNATIONS

Nurse

Employed In

Consultant to Local Public Health Nurses - 23

R.eason for Resignation

Haloy, Miss Hary Louise
Public Health Nurse - 19

Northwestern Region Program was not 1-Jhat she expected

Clemons, Hiss Hilda C. Cole, Miss Jean W. Harmon, Hiss Alma P.
Hendon, Hrs. Helen c.
Hogan, Miss Mary V. Holness, Nurse Harie J. Jenkins, Hrs. Victoria Johnson, Mrs. Ruby H. Jolley, Hiss S3:ra .
Joiner, Mrs. HaryB. Lambert, Nurse Ida P. Haynard, Hrs. Hell Meyer, Hrs. Annie B.
Moore, Mrs. Clara S. Nelson, Miss Edna Olive, Hrs. Frar~es I. Richards, Hrs. Evelyn H. Snodgrass, Mrs. Nell H. lrJheeler, Hrs. Lillian W.
Wheelis, Mrs. Elizabeth F.

Fulton County Gilmer County Huscogee Co. Fulton County Fulton County Fulton County Fulton County Wheeler County Dougherty Co. Dougherty Fulton County Carroll Co. Houston Co. Walton County Fulton County Muscogee Co. Fulton County DeKalb County Treutlen Co. Morgan County

Enter Armed Services Moved out of County
I l l Health & Aged Parents
Accept position elsewhere Temp., Returned to Hospital Temporary position Hoved from city Home Responsibilities Enter Armed Services Change of Plans Personal Reasons Employment elsewhere Hoved away
Naternal Reasons To be nearer family Haternal Reasons Accept position in hospital Family Responsibilities Haternal Reasons Hoved from county

- 9-

RESIGNATIONS (Continued)

Nurse

Employed In Reason for Resignation

Graduate Nurse in Public Health - 16

Certain, Mrs. Elizabeth R. Cliett, Mrs. Ann Mt Dillard, Mrs. Lorena Y. Dunham, Mrs. Eloise M.
Forrest, Mrs. Miriam 1'.
Franks, Mrs. Margaret B. Garland, Miss Myrtle E. Gober, Mrs. Mary T. Griner, Miss Faytie Mae Johnson, Mrs. Nell K. Jones, Miss Billie Joyce Kelley, Mrs. Josephine G. Kimbrell, Mrs. Theresa H. Miller, Mrs Natalin J. Mills, Mrs. Alberta Joyce Nonk, Nrs. Delenith M. Phillips, Hrs. Hinnie L. Prochaska, Mrs. Agnes E. Rivenbark, Vrrs. Audrey F. Robinson, Nrs. Nadeline E. Shipp, Mrs. Lucille T. Trulove, Nrs. Sarah J. lvatson, Mrs. Virginia B. \-Jells, Mrs. Melba B.
Hilliamsm, Mrs. Grace z.
Wright, Nurse Pauline T.
Public Health Clinic Nurse - 14

Muscogee Co. Chatham Co. Dodge County Wayne County Brooks Co. Franklin Co. Fulton County Nadison Co. Upson County Tift County Harris County Barrow County Dougherty Co. Bibb County Muscogee Co. Muscogee Co. Screven Co. Camden Co, Floyd County Chatham County Lowndes Co. Towns County Bulloch Co. McDuffie Co. Liberty Co. Muscogee Co.

Maternal Reasons Maternal Reasons Unknown Personal Reasons Moved out of county Maternal Reasons
Maternal Reasons Dissatisfaction with work Home Responsibilities Enter Armed Services Maternal Reasons Naternal Reasons To join hustand inS. C. Husband going to l~rmy Maternal Reasons Accept position as office nurse Husband returned from Korea Unknown Leaving city Moved out of state Moved out of county Illness Maternal Reasons Maternal Reasons Home Responsibilities

Butler, Nurse Virianda VJ. Comer, Nurse Freida Kendricks, Nurse Ethel Marshall, Nurse Mary Louise Sabbath, Nurse Willie L.

Fulton County Fulton County Fulton County Fulton County Fulton County

Unknown Unknown Unknown Temporary position Unknown

Johnson, Miss Vesta C. Mosley, Nurse Ruth H. Mosley, Nurse Frances

RETIREMENT
Fulton County Bibb County Richmond County

- 10 -

Table VI DISTRIBUTION OF PUBLIC HEALTH NURSES
IN GEORGIA LEGEND:
'-----11 No Public Health Nurse
One Public Health Nurse i If 2 - 5 P. H. N.
p,,,,j 6 - 10 P. H. N.
More than 10 P.H.N.
-ll-

Table VII
POPULATION PER PUBLIC HEALTH NURSE*

Under 5,000

,.....~ 5,000

9,999

..~

~ 10, 000 14, 999

V2lZI2J ...t5, ooo Up

No Public Health Nurse

*Based on number of nurses employed December and 1950 census population.
- 12-

Table VIII

- 13 -

aa-a-

aaa---

P..

0 a- .".<..t.' ::J

0

0

,..LC) 0

G)

0

"tt 0

0 0 0

0 0 0

l:l
::J

LC)

.0....

.L.C...)

I ~ 8~

1952

RATIO OF PUBLIC HEALTH NURSES PER POPUlATION IN U. S.

States

Population

Number of Nurses Population per nurse

Alabama Arizona Arkansas California Colorado Connecticut Delaware District of Col. Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Haine Haryland Hassachusetts Hichigan Hinnesota Mississippi Hissouri 1 Hontana Nebraska Nevada New Hampshire Ne'!tr Jersey New J'v1exico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Ut2h Vermont Virginia
1rJash~ngton
\Vest Virginia I'Jisconsin lrJyoming

3,061,743 749,587
1, 909,511 10,586,223 1,325,089 2,007,280
318,085 802,178 2,771,305 3,444,578 588,637 8,712,176 3,934,224 2_,621,073
1,905,299 2_,944,806 2,683,516
913,774 2,343,001 4,690,514 6,371,766 2,982,483 2,178,914 3,954,653
591,024 1,325,510
1.60,083
533,242 4,835,329
681,187 14,830,192_ 4,061,929
619,636 7,946,627 2_,2_33,351
1,521,341 10,498,012
791,896 2_,117,02_7
652,740 3,2:91,718
7' 7:!.1,194 688,862
377,747 3,318;680 2,378,963 2,005,552:
3,434,575 290,529

197 167 100
1,965 204 606
94 173 362
454 68 1,017 440 248 185 2_53
207 136 429 1,185 728 389 188
365
56
112 23
149
1,343 113
3,175 446 49
1,030 185 139
1,692 190 242 30 316
794 112
74 420 311 142
433 34

15,542 4,489 19,095 5,387 6,496 3,312 3,384 4,637 7,656 7,587 8,656 8,567 8,941 10,569 10,299 11,640 12,964 6, 719 5,462 3,958 8,752 7,667 11,590 10,835 10,554 11,835 6,960
3,579 3,600 6,028
4,671 9,107 12,646
7,715 12,072 10,945 6,204 4,168 8,748 2_1,758
10,417
9' 712 6,151 5,105 7,902 7,649 14,124
7,932 8,545

-14-

Table IX
TYPES OF HEALTH PROGRAMS LEGEND:
.___ _.J Counties with no health personnel r//@ Nursing counties
Health officer counties
!t Health officer districts .,.r-J&uzi Regions
- 15-

III
TRAINING AND ORIENTATION
The guide of policies and standards prepared last year by the Orientation
Committee was used in 1952 in planning the orientation of graduate nurses to public health. During 1952, only 27 of the 90 newly appointed nurses
had had at least six months of training in public health. This left 82 for whom some type of orientation to public health must be planned. Plan I, which provides for a two months' period of which one month is spent in an organized health commissioner county, two weeks with a county nurse \.vorking alone and two weeks of observation in various related agencies, was
used for 14 of the graduate nurses entering public health. In some
instances it was impossible for the new nurse to leave her home county and in these cases Plan II, which provides for a one month period in the home county during which time a supervising nurse will introduce the new nurse to the job; cr Plan JII, which prcvidcs for_ the introduction of the nurse in her home county by the regional consultant nurse and covers a period of six months of less concentrated supervision, was used. Five
nurses were introduced to public health under Plan II and 44 under Plan
III.
A program in tuberculosis was developed as a part of the orientation of newly appointed nurses in public health. This program consisted of one week spent at Battey Hospital. Lectures, demonstration, observations, visual aids, case study reports, role playing and visits to hospitalized cases were used to familiarize the nurse with methods, procedures and complications in the diagnosis and treatment of tuberculosis. Thirty-five nurses attended these classes which were held at four different periods-March, Apri 1, October and November.
Fifteen nurses took advantage of state scholarships to improve their public health nursing background. This academic work was taken at schools of public health which prepares the nurse to return and take her place in the health team.
One nurse had a course in superv1s1on as a part of preparation for the position of district orthopedic nurse.
Seven public health nurses took the one month course "Care of Inrrnature Infants" at Crawford Long Hospital during the year. For a coordinated program it was planned that a public health nurse and a hospital nurse from the same area would take this course at the same time. However,
this was not possible during 1952.
One nurse elected a course in Mental Hygiene for better management of problems of guidance and adminis~ration.
- lb-

TyPes of Educational Programs for Public Health Nurses for which Scholarships were Provided
1948 - 1952_

Public Health Nursing - - - - - - - - - - 42 35

8

9-:~ 15

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

2_

Orientation -- - - - Prior to Assignment - 18 10 15 13 21

Care of Premature Infant - - - - - - - -

9 28 13 17

7

Extension Courses - - - - - - - - - - - -

12 26

Supervision in Public Health Nursing

1

Midwifery - - - - - - - -

3

Mental Hygiene Workshop -

----

3

Mental Hygiene - - - - -

----

1

Senior Cadet Nurses

10

Orthopedic Nursing

1

Industrial Hygiene

1

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

1

TOTAL

83 89 63 41 45

~~ Included was a specialized consultant nurse in Chronic Diseases.

Institutes, Workshops and Short-Term Courses For Which E~penses Were Provided In
19SO --- 1952

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

6 31

Mental Hygiene and Tuberculosis - - - -

---- 1

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

1

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

3

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

1

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

---- 1

Child Growth ~nd ~evelopment - - - - - -

---- 1

Georgia Heart Association Convention - - -

----

7

Cardiac Nursing - - - - - - - - -

---- 6 1

Health Education \iorkshop - - - - - - - - - - - -

2

2_

Venereal Disease Control - public health nurses

74 72 51

Venereal ~iseaso Control - students from schools of

nursing - -

195 101

Orthopedic Nursing Body Mechanics - - - - - - - - - -

3

Gerontology - - - - - - - - - - - - - - - - - - - - -

1

Cardiovascular Diseases - - - - - - - - - - - - - - -

5

Nursing Service Administration in Hospitals &Public

Health Agencies

l

TOTAL

291 214 61

- 17 -

IV
IN-SERVICE EDUCATION, INSTITUTES, WORKSHOPS
Regional Consultants
The regular quarterly regional consultant meetings planned by a rotating committee started in 1952 with a meeting on exhibits. Exhibits of all public health services which were available to nurses in Georgia -vms displayed, discussed and photographed. The interest from this meeting extended to the next quarterly meeting which resulted in a Utilization Clinic of Audio-Visual Aids presented by the Communicable Disease Center of United States Public Health Service.
Local Supervisory nurses throughout the state participated in one of the quarterly meetings: -- the topic -- 11 Evaluation of performance of the public health nurse.u
For the final meeting of the year the team approach was stressed. All disciplines represented in the Local Health Services held their meeting at the same time. A joint program was planned as well as sectional meetings for each discipline. This represented a new approach to solution of common problems and was so successful it will probably be continued.
State Office Nurses
Weekly conferences have been held throughout the year with the specialized and generalized state office nurses for the purpose of correlating special services with the generalized public health program and solving of common problems.
A two day mental hygiene conference was held by the staff of Mental Hygiene Division for the nurses in the state office to discuss application of mental hygiene to all phases of public health nursing.
Local Nurses
In-service education programs for county nurses have been planned by local committees using programs to meet the felt needs of staff nurses. Members of tho Nursing Division as well as memeors of the specialized divisions have participated in these programs.
MatGrnal & Child Health
Midwife Institutes
Three day institutes for midwives and nurses were planned over the entire state by Maternal and Child Health Division. One member of the Nursing Division lead each panel in the discussion of 11What a nurse expects of a midwife and what a midwife can expect from the local nurse. 11
- 13 -

Table X MOTHER AND BABY CARE CLASSES

Legend
Classes Taught - - - U7

c::J Certificates Issued

1415

-19-

JVIaternal & Child Health -- JVIother & Baby Care Classes

Throughout the year cooperation with the Jviaternal and Child Health Division has continued in Instructor Training of American Red Cross, Unit II, JVIother and Baby Care Classes. Supervision of instructors in the Hall County class was completed and a new group of 18 instructors from DeKalb and Fulton County received their instruction. It is hoped that nurses in all regions of the state will soon have had the opportunity of these classes.(See Table X)

Number of Nurses Had Course i Taught Course

98

61

JVIother & Baby Care Classes
........... .9.~':l::?.:?..~.S..... ~C::\l:g~-~: ....................................9.~.:!=:'~-~:f.~.C..~~.~~.... J.~.S.~.~-~ ... .
1950 !1951 '1952 j: Total 1950 ! 1951 [ 1952 i! Total
48 : 41 28 .. 117 . 543 473 399 1415

Chronic Diseases
During the year in-service education programs in Chronic Diseases were held in four regions. Assistance was given by a member of this division in planning the content of these meetings, securing help from other divisions, preparing reference and teaching tools and presenting material. Such subjects as rheumatic fever, cancer, diabetes and cardiovascular diseases were covered.
Chronic Disease materials prepared and distributed were: a guide for public health nurses observation in tumor clinics, glossary, bibliography and patient instruction aids in diabetes, a set of guides for planning home visits to cancer patients.
One large county in the state held a five day institute on Cardiovascular Diseases. A nursing consultant of United States Public Health Service and a member of this division participated in the planning and presentation of the nursing aspects of cardiovascular control.
A three day Chronic Disease Seminar held in Atlanta by the United States Public Health Service, Region VI was participated in by all members of the Nursing Division. This meeting was attended by nurses representing schools of nursing and public health agencies as well as nutritionists and health officers.
Assistance was given in a two day program on diabetes planned by Emory University for their rural nursing affiliation area.
Workshops
A work conference in Nursing Service Administration held at Teachers College, Columbia University, New York, July 28 - August 1), 19)2, was participated in by a member of this division. The Kellog[ Foundation give financial support to the conference. The participants consisted of 24 institutional and public
health nurses with representation from 14 states, Canada and South America.
Three work groups functioned independently with rotating leaders and recorders. Written reports from each work group were distributed to the entire group daily. The main problems selected were:
- 20 -

Group I

11\rJhat are the: implications of interpersonal relationships in the c:tdministrative process 11

Group II - 11 Continuity of patient nursing care11

Group III - 11 How can nursing service administration assist nursing service staff in giving comprehensive nursing carG11

At the request of the Instructional Supervisor, a member of Nursing Division participated in a three day School Health Workshop in Glynn County. There was a total of sixteen consultants representing three states participating in this group work. Hany worthwhile recommendations were made by the teacher participants to the local dGpartments of education and health.

The short institutes at the schools of public health were taken advantage
of by nine nurses--Gerontology - l; Cardiovascular diseases - 5; Ortho-
pedic Nursing Body J.Vlechanics - 3.

Health Education classes at the University of Georgia were participated in for a three day period during the summer session.

Alto Medical Center
Public Health Service, Alto HGdical Center arrl VenGreal Disease Division personnel were joined by this division in planning a two weeks course for instructors of public health nursing from universities throughout the country. This work conference type of course given direction by two mem-
bers of United States Public Health Service was attended by 23 instructors
and a member of Nursing Division. Provision was made for work in small groups with group leaders and recorders. J.Vluch valuable material was created and assembled with suggested ways for its use. A "Suggested Outline for the Teaching of Venereal Disease Nursing" prepared by the participants has subsequeBtly been published by the National League of Nursing Education.
Fifty-one nurses were able to attend the short course for public health nurses at .i~lto Hedical Center during this year. This trainir1g program was discontinuGd with the closing of Alto J.Vledical Center October l, 1952;
however, during the period of time that training was available, 178 public
health nurses had this experience.
As a result of the courses in Venereal Diseases, sponsored by Public Health Service and the State Health Department, service to patients have improved, and nurses are finding a greater degree of satisfaction in working in this area.
The following map shows the number of student, graduate and public health nurses in attendance at the courses in Venereal Diseases at Alto Medical Center, and the place of employment at the time the course -vras t2ken.

- 21 -

Table XI

NURSES ATTENDING ALTO CLASSES -- 1950 - 1951 - 1952

Leg.:md

Public Health Nurses - - - 174

~If..,:

--Hospitals:

"11' Student Nurses

278

@ State Office Nurses - 2

.,.., Regions

Other Nurses Attending: 2 Foreign Nurses 2 Liberty Life Insurance Nurses
17 Peabody Public Health Nurses
- 22 -

v
FIELD WORK, STUDIES ANn SURVEYS
Field work this year has been made most pleasant by participation in Open House programs for nmv health centers. It is an inspiration to everyone to move into new quarters. Better work will be done because of adequate facilities and the stimulation of working in a beautiful building.
More intensive help to improve the effectiveness of the nursing program has been given regional and county nurses through longer visits to counties. This has included assistance with planning content of a broad.,. oned public health nursing program as well as that of an expanded school health program; analytical review of case loads of nurses; evaluation of methods of orientation of new nurses to the field.
Visits were made by the Chronic Disease Consultant Nurse to regional offices and counties for conferences and home visits for interpretation of program planning and visit content in cancer, diabetes and cardiovascular diseases. Visits were made to state-aid tumor clinics for interpretation of the contributions of the public health nurse in follow-up care of patients.
Five counties in the state were given concentrated time in program review and case load study.
Bibb County -- At the request of the staff nurses of this county through the regional consultant nurse, a study of field case loads, district boundaries, clinic ar.d school loads of each nurse was made. The general recommendations were: each nurse should carry a generalized case load; districts be divided so each nurse has some city and some country territory; nurses be relieved of non-nursing activities; nurses be given more field supervision.
Fulton County -- The United States Public Health Service Regional Nursing Consultant and a member of the Nursing Division were requested to do a time study and program review of the nursing staff of Fulton County. Huch of the statistical data was collected and the periods of time study by both supervisors and staff nurses were completed by tho end of the year. Inter-
pretations and recommendations will be completed in 1953.
Burke, Screven and Jenkins Counties This tri-county health unit was also given concentrated time in program review. As many changes in nursing personnel were taking place, the recommendations were made as future goals.
Promotional work was done with Haternal Child Health Division in relation to the special school project in the tri-county unit of Spalding, Pike and Lamar Counties. Records were reviewed with the idea of eliminating duplications of efforts and simplifying the school and orthopedic service. This division participated in planning for and reviewing the tri-county nursing service.
A study of staff nurses' monthly calendars of activities submitted during
1951 was completed. Two aspects were considered: (l) Time planned for
home visiting, school, clinic and office work; (2) Number of calendars submitted by each nurse.
These d2.ta were summarized by regions and distributed to regional consultant nurses. Suggestions were given for follow-up and futuro use of the
- 23 -

calendars as a supervisory tool in assisting nurses to plan their work. It was found that the nurses planned to devote the following time to the various types of activity considered,

Home visiting -

40.1%

Clinics - - -

25.4%

Schools - - - -

9.5%

Office - - - - - - - 15.3%

The number of nurses sending in calendars each month varied from 28.5% to 85% among tho regions in the state.

Schools of Nursing
A survey with Georgia schools of nursing and selected health department personnel who have worked with schools of nursing, was started in October and will continue into next year, The purpose is three-fold--
To determine:
1. In what areas schools of nursing and health departments have worked together in behalf of student nursing education.
2. Whether health departments have a responsibility in nursing education. If so, what is the philosophy with reference to this responsibility?
3. How schools of nursing and health departments can work together
in the future.
The survey is being made through individual interviews with schools of nursing personnel and with selected health department personnel. Eight schools of nursing have been visited for this purpose. Although the survey is incomplete, the data obtained from interviews show that schools of nursing and health department personnel believe health departments definitely have responsibilities toward education of the student nurse. This survey already reveals the need for more joint planning between schools of nursing and health department personnel.
At the request of an instructor, a member of Nursing Division gave assistance BO Grady School of Nursing in constructing a course in Communicable Disease Control for junior nurses, with consultation from the Educational Supervisor of the State Board of Nurse Examiners.
At the request of the Macon School of Nursing, observations for students in various areas of public health were arranged, Selected visits were subsequently made by students with public health nurses to homes, schools and clinics.
School Health
At the request of the Director of Health Conservation Services, a member of the Nursing Division spent considerable time in the school health program. The schools are interested in expanding the school health program because of the Georgia Minimum Foundation Program for Education moving along so rapidly.
The regional consultant nurses requested a discussion of "A practical school health program for a one nurse county." The basic school health material
- 24 -

was covered at one of their quarterly meetings. Following this meeting, similar presentations were requested for the county nurses. Several methods were used to disseminate this basic school health material.

1. Large meetings of all staff nurses and supervisors in a region.

2_. Smaller meetings of staff nyrses in part of one region.

3. Group meetings of staff n~rses in a few surrounding counties.
4. Periods of three-days to a week spent with individual nurses in
visiting all teacher groups in counties.
5. Preparation of a manual of available school health material for use
by teachers and public health nurses. Many areas have reported a closer relationship and better understanding of oach other 1s problems by both Departments of Health and Education following those processes.

6. As the need for a Lea lth room in each school became more widely recognized, questiCJns arose as to amount of space and equipment necessary. Intere~ted personnel working in school health from both Georgia Department of Education and Department of Public Health produced 11 Suggested p:j_ans for School Health Rooms. II These included three possible floor plans for health units in small, medium and large school buildings.

To further depict a school health room in operation a miniature wooden model was made by the Georgia Laboratory Mechanic in his small workshop. The model was then furnished and equipped with miniature furniture by a member of Nursing Division. This exhibit was in constant use over the state in school health work as well as other health meetings.

As the school building program progressed members of the Health Department were requested to review floor plans for school health rooms. To save space in some plans cots for sick children were being placed in the teachers' lounge. To assist in eliminating this error a second miniature exhibit was prepared. To make this model a more versatile one movable partitions were provided so it could be used ~s school health, clinic conferences, or home visiting exhibits. JVIost of the same miniature furniture would fit into all exhibits. Following are the floor plans which can be arranged by the movable partitions:

Home Visiting

School Health

Clinic Conference

I [~f;fllJWJulr ' ~ _!rP~~5,St_A-~_-i"'

" .....
l\ OD .-,

"J1I:--~-!---!To--

EX4MJNII<tl1( DD 1"1

,1

If-______, ~

CDIIFERf"Atal

"ll ROLli>']

-

W~tTIW6-
Roo "'l

- 25 -

VI
INTERDIVISIONJ~L RELATIONSHIPS
Although Nursing Division is primarily a service division and has \-Jorked closely with other divisions, this year there has been a broadening of teamwork. This teamwork can be demonstrated in such projects as: revievJ of plans for health centers with representatives from Maternal Child Health, Local Health Organizations and Hospital Divisions; serving as a member of the advisory committee to tho Training Division; participation in tho program of nursing education in Immature Infant Care training at Crawford Long Hospital; cooperative efforts with the Maternal and Child Health Division arn Health Education Division on revision of the pamphlet for recruitment of nurses for the course on Immature Care.
The specialized consultant nurses have worked through the Nursing Division in reaching the generalized nurses and correlating the specialties with the generalized work.
The Hental Hygiene Consultant Nurse has participated in planning as well as implementing in-service education programs for staff nurses, generalized and specialized consultant nurses and other public health 1-Jorkers. An effort has been made to stimulate an interest in Hental Health as a part of a total generalized public health program.
During the past eighteen months the Mental Hygiene Consultant Nurse and Tuberculosis Consultant Nurse have worked together ve~ closely in the area of tuberculosis nursing. Joint visits have been made to counties over the state at the request of the local public health nurses, assisting them in analyzing and dealing with difficult tuberculosis problems. An attempt has been made to improve services to patients through education in regard to the disease and a better understanding of factors involved in individual situations.
Two regional consultant nurses have expressed an interest in extending public health nursing services to families of patients in the state hospital at Hilledgevillo. Under the guidance of the Hental Hygiene Consultant Nurse six counties have been selected for the project. Public health nursing interest has been determined and details of referral worked out with the mental hospital. This is an area of public health nursing which has been neglected in the past, but it is felt that it affords many opportunities for service.
The Tuberculosis Consultant Nurse made demonstration home visits to tuberculosis cases with sixteen public health nurses in eleven counties in an effort to improve content of tuberculosis visits.
The consultant nurse assigned to the Epidemiology Division has worked with the Nursing Division in consultation with state, regional and local public health nurses on communicable disease surveys. Field investigations hav8 involved close contact with the local public health nurse in a demonstration of collecting and forwarding of blood specimens as well as use and interpretation of laboratory reports. Personal visits to private physicians stressed the importance of reporting of communicable diseases and the availability and usc of laboratory services. Especial attention was given to investigation and confirmation of suspected cases of Malaria and Typhus.
- 26 -

Consultation in hospital nursing has completed its third year in Georgia. The Hospital Nursing Consultant has continued to promote all activitiGs 'lrh ich has to do with implementing nursing services to the patients in our hospitals. Nursing needs have been defined through studies and interpretation.
The Hospital and ChrOJnic Disease Consultant N"urses have been members of tho Nursing Homes Study Planning Committee. Exploratory discussions have begun regarding plans for a survey of nursing homes in the state.
Consultation and joint planning has been done by Nursing Division--Chronic Disease Nursing Consultant in relation to in-service education programs on diabetes and cardiac nursing with the dietary and nutrition consultants; the directors of the Cancer, Cardiac and Diabetes Control Programs; the Hental Hygiene Consultant Nurse, Haternal Child Health and Crippled Children's Division personnel.
Hany of the divisions requested Nursing Division to participate in tho writing of their "Two-year Plan" for the United States Public Health Service.
The Division of Public Health Nursing has cooperated with tho Division of Health Education in preparing and setting up demonstration material at the "Open House" of new health centers. These divisions also jointly prepared a weekly article giving a word picture of the activities of the public health nurse working alone in a county.
The Director of Public Health Nursing Division worked with the committee chairman in planning for the Industrial Nursing Course '\~Thich was held at the University of Georgia, Atlanta Division, during the summer. The director also assisted the Occupational Health Division in carrying out tho recommendations given by Miss Winifred Devlin of United States Public Health Service regarding the Occupational Health Nursing Program.
Members of Local Health Organizations, Public Health Engineering and Nursing Divisions met with the architects of Department of Education to discuss requisites of a school health room. An exhibit of a school health room suitable for a combined elementary and high school was then prepared by a member of Nursling Division. Suggested floor plans for school health rooms were jointly prepared by the Department of Education Coordinator and a member of the Nursing Jivision. These plans were distributed to local departments of education and health.
- 2_7 -

VII
COMMITTEES, MEETINGS, CONVENTIONS
American Red Cross, Nursing Advisory Committee American Public Health Association, Nominating Committee American Nurses Association, Rules and Regulations Committee United Community Defense Services Georgia Association of Industrial Nurses, Advisory Committee to Education Fulton County Health Department, Advisory Committee for Training Program
State Depts. of Education & Health, Health Education Joint Committee
State Dept. of Health Training Division, Advisory Committee State Department of Health, Immunization Committee Atlanta Planning Council, Health Committee Atlanta Visiting Nurse Association, Board of Directors Committee for Development of Criteria for Field Training Centers Executive Committee of Georgia Public Health Association
Georgia League for Nursing, Committee on Constitution & By-laws
Georgia League of Nursing Education, Curriculum Committee School Health Committee-a sub-committee of tho Special Fields Committee of the
Teachers Education Council Georgia Department of Public Health, Critical Areas Committee Georgia State Organization for Public Health Nursing, Program Committee District V, Georgia League for Nursing, Ways and Means Committee U. S. Public Health Service Communicable Disease Center, Advisory Committee--
Audio-Visual Aids Annual and monthly meetings of Georgia League for Nursing, Georgia Organization
for Public Health Nursing and Georgia State Nurses Association Quarterly meetings of State and Regional Nursing Consultants Gear gia Bet tor Health Counail Fulton County Cardiac Institute Community Planning Council fficorgia Heart Association Annual Meeting lr'lork Conference for Administrative Nurses of small hospitals Chronic Disease Seminar Monthly Meetings State Civil Defense Organization--Public Health Section Georgia Hospital Association Meeting Southern Education Association Meeting for Collegiate Schools of Nursing PGabody College Field Training Center Workshop United States Public Health Service Communicable Disease School Supervision of Midwives Institute Fathers' and Mothers' Classes for Venereal Disease Patients, Alto Venereal Disease Classes for Public Health Nurses, Alto Curriculum lr'Jork Conference Sponsored by Georgia League for Nursing Community Hospital Field Service Educational Programs--Emory Tulane University Mental Hygiene Regional Conference Ardon House, Harriman Campus, Columbia University, Conference on Public Health
Nursing Care of the Sick11 Georgia Public H0alth Association Convention, Savannah American Public Health Association Convention, Clevoland Ohio Biennial Convention, National LEague of Nursing Education, American Nurses
Association,National Organization for Public Health Nurses
- 28 -

VIII

SUMHi\RY OF VISITS AND MEETINGS

Visits to health departments . 189

. Visits to regional health offices

. . . . . . . . Visits to hospitals

. . . . . . Visits to universities

. . . Visits to other agencies



Visits to clinics

...

37 29
8
8
. . 10

Visits to schools

32

Talks at meetings

. I

32

Average number of meetings attended during tho
year by each member of this division 40

- c9 -

IX
Statistical Data of
Field Visits and Immunizations by Staff Nurses

Field Visits:

1948 1949 1950 1951 1952

Communicable Disease Control - 17,235 19,339 18,037 19,907 15,871

Venereal Disease Control - - - 36,578 45,905 41,155 37,061 27,387

Tuberculosis Control - - - - - 48,138 50,411 52,332 59,064 59,849

Haternity Service - - - - - - 63,698 60,166 55,172 58,138 57,518

Infant and Preschool Hygiene- 12.3,377 93,293 90,092 103,384 118,279

- - - School Hygiene - - - -

- ------ 42,726 2.0,755 25,409 28~701

Horbidity Service - - - - - - 13,329 15,814 23,015 22,041 22,760

Cancer Control - - - - - - - - 704 1,143 1,366 1, 72.2 1,839

Crippled Children's Services - 7,769 2., 787 3,393 5,096 9,057

TOTAL

334,644 331,584 305,137 331,822 341,261

The number of completed immunizations for all diseases have risen during
1952. Hm-rever with the formulation of proposed new policies by the Immun-
ization Committee for all types of immunization, we hope to see a substan-
tial reduction in the number of typhoid vaccinations and a greater increase
in D-P-T immunizations. The conunittc;e has stated, 11 It is probable that the
number of typhoid vaccinations could be reduced 95% without affecting the
incidence of the disease. The enteric diseases have been controlled chiefly
through sanitatio~and immunization played only a secondary role ... at
the present time in Georgia, if routine immunization is employed without
regard for chances of exposure, one case of typhoid will be prevented for
every 40,000 vaccinations , 11 -~~

-lr Guide to Immunization Procedures for Public Health Personnel--Tentative Outline.

Immunizations:

1948 1949 1950 1951 1952

- - - - Small Pox - - - - - -

80,501 88,434 83,399 85,776 92,844

Diphtheria - - - - - -

51,919 27,607 19,049 15,180 13,121

Triple Vaccine D.P.T. - -

Q-)~-3~ 41,315 53,886 66,802 86,457

- Whooping Cough - - - - - -

29,82.5

0 14,246 11,953 11,570

Typhoid Fever - - - - - - 369,985 419,633 438,178 442,167 472,641

TOTAL

552.,2.30 590,398 608,758 62.1, 878 676,633

-~(-:~ The use of triple vaccine was started in 1949.

- 30 -

Table XII NUMBER OF FIELD VISITS
VISITS INCLUDE Maternity -Child Health--Crippled
Children--Cancer- -Communicable Diseases- -Morbidity-Tuberculosis Sick Care
- 31-

X
HHAT 1 S AHEAD FOR 1953
Revision of the orientation plans for graduate nurses entering public health.
Completion of survey of cooperative efforts of schools of nursing and hen lth departments.
Completion of Fulton County Nursing Time Study Pilot rroject with six counties to extend public health nursing service
to families of the mentally ill. Regional workshops on Chronic Diseases for local nurses. Program in selected counties to concentrate efforts in meeting the
needs of local nurses. This will include services of all specialized consultants Plans for regional institutes in relation to the exceptional child. We have reviewed the past year and now look forward to the programs for the new year. He hope our philosophy of helping others to help themselves is reflected in the above in-service educational programs for
1953. From these we hope the nursing staff will gain a broader under-
standing of the significance of their work and greater satisfactions in helping people meet their own needs.
- 32 -

~ THRVfl
fi{fjj flejf6 (!. !}ohrdan, %/ton c?ounfJ
Alu'Ue AJutlz /ftcd!e!h f!t_ljlj c?aunfy
~flR XR 110 n

ENVIRONMENTAL HEALTH SERVICES
Division of Industrial Hygiene Alb occuPATI:J:~AL HCl\Ll'H Division of Public Health Engineering Division of Typhus and Rodent Control Division of Water Pollution Control

Division of Industrial Hygiene

ANNUAL NARR.i\.TIVE REPORT DIVISION OF OCCUPccTIONAL HE}..J~TH DIVISION OF INDUSTRIAL HYGIEITE GEORGIA DEPARTLENT OF PU:RLIC HE..:cLTH
January thr0ugh Decenbor, 1952

FOPcE 1'TORD

For nany ye2rs it has boon realized th2t tho connuni ty in

which we livo presents problons of public health to all

those 1ft1ho li vo in such an area! These heFLl th problous re-

sult fron tho forces of tho connunity environnent inpinging on tho in-

hPcbitcnts, both individuall;~-' and collectively. The couuuni ty has tho

responsibility for providing certain safeguards to protect tho public health.

For oxanplo, it is accepted without question that tho cor.muni ty nust bo pro-

victed ~erith 2 s.".fe end wholesoLle drinking w2.tcr. "':o.cilitios for clislJosal

of sewgo uust be provided. In certain .:\roas the control of insects is

required in order to prevent the spread of diso2sos such as nale1ria. rthcr

cnviron:.1ontal probleL1S of puoli c health <>ro recognized E'nd propcrl;;r con-

trolled. l;ost of these involve application of certain engin8ering prin-

ci~1les in order to 2djust tho living enviromwnt to th8 point ''rhere it

is suitr.ble for hmwn habit2.tion. In certEdn 1,10rld B.reas toclay, 1,rhoro

those environuental control techniques for the protection of public heBlth

are not in force, one can see the devolopLlent and spread of epidoL1ics and

unc2lled-for huu,om wB.ste which HCC oup.omies these conditions.

It has now becoE10 cle~u that the working environuont in vJhich the ~worage individual spends one-third of his tiL1e L1aY also present ho2.lth hazc.rcls. l'lany th1os those are uuch uore couplex than generally realized. Recognizing this fact, Lwdern industrial uanager.wnt ha.s cone to assune tho responsibility for providing health safeguards in tho industrial onvirom:ent in orcler to uake th2.t area a satisfactory working place. The study, investil!2tion, evaluc.tion, and control of the 1'orJcing onvironncnt is a.n 2.cti vi ty cotmonly known as industri8.l hygiene.

Tho objectives of industriFll hygiene are to discovor, cl_ofine, cvalu2to, a.nd control those environr:1ental factors in an industqr 11rhich effect tho ho2.lth, 1,rell being, and_ efficiency of the workers. In order to accouplish this, it is necessary to have an understanding of tho L12.n c:md his role>tion to the tools 1rith '11rhich he works, the r.wtori2ls upon which he HOrks, B.nd the physical and chei:lical properties of the working environraent.

IF'I'RODUCTIOlJ During the first six nonths of 1952, tho Jlivision of the
State Health Dopartuont offering hc8.l th services to industry was known 2.s tho Incl_ustrial Rygicme Division. :?orsonnel inclucl.od in this Division was 2s follows: a uodical director, a chief inctustrial h;ygionist, two consul t8nt nurses, two chonical ont::inoors, four c'C.cuists, and four stonosraphers. In addition 1rc h8.d tho -.'Jart-ti'!O services of ? nutritionist
.left or Jul~r l , 1952 the Gc:orgia. DcJJ2rt:":en t of FulJl ic :Co<.l th
covised a nov fon1 of BduinistrFJtion at 1.d1ich tine tho Inc'ustrial Hy/'_ionc
1

Division ,_,~s cLivided into t,_,JO Divisions - the Industrial Hyf=;iene Division
1-rhich is res:~~onsi'ole for the control of the inc1ustrial environuent DrincipallJr b~i enGineering and_ cheElical methoo_s and the Occu-G?tionccl Ee.;lth Division Hhich is responsible for the me(l_ical asl)ects of.. the pro~ram. The
chert belo1:J sho''S this 1Jreakc1.mvn as it stands rt .. present.

Director (forusrly Chief Industrial ?ygienist)
Chemical Engineers (2)
Cheoists (4) Stenographers (2)

Director (Director of Preventc<.ble Disease Services now Acting Director of Occupetional S:ealtJ.J. It is hoped that in the neRr future the services of a doctor can be sec~red to fill this position)
Consultant I.'Turses ( 3) (One consultant nurse returned from two years active duty in the
u. s. na.vy)
Stenographers (2)

'l'hese t\vo Divisions will continue to operate as a team. The statistics for the ye2r 1952 are a combination of the achievements of the hro Divisions. Even ,,rith the viell-trained staff availa.ble, there are, however, o~casions v'hen it is necessary to request the service of specia.lists from the U. S. Public Hea.l th Service ~:md other allied state and fec:_eral af;encies. These services are freely available to us upon request and Pith their assistance it is possible to evaluate any hea.lth problew.

There are 5,000 factories and 15,000 mercantile osteblishnent s in Georgia. i!oro than 027,000 non-agricultural Porkers are GE-rnloyed. All of the present or prospective defense or va.r prodll.Ction la.bor forces of tho State are included among these. Probably less than 10% of those 110rkers enj o~r the benefits of a.n in-pla.nt health maintenance service. ThG ~--cal th Dorl<'rtncnt is the official 8f~cncy s;>ecifica.lly c~1arged ,,i th tho responsibility of a.ssisting these establishtwnts a.nd their em1lloyeGs in all hoplth natters.

;_:::jDICAJ~ AFD

eclical and nursing activities includG the investig<ttion 2nd

l'TJRSICG

rccorcHng of occupational (l_isoases, assista.nce in the con-

ACT:!:VI'=':rES

trol of non-occu11ational diseases cmd accidents, tho l'ro-

motion a.nd establishrJent of r,wdical and nursing services in

industry including cooperative hea.lth cerctors for suall

incl.ustries anc'c the este.blishoent of :woper .:mo_ adequa.te recorci.s. Also in-

cluded are tho promotion of general health maintenance procedures in in-

(l_ustry and the coorclina.tion of industrial he2.lth procr2E1S ,,ith the corar,mnity

hoP.l th prog:rams c-cnd all other resou::cces. Prograras dealing Hi th tu'oorculosis,

venereal clisGCl.sO, irxn:mi zc.tion, e~~e sith t conscrv2.t ion, nutrition, sani ta-

t ion, clental hygiene, and hcc.lth eclucation are 8EllJhasizec1.1rhenc"rcr l)ossiblo

tho same as the pro,~:ram for occu1)2tional disoase control.

IFD'lJST-='~AL

CJ1hE:::ce p.rc a few full-time industrial medical dopartuccnts in

H--:ALTH ijAIYTIJ- Georgia. 'J'hose a::ce usually found only in larger inc_J_strics

~~AI'CB I'O:R

:.:ven thouF;h it is 8stiEi2L;d that the suallcr ~llc'-nts GUlJlo~r

Si;LLL PLX-TS 90', of the ''or::::crs. One of tho uost significi'nt do"-c;loJJLients

2

in tho ind_ustrial hygiene program in Georgia is the promotion of full-th10 ind_ustrial health clinics for sraall plonts on a coopor2tiyo oe,sis -- o,-ch full-tinl8 clinic giving specialized_ health maintenance service to a nUlllbor of small plants. There are no bettor facilities to servo as nuclei round l>~hich to c'_ovelop civilian med_ical defonso than are afforctcd b;;c modern industrial clinics staffeo_ oy full-time specialists in industria,l health maintenance. Such clinics should oo estc',Dlishod throughout tho stE,to by the industries themselves in every industrialized area. '::'hoy prorido an effective answer to tho (l_omeno_ on tho pP.rt of omjJloyod lJOOlJlo for b8tter distri out ion and applice.tion of mocUcal ~::nowledg:e; and they '_ro 1-ri thin tho fremework of prive,te enterlJrize and divorced from goverm1ental 'ouroauracy. Industr~es 1--rhich have a medical dopartr,wnt arc bettor oguilJ~Jod to carry out anci 11rofit from tho fino_inr:s and rocommonc1_P_tions of ino_-o_striBl h~r!"-'icno surveys.

Tho idea of sr,Jall l'lent inclustrial health is i)ocoming '''lO_e sproao_ Bnd Llany various organizations e.re Hor~dng sopB.ratoly end_ ,jointly for tho pur:;_;oso of formul2ting and fulfiHinf, these ple_ns. Tho acting Diroctor of Occu~02tional Health is Etlso Vico-ChPirnEm of tho Committee on InC!_-~strial Foelth of tho Lcdical Association of Goor{-:ia. This is only one or~anization th2.t has a vital interest in this project.

At the present thw this Division is '''orl:ing in coo~ooration 1-ti th rcprosentE\t i ves of tho Fulton County ;iediCE\l Society, Industrial lTursos 1 Club, Atl2nta Chamber of Comwerco, Local and StC',to Hca_l th Depe_rtrnonts, Georgia School of Technology and Labor and i anageraent for tho lJur~:'oso of c:evololJing en 11Inctustrial He2lth Council of GrGe.tor Atl[\nta 11 Tho in-
clustrie,l llc::1lth oduCE\tion phase of this council, if esti:\Dlishocl, \-rill have
a two-fold purpose as stated belou:

For industry it will offer ,_,rays:
l. to improve efficiency
2. to reduce p,bsontoeism
3. to ouild ,cmcL mainte.in -,Jl<mt more,lo 4. to reduce turnover in cmployQc::nt

ror tho Cowmuni ty C:\S a. whole: It \-rill mnke availnolo upon request services, matoriBl s, and personnel from tho follm-ring COQ!,luni ty E\goncies:

i1odiCE\l Society Dental Society ~{ep l th Dep2.rtmont s Tuberculosis Association Rod Cross iToce,tional Rehabilitation Alcoholics Anonymous Georgia Com~ission on
Alcoholism

~C\E1ily Service Society Polio Founcl.nt ion Cancer Society Heart Association iTisi ting Furse Association :~cmtal Health Association i.-rolfaro Dopa.rtlllont Hospit~ls ~ Clinics

Tho acting Director of Clccu~~'""tional P'oo.l th COE1plctod his
COl:'c"";'J?'Jl'CE OF sorrico <"'.s Chairrllen of tho A.C.G.I.H. in ;,lJril 1952 anc

GOif'GBF JJ~'T.\L continuos to servo E\S 8, momlJor of tho Commi ttoo on Inclustrie.l

h:SUST?,IAL

:.Jygione Codes of the saJo organization. 'Chis or:s,<mization

FYGL"iriSTS

is tho ~00lic~c forming OOO.y of tho ste_te a.ncl federal G:OVCrn-

montal industrial hygioni st s. Tho now raothods in inc~ustri2,l

h~"giono Here discussed 2t t}w .\nnue,l !Ioct ing helcl concurrontl;:,r vri th tho

InC us tr i1Jl i,oo_i cal J,s soc i2.ti on, J,_J;wriccm Indus tri e.l H~rr:i0no .is soc i<'.t ion, tl1o

;.E1Crican .issociation of Industrial :t<Tursos ano_ tho !IJJOrican ;,ssoci2_tion of

Industrial Dentists.

3

During 1952, tho Director of tho Division of Inclustrio,l
TVgiono C1ttonclod the Qbovo mooting. Fo Qlso served on tho Comuittcc for the Development of Stcmde.rct L2bor"tor;{ Lcthocls C1nd_ tlo,_c ComDi ttco on Uniforra Lr'boling of Chemical Compounds.

.,i :~:s_r CJJ:

Tho acting Director of Occupationc\l Her'l th served ,,_s Vico-

l1C:DIC~~L
.,SSOCLT101T

Chc-\irmm of tho Inc_-o_strinl RoPl th Comi,li ttoo of tho iicdic2l
:,.ssocintion of Georgia. In ?cbnw.r;y-, 1952 he HRS ,._s:"::ocl

O~" tho Council on Industriccl ~or lth of tho __,L1Cricen liccl_ico.l

~'.ssociP.tion to pPrticip9to in "- joint stud~r lJy F'.n F'cl hoc

comai ttce to develop stRndPTcls for suall plnnt inc'ustriccl hee-l tll services.

This Committee had roprosontativos from vnrious states to present all phQsos

of industricl hoPlth such rs: Ci'\SUr'.lt;{ insur2,nco, first i',io_, h?giono,

rac:nc-.f;owont, mGdicino, nursing, occupF',tionc\l hoF'lth P,nd SP.fct~r. - (r.~ft of

rccomuondod sto.ndi"rds has boon completed C",nd prosontoo. to tho Council for

qJlJrovr',l and publicntion. Further work v:ill be dono rog2rcling this project

in tl1o fuh.cro C\nd lJlans Fill be formulC'.tod for putting tho icons into effect.

GEO:-:'GL~

This Division hns long felt tho need to impro'.~o tho visur.l

OPTOL:?:TRIC

'--'elfc=cro of tho people in industr7 i'nd olso,Hhoro. Tho <'-cting

~-~ss C' CLcT I C'-N

Director of Occupe.tion<'.l ~O<".l th served to coordin2.to tho

work of tho Georgia Optometric ;,ssoci<'t ion vi th tho Goorgi2

.:~.ssociC'.tion of OphthC'.lmologists and Ctorhinol9-r:;rnlologists ,,,hich led to the;

f ormnt ion of tho SouthoP.st ern Ind_ustrial Vision Council C'.no_ 2 s o. rcsul t of

his efforts ho WC',S voted 11 Han of the Yo;:~r in Optometry''

1'rORLD

Tho 'Torlc3_ Eoe,lth OrgP.nizc:.tion roquostod tho actin; Director

HJL.LTH

of Occupationel Eoalth to bo n spccio.l consulto.nt on Occupn-

ORGLNI Z.l.TIOH tional HcRlth to Turkey for three months. This mission 1'/P.s

coraplotcd in Docomoor, 1952. It is felt thPt this E1issioE

'""'s successful. L program WC'.s outlined of rosoi'rch, service n.nd oc_ucC'tion

for Turko;' s lJroposcd IncLustri!:tl Ec-".lth Institute in J".nlG'.r"-.

N~~D FOR
F::-'i!~LTH Ii..\D~
TEr:/:..liCE SZPVICES Ji'OR
ST:~TE
:8i ;?JJO"l'S':::S

This Division is frequently cPllod UlJOn to ?,dministcr first aid to omplo;yoos ;;nd pr>.sscrs 'by o.lthough ,,,c 2ro not oc1uip~lod to rono.er this service. ''o have long stressed the formC',tion of hoC'.l th maintono.nco soryicos for sraall plC',nt s--nost lnrgo ones h<"vo them. Plnns nrc being considered to provide such 8. service for st.~to OLlployoos in the now stC'.to offico 'building upon its completion.

GEOPGI.il.

Tho IncLustriHl Hygiene rncl Occupo.tionC'.l ~oolth Divisions

SJJCTIOH -

continuo to 'bo activo in tho nffnirs of the Geor~ia Section,

~~L3RICAN IN- ,;\_Llor ic2n Inctustri2.l Hygi ono ...ssoci Pt ion. In Do comb or, tho

DUSTRL\L

Georgia Section VJE\S privileged to hcPr c\ raost interesting

HYG-I.GlT:EJ i~SSOC. and tiLloly discussion by Dr. Cl2r<'. ~\C'rrett of the TubercU-

losis Control Division. Dr. En.rrott 1 s topic vns a report

of tho 7th Sr.ro.nnc Symposim1 in ,,,hich she di scussocl hc<'.l th

lJrol;loras portt:dning to 1rorkors oxnoscd b;.r inh9,l2,tion of industriP.l sub-

stC~.ncos.

CIVIL D'i1T''!J:NSE In ;:;_c1dition to other duties tho o.cting Director of tho

.L,CTIVITL~S

Occu}Jntionnl Hco,lth Division continuos to servo c.;_s Dop11ty

Director of tho Civil Doonso Hcolth Services. Tho Division

ha,s rocon tly secured tho services of pnothor doctor to hE'_n(l_lo tho e>drainis-

tr;otivo \rork rog[.rding Civil Dofonso ond n full-tirao socrotr'ry hP,S boon

CLlployocl. Two Consul tent Nurses hc\VO taught sovcrP.l clP.ssos OC~.ch in "Hurs-

ing ~~spocts of ~',tomic '-TC',rfnro".

4

GEO:OGil~.

One of tho consultCl.nt nurses '.'ith this Division 'J:>.s elect::::d

i.SSOCL,TIOi.ii President of tho Georgia .::cssocio.tion of Inclustrinl lTursos.

OF

One nurse iT" s nf'racd Publici t3r Chr.i nw.n of tho Georgia

IlTDUS TRI.t. L

Associi'tion of IndustriC'.l lTurses. ,\nothor consult<'nt nurse

l-"ITI2S:-JS

continued C'.S Ch""irrMm of tho :Cducrtion Comuittoo of tho sr'.IJ10
orgC".nizil.tion until :i:TovOi;1bor 1952. Through their efforts em

inclustrinl nursing course '"T<"S given C1t tho tlrntn Division of tho Univor-
sit2r of Georgia under tho lo<'.clorship of f'. visiting nurse frou t~10 U. s.

Pu~!lic F::::rlth Service.

GEOEGIA PUB~I C Soverrl ncnoors of tho Occup~t i one>.l EcC'.l th Divis ion vrcre
~1EHLTH -'-ssoc. roprosentod C'.t tho PnnuPl L1ccting of tho Georgi" Public
HcP.lth Lssocio.tion rnd wore o.ctivcly ongpgod in cOJ;u;1ittoo v.rork and in ne.king spooche s.

OCCUF~.TIOKAL In carrying out o. pllP.so of tho progrPm begun in 1951, both

D I S E /.. S~S

Divisions spent raore Pncl more tirac follo,,Jing up occupi'.tionnl

diseo.so reports subr;littod to tho Division L1rough tho ~:ork

r.w.n1 s Cor,1pens['.tion BoPrd of the Lebor Dcpnrtraont. lcmy of tho occupP.tionnl

disoRse reports received did not require follow-up cvaluP.tion, but reports

thCit vrerc in any 'He.y suspicious. vcro follm.rod up 1:Jhcn possible 2nd., in

scvcrnl instP.nccs, led to surveys of lJlC1Ets thPt would othenJisc h<wo boon

po s tponcd until some lnt or d<'to.

:r<:HGIN"J"'CEIHG Environwental control by tho Division of Industrial H7gionc

i\.i D CP:FDi 'ii C.;.L h<'.s encowpP.ssed i"mrk in a 1:Jicle VE1.riet;y of industries ci_uring

;cCTIVI'I'PJS

1952. For inst""'.nce, personnel fror.1 tho Division have

cFJrrioo. out stuo.ios in foundries, brick conprmics, pnpor

mills, fertilizer plP.nts, textile wills, Army e.nd Navy instnll:otions,

grPnito n.nd other stone qurcrries C'nd. shcd.s, aircr2.ft assorably plants, countzr

hcC'lth dopP.rh10nts, P.nd. others too nuE1Crous to LJontion.

Rowcvor, it should oe pointed out thcct tho :>ctivities of tho Division '''oro not confined solely to studios in industr;y. 12ny raccn-hours of effort 1rero spent oy sovorr'l of the ino.ustrinl hygienists in the field of Civil Defense ns rol?t:;d to rPdiP.tion woni toring. Such Fork involved. oxtonsi vo te,~ching of city Pncl. county ong~_nocrs 2.nd sr'ni tPri<:ms in tho public hc-~lth ?.spccts of r<"o.iolog::icF'l r,wnitoring 2nd survcx "ork.

Tho l<'.borr'tory section of tho Division founcl tir,lc to c,.,.rr:r out rosc<'.rch vJork in conjunction v'i th tho dovelopmon t of P. no1J C'ncl dr<'Dr'.ticCJll~,r effective <'.gent for tl1c control of hcnvy uotPl poisoning. This 1-rorl-c involved nmilcrous o,_rnluPtions of loPd nncl racrcur;y concontrC'tions in pntionts in hospitals in metropolitAn ~tlantn.
During the ~repr of 1952, tho Division of Industd.<tl H;r,-:;ionc
P.sswuod tho roslJOnsibility for tho lFJborntory phr'.SC in tho onforcoiJOnt prof'TPE1 of tho bodc1ing e.nd Emttross 1tJork in tho St<'"'to Hc."l th Dop2.rtracnt. This nc;cessi tC'.tod further trnining on tho p2rt of ono of tl1o i_nc~ustrir'l h~,rgiono chouists. T1,oT0 1proeks ,,rore SlJOnt o~r tho chOLliSt in obsorvPtion of boclcling lP.oorPtory 1'ork ~.n tho Lro.bor Dop2.rtmcnt in l:'OiJ York City ?.nd the Eo!"'.lth Doprrtmont in ECiltinorc.

Since the inc::option of tho Ind;,,striP1 H;ygicne Unit of tho T'ul ton Count~r Hor'l th Doprrtn1cmt, it h2s been the polic;{ of tl1e Steto Indu.striPl Hyc;icno Lobor!"'.tory to crorry out lnborrotory "ork for this count~r
unit. This CJ.ssistPnco '"'"s continued in 1952.

5

STUDIBS OF IT- During 1952, the health hazard associated ~ith the

DUS T?I AL RAD IUl i handling of radium and ra,dioe,ct ive materials '.ras in-

PIWC:SS :) IrG

vestigated in three separate installations. ' 1ith the

assistance of the l~8tional Bureau of Stand8ros in 'Tash-

ington, radon oree.th and atmospheric 1.'ork room samples ''ere perforraed on

all ind.ividuals exposed. This 1.1rork carried us into the instruraent section

of an airline installation, into an Army Ordnance insta,llation, ancl into

a civilian watch shop.

~'TALUATION OF

In 1951, an extensive program of evalua,ting the hec:.l th

X--:oAY CLIFICS AFD hazc.rd in the use of shoe-fitting fluoroscopes vras in-

SEOE-FI TrrilTG

itiE'.tecl. This pro'T8m was continue( in 1952 and ex-

~LUORCSCOFSS

panded to incluCie eve.luEttions of X-ray f8.cilitic.s in

county hePl th 0 apartments and mobile X-r2;y trailer illli t s.

It is antici1)ate.d th<'t this phase of industrial hygiene activity 1.1ill be

freatly accelerated in 1953.

STUDF:S ItT THE Since the ee.rly 1940's efforts have been mac'.e to assist

GEAlJIT:S SEEDS IN the Emnc'-ger,1ent of the stone o~uarries anCI sheds in 'Slllert

ELJERTOlJ

County in the development of control me2.sures required

in this type of inclustr:r. Over the past fe,,,, :re2rs, the

crec:t r.mjority of sheds in this area h2Jre instaJ.led., D2.rtl;y at ollr instiga-

tion, enr~ineering ecru.il')J,lOnt for the control of th: s oust hcozord. In 1952,

all insta,lled ec1ui})r,1ent ,_,as surve~recl to ascert2.in its effectiveness 2S a

control me2.sure.

I l;DUS '::'? I.AL

Frequently industries v1ith defense contra.cts Bnd g:ovcrn-

--YG-EJ.E ACTiifi- mental military install2tions request assist2.nce in a

TIZS IF DE':"El:SE ,,,ri(l_e vc>riety of problems. "~ork of one type or another

IFDUSTRBS

has been carried out at the Atlc:nta General Depot, u. S.

Army Arsen8.1 in August<?' the ~ 8COYl :'cval n:rcn2.l1CO r~lcnt'

" 1arner ::Cobins Air 1i'orce :GBse an0. tlw T_,ockheed. ~\.ircrc:ft LSS2TJ1l'ly Plant in

;:arietta. It is anticipated tha.t t'lc c:;:cellcnt COOl)erc>.tion c=~istL1g ll::::t-

,_,ocn these governrdental ar;encies and tho Division of Inf.ustri2l "'~r:_?:ienc

,._,ill continue in 1?53.

sr:rcTD:'.'"':S IN r::':t"J'J 'I'llis Division "'cS Cc\llod upon b~r n1cU18.f':CL1ent in the

POUJRRY F'SO-

poultry processing industries to c>ssist theiJ in clevising

CESSI G nr::usr:-;:cv uethoos for the control of odors resulting from the pro-

cessing of entrails for tho conversion to fertilizer anf

poultry feeds. An ef~cctive IJethod was devised Pnd a mocifiocl installBtion

of this ty}e was installed furing the ye-r. rhe division also assisted i~

tho clevclomnent of a propos eel. seni ter;.r code for t~'lo :ool,_l tr~r Jrocessing

incl_ust ry.

~D'TCA':::'I0]'AT,

It 'ems lleen tho :oolicy to encourPf-:O ecluc2tional trc:ining

:-PJUri G

in ac1.vanced phnsr:s of industrial hygiene j .rork. One of

tbe inc~ustri2l h;ygienists has ta~cen achrantc:cge of this

opportunity ancl is a.tteno.ing,. at this tiEw, ?:c>rvc;rcl Univcrsit~-.

riSI::'ORS

During 1952, fifty-four visitors hc>.Ye been rocorC:.cd in

the guest boo~c. ':'here ,,,rcro four st:.tos m1CI. so,_-on foreign

countries represented. One of tho visitors was from ~urkoy, and when tho

acting Director of tlle Occurl9.tional T~calth Division 1:'2.S on his assir:nuent

to Tur:~ey ho renc''Cd the acouainta_nce.

6

PP::::JS-::~-~ AlTD

In .?ddition to continue,tion of routine services, it is

CO~'T:S! P:r~AT"SD

planned to er,J:;_)hasize the following: l) continued guid_an(.;e

PL'".2'S

of estaolished small plant cooperc:\tive he:c-lth Elaintenance

centers and promotion of additional centers ttroughout the

st2te; 2) closer integretion of the industrial nursing consult2nts 1 ':'ork
~ith the engineering and chemical aspects of the progrem; 3) corrdination

of the industri.?l heel th )ror:rem "'i th overell medicel civil defense end

~weparation for '"'ertime racliolocic8l defEmse; 4) contl_nued coo>.leretion ,,i th

the U, S. Fuolic =--ePlth SerYice in occupational dise2.se ro;)orting sno. more

effective follow-up of ce_sos for preventive action.

7

CLASSIFICATION OF LABORATORY ANALYSES

January-December, 1952

Samples from

Industrial

CONTAMINANT

Plants

Experimental -TO-TA-L-S

. . . . . . Acroleins
. . . . Arsenic, Biol

..

2 1

2 1

Benzene, Atmos.

42

2

44

Cadmium, Atmos.

. . . Chlorides

. . . . . Chlorinated Hydrocarbons.

. . . . .. .. . Cholinesterase.
Combustion.



2

6

36 16 2

.. . . ..

2 6
36 16
2

Copper, Biol.
. . . . . . . . . . Cyanides. . . . . . . . . . Dusts .

. . Fluorides, Atmos.



3 2
459 25

.. .. ... ..

3 2
459 25

Fluorine (Fluorides) Qual
. Formaldehydes, Atmos.

. . . . Free Silica . . . Lead, Atmos

.. .

. . . . Lead, Blood

. . . . . . . Lead, Urine

27 9
114
177 173 256

11

38

9

8

122

177

173

256

Lead, Hisc

Methyl Ethyl Ketone
. . . .. . . . . Hercury, Atmos.
Hercury, Biol

. . . . Mesityl Oxide
. . . . .. . . . . . . Particle Size
pH.

.. ..

.
.

. . . . . . lualitative, Gen. Analysis.
Solvent

. Specific Gravity.

. Standardization . . . . . Toluene, At.nos

.

. . . . . Toluene, Biol . . . . . . . . Zinc, Atmos

TOTALS

.....

3 2

..

40 18

....

1 6

....

25 1 1
583 10

.. .

.. .

....

..
.

6

. 3
. . .
2,051

3 2

40

4

22

11

11

1

6

25

1

1

. 8

591

. 5

15

6

3

. 49

~00

8

REPORTED OCCUPATIONAL DISEASES 1949-1952

DISEASE

CASES 1949 1950 1951 1952

. . . . . . . . . . Allergy

. . . . . . . . . . Bronchitis.
. . . . . . . . . . Burns . . . . . . Carbon Dioxide.

. ...

. . . . . . . . Carbon Monoxide

. . . . . . .. . . . Carbon Nonoxide~H~
Carbon Tetrachloride. . .

. . . . . . . . . . Cellulitis
. . . . . . . . . Conjunctivitis.
. . . . . . . . . . Dermatitis.

. . . . . . . . Economic Poisons.
. . . . . . . Fumes and Vapors.
. . . . . . Heat Exhaustion

.

.

. . . . . . . . . Lead Poisoning.

. . . . . . . . Hetal Fume Fever.

. . .. Poisonous Gas - Ammonia

. . . . . Pneumoconiosis-::-

0

. . Tuberculosis - Occupational

. . . . . . . . Silicosis 0

----
----
l
----
3
----
-------
l
60
----
l
----
9 l
l
l
5
4

3
----
l
----
2
----
2
3 l
124
2
5
51
13
7
-------------

6
----
ll
----
7
----
2
l
l
105
3 l
59
7
----
3
----------

3 l
139
----
5
12
2
----
42 165
2
17 80
5
----
4
----
-------

TO'I'.AL

-FJ1 214 2Gb liFi

* Not otherwise classified.
~H~ Includes cases not necessarily of occupational origin.

DEATHS 1949 1950 1951 1952

CUHULATIVE TOTAL

1949-1952

CASES

DEATHS

. . . ---. . . ---. . . ---. ----
. . . 3
. . . ---3
. . ---. ----
----
. ---. ----
----
. l
. ---. . l . 6 . 5
. . . ----

----
----
-------
13
----
3
-------
----
l
----
----
----
-------
----
4
----

----
----
-------
8
----
2
----------
l
l
----
----------------
16

----
----
----
2
----
3
----
----
-------
2 l
----------------
l
9

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

. .
..... . ..

.. .........
..
.0

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

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

. .
....
...

12 l
152 -----
17 12
6
4 45 454
7 24 190
34 8 8 l
5
4

19 ~ 28 J:"E

~

----------------
2
24
3 8 0'-
----------------
4 2
------
l
------
l
6 10
25
86

FIELD DETERMINATIONS 1952

CONTAHINANT
. Carbon Monoxide . Humidity . . Radiations
Ventilation Heasurements. 0

TOTAL
4
2
373 143

TOTAL 522

10

TABLE I G::JOBGIA

S'Jl,' :ABY OF IHDUSTRIAL HYGBlTE Alm OCCUJ?ATIOlTAL lD'~ALTH ACTIVI TL::S

January - December, 1952

}!o. Jstablislrrne11ts ............................................... . J.T o of i,-\ror ke r s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i:Jo. of Plant Visits .......................

Bee.son For Service:

Self-initiated........................................... .

320

Bequest:

Hanagement .............. ~ 79

LaO or.... . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Local Health Department ........ l4

Private Physician 9

Insurance Carrier ............ 0

Other ...................... 15

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

101

F o11O\rJ-up . . . . ........................ ~ ..................

10

T~,rpe

........ of Service Given:

j\Jo. Plants

Promotional .... ~. 332

]'To.
~

Environmental Surveys .. ,. 261 Technical Studies .. ,.. 136

.. , ..... .

Nuisance Complaints.................. 18

Appraisal of liedical Department .... ,. 12 Investigation of Occupational Diseas~ 126 Examination of Plans .. ~ 18
Tuberculosis Surveys.. . 39 Blood Test Surveys................... 32

........~...'.!..'..~..'
...~ ..............

Consultations Regarding:

1vorking Environment.......... 164

liecLical Services............. 37

Nursing Services ..... 100

Health Services.............. 44

Feeding............ . . . 0

of Services 3SS 310 184 20 12 154 23 70 63
210
)_f3
132 75 0

Improvements Recommended:
1vorking :Snvironment Health and Welfare

No. Plants

lTo. Recom-

lTo. of 1:.Jorkers

85

..... mendations

.Affected

298 ........

77

126 ...

Improvements Carried Out:

Working Environment

20

Health and \','elfare

34

.........

ll04

31051

(11)

Specific Services:
Chest X- rays . ......................................... . Blood_ Tests ........................... , ........ Sanples For Laboratory Analysis ................. ?ield Determinations ................ Occupational Disease Cases Investigated........... Lectures ....................................... Literature Distributed....................... l~octin[;s ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Otl1or .................................................

l!umber
19879 14790
930 1015
ll4
20
1965 16
530

-----.

TA.BL~ II

N

.--!

'---"'

l'UliDER OF PLAl~TS S~:SV~D BY 1'P:S DIVISI ~~TS OF Ili"DUS'i'':L'\.1 ~'YGL':~'E AJD OCCUPA~! \TAL ;:';:ALTH

AJ.TD

TYP:SS OF SERVI CE PJ'ThTDZR~D

1941 1942
1943 1944
1945 1946 1947 1948 1949 1950 1951 1952

i,,1T., o. Y-- e\J Pl ant s ITo. Olcl Plants
II( ini tinl service (service initiatecl

'C:_u.ring current during previous

periocl)

;jrear)

---

20

---

87

9

47

66

34

51

96

57

12G

55

83

99

126

107

268

144

356

146

137

271

325

226

CUi1ULA+.

~IY::J

I
!

TOTAL

1707

---

1941-

1952

I

~'o. Plants Receiving

.--! Q)

0..00>

Q)

Q)

0..00>

cU C)
C) rl
rl ?
rd H

:::: C)
(r[)l ?rl
HH

C) rl
H?
CJlH

C)

:::: C)

?rl
,0 H

rl rl
'Cl ?
(.) H

H
..CcJ:

Q) Q)

;::; CJ

:::: Q)

cU CJ

(.) Q)

+"

;=: UJ

~ (/)

fiJW

,_:j[j)

li< t')

0

17

11 17 4 -- --

61

L!-4

31 12

--

--

75

64

33 18

5 --

64

17

44 23

21

--

86

87

64 13

13

--

146

120

49

5

4 --

36

77

87 47

--

--

30

43 179 85

1 --

69

93 306 34

5 --

32

233 233 24

12

--

25

115 290 20

--

40

3

148 338 15

--

4

Total fuployee population of plants

1To. Counties in 'i!hich plants Here located

-------

1~-

-------

28

163,798

31

186,800

21

124,389

31

120' 213

25

98,556

45

80,466

68

108,119

78

129,939

60

129,550

6o

294.968

65

435

765 1161 220

I

39

42

j

403,013

135

i

Division of Public Health Engineering

PUBLIC HEALTH ENGINEERING
This Division of Environmental Health Services has the responsibility of administering the program of public health engineering, including the assignment of duties, supervising and reviewing all activities of the engineering and sanitation personnel, coordinating the program with other divisions and services of the Department, establishing and maintaining cooperative relationships with other agencies, state and federal) in problems of engineering and sanitation in the field of public health.
The operation of the Division is a part of that normal function of federal, state, district, county and municipality which has as its purpose the improvement of sanitation and maintenance of a cleaner way of living for all. The services rendered are quite variable because of the many facets involved in environmental sanitation, in rural, suburban and urban populations. These services are available to the public through (l) the central administration in the State Department of Public Health, (2) regional engineers and sanitarians in the five regional offices, (3) county engineers and sanitarians in the counties and districts and
(4) municipal sanitary engineers and sanitarians in the towns and cities.
The accomplishments in the field of its jurisdiction are set forth in rather condensed form under a number of headings.
1. Nalaria Prevention and Insect Control
Nalaria as a public health problem has virtually disappeared from the State of Georgia. No one factor can be said to have caused its disappearance, but by a combination of circumstances it has, for the time being at least, ceased to be a major problem. It would be unwise to assume that malaria has disappeared entirely as long as there exists the favorable environment, the insect vector and the possible introduction of infected individuals. The major safeguard on vector control is in the impounded water regulations of the State Board of Health.
Impounded Waters
Impounded water permits were granted to 245 individuals and agencies during 1952. These were largely farm ponds constructed for stock watering purposes under a farm practice of the Production and Narketing Administration, U. S. Department of Agriculture, which requires that the client must possess an unrevoked permit from the State Department of Public Health as one of the requisites for payments. Credit should be given here for the excellent assistance and cooperation rendered this program by the Soil Conservation Service whose personnel furnishes such excellent basic guidance in proper pond construction and conditioning.

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The State has many hydro-electric developments throughout its vast area, Many of these are so constructed and located as to present no particular problem of mosquito breeding. Those still under surveillance of this division include:

Georgia Power Company

Flint River, at Albany Lloyd Shoals, Butts County)
near Jackson Bartletts Ferry, near Columbus Sinclair Lake, near Milledgeville

Georgia Light & Power Co. Tennessee Valley Authority

Spring Creek, near Bainbridge Blue Ridge, near Blue Ridge Chatuge, at Hiawassee Nottely, near Blairsville

Crisp County Power Comm, U. S. Army Engineers

Lake Blackshear, near Cordele Allatoona, near Cartersville Clark Hill, near Augusta Jim IJoodruff, near Chattahoochee . Fla. Buford, near Buford Hartwell, near Hartwell

The accomplishments of the various agencies listed have been good, The Georgia Power Company has contracted for larviciding the Flint River and Lloyd Shoals Reservoirs with DDT by airplane. The Bartlettst Ferry control work was conducted from a boat using an oil-water spray but in
1953 this will be included in the contract with the other reservoirs.
Sinclair Lake has just been impounded and larviciding with DDT will be grouped under the contract mentioned. Inspection of larvicidal results are made by the power company on all except Flint River 1vhere the results are observed jointly by the division and Dougherty County personnel.

Larviciding on Spring Creek is still conducted with paris green dust,

On county-ol,Vlled Lake Blackshear improvements have been continued so as to make control operations more effective. Larviciding is done with a power mist sprayer both from land and water. Residual spraying of mosquito resting stations is also practiced in the area adjoining the perimeter of the lake.

The Allatoona and Clark Hill impoundments have been completed. With the exception of a short period during the later summer very good mosquito control was maintained on Clark Hill. This exception was due partly to incomplete clearing of a small area. Control on Allatoona was very good.
Construction on Jim \voodruff Dam is well along and clearing of certain
parcels has begm1. Negotiations are still being conducted with U. s.
Engineers looking to entire clearing of parcel 4 which is proposed to be left uncleared.

Other reservoirs mentioned have had no special problems during the past year.

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Residual Spray Program
Financed jointly with federal, local and limited state funds a cooperative program, labeled the Georgia Malaria Program, has been conducted in 18 counties directed ae:,ainst the insect vector of malaria. Walls and ceilings of 41,190 homes (and privies) were sprayed with DDT emulsions at a concentration sufficient to provide 100 milligrams of DDT per square foot of sprayed surface, sufficient to remain toxic to mosquitoes alighting thereon for a period of ten to fourteen weeks.
The residual benefits of DDT spraying of homes in eliminating other household insects than malaria-carrying mosquitoes have maintained a continued demand for the program. Sup~ementing the DDT spraying with spot spraying with Chlordane has been particularly effective in controlling roaches and in increasing the control of flies.
The contribution of federal funds for the residual program has been so curtailed that no further assistance can be expected in the future. Local authorities must be prepared to assume full cost of such a program. The greatest asset gained in conducting this program may have been the education of the general population to the fact that it is possible to live without mosquitoes, flies, bed bugs, roaches, ants and other household insects in the home when proper sanitary safeguards are set up supplementing this with a limited spray program. Life is definitely more pleasant and many health hazards are removed.
2. Housing Sanitation
"Fringe area" sanitation has been a continuing problem in the vicinity of the major cities. Suburban development continues apace bringing in the problems of water supply and sewage disposal. Part of this is due to defense area concentrations, but much is the result of many new families seeking homes of their own.
The development of new subdivisions without public water supply and sewerage is discouraged as much as possible. \ftJithout legal jurisdiction much of this is accomplished with the cooperation of the Federal Housing Administration, which lean on the health department for guidance and approval on water and sewerage problems.
For many years the division has cooperated with the Federal Housing Administration by approving, when so indicated, individual sewage disposal systems at homes built under FHA insured loans. During the past year the Veterans Administration has also required local health department approval of water supplies and sewage disposal systems at new homes financed by GI loans.
The program outlined above has also been instrumental in many miles of new sewer being built. A total of 7956 septic tanks were built under health department supervision in 1952 -- 7567 at homes, 58 at schools and 331 at other public places. In the same period there were built 856 privies -- 731 at homes, 47 at schools and 78 at other places. More than 1329 privies were repaired and made to comply with health department standards.

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The division has cooperated with the Public Housing Administration in reviewing many rural non-farm low rent housing sewage disposal plans where public sewerage was not available. Approval of such plans by the
division are required by P. vv. A. Review often requires consultation
and joint inspections with regional and county health department repreSl3ntatives.
3. School Sanitation
County maps have been furnished to almost all of the 159 counties of the state for use by committee review of school facilities. Committees in most cases included engineer or sanitarian representation from regional or local health departments.
The stepped up program of the JVIinimum Foundation Plan has given great impetus to school improvements. The division reviews plans and specifications for major sanitation installations at schools in cooperation with private architects and engineers and education department officials.
The recently inaugurated program of the State School Building Authority promises to increase the responsibilities of the division many fold, as the cooperation requested has been in all phases of sanitary facilities at the new schools. The full assistance of regional and county sanitation personnel will be required to meet responsibilities of the health department in this field,
4. Camp Sanitation
The maintenance of sanitary surveillance of recreational and public works cmnps by local personnel is encouraged by the division to insure asafe water supply, sanitary sewerage, screening, proper garbage disposal, milk and food sanitation, insect control and sanitation and safety of swimming areas.
5. Tourist Courts and Trailer Parks
Permits were issued to 558 tourist courts and trailer parks in 1952. The number was less than in 1951 because all of those complying in other respect::; were not in compliance with the new regulations on heating a.ppliances as protection against accidental carbon monoxide poisoning and fire extinguishers for protection of life and property. 287 were still operating without permits, because of not meeting minimum sanitation requirements. Especial attention has been concentrated on proper heating appliances and their installation. Two deaths due to unapproved inste.llations occurred at one tourist court during 1952. The Department prepared a bill for introduction in the legislature meeting in January 1953 to strengthen control over similar hazards in the 300 or more courts operating without permits. The total number of tourist courts and trailer parks in the state increased from 727 in 1951 to 845 in 1952.

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6. Hospital Sanitation
Certain phases of hospital sanitation have been delegated to the Division by the Hospital Services Division. All of the sanitary aspects of water supply, sewage disposal, food handling and milk supply are involved, To this group, at the direction of the State Board of Health, has been added all nursing homes,
Phy~ical inspections are made by county and regional sanitation personnel, the reports being received and coordinated in the division office which reports directly to the Hospital Services Division,
The addition of many new hospitals has made it possible for many of the smaller clinics to transfer their activities to better staffed and better equipped institutions, This results in better food handling processes,
7. JYiapping and Photography
Original maps of towns and communities were prepared from aerial photographs for use in the development of sanitary surveys by local and regional sanitation personnel, County and town maps were prepared for communicable disease spot maps, All county and town maps required by
the DDT residual spray program were revised as of December 1951, State
maps were prepared for location and density of specific disease problems, such as tuberculosis, rabies, etc,
Reproduction of the above maps and of many additional town, county and state maps were made as required for public health purposes, Others were furnished to various official agencies at cost of printing,
Other mechanical and architectural drafting included floor plans of the State Office Building for space studies; dairy barn plans revised; plans and specifications revised for mobile milk laborator); redraft standard plans for swimming pools; prepare plot plan and land acquisition map for new Eugene Talmadge Memorial Hospital; plot plan for Alto Medical Center; survey state property, Revisions of state water 5.nd sewer maps were made; Hospital Services spot map 1<J"as revised; permanent laboratory records and graphs vvere brought up to date; personnel organization charts were drawn; civil defense charts were prepared; and charts were prepared for Administration. Laboratory progress report sheets were redrawn and printed.
Photographs of public health activities of other than the Division of Public Health Engineering were made for Health Education, Industrial Hygiene, Hospital Services, Nursing, Typhus, Crippled Children, laboratory, Local Health Organizations, Venereal Disease, Dental and Administration Divisions. Contact prints, enlargements and lantern slides were furnished as requested, Exhibit materials and color slides were prepared for group meetings, Numerous negatives were made for multilith printing in the print shop, Aerial photo enlargements to exact scale were made for use in preparing sanitary survey and mosaic maps,

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8. Food Sanitation
The food sanitation program is primarily an advisory service to local personnel in the promotion, and adoption, of local food ordinances and conducting a program in conformity therewith. Food handling schools are held at the local level, training operators and employees of eating :md drinking establishments in the proper techniques of construction, maintenance and operation. The objective is to bring all into compliance with Grade A standards,
The school lunchroom inspection program has been an important function of the division, This operates through local and regional health personnel in cooperation with the Ste>.te Derartment of Education. Under tho expanded school building program the review of plans for school lunch room design and equipment, consultation with engineers J architects and school officials in their needs is a major activity,
The liaison maintained with the Hospital Services Division on food handling in hospitals has resulted in tremendous improvement in that phase of food handling.
Inspections of places serving foods to be used on interstate carriers are certified to the U. S. Public Health Service.
9. Milk Sanitation
The milk sanitation program continues to be basically that of a.ssisting local health departments to conduct their own milk program on a very high level, Such assistance is rendered by direct contact with regional <:md local health department personnel. Generally speaking there are tvro phases of the milk sanitation program, namely: (1) advisory service and (2) material assistance.
In an advisory capacity the following services are rendered:
1. Tr01.ining of personnel
2, Promoting the adoption of a uniform and nationally recognized milk ordinance
3. Providing uniform interpretations of local milk ordinances
4. Encouraging frequent submission of milk samples to Georgia
Dep:1rtment of Public Health Laboratories for laboratory an2. lyses
5, Interpretation of laboratory results
6, Providing adequate record keeping forms
7. Providing of modern and practical dairy barn and milk house
plans. This is accomplished through close cooperation with the Agriculture Extension Service of the University of Ga.

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8, Reviewing new and remodeling plans for pasteurization plant construction

o. Testing efficiency of pasteurization equipment

10. Making of milk sanitation surveys to determine efficiency of local milk sanitation programs

11. Advice and encouragement relative to good enforcement of local milk ordinance

12. Provision of local departments with all survey ratings in order to promote the movement of good milk from one community to another

Material assistance to local health departments is mainly rendered through the usc of two mobile milk laboratories. The interiorsof two modern house trailers have been remodeled to accommodate only laboratory equipment. Each unit is staffed with one well qualified milk sanitarian who devotes full time with pasteurization plant and dairy farm inspections. Also a well qualified laboratory technician devotes full time to the collection and analyses of milk samples. These mobile units and the operating personnel are stationed at, and loaned to, local health departments for a period of two to four months. During this time a very intensive milk sanitation program is conducted in cooperation with the local health department. This has been one of the most popular and gratifying services of the milk sanitation program. This is evidenced by the fact that both the milk industry and local departments have continually made requests for this service that we have been unable to fulfill. The Georgia Dept. of Public Health remains a leader in this phase of milk sanitation. Hol:ile units were stationed at the following cities during 1952: Brunswick, Cairo, Camilla, Gc1inesville, JVIoultrie, Newnan, Savannah, Valdosta and Winder.

In coopera.tion with the director of laboratories and lo~al health departments, this division has continued to urge local health departments to be very vigilant concerning the matter of excess water in milk. That this work has been very effective is evidenced by the following:

Year

Number of Samples Examined

Percent containing Excess Water

1950

2000 (approx.)

30

1951

9074

42

1952

10140

9.8

Also during 1950 and the early part of 1951 there was frequent evidence of gross adulteration. This was not the case during the latter part of 1951. During 1952 evidence of gross adulteration was a rarity. It is now believed that in most instances when excess water is found in a milk sample, the cause is poor drainage of equipment after washing and sterilization.

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Supervision of milk supplies by public health personnel is for the primary purpose of preventing the spread of disease. This is accomplished by requiring producers and distributors to provide certain protective facilities, such as adequate barns and milk houses, sanitary utensils, protected water supplies, safe sewage disposal, sufficient refrigeration, adequate hand washing facilities, ample hot water, clean barns and clean and screened milk houses, etc. Of course such f2_cilities Jrc of no value unless they are routinely and correctly used, This can only be determined by frequent and thorough milk plant and dairy farm inspection. That this phase of the progre~ has been vigorously pushed in cooperation with regional and local departments is indico.ted by the following:

Inspections accomplished Barns and milk houses painted Milk houses screened or screemrepaired 11')"ater heaters provided Toilets constructed or repaired Water supplies protected Herds tested Handwashing facilities provided

1250 approx. 151
64
9
90 145
67
135

A milk sanitation program can be conducted on a high level only when frequent laboratory analyses of milk samples are conducted. That this phase of the program received much emphasis is evidenced by the following:

Milk samples examined for total bacteria Pasteurized milk samples examined for coliform
organisms Phosphatase (efficiency of pasteurization) Excessive sediment determination Temperature determinations Refractometer

4226
1533 1197 2305 2570 1332

Even today the one great demcmd of the milk industry is more uniformity of milk ordinances in order that milk may move from one area to another, Almost without exception the milk ordinances adopted by loco.l boards of health in Georgia are identical, Uniformity is not 3. problem, interpretations of local ordinances can and do vo.ry. This division has placed much emphasis on uniform interpretation of milk ordinances. The effectiveness of this effort is illustrated by the fact that it is a very very rare occasion when milk which is under adequate supervision of one loco.l health department is not o.llowed to move freely into all other areas. This fact is of very significant value to the milk industry.

From the above the following conclusions seem justified:

l, The milk sanitation program is conducted on a very high level, as evidenced by tho fact thd there has been no known inr::idence of disease transmitted by milk this year, Twenty-two communities now have milk sG.nitation programs recognized as being excellent by the U. S. Public Health Service. This is compared to fifteen
in 1951.

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2. Within two and a half years the matter of excess water has been reduced from a major problem to almost one of insignificance.
3. Providing for coliform requirements in local milk ordinances
has resulted in revolutionary methods of equipment cleaning and handling of milk in pasteurization plants.
Certainly the consuming public has profited from efforts of the engineering division personnel regarding milk sanitation and because of this effort can enjoy even greater confidence in its milk supply.
It is contemplated that the milk sanitation program will be conducted on the same high level during 1953 and that this program will continue to play a part in making Georgia a healthier state in which to live.
10. Shellfish Sanitation
The Shellfish Sanitation Program is a joint operation with the Coastal Fisheries Division of the State Game and Fish Commissior provided by law in which each agency has certain responsibilities. Health aspects are assigned to the health department. These are set forth in the regulations of the State Board of Health and apply to oyster beds or areas, and to shucking houses, equipment, and sanitary handling) preparation and shipping.
The first step is the designation of the polluted areas from which shellfish may not be taken except under special permit. In accordance with recommendations made by the United States Public Health Service, the pollution survey sampling program was extended to cover certain areas heretofore not included. Sixty-seven new sampling stations were established in the Savannah area. Results from laboratory analyses indicated all of the new areas to be free from pollution.
In March of this year, an investigation was made to determine whether shellfish could be involved in a typhoid outbreak in Bryan County. No evidence was found that would incriminate shellfish in this epidemic.
During the open season for harvesting and marketing of shellfish an inspection program was carried out covering both the oyster growing areas and the shucking and packing plants. During 1952 twelve plants were certified to the United States Public Health Service for interstate shipment. One of these certifications was for the 1951-1952 season, the other eleven being for the 1952-1953 season. Periodic inspections of crab meat plants were made throughout the year.
Assistance was given to owners and operators of shellfish plants in planning new construction as well as planning remodeling and repair operations. Three new shellfish shucking and packing plants were constructed and one plant was completely remodeled to include a new shucking room. One new crab meat processing plant w2.s completed to replace an old one.

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In cooperation with the Coastal Fisheries Division of the State Game and Fish Commission, permits for gathering of oysters were issued to all commercial oyster gatherers. Each gatherer when issued a permit was furnished a photographic copy of a chart covering the area in which he v1Torks, such chart having all polluted and closed areas indico.ted thereon. All closed areas were patrolled during the marketing se2son by our own shellfish boat as well as by the six boats and one pl<me of the State Game and Fish Commission. All of these units are linked together by short vmve radiotelephone, making excellent patrol coverage possible.

Following are statistics on Shellfish Sanitation Program for 1952:

Oyster shucking and/or packing plant inspections Crab meat packing plant inspections Retail seafood markets checked vJholesale seafood markets checked Bacteriological samples collected and examined (water) Chemical samples collected and examined (water) Shellfish plants certified to USPHS for interstate shipment Oyster gatherer's permits issued with charts Hours shellfish boat operated taking water samples Hours shellfish boat operated patrolling closed areas

129
17
18
9 1292
15 12
62
125~ 141~

11. Recruitment of Sanitation Personnel

The recruitment of personnel for training at the training station at Columbus, Georgia, is a responsibility of the Division. This training under the direction of the Training Division, U. S. Public Health Service, is for the purpose of preparing men to qualify under the State Merit System for later assignments to local health departments.

12. vvelfare Placement Sanitation

The State Department of Public Welfare relies upon the health department for guid<:mce in sanitation aspects of prospective homes for placemcmt of orphans or other charges of that department. To this end, upon request, water supplies, sewage disposal, screening, milk supply and other environmental conditions are investigated and reported to the \~Tel fare Department with recommendations. Under this plan the State Departmont of Public Health is instrumental in obtaining for the displaced child a home environment embracing all fundamental sanitation requirements thus creating a general desire for better living through sanitation.

13. Nuisances

The Division is a clearing house for complaints of all kinds, registered from all parts of the State, concerning environmentCtl conditions. Quite often these originate from clashing personillities Ctnd the solution is difficult, but the abaterr,ent of nuisances for better living and health protection through cooperative measures also results in preventing unnecessary and unpleasant legal actions, showing a better
way of living.

Division of Typhus and Rodent Control

DI VI S I 0 N 0 F T YP H US AND R 0 DE NT C0 NT R 0 L G E 0 R G I h D E P b R T ME NT 0 F P U B L I C H E A L T H

A NNUAL R E P 0 R T CA L E NDb R YE b R 1 9 5 2

Roy J. Boston, M.S., Directr Henry Greene, M.S.P.H., Field Supervisor
Clifford J. Jessup, Refuse Collection & Disposal Consultant
Typhus & Rodent Control Regional Supervisors

Jesse F. Piland, B.S. James H. Rigsby Harold S. Taylor

- Central Region - - Southwestern Region - - - - - - - - Southeastern Region

TYPHUS CONTROL SERVICE
ANNUAL REPORT
Calendar Year 1952
The administrative phases of the Typhus Control Program, continued to operate from the 1.~.tlanta office. All field operations were under the supervision of the State Field Supervisor, who was responsible to the Director. In The Southwestern, Southeastern, and Central Regions, a Sanitarian of the Regional Office continued to render services pertain-
ing to Typhus & Rodent Control to the counties in their regions.
FiLancial assistance from the United States Public Health
Service, Communicable Disease Center, during 1952, amounted to 26% of the
total cost of the State-wide typhus control program as compared with
36.6% during 1951.
Local participation, consisting of personnel, the purchase of rodenticides, gas, oil, and maintenance of federally loaned vehicles,
amounted to 48% of the total cost. In addition, storage and office space
was provided by local agencies at no cost. State Depar"l.nent of Public Health provided personnel, travel expenses, gas and oil for the operation of federally loaned vehicles on state level, office space and equipment
for state supervisory personnel to the amount of 26% of the total cost.
Graph No. l shows the trend of Federal, State, and Local financial participation during the past six years.
During 1952, the typhus control program followed the established
pattern of education; investigations of reported human typhus fever cases followed by the application of insecticides and rodenticides to rat infested premises associated with each case; spot control measures, by local personnel, around known foci of infection of the disease; anti-rat sanitation and environmental sanitation; ratproofing, and the inauguration of the Lowndes County Typhus Eradication Program.
During 1952, thirty-two cases of Murine Typhus Fever,
including four deaths, from this disease were reported from twenty-five counties in Georgia; as compared '~ith fifty-eight cases, including four
deaths, from thirty-six counties in 1951. This is a reduction of 45% in
the number of cases reported. Only five counties reported more than one case. Ho,111ever, it is believed that the widespread and early use of antibiotiotics reflects upon the reporting of human cases to the extent that
the actual number of human c~ses reported for 1952 does net appear to
have represented the true level of the disease problem. For this reason, it is necessary to place more emphasis on the widespread incidence of typhus in rats as the reservoir of the disease than heretofore,
The Central, Southeastern, and South"restern Regions still
continued to report the greatest number of typhus cases in 1952. However, the number of cases reported from these regions in 1952, comprising 87%
of the total reported for the state, was less than the numbe: reported

Annual Report

1952

in 1951 1'\lhen 99% 1'\IFiS reported from these th~ee southernmost regions.
Since the inauguration of the DDT dust program for rat flea eradication
during the latter part of 1945, it is interesting to note the reduction
in the reported typhus fever cases. Graph No. 2 shows the reduction in
typhus cases from 1945 through 1952.

J,t the end of 1952, the number of personnel engaged in typhus control activities had been reduced to 32 as compared to 52 in 1951. A
decrease in federal funds necessitated a reduction in federal paid person-
nel--from ll in 1951 to 5 in 1952. State employees included a State
Director, a Refuse Collection and Disposal Consultant, 3 Regional Super-
visors, & 1 Stenographer. The number of local personnel varied throughout the year, although at the close of 1952, there were 21 full-time
local paid employees.

Educational activities included the attendance of personnel at 7l meetiigs of local groups; the distribution of pFimphlets and posters;
showing of movies and film strips; and the publishing of 165 newspaper
Firticles throughout the State.
During the calendar year 1952, there were 10,523 personal
conferences and contacts made by typhus control personnel. An estimated
3,472 persons attended the 70 meetings mentioned above. Typhus control
personnel addressed the groups on various phases of typhus control at
42 of these meetings.

The investigation of all reported cases of typhus fever con-
tinued throughout 1952. Inspections of the home environment, place of
employment, and premises visited within two weeks prior to the onset of the illness 1'\lere made. If rat infestation was evident, traps were set, and from the captured rats, blood specimens and ectoparasites 11\l'ere secured and forwarded to the laboratory for analysis. The findings in these cases aided the local and regional personnel in applying Fippropriate rat control measures according to the needs.
T'.. enty-four reported cases of typhus fever 1':7ere investigated,
and 486 premises associated 1Pith these cases '~Jere treA.ted with DDT dust or
rodenticides as the findings indicated.
Table No. l shows that of the 32 cases reported, 27 or 84%
were white, 'i'rith the distribution bet,.,reen males and females being fairly
even. However, among the color~d, the males reported 80% of the total
number of cases.
2

hnnual Report

1952

Reported cases were received from all age groups ~rith the
highest percentage falling in the 10-19 age group. In past years, the 30-39 age group usually reported the greatest percentage of cA.ses; ho'"ever, in 1952 this group reported only 3.1% of the total number of cases.
l1s in 1951, the occupations of agriculture and home, ~ith 60%
of the total cases reported, had the greatest number of cases in this group. No cases were reported from the professional or clerical groups, and the food handlers have only reported one case in the past two years.

The work done under the above category was performed in Richmond, Colquitt, Chatham, and Lowndes Counties. In the first three counties named vuere routine biological surveys, while in Lowndes County the program was called a "Typhus Er'ldic!'ltion Demonstration Program". In the Lowndes County program the purpose was to demonstrate the feasibility of eradicating typhus not only in humans but in the rat population as well. The program 1"'1'1S divided into three parts--- 11 0riginal Survey",
"Control", and "Evaluation." By December 31, 1952, approximately 38% of
the county had been surveyed and rat control measures carried out. The evaluation of this section of the county revealed a substantial reduction in the rat population.
In the four counties mentioned above, 845 premises were tn.pped and 766 rat bloods were tested. Tmenty-one of the bloods tested
were positive to the compliment fixation test for Murine typhus 'lntibodies.
Graph No. 3 shoms the decre11.se in the number of rat blonds
positive to typhus fever from 1946 through 1952 in selected areas of the
str:tte.
Ectoparasites from rats examined totaled 4,327.

DDT dust continued to be the insecticide of choice in the control of rat ectopl'lr8.sites, namely the rat flea. Premises thl'lt were found to harbor a heavy rat and flea population received treatment mith
this insecticide. During the year, 24,476 premises vrere treated vuith 92,696 pounds of DDT dust. Of the 24,476 premises treated, 15,016 ~ere
f'1rms and the balance were residential and business establishments.
Thirty-nine counties participated in this phase of the control
program as compared to 57 counties in 1951.
lliiarfarin, a comparatively neH rodenticide, was found to be
very effective in wide-sc11le usage. A total of 109,582 pounds of '"qrf11rin poisoned b11it was used on 42,476 Premises by State and Loc'll health
department personnel throughout the state. In addition, Red Squill and
3

J..nnual Report

1952

Cyanogns 11 1\11 dust ""ere 11lse used on premisesy but to a much lesser extent than Warfarin. The total number of premises treated VTith poison material was 59,724, using 126,728 pounds of various types of this material.

Only one ratproofing project (l..tlanta) remained in open.tion during 1952. h total of 87 establishments ~'ere ratproofed as compared to 274 in 1951.

Environmental sanitation, including the proper storage, collection and disposal of refuse plays a major role in the control of insects and rodents.
During 1952, the Refuse Collection and Disposal Consult<:tnt held 396 conferences involving 567 persons. Eight new municipal sanitary landfills for the disposal of refuse were inaugurated. In order to carry on this program of sanitation in a proper manner, the communities involved and from the records available,purchased refuse collection and disposal equipment valued at approximately $88,600. Many cities m,hich have requested and received consultant services in connection ~ith their refuse collection and disposal activities are anticipating an early termination of insanitary disposal of refuse and converting to sanitary methods of disposal such as the landfill method.
In addition, assistance ~as rendered to communities in the promotion of clean-up campaigns for the removal of rat harborages and refuse.

During 1952 thirty-t"'o cases of Murine Typhus Fever and four deaths from this disease were reported from t~enty-five counties in Georgia, as compared ~ith fifty-eight cases and four deaths from thirty-six counties in 1951. This is a reduction of 45% in the number of cases reported. Only five counties reported more than one case. However, it is indicated that the widespread and early use of antibiotics reflects upon the reporting of human cases to the extent thn.t the actual number of humA.n cases reported for 1952 does not appear to represent the true level of the disease problem. For this reason, it is necessary to pl13.ce more emphasis upon the widespread incidence of typhus in rats as the reservoir of the disease than heretofore.
State and local participation in the statewide typhus control program was augmented by assistance from the U. S. Public Health Service, Communicable Disease Center. ~bile the assistance of this Federal agency has been greatly reduced, as compared with previous years, it consisted essentially of personnel, motor vehicles, certain small equipment and supplies.
Educational activities included the attendance of personnel nt seventy meetings of local groups; the distribution of pamphlets and
4

Annual Report

1952

posters; shov.ring of movies and film strips; and the publishing of 165
nevrspa.per articles throughout the state.
During the year, 486 premises associ9.ted 1i'Jith twenty-four
cases of reported typhus fever 1'1ere tre.qted for rat ectoparasite and rodent eradication.
A special investigative program to determine the feasibility of eliminating typhus in humRns by the eradication of typhus-infested r8.ts was stA.rted in Lov:ndes County. This program 1"7as under way the last
three months of 1952 and, although only 38% of the county has been covered,
a remarkable decrease in the rat population has already been noticed. If this type program appears to be economically feasible, it may be extended to other counties, ,,,i th the aid of Communicable Disease Center.
Efforts to locate and eliminate the foci of infection in
rodents '"7ere continued during 1952. Rodent investigations included the
trapping of r<J.ts, to obtnin rat ectop!lrasites '1nd rA.t blood specimens
for laborA.tory examination. Rat blood specimens mere obtained from 766
rats which were examined for typhus fever antibodies. Twenty-one of the specimens were found to be positive to the complement fixation test. All rn.t ectoparasites recovered, which included fleas, mites, and lice, totA.l-
ing 4,327, were identified to determine in specific areas, the prevalence
of the X. Cheopis flea, which is the principle vector in the transmission of typhus to man.
DDT dust continues to be the insecticide of choice in the control of rat ectop'l.rasites, namely, the rat flea. Premises that were found to harbor n heavy rat and flea population received treatment with
this insecticide. During the year, 24,476 premises were tren.ted with 92,696 pounds of DDT dus~.
"VWarfqrin", a comparatively new rodenticide, '."7A.S found to be
still very effective in wide-scale usage. b total of 109,582 pounds of Warfarin poisoned bait was used on 42,476 premises by state and local
Health Dep<J.rtment personnel throughout the State.
Environmental sanitation, including the proper storage, collection, and disposal of refuse, plays A. major role in the control of insects
and rodents. During 1952 the Refuse Collection and Disposal Consultant held 396 conferences involving 567 persons. Eight new municipal sanitary land-
fills for the disposnl of refuse were inaugurated. In order to cnrry on this sanitation program in a proper manner, the communities involved and from 1i'Jhich records ~ere available, purchased refuse collection and disposal
equipment valued at approximately $88,600. Many cities ~rhich have requested
and received consultant services in conducting their refuse ~ollection and disposal activities are anticipating an early termination of open dumps and converting to the landfill method of refuse disDosal.
Although the incidence of typhus fever as reported during 1952
is considerably less than any previous year, the geographical distribution of the disease is about the same and continued surveillance is necessary te prevent any increase in this disease which might occur if all programs were terminated. Therfore continued financial support is needed to maintain the present control level and, if possible, to search out and reduce the existing foci of infection in the rat population.
5

GRAPH NO. 1
FINANCIAL PARTICIPATION BY FEDERAL (USPHS) AND STATE OR LOCAL AGENCIES in
TYPHUS CONTROL PROGRAM

z
0

80

......

E-4

<(

70

0.. ......

u

......

60

E-4

o:;

<(

50

0..

~

0

40

zE-4

30

~

u

o:;
~

20

0..

10

~ n Participation
Federal State/Local

0 1947

1948

1949

1950

1951

1952

GRAPH 2 Number of Typhus Fever Cases Reported in Georgia
1, lll

GRAPH NO. 3 Percent of Rats Examined Having Murine Typhus Antibodies
_}~ - - - - - - - - - - - - - - - - - -

U) 600 Uj:i)l
<x:
u g5 500 p::r,.: ><
E-<
q 400
j:il
E-< lXI
0 p,. 300
j:il
lXI
~
0
lXI 200
j:il ~
~
z::;J 100
0

]Q_I31.-tJ~-- - -

I J q
j:il
,2~:i2-5 -

- 126=.9o/"o = 1 - - - - - - - - - - _______ _

:><
j:il

UE- )0-+-- 1-- -
~
lXI

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

~

z01-LI-+-
E-<

-I- "4-

j:il
u

~~l.Q +- - 1-- -f - 1-

p,.

II -5l_l_ j - t _0_0 ,, 0

-_ntr-__ _ 6.4o/o

1945 1946 1947 1948 1949 1950 1951 1952

1946

YEARS

1947

1948 1949 1950

1951

1952

1:~121E_.l
Reported Murine Typhus Fever Cases in Georgia by C1lor, Sex, and Age During the
Calendar Year 1952 (Provisional Figures)
Reported Murine Typhus Fever Cases in Georgia by Occupational Groups During the
Calendar Year 1952 (Provisional Figures)

STATISTICAL REPORT
I. Typhus Fever Morbidity
No. Typhus Fever cases reported for State
II. Personnel A. l, End of year-a. Lecal b. State c. Federal d, Total
B. No. of man hours: l. Local 2, State
3. Federal
4. Total
III. Education
A. Personal conferences and contacts B. Meetings attended C. Meetings addressed D. Persons attending meetings E. Films shown F. Radio talks G. Newspaper articles H. Literature distributed
IV. Investigations
A. Epidemiology: l. Reported typhus fever cases investigated 2. Premises treated with DDT dust
3. DDT dust used (pounds)
4. Premises treated with Warfarin
5. 'Narfarin used (pounds)
B. Rodent Investigations: l, Premises trapped 2. Rats examined
3. Premises with infected rats
4. Blood specimens examined 5. No. of blood specimens positive 6. %of blood specimens positive Typhus Fever
7. Rat Ectoparasites examined
V. Control Measures
A. Ratproofing: l, Establishments ratproofed-a, Business establishments b, Residential establishments c. Tetal number establishments 9

Comparative Totals

1951

1952

58

32

33
8 ll
52
67,309 6,182 22,616 96,107
11,762 135 77
2,863 3
0
105 898

21 6
5
32
53,674 ll, 230 15,212 80,116
10,523 71 42
3,472
22
165 13 '249

57 1,107 3,445
51 119
3,050 1,474
66 1,256
79 6.3 12' 63 7

24 471 2,153 15 66
845 791 14 766 21
2.7 4,327

274

87

0

0

274

87

v. Control Measures

STATISTICAL REPORT

Comparative Totals

1951

1952

B. Rat Eradication: l. Premises treated with--
a. Poisoned liquid (1080)
b. Poisoned gas (A Dust) c. Poisoned bait (Red Squill) d. Poisoned bait (Warfarin) e. Poisoned bait (Warfarin-
Epidemlologic Investigations)
f. Total number treated with liquid g. Total number treated with gas h. Total number treated with bait

3 3,431 34' 630 30,127
51 3 3,431 64,808


453 16,795 42,461
15 0 453 59' 271

"c. Poisons used--
a. Pints poisoned liquid (1080)
b. Pounds poisoned gas (A Dust) c. Pounds poisoned bait (Red Squill) d. Pounds poisoned bait (Warfarin) e Founds poisoned bait (VJarfarinO
Epidemiologic Investigations) f. Total pints poisoned liquid used g. Total pounds poisoned gas used h. Total pounds poisoned bait used
c. Rat-Flea Eradication - DDT dusting:
l. Premises treated with DDT dusta. Farms b. Residences c. Businesses d. Epidemiologic Investigations e. Total number treated

12 2,607 32,445 61,275
119 12 2,607 93,839
19,919 9,337 2,640 1,107
33,003

c
252 17,146 109,516
66
252 126' 728
15,016 7 ,9J6 1,051 471 24,474

2. DDT Dust used--
a. DDT dust used (pounds) b. DDT dust per premise (pounds)

115,816 3.5

92' 696 3.8

10

-Cou-nti-es

:~
~

Bacon Baker Barrow

Ben Hill

Bibb

Bleck ley

Brantley

Brovks

Bulloch

Calhoun

Candler

Chatham

Cobb

Coffee

Colquitt

Cook

Crisp

Decatur

il,.

Dodge

~t:

Do e l y

Dougherty

Emanuel

Evans

Fl)yd

Fersyth

Fulton

Grady

Irwin

Johnson

Lanier

Lowndes

Macon

Marion

J\11iller

IV!ontgcmery

Pierce

Pulaski

Seminole

,.-:,.

Spalding

;.::._.i

Sumter Tattnall

Taylor

Telfair

Thomas

Tift

roombs

Treutlen

Turner -\'fare

VTashington

Wayne

vYheeler

COUNTIES REPORTING J\J,URINE TYPHUS FEVER CASES
1951
7 l
l
2
l l
2
l l 3 l l
2
2
l l
2
3
2
l l l
l
l
2
l l 3 l l l
2
l
2 2
l

1952-!:-
l l l l l
l l
l
l l
2
l
..L
l l l l
2 2
3
3 l l l
l l

TOTALS

~f- 1952 Figures Provision al

ll

58

32 ~~

SUMMARY OF TYPHUS CONTROL OPERATIONS DY C~OUNTIES

County

DDT Dust &
Poisons

No. Premises Treated

I N.
No. I Pounds Pounds I /Premise

No. Man Hours

No.
Man Hrs. /Premise

---------4-----------~----------,~-------,~--------~--------;--------------

Appling DDT

Cyanogc::.s

VJarfarin

Barrevv

Warfarin

Ben Hill DDT

'ilarfarin

Berrien DDT

Cyanogas

'i'(arfarin

Brantley DDT

Warfarin

Bullech DDT

Cyanogas

~,Varfarin

Burke

DDT ',\-arfarin

Candler DDT

Charlten
Chatham Clinch Coffee

1Yvarfarin
II DDT Vlarfarin
1 DDT 1 Warfarin
I DDT
'.rarfarin

Colquitt DDT

':Jarfarin

Crisp

DDT

,':arfarin

Decatur '."iarfarin

Dodge

DDT

Dooly

DDT

::arfarin

Dougherty DDT

Emanuel

~.. ~arfarin

Evans

DDT

Fulton

DDT

Red Squill

i!arfarin

Harris

'iiarfarin

Irwin

DDT

Jenkins 1 DDT '.':arfarin

Lamar

DDT

Jarfarin

Lanier

DDT

laurens DDT

Cyanogas

~,arfarin

Lovmdes DDT

Cyanegas ..,arfarin

Mac:..:n

.,~arfarin

1582
2
1619 3200
1573 289
1144 224
1696 13
l
1639
2
2004
377
2488
41
27 23
59 638 69 1468 3561 103
905 1076
4679 598
8
951 103 1194 390
6
542 16795 4327
160
23 291 1810
7 38 14
l3C5
19 1736
997 95 1975 209

6181
l
7008
L503 2730
533 3665
110 21)6 126
20 6859
2
7354 1536 6169 159 137
53 144 1181 141
5244 5996 1386 )098 6026
14575 1672
25 2073 173 5155 500
33
1869 17146 4646
251
100
lliO
6624 15 101
1no
3744 23
7203 Lt484
Sl
3795 200 . II 12

3..9so1
4.33 1.41 l. 74 1.84 3.20
.49 1.27 9.69 20.00 4.18
1.0(
3.67 4.07 2.48 3.98 5.07 2.30 2.44 1.85 2.04
3.57 1.68 13.46 5.63 ).60
3oll
2.80
3.13 2.18 1.68
4.32 1.28
5.50 3.45 1.02
1.07 1.56 4.35 J,8l 3.66 2.14 2.66 7.14 2.87 1.21
4.15
4.).;
.54 1.92
.96

712
2
986 1667
)60 318 587
95 824
7 l
775
4
1179 362 1534
20 12
4
20
178 24
790 2369 175 1973 874 3040 1579
8
353 166 1058
121
8
766 7150 5596
)2
8
304 1423
17
1+7 8
746 18 1203 510 69 11C5 38

.45 1.00
.61
.)2
,Jc 1.10
.51 .42
.49 .54
1.01
.47 2.00
.59 .96 .62
.5C
.44
.17
.34 .28
.35 .54 . 67 l. 71 2.18 .81
.65 2.64
1.01
.3 7 1.61
.89 .31
1.33
l.Ll
.43 1.29
.33
.35
1.14
79 2.43 1.24
.)7 .57 .95 .69 .51 .7J .56 .18

SUlVlMARY OF TYPHUS CONTROL OPERATIONS DY rOUNTJES -Page II-

----~DDT .Just.

I&

County 1 Prisens

-l--

I

lVJlLLer IVlvn tgernery

I
II

DDT DDT

No. Premises Treated
99 25

I I

No.

No.

I I

Pounds

+ Pounds I /Premise

455

4.61

66

2.64

lvluscegee Peach

I
I
I

DDT -::arfarin

141 65

416

2.95

474

7.29

Fierce

I DDT ,[arfarin

12 12

131 10.92

52

4.33

Pulaski

DDT

75

200

':'.67

Warfarin

75

210

2.80

Randolph

~Narfarin

124

349

2.81

Richmond DDT

385

910

2.36

Cyanogas

84

36

.43

Warfarin

912

1303

1.43

Schley

-,7arfarin

55

100

1.82

Screven

DDT

1489

4592

3.08

Viarfarin

1374

3679

2.68

Seminole I DDT

227

1128

4.97

Warfarin

1531

4446

2.90

Stewart

Warfarin

168

482

2.87

Sumter

DDT

1703

7957

4.67

Viarfarin

1680

7257

4.32

Telfair

DDT

55

166

3.02

Terrell

DDT

374

363~

9.71

:;arfarin

876

3975

4.54

Treutlen DDT

6

19

3.17

Troup

-,:arfarin

951

lG51

1.10

':lare

DDT

1454

51C5

3.44

Cyanegas

8

23

2.88

warfarin

685

2092

3.05

Wayne

DDT

1491

6378

4.28

r.yanogas

19

6

.32

Warfarin

12

48

4.00

vVheeler VJorth

DDT Warfarin DDT '.Varfarin

908

3086

3.41

797 1016

I
I
I

2458 4701

3.08 4.63

I 1216

2607

2.14

I

=t= I

I l

GRAND TOTALS

DDT

I I

I Cyanogas

Red Squill Warfarin

I
I

I

24474
453 16795 42476

I I

92696

I
I
I

252 17146

I
I

109582

3.79 .56
1.02
2.58

I

I

No. Man Hours
32 12
Be
152 7 16 18 18
187 1131 88 1707
24 799 1071 202 1980 136 773 1494 23 387 1736
8 196 6C2
5 281 795
ll
6 655 763 670 1458
15024 292 7150
36501

No. IV1an Hrs. /Premise
.3~
.48 .51 2.34 5e 1.3) .24 .24 1.51 2. 9Lf 1.15 1.87 .44 .54 .78 .89 1.29 .81 .45 .89
.42
l.CJ
1.98 1.33
.21 .41 .63 41 .5J .58
..5n1
.96 .66 1.20
.61 .64 .43 .86

Above summary includes DDT dusting, rat eradication, and treatment of premises associated with reported cases of l',mrine Typhus Fever.

lJ

R 0 DE NT AND E CT 0 P h R~ S I T E I NVES T I G i T I VE D~ T~ C~lendar Year 1952

----------------------------------------,-------,----.---..,------~--------

COUNTIES PLRTICIP;~.TING

I I1 s II t II [/) II ] I

IN RODENT i1ND ECTOP!,R\SITE INVESTIG',TIVE

1 I

..e.c0:

1 +'

I1 rl o;::<j

1 mI
I '"d I 1 >::: 1

..so.c:

I 1

(!)
f---'1~

_l..:_.__N_:!d_!J_lb_e_.r__g_.:oLPl2~.I:., iTlll:o..Nl~L-1-.I2-.-!2-P-e-g-_-_--_-_--_-_--_-_-_--j-_1ILI --9~c3;<-_-_-_j-1III-.-2-23IJ____jjII I__?t__~: ~__2___j1,II_____?~_u_2__r_jIIIj__E ____-__< _~-r.-2-_-__--_

____ I

I

I

I

I

?.~_No~_.Qf_.IQ.:t._lQYg~_l2I-l2remise _

_

_

_

_

_

_

_

_

j __ ~7 ___
II

jII_~g__jI___

~2_+1 ---~-1------~2

I

II

1.:._-'No..:._.Qf__:1.IQl2._..I_countY--------------I--87_~282Q__~_JQ13_j__196_2_j_____2?_2____

I 4.
___

No. of NorVTA.Y rats examined for _.2ct.QI2Q.IQ~ite. ___________________________ j

I 1

1

I

L__ __~r---~-258__~____Q__ f2

2

_

I
j_

_

_

_ 2?.1 ___

_

5. No. of Roof rats examined for

1

1

I

I

_ _ _Ct.Ql2QQ.l.:t~--------------------------_J---Q---J-_g__j _ _ 1 6 7 _ j_____Q_j______d69 ____ _

f-'
0

6. Total no. of rats examined for

I

II I

I

____QtOQ.IQ.ites ___________________________j_~___j 36Q__j __127_j___goo_j_____121____

7. No. of rf1ts examined having

I

I

I

I

I

____X._Qh.2l2l._flg~.__________________j ___Q___j___j___g_j____~J_----_1Q____

~..:.-

.
No~gf_flea_g_gollect.g _

_

_

_

__

__

__

__

__

_

j

I
I__]Q__

II
_Jl77.2

__

I
j I ___

I I
~_j ___

l

]

l

_

I I
l ___

_122.2_

_

_

1 I

I

I

I

I

I___ 2..:.-_N.2..:._.2f_mit~_.Qll1g_______________~_I22?.___~I-2~Q--iI --22_

~Q1_tI ___gggg____

lD..:._N2..:.-of 11iL.2ll1.f2g_______________jI_169_ I __t__.24__.I___2~JI____it2_lI _____J.2Q____

I

I

I

I

I

I

I

I

I

I

11..:._ll.Q..:._of_ra,:t_1?1god_.8.ml21.__:1..1.g_______j __62__j_]iJ:it-:_J__12LJ___127_J._____722____

__Q_-i__ _____ 12. No. of blood samples positive

I

___ to_Comi:lim,D,:t-Fi~~i~n_teE.:t_____________~_

I

I

I

I

lO -+----~-i-~---1_~

?.1 __ __

13. Percent of rats ___fgund D011iV__

examlned ____________

____

1
________[

__Q____1~_g.!.2-..t1__g~_j1___]..:.f2_1L____g.!.1_

_

_f__ 14. No. of premises from which blood
___2lill&D!L.::!.I._.QbtQ]:Q.g______________

I

1

I

_21_-f_l7_Q __ _l_ _

__

I 2f_l __

_

11

I
2_l _

_

_

_

41tg ___ _

15. No. of premises from "'hich blood

1

1

I

I

I

____l2~lill.Q._:J..I.f;o_~.QQ.Q.SLI2.QS i,:ti v&-----------~--Q--J.---~-~--b-i-----b-+-----1____

16. Fercent of premlses s~mpled

1

1

1

1

1

----h-f-l.-V-.ln-g--o-o--s-l-t-l-v-e--r-a-t--b-lo-o-d----------------II---0-----II .- - "''C ~..,:: -II -.:/L!? ..d_1_,_____3_:5__1J.____ '36 _~...!-----

Division of Water Pollution Control

January 2, 1953

ANNUAL REPORT ON GEORGIA 11\TATER POLLUTION CONTROL IN 19)2

This progress report on water pollution control
in Georgia in 1952 follows the form of previous annual
reports in which brief descriptions of activities of general statewide or specific interest are given. It is not intended to present a mass of statistical details but rather to suggest the varied fields of activity involved
and to illustrate some of the plans and patterns of development. It recognizes the close cooperation existing between municipal and industrial officials throughout Georgia and the Georgia Water Pollution Control agency in attaining a high degree of human safety and stream pollution protection.

In covering the complex field of water pollu-

tion control spread over the entire state in a condensed

review many interesting and significant features must be

omitted. If you have questions on any phase of water

pollution control not answered in the Report you are invited to communicate with us. Every effort will be made to supply the specific information desired,

l
1

~~~ 111. H. Weir, Director lvater Pollution Control



GEORGIA DEPARTMENT OF PUBLIC HEf.\.LTH ATLANTA
WATER POLLUTION CONTROL REPORT FOH 1952
The \ll}"ater Pollution Control Division of the Georgia Department of Public Health is the agency of the State of Georgia functioning in the cooperative program of statewide water pollution control, in its many and varied forms, loJith municipalities, industries and citizens concerned with this vital element of public health and vJater resources protection. The continued public health protection rests on the scientific and engineering supervisory services to the public water supplies in the state in preventing waterborne diseases. The 1'1Tater resources protection program, having now attained its proper place in public recognition, constitutes a groc\fing field of service responsibilities 1'1Thich will necessarily expand rapidly in step with the accelerated industrial developme:.1t of Georgia. No cause of disease was traceable during 1952 to any of the more than four hundred public water supplies owned and operated by municipalities, counties and industries furnishing potable water to approximately one half of the total population of the state. 1952 marks a very productive period in the continuous multi-milliondollar-a-year water and sevJage works improvement program being carried on by the many local governmental units and industries composing the urbanized segment of the state.
The procedures and rr.ethods stemw.ing from basic principles and sound concepts constantly promoted and applied by the Division of Water Pollution Control are generally accepted by the many municipal and industrial managements and citizens groups throughout the state. This highly satisfactory state of affairs together with a continuous educational program has created a medium of operation in which practically all efforts, local and state, are directed to the same end in a coor;erative atmosphere of maximum improverr:ent lJithin the limits of economic and financial abilities. The citizens of Georgia now will not tolerate the pollutional abuse of their water resources. General intolerance of water pollutional abuse of stream provides the favorable public opinion factor which supports public officials and industrial managements in their successful efforts to finance the required sewage and industrial waste treatment facilities.
Revim-J and Approval of Engineering Reports Plans and Specifications
Engineering reports, plans and specificat:.ons are the technical and contract documents describing or portraying in detail all features of a construction project for the full understanding and compliance of all parties concerned. These docu1nents are basic in water procurement and purification projects, sewerage, and sewage

and manufacturing process waste treatment undertakings. Each water pollution control remedial measure included in the above categories presents a distinctive set of conditions or relationships to be given consideration and problems to be overcome. A thorough knowledge of local conditions and an extensive water engineering background is essential in each case. Comprehensive field investigations, laboratory studies, and frequent conferences with consulting engineers, municipal and industrial officials are engaged in by the irJater Pollution Control staff to assure sound decisions to protect the citizens of the corr~unities affected. hl11en all of the necessary factors have been accorr;plished and coordinated into finished documents they, either as engineering reports or as plans and specifications, are given final review by the \rJater Pollution Control Division. If determined to be satisfactory, approval of the Georgia Department of Public Health is issued.
Municipal and County irJater Supply and Sewerage Development
Municipal officials are alert to the increased requirements for more water and sewage works facilities to serve their growing corr.munities. The rapid movement of population to the cities and towns is continuing and many water and sewerage systems previously considered adequate for the next fifteen or twenty years are now known to be overloaded. Reappraisal of municipal growth plans has been necessary. Future planning must now be expansive rather than for a static condition. Excellent progress is being rr.ade in many municipalities and counties in planning and constructing water and sewage works facilities on the basis of future expansion. Replacement of inadequate facilities as well as construction of entirely new systems is going ahead at an accelerated rate. In general, financing of water and sewage works is being accomplished very satisfactorily by revenue anticipation certificates with direct service charges on consumption of water and sewerage usage. There are a nurr~er of municipalities still penalized industrially and corr.mercially because of insufficient water supply and lack of sewerage or sewage treatment adequate to their requirements. Du-
ring 1952 several small cities in the Piedmont section of the state
Here forced to abandon wells drilled into the granite, which yields only scant quantities of water, and develop larger sources of water from surface streams with modern purification plants. This group of communities is now released from the growth handicap previously suffered by inability to attract industry and new population. A distinctive feature of recent suburban growth is the development of water and sewerage systems under county mmership. This is a new activity for county goverr~ents but must be expanded by means of independent systems or combined with the adjacent municipal facilities.
2

Stream Quality Protection and Industrial Development
Georgia is in the forefront of industrial development in the Southeast. Many of the new industrial plants are large users of water and producers of manufacturing process wastes. Each producer of industrial vJaste is responsible for its treatment or adjustment to the receiving stream. Industrial managements seeking sites for new chemical processing plants are including stream investigations and surveys in the preliminary studies before locations are selected. Provision for industrial waste treatment is included in the manufacturing plant construction budget together Hith an operation cost item to maintain stream protective facilities. Pilot plant operation is being continued by a few industries having large quantities of wastes which, without adequate treatment, are unsatisfactory for discharge into the receiving stream. The results obtained in these pilot plants will guide the design, construction and operation of full scale treatrrent facilities or indicate process changes to reduce the quantity of waste or its stream deteriorating characteristics.
The Water Pollution Control Division coordinates the stream investigations of industries and integrates the results into the composite plan for the entire stream or the portion within the zone affected by the particular waste. There is a constant interchange of data and information on stream pollution prevention between industries and the Division. Frequent conferences with industrial managements, chemical engineers, and consultants are held before plant sites are selected at which time all phases of the potential stream pollution problems are explored. Industries generally are accepting their responsibilities for maintaining satisfactory stream conditions. Agencies promoting the corrercial and industrial development of Georgia have recognized and accepted this inescapable principle of procedure. They are cooperating in informing industrial prospects that the invitation to use Georgia's stream resources includes obligation to protect them against abuse.
National Defense Impact Upon Community Facilities
The construction of additional national defense manufacturing installations and military posts, camps and stations within or near the boundries of the state is bringing a large influx of industrial and military service personnel and their families to areas whose water and sewage facilities are either limited or non-existent. In some cases emergency measures have been resorted to until a basis of future planning could be determined and programs of permanent construction with a workable degree of accuracy have been adopted. Public financing of immediately needed corr~unity facilities to meet the sudden impact of such unexpected loads is difficult because of the uncertainty of the permanence of the need for such greatly expanded utilities. Ho~~>rever, even under the uncertainties of migrating populations, some order in providing water and sewage facilities in critical areas is replacing the initial chaos with resulting substantial progress.
3

Drought and Disaster Situations
For the second year in succession a drought occurred in
1952 extending well into the late fall. Cumulative rainfall
deficiency brought about a sustained period of low stream flows. Those municipal water supplies normally operating vvith low water reserve sought emergency water sources which were usually not available for improvised use. Curtailed water usage 1-Jas resorted to most frequently and active planning, long deferred Dl some cases, begun to permanently relieve the deficiencies by development of more reliably adequate sources. Thus, a moderately severe drought can serve as a warning which, if heeded, -vJill pay dividends in the long run in compelling an adequate water supply or improved sewage treatment plant before a drought of more severity brings real corr~unity suffering.
In May 1952 a tornado of high destructive force struck
through the center of Alapaha demolishing the elevated vmter tank and damaging the deep well pumping equipment to make it inoperatable. Hith the public water supply completely out of service, emergency measures were put into effect by disaster relief forces to establish an improvised central watering point for drinking and culinary water only. Within a few hours after the disaster 1-Jas announced, the Division of Water Pollution Control was able to locate an available pneumatic tank at a distance of about one hundred miles from the disaster point. Through the generosity of a water works contractor and the utilization of a heavy capacity transport vehicle of the Army, the tank was hauled and placed in position in Alapaha. Water works superintendents in neighboring towns rendered assistance with other repairs to restore a safe and nearly normal water service to the town in the shortest possible time.
Chemical Effect of Impounding Stream Water
The presence of the element manganese in more than one or two tenths of a part per million in a public water supply usually renders the water unsatisfactory for many industrial and domestic purposes and undesirable from an aesthetic standpoint. Manganese, in varying amounts, occurs in geological formations over wide areas of the state but under normal conditions of stream flow very little of the element goes into solution, consequently, it has not presented a general problem in the past.
However, in recent years the construction of impounding reservoirs by Federal agencies, municipalities, industries and private individuals has created conditions along several streams favorable for the ready solution of rr.inerals containing manganese and other elements. This is due in part to the depJe tion of oxygen, formation of carbon dioxide and increase of hydrogen ion concentration (lowering of pH) which frequently occurs in the bottom stratum of such reservoirs.
4

At times the water leaving these reservoirs contains manganese in amounts sufficient to be objectionable to dolmstream consumers since it is not readily removed by the methods of treatment most co~~only employed in purifying the soft, turbid waters in this area. Members of the I:Jater Pollution Control Division have devoted considerable tirr.e in helping various water departments set up research projects or modified treatment methods to combat this problem and several plants are now handling the situation in a satisfactory manner.

Training Local Hater and Sewage Works Personnel Twenty-first Annual Georgia Water and Sewage School

A considerable amount of instruction to water and sewage plant operating personnel is given during field visits by the staff members of the Division of "\rJater Pollution Control. This type of instruction is highly practical in nature and is for the purpose of adapting the person to his particular position to assure sufficient knowledge to operate the facilities in his charge in a safe and satisfactory manner and to promote proper preventative maintenance to prolong the life of expensive equipment.

Much of the effectiveness of the water pollution control program rests in the hands of the local water and sewage works operational and managerial personnel. Often their knowledge, ability and determination to see a job well done is the deciding factor in the success or failure of a control project.

In order that the Georgia water and sewage works operators and others carrying responsibility for these matters may have an opportunity to learn fundamental principles of their particular jobs and keep abreast of current developments in their fields, a 1\fater and sewage works school has been held annually for the past twenty-one years. This school is conducted at the Georgia Institute of Technology under the joint sponsorship of the Water Pollution Control Division of the Georgia Department of Public Health, the Engineering Extension Division of the Georgia Institute of Technology and the Georgia Water and Sewage Association.

The Twenty-first Annual Georgia Water and Sewage School
held in 1952 was attended by more than four hundred operators,
superintendents and engineers. This was a record attendance for the School. Instruction was given in various phases of water and sewage works subjects at both the elementary and advanced levels and included topics dealing with public health; construction and maintenance; conservation; financing; public relations and related matters. At the close of the School the following number of certificates by grade and classification were issued by the Georgia ~Vater and Sewage Association to those successfully pass-
ing an examination:

Class A Water - 3 Class B Water - 6 Class C Water - 13

Class A Sewage - l Class B Sewage - l Class C Sewage - 10

5

The Water Laboratory
The Hater Laboratory is the scientific workshop of the Division of Water Pollution Control, The data and information developed in it provide the tools used by municipalities, institutions, industries, consulting engineers and plant operating personnel in solving many of the varied problems inherent in a statewide water pollution control program, One of its important functions is to meet the need for practical study and demonstration of water treatment methods. The effects of new types of pollutional materials make evident the gaps in knowledge of their treatment possibilities and special investigations are required to bring them vJithin the area of practical engineering application. The bacteriological examination of samples collect-ed from sources of drinking water throughout Georgia constitutes the largest volume of work in the Water Laboratory.
The Water Laborato~ was selected as one of the twelve laboratories in the United States and Canada to participate in a study of the membrane filter technique in the bacteriological examination of water from a variety of sources. The purpose of the investigation is to determine the acceptability of this radically different technique for inclusion in future revisions of "Standard Methods for the Examination of Water and Sewage." This special study of the membrane filter technique to continue for one year was begun in July 1952, The Director of the Water Laboratory is a special consultant on the study project.
The nitrate and fluoride investigatory program previously reported upon has been continued during the year with considerable information on these two trace constituents in water being secured both as basic background data and for specific local use. The survey of hardness qualities of public and semi-public water supplies in the several geological and geographic areas of the state has been revised to add to existing basic data. In all of the above survey work much time and attention has been required in comparing various proposed testing techniques and methods and studying the adverse effect of interfering substances which complicate and make difficult the securing of comparable results in this group of chemical determinations.
The service functions of the Water Laboratory are made available to the widest possible extent in performing all laboratory tests in shellfish sanitation, the field work of this program being carried on by the Division of Public Health Engineering. A similar service is provided for regional and organized county health departments on non-public water supplies.
The Water Laboratory is well equipped and staffed to perform the great variety of tests closely related or directly involved in a public health water pollution control program. Illustrative of these tests are those concerned with taste and odor situations, excessive corrosion problems, insect and algae identification, water and sewage treatment plant control tests, and
6

special stream pollution studies. Much consultation and correspondence is required in explaining and directing citizens to other agencies for information on water subjects entirely unrelated to public health.
The instructional extension activities of the Water Laboratory are intangible services maintained to meet the demand for training local personnel and reception of visiting observers. The areas of interest include field training for local water and sewage plant operators combined with their visits to the Laboratory or to the annual water and sewage school. The ~fater Laboratory annually is visited by numerous groups of grammar and high school classes and college science, nursing, medical and dental students.
The following tabulation of bacteriological, bio-chemical and chemical determinations performed during the year indicates the wide distribution among the several categories of tests:

Bacteriological Samples
Drinking Water: Public and semi-public water supplies Camps and tourist courts Dairies Lunchrooms and markets Airplanes and trains Schools Private water supplies

14,292 8.5 147 10.5 494 199
1,.560

Shellfish survey Swirrmin g pools Hembrane filter studies

1,292 292 29.5

Chemical Samples
Bio-chemical, sanitary and chemical analyses

Total

16' 882 1,879

7

\rJater and Sewage IN"orks Construction
Water and sewage works construction projects have continued at an increased rate during the year. The contributing factors bringing about the continuing high construction rate are illustrated by the following conditions being experienced throughout Georgia. Cver the past several years there has been a large migration from the rural areas to industrial and commercial centers and congested areas near national defense installations. Within steadily grovJing communities there is a constant population shift to suburban areas, this movement attending accelerated public and private housing facilities in satellite areas developing around metropolitan centers. The increased urbanization and shifting nature of the population has necessitated many expansions and improvements to existing water and sewerage systems and the construction of entirely nevJ systems in many areas. The occurence of two successive years of deficient rainfall in the surr~er and fall seasons caused critically low flows in certain surface streams at the same tirrB of maximum water consumption. To overcome deficiencies in quantity of Hater available and to provide remedial measures in stream pollution control, new sources of surface water had to be selected and developed together with expanded water purification and sewage treatment facilities. The increasing awareness of the general public and citizen organizations to needed public water supply and stream protection gives public opinion support to municipal officials confronted with the problems of providing essential services for modern urban comrrmnity requirements. Industrial growth, particularly in the field of large water using manufacturing processes, has added its considerable effect to water supply and liquid waste treatment situations. Except in a few cases, municipal water and sewage works construction projects are being financed by the issuance of revenue anticipation certificates vrith direct service charges applied to cover these securities.
The record of accomplishment in planning, financing, design and construction of water and sewerage facilities is one in which each Georgia municipal and industrial representative who has participated should take pride. The completion of a larger number of
sewage treatment plants, fifteen, during 1952 than in any other
year is only one illustration of the general progressive trend. Both large and small cities are included in the construction program rather widely distributed between the geographical sections of Georgia indicating a uniform development over the state as a whole.
There follows a list of the majority of water and sewage works projects approved during the year and also a list of projects completed or under construction with a brief description of each. The lists do not include minor extensions, repairs or normal maintenance and there may be unavoidable omissions due to unavailability of information on a particular project.
8

Plans and Specifications Approved 1952 - Water Supplies

Atlanta -
Augusta -
Blakely Blackshear Carrollton -
Cleveland Cochran Columbus -
Dawsonville Dearing DeKalb County -
Douglas Greensboro Grovetown Jasper Jesup -
Ringgold -
Riverdale Snellville Surrmerville Sylvania Sylvester -
Thomson -
Thomasville -
Valdosta Wadley Waycross -

Distribution system additions and improvements. Water purification plant additions, clear water reservoir, ra1:-J water line, additional raw water pumping facilities and distribution system additions, extensions and improvements. Distribution system extensions. Distribution system extensions. Additions and improvements to water purification plant. Distribution system extensions. Distribution system extensions. Additions and improvements to ~rrater purification plant, raw water pumping facilities, and distribution system. New water vJOrks system. New water works system. Additions to water purification plant and raw water pumping facilities, new raw water reservoir and extensions and improvements to distribution system. Distribution system extensions. Distribution system extensions. New water ,,o rks system. New water purification plant. Elevated tank and distribution system additions and extensions. \ll]ater purification plant additions and distribution system extensions. New water works system. New water works system. New water purification plant. Specifications for proposed new deep well. New deep well, pumping equipment and chlorinator installation. New water purification plant and distribution system additions and extensions. Elevated tank and distribution system extensions. Distribution system extensions. Distribution system extensions. Fluoridation equipment installation.

C-1

Plans and Specifications Approved 1952 - Sewage Horks

Albany U.S.Marine Corps Depot -
Augusta Blakcshear Blakely Camilla Cleveland Cochran Douglas Fort Valley Greensboro Griffin -
Jesup Harietta -
Ringgold Savannah Savannah -
State College -
Sylvester -
Valdosta Wadley Waycross -

Complete treatment plant. Trunk and interceptor se-Jer. Sewer extensions. Sewers and primary treatment plant. Sewer extensions and two se1...rage lift stations. Sewer extensions and sewage lift station. Sewer extensions and sewage lift station. Sewer extensions. Sewers and complete treatment plant. Sewer extensions. Sewers and major enlargements to tvm existing complete treatment plants. Sewers and nm...r complete treatment plant. Sewers, pump station and two nevJ" complete treatment plants. Se1...rers and new primary treatment plant. Sewer extensions.
New sewer system, pump station and connector sewer to City of Savannah outfall to complete treatment plant. Sewers, pump stat ion and new primary treatment plant. Sewer extensions. Sewer extensions and pump station. Sewer extensions.

Water and Sewage Works Construction Projects - 1952

Acworth Albany-
Albany U. S.Marine Corps Depot -
Alpharetta -
Augusta -
Atlanta -
Blakely -

Major se1'1Ter extensions under construction. New deep wells drilled; water and sewer extensions under construction.
1.0 million gallon per day complete sewage treatment plant under construction. Hajor water distribution system extensions completed. New 36" raw water line and raw Hater pumping facilities, distribution system extensions and improvements under construction. Extensions and improvements to Hater distribution and seHer systems under construction. NeH deep well drilled; 200,000 gallon elevated tank, water distribution and sewer system extensions, and 400,000 gallon per day primary sewage treatment plant under construction.
C-2

Bremen Camilla Chipley Clarkesville Cleveland Cobb County Water
System -
Cobbtown Columbus -
Commerce -
Crawford Dacula Dallas -
Dalton -
Dawson Dearing -

Sewer extensions, pump stations, outfall and 250,000 gallon per day complete sewage treatment plant completed. Sewer extensions, two sewage lift stations
and 5oo,ooo gallon per day complete sewage
treatment plant completed. New sewer system and 50,000 gallon per day primary sewage treatment plant completed. Sewer extensions, sewage purr~ station, outfall and 200,000 gallon primary treatment plant completed. Sewers and sewage lift station under construction.
Distribution system additions, 4 million
gallon elevated storage, and 8 million gallon per day water purification plant under construction. New 1'1Tater system including deep well, hypochlorinator, 5,000 gallon pressure tank, and distribution system completed. Additions and extensions to water distribution and sewer systems, 9.0 million gallon per day enlargement to water purification plant, new 600,000 gallon elevated storage tank, additional raw water pumping facilities and new high service pumping station under construction. Major extensions to water and sewer systems, 200,000 gallon elevated tank, sewage pump
stations, and 5oo,ooo gallon per day pr~mary
sewage treatment plant completed. Water purification plant improvements and addition of 140,000 gallon per day filtration capacity completed. Water distribution system extensions and improvements completed. Major sewer extensions, outfalls, sewage pump station and two (225,000 gallon per day and 135,000 gallon per day) primary sewage treatment plants completed. Major water distribution system extensions under construction; major sewer extensions, trunk sewers, outfall and 1.5 million gallon per day complete se-vmge treatment plant completed. New deep well drilled. New water works system including deep well, hypochlorinator, 100,000 gallon elevated storage tank and distribution system completed.
C-3

DeKalb County -
Douglas -
East Point Fayetteville Fort Valley Gainesville Garden City -
GrayGriffin -
Groveto"Wn -
Hiawassee -
Hinesville Hogansville Jasper Kennesaw LaGrange -

Major water distribution and sewer system extensions, sewage pump stations, raw water
pumping additions, new 30 million gallon raw l>mter reservoir and 4. 0 million gallon
per day enlargement to water purification plant under construction. Sewer extensions, trunk sewers, two sewage pump stations and 1.0 million gallon per day complete sewage treatment plant under construction. New raw water reservoir completed. 144,000 gallon per day water purification plant completed. 1.0 million gallon per day complete sewage treatrrBnt plant to replace existing primary treatrrBnt plant under construction. Application of fluorides to public water
supply started during 1952.
Major water works improvements including new 60,000 gallon elevated storage reservoir, ne1v high service pumping station, hypochlorinator and distribution system extensions and additions completed. New deep well drilled. Major water and sewage works improvements under construction including: Raw water pumping additions, 1.0 million gallon elevated
tank, new coagulation structures and 2.0
million gallon per day addition to water purification plant, water distribution and sewer system extensions, trunk sewers and major enlargements of two existing complete
treatment plants to total capacities of 1.35 and 1.5 million gallons per day.
New water works system including deep well,
hypochlorinator, 23,500 gallon ground storage
reservoir, 4,000 gallon pressure tank and distribution system under construction. Major vmter works improvements including spring developments, hypochlorinator, new 60,000 gallon elevated storage reservoir and distribution system extensions and additions completed. Major water and sewer extensions completed. Major water and sewer extensions completed.
New 5oo,ooo gallon per day water purifica-
tion plant completed. New water works including deep well, hypochlorinator, 100,000 gallon elevated tank and distribution system completed. Major sewer extensions, interceptors, smv-age
pump stations and new 3.0 million gallon per
day complete sewage treatment plant completed.
C-4

Lakeland Lawrenceville Ludowici Macon -
Marshallville 1'1cRae -
Honroe Montrose Nashville Newington -
Ocilla Pelham -
Plains Portal Richland Richmond County Ringgold -
Riverdale -
Rome -
Ro ckrr.art -
Royston Sandersville Savannah -
Snellville -

New sewer system under construction. New deep well drilled, New sewer system completed, Major 1-rater 1-Jorks improvements including distribution system extensions, new raw 1-Jater pump station and additional coagulation structures to filter plant completed. Additional water treatment units for carbon dioxide removal completed. Major sewer extensions, outfall and new 175,000 gallon per day primary se1..rage treatment plant completed. Application of fluorides to public water supply started during 1952. Hypochlorinator installed on previously untreated well supply. Ne1o1 deep well drilled. Major water works improvements including pump house and pumping equipment, hypochlo-
rinator, 35,000 gallon standpipe and dis-
tribution system extensions completed. New deep well drilled, Water and sewer extensions, sewage pump stations, and 625,000 gallon per day primary sewage treatment plant completed. New deep well drilled, HYpochlorinator installed on previously untreated well supply. New deep ~vell drilled. New ~vells drilled; water and sewer extensions under construction, Major water and sewer extensions, trunk sewers, outfall, 400,000 gallon per day addition to water purification plant and a new 15 0, 000 gallon per day primary smvage treatment plant under construction. New water works system including two deep wells, hypochlorinators, carbon dioxide removal equipment, 5,000 gallon pressure tank, and distribution system completed. Application of fluorides to public water supply started during 1952; water and sewer extensions under construction. Water and sewer extensions, outfall, sewage
pumping station and new 6oo,coo gallon per
day complete sewage treatment plant completed, New deep 1..rell drilled. Two new deep wells drilled. Sewage pump stations, outfall, and 2.5 million gallon per day complete sewage treatment plant completed; major water and sewer extensions under construction. New water works system including deep 1-vell, hypochlorinator, 60,000 gallon elevated storage, and distribution system completed.
C-5

Sparta Sylvania Sylvester -
Summerville Suwannee Thomson -
Thorr.asville Union City Vidalia Wadley -
Waycross Whitesburg
Willacoochee Woodstock Wrens Zebulon -

New 310,000 gallon per day >vater purification plant under construction. NevJ deep well, pump house and chlorinator installation completed; contract let on 2)0,000 gallon elevated tank. Major vJater and set'll"er extensions, outfall, sewage pumping station, 200,000 gallon elevated tank and )00,000 gallon per day primary sewage treatment plant under construction. Contract let on new well, pumping equipment and chlorinator installation. New 800,000 gallon per day 1..rater purification plant under construction. Deep well drilled preparatory to constructing public water works. Major water 1'1Torks improvements including distribution system extensions and additions, and a new 1. 0 million gallon per day V>rater treatment plant under construction. Major water distribution system extensions and new )00,000 gallon elevated tank under construction. New deep well drilled. Major water and sewer extensions, outfall, pumping station and new 400,000 gallon per day primary sewage treatment plant completed. NeV>r Hell, pump house and chlorinator installation completed; major water and sewer extensions and sewage pump stations under construction. Major sewer extensions under construction. New water works system including deep well, hypochlorinator, )0,000 gallon elevated storage reservoir and distribution system completed. l'1aj or water distribution system extensions under construction. New 1'1Tater works system including deep well, hypochlorinator, 90,000 gallon elevated storage and distribution system completed. New sewer system and 22),000 gallon per day primary sewage treatment plant completed. New 288,000 gallon per day water purification plant under construction.

C-6

PREVENTABLE DISEASE SERVICES
Division of Chronic: Diseases Divison of Epidemiology and Canc:er Control Division of Oc:c:upational Health* Division of Tuberc:ulosis Control Division of Venereal Disease Control Battey State Hospital
* See Environmental Health Services

Division of Chronic Diseases

ANNUAL REPORT CHRONIC DISEASE CONTROL

1952

Cardiac Control Program

The following table is a statistical report of the activities of the

Fulton County Cardiac Clinic in which this Department participated in the

salaries of personnel. There was no official participation in the other

clinics except for the furnishing of fluoroscopes and electrocardiographs,

In addition to the clinics located in Atlanta, Albany, Augusta, Savannah,

Brunswick, Columbus, l'llacon and LaGrange new clinics have been set up during

1952 in Jesup, v,Jaycross, and Thomasville. It is hoped that a clinic will be

formed in the Northeastern Region and the Northwestern Region during the

coming year.

Summary of Activities of the Fulton County Cardiac Control Program

Number of cases admitted to service

783

Number of cases admitted to medical service

666

Number of cases admitted to nursing service

773

Number of cases admitted to social service

820

Medical clinic visits by patients

4,199

Social service clinic visits ~y patients

1,120

Field nursing visits to patients

6,075

Field social service visits to patients

136

Cases hospitalize

35

Transferrals or dismissals

272

1. No pathology

36

2. After treatment

8

J, Not eligible for Gra0y

24

4. DeceaseC.

151

5. Other reasons fr-r transfer or dismissal

53

Dismisse~ from social service

738

-----------------------------~------

Diabetes Control Program

At the completion of the third year of its operation the Diabetes Casefinding Program of the Georgia Department of Public Health began to organize and consolidate its position. A permanent director was appointed in November, and since that time tte Program has progressed slowly towards the goal of education of the practid ng physician in the State regarding diabetes, as well as towards uncovering cases of early unknown diabetics in whom early regulation of the disease should prevent the serious complications that notoriously arise.

In all, 186, 7CJ5 persons were screened y means of a bloc,d su.gar

examination and 4_, 775 persons vJere refer~sd to their private physicians

after a glucose tole:'c'lnce test disclosed an ar1ormal cartohydrate metabo-

lism or for practic~ 1 purposes, d::..ahetes mellitus. Of those referred,

4,286 denied any

ous knowledge of diabetes in themselves.

Divison of Epidemiology and Cancer Control

C J~CEH CONTROL
1952
The activities of the Cancer Program were similar in size and scope to those of the preceding year. Only minor changes were made in the operation of the program.
A new clinic was approved in Albany at the Phoebe Putney Memorial Hospital. With this addition, the number of clinics participating
in the program totals 19. However, one of them (Steiner) accepts
only an occasional case.
Effective \pril 1, local welfare departments were requested to furnish a report of each applicant's financial resources. This requirement led to a sizable reduction in the number of applicants but did not materially affect the case load. The number of return cases from prior years in now sufficiently large to be an appreciable factor in the case load.
The cost of the progrvm increased substantially above the figure for the previous year due primarily to increased expenditures for hospi~
tal care. Since July 1, 1951 hospitals have been paid at a per diem rate equal to 75 per cent of cost. When that policy became effective,
it resulted in a substantial increase in rates for many of the hospitals. This year was the first one in which the new rates were in effect during the entire year.
Distribution of the Cancer Bulletin to all physicians in the state was continued. Also, as in previous years, physicians participating in cancer seminars were reimbursed in the amount of their expenses.
The tables which follow show the number of patients vvho received diagnostic and treatment services at the various clinics and the expenditure for different types of service. It will be noted that
hospital care accounts for about 75 per cent of the cost of the pro-
gram. It is also apparent that the average cost of treatment varies greatly in different clinics. This is due, in part, to the fact that a few clinics receive the more difficult cases which require long periods of hospitalization. On the other hand, some clinics have not sho1m as much interest as others in keeping the hospital stay at a minimum.

TABLE I

Expenditures !lccording to Type of Service Rendered By Clinics 1952

Hospital Board Out- Chg. l Hosp.

Diagnostic

Cost Side Hosp. Day-Out-Patients Biopsies

X-Rays

Radium

X-Ray Therapy

Albany Americus Athens Auguf"t.::>

1,435.00 5,628.08 21,584.00 77,482.56

528.00 1,315.00

59.98 102.24 1,640.88

24.00 684.00 516.00 2,180.00

178.00 l, 113.00
628 .oo 7,029.50

60.00 782.43 414.16 852.38

373.98 3,426.85 4,168.67 !.+,597 .01

Canton

3,385.90

Columbus 6,898.98 372.50

Craw. Long 7,128.24

72.00

Dalton

949.20

LaGrange 9,503.68 161.82

Macon

27 '717 .20 2,357 .4o

Rome

5,352.58

Savannah 12,373.95 625.00

Sheffield 27,609.37 191.50

Steiner

210.50

st. Joseph 13,457.64

Thomasville 31,573.56

Valdosta

2' 241.28

15.00

li'aycross 5,216.94

30.00

ins hip 19' 271.90

TOT~.Ls $279,020.56 :;1)5,668.22

10.38
8.82 299.60 67.52 551.29 331.25
675.22 39.24 10.88 18.18 14.00
~3,829.48

220.00 204.00 284.00 88.00 524.00 1,456.00 416.00 1,224.00 804.00

210.00 458.00 560.00 100.00 493.50 2,616.00 172.00 1,734.00 2,541.00

331.50 782.93
86.10 113.25 750.45 3,88o.85 326.49 1,217.28 426.28

1,033.13 3,261.58
465.25 909.50 3,120.60 3,363. 76 l, 101.50 6,995.06 3,163.64

740.00 328.00 240.00 336.00 372.00
~10,640.00

866.00 138.38 1,334.50 549.96
292.00 245.63 440.00 632 . l l 291.00 $21,056.)0 ~11,590.18

1,004.00 4,995.00 1,389.38 2,LJ3.05
3' 123.82
s. ~:148' 92 78

Others

-To-ta-l
2,070.98

170.68 12,393.02

27,413.07

2,301.95 97,399.28

8.00 5,188.53

ll,98d.37

8,595.59

62.50 2, 222.45

630.00 15,167.87

45.92 41,736.73

24.85 7,460.94

24,720.58

606.52 35,673.56

210.50

517.50 17,398.74

79.84 38' 900.10

4,434.17

3).00 9' 141.28

67.50 23' 140.22

$4,550.26 ~385,255.98

Clinics
Albany J\mericus Lthens
imgu~t::J
Canton Columbus Craw. Long Dalton LaGrange Macon Rome Savannah Sheffield Steiner St. Joseph Thomasville Valdosta Waycross Winship T:'Ti\LS

Tii.BLE II

Halignant No. Cases 'Unount

17 174 147 389 82 101 58 51 154 448 76 263 210
l 85 236 53 110 -1-142769

1,629.18 9,186.30 18,308.32 77,742.57 3,707.46 10,070.42 6,600.27 l, 936.16 12,215.09 29_,661.17 6,012.90 19,475.85 28,719.99
210.50 11,933.26 33,441.20 3,090.4SJ . 8,145.41 20,382.55 t;J02' 469.09

Summary of People on Vihom Bills Here Paid 1952

Average Gost

Non-Malignant
No. Cases Amount Average Gnst

95.83

16

441.80 27.61

52.79

101

3,206.72 31.75

124.55

116

9,104.75 78.49

199.85

152

19,656.71 129.32

45.21

50

1,481.07 29.62

99.71
113 .so

23

1,917.95 83.39

25

1,995-32 79.81

37.96

7

286.29 40.90

79.32

84

2,977-78 35.45

66.21

182

12,075.56 66.35

79.12

36

l, 448.04 40.22

74.05

164

5,244-73 31.98

136.76 210.50

95

6' 953-57 73.20

140.39

60

5,465.48 91.09

141.70

60

5,458.90 90.98

58.31

49

1,343.68 27.42

74.05

44

995.87 22.63

178.79 (~109. 23

- -261290

2,757.67 106.06 ::>82' 811.89 ~~)64. 20

Malignant and Non-Malignant No. Cases Junount ;Lverage
r.nst

33

2,070.98 62.76

275

12,393.02 45.07

263

27,413.07 104.23

541

97,399.28 180.04

132

5,188.53 39.31

124

ll, 988.37 96.68

83

8,595.59 103.56

58

2,222.45 38.32

238

15' 167.87 63.73

630

41,736.73 66.25

83

7,460.94 89.89

456

24,720.58 54.21

305

35,673.56 116.96

l

210.50 210.50

145

17,398.74 119.99

296

38' 900.10 131.42

102

4, 4J)_j..l7 43.47

154

9J 141.28 59.36

-14-0 4059

23,140.22 -1-65-.2-9 -~385,255.98 694.91

T:\BLE III
Summary of ~~cti vi ties
1951-1952

hP.?LIC.,TIONS

1951

Total received Number approved Number disapproved Counties represented

3545 3527
18
158

C ~sES GIVEJ\T FIN YNC I ,L UD
Total number Malignant Non-malignant

4153 2761 1392

.J!IOUNT OF FIN J\TCLL _ID

Total amount given

317,237.21

i.verage amount per malignant case

89.15

J,verage amount per non-malignant case 51..08

OTHER ACTIVITIES

Lddresses made

13

Other meetings attended

10

Clinic visits and consultations

33

;.rticles written

10

1952
3087 3064
23 157
4059 2769 1290
385,255.98 109.23 64.20
13 19 34
7

DIVISION OF EPIDEMIOLOGY ANNUAL REPORT 1952
I. OBJECTIVES
"Whether the unit of study is the individual or the group; the primary consideration is the search for causes to direct remedial procedure. In clinical medicine we recognize these interests as diagnosis and prognosis. In mass medicine they are the business of epidemiology" *
In this period of re-evaluation and re-adjustment brought about by increasing limitation of funds available for public health; the function of epidemiology in the direction of public health practice becomes a particularly important one. In a very real sense epidemiology is a medical accounting service which has the function of determining: (a) the relative importance of diseases; (b) the relative hazard presented by the various sources of disease; (c) the feasibility and relative value of types of disease control; (d) whether epidemic illness is a consequence of natural variations in the pattern of disease or is a result of biologic warfare. The Division of Epidemiology is also responsible for informing the U. S. Public Health Service of the existence of any high incidence of disease and for alerting the medical facilities within the state to impending or possible epidemics.
II. PLAN OF ORGANIZATION
These objectives involve what a di~ti~uished epidemiologist has called "an ecologic approach to mass disease and injury"-l<-, that is to say, epidemiology deals with those relationships between man and his physical and organic environment which produce mass illness. Therefore epidemiology includes not only the familiar fields of clinical and public health laboratory diagnosis but also has within its scope certain aspects of the biological, veterinary medical, mathematical, physical, and social sciences. The attached chart* illustrates the integration of the sciences into medicine and public health. For these reasons the professional personnel of the Division includes two physicians, three biologists, two veterinarians, and two nurses, as well as the associated statistical and clerical personnel. The Division works in close association with the Central Statistical Unit and the Division of Laboratories, and with the insect and rodent control activities of Environmental Services.
* John E. Gordon, Professor Preventive Medicine and Epidemiology,
School of Public Health, Harvard University. Presented 23 February 1951 to the Medical Service Officer, Basic Course, Army Medical Service Graduate School, Army Medical Center, Washington, D. C.
- 1-

PUBLIC HEALTH PRACTICE

The Integration of The Sciences Into Medicine and Public Health

MEDICAL
AIIATOII'I IACTIRIO\.MT IIOCIICMIITRY PATIIOLOIY PMARMACO\.OIY 'PMYIIO\.MY
,.....,..,., IIOLOGIC:
MTIIIIOPOl.MY lOYAllY
MIITCK.MY PIYCIIOLOIY ZOOLMY
..,., ALUIRA
IIOITATIITICI CALCULUS
TRI.cMIOIIITIIY
..HYSIC:AL
CMIM . .TRY IIIIIIIURIIII IIOIRAPM'I IIOLOIY PMYIICI
SOCIAL
ICOIIOIIICI MilT OilY POLITICAL ICIIIICC IOCIO\.MY

DIAGNOSIS

Figure 1

TREATMENT

2
19012

III. MORBIDITY REPORTING
36,739 cases of thirty-four notifiable diseases were reported through the Division of Epidemiology in 1952. The situation with regard
to morbidity reporting is well illustrated by the following quotation
from the February, 1953 issue of the Journal of the Medical Association of Georgia: "In a 1941 survey of all pest-mortem examinations at Grady Hospital over a five year period ending in 1940, 3.5 percent of the
cases showed rheumatic heart disease ..... Unfortunately the inadequate and incomplete reporting of this reportable disease has slowed down efforts to study statistically the incidence of the disease in Georgia. To this end the Georgia Heart Association urges all physicians to diagnose and report this serious disease and allow us to develop a more intelligent and competent statewide rheumatic fever program". What has been said of rheumatic fever, and by implication of other streptococcic infections, is equally true of a number of other diseases, which are in some degree controllable by use of the antibiotics. The ever increasing number of reports of resistant strains of bacteria and of drug reactions in patients makes it clear that the antibiotics, as good as they are, do not represent the final answer to communicable disease and do not obviate the collection of disease statistics.
Some dramatic and well-advertised diseases, polio for example, are comparatively well-reported and, if a further example were needed of the value of morbidity reportiLg, the present situation with regard to the distribution of gamma globulin for the prevention of poliomyelitis would provide it. The problem confronting the Office of Defense Mobili-
zation in 1953 is the allocation of approximately 500,000 protective
doses of gamma globulin to those areas in the United States which are about to experience an epidemic of poliomyelitis. Data from our records have been provided on the incidence of poliomyelitis for the past five years in a selected series of counties for the purpose of enabling the allocating agency to determine when epidemic conditions exist or threaten.
Hookworm infection provides an example of another method of
disease reporting. In this disease, 73,530 laboratory specimen blanks
were forwarded by the various laboratories of the Department directly to the Division of Epidemiology where they were tabulated. This provides the most accurate reporting possible of this undramatic aiiment since nearly all positive diagnoses of hookworm are made in the laboratories
of the State Health Department. The total number of positives was 15,491, or 21 percent of those examined.
Comparative figures on the incidence of other diseases in 1951 and 1952 are given in the attached table. The five year median for the years 1948 - 1952 is also shown since this is the average least affected
by unusually high or low years.
IV. EPIDEMIC INVESTIGATIONS
(a) Leptospirosis. An extensive epidemic investigation was made
following an outbreak of leptospirosis involving 26 persons in Muscogee
- 2-

County. The causative organism, Leptospira canicola, was isolated from 2 patients, 3 dogs, and 1 hog, Two of 21 cattle, which also had access to the dammed up stream in which the patients swam, were serologically positive. This investigation is being reported in detail in clinical, laboratory, and epidemiologic papers.
(b) Food Poisoning Outbreaks
(1) Salmonella montevideo was isolated from canned egg-yolk corr~ercially prepared for infants and from 2 sick infants in Atlanta. This episode was part of a nation-wide outbreak.
(2) An outbreak in a State Park could not be studied satisfactorily because the group involved scattered over several states. Salmonella infection is strongly suspected on epidemiologic grounds.
(3) An outbreak involving 92 school children was traced to surplus commodity turkey served in the lunchroom.
(c) Neurotropic Diseases
(1) An outbreak occurring in northwest Georgia involved three persons living in one block of a small city and two persons residing in other parts of the same town. The chief complaints were nausea, vomiting, and muscle weakness which persisted during convalescence. One of the cases was diagnosed as bulbar poliomyelitis and another as paralytic poliomyelitis involving both legs. However, virus and serologic studies on the entire group were negative for poliomyelitis and for other encephalitides.
(2) A somewhat similar outbreak in east central Georgia involved at least five persons. Again the area affected was circumscribed although the community was a rural one. Four of the patients had been present at the same place briefly on at least one occasion, about two weeks before onset of the illness. These cases were characterized by sudden onset, severe and painful flaccid paralysis of the extremities on one side of t~e body with remissions and exacerbations and disturbances of vision. Fever was reportedly absent in three cases although there may have .been a tran:::ient febrile period. These patients were recently given a muscle evaluation test and all were considered to have some residual damage. Visual changes have also persisted.
V. FIELD STUDIES
Space limitations permit only brief mention of field studies. These are discussed in detail in individual reports on file in the Division.
(a) Among diseases now or formerly endemic in Georgia, malaria and typhus rank high. The following tabulation based on field investigations of these diseases will serve to indicate their present status. As the figures show, domestic malaria is non-existent and the large number of
- 3-

cases in Korean veterans accounts for the high malaria total:

Indigenous Cases

Malaria

Reported

2

Appraised

2

Confirmed

l

Awaiting Lab. Report None

Under Investigation None

Typhus r-..--.., c
27 16
4
7

Foreign Cases Reported Appraised Confirmed

Malaria
505 505 474

Typhus None None None

On the other hand typhus fever, the case totals of which have fallen from an average of over 1100 cases in the early 1940's to 27 cases in 1952, has not been eradicated and the number of cases being reported is probably somewhat less than the ~umber actually occurring.

(b) Infectious hepatitis (yellow jaundice). Cases of this serious disease occurred in more than half the counties of Georgia in 1952. The results of special studies in Whitfield, Hall, Meriwether, and Forsyth counties will soon be reported in the medical literature.

(c) Diphtheria. Studies are under way in an effort to discover the source of this infection in several areas where the case total is always high.

(d) Influenza. The purpose of this continuing project is identification of the strains involved in order to determine the possibility of and need for widespread immunization.

(e) Rocky Mountain spotted fever, Tularemia, and Brucellosis. Sixty cases of these diseases were investigated in 1952 with the purpose of finding the source of infection.

VI. RESEARCH INVESTIGATIONS

Under this heading are included field studies in which experimental observations or repeated epidemiologic observations were made.

(a) Hookworm

(l) During 1952 studies were continued in support of the hookworm control program of the Department. As the result of special morbidity studies referred to in another section, an estimate was prepared of the number of children infected by hookworm in each of the counties of the health regions located in the Coastal Plains section of the state. A copy Qi this estimate is attached.

(2) Studies on the relative effectiveness of Caprokol and tetrachlorethylene in treatment in areas where tetrachlorethylene has been used extensively were carried on in an e:'fort to determine whether or not strains of hookworm have become resistant to tetrachlorethylene.

(3) A study on the effect of improved nutrition in the control of hookworm infection in individuals and in families has been completed and will be reported by publication in a short time.

- 4-

(4) A paper on the activities of dung-burying beetles in
disguising defecation places and distributing infective hookworm larvae has been submittedfor publication.
(5) The relationship between types of sanitary installa-
tions and the level of hookworm infection in family groups is being studied in Bulloch county. While this study is far from complete, some interesting facts have come to light, For example, existence of hookworm infection in families having flush toilets is not negligibleJ a fact which indicates that dooryard pollution particularly by men and very young children is still a problem in many rural families. The solution of this problem appears to lie in the development of auxiliary sanitary installations of the pit privy type,
(b) Sanitary Installations
(l) A completed study of fly-breeding and fly-harborage in maintained pit privies in Georgia indicates that this hazard to health has been overestimated.
(c) ~eports on Leptospirosis investigations made in 1940, 1947, and 1949 are being completed for publication as a result of the devel-
opment of successful laboratory methods for the identification of leptospiras.
(d) Work is Jnderway in an attempt to identify suspected sources of leptospiral infection in the wild rodent population in Jefferson, Grady, and Emanuel counties.
VII. RABIES CONTROL
The activities, both epidemiologic and experimental, undertaken for rabies control are extensive and have been reported separately.
VIII.CANCER CONTROL
This is one of the most difficult and far reaching medical, financial, and social problems of the Department of Public Health. It is reported separately.
-5-

1952

Actinomycosis Anthrax Conjunctivitis Dengue Fever Diphtheria Dysentery Encephalitis j Inf. Hookworm Influenza Leprosy Malaria Measles Meningococcus
Paraty. & Salmon.
Poliomyelitis Rabies (in man) Rheumatic Fever Rocky Mountain Spotted Fever Scarlet Fever Screw Worm Infection Septic Sore Throat Smallpox Tetanus Trachoma Trichinosis Tuberculosis Tularemia Typhoid Fever Typhus Undulant Fever Hhooping Cough Leptospirosis* Infectious Hepatitis** Psittacosis

274
l
205 328 20 15491 5975
1 8573 119
95 505
102 8
357 0
485 0 30
l
4 1985
44
96
27 64 398 26 1525 1

Total

36739

* - Not reportable until 1952 **- Not reportable until 1951

1951
l
178
190 292 10 18710 6058
1
ll
7411 93 82 630 1 95 8 506 0 206 0 45 0 0
2502
6o
64 58 84 1192
699 0
39187

Five Year Median
l
0 93 0 292 311
ll
17547 5937
0 26 7411 59 54 477 0 So 13 546 0 223 0 36 0 0 2894 68 90 162 95 542
0

Ai.iJ ~SThiA'J:'E OF THE HOOK.lJOPJvl PROBLEJ'ci

Southeastern Region

l

2

3

4

5

6

7

County

Estimated Hhite Rural Pop. , Ages 3 yrs. through High School

%Infected Hook-
'fJorm 1950 reports from Health Departments

Estimated .LiJumber of Children Infected

Percentage of Estimated 11 State11 Total

County Q,uota of Lab Tests (including rechecks)

Estimated liJo. rechecks of positives after treatment

Recommended Routine Examination Q.uo ta*

Appling

3339

50

Atkinson

1580

50

Bacon

1987

45

Berrien

3271

50

Brantley

2018

55

Camden

637

35

Charlton

844

35

Clinch

975

50

Coffee

4133

40

Cook

2006

40

Echols

667

40

Glynn

1044

25

Jeff Davis

2124

50

Lanier

343

50

Liberty

1107

25

Long

616

35

Lowndes

1139

35

Mcintosh

661

30

Pierce

25ll

50

,,,Tare

1221

45

\~Jayne

2732

50

1670

3.8

2850

790

1.8

1350

894

2.0

1500

1636

3-7

2775

lllO

2.5

1875

223

0.5

375

295

0.7

525

488

l.l

825

1653

3-7

2775

802

1.3

1350

267

0.6

450

261

0.6

450

1062

2.4

1300

422

0.9

675

277

0.6

450

216

0.5

375

299

0.9

675

198

0.4

300

1256

2.8

2100

549

1.3

900

1391

3-l

2325

950

1900

450

900

466

1034

925

1850

666

1209

97

278

136

389

275

550

793

1982

386

964

129

321

90

360

600

1200

225

450

90

360

97

278

175

500

69

231

700

1400

279

621

775

1550

Regional To tal 35.505

-

11 State 11 Total n6,84o

-

15,759 44,390

35.0 100.0

*Note:

About 20% of the suspected cases will be in 3-6 year old children. If it is possible to do complete follow-up work at the homes of infected individuals, one-fifth of the ~uota should be saved for
this purpose.

26,700

8,373

18,327

76,525

21,655

53,370

Georgia Department of Public Ieal th Division of Epidemiology - October, 1952

-- __ , ____

~--
M; ESTii,L_I\TB OF THB H001\.'!0RJY; PROBLEl,i

-- -- .,.--..-----

--.~

~----

East Central Region

County

1

2

3

4

5

IGstimated ~:Jhi to Rural Pop., Ages 3 yrs. through High School

~ Infected Hook1tJorm 1950 Reports from Health Dopartments

Estimated Humber of Children Infected

Percentage of Estimated 11 State" Total

CoWlty Quota of Lab Tests (including rechecks)

6

7

.l!Jstimated 1'Jo. rechecks of positives aftor treatment

Roc~mmended
Rout inc Examination Q.uota*

Baldwin

1001

15

Bleckley

1032

30

Bryan

985

40

Bulloch

3400

30

Burke

1554

35

Candler

1270

35

Dodge

2930

40

Effingham

1283

25

Emanuel

3304

35

Evans

893

30

Glascock

885

25

Jefferson

1799

35

Jenkins

957

30

Johnson

1572

30

Laurens

3017

35

Montgomery

1129

30

Pulaski

945

20

Screven

1979

25

Tattnall

2875

35

Telfair

2035

40

Toombs

2181

40

Treutlen

1190

45

Twiggs

877

30

Hashington

uso6

10

<!heeler

605

40

'Jilkinson

1122

35

Regional To tal 42,626

-

11 Stato 11 Total 116,840

-

150 310 394 1020 544 445 1172 321 1156 268 221 630 287 472 1056 339 189 495 1006 814 872 536 263 181 186
393
13,720
44,390

0.3 0.7 0.9 2.3 1.2 1.0 2.6 0.7 2.6 0.6 0.5 1.4 0.6 l.l 2.4 0.8 0.4 1.1 2.3 1.8 2.0 1.2 0.6 0.4 0.5 0.9
31.0
100.0

225 525 675 1725 900 750
1 nr-
675 23,175 76,525

29

196

122

483

193

482

398

]?;?"'1

233

c:.(
107 175
5,856
21,655

34b 273 268 5:)0
17,319
54,870

.. ..

. ~t:

.!\.l'J ESTIMATE OF THE HOOl'I.WORN PROBLEJYI

South,,,restern Region

l

2

3

4

5

6

7

County

~stimated '.'!hi te Rural Pop. , Ages 3 yrs. through High School

p Infected Hook-
worm 1950 Reports from Health Departments

Estimated iiJumber of Children Infected

Percentage of Estimated 11 State11 Total

County r<,uota of Lab Tests (including rechecks)

Estimated liJo. rechecks of positives after treatment

Recommended Routine Examination
~uota*

Baker

552

30

Ben Hill

749

35

Brooks

1545

50

Calhoun

1015

45

Clay

335

20

Colquitt

3643

25

Crisp

771

30

Decatur

2441

6o

Dooly

1613

20

Dougherty

1382

15

Early

2148

50

Grady

2906

50

InN"in

2318

45

Lee

516

25

!cii11er

2004

50

Mi tche11

1400

50

~uitman

294

35

Randolph

795

30

Seminole

llll

45

Stewart

455

10

Sumter

661

10

Terrell

856

15

Thomas

1584

40

Tift

1233

45

Turner

1356

40

'vebster

425

20

'<'Til cox

1798

35

\Jorth

2803

40

166

0.4

300

69

231

262

0.6

450

117

333

773

1.7

1275

457

l.O

750

67

0.2

150

911

2.0

1500

425

850

233

517

25

125

289

1211

231

0.5

375

87

288

1465

33

2475

323

0.7

525

928

1547

87

438

207

0.5

375

1074

2.4

1800

49

326

600

1200

1453

3-3

2475

825

1650

1043

2.3

1725

535

1190

129

0.3

225 .

45

180

1002

2.2

1650

550

1100

700

1.6

1200

103

0.2

150

239

0.5

375

400

800

39

111

87

288

500

1.2

825

46

l.O

750

256

569

68

682

66

0.2

150

14

136

128

0.3

225

29

196

634

1.4

1050

555

1.2

900

542

1.2

900

300

750

279

621

257

643

85

0.2

150

25

125

629

1.4

1050

272

778

1121

2.5

1875

536

1339

Regional Total 38,709

-

14,911

34.0

25,650

7,426

18,224

u Stato11 Total ll6,840

-

44,390

100.0

76.525

21,655

54,870

VETERINARY ACTIVITIES
ANNUAL REPORT FOR 1952
DIVISION OF EPIDEMIOLOGY
Rabies incidence for 1952 sho~ed a slight increase over that for 1951. This was due in part to a severe epidemic in dogs and
foxes which occurred in Harris, Meriwether, Troup, Coweta, Fayette, and Upson counties. Through special grants of funds chick embryo live virus antirabic vaccine was purchased by the State Department of Health for free distribution to counties in which the disease was prevalent where county boards of health agreed to put on satisfactory organizational programs. Our activities in this respect were confined to north central Georgia in a belt extending diagonally southwest across the state from the North Carolina line. This procedure was followed in a total of twenty-five
counties. In most of these counties a total of about 70 - 75
percent of the dogs in the counties were immunized. This figure is based on dog censuses which were taken in a number of counties prior to inauguration of the vaccination programs. In a few counties, notably Fulton and DeKalb, the county organization was faulty due to a number of reasons and only a small percentage, 20 - 25. percent, of the dogs were immunized. This was not adequate to control the infection with the result that the disease is still prevalent in these counties. Sporadic cases have occurred in a tier of counties bordering the Chattahoochee River
in southwest Georgia late in the year 1952. This has been par-
ticularly serious in foxes. Late information indicates that the disease is approaching epidemic proportions in many of these counties. There is also a foci of infection in Telfair, Dodge, and Wheeler counties. This likewise is confined largely to foxes. Cattle losses have continued rather high. Butts county exper-
ienced a similar outbreak in November and December, 1952, in-
volving dogs, foxes, and cattle. Through special action by the Butts County Commissioners, funds were appropriated to elliploy a local veterinarian to vaccinate the dogs and for promotion purposes. The State Department of Health furnished vaccine without cost. Between 85 - 90 percent of the dogs in the county were vaccinated in a period of about ten days without cost to the owners. Rabies incidence in this county has decreased very materially since that program was completed.
Rabies in cattle has constituted a very considerable economic loss to the dairy and beef cattle industry over the past several years. To date there has been no experimental work done on the efficacy of immunization against rabies in these animals. \ve have been unable, therefore, to advise cattle owners as to the proper procedure to pursue following real or supposed exposure to rabid animals. \forking i:1 conjunction with Lederle
-l -

Laboratories, Pearl River, New York, we vaccinated 32 animals in July, 1952 to establish the safety of chick embryo live virus
antirabic vaccine in these animals. The animals were observed periodically and after a period of approximately three months, during which time there were no incidents in these animals which could be attributed to the virus, further studies were carried
out. A total of 531 animals were vaccinated in October and 359
animals were not vaccinated to serve as controls. The vaccine and personnel to vaccinate the animals were furnished Y Lederle Laboratories. It is planned to conduct challenge experiments on
part of these animals early in 1953 to determine the degree and
length of immunity. Serological studies on the blood of part of these animals indicate that a high blood titre is induced by a single injection of vaccine. This is particularly true in young calves in which animals the blood titre was much higher than in adult animals. This would seem to indicate that the immunity induced was quite satisfactory and would probably persist for a long period of time. The actual duration and degree of immunity can only be determined by challenge experiments under rigidly controlled conditions.
It is hoped that funds will be made available for 1953 for
the purchase of antirabic vaccine to be used in the manner men-
tioned above in 1952. A new law was prepared for introduction at the 1953 meeting of the Legislature to authorize the State
Department of Health to declare quarantines in infected areas and to take whatever measures are necessary for the control of
the disease in these areas. The course to be followed in 1953
is dependent to some extent on the passage of this Act. This bill was not enacted by the Legislature, therefore we are oper-
ating under the 1945 law.
We participated with other personnel of the Division of Epidemiology in investigating leptospirosis in humans, cattle, hogs, and dogs in the neighborhood of Columbus. This activity is being continued.
Through the cooperation of the Branch Laboratory in Albany, 2000 swine blood samples were collected from a local abattoir for brucellosis testing. This is an attempt to learn the extent and geographical distribution of brucellosis infection in swine in the southern third of the State. This is important information considering the high incidence of undulant fever in man in that section, most of which is of porcine origin. This will be
continued through 1953 at Tifton, Moultrie, and Waycross. Data
obtained will be used in undulant fever studies and referred to the Department of Agriculture for their information.
We have continued to act in a consultative capacity with other Department personnel upon request and with the Battey State Hospital Dairy management at the Battey Tuberculosis Sanitarium.
-2-

Division of Tuberculosis Control

ANNU'iL R-:;;PORT, 1952 DIVISION OF TUB~RCULOSIS CONTROL GEORGIA D'.:i:nARTl'TENT OF PUBLIC HE'\LTH

Item l.

The picture of tuberculosis as a killer has improved

vronderfully over the past several years. This improvement has

been goinr: on almost constantly sine e the beginning of our record

keeping, though there has been definite acceleration of this

decline in more recent years, as shmm by the exhibited table c:.nd

graph. Yet tuberculosis still ranks as the greatest cause of

death from communicable disease. It is responsible for a large

percentage of the deaths among young adu~.Lts and it has a very

high rate of fatality among chronic disease patients. In spite

of the superior treatment now offered, the death rate remains

too high and will continue to do so unless something to make it

more available to more patients at the right time and more

effectively can be brought about. The number of deaths in 1952

in Georgia was 467 - 199 white, 268 colored - with rates per

100,000 population of 13.1, total; 8.1, vmite; and 24.4, colored -

almost 40 deaths every month.

Item 2.

Compared to the declining tuberculosis death rate,

the trend of newly reported cases is not all encouraging, unless

the fact that the number is not increasinp- be taken to mean that

there is a gain for the better. 1983 new cases were reported in

1952, 1108 white; 865 colored; 10 were not identified. (From

January 1, 1953, through July 18, 1953, 1114 cases were reported

as against 1164 for the same period in 1952 - slightly less, it

is true, but hardly enough to justify any conclusion regarding

an up and dovm trend at this time, since we do not know that

treatment and cooperative behavior of one group of patients can

offset the damage that can be done by the amount of infection

produced by a large group of uncooperative patients who do not

accept diagnosis, treatment or even the need to exercise

infection preventive measures.)

Item 3.

Our Central Case Register indicated that on

December 31, 1)'52, 1922 cases were hospitalized at Battey

State Hospital, 301 in Veterans Administration Hospitals,

90 in local Tuberculosis Hospitals, and 9094 active and

questionably active cases nere in their homes. Liany of the

latter have positive sputum and many have left the Sanatorium

against medical advice. 1830 newly reported cases were ad-

mitted to the register during the year. 433 previously known

cases 1vere admitted for the first time. 539 other cases

previously unknown but not reported through morbidity vvere

admitted to the register during the year or a total of 2802

cases. In addition to those listed above, 356 patients are

reported to havo left the state and 604 others are lost

(vJhoreabouts unknOYm) and among these nearly 1000 persons,

many have positive sputum.

2.

Item 4.

The usual activities of the Division in case

finding and assistance to local health departments and

physicians in x-ray interpretation and patient guidance

recommendations have been maintained. 434 local 14xl7

x-ray clinics and 33 chest x~ray surveys (70 mrn.) resulted

in our interpretation of 238,045 x-ray pictures and the

finding of 802 new cases.

Item 5.

Pneumoperitoneum Refill Services have been

maintained as usual. Nearly 1,000 patients received such

service during the year and 699 remained on the treatment

list at end of the year.

Item 6.

Rehabilitation and Case ~Jork: ;re now have

six (6) Tuberculosis Case :rorkers. Although a new venture,-

studies have been made of over 500 cases and their families,

involving a total of over 3,000 persons. The object is to

determine the total treatment and social and economic and

rehabilitation needs of each patient together with his family

and hon they best may be met. Since the case 1rorkers alone

cannot cover the entire field, it is expected that their

example and counselin!? will result in a universally stepped-

up pro gram of such work through the local health department

nurses.

Item 7.

Nurse Consultant Service: 4 Tuberculosis

Orientation classes of 1 rreek each were organized with

35 Public Health Nurses in attendance. Special conferences

and educational meetings were conducted and attended, 33 in

all. Tvventy-five (25) local health department tuberculosis

case registers V<ere established, leaving only 13 counties

without them. Registers were reviewed in 50 counties and

many other services vrere rendered to local health department

nurses.

Item 8.

Scope of the Problem: Some idea is suggested

by the following: 8,451 cases, 12,352 suspects and 21,668

contacts to cases, a total of over 42,000 persons, were ad-

mitted to service in local health departments, representing

over 100,000 visits to the health departments and nearly

60,000 visits to them by local health department personnel.

Item 9.

The Future: There appears to be better general

recognition that tuberculosis continues to be one of our

larger and most difficult public health problems. Although

more deaths from it are being prevented or postponed, there

remains the fact that many of the living have disabling and

chronic illness and the others yet have need of more or less

extended convalescent care and treatment during which time

theymust be regarded as disabled. It must be remembered too

that dissemination of tubercle bacilli by ungoverned patients

vrith contagious tuberculosis is lar"cly responsible for the

perpetuation of the disease. It is believed lef!islativo

relief providinfl: an o.dequate means of control of this group

will be given by the Assembly 1.1hen it reconvenes in November.

3.
PROGRAF PLAN OF DIVISION OF TUBZRCULOSIS CONTROL FOR FISCAL YEAR JULY 1, 1953 TO JillJ:S 30, 1954
Case-Finding: It is proposed to operate 3 regional l4xl7
x-ray units as at present. They made 24,484 chest pictures in 434 county clinics organized by local health departments in 1952.
3 l1.~obile 70 mm. photofluorographic units on state-wide basis will x-ray selected groups, in industry, schools, colleges, institutions, communities, etc.
l Follow-up unit will operate to make l4xl7 x-ray pictures of referrals from the 70 mm. mobile unit service.
Tho 70 mm. service will be cut about in half because of reduced funds of the Division of Tuberculosis Contl'ol and tho Division of Venereal Disease Control. About 100,000 such pictures will be made.
Consultation x-ray interpretation services offered to physicians and county health departments will be continued. 9,054 x-ray interpretations were furnished by the Division through this service in the past year.
The practice of loaning equipment to local health departments will be continQed without any further purchase of capital equipment. 31, 14xl7 radiographic-fluoroscopic units and 4 photofluorographic units are now on loan. "ith these is included developing apparatus and other accessories. It may be possible to increase these loans from apparatus in stock if they are not to be used by tho Division.
Nurse Consultant Service~. \Je expect to continue the services of TB Nurse Consultation, advice and participation in training as heretofore. This will include local tuberculosis case register installation (90% of local health departments now have them in operation), and consultation advice as to their operation, and continuance of our tuberculosis information exchange between county and State Health Departments.
Case vJork: It is planned to keep this group which henceforth will consist of a Rehabilitation Consultant acting as supervisor and participant, and 3 case workers. They will make special investigations to determine what the best disposition of cases of tuberculosis should be in tho light of their individual medicnl needs and their socio-econmnic condition. Information of this kind is to be used to determine whether care and trontrrDnt in any particular case is reasonably possible in tho homo or Hhcther it is only possible in a sanatorium. Tho work of the Case-worker group should be valuable in demonstrating to local health department personnel (public health nurses) the methods to pursue in such case evaluation.

4.
The physicians, nurse consultant, rehabilitation consultant, case Tmrkers ' x-ray technicians, y:ill participate in training proprams into r.rhich they may fit,
Tho central case registc;r of the Division is to be continued in its present useful service of inf~rmation gathering and oxch2nge.
A full time Public Health Physician is to be added to tho Division in September.
It is planned to keep up tho pneumothorax and pneumoperitoneum refill service at our expense, though on a somewhat reduced scale. It is recommended that the service in tho larger cities be provided in clinics to be operated by the local health departments. The fee we pay is too small when the service is rendered for one or a very few patients at a time, and it amounts to too much in very large groups.
About (~20,000.00 worth of x-ray films arc furnished annually to local health departments having x-ray apparatus, either their own or loaned by us.
It has boon proposed that the furnishing of certain ~ntibiotics for tre2tment of those patients that can be profitably treated in their homes be dono by tho State Health Department. In a limited way nrrangements for this are being put into effect.
Pooling of resources of the Health Department, including those of Battey State Hospital, for various phases of training is being explored.
The use of general hospitals in case-finding by x-ray of their admissions is being p:iven consideration and methods by v-rhich it may be brought about will be suggested later.
Development of better consultation services to local health departments and local physicians in tho care of patients not hospitalized v'Till be givon serious consideration by the several agencies of the State Health Department and particularly by this Division.
The Huscogee County Tuberculosis Study established in 1947 has had an increasing allotment from the State Health Department in spite of a decreasing tuberculosis fund allocation from the USPHS. It should be kept up for its importance to lluscogee County, the Stnte of Georgia, and for its Nntional importance. It may be necessary to make some reduction, but upon re-ovnluation of tho program it mny be found fonsible to continuo it in some way or. a decreased i1ppropriation, or it may be found it should have increased support by other moans.

DIVISIOIJ OF TUBERCULOSIS COHTROL

TABL3 I

SUIJiARY OF X.:.RAY S2RVIC~S "\:.JJ ~-:::.SULTS tYANUflRY 1, TO DEC:=LB:0R 31, 1952

NUl :SER NUl :BER NUllB3R 14xl7 NE'; CAS:ZS ----------------------S-_"-3R-V=IC~E~S~X~-RAYS FOUND

REGUVIR COUNTY CLINICS (14xl7) 4340riginnl Exo.minZ'l.tions Re-exc:minations Total

9;087 110 15;397 164 24,484 274

PEJi.C:":NT
1.21 1.06 1.11

IndustriCJ.l Survey Follow-ups on

13,690 x-rCJ.ycd by 70 MM film

7

244 16

,12

HCJ.sS TB-VD Survey Follow-ups on

100,076 x-r2yed by 70 lv!M film

11 3,162 251

.26

College CJ.nd School Survey follow-

ups on 28,447 x-ro.yed by 70 i>'~if

film

5

369

9

.03

Public Survey Follon-ups on

44,735 x-rayed by 70 MM film

10

633 41

.09

Other Survey Follow-ups on 11,324 x-rayed by 70 JiJThi film

Eiscollaneous x-rays

35

X-rays mCJ.de in Contr:J.l Office

134

1

.74

(continuous)

Total x-rCJ.ys made and interpreted

by the Division except as noted

29,061 592

Less films Hnde by locCJ.l health depts, 198

Tot:J.l x-rays made and interpreted

28,863

Survey Follov.r-up films made by

local Health Depnrtments

198

Consultation Film Interpretations:

From Physicians 1st x-ray

304 26

Ro-oxam. x-ray

199

2

From locnl HeJ.lth Department

lst x-ray

3;031 109

Re-exnm. x-ray From State Prison

3,943

48

lst x-rny

1,070

22

Re-exnm. x-ray

409

~ TO~ T"A~ ,L~F~ ID~ eS~~ IJ\~ JTE~R~ PR- ET- ED~~--------~9,154

3

8.55 1.01
3.60 1.22
2.06 73

TOTAL NK' CAS<;S FROi.1 IIJTSRPilETl\TIOIJS

210

FIUIS LIADE BY OTruRS

TOTAL X-RAYS Ii''T:::Pc'?InT:::D BY DIVISION 38,017

802

TABLE U

TUBERCULOSIS D:~.\T:~S A.:m DEATH RAT3S PER 100,000 POFUlJ1TION
FT GZCRGIA
1921 THROUGH 1952
IHCLUDI?TG c:;.\~TG2 IN l.JU~::I:R OF DEATHS PE::?. Y"ZAH.,
rLUS OR : "INUS

m- -n:-B-3R-
"LAR TOTAL
1921 2531 1)22 2683 1923 2642 1924 2620
1925 2448 1926 2278 1927 2307 1928 2375
1929 2190 1930 2175 1SJ31 2165
1932 1933
1933 1777 1C'34 1"/72 1S'35 1731 1936 1713
1937 15h9 1938 1612 1939 1533 1940 1533
1941 1385 1942 1265 1943 1304
1944 1107 1945 1108 1946 1048 1947 1074
1948 998 1)'49 946 1950 824 1951 686
1S'52 467

Ci-:~i:TG~
t152 -41 -22
-182 -170 t69 t68
-185 -15 -10
-232
-156 -5 -41 -18
-164 /-63 -79
0
-1h8 -120 /-39
-197
1- 1
-60 /-26
-76 -54 -122 -138
-219

i ~~ITE;
892 991 965 917
872 807 798 832
742 774 700
665
675 605 649 648
559 602 543 544
501 465 499
418 h34 1:.67 415
400 372
"')'Jr>
.F-J
294
199

COLOR3D
1639 1692 1677 1703
1576 1471 1509 1543
1448 1401 1465
1268
1102 1167 1082 1065
990 1010 990 989
88h 800 805
689 6'7L1 . 581 659
598 57/.t. 501 392
268

TOT.'~L
87.4 92.6 91.1 90.3
84.4 78.5 '/9.4 81.7
75.3 74.6 73.7
65.3
59.6 58.9 57.1 56.1
50.3 52.0 49.1 49.1
44.0 L.a. 5 41.7
35.4 35.5 33.5 33.2
31.2 29.3 23.9 19.3
13.1

~.\TE
\Tl~J:TE
52~1
57.4 55.5 52.3
49.3 45.3
44~4
45.9
40.6 42.0 37.7
35.4
35.6 31.7 33.6 33.3
21:3.5 30,4 27.2 26.7
24.3 22.8 24.5
20.5 21.3 22.9 19.4
1.'1. (/1 17.4 13.8 11.9
8.1

COLORED
138.1
144~2
144.5 148.4
139.0 13L2 136.2 141.0
133.9 130.6 135.8
116.9
101.1 106.5 98.2 96.2
89.0 90.3 88.1 91.2
81.3 73.7 74.2
63.5 62.1 53.5 60.3
55.2 53.0 45.2 35.6
24.4

T!\BI.u"S III
ST.'\T~:; PN.=;mcoTHORAX AND PNEUHOP:3RITOIJEUH R:ZFILL P]OGR.'\li COST BO:lli2 BY GEORGI1\ DEPARTI~NT OF PUBLIC HE.'\LTH JANUARY l to DECELBER 31, 1952
Number patients under treatment January 1, 1952 662 Cases o.dmittcd to service during year 1952 . 311 Total cases under treatmont during 1952 973
Patients dropped from service during 1952: "\dmitted to Battey State Hospital. .. 61 Admitted to County So.natoria 13 Admitted to Veterans Administration Hospitals 9 Admitted to Milledgeville State Hospital. 3 Pneumothorax or pneumoperitoneum discontinued 133 Asswned ovvn pnyment 25 n.Ioved nway 36 Refused' trcilt1nent ................................. . . ll Deaths ..................................... 10 Imprisoned . ........................................ 3 304
TOTAL NmJBER PATIENTS UNDER TR:CAT~TENT DECEFBER 31, 1952 669

TABLE IV

Ai'TALY:-3!3 OF TUBERCULOSIS C!\SE RECORDS H~ C:C~'TRAL n::::GISTER r;;.; DEC:S'BER 31, 1952

STAGE OF DISEASE

EU! iJER

ACTIVL AKJ
CONVA~~ESCEl\TT
CASES AT HO:JE -:c

CASES HT Vii TERitl\:S
BATTEY -:HHH:HOSPITALS

IN ST,,TE PIHSOl'
J\l\~D
~ iiLLEDGEVILLE ST\TE HOSPITAL

F~r Advanced ......... 2664

1389

1082

193

Jfud~rateJy AdvancLd . . . . . 3688

3136

1~95

57

Minime.l ................ 1865

1809

36

20

Unclassified .......... 3291

2594-:HH~-

307

21

Primary .............. l9l

189

__ OthEcr .................. _]]_

67

2

--

10

Total ............... 11,776

9,184

1,922

301

369
369 -:~-k

-,- Includes about C)O patLnts in Chatham and' 'iuscogee County Sanatoriums. c~r Does not include all patients that are hospitalized in these institutions, but
only thos on who~ w~ have reports. -/~-:H~- This fir;11r.' rrob2bJ y contair; s 2. c onsidcrable number of inactive cases.
:-::--:c-:c Battey Census, Dec..mber 31, 1952 was ... 1930.

fiGURt. 1
NUMBER OF TUBERCULOSIS CASES REPORTED, BY RACE GEORGIA, 1942-1952

'Tumber ! :_' Cases
1-

W'nite

-- - - - N--o-n- w--h--i-t--e-

:
--------. ------ -- ---''

- - -~

_:~,

I -'

.,i

---- -- I .. -

---

20GO _

I '-.._

I

'-

!

I

,, -,__

_.......-t"-

"'~.......-

:

'

I

i
I

--.. --- ---- I // _.-------------. ____]

- . ~ j/. -. . ~

I~- .. -

looo -~~~~---t

--~---~~--

I

I

I

!

I

I

1-

I

I

--'----l----'----'----'---1----'---'------'--~~~_j 0 1._-...........1----'-----l-----'----L-_..___;._i 1942 1943 1944 1945 1946 1947 \948 1949 1950 1?51 1952
SOURCE: GCORGII\ DEPARTMENT or- PUBUC HEALTH
DIVISION OF TUBERCULOSIS '=ONTROL

FICjURE 2
TUBERCULOSIS DEATH R1\TE, BY RACE GEORGIAI I932-1952

Rate Per 100,000 PO!IUlation
r--- 'IrL1c) ... - ....

r-------- ----I---- --------I---.

1 To~al I\.11 r:.o.cc;s

i~~-----~--------f

KEY I'u te

;~--~~~-:-- :] --

IJ!onrh.i.+;c

I - - -- - -l

------------ ----------------,----

i
loci~------\:_<~":,~:--

---+---------- ____________

1-

\

l1

i

.__ .. -~. __ ,'l,

!

---... .- --- -... 1.

.

---+~~-,:---~- 75 i---

--+----------

\

I ..

----- I

~-. ~~"--

)'-

~

.- '-

'-' -----------.

:-------. ------~ ------ -- -- ---:---------- .... --,-

\. '

l "--+" '~~~- ~\ 1..-~~~----- . r

I
i

2 51 ---- .. -- .! .... -_/-

.

iI

I ~~1~~
-!-:...--- . -- --- 1:..... --- . - - .'-...._ I - , -- /'--"-,

1
I\
~\
-- ~
~

II -

i
:I

~

i;
j

--.

~ ~

':-,

'

Ol t

I

!

f

4

I

!

!

!_

'

i
_____.L--l..__;___.__

I

lI

1931

193)

194:::>

1945

1950

SOUkCE: GEORGIA DCPARTMENT OF PUBLIC HEALTH

DIVISION Of TUI3ERCULOSIS CONTROL

Division of Venereal Disease Control

J-~.NNUAL RiPORT DIVISION OF VENER..!.:J-1.1 DIS~ASi CONTROL
1952
Division Function
To control venereal diseases in the State of Georgia through effective programs of case finding, treatment, and prevention.
General
Throughout 1952, our records continue to show dowmvard trends in both the incidence and prevalence of syphilis. The constant decrease in our patient load at Alto Hedical Center necessitated the closing of this in-
patient facility on September 30, 1952. As an alternative we set up 1
out-patient Diagnostic and Treatment Centers in existing local health department facilities in the following counties: Fulton, Richmond, Bibb, Muscogee, Dougherty, Ware, and Chatham, By the end of 1952 the smooth
operation of these 1 out-patient Diagnostic and Treatment Centers clearly
demonstrated that the job of diagnosis and treatment could be effectively accomplished through such Centers at a cost of approximately 25% of that required to operate Alto Medical Center on a minimum basis.
.~~.-.:
In addition to these 1 out-patient Diagnostic and Treatment Centers,
several of our larger health departments throughout the State resumed the diagnosis and treatment of venereal disease cases within their respective jurisdictions.
Statistics of the Division of V. D. Control, U.S. Public Health Service, continue to show that Georgia's Program of VD Control is outstanding in comparison with such programs in other states throughout the country.
Our Training School at Alto Medical Center had achieved such outstanding success du.ring its several years of operation that the U.S. Public Health Service provided funds for its continuation at the Fulton County Health Department in Atlanta following the closing of Alto Medical Center.
Table I (Appended) -Multiphasic Healthtesting Surveys:
During 1952, Multiphasic Healthtesting Surveys were conducted in Crisp, Toombs, Upson, Wilkes, Early, Warren, Stephens, Jefferson, Hall, Emanuel and Pierce Counties. In these surveys we did a chest x-ray for tuberculosis and other chest pathology, serologic test for syphilis, hemoglobin determination for anemia, and a blood sugar determination for diabetes. In these 11 surveys conducted during 1952, we tested a total of 125,761 persons for syphilis. Of these, 2,627 were positive and 704 doubtful by the Kahn test. From this number of positive findings, 1,265 new cases of syphilis were brought to treatment. This compares with a total of 11 ~ surveys conducted during 1951, in which we tested a total of ll8,56~persons for syphilis, of whom 4,863 were positive by the Kahn test, of which 1,614 were new untreated cases of syphilis.
Table II (Appended) - Communicable Disease Investigator Program:
This table shows 12,491 suspects were investigated by our Communicable Disease Investigators during 1952, and that 2,509 previously unknown cases were brought to -treatment, of which 396 were primary and secondary syphilis. This compares with 10,346 suspects investigated during 1951 with 2,907 previously unknown cases brought to treatment, of Hhich 331 cases were

primary and secondary syphilis. During 1952, our Communicable Disease Investigators brought to treatment 206 cases of congenital syphilis. This compares with 543 cases of congenital syphilis brought to treatment by these Investigators during 1951.
Ir. addition to the above activities of our Communicable Disease Investigators in the field of investigation of susp~cts, they also conducteu 45 miniature hultiphasic H.:;althtc)sting Programs in 36 counties. In these 45 miniature surveys they tested a total of 63,969 persons with 1,994 positive findings and 1,313 weakly positive findings.
Table III(Appended) Alto Medical Center - In-Patient Care:
This table shows that 3, 290 cases of syphilis were treated at l~lto Medical Center during 1952 and that our total admissions for 1952 were . 8,236. This compares with 6,688 cases of syphilis treated at Alto Medical Center during 1951 and 12,764 total admissions for the same yaar. During 1952, 209 cases of primary and secondary syphilis were treated at Alto as compared with 504 cases of primary and secondary cases of syphilis treated at Alto in l95r:- During 1952, 448 cases of conL,enital syphilis were treated at Alto as compared with 980 cases of congenital syphilis treated there during 1951. (The lower figures for 1952 are partially due to the closing of ,\.lto l'Jiedical Center on September 30, 1952).
Table III-a(Appended) - Diagnostic and Treatment Centers - Out-Patient Care:
This table shows that from October l through December 31, 1952 our 1
newly established out-patient Diagnostic and Treatment Centers treated a total of 446 new cases of syphilis, 989 cases of gonorrhea, and 28 cases of other vanereal disease, and admitted for diagnosis and/or treatment a total of 15,153 patients.
Table IV(Appended) - New Venereal Disease Cases Reported:
During 1952, 3.518 cases of syphilis were reported, of which 576 were primary and secondary infections. This compares with 5.173 cases of syphilis reported during 1951, of which 964 were primary and secondary infections. During 1952, 12,779 cases of gonorrhea were reported. This compares with 13,308 cases of gonorrhea reported during 1951. During 1952, 700 cases of other venereal diseases were reported. This compares with 1,022 casas of other venereal diseases reported during 1951.
Table V (t~pended) - Distribution of Antisyphilitic Drugs:
This table shows comparative figures for the distribution of free antisyphilitic drugs for the years 1951 and 1952.
Table VI (Appended) - Alto Medical Center Training School:
This table shows that 288 trainees attended Alto Medical Center Training School during 1952:-ln a total of 38 classes conducted during 1952, there were trainees representing practically every state in the Union, several from the Military, and one from Puerto Rico.

City

County Period

c-

Cordele Crisp 1- 2 to

l-20-52

Lyons

Toombs l-20 to

2-26-52

Thomaston Upson 2-27 to

4- 8-52

Washington Wilkes 4 -7 to

5 -6-52

Blakely Early

5- 7 to

6- 3-52

vJarrenton Warren 6-4 to

6-24-52

Toccoa

Stephens 6-25 to

7-22-52

Louisville Jeffersor 7-23 to

8- 8-52

Gainesville Hall

9-10 to

10-28-52

Swainsboro Emanuel 10-29 to

ll-25-52

Blackshear Pierce ll-26 to

12-19-52

Total

VENEREAL DISEASE SURVEYS IN GEORGIA

1- ,9_5,2-

Pop. Number of New Syphilis Cases

Tested Brought to TreatmEnt

Agfl~ Prim. Early! Other Total

15-64 and
% Sec.

Latentr

Total

115

l

28 200 _____229 12,875

98

0

7 89

96 10,009

110

2

44 172

218 17,697

81

0

15 119

134 8,340

76

l

17 106

124 9 522

72

8

ll 87

80

l

3 24

106

4 495

28 8,690

94

2

23 210

235 ll 600

97

l

8

24

33 25,192

75

0

12

41

53 10,904

89

0

0

9

9 6,437

16 168 1,081 1,265 1125,761

Kahn Tests Negative Positive

Table I

Douptful

V.D.R.L. Positive
or W/Pos.

12,308
9,79~
17 270 8,008 9,143 4,294 8,615
11,018 24,998 10,612
6,365 122,430

471

96

169

41

344

83

267

65

288

91

160

41

57

18

455

127

140

54

217

75

59

13

2,627

I
I

704

1,193 473 883 645 816 455 144
1,220 503 581 200
7,113

CQlJ:iJ[UNICABLE DISEASE INVESTIGATION PROGRAI'-'1

1952

Tablo II

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

Disposition 2 (~xamined- Not infected) .............. 5,174

II

2X (Previous treatment adequate) .... 2,170

II

3 (Old cases returned to treatment) .....

423

II

3X (New cases brought to treatment) ........ 2,503

II

4 (Located- Already under treatment) ...

470

II

6 (Cannot locate)

648

II

7 (Moved from jurisdiction)

540

II

8 (Insufficient information to investigate)

309

II

9 (Other) ........................... , ........ .

~

Total suspects investigated .................... 12,47J

Breakdown of Disposition 3 (Found infected - No previous treatment )

Primary syphilis ................. e

137

Secondary syphilis ...............................

259

Early latent syphilis . .................................... .

471

Late latent syphilis ..................................... .

466

Cardiovabcular syphilis ........................

17

Neurosyphilis .................. , ......................... .

75

Congenitai syphilis ...................................... .

206

Gonorrhea

784

Chancroid ................................................. 62

Granuloma Inguinale ...................................... .

15

Lymphogranuloma Venerelliil ................................. .

17

Total cases untreated V.D. found

2,509 ->~

"*'Number of indi victuals found infected

CLASSIFICATION OF PATIENT LOAD

ALTO ~lliDICAL CENTER
1951 and 1~52

Table III

I. Syphilis (Treated)

1951

1952

l. Primary and Jecondary
2. Early Latent

504

209

1,297

611

3. Late Latent

2,821

1,485

4. Neuro-Syphilis

818

457

5. Other Late

268

80

,~....~.~'

6. Congenital

980

448

Total syphilis cases

6,688

3,290

II. Not in Combination with Syt~hilis (Treated)

l. Gonorrhea
2. Other VD
III. Observation dnd No VD

CJ9

G2

244

179

l. Observation only
2. Treatment given
IV. Patients Treated

5,623 25

4,835 19

l. Total number
v. Patients Treated and Observed

7,056

3,550

l. Total number
,.r:,~
VI. Admissions

12,679

8,385

l. vvhite
2, Colored
Total admissions VII. Total number of patient days

666 12!098
12,764
84,779

378 7,8h,_L 8,236 44,773

DIAGNOSTIC AND TREATjVJ..GNT CENTERS and
OTHER VD CLINICS
October l - December 31

Table III-a

Classification

Diagnostic
&
Treatment Centers

Other VD Clinics

I. Sr.f2hilis (Treated)

l. Primary and Secondary
.'_)__, Early Latent
3. Late Latent 4. Neuro-Syphilis 5. Other Late 6. Congenital

36

11

104

54

158

7

32

22

22

Total

327

119

II. Not in Combination with s;z.f2hilis

l. Gonorrhea (Treated)

2. Other VD

II

882

107

28

III. Observation and No VD

l. Observation only 2. Treatment given(Prophylactic)

6,231 20

7,439 0

IV. Patients Treated

Total number

1,237

226

v. Patients Treated and Observed

Total number

7,488

7,665

Total
47 158 158
7 32
44
446
989 28
13,670 20
1,463
15,153

NEw VENEREAL DISEASE CASES REPORTED TO

..,

VENEREAL DISEASE CONTROL DIVISION

1952

Table IV

DIS~ASE
SYPHILIS: Primary and Secondary .l!.:arly Latent Late and Late Latent Congenital Not stated Total syphilis cas2s

PRIVATE PHYSICIANS

CLINICS

White

Colored

White

Colored

IVl

F

M IF

lVI

F

MF

2 18

I2 9 7 30 17 244 265
4 29 20 19 32 324 560

7~

6 -

!

18 -

I

14
-

12 6 37 16

49 12
-

45 8
-

1567~0 1 71881~

39 18 93 57 110 102 1307 1792

GONOCOCCUS INFBCTION
OTHER VENEREAL DISEASBS:
Chancroid Granuloma Inguinale Lymphogranuloma Not -_)tat2d
Total other VD

I3 1

4

2 731 451 8424 3161

- - - - 18 6 316 127

-

-
-

-

-
-

1
-

3 -

I

77 64

65 18

-

-

-

-

-

-

--

___- -

_______ I ..._~

.

- - 19 9

j

I

I

i

f- " -- ___J____

457 210

ALL SOURCES

vvhite

Colored Unknown

lVI

FM

F

TOTAL

32 37

19 36

325533

' 257820

56 51 588 j 795

12

8 169 I 186

12

6 37 16

149 120 1400 1849

576 1,006 1,490
375 71 3,518

734 452 8428 3163 2

12,779

I 18 i 6 316 127

1

3 77 65

-

- 64 18

-

-- - 5

1/

'1 457 ~ 210

5

\

467 146 82
5 700
--

DISTRIBUTION OF FREE ANTISYPHILITIC DRUGS

1952

Table V

Name of Drug

l. Arsenicals (Estlinated number of doses)

2. Bismuth

II

II

II

II

3. Sulfathiazol II

II

II

II

4. Fuadin

II

II

II

II

Total doses

5. Penicillin (No. of 100,000 units)

Penicillin tablets

6. Vaccines:

a) Ducrey No. of tests)

b) Frei

II

II

II

7. Streptomycin (Grams)

8. Sulfadiazine (Tablets)

9. Terramycin (Tablets)

10, Chloromycetin (Ampules)

1951 130 2,820
0 0 2,950 241,369

1952_ 0
1,110 0 0
110 316,381
24

3,450 1,610
3,416 141,90)
0
0

1,254 1,170 1,845 179,500 2,976
50

ALTO ~iliDICAL CENTER TRAINING SCHOOL FOR VENEREAL DISEASE INTERVIEWERS

Table VI

Length of Course

Number of Courses Presented

Number of Students Attending

1-Week

26

193

3-vveek

12

95

Battey State Hospital

ANNUAL REPORT 1952
BATTEY STATE HOSPITAL

TABLE I

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

Year

White

Colored

Total

1943

575

1944

524

1945

477

1946

964

314

889

251

775

298

775

586

1550

1947

1033

616

1649

1948

998

6~{9

1677

1949

914

615

1529

1950

939

639

1578

1951

981

717

1698

1952

1020

735

1755

This represents an increase of only 57 more applications received in 1952 than were received during the calendar year of 195L

Page 2

TABLE II

The following table shows applications by age group
for admission to B?ttey and Alto during the past eleven years:

Under 20 20 - 39 40 - 59 60 plus

Total

Year White Col. White 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 90 404 314 334 168 127 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

1952 60 102 375 349 407 220 178 64 1020 735

It can be seen that there was an increase in the applicants under twenty years of age in 1952. There was a total of 162 applicants this year under twenty as compared to 122 for 1951. In the 20 to 39 age group there was again a slight increase with a total of 724 in 1952 in comparison with 706 in 1951. In the 40 to 59 age group there was a total of 627 applications in 1952 as compared to 655 in 1951. In the age group above sixty there were 242 in 1952 as compared to 215 in 1951. Taking the two groups together, that is all patients above forty years of age, there was a total of 869 applications in 1952 as compared to 867 in 1951.

Page 3

TABLE III

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

Under 20 20 - 39 40 - 59 60 plus

Total

Year vJhi te Col. White Col. White Col. White Col. White Col.

1942 18 58 14 54 20 37 43 66 19 52

1943 28 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

1952 11 10

72

66

78

75

In reviewing this table one can see that in 1952 the greatest reduction in patients rejected occurred in the col-
ored population. In the age group of 20 to 39, the colored patients rejected is now down to 2%. In the 40 to 59 age
group, the percentage rejected is down to 6% and in the 60 plus age group there were only 8% of the colored patients rejected. In the total rejections, the rejection rate for the
whites dropped from 9% in 1951 to 7% in 1952, whereas in the total for the colored admissions, it dropped from 15% in 1951 to 5% in 1952. Again it can be stated that the great majority of all rejections were in persons who were not considered to have active disease. This trend seemed to indicate that practically all pati~nts with active disease who applied for admission during 1952 were accepted for hospitalization.

Page 4

TABLE IV

The following table shows the number of admissions by color, for the past ten years at Battey and Alto, as compared with 1952:

Year 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952

White 425 425 470 765 738 803 728 731 842 872

Colored 134 121 210 377 362 322 284 456 561 597

Total 559 546 680
1142 1100 1125 1012 1187 1403 1469

A review of this table shows patients admitted in 1952 than in

that there 1951.

were

66

more

Page 5

TABLE V

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

Year
1944 1945 1946 1947 -1948 1949 1950 1951 1952 1953

Total
453 518 544 986 1199 1305 1444 1597 1762 1957

This reflects a steady increase in the number of beds
being made available for the treatment of tuberculosis in this institution.

Page 6

TABLE VI

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

OTHER FAR ADV. MOD.ADV. MINIMAL FORMS NON-TBC. TOTAL

Year Wh. Col. Wh. Col. Wh. Col. Wh Col. Wh 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 1952 444 403 291 94 21

18 27
ll 4

39 60 37 842 561 21 lll 68 872 597

During the year of 1952 57% of all patients admitted were classified as far advanced and nearly 70% of all colored patients admitted were classified as far advanced. Twenty-six per cent of all patients admitted were classified as moderately advanced~ 12% were classified as inactive tuberculosis at the time of admission or with a diagnosis deferred, 2% had
minimal tuberculosis and 2% had other types of tuberculosis ~uch as pleural effusion~ miliary tuberculosis, tuberculous
abscesses or extra-pulmonary tuberculosis.

When one compares Table I and Table VI~ it is obvious that all applicants for the year of 1952 were not hospitalized. The status of all applicants not hospitalized is shown as follows:

l. Waiting list for admissions to Battey as of l-l-53

98

2. Applications rejected during 1952

106

3. Patients requesting names be removed from waiting list 61

4. Failed to report for admission

38

5. Died prior to admission

56

6. Hospitalized elsewhere

12

7. Miscellaneous

3

This shows that there were possibly 99 patients considered to have tuberculosis refusing hospitalization.

Page 7

TABLE VII

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

Age Group Under 20

Year

White Col.

1944

16 13

1945

24 21

1946

39 38

1947

47 33

1948 1949

45 33
44 40

1950

47 57

1951

27 55

1952

47 84

20 - 39 White Col.
251 80 351 134 368 217 379 181 344 196 336 150 309 240 328 278 333 282

40 - 59 White Col.
137 27 164 51 287 113 316 99 319 80 267 76 284 136 352 199 362 181

60 plus

White Col.

21

l

31 4

71 7

41

2

95 13 81 15

91 23

135 29

140 50

When one compares the 1952 totals to the year of 1951
it is apparent that there were 49 more patients admitted in the age group under 20 during 1952 than in 1951. When one compares the total of the age groups of 20 to 39 for these two years, there were 9 more patients admitted in this age group in 1952 than in 1951. When one compares the age group of 40 to 59 for these two years, there were 8 less patients admitted during 1952 than in 1951 in this age group. When one compares the 60 plus age group totals, one can see that there were 26 more patients over 60 admitted in 1952 than in 1951. The most significant rise in admissions, as far as age groups go, between these two years occurred in the under 20 age group. The next most significant occurred in the 60 plus age group.

Page 8

TABLE VIII

The following table shows the number of discharges from the hospital at Alto and Battey during the past ten years:

Years
1943 1944 1945 1946 1947 1948 1949 1950 1951 1952

White
546 431 376 459 629 754 613 652 789 872

Colored
129 149 168 159 267 275 212 331 473 487

Total
675 580 544 618 896 1029 825 983 1262 1359

One can see from the previous tables that there was a
total of 1,469 patients admitted and a total of 1,359 discharged. Of the 1,359 patients discharged, 116 were discharg-
ed without a diagnosis of tuberculosis having been established.
We are considering them as non-tuberculous, which leaves a
true adjusted total of 1,243 tuberculous discharges.

1,359 - Total No. patients discharged 116 - Non-tuberculous
1,243 - Tuberculous discharges

Page 9

TABLE IX

The following table shows the status of patients at discharge during the past nine years at Alto and Battey:

QUIES. OR
ARREST.

IMP.

UNIMP. DEATHS

TOTAL TBC.

NON-TBC.

Year Wh. Col. Wh. Col. Wh. Col. Wh. Col. Wh. Col. Wh. 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

1952 251 170 350 160 143 40 55 74 799 444 73 43

During the year of 1952 34% of the discharges were quiescent or arrested and represented inactive cases of tuberculo-
sis. Forty-one per cent of the discharges were discharged as improved and 15% as unimproved, meaning that approximately 55% of the discharges were considered to have active tuberculosis. Ten per cent of the discharges were accounted for by death.

Page 10

TABLE X

The following table shows a breakdown as to the type of
discharge these patients received in 1952

Medical Disch. Disciplinary Signed Out Leave, No Return Dead With Consent Transferred Total

WHITE WHITE COLORED COLORED

MALE FEMALE MALE

FEMALE

166

145

119

130

35

4

23

ll

245

128

56

27

18

18

5

17

45

13

37

37

15

9

0

2

25

6

14

9

549

323

254

233

TOTAL
560 73 456 58 132 26 54 1359

Approximately 41% were given medical discharges, 5% disciplinary discharges, 33% signed out, 4% failed to return from leave, about 10% died, about 2% were discharged with consent but against advice, while about 4% were transferred from this
institution to other institutions.
Approximately 45% of all discharges from the institution during this year left against advice. A further breakdown on the sputum status of these 613 patients that left against advice revealed that 27% of them were positive to direct smear, 17% of them were positive only to culture and 56%
of these patients were negative to culture at the time they left the institution.

Page ll

TABLE XI

The following table shows the number of discharges who had positive sputum, either to direct smear or culture, at the time of discharge by status, by year and by color:

Year
1944 1945 1946 1947 1948 1949 1950 1951 1952

Q,UIESCENT OR
ARRESTED
White Col.
30 l0 40 20 8l 50 62 8l 82

IMPROVED White Col.
37 10 30 14 25 12 64 23 101 28 68 27 104 60 118 74 102 68

UNIMPROVED White Col.
45 23 60. 16 87 26 106 31 9S 20 73 6 80 ll 130 44 115 33

TOTAL White Col.
85 33 91 30 116 38 170 54 207 48 146 33 190 73 256 119 225 103

One can see from a review of this table that even though there was a greater number of discharges during the year of
1952 than during the year of 1951 there was a lessened number
of patients leaving the institution with positive sputum in
1952 than in 1951. This is undoubtedly accounted for by the
number of people leaving the institution while having been on
drug therapy, which would be classified as improved and prob-
ably have a negative sputum due to antibiotic therapy.

Page 12

TABLE XII

The following table shows the discharge status of patients,
per cent of total tuberculous discharged, during the past nine years at Alto and Battey:

Year 1944 1945 1946 1947 1948 1949 1950 1951 1952

QUIESCENT OR
ARRESTED White Col.
29 37 32 20 23 10 21 12 22 19 38 25 38 27 30 26 31 38

IMPROVED White Col.
40 32 29 37 24 21 35 26 43 33 32 36 37 50 38 46 44 36

UNIMPROVED White Col.
21 22 29 18 38 32 30 21 23 12 16 5 15 5 23 12 16 9

DEATHS

White Col.

10 9 10 25

15 37 14 41

12 36

14 33 10 18

10 16

7

6

Page 13

TABLE XIII

LENGTH OF STAY OF PULMONARY TUBERCULOSIS DISCHARGES - 1952

COLORED PATIENTS

Total No" Discharges

Total No. Hospital Days

Average No. Days

487

225,021

460

Males

254

103,613

468

Far advanced 156

73,562

472

Mod. advanced 56

23,703

459

Minimal

2

216

108

Females

233

Far advanced 128

Mod. advanced 81

Minimal

6

121,408 72,878 44,671 2,236

WHITE PATIENTS

Total No, Discharges
872

Total No. Hospital Days
371,696

521 569 544 374
Average No. Days
424

Males

549

213,410

389

Far advanced 302

146,734

453

Mod. advanced 185

6,315

326

Minimal

16

3,104

194

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

Females

323

151,280

489

Far advanced 145

86,95J

600

Mod. advanced 134

63,224

472

Minimal

13

5,692

438

Page 14

TABLE XIII (continued)

Total Number of Discharges Total Number of Hospital Days Average Hospital Stay

1,359 596,717
432

This table shows that the average length of stay of
the pulmonary tuberculosis discharges in 1952 was 432 days.
One can see that the average length of hospitalization was
lowest in the white male patients where the sign-out rate was the highest and on an average was longer for females than males, as would be expected.

Page 15

TABLE XIV

LENGTH OF STAY OF OTHER TYPES OF DISCHARGES COLORED

Male No. pts. No, days Avg.

Female No. pts No. days Avg.

Abscess

4

Sarcoid

1

Bronchiectasis 3

Suspic-ious

1

Non-tbc.

25

Extra-pul.

1

Pul. eff.

2

Carcinoma

1

Miliary tbc.

2

Silicosis

Incomplete

Average

294

74

156 156

442 147

431 431

2,421

97

32

32

165

83

37

37

154

77

103

3

241

80

5

319

64

2

186

93

5

777

155

3

700

233

123

Page 16

TABLE XIV (continued)

WHITE

Male

No. pts. No. days Avg.

Abscess

4

282 70

Sarcoid

Bronchiectasis

l

74 74

Suspicious

3

198 66

Non-tbc.

29

2~063 71

Extra-pul.

l

55 55

Pul. eff.

2

184 92

carcinoma

4

312 78

Miliary tbc.

Silicosis

l

86 86

Incomplete

l

33

Average

70

Female

No. pts. No. days Avg.

l

83 83

l

lll lll

4

162 40

20

1~667 83

l

145 145

2

220 110

2

31 15

78

This shows the average length of stay of other types of discharges and it is of interest to note the length of stay
of the non-tuberculous patients showing how long it takes to adequately rule out tuberculosis~ as an average~ on these patients.

Page 17

TABLE XV

LENGTH OF STAY OF TUBERCULOSIS DEATHS IN HOSPITAL - 1952

MALE
Far advanced Mod. advanced Minimal
Far advanced Mod. advanced Minimal Extra pul. Miliary

No. of Patients HHITE 40 3 0
COLORED 32 2 0 1 2

Average No. Days
520 564
0
274 266
0
32
77

FEMALE

WHITE

Far advanced

13

796

Mod. advanced

0

0

Minimal

0

0

COLORED

Far advanced

33

496

Mod. advanced

2

184

Minimal

0

0

Extra-pul.

2

93

This table shows the length of stay of tuberculous patient~ prior to their death in the hospital in 1952. In addition to this there were two cancer of the lung cases dying in the hospital during 1952 with an average stay of 54 days.

Page 18

THERAPY

The trends in therapy in pulmonary tuberculosis have been

changing so rapidly that comparison between treatment of pa-

tients discharged in 1952 with previous years does not seem

too practical. The following tab!e shows the various types

of therapy used on the patients discharged in 1952

l. Bed rest only

76

2. Phrenic nerve crush 7

3. Pneumothorax

16

4. Thoracoplasty

80

5. Pneumoperitoneum

562

6. Diagnosis only

108

7. Chemotherapy

771

8. Resections

48

It is of interest to note that of the 1,243 discharges

that ~~re,treated for pulmonary tuberculosis 771 had received

chemotherapy, 128 had been treated by major surgery and 562

had received pneumoperitoneum. It is also of interest to

note that there was only one initial pneumothorax started in

the institution during the year of 1952. There was a total of

374 pneumothorax refills given. During the year of 1952 there

were 317 initial pneumoperitoneum treatments given, there were

62 patients that had pneumoperitoneum reestablished and there

was a total of 24,188 pneumoperitoneum refills given More and

more patients are receiving antibiotic therapy. During the

year 1952 a great deal has been learned regarding the newest

antibiotic drug, Isonicotinic Acid Hydrazide (INAH). During

the year 1952 Battey State Hospital has been one of the coop-

erating hospitals in a study of anti-tuberctJlosis drugs spon-

sored by the United States Public Health Service. This study

has been supplemented by 509 patients from Battey Hospital,

making Battey the largest contributing hospital in this care-

Page 19
fully controlled study The final answer regarding INAH and its place in the
therapeutic field for pulmonary tuberculosis has not defi nitely been established. From the information and data on hand it would appear that INAH is equally as effective as streptomycin in the therapy of tuberculosis It has one big advantage in that it can be given orally, This is a time saver for the nursing staff and more comfortable for the patient.
Also in the therapy for tuberculosis, it would seem that more patients are coming to major s11rgery than was the situation some years back, This continues to be one of the large bottle-necks in our therapeutic program, as there weEe o~er one hundred patients that had been approved for surgery
by the end of 1952 that were awaiting major thoracic surgery
because of limitations in personnel in the institution" Con-
siderable strides have been made during 1952 with the number
of cases completed being greater than in any other previous year. The fact still remains that there is a dire shortage of surgeons in the institution,and this shortage is apt to become even more acute because of the relatively low salary being offered in an attempt to recruit the type of men that are necessary to fill these positions

Page 20

COST

The table below shows the average per diem cost for a
patient during each half of the calendar years 1945 through
1952~ inclusive:

PERIOD

SALARIES

First half 1945 Last half 1945 First half 1946 Last half 1946 First half 1947 Last half 1947 First half 1948 Last half 1948 First half 1949 Last half 1949 First half 1950 Last half 1950 First half 1951 Last half 1951 First half 1952 Last half 1952

$1.29 l. 27 l. 62 l. 92 l 61 1.66 1.85 l. 89 1.88 l. 94 2.07 2.10 2.23 2.35 2.47 2.50

SUPPLIES
$1.21 1.05 147 2.49 l. 73 1.75 2.69 2 28 2.31 2.11 2.50 2.34 2.90 2.28 2.75 2.25

NET COST
$2.50 2.32 3.09 4.41 3.34 3.41 4.54 4.17 4.19 4.05 4.57 4.44 5.13 4.63 4.97 4.62

OUTLAY
$ .08 .17
l. 45 l. 71
.85 .30 .28 .17 .29 .38 .71 74 .78 .42 .25 .13

TOTAL
$2.58 2.49 4.54 6.12 4.19 3.71 4.82 4.34 4.48 4.43 5.28 5.28 5-91 5.05 5.22 4.75

Page 21

EMPLOYEE-PATIENT RATIO 1-1-53

Dept.

7-1-46 l-1-48 1-1-49 1-l-50 1-1-51 1-1-52 1-1-53

Admin.

1:26

Medical

1:20

Nursing

1:8

Housekeeping 1:12

Culinary

1:7

Laundry

1:19

Maintenance 1:12

Farm & Dairy 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

1:43.5 1:34.9
1:6.7 1:13.9 1:10.3
1:39.1 1:30.5 1:75.2

Total Ratio 1:1.6 1:2.4 1:2.2 1:2.2 1:2.1 1:2.1 1:2.27

Employees 386 507 610 669 758 832 859

Patients

625 1199 1305 1444 1597 1762 1957

BATTEY STATE HOSPITAL LABORATORY

TUBERCULOSIS:
Microscopies Cultures Animals Sensitivity tests
TOTAL
CLINICAL TESTS
Hematology Blood Chemistry Urine Spinal Fluids Body Fluids Miscellaneous
GRAND TOTAL

1952

Positive Total

4,724 7,206
522

28,146 24,492
2,547 2,951

12,452 58,136

17,676 1,000 5,416 774 121 1,428
26,415

1951

Positive Total

3,816 5;127
695

27,376 205668
3,311 2,166

9,638 53,521

Page 22

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

QUIESCENT OR
ARRESTED IMPROVED

UNIMP.

DEATHS

TOTAL TBC.

Wh. Col. Wh, Col. Wh CoL Wh. Col. Wh Col.

Savannah 3 Columbus 0

3 9 13 3 3 7 ll 4

5l l2

4 16 21 2 13 16

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 prognosis,
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

UNIMP.

TOTAL

Wh . Col. Wh . Col. Wh . Col. Wh . Col .

Savannah 0 0

35

33

68

Columbus 0 0

37

30

67

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 23

Table showing length of stay in the hospital:

Savannah: Columbus:

Under 3 mos. _ 4 - 13 mos.

18

19

15

14

14 -- 22 mos.
0 0

More than 2 3
0 0

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.

DENTAL HEALTH SERVICES

GEORGIA DEPARTMENT OF PUBLIC HEALTH DIVISION OF DENTAL H~LTH

Synopsis of Report for the Year nding December 31, 1952

There have been no changes in operating policies during 1952. On October 29 a senior stenographer was added to the staff. B,y December 31 the prospects for employing a full-time dental director were quite hopeful. The setting up of the position of Director of Public Dental Health Services had been proposed and was being considered by the Merit Board and a candidate had been offered the position pending Merit Board clearance.

Dental Disease Prevention, Dental Health Education, and Limited Treatment Services continue to be the objectives of the Division of Dental Health with the major emphasis ouring 1952 on prevention.

Fluoridation of Public Water Supplies for the reduction of tooth decay is a real challenge to all concerned with public dental health programs. Increasing evidences prove conclusively that the incidence of dental caries can be reduced about sixty-five percent through fluoridation and that this public health measure is safe, economical, and practical. Reliable studies in various sections of the country and under different sponsorships, after six years or more of fluoridation, show uniform reductions in DMF rates (decayed, missing, filled) and uniform increases in the percentage of caries-free children. Benefits to older age children (14 to 16 years) have been greater than anticipated. Since fluorides have given the first reql opportunity to control tooth decay effectively, safely, and practically, the staff of the Division of Dental Health has devoted a major proportion of time, effort, and activities to promotion and institution of fluoridation of public water supplies. By the end of 1952, the following water supplies were being fluoridated:

Town

Population

Dat~ Started

DeKalb County Athens Gainesville Rome Monroe Rossville and vicinity

90,000 28,300 11,936 29,615 4,542 10,000

April 26, 1951

May 27, 1951

June 5, 1952

1

June 24, 1952

August 14, 1952

September 1, 1952.

The Georgia Dental Association, through its Public Health and Welfare Committee, its officers and individual members, worked admirably for fluoridation, cooperating in every possible way with the Division of Dental Health. Appreciation is also expressed to the Georgia Congress of Parents and Teachers, Georgia Junior Chamber of Commerce, Georgia Better Health Council, and many civic clubs that have actively worked to interpret the benefits and to overcome uninformed opposition.

ToPical Fluoride Treatment Progcams were conducted for all second, fifth and eighth grade children in Dougherty, Ware, Mus cogee, and Harris Counties, and for limited groups in Atlanta and Fulton County. Indications are that an increasing number of children are receiving this preventive treatment from private dentists.

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Dental Health Education has been promoted through publications, films, radio, television, newspaper articles, conferences, public meetings, talks and discussions. The staff has cooperated with and worked through State and local official and voluntary agencies as the Georgia Dental Association, Georgia Department of Education, Agricultural Extension Service, University System, Georgia Congress of Parents and Teachers, Georgia Education Association, and Georgia Better Health Council. School health and teacher education always receive major emphasis in the dental health education program.
Dental Clinic Services:
In accordance with "Organization and Operation of Dental Clinics in Local Health Departments", forty-four counties have operated fifty-seven dental clinics, January through December, 1952. A total of 116 white dentists and 10 negrb dentists have worked 9,229 hours with 10,847 children admitted; 18,631 visits recorded; and 5,299 children completed; requiring a total of 37,563 operations. A detailed report of dental clinic services is attached.
New clinics operated in Atkinson, Effingham, Elbert, Lamar, Lumpkin, Meriwether, and Oconee Counties. Clinics were reactivated in Thomas and Wayne Counties. The attached Georgia map shows the distribution of dental clinics.
Special Pro,i ects:
1. Dental Seminar - A total of 121 dentists from all over the State attended the Sixth Annual Dental Seminar, June 16-20, sponsored jointly by the Georgia Dental Association and the Georgia Department of Public Health at Columbus, Athens and Brun3wick. The speakers were:
Dr. Roy J. Doty, Secretary of the Council on Dental Therapeutics, American Dental Association; "Dental Caries - Prevention and Control".
Dr. Drexell A. Boyd, Head of Department of Operative Dentistry, Indiana University School of Dentistry; "The Auto-Resin Restoration" and 11 The Amalgam Restoration".
2. Athens Pre-fluoridation Survey - On November 12, 1952, seventeen months after fluoridation of the Athens water supply was inaugurated, the Athens school children were examined to obtain baseline data for evaluation of the fluoridation program. A detailed report has been made of this study. The following summary is of interest:
No. Children ExamL1ed, 6-17 Years of Age .. 2,372
Percent 6-17 Years with Caries Free Permanent Teeth l5.9%
Percent 6-11 Years with Caries Free Deciduous Teeth l4.6%
DMF Rate per child ................................ 4.60
DMF Rate for Six Year Old Children ..... 1.21
DMF Rate for Sixteen Year Old Children .... 9.98