Annual report 1953 [1953]

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Georgia Department of P ublic Health

TABLE OF CONTENTS

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

Section
A B
c
D
E

Pages
1 - 18 1 - 11 1- 4 1- 8 1- 2

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

F

1- 2

G

1 - 19

H

1- 2

I

1 - 17

LABORATORY SERVICES - -

J

1 - 13

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

. - - .. K
L

1 - 32 1 - 2(>

ENVIRONMENTAL HEALTH SERVICES Home Safety Unit- - - - - - - - - Division of Industrial Hygiene - - (Occupational Health included) Division of Public Health Engineering- Division of Typhus and Rodent Control Division of Water Pollution Control -

M

1- 7

N

1- 9

0

1 - 14

p

1 - 14

w

1 .. 12

PREVENTABLE DISEASE SERVICES

- - - - Division of Chronic Diseases- - - - - - - -
- - - - - Civil Defense Program- - - - - - - - - -

X y

Division of Epidemiology and Cancer Control -

z

Veterinary Activities

Division of Occupational Health

(See Industrial Hygiene) Division of Tuberculosis Control

- - - - AA

Division of Venereal Disease Control

BB

Battey State Hospital

cc

DENTAL HEALTH,SERVICES

- - - - - DD

1- 2 1- 2 1 - 2, 1 - 5 1
1 - 11 1- 9 1 - 25
1- 9

Georr)a Depa1ment ofPublic Herith Atlanta 3, Georf!i.a

ADMINISTRATIVE SERVICES

Division of Hospital Services

Division of Personnel

Division of Public Health Education

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Division of Training

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Dhflslon of VitaiStatistics

Division of Hospital Services

1953 ANNUAL REPORT DIVISION OF HOSPITAL SERVICES GEROGIA DEPARTMENT OF PUBLIC HEALTH
R. c. Willi<'.ms, M.D., Director

ANNUAL REPORT 1953 DIVISION OF HOSFIT'1L SERVICES
T~ble of Contents
General
Summc>.ry of 1953 Activities
A. Survey and Planning B. Construction Program
c. Consultative Services for Hospitals
D. Licensure Program E. Other Related Activities
I. Program Planning
A. The 1953 State HospitEJ.l 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 L1nterials Plan 6. Status of the Program
B. Technical Services
c. Equipment Planning
III. Consultation
A. Acministration Consultation Service B. Consultation in Nursing Service C. Dietetic Consultation Service D. Laboratory Consultation Service E. Accounting Consultation Service
IV. Licenslrre Program
V. Related Activities
VI. Hospitctl and Health Center Construction Program

Page 1 1-3
3-4
4-8
8-10
10-11 12-13 14-18

GENERAL

The Division of Hospital Services is responsible for:
(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) as amended.
(2) Administering the Georgia Hospital Regulation Act No. 623, 1946. (3) Conducting periodic surveys and studies to determine the relative need for
medical facilities in the various sections of the State.
(4) Providing various types of consultative services to existing hospitals and
potential project sponsors.

The broad objective of the Georgia Hospital Program is to assist communities to provide improved hospital facilities and services for all citizens of the State.

SUMMARY OF 1953 ACTIVITIES

The activities of the Division of Hospital Services during 1953 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 ~nd rol~t0d ~ssociQtion meetings, conferences, institutes, training programs and civil defense planning activities.

Survey and Planning

Survey personnel completed studies of the need for and ability to finance hospital facilities in seventeen (17) communities in Georgia that requested Federal and State aid during the year., The following studies were published:

(l) Survey of Salaries, Hours and Perquisites and Personnel Practices of General Hospitals in Georgia
( 2) The Need for Construction of Nurses' Residences in Conjunction vrith Hospital Facilities in Georgia
Other activities included a survey of nursing home patients in the State, assistance
to communities in obtaining the services of physicians, the revision of the State Hospital Plan, and dissemination of information and statistics relating to hospital facilities and services in Georgia.

Construction Program

Although there was a reduction in Federal appropriations for 1953-54, sixteen (16) new projects started construction, twenty (20) projects were completed, and nine (9) new projects were approved. The following table summarizes, as of December 31, 1953, the cumulative status of the program which began with the passage of the Hill-Burton Act of 1946:

Category

Completed

Projects

Cost

Under Construction

Approved

Projects

Cost Projects

Cost

Hospitals

41

Additions

8

Health Centers 18

Other Projects

6

Total

73

~p26,o9S, 775.41

6

2,420,028.58

5

3' 896' 749.83 10

630,698.22

',,J3' 044,252.04 21 A-1

~p8' 427' 191.12 4 8,600,202.97 2 1,146,526.26 ll
$18,173' 920.35 17

$3' 197,902.00
766/;00~0
964;3 27.00
-----
,)4,928,729.00

In addition to the approval of project applications, plans and specifications, the Division assisted project sponsors in selecting project sites and obtaining construction permits and controlled materials. Aid was also given in planning financial and construction programs. Technical personnel provided architectural, engineering, and equipment consultative services in approving projects and during the
construction period. These activities, during 1953, included one hundred four (104) pnysical inspections of projects under construction, processing seventy-seven (77) sets of plans and specifications, inspecting thirteen (13) sites and attending
thirty-two (32) bid openings and contract awards.
Consultative Services for Hospitals
The Division of Hospital Services provides consultative services to existing hospitals as well as to those constructed under the Hill-Burton Program. These services embrace the fields of nursing, dietetics, administration, engineering, accounting, and medical technology, and have included not only visits to hospitals to assist in operational problems but also the sponsorship of instructional programs and the preparation of resource materials. Consultation in medical technology and accounting, previously carried out on a part-time basis, were elevated to the rank
of permanent, full-time consultative services in 1953. Among the consultative
accomplishments of the year were the sponsorship of educational programs in medical technology, medical records and nursing, as well as the promotion of the new uniform accounting system for hospitals.
Licensure Program
The nursing home licensure program, under consideration and planning during
previous years, vYas implemented during 1953 with the visitation of nursing homes
within the State and the issuance of operating permits to institutions in that category. The activities of the hospital licensure program increased during the year with a larger number of hospitals making substantial improvements and thus qualifying for the annual permit.
Other Related Activities
Follovdng a series of conferences with hospital trustees and administrators, the Division assisted in sponsoring the first ~nnual Conference of Georgia Hospital
Governing Boards in Atlanta on February 17, 1953. Another effort towards the
integration of activities in the institutional care field resulted in the organi~
zation of the Georgia Association of Nursing Homes at Macon on June 17, 1953, under
the guidance of the Division of Hospital Services.
Representatives of the Division of Hospital Services, particularly those performing consultative services, managed to attended almost every regional hospital council meeting. During the year, the East Central and Southeastern Hospital Councils were consolidated into the new Southeastern Hospital Council, reducing the total number of such councils to six.
The Training Program in Hospital Administration, sponsored by the Division of Hospital Services in conjunction vrlth the Atlanta Division, University of Georgia,
began its second ;year of instruction during 1953. Members of the staff of the
Division assisted the program by serving as part-time instructors and by securing the cooperation of hospitals in permitting students to obtain the required practical experience in hospital work.
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Members of the Division participated in the Georgia Civil Defense Plan by collecting information relating to hospital activities within the State and in preparing a Civil Defense anual for I-iospitals.

I. P 'DG:itUI PLAl!NING
The Survey and Planning activities during 1953 may be divided into the follow-
ing broad categories:
(l) The 1953 State Hospital Plan
(2) Community Surveys (3) Special Studies
A, The 1953 State Hospital Plan
The Division of Hospital Services is entrusted with the responsibility of assembling current information necessary for the revision and administration of the State Hospital Plan, This basic document is a master plan which presents the annual inventory of existing facilities, which may be classified as "acceptable" or
"replaceable", together with the relative priority of the forty-seven (47) hospital
service areas. The primary purpose of the Plan is the systematic, 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 function of the Division of Hospital Services is to conduct socio-r
economic survey of communities vrhich have requested assistance for hospital construc-
tion. During 1953 seventeen (17) such surveys were conducted:

(l) Franklin
(2) Hogansville
(3) Athens
( 4) 1,~Jadley (5) Cochran (6) Homer
(7) Conyers
(8) Jesup

(9) Columbus
(10) Cairo
( ll) Milledgeville
(12) Austell (13) Claxton (14) Meriwether County (15) Forsyth (16) Homerville (17) Tiillac oochee

In addition, three communities were resurveyed for additions to existing hospitals:

(l) Chatsworth ( 2) Cedartown (3) Albany

The purpose of these surveys is to determine whether communities vrhich have requested grants-in-aid are capable, by virtue of their size, financial resources, available medical personnel and degree of community integration, of constructing and
operating a modern hospital with at least tvventy-five (25) beds. Furthermore, these
surveys provide an opportunity for the explanation of the hospital construction program to local communities throughout the State as well as for the gathering of pertinent information for the annual revision of the State Hospital Plan and for

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tho administration of the Hospital Program.

Five spacial conferences v-rith representatives of local communities were also attended for tho purpose of assisting the localities in planning for improved hospital care.
c. Spacial Studios

The Division was particularly active in the preparation of reports and studies during 1953. The usual post-audits to determine the success of the first year of operation were conducted of the following Hill-Burton projects:

( 1) Athens (addition)
(2) Clayton (3) Barnesville
(4) Monticello (5) Thomson

(6) Winder (7) McRae
( 8) Cedartown (addition)
(9) Atlanta (Hughes Spalding EJ.vilion)
(10) Swainsboro

In addition a number of special reports were completed, as follows:

(1) Report Upon the Equipment Policies and Procedures of the Division.

(2) Hospital Construction Program in Georgia, 1947-1952.

(3) Survey of Salaries, Hours and Perquisites and Personnel Practices of General

Hospitals in Georgia.



( 4) 1953 Revision of Georgia Hospital Plan.

(5) Study of the Noed for the Construction of Nurses' Residences in Conjunction

vdth Hospital Facilities in Georgia.

(6) Survey of Nursing Homo Patients in Georgia.

( 7) Survoy of Communities which had Requested Assistance in Obtaining the Services

of Physicians.

Considerable assistance was also given to organizations, newspapers and private individuals who had requested information and statistics concerning hospitals and hospital problems in the State.

II. CONSTRUCTION PROGRAM

A. Administration of Construction Program

(1) General

The Hospital Construction Program suffered a setback in 1953 from its peak of
activity in the previous year due to a reduction in Federal appropriations. Sixteen
(16) projects began construction, twenty (20) projects were completed, and only nine
(9) new projects were approved. Although the Hill-Burton L. ct authorizes an annual
appropriation of (?150, 000,000.00, only \':i65, 000,000.00 vvas actually appropriated
for the fiscal year 1953-54, of which Georgia was allotted 1~2,358, 440.00

To be eligible for grants, project sponsors must gjve assurances that local funds will be available to finance their sharo of the project costs, and that the construction vrill b8 started during the year in Yrhich the project is approved.

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Tho follmvi.ng table lists tho amount of Federal and State funds available to the program since 1947:

Fiscal Year

Federal Funds

State Funds

1947-48 1948-49 1949-50 1950-51 1951-52 1952-53 1953-54
Totals

~:?2,976,228.00
~~2, 791,307 .oo
(?5' 248' 356.00 ~~2' 609' 914.00 ~?3' 068,889 .oo ~2' 77 4, 251.00 ~::>2 ,358' 440.00 ')21, 827 ,385.oo

None ~~3' 000' 000.00 ~:~3' 000' 000. 00
::?3' 000' 000. 00 03,000_,000.00
:?3' 000' 000 00 $2,500,ooo.oo
-\.il7 ,5oo,ooo.oo-

(2) Processing Applications

At tho beginning of each fiscal year, a project construction schedule is prepared listing the projects eligible to begin construction during that year. \Yhcm a project has boon entered on the construction schedule, the sponsor is notified to proceed 1vith submission of his formal application and supporting documents and the preparation of a program, plans and specificaltions. The processing of applications requires a review of financial statements, legal opinions, construction contracts, bonds and insurance certificates to insure that they moot tho Federal and State regulations.

Many meetings vvi th project sponsors and a groat amount of correspondence vrore necessary during 1953 in explaining and carrying out the rec;uiroments of tho construction pro gram.

(3) Construction Period

After plans and specifications have boon rroparod in accordance with minimum skmdards and approved by the Division of Hospit2L Services and the U. S. Public Health Service, bids are received and construction contracts awarded. Periodic inspoctions are made during the construction p::; riod to assure that tho vn rk is being done in accordance l!Yi th plans and specifications.

Federal and State payments are made periodically, not to exceed six payments for any one project, to tho project sponsor during tho construction period. During 1953 one hundred and eighty-four (184) paymonts were processed, totaling :?3, 14), . 241.00 Federal ;:md "?1, 982,000.00 State funds. Extensive financial audits wore made for all projects completed during tho year.
(4) Percentage of Participation

Public Law 725, as amended, provides that tho State Agency will establish
annually the percentage of project cost to be paid out of Federal funds. At its
regular mooting in May 1953, tho State Board of Health sot the Federal percentage; as
33 l/3;~ of the cost for projects approved during tho 1953-54 fiscal year.

(5) Controlled Materials Plan

In tho early part of 1953 tho supply of such critical materials as steel, copper and aluminum became more plentiful and the necessity of controling thoso miltorials vrils

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eliminated. All projects woro notified that applications for material allotments wore no longer necessary.

(6) Status of tho Program

Tho following table presents in summary the status of tho hospital construction
progr~ as of December 31, 1953:

REPORT OF CONSTRUCTION STATUS:

HOSPITALS:
New Facilities: Completed Under Construction Approved

TOTAL PROJECTS
41 6 4

TOTAL
-BED-S
2,022
559
225

TOTAL ESTIMA.TED COST
'r,i'>' 25,096,775.41 8' 427' 191.12 3,197,902.00

Additions and Alterations:
Completed Under Construction Approved

8

204

5

248

2

42

2,420,028.58 8,600,202.97
766,5oo.oo

Equipment Only Projects: Completed

2

37

58,217.22

PUBLIC HEALTH CENTERS:

Health Centers:

Completed

16

Under Construction

6

Approved

5

2,419,335.55 909,028.26 343,707 .oo

Auxiliary Cantors:

Completed

31

Under Constrll.ction

4

Approved

5

Combination vr/Matornity Sheltor:

Completed

1

10

Approved

1

15

1,312' 042.28 237,498.00 368,050.00 16S~Y72 .oo 252,570.00

NURSES HOMES:

Now Projects:

Completed

3

L~l9 , o6 782

-LA-BO-RA-TO-RIE-S:
Now Projects: Comolotod r_o_t_~I---=-~~t~--JlDJji_9_ts

1 JJ:ii- 3,362

_~?_56.'.,1l5f3t~f41o3l..1389

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B. Technical Services
The Division of Hospital Services is responsible for the review and approval of plans and specifications, as well as for the inspection and approval of sites, for all projects approved for construction. In order to insure that each hospital built under the Hill-Burton program is an efficient and safe structure that moots
tho specifications set up by the U. s. Public Health Service, it has boon found
advantageous to submit plans and specifications to the Division for review and approval. This analysis occurs in three stages:
(l) Review of schematic plans, outline specifications and cost estimates. (2) Review of preliminary plans, showing equipment for each room together with
elevations, outline specifications and revised cost estimates. (3) Review of working drawings, specifications and revised cost estimates.
Tho plans and specifications for each project are chocked in detail at least
three times by this Division and tho Regional Office of tho U. s. Public Health
Service in Atlanta prior to the opening of bids for the project. This procedure has resulted in-the correction of numerous errors which formerly resulted in dissatisfaction, censure of tho planners and builders, and even excessive remodeling or operating costs. Many meetings between the Divisional technical staff and project sponsors, engineers and architects are necessary in order to work out such details of functional planning as heating, plumbing, electrical work, air condition~ ing, ventilation, fire safety, materials, finishes and cost trends.
During 1953 such activities included the processing of seventy-seven (77) sots of plans and specifications; in addition, thirteen (13) proposed sitos were examined
to determine their suitability.
After the contracts have boon awarded, the Technical Section makes periodic inspections to see whether the construction conforms with tho details set forth in
tho plans and specifications. During 1953 one hundred four (104) such inspections
were completed. Properly certified inspection reports by Technical Section personnel must be submitted by tho sponsor with any request for installment payments of Federal and State funds; furthermore, any changes in plans and specifications made after a project is commenced must bo approved by the Technical Section.
Consultative services may be rond~red by the Technical Section to any Hospital Authority or Board of Trustees which wishes to expand, remodel or replace existing facilities. The State Hospital Licensing Act also requires that tho plans for any now hospital to be constructed in Georgia be reviewed and approved by tho Division of Hospital Services as a prerequisite for obtaining a license.
C, Equipment Planning
Tho equipment planning and consultation services of tho Division may bo properly classified into four general categories:
(l) Initial Visitation: Shortly after construct~on has commenced, tho community is visited to familiarize tho project sponsors with tho steps that must bo undertaken in tho equipping of a Hill-Burton hospital. Although assistance is often given to tho project sponsors in tho vrri ting of specifications and tho evaluation of quotations, all final decisions and orders are the responsibility of tho local sponsors.
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Tho follovring hospito.l projects wore given this service during 1953:

Marietta Camilla Valdosta

Waycross Covington Tifton

(2) Equipment List: Contact is next made Yri th oithor tho hospital administrator or tho equipment committee for tho purpose of assisting in making up an equipmod list. Several visits may bo nocossnry if a hospital administrator has not yot boon engaged. Communities generally require assistance in listing oo.ch item of equipment and its estimated cost.
(3) Submitting Invoices: Tho majority of projects are visited for tho purpose of assisting tho sponsors or administrators in submitting invoices to tho Division
for payment. During this visit it is common to inspect quotations and also to
give advice concerning the varied equipment problems that might arise.
(4) Final Equipment Inspection: Tho final equipment inspection is conducted in
those hospitals whore equipment has boon roceivod and is in place. At this time tho final supplemental equipment lists are prepared for approval.

Consultation regarding equipment matters is available to all public health centers, as well as hospital projects, constructed under tho Hill-Burton Program.

Certain difficulties oxporioncod in obtaining hospital equipment that wero
prevalent during tho period of tho Korean War coasod to bo problems during 1953.
Little or no delay in tho delivery of equipment was experienced, and prices have
oi ther romainod stable or shown do clines.

III. CONSULTATION

A. Hospital Administration Consultative Service

In an effort to alleviate tho situation arising from tho current shortage of
oxporioncod hospital administrators, tho Division of Hospital Services has provided
a consultative service to assist hospital administrators vdth their problems.
Because of tho prevalence of problems associated with the opening of now hospitals, tho greater part of tho consultation timo vras allotted to hospitals under construe-
tion or experiencing their first year of operation. During 1953 a total of fiftyfive (55) field trips wore made for consultative service to eleven (ll) now hospitals and five (5) older ones. Tho greatest emphasis was placed upon tho following phases
of hospital administration:

(l) Adoption of By-Laws by Hospital Authorities (2) Adoption of Rules and Regulations for tho Medical Staff by Hospital Authoritics (3) Supplies and Equipment for Now Hospitals
(4) Preparation of Hospital Budgets (5) Organization (6) Establishment of Hospital Rates
(7) Salary and Personnel Policies ( 8) liJiothods for Collecting Statistical Data (9) Inventory Controls

B. Consultation in Hospital Nursing Service

Activities promoted during tho fourth yoar of nursing consultation could bo classified under five main categories:

(l) Hospital Consultation: Fifty-two (52) visits vroro made to tvmnty-oight (28)

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hospitals at the requests of tho administrators and directors of nursing sorvico ( 2) Work Conferences, Insorvice Education and Conferences: rJork conferences wore held in Atlanta, Colwnbus and McR2.o in cooper2.tion -vvith tho local departments of public health and hospital personnel. Three (3) hospitals wore assisted with programs of inservico education, assistance lNas givon to hospitals concorning tho toaching of nurses' aides, two (2) cl2.sses wore taught at tho University of Georgia, and throe (3) pro-opening conforoncos wore attondod. (3) Out of Stato Travol:In addition to tho eight (8) nurses' residences visited in North Carolina during tho Survey of Graduate Nurses' Residences, two (2) consultation visits woro mCJ.dc at tho request of tho NCJ.tional League for Nursing CJ.nd tho Children's Bureau, ( 4) Research: Tvvo ( 2) surveys relating to nursing problems vroro completed, one in conjunction with tho Children's BuroCJ.u and ono with tho Survey and Pl3.nning Section of tho Division.
(5) Source Materials: A 11 pCJ.ckot11 on nursing service, covering various facets of
nursing CJ.dministration and technique, was preparud for tho hospitals of tho StCJ.to CJ.nd much time 1irCJ.s spent editing tho Nursing Procedure Manual.
Four and one-half ( 4!) months wore spent by tho llf.ursing Consultant on edu-
cational loavo studying nursing service administration at Colwnbia University in Now York City.
C, Dietetic Consultation Service
During 1953 a nwnbor of different activities wore carried out under tho program of dietetic consultation:
(l) Hospital Construction: Schematic plans and blueprints of tho dietary depCJ.rtmonts of all hospitals which submittod plans to tho Division during 1953 vrcro chocked and discussed vvith tho TochnicCJ.l Section,
(2) Hospital Consultation: Thirteen (13) visits to hospitals wore made at tho request of tho administrators and food service supervisors for tho purpose of evaluating tho operation of their dietary departments, Hospitals woro also visited for tho purpose of familiarizing the administrators and food service supervisors with the diototic consultation program ::md to help with tho organization of tho dietary departments of now hospitals prior to their opening,
(3) Workshops: A five (5) day workshop, vrhich was attended by thirteen (13) food service supervisors, was hold during July in Athens, Georgia under tho joint sponsorship of tho Division and tho University of Georgia,
(4) Source Materials: Tho Georgia Hospital Diet Manual was completed during tho
year CJ.nd plans wore made to have tho vmrk published during tho early pi::Lrt of 1954. Several simple record-keeping forms wore CJ.lso dovolopod for usage in smaller hospitals,
(5) Out-of-StCJ.to Travel: Training programs for hospital dietary personnel in
GoorgiCJ. were discussed CJ.t tho annual convention of tho American Dietetic Association in Los Angelos, California during August, 1953, CJ.nd tho dietary consultation program for smCJ.llor hospitals ::n Goorgi2. vro.s discussed CLt tho annual mooting of tho Florida Dietetic Associo.tion in To.llo.ho.ssoo, Florida during October,
D, LaborCJ.tory Consultation Service
Full-timo medical laboratory consulto.tion service to hospitCJ.ls VhlS commenced
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in J~nuClry 1953. After Q thorough study of tho lClborCltory consultCltion progrClms of other states Clnd numerous conferences vrith technologists, pC1thologists, physiciClns C1nd hospitC1l administr<ltors vrithin tho State, labor<ltory consult<ltivc services vmrc org<lni!l!cd Clnd cilrricd out in tho follovring ilroas:
(l) HospitC1l Construction: SchomC1tic plilns and blueprints of tho laboratories of
illl hospi tells plilnnod in Georgia during 1953 vmre reviewed ~nd suggestions vrere milde for tho more efficient organiz<ltion of lilboratory services. (2) Regional Refresher Courses: A refresher course for medical technologists in tho Northeastern Hospital Council Area was presented Clt Athens, Goorgi<l during October and plans vvore laid for futuro courses in other hospit<ll council areas, covering both laboratory and in X-ray techniques. (3) Consultation: A number of visits vrorc made to hospitol s throughout tho State at tho request of tho <ldministr<ltors and medical technologists in order to evaluate present services and laboratory techniques. ( 4) Research: rJork was in progress in cooperation with tho Blood C1nd Blood Doriv<ltivos Committee of tho I.1edical Associ<ltion of Georgia to sot up recommended minimum standards for blood bilnks in Georgia.
(5) Conventions: Conventions of tho Georgia Society of Mcdic<ll Technologists,
Amoric<ln Society of Medical Technologists, Georgia Hospit<ll Associ<ltion and Florida Society of Modicd Technologists ilnd sovero.l council meetings of tho Georgi<l Hospi t~l Association wore attended during tho :JD ar.
E. Accounting Consultation Service
During tho month of October, 1953 Clccounting consultation to hospitills WilS ost<lblishod ilS a full-time ilctivity of tho Division. Prior to this time, accounting consultCltion was carric.-d out as C1 pClrt-timc service of tho Program Operations Section. Tho following services wore provided during tho year under tho part-time and full-time programs:
( l) Accounting Institutes: Three-day periods of instruction in accounting vmre hold in Alb~ny, Wilycross, Athens o.nd MC1riotta, v-rith a tot<ll of fifty-nino (59) <ldministrators, accountants, bookkeepers ilnd other interested individuals in <lttondanco.
(2) Consultation: Numerous hospitc:ls in tho Sto.to vwro visited 2.t tho request of their administrators, ~ccount<lnts, C1uditors C1nd bookkeepers to give help ilnd advice concerning accounting problems.
(3) Uniform Accounting System: A spociC1l effort has boon m2.do to encourilge hospitals vrithin tho St<lte to convert their records to conform to tho ch<lrt of accounts approved by the American Hospital Associ<ltion. 11. number of institutions C1rc illready cooperClting vrith tho Division. It is hoped eventually th<lt comparilblc information regarding accounts may be grouped Clnd classified for the various sizes of hospitals.
( 4) Service to Nevr Hospitals: Much service WClS rendered to now hospi t~ls prior to their opening regarding tho organiz<ltion of their accounting departments and systems of record keeping. ri thout exception these institutions have adopted tho uniform accounting system.
IV. LICENSURE PROGfu\M
Tho "Hospital Rogul2.tions Act", No. 623, Ga. Lc:wrs 1946, Duthorizcs tho State Bo~rd of Hcill th to promulg<ltc stando.rds for tho protection of tho hoo.lth o.nd lives of po.tients in hospitals ~nd nursing homos. i1. sot of rules and regul~tions recommended by tho Sto.tc Hospital Licensure Advisory Committc;o wils Cldoptod by tho Boilrd of HG<llth in Octobc;r 1948.
.ii-10

Since the approval of these rules and regulations the licensure program has gone through the follovring stages of development:

(l) The publication of the required minimum standards. (2) The visitation of institutions and explanation of the regulations. (3) The inspection and detailed reporting of deficiencies in individual
institutions.

Annual licensure permits are issued, bJ.sed upon the information contai. ned in inspection reports by Division licensure field personnel, reports of the State Fire Marshal regarding compliance with provisions of the Georgia Fire Safety Lavr, and reports from the local or regional health departments concerning standards for food handling, sewage disposal and water and milk supplies. Those institutions which
have met all major requirements are issued an 11Annual11 re rmit. Those not meeting
the major requirements but having demonstrated progress tovrard correcting reported deficienciGs are issued 11 Temporary11 permits

.l:l.S of January 1, 1953, only twelve (12) of the two hundred thirty-five (235) and three (3) of the eighty (80) nursing homes in Georgia had qualified for the 11Annual 11 permit. However, by December 31 the number had increased to tvmnty-seven (27) hospitals and ton (10) nursing homes. Reports by field fOrsonnel indicate that by December 1953 at least 80~ of the hospitals in the State had alteration, remodel-
ing or expansion programs, underway or planned, aimed primarily tovvard improved conditions for the safety and comfort of patients.

During 1953 three hundred sixty-seven (367) inspections were made by licensure
personnel, including at least one visit to Gvery hospital and nursing home within tho State. idditional reports concerning food handling and sanitation, from the Engineering Division, and fire safety, from the State Fire Marshal , wore processed during the year.

The most frequent deficiencies in hospitals vmro found in tho following areas in the order named:

(l) Fire Safety
(2) Operating Room Safety
(3) Food Handling and Sanitation
(4) Clinical Records

(5) Adequate Space for Patients
(6) Refrigeration Equipment
(7) Emergency Lighting
(8) Maintenance of Equipment

The Licensure Section has also been cmtrusted vrith the issuance of certificates of non-profit status to hospitals wishing to purchase equipment and supplies under
the Federal Surplus Property Program in Georgia. During 1953 thirty (30) hospitals
vmro assisted in obtaining surplus property, such as automobile, generators, office equipment, food service and laundry equipment, tools, dental and surgical equipment,
and tho like. Tho total cost of this property was only ~P4, 700, which is loss than 10% of the cost of such equipment when purchased new.
Other activities in connection vrith tho licensure program during 1953 included:

(l) Revimr andapproval of plans for nevv hospitzls crd nursing homes.
(2) Inspections of buildings intended for conversion to use as nursing homes.
(3) Frepar2.tion of proposed revisions to the Hospital Hules and Regulations for considerJ.tion by tho Advisory Committee and the Board of Health early in 1954.
(4) Field vrork in connection -rvith the Survey of Patients in Nursing Homes. (5) 1l.ttendance and participation by licensure personnel in conferences and insti-
tutes sponsored by hospital and nursing homo associations.

A-ll

V. REIJ~TED ACTIVITIES
Hospital Governing Board Conference
Following a series of conferences participated in by hospital trustees and
hospital administrators during 1952, tho Division of Hospital Services sponsored
tho first nnual Conference of Georgia Hospital Governing Boards. The meeting,
held in i~tlanta on Februo.ry 17, 1953, was well attended and the participation and
interest of hospital trustees was spontaneous and gratifying. It vvas the concensus of this first conference of hospital trustees that a sbatevddo organization should be formed for the purpose of sponsoring similar meetings to be hold each year.
i~ssociation of Georgia Nursing Homos
During prolimina~J studies made prior to the inauguration of the licensure program for nursing homes, it became evident that very few of the operators of such establishments Trere in contact with other porro ns in their field, and that consequently there vras a need for a state organization of tho o:p.; rators of nursing homes in Georgia, Under tho guidance of the Division of Hospital Services, the Georgia Association of Nursing Homes was organized at a state-vdde meeting of nursing home
operators held at Macon on Juno 17, 1953.
Hospital Councils
There vras a consolidation of two of the seven hospital councils during 1953.
The East Central and Southeastern Councils vrore consolidated and designated as the Southeastern Hospital Council, leaving six hospital councils in the State as follows:
Northeastern Hospital Council. Southeastern Hospital Council West Central Hospital Council Northwestern Hospital Council Atlanta-DeKalb Hospital Council Southwestern Hospital Council These councils are constituent parts of the Georgia Hospital Association. It is tho definhe policy of the Division of Hospital Services to work closely with these councils and to maintain contact with officials of the Georgia Hospital j,s sociation.
The Division is represented at almost every council meeting. Any changes in existing programs or the initiation of new programs by the Division of Hospital Services are discussed -vvi th tho councils before being put into effect. In this way hospital administrators throughout the State are given an opportunity to make comments and suggestions regarding any such changes or plans. In addition, the several consultants of the Division, particularly those in accounting, dietetics, laboratory vrork and nursing, have actively participated in programs of the hospital councils.
Training Progro.m in Hospital Administration
Instruction in hospital administration was inaugurated at the ;~tlanta Division
of the University of Georgia in Fall ~uartor of 1952, with an average of seventeen
students enrolled for instruction during the academic year. Certificates indicating satisfactory completion of tho v1ork have boon granted to seven students. The second
A-12

session of this program began with tho Fall -:uartor in 1953 vrith nineteen students enrolled,
Tho course of instruction consists of nino months of academic study and slightly more than six months of practical ,,-vorking experience in a hospital, Tho objective of tho training is to prepare persons for administrative positions in hospitals of one hundred ( 100) beds or loss vri th special reference to tho needs of Georgia and tho Southeast, Four members of tho staff of tho Division served as part-time instructors for several of those classes, and the arrangements necessary in securing cooperation of hospitals in permitting students to secure their practical training follovdng tho completion of tho academic work was handled by a member of the staff of the Division, It is tho policy of tho University to waive the proscribed practical experience for those students Hho have had satisfactory prior hospital experience,
Civil Defense
Two members of tho staff of tho Division have participated continuously in tho Statevdde Civil Defense Plan and an appreciable amount of time has boon spent in tho preparation of a Civil Defense Manual for Hospitals, ll.ssistnnco has also boon rendered to the State Civil Defense Organization in collecting information as requested relating to different phases of hospital activities in tho State.

HOSPITAL ;~.ND H&i.LTH CENTER CONSTRUCTION PROGRfuiJ[ December 31, 1953

HOSPITALS COMPLETED:

Name
l. Tanner Memorial Hospital 2. Minnie G. Boswell Memorial 3. Upson County Hospital 4. Hall County Hospital
5.. Mitchell County Hospital
6. Elberton-Elbert County 7. Cobb Memorial Hospital 8. IJorth County Hospital 9. St. Francis Hospital 10. Stewart-1Tebster Hospital ll. Griffin-Spalding County 12. Kennestone Memorial
13. The Memorial Hospital 14. Jasper County Hospital 15. McRae-Telfair County 16. Burke County Hospital 17. Arlington City Hospital 18. Rabun County Hospital 19. Lee M. Happ, Jr. Memorial 20. Terrell County Hospital
21. Baxley-hppling County 22. Chattooga County Hospital 23. Screven County Hospital 24. McDuffie County Hospital 25. Winder-Barrow Hospital 26. Hughes Spalding Pavilion 27. Emanuel County Hospital 28. Habersham County Hospital 29. Laurens County Hospital 30. i1mericus-Surr..ter County 31. St. Joseph Hospital 32. Bacon County Hospital
33. Rockmart-l,ragon Hospital
34. Turner County Hospital
35. Coffee County Hospital 36. Tri-County Hospital
37. Irwin County Hospital
38. Pierce County Hospital 39. Peach County Hospital
40. Gordon County Hospital 41. Crisp County Hospital

Location

Number of Beds

Carrollton

37

Greensboro

28

Thomaston

92

Gainesville 112

Camilla

32

Elberton

47

Royston

23

Sylvester

28

Columbus

154

Richland

24

Griffin

96

Marietta

105

A.del

27

Monticello

25

McRae

30

~>v'aynesboro

38

.i-~.rlington

16

Clayton

20

Hiawassee

14

Dawson

28

Baxley

27

Summerville 31

Sylvania

34

Thomson

29

vYinder

40

Atlanta

116

Swainsboro 50

Demorest

44

Dublin

60

Americus

100

Augusta

110

.Alma

30

Rockmart

25

Ashburn

25

Douglas

60

Ft.Oglethor f'8 100

Ocilla

25

Blackshear

25

Ft. Valley 25

Calhoun

40

Cordele

50

Date Opened
ll/49 8/49 4/51 8/51 9/49
9/50
l/50 2/50 10/50 l/50 l/51 6/50 8/51 l/52
3/52 5/51 4/51 ll/51 2/52 4/51 6/51 l/52 9/51 l/52 12/51
7/52 6/52 7/52 9/52 l/53 12/52 12/52 l/53
9/53
10/53 ll/53 ll/53 10/53
lOj53
ll/53 10/53

-To-tal-Co-st
t; 528,000.00
401,250.00 1,122,000.00 l,6o8,3o6.oo
268,139.19 780,276.00 213,460.32
293' 113.72 1,909,806.88
255,536.38 1,321,491.00 1,208,563.96
193,800.00 259,845.01
359,973.80
416,069.91 158,900.00 237,000.00 179,604.10 255,867.50 257,196.20 345,000.00 332,000.00 325,500.00
55o,ooo.oo
1,725,984.02 591,790.00 550,228.00
879,333.97
1,339,000.00 1,626,000.00
327' 138.16 329,956.00 416,674.00 937,264.00 1,109,066.00
328,775.46 340,563.76 408,000.00 639,302.07 767,000.00

Totals

2,022

,;26' 096' 775.41

HOSPIT.l.LS UNDER CONSTRUCTION

Name
l. Treutlen County Hospital 2. Lovmdes County Hospital
3. Brunswick City Hospital
4. Newton County Hospital S. Memorial Hospital 6. Bremen General Hospital
Totals

Location
Soperton Valdosta Brunswick Covington Savannah Bremen

Number
-of-B-ed-s
25 100
75 34 300
-25-
559

Total Cost
$ 310,410.00 l,S8o,ooo.oo l, 133,303.62
SS4,736.So 4,473,741.00
37S,ooo.oo
:?8' 427' 191.12

APPROVED:

Number

Name

Location

of Beds Total Cost

1. Watkins Hemorial Hospital

Ellijay

25

2. General Hospital

VJ"aycross

100

3. Villa Rica Community Hospital Villa Rica

25

4. Hamilton Memorial Hospital

Dalton

75

$ 361,902.00 l,426,ooo.oo 240,000.00 1,170,000.00

Totals

225

$3,197,902.00

itDDITIONS i~ND ALTERATIONS TO HOSPITALS

COMPLETED:

Name

Number ~-)c-:., C2 Location of Beds l\01190

Total Cost

l. City-County Hospital 2. .i~thens General Hospital
J. Macon City Hospital
4. Macon City Hospital s. Polk General Hospital 6. Stephens County Hospital 7. Tift County Hospital
B. i~.mericus-Sumter County Hosp.
Totals

LaGrange 74

.l.thens

ll

Macon

Macon

28

Cedartown 10

Toccoa

16

Tifton

30

ll.mericus 35

204

9/49 4/Sl 8/48
9/~8
7/Sl 7/52
7/53 ll/53

$ So4,ooo.oo 552,900.00 154,592.55 57,833.79 69,500.00 424,ooo.oc 371,120.00 286,082.24
~~2, 420,028,58

UNDER CONSTRUCTION: Name

Number Location of Beds

Total Cost

l. University Hospital

"'~.ugusta

10

2, Vereen Memorial Hospital

Moultrie

24

3. Kennestone Memori~l Hospital Marietta

so

4. Mitchell County Hospital

Camilla

18

s. Macon City Hospital

Macon

146

Totals

248

ol.-15

'.)1, 06 7' 000.00 787,940.00 7So,ooo.oo 116,760.00
5,878,502,00
~,6oo,2o2:9'7

.... PPROVED: Name

Location

Number of Beds

Total Cost

l. Bulloch County Hospital

Statesboro

30

2. Minnie G. Boswell Mem.

Greensboro

12

.~ 6oo,ooo.oo 166,500.00

Totals

42

G> 766,500.00

t-HJRSES I H011ES

COMPLETED:
-Na-me-
l. Mitchell County Hospital 2. Battey State Hospital 3. Columbus City Hospital
Total

Location
Camilla Rome Columbus

Date Opened
12/49 3/52 8/52

Total Cost

/' )

42,903.00

164,161.82

(p

212,003.00 419,067.82

L.i~BOR:~T ORY

COMPLETED: Name

Location

Date Opened

Total Cost

1. Battey State Hospital

Rome

Total

5/52

~53,413.18
,, ;,p 153,413.18

E~UIHvlENT ONLY

COMPLETED:
Name
1. Heard County Memorial Hosp. 2. Murray County Hospital

Number Location of Beds
Franklin 18 Chatsworth 19

Date Opened
5/48 8/50

Total Cost

,...,,
<;1>

17,217.22

41,000.00

Totals

37

I~t'> 58,217.22

PUBLIC HE".LTH CENTERS

COMPLETED:
County 1. DeKalb 2. Fulton 3. Bulloch 4. S9alding 5. Thomas 6. Elbert 7. r.t[eriYrether

City Decatur ,\tlanta Statesboro Griffin Thomasville Elberton Greenville

Date Opened
1/SO
5/49 9/51 6;,51 2/52 8/51 2/52

Total Cost
Tl95, 216 .oo 476,881.00 61,470 .. 44
l73,9L~4.96
163,250.00
79' 491.28 82,500.00

COMPLETED: (CONr 'D.)

County

City

Date Opened

Total Cost

8. 'Nayne

Jesup

S/52

$ 87,)08.00

9. Clarke

Athens

4/52

164,871.81

10. Gwinnett

Lawrenceville

7/52

119,215.00

11. Burke

l'faynesboro

5/52

61,822.00

12. Mitchell

Camilla

4/52

85,397.76

13. Floyd

Rome

8/)2

65,226.48

14. Walton

Monroe

2/53

93' 270.82

15. Polk

Cedartown

4/53

82,650.00

16. Richmond

Augusta

8/53

426,620.00

Total

$2,419,335.55

UNDER CONSTRUCTION:

County

City

Total Cost

l. Glynn
2. Coffee 3. Coweta
4. Musco gee
5. Carroll 6. Appling

Brunswick Douglas Newnan Columbus Carrollton Baxley

I<;'!' 145' 249.82 86,978.4Lt 9),000.00
425,350.00 81,450.00 75,ooo.oo

Total

$ 909' 028. 26

APPROVED:

County

City

Total Cost

l. Baldwin
2. Bartow
3. Laurens 4. Houston

Milledgeville
Cartersville Dublin Perry

$ 90,307 .oo 93,400.00 90,000.00 70,000.00

Total

343' 707 .oo

AUXILIARY HEALTH CENTERS

COMPLETED:

County

City

Date
Opene~

Total Cost

l. Fulton 2o Fulton 3. Fulton 4. Fulton 5. Fulton 6. Fulton
7. Fulton 8. Fulton 9. Fulton 10. Fulton
ll. Fulton
12. Fulton
13. Fulton

Lakewood South Fulton Alpharetta Sandy Springs Center Hill Adamsville Howell Mill Fairburn Collins Buckhead
Red Oak Rockdale Perkerson
A-17

5/49 5/49 6/49 6/49
5/49 5/49 12/49 12/49 12/49 l/)0
12/49 12/49 12/49

$ 37,935.18 33,111.1)
37,653.50 36,270.70 42,120.28
43' 001.45 31,678.08 40,696.08
39,379.81 38,726.14
42,085.78 32,900.00 38,189.79

Cm1PLBTED (CONT 'D.)

County

City

14. Harris

Hamilton

15. 'dilkinson

Irwinton

16. Atkinson

Pearson

17. Taylor

Butler

18. Lamar

Barnesville

(PHC and Maternity Shelter - Ten Beds)

19. Oconee

"\:vatkinsville

20. Dawson

Dawsonville

21. Camden

Vvoodbine

22. Effingham

Springfield

23. Brooks

f"}uitman

24. Evans

Claxton

25. Dade

Trenton

26. Mcintosh

Darien

27. Rabun

Clayton

28. Charlton

Folkston

29. Butts

Jackson

30. Berrien

Nashville

31. Douglas

Douglasville

32. Jenkins

Millen

Total

UNDER CONSTRUCTION:

County

City

l. Peach 2. Putnam
3. Macon 4. Pike
Total

Fort Valley Eatonton Oglethorpe Zebulon

APPROVED:

County

City

l. Jones 2. Hart
3. Fulton
4. Habersham
5. Clayton
6. Long

Gray
Hartwell (PHC
& 15 beds)
Atlanta Clarkesville Jonesboro Ludowici

Total

Date _9pened
l/51 ll/51 ll/51
8/52 12/51
l0/51
9/51 6/52 l0/52 6/52 12/52 9/52 ll/52
3/53
l/53
5/53

Total Cost
$; 33,800.00
36,878.69 20,392.04 23' 730.00 165,372.00
43,500.00 L(4, 082.38 45' 713.78
38,366. 84
66,41).00 39,762.97 53,250.00 49,919.16 65,200.00 46,ooo.oo 57' 988.95 49,544.00 52,000.00 51,749.10
$1,477,414.28

Total Cost
$ 55,ooo.oo 71,010.00 69,488.00 42,000.00
$ 23 7, Li9 8. oo

Total Cost

I', ~

55,o5o.oo

252,570.00

l25,ooo.oo 66,ooo.oo 90,000.00 32,000.00

) 620,620.00

Division of Personnel

DIVISION OF PERSONNEL

GROWTH OF PUBLIC HEALTH WORK:

For the first time since the depression days of the Thirties, the State Health Department ended the year with fewer employees than it had at the beginning of the year. This was due to the final release of the maintenance crew at Alto Medical Center, the layoff of workers on certain projects in the Health Department due to a decrease in Federal allotments, and increased efficiency
of operation at Battey State Hospital. These losses were partly offset by a substantial gain of 42 employees in local health departments.

TABLE I

FULL TIME EMPLOYEES IN PUBLIC HEALTH VVORK

1952

1953

Net Gain

Local

828

870

42

State

629

608

-21

Alto

15

0

-15

Battey

~ 2,331

~ 2,308

~ -23

TABLE I-A

FULL TIME EMPLOYEES---LOCAL HEALTH Dl!:PARTMENTS

1952

1953

Net Gain

Physicians

34

31

-3

Dentists

3

3

0

Nurses

438

457

19

Engineers

15

15

0

Sanitarians

101

103

2

Clerks

212

230

18

Laboratorians Others

8

ll

3

__rr_
828

-2-0 870

3 42

Bl

TABLE I-B

FULL TIME E1~LOYEES---STATE AND REGIONAL OFFICES

1952

1953

Biologists

3

3

Clerical, Administrative, Fiscal

264

252

Cornmunh.able Disease Investigators

23

22

Dentists

0

l

Engineers

18

20

Health Educators

9

10

Hospital Specialists Industrial Hygienists

7

ll

7

8

Laboratorians

87

78

Maintenance, Service, Custodial

72

72

Nurses

38

36

Nutritionists

10

9

Physicians

19

19

Sanitarians

22

26

SoL;ial workers

12

6

Statisticians

5

6

Veterinarians

l

l

X-ray Technicians

18

10

Others

__& 629

-1-8
608

Net Gain
0 -12
-l l
2
l
4
l
-9 0
-2
-l
0 4 -6
l
0 -8
4 -21

B2

TABLE I-C FULL TIME EMPLOYEES---BATTEY STATE HOSPITAL

Administrative and Fiscal Clerical Custodial and Protective Dentists Dietary Executives Educators Graduate Nurses Nurses, Sub-professional Nurses Aides Physicians Skilled Labor Skilled Trades and Crafts Supervising and Managerial Technical Unskilled Labor

1952
2 54 14
2 14
2 31 181 67 31 38 20 7 ll __lQ2_ 859

1953
2 50
6 2 14 4 30 169 67 31 34 20 7 12 ~ 830

Net Gain
c
-4 -8
0 0 2 -1 -12 0 0 -4 0 0 l --=-.]__ -29

B3

900

800

700

600

500

400

300

200

100
0 1947

1948

1949

1950

1951

i952

FULL-TIME EMPLOYEES BY ORGANIZATION

LOCAL BATTEY STATE
ALTO 1953

2400 230 0 220 0 21 00 20 00 1900 1800 1700 1600 1500 1400 1300 1200 II 00 1000

,
~
~

!=-

>

>

>

l

0
1947

1948

1949

1950

1951

1952

TOTAL FULL-TIME EMPLOYEES IN PUBLIC HEALTH

1953

TABLE II DISTRIBUTION OF STATE HEALTH DEPARTWJENT EMPLOYEES
ON L~VELS 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, 1952
28
26
0 2 41
3
142 2
90 25 44
28 25 19
33
34 8
32 3 9
8 5 4
12 0 3 626

Average salary, 1952 Average salary, 1953

$286.53 $307.34

Number of Employees, 1953
27
26
0 2 28
5 132
2
91 25 36
22 29 17
35 40 ll
30 3 12
8 4 2
15 0
3
605 (For each year, 3 unclassified positions are omitted.)

B6

~MPLOYEE TURNOVER:

During the year, there was a substantial reduction in the turnover rate, although it remained expensively high. VJhile this was due in part to the insistance of the State Budget Bureau that personnel be reduced, it is also apparent that better working conditions are reflected in this decrease. This was the first year in which the full impact of the adjusted salary scales was felt. The addition of Survivors' Benefit coverage to the excellent retirement system for state employees tended to hold workers on the job. It is also probable that the tightening economic situation caused fewer changes in jobs.

TABLE III

EMPLOYEE TURNOVER IN 1953

Appointments

Separations

Net Gain

Local

227

185

42

State

205

226

-21

Alto

0

15

-15

Battey

480

912

__2_Q2_ 935

--=2...
-23

COMPENSATION:

Table II, showing the number of employees in the various pay levels at the end of 1953, points out that the average salary for State Health Department employees was $307.34. Since 70% of the employees received less than this average figure, the table calls attention to the necessity for adequate payment to the highly trained and skilled professional workers responsible for guiding public health work. During the year, a substantial number of employees received salary advances in recognition of increased ski11 on the job. There were also a few promotions to more responsible positions.

TABLE IV

Salary Advances

Promotions

Local

736

28

State

553

Battey

~

74

1,997

161

B7

The salary advance program plays an important part in assuring stability of service, thereby retaining experienced workers in the Department. Table V shows a comparison of the percentage of employees in the various steps ~~thin the pay
ranges. Th3 fact that 18% (or 106) of all of the employees
have been with the Department long enough to have reached the maximum step on the pay plan points out the need for consideration of some method for extending the benefi~s secured by the salary advance program.

TABLE V

PERCENTAGE OF STATE HEALTH DEPARTJ\JIENT EMPLOYEES

ON PAY STEPS

1952

1953

Step l

18%

11%

Step 2

23%

19%

Step 3

17%

18%

Step 4

15%

13%

Step 5

10%

12%

Step 6

9%

9%

Step 7

8%

18%

INSURANCE PROTECTION FOR EMPLOYEES:
The expansion of the State Employees' Retirement System to
include the Survivors' Benefit program, in July, 1953, provided
for Health Department employees a well-rounded plan of insurance
protection. While employees have had since January, 1950
protection under the State Employees' Retirement System against loss of income after retirement, disability, and some protection
for survivors, these benefits were available only after 15 years
of service. The new plan, provided by legislative action, makes immediately available to all employees after their first month of service protection up to a maximum of one year's salary for survivors. The cost of all these benefits under the State Employees 1 Retirement System is shared by the employees and the State.
A group plan for hospitalization insurance is available to all State Office employees, although the State does not participate in the cost.
B8

State employees of the Health Department are :=>lso eligible
for coverage through the Workmen's Compensation Law for accidents
rising out of and in the course of their work. In the Spring
session, 1953, the Legislature also made available to State
employees protection against the remote possibility of contracting tuberculosis as an outcome of the assigned work.

ACTIVITIES OF THE PERSO}fflEL OFFICE:
Major emphasis was given during the year to a study of the classification of positions pertaining to environmental sanitation and to those positions pertaining to laboratory work. Policies pertaining to utilization of leavo were reviewed and the entire system of maintaining leave records simplified. In cooperation with other divisions, a short training school for secretaries was conducted.
During the year, Mrs. Charlyn B. Harper, Personnel Assistant, received three months graduate training at New York University. Miss Martha C. Caldwell, Senior Personnel Assistant, began her work toward a Master of Public Health degree at the University of North Carolina.

APPEALS TO THE PERSONNEL BOARD:

The following appeals were made to the Personnel Board:

March

Mr. Cornell Bryson, formerly of Alto Medical Center. Prejudice removed.

April

Mr. Jesse Lee Speller, formerly of Battey State Hospital. Prejudice removed.

July

Mrs. Leila Grindle, formerly of Battey State Hospital. Appe~l against dismissal denied.

October

Mr. Lester Broome, formerly of Battey State Hospital. Appealed against suspension, but failed to report for hearing. Appeal denied.

B9

THE CLASSIFICATION PLAN:

A number of changes were made in the Classification Plan. The following classes were established:

March

Patients 1 Advisor 15 Senior Patients 1 Advisor 17 Senior Medical Laboratory Technician (Survey) 18

October

Vital Statistics Executive II 25

November

Medical Anesthesiologist

The following classes were abolished:

September

Tabulating Executive B

The following classes were reassigned to a different pay level:

January

Director of Dental Health Services - 5th step made entrance step

February

Vital Statistics Field Agent 17 to 19

May

Physical Therapist 19 to 20

July

Pharmacist 24 to 26 (at request of Welfare Department)

November

Tho'racic Surgeon

The following classes were revised:

July

Physical Therapist

August

Public Health Nurse Consultant (Home Safety Option added)
Occupational Therapist - Training and Experience revised

BlO

PERSONNEL CHANGES IN THE PERSONNEL OFFICE: During the year, Mrs. Gwen Middlebrooks .-vas promoted to a
more responsible position in another division in the Department and was replaced by Mrs. Louise Lemming who returned to the
Health Department from a brief absence after 6 years of
employment in the Department. Mrs. Anne Hitchcock was also promoted to a more responsible position in another division and was replaced by Mr. John Latty who served the Health Department as Personnel Clerk at Alto Medical Center.
flll

Division of Public Health Education

ANNUAL REPORT DIVISION OF PUBLIC HEALTH EDUCATION
l 953
This division continued its direct and consultive services in 1953, in the areas of public and professional information; community organization; school health education; in-service education; and recruitment and placement of public health education personnel.
Three public health educators received orientation and/or academic training during the year. One (Robert M. Alden) was employed as health education consultant with the newly-organized Home Safety Unit in the central office of the State Health Department; another (Miss Mary Lee Anderson) as director of public health education in DeKalb County. The third (C. Dexter Kimsey) attended the University of Michigan School of Public Health following a five-month orientation period at the ColumbusMuscogee County Health Department under the supervision of Mrs. Ferne Jackson, director of public health education. Following his academic
work, Mr. Kimsey was to be employed, in 1954, as director of public health
education at the Savannah-Chatham County Health Department.
PUBLIC INFORI\ffiTION
This division, in 1953, used newspapers, radio, television and professional journals; and used exhibits, pamphlets, posters, films and library service in disseminating health information and health department information. Georgia's Health (a health information bulletin) was sent monthly to about 12,000 Georgia citizens, and FAX, an internal monthly publication ("about public health workers in Georgia") was mailed to state, regional, and local public health people, and to other individuals and agencies.
In an economy move, the mailing list of Georgia's Health was "streamlined" in 1953. A notice was placed in four consecutive issues of the publication asking that persons wishing to be continued on the mailing list write this Division a letter or post card to that effect. More than 10,000 cards and letters were received, with a resulting two-third reduction in number of copies printed and distributed each month.
The Division of Health Education assisted with editing, proofreading and cover design for a 228-page book published in 1953 by Dr. T.F. Abercrombie, director-emeritus of the Georgia Department of Public Health. The book, History of Public Health in Georgia, covers the years 1733 to 1950.
A public inquiries system was developed for answering mail requesting information about health or the health department. All mail which bears no specific personal or division address, and which cannot by its nature be referred immediately to a specific person or division, is routed to the Division of Health Education. The Division immediately answers the mail with an acknowledgement and sometlines with a complete answer. Sometimes consultation with other divisions is required_, or other departments of the state government.
cl

Exhibit Manual Begun
As a partial answer to considerable demand from local health departments for aid in producing exhibits, a loose-leaf Exhibit Manual was
issued in 1953. The manual deals with (1) i'l"here to obtain exhibits,
(2) how to make exhibits, and (3) where to got materials for making exhibits. A series of ready-made exhibit panels was begun, mass-pruduced by silk screen process for distribution to local health departments.
~vo three-panel displays were produced in full color during 1953; one
dealing with Environmental Health Services, the other with Home Safety.
Television Use Planned
The Director of this division served as chairman of a state-wide committee for planning of health education programs on television. The committee, consisting of representatives of numerous voluntary health agencies, discussed subject matter of programs, and techniques of presenting health education programs on connnercial TV stations, with an eye toward developing skills and resources for use of educational TV channels when they become available.
New Film Catalogue Issued
Improvements were made in the Fi~u Catalogue distributed by this
division; among which were (1) better typography, (2) more effective
indexing, and (3) conversion to the loose-leaf method, whereby additions, changes and deletions can be mailed out to catalogue holders. Publicity was given in the catalogue and by other methods to the policy that requests for films should be made to local health departments by local individuals or agencies rather than directly to the Central Office in Atlanta. This promotes closer contact between users of health information materials and their local health department, and makes for more efficient and expeditious handling of the limited numbers of reels in this division's film library.
Pamphlet Production Continuos
New pamphlets produced by the Division for other divisions or pro-
grams during 1953 included: 11RF/RHD (Rheumatic Fever/Rheumatic Heart
Disease) ; 11A New Life Ahead11 (Crippled Children) ; 11 Fluoridation Story; 11
11You'll Love This Boss, But It 111 Kill You 11 (on use of warfarin, a rat
poison); and 11vve're in This Business Together" (on health education in industry).
Distribution of these and other pmuphlots was promoted through a loose-leaf Pamphlet Manual, provided to each local heo.lth departr:1ent, and containing samples of all publications available from the Central Office in ll.tlanta for distribution to the public. This division encourages local heo.lth departments to r:taintain stocks of pamphlets or order publico.tions o.s needed through Local Health Organizations Division.
c2

Revision of Written Ivinterials The Division often assisted other divisions in revising written mnterials such as reports, speeches, etc.
IN-SERVICE EDUCATION
Audio-Visual Instruction Given Jl. highlight of this DivisionIs in-service education activities in
1953 vms the loan of an audio-visual specialist from the U. S. Public
Health Service Is Training Branch, who, working through this office, visitc;d roc;ional health offices and numerous local health depart110nt s for halfday sessions on utilization of nudio-visual aids.
This Division assisted in plannins or publicizing various institutes o.nd SGElino.rs, including (l) sanito.ry lo.ndfill de:r;10nstrations; (2) dontal seminar (annual meeting sponsored jointly by Georgia Department of Public Health and Georgia Dental Association); Georgia Public Health Association; and the annual v1ater and Sewage .School.
C01.11UNIT'I ORGANIZATION
Hembers of this Division have served on cor;unitteos of various statc;vride agencies and orgcmizntions which have an interGst in health. They include the Joint Committee on Health and Education, Georgia Comr.littee for Children and Youth, Georgia Tuberculosis 1\ssociation, Georgia Heart J\ssocieltion, Better Health Council of Georgia, Georgia Congress of Parents and Teachc;rs, Georgia Society for Crippled Children and Adults, and many others.
SCHOOL HK1.LTJ-I EDUC;,TION
Liaison With ~duc2.tion V\TorkelB' This Division worked closely with teacher-education institutions, lJroviding educational materials and arranging for contacts with t0chnical consultants on health depJ.rtmont staffs. l!::duco:tion workshops o..nd conferences hrere -=tttcm dod in tho interest of or:1phasizing tho hea.lth education of tho child and ~.pprising oduc-=ttion personnel of available hGc\lth resources,
c3

INDUSTRL\L HEALTH EDUCATION This Division provided consultation and materials during 1953 for use
in health education programs for industrial workers. Members of this Division served on conm1ittees of the Industrial Health Council of Greater Atlanta, a group which sponsored a pilot study in health education methods for industry. Tho Division also prepared a report, in pmuphlot form, on tho pilot study.
NEGRO HEALTH EDUC1\TION The Negro Health Education Section of this Division participated in
and cooperated with tho health education activities of the YVJCA, Georgia Tuberculosis Society, tho Distributive Education Program, colleges, and olemontary and high schools.
Health information was dissoLnnated through tho media of informal health talks, individual conferences, marriage and fmuily life institutes, filD sessions, distribution of panphlets, charts and bibliographies of health education materials.
LIBRARY SERVICE The State Health Department Library,staffod by a trained full-tiue
librarian and library assistant made an important contribution to tho staff's cultural growth and professional development. Nuu1orous queries were researched and answered, bibliographies furnished, and books and periodicals suggested for purchase and/or ordered upon request. Total nULlber of periodicals received by subscription, gift and oxchange--516; total number of books and bound volumes--15,131; total circulation from Contrctl Library--4,601; total nm,1ber of reference calls answered--2,859; total attendance--9,519.
c4

Division of Training

ANNUAL RE P 0 RT
DIVISION OF TRHI!HNG
1953
1953 was the first full year of operation in the Division of
Training, Georgia Department of Public Health. During the year, the organization of the Division and the establishment of operational policies were completed. This permitted the organization of varied training experiences and more effective administration of the programs.
While general policies for the Division had been approved during the previous year, specific policies were in the process of development at the time of the last annual report. Two of these, ?olicies for the Support of Training and Criteria for the Selection of Local Health Departments as Field Experience Centers, were completed by the Advisory Committee and approved by the Director of the Department on March 2,
1953. Mimeographed copies were immediately distributed to all divisions,
regional offices, and commissioners of health and are available from the Division,
Policies for Support of Training
The Policy for Support of Training states that general support of sponsored training has as its primary aim the meeting of the needs of the Department and states that only those for Whom there is a definite plan of employment 1Nill be considered. The various types of training are defined and there is a detailed statement of the financial support that may be provided under various circumstances. Because of budget cuts, this policy was modified to restrict training to those who were to ,,ork for the Georgia Department of ?ublic Health for the duration of the financial emergency.
Criteria for the Selection of Local Health Departments as Field Experience Centers
These criteria were recommended by the Advisory Committee and approved by the Director to set up desirable characteristics of local health departments, most of ,,Jh:ich should be present for the operation of a satisfactory field training program. These criteria are rigid enough so that probably no single health department in the state no1rr would qualify, but it is expected that several will move rapidly toward full compliance,
SoutheasL;rn Field Training Center
A memorandum of agreement between the Training Branch of the Communicable Dis 'ase Center, Hegion IV of the U. S. ~~ublic Hr:alth Service, Fulton County Health Department, DeKalb County Health Department, and the Georgia Department of Public Health, establishing a Southeastern Field Training Center in Atlanta was completed ~-luring the year. The field training center formerly located at Columbus, Georgia was transferred to Atlanta and serves as the nucleus of this training fac Uity. It is located in the Training Branch of the Communicable Dis;:ase Center, 441 dest Peachtree Street. Copies of this memorandum ha1re been distributed to all
I1-l

divisions of the Georgia Department of ~)ublic Health and are available from the Division of 'Training.
Institute for Local Boards of Health
lv!any training programs have been undertaken during 1953, 1-vhich will be described briefly in the following para.gra:'hs,
The first Institute for Local :~oards of Health, ,,rhich was forecast in the last annual report, was undertaken in one district during the year, A one-day institute was held for members of local boards of health from three counties, .ith staff participation by four members of the Georgia Department of ?ublic Health and the Commissioner of Health of that district. An attempt was made to evaluate the results of this institute some four months later, leading to the conclusion that such institutes should be offered to all local bo::trds of health that -,,rere interested. >Iachinery has been set in motion announcing this opportunity and an attempt is being made to stimulate requests for this experience.
Undergraduate Professional Programs
The Division has '''orked closely rith institutions doing professional training in medicine, dentistry and nursi~g. During the year, the Division Director accepted the responsibility for a course in public health administration offered by the T)epartment of Nursing 3ducation at the ,~tlanta Division of the University of Georgia during the spring quarter. The Director and another member of the Georgia Department of 'Jublic Health
taught this 4 quarter hour course for the University.
The Director of the Divis on, the local Commissioner of Health, and the Superintendent of the Eugene Talmadge Hemorial Hospital at Augusta taught a course in preventive medicine to the Junior medical students at the University of Geor'-';ia hedical School during the spring quarter.
The Director was invited to participate in Dr, J, G. dilliams 1 course in public health and preventive medicine for Senior dental students at Emory University 3chool of Dentistry.
The Director also participated in the course in Preventive i1edicine for Junior medical students at the Emory University School of lviedicine.
In--Service Training
A number of in-service training courses were offered by various divisions of the 1epartment. Those for v1rh ich the primary responsibility was in other divisions "I-fill appear elsewhere in this c\.nnual Report.
One experience in in-service training of clerical personnel should be mentioned here. A 12-hour course for division secret'lries was conducted throursh the cooperative efforts of the staff of the Divisi,,ns of General Administration, Personnel and Training. To this course came secretaries of all State Health Department Divis-ions, together with their immediate substitutes, for discussion of routine procedures. Universal reaction to this course was that it --ms very helpful in increasing interdivisional understanding of procedures and activities.
D-2

Other in-service training, for example, the short school for sanitarians, colill appear under a statistical summary of training.
Orientation and Apprenticeship
Orientation programs for new employees have been developed with the divisions concerned and have been provided for all persons recruited during the year.
Our first experience 'rith apprenticeship training came during the year 'd.th the cooperation of the Iviuscogee-Harris County He3.lth Departments. A health education trainee ,,ras put in apprenticeship training under the immediate direction of the health educator of i11uscogee County for field experience prior to academic study of health education, Hhich was begun in the fall. This experience demonstrated the value of such field experience in anticipation of academic training.
The statistical summary will indicate the number and types of personnel who had orientation.
Visitors from Other Countries
One of the pleasant duties of the Division of Training is to serve as host for the Department to our visitors from other countries. Host of these guests are routed to us throuzh the Training Branch of the Communicable Disease Center, although a few come directly to one of our divisions from schools of public health or other agencies.
During the latter half of 1953, we have welcomed more than thirty visitors from twenty countries and arrane;ed for observation and conferences to meet their needs, Such experiences have varied in length from one day to several weeks and have been provided in the Georgia Department of Public Health, a regional office, or in a local health department.
Each experience is planned individually to best meet the needs and interests of the visitor. Such individual planning and execution is time consuming and has created many problems for busy program directors. But the effort has been well repaid in the satisfaction of helping others, in gaining knowledge of our country and in friendships gained. Je are grateful to all those who have helped make these visits profitable.
Summer Work for Medical Students
Eleven Junior medical students were employed for eight weeks during the summer of 1953 in continuation of a program of some years' standing. After hvo days of orientation to public health and the state department, these students were placed in local health depa.rtments for observation and activity under the direction of the commissioners.
Technically, these men were in Nork status rather than on training, but the Division of Training work.::d closely ,,rith the programs to the objective of providing a situation in 1vhich an understanding of public health and its activities could be secured by prospective practitioners of medicine.
D-3

Everyone concerned was pleased vv-ith the results of this experience and felt that such opportunities should be continued,
Formalized Training
In spite of the reduction of training funds for the fiscal year beginning July 1, academic training continued at the same rate as in the previous year, hany commitments had been made before we knew of the reduction in funds, so that an unusually lar c;e proportion of the training budget was directed into academic training for the academic and fiscal
year 1953-54.
Formalized, non-credit training '-Jas continued for sanitarians in the Columbus Field Training Center, 1tJhich did not move to Atlanta until the end of the year.
Statistical Summary
Certain important data concerning the amount of training we have been able to do appears in three tables and four figures, Which are self-
explanatory, In most cases, data is compared for the last 5 years for
three professional categories of oersonnel and the group of all others not included in professional categories,
It should be pointed out that, :oarticularly in regard to academic training, the academic year does not conform with the calendar year for ,,rhich the annual report was written, There is in each calendar year, therefore, data on individuals who completed the academic course and a different group of individuals being sponsored for an academic course beginning in that year. These differences are clearly marked in the illustrations.
Attached also is a summary, indicating the types of training sponsored for various categories of personnel and a list of in-service training experience, including only those for which stipend or fees were paid by the Division of Training and those 'tlhose out-of-state travel for training were processed by the Division. As pointed out before, there are many in-service programs which ,.,Jill be reported by other Divisions concerned.
Future Training Needs
The primary need in Georgia's training program is the establishment of good field training centers in enough local health departments to meet the demand for well supervised and adequate field training experience. Criteria for the selection of such areas have been established and several local health departments have indicated an interest in becoming such centers, The operation of a field training center in a local health department produces many intangible advantages for that department, but at the same time increases operation costs for the local area. Such costs are not completely balanced by the intangible advantages so that a method of at least partially financing training center activities through some form of increased grant-in-aid must be devised and financed. hlhen this is made possible it is believed we can rapidly proceed crith the establishment of one or more centers.
D-4

Another immediate need is the establishment of more short courses in specialized areas for the gradual educ,lt ion of those individuals already on the job ':ithout sufficient trainins;. This is the sort of activity that the Southeastern Field Training Center is expected to provide, but that part not applicable to all states in Region IV must be developed >,Jithin the Georgia Department of ?ublic Health itself.
Academic training must be maintained at or near its present level, particularly in view of the anticipated district plan of local health services, for the success of 1,Ihich well-trained key personnel must be available for each district.
For all of these objectives funds vfill be necessary. But, because of the interest and cooperation of all those concerned, such funds vfill probably be needed in only reasonable amounts over and above those currently budgeted.
D-5

TABLE l

STIPEND TRAINiiJG SPOIJSORi~D BY DEPAHTHENT
1953

Nurses:

January-June

Academic

10

Orientation

8

Specialization & Refresher

f-;

July-December
ll
7

Sanitarians:

Short course in environ-

mental health

12

6

Academic

4

In-service

2

Engineers: Academic
Orientation

l

l

l

Physicians : Orientation
Academic

l

l

2

Bacteriologists: Academic

Others:

Academic Orientation Apprenticeship

3

8

4

2

l

l

53

39

Total
21 15
6
18 4 2
2
l
2 2
3
12 3
l
92

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TABLE 2
MISC::;:LLANEOUS IN-S:C~RVICE TR:-\.IIJING
(Some or all of the expense of these experiences was supplied by Department)
Short course in milk sanitation - 10 sanitarians Short course in food sanitation - 28 sanitarians
Sanitation Short School, Georgia Tech - 157 sanitarians & engineers
Rehabilitation course at Gallinger Hospital, Washington, D. C. - 10 nurses Seminar on Rehabilitation of Children, New York University Seminar in Physical Rehabilitation for Nurses, !Jew York University Filing school at Ivan-Allen for clerical personnel - 43 University of Pennsylvania \Jork Conference on VD - 2 nurses Education of Exceptional Children:
'tlestern C1rolina Teachers College - l school teacher Syracuse University - l school teacher South Georgia Teachers College - l teacher University of Georgia - 16 teachers Personal course in cerebral p<Llsy, Cook County Hospital uostgraduate School of Medicine, Chicago - 2 doctors Clinical psychology, speech correction and audiology, Northwestern University l employee of Jr. League School for Speech Correction Nutrition Institute, Syracuse University- 2 nutritionists Human Rel~ions Training Conference, CDC, Atlanta- 2 Southern Pediatric and Obstetrical Seminar, Saluda, N. C. - 4 doctors Educational experience at Menninger Clinic - l mental health consultant Visit to Machlett Laboratories, E. I. Dupont DeNemours Company, Bar Ray Products Company, and Keleket X-ray Company Showroom - l chief of X-ray services Milk sanitation (mobile laboratory) - 4
Tri-State Obstetric Seminar, Daytona- 4 health officers
Occupational Health 1'Tork Conference, University of Ga., "'\.tlanta Division - 6 Institute on Business Hanao;ement for Nursing Homes - l hospital program specialist
Orientation Conference on Home-Accident Prevention, Chicago - 4
Observing cleaned-in-place milk systems, Florida - l sanitarian Training in blood sugar laboratory, Boston - l industrial hygienist Work Conference in Human Relations, CDC- l Director of Mental Hygiene CliniG Institute on Nursing Service Administration, New Orle'lns - l Hospital Administration
Technician
D-7

TABLE 3
NUMBER OF ?~RSONS IN :JWLOYJillifJT AtW tJUHEc;H 'l'li Uhtl.:;D lH FCJUrl CATEGORib_S OF ?ER3m~NEL
1949 - 1954

j Nurses

;:: T:. :r ~ :: T:l ~:~ ::1 :: :1 :~:~3- :~~ 1949-50

--------,----

I 195_9-51

i 1951-52 I

1952-53 i 1953-54 i ----~,---------~---~

Total

1
i

i ::

I

i

I

I

1;

~ngine ers .".:: Sanitarians

126

Physicians

46

1 Others
I' I TOTAL

596 1,171

1 1134
I
0 I 45
I
2 I 615 ; -~i
11 I 1,211

1 I 143
I
0 II 47
I
3 I 707
I!
5 i 1,333

0 1156

5 1164

I
I2 53

'
0 I 50

! I,
10 I 772

I i'
3 I 771

rI ----~ I -

i 15 1,457 18 I1,478

l !I 723

8I

.
1 I 241
I II

I

tD I

r=l

3!

II,

6 ! 3' 461

24 I

II

-----------~i

18 : 6,648

67 i

1953-1954 1952-1953 1951-1952 1950-1951 1949-1950

FIGURE 1

5

10

15

20

Nurses Engineers and Sanitarians Physicians
Others

NUMBER OF ACAD.EJvliC SCHOLill3HIPS GRANTED 3Y CATEGORY OF PER.SONN':1
1949 - 1954

FIGURE 2

0.5

1.0

1.5

.:::::::.:..:.:.:.:..:.:.:.:..:.:.:.:.:..:.:.:.:..:.:.:.:..:.:.:.:.:..:.:.:..:.:.:.:.:..:.:.:.:.:..:.:.:..:P..h.i.~..i.~.i..m..~..:..::..:.::.::.:.::..::..:.:.:..:.:.:.:.:..:.:.:..:.:.:.:.:..:.:.:..::..:.:.~..:.:.:.:.:..:.:.:..::.::.:::::::::::::

PERCENTAGE CF PERSONNEL CRAJ':T~"D ACADEMIC SCHOLAB.SHI?S
1949 - 1954

;.Jurses

FIGURE 3

10

20

30

40

50

Engs. & Sans.
Physicians Others

~ % of E.ctp1oyed

COHPAri.I3or; C;F P J-l.CEI':TA;E OF ACADill-:IC YE::,\{ SCHOLARSHIPS AND P"jtCJ<::;T.\'~.1!.: OF ~1-lPLOYlt-:;:::~T l3Y CATrT:OH.Il:;S OF ?:~Ft:30N:-L~L
1949 - 1954

Nurses

FIGURE 4

15

.30

45

60

75

Engs. & Sans.
Physicians

%of Training
~ %of Employed

COMPARISON OF PERC~'TAGE OF ACADEHIC YEAR SCHOLARSHIPS AND PtRCENT K~E :":1-:PLOYM~~T EXCLUDING 11 0TH:<ES 11
1949 - 1954

Division of Vital Statistics

Division of Vital Statistics
1953 Annual Report
The year 1953 was a very busy one for the Division of Vital Statistics. The number of records placed on file with the Division during the year exceeded by fifty-four thousand those filed during any previous year. This increase was absorbed with no addition to the staff but was absorbed by streamlining certain office procedures.
During the Spring Session of the General Assembly the Vital Statistics Act of 1945 under which vfe were operating \\'aS amended to meet the current needs of a comprehensive registration program designed to best serve the needs of the people and for better Public Health planning. This amended law now includes "Fetal Death Registration" which provides for the registration of the "Product of any Determined Pregnancy~ It also modernizes the Section of the law which deals with adoptions and legitimations and strengthens the section pertaining to the correction of Birth or Death records already on file. It more clearly defines the responsibility of Funeral Directors, Physicians, Health Officers, and Coroners in filing certificates of death. However, another law "The Post lvtortem Examination Act 11 was enacted during this session of the General Assembly which tends to confuse the Administration of the amended Vital Statistics Law. It will be necessary for a later assembly to clarify the function of each of these laws.
Fetal Death registration was designed to get a better measurement and understanding of prenatal care ancl human wastage; it also was new in the field of registration. For these reasons the Division sought the guidance of our Division of Maternaland Child Health and the Maternal and Child Care Committee of the lvtedical Association of Georgia toward implementing the law. The Division owes a debt of gratitude to both these groups for their untiring assistance in designing a certificate of registration that would adequately fulfill the purpose of the program. In December the program was introduced to be effective January 1, 1954, to all the Private Physicians of the State, the Hospitals, Funeral Directors, Coroners, Health Officers, Public Health Nurses, Midwives, Ordinaries and Local Registrars. This is a long range program and its maximum effectiveness is not anticipated for several years.
A total of 366,898 vital records were recorded with the Division during 1953, consisting of 99,785 Live Birth Certificates, 99,785 Confidential Hedical Reports of Birth, 2,049 Stillbirths, 30,908 Deat:1s, 52,146 Applications for Marriage License, 52,146 Marriage Licenses, 7,174 Divorces, 22,903 Delayed Birth Certificates, 14,315 of which were filed by the court order procedure and 1,194 adoption decrees. vfuile these records were recorded during 1953, they are not to be construed as events occuring during the year.
During 1953, there were 97,421 live babies born to parents who are residents of Georgia and 1,967 Stillbirths. Death occured to 30,754 Georgia residents during the year. Unfortunately 3,051 of these deaths were among infants under one year old and 119 were maternal deaths. The Statistical summary of these vital e'.'ents will be published later in the year.
The Division issued 30,338 Certified copies of birth and death records during the year of these 2,934 were issued free to Veterans Each year a greater number of schools require a birth record for school admission. Thousands
E-1

Division of IT:ital Statistics -- Page 2
of these school certificates were issued free as well as for allotments for dependents of service men, welfare agencies and other organizations require verificatio' of birth and/or death and thousands of such verifications were made.
New birth certificates were filed for 815 of the children adopted during the year. There were also 761 new certificates filed for the children Who were legitimated iur:"''lg 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 hospitals 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 statements are prepared for county fiscal officers and 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 eve~ child born with a congential 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 "f 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 Association are notified of the death of doctors and 3e~tists. 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 stPtes,
The Division of Maternal and Child Health is furnished a photostat copy of each such neonatal death also such maternal death w.ith a photostat of a birth or stillbirth certificate of the 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 de~d when the medical report ~as filled in, Cards are slso made from death certificates for each infant under one year of age and the birth and death card are matched, In many 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.
E-2

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

Division of Crippled Children

JlliNUAL REPORT - 1953
CRIPPLED CHILDREN'S DIVISION

Crippled Children's Division has shown steady growth during the calen-
dar year of 1953. 5,319 individual patients received treatment. This was an increase over the 4,601 patients treated in 1952. Of the figure quoted above for the past year, 1,917 were cases that had never
been seen before by our doctors. In order to handle the increased
number of patients, it was necessary to hold more out-patient clinics.
562 clinics were held in the eight clinic centers, an increase of 120 clinics over 1952. Two orthopedic surgeons were added to help ~arry
the load. One physical therapist was added late in the year.

A new clinic was opened at Vvaycross, Georgia, where a large orthopedic clinic is held once each month. This is an itinerant clinic and staff from Savannah and Atlanta travel there on regular schedule to examine the children. This increases our itinerant clinics to three, the other two being held in Albany and Cordele. Our permanent clinic centers remain at Augusta, Atlanta, savannah, Thomasville and Columbus.

During the early part of the year, it appeared that our budget would be sufficiently large to allow us to expand, so we began to accept for care children with hernias, esophageal strictures, papilloma of the larynx, congenital deformities not heretofore accepted, such as extrophy of the bladder, hypospadias, pyloric stenosis, and atresia of the ileum. Since this extended our area to a larger nwnber of infants and small children, we employed pediatricians to attend all of our clinics except for a few in Atlanta where we have better facilities for pediatric care.

Better staffing of cases was obtained in the clinics when the orthopedist and pediatrician discussed each child's needs. This resulted in greater awareness of the "whole child11 and consequently we found more and more consultants being called in from all of the medical fields.
This has certainly resulted in much more adequate care for the patients.

As our case loads rise and we see the need for wider services for each child, it makes us more aware of the need to further research for the prevention of some of the many cases that vre see. A study of part of
the 5,319 children treated shows a breakdmm as follows:

Congenital Deformities:

Clubfoot

351

Harelip and Cleft Palate

202

Congenital heart defects

64

Spina Bifida and Heningocele 42

Dislocated hip

33

Liiscellaneous Total Congenital Deformities

- -58-1

Poliomyelitis

Cerebral Palsy

Burns

~\ccidents, poisonings and violence

GRAND TOTAL

1,273
796 725 193 231

3,218

Fl

Note what a large part of our case load is composed of conditions that Yve might hope could be prevented in the future when medical science and research have found the causes and can prevent many of these conditions.
In our last .Annual Report we stated that 1;ve had opened a physical therapy center at Harris i,:Lemorial Hospital. By the middle of the year, it vvas found that one physical therapist could not carry the load. It was difficult to find another qualified person, but eventually we added a second member to our staff. During the year, these tvvo young Yromen gave
a total of 2,997 treatments. 1,636 of the total number were given to
polio patients vrho lNere admitted under the auspices of various county chapters of the National Foundation for Infantile Paralysis. By the end of the year, the Division had completely out-grown its quarters and the hospital was planning to add several rooms for the use of the physical therapists. This has indeed been a vmrthvvhile venture.
As our public health nursing supervisors have found it possible to get out in the field more, we have found referrals increasing. Many of them are valid, but many of them are not acceptable to our Program. It points out the need for better facilities for medical care for indigent patients throughout the State.
At the end of the year, we realized that costs had continued to rise in all aspects of rredical care as hospitals submitted their statements of reimbursable cost, there were no reductions. Even a few cents a day in each hospitZ~.l means a great increase at the end of each month. Braces and appliances shovred an increase. .~Jbereas the average cost of a pair
of shoes in the previous year had been :)12.00, it was 013.00 in 195'3.
Every effort was me>.de to help the parents plan to meet part of their ovm expenses, but this has met only a very, very small part of the need.
"!e are f2.cing 1954 Yvith the fear tho.t our budget vrill be decreased and
that with rising costs, we nill not be able to offer as much service as vre have the past tvro years. We have, however, an advo.ntage in having increased our staff very slightly and vre hope that the deficit can be obviated by better case planning.
F2

Division of Maternal and Child Health

ANNUAL REPORT - 1953
DIVISION OF MATERNAL AND CHILD HEALTH
Helen W. Bellhouse, M. D., Director
Acknowled~ements
An annual report from the Division of Maternal and Child Health is actually a report not only of the MCH divisional activities, but also of the co-ordinated work and thought of all those divisions at state level, of all the regional and local public health personnel, and of voluntary agencies who have worked to improve the health of mothers, children, and families ~s a whole, either directly or indirectly. To us it is only proper that this acknowledgement be made, particularly since our state level staff is now limited to one physician, one nurse, a professionally experienced public health education executive, and in the Nutrition Unit, to one nutritionist and a dietitian.
Basic Statistical Data Used
Two basic types of reporting of activities related to Maternal and
Child Health are used in this report - LHO 7 and MCH 1-2-3.
MCH 1-2-3 gives an unduplicated count of clinic admissions of, and a count of clinic services to mothers, infants and children. It admits only once for each pregnancy or each postpartal period, and for each age group of infants and children.
LHO 7 shows total admissions to service, whether or not admitted
to clinic service. Each mother, infant or child is re-admitted annually, beginning the first of January. A much larger number of persons is therefore admitted, and a broader picture of total service is reported.
Since LHO 7 includes reporting of additional activities in the area of
nutrition, maternity classes, and midwife supervision, we felt it should be included in the annual report.
This explanation seemed necessary to avoid confusion.
Also included are tables showing trends in maternal and infant and child mortality. These are attached as an appendix.
Accomplishments and Activities
In General
As in most programs there have been accomplishilisnts which are not always too easily measured, and, as progress is made, there are new challenges.

Increased emphasis on the continued health supervision of the well child from birth to school entry, rather than just in infancy> is bearing fruit. Our objective is that at school entry we can present a "well child" in the fullest sense of health, both emotional and physical.
Nutrition instruction increased 80% in the preschool group. This
increased emphasis is showjng results not only in nutrition instruction, but by increased attendance of, and medical and nursing attention to,' the preschool child, both in clinics and in the home. Defect finding and correction in the preschool group is being encouraged. (Tables I and II)
We must, however, continue to maintain and extend services to the infant. Only nutrition instruction was increased in this age group. Medical and nursing admissions and activities were reduced in number and
frequency on LHO 7 (Table I). While there was an increase in admissions
to Child Health Centers, there was a decrease in total visits.(Table II)
TABLE I
INFANT AND PRESCHOOL HYGIENE

Infants:
1. Individuals admitted to service a. Number of above admitted to medical service b. Number of above admitted to nursing service
2. Visits to medical conferences
3. Visits to nursing conferences 4. Field visits 5. Instruction in nutrition

45,476 20,633 44,876 44,244 75,567 69,385 88,506

44,863 18,908 44,812 40,222 71,140 67,020 91,485

Preschool:
6. Individuals admitted to service
a. Number of above admitted to medical service
b. Number of above admitted to nursing service
7. Visits to medical conferences 8. Visits to nursing conferences
9. Field visits
10. Instruction in nutrition
11. Inspections by dentists or dental hygienists
12. Prophylaxis by dentists or dental hygienists
13. Infant and preschool classes 14. Sessions held 15. Attendance 16. Food demonstrations 17. Attendance

51,159 24,910 50,431 37,585 63, 121+ 48,944 66,074 1,485
93
29 50 726 28 313

57,006 28,155 56,405 40,038 67,310 49,067 73,218 2,302
231
20
21
506
22
593

Source: Georgia Department of Public Health LHO 7 - Annual Activity Report

G2

TABLE II CHILD HEALTH CENTER ACTIVITY

1952 Admissions--Infant and Preschool

Admissions, total White

32591 11124

Negro

21467

Age groups, total Under 4 months

32591 12002

4-12 months 1-5 years

6315 14274

%
36.83 19.38 43.80

1953
33265 11339 21926 36518 13289
6258 16971

%
36.39 17.14 46.47

Increase or Decrease

f 674

f 215

f 459

f 3927

f 1287

-
f

57 2697

Visits and Activities Visits, total White Negro Visit/admission ratio White Negro Referred cases

95103 30427 64676 2.92 2.74
3.01 3158

91402
29521 61881
2.75 2.60 2.82
2329

- 3701
- 906
- 2795
I
I
I
- 829

Source: Georgia Department of Public Health MCH l-2-3 - Report of Clinic Activities

G3

Immunizations

A decreased amount of time spent on typhoid immunizations, one of the objectives of the past five years for the entire immunization committee, actually showed up this year. This will release more professional time for work with the "whole child". Fortunately the carrier rate is now so low that less public health emphasis is necessary on typhoid, except in endemic areas.
Decreased single diphtheria immunizations were more than compensated for by the increased number of desirable triple vaccine (D.P.T.) administered in all age groups.
The decreased number of smallpox vaccinations completed is not necessarily desirable.
TABLE III
Some of Immunizations (Persons Immunized) (Completed by Personnel of Georgia Department of Public Health

Type

1. Triple Vaccine - D.P.T. (Diphtheria, Pertussis and Tetanus)

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

19,411 67,046 86,457

Increase or Decrease

21,638 76,485 98,123

f 2227 f 9439
/11666

2. Smallpox a.

93,669

84,935

- 8734

3. Typhoid a. Total

472,631

382,277

- 90,354

Source: Georgia Department of Public Health LHO 7 - Annual Activity Report

G4

MATERNAL HEALTH
"Maternity service" on the whole showed little change in terms of numbers. Over 25% of the expectant mothers in our state receive some prenatal attention. There was a slight increase in numbers of cases admitted to ante-partum care, but a discouraging decrease in the already low number of mothers admitted to postpartal care, both in medical and nursing supervision in the clinic and at home. There was an encouraging increase in number of visits the antepartal cases made.(Tables IV and V)
TABLE IV
MATERNITY SERVICE

1952

l. Cases admitted to antepartum service

27,130

a. Number of above admitted to medical service 19,124

b. Number of above admitted to nursing service 26,853

2. Visits by antepartum cases to medical conferences 52,397

3. Visits by antepartum cases to nursing conferences 72,434

4. Visits by antepartum cases to private physicians 1,229

5. Field visits to antepartum cases

18,948

6. Cases attended by nurses for delivery service

659

7. Cases admitted to postpartum service

19,971

a. Number of above admitted to medical service 5,210

b. Number of above admitted to nursing service 19,821

8. Cases given postpartum medical examination

5,540

9. Office or clinic visits by postpartum cases

11,453

10. Field visits to postpartum cases

38,449

11. Instruction in nutrition

72,954

12. Midwives registered for instruction

1,254

13. Midwife meetings

984

14. Attendance at meetings

6,028

15. Visits for midwife supervision

2,251

16. Maternity classes

73

17. Sessions held

317

18. Attendance

3,056

19. Food demonstrations

178

20. Attendance

2,518

Source: Georgia Department of Public Health LHO 7 - Annual Activity Report

1953
27,570 19,156 27,487 53,025 77,840 1,257 19,882
650 20,314 5,108 20,020 5,336 11,458 36,957 82,976 1,181 1,042 6,303
2,145 103 351
I 4,950 199
3,101 I

G5

TABLE V MATERNAL HEALTH CENTER ACTIVITY

Prenatal Admissions
Admissions, total
White
Negro
%white %negro
Period gestation, total
Under 16 weeks 16-27 weeks 28-36 weeks Over 36 weeks

1952
19378 1484 17894
19378 4718 10145 4040 475

%
24.35 52.35 20.85 2.45

1953
19330 1535 17795
20489 5050 10520 4345 574

% ~lus or Minus

24.65 51.34 21.21 2.80

t-

48 51

- 99

tt

1111 332

f 375

f 305

f 99

Prenatal Activities Visits, total " White Negro Visit/admission ratio White Negro Transferred, total

69584 6215
63369 3.59 4.19
3.54 504

65431 6888
58459 3.38 4.49 3.29 669

t-

4153 673

- 4910

t 165

Postnatal Activities Admissions, total White Negro Visits, total White Negro

5108

%

504

4604

5801 26.36

529 33.96

5272 25.73

4869 % 461 4408 5602 25.19 498 30.03 5104 27.77

-
-

239 43

- 196

- 199

- 31

- 168

Source: Georgia Department of Public Health
MCH 1-2-3 - Report of clinic activities

G6

Whereas there was an increase both in number of midwife classes and in attendance, there was a slight decrease of visits for midwife supervision. "Maternity classes" increased in number and attendance. Nutrition instruction in numbers shows a sizeable increase.

TABLE VI

MIDWIFE CERTIFICATION

IN GEORGIA

Y8ar

Midwives Certified
Total w N.W.

Midwives Refused

Ages of New Midwives Age

Certifi-

Under 50- Over not

cates Died 50 yrs. 65 65 given

Badges Sent to Retired Midwives

1952 1249 79 1170

68

28 26

34 2

48

1953 1159 59 1100

74

21 16

5l 5

51

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

A total of 103 counties, two less than in 1952, sponsored MCH clinics. Although there was a decrease in the total number of counties participating in the maternal, and combined types of clinics, there was an increase in the number of well child conferences. All existing centers increased the number full clinic sessions.

TABLE VII

MATERNAL AND CHILD HEALTH CENTERS REPORTING TO THIS OFFICE, 1953

Maternal Counties Sponsoring Medical MCH Centers

1952

1953 1952

1953

105

103

59

53

Full sessions

1952

2300

One haJf sessions 340

303

Combined.

1952
96
2120 340

1953 94
2292 208

Source: l-2-3 - Report of Clinic Activities

Well Child.

1952
96
2985 163

1953 107
3723
167 I

G7

Personnel and Activities
Personnel
In June, 1953, the specialized consultant nurse completed study of
the University of Pittsburgh School of Public Health, leading to a Masters Degree in Public Health, and returned to the Division. In September the public health administrative assistant assigned to the Division moved over toLocal Health Organizations. Otherwise, the staff remained stable.
Medical
The physician administrator made great efforts to delineate and delegate responsibilities within the group. As the year progressed this has seemed more and more successful and has helped in integration. Monthly professional staff meetings and exchange of correspondence helped keep information lines clear.
There has been a great deal of work done with physicians as individuals and in groups, both in committee work with the medical association and special advisory groups, and as a part of study groups in the medical schools, particularly at Emory (Grady). Our particular emphasis has been on developing recognition of the responsibility of the physician giving prenatal care for the perinatal health of the infant, as well as the health of the mother. This involves not only the obstetric and pediatric groups, but the general practitioner. In this regard it is felt that the development of the new fetal death and live birth certificates is very significant, particularly since it was a joint undertaking with a committee from the Medical Association of Georgia.
There has been a constant effort to bring to the attention of both the graduate and student physician those resources of the local health department which can help him reduce the incidence of maternal morbidity, and aid in the follow-up care of the premature and newborn.
Partly as the result of about four years of this kind of work one large local hospital is coordinating its efforts with those of the local health department to decentralize and individualize prenatal care. Though the mothers affected are still relatively few, about 900, the results in fetal salvage through improved maternal health are suggestive of the value of the project.
The physician participated in two of the institutes on cardiovascular diseases and diabetes, since either or both diseases have a marked effect upon the health of a woman during pregnancy, and since they may occur in infancy and childhood.
G8

Nursing
In cooperation with personnel from the Southeastern Area Head~uarters of the American Red Cross,Health Conservation Services, and the Division of Public Health Nursing, two Instructor's Courses in Mother and Baby Care were offered to 17 public health nurses in the Southeastern Health Region and 16 public health nurses from Fulton and DeKalb Counties and the state office. By December of 1953, 2,293 certificates had been issued in Georgia to students of Mother and Baby Care classes taught by instructors who had had this course in 1950, 1951, 1952 and the first half of 1953.
Two of the Institutes on diabetes and cardiovascular disease were participated in, to demonstrate that specialized areas of activity fit naturally into already functioning generalized programs.
Activities with the midwives consisted mostly of field visits for the purpose of helping personnel in local health departments cope with midwives who were not complying with the Midwife Regulations and with state laws. Other activities in behalf of the midwives include preparation of an outline to be used in teaching new midwives and observation with foreign personnel of a regional midwife meeting.
Committee membership on Crawford w. Long and Grady Hospital
Premature Advisory Committees has broadened the contacts of the consultant nurse.
Midwife Problems in Georgia was the subject of one class with white and Negro nursing students of the Grady Memorial Hospital School of Nursing. Information regarding Maternal and Child Health activities in the state was provided for nursing students at Crawford W. Long Hospital.
Ten days were spent in nurse-midwife vacation relief in Thomas County. Thirteen other counties were visited for varying periods of time to observe and assist with maternal and child health activities.
As chairman of the Thermometer Techni~ue Revision Committee, the consultant nurse had an opportunity to work with many other divisions of the State Health Department.
A considerable amount of time was spent preparing material for nursing projects in the state. Notes covering both medical and nursing aspects from meetings attended, were also prepared to distribute to public health nurses.
A considerable amount of time was spent with the Legislative Committee and with the Attorney General's office, reviewing and revising proposed midwife legislation.
G9

Health Education
The Flaherty citation winning documentary film, "All My Babies", is proving a valuable tool not only with the midwives for whom it was intended, but in a shortened version with physicians, nurses, and for patient education, and it is anticipated that it will be used more and more with related agencies and with community groups. A project is under way to broaden its teaching value by developing a slide series which will bring certain areas of activity into higher power focus, including activities of many professional personnel such as commissioners of health, nutritionists, and public health nurses and physicians.
In the future more attention will again need to be focused upon the use of the child growth and development films. The need for midwife education, and the problems of learning how to best use, and with whom to use "All My Babies" has necessarily distracted attention from this activity.
Nutrition
Each year shows a gratifying increase in the nutrition program. There were 305,754 individuals reported as receiving instruction in nutrition in 1953. Chief emphasis continues to be on work with mothers, infants and small children. Almost 80% of reported work is to these groups. Other categories, however, show a greater percentage increase. Since 1950 work with tuberculous patients or suspects is 120% greater, with school children 114%, and with crippled children 385% more. Increasing work on special diets doubtless accounts for 24% more patients admitted to morbidity service receiving nutrition instruction in 1953 than did in 1952.
There has been an expansion of types of service given as well as numbers reached.
In chronic diseases a series of six classes was conducted for one group of diabetics. Classes on diet for diabetics were held for private duty nurses, public health nurses and the parents of diabetic children. Help was given on a Diabetic Fair which had as .its purpose the education of professional people, the general public and diabetics.
Six two-day institutes on cardiovascular diseases and diabetes were held for all public health workers in the state. Diet was an important component of these institutes.
Assistance on menu planning, operation and nutrition education were given to several industries, a convalescent home and a day nursery.
Much help was given in the preparation of an Emergency Feeding Manual for Civil Defense, a Diet Manual for hospital use in the state and material on combating food misinformation.
GlO

TABLE VIII INSTRUCTION IN NU~ITION

1952

In Tuberculosis Service

16,568

To Prenatals For Infants

72,954 88,506

For Preschool Children

66,074

For School Children

8,884

For Morbidity Patients

11,471

For Crippled Children

3,789

Food Demonstrations

No. for Prenatals Attendance

1952
178 2,518

1953 24,875 82,556 91,485 73,218 13,492 14,234 5,894

I

1953

I

199 3,101

No. for Infants and Preschool

Children

28

22

Attendance

313

593

I

Source: LHO 7 - Annual Activity Report

Special Pro,jects
The MCH staff, including the nutritionist, has participated directly or indirectly in the continuing Crawford W. Long and Grady Hospital premature education program.
The Grady Hospital-Fulton County decentralized premature program was set up in cooperation with the State Health Department, and has a good start. The Grady Abnormal Clinic continued in operation with changes in personnel. The three nurse-midwife counties continued in operation.

Gll

Special Needs Personnel There is a continuing need for an obstetrical consultant physician, a pediatric consultant physician, and an additional consultant nurse if there is to be adequate administrative and professional relationship with the local programs. This staff need will be particularly acute when the new district-plan is in operation. Post-Partal The poor percentage of mothers receiving postpartal supervision and medical examination is even more marked this year. Legislation There is continued effort to devise and have passed by the legislature a suitable hill for the certification and supervision of local lay midwives. Despite cooperative efforts with other personnel of the State Health Department, the old bill did not pass. However, if and when the new enlightened bill does pass, it will serve as protection not only for mothers and babies of our state, but for the better midwives.
Gl2

~ .... :;;: ;"

LIVE BIRTHS, NUMBER AND RATE BY RACE, GEORGIA, 1952 AND 1953

1952
Number

Rate *

I

1953

Number

Rate

TOTAL

97,130

27.3

97 421

27.0

White

61,439

24.9

61,671

24.5

! Non-White

35,691

33.0

35,750

32.9

I

I

*Rate per 1,000 estimated mid-year population

Source: Georgia Department of Public Health

Central Statistical Unit

LIVE BIRTHS: NUMBER AND DISTRIBUTION BY RACE, BY PLACE OF
OCCURRENCE AND ATTENDANT, GEORGIA, 1952 and 1953

Q I-'

TOTAL

WHITE

NON-WHITE

l

LA)

1952

1953

1952

1953

1952

1953

Place of Occurrence Total Hospital ether

97,130 74,211 22,919

97,421 76,722 20,"699

61,439 58,518 2,921

61,671 35,691 59,427 15,693 2,244 . 19,998

35,750 17,295 18,455

Attendant Total Ihysician Midwife ether

97,130
79,325 17,417
388

97,421 80,694 16,271
456

61,439 60,490
899 50

Source: Georgia Department of Public Health Central Statistical Unit

61,671 60,839
747 85

35,691 18,835 16,518
338

35,750
I 19,855
15,524 371 '
.i

LIVE BIRTHS: PERCENTAGE DISTRIBUTION BY RACE, BY PLACE OF
OCCURRENCE AND ATTENDANT, GEORGIA, 1952 AND 1953

TOTAL

WHITE

!
NON-WHITE

1952

1953

1952 1953

1952

Place of Occurrence

Total

Hospital

Other
I A.ttendant

! Total Physician

I
I

Midwife Other

100.0 76.4 23.6

100.0
78.8 21.2

100.0 100.0

81.7

82.8

17.9

16.7

I

o.4

0.5

'---

100.0 95.2 4.8

100.0
96.4 3.6

100.0 98.5 1.5 0.1

100.0
98.6 1.2 0.1

100.0 44.0 56.0
100.0 52.8 46.3 0.9

Source: Georgia Department of Public Health

0
1+-'

Central Statistical Unit

MATERNAL DEATHS, NUMBER AND RATE* BY RACE, GEORGIA, 1952 AND 1953

1952

Number

Rate*

1953

Number

Rate

1953
100.0 48.4 51.6
100.0 55-5 43.4 1.0
l

TOTAL

128

13.2

116

11.9

White

36

5-9

39

Non-White

92

25.8

77

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

-

--~----

*Rates per 10,000 live births.

~~- - - - - - - -

6.3

21.5

I

Maternal decreased 12 in number, with all this decline occurring in the non-white group. Three more white mothers died in 1953 than in 1952

Source: Georgia Department of Public Health Central Statistical Unit

MATERNAL DEATHS: NUMBER AND DISTRIBUTION BY SPECIFIED

CAUSE AND RACE, GEORGIA, 1952 AND 1953

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

TOTALS

1952

1953

WHITE

1952

1953

NON-WHITE

1952

1953

Total Maternal Deaths

128

Toxemia (642, 685-686) (a) Toxemias of pregnancy(642) (b) Puerperal toxemias(685-686)

44
36 8

Hemorrhage(643,644,670-672)

29

(a) Hemorrhage of pre~nancy

5

(643, 64 )

(b) Hemorrhage of childbirth and

puerperium(670-672)

24

Abortion, all causes (650-652)

11

{j)

I-' V1

Infection during childbirth and

-puerperium (680-684)

7

Other accidents and specified con-

---aftions of childbirth(673-678,687) 12

Other complications arising during

pregnancy (640,641,646-649)

7

Ectopic pregnancy (654)

12

I
: Other and unspecified conditions

I

of childbirth and the

puerperium (660, 688 )

6

I

-~-

Source: Georgia Department of Publ~c Health

Central Statistical Unit

116 42
36 6 22 4
18 14
14 11
6 5
2

36 14
10 4
10 0
10 1
~
4
2 1
0

39 12
8 4 6 1
5 6 6 6
-2
1

92 29
25 4 19 5
14 10
5 8
5 11
5

77 30
28 2 16 3
13 8
8
i
5
6 3
1

MATERNAL DEATHS: PERCENTAGE DISTRIBUTION

-~-

~-

BY SPECIFIED CAUSE AND RACE, GEORGIA, 1952 AND 1953

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

TOTALS

WHITE

---
NON-WHITE

Cause of Death (International ~~~e Number 2 Sixth Revision)

1952

I
1953

1952 1953

1952

1953

Total per cent all causes

100.0 100.0

100.0 100.0

100.0

100.0

Toxemia (642, 685-686)

34.3

(a) Toxemias of pregnancy (642)

28.1

(b) Puerperal toxemias (685-686) Hemorrhage (643,644,670-672)

II

6.2 32.7

(a) Hemorrhage of pregnancy(643,644),

3.9

(b) Hemorrhage of childbirth and

36.2 31.0 5.2
19.0 3.4

41.7 30.6 11.1
27.8
---

30.8 20.5 10.3
15.4 2.6

31.5 27.2
4.3 20.6
5.4

39.0 36.4 2.6
20.8
3-9

puerperium (670-672) ~bortion, all causes (650-652)
Infection during childbirth and

18.8

15-5

8.6

12.1

27.8

12.8

15.2

16.9

2.8

15.4

10.9

10.4

puerperium (680-684)

5.5

ether accidents and specified condi-

12.1

5.6

15.4

s.4

10.4

tions of childbirth (673-678, 687)

9.4

9-5

ether complications arising during

11.1

15.4

8.7

6.5

Q

pregnancy (64o, 641, 646-649)

55

5-2

5.6

0

s.4

7.8

f-' 0\

Ectopic pregnancy (654)

9.4

4.3

2.8

5.1

12.0-

3.9

ether and unspecified c~nditions of ,

childbirth and the puerperium(66o,68~) 4.7

1.7

2.8

2.6

5.4

1.3

I

Source: Georgia Department of Public Health - Central Statistical Unit

INFANT DEATHS, NUMBER AND RATE* BY R.ACE, GEORGIA
1952 AND 1953

Total

1952

Number

Rate

315S

32.5

Number 3051

White

1567

25.5

1469

Non-White

1591

44.6

1582

----
*Rates per 1,000 live births

Source: Georgia Department of Public Health

Central Statistical Unit

1953 Rate 31.3
23.8 44.3

'

FIVE LEADING CAUSES OF DEATH FOR SPECIFIED AGES, BY RACE, WITH NUMBERS OF DEATHS BY CAUSES GEORGIA, 1953

!

_ ___lLn.der_l Year

IRANK

White

Post-natal

I 1 Asphyxia

I

and

I
I

Atelectasis

I

I

I

I I
I i

I 264

1----

I

Immaturity

I

Non-White Immaturity
355 Influenza and pneumonia ineluding pneu-

I2

mania of newborn

254

296

Under ;J8 DavA

White

Non-White

Post-natal

Asphyxia -Immaturity

and

I

Atelectasis

~ - 11 Months

White

Non-White

nfluenza Influenza

~nd pneu- and pneu-

tnonia.

monia.

263

336

.:.._!!
- .. 101

228

Immaturity

Post-natal ~ongenital asphyxia and malformaAtelectasis tions

Congenital malformations

1 - 5 Years White Non-White

Accidents excluding motorvehicle

Pneumonia and
Influenza

49
Pneumonia and
Influenza

69
Accidents excluding motorvehicles

249

126

89

4o

33

49

Congenital Gastro-enter-

Other and ill- Gastro-

Gastro-

malforma- itis, colitis, Birth

defined

~uteritis, ~uteritis,

Motor-

Motor-

Q

tjons

1-'

-..J

3

and diarrhea of newborn

injuries

diseases

colitis and olitis and vehicle

vehicle

peculiar to iiarrhea of iarrhea of accidents accidents

early iJ?.fancy newborn

newborn

242

141

179

78

44

110

33

22

I
Malignant

I

B:irth

Post-natal

Congenital Influenza and Accidents Accidents neoplasms Gastritis

I

Injuries

Asphyxia and malforma- pneumonia

excluding excluding including duoden-

4
-
180

Atelectasis I I
128

tions

I I

l r: _...,

I

' ) .}

including pneumonia of newborn
68

motorvehicles
41

motorvehicles
~)~)

neoplasms o itis

lymphatic enteritis

and haema- and colitis topoietic tissues

33

17

Influenza and pneu-

Birth

i Other and Ill-defined Ill-defined Ill-defined Congenital Ill-
I
! ill-defined and unknown and unknown and unknoWJ~ malforma- defined

5 mania includ injuries
I ing pneuma
nja of new-

! diseases causes
: peculiar to ' early in-

causes

causes

tions

and unknown causes

born

fancy

148

115

97

52

22

50

SOUR.C. E:---- -Georgia Department of Public Health

Central Statistical Unit

25

14

FIVE LEADING CAUSES OF INFANT DEATHS, BY AGE, BY RACE, GEORGIA, 1953

~--

I

-

I

I Cause of Death
(International List

Under One Year

I

NUMBER

j

Under 28 Davs

I 28 Days- 11 Months

I
II

Number -Sixth Rev.) Total White

Non-White Total

White

Non-White

Total

White

I

Non-White/ r

I Total, All Causes

3,051 1,469 1,582

2,005 i 1,083

922

l

'l.Immaturity (774-776) 609 254

355

585 I 249

336

1,046 386

24

5

660 I 19

2.Inf1uenza and

pneumonia including

pneumonia of newborn

(480-483,490-493,763) 444 148

296

115

47

68

329 101

228

3.Post-natal asphyxia

and atelectasis(762) 392 264

128

389

263

126

3

1

2

4.Congenital ma1forma-

tions (750-759)

327 242

85

198 153

45

129 89

40

5.Birth injuries (760-761)

295 180

115

290

179

111

5

1

4

PER CENT OF TOTAL

Total, All Causes

100.0 100.0 100.0

l..Immaturity (774-776) 20.0

2.Influenza and pneu-

monia including pneu-

monia of newborn

(480-483,490-493,763) 14.6

3.Post-natal asphyxia

and atelectasis(762) 12.8

4.Congenital malforma-

tiona (750-759)

10.7

5.Birth injuries

(760-761)

9.7
!

17.3
10.1 18.0 16.5 12.3

22.4
18.7 8.1 5.4 7-3

Source: Georgia Department of Public Health Central Statistical Unit

100.0 100.0 29.2 23.0

57 19.4
99 14.5

4.3 24.3 14.1 16.5

100.0 36.4
7.4 13.7
4.9 12.0

100.0 100.0 2.3 1.3

100.0 2.9

31.5 26.2

0.3

0.3

12.3 23.1

0.5

0.3

;

I

34.5 0.3 6.1 0.6

NUMBER AND PERCENTAGE DISTRIBUTION OF DEATHS IN 1-5 YEAR AGE GROUP FOR SIX LEADING CAUSES OF DEATH BY RACE, GEORGIA, 1953

I

Cause of Death (International

~r

Code Number, Sixth Revision)

j _____ --~~b~-~-T Non- __-l_!~X:~_en~- Dist:_~~~:~

~White I I iT-otal --W-h-i-t-e- tl_W_h_it_e_ l _T_o_ta_l_ -W--h-i-t-e- ----- -

I
__To__ta_l_,_a_l_l_ca_u_s_e_s_______ l 602 _ 313

289

I
1100. 0

100.0 ~-~~-~. 0

1. Pneumonia and Influenza (480-483, 490-493)

I 102

2. Accidents excluding motor- I

vehicle (E800-E802, E84o- 1

I E962)

98

(a) Accidental b~ns (E916- 1

E917)

I 42

(b) Accidental drowning and I

submersion (E929)

11

(c) Inhalation and ingestion

of food causing obstruc

tion and suffocation

I (d)

(E921) Accidental

suffocation

i~

3

bed (E924)

2

I 33 I 69 16.9
1

16.3

25

7

4

1.8

10.5 23.9
15.7 17.0 2.2 1.4

3 2

1.0

0

0.3

0

0.7

3. Motor-vehicle accidents (E810-E835)

55

33

22

9.1 10.5 7.6

4. Malignant neoplasms, includir1g

neoplasms of lymphatic and haematopoietic tissues

(140-205)

42

33

9

s. Congenital malformations

('750-759)

37

25

12

6. Gastritis, duodenitis, enter-

itis, and coli tis (543, 571,1

572)

27

10

17

All other causes

I 241 130 111
' ------- ----'--

Source: Georgia Department of Public Health Central Statistical Unit

7.0 10.5 3.1 6.1 8.0 4.2
3.2, 5.9
40.0 --~-~~_t 38 .4

Gl9

Division of Mental Hygiene

DIVISION OF MENTAL HYGIENE
ANNUAL REPORT --- 1953
During 1953 the l1ental Hygiene Division continued in general the programs that were being carried out in 1952. A shortage of funds
caused by the cut in grant-in-aid funds by the Congress prevented any great expansion of the program.
The staff of the Division consisted of an Acting Director, a l1ental Hygiene Consultant Nurse, a Regional l\1ental Health Consultant, a Consultant Psychiatrist (part-time), and two Psychologists (one returned from training in April).
The project, in cooperation with Hilledgeville State Hospital, to extend public health nmsing services to families of the mentally' ill was begun in January in six counties (Dodge, Toombs, Tattnall, Johnson, Jones, and Hilkinson). Started as a pilot project, this program has been so satisfactory that plans to extend it to two of the larger counties (Huscogee and DeKalb) have been made. It is anticipated that sometime in the not too distant future this will be made a part of the regular public health nurses' job in all counties that have one or more public health nurses.
The in-service training program for mental health workers has been continued through a number of staff conferences. The Clinic Directors have also met with the State staff several times to work on criteria for determining priorities for services in mental health programs. It is anticipated that these criteria will be
published sometime in 1954.
The third annual health officers' conference was held in Rome.
Some preliminary planning has been done regarding a program to improve maternal care and prevent maternal deprivation for infants and pro-school children with the cooperation of the Governor's Committee on Children and Youth.
The special grant to tho School of Education at the University of Georgia for a mental health worker has been continued.
The addition of specialized staff in Whitfield and Cobb Counties has boon promoted and requests hGvo been received for Psychologists or Social 1.Jorkers from Albany, Brunswick, and Valdosta. At the end of the year, local programs (child guidance clinics, mental hygiene clinics, or mental health worlwrs) woro operating at Atlanta, Columbus, Dalton, Decatur, Griffin, Hacon, l111rietta, and Savanm1.h.

These programs rendered service to 772 different individuals during the year. This service can be broadly classified as follows:

Interviews with patients by Psychiatrist

189

Interviews about patients by Psychiatrist

136

Interviews with patients by Psychologist

1,272

Interviews about patients by Psychologist

1,112

Intervie1..rs with patients by Psychiatric Nurse or Social Worker

1,816

Interviews about patients by Psychiatric Nurse or Social Worker

1,431

The Division has continued to make available a number of mental health pamphlets and films on request. The distribution of "Pierre the Pelican" to parents of first born children has been continued as has the distribution of the "Psychiatric Bulletin" to certain general practitioners.

H2

Division of School Health

Division of School Health
MILDRED SCOTT. M. TI., DIRECTOR

1953 ANNUAL REPORT
Division of School Health
School health is that part of public health designed to function in a cooperative program, state-~~de, to promote health and development of children (aged six to twenty-one years).
The policy of joint responsibility shared by the State Department of Education necessitates close 11workingship 11 with the various services and divisions of Education for joint planning and execution of the total program. Also, there is close inter-relations of work vrith the various divisions and services within the Department of Public Health which are concerned with schools and health of school-aged children.
Because of the complexities of school health and widespread interest in children, the program of the Division af School Health is strengthened by the cooperative work of other official agencies and non-official agencies, including the State and local Parent-Teacher Association, and civic groups such as the Lions Club, who sponsor a vision program.
Not overlooking the fact that the primary responsibility of health of a child rests upon the parent, the State Departments of Public Health and Education also hold responsibilities for the health of children. The State Department of Education assumes some responsibilities of health, development and knowledge to the child when he is in school. Public Health is interested in school-aged children as an important part of the community, numbering approximately one-fourth of the total population; the early age is an important period to mold health, both physical and mental, promote growth and development, prevent sickness, and determine corrections when defects are pre sent. Children represent all of the future population; what the child of today is physically, what he thinks mentally, how he reacts emotionally, determine the future caliber of the community and the nation.

PRESENT PROGRAM CONTENT
What - vl!here - How
I. Administration
There is joint responsibility by both Departments of Public Health and Education for the school health program. At a State level the administrative program is gaining strength. Joint responsibility carries through to the county level.
II~ Provision for Health Care
A. Public Health activities to schools -- services for school-aged children
l. Planned scheduled visiting to schools with joint participation by Education personnel
a. Public health nurse program to schools b. Sanitarian c. Other public health personnel
2. Health services (medical)
a. Health appraisal
(l) Physical examinations (a) by private physician. The policy of private physician examinations is becoming more general--
in one area has been as high as 80-95% on the
first request. (b) by private physicians working in school health
clinics and in cooperation with local health department.
( 2) Screening (a) Physical examination - rapid observation of the physical condition of the child. (b) Vision screening program (See Vision Conservation Program) (c) Hearing screening program (See Hearing Conservation Program) (d) Nutrition and hemoglobin Nutrition screening program varies widely with individual schools and health departments. For the most part, these have been specialized or spot activities or selective surveys. (e) Hookvvorm Selected groups of lew hemoglobin and poor nutrition in the hookworm area.
(3) Pre-school examination or entrance examination should include the health of the whole child and not merely the physical aspects or physical status
I2

at any particular time. The goal is to make this an accumulative summation of continuous previous records of the pre-school child regarding his physical and emotional health and supervision. (a) The physical examination is recommended to be
done by a private physician and, whenever available, by a pediatrician. (b) Includes checking of immunizations and boosters. (c) Includes dental examination.
b. Records
Continuing records of health to be used by public heal tih personnel and school personnel as indicated. This record includes:
(1) Health his tory (2) Health appraisal (3) All pertinent information pertaining to the physical
and mental health, growth and development.
c. Evaluations of program procedures
(1) Availability of services (M.D. and other professions) according to recommended standards.
(2) The volume of participation: (a) By the child and the parent. (b) Interest and cooperation by the private physician, dentist and other professional persons in the school health program. (c) Community interest and participation.
(3) Evaluation of quality of the program is very limited.
3. Special programs for handicapped children
a. Support programs for the handicapped and services to individual children.
b. Provide consultation to the teacher about the recommendations and procedures for handicapped children, including individual cases.
c. Encourage the teacher and furnish information to help her to provide for handicapped children within the regular classroom.
d. Support and cooperate with programs for special. classes for handicapped children as provided by the State Department of Education.
B. Health Education
1. Supply information and consultation on general health to teachers, such as: a. Nutrition; b. classes in home-making; c. classes in child care; d. other.
I3

2, ?ublic health education Develop an awareness and appreciation of health for the individual and the communit,y.
III. Health Services (Health Protection) A. Recommended procedures for the promotion of normal growth and development. B. Communicable disease control. C. Preventive measures for other diseases and defects. D. Support of other approved programs within a school health program: l. Integration of other programs of public health into the planned school health program. 2, Mental and emotional health. 3. Efforts to develop an awareness and appreciation of health (educational program).
4. Safety and accident control. 5. First aid.
6. Correlation of physical education and health protection. 7. Civil defense 8. Community program of public health -- child-citizen
participation. 9. Dental health. 10. Others. E, Health program for school personnel As an organized program, this is very limited and varies completely with the recommendations and policies of the local area.
IV. Program for Correction of Defects A. Follow-up pro gram 1. School health as a part of the generalized public health program.
2. Cooperation and correlation of teacher activities with those of the public health nurse.
I4

3. The health department as liaison between private physician,
clinic care, home, school and community. B. ?rogram of professional services for carr ection of defects
The strength of this program varies with the locality and its local resources. 1. Private physician 2. Specialized services, including Crippled Children and
Rehabilitati on
3. Clinics
c. Evaluation of accomplishments
1. Number of corrections obtained
2. Number of corrections not obtained
3. Number of defects occurring in young age groups
4. Facilities and professional care not available 5. Quality evaluation of programs is very limited
V. Healthful School Environment Env:ir onmental Health
A. Sanitation
1. Food and Lunch Room All lunch rooms in school cafeterias are provided guidance and periodic checks and approval through the Department of Public Health.
2. Water supply
3. Sewage disposal
a. School toilet facilities
4. School he al th rooms
B. Physical Environment 1. Construction and new building program a. Sit~ selection b. Assistance v'lith plans and specifications c. Participation on revievving committee
I5

d. Approval for construction on school buildings e. Field review of plans with field engineers and
contractors f. ?rovision of consultant services on sanitation g. Inspection of construction
C. Emotional Environment
1. Mental health program within the school health program
2. Teacher's responsibility in emotional environmental health pro gram
VI. Community Participation
A. Local professional
1. Fhysicians
a. Representation in school health council b. Private physician participation or services in
clinics in the health appraisal, school health program c. Representative from medical society and is a member of the local board of health
2. Specialists, including dentists, psychologists and others (limited, such services are available in only a few areas)
B. Civic groups
C. Local departments of official and voluntary agencies
D. Community leaders
E. Local lay organizations
VII. Evaluation of Total School Health Program
A. Development and expansion of local school health programs
1. Development and adherence to a written guide for the local area.
B. Measurement of specified activities (physical examinations, special screening, nutritional habits, and others)
C. Reporting of activities accomplished in the local area to the Division of School Health.
D. EvaluRtion for quality of programs is very limited
I6

VIII. SpeciRl Projects
A. Existing projects
1. Special School Health froject 2. Hearing Conservation Clinic - Junior League School for
Speech Correction
3. Survey of Handicapped Children (birth to 21 years) -
Clarke-Oconee Counties (done by Society of Crippled Children, Society for Mentally Retarded Children and Dep3Ttment of Public Health)
4. Tuberculin testing
a. The Division of Tuberculosis Control conducted studies approximately 20 years ago in a selected
coun t.Y, tuberculin testing the school population,
county-wide. Recently a comparaple county was selected for a similar general survey for the purpose of determining the changes that have occurred in the last 20 years, as revealed by tuberculin testing.
b. Follcwing the discovery of an open, active case of tuberculosis in a school teacher, tuberculin testing was done with follow-up to determine the number of active cases that developed from contact in ordinary school life. (Refer T. B. Division)
5. A conference on school health programming by city-county
unit:
An intensive one-week conference was conducted on school health programming and problems by health and education administrators for 900 school teachers and public health nurses from the local health department. Evaluation of this work will be reported. The first immediate evaluation was done thirty days later with the idea of having the final evaluation at the end of one year.
6. Beta-Hemolytic Streptococcal Infection Study, DeKalb County.
IX. State Planning
A. Joint Committee of Health and Education
Early in the spring, there was reorganization of the Joint Committee of Health and Education. The Committee meets regularly once a month. Its objectives are:
1. To serve as an advisory group to the directors of its component agencies (Department of Education, Department of Health, the University System--represented by the College of Education at Jthens) in the area of health education -- i.e., health experiences, health services, environment, and health instruction.
I7

2. To foster cooperation among the component agencies, and encourage coordination of their separate programs. Duplication of activity may be reduced thereby.
3. To seek to identify and stimulate the utilization of
both the human and material resources of other agencies working in the area of health education as defined above. Also, to encourage cooperation among and coordination of these agencies' health education programs.
4. To create an awareness of health education needs among
state, regional and local groups. To stimulate development of programs for meeting these needs.
B. University of Georgia
Numerous conferences have bee!1 held with personnel of the
Universi t.Y of Georgia, and to a lesser extent with personne 1
from other schools. A closer working relationship is developing between the departments of health and education at the University and the Division of School Health.
c. Conferences
1. Health Department - Numerous conferences have been held with other divisions: Maternal and Child Health, Mental Hygiene, Sanitary Engineering, Nursing and others.
2. Education Department - A closer unity and working relationship with personnel of the Education Department has already become evident. Much of this is the result of various conferences between the Director of the Division of School Health and directors of divisions in the Education Department.
3. National Conference on Physicians and Schools - The
Director of the Division of School Health attended the National Conference on Physicians and Schools at Highland Park, Illinois. Emphasis was given to the section on Mental Health. A report was made available to personnel concerned with school health.
4. University of Georgia - Numerous conferences have been
held with personnel of the University of Georgia, and to a lesser extent with pers onne1 from other schools.
X. Vision and Hearing Conservation Programs
A. Vision
In the conservation of VlSlon program an effort was made to reach the schools in counties which do not have the local facilities necessary for screening children. The Division of School Health participated in vision screening surveys in
I8

forty-eight, or approximately one-third, of the 159 counties in
the state.
Six counties in Georgia have the local facilities necessary for carrying on effective vision screening pro grams. Therefore,
screening surveys were corducted in a total of 54 counties, or 34 per cent of the total counties in the state, during the 1953-54
school year.
In 47 of these counties, 78,436 childrenwere screened. This is
9.2 per cent of the total school population of approximately
850,000 children. Of those screened, 10,009 or 12.8 per cent
were referred for eye examinations by eye specialists.
The vision testing instructors trained approximately 500 lay workers, health department and school personnel to screen the children, using the Massachusetts vision test, the Snellen test, and the Snellen test including Plus-Lens. The follow-up of referrals has been done almost completely by public health nurses. without their cooperation and tireless efforts in this phase of the program it could not have been a success.
The Division of School Health is encouraging the annual screening of all children by the classroom teachers; using the Snellen test. This not only gives the teacher information regarding the most effective pathway to the child's mind but also is an excellent opportunity for bringing eye-health education into the classrooms. It is recommended that the re-test be done by the public health nurse, employing the Snellen test with Plus-Lens or the Massachusetts vision test.
B. Hearing
The hearing testing instructors participated in the scr\3ening
of children for hearing impairments in 34 counties or one-fifth
of the counties in the state. The instructors trained approximately 350 lay people, health department and school personnel in the techniques involved in mass screening of children with the pure -tone audi orne ter. TvV"en ty-six counties new own audiometers, which is a step forward in strengthening the program.
Five counties in Georgia have the local facilities necessary for carrying on effective screening programs. This gives a
total of 39 counties or one-fc>llrth of those in the state in
which hearing testing surveys were conducted.
In 35 of these counties, 54,305 children were screened. This is 6.4 per cent of the total school population. Of these, 3,311 or 6.1 per cent of the number screened were referred for
medical attention, preferably by an otologist.
More emphasis is being placed on the importance of health education in the prevention of hearing impairments, early detection of irrpairments, and the necessity for more effective
I9

means of follow-up of referrals. In an effort to reach more children as early as possible in screening for hearing difficulties, consultant nurses and supervising nurses are being encouraged to instruct public health nurses and lay people throughout their respective counties in the techniques of hearing screening with the pure-tone audiometer.
XI. Special Activities Survey by Mr, J. M. Goeden, Coordinator of Health and Education:
The follcwing inforw.ation cones from the reports of the 432 Georgia
high schools to the State Accrediting Agencies for the school year,
1953-54. The reports show that 39 per cent of the schools are teaching classes in health; 17 per cent have classes in Family Living; 3 per
cent have classes in Human Biology; 75 per cent list classes in
Physical Education.
All schools are doing some teaching in health. Those that do not list classes in health are teaching it in other related areas. There is need for both types in all schools to include all students,
Also, all schools should teach classes in physical education and all students should be included. Classes in health and physical education should be taught by teachers well traired in these areas. In elementary schools health and physical education should be a definite r:art of the school program, Teachers should be trained in these areas comparable to their training in other major areas of the curriculum,
XII .Accomplishments and New Activities
A. A new manual, ttinstructions- The Snellen Testtt, was prepared to be used in connection with Snellen vision testing,
B, Broadening of the vision and hearing programs,
c. Work has been done toward preparing over-all school health guides.
D. Consideration of the development of a field training center in school health.
I lt

HEALTH NEEDS

I. Nutrition
A. i~ state-wide problem among children of school age is inadequate nutrition and poor eating habits. The problem is general and state-wide, varying in degree with the geographic area and with the individual school and its facilities. Studies and spot surveys indicate that eating h3bits of children become poor instead of better with age.
B. Hookworm infestation
Hookworm infestation is limited to the southern part of the State, and presents problems corresponding to the degree of inadequate nutrition and lew hemoglobin.

II. Correctable Defects
A. Physical defects
l. On entrance to school (six years of age), children average
between one to two defects per child, which can be corrected and which could have been prevented. .~lso, the number of defects does not seem to decrease during the school life. Tho Division of MCH plans to offer more attention to the pre-school child (l-5 years).
Special Project Survey

Grade Total

Number 2,478

.Average No. of Defects per Child Examined
1.08

l

548

0.90

2

469

1.04

3

423

1.21

4

370

5

242

1.19 1.13

6

232

1.15

7

173

1.12

Other &

19

Unknown

1.46

2. More elaborate tabulations will be available within a short time, giving number of defects per age distribution.
I ll

B. Correction program for defects
1. Correlation of all services available to school age children within the planned program of school health.
C. There is an overwhelming lack of provision to care for the exceptional child.
D. Emotional health
1. Many teachers have not been adequately prepared to understand the emotional health of the normal child or to cope with the everyday problems of school children.
2. There are only limited facilities for psychological examinations and evaluation of children needing such.
3. There are only limited and, in most areas, no facilities
for children with emotional disturbances or overwhelming problems.
4. There are only very limited programs (special projects)
for mental health in the classroom.
III. Epidemiological Studies
A. Provision for epidemiological studies within the school health program does not exist. The availability of such services from the Divisions of Epidemiology and Tuberculosis Control and others is very limited and has existed only on special occasions for emergency need.
1. Tuberculin studies
It is believed that the school population is a fertile field for directing case finding to the home and tuberculosis control, but lack of personnel and funds for conducting such studies has sharply curtailed activities in tuberculosis control. The lack of personnel in local health departments prevents the carrying on of these studies within the planned school health program. There is reason to believe that such programs should be developed.
2. Venereal disease
Recent epidemiological studies conducted by the Division of Venereal Disease Control demonstrate the need for a more adequate program of venereal disease control within the school health program.
Education and knowledge of venereal disease control as a part of health information is needed within the planned school health program.
The policy of blood-testing Negro children entering school has proved to be of excellent benefits and should be continued.
I 12

IV. Educational fersonnel- Health Program A. There is very limited and, in most areas, no program concerned with health of the teacher and other personnel of the school. l. In only a few areas are physical examinations required. 2. Most areas have given no consideration to the emotional health of the teacher, and there are very few, if any, planned programs for such.
V. Teacher Education in Health More adequate information on health to college students preparing to be teachers is needed. Also, facilities for in-service training and possibilities of additional training in health are very limited.
VI. Training in School Health for Fubl ic Health Personnel There are no provisions for training of our public health personnel in school health, other than occasional observation which may be selected for the particular new employee. We need a planned program of training in school health for the health officer, nurse, sanitarian, nutritionist (regional), psychologist (regional), social worker (regional), health educator, as well, as personnel of Education,
VII. School Health as a Part of an Organized Community Health Program Expansion of planned programs of school health as a part of the community-wide health program is needed.
I 13

ADMINISTRATIVE PROBLEMS
I. The joint responsibility between the two departments of Public Health and Education is working nicely. Hcwever, many details need to be solved by closer working relationships. For example, the policy of joint responsibility and approval as is now being done in the building program for the construction of new schools could benefit other programs within the school health program.
II. Geographic
Administrative division of the state
The administrative areas of the Department of Education, the Crippled Children's Division of the Health Department, Vocational Rehabilitation, the Department of Welfare and the local health departments do not coincide, which sometimes causes awkward situations.
III. Legal and Professional
A. As long as schools receive their appropriations based on average daily attendance, health programs of school children will be jeopardized both locally and state-wide.
B. Redistricting of health units in the new state plan will put Pike, Lamar and Spalding Counties under different public health administration. As a result, the long term follow-up of the Special School Health Project will be influenced at least statistically.
C. State policies pertaining to school health var,y widely in the local areas and individual schools because of the policy of local county autonomy and individuality of school administration. However, the primary goals of health for children are the same and the difference3 are variations only in the local facilities, and policies in which they are utilized.
D. Professional (M.D.'s and other) cooperation and participation in school health would be enhanced by better understanding of a school health pro gram. This can be provided by in-service training; such as, in a standardized field training center, by institutes, workshops, and through the planned curriculum in the initial professional training.
IV. Inadequacy of Facilities and Funds
This is a new division, starting with a limited number of personnel and funds. Our greatest need for the present and for the next few years is for personnel and funds to permit them to function.
I 14

FUTURE PLANNING
I. Development of uniformity, state-wide, in planned program of school health, for State, county, and the individual school.
II. Demonstration area for the development and expansion of the school health program
A. Selected county or ceunties presenting unusual amount of interest in school health, having an organized and staffed health department and cooperative personnel from Education, will be used to measure the development and expansion of a school health program and the selection of policies and procedures which will be more practical and efficient.
At the county level, a demonstration area will be used to show the necessity for an organized and planned program of school health, demonstrating the development and expansion of the school health program within that area. Results from this example will be evaluated and used for developing and expanding school health programs in other parts of the State, and eventually state-wide.
III. Future plaguing for expansion of present program
A. Expansion of consultative services to regional and local public health personnel doing school health, and to the educational area and county personnel, for the purpose of developing a stronger school health program, minimum standards of activities, and uniformity of local areas toward a state-wide program.
This has been started during the past year by:
l. Giving emphasis to regional personnel who serve as consultants to county personnel.
2. Fulfilling as far as possible requests for consultation to the local areas.
3. Organized planning of scheduled visiting of public health
personnel to schools.
~. Encourage local areas to maintain programs with private physician participation.
C; Strengthen cooperation and understanding between medical society and school programs, at state and county levels:
1. School Health ~ommittee within the State Medical Society to serve as liaison between State and Division ef School Health, for such purposes as approving activities and policies of school health work, and ly making recommendations of the council to the Division of School Health.
2. At county level, the local health department is expected to cooperate with private physicians, to obtain approval of local
I 1)

medical society for all policies and medical activities of the school health program. It is recommended that one or mere of the medical society ce appointed as a school health council representing the medical society to consult with the health cfficer.
D. Encourage the use, state-wide, of the school health records which were revised and approved, state-wide, by health department and education department personnel.
IV. Epidemiological Studies
As availability for such services is made possible or as the services are expanded, the School Health program will cooperate with the Division of Epidemiology, Tuberculosis Control and others to include such in the Schcol Health program.
V. Evaluating and DefiniEg the Problem
A. Methods
1. Cooperating with the Division of Vital Statistics, the Adrr1inistrative Assistant to Health Conservation Services, and with public health and education personnel in certain selected local areas, plans are being developed for determining useful and practical measuring sticks in considering school health programs and activities within the school health program.
2. Building program
A joint evaluation of school sanitation by personnel from the State Departments of Public Health and Education is being developed at the present time. It is anticipated that this program can be implemented by a pilot study or demonstrations in local areas, beginning next Fall about the time of the opening of school. One of the purposes is to develop standard measures for evaluation of sanitation and for obtaining uniformity of methods in this program.
B. Evaluating and defining accomplishments accordingly
From the above data and recommendations, methods for defining accomplishments and practicability of activities can be determined and subsequently developed into uniformity of the school health program throughout the State.
VI. Development of a Field Training Center in School Health
A. The State Department of Education and the University System have agreed to cooperate with the State Department of Public Health in the development of a field training center.
I 16

B. Health needs in Georgia that such a program can help to meet:
l. The improved training and experience for education personnel.
2. Training and experience for public health personnel.
3. Improved cooperation between the local health departments
and the public schools.
~. Increased understanding of the need for total cooperation of Educatio~ and Health and of the lay group.
5. A demonstration center in which persons in training may
obtain experience and may observe an excellent program in action.
6. A place for students in teacher education tc serve intern-
ships and to observe.
7. A demonstration center for improved methods in teaching
children and adults about health.
8. An opportunity for developing curriculum instruction and
experiences for children, teachers and parents.
9. A demonstration for a well-planned physical and emotional
environment.
10. To serve as a demonstration in record-keeping and record developing.

VII.

Building Program
Georgia is in the midst of an extensive program of school construction. (Refer to Sanitation and Building Construction activities. Also, references to this could be found under the reports of the State Department of Education). In those area& having new buildings, guide the school health program in keeping with new facilities and new problems.

VIII.

Work more closely with Department of EducatL.m which has a division for providing facilities for the exceptional child .

...

IX.

Continue joint planning among State Departrrnts of ~ealth,

Education and Welfare for providing psychological examinations

to children of school age.

X.

Health of School Personnel - It i~ hoped that a program for the

health of school personnel with minimum standards and uniform

activities can be developed as rapidly as possible.

MES:jm:w
6-24-54

I 17

.~
'\ .
.,
LABORATORY SERVICES
I
ii .
:I,
,j .. .

. ..

. '.

The functions of the Division of Laboratory Services are r-ultiple, but of prime importance, is the assistance rendered to physicians and local health departments in the diagnosis of infectious diseases by the application of scientifically approved techniques to various types of specimens collected from patients or suspected carriers. Complete records of all examinations are maintained, from which data is compiled and made available to other divisions of the department and to ether health agencies. This information is very useful in epidemiologic investigations and control of communicable diseases.

Since reliable laboratory examinations are dependent upon the proper collection and transmission of specimens, suitable outfits are prepared and furnished for this purpose. This division also prepares and distributes antirabic treatment, typhoia vaccine and silver nitrate ampules. A variety of biologics, antibiotics and drugs used in the treatment and prevention of communicable 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 premarital and prenatal laws.

The Division of Laboratory Services is composed of the Central Laboratory in Atlanta, branches in Albany, Hacon and Faycross, and the laboratory of the Battey Hospital in Rome. The branch laboratories render the same complete service, with very few exceptions, as does the Central Laboratory. The work of the Battey laboratory is limited to the requirements of the medical staff for the treatment of the patients in the institution.

This division is connected through its services directly or indirectly
with the activities of all other divisions of the department. As their
programs expand or recede, the floiv of specimens into the laboratories
fluctuate. As a result of the curtailment in the programs of some of the
divisions, the small decline in laboratory examinations in 1952, occurring for the first time since 1945, became much more pronounced. A total of 1,112,397 examinations was made and represents a decrease of 18.6 percent
from the previous year. This loss resulted almost entirely from the dis-
continuation of the multiphase testing program on July 1. The closing of
the Alto Medical Center and its laboratory on September 30, 1952 also con-
tributed to the decrease shown in this report.

Table 1 shows the volume of work done in the several laboratories
compared to the examinations made in 1952, and Table 2 gives the number
of examinations by units and types in each of the laboratories.

TABLE l. S?ECHTEN LO,,,D BY LABORJ\TORI:rES

Central Albany Hac on 1Jaycross
Alto l'Iedical Center Battey State Hospital TOTAL

1953 629,771 141,217 147,384 106,175
(Closed)
87,850 1,112,397

1952
845,242 143,336
145,573 104,531 38,718
90,013 1,367,413

Incr. or Deer.
-215471 -25.5% 2119 - 1.5%
+ 1811 + 1.2% + 1644 + 1.6% - 38718
2163 - 2.4% -255016 -18.6?6

Jl -

lVIicroscopy Unit
Tuberculosis Diphtheria
Gonorrhea-i~icroscopic
}~ala ria Intestinal PErasites Rabies Hiscellan3ous TOT.nL l"Urt UN::iT
Culture Unit
Agglutinatior, series Blood Cultures Feces-Urine Cultures Culture Identification Gonorrhea-culture Miscellaneous TOTAL FOR UNIT
Serology Unit.
Syphilis-Blood Spinal Fluid
Rh Factor Blood Group Heterophile Antibody TOTAL FOR UN2T

Table 2, EXAJVIINATIONS BY L.nBORATORIES, UNITS, AND TYPES

Central
45,840 1,937 6,596
519 22,319
934 589 78,734

Albany
6,080 601
2,885 843
25,769 222 258
36,658

Macon
9,249 1,309 6,155
225 15,503
73 1,365 33,879

l'Jaycross
6,345 339
1,570 219
21,787 63 243
30,566

3,888 1,580 6,163
650
893 13,174

2,321 1,176 8,828
3,346 15,671

1,613 695
2,613
4 2,321
200
7,446

1,183 689
7,394
1,468 10,734

320,765 529
53,034 53,048 4,059
431,435

56,153 135
9,492 9,500
75,280

71,461 74
13,436 13,436
98,407

42,469 130
8,593 8,598
59,790

Battey
55,260 36 9
1,610 873
57' 788
151 39 314
2 830 1,336
2,605 10 603 603
3,821

Total
122,774 4,186 17,242 1,815 86,988 1,292 3,328
237,625

9,156

4,179

25,312

0l
!--;)

656

2,321

6,737

48,361

493,453 878
85,158 85,185
4,059 668,733

Milk Unit
Plate Count Coliform Phosphatase Butterfat Cryoscope Refr-'1ctometer Miscellaneous TOTliL FOR UNIT
Blood Sugar lnit
Primary Secondary TOTAL FOR UNIT
Clinical Unit
Hematology Blood Chemistry Urine Spinal Fluid Body Fluids Miscellaneous TOTAL FOR UNIT
GRAND TOTAL

Table 2. EZAI"llNATIONS BY LABORATORIES, UNITS, AND TYPES

Central
5,864 2,175 1,728 5,952 1,990 7,250
147 25,106

Albany
3,215 1,954 1,916 3,257
580 2,686
13,608

Macon
2,247 556 529
2,054 331
1,744 191
7,652

Waycross
1,204 732 721
1,192 180
1,056
5,085

Battey

Total
12,530 5,417 4,894
12,455 3,081 12,736
338 51,451

77,685
3,637 81,322

629,771

141,217

147,384

106,175

77,685

3,637 81,322

C'\ '-:>

I

16,534 2,532 4,128 436 84 1,191 24,905
87,850

16,534 2,532 4,128 436 84 1,191 24,905
1,112,397

In the following chart, the growth of laboratory services over the last 20 years is illustrated. Five year ~)eriods are shown through 1943 and two year comparisons are given for the last ten year )eriod. For irrunediate comparison the previous year is inserted. The decline shown in 1945 is not realistic in depicting the normal expansion of services due to the unusual rise in 1943 which resulted from the serologic examinations on registrants during the war period.
LABORATCRY X.'-~IPJATIOHS

670,349

1,372,216 1,367,413

1,016,989
\
724,300

I 1,112,397
I
I

355,514

463,675

96,579

II

1933

1938

1943

1945

1947

1949

1951

1952

1953

For several Jrears the Central laboratory has been making syphilis serology and blood sugar tests on specimens of blood collected in co~munity wide surveys. This multiphase testing program reached its peak in 1952, and the sharp reduction in its field activities resulted in a drastic drop in the number of laboratory examinations. Blood sugar tests accounted for more than half of the loss shown, followed closely by the serologic tests for syphilis. Routine serology of syphilis, however, showed an increase as did the Rh and blood group tests. An increase of approximately ll percent occurred in the work of the microscopy unit, due chiefly to gains in tuberculosis and diphtheria examinations, and to a lesser extent, in intestinal parasite specimens. The culture unit showed small losses in all phases of its work except for identification of cultures sent by the branch and other laboratories in the state. The milk unit reflected a continued growing demand for its services.
BRANCH LABORATORIES
The combined work of the three branch laboratories showed but little change in the total number of examinations compared to the previous year. The increase in the --aeon and '. -aycross laboratories exceeded the loss in the Albany laboratory by 1336 examinations. Fluctuations in types of examinations were comparatively small in each of the laboratories. In the Albany laboratory moderate gains occurred in the milk, microscopy and culture units, but they were not sufficient to offset the larger loss in the serology unit. The ~iacon laboratory also showed small increases in the microscopic, culture and milk units, vihich exceeded the loss in serologic
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examinations, In the Faycross laboratory the decrease in the microscopic unit was less than the combined gains in the other units.
BATTEY tA3CRATO:tY
The Battey laboratory showed a slight loss in the total number of examinations, The decreases occurring in the microscopic and clinical units were greater than the gains in the culture and serology units, Of particular interest, however, was the increase in the culture unit, which was due to a full year's operation after a technician was assigned for miscellaneous bacteriology in the latter part of the previous year. Drug therapy is thought to be responsible for the drop shown in positive findings in cultures and animal inoculations for tuberculosis, The loss in the clinical unit resulted from the discontinuation of screening tests in hematology and urinalyses, Participation was continued in the INAH studies conducted by the Public Health Service.
THE rUCROSCOPY UNITS
The total of 237,625 examinations in the microscopy units shows a g3.in of 2,8 percent over the 231,120 made in the previous year, Increases of 11
percent in the Central laboratory and 5 percent in the Albany laboratory
barely offset the losses in the 1iJaycross and Battey laboratories, The increase is due primarily to the continued rise in examinations for tuberrulosis and to the higher incidence of diphtheria, The distribution of the specimen load in the other types of examinations remained essentially the same in the several laboratories,
TUBERCULOSIS
Continuing the trend of the past few years, examinations for tuberculosis showed a marked increase. Of particular interest are culture studies which show a gain of 42 percent with a drop of 38 percent in guinea pig inoculations. The increase in culture examinations is due to both the growing demand by physicians and the laboratory's substitution of culture for the more expensive guinea pig inoculation, as it has been found that these two methods give comparable results in a large percentage of the specimens. The great majority of the animal inoculations were made in the Battey laboratory,
The curtailment in the multiphase testing program resulted in approximately a 50 percent drop in the specimens received from this source, The survey specimens, however, constituted only a small percent of the specimen load so the curtailment of this program did not appreciably alter the total number of examinations, There were 1374 microscopic examinations and 533 cultures made on specimens from surveys conducted in 13 different counties in the first six months of the year,
DIPHTHERIA
The high incidence of diphtheria during the year was reflected in increases of 748 specimens and 149 positive findings. The cases were widely distributed throughout the state in 58 counties. The greater number of cases, however, occurred as in recent years, in the northern portion of the state where the gravis type is predominant. Among the surveys conducted, 12 positives were found in 158 specimens collected in Cherokee county, The laboratory participated in a limited throat culture and Schick testing program carried out in Hall county for the purpose of securing data on immunity and carrier rates in a population where the gravis
- J5-

type has continued high for several years.
1'10N0'1nHEA
The number of smears submitted for microscopic examination for gonococci remained at the level for the two previous years with but little deviation from approximately 6 percent in positive results for those years.
i:IALARIA
A total of 1815 blood smears were examined for malaria and ?lasmodium vivax was found in 10 instances from 8 Korean veterans. There was only one case of malaria reported as having been acquired within the state. The patient, a resident of Floyd county, was diagnosed by a local laboratory and the diagnosis was confirmed in our laboratory.
There was a very slight increase in the total number of examinations for intestinal helminths. Of special interest was the large increase in the cellophane tape slide examinations for pinworm and the higher percentage of positives which have been found since this outfit was placed in use in 1950. More extensive use was made of the PVA outfits which resulted in an increase in both the number of examinations for E. histolytica and in the percent of positive findings.
Unusual helminth findings included the blood fluke Schistosoma mansoni from a Latin American student. This is the second report of a trematode
infection in Georgia. Other helminths of interest were 3 Taenia, 3 H.
diminuta and 8 Strongyloides. In a survey conducted by the Division of Epidemiology to investigate amebiasis in Blakely, Early county, an infection with the intestinal protozoan Isosporo was found, the third reported in Georgia and the twenty-second for the entire country.
RABIES
There was a decrease both in the total number of microscopic examinations for rabies and in positive findings. Of the 1180 examinations made,
29 percent showed positive evidence of rabies as compared to 33.4 percent
in 1952. .1.s in the previous year approximately two-thirds of the positives occurred during the first six months of the year. llunicipal and federal laboratories diagnosed 9 additional cases out of 70 examinations, Nineteen other cases which were negative by microscopic examination were diagnosed by mouse inoculation. The total incidence of laboratory diagnosed rabies was
368 cases, occurring chiefly in dogs, foxes and cattle in 66 counties. l1ost
of the rabies in dogs occurred in Fulton and DeKalb counties and contiguous areas, while the incidence in foxes was higher in the southwestern part of the state.
lHSCELTAi\JEOUS
Although the Battey laboratory showed some increase, there was but little change in the total number of miscellaneous examinations. The waycross laboratory continues to have the highest incidence of conjunctivitis due to Koch-l.eek r s and l'Iorax-!\.xenfeld organisms, Two cases of conjunctivitis were diagnosed in the Central laboratory as due to Hemophilus species, probably influenzae,
- J6 -

THE Cl_~':'URE UNUS
The total of 48,361 examinations made in the culture units is an increase of 425 over the previous year, There was very little change in the various types of examinations except for miscellaneous specimens, Exclusive of the increase of 1155 hog serums examined for Brucella agglutinations the miscellaneous group shows a gain of 1025 specimens, most of which require much time and individual attention, The apparent decrease in the number of feces cultures was due to the change in the method of reporting rather than to fewer specimens,
ENTERIC DISEASES
Laboratory diagnosed cases of typhoid fever dropped from 63 to an all-time low of 43, Two of these were residents of other states who were hospitalized in Georgia, There were no outbreaks involving a large number of persons, Fifteen new typhoid carriers were found, making a total of 184 carriers known to date, 142 of which have been typed,
Shigella isolations increased by 43, with an increase of 41 individuals. Isolation of Shigella flexneri 6 were made from each of 22 persons in an outbreak in a boys' camp near Hiawassee, Salmonella isolations increased by 68, with an increase of 61 individuals. There were 30 different types, 8 of which to our knowledge, have not previously been isolated in Georgia.
BRUCELLA, TULAREMIA AND TYPHUS
As indicated by laboratory examinations these diseases have receded
to a low incidence, There were 7 more positive agglutination tests for
Brucella than in 1952 but 8 fewer isolations, Positive agglutination tests for tularemia decreased by 4, There were 4 more positive agglutination tests for endemic typhus than in the previous year,
BRUCELLA AGGLUTININS IN Hffi SERUMS
This study was continued in the Albany laboratory where it was initiated in 1952 and was extended to the ~,Jaycross laboratory in 1953, The two laboratories together made 3177 agglutination tests with 444 positive findings,
FUNGUS INFECTIONS
There was an increase of 24 percent in the number of specimens for mycological examinations, Of special interest were isolations of Sporotrichum schenckii from a cheek ulcer and a hand sore; Actinomyces bovis from an empyema tap and from a jaw abscess; and Nocardia asteroides from lung tissue at autopsy,
THE SEROLOGY UNITS
Due to the drastic curtailment of multiphase testing in the field on July 1, the number of examinations in the serology units showed a marked decline, A total of 668,733 tests were performed compared to 794,805 in 1952, This is a decrease of 126,072 examinations or 15.9 percent.
SEROLOGIC TESTS FOR SYPHILIS
The downward trend in the serologic tests for syphilis first observed
- J7 -

in 1952, after an uninterrupted rise for several years, became much more marked, A total of 494,331 tests were made compared to 635,316 in the previous year, a decrease of 140,985 or 22.2 percent. Most of this loss occur red in the survey section of the Central laboratory which made only 81,719 examinations from 31 surveys in 30 counties compared to 196,732 specimens examined in 1952. The routine specimens decreased to a varying degree in all the branch laboratories but the Central and Battey laboratories showed slight gains,
Positive findings were 4.3 percent compared to 4.4 percent in the previous year. The Kahn quantitative test dropped to 13,888 from 18,807 performed in 1952, The Hicro-Kahn test was performed on 464 specimens on small children from whom a sufficient amount of blood could not be secured for the routine test.
PREJ'!IARITAL SFECilviENS
A total of 53,710 specimens were examined for premarital purposes compared to 54,255 in 1952. Approved laboratories outside the state system examined 45,081 specimens making a total of 98,791 for the entire state, a decrease of 862 from the preceding year. Of the specimens examined in the state laboratories 3.7 percent were positive compared to 1.1 percent for other approved laboratories. This difference in percentage of positive findings is probably largely due to the state laboratories, rendering a free service, examining specimens from most of the colored people, in whom the disease is more prevalent.
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 specimen are used. Their application is limited to prenatal and immediately related cases. A total of 85,158 Rh tests and 85,185 blood group tests were performed which is an increase of approximately 7500 for each over the previous year, All laboratories show an increase in the performance of these tests. Due to lack of personnel and facilities, it has not been possible to comply with the many requests for Rh and blood group tests in connection with the establishment of volunteer blood donor groups or in the Civil Defense Program,
HETEROPHILE _c.l\JTIBODY TEST
This test, performed only in the Central laboratory, was applied to 4,059 specimens compared to 4,070 in the previous year. Positive results are considered only as presumptive evidence of infectious mononucleosis.
SVALUATION STUDIES
There was no national serology evaluation study since these studies are now conducted biennially. The Intra-State study consisted in the preparation and distribution of 100 specimens of serum ~ontaining syphilitic reagin and an equal number containing no reagin. The specimens are distributed at the rate of 20 per month for the first 10 months of the year. Participation in this study serves as basis for approval of laboratories after inspection of facilities and demonstration of test performance, The criterion for approval is the achievement of not less than 99 percent in specificity and a sensitivity rating of not more than 10 percentage points lower than the Central laboratory which serves as the control.
- J8-

During the year, 81 laboratories, including those in the state system, participated in the evaluation study. Sixty-four of these laboratories were granted approval for the next year and 9 were given temporary approval. One laboratory did not request approval, 3 withdrew from the study and 4 could not be approved. In conjunction with this study inspection visits were made to 19 laboratories.
Refresher courses of instruction were offered at intervals to technicians who felt that such instruction would be helpful in achieving better test performance. These courses were adapted to the individual need of the
technician and varied from 1 to 5 days. Twenty-seven technicians attended
these courses which represent a total of 66.5 days of instruction.
An evaluation study of the performance of the Rh and blood group tests was conducted with the Routine section of the Central laboratory, the 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 report shows complete agreement in results for both tests among these laboratories.
Following an investigation made in 1952 the V,D.R.L. test was substituted for the Kahn test on spinal fluids on the first of the year.
THE JVIILK UNITS
The tests usually employed in dairy bacteriology were applied to 15,994 samples of milk and related products as compared to 14,328 in 1952. JVIilk samples are examined in all the laboratories except Battey. The number of various types of tests made represent 51,451 examinations which is an increase of 7,697 or 17.5 percent over the 43,754 for the previous year. The gain of the milk units is attributed chiefly to an increase in the number of sanitarians and to more regular sampling of milk supplies throughout the state. 'Jhile increases occurred in each of the four laboratories, they were more marked in the Albany and Macon branches.
The samples were collected by representatives of local health depar'ments in 62 counties and by personnel of two air force bases and Battey Hospital. One of the problems connected with the work of the milk units is scheduling collections so as to avoid peak loads.
EVALUATION STUDIES
The monthly evaluation of cryoscope work in the Central and branch laboratories was expanded in September to include all examinations routinely made. Concurrent with this expansion, the personnel of the two mobile milk laboratories operated by the Division of Public Health Engineering began participating in this work. This expanded evaluation program has proven to be of great value in standardizing our procedure in the various locations.
THE BLOOD SUGAR UN~T
Blood sugar determinations, made only in the Central laborato~, showed a precipitous drop from the all-time high of 203,568 in 1952. Only 81,322 examinations were made, which is a decrease of 122,246 or 60.1 percent. This unit is entirely dependent upon the activities in multiphase testing, and the drastic curtailment of that program on July 1 resulted in the marked decrease shown. Specimens were received only from small surveys in schools and industrial plants during the last six months.
- J9-

Included in the total number of specimens were 3637 submitted for the glucose tolerance test. Abnormal blood sugar levels suggestive of diabetes were found in 1371 or 1.7 percent of the population tested, Only 222 of these persons were previously known to have diabetes.
THE CLINICAL UNIT
The clinical tests covering a variety of procedures are performed only in the Battey laboratory in connection with treatment of patients in that institution, A total of 24,905 tests were made, compared to 26,415 examinations in the previous year. The decline occurred chiefly in hematology and urinalyses due to the discontinuation of some screening work begun in 1952 when isoniazid was first administered, Blcod chemistry tests, however, more than doubled as a result of the addition of 2 other procedures, The increases in the number of pre-transfusion blood cross matches reflects an expanded thoracic surgery program in the hospital,
ANTIRABIC TREATl1ENTS
Antirabic treatment for humans is manufactured in the Central laboratory. The branch laboratories are furnished with an adequate stock for supplying the first 4 doses. The order is then referred to the Central laboratory for completion,
A total of 660 courses of antirabic treatment was prepared and furnished, and compared to the SO? treatment supplied in 1952, represents a decline of 147 or lS,2 percent. These treatments consisted of 356 precautionary (12 dose), 269 mild (21 dose) and 35 intensive (31 dose) types distributed in 92 counties. For the third consecutive year no drastic type (42 dose) was supplied, since hyper~nmune serum was available as an adjunctive for the more severe exposures in 4 cases, Records of antirabic vaccine administration were returned by physicians for 609 or 92.3 percent of the persons treated,
Exposures to dogs accounted for 471 of the patients treated; cat exposures were S3 in number; fox exposures, 21; and 34 were exposed to other kinds of animals. In 52 cases of exposures the patients had previously received antirabic treatment. Twenty-two of these were given 6 additional doses as a booster series, and the nature of exposures did not indicate retreatment in the remaining 30 cases. For the eighth consecutive year, no case of postvaccinal paralysis was reported,
There was one human death from rabies, in which case antirabic treatment was not given, The history is presented in abbreviated form below:
s. H., colored male, age 11, lived on Route 1, Jeffersonville, Twiggs
county. The patient was bitten about August 15 by a puppy belonging to his uncle, The wound consisted of a scratch about two inches long which bled slightly. lledical advice was not sought. The puppy, which presumably had been bitten by a fox about two weeks previously, was destroyed without laboratory examination,
On September 3 the patient became ill exhibiting symptoms characteristic of rabies. His condition became progressively worse, terminating in
death on September 9. Although an autopsy was not obtained, and the diag-
nosis was not confirmed either on the patient or the animals involved, the series of events and clinical symptoms warranted a diagnosis of rabies. A more detailed report of thi~ case is available in the laboratory files.
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Host of the media is prepared and supplied by the Central laboratory. The other laboratories prepare some of the less complex media for their own
use. A total of 5009 liters of various kinds were produced, which is an
increase of 472 liters over the previous year. This increase occurred chiefly in Lowenstein, \,,Jilson-Blair, Loefflers and infusion agar media.
Typhoid vaccine, produced only in the Central laboratory, showed a small decrease while the preparation of silver nitrate ampules increased slightly. For the first time in six years a small decrease occurred in the distribution of Koch's old tuberculin. The preparation and distribution of distilled water was discontinued in July.
BIOLOGIC SALES
There was no significant change in the over-all demand for biologic products. Some items showed an increase and others a decrease in distribution. Requests for specimen containers declined except for throat culture, sputum, pinworm, and PVA outfits, which were in greater demand.
As in the past, immune serum globulin was distributed throughout the state for the prophylaxis of measles and infectious hepatitis. In addition, it was supplied to 37 centers for distribution as a prophylaxis against poliomyelitis. The stocks of these centers were replenished as reports were received showing the amount of the material used. Hetrazan was added to the list of drugs for the treatment of roundworm in very small children. Gantrisin, as a substitute for sulfadiazine, together with pyribenzamine and adrenalin were stocked for use in treatment of venereal diseases. In September the distribution of isoniazid and para-aminosalicylate for the treatment of patients returned home by Battey State Hospital was begun. These two drugs are supplied only on orders from that hospital or the Division of Tuberculosis Control.
INVBSTIGATIONS
Reports from Florida and ~ennsylvania of attacks made on humans by bats diagnosed by laboratory examination as showing positive evidence of rabies provoked concern regarding the potential public health problem in this animal. The Division of Epidemiology began trapping bats in some of the counties bordering on Florida and forwarded them to the Central laboratory
for examination. To date, 185 wild bats representing 4 species have been
examined by mouse inoculation. Although none of them have shown evidence of rabies, the study is to be continued. bXtensive examinations of experimental animals by both the microscopic and mouse inoculation tests were carried out by the Central laboratory in an investigation undertaken by the Division of Epidemiology to determine the efficacy of chick embryo vaccine in protecting cattle against rabies.
The Central laboratory cooperated,with the Division of Epidemiology in a follow-up study of an outbreak of infant di~rrhea in the premature ward of Grady Hospital. This outbreak was thought to be due to Escherichia coli 0
group 55 as this organism has been isolated previously from most of the sick
babies. Cultures were made on 282 rectal swabs and feces specimens but this organism was isolated in only one patient. Bloods from 27 newborn babies
and from 9 of the mothers were examined for agglutinins against E. coli 055,
but all were negative.
The Central laboratory also participated in a study of throat cultures
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from persons in DeKalb county who had glomerulonephritis following sore throat. The Communicable disease Center Laboratories of the Public Health Service assisted in this study, making a large number of cultures as well as typing all the streptococci which were isolated. Beta hemolytic streptococci were isolated in 151 of the 248 throat specimens cultured. Of these isolations, 105 were in Lancefield's Group A, 74 of which were Type 12;
six were Type 1, one was Type 3, two were Type 4, while 21 were resistant
to typing.
As a result of a study made, it was found that the screening point on the refractometer for added water could be lowered so as to reduce considerably the number of confirmations by the cryoscope. A number of small investigations have been made in regard to means for improving services.
A screw cap sample bottle was put in use in place of the paper capped pint milk bottle. A study was begun relating to the detection of quaternary ammonium and chlorine compounds added to milk but had to be discontinued because of pressure of routine work.
Studies were made with a view of finding means of eliminating certain factors believed to influence the reproducibility of the anthrone method employed in these tests. Investigations were also made in an effort to find a preservative which would enable the laboratory to measure the test dosage of the specimen instead of having this done in the field by the person who collects the blood. Valuable information has been gained from these studies even though they have r't completely solved some of the problems which will require further effort.
RESIGNATIONS AND APPOINTMENTS
There were 39 resignations for various reasons. Nineteen were technical, 7 clinical and 13 unskilled personnel. Twenty-six appointments were made to fill 14 technical, 3 clinical and 9 unskilled positions.
Replacements were not requested in the 13 remaining positions due to the decline in the volume of work.
HISCELLANEOUS
The Fulton County Health Department on August 1 took over the consultation service in regard to the advisability of antirabic treatment for exposures of residents of that county. This action greatly relieved the Central laboratory office which renders this service to physicians or patients throughout the state.
A seminar on rabies was conducted jointly by personnel of the Division of Laboratories and Epidemiology for the senior students of the University School of Veterinary Medicine. A three day course of instruction in dairy bacteriology given in Athens under the sponsorship of the Division of Laboratories and the University of Georgia was well attended by personnel of state and county laboratories and dairy plants.
The use of the Ozalid machine in reporting results of examinations in the Central laboratory was expanded with a view of utilizing this method for all reports, with the possible exception of the interleaved carbon forms used for the serologic tests for syphilis. The glassware cleansing room in the Central laboratory was completely renovated and more modernly equipped. Due to the increase in milk work and the decrease in serology specimens, the milk laboratory and the serology survey section exchanged locations, with the microscopy unit expanding to one of the rooms formerly occupied by the milk laboratory.
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Papers were presented before the Laboratory Section of the Southern Branch, American Public Health Association, by two of the personnel. The titles of these papers were "Direct Plating Compared with Selenite F Enrichment for the Isolation of the Shigella Organismsn and 11A Comparative Study of the Tube and Slide l!J:ethods in Rho Testingn. The milk unit demonstrated its method of detecting excess water in one of the curbstone booths. An exhibit depicting performance of various types of laboratory examinations was displayed at this meeting.
Two of the laboratory staff attended refresher courses at the Coromunicable Disease Center. One attended an advanced course in dairy bacteriology at the Environmental Health Center at Cincinnati, another received refresher instruction in Rh testing in the laboratories of Dade Reagents in Miami, and a third was given instruction in the various techniques of blood sugar determination at the Boston laboratory of the Public Health Service,
Thirty-seven visitors from 23 foreign countries and 13 visitors from other states were shown the facilities and work in the Central laboratory. These visits varied from a few hours to several days. Among other visitors from within the state, were many school groups manifesting an interest in public health work.
The Division of Laboratory Services has 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.
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.
LOCAL HEALTH SERVICES
Divisl of Local Health Organiza+ls Division of Public Health Nursing
;.
I ) ,'
l
.. \ .I .

Division of Local Health Organizations

PERSONNEL OF THE
DIVISION OF LOCAL HEALTH ORGAI'JIZATIONS December 31, 1953

S. c. Rutland, M. D.
L. R. Tabor James E. Crank Edith C. Thomas Phy ll i s E. Lee Phyllis C. Smith Elizabeth P. Richardson Carol Joanne Reese

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

REGIONAL MEDICAL DIRECTORS

w. D. Cagle, M. D. w. B. Harrison, M. D.
F. o. Pear son, M. D. o. F. Whitman, M. D.
J. F. Hooker, M. D.

Northwest Region Northeast Region Central Region Southwest Region Southeast Region

HEALTH REGIONS, DISTRICTS AND COUNTY UNITS

CATOOSA

STATE OF

GEORGIA

DEC. 31, /953

.,__, ., BIEN
i

CANDLER

LEGEND:
~- BUDGETED COUNTY HEALTH UNITS
r--l=l
- ~~lMd BUDGETED COUNTY HEALTH DISTRICTS
g

-HEALTH REGIONS

DIVISION OF LOCAL HEALTH ORGANIZATIONS
ANNUAL REPORT - 1953
The Division of Local Health Organizations has as its responsibilities the development of local health departments and the coordination of state and local programs. This Division is responsible for the promotion, establishment, maintenance, and extension of local health departments. It works with these departments in determining the standards of operation and personnel and reviewing their plans and budgets. In order that state funds may be disbursed to local health departments by an established plan and matched by local appropriations, the Division administers a state financial assistance program for local health departments. This program is conducted according to a reimbursement formula utilizing the factors of population, financial need, and public health problems.
The Division is also responsible for coordinating the programs of the various divisions of the state health department concerned with local health and for channeling these services to the local health departments. This carries with it the accompanying responsibility of promoting and balancing these various programs in the local areas.
Personnel
Personnel of the Central and Regional Offices at the beginning of 1953 included the Director of the Division, 4 Regional Medical Directors, 1 Assistant to the Director, 12 Consultant Public Health Nurses, 8 Public Health Engineers, 15 Public Health Sanitarians, 6 Nutritionists, 1 Administrative Aide, 27 Clerical persons, 3 Building Custodians, and 3 Janitors. During the year the Administrative Aide went on leave of absence and a Public Health Administrator was added to the Central Office Staff; also, one Regional clerical position was abolished when it became vacant.
Of special importance in 1953 was the addition of a Medical Director to the Central Regional Staff. An urgent need was met when a qualified person assumed the administrative responsibility for coordinating the program in this large area.
Although the Health Region Organization Plan provides for the addition of certain program consultants to develop and strengthen services to local health departments in their specific areas, it is still deemed advisable by the Director of the Division to apply the limited funds which are available toward more adequate staffing of local health departments.
Regional Programs
The Regional Offices are established and staffed for the purpose of decentralizing, as far as possible, the public health programs conducted by the Georgia Department of Public Health, to make consultant and supervisory services readily available to the community, and to coordinate
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programs of tho state and locul health departments. Those branch offices arc located in Albany, Athens, Macon, Rome, and lNo.ycross.
Services arc performed in both the o.dministrative and program areas. Regional personnel act as consultants to local health departments having a commissioner of health and provide both administrative supervision and program consultation to those without a commissioner. Many direct program services arc rendered in unorganized counties as well as o. limited amount in some organized counties.
In addition to tho regular members of the Regional staffs, other personnel arc assigned to those offices to work in special programs. Those include Communicable Disease Investigators, Mental Health Consultants, and X-ray Technicians.
A total of 10,512 field visit'S wore made by tho regional staffs during 1953 in such areas as administrative and supervisory services, conducting epidemiological and communicable disease investigations, educational activities, environmental health services, tuberculosis control, maternal and child health clinic programs, and record keeping.
Northwestern Health Region Annual Narrative
w. D. Cagle, M. D., Medical Director
During tho year 1953, no serious outbreaks of disease occurred in tho Northwest Region. A few scattered cases of communicable diseases 'were reported and investigated either by local or regional personnel.
Lack of personnel still remains as tho greatest problem. Almost every county, in which thoro is no local health work being dono, is demanding service. Some of them are paying rent on quarters, hoping to got some type of loco.l health work started.
During tho year, nino now nurses accepted public health nursing positions in tho counties. One of those was a fully trained public health nurse, two wore reappointments, five received two months planned orientation before beginning their work, and one received orientation under local supervision. Those and all other nurses received as much supervisory and nursing consultation service as could be provided by one Regional Consultant Nurse. Consultant nursing service was incroasod by tho :return to duty of tho second Consultant Nurse in November. In-service training for all nurses was provided in ton monthly moGtings on v&rying topics of current interest and need. These wore well o.ttendod and po.rticipation was good.
Consulto.nt Nurses o.lso have o.ssistod civic groups, local Tuberculosis Associations, Bettor health Groups, etc., on both Rogiono.l o.nd County basis, and have participated in tho Regional Personnel Conferences. Also, emergency services were rendered by the Regional Consultant Nurses in counties not having health personnel,
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The Regional Nutritionist served 'as a member of the College in the Country, a program of adult education carried on by the West Georgia College, Carrollton. The Nutritionist attended and participated in the staff meetings in Cobb, DeKalb, and Whitfield Counties, She participated in the programs of the monthly conferences of the regional nurses. Nutrition surveys were begun in two schools in the fall of 1953. The children were found to be eating poorly. Educational activities in this area planned for the school year.

One hundred twenty-four school sites wore surveyed with special emphasis relative sewage systems and water supplies, Assistance was given to school boards, architects, and engineers in planning sanitary facilities for schools.

Meetings were held with the city officials in several cities for the purpose of planning improvement of sower systems, As3istance was given five large developments on Allatoona Lake where water and sower systems were developed. Also, the same service was given to many individuals in the Allatoona area,

One hundred and ninety-five tourist courts were inspected and permits issued to one hundred eighty-nine. Fifty-one of these inspections wore made by regional sanitation personnel. Technical assistance was given in all the counties in the region except Fulton and DeKalb, All applications for tourist court permits except those from Fulton and DeKalb Counties were reviewed by regional personnel and submitted to the Division of Engineering for issuance of these permits,

Food Service personnel training sessions were conducted in Walker, Chattooga, and Cobb Counties. A special school was conducted at Battey State Hospital for one hundred fifty persons. Organized food sanitation programs were initiated in Polk, Chatooga, VVhitfield, Lumpkin, Forsyth, Dawson, Gordon, and Walker Counties.

Coverage under the milk sanitation program in the Northwest Health Region during 1953 is as follows;

Milk Program

Number

Counties having milk ordinance

8

Milk plants under local supervision

20

Plant producers under local supervision

293

Plant producers inspected for other counties

5

Retail-raw-distributors under local supervision

26

Milk plants under reciprocal inspection

25

Counties in region having no milk program

16

Milk sanitation activities in counties having no local sanitation personnel or milk ordinances were confined to work with school, hospital, and institutional milk supplies upon request by the Division of Public Health Engineering.

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In spite of a big turn-over in personnel, tho Venoral Disease Investigators in this Region showed a considerable increase in volume of work done. Almost twice the number of contact inve'stigations were completed (excluding Survey follow-up) and more than throe times the number of new cases of syphilis were identified and brought to treatment than in the previous twelve-month period.
During the year, a clerk wont on leave of absence in Cherokee County and was replaced for the period of her leave. An additional clerk was added to tho staff in each of the following counties Cobb, Forsyth, and Whitfield. A vacancy occurred on tho cloric.J.l staff of Floyd County and was subsequently filled. In the regional office, a stenographic position became vacant and we wore fortunate to secure a qualified person to fill the vacancy. Later in the year, a former employee was reappointed to this same position on the regional clerical staff when it again bec~me vacant.
The stenographers in tho regional office attended to their regular duties such as corre spondEmce, keeping of records, filing, answering telephone, compiling and checking reports, etc. The Clerical Field Representative visited in some of the counties and instructed local clerks in their duties, and some of tho county clerks visited the regional office (at the same time their county nurse attended the nursing conferences) and wore instructed in their duties. The regional clerks participated in tho Quarterly Conferences of Regional Personnel,
Northeastern Health Region Annual Narrative vv, B. Harrison, M, D., Medical Director
It is felt that progress was made in the Northeast Region during 1953, Thoro wore no pronounced epidemics of serious communicable disosos, Plans for in-service education, by means of meetings of the various categories of workers, have gono forward with good results,
In the field of Mental Health it is thought that thoro is bettor understanding and a greater demand for services than heretofore, Late in tho year, the Mental Health Consultant went on leave of absence for one year, so at the present time tho Region is without this service. However, tho mental health concept seems to be deeply embedded in o.ll tho other services as a result of the special efforts that wore expended in this field,
It was a busy year in the field of sanitation, with increased demands for inspection of individual water supplies and sewerage systems, routine soil percolation tests for nitrification fields and increased iatore st in slaughter house sanitation. Tho multi-million dollar school building program and activities in tourist court sanitation has domo.ndod much of tho time of the personnel. Thoro has also been continued activity in poultry sanitation due to tho fo.ct that the Northeast Region is tho homo of the World's largest poultry center,
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One of tho two state mobile milk laboratories spent the entire year in the region. As a result, throe largo milk sheds in Elbert, Richmond, and Wilkes counties wore given tho U.S.P.H.S. rating of 90% or better for the first time in 1953 1 and milk sheds in Barrow and Clarke counties wore reinspected and approved for continuance with this rating. Other counties arc iniho process of making this rating.
A successful sanitary landfill demonstration was hold on a regional basis in cooperation with tho State Health Department and tho various equipment dealers who participated. Immediate results were shown in the starting of now landfill programs and in improvement of tho lo.ndfills already in operation in the Region.
In cooperation with tho Division of Industrial Hygiene, chocks wore made of all known fluroscopic shoo fitting machines, and in most cases corrections made whore needed. Chocking of x-ray machines in hospitals and doctors offices has been started.
Changes in sanitation personnel taking place during tho year included resignations by Malcolm Sayer in Gwinnott County, Robert Gunby in Baldwin County, and Henry ~toed in Richmond County; the employment of Robert Powell in Gwinnott; and the transfer of Alvin Powell from the Southwestern Regional Office to the Northeastern Regional Office.
Tho nursing status of tho counties has remained essentially tho same. Oconee County employed Mrs. Carrie W. Marsh in November after tho county had boon without a nurse for one and one-half years. In Elbert County, Mrs. Laura Wilson was employed to fill the vacancy loft by Mrs. Doris Carrithers, who is temporarily suffering with a disability.
Dr. w. C. Carnes is now the Health Commissioner for Elbert and Hart
Counties.
An application for tho construction of a now Health Center in Habersham County has boon approved
In 1953, Mrs. Duke, public health nurse in Madison County, was transferred to the Richmond County Health Department. Mrs. Ann Gober returned to her previous position as county nurse in Madison County.
Tho Health Center in Monticello has boon renovated. l!Vi th Mrs. Oro. Russell's suggestions and help it has rco.lly become a most attractive and comfortable building -- quito different from the old days of coal stoves and no stoves.
In tho futuro, Wilkes County will ho.ve two nurses, Mrs. Holen Kish and Mrs. Elizabeth Arnold. Mrs. Kish was granted a leave of absence for tho last three months of tho year and Mrs. Arnold has boon the only county nurse rendering services during tho.t time.
The greater part of the Nutrition program during this year was slanted toward school work. At times tho results in this program have
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boon encouraging, while at other times tho progress was slow. However, it is felt that tho amount of time spent was quite valuable. Thoro aro thirteen activo Nutrition programs under way in different schools.
It is also felt that tho staff education program in Nutrition has boon intensified during this past year. This is evidenced by tho frequency of inclusion of Nutrition as a part of the programs planned for tho county nurses and by the interest the nurses have shown during the individual conforonco s.
Work with other agencies has iDcroasod during the past year. Tho relationship with tho Homo Economics School and the Education School at the University of Georgia has boon strengthened through cooperative work,
During tho year 1953, the Communicable Disease Investigators held multiphase surveys in Baldwin and Taliaferro Counties, In addition to this, 810 named contacts were examined. Among tho persons examined, 24 wore diagnosed Primary and ~econdary Syphilis, In addition to this, 127 were diagnosed 11 othor 11 syphilis, Over 18% of tho contacts examined were infected,
Central Health Re~ion Annual Narrative F. 0. Pearson, M. D., Medical Director
The Central Region covers 18,912 square miles with a population of 924,352 (1950 census) in 51 counties, There are only 7 local Health Commissioners in tho area, Dr. 0, L. Rogers having retired during tho year, leaving a largo area for administration through the Regional Office.
Only 5 of those 51 counties aro without local health service and most of those arc interested in employing personnel when they become available. Our greatest need is for qualified and trained people to staff county and district health departments, The increasing realization by county officials of the need for sanitation and clerical personnel is encouraging. Most loco.l boards or health and county officials arc interested and cooperative, A concreto evidence of local public health interest is tho number of new health centers completed and in operation, those under construction, and those approved for construction. Several applications for health centers under the Hill Burton Act have not boon approved because of lack of federal matching funds,
The ability of all public agoncie s to work together was we 11 demonstrated by tho cooperative assistance rendered to those affected by tho tornados which caused many casualties and did extensive property damage at Warner Robins, in Houston County, and Columbus, Muscogeo County. This was th~.;. worst disaster in this area in many years.
Although many preventable diseo.sos have boon brought under control and tho incidence of others has declined, Tuberculosis remains as one of our major public hoo.lth problems,
Also, in spite of tho fact that much progress has been made in Venereal Disease Control, tho problem of control is still with us. This was impressed
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upon us rather dramatically by tho occurrence of a local epidemic in the Region during tho year. Duo to hard and accurate work on tho part of our Investigators, in a period of approximately 6-wocks, 62 cases of primary and secondary syphilis wore traced to one original case. This makes it more evident than over that control efforts should not be discontinued,
Because the problem of acute communicable diseases is not so groat, thoro is more time for work in tho fields of chronic and disabling diseases and in mental health. In this field tho Regional Nutritionists are proving more and more valuable as they become closely integrated in the total local programs. Much work has boon dono in special food demonstrations and group education as well as individual instruction on nutrition. Since thoro are only 2 Nutrition Consultants for all 51 counties their work cannot be as concentrated as is desirable,
Although it has boon possible to roduco the amount of direct services by tho sanitation staff, the load is still heavy, particularly with schools and tourist courts. More supervisory and consultant service can be made available as local sanitarian coverage is extended.
Tho demands on tho Regional Consultant Nurses continuo to increase and it was fortunate that no personnel changes or extended illness in this group were seen during the year.
The efficient clerical and stenographic staff of tho Central Region also remained intact during 1953, The Region was divided into two areas of approximately tho same size and a Clerical Field Representative was assigned to each area. Those Field Representatives working with tho staffs of tho local health departments in their designated areas have brought about closer working relationship between the Regional and local offices.
While defini to progress is being made in improving public health programs, many problems remain which can be solved only through expansion of local health departments.
Southwestern Health Region Annual Narrative 0. F. Whitman, M, D., Medical Director
Tho Southwestern Health Region, with headquarters at Albany, is composed of twenty-eight counties in Southwest Georgia. The total population of 446,119 (1950 census) is about equally divided among the white and colored. Thirty per cent of tho population is urban and seventy per cent rural. Diversified farming with increased livestock production is raising tho economic level in tho rural areas. The growth of industry is causing a migration of farm workers to the urban centers.
Of the twenty-eight counties in the Southwestern Health Region, five are being served by local basic personnel. The remaining twenty-throe counties are without public health medical service, except that which is rendcred by tho regional and central offices. Twenty-five counties have public health nursing service and ten of those counties have environmental sanitation personnel.
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To give this urea basic health protection, additional personnel must be secured. Little progress has been made in tho recruitment of professional personnel due to the inadequacy of our compensation plan. To cite one example of this nood, tho need for sanitation services in the milk program has inc rea sed due to the growth of the dairy industry and tho passage of county health regulations relating to the movement of milk and milk products,

Tho Diagnostic and Rapid Treatment Center for Venereal Disease, located in tho Dougherty County Health Department in Albany, continues to render service to most of tho counties in this area, Attendance at this clinic indicates that Venereal Diseuse is an ever present threat ar.d has by no means been brought to an irreducible minimum.

Tho sandy soils, moisture and mild winters of this section are favor-

able to tho production of hookworms. Hookworm infestation continuos to be

a problem in tho rural areas, roaching as high as sixty per cent in many

of tho schools. Rural electrification has resuQtod in estimable improve-

mont in rural sanitation; however, those areas not having this service show



little or no improvement duo to excessive cost of homesanitation facilities,

An increased interest in nutrition and a desire for more help and information has bo~n noticed among some of tho local nurses, Some schools arc doing definite health and nutrition work, but tho need for more health training for teachers and school officials along health lines is still urgent.

In-service training has been stressed for all public health personnel, Much interest has boon stimulated in tho various aspects of public health through regular meetings of the personnel. Tho short courses on Diabetes, Cardio-Vascular Disease and Crippled Children have boon well attended by tho nurses. Tho short courses offered to sanitarians and engineers have also boon well attended. Two regional sanitarians who had boon on educational leave, returned to duty in Juno. One had completed tho course of study loading to a Master's Degree in Sanitary Science.

Throe Crippled Children's Clinics arc operating in tho region on a monthly or quarterly basis, giving rise to increased interest in this phase of public health,

During 1953, tho Southwestern Health Region has shown estimable progress in many areas because of tho faithful devotion of its workers. Tho Regional Staff is confident that progress will continuo in those 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, since such coverage should have priority over everything else. Public health protection is purchasable. More and more communities arc expressing a desire for this protection. It is tho responsibility of health department personnel, as protectors of the public health, to present facts ar.d figures to tho proper authorities in order thC\t they may act intelligently in the administration of public health funds.

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Southeastern Health Region Annual Narrative J. F. Hooker, M. D., Medical Director
Monthly staff conferences have become a vital part of Regional in-service training. At each mooting, every member brings tho staff up to date on what is new in his or her particular field as abstracted from tho Journals. This has made tho staff more aware than over of tho value of teamwork. One monthly conference was converted into a workshop by inviting tho Welfare workers and County Agent to spend tho day with tho Public Health personnel. This was such a success that tho county health workers arc asking for more meetings with allied workers.
Tho senior stenographer assumed tho duties as Clerical Field Rcpresonto.tivo, thereby greCttly reducing tho amount of work tho nurses had to do in the clerical field when a now clerk was added.
The Southeastern Region comprises 7 budgeted health districts. It was fortunate that the District was able to secure the services of Dr. J. L. Sawyer as Commissioner of Hoo.lth for tho District of Liborty-Long-WaynoBrantloy Counties. This loaves in this region only two Districts, comprising six counties, without a commissioner of health.
Health centers wero completed in Berrien, Charlton and Mcintosh Counties; centers were under construction in Appling, Coffee and Glynn Counties; and a center has boon approved for Long County.
Hill-Burton Hospitals wore completed in Bacon, Glynn and Pierce Counties with a hospital approved for Waro County.
During 1953 the Region gained throe new public health nurses o.nd lost two. Every county has nursing service except Joff Davis, which has recently provided quo.rtors for personnel when it is o.vail~blc. Throe nurses participated in tho training course in tuberculosis control at Battey State Hospital. One nurse attended tho seminar on rehabilitation at Now York University, Bellevue Physical Medical Center, and two attended tho workshop on rehabilitation at Gallinger in Yvashington. Eighteen nurses roceivod tho instruction course in Mother Baby Care. A totnl of fifteen Mother and Baby Care classes have boon taught throughout tho region. A three day institute was held on diabetes and cardiovascular diseases and it wus attended by fifty..,tnrco public he2lth ~,urscs."
Special emphasis has boon placed on tho school health progrem during tho yoar. A now Crippled Children's Clinic was opened in Waycross for this aroa.
Assistance was given in planning and setting up exhibits for several fairs and health center dedications.
The Regional Food Sanitarian returned from educational leave after completing requirements for tho degree of Master of Public Health. Two additional counties began sanitation programs giving a coverage of sanitation personnel in 19 of tho 22 counties in region. Bi-monthly conferences
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W<HO instituted with good o.ttendance o.nd a greo.t deo.l of interest, With tho o.ddition of the food specio.list to the staff, a. program of promotional activities, including food surveys and food service schools, was instituted with good reception from local personnel.
The office has cooperated closely with the Division of Engineering and Department of Education in sur-yoying proposed school building sitos and has consulted with tho designing architects and engineers for these schools. Inspection of the health o.spects in the construction of these schools is progressing.
Emphasis of quality milk production was continued. The Douglas milk supply was surveyed and placed on US.PHS list of 90% milk sheds; with this addi tion 1 all milk sheds in this region are now on the 90% compliance list except in l county which processes o.pproximately 250 gallons of milk daily. Continued ompho.sis was also plo.cod on tourist court program, and thoro o.ro now only a few in operation without heo.lth department permits.
Insect and rodent control activity included 6246 premises dusted and 14,834 premises troo.ted with rodonticidos, using 40,965 pounds of rodonticides. A sanitary survey wo.s conducted in Wo.re County. Expenditures for insect o.nd rodent control in Appling, Bo.con 1 Berrien, Coffee, Cook, Lowndes, Ware, and Wayne Counties toto.led $16,522.15, Lo.rviciding and promise spraying programs wore co.rried on in Douglas county o.nd an intensive larviciding program was conducted in Lowndes and Appling Counties, Berrien County carried on premise spraying to some extent.
More emphasis has boon placed on nutrition education for teachers and PTA members Nutritiono.l deficiency slides wore shown to and their significance was discussed with three hundred and seventy-nine members of those groups, The onsu~ng requests for nutrition programs in schools were most rewarding. Throe hundred and ninety-five preschool children and their parents were given nutrition information o.t the :);wo:tv<~Lp!l.eschool clinics atten.dod- by tho nutr;itionists,
Two Communico.blo Disoo.so Investigators collected 6591 blood specimens for serological tests for syphilis, During tho year lll cases of syphilis, 144 cases of G,C,, and 12 co.sos of other venereal disease wore placed under treatment, On July l tho Diagnostic o.nd Treatment Center in Waycross was closed, leaving centers in Macon, Albo.ny and Savannah to serve tho southorn ho.lf of tho state.
Recruitment o.nd Traininre;
A continv.ing program of recruitment and traini~1g is being conducted in o.n effort to moot tho need for o.ll classifications of public health personnel throughout Georgia, Again in 1953, both academic o.nd in-service training wo.s provided.
Durint; the year, 2 local commissioners of heo.lth went on educo.tiono.l leave under tho sponsorship of this Division, to complete the requirements for a Ivlastor of .Public Heo.l th degree, and l physician recci vcd orientation in local health administration, Also, 2 so.nitariarts received their Masters
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degrees in either Public Health or Sanitary Science, following satisfactory completion of tho course of study at recognized schools of public health, and returned to duty. Two other sanitarians returned from educational leave for the purpose of continuing undergraduate work. The Division continues to cooperate with the Division of Public Health Nursing in tho recruitment and orientation of nursing personnel and in securing academic training for them.

Tho three-day conference for local commissioners of health and regional medical directors was conducted this year in cooperation with tho Divisions. of Mental Hygiene and Tuberculosis Control with those programs under discussion. The course again met with a favorable response on tho parts of those who participated.

Continuing a program started several years ago for the purpose of familiarizing tho young physician witp his relationships to public health and tho place of public health in tho community, eleven junior medical students worked in local health departments during tho summer months under the sponsorship of this Division.

This year also saw a continuation of participation in the short training courses for sanitation personnel. Twelve sanitarians completed tho short school for sanitarians conducted by tho United States Public Health Service at Columbus before returning to work in local health departments. A largo number of county and regional sanitarians and engineers attended tho intensivc throe-day course "in environmental health services. This school is conducted by tho Divisions of Public Health Engineering and Local Health Organizations in cooperation with tho Georgia School of Technology.

Quarterly three-day staff conferences of tho Central and Regional Offices wore conducted flor consideration of administrative problems and tho content of various programs. This plan for in-service training has boon well-received and in showing results both in increased knowledge and improved coordination between the various offics .

Public Health Center Construction Program

Community interest in the provision of health facilities to moot tho needs for expanding local public health programs remains high. At the ond of 1953, the report of the health center construction program showed:

I. Health Centers Completed During 1953

Walton County Richmond County Douglas County Polk County

Butts County Jenkins County Charlton County Berrien County

II. Health Cantors Under Construction

Glynn County Coweta County Poach County Coffee County Muscogee County

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Putnam County Appling County Carroll County Macon County Pike County

III. Health Contor Projects Approved for Construction

Baldwin County Houston County Fulton County Long County Bartow County

Jonos County Habersham County Lo.urons County Ho.rt County Clo.yton County

By tho ond of tho yoo.r, 48 public hoo.l th and auxi lio.ry centers ho.d boon completed o.nd occupied under tho construction progrum using specio.l State appropriation o.nd Fodoro.l Hill-Burton funds to supplement locc.l moneys. County roque sts for o.ssi sto.nce in tho construction of public hoo.lth centers continues to greatly exceed tho numbers which can bo o.pprovod, duo to limitation of avo.ilc.ble Federal funds for matching purposes.

Local Hoo.lth Departments

For many years, tho Division of Local Health Organizations ho.s operated under tho philosophy that tho local heo.lth department is tho basic sorvico unit in tho administration of public hoo.lth and, consequently, ho.s as its goo.l tho development of total local hoo.lth department covoro.go of tho entire population. It's ultimate objective has boon adequate as well o.s total cov~rago, for which o.ro required adequate budgets, o.doquo.to numbers of woll-tro.inod personnel to work in local units, and offocti vo economical coordino.tion of progro.ms,

Tho trend in providing public h8o.lth services in the lo.st decade ho.s boon toward increased coverage by local health departments; however, o.doquo.to coverage has not increased at tho same rate. Although soma health services arc o.vo.ilo.blo in counties with ovor 95% of the State's populo.tion, many of those departments remain understaffed in both supervisory o.nd service personnel.

Coverage on December 31, 1953, showed 49 counties (with 57.1% of tho State's populo.tion) employing o. commissioner of hoo.lth, 142 counties (95.4% of tho populo.tion) having public heo.lth nursing services, 84 counties (70,1% of tho populo.tion) with tho services of sanito.tion personnel, o.nd 131 counties (92.5% of tho populo.tion) ho.ving clerical personnel services. Also, 107 counties oporo.ted mo.torno.l, info.nt, o.nd well-child clinics with po.rt-timo modico.l o.nd nursing staff o.s of December 31, o.nd 49 counties ho.d donto.l clinics in operation with parttime dental clinicians and o.ssisto.nts on tho.t do.to.

As of December 31, local heo.lth dopo.rtments ho.d a total of 1,181 employees, This totnl included 24 commissioners of health; 7 physicians; 10 assistant commissioners of health; 477 public hoo.lth, gro.duo.te, and cli~lic nurses; 25 public health ongiriocrs~ 140 public' hcalt~ snnitnrinns; 274 clcrico.l staff members; ctnd 224 others including dentists, dental hygienists, nutritionists, mental health workurs, educators, votcrinrlrians, cnse workers, o.nd x-rrly nnd lnboro.tory technicians. Only 8 counties held not provided for financing o.t lco.st limited services; however, including those with temporary vc-co.ncic s, 17 countio s were i thout public hoo.l th personnel o.t tho end of tho yoo.r.

K-12

A comparison of tho number of full-time public health workers employed in local health departments at tho end of 1953 with that of 1952 is as follows:

Personnel

1952 1953

Physicians Donti sts Dental Hygienists Public Health Nurses Clinic Nur so s Public Health Engineers Sanitarians Other Sanitation Personnel Health Educators Nutriti oni st s Mental Health Personnel X-ray and Laboratory Technicians Medical Social Workc rs Public Health Investigators Clerical and Statistical Personnel Custo din l, Maintenance, and Other

39

41

3

6

'6

7

428 445

43

32

20

25

114 140

47

29

2

2

2

8

0

6

28

30

4

4

9

4

244 274

172 128

TOTAL

l, 161 1,181

The summary above shows an increase of 20 full-time personnel employed in local health departments at the close of 1953 (1,181) over 1952 (1,161). Participation in the salary of these personnel was extended by tho State Health Department to 870 this year as compared with 828 in the preceding year.

Expenditures in local health departments in 1353 totaled ~4,820,934.78, or $1.45 per capita. Grant-in-aid from the 0tate Health Department amounted to $1,508,107.91 of this total, representing 451 per capita. There were 145 reporting counties during tho year and tho per capita figure is based on their combined population.

From 1952 to 1953 total expenditures by local health departments showed an increase of $272,935.22, or from $1.36 to $1.45 per capita, and State grant-in-aid funds increased $73,604.76, or from 43f to 451 per capita.

Those increases in expenditures and in numbers of personnel employed continuos to reflect tho efforts of both local and state agencies to overcomo two of the basic problems in strengthening local health units insufficiency of operating funds and lack of availablility of qualified personnel. However, progress in this direction has been so slow that modification of the present state organizational plan for local health depo.rtments and the plan for fL1ancial assistance to loco.l hoo.lth depo.rtmonts is doomed necessary at this time, and a proposed now plan has boon o.dvo.nced.

K-13

-- ".._,.-fi-e-~,.-.----~~~~~~~~~~---------------------------------------.
This proposal is based on the principle that, under tho existing legal structure EJ.nd administrative po.ttorns of public health in Georgio., medical o.nd other supervisory services aro essential to overcoming prosont handicaps in providing total public health covero.go and to tho development of adequate programs to servo o.ll tho pooplo in the Sto.to. It is based on tho tenets that those administrative EJ.nd supervisory professional personnel in tho categories basic to public hoo.lth administration can adequately administer a program for a larger population than has heretofore boon provided, and that such action is tho only immediate prospect for wider cmd more efficient utilization of tho personm l now employed or soon to be available to assume increasing public health responsibilities. The plan presupposes tho.t u larger population car, more easily and willingly provide tho financial support necessary for conducting o.n adequate public health program. Finally, tho proposal incorporates tho premi_sc. th<J.t, if these supervisory and administrative services aro provided in local areas, they will help to stimulate tho necessary financing of personnel to provido direct and personal services.
Under such o. plan, tho number of Health Districts provided for in tho existing state plan should be reduced from 54 to approximately 38, and enabling financial policies conforming to the plan should bo o.doptod by the State Department of Health, The size of the Health Districts and the populo.tion served should be increased accordingly. Grant-in-aid funds would still be made available to local arcns, with total reimbursement made to tho Health District for the salaries of a District Staff allowable under tho Merit System Pay Plan, and with additional grants-in-aid made to counties foro. percentage of tho salaries paid to county personnel. Funds expended under the plan would continue to be supplomontctl to local moneys spent for public health programs and would not be used to replace local appropriations.
It is boliovrsd that the changes which would bo incorporated in such o. plan would stimulctte improvement of existing health departments and tho o stn bli shmont of now ones.
Local Public Health Services
Following is a report of public hectlth activities performed in 1953. This report shows that some activities wore co.rriod on in almost every county in tho basic public health programs, Generalized programs nrc expanding from work primarily in such areas as communica,ble disease control, maternal and child hunlth, environmental health services, health education and record keeping to include increased o.ctivities in chronic disoo.se programs, mental hygiene, housing and homo so.fety.
Tho informcttion co:1tainod in this report nf acti vi tio s continues to reflect the lack of adequate staffing ctnd insufficieucy of funds in many c:.roo.s, mctking it impossible to codduct adequate progro.ms based on tho needs of tho respective communities.
K-14

Appling

Atkinson

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Baker

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Brantley

Brooks

Bryan

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Burke

Butts

Calhoun

Camden

Candler

Carroll

Catoosa

Charlton

Chatham

Chattahoochee

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o+' (I) 0+' o

r1r1 (1j .-1-.-1 Ct-j(I)C) Ct-j(l)(l)

'Hr1 'Hr1 ;::::l o:><D op.o

:> "C)o.-1 'Dr1+' r-1 S::.-1 <Dr1 (I)

r1 "'C) C)
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rir-1 0 .-'rl ;::::l II-.00.. [L;C)(I)

117 37 190 420
78 182 71 26 195 113 89 226 236 112 68 43 416 170 1
54 64 1784 452
44 82 98 90
43 69 107 87
55 so 14 13 149 224 36 53 454 lOS 112 34 28 44 179 134 212 232
2303 573 295 361

0 c0+'
<])(I) 0+' Cr1t-j(rl1) 'H r1 0 :>(I)
+' "'C)C) u r1C1:l
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154 335 205 350 290
79 164 170 134
9Lo 727 93 171 1:?7 332
97 18 598 70 l 119 22 349 160 1618 315

(I)

P.,S:: (1j 0

H r1

I+'

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r81

+' (1j

0 :>< E-< Q)

160 288 141 1)2
1534 206
317 130
2456

68
790 120 4192
I76 1
4228 134 119 218
74 319 175 29 266 i
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317

Oconee

Oglethorpe

Paulding

Peach

Pickens

Pierce

Pike

:>
I

Polk Pulaski

-I--a' Putnam

Quitman

Rabun

Randolph

Richmond

Rockdale

Schley

Screven

.Seminole

Spalding

Stephens

Stewart

Sumter

Talbot

Taliaferro

Taylor

SPECIFIED ACTIVITIES BY COUNTIES: JANUARY l - DECEMBER 31, 1953

~ Communicable isease Control

I
i

DiVseeanseereCalontrol

Tuberculosis Control

1
I 'D (]) +' +'
srl (]) 0 'Drl elll>
H (I)(]) (])(I) (I) ell 0 0+'
l

(]) 0 rl 4--i
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c<3 (I)
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2

s(I:):
0 rl +' ell t'l
rs:l:
s:s::s
H
l79S

2

4 1069

511 1300 33S5

3

16 2768

9 17 l23S

lS 47 2635

3031

25 65 834

12 14 1957

40 46 5o4S

299 S67 26S9S

1

l

357

43 44 5683

105 105 400

3 lS S468

l

5 3787

254 390 6SlS 22S
3 12 225 9S 193 332

'D
(])
+' +'
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H
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7 24
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47 12
47 76 90
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9
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167 2739 112
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5
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6
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9 57
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106 214
192
243
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22 341

H
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46 45 107 29 12
7 49 36 44S 20
29 3
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74 91 303 42 36 15 49 6S 93S 104
109 13 303 49

0 c.::l+' (I) (]) (I)(])
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l> .., Orl 'Drl+' rl S::rl (]) rl (I) rl rl 0 II< 0 0,

0(1) c(j+'(J)
(I)
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4o--i:>rl o:::s .,oorl
'drlrl rlS::P, (j).,-j(l)
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14
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73 30 20 l2S 72' 1510 S4
48 29 1000 62

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89 54 39 148 114 2568 406
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207 250 2668 153 145 70 155 157 ll9S6 174
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209 216 265 405 625

7 24 7

8

73

40 55 61 95 79S

31 60 204 104 291

I

SPECIFIED ACTIVITIES BY COUNTIES: JAi\TUAfl.Y l - DECEMBER 31, 19)3

Telfair Terrell Thomas

Communicable Disease Control

ii

Venereal

i

Disease Control 1

I

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223 891
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21 43 28 47 128 234

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23 6 25

Tuberculosis Control

'd
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102 54 85 2) 1)8 56

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Tift Toombs Towns Treutlen

12

88

5991

I
I

73

121

12

I- 89 102 3566
--

64 99
--

9
-

-

- 132 I 9

9

-

36 28

49 149 31 85

185 192 180 129

355 336

32336_6,.

-

-

-

--

-

3

-

-

8-

1

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I 1\)

Turner

7 16 4581 597 1731

6

18 35 2041

56 178 Sl

136 100 440 1203 276 996 1043 I

"'

30 30 so 122 99 158 131

0 Twiggs

14 31 1802

48 69 18

14 14 46 136 30

97

87

Union

Upson Walker Walton
~~!are
,.farren

15

87 1913 I 45 112

11

' ll
7

26 60

8114 5140

i

20 205

45 342

995 2093 7889 325 990

-
39

s 11 3781

38 114

3

81 67 46 588 180 180 233

80 lll 131 42 25 100

428 285 138 69

428 227

5363841

76 29 188 21)2 168 1111 579

21 75 203 134 185 673 163

Washington

13 18 3869

39 166

6

71 54 77 328 162 253 226

Wayne

162 717 4899

31 178

7

58 36 128 269 147 393 237

1T\febster

-

-

-

1 13

~iheeler
t e 1 ~Jhi

9

9 1622

-

-

-

s 23

-

11

-

4

9

7

18 14

37

24

1

,.ihi t f i e l d

6 238 8980 llS 266 14

229 1576 286 3037 2352 1708 11338 1

Wilcox '"Jilkes li1Jilkinson
:,~forth
TOTAL

97 131 2030

71 118 47

-

- 543

26 80

8

I 45 I 142

107 200

2766 3181

I
I
I

57 42

73
109

26 27

i

113286 32332 499117 j' 282So J26S69 2381

I

25 20 lll 33 28 78 23 so 33 26 33 98 8614 12839 21558

127 112 6So 92 100 173 ~L4l lOS
66180 33179

323 167 174 295
62881

32061 192 138 i
259 I 281214 Ii

I SPLCII"I.t;lJ J\.CTIVITIE:::J dY COUNTILS: JANUAttY 1 - DEC.slVIBER 31, 1952

Maternal & Child Health

Infant & Preschool Hygiene !school ~ygiene ~- ~f

I ---=0Qrl)---------------,rr0Qr-l)---------T---------------------m~ Q) 0-rl-----------;1I

II ~

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.I1
t

I

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0

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Appling Atkinson

122 769 89 101 627 142

Bacon Baker

20

33 17

116 798 74

Baldwin

233 1127 194

Banks

21 118 30

Barrow

67 396 68

Bartow

13

35

9

:;:<. Ben Hill

I

Berrien

1\.)

I-'

Bibb

Bleckley

lOS 404 73 71 329 26 2137 12812 1242
154 914 59

Brantley Brooks

67 462

7

183 1178 88

Bryan

112 848 141

Bulloch

299 1559 133

Burke Butts Calhoun

478 2586 140
154 So5 69
259 1494 183

Camden Candler Carroll

70 393 29

86 313 59

s

19

7

Catoosa

2

2

Charlton

78 486 77

Chatham

1207 11039 1949

Chattahoochee'

139 185 545 280

200 476 1154 384

32 19

79 99

398 74 541 45

412 223 134 68

405 386

4s6s

215 100 583 230

20 22

63

5

160 116 341

58 61 223 119

1883 2237 8254 2520

82 166 745

9

13 27 105 109

159 112 253 10

141 159 465 113

259 374 1283 184

320 284 1815 11

148 121 381 296

353 245 678 228

62 43 113

2

94 78 175 120

27 27 87

119 269

5so5

113 91 220 92

9467 5462 22359 2743

644 1067 103 172 124
324 646
5
204 5483
24 248 16 127 659 15 1094 598
4 296 132 260
177
8497

107 100 373
1
202
589
42
3 4256
502
1
79 78 68 39 111 14
130
19 56
30024

74 78 98 61 53 37
67 108 16o
3 191 62 48
9 14 2299 958
1 37 31 60 92 190
112 1 265 96 104
45 67 787 30 39 25 60 79 58 67 3048 2752

56
97
406 4
281
65 2792
98 84 453 146 840 102 51
59
15
3465

72 186 405

95 277 151

16 50 165

104 272 10

2

12 19

85 455 28

5 33 110

2
310 120 10
4
3 30 17 25 25 6
4
13
7
4
7 6079

7
698
732
39s
3 36 41 134 51 6
12
50
11
36 25 28720

81 317
27 154 178 154 318
5
45
59
39
2
148 2445

SPtCIFI1 nCTIVITIES BY COU11JTILS: J"_:f\JU"JU l - DECEMBER 31~ 1953

Chattooga Cherokee Clarke Clay Clayton Clinch

' MaternC'l & Child Health

i Infant & Preschool Hygiene

Q) C)
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6 7 3Ll4 3 66 141

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12 12 2640
5
330 1113

Q) C)
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10
3
232
5
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23 12

'~I ill +> +> srl ~ill ell C)
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I 14 ll

739
5

1 417 6

75 1 100 165 i 79

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cJ+'

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45 23 2776
7 258
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2
3 370
549 82

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2
4
1460

1153 194

School Hygiene

(/)
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352 511
2
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370 47 67

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14780 155
47 74 57

I
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f Morbidity Service i

I

. a;--~

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~ ~(/) I

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4 .-II

14 28

4 13

30

128 606 6

64 207 349

Cobb

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Columbia

I

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Cook

Coweta

Crawford

Crisp

Dade

Dawson

Decatur

DeKalb

Dodge

Dooly

Dougherty

Douglas

Early

Echols

Effingham

Elbert

Emanuel

112 340

212 1293

270 1571

69 331

56 298

201 975

51 167

271 1494

15

39

6

17

257 1062

616 4145

:;1.47 370

77 204

383 2618

41 194

249 706

24

99

79

218

151 823

144 866

80 316 234 844 1252 2940

81 166 285 2102 486 1762

I 149 271 328
24 44 57
63 109 182

987 499 1147 252 181 696 467 485 871

133 211 1 330 1389 747 2168

68

8o . 72

lll

64

92

93 16

154 25

!1

234 36

735 55
117 167

84 251

I 2

2I 6

156 214 355

13 52 898 413

62 924

572 1045 !'1050 3678 1787 5496

126 132 163 418 260 385

77

210

33

60

208 938 590 2325 1474 2836

12

31 33

128

ll

23

76 106 121 345 65 133

13 31 46 184 19

40

64 73 181 511 312 666

142 355 159 618 82 216

2

3 75 406 159 412

2033 270 983 449 396 3910
2 55
12

365

110

1767

2612 16

3245 1279

14

34 100

2350

9

ll

94 108

88

l

293

l

1

515 2039 95 363 73

116

5 12 1144,.

lll 70 421 33 44 183
213 30 184 1058

73

2 29 56 154

106 28
95 376

J 35 187
21 118

67

13 49 361

86

ll

31

7

179 840 68 527 1009

862 2239 2330 9083 85

74 276 89 161 451

110

2

83 172 21

567 2123 585 2245 244

40

2

16

l

63 183

2

6 191

52
95 455
23

13 31

22

9: I 4

I 96

3

200 71

38 1291

27

I
331

45 831

I

I

SPECIFIED ~CTIVITIES BY COUl~TIES: J"NUnRY l - LECEMBER 31. l9S3

Maternal & Child Health

j j Infant & Preschool Hygiene ~--S-;;ho;l Hygiene

Morbidity Sorvic

~~ ~~ I ~ - - Q ) - - - - - - - - Q ) - - - - 1

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Cancer Control

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Morgan

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SPECIFIED ACTIVITIES BY COUNTIES: JANUF.RY l - DEC1MBER 31, 1953

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Cancer Control

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Talbot

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110 1047 - 922 8.5 3610 -

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Telfair Terrell Thomas Tift Toombs Towns Treutlen
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Union Upson 1Halker lffalton Ware Vvarren -t'Jaffi ington -\"layne
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Wilcox Wilkes 1Jilkinson Worth

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7 13

37

2 18
I 24 98
I~ 8 12 88

TOTAL

881 2918

SPECIFIED ACTIVITIE.':J BY COUNT'IloS: JANUA11.Y 1 - DEC~lviE.t:,l{ 31, 1953

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LEGEND: ll
0
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FILLED MEDICAL
NURSING SANITATION CLERICAL

BUDGETED

STATE DEPARTMENT
OF PUBLIC HEALTH

DECEMBER 31, 1953

TOTAL PER CAPITA EXPENDITURE FOR PUBLIC HEALTH
-I 9 53-

7,364/ i 15,146

.

1 15 192 .

4,803 ,.-J

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STATE OF
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-. ..- r l r tEE ) \ -r-- J. rt;r"\-sf., f \ i .OU1lT.M7A~N

,
J

~~~~O~H

, 14,314'---, ! TERRECC ' 6,674
I,Q3

9

,........~-L-----{c:

'-/
8,808

i/

14,159

! PUC. . ., -,
I .89 ;'

DOOL't'



1~---.4-7---..J

'> 10 167 \

\
17,865
DODGE
45

> \
.

./..~.~\/-/W6HI '7:31E2R-"\()r~.a"";>''1-,5."~'''/

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TOOMBS
.51

\

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15

// '"'\

\

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1.46

i wl'ccox \.

/

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-,_./

.46 J..l./.

-"

_: -,_T __1_0~_479 >--.....r""": 1a4~Ne-H19IL-L--.

_A' JE9~O,O2V9I.9S

,- 14003
AP;LfNG

' ...._ \ 6,653\
EVANS ... -

~--- j \
'



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\/

939 I_, I.

')-.,_ 5 965 151 481

ATTNALL---;/
.35

.!:.~~ ,, 'RYAN
1. .

1

l

I/ / "-.

8,44

1.. 4

\~ .

'-,/

3 598'- CIIERTY -,_

\oNO '-......2.19

44'I----.6-5-1""'--'1-<--,---,I-'--.-1-9--'{I~

t C.1CA2Y I 8,578 !( 43'617

r'1

----~--:~~~-~~~~:~---~

9

,w3.o55R7T7HI'L.~TU'.61(i3"~2'"2-;-~<I.~I.,_)5_,\0I>III.~39~W:I97._N334r----~-J/' 1I

'

1'' .63 I

L----'I - ' -.,

'I

I 23,961 cof"FEE

i'

8,940 -,

BACON

.,

1

,L_~62 ,~A'-~-. .86

"\ 1.46

).\

,...,\..

.I v----.

MCI.I~~osH 14,248 WAYNE 1.51

"-, , ___ /

/ 6,oo8

\)

! '--1.-' /~_1 17,413 i 5,952

.(

i U~R~C-Y-......J--,

lAKER
.13

/

r

'

22

,528

! ! , ~~~C~; i

MITCHELL
1.08

'~----~-r-.1.i.--.93

)
-1

\\.,-\--~7--3-6,2----~

11112
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13,966
atRAfEN

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124 l _:_ _____\

l,_ I.OI , 30~~,!9 '-..!"..:_~,.;

.

-

-

-). 6,..,

87

IOANTCEY

( oc''"" 4 01
('

l lot ( T \ .J.-A----...---.,~1 I .64 ' I'

.98

t

r-)

I. 74

I .!_!5

! \ ' I ;- . __.____T ____.LL.-r-----,--1

( . 0 \ _;5,151

. ! ?,:..~.~' I
45 !
.( ,:
I . ......

23,620
DECATUR
1.08

'

!'

----........-----J
!

L ....._"(""'" ....J. L,LANIEA
\--- --- Leo

I
,

'
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I 18,928 'I GRAO't'

\
I

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1 1.25
I'

'

1 59

1

'

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I
-
1'

{ 35,211 --\ I

18r11~69 --~--J
5 I . . " I (

J.-1. LOWNDES

1..91

1.68 -" --1

i 2,494 ~--------

i \.

i

ECHOLS

.......

"-

,

2.85

'

': 1

Ii

4,821
CHARLTON

L_ . 2.13

liL - - - - - ,,.

'

!

~1 l 1


LEGEND: 8,579 - POPULATION .69 - PER CAPITA EXPENDITURE

STATE DEPARTMENT
OF PUBLIC HEALTH

PER CAPITA GRANT -IN -AID FOR LOCAL HEALTH SERVICES
BY GEORGIA DEPARTMENT OF PUBLIC HEALTH
(BY COUNTY)

i .20
i CATOOSA;

.20 :..
.......

L

.-

--..TOWNS,,... I. 0 4

STATE OF

i . I 2 4 'l -y j '

;-56 ) .48 L- - - ,~"-

I MURRAY )

WHITfiELD;

_..-

---,
19 \

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,.t\1....-.I~~ ,) RAOUN

J .r-JJ ) "-

.35

! WHITE \

~----'..5'~--"('-" ~ < r 2 5 /\
CHA. TTOO~....../1

,05
GORDON

LUMPKIN \

')

r1

., PICKENS l.lJ.I4 -.....

... --'\,._

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'

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. 1 ! ,;~----r-T1L.--.,..-~~-DA-W-SO-N --1

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( BANKS

.17 '
FRANKLIN {

i .25 ~I .14

.14 . . 17 >,

'

CHEROKEE

I J fORSYTH

'.

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GEORGIA
CALENDAR YEAR - 1953

l 1 ..__,- r-i i
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WARE

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i ..- .....,....J I . .

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! ___\ ___ ! L_J -----~T-'

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.

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!/

STATE DEPARTMENT
OF PUBLIC HEALTH

PUBLIC HEALTH CENTERS IN GEORGIA
LEGEND:
181 EXISTING PUBLIC HEALTH CENTERS
EXISTING AUXILIARY HEALTH CENTERS
0 PROPOSED PUBLIC HEALTH CENTERS
0 PROPOSED AUXILIARY HEALTH CENTERS
IZI0 PROJECTS APPROVED FOR
CONSTRUCTION UNDER PUBLIC LAW 725.

OE:C.ATUA
10

GRADY
0

DECEMBER 31, 1953.

----~~---
i THOMA~ i
~ ! r

Division of Public Health Nursing
,

DIVISION OF PUBLIC HEALTH NURSING ANNUAL REPORT 1953
T HEODORN A. FLOYD DIRECTOR

CONTENTS

FCREWCRD . . . . . . . . . . . . . . . . . . . . . . . . 1
. . . . . . . . DIVISIONAL ACTIVITIES . . . . . . . . . 2
RECRUITMENT TRAINING SUPERVISION

INTER-DIVISIONAL ACTIVITIES . o o o o

16

. . . . . INTER-AGENCY ACTIVITIES . . . . . . . . . . . 19

STATISTICAL DATA OF FIELD VISITS AND IMMUNIZATIONS

BY STAFF NURSES

20

. . . . . . . . . . . . . . WHAT'S AHEAD FOR 1954

. ..

27

FOREWORD
Changes in the general fields of public health affect the work of the nurse members of the team. This necessitates preparation for changes. The quality of performance of each nurse member depends to a large extent on her personal and professional qualifications.
Education, both in-service and extramural, on a continuous basis is one method of preparedness for change in public health.
The diminishing funds for training makes it necessary that better selection of personnel for training be made; more exact evaluation of public health nursing activities following completion of public health courses; and more effective methods of in-service education. This will enable the nurse to render a complete family health service and be better prepared to meet the changing needs in public health.
One hundred years of medical and social progress has helped create the need for more emphasis on the care of the aged. The many problems arising out of the increasing older age group are being partially solved as public health nurses have a part in studying their needs and working with the various disciplines in health, education, recreation, rehabilitation and welfare. Chronic disease, though not confined to the aged, is more common among this age group. It is essential that public health nurses carry out their responsibilities in meeting the needs of this group in their homes, nursing homes or wherever they are found in the community.
Early discharge from the hospital has added to the need to provide nursing care of the sick in their homes.
The American Public Health Association, recognizing a change in the magnitude of the problem of home care of the sick, voted at a recent meeting "to encourage experimentation and evaluation of a wide variety of patterns for providing this type of care."
Rehabilitation is another area in which the need for nursing help is essential. Dr. Howard Rusk says, "Medical responsibility is not met until the patient has been trained to live within the limits of his disability and to the hilt of his capabilities." It is the concept of the Division of Public Health Nursing that nurses need help in developing an understanding of the basic philosophy, goals and tools that are available to them for the rehabilitation of the disabled.
A look at old programs and at nearly emerging ones shows the need for constant study of services and for increasing use of nursing skills in this expanding public health program.
L - 1-

The objectives originally set for 1953 have with one exception been
accomplished.
A study of the public health nurse's use of a day's time was carried out in Fulton County. The methods, forms and techniques established in this study were adapted to a broader program begun later in the year. This later program is known as the program for the better utilization of nursing resources. It includes detailed studies of six counties in order to gain a cross-sectional view of the state's utilization of nursing resources. Eventually the program is expected to be made available to other counties.
Another objective which has won not only state but national attention is the survey of schools of nursing and health departments to combine the efforts of both these institutions to promote basic nursing education.
Still another objective, the rev1s1on of the orientation plans for graduate nurses entering public health, has enriched the field experience of these nurses.
The regional institutes on diabetes and cardiovascular diseases for county public health nurses has had state-wide results. The nurses are better prepared to assist the private physicians in caring for these chronically ill persons.
Participation in a pilot project which was instituted by the Division of Mental Hygiene has won national attention. This is a project to extend supportive service by the public health nurses to families of the mentally ill. These families are very grateful for the sympathy and understanding of their problems.
Looking toward the future of better nursing, one of the greatest needs today in Georgia is more field training centers to give nurses working experience in public health. It is hoped that next year will see progress toward this accomplishment.
RECR UITIVIENT
At the end of the year a total of 503 nurses were employed on the local and state level. This is a gain of 37 nurses over the 1952 total.
During the year there were 94 appointments to nursing positions, 51 resignations, l retirement and 3 deaths. Of the 94 appointments, 21
were public health nurses, 60 were graduate nurses in public health,
12 were public health clinic nurses and l was a nurse midwife. Of the 51 resignations, 24 were public health nurses, 21 were graduate nurses
in public health, 5 were public health clinic nurses and 1 was a public health nurse supervisor.
In 1952, the ratio of population to public health nurse was 7,390 to one. The increased number of nurses in 1953 has not affected this ratio very
much. There is still a great disparity in the distribution of nurses
1 - 2-

according to the estimated 1952 population in the different counties as shown in the table below.
The 18 counties with one nurse to less than 5,000 population are Charlton, Chatham, Columbia, Dougherty, Echols, Effingham, Fulton, Glynn, Jenkins, Lamar, Long, Quitman, Rabun, Spalding, Taliaferro, Thomas, Walton and Wilkinson.
A greater number of counties in Georgia now have nursing service than at any time since the Nursing Division was organized as shown on the map giving the distribution of public health nurses in Georgia.

Population per nurse
15,000/

NUMBER OF COUNTIES BY POPULATION PER PUBLIC HEALTH NURSE, GEORGIA, 1953

Number of Counties~

10

20

30

40

50

60

70

~~;~~~ ,-------,-------,-------,-------~------r~

Less than 5, OO(f.iillm~~illilitt~tf~

J

.\:.______, _ _ _ _J._____, ______, _______..!._______,_- - - - - ' -

o<There are 18 counties in Georgia with no public health nurse

L - 3-

MAP SHOWING DISTRIBUTION OF PU'IiLIC HEALTH NURSES
IN GECRGIA

TABLE I

LEGEND:

c::J No Public Health Nurse IIIIII!ml One Public Health Nurse

~ 2- 5 P. H. N.
tmJ 6 - 10 P. H. N.

-

More than 10 P. H. N.

L- 4

Table IT

GEORGIA
f STATE BoARD kiEALTI-I
T F. SELLERS. H. D. Commissioner ofIleal/It

RATIO o.P . PUBLIC HEALTH NURSES
to POPULATION

L- 5

APPOINTMENTS AND RESIGNATIONS AND
TRANSFER FROM LCCAL TO STATE PARTICIPATING BUDGET
January through December
1953

Alexander, Miss Susan A, Campbell, Mrs. Delphine D. Casper, Miss Elizabeth A. Cook, Mrs. Evelyn C. Cook, Mrs. Sybil Dismukes, Mrs. Lucile Fulford, Mrs. Dorothy Gibson, Mrs. Emilie T. Goodroe, Miss Helen Graf, Mrs. Alice Harrison, Mrs. Patricia Ann Hartley, Miss Sara Laura Johnson, Miss Ruby McCombs, Mrs. Tempie L. Marchant Meyer, Mrs. Annie B. Powell, Mrs. Mary Elizabeth H. Taft, Mrs. Patricia Mae Thompson, Mrs. Thelma G. Tigner, Miss Betty Wade, Mrs. Mary K. Williams, Miss Rebecca Ann
Marraine, Mrs. Isabelle
Abercrombie, Miss Esther L. Adams, Mrs. Fannie Penn Arnold, Mrs. Elizabeth Bacon, Mrs, Evelyn Owens Barnes, Mrs. Emily Ann Coody Bolton, Mrs, Alice G. Brown, Mrs. Fern D. Brown, Nurse Magnolia Louise Bryant, Mrs. Iv;ary L. Carpenter, Miss Betty Ann Cates, Mrs. Judith Nelson Cox, Mrs. Laurette M. Crowley, Mrs. Dorothy B. Dorough, Mrs. Gladys B. Eller, Mrs. Margaret
L - 6-

Fulton County Fulton County DeKalb County Telfair County Tift County Fulton County Wheeler County Fulton County Muscogee County Fulton County Fulton County Carroll County Telfair County Muscogee County Clay County Fulton County Fulton County Pike County DeKalb County Fulton County DeKalb County
Lamar County
Floyd County Clarke County Wilkes County Bulloch County Bleckley County Richmond County Harris County Chatham County Clarke County Cherokee County Muscogee County Taylor County Bacon County Crisp County Fulton County

APPOINTMENTS (Continued)

Fitzgerald, Mrs. Elsie
Floyd, Mrs. Era w.
Forrest, Mrs. Miriam F. Franks, Mrs. Margaret B.
Gray, Miss Amelia z.
Gober, Mrs. Ann T. Greer, Mrs. Leora Quarles Griffin, Mrs. Elfrieda Holton, Mrs. Floye P. Horne, Mrs. Essie Mae Jenkins, Miss Mary N. Johnson, Mrs. Ann K. Johnson, Mrs. Elizabeth D. Johnson, Mrs. Hazel Irene Kendrick, ! urse Ethel Kilpatrick, Mrs. Virginia Kish, Mrs. Helen E. Langford, Mrs. Lucille
Lay, Mrs. Gladys s.
McCracken, Miss Margaret M. Marsh, Mrs. Carrie A. Mazur, Mrs. Lillie P. Milam, Mrs. Hazel L. O'Brien, Mrs. Willa Mae Padgett, Mrs. Daisy L. Palmer, Mrs. Jane M. Pettit, Miss Billie Carol Phillips, Mrs. Elizabeth T. Polk, Mrs, Julia F. Reese, n~s. Lois B.
Reilly, Mrs. Robbie Lee Stewart Rogers, Mrs. Joella W. Ruark, Mrs. Martha V. Shepard, Mrs. Bette Helms Siefferman, Mrs. Phyllis Stafford, Mrs. Eunice H. Stansell, Mrs. Thelma T. Tappen, Miss Cindy Beard Trulove, Mrs. Sarah June Tyler, Mrs. Laura Allen Parsons Wilson, Mrs. Laura J. Withers, Mrs. Elizabeth Wood, Mrs. Hazel E. Woodall, Mrs. Jeanette Youmans, Mrs. Kathryn S.

Fulton County Harris County Colquitt County Franklin County Treutlen County Madison County Clayton County Lamar County Fayette County Fulton County Burke County Dougherty County DeKalb County Floyd County Fulton County Rockdale County Wilkes County Fulton County Fulton County Walton County Oconee County Fulton County Fulton County Lumpkin County Cobb County Dodge County DeKalb County Glynn County Fulton County Dougherty County Richmond County Murray County Bibb County Upson County DeKalb County Long County Floyd County Richmond County Forsyth County Richmond County Elbert County Colquitt County Gilmer County Upson County Richmond County

Bagwell, Mrs. Merle D. Comer, Nurse Freida

L - 7-

VVhi tfield County Fulton County

APPOINTMENTS (Continued)

Dugger, Miss Evelyn Eller, Mrs. Margaret Graham, Mrs. Blanche Henderson, Nurse Elizabeth Hill, Mrs. Lucille V. Rafter, Mrs. Omie Rollins, Mrs. Mary R. Ruark, Mrs. Martha Walker, Nurse Almena Wells, Mrs. Margaret Eliz.

Fulton County Fulton County Fulton County Fulton County Fulton County Fulton County Whitfield County Bibb County Bibb County Whitfield County

;BES I GNAT I.QNS EMPLOYEJLIN

Richeimer, Mrs. Veronica

Muscogee-Harris Poor relationships

Black, Mrs. Billie H. Burgess, Mrs. Jimmie P. Cook, Mrs. Sybil Cooper, Miss Doris Coursey, Mrs. Martha D. Crowe, Mrs. Lucille F. Eidson, Mrs. Doris S. Garner, Miss Ann Gentry, Mrs. Anna M. Goodman, Mrs. Peggy 0. Graf, Mrs. Alice Galt Johnson, Mrs. Ruby M. Lemmond, Mrs. Frances Lewis, Mrs. Frances McCombs, Mrs. Tempie L. Murphy, Miss Mary Evelyn Powell, Mrs. Mary Elizabeth H. Reeder, Mrs. Dorothy Rhodes, Mrs. Blanche W. Shay, Mrs. Barbara L. Taft, Patricia M. Wade, Mrs. Mary K. Wall, Mrs, Sue Agner Weaver, Mrs. Mary W.

Cobb County Fulton County Turner County Fulton County Fulton County Fulton County Bibb County Fulton County Fulton County Lumpkin County Fulton County Telfair County Fulton County Fulton County Muscogee County Fulton County Murray County Tift County DeKalb County Muscogee County Fulton County Fulton County Fulton County Colquitt County

Maternal Family responsibilities Travel distance Unhappy in work Maternal Husband transferred Husband transferred Not known Family responsibilities Family responsibilities Maternal Family responsibilities Marriage Accept other position Health Accept other position Accept other position Accept other position Maternal Accept other position Husband transferred Personal Maternal Moved out of state

L - 8-

RESIGNATIONS (Continued)

Adams, Mrs. Fannie P. Browning, Mrs, Virginia F. Cole, Nurse Martha F. Dukes, Miss Gladys Easterlin, Mrs. Thelma Faircloth, Mrs. Jimmie C. Griffin, Mrs. Elfrieda Hughes, Mrs. Evelyn K. Many, Mrs, Juanita Matthews, Mrs, Martha A, Mazur, Mrs. Lillie P. Miller, Miss Faith D. Face, Miss Wilma Roach, Mrs. Catherine VI. Robbins, Mrs. rf!argaret H. Smith, Mrs. Virginia C. Stinchcomb, Mrs. Geraldine Thompson, Mrs. Olive P. Warren, Nurse Carine B. Williams, Mrs, Betty M. Woodall, Mrs, Jeannette

Clarke County No record

Spalding County Maternal

Chatham County Moved out of town

Bulloch County No recorJ

Crisp County

Illness

Floyd County Maternal

Lamar County Temporary appointment

Richmond County Family responsibilities

Liberty County Husband transferred

Floyd County Accept other position

Fulton County Husband transferred

Wayne County Enter college

Chattooga County Health

Rockdale County Moved out of town

DeKalb County Moved out of town

Long County

No record

Fayette County Family responsibilities

Talbot County Moved out of town

Richmond County Moved out of town

Bacon County Husband transferred

Upson County Family responsibilities

Bagwell, Mrs, Merle D. Dugger, Miss Martha Evelyn Rollins, Mrs, Mary R. Sires, Mrs. Claudia Stillwell, Miss Adalaide

Whitfield County Husband transferred

Fulton County Accept other position

Whitfield County Maternal

Bibb County

Family responsibilities

Fulton County Military service

Tarver, Mrs, Elizabeth

Dougherty County

Ellis, Nurse Marie Quinby, Miss Eliza beth Vickers, Mrs. Valeria Shell

Richmond County Wilkes County Coffee County

L - 9-

Educational Qualifications of All Nurses ------D-oi~ng-_-fu-b-1i-c-H-~a-l-~h-_-Wo-r-k -----
- 1948 1953

194g 1949 l95.Q 1951

. . Number of nurses having no public health education 205

223

206

243

Number of nurses having less

. . . . . . than a year of public health

education





121 112 158 142

Number of nurses having one or

. . . . . . more years of public health

education



lll 135 130 102

l9_2g_ 238 123 131

195'3 254 122 127

Total

437 470 494 487 492 503

Fifty percent of Georgia's 503 public health nurses have had no formal public health education. Although there has been an increase each year (with the exception of 1950) in the number of nurses appointed without public health education, the percentage of those without public health training has not varied too much.
The figures above show that the proportion of about one fourth of the nurses employed having less than a year of public health education and the one-fourth having one or more years of public health education has been rather constant.

TRAINING

There are three plans for orientation, which were established in 1951. Plan I provides for a two months' period of field training, of which one month is spent in an organized health officer county. Plan II provides for a one month period of field training in the home county during which a supervising nurse designated by the Georgia Department of Public Health will introduce the new nurse to the job. Plan III provides for the introduction of the nurse in her home county by the Regional Consultant Nurse and covers a period of six months of less concentrated supervision.
Almost two-thirds of the number of nurses appointed during the year were without experience or training. Of the 60 graduate nurses in public health appointed, 13 had orientation under Orientation Plan I; 4 under Plan II; and 1 under Plan III. 14 nurses who were appointed to positions without direct nursing supervision received no orientation. The remaining 28 were appointed in counties with direct supervision. In the Central Region, 100 percent of the appointments for the position of graduate nurse in public health were oriented under Plan I.

L- 10-

During the year the Orientation Committee made a study of experiences received by the nurses under Plan I from July 1950 through December 1952. It was found that a wide variation existed in the type of experiences received by each nurse. Frequent meetings of the committee and work with regional staff members resulted in a revision of Plan I to provide a fuller experience in those areas felt to represent the basic needs for beginning public health nurses.
To meet the needs of the nurses without academic training in public health and as refresher courses for all others, a program of in-service education to increase the proficiency of the staff has been continuous. The list below shows the types of in-service education which have been used to better prepare the nurses over a period of four years.

Number nurses attending 195Q 19.21 1952 1.253

Care of Immature Infant -
Orientation - - - - - Cancer Institute - - - - - - - Mental Hygiene and Tuberculosis

13

17

7

8

15

13

21

13

6 31

l

Operating Room Technic Tuberculosis - - - Maternity Nursing - - -

--------

l

3

l

Cancer Control - - - -

l

Child Growth and Development

l

Georgia Heart Association Convention - - - -

7

Cardiac Nursing - - - - - - - -

----

6

1

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

2

2

Venereal Disease Control - public health nurses 74

72

51

Venereal Disease Control - students from schools

of nursing - - - - - - - - -

- - - - 195 101

Orthopedic Nursing Body Mechanics

3

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

1

Cardiovascular Diseases - - - - - -

5

Nursing Service Administration in Hospitals

and public health agencies - - - - - - Observation at Milledgeville State Hospital Orientation in Tuberculosis at Battey State

1 8

Hospital - - - - - - - - - - - - - - - -

33

Rehabilitation of the Physically Handicapped-

19

Institute on Diabetes and Cardiovascular

Diseases - - - - - - - - - - - - - - - -

19

Total

319

89 100

L- ll-

One of the major objectives for 1953 was an institute on Diabetes and Cardiovascular Diseases. This was realized with six regional institutes for the public health nurses and other interested personnel on diabetes and cardiovascular diseases in October, These meetings were the outcome of joint planning among many health department personnel who gave wholehearted and constructive support to the objectives of the project. The Dietary Consultant worked intensively on program planning. Nurses were brought up to date on latest methods of diagnosis and treatment, Benefits of the institutes were shown almost immediately in the case-finding and nursing service given to diabetics in Georgia. A total break-down of participants shows:

34 - Staff Public Health Nurses 10 - Public Health Nursing Supervisors
10 - Consultant Nurses
4 - Orthopedic Supervising Nurses
5 - Health Officers
4 - Regional Medical Directors
6 - Regional Nutrition Consultants l - Dietary Consultant
3 - Division Directors
7 - Hospital Nurses l - Industrial Nurse
2 - Visiting Teachers
7 - Private Physicians

Attendance:

Regional and County Nurses

235

Total Attendance - - - - - - - 300

In-service education programs for county nurses have been carried on in each region at intervals varying from once monthly to once each quarter. Members of this division, as well as specialized consultant nurses in other divisions, have participated in these programs on request.

Academic public health education has been limited this year due to the decrease in educational funds. Only ten nurses were granted scholarships for the course in Public Health Education which prepares them for the position of Public Health Nurse - 19. Cne regional consultant was granted a scholarship to prepare for a specialized service. Six other nurses requesting this education had to be refused because of lack of funds.

One nurse enrolled at the college at her expense. Another nurse completed her

degree at her own expense in order to prepare for supervision. Until addi-

tional funds can be obtained it is hoped that others can finance their own

public health education.

J

1 - 12 -

1948 1953

Public Health Nursing - - - - - - - - -

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

Supervision in Public Health Nursing

Maternal and Child Health -

Midwifery - - - - - -

-----

Mental Hygiene

----

Orthopedic Nursing - - - - - - - - - -

Industrial Hygiene

Pediatric Nursing - -

Total

42 35 8 12 26 l
3
l l

9* 15 10
l
l
l

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

43 51 35 9 17 11

*Included was a specialized consultant nurse in Chronic Diseases.

SUPERVISION
The specialized nurses meet with the Divisional Staff each week to discuss activities. Some of the broad outcomes of these meetings are as follows: revision of the bag thermometer technic based on research done at the Communicable Disease Center and a plan for better utilization of nursing skills.
Regional meetings have been held with personnel of each of the branches of public health during each quarter of the year. A member from the Public Health Nursing Division served on the Nursing Section Committee to plan the program. The content of the Nursing Section meetings included: Immunization Committee report; nursing aspects of civil defense; interviewing and recording of pertinent data; film services to mothers, infants and preschool children in Maternal and Child Health clinics; organization policies and functions of Macon Child Guidance Clinic; Rickettsial diseases; tomorrow's public health program; the tuberculosis program at the county level; nursing service projects - their progress and plans; content of orientation; and need for expanded program on orientation.
All the regions were visited during the year. A map showing the distribution of visits to counties and regions by the divisional a~d specialized staffs follows.

1. Attend staff conferences. 2. Conduct survey for bettor utilization of nursing services. 3. Discuss plans for in-service educational programs.

L - 13 - .

4. Evaluate educational programs.
Care of immature infants Orientation programs ?ublic health course V. D. course at Alto Red Cross mother and baby care classes.
5. Give performance rating.
6. Plan programs. 7. Recruit nurses. 8. Make visits to:
Recently appointed nurses New health centers.
9. Accompany U, S. ?ublic Health Service personnel to counties and regions.
10. Assign foreign students.
- 14 -

Table Til

GEORGIA
f STATE BoARD I-IEALT~
T F. SELLERS. H.ll Commissioner ofIleal/It

DISTRIBUTION of' VISITS MADE by GENERALIZED and SPECIALIZED NURSES FROM STATE OFFICE
eviSITS TO REGIONAL OFFICES

This division has worked with other divisions of the Services in promoting generalized public health nursing throughout the state. The director has represented the division to the Advisory Council relative to budgets and the new district plan.
ADMINISTRATIVE SERVICES

This division has continued its work with the Division of Fublic Health Education in preparing news articles on the activities of the public health nurse.

Advisory service was given to the consultant nurse of the Division of Hospital Services at her request, in relation to the establishment of policies, a manual of nursing procedures, workshops and the promotion of joint educational meetings for hospital and public health nursing personnel.

The Director of the Division of Fublic Health Nursing and one of the associates have served on the Advisory Committee, as well as on committees pertaining to policies for establishing priority for training and setting up criteria for selection of field experience centers.
HEALTH CONSERVATION SERVICES

The Division of Public Health Nursing has worked with the Division of Maternal and Child Health in the following activities:

(1) Course in Care of Immature Infant (3) Mother and Baby Care Classes

(2) Midwife Program

(4) Nutrition.

There has been continuous cooperation with the Division of Maternal and Child Health on the committee interested in the care of immature infants at Crawford Long Hospital. The pamphlet describing this course was revised during this year with the assistance of the Divisions of Training, Maternal and Child Health and Health Education.

Conferences have been held with members of the Division of Maternal and Child Health, Health Conservation Services and Division of Local Health Organizations regarding the evaluation of the nurse midwifery programs during the coming year. The plans are that this will be a joint program between the counties, regional personnel and the divisions concerned.
L - 16-

M--ot-h-er--an-d-B-a-b"y "C-ar-e-C--la-ss-e-s
Meetings were held with the Regional Nursing staff of the American Red Cross in relation to conducting Mother and Baby Care Classes in another section of the state. This was in the Southeastern Region where twelve classes were conducted.

Conferences have been held with various members of the Nutrition Unit of

the Division of Maternal and Child Health. A great deal of help has

been provided, particularly in relation to the Chronic Disease Institute

by the members of the Nutrition Unit. Conferences were also held with

the senior nutritionist regarding revision of the Maternal and Child

,

Health record.

The notes of the lectures taken by the nurses from the Division of Crippled Children who attended the two-week seminar at New York University - Bellevue Physical Medicine Center were compiled and distributed to every nurse in the state by the Division of Public Health Nursing.

The Division of Public Health Nursing participated in planning a pilot study in several counties in Georgia. This is a program in which public health nurses offer supportive services to families of the mentally ill. Six counties were chosen by the mental hygiene consultant nurse and the regional consultant nurses. They are Jones, Toombs, Tattnall, Dodge, Johnson and Wilkinson. In preparation for this pilot program, a two-day in-service educational program at Milledgeville State Hospital was planned.

One associate was given the specialized duty of school health nursing in addition to her generalized public health nursing activities. Until the Director of the Division of School Health was appointed July 20, she spent over 50% of her time on the school health program. She worked with the coordinator of the Georgia Department of Health and Education in promoting joint school health meetings at the county levels, participated at the principals' meetings throughout the state and prepared visual aids for the use of the nurses in their school health programs.
LOCAL HEALTH SERVICES
The committee for better utilization of nursing resources worked with the Director of Local Health Services, and county and regional personnel, to prepare an outline to be used by the personnel of the counties selected for the first surveys.
Revision of the Merit System requirements for the position of graduate nurse in public health was worked on with the Division of Fersonnel and the Director of Local Health Services.
L- 17-

This division worked with the Division of Local Health Organizations, the Division of Public Health Engineering and the Nutrition Unit regarding the content of monthly narrative reports.
ENVIRONMENTAL HEALTH SERVICES
Members of this division participated in the Sanitation Short School held at the Georgia School of Technology. The role of the public health nurse in relation to the work of the sanitarian was demonstrated in a dramatic skit.
Real team work was achieved by members of a committee appointed by the Director of Georgia State Department of Public Health to prepare material to be used in an application to Kellogg Foundation for a grant to put on a state-wide program on home accident prevention. Four members were appointed, including the Director of the Division of Public Health Engineering as Chairman; Director of the Division of Public Health Education; Director of Vital Statistics and Director of Division of Public Health Nursing. The work of this committee was successful and a grant was made to the state for carrying on a home safety program. An Advisory Committee to the Home Safety Unit, which is composed of representatives from numerous divisions and services was organized. The nurse consultant on this team was the first member appointed. Her early efforts in assembling materials, conferring with members of various industries interested in home safety and the preparation of guides to be used in the program have contributed much to the progress made in this timely program.
PREVENTABLE DISEASE SERVICES
The increased emphasis on protection against Diphtheria, Whooping Cough and Tetanus with less emphasis on Typhoid immunizstions may be attributed to the work of the Immunization Committee of which the Director of the Division of rublic Health Nursing was a member.
A Cancer Nursing Resource Committee was organized in order to revise a set of home visit guides written last year with the objective of improving the ltNursing Careu content and making them available to public health and other nurses in the state. Nurses from the Visiting Nurse Association of Atlanta, Emory University, Georgia Baptist Hospital School of Nursing, Home Safety Unit and Environmental Health Services participated.
This division and the consultant nurse from the Division of Tuberculosis Control promoted a seminar in the Rehabilitation of the Physically Handicapped at Gallinger Hospital, Washington, D. C. Notes of the lectures were
L - 18 -

combined with those taken by nurses from the Division of Crippled Children who attended New York University- Bellevue Physical Medicine Center, and sent to all public health nurses in the state,
Conferences and meetings were participated in with members of the Division of Venereal Disease Control and members of local health departments on records, practices and the reorganization of clinics,
The Division of Public Health Nursing collaborated with the Division of Chronic Disease Control in offering a diabetes and cardiovascular diseases institute to the public health nurses throughout the state. A complete report of this institute will be found under in-service education.
The duties to be performed by public health nurses in case of disaster were formulated by an associate director of the Division of Public Health Nursing and a consultant nurse from the Division of Occupational Health to be inserted in the manual for public health personnel in civil defense, The Division of Public Health Nursing sponsored a standard Red Cross first-aid course for personnel in the State Office Building.
DENTAL HEALTH SERVICES In the orientation program this service has given the nurses introduction to concepts of Dental Health and community planning.
-INT-E-R-A-G-EN-CY- -AC-T-IV-IT-IE-S
Members of the division have served as officers and committee members of the following state, county and city organizations:
Georgia Tuberculosis Association - Affiliation in Tuberculosis for all student nurses was a major interest.
State Department of Education - Educational program for the practical nurse,
This division was represented on the Fulton County Child Guidance Clinic and Fulton County Health Department Advisory Committee.
The director was a member of the Board of Directors of the Atlanta Visiting Nurse Association. Other members served on the Grady and Crawford Long Hospital Premature Infant Advisory Committees,
L- 19 -

SCHOOLS OF NURSING, GEORGIA
The Division of Public Health Nursing works with graduate nurses and students both in institutions and nursing groups to promote public health education.
The director has worked with Emory University to promote rural field experience for student nurses, and the University of Georgia to plan curriculum of the new University of Georgia School of Nursing.
A manual for the use of school of nursing and health department personnel was prepared and distributed by this division, The objectives of the survey were to look at some of the types of activities carried on jointly by schools of nursing and health departments in the interest of basic nursing education and to analyze philosophies, responsibilities, and ways of working in the future.
STATE AND NATIONAL NURSING ORGANIZATIONS
There was amalgamation of the six national nursing organizations into three; the American Nurses Association, the National League for Nursing and the American Association of Industrial Nurses. For the first time a section for the public health nurse in the National American Nurses Association was formed. Members of this division served as officers and committee members on these national and state organizations.
FEDERAL AGENCIES
The director of this division served as member on the State Council of Directors of Public Health Nursing. She is also a member of the Advisory Committee of the American Red Cross Nursing Service.
Since January 1953, when the new policy on immunizations became effective, there has been a 90,364 decrease in the number of Typhoid Fever immunizations completed for the year. This is only about one-fifth of the 95% reduction it is estimated could take place and not affect the incidence of the disease. There has been an increase of 11,666 in the number of triple vaccine immunizations given over 1952.
The map showing the provisional estimated number of births and number of triple vaccines given to children under one year by the health department staffs shows a need for a still greater increase in the number of immunizations of infants against Tetanus, Pertussis and Diphtheria.
There has been an increase in the number of home visits in tuberculosis, morbidity, cancer and crippled children's services during the year, but a decrease in the number of field visits in the other services. The map showing the admissions and field visits of prenatal, postnatal, infants and preschool cases will give a more complete picture in that service for the year,
L- 20-

J!!!!J!Jdni~.ti.QU.21.
- - - - Smallpox - - - -
Diphtheria Triple Vaccine D.P.T.
- Pertussis - -
Typhoid Fever
Total

1942

191)0

1951

1952

19.22

88,434 83,399 85,776 92,844 84,935

27,607 19,049 15,180 13' 121 7,300

41,315 53' 886 66,802 86,457 98,123

0 14,246 11,953 11,570 7,320

419,633 438,178 442,167 472,641 382,277
---- ------ ---- ----- -----
590,398 608,758 621,878 676,633 579,955

Fie1g,_Visits:

126:2 1950 1951 1952 1953

Communicable Disease Control 19,339 18,037 19,907 15,871 10,431

Venereal Disease Control - - 45,905 41,155 37,061 27,387 19,292

Tuberculosis Control - -
- - Maternity Service -

50,411 60,166

52,332 55,172

59,064 58,138

59,849 57,518

60,898 56,216

Infant and Preschool Hygiene 93,293 90,092 103,384 118,279 116,087

School Hygiene

42,726 20,755 25,409 28,701 27' 253

- - - Morbidity Service -

-

15,814 23,015 22,041 22,760 29,418

Cancer Control

1,143 1,366 1,722 l, 839 2,068

Crippled Children's Services

2,787 3,393 5,096 9,057 11,928
----- ---- ----- ----

Total

331,584 305,137 331,822 341,261 333,591

1 - 21-

Table N

GEORGIA
STATE BoARD { ~EALTI-I
T F. SELLERS. H. D Commissioner ofIleal/It

.\
NUMBER ofl BIRTHS" ESTIMATED NUMBER of TRIPLE VACCINES UN[;)ER I YEAR
ADMINISTERED by PUBLIC HEALTH PERSONNEL

T-able v_

GEORGIA
f STATE BoARD ~ EA LTI-l
T F. SELLRS. H. Q Commissioner olllealllt
T

NUMBER of ADMISSIONS of ANTEPARTUM CASES
NUMBER of HOME VISITS to ANTEPARTUM CASES

Table

GEORGI!\
f STATE BoARD I-IEALT~
T F. SELLERS. H. D. Commissioner of Ileal/It

.'

I

NUMBER o ADMISSIONS of POST PARTUM CASES

NUMBER o.f' 1-\0ME VISITS to POST PARTUM CASES

Table W

GEORGI/\
f STATE BoARD I-IEALT~
T F. SELLERS. H. D. Commissioner ofIleal/It
T

A NUMBER o- ADMISSIONS o~ INFANTS
NUMBER of HOME VISITS +o INFANTS

.'

I

Tab\e WI.

GEORGIA
f STATE BoARD J...IEALT~
T F. SELLERS. H. D Commissioner of1/ea/lh

.'

I

NUM&ER of PRESCHOOL ADMIS510NS NUMBER of HOME VISITS to PRESCHOOL

WHAT 1S AHEAD FOR 1954
Complete county surveys. Evaluate the courses in Venereal Disease Control given at Alto. Cooperate with the Division of Training to increase number of counties to be used as laboratories for orientation and field experience for new nurses. Make plans for providing supervisory personnel for new regional program. Follow-up on Institutes on Diabetes and Cardiovascular Diseases.

\.
ENVIRONMENTAL HEALTH SERVICES
Home Safety Unit Division of Industrial Hygiene
(Including Occupational Health)
D, ivision of Public Health Engineering Division of Typhus and Rodent Control Division of Water Pollution Control

Home Safety Unit

ANNUAL REPORT HOivlE SAFETY UNIT ENVIRONJVillNTAL HEALTH SERVICES GEORG U DE.PARTllENT nF FUilLIC HEALTH ATlANTA, GEORGIA
1953

I . PROGRESS

The Home Safety Program for the State of Georgia was inaugurated
on August l, 1953, with the employment of Hrs. lVladelyn H. Davis) Nurse
Consultant. In October Hr. Robert H. Alden, Public Health Education
Consultant, and lVlrs. Aielaide C. Cooper, secretary, were employed. Hiss
Edith Petrie, statistical clerk, whose office is with the Central Sta-
tistical Unit, was added to the staff in November. nn December 7, 1953,
the organization was completed with the employment of Ivir. H. C. Steed,
Jr., as Engineer-Director. Offices of the Home .::>afety Unit were established under EnviroTh~ental Health Services, Mr. Roy J. Boston, Director.

At the beginning of the Home Safety program in Georgia, the Nurse Consultant worked alone for a period of about two months. During this period she spent much valuable time orienting herself to the job and conferring with other members of the State Health Department staff in acquainting them with the problems of home safety as they related to other fields of public health. Much time was alm spent in conferences with outside organizations interested in safety, such as Parent-Teacher Association groups, local Safety Council, Better Health Council, Federated ~vomen 1 s Clubs of Georgia, and others. Several visits were made to local health departments to discu~s the problems involved in the Home Safety program.

When the staff was increased, conferences with other health personnel and outside organizations continued, and more detailed work was done in the establishment of a library of educational materials to be used by the Home Safety Unit in its program.

In November all members of the Home Safety Unit attended the nrientation Conference on State Home Accident Prevention in Chicago. The Engineer-Director was able to attend this conference with the other members of the Unit prior to his reporting to the Unit in December.

Following the arrival of the Engineer-Director, steps were taken to complete the organization of necessary committees to work with the Home Safety Unit.

Considered of more immediate importance was the formation of the Unit 1s ll.dvisory Committee. This interdepartmental Advisory Committee was appointed by Dr. T. F. Sellers, Director, Georgia Department of Public
Health, and includes the fo1lowing:

Hr. Roy J. Boston, Chairman, Advisory Committee

Dr. Helen Bellhouse, Director, Division of Haternal and Child Health

Dr, C. D. Bowdoin)

11

11

11 Venereal disease control

l'....L

Hiss Theodora Floyd, Director, Division of Public Health Nursing

JVir. L. H. Lacy,

II

II

II Vital Statistics

Hr. Dr.

H. L.

L. H.

Parker Petrie,

'

II II

Dr. s. c. Rutland,

II

II

II Industrial Hygiene

II

II Occupational Health

II

II local Health Organizations

Dr. Hildred E. Scott, II

II

II School Health

Hr. G. H. Stenhouse, II

II

II Public Health Education

Dr. J. H. Venable,

II

II

II Training

The Home Safety Advisory Committee meets at periodic intervals to review plans of the program and offer assistance to the Unit.

To be organized in the near future is a Technical Cornrnitt ee with representatives of such fields as advertising, education, insurance, law, press, and welfare. Also to be formed is a Coordinating Committee, to consist of Health and/or Safety Chairmen from various state civic organizations.

The following is a breakdown of activities of the Home 0 afety Unit for the period of this report:

Statistics:

The Home Safety Unit worked in very close cooperation with the Central Statistical Unit of the State Health Department, collecting, tabulating and analyzing statistical information on home accidents. Prior to the establishment of the Home uafety Unit, the Central Statistical Unit had been sending out follow-up forms on all home accidental deaths and tabulating the information received therefrom.

During the last week in September, the Central Statistical Unit began compilation of all fatal home accidents recorded in Georgia during 1950-52. This study has been completed and mimeographed and has been distributed to most regional and local health departments of the state. Copies were also distributed at the Chicago conference in November.

Steps are now being taken to improve the quality of information gathered from the National uffice of Vital Statistics Home Accident Fatality Report Form. This "Will te done by sending these forms to local health departments for follow-up on deaths occurring in their areas rather than sending the form to the informant named on the death certificate.

Progress has been made in the establishment of a pilot study area and a control area in the state, in which the problems of home accident prevention can be more closely studied on the local level. Conferences have been held in several county health departments where a desire to participate in such a study has been indicated. The job of designing forms to be used in such a study area is nearly complete and the necessary steps in getting such a study under way have been outlined.

A form for the collection of home accident injury information on all Health Department personnel in the state has been completed and will e sent out immediately. The purpose of this ~ove is to obtain morbidity information on a cross-section of the state s population, "I'Jhich will number

H2

approximately 7,500, to acquaint all Health Department employees with Home .Safety, and to carry out the adage that we should "practice what we preach." It should also be beneficial in determining the usability of a volunteer type of report form.
Education
All members of the Unit have been carrying on a concerted program of inservice education, designed to acquaint health workers in the state with the magnitude of the home accident problem in Georgia and the role
of the Health Department in home accident prevention. A panel discussion
on the home accident prevention program was held with personnel from the state central office and regional health offices, at which time they were familiarized with the work of the Unit. The feasibility of integrating this program into other phases of health work was discussed at this meeting. The first of five scheduled conferences was held with the field staff personnel of the Central Region of the State Health Department during the period of this report. Remaining conferences for other areas of the state will be completed during February and March.
Many visits have been made by members of the Unit to local health departments for the purpose of discussing ways of integrating home safety into their established program. This has been a learning process for the Unit, as well as the county personnel. Many suggestions have come from the local level.
In summing up the phase of inservice education, it should be noted that a great deal of work has been done during this period and will continue to be done until all health workers in the state have been familiarized with the need for home accident prevention and how the Home Safety Unit will be able to assist them.
Progress has been made in the designing and collecting of educational materials to be used in Home Safety activities. A file of Home Safety material, such as pamphlets, brochures, checklists, posters, etc., received from other agencies in the country doing home safety work has
been established. A bibliography of such materials has been compiled for
the use of local health departments. Before the material is placed on the bibliography list, it is evaluated as to its usefulness in the Home uafety program. hany films have been previewed and those that the Unit felt were valuable in this work have been placed in the film library for general distribution to local health departments and other agencies interested in using them.
Follo1-ling is a list of the materials that have been or are now being prepared by members of the Home 0 afety Unit
a. A Nursing Manual Supplement on the subject of home accident prevention is being prepared.
b. A poster on Georgia's home accident problem has been prepared
for use in displays and exhibits by local health departments and other interested groups. This poster has already received considerable distribution in the state.
MJ

c. News releases throughout the state have been used in the development of the program.
d. Articles have been prepared for the Department of Public Health publication, "Georgia 1 s Health, 11 which is distributed throughout the state.
e. The preparation of a packet containing formula, outline and materials for setting up a local health department accident prevention program has been started.
The cooperation and help of many organizations, both official and unofficial, outside of the Health Department have been solicited, and steps are being taken to coordinate all of the work in relation to home safety into one uniform purpose. Organizations that have been visited are as follows:
State Department of Education, State Commissioner of Safety, Regional Office of the U. S. Public Health Service, University of Georgia, Emory University, National, State and local P.T.A. groups, Atlanta Traffic and Safety Council, Better Health Council, Federated v\[omen Is Clubs of Georgia, Georgia Division of the American Automobile Association, various Industrial Nurses 1 Clubs in the state, Civil Defense organiz~tions, Business and Professional vvomen 1 s Clubs, and others.
Su1nmar.v
In summarizing the progress made to date by the Home Safety Unit, it should be remembered that the Unit was not fully staffed until December 1,
1953. However, in this short time definite progress has been made in the
areas of inservice education and the preparation of informational materials for use by local health departments. vve believe that the ground floor has been laid for a productive Home Safety Program in Georgia.
II. PLAN FOR 1954.
Now established and on a firm footing, the Hom2 Safety Unit plans to develop and expand its general aims of accident prevention in the State
of Georgia. During 1952, 651 persons died from home accidents in Georgia and, from all indications, the 1953 death total will not be appreciably
reduced.
A. Personnel:
The Home Safety Unit staff is complete, with the possible exception of the addition of a key punch operator, scheduled to be employed in approximately six months if the need arises.
3, Objectives of the Home Safety Unit:
1. To reduce to a minimum, fatalities and disabilities resulting from accidents occurring in the home.
2. To demonstrate the desirability of continued state parti0ipation in home safety.
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C. Methods of Attaining above Objectives:
l. oecure information regarding environmental hazards, incidence of nonfatal accidents.
2. Stimulate public interest and activity.
3. Cooperate with other agencies and organizations.
4. Prepare educational materials.
5. Motivate public health personnel to integrate Home Safety into
entire program.
D. Implementation of the Program:
l. Jtatistics (Epidemiology): lViore emphasis will be placed on the statistical phase of home
safety during the coming year by the following:
a. Continuance of tabulation and analysis of home accident mortality data obtained from death certificates, and follow-up report on the NOVS form by regional and local health departments.
b. Setting up reporting, tabulating and analyzing system for home accident morbidity data, beginning on a local basis with the future objective being to obtain statewide reporting.
c. Selecting demonstration areas in the state in which program plans can e tried and studied. This will require the design of a survey for the study areas and selected control area, the implementation of this survey, and alse tabulating and analyzing the data collected in this survey.
d. Continuing to work with local health departlliLlents to stimulate and assist them in establishing their own home safety programs.
E. Education:
In the coming year the educational aspect of the Home Safety program will be increased to meet the demands for assistance from local health departments and to put into use the information received from pilot studies that will be started. Following is a breakdown of points to be emphasized during the coming year:
l. Health Department
a. Participate in orientation of all new personnel.
b. Maintain active interest in all phases of public health and devise ways of inserting home safety measures into each.
c. Continue inservice education programs relative to home safety.
d. Prepare home safety manual supplements for each, public health discipline.

e. Provide visual aids covering all phases of causation and prevention of homeaccidents.

f. Give consultation to local personnel on preparation and channeling home safety information, and operation of Home Safety program.

2. Official and Voluntary Agencies

a. Learn existing interest and stimulate increase of interest by:

(1) Attending meetings and using every opportunity to participate on programs.

(2) Promote organization of local safety councils made up of representatives from these agencies.

(3) Provide 11 technical 11 information and program suggestions related to home safety.

3. Civic Groups:

a. Promote addition of safety to the health committees.

b. Provide consultation on safety to health committees

c. Suggest special projects relative to.home safety.

4. Other Community Resources:

a. Schools

(1) Work closely with school health and safety committees in arousing interest and coordinating program.

(2) Interest schools in keeping records of children injured at home as well as at school.

(3) Encourage school children (possibly through F.T.A. and other club projects) to do home safety surveys.

(4) Work with educators (all levels) to incorporate home safety education into the curriculum.

b. Industries

(1) Approach management and enlist interest in program.

(2) vJork with health and safety committees to include home safety education in their existing programs.

(3) Work with Industrial Nursing Organization and with individual nurse in industry to solicit their aid in:

employees.

(a) Promoting home accident fact-finding surveys by

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(b) Doing home accident prevention education as part of health counseling and through group education programs. (Educational materials, check lists, etc., will be provided by the Home Safety Unit.)
F. Evaluation of Program: l. At the end of each year the effectiveness of the program will be
evaluated according to: 11.. Statistics: (l) Analysis of mortality and morbidity records will reveal:
(a) Change in rates of occurrence. (b) Need for change of emphasis (Example: Concentration on one age group necessary when shown to t e fewer in incidence.). (c) Effectiveness of recording methods and changes needed. b. Interest: (l) How program is received by Health Department personnel.
(a) How well demonstration areas are functioning. (b) Number of requests from local health departments for help in organizing own home safety program. (c) Amount of participation on educational programs, both in Department and other agencies and groups. c. Education: (l) Difficult to evaluate unless: (a) Reflected in reduction of accidents. (b) Extent and effective use of educational material (visual aids, films, etc.). G. Summary:
In general, the chief aims of the Home Safety Unit for 1954 will
be to (l) set up at least two pilot studies in local health departments, (2) continue to urge local health departments to establish their own home safety programs, (3) obtain as much information on injuries due to
home accidents as possible, and (4) devise means of evaluating the effectiveness of the Home Safety Program. We look to 1954 as the year
Home Accident Prevention comes into being in Georgia.
M7

Division of Industrial Hygiene
(Including Division of Occupational Health)


A~'E'JU kL lllAf:R,lTIVE H.LPORT DIVISIONS OF INDUSTRIAL HYGiiNE
AND OCCUPATIONclL HEALTH GEORGIA DEPARTL;ENT OF PUBLIC H~ALTH
January through December, 1953
For many years it has been realized that the community in which we live presents problems of public health to all those who live in such an area. These health problems result from the forces of the community environment impinging on the inhabitants, both individually and collectively. The community has the responsibility for providing certain safeguards to protect the public health. For example, it is accepted without question that the community must be provided with a safe and wholesome drinking water. Facilities for disposal of sewage must be provided. In certain areas the control of insects is required in order to prevent the spread of diseases such as malaria. Other environmental problems of public health are recognized and properly controlled. Most of these involve application of certain engineering principles in order to adjust the living environment to the point where it is suitable for human habitation. In certain world areas today, where these environmental control techniques for the protection of public health are not in force, one can see the development and spread of epidemics and uncalled-for human waste which accompanies these conditions.
It has now become clear that the working environment in which the average individual spends one-third of his time may also present health hazards. Many times t:1ese are much more complex than generally realized. Recognizing this fact, modern industrial management has come to assume the responsibility for providing health safeguards in the industrial environment in order to make that area a satisfactory working place. The study, investigation, evaluation, and control of the working environment is an activity commonly known as Industrial Hygiene.
In addition to the environmental forces in the community and in industry mentioned above, we must also consider the individuals exposed to the health hazards of these forces. Industry has a moral and legal responsibility for protecting the individual from the industrial hazards. But industry also shares in the humanitarian and economic advantages to be gained from protecting the worker from the general community health hazards. The part which industry plays in study and control of the worker exposed to these health risks is called Occupational Health.
The objectives of occupational health and industrial hygiene are to discover, define, evaluate, and control those environmental factors in an industry which affect the health, well being, and efficiency of the workers and to teach the workers to protect themselves from all known health hazards. In order to accomplish this, it is necessary to have an understanding of the man his physiology and his emotions; and his relation to the tools with which he works, the materials upon which he ',,'orks, and the physical and chemical properties of the viorking environment.
Nl

INTRODUCTION

The implementation of such a program as outlined

above requires a well-trained staff of professional

personnel. The Division of Industrial Hygiene is

fortunate in having such a staff comprised of a Division Director, two

engineers, four chemists and one stenographer. This staff, although

administratively separate from the Division of Occupational Health continues

to operate as a team with its co-division. This latter Division has an

Acting Medical Director (who is also the overall Director of the Preventable

Disease Services), two consultant nurses, and two stenographers. One of the

stenographers is responsible for work from the Preventable Disease Services

and for Civil Defense stenographic activities.

Even with the well-trained staff available in the Divisions there are occasions when it is necessary to request the services of specialists from the Public Health Service and other allied Federal and State agencies. These services are freely available to us upon request, and with their assistance it is possible to evaluate most health problems.

There are more than 5,000 factories and 15,000 mercantile establishments in Georgia. More than 800,000 non-agricultural workers are employed. It has been estimated that possibly less than 10% of these workers enjoy the benefits of an in-plant health maintenance service. This lack of health protection throws an added burden on the Divisions' program. The Local Health Department is the official agency specifically charged with the responsibility of assisting these establishments and their employees in all health matters. Assistance from the State Health Department is available to local industries only through their local health department.

ENGUJEEHING AND

In carrying out the program for improvement of

CHE,tiCAL ACTIVITHS environmental sanitation in industry, Industrial

Hygiene personnel made investigations in a wide

variety of industries during 1953. As an example, personnel from the

Division made studies in foundries, paper mills, textile mills, paint

companies, poultry processing plants, granite and other stone quarries as

well as sheds and crushing plants, Army, Navy, and Marine installations,

an aircraft assembly plant, many County Health Departments, Doctor's offices

and others much too numerous to mention.

Since the inception of the Industrial Hygiene Unit of the Fulton County Health Department, it has been the policy of the State Industrial Hygiene Laboratory to carry out laboratory work for this county unit. This assistance was continued in 1953.

Since assuming the responsibility for the laboratory phase in the enforcement program of the Bedding and Mattress work of the State Health Department, chemists in the Industrial Hygiene Division have assisted the mattress inspector in a large number of investigations of suspicious bedding materials.

EVALUATION OF X-RAY CLINICS AND SHOE FITTING FLUOI~OSCOPES

A program for evaluating the health hazard in the use of shoe fitting fluoroscopes was initiated in 1951. This program has been continued to date. It has been possible to make preliminary surveys of
N2

these devices in most of the installations in each of the 5 health regions.

DUST STUDES AND

Considerable amount of effort was spent evaluating

STON:S CRUSHING

the severity of tha dust hazards in a number of

INDUSTRI.GS

granite crushing plants in the State. As a result

of these studies improvements have been carried out

which materially reduce the exposure of these operations.

LABOHATORY AoSIST!-\.:TCE TO Ti-J:E ATL ,IJT A VET2RANS ADl:iiNI STRATI ON HOSPITAL

The laboratory of the Industrial Hygiene Division has been able to assist the Veterans Administration Hospital in evaluating numerous cases of suspected lead poisoning.

ACTIVITIES IN THE

On numerous occasions Engineers from the Division

AIRCTIA?T ASSELIBLY

have been called on by the Safety Director in the

PLANT, MARIETTA, GA. Lockheed-operated Aircraft Assembly plant in

Marietta to assist in evaluating a wide variety of

hazardous operations in the plant.

OCCUPATIONAL

In carrying out a phase of the program begun in

DISEAS~S

1951, the Divisions have spent more and more time

following up occupational disease reports submitted

to the Divisions through the Workman 1 s Compensation Board of the Labor

Department. r.1any of the occupational disease reports received did not

require follow-up evaluation, but reports that were in any way suspicious

were followed up when possible and, in several instances, led to surveys

of plants that would otherwise have been postponed until some later date.

EDUCATIONAL

It has been the policy to encourage educational

TRAINING

training in advanced phases of Industrial Hygiene

work. In this connection the Director and one

Industrial Hygienist took a month 1 s training in radiological health at the

U.S. Public Health Service school at the Environmental Health Center in

Cincinnati, Ohio,

One of the Industrial Hygienists also completed a year 1 s advanced graduate study in Industrial Hygiene at Harvard University.

Another Industrial Hygienist spent tv10 and one-half months studying radiological survey methods under the auspices of the U.S. Public Health Service and the Atomic Energy Commission at the Nevada Proving Grounds.

GEORGIA SSCTION,

The Industrial Hygiene and Occupational Health

M.LJUCc.1J INDUSTRIAL Divisions continue to be active in the affairs of

HYGI2NE ASSOCIATION the Georgia Section, American Industrial Hygiene

Association. During the year several members of

the Divisions served as officers in the Association.

N3

GEORGIA PUBLIC

Several members of both Divisions were representatives

HE:\.LTH ASSOCIAT:LON

at the annual meeting of the Georgia Public Health

Association and 111ere actively engCJ.ged in committee

work and in making speeches.

VISITORS

During 1953, a total of 25 visitors have been guests
of the two Divisions. Two states and fourteen foreign countries were represented.

SOUTHRB r;JEDICAL

The medical director read a paper 11 Provision of

ASSOCIATION

Medical Services for Small Industries 11 at the Annual

meeting in Atlanta. The two divisions cooperated

in presenting an exhibit on radiation monitoring, which has resulted in

several requests from private physicians for assistance in evaluation and

control of their personal X-ray installations.

INDUSTRIAL HEALTH

The Acting Medical Director assisted in initiating

COUNCIL OF GREATER

the organization of the Industrial Health Council of

ATLANTA, INC.

Greater Atlanta, Inc., and in formulating its

objectives, one of which is to promote and sponsor

health education programs in industry. The council was established in

January of 1953 and a pilot study in health education was made in an

Atlanta industry for eight months. A detailed report of this study is

available upon request.

PR.t:VEl!TIVE HEALTH

The Division of Occupational Health has always

ivlAINTENAHCS SERVICE3 advocated health programs in industry. Our ovm state

FOR STAT~ :SJ;PLOYEE3 employees are 'Ni thout such a service. Plans for such

a center however, are included in the proposed new

State Office Building now in the ground-breaking stage. The program will

consist of: case-fihding, referrals to private physicians, health counsel-

ing, health education and health supervisioni emergency treatment for on-the-

job accidents and illnesses.

DEPA.Far.f~lJT AL AND

Through continued cooperation with the Division of

DIVI3IOBAL INTER-

Public Health Nursing, newly employed nurses, during

ACTION

their orientation period, are introduced to the field

of occupational health, In the visits to the two

Divisions, they are given an understanding of the ways in which the county

health department personnel can most effectively serve the industries in

the community.

The Divisions of Occupational Health and Industrial Hygiene presented a program at the Quarterly Meeting of State and Regional Personnel in January. This was the first opportunity that the overall work, aims and problems relating to Industrial health and productivity had been presented in such a program to this group.

It has been observed that, as a result of this approach and \lith the cooperation of the Division cf Local Health Organizations and Regional personnel, much better use is being made of the

N4

Occupational Health and Industrial Hygiene services in the local health departments over the state.
The Vocational Rehabilitation Division of the State Department of Education joined our Divisions in presenting a one-day program on Occupational Hoalth and Vocational Rehabilitation. Many outstanding medical authorities, other interested agencies and individuals came together for this program.

CONSULTi\.NT

One of the consultant nurses with this Division

NURSING ACTIVITIES

served as President of the Georgia Association of

Industrial Nurses. One nurse v1as Publicity Chairman

of the Association. Through their efforts and in conjunction with the

Association (GAIN) and the Department of Nursing Education, Atlanta

Division University of Georgia, a three-day Occupational Health Work

Conference was held. Conference registrants included industrial nurses,

educators in schools of nursing, administrators in hospital nursing

services and others interested in Occupational Health. Numerous pre and

post conference meetings \Jere held concerning this Occupational Health

Work Conference. A complete report is available upon request.

All industrial nurses in Georgia continue to receive the quarterly "Industrial Spotlight", sources of educational materials and other-helpful materials and suggestions. New nurses particularly avail themselves of this service.

Numerous planning and action meetings with other agencies and nursing organizations were participated in by the tiJO consultants.

Schools of Nursing continue to call on the nurses for isolated lectures on industrial nursing. It is hoped that much progress nill be made toward the integration of Occupational Health in the basic nursing curriculum 11ithin the next fevJ years.

OBJ.GCTIV:2:S FOR

In addition to a continuation of routine services,

1954

it is planned to emphasize the following:

l) More intensive follow-up of previous recommendat-

ions for control of environmental hazards; 2) An intensive effort will te

made to survey the usage of radioisotopes in the state; 3) Further

investigations into the hazards of X-ray devices in hospitals, doctor 1s

offices, and in industryi 4) Further investigations are contemplated in

the relation of Kaolin dust to pulmonary disease; 5) Extended investigations

of the degree of hazards presented to agricultural workers through the use

of organic phosphorus-containing insecticides; 6) Health Education Programs

in industry patterned after that as outlined by the Industrial Health Coun-

cil of Greater Atlanta, Inc., vJith promotion of the formation of similar

councils in other industrial communities; 7) The integration of occupational

health in the basic curricula of schools of medicine and nursing.

NS

TABLE I

GEORGIA~~
SUlJj]V]ARY OF INDUSTRIAL HYGIE:NE AND OCCUPATION'\L H:::SALTH ACTIVITBS

January - December, 1953

. . . . . . . . . . Number Establishments

. . . . . . . . . . . . . . Number of Workers

. . . . . . . . . . . Number of Plant Visits



.



295

117,567

360

. . . Reason for Service: Self-initiated Request:

. . . . . . . . . . . . 209

Hanagement

39

Labor Local Health Department

.. 4



66

Private Physician

29

. . Insurance Carrier
Other

1
. 14

. . . . Occupational Disease

Follow-up

"

32 29

. . . . Type of Service Given: Promotional

No. Plants

No. of Services

100

114

Environmental Surveys 71

Technical Studies

133

. . .

89 174

Nuisance Complaint 6

6

Appraisal of Hedical Department 0

Investigation of Occupational Disease. 34

Examination of Plans Health Tests

. . 13 8






.. .. .. ...

.
.

..

..

0
48 15
8

Consultations Regarding:

. . . \rJorking Environment



. . . . . Health Service

. . . . . Feeding Service

66
71 6

. .. .. .. . . . .

90 109

9

Improvements Recommended

No. Plants

No. Recom..

. . Working Environment.

60

. . Health Service

42

. . Feeding Service

1

mendations

. . . ... 154
. . 71 l

.


No. of ~Jorkers
. .Affected 3,867
. . . . 5,424

Improvements Carried Out:

\rJorking ~nvironment
. . Health Service
. . Feeding Service

9 26
0

. . .. 21 32
0



.. .. .. . . . .



1,075 5,320
0

. . . . . Specific Services: Chest X-rays



















0



Blood Tests



Samples for Laboratory Analysis

Field Determinations o o

Occupational Disease Cases Investigated

Physical ;:examinations o o



Lectures o o o

o

Literature Distributed

o



. . . . . . . Heetings

0





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

~~Exclusive of Fulton County in 1953

N6

5,941 431
565
1,137 87
0
1
4,867 10 179

TABLE II
NUNBER OF PLANTS S3RVED BY TW~ DIVISIONS OF INDUSTRIAL HYGLSNE AND OCCUPATION.L'.L H:::.:ALTH
A~ID
TYP~S OF S':i:RVICE RSNDSRED~~
January - December, 1953

. . Tot2.l Number Plants . . . Number of Ne1-T Plants . . . . Number of Old Plants . . . . . Out-of-State Plants ,

..


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

....

. ..

....

.

..

.

.

.

.

.. .

...

.

.

..

. .

...

....

...

.

295 137 155
3

. . . . . . . . . . . . . Nu:1ber of Plants 11eceiving: IIedical Service







0





0

NursinG Service .

.

112

~ngineering Service

.

248

Laboratory Service

48

Feeding Service

2

Other ,

16

Population in New Plants , , ,

Total Counties Served

, , ,

Total Plants Served (1941-1953) .

Total Number Counties Served (1941-1953)

Total Number Employees receiving Service (1941-1953)

10,913 61
1,844 137
413,926

~;- :Sxclusive of Fulton County for 1953.

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TABLE III

CLASSIFICATIOF OJ:i' LABORATORY 1\.NALYSES

January - December, 1953

CONTAI1INANT

Acroleins



Acidity Alkalinity

Ammonia




Arsenic, Biol.



Barium

Butyl Acetates



Chlorides



Chlorinated Hydrocarbons

Cholinesterase

Chromate





Copper, Biol.

Coproporphyrins

Cyanides

Dusts Fluorine





(Fluorides)

Qual.

. Formaldehydes, Atmos.
Free Silica

Lead, .~tmos.

Lead, Biol.

Lead, Blood

Lead, Urine

Lead, Hisc.

. Hethyl Alcohol



l'lethyl =:thyl Ketone



l1ercury, Biol.

Phenols

Solvent





Standardization

Tetryl



Toluene, Atmos.

Xylene



Zinc, Atmos.



Zinc, Biol.





TOTALS













Samples from Industrial Plants

Experimental

TOTALS

3

3

6

7

31



2



7 31 2

2

6

2



54 20



.. '

20

5

16





1

8 2
54 20 25 16 1

';l.

21

21

4

4

488





4



6



488

4

6

82



46

82 46

5

5

256



256

447



447

9

9

45



12



63

1



45

12



63 1

3



697

4

4





9



2

3 701
4 9 2

32



1





32 1

2369

44

2,413

TABLE IV BEDDING LliJ :CNFORC.2l'i.':NT ACTIVITIES JULY 16 through DECErlBER 31, 195'3
Field Deter~inations 275
Plant Inspections . 314
Retail Outlet Inspections 573 Miscellaneous Investigations 68
LABORATOHY ANALYSES:
Ammonia 22
Urea 21
Formaldehyde. 5 Oil 7
N9,

Division of Public Health Engineering

PUBLIC HEALTH ENGINEERING
The Division of Public Health ;:.:;ngineering has the responsibility of administering the program of Public Health Engineering, including the assignment of duties, the technical supervision and review of all activities of the engineering and sanitation personnel, the coo~dination of the program with other divisions and services of the department, and the establishment and maintenance of cooperative relationshi~s 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 growing function of federal, state, district, county, and municipal government which has as its purpose the improvement of sanitation and the 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 (1) 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 jurisdiction of the Division are set forth in condensed form in the following summaries:
Hilk Sanitation
The mil~ sanitation program conducted by the Georgia Department of Public Health continues to be essentially that of assisting local health departments to carry on satisfactory milk se>nitation programs at the county level.
There were three major phases of the milk sanitation program during
1953, namely:
l. Acting as a liaison between national agencies, such as the United States Public Health Service and the 3A Committee on Dairy Dquipment Standards, and regional and local health departments. This phase of the program consisted
mainly of interpreting the 1953 United States Public
Health Jervice Ordinance and Code for regional and local health departments, the inspection and certification of milk supplies for interstate shipment, and the obtaining and application of 3A Standards to cleaned-in-place milk pipe lines.

2. Jerving in a liaison manner between the Division of Laboratories and regional and local health departments. Some 15~000 (approximately) milk samples are submitted to the Division of Laboratories to be examined for bacteria content, excess water, foreign matter, butterfat, total solids, and efficiency of pasteurization~ In many instances this division has , called upon to interpret the significance of the results. Also, continuous records of these reports are maintained in this division. Not infrequently has a tabulation of these results indicated a failure on the part of local health departments to submit samples at frequent intervals and/or a weakness in enforcing the Grade A requirements of the Ordinance by the official in the community responsible for the milk sanitation program. The results of this work have been generally gratifying.
3. Rendering assistance to regional and local health
departments consists of two major phases, advisory service and m2terial assistance.
In an advisory capacity the following services are rendered:
a. Training of personnel.
b. Promoting the adoption of a uniform and nationally recognized "milk ordinance.
c. Providing uniform interpretations of local milk ordinances.
d. Providing adequate record keeping forms.
e. Providing modern and practical dairy barn and milk house plans. This is accomplished through close cooperation with the Agriculture Extension Service of the University of Georgia.
f. Reviewing construction and remodeling plans for pasteurization plants.
g. Testing efficiency of pasteurization equipment.
h. Haking of milk sanitation surveys to determine efficiency of local milk sanitation progr2ms.
i. Advice and encouragement relative to good enforcement of local milk ordin~nce.
j. Provision of local departments with all survey ratings in order to promote the movement of good milk from one community
02

to another.

Material assistance to local health departrrents is rendered primarily through the use of two mobile milk laboratories. The interiors of two modern house trailers have been remodeled to accomodate only laboratory equipment. Each unit is staffed with one well qualified milk sanitarian who devotes full time to pasteurization plant and dairy farm inspections. Also, a well qualified laboratory technician devotes full time to the collection and analysis of milk samples. These mobile units and the operating personnel are stationed zt, 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 scmita.tion progrC~m. This is evidenced by the fc;_ct that both the milk industry and the local depc.rtments have continually mPde requests beyond the capacities of the Division for this service. The Georgia Department of Public Health remains a leader in this phase of milk sanitation. During 1953, the units were st01.tioned at Cairo, Quitman, Thomasville, Athens, Eatonton, Augusta, Douglas, ~lberton, Lawrenceville, Bainbridge, Tifton, ~1Jinder, Nadison, Waycross, VJashington, and Camilla, Georgia.

Accomplishments:

New milk sanitation programs were initiated under the direction of the Local Boards of Health in Coffee, Elbert, Gwinnett, and Appling Counties. This placed an addition2.l 1,500 (approxill12tely) gallons of milk under the close supervision of local health departments.

The first cleaned-in-place pipe lines were installed in Georgia during 1953~ There are many unorthodox and one orthodox method of installation~ Because of close supervision of this Division, the installations in this state have been installed according to nationally recognized standards and have functioned as they should. If such was not the case, these lines would of necessity hdve to be disapproved by local health departments at a very great financial loss to dairy farmers.

Grade A milk is essentially milk which is protected from contamination by disease organisms a.nd other foreign matter. This requires healthy animals, sa[e water, adequate sewage disposal, hot water, screened milk houses, etc. 2.nd proper use of the same. Adequate fClcilities and proper use can only be determined by dairy inspections end lebor2tory analyses of milk samples. The following statistics revec>.l the t the personnel of this Division was very actively eng2ged in protecting the milk consumed by the citizens of this state.

Inspections

3,208

Barns and/or milk houses :r:;<'dnted

285

ltllk houses screened or screens repaired

232

13

vJater heaters provided

5

Toilets constructed or repaired

146

1:vater supplies protected

170

Herds tested

41

Laboratory analyses of milk samples

3,673

Excess water, which was a major problem in 1950 and 1951, vms brought under control in 1952, but was even les~ of a prob~em in 1953. This
was due to very close supervision by this Division and local health
departments.

Twenty-eight corrnmimities now enjoy "Honor Roll" listings by the U. S.
Public Health 0ervice. Said listings indicate a very sc.tisfc:.ctory
milk program. There were 22 such listings in 1952.

Outstanding Problem:

Pasteurization plant operators in many instances have been unable to control coliform content of pastem'ized milk and milk products. Local health departments have been slow to revoke permits due to viol~tion of this requirement. This is true because the coliform requirement is relatively new and, at best, it is difficult to revoke the permit of pasteurization plants. However, it appears that the major problem in milk sanitation in this state is that of excessive coliform organisms in pasteurized milk and milk products.

It is contemplated that the milk sanitation program conducted by the
Georgia Department of Public Health will be conducted on an equally
high level during 1954, and that the consuming public can continue to
enjoy every confidence in its milk supply.

Food Sanitation

The level of the food sanitation program in the Division has been altered considerably during the past year. This activity has to do with the s~fety, quality, and aesthetic aspects of food consumed in Georgia. The primary concern is that food is safe for human consumption, and that the application and interpretation of public health food sanitation programs be uniform and in keeping with the highest possible standarEl.s,
The most important function rendered by the Division on food sanitation is the advisory service to sanitation personnel in the local 2nd regional health departments. This service primarily involves restaurants, bakeries, markets, and grocery stores as well as itinerant restaurants, school lunch programs, hospital and institutional food service operations, plant feeding, interstate carrier catering points, equipment Pnd materials of construction, etc.
The food sanitation program is associC1.t3d with every phase of environmental health. The broad concept can be be illustrated by the outline listing of major activities in this field:
04

I. Consultant Services
A. Promotional:
l, Promote the adoption of standard uniform regulations.
2. Conduct standard uniform programs.
3. Promote adequate record keeping. 4. Promote organization of restaurant
associations.
B. Services to Regional and County sanitation personnel~
l. Serve as clearing house for current problems.
2. Furnish advisory service on problems,
3. Frovide standard inspection sheets,
copies of ordinances, and other materials.
4. Develop educational materials
through joint planning,
5. Present broad policy and recommendctions
on technical phases of food sanitation.
6. Preview, recommend, and assist in
securing current films,
7. Conduct research on specific problems.
8. Assemble a comprehensive file on technical information.
9. Aid in planning educational programs.
10. Evaluate the effectiveness of local programs.
II. Training
A. Food sanitation personnel:
l. Indocrination and orientation of new personnel,
2. Joint planning of in-service training programs,
3. Lectures to and discussions with
groups of regional and local personnel.
05

B. Food Service Personnel:

l. Assist in promoting, planning, and conducting Food Service Personnel Conferences on local level for commercial establishments (including operators and employees).

2. Assist in promoting, planning, and conducting Food 3ervice Personnel Conferences for employees of State institutions (including public schools).

3. Thirty-three such programs were conducted in 1953.

C. Others:

l. Lectures on hospital and food service sanitation.

2. Indoctrination of other health department personnel in food sanitation activities .

III. Evaluation and Inspection Services

A. School Lunch Program.

B. Maintenance of adequate records.

C. R.eview of school lunch facilities in plans for new school buildings.

D. Inspection of interstate carrier catering points.

E. Surveys of local food sanitation programs (21
official surveys were made in 1953).

IV. Liaison and Correlation of Food Sanitation Program with
Activities of

A. Other divisions of the State Department of Public Health:

I

l. Epidemiology.

2. Nutrition.

3. School Health Services.
4. Hospital Services.

5. Local Health Organizations.

6. Public Health Education.

06

7. Training.
8. Civil Defense.
B. State Department of Education:
l. S~ocl lunch program.
2. School building services.
c. u. s. Food and Drug Administration:
1. Crab meat industries.
D. u. s. Public Health Service.
E. National Sanitation Foundation.
F. Professional organizations.
G. Industry groups.
H. Manufacturers and Distributors of equipment, materials, and services.
I. Other organizations.
School Sanitation
A greatly accelerated school construction activity stimulated the organization of procedures leading to a systematic review of sanitation elements in school plant developments throughout this program during
early 1953. Through joint planning and mutual cooperative assistance
between the Department of Public Health, the Department of Education, and the' School Building Authority, the following practices were found effective in obtaining better sanitation in Georgia's schools.
I. Sites: Proposed improvement programs for school systems were obtained from the Department of Education. Reports on sites were then requested from the regional offices concerned. These site reviews covered topography, water supply, sewage disposal information, soil characteristics, swamp areas, accident hazards, noise, smoke, fumes, and off-site sanitation considerations. The number of schools
for which site studies were made during 1953 is 484. In
many instances, several sites were considered for one school so that the number of sites actually reviewed is
considerably in excess of the 484 sites reported.
These sites were reported to the Department of Education for their use in evaluating and approving proposed school locations. The report was also routinely used in reviewing sanitation features of school plans.
II. Criteria: Sanitation criteria were revised and expanded to cover several areas of school sanitation not covered
07

in previous releases, This revision was distributed to practicing architects and engineers eng~ged in school planning. These design features have received extensive application and are now used, with modification, in construction other than schools.
III. Plans: Plans for 220 school buildings were reviewed for sanitation features during 1953. This plan review service comprised a complete review of the sanitation elements of working drawings and specifications. A written critique was issued on each set of plans and discussed with the designing architect or engineer. Reasons for each criticism were given and methods of correction were suggested. When corrections were made, the final working drawings and specifications were resubmitted and again reviewed. vvhen found to be in compliance with standards, a letter of approval was issued, Items routinely reviewed included:
A. vvater supply: Proximity of municipal water mains was considered and connection to such supply obtained whenever possible. This procedure enabled extension of water service lines in many cases, affording water service to residential areas previously served by individual wells.
vvhen private supplies were necess?_ry for school water service, plans .:md specifications for development of these supplies were reviewed, In many cases, geological data for guidance in well drilling procedures was requested and obtained from the Department of Hines, Lining, and Geology,
B. Sewage disposal: Insistence on connection to public sewers wherever prectical resulted in many extensions of sewers through previously unsewered areas, Where public sewers were not available, each individual system was carefully checked against previously published criteria. Soil studies were required at each site as a basis for design of subsurface absorption fields,
C. Plumbing design: The American Standard Plumbing Code 1tras adopted for use in areas where local plumbing codes do not exist.
D. Cafeteria: School cafeteria plans and specifications were reviewed for compliance of design, materials, and equipment with the Standard Ordinance and Code Regulating "~ating and Drinking Establishments. Specific attention was given in each case to wall and floor finishes, hot water equipment, dishwashing equipment, serving counters, built-in cabinets, storage room ventilation, rodent proofing, insect protection, toilet and levatory fixtures and locetion, and garbage storage. Other miscellaneous items were
08

reviewed as the occasion arose.
E. Health Rooms: Plans for Health Rooms provided in new schools were reviewed for adequacy of size, ventilation, and lavatory and toilet facilities.
F. Toilet Rooms: The pupil-fixture ratio developed by a joint Education Depart~ent-Health ~epart ment study of a few years ago was revised and released as a part of the sanitation design criteria mentioned earlier. Each school's toilet facilities were reviewed to determine compliance with these joint standards. During the latter part of the year, Lducation Department architects relieved Health Department engineers of this detail because a change in fixture requirements usually necessitates a change in architectural design.
IV. Construction: By. notifying the regional offices of work authorizations on school contracts, an early working liaison with the .:ichool Building Authority's job representative was established at each construction project. Through this representative, assistance and guidance through the construction phase was offered by regional and local sanitation personnel and an inspection schedule outlined. Arrangements were made for a report of these inspections, including a statement of approval or disapproval of water supply, sewage disposal, and cafeteria to be sent to the School Building Authority for incorporation into their records and for such action as they deemed appropriate.
Tourist Courts
In 1953 there were 904 tourist courts, including trailer parks, registered
with the 3tate Department of lublic Health. Inspection reports and per-
mit applications were received from 766. There were 586 found to be in
compliance with regulations and these were issued an operational permit. Principal violations of regulations were found in the following categories:
(l) inadequate fire protection, 90; (2) defective gas heater venting, 63; (3) insanitary waste disposal, 43; (4) inadequate toilet facilities, 42; (5) unapproved water supply, 38; (6) unapproved trailer park facilities, 25; (7) substandard housing, 17; (8) inadequate maintenance, 16; and (9) defective plumbing, 13.
The November session of the 1953 Legislature enacted a law requiring all
tourist courts, trailer parks, and tourist homes to obtain an annual permit from the State Department of Public Health. The law also authorizes the State Department of Public Health to prepare regulations governing the issuance of such permit. This act was signed by the
Governor on January 5, 1954.
It is anticipated that the inclusion of tourist homes will increase the
number of establishments to approximately 3,500.
09

Happing and Photography
New sanitary survey and basic maps were made for a number of towns this year. Other city and town maps were revised to include additional area which had been annexed and sanitary fecilities platted. Revisions vwre also made to county maps to bring them up to date. Copies of these maps were furnished the State Office and local health departments for use as required for public health purposes. County outline maps of the state were made to show the location and density of specific disease problems such as rabies, tuberculosis, etc,
Hany copies of maps were ordered by engineering firms, utility firms, and various official agencies, A charge was mPde for these prints to cover the cost of printing.
Other layout and drafting work includes personnel organization charts, civil defense planning, graphs and diagrams show;i..ng trends in diseases, architectural and mechanical drafting.
Photographs were made of public health activities for all of the divisions. Contact prints, enlargements, and lantern slides were furnished as requested. Exhibit materials were made for work shops, group meetings, and the annual convention of the Georgia Public Health Association. Aerial photographic enlargements were made to exact size for use in preparing sanitary survey and mos~ic maps. All multilith film negitives for the Print Shop are now made by this section.
Housing Sanitation
3uburban development around practically all of the larger cities continues unabated. This is particularly true of development in the counties of Chatham, Cobb, Clayton, Dougherty, DeKalb, Fulton, Bibb, and Huscogee,
The development of new subdivisions without public water supply and sewerage is discouraged as much as possible. vvithout legal jurisdiction much of this is accomplished with the cooperation of the Federal Housing Administration and the Veterans Administration. These agencies rely on approve>_l by the health department of all individual water and sewage disposal systems They also require developers to obtain the approval of the State Department of Public Health for community water supplies and the use of individual sewage disposal systems in subdivisions which do not have municipal sewers available-
In the review of subdivisions submitted to the Division for review and approval, it has been possible in many instances to obtain new sewer lines and thus avoid the use of septic tanks on individuPl lots,
During the year there have been 7,387 septic tnnks bufr.lt under he.s.lth department supervision, 7,058 at homes, 47 0t schools, and 282 2t other public places. In the s81Tle period there were built 871 privies, 792 c-t homes, 24 c:t schools, :>.nd 55 at other public places. Ivlore thc.n 850 privies were repaired end made to comply with health departmcmt str>ndo.rds,
010

Hospital Sanitation
Certain phases of hospital sanitation have been delegated to the Division of Public Health ~ngineering by the Hospital Services Division. All of the sanitary aspects of water supply, sewage disposal, food handling, and milk supply at hospitals and nursing homes are involved.
Physical inspections are made by county and regional sanitation personnel. The reports are received, recorded, and reported to the Hospital Jervices Division by this Division. This arrangement provides for coordination of this work with the general sanitation program, making it a part thereof.
The addition of the better equipped, better staffed Hill-Burton hospitals has resulted in many of the small clinics being closed. A considerable number are still operating, but in time these will no doubt find it better business to combine their facilities. A tremendous improvement has been made in food handling at hospitals as well as the sources of milk supply..
Shellfish Sanitation
The shellfish sanitation program is a joint operation with the Coastal Fisheries Division of the Jtate Fish and Game Commission provided by law, in which each agency has a certain duty and responsibility. The health department is charged with all health aspects. These are set forth in the regulations of the .__-;tate Board of Health which apply to the oyster growing areas, setting forth the waters from which oysters may not be taken because of pollution; to the shucking houses, their equipment and the sanitary handling, preparation, and shipping of oysters; and the oyster gatherers, their health and equipment.
The first step is the designation of the polluted areas from which shellfish may not be taken except under special permit. Due to shortage of personnel in the Water Pollution Control Division's water laboratory, it was impossible to initiate needed check surveys during the year. It is planned in the coming year to assign one of the mobile milk laboratories to do the water tests and assist in collecting samples from selected areas of the coastal waters temporarily.
During 1953 twelve shucking houses were certified to the U. S. Public
Health Service for inclusion in the semi-monthly listing of shucking and packing plants as meeting the requirements for interstate shipping. One plant~ engaged in breading and quick-freezing oysters,was certified as a reshipper.
Assistance was given throughout the season to owners and operators of shellfish plants in maintaining necessary standard of construction and operation.
011

Halaria Prevention and Insect Control

By a combination of circumstances, malaria has ceased to'be a major public health problem in the stat.e, or for that matter in the United Jtates. ~o one f2ctor can be said to be responsible for its disappearance. It would be very unwise, ho1rwver, to assume at this time that there will never be a recurrence of the disease. So long as there remains a favorable environment, continued production of the insect vector (Anopheles quadrimaculatus), and the possible introduction of infected individuals to begin the cycle of man-to mosquitoto man, there will be a possibility for its reintroduction.
The major safeguard on vector control is in the impounded water regulations of the State Boe<.rd of Health. The increased tempo of the Soil Conservation Service in developing farm stock watering ponds, the building of fish ponds, the construction of dams for maintenance of ground water levels, for irrigation and recreation, the harnessing of rivers for navigation, flood control, and hydroelectric development have multiplied the lakes many times. It has been estimated that there are now as many as 30,000 lakes, ponds, and pools in the state,

Impounded Waters

Impounded water permits were granted to 537 individuals end agencies during 1953. These were largely farm ponds and water holes constructed
for stock watering pur~oses under a farm practice of the Production and Marketing Administration of the U. 3, Department of Agriculture. This agency requires as one condition for conservation benefit payments that the client must possess <:m unrevoked permit from the .State Department of Public Health. Credit should be given here to the excellent service and cooperation rendered the client and the state by the 3oil Conservation Service personnel. 1 Were it not for this basic guidance and assistance in construction and conditioning it would be difficult indeed for the local and regional sanitation personnel of the health departments having jurisdiction to cover this important phase of public health engineering.

The increased development of hydro-electric impoundments has required incre~sed vigilance of the Division. The construction of the later impoundments has usually been such as to require a minimum of control for mosquito breeding.

The impoundments of the Tennessee Valley Authority particularly, such as Blue Ridge, hear the town of Blue Ridge in Fannin County, Chatuge, near Hiawassee, and Nottely, near Blairsville, are outstanding examples of good construction and maintenance.

Other reservoirs under surveillance of the Division include:

Georgia Power Company

Flint River, at Albany Lloyd ohoals, near Jackson Bartlett 1 s Ferry, near Columbus Sinclair Lake, near Hilledgeville

Georgia Light & Power Company Spring Creek, near Bainbridge

012

Crisp County Power Commission Lake Blackshear, near Cordele

U. 3. Engineers

Allatoona, near Cartersville Clark Hill, near Pugusta Jim Woodruff, near Bainbridge Buford, near Buford

The Georgia Power Company reservoirs, the Crisp County Power Commission's Lake Blackshear, and the U. 3. Engineers' Clark Hill Reservoir are all being larvicided under contract with D.D.T. by airplane.

Considerable controversy has arisen regarding clearing requirements set
up by the 3tate Board of Health and U. s. Engineer Corps plans for
clearing the entire basin of the Jim :,voodruff Reservoir. With present
thinking of federal engineers there is considerable doubt of satisfactory clearing being done on approximately 4,000 acres in Georgia and 3, 000 acres immediately adjacent thereto in Florida. This will probably
result in serious mosquito control problems in the future.

The Crisp County Power Commission has permitted the entry and growth of considerable areas in water hyacinths and parrot feather. This was pointed out to them and some steps have been taken to control present infestation and prevent additional spread of these objectionC'ble aquatics.

Residual Spray Program

This progr~~ ifi~ugurated in 1945 for destruction of adult mosquitoes
entering homes, for the purpose of interposing one more barrier between malaria carrier and well people through the bite of infected mosquitoes,
was operated in ten counties during 1953. Twenty-five thousand homes
were sprayed with a D.D.T. emulsion. This is the last season this program can be furnished under supervision. Some insecticide and equipment left over will be offered to counties caring to conduct programs entirely on their own resources and direction.
At the end of the mosquito breeding season all insect control operations of the Division, with the exception of that involving impounded waters or drainage programs reqUlrlng engineering consultation, have been transferred to the Division of Insect and Rodent .Control.
welfare Placement Sanitation
The State Department of Public Vvelfare, through its Child Welfare Consultants, relies upon the Division to make reco:t_nmende>.tions on sanitary conditions at homes which propose to adopt or board children.
Local and regional personnel are requested to make the physical inspections of such homes reporting on such items as water supply, sewage dispose,l, screening, insect and rodent infestation, garbage disposal, vaccination of dogs, milk supply including testing of cows for T.B. and Brucellosis, and general cleanliness of premises.
The Division receives the information and interprets the results to the vvclfare Department

013

Nuisances The Division has always been a clearing house for complaints of all kinds, concerning environmental conditions. Quite often these result from clashing personalities and the solution is difficult, but the abatement of nuisances through mutual understanding results in more lasting correction and a better way of living.
014

Division of Typhus and Rodent Control

DI VI S I 0 N 0 F T YP HUS ~ ND R0 DE NT C0 NTR0 L * GEORGI~ DEPhRTN!ENT OF PUBLIC HEh.LTH
l.~.NNUJ~.L REPORT .CA L E NDA R YE A R 1 9 5 3
Roy J. Boston, M. s., Acting Director
Harry C. Essick, Insect and Rodent Control Consultant (USPHS) Harold B. Hayes, Jr., Field Supervisor - Insect Control (USPHS)
Clifford J. Jessup, Refuse Collection &Disposal Consultant
*In November, 1953, name changed to Division of Insect and Rodent Control P-1

DIVISION OF TYPHUS AND RODENT CONTROL
b.NNUliL REPORT
Calendar Year 1953
The services of the division personnel were rendered primarily in an advisory capacity to State Health Department regional and county health department sanitation personnel. Direct services in local areas were rendered by county health department sanitation personnel where available or the State Health Department regional sanitation personnel. In addition, the division ~orked closely with the Communicable Disease Center, U. S. Public Health Service, and other federal and state agencies and voluntary groups concerned ~ith typhus fever and/or rodent control activities in Georgia.
Due to the reduction in assistance from th~ Communicable Disease Center, U. S. Public Health Service, activities in the state-wide typhus and rodent control program were either curtailed or eliminated, as discussed elsewhere in this report. Federal assistance consisted of assignment of personnel equipment and materials.
Typhus fever reached an all-time peak incidence of 1256 reported cases during the calendar year 1943. The reported incidence of the disease decreased slightly until the end of the year 1945 during which year 1,111 cases and 59 deaths were reported. Immediately following the year 1945, the incidence of the disease decreased sharply, reaching an a~l-time low level of 32 reported cases and 4 deaths during the year 1952. However, in 1953 a slight increase was experienced for the first time since 1945. During this year 41* cases and 2*- deaths were reported, an increase of 28% over the number of reported cases for 1952. Graph No. 1 illustrates the sharp decrease in the number of typhus fever cases reported in Georgia for the nine-year period of 1945 through 1953. Eight counties reported two or more cases of typhus fever in 1953, as compared with five counties in 1952. The largest number of cases reported in any one county during 1953 was four cases in Lanier County.
Seventy-one percent of the total number of cases reported for the state during 1953 were from the area south of Augusta, Macon and Columbus. In 1952 87% of the total number of reported cases for the state were from this area.
Of the 41 cases reported in 1953, 36 were white, five colored. White males accounted for 53.7% of the total cases reported for the state. Table No. 1 sho~s the reported number of murine typhus fever cases by color, sex, and age during the calendar year 1953. The largest number of the reported cases in 1953 was in the 50-59 age group, as compared to the 10-19 age group during 1952; and 30-39 age group for 1951; and 10-19 and 30-39 age groups for 1950.
As a result of the reduction in the number of federal personnel assigned to the State Health Department by the Communicable Disease Center, U. S. Public Health Service, for typhus and rodent control, only two federal
*Provisional Figures P-2

employees rem~ined on ~ssignment to this division ~t the end of 1953, as compared "'i th 79 federal employees assigned to this division in 1945. Of the
t~o remaining federal employees, one is on assignment to the division principally for typhus and rodent control ~ctivities and the other for malaria and insect control activities. Further indications are that all federal personnel on assignment to this division by the U.S. Public Health Service ~ill
be terminated by the end of June, 1954.
At the close of the calendar year 1953, the personnel of the division
consisted of an acting Director (State) ; Insect and Rodent Consultnnt(USPHS);
Field Supervisor-Insect Control (USPHS) ; Refuse Collection & Disposal Con-
sultant (State); and a Stenographer (State). On the local level, there were
43 employees in 17 counties employed in typhus and rodent control activities.
During the year, 34* meetings ~ere attended by the division personnel
for the purpose of discussing typhus and rodent control measures. In addition, about 335 ne~spaper articles pertaining to tvphus and rodent control <:ictivities were published throughout the state
.l pamphlet describing the use of Warfarin (rodenticide) for the eradication of rats mas prepared, of which more than 16,000 copies were distributed. .Utogether, approximPtely 23,600 pieces of literature, as part of the division's activities, were distributed during the year.
[EDERAL PBQEERTX
l~t the request of the Communicable Disease Center, U. S. Public Health Service, a gradual reduction in the inventory of federal property on assignment to Georgi11 for insect '3.nd rodent control purposes was inaugurated. Forty motor vehicles, principally trucks, were declared surplus. Of this number, fourteen were donated to local health centers for public health purposes by the federal government. The remaining number of federal motor vehicles are in the process of being released.
Investigations during the year involved: li. Environmental investigations of reported typhus fever cases. B. Rodent investig11tions.
Environmental investigations of reported typhus fever cases consisted of inspections of home premises, employment premises and premises at places visited 1/'ithin a :two-VTeek period prior to the onset of illness to determine the presence of rat infestation. Concurrent 1~ith these inspections, premises showing evidence of rat infestation ~ere treated ~ith DDT dust to control the r~t ectop~rasites. Occupants were requested to treat their premises with poison bait for the destruction of rats. In several instances, where indicated, for the purpose of determining VThether or not typhus-infected rats mere present in the area, rats were trapped, and blood specimens taken from the rats vrere form11rded to the labor1:1.tory of the Communicable Disease Center, U.s. Public Health Service, Chamblee, Georgia, for examination. These l11boratory
P-3
*Figure includes region11l
personnel up to October 1, 1953

ex~min~tions aided the StA.te regional and local health departments sffilltation personnel in effectively controlling typhus fever in the rat population by concentrnting appropriA.te rat control measures in those areas in which t,Yphusinfected rats were trapped. However, this phase of the inves~igative program was greatly curtailed, in comparison with previ~us years, due to the reduction in the number of federal employees on assignment to the Typhu~ and Rodent Control program.
The Lowndes County "Typhus Eradication Demonstration Project" was term-
inated on July 1, 1953, due to the discontinuance of federal allocation of funds for this purpose. This project was started in September, 1952 for the
primqry purpose of studying the feasibility of eradicating typhus in the rat population by means of rat eradication. The project v11as sponsored by the Communicable Dise'lse Center, U. S. Public Health Service, the LoPndes County Health Department, nnd the Georgia Department of Public Health. Inasmuch as this project w~s only in operation about nine months, the results obtained were insufficient to make a signific'lnt evaluation of the project. During the time that the project was in oper$J.tion, field reports showed th11t traps
mere set on 834 premises and 1382 rats ~ere trapped. The results of the laboratory examinntion of 800 rat bloed specimens showed that 3.3% or 26 speci-
mens mere positive to the murine typhus complement fixation test, thereby indicating the presence of murine typhus antibodies in the specimens.
Rat eradication measures consisted of treA.ting 366 premises with DDT dust, using about 1,511 pounds of DDT dust material and treating 487 premises with poison bait, using about 2,730 pounds of bait. The poison used in
preparing the bait was warfarin.
The surveys of rat ectopara~ites, carried on in previous years as part of the investigative phase of the control program to determine the efficiency of the DDT dusting crews in applying DDT dust to rat runs and harborages,
vereeliminated from the program during the year 1953.
hccording to field reports received during the year, 51 counties participated in rodent control activities. Of this number of counties, 17 had a total of 43 employees engaged in this activity.
12121_12JJ..:ting DDT dust was first used in the Georgia Typhus Control program during the
latter part of 1945. Over the period of years, DDT dust (10% strength) has
proven effective in controlling the rat flea vector ef Murine Typhus Fever. ~ide-scale use of DDT dusting of rat runs and harborages was greatly reduced
during 1953, as compared with previous years. Reduction in the use of DDT
dust was due primarily to the low incidence of typhus fever ~nd, to some extent by the reduced staff of typhus and rodent control personnel in the
local health departments. However, during 1953 a total of 38,343 pounds of DDT dust was used in 41 counties in treating 10,103 premises.*
Ra.:t_]:,rad],_s:~ti.Q.U
Local health departments, placing more emphasis on the rat eradication
phase of the rodent control program, treated about 25% more premises* with poison bait in 1953 than during the preceding year.. Warfarin, due to its
safety and effectiveness, continued on the increase as the choice of
P-4
l<-E<J.ch time a premise was treated it mas recorded as one tre'l.ted premise, even though it had been treated previously.

rodenticides for preparing poison bait. Warfarin mixed bait was first used in the state-wide program in 1950 and since that time has gradually replaced the use of Sodium Fluoroacetate (Compound 1080); ANTU (alphanaptholthiourea); Phosphorous; and Arsenic, as rodenticides in the Georgia program.
!>- total of 75, 03'9 premises* were treated with 158,4 71 pounds of poison bait and 309 pounds of poison gas.
RatP,!QQfl!lli During the year 1953, 132 building establishments were ratproofed, as
compared to 87 during 1952. These results were reported from the City of t~.tlanta project.
Ref~~-Coll~ct];Qn_~g_QiPOal
The sanitary storage, collection and disposal of refuse is a permanent method for the control of insects and rodents. The source of fly and mosquito breeding, the harborage and food supply for rats in a community, may be largely attributed to insanitary storage of refuse on premises and insanitary disposal of refuse by the community.
The sanitary landfill method for disposal of refuse has gained popularity among communities as the preferred method of sanitary refuse disposal. Since the beginning of the state-wide iFphus control program in 1937, more and more emphasis has been placed on this sanitation activity by local officials, civic organizations, and other interested groups. Manufacturers of earth-moving equipment have in recent years recognized the importance of this field of sanitation and have devoted a considerable amcunt of interest toward the manufacture of machinery for this purpose.
Increased emphasis was placed on this activity during 1953, as compared with previous years. During the fall of 1953 a series of sanitary landfill demonstrations were conducted throughout the State, at which time all types of earth-moving equipment of the track type were utilized.
In preparing for the demonstrations, several preliminary meetings were held 111ith state and local public health groups, to work out the details for the proposed demonstrations. In addition, all dealers in Georgia selling this particular type of earth-moving equipment were invited to meet with representatives of the Georgia Department of Public Health in l~tlanta on July 20, 1953. The result of this meetinp was that all dealers agreed that the demonstrations of the landfill method of refuse disposal should be conducted in all five public health regions of Georgia, namely: Northwest, Northeast, Central, Southwest, and Southeast, with the exception of the Central Region in which two demonstrations would be held. Following this meeting, representatives of this division visited the state health department regional offices, local health departments, and certain cities, which had been selected as possible places in which to hold the demonstrations, and discussed the proposed program with municipal officials and representatives of civic organ}zations. The demonstrations were scheduled as follows: Cartersville, Sept. lst; ~thens, Sept. 3rd; Statesboro, Sept. 8th; Waycross, Sept. lOth; ];.lbany, Sept. 15th; and Fort Valley, Sept. 17th.
It was also agreed among equipment dealers that only two pieces of equipment (on~ of the larger type tractors and one of the smaller type tractors) would be used in each of the landfill demonstrations. The dealers not participating would have their equipment on display.
P-5
*Each time a premise was treated it was recorded as one treated premise, even though it had been treated previously.

Publicity and educational materials vJere prepared and handled by the Division of Public Health Education. Prior to the series of demonstrations, a news release announcing the purpose, time and place of the proposed demonstrations was prepared and ma~led to more than 201 daily and weekly newspapers in the State; to each radio station in the State; and to all local health departments. Tape recordings of outstanding features of each demonstration were used by radio stations in host cities. Following each demonstration, home-town news stories ~ere mailed to every city represented at each demonstration. Photographs were taken at all demonstrations and made available to State Health Department regions and local health departments for newspaper publicity and other purposes. &11 programing ~as under the direction of the Division of Training. Members of the staff of the Division f Typhus and Rodent Control participated in the original promotion and supervision of demonstrations.
Each demonstration began at 9:30A.M. with registration of visitors. The program consisted of an address of welcome by the local mayor; a lecture on "Medical Importance of Sanitary Disposal of Garbage" by the regional medical director of t~e Georgia Department of Public Health or the local Comm. of Health; a lecture on "Economics of Sanitary Landfill OperR.tion" by an engineer; and a lecture on "Engineering Problems of Landfill Operations" by an engineer. Following the lectures, several movies were shown which illustrated the sanitary storage and collection of refuse and sanitary landfill operations.
During the afternoon, the actual demonstration of the construction and operation of a sanitary landfill took place. This, in part, included digging the landfill trench, dumping and compacting the ref.use, and covering the compacted material with approximately two feet of earth. The area used for the demonstration site was prepared during the morning. Five to eight truckloads of refuse were scheduled for delivery to the site, starting early in the afternoon and continuing throughout the demonstration.
Ttal attendance at the demonstrations was 460 persons from 57 counties. Persons attending were principally county and city officials, representatives of civic organizations, press, radio, state and local health department personnel, and representatives of equipment manufacturers and dealers.
In addition to the sanitary landfill demonstrations, the Refuse Collection-and Disposal Consultant made 106 field trips, visiting 35 counties during the year. These visits to the counties ranged in length of time of
about t day to a maximum of about 3 days for each visit. The purpose of the
visits was to assist the state regional and local health departments in the promotion, construction, and maintenance of sanitary landfills in counties and cities and to assist in the improvement of existing refuse collection syst.ems.
In November, 1953, malaria R.nd insect control activities, other than mosquito control on impounded waters, formerly conducted by the Division of Public Health Engineering, mere combined with the activities o"' the Division of Typhus R.nd Rodent Control. To be representativ~ of those services, formerly conducted by the two divisions, the title of the Division of Typhus and Rodent 6ontrol was changed to the Divsion of Insect and Rodent Control.
P-6

Typhus fever, which h~d been on the incre~se until the end of the calendar year 1945, in which 1,111 cases and 59 deaths were reported, decrease~ reaching an all-time low ef 32 cases and four deaths in 1952. Federal asswtance for the control of typhus and rodents, which began in Georgia during the latter part of 1945, likewise decreased to the extent that only two federal employees remained on the assignment to Georgia at the end of 1953. Indications are that federal assistance will be completely eliminated by June 30, 1954.
During 1953, 41* cases ana two* deaths were reported from 27 counties
in Georgia, an increase of 28% over the number of reported cases for the previous year. This was the first increase reported since 1945.
As environmental sanitation is the basis for all insect and rodent control, special emphasis was placed on this activity as related to the collection and disposal of refuse. During the fall of 1953, six demonstrations of the landfill method of community refuse disposal were held in each of the five regions of the Georgia Department of Public Health, ~ith an additional one being held in the Centr~l Region. These demonstrations were attended by county and city officials and representatives of civic organizations, state and local health departments, press and radio. The total attendance was 460 individuals from 57 counties.
Wide scale control of rat ectoparasites by the use of DDT dusting was greatly reduced during 1953, due primarily to the low incidence of typhus fever, and to some extent by the reduction in the number of insect and rodent control personnel of the local health departments.
Local health departments, placing more emphasis on the rat eradication phase of the program, treated about 25% more premises with rodenticides in 1953 than the preceding year.
During the latter part of the year, activities pertaining to typhus and rodent control and certain activities pertaining to malaria and insect control, formerly conducted by the Divisions of Typhus and Rodent Control and Puhlic Health Engineering, were combined to form the Division of Insect and Rodent Control.
Encouraging to the division has been the high level of community interest to improve insanitary conditions and to employ other measures to control insects and rodents.
*Provisional figures
P-7

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

GRAPH NO. I NUMBER OF TYPHUS FEVER CASES REPORTED IN GEORGIA

I, Ill

.,., 600
Ill
c
.0 ,
~ 500 - - - -
X
,>C_L

,_0
Ill

400 ----

.:

0 CL

...Ill
.:

300 -----

0

.:
:: 200 -----

2
z~

100

50 -----

0 ---- I I I

II

II II

II

II

II

II

I

YEAR 1945 1946 1947 1948 1949 1950 1951 1952 1953

Ti>.BLE I Reported Murine Typhus Fever Cases in Georgia by Color, Sex and l;.ge During
the Caler~dA.r Year 195 3*
*Provisional figures
P-9

MURINE TYPHUS FEVER GASES REPORTED IN GEORGIA BY COUNTIES AND YEARS 1952 AND 1953

QQUNTIES
Appling
b.tkinson Baldwin Barrow Ben Hill Berrian Bleckley
Brantl~y
Bro'Jks
Bulloch Calhoun Candler Charlton Chatham Coffee Gclquitt DeKalb Dodge Dc0ly Dougherty Emanuel Evans Floyd Forsyth Fultcn Gilmer Gwinnett Irwin Jeff Davis Lanier Lowndes Miller Mitchell Monroe Montgomery Pierce Polk Pulaski Spalding Sumter Tattnall Telfair Thomas Tcembs Treutlen Wayne Wheeler

TOTALS

1952

195.:1 *

1

3 1
1 1

1

1

1

1

2

2

1

1

1

2

1

1 1

1

1

1 1

1

2

2

1

1

1

3

1

1

1

1

1

4

1

2 1

1

2

3 1

1

3 1

1

3

1

1

1

1 1 1

'I
l

32

41

*1953 Figures Pr)visirnal P-10

STATISTICAL REPORT

No. Typhus Fever cases reported for State
A. 1. Local 2. Stato 3. Federal
4. Total at end of year

32

41

21*

43

6**

6**

5

2

32

51

A. Personal conferences and contacts B. Meetings attended C. Meetings addressed D. Persons attending meetings E. Films shewn F. Radio Talks G. Newspaper articles
H. Literature distributed

10,523 70
42 3,472
22
0
165 13,249

5,186 53 29
1,587
7
0
335 22,713

A. Environmental:

1. No. reported typhus fever cases investigated

24

29

B. Rodent Investigations:
1. Premises on which traps were placed
2. Rats examined 3. Premises with infected rats 4. Rat blood specimens examined 5. No. of rat blood specimens positive
o/ . %of rat blood specimens positive to tyohus fever
7. Rat Ectoparasites examined

845 791
14 766 21
2.7 4,327

600 658 13 651
22
3.4 941

V. Control Me!!~~ (51 Counties - see attached "Summary of Typhus Control

Operation by Counties") A. Ratpruofing:

1. Establishments ratproofed --

a. Business establishments b. Residential establishments c. Total numter establishments

87

132

0

0

87

132

B. Rat Eradication:

1. Premises treated with --

a. Poison gas - Cyan~gen (Dust) t. Poison bait (Red Squill) c. Poison bait (1Parfarin) d. Total number premises treated
*Fulton County not included

453 16,795
42,476 59,724

71'>2
33,009 41,328 75,039

**

Includes three regional Typhus c,ntrol Supervisors whose duties includeP. insect and rodenip_1_')_ntrol activities.

over-all

sanitation

B. Rat Eradication: 2. Poisons used -a. Pounds poison gas-Cyanogen (Dust) b. Pounds poison bait (Red Squill) c. Pounds poison bait (warfarin) d. Total pounds poison gas Cyanogen (Dust) used
e. Total pounds poison bait used
C. Rat-Flea Eradication - DDT dusting: 1. Premises treated with DDT dust a. Farms b. Residences c. Businesses d, Typhus fever case investigations e. Total number treated
2. DDT Dust used -a. DDT dust used (pounds) b. DDT dust per premise (pounds)

125'3

252 17,146 109,516
252
126,662

309 31,579 126,892
309
158,471

15,016 7,936 1,051 471 24,474
92,696 3.8

6,313 3,216
57/1-
10,103*
38,343 3.8

* 194 premises treated which includes 113 farms; 66 residences, and
13 businesses. These figures are included in a, b, and c above. NOTE: Number of premises treated in V,B,l and V,C,l were recorded
on the basis of each time a premise was treated even though the same premise had been treated previously.
P-12

SUMMil.RY OF TYPHUS CONTROL OPERliTI ONS BY COUNTIES

___ ----------Tl-nPnoiTso-nnuB;ati;t-;--I-,---PNreom:i-s-e-s---I-r---N-o-.------rI---NPoou:n-d-s-------
~~::_---+-~~=~---t---~:~---t---~--t--~:=

I Appling

DDT

1 Warfarir_

I 1258 I 2189

5277 11944

1I

4.2 5.4

Baldwin Ben Hill Berrien
Bleckley

1 DDT

1

I warfarin
I1 DDT DDT

1

Cyanogen Gas

Warfarin

DDT

6 1
1198 9
3064 6

22 1

3.6

I 1 1
468

1.

1868 8

I1

1.5 .9

6451 I

2.1

20 I

3.3

Bulloch

DDT

992

2813 1

2.8

Warf~rin

2134

7260

3.4

Burke

DDT

27

77

2.8

1JI!arfarin

2004

5366

2.6

Brantley DDT

6

30

5

Warfarin

103

515

5.

Candler DDT

10

41

4.1

Chatham

DDT

37

81

2.2

Coffee

DDT

376

1497

4

Warfarin

3105

6621

2.1

Colquitt DDT

66

500

7.6

\Harfarin

1001

4822

4.8

Cook

1!1arfarin

100

300

3.

Crisp

DDT

1007

5742

5.7

Warfarin

5529

18728

3.3

Decatur DDT

50

Dodge

Warfqrin

700

300

.4

Dooly

DDT

178

Early

DDT

174

Emanuel

DDT

15

44

2.9

Evans

DDT

19

73

3.8

Fulton

DDT

177

1753

9.9

Red Squill

33009

31579

.9

Warfarin

3196

6006

1.9

Harris

Warfarin

49

125

2.5

Jefferson Warfarin

250

150

.6

Jenkins

DDT

8

36

4.5

Cyanogen Gas

1

2

2.

Warfarin

2650

8086

3.

Lamar

~arfarin

260

655

2. 5

Lanier

DDT

54

210

3.9

Warfarin

28

100

3.5

Laurens

DDT

528

1612

3.

Cyanogen Gas

38

66

1.7

1Farfarin

1677

7266

4.3

Lo'IJITndes

DDT

782

2116

2.7

Warfarin

934

5808

6.2

Merivrether Cyancgen Gas

5C2

127

.3

Mitchell 1 DDT
Monroe I DDT

61

6

26

4.4

P-13



SUMMJ.RY OF TYPHUS CONTROL OPER!.TIONS BY COUNTIES

-----------.--nD~Dust;----r-N~:------,-------------l--No:----------

I 1 Poison Bait; Premises I No.

I Pounds

co~~~=------l-Po~~~~~-li __ Tr~ate~-------~~nd~---J--~-Pr~~se ___ _

I



I Mus cogee
Peach

1 DDT
~arfarin

108 I 195

1

Pike

Warfarin

65

I

308 1 2 9

585

3.

150

2.3

Pulaski 1 DDT

12

41

J .4

1 V'1arfarin

320

210

.7

Richmond I DDT

133

370

2.7

Screven

II I Cyanogen Gl3.s I Warfl3.rin 1 DDT

108 925
276

54 1247
709

5 1.3
2.5

1 lfll3.rfarin I 1175

5176

4.4

Seminole
Spalding Sumter

DDT Wl'l.rfarin
IDDT
I DDT

650 29 21
707

1167 84 51
4809

1.8 2.9 2. 4
6.8

1 Warfarin

2225

10617

4. 7

Tattnall 'I DDT

Telfair

DDT

6

19

3.2

9

29

3.2

Terrell

Warfarin

481

2363

4.9

Tift

I DDT Warfarin

5
I 406

8 1160

1.6 2.8

Toombs

I DDT

I5

14

2.8

Troup

I I!Tarfl'l.rin , 950

950

l.

Upson

t

DDT Cyanogen

Gas

I1

8 8

10

1.2

3

.4

Ware

II

Warfarin DDT

,

29

767

20 2594

.6 3.4

Cyanogen

Gas

1 1

6

17

2.8

Warfarin , 577

1672

2.9

\Fayne

I DDT

239

Cyanogen Gas 1 21

1068 19

4.5 .9

Wheeler

Warfarin DDT

I 3002 240

7509 898

2.5 3.7

Cyanogen Gas I

9

13

1.5

Warfl3.rin 1 672

2016

3.

111 orth

DDT
I ~~"arfarin

I 342 I 1303

II

1479 2629

4.3 2.

-------=1'---------j_______ ------ --------i-------t-j _-_-_-_-__-_-_r__-_-.J_ --_-_-_-_-_-_-_-_-_

I GRJ;.ND
I TOTJ.:.LS

DDT

I 10103

I Cyanogen Gas I 702

38343 'I 3 .8

309

.4

I Red Squill 1 33009

31579 I

.9

51 Co~nti~~-=:rfl'l.ri~-----~-41::~___j___:26~~~---~----~~------

P-14

Division of Water Pollution Control

January 4, 1954

ANNUAL REPORT ON GEORGIA NATER. POLLUTION CONTROL IN 1953
The staff of the Water Pollution Control Division takes pleasure in presenting to you this report of progress being made in the accomplishment of the Georgia program of water pollution control and related activities.
The Report prepared in non-statistical form is intended only to give a general view of the status of water pollution control. It is brief because we realize your reading time is perhaps limited. However, the Report is derived from a large volume of material, engineering project reports, documents and records of events on file for reference. If you desire further information or need data on a specific situation you are invited to ask us for it. We shall make every effort to supply the desired informa~ tion and be delighted to discuss any matters of interest with you.

_./-L01~kc0 ~,c~---

,

I

W. H. Weir, Director

Water Pollution Control

GECRGIA DEPARTNEN'l' OF PUBLIC HEALTH ATLANTA
T:HSER POLLUTION CONTROL REPCRT FOR 1953
The ~Vater Pollution Control agency of the Georgia Department of Public Health has been continuously active for many years in developing and effectuating a practical program of water quality control throughout Georgia. The objective of this agency has been and now is to give direction to and furnish constructive guidance in the statewide program to provide safe water supplies, sewerage service, sewage and industrial 1-vaste treatment, and stream pollution control for the protection of the maximum number of the state's citizens.
Water as a substance is encountered by the individual so frequently and in so many ways that it usually is taken for granted which can lead to disregard for its essentiality and absolute necessity for protection. vJater occurs at times with lavish or even destructive abundance and at other periods dwindles to a disturbing scarcity all within the same locality. To have at all times a sufficient amount and of the high quality required for human and industrial consumption is one of the problems with which organized society has to cope in order to exist in its present complex form. The water needs of community life are met by public water supplies consisting of approved sources, purification plants and distribution systems to deliver safe water to the home, school, business establishment or whereYer human or industrial usage requires. Water upon use becomes sewage or industrial waste and must be collected from each water using point, conveyed to a common point and given adequate treatment before being returned to the sources from 1r1hich it came. Thus a continuous cycle of water change due to usage is in effect. The critical features of this cycle are the public water and sewerage systems including industrial 1-vater and waste facilities, and the streams wholly within tbe state in addition to those shared as interstate streams with neighboring states. It is apparent then that the satisfaction of the water demands of fast growing cities and towns and the rapid industrial development in Georgia requires very careful attention by many responsible municipal and industrial officials. The problem is both one of immediate sufficiency and at the same time recognition of greater future demands to be met. Action thus takes t1.vo forms: one, a long range planning concept and, two, provision for scheduling construction as required without violating the basic plan. Such is the general pattern now in effect in an ever growing list of Georgi_a communities and industries. It is the pattern which others will adopt and adhere to in the future as local requirements dictate.
Review And Approval Of Engineering Survey, Report) ?lans And Specifications
Each separate water pollution control project which may be either a public water supply or sewerage system, an industrial water service,
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waste recovery or treatment facility or combination of any of these involving water quality for consumption or disposal presents special conditions which must be carefully analyzed and evaluated. A thorough knowledge of local conditions and capabilities is essential in each case. Securing factual information and assuring sound decisions based thereon require extensive field investigations, laboratory studies, estimates of the situation, coordination with related projects and numerous conferences to correlate the various items into a practical program for local application. When basic decisions have been made the project can not become a reality until it has had engineering planning. When the engineering reports and plans and specifications have been prepared they are submitted to the Water Pollution Control Division for review and approval before construction begins. Through this system of consultation, review of engineering documents, laboratory investigation and attention to essential steps in the entire project planning, fundamental water pollution control principles are applied to each project from inception to completion. A list of the major municipal projects
receiving such review and approval during 1953 is given in a later sec-
tion of this report.
Industrial Wastes And Stream Quality Control
The industrialization of Georgia is continuing at a very favorable rate. A great segment of the new industrial plants being constructed in Georgia consists of those employing chemical processes involved in converting the raw materials of the forests and farms into more valuable end products. In practically all of these chemical process industries water in extremely large quantities is required. The raw materials of the forests and farms are organic in nature. Each extractive process plant removes one or more substances from the raw material which is the product it markets. Along with the desired substances there occur all of the unwanted materials which have no ccmmercial value. This latter material creates the major waste problems of the chemical process industries. The unwanted materials vary widely in different types of industries and assume many complex forms depending upon the particular chemical process used in extracting or manufacturing. The waste materials removed continuously from the chemical manufacturing processes are water solutions or suspensions. These liquid wastes go eventually to some surface stream. Streams have a limited natural capacity to receive such wastes in varying degrees. There is no universal yardstick or simple criterion which can be generally applied. in expressing the assimilative capacity of streams for industrial wastes. The desirable qualities necessary to be maintained in streams for their normal usages are known and in most cases can be quantita~ively expressed. Each specific industrial waste taken in relation to the particular recelVlng stream presents a series of special problems which must be solved before a waste producing industry can go into production.
There was a time not too many years ago when industrial managements attempted to overlook the effect of wastes on the streams hoping that other people would not notice the effect. However, it was not long before the effects of disregard for the receiving stream and its do~nstream usages became all too noticeable and objectionable. This required industries to abandon the old ways of direct disposal of their
~2

wastes and to seek improved methods for coping with their problems. The solutions to all of the problems are not yet fully known but much progress has been made and extensive research is being carried on at the present time to develop feasible and financially practicable methods of industrial waste treatment. The results of research in industrial waste reduction and treatment used in conjunction with stream surveys and quality studies are being applied generally by the ne1or and some of the older chemical processing industries in Georgia. With acceleration of the research and development program in this field there can be a continued expansion of these types of industries in Georgia. Many potential sites along the state's system of streams can be utilized for the location of wet process industries if the managerial officials can demonstrate convincingly that the particular waste inherent in their process can and will be treated or reduced to such an extent as to ~Bin tain the desirable characteristics of the receiving water course.
Local Governing Officials Are Accepting Responsibility
Municipal officials are active in providing public water and sewage works facilities to serve the growing communities. County governments are becoming increasingly aware of the water and sewerage requirements for thickly settled areas outside incorporated cities and are
planning facilities for these areas. During 1953 several joint surveys
were authorized by city and county governments to determine the best methods for future water and sewerage service for metropolitan areas. This is a very progressive step towards efficiency and sufficiency in providing the basic public health services to e~tire communities regardless of the intervening boundaries of political subdivisions or privately owned industrial areas.
It is desired to recognize the great amount of time and effort which is being given by municipal, county and industrial officials and their technical associates in cooperating with the \rJater Pollution Control agency and in many situations with each other in developing comprehensive plans for necessary projects often of a complex governmental and administrative nature. The part played by representatives of the legal profession should not be overlooked. City and county attorneys and legislative representatives with the aid, where necessary, of specialized legal consultants have authored a number of laws of either local or statewide application to make possible the financing of water and sewage works facilities. These constructive acts have been a major contribution to the entire program of water pollution control. It has been fully demonstrated that where there exists a strong desire for water and sewage projects for more healthful living any community can have these facilities if a determined and sustained effort is applied towards attainment. It is most encouraging to record a general willingness to accept responsibility on the part of those nearest to the problems and to apply informed and effective leadership in their communities or industries in making possible the great number of modern water, sewage and industrial wastes projects being provided to safeguard the health and comfort of Georgia 1s citizens and to protect the state's v-rater resources from excessive pollutional damage.
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Cooperation With Adjoining States
Hany of the rivers traversing Georgia are interstate streams being shared with neighboring states. Special effort is made to cooperate Hith adjoining state stream pollution control agencies in maintaining satisfactory conditions in the interstate streams. In close proximity to both the northern and southern boundaries of the state there are large Het process industrial establishments in Georgia using interstate streams for waste discharge. Both of these two industrial areas have received
considerable attention during 1953 and remedial measures for eliminating
unsatisfactory conditions are being effectuated at this time. Unsatisfactory conditions in one of these areas are being eliminated by connection Hith a metropolitan interceptor sewer across the state line. The other situation is being met through the construction of extensive waste treatment facilities to serve a large pulp and paper industry.
Trained Operating Personnel Is Required
Hodern facilities for the purification of vJater and the treatment of sewage and industrial wastes require a large body of trained personnel to operate and maintain them, There is little use to construct extensive and expensive water and sewage works facilities unless informed managerial and operating personnel are provided. It is well known that there is a great and increasing shortage of professional and subprofessional men in practically every scientific and technical field. It is extremely difficult to secure and retain well qualified men in the water purification and sewage treatment fields. This is especially true in the smaller communities Hhere technical knowledge and ability is just as essential as in the larger cities and industrial establishments.
Recognizing the necessity for continual training of local personnel engaged in providing safe water fbr approximately one half of Georgia's population and properly treating seHage from a somewhat fewer number of people, the very small professional staff of the Division of Water Pollution Control spends a large portion of its time instructing in methods of plant operation and control laboratory procedures. HoHever, the need is so great that individual instruction within each of the several hundreds of plants by the Water Pollution Control staff does not begin to furnish all required instruction, although it is very effective for the relatively feH who receive it.
The Georgia Water And Sewage School
The continuous training program for operating personnel includes as a major feature the Georgia Water and Sewage School. This School is a short course conducted each year and open without charge to all persons engaged in water and sewage service in any municipality or industry in Georgia. The Georgia ltiater and Sewage School is sponsored and conducted jointly by the Georgia Water and Sewage Association, Georgia Institute of Technology, and the Hater Pollution Control Division of the Georgia Department of Public Health. The twenty-second annual session of the
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School in September 1953 was attended by three hundred thirty representatives of Georgia cities, towns and industries. In addition to presenting opportunity for acquiring practical knowledge directly derived from the theoretical, the annual School sessions maintain an esprit de corps essential to the raising of standards of performance in any collective enterprise. A direct result of the School is a volunta~ system of graded certification of water and sewage plant operators maintained by the Georgia "\~.Tater and Sewage Association. Certification is now recognized as a measure of ability in placing responsibility on local personnel for water purification and sewage treatment safety. The Georgia lrJater and Se1.;rage School annually attracts observers from outside the state. It has been the model for similar schools in several other states. No public funds have ever been appropriated for this training activity. The entire cost is absorbed by other programs or borne personally by those 1-iTho generously contribute to its maintenance and support.

At the close of the 1953 School certificates in the following grades and numbers were issued by the Certification Committee of the Georgia \rJat::;r and Sewage Association to those successfully passing a 1.;rritten examination:

Class A Water - l Class B Water - 6 Class C Water - ll

Class B Sewage - l Class C Sewage - l

Conclusion And Outlook
The past year has been a very productive one in practically all phases of water pollution control in Georgia. Public water supplies and sewerage facilities are being constructed, enlarged and expanded at a sustained highly accelerated pace. During the early part of the year there was an upward turn in interest rates on municipal securities accompanying the general increase of the price of borrowed money. The higher interest tendency had some deterring effect upon several projects but only served to delay them. During the latter part of the year the interest rates tended dm-mward from the earlier peak and financing again became attractive on favorable terms to the municipalities. Construction costs have not continued to increase during the year and there was little, if any,delays or postponements due to critical material shortages. Weather conditions during the year were nearly normal with a year-end drought of moderate severity. There were several windstorms which did considerable damage to property but the effect on the water and sewage works facilities was limited to temporary electric power interruptions for purr~age. Windstorms of destructive intensity usually reveal weaknesses or absence of standby pumping facilities and serve to bring about provisions for emergency power supplies. At the close of the year there is a good number of engineering studies in process which 1oJill provide comprehensive reports for metropolitan seweraga and sewage treatment projects. Industrial waste investigations and surveys of streams and pilot plant studies on particular wastes have been carried on by industrial concerns or groups of companies having a common local interest in specific sections of streams. The present and potential problem of toxic wastes

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from the electroplating of metals and other metal surfacing processes is increasing in volume and is receiving more attention than in former years. The prospect is bright for continued progress in all phases of
the water pollution control program during 1954. The desire for better
water and sewage works is strong in the citizens and officials of Georgia's cities and towns. Industrial managements are taking a more realistic attitude towards their waste situations. There is general and wholehearted statewide support of the 1...rater pollution control program.
There "rere no cases of disease during 1953 attributable to public
water supplies.
Water Laboratory
The Water Laboratory, functioning as an integral part of the Division of Water Pollution Control, made all the laborato~ tests necessary for a statewide water pollution control program.
A regular and systematic program was maintained for the bacteriological examination of water samples from the more than four hundred municipal, institutional and industrial supplies in the state; technical assistance was made available to the water and sewage plant operators, both in the Water Pollution Control Laboratory and in the individual plant laboratories; laboratory services were provided for county, regional and state personnel on problems both of a bacteriological and chemical nature; the theoretical and practical aspects of the basic principles underlying laboratory procedures used in a statewide water pollution control program were presented to high school, college, dental, nursing and medical students and state} national and international public health personnel; and assistance was rendered to the owners of private water supplies having a multiplicity of problems such as tastes, odors, insect infestation, corrosion, iron, hardness, and accidental or malicious contamination.
Lack of experienced personnel necessitated the discontinuance of
the membrane filter study started in 1952, prevented the laboratory
from participating in various studies as outlined by the Committee on Standard Methods for the Examination of Water and Sewage, and reduced the a~Dunt of work usually conducted on the state shellfish control program.
Tests of swimming pool waters were held to a minimum but more attention was directed toward better plant control and operation, resulting in a safer quality of water for swirrming purposes.
Tests for nitrates, particularly in water from private supplies, just about kept pace with previous years and as wider spread and keener interest developed in fluoridation of water supplies, the Laboratory studied with renewed enthusiasm both the natural and applied fluorides in the public water supplies in the state.
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The several categorie~ in which the Water Laboratory performed most of the Hork are listed in the table below:

Bacteriological Samples
Drinking Water: Public and semi-public water supplies Airplanes and trains Camps and tourist courts Dairies Lunchrooms and markets Schools Private water supplies
Shellfish survey
Swirrming pools
Membrane filter studies

Chemical Samples
Bio-chemical, chemical and sanitary analyses

Total

14,049 241 103 82 114 260
1,541
64
366
30

16,390 460

3,274
20, 124
/

Water And Sewage 'VIlorks Construction
During the year the total and per capita water consumption in numerous urban areas has continued to rise with a resultant increase in the volume of sewage produced. Cause of this increase may be attributed to a continued population growth in numerous cities and towns; industrial expansion, especially in the 11wet process" field; accelerated use of air conditioning equipment and heat pumps; automatic washing machines and other water consuming appliances for the home.
As a result of this increase in the amount of water used many communities are nearing or have already reached the designed capacity of their water and sewage works. In some instances periods of peak water consumption have taxed sources of supply; in others shortage of purification capacity has developed and almost all larger communities have experienced distribution system bottle necks. This impact has likewise been extended to seHers and sewage treatment facilities.
The year 1953, therefore, has seen a determined effort on the part
of local officials to finance, plan and construct water and sewage facilities at a pace in keeping with local requirements and as a consequence the number and magnitude of construction projects initiated has been gratifying.
W-7

The following lists of 1-vater and seifage works have been approved, placed under construction or completed during the year. No effort has been made to enumerate all improvements such as water or sewer extensions, consequently the lists are not entirely complete.

?lans And Specifications Approved 1953 - Water Supplies

Augusta Barnesville -
Carrollton Chatsworth Elberton Ellijay -
Fort Valley StB.te College -
Gainesville Gracewood Griffin Glennville Louisville -
Lumber City Macon Hilledgeville -
Newnan -
Richmond County -
Savannah State College -
Sparta -
Suwanee 'rifton Temple \farner Robins -
1'17aycross -

Distribution system extensions. Raw water impoundment, pump station and supply line for additional raw water supply. Water purification plant additions and improvements. Elevated storage and distribution system extensions. Water purification plant additions and improvements. Raw water pump station, new purification plant and distribution system additions.
Elevated tank and connections to distribution system. New water purification plant. New well and carbon dicxide removal plant. Distribution system extensions and improvements. Elevated storage and distribution system additions. Elevated tank, water mains, primary sewage treatment plant. ~istribution system extensions. Additional water supply mains. New purification plant, elevated tank and distribution system improvements. Raw water pump station and supply line on additional source of supply. Carbon dioxide removal plant, elevated storage and distritution system additions and improvements.
Elevated tank and connections to distribution system. Raw water pump station, water purification plant and distribution system additions. New waterworks system. Distribution system extensions. Distribution system extensions. Elevated storage, carbon dioxide removal plant and distribution system extensions; specifications on deep well. Specifications for new deep well.

Plans And Specifications Approved 1953 - Sewage \oJorks

Augusta -

Sewer system additions and improvements.

Ateo

J-oodyear Clearwater

Hills -

Sewers and primary treatrr.ent plant.

Atlanta -

Additions and improvements to R. M. Clayton and

South River sewage treatment plants.

W-8

Cair0 -
Cleveland reKalb County Glennville Lurr:ber City lliiarietta Rome
Garden Lakes Subdivision Savannah~varner Robins -

Sewers, pump station and treatment plant additions and improvements. Outfall and primary treatment plant. Sewers and pump stations. Sewers, pump stations and complete treatment plant. New sewer system. Outfall sewer and complete treatment plant.
Sewers including outfall to City of Rome sewer system. Sewers and pump stations. Sewers and complete treatment plant.

Water And Sewage Works Construction Projects - 1953

Am'l!orth -

Major sewer extensions and water distribution system

connection to Cobb County-Harietta T,fater Authority

supply completed.

Albany-

New deep well drilled; water and sewer extensions

and sewage pump station under construction. Fluori-

dation of water supply begun.

Albany

U. s. Harine

Corps llipo t -

1.0 million gallon per day complete sewage treatment

plant completed.

Americus -

New deep -,rell drilled.

Atco

Goodyear Clearwater

Mills -

Sewers and 200,000 gallon per day primary sewage

treatrrent plant under construction.

Atlanta -

Water works improvements including raH water intake

structures, 2.0 million gallon elevated tank and

distribution system extensions under construction;

sewage works improvements including sewers, additions

and improvements to the R. M. Clayton Sewage Treat-

ment Plant and additions and alterations to the South

River Sewage Treatment Plant to provide capacity of

7.5 million gallons per day under construction.

Augusta -

3611 raw water line and raw water pumping facilities

completed; sewer system additions and improvements,

-,rater purification plant alterations and additions

to increase filtration capacity 9.0 million gallons

per day, and distribution system additions under

construction.

Barnesville -

llivelopment of an additional source of raw 1vater

from Edie Creek including raw water impoundment,

intake, purr~ing station and supply line under con-

struction.

Berryton -

Connections to City of Surrmerville water supply com-

pleted.

Blakely -

vJater and sewer systerr. extensions and new 400,000

gallon per day primary sewage treatment plant corr.-

pleted.

W-9

Cairo -

Major sewage works :improvements including altera-

tions and additions to existing complete treatment

plant to provide capacity of 80G,OOO gallons per

day, relief sewers, pump stations and sewer exten-

sions under construction.

Calhoun -

Contract awarded for 200,000 gallon elevated storage

tank.

Chatsworth-

Water distribution system additions and 300,000 gallon

elevated storage reservoir completed.

Chattooga County - I:eep well drilled preparatory to constr'.1Cting public

water supply to serve northern section of county.

Cleveland-

Sewers, sewage lift station and 53,000 gallon per day

primary sewage treatment plant completed.

Clirr:ax -

Existing public water supply (previously privately

owned) acquired by City during 1953.

Cobb County-Marietta

Water Authority- Raw water pumping station, raw water reservoir, 8.0

million gallon per day water purification plant,

finished water storage and supply lines completed.

Cobb County Water

System -

Water distribution system connections with Cobb

County-Marietta Water Authority supply completed.

Co lurr,bus -

9.0 million gallon per day enlargment to water puri-

fication plant, additional raw water pumping facili-

ties and new high service pumping station completed;

additions and extensions to water distribution and

sewer systems and two new elevated storage tanks

(600,000 and 100,000 gallons) under construction.

Jaws enville -

New water works system including spring developments

and collecting reservoir, hypochlorinator, 60,000

gallon elevated storage and distribution system com-

pleted.

JeKalb County -

Water and sewer system extensions under construction;

sewage pump stations, raw water pumping additions,

new raw water reservoir, two new elevated storage

tanks (500,000 and 300,000 gallons) and 4.0 million

gallon per day enlargement to water purification

plant completed.

Douglas -

Sewers, two sewage pump stations and 1.0 million

gallon per day complete sewage treatment plant com-

pleted.

Edison Elberton -

New deep well drilled. Haj or alte rat ions and additions to water purification

plant including new raw water intake and pumping sta-

tion, 75,000 wash water tark, new coagulation struc-

tures and 1.0 million gallon per day increase in

filter capacity under construction.

Ellijay -

New 700,000 gallon per day water purification plant and distribution system additions under construction.

Fitzgerald -

New deep well drilled.

Fort Valley -

l.O million gallon per day complete treatment plant

to replace existing primary treatment plant completed.

Fort Valley

State College - 100,000 gallon elevated tank completed.

W-lG

. Gainesville Glennville -
Gracewood Griffin -
Homerville Jackson Lakeland Louisville -
Lumber City Jesup Milledgeville -
Millen Holena Monroe -
Newnan -
PelhamRichmond County -
Ringgold -
Rome Garden Lakes Subdivision -

New 4.0 million gallon per day water purification plant under construction. Water distribution system extensions, 300,000 gallon standpipe, sewers,two sewage pump stations and 400,000 gallon per day complete sewage treatment plant under construction. New well drilled; water treatment plant (carbon dioxide removal and chlorination) under construction. Hajor water works improvements including l. 0 million gallon elevated tank, raw water pumping additions, new coagulation structures and 2.0 million gallon per day addition to water purification plant completed. Water system additions and extensions, and major enlargements of two existing complete treatment plants to capacities of 1.35 and 1.5 million gallon per day under construction, for sewage treatment. $100,000 bond issue passed for sewer extensions. Development of an additional source of raw ivater including impvunding reservoir and supply line completed. New sewer system completed; new deep well drilled. Contract awarded for 100,000 gallon elevatedtank, water main extensions and primary sewage treatment plant. Water distribution system improvements and new sewer system under construction. Contract awarded for sewer extensions and 600,000 gallon per day sewage treatment plant. Major water works improvements including 500,000 gallon elevated tank; new 2.0 million gallon per day purification plant and distribution system additions under construction. New deep well drilled. Contract awarded for Hater system. New raw water pump station on Jacks Creek and 500,000 gallon per day additional filter capacity to water purification plant completed; 300,000 gallon elevated tank under construction. Development of an additional source of raw water from White Oak Creek including pumping station and supply line under construction. New deep well drilled. Major water works improvements including distribution system additions; 250,000 gallon elevated storage and treatment plant (carbon dioxide removal and chlorination) under construction. 1'-iajor water and sewer extensions, elevated storage
reservoir, 4oo,ooo gallon per day addition to 1vater
purification plant and a new 150,000 gallon per day primary sewage treatment plant completed.
Sewer system including outfall to City of Rome sewer system under construction.

vv-ll

Savannah Savannah
State College Smyrna -
Sparta -
St. Harys Sylvania Sylvester -
Surr.merville Suwanee -
Talbotton Temple Thomson -
Thomasville Tifton -
Tifton Abraham Baldwin College -
Toccoa Villa Rica
\rJadleyWarner Robins -
\1aycross \~est Bainbridge Willacoochee Zebulon -

\N"ater and sewer extensions and sewage pump stations completed.
New 50,000 gallon elevated tank under construction. Sewers, sewage purr~ station and water distribution system connection to Cobb County-Harietta "\N"ater Authority supply completed. Raw water pump station and supply line, neif 310,000 gallon per day water purification plant and distribution system additions completed. Major water works improvements completed. New 250,000 gallon elevated tank completed. New well drilled; major water and sewer extensions, sewage pump station, 500,000 gallon per day prima~ sewage treatment plant, 200,000 gallon elevated tank and pump house 1.;rith chlorinator installation completed, Water and sewage extensions, and new 800,000 gallon per day water purification plant completed. New water works system including deep well, hypochlorinator, 60,000 gallon elevated reservoir and distribution system completed. New well drilled. Water distribution system additions completed. New 1.0 million gallon per day water purification plant and water distribution system additions completed. Major water distribution system extensions and new 500,000 gallon elevated tank completed. Water and sewer system extensions, sewer outfall, and new 1.0 million gallon per day complete treatment plant under construction.
Connections to City of Tifton water supply completed. Contract awarded for auxiliary raw water pump station and supply main. Raw water impounding reservoir and new coaguation structures at water purification plant under construction. Major water and sewer extensions and sewage pump station completed. New deep wells, major water and sewer extensions, sewer outfall, 1.65 million gallon per day complete sewage treatment plant; 1.0 million gallon standpipe and water treatment plant (carbon dioxide removal and chlorination) under construction. Several existing wells, water and sewer lines and 150,000 gallon ele-
vated tank inside city, previously owned by U. s.
Government, acquired by city. Major sewer extensions completed; deep 1'1Tell drilled. Hypochlorinator installed on well supply. Hajor water distribution system extensions completed. New 288,000 gallon per day water purification plant completed.

W-12

. /- .. , . >' .

PREVENTABLE DISEASE SERVICES

Division of Chronic Diseases

Division of Epidemiology and Cancer Control

Division of Occupational Health
(See Industrial Hygiene, Page N-1 through N-9)
Division. of.Tub~rculosis Control .

.Division

of Venereal . ~

Disease

Control

Battey State Hospital

Division of Chronic Diseases

A, LU1-\.L fl_,.\J,~T
CERUJI!IC fiS":::A.S2S COl'iTROL 1953
Durin::; 1953, six 3-day institutes vrere held for our public health nursing personnel. These institutes devoted one day to the medical and nursing prob-
lems .Jf cardiovascular diseases, one day to the medical and nursing aspects 8 r
diabetes, and the third day to dietary needs and controls for both categories,
This was a cooperative undertaking by the Divisions of Chronic Diseases, P~blic Health l\Tursin:; and Laternal and Child Health. Assistance was :;i'ren by SlX of our leading internists in the State and by nursing consultants from the U. S. Public Health Service, The institutes were unusually well attended and enthusiastically received by our public health nurses.
~leven clinics were in operation in the State during the year 1953. These clinics were located at Atlanta, Athens, Au;::susta, Savannah, Brunsvrick, \Taycross, Thomasville, Albany, l1lacon, Columbus and LaGrange. A clinic was established at Jesup but operation will not begin until January 1954.
Georgia is the only state in the nation having a statewide system Cf Eeart Clinics, providing free diagnostic and treatment for those unable to pay for these services.
These eleven clinics are strategically located, except for the upper northern part of the State. During 1953, these clinics handled approximately 15,000 patient visits and were manned by 65 doctor members of the Georgia Heart Association, who gave their time free to handle more than 1,250 patient visits each month. These physicians averaged 230 visits each for patients of all ages from all parts of the State whc otherwise vvould not have received these services.
The Georgia Department of Public Health supplies fluoroscopes and electrocardiographs for all clinics, but only participates financially in the operation .Jf the Fulton County Clinic. This clinic was the first to be established and is operated in cooperation with :2mory University and Grady Hospital as a demon:stration in Heart Disease Control. It has achieved outstanding success and has t.ecom::a model for the nation. Sufficient funds have not been available for orsrational participation in other clinics. Consequently, reports of achievement are only available for this clinic, which are shown in Table I.
DL\BiTES CONTROL
During 1953 _, due to rec~uctions in Federal and State funds, our prograni of casefinding and referral had to be severely curtailed. Our physician director of this service resigned and accepted employment in the Reserve Corps of the U. S. Public Health Service. Our mass testing team had to be dissolved on June 30, stri~Jpinc, us of our most effective tool for casefinding,
In 1952, 186,759 persons were screened for diabetes in comparison to 82,127 during 1953. Of the 82,127 people screened 2,336 were referred for gl~cese tolerance tests. 678 of those re~orting for tolerance t::;st Kere found to be normal by our test. The others were referred to their private physician for further study and tredtment if necessary. For further detail Table II may b0 studied.
Xl

~''umbc;r of c::_ses adrr~i::,~Gc1 to service Lum1:':.::r .,f CEtscs aclmitt..;c! to :11edical service ]\Jumber 0f cases admitted to nuroin; service I~ciT,lber of casc::s arlmitted t:l social s.::rvice "-edical clinic visits by ;_::1atients 3ocial s.rvic0 clinic visits by pati0nts Fi::;ld :1ursing visits to patients ?i0ld soci~l service visits to patients Cases hospitalized 'l'ransferrals or dismissals
Lo pathology ,~ftGr tr-:oatr.Lmt iJot :.;lic;iblo for c~rady Decc;ascd Other rc:asons for transfer or disr,tissal Dismissed fror,l social service

8~-7
847 677 879 3,584 856 6,220
52 60
536 222
34 31 62
185 918

TabL:: I

I. P._lood _Sugar ?rir~3:_ry _1e~ts: l. Tested
2. Known diabetics
3. Normal 4. Abnormal) r._::fcrred for tolerance test

-NU-Jn-be-r
82,127 222
79,569 2,336
81)618

Table II
-Pc-r-cG-n-t
0.27 96.9
2.8
99.4

l. Referred for toloerance tcst of 81)618 2. Reported for tolerance test of 2,336

2)336 1)827

3 . Findings:

a) Uormal (37 .l/~ of l) 827 re:oorting)

678

b) Abnormal (34.7ib of 1)827 reporting)

634

c) Borderline (28.2~ of 1,827 reporting)

515

d) Failed to report (21.8~ of 2,336 referred)

509

4. .Suspects refern:;d to physicians:

a ..bnormal

634

b Borderline

515

c 1\nmm diabetics

222 1)371

Total
5, H_;ports r._::coived from physicia.ns of 1,371 6. Diagnosed as diabetics by physicians of 381

-,, Pcrcenta::_,e of 81,618 completing 0Xadina tions

2.9 78.2 0.83<
o. 78->
0,6Jl:-
Q.ot_-ec>.o"_
1.68-;<-
27.8 51.4

Civil Defense Health Services

ANNUAL REPORT GEORGIA DEPARTI1IENT OF PUBLIC HEALTH
CIVIL DEFENSE HEALTH SERVICES 1953
Since the Georgia Department of Public Health and the Civilian Preparedness Committee of the Medical Association of Georgia are working in close cooperation in the approach to the problem of Civil Defense Health Services, an effort will be made in this report to outline only a few of the salient points.
First of all, the regular Civil Defense Health Services School held every month, 7:30 to 9:30P.M., has most likely done more than any one single activity to provide leadership, coordinated approach and understanding and really kept the program going under the very able direction of the Dean of the School, Dr. Edgar M. Dunstan. Due to his enthusiastic guidance, his special interest, fitness and unlimited energy, most constructive planning has been done.
The following brief statements point out rather clearly some of the features of the program and accomplishments:
l. Various medical publications in the Journal of the Medical Association of Georgia;
2. Georgia Civil Defense Health Services Plan completed (A Summary) 30,000 copies distributed;
3. Manual for Organization of Improvised Civil Defense SchoolHospitals (Eberhart) completed, 6,000 copies distributed;
4. The Georgia Nurse in Civil Defense Completed, 6,000 copies
distributed;
5. Short Course for Dentists with over 50 dentists taking the course;
6. Georgia Civil Defense Health Services Recommended Plan for Major Disaster completed and distribution begun;
7. Appointment of the Georgia Civil Defense Blood Bank Com,ni ttee, represented by: Medical Association of Georgia; Georgia Department of Public Health; American Red Cross; Georgia Hospital Association; American Association of Blood Banks;
8. Fourteen (14) key city approach made (see map);
9. Red Cross Agreement in Natural and Enemy Disaster approved
and distributed;
10. Plan completed for Recommended Practice Run for l\iajor Disasters.
- y 1-

Dr. Dunstan was appointed as Consultant to the Federal Civil Defense Administrator and the American l\'Iedical Association. Both he and Dr. T. F. Sellers, Director, Georgia Department of Public Health, were appointed to serve on the Regional Staff of the Federal Civil Defense Administration as Consultants, Dr. Dunstan representing the American Medical Association and Dr. Sellers the State and Territorial Health Officers. Very valuable cooperation has been extended from the Federal Civil Defense Administration on both the regional and national levels.
The Georgia Department of Defense has been most cooperative in the publication of various Civil Defense Manuals, Bulletins, plans and other valuable assistance.
The official State, regional and local health authorities and their affiliated medical, hospital and other professional groups of all categories have given good leadership to develop Health Services as an integral part of their existing framework.
The group leaders in larger areas in Georgia now realize that Civil Defense Health Services must be built around existing organizations, since no medical, hospital or health facility in any city is strong eno~gh to cope with the magnitude of handling casualties we may anticipate in an enemy attack. Pre-disaster planning is the key word. Auxiliary or volunteer personnel must be selected, trained and ready to go into action and work together during Civil Defense Emergency.
- y 2 .:..

CHATTANOOGA, TENN. 120
ANNISTON, ALA.
100 MI. B'HAM,ALA.
163MI.
MONTGOMERY, ALA.
172 MI.
173MI.

GEORGIA
f STATE BoARD J-1 [A LTI-l
T F. SELLRS. N.Q Commissioner olllealllt
T
COLUMBIA, S.C. 221 MI.
JACKSONVILLE, FLA. 324 MI.

Divison of Epidemiology and Cancer Control

CANCER CONTROL SERVICE
Annual Report
1953
The cost of the state-aid program during 1953 showed a decrease of almost 10 per cent below the figure for the previous year. This reduction was
accomplished during the last 4 months of the year during which time
expenditures were more than 20 per cent below those for the corresponding period in 1952. This was the first year since 1945 that the cost of the program failed to rise.
On the other hand, the number of applicants for state-aid continued to increase. Unfortunately, not all patients who report to the clinics are suitable cases. There is an increasing tendency on the part of local agencies and local individuals to use the cancer clinics as general diagnostic clinics and to refer patients with advanced cancer. This is one of the most difficult problems with which the program has to contend at the present time.
Another problem of immediate concern is the matter of hospital costs. The continuing rise in per diem rates coupled with the reduction in available funds presents an acute problem for the coming fiscal year. Since hospital care accounts for approximately 70 per cent of the cost of the program, significant reductions in expenditures can only be accomplished by reducing the case load, shortening the hospital stay or lowering hospital rates.
No new cancer clinics were approved during the year although medical groups in three different areas of the state indicated an interest in qualifying for approval. At the present time, however, the addition of new treatment centers to the program is not an urgent matter. In areas where medical and hospital facilities are adequate to meet the minimum standards for approval, new clinics are not needed. On the other hand, in a few areas where new clinics would be helpful, facilities are inadequate.
Distribution of the Cancer Bulletin to all physicians in the state was continued. Beginning with the current subscription, the Bulletin is being mailed by the publisher direct to the physicians.
The tables which follow show expenditures for various types of service, the number of patients who received diagnostic and treatment services, and a summary of activities.
Zl

T.ABIE I

Expenditures .According to Type of Services Rendered By Clinics 1953

.Albany

Hospital Beard Out- Chg. 1 Hoepital C0~t Side Hos2. Dax Out-Patients Bio2sies

6,915.00

105.00

152.00

Diagnostic X-Rays
605.00

Radium 258.23

X-Ray Therapy
1,760.49

Others

.Americus 4,769.48 1,036.00

.Athens

21,739.90

.Augusta 61,651.68 1,290.00

Canton

2,344.59

Columbus 9,503.70 407.50

Craw. Long 6,829.20

62.97

Dalton

537.88 125.00

LaGrange 13,607.20 135.00

Macon

30,328.00 1,865.00

Rome

7,602.76

Savannah 7,794.70 985.00

Sheffield 24,862.89 333.00

Steiner

414.00

st. Joseph 14,612.08

38.00

Thomasville 17,134.32

Valdosta 1,555.84

11/"aycross 4,475.16 391.00
Hinship 13!280.51 TOT.A IS $249,958.89 ~r6,668.47

142.24 34.46
2,053.68 29.43
27.96 160.00
58.72 483.45 345.25
774.06
22.32 17.09 ::i>4,253.66

604.00 572.00 2,520.00 152.00 284.00 356.or 116.00 528.00 1,444.00 636.00 1,256.00 728.00

1,139.75 660.00
6,740.75 173.00 610.00 632.50 91.00 613.00
2,980.00 231.00
2,068.00 2,621.00

649.89 364.86 414.49 114.00 569.34 110.60 135.00 665.25 3,535.37 398.90 733.84 617.25

3,279.92 4,172.22 3,111.15
733.50 3,630.68
626.63 1,647.75 2,231.68 4,490.51 1,443.75 6,931.88 3,570.71

160.00
2,117.50 44.00
30.00 710.50 40.70
20.00 551.75

732.00 1,038.25 224.25 1,040.25

372.00

699.25 347.05 2,601.75

240.00

264.50 175.14 1,914.01

308.00

410.00 926.76 4,530.82

3!8.00

271.00

1!825.84

~11,348.00 $21,848.00 $10,240.22 ~49,543.54

Z2

659.00
25.00 19.00 ~P4,377 .45

Total
9,795.72 11,781.28 27,543.44 79,899.25
3,590.52 15,005.22 8,617.90 2,682.63 18,499.41 44,843.58 10,371.13 20,216.17 33,629.85
414.00 19,117_.89
21,154.37 4,149.49 11,089.06 15 !761.44
~r358,162.35

TABLE II

Clinics
Albany Americus Athens Augusta Canton Columbus

No. Cases
55 154 203 416 69 103

Summary of People on VJhom Bills VJere Paid 1953

Malignant

Non-Malignant

Amount Average Cost

No. Cases Amount

Average Cost

8,174.52 148.62

32

1,621.20

50.66

9,034.09 23,343.05 66,053.38

58.66 114.99 158.77

102

2,747.19

80

4,200.39

166 13,845.87

26.93 52.50 83.40

2,947.41 42.71

39

643.11

16.49

12,766.77 123.94

38

2,238.45

58.90

Crawford Long 65

Dalton

53

LaGrange

129

Macon

450

Rome

97

7,336.20 2,328.11 14,146.94 33,038.08
8,927.31

112.86 43.92 109.66 73.41 92.03

25

1,281.70

16

354.52

64

4,371.65

242 11,805.50

50

1,560.82

51.26 22.15 68.30 48.78 31.21

Savannah

245

Sheffield

210

Steiner

1

15,978.02 28,452.02
414.00

65.21 135.48 414.00

175

4,294.85

81

5,177.83

24.54 63.92

st. Josephfs

99

Thomasville 152

Valdosta

60

Waycross

150

14,220.68 18,727.80 3,459.79 10,137.78

143.64 123.20
57.66 67.58

72

4,897.21

41

2,426.57

33

689.70

39

951.28

68.01 59.1$ 20.90 24.39

Winship TOTALS

-8-8
2799

14,598.46 165.89
~p294,084.41 ~$105.06

-2-2 1,162.98
1317 $64,270.82

52.86 $48.80

Malignant and Non-Malignant

No. Cases

Amount

Average Cost

87

9,795.72

112.59

256

ll, 781.28

46.02

267

27,543.44

103.15

598

79,899.25

133.60

108

3,590.52

33.24

141

15,005.22

106.42

90

8,617.90

95.75

69

2,6e2.63

38.87

193

18,499.41

95.85

692

44,843.58

64.80

147

10,371.13

70.55

420

20,216.17

48.13

291

33,629.85

115.56

l

414.00

414.00

171

19,117.89

111.80

193

21,154.37

109.60

93

4,149.49

44.61

189

11,089.06

58.67

-11-0

15,761.44

4116 $358,162.35

143.28 ~:$87. 01

Z3

TABLE III
Surr@ary of Activities 1952-195.3

APPLICATIONS
Total received Number approved Number disapproved Counties represented

1952
.3087 .3064
2.3 157

CASES GIVEN FINANCIAL AID

Total number Malignant Non-malignant

4059 2769
1290

AHOUNT OF FINANCIAL AID

Total amount given

~~.385 ,255. 98

Average amount per malignant case

~pl09.2.3

Average amount per non-malignant case $64.20

OTHER ACTIVITIES

Addresses made

1.3

Other meetings attended

19

Clinic visits and consultations

.34

Articles written

7

1953
3203 .3127
76 159
4116 2799 1.317
$.358,162 .35 $105.06 $48.80
10 12 12
5

Z4

DIVISION OF EPIDEMIOLOGY ANNUAL REPORT
1953
I. Objectives
The purpose of a Division of Epidemiology is the collection and dissemination of valid information concerning the causes of mass disease and injury. The scope of this activity touches every field of public health and epidemiologic considerations enter into every decision taken with regard to public health
II. Plan of Organization
The problems of epidemiology arise not only from the relationships between members of human populations but also from the impact upon man of his organic environment. The disciplines of veterinary medicine and human biology are as directly and essentially involved as those of medlClne. The organization of the Division represents an attempt to combine these skills into a convenient and efficient grouping.
III. Morbidity Reporting
There is attached a summary of cases of thirty notifiable diseases
reported during 1953. Reporting of diseases remains a serious problem
for all health agencies with no solution in sight. Many physicians do not report illnesses which yield readily to antibiotic therapy. In othe~ instances the clerical work entailed is a major deterrent. Also, the present climate of opinion concerning all forms of government activity seems to discourage reporting. Efforts are constantly being made to make rep0rting easier for the private physician and more useful to him. Search is being made for acceptable means of arousing interest in this oldest and most essential of public health activities, upon which medical science and medical education are directly dependent. Laboratory information is being utilized to supplement direct reporting.
IV. Epidemic Investigations
(a) An outbreak of acute glomerular nephritis involving ten chil-
dren occurred in DeKalb County, Georgia in 1953. Investigation revealed that the causative organism was a beta hemolytic Group A, Type 12
streptococcus. Eighty-one (81) asymptomatic or subclinical infections were found on culture of two hundred children in the affected school group. Prophylactic penicillin was given students and family rontacts with striking results. No further cases occurred and all fully treated
individuals became negative. Seven (7) untreated children remained
positive.
(b) An outbreak of gastroenteritis involving 252 of 1019 students
at Jesup High School was traced on epidemiologic grounds to frozen turkey served in the school lunchroom. Salmonella typhimurium was isolated

from frozen turkey but the illness was so mild that it is difficult to envision this organism a:s the true etiologic agent. Similar outbreaks in Iowa and New York were unproductive of laboratory findings and were attributed to virus infection.

(c) An outbreak of gastroenteritis among 121 boys attending Camp
Pioneer, Presley, Georgia involved 44 persons. Fifteen of these were found to be harboring Shigella Flexneri, type 6. Shigellosis was prev-
alent in the local population and the source of infection was apparently two loggers who had moved into the camp watershed area without knowledge of the authorities. Lightning temporarily knocked out the water chlorination system approximately one week before the first case occurred.

(d) Food Poisoning Outbreaks

Several food poisoning outbre'-.ks traceable to growth of Staphylococcus aureus in improperly refrigerated foods were investigated. Turkey, ham, and other meats were involved on one or more occasions but the most spectacular episode involved coconut cream filled cake baked in Atlanta. Illness was reported from Columbus, Georgia, Columbia, South Carolina, and Knoxville, Tennessee as well as locally. A health officer, his wife (also a physician and a health officer), and two children were among the thirty persons involved.

V. Field Studies

(a) Investigation of all reported cases of malaria and typhus was
continued in 1953. Seventy-seven (77) cases of malaria, only one of
which was indigenous, were confirmed. Forty-six cases of typhus were reported and forty-two were followed up at the reporting physicians' request. Thirteen were completely confirmed by laboratory procedures, three were partially confirmed, five were identified as Rocky Mountain spotted fever, and twenty-one cases remained diagnostic problems. Delay or suppression of development of complement fixing antibodies by antibiotic therapy creates this problem. An additional group of fevers of unknown origin are suspected of being leptospiral infections.

(b) Four (4) cases of Rocky Mountain spotted fever were confirmed
from cases originally so reported. As stated above, typhus was the
provisional diagnosis in five additional cases which confirmation studies revealed to be Rocky Hountain spotted fever. Two (2) of the five (5) remaining reported cases resulted in fatalities before adequate laboratory study was possible.

(c) An increased incidence of diphtheria was noted in several
scattered areas and plans have been made to study more intensively the
behavior of this disease.

(d) Twenty-two (22) cases of Tularemia were investigated as to

J

source of infection. Case investigations on Brucellosis in 1953 had

to be omitted.

-2-

VI. Poliomyelitis and Gamma Globulin
The Division of Epidemiology participated in a nation-wide program for the evaluation of the efficacy of gamma globulin in the prophylaxis of paralytic poliomyelitis during 1953. Direct scientific evidence obtained during the field trials of 1951 and 1952 suggested the value of mass use at least when administered at a suitable time prior to expected illness in communities experiencing severe epidemics. With regard to the alternate method of use of gamma globulin, namely, contact use, no direct scientific evidence based on field observation was available. A plan for the study of the severity of paralysis_ among multiple case households, therefore, appeared to present the best opportunity for the accumulation of useful information. A standard procedure established by the National Advisory Committee was carried out in several participating states.
In Georgia, the expected number of multiple cases was 18. The actual results obtained by nursing home visits and evaluation of each case 50 to 70 days after onset by a physical therapist were as follows:
Number of households investigated - 12 Number of households reported but proven to be not multiple caf;!e
households - 3 Total number of cases by household number
I -0 II - 2 III - 3 IV - 2
v-0
VI - 2 VII - 2 VIII - 2
IX- 0 X- 3 XI - 2 XII - 2
Total Cases - 20
Upon the basis of the assembled results, the National Advisory Committee came to the conclusion that with the preparations employed and in the dosages used, the administration of gamma globulin to familial lW- . sociates of patients with poliomyelitis had no significant influence on:
(1) The severity of paralysis developing in subsequent cases.
(2) The proportion of non-paralytic poliomyelitis among the subsequent cases who received gamma globulin before onset.
( 3) The classical pattern of familial aggregation of cases in the county at large.
- 3-

These conclusions form the rationale for use of gamma globulin in 1954
only in mass prophylaxis among more or less coherent, non-familial groups in which exposure may be considered likely to occur. The indication for the use of gamma globulin is the appearance of an index case. A number of competent workers in the field of gamma globulin prophylaxis of poliomyelitis disagreed with the Committee's interpretation of its findings. As this report is being written, evidence had just been pre-
sented from cultural and serologic confirmation studies on 1951 and 1952
mass immunizations which indicated that a substantial number of children did receive protection from gamma globulin. The picture had apparently been somewhat confused by the inclusion of clinical cases for which no cultural or serologic confirmation was obtained. Accordingly, the National Foundation for Infantile Paralysis, acting in concert with the other interested agencies, advised a return to the policy of giving gamma globulin to all contacts of cases.
These unavoidable steps in the development of a realistic gamma globulin prophylaxis program have naturally imposed a heavy administrative responsibility upon the Division of Epidemiology. The distribution of gamma globulin and the co,llection, tabulation and publication of poliomyelitis morbidity information is for the period June through September each year a major activity, which is not likely to diminish until an effective vaccine comes into use.
VII Continuing Investigations
(a) Hookworm
(l) A standard procedure for management of Health Department
hookworm activities was inaugurated in 1953. This is based on an epi-
demiologic estimate of the problem cunty by county and was offered as a means of reducing ill-considered surveys and focusing attention on hookworm families rather than on individuals.
(2) A special study on the relationship between home sanitation and the level of hookworm infection in Bulloch County was brought to a
temporary close in December, 1953 by lack of funds. Data derived from
this study are now being tabulated and s1umnarized. While incomplete, they show that rural sanitation has not kept pace with economic improvement and that popular understanding of hookworm infection and popular acceptance of rural sanitation standards have been significantly overestimated.
(b) Insect Control
(l) A report onfly-breeding and fly harborage in privies has been prepared for publication.
(2) Slightly more than one-half the time of one field worker was devoted to entomologic surveys of communities planning insect control programs and to technologic assistance in programs which have con-
- 4-

tinued from year to year As resistance to insecticides continues to develop, accurate species determinations, population estimates, breeding place location, and data on normal and seasonal trends become more essential to effective and economical insect control These are, of course, the established principles of economic entomology from which public health insect control tended to drift away before the shortcomings of chemical control began to be evident.
(c) Ornithosis
Nine (9) cases of psittacosis were reported in Georgia in
1953. Investigation of these cases led to psittacosis virus isolations
from the organs of 50 birds in 22 flocks. The highest incidence of infection occurred in birds shipped in for sale by ten cent stores, jewelry stores, etc. However, very few of the flocks tested gave neither positive virus isolation nor complement fixation tests and it is evident that the infection is rarely absent in large collections of psittacine birds.
The small number of human cases reported probably reflects the difficulty experienced in differentiating between psittacosis, primary atypical pneumonia, and severe influenza. The picture is further complicated by the suppression of virus in the sputum and inhibition of complement fixing antibody formation by antibiotics, particularly ameomycin. It seems probable that many clinical cases are not being identified Also sub-clinical cases, particularly among children, undoubtedly occur.
Nevertheless, the total number of cases which can be estimated to occur seems small in proportion to the existing contact with parakeets. It can only be supposed that the degree of exposure necessary to the transmission of psittacosis is seldom attained. Fortunately, no cases have occurred among workers in the chicken industry and the problem in Georgia is limited to psittacine birds. Because of the increasing popularity of parakeets as pets and the potential importance of infection in turkeys and possibly in chickens, it has been necessary to give considerable attention to this problem.
(d) Leptospirosis
Sporadic leptospiral infections in man continue to be iden-
tified in Georgia but no outbreaks occurred in 1953. Leptospira pomona,
the cattle leptospira, is the chief offender although ~ canicola and L. icterohemorrhagiae also occurred, The problem of identifying these Infections is complicated by the lack of an efficient screening test applicable to single blood specimens early in the disease. Dependence now has to be placed on paired blood s~ecimens and laboratory diagnosis in retrospect.
-5-

NUMBER OF CASES OF NOTIFIABLE'DISEASE REPORTED FOR GEORGIA, 1953 and 1952 WITH A FIVE YEAR MEDIAN FOR 1949 - 1953

DISEASE
Anthrax Conjunctivitis, infect. Diphtheria Dysentery Encephalitis, Inf. Hookworm Infectious hepatitis Influenza Leptospirosis Leprosy Malaria Measles Meningococcal Meningitis Poliomyelitis Psittacosis Rabies in man Rheumatic fever Rocky Mountain spotted fever Salmonellosis Streptococcal Infection Smallpox Tetanus Trachoma Trichinosis Tuberculosis Tularemia Typhoid fever Typhus fever Undulant fever Whooping cough

1953
128 276 610 15 15447 357 40330
l l
3 3002 136 390
9
l
70 14 150 867
34
2085 41 58 41 63 122

1952
274 205 328 20 15491 1525 5975 26
l
8573 119 505
l
102 8 95
842
30
l
4 1985
44 96 27 64 398

5 Year Median
128 276 \ 328 15 17547 699# 6058
NR
ll
7411 93 472
80 13 82 729
34
2502 6o 72 58 84 398

NOTE:

Corrected Totals; Final Figures

# The hepatitis median is a 3 year median

SOURCE: Central Statistical Unit Georgia Department of Public Health

VETERINARY ACTIVITIES ANNUAL REPORT FOR 1953 DIVISION OF EPIDEMIOLOGY
During 1953 rabies was confined almost entirely to a group of counties in North Georgia extending from the North Carolina line through Metropolitan Atlanta and in Southwest Georgia in a tier of counties bordering the Chattahoochee River. It was predominantly dog rabies in North Georgia and fox rabies in Southwest Georgia. Almost the entire southeast portion of the State is free of rabies so far as our records show.
We have confined our efforts to known infected areas, attempting mass immunization of dogs and wherever the fox appeared to be a prob lem, a simultaneous fox-thinning program. Mass immunization of dogs using chick embryo vaccine was carried out in Fulton, Dodge, Fannin, and Calhoun counties The young dogs were treated in Harris, Lamar, and Meriwether counties.
According to the challenge data from the Virus Research Laboratory at Montgomery, Alabama, live virus vaccine of chick embryo origin has been shown to confer a solid immunity in all dogs treated for three years and three months. Therefore, we are recommending that dogs vaccinated with this vaccine be not re-treated for at least four years.
Because of an outbreak of fox rabies in portions of Jasper, Morgan, Newton, and Henry counties, in the portion of these counties known to be infected free mass immunization of dogs was carried out and a trapping program was instituted by Mr. Canup to control the fox in these particular areas. Cattle losses in these areas were quite heavy.
Mass immunization of dogs was carried out in DeKalb county using the killed virus brain tissue vaccine. Approximately 8000 dogs were vaccinated in a period of one month.
He have had a gradual decline in the incidence of rabies in all animals with much of the State remaining entirely free. We did not have any severe epidemics in the State in 1953 with the possible exception of Twiggs county where a fox epidemic has been in progress since September or October. A negro boy died in Twiggs county as a result of having been bitten by a puppy which had in turn been bitten by a rabid fox. Largely due to the opposition of the fox hunters, we were not able to get any program either with dogs or foxes in that county.
There is attached a summary of the positive heads, clinical cases, and cases treated after exposure reported in 1953.
During 1952 1107 cattle on twenty-nine farms were immunized by a single injection of live virus antirabic vaccine. These farms were

located in the neighborhood of Fayetteville, Jackson, and McDonough. This is an area in which fox rabies is more or less prevalent. Following a period of observation over several months during which there were no reactions or deaths from rabies, sixteen head of these animals were purchased and challenged with live street virus, New York strain, along with sixteen non-vaccinated animals to act as controls. The challenge was made on May ll, 1953. The animals were confined in an abandoned dairy farm on the Jonesboro road. In the vaccinated group five of sixteen died of rabies. Diagnosis was confirmed by direct examination of the brain and mouse inoculation of brain material and salivary glands. All deaths occurred in animals which had been vaccinated as calves approximately eight months prior to challenge.
Cattle apparently do not react to rabies exposure either in the field or as a result of laboratory challenge the same as other animals. It is apparent from this experiment that further work should be done on the immunization of cattle against rabies before definite conclusions can be drawn. The results of this experiment have been published in Veterinary Medicine, XLIX, No. 9, September, 1954.
Brucellosis in Swine. 1-Je have completed br1Jcellosis sampling in the swine population in the southern portion of the State. Samples were obtained from the general areas of Albany, Tifton, and Waycross. Blood samples were obtained from the hogs at the time of slaughter and agglutination tests were conducted at the Albany and Haycross Branch Laboratories. There were 2000 samples tested from the Albany area, 2021 from Tifton, and 1667 from Waycross, with .096, .1002, and .0840 or roughly 10 percent positive from the area. This indicates that swine brucellosis is well distributed throughout the swine belt and at least 10 percent of the hogs may be presumed to be positive and probable spreaders of infection. The results of these tests have been submitted to Dr. T. B. Clower for information and future control action.
- 2-

Brucellosis Agglutination Tests in The Albany) Tifton, and Waycross Areas

Albany Tifton ivaycross

Total
2000 2021 1667

I Nega-
tive

Positive

1541

192

1574

207

1220

140

Suspect Trace

Percent Positive

I
Percent I I
Suspect

102

165

0096

00510

92

148

ol002

.0455

182
-

125

.o84o

.1092

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

RABIES DATA FOR 1953

County

Dogs

POSITIVE HEADS

Human

CLINICAL CASES

TREATED AFTER EXPOSURE

Vacc. Dog Fox Cat Cow Other Treat. Dog Fox Horses Cactle Hogs C~t Dog Hogs Cattle Horse Cat

Appling

446

Atkinson

377

Bacon

1
1

3

Baker

~69

2

7

2

~

1

Baldwin Banks

71 --rl.f6

1 -- 1

Barrow

804-- 3

-- - - ""8

Bartow

910

o--

1

Ben Hill

300

Berrien

251

Bibb

237 --1

9

B1eckley

71 1 1

1

Brantley

-- 245

BBrryoaon~k~s----------------------------------------------------------------------------------------------------

Bulloch

--l19ff

1

Burke

120

2

Butts

35 1 1

1

Calhoun- - - ---r98"" 1

5

1

10

Camden

Cand~1'e-r--------------------------------------------------------------------------------------------------------------

Carroll

240 1

Catoosa

455 1

9

Charlton

130

Chatham

2ill

1

Chattahoochee 1297

1

Chattooga

710 1

5

1

10

Cherokee

I

Clarke

22

Clay Clayton

368

- - -- 122- -16---~--- 3o

3

Clinch

Cobb

033IT 7

22

25 -----o5

Coffee

Ii1~

1

Colquitt

1201

4

Columbia

Cook

230

21

11

RABIES DATA FOR 1953

Dogs

POSITIVE HEADS

Human

CLINICAL CASES

TREATED AFI'ER EXPOSURE

County

Vacc. Dog Fox Cat Cow Other Treat. Dog Fox Horses Cattle Hogs Cat Dog Hogs Cattle Horse Cat

Coweta

315 2 1

19

Crawford

Crisp

165

5

Dade
Daw~s~o-n----------3~7~5~------------------------~2~----------------------------------~5~--------------------

Decatur DeKalb Dodge

661 2

2 u

1

4-

9265 42 i

4

58

2000-

2~---

Dooly Dougherty Douglas Ear~ Echols Ef::'i'ilgham Elbert Emanuel
Eva~
Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock
Haralson

5lt4

1

1075 2 15

1

1

137
163
1+38 1025 2

1
3

1050 2 19 5
43 1505 2
501 4 31494 43 2 2 6 1079 1

1

1

1

3

11

1

94

5

2

1

200

oOO 1

1400

4~

4013----rb

1

217 1

552 3

1

5

4oo

2

1

1

33

2

10

3

B
1 1
2

- 2-

RABIES DATA FOR 1953

County Harris

Dogs

POSITIVE HEADS

Human

CLINICAL CASES

TREATED AFTER EXPOSURE

Vacc. Dog Fox Cat Cow Other Treat. Dog Fox Horses Cett).e Hogs Cat Dog Hogs Cattle Horse Cat

-

---

Hart HHeenarrdy

179 137 2500 ~a---0~-------r~~--------~-:-------------------~----------------------~~----------

Houston

1922

Irwin

224

Jackson

2129

Jasper

Jeff Davis

78

Jefferson

78

Jenkins

Johnson

257-

Jones

584

LLaa.nIDiea_r r__________---6~1-

Lau"iens

25

1

3

Lee~-

3

1

Liberty

?5

Linc-oln

1

2

Lon6
Lownd~e~"s~------Q2~5~--------------------------~-----------------------------------------------------------

Lumpkin

158 5

- - - - ---~-

I4

2

McDuffie

55

1

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

Mcintosh

274 -

Macon

1149 2 1

Madison

2 17

Harion

39

Meriwether

740 1

Miller

3

1

Mitchell

1~92

1

Monroe

170

Montgomery

Morgan

159 5

1

Murray

15

61

1

2

l(Goat) 1

1

1

1

1

5

1

8

3

5

23

16 5 2

1

1

Muscogee

1119 1

17

Newton

2347 8

14

13

42

2

25

5

1

- 3-

RABIES DATA FOR 1953

County Oconee Oglethorpe Paulding Peaeh Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph-
Richmond Rockdale Schley Screven Seminole Spalding
Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor
Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner
Twiggs

Dogs

POSITIVE HEADS

Human

CLINICAL CASES

TREATED ~FTER EXPOSURE

Vacc. Dog Fox Cat Cow Other Treat. Dog Fox Horses Cattle Hogs Cat Dog Hogs Cattle Horse Cat

72 1531-- ~

1 -- - - - 1

l -- -~~-~------~

5

-~----210-------~---~-~

-- -~-~2------

-~~~

4

1
150 1101 1
456 7b

1 1

2

1

7

1

1195

1

T435-- -------

~ 1-- -- -

21

1

3

2814 1

1

221

3 1~

22

1

224cr-

19

1155

1

1519 5

11

13 2
1E
1
3

-T-~~-6

1

1

-4

400--4 14 1 2

5

1)

1

7

2

1

1

3

15

1

23

2

1

11

1551 2 b

3

740

4

551

1

192 1
78
2141 8

10

15

1

10

1

2

-4-

RABIES DATA FOR 1953

Dogs

POSITIVE ~.DS

Human

CLINICAL CASES

TREATED AFTER EXPOSURE

County Union

Vacc. Dog Fox Cat Cow Other Treat. Dog Fox Horses Cattle Hogs Cat Dog Hogs Cattle Horse Cat

590 1

1

1

+

-

2

Upson

2116

1

1

6

Walker

115

-- -

5

Walton

1202 2 3 1

5

Ware

341

Warren
Washi~n~gt~o~n~----~6~6~sr-------------------------------------------------------------------------------------

Wayne

258 ------

----

Webster

1

Wheeler
Whit-e--------~1~24n4~~3~-------------------~7~--------------------------------~1~'7~-------------------

Whitfield

5

Wi~COX
Wil~es

10 614 1 1 1

Wil~:inson

211

1

1

Worth

2048

---~

1

2

2

TOTALS

133153 230 79 18 38 3 660

128 17

7

75

0

2 176 0 325 6

2

There was one case of Human Rabies in 1953.

-5-

Division of Occupational Health
(See Division of Industrial Hygiene, page N-1 through N-9)

Division of Tuberculosis Control

ANNUAL REPORT, 1953 DIVISION OF TUBERCULOSIS CONTROL GEORGIA DEPARTl'IENT OF PUBLIC I-IEALTH
FOLLOWING IS A COMPREHENSIVE DISCUSSION OF THE COl11POSITION, FUNCTIONS AND ACTIVITIES OF THE DIVISION OF TUBERCULOSIS CONTROL AND ITS RELI\TION TO PHYSICIAN) PATIENT AND REGIONAL AND LOCAL PUBLIC HEALTH DEPARTHENTS IN TUBERCULOSIS CONTROL "lrJORK; PARTICIPATION IN TUBERCULOSIS CONTROL lrJORK BY OTHER DIVISIONS OF THE STATE HEALTH DEPARTMENT; AND SOHE COST FIGURES AND SUGGE:STIONS FOR AN IJVIPROVED CONTROL PROGRAJ'1.
The Division of Tuberculosis Control employs personnel as follows:
l - Public Health Administrator 2 - Physicians Full time l - Physician Part time l - Consultant Nurse 2 Rehabilitation and Case v,Jork Consultants 20 - Clerks, stenographers, typists l - Chief of X-ray Services 9 - X-ray technicians
It has in use:
3 - X-ray Regional Field Units, l4xl7 3 - Mobile Units, 70 mm. l - follow-up unit, l4xl7
X-ray and JVIedical Consultant Service: The 3 - l4xl7 units provide 25,000 chest x-ray pictures in clinics organized by local health departments.
These are of suspects referred by physicians. Contacts of cases. Follow-up re-examination of cases and suspects.
A history of the case and the x-rays serve as a basis for medical conclusions and advice. Other l4xl7 x-ray films sent in by local health departments and physicians amount to nearly 10,000 annually. The same medical opinions are given for these consultation pictures as for the regular clinic service.
Over 2400, l4xl7 chest x-ray films as mass case finding follow-up service are interpreted annually, making a total of over 36,000, l4xl7 chest x-ray interpretations.
Aiil

70 mm, mass chest x-ray service is being done on a basis of about 123,000 films per year, This means that the Division interprets
over 3,000 l4xl7 films and over 10,000 - 70 mm, films per month,
a total of over 13,000 per month.
A tuberculosis case register system has been established by the Division. It provides for a central case register maintained in the office of the Division and similar registers maintained by local health departments. Exchange of information between the local health departments and the Division is a function of the system. It has enabled both the local health departments and the State Health Department to have more complete information about the general tuberculosis situation than was ever possible in the past.
A very active Tuberculosis Nurse Consultant accomplishes much in getting done a better tuberculosis public health nurse service at the local level and in securing special orientation courses for them at Battey. This consultant has been largely instrumental in getting the local tuberculosis case registers established and in keeping them in useful operation.
The Rehabilitation Consultant and tuberculosis case workers are performing a most important service in doing and demonstrating to the local health department personnel how to do tuberculosis case work directed toward the rehabilitation of tuberculosis cases and toward the making of necessary adjustments of patient, family and community.
Therapy: For years the State Health Department has paid for pneumothorax and pneumoperitoneum services for patients advised to have such treatment who were not or could not be in sanatoriums for any reason whatever and who could not, without sacrifice of other necessities, pay for the service themselves, With the wider use of antimicrobial drugs the Pneumoperitoneum Refill Service has been very materially reduced. For instance, from 705 such pa~ients in January 1953, at a cost of $5,244.00, to 443 patients at a cost of
~3,140.00 in February 1954. It is probably reduced to 50% from
January 1953 to June 1954, or to even less. However, drug therapy is rapidly increasing.
The State Health Department began in August 1953 to furnish two drugs, isoniazid and PAS, to all patients regularly discharged from Battey State Hospital as prescribed by the Battey medical staff. Close to 400 patients have benefited by this means. This drug case load is going to increase greatly as patients are discharged from the sanatorium after shorter stay and as there is an increasing tendency tovJard prolonged drug therapy, therefore, the furnishing of these drugs, and possibly others, must for a long time be an increasing necessity.
ilA2

The Division furnishes about 36,000 l4xl7 x-ray films to local health departments for use in their tuberculosis casefinding and tuberculosis clinic work. The cost to us is about ,;24,000,00 annually,

The Division has a considerable number of x-ray machines, as listed below, on loan to health departments who are using them for chest x-ray services:

Jl - l4xl7 Radiographic-Fluoroscopic Units 8 - 70 mm. Fluorophotographic Units

The Division maintains an x-ray work shop and skilled technicians keep our machines, those operated by us, as well as those on loan, in repair, Thousands of dollars are saved each year to the State through this facility.

The above related activities, together with the large volume of c0nsequent correspondence, require that an enormous amount of clerical work be done by the Division. This, and other business of the Division is handled by the Public Health Administrator.

As may be noted from the above, a very great volume of service to local health departments is rendered by the Division.

Although an enormous amount of assistance is given considering the personnel and money available, practically all health departments need greater assistances than ever before. Or putting it another way, nowhere in the State are any of the services needed fully adequate for control of tuberculosis.

In addition to services rendered by this Division directly to counties, sight should not be lost of the fact that the State Health Department contributes a considerable amount of money on a matching basis to local health departments. This contribution helps to employ public health physicians, nurses, clerical help and clinics personnel. It is estimated that 14% (:>572,000.00) of all of the funds expended by local health departments goes into local tuberculosis activities. It is estimated that the State's share of the above amount is about $200,000.00. The following table is explanatory:

$372,000.00 200,000,00 572,000.00 285,000.00
'r857 ,ooo.oo

Local Health ~~Contributed by State Health Department
Total expended by Local Health Departments *Division of Control Budget

-~~ ')485' 000.00

Participation by State Health Department

AA3

This does not include the cost of a large amount of laboratory work, sputum examinations, sputum and body fluid cultures, etc., as a result of tuberculosis control activity demands. Neither does it include the contribution of the regional health office personnel toward tuberculosis control activities nor the cost of certain consultation services emanating from Battey State Hospital, nor any of the cost of treatment borne by the State in its operation of Battey State Hospital and support of the County Sanatoriums at Savannah and Columbus.
What else is needed: A veritable multitude of cases of tuberculosis who are not and cannot be hospitalized is existent. They need medical supervision, nursing supervision, study in each case and in each family involved of the socio-economic factors that are involved, provision for the treatment required of each case and provision of the things necessary to enable the patient and the family of the patient to so live that the patient may follow the medical advice pertinent to his ca2e. There is a tendency to advocate shorter sanatorium stay, less strict bed care, less collapse therapy, like pneumothorax and pneumoperitoneum, and more long-term drug therapy.
A large number of people must be examined because of symptoms which might be a result of tuberculous infectiono X-ray, sputum examinations, tuberculin tests, etc., are necessary to such examination.
A large number of contacts to known cases require periodic x-ray, tuberculin testing, and/or other examinations.
There are always undetected cases in the general population. To find these, tuberculin testing and x-raying and otherwise examining the reactors is one way. Another is the x-raying of the general population.
The success of a tuberculosis control program will depend on hovJ well it is built up at the local level. It requires the integration within it of the family physician, the social or case worker, the public health physician and nurse, the welfare department and other relief organization8, the rehabilitation consultant and in fact, the entire community. The program should contain all the elements needed, such as case finding and case medical supervision. Although patients may be hospitalized within certain limits, it must be kept in mind that they cannot be hospitalized in the public hospitals throughout a treatment period lasting years and that somehow, by far the greater number must have their medical supervision outside the sanatorium. The logical source of such medical supervision is the family physician or the physician employed in thA local clinic. To date, except in a few places, too much dependence for medical supervision has been placed on the physicians of the Division of Tuberculosis Control, and not enough on the local physician.

Local tuberculosis clinics in charge of local physicians should be dE::veloped wherever possible through local public health departments. The State Health Department may well assist in making such clinics possible, usins the personnel of the Division of Tuberculosis Control as advisors and consultants, but these should not be expected to supervise the cases.
Honey for part-tim8 local clinicians would have to be provided in some way. In such clinics, physicians and other personnel of the Division of Tuberculosis Control (Nurse and Rehabilitation Consultants) could function usefully as consultants and advisors.
Doubtless there are 1vays in vJhich sanatoriums might assist in expanding the enormous work being done by the Division of Tuberculosis Control and the local health departments within the framework of the principles expressed in this discussion. The first of these principles is that neither the Division of Tuberculosis Control-nor thE:: Sanatorium has any supervision over any case not within the sanatorium, but may in certain limits act as consultants through the family physician and local health department.
The training or orientation of the local physician in tuberculosis work needs further devclopmont and it may be done by furnishing the physician with an incentive to arouse his interest and through various informative means of the Division of Tuberculosis Control, Division of Training and Battey State Hospital.

TUBERCULOSIS IN GEORGIA

Following are discussions about tuberculosis in Georgia, more cost figures, character of our tuberculosis case load and why such a case load exists, and summary of the discussions presented and recommendations for improved tuberculosis control and eventually lm.;,rer costs.

Trends in Deaths and Cases Reported

The number of cases reported in Georgia in 19)2, 19)3 and through March 6 in 19)4 shows little change, 198) cases having been reported in 19)2 and 1977 in the year 19)3, and a few more were;
reported to date (March 6) this year as compared for the same period
in 19)3.

TUBERCULOSIS DEATHS

The provisional number of dnaths reported in 19)2 was 447, and 417 in 19)3, a 6.7% decrease. The figures by race and sex follow.~<

Year

White

Colored

White & Colored Combined

M. F. T.

M. F. T.

M. F. T.

19)3 127 47 174 19)2 134 )) 189

140 103 243 149 109 2)8

267 l)O 417 283 . 164 447

Deaths in last 6 months of 19)3 compared with the same period in 19)2.

Year

White

Colored

White & Colored Combined

JVI. F. T.

M. F. T.

M. F. T.

19)3

)8 18 76

62 )2 114

120 70 190

19)2

)8 28 86

)8 45 103

116 73 189

This latter comparison may or may not have the significance it
seems to imply - that decrease in deaths has materially slovJed up,
as the number of deaths in the last half of 19)3 was slightly higher than in 19)2. It shows decreased deaths in white females and
increased in colored males and females, and a stationary number of deaths in white males. Definite conclusions regarding death trends cannot be reached with this data, however.

The total final number of deaths in 19)2 was 467 which was 23% of the number (1985) of cases reported in the same year. It
is still a dangerous disease.

~~~ 'J;otal of deaths in 19)3 was 438, a reduction from the year, 19)2, of 6.2%.

, (~
.LWl..O

THE TUBERCULOSIS CASE LOAD

Although the rate of deaths has markedly decreased over the years and the number of cases reported has been almost stationary the past 2-l/2 years, our known case load becomes greater each year, and this increase comes about in spite of the fact that patients are being removed from the Central Case Register for various reasons including deathsj classification as Inactive, Apparently Cured or Arrested; diagnosis changed to non-tuberculous; moved out of the State; lost cases - that is, unable to locate; etc.
' There are many good reasons 1Jhy no living tuberculosis cases
should be removed to a dead fil~. iven though in~ctivs, they may later develop active disease. And in order to evaluate treatment and other factors that influence the course of tuberculosis in individuals, long-time observation is necessary. Certainly under no circumstances should an active or probably active case be removed from the register ~ecause the patient cannot be located. He still exists and he may even be in the same city or county, merely with a changed address even a changed name.

Roughly our Central Case Register shows the following:

~Hospitalized in State, County and V. A. Hospitals

2,340

Hospitalized in mental disease hospital, State Frison

and Military Hospitals

600

Active, questionably active and convalescent patients

at home

9, 000

Probably inactive cases

3,000

Total

14,940

COSTS OF TUB~RCULOSIS

The total cost of tuberculosis to the State is difficult to determine. We knoVJ some of them pretty closely, as follo-,rs:

Hospitalization of about 18)0 patients at Battey State Hospital ~3,050,000.00

II

II

II

90 patients in Savannah and Columbus 1)0,000.00

II

II II 400 patients in V.A. Hospitals

1,750,000.00

II

II II )00 patients in Milledgeville State

Hospital -~~-~~

434,000.00

II

II

II

50 patients in State Prison ~H(-

20, 2)0.00

II

II

II

)0-~:- patients in Military tlospitals

2)0,000.00

Total hospitalized patients

,)),654,2)0.00

* Entirely an estimation.
~He All of this cost should not be charged to tuberculosis. -:HH:- Note that this figure includes 600 beds not available to the
grc:neral public. These are in Hillcdgeville State Hospital, State
Prison and 1'1ilitary Hospitals

7 .J_..J..'....

Active and questionable and probably active casss at home numbering over 9,000 persons, to which should be added a considerable number who have been reported lost and moved out of the State, about 350 of the former and 275 of the latter, which -vwre discharged from the register, present additional costs to State and local agencies for their patient follow-up needs; contact follow-up needs; casefinding efforts because of inability to control infection; relief through public welfare and other agencies, rehabilitation services; care of children orphaned by reason of tuberculosis of the parents, etc.

For some of the follow-up of cases, contacts and susplClous cases and for case-finding efforts the State Health Department spends through the Division of Tuberculosis Control

about

$285,ooo.oo

and the County Health Departments

572,000.00 -lf-

Add relief through Welfare Departments

6oo,ooo.oo

and State Rehabilitation services

37,725.00

making a total of

l,49L~, 725.oo

which, added to hospitalization costs, amounts to an expenditure for tuberculosis in Georgia of

$7,148,975.00

-:< Includes about )200,000.00 of State Health Department funds.

This figure does not include other large costs of medical care, drugs, time lost from work, loss of efficiency, etc. Nor does it include costs to a general economy by reason of a still large number of untimely deaths from tuberculosis. That tuberculosis costs Georgia ~plo,ooo,ooo.oo annually is a very conservative figure.

What can be done to lessen this growing cost of tuberculosis?

Among factors that tend to perpetuate tuberculosis are those that are concerned with unknown and unhospitalized cases.

Tho unknown infectious case never having had a diagnosis of tuberculosis is an unwitting source of danger to other people. There would be fewer cases of this type if physicians in their practice generally would insist on having chest x-ray and adequate sputum study made in every case whore persistent cough is a symptom. There vJOuld be f(:;wer unknown cases if chest x-rays were done routinely on all persons admitted to hospitals and clinics. There would be fewer of such cases if more people with symptoms, particularly those with chronic cough, would seek and obtain adequate examinations that would disclose the reason for tho symptoms.

Another type of unknown case is the patient who has had diagnosis established but, while known to himself, is unknown to the community and local health department. The case may not have been reported as a case by the physician who made the diagnosis. The patient may have r~oved to the neighborhood and the information was not transmitted to the local health authority and, if the present address is unknoHn to tho health department having had jurisdiction previously, he is called a lost patient. Some of these patients are extremely dangerous and often very difficult to locate. I1ore frequent check by the local health department on kno1rm cases and Hhen the patient has moved, immediate transmission of tho new address to the health department concerned, would prevent a considerable number of patients being classified as 11lost 11
Unhospitalized patients represent by far the larger group of tuberculosis patients. Not all of them by any moans constitute serious community problems. 111any have refusc:;d hospitalization, or have left the hospital against medical advice (k~A) and many are in the infectious stage. Close follow-up, particularly of positive sputum cases, by health department is a most important requisite to any real control of tuberculosis. If hospital beds are not available, everything the patients need should be obtained for thorn somehow by tho community in which they live. If hospital beds are needed and are available, the family needs must be met before it can be expected the patient will be content to stay in the hospital.
Because of the prolonged period necessary for treatment, convalescence and rehabilitation, long-time planning and relief for the patient and the family is required. The sooner we recognize that the tuberculosis patient and his family cannot boar the burden alone, even when free hospitalization is offered, and make up for the deficit for them, the sooner will we have taken the principal step to bring tuberculosis under real control.
CONCLUSION
Tuberculosis, although modifiect in certain aspects, is growing as a public health problem.
The incidence of newly reported cases remains practically stationary or only slowly decreasing.
Deaths are decreasing more slowly than in immediately previous
years (less than 7% in 1953).
Of a known tuberculosis case load of over 14,000 patients, nearly 2,300 are in V.A., State and local hospitals, 600 in a mental disease
hospital and the prisons, and the:; remainder are at home. Nine
thousand (9000) of those at home are classified as active, convalescent
or probably active cases.

Present costs of tuberculosis in Georgia are high and in the neighborhood of $10,000,000.00 per annum and are not yet lessening.

To overcome these costs and at the same time develop more effective tuberculosis eradication we need to step up some very important phases of case-finding, such as tho routine chest x-ray of all hospital and clinic admissions, and the wider use by physicians of chest x-ray and adequate sputum study in every-day practice, and an aroused interest by these same physicians in the management and treatment of their tuberculosis patients.

we need a greater and proper interest of local health departments in the follow-up of all tuberculosis cases and their contacts. This requires a sufficient number of Hell-trained nurses, social case workers and physicians and the establishment of medically guided public clinics.

We need a greater and sufficient amount of welfare funds to afford relief wherever and whenever needed for patients and their families and to meet all needed medical care expenses.

We need to apply legal restraint to roving and other uncooperative positive sputum cases.

We need universally to teach what all in their respective fields should know about tuberculosis.

We need prompt reporting of all cases of tuberculosis.

We need thorough epidemiologic study to determine the source of each newly reported case,

All of these things are related to a well-rounded tuberculosis control program. To neglect any one of them may spell the difference between success and failure to accomplish eradication of tuberculosis.

Table I, which appears on page BEll, gives the details of the x-ray service of the Division. However, it does not fully reflect the total amount of service rendered by the local county health departments in which certain support is given by tho State Health Department as previously discussed. Among the additional local health services so rendered are the following:

Hade approximately 95,000 chest x-ray pictures; admitted to their

services 8,614 cases of and 21,558 tuberculosis

tuberculosis, 12,839 contacts, a total of

t4u3b,0o1r1cuploerssios n1ssu, spanedcts

nearly 60,000 field visits and about 150,000 office visits wero

made in their interest; admissions to sanatoria of 1,346 patients

was secured and over 30,000 tuberculin tests were dono.

lJlVlCilUl\J Ul'' 'l'UH.I:!l{CULOSIS CONTROL TABLE I

SUMMARY OF X-RAY SERVICES AND RESULTS, JANUARY 1, TO DEC,!;jViBER 31, 1953

NUMBER NUMBER NUl'1BER NEH FC:RCENT

SERVICES 14 x 17 CASES FOUND

X-RAYS

REGULAR COUNTY CLINICS (14xl7)

427

Original Examinations

8,570

54

.63

Re-examinations

15,753

182

1.16

Total

24,323

2jb

.97

Industrial Survey follow-ups

on 19,368 x-rayed by 70 Ml'1 film

467

.07

Mass TB-VD Survey follow-ups

on 46,715 x-rayed by 70 MM film 12

1,190

70

.15

College and School Survey follow-ups

on 18,879 x-rayed by 70 ~lli film

5

204

6

.OJ

Public Survey follow-ups

on 23,854 x-rayed by 70 Ml'1 film

7

397

15

.06

Other Survey follow-ups

on 13,433 x-rayed by 70 MM film

1

6

Floyd County 45 MM follm-v-ups

26

Hiscellaneous x-rays

57

14 x 17 Surveys

3

257

X-rays made in Central Office (continuous) 150

Total x-rays made and interpreted by the

Division except as noted.

27' 077

341

-Less films made by local health depts.

304

Total x-rays made and interpreted

26,773

Survey follow-up films made by local

health departments

Consultation Film Interpretations: From PhysiciGns 1st x-ray Re-exam.

294

22

233

From Local Health Depts. 1st x-ray Re-Examo

3,023

106

3.51

3,629

18

.50

From State Prison lst x-ray Re-exam.
TOTAL FilllS INTERF-RETED

1,566

32

425

4

9,474

TOTAL NEW CASES FROM INTERF-RETATIONS

OF FILIVIS l'1ADE BY OTHERS

182

~tTOTAL 14xl7 X-RAYS INTERPRETED BY DIVISION

36,247

TOTAL NuJ CAS3S FOUND

523

-)tiN ADDITION_, _ 122,249 70 .em CHF.S'T' fiCTURES ~JERE INTERPRET~D BY THE DIVISION.

-~11

Division of Venereal Disease Control

A~~NU AL H_2POR T DIVISION OF V3N..C:R3AL DIS2ASE CONTROL
1953
Division Function
-----~----
To control venereal diseases in the State of Georsia through effective programs of case finding, treatment, and prevention.
General
Drastic reduction in Federal funds, allocated to the states for venereal disease control activities, necessitated the discontinuation of
our l'mltiphasic Healthtestin:s Program on June 30, 1953. This re(uction in funds also necessitated the discontinuation of 2 of our 7 Diagnostic
and Treatment Centers on the same date. The numbe; of Communicable Disease Investigators was also reduced on the same date as a result of this retrenchment in appropriations.
Diagnostic and treatment services in our lare;er county health
departments and in. our 5 remaining Diagnostic and Treatment Centers located.
in Fulton> Bibb, l'1usco;-_,ee, Dougherty) and Chatham County H.:;alth Dep-.1rtments
enabled us to do a fairly satisfactory job in diagnosis and treatment of
venereal disease Cdses during 19'53. Although this plan for diagnosis and
treatment operated as .smoothly as could be e"cpected, the quality of diagnosis and treatment is somewhat below that formerly afforded at Alto 11edical Center. Further drastically needed education of private physicians and part-time clinicians> working in our Diagnostic and Treatment Centers, _ should improve the quality of diagnostic and treatment services now being rendered under this plan,
The marked decline in the incidence of syphilis and the other venereal diseases reported over the past several years is conspicuously
reversed for the year 1953. Statistical data which follow in this report
will indicate that there is no marked decline in the incidence of the
venereal diseases in 1953 over 1952. 1/Je are also satisfied that, due to
lack of continued mass serologic surveys, there was little, if any, decline
in the prevalence of the venereal diseases in 1953 over 1952. This failure
in the heretofore marked decline in the incidence and prevalence of the venereal diseases we believe to be directly attributable to the unwise drastic reduction in appropriations in support of necessary case finding, diagnostic, and treatment services. This trend is not peculiar to Georgia
alone during 1953, since 12 states actually reported increased incidence rates for 1953 over 1952.
Several epidemics of infectious syp!1ilis in Georgia during 1953
convince us that any further reduction in case finding, diagnostic, and treatment services in the state could become disastrous, resulting in the loss of the gains made in the pas(, fe1f years, If the proposed further reduction in Federal funds for venereal disease control for the next fiscal year becomes effective without restoration from Federal or other sources, to at least the present level of appropriation, it vfill be impossible to carry out an effective venereal disease control program in Georgia or in the nation,
BB J.

If the prcsont Fedoral Administration budgetary proposals stand without restoration of proposed cuts, it will also be n:;cessary that our Training School for Interviewers and Investigators, conducted at the Fulton County Health Department since the closing of Alto hedical Center, be discontinued.
Alt',ough statistics of the Division of VD Control, U. S. Public Health Service continue to show that Georgia's program of venereal disease control is outstanding in comparison with the programs of oth:;r states, we are gravely conc0rned about its future and the future of vener0al diseas0 control in the nation, due to proposed further reduction in appropriations in support of venereal disease control ac-::,ivity.
Table I (Appended)- l'~l!::l:t.iJ?hc:tsic _H_e_aJthtestinp; Surveys:
During 1953, i~ultiph::;,sic Healthtesting Surveys were conducted in Green0, Butts, Turner, Liberty, hacon, Taylor, Clayton, Jenkins, Baldwin, Pike, \Iilcox, and Dooly 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 12 surveys conducted in 1953, we tested a total of 63,222 persons forsyphilis. Of these, 1,360 were positive and 329 doubtful by the Kahn test, From this number of positive findings, 431 new cases of syphili:s were brought to treatment. This compares with a total of 11 surveys conducted during 1952, in which we tested a total of ~25,76~persons for syphilis, of whom ?~27 were positive by the Kahn test, of which 1, 265 were new untreated cases of sy)hilis.
Tables II and II-a (Appended) - Communicable Disease Investigator
Progra~:
Tabl0 II shows that 15,107 suspects were investigated by our Conmrunicable Disease Investigators during 1953 and J,950 previously unknown cases were brought to treatment, of which 415 were primary and secondary syptilis. This compares with 12,491 suspects investigated during 1952 wi~h 2,509 previously unknown cases brought to treatment, of which 3'1o were primary and secondary syphilis. During 1953 our Conunicable Disease Investigators brought to treatment 221 cases of congenital syphilis. This compares with 206 cases of congenital syphilis brought to treatment by these investigators during 1952.
Of the 548 cases of primary and secondaDr syphilis reported by all sources in the state for 1953, it is of outstanding credit to the Communicable Disease Investigators that 415 of the 548 cases were located and brought to treatment through their efforts.
In additior'- to the a~ove activities of the Cor'1ElUnicable Disease Investibators in the field of suspect investigation, they also conducted 30 miniature Hultiphasic Healthtesting Programs in 30 different counties during 1953. In these 30 miniature surveys they tested a total of 83~546 persons with 1,8~positive findings by the Kahn test.
Table II-a shows the activity and results of our Speed L.one Gonorrhea project started in the Fulton County Health Department on July 13, 1953. This project is an attempt to demonstrate that the

principles of c;pidemiology, formerly applied to tho control of infectious syphilis, could be effectivel~' appli0d in the con-::.rol of gonorrhea, Briefly, all m,clles reporting with gonorrhea ara intervievred for contacts, the femal2 contacts named are follo1t1red up and brought to diagnosis and treatment in the shortest possible period not to exceed 6 days ( the normal incubation period of gonorrhea), all female contacts having clinical evidence of gonorrhea are diagnosed and trGated as gonorrhea, and all named.contacts having no evidence of gonorrhea are treated prophylJ.ctically and re}JOrted as epidemiolo."Sic treatment.
At the outset of this projc;ct the.; ro.tio of maL;s to femalc:s reporting to the Fulton County Health Department for the treatment of
gonorrhea was approximately 5 males to one: female, It was our feeling
that something should be done to bring to treatment the vast rosc.Jrvoir of infectious female cases responsible for the never ending infection of males. In the first months of operation the number of f8males being treated in the Fulton County H.aalth Department novr exceeds for the first time the number of males being treated. The critical analysis of this project will be the decline in the incidence of male gonorrhea cases reporting for treatment. A'ready there is a significant decline in the number of male cases re}Jorting, HG have now instituted similar epidemiologic procedures in connection with gonorrhea control throughout the state; with the hope that through this epidemiologic technique we can make more significant strides in reducing the incidence of gonorrhea
Table III (Appended) - Diagnosti_g__:_nd_Tr~C?:_~llle_l}_~__Ccmt_~:t_:~_:-:__ _Q_~il-~sif.ic_at:j_on__ of Patient Load:
This table shows that 1)_,][. patients vrere treated for venereal
disease in our Diagnostic and Treatment Centers during 1953. Of these, _0.033 casGs were previously unknown and untreated syphilis, 11.:._58;5_ gonorrhea, and 598 other venereal disease. The remaining cases were
previously inadequdtely treated syphilis returned for further treatment or treated prophylactically as a r0sult of known exposuro to infoctious venereal disease,
Table IV (Appended) - New Veneraal Dis~ase Cases Reported:
During 1953, 3,160 cases of previously unknown and untr(;atad syphilis cases were reported in Georgia, of vrhich 548 were primary and secondary infections. This comparlJS with ;2,518 cases of syphilis reported during 1952, of which 576 were primary and secondary infections. During 1953, _l~04 cases of gonorrhea were reported. This compares with 1~,779 cases of gonorrhea reported during 1952. During 1953, 644 casas of other venereal diseases were reported. This compares with 700 cases of other venereal diseases reported during 1952.
This tablo shows comp2.rative figures for the distribution of
free sntisyphilit drugs for the years 1952 and 1953.
BB 3

lv.iASS
V3Nli:REAL DIS.GAS2 SURVEYS Il\f GEORGIA
1953~<-

~

Table I

iXl iXl

-Cl-.t-y-~---Co~n-t;y-r\Pe-rioct_T.fop. ; Number of New -Syph_i_l_is-Ca~-es- -~--~---~-- ----K<:1h~-Tests-

: J -1 I 1

1

Tested Ages

p' rimB. r0: 1wEab~tlyto

~.

Treatm Other

nt ;

Total

.

Total

_ Negative j Positive

---r-v.-D-.-H-.-L-. --
Positive Doubtful . or -----

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

~%~~--.&~~___;__LaG:nt ~--~----~~----------

---~- 1J/P_:~-- -------

---- - - - __....________:

'

.

I

.

30 Greensbo
------

ro Greene - - - - __

_

; 1j_l-

9 to I 22-5Lj__

_7~L

..

_

-

-

L

-

-

-

4

1~

;
j

37l __ ---~1~ 6J_i>QJj_22469-

____]2 __1_______ __]2_9_

:_Q_ .J- --- ]__ .____ Jackso~ --~~~~-s- _j_t=~I-~-~--~
l Ashburn Turner ~ 2- 4 to

42_

___________ -~ 2-12-53 i_ ___~o

'
_

_

-i--~Q_II_____)_ I!---~-

LJ__ '

.,

o__ ;___

~g_L _

__ _)_ _2}_~

2.3_~()_ _j__- 2~)A__ ----- ..1-.~L-

1 4,423

4.)_1_2_~-----

I~- 4.4.. __
26 --0 0 __ ]-9~---

Hinesville Liberty : 2-16 to

;

!:

I

1

- - .

; 2-21-53.~ 48 ___Q_'

_LI--__ Q _[~_

1 3 408 -1-J_,)~-------

1~7

Oglethorpe hacon : 2-25 to

'3-10-53

57

Butle_r_ _ Taylor ! 3-16 .to ,

_:__2Q___ __________ -~------1 3-21-53

1

1

0

13 i1 32

45 5 612

h444 1.__ 1

_]__L_ 1 i _____1_4 ,_

___j3___ 3..2..432 1 _ _527u____ni..___~____~_l_____217 __

7 j .,J.

o_n-es~b-o-ro--C-lay

t
.

o

n

I 3-25 to 14-14-53

J:nllen

J enlans , 4-21 to

1
1,

1
l3L_: _0_1 _____.?__

:4-28-53 I 51 __0 _ __3__

2LU.O, 904 _j_ __lO, 77?:. .J____9_2_.1.__ _4_Q._j_ _))_9__

65 5.349

I _ 52115

__1_~8_L_46_j___]_4_2_ _

Lilledgeville

; 5- 6 to

Baldvv-in : 5-19

-1---- __2.___ 5 . ____L___lti_ _LS::J:Q__ _0_485

_3_9_. _J ____ _?. j ____ .... ..232__ __

~ebulon

Pike

5-26 to

5-30-53

Q._l___ ~-9__ j 35 l

44 1-_2,8oo 1 2,69;5__j_______lgj__j ___o__l______:s51 _

t_,___ _l ____ Abl;8ville : V>JilcoX- 6- j to ,
__________________:. 6::.J..l-5l___~ ___6_Q____

o I_______2 _J _____3.4_L _____ 36_j__]~Jl

},2_Q6~L ___ _136___ j _____ _29 .. I._ .... _2.7__9_ -

Vienna

Dooly :6-17 to j

--------

:6-27-53 I 45

::..-~~.1-~- 5 I .50 j ___ _2LJ 4. 752 _J__4..L487 I - __2_01

-~-t:.4._..1 _____ - 4_2____

To~-al ---~------

i

I I I. 7jI____~-~-l 354 j 431 163J2~2

61,533

~':_6~---'- __:2~

2J982

''l:1ass surveys discontinued July 1, 1953.

ANNUAL REPORT COl_l_UFIC ,,BL::; DIS_::d~~ r;:v:_::sl'IGATIO'i PRuGRlil:_
1953

Table II

- - - - - - - - - - - - - - - - - - ------~---------------------Disposition 2 (:'::xamined- Not infected) ,, ............... 3456 Disposition 2X (Previous treatment adequate) ......... , ..... 1944 Disposition 3 (Old cases returned to treatment) . . .. . .. .. . .. 467 Disposition 3X (New cases brought to treatment .......... 3847 Disposition 4 (Located- Already under treatment) ........ 645 Disposition 6 ( Car1not locaJce) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1109 Disposition 7 (1''.coved from jurisdiction ) ..... , . . . . . . . . 449 Disposition 8 (Insufficient information to investigate) .. , . . 214 Disposition 9 (Other) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603 Disposition 9X (~pid~uiologic treatment) .................. 1290 Total suspects investi.:;ated .......................... 15,107

Breakdown of Disposition 3X (New cases brought to treatment)

Second.ary syphilis ..................... , . . . . . . . . . . . . . . . . . . . . 161

Primary syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

~~arly latent syphilis ............................... , . . . . . . . .

502

Late Latent syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . 490

Cardiovascular syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

~I eurospyhilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Con6enital syphilis

Gonorrhea

0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 II 0 0 0 I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Q 0 0

Chancroid ....................................................

10
221 2263
25

Granuloma Inguinale ................... o o

9

Venereun1 ... Lympho~ra11uloma

o o o o

Total cases untreated VD found and brou;ht to treatment ..

3950

BB 5

COli"Ul'JIC;i.BL~ DIS;:<;ASJ INVJSTIGA'l'OR SP_c.:;zD ,WN2 GOIJOhRHEA ?ROJ.GCT IN GOOP~RATION VHTE FULTON COUNTY HJALTH D:2;PARTh.GNT

July 13 - December 31; 1953

Table II -a

ACTIVITY:

No. of male GC patients available for interview

No. of male GC patients interviewed

No. of contacts obtained

Contact index

~.5l_

No. white male GC patients interviewed

No. white contacts obtained

Hhite contact index

1.17

No. colored male GC patients interviewed

No. colored contacts obtained

Colored contact index

1.54

No. male GC repeaters

No. of repeater contacts obtained Repeater contact index

1.71

Audit interviews done

No. not naming informant

No. of symptomatic contacts named

No. of out-of-jurisdiction contacts

?Jo of in-jurisdiction contacts

2278 2268 3415
236 276
2032 3139
244 (11% of total) 418
102
l3
217 (6% of total) 581 (17~ of total) 2834

DISPOSITION BY l'1ETHOD OF INVESTIGATION;

Telegrams sent Telegrams delivered Brought to examination by telegram only Telephone calls initially made Brought to examination by telephone only Assigned to informant to bring in Brought to examination by informant Previously treated contacts Assigned and reassigned to investigators No. brought to examination by investigators No. not located Hoved out of jurisdiction
Reported after 6 working days

482 243 (50% delivered) 197 (7% of case load) 727 467 (16% of case load)
454 308 (11% of case load) 146 (5% of case load) 1681 1351 (48% of case load)
305 \- __ (12% of case load) 44 J 16

DISPOSITION SUhNARIES

Steady

Total Closed
Infected with cc
Epi. Treatment
Previous Treatment
Not Treated
Trc:ated in 12 hrs. Treated in 24 hrs. Treated in 72 hrs. minus Treated in 72 hrs. plus 1Ialked in after 6 working
days

2308 906 1067
94 241 673 1406 1778 1959 12

Casual
526 143 223
52 108
88 201 309 364
4

Total
2834
112094091' (8$% of case load)
146~/
349 (12% of case load 761 (33/b) 1607 (69%) 2087 (89%) 2323 ( 99%) 16

BB 6

CLASSIFICATION OF PATI~JT LOAD DIAGNOSTIC AND TR3AT~.SNT CJUERS
1953

Table III

I. New and Reinfected Cases of VD

A. Syphilis (Treated)

l. Primary and Secondary
2. Early Latent 3. Late Latent
4. Neuro Syphilis 5. Congenital
6. Other (Not Stated)
Total

329 726
713 18
219 28
2,033

B. Not in Combination with Syphilis (Treated)

l. Gonorrhea

11,585

2. Other Ven2real Disease

~

Total Not in Combination with Syphilis 12,183

c. VD Cases, New and Reinfected (Treated)

14,216

II. Observation and No Venereal Disease

A. Observation Only B. Observed and Treated Prophylactically
III. Previously Inadequately Treated Returned for Treatment

9,951 2,158

A. SyDhilis (Treated)

l. Primary and Secondary
2. Early Latent 3. Late Latent
4. Neuro Syphilis
5. Congenital 6. Other (Not Stated)
Total

5 205 659 47 156 12 1,084

B. Not Combined with Syphilis

l. Gonorrhea 2. Other Venereal Disease
Total
IV. Total Patients with Venereal Disease Treated)

32
l3
45
15,346

BB 7

lJ }}.J 'J ..::, ~R~AL Dioi:;I.Sii: CASES HE~:.-UHT~I) TO V~l'J .:RZAL DIS~ASE CONTROL DIVL3IOH
1953

"(:()

Table IV

~

~

--~-~------~---~ ------- ;_------PRivA:if-l=;:risr-ci~s_l_-~--~---~- -c-LiiTrcs____ --=-=-~=~- i~:L suul~CEs~coloredJ TOTA:L-

DIS~ASE
SYP:aLio: Primary and Secondary _;arly Latent Late & Late Latent

-I ----1---- t_E_ ; _ 'Jhite -l-li - - -F-

Colored =fC'Jlite Colored
h -F-_ h --; _F__ _ _!.'1___

:~

I 1 0 l.

1
'

1

1

I

I I 15 !12 I' 10

7 !. 259 244

j 3;4 ; 9l6

22 29

I1

23 23

25 I 20 i :351
47 l 50 l 453

528 594

__ IJhite
-~ _j F
~, 11 : 7 28 1 24
56 l 56

_Colored _

_I~- -~K_ . 11- _____ _

I

I

I 27 4 256

I1

373 482

551 617

548
976 1211

Congenital
l\fot Stated Total syphilis

-~-m-~-t-=sl- : 1 ; 2 0 ; 4 5 I 6 I 148 139 , 6 ; 8 1 148 1143

305

: :

5 1 4 1 29 1 19

-892--11

b I 12
--89-1 1223.

43 1548

'

7 10 ' 41 62 108-t -1o5 ___!'1318- fC29-

--- ---

----3116200__ _

'

'

I

I

I

I

1

I

I

14504

OTlliH V61LiHEAL DISJASES: :

Chancroid

Granuloma Inguindle

Lympho::;;ranuloma

Other

,

7otal Other V.D.

I

lII

I!
.
00

1~
;3

I
!
i0

0 I 0 I1 l 2

0

0 , 0 ,0

-r o

o 1 o lo

0 1! 0 1 4 2

--------- ---!----!- --- -1------1-.

I:

I~

I

24 l

3

0,

I
4 ~46
g ; 53
0 l 45

99 'I 42
, ll

24 3
0

lI
j
'!
I
:

4 0
0

:I

J

l;

349 54

45

i

1

rII

t

99 I

;

44 11

!~-

I'II

476 101
56

-6 ll56-- 2?~r-:-T4-53 ~ l58-r~--~-r- ~:- 10 1 215

4

o 12; 5

4

.

11

:--:.L~!-1-44-9 L--~

1

i

I

-~- -~ -------~ L ------------ ---

----

DISTRIBUTION OF FR:::.::: ANTISYPHILITIC DRUGS

1952 - 1953

-- -- D--r-u-. ----------------- -

1. Adrenalin (Amps.) 2. Chloromycetin (Amps.)
3. Gantrisin (Tablets) 4. Penicillin (No. of 100,000 units) 5. Penicillin (Tablets) 6. Pyribenzamine (Tablets) 7. Vaccines:

0
50
0
316,381 24
0

a) Ducrey (No. of tests) b) Frei Antigen (No. of tests)
8. ,.:Jtreptomycin (Grams)
9. Sulfadiazine (Tablets)
10. Terramycin (Tablets)

1,254 1,170
1,845
179,500
2,976

Table Y
10
0
153' 900 397' 830
60 2,900
860 650 308 27,600 16,454

Battey State H~spital

ANNUAL REPORT - 1953
BATTEY STATE HOSPITAL ROME, GEORGIA
TABLE I

The following table shows the number of persons making apolication for admission to Battey and Alto during the past eleven years.

Year
1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953

White
575 524 477 964 1033 998 914 939 981 1020 1047

Colored
314 251 298 586 616 679 615 639 717 735 775

Total
889 775 775 1550 1649 1677 1529 1578 1698 1755 1822

Again there was a slight increase in the number of appli-
cants during 1953. There were 57 more aoplications in 1952 than 1951 and 67 more in 1953 than in 1952.

CCl

TABLE II

The following table shows the applications by age group for admission to Battey and olto during the past eleven years:

Under 20 20 - 39 40 - 59 60 plus

Total

Year White Col. White Col. White Col. White Co 1. \1Th i t e C0 1 .

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 g64 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 go 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 g8l 717

1952 60 102 375 349 407 220 178 64 1020 735

1953 65 59 346 405 429 251 209 58 1049 773

The most marked changes as shown by this table are in the lessened number of colored patients under 20 applying for admission and the increase among the colored population applying for admission in the age group of 20 to 39.

CC2

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

1943 28 50 19 49 25 53 53 85 24 51

1944 1945 1946 1947

33 15 2 33
19 41 8 43

15 42 16 35 12 26 13 46

26 40 20 27 15 27 21 39

37 28 55 55 41 33 47 58

25 35 21 33 17 29 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 1952

16 12 ll 10

6 14 72

8 14 66

15 32 78

9 15 75

1953

2

2

52

42

32

42

This table shows that the percentage of persons rejected for admission in all age groups has again diminished. Four
(4%) per cent of the white applicants were rejected and only 2% of the colored applicants were rejected. The year 1952 was the best previous year in which a total of 12% of all applicants were rejected and this was diminished further to a
total of 6% in 1953. Most of the patients rejected were on the basis of not being considered suitable patients for hospitalization due to previous trials at sanatorium hospitalization.

CC3

TABLE IV

The following table shows the number of admissions by color for the past eleven years at Battey and Alto:

Year 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953

White 425 425 470 765 738 803 728 731 842 872 948

Colored 134 121 210 377 362 322 284 456 561 597 653

Total 559 546 680
1142 1100 1125 1012 1187 1403 1469 1601

A review of this table shows that there were 132 more patients admitted during the year 1953 than during any previous year and this was done without increasing the bed capacity of the hospital. In fact, the bed capacity of the hospital was diminished slightly during 1953 and the bed distribution altered somewhat.
One ward on the white female service was closed, a total of 65 beds being removed from this service. This was done because this service had been carrying about 100 empty beds for nearly one year. This slack was partially taken up by opening a new 36 ted colored surgical ward which represented an increa~ of 28 beds over the previous facility.

CCL;_

TABLE V

The following table shows the number of patients in the hospital on the first day of each year for the pest eleven calendar years:

Year

Total

1944 1945 1946 1947 1948

453 518 544 986 1199

1949

1305

1950

1444

1951 1952

1597 1762

1953

1957

1954

1793

Although we have more than 1900 beds in actual operationJ we are budgetarily limited to carrying a total of 1900 patients
on the daily census and during the year maintained an average census of retween 1840 and 185~, leaving us an operating margin of approximately 50 beds.

CC5

TABLE VI
The following table shows the number of admissions, by diagnosis, during the past ten years at Alto and Battey:
OTHER FA~ 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 18 27 39 60 37 842 561 1952 444 403 291 94 21 11 4 21 111 68 872 597 1953 507 462 273 100 13 8 ll 11 144 72 948 653
During the year of 1953 61% of all patients admitted were classified as far advanced. Seventy-one (71%) per cent of all
colored patients admitted were classified as far advanced.
Twenty-three (23%) per cent of all patients admitted were classified as moderately advanced" Thirteen (13%) per cent
were classified as inactive tuberculosis at the time of admis-
sion or with a diagnosis deferred. Two (2%) per cent had minimal tuberculosis. One (1%) per cent had other types of tuber-
culosis, such as pleural effusion, tuberculous abscesses or extra-pulmonary tuberculosis.
CC6

TABLE VII

APPLICANTS NOT ADMITTED

l-l-53

Awaiting Admission

98
*************

l-l-54 107

Applicants rejected

106

60

Refusal of hospitaliza-

tion after acceptance

61

46

Failed to report for

admission

38

50

Died prior to admission

56

60

Hospitalized elsewhere

12

28

Miscellaneous

3

4

CC7

TABLE VIII

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

Age Group Under 20 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

1953

58 54

20 - 39 White Col.
251 so
351 134 368 217 379 181 344 196 336 150 309 240 328 278 333 282 320 364

40 - 59 White Col.
137 27 164 51 287 113 316 99
319 so
267 76 284 136 352 199 362 181 400 184

60 plus White Col.

21

l

31 4

71 7

41

2

95 13

81 15

91 23

135 29

140 50

170 51

There were 132 more patients admitted during 1953 than during 1952, which was the highest number of admissions for any year prior to 1953 A comparison of these figures reveals that the main differences were in the colored admissions in the 20 to 30 age group and in the white admissions over 40.

CC8

TABLE IX

The following table shows the number of discharges from the hospital at Alto and Battey during the past eleven years based on discharge diagnosis:

Years
1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953

White
546 431 376 459 629 754 613 652 789 872 1101

Colored
129 149 168 159 267 275 212 331 473 487 636

Total
675 580 544 618 896 1029 825 983 1262 1359 1737

Three hundred seventy-eight (378) more patients were discharged during 1953 than any previous year One hundred one (101) of these discharged patients were considered to be nontuberculous, leaving an adjusted total of l 636 patients with tuberculosis being discharged from the institution during 1953. This means, according to the true adjusted figure of 1952, that 393 more patients with tuberculosis were discharged during 1953
than any previous year. With the cooperation of the Division of Tuberculosis Control and local health departments, we were
able to discharge some patients who had been in the institution for years that were non-infectious Also, we were able to in-
stitute a program of post-sanatorium home care with continua-
tion of antimicrobial agents at home Only patients discharged with consent and advice were eligible for drugs at state expense.

CC9

TABLE X

The following table shows the status of patients at discharge during the past ten years at Alto and Battey:

QUIES. OR
ARREST.

ITvTP.

UNIMP. DEATHS

TOTAL TBC.

NOl\-TBC.

Year Wh. Col. Wh. Col. Wh. Col. Wh. Col. Wh. Col. Wh. Col.
1944 110 52 151 45 so 31 40 13 381 141 so 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 R7 9 73 64 540 191 73 21

1950 232 84 225 157 SR 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 1953 400 304 436 215 144 32

55 74 799 444
so 55 1030 606

73 43 71 30

During the year 1953, 41% of the discharges were quies-
cent or arrested and represented inactive cases of tuberculo-
sis. Thirty-seven (37%) per cent of the discharges were discharged as improved and 10% as unimproved, meaning that approximately 47% of the discharges were considered to have active tuberculosis. Six (6%) per cent of the discharges were accoun~
ed for by deaths in the institution from tuberculosis. Six
(6%) per cent of the total were accounted for by patients
being discharged with non-tuberculous diagnoses, inluding in
this total one white and 6 colored deaths from non-tuberculous
causes.

CClt

TABLE XI

The following table shows a breakdown as to the tyDe
of discharge these patients received in 1953:

\rTHITE MALE

fi!edical Disch 231

Disciplinary

so

Signed Out

273

Leave,No Return 44

Dead

42

With Consent

16

Transferred

26

Total

682

WHITE FEMALE
218 2
121 21 10 41 6
419

COL. MALE
163 46 75 15 30 0
_9 338

COL.
FE~1TALE
201 10 36 15 31
l
4 298

TOT.h.L
813 108 505
95 113
sR
45 1737

(47%)

(
\

6%)

(29%)

5%)

7%)

( 3%)

( '\

3%)

Approximately 47% were given medical discharges, 6% disciplinary discharges" 29% signed out, 6% failed to retur~ from leave, 6% died, 3% were discharged with consent tut against advice, and 3% were transferred from this institution
to other institutions.

CCll

TABLE XII

(A)

I'1REGULAR DISCHARGES

Leave No

Per cent of

'Type Dischg, AMA Discpl. Return Total All Dischg's.

Wh. )11Ta le

273

50

44

367

54%

\tlh. Female

121

2

21

144

34%

Col. Male

75

46

15

136

40%

Col. Female 36

10

15

61

20%

One can see in Table No. (A) that there were 367 white males irregularly discharged which accounted for 54% of the
total number of discharges from the White Male Service. There
were 144 white females discharged irregularly, accounting fer 34% of the total number of discharges from that service. The colored males had 136 irregular discharges, accounting for 4C% of the total discharges from that service. The colored females had 61 irregular discharges, accounting for 20% of
all colored female discharges,

(B)

SPUTUM STATUS OF IRREGULAR DISCHARGES

\t-Th. Male Wh. Female Col. Male Col. Female

No. % No. % No. % No. %

Negative

189 51% 86 60% 80 59% 36 5Sl%

Pos. Smear 170 46% 46 32% 55 40% 25 41%

Pos. Culture 3 1% 9

6% 1

1%

Undetermined 5 2% 3

2%

Table No. (B) shows the sputum status of irregularly dis-
charged patients. Fifty-one (51%) per cent of all the irreg-
ularly discharged white males had negative sputum, including cultures, at the time they were discharged from the hospital.
Sixty (60%) per cent of the white females were negative. Fifty-nine (59%) per cent of the colored males were negative. Fifty-nine (59%) per cent of the colored females discharged
were negative, This would tend to indicate that a considerable number of these patients were at least non-infectious cases of tuberculosis when they left here, even though they did receive an irregular discharge and, with adequate followups, a considerable number of these people shculd remain negative.

CC12

TABLE XII (cont'd.)

(c)

READMISSIONS IN 1953 FROM 1953 DISCHARGES

Discharged with advice and readmitted

29

Irregular discharge anc readmitted

90

119

One can see that there were 708 irregular discharges during the entire year and only 90 of these were readmitted the same year they were discharged. The sputum status of
these 90 patients readmitted has been tabulated. Forty (40)
of them were positive to smear on readmission (45%); 46 were
negative (51%); 3 had positive cultures (3%); 1 undetermined
(1%). This coincides fairly well with the overall sputum status on these patients at the time of their discharge.

(D)

OTHER READMISSIONS FOR 1953

~ischarged with advice

Discharged AMA

112 (7%)
220 (14?11 332 (21%)

This table shows that 112 patients were readmitted that had at some time in the past been discharged with consent and adviceo This accounts for 7% of all admissions. Two hundred twenty (220) had been readmitted that had been discharged AMh at some time in the past. This accounts for 1.4% of the total number of admissions, All in all a total of 332 readmissions were made during the year of 1953 for a percentage accounting for 21% of the total admissions,or meaning that one in every five patients admitted during the year was a readmissicn.

CC13

TABLE XIII

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 1953

QUIESCENT OR
ARRESTED

IMPROVED

White Col. White Col

3

0

37 10

1

0

30 14

4

0

25 12

2

0

64 23

8

1

101 28

5

0

68 27

6

2

104 60

8

1

118 74

8

2

102 68

10

2

169 77

UNIMPROVED

TOTAL

White Col. White Col.

45 23

85 33

60 16

91 30

87 26

116 38

106 31

170 54

98 20

207 48

73 6

146 33

80 11

190 73

130 44

256 119

115 33

225 103

96 17

275 96

This table reveals that there were 371 patients discharged from the institution during 1953 that had a positive sputum, either to direct smear or culture. This represents an increase of 43 patients over the year of 1952, but it must be kept in mind that there were 393 more patients discharged with a diagnosis of tuberculosis in the year of 1953 than in the corresponding year.

CCl4

TABLE XIV

The following table shows the discharge status of pa-
tients, per cent of total tuberculous discharged, during the past ten years at Alto and Battey:

Year 1944 194S 1946 1947 1948 1949 19SO 19Sl 19S2 19S3

QUIESCENT OR
ARRESTED
White Col. 29 37 32 20 23 10 21 12 22 19 38 2S 38 27 30 26 31 38
39 so

IMPROVED White Col.
40 32 29 37 24 21 3S 26 43 33 32 36
37 so
38 46 44 36 42 3S

UNIMPROVED

White Col.

21 22

29 18

38 32

30 21

23 12
16 s lS s

23 12

16

9

14 s

DEATHS

White Col.

10

9

10 2S

lS 37

14 41

12 36

14 33

10 18

10 16

7

6

s 10

The main thing shown on this table is that there were more patients, both white and colored, discharged as quiescent or arrested. There were slightly fewer patients discharged improved, both white and colored, and there was also a slight diminution for both white and colored patients discharged as unimproved. The colored death rate increased slightly

CC15

TABLB XV

LENGTH OF STAY OF PULMONARY TUBERCULOSIS DISCHARGES BASED ON ADMISSION DIAGNOSES

WHITE PATIENTS

Iviales Far Adv. i'IIod.Adv. Minimal Total

Total No. Discharges
414
198 10
622

Total No. Hospital Days
192,477 83,175 1,837 277,489

Average No. Days
465 420
184 446

Females

Far Adv.

1R6

128,337

690

l'~od. Adv.

188

109,571

583

Minimal

15

6,426

428

Total

389

244,334

628

Total White

1,011

521,823

516

CCl6

TABLE XVI

LENGTH OF STAY OF PULMONARY TUBERCULOSIS DISCHARGES BASED ON ADMISSION DIAGNOSES

COLORED PATIENTS

Males

Total No. Discharges

Far Adv.

222

Mod. Adv.

76

Minimal

4

Miliary

5

Total

307

Total No. Hospital Days
115,468 48,412
968 2,076 166,924

Average No. Days
520 637 242 415 544

Females

Far Adv.

182

Mod. Adv.

80

Minimal

8

Miliary

11

Total

281

Total Colored 588

110,661

608

41,709

521

4,325

541

3,757

342

160,452

571

327,376

557

CC17

TABLE XVII

LENGTH OF STAY OF OTHER TYPES OF ADMISSIONS
DISCHARGED IN CALENDAR YEAR 1953

COLORED PATIENTS

Males Suspicious Non-tbc. Extra -pul. Pleural Eff. Carcinoma Silicosis Total

No Pts.
1 14
3 10
2 1 31

No. Days
57 1,038 3,051 2,883
98 559 7,686

No. Days. Avg.
57 74 1,017 288 49 559 248

Females

Non-tbc.

7

573

82

Extra-pul.

4

786

196

Pleural Eff.

5

1,556

311

Carcinoma

1

2

2

Total

17

2,917

172

CC18

TABLE XVIII

LENG'IH OF STAY OF OTHER TYPES OF ADMISSIONS
DISCHARGED IN CALENDAR YEAR 1953

WHITE PATIENTS

Males Suspicious Carcinoma Pl. Effusion Non-tbc. Total

No. Pts.
19 2
l
38 60

No. Days
926 128
28 2,615 3,697

No. Days Avg.
49 64 28 69 62

Females

Suspicious

3

244

81

Pleural Effusion

4

1,875

469

Non-tbc.

23

2,222

97

Total

30

4,341

145

Total No, of Discharges Total No. of Hospital Days Average Hospital Stay

1,737 867,840
500

It can be seen that the average hospital stay during
1953 was 500 days per patient. We had anticipated that
the average hospital stay would have diminished during
1953 as there were nearly 400 more patients discharged
from approximately the same number of beds during this
year as during the previous year, when the average hospi-
tal stay was 432 days. The increase could be accounted
for because of the fact that there were a considerable num-
ber of patients discharged during 1953 that had between 5,000 and 6,000 continuous days of hospitalization.

TABLE XIX

LENGTH OF STAY OF PATIENTS DYING IN HOSPITAL - 1953

Male

No. of Patients No. Days Avg. No. Days

WHITE

Far advanced Mod. advanced

35

18,164

6

8,273

519 1,379

Non-tbc.

l

49

49

COLORED

Far advanced Mod. advanced Carcinoma

24

6,590

275

2

225

112

2

98

49

Non-tbc. Miliary

l

97

97

l

8

8

WHITE

Female Far advanced Mod. advanced

8

5,316

664

l

106

106

Non-tbc.

l

15

15

COLORED

Far advanced Carcinoma Miliary Extra-pulmonary

27

15,078

558

l

2

2

l

4

4

l

62

62

Non-tbc.

l

69

69

CC20

THERAPY

Battey State Hospital has continued to participate in the cooperative study, as onf of twenty-two cooperating
hospitals located throughout the United States, evaluating isoniazid, streptomycin and PAS in various dosages and combinations. It has been conclusively shown that isoniazid
is a very important therapeutic agent in the treatment of tuberculosis. Several scientific papers have been published, regarding these studies, and during the year of 1953 Battey contributed approximately one-third of all the patients entering into the cooperative study.

The following table shows the various types of therapy used on the patients discharged in 1952 and 1953:

l. Bed rest only 2. Phrenic nerve crush 3. Pneumothorax 4. Thoracoplasty 5. Pneumoperitoneum 6. Diagnosis only 7. Chemotherapy 8. Resections

1952 76 7 16 80
562 108 771
48

1953 122 16 9 70 684 89
1,475 124

One can see that the use of chemotherapy, or antimicrobial therapy, has become much more widely used and practically all patients receive antimicrobial therapy as a part of their routine therapy within the sanatorium. The length of time of administration of antimicrobial therapy has gradually lengthened over the years so that now all patients that are started on the drug are kept on it for twelve to twenty-four months, continuously

Slightly over 11% of all patients discharged from the institution in 1953 had been treated with major thoracic surgery, in addition to other standard forms of therapy. The addition of 36 surgical beds for colored patients will
lead to even a greater number of patients being treated surgically than we were able to accomplish in the past.

CC2l

COST

The table below shows the average per diem cost for a
patient during each half of the calendar years 1945 through l953J inclusive:

PERIOD

SALARIES SUPPLIES NET COST OUTLAY TOTAL

First half 1945 $L29

$1.21

$2.50 $ .08 $2.58

Last half 1945 l. 27

l. 05

2 32

.17 2.49

First half 1946 l. 62

l. 47

3.09

l. 45 4.54

Last half 1946 l. 92

2.49

4.41

l. 71 6.12

First half 1947 l. 61

l. 73

3.34

. 85 4.19

Last half 1947 l. 66

l. 75

3.41

.30 3.71

First half 1948 l. 85

2.69

4.54

.28 4.82

Last half 1948 l. 89

2.28

4.17

.17 4.34

First half 1949 l. 88

2.31

4.19

.29 4.48

Last half 1949 l. 94

2.11

4.05

.38 4.43

First half 1950 2.07

2.50

4.57

.71 5.28

Last half 1950 2.10

2.34

4.44

.74 5.28

First half 1951 2.23

2.90

5.13

78 5.91

Last half 1951 2.35

2.28

4.63

.42 5.05

First half 1952 2 47

2.75

4.97

.25 5.22

Last half 1952 2.50

2.25

4.62

.13 4.75

First half 1953 2.60

2.22

4.80

. 02 4.82

Last half 1953 2.67

2.24

4.88

.02 4.90

CC22

EMPLOYEE-PATIENT RATIO l-l-54

(Based on 1793 patients as of that date)

Department

Employees

Prisoners

Administration Medical Nursing Housekeeping Culinary Laundry Maintenance Farm & Dairy

l-l-54
1:41.6 1:32.0 1: 6.4 1:13.0 1: 9.6 1:35.8 1:30.9 1:77.9

l-1-54
1:39.8 1:34.4 1:112.0

Total Ratio

1: 2.16

1:15.8

Total Number

830

113

Combined Ratio for Employees and Prisoners 1:1.90

TUBERCULOSIS:

********** BATTEY STATE HOSPITAL LABORATORY

1951

Pos.

Total

Microscopies

3,816

Cultures

5,127

Animals

695

Sensitivity tests

27,376 20,668
3,311 2,166

Total

9,638 53,521

CLINICAL TESTS

lSJ52

Pos.

Total

4,724 7,206
522

28 J 146 24,492
2,547 2,951

12,452 58,136

1953

Pos

Total

3,688 5,085
327

25,727 26,201
1,806
1,526

9,100 55,260

Hematology Blood Chemistry Urine Spinal Fluids Body Fluids Miscellaneous
Grand Total

1952
17,676 1,000 5,416 774 121 1,428
26,415

1953
16,534 2,532 4,128 436 84 1,191
24,905

CC23

COUNTY SANATORIA

The applications, admissions and discharges for both the Muscogee County Sanatorium at Columbus and the Savannah Sanatorium have been included in the previous totals, The following table shows the stage of patients at discharge,

QUIESCENT OR
ARRESTED IMPROVED

UNIIviP.

DEATHS

TOTAL TBC.

Wh. Col. \IJh Col. Wh. Col. Wh. Col. Wh. Col.

SAVANNAH 6

4

7

14

l

l

4

l 18

20

COLUMBUS 2

7 29

10

0

0

2

5 33

22

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

QUIESCENT OR
ARRESTED IMPROVED

UNIMP.

TOTAL TBC.

Wh. Col. Wh. Col. Wh. Col. Wh. Col.

SAVANNAH 0

0

l

40

0

l

4

COLUJVIBUS 0

0

8

50

08

5

Both of these hospitals are financed out of a special appropriation for local sanatoria and administered under Battey State Hospital. The Muscogee County SRnatorium is allowed $3.591 per day per patient and has been able to operate satisfactorily on that figure. It is realized, of course, that their medical care is not included in the budget as Dr Comstock, a United States Public Health Service Officer, has been the medical director of the sanatorium.

The Savannah Sanatorium has operated on a $4.86 per diem day cost. The Savannah-Chatham County Sanatorium was in very poor physical condition at the beginning of the year and it was not possible to determine how the money the state was supplying for the operation of this installation was being spent. An audited account of the money was requested and could not be furnished by the City of Savannah. rccordingly, the funds were removed from the City Treasury of Savannah and placed in the hands of the Health Department in Savannah to administer starting August l, 1953.

CC24

Through May of 1953 the actual operating expense of the sanatorium had been $5.05 per diem During June and July of 1953 the operating expenses were up to $5.15 per day. After
the sanatorium was placed under the administration of the Health Department, the per diem operating cost dropped to
$4.86 a day which is still 27 cents a day more than they are receiving from the state, as we allow them $4.59 a day per
patient.
Alterations in the physical plant at the Savannah Sanatorium were duly discussed and changes were instituted. The contemplated plan is to enlarge the capacity of the one new building there to the point that all fifty patients can be housed in that building. This building was in need of considerable renovation, including floors, walls, painting, kitchen and storage space and a program of renovation was embarked upon,which was progressing very nicely at the end
of 1953.
The following table shows the average length of stay for the patients discharged from each of these sanatoria dur-
ing the year of 1953. It can be seen that the average length
of stay is considerably less than that of Battey state Hospital.

SAVANNAH COLUMBUS

No. Patients
38 55

No. Days

Avg. No. ~ays
338 276

CC25

''
DENTAL HEALTH SERVICES

GEORGIA DEPARTMENT OF PUBLIC HEALTH DENTAL HEALTH SERVICES
Report for the Year Ending December 21, 1953
In order to fulfill one of the principal objectives of the Georgia Department of Public Health, which is to improve the general health of the people, Dental Health Services has worked constantly throughout the year to improve the dental health of the people.
At the suggestion 'Jf the State Dental Society, dentistry was made one of the seven health services of the department, and a full-time public
health dentist was employed February 1, 1953. The program continued along
the lines originally planned, which was to become an integral part of the total health program, and to expand dental health services to as many areas not already served with dental health programs, as possible,
The main objective of Dental Health Services is to bring the incidence of dental caries within the range of control and to create a general dental health consciousness of the public.
It has been the custom of health departments, and is the philosophy of Dental Health Services, that the problem of most health significance should receive the greatest emphasis and priority. It is evident that any disease
that is not self-limited and which is attacking 98% of the population poses
a tremendous problem. The problem looks too big to undertake with any degree
of success, especially with the present ratio of one dentist for each 3,837
people in the State of Geor~ia and a backlog of approximately 10,000 unfilled teeth per dentist, with another 4,000 expected during the year. Therefore Dental Health Services has placed greater emphasis on the prevention of dental caries since it can be attacked in a mass or on a county-wide basis. In most counties it is now possible to reduce the incremental load by two-thirds,

The preventive proryrams are directed largely to the pre-school and school-age children, believing that mass clinical services could never solve the problem 1Ni th present economic and personal problems.
This does not mean that Dental Health Services does not encourage programs such as clinical services or perhaps pre-pa~~ent and post-payment plans that should be developed and expanded. Some of the great backlog can be eliminated through such plans, and such plans and programs will have the full cooperation of Dental Health Services.
PROGRAMS Prevention
During the year a large part of Dental Health Services 1 efforts were directed toward fluoridation promotion. 11The Policy of the Georgia Department of Public Health for the Fluoridation of Public f,vater Suppliestt was established and approved by the department. Local l:ommuniti_i.:;s interested in fluoridation were encouraged to use the policy as a guide in order to have full support of the department for their fluoridation project. Time spent on helping to develop these projec~s has seemed to be excessive, but because of the highly unscientific but vocal opposition, the program vvas retarded in many areas of the state, especially Atlanta. Even without opposition, fluoridation promotion involves many activities in which Dental Health Services contributed as liberally as was practical. Such areas are talks, preparations and dissemination of specific materials, reviewing literature, preparing articles, encouraging newspapers to support fluoridation, as well as special consultation with local health departments, county and city officials, community organizations and professional groups, on this subject.
Despite the opposition fluoridation became a reality in one corr~unity brin~in~ the total number of water systems fluoridatin~ to seven that
DD-2

serve 248,712 people. Four other counties were in the process of installing equipment and will begin operation durinp the next year. (See map "Georgia Communities Fluoridating Their Public Water Supplies".)
A pre-fluoridation survey was conducted in the City of Marietta where the local dentists in cooperation with the Emory University School of Dentistry
and the Georgia Department of Public Health examined 3,961 school children ranging from 6 to 18 years of age. Tabulations were made and rates established
for each age group by the Georgia Department of Public Health. Future evaluations of the proqram may be made by comparing future examinations to those conducted before fluoridation.
Topical fluoride programs were conducted by dental hygienists employed by the counties in Ware, Muscogee and Dougherty. It is anticipated that the City cf Albany will discontinue their topical fluoride program when the fluoridation project begins to show results in the younger age groups. Clinics
There were practically no changes made in the operational procedures of the clinical programs which provided services to under-privileged children. All new clinics that began operation durin~ the year were encouraged to admit only the younger children to these clinics, rather than attempt tc rehabilitate the older age groups. It has been demonstrated that maintenance programs can provide service to many more children than rehabilitation programs. Too, this method of operation is definitely a public health procedure in that such programs save teeth. Extraction and emergency relief clinics are desirable, but fall more into the welfare program than public health.
The monthly dental clinic reports that are required of the local health departments that expect reimbursement from the state show that 50 counties operated dental clinics throughout the year, while ll existing clinics failed
DD-3

to operate principally because no dentists were available in the county to provide the service. DeKalb and Fulton Counties operate several clinics independent of state financial aid, since the state does not participate in programs providing dental services to the adults and older children. Several counties have more than one center providing clinical services, and the total number of centers operating in 1953 were 81 for the state, which does not include three mobile units in Fulton County. The map, "Operation of Dental Clinics," shows the location of the clinics that were in operation during the year as well as the five new clinics that began operation during the year.
A clinic session is generally considered four hours. However, a wide deviation was noted in this practice throughout the state. According to the reports, 13,414~ clinic sessions were conducted during the year. Only a small percentage of these clinics were for Negro children. Since the number of qualified Negro dentists is extremely limited, the ratio of white and Negro clinics does not compare to the population ratio. The total number of children admitted to clinics for service was 21,439 and this group made a total number of visits equal to an average of 1.6 visits per child. The number of visits per child cannot be used as an average number of visits needed to complete a child, as only 49% of the 21,439 children admitted received completed care. (See "Summary of Dental Clinic Services for 1953 11 .) It may also be interesting to note that each child received an average of
6.5 treatments, consisting of fillings, extractions or miscellaneous treat-
ments, which is not the needed number of treatments for complete service. For this service, the local practicing dentists are used as clinicians
and are paid ~15.00 per clinic session. The assistants are generally paid $3.00 per session, making a total of ~18.00 for each clinic session held.
DD-4

The average state participation amounts to approximately one half the total
cost. During the year, 159 dentists served in these clinics and the total
cost for the state and local health departments' .participation in these was $85,255.00 Education
All dental health activities rely a great deal upon education for the program recipient. This education takes the form of county organization, talks, conferences, seminars, in-service training, news articles, preparation and dissemination of materials as well as reviewing the literature to screen out undesirable information and thereby present f~ctual materials to the people. In order to encourage fluoridation of public water supplies, it has taken much time and effort to convey proper information to the public, because of the vast amount of unscientific materials and false information that has been distributed throughout the state by anti-fluoridation groups. Since it is quite difficult for the average person to distinguish between scientific and unscientific information, the job has been doubly hard.
One of the outstanding features of the educational program was the Dental Seminar designed for the dental profession and publi~ health workers. Considerable time and effort and funds were devoted to this project, in which more than 200 dentists throughout the state participated. The selection of the subjects, speakers and localities to be held is no small job and to encourage dentists and health workers to take advantage and attend these carefully planned programs, adds more work to the planning.
Several conferences were held in which dental personnel participated, Parent-teacher organizations, Better Health Councils, summer training courses for teachers, the American Public Health Association and the
DD-5

State and Territorial Dental Directors' meetings are examples of areas where educational activities were conducted.
Students at the Emory University School of Dentistry were included in the educational phase of the program. By ingraining community health in the minds of the future dentists, better health programs can eventually be expected at the local or county level. For long range education, this is one area where more good can be done than perhaps any other area of the educational program. Personnel for Dental Health Services helped with this under-graduate work.
ADMINISTRATION In addition to serving on the Advisory Committee in the policy making for the department, staff conferences and field trips were areas in which Dental Health Services spent some time. It is quite evident that with the limited number of field workers, consultant and advisory services for the local health departmentshave been lacking and only where requests were made for help was Dental Health Services able to supply this limited service. In cooperation with the Dental Consultant of the Regional Office of the United States Public Health Service, a survey of the dental program was conducted in Fulton County. Even though some pressure was exerted for a quick completion of this report, no action has been taken to carry out the proposed recommendations made in the final draft that was submitted. An evaluation of the total dental program shows some progress is being made. On the other hand, it is evident that the size of the problem is so great that the small progress made is infinitesimal when compared to the total needs. It i~ however, encouraging when one can note that the filled tooth rate for the children in Georgia is equal to the rates in other states that have a much better ratio of dentists to the population than is found in Georgia. Such information shows the interest the dentists
DD-6

in Georgia have for the child patients. They are concentrating more in the area where the most lasting results can be effected, perhaps, because of the dental public health program.
RECOMMENDATIONS No program can accomplish its objectives without personnel and funds to do the job. Therefore it is necessary for more funds to be made available in order to employ more full-time dentists both in the Stgte and local health departments, if this objective of improving dental health is to become a reality. Every effort should be made by all disciplines interested in health to help decrease the dental needs and improve the services in the areas of dental health. Dental health programs at the local level must be expanded if progress is to be made.
DD-7

STATEMENT OF DENTAL CLINIC ACTIVITIES FOR 1953

Number of Counties White

Operating

Dental

Clinics,,,, ....5.0...... 50

Negro

13

Net receiving state financial participation for

')

dental clinic program

Number of Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

White

54

Negro .

13

Not receiving state financial participation

14

.

.

1

Number of Sesslons ...... , .................................................. 13,4142

White

3,105~

Negro

665 2/3

Not receiving state financial participation

2,101

Number of Dentists Working in Clinics ........................................ 159

White

133

Negro

12

Not receiving state financial participation

14

Honoraria paid part-time dental clinicians $56,567.5C

Salaries paid three full-time dentists on local level . 19,404.00 Travel expenses allowed for three full-time dentists on local level 1,560,00

Salaries paid part-time dental assistants 7,723.50

TOTAL STATE AND LOCAL EXPENDITURES FOR DN~TAL SERVICES

$85,255.00

DD-8

SUMMARY OF DENTAL CLINIC SERVICES FOR 1953

I
~
~
i,,
"::

Total Admissions

By Ages:

6-8 yrs.

9-ll

12-14

%6-8

%9-ll %12-14 Total Visits

I
i
I I

Total Patients Dismissed Completed Other
% Completed

Prophylaxes

TOTAL 21,439

rl Clinics Receiving State 'I Clinics Not Receiving '

1 Financial Participation !state Financial Parti-

!

~

cipation

vlhite 'IJ Negro

i

i

11,344 4,062

6,033

9,037 6,773 ,1
5,629 i
42% I 32% 26%
35,342

5,507 3,483 2,324
49% 31% 20% 22,254

1,581

1,329

' 1,152

39%

I
!

33% 28%
5,252

13 2056 10,611
2,445 49%
5,169

7,81g

1 2 508

I

,88

748

926

760

60%

l$%

4,039 I 607

1,949 1,931 2,153
33% 32% 35% 7,836
I
3.736 2,977
759 49%
523

Number Teeth Extracted Deciduous lst Perm. Molars

20!495 14,645
4,436

11 2004 8,589 1,904

5,177
3,349 1,503

I
1

Other Perm. Teeth

1,414

511

325

I

Number ': eeth Filled Deciduous lst Perm. l'l[olars Other Perm. Teeth

41 2150

23 2 648

2,495

I

11,466

7,658 1,129

!

18,149 11,535

10,935 5,005

878 488

I

4,314 2,707 1,029
578
15,007 2,679 6,336 5,992

Number of Fillings Cement Alloy Silicate

632476 13,809

30 2968 3,835

2,808 604

'
i
I
I

46,349 3,318

25,523 1,610

2,033 171

I

!

TOTAL OF ALL SERVICES RENDERED

I 130,290
I

i
69,659

111,087

29,700 9,370 18,793 1,537
49,544

DD-9

OPERATION OF DENTAL CLINICS
JANUARY THROUGH DECEMBER 1953

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WARE

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DECATUR

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iI THOMAS
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LOWNDES
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LEGEND: e DENTAL CLINICS OPERATING IN 1953
0 = NEW CLINICS BEGUN IN 1953
181 = CLINICS OPERATED IN 1952, NOT OPERATIN
0 = CLINICS EQUIPPED, BUT NOT OPERATED IN
'((: EMPLOYING A FULL TIME DENTIST

\TE TMENT
F HEALTH

GEORGIA COMMUNITIES FLUORIDATING THEIR PUBLIC WATER SUPPLIES
JANUARY THROUGH DECEMBER 1953

ii CATOOSA/
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MURRAY )

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GRADY

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CHARLTON

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ECHOLS

).7

LEGEND:
0
0

COMMUNITIES FLUORIDATING PRIOR TO 1953 COMMUNITIES BEGINNING FLUORIDATING DURING 1953

COMM, RECEIVING OFFICIAL STATE APPROVAL OF THEIR FLUORIDATING PROJECT IN 1953

LOCAL

1953

STATE DEPARTMENT
OF
PUBLIC HEALTH