Annual report 1954 [1954]

RiPORT m~ORGIA D2ll.RTrU.TT OF PU3LIC H.&\LTH
to the
GEOHGIA STAT;<; BC~lfm CF ESALTH
1 9 54

~tate of <J3eorgia
jE)epartment of ~ublic llealth
T. F. SELLERS, M. D., DIRECTOR ATLANTA

I1EHORANDUM

From: To:

T. F. Sellers, M. D., Director :Members, State Joarc of Health

This is a summ:w;.r r0port frq~ 195L~) by the Director of the Georgia Department of Public Eonlth to tho State 3oard of Heulth. It is our plan to reproduce this report in a suitaolr:; manner for distribution to public health departments, schools of public health and other individuals and institutions who each yee1r request such a report of health department activities. It is also felt that this report mipht serve as the annual report of the State Board of Health to the Governor, as required by state law. .\ statistical supplement "~frill be produced by tho Dopn.rtment ns soon as final morbidity :md mortality figures are ,g,vailable,
Following, for your convenience, is a brief resume of information contained in this report:
-HESUNE~1Je have seen 1.n e.xtcmsion of the Eill-Gurton hospital program lfThich
has already helped provide the stata with 74 projects, including 54 new
hospitals (page l). -,:e are worl<ing toward 100 prJrcent r,.gistration of births, deaths,
fetal deaths, marriages, and divorces (pap;e 3). 1:e had 2,332 employees, a net gain of 24 over the previous year, with
a turnover of 32 percent (page 5).

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V:e have continued to educate "lmi. inform the people about health and health department matters through every channel of mass communications as well
as through state and community organizations (page 7).
Training funds were used less last year for full-year academic training, and more emphasis has been placed on short-term specialization and refresher courses. Needed are adequate tmining funds and the development of local field
training centers for training of public health p<3rsonnel (page 9).
We have seen five communities begin fluoridation of water supplies to
reduce tooth decay, and we have conducted dental public health clinics in 56
counties, but we arG limited by 0 shorto.ge of personnel, private dentists and funds (page 11).
ii'Je have given public he9.lth engineering s0rvice, training and consultation in sanitA-tion of milk, food, schools, tourist courts, housing, shellfish, hospitals, impounded water, and welfare placement, as well as mapping and photography service (page 14).
l,e found there ~rere no reported cases of diseases in the state attributed to water supplies, e.s our work continued in the field of water-sewage control
with especial difficulties duo to tho 1954 stmunor drouth (page 17).
11\e have studied the problems of health in industry and given advice as to the control methods and facilities Hhich industry must provide for itself;
this service affected 401 establishments employing 98,000 workers in 80 counties (page 55).
~dthdrawal of federal funds caused a chango in our methods of insect and rodent control, with some duties of the Division of Insect and Rodent Control going to the Divisions of Epidemiology and Public Health Engineering.
~:e gathered statistical informRtion on the number and kinds of home accidents and began educational programs in home safety, based on this information - which showed home accidents to be the scwenth cause of death in the state (page 21).

- 3We had the best nursing covGr.:gc so far, with at least one of our 535 public health nurses in 146 counti,_:;s; 20 counties had a ratio of one nurse to less than 5,000 populetion, while 14 had a ratio of one nurse to more than 15,000 popul~tion (page 24).
Details were comph;ted for carrying out the new dj_strict pla.n, o.pproved by the Board of Health, for creating 38 hcn.lth districts in the sta.tG, and we believe it wil1 take five Y'-'e.rs or long3r to Gstablish the districts (page 27).
I;Je found WJ.tr~rnal and child hGo.lth care service facilities in rural Georgia to be shocldngly inJ.dequ'~.te, :::md with the help of 25 statewide organizations are working on plans to stinulate countios to correct this situation; also, we continued to promote the nutritional well-b<Jing of the population (page 29).
Ide conductod vision screening surveys of almost 100,000 children, and hearing screening surveys of over 50,000 - yet about 750,000 to 800,000 children were not reached because of lirnit ;tious in our progrmn (page 32).
In our mental health progrtllll vve gave priority to the following programs: ''exceptionAl children," families of the ment."llly ill, maternf'll depriv'ltion, and juvenile delinquency. !rJe plan additional child guidance centers at Rome, Augusta, Athens, Vaycross and .rllb"my (p1.go 35).
Decrease in our funds for crippled children's program in 1954 led to fewer cleft palate clinics; lB.cl< of hospitalization for C!lrdiac children; lack of service for children needing plastic surgery; and iwl.bility to open up new areas of treatment, such as eye ~nd hearing defects, epilepsy, and other types of handicapping conditions (page 38).
Despite our phenomenal progr0ss in control of .:1cute communicable diseas(')S in past decade, A, total of 30,553 cases, excluding V\.mereal diseases, occurred last year, showing tint they still romain a major threFLt to Georgia citizens (page 40).
\r,'e were forcad to spend less money on cancer control in spite of an increased caseload. \:e do not b~liev8 we c.qn continue if funds are cut any

further (page 40).

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Rr.tbies in dogs reached the lowest point in 1954 for many ye<~rs through

mass immunization of dogs in known infected areRs and a "fox-thinning" program

(page 40).

1~>1J1ile tuberculosis deaths dropped to about 317, new cases are rapidly

developing, ::md we see r.t need for expanded casefinding as well as adequate social

casework service for patients ::md famili;;s of patients (page h6).

'.'e had fewer patients at Bettey Hospital in 1954 (1,660) than in 1953 (1,822). Only L~4 applic;:mts, or 2.6;:; of the totnl, were rejected (page 49).

Venere'll dis l3ases could bo brought 1.mder control with the knowledge and

therapeutic woapons t'll3 hA.v.:;, but U:e job cannot be completed v.Jithout a return to

adequate financial support (page 52).

Cutting, of :funds stopped our diabetes casufinding and referral Si::Jrvice,

closed our diabetos detection lo.borrJ.tory, <J.nd took away the services of a

physician in the Chronic Disease Division. Only ten heart disease control

clinics were in full operation during 1954 (page 59).

:,le continued to work closely with tho Civilian Preparedness Committee

of the Medical Association of Georgii'l to provide a program for Civil Defense

Health Services, ~l vit:=tl aspect of defense e.g1inst enemy attack or natural

disaster (page 62).

For the first tirae since the peak of 1951, our laboratory examinations

fell below the million mnrk. The flow of specimens into the laboratory fluc-
tuates as the progr.~ms of other divisions exprmd or recede (page 64).

T AB1 E 0 F C 0 NT E NT S

ADMINISTRATIVE SEilVICE Division of Hospitaj Services Division of Vital S-t,atistics Division of Personnel - - - Division of Public Health Education
Division of Training - - - - - - - - - -

DENTAL HEALTH SERVICE Division of Dental Public Health - - - - - - - - - - -

EIWIRONMENTAL HEl1LTH SEHVICE

Division of Public Health Engineering- -

-- - -

Division of Water Pollution Control- - -

----

Division of IndustriRl HygienG

(See Occupational Health)

Division of Insect and Hodent Control - - - -

Home Safety Unit - - - - - - - - - - - -

LOCAL HEALTH SERVICE

Division 0f Public Health Nursing

--- -

Division of Local Health Organizations

HEALTH CONSERVATION SERVICE Division of Maternal and Child Health D::.vision of School He.':J..lth
Division of Mental Hyeione - Division of Crippled Children

----- - - - - -

PREVSNT!~BLE DISEASES SERVICE

Division of Epidemiology, Cancer Control and Veternary

Activities - - - - - - - - - - - -

- - -- -

Division of Tuberculosis Control - - - -

Battey State Hospital - - - - - - - - - - - - - - - -

Division of Venere~l Disease Control - - - - - -

Division of Occupational Health

-----

(Industrial Hygiene included)

Division of Chronic Diseases -

-----

Civil Defense Health Services

- -- - --

LABORATORY SERVICE Division of Laboratories - - - - - - - - - - - - - - -

Pages 1- 2 3- 4 5- 6
7- 8
9 - 10
11 - 13
14 - 16 17 - 19
20 - 21
21 - 23
24- 26 27 - 28
29 - 31 32 - 3L~ 35 - 37 38- 39
40- 45 46- 48 49 - 51 52 -54 55 - 58 59 - 61 62 - 63
64 - 66

Division of Hospital Services Division of Vito.l Statistics Division of Personnel "'Division of Public Health Education Division of Training

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DIVISION OF HOSPITAL SERVICES
The objective of the Division of Hospital Services is to assist communities to improve hospital and related medical facilities and services, in order to maintain and extend good patient care to all Georgia citizens. To carry out these objectives the Division is responsible for:
l. The administration of the hospital and related medical facilities construction program (Hill-Burton Act) as amended,
2. The administration of the Georgia Hospital Regulations Act (No. 623, 19~.6).
3. Surveys and studies to dotornune relative need for improved medical facilities,
4. Consultation services to local communities relative to hospital problems,
--- Activities ~--~ ..........
Under the Hospital Constr1..wtion (Hill-Burton) Program, 74 projects, including 52 new hospitals, at a total cost of tj;;54,915,522.26 have been either completed, placed under construction or approved for construction~ The 1954 construction schedule included a new 75-bed community hospital at Milledgeville, and alterations and/or additions to hospitals at Cedartown, Columbus and Athens, During the year the Division was delegated the responsibility for the administration of the Medical Facilities Act which was passed by the Congress in 1954 to encourage hospitals to expand their scope of services to include more adequate provision for ambulatory and long-term patients. Preliminary planning vras startGd and some 19 corrunu.nities have requested assistance 1..mder the ex.pandc:Jd program.
During the year, the Division processed 39 schematic, preliminary and final building plans, inspected 13 sitGs, processed 104 contract modifications,

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attended 17 bid openings and made90 building inspections during and after
construction, The Division conducted 1~50 visits to hospito.ls and nursinc; homes
relative to the apolication of licensure rules and regulations. For the year
ending January 1, 1955, 49 annual permits m;re issued for hospitals, and 17
for nursing homes. A complete revision of licunsure regulations relating to hospitals and to nursing homos vras mctde and subsequently approved by tho State Board of Health, Special assistance was given to 37 hospitals in obtaining hospital equipmE:::nt under tho Fuderal Governrnent rs Surplus Property Program, Purchased at ~)16 ' 8L,4, 82, this equipment was valued at ten times this amount.
The Division made five comrn.unity surveys for improved hospita.l facili-
ties, held 25 formal community modings to explain the objectives and operation
of the hospital construction program. Tho evaluation of the first year's operating experience of l.O nevr hospitals were made, o.nd seven spocie.l. statewide studios relating to hospital and medical care problems in Georgia were completed,
lihth the completion to date of 45 now hospito.ls in the State, the need for more and better trained hospital personnel. is becoming more urgent. Tho Division provided assistance to hospit<1.ls throughout the State in the areas of hospital administration, dietetics, nursing, 1a.boratory services, accounting, and equipment. A v0.rioty of institutes anc~ work conferences were sponsored by the division in cooperation v:itL the Goorgia Hospital. Association.
During the yoar the Division particip:::ted :,.n tho planning and develop- mont of the: Civil Defense progra:n for hospitals.. AJ.S') J the Division assisted the Atlanta Division, University of Georgia with the program of instruction in hospital administration.

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DIVISION GF' VIT:\.1 i)TATISTICS
Tris Division has been givt:n the responsioility of administering the laws of G,,orgia relating to the registration of births, deaths, fetal deatls, marriages, and divorcP.s, The ultim"lte aim of tho Division is to achiove 100 per cent registration of ell suet~ 0vents as they occur,
During 1954, for the first tin10 r"!lore than 100,000 live births occurred one year in Georgia. Through Dc;cc:nbcr 31, 100,069 comploted certificates had becm placed on file. It is difficult to t-:!sUm::>.,tc:J accurately the number of c<:;rtificn.tes Y''t to be .;:'iL;d. Howcv(::r, due tc the effectiveness of efforts to have certificr,tes filud promptly ~lfter birth, it is believed the final tot.'J.l rucorded live birtbs for th:: yc:ar will b\.:; approximA.tely 102,000.
There; were 30,521 de,!.ths recorded in 1954, but again the registration fa.ctor mah:es fim~.l ostim::tt,:s difficult. ]iowE,vor, tJ:-:e final recorded tot <:cl will be apurc:xim,:.tely 31,000.
The program for tho registration of fetal dua.tr's was inaugur.c:ted on
JFtnUA.ry 1, 1954, t-J.nd while there: soems to oo a misundc::rstandinR: of the
pro<:;ram by some physicians in the St<ttn, :i.t has been >mll received by most, Its acceptAnce was largc~ly due t1, th.3 cooperation of thG Division of Naternal and Child Health and the lV!<ttc;rno.l nnd. In:t'ant ~<clfare CommHtve of the Medic3.1
Association of Georgin.. llorc than L.,ooo :t\;tal d.e1.ths were recorded during
1954 as compared to a totnl of 2,040 stillbirths rtJcord:;cl for 1953. vJhile the progress of the program hPs e.xccoeded expectA.t:'.0r'l'3, much r<.:omains to be done to realize its full potentic:;.l 2s :1 tool for <J b,.;tter measurement and und0rstanding of prenatal care Rnd hmnan wastago,
l'i:1rriage registration continUt3S to be effect.. '/C. There were 51,455 marriages recorded during 195h, which "'as 795 less th:m in 1953. This decline is not an indicati0n of n br,;.'lkdown in rsgistrn.tion but follows a national

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pattern of a lower marriage rate for 1954.
Neither tl:.e quality nor qur:ntity in divorce rogistrntion was as good as it should be .'l.nd a concentrat~,~d effort v</as made during the year toward its improvement. Clerk:s of th-:; SupGrior Courts are rt;sponsible for completing and filing thest.O re:cords i'l.nd work ~ras primarily with them. Most of them were contacttx1 one: or more times lvith the rc:::sult tlw.t quality was
improved. However, only 6,7Lf3 divorces were recorded vvhich is a dr.::crease of 431 as compared to 1953. Sc:.woral probl;;m 1.reas still exist and efforts during 1955 shall bG dir.3cted toward them.
Filing birth certific,,t,~E; by th0 ch~la.yed procedure is still an
importrmt functicn of the Division. 18,677 dolnycd certificates were filed during the year of which 11,692 wor~ filed by the court order procedure,
The need for birth and c1eath v<:rifications or certification continues
to grow. Th,-: Division issued 30,012 c0rtified copic;s of these records during tlle year. Of these 3,161 were i.ssucd free to v:;terans. Thousands of school certific:atGs wert; issued, as wer.;; allotment certificates for the
o"' births for publj c ;;,g,:;ncic;s but they munber many thous:md l~ach year.
New birth certificntes w ;re filed during the y,)8r for 1,263 adopted children and 625 childrt.m who WGrt" legitimated,
Th,:; Field ReprescrrLatives c:ontinued their educn.tional and promotional progr0m toward b,otter r;gistr:ltion c>f all Vit?,l .GV::nts, This has proven to be a worthwhile prcfSr"m and -v, ry effective.
A complete st.qtistic:.::;l 3.nalJsis of births, deaths, \;tal deaths,
marriages and divorces for 1954 will be published ] .-~ten.

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DIVISION OF PEli.SON1JEL A.DHINISTR.ri.TION

uuring 195h an expansirm of direct h~alth services in local health clGp'i.rtnents rmd a strengthening of sc.;rviccs :1t i3attey State Hospital was offset by ,~ marked decrease in the number of persons employed in the State Health Department, In additic:n to the tot~l of 902 full tim,~ employees in whose salP.rh;s the StJ.t':: po.rticip:'1tod, lqc::t1 he,.. J.th dE:pCJ.rtmcnts paid in full the salaries of mrmy additionFLl h~ol1th vmrl<:,.;rs,

Fu11 Tirn~ frnploye0;s in Pu_i:)1ic lk.'llth

1948 1%.9 1950 1951 1952 1953 1954

Local

642

650

687

724

828

870

902

Stqte

496

521

524

608

629

608

574

Alto

177

Jettcy ___.22.2

1) SlO

183 _658 2J012

191
_]~59
2,161

163 - 832 2,327

15 __ 259 2,331

0 -~)_Q 2_,308

0
__s;_~
2,332

,u., al.nN,et1954
32 -34
0 26 24

There was a continued incr<';asing stai-dlity of employm1mt and cor responding reduction of employee turnovt!r, The turnuver rate decreased from 39% in 1953 to 32;s in 1954.

Local State 3attey

Er'tployee Turnnver in 1954

A.ppointm.omts

3ej.Ycr:itions

198

166

139

173

1-~-13

J8'Z

750

726

Net Gain 32
-34 26 24

Juring th2 ye,~.r nn intr:msive study uf the classificntions of cmviro:nmental s::tnittttion w:01s brou:~ht tc ;:;, successful conclusion. In

accor'i 'me e with St,t,; l'lw, t lo:J"tlf:y :investit:'tion of 'lll employees was conducted, A r-wision of the; St:'t,; ~nployc:oes 1 Hetirc:!71cnt L~W rcnvwed certain
inequitir..33 in the ttpplic"tion Jf t: .:: l'l'-'' to health dc:p::l:rt;;-wnt '~mployees.
The> hospitr::.liz'ltion incur1ncc p;:-c~,r~'m for ,-;mploy(;,,s V'lS broa.dc.oned to include surgicRl insuranc~.

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DIVISION OF PUBLIC HEALTH EDUCATION
"An informed people, with sound health attitudes and good health habits, working together to improve the health of their neighborhood, their cornnmnity, and their State."
The purpose of the Division of Public Health Education is to previde personnel, techniques, and rr.aterials to help achieve this goaL
~~~~~ of the division consist of (l) health education consultants, (2) public information specialist, (3) illustrator, (4) librarian, (5) film librarian, and (6) stenographic and clerical workerso
Tec~ue.._ include ( l) use of the "mass" informational media--newspaper, radio, television; ( 2) consulting >vi th and providing materials for agencies interested in health (Georgia Congress of Parents and Teachers, Juni,)r Chamber of Cornmerce, Better Health Council. of Georgia~ Georgia Denta,l Associatic.:1 and others;) (3) maintaining contact with persons in the field of education through attendance at teacher vmrki3hops, health council meetings, Joint Committee on Health-Education> parent-teacher meetings, etE:. These acti'rities are carried on in order to promote joint planning of school health programs, to encourage health teaching; &!d to inform school people as to resources available in the health department; (4) encouraging the formation of local community health councils, furthering the ideal of the community's grappling with its m'm health problems; (5) in-se::vicFJ education programs-organized efforts to bring to public health worke:('3 l:::;Lest techniques of health education, in line with the philosophy that every public health worker is a ''health educator;" (6) consultation Wlth other divisions in pla1ning for and publicizing institutes and semina.::so
Mat~~ials ~repared and/or distributed include films, filmstrips, radio transcriptions, pamphlets, eyJlibits, posters, radio tape-recordings, and television film clips. 'l'his division produces GEORGIA'S H~ALTH, a

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monthly bulletin of health hints \Nhich is mailed, upon request, to some 10,000 Georgians. This division also produces FAX, a monthly newsletter for public health personnel. !iigg].i.f{~~ LC?,f 19 5~;
L Going ~lace:;? i~_sJ;_lth. A 28-page booklet, outlining an 11 Action Progrcun in Health for the local ParGnt-Teacher Association, 11 was prepared by this division and published by the Georgie, Congress of Parents and Teacherso
2. !~~~~~moyies. Short Jnovies have been taken of public health activities and hwe been used by television st.J..tions throughout the state, At relatively low cost, public health informl".tion is thus made available t~' thousands of Georgians who hitherto have hot;:-,.hefJJ::1.:1~eachJ3d::biY. 'pamph;Lets, newspapers and other media.
. 3o I:~dership q_on~~!'.:!2.2.?...~L1?-_ chgoL~e<?-J.!,hQ This Division took an
ac~ive part in planning and carrying out a workshop in school health educa~ tion, h0ld at the Continuing Education Center, University of Georgia, Athens~ Other agencies participating were the University Systom and the University of Georgia. Public health workers, school administrators, teachers, were among participants.
4. In-servi...s~_Eq~~<?.~.ti9.1 This division mot with groups of local and regional public henlth workers to encourage the use of educational te0hniques by public health personnel in every category"
5Q New Lo_2lj'ubl~...~illlL Educ:.S:.is2r. A health educator l.'Tas employed
by Savannah-Chatham County Health Department, bringing the state total to three. This health educator was given five-months apprenticeship supervised by this division and received grnduate work in public health education I'Tith f,:. nds made available to this Division for that purposeQ Employment of public health educators in local health dopartmonts is perhaps the greatest need in tho public health education program in tho state.

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The Division of Training ccntimLd in 1954 its responsibilities for Rdrninist,:;ring training fcmds cf U:e Dcp:J.rtmcnt, developing better tr<dning f".cilitics within the st:Jtc, :1.nd .t:lrorwting int(::rcst in training in public hw,_lth workers.

training cxpcriencGs lasti11g from 2 ~~c 9 wmths <.O"tch, 1'hc number of appli-

Ct>tions for 3.C1.d~rnic tr-:j ning fer U-;,_; fall uf 19:-Jh W2.S ccnsidc:r<lhly less

th1.n that for tho fc-,11 ,,r 1953. This 'tJ:"'S prJIJ'ibly due primrtrily to general

knnv:ledge th(lt le~3s tr:'dnin[! mr.;rwy W!lS .c:.v-dli'.-Jh; .for fiscal 1 55. The;

follnvdn>; t1.ble lists th, numb(~Y' nd type rjf persr,nncl recuiving stipond:

_St.tQ~EJ:..cLJ.'r1.i[!ing___:-__.195J.__________~---------
NU'i.:JES Ac3.demic Ori-::mt '!.tion

J::muclryJune:
12
3

SANITAiUANS Short Course in Lnvironm~nt'll :>lnit.,tion 10

ENGIPE~D.S

Acc1dcmic

1

PHYSICIANS

Ac3.dc::mic

2

Ori~~nt ;.tion

2

BAC'rERIOLOG I.STS Academic

P~RSONN:ii;L A.SSIST,~;JTS

Acad3mic

l

HZ:JIC:~L 30CI;tL v;ORKERS

Academic

l

PSYCHIATTUC SCCUL :oRKEHS

Academic

l

PSYCHOLCGISTS

Academic

l

STAfiSTIChL TECHNICIANS

Academic

l

PU'iLIC HEl.;.LTH EDUCATIC.1N EX~;CUT.IVES ''c::tdsmic

July:Uecember
5
5 5
l l
17

17
8
15
1
3
2
4
l l
l 1 l _ _l
56

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During this ye:1r, th,; Division of Tr:dning h:ls also been responsible .for a.pproval of short-term SP'"cialization and refresher courses where the only expense is for travel and subsist.cmce. These expr:.::riences are of interest to the wrious Divisions, frcm which applicntion is lYli"'.de for travel and
subsistence. ?urty-s;ven eli f'fer.;.;nt sr ';rt-L~rrn experiences ~vere participated
in by more than 160 individtnls durin;2; the. ;)'co'cr. 'Th.;se v:J.ried from inservic8 orientation f0r new em:plc;,'.:cs t) ,:.ttenchnc,, at highly technical courses in severr1l rrv~dicDl sr,~cial ti~s.
Thu Divisi:n of l'ra:i.ni ng lns continued to v1rticipate in the planning f0r visits to Gc:orgia by pt1blic h JJ.lth pc.~cph: from w:rious countries. 1Ul
divisions and lncal hen.lt,h d :r:. rt::::cnts rnve be:;n v(;ry cooper,,tive in pro-
viding vc:.lu.s.blJ oxperir:;nct:s l<'r th.::'sc pGr;ple. During trw year, more than 60 such visitors from 25 fcr,:;ign cc,w1trit::s h<w'-' visited in tb.c st:..te for periods varyin.r; from one d,c.y tG sAvcral w:;..:;ks.
The princ:i.p::tl tl~::tining needs in the G,,-;or.gi<l .:Jepartment of Public Health continue to be adequ::ttc trC>.ining funds and the devt:;lopmcnt of local fL~ld trP.ining ccmt crs for tr:e trn,:i.nin g ~. f public hc;clth personnel. Plans for traininR; CJnt.::rs have 1x:en S;nh;what :~urt.hor dcvclcpud during the yec:.r, and it is expectc;d ths.t 1t lea;:::t c:ne will lw clev.:lopnd during th::: coming year.

___ ____ DENTJ'J..J..........I...J...E......L.._L..',l'II SI:Jl.VICE _,_ ...__...._..,
Division of Dental P1.1.blic Health

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DIVISION OF DEl\JTAL PU:3LIC HEALTH
During 1954 Dental HeA.lth Services h:1s emphasized prevention of
dental ca.ries through topicnl fluoride treatments, fluoridation of public water supplies 2.nd the expansion (>:f remedial services for young children.
,IogiQ.~l fluoride I?rOf.T~ wcrtJ conducted in Douvherty, \iare, Huscogee, Harris, Rockdale and Fulton Counties 11here d,-;ntal hy!~ienists -vmre employed by the local health department to trof~t the; toeth of second, fifth and eighth grade children vJi th il s Jrj_,;s of four t:c>uatmc!Tts which have been proved to
reduce new decay by as much as 4CJJ6.
fhoric@i.ism o.:.~:'2-]~_::;r -~-:lf22.:J-h;s was started in five new communities
during 1954: Fort Valley, Thom~3sville, V:cldosta, Griffin and Cobb County, with a total population of 114,851, 'orinp;ing thG total nurnber of Georgians receiving the benefits of fluorid<':tion to 364,856 through 11 water systems.
Heferendums on fluoridation v'rere held in four communities - .\'~aycros s, Cordele, Hogansville and Furry. All four carried for fluoridation despite somo wild ~md vicious opposition, Opposition groups have been successful in delaying fluoridation in some ;.:.n::as despite the work done by Dente,l Health Services, the dent.'J.l profession, Junior Cham~~Jer of Commerce, P. T.A, 1 s and the Atlanta and state-wide newsp.:tpers,
Clinical serv:i.cos provided by tho local health departments may be classed in tvJO groups - ( 1) 'rhose recui ving state fin.:mcial assistance and (2) those financed totally b:i local hee.lth departments. ~Vith the shortage of funds, state. p.:1rticipation j_s lir:1itc;c1 to programs serving children ~md prenatal patients.
Clinical service reports show th.at a total of 31,255 children received 109,196 treA.tments during 195!+. It is sir;nif:i.cant that '!.bout 1/3 of the
children trec>.ted were Negro, 1vhich is good considering tho shortage of Negro

--12-
dentists in Geor~ia.
TJental Public Ee-<:tlth Clinics "rere conducted in 56 counties operating in 95 separate csnters where all utilities and supplies were provided by the
county with the state participating in the honorarium paid local dentists and assistrmts. It is most con1Trwndable that 183 of Georgia 1 s approximately 700 dentists worked in these clinics.
Effectiv': September l, revised P~.1.ns _}1CLPo1ic~::.~. for the Opc:ration of _A._E_'0lic He._ltl}__Denta.J__g.liD.i sc:t forth new regulations which if followed will m::1ke dental clinics more public health And less Nelfare types of programs in which the younger children ar'-' treated to prev.;;nt th0; loss of teeth. Huch of the dental director's tim0 lr s bc"en spent working with the Divisions of Local Health OrgEmizntions ::mel Hospital Construction o.nd with local dentists and health offidals to st.;o that the proper equipment .':md suitable space for dental clinics are provided in .::;,11 new he.'l.lth ccmters.
The od_]:-1.2::tiQ:rg], J?..lWsL0.. of the program continued in its usual high strmdard with much tir.rK! and vJork of thu dental personnel d.-2voted to teachereducation, both pre-service !lnd in-service, and to workshops and conferences of many and varied types vhere ckntal henlth W::l.s involved. The Educational Director, as Chairman of the Committee on He;llth for Gcnrgia Congress of Parents and Teachers, took the len.clership in the devolopment of the booklet Qo:t.n.<:?: Places in li.S:!lth. which he.s r)C(:JiV("d state 'lnd national recognition. Dental health educational rnatc~ri.'<.ls hcwe been screened, and only those publicCJ.tions giving f.qctual inforPlc:ti<)l1 ar.:3 distributed by the Division of Dental Health.
The dental seminar, lP:hicb is com-<.ucted in cooperation with the Georgia Dentn.l Association and which provides in-service training for dentists, was held in three localities - :ltlant::t, il.lb.:my and S.:wannah. More than 250

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practicing dentists n.nd h::C'lltl; cffid als h-'ld .qn opportunity to hear and question three outstanding scientists.
Dental I-Ie.1.lth Services also a.ssisted in conducting th.:; undergraduate course in dentfl.l public heclt!l fer the senicr de.:mta.l students at the Ernory Univsrsity School of Dentistry.
To develop a c.ent-'11 prOf!'rC!~'l that will shov' stats-wid: improvement J it vrill lxo n.:;cessary to have .'1 i)['C'ld .~xr.::msion in prev011tive s<-::rvices and mor'::; moner for clinicPl a.nd p.cil_lc . ,_tion3.l prcgrarns. This was r8COJ11Jnended more specifically in last ;,r:;"'r' s :r>:port,

Division of Public Herdth Engineering Division of 1Hc:tter Pollution Control Division of Industrial H~rgiene (See Occupational Health) Division of Insect and f:.ocl.ent Control Home Safety Unit

-lh-
DIVISION OF PUBLIC I-IEAI,TH ENGINEERING
Services of the Division of Public Health Ene;ineering, embracing the field of milk sanitation, food sanitation, school sanitation, tourist court sanitation} housing sanitation, shellfish sanitation, hospital sanitation, impounded water control, welfare placement sanitation and the mapping and
photography section~ are available to the public through (1) the central
office in the Georgia Departmellt of Public Health, (2) regional engineers and sanitarians in the five regional offices 5 (3) county engineers and sanitarians
in counties and districts, and (4) municipal sanitary engineers and sanita-
rians in the tov:-...'1s and cities, Liaison is maintained with national agencies and local and regional
personnel, for interpretation of the 1953 U. S. Public Health Service Ordinance and Code_, -:ertification of milk suplies for interstate shipment, and application of 3~~ Standards to new dairy enuipment. Bulk milk tanks are rapidly j:?)i.acing the old familiar ten-gallon milk can following the increased use of cleaned-in-place lines. 'f!Nenty-nine cormnunities now enjoy 11Honor Roll II listings of their milk sanitation programs. Three additional communities began m:i.ll;. :-'enitation programs. Major ai:ns are the maintenance of the high standards reached and devotion of more time to excessive coliform in milk and milk products.
Food sanitation activities are likewise p::.~imar:i.ly advisory to local and regional programs. Very limited field personnel. is available, but there
have been 52 surYeys of local programs, 55 training conferences for food
service personneJ and the staff has pc>.rticipated in 15 staff, hospital and schr)ol food Perd.ce training confe.,ences. Seminms Here plar;ned and conducted, vdth the assistE!...nce of the U.S.P.H.S. on general food sanitation and bakery sanitation. Poultry sanitation studies have continued, as have the discussions on recommended meat processing ordinances.

-15-
A research project was begun on ~he study of hot water requirements in schools and school lunch rooms.
No less than 2L.% of the total cost of the multimillion dollar construction program of the Sta.te School Building Authority involved environmental health aspects of plans for school construction, such as plumbing, sewage disposal, water supply, food service, heating, ventilation and lighting, totaling rji32,00o,ooo. 'rhe f1rst four items mentioned have been reviewed in the planning stages removing many of the certain failures in the years to come. This is done through the School Plant Services of the State Department of Education.
Preliminary wor.k was done in coope~ation with the education department of a manual on the environmental aspects of school living, including basic sani-l:ation standards, design data, landscaping, custodial care and plant mair::.:.er:cwc ao
E:c-~ensive work was done in the preparation of a school health guide in cooperation with the School Health Division and the Education Department.
The Tourist Court Law enacted in December, 1953, has required many prelimina?.ies leading to the adoption of rules and regulations of the State Board of :r;e.[-,lth, printing, and preparation of procedures, Permits were
issued to 768 tourist courts in 1954 under the regulations existing when the
law was adoptedo The drought of l95h undoubtedly coEtributed to the increased construc-
tion of farm ponds for which permits are issued when compliance with the regulations is assured. This pro~_>:ram involving liaison with the Agricultural, Stabilization) and Conservation Aclministration and the Soil Conservation
Service of the U. s. Department of Ae;riculture will no doubt be greatly aug-
mented in the coming year.

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The housing shortage has resulted in the increased demand for new homes in new areas many of which do not have public water and sewerage available. This requires studies of new subdivision plans involving topography, lot sizes, soils, etc. Close cooperation by the Federal Housing Administration and the Veterans Administration has resulted in excellent control of water supplies and seV'rerage. Much more could be done in this field with better organization of planning boards to consider health problems involved.
The Division furnishes advisory services to the Hospital .services Division on their Licensure Program relating to water supply, sewage disposal, food handling e.nd milk sup;Jly. A tremendous improvement in these facilities has been noted through continued efforts of field personnel in local and regional health fieldso
Sueh adv:i. sory service is also giv9n to the State Welfare Department on homes for ado:;..tion and/or boarding of childreno

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DIVISIOH (;:? -,;r~.T~H POLLUTION CONTROL
There were no reported c;::ses of disease in th1" state in 1954 attri-
buted to water. Prim,1r~' obj.;ctives of this Division include hdping the citizens of
Georgia maint<dn 2.dequat<.:~ end s.<J..fe wat,;r suppli\;s; collect and dispose of sewage and industri11 wastes so "tS not tc endang<'r public heAlth, and preserve natural water rrcsources for tbd.r J; .. st usu in our complex and expi:mding Hconomy.
Tho Division 1 s s,)rvlc -,s r.:~tch e')out 50~;; of Georgi3. 1 s citizens through contact with the puoli c wc.ttcr s;:,'st.:;rr.s whcr3 activities include investigation of existing and proposed water supr;lir-?s; promotinre; ch3sirable improvements; rovicvring plans ;-nd spr-,cific"'tions,; trE!.ining op!Jrating personnel; providing L1bor1?.tory servic c;s and others.
Sc;rvice to the r::mainin;:: citiz' ns who use })rivnte vrater supplies is chiefly through local health dope.rtmcn.ts, th.;; Division providing literature on '\'IJ,?,ter suppl:l' construction an<~ safety, cncl consultzltion and laboratory servic,3.
During l95h thr~ Division continued its practice of working with municipalities, instHutions D.nd. indlJstrics, "nd with local hE~alth departments on vmtor supply matters. Plans c:mc:i sp:cL'ications for L~3 major construction projncts were reviev.r~d 3.nd apprcvecl.
Tho extremely high tu::per'l.tur<';s throu:~hout tlF. suJ1mer cmd tho severe drought lt<Jhict :oJ.low3d taxed nnny vnt'T supplies to U::J utmost. \vater consumption r:-;.J.chod :1.11 time penl<s vJith ddn<Hlds f'rr:;quEmtly exceeding source of supply, pumpine: or distribution f1.cilities. Twmty comnn.mities ,:;xperit:onced sourcu f~ilur;s so s ::vcr,, th~>.t acuttJ short ..,.g,;s prevAiled. ':.1wre possiblf? the Division essiste;d such communities in d.<Jvelopin,~ ?.dditional

-18-

supplies and otherwise solvi.np; their prGbloms.

'I'he drought also cnused the: failurG of num2rous farm ~Arells compelling

farmers to haul water from other sources for domestic use and for wat.Jring

livestock.

Due tC' unprecedentodl;r lovf stream flows l::t"' in tht:: year, waste

trentment fa.cilitios proved inedc;qu~.t<::J giving rise +,o nuisance complaints

and in a few inst~mc es destruction of aqun.tic life.

On the other hand, municip-:1 .:md industrial officials, as well as

the public generally, Art:: realizing mor:: . nd mor'-~ th;::: jJnportance of waste

treA.tment and stream qu:1lity pr,Jscrvation a:ud are, tlwrl~fore, willing to

finance necessary vJaste trnatwent :":.cilities. Durint!, tbf; ;yue>.r pl?.ns and

specifications

involving constrr:.ction

c:.. .0 -~-

sc:-~oJage

1md/or waste

treatment

works

to serve 20 comm'HJ.ities vJerc app:rcYv~::ld by tl;'~ Division.

Collection -'lDd proper disposal of src;'IJag0 and industrial wastes is

most impo::."tant, first, for the prcvuntion of filth-born;:; diseases in the

irrunediate area of od_gin ::mc1 sr:condl~r to presGrvc the quality of tne natural

water courses at such a level as to pc:;rmi+, th<';ir use a.nd re-use for whatever

purposes best serves our citizens.

The Division hD.s ,mdc:;avnr,;d to ::tpproach th,; su:Jjcct realj_stically

and work out each situation so 'lS to minir1ize health hn.zards, prGs,':3rve stream

quality, yet kGep thG doclr open to an;:;r incltlstry wi11i.ng and 0.ble to do a

reasonable job o.f treating its W'3.SL~s. ''.lith the conflicting interests of

public water supply, agriculturoJ.. 'ncl indnstrial usag<:>, recr8ation rmd wild

life requirements and others, this ll"s not ah;a~'S b<,cn 0:asy.

The Division h0.s m.':lint.cJ.irh~d its w1.ter labor .ton' for conducting what-

ever tests appe;=J.rod necessary .for carr:rin;; m.ct the a.:JOVt~ prc.e;ram; has pa.rti....

cipe..ted in conducting the 23rd Annual ';Jatcr and S<,wage School 2.ttended by

-l)-
morl:: than three hundred wqt,:;;:r ::mG. s ;W"..F!J3 v:orks op:::rators and cngine(ors; s,jrved on committ~_:es o:' V'irious cnpine'-'ring, scientific and technicn.l organizations engili';C~d in W'lter md St)W'lge '"'ctiviti.;s 'md oVl3I'VJiS3 S8rV(;d in t};," inttcrests of ths citizcns of G::or&;i:". on w,"lt.:r :>:.nd Sf;N'~V'~' mFLtt:rs.

DIVISIOH OF IHS3CT & 1101);:;;1-JT CONTROL
li">Tith the withdrawal of an: federal assistance to activities of this
Division, steps were taken early in 1954 to perform necessary public health
duties in insect and rodent control through a cooperative plan with other divisions in t.h.e department.
The principal function of this Division under this new plan is to coordinate its p:;:ogram. with insect and rodent control activities performed by the Divisions of Epirlemiology and Public Health Engineering.
The Division of Epicl.e;,[i_ology, ha:ving biologic and entomologic personnel; applies these services in the insect and rodent control program. The division of Public Heal.th Engineering is responsible for mosquito control activities on water impmmdmer1ts.
'r~hile this cooperative plan has been successful in utilizing all available personnel in the departHtent, it has shc1rn a need for an associate director w~1ose full time duties can be devoted toward the coordination of these activities on the state and local level. The division now consists of an actin13: director, who.se time is divided auong other activities; a refuse col~_ection & disposal consultant, whose du.ties are to assist local health departments in the promotion of improvements in municipal and community refuse storage, collection, and disposal facilities; and a secretary,
On the local level, re'>orts show that 28 cmmt.ies, du:ring 1954
conducted rodent control activities. T1trelve countj_es had full time
personnel employed in insect and rodent control with a total of 36
employees" These cotmties received technical assistance from this division and regional sanitation personneL State technical assistance, available to all local health departments, inclucled investigations,

-21-
applied research, educational and p1om.otional activities, training of local personnel, assi. si>:mce in the nromoti on of control measures, and evalu-
ation oi' control measures applied.
vThile malaria has become l:Jss and less a public 1v;alth nroblem, and the ty,)hus incidence has been rer'u ced 97~0 since reaching a peak in
191+3, the carriers of these eli sea~.es still exist in mo t sections of
Georgia, and U.e Division believes it unvrl.se to di.scontinue, altogether, plans for their controL
Enidemiology persom1,3], as ~')'l.rt of the cooperative plan of control
new in effect, in 1954 carried out entomologic inv0stigations in 35
counties and com;ulted with h~;alth and municipal officials "ri th regard to
insect control in 17 others, These activitifJS consisted of evaluating
problems of mosquito and fly infestations and serving e>s consultants to health personuel on numerous minor :.'est problems in restaurants and public institutions with which the dcpa:etm;.;:nt bad oeen asked to offer advic,3. Occasionally, pest control opl:)rators askJd assistance with unusual insects or when insecticides hud to be u.sed under conditions tnvolving some hazards to the public.
The program of refuse colh1ction and disposal d:.tring 195/+ went
forward during tllG ye::o.r with five coHLauniti8s inaugurating the sanitary landfill method of refuse disposal. Nin<3 other communities were assisted in closing existing landfill sites and movinp. to new locations.
To our knowledge, thore arG h3 cor.:n~mnities operating the sanitary
landfill method of disposal in Georgia, During the year the refuse collection and rlis 1~>osa.J consultc:.nt
visited with health and local officials in 36 counties, as:isting in the
improvement of a progra ~ l.vhid' bast neets the reqt'ire ents of their community,

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HOI.viS .:_,\f-;;TY UNIT
'the im:Jortance of accidents as a uublic health probJ.e,:t has been clearly shown in stati::tical reports of causes of death in Georgia. Each year approxin1a:tely 2,000 citizens die as a result of accirlents of all types. Around one third of these accidents occur in the home.
Hom0 accidents are now the second leading cause o.f death in Georgia
for children between one and 15 yc=trs of age. In the entire population,
this is the seventh leading cause of death.
The Department has had a fully-staffed Home Safety Unit since 1953,
when a grant was made by the 1::. I~, Kellogg Foundation for accident prevention activity. This financial aid was also extended to seven other state health de~;artments, ,,,Jith Foundation supo1ort for three years~ the eight states seek to determine the role of health dep'-'rtments in hor,le accident Drevention.
G,Jorgia 1 s Home Safety Unit workod toward this objective during 1954
by a contJ_nuation of in-service educ0.tion for public health personnel in accident prevention, and the secvd.I'g of data on non-fatal accidents through pilot studies in two co1mties. ~~n the smrHlJr a sample survey of home injuries '1-ras conducted in ''are Covnty, jn \,rLich 1oco.l e-roups joined with the health d.e;Jartment staff to obtain information on accid.ents through personal interviews in nearly 1 3 000 homes. Homes wer<) selected at random, and represented a11 scctj ons of the county.
On the basis of this survey, statisticians have expanded these findings to indicate that th.:;re are n,Jarly 130,000 major home injuries in Georgia each year. 1~ major injury, as cJefin-.:d in the l1!are Coun.ty Survey, is one which involves any one or a combina. tion of the following: (1) Loss of time of the injured person; (2) treatm.on t by someone from outside the household; (3) costs as a result of the injury or accident;

-23-
(h) disability of the injured. This fact-finding program conducted in Georgia is believed to be
statistically sound, and the results are being used as a guide for future activity in the state. A similar survey was conducted in another county
in the latter part of 1954o This study, in Hart. County, sought information
on farm. accidents as weJl as home accidents. v7hile t..cbulations of the
results of this survey have not been com.plet0d, a 1;(eliminary report
1indicates it substantiates the early stndy. Further r->fforts to ~lTO\ride addiUond inforwation on home accidents .hale been made through surveys in schools, tabul"l.t..ion of hos}Jital records,
...:".anij. a more detailed follow-up of fa:tal home accidents by health depArtment
personnel. In the a.rea o:f in-service educo.tion, the Home Safety Unit staff
has visitGd in all thrJ regions, and D3D.j:oly one third of the 159 countiGs, presentir:.g programs ~im0d at stimulating the interost of health department workers in their responsib:LJ..ity in accid.<.mt pr0verrti on.
Along vfith this 11ork in tho areas of in-service education and o.ct-finding programs, the Unit bee;an to dissemin:-1.te information on accidents throue;h nev.rspapGrs, radio and telcrvi s:i.on, pamphlets, posters, etc. Emphasis has been placGd on "rork -vdth community groups.
At the end of the Unit 1s first compL:to year the staff has evidence of increased activity in home accident provGntion throughout the state, In cooperative worh: vd_th oth::Jr irrt or0sted tzroups, the Unit anticipates increased progress toward its ulti.m~i.tt~ objective: To reduce to a minimum the fatalities and disabilities :resu1:ting from accidents occurring in the home.

Divi.sion of Public Hr3alth Nursing Division of I.ocal Hec.lth Organizations

NURSING ;)IVISION

The end of 1954 finds us with the most complete geographic coverage

by public health nurses we have ever had with at least one in 146 counties.

There are 535 staff, supervisory and consultant nurses employed by county

and state health departments, a gain of 32 over 1953. Public health nurse-

population ratios are:

20 counties ------ 1 nurse to less than 5,000 pop.

76

II

If

II

11 5;000 to 10~000 11

35 "

14

II

If

II

II

If

11 10 1 000 to 15,000 11 11 more than 15,000 11

During the year there VJere 66 appointments} 50 resignations> four re-

tirements and one death. lJJe received 62 additional inquiries or applications

for positions. These nurses l"l'ere not employed for the following reasons:

19 expres2ed an interest in public health nursing but did not make applica-

tion; 15 applied but were not accepted; 27 wanted positions in certain

counties in which there 1r-ras no vacancy; one was unable to accept appointment.

Ten nurses received scholarships to complete courses in public health

nursing; eight received two months of orientation (eight additional nurses

should have had orientation); four attended courses in premature infant care;

three in epidemiology; three in venereal diseases; two in child growth and

development; one in tuberculosis and two in accident prevention. In addi~

tion to these, through the efforts of the tuberculosis and mental hygiene

consultant nurses, short periods of observation were planned for 58 nurses

at Battey State Hospital and for 28 nurses at JYiilledgeville State Hospital.

A major objective of the Division is to promote continuous in-service

education among the pub~ic health nurses in all positions, beginning with

close supervision and frequent evaluation during the orientation period.

Quarterly meetings have been held with the specialized and generalized con-

sultant nurses. We have assisted consultant and supervisory nurses in plan-

ning for and carrying out educational programs in the regions and districtso

-25-
!tie made 228 field trips to 76 counties and the five regional offices, for consultation and observation related to in-service education and other training, personnel adjustment, quantity and quality of services and program development.
Considerable emphasis has been given to a revision of nursing classifications and this work will be continued~ Other projects which have been carried out with cooperation of various consulta.'1t nurses are: a plan for the more effective use of nursing resourees which is being implemented in five counties; revision of the thermometer cleansing technique and the production of film strips and a record demonstrating this new technique; comp1etion of a guide for planning and evaluation of visits in cancer nursing;
\
consultation with schools of nursing for correlation of public health aspects of nursing in the basic curriculum; preparation of nurses to teach mother and baby care courses to adult and high school groups; follow-up of the venereal disease course at Alto with review of current needs. Members of the Division have participated in many programs of the Health Department and other agencies in the state, for example: advisory comm~ittee of Home Safety unit; conference on rural obstetrics; preparation of a manual on 'school health; advisory committee to Fulton County Director of Nursing; committee on the care of premature infants at Crawford Long and Grady Hospitals; Board of Directors of the Atlanta V,N .Ao; joint committee of Departments of Health and Education; work conference on the problems of migratt~ry laborers in the southeastern states; a survey of handicapped children in Clarke and Oconee Counties; orientation of a faculty member of the University of Georgi.a School of Nursing.
Contributions to nursing and public health organizations on the state, national and international levels were made, such as: nursing advisory committee of the American Red Cross; participation as officers and committee members in the State and National League for Nursing; the Georgia and

Southern Branch of the American Public Health Assodation; the Georgia State Nurses 1 Association, Nine foreign public health nursing students were given one month of field observation in Georgia, following completion of public health courses at various universities in the United States. These nurses are returning to their homes in the Dominican Hepublic, Thailand, the Phillipines, India, Formosa, Iran, Peru, and Bolivia"
The reorganization of the state into districts vJill require 38 district directors of nursing. This plan emphasizes the need for recruitment and preparation of nurses for supervisory and administrative responsibility which has been felt throughout the years. Intensive in-service education programs
in this area are planned for 1955o This Division is working with the Division
of Training to establish a training center where public health nurses will be prepared with other professional 1trorkers.

DIVISION OF LCCAL E~;ALTH ORGldiJIZATIONS
Though not spectacular, progress was made by this division during 1954. To ultimately accomplish its objective of making adequate public health services available to all Georgia citizens through full-time local health depg.rtments the Division developed a plan to create 38 health districts. The plan was approved by the State Board of He<'tlth on H:::ty 20, 1954.. It provides for the staffing of each heR.lth district '<vith a disb:'ict director of public health, a district director of publir:: health nursing, and a district director of environmental s'lnitation. The Stat;"3 Health Department will reimburse the districts for the ss.laries allovnule under the Herit System Pay Plan. In the eight districts of largest popula:tion an D.dditional position, public health administrator, is allowablo. Gr::mt--in-aid funds will continue to be available to counties for assistance in th,:. salaries ()f county health department personnel. To eff,~ctuate the plan it o'ras n(oCe~osary to establish Nerit System classes and salar:,r scb.r3d1J.lc)S for the district positions and to revise the State Health Department 1s F'J::tn for limmcial "~ssistrmce to Cou..nties and Health Districts, The details of the; pla.n are now complete and the :Civision of Local Hea.lth Organizations ,,;xpects to esteblish 10 new health districts
during 1955. It is beliov:-~d tlnt :Lt will take 5 ye-'H'S or longer to establish
all the proposed 38 districts. At l95h's end, L~5 co1.mties (54..8;-:'o of the State's population) had
full-time commissioners of hec:tlth; lL1.5 counties (96.76%) had public health
nurses; 86 counties (78.97~) had s~1nitation personnel, ::.nd 134 counties (93.7%) were employing clerical personnel. This is ::m increase over 1953 of three counties with nurses, three counti,;;s vdth clerical workers, and two counties with sanitation personnel.

-28-
During the yoar we had a decrease of four counties h<wing ::.t full-time commissioner of health even though the num_ber of commissioners of health
remained the same, namely 24. As of December 31, 195h, county het1l th dep<:~rtments were employing
1,174 full-time personnel, nine less than for the sct.me period of 1953. Of
th:?. total full-time personnel employed by local health depnrtments the State
Health Dep::~.rtment was participating in the salaries of 902 which is 32 more than in 1953.
Total loca.l health d<3p<-:.rtraent c;xpenditures for 1954 amounted to $4,720,278.09 or ,::,1.37 pr~r corpit.'l., Of this total ;>Pl,5L~0,275.36 or 44.7 cents
per capita was State realth D'0IJ-'lrtment grnnt-in-rdd. The total expenditure
was three cr-;nts per capita lass and the grant-in-aid 0.7 cents per capita
more than for the pr0vious year.
During the year 10 public hea.lth centers were constructed. Fifty-nine
Hill-Burton Health Center projects have now been completed and occupied, eight additional centers ar:'~ l.lnder construction and five are approved for construction during thcl fiscal yner. Three counties having previously requested financial ,".ssistrmce for the construction of public health centers withdrew their applications :1ccauc3e of crop failur8 due to the drought, and four counties tentatively scboduled. for construction projects this year have requested a delay until the next fiscal ye11r,
The personnel of the ;(e[~ional Offi.c<3S nade valuable contributions to the public health progrAms throu?hout G(~orgia. The Eei~ional Staffs made
10,628 field visits to countids to render consultant and advisory services
in program planning and appraisals and in administrative practices.

Division of Maternal and Child Health Division of School Health Division of Mental Hygiene Division of Crippled Children

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VJ.A'rERNAL AND CHILD W!;ALTH DIVISION
Each year the Division of JY.iaternal and Child Health is responsible for the promotion of the health and well-being of 100,000 or more expectant mothers and 500,000 infants and preschool children, Last year approximately 15,000 infants in Georgia were delivered by local lay rrd.dwives. The nutritional well-being of the entire population of the state is also included in activities, since nutrition is administratively the responsibility of this Division.
The staff consists of: one physician, one public health nurse consultant, the part-time service of another public health nurse-midwife, a nutritionist, a dietary consultant, a,nd a health educator executive. In addition to over-all program planning and adr.o.:Lnistrat:Lon, they are responsible for consultant service, in-service training and supervision to the regional and local health departments in regular and special activities.
All members of the staff have responsible positions in~ or relations with, the various professional organizations and special committees related tc or active in areas contributing to the maternal and child health program, These include medical societies) nursing Yrganizations; and Georgia Nutrition Council and Georgia Dietetic Association.
The Division in 195lt- has been active in evaluating local programs with the staffs of the regional health offices and, in certain instances, in the local health departments. This evaluation seems especially necessary since, because of limited staff, we must knov.r where help is most needed. Already some good has resulted. About 140 county programs were reviewed as to activities and resultso Hecommendations were developed and some are in effect alreadyo
Much work and time was spent by the physician and public health nurse in preparing education materials for newly enacted midwife legislation.

-30-
Also a great dEl.al of time was spent by the nurse working with local public health nurses and the midHives fo:c whose training and supervision the nurses are responsible"
Interdivisional activities included some special projects. Together with the Hospital Division and tho Central Statistical Unit, a study of the needs for obstetric and newborn infant care in the rural areas was prepared and presented to a great mm1ber of disciplines who met for one day and mg,de recorrunend.ations. A subsequent meeting is planned to try to get action started. Also joining with the Hospital Division) work is beginning to"!Jirard raising standards of obstetric and nevJborn care in hospitals throughout the stateo This will be an infonnal educational approach on the basis of readiness.
1J,Jorking w:Lth Local Health Organizations and the Division of Nursing, the programs and policies of the three nurse lllid,vife areas have been revievJed?
The premature programs at Crawford Long and Grady Hospitals have continued to train nurses in the care of premature infantso The decentralized prenatal program od.th Fulton County continues successfully. It is hoped that, as one result, a physician from the Department can be professionally prepared to assume the position of JVlCH director for this county.
Only 115 of the 159 counties have maternal and/or well child confer-
ences o There were 57 conferences designated as "Maternal_, 11 and 113 as "irvell
Child, 11 and 101 "Combined." Activities, holfiever, increased in all nursing services, particularly in the preschool age group.
We are concerned that there has been so similar increase in the number of mothers, infants and prGschool children admitted to medical service, or in the frequency of their visits for medical supervision. The prenatals average not quitE:; three visits for medical supervision as against five for nursing supervision in the same periodc Only 25% of these prenatals receive post-partal medical examinations. 'l'he infants are averaging slightly less than two visits for medical well child supervision in the first year of ltfe,

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and the preschool group averages about 1.5 visits per year. This situation
is serious and calls for concentrated efforts on the part of all, particularly the medical group. The present shortage of physician personnel in the MCH staff, due partly to low salary level, does not allow the constant and slose attention which should be given on a statewide l:asis, tofu for quantity and quality care.
There has been a gratifying increase in both quantity and quality of nutrition and dietetic work by all agencies and public health workers. This has been especially true in vmrk with crippled children, diabetics, cardiac patients, the obese, and vwrk in institutions. Special emphasis, however, is still being given to work idth mothers and children. Future Plans:
(1) Continue nutrition program promotion, 1vorking chiefly \vith loca~ staffs to help them keep up-to-date about nutrition, and effective methods of teaching. Local health departments w.ay request help v;here special nutrition problems exist or where a family has an unusual problem. (2) Promote better quality of maternal and child health services in the county health departments, including improved midwifery. (3) Encourage more counties to make provision for adequate medical, nursing, and hospital care for abnormal {'bstetric patients, premature and full term infants. (4) ll'lork with the Hospital Division to promote the most moc:kern concepts of medical and nursing; pediatric, and obstetric practices and procedures in the hospitals of the state. Needs:
In order to meet the program needs for consultation, in-service training and supervision at the regional and local levels, there should be at least one additional physician 1-ri.th special training, and a pediatric consultant nurse. At present the one physician staff member must function chiefly as an administrator limiting needed field work, especially with physicians.

I. Ob.iect_ives A. D"wolop unifo:rmity, stattc;-wide, in il planned pror~ram of school health for st11tc, county, ~md th~ individual school. 3. Strengthen consultative s,;rvic es t.) r,;gion::tl and local public health personnel doin;z schnol 1''".lsh 2r:c; to -.rs1 .l'1cl cou11ty educational personnel, for tf:c purpos,; C1. d:.;velopim~ n. strong0r school health pror,:ra;n., minimu.l"'l. stmd,rc1s of 1ctivities, 'md uniforr:~ity of local ilreJ.s towc1.rd 't stn.t:;-wj J,;e prcgr1.m. C. ;~xpD.nd pl;mnF:d plogr.T'l.::; u f school lw!llth "S a p'lrt of the communitywide health progrmn. D. D(W8lop in-scrvic3 f'lciliti.,;S, suer~ J.S workshops, institutes, 2.nd a sto.ncbrdizcxl field c0ntor to dcv<:.lop gre'ltCjr knov.Jledge, better participation 'l.ncl str,ng,cr co0pr::;r:ltion in school h:.:n.lth. A planned curriculum in tlP initj '11 prc,fcssional training in school health should b.~ developed :.nd str'--=mgthencd. E. Develop m:tl-u:ds for '.'v:'IJ.'i'l'U-'1'? :-md definir.g school health programs and activitiGs, F. Strengthen coopRr<=Jtir:m in th'~ fi,'lcts of vision :-:.nd hePring conservation for prof<":ssion.s.l workers and school personnel. Encourage vision screenin<s of all cbildr''n by th0 cl1.ssroc)m t011chers, u.sing the SnollGn ch'lrt. G. .Strongthr~n coopcratioj' ,nj 1md -c:rstrmding br;twoen medic 1.l profession and school he2lth pr0,2T''r:1s, -t st"L; e.nci county le;vcls.
II. 'ictiv~ti.... 1-l., Vision and Hc'lrin1 CotJ.s::rvation Pro~:rA.rns - To strmc;thc;n th,: pro,Sr31ll g,nd make r:1ore "ffici 'nt uss of p :rsonn,~l, th; progrn.ms of vision and

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hearing conservA.tion hJ.ve e"tch been pl<ccd under a St)parat(;) full-time iustructor. The planning of th", work and scheduling of their time are no-vr done through and with th'J regionnl offices.
Th,; Division of School H0alth conducted vision screening surveys in 48 of the 159 counties in th':: stAte during the 1953-5L~ school year. Six countiE:;s have loc-11 f".cilities for c::trryinf. on CJffective pro;:srams, r;iving a total of 54 countks having vision screening surveys. In 49 of th,;so counties, 97,175 children wer<; screened. Of those screcn.:::d, 11,056 or 11.4 pvr cent Wf:;ro referred for eye examim.tions by eye: sp-.cic.lists. lcpproxirnately 750,000 children in Ge;or8in. wr:1re not scrum,.d, -~.nct nn c~stimat,;d 150,000 children -who n8ed ;3yc cRre are being ncglnct0d. :O:c:lucJ.tion.:tl mat(jrials on vision wore developed and printed, including 11'/ision 'l'esti~1g of 0chool ,,hilc:.~cn, 11 11 Eye !-k:alth--For Use b;y '1\~.'!.Ch<-'rs, tr and 11 Sight-.::Javing Tips.''
Thu Division of >chool Hull th conducted h~:<ring screening surveys in 34 counti:;s du:ing th,J 1953-54 school year. Five counties have loc<".l f.'-teilith:s for c:1rryinr:r on c;f l'ectivtj scre1:ming programs, giving a total of 39 counti-:;s in v.rbich ho.'ld.ng t'-'lsting surveys v.rere
conducted. In 35 of thds'; counties, 54,305 children were screened.
Of those scrGened, 3,3ll or 6.1 p:r cent were referred for medical care, pre:f<3ra'.1ly by 1.n otologist. hpproY-ii1w.tol:l 800,000 children in Gr::;orgia wer~~ not scrc;en,d, :md a.n dsti;natGd 40,000 childrcm who have hearing defects ar ~ lkirF n.;glccted. B. Sf?ecial School he c:J tl]_)):Q.:~:;ct - ;::rr:parc.:.tion of the final report of the Project, whicb ternin::ttc.:rl. in June, 1954, is now in process. C. .School Health Guide:: - Tlk State Departments of Public :H,~alth and Education are coopcr.<:ting in tho prepar\:ttion of P" school health guide.

Thu Director of .'::;chor-1 E; ;lth took this b0;fore; the Joint Corunit tee; on !i<<-lth 'lnd ~:;;duc"tion JnJ obtnin.;d Uwir qpprGV''cl. In Dccr?mlH-or, directors "..Dd ~dninistr'l.tiv. L. :d("rs ~ro~1 th,: two stat,_, de partmcnts and ccnsultPnts i'rorn s"lr;ctec1 locJ.l ar,3as r,i.;t fnr .;n.~ week at GSC1d for th': purposl. of c~st".bl:ishing th:::: fundilr;l nt;ol id::.:c:s in school hr~qlth md C3:tcnting t;,_ "ctivitj_,;s of th; r:;c:rsonnc;l from the two d ..partm,;nts. :"ollowi:w t!lis p;.t t rn, sim:' l::tr G 0tings have been taken to v;crious loc::liU :'s cv r th.c st".t t:; ob t-'1in t:v; thinking of th;:; p;rsonn.l :rh(: dl t.;_; '.nr1 in schc(,l h::rJth :ld to slvlrt; the information 1.CC0t':plish-J1 c1t U r:' ".in.::- in ... c;C,;mb..:;r,

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IJ!i;N'I'AL HYGlENE DIVI:.JION
The Mental Hygiene Division has continued to develop as complete a program as possible 1dthout over-extending activities to the point of diminishing returns. In a relatively new program, '"rith limited budget and personnel, this is a difficult task.
The emphasis this past year has been at the local level. No attempt will be made to report here the rrBny interesting, individual, new projects developed in each of the local mental health programs, Instead, those activities which have developed on a sta.te-wide basis will be surveyed~
~:!~~P~]:y~J:..9JE-ld~" One area of activity which has increased in all of our local programs is the area of '' 6~cceptional Children," In some places mental health personnel have taken active leadership in corrmunity planning, education, and organization for special schools or classes for these children. In other places consultation to special schools or classes in terms of:
(1) Screening, (2) \vorking vvi th parent groups, (3) consulting vri.th special class teachers and similar servi.ces have taken up a considerable portion of professional time. State office personnel have also d8voted considerable time concerning "Exceptiom.l Children" in consultation with the local health departments, local schools, and the Georgia Department of Education prograi'l for Exceptional Children.
Pilo~- Proj_lct of Nur_~-~n..& Qcryices to F~J.l:l:.~.. _of_:!::[l_e_M~t-~~ly)_ll. Considerable state, regional, and local public health nursing time has been involved in the pilot project of publir health nursing to families of the mentally ill. Two urban counties, Muscogee and DeKalb, were added in Jan-
uary 1954 to the six counties already involved in the pilot project. This
has given the JVlental Hygiene Division considerable experience in dealing with urban problems in this field of s,;rvice, An evaluation of the pilot project

-36-
is being conducted prior to consideration of expanding beyond the eight pilot counties.
Juvenile Delinquency. A nuw consultative service to Public Health Staffs in local conununitios having problems of Juvenile Delinquency is in tho process of development. Two conmmnities are already involved, Sununervillo and Dawsonville, This is a community service from the State Office to be offered to those local health departments without mental health personnel. In local areas employing mcmtal health staff, much work is already being done in connection with Juvunile Delinquency.
Maternal Dopi::i;Elt~orlc Considerable staff time has boon involved in planning and in professional och.J.cE;tion and proparation for tho maternal deprivation pilot project. This h.':'.s bc3on carried on with both the Public Health Personnel and Welfare Department pc;rsonnol at state and local levels who are concerned with this problem. ThG project is tentatively scheduled to begin in tho early summer of 1955,
ProDosod Expansion in Clinic'-l..;s.':.rricos__f~_ill-tional Communj_ty Mental Health Personnel. J:t"our or five loccll health departments, in addition to those already employing ment:;.J.. hc~alth personnel have requested inclusion in the State office budget for tho fiscal yo3..r 1955-1956. These are Valcl.osta, Brunswick, Albany, Athans, t~nd possibly ,J,:~~_usta.
Tvvo state leg1slativo committees h.:we considered a plan for the expansion of clinical and cc1:mmnity mont.'1,l health services to all areas of the state. Tho plan was devolopod :1.t tho request of the House Conunittee on Juvenile Delinquency and later incorporated into the Report of the House State Sanitarium Sub-Committee, It would consist of five additional child guidance clinics, located so that ~:rith th() present lJublic Health :Mental Health Clinics in Sc:rv-annah, Mnco11, Atlanta, and Colt.unbus, all areas of the

-37-
State l<rould hzwc this l-dnd of s0rvice avrdlablc. The proposed clinics would be loco.tcd in Rome, August0., Athens, Waycross and Albany. In o.ddition to establishing these clinics, th8 plan 1.lso c<1.lls for a ment.:tl health person on the st~tff of the hc::.lth dep:1rtment in each of th8 proposed Health Districts.

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CRIPPI.2:D CHIJ...lJll:ti:N 1 S DIVISION
In 1954, the Crippl.sd Children 1s Division, for the third successive year, had a decrease in Federal funds. (1952-53 ~510,332.67; l953-5h )360,184.00; lG54-55 '~325,76P.OO.) State~ funds remain the s2.me as the previous year. This, however, was consickrrtbly less than in pr0vious years; for i:.1st::~nce, 1952-53 w<ts ;~450,000 "'l}'linst ~t376,000 allocated during the present fiscal yen.r. This, c oupl::-d with inc rea sed en ss findings by the local public he!'l.lth dcp;wtrrcents, ,,,,ith rising costs for medical care ::1nd hospital care, has m2.de it n::cessrtr;r tc' drc;.stic:J.lly curtail the Crippled Children 1 s Program.
Somt3 of' the specific Ell':; s tl:nt havu suf\:~r3d have b .;en the Cleft Palatr; Clinic where childr::.m arc brou.r.:Yt in for evalmtion of their needs in regc:>.rd to speech, hJc<.rinf, further snrgcr;y, orthodontic :lnd prosthedontic work. t% are holding omJ clinic i3Vl3r;;r oth<3r raonth, rathor than the monthly clinic originally plmncd, Tl'L .:::trcli.ec progrAm has bGen unable to hospitD,lize any children. .:i'ortunat,d;y, in July 19'5/r., ~' n,:w C/l.rcliac clinic, operated with volunteer ftmds, offered to hosri.tsliz,:; ddldrcn ne<.:::ding surgery, and have done so. ,.;,-:; h:we 'llready t-w,m n,,tificd tlHt ':.,he lo.Jd is too great for them to bG':tr '"tnd we cnnnot expect tJ, is s ;rvice imotber year. Fifteen convalescent bods were made ;w._dlnble for rh;mn.:J.tic fcw.r cases, but here again the financial strain bec,lJnc:::; too 1-,,,...,vy f0r the pr:i..v."'.tc) ag.:mcy that W'J.s off0ring this service, There is a long w:dtinP, list of ct-.ilc:r<:m with cosmetic defects awaiting plastic surgGr,y bGC!1.USd of l11cl-: of ft~nds, N>:oedlcss to s'ty, no new areas can be opened up and there' is trerY!rtf~ous nc~ecl f~..r programs L1r childr;;m with eye and h.:?ring def<,cts that can b(: cc,rr'.Cct~d by tre.:J.tment, fer the:=; epileptic and for nur1urous other typ.:;s of h:mc1icapping conditions,
In facing this si tue.tion, it b<;c.:-i'1C necessary to nvaluate the activi-

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tic"s of th0 staff and plrm fer tr;:tining in order to increase the sldlls and tuchniques of all st.qff members. Three nurses were sent to rehabilitation centers for study periods and two sodal workers attended a workshop held for medical social ''rorkers functioning in thA public health field. We believe that such tr"'ining has b<;,,m well "'rorthwhile. ,,long this line, plans wera made to 11dd other well trained perscnnel, ,~s soon as possible, to continue ::tnd to facilitate OlJ.r efforts to obtrlin the best care possible for the lor.tst monuy.
~vc have bF'en mindful ()f administr.::ctive cost versus dir<:Jct caro cost,
with 82.9 per cc:;nt of our func's budgeted for the latter. The;; administrative cost of 17.1 per cent includes th'< nonthly stipends paid tho twenty part-time
physicians 'lnd surgeons who rcgul'trly t~tt,;nd clinics qnd treat our patients, that is, medic ,CJl care of ~.,atLmts.
No new clinics WGr' opennd up nor n.-;v.r clinic centers Gstnblished during th' year. ~ve exaE1ined 5, 955 individu:.:tl patients, which was El..n increase
of 638 pati,:mts over the~ prGvious ycFlr, 13,963 visits were made to the clinics, 'tn incren.se of 772 visits cv.-;r ths previous yc-;8.r. It is easy to
see that with incraased dc.mmnds for scrvJ.ce, that less md less con be done for the individual child unless the budget is increas,3d.
~rJ,3 lf,rorked closely with th.:; G,:;orgi' Soci..:::ty for Crippled Children and the Cerebral Palsy Socibty of G,:;or.c;ia. FollmJing many hours of conference, we participated in a five we,'k projc~ct .:u--:d ~~ttempted to m9.l<:e such an appraisal. Ht the s2me time, s-"l;.:;ctrJd. communities were making self-evalua-
tions of resources. :..:e have: ,'3.ssists;d r't th.::se. In the SUJll.:mer of 1955, we
hope that th0 complct,_; study md ev-:h;Ation of tht; r.::ports made in the survey will br:;; completed, and frotl this we will h.'J.V<; a valuable aid to progrAm plcmning.

Division of E;;idemiology Control Division of Cancer Control V.eternary Activities Division of Tuberculosis Control Battey State Hospital Division of Venereal Disease Control Division of Occupational Health (Industrial Hygiene included) Division of Chronic Diseases Civil Defense Health Service

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DIVISION OF EPIDEHIOLOGY

I.

Acute Communicable Diseases

Progress toward control of the acute communicable diseases has been

so rapid in the past dec<.:.de that it is eas~r to overlook the fact th::ct they
are still a threat to the he:1lth of the public. A total of 30,553 cases of

acute comnunicable cUse:1se, not including the venereal diseases, vms reported
in Georgia in 1954 e,nd tllcse diseD.ses rer:Jain a great cause of loss of life.

Also, it appears increasingl:/ :~y;:obc,ble tLat deferred morbidity and mortality

as a result of <-'.cute infections are uajor factors in the health of an aging

population.

The following tabulation illustrates a striking simi. .larity between

two major causes of death in 1953:

1953 Georgia hortalit~- r1o.tes per 100,000

Total

10-:-19 ;yrs!. _20 yrs"&over

Home Accidents

16.3

33.8

5. 6

L,. 5

17.6

Reportable Diseases

except ToB.

17.0

32.3

5.9

6ol

18.,13

(See attached Surnmary)

In comparing these fir~;ures, it is well to note that the variety of

etiologies of the report<:tble di.se.::.ses is sc2.rcely gre<1ter than the variety

of types of accidents included in the homo accident category.

II.

Diseases of Current Interest in Georgia

Ao Diphtheria

Georgia is well above the national average in the number of diphtheria

cases and during 1954 medical authorities gave serious consideration to

recommending compulsory immunization. Lovrever, careful survey of the records

of private physicians and of hec,lth department records in one county of
continued high diphtheria rates revealed that at least 60% of individuals

-hl-
1.vere being irrmmnized e.gainst diphtheria by age one and that by age six the rate of imrmmization is almost 100%.
B, Streptococcal Infections. The true number of cases of streptococcal tnfection and streptococcal complications c:tre difficult to estimate~ Reporting o.f both is fragmentary, Hovmver, when five cases of acute glomerular nephritis occ'\J.rred among 217 children in one school, a study of recent illnesses revealed a history of sore throat in 42'!6 of the students. Cultures on the entire group then yielded a total of 61 children (3?%) positive for Streptococcus Type Al2. On the basis of urin<1ry findings <md home visits, six additional clinical cases were found, Inasmuch as residual nephritic as well as cardiac dalY!\.ge has repeatedly been demonstrated after S"tib-clinical infections, the public health prob.lem implicit in widespread streptococcal infection is seriouso C. Psittacosis. Clinical psittacosis is occurring at the rate of approximately two cases per month in Georgia, None of the hrenty-seven (27) cases investigated in the past 18 months have been .fatal, although some of the patients have
been acutely ill for consider::.cble periods. At the end of 1954, about 10,000
parakee~s were being sold per month in Georgia. III. General Investigations
Insect control act:L vi:i::,ies carried on by EpiderrG_ology biologists have been included in the relJort of the Division of Rodent o.nd Insect Control. A variety of minor disease outbreaks VJere investigated during the year and case confirmation studies were made of typhus, Roch.-y f1lountain spotted fever and psittacosiso Malaria occurred only in military personnel. Summary:
In addition to the dise:::.ses named, poliomyelitis, infectious hepatitis, brucellosis, leptospirosis, Nhooping cough and other acute diseases presented

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minor problems in GeorgiD, in 195~- The i:rmnediate problem is appreciable but the factor noir'r causing greatest concern is the apparent relationship of certain conummicable diseases to later morbidity 2.nd mortality.,

Cancer Control Service

In view of thG reductj on of funds av2.i.J..ablo for this program, much

time and effort ';vas devoted to the problem of reducing expenditures. At a

series of meetings of the Advisory Committee, sto:tisticc.l material was

presented to indicate 1nrays to l"educe the cost of the program 1dthout hurting

necessary services. 'l'he Com:uittce, in turn, approved suggested revisions in

policy. At the AnnuD.l Nceting of tho Medical Association of Georgia in

J:facon, financial problems and changes in policy were discussed at a brea!s:fast

meeting of the clinic directors. In October, all aspects of the problem

v.rero reviewed and cliscuss(.)d o;t, a meeting of clinic and hospitc.l directors

in Atlc.nta.

K"'<-P~t.l:-2-~.E. Efforts to reduce expenditures have been in progress

during the past hro yonrs. Tho results of tli.ose efforts are indico.:ted below

in a compo,rison of o.ccrued o:;qJonclitures for the pc~st 3 yeo.rs.

1952
1953 1954

~~385,255.98
358,162.35 334;900.02
,Since l1ospitul cc.rc:: o..ccotmts for 707~ of tl1e cost of

the program, efforts to reduce e:xpc.nditures 1trere directed chiefly toward

reducing the number of hospitnJ. dews. In so far as possible, cxnm..i.nations

and trentments were adnd.nistered on c:.n out-patient basis unless hospital

care Has absolutely necessary 2ond_, when admission to a hospital 1tvns required,

every effort wo,s m2.de to keep tho period of hospitaliz.ntion at a minimum.

Below is shown the nmnb0r of hospite. l days for 1i'rhich this program pc.id d1..11'ing

ec.ch of the past 3 years.

1952 1953 1954

26,597 23,498 19,301

The rates paid to the v::.rious hospitals amount to

75% of the average per diem cost. It is tho policy of the program to adjust

rates annually but, in violJir of tho reduction in funds, it wns necossnry to

freeze ro..tes nt the 1952 levoJ.,

Rates for a number of hospitals were c..djusted in January, 1954.

These hospitals had neglected to submit cost stc.tements for 1952 ::md,

therefore, their ro..tes ,continued to bo based on 1951 costs. After these

o..djustments were made, however, all ro..tes were frozen at the 1952 level.

Had it not been necessary to mt~ke those ro..te o.djustr.1ents in Jc.nuary,

the cost of the program during the year -vwuld ho..ve dropped bo1m'f ~p300, 000~

On the other hand, if the rr~tos for ,:J-11 of the po..rtici.po..ting hospito.ls had

not been f:cozen at the 1952 level, no roduc.tJ:bn in costs -vmuld have been

possible; tho increo..se in hospital ro..tes would have more than offset the

savings accomplished by n reduction in the number of hospitnl dnys.

pn~~.J.oo..d. Below is shovm tho number of pr:..ticnts for vJhom bills were

paid during ench of tho pas-t 3 yenrs. It will be noted th,-:ct the reductfi.on- in

costs referred to above lJiro..S c.ccomplished in spite of c.n increasing case load.

1952 1953 1954-

L~] 059
1~,116
4,353

It is believed tho..t the cost of the

progrOJU during 1954 represents the lo~trest figure Hhich it ll'lill be possible

to reach without denying services to eligible patients. In tho future, the

cost of the program mo.y o..gain be O}.'})ected to rise. In view of tho increasing

incidence of co.ncer, it may be anticipo.ted that the case loo..d will increase

accordingly. lcforeover, t:m upive. rd revision of hospital rates will be necessary in the neer future~
If hospital rates were adjusted to current hospital costs, the program vmuld now be operating at a level not fo..r below ~~hOO,OOO per year~ Moreover, in vieH of the continuing increo..se in the case loc,d and increasing costs associated ''lith hospital care, it may be anticipated that for some time the cost of the program will continue to increase by about $20,000 per year,
Funds for the current fiscal year are inadequate. Present indications are tho.t available funds Hill be exhausted about the first of May.
During 1954 rabies incidence reached the lowest point for a great
many years. A substantial proportion of our positive cases c.re noV'r in foxes -.v-.herects dogs furnished a gre,?.t mc.jority of cases a few years ago. Almost tho entire southco..stern portion of the State continues free of rabies: so far <1S our records shovf.
We have continued to confine our efforts to knovm infected areas, attempting mss inrrnunization of dogs and a simultanouu.s fox-thinning program wherever the fox appeared to be a problem~ H,::;,ss immunization of dogs using chick embryo vaccine was carried out in Btmks, Barrovr, Cov.reta, Crmrford, Dawson, Habersham; Jackson, Lamar, Laurens, Lumpkin, Eonroe, Horgan, Miller, Peach; Seminole, Towns, Twiggs, Union and Nilkinson Cou.Dties, Young dogs vmre treated in Butts, Harris, Forsyth, c.nd Ivierhmther Counties. Re-immunizo..tion is not being advocated for dogs receiving tho attenuated virus vaccine.
During 1954, however, 1ve conducted local :free dog clinics whenever possible
in the immediate o..rea of .::t reported co,se of ro..bies regardless of the species of c.nimal transmitting the infection.

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As indicc.tud by le.boro.tory cxarninc..tions, the decline in the incidence

of rc..bics in Georgie. during 1954 WD.S sho.rp. Eighty-one positive dog hoads vmro examined c.s compo.rocl. with 230 for 1953. Thor& wo.s one hwnc.n case of

rD.bies in l95Le, '' four y0ar old Hhite child in Barrovf County, but the

circ1..unst.::mcos concerned with tho e::posuru could not be determined so.tisfc.c-

torily. No antiro.bic trc;o.t:nont wo.s givon. Tho following is a brief surmnary

of the positive hoo.ds in 1954.

Positive Hoo.ds

Dog

Fox

Cc:ttlc

Cc.t

81

51

26

14

Others 2

Total 174

He l1o.vo continued to D.ct in a consultative cD.po.city with other

Dop.::crtmc.mt personnel upon ruc:ucst and with tho Bc.ttcy State Hospital Dairy

at tho B1.ttey Tuberculosis S.::~nito.rium~ Oth0r Votcrinc.ry Public Hoo.lth

o.ctivitios have boon included in the Epidcmiolog~r soc~~ion of this report.

DIVISION OF TUBEHCULOSIS CONTROL
Provisional estimate indicates a 27.6% drop in tuberculosis deaths to about 317 in 1954. This compares with 1~38 in 1953 and 467 in 1952, indicating excellent progress. Cases reported remain high> 2013 in the year, as compared with a similar number for the past several years, indicating that new cases are developing at an undiminishing or a slowly diminishing rate.
Seven hundred and four patients vrere given free drugs by the Division after discharge from Battey State Hospital. Nearly as many more were discharged against medical advice, but because of present policy could not be furnished the drugs after discharge. In all 15,038 pneumotherapy refills were paid for by the Division - ax1 average number of _361 patients per month being treated during the year.
Approxirrately 90% of the living tuberculosB r:.c.:'~ie~1ts discharged from Battey State Hospital renuire exercise restrictions and drug therapy and/or pneumotherapy as post-sanatorium reconm:endations. Appro:xilfately half are AIVlA or disciplinary discllargeso More than 15% have })Ositive sputum when discharged and nearly all of the latter are AMA and d.ieciplil1ary discharged patientso
Our Tuberculosis Case Hegister indicates that of nearly 12,000 cases considered a.ctive or probe:.bl;y active and needing treatrr,ent c:r medical supervision or relief assistanGe) a~out 2,200 are hospitalized in State, County and Veterans Administration facilities, and the rest must look to themselves or to the community assist~d by local and State Health De~artments and local and Sta.::,-;; T'Jelfare Departmsrr::,s, for care and treatment.
A glance at the I,ocal Health Departments Activities Report will give some idea of the immensi::.;v- of the tuberculosis problem as it exists today. The Report shows 9;.068 cat:JesJ -:..2,215 suspects and 21,967 contacts >lJere admit-

ted to their services. In addition to the drug therapy and pneumotherapy assistance, the Division furnished $22JOOO ;,vorth of x-ray films to local health departments. It held 450 x-ray clinics in 127 local health departments and 42 group rrass surveys in 42 counties~ and altogether interpreted 1/+8,306 x-ray pictures. The figures are not complete but more than 400 cases were located by the service in addition to the medical consultation given patients through the clinics and interpretation of films sent in by local physicians and local health departments. Other services rendered to local health departments are tuberculosis nurse commltation and public health nurse training, rehabilitation and tuberculosis case work consultation service~ and technical :x:-re.y consultation service.
A commitment or tuberculcsis control law was macted in 1954. Its purpose is to make ;lb p0ssible to control tuberculosis pa.tients who endanger the public health- those vvho are uncooperative in practi:::;ing prevention methods. It has been in use too short a time to evaluate_, rut properly and wisely used by local boards of healthJ should result in better control vf spread of tuberculous infection"
Practically all local health departments need greatly expanded tuberculosis services t::; provide better tuberculosis case, S"c1Spect 3 and contact follo\'1'-up service which means more clinic physicians, public health nurses, x-ray technicians and clerks) and x-ray equipment are needed, both at the state and ~-ocal levelso Hav~1g all of this made available we advocate chest x-ray of all patients admitt8d to the general hospitals, x-ray of all school personnel) and greater applicati~n of chest x-ray service to the general publico The <:;t.ate personnel may well assist in the training of the personnel required to conduct the various services. Tuberculosis is greatly concentrated in the more populous areas (the larger cities) and particular attention should be gLven L)ward the deyeJ..opment of better clinic services in them. Services through them should be arranged for the neighboring less populous counties.

c' 1 ..... ,~i..-
A particular need is the development of adequate social case work service at the local level and in the sanatorium, as socio-economic adjustment is as important in gaining control of tuberculosis as any other single factor and should be integrated in the general pattern.

--!.+ 9-
BA'l"l'EY STATE HOSPITAL
Applications for admission to Battey State Hospital dropped in 1954 to 1,660 from the all time high of 1,822 in 1953a As there had been a waiting list of approximately 100 patients on January 1, 195h, we were able to admit 1, 737 patients during the year j 65~{; of these patients had far advanced pulmonary tuberculosiso Only h4 applicants, or 2,6% of the total, were rejected. These were rejected pri:rrarily on the basis of not having active tuberculosis.
The great majority of patients discharged. during the year had received some type of anti-tuberculous drug therapy. Thirteen per cent of the total number of patients discharged had been treated with major thoracic surgery; in addition to drug therapy and other types of treatment. There were 1,832 patients discharged; this was the highest rn.tr.c.ber in the history of the institution. The greatest previous number v.ras ::~'1 1953 Y.Then 1,737 patients were discharged. In 1952, 1,359 patients werE- dischargedo During both 1953 and 1954 the bed capacity was diminished and on January 1, 1955 there were nearly 250 less patients in the hospital tha.n on January 1, 1953~ As of the last few months of 1951,., the waiting list had been reduced to a current problem so that patients could be admitted within a matter of two weekso IJ'Jhether or not this v.J:i.ll continue depends 1~pon the demand for beds. Fifty-six per cent of the pa;_,Lents discharged from the i1ospit.al >vere discharged with medical advice; 38'~ of this 56% were patients that had been discharged to continue on drug therapy at home. The irregular discharge rate dropped to 33% which v.ras 10% lower than either the years 1952 or 1953. Only 17% of the 1,832 patients discharged from the sanatorhun had positive
sputum at the time of their discharge. The average hospital stay was 48h
days, v-Jhich was still longer than we would like, but when one considers that 65% of our patierrt.s comil:.g into this institution have far advanced

-50-
pulmonary tuberculosis, this is not an unduly long period of hospitalization.
The ratio of employees to patients continued at the rate of approximately one employee for 1.8 patients. The nu~ber of employees in most categories is sufficient. The supervision in 111.any categories is extremely sparse.
The cost in 1954 was $5.16 per day for keeping a patient at Battey
State Hospital. The maintenance program showed an ups~oling during the latter half of
1954. A contract was let for v;aterproofing and r:ainting all the exterior
surfaces of the block constructed buildines and work was started on this and
was progressing satisfactorily. This project will take well into 1955 to
complete. A new picnic area was also built during the year and should answer a need for patients and visitors a.like. One new staff horne was started dur-
ing the year fli' 195Lh A conc:;ntrated effort was being :0:.ade to bring all the
kitchens in the hospital up to standard::: equivalent to Grade A restaurant specifications.
La..f H.B. 802 was passed during the year making it possible to hospitalize recalcitrant patir:-mts and com.rnit them to hosp2.-'c.alization by lawo This required the constructior.. of the enclosure of two semi-security wards in the whj_"t,e sanatorium. A new 100-bed prison facility for the tuberculous inma;tes from Tattnall Frison is under way and is e:xpectGd to be completed
during 1955. The wards that vmro previously used for health violators and
prisoners from Tattnall State Frison V>lill be used for commitment of colored patients, once the new 100-bed fr:J.cility is opened.
Acldi tional funds may be needed to replenish Horn out materials and equipment that have run an ordinilry life span. Our budget is such, and we have operated on such a close margin, that there is lit.tle available surplus

-51-
and, if any one large item should become necessary for purchase, a special appeal might have to be made.

-52-
DIVISION OF VENEREAL DISEASE CONTROL
- .Division Function
T0 control venereal diseases in the State of Georgia through effective pro grams of case finding, treatment, F.ll'ld prevention., General
Continued drastic reduction in Federal funds allocated to the State for venereal disease control hB.s rendered ineffective our programs of casefinding, treatment, and prevention.
In l94S, Georgi~ received $1,325,000 in Federal funds for venereal disease control; for the current fiscal year (July 1, 1954-June 30, 1955) Georgia received $50,000 in Federal funds for venereal disease control. No State or local funds have been appropriated or made available to compensate for this loss in Federal funds.
During 1953 and 1954, our community-wide healthtesting program has been totally abandoned and our communicable disease investigator, public infor:ri!Cl.tion, diagnostic, treatment, and prevention programs drastically retrenched.
The continuous nnrked annual decline in the incidence and prevalence of the venereal diseases in Georgia which we have reported since 1947 cannct be shown for 1954. Instead, Georgia and 42 other states reported a rise in the incidence of early infectious syphilis and gonorrhea during the last six months of 1954. It is feared that this alarming trend will continue unless appropriations for venereal disease control can be reinstated to such a level that ef:''ective programs of case finding, treatment, and prevention can be financed.
VJithin reason, 1rfe have the knowledge, therapeutic ,.reapons, and the detennination necessary to bring the venereal diseases undur control, but the job cannot be completed vJithout a return to adequate financial support.

-53-
I1~_ltiphasic Healthtesting Sl!-:r:."~n;ys:
None were done in 1954.
Comm~E-~able Dise~~~~~igatZE Program:
During 1954, 17"509 suspects were investigated by our Communicable Disease Investigators, from which 5,557 previously unknown cases of venereal disease V'rere brought to treatmont, of vrhich 403 were primary and secondary syphilis. This compares with 15,107 suspects inv3stiga~ed during 1953, from which 3,950 previously unknown cases of venereal disease were brought to treatment, of which 415 were primary and secondary syphilis.
Of the 508 cases of pri..mary and second3.ry syphilis reported from all sources in the ,State for 1953;; it is interesting to not,e that 403 of these
cases were located and brought to treatrn<:nt through the efforts of our Commun~cable Diseqse Investigators~
In addition to the ab0ve activities, our Communic:able Disease Inves-
tigators in selective miniature bloodt0sting programs tested 22,392 persons
during 195L~ with 6L~6 Kahn positive or doubtful findings. This compares with
83,546 persons tested in such surveys during 1953 1'>1ith 1)805 positive or
doubtful f:.ndings 0 O'l!.r Speed Zone Gonnorhea Gontrol Project at the Fulton County Health
Department has continued during 195~- Diagnt1stic and Treatment Centers-Classification of Patient Lond:
.;;.;;:~~--------------------------------------------
During 1954, 14~897 patients v.rere treated for venereal disease in our 5 Diagnostic and Trcatmont C<..ntc:rs. Of these, 1,320 were previously unknov.rn and untreated syphilis; 12,100 gonorrhea, and 547 other venereal dis-
eases. This compares with 15,3L~5 patients trc::ated in these Centers during
1953, of wi1ich 2,033 cases were previously unknown and untreated syphilis, 11,585 gonorrhea, and 598 other venereal diseases.
During 1954, 2,327 ca3,~s of p1~eviously unknov.rn untreated syphilis

-5h-
were reported in Georgia, of which 508 were primary and secondary infections. This compares '-'Tith 3,160 cases of syphilis reported during 1953, of which 548 were primary and secondary infections.
During 1954, 15,014 cases of zonorrhea were reported. This compares with 14,504 cases of gonorrhea reportGd during 1953.
During 195'-~, 610 cases of other venereal dise?,ses w~,re reported. This compares with 644 cns0s of other veneroa1 dL;oase;;) reported during 1953.

-55-
DIVL3ION OF OCCUPATIONAL HE;ALTH DIVISION OF INDUSTRIAL HYGIENE
------- The purpose and function is to protect the health of employed people -~--------4.._.,.._
(the people who produce the wealth 1'fhich makes public health or any other luxury possible) o The p:::Lncipal industria.l functions a:::e study of the problems of health ir.. indu.::;'~ry a~2d consultation and a.dvicc to industry as to the control methcc"ls and :acilities which industry must :t;rovide for itself to handle hec:dth p:..~obleom3, T:1e medical aspects of the iLdividuals exposed to risk are handle~l by t/!e Occ;1pational Health Didsio~;. and the engineering and chE:::IDical aspe'::,s of :.,he environment are handled by ::.he Industrial Hygiene Division.
A good pr-:Jg;:oam requires a team nB..de up of doctors~ nurses, engineel"S, and chemists and specialists in such fields as radi,Jacti vity, noise, and lighting. Employees of other divisions of the State Health Department and of local health departments have also contributed services to industry within their respective sp8cialties.
A le..boratory is provided in the Division c-f In<iustria~ Hygiene for measuring tl1e quantity of air contaminants and dangeroun radiations;, and for bio~chemical work on blood, urine and other biological sampleso
During the year of 1954> Occupational Health and Industrial Hygiene services were rendered in 401 establishments exploying 98;;000 workers in 80
counties. If we assume that each worker represents a household of four people, the effects of the Occupational Eealth and Industrial Hygiene program
were felt to some e:;.,.rtent by 392,000 people. Seldom is such a large segment
of the population reached so effectively by any other public health technique. The health depart;rn.ent in teamwork with local employers, employees,
and health professions, helped develop the Industrial Health Council of

-56-
Greater Atlanta, Incorporated. In this long range project, 1954 was a cri-
tical year. During the closing months of the year, industrial and business leaders contributed $12;000, and the Council employed a fulltime business director.
The Indus7.rial Hygiene Division took part in developing the section on Heating in the Touri.st Court Law and Regulatior..s wi':-'1 particular reference to the car;;on mon')Yide h"'z:.ard and ventilation. ::I>terv:0tations of this section of the Law a:..e rendc::ced by the Divisio~lo I::-~spect~_on and approval under the La''i' is undert.at::en a+, the request of local or ::--egior:-:11 health departmentso Sur\;-eys of heatir"::; instc-.ll.ation.s in industry, sc::ools ac.d hcmes were undertake:!. when requesc3d by man-3.gement or health authoritieso
The Div:i.sion of Industrial Hygiene gets regular reports from the Atorr.ic Ener;~v C<2J.'..r:~"5:~_o_ concerning any shipment of raC.~.oactiYe mate:rials into the state. Each of the users of these radioactive matedals m1.1st be checked for proper equipment and protective devicesa Civil defense radiation monitoring personnel have been trained throughout the state.
Intensive work has been done in 195L~ in Georgia's kaolin industry, This 1ADrk has taken two approaches. Chest x-rays and o:::cupational histories of workers have been taken. 'I'he m-::mu.facturing plc..nts h2:ve had environmer.tal dust studies ..
One of the most dangerous economic poisons is parathion. One of the means of prol:,ectir.g the health of the workers is to do periodic blood tests
for cholinesterase. The laboTatory ran approxinntely 137 of these blood
specimens during the year. One of the most talked about subjects during recent years is air
pollutiono This problem is not as yet as acute in Georgia as it is in many states. However, the Industrial Hygiene Division spent considerable time in
1954 following up complaints and helping alleviate air pollution problems.

-57-
In August of 195h, the person in charge of bedding inspection died.
Rather than employ another specialist for this job, the work load was distributed among the industrial hygiene field men. This program is now being carried on along with their other industrial hygiene duties.
All members of the t>vo staffs participated in health education in different ways a!lcl. to carying extento A television program on the services of the Indvstrial I-1ygie:1e and Occupational Health Divisions was put on in February by three membersv Various aspects of t;,.e Occ'clpe.tior..al Health and Industrial Hygiene services were discussed with p~1blic health personnel at program meetings O'J.ring "L,he year., Student ~roup,:; in r.L'!lbers of Schools of Nursing were reached in interpreting occupational h8alth concep:.so Numbers of industrial nurses and industrial employees were reached directly in health education programc; indirectly several thousand eml.:::lc.ye8s were reached healtheducation-wise, we hope, through 1i'rork with industrial management representatives"
The Indust::cial Nursing Bulletin, 111.'he Industrial Spotlight, 11 is edited quarterly and mailed to public h2alth departments in industrial areas; and to all industrial nurses in Georgia; to occupational health consultant nurses, nursing associations, journals, industrial nursing leaders in the United States, and to a few abroado
Requests for Occupational Health and Industrial Hygiene services from local and regional health departments are on the increase. Many public health workers work closely with their industries and know of special needs in the field "lf environmental health and adult health education.
The Occupational Health 111ork Cormnittee is an outgrowth of the Occu-
pational Health -v,iork Conference of October 1953, sponsored by the Georgia
Association of Industriu.l Nurses, the Department of Nursing, Atlanta Division, University of Georgia, Eh>'J.d the Georgia Department of Public Health.

5 - or\. -
Representatives and advisors from the above organizations and from the Georgia 0tate Nurses Association, the Georgi<J. State League for Nursing and Emory University School of Nursing make up the present Occupational Health Committee. Its purpose is to carry out recommendations which came out of the original Occupational Health ~,rork Conference and to coordinate occupational health nurs:Lng activities.
1. Continued support of the Industrial H<calth C01te1cil of Greater Atlanta, Inc., as long as it is supported by thu local medical society and is ethical and legal; if this project is successful, s"2.milar projects will be promoted throughout tho state.
2, Continued development of occupatiomtl health nurse training in the curricula of the Atlanta Division, University of Georgia and other schools of nursing.
3<> Continued investigatiorls of the relationships between kaolin dust exposures and lung disease.
4o Better follow-up of recommendations for control of environrrBntal hazards~ 5. Continued development of pbacetime as well as civil defense radiation
monit oriJ.'lg.

DIVISION OF CHRONIC DISEASES 1954
P.il:~_e_t~-Control Program The severe curtai1EKmt of funds during 1953 resulted in the
elim:LnA.tion of our diabetes casefinding 1.'\nd referral service, the closing of our diabetes detection la~oru.tory, and the loss of our physician in the Division of Chronic Dise3ses,
In 195h, activities Here confined to follow-up of the Diabetes and Heart Disease Control ,'~eJllillnrs hold in 1953. 'i'h:Ls cor,sistecl of nursing and dietary consult:i.tion upon rccpwst, Three sets of food models were purchased by the Division and have been of grec.:t help in teaching diet classes. These models are scaled to proper size sc:rvings, appear very real and are unbreakable. They also have Uw advantage of easy transportation, storage, and display of out of season foods,
Only 10 clinics ivere in full operation during the entire year at Atlanta, Athens, Augusta, Savannah, 1>Taycross, Thomasville, Albany, Macon, Columbus, and LaGrange, The clinics at Jesup, Valdosta and Brunswick operated only part time due to psrsonnel or housing shortages,..
Establishment of the Giddings Mcr.~orial Clinic at St. Joseph 1 s Infirmary in Atlanta <.:.cJ.ds another major facility to Georgia! s system of heart clinics. It provides ''.dvan.ced. diagnosis, surgery and hospitalization for patients referred by heart clinics or by physicLms who do not have access to a local heart clinic, I'atients from 20 North Georgia counties have realized the benefits of this clinic since its beginning on July 2, 1954.
All heart clinics arc noH engaged in the study of a new drug to determine its effectiveness in preventing recurrent attacks of rheurnlltic

... 6ci-

fever. This is a joint research project between the Georgia Department of

Public Health and the Georgia Heart Association. The Department is furnishing

the drug free of charge to those clinics participating,

Only partial reports are obtained from some clinics and in a few

instances no reports have been obtained at all. According to incomplete
information, 23,035 patient visits were made; 1,101 ne1'r patients were ad.mitted from 123 counties; 852 clinics vmre held, :representing a total of 5,813 doctor hours contributing to the welfare of the indigent cases; 87

individuo..l physician members of the Georgia Heart Association contributed
their time; and some 9,776 home visits were made by public health nurses to

these cardiac patients. rehe number of patient visits has increased some
8, 000 over the previous year and the number of doctors vvorking: in the clinics has increased from 65 to 87o

Financial restriction prevenl.:.ed the Georgia Department of Public

Health from doing all it "lAJanted to in this most necessary and ~wrthwhile

activity. TJarticipation so far has been in the form of supplying equipment

such as .fluoroscopes,, electrocardiographs, and dictating and transcribing

machines. Financial participation in clinic operation has been limited to

the clinic operated by th<:; Fulton County Heo.lth Department in conjunction

with Grady lVIemorial Hospit3.l and Emory University. The activities for this

particular clinic are shown bclmv:
Number of cases ad.rnitted to service Number of cases admitted to medical service Number o.f cases admitted to nursing service Number of cases admitted to social service J.Vledical clinic visits by patients Social service clinic visits by patients Field nursing visits to patients Field social service visits to patients Cases hospitalized Transferrals or disrnissals
No pathology After treatment

1001
108~.
5h5 924 3861 1347 5866
8 67 572 344 23

Not eli::;iblc for Gr:1.c.ly

52

Deceased

48

Other reasons for transfer or dismissal

105

Dismissed from social service

92h

CIVIL DEFENSE HEALTH SERVICES
As in the past, the Georgia Department of l_;ublic Health and the Civilian Preparedness Committee of the J:.iedical ;~ssociation of Georgia worked in close cooperation.
The regular monthly Civil Defense Heo.lth Services School was continued at the Fulton County Hodica1 Societyls Academy of Medicine.
We took part in tho follow:i.ng key activi.ties:
1. The .~\merican Hedical Associo..tion-sponsored 1954 National
Civil Dofc::nso Conference in S::m Fracwisco at which the pamphlet "'Hhat Every Georgia Citizen SholJld E:now About His/Her Civil Defense Health Services, tt v.ras first presontodo 2. Contributed a paper, "Civil Defense Responsibilities of Physicians" in a series of sj_x which appeared successively in the Journo.l of the American l'lledical Association and were later published. and distributed by tho American 1'1edical ;.ssociation in a booklet entitled "Hedical Planning for Civil Defense" .u 3" Participated in the dclibcr<.ttions for obtaining an Improvised Hospital from the Federal Civil Defense Administration for'tro..ining purposes in Georgia. Deliv:ery of this unit is expected this SlJring and should provide the stimulus for stepping up the training program v-.rlth are-:1-wj_dc practice runs. L~. Took part in confcrcncus ~Jith the Hod Cross to work out sto.ndardization of mobile teams to be used interchangeably in natural or cnomy-co:uscd disaster.

5. Cooperated 1tdth the Hc;alth ,Services Implement~:tion
Committee of tho FEJdoral Civil Defense :'-dministration (Region 3) in its vital vmrk of coordination of General
Order No. 13 in the southeastt>rn states. Dr. Petrie was
elected socrotary of this Corrunittee.
6, Short Course for veterinarians" 7. Hanual for Georgia Hospitals in Civil Dcfe;nse (Hospital
Services) completed .::md distributedo
8. The u. s. Public Health Service has been assigned
extensive ne1tJ defense responsibilities as a result of authority delegated by the; Federal Civil Defense Administration to tho Dopartmont of Health, Education and vJelfare, roccmtly a.pproved by tho President. On
October 1, 1954, the Civil Defense Training Section at
the Communicable Disease Cuntor in Chamblee received its portion relating particularly to training activities of this delegation of authority. The Georgia Civil Defense Health Services coor)orated with tho C.D.C. Training Section in developing tho mutuo.l understanding concerning mutual rclD.tj_onships involved.
The State Civil Defense Gonoral ardor No. 13 (Operational Plan
No. 1) released Jam12.ry 1, 1955, specified tho definite evacuee assignment
areas in connection with tho fivo m~.in to.rgut areas in the State as well as 1<Tithin tho nearby main target arco.s, no.mely, Jacksonville, Tallahassee and Chattanooga. This makes possible tb.u o.rea-vrlde eX<..;rcises in the improvised hospital pattern being developed by State Parent 'reacher Associations in general hospitals. ,'. pilot exercise is being planned in DeKalb County, using tho imp:t.'ovisod hospitc.~l equipme;nt mentioned in Item '3 Rbove,,

LABOHNrOHY .SERVICE Division of L~boratorios

DIVISION OF 11\.BOl~A'rORIES
The flow of specimens into the Division of Laboratories fluctuates as the programs of other divisions expand or recede. 3incv the p::;ak year of
1951, when the multiphase testing program was at its height, there has been
a general decline in the number of e.-;caminations made. However, for the
first time since 1948, the number fell under the million mark. The total of 998,834 examinations made i.n 1954 was a decrease of 112,563 or 10.1 per cent, compared to 1953. Approximately 77)000 of the decrease was due to the
closing of the Blood Sugar Detoction Th.'lit on April L Likewise, the discontinuance of the multiphase tusting program on July 1 resulted in a comparable reduction in S1'ecim.c:ns submittod for the serologic tests for syohili.s. These losses primarily account for the decrease of over
131,000 examinations or 20o 9 per cent in the Central laboratory. The Albany
laboratory showed a small loss whilo the l,raycross ~ l:acon and Battey laboratories showed increases. The [TG:ttest gaj_n occurred in the Battey laboratory due primarily to an increase in clir:ical t.Jsts resulting from a revision in the hospital's Drograrn of thorapy and the laboratory's participation in drug evaluation studies.
The tuberculosis work contirnws its uptv.:lrd trend. The 129,745 exahlinations r.nade represent an increase of 6, 971 ovur the preceding year.
The only ph::-ts0 of this work showing .:1 decline wo..s the animal inoculations
at the Battey laboratory which docre'1.s0d 67,3 per cc:_mtJ due for the most
part to trw disconUnuation of this t.3St on sputum cmd gastric lavage specimms. The less expensive cultnra}_ m::.thods have beon found to be as
efficient. A total of 162 ca::;es of laboratory diagnosed diphthGria, in 53 widely distributod counties, itras fou..nd as compared to 220 in 58 counties during 1953. Gr<J.vis type diphth:3ria continuos to be r:>.ore predominant in the
northern part of the st -,te J with mitis and minimus the prevailing types in

-65-
central and southern Georgia. Of the 1,298 blood smears exmni.ned for malaria, P. vivax was found in two casJs, both of whom were Korean veterans. The intestinal parasite work showed little change except for a ma.rked increase in the number of examinations of cellophane ta;.)e slides for pinworm and positive findings. There was, likewise, an increase in examinations for E. histolytica an.d positive findings. There w1.s a 1Jhcmomcma1 drop in the number of brains showing positive evidence of rabi.es. tr.Jhereu.s in 1953 there w:;;re 368 labor':!.tory diagnosed c:~.ses from 66 counties, during 1954 there were only 174 in L1-5 counties. Positj v,J findings were :roCJorted in 81 dogs, 51 foxes, 26 cattle, lJ cats and tho ba.J .q,nco in two othcn~ species. 'I'here were 425 hwnan antirabic treatridnts dist:d bttt0d to 80 Georgia counties, comp'.red to 660 sent to 92 counties in the p:c,;vious year. One hurn::.n de'l.th from rJ.bies occurred
during 1954 in a patient for vJhom m0clical advice was not sour.:.:;ht until onset of
symptoms. Lo.boratory diagnosed c1ses of typhoid fever continued on the 1ownward
trend with only 24. There w(~re 77 :Lsol.tions including cases and cs.rriers. Nine new carriars were found. ShigJlla isolations showod little change, whili3 Salmonella isolations incrt;::.sod by 58) with on incro::.se of 39 persons involv0d. Pathogenic strains of ti::. coli were isolJ.ted 27 times from 12 infants during two outbreaks of inf:mtile diarrhoc;a in an Atlanta hospital. Two isolations were also made from prom:ttur,_; infu.nts in .::mother Atlanta hospital. Brucella isolations fdll to a nev-r low, thore being only 16 isolations from 12 persons. Of unusual interGst ws.s our .first isolation from spinal fluid of Listeria monocytogen..;s, ''1hich is r<:.rely found o.s a causative agent o.f meningitis. The number of mycologica.l e:xa :inations re ,;,dned essenti.'3.lly the some although o. number of unusual findings were reported.
lviilk examin!ltions showed o.n incr0ase of 15,730 or 30.6 per cent over 1953. This can be attributed chiefly to more sanitarians in local health

depD.rtraonts ::tnd to more regul3.r sampling of milk supDlies throughout the st9.te. In addition to regPle.r scnmles rGceived for routine examin:ttions, a number of local health dep:J.rtments which m:tjr,tain the.:r O"tm loJYr.ratories for bacteriological ex:1mim. t:l.ons rGferred samples to th.a c,:mtrlll laboratory for excess water detGrmin::ttions.
In syphilis serology, very Utl-,J.e change occurr8d in receipt of specimens from J:::hysicians and loc3.l health departments. Positive results
were L> .1 per cent, comp3.red to ~. 3 p0r cent in the previous year. Of the 86
laboratories p2.rticipating in the Surol.ogy E:v'11U:J.tion Study, 80 were granted approval for the naxt year and two wore given ter,ll..,orary 3.pproval under the provisions of the State Pr-:;m-:>.ritnl L3.w. One laboratory d.i.d not request approval, one withdrew from tl:e study, :md two could not be approvGd. In connection with this study, 21 inspection visits were made to laboratories. There was continued growing demand for tho blood group, Rh and heterophile antibody tests,
Tho manufacture and distribution of ty>Jhoid vaccine decreased about
16 per cent, silver nitrr>.te ampm:l'3S 25 pGr cent, while the amount of Old Tuberculin distributed incre".l.sed anprox:irrl:.to1y 67 'Vor cent. Narked incre':lses
were noted in tho distrib1.J.tion of iml':1.me serum globulin, Isoni-3-zid ;.nd PAS. Visitors from 17 foreign countri~s and frow. 12 other states were shown
the f3.cilities of the Central hbor~tory. !-\mong other visitors from within the state were school groups int<:JrGsted in public health vwrk. In the technic:,l group, there were 19 r0sigm.tions with only 12 replace!,lents. The acquisition of qualified ap;)lic:mts to fill vac.:mt technical positions is becoming increasingly diffim1lt,